Thermal energy storage systems (TES) have emerged as a vital solution for addressing the gap between energy supply and demand. While research on solar energy storage has primarily focused on flat-plate collectors, limited work has been done to explore the potential of Scheffler solar concentrators. This study proposes an innovative approach to thermal energy storage using a Scheffler solar concentrator and phase change material (PCM) to address the energy needs of rural areas with limited access to electricity. Real-time design and testing were conducted using paraffin wax as the PCM, and CFD analysis was performed using the ANSYS Fluent software to determine the optimal charging and discharging times. The results indicated that the required charging time was 17 min according to the CFD analysis, while the experimental results yielded a charging time of 18 min. The results demonstrated that the proposed approach is a feasible and effective solution for meeting the energy demands of rural communities. The charging time was optimized using the response surface method, yielding an optimal charging time of 20.5 min and an optimal discharging time of 26.2 min. Overall, these findings highlight the potential of utilizing Scheffler solar concentrators and PCMs for sustainable and reliable thermal energy storage.

Objective: The purpose of this study was to investigate the current status of emotional and behavioral problems in children with cancer and to explore the buffer role of parental psychological flexibility in the effects of anxiety, depression, and pressure on emotional and behavioral problems in children. Method: 138 pairs of Children with cancer and their caregivers were included in the study. Explanatory variables included demography, parental psychological flexibility, depression-anxiety-stress, strengths, and difficulties of children. The effect of parental psychological flexibility on children’s emotional and behavioral problems was explored by simple intermediary analysis. Results: 138 valid questionnaires were collected in the First Affiliated Hospital of Zhengzhou University. The abnormal rate of emotional symptoms was 8.2%, conduct problems was 6.8%, hyperactivity score was 7.7%, peer interaction score 24.2%, total difficulties was 9.2% and pro-social behavior was 9.7%. Intermediary analysis showed that parental psychological flexibility partially mediated the effects of caregivers’ depression, anxiety, and stress on the emotional and behavioral problems of children with cancer (P<0.001). Conclusion: Psychological inflexibility of caregivers of children with cancer have relatively apparent effects on children, including direct direct and indirect effects. And the mechanism needs further investigation.

Title PageSubmission Category: Case ReportTitle: Case Report: Coexistence of Jacob Syndrome, congenital Adrenal Hyperplasia, and Ambiguous Genitalia in a Male Infant.Qaisar Ali Khan1; Faiza Amatul-Hadi, BS2; Amritpal Kooner, MA3; Amber Lee4, Rahma Ahmed5, Adithya Nadella6 Harshawardhan  Pande 7 , Yaxel Levin- Carrion 8,Muhammad Afzal9,Moses Alfaro, BSA10

Investigating diversity patterns along altitudinal clines brings important insights about the responses of biodiversity to changes in environmental conditions, with implications for conservation actions. We analyzed the species richness and functional patterns of liverworts along the entire altitudinal gradient (0-5000 m) in Colombia, the country with the richest liverwort flora in tropical America. Published data on the elevation ranges of the 705 liverwort species and functional traits related ecological strategies were compiled. The elevation gradient was divided into 100-m vertical bands. General linear and additive models were used to investigate trends in liverwort richness. Functional entities richness and functional diversity (Functional Redundancy, Functional Over-redundancy and Functional Vulnerability) were evaluated along the altitudinal gradient. We also assessed the species richness-dependency in the functional patterns through NMDS. A unimodal hump-shaped relationship was observed for species richness and functional diversity, with the highest values recorded in the intermediate zones (2000-3000 m) of the altitudinal gradient. The most representative traits explaining the functional differentiation were the presence of monoicous and dioicous reproductive system, lobules, inflated lobules, and thalloid and leafy gametophytes. Functional vulnerability showed an exponential pattern, with higher values at altitudes above 4000 m, where life forms tolerant to high humidity and dark pigmentation were the most relevant traits. The unimodal hump-shaped pattern was explanatory of the distribution of species and functional diversity of liverworts along the altitudinal gradient. These functional patterns indicated that environmental filters select functional traits, mainly those related to water uptake and retention, as adaptive strategies. We found a high functional vulnerability generated by functional entities with a single liverwort species in high-Andean areas (4000-5000 m), implying a threat to the ecosystem functions provided by liverworts in these areas

A document by Arjun Basnet. Click on the document to view its contents.

