Background Noise-induced hearing loss (NIHL) is a common cause of sudden sensorineural hearing loss. Exposure to loud music noise especially in music events has increased the prevalence of NIHL in young adults. The awareness about noise-induced harm to ears is crucial in the current scenario as SNHL has a significant impact on the quality of life and social participation of young adults. The most effective ways to deal with NIHL are prevention and early detection. Study details We present case studies of our four patients who presented to our department with SSNHL after loud music exposure. All patients underwent a complete audiometric evaluation and were managed as per the SSNHL protocol followed in our department. All our patients had normal middle ear functions and normal otoscopic findings. Conclusion Our experiences have convinced us of the need of protecting hearing from loud music and early detection of NIHL, especially in young adults.

The study aims to evaluate and analyze the operational and technical aspects of a compression ignition engine running on biodiesel containing graphene nanoparticles is examined in relation to the geometry of a toroidal piston and a five-hole injector nozzle. A one-cylinder diesel engine was utilized in the experimentation work and performance traits such brake thermal efficiency and pollutants were assessed and compared. The results demonstrate that using a toroidal piston shape and a five-hole injector nozzle increases brake thermal efficiency for Diesel, RBME, RBME30PPMGRAPHENE, and RBME60PPMGRAPHENE at 80% load are 25.6%, 20.4%, 22.4%, and 24.9% respectively, while hydrocarbon found to 42, 60, 48, and 38 ppm respectively, Nitro oxide are recorded as 1080, 650, 942, and 984 ppm respectively and carbon monoxide are 0.12%, 0.34%, 0.2%, and 0.15%, for, Diesel RBME, RBME30PPMGRAPHENE and RBME60PPMGRAPHENE respectively. Overall, the results demonstrate the potential of using a five-hole injector nozzle and toroidal piston geometry in combination with graphene nanoparticle biodiesel the brake thermal efficiency of RBME60PPMGRAPHENE fuel is greater than RBME, RBME30PPMGRAPHENE while the NOx is less in RBME as compared to Diesel, RBME30PPMGRAPHENE and RBME60PPMGRAPHENE.

Background and purpouse Psychological disorders, such as anxiety and anhedonia are pain comorbidities, however how pain affects male and female individuals and through which mechanism is not well understood. Previous research show pain-induced alterations in the dynorphinergic pathway in the mesocorticolimbic system (MCLS) together with a relationship between corticotropin-releasing system and dynorphin release in the MCLS. Here, we analyse the sex and time course-dependent effects of pain on negative affect. Additionally, we study the implication of dynorphinergic and corticotropin releasing factor involvement in these pain related behaviours. Experimental approach We used behavioural pharmacology and biochemical tools to characterize negative affective states induced by inflammatory pain in male and female rats, and the alterations in dynorphinergic and corticotropin systems in the MCLS. Key results. Female rats showed a persistent anxiety-like together with a reversible anhedonia-like behaviours derived from inflammatory pain. Additionally, we found alterations of in both dynorphin and corticotropin releasing factor in NAc and amygdala that suggest sex-dependent dynamic adaptations. Finally blockade on the kappa opioid receptor in the NAc confirmed its role in pain-induced anxiety-like behaviour in female rats. Conclusions and implications Our results show sex and time dependent anxiety- and anhedonia-like behaviours induced by the presence of pain in female rats. Furthermore, we replicated previous data pointing to the KOR/dyn recruitment in the NAc as key neurological substrate mediating these behaviours. This research encourages the study the mechanisms underlying these behaviours, to better understand the emotional dimension of pain.

Salt and alkaline stresses often occur together, severely threatening plant growth and crop yields. Salt stress induces osmotic stress, ionic stress, and secondary stresses, such as oxidative stress. Plants under saline-alkali stress must develop suitable mechanisms for adapting to the combined stress. Sustained plant growth requires maintenance of ion and pH homeostasis. In this review, we focus on the mechanisms of ion and pH homeostasis in plant cells under saline-alkali stress, including regulation of ion sensing, ion uptake, ion exclusion, ion sequestration, and ion redistribution among organs by long-distance transport. We also discuss outstanding questions in this field.

There is abnormal wear and fracture of the retainer in the faulty piston pump. To investigate the early failure mechanism of the fractured retainer, a model for the calculation of the transient contact between the overturning retainer and the slipper is presented. The equations of the trajectory between the overturning retainer and the slipper are established based on the transformation matrix and the operating mechanism of the slipper in the oil sucking and discharging areas. The trajectory of the push points between the overturning retainer and the slipper is solved. The failure mechanism of the retainer extrusion wear is determined. The results show that with the increase of the degree of overturning, the degree and range of extrusion and wear between the failure retainer and the slipper is increased. The research elucidates the failure mechanism of the retainer and lays the foundation for the dynamics modeling and coupling vibration analysis of the overturning retainer.

