This paper synthesizes the previously developed modal contexts with quantum contextuality. We reformulate the Kochen-Specker theorem in terms of cobordisms. Finally, we provide a concrete example of a (1 + 1)-dimensional topological quantum field theory as a toy model. It is shown that the Kochen-Specker theorem is equivalent to this special type of TQFT.

This paper proposes a new theory of subparticle reassembly by decomposing quarks into rhythm units using phase-resonant analysis based on the "Knoton" model. Extending from the "Knot of Light" theory, it assumes that an attenuating flow of intrinsic light speed generates a phase-responsive field, within which particles become spatially aligned.

This paper introduces a novel AI-powered demand prediction framework designed to transform the planning and operation of Demand-Responsive Transit (DRT) systems. Using advanced Graph Convolutional Networks (GCNs) implemented via PyTorch Geometric, the model captures complex spatial-temporal correlations in transit demand across 251 zones in Kalamazoo County, Michigan. By integrating geo-temporal clustering with a Deep Multi-View Spatial-Temporal Network (DMVST-Net), the framework dynamically forecasts passenger requests with high accuracy and geographic specificity. Experimental results demonstrate strong predictive performance, achieving a Mean Absolute Error (MAE) of 4.96 and a Mean Squared Error (MSE) of 32.80 on a dataset of 1.7 million points. More than a forecasting tool, the proposed framework serves as a decision-support system for civil and transportation engineers, enabling data-driven design of DRT service zones, stop placement, fleet deployment, and infrastructure investments. This study marks a significant advancement in bridging deep learning with practical transit planning, offering a scalable, adaptable, and engineering-relevant solution for innovative mobility systems in mid-sized urban regions.

Submitted as: Case ReportAuthors declare that the contents of this article are their own original unpublished findings.Title: Waldenström Macroglobulinemia Presenting a Subcutaneous Nodule as an Initial Skin Lesion: A Case ReportAuthors: Toshiyuki Sato¹, Michie Katsuta¹, Yoshimasa Nobeyama¹, Hideki Uryu2, Masaharu Kawashima2, Shingo Yano2, and Akihiko Asahina¹Affiliations: 1) Department of Dermatology, The Jikei University School of Medicine, Tokyo, Japan2) Division of Clinical Oncology / Hematology, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, JapanE-mail address: Toshiyuki Sato: sato-toshiyuki@jikei.ac.jp, Michie Katsuta: mkatta1219@gmail.com, Yoshimasa Nobeyama: nobederm@jikei.ac.jp, Hideki Uryu: uryu@jikei.ac.jp, Masaharu Kawashima: kawashimasa-k@jikei.ac.jp, Shingo Yano: yano@jikei.ac.jp, Akihiko Asahina: asahina-tky@umin.ac.jpCorresponding Author: Toshiyuki SatoDepartment of Dermatology, The Jikei University School of Medicine25-8 Nishi-Shimbashi 3-chome, Minato-ku, Tokyo 105-8461, JapanTEL: +81-3-3433-1111 Ext. 3857; FAX: +81-3-5401-0125E-mail address: sato-toshiyuki@jikei.ac.jpKeywords: Case report, Ibrutinib, Lymphoplasmacytic lymphoma, Nodule, Waldenström MacroglobulinemiaPotential conflicts of interest: The authors declare no conflicts of interest.Key Clinical Message: Cutaneous manifestations of Waldenström macroglobulinemia (WM), particularly subcutaneous nodules, are rare but easily biopsied, suggesting that subcutaneous lesions may contribute to diagnosis. Therefore, dermatologists need to understand the cutaneous manifestations of WM.Abstract: WM is a rare subtype of lymphoplasmacytic lymphoma characterized by bone marrow infiltration of small B lymphocytes, plasmacytoid lymphocytes, and plasma cells. WM accounts for only 1-2% of hematological malignancies. Cutaneous involvement in WM is rare, with nodular lesions being even more uncommon. We reported a rare case with cutaneous nodular lesion as a clinical presentation of WM. A 65-year-old man presented with a subcutaneous nodule on the right upper arm. Nine years ago, he had been diagnosed with follicular lymphoma and treated with multiple therapies, including R-CHOP therapy, BR therapy, Bendamustine monotherapy, and R² regimen. Following R² regimen, a new lesion was detected on PET-CT. Physical and histopathological examinations revealed a dome-shaped nodule, which consisted of plasmacytoid lymphocytes and plasma cells positive for CD20 and CD138, but negative for CD10. A diagnosis of WM was made based on these findings. MYD88 L265P gene testing was not performed due to insurance limitations. The patient began treatment with ibrutinib, leading to a significant regression of the nodule. WM with cutaneous manifestations, particularly nodular lesions, is rare but important for dermatologists to recognize. Biopsy of subcutaneous lesions can aid in early diagnosis and treatment.Introduction: Waldenström macroglobulinemia (WM) is a rare subtype of lymphoplasmacytic lymphoma, accounting for