Background: Recent literature documented the expression of miRs in gastric cancer (GC), however their clinical utility is still unclear. Methods and Results: 117 resected GCs were evaluated for miR21, miR135b, miR196a, miR196b relative expression (RE). The performance of miRs’ to differentiate cancer vs normal mucosa was tested using ROC curves. Univariable and multivariable analyses were conducted to correlate miRs RE with pathological features and survivals. Although all the 4 miRs were upregulated, ROC curves documented that this was not-significant in differentiating GC (p ns). miR135b significantly correlated with Lauren’s intestinal type and more advanced pT stages (p 0.017, and p 0.025), whereas miR196a and miR196b were more expressed in advanced pStages (p 0.016, and p 0.038). miR196b was also more expressed in nodal positive patients comparing N0 (p 0.035). Survival curves were non-significant for miRs RE, while pStages could significantly differentiate oncological outcomes (p<0.0001). On Cox analyses, pStages independently correlated with OS (HR 4.9, 95%CI 2.041-12.104), whereas increased age correlated with a worse DFS (HR 6.0, 95%CI 2.596-13.947), and lymph-node ratio with DSS (HR 14.4, 95%CI 4.213-49.373). Literature was reviewed a using PRISMA method focusing on miRs and response to therapy and the detection of peritoneal metastases: out of 116 manuscripts retrieved, just 41 were pertinent with the outcomes of interest, and 14.6% were from Western countries. miR21, miR135b and miR204 were reported to correlate with response to therapy. Conclusions: miR21, miR135b, miR196a and miR196b were documented up-regulated in GC, but their clinical utility is still to be fully investigated.

Background: Coiled coil domain containing protein 51 (CCDC51), as the two transmembrane helical domains protein, little is known about the function of it in human cancer. Methods: TCGA, GEPIA, cBioPortal, GTEx, and TIMER were employed to analyze expression, immune cells infiltration, prognostic value, genetic alteration, cancer patients’ mutation burden, stem cell stability, and microsatellite instability of CCDC51 . Results: Decreased CCDC51 expression significantly related with poor overall survival (OS) of acute myeloid leukemia (LAML), adrenocortical carcinoma (ACC), glioma (GBMLGG), kidney chromophobe (KICH), liver hepatocellular carcinoma (LIHC), lung squamous cell carcinoma (LUSC), skin cutaneous melanoma (SKCM) and uveal melanoma (UVM), lung adenocarcinoma (LUAD), disease-specific survival (DSS) of ACC, GBMLGG, SKCM and UVM, and progression-free interval (PFI) of ACC, KICH and pancreatic adenocarcinoma, squamous cell carcinoma of the head and neck (HNSC). In human cancer, immune cell infiltration, and tumor microenvironment, CCDC51 expression is associated with MSI, RNA modifications, and diverse cancer drug sensitivity. There is potential for it to be an independent factor contributing to OS in LIHC. CCDC51 was an independent factor for LIHC prognosis in Cox regression and nomogram analysis. The results of the the Kyoto Encyclopedia of Genes and Gene Ontology and Genomes indicated that CCDC51 was involved in aminoacyl-tRNA biosynthesis, RNA transport, colorectal cancer, Wnt signaling pathway, mismatch repair, mitochondrion, pseudo uridine synthase activity, mRNA processing, mitochondrial matrix, regulation of mRNA stability, and mitochondrial inner membrane. Conclusion: Our research can provide new-insights for LIHC prognostic biomarkers of CCDC51.

Off-label drug use which could be defined as the practice of prescribing a drug for a different purpose than what is permissible by the regulation is a common practice among clinicians, nevertheless, it is often subject to ethical and legal uncertainties. In general, clinicians must balance the need to provide patients with the best possible care while complying with the regulatory requirements governing drug use. This paper will review the current literature on off-label drug use, including its prevalence, the regulatory landscape, and the ethical issues involved with the aim of formulating an ethical and legal framework that could guide clinicians in using off-label drugs in clinical practice in Malaysia. The framework will include ethical considerations that are centred on the principles of beneficence, non-maleficence, and autonomy, which require clinicians to balance the benefits and risks of using off-label drugs while respecting patients’ autonomy. The legal framework consists of federal and state regulations governing drug use, including the Control of Drugs and Cosmetics Regulations (CDCR) 1984 and other regulations published by the National Pharmaceutical Regulatory Agency (NPRA). The aim of this paper is to provide guidance on how clinicians can navigate the ethical and legal terrain of off-label drug use by understanding the regulatory requirements, being obliged to the requirements of obtaining informed consent from patients and documenting the rationale for off-label use. Ultimately, by understanding the ethical and legal framework, clinicians can provide patients with the best possible care while complying with the regulatory requirements governing drug use.

