The Association Between Meeting Physical Activity Guidelines and Mental Health Among High-School Students in the United States During the COVID-19 Pandemic.

PURPOSE: Physical activity (PA) is associated with mental health outcomes in high-school students, yet many students do not meet the recommended PA levels. Furthermore, both PA levels and mental health were severely impacted by the COVID-19 pandemic. The aim of this study was to assess whether the number of PA recommendations students met during the COVID-19 pandemic was associated with their self-reported mental health (including their experiences with stress, anxiety, and depression) during the COVID-19 pandemic. METHODS: Students completed the Adolescent Behaviors and Experiences Survey, where they reported PA behaviors, mental health, and COVID-19-related experiences (as control variables) during the pandemic. RESULTS: Each PA recommendation that was met was associated with a 17% decrease in the odds of students self-reporting that they experienced stress, anxiety, or depression most of the time or always during the COVID-19 pandemic. DISCUSSION: Students should be provided with opportunities to participate in PA to obtain the physical and mental health benefits, especially in the event of a crisis like the pandemic.

Determinants of Change in Physical Activity in Children during the Transition from Elementary to High School.

INTRODUCTION: Effective public health interventions targeting factors that influence physical activity are urgently needed to reduce the age-related decline in physical activity in youth. The purpose of this study was to identify associations between physical activity and a set of potential influences on physical activity in children as they transition from elementary to high school. METHODS: Participants were 951 children from South Carolina school districts who completed outcome and independent variable measures on at least two time points from the 5th to 11th grades in 2010-2017. The primary outcome variable was physical activity, measured by accelerometry. Independent variables included a comprehensive set of variables in the child, parent/home, school, and community domains. Children, parents and school administrators, and staff completed questionnaires to assess psychosocial and home, school, and neighborhood environmental influences. Growth curve analyses identified independent variables associated with physical activity over time, either as a main effect or as an interaction with age. RESULTS: As main effects, self-efficacy, self-schema, sport participation, weekday outdoor hours, importance of child participating in sports and physical activity, safe to play outside, and Physical Activity Resource Assessment weighted score were positively associated with physical activity. The associations between physical activity and enjoyment motivation, appearance motivation, weekend outdoor time, and home equipment exhibited significant interactions with age. Enjoyment motivation influenced physical activity during the earlier years, whereas the remaining three variables influenced physical activity in the later years. CONCLUSIONS: Interventions should target multiple domains of influences that may vary by age.

Risk factors for deliberate self-poisoning among children and adolescents in The Netherlands.

INTRODUCTION: In the past decade, the number of deliberate self-poisonings involving young people has increased strongly worldwide. This study aimed to gain insight into risk factors associated with deliberate self-poisonings among children and adolescents reported to the Dutch Poisons Information Center. METHODS: A study was performed between 1 February 2022 and 31 January 2023 involving those aged 8-17 years of age with deliberate self-poisoning. Data were collected on patient characteristics (age, gender, body mass index and living situation) and exposure characteristics (type of toxicant, way of acquiring toxicant and day of exposure). RESULTS: The Dutch Poisons Information Center was consulted about 1,424 deliberate self-poisonings among children and adolescents (10-17 years old). A high percentage of patients were female (85 percent), had a body mass index classified as overweight/obese (27 percent) and lived in a mental healthcare facility (13 percent). Patients mainly exposed themselves to pharmaceuticals, especially over-the-counter medications such as paracetamol (46 percent) and ibuprofen (15 percent). Young people living with parents/caregivers had higher odds of ingesting prescription pharmaceuticals or over-the-counter medication, while those living in a mental healthcare facility were more likely to ingest household products, personal care products or foreign bodies (predominantly batteries). DISCUSSION: This study sheds light on the pervasive issue of deliberate self-poisoning among children and adolescents, advocating for poisoning prevention strategies and promoting mental health of youth. Limitations include reliance on self-reported data from patients and the absence of clinical outcome data. CONCLUSIONS: Female gender, a high body mass index and living in a mental healthcare facility are associated with in increased risk of deliberate self-poisonings in children and adolescents (10-17 years old). Prevention of deliberate self-poisonings among youth could focus on restricting access to medication and other potentially hazardous non-pharmaceuticals, such as household products and batteries, as well as limiting the sales of over-the-counter medication, especially paracetamol, to this young population.

