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The rhizosphere represents an intricate microenvironment, consisting of a complex network involving soil, root and soil microbes. Conditions in the rhizosphere exert a direct influence on the growth and yield of crops. The unregulated and widespread application of synthetic fertilizers has emerged as a grave concern for the sustainability of agriculture and the equilibrium of ecosystems. These chemical substances accumulate within the soil, leach into water sources and release into the atmosphere, persisting for decades and posing a substantial threat to the overall ecosystem. This issue is of significant concern, necessitating a potential solution that can only be realized through the involvement of microorganisms and organic amendments. Plant growth promoting rhizobacteria (PGPR) has assumed a pivotal role in addressing this concern. The established role of microorganisms in enhancing plant growth, managing nutrients and exerting biocontrol is well-documented. PGPR, present in the rhizosphere, has the capacity to transform numerous nutrients that are initially inaccessible to plants into forms that can be readily utilized. Additionally, PGPR synthesize plant hormones, secondary metabolites, antibiotics, stressrelieving compounds, chelating agents, and signaling molecules, enabling interactions with both beneficial and pathogenic organisms within the rhizosphere. Moreover, PGPR is involved in the improvement of soil physical properties, chemical properties and overall functioning that offers direct or indirect benefits to crop growth. [ABSTRACT FROM AUTHOR]

Lodging is more than just plants falling over; it incurs significant economic losses for farmers leading to a decrease in both yield and quality of the final produce. Human management practices, such as dense sowing, excessive nitrogen fertilizer applications, inappropriate sowing dates, and upland rice cultivation, exacerbate the risk of lodging in rice. While breeders have developed high-yielding rice varieties utilizing the sd1 gene, relying solely on this gene is insufficient to enhance lodging resistance. Identifying the traits that contribute to lodging resistance is crucial. Key factors include biochemical, anatomical, and morphological traits, such as the levels of lignin, cellulose, hemicellulose, silicon, and potassium, along with the number and area of vascular bundles and the thickness, diameter, and length of the culm. Moreover, markers associated with lodging-related genes, like SCM2, SCM3, SCM4, and prl4, can be utilized effectively in marker-assisted backcrossing to develop rice varieties with desirable culm traits. This literature review aims to aid rice breeders in addressing the issue of lodging by examining traits that influence lodging resistance, developing phenotyping strategies for these traits, identifying suitable instrumentation, exploring methods for screening lodging-resistant plants, understanding the mathematical relationships involved, and considering molecular breeding aspects for pyramiding genes related to lodging.

The first step in developing high yielding heterotic hybrids is to find restorers that can effectively restore the fertility of CMS lines. Two distinct and dominant nuclear genes for restoring fertility, Rf3 and Rf4, are primarily in charge of the fertility restoration of CMS-WA lines in rice. Identifying fertility restorer lines can be accelerated and made simpler by molecular mapping of Rf3 and Rf4. The present investigation was carried out to validate the presence of two fertility restorer genes Rf3 and Rf4 in the F4 generations of two populations viz., CBSN 25/WRM 21-24 (86 families) and CBSN 25/WRM 93-20 (79 families) using seven SSR molecular markers. The results revealed that 17 plants in the cross CBSN 25/WRM 21-24 and 47 plants in CBSN 25/WRM 93-20 were found to be double positives for both Rf3 and Rf4 genes. Hence, after stabilization these identified plants from both crosses could be used as male parents or restorers in CMS-based hybrid rice breeding programs. [ABSTRACT FROM AUTHOR]

Current dietary patterns are suboptimal for both human and planetary health(1,2). With growing consumer and business concerns around food sustainability, estimating the environmental footprint of foods and diets is pertinent. In many countries, supermarkets are the primary provider of foods and beverages; therefore, supermarket purchasing records represent a novel source of population dietary data that offers advantages over traditional methods(3). We developed a method for mapping greenhouse gas emissions (GHGE) to food and beverage products from a high-street retailer's portfolio, to enable the estimation of the environmental footprint of population diets when linked with sales information. We used data from the food and beverage portfolio of a high-street retailer in the United Kingdom (UK), including product name/description, categorisation, ingredients, and weight. We mapped these products to GHGE (kg CO2-eq/kg) using a global database on the average environmental footprint of food commodities(4). This mapping process involved three stages utilising different mapping approaches, guided by product sales data, which we extracted from the retailer's loyaltycard transactions for Yorkshire and the Humber (UK) region during 2022. Stage 1 involved categorising the products into Living Costs and Food Survey food categories and mapping each category to GHGE, where possible (food-category approach). Stage 2 involved splitting selected food categories (based on complexity, necessity of a better mapping, and sales) and creating a sub-category-specific mapping based on an indicator product, which was selected as most popular using sales data (food-sub-category approach). The indicator-product mapping represented a weighted average GHGE value calculated using information on product ingredients and their estimated proportions (ingredient approach). Stage 3 utilised word-searches in product descriptions to distinguish further between product types within selected prioritised subcategories. We used the estimated product-level GHGE (mapped GHGE × product weight) and sales data to estimate food-category contributions to total GHGE and assess how these estimations change by mapping stage. Of >28,000 products, 77.7%, 98.0% and 98.6% were mapped to GHGE at the end of stages 1, 2 and 3, respectively. Of the final product mappings, 40% were at a food-category level and 60% at least at a sub-category level. We calculated 153 product-specific GHGE using ingredients information for prioritised indicator products. When using mappings from stage 3 vs 1, the contributions of 'savoury snacks' and 'chocolate' to total GHGE were approximately four and two times higher respectively, due largely to improved mapping that accounted for product sub-category and ingredients. Mapping environmental sustainability metrics to a retail product dataset is feasible when using a staged approach, guided and prioritised by sales data. However, mapping approach and the estimations' variability should be considered. This method could be used for estimating the environmental footprint from food purchasing data, helping to inform responses towards promoting healthier and more sustainable diets. [ABSTRACT FROM AUTHOR]

