AbstractThis paper analytically analyzes the use and limitations of ranking systems for highly cited researchers compiled by Stanford University’s ranking of the world’s top 2% most influential scientists. This list is commonly used to identify influential and respected members of a particular field. However, it is important to critically evaluate the list and its methodology and  no such analysis to this date. From a critical analysis of the September 2022 version of this world’s top 2% of scientists list, this research finds that the database of the list is flawed, including inaccurately listing researchers as first publishing in the 19th century and continuing to publish until 2022, listing authors with low publication numbers and career lengths, mixing news articles and editorials with research papers, listing institutes as authors rather than individuals, and listing authors with a high percentage of self-citations. The study suggests that the promotion and use of such “standardized” citation rankings should be discouraged.

Viral vectors for gene therapy, such as recombinant Adeno-Associated Viruses (rAAV), are produced in Human Embryonic Kidney (HEK) 293 cells. However, the presence of the SV40 T-antigen-encoding CDS SV40GP6 and SV40GP7 in the HEK293T genome raises safety issues when these cells are used in manufacturing for clinical purposes. We developed a new T-antigen-negative HEK cell line from ExcellGene’s proprietary HEKExpress®, using the CRISPR-Cas9 strategy. We obtained a high number of clonally-derived cell populations and all of them were demonstrated T-antigen negative. Stability study and AAV production evaluation showed that the deletion of the T-antigen-encoding locus did not impact neither cell growth nor viability nor productivity. The resulting CMC-compliant cell line, named HEKzeroT®, is able to produce high AAV titers, from small to large scale.

Objective: To identify postoperative vaginal morphology and position factors associated with prolapse recurrence following vaginal surgery. Design: Secondary analysis of MRIs of the Defining Mechanisms of Anterior Vaginal Wall Descent cross-sectional study. Setting: Eight clinical sites in the US Pelvic Floor Disorders Network. Population: Women who underwent vaginal mesh hysteropexy (hysteropexy) with sacrospinous fixation or vaginal hysterectomy with uterosacral ligament suspension (hysterectomy) for symptomatic uterovaginal prolapse between April 2013 and February 2015. Methods: MRIs (rest, strain) obtained 30-42 months after surgery, or earlier for participants with recurrence who desired reoperation prior to 30 months, were analyzed. Prolapse recurrence was defined as prolapse beyond the hymen at strain on MRI. Vaginal segmentations (at rest) were used to create 3D models placed in a morphometry algorithm to quantify and compare vaginal morphology (angulation, dimensions) and position between groups. Main Outcome Measures: Vaginal angulation (upper, lower, and upper-lower vaginal angles in the sagittal and coronal plane), dimensions (length, maximum transverse width, surface area, volume), and position (apex, mid-vagina) at rest. Results: Of the 82 women analyzed, 12/41 (29%) in the hysteropexy group and 22/41 (54%) in the hysterectomy group had prolapse recurrence. After hysteropexy, recurrences had a more laterally deviated upper vagina (p=0.02) at rest than successes. After hysterectomy, recurrences had a more inferiorly (lower) positioned vaginal apex (p=0.01) and mid-vagina (p=0.01) at rest than successes. Conclusions: Vaginal angulation and position were associated with prolapse recurrence and indicative of vaginal support mechanisms related to surgical technique and unaddressed anatomical defects. Future prospective studies in women before and after prolapse surgery may distinguish these two factors. Funding: Eunice Kennedy Shriver National Institute of Child Health and Human Development-sponsored Pelvic Floor Disorders Network (Grant/Award Number: U10 HD054214, U10 HD041267, U10 HD041261, U10 HD069013, U10 HD069025, U10 HD069010, U10 HD069006, U10 HD054215, U01 HD069031); National Institutes of Health Office of Research on Women’s Health; Boston Scientific Corporation; National Academies of Sciences, Engineering, and Medicine’s Ford Foundation Predoctoral Fellowship Program

Aims: The present study examined whether people higher in psychopathy experienced less self-reported and psychophysiological pain than people lower in psychopathy. We also examined via self-reports and psychophysiological measures whether psychopathy affects empathy for others’ pain. Method: Three hundred and sixty-nine students (18-78 years; M = 26, SD = 9.34) were screened for psychopathic traits, and stratified sampling was used to recruit 49 adults residing in the highest (n = 23) and lowest (n = 26) 20% of the psychopathy spectrum. Using skin conductance response (SCR) and self-report measures, participants responded to directly experienced pressure pain and observing others’ pain images. Results: People higher in psychopathy self-reported feeling less physical pain compared to people lower in psychopathy, however, we did not find any differences in SCR to physical pain. High psychopathy group displayed lower SCR to viewing other people’s pain compared to low psychopathy. Additionally, high psychopathy group self-reported less empathy to other people’s pain compared to low psychopathy group. Discussion: Our results suggest that psychopathic traits relate to problems with empathising with others’ pain as well as rating pain as feeling less intense. Additionally, a lack of awareness to ones’ body sensations may underlie emotional impairments in psychopathy. We suggest psychopathy interventions for empathy should focus on recognising and empathising with pain.

