In a variety of systems, heat transfer is crucial for the optimal use of energy. The correct interpretation of heat transfer data is driven heavily by data pre-processing. Examples are Data Reconciliation (DR) and Gross Error Detection (GED). These techniques are suitable when a process model is available. This is advantageous compared to statistical methods, since the physical relationships among measured variables are considered. This make the use of DR and GED in heat transfer applications convenient, as conservation laws are usually well derived. This work aims to review the most common methods for DR and GED, in the context of heat transfer equipment. Preliminary concepts for these techniques are provided. Then, each method is described with their advantages and disadvantages. Next, the focus is turned into heat transfer applications. Finally, guidelines are proposed to guide the selection of suitable DR and GED strategies in future heat transfer studies.

In this article, we extend a previously developed globally optimal enumeration methodology for the synthesis of Heat Exchanger Networks to the simultaneous synthesis of the network and the basic design of Heat Exchangers. Our procedure guarantees global optimality, unlike previous approaches, such as Pinch Technology, metaheuristics, or mathematical programming that do not guarantee it and sometimes do not even guarantee local optimality. The procedure is not iterative, and does not present any convergence issues. To enumerate HEN structures, we use linear methods and for the HEX design we use Set Trimming followed by sorting. In addition, because some network structures are incompatible with single shell exchangers, we use multiple shell exchangers in series. The comparison of the results of the proposed approach with two solution alternatives from the literature in two different problems indicates that considerable cost reductions may be obtained.

A document by Zhennan Liu. Click on the document to view its contents.

Phytosterols usually have to be esterified to various phytosterol esters to avoid their disadvantages of unsatisfactory solubility and low bioavailability. The enzymatic synthesis of phytosterol esters in solvent-free system has advantages in terms of environmental friendliness, sustainability, and selectivity. However, the limitation of the low stability and recyclability of the lipase in the solvent-free system, which often requires a relatively high temperature to induce the viscosity, also increased the industrial production cost. In this context, a low-cost material, namely diatomite, was employed as the support in the immobilization of Candida rugosa lipase (CRL) due to its multiple modification sites. The Fe3O4 was also then introduced to this system for quick and simple separation via the magnetic field. Moreover, to further enhance the immobilization efficiency of diatomite, a modification strategy which involved the octadecyl and sulfonyl group for regulating the hydrophobicity and interaction between the support and lipase was successfully developed. The optimization of the ratio of the modifiers suggested that the -SO3H/C18 (1:1.5) performed best with an enzyme loading and enzyme activity of 84.8 mg·g-1 and 54 U·g-1, respectively. Compared with free CRL, the thermal and storage stability of CRL@OSMD was significantly improved, which lays the foundation for the catalytic synthesis of phytosterol esters in solvent-free systems. Fortunately, a yield of 95.0% was achieved after optimizing the reaction conditions, and a yield of 70.0% can still be maintained after 6 cycles.

Power production of offshore wind farms depends on many parameters and is significantly affected by wake losses. Due to the intermittency of wind power and its rapidly increasing share in the total energy mix, accurate forecasting of wind farm power production becomes increasingly important. This paper presents a data-driven methodology for forecasting power production and wake losses of wind farms, taking the dynamics of weather conditions into account. A modular approach is adopted by integrating multiple deep neural networks, resulting in a digital twin of the wind farm that can be interfaced with weather forecasts of different meteorological service providers. Another key advantage of the employed data-driven approach is its high prediction speed compared to physics-based methods, such that it can be employed for applications where real-time power forecasting is required. The methodology has been applied to two large offshore wind farms located within the Belgian-Dutch wind farm cluster in the North Sea.

Background: Corticosteroids are commonly used for intra-articular (IA) treatment of osteoarthritis (OA) in horses; however, there is controversy regarding its use as a multiple-injection treatment and for the appropriate dosing. Objectives: This systematic review collected and critically appraised the current evidence regarding the effects of multiple injections and various doses of corticosteroids for treating osteoarthritis. Study design: Systematic review. Methods: Titles of published articles up to June/2022 generated by searches in PubMed, CAB, and the Web of Science were screened using general inclusion criteria. Each question for corticosteroid effects (multiple treatments and different doses) had further inclusion requirements. The risk of bias was assessed according to the study design. Results: Of 6,417 titles generated by the systematic search, only nine met all inclusion criteria for multiple-injection treatments, and 14 were included for screening the effects of various doses. Most studies showed unclear/high risk of bias. Multiple-injection protocols showed better symptom-modifying changes at first injections with decreased improvements. Disease-modifying changes improved over shorter follow-ups; however, degenerative changes were seen in the longer term. Determining the dose effect of corticosteroids was challenging regarding different doses because there were few in vivo studies. In vitro, lower doses appeared to be safer for articular tissues. Main limitations: Lack of studies regarding the topics. Conclusions: No benefits but drawbacks of multiple IA injections in the long term were found in this review, and results regarding the dose of corticosteroids in OA joints were not consistent in in vivo, but in vitro, studies pointed out that lower doses might be safer for joint tissues.

