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Carrying out quality grading detection on the harvested dragon fruit is an important step in the dragon fruit industry. To reduce the high costs and damage rates caused by this process, an online spectral sensor and a weighing sensor embedded at the end effector of the dragon fruit-picking robot were designed to detect the sugar content, hardness and weight of the dragon fruits in real time during the picking process, thereby achieving the quality classification of the dragon fruits. After collecting the spectral data of dragon fruit, typical linear and nonlinear machine learning methods were used to establish prediction models for SSC-edge, SSC-center and hardness of dragon fruit. The results showed that PLSR models were selected as optimal models for prediction sugar content and hardness, and R2 of test set for SSC-edge, SSC-center and hardness are 0.876, 0.826 and 0.902, respectively. Subsequently, the dragon fruits were classified based on the weighing sensor, and the SSC-center and hardness were predicted. The results showed that the established quality prediction model and the prototype could achieve the integrated operation of non-destructive quality detection and grading of dragon fruit during picking. The study provides technical support for the intelligent upgrade of fruit-harvesting equipment and the grading operations.
Posttraumatic stress disorder (PTSD) is associated with significant health and societal economic burdens, making treatment a priority. There are effective treatments, but there is no indication at this point which treatments will work best for which patients. Patient decision aids (DAs) are evidence-based tools designed to support patients and providers in weighing the benefits and risks of different treatment options and in making value-informed choices as one part of shared decision-making. The National Center for PTSD published an online PTSD Treatment DA in 2017. This paper outlines a collaborative process for significantly updating the PTSD Treatment DA in line with newer clinical practice guidelines and updated technological needs. The development and updating process was conducted by a small team in consultation with an expert panel and consumer input. User experience testing with people who screened positive for PTSD focused on the experience of completing specific core tasks such as comparing treatment options using the DA. Field testing included Veterans Administration patients and providers using the DA in clinical appointments to gather feedback about feasibility, satisfaction, acceptability, balance, fidelity, decisional conflict, and decisional self-efficacy. Pilot field testing suggested that the PTSD Treatment DA was acceptable, satisfactory, balanced, feasible to implement, and associated with improvements in decisional conflict and in decisional self-efficacy in this small sample. Design decisions based on stakeholder feedback are described, including which treatments to include, what design format to use, how to assess preferences, and how to most effectively convey treatment effectiveness information. The revised PTSD Treatment Decision Aid is freely available online and is consistent with the International Patient Decision Aid Standards.
Emotional eating under negative affect refers to eating responses that occur in brief unpleasant emotional states and are not explained by hunger alone. This narrative review synthesizes representative evidence from experimental, ecological, and neurocognitive studies on emotional eating under negative affect, with emphasis on two interrelated pathways. (1) Emotion regulation: emotional eating may function as a rapid and accessible regulatory strategy through which food, especially highly palatable food, is used to attenuate negative affect. The immediate soothing effects of eating may reinforce later motivation and habitual responses to regulate emotions through food, whereas more adaptive strategies, such as cognitive reappraisal, may reduce the likelihood and intensity of emotion-related eating. (2) Reward processing and biased decision making: negative affect and affective stress contexts may diminish cognitive control and bias food choice toward immediate rewards. This pathway is reflected in increased attentional bias to food cues, stronger weighting of taste and palatability during value weighing, heightened responsivity to highly rewarding foods, and reduced regulatory influence of health and nutrition attributes. These processes may shift food choice toward energy-dense, nutrient-poor, and ultra-processed foods. The nutritional manifestations of emotional eating are not limited to total intake. Changes in intake quantity are heterogeneous, whereas changes in food choice, diet quality, degree of processing, and eating patterns appear more consistent. Repeated emotional eating may therefore contribute to less stable eating patterns and potential nutritional implications, although links with long-term physiological outcomes remain indirect. Future longitudinal and ecological momentary assessment studies are needed to clarify when emotional eating becomes a stable dietary pattern and which individual or contextual factors increase vulnerability.