Critical aspects in dissolution testing of nanomaterials in the oro-gastrointestinal tract: the relevance of juice composition for hazard identification and grouping.

The dissolution of a nanomaterial (NM) in an in vitro simulant of the oro-gastrointestinal (OGI) tract is an important predictor of its biodurability in vivo. The cascade addition of simulated digestive juices (saliva, stomach and intestine), including inorganic/organic biomacromolecules and digestive enzymes (complete composition, referred to as "Type 1 formulation"), strives for realistic representation of chemical composition of the OGI tract. However, the data robustness requires consideration of analytical feasibility, such as the use of simplified media. Here we present a systematic analysis of the effects exerted by different digestive juice formulations on the dissolution% (or half-life values) of benchmark NMs (e.g., zinc oxide, titanium dioxide, barium sulfate, and silicon dioxide). The digestive juices were progressively simplified by removal of components such as organic molecules, enzymes, and inorganic molecules (Type 2, 3 and 4). The results indicate that the "Type 1 formulation" augments the dissolution via sequestration of ions by measurable factors compared to formulations without enzymes (i.e., Type 3 and 4). Type 1 formulation is thus regarded as a preferable option for predicting NM biodurability for hazard assessment. However, for grouping purposes, the relative similarity among diverse nanoforms (NFs) of a NM is decisive. Two similarity algorithms were applied, and additional case studies comprising NFs and non NFs of the same substance were included. The results support the grouping decision by simplified formulation (Type 3) as a robust method for screening and grouping purposes.

Significant Increase in Deliberate Self-Poisonings Among Adolescents During the Second Year of the COVID-19 Pandemic.

PURPOSE: The COVID-19 pandemic has been associated with a decline in mental health of adolescents. The aim of this study was to analyze the rate of deliberate self-poisonings (DSPs) among adolescents reported to the Dutch Poisons Information Center before and during the COVID-19 pandemic. METHODS: A retrospective study from 2016 until 2021 was performed to characterize DSPs among adolescents, and to analyze trends in the number of DSPs. All DSPs among adolescents with the age of 13 up to and including 17 years were included. DSP characteristics included: age, gender, bodyweight, used substance, dose, and treatment advice. Trends in the number of DSPs were analyzed using time series decomposition and Seasonal Autoregressive Integrated Moving Average models. RESULTS: Six thousand nine hundred fifteen DSPs in adolescents were recorded from January first 2016 until December 31st 2021. Females were involved in 84% of adolescent DSPs. A strong increase in the number of DSPs was observed in 2021 (45% increase compared to 2020), which deviated from the predicted trend based on previous years. This increase was most prominent in 13-, 14-, and 15-year-old female adolescents. Commonly involved drugs were paracetamol, ibuprofen, methylphenidate, fluoxetine, and quetiapine. The contribution of paracetamol rose from 33% in 2019 to 40% in 2021. DISCUSSION: The strong increase in the number of DSPs during the second year of the COVID-19 pandemic suggests that long-term containment measures such as quarantines, lockdowns, and school closures may enhance self-harm behavior among adolescents, especially among younger females (13-15 years of age), with a preference for paracetamol as DSP substance.

Longitudinal associations between sleep and weight status in infants and toddlers.

