Bilateral Symmetrical Fusion of Permanent Mandibular Lateral Incisors and Canines: A Rare Clinical CaseDr. Suresh Kandagal VeerabhadrappaSEGi University and Colleges, Faculty of DentistryPetaling Jaya, Selangor, 47810, Malaysiadr.suri88@gmail.comDr. Jayanth Kumar Vadivel’Saveetha University, Saveetha Dental College and HospitalsChennai, 600077, Indiajayanthkumar@saveetha.comDr. Mohamed Zahoor Ul HuqhSEGi University, Faculty of DentistryPetaling Jaya, Selangor, 47810, Malaysiadr.mdzahoor@gmail.comDr. Siddharthan SelvarajUniversity of Puthisastra, Faculty of DentistryPhnom Penh, 12211, Cambodiassiddharthan@puthisastra.edu.khProf. Anand MaryaDepartment of Orthodontics , University of Puthisastra,Phnom Penh, 12211, Cambodiaamarya@puthisastra.edu.khDr. Seema YadavSEGi University, Faculty of DentistryPetaling Jaya, Selangor, 47810, Malaysiayadavseemar@segi.edu.my

Thymic Neuroendocrine Tumor Presenting with Cervical Lymphadenopathy: A Case Report and Diagnostic ChallengeXiaohui Xie2, Jinming Tang, Wenxiang Wang1, Desong Yang1, Kele Qin1*1 Second Department of Thoracic Surgery, Hunan Cancer Hospital, Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Tongzipo Road 283, Changsha 410013, China.2Department of Cardiovascular Surgery, the Second Xiangya Hospital, Central South University, Middle Renmin Road 139, Changsha 410011, China.Correspondence: qinkeke@hnca.org.cnAddress: Hunan Cancer Hospital, Tongzipo Road 283, Changsha 410013, China.

This study assesses the potential for water reuse from treated wastewater in the Rio dos Sinos and Rio Sapucaí watersheds in Brazil, applying the Analytic Hierarchy Process (AHP). The criteria evaluated include treatment efficiency, proximity to demand, supply capacity, and legal and institutional frameworks. An interactive dashboard was developed to support decision-making. Results show higher reuse potential in Rio dos Sinos for BOD removal >80%, meeting up to 46% of industrial or 17% of irrigation demand; the municipalities of Esteio, São Leopoldo, and Sapucaia do Sul are highlighted as high-potential areas. Rio Sapucaí shows better performance with 60-80% BOD removal, meeting 100% of industrial or 68% of irrigation demand, with Pouso Alegre identified as a high-potential municipality. Further development of the evaluation matrix and cost estimations are recommended.

Rapidly Progressive Multiple system atrophy - cerebellar type: In a 52 years old Female

We present and discuss Carl Friedrich v. Weizsäcker’s historic 1948 derivation of the 5/3 law for energy dissipation in turbulence. His discussion assumes of a cubic volume filled with isotropic quasistationary turbulence, where he then introduces a systematic partitioning of that volume into ever smaller nested cubes. Weizsäcker’s dimensional analysis in real space parallels Onsager’s 1949 partly k-space and partly real space dimensional analysis, and foreshadows the fractal beta model. We compare several steps in Onsager’s and Weizsäcker’s approaches and then extend Weizsäcker’s dimensional analysis to the beta model. The more recent experimental violations of the assumption of homogeneity and isotropy are discussed. We end with a practical experimental measure for isotropy plus the consideration of the unstable vortex sheet in the ink droplet generation of an anisotropic and inhomogeneous branching cascade from large to small scales.

A case reportAasim Ali1, Armaghana Abdullah2, Anousha Tanveer2, Mukesh Sharma3, Muhammad Abdullah Mushtaq 4, Muhammad Mujtaba4, Summaya Mushtaq51 Department of Neurology, Allied Hospital 1, Faisalabad, Pakistan2 Department of Internal Medicine, Allied Hospital 1, Faisalabad, Pakistan3 Dhankuta District Hospital, Dhankuta, Nepal4 Punjab Medical College, Faisalabad Medical University, Faisalabad, Pakistan5 Shalamar Hospital, Lahore, PakistanCorresponding author: Mukesh Sharma, mukeshsharmakumar95@gmail.com

A Snap in the Night: A Case Report of Penile FractureDennis Awedam Achio1 , Richmond Buckner1 , Mary Monney-Bortey1, Celestine Tsogbe1 , Bernice Ahiadormey1, Priscilla Mary Tetteh1, Eunice Wilberforce A. Achio21Urology Department, University of Ghana Medical Center, Accra, Ghana.2Department of Family Medicine, University of Ghana Medical Center, Accra, Ghana.

