A Machine Learning-Based Severity Prediction Tool for the Michigan Neuropathy Screening Instrument.

Diabetic sensorimotor polyneuropathy (DSPN) is a serious long-term complication of diabetes, which may lead to foot ulceration and amputation. Among the screening tools for DSPN, the Michigan neuropathy screening instrument (MNSI) is frequently deployed, but it lacks a straightforward rating of severity. A DSPN severity grading system has been built and simulated for the MNSI, utilizing longitudinal data captured over 19 years from the Epidemiology of Diabetes Interventions and Complications (EDIC) trial. Machine learning algorithms were used to establish the MNSI factors and patient outcomes to characterise the features with the best ability to detect DSPN severity. A nomogram based on multivariable logistic regression was designed, developed and validated. The extra tree model was applied to identify the top seven ranked MNSI features that identified DSPN, namely vibration perception (R), 10-gm filament, previous diabetic neuropathy, vibration perception (L), presence of callus, deformities and fissure. The nomogram's area under the curve (AUC) was 0.9421 and 0.946 for the internal and external datasets, respectively. The probability of DSPN was predicted from the nomogram and a DSPN severity grading system for MNSI was created using the probability score. An independent dataset was used to validate the model's performance. The patients were divided into four different severity levels, i.e., absent, mild, moderate, and severe, with cut-off values of 10.50, 12.70 and 15.00 for a DSPN probability of less than 50, 75 and 100%, respectively. We provide an easy-to-use, straightforward and reproducible approach to determine prognosis in patients with DSPN.

Formation of Type II Silicon Clathrate with Lithium Guests through Thermal Diffusion.

At low guest atom concentrations, Si clathrates can be viewed as semiconductors, with the guest atoms acting as dopants, potentially creating alternatives to diamond Si with exciting optoelectronic and spin properties. Studying Si clathrates with different guest atoms would not only provide insights into the electronic structure of the Si clathrates but also give insights into the unique properties that each guest can bring to the Si clathrate structure. However, the synthesis of Si clathrates with guests other than Na is challenging. In this study, we have developed an alternative approach, using thermal diffusion into type II Si clathrate with an extremely low Na concentration, to create Si clathrate with Li guests. Using time-of-flight secondary-ion mass spectroscopy, X-ray diffraction, and Raman scattering, thermal diffusion of Li into the nearly empty Si clathrate framework is detected and characterized as a function of the diffusion temperature and time. Interestingly, the Si clathrate exhibits reduced structural stability in the presence of Li, converting to polycrystalline or disordered phases for anneals at temperatures where the starting Na guest Si clathrate is quite stable. The Li atoms inserted into the Si clathrate lattice contribute free carriers, which can be detected in Raman scattering through their effect on the strength of Si-Si bonds in the framework. These carriers can also be observed in electron paramagnetic resonance (EPR). EPR shows, however, that Li guests are not simple analogues of Na guests. In particular, our results suggest that Li atoms, with their smaller size, tend to doubly occupy cages, forming "molecular-like" pairs with other Li or Na atoms. Results of this work provide a deeper insight into Li guest atoms in Si clathrate. These findings are also relevant to understanding how Li moves through and interacts with Si clathrate anodes in Li-ion batteries. Additionally, techniques presented in this work demonstrate a new method for filling the Si clathrate cages, enabling studies of a broad range of other guests in Si clathrates.

Performance Analysis of Conventional Machine Learning Algorithms for Diabetic Sensorimotor Polyneuropathy Severity Classification Using Nerve Conduction Studies.

Background: Diabetic sensorimotor polyneuropathy (DSPN) is a major form of complication that arises in long-term diabetic patients. Even though the application of machine learning (ML) in disease diagnosis is very common and well-established in the field of research, its application in DSPN diagnosis using nerve conduction studies (NCS), is very limited in the existing literature. Method: In this study, the NCS data were collected from the Diabetes Control and Complications Trial (DCCT) and its follow-up Epidemiology of Diabetes Interventions and Complications (EDIC) clinical trials. The NCS variables are median motor velocity (m/sec), median motor amplitude (mV), median motor F-wave (msec), median sensory velocity (m/sec), median sensory amplitude (µV), Peroneal Motor Velocity (m/sec), peroneal motor amplitude (mv), peroneal motor F-wave (msec), sural sensory velocity (m/sec), and sural sensory amplitude (µV). Three different feature ranking techniques were used to analyze the performance of eight different conventional classifiers. Results: The ensemble classifier outperformed other classifiers for the NCS data ranked when all the NCS features were used and provided an accuracy of 93.40%, sensitivity of 91.77%, and specificity of 98.44%. The random forest model exhibited the second-best performance using all the ten features with an accuracy of 93.26%, sensitivity of 91.95%, and specificity of 98.95%. Both ensemble and random forest showed the kappa value 0.82, which indicates that the models are in good agreement with the data and the variables used and are accurate to identify DSPN using these ML models. Conclusion: This study suggests that the ensemble classifier using all the ten NCS variables can predict the DSPN severity which can enhance the management of DSPN patients.

