Cassia angustifolia is a species of a plant from the Senna family that has traditionally been used as a laxative in different herbal products and commercial medicines. There are few described interactions between Senna and drugs, most of them related to electrolyte disturbances due to concomitant use with other laxatives or due to increased intestinal transit that may limit the absorption of drugs with low bioavailability. We present a case with supratherapeutic trough concentration of tacrolimus in a liver transplant patient after concomitant intake of tacrolimus and a herbal product based on Cassia angustifolia, suggesting a possible drug-plant interaction by means of P-glycoprotein. We observe an increase in their plasma concentration 2.8-fold and the AUC 2.1-fold.

This paper introduces a set of datasets grouped under the name Turkish Software Bug Reports (TSBR), which comprises commercial software bug reports from a closed-source project. We investigate and report the statistical properties and classification difficulty of the TSBR datasets. We employ various methods from the text classification literature to apply several classification tasks related to software development on the TSBR datasets. The methods we employ include traditional machine learning (ML) methods such as k-nearest neighbors (KNN) and random forest (RF); sequential deep learning (DL) models such as gated recurrent unit (GRU) and convolutional neural network (CNN); transformer-based language models; and ensembles of the employed models. Our work is among the first efforts in automated bug report classification literature that uses ensembles of DL models.

Natural convective heat transfer finds importance in applications such as cooling of low power electronics, Printed Circuit Boards (PCBs) and of components in a restricted space. The variable load on such components also warrants the study of transient behaviour. In this investigation, unsteady natural convection was numerically computed around thin horizontal flat isothermal plates of different shapes using commercial CFD solver Ansys FLUENT. The plates were maintained at 400K and exposed to air at ambient temperature of 300K. Boussinesq approximation was adopted. Transient heat transfer from the top and bottom surface of the plates were presented in terms of the Nusselt number, Rayleigh number and dimensionless time, calculated using two length scales- 4*Total Area/Total Perimeter and square root area of single side surface area. Rayleigh numbers between 10 5-10 7 were considered. Analysis of the transient heat transfer profiles, calculated using the two length scales revealed that plate shapes had more pronounced effect on the heat transfer process compared to the length scale. Prior to reaching the steady state, the Nusselt number profile undergoes transition from initial conductive phase to convective flow development. Increasing the Rayleigh number tends to shorten the conduction and convective flow development phases. Further investigation revealed that unlike in laminar flow regime, the heat transfer in turbulent regime is significantly affected by fluid flow pattern, influenced by plate shape. Normalized Nusselt number was used to incorporate this shape effect, which enabled obtaining a singular transient heat transfer variation independent of plate shape and size. These profiles would assist the designers to compute the complete transient natural convective heat transfer characteristics of any plate shape using only the steady state heat transfer value.

The population of the Common Leopard (Panthera pardus) are increasingly becoming isolated due to human activities, which has increased human-leopard interaction. Bhutan is experiencing an increase in human-wildlife conflict, partly as the farmland and crops are being abandoned, which has allowed wildlife to encroach upon human settlements. It is extremely difficult to balance farmers’ socioeconomic requirements with ecological conservation. Large animals like tigers and snow leopards have been the subject of much investigation but the leopards have received less attention. To address this gap, a study was conducted to document incidents of livestock depredation by leopards, identify the threats they face, and raise awareness about leopard conservation. Before commencing the field survey, researchers engaged with villagers to gather general information about leopards and their habitats. Data collection involved active participation from the local community, with a total of 340 respondents, mostly comprising elderly villagers and pastoral nomads. Over the past five years, 242 livestock animals fell victim to predators, with the highest number of attacks occurring in 2018. The Common Leopard was responsible for the majority of livestock losses in the study area. Incursions by leopards into human settlements have been on the rise, exacerbating conflicts, especially among rural communities residing near the forest. Some villagers resorted to killing leopards as a form of retaliation against livestock losses and to trade their body parts for various purposes. To address these challenges, forest officials and managers received guidance on monitoring and leopard conservation. The involvement of local communities through extensive awareness campaigns played a crucial role in supporting leopard conservation efforts.

