Iron-promoted zirconia-alumina supported Ni catalyst for highly efficient and cost-effective hydrogen production via dry reforming of methane.

Developing cost-effective and high-performance catalyst systems for dry reforming of methane (DRM) is crucial for producing hydrogen (H2) sustainably. Herein, we investigate using iron (Fe) as a promoter and major alumina support in Ni-based catalysts to improve their DRM performance. The addition of iron as a promotor was found to add reducible iron species along with reducible NiO species, enhance the basicity and induce the deposition of oxidizable carbon. By incorporating 1 wt.% Fe into a 5Ni/10ZrAl catalyst, a higher CO2 interaction and formation of reducible "NiO-species having strong interaction with support" was observed, which led to an ∼80% H2 yield in 420 min of Time on Stream (TOS). Further increasing the Fe content to 2wt% led to the formation of additional reducible iron oxide species and a noticeable rise in H2 yield up to 84%. Despite the severe weight loss on Fe-promoted catalysts, high H2 yield was maintained due to the proper balance between the rate of CH4 decomposition and the rate of carbon deposit diffusion. Finally, incorporating 3 wt.% Fe into the 5Ni/10ZrAl catalyst resulted in the highest CO2 interaction, wide presence of reducible NiO-species, minimum graphitic deposit and an 87% H2 yield. Our findings suggest that iron-promoted zirconia-alumina-supported Ni catalysts can be a cheap and excellent catalytic system for H2 production via DRM.

Investigation of the mental health and cognitive correlates of psychological decentering in adolescence.

The ability to notice and reflect on distressing internal experiences from an objective perspective, often called psychological decentering, has been posited to be protective against mental health difficulties. However, little is known about how this skill relates to age across adolescence, its relationship with mental health, and how it may impact key domains such as affective executive control and social cognition. This study analysed a pre-existing dataset including mental health measures and cognitive tasks, administered to adolescents in Greater London and Cambridge (mean age (SD) = 14.4 (1.77) years, N = 553). A self-report index of decentering based on available questionnaire items in the dataset was developed. Multiple linear regression was used to examine associations between decentering and mental health, affective executive control (measured using an affective Stroop Task, affective Working Memory Task, and affective Sustained Attention to Response Task) and social cognition. Higher decentering was significantly associated with lower depression and anxiety scores and higher psychological wellbeing. Results did not indicate significant relationships between decentering, affective executive control and social cognition. Further research is needed to discover cognitive mechanisms associated with this process, which could allow for optimisation of existing psychological therapy and reveal new avenues of intervention.

Barriers and Facilitators of Using Standardized Outcome Measures in Stroke Rehabilitation in Saudi Arabia: A Cross-Sectional Study of Practice Among Neurophysiotherapists.

Background: Clinical guidelines emphasize the use of standardized outcome measures (SOMs) in post-stroke rehabilitation. However, the extent of SOM utilization among physiotherapists in this context in Saudi Arabia remains unclear. Aim: 1) assess the current use of SOMs by physiotherapists involved in stroke rehabilitation in Saudi Arabia and 2) identify facilitators and barriers influencing the use of SOMs. Methods: An online survey was administered using a three-section questionnaire designed for this study. The first section collected demographic data, the second evaluated the use of SOMs recommended by the American Physical Therapy Association, and the third explored factors facilitating or hindering SOM use in clinical practice. Only highly recommended outcome measures capturing the three levels of the International Classification of Functioning, and Disability (ICF) model were considered: body structure and function, activities, and participation. Poisson regression analysis was used to investigate the association between SOMs utilization and educational level, work experience, type of work facility, and the number of patients treated per week. Results: A total of 138 physiotherapists responded. Most participants (98.5%) used at least one outcome measure in clinical practice. Regression analysis showed that number of strokes treated per week and facility type were associated with the likelihood of using higher number of SOMs. Physiotherapists managing more than 10 stroke patients per week and working in private sector had significantly higher odds of using a greater number of SOMs. The most pronounced barriers were time restrictions and limited resources. Conclusion: Physiotherapists working with stroke patients in Saudi Arabia demonstrate a high awareness and positive attitude toward SOM utilization. Addressing barriers such as time management and resource allocation is crucial to enhancing SOM integration in clinical practice. Clinical Rehabilitation Impact: Organizational support in terms of adequate time and resources is needed to enhance the use of SOMs among physiotherapists.