only 1-2% of hematological malignancies [1-3]. It is characterized by bone marrow infiltration of small B lymphocytes, plasmacytoid lymphocytes, and plasma cells, along with the presence of monoclonal immunoglobulin M (IgM) in the serum. According to the World Health Organization classification, a definitive diagnosis of WM requires evidence of bone marrow involvement by lymphoplasmacytic lymphoma and the detection of monoclonal IgM gammopathy, regardless of its concentration [3]. Although extramedullary involvement can occur in various organs, cutaneous manifestations are exceedingly rare, observed in only about 5% of cases [1]. These cutaneous lesions are typically classified into primary and secondary types, based on tumor cell infiltration or cryoglobulinemia [4]. In this report, we present a case of WM with rare subcutaneous nodular involvement, highlighting its significance in emphasizing the importance of recognizing this dermatological manifestation.Case history: A 65-year-old man was referred to us with a several months’ history of a subcutaneous nodule in the right upper arm. Left cervical lymphadenopathy was detected by a routine examination 9 years ago, he underwent lymph node biopsy and bone marrow examination. In the lymph node biopsy specimen, the normal lymph node architecture was lost, and a diffuse proliferation of small to medium-sized neoplastic lymphocytes were observed. The infiltrating cells were positive for CD20, CD79, and BCL2. In the bone marrow biopsy specimen, dense clusters of small to medium-sized neoplastic lymphocytes were observed and immunohistochemical analysis revealed strong positivity for CD20, CD79a, and BCL2, along with focal positivity for CD10. (Figure 1A and B). He was diagnosed with follicular lymphoma as a provisional diagnosis. He underwent R-CHOP therapy (rituximab, cyclophosphamide, doxorubicin hydrochloride, oncovin, and prednisolone), BR therapy (bendamustine and rituximab), Bendamustine monotherapy, and R² regimen (lenalidomide and rituximab). Following R² regimen, a new lesion was detected in the right upper arm on PET-CT (standardized uptake value max: 3.37), leading to referral to our department (Figure 2A). No lytic lesions were observed on PET-CT. Physical examination showed no evidence of generalized fatigue, fever, or weight loss. A dome-shaped subcutaneous nodule, measuring 50 × 70 mm, was observed on the outer side of the right upper arm (Figure 2B). The complete blood cell count revealed white blood cell 3700 /μL (normal range, 3300-8600), hemoglobin 11.0 g/dL (normal range, 13.7-16.8), and blood platelet 135,000 /μL (normal range, 158,000-348,000). A biochemical blood test revealed a high β2-microglobulin level of 4.34 mg/L (normal range, 0.8-2.0), lactate dehydrogenase (LDH) level of 183 U/L (normal range, 124-222), albumin level of 3.8 g/dL (normal range, 4.1-5.1), creatinine level of 0.7 mg/dL (normal range, 0.65-1.07), calcium level of 8.9 mg/dL (normal range, 8.8-10.1) and high immunoglobulin M (IgM) level of 295 mg/dL (normal range, 33-183) which reached a maximum value of 321 mg/dL during the clinical course. Electrophoresis revealed a monoclonal peak of IgM-kappa type. We prioritized low-risk diagnostic procedures and performed a punch biopsy. Histopathological examination revealed dense clusters of small to medium-sized lymphocytes in the deep dermis, along with plasmacytoid neoplastic lymphocytes and plasma cells (Figure 3A and B). Infiltrating cells were positive for CD20, CD79a, and CD138, and negative for CD10 and a follicular dendritic cell meshwork positive for CD21 was not observed (Figure 4A, B and C). Immunohistochemistry showed kappa light chain was observed 3-fold more than lambda light chain (Figure 5A and B). On retrospective review of the initial bone marrow biopsy, infiltration by plasmacytoid lymphocytes and plasma cells was identified, and CD138 positivity was observed in these areas (Figure 1A and 6). Unfortunately, testing for the MYD88 L265P gene mutation is not covered by insurance, and therefore, has not been conducted in this case. Based on the presence of plasmacytoid lymphocytes, CD10 negativity in tumor cells, bone marrow infiltration of plasmacytoid lymphocytes, and monoclonal immunoglobulin M-kappa protein, a diagnosis of follicular lymphoma as a provisional diagnosis was changed to Waldenström macroglobulinemia.Methods (differential diagnosis) : WM is often described as challenging to differentiate from marginal zone lymphoma, plasmacytoma and IgM-type multiple myeloma. Marginal zone lymphoma is classified into extranodal marginal zone lymphoma (MALT lymphoma), nodal marginal zone lymphoma, and splenic marginal zone lymphoma. In the present case, the affected organs were bone marrow and skin. A follicular dendritic cell meshwork positive for CD21 was not observed. On the other hand, MALT lymphoma typically affects stomach, eyes, and ocular adnexa. In addition, in