BACKGROUND: The limited research assessing relationships between sleep duration and weight status in infants and toddlers relies primarily on parent-reported sleep and cross-sectional studies. OBJECTIVES: Examine whether average sleep duration and changes in sleep duration among 6-24-month-old children were associated with weight-for-length z-scores, and whether these associations varied by race/ethnicity, socioeconomic status and sex. METHODS: Data were collected when children were approximately 6, 12, 18 and 24 months old (N = 116). Sleep duration was measured using actigraphy. Weight-for-length z-scores were calculated using children's height and weight. Physical activity was assessed using accelerometry. Diet was assessed using a feeding frequency questionnaire. Demographic characteristics included sex, race/ethnicity and socioeconomic status. Separate associations of between- and within-person changes in sleep duration were estimated with weight-for-length z-score treated as the outcome variable in linear mixed model analyses. Additional models were assessed that included interactions between sleep and demographic characteristics. RESULTS: At time points where children slept longer at night compared to their own average, their weight-for-length z-score was lower. This relationship was attenuated by physical activity levels. CONCLUSIONS: Increasing sleep duration can improve weight status outcomes in very young children who have low physical activity levels.

Patients with infective endocarditis undergoing cardiac surgery have distinct ROTEM profiles and more bleeding complications compared to patients without infective endocarditis.

BACKGROUND: The coagulation system is crucial in the pathogenesis of infective endocarditis and undergoes significant changes during course of the disease. However, little is known about the implications of those changes in the perioperative period. Aim of the present study was to delineate the specific coagulation patterns and their clinical consequence in patients undergoing cardiac surgery due to infective endocarditis. METHODS: In this single-centre, exploratory, prospective observational study, we investigated the incidence and degree of coagulopathy in patients with (n = 31) and without infective endocarditis (n = 39) undergoing cardiac valve surgery. The primary outcome was the differences between these two groups in rotational thromboelastometry (ROTEM) results before, during and after surgery. The secondary outcomes were the differences between the groups in heparin sensitivity, bleeding complications, and transfusion requirements. RESULTS: Most ROTEM parameters in EXTEM, INTEM and FIBTEM assays were significantly altered in patients with infective endocarditis. Clotting time in the EXTEM assay was significantly prolonged in the endocarditis group at all time-points, while all clot firmness parameters (A5, A10 and MCF) were significantly increased. The heparin sensitivity index was significantly lower in the endocarditis group (median index 0.99 vs 1.17s. IU-1.kg-1, p = .008), indicating increased heparin resistance. Patients with infective endocarditis had more bleeding complications as assessed by the universal definition of perioperative bleeding score (OR 3.0, p = .018), and more patients with endocarditis underwent early re-exploration (p = .018). CONCLUSIONS: The findings of this exploratory investigation show significantly altered coagulation profiles in patients with infective endocarditis, with concomitant hyper- and hypocoagulability. Furthermore, the incidence of bleeding complications and transfusion requirements were increased in patients with endocarditis. These results show the potential of ROTEM to detect coagulation abnormalities in patients with infective endocarditis. Existing point-of-care coagulation testing guided algorithms for optimizing perioperative coagulation management possibly need to be adjusted for these high-risk patients undergoing cardiac surgery.

How to formulate hypotheses and IATAs to support grouping and read-across of nanoforms.

Manufacturing and functionalizing materials at the nanoscale has led to the generation of a whole array of nanoforms (NFs) of substances varying in size, morphology, and surface characteristics. Due to financial, time, and ethical considerations, testing every unique NF for adverse effects is virtually impossible. Use of hypothesis-driven grouping and read-across approaches, as supported by the GRACIOUS Framework, represents a promising alternative to case-by-case testing that will make the risk assessment process more efficient. Through application of appropriate grouping hypotheses, the Framework facilitates the assessment of similarity between NFs, thereby supporting grouping and read-across of information, minimizing the need for new testing, and aligning with the 3R principles of replacement, reduction, and refinement of animals in toxicology studies. For each grouping hypothesis an integrated approach to testing and assessment (IATA) guides the user in data gathering and acquisition to test the hypothesis, following a structured format to facilitate efficient decision-making. Here we present the template used to generate the GRACIOUS grouping hypotheses encompassing information relevant to "Lifecycle, environmental release, and human exposure", "What they are: physicochemical characteristics", "Where they go: environmental fate, uptake, and toxicokinetics", and "What they do: human and environmental toxicity". A summary of the template-derived hypotheses focusing on human health is provided, along with an overview of the IATAs generated by the GRACIOUS project. We discuss the application and flexibility of the template, providing the opportunity to expand the application of grouping and read-across in a logical, evidence-based manner to a wider range of NFs and substances.

