Intramedullary spinal cord high-grade gliomas are rare and almost always fatal pediatric tumors. The current treatment paradigms are surgery, and radiotherapy. This is the first description of a toddler with an intramedullary cervical high-grade glioma harboring an anaplastic lymphoma kinase (ALK) fusion (KIF5B) whose treatment with the ALK inhibitor, alectinib, achieved clinical and radiological evidence of complete remission after six months of treatment. Our findings suggest that ALK inhibitors may emerge as an effective therapy in malignant spinal tumors with a dismal prognosis.

The East China Sea (ECS) off the Coast of Zhoushan Archipelago, Zhejiang (ECS-CZA) is home to abundant fishery resources and an important spawning, feeding, and nursing ground for a variety of fish species. Due to long-term overfishing, the ichthyoplankton structure has been dramatically altered. Understanding the species composition and distribution of fish eggs and larvae is one of the most essential tasks to accurately regulate fishery resources and formulate effective management policies; however, little is known about the ichthyoplankton in this region. In this study, an integrated strategy of morphology identification (MI) and mitochondrial COI DNA barcoding were used to identify species of fish eggs and larvae collected from the ECS-CZA. MI revealed 15 fish egg species belonging to 12 families and 12 fish larva species belonging to 12 families; in contrast, DNA barcoding altogether identified 30 species, including 18 fish egg species and 13 fish larva species. One species was shared between the egg and larva samples. Our study offers useful tools and critical scientific information for understanding the recruitment, distribution, and conservation management of various fish species in this marine environment.

Time, cost, and quality are the main factors affecting industrial production, and balancing various constraints to make the production parameters reach the optimal value is an NP-hard problem. With the progress of process production, the production process of various products is more refined, and in the actual production process, the production process has the characteristics of multi-stage and parallel proceeding, therefore, for the difficult problem of multi-stage and non-linear production process optimization, this paper proposes a workflow multi-objective optimization algorithm ( DVSP) based on dynamic virtual phased pruning strategy, which is divided into three stages, firstly, eliminating the indirect constraint relationship between tasks by pruning strategy and simplifying directed acyclic graph (DAG), secondly, dividing the task node set by virtual hierarchical strategy and generating virtual nodes by using virtualization technology, and finally, calculating the stage in stages by an inverse reductive contracting optimal set of service nodes, forward scheduling generates the optimal path, and the global optimal solution is sought through algorithmic integration. After experimental comparison, the algorithm has a more obvious optimization effect than the traditional critical path algorithm and mass maximum algorithm, which meets the actual production needs.

A document by Evan Cantor. Click on the document to view its contents.

Decentralized cryptocurrency systems, known as blockchains, have shown promise as an infrastructure for mutually distrustful parties to securely agree on transactions. Nevertheless, blockchain systems are constrained by the CAP Trilemma. Due to performance degradation, it is impossible to address this issue by improving simply the consensus layer or the network layer. To alleviate the CAP constraint in consortium blockchains, we propose a topological construction method to optimize the physical layer based on multi-dimensional hypercubes with excellent partition tolerance in probability. The basic topology has the advantage of solving the mismatch problem between the overlay network and the underlying network. It is further extended to hierarchical recursive topologies with more intermediate links or short links to balance the reliability requirement with the cost of building the physical network. We prove that the proposed hypercube topology has better partition tolerance than the regular rooted tree and ring lattice topologies, and effectively fits the upper-layer protocols at the consensus and network layers. As a result, combined with suitable transmission and consensus protocols that satisfy strong consistency and availability, the proposed topology-constructed blockchain can reach the CAP guarantee bound.