Binary Solvent Extraction of Microplastics from a Complex Environmental Matrix.Oluniyi O. Fadare1, Leisha Martin2, Nigel Lascelles1, Jessica T. Myers1, Karl Kaiser3, Wei Xu2, and Jeremy L. Conkle11Department of Physical & Environmental Sciences, Texas A&M University-Corpus Christi, 6300 Ocean Drive, Unit 5892, Corpus Christi, Texas 78412, United States.2Department of Life Sciences, Texas A&M University-Corpus Christi, 6300 Ocean Drive, Unit 5892, Corpus Christi, Texas 78412, United States3Department of Marine and Coastal Environmental Science, Texas A&M University at Galveston, Galveston, TX 77553, United StatesAddress correspondence to Jeremy L. Conkle - Department of Physical and Environmental Sciences, Texas A&M University, Corpus Christi, 6300 Ocean Drive, 78412, Texas, United States. Tel: +1 361.825.2862; Email: jeremy.conkle@tamucc.edu

Einstein-Poincare synchronization and deformation of space-time by gravity are sufficient for obtaining Lorentz transformation starting from Galileo transformation.

A document by Matthew Gidden. Click on the document to view its contents.

Summary: A 16-year-old, French Saddlebred was referred for colic signs, diagnosed with incarceration of the jejunum in a mesoduodenic rent and subsequently treated surgically (with an end-to-end anastomosis of the jejunum and an enterotomy of the pelvic flexure). The horse recovered uneventfully, but the next day developed moderate signs of endotoxemia and severe sero-sanguineous discharge from the abdominal wound. Substantial peritoneal effusion was assessed on abdominal ultrasound and required an abdominal drain placement. The site was at first checked with ultrasound, and insertion of a redon drain was performed. Immediately, a brown smelly liquid drained in large quantities (figure 1), and examination of this liquid revealed it to be enteral fluid. The drain was pushed in the viscera and the horse brought to surgery. Placement of an embolectomy catheter was performed before induction and as the horse was induced the balloon catheter was inflated. The drain was pulled out of the viscera and traction on the embolectomy catheter was kept until a repeat laparotomy was performed (figure s2). Moderate contamination of the abdominal cavity occurred during the iatrogenic perforation of the cecum. The balloon catheter effectively occluded the breach in the cecum and revealed to be strong enough to pull on the viscera without tearing it. The abdominal cavity was then lavaged with 80 L of ringer lactates and another abdominal drain was placed. The horse recovered uneventfully and did not display any further complication during the rest of his hospitalization. The horse returned within 6 months to its intended use. KEY POINTS Abdominal drain placement carries risks of complication, one of them being enteric placement of the drain Temporary occlusion of the defect is feasible using an embolectomy catheter pending surgery If swift action is taken, contamination of the abdominal cavity can stay moderate.

The elemental composition of plants (i.e., the elementome) relates to their functional traits which has important implications for understanding nutrient cycles and energy flows within ecosystems. Theoretically, elemental diversity (ED) captures functional diversity by comparing the n-dimensional elementome of the present species in a community. However, empirical evidence linking ED with ecosystem functioning is still lacking. We collated an unprecedented volume of data (> 2500 species and 14 analyzed elements from leaves, stems, trunks, and fine roots) across eight biomes from 72 sites to explore the spatial patterns and drivers of ED and its relationship with ecosystem productivity and stability. Our results revealed that interannual variability in temperature is the main factor explaining ED spatial patterns. We provide strong empirical evidence indicating that ecosystems with higher ED show higher productivity and stability. The results provide important insights into how elementome differences among organisms affect ecosystem function across ecosystems and biomes.