Native tricuspid valve infective endocarditis with Staphylococcus lugdunesis: An unusual complication post spinal epidural injection - Case report and literature review.

Infective Endocarditis (IE) is a very rare complication following spinal epidural injection and requires high index of suspicion for early diagnosis and effective management. Staphylococcus Lugdunesis is a coagulase negative staphylococcus (CoNS) that, unlike other CoNS, may result in aggressive form of native valve infective endocarditis (IE) mimicking IE caused by S aureus. Surgical intervention is usually needed to control infection in most cases of S. Lugdunesis IE. Herein, we report a case of young lady with congenital Gerbode defect who developed tricuspid native valve IE with S. Lugdunesis secondary to spondylodiscitis post lumbar epidural injection that was performed for disk prolapse. She required urgent surgical intervention and had an excellent outcome.

Synthesis, Optical, Chemical and Thermal Characterizations of PMMA-PS/CeO2 Nanoparticles Thin Film.

We report the synthesis of hybrid thin films based on polymethyl methacrylate) (PMMA) and polystyrene (PS) doped with 1%, 3%, 5%, and 7% of cerium dioxide nanoparticles (CeO2 NPs). The As-prepared thin films of (PMMA-PS) incorporated with CeO2 NPs are deposited on a glass substrate. The transmittance T% (λ) and reflectance R% (λ) of PMMA-PS/CeO2 NPs thin films are measured at room temperature in the spectral range (250-700) nm. High transmittance of 87% is observed in the low-energy regions. However, transmittance decreases sharply to a vanishing value in the high-energy region. In addition, as the CeO2 NPs concentration is increased, a red shift of the absorption edge is clearly observed suggesting a considerable decrease in the band gap energy of PMMA-PS/CeO2 NPs thin film. The optical constants (n and k) and related key optical and optoelectronic parameters of PMMA-PS/Ce NPs thin films are reported and interpreted. Furthermore, Tauc and Urbach models are employed to elucidate optical behavior and calculate the band gaps of the as-synthesized nanocomposite thin films. The optical band gap energy of PMMA-PS thin film is found to be 4.03 eV. Optical band gap engineering is found to be possible upon introducing CeO2 NPs into PMMA-PS polymeric thin films as demonstrated clearly by the continuous decrease of optical band gap upon increasing CeO2 content. Fourier-transform infrared spectroscopy (FTIR) analysis is conducted to identify the major vibrational modes of the nanocomposite. The peak at 541.42 cm-1 is assigned to Ce-O and indicates the incorporation of CeO2 NPs into the copolymers matrices. There were drastic changes to the width and intensity of the vibrational bands of PMMA-PS upon addition of CeO2 NPs. To examine the chemical and thermal stability, thermogravimetric (TGA) thermograms are measured. We found that (PMMA-PVA)/CeO2 NPs nanocomposite thin films are thermally stable below 110 °C. Therefore, they could be key candidate materials for a wide range of scaled multifunctional smart optical and optoelectronic devices.

Effect of Iodine Filler on Photoisomerization Kinetics of Photo-Switchable Thin Films Based on PEO-BDK-MR.

We report the effect of an iodine filler on photoisomerization kinetics of photo-switchable PEO-BDK-MR thin films. The kinetics of photoisomerization and time progression of PEO-BDK-MR/I2 nanocomposite thin films are investigated using UV-Vis, FTIR spectroscopies, and modified mathematical models developed using new analytical methods. Incorporating iodine filler into the PEO-BDK-MR polymeric matrix enhances the isomerization energy barrier and considerably increases the processing time. Our outcomes propose that enhanced photoisomerized and time processed (PEO-BDK-MR)/I2 thin films could be potential candidates for a variety of applications involving molecular solar thermal energy storage media.

New Insight on Photoisomerization Kinetics of Photo-Switchable Thin Films Based on Azobenzene/Graphene Hybrid Additives in Polyethylene Oxide.