cases of MALT lymphoma and nodal marginal zone lymphoma, a follicular dendritic cell meshwork positive for CD21 is observed. Therefore, the present case was not compatible with typical MALT lymphoma and nodal marginal zone lymphoma. Additionally, extranodal infiltration in splenic marginal zone lymphoma is extremely rare; therefore, we did not consider it a likely diagnosis. Plasmacytoma typically presents as a localized proliferation of monoclonal plasma cells, without systemic IgM monoclonal gammopathy. Our patient, however, had a detectable serum IgM protein and bone marrow and skin infiltration by small to medium-sized lymphocytes, plasmacytoid lymphocytes, and plasma cells making plasmacytoma unlikely diagnosis. IgM multiple myeloma was also excluded diagnosis based on both clinical and laboratory findings. IgM multiple myeloma is usually accompanied by features such as lytic bone lesions, hypercalcemia, renal impairment, and significant anemia. In our case, PET-CT revealed no bone lesions, and laboratory tests showed a normal serum calcium level (8.9 mg/dL), preserved renal function (creatinine 0.7 mg/dL), and only mild anemia (hemoglobin 11.0 g/dL). Therefore, based on fulfillment of the diagnostic criteria for WM and the exclusion of other differential diagnoses, the diagnosis of WM was confirmed.Conclusions and Results (outcome and follow-up) : The patient met favorable prognostic criteria according to the Revised International Prognostic Scoring System for Waldenström’s Macroglobulinemia5); i.e., the patient’s age ≤65, β2-microglobulin >4 mg/L, LDH <250 IU/L, serum albumin level ≥3.5 g/dL, resulting in a total score of 1 point. Treatment with ibrutinib monotherapy was initiated by the internal medicine department. At the follow-up examination in our department two months after the introduction of ibrutinib, the palpable subcutaneous nodule in the right upper arm had regressed.Discussion: Waldenström macroglobulinemia (WM) is a subtype of lymphoplasmacytic lymphoma (LPL) characterized by bone marrow infiltration of lymphoplasmacytic cells and the presence of serum monoclonal immunoglobulin M (IgM) [1-3]. It is a rare malignancy, accounting for only 1-2% of hematological malignancies.According to the World Health Organization classification [3], WM is characterized as a tumor composed of small B lymphocytes, plasmacytoid lymphocytes, and plasma cells. This neoplasm typically involves the bone marrow, lymph nodes, and spleen. The definitive diagnosis requires the presence of bone marrow involvement by LPL and the detection of a monoclonal IgM gammopathy, irrespective of the concentration level. In our case, based on the presence of plasmacytoid lymphocytes, bone marrow infiltration, and monoclonal immunoglobulin M-kappa protein, a diagnosis of WM was made.While extramedullary involvement can occur in various organs, cutaneous manifestations are very rare, observed in approximately 5% of extramedullary WM cases [1]. Shakeri et al. classified the mechanisms of cutaneous manifestations in WM into primary and secondary types [4]; primary types are caused by tumor cell infiltration or IgM deposition and secondary types are caused by concurrent cryoglobulinemia. To the best of our knowledge, the previously reported cutaneous manifestations are papules, bullae, ulcerations, nodules and discoloration.Our case showed dense infiltration of plasmacytoid lymphocytes subcutaneously, indicating primary type of tumor cell infiltration. In a study by Stien et al. [2] reporting 19 cases of WM with cutaneous manifestations, 7 cases showed transformation to diffuse large B-cell lymphoma, while 12 cases did not. Among these 12 cases, nodular lesions were observed in 5 cases. Because i) cutaneous involvement occurs in few percentages of extramedullary WM cases and ii) cutaneous nodular lesion appears in only about half of these cases, the nodular lesions in this study are considered to be rare.In LPL, MYD88 L265P mutations are present in 90% of cases, and CXCR4 mutations occur in approximately 30% of cases [3]. Therefore, screening for these mutations is considered to contribute to a diagnosis. However, in our case, it was not possible to perform these mutation analyses. This limitation is acknowledged in the context of this case report. Nevertheless, since the MYD88 L265P mutation is not included in the diagnostic criteria, it is believed that this omission does not alter the diagnosis in the present case. Additionally, in situ hybridization was not performed to confirm light chain restriction. Instead, we assessed clonality using immunohistochemistry, which is the primary method employed in our routine diagnostic practice.Conclusion: Cutaneous manifestations of WM, particularly subcutaneous nodules, are rare but easily biopsied, suggesting that subcutaneous lesions may contribute to diagnosis. Therefore, dermatologists need to understand the cutaneous manifestations of WM.