Case reportEcthyma Gangrenosum in Three Unrelated Patients with Combined Immunodeficiency Arefeh zahmatkesh1, Amirhossein Hajialigoli2, Mahnaz Jamee3, Zahra Chavoshzadeh4 1Pediatric Nephrology Research Center, Research Institute for Children’s Health, Shahid Beheshti     University of Medical Sciences, Tehran, Iran2Alborz Office of Universal Scientific Education and Research Network (USERN), Alborz University of      Medical Sciences, Karaj, Iran3Pediatric Nephrology Research Center, Research Institute for Children’s Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran4Immunology and Allergy Department, Mofid Children's Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran Correspondence should be addressed to Arefeh Zahmatkesh: arefeh.zhmtksh@gmail.com.  AbstractBackground:Ecthyma Gangrenosum(EG) is a necrotizing vasculitis characterized by cutaneous manifestation ranging from a nodule or papule to necrotic ulceration with surrounding erythema, especially with black eschar or central crust. The most common pathogen that causes EG is Pseudomonas aeruginosa(PA). PA is an opportunistic pathogen with predominance incidence among patients with primary immunodeficiency with hypo or agammaglobulinemia, malignancies, and acquired immune deficiency.Case presentation:In this case study, we present three unrelated patients (three male toddlers, mean age: 0.75 years) with the primary manifestation of EG, who underwent immunological assessment and were diagnosed with combined immunodeficiency. all patients were alive although EG has a high mortality rate, the prognosis depends on the host and the degree of immunosuppression.  A history of Persistent fever followed by skin lesions was common in our cases. Surprisingly, the initial immunological assessment reported different cellular and humoral immune deficiencies with the overall diagnosis of combined immunodeficiency based on the ESID criteria. For patients suspected of EG, early diagnosis and administration of appropriate systemic antibiotic therapy can considerably reduce morbidity and potential mortality.Conclusions:This case report illustrates the importance of immunodeficiency evaluation in patients with a skin lesion and considers pseudomonas aeruginosa culture for initiating appropriate antipseudomonal antibiotic therapy. Although recent studies show high EG-related mortality with predisposing factors, hopefully, due to appropriate intravenous antibiotics and immunoglobulin therapy, all patients remained alive.Key-words:Ecthyma Gangrenosum, combined immunodeficiency, Immunoglobulins I. Introduction Ecthyma gangrenous (EG) is a rare skin disorder, that usually starts as an erythematous macule, which developed into a vesicle. These Lesions can rapidly indurate and develop pustules or bullae, which slough and leave an eschar. (1) The first case of EG was reported by L. Borker. Hitschman and Kreibichin 1897, which accompany Pseudomonas septicemia. (2) although several studies show more pathogens associated with EG, Pseudomonas aeruginosa(Pa) is the most reported cause. (3). Pa as an opportunistic bacterium can detect from the skin, nose, throat, and stool. (4) The most common site for superinfection of the skin with Pa includes the gluteal and anogenital region, the extremities, the trunk, and the face. (5). The pathogenesis of skin lesions due to Pa is mainly dependent on the vessel walls invasion interfering with the toxin followed by ischemic necrosis resulting in necrotic ulcer with a black/gray eschar surrounded by an erythematous halo. (6) Since the first report of EG, several studies show the EG incidence among patients with predisposing risk factors like pre-existent viral infections, weak mechanical skin barriers, especially immunocompromised individuals, and even previously healthy patients. Also, malignancies like leukemia (7) and primary immunodeficiency disorders like leukocyte adhesion deficiency-1(LAD) (8), and X-linked agammaglobulinemia(XLA) are reported related to EG. (9) However, skin necrosis is a symptom of a broad range of pathologies, (1) the diagnoses of EG are based on clinical findings, that are confirmed by the skin and blood culture. (2) Besides, early appropriate treatment e.g., antibiotics, and surgical debride reduce EG-related mortality rates, also understanding the patient’s immunological status and underlying disease affect the prognosis, and initiation of appropriate treatment can reduce mortality rates. (3)This manuscript summarizes three cases of EG who were admitted to a tertiary hospital with pursuing chief complaints, initial evaluation, and treatment.II.   Case reportsA. Case 1A 16-month-old male was admitted to the hospital with a one-week history of fever and lesions on his left groin, neck, and left axilla. his fever started 3 days after influenza vaccine and didn’t respond to initial treatment(Acetaminophen). He hospitalized due to persistent fever and then Bullae lesions began 2 days after admission and progressed to a necrotic lesion with infectious secretion with a positive lesions culture which showed pseudomonas aeruginosa, he received appropriate antibiotics (Amikacin and Imipenem) based on the culture and G-CSF due to leukopenia with no response. He had a diarrhea history due to milk powder allergy when he was 2 months. His vaccination was upon the routine plan.  His parents were relative and did not report any recent travel and allergic reaction. The physical examination showed vesicular dark lesions on his left leg, axillary region, and neck. His lower extremities were swollen and tender, especially on left foot. The left foot was warmer than the right and had more lesions compared to other sites. The liver was enlarged up to 3 cm below the right costal margin, and the spleen was impalpable. In chest examination, coarse crackles at both lungs and the right lung consolidation on the chest X-ray (CXR) were found. The laboratory findings are summarized in Table 1. In the first days of admission, neutropenia and thrombocytopenia was detected, which improving during hospitalization.On the second day of administration, he was admitted to the intensive care unit (ICU) due to his unstable condition. He suffered extensive ulcerative lesion with necrotic center on his left foot which was more tender and warmer than the opposite site. Following surgery consultation, Doppler sonography and X-ray of lower extremities were performed, which showed subcutaneous and intermuscular adenoma, which suspected to myositis and necrotizing fasciitis was ruled out.In this center bacterial blood culture was negative. we started antibiotics therapy with Meropenem, Vancomycin, and Clindamycin, then changed the regimen to Ceftazidime and Clindamycin after 22 days of administration. In addition, human serum albumin and calcium with heart monitoring, were prescribed and because of low hemoglobin, packed red blood cells was infused. He received Ribavirin suspected for Crimean Congo Hemorrhagic Fever. On hospital day 3, the necrotic lesion was debrided and drained surgically. Finally, based on immunology consultation, he started receiving 5-gram intravenous immunoglobulin (IVIG). He was continued on antibiotics and finally discharged from the hospital in a stable condition with receiving monthly IVIG. B. Case 2A 5 month years old male was admitted to this center with four days’ history of fever and chilling, which did not respond to medical treatment with cephalexin. The fever was complicated with several lesions on the face after one day. Erythematous plaques without pus were seen on the cheek, under the right eye, and genitalia Picture 1. His vaccination was upon the routine plan. His parent were not relatives and did not report any recent travel or contact with the ill person. His sibling was healthy. In his physical examination, multiple hemorrhagic plaques were observed on the right leg and left thigh. Lower extremities and scalp were swallowed. He did not have organomegaly on the abdominal examination. The chest examination was normal. He was under observation in the pediatric intensive care unit and received 2 gr intravenous immunoglobulin (IVIG) because of his severe edema (suspicious of Kawasaki disease) on the first day of admission. He was also started on abroad-spectrum systematic antibiotic regimen (Meropenem, Vancomycin, and Amikacin) after admission. On hospital day 5, his fever was reduced and skin lesions improved, while his wound culture grew Pseudomonas aeruginosa. Because of the immunodeficiency suspicion, bone marrow aspiration(BMA) was performed, which reported maturation arrest in the myeloid series. For agammaglobulinemia assessment, immunologic workup was performed which yielded in Table 1. and compare with other cases.With Ecthyma Gangrenosum impression, he received intravenous methylprednisolone 1 mg/kg/BD and Mometasone ointment twice a day. He continued on antibiotics and underwent surgical debridement of the necrotic lesion and skin graft. His temperature gradually returned to normal after surgical and medical treatment on hospital day 15, he was discharged from the hospital in stable condition with prophylactic antibiotic (Cotrimoxazole) and repeating complete blood count every 2 weeks.C. Case 3:A 6months old male was admitted to this center with a history of a two-week fever. The fever was accompanied by erythematous papule which transformed into necrotic, bullous, and gangrene lesions and spread through his thigh, posterior conjunctiva, and left flunk Picture 2. One week before referral to this center, he was hospitalized and received antibiotics (Meropenem, Vancomycin, and Ciprofloxacin) upon a positive pseudomonas wound culture and positive Klebsiella cerebrospinal fluid (CSF) culture. He had a history of acholic defecation two days before hospitalization. His parents were not relatives and his older siblings were healthy. He did not have a history of recent travel or contact with a contiguous disease. In the physical examination, a few gangrenous 2*3 mm lesions with surrounding blisters were scattered on his left flank, thigh, and posterior conjunctiva. The right testis was larger than normal and bilateral hydroceles were noted. The sclera was icteric. Pulmonary and heart examinations were normal. The abdomen was distended with a bilateral erythematous lesion, without tenderness, rebound, or guarding. The liver was enlarged to 3 Cm below the right costal margin and the spleen was impalpable.The broad-spectrum antibiotic (Amikacin, Meropenem, and Vancomycin) were administrated as well as two doses of IVIG to provide passive antimicrobial coverage. In addition, abdominal sonography and surgical debridement were performed. Sonography showed mild pulmonary edema, cellulitis, myositis, and hydrocele. On hospital day 2 regarding the abnormal liver function test (LFT), he received Ursobil, and LFT was checked two times every week. Vitamins and fresh frozen plasma (FFP) were also prescribed to correct international normalized ratio(INR). The immunologic function was tested. the lymphocyte subtypes detail notice in the Table 1 and compared with others. The T CD8+ cells were reduced and the lymphocyte transformation test (LTT) was dysfunctional Table, further confirming the diagnosis of combined Immunodeficiency. He was discharged with 5 mg IVIG, antibiotics, and antifungal prophylaxis.The first step of Biochemical diagnosis of CID suspected patients is complete blood count which gives clues of immunological alteration. despite, the assessment of absolute neutrophil and lymphocyte count of our cases was influenced by Pa toxin, after human immunodeficiency virus (HIV) ruled out the specific evaluation of immunological parameters was performed. this evaluation included: i. Measurement of immunoglobulins (IgA/IgG/IgM/IgE) which is summarized in Table 1-D. Except for generalized hypogammaglobinemia in case 1, reduced IgE and IgA were seen in cases 2&3. ii. Vaccinal response which done when maternal antibodies transferred via placenta decrease (6 month years old) Table 1-E. based on our data we detected less than 1 Iu/mL Anti-Diphtheria IgG in case 2. iii. Measurement of leukocyte subtypes by flow cytometry (Immunophenotyping of CD3/CD4/CD8/CD19 and NK) summarized at Table 1-C. CD3+ as a general lymphocyte and CD19+ as a B lymphocyte marker reduced in case1&3.  