Clinical outcomes in perineural spread of cutaneous squamous cell carcinoma via the ophthalmic nerve.

BACKGROUND: There are no large studies reporting oncological or survival outcomes for patients diagnosed with perineural spread (PNS) of cutaneous squamous cell carcinoma (cSCC) via the ophthalmic nerve (V1). Where orbital exenteration may be necessary for curative treatment, it is critical to have survival data with which the morbidity associated with surgical treatment can be justified. Furthermore, with the emerging treatment option of immunotherapy, current standard of care outcomes are needed to help guide future trial design and eventually changed management guidelines. OBJECTIVE: To determine the oncological and survival outcomes observed in patients with PNS of cSCC via V1. MATERIALS AND METHODS: Retrospective analysis of prospectively maintained cohort of patients with PNS of cSCC via V1 treated in a tertiary Australian head and neck oncology/skull base referral center. Consecutive sample of 53 patients managed between March 1, 1999 and April 30, 2020. Follow-up closure date was September 1, 2021. Curative-intent surgery, curative-intent radiotherapy, or palliative care was undertaken. Endpoints included five-year overall, disease-specific, and disease-free survival from the date of treatment. RESULTS: Five-year Kaplan-Meier overall survival was 61.9% (95% CI 46.2%-74.3%), with disease-specific survival of 74.6% (95% CI 58.8%-85.3%), and disease-free survival 62.1% (95% CI 46.5%-74.3%). Survival was superior in patients treated via surgery and adjuvant radiotherapy than in those receiving surgery alone or definitive radiotherapy. Survival was superior among patients with less advanced disease as assessed by the Williams zonal staging system; patients with Zone 1 disease had disease-specific survival of 94.1% at 5 years with 82.5% disease-free survival. DISCUSSION: Five-year oncological and survival outcomes in this cohort were favorable. Superior survival was observed in patients treated with curative-intent surgery and adjuvant radiotherapy. Less extensive disease as delineated by the Williams zonal staging system was associated with improved survival. CONCLUSION: Surgical resection with adjuvant radiotherapy confers favourable oncological and survival outcome in patients with V1 PNS, particularly with early disease limited to Zone 1.

Prevalence and molecular characteristics of intestinal pathogenic Escherichia coli isolated from diarrheal pigs in Southern China.

Intestinal pathogenic Escherichia coli (InPEC) is one of the most common causes of bacterial diarrhea in farm animals, including profuse neonatal diarrhea and post weaning diarrhea (PWD) in piglets. In this study, we investigated the prevalence of InPEC and associated primary virulence factors among 543 non-duplicate E. coli isolates from diarrheal pigs from 15 swine farms in southern China. Six major virulence genes associated with InPEC were identified among 69 (12.71 %) E. coli isolates and included est (6.62 %), K88 (4.79 %), elt (3.68 %), eae (1.47 %), stx2 (0.92 %) and F18 (0.55 %). Three pathotypes of InPEC were identified including ETEC (8.10 %), EPEC (1.29 %) and STEC/ETEC (0.92 %). In particular, K88 was only found in ETEC from breeding farms, whereas F18 was only present in STEC/ETEC hybrid from finishing farms. Whole genome sequence analysis of 37 E. coli isolates revealed that InPEC strains frequently co-carried multiple antibiotic resistance gene (ARG). est, elt and F18 were also found to co-locate with ARGs on a single IncFIB/IncFII plasmid. InPEC isolates from different pathotypes also possessed different profiles of virulence genes and antimicrobial resistance genes. Population structure analysis demonstrated that InPEC isolates from different pathotypes were highly heterogeneous whereas those of the same pathotype were extremely similar. Plasmid analysis revealed that K88 and/or est/elt were found on pGX18-2-like/pGX203-2-like and pGX203-1-like IncFII plasmids, while F18 and elt/est, as well as diverse ARGs were found to co-locate on IncFII/IncFIB plasmids with a non-typical backbone. Moreover, these key virulence genes were flanked by or adjacent to IS elements. Our findings indicated that both clonal expansion and horizontal spread of epidemic IncFII plasmids contributed to the prevalence of InPEC and the specific virulence genes (F4, F18, elt and est) in the tested swine farms.