INTRODUCTIONThe PIEZO1 gene is located on chromosome 16 (16q24.3) and encodes the largest known human transmembrane protein, PIEZO1. The PIEZO1 protein has low tissue specificity, showing expression in at least 27 different tissue types.1 This mechanoreceptor is activated by mechanical force and controls potassium and calcium flow in multiple cell types, most prominently lung, bladder, skin, and red blood cells.1,2 Studies have shown that in fetal tissue the highest expression of this protein is in the liver, spleen, and lymphatic vessels.1,2 PIEZO1 channels are crucial during development of lymphatic vasculature, acting as baroreceptors in the lymphatic and vascular systems, and sensing frictional force to determine vascular structure.3 Pathogenic variants inPIEZO1 have therefore been phenotypically associated with lymphatic malformation, perinatal edema, and non-immune fetal hydrops, as well as hemolytic anemia and pseudohyperkalemia.2,4PIEZO1 -related disorders include autosomal recessive lymphatic malformation 6 (LMPHM6, OMIM 616843) due to biallelic loss-of-function variants and autosomal dominant dehydrated hereditary stomatocytosis (OMIM 194380) due to heterozygous gain-of-function variants.5 Despite significant phenotypic heterogeneity, both disorders may present with perinatal edema and non-immune hydrops fetalis.5Congenital lymphatic dysplasia is the hallmark feature of LMPHM6, resulting in severe impairment of vascular development, and commonly causing in utero demise. The associated primary lymphedema affects all body segments, causing pleural effusions, pulmonary and intestinal lymphangiectasia, facial and neck swelling, chylothoraces, and pericardial effusion. In some cases, hydrops fetalis has resolved postnatally with concomitant recurrence of peripheral edema during childhood, typically in the lower limbs. Most reported cases of LMPHM6 have resultant pleural effusions that become chylous with the introduction of enteral feeds.5More recently, PIEZO1 has been implicated as a potential mechanotransducer in osteoblastic bone formation. Osteoblasts respond to mechanical loading and bone growth and maintenance is known to be impaired in microgravity environments and non-weight bearing patients. However, the mechanism by which this occurs has previously been uncertain.6 Recent research found that knockout mice with PIEZO1-deficient osteoblasts sustain spontaneous fractures in the setting of impaired bone density and strength. Patients with osteoporosis have been found to have reduced expression of the PIEZO1 protein.6 Likewise, simulated microgravity environments result in decreased osteoblastic function via suppression of PIEZO1 activity.7 Here, we present a patient with LMPH6 due to likely pathogenic homozygous loss-of-function PIEZO1variants who has unexplained bone disease, the first reported case of significant bone disease in this phenotype.

When two putative cryptic species meet in nature, hybrid zone analysis can be used to estimate the extent of gene flow between them. Two recently recognized cryptic species of banded newt (genus Ommatotriton) are suspected to meet in parapatry in Anatolia but a formal hybrid zone analysis has never been conducted. We sample populations throughout the range, with a focus on the supposed contact zone, and genotype them for 31 nuclear DNA SNP markers and mtDNA. We determine the degree of genetic admixture, introgression and niche overlap. We reveal an extremely narrow hybrid zone, suggesting strong selection against hybrids, in line with species status. The hybrid zone does not appear to be positioned at an ecological barrier and there is significant niche overlap. Therefore, the hybrid zone is best classified as a tension zone, maintained by intrinsic selection against hybrids. While the two banded newt species can evidently backcross, we see negligible introgression and the pattern is symmetric, which we interpret as supporting that the hybrid zone has been practically stationary since its origin (while extensive hybrid zone movement has been suggested in other newt genera in the region). Our study illustrates the use of hybrid zone analysis to test cryptic species status.

Objective: To investigate the value of the left ventricular pressure-strain loop (LVPSL) for quantitative assessment of myocardial work (MW) in patients with chronic kidney disease (CKD), and to analyze the factors influencing MW. Methods: Retrospective analysis of 75 patients with CKD (37 patients with CKD stages 2-3, and 38 patients with CKD stages 4-5) and 35 healthy volunteers between March and August 2022. Global work index (GWI), global constructive work (GCW), global wasted work (GWW), and global work efficiency (GWE) were obtained by echocardiography, and the differences between the groups were compared.These parameters were further analyzed for correlation with conventional echocardiographic indices, global longitudinal strain (GLS), and the characteristics of participants. Results: GWE and GLS were reduced and GWW was increased in the CKD group (all P <0.001). GWW was higher and GWE was lower in CKD stages 4-5 than in CKD stages 2-3 (all P <0.01). Multiple linear regression revealed that age, serum creatinine, and GLS influenced GWE (β = -0.054, P = 0.005; β = -0.003, P = 0.020; β = -0.563, P <0.001, respectively), whereas age, serum creatinine, and systolic pressure influenced GWW (β = 1.362, 0.068, 1.167, P = 0.001, 0.016, 0.003, respectively). Conclusion: LVPSL can be used for non-invasive quantitative assessment of MW in patients with CKD, providing a new sensitive approach for the clinical assessment of myocardial function. Increased age, serum creatinine and systolic pressure may be potential drivers of increased GWW, whereas increased age, serum creatinine and decreased GLS may be potential drivers of decreased GWE, thereby providing some reference for the clinical treatment of CKD

