Cancer is a recursive biological error of tempo-where systemic harmony is displaced by high-frequency physiological discord. This paper proposes that long-term therapeutic success in oncology correlates not solely with tumor shrinkage, but with the restoration of low systemic tempo, especially through stabilized, reduced blood pressure protocols. We build upon prior tempo-based frameworks to advance a radical hypothesis: that lower-than-baseline, controlled hypotension is not a side effect of chemotherapy-it is a required physiological state for recursive coherence and tumor regression. This abstract reframes oncological focus from cellular annihilation to rhythmic correction, emphasizing circulatory tempo, metabolic entrainment, and recursive feedback loops as interventional leverage points. Our proposal shifts the clinical lens from warfare to rhythm management, and redefines success as the reestablishment of harmonic systemic oscillation.

The increasing adoption of digital technologies across industries has significantly transformed organizational processes, services, and customer interactions. However, this digital transformation has also exposed organizations to a wide range of cybersecurity threats and vulnerabilities. This study examines the level of cybersecurity readiness among organizations in the context of digital transformation. It explores how well-prepared institutions are to prevent, detect, and respond to cyber threats while undergoing digital change. The research utilizes a survey-based methodology, collecting data from professionals in IT, cybersecurity, and management roles across different sectors. The results indicate that while most organizations recognize the importance of cybersecurity, many still lack structured frameworks, adequate employee training, and regular risk assessments. The study concludes that enhancing cybersecurity readiness requires a strategic alignment between technology adoption and security practices, supported by leadership commitment and a culture of continuous improvement. The findings offer practical recommendations for improving cybersecurity readiness and contribute to the ongoing discourse on secure digital transformation.

Author: Maxwel Adriano AbeggAffiliation: Institute of Exact Sciences and Technology (ICET), Graduate Program in Sciences, Technology and Health (PPGCTS), Federal University of Amazonas (UFAM), Itacoatiara, Brazil ORCID: 0000-0002-0328-1122 Abstract Invasive fungal infections—Candida auris, Aspergillus fumigatus, Cryptococcus neoformans—carry 40–90% mortality in immunocompromised patients. We conducted an automated literature and web survey via ChatGPT o4-mini, generating 750 vector–linker–payload hypotheses. Applying stringent filters (RDKit SA ≤ 4; ≥ 90% stability at pH 7.4; t₁/₂ < 60 min under trigger; predicted docking) yielded 25 top-ranked antifungal conjugates. Although based solely on automated evaluation, we publish these designs to stimulate in vitro testing and future therapeutic development. We present mechanistic rationales, linker selection, synthetic outlines (expected yields: 15–40%), and validation assays (cytotoxicity, resistance induction, biofilm models) to guide experimental efforts.  Keywords: Antifungal Conjugates, Multitarget Drug Design, Artificial Intelligence in Drug Discovery, Fungal Pathogens, Vector–Linker–Payload Strategy, In Silico Screening

This article develops a variational formulation for modeling a protium hydrogen molecular ionization obtained through a high temperature scalar field and an appropriate electric one action. The results are based on standard tools of calculus of variations and optimization theory. Finally, we highlight the context here addressed is essentially an Euler-Bernoullian one and includes the establishment of a new approximate Bernoulli-interacting-gas type equation.

A system, when recursive, folds in upon itself-its mechanisms re-entering their own cycle, reinforcing their own persistence. Life, too, is recursive, a pulse of energy endlessly seeking restoration through equilibrium, disruption, and adaptation. HIV, embedded within the rhythm of biological systems, is no different-it thrives within its own recursion, hiding in latency, evading detection, manipulating cellular cycles to ensure its survival. But what if its recursion could be broken? What if extreme conditions-pressure modulation, vascular redistribution, hydrogen bioavailability-could force the virus into exposure? Not merely forcing it into visibility, but ensuring that visibility leads to systemic collapse. A full unraveling. A point of no return where HIV's survival mechanism fails, caught within the recursive force of its own exposure. This paper presents a new paradigm-an engineered biological environment that cancels latency, rendering HIV incapable of retreat. By leveraging metabolic stressors, high blood pressure redistribution, and molecular hydrogen modulation, we disrupt HIV's recursive cycle, forcing viral activation under conditions that eliminate its ability to persist. A system that collapses its own recursion is a system that ceases to exist.

Traditional feedback analysis methods are inadequate for extracting detailed insights from customer reviews, surveys, and opinions. They fail to identify specific topics, features, sentiments, and temporal references, making it difficult for businesses to understand customer concerns and competitive positioning. This paper presents a comprehensive framework that integrates Named Entity Recognition (NER), quintuple extraction, comparative opinion analysis, and coreference resolution to provide structured feedback analysis. The system employs advanced Natural Language Processing techniques with Retrieval-Augmented Generation (RAG) using FAISS vector databases for contextual similarity search. The approach utilizes specialized agents powered by Large Language Models (LLMs) to extract actionable insights including target objects, features, sentiments, opinion holders, and temporal references. The framework supports both single review analysis (up to 8,000 words) and batch processing capabilities. Experimental evaluation demonstrates significant improvements in feedback comprehension and business decision-making capabilities. The system addresses key limitations of traditional approaches by providing structured, disambiguated, and contextually-aware feedback analysis suitable for real-world business applications.

A Case Report on Disseminated Mycobacterium Avium Complex Infection in an Otherwise Healthy Individual - A Diagnostic Challenge

Case ReportTitle： Fatal diarrhea due to systemic AL amyloidosis associated with multiple myeloma: a report of a rare caseKey words: AL amyloidosis, multiple myeloma, gastrointestinal tract, case report.

Background: Exercise is an important part of a healthy lifestyle for people with cystic fibrosis (CF). Exercise testing is also recommended as part of a routine assessment to provide physical activity counseling/exercise prescription. Body composition assessment is also an important assessment to can also guide dietary counseling. Prior studies have found that exercise testing and exercise training programs are underutilized in CF care centers, and no one has assessed the prevalence of body composition assessment. Thus, the purpose of this study was to develop and validate a survey to explore the barriers and facilitators that obstruct or promote the use of exercise and body composition testing in the CF care centers. Methods: Seventy-nine individuals with expertise in exercise and CF were invited to participate in a Delphi study. They rated the importance and quality of a 106-item survey on exercise and body composting testing and exercise training and shared their feedback. Results: Thirteen subject matter experts (SMEs) agreed to participate in the study, which lasted 3 rounds, but only 6 of them were in the final round. Of the 106 original items, 46 were kept with revisions, 58 were revised, 2 items were dropped, and 8 items were added, resulting in a final survey of 114 items. Conclusions: This Delphi study validated a survey to be used in CF care centers to provide valuable information about the benefits and barriers to exercise testing, exercise training, and body composition assessment in people with CF in the CFTR-modulator era.

