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Early and accurate identification of clinical warning signs in young infants may help avert sepsis morbidity and mortality in resource-limited settings. To systematically review evidence on the association and accuracy of clinical signs to diagnose sepsis or predict mortality in young infants aged 0 to 59 days to inform management in settings with limited laboratory diagnostics. MEDLINE, Embase, CINAHL, Global Index Medicus, and Cochrane CENTRAL Register were searched from inception through May 2023, with updated searches on September 5, 2024. An umbrella search of systematic reviews was conducted in January 2024. Included studies reported data on 24 infant clinical signs informed by current World Health Organization (WHO) Integrated Management of Childhood Illness (IMCI) and hospital-based algorithms for the care of sick young infants reporting odds ratios (OR), risk ratios, or sensitivity and specificity. Data were extracted independently by 2 reviewers. Quality assessment used the Newcastle-Ottawa, Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2), and Quality Assessment of Prognostic Accuracy Studies (QUAPAS) scales. OR data were pooled using random-effects models. Data analysis was performed from July to September 2025. OR of all-cause mortality, culture-confirmed sepsis, or clinical sepsis (with access to laboratory investigations). Of 7641 studies, 52 studies with 140 885 participants were included. A total of 16 clinical signs were significantly associated with mortality, 11 with culture-confirmed sepsis, and 13 with clinical sepsis. For mortality, the 5 strongest associations were weak, abnormal, or absent cry (OR, 20.48; 95% CI, 6.59-63.67); not able to feed at all (OR, 18.32; 95% CI, 6.00-55.97); not feeding well (OR, 13.39; 95% CI, 6.97-25.72); drowsiness or unconsciousness (OR, 12.46; 95% CI, 6.06-25.62); and prolonged capillary refill (OR, 12.06; 95% CI, 2.77-52.53). The top 5 signs associated with culture-confirmed sepsis were not feeding well (OR, 4.52; 95% CI, 1.10-18.59); prolonged capillary refill (OR, 3.59; 95% CI, 2.05-6.28); lethargy (OR, 3.44; 95% CI, 1.89-6.26); drowsiness or unconsciousness (OR, 3.07; 95% CI, 2.01-4.68); and feeding intolerance (OR, 2.95; 95% CI, 1.67-5.21). All current WHO IMCI clinical signs were significantly associated with mortality or culture-confirmed sepsis. Several signs not in IMCI were identified that may improve identification of life-threatening illness in young infants in resource-limited settings where clinical sign algorithms are the primary diagnostic tool.

BackgroundMigrating birds do not always travel along the shortest possible routes between breeding and wintering sites. Rather, detours are a common phenomenon in response to availability of foraging habitats, generic wind patterns, predation risk, and ecological barriers. The Himalayas are a formidable ecological barrier within the Central Asian Flyway (CAF), but hitherto research has focused on high-altitude flights of species that cross the Himalayas, and thus information on species that circumvent this mountain range is lacking in this understudied migration system.MethodsWe tracked Montagu’s Harriers Circus pygargus for 5 years from their wintering range in India, and found that these long-distance migrants travelled by a grand westward detour around the Himalayas to their breeding areas in Kazakhstan. We calculate the energetic optimality of the detour on the basis of a well-known theoretical model and explain the general migration patterns of Montagu’s Harriers in the CAF. Additionally, we compare ecological factors such as ground elevation, habitat greenness (NDVI), land cover and wind patterns along the actual migration route with the hypothetical shortest route to explain why Montagu’s Harriers follow a detour migration pattern in the CAF.ResultsThe observed (detour) route was on average 1245 ± 94.4 km (27%) longer than the hypothetical shortest direct route. The detour did seem to be optimal for Montagu’s Harriers as per the model that considers a distance of up to 1288 km to be optimal. With the detour, harriers circumvented the high altitudes of the Himalayan plateau, effectively avoiding high ground elevations over 4000 m above mean sea level (AMSL). Harriers followed the same detour during spring and autumn migrations, encountering both supporting and opposing winds, and thus the detour cannot be explained by generic wind patterns. The detour was facilitated by the availability of open natural ecosystems (ONEs) and stopover sites with higher productivity west of the mountain range along the floodplains of the Amu Darya river and in the Thar Desert during spring and autumn respectively.ConclusionWe argue that circumventing the mountain range, as illustrated by our pioneer study on the Montagu’s Harrier, could be a common behaviour among migrating landbirds in the CAF. We also emphasize the importance of the protecting ONEs along the western detour for the long term conservation of migratory birds in the CAF.