Reduced CD3+/CD4+  in case 2&3 shows lymphocyte impairment, and high CD3+/CD8+ indicate low CD8+ in all cases. More CD information provide in Table 1-F. iv. Lymphocyte function assessment by Lymphocyte Transformation Test (LTT) can be measured by lymph proliferation after stimulation with phytohemagglutinin(PHA). Table 1-B. In our study all patients had normal PHA level, however cell proliferation against BCG in case 1 was slightly low and also cell proliferation against Candida in case 2&3 were reduced. II.  Discussion and conclusion:  Ecthyma Gangrenosum is a rare skin disorder, which is an ulcerative variant of septic vasculitis. EG is characterized by sharply circumscribed “pinched out” deep ulceration. These lesions usually start as an erythematous macule, which subsequently forms a vesicle, pustules, bullae with debris, and necrotic material within the ulcer. (1) since the first case report of EG, several studies show different causative pathogens. (2) In a study of 164 patients diagnosed with EG  between 1974 to 2014, PA was detected in 73.65% of cases, whereas other bacteria and even Candida albicans, were detected in only 17.35% and 9% of cases respectively. (3) Although in case 3 we isolated Klebsiella from CSF culture , Pa was detected from all lesions culture. However, Klebsiella can cause EG.(4) A case report from Isezuo K.O in 2018, shows different isolated organisms from CSF(S.aureus) and lesions(E.coli) culture in the concept of co-infection at EG pathogenesis. (5) Pa species are a normal part of the skin flora and usually found in the anogenital, axillae, and external ear canal. (6) clinical manifestations related to PA  are mainly due to the vessels walls invasion mediated by the toxin, (7) and usually affects the lower extremities, especially gluteal and genital areas. fever, diarrhea, pneumonia, shock are the most relevant associated symptoms especially in PA sepsis. (5) As CCHF was suspected in case 2, several studies show infections that can mimic EG, like mycobacterial ulcer, cutaneous leishmaniasis cutaneous tuberculosis, and even deep fungal infections thus, EG must be considered in any necrotic lesions that are unresponsive to prolonged antibiotics. (8) Another important differential diagnosis is necrotizing fasciitis which was ruled out by MRI in case3. (9)Despite, EG usually being described in immunocompromised patients, it also has been seen in patients suffering from malnutrition, underlying (hematological) malignancy, and even previously healthy individuals. (10)A literature review by Danel J Lewis et al in 2019, shows cutaneous manifestations of primary immune deficiency disorders (PID). (11) several studies show EG in patients who suffer from X-linked agammaglobulinemia (XLA) (Burton hypogammaglobinemia), which is characterized by the complete absence of circulating B-cells and plasma cells, with decreased(IgG) or absent (IgA and IgM) levels of immunoglobulins. (12) Leukocyte Adhesion Deficiency (LAD) is also reported with EG. these disorders involve an absence of ß2-integrin subunit(CD18), which prevents neutrophils aggregation. (11)  neutrophils are a vital part of the cellular host defense against bacterial infections, whereby neutrophil count bellow 500/mm3 cause the greatest risk of bacterial infections. (13) two cases of our study (Case1&2) had neutropenia on the first days of admission which resolved after treatment. In addition to several case reports of neutropenia with EG, PA toxins can produce neutropenia through bone marrow suppression and inhibition of granulocyte migration. (2). In 2003 Maria Baro et all reported X-linked agammaglobulinemia with EG, that neutropenia with bone marrow granulocyte arrest resolved when infection was treated. They also postulated that neutropenia could result from a neutrophil-altered response to stress due to mutations in the Btk gene that is expressed in myeloid series. (14) unlike other cases, case 3 had neutrophil predominance. in a case report at a tertiary hospital in Sokoto, the index patients also had neutrophil predominance as usual neutropenia associated with PA. However, our patient’s immunological comparison didn’t show obvious differences, this may be explained by their relatively good immunity. (8) another primary immune disease that leads to neutrophil dysfunctions is chronic granulomatous disease(CGD), it is caused by gene mutations encoding essential subunits of NADPH oxidase complex subsequently neutrophils fail to increase oxygen consumption for the destruction of phagocytes bacteria (e.g.; Klebsiella, Pseudomonas, Candida) and fungi. (15)  Nitro blue tetrazolium Blood Test(NBT) was normal (100%) in all our cases, thus we rollout CGDs. Besides underlying immunodeficiency diseases, some studies suggest that the immunoglobulin level and B cell percentage were decreased in the disease process and are transient.(10) However hypogammaglobinemia and reduced B cell were observed in our cases, CID was applied based on other flow cytometry data and ESID criteria. However it should be considered molecular diagnosis such as next-generation sequencing(NGS) is the exact diagnostic modality.(16)Combined immunodeficiency (CID) is an Inborn Error of Immunities(IEIs) characterized by defects in both humoral and cellular limbs of the immune system. the main clinical manifestations of IEIs are susceptible to unusual or recurrent infections that are difficult to treat. (17)  Previous studies show variable skin manifestations in CID patients with syndromic features (e.g.: atopic dermatitis in Wiskott-Aldrich syndrome (18), bulbar telangiectasia and ataxia in Ataxia-telangiectasia (19), Café au lait macules and telangiectasia in sun-exposed are in Bloom syndrome (20), dermatitis, prominent papulopustular eruption and recurrent staphylococcal infections with abscess formation in Hyper-IgE syndrome (Job syndrome) (21).The first step of Biochemical diagnosis of CID-suspected patients is a complete blood count which gives clues of immunological alteration. (22) despite, the assessment of absolute neutrophil and lymphocyte count of our cases being influenced by Pa toxin after HIV was ruled out the specific evaluation of immunological parameters was performed. this evaluation included (23, 24):In our study all patients were alive. although EG has a high mortality rate, prognosis depends on the host and the degree of immunosuppression. in patients with EG and septicemia secondary to pseudomonas it ranged from 38%-77%, and in patients without sepsis is about 15%. (25) Notably, neutropenia below 500 cells can predispose a patient to severe PA infection and this seems to be associated with a higher mortality rate even in a previously healthy child. (13) EG’s high mortality rate emphasizes the importance of early suspicion and proper treatment even when the diagnosis has not been confirmed. While awaiting culture results, empirical antimicrobial therapy with anti-pseudomonas penicillin and aminoglycoside should be started, and adjusted based on culture results. Administration of GCSF along with antibiotics should be considered to shorten the duration of neutropenia, to help resolve the EG, and to minimize the risk of septicemia in immunocompromised patients.  In conclusion, EG is a rare skin disorder, usually caused by PA, and commonly occurs in immunocompromised individuals. despite, the previously healthy and immunocompetent individuals, may become affected, we must consider an immune assessment for all patients, especially in early childhood. furthermore, early diagnosis of an underlying illness, notably primary immunodeficiency, leads to using the appropriate treatment and preventing EG-related mortality.Data Availability: Not applicable.Ethical Approval: Informed consent was obtained from the patient and parents of the patient prior to being included in the study.Consent: Written informed consent for publication was obtained from the parents of the patients prior to being included in the study.Conflicts of Interest: The authors have no conflicts of interest.Acknowledgments The authors thank the patients and their families for their participation in this study.    Ⅳ. Table 1Laboratory data: A.       Complete blood count:                           CBC1 Case number WBC 1000/ul Neutrophils 1000/µl Lymphocyte 1000/µl HB g/dl Platlet cell/ul 1 2700 1215 1405 10.7 306000 2 7980 1516 5426 9 381000 3 7900 5925 1422 11.9 219000 1.CBC: Complete Blood Count B.       Lymphocyte transformation test:                 LTT1    Case PHA2 (normal range≥3) BCG (normal range≥2.5) Candidia (normal range≥2.5) 1 4 2.2 4.4 2 3.2 3.1 2.2 3 4.3 3.1 1 1.LTT: Lymphocyte Transformation Test, 2.PHA: Phytohemagglutinin, C.       Flow cytometry:             CD markers1   Case   CD3+    CD4+   CD3+/CD4+    CD8+      CD3+/CD8+      CD16     CD19     CD56         1     88% Absolut=1236×103/µl (range=1400-8000)               58%        1.51 (range=0.9-5.5)                31%                2.84 (range=0.4-2.3)             4%      7% Absolut=98×103/µl (range=600-3100)         4%         2         70.1% Absolut=3798 (range=2400-6900)      55.2%       1.27 (range=1.4-5.1)      18.2%          3.84 (range=0.6-2.2)        -           14.2% Absolut=770 (range=700-2500)       -          3     68% Absolut=967 (range=2400-6900)      62%        1.09 (range=1.4-5.1)      6%           11.37 (range=0.6-2.2)       1.5%          14% Absolut=199 (range=700-2500)                3%  1.CD3: T-cells(general), CD4: T helper, CD8: T cytotoxic, CD16: Granulocytes/natural killer cells(NK), CD19: B-cells, CD56: NK D.       Immunoglobulins             Igs Case       IgG mg/dl        IgM mg/dl        IgA mg/dl            IgE mg/dl             1         110 Normal range for age:(666-1340)            18 Normal range for age:(76-233)          <3 Normal range for age:(24-116)           1 Normal range for age:()             2         820 Normal range for age:(377-774)           65  Normal range for age:(40-141)          <37 Normal range for age:(13-56)           3 Normal range for age:()             3         698   Normal range for age:(363-1690)           86 Normal range for age:(48-249)          7 Normal range for age:(7-78)           0.7 Normal range: 70-400)   E.        Immunoglobulin response:  Case Anti-Tetanus IgG Anti-Diphtheria IgG                 1                 1.5                0.26                 2                 2.12                >1                 3                 -                 -  1.NBT: Nitroblue Tetrazolium Test F.         Further flow cytometry information: Case2: flow cytometry lymph phenotyping analysis, Gate: Lymph (21.0%), Viability:>90% CD1 0.1 CD34 2.3 CD2 69.6 CD11 2.5 CD3 70.1 CD9 0.3 CD4 55.2 CD10 0.1 CD5 68.2 CD19 14.2 CD7 69.2 CD20 13.5 CD8 18.2 CD22 12.9 CD13 0.1 CD45 95.1 CD33 2.5 CD18 90  rang(60-90) CD14 1.3 CD11a 99 rang(Total=50-90,Lymph=50-90) CD15 97 rang(60-90) CD11b 90 rang(Total=40-85,Lymph=5-20)   CD11c 97 rang(Total=10-30%,Lymph=2-8%)    Case3: flow cytometry lymph phenotyping analysis, Gate: Lymph (39%), Viability:90%, Specimen: PB   CD2 77.4 CD20 21.3 CD56 0.3 CD3 84.3 CD38 0.1     CD4 67.2 CD4/CD8(dual) 0.4     CD8 7.9 CD2/CD19(dual) 0.2     CD10 1 CD3/HLADR(dual) 2.1     CD19 19.1 CD16 1.5        V. PicturesPictures-1:Case B:·         Initial lesions

