Objective: Determine the voiding function one year following Pelvic Reconstructive Surgery (PRS) for women with Bladder Outlet Obstruction (BOO) and advanced pelvic organ prolapse (POP). Additionally, identify potential risk factors contributing to persistent voiding dysfunction (VD) after PRS. Design: Retrospective study Setting: Tertiary Centre in Taiwan. Population: Women who underwent PRS for POP-Q stage III-IV and had urodynamic study (UDS) findings of BOO from January 2006 to January 2022. Methods: Records of 1894 women underwent PRS for advanced POP reviewed. Patients with clinically confirmed POP-Q stage III-IV and UDS findings of BOO were included. Main Outcome Measures: Primary outcome: Resumption of normal voiding function one-year post-surgery, clinically and via UDS. Failure: UDS diagnoses VD and BOO. Secondary outcomes: Identify risk factors for persistent VD one-year post-surgery. Results: Total of 431 women with POP-Q Stage III and IV, UDS of Qmax <15 ml/s and PdetQmax ≥20cmH20 were included. Resumption of normal voiding function were found in 91% (n=392/431), while 9% (n=39/431) remains to have VD 1 year post operatively. Those with persistent VD, 20.5%(n=8/39) remains having urodynamic diagnosis of BOO. Univariate and multivariate logistic regression reveal factors associated with post-operative VD are pre-operative maximal cystometric capacity MCC ≧500 and post void residual PVR ≧200 had significant odds ratios with 95% confidence intervals (Univariate: 3.1 [1.6-7.1], 2.1 [1.1-5.0]; Multivariate: 3.4 [1.6-8.4], 2.3 [1.5-6.5], respectively). Conclusions: VD may persist in women with BOO following PRS, particularly in those with pre-operative MCC ≥500ml and PVR volume ≥200ml.

The study of natural suitability of human settlements environment aims at objectively revealing the human settlements under the influence of natural geographic elements, which to quantitatively characterize the pattern of regional population distribution under natural limitations or suitability. Based on the kilometer grid, the study establishes the Human Settlements Index (HSI), which includes Relief Degree of Land Surface (RDLS), Temperature-Humidity Index (THI), Land Surface Water Abundance Index (LSWAI) and Land Cover Index (LCI). The main conclusions are as follows: (1) The RDLS of Qinghai-Tibet Plateau is dominated by high values (high elevation, sharp topographic undulation), with great regional differences. It is obviously different that the THI of the region, which shows an increasing trend from the northwest arid region to the southeast. However, both the high LSWAI and the LCI distribute on intensively and zonally. (2) Supposed that the auxiliary elements (hydrology, vegetation) enhance dominant elements (topography, climate), the conclusion shows that the HSI between 0.07~1 in the study area, averages 0.45. According to the grading judgment of the topographic and climatic suitability, with the restriction of physiological elements on human habitation, there defines the 7 types of human settlements environment suitability. (3) The unsuitable type account for 32.48% of the total area, and only 1.87% of the corresponding population, mainly distributed in the Kunlun mountains, the Gangdis mountains and the western side of the Himalayas. As an important basis, human settlements suitability provides scientific basis for resources and environment carrying capacity, moreover, it supports the regional planning and population distribution.

The high phosphorus fixing characteristics of Vertisols and the lack of crop response to its application as a fertilizer is one of the major challenges leading to phosphorus deficiency. Its bioavailability is determined by adsorption and desorption characteristics. A Pot experiment was conducted to investigate the effect of mixed manure on phosphorus adsorption characteristics using the batch equilibrium method including selected properties of Vertisols. Four rates of mixed manure (0, 5, 10, and 15 t ha -1) were added to the soil. Following 30 days incubation period, changes in selected soil properties, phosphorus adsorption, and desorption characteristics were studied. The data were analyzed using ANOVA. The results revealed a significant decrease in soil pH, and increase in soil organic carbon, total nitrogen, available phosphorus, and cation exchange capacity as compared to the control. The overall means of the amount and efficiency of adsorbed phosphorus were significantly decreased due to mixed manure. Besides, the interaction effect of mixed manure and added phosphorus concentration revealed a significant increase in both the amount and efficiency of adsorbed phosphorus. Both parameters revealed an increasing trend with increased rates of added phosphorus concentration but decreased with increased rates of mixed manure. Though all treatments were fitted well to both the Freundlich and Langmuir isotherms, the former one was used to due to its higher R 2 value. Freundlich adsorption coefficient and intensity were found reduced significantly compared to the control. Therefore, mixed manure application has increased phosphorus availability by reducing its adsorption and related properties of Vertisols.

