This review presents a state-of-the-art literature review of automatic generation control (AGC) control strategies for power systems containing new energy sources. The incorporation of new energy into the power system has a large impact on the stability, reliability, economy and security of the power system. In order to mitigate these effects, it is important to choose a suitable control strategy for AGC. However, there is no review of AGC control strategies specifically for new energy-containing power systems, so a review of AGC control strategies for new energy-containing power systems is necessary. The investigation of this paper focuses on all kinds of different AGC control strategies for new energy-containing power systems, such as PID control, fuzzy control, artificial neural network control, etc., and compares and considers these different control methods, while this paper summarises the power system models with/without new energy. In addition, this paper summarises and discusses the application of intelligent optimization algorithms and energy storage systems to control strategies. The problems and future research directions of the current research on power systems with new energy sources are also discussed.

Pregnancy is a period that is characterized by several metabolic and physiological changes and requires special attention, especially with regard to the relationship between feeding and fetal development. Therefore, the objective of this study is to evaluate whether the practice of voluntary physical exercise in combination with chronic consumption of fructose from the beginning of life and/or until the gestational period causes biochemical and genotoxic changes in pregnant females and in their offspring. 70 Swiss female mice received fructose in the hydration bottle and/or practiced voluntary physical exercise (VPE) for 8 weeks (pre-pregnancy/pregnancy). After the lactation period, the offspring groups were separated by sex. It was observed that the consumption of fructose affected the food consumption, serum concentration of fructose and glycemic profile in the mothers and that the VPE decreases these parameters. In addition, fructose was genotoxic in the mothers’ peripheral tissues and VPE had a preventive effect on these parameters. The offspring showed changes in food consumption, serum fructose concentration and body weight, in addition to an increase in the adiposity index in male offspring in the FRU group and a decrease in the FRU+VPE group. Fructose lead to hepatic steatosis in the offspring and VPE was able to decrease the area of steatosis. In addition, fructose led to genotoxicity in the offspring and VPE was able to modulate this effect, reducing damages. In conclusion, we observed that all interventions with voluntary physical exercise had nutritional, genetic and biochemical benefits of the mother and her offspring.

Ecotypic divergence in tree taxa often occurs in sub-alpine habitats, where environmental conditions are more stressful than those in lower elevations. In the mountain oak species in Japan, Quercus crispula (Qc), the sub-alpine shrubby variety, Q. crispula var. horikawae (Qch), has been recognized in central and northern Honshu. Although Qch has different phenotypes from Qc, genetic divergence between Qc and Qch has not been examined yet. Pairs of Qc and Qch populations in eight locations and additional Qc and Qch populations around these locations were investigated. Leaf size of Qch was smaller than that of Qc. Chloroplast DNA haplotypes were shared between the Qc and Qch populations. In genotypes at 29 nuclear microsatellite loci, genetic diversity did not differ between the Qc and Qch populations. Principal component analysis and a neighbor-joining tree of populations based on microsatellite genotypes demonstrated that 13 Qc populations and eight Qch populations were grouped separately, except for three Qch populations that were grouped to Qc. Climatic conditions in the eight Qch populations were characterized by lower temperature and heavier snowfall than those in the 16 populations of the genetic group of Qc. These results suggest the genetic divergence between Qc and Qch associated with sub-alpine climatic conditions, irrespective of leaf size. The origin of the sub-alpine Qch lineage and the history of ecotypic divergence should be investigated in future genomic studies.

Biased signaling is a natural result of GPCR allosteric function and should be expected from any and all synthetic agonists. Therefore, it may be encountered in all agonist discovery projects and must be considered as a beneficial (or possible detrimental) feature of new candidate molecules. While bias is easily detected , the synoptic nature of GPCR signaling makes translation of simple in vitro bias to complex in vivo systems problematic. The practical outcome of this is a difficulty in predicting the therapeutic value of biased signaling due to the failure of translation of identified biased signaling to in vivo agonism. This is discussed in this review as well as some new ways forward to improve this translation process and better exploit this powerful pharmacologic activity.