Dyspnea After an Acute Intermediate-Risk Pulmonary Embolism: A Case-Based Approach to Evaluation and Treatment.

Exercise intolerance after acute pulmonary embolism may be caused by residual pulmonary vascular obstruction, which presents as chronic thromboembolic pulmonary disease with or without pulmonary hypertension. We present a case highlighting a systematic approach to evaluating functional limitations due to residual pulmonary vascular obstruction, emphasizing the utility of cardiopulmonary exercise testing.

Emerging Insights: miRNA Modulation of Ferroptosis Pathways in Lung Cancer.

The newly discovered programmed iron-dependent necrosis, ferroptosis, is a novel pathway that is controlled by iron-dependent lipid peroxidation and cellular redox changes. It can be triggered intrinsically by low antioxidant enzyme activity or extrinsically by blocking amino acid transporters or activating iron transporters. The induction of ferroptosis involves the activation of specific proteins, suppression of transporters, and increased endoplasmic reticulum (ER) stress (a condition in which the ER, a crucial organelle involved in protein folding and processing, becomes overwhelmed by an accumulation of misfolded or unfolded proteins. This situation disrupts the normal functioning of the ER, leading to a cellular stress response known as the unfolded protein response), leading to lipid peroxidation byproduct accumulation and toxic reactive oxygen species (ROS), which are highly reactive molecules derived from diatomic oxygen and include various forms such as superoxide (O2⁻), hydroxyl radicals (•OH), and hydrogen peroxide (H2O2). Ferroptosis is closely associated with signaling molecules in lung cancer, including epidermal growth factor receptor (EGFR), mitogen-activated protein kinase (MAPK), hypoxia-inducible factor 1-alpha (HIF-1α), and P53, and is regulated by epigenetic factors such as microRNAs (miRNAs). miRNAs are small non-coding RNA molecules that regulate gene expression by binding to target messenger RNAs (mRNAs), leading to translational repression or degradation. Several miRNAs have been found to modulate ferroptosis by targeting key genes involved in iron metabolism, lipid peroxidation, and antioxidant defense pathways. The research on ferroptosis has expanded to target its role in lung cancer treatment and resistance prevention. This review encapsulates the significance of ferroptosis in lung cancer. Understanding the mechanisms and implications of ferroptosis in lung cancer cells may lead to targeted therapies exploiting cancer cell vulnerabilities to ferroptosis Also, improving treatment outcomes, and overcoming resistance.

Comparison of Khoury's Bone Shell Technique vs Titanium-reinforced Polytetrafluoroethylene Membrane for 3D-bone Augmentation in Atrophic Posterior Mandible: A Randomized Clinical Trial.

AIM: This study was designed to compare between the use of Khoury's bone shell technique vs titanium-reinforced PTFE membrane for 3D-ridge augmentation of atrophic posterior mandible. MATERIALS AND METHODS: Sixteen patients were equally and randomly assigned to either the Khoury or PTFE group. In Khoury group, a mandibular bone block was harvested, split and then fixed to augment the mandibular defect using osteosynthesis screws. In PTFE group, augmentation was achieved using Titanium-reinforced PTFE membranes fixed with bone tacks/screws. A mixture of autogenous and xenogenic graft material at a 1:1 ratio was used in both groups. Vertical and horizontal bone gain were obtained using cone-beam computed tomography (CBCT). Preoperative dimensions were compared with the final dimensions obtained 6 months postoperatively. RESULTS: No significant complications or neurosensory dysfunction were encountered. A solitary patient in the Khoury group experienced limited wound dehiscence, which was treated conservatively. For both groups, there were no significant differences between preoperative and postoperative vertical (p = 0.849 and 0.569) and horizontal (p = 0.778 and 0.367) dimensions. CONCLUSION: No significant differences exist between the augmentation dimension which can be obtained using either Khoury of Ti-PTFE membranes. CLINICAL SIGNIFICANCE: Both approaches are delicate and necessitate surgical expertise and experience. Both techniques can be used to achieve predictable augmentation results with a low rate of complications. How to cite this article: Shaker AES, Salem AS, El-Farag SAA, et al. Comparison of Khoury's Bone Shell Technique vs Titanium-reinforced Polytetrafluoroethylene Membrane for 3D-bone Augmentation in Atrophic Posterior Mandible: A Randomized Clinical Trial. J Contemp Dent Pract 2024;25(6):518-526.