The gut microbiota (GM), as a forgotten organ”, refers to microbial community that resides the gastrointestinal tract that plays a critical role in a variety of physiological activities in different body organs. The GM affects its targets through neurological, metabolic, immune and endocrine pathways. The GM is a dynamic system that exogenous and endogenous factors have a negative or positive effect on its density and composition. Laboratory animals are known as only model systems for preclinical research, however, each model has its own limitations. Since the establishment of the first animals in the mid-twentieth century, until recently, various methods have been developed to produce these research models in different animals. Methodologically, two main models have used so far to explore the effects of microbiota on physiology and disease in animals. Germ-free (GF) models and antibiotic-induced intestinal dysbiosis. Both methods have strengths and weaknesses. However, recent advanced approaches have also simplified current understanding of these complex interactions. In many fields of host-microbe interactions researches GF animal models are known as appropriate experimental subjects. The use of GF animals enables the direct assessment of the role of the microbiota on all features of physiology. The animal, mainly mice, models present biological model system to either study outcomes of absence of microbes, or to verify the effects of colonization with specific and known microbial species. This paper reviews these current approaches and gives advantages and disadvantages of both models.

Electromagnetic transients program (EMTP) is widely used to analyse transients in power systems. With the increasing interest in integrated energy systems (IESs), it would be beneficial to extend the application of EMTP to multi-physics transients in integrated electrical and heating networks. In this paper, an accurate and efficient lumped-element circuit model of the heating district pipe is developed in EMTP. The pipe is split into segments using spatial discretisation. The application of the numerical discretisation to the energy conservation equation gives the discretised pipe equation which is expressed in the form of a companion model of EMTP. In order to reduce the computational effort, the time-varying terms in the admittance matrix of the companion model of pipe are eliminated. The modification of the admittance matrix is avoided. Furthermore, the internal nodes resulting from spatial discretisation are eliminated, and the pipe model appears as a lumped-element circuit with two external nodes. Case studies are carried out to verify the accuracy and efficiency of the proposed lumped-element circuit model of pipe. The implementation of the proposed pipe model in the EMTP-type simulator enables the analysis of multi-physics transients in a multi-carrier energy system.

Background: The importance of intra-articular corticosteroid treatment for osteoarthritis with its possible adverse effects requires a comprehensive review. Objectives: This review answers the following questions: 1) What evidence is available regarding the symptom-modifying and disease-modifying changes related to a single intra-articular corticosteroid injection for treating osteoarthritis? Moreover, 2) What evidence suggests corticosteroids are detrimental to equine joint health? Study design: Systematic review. Methods: A systematic search was conducted in June/2022 in PubMed, CAB, and the Web of Science. Inclusion criteria were applied to titles and abstracts. For each question, further criteria were applied. The risk of bias was assessed according to the study design. Results: We generated 6,417 titles, and 23 articles fit all inclusion criteria for single-injection corticosteroid treatments; 21 were included regarding corticosteroid effects on joint health. Studies were usually rated as having an unclear risk of bias. Single-injection protocols lead to short-term symptom-modifying osteoarthritic changes with conflicting results regarding disease-modifying osteoarthritis. Healthy joints demonstrated disturbances in metabolism and tissue changes, with dose-dependent effects found in vitro. Main limitations: There is a lack of studies regarding the topics–primarily for equine species. Conclusions: Symptom-modifying osteoarthritic changes after a single injection are short-term; however, a consistent disease-modifying osteoarthritis effect is yet to be established. Joint health appears to be disturbed by corticosteroids as their effects on normal joints show adverse changes in tissues and metabolism.

