Notes

Cocaine-Induced Midline Dangerous Lesions (CIMDL): A true Obstacle in Analysis.
There were no treatment-related serious adverse events and only two withdrawals for treatment-related adverse events (both in the panNET cohort).

In patients with progressive NETs following standard-regimen LAN, reducing the dosing interval to every 14 days provided encouraging PFS, particularly in patients with a Ki-67≤10% (post hoc); no safety concerns and no deterioration in QoL were observed. Increasing LAN dosing frequency could therefore be considered before escalation to less well-tolerated therapies.
In patients with progressive NETs following standard-regimen LAN, reducing the dosing interval to every 14 days provided encouraging PFS, particularly in patients with a Ki-67 ≤ 10% (post hoc); no safety concerns and no deterioration in QoL were observed. Increasing LAN dosing frequency could therefore be considered before escalation to less well-tolerated therapies.
Intestinal webs which are categorized under type-1 intestinal atresia rarely occur in the jejunum. These webs are occasionally diagnosed late because their central fenestration allows the passage of food.

We report a toddler who presented with atypical symptoms of bowel obstruction and non-specific plain radiograph and ultrasound findings. The diagnosis of jejunal obstruction was made possible with contrast-enhanced computed tomography and obstruction was found to be the result of a jejunal web at the surgery.

Few cases of jejunal webs are reported in the literature. The jejunum is the site of only 8% of webs and 33% of jejunal webs are associated with other congenital anomalies and/or prematurity.

Jejunal web needs a high degree of suspicion to be diagnosed and should be kept in mind as a differential diagnosis in the setting of unexplained persistent non-bilious emesis in otherwise normal toddlers.
Jejunal web needs a high degree of suspicion to be diagnosed and should be kept in mind as a differential diagnosis in the setting of unexplained persistent non-bilious emesis in otherwise normal toddlers.
Situs inversus totalis (SIT) is a rare anatomical variation of the thoracic and abdominal organs. It is a congenital anomaly with an incidence of 110,000 to 120,000. Patients with SIT do not have a decreased survival rate as compared to patients without SIT because SIT generally does not have a pathophysiologic significance. However, the anatomical variations in SIT can cause some challenges when assessing intraabdominal and intrathoracic symptoms or performing operations.

We report a case of a 93-year-old woman with a past medical history of hypertension, hyperlipidemia, atrial fibrillation, and situs inversus totalis who presented with diffuse abdominal pain for 4days. Abdominal exam was significant for diffuse tenderness. Computed tomography (CT) imaging was significant for pneumoperitoneum. She emergently underwent an exploratory laparotomy, descending hemicolectomy and left in discontinuity with an open abdomen. On postoperative day 2 she underwent a stamm feeding gastrostomy tube, incisional hernia patient safety and care in patients with SIT. However, in the case of emergency this should not delay definitive management.
Medullary thyroid carcinoma (MTC) is a neuroendocrine tumor that originates from the parafollicular C cells of the thyroid gland. MTC can be due to sporadic or hereditary causes due to gain of function germ line mutations in the RET proto-oncogene. MTC presenting as ocular symptoms due to choroidal mass is rare with bad prognosis.

A 38-year-old Sudanese male presented to Hamad General Hospital, complaining of sudden painless decrease of vision of the right eye of 3 weeks duration. After investigations using imaging methods, the patient was discovered to have metastatic MTC that presented as choroidal mass and metastasized to his lung, bone, brain, pituitary, liver and mediastinum.

In terms of investigations, serum levels of calcitonin have superior diagnostic accuracy. Our patient undertook diagnostic imaging including ultrasonography, fine needle aspiration and computerized tomography (CT) scan and/or MRI imaging. He undertook total thyroidectomy and left neck dissection followed by stereotactic radiosurgery for the right orbit and pituitary. He then received systemic anti-RET therapy (Selpercatinib). At 5 months follow up there was dramatic drop in CEA from 888 μg/L to 164 μg/L, and calcitonin from >585.2 pmol/L to 354 pmol/L.

