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A case of tetanus presenting with catatoniaSima Mohseni Ahangar1, Sussan Moudi2, Hadi Ahmadi Juybari3, Maria Yazdani4, Babak Yeganeh5, Masoud Ghasemi6, Maryam Vajdi7, Seyedeh Mahboobeh Mirtabar8*1MD, Infection Diseases and Tropical Medicine Research Center, Babol University of Medical Sciences, Babol, Iran. Orchid: 0000-0001-0201-7952Email: simamohseni6010@yahoo.com2MD, Associate Professor of Psychiatry, Fellowship of Psychosomatic Medicine, Social Determinants of Health Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran. Orchid: 0000-0002-6573-8861 Email:sussan.mouodi@gmail.com3MD, Infection Diseases and Tropical Medicine Research Center, Babol University of Medical Sciences, Babol, Iran. Orchid: 0000-0001-6630-0100Email: dr.h.ahmadi.j@gmail.com4MD, Infection Diseases and Tropical Medicine Research Center, Babol University of Medical Sciences, Babol, Iran. Orchid: 0009-0009-4659-2455Email: Mariayazdani3255@gmail.com5MD, Infection Diseases and Tropical Medicine Research Center, Babol University of Medical Sciences, Babol, Iran. Orchid: 0009-0000-5426-7569Email: babak74ids@gmail.com6MDAssistant Professor of Anesthesiology, Department of Anesthesiology, School of MedicineBabol University of Medical Sciences, Babol, Iran. Orchid: 0009-0004-2816-0513Email: masoud.ghasemi.dr@gmail.com7MDAssistant Psychiatric Student, Clinical Research Development Unit of Yahyanejad Hospital, Babol University of Medical Sciences, Babol, Iran. Orchid:0009-0004-7528-3786Email: Maryamvajdi1991@gmail.comCorresponding author: 2PhD for By Research Clinical Psychology, Health Research Institute, Babol University of Medical Sciences, Babol, Iran. Orchid: 0000-0003-2679-5449. Email:seyedehm.mirtabar@gmail.comKey Clinical MessageTetanus is a potentially life-threatening disease that, although largely controlled in most parts of the world through childhood vaccination programs, remains a significant challenge in developing countries. We report a case of generalized tetanus presenting atypically with catatonia and complicated by aspiration pneumonia, who astonishingly survived.IntroductionTetanus is a potentially life-threatening disease presenting with muscle spasm and usually ending with death. However, it has been controlled to a great extent in most regions of the world as a result of childhood vaccination program. Yet, tetanus is still a challenging problem in developing nations with low socioeconomic level, contaminated environment, inadequate immunization coverage, and improper management1. The clinical diagnosis of tetanus is usually straightforward and is made by demonstration of body stiffness, trismus and dysarthria. Nonetheless, atypical presentations can be overlooked, delay the diagnosis and management and consequently worsen the outcome2. Herein, we report a case of generalized tetanus presenting atypically with catatonia and complicated by aspiration pneumonia, who astonishingly survived.Case presentationA 39-year-old male patient was admitted to the emergency department of the psychiatric hospital with a 2-3 weeks history of Catania-like changes. His complaints began after a family dispute with fatigue, weakness and lethargy, dysphoric mood, decreased ability to walk, loss of interest and refusal to eat and talk, desire to drink fluids, and social withdrawal, which prompted him to see a psychiatrist. An initial diagnosis of adjustment disorder was made and he was started on sertraline, propranolol, and clonazepam, but no significant improvement was achieved. Due to the lack of improvement in symptoms, he was referred to a neurologist, and brain imaging and necessary tests were performed, which were normal. After 2 weeks, his condition worsened, leading to hospitalization in the psychiatric department. The patient had no history of trauma, alcohol/substance abuse, or medical illness. However, his brother had an opiate use disorder. During the visit, the patient had general body tremors, sweating, upper limb tremors, inability to speak, retardation, drowsiness, rigidity, and increased DTR. He had no delusions or hallucinations. On examination, his pupils were of normal size and reaction to light. His vital signs were as follows: blood pressure 110/70 mmHg, heart rate 84 beats/min, respiratory rate 18 breaths/min, and body temperature 36.9°C. Physical examination revealed no significant abnormalities. He was alert and cooperative in psychiatric evaluation. His mood was anxious. Assessment of content and thought process was not possible. A complete clinical and necessary laboratory examination was performed. The patient’s blood tests were within normal limits, except for elevated creatine phosphokinase (CPK) (1313 units/L), lactate dehydrogenase (LDH) (570 units/L), aspartate aminotransferase (AST) (69 units/L), and aldolase (72 mIU/L).On day 1 of hospitalization, he developed akinesis and rigidity of upper and lower extremities; thus, neurological consult was done which advised cervical and thoracic vertebra and brain magnetic resonance imaging (MRI), and started the patient on bromocryptin, baclofen and diazepam. Moreover, testing for HTLV1 and 2 antibodies was recommended. Brain computed tomography (CT) scan was normal except for a nonsignificant left maxillary sinus opacification; however, lumbosacral MRI revealed bilateral spondylolysis at L5 and anterolisthesis between L5-S1.two days after admission, he developed fever and headache. Thus, infectious diseases consultation was requested. He was subsequently transferred to infectious diseases service with suspected meningoencephalitis. On physical examination, there was no meningioma’s but mutism, waxy flexibility and rigidity were evident. He was started on acyclovir, vancomycin and meropenem and underwent lumbar puncture (LP). Cerebrospinal fluid (CSF) parameters were normal except for elevated protein (61.7 mg/dl) level. Test results for human herpes virus (HSV) polymerase chain reaction (PCR) was negative in the CSF. Moreover, other workup for human immunodeficiency virus (HIV) and malaria did not provide conclusive results. Echocardiography and abdominopelvic ultrasound were also normal. Anti-nuclear antibody (ANA), anti-neuronal antibody panel for autoimmune encephalitis and anti-myositis antibody were negative, all of which excluded rheumatologic and autoimmune neurologic disorders. Meanwhile, the patient developed trismus, severe muscle spasms, dysphonia and dysphagia, which along with evidence of autonomic lability such as diaphoresis was consistent with signs of tetanus. The differential diagnosis of serotonin syndrome was also given. Thus, past history was again questioned which revealed no history of acute trauma, but the patient recalled a sole puncture with a nail with spontaneous resolution about 2 months prior to his symptoms initiation. Furthermore, it was found that his childhood immunization was complete but he had not received any booster dose of tetanus vaccine since then. Based on history and clinical manifestations, the likely diagnosis of tetanus was made. He was admitted to the intensive care unit (ICU) for further treatment. Antimicrobial and antiviral agents were discontinued except metronidazole which was prescribed 500 mg intravenously every 6 hours based on Centers for Disease Control and Prevention (CDC) guidelines. Blood was drawn for investigations including tetanus serology. This was followed by the administration of one tetanus toxoid dose, intramuscular (IM) tetanus immune globulin (TIG) for 6 times and two 5-day series of intravenous immunoglobulin (IVIG). Electroencephalography (EEG) was normal. Electrodiagnostic examination including nerve conduction study (NCS) was normal except for reduced amplitudes with distal stimulation; however, voluntary activity of muscles was not evaluable with needle electromyography. Muscle biopsy was performed to exclude neuromuscular disorders which demonstrated the presence of focal neurogenic atrophy with no vasculopathy, inflammation or myopathy. The spasms gradually ameliorated over 45 days of hospital stay but trismus was persistent and the patient was still listless. However, a single dose of tetanus toxoid was given as a booster and he was planned to be discharged home when he developed dyspnea and lowering of consciousness. Chest CT scan revealed consolidation and air-bronchogram in posterior right upper lobe and basal segments of both lungs suggestive for aspiration pneumonia. Due to the patient’s condition and arterial blood gas (ABG) results, he was intubated and remained in the ICU. He was restarted on broad-spectrum antibiotic therapy. Tracheal aspirate culture was positive for Pseudomonas aeroginosa and Klebsiella pneumonia which were both pan-drug resistant. Meanwhile, erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) levels also increased significantly. This nosocomial infection led to an extra 2 months of hospitalization which fortunately ended with the patient’s improvement and systemically good condition for discharge. He was sent home and advised to institute physical therapy and receive the third toxoid dose in 2-4 months. His clinical condition was stable over the following weeks and he had full recovery with no spasms and trismus at the 2-month follow-up visit.DiscussionTetanus is a potentially lethal infection caused by the neurotoxin produced by Clostridium tetani. This gram-positive pathogen is ubiquitous and its spores can survive for long periods particularly in soil 3. Global tetanus vaccination programs reduced tetanus incidence and the associated morbidity and mortality all over the world; nonetheless, incomplete vaccination coverage in underdeveloped countries and also neglect in receiving tetanus-toxoid vaccine boosters even in developed and developing nations are causes of sporadic tetanus reports in various parts of the world especially in resource-limited countries. In fact, inadequate vaccination and decreased immunogenicity are thought to be the main reasons of tetanus incidence in the unvaccinated and vaccinated individuals, respectively4. Puncture wounds and injecting drug use have been among the most common routes of tetanus transmission; however, similar to our patient, tetanus can be transmitted through