38 year old young female presented with a two-week history of dyspnoea and general malaise without any other clinical signs of malignancy. Two-dimensional Echocardiogram showed findings suspicious for a right atrial mass. Transoesophageal echocardiogram showed rupture of the right atrial free wall with a pseudoaneurysm and mass that has also infiltrated the right ventricle. Histopathology of the biopsied specimens confirmed the diagnosis of cardiac angiosarcoma. Given its rapid growth, nonspecific symptoms and late presentation to the hospital, diagnosis is often delayed. Early diagnosis is key as these patients can be referred to surgery sooner than later due to rapid progression of the mass and poor survival rates. Unfortunately, our patient had brain and lung metastases and local tissue destruction by the time she presented to the hospital. Echocardiography plays a crucial role as a readily available imaging technique to help locate the tumour and define its extent.

Immune Thrombocytopenic Purpura After Receiving AstraZeneca Coronavirus Disease-2019 Vaccine in A Patient with A Past History of the Same Disease: A Case ReportSaba Seyedia, Shadan Navidb,Zahra Saadatianc*Department of Medical laboratory sciences, School of Medicine, Gonabad University of Medical Sciences, Gonabad, Iran.Department of Anatomy, Faculty of Medicine, Social Determinants of Health Research Center, Gonabad University of Medical Science, Gonabad, Iran.Department of Physiology, Faculty of Medicine, Infectious Diseases Research Center, Gonabad University of Medical Sciences, Gonabad, Iran.Corresponding author: Zahra Saadatian. Department of Physiology, School of Medicine, Gonabad University of Medical Sciences, Gonabad, Iran.z.saadatian@yahoo.comsaadatian.z@gmu.ac.irkey words: AstraZeneca, immune thrombocytopenic purpura, ChAdOx1 nCoV-19, AZD1222, case report, covid-19Immune Thrombocytopenic Purpura After Receiving AstraZeneca Coronavirus Disease-2019 Vaccinein A Patient with A Past History of the Same Disease: A Case ReportKey Clinical Message: Immune thrombocytopenic purpura (ITP) is an autoimmune disease characterized by a low platelets count, petechiae, purpura, and conjunctival hemorrhage. In this paper, we present a relapse of ITP in an Iranian 31-year-old woman as a potential complication of the AstraZeneca vaccine.IntroductionSevere acute respiratory syndrome coronavirus-2 (SARS-Cov-2)classified in the coronaviridae family is characterized as a pandemic, and the virus is spreading increasingly worldwide (1). Accelerated efforts to develop safe and effective vaccines commenced immediately to control this pandemic (2). AstraZeneca/Oxford’s AZD1222, a vaccine candidate that entered phase 1 clinical trial in mid-May 2020, was injected intramuscularly in two doses to the participants aged 18-55 years at least 28 days intervals (3). Early observations insinuate that exposure to the AstraZeneca COVID-19 vaccine might trigger the expression of antiplatelet antibodies, resulting in a condition with thrombocytopenia and venous thrombotic events (e.g., intracranial venous sinus thrombosis) (4). ITP is a rare autoimmune disorder with reduced circulating platelets and occasionally impaired megakaryopoiesis (5). Platelets, as the smallest cell fragments of the human blood, are central players in the processes of hemostasis and thrombosis (6). The normal human platelets count ranges from 150 × 109 to 450 × 109platelets per liter of blood, and its insufficient count elevates the risk of spontaneous bleeding (7). In this case report, we confer the relapse of immune thrombocytopenic purpura after the first vaccination with ”the COVID-19 vaccine AstraZeneca” the first time.Case historyAn Iranian 31 years old female with a previous history of ITP presented with progressive, vast, and diffuse ecchymosis, increased scattered petechia purpura, and fatigue three weeks after receiving the first dose of AstraZeneca. As a result of symptoms persistence, she was referred to an outpatient laboratory to evaluate her complete blood count (CBC) 28 days after vaccine injection. CBC result showed a platelet count of &lt2000 / Mm3 and demonstrated ITP relapse. Considering her previous medical history, she had experienced a platelet decrease (9000/ Mm3 platelet count) when she was 25. On that occasion, various tests including autoimmune diseases tests (rheumatoid arthritis, lupus, and antiphospholipid syndrome), and bone marrow aspiration had ruled out other causes of platelets decrease and confirmed ITP. She had been treated with dexamethasone injection for three days in the hospital and taking prednisolone pills for six months. She had periodic checkups of CBCs, and the range of platelets was different between 210-100× 103/ Mm3. The last CBC monitoring was carried out in 2019.Differential diagnosis, investigations and treatmentAfter the COVID-19 