Anemia is a public health problem affecting about a third of the world's population, the major cause of it being iron deficiency. The many oral iron preparations available at present, are inadequate due to intolerance, or contraindications. IV iron preparations are painful, require patient monitoring and carry the risk of anaphylaxis. Iron salts like Iron pyrophosphate are covered with liposome, a spherical structure of a phospholipidic nature that is similar to those human cell membranes. The bioavailability of liposomal pyrophosphate iron is 3.5 times greater than the free pyrophosphate iron, 2.7 times higher than iron sulfate, and 4.1 times higher compared with iron gluconate. Clinical studies showed that oral liposomal iron is a safe and efficacious alternative to correct anaemia, as also it is a viable treatment option for iron deficiency anaemia in pregnant women.

The two-dimensional paraxial equation of optics and the twodimensional time-dependent Schr odinger equation, derived as approximations of the three-dimensional Helmholtz equation and the three-dimensional time-independent Schr odinger equation respectively, are identical. Here the free propagation in space and time of Hermite-Gauss wavepackets (optics) or Harmonic Oscillator eigenfunctions (quantum mechanics) is examined in detail. The Gouy phase is shown to be a dynamic phase, appearing as the integral of the adiabatic eigenfrequency or eigenenergy. The wave packets propagate adiabatically in that at each space or time point they are solutions of the instantaneous harmonic problem. In both cases, it is shown that the form of the wave function is unchanged along the loci of the normals to wave fronts. This invariance along such trajectories is connected to the propagation of the invariant amplitude of the corresponding free wave number (optics) or momentum (quantum mechanics) wavepackets. It is shown that the van Vleck classical density of trajectories function appears in the wave function amplitude over the complete trajectory. A transformation to the co-moving frame along a trajectory gives a constant wave function multiplied by a simple energy or frequency phase factor. The Gouy phase becomes the proper time in this frame.

：Based on the use of CQDs as fluorescent probe and covalent coupling method to detect biological molecules with amino groups, this method was applied to the analysis and detection of metabolism of Microcystis aeruginosa. The metabolic changes of carboxyl biomolecules in Microcystis aeruginosa were analyzed by covalent coupling method, including GSH, phycocyanin and SOD enzyme. The changes of GSH content in Microcystis aeruginosa at different growth stages and the correlation between phycocyanin, SOD and GSH were analyzed from one-dimensional, two-dimensional and three-dimensional fluorescence. The content of phycocyanin and SOD reached the maximum on the 65th day, and GSH was more sensitive to the growth and metabolism of microalgae and began to decrease on the 50th day. GSH plays an important role in reducing the external oxidative damage of microalgae cells at each growth stage of microalgae cells. Among them, GSH synthesis, GSH/GSSG mutual transformation, synthesis of phytochelating peptides (PC), ASA-GSH cycle and metabolism and other physiological activities in Microcystis aeruginosa have interactions, which play a key role in maintaining the antioxidant properties of microalgae and regulating redox-sensitive signal transduction.

Coastline ecosystems are resilient, and the mangrove species that inhabit them are well-suited to deal with harsh, stresses such as anoxic soils and fluctuating salinity. Mangrove leaves are specialised plant structures that enable them to preserve their photosynthetic capability and functionality despite frequent changes in their habitats. Along the coastline of Guyana, we studied the morphological characteristics and chlorophyll content of 400 leaves taken from Laguncularia racemosa (white mangrove) trees in one degraded and one restored ecosystem. The closest individual sampling method was used to collect leaf samples throughout the wet and dry seasons. Our results demonstrate that L. racemosa leaves are affected by both habitat type and seasonality. The leaves of L. racemosa are mesophyllous, and leaf characteristics such as length, width, area, perimeter, mass, leaf specific area, and relative water content were significantly correlated (p < 0.05, R > 0.75), with the restored ecosystem during the dry season and the degraded ecosystem during the wet season having greater values. Differences in chlorophyll content were seen in the two types of ecosystems, but not seasonally, with the degraded ecosystem showing the most variation. The results of PCA and regression analysis further verified correlations between leaf morphological characteristics and ecosystem type.