Hospital fomites are major reservoirs of nosocomial pathogens, facilitating healthcare-associated infections, particularly in critical units. However, longitudinal studies investigating the persistence of pathogens on hospital surfaces and their antimicrobial resistance (AMR) patterns remain limited. This study examined the spatiotemporal distribution and antimicrobial resistance of bacterial pathogens isolated from fomite surfaces at Princess Marie Louise Children's Hospital (PML), Accra, Ghana. A 12-week longitudinal study (September 4-November 26, 2023) was conducted across four departments: Emergency, Neonatal Intensive Care, Malnutrition, and Outpatient. High-touch surfaces (including bed rails, incubators, infusion stands, blood pressure cuffs, thermometers, stethoscopes, etc.) were sampled weekly using sterile saline-moistened swabs. Samples were promptly transported in STGG medium on ice to the bacteriology laboratory of the University of Ghana Medical School's Department of Medical Microbiology, for standard culture and antimicrobial susceptibility testing using the Kirby-Bauer method. A total of 1,120 bacterial isolates belonging to 33 genera were recovered from 600 swab samples. Among Gram-positive bacteria, Staphylococcus epidermidis (97 isolates, 34.3%), Staphylococcus haemolyticus (42 isolates, 14.8%), and Staphylococcus aureus (34 isolates, 12.0%) predominated. The most frequently isolated Gram-negative bacteria were Acinetobacter baumannii (91 isolates, 18.2%), Klebsiella pneumoniae (54 isolates, 10.8%), and Escherichia coli (38 isolates, 7.6%). Contamination levels varied by surface type. Thermometers (N = 25 isolates), thermometer trays (N = 24), weighing tables (N = 24), and IV setting trays (N = 22) exhibited the highest contamination frequencies. Among individual items, Babe's Cot A recorded the highest contamination (N = 30), while Omicron thermometer B had the lowest (N = 18) within the top-ranked fomites.AMR rates were moderate to high across several key pathogens, with resistance ranging from 0-93% in Staphylococcus aureus, 66.7-91.7% in Enterococcus faecium, 18.9-90% in Enterococcus faecium, 29.6-88.9% in Escherichia coli, and 40-82% in Klebsiella pneumoniae. Overall, the evaluated hospital fomites were heavily contaminated with a diverse array of bacterial pathogens exhibiting substantial antimicrobial resistance, underscoring the need to strengthen infection prevention and control measures in healthcare settings.
Shared decision making (SDM) is a patient-centered approach for conditions where multiple, preference-sensitive treatment options exist and there is no single best choice. Eosinophilic esophagitis (EoE), an increasingly prevalent chronic immune-mediated disease, offers an example of how patients and physicians use SDM to navigate the challenging tradeoffs of weighing pharmacologic and dietary therapies. We aimed to identify communication challenges for SDM in EoE care from physician and patient perspectives and to explore how patient treatment preference archetypes influence SDM. We conducted a qualitative study with one-on-one, semi-structured interviews with adult patients with EoE and physicians. Patients (n = 35) were recruited from a single academic center (mean age 41 years [(SD 15.2]; 51% male; predominantly White 83%). Physicians included gastroenterologists (n = 9) and allergists (n = 7) from varied practices across Michigan. Interview guides were informed by the Theoretical Domains Framework and iteratively refined. Interview transcripts were coded using both deductive and inductive strategies and analyzed thematically via descriptive content analysis. Three central themes emerged: 1) Patients often lack knowledge or have misconceptions about EoE and its treatments, but differed in how and from where they want to gain disease-focused information, 2) Physicians generally supported SDM, but patients varied in how they want to be involved in decisions about their care, and 3) Both patients and physicians wanted accurate and user-friendly informational resources about EoE to support effective communication and SDM. Our analysis revealed that patients with EoE have diverse preferences for disease-related learning, decision making, and communication. There is a clear need for accurate, accessible, and personalized information to improve patient-physician understanding and communication, without which SDM and patient-centered care in EoE cannot be achieved. What we learned can be applied to other health conditions where there is clinical equipoise between various effective management options.