Globally, a third of total anthropogenic greenhouse gas emissions (GHGE) are produced by the food system(1). Estimating the carbon footprint of current diets is therefore important to consumers, businesses, and policymakers. With most home-consumed food in the United Kingdom (UK) purchased from supermarkets(2), supermarket purchasing records represent a novel data source that can provide insights into dietary patterns(3). These data are particularly useful in an environmental sustainability context as they provide information on the amounts of foods and beverages purchased, not just the amounts consumed (as in traditional dietary assessments). We estimated GHGE of foods and beverages purchased in Yorkshire and the Humber region of the UK using supermarket transaction data from primary-shopper loyalty cards over 12 months in 2022. We mapped a UK retailer's food and beverage products to GHGE (kg CO2-eq/kg) using data on the environmental footprint of food commodities(4), and grouped the products according to the Living Costs and Food Survey (LCFS) categories. The sustainability mapping process was guided by product sales (i.e., prioritising the most sold products and categories) and involved three stages utilising mapping approaches with different complexity, resulting in 98.6% of >28,000 store products being mapped. We estimated total GHGE of each product by multiplying the final mapped GHGE by the product weight (as sold). We then used these product-level GHGE estimations (kg CO2-eq/item) in conjunction with the sales data (number of items sold) to estimate the contribution of each product, and subsequently each LCFS category, to total GHGE from all purchases. When incorporating sales, the LCFS categories with the highest contributions to total GHGE included 'beef' (19.6%), 'milk' (9.8%), 'cheese and curd' (8.6%), 'ready meals' (6.9%), and 'poultry' (5.5%). The LCFS categories among the lowest contributors to total GHGE included 'confectionery products' (0.2%), 'pasta products' (0.4%) and 'soft drinks' (0.5%). Although some LCFS categories had higher GHGE per kg for their products, they were sold in smaller quantities, and therefore, their contributions to total GHGE were lower in total. For example, 'lamb' was in the top five LCFS categories with the highest GHGE per kg (39.7 kg CO2-eq/kg) but contributed to 1.4.% of total estimated GHGE when incorporating sales information, which was less than 'bread' (2.2%) and 'yoghurt' (1.7%). Our results highlight that although some foods might be very GHGE-intensive on a per weight basis, they have a lower overall GHGE impact if they are not frequently purchased in the population. These supermarket sales data are an important resource to understanding and subsequently tackling the environmental impact of the food system. Further research, including other environmental sustainability metrics (e.g., water and land use), is needed to provide a more comprehensive picture of the environmental footprint of foods and beverages purchased by UK consumers. [ABSTRACT FROM AUTHOR]

The present investigation was carried out to understand the genetic variability, association, cause and effect relationships between yield and its attributing agronomic and physiological traits in 23 F3 families of pre-breeding restorer germplasm in a hybrid rice program for six agronomic and three physiological characters. The variability and heritability parameters were grouped under the high category for the number of productive tillers per plant, leaf area per plant, dry matter production and single plant yield. The traits viz., the number of tillers per plant and panicle length, leaf area per plant and dry matter production showed a direct correlation with single plant yield and in cause and effect relationships. All traits had a direct influence on single plant yield except days to 50% flowering and chlorophyll index. At the intra-family level, six families namely 30, 35, 36, 46, 55 and 82 showed high variability and heritability values of all parameters for six traits. All nine traits exhibited normal distribution. [ABSTRACT FROM AUTHOR]

