This clinical image presents unexpected bronchial dilatations with radiographic images suggestive of progressive pulmonary tuberculosis. The aim is to remind the value of thoracic imaging in the early diagnosis of bronchopulmonary pathologies to improve the prognosis of patients.

This paper addresses a multiple-input, single-output (MISO) downlink secure wireless communication system assisted by an intelligent reflecting surface (IRS). Instead of employing a conventional IRS model that requires an external power supply, we consider a self-powered IRS to achieve extra resource efficiency. Our goal is to design a beamforming vector at the transmitter side and phase shifters for the IRS that maximize the secrecy rate while assuring seamless IRS operation via energy harvesting (EH). Since the considered optimization cannot be solved analytically, we propose to utilize deep reinforcement learning (DRL). Numerical results verify that the proposed DRL-based solution outperforms the conventional relaxed convex optimization approach in both secrecy and energy harvesting perspectives.

This article concerns the dynamic transitions of a non-Newtonian horizontal fluid layer with thermal and solute diffusion and in the presence of vertical magnetic field. First, a linear stability analysis is done by deriving the principle of exchange of stability condition, which shows the system loses stability when thermal Rayleigh number exceeds a critical threshold. Second, we considered the transition induced by real eigenvalues and complex eigenvalues, respectively, and two nonlinear transition theorems along with several transition numbers determining the transition types are obtained via the method of center manifold reduction. Finally, rigorous numerical computations are performed to offer examples of possible transitions, as well as the stable convection patterns. Our results show that when the diffusivities from big to small are thermal, solute concentration and magnetic diffusion, both continuous and jump transitions can occur for certain parameters; and if the diffusivities from big to small is the inverse of the previous case, only continuous transition induced by real eigenvalues are observed, which indicate a stationary convection.

The theory of regular wavelet/Gabor frames has been extensively investigated, including the sufficient and necessary conditions for regular wavelet/Gabor systems to be frames and the perturbation theorem. This paper addresses the irregular wavelet/Gabor systems in Sobolev space Hs(R). The sufficient and necessary conditions for irregular wavelet/Gabor systems to be frames are presented. As corollaries, under certain restrictions on the support, we also give the characterization of irregular wavelet/Gabor systems to be frames. Finally, we discuss the perturbation theorem of irregular wavelet/Gabor frames.

Sporotrichoid-lymphocutaneous-pattern is classically seen in sporotrichosis, though also present in other infections like atypical mycobacteriosis and leishmaniasis. Cutaneous atypical mycobacterial infection presents as localized lesions in immunocompetent and is widespread in immunosuppressed patients. Here, we present a case of sporotrichoid-lymphocutaneous infection due to atypical mycobacteria, in a fish-seller under immunosuppressants.

Background and Aims: Worldwide, the incidence of COVID-19 is lower in children than in adults and symptoms are less severe. So far, few studies from Latin America have been published on the behavior of COVID-19 in children with cancer. Purpose: To characterize the epidemiology, clinical course, morbidity, and mortality in children with cancer and COVID-19. Methods: All patients registered in the Argentine National Pediatric Cancer Registry (ROHA) with diagnosis of SARS-CoV-2 between December 4, 2020, and May 3, 2022 were included. Variables analyzed were: sex, age at COVID-19 diagnosis, clinical presentation at diagnosis, symptom severity, tumor type, intensive care requirement, specific treatment for COVID-19, vital status, and cause of death. Mortality was analyzed comparing the three main waves. Results: Overall, 888 children with cancer and COVID-19 infection were registered (484 females); 437 (49.2%) had leukemia, followed by central nervous system tumors (CNS-T) 120 (13.5%). Of the children, 57.2% (n=508) were symptomatic; 75% were febrile, and 37% (n=210) had neutropenia; 17.1% (n=152) were diagnosed within one month of cancer diagnosis. A total of 154 children had severe or critical symptoms (17%). In this study, 112 deaths were reported, 105 (94%) due to disease progression, sepsis, comorbidities, or treatment complications. Seven patients (0.8%) died from COVID-19, all diagnosed with leukemia/lymphoma. No association of deaths was found between the three waves analyzed. Conclusions: Based on the ROHA data, we may conclude that in pediatric cancer patients, contrary to what was initially expected, morbidity and mortality due to COVID-19 were not increased.