Species coexistence attracts wide interest in ecology. Modern coexistence theory (MCT) identifies coexistence mechanisms, one of which, storage effects, hinges on relationships between fluctuations in environmental and competitive pressures. However, such relationships are typically measured using covariance, which does not account for the possibility that environment and competition may be more related to each other when they are strong than when weak, or vice versa. Recent work showed that such ‘asymmetric tail associations’ (ATAs) are common between ecological variables, and are important for extinction risk, ecosystem stability, and other phenomena. We extend the MCT, decomposing storage effects to show the influence of ATAs. Analysis of a simple model and an empirical example using diatoms illustrate that ATA influences can be comparable in magnitude to other mechanisms of coexistence, and that ATAs can make the difference between species coexistence and competitive exclusion. ATA influences are an important new mechanism of coexistence.

We propose an updated approach for approximating the isotope distribution of average peptides given their monoisotopic mass. Our methodology involves in-silico cleavage of the entire UNIPROT database of Human reviewed proteins using Trypsin, generating a theoretical peptide dataset. The isotope distribution is computed using BRAIN. We apply a compositional data modelling strategy that utilizes an additive log-ratio transformation for the isotope probabilities followed by a penalized spline regression. Furthermore, due to the impact of the number of Sulphur atoms on the course of the isotope distribution, we develop separate models for peptides containing zero up to five Sulphur atoms. Additionally, we propose three methods to estimate the number of Sulphur atoms based on an observed isotope distribution. The performance of the spline models and the Sulphur prediction approaches is evaluated using a mean squared error and a modified Pearson’s χ² goodness-of-fit measure on an experimental UPS2 data set. Our analysis reveals that the variability in spectral accuracy contributes more to the errors than the approximation of the theoretical isotope distribution by our proposed average peptide model. Moreover, we find that the accuracy of predicting the number of Sulphur atoms based on the observed isotope distribution is limited by measurement accuracy.

Understand the mechanisms underlying diversity-productivity relationships (DPRs) is crucial to mitigating the effects of forest biodiversity loss. Tree-tree interactions in diverse communities are fundamental in driving growth rates, potentially shaping the emergent DPRs, yet remains poorly explored. Here, using data from a large-scale forest biodiversity experiment in subtropical China, we demonstrated that changes in individual tree productivity were driven by species-specific pairwise interactions, with higher positive net pairwise interaction effects on trees in more diverse neighbourhoods. The aggregated interaction effects subsequently determined the community DPRs. We further revealed that the positive differences between inter- and intra-specific interactions were the critical determinant for the emergence of positive DPRs. Surprisingly, the condition for positive DPRs corresponded to the condition for coexistence. Our results thus provide a novel insight into how pairwise tree interactions regulate DPRs, with implications for identifying the tree mixtures with maximised productivity to guide forest restoration and reforestation efforts.

Background: This study compared the efficacy and safety of CsA monotherapy with eltrombopag (E-PAG) + CsA combined treatment in children with severe aplastic anemia (SAA). Method: The study including 30 children had SAA. Ten were a retrospective cohort treated with CsA monotherapy. The other 20 were prospective cohort received E-PAG + CsA . All patients were evaluated for partial (PR) and complete (CR) hematological response at 3, 6, and 12 months. overall response (OR), overall survival rates (OS) and treatment safety. Results: OR for the E-PAG patients was 40% after three months of therapy. At six months, this had increased to 75 % with significantly higher CR rate (40%) than in the CsA group (p = 0.0001). After a year of treatment, the CR for the E-PAG regimen had increased to 50% and the OR to 85%, compared to 20% in the CsA group (p = 0.0001). The OS at 12 months was 100% in the E-PAG group compared to 80% in the CsA cohort. At 24 months, the OS in the E-PAG group was 90%. Conclusion: CsA + E-PAG was found to be a safe and effective alternative treatment for children with SAA particularly in countries with limited resources.