Background: Groundnut, commonly known as peanut, is a significant oil, food and feed legume crop grown in all seasons in Tamil Nadu, including kharif, rabi and summer and it is cultivated both under irrigated and rainfed conditions in all the seasons at Thiruvannamlai district. One of the most important applications of remote sensing in agriculture is a crop acreage and production estimation (CAPE). The CAPE's main goal is to estimate crop acreage and production of important crops, so that advanced food production, distribution and supply data were achieved. Methods: Multi-temporal Sentinel 1A SAR IW-GRD data with 20 m spatial resolution and 12 days temporal resolution of vertical - horizontal (V-H) polarization were downloaded for the period of 4th October 2020 to 8th January 2021 to have the full coverage during the crop growth period in the study area used for this work. Crop backscattering and multi-temporal features were extracted from MAPscape 5.2 automated pre-processing tool and its classified using supervised maximum likelihood classification for groundnut acreage extraction for Thiruvannamalai district. Result: The rabi groundnut area of Thiruvannamalai district of Tamil Nadu was estimated using SAR Sentinel-1A data as 32298 ha with a higher accuracy percentage of 87.4 and kappa coefficient of 0.75. [ABSTRACT FROM AUTHOR]

Objectives Arteriovenous malformations (AVMs) are high-flow, aggressive lesions that cause systemic effects and may pose a risk to life. These lesions are difficult to treat as they have a tendency to recur aggressively after excision or embolization. So, it requires a regulating free flap with robust vascular flow averting the postexcisional ischemia-induced collateralization, parasitization, and recruitment of neovessels from the surrounding mesenchyme—a phenomenon precipitating and perpetuating the recurrence of AVM. Materials and Methods Sixteen patients (12 males and 4 females) with AVMs Schobinger type 4 involving face were treated from March 2015 to March 2021 with various free flaps: three free rectus abdominis flaps, one free radial forearm flap, and twelve free anterolateral thigh flaps were used for reconstruction following the wide local excision of Schobinger type 4 facial AVM. The records of these patients were analyzed retrospectively. The average follow-up period was 18.5 months. The functional and aesthetic outcomes were analyzed with institutional assessment scores. Results The average size of the flap harvested was 113.43 cm2. Fourteen patients (87.5%) had good-to-excellent score (p = 0.035) with institutional aesthetic and functional assessment system. The remaining two patients (12.5%) had only fair results. There was no recurrence (0%) in the free flap group versus 64% recurrence in the pedicled flap and skin grafting groups (p = 0.035). Conclusion Free flaps with their robust and homogenized blood supply provide a good avenue for void filling and an excellent regulating effect in inhibiting any locoregional recurrences of AVMs

The foliar application of nutrients and plant growth regulators (PGRs) at critical crop growth periods can improve the yield of field crops. Hence, the present study was conducted to quantify the effects of the combined application of nutrients and PGRs (crop-specific formulation) on maize, blackgram, greengram, groundnut, cotton, sugarcane, and coconut yield. In all the crops except coconut, the treatments included (i) a foliar spray of crop-specific nutrients and PGR combinations and (ii) an unsprayed control. In coconut, the treatments included (i) the root feeding of coconut-specific nutrients and PGR combinations and (ii) an untreated control. Crop-specific nutrient and PGR formulations were sprayed, namely, Tamil Nadu Agricultural University (TNAU) maize maxim 1.5% at the tassel initiation and grain-filling stages of maize, TNAU pulse wonder 1.0% at the peak flowering stage of green gram and black gram, TNAU groundnut-rich 1.0% at the flowering and pod-filling stages of groundnut, TNAU cotton plus 1.25% at the flowering and boll development stages of cotton, and TNAU sugarcane booster 0.5% at 45 days after planting (DAP), 0.75% at 60 DAP, and 1.0% at 75 DAP of sugarcane. The results showed that the foliar application of TNAU maize maxim, TNAU pulse wonder, TNAU groundnut-rich, TNAU cotton plus and TNAU sugarcane booster and the root feeding of TNAU coconut tonic increased the yield of maize, pulses, groundnut, cotton, sugarcane, and coconut, resulting in higher economic returns.

In crops, drought stress reduces the photosynthetic rate and gamete function through oxidative damage. Earlier studies showed that nanoceria possesses an antioxidant property; however, the ability of nanoceria to alleviate drought-stress-stimulated oxidative damage in pulse crops has not been studied. Therefore, experiments were conducted to assess the impacts of nanoceria on drought-induced oxidative damage in mungbean [Vigna radiata (L.) Wilczek]. We hypothesize that foliar application of nanoceria under drought stress can scavenge the excess produced reactive oxygen species (ROS) due to its inherent properties which could result in increased photosynthesis and reproductive success of mungbean. Three experiments were conducted under well-watered and limited-moisture conditions. The traits associated with oxidative damage, photosynthesis, reproductive success, and yield were recorded. Results showed that for mungbean, the optimum concentration of nanoceria for foliar spray was 100 mg L−1. Field and pot culture experiments showed that foliar application of nanoceria under drought decreased the superoxide radical content (29%), hydrogen peroxide content (28%), and membrane damage (35%) over water spray. Nanoceria increased the photosynthetic rate (38%), pod-set percentage (16%), and seed weight m−2 (44%) in drought-stressed plants compared to control plants. The increased photosynthetic rate by nanoceria spray under drought stress is associated with lesser oxidative damage and stomatal limitation caused by nanoceria’s inherent ROS-scavenging ability. Hence, foliar application of nanoceria at the rate of 100 mg L−1 under drought stress could increase mungbean seed yield per plant through increased photosynthetic rate and pod-set percentage.