Chromium is characterized by toxicity to living organisms due to their ability to accumulate in biological tissues and disrupt normal physiological functions. The current study assessed the effect of chromium on the serum biochemistry, hematology, antioxidant enzyme system, and histopathology of the selected freshwater fish (Ctenopharyngodon Idella). For this purpose, Ctenopharyngodon Idella, weighing ∼60-80 g, were divided into four groups at random and subsequently subjected to chromium exposure i.e. control, 0.44 mg L⁻¹, 0.89 mg L⁻¹ and 1.34 mg L⁻¹ from LC50 (74.35 mgL- 1) for 21 days and data was taken after 7, 14, and 21 days. Results showed a significant effect of treatment and duration on fish body weight (p < 0.05). A significant increase in leukocytes and heterophils was observed between the treated groups which showed a significant decrease in red blood cell count, hemoglobin, hematocrit, mean corpuscular hemoglobin, mean corpuscular volume, and lymphocytes. Significant reductions (p < 0.05) were observed in serum biochemical parameters such as total proteins, albumin, and globulin. Conversely, the treated groups exhibited significant increases (p < 0.05) in alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (ALP), lactate dehydrogenase (LDH), glucose, and cholesterol compared to the control group. Decreased values of antioxidant enzymes, including superoxide dismutase (SOD), catalase (CAT), and peroxidase (POD) in the kidney and gills tissues of fish were recorded. The micronucleus (MN) assay confirmed genotoxicity, revealing elevated frequencies of nuclear abnormalities such as notched, condensed, binucleate, pear-shaped nuclei, and micronuclei. There was a noticeable rise in the frequencies of nuclear irregularities within the erythrocytes. The presence of altered nuclei suggests that chromium chloride might be causing damage to the cells and their genetic material. The histopathological analysis of fish gills and kidneys revealed inflammation and degenerative alterations attributed to exposure to chromium. Within kidney tissues, there was an increase in degenerative changes such as expansion of Bowman's space, necrosis of tubular cells, and deterioration of the glomerulus. Congestion, Lamellar fusion, and Lamellar disorganization were observed in the gill's tissues exposed to chromium. In conclusion, the study indicates that exposure to chromium chloride, even in smaller concentrations, can cause adverse hematological and histopathological changes in Ctenopharyngodon Idella.
Mass administration of azithromycin reduced child mortality in parts of sub-Saharan Africa. Promotion of infant growth may be an additional benefit of azithromycin treatment. To investigate whether the provision of mass administration of azithromycin for infants aged 1 to 11 months improves growth outcomes. This cluster randomized clinical trial conducted from December 1, 2020, to December 31, 2024, included 1151 villages in southwestern Mali. Villages were randomized in a 3:4:2 ratio to placebo, twice-yearly azithromycin, or quarterly azithromycin. Participants and study personnel were masked. The prespecified growth substudy, conducted from August 31, 2022, to July 31, 2023, was conducted in 59 villages in the Kita region. Eligible participants were infants aged 1 to 11 months, weighing 3.0 kg or more, with no macrolide allergy or severe illness. Anthropometric data were collected cross-sectionally from children aged 6 to 8 months and 12 to 14 months at 15, 18, 21, and 24 months after village enrollment. Infants received a single oral dose of azithromycin, 20 mg/kg, at each quarterly visit: placebo at all rounds (control); azithromycin at 2 rounds from January to June and placebo at 2 rounds from July to December (twice-yearly azithromycin); or azithromycin at all rounds (quarterly azithromycin). Prespecified outcomes were weight and length; weight-for-age (WA), length-for-age (LA), weight-for-length (WL), and mid-upper-arm circumference (MUAC) z scores; and underweight, stunting, and wasting. Analysis was performed on an intention-to-treat basis. A total of 1205 infants (mean age, 5.7 months [95% CI, 5.6-5.9 months]; 633 boys [52.5%]) were