The reef-building coral genus Acropora is essential for coral reefs due to its role in the reef, as a habitat for other marine organisms. The diversity of coral species might have arisen explosively, accompanied by hybridization in response to historical climate change, Pleistocene, with sea level changes. Here, we aimed from integrative approaches (morphology, genetics, and reproduction) to evaluate the speciation history of the four tabular Acropora species (Acropora aff hyacinthus, A. cf bifurcata, A. cf cytherea, and A. cf subulata). Here, we show that introgression might have a minor role in specifying the four tabular Acropora spp. Instead, rapid genetic divergence occurred, accompanied by morphological differences and gamete incompatibility. Furthermore, extensive morphological analyses showed that these four species were distinguishable from morphology, and their gamete incompatibility was sufficiently high to prevent hybridization. Population structure and principal component analyses with the SNPs (>60,000) indicated these four species were also distinctive, and the ABBA-BABA test did not support introgression among these species. In addition, many coding and noncoding RNA sequences were in the high genetic variances among four species with high Fst loci along the genome. Comparing these orthologs among other Acropora species suggests that many of these genes were under positive selection, which could be associated with their divergence at spawning time, gamete incompatibility, and morphological differences. These results show that the speciation of the tabular Acropora occurred without hybridization, and divergence accompanying the genes’ rapid evolution could be associated with specifying in the species-rich Acropora.

The Southern Ocean surrounding Antarctica harbours some of the most pristine marine environments remaining, but is increasingly vulnerable to anthropogenic pressures, climate change, and invasion by non-native species. Monitoring biotic responses to cumulative impacts requires spatiotemporal baselines and ongoing monitoring - traditionally, this has been obtained by continuous plankton recorder (CPR) surveys. Here, we conduct a 3000 nautical mile environmental DNA (eDNA) transect from Hobart (Australia) to Davis Station (Antarctica). We evaluate eDNA sampling strategies for long-term open ocean biomonitoring by comparing two water volume and filter pore size combinations: large (12 L with 20 μm) and small (2 L with 0.45 μm). Employing a broad COI metabarcoding assay, we found the large sample/pore combination was better suited to open-ocean monitoring, detecting more target DNA and rare or low abundance species. Comparisons with four simultaneously conducted CPR transects revealed that eDNA detections were more diverse than CPR, with 7 (4 unique) and 4 (1 unique) phyla detections respectively. While both methods effectively delineated biodiversity patterns across the Southern Ocean, eDNA enables surveys in the presence of sea-ice where CPR cannot be conducted. Accordingly, 16 species of concern were detected along the transect using eDNA, notably in the Antarctic region (south of 60°S). These were largely attributed to hull biofouling, a recognized pathway for marine introductions into Antarctica. In a warming Southern Ocean, continued biomonitoring is vital for conserving Antarctic ecosystems. We advocate for the long-term implementation of eDNA metabarcoding alongside CPR surveys to facilitate ecosystem-based management of these vulnerable environments.

This paper introduces an open-source solution for real-time object awareness in the context of intelligent vehicles, designed to seamlessly adapt to simulation environments. The system transcends traditional vehicle detection, offering a comprehensive framework that includes object classification, precise location, and rotation estimation. Leveraging a multi-camera setup, our approach provides a comprehensive understanding of the surrounding environment, extending beyond vehicle recognition to include various other objects. What sets our solution apart is its capability to efficiently reformat and transition to simulation environments like Blender, enabling integration and testing within virtual contexts. The core components of our system encompass data collection, preprocessing, deep learning model selection, Use of Look up table, model training, efficient inference, and post- processing techniques. Designed for open-source collaboration, this solution is positioned for continuous improvement, adaptation to evolving needs, and addressing emerging challenges in the field of intelligent transportation and related domains. This paper represents a foundational step towards establishing an accessible and adaptable real-time object awareness system, encouraging innovation and research in the realm of intelligent vehicles and their applications, both in the real world and in simulated environments

COVID-19 caused substantial damage for the world and more than one million individuals succumbed to this contagious disease. During the 2020-2021 autumn-winter season, there was a huge wave of new COVID-19 infection cases in the United States (US). We intend to investigate whether this high COVID-19 burden had a link to adverse drug reactions in the US, thus we extracted online data from the US Food and Drug Administration (FDA) comparing the adverse drug effect-related mortality between two autumn-winter seasons (2020/2021 cohort 1 vs 2022/2023 cohort 2). The primary outcome is measured via multi-variable logistic regression models which adjust age, sex, and drug indication. A second analysis investigated the association between the high COVID-19 burden and the adverse drug effect mortality for the 25 most reported drugs during the two seasons. The average age is 58.87 vs 59.27 years, respectively. In Cohort 1 54.29% are females and in Cohort 2 the percentage is 55.32%. The crude mortality in Cohort 1 is 19.80% and in Cohort 2 it is 20.72%. We did not find a positively significant primary outcome and the odd ratio (OR) of high COVID-19 burden for adverse drug effect mortality is 0.946 (95%CI 0.926-0.965, p < .0001). However, the subgroup analysis shows for some drugs, most of which compromise the immune response, the high COVID-19 burden is linked to increased risk of death significantly. They include adalimumab, clozapine, duplilumab, lendlidomide, palbocicib, pomalidomide, rivaroxaban, tofacitib, ibrutinib, and updadacit. Our study probably provides preliminary evidence supposing that patients suffering an adverse drug effect involving the immune system from medications might be at increased risk for deteriorating outcomes during the high pandemic burden period of a serious and contagious disease. However, future prospective studies are needed to confirm the results. We think an adverse drug reaction mitigation strategy during future pandemics is needed to better protect those who take these drugs.