Background: The presence of a pseudodiverticulum of the anterior pharyngeal wall, or prominent "pharyngeal bar," is a well-known phenomenon that occurs following total laryngectomy, which can be visualized by nasolaryngoscopy or videofluoroscopy. Among the different techniques of pharyngeal reconstruction, there is higher incidence following primary vertical multilayered closure. It has been postulated to cause dysphagia and lack of dietary progression despite a paucity of data. However, the direct impact of pseudodiverticulum is less clear and anecdotally its presence and severity does not necessarily correlate with dysphagia., Methods: A retrospective case series was performed of all consecutive patients who underwent total laryngectomy or laryngopharyngectomy between 2015 and 2022 at two tertiary head and neck institutions. All patients underwent routine videofluoroscopy postoperatively for swallow assessment. The presence of pseudodiverticulum on postoperative contrast swallow study was recorded to investigate the relationship with patient's ability to tolerate oral intake at 3 months discharge from the hospital., Results: Of 50 laryngectomized patients (mean age 63.8 ± 10.0, 86% male), the main closure techniques were primary vertical (n = 9, 18%), primary T-closure (n = 14, 28%), and flap reconstruction (n = 27, 54%). Pseudodiverticulum was identified in 19 cases (38%). 43 patients underwent primary surgery and 30 had adjuvant radiotherapy. The presence of pseudodiverticulum was significantly associated with vertical primary closure versus non-vertical (T-closure or flap reconstruction) techniques (χ 2 (df 1) = 7.4, p = 0.007, OR = 5.7, 95% CI 1.3-24.7). Pseudodiverticulum was not associated with an increased inability to tolerate solid intake or full diet compared to patients without pseudodiverticulum. 26.3% of patients with pseudodiverticulum were on full diet compared to 25.8% of patients without. The vertical closure technique showed no difference in ability to maintain solid intake compared with non-vertical closure; however, no patients were on full diet. Only one patient in the pseudodiverticulum group required surgical management during the study period for retention., Conclusion: The presence of a pseudodiverticulum does not appear to be significantly associated with a need for postoperative dietary modification. The authors postulate that postlaryngectomy dysphagia is multifactorial with sensorimotor aperistalsis of the pharynx and cricopharyngeal stenosis. While a pseudodiverticulum is a common phenomenon, patients did not require modification of diet at higher rates than those without, and they seldom require intervention., (© 2024 Wiley Periodicals LLC.)

Background: Tracheoesophageal puncture (TEP) with voice prosthesis (VP) insertion is the gold standard of surgical voice restoration in postlaryngectomy patients. The conventional technique involves rigid esophagoscopes and trocar performed by ENT surgeons alone, with technical limitations encountered in patients with cervical abnormalities - in particular those with free or rotational flap reconstructions and postradiotherapy strictures. We report our technique using flexible endoscopy which we show to be feasible and without major safety events, as a possible consideration in the anticipated difficult TEP., Methods: Our study describes a multidisciplinary approach to secondary TEP involving a combined upper gastrointestinal (UGI) and (Ear, Nose, and Throat) ENT procedure, under the guidance of flexible esophagoscopy, with intraoperative involvement of the speech pathologist to guide VP insertion and placement. The procedure was performed with ease without major complications., Results: We identified nine postlaryngectomy and laryngopharyngectomy patients in our institution who underwent secondary TEP with VP insertion using flexible esophagoscopy and multidisciplinary intra-operative involvement. All patients had pharyngeal reconstruction, including radial forearm free flap (n = 4), pectoralis major rotational flap (n = 3), and anterolateral thigh flap (n = 2). Eight out of nine patients underwent adjuvant radiotherapy. The technique was successfully performed in all patients. There were three cases of early TEP displacement in two patients, of which one patient had a successful repeat procedure. We found the technique advantageous in terms of feasibility and practicality compared to the conventional approach, and without intraoperative difficulties encountered in achieving the desired field of views or navigating the challenging anatomy in a free flap and post-radiotherapy patients. This includes distorted cervical anatomy, the presence of bulky and hair-bearing flap skin, and stricture formation. Minor complications in our cohort included pharyngo-esophageal spasm, TEP displacement, granulation tissue, and peri-prosthetic leaks., Conclusion: Our multidisciplinary approach to secondary TEP was performed with flexible esophagoscopy without major related complications. The technique is advantageous in the surgical approach to VP insertion in postlaryngectomy and laryngopharyngectomy patients who have had radiotherapy or pharyngeal reconstruction. It allows for safe anatomical insertion and thorough evaluation of the upper aerodigestive tract for comorbid benign or malignant esophageal pathology., Competing Interests: Disclosure The authors have no competing interests or specific funding to disclose, (Copyright © 2022 The Voice Foundation. Published by Elsevier Inc. All rights reserved.)