minor injuries by even a rusty nail 5.Clinical manifestations of tetanus is dependent upon the forms which include cephalic, localized, generalized, and neonatal ones6. Our patient presented with the generalized form of tetanus which is characterized by muscle rigidity predominantly in the extensor muscle groups, hypertonic reflexes, signs of cranial nerve involvement like facial muscle spasm (risus sardonicus), trismus, laryngeal spasm, and dysphagia. Any stimuli including auditory, tactile, or visual may trigger the tonic contractions 7. In addition, signs of autonomic dysfunction, such as hypersialosis, diaphoresis, hypertension, tachycardia and tachypnea may be evident8.Diagnosis is primarily based upon history and clinical manifestations; however, atypical presentations can result in overlook or mistake of tetanus for other medical conditions and delay the diagnosis9. Our patient presented with a long duration of depressive mood which had been managed with anti-depressant agents. Similar to our patient, wounds may not be apparent due to the long time passed since the traumatic event 10.Laboratory tests do not commonly aid in the diagnosis of tetanus. However, certain changes which may support the diagnosis include neutrophilic leukocytosis, and elevated CPK, LDH and AST levels. Moreover, there is a possibility of acute renal failure due to rhabdomyolysis, which did not fortunately occur in our patient11, 12.Although electromyographic testing should be delayed in order to prevent disease progression, but prolonged electrical discharges with normal nerve conduction velocities are predicted to be present in tetanus13.Any suspected case of tetanus should undergo aggressive workup and rapid management. Therapy is consisted of both generalized and specific care. Generalized care is consisted of supportive therapy and symptomatic care which include wound debridement, and administration of antibiotics to cover C. tetani and sedatives for muscle spasms. Antimicrobial agents are administered to eliminate the clostridial spores in order to prevent further toxin production. Metronidazole is the antibiotic of choice with good anaerobic tissue penetration and anti-spore activity14 . Our patient did not have any apparent wound but he was started on metronidazole. He was nutritionally supported and placed in a dark and quiet environment in order to avoid any stimulus like light and noise to trigger further spasms 15. In addition, diazepam and baclofen was administered without the use of narcotics to prevent respiratory depression 16. Magnesium was also started to regulate muscle contraction and relaxation and control autonomic dysfunction. Moreover, magnesium sulfate reduced our patient’s need to sedation, dispense him of the need to ventilatory support and improved his tolerance of enteral feeding17.Specific care includes antitoxin to neutralize the circulating toxin. Human TIG is the currently recommended antitoxin licensed for IM use. This immunoglobulin is only effective prior to toxin transportation into nerve cell; thus, it should be promptly administered as soon as when the toxin is present in the blood. However, it is suggested that intrathecal administration of immunoglobulin can be effective even when the toxin has penetrated the central nervous system (CNS) 15,18Since the clinical disease does not induce lifetime immunity, the infected patient should be routinely vaccinated post infection15. Thus, we started the patient on 3-dose series of tetanus toxoid and advised him to receive the third dose after discharge.The prognosis of tetanus is unfavorable, particularly in the untreated generalized form which is followed by cardiovascular collapse or respiratory failure 19. Fortunately, our patient did not develop any electrolyte abnormalities or end organ damage during the long period of hospitalization until aspiration pneumonia intervened which led to tracheal intubation and the need to ventialtory support.There is no doubt that national immunization programs have indeed abolished almost all cases of tetanus in developed countries. However, there are still a small number of cases, which present with ambiguous or non-specific symptoms such as dysphagia, neck stiffness, and other oropharyngeal symptoms portraying a prodromal state of the illness, which could eventually lead to full-blown generalized tetanus. Once developed or allowed to progress, it ultimately leads to respiratory or autonomic dysfunction necessitating long-term intensive care or even death in more severe cases.Another diagnostic challenge lies in the distinction between localized and other forms of this disease. The former involves muscle spasms limited to specific body areas with generally good outcomes, but rare cases go on to involving vital structures such as the cranial nerves leading to cephalic tetanus and increasing the risk of developing generalized tetanus with high mortality rates 7.Moreover, there have been reports of similar cases in the past whereby partially or completely immunized individuals have been misdiagnosed as suffering from illnesses other than tetanus and physicians have taken their immunization status for granted [8]. This highlights an important aspect of diagnosing this rare infection, considering some cases may even present without an acute wound as evident in our case and in another case series 9.Treatment of tetanus involves wound debridement, antibiotics to decrease bacterial load, and supportive care. Some studies have shown metronidazole to be more efficacious when compared to penicillin, as penicillin is thought to enhance inhibitory effects on neuromuscular junctions aggravating the disease further 10.The second step and the most vital aspect of managing this disease is the administration of tetanus immunoglobulin, which greatly reduces the mortality from generalized tetanus. It is generally recommended that tetanus accelerated immunization course should include immunization when the patient presents or is at high risk, at discharge, and 4 weeks later to confer concrete immunity and greatly reduce further risks.ConclusionThis case report acknowledges that tetanus is still a probability particularly in developing countries and in individuals who neglect to receive booster vaccine doses. In addition, this article signifies the fact that tetanus can present with atypical manifestations such as that happened for our patient who presented with psychiatric features; thus, a high index of suspicion should be undertaken for any patient with compatible findings.AcknowledgmentNot applicable.Conflict of interest:No conflict of interest was declared by the author.Author contributions:SM: took the lead in patient management and supervised work.ZM: conducted literature search on the topic and drafted and revised the paper.SMM: was responsible of the patient follow-up and wrote the drafts and final article.All authors read and approved the final manuscript.Ethical approval:Consent:Written informed consent was obtained from the patient to publish this case report in accordance with the journal’s patient consent policy.Reference:1. Thwaites CL, Loan HT. Eradication of tetanus. British medical bulletin . 2015;116(1):69.2. Mahmoud TM, Shawky JA, Abdelwahab NA. Atypical Presentation of Tetanus ‎. Afro-Egyptian Journal of Infectious and Endemic Diseases . 2024;0(0):259-264. doi:10.21608/aeji.2024.3760613. Megighian A, Pirazzini M, Fabris F, Rossetto O, Montecucco C. Tetanus and tetanus neurotoxin: From peripheral uptake to central nervous tissue targets. Journal of neurochemistry . 2021;158(6):1244-1253.4. Nadella P, Smith ER, Muhihi A, et al. Determinants of delayed or incomplete diphtheria-tetanus-pertussis vaccination in parallel urban and rural birth cohorts of 30,956 infants in Tanzania. BMC infectious diseases . 2019;19:1-11.5. Ljubez A, Čamo D, Mutevelić T. Can the nail damage be fatal? A case report of the tetanus in German Boxer.Veterinaria . 2024;73(3):250-255.6. Miranda-Filho DB, Ximenes RAA, Barone AA, Vaz VL, Vieira AG, Albuquerque VMG. Clinical classification of tetanus patients. Brazilian journal of medical and biological research . 2006;39:1329-1337.7. Ergonul O, Egeli D, Kahyaoglu B, Bahar M, Etienne M, Bleck T. An unexpected tetanus case. The Lancet Infectious Diseases . 2016;16(6):746-752.8. Seo SW, Lee J, Yoo BG, Kim J, Huh SY. Autonomic instability in severe tetanus: a case report.Annals of Clinical Neurophysiology . 2021;23(2):117-120.9. Thakur RK, Singh R, Nepal S, Ghimire P. An unusual case of tetanus masquerading as an acute abdomen: A case report. Clinical Practice and Cases in Emergency Medicine . 2020;4(4):599.10. Mallick IH, Winslet MC. A review of the epidemiology, pathogenesis and management of tetanus.International Journal of Surgery . 2004;2(2):109-112.11. Weiss MF, Badalamenti J, Fish E. Tetanus as a cause of rhabdomyolysis and acute renal failure. Clinical nephrology . 2010;73(1):64.12. Stirnemann U, Stirnemann H, Richterich R, Lundsgaard-Hansen P. Serum enzyme activities in clinical and experimental tetanus. Enzymologia biologica et clinica . 2017;8(1):7-20.13. Bucelli R, Harms MB. Neuromuscular emergencies. In: Seminars in Neurology . Vol 35. Thieme Medical Publishers; 2015:683-689.14. Rodrigo C, Fernando D, Rajapakse S. Pharmacological management of tetanus: an evidence-based review. Critical Care . 2014;18:1-10.15. Becker DG, Lineaweaver WC, Edlich R, et al. Management and prevention of tetanus. Journal of Long-Term Effects of Medical Implants . 2003;13(3).16. Tkachenko YA, Shkatula YV, Badion YO, Lekishvili SE, Khyzhnia YV. Current concepts in the management of tetanus. Published online 2020.17. Rodrigo C, Samarakoon L, Fernando SD, Rajapakse S. A meta‐analysis of magnesium for tetanus. Anaesthesia . 2012;67(12):1370-1374.18. Kabura L, Ilibagiza D, Menten J, Van den Ende J. Intrathecal vs. intramuscular administration of human antitetanus immunoglobulin or equine tetanus antitoxin in the treatment of tetanus: a meta‐analysis. Tropical Medicine & International Health . 2006;11(7):1075-1081.19. Karunarathna I, Kusumarathna K, Jayathilaka P, et al. Intensive Care Management of Tetanus: Current Strategies and Challenges. Uva Clinical Lab Retrieved from ResearchGate . Published online 2024.