pandemic, nevertheless, our case did not perform routine checkups, nor did she have any symptoms of platelet depletion such as scattered ecchymoses and fatigue before receiving the vaccine. Since she previously had ITP, she was given high dose dexamethasone and then saw a physician who recommended hospital admission when her platelet count came back at 25000/ Mm3. Other hematological, biochemical, and immunological tests did not reveal any other disease except intensive thrombocytopenia (Table 1).In addition, her CRP was negative, and ESR was normal, ruling out any infection and inflammation existence that could be related to other causes of ITP. In the hospital, she received intravenous immunoglobulin (IVIG)(50gr) and dexamethasone (40mg) for four days, and after her platelet count reached above 100× 103/ Mm3, she was discharged. On completion of treatment, she had been prescribed 40mg per day of dexamethasone for four days at intervals of two weeks with periodic monitoring of her CBC. Figure1 illustrates platelet counts considering before and after disease diagnosis and treatment.Outcome and follow-upConsidering the persistence of platelet count in the normal range and with due attention to the previous finding that expresses the benefit of vaccination is more than its risks (8), our case received the next dose of AstraZeneca vaccine three months after the first dose and about 1.5 months after treatment completion. Nevertheless, her platelet stability did not collapse (210× 103/ Mm3), nor did she present signs of ITP. Moreover, she got vaccinated with the same vaccine for the third time about six months later and she did not experience any side effects (platelet count: 213× 103/ Mm3).DiscussionImmune thrombocytopenic purpura is an autoimmune blood disorder characterized by platelet reduction followed by petechiae, purpura, conjunctival hemorrhage, or other types of mucocutaneous bleeding (9). The incidence of the disorder is about 100 in 1milion people each year, and most of the patients are children (9). However, it is developed in acute form lasting about six months in children and adults. It is generally chronic and occurs more in women than men (9). Early detection of ITP is critical because intracranial hemorrhage could be the major cause of fatal bleeding in these patients (9). Immune thrombocytopenic purpura usually appears following autoimmune conditions and viral infections (6). In addition, considering many reports, ITP could be manifested as a result of vaccines (6).More than 100 COVID-19 vaccine candidates are currently under development, and the number is increasing (10). Various types of vaccines are classified into recombinant protein vaccines, mRNA-based vaccines, DNA- based vaccines, and vector-based vaccines (10). The AstraZeneca vaccine is from the adenovirus category, and the vaccine candidate is ChAdOx1 nCoV-19 (10). The advantages of this vaccine are a high transfection efficacy, as the viral vector imitates the natural infection process. Disadvantages are that the vaccine may promote thrombocytopenia and intracranial venous sinus thrombosis (4). In addition, there are some reports of post vaccine ITP (11).Previously, Koch and his colleagues described a 41 years old male with ITP, 14 days after the first dose of vaccination with AstraZeneca from Germany (5). Furthermore, there were other reports of ITP three and two days after receiving AstraZeneca in a Korean 66 years old female and an Iraqi 25 years old male respectively (16, 17). In a case series, 17 cases were reported with secondary ITP related to AstraZeneca. All of them had onset within 28 days after vaccine administration, but one case diagnosed with ITP after 78 days (11).According to the information from previous vaccines, various mechanisms could trigger ITP after vaccination, such as impairment regulation of T cells, elevated pro-inflammatory cytokine production, and increased macrophage-mediated eradication (12). Although the mechanism of vaccine-Induced Immune Thrombotic Thrombocytopenia (VITT) post-AstraZeneca vaccine has been elucidated in some research (13), there isn’t much known about the mechanism of immune thrombocytopenia post-AstraZeneca vaccine. It seems IgG antibodies against platelet factor 4 (PF4) are responsible for VITT (14). On the other hand, IgG is the principal antibody in ITP, which is opposed to platelet membrane glycoproteins such as GPIIb/IIIa (15). Moreover, spike protein is the antigenic target for vaccines such as SARS-CoV-1 and MERS (15). But it’s unclear whether spike protein and the PF4 have any cross-reactions with each other (15). Altogether, more information is required to determine if the underlying mechanism of other vaccines can be the same as post-COVID19 vaccine ITP.In this paper we introduced an Iranian 31 years old female with a past history of ITP who developed petechia purpura and