A 22-year-old male was admitted to our hospital after taking 2450 mg of pilsicainide. On admission, the patient was in cardiac arrest, and percutaneous cardiopulmonary support was introduced to maintain his circulation. After three days of intensive care, he was no impaired consciousness and transferred another hospital for psychological problem.

Objectives: Viral blips (VB) have been reported in people with HIV (PWH) after COVID-19 vaccination. Materials and Methods: We performed a retrospective cohort study among virally suppressed PWH vaccinated against COVID-19 with mRNA-1273, comparing the occurrence of VB in the 12 months after the first vaccine shot with those recorded in the 12 months before. The association between several clinical and immunologic variables and VB have been evaluated through logistic regression. Results: Overall, 48 individuals were included in our analysis. No difference was recorded between VB incidence in the 12 months before and after vaccination [11/48 (23%) vs 15/48 (31.3%), p=0.42]. No significant association was detected between selected variables and VB occurrence after vaccination. In a post hoc analysis including also 8 PWH excluded for not reaching the definition of viral suppression, we observed 15 increases of HIV RNA out of 56 PWH (26.8%) before vaccination and 23 increases of HIV RNA out of 56 PWH after vaccination (41.1%). This difference in incidence remained not significant (p=0.10) but a strong association between increases of HIV RNA occurrence before and after vaccination [p=0.02, OR 4.3 (95% CI 1-22-15.17)] was found. Conclusion: Among virally suppressed PWH, COVID-19 vaccination with mRNA-1273 is not associated with increased occurrence of VB.