1. IntroductionThe thalassaemias are a group of inherited haematological disorders caused by defects in the synthesis of one or more of the globin chains. It is an autosomal recessive disorder and affects men and women equally. Approximately 5% of the world’s population has a globin variant, but only 1.7% has alpha or beta thalassaemia trait [1]. α-thalassaemia and β-thalassaemia is caused by reduced or absent synthesis of α and β globin chains respectively [2].Globally, the most common single gene disorders of haemoglobinopathies are haemoglobin E (HbE) and sickle cell anaemia (HbS) [3]. The primary feature of this illness is decreased or non-existent production of either the β-like or the α-like globin chains to form haemoglobin tetramers during foetal and postnatal life [4].The α/β thalassaemia and hereditary persistence of foetal haemoglobin (HPFH) are the disorders of haematopoiesis, caused by large deletions in both α and β globin genes and show raised foetal haemoglobin (HbF) levels in adult life [5]. With both types of thalassaemia occurring at such high frequencies, and the fact that α and β-globin genes are inherited on 2 different chromosomes (the α-globin gene on chromosome 16 and β-globin gene on chromosome 11), it is not uncommon for individuals to inherit α-thalassaemia trait from one parent and β-thalassaemia trait from the other. It is well known that the diagnosis of double heterozygotes of α and β-thalassaemia poses challenges both during diagnosis and treatment. This has been documented since 1982 [6-8] and summarised in Weatherall and Clegg [9]. Although, it is not documented, the frequency of α/β thalassaemia in Bangladesh is being detected more in the recent years. In this case, a 4 month old patient is diagnosed with α/β thalassaemia with the help of genetic testing.

Background: The Covid-19 pandemic has significantly disrupted the epidemiology of acute respiratory infections (ARI). It is important to investigate the trends of ARI following Covid-19 pandemic. Methods A retrospective study was conducted using PCR testing data for respiratory infection pathogens from febrile patients at Huzhou Central Hospital from June 1, 2024, to April 30, 2025. Results: Among a total of 34,893 febrile patients, 16,643 (47.7%) males and 18,250 (52.3%) females, the total number of conformed ARI cases was 17,750 (50.9%), of which 2,897 (16.3%) cases were infected with SARS-COV-2, 5,592 (31.5%) with Influenza A Virus (IAV), 40 (0.2%) with Influenza B Virus (IBV), 701 (3.9%) with Respiratory Syncytial Virus (RSV), 3,205 (18.1%) with Adenovirus (ADV), 3,737 (21.1%) with Human Rhinovirus (HRV), and 1,578 (8.9%) with Mycoplasma Pneumoniae (MP). An outbreak of SARS-CoV-2 infection was found from June 30 to August 3, 2004, and two outbreaks of IAV occurred from December 21, 2024, to January 18, 2025, and from February 9 to March 1, 2025. In terms of age distribution, SARS-CoV-2 and IAV infections peaked in children (≤12 years), while multiple peaks appeared in adults (≥13 years); RSV, ADV, HRV and MP infections were focused on patients aged ≤12 years. There were 1530 cases (8.9% of pathogen-positive cases) with co-infections of 2, 3 or 4 pathogens, including 856 cases with co-infection of ADV and HRV, 172 of IAV and HRV, and 134 of HRV and MP. In the last week of April 2025, the number of COVID-19 patients increased to 100. Conclusions: In the second and third years following Covid-19 pandemic, acute respiratory infections caused by RSV, ADV, HRV and MP continued to occur weekly, but outbreaks of SARS-CoV-2 and IAV have been observed in the past 11 months. A new outbreak of COVID-19 may occur in May.