Male ornamentation is usually costly and may show trades-offs with other life-history traits such as paternal care, which can subsequently affect female preference. Studies on female mate choice have mostly examined how mate-choice cues differ in their expression or ability to be detected in different environmental contexts. However, less focus has been placed on examining how external forces affect female preferences. The purpose of this study was to explore how parental investment strategy and mate choice were mediated by ambient temperature. Specifically, we examined how male ornamentation characteristics and subsequent female incubation investment were impacted by ambient temperature in four plover populations that were breeding across an environmental gradient. We discovered that larger males had more ornamented plumage in warmer conditions, and they were favored by larger females who invested an elevated time into incubation. In contrast, in cooler conditions, males' body size and the color of their ornaments were inversely associated, and females showed weak preference for males with more colorful ornaments. These results imply that female preference for male ornament can change in response to ambient temperature and demonstrate that female preference for male ornamentation may be limited in harsher conditions with higher parental care expenses.

Circadian regulation is linked to local environmental adaptation. Accordingly, many species with broad geographic and climatic niches display variation in circadian clock genes. Here we hypothesize that lichen-forming fungi, which occupy different climate zones along elevation gradients, tune their metabolism to local environmental conditions with the help of their circadian systems. We study two species of the genus Umbilicaria, which occupy similar climatic niches along elevation in different continents. Using homology to known functional genes from Neurospora crassa, we identify gene sets associated with circadian rhythms (11 core, 39 peripheral genes) and temperature response (37 genes). Population genomics approaches indicate that nucleotide diversity of these genes is significantly correlated with mean annual temperature, minimum temperature of the coldest month, and mean temperature of the coldest quarter. Altitudinal clines in allele frequencies pertain to several non-synonymous substitutions in core clock components, e.g. white collar-like, frh-like and various ccg-like genes. A dN/dS approach revealed a small number of significant peripheral clock- and temperature-associated genes (e.g. ras-1-like, gna-1-like) that may play a role in fine-tuning the circadian clock and temperature-response machinery. These results highlight the likely relevance of the circadian clock in environmental adaptation, particularly frost tolerance, of lichenized fungi. Whether or not the fungal clock modulates the symbiotic interaction within the lichen consortium remains to be investigated. We corroborate the finding of significant genetic variation in clock components along altitude – not only latitude – as has been reported in a variety of species.

Lignocellulose is a major component of plant biomass. Its decomposition is crucial for the terrestrial carbon cycle. Microorganisms are considered as primary decomposers and evidence increases that some invertebrates may also decompose lignocellulose. We investigated the taxonomic distribution and evolutionary origins of GH45 cellulases in a collection of soil invertebrate genomes and found that these genes are common in springtails and oribatid mites. Phylogenetic analysis revealed that cellulase genes were acquired early in the evolutionary history of these groups. Domain architectures and predicted 3D enzyme structures indicate that these cellulases are functional. Patterns of presence and absence of these genes across different lineages prompt further investigation into their evolutionary and ecological benefits. The ubiquity of cellulase genes suggests that soil invertebrates may play a role in lignocellulose decomposition, independently from microorganisms. Understanding the ecological and evolutionary implications might be crucial for understanding soil food webs and the carbon cycle.

Objective: Ciprofol combined with sufentanil was used to explore median effective dose and 95% confidence interval for inhibiting the upper gastrointestinal endoscopic insertion response in elderly patients using up-and-down sequential allocation trial, provide a reference for clinical rational drug use. Methods: We studied fifty-seven patients who were scheduled to undergo a diagnostic upper gastrointestinal endoscopy. According to age, it is divided into two groups: 65~74 years old and over 75 years old. Using the modified Dixon sequence test method, intravenous bolus of 0.1 μg/kg sufentanil is given after 3 min before ciprofol is administered, the initial dose of ciprofol is 0.4 mg/kg, the upper gastrointestinal endoscopy is placed after reaching the depth of sedation. Results: In the group A, when combined with 0.1 sufentanil, the ED 50 of ciprofol to inhibiting responses to insertion of upper gastrointestinal endoscopy was 0.23 mg/kg， and the 95% CI was 0.09~0.30 mg/kg; in the group B, the ED 50 was 0.18mg/kg，and the 95% CI was 0.13~0.22mg/kg. Conclusion: The ED 50 of ciprofol in combination with sufentanil (0.1 μg/kg) for upper gastrointestinal endoscopy in elderly patients: 0.23 mg/kg in group A, 0.18 mg/kg in group B.