ecchymosis following AstraZeneca first dose administration and diagnosed with thrombocytopenia. After completion of treatment the next doses of the same vaccine are injected and there were no side effects. To the best of our knowledge, this paper may be the first case report presenting a patient with a past history of vaccine complication receiving the second and booster doses of the same vaccine without any incident.ConclusionSome patients with past history of ITP may be more susceptible to immune thrombocytopenia from drugs or inciting agents as well as AstraZeneca Coronavirus Disease-2019 Vaccine. Physicians should always be cautious administering new agents to ITP patients since that disorder, a prior indicated altered immune response. In addition, measuring platelet count before and after vaccine reception is suggested. Furthermore, it is indispensable to pay attention to any early signs of ITP to primarily manage the condition and prevent disease deterioration that could be life-threatening.DeclarationsEthics approval and consent to participateThis study was approved by the ethics committee of the Infectious Diseases Center, Gonabad University of Medical Sciences, Gonabad, Iran. (IR.GMU.REC.1400.207).Author contributionsSaba Seyedi: Conceptualization, Writing – original draftShadan Navid: investigation, data curationZahra Saadatian: Supervision, writing – review and editingAcknowledgementsWe would like to thank the patient for agreeing to share her clinical information with the readers of this article.Funding informationThis research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.Conflict of interest statementAll authors have approved the manuscript for submission and have no competing interests to declare.ConsentWritten informed consent was obtained from the patient for publication of this case report.Availability of data and materialNot applicableReferences1. Hu B, Guo H, Zhou P, Shi Z-L. Characteristics of SARS-CoV-2 and COVID-19. Nature Reviews Microbiology. 2021;19(3):141-54.2. Heath P, Galiza E, Baxter D, Boffito M, Browne D, Burns F, et al. Safety and efficacy of NVX-CoV2373 Covid-19 vaccine. The New England journal of medicine. 2021;385.3. Sharma O, Sultan AA, Ding H, Triggle CR. A Review of the Progress and Challenges of Developing a Vaccine for COVID-19. Front Immunol. 2020;11:585354.4. Wolf ME, Luz B, Niehaus L, Bhogal P, Bazner H, Henkes H. Thrombocytopenia and Intracranial Venous Sinus Thrombosis after ”COVID-19 Vaccine AstraZeneca” Exposure. J Clin Med. 2021;10(8).5. Koch M, Fuld S, Middeke JM, Fantana J, von Bonin S, Beyer-Westendorf J. Secondary Immune Thrombocytopenia (ITP) Associated with ChAdOx1 Covid-19 Vaccination - A Case Report. TH Open. 2021;5(3):e315-e8.6. Idogun PO, Ward MC, Teklie Y, Wiese-Rometsch W, Baker J. Newly Diagnosed Idiopathic Thrombocytopenia Post COVID-19 Vaccine Administration. Cureus. 2021;13(5):e14853.7. Msaouel P, Lam AP, Gundabolu K, Chrysofakis G, Yu Y, Mantzaris I, et al. Abnormal platelet count is an independent predictor of mortality in the elderly and is influenced by ethnicity. Haematologica. 2014;99(5):930.8. Simpson CR, Shi T, Vasileiou E, Katikireddi SV, Kerr S, Moore E, et al. First-dose ChAdOx1 and BNT162b2 COVID-19 vaccines and thrombocytopenic, thromboembolic and hemorrhagic events in Scotland. Nat Med. 2021;27(7):1290-7.9. Cines DB, Blanchette VS. Immune thrombocytopenic purpura. N Engl J Med. 2002;346(13):995-1008.10. Wang J, Peng Y, Xu H, Cui Z, Williams RO, 3rd. The COVID-19 Vaccine Race: Challenges and Opportunities in Vaccine Formulation. AAPS PharmSciTech. 2020;21(6):225-.11. Gordon SF, Clothier HJ, Morgan H, Buttery JP, Phuong LK, Monagle P, et al. Immune thrombocytopenia following immunisation with Vaxzevria ChadOx1-S (AstraZeneca) vaccine, Victoria, Australia. Vaccine. 2021;39(48):7052-7.12. Perricone C, Ceccarelli F, Nesher G, Borella E, Odeh Q, Conti F, et al. Immune thrombocytopenic purpura (ITP) associated with vaccinations: a review of reported cases. Immunol Res. 2014;60(2-3):226-35.13. Greinacher A, Thiele T, Warkentin TE, Weisser K, Kyrle PA, Eichinger S. Thrombotic Thrombocytopenia after ChAdOx1 nCov-19 Vaccination. N Engl J Med. 2021;384(22):2092-101.14. Schultz NH, Sørvoll IH, Michelsen AE, Munthe LA, Lund-Johansen F, Ahlen MT, et al. Thrombosis and Thrombocytopenia after ChAdOx1 nCoV-19 Vaccination. N Engl J Med. 2021;384(22):2124-30.15. A Ali E, Al-Maharmeh Q, Rozi WM, Habib MB, Yassin M. Immune thrombocytopenia purpura flare post COVID-19 vaccine. Ann Med Surg (Lond). 2022;75:103164-.16. Kim G, Choi EJ, Park HS, Lee JH, Lee JH, Lee KH. A Case Report of Immune Thrombocytopenia after ChAdOx1 nCoV-19 Vaccination. J Korean Med Sci. 2021;36(43):e306.17. Razzaq AK, Al-Jasim A. Oxford-AstraZeneca Coronavirus Disease-2019 Vaccine-Induced Immune Thrombocytopenia on Day Two. Case Reports in Hematology. 2021;2021:2580832.

