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Lymphoedema tissue is characterised by excess free fluid and structural changes to the extracellular matrix (ECM) in the form of fibrotic and fatty deposition. These tissue characteristics are integral to the assessment of lymphoedema progression; however, clinicians and researchers often focus on changes in the free fluid, volume and function of lymphatic vasculature to inform practice. Subsequently, little is known about the effect of clinical interventions on lymphoedema tissue composition. This article presents a novel approach to classify lymphoedema tissue. The Localised Objective Characterisation Assessment of Lymphoedema (LOCAL) classification combines diagnostic and clinically meaningful objective assessment thresholds to infer lymphoedema pathophysiological changes in tissue layers. The LOCAL classification method was verified using data from fifteen women with unilateral breast cancer-related lymphoedema who were evaluated at three sites on each arm using high-frequency ultrasound (HFUS), bio-electrical impedance spectroscopy (BIS) and volume measurements. Participants exhibited an uneven distribution of volume between the proximal and distal segments of the arm (p = 0.023), with multiple tissue compositional categories observed across sites on the same limb (p < 0.001). The LOCAL method demonstrated utility in categorising a diverse range of lymphoedema tissue layer changes beyond what can be ascertained from whole-limb measures.

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Screening tools can help with the identification of intellectual disability, but little is known about who uses them. This study analysed anonymous information from 2691 users of an evidence-based, online, intellectual disability screening questionnaire for children and adolescents (CAIDS-Q) to explore the characteristics of the users and of those being screened. The users were split almost equally between parents/family members (48.6%) and professionals (49.9%), with the majority (63.8%) of the latter group being health staff. Significant differences in the characteristics of the children being screened were found, according to whether the user was a parent/family member or a professional, with the overall pattern suggesting that professionals screened children with greater complexity of needs, but about whom less was known. The screened children had a range of areas of difficulties that are common to those with intellectual disability. Implications for practice are discussed.

Malignant urban gas accidents, accounting for only approximately 1 % of the total gas accidents in China, are responsible for over 50 % of fatalities, thus becoming a major cause of public concern regarding gas safety. A comprehensive understanding of the characteristics of historical accidents is an effective way to prevent and reduce future accidents. In this regard, the study meticulously collects and analyzes all malignant gas accidents that occurred in China from 2013 to 2022. This approach can effectively clarify the focus of gas accident prevention, and also facilitate the implementation of more targeted preventive measures. The study provides diverse perspectives and comprehensive statistics on accidents using 10 variables in 6 dimensions: time (year, month, day, hour), location (province, place), gas source, type, cause, and level. In addition to common quantitative statistics, proportional analyses and visual displays, methods such as contingency tables, t-tests, chi-square tests, and cluster analyses were also used to provide more in-depth analyses and identify more potential patterns. The findings elucidate that: (1) Over the past decade, the yearly distribution of malignant gas accidents in China has been relatively stable; but, individual, particularly major accidents, have significantly influenced the overall severity; (2) June and July are the peak months for such accidents; (3) The most severe accidents occur during 6:00-6:59 a.m., 11:00-11:59 a.m., and 11:00-11:59 p.m.; (4) Central and eastern provinces are the epicenters of malignant gas accidents; (5) Residential accommodations, and restaurants and shops are frequently affected; (6) Liquefied petroleum gas, despite comprising merely 8.7 % of the aggregate supply, is implicated in over half of the malignant occurrences and associated fatalities; (7) Explosions account for approximately 78.49 % of these accidents; (8) Among the accident causes, violations of rules by workers stands as the foremost contributor; (9) Malignant gas accidents are generally larger accident. Moreover, this manuscript delves into the underlying reasons behind each noteworthy statistical trend and analyzes the critical issues facing the gas industry. This investigation not only bridges the gap in the statistical profiling of malignant gas accidents within China but also furnishes invaluable insights that may guide preventive measures against urban gas-related disasters. Furthermore, the methodological approaches and variable selections explored in this study lay a robust foundation for future endeavors in the realm of malignant gas accident management research and practice.

In this study, pectin extracted from pomelo peel was investigated using three different combination methods of pulsed electric field (PEF) and cellulase. Three action sequences were performed, including PEF treatment followed by enzymatic hydrolysis, enzymatic hydrolysis followed by PEF treatment, and enzymatic hydrolysis simultaneously treated by PEF. The three corresponding pectins were namely PEP, EPP and SP. The physiochemical, molecular structural and functional properties of the three pectins were determined. The results showed that PEP had excellent physiochemical properties, with the highest yield (12.08 %), total sugar (80.17 %) and total phenol content (38.20 %). The monosaccharide composition and FT-IR analysis indicated that the three pectins were similar. The molecular weights of PEP, EPP and SP were 51.13, 88.51 and 40.00 kDa, respectively. PEP showed the best gel properties, emulsification stability and antioxidant capacity among the three products, due to its high galacturonic acid and total phenol content, appropriate protein and low molecular weight. The mechanism of PEF-assisted cellulase hydrolysis of pomelo peel was also revealed by SEM analysis. These results suggested that PEF pretreatment was the best method, which not only improved the efficiency of enzymatic extraction, but also reduced resource waste and increased financial benefits.