Background: Acupuncture, as a non-drug therapy, has been an effective and safe treatment for neuropathic pain (NP). However, a bibliometric analysis of the global use of acupuncture for NP is rare. Objective: This study aimed to demonstrate the state and trend of the global use of acupuncture for NP in recent 20 years. Method: Publications relating to acupuncture for NP were retrieved from Web of Science (WoS) database. Reviews were specifically excluded from this study. Vosviewer1.6.16 was used to analyse countries/institutions, cited journals, authors / cited authors, cited references, and keywords. Statistics and centrality analysis were used to reveal publication output, countries/institutions, core journals, active authors, foundation references, hot topics, and frontiers. Results: A total of 868 articles were obtained from the WoS database. The number of publications has increased over the last two decades. China was the most productive among countries or regions in the field. Journal articles were the most frequently occurring document type. Kyung Hee University was the most active institution. The six main types of NP using acupuncture treatments were peripheral neuropathy, carpal tunnel syndrome, trigeminal neuralgia, spinal cord, postherpetic neuralgia, and chemotherapy-induced peripheral neuropathy. Conclusion: Publications about NP treated with acupuncture had remarkably increased from 2002 to 2022. This study provided an in-depth perspective for research on acupuncture for NP and provides researchers with valuable information to determine the current status, hot spots, and frontier trends.