Arboviral diseases, transmitted primarily by Aedes mosquitoes, represent a growing global health challenge. The spread of dengue, Zika, chikungunya, and yellow fever has been exacerbated by factors such as climate change, urbanization, and increased global mobility. We conducted a comprehensive analysis of recent studies, utilizing molecular surveillance data, vector dynamics, and outbreak reports (Registered in the PROSPERO system with code CRD42021231605). The review highlights the significant role of climate change in expanding vector ranges and the increasing genetic diversity of circulating viral strains. Key findings include the rapid evolution of arboviruses in response to environmental and host pressures, the challenges posed by insecticide resistance, and the promise of innovative control measures, such as genetic modifications of mosquitoes. The review emphasizes the need for integrated global efforts to enhance early detection, strengthen public health responses, and develop broad-spectrum vaccines to combat these diseases effectively.

This document presents a mathematical formalism for the study of Causal Graphs with Dynamic Trace (GCTD). It defines their fundamental structures, their algebraic and topological properties, and explores the intrinsic dynamics of accumulation, dissipation, and generation of "novelty" of the causal trace. The goal is to establish the foundations for a new field of research in discrete mathematics and network theory, with potential intersections with category theory, algebraic topology, and complex dynamical systems. A particular focus is placed on structural covariance properties and the emergence of aggregate concepts such as measures of "volume," "depth," "entropy," and "expansion" from this discrete structure.

Abrus precatorius a herbaceous flowering plant belonging to the Fabaceae (bean) family is extensively utilized in traditional medicine across India and tropical and subtropical regions of Asia, including China, Indonesia, and parts of South Africa. This study focuses on extracting oil using purified A. precatorius seeds, Eclipta prostrata leaves (Karisalankanni keerai), and sesame oil. The formulated oil was assessed for its physical properties, including a density of 0.88 g/cm³, 0.41% moisture content, 0.8820 specific gravity, and 0.01% ash content. Additionally, its physicochemical characteristics were analyzed, revealing a free fatty acid content of 2.96%, an iodine value of 58.3 mgI₂/g, a peroxide value of 4.2 mEq/kg, an acid value of 5.90 mgKOH/g, a refractive index of 1.4620 at 40°C, a saponification value of 221 mgKOH/g, and a total phenolic content of 1.5 mgGAE/g. The obtained results were compared with those of other oils, and the extracted oil was further examined for its total fatty acid composition and the formulated oil comprises 99.43 g of total fat per 100 g, with monounsaturated fatty acids (MUFA) constituting 42.05%, polyunsaturated fatty acids (PUFA) 40.42%, saturated fatty acids (SFA) 16.96%, and trans-fatty acids (TF) present in negligible amounts (<0.05%). Additionally, its shelf life was evaluated to ensure its quality and stability.

Introduction

We rigorously define and develop the fixed-point identity φ∞(S) ≡ S as a self-referential transformation with curvature in the sense of an iterative process that loops back onto its origin. Within the framework of Alpay Algebra, we treat φ∞ as a transfinite recursive operator over closed symbolic systems S. We formalize φ: A → A as an endofunctor on a small cartesian closed category, and define the k-th iterate φᵏ(S) and the transfinite limit φ∞(S). Leveraging category-theoretic constructions (endofunctors, natural transformations, and limit objects) and ordinal-indexed induction, we present lemmas and theorems that connect classical fixed-point results with φ∞-curvature. Each result is derived in a way that recursively validates its own provability. The main theorem, referred to as Alpay Theorem I: Transformational Fixation, establishes the self-referential identity φ∞(S) ≡ S. Its proof is structured as a recursive (non-linear) proof sketch, which avoids a terminal conclusion and instead demonstrates a recursive return to the premise. We illustrate the φ-curvature with a commutative diagram: S → φ(S) → φ²(S) → ⋯ → φ∞(S), where the final arrow φ∞(S) → S is labeled as an equivalence (≡) rather than a categorical isomorphism. In a concluding discussion, we interpret φ∞(S) ≡ S not merely as a fixed-point equation but as an involutional transformation that collapses meta-theory into object-level reconstruction. In particular, φ∞ absorbs any potential contradictions into its own curvature, making φ∞(S) ≡ S internally unfalsifiable by external means. Permanently archived on Arweave.

This work extends the foundational framework established in Alpay Algebra III to recursive curvature structures in φ^∞ manifolds. Given an initial curvature state χ₀ in a φ^∞ manifold, successive curvature increments δχ₁, δχ₂, δχ₃ generate evolved states χ₁, χ₂, χ₃. We establish χₙ₊₁ = χₙ + δχₙ₊₁ under torsion-free conditions for n = 0, 1, 2, yielding χ₃ = χ₀ + δχ₁ + δχ₂ + δχ₃. The composite curvature operator δχ₃ ∘ δχ₂ ∘ δχ₁ closes the curvature loop in a nine-fold composition, preserving the agent's trace in the φ^∞ manifold.

DBP, a representative PAR leucine zipper transcriptional activator intricately involved in circadian rhythm regulation, has garnered considerable attention for its potential therapeutic role in ameliorating metabolic disorders and modulating pharmacokinetic processes. In this review, we systematically elucidate the mechanisms underlying DBP’s involvement within the circadian rhythm regulatory network and its subsequent influence on pharmacokinetics. DBP, functioning as a D-box binding protein, is transcriptionally regulated by the CLOCK/BMAL1 signaling pathway and interacts synergistically with ROR/REV-ERB-mediated transcriptional regulation of NFIL3, ultimately controlling the expression of core circadian genes, such as PER. Furthermore, DBP significantly affect drug absorption and metabolism in peripheral tissues by modulating various drug-metabolizing enzymes, transporter proteins, and hormonal pathways. These findings underscore the potential of DBP as a key regulator of circadian rhythm disorders and a pivotal factor in optimizing drug bioavailability. The comprehensive summary presented herein highlights DBP’s clinical significance in addressing circadian-related pathologies, managing associated chronic diseases, and improving pharmacotherapeutic efficacy. Additionally, this review provides novel insights and therapeutic targets that could inform future advancements in drug delivery systems and pharmacological research.