3-Hydroxybutanone (Acetoin, AC) and 2,3-butanediol (2,3-butanediol, BD) are two essential four-carbon platform compounds with numerous pharmaceutical and chemical synthesis applications. AC and BD have two and three stereoisomers, respectively, while the application of the single isomer product in chemical synthesis is superior. AC and BD are glucose overflow metabolites produced by biological fermentation from a variety of microorganisms. However, the AC or BD produced by microorganisms using glucose is typically a mixture of various stereoisomers. This was discovered to be due to the simultaneous presence of multiple butanediol dehydrogenases (BDH) in microorganisms, and the AC and BD can be interconverted under BDH catalysis. In this paper, beginning with the synthesis pathways of microbial AC and BD, we review in detail the studies on the formation mechanisms of different stereoisomers of AC and BD, summarize the properties of different types of BDH that have been tabulated, and analyze the structural characteristics and affinities of different types of BDH by comparing them using literature and biological database data. We also review recent work on the production of octadecanoic acid. Using microorganisms, the recent research on the production of optically pure AC or BD was also reviewed.

A wound in the distal part of the horse’s limb with involvement of the foot can lead to large impacts in life prognosis and, depending on the severity of the lesion, may render successful recovery of the horse difficult or even questionable. Due to that fact and the high frequency of complications associated with wounds in the foot, the approach and management is not always straightforward, nor easy. In this case report a 9-year-old mare is presented with a chronic wound in the inner surface of foot of the right hind limb. The wound involves the medial coronary band with its proximal displacement and an inadequate push of horny tissue. For treatment, a surgical approach was chosen with application of a uniaxial traction device between the coronary band and the hoofwall in order to direct and adapt as much as possible the growth direction of coronary papillae after resection of the scar tissue. The aim of this approach was to reduce, firstly the defect in the proximal hoof wall, and secondly, the deviated growth of the hoof wall. 15 days after surgery and a resin casting, an orthopaedic shoe (three-quarter bar shoe) was placed to stabilize the hoof and eliminate weight bearing on that portion of the hoof wall This additional management changed the deviation from a 135° to a completely parallel growth, with complete healing of the tissue. This case example demonstrates the importance of working together between the farrier and the veterinarian to improve the aspect and functionality of the hoof.

It has been over 200 years since the organ/tissue perfusion was first used in the experimental research. Today organ/tissue perfusion has been widely used in the study of pathological mechanisms study, drug metabolism, drugs screening, tissues/organs fixation, cells preparation, cancer topical treatment, target products preparation, experimental methods improvement and makes great contribution to the scientific researches. In the present paper, we provide a comprehensive overview of experimental organ/tissue perfusion, mainly covering the classification, experimental influence factors and their application.

Introduction Hemophagocytic lymphohistiocytosis (HLH) is a hyperinflammatory syndrome that is associated with a high mortality rate. HLH is characterized by hemophagocytosis and histiocytic proliferation (1). Primary HLH has a familial pattern and secondary HLH is reactive and also called macrophage activation syndrome (MAS). This type of HLH is usually acquired following autoimmune diseases, infection, and malignancy (2).The prevalence of HLH is not completely measurable because the diagnosis of this disease is hard and there are other comorbid diseases at the time of diagnosis. In a study that was done in Sweden from 1987 to 2006, the prevalence of HLH was 1.5 per million (3).The manifestations of HLH are fever and cytopenia. The diagnosis of HLH is made by clinical suspicion of physicians. The criteria for diagnosis of HLH include fever; splenomegaly; cytopenia (affecting at least two of three lineages in the peripheral blood); fasting triglyceride levels ≥3 mmol/L and/or fibrinogen level ≤1.5 g/L; serum ferritin level ≥500 ng/ml; CD25 level ≥2400 U/ml; decreased or absent natural killer (NK) cell activity; or hemophagocytosis in bone marrow, spleen, or lymph nodes (4).Adult-onset Still’s disease (AOSD) is an autoimmune disorder that can predispose patients to HLH. The co-incidence of AOSD and HLH is rare (5).In this report, we present a woman with a co-incidence of AOSD and HLH.

Background: Endoscopy, including tracheal mucus score (TMS) and bronchoalveolar lavage (BAL) fluid cytology, are commonly used to diagnose equine asthma (EA). Large-scale studies comparing clinical signs, TMS and BAL cytology are warranted. Objectives: Investigate associations between clinical signs of EA, tracheal mucus score and BAL cytology. Study design: cross-sectional study Methods: Data from 604 horses, each horse having one BAL cytology sample evaluated at the laboratory service at the Large Animal Teaching Hospital in Denmark, with further information provided by an owner questionnaire and veterinarian performing the endoscopy and BAL. Results: Tracheal mucus score increased significantly with EA severity, BAL neutrophilia and owner reported coughing, but not with BAL mastocytosis. Owner complaint of coughing was associated with an increasing amount of BAL neutrophils, but not with an increase in BAL mast cells. Poor performance was not correlated to BAL neutrophils, mast cells or TMS. Percentage of BAL aspirated was found lower in the SEA group compared to the non-asthmatic and MEA groups. Main limitations: Several different veterinarians performed the BAL sampling, BAL samples were shipped and a 24 hour delay in processing of the sample. Not able to adjust for season as these data was not recorded. Conclusion: this large-scale study showed a correlation between TMS and increasing severity of lower airway inflammation, confirming TMS as a reliable diagnostic factor for EA. Owner complaint of coughing, was found to be associated with TMS and BAL neutrophilia, and poor performance without coughing is not a reliable parameter for EA.