In this work, we reported a new insight on the kinetics of photoisomerization and time evolution of hybrid thin films considering the azo-dye methyl red (MR) incorporated with graphene accommodated in polyethylene oxide (PEO). The kinetics of photoisomerization and time-evolution of hybrid thin films were investigated using UV-Vis s and FTIR spectroscopies, as well as appropriate models developed with new analytical methods. The existence of azo-dye MR in the complex is crucial for the resource action of the trans cis cycles through UV-illumination Visible-illumination relaxations. The results of the UV-Vis and the FTIR investigations prove the cyclical trans [...] .

Auditory sensory gating in Huffaz using an auditory brainstem response with a psychological task: A preliminary investigation.

OBJECTIVE: This study aims to investigate the auditory sensory gating capacity in Huffaz using an auditory brainstem response (ABR) test with and without psychological tasks. METHODS: Twenty-three participants were recruited for this study. The participants were comprised of 11 Huffaz who memorized 30 chapters of the Islamic Scripture (from the Quran) and 12 non-Huffaz as the control group. All participants had normal hearing perception and underwent an ABR test with and without psychological tasks. The ABR was elicited at 70 dB nHL using a 3000 Hz tone burst stimulus with a 2-0-2 cycle at a stimulus repetition rate of 40 Hz. The ABR wave V amplitude and latencies were measured and statistically compared. A forward digit span test was also conducted to determine participants' working memory capacity. RESULTS: There were no significant differences in the ABR wave V amplitudes and latencies between Huffaz and non-Huffaz in ABR with and without psychological tasks. There were also no significant differences in the ABR wave V amplitudes and latencies in both groups of ABR with and without psychological tasks. In addition, no significant differences were identified in the digit span working memory score between both groups. CONCLUSIONS: In this study, based on the ABR findings, Huffaz showed the same auditory sensory gating capacity as the non-Huffaz group. The ABR result was consistent with the digit span working memory test score. This finding implies that both groups have similar working memory performance. However, the conclusion is limited to the specific assessment method that we used in this study.

A molecular dynamics study on the thermal properties of carbon-based gold nanoparticles.

Due to unique features in surface activity, thermal stability, electrical and thermal conductivity, and compatibility with biomolecules such as DNA and proteins, carbon-based nanoparticles are raised potential as a candidate for various applications such as catalytic processes, drug delivery, light, and electrical engineering. Based on this premise, thermodynamic features of pure, graphene, and carbon nanotube (CNT)-based gold nanoparticles (AuNPs) are investigated using molecular dynamics approach. Melting, heat capacity, thermal conductivity, contact angle of molten AuNPs, and phase transition are calculated as indicators of thermodynamic properties of pure and carbon-based AuNPs. Simulation results indicate that the presence of a carbon platform and its contact surface area has a significant role in the thermodynamic properties of AuNPs and leads the phononic heat capacity and thermal conductivity to decrease for AuNPs. The platform also causes the melting point temperature of AuNPs to increase. The melting of gold on the carbon base is of the first-order type. In addition, contact angle for molten AuNPs on the Graphene is significantly higher than the one on the CNT due to more contact area on the Graphene substrate.Graphical abstract .

Prediction of the Influential Factors on Eating Behaviors: A Hybrid Model of Structural Equation Modelling-Artificial Neural Networks.

The importance of eating behavior risk factors in the primary prevention of obesity has been established. Researchers mostly use the linear model to determine associations among these risk factors. However, in reality, the presence of nonlinearity among these factors causes a bias in the prediction models. The aim of this study was to explore the potential of a hybrid model to predict the eating behaviors. The hybrid model of structural equation modelling (SEM) and artificial neural networks (ANN) was applied to evaluate the prediction model. The SEM analysis was used to check the relationship of the emotional eating scale (EES), body shape concern (BSC), and body appreciation scale (BAS) and their effect on different categories of eating behavior patterns (EBP). In the second step, the input and output required for ANN analysis were obtained from SEM analysis and were applied in the neural network model. 340 university students participated in this study. The hybrid model (SEM-ANN) was conducted using multilayer perceptron (MLP) with feed-forward network topology. Moreover, Levenberg-Marquardt, which is a supervised learning model, was applied as a learning method for MLP training. The tangent/sigmoid function was used for the input layer, while the linear function was applied for the output layer. The coefficient of determination (R 2) and mean square error (MSE) were calculated. Using the hybrid model, the optimal network happened at MLP 3-17-8. It was proved that the hybrid model was superior to SEM methods because the R 2 of the model was increased by 27%, while the MSE was decreased by 9.6%. Moreover, it was found that BSC, BAS, and EES significantly affected healthy and unhealthy eating behavior patterns. Thus, a hybrid approach could be suggested as a significant methodological contribution from a machine learning standpoint, and it can be implemented as software to predict models with the highest accuracy.