Introduction:Cerebrovascular accidents (CVAs) following combined coronary artery bypass grafting (CABG) and mitral valve replacement (MVR) is a severe complication, with an incidence rate of approximately 7.4% [1]. We report a case of a 60-year-old man who presented to the hospital for an elective MVR complicated by ischemic stroke with hemorrhagic transformation and thrombus discovered on the replaced mitral valve during subsequent stroke evaluation. Some risk factors for CVAs in the perioperative setting include advanced age, prior cerebrovascular incident, peripheral vascular disease, carotid artery stenosis, prolonged cardiopulmonary bypass time, diabetes, postoperative atrial fibrillation, with the combination of CABG and MVR often compounding the risk [2]. The cause of a CVA can be thromboembolic, cardioembolic, or due to hypoperfusion. Diagnosis involves a clinical assessment of neurological deficits confirmed by imaging modalities such as computed tomography (CT) or magnetic resonance imaging (MRI) to identify areas of ischemia. The treatment of CVAs is tailored to the type and cause of the event, with ischemic strokes often managed by restoring blood flow (e.g., thrombolysis or thrombectomy), while hemorrhagic strokes require controlling bleeding and reducing intracranial pressure (ICP). Preventive measures, such as minimizing aortic manipulation during surgery, intraoperative epiaortic scanning and careful management of anticoagulants, are key in lowering CVA risk [3].Case presentation:A 60-year-old male with a past medical history of heart failure with reduced ejection fraction (HFrEF) (ejection fraction 30-35%), severe mitral regurgitation (MR), coronary artery disease CAD), marijuana use and hypertension (HTN) presented for elective MVR. At time of presentation, the patient’s vitals were all within normal limits. Physical exam revealed a systolic murmur on auscultation and the patient was euvolemic. Preoperative labs were all within normal limits and EKG revealed a normal sinus rhythm.The patient underwent cardiac catheterization which revealed moderate pulmonary hypertension, mitral stenosis and mitral regurgitation. Cardiac MRI was obtained as well which demonstrated ischemic cardiomyopathy with an Ejection fraction of 27%, mitral stenosis consistent with rheumatic etiology, mitral valve regurgitation, and LAD territories nonviable for revascularization, as demonstrated in Figure 1.