Spread-out Bragg peak FLASH: quantifying normal tissue toxicity in a murine model.

Objective: A favorable effect of ultra-high dose rate (FLASH) radiation on normal tissue-sparing has been indicated in several preclinical studies. In these studies, the adverse effects of radiation damage were reduced without compromising tumor control. Most studies of proton FLASH investigate these effects within the entrance of a proton beam. However, the real advantage of proton therapy lies in the Spread-out Bragg Peak (SOBP), which allows for giving a high dose to a target with a limited dose to healthy tissue at the entrance of the beam. Therefore, a clinically relevant investigation of the FLASH effect would be of healthy tissues within a SOBP. Our study quantified the tissue-sparing effect of FLASH radiation on acute and late toxicity within an SOBP in a murine model. Material/Methods: Radiation-induced damage was assessed for acute and late toxicity in the same mice following irradiation with FLASH (Field dose rate of 60 Gy/s) or conventional (CONV, 0.34 Gy/s) dose rates. The right hindleg of unanesthetized female CDF1 mice was irradiated with single-fraction doses between 19.9-49.7 Gy for CONV and 30.4-65.9 Gy for FLASH with 5-8 mice per dose. The leg was placed in the middle of a 5 cm SOBP generated from a mono-energetic beam using a 2D range modulator. Acute skin toxicity quantified by hair loss, moist desquamation and toe separation was monitored daily within 29 days post-treatment. Late toxicity of fibrotic development measured by leg extendibility was monitored biweekly until 30 weeks post-treatment. Results: Comparison of acute skin toxicity following radiation indicated a tissue-sparing effect of FLASH compared to conventional single-fraction radiation with a mean protection ratio of 1.40 (1.35-1.46). Fibrotic development similarly indicated normal tissue sparing with a 1.18 (1.17-1.18) protection ratio. The acute skin toxicity tissue sparing was similar to data from entrance-beam irradiations of Sørensen et al. (4). Conclusion: Full dose-response curves for acute and late toxicity after CONV and FLASH radiation were obtained. Radiation within the SOBP retains the normal-tissue-sparing effect of FLASH with a dose-modifying factor of 40% for acute skin damage and 18% for fibrotic development.

Perception of misinformation on social media among Chinese college students.

Background: Chinese college students predominantly use social media applications to collect information, communicate with each other, advance their education, and go shopping. Research has highlighted the spread of misinformation or fake news on social media, and this has affected college students negatively as they are the most frequent users of social media. Objective: This research aims to investigate Chinese college students' perceptions of misinformation on social media, including their views on the consequences of misinformation, insights into the reasons for its dissemination, how misinformation impacts their mental health, and their perspectives on how to control misinformation. Methods: This study followed a qualitative approach, selecting 36 participants from 12 universities in China, collecting data through semi-structured interviews, and analyzing the data to enable thematic analysis. Results: Chinese college students are aware of the adverse impact of spreading misinformation on social media. They believe that false information is disseminated primarily due to inadequate punishment for those who intentionally spread it. Most college students lack proficiency in identifying misinformation, and they expect the government to do more to control the misinformation phenomenon. Moreover, misinformation on social media may cause Chinese college students to feel dysphoric, angry, and even depressed, thereby affecting their mental health. This research indicates that the public and government should make efforts to address the misinformation phenomenon in order to protect college students from being harmed.

The evolution of cropping structure in prehistoric Xizang.