This paper addresses the event-triggered prescribed-time control problem for a class of high-order nonlinear systems based on finite time-varying gain. Due to the existence of unknown time-varying gain and system uncertainties, the resultant control with prescribed-time convergence performance becomes nontrivial. The problem becomes even more complex due to the use of event-based communication instead of continuous communication. To tackle the aforementioned challenges, this paper proposes an event-triggered prescribed-time stabilization approach with the following key steps. Firstly, we establish a new prescribed-time stability lemma to overcome the technical difficulty arising from the prescribed-time controller design, and stability analysis. Secondly, we given the controller design procedure upon using the backstepping technique. Thirdly, we redesign the time-varying trigger conditions based on time-varying functions and saturation ceilings, which allows the controller terminal jitter to be mitigated and the controller to be implemented straightforwardly in practice. Meanwhile, we incorporate the compensation technique upon using symbolic functions and time-varying finite decay gains into the controller design to handle the error caused by event-based communication. Furthermore, the proposed control scheme avoids Zeno behavior. The numerical simulation confirms the effectiveness of the proposed control scheme.

In this study, we present a novel L 2 norm-based preview tracking controller design for discrete-time periodic linear parameter-varying (LPV) systems based on a linear fractional representation (LFR). It also proposes a robust controller design method using actions that are integral and preview to achieve excellent tracking performance and output constraints assuming that the reference signal may be previewe. First of all, an augmented error system (AES) with future knowledge about related signals was performed for a linear periodic system using LFR, transforming a control issue with the preview leading to a stability issue. The proposed conditions depend on using slack variables and decision matrices related to LFR to generate novel preview control. Second, Lyapunov functions dependent on parameters and full-block multipliers were addressed to achieve synthesis situations that are less conservative for discrete-time periodic LPV/LFR systems, which were expressed as linear matrix inequalities (LMIs) to produce reliable output and condition feedback with preview actions. In the end, the efficiency of the proposed control methods was demonstrated based on two numerical cases.

Introduction:Varicella-zoster virus (VZV) is the causative agent of chickenpox, a viral rash that is generally benign and self-limiting, requiring minimal treatment. However, in rare cases, complications can arise. Although chickenpox is commonly associated with mild thrombocytopenia in children, severe thrombocytopenia resulting in bleeding is uncommon [1]. Immune Thrombocytopenia (ITP) is a blood disorder characterized by the destruction of platelets through immune-mediated mechanisms, leading to a decrease in platelet count below 100×10^9/L. Viral infections and live virus vaccinations are frequent triggers of ITP. It presents as acute, self-limiting episodes of bleeding, usually minor, but with the potential for intracranial hemorrhage (ICH). Compared to other causes of thrombocytopenia, ITP typically results in less severe bleeding. Diagnosis is based on clinical presentation and laboratory findings, and it is a diagnosis of exclusion [2]. The primary goal of treating a patient with ITP is to raise their platelet count to a safer level, reducing the risk of severe bleeding, particularly intracranial hemorrhage (ICH). Corticosteroids have been effectively used since the 1950s, reducing the production of anti-platelet antibodies and enhancing the clearance of opsonized platelets. Intravenous immunoglobulin (IVIG), introduced by Imbach et al., has also shown high efficacy in increasing platelet counts in over 80% of patients, with a faster onset of action compared to steroids [3].The coexistence of chickenpox and ITP presents a clinical conundrum, as the underlying mechanisms linking these conditions remain elusive. Although there are sporadic reports in the medical literature of patients developing ITP following chickenpox, the incidence of this simultaneous presentation is exceedingly rare. Furthermore, the majority of these reported cases lack comprehensive hematologic data, hindering a thorough understanding of the clinical course and management strategies.We thus present one such intriguing and rare case of chickenpox with simultaneous ITP purpura.

Currently, there is some controversy surrounding surgery for papillary thyroid carcinoma (PTC) that involves more than half of the cricoid cartilage, as some studies suggest that partial cricoidectomy may cause tracheal stenosis and total laryngectomy may be necessary. The aim of this study was to describe a new technique for subtotal cricoid resection and crico-trachea reconstruction that preserves laryngeal function. A 51-year-old man with recurrent PTC underwent subtotal cricoid cartilage resection, tracheal resection and crico-tracheal reconstruction. The PTC had spread to the frontal and right lateral parts of the cricoid cartilage and the 1st to 3rd tracheal rings. The surgery involved removing three quarters of the cricoid cartilage and the 1st to 4th tracheal rings, and modifying, rotating, and anastomosing the remaining trachea to the remaining part of the cricoid cartilage. The procedure was successful in completely removing the tumor, preserving speech function, and avoiding tracheal stenosis. The patient did not experience dyspnea after tracheal cannula removal. This novel crico-trachea reconstruction surgery shows promise in preserving speaking function while avoiding complications associated with partial cricoidectomy.