Introduction: Inappropriate sinus tachycardia (IST), a clinical syndrome with distressing symptoms, is characterized by paroxysmal or persistent sinus tachycardia in the absence of any identifiable primary etiology. Sinus node modification is not first line therapy given frequent recurrence and high complication rates. While medical therapy may be effective, symptoms frequently persist. Our objective is to describe the range of arrhythmias encountered during ablation in a cohort of IST patients refractory to medical therapy and to further the understanding of the etiology and mechanism of IST. Methods: We present a retrospective review of 33 patients who underwent sinus node modification for the treatment of therapy-refractory IST. Results: Arrhythmias included IST in 33 patients (100%), atrial tachycardia or frequent premature atrial contractions in 16 patients (48%), atrial fibrillation in 7 patients (21%), typical and atypical atrial flutter in 13 (39%) and 2 patients (6%), respectively, Wolff-Parkinson-White syndrome in 3 patients (9%), AV nodal reentry tachycardia in 3 patients (9%), and ventricular tachycardia or premature ventricular contractions in 4 patients (12%). Accelerated atrioventricular junctional (AVJ) tachycardia was present in 7/33 patients (21%), was refractory to medical therapy and caused disabling symptoms in all seven patients. Patients with AVJ tachycardia required extensive ablation at multiple sites, and 3/7 patients became pacemaker dependent. Conclusion: In patients undergoing SAN modification for IST, multiple arrhythmias were encountered. Accelerated AVJ tachycardia was frequently encountered and required extensive ablation of up-regulated tissue in the AVJ to improve symptoms. Thus, the pathologic process underlying IST may not be limited to the sinus node.

Female thalassemia carriers are often symptom-free until their prenatal visit, discovering their fetus has hydrops fetalis. However, a single alpha-thalassemia gene mutation doesn’t cause this. It requires an additional mutation from both parents, impacting the fetus’s genotype and phenotype. Here, we present a case of a one-year-old girl with an uncommon alpha-thalassemia type. Genetic testing revealed the mother’s heterozygous south-east Asian (SEA) α-gene deletion and the husband’s heterozygosity for a rare non-deletional alpha-thalassemia mutation, hemoglobin (Hb) ADANA. (1-3)

Background: Hyperglycemia contributes to a cascade of inflammatory response mechanisms in kidneys that result in the development of renal hypoxia and angiogenesis with subsequent chronic renal failure. Under a certain degree of hyperglycemia, the kidney possesses self-protection mechanisms through adaptation to hyperglycemia and hypoxia. As the hypoxia-inducible factor-1α (HIF-1α)/vascular endothelial growth factor (VEGF) axis is a key pathway for neovascularization, the inhibition of this axis is a target for renal angiogenesis therapy. Methods: Male Sprague–Dawley rats were exposed to hyperglycemia and subdivided into four groups, namely groups 1, 2, 3 and 4. Renal tissue samples were processed and analyzed to determine pathological and morphological changes, the gene expression of HIF-1α, VEGF, inflammation factor and effect of treatment. Results: We found that with hyperglycemia, HIF1α and VEGF expression were increased, inflammatory mediator IL-6 increased and vascular changes in the kidney tissues are severe in diabetic group. In contrast, the changes are minimal in the treated group. The expression of HIF-1α increased as well as the expression of VEGF, but VEGF expression in group 3 was the lowest. Group 3 had lower levels of IL-6, and least vascular changes. The results revealed that PB treatment suppressed the development of angiogenesis and DN. Conclusion: These findings suggest that affecting the HIF-1α/VEGF signaling pathway to regulate angiogenesis after infliction of hyperglycemic kidney injury may provide clues for the development of novel CKD treatments.