Early Optic Nerve Symptoms in Neurosarcoidosis: A Clinical Case ReviewIsabella Passarelli Giabardo Marques1 - orcid.org/0009-0004-1235-9800Caio Henrique Peres Oliani1 - orcid.org/0009-0003-3800-2984Nicoli Lopes de Oliveira1 - orcid.org/0009-0008-6516-3245Jade Pinto de Queiroz Guerra1 - orcid.org/0009-0002-8377-3254Guilherme Lopes Coelho1 - orcid.org/0009-0009-9105-7064Guilherme de Oliveira Aurich1 - orcid.org/0009-0005-7643-6454Marcello Novoa Colombo Barboza1 – orcid.org/ 0000-0001-7573-885XPriscilla Fernandes Nogueira1 – orcid.org/ 0000-0002-3107-67321 Hospital Oftalmológico Visão Laser, Department of Ophthalmology, Santos, SP, Brazil.CORRESPONDENCEIsabella Passarelli Giabardo Marquesisabellamarques_ms@hotmail.com+55 (67) 992967291Department of OphthalmologyHospital Oftalmológico Visão Laser355 Conselheiro Nébias Ave., Vila Matias, Santos - SP, 11015-001, BrazilFINANCINGThis research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.ASSOCIATE ACADEMIC WORKIt does not apply.CONFLICTS OF INTERESTThe authors declare no conflicts of interest related to this case report.ETHICS APPROVAL STATEMENTEthical approval for this case report was obtained through Plataforma Brasil under the approval number CAAE: 84583824.7.0000.0175, in accordance with the Declaration of Helsinki and Resolution CNS nº 466/2012.PATIENT PERMISSION/CONSENT DECLARATIONSFollowing ethical guidelines and journal requirements, the authors declare that informed consent was obtained from the patient to publish this case report. Additionally, the patient consented to using anonymized clinical data and images, ensuring their privacy and confidentiality were maintained. A signed consent form is available.

Background : Recruitment and retention of veterinarians are major problems. Objectives : Investigate equine veterinary surgeons’ perceptions about working in the UK equine veterinary industry. Study design : On-line questionnaire of veterinary surgeon members of the British Equine Veterinary Association (BEVA). Methods : The questionnaire was distributed to equine veterinary surgeons via BEVA newsletters between May and December 2022. Results : There were 480 usable responses (180 males and 297 females; median age 39 years). 81% worked full-time. 86% worked in equine practice (13% in mixed practice). 41% thought there were sufficient staff numbers relative to the workload, with a significant association with age (p<0.001). The median average working week (excluding out of hours) was 52.5 hours. 70% reported “chasing their tail” all the time / frequently. Frequent discrimination from clients was reported by 10% and was statistically associated with age (P<0.001). Over 60% reported they were worried about having complaints lodged by clients with the RCVS, statistically associated with age (p=0.007). 43% felt they received adequate mental wellbeing support from their employer. 50% acquired their current job by personal recommendation. 34.5% said they would likely to be looking for a new job in the next two years. The most important reasons why respondents would consider leaving their current job included work life balance (13%), family (112%), salary (10%), working times (7%), career prospects (6%) and out of hours rota (6%). The most important reasons for staying in their current job were location (12%), team (10%), family (8%), salary (6%), work-life balance (5%), and case load (5%). Conclusions : Recruitment and retention are important problems facing the equine veterinary profession. Working times (including out of hours), work life balance, general and mental wellbeing support remain important factors affecting equine veterinarians’ perceptions about their jobs, especially for younger veterinarians.