Energy-harvesting tile incorporating an origami coupling mechanism.

We present the design and evaluation of a simple, compact and efficient electromagnetic energy harvesting tile that can be used to harness energy from footsteps. The proposed harvester incorporates a translational-rotational origami-inspired coupling mechanism to transform the axial loads exerted by human footsteps into a localized rotation of an electromagnetic generator. The coupling mechanism employs a non-rigid tunable Kresling spring, the restorative behaviour of which is tunable to maximize energy transduction from the applied load to the generator. A computational model is developed to optimize the design parameters of the mechanism, which are then utilized to fabricate a prototype of the energy harvester. The tile is tested under loading conditions that mimic a human step, where it is demonstrated that it is capable of generating 4.18 W of electrical power per step with a surface power density of 2609 µW cm-2.This article is part of the theme issue 'Origami/Kirigami-inspired structures: from fundamentals to applications'.

Evaluation of Antibacterial Activities of Aqueous Extract of Black Pepper (Piper nigrum L) Seeds against the Gram Positive Staphylococcus aureus and Gram-Negative Escherichia coli.

Antibiotic resistance (AMR) represents a serious threat to public health and poses challenges in disease prevention and treatment despite various efforts to combat it. Evaluation of the in vitro antibacterial activity of aqueous extracts of black pepper seeds (Piper nigrum L.) against two infectious pathogens: Gram-positive Staphylococcus aureus and Gram-negative Escherichia coli. The Department of Pharmacology and Therapeutics and the Department of Microbiology of Mymensingh Medical College conducted the study from Octy 2022 to June 2023. The antibacterial activity of Aqueous black pepper seed extract (ABPE) was evaluated at different doses using disk diffusion and broth dilution methods. The extract was prepared using 10.0% dimethyl sulfoxide (DMSO) and water as solvent. The commonly used antibiotic ciprofloxacin was used in the broth dilution method and the results were compared with those for aqueous extracts. To confirm a more precise range of antimicrobial susceptibility of the extracts, ABPE was used at seven different concentrations (100, 80, 60, 40, 20, 10 and 5 mg/mL). Selected concentrations were then used as needed. ABPE showed an inhibitory effect on the above bacteria at doses of 90 mg/ml and higher. The Minimum inhibitory concentration (MIC) values for Escherichia coli and Staphylococcus aureus were 85 and 90 mg/ml ABPE, respectively. The MIC of ciprofloxacin against Staphylococcus aureus and Escherichia coli was currently 1µg/ml. The MIC of ciprofloxacin was lowest for the organisms tested compared to the MIC of ABPE. This work clearly demonstrates the antibacterial sensitivity of Staphylococcus aureus and Escherichia coli to an aqueous extract of black pepper seeds.

Pattern of ENT Diseases in Children: A Peripheral Military Hospital Based Study.

This study was aimed to find out the hospital based prevalence of paediatric ENT disorders in an ENT OPD of a peripheral military hospital of Bangladesh Armed Forces. This observational study was carried out at ENT out patient department of CMH Momenshahi, from 1st April 2017 to 31st March 2020. Irrespective of age and sex a total of 4612 children, between the ages of 0-14 years were included in this study. All types of ENT disorders were taken in to account. Data were obtained after ENT examination and necessary investigations. Total 4612 cases were studied. Male children (52.2%) were affected more and most of the children belongs the 6-10 years age group (44.4%).Throat related disorder (40.7%) were predominant followed by ear (34.8%). The most common ENT disorders were Chronic Tonsillitis (21.8%) followed by acute otitis media (16.1%) and pharyngitis (9.8%). Rate of Chronic otitis media (COM) was only 46(1%). ENT diseases are one of the major health problems among children. In addition to improved health education, socioeconomic status and better access to health care facilities; provision of early ENT specialist consultation may significantly reduce chronic or recurring symptoms and long term morbidities of common ENT disorders in children.

Sero-evidence of Rickettsia Infection by ELISA in the Northern-Central Area of Bangladesh.