included in the trial at baseline. Among 1789 children (923 boys [51.6%]) assessed for growth, the mean anthropometric indices did not differ between the placebo, twice-yearly azithromycin, and quarterly azithromycin groups: weight, 7.8 kg (95% CI, 7.7-7.9 kg), 7.8 kg (95% CI, 7.7-7.9 kg), and 7.8 kg (95% CI, 7.7-7.9 kg), respectively; length, 70.2 cm (95% CI, 69.9-70.8 cm), 70.6 cm (95% CI, 70.2-70.9 cm), and 70.6 cm (95% CI, 70.1-71.0 cm), respectively; WA z score, -1.12 (95% CI, -1.23 to -0.95), -1.10 (95% CI, -1.19 to -0.98), and -1.12 (95% CI, -1.27 to -1.01), respectively; LA z score, -0.86 (95% CI, -1.06 to -0.70), -0.79 (95% CI, -0.93 to -0.65), and -0.78 (95% CI, -0.98 to -0.63), respectively; WL z score, -0.87 (95% CI, -1.00 to -0.68), -0.89 (95% CI, -1.01 to -0.77), and -0.95 (95% CI, -1.12 to -0.81), respectively; and MUAC z score, -0.30 (95% CI, -0.43 to -0.10), -0.24 (95% CI, -0.37 to -0.12), and -0.26 (95% CI, -0.41 to -0.10), respectively. The proportions of underweight, stunting, and wasting did not differ between groups. In this prespecified analysis of secondary outcomes of a cluster randomized clinical trial of the provision of mass administration of azithromycin for infants aged 1 to 11 months, growth outcomes did not differ between azithromycin and placebo groups. These findings suggest that mass administration of azithromycin to infants is unlikely to promote growth. ClinicalTrials.gov Identifier: NCT04424511.
Cardiac arrest in pregnancy can occur for a variety of reasons. During maternal cardiac arrest or shortly thereafter, the fetus may remain viable. Postmortem caesarean section can potentially save the fetus with or without long-term neurological sequelae; in the absence of timely intervention, however, fetal death is inevitable. Given the limited documentation in developing countries and the possibility of unfavourable outcomes, this report presents one of the few documented cases from resource-limited Sub-Saharan Africa describing a live birth with a sustained favourable neurological outcome following a postmortem caesarean section performed after maternal death from a dental abscess. This case expands the evidence base for the feasibility and value of such a procedure in settings lacking advanced critical care. We report the case of a 34-year-old multigravida at a gestational age of 36 weeks and 2 days, who was admitted to Sumbawanga Regional Referral Hospital as a referral from a lower facility, presenting with a painful left jaw swelling and a diagnosis of dental abscess. She had a one-month history of this swelling associated with fever, hoarseness of voice, and purulent discharge. Abdominal examination revealed a gravid uterus with fundal height of 36 cm, longitudinal lie, and cephalic presentation. There were no palpable contractions, and the fetal heart rate was 143 bpm. The patient was managed as a case of dental abscess in a near-term pregnancy. The dental team performed incision and drainage, and during the procedure, the patient developed cardiorespiratory arrest attributed to endotoxic septic shock secondary to the dental abscess. The exact cause of death, beyond endotoxic shock, could not be determined in the absence of an autopsy, and other potential causes of death cannot be definitely ruled out. Despite resuscitation attempts, the patient could not be saved and was pronounced dead. In consultation with the Obstetric team, an immediate postmortem caesarean section was performed, delivering a female neonate weighing 2600 g with an APGAR score of 6 and 8 in the 1st and 5th minutes, respectively. The newborn was admitted to the neonatal care unit for further management. At the time of this publication, the child is one year and nine months old and has no apparent neurological impairment, with normal developmental milestones. Despite several limitations and the possibility of poor neonatal outcomes, a timely postmortem caesarean section performed at a favourable gestational age, in an appropriate setting with skilled personnel, basic equipment, and access to a neonatal care unit, can result in a live birth with good early neonatal outcomes even in a resource-limited environment.