The aim of this study was to assess the organic carbon (OC) content in the PM10 emitted by agricultural soils and rural roads under controlled conditions. Samples were collected from agricultural soils and rural roads. The PM10 was generated and collected using an electrostatic precipitator coupled with the Easy Dust Generator (EDG). This procedure ensures that the PM10 collected come specifically from soil. OC contents were measured in both the soil and PM10. The enrichment ratio (ER) was calculated as the ratio between OC content in the PM10 and OC content in the soil. The results showed that OC content in the PM10 ranged from 2.7 to 3.5 % in agricultural soils and from 1.4 to 2.9 % in rural roads. These values were comparable to the OC contents observed in fine particles transported by the wind, but lower than OC contents observed in PM10 samples collected in rural areas using active samplers and filters. A quadratic function described the association between OC in PM10 and OC in the soil. A negative potential function described the association between ERs and OC in the soil. Both associations suggested a saturation of OC in PM10 when the OC content in the soil was high. This information is crucial for a better comprehending of the dust emission role in the redistribution of OC within terrestrial ecosystems and to the atmosphere and oceans.

Since its inception in the 1930’s, transmission electron microscopy (TEM) has been a powerful method to explore the cellular structure of parasites. TEM usually requires samples of < 100 nm thick and with parasites being larger than 1 µm, their study requires resin embedding and ultrathin sectioning. During the past decade, several new methods have been developed to improve, facilitate and speed-up the structural characterisation of biological samples, offering new imaging modalities for parasitology. In particular, scanning transmission electron microscopy (STEM) can be used to observe sample sections as thick as 1 µm thus becoming an alternative to conventional TEM. STEM can also be performed under cryogenic conditions in combination with cryo-electron tomography providing access to the study of thicker samples in their native hydrated states in 3D. This method, called cryo-scanning transmission electron tomography (cryo-STET), was first developed in 2014. This review presents the basic concepts and benefits of the STEM methods and provides examples to illustrate the potential for new insights into the structure and ultrastructure of parasites.

Environmental DNA is an effective tool for describing fish biodiversity in lotic environments, but the downstream transport of eDNA released by organisms makes it difficult to interpret species detection at the local scale. In addition to biophysical degradation and exchanges at the water-sediment interface, hydrological conditions control the transport distance. We have developed an eDNA transport model that considers downstream retention and degradation processes in combination with hydraulic conditions and assumes that the sedimentation rate of very fine particles is a correct estimate of the eDNA deposition rate. Based on meta-analyses of available studies, we successively modelled the particle size distribution of fish eDNA (PSD), the relationship between the sedimentation rate and the size of very fine particles in suspension, and the influence of temperature on the degradation rate of fish eDNA. After combining the results in a mechanistic-based model, we correctly simulated the eDNA uptake distances observed in a compilation of previous experimental studies. eDNA degradation is negligible at low flow and temperature but has a comparable influence to background transfer when hydraulic conditions allow a long uptake distance. The wide prediction intervals associated with the simulations reflect the complexity of the processes acting on eDNA after shedding. This model can be useful for estimating eDNA detection distance downstream from a source point and discussing the possibility of false positive detection in eDNA samples, as shown in an example.