Objective To identify primary care recorded factors associated with the short-term human papillomavirus (HPV) vaccination among girls and female adolescents. Methods We used the Spanish Pharmacoepidemiological Research Database for Public Health System to identify girls aged 9-18 years in 2007-2016 with ≥1 year of primary care data (start date) and collect baseline characteristics and consultations. The link between those factors and the 1-year HPV vaccination was assessed through multivariate adjusted Odds Ratios (OR; 95% CI). Results Among 388,669 girls identified, 14,999 were vaccinated against HPV during the first year. The vaccination decreased among girls consulting for social (0.62; 0.55-0.70) or adaptation (0.60; 0.38-0.93) problems, prescriptions of benzodiazepines (0.58; 0.35-0.94) or drugs for gastrointestinal symptoms (0.58; 0.38-0.89), with recorded tuberculosis test (0.68; 0.52-0.87), B and C meningitis (0.46; 0.43-0.50) vaccination, consulting the doctor in the last 3 months (0.92; 0.87-0.98) and with severe thinness (0.68; 0.59-0.78) or obesity (0.88; 0.78-0.99). The odds increased among girls with abdominal pain (1.10; 1.04-1.16), prescriptions in the last 3 months (1.17; 1.10-1.25), and vaccinations against chickenpox (1.16; 1.07-1.27), influenza (1.23; 1.08-1.40), hepatitis (1.46; 1.35-1.58) and diphtheria-tetanus (1.91; 1.82-2.01). Conclusions The correlation between the HPV and other vaccinations suggested medical (contra)indications or willingness and knowledge/beliefs that might affect different vaccinations similarly. The higher frequency of the HPV vaccination among females requiring specific treatments or with abdominal pain suggested vulnerability to HPV complications. While a decreased HPV vaccination linked to certain social and personal situations (and benzodiazepines treatment) requires further research.

Using CiteSpace 6.1.R6 bibliometrics software, we retrospectively analysed and mapped 1,184 articles in WOS in terms of co-citation, authors, institutions, keyword co-occurrence, keyword emergence, and keyword frequency, to summarize the hotspots and trends of the research on the health of the rural elderly, and to provide a basis for the research on the health of the rural elderly. The results of the analyses show that: (1) the research on the health of the rural elderly generally shows an annual trend of “fluctuating upward”. (2) The inter-institutional and inter-authorship collaborations show low network density and intermediary centrality, with fragmented research efforts and fewer collaborative achievements. (3) There are some differences in the research hotspots of rural elderly health, but the keyword cluster analysis shows that the research hotspots involve more areas. In the future, we should continue to broaden the depth and breadth of rural elderly health research.

1. Secondary metabolites produced by primary producers have a wide range of functions as well as indirect effects outside the scope of their direct target. Research suggests that protease inhibitors produced by cyanobacteria influence grazing by herbivores and may also protect against parasites of cyanobacteria. In this study we asked whether those same protease inhibitors produced by cyanobacteria also can influence interactions of herbivores with their parasites. 2. We used the Daphnia-Metschnikowia zooplankton host-fungal parasite system to address this question because it is well documented that cyanobacteria protease inhibitors suppress trypsin and chymotrypsin in the gut of Daphnia, and because it is known that Metschnikowia infects via the gut. We tested the hypothesis that Daphnia gut proteases are necessary for Metschnikowia spores to be released from their asci. We then also tested whether diets that decrease trypsin and chymotrypsin activity in the guts of Daphnia lead to lower levels of infection. 3. Our results show that chymotrypsin promotes release of the fungal spores from their asci. Moreover, a diet that strongly inhibited chymotrypsin activity in Daphnia decreased infection levels, particularly in the most susceptible Daphnia clones. 4. Our results support the growing literature that cyanobacterial diets can be beneficial to zooplankton hosts when challenged by parasites and uncover a mechanism that contributes to the protective effect of cyanobacterial diets. Specifically, we demonstrate that host chymotrypsin enzymes promote dehiscence of Metschnikowia spores; when cyanobacteria inhibit activity of chymotrypsin in hosts, this most likely traps the spore inside the ascus, preventing the parasite from puncturing the gut and beginning the infection process. 5. This study illustrates how secondary metabolites of phytoplankton can protect herbivores against their own enemies.