The origin and spread of agriculture facilitated a decline in human mobility and eventually led to a predominantly sedentary lifestyle globally, including on the Tibetan Plateau. Previous studies have proposed an evolution of prehistoric agriculture, from millet-based to barley-based farming. However, details regarding the process are vague. Here, we present diachronic changes in cropping structure from Xizang on the basis of a quantitative analysis of archaeobotanical remains from 12 sites located in southeastern Xizang. The advent of agriculture in Xizang began in the southeastern region around 4800 cal a BP and resulted in a quick spread of millet agriculture from the Hengduan Mountains to the Yarlung Zangbo River region. Subsequently, the introduction of barley and wheat in Xizang led to the transformation of millet-based farming into mixed farming after 3600 cal a BP. Eventually, around 3000 cal a BP, barley and wheat dominated across the entire Xizang with declining occurrences of millet. It took more than 600 years for barley and wheat to dominate in the Tibetan cropping system, which may reflect the time required for these exotic species to adapt physiologically to their new niche. In addition to the diachronic changes in crop farming, the ratio of barley to wheat and foxtail millet to broomcorn millet also varied at different elevations possibly due to local environmental variations and the crops' physiological requirements.

Transmission of global clones of NDM-producing Enterobacterales and interspecies spread of IncX3 plasmid harboring blaNDM-5 in Tokyo.

OBJECTIVE: The aim of this study is to characterize the molecular characteristics of NDM-producing Enterobacterales, which have been on the increase in recent years in Japan, where IMP-producing bacteria are dominant among carbapenemase-producing Enterobacterales. METHODS: We collected 21 strains of NDM-producing Enterobacterales detected between 2015 and 2022 at five hospitals in Tokyo and performed illumina whole genome sequencing. For the seven selected strains, nanopore long-read sequencing was also performed to characterize the plasmids harboring blaNDM. RESULTS: Fourteen strains were Escherichia coli and all carried blaNDM-5. Among these strains, eight and three were sequence type (ST) 410 and ST167, respectively, and both groups of strains were spread clonally in different hospitals. Two strains of Klebsiella pneumoniae ST147 carrying blaNDM-1 were detected in a hospital, and these strains had also spread clonally. The remainder included Enterobacter hormaechei, Klebsiella quasipneumoniae, Citrobacter amalonaticus, and Klebsiella michiganensis. Plasmid analysis revealed that an identical IncX3 plasmid harboring blaNDM-5 was shared among four strains of different bacterial species (E. coli, C. amalonaticus, K. michiganensis, and E. hormaechei) detected at the same hospital. In addition, a Klebsiella quasipneumoniae strain detected at a different hospital also carried an IncX3 plasmid with a similar genetic structure. CONCLUSIONS: Nosocomial spread of multiple multidrug-resistant global clones and transmission of IncX3 plasmids harboring blaNDM-5 among multiple species were detected as the major pathways of spread of NDM-producing Enterobacterales in Tokyo. Early detection of carriers and measures to prevent nosocomial spread are important to prevent further spread of NDM-producing organisms.

The role of extrinsic and intrinsic factors in perceptual filling-in of the blind-spot with variegated color and texture stimuli.

Vision scientists dedicated their efforts to unraveling the mechanism of filling-in at the blind-spot (BS) through numerous psychophysical experiments. The prevalent interpretation, emphasizing active filling-in, has spurred extensive research endeavors. In a parallel vein, a pertinent study highlighted the predominance of the nasal Visual Field (VF) over the temporal one and postulated the role of the Cortical Magnification Factor (CMF) in explaining the asymmetry of filling-in. In this study, we first replicated this experiment and then conducted BS-specific psychophysical experiments employing various bi-colored and bi-textured (patterned) stimuli. We observed that nasal dominance is not persistent in the context of the spread of perception for BS filling-in. We posit that the visual information processing priority index (VIPPI), comprising the CMF (an intrinsic factor unaffected by stimulus characteristics) and relative luminance (an extrinsic factor dependent on stimulus characteristics), governs the spread of perception for filling-in in case of diverse neighborhoods of the BS.