Background and purpose: Castration-resistant prostate cancer (CRPC) has been a major cause of tumor-associated death among men worldwide. The discovery of novel therapeutic approaches for CRPC remains imperative. Atractylenolide I (ATR-I), a prominent bioactive component from Atractylodes macrocephala, exhibits powerful anticancer potentials in various malignancies. Nevertheless, the ATR-I’s activity on CRPC and its underlying mechanism has not been reported. Experimental approach: An enzalutamide-resistant (EnzR) cell line was successfully constructed. The pharmacological effects of ATR-I were assessed in vitro and in vivo. The changes in the gene expression profiles after ATR-I treatment were analyzed using RNA sequencing (RNA-seq). Key results: ATR-I suppressed the proliferative and migratory abilities of CRPC cells, while triggering cell cycle arrest and apoptosis. In constructed EnzR cells, ATR-I also inhibited their proliferation and promoted apoptosis. Intriguingly, a combination of ATR-I with enzalutamide synergistically induced more apoptosis of EnzR cells. Mechanistically, RNA-seq results identified kinesin family member 15 (KIF15) as a potential target of ATR-I. KIF15 was up-regulated in prostate cancer (PCa), and its higher level was associated with poorer clinical outcomes. Further investigation showed that ATR-I inhibited the expression of KIF15 mRNA and protein, thus mediating ubiquitin-proteasomal degradation of AR/AR-V7. Finally, our in vivo experiment verified that ATR-I alone or in combination with enzalutamide retarded the growth of EnzR xenograft tumors. Conclusion and implications: This study elucidated the antitumor mechanism of ATR-I against CRPC. Notably, ATR-I may be a promising therapeutic drug for CPRC patients and enhance the response to enzalutamide in EnzR patients.

Background- COVID-19 took a major toll on the healthcare system in India. Multiple vaccines were developed to prevent infection with the SARS-CoV-2 virus. Infection outcome was different among unvaccinated patients and those vaccinated. Aims and Methodology- The research aimed to find out various outcomes of COVID-19 disease and to compare these outcomes in vaccinated and unvaccinated patients. Data was collected from the records in a tertiary care hospital. The patients were segregated into mild, moderate, and severe disease according to the ICMR guidelines and the results were analysed using SPSS software. Results- Data of 816 and 2010 individuals for second and third wave respectively was collected and analysed. The results show that a higher percentage of unvaccinated individuals were asymptomatic (54.7 and 59.3%) but within symptomatic individuals, mild forms of the disease are much more common in vaccinated individuals (66.6% and 63.3%) while severe forms of the disease were more common in unvaccinated individuals (5.7% and 3.1%). This suggests that while vaccination may not have a significant effect on whether symptoms are contracted, it plays a vital role in lowering the severity of the disease form. Implications- This study proved that there exists a strong correlation between vaccination and reduced severity of disease, and further emphasized the importance of vaccines in protection from grave outcomes. Calculation of risk estimate showed that the unvaccinated individuals were more at risk for severe disease than those vaccinated with one or two doses of vaccines.

The quality of machine learning (ML) models deployed in dynamic environments tends to decline over time due to disparities between the data used for training and the upcoming data available for prediction, which is commonly known as drift. Therefore, it is important for ML models to be capable of detecting any changes or drift in the data distribution and updating the ML model accordingly. This study presents various drift detection techniques to identify drift in the survival outcomes of patients who underwent cardiac surgery. Additionally, this study proposes several drift adaptation strategies, such as adaptive learning, incremental learning, and ensemble learning. Through a detailed analysis of the results, the study confirms the superior performance of ensemble model, achieving a minimum mean absolute error (MAE) of 10.684 and 2.827 for predicting hospital stay and ICU stay, respectively. Furthermore, the models that incorporate a drift adaptive framework exhibit superior performance compared to the models that do not include such a framework.

IntroductionCoronary artery disease (CAD) is the predominant etiology of early postoperative mortality and delayed mortality subsequent to resection of non-ruptured abdominal aneurysms. Myocardial infarction accounts for approximately 40% of all fatalities among patients who undergo aneurysm resection1. Conversely, a ruptured abdominal aortic aneurysm (rAAA) is a life-threatening condition necessitating urgent diagnosis and surgical intervention. Herein, we depict a case of acute myocardial infarction that ensued immediately after a ruptured abdominal aorta, culminating in a life-saving outcome.