Background International consensus statements on depression and anxiety in adolescents and adults with CF recommend assessment for comorbid substance misuse. However, at CF centers, the frequency and impact of substance misuse have not been well characterized, and best practices for prevention, identification, and evidence-based treatment have not been routinely implemented. Methods Medical records of 148 adults with CF over 3 years were reviewed to determine the prevalence of substance misuse (alcohol or opiates) and its relationship with clinical variables and healthcare utilization. Independent-sample t-test for continuous outcomes and chi-square test for binary outcomes were used to compare groups with and without substance misuse. Results Substance misuse was documented in 28 (19%) adults with CF, equally distributed between alcohol (n=13) and opiates (n=15). Adults with substance misuse were more likely to be male. The prevalence of diagnosed anxiety and depression did not differ significantly between groups, but those with substance misuse had more severe anxiety (GAD-7: 10.0±6.1 vs. 3.3±4.4; p<0.001) and depressive symptoms (PHQ-9: 10.4±6.5 vs. 4.0±4.8; p<0.001). Adults with substance misuse had higher annual rates of missed outpatient CF visits and inpatient hospitalizations, with hospital admissions of longer mean duration. Conclusions In adults with CF, substance misuse is common and is associated with adverse indicators of emotional and physical health and service utilization, suggesting that systematic approaches to addressing substance misuse in CF clinics should be considered. Prospective, longitudinal study is warranted to elucidate the complex relationships between depression, anxiety, substance misuse, and health outcomes in individuals with CF.

Unperceived button battery ingestion in infants may be associated with significant morbidity, especially when medical assistance is restricted.

Objective: To explore whether Neurotrophic factor 4 (NT4) could improve human follicular in-vitro- development and achieve mature and fertile oocytes. Design: Prospective study. Setting: Research institute. Population: Discarded ovarian tissues were collected from 7 patients (6 to 21 years old) underwent unilateral oophorectomy for fertility preservation. Methods: Isolated secondary follicles were cultured in vitro with or without NT4 in a matrix-free system individually. Main outcome measures: Follicle growth and survival were assessed by microscopy. Anti-Müllerian hormone (AMH), estradiol and progesterone levels were quantified in the medium. Oocyte marker was evaluated under confocal fluorescence microscopy. Oocyte mature and fertile potential were assessed by in-vitro maturation and intracytoplasmic sperm injection (ICSI) with donated sperm, separately. Results: In control condition, isolated follicles survived for 4-6 weeks with increased diameters over time ( P < 0.05), reaching a terminal diameter of 967.00 ± 41.1 μm with the induction of steroidogenesis and expression of oocyte marker. And 4/16 of alive follicles were matured in vitro, producing morphologically normal MII oocytes (120 ± 2.1 μm). The diameter and steroid hormone production were significantly higher in the NT4 group than the control group ( P < 0.05). A slightly increased efficiency of MII oocyte production in the NT4 group was also observed. MII oocyte obtained from the control group showed abnormal fertilization after ICSI, while progressed to available blastocyst in the NT4 group. Conclusions: NT4 promotes the proliferation, steroid hormone production of human secondary follicles cultured in vitro (including post- and pre-pubertal patients), thereby yielding mature and fertile oocytes.

ABSTRACT Our objective is to demonstrate that moderate size type 2-4 fibroids should be removed with laparoscopic myomectomy. The use of 3D ultrasound imaging to accurately identify size and position of fibroid is essential, since it guides operative strategy especially when hysteroscopic evaluation of the submucosal fibroid component may give a false impression of its size and transcervical resection feasibility. We present a video demonstration of the diagnostic sequence and then laparoscopic myomectomy in simple steps. In conclusion, robust pre-operative assessment is necessary to avoid transcervical fibroid resections requiring prolonged operative time or multiple sessions.

Non-native and invasive species are the second leading cause of species extinction and one of the major threats to freshwater ecosystems. Hemiculter leucisculus is one of the introduced species of Iran’s aquatic ecosystems for many years (1967) that has been reported from Iran in the Anzali wetland for the first time. The aim of the current study is to assess the diversity and origin of H. leucisculus a non-native species and also its response to current and future climate change in Iran’s freshwater. To this, we collected the specimen from the species distribution range in the country and performed the mitochondrial gene, cytochrome b (cytb) combining them with the 84 GenBank(NCBI) sequences. In addition, an ensemble model approach was used for future Species Distribution Modelings (SDMs) and it was estimated according to two Shared Socio-economic Pathways (SSPs): 126 and 585 of the MRI-ESM2 based on CMIP6. According to our results, all the samples examined in the current study originated from the same locatlity, the river basins of china. The results also show a high genetic and haplotype diversity that can have a positive effect on the success of its non-native in different catchments of inland waters of Iran. Afterward, the result of SDM maps, clearly illustrated that climate change would significantly affect the distribution of H. leucisculus and it showed a sharp tendency to expand over time in its distribution areas.