Quantum Mechanics and General Relativity appears to be incompatible because we are using the wrong model of the universe. Nature does not use two separate rule-books, but uses two different viewpoints. To see how the conflicting demands of Quantum Mechanics and General Relativity can be easily satisfied, we need the true model of our universe.Ever since Hubble’s law was discovered, scientists speculated that the analogy of an expanding balloon best described the shape of our universe. This view was rejected based on wrong assumptions and replaced by the presently accepted model of a flat and infinite universe, which is wrong! We are confident that we have measured the universe to be (3d) flat using two different methods. Unfortunately, neither method is capable of measuring the extrinsic curvature of a 3d hyper-surface: 1)      We cannot measure the curvature of a 3 dimensional (hyper) surface using summation of angles in a triangle. That works for a 2 dimensional surface curving in the 3rd dimension. But for our case, we need the sum of solid angles (i.e. we need a tetrahedron, and not a triangle). The ‘sum of angles of the triangle’ checkup which we had applied to CMB (Cosmic Microwave Background) spots is bound to show that our universe is (3d) flat! 2)      We cannot measure the curvature of our universe using the critical mass-energy density method of General Relativity (General Relativity can measure intrinsic curvature, but not the extrinsic curvature). That proves that the universe may not be 3d flat. But how can we be sure that it is curved? Here is another piece of clue which finally nails it: Our universe does have has a Center (although the Center does not lie anywhere in our 3d space). This can be easily proved:The Center of Mass equation is a powerful equation. In the vastness of our cosmos, we can consider each galaxy (or maybe a galaxy cluster) as a point mass. Even as the number of galaxies tend to infinity, we are still left with a single point center of mass. Simply invoking infinity isn’t going to help us escape from the conclusion that there is indeed a Centre. And it has to lie outside the 3d hyper-surface. Otherwise, we could have located the true center, and Hubble’s law would not have the particular form v = H0D. Also, the Big Bang would not have appeared to have happened everywhere. In fact the cosmos would be an irregular structure composed of an empty central region, the “crater of the explosion,” an intermediate region containing the galaxies and an external part containing only radiation. No structure in the three-dimensional space, born from an explosion occurring 13.8 billion years ago, could resemble the universe we observe today.The Minkowski SpaceTime equation  ds2 = (i.c.dt)2 + dx2 + dy2 + dz2 = (i.c.dt)2 + dr2 (which explains all of special relativity, including time dilation, length contraction, and relative simultaneity) is not a statement for 4d spacetime continuum (since i cannot be used as an independent axis). Einstein & Minkowski made that mistake, and assumed a block universe view in which the past, the present and the future simultaneously coexist! This view is in stark contrast to our everyday experience, as well as with an astonishing number of observations in the whole of science. In fact, an entire book has been written to highlight this mistake. [The arrow of time: the quest to solve science’s greatest mystery]. The above equation represents a dynamic 3d hyper-sheet, moving with a velocity c in the 4th dimension in an embedding 4d hyperspace. This perfectly describes a small section of an expanding (hyper) balloon. c is the radial expansion velocity of our universe. Using this concept, and taking the age of our universe to be 13.8 billion years, the calculated Hubble constant value (71.002 km/s/Mpc) matches very well with accepted values (69.8 km/s/Mpc and 74 km/s/Mpc determined by two different methods).Therefore, relativity is all about being trapped inside the wall of the expanding (hyper) balloon. But, what is this 3d hyper-surface made of? It is made of (scalar) fields, and particles, which are mere resonance/excitation in that field. That is just the core statement of stunningly accurate Quantum Field Theory (QFT) which forms the foundation of Standard Model of Particle Physics. Thus, we get a glimpse of the unity between relativity and Quantum Mechanics.Copernicus broke with 1300 years of tradition, and revolutionized science by moving from earth-centric to sun-centric