Radiologic-pathologic correlation of lesions in resected liver specimens with an ex vivo MRI-compatible localization device.

OBJECTIVE: Liver lesion characterization is limited by the lack of an established gold standard for precise correlation of radiologic characteristics with their histologic features. The objective of this study was to demonstrate the feasibility of using an ex vivo MRI-compatible sectioning device for radiologic-pathologic co-localization of lesions in resected liver specimens. METHODS: In this prospective feasibility study, adults undergoing curative partial hepatectomy from February 2018 to January 2019 were enrolled. Gadoxetic acid was administered intraoperatively prior to hepatic vascular inflow ligation. Liver specimens were stabilized in an MRI-compatible acrylic lesion localization device (27 × 14 × 14 cm3) featuring slicing channels and a silicone gel 3D matrix. High-resolution 3D T1-weighted fast spoiled gradient echo and 3D T2-weighted fast-spin-echo images were acquired using a single channel quadrature head coil. Radiologic lesion coordinates guided pathologic sectioning. A final histopathologic diagnosis was prepared for all lesions. The proportion of successfully co-localized lesions was determined. RESULTS: A total of 57 lesions were identified radiologically and sectioned in liver specimens from 10 participants with liver metastases (n = 8), primary biliary mucinous cystic neoplasm (n = 1), and hepatic adenomatosis (n = 1). Of these, 38 lesions (67%) were < 1 cm. Overall, 52/57 (91%) of radiologically identified lesions were identified pathologically using the device. Of these, 5 lesions (10%) were not initially identified on gross examination but were confirmed histologically using MRI-guided localization. One lesion was identified grossly but not on MRI. CONCLUSIONS: We successfully demonstrated the feasibility of a clinical method for image-guided co-localization and histological characterization of liver lesions using an ex vivo MRI-compatible sectioning device. KEY POINTS: • The ex vivo MRI-compatible sectioning device provides a reliable method for radiologic-pathologic correlation of small (< 1 cm) liver lesions in human liver specimens. • The sectioning method can be feasibly implemented within a clinical practice setting and used in future efforts to study liver lesion characterization. • Intraoperative administration of gadoxetic acid results in enhancement in ex vivo MRI images of liver specimens hours later with excellent image quality.

Grouping of orally ingested silica nanomaterials via use of an integrated approach to testing and assessment to streamline risk assessment.

BACKGROUND: Nanomaterials can exist in different nanoforms (NFs). Their grouping may be supported by the formulation of hypotheses which can be interrogated via integrated approaches to testing and assessment (IATA). IATAs are decision trees that guide the user through tiered testing strategies (TTS) to collect the required evidence needed to accept or reject a grouping hypothesis. In the present paper, we investigated the applicability of IATAs for ingested NFs using a case study that includes different silicon dioxide, SiO2 NFs. Two oral grouping hypotheses addressing local and systemic toxicity were identified relevant for the grouping of these NFs and verified through the application of oral IATAs. Following different Tier 1 and/or Tier 2 in vitro methods of the TTS (i.e., in vitro dissolution, barrier integrity and inflammation assays), we generated the NF datasets. Furthermore, similarity algorithms (e.g., Bayesian method and Cluster analysis) were utilized to identify similarities among the NFs and establish a provisional group(s). The grouping based on Tier 1 and/or Tier 2 testing was analyzed in relation to available Tier 3 in vivo data in order to verify if the read-across was possible and therefore support a grouping decision. RESULTS: The measurement of the dissolution rate of the silica NFs in the oro-gastrointestinal tract and in the lysosome identified them as gradually dissolving and biopersistent NFs. For the local toxicity to intestinal epithelium (e.g. cytotoxicity, membrane integrity and inflammation), the biological results of the gastrointestinal tract models indicate that all of the silica NFs were similar with respect to the lack of local toxicity and, therefore, belong to the same group; in vivo data (although limited) confirmed the lack of local toxicity of NFs. For systemic toxicity, Tier 1 data did not identify similarity across the NFs, with results across different decision nodes being inconsistent in providing homogeneous group(s). Moreover, the available Tier 3 in vivo data were also insufficient to support decisions based upon the obtained in vitro results and relating to the toxicity of the tested NFs. CONCLUSIONS: The information generated by the tested oral IATAs can be effectively used for similarity assessment to support a grouping decision upon the application of a hypothesis related to toxicity in the gastrointestinal tract. The IATAs facilitated a structured data analysis and, by means of the expert's interpretation, supported read-across with the available in vivo data. The IATAs also supported the users in decision making, for example, reducing the testing when the grouping was well supported by the evidence and/or moving forward to advanced testing (e.g., the use of more suitable cellular models or chronic exposure) to improve the confidence level of the data and obtain more focused information.