This study investigated strategies and actions for inclusion in the national strategic and action plans to increase physical activity (PA) levels in Thai children and youth (≤24y). It also describes the evidence and processes used to develop these plans. A mixed methods study design was employed to develop the plans. The qualitative approach included a document review, focus group discussions with 36 participants, and in-depth interviews with 5 informants. Quantitative data were collected through an online survey, gathering feedback on all proposed strategies from 140 respondents. The development process involved extensive stakeholder participation. Six key themes emerged from the qualitative data, leading to the "EMPACT" strategy. The 6 strategies are promoting PA through educational settings (E), involving families (M), obtaining policy support (P), augmenting research capacity (A), fostering community support (C), and utilizing technology (T). Each strategy contains a set of actions. The survey revealed that stakeholders strongly agreed with the proposed strategies (average scores >4.2 out of 5). Thailand national PA promotional and action plans for children and youth were specifically developed to address the low levels of PA among this population. Key challenges identified for successful implementation include fostering a positive mindset toward PA, establishing a national coordinating body, and integrating plans into the national system. Sharing the contents of these plans, their development processes, and implementation challenges with the international research community offers valuable insights and lessons learned for other countries seeking to advance the promotion of PA among children and youth worldwide.

For the treatment and monitoring of Parkinson's disease (PD) to be scientific, a key requirement is that measurement of disease stages and severity is quantitative, reliable, and repeatable. The last 50 years in PD research have been dominated by qualitative, subjective ratings obtained by human interpretation of the presentation of disease signs and symptoms at clinical visits. More recently, "wearable," sensor-based, quantitative, objective, and easy-to-use systems for quantifying PD signs for large numbers of participants over extended durations have been developed. This technology has the potential to significantly improve both clinical diagnosis and management in PD and the conduct of clinical studies. However, the large-scale, high-dimensional character of the data captured by these wearable sensors requires sophisticated signal processing and machine-learning algorithms to transform it into scientifically and clinically meaningful information. Such algorithms that "learn" from data have shown remarkable success in making accurate predictions for complex problems in which human skill has been required to date, but they are challenging to evaluate and apply without a basic understanding of the underlying logic on which they are based. This article contains a nontechnical tutorial review of relevant machine-learning algorithms, also describing their limitations and how these can be overcome. It discusses implications of this technology and a practical road map for realizing the full potential of this technology in PD research and practice. © 2016 International Parkinson and Movement Disorder Society.

International Journal of Case Reports and Images (IJCRI)International Journal of Case Reports and Images (IJCRI) is an international, peer reviewed, monthly, open access, online journal, publishing high-quality, articles in all areas of basic medical sciences and clinical specialties.Aim of IJCRI is to encourage the publication of new information by providing a platform for reporting of unique, unusual and rare cases which enhance understanding of disease process, its diagnosis, management and clinico-pathologic correlations.

