A 55-year-old male cancer patient with ICI therapy (PD-1 antibody) started to manifest myasthenia gravis (MG) symptoms, cardiac injury, intermittent third-degree atrioventricular block, and ventricular pause necessitating temporary cardiac pacing. Intravenous steroids and immunoglobulin, pyridostigmine, and mycophenolate mofetil were sequentially initiated and the above symptoms were gradually resolved.

Very recently one has started to study Bergman and Szeg\“o kernels in the setting of octonionic monogenic functions. In particular, explicit formulas for the Bergman kernel for the octonionic unit ball and for the octonionic right half-space as well as a formula for the Szeg\”o kernel for the octonionic unit ball have been established. In this paper we extend this line of investigation by developing explicit formulas for the Szeg\“o kernel of strip domains of the form ${\cal{S}} := \{z \in \mathbb{O} \mid 0 < \Re(z) < d\}$ from which we derive by a limit argument considering $d \to \infty$ the Szeg\”o kernel of the octonionic right half-space. Additionally, we set up formulas for the Bergman kernel of such strip domains and relate both kernels with each other. In fact, these kernel functions can be expressed in terms of one-fold periodic octonionic monogenic generalizations of the cosecant function and the cotangent function, respectively.

background：Periodic fever, aphthous stomatitis, pharyngitis and cervical adenitis (PFAPA) syndrome has been considered as a childhood syndrome. Its etiopathogeny is unknown however, currently considered as auto-immune inflammatory disease. Recently, a few cases of adult-onset of PFAPA syndrome have been reported. However, there is no report about the adult-onset of PFAPA case with a novel TNFAIP3 Mutation. Objective and Method: Followed by detailed clinical inquiry, related laboratory tests, genetic sequencing and treatment, we reported a case with the adult-onset of PFAPA syndrome with a novel TNFAIP3 Mutation. Results：we have found a novel mutation in the gene TNFAIP3 in an adult patient with periodic fever, aphthous stomatitis, pharyngitis, and adenitis—the PFAPA syndrome, under the environmental factor-COVID-19 vaccination. Conclusion：This case demonstrated adult-onset of PFAPA symptoms, including periodic fever of unknown origin, which can occur in adult patients with the familial hereditary TNFAIP3 mutation and environmental factors. And the therapeutic measures provide some reference and practical significance for the treatment of PFAPA syndrome. Keywords: adult-onset of PFAPA, TNF alpha induced protein 3, periodic fever, aphthous stomatitis, pharyngitis, adenitis, case report

Deeply rooted in its developmental philosophy of gross national happiness (GNH), Bhutan’s healthcare system strives towards achieving a shared goal of universal health coverage (UHC). Despite being primarily financed by the government, the healthcare system faces a plethora of challenges. To overcome these hurdles and achieve UHC goals, expanding the fiscal space for health and improving operational efficiency is crucial. This policy brief aims to address Bhutan’s evolving healthcare landscape and advance the achievement of UHC through two policy options. The first policy option focuses on dual objective of improving health outcomes and promoting financial sustainability by leveraging heath taxes, while the second option emphasises reinforcing a systematic Health Technology Assessment (HTA) in the healthcare system. First, to promote financial sustainability, the proposal suggests introducing earmarked taxes on alcohol and tobacco products for the health sector. Global evidence suggests that earmarked taxes are a reliable source of revenue for health, and Bhutan’s high prevalence of tobacco and alcohol consumers assures a reliable revenue base. The Goods and Services Tax (GST) will be implemented in 2024, and it will be a good opportunity for the Ministry of Health to advocate and negotiate with Ministry of Finance (MoF) for the earmarked taxes to the health sector. Second, integration of HTA into policymaking and decision-making processes is essential for effective resource allocation in UHC. Nurturing and strengthening the existing HTA structure under MoH and establishing a dedicated multidisciplinary HTA Committee will ensure informed decision-making and resource optimization. HTA evidence should abided to revise health service standards, develop clinical guidelines, make procurement decisions, and set healthcare priorities. These policy options can assist the country in improving ensure financial sustainability, enhance effective resource allocation and utilisation, and improve healthcare delivery, aligning with its vision of GNH and ultimately accelerating progress towards achieving UHC.

As our understanding of the uncommon group of disorders called plastic bronchitis has evolved, so too has the classification of these disorders.