Biliary Atresia with Situs Inversus Abdominalis Managed by Kasai Portoenterostomy: A Case Report from Muhimbili National Hospital, Tanzania.Rajabu Athumani Bakari1,2*, Alfred Chibwae1, Brian Kimanthi1, Tariq Aziz3, Georvin Marco Haule1, Novath Ngowi1, Ally Hamisi Mwanga1, Zaitun M. Bokhary21 Department of Surgery, School of Medicine, Muhimbili University of Health and Allied sciences, Dar es Salaam, Tanzania.2 Department of Surgery, Muhimbili National Hospital, Dar es Salaam, Tanzania.3Department of Radiology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.*Correspondence : Rajabu Athumani Bakari, Department of Surgery, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania. Tel: +255738297925; E-mail: rogerluhizo@gmail.com

Editor-in-ChiefClinical Case ReportsJune 5,2025Dear Editor-in-Chief,We would like to submit our manuscript entitled “Neglected inguinal hernia with endometriosis: A case report” for publication as a case report in Clinical Case Reports.Inguinal hernia with endometriosis is a rare and misdiagnosed situation in clinical practices. In this study, we report an unusual case of neglected inguinal hernia with endometriosis, presenting as a reversible mass in the right inguinal region without painful during menstruation. This case shows that caution must be exercised when diagnosing a groin mass in child-bearing period female, ultrasound and CT are useful for assessing lesions, and MRI can also help identify specific patterns.We believe this case will be of great interest to clinicians. As the premier international journal devoted to publish scientifically accurate and valuable research, Clinical Case Reports represents the perfect platform for us to share this case with the international research community.We confirm that this manuscript has not been published elsewhere and is not under consideration by another journal. All authors have approved the manuscript and agree with submission to Clinical Case Reports . The authors have no conflicts of interest to declare.Please address all correspondence to: Tao Yang, Department of Gastroenterology, Shaoxing People’s Hospital, Shaoxing 312000, China. taoyang2017@zju.edu.cn. Telephone: +86-15757193769We look forward to hearing from you at your earliest convenience.Yours sincerely,Tao Yang.Title pageCase ReportTitle ：Neglected inguinal hernia with endometriosis: A case reportJing-Jing Feng1, Li-Xin Li1, Tao Yang2*1Department of Gynecology, Shaoxing People’s Hospital (Shaoxing Hospital, Zhejiang University School of Medicine), Shaoxing,Zhejiang, China.2Department of Gastroenterology, Shaoxing People’s Hospital (Shaoxing Hospital, Zhejiang University School of Medicine), Shaoxing,Zhejiang, China.*Correspondence addressed: Department of Gastroenterology, Shaoxing People’s Hospital, Shaoxing 312000, China.Tel: +86-15757193769E-mail: taoyang2017@zju.edu.cnCONFLICT OF INTEREST:Authors declared no conflict of interest.ConsentThe patient’s written consent for the publication of this case report was obtained.Case ReportTitle ：Neglected inguinal hernia with endometriosis: A case reportKeywords: Inguinal hernia, endometriosis, round uterine ligament, cutaneous endometriosisKCMA 42-year-old female, gravida 3, para 1 (G3P1), presented to our general surgery department with a reversible mass in the right inguinal region for one month. She underwent tension-free repair for groin hernia, removing the uterine round ligament and the mass. The pathology result of mass was round uterine ligament endometriosis. The patient was followed up in gynecology outpatient clinic and received hormone therapy.1 | IntroductionEndometriosis(EMs) is a chronic gynecologic condition affecting around 10% in reproductive-aged women[1]. It is described as the presence of endometrial epithelial and stromal cells outside the uterus, frequently associated with infertility, dysmenorrhea, dyspareunia, chronic pelvic pain and urinary tract symptoms. The most common sites of EMs are ovaries, pelvic peritoneum, broad ligaments and uterosacral ligaments, can also occur in bladder, rectum, abdominal incision or umbilical cord [2]. However, cutaneous endometriosis is considered a rare form of EMs, the incidence of cutaneous endometriosis is approximately 5%[3]. Inguinal endometriosis (IEM) is a rare and misdiagnosed situation in clinical practice. Patients usually present with periodic distention pain. It is easily misdiagnosed as other diseases such as femoral hernia, inguinal leiomyoma, cysts and soft tissue tumors[4]. Patients with IEM were divided based on the site of occurrence. In type I, endometriosis exists at a hernia sac or hydrocele of Nuck’s canal. In type II, endometriosis originates in the round ligament. In type III, endometriosis locates in the subcutaneous area[5]. Here, we report an unusual case of inguinal hernia with endometriosis without clinical symptoms or surgical history.2 | Case Presentation2.1 | Case History and ExaminationA 42-year-old female, gravida 3, para 1 (G3P1), presented to our general surgery department with a reversible mass in the right inguinal region for one month. The patient had regular menstrual cycles and denied dysmenorrhea history. Physical examination revealed a 2*2cm, soft and no tenderness in the right inguinal region. The patient denied a history of pain and the VAS pain scores was 0. The patient’s tumor marker CA125 was 26.61U/ml, within normal range. Blood routine, hepatitis B, preoperative infectious disease examination, biochemical routine and so on were within the normal range. The mass disappeared after the patient was supine and the transmittance test was negative. Computed tomography (CT) of the hypogastric region revealed the inguinal region was widened, part of the abdominal cavity contents herniated, an 18*15mm nodular density shadow was seen in the left ovary(Figure 1).2.2 | Investigations and TreatmentComplete excision of both tumor tissue and round ligament is performed for pathological analysis. The hernia sac is identified and opened, hemostasis at its distal end is maintained while leaving it in situ, followed by detachment of its proximal segment up to the internal ring, where a high ligation at this site is executed. After thorough hemostasis, suturing of the transversus abdominis muscle layer occurs, with subsequent repair utilizing a 6*8 cm biological mesh patch secured to both the conjoint tendon and inguinal ligament as well as to the anterior sheath of rectus abdominis. The patient was in stable condition after surgery.2.3 | Outcome and Follow-UpFollow-up and outcomes: the round ligament of the uterus mass was sent for pathology department. The pathological result was round uterine ligament endometriosis, we considered this IEM was type II(Figure 2). She was counseled to our gynecology outpatient clinic review. The patient completed transvaginal ultrasonography finding no lesions and VAS pain scores was 0. Considering that the patient had no obvious symptoms and no indication for laparoscopic surgery, the ASRM table score could not be performed. Endometriosis was prone to recurrence, and 3 injections of GNRH were performed after surgery (Figure 3).3 | Discussion and ConclusionThis study discussed a patient with a right groin mass who underwent surgery at a surgical clinic with a pathological indication of IEM and was subsequently treated at an outpatient clinic. In a meta-analysis of 133 patients with inguinal endometriosis, the mean age of onset was 36 years, about half of the patients presented with a right inguinal mass, and 54.1% of the study patients presented with periodic inguinal pain[6]. However, CA125 is not elevated in all patients with IEM, in one study of 8 patients, 2 patients had above-normal levels[7]. In our case, CA125 was within the normal range, indicating that this indicator was not specific in IEM cases.According to the guidelines for the diagnosis and treatment of endometriosis, it can be divided into the following types: peritoneal endometriosis, ovarian endometriosis, deep infiltrating endometriosis (DIE), and other endometriosis (bladder, lung, umbilical, inguinal, appendix, rectum, nasal, breast), inguinal endometriosis is rare in domestic and foreign cases, the most typical manifestation is a mass in the groin area associated with menstruation[8]. At present, the pathogenesis of inguinal endometriosis is not clear. According to literature reports, the pathogenesis may be as follows: (1) endometrial reverse tubal implantation; (2) static transmission; (3) embryonic cells of the Mullerian canal are activated by hormones; (4) metaplasia of mesenchymal cells; (5) Adjacent pelvic lesions spread directly along the round ligament, the main principle is based on the theory of countercurrent implantation of menstrual blood and supracoelom metaplasia. IEM occurs in the extraperitoneal part of the round ligament, which may be related to the obstruction of the left sigmoid colon, gravity and clockwise peritoneal movement. The characteristic of the disease is the non-retrievable lump of the inguinal in the extraperitoneal part of the round ligament, the mass becomes large and painful during menstruation, often occurring in the right[9].The inguinal endometriosis is easily misdiagnosed as inguinal hernia or round ligament cyst. Imaging examinations such as ultrasound, computed tomography or magnetic resonance imaging (MRI) have a certain significance for diagnosis and evaluation[10]. However, the final diagnosis is based on histology and immunohistochemistry. Complete surgical resection must include the mass and the round ligament[11]. General surgeon surgery discovered significant hernial sac wall thickening, adhesion, sac with blood, cylindrical or peritoneal ligaments apparent thickening, should consider inguinal endometriosis. The surgeon should conduct intraoperative gynecological consultation when encountering such patients. For infertile patients, laparoscopic pelvic examination is necessary. In this case, the patient refused to undergo laparoscopy, Considering that it was easy to relapse after surgery, GnRHa was given for 3 cycles after surgery, there was no recurrence after surgery and further treatment follow-up is still under way. Due to the rarity of inguinal endometriosis, the number of cases is small, we cannot discuss the efficacy of postoperative hormone therapy in preventing recurrence. Therefore, more cases are needed for further statistical analysis of the effectiveness of surgical treatment and postoperative hormone therapy[12].In conclusion, inguinal endometriosis is a rare disease usually seen with menstrual cycle pain. However, caution must be exercised when diagnosing a groin mass. Ultrasound and CT are useful for assessing lesions, and MRI can also help identify specific patterns. Surgical is the primary treatment and recurrence is rare after surgical resection. When patients with pelvic endometriosis are combined, individualized treatment can be selected according to the patient’s age, fertility requirements, and lesion degree.Author ContributionsJingjing Feng: data curation, project administration, writing – re-view and editing. Li-Xin Li: data curation, investigation, writing– original draft, writing – review and editing. Tao Yang: investigation, writing – original draftAcknowledgmentsThe authors have nothing to report.ConsentThe patient’s written consent for the publication of this case report was obtained.Conflicts of InterestThe authors declare no conflicts of interest.Data Availability StatementThe data that support the findings of this study are available from the corresponding author upon reasonable requestReference[1]Zondervan KT, Becker CM, Missmer SA. Endometriosis. N Engl J Med.2020;382(13):1244-56[2]Chapron C, Marcellin L, Borghese B, Santulli P. Rethinking mechanisms, diagnosis and management of endometriosis. Nat Rev Endocrinol 2019;15(11):666e82.[3]Raffi L, Suresh R, McCalmont TH, et al. Cutaneous endometriosis. Int J Womens Dermatol 2019;5:384–6[4]Basnayake O, Jayarajah U, Seneviratne SA. Endometriosis of the inguinal canal mimicking a hydrocele of the canal of nuck. Case Rep Surg.2020;2020:8849317[5]Niitsu H, Tsumura H, Kanehiro T, Yamaoka H, Taogoshi H, Murao N. Clinical Characteristics and Surgical Treatment for Inguinal Endometriosis in Young Women of Reproductive Age. Dig Surg. 2019;36(2):166-172.[6]Dalkalitsis A, Salta S, Tsakiridis I, Dagklis T, Kalogiannidis I, Mamopoulos A, Daniilidis A, Athanasiadis A, Navrozoglou I, Paschopoulos M, Vatopoulou A, Kosmas I. Inguinal endometriosis: A systematic review. Taiwan J Obstet Gynecol. 2022 Jan;61(1):24-33.[7]Haghgoo A, Faegh A, Mostafavi SRS, Zamani HR, Ghahremani M. Inguinal endometriosis: a case series and review of the literature. J Med Case Rep. 2024 Mar 2;18(1):83.[8]Andres MP, Arcoverde FVL, Souza CCC, Fernandes LFC, Abrão MS, Kho RM. Extrapelvic endometriosis: A Systematic Review. J Minim Invasive Gynecol 2020; 27: 373-389[9]Sourial S, Tempest N, Hapangama DK. Theories on the pathogenesis of endometriosis. Int J Reprod Med 2014; 2014: 179515[10]Gaeta M, Minutoli F, Mileto A, Racchiusa S, Donato R, Bottari A, Blandino A. Nuck canal endometriosis: MR imaging findings and clinical features. Abdom Imaging 2010; 35: 737-741[11]Niitsu H, Tsumura H, Kanehiro T, Yamaoka H, Taogoshi H, Murao N. Clinical Characteristics and Surgical Treatment for Inguinal Endometriosis in Young Women of Reproductive Age. Dig Surg 2019; 36: 166-172[12]Sun ZJ, Zhu L, Lang JH. A rare extrapelvic endometriosis: inguinal endometriosis. J Reprod Med 2010; 55: 62-66