IntroductionMultiple Sclerosis (MS) is a chronic autoimmune disorder causing nerve sheath demyelination and symptoms such as muscle weakness, mobility decline, and lack of coordination 1,2, generating unique health challenges and an economic burden 3-5. Patients experience reductions in bone and skeletal muscle mass6, muscle strength and function 7,8, and increased fracture risk 9, negatively impacting quality of life 10. Lower limb strength impairments8, poor balance 11 and spasticity12 also contribute to a lower quality of life10. Pharmacological treatments have been the primary option for patients with MS 13.Recent research has explored non-pharmacological treatments such as exercise, nutritional supplementation, and improved sleep quality14-21. Resistance exercise (RE) is particularly beneficial for MS rehabilitation, as it improves muscle strength and function, mobility, quality of life 22,23, and the immune system 24. High-dose vitamin D supplementation raises interleukin-10 (IL-10) levels in MS patients19, who tend to have lower levels of IL-10, which may contribute to the disease’s development 25. However, RE and vitamin D may not always improve physical fitness20,21. This could be due to unsatisfactory energy and protein intake, containing essential amino acids (EAA), which are necessary to stimulate muscle protein synthesis (MPS) and ultimately address sarcopenia 26, a condition prevalent in MS patients 27. EAA-based supplements enriched with L-leucine increase protein intake and optimise MPS in healthy older adults without compromising total energy intake during mealtimes28,29 and plasma EAA concentration is associated with muscle function in older women in the community 30. A higher protein intake, including specific amino acids, may positively impact bone health through mechanisms such as increasing insulin-like growth factor 1 (IGF-1) 31,32. Therefore, addressing dietary protein deficiencies alongside RE may optimise musculoskeletal health and function in female MS patients. This case study evaluated the effects of a 24-week home-based intervention, including EAAs and vitamin D3 supplementation, on muscle, bone, muscle strength, and function in a female patient with MS.

Trans-grafting could be a strategy to transfer virus resistance from a transgenic rootstock to a wild type scion. However contradictory results have been obtained in herbaceous and woody plants. This work was intended to determine if the resistance to sharka could be transferred from transgenic plum rootstocks to wild-type apricot scions grafted onto them. To this end, we conducted grafting experiments of wild- type apricots onto plum plants transformed with a construction codifying a hairpin RNA designed to silence the PPV virus and studied if the resistance was transmitted from the rootstock to the scion. Our data support that the RNA-silencing-based PPV resistance can be transmitted from PPV-resistant plum rootstocks to non-transgenic apricot scions and that its efficiency is augmented after successive growth cycles. PPV resistance conferred by the rootstocks was robust, already occurring within the same growing cycle and maintained in successive evaluation cycles. The RNA silencing mechanism reduces the virus titer progressively eliminating the virus from the wild type scions grafted on the transgenic resistant PPV plants. There was a preferential accumulation of the 24nt siRNAs in the scions grafted onto resistant rootstocks that was not found in the scions grafted on the susceptible rootstock. This was coupled with a significant lower quantification of the hpRNA in the resistant than in the susceptible or tolerant rootstocks. Using transgenic rootstocks should mitigate public concerns about transgenes dispersion and eating transgenic food and allow conferring virus resistance to recalcitrant to transformation cultivars or species.

In response to the lack of an accurate and comprehensive understanding of the specific use of energy and the benefits it generates by beer producers in the brewing industry. Causes the difficult problem of energy loss and waste in the production process，For the first time, an energy efficiency evaluation index system was constructed based on the seven factors affecting energy efficiency in breweries; using this index system and the quantitative evaluation model, the seven primary indices affecting energy efficiency can be ranked, and the superior links can be found to continue to build on and the weak links to be rectified. Combining the actual monitoring data of a brewery over a period of time with the scores scored by on-site experts, and the proposed scheme was simulated and experimented by Python. The results show that the assessment results are consistent with the actual situation of the enterprise and prove the effectiveness and feasibility of this energy efficiency assessment index system.