Abstract : Is having a personal academic website worth the effort? Does a personal site provide real benefits to the research, education, and societal service activities of a scholar? Referring to selected examples, this study shows how a personal academic website can effectively serve the overall purpose of scholarly work, whatever the scholarly field.1. IntroductionA personal academic website is a personal website owned and managed by a scholar to present her/his activities in the three fields (research, education and societal service) comprising the academic profession [1].Usually, it is a website with its own domain (uniform resource locator, URL), and not a subdomain of another website, owned and managed by a scholar. Plentiful websites (Wix, Squarespace, Weebly, WordPress.com, etc.) offer free web space to create a personal academic website, but only using their subdomain. Owning the domain name has a modest annual cost but the domain permanently belongs to its owner (modest annual renewal cost) and the website is controlled uniquely by its owner with no advertising and other content not pertinent to a personal academic website [2].Several guides are freely available on the web to develop a usable and aesthetically pleasant academic website. Numerous online companies offer websites specifically designed for academics with templates for publications, projects, courses, etc. One company, for example, offers a basic service for free and a “pro” version at affordable cost which allows to create and release a personal academic website in less than an hour, and then grow it over time by updating it regularly [3].This study aims to answer a research question: is having a personal academic website worth the effort with respect to the three main dimensions of scholarly work (research, education, and societal service)? Surprisingly, very little scholarly research has been published on personal academic websites. A search carried out by early May 2023 on two large research databases online (Google Scholar [4] and Dimensions [5]) with the query “personal academic website” returned only 33 and 23 articles, respectively. Said pioneering research, however, unveiled early revealing outcomes.In 2006 Thelwall and co-workers found that the web impact of a scientist “personal homepage” measured by the “inlink” counts (the number of incoming links to the page) was clearly associated to the presence of full-text articles (the latter articles being the most linked-to content in homepages) [6].Seven years later Más-Bleda and Aguillo found that 64% of highly cited researchers in western Europe and in Israel only had a personal web page hosted on the domain of the employer institution [7]. The same researchers, they also found, publicized their research online either through a digital object identifier (DOI) link to the online version of their articles on the publisher website or by “outlinks” to PDF versions of their articles generally posted in open access (OA) repositories [8]. Confirming the poor uptake of open science principles and tools by research chemists [9], not even one of the fifty highly cited chemistry researchers in the ranking linked to any OA repository [8].The need for the present study stems from a single fact: thirty years after the introduction of the World-Wide Web in 1993 [10], most scholars worldwide do not have a personal academic website. For instance, in 2016, the share of the surveyed researchers maintaining websites that also targeted web users “who are not scientists or students” was found to be 11% in Germany, 13% in Taiwan and 17% in the USA [11]. These figures may even be overestimated because the surveyed scientists likely referred to the personal web page hosted by their employer website, and not to their personal academic website, namely a self-managed website either on a personal domain or on one. Accordingly, recent investigation of nearly 1,000 faculty members in the disciplines of physics, biology and chemistry at universities in Germany’s Lower Saxony found that online presentations on institutional websites were “mostly rudimentary” [12]. The scope of having a personal academic website, as we show in the following, goes far beyond the need to “attract attention to your publications”, or increase “your name recognition”, and “get cited more” [13].2. Serving academic work purposeOn April 1993 Berners-Lee, a physicist working at European Laboratory of Particle Physics, published the source code for the first royalty-free “browser” and editor dubbed “World-Wide Web” [10]. In a few months, the first browsers became freely available to “navigate” content in the WWW (shortened “Web”) alongside editing software “applications” to produce the web pages written in the hypertext markup language (HTML).Likewise the internet [14], also the Web was invented by scientists to enhance communication amid scientists as “a pool of human knowledge which would allow collaborators on remote sites to share their ideas and all aspects of a common project” [10]. Scholars en masse , one would expect, would have soon adopted a personal website to share their research, educational and public outreach academic work. Unfortunately, this was not the case with the share of scholars owning a personal academic website nearly 25 years after the invention of the Web being remarkably low even in high income countries hosting a large number of scientists [11].This fact shows that most scholars continue to consider a personal website an unnecessary communication tool wasting valued working time. Perhaps, only early career researchers working in today’s “precarious times” [15] understood the relevance of a personal website to their work “to aggregate… dozen course pages, three project blogs, scattered professional profiles and twitter account, into one accessible, aesthetically pleasing and not too difficult to manage personal website” [15]. In the following, thus, we show how having a personal academic actually serves the purpose of scholarly work with respect to its three main dimensions of scholarly work: research, education, and societal service.