A document by Olfa Frikha. Click on the document to view its contents.

A new coccidian species, Isospora elliotae n. sp., from the Australian magpie Gymnorhina tibicen (Latham, 1801) in Western Australia is described and characterised morphologically and molecularly. Microscopic analysis of a faecal sample identified subspheroidal oöcysts (n = 20), 20–22 × 18–20 (20.7 × 18.7); length/width (L/W) ratio 1.05–1.14 (1.10). Wall bi-layered, 1.0–1.3 (1.2) thick, outer layer smooth, c.2/3 of total thickness. Micropyle and oocyst residuum absent, but usually two polar granules are present. Sporocysts (n = 28) ovoidal, 12–13 × 9–11 (12.6 × 9.7); L/W ratio 1.22–1.35 (1.30). Stieda body present, flattened to half-moon-shaped, c. 0.5 deep × 2.0 wide; sub-Stieda indistinct or barely discernible, c. 1.0 deep × 2.5 wide; para-Stieda body absent; sporocyst residuum present, composed of granules dispersed among the sporozoites. Sporozoites vermiform, with anterior and posterior refractile bodies and nucleus. Segments of three gene loci (18S rRNA, 28S rRNA and COI) were sequenced and I. elliotae n. sp. exhibited 99.8% genetic similarity to Isospora sp. MAH-2013a (KF648870) followed by 99.7% genetic similarity to Isospora neochmiae Yang, Brice & Ryan, 2016 (KT224380) at the 18S rRNA gene locus. It shared 97.0% genetic similarity with an unnamed Isospora sp. (AY283852) at the 28S rRNA gene locus and it also shared the highest genetic similarity of 99.8% with the unnamed Isospora sp. from an American crow (OL999120) at the COI gene locus. Based on morphological and molecular data, this isolate is a new species named as I. elliotae n. sp.

IntroductionSolitary Fibrous tumours (SFTs) were first described in 1931 by Klemperer et al. as pleural tumours. Since then, it has been reported in many extra-pleural sites but is found to be exceedingly rare. Most of them are reported to arise from the pleura, and only 30% are of extra-pleural origins. Less than a hundred cases of Primary Retroperitoneal Solitary Fibrous Tumours have been described till now. These are rare soft-tissue sarcomas, with mesenchymal origins. The symptoms of these tumours depend on the location. The diagnosis is done mainly by imaging such as ultrasonography, Computed tomography or Magnetic resonance imaging. The standard of treatment for these tumours is by surgical excision with clear margins. The role of adjuvant chemotherapy is controversial.

The Left bundle branch area pacing (LBBAP) is a novel pacing strategy that utilizes the conduction system distal to the left bundle branch block level for direct activation of the left bundle and the right ventricular myocardium. Our meta-analysis compared the structural, electrophysiological, clinical, and procedural outcomes of LBBAP and Bi-ventricular pacing (BVP). The meta-analysis included two randomized control trials and showed significant reductions in left ventricular systolic and diastolic volumes with LBBAP compared to BVP, along with a statistically significant decrease in QRS duration, NYHA class, and heart failure hospitalizations. Fluoroscopic time was also significantly shorter in the LBBAP group. However, no significant change in LV ejection fraction was noted. Although not statistically significant, procedural complications were slightly higher in the LBBAP group. Our findings suggest that LBBAP may be a superior alternative to standard BVP in improving structural and electrophysiological components and clinical components of cardiomyopathy, including NYHA class and heart failure hospitalizations. LBBAP is a more physiological pacing strategy that results in normal ventricular activation and may be a viable alternative to BVP for cardiac synchronization therapy.

The enteropathogen Salmonella enterica subsp. enterica sv. Typhimurium str. LT2 (hereafter S. Typhimurium) utilizes a cluster of genes encoded within the pathogenicity island 2 (SPI-2) of its genome to proliferate inside macrophages. The expression of SPI-2 is controlled by a complex network of transcriptional regulators and environmental cues, which now include a recently characterized DNA-binding protein named PagR. Growth of S. Typhimurium in low phosphate low magnesium medium mimics conditions inside macrophages. Under such conditions, PagR ensures SPI-2 induction by upregulating the transcription of slyA, a known activator of SPI-2. Here we report that PagR represses the expression of a divergently transcribed polycistronic operon that encodes the two subunits of transketolase TktC ( i.e., tktD, tktE) of this bacterium. Transketolases contribute to the non-redox rearrangements of phosphorylated sugars of the pentose phosphate pathway, which provide building blocks for amino acids, nucleotides, cofactors, etc. We also demonstrate that PagR represses the expression of its own gene and define two PagR binding sites between stm2344 and pagR.