Integrated approaches to testing and assessment for grouping nanomaterials following dermal exposure.

Exposure to different nanoforms (NFs) via the dermal route is expected in occupational and consumer settings and thus it is important to assess their dermal toxicity and the contribution of dermal exposure to systemic bioavailability. We have formulated four grouping hypotheses for dermal toxicity endpoints which allow NFs to be grouped to streamline and facilitate risk assessment. The grouping hypotheses are developed based on insight into how physicochemical properties of NFs (i.e. composition, dissolution kinetics, size, and flexibility) influence their fate and hazard following dermal exposure. Each hypothesis is accompanied by a tailored Integrated Approach to Testing and Assessment (IATA) that is structured as a decision tree and tiered testing strategies (TTS) for each relevant question (at decision nodes) that indicate what information is needed to guide the user to accept or reject the grouping hypothesis. To develop these hypotheses and IATAs, we gathered and analyzed existing information on skin irritation, skin sensitization, and dermal penetration of NFs from the published literature and performed experimental work to generate data on NF dissolution in sweat simulant fluids. We investigated the dissolution of zinc oxide and silicon dioxide NFs in different artificial sweat fluids, demonstrating the importance of using physiologically relevant conditions for dermal exposure. All existing and generated data informed the formulation of the grouping hypotheses, the IATAs, and the design of the TTS. It is expected that the presented IATAs will accelerate the NF risk assessment for dermal toxicity via the application of read-across.

Cardiac macrophage density in Covid-19 infection: relationship to myocyte necrosis and acute lung injury.

SARS-Cov-2 infection is not limited to the respiratory tract and can involve other organs including the heart, blood vessels, kidneys, liver, gastrointestinal tract, placenta, and skin. Covid-19 patients with cardiac involvement usually have higher morbidity and mortality compared to those without cardiac involvement. The frequency and the specificity of the myocardial pathological changes in patients who die after documented infection with SARS-Cov-2 is uncertain. Macrophages can be found in the normal heart (interstitium, around the endothelial cells and in the epicardial adipose tissue), and they are considered part of the major immune cell population in the heart. In this case-control autopsy study, we compare the gross and microscopic cardiac findings, and the available clinical characteristics between a group of 10 Covid-19 decedents and a control group of 20 patients who died with non-SARS-Cov-2 severe bronchopneumonia and/or diffuse alveolar damage. The objectives of this semi-quantitative study are to study single myocyte necrosis and its relation to the strain on the heart caused by lung injury as a causative mechanism, and to study the density of myocardial and epicardial macrophages in Covid-19 hearts in comparison to the control group, and in Covid-19 hearts with single myocyte necrosis in comparison to Covid-19 hearts without single myocyte necrosis. Lymphocytic myocarditis was not identified in any of the hearts from the Covid-19 or the control group. Single myocyte necrosis is more frequent in the Covid-19 group compared to the control group, suggesting that it is unrelated to the strain on the heart caused by underlying lung injury. The density of the macrophages in the epicardium and myocardium in the hearts of the Covid-19 group is higher compared to those in the control group. The density of epicardial macrophages is higher in the Covid-19 hearts with single myocyte necrosis than in those without. These observations contribute to our increasing appreciation of the role of macrophages in the pathophysiologic response to infection by SARS-CoV-2.