Stock enhancement can effectively increase population sustainablility and improve fishery resources, making it crucial to discern the suitable habitats for stock enhancement based on efficiency considerations. In this paper, a comprehensive model was established to simulate environmental characteristics in the Liaodong Bay. A habitat suitability model was developed by considering the optimal growth conditions of the Portunus trituberculatus larvae (PTL). The coupled model showed that the optimal area for stock-enhancement with PTL occurs in late June, and the initial suitable habitat area identified represents 17.12% of the whole Liaodong Bay. Based on the larval migration model of PTL, the deviation between the larvae and the suitable habitat, as well as the actual available area for stock enhancement, were further determined after larval release in the initial suitable habitat. Only 33.67% of the larvae fulfilled the criteria of remaining within the suitable habitat for 95% of the time, and these larvae represented 6.19% of the whole area of Liaodong Bay. These findings means that the truly area available for stock enhancement is likely to be a very small portion of the entire bay, and more precise release of larvae will be necessary to ensure survival rates after release. Our study actually provides a methodological framework for the identification of suitable environment of stock enhancement. This methodology can provide technical guidance for the stock enhancement of marine larvae with same applicability for other bays, which in turn contributes to the sustainable use of marine ecosystem services and fisheries resources.

Micromagnetic tomography (MMT) aims to go beyond paleomagnetic measurements on bulk samples by obtaining magnetic moments for individual iron-oxide grains present in a sample. To obtain accurate MMT results all magnetic sources and all their magnetic signals should be known. Small particles (<<1 µm) are often not detected by MicroCT analyses, but do have a magnetic signal, and therefore hamper obtaining reliable MMT results. Currently it is unknown how many of these small ‘ghost grains’ are present in basaltic samples. Here we aim to obtain a realistic grain-size distribution for iron-oxides in a typical Hawaiian basalt. We characterize the entire grain-size range of interest to paleomagnetism, from the superparamagnetic threshold of ∼40 nm to multidomain grains with sizes up to 10 μm. This requires a combination of FIB-SEM slice-and-view and MicroCT techniques: FIB-SEM characterizes the grains between 20 nm and 1 μm and MicroCT detects iron-oxides >750 nm. The FIB-SEM and MicroCT data are combined through normalizing the grain-size distribution using the surface area of non-magnetic minerals that are characterised in both datasets. Then, a lognormal-like grain-size distribution is acquired for the entire grain-size range. Our dataset enables future studies to populate (MMT) models with a realistic distribution of even the smallest iron-oxide grains, which ultimately may shed light on the confounding influence of such ghost grains on MMT results.

The paper describes a technique of building basic digital logic circuit’s like NOT gate, NOR gate and NAND gate using a combination of two circuits, one exploiting the phenomena of quantum entanglement and the other is based on conventional electronics, for simplicity the author will refer such circuits as hybrid quantum logic gates(or HQLG).

ABSTRACTThe use of gene editing (GE) technologies like CRISPR/Cas9 on human embryos constitutes a controversial application that would primarily rely on in vitro fertilization (IVF) and preimplantation genetic testing (PGT) technologies to be applicable clinically. In today’s world, IVF is rapidly advancing through artificial intelligence, time-lapse microscopic cinematography, and microfluidics, thereby edging closer to this ethically complex application. PGT results, on the other hand, could possibly be unrepresentative of embryo genomes due to the normalized testing of extraembryonic cell lineages (that form the placenta), instead of testing embryonic cell lineages (that form the embryo): a critical error that is based on outdated science. While the use of CRISPR/Cas9 on human embryos has varied results in different studies, some approaches to the gene-editing tool could prove more effective on embryos than others. The discussion of to what extent this tool should be used has received significant attention in the scientific community. Although, a lack of global consensus gives no clear answer to this essential question for research to continue in this field. This paper will discuss IVF and PGT in the context of human germline gene editing using CRISPR/Cas9, as well as the gene-editing tool’s applications, limitations, and ethical considerations on human embryos.

Yue Lei was once involved in the literature review writing of this article and was responsible for ensuring the correctness of the English writing. However, during the process of revising the article, Yue Lei and Guo Liang had disagreements and conflicts regarding how to modify the content. Therefore, Yue Lei is no longer involved in the editing and publication of this article and bears no responsibility for the content published. As of today, Guo Liang is the sole author of this article. Please be informed. January 20, 2024.