view. But, moving the viewpoint to the true center of our expanding universe explains the origin and true nature of time itself!Clearly there are two viewpoints: the Center of Universe viewpoint (God’s view/nature’s view) and our viewpoint (i.e. viewpoint of an unfortunate creature trapped inside the wall of the hyper-balloon). From our viewpoint, the radius of the universe is an impossible direction (which forces us to use imaginary number) and hence it is a temporal dimension. But from the center of universe viewpoint, the radius is a real dimension, and hence is spatial dimension. Thus time and space dimension exchange roles. The radial expansion of the universe appears as passage of time from our viewpoint. From the center of universe viewpoint, simultaneity is absolute (as demanded by Sagnac effect), and there is indeed absolute universal time (as demanded by quantum mechanics) since the time passed since the Big Bang is just a function of the radius of the universe. From our viewpoint (located at an awkward position in the universe), locality is absolute, and velocity c is the upper limit, and remains constant for every observer. This turns (our) space and time into inseparable twins, and makes (our) time a relative concept. This solves the time problem which had so stubbornly resisted the reconciliation of Quantum Mechanics and General Relativity.The two viewpoints differ drastically. As explained later, temporal dimension is that dimension along which any movement can be ignored. For example, we can easily ignore the tremendous velocity with which we are traveling along the radius of the universe. In a similar manner, nature/universe ignores movement along the wall of the balloon whether we travel to the moon or to the sun or to the Andromeda galaxy, because the moon, the sun, and Andromeda galaxy are all equidistant from the true center of the universe. This fact, combined with the fact that the (entire) closed universe is an absolutely isolated system (Absolute Island) and has to conserve total momentum etc. gives rise to non-locality in entangled particles.Relativity is our viewpoint from an awkward position of the universe, while Quantum Mechanics is the other viewpoint. Both phenomena are like two sides of the same coin. Relativity is inside the light cone phenomena (since nothing can travel faster than light), while Quantum Mechanics is outside the light cone phenomena (allowing instant communications in ‘quantum entanglement’ experiments). Both are dictated just by the scale (i.e. whether we use classical/human scale or sub-atomic scale) for a very good reason (explained in detail in my paper). But why does the transition from Relativity to Quantum Mechanics happens with decreasing size scale? That’s because, this is what is happens to spatial and temporal dimensions at different scales:3+1 (Classical regime) <=> 2+2 (Compton regime) <=> 1+3 (Planck regime).General Relativity makes things a bit tricky since it involves curvature/warping of spacetime, but it does not become incompatible with Quantum Mechanics. The only difference between the warped spacetime of General Relativity, and the flat spacetime of Special Relativity is very similar to the difference between a stretched rubber membrane, with and without a metal ball placed on it. This stretching also produces the same time dilation (as predicted by Einstein), but now it is due to the cos and sine components of the temporal dimension. General Relativity and Quantum Mechanics are the two pillars of modern Science. Reconciling the two leads us to 'Theory of Everything'.The list of achievements in my above-mentioned paper is simply too long to be detailed here. The ‘Principle of Least Action (PLA)’ comes closest to the ‘theory of everything’ in physics, and from PLA, all known laws of physics can be derived. PLA can be generalized to ‘Principle of Maximum Proper time’, which is just the Minkowskian version of the Euclidean statement “The least distance between two points in (hyper) space is a straight line”.  My paper also explains why dualities like wave-particle duality, or Lagrangian-Hamiltonian duality arises. Duality is a bedrock concept of modern physics. The crucial conservation laws of Physics arise from symmetries of nature (as per Noether’s theorem). We can directly see from this simple structure of our universe, why those symmetries (e.g. homogeneity and isotropy) arises in the first place.  Nature, the ultimate judge, has stamped TOTALLY APPROVED on my paper.