Purpose : To determine whether extent of surgical resection of the primary tumour correlates with survival in patients with International Neuroblastoma Staging System (INSS) stage 4, high-risk neuroblastoma. Methods : Data were extracted for patients with newly diagnosed INSS stage 4, high-risk neuroblastoma between 2001-2019 from the national Cancer in Young People in Canada (CYPC) database. Complete resection was defined as gross total resection of primary tumour based on operative reports. Primary endpoints were 3 and 5-year event-free (EFS) and overall survival (OS). Survival analyses were completed using log-rank test and Cox proportional hazards regression including covariates of age, sex, decade of treatment (2001-2009 vs. 2010-2019), immunotherapy, and tandem stem-cell transplant (SCT). Results : One-hundred and forty patients with complete surgical data were included. On univariate analysis, 3-year EFS and OS for patients that had complete vs. incomplete resection was 71% (95% CI 57-80%) vs. 48% (36-60%) and 86% (75-93%) vs. 64% (51-74%), p=0.008 and p=0.002, respectively. 5-year EFS and OS for patients with complete resection also demonstrated significantly improved survival. On Cox Proportional Hazards models adjusted for age, immunotherapy, tandem SCT and surgical resection, only complete resection was associated with statistically significant improved 3 yr EFS and OS, HR=0.48 (0.29-0.81; p=0.006) and HR=0.42 (0.24-0.73; p=0.002). Conclusions : In a large Canadian INSS stage 4 high-risk neuroblastoma cohort, complete surgical resection was associated with increased EFS and OS. Within the constraints of a retrospective study, these results suggest that the ability to achieve primary tumor complete resection in patients with metastatic high-risk disease is associated with improved survival.

In this paper, we study the simplest quadratic matrix equation: $\mathcal{Q}(X)=X^2+BX+C=0$. We transform this equation into an equivalent fixed-point equation and based on it we construct the Krasnoselskij method. From this transformation, we can obtain iterative schemes more accurate than successive approximation method. Moreover, under suitable conditions, we establish different results for the existence and localization of a solution for this equation with the Krasnoselskij method. Finally, we see numerically that the predictor-corrector iterative scheme with the Krasnoselskij method as a predictor and the Newton method as corrector method, can improves the numerical application of the Newton method when approximating a solution of the quadratic matrix equation.

Tailgut cyst, a type of retro-rectal cyst, is a rare condition requiring evaluation for malignant transformation. We report a case of squamous cell carcinoma arising in the retro-rectal cyst, in a 51-year-old female who underwent incomplete resection of the cyst and chemo-radiotherapy, subsequently became locally recurred and metastatic.

Myonecrosis and compartment syndrome are rarely seen in sickle cell disease (SCD). Myonecrosis and compartment syndrome have not been previously reported in HbSC. This case report presents the first case of an HbSC patient presenting to emergency department (ED) with bilateral leg pain and swelling.

Insects, the most numerous and diverse group of animal species on Earth, have important interactions with humans through providing resources, transmitting diseases, and damaging agricultural cultivars. Cytochrome P450 monooxygenases (P450s) are one of the most important protein families in insects implicated in the endogenous metabolism and detoxification of xenobiotics, including allelochemicals, insecticides, and environmental pollutants. To better understand the evolution and function of insect P450s and support the development and application of insecticides for pest control, an integrated bioinformatics platform is highly desirable. Here, we present the Insect Cytochrome P450 database (ICPD, http://www.insectp450.net/), which contains 66,513 P450s collected from public databases and predicted from the genomes of 680 insect species using a standardized bioinformatics protocol. Phylogenetic relationships between P450 genes are constructed for each species. The structures of all P450 proteins in the database are predicted using AlphaFold v2 and/or ESMFold, then visualized using WeView. Web services, such as BLAST, homogeneous modeling, and molecular docking, are provided for determining the catalytic activities of P450 proteins. The ICPD will facilitate systematic investigations of the evolution and functions of the complete insect P450 complement, and represents a powerful tool for guiding insecticide design and application.

By designing a novel combined event-triggered control technique, this article analytically studies the distributed leader-following consensus problem of nonlinear fractional chaotic multi-agent systems. First, a novel combined event-triggered mechanism which takes into account both the relative error and the absolute error of the samples is proposed, under which each follower agent executes control update independently at its own event times. Next, a fully distributed event-triggered consensus protocol is designed and the sufficient conditions of consensus are attained. Finally, compared with other event-triggered mechanisms, the simulation experiments illustrate that the event-based consensus protocol proposed in this article can effectively reduce the frequency of actuator data update while ensuring desired consensus performance.