Aim: To research the relationship among CDK8, TGF-β/BMP signaling pathway and apoptosis in nervous system. Methods: Mouse neuronal cells (NE4C) were subcultured. CDK8 was overexpressed and silenced (overexpressed plasmid was pcDNA3.1(+), silenced plasmid was pGPU6-si103). The factors (TGF-β1, Smad2, Smad3, BMP6, BMP7, Smad1, Smad5, Smad8) of TGF-β/BMP signaling pathway were detected by qRT-PCR. Western blotting was used to test the caspase1 and caspase3. Resluts: The overexpression of CDK8 can cause that TGF-β1, Smad2, Smad3, BMP6, BMP7, Smad1, Smad5 and Smad8 were increased obviously. After CDK8 silencing, TGF-β1, Smad2, Smad3, BMP6, BMP7, Smad1 and Smad8 decreased, except Smad5. The overexpression of CDK8 can lead to a rise of caspase1, but caspase3 was only an upward trend. After CDK8 expressed silencing, caspase1 increased significantly, and caspase3 tended to increasing. Conclusion: In the nervous system, CDK8 positively regulates TGF-β/BMP signaling pathway, and apoptosis is one of their downstream mechanisms.

Most amniote genomes are diploid, moderate in size (approximately 1–6 g), and contain a large proportion of repetitive sequences. The development of next-generation sequencing technology has made it possible to resolve the genome assembly of non-model species. However, traditional genome assembly methods usually involve the acquisition of a large amount of sequencing data and complex calculations, making the de novo genome for non-model species expensive and difficult for most projects. The development of long-read sequencing, especially the emergence of high-fidelity (HiFi) long-read data, has made it possible to assemble genomes efficiently, but how to obtain high-quality reference genomes economically and quickly still lacks practical evaluation. Here we de novo assembled the first chameleon genome, the panther chameleon (Furcifer pardalis). We obtained chromosome-level contigs using only HiFi data, and further combined Hi-C data to assemble all contigs to pseudochromosomes. We also found that sequencing depth > 30 folds can ensure both the integrity and accuracy of the genome, while insufficient depth led to false increase in genome size and proportion of duplicated genes. Our results provide an accurate and efficient de novo assembly strategy for reference genomes of non-model species.

Background: Application of electrocautery to a J-wire is used to perform transseptal puncture (TSP), but with limited evidence supporting safety and efficacy. We conducted a prospective randomized controlled trial to evaluate the safety and efficacy of this technique. Methods: 200 consecutive patients were randomized in a 1:1 fashion to either the ICE-guided electrified J-wire TSP group or a conventional Brockenbrough (BRK) needle TSP group. The TSP was performed with a 0.032″ guidewire under 20W, “coag” mode and was compared to TSP using the BRK needle. The primary safety endpoints were complications related to TSP. The primary efficacy endpoints included the TSP success rate, the total TSP time, and the total procedure time. Results: All patients complete the procedure safely. The electrified J-wire TSP group had a significantly shorter TSP time than BRK needle TSP group. The total procedure time, number of TSP attempts required to achieve successful LA access, width of the intra-atrial shunt at the end of ablation were similar between the two groups. The incidence of new cerebral infarction detected by MRI were similar between the 2 groups (3/32 patients in the J-wire TSP group and 2/26 patients in conventional BRK TSP group, p=0.82). And no difference in the incidence of residual intra-atrial shunt (4.3% versus 6%, p=0.654) during the 3-month’s follow up. Conclusion: Using an electrified J-wire for TSP under the guidance of ICE appears to be as safe as and more efficient than conventional BRK needle TSP, which may be especially useful in the era of non-fluoroscopy AF ablation.