Optimizing Home Dialysis Outcomes in Continuous Ambulatory Peritoneal Dialysis Patients: A Retrospective Analysis of Domiciliary Continuity Care StrategiesAbstractPurpose: To explore the role of home visits by peritoneal dialysis teams in the management of recurrent peritoneal dialysis-related peritonitis. Methods: Retrospective analysis was made on the contents of home visits, guidelines and subsequent recurrence of peritonitis by peritoneal dialysis team of Shenzhen Hospital of Traditional Chinese Medicine in recent 10 years.Results:Patients who recommendations were followed showed the greatest improvements in the recurrence of PADP.The improvements were based upon the continuity of care for peritoneal dialysis under the direction of health care providers.There is a frequent lack of reported symptomatic improvement in those who miss visits. Conclusion: For patients with frequent peritonitis, in addition to the re-education and training of patients returning to the hospital, the increase of home visits by professional teams is helpful to timely help patients adjust the home dialysis environment and standardize the patient’s home fluid exchange behavior, so as to effectively prevent the recurrence of peritonitis.Key Clinical Message:The persistently high incidence rates of peritonitis associated with home-based exchanges among continuous ambulatory peritoneal dialysis (CAPD) patients necessitate an integrated outpatient-inpatient-home care continuum. Home visits optimize aseptic exchange techniques and environmental management, thus extending technique survival.Keywords: continuous ambulatory peritoneal dialysis, home visit, continuity care, peritoneal dialysis - associated peritonitis, environment managementIntroductionPeritoneal dialysis (PD) is one of the renal replacement therapies for end-stage kidney disease (ESKD) patients. Globally, 3.8 million people rely on dialysis each year, with PD accounting for approximately 11% of this population[1]. As of December 2022, the number of dialysis patients surpassed 1 million in China, with PD usage continuing to grow by 12%-15% annually. Compared with kidney transplantation and hemodialysis, PD offers advantages in terms of hemodynamic stability, simplicity, and lower economic burden. The most common PD method is continuous ambulatory peritoneal dialysis (CAPD), which accounts for 90% of PD patients. CAPD patients perform self-care and dialysis at home, with regular follow-ups at the hospital. Notably, contamination, gastrointestinal infections, catheter-related infections, and iatrogenic procedures can trigger CAPD-related infections[2]. The most commonly reported adverse event is peritoneal dialysis-associated peritonitis (PDAP)[3、4]. PDAP is a major cause of PD failure and patient mortality, contributing to 16% of direct or indirect deaths among PD patients[5、6]. To investigate the clinical outcomes of CAPD patients, we used the continuity care (home visit model) to explore relevant cases. Continuity care involves a series of evidence-based nursing interventions aimed at helping patients meet their health needs and transitioning care from the hospital to the home. This model has been shown to reduce infections and complications in PD patients[7、8]. This study reports on 17 CAPD patients and compares their outcomes before and after home visits, with the goal of exploring the role of home visits by peritoneal dialysis teams ,suggesting targeted solutions to improve self-management to improve the management of recurrent peritoneal dialysis-related peritonitis, ultimately extending dialysis duration.Materials and MethodsPatient Selection This single-center, retrospective study reviewed 17 CAPD patients from the nephrology outpatient clinic at Shenzhen Traditional Chinese Medicine Hospital in recent 10 years. The 2022 International Peritoneal Dialysis Association guidelines on PDAP were used to define PDAP for inclusion in the study:1)Clinical features of peritonitis, including abdominal pain and/or cloudy dialysate;2)Dialysate white blood cell count >100 cells/µL or polymorphonuclear leukocyte percentage >50%;3)Positive dialysate culture. Inclusion criteria1.Diagnosed PD patient on CAPD;2.Age ≥18 years;3.Clear consciousness and ability to cooperate with the study;4.Informed consent provided voluntarily.Exclusion Criteria Exclusion criteria included:1.Cognitive impairment;2.Critical illness or life expectancy <6 months;Additionally, patients with poor adherence were excluded to ensure the scientific validity and sustainability of the study.Preparation of Materials Face masks, blood pressure monitors, follow-up records, assessment forms, cameras, and recording devices were prepared.Home Visit Personnel The home visit team consisted of 1 peritoneal dialysis clinician and 2 peritoneal dialysis charge nurse, both with prior training in home visits.Home visits were conducted by our team who reviewed the patient’s general condition prior to obtaining consent for the visit.The visit schedule and route were planned, and after reaching the patient’s residence, the home care procedures were carried out. As no treatments or human trials were involved, ethical approval was not required. Informed consent was obtained from patients prior to the visit. All patients data were anonymized, eliminating the need for consent for data publication.Home Visit Key PointsPeritoneal dialysis carries out diffusion, ultrafiltration, and absorption activities through the peritoneum as a semipermeable membrane, and peritonitis is its major complication risk[9]. The patient’s living environment includes both the indoor environment and the surrounding environment.Since the cleanliness, ventilation status and bacterial load of the living environment will have an impact on the individual and population health[10], healthcare professionals need to focus on whether there are any pollutants around the outdoor environment, and whether the interior of the home can ensure sufficient light, good ventilation, and achieve regular cleaning(Table 1).As the home dialysis process is cumbersome, patients are required to have certain nursing skills and asepsis awareness, and it is best to have a separate dialysis space to facilitate ultraviolet disinfection and storage of related items.We also note that the placement of greenery and pets in the room, as well as the location of outlets for ventilation facilities also need to be documented.Next, the patient will need a clean area (preferably separate) to prepare the dialysate, dialysis equipment and cleaning supplies.Note that he needs to make sure that the dialysis fluid is at the right temperature, that the dialysis equipment is well sealed and within its shelf life, and that the cleaning supplies (e.g., sterile gloves, sterilized alcohol, etc.) are adequate and used in the correct manner.Before starting the operation, he needs to carefully wash and disinfect his hands, wear sterile gloves and mask, and then make the connection of the dialysis equipment.When the liquid flows into the peritoneal cavity through the catheter, observe the condition of the catheter outlet and the connecting tube, keep the outlet clean and dry, and avoid the catheter from being pressurized and entangled.Maintaining asepsis throughout the dialysis process and carefully cleaning and disinfecting contacted areas and equipment before and after fluid changes reduces the risk of infection.Such dialysis fluid changes will occur 3-4 times a day, with a 4-6 hour interval between each change.At the end of dialysis, patients are required to observe the color of the discharged fluid and the contents of the dialysis bag to rule out any signs of blood or turbidity.Properly dispose of what has been used and record the duration of dialysis, the amount of dialysate used, the amount of fluid drained and any symptoms (especially PD-related pain, gastrointestinal symptoms, depression and anxiety, itching, etc.).Case series presentationIn this systematic strategy, we have designed a total process of care approach for managing patients with CAPD. This strategy relies primarily on the outpatient and inpatient nephrology departments of Shenzhen Hospital of Traditional Chinese Medicine (SZTCM), extending to the patient’s home. During hospitalization, patients receive re-education and training on home peritoneal dialysis and establish a