CASE REPORTOccurrence of adult-onset Still’s disease aftercoronavirus disease 2019 BNT162B2 vaccination in a patient with ulcerative colitisTakahiro Kobayashi1, MD | Kenichi Hashimoto1, MD, PhD | Yasuyoshi Kusanagi2, MD | Yuji Tanaka1, MD, PhD1Department of General Medicine, National Defense Medical College, Tokorozawa, Saitama359-8513, Japan2Department of Internal Medicine, Division of Hematology and Rheumatology, National Defense Medical College, Tokorozawa, 359-8513 Saitama, JapanCorrespondence: Kenichi Hashimoto, Department of General Medicine, National Defense Medical College, 3-2 Namiki, Tokorozawa, Saitama 359-8513, Japan.Tel: +81-429-95-1211 (ext. 3633); Fax: +81-429-91-1238Email:hashimoto.kenich2@gmail.comDATA AVAILABILITY STATEMENTNot applicable.FUNDING STATEMENTThis work was supported by the Fukuda Foundation for Medical Technology (2019).CONFLICT OF INTEREST DISCLOSUREThe authors report no conflict of interest.ETHICS APPROVAL STATEMENTThe study was approved by the Competent Authorities and Ethics Committees of National Defense Medical College (approval no. 4609). Written informed consent was obtained from all patients.PATIENT CONSENT STATEMENTPublished with written consent of the patient.PERMISSION TO REPRODUCE MATERIAL FROM OTHER SOURCESNot applicableCLINICAL TRIAL REGISTRATIONNot applicable

Introduction:Lichen Planus is a skin disease that can also affect the mucous membranes and nails (1, 2). The skin manifestations of this disease are multiple purple papules often accompanied by itching (3). The mucosal involvement of this disease is known as mucosal erosions that often involve the oral mucosa and genital area (4).One of the rare types of this skin disease is called ulcerative lichen planus, which presents as chronic ulcers resistant to treatment, associated with pain and many disabilities for patients (5, 6). The involvement of the soles of the feet is one of the most significant areas affected by ulcerative lichen planus. Despite several treatment options having been studied in the past, treating plantar ulcerative lichen planus remains a challenge for dermatologists (4-8).Tofacitinib, a Janus Kinase inhibitor, has a special place in the treatment of inflammatory diseases in medicine (9). Recently, studies have shown its effectiveness in treating various skin diseases such as psoriasis, alopecia areata, vitiligo, and atopic dermatitis (10). In recent studies, the effectiveness of this drug in treating certain types of lichen planus has been mentioned, including lichen planopilaris and erosions of the oral mucosa (9, 11).In this article, we presented a case of plantar ulcerative lichen planus that was initially resistant to treatment but exhibited a remarkable response upon being treated with oral tofacitinib. In addition, we conducted a comprehensive review of literature on the efficacy of tofacitinib in treating various types of lichen planus lesions, while also discussing other proposed treatments for plantar ulcerative lichen planus.

Secondary syphilis in the third trimester of pregnancyRyosuke Tajiri, Emi Kondo, Yuma Saito, Mao Sekimata, Yasuyuki Kinjo, Hiroshi Mori, Kiyoshi YoshinoFacilities: Department of Obstetrics and Gynecology, School of Medicine, University of Occupational and Environmental Health, JapanIseigaoka, Yahatanishi-ku, Kitakyushu 807-8555, Japan.Corresponding author: Dr. Ryosuke TajiriDepartment of Obstetrics and Gynecology, School of Medicine, University of Occupational and Environmental Health. Japan, 1-1 Iseigaoka, Yahatanishi-ku, Kitakyushu 807-8555, Japan.Tel: +81-93-603-1611, Fax: +81-93-691-8892e-mail:r-tajiri@med.uoeh-u.ac.jpConsent statement: Written informed consent was obtained from the patient to publish this report in accordance with the journal’s patient consent policy.

