Idiopathic thrombocytopenic purpura (ITP) is an autoimmune condition marked by isolated thrombocytopenia, which makes people more likely to hemorrhage. We provide a case of a 45-year-old female patient with ITP who displayed unusual clinical symptoms, emphasizing the diagnostic difficulties and treatment options in such circumstances.

A Systematic Literature Review of Healthcare Services on Cloud Services: Application Scenarios, Challenges, and Benefits

The Zero Trust network architecture is an embodiment of the Zero Trust security model, and is progressively being utilized for the improvement of security standards of the current security infrastructures. Fine-grained access control is one of the primary principles of developing zero trust solutions, in which it is expected to manage an overwhelming amount of security policies. Managing the compliance of policies at fine grain level is thus necessary for utmost security stature. This paper aims at developing a novel approach to improve the task of policy management workflow and compliance tracking.

Rising ocean temperatures are threatening marine species and populations worldwide, and ectothermic taxa are particularly vulnerable to warming. Echinoderms are an ecologically important phylum of marine ectotherms and shifts in their population dynamics can have profound impacts on the marine environment. The effects of warming on echinoderms are highly variable across controlled laboratory-based studies. Accordingly, synthesis of these studies will facilitate the better understanding of broad patterns in responses of echinoderms to ocean warming. Herein, a meta-analysis incorporating the results of 85 studies (710 individual responses) is presented, exploring the effects of warming on various performance predictors. The mean responses of echinoderms to all magnitudes of warming were compared across multiple biological responses, ontogenetic life stages, taxonomic classes, and regions, facilitated by multivariate linear mixed effects models. Further models were conducted which only incorporated responses to warming greater than the projected end-of-century mean annual temperatures at the collection sites. This meta-analysis provides evidence that ocean warming will generally accelerate metabolic rate (+ 32%) and reduce survival (– 35%) in echinoderms, and echinoderms from sub-tropical (– 9%) and tropical (– 8%) regions will be the most vulnerable. The relatively high vulnerability of echinoderm larvae to warming (– 20%) indicates that this life stage may be a significant developmental bottleneck in the near-future, likely reducing successful recruitment into populations. Furthermore, asteroids appear to be the class of echinoderms that are most negatively affected by elevated temperature (– 30%). When considering only responses to magnitudes of warming representative of end-of-century climate change projections, the negative impacts on asteroids, tropical species and juveniles were exacerbated (– 51%, – 34%, and – 40% respectively). The results of these analyses enable better predictions of how keystone and invasive echinoderm species may perform in a warmer ocean, and the possible consequences for populations, communities, and ecosystems.

Abstract: Background: Sotrovimab, a monoclonal antibody, is among the approved therapies for coronavirus disease – 2019 (COVID-19). Sotrovimab binds to the spike protein of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and inhibits virus attachment to human cells. Real-life experience about the effectiveness of Sotrovimab is limited. We aimed to evaluate the efficacy of Sotrovimab in preventing COVID-19 hospitalizations and other patient-related outcomes as well as the appropriateness of use in an academic hospital in Lebanon. Methodology: In this retrospective observational study, we included adult patients with positive test results for SARS-CoV-2 who received intravenous (IV) Sotrovimab at the American University of Beirut Medical Center (AUBMC) from November 2021 through March 2022. The data collected included patient demographics and comorbidities. Primary outcomes were hospitalization, deterioration after 24 hours, and death due to any cause up to 60 days after the Sotrovimab infusion. Secondary outcomes were progression to critical illness and adverse events. Results: A total of 62 subjects received Sotrovimab infusion at our hospital. More than 50% of the patients had a malignancy. About 77% of the cohort belonged to Tier 1 of the National Institutes of Health (NIH) criteria for Sotrovimab use, and 21% of the patients had clinical deterioration 24 hours after Sotrovimab infusion. The percentage of progression to critical disease was 9.7% and the mortality 6.5 %. Conclusion: Sotrovimab is effective against COVID-19 infection and prevents mortality in high-risk patients.