In order to explore the stoichiometric characteristics of nitrogen (N) and phosphorus (P) of Haloxylon ammodendron on the south edge of Gurbantungut Desert, and to reveal the adaptability of desert plants to nutrient utilization in barren habitats, this study took the south edge of Gurbantungut Desert in Xinjiang as a typical area. The contents of N and P in leaves, stems and roots of H. ammodendron were measured and analyzed, and the correlation between the ecological stoichiometry of N and P in organs and soil factors was discussed, as well as the influence of the samples and organs. The results showed as follows: (1) There were significant differences in N content, P content and N:P among different organs of H. ammodendron, and the trend of each index was roughly the same. The general trend was higher in leaves, followed by stems and roots. (2) Correlation analysis showed that N content in all organs of H. ammodendron was positively correlated with soil total nitrogen. P content in leaves and roots was significantly positively correlated with soil total P, while P content in stems was significantly negatively correlated with soil total P. P content in all organs was negatively correlated with soil N:P. The contents of N, P and N:P in different organs were negatively correlated with soil pH and electrical conductivity. (3) General linear model analysis showed that organs had great influence on N content, P content and N:P of H. ammodendron.

The interaction of recent orographic uplift and climate heterogeneity acted as a key role in the East Himalaya-Hengduan Mountains (EHHM) has been reported in many studies. However, how exactly the interaction promotes clade diversification remains poorly understood. Here, we both studied genetic structure of the chloroplast trnT-trnF region and 11 nuclear microsatellite loci in Hippophae gyantsensis and examined what role geological barriers or ecological factors play in the spatial genetic structure. The results showed that this species had a strong east-west phylogeographic structure, with several mixed populations identified from microsatellite data in central location. The intraspecies divergence time was estimated to about 3.59 Ma, corresponding well with the recent uplift of the Tibetan Plateau. Between the two lineages there was significant climatic differentiation without geographic barriers. High consistency between lineage divergence, climatic heterogeneity and Qingzang Movement demonstrated that climatic heterogeneity but not geographic isolation drives the divergence of H. gyantsensis, and the recent regional uplift of the QTP, as the Himalayas, create heterogeneous climates by affecting the flow of the Indian monsoon. The east group of H. gyantsensis experienced population expansion c. 0.12 Ma, closely associated with the last interglacial interval. Subsequently, a genetic admixture event between east and west groups happened at 26.90 ka, a period corresponding to the warm inter-glaciation again. These findings highlight the importance of the Quaternary climatic fluctuations in the recent evolutionary history of H. gyantsensis. Our study will improve the understanding of the history and mechanisms of biodiversity accumulation in the EHHM region.

Objective: To assess the clinical performance of the human papillomavirus (HPV) 16 18/45 genotype assay (AHPV-GT) combined with age stratification in triaging women with histologic low-grade squamous intraepithelial lesion/cervical intraepithelial neoplasia grade 1 (LSIL [CIN1]) preceded by HPV E6/E7 mRNA assay (Aptima HPV, AHPV) positive/normal or mildly abnormal cytology. Design: Longitudinal study. Setting: Gynaecological clinic in Huzhou Maternity & Child Health Care Hospital, China. Population: Women aged ≥21 years with histologic LSIL (CIN1) preceded by AHPV-positive/normal or mildly abnormal cytology. Methods: Women underwent AHPV-GT testing at baseline and were followed at 6-month intervals for up to 2 years. At each follow-up, women with abnormal cytology or AHPV positivity were referred for colposcopy and then biopsy if indicated. Main outcome measures: The 2-year cumulative incidence rates (CIRs) of CIN3+ stratified by baseline AHPV-GT genotyping. Results: Of 349 eligible women, 25 women (7.2%) progressed, 301 (86.2%) regressed, and 23 (6.6%) persisted during the follow-up. The 2-year CIRs of CIN3+ in AHPV-GT-positive women were both significantly higher than those in AHPV-GT-negative women overall (8.6% vs. 1.7%, P = 0.014) and in the ≥25-year-old group (10.9% vs. 1.5%, P = 0.002) but slightly higher in the 21–24-year-old group ( P > 0.05). Conclusions: AHPV-GT testing with age stratification is effective for triaging women with histologic LSIL (CIN1) preceded by AHPV-positive/normal or mildly abnormal cytology. Immediate treatment is a rational recommendation for women ≥ 25 years old with histologic LSIL (CIN1) preceded by AHPV-GT positivity when good surveillance is not assured.