This paper presents a novel depth-based navigation system for quadrotors to enable autonomous flight in the GPS-denied environment. Our system leverages depth data transformed from the camera frame to the UAV’s local frame, and integrates this information with the onboard inertial measurements to counter drift of location signal. Using the radial basis function (RBF) filter, the system can efficiently identify passable area from the depth map, which are then used as inputs for a nonlinear model predictive control (MPC) framework. The integration of the perception and control components enables obstacle avoidance without requiring global positioning. Simulation tests demonstrate the effectiveness and robustness of this navigation system in maintaining safe, autonomous flight in unknown and GPS-denied environments. The actual experiment of traversing 100m long trees with an average speed of 5m/s also verifies the practicability of the proposed algorithm.

Modulating biological functions often relies on structural changes mediated by molecular switches. However, conventional achiral molecular switches designed to mimic biological regulation intrinsically fail to capture chirality-dependent processes. To address this limitation, engineered chiral molecular switches offer a promising strategy for elucidating the role of chirality in living organisms. Herein, we report a family of pH-sensitive, chromenoindole-based chiral switches ( CI-1 to CI-6) that exhibit distinct multicolor chromism—from yellow to azure—upon acid-induced ring-opening, generating the corresponding zwitterionic species ( ZI-1 to ZI-6). These switching processes are fully reversible and can be triggered by the addition of base, leading to original colorless solutions. Chiral chromatographic separation afforded enantiomerically pure molecular switches. By combining theoretical calculations with experimental circular dichroism (CD) analysis, we assigned the absolute configurations of (5aR,10bR)/(5aS,10bS)-CI-3, CI-4, and CI-5. These chiral switches exhibited attenuated chiral signals upon ring opening due to the loss of one chiral center, with full signal restoration upon neutralization. This family of structurally simple yet functionally versatile chiral switches offers both mechanistic insights and practical potential for the development of smart materials.