Routes to diagnosis of Hypopharyngeal cancer: A Single Centre ExperienceINTRODUCTION In the United Kingdom, hypopharyngeal cancer accounts for 3% of head and neck cancers, with an age standardised reported incidence of 0.63 per 10,000. (1). Cancer of the hypopharynx often presents late. Cardinal symptoms of hypopharyngeal cancer include evidence of a neck mass, sore throat, dysphagia, hoarseness and referred otalgia. Referral pathways in patients with suspected head and neck cancer vary (1). They include but are not limited to referral from a primary care setting, acute presentation to secondary care and inter-departmental referral.In 2015, the National Institute for Clinical Excellence (NICE) established guideline NG12; Suspected Cancer, Recognition and Referral Guidelines, which defined the symptoms indicating a possible head and neck (H&N) cancer that warrant further investigation (2). The two symptoms pertinent to timely referral of hypopharyngeal cancer are persistent hoarseness and neck lump. The Northern Cancer Alliance (NCA) has used the NICE guideline to refine its 2 Week Wait (2WW) proforma to be used by healthcare practitioners when cases of H&N cancer are suspected (3). Symptoms that were originally included on the 2WW proforma, and pertinent to hypopharyngeal cancer, included dysphagia, sore throat and referred otalgia. The NCA proforma does not include these symptoms and only includes those recommended by NICE NG12 guidance. At the request of general practitioners (GPs), ‘unexplained, persistent, unilateral enlargement or ulceration of the tonsil or adjacent soft palate’ were included. The proforma does include a free text box encouraging primary care clinicians to describe concerning symptoms that do not fit with the NICE NG12 symptoms. The other symptoms/signs included on the NCA 2WW proforma relate to oral cavity cancer detection. 2WW proformas vary across regional Cancer Alliances in England, with many including dysphagia, sore throat and otalgia. This study aimed to evaluate routes to diagnosis of hypopharyngeal cancer in a large teaching hospital to establish if the current NCA 2WW proforma is appropriate to capture suspected cases of hypopharyngeal cancer.METHODS Basic settings and patient selection This was an observational case review study of all patients with a diagnosis of hypopharyngeal cancer at a large teaching hospital in England between December 2019- July 2022. The audit was registered and approved by the local hospital trust governance department prior to data collection. A total of 68 patients were identified from a prospective H&N audit database. The patient’s NHS number was used to search the hospitals electronic patient record system.Collected data The following parameters were extracted for each case: patient demographics, referral route, time from initial referral to first appointment, Tumour (T), Node (N), Metastases (M) stage, first treatment modality and socio-economic factors; smoking status and index of multiple deprivation decile which was calculated based on the patient’s postcode. A number from one to ten was generated; 1- most deprived lower-layer super output areas (LSOAs) nationally, 10- least deprived 10% of LSOAs nationally. Information regarding referral criteria was recorded from the NCA 2WW proforma. Practitioners could select one or more of the following categories to instigate the 2WW referral pathway:A persistent, unexplained lump in the neck or parotid region of recent onset.Persistent (not intermittent or fluctuating), unexplained hoarseness (over the age of 45 years).Unexplained, persistent, unilateral enlargement or ulceration of the tonsil or adjacent soft palate.AnalysisDescriptive data was collated on a spreadsheet and analysed. Analysis adhered to STROBE guidelines.RESULTS Of the 68 patients, 34 (50%) presented via a 2WW pathway, all from GP referrals. 23 (34%) were referred on non-2WW pathways: eight patients were referred by their GP on a routine basis, eight same site inter-departmental referrals and seven referrals were from another hospital site (no 2WW proforma). Three referrals were identified through routine departmental follow-up (FU) within ENT. Eight patients presented to the ENT service via an emergency route and were not previously known to the service (Figure 1). Characteristics of the patient group are shown in Table 1.Data on the time from initial referral to first appointment date was available for 50 of the 68 patients. 97% (n=33) of patients referred on the 2WW pathway were seen within 14 days of initial referral date. One patient waited 23 days, having rescheduled their appointment. The median time from initial 2WW referral to first appointment date was nine days (range 2-23 days). Of the 50 patients in total, median time from initial referral to first appointment was 10 days (range 2-117 days).18 patients were lacking data detailing initial referral to first appointment. Eight patients presented via an emergency route and were reviewed by ENT services at the time of presentation. Three patients were identified by routine departmental follow-up, and were lacking an initial referral date. Six patients were referred from other hospital sites with a previous diagnosis of hypopharyngeal cancer and one patient referred on a routine basis from GP was lacking referral documentation.Of the 16 patients referred into ENT services on non-2WW pathways, seven patients presented with dysphagia (44%), five patients presented with odynophagia (31%), two patients presented with a sore throat (13%), one patient presented with globus (6%). One patient was referred after incidental findings on previous imaging (6%). Of those 16 patients, median time from initial referral to initial appointment was 14 days (range 6-117 days). Of those presenting with dysphagia specifically, the mean time from referral to initial appointment was 11 days (range 6-14 days).Of the 34 2WW referrals from general practice, 23 patients were referred with a neck lump, 13 patients with persistent hoarseness and two patients with tonsillar ulceration. For all 2WW referrals, practitioners provided additional clinical information in the ‘reason for referral’ box. 44% of patients presenting via the 2WW pathway with a pre-treatment T category of T4. Analysis of pre-treatment category shown in table 2.26 patients (38%) received palliative radiotherapy as their first treatment modality. Of those referred by the 2WW pathway, 13 (38%) received palliative radiotherapy and four (12%) received radical radiotherapy. Analysis of primary treatment modality categorised via referral route is shown in table 3.DISCUSSION The NCA adopted the NICE NG12 symptom to refine their 2WW suspected cancer referral proforma. Our data suggests that choosing to not include those symptoms that may be suggestive of hypopharyngeal cancer; dysphagia, sore throat and otalgia, does not seem to have negatively impacted on the referral of patients with hypopharyngeal cancer. The majority of patients were seen in a timely manner. McKie et al. (8) evaluated referral patterns and diagnostic efficacy of the UK 2WW pathway, and demonstrated 21.4% of H&N cancers were diagnosed via 2WW pathway. The results from our study showed that half of patients diagnosed with hypopharyngeal cancer were referred on the 2WW pathways. Round et al. (9) demonstrated that over the past decade 2WW referrals for all types of suspected cancer have increased significantly.The ‘reason for referral’ box was populated in 100% of cases. This suggests that if the patient’s general practitioner was sufficiently concerned to detail the patients presenting symptoms, they would do so. Pooled data from previous studies of patients referred with suspected H&N cancer presenting with dysphagia indicated that head and neck cancer was diagnosed in only 5.6% of cases (4,7,8,10). In our study, the patients referred from primary care, via a non-2WW pathway, presenting with dysphagia had a median time from referral to first appointment was 11 days. Even in the absence of a 2WW proforma, this implies that referrals in to our centre were likely marked as urgent by the triaging ENT clinician reviewing these, based on the appropriate information provided by the referring practitioner. Together, these suggest that the 2WW proforma and written communication between primary and secondary care is an effective approach.The 2WW system is a balance of promoting earlier diagnosis with the capacity to investigate patients within 14 days (7). Dysphagia, sore throat and otalgia are clearly concerning symptoms when they occur together and are observed in patients who smoke and/or drink alcohol to excess (1). As individual symptoms, they can be vague and common in nature, overlapping with many of the benign persistent throat symptoms that are commonly assessed in ENT clinics. Patients with these symptoms can overload the capacity of the 2WW referral system thereby potentially delaying the system’s ability to assess higher risk symptoms in a more timely manner (7).Early cancer detection correlates with improved survival rates (5). Previous studies suggest that patients presenting via an emergency route are more likely to present with more advanced disease (5,10). Therefore, emergency presentations with advanced disease remains an area of concern to clinicians. This study highlights the link that patients presenting at a late stage, more commonly present via an emergency route, typically go on to have palliative treatment.CONCLUSION This study suggests that removal of non-NICE guidance H&N symptoms from the NCA 2WW proforma, when combined with an appropriate secondary care triaging system, has not negatively impacted on time from initial referral to diagnosis of hypopharyngeal cancer.