It is necessary to conduct research that will serve as a foundation for pharmacotherapy for patients with mental illnesses. Digital data are widely available, which has facilitated pharmacoepidemiology and, in particular, observational studies on the efficacy of real-world medications. The availability of large patient samples and the availability to study understudied subpopulations in their natural settings are benefits of pharmacoepidemiological research. This type of research is also less expensive and takes less time to complete than randomized controlled trials, making it more likely to address issues relating to long-term outcomes, generic medication, and stopping medication (deprescribing). We can expand Pharmacoepidemiological techniques to pharmacovigilance and use them to help the development of medicines that are already on the market. The non-randomized nature of treatment selection, which causes confounding by indication, is a drawback of observational pharmacoepidemiological studies. Active comparison groups, within-individual designs, and propensity scoring are potential solutions to this problem. To increase confidence in the inferred causal relationships, it has strengthened many of the more rigorous pharmacoepidemiology studies through the triangulation of multiple analytical approaches. It is encouraging that guidelines are considering evidence from reliable observational pharmacoepidemiological studies besides randomized controlled trials considering advancements in data resources and analytical methods. cooperation among pharmacoepidemiology researchers and guideline writers may enable researchers to respond that important policymakers’ questions and guarantee that findings are included in the evidence base. To fully capitalize on future opportunities, it will be necessary to advance statistical and data science techniques, general engagement, and capacity building (data resources and researcher base).

IntroductionCornual pregnancy is rare, accounting for approximately 2-4% of all ectopic pregnancies [1]. By definition, it refers to the implantation and development of a gestational sac at the proximal and lateral regions of the uterus (aka uterine horns or cornua). As with the majority of other types of ectopic pregnancy, cornual pregnancy diagnosis is based on clinical suspicion, β-hCG measurements and transvaginal ultrasound findings [2]. As with other types of ectopic pregnancy, cornual pregnancy is associated with severe patient morbidity and mortality [3]. Therefore, timely and accurate diagnosis is key as it directly affects treatment type and urgency. Several management options are available from the conservative (methotrexate administration and expectant management) up to the more radical side of the spectrum (cornuotomy, cornual resection, hysterectomy) [4]. Hysteroscopy is an additional option that combines effective and complete removal of the gestational sac, without severely affecting uterine anatomy, however its application usually requires imaging guidance [5].In this report, we present the case of a cornual ectopic pregnancy, which could not be diagnosed via traditional ultrasonographic imaging and instead was verified by MRI imaging. Subsequently, guided by the MRI imaging data, hysteroscopic resection and removal of all products of gestation was safely and successfully performed without any complications and with the patient making a swift recovery.

The Psychiatric Symptoms in Anti-IgLON5 Disease: Case Report and Literature ReviewKey Clinical MessageImmunotherapy may be ineffective in the advanced stages of anti-IgLON5 disease with psychiatric symptoms. The psychiatric symptoms in advanced stages of anti-IgLON5 disease may be associated with neurodegeneration.Keywords: Anti-IgLON5 disease, Psychiatric symptoms, Neurodegeneration, Immunotherapy, Case report.

Background: While most research has largely focused on medical risks associated with reduced quality of life (QOL) in survivors, sociodemographic and family factors may also play a role. Thus, we examined sociodemographic factors and family factors associated with survivor QOL, including adolescent’s cancer-specific stress, mother’s general stress, and mother–adolescent communication. Methods: Mothers ( N=80) and survivors (ages 10-23, N=50) were assessed 5 years following initial diagnosis. Mothers completed measures regarding sociodemographic background adolescent’s cancer-specific stress, mother’s general stress, mother–adolescent communication, and adolescent QOL. Survivors also reported on their own QOL. Two hierarchical multiple regressions examined predictors of: (a) mother’s report of adolescent QOL and (b) survivor’s self-report of QOL. Results: The final model predicting mother-reported adolescent QOL was significant, F(5,74)=21.18, p<.001, and explained 59% of the variance in QOL. Significant predictors included adolescent stress ( β=-0.37, p<.001), mothers’ stress ( β=-0.42, p<.001), and communication ( β=0.19, p=.03). The final model predicting survivor-reported QOL was also significant, F(5,44)=5.16, p<.01 and explained 24% of the variance in QOL. Significant predictors included adolescent stress ( β=-.37, p=.01) and communication ( β=-.31, p=.04). Sociodemographic factors were not a significant predictor of QOL in any model. Conclusion: Family stress and communication offer potential points of intervention to improve QOL of pediatric cancer survivors from mother and survivor perspectives. While additional research is needed, healthcare professionals should encourage stress management and strong mother–child communication to enhance survivors’ long-term QOL. Such interventions may be helpful, irrespective of known sociodemographic factors that often affect health.