Gunshot wounds to the craniofacial region are often fatal, and isolated orbital involvement is exceptionally rare. Severe ocular and systemic complications, such as vision loss, neurological damage, and infections, can arise from high-velocity bullet injuries to the orbit. The case presented involves a male patient with two cranial impacts, one of which left a projectile lodged in the retrobulbar space. The initial treatment was surgical reparation of the wounds and observation. However, due to a persistent fever and the development of an abscess, the orbital projectile was removed. The patient's condition improved, but amaurosis remained. In this instance, timely surgical removal of the projectile, guided by a customized risk-benefit analysis, early localization using computed tomography for accurate assessment, and multidisciplinary management to address complex injuries were all crucial elements. Orbital injuries caused by firearms are uncommon and extremely complicated, necessitating timely and individualized treatment to optimize the prognosis. Clinical evaluation should always be the basis for projectile removal decisions, weighing potential risks against benefits.
Peripartum depression (PPD) is often underdiagnosed and left untreated. PPD can negatively impact maternal health and child development and is associated with an increased risk of maternal suicide. Effective and safe treatments that are viewed as acceptable by patients are needed. Repetitive transcranial magnetic stimulation (rTMS) is a non-invasive neuromodulatory treatment that has the potential to meet this need. The objective was to identify the level of awareness of rTMS among participants who experienced depressive symptoms during the peripartum period and to understand the barriers and facilitators that impact access to rTMS. Three focus groups with a total of 9 participants who experienced depressive symptoms during the peripartum period were conducted. A descriptive interpretive thematic analysis was completed. The majority of participants (6 out of 9; 67%) never heard of rTMS prior to this study. Following a brief description of rTMS by the researcher, all participants expressed an interest in rTMS and a willingness to learn more about it as a treatment for PPD; however, some expressed reservations about receiving the treatment during pregnancy due to uncertainty regarding whether it could have an impact on their child's well-being. The following four themes were identified as the primary factors that impact access to rTMS: limited awareness of rTMS's existence, financial challenges, physical accessibility, and weighing the pros and cons of medication vs. rTMS. Increasing the general public's and their health providers' awareness regarding rTMS and other novel treatments is a crucial step toward improving access to care. Greater awareness of rTMS for PPD may support earlier recognition of appropriate candidates, improve referral pathways, and reduce barriers related to knowledge, accessibility, and treatment hesitancy. Further research is needed to continue evaluating the safety, effectiveness, and accessibility of rTMS for PPD.
Little is known about factors driving rural providers-who face unique challenges-to participate and remain in accountable care organization models. The purpose of this study was to investigate the specific factors that rural hospitals evaluate when weighing both initial and continued participation in Medicare as well as commercial ACO models. Furthermore, we explored policy implications to improve ACO models' capacity to attract, retain, and promote success of rural providers. Semistructured, in-depth interviews were conducted with rural hospital executives with direct knowledge of ACO agreement terms and factors driving ACO participation. The interview guide contained seventeen open-ended questions. Interviews were recorded, transcribed, coded using codebooks informed by the interview guide, and analyzed using a thematic analysis approach. Interviewees identified five primary multi-faceted motivations for participation: (1) financial incentives-shared savings, upside-only risk initially, and upfront funding for some providers, (2) getting ahead of the curve of the move to value-based reimbursement, (3) importance placed on capacity to push toward improving population health or quality, (4) additional forms of resource gain, and (5) key outside factors. The specific ACO design affects rural providers' decision-making on timing and selection of particular models. Importantly for future policy development, multiple respondents raised concerns about moving to risk in ACO models, leading them to consider dropping out. Findings from this qualitative study provide an in-depth understanding that is vital to achieving CMS's goal of increasing participation in value-based care. In turn, this could further improve health care quality for countless lives.