Evolutionary algorithms must be able to quickly and effectively approach the optimal frontier, locate the best collection of solutions, and sensitively perceive and react to environmental changes in order to successfully solve dynamic multi-objective optimization problems. Most dynamic multi-objective optimization algorithms currently in use evolve the decision variables uniformly, without taking into account how environmental changes may affect the decision space, without effectively addressing decision variables with different characteristics, and without being able to handle the useful information produced during the evolutionary process. In order to address the problem, this paper proposes a dynamic multi-objective evolutionary algorithm based on the classification prediction of decision variables (DMOEA-DVCP). Firstly, the degree of influence of environmental changes on each dimension of the decision space is measured by calculating the degree of change of each dimension of the decision variables; secondly, the decision variables are classified into three categories according to the strength of change, i.e., strong change, weak change and change between strong and weak strength; finally, three distinct response strategies are employed based on classification, the decision variables of each dimension are initialized adaptively, and the newly generated individuals are considered the initial population in the new environment. To verify the effectiveness of DMOEA-DVCP, it is compared with four representative algorithms on 10 typical dynamic test functions, and the experimental results show that the DMOEA-DVCP algorithm has obvious advantages in solving dynamic multi-objective optimization problems.

India contributes to 70% of cervical cancer mortality worldwide in spite of the available pap smear screening and administration of vaccine as prognosis with advanced recurrent cervical cancer is still very poor. Though cervical cancer has been linked with HPV positivity, increasing evidence suggests that cancer stem cell population (CSCs) may play an important role in cervical cancer (CC) tumorigenesis, metastasis, relapse and chemo-resistance, thus requiring potential targets which would not only affect HPV + cervical cancer cells but also cervical cancer stem cells. Selective phosphodiesterase type 5 inhibitors are well known as examples of successful drug repurposing. In a small screen, previous research identified cGMP-PDE inhibition as potential strategy to target CSC maintenance and survival in various cell lines. Hence, we were interested to study the status of cGMP-PDE in cervical cancer and the efficacy of a cGMP-specific phosphodiesterase inhibitors like PDE5 inhibitor, sildenafil on cervical cancer cells as well as cervical cancer stem cells. Amongst cGMP-PDEs and PDEs having dual specificity, expression of PDE5 was observed to increase significantly in both the HPV + cervical cancer cells (HeLa and SiHa) while PDE3 was detected only in HPV + HeLa cell line. Sildenafil elevated cGMP levels, was cytotoxic to HPV + cell lines and was effective in the modulation in telomerase activities. Sildenafil also showed significant abrogation of cervical cancer spheroids through pro-apoptotic induction regressing stemness markers like ALDH1, Oct4 and SOX2 associated with CSC phenotype in cervical cancer spheroids. Moreover, sildenafil-mediated significant regression of metastasis was observed in cervical cancer cell lines making sildenafil a possible therapeutic option for cervical cancer having efficacy against HPV positivity as well as cervical cancer stem cells which attribute to the lion-share of the cervical cancer cases.

This article constructs an investor topic preference mining model through stock bar text data and the FNS-LDA2vec method. Firstly, dynamic topic mining of the LDA model is achieved by dividing user documents in the stock community by time. Then, by combining the improved LDA topic model and the Word2vec word vector model, a dynamic mining model of stock bar user topic preference based on FNS-LDA2vec is constructed, and topic representation is learned through the joint learning of document vectors and word vectors. Finally, empirical results show that the topic extraction model constructed in this article is superior to the comparison model. The model has broad application value in personalized recommendation for investors and stock prediction.

Allergy of type I hypersensitivity affects about 150 million people in Europe. It is clinically manifested as atopic dermatitis, conjunctivitis, rhinitis, rhinoconjunctivitis, and allergic asthma. However, the underlying mechanisms occurring at the gene expression level remain poorly understood. To address this gap, the transcriptome of peripheral blood cells from participants with type I hypersensitivity symptoms was measured to gain insights into mechanisms underlying the disease. We examined immunological pathways of observed transcriptomic profiles to examine immune-related alterations in participants with atopic disorders. A diverse array of enriched pathways and cellular processes associated with type I hypersensitivity reactions were identified within domains such as antigen-presenting cells (APCs), interleukins, mast cells, CD molecules, T helper (Th) and T regulator (Treg) cells, and B cells. These findings collectively suggest that disturbances at the gene expression level contribute to immunological disorders in individuals experiencing allergic manifestations.

