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The meso-Rex bypass is a physiological and anatomical bypass procedure for relief of extrahepatic portal vein obstruction and restoration of mesenteric venous return to the liver. Most patients who are candidates for the bypass are children or young adults with portal hypertension and hypersplenism secondary to cavernous transformation of the portal vein. Most frequently, the bypass utilizes an autologous venous graft to connect the intrahepatic left portal vein to the infrapancreatic superior mesenteric vein (SMV) re-establishing first-pass portal perfusion. We describe the preoperative imaging of the 92 bypass candidates, the surgical anatomy as reflected in postoperative imaging, and the imaging of bypass complications at our institution. Preoperative imaging with US, CT and MR is directed to demonstrate patency and size of the left portal vein and SMV, to define the extent of cavernous transformation and splanchnic collaterals, and to assess for any associated abdominal vascular or solid organ abnormalities. Postoperative imaging is aimed at diagnosing meso-Rex bypass stenosis or occlusion and the interventional management of these complications.

A variety of fetal injuries, including those inflicted to the gastrointestinal tract by amniocentesis, have been reported before. This brief report describes the first documented case of sigmoid perforation owing to the common procedure of amniocentesis that manifested as abdominal distention at birth. A potential link between this complication and a recent increased incidence of \"intrauterine spontaneous perforation\" of the gastrointestinal tract has been mentioned. Practicing radiologists are encouraged to inquire directly about the history of amniocentesis in unexplained cases of intrauterine intestinal perforation.

OBJECTIVES: To determine whether there is an unconfounded association between neonatal intraventricular hemorrhage (IVH) and lenticulostriate vasculopathy (LSV (also known as thalamostriate or mineralizing vasculopathy)). STUDY DESIGN: During the conduct of the Magnesium and Neurologic Endpoints Trial (MagNET), a randomized controlled trial involving maternal, hence fetal, exposure to antenatal magnesium sulfate in the context of preterm labor, head ultrasounds were obtained for each of the surviving neonates. Because of our previous experience in the diagnosis of LSV, when ascertaining the presence of IVH, as called for by the research protocol of our study, the presence or absence of LSV was also determined. RESULTS: We found LSV to be relatively prevalent (10% (14 of 140) among surviving babies). More importantly, it was significantly associated with the occurrence of neonatal IVH, even when controlled for possible confounding (adjusted OR 9.8, 95% confidence interval 1.3 to 73.1; p =0.03). CONCLUSION: Given the known relationships between IVH and neonatal morbidity and mortality, the finding of a statistically significant association between neonatal IVH and LSV may suggest more substantial implications for the latter than previously believed.

A roundtable discussion on the medical condition of a 4-month-old girl with bilious emesis, featuring Karna Murthy, Lisa Abramson, Marlet Reynolds, among others, and with moderation by Robert Listernick, is presented. The main diagnostic consideration in a newborn with abdominal distention and bilious emesis is a malrotation with volvulus. Other potential concerns include lower intestinal obstruction such as jejeunal or ileal atresia, necrotizing enterocolitis, or sepsis.

Cell-free DNA (cfDNA) in human plasma provides access to molecular information about the pathological processes in the organs or tumors from which it originates. These DNA fragments are derived from fragmented chromatin in dying cells and retain some of the cell-of-origin histone modifications. In this study, we applied chromatin immunoprecipitation of cell-free nucleosomes carrying active chromatin modifications followed by sequencing (cfChIP-seq) to 268 human samples. In healthy donors, we identified bone marrow megakaryocytes, but not erythroblasts, as major contributors to the cfDNA pool. In patients with a range of liver diseases, we showed that we can identify pathology-related changes in hepatocyte transcriptional programs. In patients with metastatic colorectal carcinoma, we detected clinically relevant and patient-specific information, including transcriptionally active human epidermal growth factor receptor 2 (HER2) amplifications. Altogether, cfChIP-seq, using low sequencing depth, provides systemic and genome-wide information and can inform diagnosis and facilitate interrogation of physiological and pathological processes using blood samples. Circulating cell-free DNA from patients is analyzed by ChIP-seq to reconstruct gene expression in human organs and tumors.

The return of large carnivores to human-dominated landscapes complicates predator–prey dynamics. While predator and anthropogenic effects are well-documented in intact systems, their interplay in fragmented landscapes remains understudied. We examined whether apex predators still regulate prey and mesopredators in the large mammal community of the Golan Heights—a mosaic of nature reserves, farmland and military zones—where wolves ( Canis lupus ), golden jackals ( Canis aureus ) and wild boar ( Sus scrofa ) are culled to mitigate agricultural losses and human-wildlife conflict. Using 60 camera traps and high-resolution culling data, we quantified predator–prey and intraguild relationships, identifying land protection thresholds at which they shifted. We found that endangered mountain gazelles ( Gazella gazella ) were most active in protected areas (top 50% of sites) with higher wolf activity and consistently avoided jackals. Species-specific culling increased jackal activity but decreased boar activity in nonprotected areas (lower 65% and 62% of sites, respectively), outweighing the suppressive effects of wolves. While jackal culling modestly benefited gazelles in protected areas, the positive association between wolves and gazelles was sevenfold stronger. These findings suggest that apex predators may maintain their ecological roles in fragmented landscapes up to a threshold of human disturbance, beyond which top-down regulation weakens and ecosystem function deteriorates.

