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Screening genotypes based on grain yield stability in different ecological zones is a prerequisite for developing a widely adapted genotype. For this purpose, 16 chickpea desi genotypes' evaluation through cooperative yield trial commenced during 2019-2020 at nine diversified locations across Punjab, Pakistan. Data underwent genotype by environment interaction (G × E) and mega environment analysis. Genotype plus genotype × environment (GGE) biplot view for yield depicted that G-4 (CH-21/13) was the ideal and superior genotype for stability and yield potential. GGE biplot 'what-won-where' for yield formed an irregular polygon showing interconnection among G-3 (CH-2016), G-4 (CH-21/13), G-8 (D-17003), G-11(D-17019), G-13 (TG-1427), G-14 (TG-1430), and G-16 (TG-1510), indicating these genotypes were comparatively more stable. Graphical representation of the mega environment analysis illustrated that E-1 (Pulses Research Institute, AARI, Faisalabad, Pakistan) was ideal and most discriminating for genotype screening. Results also revealed that the first mega environment's construction included the grouping of E-1 (Pulses Research Institute, AARI, Faisalabad, Pakistan), E-2 (Nuclear Institute for Agriculture and Biology, Faisalabad, Pakistan), E-3 (Gram Breeding Research Station, Kallurkot, Pakistan), and E-4 (Gram Breeding Research Station, Kallurkot, Barani, Pakistan), with G-4 (CH-21/13) as the winning genotype. Biplot also depicted that G-3 (CH-2016) was best in the second mega environment made by E-6 (Regional Agricultural Research Institute, Pakistan), and G-8 (D-17003) was a winner in E-4 (Gram Breeding Research Station, Kallurkot, Barani, Pakistan). Combined analysis showed that G-4 (CH-21/13), G-8 (D-17003), and G-13 (TG-1427) were the most stable and high-yielding; therefore, these genotypes may considerably be widely adaptive across environments. [ABSTRACT FROM AUTHOR]

We report a rare case of atypical Mycobacterium intracellulare infection encountered in a left sternoclavicular joint of an immunocompetent patient. The 34-year-old female patient presented with a one-year history of left sternoclavicular joint pain and swelling. The patient had multiple radiological investigations, which were suspicious for an infective cause. The patient had a biopsy of the joint, which returned showing acid-fast bacilli. The patient consequently received a prolonged course of medical treatment for M. intracellulare. [ABSTRACT FROM AUTHOR]

Present study aims to determine probable relation between Toxoplasma gondii infection and diabetes mellitus by investigating serum levels of insulin and anti-Toxoplasma antibodies through ELISA among diabetic and non-diabetic persons in Lahore, Pakistan. Results showed that insulin level was higher in subjects positive for Toxoplasma infection as compared to Toxoplasma free one's (p<0.05). The analysis revealed that Toxoplasma infection was more prevalent in diabetic patients (p<0.05) than non-diabetic individuals. Results also showed that insulin level was higher in persons with chronic infection. Gender-wise comparison revealed that in males, insulin level had significant association with Toxoplasma infection (p<0.05). It was concluded that participants who had Toxoplasma infection had higher insulin level that showed the probable relation of infection with diabetes. [ABSTRACT FROM AUTHOR]

The article presents a study which investigates on the potential of antitermitic activities of eucalyptus oil concerning several termite species in Pakistan such as Heterotermes indicola (Wasmann), Mierotermes obesi (Holmgren) and Odontotermes obesus (Rambur). It mentions that the toxicity, repellency and fumigant activity tests were conducted to the laboratory assays from the essential oil from Eucalyptus (Eucalyptus citriodora). The study shows that eucalyptus oil was highly repellent against termites. The study suggests that eucalyptus oil can be considered to be the best at dose of methanol.