Choroidal metastasis as initial presentation of MTC is extremely rare and challenging to diagnose. Surgeons need a high index of suspicion when ocular symptoms accompany a neck mass or thyroid-related symptoms. MTC has a progressive course with involvement of blood vessels and neck lymph nodes. Choroidal metastasis of MTC is challenging to manage.
Choroidal metastasis as initial presentation of MTC is extremely rare and challenging to diagnose. Surgeons need a high index of suspicion when ocular symptoms accompany a neck mass or thyroid-related symptoms. click here MTC has a progressive course with involvement of blood vessels and neck lymph nodes. Choroidal metastasis of MTC is challenging to manage.Biochar can help promote direct interspecies electron transfer (DIET) and increase methane production; the surface redox groups play a constructive role in these processes. This study attempted to improve the anaerobic digestion (AD) performance by modifying biochar with HNO3 to increase its redox activity. A comparative experimental study, raw biochar (BC0) and biochar treated with HNO3 for 6 h (BC6), were conducted to investigate the effect of HNO3 treatment on the medium temperature AD performance of food waste. Both BC0 and BC6 can enhance CH4 yield and facilitate the degradation of volatile fatty acids. The enhanced yield of CH4 was 36% for BC0 and 90% for BC6, respectively. Biochar can also enhance methanogenesis, presumably owing to direct interspecific electron transfer (DIET). Compared with BC0, BC6 had a higher redox activity and a smaller conductivity. It was supposed that BC0 mediated DIET through its conductivity, whereas BC6 accelerated DIET by surface redox groups.This study investigated the effects of representative co-substrate (corncob particles) and additive (brick granules) alone on antibiotic resistome of swine manure during composting and subsequent compost application. For relative abundances, four antibiotic resistance gene (ARG) types encoding resistance to aminoglycoside, multidrug, florfenicol-chloramphenicol-amphenicol-fluoroquinolone-quinolone, and sulfonamide increased remarkably during composting, whereas all the ARG types decreased after compost application. Interestingly, much more ARG subtypes (50.1% in total) were reduced in corncob addition treatment. Meanwhile, the addition of corncob particles lowered the relative abundance and diversity of ARGs more significantly. Microbial community exhibited conspicuous changes across the manure, compost, and soil samples where the dominant genera were completely different. Procrustes test proved the co-occurrence and driving effect of microbial community on resistome variation, especially in corncob addition treatment during composting. Network analysis demonstrated that the dissipation of the dominant genera such as Ruminofilibacter, Luteimonas, and Pseudidiomarina in the composts after application contributed greatly to the reduction in ARG relative abundance. Besides, the low abundance of mobile genetic elements (MGEs) in soil also accounted for the attenuation of ARGs to some extent. Our findings clearly proved that co-composting materials can further affect the attenuation of antibiotic resistome in soil application, which can help in understanding the spread and control of ARGs during agricultural process.The widespread use of antibiotics has raised global concerns, but scarce information on antibiotics in the subtropical marine environment is available. In the present study, seawater and sediment samples were collected to investigate the occurrence, spatial distribution, source, and ecological risks of 22 antibiotics in the Beibu Gulf. The total concentrations of target antibiotics (∑antibiotics) were in the range of 1.74 ng/L to 23.83 ng/L for seawater and 1.33 ng/g to 8.55 ng/g dry weight (dw) for sediment. Spatially, a decreasing trend of antibiotic levels from coast to offshore area was observed, with relatively high levels at the sites close to the Qinzhou Bay and Qiongzhou Strait. Sulfamethoxazole (SMX), trimethoprim (TMP), and norfloxacin (NOX) were predominant in seawater, while NOX, enoxacin (ENX), and enrofloxacin (ENR) were the most abundant antibiotics in sediment. In general, the sediment-water partitioning coefficients (Kd) were positively correlated with log molecular weight (MW). Salinity, particle size, and pH of water were predicted to be vital factors influencing the partition of sulfadiazine (SDZ), CIX, and ENR (p less then 0.05). Livestock and aquaculture were identified as dominant sources of antibiotics in the Beibu Gulf based on PCA-MLR and Unmix model. Risk assessment revealed that SMX, CIX could pose medium risks to algae in the Beibu Gulf. Overall, our results provided paramount insights into understanding the fate and transport behaviors of antibiotics in the subtropical marine environment.River meander migration is a process that maintains biodiverse riparian ecosystems by producing highly sinuous rivers, and oxbow lakes. However, although the floodplains support communities with fish and other practices in the region, meandering rivers can directly affect the life of local communities. For example, erosion of river banks promotes the loss of land on community shores, while sedimentation increases the distance from house to the river. Therefore, communities living along the Juruá River, one of the most sinuous rivers on Earth, are vulnerable to long-term meander migration. In this study, the river meander migration was detected by using Landsat 5-8 data from 1984 to 2020. A per-pixel Water Surface Change Detection Algorithm (WSCDA) was developed to classify regions subject to erosion and sedimentation processes by applying temporal regressions on the water index, called Modified Normalized Difference Water Index (mNDWI). The WSCDA classified the meander migration with omission and commission errors lower than 13.44% and 7.08%, respectively. Then, the number of riparian communities was mapped using high spatial resolution SPOT images. A total of 369 communities with no road access were identified, the majority of which living in stable regions (58.8%), followed by sedimentation (26.02%) and erosion (15.18%) areas. Furthermore, we identified that larger communities (>20 houses) tend to live in more stable locations (70%) compared to smaller communities (1-10 houses) with 55.6%. A theoretical model was proposed to illustrate the main impacts of meander migration on the communities, related to Inundation, Mobility Change, and Food Security. This is the first study exploring the relationship between meander migration and riverine communities at watershed-level, and the results support the identification of vulnerable communities to improve local planning and floodplain conservation.In-situ immobilization is an effective strategy for Cd remediation and food safety, while some modifications are necessary to improve immobilization efficiency. In this study, a composite amendment (RFW) derived from rice straw biochar (RSB), fly ash (FA), and white marble (WM) was modified by oxidization (RFW-O) and pyrolysis (RFW-P). The RFW-O showed stronger Cd2+ sorption ability than RFW and RFW-P due to larger BET surface area and more oxygen containing-functional groups. Complexation and iron exchange were the two main processes of Cd2+ sorption on RFW-O. As a result, the application of RFW-O significantly reduced Cd availability in soils by 10.11-26.24% along with increased soil pH. It was found to be optimal to apply the RFW-O at a dosage of 2.5 wt% for 15 days before transplantation. After RFW-O application, Cd concentrations in brown rice decreased by 40.49% and 41.59% for pot and field experiment, respectively, and were less than 0.2 mg kg-1. The catalase, dehydrogenase, acid phosphatase and alkaline phosphatase activities in soils increased significantly.
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