BACKGROUND Food ladders (FLs) are increasingly utilised for the management of children with food allergy. We aimed to characterise the utilisation of FLs among ASCIA-affiliated healthcare professionals (HCPs) in Australia and New Zealand (NZ) focusing on cow’s milk, egg, soy and wheat allergies. METHODS A quantitative survey approach was employed using a structured questionnaire comprising 20 questions. Measures included demographics, indications for FL usage, timing strategies for reintroduction when ladder steps are not tolerated and scenario-based decision-making. Descriptive statistical analysis explored similarities and differences in practice among respondents. RESULTS Seventy respondents participated in the study, comprising doctors (72%), nurses/nurse practitioners (14%) and dietitians (14%). A mixture of public and private HCPs were represented, primarily involved in paediatric care (93%). Seventy-one percent of respondents utilised food ladders for both non-IgE and IgE-mediated allergies, employing diverse strategies such as providing recipes (65%) or home food introduction protocols (68%). FLs were frequently recommended in patients with non-anaphylactic IgE-mediated allergy (67% for milk and 79% for egg) and much less so in patients assessed as having had an episode of anaphylaxis (13% for milk and 19% for egg). CONCLUSION Our study highlights widespread adoption of FLs among ASCIA-affiliated professionals for managing food-allergic children. Substantial variability exists as to implementation practices, the largest differentiating factor in our cohort being based on history of allergy severity. Further research into indications for FL usage, optimal timing of commencement and other pragmatics of implementation is warranted.

Background: The ultrasonographic diagnosis and prognosis for curb in Thoroughbred racehorses is poorly documented. Objectives: To describe the clinical and ultrasonographic features, treatment and outcome of curb in a Thoroughbred flat racing population. Study design: Retrospective case series study Methods: Cases with ultrasonographic evaluation of curb were retrieved from medical records at the Hong Kong Jockey Club from 2006 to 2025. Data analysed included signalment, clinical presentation, ultrasonographic findings, treatment, rehabilitation period, and performance indices. Results: 32 limbs of 27 horses were affected; plantar fasciitis was present in all cases, superficial digital flexor tendonitis in two limbs (6%) and long plantar ligament desmitis in one limb (3%). The left (n=17), right (n=5) or both hindlimbs (n=5) were affected. Treatment included a variable period of rest and variable use of systemic and local anti-inflammatory medication, cold therapies, radial pressure wave therapy, focused shockwave therapy, class IV therapeutic laser and therapeutic ultrasound. Horses resumed trotting, galloping and racing within a median 20 days, 58 days 108.5 days respectively. The prognosis for return to racing without re-injury was good with 92.3% of horses that underwent a rehabilitation program racing after injury. There was a low recurrence rate, with curb-related lameness recurring in two horses after resuming trotting exercise necessitating more time walking. Main limitations: Limited case number, variable quality and completeness of stored ultrasound images and clinical notes, and multiple factors that can affect racing outcome. Conclusions: Periligamentous and peritendinous fasciitis is the predominant ultrasound finding in flat-racing Thoroughbred horses. Involvement of the underlying superficial digital flexor tendon and long plantar ligament is unusual. The prognosis for return to racing is favourable following adequate rest and rehabilitation.