Introduction: Molecular phenotypes of invasive breast cancer predict early recurrence and survival. DCIS exhibits similar phenotypes but their frequency and clinical significance remain uncertain. To determine whether molecular phenotypes of DCIS predict recurrence, 273 women (median age 57 years) with primary DCIS who were screened for or entered DCIS trials (Iressa/Lapatinib/ERISAC) in one unit from 1990-2010 were studied. Methods: HER2, oestrogen receptor (ER) and progesterone receptor (PR) expression within primary DCIS were established using immunohistochemistry within the trial protocols. HER2 was scored 0 (absent) to 3 (maximum). Scores ≥ 2 were taken as positive if amplified on FISH testing. ER and PR scored positive if ≥ 5% of cells stained. 64.2% patients were ER positive, 43.3% were HER2 positive and 31.8% were high-grade lesions. 94 underwent mastectomy whilst 185 had BCS. Results: There was an overall recurrence rate of 20.14% after a median follow-up period of 74 months (range 12-240). Of these recurrences, 36.4% were invasive. Conservation surgery (BCS) was used in 185 women who suffered 47 recurrences. Molecular phenotype predicted local recurrence by Log Rank analysis (P < 0.01) and invasive recurrences (P < 0.016) overall and in the BCS group remained predictive of invasive recurrence (p <0.005) and overall recurrence (p < 0.001). ER negative DCIS had higher invasive recurrence (p < 0.01: Chi-squared). Grade 3 was a weak predictor of overall (p < 0.02) but not invasive recurrence. HER2 positive DCIS had poorer cumulative 5-year disease-free survival than HER2 negative cases (p = <0.001, Kaplan -Meier), irrespective of ER status. On multivariate COX regression analysis, HER2 positivity was an independent predictor of increased recurrence risk (p = 0.01) H.R. 7.39, 95% CI 1.61-33.8) Discussion: Determination of molecular phenotypes of DCIS aids identification of women at high-risk of recurrence. ER-HER2+ patients need maximal adjuvant treatment to avoid invasive recurrence whereas lower-risk ER+HER2- patients might avoid adjuvant radiotherapy. [ABSTRACT FROM AUTHOR]

Using diffusion tensor imaging (DTI), we assessed the extent to which fractional anisotropy values in the dorsal (i.e., arcuate fasciculus; AF) versus ventral (i.e., inferior fronto-occipital fasciculus; IFOF) distinction of structural white matter pathways associated with selected reading processes, could be replicated in skilled adult readers (N = 17) and extended to adults with reading impairments (N = 13). In addition to the AF and IFOF, motor-based tracts (i.e., posterior limb of the internal capsule (PLIC) and the frontal aslant tract (FAT)) were isolated to explore their role in reading performance. Several interesting relationships with reading performance emerged. First, orthographic awareness was related to the left IFOF in skilled readers, whereas orthographic awareness was related to left PLIC for impaired readers. Morphological awareness was related to left FAT for skilled readers, whereas morphological awareness was related to right AF, right IFOF and left PLIC for impaired readers. Overall, these findings support the notion that adult reading performance (both skilled and impaired) is related to the structural properties of the ventral white matter pathways. More consideration should be paid to motor pathways, particularly the PLIC, and their role in compensatory reading strategies in individuals with reading impairments.

Purpose: To shorten CEST acquisition time by leveraging Z-spectrum undersampling combined with deep learning for CEST map construction from undersampled Z-spectra., Methods: Fisher information gain analysis identified optimal frequency offsets (termed "Fisher offsets") for the multi-pool fitting model, maximizing information gain for the amplitude and the FWHM parameters. These offsets guided initial subsampling levels. A U-NET, trained on undersampled brain CEST images from 18 volunteers, produced CEST maps at 3 T with varied undersampling levels. Feasibility was first tested using retrospective undersampling at three levels, followed by prospective in vivo undersampling (15 of 53 offsets), reducing scan time significantly. Additionally, glioblastoma grade IV pathology was simulated to evaluate network performance in patient-like cases., Results: Traditional multi-pool models failed to quantify CEST maps from undersampled images (structural similarity index [SSIM] <0.2, peak SNR <20, Pearson r <0.1). Conversely, U-NET fitting successfully addressed undersampled data challenges. The study suggests CEST scan time reduction is feasible by undersampling 15, 25, or 35 of 53 Z-spectrum offsets. Prospective undersampling cut scan time by 3.5 times, with a maximum mean squared error of 4.4e-4, r = 0.82, and SSIM = 0.84, compared to the ground truth. The network also reliably predicted CEST values for simulated glioblastoma pathology., Conclusion: The U-NET architecture effectively quantifies CEST maps from undersampled Z-spectra at various undersampling levels., (© 2024 International Society for Magnetic Resonance in Medicine.)