Background: Atopic dermatitis (AD) is a chronic inflammatory skin disease often associated with non-atopic comorbidities. Recently, a severity-dependent relationship between AD with sleep and mental health diseases has been proposed, but few studies investigated this topic through validated questionnaires. Therefore, the present study aimed to: (i) assess the impact of AD on sleep and psychological disorders using validated instruments and (ii) estimate the association of AD severity with sleep disorders and psychological symptoms distinguishing between clinical-oriented and patient-oriented measures. Methods: We conducted a cross-sectional, case-control study, recruiting 57 adult AD patients matched for age and sex with 57 healthy adults. To investigate the differences in sleep quality, insomnia, depression, and anxiety between the two groups, we performed independent samples t-tests. Moreover, we conducted several univariable linear regression analyses to examine the relationship between objective/subjective severity of AD and sleep quality, insomnia, and psychological symptoms. Results: AD patients presented poorer sleep quality and more severe symptoms of insomnia and depression than healthy adults. Objective and subjective AD severity were similarly associated with worse sleep quality, anxiety, and self-perceived stress. However, subjective AD severity was more strongly associated with insomnia and depressive symptoms than clinical-oriented AD severity. Conclusions: The study demonstrated poor sleep quality and high levels of insomnia, depression, and perceived stress in AD patients, with an aggravated psychological status for adults with more severe disease. We suggest implementing a multidisciplinary approach to AD management and treatment that considers objective and subjective measures of disease severity.

Gestational surrogacy for women with recurrent pregnancy loss due to refractory chronic histiocytic intervillositis: Research Letter

In this paper, a quasi-optical resonator with new coupling method and parasitic-mode-suppressing in 110~170GHz is proposed. The coupling of THz quasi-optical resonator in this paper is realized by PCB substrate processing and pressurized flange. At the same time, the parasitic mode is effectively suppressed by slitting the plane mirror to reduce the influence on the main mode during the test. And fused quartz sample was tested to verify the feasibility of the system for complex dielectric testing of materials in 110~170GHz.

The fully passive noise shaping (NS) successive approximation register (SAR) analog-to-digital converters (ADCs) are simple, OTA-free and scaling friendly. Previous passive NS-SAR ADCs rely on the multi-path-input comparator or capacitors stacking to realize the passive gain for compensating the signal attenuation during passive integration. However, the former causes high comparator power consumption, and the latter suffers from additional signal attenuation due to the parasitics and is hard to extend to high-order systems. This work proposes a new fully passive NS-SAR technique, it can realize 2× gain with a simple structure, leading to the reduced comparator power and less parasitics. This technique is also easy to extend to high-order NS-SAR ADCs.

Granular parakeratosis is an acquired keratinization disease. We describe the unusual presentation of granular parakeratosis. A 27-year-old healthy female presented with multiple erythematous and brown discoloration plaques on the dorsal aspect of her hands for eight months. Repeated washing, using detergents, and maceration of the skin could develop her lesion.

Hepatitis E virus (HEV) is transmitted via the fecal-oral route and can cause chronic infection in immunocompromised individuals. A 23-year-old man with no medical history visited our hospital after testing HEV positive during blood donation. Although he did not develop acute hepatitis, HEV IgA remained positive for over eight months.

Sclerosing Encapsulating Peritonitis (SEP), also known as Abdominal Cocoon Syndrome, is a rare condition characterized by nonspecific episodes of bowel obstruction and intestinal dysfunction. This is a case of a 45-year-old male with multiple previous episodes of abdominal pain and obstruction.