Soil fungal community plays an important role in forest ecosystems, and forest secondary succession is a crucial driver of soil fungal community. However, the driving factors of fungal community and function during temperate forest succession and their potential impact on succession processes are poorly understood. In this study, we investigated the dynamics of the soil fungal community in three temperate forest secondary successional stages (shrublands, coniferous forests, and deciduous broadleaf forests) using high-throughput DNA sequencing coupled with functional prediction via the FUNGuild database. We found that fungal community richness, α-diversity, and evenness decreased significantly during the succession process. Soil available phosphorus and nitrate nitrogen decreased significantly after initial succession occurred, and redundancy analysis showed that both were significant predictors of soil fungal community structure. Among functional groups, fungal saprotrophs as well as pathotrophs represented by plant pathogens were significantly enriched in the early-successional stage, while fungal symbiotrophs represented by ectomycorrhiza were significantly increased in the late-successional stage. The abundance of both saprotroph and pathotroph fungal guilds was positively correlated with soil nitrate nitrogen and available phosphorus content. Ectomycorrhizal fungi were negatively correlated with nitrate nitrogen and available phosphorus content and positively correlated with ammonium nitrogen content. These results indicated that the dynamics of fungal community and function reflected the changes in nitrogen and phosphorus availability caused by the secondary succession of temperate forests. The fungal plant pathogen accumulated in the early-successional stage and ectomycorrhizal fungi accumulated in the late-successional stage may have a potential role in promoting forest succession. These findings contribute to a better understanding of the response of soil fungal communities to the secondary forest succession process and highlight the importance of fungal communities during temperate forest succession.