peritoneal dialysis file. After discharge, regular outpatient follow-ups are conducted, incorporating personal appointments and consultations through software such as WeChat, intelligent remote monitoring, and hospital infection surveillance to provide timely home care guidance. If patients experience abnormal symptoms after strictly adhering to the prescribed dialysis procedures at home, immediate arrangements are made for specialized outpatient or inpatient peritoneal dialysis treatment. Our team includes 5 dedicated peritoneal dialysis nurses and 4 physicians. Under this strategy, 17 patients received comprehensive care spanning inpatient, outpatient, and home-based services. We identified a genuine demand among dialysis patients for this deeper level of care.As demonstrated in Figure 1, PD home visit records were established for each CAPD patient, covering seven domains: family situation, pre-dialysis renal function assessment, PD prescription, related laboratory reports, adverse events, nursing evaluation, and training status. The home visit content included: the patient’s home hygiene environment, self-care methods, diet and nutrition, family support, medications, and dialysis materials (Figure 1). All patients received the same initial training, and these records were filled out based on verbal responses from patients and relevant medical records, managed by specialized PD nurses. We formed home visit teams of 3 personnel ( 1 doctors, 2 nurse), who conducted the visits after obtaining patient consent and signed informed consent forms. The goal was to observe whether continuous, standardized home visits could reduce the incidence of PDAP in home dialysis patients.In our study, 5 patients received routine home visit evaluations, 1 patient received a nurse visit for catheter change due to immobility, 11 patients underwent home visit evaluation after experiencing recurrent peritonitis of unknown etiology within six months after discharge.During the two home visits, we assessed the patients’ living environments to determine whether they were near roads, garbage stations, and crowded areas. We also ensured that the dialysis area was free from contamination and overcrowding, and that the dialysis room was clean and properly ventilated. We observed whether patients washed their hands and wore masks during dialysis procedures, and if sterile techniques were followed. After the first visit, all patients, except for one who experienced repeated peritonitis after relocating, showed no further occurrences of peritonitis.DiscussionThis study demonstrates a continuity of care-based peritoneal dialysis home-visiting strategy, including outpatient support and home-visiting appointments, and post-hospitalization peritoneal dialysis file management, with different components: duration and members of the home-visiting team, content of the home-visits, and methods of peritoneal dialysis training provided.A total care management strategy of inpatient-outpatient-home has been developed.The home visiting strategy has a long history of proven beneficial effects in chronic disease [11].Over the past decade, a home visiting strategy based on continuity of care has been successfully implemented in clinical practice, forming an organic link between inpatient, outpatient, and home, where patients are able to have an independent personal profile and home visit recommendations.This model greatly increases patients’ access to care and provides additional benefits: higher comfort than in-hospital dialysis, lower infection rates of peritoneal dialysis-associated peritonitis in the absence of physician guidance for home operations, and more.By practicing home visits, the outpatient team is able to dynamically keep track of patients, improve the quality of the peritoneal dialysis environment and provide community support.The International Society for Peritoneal Dialysis (ISPD) has incorporated home visits into the PD patient re-education guidelines. A survey by the Italian Society of Nephrology’s PD research group showed that 59.6% of PD patients in Italy receive home visits[12]. Recently, with the advancement of technology, healthcare professionals have begun using remote systems for virtual home visits to provide PD management services, although there is limited research evaluating patient-reported experience measures of PD care[13].Current home visit modalities predominantly rely on telephone communication, text messaging, and instant messaging platforms. As represented in Figure 2, we have innovatively developed a Peritonitis Mapping System (PMS) that integrates patient clinical data with geospatial visualization. This novel system enables graphical representation of peritonitis incidence among PD patients alongside relevant environmental factors - an approach not previously documented in existing nursing models. The implementation of this visualization-enhanced home visit paradigm provides a groundbreaking strategy for optimizing home-based management of PD patients, potentially establishing new standards for complication surveillance in domiciliary dialysis care.In this study, researchers sought to trace the etiology of peritonitis in these patients. Through the analysis of peritoneal fluid from patients, we identified Streptococcus species as the most common pathogens associated with peritoneal dialysis-related peritonitis in home-visited patients, including Streptococcus mitis, Streptococcus salivarius, and Streptococcus anginosus. Streptococcus species are Gram-positive bacteria, and studies have demonstrated that the proliferation of Gram-positive bacteria correlates with environmental contamination[14]. After conducting detailed reviews of medical histories and dialysis fluid exchange procedures, and excluding other risk factors, we performed home visits for peritoneal dialysis (PD) patients with recurrent peritonitis. The two home visits enabled healthcare professionals to gain initial insights into patients’ conditions and provide guidance on optimizing the home dialysis environment, operational practices, and dietary management. Patient feedback was incorporated into subsequent follow-ups to refine PD care. Patients were stratified into two groups based on peritonitis occurrence for standardized home visits. Results indicated that, except for one patient who experienced recurrent peritonitis after relocating to a new residence, no new episodes were reported among the remaining patients following the second home visit. Comparative analysis of peritonitis recurrence rates before and after home visits revealed substantial evidence indicating that the home dialysis environment may serve as a potential risk factor for frequently recurrent PD-associated peritonitis, a finding scarcely addressed in prior literature.The study’s findings, including the issues presented in the tables, were compiled into research data. After PD catheter insertion, patients established independent dialysis records managed by specialized personnel, who conducted training. The training included five key modules: health education, preparation and storage of materials, basic knowledge, sterile techniques, fluid balance, reasonable diet, and adequacy assessments. During each training session, nurses briefly reviewed previous content and conducted theoretical exams and Q&A during the final session. After completing the training, patients participated in regular follow-ups at the clinic. Healthcare professionals then conducted the first home visit, evaluating and guiding patients’ dialysis practices, improving their PD environment, and reducing the risk of PD-related peritonitis. After a period, a second home visit assessed peritonitis incidence and the impact of the home visit model on CAPD patients. The key findings are summarized as follows:1.High Self-Efficacy Correlates with Better Adherence in PDIn selecting participants for home visits, we found that patients with higher adherence were more consistent. Psychological studies[15] show that self-efficacy influences health information avoidance, with higher self-efficacy patients less likely to avoid their health information and more likely to adopt active coping strategies. Gaining experience enhances self-efficacy[16], which is critical in CAPD, as the process demands both operational skills and care knowledge. Therefore, assisting patients