Excessive generation of reactive oxygen species (ROS) resulting in oxidative stress and plays a crucial role in the progression of inflammatory bowel disease (IBD), which may in turn serve as a potential therapeutic target. To date, efforts on ROS scavenging systems have been focused predominantly on metal oxide nanoenzymes and polyphenol-based nanomaterials. Polyphenols, as a natural plant extract, have attracted increasing interests and showed great antioxidant properties in IBD therapy. The unique catechol groups in polyphenols allowing them to interact with biomolecules, such as proteins and nucleic acids. Additionally, the strong metal ion chelating ability of catechol enriched the structure and function of nanomaterials. This characteristic not only improves the physicochemical properties of polyphenols based nano-carriers but also enables innovative designs of multifunctional drug delivery systems (DDSs). To date, research on polyphenol-based DDSs has increased, including epigallocatechin gallate (EGCG), curcumin (CUR), resveratrol, tannic acid (TA), rosmarinic acid (RA) and dopamine (DA). In this review, we mainly focus on the design and application of natural polyphenol based nanomaterials in IBD, providing a comprehensive discussion on the use of polyphenols in DDSs. We will also discuss the potential challenges in innovative drug delivery strategies, including their impact on the physical and chemical properties of drug delivery systems.

Background: Parkinson’s disease (PD) continues to be a neurological challenge with limited therapeutic options. This study aimed to investigate the potential therapeutic effects of GM3 ganglioside, focusing on its role in mitigating LPS-induced parkinsonism behaviors, gliosis, and neurotoxicity. Methods: We employed a range of in vivo tests, including rotarod and beam-walking, to assess motor function improvements in LPS-induced parkinsonism following GM3 ganglioside pre-treatment. Dopaminergic neurotoxicity was examined using [18F]FE-PE2I PET imaging and TH staining of the striatum. Further, we investigated the impact of GM3 ganglioside on LPS-induced gliosis by observing changes in microglial activation and astrocytic proliferation. Results: Pre-treatment with GM3 ganglioside significantly improved motor functions, as evidenced by enhanced performance in rotarod and beam-walking tests. Our findings also showcased GM3 ganglioside’s efficacy in countering LPS-induced dopaminergic neurotoxicity, with [18F]FE-PE2I PET imaging and TH staining supporting its neuroprotective potential. Importantly, GM3 ganglioside pre-treatment notably reduced LPS-induced gliosis, demonstrating a significant decrease in both microglial activation and astrocytic proliferation. Conclusions: GM3 ganglioside presents promising neuroprotective capabilities, effectively mitigating LPS-induced parkinsonism behaviors and gliosis. These findings underscore GM3 ganglioside’s potential as a valuable therapeutic avenue for future Parkinson’s disease interventions.

Hydrological extremes and wildfires are increasing in magnitude and frequency due to climate change impacts; hence, it is essential to understand the compound effects of these disturbances on the different components of the global carbon cycle, particularly soil respiration (Rs). We conducted an experiment in a randomized complete block design with four replicate blocks to determine the compound effects of soil moisture extremes, types of forest fires, and aspects on Rs in postfire and undisturbed black pine (Pinus nigra Arnold) forest ecosystem. We measured Rs using an automated soil respiration machinery (LI-8100A, LiCor BioSciences), which also measures soil temperature, air temperature, and soil moisture simultaneously. The Rs exhibited significant differences among treatment combinations (p <.0001), time (p <.0001), and moisture regimes (p <0.0001) but not with the interaction effects of treatment x time (p = 0.0058), aspects (p = 0.95410), and types of forest fires (p = 0.0059). The compound effects of soil moisture drought x crown fire x exposed aspect revealed a significantly lowest Rs (1.21 µmol m-2 s-1) among treatment combinations. In contrast, the compound effects of water-saturated soil x types of forest x aspect showed no significant differences compared to the control. The Rs ranged from 1.21 to 1.81 µmol m-2 s-1 for the soil moisture drought x forest fires x aspects, 1.90 to 2.55 µmol m-2 s-1 for the water-saturated soil x forest fires x aspects, and 1.83 to 2.38 µmol m-2 s-1 for the control. The Rs exhibited a positive relationship with the soil temperature (r = 0.59) and the air temperature (r = 0.63) but negatively correlated with the soil moisture (r = -0.33). The soil and air temperatures showed a strongly positive correlation (r = 0.87), suggesting that a near-surface air temperature provides a good approximation of the soil temperature.