Protected areas are often regarded as pristine land, but in reality, they require rehabilitation and effective management to prevent increased land degradation. Soil management requires soil maps to make informed decisions, which is difficult to create in protected areas due to the large size of land, limited accessibility, little available soil data and limited budgets of such projects. In this paper a hybrid expert knowledge and machine learning digital soil mapping (DSM) method is used to create such maps for Benfontein, a 9900 ha protected area in the semi-arid region of South Africa. The hybrid method uses soil landscape rules to determine virtual soil observations which is added to the training observations used in a machine learning algorithm to create a soil associations map. Soil properties were assigned to each soil class at the 0.1, 0.5 and 0.9 percentile level, to indicate the range of properties at an 80% certainty. The soil maps were interpreted to indicate soil carbon sequestration potential, soil erodibility and off-road driving potential. The soil association map was acceptable as it achieved a kappa value of 0.69. Additionally, it was determined that the site has a large potential for carbon sequestration, the soils are relatively stable against water erosion, and off-road driving should be prohibited on approximately half of the area. The results indicate that the hybrid DSM method is viable to create useful soil maps to inform management decisions in the unique settings of protected areas.

Our aim was to estimate changes in sexual function and semen quality in men recovering from infection since the Omicron pandemic started in China in late 2022. We collected 1540 questionnaires and assessed male function before infection and acute phase after infection by using International Index of Erectile Function-5, Premature Ejaculation Diagnostic Tool, and Arizona Sexual Experience Scale. We also collected the before and after semen analysis results of 247 male patients. During the acute phase after infection, the proportion of erectile dysfunction was significantly higher than before infection, but ejaculatory function was not significantly altered； In addition, semen analysis showed significant difference in semen concentration, semen activity and PR a+b sperm forward movement after infection compared to pre-infection. Omicron can affect erectile function as well as sexual experience in male patients in the acute phase. The risk factors for decreased sexual function due to Omicron included body temperature and anxiety during infection.

Studying small mammals has a paramount significance for ecological, cultural and economic reasons. A survey on the diversity, abundance and habitat association of small mammals in Wenchi highlands, central Ethiopia, was carried out from August 2019 to January 2021. Small mammals were trapped from six different habitats (Hagenia Woodland, Erica Scrub, Qibate, Lakeshore, Erica and Albesa Forests) using Sherman and snap traps in standard trapping grids. A total of 935 rodents belonging to 12 species (Arvicanthis abyssinicus, Desmomys yaldeni, Mastomys natalensis, M. awashensis, Stenocephaylemys albipes, Lophuromys flavopunctatus, L. brevicaudus, L. chrysopus, Dendromus lovati, Lophiomys imhausi, Graphirius murinus, and an unidentified murid rodent), and 24 insectivores belonging to 3 species (Crocidura bailey, C. fumosa and C. olivieri) were recorded. Hystrix cristata and Tachyoryctes splendens were also recorded through indirect evidences. About 52.9% of the identified small mammals were endemic to Ethiopia. A significant variation was observed in the captures of small mammals. The capture rate was higher in live traps (23.85%) than snap traps (8.26%). The diversity and distribution of small mammal species varied among habitats. The highest species diversity (H’=1.74) was recorded in Albesa Forest, while the least was in Qibate Forest (1.43). The highest number of individuals were recorded in Lakeshore Forest (27.73%), whereas the least was in Erica Forest (4.27%). M. natalensis (30.86%) and S. albipes (27.53%) were the two most abundant species, whereas L. imhausi (0.1%) was the least. Wenchi montane forests are one of the most important homes to unique small mammals that need urgent conservation actions.