Although a high-resolution three-dimensional mapping system has made it possible to treat complicated atrial tachyarrhythmia (AT), there remain cases that are difficult to diagnose and treat. 1,2 When a single atrial tachycardia is present and stable, mapping is relatively easy. However, when multiple different ATs alternately appear, mapping and diagnosis of those are more difficult. Parallel mapping module is well known as a good option to simultaneously map two or more different ATs when they alternately appear. 3 When performing parallel mapping of two different ATs, one bipolar signal of the reference catheter is used as a timing reference and a cycle length filter is used for differentiating AT1, AT2, and others, including sinus rhythm, fusion beats, or catheter-induced premature atrial complex. Therefore, it has some limitations for differentiating multifocal ATs. We present a case wherein multifocal ATs were successfully eliminated by combining parallel mapping module and dual-chamber intra-cardiac pattern matching technique that we have previously reported. 4

The fungal species in Colletotrichum genus are important pathogens of black pepper (Piper nigrum) to cause dieback of leaves and branches. The black pepper anthracnose has been observed frequently in Hainan, which is the main production area of black pepper in China. Thirty-six isolates from diseased leaves were collected through different fields located in six main production areas of Hainan. Twenty-three isolates were found related to black pepper anthracnose and were identified as Colletotrichum spp. through morphological characteristics and ITS information via BLAST search. All isolates collected in this study belonged to Colletotrichumgloeosporioides complex. Six genes including ITS, TUB2, CHS-1, ACT, GAPDH and ApMat were amplified and sequenced. C. siamense,C. fructicola, C. arecicola, and C. kahawae were identified as the main pathogens based on the multi- gene phylogenetic analysis and morphological characters. This is the first report of these four isolates associated with black pepper anthracnose in Hainan, China.

Objective: The present paper is to determine the effects and underlying mechanisms of ivabradine (IVA) on atrial fibrillation (AF). Methods: Electrophysiological changes were determined using Langendorff-perfused hearts and patch-clamp techniques. Parameters of Ca2+ handling were evaluated by using calcium imaging and western blotting. Results: IVA (0.1-10 μM) slowed HR in a concentration-dependent manner in isolated hearts of rabbit. IVA induced atrial arrhythmias in 26.1% and 76.9% of hearts paced at a basic cycle length of 350 and 570 ms, respectively. In hearts pretreated with either acetylcholine (ACh) or anemone toxin-II (ATX-II) which caused no inducible atrial arrhythmias, adding to IVA administration caused atrial arrhythmias in 61.9% (13/21) and 44.4% (8/18) of hearts, respectively. In atrial myocytes, IVA induced DADs by 41.7%, 62.5% and 50.0%, respectively, in the absence and presence of either ACh or ATX-II. IVA increased the frequency, amplitude and full width at half-maximum (FWHM) of Ca2+ sparks and decreased Ca2+ transport in association with increased protein expression of RyR2 and NCX1 and decreased SERCA2. Conclusion: IVA increases atrial proarrhythmic risk in hearts with a slow HR, enhanced vagal tone and increased late sodium current by inducing DADs resulting from an enhanced intracellular Ca2+ inhomeostasis.

Indiscriminate use of antibiotics has led to the emergence of antibiotic resistant microbes and the loss of natural flora in aquaculture systems ultimately necessitating the ban of many of the chemotherapeutants in aquaculture. Actinobacteria play a profound role in the biogeochemical cycling in the marine environment and they represent the principal source of secondary metabolites with antimicrobial property. In the present study, 98 marine derived actinomycete isolates were screened for antimicrobial activity against the common aquatic pathogens. A potent actinomycete isolate S26, identified as Streptomyces variabilis based on 16S rRNA gene sequencing was used for further study. Optimization of the fermentation medium for secondary metabolite production was carried out by response surface methodology (RSM) using DESIGN EXPERT. The ANOVA of the quadratic regression model demonstrated that the model was highly significant for the response concerned i.e., antimicrobial activity as evident from the Fisher’s F- test with a very low probability value [(P model>F) = 0.0001]. Of the 10 different solutions suggested by the software, the most suitable composition was found to be starch, 1.38 %; soy powder, 0.88 %; ammonium sulphate, 0.16 % and salinity, 27.76 ‰. S. variabilis S26 cultured in the optimized production medium was applied in the Penaeus monodon larval rearing system and the total Vibrio count and survival rate were estimated. S. variabilis S26 treatment showed a significant reduction in Vibrios and better survival in the Penaeus monodon culture system compared to the control.

Abstract Recently, food fraud has been observed in all aspects more than in the past and one of the most common impurities has been identified in honey. Industries try to produce fake honey to make more profit. Recently, honey has been adulterated in more sophisticated ways that are difficult to detect by conventional methods. In this study, a new isotope ratio mass spectrometry method was used in comparison with traditional chemistry methods based on the national standards of Iran (ISIRI). twenty different honey samples were collected from other regions. These samples have been examined using two methods to determine authenticity. The first one is related to the C13 isotope and using isotope ratio mass spectrometry (IRMS) and the second one is conventional methods based on ISIRI. The results have been analyzed by Prism software, and based on this, the difference between the confidence level of IRMS method and conventional methods was statistically significant and the p-value was less than 0.05.