It has been well known for many years that males of Luciola parvula (Coleoptera, Lampyridae) have two morphs, namely small and large morphs in Japan. This article performed a statistical reanalysis of their morphological measurements based on previously published data and compared them. As a result, the two morphs were found to have different allometric patterns in the Hakone and Nagano areas, Japan. In Hakone, the relationships between their pronotum width and length were expressed by a common allometric line and a shift in location along the line. However, in Nagano, the relationships between their pronotum width and body length were expressed by two parallel allometric lines (a common slope and different intercepts). The allometric pattern of males of this species may vary among different parts of the body or among different areas. Therefore, this article recommends future studies to measure the same parts of the body as previous studies to clarify geographic variation in allometric relationships.

The scientific formulation of conservation policies to address land degradation vulnerability can better protect land resources. In this work, Shaanxi Province in China was used as a case study, firstly, Shaanxi Province was divided into several physiographic regions based on the principle of spatial homogeneity, and the vulnerability to land degradation of each physiographic regions was assessed by zoning using superposition analysis. Secondly, an analytical framework was constructed to identify the dominant factors of land degradation vulnerability in each physiographic regions. Finally, the identified dominant factors were used to formulate protection policies for land degradation vulnerability in each physiographic regions. The results show that the dominant factor of land degradation vulnerability in Shaanxi Province's low-hill basin area is soil erosion, which can be managed through bioengineering measures. The dominant factor of land degradation vulnerability in the Daba Mountain area, Qinling Mountain area and the plateau hills and gullies area is vegetation cover, which can be improved through afforestation engineering measures. The dominant factor of land degradation vulnerability in the plains area is soil erosion, which can be managed through agricultural technical measures. The dominant factor of land degradation vulnerability in the Loess Plateau area is the vegetation cover, which can be improved through the measures of forbidding grazing, resting grazing and rotating grazing. The dominant factor in the vulnerability to land degradation in the plateau area north of the Great Wall is soil texture, which can be improved through technical means by upgrading the content of soil organic matter.