Objective: 1. Evaluate whether a sensorised surgical glove can serve as an effective training tool in management of impacted fetal head; mental workload; and improvements needed 2. Examine location and amount of force applied through operators’ hands during simulated disimpaction Design: Feasibility study Setting: National course of rotational vaginal birth and complex caesarean birth Population: Obstetricians of varying levels Methods: Fetal head disimpaction using a model while wearing sensorised glove. Maximum and time-averaged force data were captured by 12 sensors, including amount and location of force. Main Outcome Measures: Mental workload of using the system was evaluated with NASA Task Load Index (NASA-TLX) score and free-text answers. Results: 13 obstetricians of varying seniority participated. One was considered an expert, used as reference. Fingertip sensors: highest maximum force values, consistently across participants. Palmar sensors: relatively high peak forces, greater variability. Dorsal sensors: lower forces overall, high variability. Force during fetal disimpaction was applied in brief, targeted bursts (maximum) rather than continuously (time-averaged). Mental workload was high: NASA-TLX score 53.92 (weighted), 33.75 (unweighted). Desirable improvements identified included: making glove wireless, avoiding need to triple glove, and standardised model. Conclusions: A sensorised glove has been developed and found useful for training and management of impacted fetal head. There was consistent use of fingertips to deliver force, perhaps for precision and control. Variability in dorsal and palmar regions uncovered differences in hand positioning and technique. Funding: MJ studentship: 2901951 (EP/W524335/1) TN studentship: 2925311 (EP/Y034929/1) Royal Society Wolfson Fellowship: RSWF\R3\193013 ERC Proof-of-concept SaferBirths: 101189504

Pulsed Field Ablation Systems for Atrial FibrillationIbrahim Hasan MD, Marwan M. Refaat, MDDivision of Cardiology, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, LebanonRunning Title: PFA Systems for AFWords: 568 (excluding the title page and references)Keywords: Ablation, Pulsed Field, Atrial Fibrillation, cardiac arrhythmias, cardiology, cardiovascular diseasesFunding: NoneDisclosures: NoneCorresponding Author:Marwan M. Refaat, MD, FACC, FAHA, FHRS, FASE, FESC, FACP, FRCPTenured Professor of MedicineTenured Professor of Biochemistry and Molecular GeneticsMember, Division of Cardiology/ Section of Cardiac ElectrophysiologyDirector, Cardiovascular Fellowship ProgramAmerican University of Beirut Faculty of Medicine and Medical CenterPO Box 11-0236, Riad El-Solh 1107 2020- Beirut, LebanonUS Address: 3 Dag Hammarskjold Plaza, 8th Floor, New York, NY 10017, USAOffice: +961-1-350000/+961-1-374374 Extension 5353 or Extension 5366 (Direct)The field of atrial fibrillation (AF) ablation is witnessing a transformative shift with the pulsed field ablation (PFA) technologies. PFA, a non-thermal energy source that selectively targets myocardial tissue while sparing adjacent structures such as the esophagus and phrenic nerve, holds promise in addressing the limitations of conventional thermal ablation techniques. The recent multicenter registry study comparing the FARAPULSE™ pentaspline catheter and the PulseSelect™ circular catheter provides valuable real-world data on procedural characteristics, acute efficacy, and safety of these commercially available PFA systems.This registry, encompassing over 400 patients from six international centers, demonstrated 100% acute pulmonary vein isolation (PVI) success in both cohorts, confirming the robust efficacy of PFA in AF ablation. Notably, procedural times were significantly shorter with the pentaspline catheter (median 36.0 minutes) compared to the circular catheter (median 49.0 minutes, p < 0.001). These findings align with earlier studies, such as the ADVENT trial [1], and a meta-analysis by Aldaas et al [2], which highlighted the procedural efficiency of PFA over traditional thermal ablation techniques. The shorter procedure times observed with the pentaspline catheter may reflect its design optimized for rapid and efficient PVI, though operator experience and workflow factors likely contribute as well. Both systems exhibited low rates of major adverse events, with only 0.5% of patients experiencing a stroke and 0.2% suffering a serious vascular complication. Importantly, minor vascular access site complications were more frequent in the pentaspline group (11.9% vs. 1.1%, p < 0.001), underscoring the need for meticulous vascular access techniques in PFA procedures.The authors appropriately acknowledge several limitations inherent to the study’s observational, non-randomized design. Missing data, potential underreporting of adverse events, and variations in operator experience and institutional protocols across centers could influence outcomes. While most patients underwent standardized post-procedural monitoring and at least one follow-up visit, the possibility of undetected events cannot be fully excluded. Selection bias, although minimized by system availability, remains a potential confounder. Importantly, the study reports only acute procedural outcomes, leaving long-term efficacy, lesion durability, and arrhythmia recurrence unaddressed. While prior studies, including the PULSED AF pivotal trial [3] and data from the MANIFEST-PF Registry [4], suggest promising long-term outcomes for PFA comparable to thermal ablation, randomized controlled trials comparing different PFA systems over extended follow-up periods are needed to establish their relative benefits.This study represents the first head-to-head, multicenter comparison of two commercially available PFA systems in a real-world setting. Despite procedural differences, both systems achieved excellent acute outcomes with low complication rates. The multicenter design, while introducing heterogeneity, enhances the generalizability of findings and provides a broader perspective on current clinical practice. Looking ahead, several critical questions remain: Will the procedural efficiency advantages of the pentaspline catheter translate into meaningful improvements in long-term arrhythmia-free survival? Can the lower incidence of vascular complications with the circular catheter be maintained in larger, diverse patient populations? Moreover, as PFA technology evolves, how will novel catheter designs, lesion assessment tools, and mapping strategies influence clinical outcomes?The findings of this comparative registry study reinforce the safety and efficacy of PFA as an emerging standard for AF ablation. Both the FARAPULSE™ and PulseSelect™ systems demonstrate high procedural success and low major adverse event rates, though procedural characteristics and minor complication profiles differ. Further research—particularly prospective, randomized trials with long-term follow-up—will be critical to define the optimal role of each PFA system and solidify PFA’s position in the therapeutic armamentarium for atrial fibrillation.