Financial markets represent one of the most complex and dynamic environments where traditional prediction models consistently fail to provide sustainable competitive advantages. This study presents a novel Deep Reinforcement Learning (DRL) framework that addresses the fundamental limitations of conventional machine learning approaches in stock market prediction and portfolio management. Our research systematically evaluates seven traditional machine learning algorithms, including K-Nearest Neighbours, Decision Trees, Support Vector Machines, AdaBoost, Random Forest, Multi-Layer Perceptron, and Kolmogorov-Arnold Networks, for stock price movement classification. This evaluation demonstrates that these methods perform no better than random classifiers when applied to financial data without sophisticated preprocessing.

This research presents a comprehensive study on cryptocurrency price prediction by integrating traditional financial modeling techniques with social media sentiment analysis. Considering the high volatility and sentiment driven nature of digital assets conventional models often fall short in delivering accurate forecasts. To address this gap, we conducted a multi-dimensional investigation encompassing a systematic review of 50 scholarly studies. an empirical analysis of over 25 million cryptocurrency related tweets and the application of quantitative methods including correlation matrices, Vector Autoregression (VAR) and Granger causality tests. Our findings reveal that social media metrics such as tweet volume, retweets, favorites and sentiment polarity serve as statistically significant predictors of market volatility. The correlation matrix confirms strong associations between sentiment indicators and price fluctuation while the VAR model and Granger causality analysis provide evidence of temporal and predictive causality. These results demonstrate that public discourse on platforms like Twitter can offer valuable foresight into market dynamics. The research further outlines practical implications for developing sentiment-enhanced predictive models including deep learning architectures (e.g., LSTM, GRU) and ensemble approaches (e.g., XGBoost). By validating the role of social sentiment in shaping market behavior this study contributes to the growing body of literature in behavioral finance, financial technology and data-driven trading. Ultimately, the proposed framework offers a forward-looking approach for academic researchers, financial practitioners and policymakers aiming to navigate and model the evolving landscape of cryptocurrency markets.

C-glycosyltransferases from glycosyltransferase family 1 transfer sugar moieties to carbon atoms in substituted aromatic rings of various small molecules. They are coveted biocatalysts for the synthesis of high-value glycosides since the resulting 𝛃- C-glycosidic linkage is usually more stable in vivo and in vitro than its O-glycosidic counterpart. One of the main bottlenecks in biocatalytic glycosylation processes of small molecules is the low aqueous solubility of the acceptor substrate, drastically limiting product yields. One solution is to conduct the reaction in organic solvent, providing the enzyme activity is preserved. Salt-tolerant organisms often have enzymes that are tolerant to organic solvents. In this work we report the discovery and characterization of three novel C-glycosyltransferases from halophytes ( i.e., salt-tolerant plants) through sequence mining. All enzymes converted phloretin to its C-glucosides efficiently with high regioselectivity and surprisingly exhibited significantly enhanced conversion yields in the presence of acetonitrile or methanol – up to 1563% for the enzyme from Trifolium fragiferum (TfCGT) in 30% methanol. The halophytic C-glycosyltransferases had activity maxima at 55 – 65 °C and pH 8.7 – 10.0. They exhibited varying chemostability profiles towards their substrate, with the newly described enzyme from Phragmites australis (PaCGT) performing remarkably well at low enzyme and high phloretin conditions. In line with the extreme adaptations of their hosts, halophytic C-glycosyltransferases might have evolved to perform better in water-restricted conditions ( e.g., in highly saline or arid habitats), thus carrying great potential for industrial glycosylation processes with reduced enzyme and increased aglycon concentrations.

Here, we study connections between (quasi-equationally) critical and relatively sub-directly irreducible members of [finitely-generated] quasivarieties [subsuming those between former ones and critical sets and enabling one to reduce the task of finding latter ones to that of former ones. We then demonstrate the usefulness of our universal elaboration by applying it to quasivarieties of {De} Morgan lattices, the finite lattice of which was found in an earlier work of ours.] 2020 Mathematics Subject Classification. 06D30,

Title- ”Targeted Therapy Meets Precision Radiotherapy: Fractionated stereotactic Radiotherapy for Solitary Extradural Renal Cell Carcinoma Metastasis on Cabozantinib”