This last decade, Medical Cyber-Physical Systems (M-CPS) have emerged to enable smart healthcare systems to monitor, process and make autonomous decisions without the need to involve doctors and other users. However, M-CPS pose several challenges, the security of medical devices being one of the most critical ones. To deal with these issues, formal reasoning facilities will undoubtedly have a profound impact in this context. In this paper, we present an iterative process which supports design and modeling of any CPS in general, as well as the analysis and the reasoning about its dynamic and secure behavior. In the main phase of this process, we utilize CA-BRS (Control Agent and Bigraphical Reactive System) model, an extension of BRS formalism to deal with physical and virtual aspects of CPS, and GTR (Guided Transitions System), a state space definition to specify dynamic and adaptive behavior of safe and secure CPS. To ensure security and safety of M-CPS, we apply our formalization approach to represent the structural aspect of M-CPS, consisting of physical or cyber entities in which agents of CA-BRS are hosting, and their complex behavior aspect. By modeling the interactions and behaviors of individual agents, through a set of controlled reaction rules, emergent properties can arise at a higher level, which may not be immediately predictable from the behavior of individual agents alone.

The Web-Based Blood Bank and Donation Management System (BBDMS) presents a comprehensive solution to optimize blood donation processes by integrating data security, predictive analytics powered by machine learning, and efficient management strategies. With a focus on safeguarding sensitive information and enhancing donor recruitment through ML-driven predictive models, the BBDMS utilizes encryption and access controls to ensure data integrity. Leveraging advanced data analytics and machine learning, the system predicts potential blood donors based on factors like age and location, improving recruitment efforts. Streamlining blood camp organization and appointment scheduling, the BBDMS enhances donor engagement and satisfaction. Moreover, by accurately forecasting blood demand using machine learning techniques and optimizing stock management, the system aids in efficient emergency response. Overall, the BBDMS transforms blood donation processes by enhancing security, prediction accuracy using machine learning, resource allocation, and emergency preparedness, contributing to improved public health outcomes and the effectiveness of blood banks and organizations.

The reproductive organs of rose-ringed parakeet (n= 6) were studied in detail in this research work during breeding (December to April) and non-breeding (May to November) seasons. After slaughtering, organs of the reproductive system were collected for anatomical and histological study. The right ovary and oviduct were absent, the left ovary and oviduct were collected to record weight and dimensions (width, length, diameter, and volume). The results showed a higher weight (1.08±0.116 g) of the left ovary during the breeding and a decreased (0.069±0.015 g) in the non-breeding season (P< 0.05). The length of the left ovary during the breeding and non-breeding season was recorded as (6.59±0.20 mm) and (5.75±0.12 mm). The width of the left ovary during the breeding season and in non-breeding was recorded as (5.86±0.09 mm) and (3.76±0.18 mm). The results showed maximum volume (0.05±0.003 cm3) during the breeding season and a decrease in volume (0.03±0.003 cm3) in the non-breeding season in the left ovary. A higher weight (1.21±0.13 g) of the left oviduct during the breeding and a decreased (0.08±0.016 g) in the non-breeding season was observed. The length of the oviduct during the breeding season was (33.21±0.14 mm) and during non-breeding season as (30.23±0.29 mm). The width of oviduct during breeding season was recorded as (1.12±0.01 mm) and during in non-breeding season as (0.83±0.03 mm), respectively. Thus, the ovary and oviduct have higher weights and dimensions during the breeding season that correspond to breeding activity.  