This paper studies the global regularity problem for the 2D micropolar Rayleigh-B e ̵́ nard convection system with velocity zero dissipation, micro-rotation velocity Laplace dissipation and temperature critical dissipation. By introducing a combined quantity and using the technique of Littlewood-Paley decomposition, we establish the global regularity result of solutions to this system.

High frequency heart rate variability (HRV) is a vagally-mediated physiological index reflecting parasympathetic activity that has been linked to emotion regulation capacity. However, very limited research has examined associations of physiological indices of regulation such as HRV with emotional functioning in daily life. The few studies that exist have small samples sizes and typically focus on only a narrow aspect of emotion regulation or emotional functioning. In this study, we examined associations between HRV assessed in the laboratory and emotional/mental health functioning in daily life using a 7-day ecological momentary assessment design in 303 adult community participants. We hypothesized that higher resting HRV would be associated with higher positive affect, lower negative affect, less affective variability, greater wellbeing, fewer depressive and idiographic [person-specific] symptoms, greater use of engagement emotion regulation strategies, and less use of avoidance emotion regulation strategies, as assessed in daily life. Results revealed that higher resting HRV in the laboratory was significantly associated with lower negative affect and less frequent use of avoidance emotion regulation strategies in daily life, although only avoidance strategies remained significant when both were included in the same model. We also observed a trend association, such that idiographic symptoms in daily life were associated with lower resting HRV. Theoretical and clinical implications are discussed, including the association of HRV with negatively-valenced, rather than positively-valenced, daily life experiences.

The performance of industrial strains has gradually improved with the rapid development of synthetic biotechnology. The production efficiency of traditional batch and fed-batch culture is limited and product quality varies since both are dynamic processes, whereas multi-stage continuous culture can maximise the production efficiency of specific fermentation processes and achieve consistent product quality. However, each single-stage fermentation under multi-stage continuous fermentation requires accurate steady-state control, and a model with adequate accuracy is required for designing and controlling a multi-stage continuous fermentation process. At present, there are few reports on kinetic models for the control of multi-stage continuous fermentation. In this work, we constructed a hybrid model for Saccharomyces cerevisiae multi-stage continuous culture, taking both oxygen limitation and Crabtree effect. The accuracy of the model was ~ 80%, advantages and limitations of the model are discussed and potential improvement strategy is proposed.

Introduction: Assessment of and intervention for sleep-disordered breathing and malnutrition are related to respiratory management for preventing recurrent respiratory tract infections (RRTIs) and acute respiratory failure (ARF) in children with spinal muscular atrophy (SMA). However, the specific standard has not been clarified. Purpose: The study aimed to obtain the risk factors and the predictive index for RRTIs and/or ARF in children with SMA. Methods: In this retrospective study, the differences in clinical characteristics in patients with or without RRTIs and ARF were compared, and binary logistic regression analysis was carried out. The best cutoff points of the positive predictive index were obtained. Results: Type 1 (OR = 4.12, 95% CI 1.30-13.07, P =.016) and apnea hypopnea index (AHI) (OR = 1.14, 95% CI 1.05-1.24, P =.001) were risk factors, while body mass index z score (BMIz) (OR = 0.68, 95% CI 0.49-0.94, P =.018) and mean pulse oxygen saturation (MSpO 2) (OR = 0.67, 95% CI 0.50-0.91, P =.010) were protective factors. The sensitivity and specificity of the standard of MSpO 2 < 96% and AHI > 10 events/h or BMIz < -1 with the occurrence of RRTIs and/or ARF were 0.513 and 0.957, respectively. Conclusion: SMA Type 1, BMIz, AHI and MSpO 2 should be used to estimate the risk for RRTI or ARF in children with SMA. MSpO 2 < 96%, and AHI > 10 events/h or BMIz < -1 should be used as the intervention standard.