Background Childhood cancer is the sixth leading cause of global cancer burden. Indeed, 90% of childhood cancer cases occur in low-middle-income countries (LMICs), where mortality can be 4-5 times higher than in high income settings. In addition, many LMICs lack data on pediatric oncology for policy development and resource prioritization. In this paper, we describe the state of pediatric cancer care and treatment in Cameroon. Procedure We conducted cross-sectional survey in July 2020, which enabled us to collect data from two hospitals providing pediatric oncology services in Cameroon. We collected data on service availability, human resource capacity, frequent cancer types, treatment dropout, primary reasons for drop out, disclosure of status, and management of oncology data. Result The surveyed hospitals offered both pediatric chemotherapy and palliative care services; however, none offered nuclear medicine or radiotherapy services. In terms of workforce, human resources were grossly lacking in both hospitals. The available ones include one pediatric hemato-oncologist, one medical oncologist, one resident pediatric oncologist, one pediatric surgeon, and 14 oncology nurses and about 40% (18/45) of have received specialty training in oncology. The commonest childhood cancer managed in these facilities, was Burkitt lymphoma, (39, 23%). About 30% of children on chemotherapy abandoned their treatment, primarily due to lack of funds to continue with treatment sessions. In both settings, the capacity to diagnose cancer and provide counselling was limited. In addition, the tools to capture and transmit data varied by facility, resulting to different data set being generated. Furthermore, both facilities, had no schedule and timelines for data reporting. Conclusions Our results suggest that several factors negatively impact proper cancer care and treatment of pediatric Cancers in Cameroon. These include, inadequate human resource capacity, a high proportion of dropouts from chemotherapy due to high cost, and lack of harmonized data collection and reporting tools and systems. Systematically addressing these factors could contribute to improving treatment outcomes for pediatric cancer patients in Cameroon.

A two degree-of-freedom vibration isolation system with magneto-rheological damper (MRVIS) is analyzed. Under the harmonic excitation, the nonlinear behaviors are discovered. With the excitation frequency increased, the period-doubling bifurcation and saddle node bifurcation, route to chaos are found. Then, the system returns to steady state through the route out of chaos, with inverse period-doubling bifurcation. Furthermore, a sliding mode controller through tracking the error between actual and ideal state system, is proposed to suppress the increasing amplitude of the system caused by the chaos. Both the calculation and experiment show that the chaotic motion is effectively repressed.

This article is a rejoinder to the rebuttal letter authored by Jair Bolsonaro’s former Minister of Health and Secretary of Primary Care to our initial article, “From Bolsonaro to Lula: The opportunity to rebuild universal healthcare in Brazil during the government transition,” published in the International Journal of Health Planning and Management. We aim to refute the claims that we consider unsubstantiated and disconnected from reality, while reiterating the risks posed by authoritarian and antidemocratic far-right governments, such as Bolsonarism in Brazil, to the sustainability and resilience of universal health systems. This political threat is gaining momentum across several countries worldwide, thereby endangering the Democratic Rule of Law, institutions, and social policies. Furthermore, we emphasize the significant actions implemented during the first 100 days of President Lula’s government, which align with the priorities established during the governmental transition process and strengthen the prospects of reconstructing and fortifying the Brazilian universal health system.