This paper introduces version one of an assessment tool developed to address the challenges posed by the assessment of data thickness and richness in primary qualitative studies for Qualitative Evidence Syntheses (QES). The tool has been in development since 2014. Three pilot versions from three review teams have been used in six Cochrane reviews. Key members from the original three review teams came together to create a consensus-based definitive version 1 of the tool for publication. Four review authors piloted the version 1 tool. The definitive version 1 assessment tool consists of two components: assessing the thickness of contextual data and assessing the richness of conceptual data. A sliding scale with four points is used to rate these aspects, offering nuanced and qualitative judgments. The accompanying guidance emphasizes the importance of assessing data that addresses the review question. Paragraph locked by Heather Melanie R Ames The paper provides guidance on how to apply the tool, emphasizing the importance of reaching a consensus among review authors, and fostering a shared understanding of what constitutes rich and thick data in the context of the review. The potential challenges related to the time and resource constraints of this additional review process are acknowledged. Version 1 of the data thickness/richness assessment tool represents a significant development in QES methodology, filling a critical gap in tools for evaluating the richness of conceptual data and the level of contextual detail in primary qualitative studies. It enhances the transparency and rigor of the sampling process and offers valuable insights for assessing the thickness and richness of data in primary qualitative studies that addresses the review requestion, objectives and context as specified in the review protocol. The authors invite feedback from the research community to further test, refine and improve this tool based on wider user experiences.