Overview of potential adverse health effects of oral exposure to nanocellulose.

Nanocellulose is an emerging material for which several food-related applications are foreseen, for example, novel food, functional food, food additive or in food contact materials. Nanocellulose materials can display a range of possible shapes (fibers, crystals), sizes and surface modifications. For food-related applications in the EU, information on the safety of substances must be assessed. The present review summarizes the current knowledge on (possible) adverse health effects of nanocellulose upon oral exposure, keeping EU regulatory aspects in mind. The overview indicates that toxicity data, especially from in vivo studies, are limited and outcomes are not unambiguous. The hazard assessment is further complicated by: the diversity in morphologies and surface modifications, lack of standard reference materials, limited knowledge about intestinal fate and absorption, analytical difficulties in biological matrices, dispersion issues, the possible presence of impurities and interferences within biological assays. Two subchronic in vivo toxicity studies show no indications of toxicity for two specific nanocellulose materials, even at high doses. However, these studies may have missed certain early or nano-specific toxic effects, such as inflammation potential, for which other, subacute studies provide some indications. Most in vitro studies show no cytotoxicity; however, several indicate that effects on oxidative stress and inflammatory responses depend on differences in size or surface treatments. Further, too few studies assessed genotoxicity of nanocelluloses. Therefore, immunotoxicity, oxidative stress and genotoxicity require further attention, as do absorption and effects on nutrient uptake. Recommendations for future research facilitating the safety assessment and safe-by-design of nanocellulose in food-related applications are provided.

Prospective Observational Cohort Study on Dorsal Root Ganglion Stimulation in Chronic Postsurgical Pain: Results of Patient-Reported Outcomes at Two Years.

OBJECTIVES: This study aimed to determine the long-term effects of dorsal root ganglion (DRG) stimulation on pain, physical function, and quality of life in patients with chronic postsurgical pain. We hypothesized that the effects of DRG stimulation would be sustainable through two years of follow-up. MATERIALS AND METHODS: This prospective observational cohort will include 30 patients, at least 18 years old, scheduled to receive DRG stimulation in two Dutch hospitals. A minimum pain score of 50 mm on a 100-mm visual analog scale was required. Following written informed consent, patients completed validated questionnaires on pain, physical function, and quality of life at baseline, one year, and two years. Change over time was analyzed using mixed model statistics, with Tukey-Kramer correction. A p-value of <0.05 was considered statistically significant. RESULTS: Follow-up was completed by 22 of 30 enrolled patients. Pain scores decreased at one year (-38 ± 7, 95% CI [-51 to -25], p < 0.001) and two years (-29 ± 6, 95% CI [-42 to -17], p < 0.001) compared with those at baseline. Physical function measured with pain severity and interference decreased at one and two years (-2.5 ± 0.5, 95% CI [-3.3 to -1.5], p < 0.001, and -2.3 ± 0.5, 95% CI [-3.3 to -1.3], p < 0.001, respectively). Quality of life increased over time (0.22 ± 0.05, 95% CI [11-33], p < 0.001, at one year; 0.21 ± 0.05, 95% CI [10-31], p = 0.001, at two years). CONCLUSIONS: DRG stimulation in chronic postsurgical pain is associated with a sustainable reduction in pain and an improvement in physical function and in quality of life, through two years of follow-up.

Effect of positioning error on the Hilgenreiner epiphyseal angle and the head-shaft angle compared to the femoral neck-shaft angle in children with cerebral palsy.