Patients with peritoneal dialysis (PD) often develop exit-site infections (ESI) caused by nontuberculous mycobacteria. Antimicrobial therapy, including intravenous amikacin (AMK), is combined with PD catheter removal to control the source of infection. However, the efficiency of AMK removal using PD remains unclear. In this report, we describe AMK pharmacokinetics before and after PD catheter removal in a patient diagnosed with Mycobacterium abscessus from ESI. A 73-year-old female PD patient weighing 42.4 kg who received intravenous AMK + clarithromycin + imipenem/cilastatin for Mycobacterium abscessus ESI on day 1 under therapeutic drug monitoring. During hospitalization, the patient underwent a typical PD regimen including nocturnal continuous ambulatory PD with Reguneal HCa 1.5® (1.5% glucose) 1.5 L (2-hour storage) + Reguneal HCa 1.5® 1.5 L or Extraneal® (7.5% icodextrin) 1.5 L (11.5-hour storage). Dosing schedule of AMK was 200 mg every 48 h to maintain an AMK trough concentration around 10 µg/mL. On day 14, the PD catheter was removed and reinserted on the contralateral side for source control of the infection site and PD was discontinued until day 20. The elimination rate constant (Ke) of AMK was 0.027 h- 1 obtained from peak concentration (Cpeak) of 16.3 µg/mL on day 1 and trough concentration (Ctrough) of 4.5 µg/mL on day 3. In contrast, Ke was 0.020 h- 1 calculated from both Cpeak of 22.2 µg/mL on day 9 and Ctrough of 8.4 µg/mL on day 11, as well as Cpeak of 23.8 µg/mL on day 17 and Ctrough was 9.3 µg/mL on day 19. Combination antibiotic therapy was completed due to clinical improvement on day 27. Post-treatment, clofazimine and clarithromycin were administered orally, and the patient was discharged on day 32. The effect of PD on AMK concentration was limited during therapeutic drug monitoring.
Arbuscular mycorrhizal fungi form symbioses with ~70% of plant species, building hyphal networks that exchange nutrients for host-derived carbon. These tubular networks move ~1 billion metric tons of carbon per year into Earth's soils. However, we have no quantitative understanding of the hyphal infrastructure required to carry out this resource transfer. We assembled data from 322 studies representing more than 16,000 soil cores across nine biomes and developed machine-learning models to predict hyphal densities globally. With robotic imaging of more than 300,000 hyphae, we calibrated a biomass model from our spatial predictions. We estimate that global topsoils contain 1.10 × 1017 ± 0.13 × 1017 SD kilometers of living hyphae, weighing ~300 ± 60 SD megatons, ~4- to 6-fold the biomass of humans. Our uncertainty analyses identified undersampled ecosystems that require additional empirical attention.
Moral disengagement is a psychological mechanism through which individuals justify ethically compromised behavior. Understanding the experiences of nursing faculty involved in moral disengagement is essential for maintaining educational integrity and ensuring the development of ethically grounded future nurses. The purpose of this study was to explore the lived experiences of nursing faculty regarding moral disengagement and to examine how nursing faculty experienced moral disengagement as a cognitive strategy used to rationalize compromises in both academic and clinical teaching standards. A hermeneutic phenomenological approach, guided by van Manen's method, was employed. Twelve (n=12) nursing faculty members from three Palestinian universities located in the West Bank participated in semi-structured interviews conducted between February and June 2025. Participants were selected through purposive sampling based on inclusion criteria of full-time employment and a minimum of two years of teaching experience. Data were analyzed using van Manen's thematic analysis. Credibility was established through member checking, peer debriefing, and triangulation among researchers. The thematic analysis identified four overarching themes: (1) subjective weighing of educational responsibilities, (2) justification mechanisms, (3) the gap between public presentation and private practice, and (4) the 'contagion' of moral disengagement in academic settings. These findings highlight the complexity of moral disengagement among nursing educators within the specific context studied and the potential impact it had on nursing education quality and student development. The study calls for institutional reforms, including ethical workload audits, holistic faculty evaluation systems, and faculty ethics support programs, as well as context-sensitive professional ethics training and multilevel policy interventions in nursing education. Further research across diverse contexts is warranted to enhance transferability of these findings.