[September 3,2023]Editor-in-ChiefDr Charles Young

Crohn Disease: An Enigmatic Variant with Gastritis and Ileal ObstructionAbstractThere are multiple atypical manifestations of Crohn disease which sometimes delay diagnosis or even more often result in complete misdiagnosis especially in poorly equipped facilities. This is a case of an elderly woman with Crohn disease who presented with gastritis and bowel obstruction. She had hitherto been wrongly managed for peptic ulcer disease and functional constipation based mainly on her symptoms. Her diagnosis was made only after years of failed symptomatic management. This case aims to highlight the uncommon and easily misdiagnosed gastroduodenal presentation of Crohn disease, as well as clinical clues to correctly diagnosing the condition.Keywords: Crohn disease, gastritis, intestinal obstruction, constipationIntroductionCrohn disease falls under the umbrella of inflammatory bowel disease and can involve any part of the gastrointestinal tract. It is many a time misdiagnosed or diagnosed late.1 This is even more so when health centres are not well equipped to appropriately investigate it, as is the case in many developing countries. Common presentations include abdominal pain, diarrhea, unintentional weight loss and haematochezia. It is more prevalent in young adults.2There are however enigmatic variants that do not present with these tell-tale symptoms. These include those that manifest with obstructive symptoms, dyspeptic symptoms as well as those with more extra-intestinal than gastrointestinal symptoms such as arthritis, aphthous stomatitis and uveitis.Case PresentationThis is the case of a 78-year old Ghanaian woman who was admitted on account of an acute exacerbation of Crohn disease. She was diagnosed about a year prior to the index presentation, through an investigation for incomplete intestinal obstruction. No treatment was started after diagnosis as she declined medical interventions. The index presentation was a week’s history of severe generalized abdominal pain graded 9/10; colicky in her lower abdomen and burning in her epigastric region. It was associated with constipation (hard, scanty, infrequent stools averaging once a week) and vomiting which was non-projectile, non-bilious and non-bloody. The symptoms waxed and waned and were worst at night. She also reported having anorexia, and unintentional weight loss but no pain related to eating or fasting. Antacids gave partial relief to the epigastric pain. There was no abdominal distension related with her symptoms and her constipation was not absolute, as she was able to pass flatus. There was no alternation of the constipation with diarrhea and no melena or hematochezia. Her other symptoms included borborygmi, lower back and bilateral knee pain. She had hypertension well-controlled on amlodipine. She had completed empirical triple therapy for peptic ulcer disease several years prior to this presentation, but without resolution of her occasional dyspeptic symptoms. There was no history of abdominal surgeries and she had never smoked nor consumed alcohol.Her physical examination showed a soft, non-distended abdomen which moved with respiration. There was generalized tenderness which was worst at her lower abdomen. There were no palpable masses, percussion notes were tympanitic and bowel sounds were high pitched and frequent. Both knees were mildly tender on passive joint movement and worse on the left, without warmth or swelling, and there was mild tenderness at her lower back. All other examination findings were normal.Her renal and liver function tests were normal. She however had normocytic normochromic anaemia of 10.6g/dl on her complete blood count and low calcium and magnesium levels of 1.61mmol/L, 1.07mmol/L respectively. An erect and supine abdominal x-ray showed mildly dilated jejunum as well as gall stones. A contrast CT scan of the abdomen showed mild to moderate narrowing of the mid segment of the ileum with prestenotic dilatation of the ileum and jejunum. The dilated bowel measured 3.8cm-4.5cm. There were no masses seen and the large bowel was normal. Both ESR and CRP were high (30mm/h and 147mg/L respectively). Stool RE was normal and stool for occult blood and H. pylori antigen were negative.She was then managed for acute exacerbation of Crohn disease with partial ileal obstruction and gastroduodenal involvement. The noted Crohn disease associations were cholelithiasis, arthritis of both knees and sacroiliitis. Her calculated Crohn Disease Activity Index (CDAI) was 263, for moderate disease. She was hydrated with IV fluids, then put on hyoscine bromide for her crampy abdominal pains, IV omeprazole for her gastritis, SC enoxaparin for DVT prophylaxis and syrup lactulose for her constipation. After her vomiting subsided, she was switched to oral medications. Oral mesalazine 1g 6 hourly, oral prednisolone 30mg daily and oral paracetamol 1g 8 hourly were added to these medications. She had dietary interventions such as reducing meal fiber as well. She improved and had a significantly reduced frequency of the flares and was finally discharged after 5 days on admission.DiscussionIntestinal obstruction caused by strictures of Crohn disease widens the differential diagnoses for clinicians. These include intraluminal causes such as tumours, impacted feces and foreign bodies, intramural causes such as intussusception and extramural causes such as strangulated hernias, adhesions and volvulus.3-5 Most of these are purely surgical causes. It is no surprise this patient was managed by the general surgery team on her first admission. It is quite unusual that she had never experienced diarrhea at any point of the course of the disease because it is expected that before the strictures form, the preceding inflammation would cause irritative diarrheal symptoms.6 She also had peptic ulcer-like symptoms which had been treated unsuccessfully in the past. That she was managed empirically for peptic ulcer disease for a long period is because of the low availability of endoscopy in the Central Region of the country. Lack of these investigative facilities and low socioeconomic status result in the frequent use of mainly clinical impressions to make diagnoses in smaller facilities. Since dyspeptic symptoms are rare in Crohn disease,7 they are unlikely to be the clinical clue to the accurate diagnosis, which unfortunately was the case in this patient for several years. Her age of presentation was also unusual as Crohn disease is usually diagnosed in the young.Intestinal strictures form part of the natural history of Crohn disease and will occur in up to 70% of patients over a 10-year period.8 The strictures are classified as inflammatory, fibrotic, primary or anastomotic. 