in mastering dialysis experience and improving self-efficacy is crucial for enhancing adherence. Research also shows that structured pre-dialysis education increases the use of home dialysis and helps patients choose the most suitable dialysis method[17].2. Home Environment Impacts Peritonitis Incidence in CAPD PatientsA retrospective study in a top-tier hospital in China indicated that the home dialysis environment and hygiene conditions directly impact the incidence of peritonitis[18]. Other studies also suggest that factors such as air pollution, home environment, and operational habits can affect infection risks[19]. The most common bacteria in peritonitis are Gram-positive, often associated with procedural contamination[14]. During home visits, we observed that patients with certain environmental factors may more likely to experience recurrent peritonitis. We also noted that the direction of ventilation systems (e.g., air conditioning and fans) in the dialysis room could impact the environment and increase the likelihood of peritonitis—this is an area less addressed in previous literature.3. Social Support is Crucial for Home DialysisThe Kidney Disease: Improving Global Outcomes (KDIGO) guidelines suggest that all patients receiving alternative treatment for stage 5 chronic kidney disease can opt for home dialysis, though it is typically limited to those with certain autonomy and good economic standing[20]. A study from the United States showed that the three primary barriers to home dialysis were patient fear, inadequate space, and lack of family support, in addition to limited doctor support and insufficient training personnel[21]. A cross-sectional mixed-methods study identified social support as a key factor in PD patients’ perceived quality of life[22]. Several Canadian studies emphasized that obstacles to home PD include inadequate training, knowledge, and biases, both from patients and healthcare providers[23、24、25]. When patients receive proper education and support, they are more likely to opt for home dialysis[26].Therefore, education and training for healthcare professionals, enhanced nursing support, and companionship from friends and family are indispensable for patients undergoing home dialysis.ConclusionIn conclusion, the continuity of care model for home dialysis in CAPD patients provides comprehensive assessment and nursing guidance, assisting patients in enhancing self-efficacy, optimizing the dialysis environment, and strengthening social support. Simultaneously, home visits may effectively prevent recurrent peritonitis by guiding patients to improve their home environments. However, this intervention is feasible only among patients with high adherence. Moving forward, we will iteratively refine and optimize home-based management strategies for peritoneal dialysis. For patients who show no improvement, further investigation into the underlying etiologies will be conducted. Additionally, challenges such as staff shortages, limited funding, and the absence of specific standards necessitate broader support from patients, hospitals, society, and governmental bodies to advance this work.References[1]Teitelbaum I. Peritoneal Dialysis. N Engl J Med. 2021 Nov 4;385(19):1786-1795.[2]Luo, S., Xu, Y., & Dong, J. (2014). A study on the relationship between home dialysis environment and the incidence of peritoneal dialysis-related peritonitis. Chinese Journal of Blood Purification, 13(10), 677-680.[3]Gulcan A, Gulcan E, Keles M, et al. Oral yeast colonization in peritoneal dialysis and hemodialysis patients and renal transplant recipients. Comp Immunol Microbiol Infect Dis, 2016, 46: 47-52.[4]Manera KE, Johnson DW, Cho Y, et al. Scope and heterogeneity of outcomes reported in randomized trials in patients receiving peritoneal dialysis. Clin Kidney J, 2021, 14(7): 1817-1825.[5]Szeto CC, Wong TY, Chow KM, Leung CB, Li PK. Are peritoneal dialysis patients with and without residual renal function equivalent for survival study? Insight from a retrospective review of the cause of death. Nephrol Dial Transplant 2003; 18:977–82[6]Fried LF, Bernardini J, Johnston JR, Piraino B. Peritonitis influences mortality in peritoneal dialysis patients. J Am Soc Nephrol 1996; 7:2176–82.[7]Barretti P, Pereira Doles JV, Pinotti DG, et al. Evidence-based medicine: An update on treatments for peritoneal dialysis-related peritonitis. World J Nephrol, 2015, 4(2): 287-294.[8]Szeto CC, Wong TY, Chow KM, Leung CB, Li PK. Are peritoneal dialysis patients with and without residual renal function equivalent for survival study? Insight from a retrospective review of the cause of death. Nephrol Dial Transplant, 2003; 18:977–82.[9]Al Sahlawi M, Zhao J, McCullough K, Fuller DS, Boudville N, Ito Y, Kanjanabuch T, Nessim SJ, Piraino BM, Pisoni RL, Teitelbaum I, Woodrow G, Kawanishi H, Johnson DW, Perl J. Variation in Peritoneal Dialysis-Related Peritonitis Outcomes in the Peritoneal Dialysis Outcomes and Practice Patterns Study (PDOPPS). Am J Kidney Dis. 2022 Jan;79(1):45-55.e1.[10]Perales RB, Palmer RF, Rincon R, Viramontes JN, Walker T, Jaén CR, Miller CS. Does improving indoor air quality lessen symptoms associated with chemical intolerance? Prim Health Care Res Dev. 2022 Jan 12;23:e3.[11]Sayed SA, Abu-Aisha H, Ahmed ME, Elamin S. Effect of the patient’s knowledge on peritonitis rates in peritoneal dialysis. Perit Dial Int. 2013 Jul-Aug;33(4):362-6.[12]Marinangeli G, Neri L, Viglino G, Rocca AR, Laudon A, Ragusa A, Cabiddu G; Peritoneal Dialysis Study Group of Italian Society of Nephrology. PD in Italy: the 5th GSDP-SIN Census 2014. G Ital Nefrol, 2018 Sep;35(5):2018-vol5.[13]Rivara MB, Edwards T, Patrick D, Anderson L, Himmelfarb J, Mehrotra R. Development and Content Validity of a Patient-Reported Experience Measure for Home Dialysis. Clin J Am Soc Nephrol., 2021 Apr 7;16(4):588-598.[14]Thuijls G, van Wijck K, Grootjans J, et al. Early diagnosis of intestinal ischemia using urinary and plasma fatty acid binding proteins. Ann Surg, 2011, 253(2):303-308.[15]Hua J, Howell JL. Coping self-efficacy influences health information avoidance. J Health Psychol., 2022 Mar;27(3):713-725.[16]James E, Stacey F, Chapman K, et al. Impact of a nutrition and physical activity intervention (ENRICH: Exercise and Nutrition Routine Improving Cancer Health) on health behaviors of cancer survivors and carers: A pragmatic randomized controlled trial. BMC Cancer, 15(1): 710–726.[17]de Maar JS, de Groot MA, Luik PT, Mui KW, Hagen EC. GUIDE, a structured pre-dialysis programme that increases the use of home dialysis. Clin Kidney J., 2016 Dec;9(6):826-832.[18]Liu J, Huang X, Liu Y, et al. Clinical analysis of continuous non-bedridden peritoneal dialysis-associated peritonitis. Journal of Central South University (Medical Sciences), 2016, 41(12):1328-1333.[19]Huang WH, Yen TH, Chan MJ, Su YJ. Impact of environmental particulate matter and peritoneal dialysis-related infection in patients undergoing peritoneal dialysis. Medicine (Baltimore), 2014 Nov;93(25):e149.[20]Perl J, Brown EA, Chan CT, et al. Home dialysis: conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO) Controversies Conference. Kidney Int., 2023 May;103(5):842-858.[21]Reddy YNV, Kearney MD, Ward M, et al. Identifying Major Barriers to Home Dialysis (The IM-HOME Study): Findings From a National Survey of Patients, Care Partners, and Providers. Am J Kidney Dis., 2024 Nov;84(5):567-581.e1.[22]Sitjar-Suñer M, Suñer-Soler R, Masià-Plana A, et al. Quality of Life and Social Support of People on Peritoneal Dialysis: Mixed Methods Research. Int J Environ Res Public Health., 2020 Jun 14;17(12):4240.[23]Jassal SV, Krishna G, Mallick NP, Mendelssohn DC. Attitudes of British Isles nephrologists towards dialysis modality selection: A questionnaire study. Nephrol Dial Transplant, 2002, 17:474–477.[24]McLaughlin K, Jones H, VanderStraeten C, et al. Why do patients choose self-care dialysis? Nephrol Dial Transplant, 2008, 23:3972–3976.[25]Oliver MJ, Garg AX, Blake PG, et al. Impact of contraindications, barriers to self-care and support on incident peritoneal dialysis utilization. Nephrol Dial Transplant, 2010, 25:2737–2744.[26]Manns BJ, Taub K, Vanderstraeten C, et al. The impact of education on chronic kidney disease patients’ plans to initiate dialysis with self-care dialysis: A randomized trial. Kidney Int., 2005, 68:1777–1783.