The basic idea of this article is to investigate the numerical solutions of Gardner Kawahara equation, a particular case of extended Korteweg-de Vries (KdV) equation, by means of finite element method. For this purpose, a collocation finite element method based on trigonometric quintic B-spline basis functions is presented. The standard finite difference method is used to discretize time derivative and Crank-Nicolson approach is used to obtain more accurate numerical results. Several numerical examples are presented and discussed to exhibit the feasibility and capability of the finite element method and trigonometric B-spline basis functions. More specifically, the error norms $L_{2}$ and $L_{\infty }$ are reported for numerous time and space discretization numbers in tables. Graphical representations of the solutions which describe motion of wave are presented.

Proteins in the tumor necrosis factor (TNF) superfamily (TNFSF) regulate diverse cellular processes by interacting with their receptors in the TNF receptor (TNFR) superfamily (TNFRSF). Ligands and receptors in these two superfamilies form a complicated network of interactions, in which the same ligand can bind to different receptors and the same receptor can be shared by different ligands. In order to study these interactions on a systematic level, a TNFSF-TNFRSF interactome was constructed in this study by searching the database which consists of both experimentally measured and computationally predicted protein-protein interactions (PPIs). The interactome contains a total number of 194 interactions between 18 TNFSF ligands and 29 TNFRSF receptors in human. We modeled the structure for each ligand-receptor interaction in the network. Their binding affinities were further computationally estimated based on modeled structures. Our computational outputs, which are all publicly accessible, serve as a valuable addition to the currently limited experimental resources to study TNF-mediated cell signaling.

Considering the worsening opioid epidemic, complicated infective endocarditis (IE) secondary to intravenous drug use (IVDU) that fails medical management is increasingly common. We present a 31-year-old patient post tricuspid valve replacement who relapsed with recurrent IE and secondary complications of severe tricuspid stenosis and regurgitation, ventricular septal defect (VSD), pulmonary emboli, right-sided heart failure with severe hepatic congestion, and cardiogenic shock. Despite maximal medical management, the patient remained in septic and cardiogenic shock with a potential disposition to hospice care. Upon consulting cardiothoracic surgery, she underwent a first-stage valvectomy with Extracorporeal Membrane Oxygenation (ECMO) as a bridge to definitive treatment. After clearance of infection, she underwent a second-stage valve replacement, VSD repair, and final ECMO decannulation. Our case alludes to ECMO as a potential bridge for patients with complicated infective endocarditis who fail medical management and are high-risk candidates for immediate definitive surgical management.

Objective: To develop a machine learning-based model for predicting the risk of acute respiratory distress syndrome (ARDS) after cardiac surgery. Methods: Data were collected from 1011 patients who underwent cardiac surgery between February 2018 and September 2019. We developed a predictive model on ARDS by using the random forest algorithm of machine learning. The discrimination of the model was then shown by the area under the curve (AUC) of the receiver operating characteristic curve. Internal validation was performed by using a 5-fold cross-validation technique, so as to evaluate and optimize the predictive model. Model visualization was performed to reveal the most influential features during the model output. Results: Of the 1011 patients included in the study, 53 (5.24%) suffered ARDS episodes during the first postoperative week. This random forest distinguished ARDS patients from non-ARDS patients with an AUC of 0.932 (95% CI=0.896-0.968) in the training set and 0.864 (95% CI=0.718-0.997) In the final test set. The top 10 variables in the random forest were cardiopulmonary bypass time, transfusion red blood cell, age, EUROSCORE II Score, albumin, hemoglobin, operation time, serum creatinine, diabetes, and type of surgery. Conclusion: Our findings suggest that machine learning algorithm is highly effective in predicting ARDS in patients undergoing cardiac surgery. The successful application of the generated random forest may guide clinical decision making and aid in improving the long-term prognosis of patients.

A document by Muhammad Maaz. Click on the document to view its contents.