Efficient metal contact formation is pivotal for the production of cost-effective, high-performance crystalline silicon (Si) solar cells. Traditionally, screen-printed silver (Ag) contacts on the front surface have dominated the industry, owing to their simplicity, high throughput, and significant electrical benefits. However, the high cost associated with using over 13-20mg/Wp of Ag can impede the development of truly cost-effective solar cells. Therefore, there is an urgent need to explore alternative, economically viable metals compatible with silicon substrates. This study reports on the application of a contact stack consisting of Ag, nickel (Ni), and copper (Cu) in Si solar cells. To prevent Schottky contact formation, Ag is implemented as a seed layer, while Ni and Cu form the metal bulk layer. The fabricated bi-layer stack without selective emitter exhibits a maximum efficiency of ~21.5%, a fill factor of 81.5%, and an average contact resistance of 5.88mΩ·cm 2 for a monofacial PERC cell. Microstructure analysis demonstrate that the metals within the contacts remain distinct, and Cu diffusion into the silicon during the firing process is absent. Consequently, printed bi-layer contacts emerge as a promising alternative to Ag contacts, reducing the Ag consumption to below 2.5mg/Wp per cell without compromising overall efficiency.

Summary An elderly gentleman presenting late with inferior wall myocardial infarction and complete heart block underwent revascularization of an occluded proximal right coronary artery more than four days after the onset of symptoms and recovered sinus rhythm within 48 hours of the procedure. There are no clear guidelines for time to percutaneous coronary intervention (PCI) in late presenting myocardial infarction with complete atrioventricular blocks (CAVB), and studies looking at outcomes of primary PCI in this situation appears to be scarce. The case presented here is a good example of the relevance of late PCI.

IntroductionHereditary hemorrhagic telangiectasia (HHT), also referred to as the Osler-Weber-Rendu syndrome, is a rare autosomal dominant hereditary disease that results in abnormal vasculogenesis in the skin, mucous membranes, and visceral organs such as the liver, lungs, and brain [1]. The prevalence of HHT ranges from one in every 5,000 people to one in every 8,000 people with an estimated 85,000 cases in Europe [2, 3] and the rate of diagnosis is lower in lower socioeconomic groups [4].Four important genes, including ENG (endoglin), ACVRL1 (activin receptor-like kinase 1), SMAD4 (mothers against decapentaplegic homolog 4), and GDF2 (growth differentiation factor 2), have recently been linked to the underlying mechanism of HHT [5]. Arterio-venous malformations (AVMs) are caused by mutations in these genes that interfere with the TGF-β (transforming growth factor)-beta signaling pathways in vascular endothelial cells, which impair cell division [5]. Heterozygous mutations are the common cause of the two primary kinds of HHT. Endoglin (ENG) is mutated in HHT1. Patients, especially women, with this type are more likely to develop pulmonary and cerebral AVMs. Activin A receptor-like type 1 (ACVRL1), commonly referred to as ALK1, is mutated in HHT2. Of the mutations known to cause HHT, ENG makes up around 61% and ACVRL1 makes up about 37% [7, 8].About 90% of those with the condition experience recurrent nosebleeds, which usually begin in childhood. Other symptoms include gastrointestinal bleeding (25–30%), which can cause melena and severe symptomatic microcytic anemia; pulmonary AVMs (50%) that can cause dyspnea, hemoptysis, paradoxical emboli, and cerebral abscesses; cerebral AVMs (10%) that can cause headache, seizures, and focal neurological deficits; and hepatic AVM (40–70%), which are typically asymptomatic but might show signs of high output cardiac failure and hepatic decompensation, ultimately necessitating liver transplantation [9].Clinical diagnosis of HHT is made using the Curacao criteria, which include first-degree family history of HHT, visceral involvement, recurrent spontaneous nosebleeds, and mucocutaneous telangiectasias. If three or more criteria are met, the diagnosis is considered to be conclusive; if only two criteria are met, the diagnosis is considered to be suspected HHT [10] [Table 1]. If less than two criteria are met, the diagnosis is considered to be unlikely HHT.Table 1 Curaçao diagnostic criteria for hereditary hemorrhagic telangiectasias

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Female intravesical foreign body penetrating the bladder wall: a rare case of traditional Asian hair stick kanzashiMasahiro Arai, MD; Hideki Takeshita, MD, PhD; Wataru Hirata, MD; Kojiro Tachibana, MD; Shoichi Nagamoto, MD; Sachi Kitayama, MD, PhD; Akihiro Yano, MD, PhD, Yohei Okada, MD, PhD, Satoru Kawakami, MD, PhDDepartment of Urology, Saitama Medical Center, Saitama Medical University, Kawagoe, Saitama, Japan