Background & Aims: We aimed to explore patient expectations regarding their treatments and prognosis in comparison to physicians' assessments in patients with advanced hepatocellular carcinoma (HCC) receiving systemic treatments., Methods: We prospectively enrolled 205 patients in France and Belgium with Barcelona Clinic Liver Cancer (BCLC) stage B/C HCC receiving systemic treatment (NCT04823754). Patients completed a 28-question survey and the hospital anxiety and depression scale (HADS), while physicians filled a 17-question survey after the initial consultation. Univariate and multivariate models were used to assess factors associated with concordant patient-physician responses, HADS, as well as predicted (by physicians) and observed overall survival., Results: Patients had a median age of 68 years with 75% having BCLC C HCC; 86.3% received atezolizumab/bevacizumab. 60% of patients did not discuss life expectancy with the physician. 63% of the patients believed they had a life expectancy >5 years. Among shared questions between patients and physicians, 36.4% concordance was observed; major differences centered on life expectancy with patients more optimistic than physicians. A lower patient-physician concordance was seen with shorter-consultations ( p = 0.003), female physicians ( p = 0.02), BCLC C ( p = 0.03) and >100 HCC patients/year per physician ( p = 0.008). Compared to France, patients from Belgium were more likely to be satisfied with the consultation ( p <0.001) but were less optimistic about life expectancy. Using HADS, 52% of the patients had anxiety/depression that was correlated with alpha-fetoprotein level ( p = 0.03). The predicted median overall survival by physicians was 18 months vs . 13 months for the observed overall survival (weak correlation, ρ = 0.31)., Conclusion: Expectations regarding systemic treatments for advanced HCC differ significantly between patients and physicians, showing notable variations across countries., Impact and Implications: This multicentric prospective study, conducted in France and Belgium, focuses on patients with advanced hepatocellular carcinoma undergoing systemic treatments. The findings of our study underscore the disparities in expectations regarding systemic treatments for advanced hepatocellular carcinoma between patients and physicians, revealing also significant variations between France and Belgium. These results suggest the need for targeted interventions aimed at enhancing patients' comprehension of their disease and fostering better communication between patients and physicians., Clinical Trial Number: NCT04823754., (© 2024 The Author(s).)

Cancer is characterized by increased metabolic activity and vascularity, leading to temperature changes in cancerous tissues compared to normal cells. This study focused on patients with abnormal mammogram findings or a clinical suspicion of breast cancer, exclusively those confirmed by biopsy. Utilizing an ultra-high sensitivity thermal camera and prone patient positioning, we measured surface temperatures integrated with an inverse modeling technique based on heat transfer principles to predict malignant breast lesions. Involving 25 breast tumors, our technique accurately predicted all tumors, with maximum errors below 5 mm in size and less than 1 cm in tumor location. Predictive efficacy was unaffected by tumor size, location, or breast density, with no aberrant predictions in the contralateral normal breast. Infrared temperature profiles and inverse modeling using both techniques successfully predicted breast cancer, highlighting its potential in breast cancer screening.

Purpose: Online resources are increasingly being utilised by patients to guide their clinical decision making, as an alternative or supplement to the traditional clinical-patient relationship. YouTube is an online repository of user and community generated videos, which is one of the most popular websites globally. We undertook a study to examine the quality of information presented in YouTube videos related to tonsillectomy., Methods: We completed a systematic search of YouTube in May 2023 and identified 88 videos for inclusion in our study. Videos were published in the English language, focussing on tonsillectomy and tonsillectomy recovery, and were greater than 2 min in length. We recorded video quality metrics and two authors independently analysed the quality of information using three validated quality assessment tools described in the literature including the modified DISCERN, Global Quality Score, and the JAMA Benchmark Criteria., Results: The overall quality of the information was low with mean quality scores of Modified DISCERN (1.8 ± 1.3), GQS (2.6 ± 1.2), and JAMA Benchmark Criteria (1.6 ± 0.7). Information published by medical sources including medical professionals, healthcare organisations, and medical education channels scored significantly higher compared to non-medical sources across all quality measures and were of moderate overall quality and usefulness: Modified DISCERN (2.5 ± 1.1 vs 0.8 ± 0.9, z = -6.0, p < 0.001), GQS (3.2 ± 1.0 vs 1.7 ± 0.9, z = -5.7, p < 0.001), and JAMA (1.9 ± 0.8 vs 1.1 ± 0.3, z = -5.2, p < 0.001). Videos published during or after 2018 scored higher on Modified DISCERN (z = -3.2,p = 0.001) but not on GQS or JAMA. Video quality metrics such as total view count, likes, and comments, and channel subscriber count, did not correlate with higher video quality. However, amongst videos published by authoritative medical sources, total view count correlated positively with higher Modified DISCERN quality scores (p = 0.037)., Conclusion: The overall quality and usefulness of YouTube videos on tonsillectomy is of low quality, but information published by authoritative medical sources score significantly higher. Clinicians should be mindful of increasing use of online information sources such as YouTube when counselling patients. Further research is needed in the medical community to create engaging, high-quality content to provide guidance for patients., Competing Interests: Declaration of competing interest No interest., (Crown Copyright © 2024. Published by Elsevier B.V. All rights reserved.)