The Colombian Andean Mountains host the headwaters of the main basins of the country. However, the interactions between high-mountain ecosystems and the isotopic composition of water in this region has been poorly studied. Here we present and analyze the first set of stable isotopes data collected in the Central Andes of Colombia. Stable isotopic composition of stream water and precipitation was determined for a period between 2017 and 2018 in the Upper Claro River Basin. The driving factors influencing the spatial and temporal variability of δ 2H, δ 18O and d-excess were identified and compared to daily air temperature and precipitation at seven meteorological stations. A Local Meteoric Water Line was defined as δ²H = 8.13 δ 18O + 12.5, R 2=0.98. δ 2H, δ 18O and d-excess values of precipitation were more negative during the rainy season and changes were more related to precipitation events and amounts than to temperature. An altitude effect of -0.11 ‰ / 100 m and -0.18 ‰ / 100 m was estimated for stream water and precipitation, respectively, where the latter showed a non-linear behavior. The data set was compared to stations of the Global Network of Isotopes in Precipitation (GNIP) database in Colombia and a back-trajectory analysis of air masses was conducted to compare with d-excess. δ 18O weighted means changed with respect to the position of the Central Andes and the altitudinal range 2,100 to 3,100 m a.s.l.. High d-excess can be attributed to moisture recycling enhanced by the local ecosystems and the travel of precipitable water from the Amazon basin across the northern Andes. The results showed a high range of variation due to the differences in elevation, seasonality and atmospheric circulation patterns across the year. The present study contributes to fill the gap of spatial and temporal isotopic composition data in the northern Andes as well as to the implementation of the first “National Network for Isotopes” in Colombia.

Title: Acute valve malfunction with thrombosed bioprosthetic valve after surgical aortic valve replacementAuthor name: Hiroki Moriuchi, Masaaki Koide, Yoshifumi Kunii, Takuya Maeda, Risa ShimboriAffiliations: SeireiHamamatsu Hospotal, Department of cardiovascular surgeryKey words: thrombus, bioprosthetic aortic valveCorresponding author’s address: 2-12-12, Sumiyoshi, Nakaku, Hamamatsu, Shizuoka, JapanEmail: porimori22@gmail.comAUTHOR CONTRIBUTIONSMasaaki Koide and Takuya Maeda involved in review and editing.ACKNOWLEDGEMENTSI appreciate Mr. Andrew for reviewing manuscript and Yuki Moriuchi for total support.FUNDING INFORMATIONNoneCONFLICT OF INTEREST STATEMENTThe authors report no conflict of interest.DATA AVAILABILITY STATEMENTNoneCONSENT STATEMENTWritten informed consent was obtained from the patient to publish this report in accordance with the journal’s patient consent policy.CASE PRESENTATIONA 74-year-old man with chest pain was diagnosed with Stanford A acute aortic dissection and severe aortic regurgitation. Aortic valve replacement with a 21mm INSPIRIS (Edwards Lifesciences, Irvine, CA, USA) and ascending aortic replacement with 26mm J Graft (Japan Lifeline, Tokyo) was performed. Anticoagulation therapy using heparin and warfarin was started immediately. Postoperative Computed tomography(CT) revealed thrombus formation to all leaflets of the implanted valve(Figure1) and echocardiography revealed restricted leaflet motion, so surgical thrombectomy was performed. Abundant fresh thrombi adhered to all leaflets of the bioprosthetic valve, and those thrombi were carefully removed (Figure2). No damage or macroscopic degeneration on the leaflets were seen, so the implanted valve was preserved. We initiated argatoroban for 1 week, followed by aspirin and warfarin and postoperative CT showed no sign of thrombus. (Figure 3).We previously reported leaflet and coronary stent thrombosis after TAVR2, but acute bioprosthetic valve thrombosis after SAVR is extremely rare.1 Reference1. Cahill TJ, Khalique OK, Geourge Im et al. Valve thrombosis after transcatheter and surgical aortic valve replacement: Incidence and outcomes. J Thorac Cardiovasc Surg. 2022 Apr;163(4):1309-1315.2. Satoshi O, Masaaki K, Yoshifumi K, et al. Leaflet and coronary stent thrombosis after transcatheter aortic valve implantation treated by aortic valve replacement. Eur Heart J Cardiovasc Imaging. 2020 Mar 1;21(3):347Figure legendsFigure1: Computed tomography(CT) shows thrombi in all leafletsFigure2: All thrombi were removed completelyFigure3: Postoperative CT shows no thrombus in bioprosthetic aortic valveKey Clinical MessageAcute valve thrombosis after bioprosthetic aortic valve replacement even under appropriate anticoagulation therapy is extremely rare. Cardiac CT is a powerful imaging tool to detect valve thrombosis after both TAVR and SAVR.

This paper is concerned with the asymptotic stability and instability of solutions to a variable coefficient logarithmic wave equation with nonlinear damping and memory term. This model describes wave travelling through nonhomogeneous viscoelastic materials. By choosing appropriate multiplier and using weighted energy method, we prove the exponential decay of the energy. Besides, we also obtain the instability at the infinity of the solutions in the presence of the nonlinear damping.