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ABSTRACT Umbilical cord knots and nuchal cords are distinct conditions associated with pregnancy and childbirth, known to potentially increase the risk of adverse perinatal outcomes. Umbilical cord knots are rare, occurring in approximately 1-2% of pregnancies, while nuchal cords are estimated to affect around 20-30% of pregnancies.We present a case of a 24-year-old woman, G3P2 with no underlying medical conditions, who presented to a resource-limited setting with hypogastric pain radiating to the lumbar region and vaginal leakage during an unknown gestational age pregnancy. The patient had limited antenatal care, with only a single visit during the fourth month of pregnancy at another health center, where no ultrasound was performed. Physical examination revealed an enlarged abdomen with longitudinal growth and noticeable respiratory movements. Symphysis-fundal height measured 29 cm, and uterine contractions were present. Vaginal examination indicated a mucus-stained vulva and a dilated cervix measuring 5 cm. Absence of fetal heart sounds on Doppler fetoscope examination raised suspicion of intrauterine fetal death; however, no ultrasound was available at the center. Following approximately 10 hours of labor, the patient spontaneously delivered a stillborn male fetus with a true cord knot and three nuchal cord loops. Examination of the placenta revealed a lengthy umbilical cord measuring 128 cm.The coexistence of a true umbilical cord knot (TUCK) and a nuchal cord (NC) can lead to fetal distress. Prenatal ultrasound diagnosis of these conditions is challenging, and there are currently no established guidelines for patient management. A proper delivery protocol with close monitoring is critical.Keywords: True umbilical knot; Nuchal cord; Triple-circular nuchal cord; Fetal demise; Obstetrics; Case Report.INTRODUCTIONUmbilical cord knot (UCK) affects around 0.3–2.1 % of all singleton pregnancies and coexisting with triple-circular nuchal cord (TCNC) is a very scare and highly unexpected complication of pregnancy that can result in fetal demise or neonatal death (1,2). The rate of fetal growth restriction (FGR) is higher in deliveries with UCK compared to normal deliveries, which can be justified by a decrease in fetal blood flow following umbilical cord constriction. Additionally, pregnancies with UCK are associated with a 4–8 times higher rate of fetal mortality in the second and third trimesters (1–3). Multiple umbilical cord entanglements around the fetal neck in singleton fetuses are extremely uncommon and can be potentially hazardous to the fetus, in contrast to single nuchal cord loops, which have a reported prevalence ranging from 15 to 30% (4).CASE DESCRIPTIONA 24-year-old woman, G3P2, with no significant medical history, presented to a resource-limited setting in a low-income country with hypogastric pain radiating to the lumbar region and vaginal discharge of mucus consistency. The gestational age of her pregnancy was unknown. The patient had sought care from a traditional midwife, as she had done with her previous pregnancies, which were successfully managed through physiological home deliveries. Until recently, the current pregnancy had been uneventful; however, the patient became concerned when she noticed a lack of fetal movements, prompting her to seek better medical attention at the center. She had only one prenatal visit during her fourth month of pregnancy at another health center, where she received two unspecified doses of vaccine, but no ultrasound examinations were performed.On examination, the patient appeared anxious and distressed, complaining of hypogastric pain radiating to the lumbar region. Her vital signs were as follows: heart rate 133 bpm, blood pressure 144/104 mmHg, temperature 37 degrees Celsius and oxygen saturation 98%. There was no evidence of jaundice, and auscultation of the lungs revealed clear breath sounds. No pedal edema was observed. Abdominal examination showed an enlarged uterus lengthwise, with palpable respiratory movements and soft consistency. Symphysis-fundamental height measured 29 cm. Uterine contractions were noted, but no fetal heart sounds could be detected using the Doppler fetoscope. Vaginal examination revealed a mucus-stained vulva, a 5 cm dilated cervix with 40% effacement. Fetal presentation was cephalic, with a station of -1. The finger pad of the glove used for the examination was soiled with glairosanguineous secretions. Unfortunately, no ultrasound was available at the center. A provisional diagnosis of probable intrauterine fetal death had been made in a pregnant woman in the active phase of labor.Limited laboratory tests were conducted at the center. The patient’s screening results were negative for Human Immunodeficiency Virus (HIV) and syphilis. Her hemoglobin level was measured at 11 g/dL, with a hematocrit of 33%. She received an intravenous injection of 2 g ampicillin, and a 1 L solution of Ringer’s lactate was administered. Approximately 9 hours later, she spontaneously delivered a stillborn male fetus with three loops of nuchal cord and a true cord knot, as depicted in Figure 1 and Figure 2. Examination of the placenta revealed an umbilical cord measuring 128 cm in length. Based on these findings, a diagnosis of coexisting true umbilical cord knot and triple-circular nuchal cord with fetal demise was established.DISCUSSIONThe umbilical cord (UC) is a vital link between the fetus and placenta, facilitating the exchange of oxygen, nutrients, and waste products. It consists of two umbilical arteries and one umbilical vein, enveloped by Wharton’s jelly, and covered by the amnion (5). The cord forms during embryonic development (weeks 3-7) and typically measures around 50 cm at full term 6. Umbilical arteries transport deoxygenated blood from the fetus to the placenta, while the umbilical vein carries oxygenated blood back to the fetus (7) Hyrtl’s anastomosis provides collateral circulation at the cord insertion in arterial occlusion (8). In the fetal abdomen, the umbilical vein merges with the portal vein, forming the ductus venosus, bypassing the liver and merging with deoxygenated blood in the inferior vena cava (9). Abnormalities in cord length, diameter, insertion, coiling, knots, or vessels can affect fetal growth, blood flow, and oxygenation. Prenatal ultrasound evaluation of the umbilical cord is recommended for detecting potential complications