Three animals (1 dog and 2 cats), all weighing < 3 kg and aged 4 to 7 mo, were treated for femoral or humeral fractures using the "safety pin tie-in" (SPTI), a proximal transverse-pin-free Type Ia intramedullary pin tie-in external skeletal fixator. Clinical assessment, radiographic follow-up, and owner-reported outcomes were evaluated. Only minor complications after surgery were observed, and radiographic interpretation of healing was achieved in all cases. For all animals, weight-bearing function was regained soon after surgery, limb function was classified as full (Cases 1 and 3) or acceptable (Case 2), and owner satisfaction was excellent. Subjective assessment of long-term outcomes revealed no or only minimal disability, with a Liverpool Osteoarthritis in Dogs (LOAD) score of 5/52 for the dog and Feline Musculoskeletal Pain Index short form (FMPI-sf) scores of 1/28 and 0/28 for the cats. The SPTI, with its simplified design, appeared to provide adequate biomechanical stability in pediatric cases without the need for a proximal transfixing pin. Key clinical message: By minimizing surgical trauma, the technique described herein may represent a practical alternative to elastic plate fixation in selected lightweight pediatric animals, though further studies are needed to confirm these findings. Fixation externe par broches de sécurité pour fractures humérales/fémorales chez le chat et le chien pédiatriques: 3 casTrois animaux (1 chien et 2 chats), pesant tous < 3 kg et âgés de 4 à 7 mois, ont été traités pour des fractures fémorales ou humérales par la technique de fixation externe par broches de sécurité (FEBS), une tige intra-médullaire de Type Ia sans broche transversale proximale reliée à un fixateur squelettique externe. L’évaluation clinique, le suivi radiographique et les résultats rapportés par les propriétaires ont été analysés. Seules des complications mineures ont été observées après l’intervention, et l’interprétation radiographique de la guérison a été obtenue dans tous les cas. Chez tous les animaux, la capacité à supporter le poids du corps a été rapidement rétablie après l’intervention, la fonction du membre a été jugée complète (Cas 1 et 3) ou acceptable (Cas 2), et la satisfaction des propriétaires était excellente. L’évaluation subjective des résultats à long terme n’a révélé aucune incapacité ou seulement une incapacité minime, avec un score LOAD (Liverpool Osteoarthritis in Dogs) de 5/52 pour le chien et des scores FMPI-sf (Feline Musculoskeletal Pain Index short form) de 1/28 et 0/28 pour les chats. La FEBS, de conception simplifiée, semble assurer une stabilité biomécanique adéquate chez les animaux pédiatriques sans nécessiter de broche de transfixation proximale.Message clinique clé:En minimisant le traumatisme chirurgical, la technique décrite ici pourrait constituer une alternative pratique à la fixation par plaque élastique chez certains animaux pédiatriques légers, bien que des études complémentaires soient nécessaires pour confirmer ces résultats.(Traduit par Dr Serge Messier).
Rats play a crucial role in advancing scientific research and contributing to the understanding of various diseases. The striking structural similarity between the rat foot and the intricate anatomy of the human hand has drawn scientific interest to these animals. However, detailed morphometric and functional analyses of the adult Sprague-Dawley rat foot, including its dimensions, range of motion, and grip strength, remain limited in the literature. We aimed to examine the hind feet of 42 adult male Sprague-Dawley rats, each weighing 300-350 g. Using a multifaceted approach, we inspected hind paw morphology and performed descriptive statistical analyses of foot dimensions (a), measured unilateral hind foot grasping strength (b), assessed joint mobility (c), and examined the microscopic appearance of the hind foot third digit (d). One animal was additionally used to observe the hind limb skeletal architecture using microcomputed tomography. This study provides critical normative data regarding the structure and function of the hind foot in adult Sprague-Dawley rats, thereby facilitating future studies on musculoskeletal diseases.
Children and adolescents with serious illness or medical complexity are often referred to highly specialized children's hospitals that offer experimental interventions, novel management, or treatments that cannot be provided at local health care centers. Referral to a geographically distant, highly specialized health center presents new complexity, with a distinct set of ethical issues, for patients, families, and clinicians. We describe ethical considerations that occur at the initiation of referral, during the process of referral, and after a referral for pediatric patients receiving hospital-based care. Using illustrative cases, we highlight salient themes surrounding these challenges that span many tenets of pediatric bioethics, including beneficence (ie, weighing benefits against harms), imposing values to impact shared decision-making, and justice (ie, lack of standardization in processes creating risk for discrimination). Pediatric clinicians and ethicists must be aware of the potential challenges arising in referring and transferring patients for higher levels of specialized intervention and treatment. When referral is indicated, institutions should facilitate collaborative care as much as possible by sharing information early, frequently, transparently, and in a standardized manner.