Systemic right ventricular failure after physiologic repair for dextro-transposition of the great arteries can be managed with durable mechanical circulatory support; however, the right ventricular morphology, such as intervening papillary muscles, presents challenges to inflow cannula positioning. Papillary muscle repositioning is an innovative technique to circumvent the obstructive anatomy.

A multiple input multiple output synthetic aperture radar anti-jamming solution is proposed and verified. Dual modulation waveforms of orthogonal frequency division multiplexing and azimuth phase coding are designed. Transmitting two sets of dual modulated waveforms alternately allows to resist repeater deception jamming.

The two-target resolution algorithm enables four-channel monopulse radars to estimate the locations of the unresolved two-target within a 3dB beamwidth. However, the algorithm mentioned above has limited practical use due to the antenna pattern inconsistent of nonrectangular arrays. For this case, an dual-pulse two-target resolution (DTR) method for monopulse radars with a nonrectangular array configuration is proposed in this letter. By solving the eight equations from the received signals of two continuous pulses, matching functions with nulls at the real locations of the targets are established, which eliminate the errors caused by the nonrectangular array configuration. By searching the nulls, the locations of the two unresolved targets can be estimated accurately. Simulations demonstrate the superior performance of the DTR approach.

Letter to the Editor- Suboptimal Dosing of EsomeprazoleI read the informative research article “Night-time gastric acid suppression by tegoprazan compared to vonoprazan or esomeprazole” by Yang E et al., with great interest.There are a few points that I would like to highlight regarding the methodology of the study. The dosing schedule used in the study for esomeprazole is likely to produce suboptimal effects. The optimal effect of esomeprazole depends on two factors i.e. timing of dosing and the cumulative effect.• Esomeprazole which is a proton pump inhibitor (PPI) inhibits gastric acid secretion by non-competitively inhibiting the enzyme H+, K+ ATPase in parietal cells. After the meal, parietal cells are maximally stimulated which results in the activation of proton pumps, thus, it is the best time for the antisecretory effect of PPI. PPIs are recommended to be taken 30 minutes before the first meal.1Therefore, timing administration of PPI with meals may be critical for optimal effect.1, 2 Plasma half-life of esomeprazole is approximately 1-1.5 hours.3 Only the expressed acid-secreting proton pumps on the luminal membrane of parietal cells are inhibited by esomeprazole. Administering esomeprazole at night will inhibit only very few proton pumps during the brief period when the PPI is available for therapeutic action. Furthermore, bedtime PPI administration will not contribute to nocturnal acid breakthrough inhibition because the drug will have disappeared by the time night-time acid secretion is perceptible. As per the dosing schedule followed in the study, by the time patient had the maximum expression of the H+K+ ATPase, esomeprazole was already eliminated from plasma. Tegoprazan and vonoprazan, being reversible and competitive inhibitors of H+K+ ATPase are devoid of such effects. • The antisecretory action of esomeprazole increases with repeated dosing to reach a plateau phase after 3-4 days to produce 80-98 % suppression of 24-hour acid output.4 Even when given 30-60 minutes before meals, PPIs are unable to block all proton pumps with oral formulations and single dosing because all pumps are not active during 1.5 hr half-life of PPIs. Because of this short t1/2, only 70% of pumps are inhibited.5 Thus, approximately 20% of pumps are newly synthesized over 24 hours. As the once optimized amount of drug is reached, increasing the dose has almost no effect. An increase in the frequency of administration seems to have some effect, a morning and evening dose before food results in approximately 80% inhibition of maximal acid output.6,7The drug metabolism by CYP3A4 (30.9%) is more common than CYP2C19 (6.8%).8 As tegoprazan and vonoprazan are metabolized by CYP3A4,9 and it makes them more susceptible to drug-drug interactions in the case of polypharmacy.Tegoprazan and vonoprazan belong to the novel class of drugs which offers reversible and competitive inhibition of H+K+ ATPase. For their comparison with esomeprazole, the dosing schedule should be designed so that its optimal effect can be considered for comparison.Conflict of interest: NoneDr. Ajay Kumar Shukla1, Dr. Sameer Khasbege1*1 Department of Pharmacology, All India Institute of Medical Sciences, Bhopal,M.P., India*Corresponding author