Comprehensive assessment of nonuniform image quality: Application to imaging near metal.

PURPOSE: Comprehensive assessment of image quality requires accounting for spatial variations in (i) intensity artifact, (ii) geometric distortion, (iii) signal-to-noise ratio (SNR), and (iv) spatial resolution, among other factors. This work presents an ensemble of methods to meet this need, from phantom design to image analysis, and applies it to the scenario of imaging near metal. METHODS: A modular phantom design employing a gyroid lattice is developed to enable the co-registered volumetric quantitation of image quality near a metallic hip implant. A method for measuring spatial resolution by means of local point spread function (PSF) estimation is presented and the relative fitness of gyroid and cubic lattices is examined. Intensity artifact, geometric distortion, and SNR maps are also computed. Results are demonstrated with 2D-FSE and MAVRIC-SL scan protocols on a 3T MRI scanner. RESULTS: The spatial resolution method demonstrates a worst-case error of 0.17 pixels for measuring in-plane blurring up to 3 pixels (full width at half maximum). The gyroid outperforms a cubic lattice design for the local PSF estimation task. The phantom supports four configurations toggling the presence/absence of both metal and structure with good spatial correspondence for co-registered analysis of the four quality factors. The marginal scan time to evaluate one scan protocol amounts to five repetitions. The phantom design can be fabricated in 2 days at negligible material cost. CONCLUSION: The phantom and associated analysis methods can elucidate complex image quality trade-offs involving intensity artifact, geometric distortion, SNR, and spatial resolution. The ensemble of methods is suitable for benchmarking imaging performance near metal.

Correlation of rheology and oral tribology with sensory perception of commercial hazelnut and cocoa-based spreads.

This study examined the effects of spread formulation and the structural/lubricant properties of six different commercial hazelnut and cocoa spreads on sensory perception. Rheology, tribology, and quantitative descriptive analysis (QDA) was assessed by also evaluating the correlation coefficients between the quality descriptor and the rheological and textural parameters. The viscosity was evaluated at different temperatures to better simulate conditions before and after ingestion. Tribological analysis was executed at 37°C to mimic the human oral cavity. The effect of saliva presence and the number of runs on tribological behaviors was investigated. Moreover, textural, calorimetric, and particle size distribution measurements were performed to reinforce the correlation between structural/thermal parameters (e.g., firmness, stickiness, sugar melting point) and sensory aspects. "Visual viscosity," defined as a sensory attribute evaluated prior to consumption, negatively correlated with apparent viscosity measured at 20°C and 10 s-1, whereas "body," defined during oral processing and related to creaminess, positively correlated with apparent viscosity measured at 37°C and 50 s-1. These attributes were mainly influenced by particulate microstructure and solid volume fraction within the formulation. Textural stickiness positively correlated with sensory "adhesiveness" and was related to fat composition and milk powder addition, while "sweetness" was related to sucrose content and sugar melting enthalpy. Tribological data provided meaningful information related to particle-derived attributes, as well as after-coating perception (fattiness/oiliness), thus better predicting food evolution during oral consumption.

The Spread Pattern of New Practice in Liver Transplantation in the United States.