We report a 51-year-old female with a history of a degenerated aortic bioprosthesis and severe valvular dysfunction who was admitted for redo valve surgery and unexpectedly developed acute flash pulmonary edema, a dramatic form of cardiogenic pulmonary edema before coronary angiography and was managed by timely and proper treatment.

The current study focuses on the thermal distribution in the boundary layer of a wedge with a variable surface temperature. The governing equations of MHD flow for variable wall temperature conditions can be converted to ODE by using similarity solutions, and the Hartmann number (Ha) from 1 to 3 can be solved via the colocation method. This method’s results are compared to those of the numerical method, and it is then evaluated and validated. As the angle or Ha increases, the width of the hydrodynamic boundary layer decreases, and the slope of the boundary layer increases, increasing the coefficient of friction on the surface. The results are obtained for variable wall temperature (n), Prandtl number (Pr) and Eckert number (Ec), where they are 0.5≤n≤1.5, 0.5≤Pr≤5, and 0.001≤Ec≤0.002, and at a certain angle. It is observed that when Ha, Pr, and n increase, the thermal boundary layer grows faster than before; thus, thickness decreases and the Nusselt number (Nu) rises; however, as the Ec adds, the Nu decreases on the wall.

Traditional agrosystems, where humans, crops and microbes have coevolved over long periods, can serve as models to understand the eco-evolutionary determinants of disease dynamics and help the engineering of durably resistant agrosystems. Here, we investigated the genetic and phenotypic relationship between rice (Oryza sativa) landraces and their rice blast pathogen (Pyricularia oryzae) in the traditional Yuanyang terraces of flooded rice paddies in China, where rice landraces have been grown and bred over centuries without significant disease outbreaks. Analyses of genetic subdivision revealed that indica rice plants clustered according to landrace names. Three new diverse lineages of rice blast specific to the Yuanyang terraces coexisted with lineages previously detected at the worldwide scale. Population subdivision in the pathogen population did not mirror pattern of population subdivision in the host. Measuring the pathogenicity of rice blast isolates on landraces revealed generalist life histories. Our results suggest that the implementation of disease control strategies based on the emergence or maintenance of a generalist lifestyle in pathogens may sustainably reduce the burden of disease in crops.

The paper presents a linear and non-linear study of convection in a viscoelastic dielectric liquids. The upper convected Jeffrey model, also known as Oldroyd-B model is used to represent the viscoelasticity. A modified method of the Venezian type is used to obtain a correction to the eigenvalue. The Khayat-Lorenz model is derived for the dielectric liquid with the aid of minimal mode double Fourier series. The classical Lorenz model is obtained as a limiting case of the present study. The effect of different parameters on heat transfer is presented. A comparison of heat transfer in different viscoelastic liquids is also discussed.

Aydan Kayserili 1 Ece Colkesen21 Assistant Professor, HealthCare Department, Faculty of Health Sciences, Toros University, Mersin, TürkiyeDOI: 0000-0002-5360-72232 Research Assistant, Healthcare Department, Faculty of Health Sciences, Toros University, Mersin, TürkiyeDOI: 000-0002-9818-6362ABSTRACTThe Purpose of the Study: The objective of the study was to better understand the process and level of digitalization of healthcare services, as well as the use of tele-medicine in healthcare settings.Materials and Methods: In-depth face-to-face interviews were conducted with total of 20 functional leaders who led the digitalization process in healthcare organizations via zoom application. For the data analysis, interviews were recorded, transcribed and analyzed.Findings: Findings indicated that receiving an HIMMS level 7 certificate was a goal of all public hospitals but was not the key for private healthcare organizations although their healthcare services have nearly become digitalized. The key benefits regarding the digital healthcare services included savings, efficiency, increased patient safety, reduced medical errors, and speed access to patient records, digital archiving and closed loop drug delivery system. Digital healthcare services were very valuable in every single area particularly, intensive care units. Use of telemedicine in public hospitals was limited to transferring patient data to e-pulse. However, the use of telemedicine services in private hospitals was becoming increasingly popular.Highlights: (1) The digitalization of healthcare services was a goal of all hospitals due to the benefits of technology (2 ) HIMMS EMRAM certification was a goal for public hospitals but not for private hospitals (3) Use of Telemedicine in public setting is limited; however, private hospitals are expanding their telemedicine services (4) The number of digital hospitals has been increasing in Turkiye.Key words: Digital healthcare services, tele-medicine, digital hospitals, HIMMS, EMRAM