Accidental Finding Prior to Rhinoplasty: Rhinolith- A Rare Case ReportKey Clinical MessageThrough this case report, we review a rare radiopacity finding within the nasal cavity and its histopathological findings in order to emphasize the importance of familiarizing oneself with all radiographic findings, regardless of their rarity.Keywords: Rhinoplasty; Nasal Cavity; Nasal Obstruction; RhinolithIntroductionA rhinolith, also known as a nasal calculus, is a densely calcified mass, possibly formed around either external substances such as stones, batteries and plastic, or internal materials including dental epithelium and dried blood clots, within the nasal cavity (1-4). However, its exact etiology remains unknown (2). Typically, it is found either between the maxillary sinus wall and the inferior turbinate or between the nasal septum and inferior turbinate (1). Rhinoliths are generally single, unilateral and have an irregular shape (5). Various sizes and internal structures have been reported based on the nature of the rhinolith’s core, including homogeneous or heterogeneous radiopacities (6). The occurrence of rhinoliths in the oral and maxillofacial structures is rare (1). However, they are more commonly observed in young adults, females, and individuals with a low socioeconomic status (2). Symptoms such as headache, anosmia, nasal obstruction, discharge, swelling, unpleasant nasal odor, halitosis, epistaxis, localized pain, and fever have been reported in approximately 1 out of 10,000 patients visiting ear, nose, and throat (ENT) specialists in relation to rhinoliths, which may persist for months or even years (4, 6). Although rhinoliths are often asymptomatic (7) and may be detected incidentally through routine radiographic imaging (5). Conventional radiographs are useful in differentiating rhinoliths from other lesions and detecting their location, especially in cases where the foreign body has high radiodensity (5, 7). However, computed tomography (CT) is more effective in localizing rhinoliths with lower radiodensity in the core (3).In this case report, we present the incidental detection of a rhinolith through radiographic imaging in a 20-year-old patient who was a candidate for aesthetic rhinoplasty.Case presentationA 20-year-old female came to the outpatient department as a candidate for rhinoplasty. The patient’s general medical history and the head and neck examinations were unremarkable. There were no complaints of nasal obstruction or discharge. On extraoral examination, there was no sensory disturbance and the face was symmetrical except for the nasal septum deviation. Cone beam computed tomography (CBCT) was prescribed to the septum deviation. The CBCT revealed an s-type deviation of the nasal septum, open ostia, and clear maxillary sinus cavity. Additionally, a solitary, densely heterogenic calcified mass measuring 9.3 mm in width, 14.4 mm in height, and 8.7 mm in anteroposterior size was noted in the right nasal fossa between inferior turbinate and nasal septum. The mass was attached to the septum and the superomedial portion of inferior nasal concha and the inferomedial part of the middle nasal concha. The mass was well defined with mix, mostly opaque, and laminated internal view. (fig. 1)Based on the radiographic findings, three differential diagnoses were rhinoliths, paranasal osteoma, and nasal foreign body.The procedure entailed the removal of the lesion under general anesthesia. The lesion, which was attached to the perichondrium, was successfully excised using a nostril approach. Unilateral perforations on the mucosa of the septum and inferior and middle conchae, resulting from the lesion removal, were left unsutured due to their size, allowing them to heal through secondary intention. The excised lesion was sent for histopathological evaluation, and a routine septorhinoplasty was performed. For this purpose, a septal graft was harvested. However, the preserved L-strut proved inadequate in supporting the septal mucosa perforation due to its location and the amount of cartilage graft required. Turbinate outfracture or cauterization were not carried out, although turbinectomy was performed. An internal splint was applied as a routine measure, and follow-up sessions were scheduled for 1 week, 1 month, 3 months, and 6 months after the operation.The histological examination revealed the presence of vascular respiratory epithelium, with subepithelial glands displaying a bland appearance and mild chronic inflammation. Calcified foreign body fragments were also identified. No atypical cells or conclusive evidence of malignancy were detected. The histological findings were consistent with a diagnosis of rhinolith. (fig.2)The patient expressed satisfaction with the results and reported no nasal obstruction. Additionally, the patient noted improved breathing, despite having had no difficulties in breathing prior to the operation. No asymmetry was detected.A CBCT scan was ordered 3 months post-surgery to validate the histopathologic outcomes and confirm the complete removal of the lesion. The CBCT evaluation confirmed the successful and complete excision of the lesion, thus supporting the rhinolith diagnosis. Synechia was found to be limited. (fig.3)DiscussionRhinoliths are uncommon findings, likely caused by the deposition of mineral salts around a nidus, such as a foreign body (8). A high level of suspicion is necessary, and differential causative factors, including osteoma, calcified nasal polyps, and ossifying fibroma should be considered to choose the best treatment approach (9). A variety of symptoms may be reported, depending on the localization and size of the lesion, such as unilateral nasal obstruction, epistaxis, headache, anosmia, epiphora, and purulent rhinorrhea (2, 9). However, rhinoliths can also be asymptomatic (6). Therefore, in cases with no symptoms, radiographic scans can lead to a diagnosis of rhinolith (4). A radiopaque lesion with lesser radiopacity in the center, located in either the nasal cavity or maxillary sinus, is a good predictor for rhinolith (5). However, rhinoliths may also appear as a homogeneous radiopaque view due to the presence of a radiopaque nidus (2).In the present case, CBCT evaluations revealed a mixture of radiopaque and radiolucent radiographic findings. Furthermore, in the absence of any symptoms, a histopathological examination was conducted to establish a definitive diagnosis.In cases where there is a coexistence of septal deviation and rhinoliths, the septum is typically deviated towards the opposite side of the rhinolith (2). This is likely due to the influence of the rhinolith on the cartilaginous septum during mass growth (2). This finding is consistent with our case.Although previous studies have reported the concurrent performance of septoplasty or septorhinoplasty and removing rhinolith (2), the specific details of the septoplasty procedures used are unclear. In this case presentation, we have provided a detailed description of the septorhinoplasty procedure to assist surgeons in surgical planning.The defects in the intranasal mucosal lining may be asymptomatic and do not require additional treatment procedures (10). However, the intranasal exposure of the spreader grafts may occur due to the presence of a defect in the mucosa. Therefore, large defects may require covering the grafts using various techniques to protect them from intranasal exposure (11).A variety of surgical interventions have been introduced to manage perforations of the septal mucosa in cases where the underlying septum is also perforated. These procedures are categorized into local flaps only or incorporation of interposition grafts (10). The local flap may be used unilaterally or bilaterally, unipedicled or bipedicled, and with an anterior or posterior base (12). The interposition graft can also be harvested from various sites including temporalis fascia, conchal cartilage, and tragal cartilage (10). In the present case, despite the absence of supporting septal cartilage, the unilateral perforation of septal mucoperichondrial tissue was left unsutured because of the intact contralateral mucoperichondrial tissue of the septum. Moreover, the internasal splint was used to prevent synechia following the unsutured perforation of the mucosa of the septum and inferior and middle conchae. Favorable outcomes revealed the secondary intention was successfully performed.However, there is insufficient evidence regarding the critical limit of septal mucosa perforation that prevents synechiae and ensures secondary intention. This may also be influenced by many other factors, including the cite of the perforation. Therefore, further researches should be conducted in this matter.Based on the favorable outcomes and absence of complications, the introduced procedure may be useful for assisting surgeons in carrying out septorhinoplasty and successfully removing the rhinolith without concerns about synechia.Conflict of interest statementThe authors have no conflict of interest to declare.ConsentWritten informed consent was obtained from the patient to publish this report in accordance with the journal’s patient consent policy.References1. Orhan K, Kocyigit D, Kisnisci R, Paksoy CS. Rhinolithiasis: an uncommon entity of the nasal cavity. Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontology. 2006;101(2):e28-e32.2. Aksakal C. Rhinolith: Examining the clinical, radiological and surgical features of 23 cases. Auris Nasus Larynx. 2019;46(4):542-7.3. Hsiao J-C, Tai C-F, Lee K-W, Ho K-Y, Kou W-R, Wang L-F. Giant rhinolith: a case report. The Kaohsiung journal of medical sciences. 2005;21(12):582-5.4. Ersözlü T, Gültekin E. Rhinolith in the concha bullosa as a rare location: a case report. Journal of International Medical Research. 2020;48(8):0300060520951019.5. Barros CA, Martins RR, Silva JB, Souza JB, Ribeiro-Rotta RF, Batista AC, et al. Rhinolith: a radiographic finding in a dental clinic. Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontology. 2005;100(4):486-90.6. Maheshwari N, Etikaala B, Syed AZ. Rhinolith: An incidental radiographic finding. Imaging Sci Dent. 2021;51(3):333-6.7. Manzi FR, Peyneau PD, Piassi FP, Machado VdC, Lopes AC. Radiographic and imaging diagnosis of rhinolith in dental clinics: A case report. Revista Odonto Ciência. 2012;27:170-3.8. Seyhun N, Toprak E, Kaya KS, Dizdar SK, Turgut S. Rhinolithiasis, a rare entity: Analysis of 31 cases and literature review. North Clin Istanb. 2021;8(2):172-7.9. Vedasalam S, Sipaul F, Hill A, Porter G. Nasendoscopy for unusual nasal symptoms. BMJ Case Rep. 2010;2010.10. Goh A, Hussain S. Different surgical treatments for nasal septal perforation and their outcomes. The Journal of Laryngology & Otology. 2007;121(5):419-26.11. Toriumi DM. Structure rhinoplasty: lessons learned in 30 years: DMT Solutions; 2019.12. Watson D, Barkdull G. Surgical management of the septal perforation. Otolaryngologic clinics of North America. 2009;42(3):483-93.Figure legends:Fig.1: pre-operative CBCT. (a) sagittal view; (b) coronal aspect; (c) axial section.Fig.2: histopathological micrograph. Note the fragments of calcified foreign bodies.Fig.3: post-operative CBCT. (a) sagittal aspect; (b) coronal view; (c) axial section. Note the limited synechiae in comparison with pre-operative CBCT.