The paper describes the detection of exoplanets in multiplanetary systems using HI line data is an approach in astronomy. Traditional methods for detecting exoplanets have limitations in terms of sensitivity and range, which makes it difficult to detect small and distant planets. We propose a mathematical model based on the analysis of the HI line emission and absorption spectra to predict the presence of exoplanets.The model is based on fitting the observed HI line profile to a Gaussian distributionf(v)=Aexp[−(v − vθ)²/(2δv²)] + δf(v) where δf(v) is the perturbation caused by the exoplanet. The amplitude of the perturbation depends on the mass, orbital distance, and other properties of the exoplanet. and searching for significant deviations that may indicate the presence of an exoplanet.The chi-squared statistic,x², measures the difference between the observed and expected HI line profiles: $x^2 =^{\infty} 2^{-n} = 1 [f_{obs}(v) - f_{exp}(v)]^2 / \sigma^2 $. The deviation caused by the exoplanet can be quantified using a perturbation term in the Gaussian distribution. The amplitude of the perturbation depends on the mass, orbital distance, and other properties. We use statistical tests such as the chi-squared test to measure the significance of the deviation and estimate the properties of the exoplanet and the Extragalactic distance scale.

The quantitative identification of nitrate sources is of great significance for the control of non-point source pollution and the comprehensive management of water resources in watersheds. δ 15N-NO 3 - and δ 18O-NO 3 - isotopes combined with the Bayesian isotope mixing model were widely used as effective methods to identify nitrogen sources. In this study, a total of 60 surface water samples and 82 groundwater samples were collected in study area from November 2021 to October 2022, and atmospheric deposition (AD), chemical nitrogen fertilizer (NF), soil nitrogen (SN), and manure and sewage (M&S) were determined as the potential nitrate sources. Source identification by SIAR indicated that in November 2021 the M&S was the main contributor of nitrate to surface water (mean 38.1%), while NF was the main contributor to groundwater (mean 39.8%). In April 2022, NF contributed the most to surface water (38.3%), while groundwater mainly originated from SN (29.4%) and MS (29.8%). The uncertainty analysis showed that the greatest uncertainties were in SN and NF, followed by M&S and AD. Sensitivity analysis showed that the changes in the nitrate isotopic composition of M&S had the greatest effect on the results for δ 15N, whereas only the mean values of oxygen isotope values of AD had a greater effect on the results for δ 18O. The sensitivity analysis results can optimize the sampling scheme and improve the accuracy of the model predictions. Additionally, the contributions of soil nitrogen and nitrogen fertilizer to nitrate in surface water and groundwater reached 58% and 64%, respectively. Therefore, optimizing fertilizer and irrigation management is necessary to improve nitrogen use efficiency in watershed management.

Flame retardants play a crucial role in improving the flame retardant properties of polymer materials. In recent years, environmental problems caused by flame retardants have attracted widespread attention. It is urgent to use green and effective methods to prepare flame retardant polymers. Bioinspired nanocomposites with layered structures seem to provide an effective idea, but in general, the hydrophilic properties of their raw materials limit their applications in certain fields. Here, we prepared biomimetic composites with a layered “brick-and-mortar” structure by gravity-induced deposition using polyimide as the polymer matrix and montmorillonite (MMT) as the filler. The well-arranged structures of the composite material could isolate oxygen and prevent combustible gases from escaping. The gas barrier performance has been greatly improved, in which the water vapor transmission rate (WVTR) and the oxygen transmission rate (OTR) decreased by 99.18% and three orders of magnitude, respectively. The flame retardant performance has also been improved, and its limiting oxygen index can reach 67.9%. More importantly, the polyimide matrix can be converted to water-insoluble by thermal imidization of water-soluble poly (amic acid) salt precursors, which endows the composites with low hygroscopicity. Such coating containing MMT can protect against polyurethane (PU) foam from fire. During the conical calorimetric test, the coated sample self-extinguished, and the peak heat release rate, total heat release, total smoke production is significantly decreased by 53.39%, 40.69%, and 53.03%, respectively. Taking advantage of these properties, this work utilizes a facile method to prepare biomimetic composites with low moisture absorption, excellent gas barrier properties, and flame retardancy, which have great application potential.