Detection of rickettsia most commonly done by simple, economical Weil-Felix test which detects IgM antibody. This initial investigation provides limited sound guidance to clinical decisions because of its low specificity and sensitivity. An alternative test, enzyme-linked immunosorbent assay (ELISA) is faster, less complicated, can also be automated. Advancements in molecular method like polymerase chain reaction (PCR) are highly specific, sensitive and rapid assays for detection of rickettsiales in many different samples including blood, tissue etc. This study was carried out to diagnose the rickettsial agent in the north-central (Mymensingh division) area of Bangladesh. In laboratory, we performed ELISA and PCR. The agent was diagnosed up to species level by molecular approach. A total of 150 febrile patients were included. All were clinically suspected cases of rickettsial fever attending inpatient and outpatient department of medicine and pediatrics of Mymensingh Medical College Hospital from Octy 2012 to January 2014. The laboratory tests were performed in Microbiology department of Mymensingh Medical College. Following universal safety precautions blood samples were collected, serum separated and both were stored at -20°C. IgM ELISA and Nested PCR were performed. Several genes by PCR were detected for confirmation of the presence of rickettsial agent in the blood. Among 150 clinically suspected cases 76(50.66%) were positive for ELISA, and 69(46.0%) were positive for PCR. The sensitivity and specificity of ELISA were 92.75% and 85.19% respectively taking PCR as gold standard. The prevalence of rickettsial infection found in this study was very much close to other countries of this Sub continent.

Evaluation of Primary and Recurrent Breast Cancer after Giving Adjuvant Therapy in Correlation with the Receptor Status.

Breast cancer is the most common type of cancer among women. The molecular subtypes of breast cancer, depending on the Estrogen Receptor (ER), Progesterone Receptor (PR) and Human Epidermal Growth Factor Receptor (HER-2) status, usually play a vital role for the adjuvant treatment. Interestingly, there is a good possibility of change of receptor status in the recurrence of same primary tumor. The study is designed April 2018 to March 2019 to see the concordance in triple-receptor expression (ER, PR, and HER-2) between the primary and the locally recurrent breast cancer patient and the results can be able to influence the management and prognosis of the breast cancer patients. This observational study was carried out in the department of surgical oncology, NICRH where total 48 patients were studied who were subjected to core biopsy of recurrent lesion for ER, PR and HER-2 status. A structured case record form was used to interview and collect data. Data analysis was done using SPSS version 26.0 to see concordance and discordance in triple-receptor expression between the primary and the locally recurrent breast cancer patient. Among 48 cases, 12(25.0%), 10(20.83%) and 2(4.16%) patients showed Estrogen Receptor (ER), Progesterone Receptor (PR) and Human Epidermal Growth Factor Receptor (Her-2) discordance that are statistically significant in every receptor status. Majority discordance of ER, PR and Her-2 were associated with invasive duct cell carcinoma (IDC); ER & Her-2 discordance was equally associated with histological grade 2 and 3 whereas PR discordance had significant association with grade 3. Staging of disease showed that all ER, PR and Her-2 discordance were associated with stage (p<0.05). Besides, majority discordance was mostly associated with lumpectomy except Her-2 discordance. Besides, among the adjuvant treatment regimen chemotherapy along with radiotherapy was mostly associated with discordance of all receptors (p<0.05). Estrogen Receptor (ER), Progesterone Receptor (PR) and Human Epidermal Growth Factor Receptor (HER-2) status of primary breast cancer showed 25.0%, 20.83% and 4.16% discordant in recurrent episodes in this study. Invasive duct cell carcinoma, histological grade 2 and 3, stage II, stage III, MRM and CT along with RT are major attributable factors in this study.

A global dataset of gross nitrogen transformation rates across terrestrial ecosystems.

Rates of nitrogen transformations support quantitative descriptions and predictive understanding of the complex nitrogen cycle, but measuring these rates is expensive and not readily available to researchers. Here, we compiled a dataset of gross nitrogen transformation rates (GNTR) of mineralization, nitrification, ammonium immobilization, nitrate immobilization, and dissimilatory nitrate reduction to ammonium in terrestrial ecosystems. Data were extracted from 331 studies published from 1984-2022, covering 581 sites. Globally, 1552 observations were appended with standardized soil, vegetation, and climate data (49 variables in total) potentially contributing to the observed variations of GNTR. We used machine learning-based data imputation to fill in partially missing GNTR, which improved statistical relationships between theoretically correlated processes. The dataset is currently the most comprehensive overview of terrestrial ecosystem GNTR and serves as a global synthesis of the extent and variability of GNTR across a wide range of environmental conditions. Future research can utilize the dataset to identify measurement gaps with respect to climate, soil, and ecosystem types, delineate GNTR for certain ecoregions, and help validate process-based models.