Effective treatment of breast cancer relies heavily on early detection. Routine annual mammography is a widely accepted screening technique that has resulted in significantly improving the survival rate. However, it suffers from low sensitivity resulting in high false positives from screening. To overcome this problem, adjunctive technologies such as ultrasound are employed on about 10% of women recalled for additional screening following mammography. These adjunctive techniques still result in a significant number of women, about 1.6%, who undergo biopsy while only 0.4% of women screened have cancers. The main reason for missing cancers during mammography screening arises from the masking effect of dense breast tissue. The presence of a tumor results in the alteration of temperature field in the breast, which is not influenced by the tissue density. In the present paper, the IRI-Numerical Engine is presented as an adjunct for detecting cancer from the surface temperature data. It uses a computerized inverse heat transfer approach based on Pennes's bioheat transfer equations. Validation of this enhanced algorithm is conducted on twenty-three biopsy-proven breast cancer patients after obtaining informed consent under IRB protocol. The algorithm correctly predicted the size and location of cancerous tumors in twenty-four breasts, while twenty-two contralateral breasts were also correctly predicted to have no cancer (one woman had bilateral breast cancer). The tumors are seen as highly perfused and metabolically active heat sources that alter the surface temperatures that are used in heat transfer modeling. Furthermore, the results from this study with twenty-four biopsy-proven cancer cases indicate that the detection of breast cancer is not affected by breast density. This study indicates the potential of the IRI-Numerical Engine as an effective adjunct to mammography. A large scale clinical study in a statistically significant sample size is needed before integrating this approach in the current protocol., (© 2024. The Author(s).)

Stark, widening health and income inequalities in the United Kingdom underpin the need for increased support for low-income families to access affordable and nutritious foods. Using anonymised supermarket loyalty card transaction records, this study aimed to assess how an additional Healthy Start voucher (HSV) top-up of £2, redeemable only against fruit and vegetables (FVs), was associated with FV purchases among at-risk households. Transaction and redemption records from 150 loyalty card-holding households, living in northern England, who had engaged with the top-up scheme, were analysed to assess the potential overall population impact. Using a pre-post study design, 133 of these households' records from 2021 were compared with equivalent time periods in 2019 and 2020. Records were linked to product, customer and store data, permitting comparisons using Wilcoxon matched-pairs sign-ranked tests and relationships assessed with Spearman's Rho. These analyses demonstrated that 0.9 more portions of FV per day per household were purchased during the scheme compared to the 2019 baseline (p = 0.0017). The percentage of FV weight within total baskets also increased by 1.6 percentage points (p = 0.0242), although the proportional spend on FV did not change. During the scheme period, FV purchased was higher by 0.4 percentage points (p = 0.0012) and 1.6 percentage points (p = 0.0062) according to spend and weight, respectively, in top-up redeeming baskets compared to non-top-up redeeming baskets with at least one FV item and was associated with 5.5 more HSV 'Suggested' FV portions (p < 0.0001). The median weight of FV purchased increased from 41.83 kg in 2019 to 54.14 kg in 2021 (p = 0.0017). However, top-up vouchers were only redeemed on 9.1% of occasions where FV were purchased. In summary, this study provides novel data showing that safeguarding funds exclusively for FV can help to increase access to FV in low-income households. These results yield important insights to inform public policy aimed at levelling up health inequalities., (© 2023 The Authors. Nutrition Bulletin published by John Wiley & Sons Ltd on behalf of British Nutrition Foundation.)