9 Inflammatory strictures result from edema of the intestinal lining while fibrotic ones are caused by chronic inflammation that results in accumulation of extracellular matrix and hyperproliferation of smooth muscle cells.10 There are also mixed variants that have both mechanisms at play at the same time. Primary strictures are those that follow the natural history of the disease and anastomotic ones are those resulting from a surgical intervention; resection and anastomosis. This woman had a primary stricture which was most likely mixed inflammatory and fibrotic because of the waxing and waning nature of her baseline constipation associated with the flares. Fibrotic strictures tend to produce a more constant type of obstruction while inflammatory ones occur in waves.Medical management was her mainstay because of her advanced age and moderate disease severity (CDAI 263). Dietary modifications such as reducing fiber in diet is necessary for reducing obstructive symptoms by reducing stool bulk to enable it bypass strictures.9Micronutrient supplementation may also be needed in cases where deficiencies such as hypocalcemia, hypomagnesemia and vitamin D are a concern due to malabsorption, as was in this patient. The deficiencies also result from anorexia caused by the abdominal pain (gastritis in this patient) and circulating inflammatory cytokines.11 Malabsorption is also the reason for formation of gallstones as in this patient (figure 1 and figure 2). The gallstones form as a result of failed reabsorption of bile acid and hence failed enterohepatic circulation, which in turn increases the concentration of cholesterol in the biliary system, precipitating the formation of cholesterol stones.12 It is usually asymptomatic and an incidental finding on radio imaging.Starting the patient on prednisolone and mesalazine resulted in a decline in symptoms by the 5th day of admission. 5-aminosalicylic acid derivatives such as mesalazine provide symptomatic relief for patients and remain the first line drugs for mild to moderate disease.13 Lactulose also improved her constipation by enabling her pass soft stools daily.Surgery is indicated in situations such as significant prestenotic dilatation, or presence of a fistula 8 —-none of which was present in this case.Gastroduodenal Crohn disease is not commonly symptomatic and seen in only about 4% of cases. 14 Its diagnosis is difficult because there are no specific or consistent pathological findings as well as the high prevalence of comorbidity with H. pylori gastritis.15 Medical therapy is usually enough in most cases except for those with gastric outlet obstruction that may require surgery. 16ConclusionBowel obstruction from strictures in Crohn disease is a common complication which may not always be preceded by diarrhea in the early stages as was in this case. Gastroduodenal Crohn disease is uncommon but should be considered in all patients being worked up for Crohn disease who have dyspeptic symptoms. Negative H. pylori antigen tests or persistence of symptoms after eradication of H. pylori should increase suspicion for gastroduodenal Crohn disease. These clinical clues are necessary not only for poorly equipped facilities, but also those that have all the investigative capacity in order to prioritize investigations and intervene as soon as possible.ReferencesCard TR, Siffledeen J, Fleming, KM. Are IBD patients more likely to have a prior diagnosis of irritable bowel syndrome? Report of a case-control study in the General Practice Research Database. United European Gastroentrol J 2014 Dec; 2(6): 505-512. PMID: 25452846Cheema YA, Munir M, Zainab K, Ogedegbe OJ. An Atypical Presentation of Crohn’s Disease: A Case Report. Cureus. 2022 Sep; 14(9): e29431. PMID: 36299929Catena F, De Simone B, Coccolini F, Di Saverio S, Sartelli M, Ansaloni L. Bowel obstruction: a narrative review for all physicians. World J Emerg Surg. 2019 Apr; 20 (14)Yeo HL, Lee SW. Colorectal emergencies: review and controversies in the management of large bowel obstruction. J Gastrointest Surg. 2013; 17(11): 2007-12Roses RE, Folkert IW, Krouse RS. Malignant bowel obstruction: reappraising the value of surgery. Surg Oncol Clin N Am. 2018; 27(4): 705-15Anbazhagan AN, Priyamvada S, Alrefai, WA, Dudeja PK. Pathophysiology of IBD associated diarrhea. Tissue Barriers. 2018; 6(2): e1463897. PMID: 29737913Zhi TX, Hong GJ, Li T, Sun D, Yu XD, Chen QZ, Li T. Gastric Crohn’s Disease: A Rare Cause of Intermittent Abdominal Pain and Vomiting. Am J Med. 2017; 130 (5)Lin X, Wang Y, Liu Z, Lin S, Tan J, He J, Hu F, Wu X, Ghosh S, Chen M, Liu F, Mao R. Intestinal Strictures in Crohn’s disease: a 2021 updateIsmail MS, Charabaty A. Management of Crohn’s stricture: medical, endoscopic and surgical therapies. Frontline Gastroenterology 2022; 13:524-530Rieder F, Fiocchi C, Rogler G. Mechanisms, management and treatment of fibrosis in patients with inflammatory bowel diseases. Gastroenterology 2017; 152:340-50. PMID: 27720839Naser SA, Abdelsalam A, Thanigachalam S, Naser SA, Alcedo K. Domino effect of hypomagnesemia on the innate immunity of Crohn’s disease patients. World J Diabetes. 2014 Aug; 5(4): 527-535. PMID: 25126398Fevery, J. Pigment gallstones in Crohn’s disease. Gastroenterology. 1999; 116(6): 1492-1494Iacucci M, de Silva S, Ghosh S. Mesalazine in inflammatory bowel disease: A trendy topic once again? Can J Gastroenterol. 2010 Feb; 24(20):127-133. PMID: 20151072Steckstor M, Adam B, Pech O, Tannapfel A, Riphaus A. Gastroduodenal Crohn’s Disease. Video Journal and Encyclopedia of GI Endoscopy 2013; 1: 178-79Ingle SB, Hinge CR, Dakhure S, Bhosale SS. Isolated gastric Crohn’s disease. World J Clin Cases. 2013; 1(2): 71-73. PMID: 3845940Ibrahim SH, Smyrk TC, Faubion WA. Treatment of isolated gastric Crohn’s disease with inhaled corticosteroids. Case Rep Gastroenterol. 2008 Nov 5; 2(3): 363-8. PMID: PMC3075198