A 43 year old male presented to a community hospital emergency department for evaluation of sudden onset shortness of breath, tachycardia, and hypertension. Initial evaluation showed an adrenal mass on chest computed tomography. There was biochemical evidence of multi organ damage. Patient had elevated plasma metanephrine and normametanephrine levels.

DectiSomes are anti-infective drug-loaded liposomes targeted to pathogenic cells by pathogen receptors including the Dectins. We have previously used C-type lectin (CTL) pathogen receptors Dectin-1, Dectin-2, and DC-SIGN to target DectiSomes to the extracellular oligoglycans surrounding diverse pathogenic fungi and kill them. Dectin-3 (a.k.a. MCL, CLEC4D) is a CTL pathogen receptor whose known cognate ligands are partly distinct from other CTLs. We expressed and purified a truncated Dectin-3 polypeptide (DEC3) comprised of its carbohydrate recognition domain and stalk region. We prepared amphotericin B (AmB)-loaded pegylated liposomes (AmB-LLs) and coated them with this isoform of Dectin-3 (DEC3-AmB-LLs), and we prepared control liposomes coated with Bovine Serum Albumin (BSA-AmB-LLs). DEC3-AmB-LLs bound to the exopolysaccharide matrices of Candida albicans, Rhizopus delemar (f.k.a. R. oryzae), and Cryptococcus neoformans from one to several orders of magnitude more strongly than untargeted AmB-LLs or BSA-AmB-LLs. The data from our quantitative fluorescent binding assays were standardized using a CellProfiler program, AreaPipe, that was developed for this purpose. Consistent with enhanced binding, DEC3-AmB-LLs inhibited and/or killed C. albicans and R. delemar more efficiently than control liposomes, which significantly reduced the effective dose of AmB. In conclusion, Dectin-3 targeting has the potential to advance our goal of building pan-antifungal DectiSomes.

We have read the article entitled ”Prone Positioning in intubated and mechanically ventilated patients with SARS-CoV-2” by Chen et al., published in the Journal of Clinical Anesthesia (2021 August) \cite{Chen_2021}[1]. We congratulate the authors for this successful publication and make some contributions.In the article, it has been mentioned in the conclusion that a prolonged prone position is a safe and feasible option to extend survival in patients with COVID-19. It was reported that among the patients that died within 14 days of intensive care admission, 11.8% received prolonged prone positioning, while 52.2% did not. The authors mentioned some study limitations, but it is incomplete.We have the following concerns regarding the methodology of the study. The authors clearly stated that patients who did not tolerate prolonged prone positioning were excluded from the study. The author should have mentioned how many patients were excluded, which could have affected the sample size distribution. Also, what was the definition of a prolonged prone position? What was the definition of intolerance to the prolonged prone position? Is it worsening oxygenation, hemodynamic stability, or other criteria? If exclusion were based on worsening oxygenation, hence prone position would have affected the outcomes and mortality. The authors did not mention if the patients excluded had an absolute or a relative contraindication to prone positioning. There are various terms used for proning in the study, prolonged proning, long-term proning, and persistent proning.During the early phase of the COVID-19 pandemic, with limited evidence of this novel disease. Many journals accepted borderline publications. Some journals didn't pay attention to major methodological concerns in published articles. We addressed our concerns in the published article addressing a similar topic \cite{Fayed_2022}. Our published meta-analysis on this topic showed no mortality benefit of prone ventilation. The study, as mentioned earlier by Chen et al., results were skewed compared to other published ones \cite{Fayed_2022a}.In conclusion, the excluded patients might have worse outcomes in the prone position. Hence, excluding these patients from the study might show results favoring the prone position, and hence there are favorable outcomes in the prone position. This should have been mentioned as a significant limitation of this study, and the conclusion should be cautiously drawn and rephrased.

Anusha Belakod2,Vanuja Hosamani1, and Nivedita Awati11S. B. Arts and K. C. P. Science CollegeSmt.Bangaramma Sajjan Campus, Solapur Road Vijayapur-Karnataka-India2B.L.D.E.A’s V.P. Dr.P.G.Halakatti College of Engineering and TechnologyDepartment of Electronics and Communication EngineeringAshram Rd, Adarsh Nagar, Vijayapura, Karnataka 586103, India