Lung cancer is the leading cause of cancer-related deaths worldwide. About 85% of lung cancer patients have NSCLC; most are diagnosed with stage IV disease at initial presentation. With the continuous development of oncology, immunotherapy or immune chemotherapy has become the first-line treatment for patients with stage IV NSCLC. However, a proportion of patients still develop resistance to the treatment regimen and experience local progression, and primary lung lesion progression is the main progression pattern of stage IV NSCLC. Preclinical and clinical studies have demonstrated that radiotherapy can induce a systemic anti-tumor immune response and that adding local radiotherapy before cancer progression can prolong survival. Therefore, we considered whether adding local radiotherapy before the progression of a pulmonary lesion in stage IV NSCLC patients receiving immunotherapy or immune chemotherapy would be beneficial. The present review focused on the anti-tumor efficacy of radiotherapy and immunotherapy, emphasizing the time of addition of radiotherapy and the safety of combination therapy for stage IV NSCLC and understanding the underlying mechanism.

It is generally accepted that Cyclooxygenase-2 (COX-2) is activated to cause inflammation. However, COX-2 is also constitutively expressed at the postsynaptic dendrites and excitatory terminals of the cortical and spinal cord neurons. Although some evidence suggests that COX-2 release during neuronal signaling may be pivotal for regulating the function of memory, the significance of constitutively expressed COX-2 in neuron is still unclear. This research aims to discover the role of COX-2 in memory beyond neuroinflammation and to determine whether the inhibition of COX-2 can cause cognitive dysfunction by influencing dendritic plasticity and its underlying mechanism. The cognitive ability was assessed by novel object recognition task (NORT) and Morris water maze (MWM) test. Immunofluorescence, Golgi-cox staining were used to observe dendritic synaptic. Gamma oscillation in hippocampus CA1 was performed by Tetrode in-vivo recording. Prostaglandins were measured by HPLC/mass spectrometry. We observed the expressions of cyclic adenosine monophosphate (cAMP)/ brain-derived neurotrophic factor (BDNF) pathway proteins in hippocampus and N2a cells by Elisa and western blot. We found COX-2 gene knockout (KO) could significantly impact the learning and memory ability; reduce the expression of postsynaptic density protein 95 (PSD95) in the neuron; cause synaptic disorder; influence gamma oscillation and reduce the expression prostaglandin (PG) E2, cAMP, phosphorylated protein kinase A (p-PKA), phosphorylated cAMP response element binding protein (p-CREB) and BDNF in the hippocampus. It suggested COX-2 might play a critical role in learning, regulating synaptic plasticity and gamma oscillation in the hippocampus CA1 by regulating COX-2/BDNF signaling pathway.

Background: Cancer is one of the most significant non-transmissible diseases at public health level, and febrile neutropenia (FN) one of its most serious life threatening complications. Objective: To estimate 5-year survival rates for children with cancer and FN from a referral health center in Santiago, Chile, by clinical-demographic variables. Method: Prognostic and analytic historical cohort survival study. (FONDECYT nº 1090194, 2009-2011). Results: 116 subjects were included, and grouped in three categories, by type of cancer: 1) leukemia/lymphomas (51.7%), 2) osteosarcoma (25.9%) and 3) another type of solid organ tumors (22.4%), the median number of days between chemotherapy and the first episode of FN was 5 days [1-7], 7 [7-8] and 7 [5-8] respectively. The five year overall specific survival rate was 64.7%. There were protective factors identified through Cox Model: age, post cancer comorbidity and average educational level of the caregiver. Risk factors identified were: presence of another type of solid organ tumor (HR 3.43 95% CI 1.64-7.19), sepsis (HR 2.89 95% CI 1.47-5.70), delay in chemotherapy treatment (HR 2.94 95% CI 1.17-7.40) and invasive fungal infection (HR 3.36 95% CI 1.22-9.22). Conclusion: This is the first pediatric study in Chile to analyze prognostic factors in children with cancer and FN. The predictor variables that were identified comply with previous reports from international literature.

Alcohol abuse is not only responsible for 5.3% of the total deaths in the world, but also has a substantial impact on neurological and memory disabilities throughout the population. One extensively studied brain area involved in cognitive functions is the hippocampus. Evidence in several rodent models has shown that ethanol produces cognitive impairment in hippocampal-dependent tasks and that the damage is varied according to the stage of development at which the rodent was exposed to ethanol and the dose. To the authors’ knowledge, there is a biomarker for cognitive processes in the hippocampus that has not been evaluated in association with memory impairment by alcohol administration. This biomarker is called Sharp Wave Ripples which are synchronous neuronal population events that are well known to be involved in memory consolidation. Methodologies for facilitation or automatic identification of ripples and their analysis have been reported for a wider bandwidth than Sharp Wave Ripples. This review is focused on communicating the state-of-the art about the relationship between alcohol, memory consolidation and ripple activity as well as the use of the main methodologies to identify SWRs automatically.