A document by Oluwagbemiga Ayoola. Click on the document to view its contents.

Prenatal ultrasound diagnosis offetal perineallipoblastoma: a case reportYujie Zhang1*, Chao Sun21Department of Ultrasound, Weifang People’s Hospital, Weifang, P.R. China.2Department of Neurology, Weifang People’s Hospital, Weifang, P.R. China.*Corresponding author : Yujie Zhang (Address: Department of Ultrasound, Weifang People’s Hospital, Weifang City 261041, P.R. China; Telephone number: +86 15318914825; Email:119282738@qq.com)

Verification and validation are key components to performing a quality computational fluid dynamics (CFD) analysis. When referring to verification, this traditionally implies a grid independence study to ensure the CFD results are accurate with respect to the mesh sizing. However, this study explores why a comprehensive verification study is necessary to evaluate the influence of the flow domain size. The drag coefficient was used as the basis to compare different flow domains. Due to flow around a rectangular cylinder near a plane wall boundary, it was found there are three main effects present that influence the domain sizing in each coordinate direction. An insufficient vertical domain leads to suppressed streamlines which locally accelerate the flow and artificially increases the drag coefficient. An adequate horizontal domain length upstream from the cylinder allows the stagnation pressure on the rectangular cylinder to propagate unimpeded to the flow inlet. A sufficient horizontal domain length downstream from the cylinder allows the flow wake to completely develop before exiting the outlet. Through appropriately sizing the CFD domain, a comprehensive verification study leads to accurate and useful results.

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Background Allergic rhinitis (AR) is a common allergic disease with increasing prevalence globally. However, the molecular mechanism underlying AR pathogenesis remains largely undefined. Methods Samples of peripheral blood and nasal mucosa from patients with AR, as well as the ovalbumin-induced AR mice model was obtained. qRT-PCR and western blot were used to detect the expression of LINC00240, miR-155-5p, PU.1 and other key molecules. ELISA assay and flow cytometry were employed to evaluate the secretion of IL-9 and T-helper 9 (Th9) cell ratio, respectively. Bioinformatics analysis, RNA immunoprecipitation (RIP), chromatin immunoprecipitation (ChIP) and luciferase reporter assays were employed to further elucidate the regulatory network of LINC00240/miR-155-5p/DNMT1. The methylation of PU.1 promoter was assessed by methylation-specific PCR (MSP). This signaling axis was finally confirmed in the AR mice model. Results LINC00240 was downregulated, while miR-155-5p and PU.1 were upregulated in the peripheral blood and nasal mucosa of AR patients, as well as in the AR mice. This was accompanied with the increased ratio of Th9 cells and elevated IL-9 secretion. Mechanistically, LINC00240 served as a miR-155-5p sponge, and DNMT1 was a target of miR-155-5p. In addition, DNMT1 mediated the methylation of PU.1 promoter. In vivo studies verified that LINC00240 mitigated AR progression, possibly via miR-155-5p/DNMT1/PU.1-dependent Th9 differentiation. Conclusion In summary, the involvement of LINC00240 in AR pathogenesis is closely associated with Th9 differentiation through modulating DNMT1-dependent methylation of PU.1 by sponging miR-155-5p.