A hunting arrow traumatism to the head: a case report from NigerAssoumane Issa Ibrahim1,2, Roméo Bujiriri Murhega1,2,3 , Sanoussi Samuila1,21. Department of Neurosurgery, National Hospital of Niamey, Niamey, Niger 2. Faculty of Health Sciences of the Abdou Moumouni University of Niamey, Niger 3. Faculty of medicine, catholic university of Bukavu, Democratic Republic of Congo Corresponding author : Roméo Bujiriri Murhega, quartier Harobanda, ville de Niamey, Niger, +22782078866,romeobujiriri1@gmail.com, ORCID: 0000-0002- 0022-6355Key clinical message Arrow injuries have not disappeared in our environment despite the advances in the development of warfare tools in the world. All regions of the body can be the target of these arrows and in particular the cephalic region whose gravity will depend on the structures reached. Abstract With the development of modern weapons of war, arrow wounds have become rare in developed countries, but they are still common in developing countries, including Niger. These injuries are often serious and life-threatening when they are in the head and neck region, due to the presence of major vessels and vital organs in these areas of the body. Extraction of these arrows is usually difficult due to the proximity of major vital structures. Unskilled extraction can aggravate the injury or result in unintentional damage to vital structures with imminent risk of death. We present the case of a patient with a homemade arrow to the head in the left periorbital region that we successfully extracted at the National Hospital in Niamey. Our objective is to highlight the experience with this patient and review some reports in the literature.Keywords: Arrow wounds, head wounds, NiameyIntroduction Since ancient times, since prehistoric times, arrows have been used as weapons of war in many civilizations, including African civilizations.1 With advances in technology, arrows as weapons of war are now almost abandoned in developed countries. Nevertheless, in developing countries, arrow injuries are still a reality.1,2In developing countries, for example, penetrating head injuries occur most often after fights and conflicts between farmers, and these situations are much more frequent in practice than the rarity of reported cases would suggest.2,3Arrow injuries are very rare.4,5 All areas of the body can be targets, including the cephalic region, and the severity of which depends on several factors. Among these factors, we cite, the distance at which the arrow was shot, the degree of penetration of the arrow and the application or not of poison on the arrowhead, which is a common practice.1 These injuries can affect any part of the human body, including the head and neck and can be fatal.6 These head and neck injuries are often life-threatening due to the presence of major vessels and vital organs. Management of these injuries is not always easy due to the proximity of major vital structures. We report on a patient who received a left periorbital arrow and was successfully treated.Case Report A 42-year-old patient from a region far from Niamey (the Diffa region), located 1,318.8 kilometers from the city of Niamey, was referred to the surgical emergency room of the national hospital in Niamey five days after a fight between farmers over agricultural land. On admission, he presented with an impacted arrow in the left orbital rim 1 cm lateral to the medial canthus (Figure 1). The patient was conscious, without signs of intracranial hypertension or focal signs. His vision was normal. The CT scan performed showed the extracranial path of the arrow. It crossed the left orbital rim, the base of the nose to the right external canthus without penetrating the cranium (Figure 2 ). The patient had received antibiotics and tetanus prophylaxis. He underwent wound exploration with arrow removal under general anesthesia(Figure 3). The arrow was approached through a left eyebrow incision. Dissection was completed to the tip of the arrow, and the arrow was gently removed. The patient did well after surgery, no complications were recorded, and he was discharged 1 week after admission. Postoperative follow-up has not noted any particularities to date and the wound has healed well (Figure 4). Discussion Head injuries are a major global public health problem. These traumas encompass a wide range of etiologies.7 Among these etiologies we can mention, accidents on the public road, accidents at work, sports, trauma by bullets, trauma by arrows etc. Head injuries from arrows are too rare in developed countries, but in developing countries they have not disappeared despite advances in the field of tools of war. In developing countries, peasants still value their agricultural land, which is a source of wealth and economy.2 Nevertheless, conflicts between them are frequent and are the source of fights that most often involve bladed weapons, including arrows. In this work we report the case of a patient suffering from an arrow trauma to the head after agricultural conflicts in his village. In the literature, very few cases are reported on head injuries by arrow. The clinical manifestation of penetrating arrow injuries in the head area depends on the structure affected and the severity of the injury. The degree and severity of the injuries depend on the distance at which the arrow was fired, the trajectory it followed, the degree of penetration and the possible application of poisons to the tip of the arrow.8 Poisoned arrows cause paralysis or severe infection of the wound depending on the nature of the poison.2,9 Poisoned arrows cause paralysis or severe infection of the wound depending on the nature of the poison.2 Brain and spinal cord injuries can lead to paraplegia, quadriplegia, ventricular hemorrhage, or immediate death.1 The good news is that our patient the path of the arrow was exclusively extracranial and the large vessels were not affected. The emergency action to be taken will depend on the clinical condition of the patient at admission. Patients whose injuries are immediately life-threatening should be treated urgently, while those who are clinically stable and have optimal hemodynamic status are examined before the decision to explore is made.10,11 Our patient was clinically stable and had received a complete and unremarkable clinical examination. CT scan is an essential examination for the lesion assessment of patients with arrow trauma to the head.1It is usually indicated in patients who are hemodynamically stable, which was the case for our patient. The scanner is a non-invasive diagnostic tool that determines the trajectory of the arrow and its relationship with vital structures.12 An attempt at blind extraction can lead to a serious disaster, especially if major vessels have been hit. Our patient was able to perform the cranioencephalic CT scan which clearly showed us the extracranial trajectory of the arrow.Conclusion Arrow wounds to the head have never disappeared in developing countries despite advances in the manufacture of tools of war. Care is difficult when noble structures are affected. The prognosis is life-threatening when there is damage to the large vessels, especially in a context of limited resources. The urgency of the emergency always depends on the patient’s clinical condition at the time of admission to hospital.ACKNOWLEDGMENT NoneCONFLICTS OF INTEREST NoneAUTHOR CONTRIBUTIONS Assoumane Issa Ibrahim and Roméo Bujiriri Murhega have designed, conceptualized the study, and written the first draft under the supervision of Sanoussi Samuila .ETHICAL STATEMENT This case report received ethical clearance from the Ethical committee of the university of the first author.CONSENT Written informed consent was signed by the patient prior to the publication of this paperDATA AVAILABILITY STATEMENT All the materials used in this study are available on request.Bibliography 1. Abdullahi H, Adamu A, Hasheem MG. Penetrating Arrow Injuries of the Head and-Neck Region: Case Series and Review of Literature. Niger Med J J Niger Med Assoc. 2020;61(5):276-280. doi:10.4103/nmj.NMJ_17_20 2. Olasoji HO, Tahir AA, Ahidjo A, Madziga A. Penetrating arrow injuries of the maxillofacial region. Br J Oral Maxillofac Surg. 2005;43(4):329-332. doi:10.1016/j.bjoms.2004.10.026 3. Olasoji HO, Tahir A, Arotiba GT. Changing picture of facial fractures in northern Nigeria. Br J Oral Maxillofac Surg. 2002;40(2):140-143. doi:10.1054/bjom.2001.0716 4. Peloponissios N, Halkic N, Moeschler O, Schnyder P, Vuilleumier H. Penetrating thoracic trauma in arrow injuries. Ann Thorac Surg. 2001;71(3):1019-1021. doi:10.1016/S0003-4975(00)02179-2 5. Brywczynski JJ, Barrett TW, Lyon JA, Cotton BA. Management of penetrating neck injury in the emergency department: a structured literature review. Emerg Med J EMJ. 2008;25(11):711-715. doi:10.1136/emj.2008.058792 6. Hain JR. Fatal arrow wounds. J Forensic Sci. 1989;34(3):691-693. 7. Menezes JM, Batra K, Zhitny VP. A Nationwide Analysis of Gunshot Wounds of the Head and Neck: Morbidity, Mortality, and Cost. J Craniofac Surg .:10.1097/SCS.0000000000009268. doi:10.1097/SCS.00000000000092688. Madhok BM, Roy DDD, Yeluri S. Penetrating arrow injuries in Western India. Injury. 2005;36(9):1045-1050. doi:10.1016/j.injury.2005.05.032 9. Milner GR. Nineteenth-Century Arrow Wounds and Perceptions of Prehistoric Warfare. Am Antiq. 2005;70(1):144-156. doi:10.2307/40035273 10. Ngakane H, Muckart DJJ, Luvuno FM. Penetrating visceral injuries of the neck: Results of a conservative management policy. Br J Surg. 2005;77(8):908-910. doi:10.1002/bjs.1800770822 11. Biffl WL, Moore EE, Rehse DH, Offner PJ, Franciose RJ, Burch JM. Selective management of penetrating neck trauma based on cervical level of injury. Am J Surg. 1997;174(6):678-682. doi:10.1016/S0002-9610(97)00195-5 12. Gracias VH. Computed Tomography in the Evaluation of Penetrating Neck Trauma: A Preliminary Study. Arch Surg. 2001;136(11):1231. doi:10.1001/archsurg.136.11.1231