Clematis chinensis Osbeck (WLX), an herbal medicine, which has been used to treat diseases for thousand years. In clinic, WLX presents four forms, including unprocessed WLX (SZ), WLX mixed with yellow wine (JB), WLX soaked in yellow wine (JJ) and WLX stir-fried with yellow wine (JC). However, few studies have focused on revealing differences in its composition and activity. In this study, metabolomics was used to screen featured metabolites of WLX and its processed products. Subsequently, network pharmacology was applied to reveal the differences in their activity. The results showed that a total of 310 metabolites were identified, and 11 featured metabolites were selected, such as tracheloside, astilbin and genistein. Network pharmacology analysis suggested that SZ samples mainly exerts its specific therapeutic effects by regulating pain pathways, including glutamatergic synapse, spinocerebellar ataxia and retrograde endocannabinoid signaling. JB, JJ, and JC groups predominantly exert their effects through pathways, including calcium signaling pathway, estrogen signaling pathway and cAMP signaling pathway, thereby inhibiting the development of inflammatory and pain transmission. This study will provide a theoretical basis for clinical application of WLX and its processed products, and offer a reference for their quality control.

The rewilding of captive animals is an important strategy for the rehabilitation of individuals and ecosystems. Assuming that wild animals are better adapted to their environment than captive ones, comparisons between the behaviour of released animals and their wild counterparts would allow an evaluation of how released animals are adjusting to their new environments. African savannah elephants once used for tourism are increasingly being rewilded, but such projects rarely consider long-term post-release monitoring, nor do they compare behavioural patterns of released animals with wild ones. In this study, we compared the movement patterns of 12 African elephants with different experiences of captivity: six captive elephants, subjected to a three-year phased soft release in the western Okavango Delta, Botswana, two elephants released over a decade previously and four wild elephants. GPS fixes were used to calculate the 18:00 daily displacement, 30-minute diurnal and nocturnal distances, and home ranges for all study animals. The effects of captivity level, release phase, year and season on these movement metrics were analysed. Movement patterns of captive elephants showed progressive increase in daily displacement and nocturnal distances and associated reduction in diurnal distances, except for home ranges. The home ranges of previously released and wild elephants were 25% larger when resources were abundant (rainy season) than when they were limited (late flood season). The same seasonal patterns were observed on other movement patterns of previously released and wild elephants, but daily displacement and nocturnal movements were larger in wild animals. This variation could be related to sample size or could indicate that rewilded animals may not fully approximate the movement patterns of wild-born individuals. These results highlight the critical importance of long-term monitoring of animals since the movement patterns of released animals may take several years to adjust and converge towards those of wild counterparts.