Background：Coffin-Siris syndrome（CSS,MIM 135900），is a multiple congenital anomaly syndrome characterized by developmental disability，coarse facial features，microcephaly and hypoplastic nails of the fifth fingers or toes. CSS is caused by mutations in several genes of the BRG1-associated factor（BAF） pathway including SMARCA4. Individuals with SMARCA4 variants have been previously reported and appear to display a variable phenotype. Pathogenic variants in SMARCA4 genes have been associated with an increasing risk of Coffin-Siris syndrome 4（MIM 614609）and Rhabdoid Tumor Predisposition Syndrome2（RTPS2）. Methods：Whole-exome sequencing（WES） was performed on an infant who presented with developmental delay，feeding difficulties，and laryngomalacia. He was also found to have testicular yolk sac tumor that has not been previously reported in CSS. Results: Germline testing identified a pathogenic variant in SMARCA4 c.2932C＞G. Conclusions: To our knowledge，this is the first report of testicular yolk sac tumor in an infant with a diagnosis of CSS with a potential predisposition to RTPS2.

The monitor of pathogenic microorganisms in water is important for public health and disease outbreaks prediction. Recently, the optical detection techniques have drawn much attention due to the advantages of rapid response, security and high sensitivity. In this paper, a fluorescence spectrometer based on 375 nm exciting laser and the microchannel liquid sample flow technology is proposed. The 4×4 narrowband filter array was used as a spectroscopic system for high fluorescence flux, which was coupled to a Silicon Photomultiplier (SiPM) array with single-photon sensitivity. B500 fluorescent microspheres and Escherichia coli were used for performance evaluation of the spectrometer. As a result, it is feasible to use random particle counting method to detect the bacteria concentration level in water even low to a single CFU/mL. In addition, the method was successfully applied to tap water samples. The results suggest that the proposed method is applicable for on-site bacteria detection.

The pandemic caused by SARS-CoV-2 infection has left behind a new symptomatology called post COVID-19. The pathophysiological mechanisms still remain controversial; however, a link between persistent inflammation and these sequelae has been suggested. Herein, we longitudinally assessed up- and downstream molecules of the NLRP3 inflammasome’s pathway in three study groups: healthy donors (HC, n=14) and donors with a confirmed SARS-CoV-2 infection who had been hospitalized, the latter divided into post COVID-19 (PC, n=27) and non-post COVID-19 patients (nPC, n=27) based on the presence or absence of symptomatology at month 6, respectively. Plasma cytokines (IL-1β, IL-3, IL-6, IL-8, IL-18, IP-10, MIG, TNF-α, IFN-γ, MIP-1α and MIP-1β) and total peroxide (TPX) levels were quantified at baseline and at months 1 and 6 after the onset of the infection. Baseline values were the highest for both TPX and cytokines that progressively decreased thereafter the acute infection. IL-1β, MIP-1α, and TNF-α at month 1 were the only cytokines that show a significant difference between nPC and PC. These findings suggest that a persistent inflammatory state one month after the onset of SARS-CoV-2 infection related to specific cytokines (IL-1β, MIP-1α, and TNF-α) might guide to predict post COVID-19 symptomatology.

Omicron emerged as the fifth variant of concern of SARS-CoV-2 coronavirus pandemic in late 2021 and rapidly overtook the previously predominant Delta variants with a significantly faster transmission rate and unique mutations on the spike gene. Hence, the ability to identify viral variants rapidly and affordably in large number of patients, which facilitates the monitoring of the transmission and clinical impact of new variants, is needed to obtain information for updating the public health policy. In this study, we evaluated the capability of two RT-PCR and mass spectrometry-based SARS-CoV-2 variant classification platforms to distinguish Delta, Omicron BA.1, and Omicron BA.2 variants in 618 COVID-19-positive samples from patients in Bangkok collected during November 2011-March 2022. Analysis of the time-evolution pattern of SARS-CoV-2 variant profiles indicated that the BA.1 and BA.2 possess up to 2-3 times higher transmission rates than the Delta variant. Our study showcases a cost-effective virus surveillance that enables a quantitative estimation of variant-specific public health impact.