Objective: A nationally representative sample of US adults was used to examine the prevalence of COVID-19 cases, testing, symptoms, and vaccine uptake, and associations with tobacco product use. Methods: Data came from the 2021 National Health Interview Survey. The 2021 Sample Adult component included 29,482 participants with a response rate of 50.9%. We investigated COVID-19-related outcomes by tobacco product use status and reported national estimates. Multivariable regression models were performed accounting for demographics (e.g., age, sex, poverty level), serious psychological distress, disability, and chronic health condition. Results: In our regression analyses, odds of self-reported COVID-19 infection were significantly lower for combustible tobacco product users (vs. non-users; Adjusted Odds ratio [AOR=0.73; 95% confidence interval [CI]=0.62-0.85]. Combustible tobacco users also were less likely to report ever testing for COVID-19 (AOR=0.88; 95% CI=0.79-0.98), ever testing positive for COVID-19 (AOR =0.66; 95% CI=0.56-0.77), and ever receiving COVID-19 vaccine (AOR=0.58; 95% CI=0.51-0.66) compared to their non-user peers. Compared to non-users, users of any type of tobacco who contracted COVID-19 had higher odds of losing smell (AOR=1.36; 95%CI=1.04-1.77), which was more pronounced among exclusive e-cigarette users. The odds of receiving vaccine were lower for all current exclusive tobacco product users compared to non-users (AORs= 0.40 to 0.70). Conclusions: Continued monitoring of tobacco product use amid the COVID-19 pandemic is crucial to inform public health policies and programs. In addition, efforts to promote COVID-19 vaccination, especially among tobacco product users, are warranted.