Background: Pancreatic cancer remains a lethal malignancy with a 5-year survival rate below 6% and about 500,000 deaths annually worldwide. Pancreatic adenocarcinoma, the most prevalent form, is commonly associated with diabetes, chronic pancreatitis, obesity, and smoking, mainly affecting individuals aged 60 to 80 years. This systematic review aims to evaluate the efficacy of immunotherapeutic approaches in the treatment of pancreatic cancer., Methods: A systematic search was conducted to identify clinical trials (Phases I-III) assessing immunotherapy in pancreatic cancer in PubMed/Medline, CINAHL, Scopus, and Web of Science, adhering to PRISMA Statement 2020 guidelines. The final search was completed on May 25, 2024. Ongoing trials were sourced from ClinicalTrials.gov and the World Health Organization's International Clinical Trials Registry Platform (ICTRP). Keywords such as "pancreatic," "immunotherapy," "cancer," and "clinical trial" were used across databases. Gray literature was excluded., Results: Phase I trials, involving 337 patients, reported a median overall survival (OS) of 13.6 months (IQR: 5-62.5 months) and a median progression-free survival (PFS) of 5.1 months (IQR: 1.9-11.7 months). Phase II/III trials pooled in a total of 1463 participants had a median OS of 12.2 months (IQR: 2.5-35.55 months) and a median PFS of 8.8 months (IQR: 1.4-33.51 months)., Conclusions: Immunotherapy shows potential for extending survival among pancreatic cancer patients, though results vary. The immunosuppressive nature of the tumor microenvironment and diverse patient responses underline the need for further research to optimize these therapeutic strategies., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Background: Goal attainment scaling (GAS), an established individualized, patient-centred outcome measure, is used to capture the patient's voice. Although first introduced ~60 years ago, there are few published guidelines for implementing GAS, and almost none for its use when caregivers GAS is implemented with caregiver input. We conducted a systematic review of studies that implemented GAS with caregiver input; and examined variations in GAS implementation, analysis, and reporting., Methods: Literature was retrieved from Medline, Embase, Cochrane, PsycInfo and CINAHL databases. We included randomized controlled trials (published between 1968 and November 2022) that used GAS as an outcome measure and involved caregiver input during goal setting., Results: Of the 2610 studies imported for screening, 21 met the inclusion criteria. Most studies employed GAS as a primary outcome. The majority (76%) had children as study participants. The most common disorders represented were cerebral palsy, developmental disorders, and dementia/Alzheimer's disease. The traditional five-point GAS scale, with levels from -2 to +2, was most often implemented, with -1 level typically being the baseline. However, most studies omitted essential GAS details from their reports including the number of goals set, number of attainment levels and whether any training was given to GAS facilitators., Conclusions: GAS with caregiver input has been used in a limited number of randomized controlled trials, primarily in pediatric patients and adults with dementia. There is a variability in GAS implementation and many crucial details related to the specifics of GAS implementation are omitted from reports, which may limit reproducibility. Here we propose catalog that may be utilized when reporting research results pertaining to GAS with caregivers to enhance the application of this patient-centered outcome measure., (© 2024. The Author(s).)

Objective: Lupus nephritis (LN) is one of the most severe manifestations of SLE; however, we know little about the lived experience of LN. This research investigates patient experiences and perspectives of (1) LN diagnosis; (2) living with LN; and (3) LN healthcare and treatment., Methods: Patients aged ≥18 years with biopsy-proven pure or mixed International Society of Nephrology/Renal Pathology Society class III, IV or V LN were purposefully recruited from a Canadian lupus cohort to participate in semistructured in-depth interviews., Results: Thirty patients with LN completed the interviews. The mean (SD) age was 42.1 (16.4) years, and 86.7% were female. Participants described challenges seeking, receiving and adjusting to a LN diagnosis, and some reported that their diagnosis process took weeks to years. While 16 participants were provided resources by healthcare providers to help them through the process of diagnosis, the need for accessible LN-specific information at diagnosis was highlighted (n=18). Participants also described the unpredictability of living with LN, particularly related to impacts on physical and mental health, relationships, leisure activities, employment and education, and family planning. While most (n=26) participants reported a positive impression of their care, the side effects of LN medications and the need to increase patient and societal awareness/understanding of LN were highlighted in the context of healthcare and treatment., Conclusions: The unpredictability of living with LN, the heavy treatment burden and a lack of patient/societal awareness substantially affect the lived experience of LN. These findings will inform the development of LN-specific patient resources to increase understanding of LN and improve well-being for patients., Competing Interests: Competing interests: FSC and SJE have no conflicts of interest to disclose. MRWB has received consulting fees from AbbVie, AstraZeneca, Janssen, GSK and Sanofi-Genzyme. KC has received consulting fees from Novartis and speaker fees from Alexion. SG and AB are employees of GSK. AB also holds stock/shares in GSK. AEC has received grant/research support from GSK, and consulting fees from AstraZeneca, Bristol Myers Squibb and GSK., (© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Objective: To model the referral, diagnostic and treatment pathway for cardiovascular disease (CVD) in the English National Health Service (NHS) to provide commissioners and managers with a methodology to optimise patient flow and reduce waiting lists., Study Design: A systems dynamics approach modelling the CVD healthcare system in England. The model is designed to capture current and predict future states of waiting lists., Setting: Routinely collected, publicly available data streams of primary and secondary care, sourced from NHS Digital, NHS England, the Office of National Statistics and StatsWales., Data Collection and Extraction Methods: The data used to train and validate the model were routinely collected and publicly available data. It was extracted and implemented in the model using the PySD package in python., Results: NHS cardiovascular waiting lists in England have increased by over 40% compared with pre- COVID-19 levels. The rise in waiting lists was primarily due to restrictions in referrals from primary care, creating a bottleneck postpandemic. Predictive models show increasing point capacities within the system may paradoxically worsen downstream flow. While there is no simple rate-limiting step, the intervention that would most improve patient flow would be to increase consultant outpatient appointments., Conclusions: The increase in NHS CVD waiting lists in England can be captured using a systems dynamics approach, as can the future state of waiting lists in the presence of further shocks/interventions. It is important for those planning services to use such a systems-oriented approach because the feed-forward and feedback nature of patient flow through referral, diagnostics and treatment leads to counterintuitive effects of interventions designed to reduce waiting lists., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY. Published by BMJ.)