A novel optical model of the experimental transmission spectra of nanocomposite PVC-PS hybrid thin films doped with silica nanoparticles.

We propose a novel derived optical model fitted to the experimental transmittance of PVC-PS hybrid thin films doped with Silica nanoparticles. The films are synthesized using a simple dip-coating method. The model has successfully interpreted the experimental spectral behaviour of transmittance of amorphous semiconductors and dielectric thin films. Interestingly, our model reproduces the optical parameters of the investigated thin films in good agreement with those predicted by Tauc plot. The great advantage of the proposed model over other models lies in its ability to explain the correlations between the film thickness and the optical bandgap. Furthermore, we investigate the structural, physical, and optical properties of PVC-PS- SiO2 thin films, in relevance to the silica percentage content. XRD measurements show that the as-prepared polymeric thin films are amorphous. In addition, SEM micrographs indicate that silica nanoparticles are well dispersed on the surface of the PVC-PS thin films with an average diameter of 100-400 nm. The effect of annealing parameters is also investigated to optimize the projected water contact angle of PVC-PS- SiO2 thin films. At annealing temperature of 2000°C, films become hydrophobic. The transmittance T% of the PVC-PS thin films is found to be about 83% in the visible region. The T% enhances to 90% upon adding silica NPs into PVC-PS polymeric thin films. Obtaining coatings with high transmittance is of crucial importance for several optoelectronic and photonic applications.

Kinematics of Photoisomerization Processes of PMMA-BDK-MR Polymer Composite Thin Films.

We investigate and report on the kinematics of photoisomerization processes of polymer composite thin films based on azo dye methyl red (MR) hosted in polymethylmethacrylate (PMMA) incorporated with Benzyl dimethyl ketal (BDK) as a photo-initiator. Understanding photoisomerization mechanisms is crucial for several optical applications such as Read/Write/Erase (WRE) optical data storage media, UV light Read/Write heads, and UV light sensors. The as-prepared polymer composite thin films are characterized using UV-Vis spectroscopy. Furthermore, Fourier transform infrared spectroscopy (FTIR) and scanning electron microscope (SEM) are employed to investigate the optical, chemical, and morphological properties of trans- and cis-states of PMMA-BDK-MR polymer composite thin films. The presence of the azo dye MR in the composite is essential for the efficient performance of the cis ↔ trans cycles through illumination ↔ thermal relaxation for Write/Read/Erase optical data storage and UV-light sensors. Moreover, UV-Vis and FTIR results confirm the hysteresis cycle of trans- and cis-states and that PMMA-BDK-MR thin films may be regarded as potential candidates for successful Write/Read/Erase optical data storage and UV-light sensors. In addition, the morphology of the thin film surface is investigated by SEM technique. The SEM images indicate that uncured surfaces of PMMA-BDK-MR thin films are inhomogeneous compared with the corresponding surfaces after curing. The transformation from inhomogeneous surfaces to homogeneous surfaces is attributed to the polymerization of thin films by UV curing.

Structural, electronic and magnetic properties of the ordered binary FePt, MnPt, and CrPt3 alloys.

We perform ab initio simulations to investigate the structural, electronic and magnetic properties of the ordered binary FePt, MnPt, and CrPt3 alloys. In particular, equilibrium structural lattice parameters, electronic properties such as density of states (DOS), partial density of states (PDOS) and electronic band structure of each binary alloys are investigated and interpreted. Moreover, the magneto-crystalline anisotropy energies (MAE) are calculated. We found MAE values of FePt, MnPt and CrPt3 ordered alloys to be 2.66, 0.46 and 0.42 meV/f.u., respectively, corresponding to magneto-crystalline anisotropy constant K of 7.6 × 107, 1.3 × 107 and 1.1 × 107 erg/cm3, respectively. The large MAE and K values reveal that FePt, MnPt and CrPt3 binary alloys are eligible to be key components in magneto-optical and opto-electronic devices. In addition, we estimated the Curie temperatures of the three ordered alloys from exchange energy. We found the TC of L10-FePt, L10-MnPt and L12 CrPt3 to be 955 K, 989 K and 762 K, respectively. The high Curie temperatures obtained enable the ordered alloys to serve as write assist in Heat-Assisted Magnetic Recording (HAMR). We believe that our findings would pave the way to fabricate bulk and thin films based on the ordered binary FePt, MnPt, and CrPt3 ordered alloys that have attractive electronic and magnetic properties.