Automated gall bladder cancer detection using artificial gorilla troops optimizer with transfer learning on ultrasound images.

The gallbladder (GB) is a small pouch and a deep tissue placed under the liver. GB Cancer (GBC) is a deadly illness that is complex to discover in an initial phase. Initial diagnosis can significantly enhance the existence rate. Non-ionizing energy, low cost, and convenience make the US a general non-invasive analytical modality for patients with GB diseases. Automatic recognition of GBC from US imagery is a significant issue that has gained much attention from researchers. Recently, machine learning (ML) techniques dependent on convolutional neural network (CNN) architectures have prepared transformational growth in radiology and medical analysis for illnesses like lung, pancreatic, breast, and melanoma. Deep learning (DL) is a region of artificial intelligence (AI), a functional medical tomography model that can help in the initial analysis of GBC. This manuscript presents an Automated Gall Bladder Cancer Detection using an Artificial Gorilla Troops Optimizer with Transfer Learning (GBCD-AGTOTL) technique on Ultrasound Images. The GBCD-AGTOTL technique examines the US images for the presence of gall bladder cancer using the DL model. In the initial stage, the GBCD-AGTOTL technique preprocesses the US images using a median filtering (MF) approach. The GBCD-AGTOTL technique applies the Inception module for feature extraction, which learns the complex and intrinsic patterns in the pre-processed image. Besides, the AGTO algorithm-based hyperparameter tuning procedure takes place, which optimally picks the hyperparameter values of the Inception technique. Lastly, the bidirectional gated recurrent unit (BiGRU) model helps classify gall bladder cancer. A series of simulation analyses were performed to ensure the performance of the GBCD-AGTOTL technique on the GBC dataset. The experimental outcomes inferred the enhanced abilities of the GBCD-AGTOTL in detecting gall bladder cancer.

Machine learning- a new paradigm in nanoparticle-mediated drug delivery to cancerous tissues through the human cardiovascular system enhanced by magnetic field.

Nanoparticle-mediated drug delivery offers a promising approach to targeted cancer therapy, leveraging the ability of nanoparticles to deliver therapeutic agents directly to cancerous tissues with minimal impact on surrounding healthy cells. The presence of these nanoparticles is governed by a concentration equation, which accounts for the diffusion, convection, and reaction of the nanoparticles with the blood components. It is well-known that whenever a disease or infection occurs in a human, in 80% of cases a rise in the concentration of hydrogen peroxide in the blood occurs. This is the reason why blood is assumed to contain hydrogen peroxide (in the present study), which is a biomarker of oxidative stress and inflammation. This study explores the integration of machine learning (ML) techniques into the optimization of drug delivery processes within the human cardiovascular system, focusing on the enhancement of these processes through the application of magnetic fields. By employing ML algorithms, we analyze and predict the behavior of nanoparticles as they navigate the complex fluid dynamics of the cardiovascular system, particularly under the influence of an external magnetic field. The predictive power of ML models enables the precise control of nanoparticle trajectories, optimizing their accumulation in cancerous tissues and improving the efficacy of the drug delivery system. The findings of this study demonstrate that ML-enhanced magnetic targeting can significantly enhance the precision and effectiveness of nanoparticle-mediated drug delivery, offering a new paradigm in cancer treatment strategies. This approach has the potential to revolutionize the field by providing personalized and highly efficient therapeutic solutions for cancer patients.

Correction: Amin et al. Hippocampal and Cerebellar Changes in Acute Restraint Stress and the Impact of Pretreatment with Ceftriaxone. Brain Sci. 2020, 10, 193.

In the original publication [...].

An eco-friendly smartphone based HPTLC method versus conventional densitometric one for determination of Naltrexone and Bupropion.