OBJECTIVE: The aim of this study was to identify risk factors for sialolithiasis patients using a large community and hospital-based cohort.
METHODS: A retrospective case-control study was conducted on 20,396 individuals, including 5100 sialolithiasis patients and 15,296 matched controls. Demographics and laboratory data were obtained from electronic medical records. Statistical analyses were performed to identify significant differences between the two groups. A p-value of <0.05 was considered significant.
RESULTS: Sialolithiasis was more prevalent in women, with a mean age at diagnosis of 55.75 years. Several geographic location variables emerged as risk factors for sialolithiasis including Israeli birth, higher socioeconomic communities, and specific areas of residency. Tobacco smoking (odds ratio = 1.46) was a significant risk factor. Low high-density lipoprotein levels, elevated triglycerides, and elevated amylase levels were associated with sialolithiasis.
CONCLUSIONS: This study provides valuable insights into the demographic and laboratory characteristics of sialolithiasis patients, indicating that area of residency and lifestyle factors contribute to the risk of developing sialolithiasis. The findings may contribute to a better understanding of the disease and the development of preventative measures or early diagnostics tools.

Influenza-Associated Encephalopathy/Encephalitis (IAE) is characterized by high incidence and poor prognosis. The aim of this study is to describe the clinical features and outcomes of IAE in pediatric patients.
We performed a retrospective review of hospitalized cases of laboratory-confirmed influenza infection between January 2018 and December 2021. Demographic, clinical, imaging, treatment and outcome data were collected. Statistical analysis was performed using SPSS software.
Of 446 children hospitalized with influenza, 71 cases were identified with a diagnosis of IAE. The median age was 3 years and 46 (64.8 %) were younger than 5 years. Only one patient was vaccinated for seasonal influenza. 46 (64.8 %) patients had abnormal electroencephalogram examination and 47 (66.2 %) had abnormal brain MRI or CT findings. 68 (95.8 %) patients were treated with oseltamivir/peramivir. 12 (16.9 %) patients suffered mortality. Non-survivors were more likely to have lower Glasgow coma score (median 7), longer duration of fever (median 3 days), with underlying medical conditions (P = 0.006), and complications including sepsis (P = 0.003), shock (P < 0.001), respiratory failure (P = 0.006), acute renal failure (P = 0.001), myocardial damage (P < 0.001), coagulation disorders (P = 0.03), electrolyte disturbance (P = 0.001) and hyperlactacidemia (P = 0.003). Non-survivors had higher percentages of corticosteroids (P = 0.003) and immunoglobulin (P = 0.003) treatments compared to survivors.
Children with IAE have a high mortality rate. Lower Glasgow coma score, longer duration of fever, with underlying medical conditions and complications pose a great risk to poor prognosis. Influenza vaccination is recommended to all eligible children.

Background: PalliPed is the first Italian nationwide project aimed at describing the characteristics of patients accessing specialized pediatric palliative care (PPC) and their families, in the main care settings (hospice, home care, and hospital). The project\'s secondary aim is to assess the extent and quality of regional PPC networks/facilities and the number of dedicated resources. In this article, we present the results of the first part of the project. Methods: All Italian PPC centers/facilities were invited to participate in the project. Children and young adults in the care of the specialized PPC networks/structures as of 24 October, 2022, including prenatal care, were involved. Children\'s eligibility for specialized PPC was assessed according to the Assessment Form for Complex Clinical Needs in Pediatrics (ACCAPED Scale) and after a multidisciplinary assessment by the healthcare team. Data were collected through an online survey. Results: A total of 867 patients were described. The lack of adequate specialized PPC service emerged, according to the available estimate of specialized PPC needs, as well as the need for improved referral to PPC by pediatricians or territorial services, particularly for infants and oncological patients. More family support measures also seem necessary, particularly for the mothers. Healthcare providers\' communication skills should be improved to ensure greater involvement of patients and families in care decisions. Conclusions: This analysis represents the first step toward defining a constantly updated database for the census and monitoring of specialized PPC activities at the national level. This research model can be extended to other realities in different countries, allowing comparison of different care models.

Epilepsy accounts for a large part of the global burden of neurological disorders. This review aimed to assess the demographics, clinical characteristics, and management of patients with epilepsy in Saudi Arabia based on studies published from 2018 to 2023. A systematic review was carried out using PubMed, Medline, Embase, and Cochrane Library from January 2018 to January 2023, where key terms related to the epidemiology, clinical characteristics, treatment, and management strategy of epilepsy in Saudi Arabia were used to search for related studies. All relevant articles published in this period in the English language were included, and data about authors, year of the study, sample size, study design, demographic characteristics, clinical characteristics, and treatment strategy were collected. A male preponderance, a 6-24.9% family history of epilepsy, an equal distribution of focal and tonic-clonic epilepsy, EEG abnormalities of 19.7-70%, and a higher prevalence of monotherapy regimens were the main findings of this review.