Children with cerebral palsy (CP) often have changes in proximal femoral geometry. Neck-shaft angle (NSA), Hilgenreiner epiphyseal angle (HEA) and head-shaft angle (HSA) are used to measure these changes. The impact of femoral rotation on HEA/HSA and of ab/adduction on HEA/HSA/NSA is not well known. This study aimed to determine and compare the effect of rotation, ab/adduction and flexion/extension on HEA/HSA/NSA. Radiographic measurements from 384 patients with Gross Motor Function Classification System (GMFCS) levels I-V were utilized. NSA/HSA for affected hips were used with femoral anteversion averages to create three-dimensional models of 694 hips in children with CP. Each hip was rotated, ab/adducted and flexed/extended to simulate malpositioning. HEA/HSA/NSA of each model were measured in each joint position, and differences from correct positioning were determined. Mean HEA error at 20° of internal/external rotations were -0.60°/3.17°, respectively, with the NSA error of -6.56°/9.94° and the HSA error of -3.69°/1.21°. Each degree of ab/adduction added 1° of the HEA error, with no NSA/HSA error. NSA was most sensitive to flexion. Error for all measures increased with increasing GMFCS level. HEA/HSA were minimally impacted by rotation. NSA error was much higher than HEA/HSA in internal rotation and flexion whereas HEA was sensitive to changes in ab/adduction. Given abduction is more easily detectable on imaging than rotation, HEA may be less affected by positioning errors that are common with children with CP than NSA. HSA was least affected by position changes. HEA/HSA could be robust, complementary measures of hip deformities in children with CP.

T1ρ and T2 MRI show hip cartilage damage in adolescents with healed Legg-Calvé-Perthes disease.

Legg-Calvé-Perthes disease (LCPD) is a juvenile hip disorder associated with residual femoral head deformity, cartilage degeneration and a high risk of early onset hip osteoarthritis. Assessing management of LCPD in the healed phase requires an understanding of when and where hip cartilage damage happens. While it has been shown that cartilage is degenerated in healed LCPD hips in adults, it is not clear when this degeneration begins. Our research question was: Are the MR markers of cartilage degeneration T1ρ and T2 increased in healed LCPD hips in adolescents? Twelve adolescents [10-17 years old (mean 14); 3 female 9 male] with healed LCPD (Stulberg 2-5; 8 unilateral and 4 bilateral) and 15 age- and sex-matched controls were imaged in a 3T MRI using a T1ρ and a T2 sequence. We applied a mixed-effects model adjusted for age and nested by subject to determine the effect of Stulberg grade on overall and regional mean T1ρ and T2 values. T1ρ was significantly higher overall and in the medial region of Stulberg ≥3 hips, and in the medial region of Stulberg 2 hips than in the control group. T2 was significantly higher in the medial region of Stulberg ≥3 hips than in the control group. Our results suggest that cartilage damage in LCPD has begun by adolescence and that T1ρ can detect early changes in cartilage associated with LCPD.

Estimation of the risk of local and systemic effects in infants after ingestion of low-concentrated weak acids from descaling products.

INTRODUCTION: The accidental ingestion of diluted household descaling products by infants is a phenomenon that poison control centers regularly encounter. Feeding infants with baby milk prepared with water from electric kettles still containing descaler is a common way of exposure. This study aimed to determine the risks related to ingestion of (diluted) descalers by infants. METHODS: pH measurements were performed using acetic acid and three different commercially available electric kettle descalers. The pH of different dilutions was measured in the absence or presence of baby milk powder. In addition, an overview was made of pH values of different electric kettle descalers as given by the product information of the manufacturer. Finally, a simple pharmacokinetic (PK) model was used to predict changes in blood pH in infants after ingestion of acetic acid, which is the most commonly used descaler. RESULTS: Several commercially available electric kettle descalers have a pH <2. Even after diluting such descalers up to 10 times the pH can remain low. The addition of milk powder increases the pH of descalers containing weaker acids, with a pH >1.5, while descalers with stronger acids and pH <1 show little pH increase after the addition of milk powder. Finally, a simple PBPK model for the ingestion of acetic acid predicted that the ingestion of larger amounts of acetic acid (>1000 mg) by an infant could result in relevant changes in blood pH. CONCLUSIONS: Commercially available electric kettle descaling products may pose a health risk to infants in case of accidental ingestion since the pH of some of these products can be very low, even when diluted 10-times or in the presence of baby milk powder. Oral exposure of infants to the common descaler acetic acid, after accidental preparation of baby milk with cleaning vinegar, will probably not result in serious local effects, but changes in blood pH cannot be excluded when larger amounts of acetic acid are ingested.