Twin pregnancies in Arabian horses is a major cause of abortion. In all cases when the abortion occurs, it occurs for both fetuses. Unusually in the case described here, which we believe has not previously been documented in Arabian horses, one fetus aborted in undersized and representing an age of 4 months. The other fetus completed the gestation and reached full term followed by birth. The authors postulated that one fetus underwent a stage of diapause like marsupials in a blastocyst stage then re-grew again, followed by abortion. The parentage analysis confirmed that both feti are derived from the same dam and sire stallion.

A large amount of data has been accumulated in the technical supervision work of power grid enterprises for many years. Considering that the family defects of power equipment have a great influence on equipment condition assessment, this paper introduces an improved hierarchical clustering method based on the analysis of the traditional hierarchical clustering method to automatically identify and cluster the family status data of power equipment. The quantitative assessment of the family defect factor is then given. The family defect assessment is combined with the MMS communication network equipment in the substation communication network, which effectively and reasonably reflects the impact of various types of family defects on the health status of the equipment and provides a strong basis for maintenance decision making.

Background Failure to understand uterine function during pregnancy is a major shortcoming of healthcare. Objective To support the hypothesis and we would call it, Hegazy’s Hypothesis for Gestation. Study Design: The thesis of this hypothesis is derived from a study that was carried out in Australia and published in PLOS in 2010. Sokolowski P et al. 2010. Human Uterine Wall Tension Trajectories and the Onset of Parturition. PLoS ONE 5(6): e11037. Results Pregnancy is a state of balance between the two opposing and interactive inhibitory and stimulatory systems secondary to EUWT mechano-transduction and Progesterone/estrogen stimulation. Pregnancy is mainly maintained through a stretch-dependent inhibitory system. Contractions of the stimulatory system transform the cervix into the lower uterine segment causing EUWT failure, which terminates the pregnancy. Light-dark cycle modulation of interactive inhibitory and stimulatory systems divides gestation into five clinical phases. Pregnancy interval and circadian timers are achieved by a single mechanism, namely EUWT failure, secondary to the complete loss of cervical strength nocturnally. Inhibitory system malfunction causes preterm labor, and most of the current therapeutic modalities for pre-term labor are focusing on delaying or preventing EUWT failure. Stimulatory system malfunction causes post-term pregnancy, and the combined malfunction of the two systems causes labor dystocia. Conclusion EUWT creation, autonomic maintenance, and autonomic EUWT termination make pregnancy an autonomic cycle with constant intervals and circadian timers. EUWT malfunctions alter birth timing and/or mode of delivery. Laplace’s law and Pascal’s principle measure EUWT which might be the laws of physics that genetically pregnancy duration.

Natural dispersal between populations, and resulting immigration, influences population size and genetic diversity and is therefore a key process driving reciprocal interactions between ecological and evolutionary dynamics. Both ecological and evolutionary consequences of dispersal fundamentally depend on the relative fitnesses of immigrants and their various descendants manifested in the context of natural environments. Yet, despite this commonality, recent research advances in predicting immigrants' legacies remain substantially disconnected across disciplines. To bridge resulting divides, we synthesize empirical and theoretical work examining fitness consequences of inter-breeding across the full spectrum of genetic divergence from inbred lines to inter-specific hybridization. We demonstrate how common underlying processes can generate positive or negative fitness consequences of immigration depending on interacting genetic and environmental effects. Impacts of inter-breeding following natural dispersal among sub-populations could consequently vary dramatically, shaping eco-evolutionary outcomes. Yet, our systematic literature review reveals a striking paucity of empirical studies that quantify multi-generational fitness consequences of immigration in natural metapopulations, precluding general inferences on outcomes. Hence, to provide new impetus, we highlight key theoretical and empirical gaps, and outline how cutting-edge statistical and genomic tools could be combined with multi-generational field datasets to advance understanding of dispersal-mediated drivers and constraints on eco-evolutionary dynamics.