BACKGROUND: Introducing new liver transplantation (LT) practices, like unconventional donor use, incurs higher costs, making evaluation of their prognostic justification crucial. This study reexamines the spread pattern of new LT practices and its prognosis across the United States. METHODS: The study investigated the spread pattern of new practices using the UNOS database (2014-2023). Practices included LT for hepatitis B/C (HBV/HCV) nonviremic recipients with viremic donors, LT for COVID-19-positive recipients, and LT using onsite machine perfusion (OMP). One year post-LT patient and graft survival were also evaluated. RESULTS: LTs using HBV/HCV donors were common in the East, while LTs for COVID-19 recipients and those using OMP started predominantly in California, Arizona, Texas, and the Northeast. K-means cluster analysis identified three adoption groups: facilities with rapid, slow, and minimal adoption rates. Rapid adoption occurred mainly in high-volume centers, followed by a gradual increase in middle-volume centers, with little increase in low-volume centers. The current spread patterns did not significantly affect patient survival. Specifically, for LTs with HCV donors or COVID-19 recipients, patient and graft survivals in the rapid-increasing group was comparable to others. In LTs involving OMP, the rapid- or slow-increasing groups tended to have better patient survival (p = 0.05) and significantly improved graft survival rates (p = 0.02). Facilities adopting new practices often overlap across different practices. DISCUSSION: Our analysis revealed three distinct adoption groups across all practices, correlating the adoption aggressiveness with LT volume in centers. Aggressive adoption of new practices did not compromise patient and graft survivals, supporting the current strategy. Understanding historical trends could predict the rise in future LT cases with new practices, aiding in resource distribution.

An Adult Case of Medulloblastoma with Multiple Lung Metastatic Lesions-Case Report and Literature Review.

Medulloblastoma (MB) cerebelli is a common brain tumor of the childhood. MB commonly spreads through cerebrospinal fluid; however, there are several reported cases of extracranial spread. The most common sites of extracranial metastasis are bones and bone marrow followed by peritoneum, liver, and lungs. Here, we report a case of pulmonary metastatic lesions of adult cerebellar MB that were discovered 1 year after the primary surgical treatment. We also tried to highlight similar reported cases in the literature.

Palm-based nanofibrillated cellulose (NFC) in carotenoid encapsulation and its incorporation into margarine-like reduced fat spread as fat replacer.

Nanofibrillated cellulose (NFC) from plant biomass is becoming popular, attributed to the protective encapsulation of bioactive compounds in Pickering emulsion, preventing degradation and stabilizing the emulsion. NFC, as a natural dietary fiber, is a prominent fat replacer, providing a quality enhancement to reduced-fat products. In this study, NFC Pickering emulsions were prepared at NFC concentrations of 0.2%, 0.4%, 0.6%, 0.8%, and 1% to encapsulate carotenoids. The NFC Pickering emulsions at NFC concentrations of 0.4%, 0.6%, 0.8%, and 1% were incorporated into margarine-like reduced fat (3%) spreads as the aqueous phase. Characterization of both NFC Pickering emulsion and the incorporated NFC Pickering emulsion, margarine-like reduced fat spreads, was conducted with mastersizer, rheometer, spectrophotometer, and texture analyzer. The particle size (73.67 ± 0.35 to 94.73 ± 2.21 nm), viscosity (138.36 ± 3.35 to 10545.00 ± 567.10 mPa s), and creaming stability (25% to 100% stable) of the NFC Pickering emulsions were increased significantly when increasing the NFC concentration, whereas the encapsulation efficiency was highest at NFC 0.4% and 0.6%. Although imitating the viscoelastic solid-like behavior of margarine was difficult, the NFC Pickering emulsion properties were still able to enhance hardness, slip melting point, and color of the reduced fat spreads compared to the full-fat margarine, especially at 0.6% of NFC. Overall, extensive performances of NFC can be seen in encapsulating carotenoids, especially at NFC concentrations of 0.4% and 0.6%, with the enhancement of Pickering emulsion stability while portraying futuristic possibilities as a fat replacer in margarine optimally at 0.6% of NFC concentration. PRACTICAL APPLICATION: Nanocellulose extracted from palm dried long fiber was utilized to encapsulate carotenoids and replace fats in margarine-like reduced fat (3%) spreads. Our study portrayed high encapsulation efficiency and successful fat replacement with promising stability performances. Hence, nanocellulose displayed extensive potential as encapsulating agents and fat replacers while providing quality and sustainability enhancements in reduced-fat food.

[Synchronies and asynchronies in the development of COVID-19 pandemic in Italy]. / Sincronie e asincronie negli sviluppi della pandemia di COVID-19 sul territorio.