and guiding management (10).TUCK and NC are two conditions that affect the UC and may compromise fetal well-being. The pathophysiology of the UCK and NC is not fully understood, but it is believed that they are caused by excessive fetal movements and variations in the length of the umbilical cord (11). A TUCK occurs when the fetus passes through a loop of the cord, creating a knot that may tighten during labor and delivery, compromising the blood flow and oxygen supply to the fetus (8, 10). A NC occurs when the cord wraps around the fetal neck or other body parts, which may also result in compression and obstruction of the umbilical vessels (10).TUCK is a rare occurrence, reported in approximately 0.04% to 3% of all deliveries (8). Several documented risk factors for TUCK include advanced maternal age, multiple pregnancies, obesity, anemia, a history of spontaneous miscarriages, chronic hypertension, and diabetes mellitus (12). On the other hand, NC is more common, affecting 6% to 37% of all deliveries (10). Risk factors associated with NC include a long umbilical cord, excessive fetal movements, polyhydramnios, monoamniotic twins, and breech presentation (13). In the case of our patient, she had none of the above-mentioned risk factors associated with the occurrence of TUCK and had one of the above-mentioned risk factors for NC since she had an UC length of 128 cm, out of the average length of approximately 50 cm (6).The prenatal diagnosis of TUCK and NC is challenging and often relies on ultrasound examination. However, ultrasound has limitations in detecting these conditions, especially in late pregnancy when the amniotic fluid decreases (13). Color Doppler ultrasound may improve the visualization of the UC and its blood flow. Three-dimensional ultrasound may also provide more detailed images of the cord and its knots (13). However, these methods are not widely accessible, and their results may not provide definitive conclusions. Due to the resource limitations at the healthcare center, the patient was unable to undergo an ultrasound examination upon arrival. Transferring the patient to a community hospital with better resources may have been considered as an alternative. However, in this specific case, there were a couple of factors that influenced the decision-making process. Firstly, there was a suspicion of intrauterine fetal death, and transferring the patient would not have significantly altered the outcome for the fetus. Secondly, the patient was already in the active phase of labor with a cervical dilation of 5 cm, which contraindicated transfer to our center. Moreover, the poor road infrastructure posed a considerable risk, as the journey could have been turbulent, potentially leading to the patient giving birth in the transport vehicle, where no healthcare personnel were present. This situation would have endangered the mother’s life.Authors have reported an association between TUCK (true umbilical cord knot) and adverse outcomes such as meconium-stained amniotic fluid, intrauterine fetal death, low 1-minute Apgar score, premature birth, and admission to the intensive care unit (2, 3, 14, 15). However, some studies suggest that TUCK does not pose a risk during delivery (16) and is not associated with long-term adverse neurological effects (15). NC has also been linked to neonatal intensive care, intrauterine fetal death, premature birth, small for gestational age babies, intrauterine growth retardation, and low Apgar score (17, 18). Tight nuchal cord loops may result in clinical signs such as hypovolemia, hypotension, decreased perfusion, and mild respiratory distress. Additional signs include facial darkness, facial petechiae, subconjunctival hemorrhage, or neck skin abrasion (19). Kong et al. found that nuchal cord with three or more turns was associated with meconium-stained amniotic fluid and suspected fetal distress (18).TUCK is associated with a higher rate of preterm delivery and cesarean section due to a non-reassuring fetal heart monitor and meconium-stained amniotic fluid (3). In contrast, Räisänen et al. reported similar delivery characteristics between women with TUCK and the control group (12). Nuchal cord (NC) as a whole or with a single turn was paradoxically associated with fewer emergency cesarean sections, but for three or more turns, there was a higher incidence of emergency cesarean section. NC, whether as a whole or with multiple turns, was not significantly associated with a higher incidence of instrumental deliveries (20). Narang et al. found an extended second stage in parturient with single or multiple loops of NC, possibly related to the length of the ”linear” segment of the cord rather than the number of loops (21).Currently, there is no specific management for patients diagnosed with TUCK or NC through antenatal ultrasound (22). Routine antenatal ultrasound for nuchal cord is not recommended as it does not influence the mode of delivery or labor management, and the standard labor protocol should be followed (21).ACKNOWLEDGEMENTArens Jean Ricardo Médéus coordinated the project. He was responsible for drafting a portion of the discussion and combining the different parts of the manuscript. He also conducted the revision and formatting of the final manuscript. Ali Mortezaei wrote the introduction, Adams Emmanuel Milhomme wrote the case description, and participated in patient care. Kohlz Erley Saint Jusca contributed to the discussion section, supervised the writing of the case description, and performed proofreading. Kundan Kumar was responsible for writing the abstract.CONFLICT OF INTEREST STATEMENTThe authors declare no conflict of interest.FUNDINGThis research has received no funding.ETHICAL APPROVALWe obtained authorization from the center’s medical director to access the patient’s record and publish the case.CONSENT STATEMENTWritten informed consent was obtained from the patient’s parent for publication of this report, in accordance with the journal’s patient consent policy.REFERENCESLinde LE, Rasmussen S, Kessler J, Ebbing C. Extreme umbilical cord lengths, cord knot and entanglement: Risk factors and risk of adverse outcomes, a population-based study. 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BMJ Publishing Group. https://doi.org/10.1136/bcr-2017-223241FIGURES LEGENDSFigure 1: Stillborn fetus with three loops of nuchal cordFigure 2: One true knot in the umbilical cord wrapped around the neck of stillborn fetus.