Total quality management in the health-care context: integrating the literature and directing future research.

BACKGROUND: Synergistic integration of predictors and elements that determine the success of total quality management (TQM) implementations in hospitals has been the bane of theoretical development in the TQM research area. Thus, this paper aims to offer a systematic literature review to provide a foundation on which research on TQM can be built and to identify the predictors of successful TQM in the health-care context. MATERIALS AND METHODS: A systematic literature survey was adopted in this paper, involving the review of 25 relevant researched articles found in the databases Science Direct, EBSCO, MEDLINE, CINAHL and PubMed. RESULT: The systematic literature survey reveals five variables to be core predictors of TQM, signifying how important these variables are in the successful implementation of TQM in the health-care context. Also, it is revealed that the identified core predictors have positive effects on an improved health-care system. However, the systematic survey of the literature reveals a dearth of studies on TQM in the health-care context. CONCLUSION: As TQM has become an important management approach for advancing effectiveness in the health-care sector, this kind of research is of value to researchers and managers. Stakeholders in the health sectors should introduce and implement TQM in hospitals and clinics. Nevertheless, this study has limitations, including that the databases and search engines adopted for the literature search are not exhaustive.

Structural, electronic and magnetic properties of MxPt1-X, (M= Co, Ni and V) binary alloys.

The structural, optical and magnetic properties of ordered MxPt1-x (M = Co, Ni and V) binary alloys have been investigated using Vienna ab initio Simulation Package (VASP) within the framework of Density Functional Theory (DFT) and the Generalized Gradient Approximation (GGA). Ab initio calculations have been performed to obtain the most stable structure for each of the three binary systems. In addition, the optical and electrical properties such as electronic band structure, density of states and partial density of states of MxPt1-x binary alloys have been investigated. Specifically, total energy minimization has been performed to calculate the equilibrium in-plane, a o , out-of-plane, c o , and volume, V o , structural lattice parameters of MxPt1-x binary alloys. We found that a o , c o and V o for CoPt, NiPt and VPt3 equal to (a o = 3.806 A, c o = 3.707 A and V o = 53.7 A3) (a o = 3.84 A, c o = 3.62 A and V o = 53.64 A3) and (a o = 3.88 A, c o = 7.88 A and V o = 118.71 A3) respectively. Furthermore, the magneto-crystalline anisotropy energies (MAE) have been calculated to get a deeper insight into magnetic characteristics of the MxPt1- x binary alloys. We found that MAE values for CoPt, NiPt and VPt3 binaries are equal to 1.60, 0.231 and 0.0116 meV/unit cell respectively. These MAE values correspond to magneto-crystalline anisotropy constant K values equal to 4.8 ×107, 6.9 ×106 and 1.46 × 105 erg/cm3. The obtained results reveal that CoPt and NiPt binary systems exhibit attractive optical and magnetic properties, which make both systems potential candidates for magneto-optical and optical-electronic devices. Our results are in good agreement with the previous experimental and theoretical findings.

Bacterial footprints in aspirate of infarct-related artery in ST-elevation myocardial infarction patients underwent primary percutaneous coronary intervention.