Purpose: A total laryngectomy creates an alternate airway for gas exchange that bypasses the upper aerodigestive tract. The subsequent reduction in nasal airflow, and therefore, reduction in deposition of particles to the olfactory neuroepithelium leads to hyposmia or anosmia. The aim of this study was to assess the quality of life impairment conferred by anosmia following laryngectomy and identify any specific patient-related risk factors that are associated with poorer outcomes., Methods: Consecutive patients with a total laryngectomy presenting for review at three tertiary head and neck services (in Australia, the United Kingdom and India) over a 12-month period were recruited. Patient demographic and clinical data were collected, and each subject completed the validated assessment of self-reported olfactory functioning and olfaction-related quality of life questionnaire (ASOF). Dichotomous comparisons were performed using the student's unpaired t-test for continuous variables (SRP), a chi-squared test for categorical variables, and a Kendall's tau-b for ordinal variables (SOC) to assess for a correlation with poorer questionnaire scores., Results: A total of 66 laryngectomees (13.4% female; age 65.7 ± 8.6 years) were included in the study. The mean SRP score of the cohort was found to be 15.6 ± 7.4, while the mean ORQ score was noted to be 16.4 ± 8.1. No other specific risk factors associated with poorer quality of life were identified., Conclusion: A significant quality of life detriment from hyposmia is conferred following laryngectomy. Further research to assess treatment options and the patient population that would best benefit from these interventions is required., (© 2023. The Author(s).)

Background: Among the determinants of nonadherence, polypharmacy (common in people with multiple pathologies and especially in elderly patients), plays a major role., Objective: In patients who are subject to polypharmacy involving different classes of medications, the first aim is to assess the impact of medication importance given by patients on (i) medication adherence and (ii) the respective effect of intentionality and habit in medication importance and medication adherence. The second objective is to compare the importance given to medication and adherence in the different therapeutic classes., Patients and Methods: Patients taking 5-10 different medications for at least 1 month were included in a cross-sectional survey in three private practices in one region in France., Results: This study included 130 patients (59.2 % female) with 851 medications in total. The mean ± standard deviation (SD) age was 70.5 ± 12.2 years. The mean ± SD of medications taken was 6.9 ± 1.7. Treatment adherence had a strong positive correlation with the patient-perceived medication importance (p < 0.001). Counter-intuitively, taking a large number of medications (≥7) was associated with being fully adherent (p = 0.02). A high intentional nonadherence score was negatively associated with high medication importance (p = 0.003). Furthermore, patient-perceived medication importance was positively associated with taking treatment by habit (p = 0.03). Overall nonadherence more strongly correlated with unintentional nonadherence (p < 0.001) than with intentional nonadherence (p = 0.02). Compared to the antihypertensive class, a decrease in adherence by medication was observed in psychoanaleptics (p < 0.0001) and drugs used in diabetes class (p = 0.002), and a decrease in importance in lipid-modifying agents class (p = 0.001) and psychoanaleptics (p < 0.0001)., Conclusion: The perception of the importance of a medicine is associated with the place of intentionality and habit in patient adherence. Therefore, explaining the importance of a medicine should become an important part of patient education., (© 2023. The Author(s).)

Background & Aims: The fragility index (FI), i.e., theminimum number of best survivors reassigned to the control group required to revert the statistically significant result of a clinical trial to non-significant, is a metric to evaluate the robustness of randomized controlled trials (RCTs). We aimed to assess the FI in the field of HCC., Methods: This is a retrospective analysis of phase 2 and 3 RCTs for the treatment of HCC published between 2002 and 2022. We included two-arm studies with 1:1 randomization and significant positive results for a primary time-to-event endpoint for the FI calculation, which involves the iterative addition of a best survivor from the experimental group to the control group, until positive significance ( p <0,05, Log-rank test) is lost., Results: We identified 51 phase 2 and 3 positive RCTs, of which 29 (57%) were eligible for fragility index calculation. After reconstruction of the Kaplan-Meier curves, 25/29 studies remained significant, among which the analysis was performed. The median (interquartile range (IQR)) FI was 5 (2-10) and Fragility Quotient (FQ) was 3% (1%-6%). Ten trials (40%) had a FI of 2 or less. FI was positively correlated to the blind assessment of the primary endpoint (median FI 9 with blind assessment versus 2 without, p = 0.01), the number of reported events in the control arm (RS = 0.45, p = 0.02) and to impact factor (RS = 0.58, p = 0.003)., Conclusions: Several phases 2 and 3 RCTs in HCC have a low fragility index, underlying the limited robustness on the conclusion of their superiority over control treatments. The fragility index might provide an additional tool to assess the robustness of clinical trial data in HCC., Impact and Implications: The fragility index is a method to assess robustness of a clinical trial and is defined the minimum number of best survivors reassigned to the control group required to revert the statistically significant result of a clinical trial to non-significant. Among 25 randomised controlled trials in HCC, the median fragility index was 5, and 10 trials among 25 (40%) had a fragility index of 2 or less, indicating an important fragility., Competing Interests: JCN has received research funding from Bayer and Ipsen. SS, NS, CC, JG, and FD have no conflicts of interest. NG-C has received honoraria from Abbie, Bayer, Gilead, Ipsen, Roche, and Shionogi. MR has received educational fees from Canon Medical System, GE Healthcare, Ipsen, Guerbet, and Sirtex. VL has no conflicts of interest. Please refer to the accompanying ICMJE disclosure forms for further details., (© 2023 The Author(s).)