Purpose: Inhalation of crystalline silica-rich dust particles can result in the deadly occupational lung disorder called silicosis. The risk of contracting tuberculosis and the potential for lung cancer increase as a result of silicosis. This review article aims to bring to light the state of Silicosis and TB scenario in the world and India for evaluating hurdles in the present and future to achieve the elimination road map, and assess these conditions in the backdrop of the COVID-19 pandemic. Methods: A PubMed Central search was conducted using the keywords “silico-tuberculosis” and “prevalence” and the time period of the last 20 years, which yielded 15 studies, out of which only the following were found to be relevant in terms of exemplifying the prevalence of Silico-tuberculosis at various geographical locations around the world. Results: A patient with silicosis has a 2.8-2.9 times higher risk of developing pulmonary tuberculosis and 3.7 times that of extrapulmonary tuberculosis. Incidences of missed cases when tuberculosis was misdiagnosed with silicosis due to indifferent clinical manifestations of the two in the initial stages aren’t uncommon. The duration of exposure to silica and the severity of silicosis, have a direct relation with the propensity to develop tuberculosis. As per a study, an average gap of 7.6 years has been noticed in a South African population for Silico-tuberculosis to develop post silicosis. In a study done on mine workers at Jodhpur, Rajasthan, it was seen that there is no definitive relation between patient with silicosis and possibility of having Covid-19. Conclusions: This paper has focused on the coexistence of silicosis and tuberculosis. It has been seen that the risk of tuberculosis is highly increased with pre-existing silicosis. There is a big need for the integration of the Silicosis control programme with Tuberculosis elimination programme for the government. A few of the steps that can include assessing the workplaces, periodic monitoring of the workers’ health, active case surveillance, identification of hotspots, and introducing reforms to curb the spread of dust and particulate matter from industrialized areas be taken in this regard.

A document by Yang Xu. Click on the document to view its contents.