BACKGROUND: the study of the possible determinants of the rise and fall of infections can be of great relevance, as was experienced during the COVID-19 pandemic. One of the methods to understand whether determinants are simultaneous or develop through contiguity between different areas is the study of the diagnostic replication index RDt among regions. OBJECTIVES: to introduce the analysis of RDt variability and the subsequent application of a recently introduced functional clustering method as highly useful procedures for recognizing the presence of clusters with similar trends in epidemic curves. DESIGN: within the considered period, trends in regional RDt are analyzed in detail over four different time intervals. SETTING AND PARTICIPANTS: to exemplify this methodology, the study of variability in the period from the end of 2021 to the beginning of 2022 may be of interest. MAIN OUTCOMES MEASURES: the variability in the regional RDt indices is assessed by means of the correlation coefficient weighted with respect to the populations of the individual regions. The clustering procedure is applied to the time series of absolute RDt values. RESULTS: it emerges that the periods of increasing variability in the RDt correspond to the initial growth or decrease in the number of infections, while functional clustering identifies macro-areas in which the epidemic curves have had similar trends. What caused contagions to increase seems to relate to a factor that is not specific to certain areas, with the contribution in some cases of a contagion dynamic between adjacent areas. CONCLUSIONS: the variability in the trend of regional diagnostic replication indices, which are calculated with only a few days delay, is a further indicator for the early detection of major changes in the trend of epidemic curves. The clustering of epidemic index curves may be useful to determine whether determinants act simultaneously or by contiguity between adjacent areas.

Spatio-temporal clustering of African swine fever virus (Asfarviridae: Asfivirus) circulating in the Kaliningrad region based on three genome markers.

INTRODUCTION: The rapid spread of African swine fever in the Kaliningrad region makes it necessary to use the methods of molecular epidemiology to determine the dynamics and direction of ASF spread in this region of Russia. The aim of the study was to determine single nucleotide polymorphisms within molecular markers K145R, O174L and MGF 505-5R of ASFVs isolated in Kaliningrad region and to study the circulating of the pathogen in European countries by subgenotyping and spatio-temporal clustering analysis. MATERIALS AND METHODS: Blood samples from living domestic pigs and organs from dead domestic pigs and wild boars, collected in the Kaliningrad region between 2017 and 2022 were used. Virus isolation was carried out in porcine bone-marrow primary cell culture. Amplicons of genome markers were amplified by PCR with electrophoretic detection and subsequent extraction of fragments from agarose gel. Sequencing was performed using the Sanger method. RESULTS: The circulation of two genetic clusters of ASFV isolates on the territory of the Kaliningrad has been established: epidemic (K145R-III, MGF 505-5R-II, O174L-I - 94.3% of the studied isolates) and sporadic (K145R-II, MGF 505-5R-II, O174L-I - 5.7%). CONCLUSION: The broaden molecular genetic surveillance of ASFV isolates based on sequencing of genome markers is necessary in the countries of the Eurasian continent to perform a more detailed analysis of ASF spread between countries and within regions.

The Incidence of Breast Cancer Lymph Node Involvement in Trinidad and Tobago.