Competing Interests: There are no conflicts of interest.

Results: While the inferior longitudinal fasciculus was more strongly related to spelling behaviour in skilled adults, the uncinate fasciculus was more strongly related to spelling behaviour in impaired adults. We found strong left lateralization of the arcuate fasciculus and inferior longitudinal fasciculus in both groups. However, lateralization of the inferior frontal occipital fasciculus was more strongly related to spelling response time behaviour in skilled adults, whereas lateralization of the uncinate fasciculus was more strongly related to spelling accuracy behaviour in the impaired adults., Conclusion: This study provides some useful information for understanding the underlying white matter pathways that support spelling in skilled and impaired adults and underscore the advantage of adopting multiple spelling tasks and outcomes (i.e., response time and accuracy) to better characterize brain-behaviour relationships in skilled and impaired adults.

Background: Although morbidity and mortality from COVID-19 have been widely reported, the indirect effects of the pandemic beyond 2020 on other major diseases and health service activity have not been well described., Methods and Results: Analyses used national administrative electronic hospital records in England, Scotland, and Wales for 2016-21. Admissions and procedures during the pandemic (2020-21) related to six major cardiovascular conditions [acute coronary syndrome (ACS), heart failure (HF), stroke/transient ischaemic attack (TIA), peripheral arterial disease (PAD), aortic aneurysm (AA), and venous thromboembolism(VTE)] were compared with the annual average in the pre-pandemic period (2016-19). Differences were assessed by time period and urgency of care.In 2020, there were 31 064 (-6%) fewer hospital admissions [14 506 (-4%) fewer emergencies, 16 560 (-23%) fewer elective admissions] compared with 2016-19 for the six major cardiovascular diseases (CVDs) combined. The proportional reduction in admissions was similar in all three countries. Overall, hospital admissions returned to pre-pandemic levels in 2021. Elective admissions remained substantially below expected levels for almost all conditions in all three countries [-10 996 (-15%) fewer admissions]. However, these reductions were offset by higher than expected total emergency admissions [+25 878 (+6%) higher admissions], notably for HF and stroke in England, and for VTE in all three countries. Analyses for procedures showed similar temporal variations to admissions., Conclusion: The present study highlights increasing emergency cardiovascular admissions during the pandemic, in the context of a substantial and sustained reduction in elective admissions and procedures. This is likely to increase further the demands on cardiovascular services over the coming years., (© The Author(s) 2022. Published by Oxford University Press on behalf of the European Society of Cardiology.)

Background: Pancreatic cancer (PC) carries a high risk of venous thromboembolism (VTE). Several risk assessment models (RAMs) predict benefit of thromboprophylaxis in solid tumors; however, none are verified in metastatic pancreatic cancer (mPC)., Methods: A retrospective mPC cohort treated at an academic cancer center from 2010 to 2016 was investigated for VTE incidence (VTEmets). Multivariable regression analysis was used to assess multiple VTE risk factors. Overall survival (OS) was compared between mPC groups with and without VTE. Survival was analyzed using Kaplan-Meier survival plots and Cox proportional hazards regressions., Results: 400 mPC patients (median age 66; 52% males) were included. 87% had performance status of ECOG 0-1; 70% had advanced stage at PC diagnosis. Incidence of VTEmets was 17.5%; median time of occurrence 3.48 months after mPC diagnosis. Survival analysis started at median VTE occurrence. Median OS was 10.5 months in VTEmets vs. 13.4 in non-VTE group. Only advanced stage (OR 3.7, p = .001) correlated with increased VTE risk., Conclusions: The results suggest mPC carries a significant VTE burden. VTE predicts poor outcomes from the point of median VTE occurrence. Advanced stage disease is the strongest risk factor. Future studies are needed to define risk stratification, survival benefit, and choice of thromboprophylaxis., (© 2023 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)