The rapid uprising technologies of smartphone applications and software introduced a new era for analytical detection techniques. It has transformed bench-top laboratory methods into simpler ones depending on cost-effective, portable, and widely accessible devices. In this work, two high performance thin layer chromatographic (HPTLC) methods were developed based on smartphone's camera detection and either ImageJ desktop software or Color-Picker smartphone's application as alternative techniques to conventional densitometric detection. A mixture of Naltrexone hydrochloride (NAL) and Bupropion hydrochloride (BUP) was chromatographed on HPTLC- plates using ethyl acetate, methanol, acetone, and glacial acetic acid (3:6:1:0.5, by volume) as a developing system. The developed plates were scanned at 203 nm for the densitometric analysis, then visualized by modified Dragendorff's reagent and shot by a smartphone's camera. The captured images were uploaded to either ImageJ software or Color-Picker application to detect the separated spots. The results derived from the three detection methods were compared over the concentration range of 0.4-24 & 0.6-18 µg/band for the densitometric method, 0.4-24 & 2-24 µg/band for ImageJ built method and 0.8-20 & 5-20 µg/band for Color Picker built method for NAL and BUP, respectively. The methods were found to be appropriate for assaying both active drug substances in pure forms and combined in marketed pharmaceutical formulations. The excellent sustainability of densitometric and ImageJ-based methods enabled also the assessment of their dosage form content uniformity. The greenness and sustainability of the methods were assessed by three metric tools, namely Green Analytical Procedure Index (GAPI), Analytical GREEnness Metric Approach (AGREE), and White Analytical Chemistry (WAC). The assessments results confirmed the sustainability and superiority of the proposed methods in terms of sample treatment, waste mount, energy consumption, cost, and number of analyzed samples per an hour.

Spectroscopic, anti-cancer, anti-bacterial and theoretical studies of new bivalent Schiff base complexes derived from 4-bromo-2,6-dichloroaniline.

In this paper, four new mono-nuclear Ni(II), Pd(II), Pt(II) and Zn(II) complexes were prepared by using a bi-dentate Schiff base ligand, (E)-2-(((4-bromo-2,6-dichlorophenyl)imino)methyl)-5-chlorophenol (BrcOH), with bivalent ions in a methanol and distil water mixture as solvent in presence of NaOH as base. The structures of the prepared compounds were characterized by spectroscopic techniques (IR and 1H NMR), CHN analysis, and molar conductivity. The M(II) (Ni, Pd and Pt) ions are four-coordinated by a bi-dentate N2O2 donor ligand, forming square planar geometry, whereas the Zn(II) is coordinated as a tetrahedral geometry. The newly synthesized compounds, which include the Schiff base ligand and its complexes, underwent antibacterial screening against E. coli and S. aureus. The results demonstrated a remarkable and noteworthy biological activity of these compounds against these pathogenic bacterial strains. Different binding energies showed good correlation, with Pd showing the strongest binding. Small energy differences indicated high reactivity, with Ni and Pd complexes being the most reactive. Electrophilicity index exhibited electron-accepting properties, with Zn showing the highest reactivity. The dipole moments showed polarity and charge separation, with Pt having the highest polarity. We evaluated the pharmacokinetic properties (ADME) of a ligand and its metal complexes using the Swiss ADME website. The results of the in-silico prediction of physicochemical properties revealed that ten compounds in total adhered to Lipinski's rule.

Temporal Trends in Acute Adrenal Insufficiency Events in Children With Congenital Adrenal Hyperplasia During 2019-2022.

Background: It is unclear whether targeted monitoring of acute adrenal insufficiency (AI) related adverse events (AE) such as sick day episodes (SDEs) and hospitalization rate in congenital adrenal hyperplasia (CAH) is associated with a change in the occurrence of these events. Aim: Study temporal trends of AI related AE in the I-CAH Registry. Methods: In 2022, data on the occurrence of AI-related AE in children aged <18 years with 21-hydroxylase deficiency CAH were compared to data collected in 2019. Results: In 2022, a total of 513 children from 38 centers in 21 countries with a median of 8 children (range 1-58) per center had 2470 visits evaluated over a 3-year period (2019-2022). The median SDE per patient year in 2022 was 0 (0-2.5) compared to 0.3 (0-6) in 2019 (P = .01). Despite adjustment for age, CAH phenotype and duration of study period, a difference in SDE rate was still apparent between the 2 cohorts. Of the 38 centers in the 2022 cohort, 21 had also participated in 2019 and a reduction in SDE rate was noted in 13 (62%), an increase was noted in 3 (14%), and in 5 (24%) the rate remained the same. Of the 474 SDEs reported in the 2022 cohort, 103 (22%) led to hospitalization compared to 299 of 1099 SDEs (27%) in the 2019 cohort (P = .02). Conclusion: The I-CAH Registry can be used for targeted monitoring of important clinical benchmarks in CAH. However, changes in reported benchmarks need careful interpretation and longer-term monitoring.