Background: There is a growing need for contemporary application of microscopic techniques in laboratory practice. Moreover, the oil immersion microscopy is rarely done because of its intricacy. As such concerned scientists need to be abreast of the step-by-step procedures for preparing a biological specimen on the whole as well as method for increasing the resolving power of a microscope. Aim: To prepare slides from various organ systems with photomicrographs of different resolutions. Materials and Methods: Tissue samples were sourced from laboratory Wistar rats ( Rattus norvegicus). Other research items included histopathology lab reagents as well as equipment including embedding mould, water bath, oven and rotary microtome. Standard method of paraffin embedding was used with some modification and sections stained with hematoxylin (Harris) and eosin. Images were prepared using a photomicroscope connected to a computer interface. Results: 500 pieces of microscope slides encompassing 20 different organ/tissue samples, with each mounted on 25 glass slides, while the photomicrographs taken at low (x100), high (x400) and higher (x1000) power magnifications were produced from the various specimens and saved on a disk. Conclusion: The outcome demonstrates the adequacy of the histological protocol used to guide researchers in related fields.

Welded joints have a large variation of their geometry and is one important reason for the comparable large scatter regarding their fatigue life. This study presents and tests an approach for the probabilistic fatigue assessment of welded joints based on their individual local geometry. This approach is adopted from the IBESS research cluster and combined with previous work regarding the evaluation of geometrical parameters from 3D-surface scans. The fatigue life was calculated based on 26 fatigue test series. In this study the fatigue strength calculated by the IBESS approach tended to be overestimated in some cases that is mainly related to the underestimation of the scatter range of the simulated fatigue tests according to the real results. Geometrical parameters were varied in the IBESS calculations and showed that no significant influence on the calculated fatigue strength was determined for weld toe radii > 2 mm and flank angle > 30°.

Background Ablation of accessory pathway from the region of anterolateral tricuspid annulus remains the most challenging although multiple approaches have been introduced. Objective To evaluate the feasibility of a sequential supra-to-subvalvular approach for mapping and ablation of right anterolateral accessory pathway. Methods Cases of right anterolateral accessory pathway ablation were reviewed and divided into group A (conventional approach) and B (sequential approach) for comparison. In group B, mapping and initial radiofrequency delivery was performed in the right atrium along tricuspid annulus, with the target marked on the 3D map. Radiofrequency was subsequently applied at the target from the right ventricle with a reversed catheter curve. Procedural and follow-up data were collected from the patients. Results Overall success was achieved in all patients in group B and 13/15 cases in group A. Compared to conventional approach, cases completed with sequential approach had a significantly shorter procedure time (124.5±13.4min vs. 152.1±36.0min, p=0.030) and mapping and ablation time (57.2±16.3min vs. 92.1±40.1min, p=0.016). Radiofrequency time was also shorter in group B but without statistical difference (536.9±161.0 sec vs. 650.7±321.9 sec, p=0.313). Conclusion The sequential approach can be feasible in routine ablation of right anterolateral pathway by improving efficiency during mapping and catheter stability during radiofrequency application.

Markus Sebastian Gross passed away on 25 January 2022, due to the injuries he sustained during a household accident on 8 January 2022, and unexpected complications at the treating hospital. In this obituary we honor his character and his contributions to science and engineering.

Objective: This study aimed to investigate the relationship between the location of implantation of the Left Bundle Branch Area Pacing (LBBAP) electrode and the coronary artery and to assess the safety of LBBAP surgery. Methods: Patients who underwent the LBBAP procedure and coronary angiography (CAG) at the Second Affiliated Hospital of Nanchang University between January 1, 2019 to October 1, 2020 were included. We read the patient’s LBBAP and CAG imaging data and used the nine-partition method to measure the vertical distance from the tip of the pacing electrode to each coronary artery in multiple projection positions during the ventricular systolic period. Changes in the ST-T segment in the electrocardiogram, serum troponin and myocardial enzyme profiles were observed before and after the LBBAP surgery. Results: Overall, 50 patients were evaluated. The average vertical distances from the electrode tip to the left anterior descending branch (LAD), right posterior coronal descending branch (PD), left posterior ventricular branch (PL) were 19.69±8.72 mm, 26.09±8.02 mm, and 21.11±7.86 mm, respectively. The minimum were 5.28 mm, 9.51 mm and 8.69 mm, respectively. CAG in all patients showed no significant injury to the ventricular septal branch. And there were no elevated serum troponin or cardiac enzyme profiles. Conclusions: This study suggested that the coronary arteries were safest when the LBBAP electrodes were placed within a rectangle formed by the PM, M, PI, and MI center points. The PM was the ideal position to implant the LBBAP electrodes, which had a low risk of coronary vascular injury.

Jasmonic acid (JA) is an important phytohormone in optimizing plant developmental growth and stress responses. The biosynthesis and signalling pathways of JA share common and unique features between herbaceous and woody plants. However, numerous reports have primarily focused on JA function in model plant species or herbaceous plants, leading to a notable lack of research on the JA regulatory mechanism in woody plants. In particular, the role of Jas in posttranscriptional regulation events such as alternative splicing (AS), has largely not been elucidated in trees. In this review article, we summarize the current progress of JA-involved regulation of developmental growth in different tree species. Along with an accumulating number of studies revealing that AS participates in the JA regulatory network in woody plants, we also update the multiple roles served by JA associated with similar properties and differential regulation within their herbaceous counterparts. The utilization of genetic studies and high-throughput proteogenomic approaches to analyse AS genes and splicing factors involved in JA signalling would further advance our understanding of JA modulation in woody plants.