Uterine fibroids, also referred to as leiomyomas, are benign uterine tumors with a lifetime prevalence of approximately 75% depending on race, age, and a variety of genetic and environmental factors. Extra-uterine leiomyomas are uncommon, and their occurrence within the rectus abdominis muscle is exceptionally rare. We present a rare case of an incidental rectus abdominis leiomyoma discovered during emergency cesarean section. A 28-year-old female (G3P1 + 1, living 1) presented to our specialty hospital in Northern Tanzania at 38 weeks and 1 day of gestation with complaints of lower abdominal pain for 8 h prior to admission. She had a previous cesarean section for breech presentation and one spontaneous abortion. On examination, she was in active labor with a 3 cm dilated cervix. Due to inadequate progression of labor, an emergency cesarean section was performed under spinal anesthesia. A live male infant weighing 3.3 kg was delivered with Apgar scores of 9 and 10 at 1 and 5 min, respectively. During the procedure, a 10 × 6 cm, well-circumscribed, firm, lobulated, reddish to dark-brown mass was incidentally identified embedded within the rectus abdominis muscle fibers. The lesion was completely separate from the uterus with no anatomical continuity and showed no evidence of local invasion. The mass was meticulously dissected and completely excised with adequate hemostasis. Histopathological examination revealed a well-circumscribed, noncapsulated benign smooth muscle neoplasm. Histologically, the lesion was composed of diffuse, uniform spindle cells with abundant eosinophilic cytoplasm and blunt-ended ("cigar-shaped") nuclei. There was no significant nuclear pleomorphism, mitotic activity, or necrosis. Immunohistochemical analysis demonstrated strong positivity for smooth muscle actin (SMA) in the tumor cells. Overall, the findings are consistent with a diagnosis of leiomyoma. The postoperative period was uneventful. The patient received standard analgesia and antibiotics and was discharged on postoperative day 4. At three-month follow-up, clinical examination and an abdominal ultrasound showed no recurrence of the mass, and the wound was healed.
Suzetrigine (JOURNAVX®) is a novel non-opioid pain medication that was approved in January 2025. Given the well-documented abuse potential of opioids, suzetrigine may become more widely prescribed as an alternative for acute pain management. However, it could still appear in forensic casework as little is understood about its role in polydrug toxicity, comorbidity with pre-existing health conditions, or abuse potential within larger populations. As such, this research aimed to develop the first forensically focused method to detect suzetrigine in blood and urine. Due to its similar physicochemical properties, suzetrigine was seamlessly integrated into a previously validated liquid-liquid extraction method developed for novel dual orexin receptor antagonists (DORAs). This report focuses on the subsequent method development and validation for suzetrigine detection using liquid chromatography-tandem mass spectrometry (LC-MS/MS). The method was validated in accordance with ANSI/ASB 036 for the quantification of suzetrigine in blood and its qualitative identification in urine. A quadratic calibration model with 1/x weighing was utilized (1.0-1000 ng/mL) with quality controls (QCs) at 1.5, 80, 400, and 800 ng/mL. The limit of detection in blood and urine was 0.25 ng/mL, while the limit of quantitation in blood was 1.0 ng/mL. Post-extraction addition at 5 ng/mL and 500 ng/mL yielded matrix effects less than ± 25%, but increased variability at the low concentration in blood was deemed to have no impact on LOD. No carryover or interferences were observed from the internal standard, matrices, or common drugs. Dilution integrity (5X) was acceptable in blood, and processed samples were stable up to 72 hours in the autosampler. In this report we describe a simple extraction for suzetrigine in blood and urine followed by LC-MS/MS analysis. This analytical workflow will be valuable as the use of suzetrigine becomes more prevalent in casework samples.