Events with extreme magnitudes of geomagnetically induced currents (GICs) in the power transmission lines on the Kola Peninsula and Karelia for the quasi-solar cycle 2012-2022 are analyzed. GIC recordings from auroral Vykhodnoy (VKH) and subauroral Kondopoga (KND) sub-stations together with data from near-by magnetometers have been examined. Extreme bursts of GIС are mainly observed in the pre-midnight and post-midnight magnetic local time sectors during substorms. From 92 extreme events (GIC >20 A) at sub-station VKH 53.2% were caused by CME magnetic storms, 34.8% occurred during CIR storms, 3.3% are caused by SC/SI and 8.7% occurred during substorms without magnetic storm. From 31 extreme events (GIC >5 A) at sub-station KND 80.6% were observed during CME storms, 12.9% occurred during CIR storms, and 6.5% took place without a magnetic storm. Therefore, for the prediction of the space weather impact on power lines, both CME and CIR storms and even non-storm intervals should be taken into account. Maximal GIC magnitude grows on average with an increase of geomagnetic field variability dB/dt, but for many events the actual GIC is less than the maximal possible value due to a localized nature of magnetic field disturbance. There is no clear linear dependence of the GIC amplitude on the parameters of the interplanetary medium (V, Es, ε) and geomagnetic indices (IE, AE, SYM-H), which indicates the difficulty of predicting GICs in particular technological system. On average, with an increase of the intensity of magnetic storm (SYM-H), substorm (IE index), higher GIC values are registered.

The main contribution of this paper is to provide a systematic review, following PRISMA - Preferred Reporting Items for Systematic Reviews and Meta-Analyses - of findings in researches that integrate computer vision algorithms in embedded hardware applied in the agriculture domain. Scopus, Web of Science, and IEEE Explorer were used as information sources, totaling 82 selected papers to compile the results. The results of the current review were categorized and shown in five main groups. The first one is related to the findings of countries' contributions and the analysis of the increase in the number of publications over the years. Followed by the cultivar domain, and agricultural tasks performed in the reviewed papers, where trends and patterns in these tasks are shown. Plant disease identification is the largest target area studied in the reviewed papers. The next one is regarding an analysis and discussion about the embedded hardware and hardware accelerator used in the researches, and also discusses patterns about the metrics used to measure its performance. Rapsiberry Pi and NVIDIA Jetson portable GPU are the most commonly used embedded hardware A section about the datasets development and data acquisition process is also presented, discussing patterns and opportunities in this process for further work. Several papers did not clearly mention how the datasets are built or acquired. The last section discussed the algorithms used and developed in the reviewed papers, as well as the techniques and optimizations in these papers, and metrics were also evaluated. This section identified three base patterns, the largest one is the use of deep learning models in computer vision tasks, followed by the usage of classical computer vision, and some papers opted for the use of models that fuse deep learning with classical in the same algorithm.

Fine-grained image recognition aims to achieve classification of subclasses by processing detailed features, which is still a critical problem to be solved in computing due to the small differences between subclasses. Most of the work extracts the detected features by reusing the backbone network or by using RPN (RegionProposal Network), these operations undoubtedly increase the complexity of the work. In recent years, Transformer has shown satisfactory performance in vision tasks. Transformer decomposes input images into patch of the same size, and classifies the input images by computing the attention scores between patches multiple times and weighting them. In this paper, we propose the PIFM (Patch Impact Factor Module) with reference to the SENet. Specifically, the weight calculation is performed on the patch obtained from each transformer layer calculation, then the patch is fused using the calculated weights. The result of the weight calculation represents the importance of the patch and indicates the factor by which the network should fuse the patch. To verify the effectiveness of our method, we conducted experiments on the CUB-200-2011 and stanford-dog datasets.

Objectives: A cross-sectional study was conducted to understand the role of weight concerns, emotion regulation, stress, anxiety and depression in the expression of eating disorders (ED) symptoms among university students in 2019, at pre COVID-19, and in 2022, at post-pandemic. Method: A total of 845 students completed the Depression, anxiety, stress questionnaire-21, the Difficulties in emotion regulation scale and the Weight concerns scale as part of a campus-wide campaign that aimed to raise awareness on psychological well-being among students, conducted at pre- and at post- pandemic. Multiple hierarchical regressions were run to test the effects of emotion regulation, stress, anxiety, depression and weight concerns on ED symptoms, controlling for participants’ age and sex. Results: Results showed significant increases in students’ levels of stress, anxiety, depression as well as higher emotion regulation difficulties at post-pandemic. There was also, significant effects of anxiety and emotion regulation on ED symptoms across both years whereas

This study investigated the impact of Heartfulness Meditation (HM) on alpha power modulation in individuals with varying meditation experience. Thirty-three participants were grouped into long-term meditators (LTM, n = 12), short-term meditators (STM, n = 11), and nonmeditator controls (CG, n = 10). EEG data were recorded using a 129-channel system across four experimental conditions: baseline, meditation, transmission, and postrest. Signals were preprocessed through a rigorous pipeline including bandpass filtering (8–12 Hz), artifact removal via RANSAC and ICA, and alpha power estimation using Welch’s method. Linear mixed-effects modeling revealed a significant three-way interaction between Group, Phase, and Region (p < 0.001), indicating that alpha power modulation varied by brain region and meditation phase. Follow-up contrasts showed that both LTM and STM groups exhibited significantly greater alpha power than controls, particularly in the frontal, parietal, and occipital regions during meditation and postrest phases. These effects were most prominent during the early meditation phase (M1) and sustained across transmission and postmeditation states. Effect size analyses confirmed moderate-to-large group differences (d = 0.52–0.65), with the strongest effects observed in the right parietal and frontal cortices. These findings suggest that regular HM practice enhances alpha activity associated with relaxation, attentional regulation, and emotional processing. The study supports the potential of Heartfulness Meditation as a nonpharmacological approach to promoting cognitive and affective well-being.