Climate change is likely to drive widespread species range shifts and extirpations, mostly on the warm distribution edges, where habitat tends to be fragmented, of lower quality, support lower population density, and at greater risk from extreme weather events. In the Intermountain West, future climate will likely be warmer and drier, driving a reduction in sagebrush (Artemesia sp.) and other shrubland cover. Among the species threatened by more xeric climate is the Greater sage-grouse (Centrocercus urophasianus), which depends on sagebrush for forage and shelter, though their response to temperature is not well studied. We deployed 75 data loggers across two valleys in southern Utah and Nevada, near the southern edge of sage-grouse distribution, and collected temperature data for 27 months. We used random forest models to test the impacts of temperature, land cover, and topography on sage-grouse habitat selection and found that temperature influenced selection in all seasons and both sites. In Utah, the warmer site, sage-grouse selected areas near trees during the extremes of both winter and summer. In autumn and spring those extremes were rarer and sage-grouse avoided habitat near trees. Conversely, sage-grouse in the cooler Nevada site selected contiguous patches of sagebrush in extremes periods but only selected habitat near trees during winter cold, avoiding trees during summer. Our findings show that extreme temperatures drive sage-grouse to select habitat near trees despite the risk likely posed by avian predators. The difference between the Utah and Nevada sites suggests that sage-grouse prefer sagebrush as thermal shelter but that it may be inadequate during the hottest times, forcing riskier selection. These models point toward a more mechanistic understanding of how sage-grouse distribution may retract at its warm edges. This will refine our understanding of seasonal habitat requirements and inform management decisions to prioritize thermal refugia for an imperiled species.

To comprehensively investigate the molecular transmission patterns of HIV-1 genotypes among men who have sex with men (MSM) in Chongqing, we employed 392 pol sequences of MSM to construct a phylogenetic tree and gene transmission network. The study collected a total of 392 sequences for analysis. Among the viral subtypes, CRF07_BC accounted for 73.2% (287/392) and CRF01_AE accounted for 20.7% (81/392), emerging as the predominant subtypes in this investigation. Additionally, we observed the presence of CRF55_01B, CRF59_01B, subtype B, CRF08_BC and other circulating recombinant forms in consecutive detections. The HIV-1 molecular network was constructed with a gene distance threshold of 1.5%, resulting in an entry rate of 61.4% (241/392). Within the network, we identified a total of 23 molecular clusters, with the largest cluster being the CRF07_BC molecular cluster comprising 148 node values. Transmitted drug-resistance (TDR) mutations were found in 4.34% of the cases, with 1.79% associated with protease inhibitors (PIs), 0.51% with nucleoside reverse transcriptase inhibitors (NRTIs), and 2.55% with non-nucleoside reverse transcriptase inhibitors (NNRTIs). Statistical analysis indicated a higher enrollment rate among infected individuals with the CRF07_BC subtype, those identifying with same-sex sexual roles as “vers,” and individuals with higher education levels. This suggests the need for strengthened investigation and intervention in this population to prevent the formation of larger transmission clusters. Furthermore, continuous monitoring of the HIV-1 molecular dynamics network is necessary to promptly and accurately track changes in molecular epidemic characteristics.

This paper examines the relationship between population aging and regional economic development in major cities in China by analyzing R-studio big data. Through correlation analysis, the study finds that for every percentage point increase in the proportion of elderly people in a jurisdiction, the city's economic growth rate falls by 10 percent, indicating a negative correlation between population aging and economic growth. The paper attributes the fundamental cause of population aging to the development of modern science and technology, particularly in the field of medical and health care. The improvement of people's health and extended lifespan, along with the rapid development of the economy and improvements in living standards, has resulted in a shift in attitudes towards childbirth, leading to a decrease in birth rates. The research then constructs a regional economic development model, population growth trend, and population aging trend chart using cluster analysis and big data R-studio algorithm. The study takes the fluctuations of residents' living consumption level and the degree of population aging in a certain region since 2010 as variables to study the relationship between the degree of population aging and regional economic development. The findings of this research contribute to the development of policies and strategies for sustainable economic growth in the face of population aging. The paper highlights the importance of exploring solutions to population aging and promoting economic development.