Introduction: Aberrant salience and psychotic-like experiences have been proven to be linked. Moreover, anxiety is a key symptom in psychosis prone subjects and in most psychotic patients. We propose a mediation model that attempts to interpret the role of psychotic-like experiences in the association between aberrant salience and anxiety among healthy controls and psychotic patients. Materials and Methods: Demographic and psychometric data (Aberrant Salience Inventory, Community Assessment of Psychic Experiences, Symptom Check List-90-revised) from 163 controls and 27 psychotic patients was collected. Descriptive statistics, correlations and a mediation analysis with covariates were subsequently performed. Results: Aberrant salience correlated with more frequent positive psychotic-like experiences and higher anxiety levels in both patients and controls. However, positive psychotic-like experiences’ frequency mediated the relationship between aberrant salience and anxiety only among controls. Conclusions: The preservation of insight onto their psychotic-like experiences among controls with high aberrant salience, and its partial or complete loss in psychotic patients seems to be the most probable hypothesis to explain why psychotic-like experiences linked to aberrant salience appear to induce anxiety among the former group but not the latter.

The sonographic finding of a McConnell’s sign, defined as right ventricle (RV) hypokinesis with apical sparing, has been described in the setting of pulmonary embolism (PE) and RV infarction. Patients with PE and RV infarction can have similar clinical presentations, and a rapid way to discriminate between these etiologies may improve care for these critical patients. While a McConnell’s sign due to PE typically results in a right-to-left ventricle ratio of ≥ 1, we observed three cases of a McConnell’s sign due to RV infarction resulting in a right-to-left ventricle ratio of < 1. One patient expired after their electrocardiogram demonstrated an inferior myocardial infarction, and two patients survived with stenting of the right coronary artery. In addition to the McConnell’s sign, the RV was smaller than the LV in all three patients. Emergency physicians should be aware that RV infarctions can present with a McConnell’s sign demonstrating an RV-to-LV ratio <1. We propose this ratio may help to distinguish an RV infarction from PE in the undifferentiated patient with McConnell’s sign. Given the rarity and higher mortality of RV infarction relative to PE, it is important to consider both diagnoses when performing cardiac PoCUS on critical patients.

The emergence of severe acute respiratory syndrome coronavirus 2 (SARS-COV-2) has been the most significant public health challenge in over a century. SARS-COV-2 has infected over 765 million people worldwide, resulting in over 6.9 million deaths. This study aimed to detect community transmission of SARS-CoV-2 and monitor the co-circulation of SARS-CoV-2 with other acute respiratory pathogens in Rift Valley, Kenya. We conducted a cross-sectional active sentinel surveillance for the SARS-CoV-2 virus among patients with acute respiratory infections at four sites in Rift Valley from January 2022 to December 2022. 1271 patients of all ages presenting with influenza-like illness were recruited into the study. Nasopharyngeal swab specimens were screened using a multiplex RT–qPCR for SARS-CoV-2, Influenza A, Influenza B and RSV. Influenza A and RSV samples were subtyped, and all the SARS-CoV-2 positive samples were further screened for 12 viral and 7 bacterial respiratory pathogens. We had a prevalence of 13.93% SARS-CoV-2, Influenza A 5.7%, Influenza B 1.96% and 0.94%. Influenza A-H1pdm09 and RSV B were the most dominant circulating subtypes of Influenza A and RSV, respectively. The most common co-infecting pathogens were Streptococcus pneumoniae and Haemophilus influenzae, accounting for 16.4% and 10.7% of all the SARS-CoV-2 positive samples. Augmenting syndromic testing in ARI surveillance is crucial to inform evidence-based clinical and public health interventions.

We report a case of a 42-year-old male with cardiomyopathy and acute bilateral femoral artery embolization. Following bilateral femoral artery embolectomy and fasciotomy, transthoracic echocardiography revealed a pedunculated highly mobile left ventricle (LV) thrombus. Surgical removal of the thrombi was not recommended for the procedural risk; consequently, anticoagulation therapy was recommenced. Unfortunately for the patient, the bleeding risk impeded the continuation of anticoagulation, which resulted in an increase in the thrombus size. The patient shortly developed multiorgan failure and possibly disseminated intravascular coagulopathy (DIC) and died. Besides this case, we have systematically reviewed the PubMed and Scopus databases for all the previously reported pedunculated thrombus/ thrombi cases.