Asthma is a common chronic airway inflammatory disease that affects both pediatric and adult population, and is associated with significant morbidity, mortality, and financial burden worldwide. One of the main concerns with asthma is the manifestation of irreversible tissue remodeling of the airways due to the chronic inflammatory environment that will eventually disrupt the whole structure of the airways. Majority of the asthma patients are treated with corticosteroids. However, the development of steroid resistance is a commonly encountered issue, which will limit the treatment options for these patients. Biological therapies are a promising therapeutic approach for this subclass of patients. Interleukin 5 is recently gaining a lot of attention as a biological target capable of ameliorating the tissue remodeling process. SinceIL-5-neutralizing monoclonal antibodies (Mepolizumab, Reslizumab, Benralizumab) are currently available for clinical use, this review aims to revisit the role of IL-5 in asthma pathogenesis at large and airway remodeling in particular, in addition to exploring its role as a target for biological treatments.

Background: Working women in Turkey, especially nurses, most of whom are women, are busy in the hospital and at home. Due to Covid 19, the working conditions of women have become even worse, and the effect of pain and fatigue because of standing has increased. In this context, the study was carried out to show the effect of yoga on coping with pain and fatigue of working nurses. Objectives: This is a randomized controlled study to determine the effect of yoga on foot/leg pain, fatigue severity and psychological well-being in nurses. Methods: This study is a randomized controlled trial. We conducted the study with nurses working in 25 control groups and 20 experimental groups. While collecting data, Individual Identification Form, Visual Analog Scale, Fatigue Severity Scale, and Psychological Well-being Scale were applied. A total of 16 sessions of yoga were done with the nurses in the experimental group, two days a week for eight weeks. Results: A significant difference between the Visual Analogue Scale and Psychological Well-being Scale sub-dimension of life goals of the nurses in the experimental group in the pre-test and post-test was found(p <0.05). The post-test mean scores of the nurses in the control group were not statistically significant (p> 0.05). Conclusions: Yoga is an effective method for reducing pain and creating a purpose in life. Yoga has a positive effect on safe, pain and psychological well-being. Nurses can use the yoga method effectively for their patients and themselves.