A Novel Treatment Paradigm for the Treatment of COVID-19 Induced Acute Respiratory Distress Syndrome (ARDS) Acute respiratory distress syndrome due to the SARS-CoV-2 virus (COVID-19 ARDS) demonstrates the same pathologic changes of diffuse alveolar damage as classic ARDS, and ARDS develops in 33%-42% of hospitalized patients with COVID-19 and in 61-81% of patients admitted to the intensive care unit (ICU).1,2 Regardless of etiology, ARDS treatment options are limited to supportive care with mechanical ventilation (MV) and new, effective treatments are needed.3ExoFloTM is an acellular extracellular vesicle (EV) product isolated from a single donor bone marrow mesenchymal stem cell (bmMSC) culture that confers the promising anti-inflammatory and regenerative benefits of bmMSCs for treatment of ARDS without the drawbacks associated with viable cell therapy.4-12 We proposed that ExoFlo could safely reduce lung injury from COVID-19, and possibly assist in the lung’s recovery process. We describe the case of a patient with severe respiratory failure and subsequent ARDS requiring prolonged mechanical ventilation who recovered after receiving ExoFlo. This case highlights this EV product as a novel therapeutic for the treatment of COVID-ARDS.The patient is a 40-year-old female with a history of mild intermittent asthma, diverticulosis, and a remote history of thyroid cancer status post thyroidectomy. The patient had a prolonged ICU course due to COVID-19 induced ARDS that started four days after delivering her second child via a Cesarean section. Treatment for ARDS included mechanical lung ventilation with prone positioning, treatment of secondary infections with intravenous antibiotics, and supportive care for multisystem organ failure. She also received standard supportive care for COVID ARDS including lung protective ventilation, intermittent neuromuscular blockade, and intravenous steroids.After one month of supportive care failed to improve her status, an eIND (IND #28207) was approved by the Food and Drug Administration (FDA) for the administration of 15 mL of ExoFlo. At the time of ExoFlo administration, she was sedated with an FiO2 of 100% and PEEP of 15cm H2O, and she was receiving norepinephrine to maintain adequate perfusion. She received two doses of ExoFlo on Day 1 and Day 2 with slight improvement. She was not considered a candidate for extracorporeal membrane oxygenation (ECMO) due to the prolonged mechanical ventilation. Seventeen days later, she continued having febrile episodes and still required maximum ventilatory support. Her FiO2 on the ventilator was 90% and her PEEP was at 14cm H2O. Since her lung function had not improved, an additional treatment course of ExoFlo was approved by the FDA. After the second day of her second course of ExoFlo treatment, we were able to wean the PEEP, wean sedation and she began to move her lower extremities again. Due to this clear improvement, she continued the ExoFlo treatment course with 15 mL every 24 hours for a total of 5 days. By the fifth dose of ExoFlo, her ventilatory requirements had improved to 55% FiO2 and a PEEP of 8. The day after her fifth dose, two months from her ARDS diagnosis, she underwent a bedside tracheostomy and PEG tube placement.Two days following her second round of ExoFlo treatment, her sedation continued to be weaned, her urine output began to increase, and she was initiated on oral intake with ice chips. Two weeks following this treatment course, the FDA approved a third treatment course with ExoFlo. Following her third course of ExoFlo (5 days, 15 mL Q 24 hours) her tracheostomy was downsized, ventilatory support was discontinued, and she achieved 96% oxygen saturation on trach collar. (Figure 1. A. Chest computed tomography (CT) imaging before five-day course of ExoFlo. B. Chest CT showing improvement after five-day course of ExoFlo.)Four days after her third treatment course with ExoFlo, she was discharged from the hospital to a rehabilitation facility. She was still regaining strength and remained on oxygen at rest. Eight months after discharge from the hospital, she was able to return to work part time. One year after discharge, she has regained most of her strength. She still has some fine motor deficits in her right hand, and she still requires oxygen with exertion. She has a mild restrictive pattern and mild DLCO reduction on her pulmonary function tests, but her chest CT and overall functional status have both greatly improved. Her most recent CT shows improvement in the fibrotic injury appreciated on her earlier chest CTs. (Figure 2. A. Chest CT before five-day course of ExoFlo B. Chest CT one year after discharge from hospital).Prior to her second course of ExoFlo, the ICU team was discussing palliative care options with the family, since she was in the severe COVID ARDS category of patients who often did not recover. Once she started showing signs of major improvement during her second course of treatment with ExoFlo, it became apparent that she had a good chance for a meaningful recovery. The multiplicity of molecules contained within ExoFlo may have promoted healing and regeneration of healthy lung tissue in this patient who appeared to have irreversible ARDS. Currently a Phase III, randomized, blinded trial is underway to evaluate the efficacy of ExoFlo in patients with moderated to severe COVID related ARDS.

Sarcoidosis appeared as Mikulicz’s syndrome : Case report

INTRODUCTION:Spleen is an unusual site of metastasis. and is usually a sign of extensive disease. Splenic metastases from solid tumors, like colon cancers, are considered exceptional (1). The most common primary sources of splenic metastasis in cases of multi -visceral cancer are breast, lung, colorectal, melanoma and ovarian carcinomas and colorectal and ovarian carcinomas in cases of solitary splenic lesion (2,3). Berge reported that the incidence of splenic metastasis from colon and rectal carcinomas as 4.4% and 1.6%, respectively (4).It is still uncertain whether the rarity of splenic metastasis is due to the splenic immunological functions or the characteristic splenic anatomical position and its bloodstream state. The rarity of splenic metastasis from other organs may be due to the histological peculiarity of splenic sinusoidal architecture and the absence of splenic afferent lymphatics (5). The prevalence of splenic metastasis, although very low, is increasing nowadays with the improvement of imaging technology (6).Studies have shown that splenectomy followed by adjuvant chemotherapy can improve survival in patients with spleen metastasis from colorectal cancer (7).When left untreated , spleen metastasis can lead to the rupture of the spleen, which can be life threatening. Interval survival following splenectomy ranged from 3 to 84 months, with a mean of 22.5 months (6).It was found that patients who received adjuvant chemotherapy after splenectomy had better survival rates than those who did not.This case report has been reported according to the SCARE 2020 guidelines (8).