Purpose: This study aimed to investigate the proportions of polypharmacy in the macroregions of Brazil, considering socioeconomic and demographic factors and their associations. Methods: A cross-sectional analysis was conducted using data from the second wave (2019–2021) of ELSI-Brazil. The outcome was self-reported polypharmacy. Independent variables included sociodemographic, health, and behavioral factors, such as diabetes and hypertension. Descriptive analyses incorporated sample weights, and Poisson regression was employed to assess associations between polypharmacy and the independent variables. Analyses were stratified by the five macroregions of Brazil: North, Northeast, Southeast, South, and Central-West. Results: Regional disparities in the prevalence of polypharmacy were observed. In the Central-West region, rural residents had a 16% lower prevalence of polypharmacy compared to urban residents (PR = 0.84, 95% CI [0.82–0.85]). In the North, non-white individuals had an 8% higher prevalence compared to white individuals (PR = 1.08, 95% CI [1.02–1.15]), while Black individuals had an 8% lower prevalence than white individuals (PR = 0.92, 95% CI [0.88–0.96]). Age also associated the prevalence of polypharmacy. Older adults aged 80 years or more had a 14% higher prevalence in the Southeast (PR = 1.14, 95% CI [1.08–1.19]) and a 17% higher prevalence in the South (PR = 1.17, 95% CI [1.08–1.27]) compared to younger age groups. Conclusion: This study identified regional disparities in polypharmacy prevalence across Brazil’s macroregions, influenced by factors such as age, chronic conditions, and socioeconomic status. Strengthening primary care, promoting rational medication use, addressing inequalities, and integrating prevention strategies are crucial to mitigating its negative impacts.

This study aimed to elucidate how osteopontin (OPN) affects the growth, invasion, and extrahepatic metastasis of Echinococcus multilocularis (Em) through the p38MAPK signaling pathway of host hepatocytes. C57BL/6J mice were randomly divided into the control group (n = 10), the LV-OPN-0423 group (n = 10), the anti-p38MAPK group (n = 10), and the anti-p38MAPK+LV-OPN-0423 group (n = 10). Em infection models in mice were set up. The mice were fed for 6 weeks under suitable conditions. The mice in the anti-p38MAPK group and the anti-p38MAPK+LV-OPN-0423 group were then given SB202190 (this is an inhibitor of p38MAPK) for 4 weeks, and the mice in each group were injected with corresponding lentivirus diluent once a week for 8 weeks. After the intervention was completed, the liver volume and weight were measured, and the liver was embedded in paraffin and sectioned. Sections were subjected to hematoxylin and eosin (HE), periodic acid-Schiff (PAS), and immunohistochemical staining to observe the growth and invasion of Em, as well as the expression levels of OPN, p38MAPK, and p-p38MAPK of the host. SB202190 hindered Em’s growth, invasion, and migration. The level of OPN facilitated Em’s growth, invasion, and migration, which can be reversed by SB202190. The OPN level promoted the expression of p38MAPK and p-p38MAPK. These results suggested that OPN could regulate Em’s growth and metastasis through the P38MAPK signaling pathway in host hepatocytes, providing evidence that OPN and p38MAPK may be novel molecular targets for treating alveolar echinococcosis.

Title: An Unusual Gastrointestinal Presentation of Sjogren’s Syndrome: A Case ReportOudai Sahwan, MBBS1; Fares Jamal, MD1; Amani Elshaer, MD2; Lin Batha3; Tala Shahin, MD2; Michael M. Pham, MD4.1 Division of Hematology and Oncology, Mayo Clinic, Phoenix, AZ, USA.2 Division of Internal Medicine, Mayo Clinic, Phoenix, AZ, USA.3 College of Medicine, Alfaisal University, Riyadh, Kingdom of Saudi Arabia4 Division of Rheumatology, Mayo Clinic, Phoenix, AZ, USA.

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A new Editor-in-ChiefJohannes A. Lenstra Faculty of Veterinary Medicine Utrecht University The NetherlandsEmail: j.a.lenstra@uu.nlIt is my pleasure to announce that per September 1, 2025, prof. Göran Andersson (Uppsala) will succeed me as Editor-in-Chief of Animal Genetics. It was my honor to serve the ISAG community as editor for 11 years. I would like to thank our authors for their contributions, patience and understanding; the Associate Editors for handling the submissions; our reviewers for their careful reading of the manuscripts; and the ISAG board as well as the Wiley staff for their support.Hans Lenstra Utrecht University Utrecht, The Netherlands.