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Objective: We sought to characterize point-of-care lung ultrasound (LUS) findings in children with asthma exacerbations and to determine whether the presence and magnitude of findings were associated with asthma severity. Methods: We enrolled a convenience sample of patients aged 5-18 years presenting with acute asthma exacerbation to a tertiary care pediatric emergency department. Severity of an asthma exacerbation (mild, moderate, severe) was assessed within 1-hour of the LUS using the Hospital Asthma Severity Score, a validated asthma assessment tool. LUS was performed by trained pediatric emergency providers . The presence of LUS findings (any B-lines, ≥3 B-lines per view, consolidations, pleural effusion and pleural line abnormalities) was assessed using a standardized criterion. Results: A total of 111 patients with a median age of 8 years (IQR 6, 12) were enrolled. LUS was positive in 57% of patients. Pleural line abnormalities were observed in 34%, B-lines in 29%, consolidations <1cm in 24%, and consolidations ≥1cm in 7 %. Patients with moderate and severe asthma exacerbations were more likely to have any B-lines (31% and 43%, respectively) than patients with mild exacerbations (12%; p= 0.021), however the presence of ≥3 B-lines did not differ across severity groups. The presence of other findings did not differ based upon asthma severity. Conclusions: LUS findings are commonly observed in patients presenting with asthma exacerbations. While B-lines were more likely to be found in exacerbations of higher severity, LUS findings associated with pediatric pneumonia did not correlate with severity. These findings provide valuable information for the diagnostic use of LUS.

Prakriti Adhikari1, Anil Nepali1,2, Amit Shah2, Shailes Paudel2, Prakriti Bhandari2, and Prakash Nepali31 MBBS doctor, Kathmandu University School of Medical Sciences2 MBBS doctor, Patan Academy of Health Sciences3 MBBS doctor, Chitwan Medical CollegeCorresponding AuthorDr. Anil Nepali, Patan Academy of Health Sciencesdr.anilnepali1@gmail.com