In the work by Zheng Quan MD et al. about the Use of Intraoperative Transit Time Flow Measurement Can Reduce Preoperative Myocardial Injury (1), the authors did a retrospective, observational study of the effects of exposure to the TTFM procedure . Fifty-nine people received TTFM, while 47 did not. In total, 7 (6.6%) had at least one grafting vessel obstruction. Only 1 patient where the TTFM was used had an occlusion graft vs. 6 patients where the TTFM was not used and had postoperative injury. In 2001, the use of TTFM techniques for assessing the quality of grafts intraoperatively, on the basis of the presence and volume of flow were clearly described) In conclusion, the work of Zheng Quan MD et al. remarks the importance of the use of TTFM to reduce the incidence of preoperative myocardial injury during off-pump coronary bypass surgery. support of, in some ways, the recent expert opinion to promote the use of TTFM

The usage of the gas sensor has been increasing very rapidly in the industry and in daily life for various potential applications. In recent years, metal oxide semiconductors (MOS) become the primary choice for designing highly sensitive, stable, and low-cost real-life applications-based gas sensors due to their inherent physical and chemical properties. Researchers have proposed numerous sensing mechanism to explain the functionality of MOS based gas sensors. In this review, we have comprehensively covered different sensing mechanisms used for MOS. We have also discussed different parameters affecting the sensitivity and selectivity of the gas sensors. Moreover, the different techniques used to enhance the gas sensing response of MOS based sensors are also extensively covered. And finally, we give our prospective on recent opportunities and challenges on future applications of MOS based gas sensors.

A document by Sara Labidi. Click on the document to view its contents.

In this paper, a family of non-monotone differential equations with mixed delays is considered. By introducing a concept of Bi-pseudo compact almost automorphic functions and establishing the properties of these functions, and using Halanay's inequality and Banach fixed point theorem, some results on the existence, uniqueness and global exponential stability of pseudo compact automorphic solutions of the equations are obtained. Our results extend some recent works. Moreover, an example is given to illustrate the validity of our results.

Abstract: Medicinal plants, contain a variety of phytochemicals promising as traditional medicine for the treatment of chronic and infectious diseases, has been safe and effective alternatives with fewer side effects than synthetic agents. Catharanthus roseus (L.) G. Don (C. roseus) has been widely available and used to treat various diseases in many countries. It is attracting more and more attention as it has been shown to have a wide range of phytochemicals with various biological activities such as antioxidant, antibacterial, antifungal, antidiabetic and anticancer characteristic. Notably, vinblastine and vincristin isolated from this plant were the first plants derived from this plant anticancer agents deployed for clinical purposes. In addition, vindoline, vindolidine, vindolicine and vindolinine isolated from C. roseus leaves showed antidiabetic properties. These findings indicate that the plant remains a promising source of bioactive substances. This article provides an overview of the tradition use and pharmacological uses of C. roseus, and a summary of updated health benefits of extracts and bioactive compounds derived from this plant have also been addressed to support their potential as therapeutic agents.

Infants born at 22–23 weeks rarely survive, and most develop severe complications, especially in the case of multiple births. This age is considered the threshold for active intervention. We report the survival of twins born at 22 2/7 weeks gestation. Recently, advances in neonatal care have improved infant survival.

Tuberous sclerosis complex (TSC) is a rare genetic multisystem disorder that was first described by Von Recklinghausen. We report a case of a female who initially presented with hematuria and was later found to have multiple manifestations of the disease. The report emphasizes the value of investigations on suspected cases.

From 2016 to 2021, two cases of rabies encephalitis were diagnosed and hospitalized at the Kiffa hospital center. Neither of them had started the rabies vaccination after the dog bites before symptoms appeared. In countries where rabies still occurs, health workers should be trained for an efficient management of dog.