Immunohistochemical study of neuroblastomas, Ewing sarcomas, rhabdomyosarcomas, and Wilms tumors demonstrate specific expression of peripherin and alpha-internexin in 20/22 and 6/22 cases of neuroblastomas, respectively. Microtubule-associated protein 1B (MAP 1B) was strongly and diffusely expressed in all 22 cases of neuroblastomas, but was also focally or multifocally expressed in 9/12 rhabdomyosarcomas and also in the blastema and stroma of 8/11 Wilms tumors. All rhabdomyosarcomas strongly and diffusely express nestin, but this marker was also expressed, multifocally, in 15/22 neuroblastomas and also in the blastema and stroma of all 11 Wilms tumors. NeuN, a neuron-specific nuclear protein, was expressed focally in 1 case of neuroblastoma and diffusely in 2 other cases (3/22). Surprisingly, it was also focally expressed in 2/12 rhabdomyosarcomas. In contrast, all 7 cases of Ewing sarcoma were negative for peripherin, MAP 1B, alpha-internexin, NeuN, and nestin. Thirteen neuroblastomas were also immunostained for neurofilaments, tyrosinase, and anaplastic lymphoma kinase 1 (ALK 1), and were found to be negative for these markers. Our results confirm that peripherin and alpha-internexin are neuroblastoma markers useful for the differential diagnostic work-up of small round cell tumors of childhood. Strong diffuse immunoreactivity for MAP 1B favors a diagnosis of neuroblastoma, whereas strong diffuse immunoreactivity for nestin favors a diagnosis of rhabdomyosarcoma.

Transverse rectus abdominis musculocutaneous (TRAM) flaps have commonly been used as a reconstructive option after total mastectomy or modified radical mastectomy, but they can also serve as an appropriate alternative after bilateral nipple-sparing total mastectomy. In this study, performed from 1992 to 2002, 16 patients underwent TRAM flap breast reconstruction after bilateral nipple-sparing total mastectomy. The indications for bilateral nipple-sparing total mastectomy all involved benign breast disease; these patients were evaluated using a health outcomes study and the aesthetic evaluations of four judges using postoperative photographs. One patient had free flaps and 15 patients received pedicled flaps. Eleven patients had secondary reconstruction with bilateral TRAM flaps after implant removal, and five patients underwent immediate reconstruction with bilateral TRAM flaps. Patients reported satisfactory physical and emotional functioning after the surgery without any significant detrimental effects on quality of life. Follow-up ranged from 3 to 90 months (median follow-up, 21 months). The cosmetic outcome of the reconstructed breast after bilateral nipple-sparing total mastectomy yielded fair to excellent results in the majority (80 percent) of patients. Bilateral nipple-sparing total mastectomy remains an option for women with symptomatic breast conditions or with a high risk of familial breast cancer. Autologous tissue remains a reasonable alternative for reconstruction after bilateral nipple-sparing total mastectomy in the appropriately selected patient. To date, all patients in the study have remained free of breast cancer (range, 2 to 21 years).

This case report presents a patient who developed persistent hiccups after epidural administration of dilute bupivacaine on several different occasions. Substitution of saline for the dilute bupivacaine during epidural steroid injection did not result in hiccups; however, subsequent postoperative epidural analgesia with bupivacaine caused a recurrence of the hiccups.

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Glutamine is utilized as an energy substrate in preimplantation mouse embryos. Glutaminase is the enzyme responsible for the conversion of glutamine to glutamic acid, which then enters the trichloro acetic acid (TCA) cycle as alpha-ketoglutarate. Glutaminase enzyme activity was assessed in preimplantation embryos that developed in vivo, and glutaminase RNA expression was examined in embryos that developed in vivo or were cultured in CZB medium to various preimplantation stages between 1-cell and blastocyst. Glutaminase activity in 1-8-cell-stage mouse embryos that developed in vivo ranged from 0.009-0.01 U/mg protein (2.39-2.95 x 10(-7) U per embryo) and increased 3-4 fold to 0.034 U/mg protein (8.13 x 10(-7) U per embryo) at the blastocyst stage. Relative stage-specific expression of glutaminase RNA was assessed by reverse transcription polymerase chain reaction (RT-PCR) in embryos that developed both in vivo and in CZB culture. In vivo, glutaminase RNA was expressed at the 1-cell stage, declined to 23% of 1-cell levels at the early 2-cell stage, and reaccumulated from late 2-cell through blastocyst stage, where it reached a high of 204% of 1-cell levels. CZB-cultured embryos exhibited a similar pattern of developmental RNA expression, declining to 30% of 1-cell levels at the early 2-cell stage, and increasing RNA expression at the blastocyst stage to 191% of the 1-cell level.