The hypothesis presented is that antibodies are constructed by the adaptive immune system using a portion of antigen, either viral or bacterial or any other, as a template to make the antibody itself. The process would be quite different from that of DNA formation, but the result would have informational similarities to an inside-out section of DNA helix. Such a process would help explain the apparently infinite range of the adaptive immune system.

Eosinophilic chronic rhinosinusitis with nasal polyps (eCRSwNP) and non-eosinophilic chronic rhinosinusitis with nasal polyps (neCRSwNP) have distinct immune-dysregulation profile and clinical features. Gaining insight into their pathogenic mechanisms could help distinguish them and facilitate their diagnosis and treatment. Therefore, we first evaluated the transcriptional profiles of 68,273 nasal polyp cells from patients with eCRSwNP or neCRSwNP using a existing single-cell sequencing database. Eight major cell types were categorized into 50 immune-cell subsets. Gene Ontology analyses of differentially upregulated genes was performed for all 50 subsets in both groups to identify enriched pathways and transcription factors with different activities. A database of known receptor–ligand pairs was used to assess intercellular communications. Potential interaction strengths were predicted based on the expression of the ligand–receptor pairs. We mined CRS risk-gene expression levels in each immunocyte subset based on previous data. Using our patient cohort, we validated the bioinformatics findings and demonstrated their correlation with disease severity. Flow cytometry was used to verify and detect the abundances of type-2 innate lymphoid cells, effector T (Teff) cells, natural killer cells (NKs), and FCGR3A+CD8+ Teff cells in our patients with CRSwNP. Besides, immunofluorescence staining and clinical correlation analysis of FCGR3A+CD8+ Teff cells were also performed. Compared to neCRSwNP patients, those with eCRSwNP showed significantly increased proportions of CD8+ Teff and CD56dimCD16+ NK cells, both exhibiting enhanced cytotoxic activity. FCGR3A+CD8+ Teff cells were significantly increased in eCRSwNP versus neCRSwNP patients, with their expansion correlating with both enhanced cytotoxic activity and worse clinical severity. FCGR3A+CD8+ Teff cells exhibited enhanced cytotoxic profiles in terms of gene expression, pathway enrichment, and intercellular communication. Compared to FCGR3A-CD8+ Teff cells that upregulated GZMK, FCGR3A+CD8+ Teff cells upregulated GZMB. Patients with eCRSwNP also showed significantly activation of tissue-remodeling responses and broadly upregulated expression of CRS-risk genes. In summary, We identified an NK-like cytotoxic FCGR3A+CD8+ Teff subset involved in eCRSwNP disease progression that correlated with CRSwNP disease severity. Our findings showed that patients with eCRSwNP and neCRSwNP exhibited extensive cellular heterogeneity, i.e. the sinus tissues of patients with eCRSwNP showed a highly cytotoxic immune microenvironment than those of patients with neCRSwNP.