Purpose : To follow the evolution of peripheral ischemia by fluorescein angiography (FA) on ultra-wide-field (UWF) images in diabetic patients treated with anti-vascular endothelial growth factor (anti-VEGF) for macular edema. Methods : Prospective, non-interventional cohort study analyzing UWF-FA images of 48 patients with diabetic retinopathy (48 eyes) treated for diabetic macular edema. UWF-FA was performed at baseline and after one year of anti-VEGF therapy (M12). The primary endpoint was the change in the non-perfusion index. Results : Of the 48 patients included in this study, 25 completed the one-year follow-up, and 20 had FA images of sufficient quality to be interpreted. The non-perfusion index did not significantly change from baseline after one year of anti-VEGF treatment (0.7% of the non-perfused area at baseline versus 0.5% at M12; p = 0.29). In contrast, the diabetic retinopathy severity score improved significantly between baseline and M12. Conclusions : Anti-VEGF treatment with aflibercept for diabetic macular edema had no impact on the retinal perfusion assessed by FA, but it allowed for artificially improving diabetic retinopathy severity scores.

Background: Recurrent laryngeal nerve (RLN) invasion by thyroid carcinoma represents an advanced disease status with potentially significant co-morbidity., Methods: In a retrospective single-center study, we included patients with invaded RLNs operated on while using nerve monitoring techniques. We studied pre-, intra-, and postoperative parameters associated with postoperative vocal cord paralysis (VCP); 5-year recurrence-free survival (RFS); and 5-year overall survival (OS) in addition to two subgroup analyses of postoperative VCP in patients without preoperative VCP and based on source of RLN invasion., Results: Of 65 patients with 66 nerves-at-risk, 39.3% reported preoperative voice complaints. Preoperative VCP was documented in 43.5%. The RLN was invaded by primary tumor in 59.3% and nodal metastasis in 30.5%. Papillary thyroid carcinoma was the most common pathologic subtype (80%). After 6 months, 81.8% had VCP. Complete tumor resection of the RLN was not associated with 5-year RFS (p = 0.24) or 5-year OS (p = 0.9). Resecting the RLN did not offer statistically significant benefit on 5-year RFS (p = 0.5) or 5-year OS (p = 0.38). Radioactive Iodine (RAI) administration was associated with improvement in 5-year RFS (p = 0.006) and 5-year OS (p = 0.004). Patients without preoperative VCP had higher IONM amplitude compared with patients with VCP. After a mean follow-up of 65.8 months, 35.9% of patients had distant metastases, whereas 36.4% had recurrence., Conclusion: Preoperative VCP accompanies less than half of patients with RLN invasion. Invaded RLNs may have existent electrophysiologic stimulability. Complete tumor resection and RLN resection were not associated with better 5-year RFS or OS, but postoperative RAI was., Level of Evidence: 4 Laryngoscope, 132:2285-2292, 2022., (© 2022 The American Laryngological, Rhinological and Otological Society, Inc.)

Context: Some women living with type 1 diabetes complain of changes in glucose values according to the different phases of menstruation., Objective: To evaluate this variability through continuous glucose monitoring (CGM) data in type 1 diabetes patients., Design: Observational study., Setting: Ambulatory data, recruitment in 2 centers in the Paris region., Patients: Twenty-four women with type 1 diabetes having spontaneous menstrual cycles., Intervention: Collection of CGM data for 62 spontaneous menstrual cycles, with evaluation of five 3-day phases during each cycle: (1) early follicular (menstruations), (2) mid-follicular, (3) peri-ovulatory, (4) mid-luteal, and (5) late luteal., Main Outcome Measure: Time in range (TIR, prespecified)., Results: TIR decreased for each consecutive phase (61 ± 18%; 59 ± 18%; 59 ± 20%; 57 ± 18%; and 55 ± 20%, P = 0.02). The linear mixed model highlighted a decrease in TIR in the mid-luteal (P = 0.03) and late luteal (P < 0.001) phases compared with the early follicular phase. Time above range was significantly higher during the late luteal phase than the early follicular phase (P = 0.003). Time below range was significantly higher during the mid-follicular phase than in the early follicular phase., Conclusion: In most of the study population, glucose levels rose linearly throughout the menstrual cycle, reaching a maximum in the late luteal phase. A sharp decrease was seen for most participants at the beginning of menstrual bleeding. This should be taken into consideration in daily care of type 1 diabetes patients to avoid hypoglycemia., (© The Author(s) 2022. Published by Oxford University Press on behalf of the Endocrine Society. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)