Objective This study aims to investigate breast cancer lymph node involvement in a West Indian population while correlating it with various histological parameters and evaluating the role of the sentinel lymph node biopsy. Method This is a retrospective study where histology reports for all breast cancer-related biopsies from 2018 to 2021, totaling 813 samples, were obtained. Histological parameters from these reports were extracted into a spreadsheet and analyzed using Statistical Product and Service Solutions (SPSS, version 28.0; IBM SPSS Statistics for Windows, Armonk, NY) software for TNM staging and axillary and sentinel lymph node dissections, among other fields found in histology reports. Results In 44.8% of cases, patients present at the T2 stage with associated lymph node spread. Each T stage had more lymph nodes involved than uninvolved for tumors sized T2 and higher. Inversely, for tumors staged under T2, there were generally more uninvolved lymph nodes than involved ones. Larger tumors were found to have advanced N staging, especially in the T3 category, where a significantly higher proportion of cases were found to have N2 and N3 staging compared to the other T stages. This trend is also seen in M staging, where larger tumors metastasize more than smaller tumors (40% for T4a, 0% for T1). Despite significant lymph node involvement being observed, sentinel lymph node biopsies were usually negative. Conclusion More patients in this population present with lymph node involvement than without. Larger breast cancer tumors are associated with greater lymph node involvement, particularly at T2 and higher stages. Sentinel lymph node biopsies can be omitted in smaller breast cancer tumors up to 2 cm in size, and the local recurrence rate is low despite a false-negative rate of around 10% in upfront sentinel lymph node biopsy.

Biopsy of the facial nerve in slow-onset facial palsy.

INTRODUCTION: Primary squamous cell carcinoma of the parotid gland typically presents as a palpable, often painless mass. Peripheral facial palsy as the only sign of malignant neoplasia is rare. In these cases, the diagnosis is regularly confirmed by radiological imaging followed by surgical exploration and biopsy. However, if there is no detection of malignant lesions and no evidence of a tumor, the reluctance to take a biopsy of an unremarkable nerve can lead to misdiagnoses. CASE REPORT: A 40-year-old female patient without medical history presented to our clinic with a complete right-sided peripheral facial palsy that had slowly progressed for 2.5 years. All other otorhinolaryngological examination findings were within normal limits. Magnetic resonance imaging examination of the head and neck and 18-fluorodeoxyglucose positron emission tomography showed unremarkable results. We proceeded with surgical exploration, which revealed no evidence of a tumor and an externally completely unremarkable facial nerve. A biopsy from the main trunk area of the nerve revealed an infiltration by a squamous cell carcinoma. Total parotidectomy with resection and reconstruction of the facial nerve and neck dissection was performed. Considering the absence of a primary tumor and other tumor formations the diagnosis of a completely regressive primary squamous cell carcinoma of the parotid gland was confirmed. CONCLUSION: In conclusion, in the case of slow-onset peripheral facial palsy that persists without signs of recovery, a gadolinium-enhanced MRI should be performed. If imaging is unremarkable and there is no primary tumor detection along the course of the facial nerve, a surgical exploration with biopsy of the facial nerve is necessary.

Evaluation of the Newborn Screening Pilot for Sickle Cell Disease in Suriname Using the Non-Adoption, Abandonment, Scale-Up, Spread, and Sustainability (NASSS) Framework.

The early detection of sickle cell disease (SCD) is vital to reduce mortality among affected children. Suriname currently lacks a newborn screening programme (NSP) for SCD. We performed a pilot programme to evaluate the scalability of such an initiative. Dried blood spots were collected from five birth centres and subjected to electrophoresis analysis. The programme scalability was evaluated using the non-adoption, abandonment, scale-up, spread, and sustainability framework. Challenges across six domains (illness, technology, value proposition, adopter system, organisation, and societal system), were categorised hierarchically as simple 😊, complicated 😐, or complex 😢. It has been proven that implementing programmes with mainly complicated challenges is difficult and those in mainly complex areas may be unachievable. SCD was detected in 33 of 5185 (0.64%) successfully screened newborns. Most of the domains were classified as simple or complicated. Disease detection and technology suitability for screening in Suriname were confirmed, with favourable parental acceptance. Only minor routine adjustment was required from the medical staff for programme implementation. Complex challenges included a reliance on external suppliers for technical maintenance, ensuring timely access to specialised paediatric care for affected newborns, and securing sustainable financial funding. Scaling up is challenging but feasible, particularly with a targeted focus on identified complex challenges.

Successful Recanalization and Neurological Restoration in Cancerous Embolic Cerebral Infarction via Endovascular Stent-Retriever Embolectomy.