”From Academic Setback to Psychiatric Breakdown: A Case of EUPD in an Adolescent Following NEET Failure”

Autonomous planetary landing is one of the toughest challenges in space exploration, especially in unfamiliar and rough terrains where quick, smart decisions are crucial. This research proposes an integrated system that uses Artificial Intelligence AI, terrain sensing, and vision analysis to improve landing navigation accuracy and safely performance. It combines LIDAR-based elevation maps and CCD images, then it is been analyzed by Convolutional Neural Networks (CNNs) to identify hazards and choose safe landing spots. A landing guidance system using an Extended Kalman Filter (EKF) and PID control adjust the landing path in real time and saves fuel. As a result, simulations show a significant improvement in landing error, it dropped from 150m in previous studies to nearly 20m. In addition, fuel efficiency rose from 70% to 85%, and hazard avoidance improved from 60% to 92%. These results show the ability of the proposed system to make smart decisions on its own, reduce the need for human control, and handle complex surfaces. The framework’s flexible design, real-time adaptability and trajectory stability make it a strong candidate for future missions to Mars, asteroids, and beyond.

Background: Dengue fever affects over 100 million of people globally per year yet there is no developed molecule targeted against Dengue Virus (DENV). Multiple plant-derived compounds, are traditionally used by ethnomedicinal systems, to manage dengue symptoms. NS5 RNA Dependent RNA Polymerase (RdRp) is found in DENV2 which is crucial for RNA replication and disease progression making it a promising molecular target for antiviral drug development. Objective: This research aims in developing a novel anti-viral drug to inhibit NS5 RdRp (PDB: 6IZY) using structure-based computational drug discovery techniques. Methodology: Over 40 ethnobotanical articles were reviewed to obtain important phytoconstituents which might be useful to treat dengue fever. Molecular docking of these compounds against 6IZY to identify key structural motifs and develop a pharmacophore model. Scaffold hoping and QSAR analysis were employed to design new molecule. Result: The novel drug molecule designed was 2-allyl-1-amino-7,7-dimethyltetradecahydro-5H-pyrrolo[2’,1’:2,3]pyrimido[6,1-a]isoquinoline-3,8,9-triol and had a wide therapeutic window (LD 50 = 3500mg/kg) with minimal predicted toxicity, and no blood–brain barrier (BBB) permeability. It had comparable docking score with standard anti-viral and binds at same active site. Conclusion: The molecule so designed can be further analysed for molecular dynamics. Synthesis of this compound can be performed to conduct in-vitro IC 50 studies to demonstrate its anti-viral activities.