Differentiation of pancreatic ductal adenocarcinoma and chronic pancreatitis using graph neural networks on histopathology and collagen fiber features.

Pancreatic ductal adenocarcinoma (PDAC) is one of the most lethal human cancers. However, the symptoms and radiographic appearance of chronic pancreatitis (CP) mimics that of PDAC, and sometimes the 2 entities can also be difficult to differentiate microscopically. The need for accurate differentiation of PDAC and CP has become a major topic in pancreatic pathology. These 2 diseases can present similar histomorphological features, such as excessive deposition of fibrotic stroma in the tissue microenvironment and inflammatory cell infiltration. In this paper, we present a quantitative analysis pipeline empowered by graph neural networks (GNN) capable of automatic detection and differentiation of PDAC and CP in human histological specimens. Modeling histological images as graphs and deploying graph convolutions can enable the capture of histomorphological features at different scales, ranging from nuclear size to the organization of ducts. The analysis pipeline combines image features computed from co-registered hematoxylin and eosin (H&E) images and Second-Harmonic Generation (SHG) microscopy images, with the SHG images enabling the extraction of collagen fiber morphological features. Evaluating the analysis pipeline on a human tissue micro-array dataset consisting of 786 cores and a tissue region dataset consisting of 268 images, it attained 86.4% accuracy with an average area under the curve (AUC) of 0.954 and 88.9% accuracy with an average AUC of 0.957, respectively. Moreover, incorporating topological features of collagen fibers computed from SHG images into the model further increases the classification accuracy on the tissue region dataset to 91.3% with an average AUC of 0.962, suggesting that collagen characteristics are diagnostic features in PDAC and CP detection and differentiation.

Fertility specialist practice in the Philippines during the COVID- 19 pandemic

@#<p style="text-align: justify;"><strong>Objective:</strong> To determine the changes in the clinical practice of infertility specialists in the Philippines, specifically, the proportion of specialists who stopped practice, length of break from clinics, the decrease in caseload, changes in consultation platform, screening frequency, number of clinicians that contracted COVI D 19 and safety protocols employed during the COVID - 19 pandemic.</p><p style="text-align: justify;"><strong>Methods:</strong> A cross-sectional study using an online questionnaire given to all members of the Philippine Society for Reproductive Medicine (PSRM) last November 2020. Participants were requested to answer the questionnaire through google spread sheet, with informed consent. All data were collated, summarized and reported in terms of frequencies, and measures of central tendency.</p><p style="text-align: justify;"><strong>Results:</strong> There were 110 active members of the PSRM who participated in the study. There was an overall decrease in the percentage of fertility consultations during the pandemic. There is also a substantial decrease in the caseload from different practices: 45.4% reported more than 50% decrease in !VF-related procedures, 54.5% noted more than 50% decrease in intrauterine insemination procedures, 52.8% reported more than 50% decrease in ovulation induction treatment, and 66.3% reported more than 50% decrease in endoscopic procedures. About 37% of the respondents deferred approximately 5-10 cases for fertility treatment, with 27.3% of the respondents reported deferring embryo transfer to less than 5 couples. More than half of the specialists (51.8%) stopped performing fertility procedures and 68.2% of the respondents completely stopped doing out patient consultations. However, some specialists resumed clinics by May 2020 (30.9%) and June 2020 (30.9%). Upon resumption of clinics, specialists used both face to face consultation and teleconsultation, with the largest proportion of respondents using both platforms. Safety measures employed during face-to-face consultations to prevent disease transmission included hand sanitizers in the clinics, restricted number of people in the waiting room and consultation room, use of personal protective equipment, symptom check prior to face to face consults, installation of air purifiers, and acrylic barriers, and use of health declaration forms. Majority of the specialists are aware of the international and local guidelines regarding infertility care during the pandemic (98.2%) and inform patients regarding the contents of the guidelines (90%).</p><p style="text-align: justify;"><strong>Conclusion:</strong> There is a significant decline in the consultations and fertility procedures during the pandemic. Specialists are well informed of the international and local guidelines regarding fertility care during the pandemic.</p>