This study aimed to evaluate the outcome measures and perceptions of patients with chronic low back pain (CLBP) after being treated with the Enhanced Transtheoretical Model Intervention (ETMI). In this process evaluation mixed-methods study, 30 patients with CLBP electronically completed self-reported measures (function, pain, and fear-avoidance beliefs) before and after ETMI treatment. Subsequently, each patient participated in one-on-one, semi-structured interviews, which were audio-recorded, transcribed, coded, and analyzed thematically. Quantitative analysis showed significant improvements in function (p < 0.001), pain (p < 0.001), and fear-avoidance beliefs (p < 0.001) after receiving ETMI treatment, with a large effect size (Cohen’s d = 1.234). Moreover, the average number of physiotherapy sessions was 2.6 ± 0.6 for the ETMI intervention, while the annual average number in Maccabi is estimated at 4.1 ± 1.5. Three main themes emerged from the thematic analysis: (1) communication between the patient and the practitioner; (2) psychosocial treatment elements, and (3) ETMI as a long-term solution for CLBP. The findings of the current study highlight patients’ perceived need for an open and sincere dialogue and for receiving reassurance and encouragement about their LBP. Notably, they had no problem with the fact that they did not receive passive treatment. Accordingly, together with the significant improvement in post-treatment outcome measures, patients perceived the ETMI method as a practical tool for self-managing their back problems in the long term.

The grey wolf (Canis lupus) population in the Golan Heights is among the densest globally, with 80–100 individuals in <1000 km2 of a multi‐use landscape that includes extensive cattle and sheep grazing. Livestock depredation and retaliatory wolf shootings create ongoing conflict between ranchers, conservationists and management authorities. Using 9 years (2013–2021) of verified cattle predation and wolf shooting records, we evaluated the effects of lethal and nonlethal wolf management strategies through time‐to‐event (survival) analysis, spatial and seasonal assessments and a study case comparison of two ranches with contrasting practices. Lethal control did not reduce recurrent predation at 1 or 36 km2 scales; instead, month and year were stronger predictors, with predation peaking in winter when wild prey availability was lowest. Spatially, 83% of subsequent predation events occurred >6 km from shooting sites, peaking at 6–12 km, indicating a potential spillover effect. The ranch comparison showed that intensive shooting did not lower predation compared to nonlethal management. Practical implication: Lethal interventions are not a consistently effective tool for reducing livestock depredation in high‐density wolf systems. Management should account for ecological side effects of culling and prioritize adaptive nonlethal strategies such as livestock guardian dogs, targeted seasonal calving and rotational grazing. תקציר תקציר אוכלוסיית הזאבים ברמת הגולן היא מהצפופות בעולם, עם כ‐80–100 פרטים באזור של פחות מ־1000 קמ”ר, הכולל מרחבי מרעה נרחבים של בקר וצאן. טריפות המקנה וירי תגובתי בזאבים יוצרים קונפליקט מתמשך בין ,בוקרים גורמי שמירת טבע ורשויות ניהול. מחקר זה בחן את השפעת צעדי ניהול זאבים על טריפות בקר תוך שימוש בתשע שנות רישומים מאומתים של טריפות וירי בזאבים (2013–2021). באמצעות ניתוח ,הישרדות בחינה ,עונתית‐מרחבית והשוואה בין חוות עם אסטרטגיות ניהול ,שונות נמצא כי ירי בזאבים לא הפחית באופן עקבי את הטריפות. במקום ,זאת חודש ושנה היו משתנים מסבירים חזקים יותר, כאשר גם טריפה של בעלי חיים וגם אירועי ירי בזאבים גדלו עם הזמן והגיעו לשיא במהלך החורף ,(נובמבר‐פברואר) כאשר זמינות טרף הבר היא הנמוכה ביותר. בנוסף, ב־83% מהמקרים הטריפות חזרו והתרחשו במרחק העולה על 6 ק”מ מאזור ,הירי דבר המרמז על אפקט “זליגה” לשטחים סמוכים. חוות שניהלו גידול בקר בשיטות לא קטלניות (כלבי ,שמירה ,גידור מרעה מתוכנן) לא סבלו מטריפות גבוהות יותר ביחס לחוות שניהלו ירי אינטנסיבי. מסקנות אלו מדגישות כי ניהול יעיל צריך להימנע מירי כפתרון עיקרי ולהתמקד באסטרטגיות לא ,קטלניות מותאמות עונות ורגישות להקשר ,המקומי כגון ,גידור כלבי ,שמירה תיאום זמני ההמלטה ומרעה מתוכנן. Lethal interventions were not a consistently effective tool for reducing livestock depredations in a high‐density wolf system. Management should account for the ecological side effects of culling and prioritize adaptive non‐lethal strategies, such as livestock guardian dogs, targeted seasonal calving and rotational grazing, to promote more sustainable coexistence.