INTRODUCTION:Tuberculosis remains a significant global health burden, with central nervous system (CNS) involvement being a rare but serious manifestation. While pulmonary tuberculosis is the most common form, extrapulmonary manifestations can affect various organs and systems. The CNS involvement in developing countries constitutes nearly 10% of all tuberculosis patients [1]. Tuberculomas with compressive myelopathies without bone involvement are an even rarer occurrence. In the differential diagnosis of extensive spinal cord injuries, particularly in young patients with a history of pulmonary tuberculosis or tuberculous meningitis, it is important to consider the possibility of an intradural extramedullary tuberculoma [2].Here we will be discussing a case of intradural extramedullary tuberculosis of the thoracic spine, with progressive neurological dysfunction. Surgery aims to decompress the spinal cord and remove the tuberculoma, thereby relieving the pressure on the neural tissues and preventing further neurological deterioration [3-5]. The specific surgical technique employed depends on the location and extent of the tuberculoma.Following surgery, anti-tubercular therapy is initiated to target the underlying tuberculosis infection. This typically involves a combination of multiple anti-tuberculosis medications, such as isoniazid, rifampicin, ethambutol, and pyrazinamide [2]. The duration of anti-tubercular therapy may vary but generally lasts several months to ensure complete eradication of the infection. Continual postoperative monitoring assumes paramount importance in assessing neurological recovery and treatment response. Concurrently, physiotherapy and rehabilitation assume significance in facilitating the functional restoration and enhancing the overall quality of life [1].This report aims to discuss the diagnostic challenges, treatment strategy, and clinical outcomes, highlighting the importance of a multidisciplinary approach in managing this uncommon condition.

Effect of Acupuncture Treatment on a Patient With Lower Lip NumbnessDr. Rida YounessDepartment of oral medicine at the faculty of Dentistry, Damascus University, Damascus, SyriaRiday28@gmail.comAss.Prof. Dr. Abeer AljoujouDepartment of oral medicine at the faculty of Dentistry, Damascus University, Damascus, SyriaAbeerjoujou@gmail.comPD. Dr. med. Lei LiHead of Maxillofacial Surgery/plastic operations department in klinikum Oldenburg, Germanykieferchirurgie@klinikum-oldenburg.deDr. Haya Al Jabban (corresponding author)DDS, Damascus university, Damascus, Syria.hayooshj@gmail.comAbstract:Background: acupuncture is a form of alternative medicine involving the insertion of fine needles into the skin in order to stimulate certain energy lines associated with different areas of the body. It has been used for many conditions, but it is best known for relieving pain, loosening muscles and reducing nausea.Case presentation: the patient presented with a complaint that she can’t feel her lower lip anymore after extracting a lower third molar 8 years ago. Acupuncture treatment was applied alongside with manual stimulation.Conclusion: acupuncture treatment was done properly along with the patient’s cooperation which led to a full return of the sensation.Keywords: acupuncture , numbness , acupoints.Introduction:Acupuncture is a form of alternative medicine involving the insertion of fine needles into the skin in order to stimulate certain energy lines associated with different areas of the body. It has been used for many conditions, but it is best known for relieving pain, loosening muscles and reducing nausea [1].Acupuncture may aid in the management of musculoskeletal problems, headaches and migraines, gagging, sinusitis, dry mouth, dental anxiety and pain management.[2]Generally speaking, there are two kinds of acupuncture — manual acupuncture (MA) and electroacupuncture (EA). When we talk about acupuncture analgesia,both methods are involved. In MA, the acupuncture needles are inserted through the skin at the acupoint and then moved up and down in different directions to induce strong mechanical stimulation of the acupoint. Sensations of soreness, numbness, fullness, or heaviness called De qi or Te qi can be felt by clinicians and patients, and this phenomenon is considered the hallmark of activatedacupoints [3]. It has been shown that local anesthesia at acupoints can block these sensations and prevent acupuncture-induced analgesia [4].Mandibular third molars (MM3s) are responsible for pericoronitis, primary and/or secondary crowding of the dentition, odontogenic tumors and cysts, periodontal defects associated with the posterior part of mandibular second molars.The surgical extraction of these molars may damage the nerve and cause hypoesthesia of the lower lip which is one of the most unpleasant post – operative complication. [5,6]Altered sensation in the lower lip associated with third molar removal occurs in approximately 4 per 1000 patients (3.9%) in the early postoperative period. [7,8]Case Presentation:A female patient (43 years old) presented at the oral medicine department in Damascus university faculty of dentistry with a complaint that her lower lip has been numb for the past 8 years ago after extracting a lower third molar. The patient was treated medically with vitamin B complex pills without any progress regarding her numbness.The patient had a full neurological examination, in addition to an oral examination.Acupuncture treatment was discussed with the patient and chosen with a total of six sessions and a duration of 30 minutes for each session and a session each 5 days. A written consent form was signed by the patient before starting the treatment.Acupuncture treatment was administrated using a sterile stainless-steel needle (0.30 x 40 mm) (HUANQIU) figure [1a,1b], in 12 local points. The points chosen were considered the most effective points that can stimulate the trigeminal and facial nerve.[9]