A document by Isabella Zappala. Click on the document to view its contents.

Brain criticality has emerged as a rapidly growing focus of research among neuroscientists and physicists. The latest experimental evidence suggests that even isolated neurons display signs of criticality. Using a stochastic type-I parametrization of the Hodgkin-Huxley model we investigate the origin of these critical dynamics. We show that the model adequately approximates the experimentally observed behavior, as it reproduces the qualitative relationship between the critical state and both the applied external stimulation and the spiking rate. External white noise further enhances any pre-existing intermittency but cannot by itself toggle the system into a critical state. The emergence of the critical state is conditional on the system's proximity to its spiking bifurcation point and any divergence from it results in the abolition of the dynamics. Treating the neuronal membrane as a complex self-organizing system composed of interacting ion channels, we discuss the possibility of an underlying absorbing phase transition and propose that the observed dynamics result from an almost critical state.

A document by Nisha V. Click on the document to view its contents.

Age determination is essential in ecological and conservation research, particularly for long-lived species, including cetaceans. Age data provide insights into life-history traits, including maturation, longevity, and population dynamics. In addition to determining age in years, estimating birth periods at a finer temporal resolution allows for the analyses of birth seasonality, early development of behavior, and mother-infant interactions. However, comprehensive age datasets for wild cetacean populations are scarce. This study presents a dataset of the age (in years) and estimated birth period of Indo-Pacific bottlenose dolphins (Tursiops aduncus) around Mikura Island, Japan. Age determination was based primarily on long-term individual identification surveys initiated in 1994. Two methods were used to estimate the age of individuals with unknown birth years: (1) speckle pattern analysis; and (2) epigenetic clock analysis using DNA methylation from fecal samples. Age data were available for 84.4% of all individuals identified in the Mikura population (n = 313), including 172 individuals with known birth years, 118 individuals with estimated ages based on speckle pattern analysis, and one individual whose age was estimated using epigenetic analysis. Birth periods were inferred from field observations recording the interval between the mother’s last solitary sighting and her first sighting with a newborn. Birth periods were determined for 120 neonates, with at least 75.7% of births occurring before July and 94.7% occurring before August. This dataset provides a valuable resource for studying life history, population dynamics, and conservation strategies of T. aduncus and offers a methodological framework for age estimation in cetacean populations.

Some inappropriate ways of activism, like road blockage, art vandalism, assaults, etc., have been recently conducted and risked causing adverse repercussions, including violence escalation. The study explores which types of environmental activism are more likely to escalate violence between activists, affected citizens, and police. Bayesian Granular Interaction Thinking Theory (GITT) analytics was employed to analyze a dataset of 89 blockage, vandalism, and harassment cases in 13 countries in this exploratory study. We discovered that rallies and demonstrations, marches, event disruption, and art vandalism were less likely to escalate violence between protestors, other citizens, and the police. In contrast, road blockades and assaults are more likely to lead to violence escalation. Apart from those, sabotage was found to have an ambiguous relationship with the violence escalation. We suggest that climate activists should be more selective in adopting activism approaches to raise public awareness and support and avoid using tactics that might be counterproductive.

not-yet-known not-yet-known not-yet-known unknown With the development of social media and the rapid expansion of cultural capital in this field, fan communities have attracted widespread attention in academia in recent years. However, various understandings exist in academia concerning the concepts, behaviors, and culture of fan communities, which necessitate a more comprehensive explanation. This study establishes a theoretical framework by combining the research perspectives of social concept and cultural capital and selects the Chinese fan communities, which has the largest number of fans and the most substantial fan economy, as the research object. Based on the comprehensive understanding of fan communities research materials obtained through field investigations, this study analyzes and interprets three social concepts in fan communities: the imagined concept between fans and celebrities, the real concept between fans, and the implicit concept between fans and popularity. The research results show that fan communities, enveloped by these three social concepts, appear to be free but are, in fact, controlled communities. The controlling factors of fans include capital from outside the community, as well as the imagination, interaction, and organizational rules within the fan communities. The phenomenon of cultural capital creating and dominating the social concept of fan communities warrants further study and attention.

Trevor A. Jackson1,2, Miguel Nájera-Rincón3, Sulav Paudel1, Mitchell K. Weston1, Amy Beattie1, Sean D.G. Marshall1.1AgResearch, Lincoln Tuhiraki, New Zealand;2Biocontrol for International Development, Christchurch, New Zealand.3Instituto Nacional de Investigaciones Forestales, Agrícolas y Pecuarias (INIFAP), Michoacán, México.Correspondence; trevor.jackson@agresearch.co.nzSummary