Mechanical thrombectomy has emerged as a promising treatment for acute ischemic stroke caused by large vessel occlusion. However, cases involving cancerous emboli retrieved during endovascular embolectomy are rare. We present a case of a 65-year-old man with a history of heavily treated rectal cancer, who developed a middle cerebral artery (MCA) infarction due to metastatic adenocarcinoma. The patient presented with sudden onset right-side weakness, right facial palsy, global aphasia, and left gaze deviation, with a National Institutes of Health Stroke Scale (NIHSS) score of 16. Following intravenous thrombolysis, endovascular thrombectomy was performed, achieving nearly complete recanalization. Pathological examination of the retrieved thrombus revealed metastatic adenocarcinoma of rectal origin. The patient's neurological deficits gradually improved, and he was successfully discharged to undergo further palliative therapy. This case underscores the importance of considering mechanical thrombectomy for patients with advanced solid organ malignancy presenting with acute ischemic stroke, even when the etiology could be a tumor embolus. Our findings highlight the potential for mechanical thrombectomy to restore neurological function in such cases, allowing patients to proceed to the next level of care with a reasonably good post-stroke quality of life.

PostBP: A Python library to analyze outputs from wildfire growth models.

Wildfire is an important natural disturbance agent in Canadian forests, but it has also caused significant economic damage nationwide. Spatial fire growth models have emerged as important tools for representing wildfire dynamics across diverse landscapes, enabling the mapping of key wildfire hazard metrics such as location-specific burn probabilities or likelihoods of fire ignition. While these summary metrics have gained popularity, they often fall short in capturing the directional spread of wildfires and their potential spread distances. The metrics depicting the directional spread of wildfire can be derived from raw outputs generated with fire growth models, such as the perimeters and ignition locations of individual fires, but extracting this information requires complex data processing. To address this data gap, we present PostBP, an open-source Python package designed for post-processing the raw outputs of fire growth models - the ignition locations and perimeters of individual fires simulated over multiple stochastic iterations - into a matrix of fire spread likelihoods between all pairs of forest patches in a landscape. The PostBP also generates several other summary outputs, such as the source-sink ratio and the fire spread rose diagram. We provide an overview of PostBP's capabilities and demonstrate its practical application to a forested landscape.•Wildfire growth models generate large amounts of outputs, which are hard to summarize for practical decision-making.•The PostBP package calculates the summary metrics characterizing the directional spread of wildfires.•The fire risk summaries generated with PostBP can support the assessments of wildfire risk and mitigation measures.

The effect of P2X7 antagonism on subcortical spread of optogenetically-triggered cortical spreading depression and neuroinflammation.

Migraine is a neurological disorder characterized by episodes of severe headache. Cortical spreading depression (CSD), the electrophysiological equivalent of migraine aura, results in opening of pannexin 1 megachannels that release ATP and triggers parenchymal neuroinflammatory signaling cascade in the cortex. Migraine symptoms suggesting subcortical dysfunction bring subcortical spread of CSD under the light. Here, we investigated the role of purinergic P2X7 receptors on the subcortical spread of CSD and its consequent neuroinflammation using a potent and selective P2X7R antagonist, JNJ-47965567. P2X7R antagonism had no effect on the CSD threshold and characteristics but increased the latency to hypothalamic voltage deflection following CSD suggesting that ATP acts as a mediator in the subcortical spread. P2X7R antagonism also prevented cortical and subcortical neuronal activation following CSD, revealed by bilateral decrease in c-fos positive neuron count, and halted CSD-induced neuroinflammation revealed by decreased neuronal HMGB1 release and decreased nuclear translocation of NF-kappa B-p65 in astrocytes. In conclusion, our data suggest that P2X7R plays a role in CSD-induced neuroinflammation, subcortical spread of CSD and CSD-induced neuronal activation hence can be a potential target.