1. INTRODUCTIONIntramuscular myxoma (IMM) are benign soft tissue that account for 0.1 to 0.13 per 100,000 populations (1). Various theories have been described regarding the mechanism of IMM occurrence. Some researchers suggest that the reason is fibroblasts (unable to synthesize collagen fibers) that are not well differentiated from mesenchymal stem cells, which cause the synthesis of myxoid stroma without reticular fibers. Others consider the etiology of IMM to be caused by traumatic mechanisms or the growth of polysaccharide-producing cells in the neoplastic process (2). IMM is rare and can occur in the buttocks, thigh, upper extremities and shoulder muscles. Epidemiologically, its occurrence rate is higher in women (70%), increases with age (6th and 7th decade of life) and the most common sites of IMM is upper extremities muscles (50%-60%) (3). According to the location of the masses, soft-tissue myxomas are classified into superficial angiomyxoma, intramuscular myxoma, nerve sheath myxoma and aggressive angiomyxoma. From the clinical point of view, IMM is a palpable mass, painless, without inflammatory secretions and symptoms, which has no contractile properties and no stretch-contraction changes during flexion-extension of the adjacent muscles (4).From a diagnostic point of view, IMM is observed as a non-calcified mass in plain radiograph, which is seen in the supplementary findings with the help of ultrasonography as echogenic cystic lesions among the muscle tissue. The most important diagnostic method of IMM from other soft tissue lesions is magnetic resonance imaging (MRI), which can be seen as hypointense homogeneous mass in T1-weighted sections and hyperintense in T2-weighted sections (5). In case of edema with IMM in MRI sections (T1-weighted sections), it should be differentiated from other fluid-containing lesions (such as cystic teratoma, hematoma, myxoid sarcoma, cystic hygroma and even normal lymph nodes). Also, IMM should be differentiated from proliferative lesions, other myxoid neoplasms, myxochondroma, myxochondroma and myxoid liposarcoma (6). Cytology-histopathology findings with the help of intraoperative frozen section and needle biopsy help the information of MRI sections in the diagnosis of IMM. Density and ratio of cells/ collagen fibers, mucoid material secretion, nodular-vesicular pattern and fat density in histopathological sections contribute to IMM (7). In the present case, forearm intramuscular myxoma was observed inter-supinator muscle.

Systems with non-Hermitian Hamiltonians, especially those exhibiting parity-time ( PT ) symmetry, are of particular interest as they can describe physical open systems with balanced loss into and gain from the environment. In this context, the study of eigenvalue locations and the corresponding phase transitions as a function of the degree of non-Hermiticity γ is accomplished hereby using feedback theory. This approach provides insight about the behavior of these systems and allows generalization of the results for higher-order ones. The proposed ideas are analyzed in detail for a class of coupled resonant circuit chains.

Circuit simulators are complex tools that depend highly on modeling of electrical circuit components. Therefore, employing an open-source circuit simulator within individuals' learning processes of electronics can be beneficial, as in both a stronger grasp of circuit component as well as circuit theory, and deeper understanding of software development. This paper demonstrates the development of an analogous circuit simulator of passive electrical components, aiming to provide a useful and open-source tool that can be used as a study project or be expanded by being further developed for practice purposes. In order to validate the correctness of the outputs of the terminal-based simulator, the simulation results of an exemplary circuit of the terminal-based simulator were compared to the simulation results of LTSpice for the same circuit.

Coco Island is of volcanic origin with an area of 24 km2, located 530 km from the Pacific coast of Costa Rica and is the furthest Costa Rican Island from the continent and with a rainfall of over 7000 mm years-1. Two types of forest are present, low elevation humid forest and high elevation cloud forest. This study aims to establish different distinctiveness of annual rings and dendrochronological potential (DP) of nine tree species. Any annual ring boundary were not observed in C. pettieri and H. fascicularis; therefore, they did not present any DP. Annual ring type 1 (density variation) was presented in A. compressa, H. succosa, H. odorata, and P. cocosensis, however the annual rings boundary was more defined in A. compressa and H. succosa than other species. O. insularis and S. Holdridgei presented annual rings boundary type 5, fiber band and were adequate distinctiveness. Finally, Eugenia pacifica presented annual ring type 3 (pattern de fiber/parenchyma) and type 4 (vessels distribution), but its distinctiveness was limited. Coco Island´s trees presented seven species with more or less distinctive of annual ring, but three species (A. compressa, E. pacifica, and P. cocosensis) presented low DP. Meanwhile H. succosa, H. odorata, O. insulares, and S. holdridgei showed medium DP. These species growth in the two types of forest in the island and add to abundance and tree diameter, these species have some DP and they can be used to establish a chronology from 50 to 130 years.