Abstract:Background and Importance: Primitive Neuro-Ectodermal Tumor (PNET) is a highly aggressive tumor composed of small round blue cells, mostly developing in children and young adults. Two subcategories of central and peripheral PNET have been discussed. Central nervous system (CNS) is the usual primary site where PNETs are found, while PNETs of peripheral nerves are uncommon. Ulnar nerve, in particular, is an extremely peculiar origin for PNET and to the best of our knowledge only few well-documented cases have been yet reported.Clinical Presentation: A 30-year-old male presented with progressive paresthesia of right hand’s little finger and painless swelling of right axillary. Magnetic resonance (MR) neurography showed a heterogeneous, high-signal, round mass within the right axillary fossa in proximity to the medial aspect of brachial plexus branches. Clinical and radiological study were unable for accurate diagnosis and surgical resection of the tumor was done. Pathology reported a small, round, blue cell tumor which immunohistochemistricaly was consistent with PNET.Conclusion: Although pPNET is not obviously the first differential diagnosis coming to mind when a rapidly growing mass in the axillary fossa arises from the peripheral nerves, but due to its highly malignant behavior, it is important to be considered in the differential diagnosis of peripheral nerve neoplasms.Running title: Primitive Neuro-Ectodermal Tumor of Ulnar NerveKeywords: Peripheral primitive neuroectodermal tumor, pPNET, Ulnar nerve

Non-reciprocal metasurfaces have recently attracted significant attention due to their ability to control electromagnetic waves in unprecedented ways. In this study, we propose a novel, non-reciprocal metasurface that utilizes a combination of magnetic materials and electrical conductors to achieve non-reciprocity to plane wave illumination at microwave frequencies. Experimental results demonstrate that the metasurface achieves an isolation characteristic of at least 15 dB at 6.5 GHz.