BACKGROUND: Bacterial infections can trigger acute coronary syndromes. This study aimed to examine bacterial footprints in the aspirate of infarct-related artery. PATIENTS AND METHODS: We studied 140 patients with ST-elevation myocardial infarction who underwent a primary coronary intervention using thrombus aspiration catheters. The aspirate was sent for bacteriological and pathological examinations and immunoassay for pneumolysin toxin. RESULTS: Bacterial culture showed different bacteria in 14 samples. Leukocyte infiltrate was detected in all pathologically examined samples. Pneumolysin toxin was detected in only two samples. Patients with bacteria had similar baseline data as those without, except for the median age [46 (44-50) vs. 55 (47-62) years, P = 0.001, respectively], and white blood cells (WBCs) (16670 vs. 7550 cells/µl, P < 0.0001, respectively). In hospital-major clinical events (death, stroke, reinfarction, lethal arrhythmia, and heart failure) were not significantly different between the 2 groups with and without bacteria [4 (28.6%) vs. 20 (18.6%) events, respectively, odds ratio (OR) 1.8 (95% CL: 06-6.3), P = 0.5]. Patients with bacteria, heavy infiltration, and pneumolysin had insignificant higher events compared with those without [10/35 (28.6%) vs. 16/105 (15.2%) events, OR 2.2 (95% CL: 0.92-5.43), P = 0.13]. However, the difference was not significant. By multivariate analysis, bacteria, leukocyte infiltration, and pneumolysin were not predictors for in-hospital clinical events. Higher WBCs and younger age were significant predictors of bacterial footprints (P < 0.0001 and P = 0.04, respectively). CONCLUSION: Bacterial footprints existed in the aspirate of infarct-related artery of ST-elevation myocardial infarction patients. Predictors were higher WBCs and younger age. Bacterial markers were not predictors for in-hospital clinical events. The presence of bacterial footprints supports the infectious hypothesis of atherosclerosis.

Estimating the scale of chronic hepatitis C virus infection in the EU/EEA: a focus on migrants from anti-HCV endemic countries.

BACKGROUND: Increasing the proportion diagnosed with and on treatment for chronic hepatitis C (CHC) is key to the elimination of hepatitis C in Europe. This study contributes to secondary prevention planning in the European Union/European Economic Area (EU/EEA) by estimating the number of CHC (anti-HCV positive and viraemic) cases among migrants living in the EU/EEA and born in endemic countries, defining the most affected migrant populations, and assessing whether country of birth prevalence is a reliable proxy for migrant prevalence. METHODS: Migrant country of birth and population size extracted from statistical databases and anti-HCV prevalence in countries of birth and in EU/EEA countries derived from a systematic literature search were used to estimate caseload among and most affected migrants. Reliability of country of birth prevalence as a proxy for migrant prevalence was assessed via a systematic literature search. RESULTS: Approximately 11% of the EU/EEA adult population is foreign-born, 79% of whom were born in endemic (anti-HCV prevalence ≥1%) countries. Anti-HCV/CHC prevalence in migrants from endemic countries residing in the EU/EEA is estimated at 2.3%/1.6%, corresponding to ~580,000 CHC infections or 14% of the CHC disease burden in the EU/EEA. The highest number of cases is found among migrants from Romania and Russia (50-60,000 cases each) and migrants from Italy, Morocco, Pakistan, Poland and Ukraine (25-35,000 cases each). Ten studies reporting prevalence in migrants in Europe were identified; in seven of these estimates, prevalence was comparable with the country of birth prevalence and in three estimates it was lower. DISCUSSION: Migrants are disproportionately affected by CHC, account for a considerable number of CHC infections in EU/EEA countries, and are an important population for targeted case finding and treatment. Limited data suggest that country of birth prevalence can be used as a proxy for the prevalence in migrants.

The Roles and Performance of Professional Driving Instructors in Novice Driver Education.

This review article aimed to analyse existing literature regarding the roles and performance of professional driving instructors (PDIs) in novice driver education (DE). A systematic classification scheme was adopted to analyse identified articles to determine the study context of PDIs in novice DE, the competency level of PDIs in relation to experienced and learner drivers and the contributions of PDIs to the novice driver learning process. A total of 14 original research articles were identified, with no systematic reviews or meta-analyses available. Overall, all of the articles were found to be inadequate in providing an in-depth understanding of the roles and performance of PDIs in novice DE. There is an urgent need to improve current understanding of the roles of PDIs in novice DE and to work towards an internationally recognised PDI management approach.

Multi-organ Metastasis of Fibrolamellar Hepatocellular Carcinoma in a Malayan Gharial (Tomistoma schlegelii).

A 38-year-old Malayan gharial (Tomistoma schlegelii) with a 2-week history of anorexia was found dead and presented for post-mortem examination. Numerous white firm nodules of various sizes were found on the surface of the liver, both left and right kidneys, the spleen and the serosa of the intestinal tract. All masses had similar microscopical appearance and were diagnosed as metastasizing fibrolamellar hepatocellular carcinoma. Immunohistochemically, the tumour cells did not react with antibodies specific for pan-cytokeratin, vimentin or HepPar-1. The anti-HepPar-1 and anti-pan-cytokeratin antibodies also did not react with normal hepatocytes or exocrine pancreatic cells. This is the first description of fibrolamellar hepatocellular carcinoma with metastases in a crocodilian.