Tuberculosis Peritonitis after spontaneous Abortion: A Case ReportAbstract:Introduction: Tuberculosis (TB) is a significant problem worldwide. The rate of active tuberculosis in pregnancy is rising and it is a significant cause of maternal mortality during pregnancy.Case presentation: This study is about a young woman who was suffering from TB peritonitis, which is rare, with a highly progressive clinical course following the spontaneous abortion of 16-week gestation that refer with abdominal pain. Our case received a diagnostic laparotomy that showed several small-scale implants on the peritoneum and viscera. Histopathology revealed chronic caseating granulomas with necrosis. With the possible diagnosis of tuberculosis anti-mycobacterial therapy was started and she received these drugs for 6 months. The patient’s clinical manifestations completely disappeared and chest CT scan was normal after treatment.Conclusion: The diagnosis of peritoneal tuberculosis is challenging and it could be made by CT imaging, explorative laparoscopy, evaluation of biopsies from specimens and culture or PCR from ascites fluid or infected tissues.Key words: TB, peritoneal tuberculosis, extra pulmonary tuberculosis, acute abdomen, pregnancy1. Introduction Tuberculosis (TB) is a significant problem worldwide. About 25% of whole world population are estimated to be infected with mycobacterium tuberculosis. Although it is a preventable and treatable disease, but according to the WHO reports, TB infected about 10 million cases and claimed 1.5 million lives in 2018.(1) It was estimated that the rate of active tuberculosis in pregnancy is rising in United States(2). Most of these pregnant women lived in Africa and Southeast Asia(3). TB is a significant cause of maternal mortality during pregnancy. Pregnancy-related complications contain increased spontaneous abortion rate, being smaller relative to the weeks of pregnancy, suboptimal weight gain in pregnancy, labor before 37 weeks of pregnancy, low birth weight, and enhance neonatal mortality. Delay in the diagnosis of this infection is an independent factor that is associated with both enhanced obstetric morbidities and preterm labor by four- and nine-folds, respectively (4). While TB mainly affects the lungs, about 33% of TB cases might suffer from extra pulmonary disease. The peritoneum is an usual extra pulmonary site of TB.(5)We presented a woman with a 16-week spontaneous abortion who referred to our emergency ward with the feature of acute abdomen as the first sign of tuberculosis, a rare case of tuberculosis peritonitis.2. Case Presentation A 20-year-old G2P1Ab1 woman who aborted spontaneously a 16 week pregnancy at home in 11 days ago, referred to our hospital with general abdominal pain from 10 days ago. The abdominal pain was intensified and associated with nausea, vomiting, anemia and, massive ascites. She had a complaint of anorexia, fainting, and sweating. On the physical examination; PR=120/min, BP=90/60mmHg, RR=18/min, OT=38̊ and O2sat=97% and she had abdominal distension with diffuse tenderness and guarding especially in the lower abdomen, and positive cervical motion tenderness that suggested a hemorrhage or massive ascites. Transvaginal ultrasonography confirmed the presence of ascites. (Figure 1-2). Laboratory data revealed Hb=5/6 gr/dL, white blood count were 6100, C reactive protein= 3+ and ESR=120. In addition UA, UC and PCR for covid 19, were sent due to abdominal pain and corona virus pandemic. The results of tests performed to evaluate renal function and level of hepatic transaminase did not indicate unusual values.The patient subsequently underwent diagnostic laparotomy due to suspicious unsafe abortion in history, abdominal examination, and severe anemia with the probable diagnosis of acute abdomen. Laparotomy revealed 3liters thick yellow pus in the abdominopelvic cavity and substantial adhesions between viscera, and several small-scale nodular implants on the surface of peritoneal, liver, and stomach. Intestine, omentum, mesentery, uterine, ovaries and fallopian tubes were normal except for inflammation. Irrigation of abdominopelvic cavity and adhesiolysis were done. There was no specific site for the purulent ascites in exploration. Tissue samples from the peritoneum, omentum and lymph nodes were sent to pathology and some tissue samples and ascetic fluid were sent for the microbiology, cytology and PCR for tuberculosis examinations. The patient was treated with intravenous broad-spectrum antibiotics till 72 hours. Tissue samples of pathological study showed granulomatous inflammation and samples for smear and culture and cytology revealed negative findings. In addition, covid19 PCR was reported negative.According to large amount of intraperitoneal pus without a specified source and granulomatous inflammation on pathology report (figure 3), with the probable diagnosis of tuberculosis, PPD and Chest radiography were done. PPD was negative but CXR revealed patchy consolidations.Despite 72hours of antibiotic therapy, there was no improvement in clinical condition so according to the laboratory findings and medical records, thoracic computed tomography (CT) scan was performed for further evaluation of the ascites etiology (figure 4). Bilateral pleural effusion, atelectasis, pulmonary parenchymal consolidations and sub plural patchy consolidation were seen. Abdominopelvic Ultrasonography was normal. With the possible diagnosis of tuberculosis anti-mycobacterial therapy with isoniazid, rifampin, pyrazinamide, and ethambutol was prescribed and the patient received these drugs for 6 months till complete the course of treatment. The patient’s clinical manifestations completely disappeared and chest CT scan was normal after treatment.

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