This paper presents a comprehensive stochastic assessment of renewable energy integration in the IEEE 30bus power system using a Monte Carlo simulation framework with 200 scenarios. By modeling the simultaneous injection of 45 MW solar and 80 MW wind generation with detailed temporal profiles, the study captures the operational impacts of renewable variability on grid performance. The results reveal that increased renewable penetration leads to substantial thermal generator displacement (10.1% to 42.6%) and the emergence of critical localized congestion, particularly in line 6-7 which experiences maximum flows of 53.586 MW. Voltage analysis highlights significant asymmetries between bus types, with PQ buses exhibiting up to 0.04 p.u. standard deviation compared to PV buses, underscoring the inadequacy of uniform voltage regulation strategies. Economic evaluation indicates that while operational costs generally decrease with renewables, cost variability and system losses may increase due to power flow redistribution. The analysis reveals dynamic curtailment patterns influenced by costprioritization mechanisms, with preferential wind curtailment due to higher marginal costs. The granular framework identifies transmission vulnerabilities masked by aggregate metrics, providing practical guidance for grid operators and planners working toward reliable and efficient renewable integration.

19-year-old female was diagnosed with an ostium secundum atrial septal defect (ASD) after presenting with shortness of breath for the past two years, which had worsened over the last two months. She also reported chest pain and palpitations for the past two months. Echocardiography revealed a 28 mm ostium secundum ASD with a left-to-right shunt, along with dilated right atrial and right ventricular chambers. There was trivial tricuspid regurgitation (TR) with a TR gradient of 20 mmHg and a right ventricular systolic pressure (RVSP) of 23 mmHg. Due to deficient inferior vena cava (IVC) and posterior rims, the patient was scheduled for minimally invasive surgical closure of the ASD. Intraoperative transoesophageal echocardiography (TOE) revealed a band adjacent to the deficient interatrial septum, towards the left atrium (Figure[1](#fig-cap-0001) ). This band extended from the coronary sinus to the superior vena cava and was subsequently excised partially ( Figure[2a](#fig-cap-0004) ,[b](#fig-cap-0004) ;3). Figure1. TEE Bicaval view showing Ostium secondum ASD(red arrow) and interatrial septal band (yellow arrow). Figure2a Figure2b Figure2b Figure 2a,b. TEE image showing postoperative status of interatrial septal band which was advertently left out. Figure3. Excised specimen portion of interatrial septal band. DISCUSSION Ostium secundum atrial septal defect (ASD) is the most common form of ASD, accounting for up to 70% of cases. It is characterized by a defect in the region of the fossa ovalis, leading to a left-to-right shunt and chronic right heart volume overload when significant in size. Patients with large defects, like in this case (28 mm), often present in adolescence or early adulthood with symptoms such as exertional dyspnea, palpitations, or chest discomfort due to right atrial and ventricular dilation and increased pulmonary blood flow. In this patient, echocardiography revealed a large secundum ASD with right heart dilation and trivial tricuspid regurgitation, confirming hemodynamic significance. RVSP was 23 mmHg, within normal limits, indicating no pulmonary hypertension. However, deficient IVC and posterior rims precluded device closure. Such rim deficiencies are known limitations for percutaneous closure due to the risk of device embolization or residual shunt, favoring surgical repair [1]. Intraoperative transesophageal echocardiography (TEE) revealed a fibrous band extending from the coronary sinus to the superior vena cava adjacent to the interatrial septum—an uncommon finding. Though the embryological origin of such bands is unclear, they may represent remnants of venous valves or congenital fibrous connections [2]. These structures can interfere with intracardiac flow or complicate closure. Excision must be performed cautiously, as they may be near vital conduction tissues. As Yasuda et al. state, “Manipulation or excision of anomalous interatrial septal structures may increase the risk of atrial arrhythmias due to their proximity to conduction pathways, particularly Bachmann’s bundle and the AV node region” [3]. Tamin et al. similarly emphasize avoiding conduction injury during surgery [4]. This case underscores the role of intraoperative TEE in guiding surgical decisions and identifying unexpected anatomical variants.

The right ventricle (RV) possesses a complex geometry and unique functional characteristics stemming from its embryologic development. Unlike the left ventricle (LV), which arises primarily from the primary heart field, the RV originates predominantly from the anterior or secondary heart field, influencing its structural organization, myocardial fiber orientation, and contractile patterns. This embryologic origin is not only essential for understanding congenital anomalies but also profoundly impacts the interpretation and accuracy of echocardiographic modalities used to assess RV function. This review explores how knowledge of RV embryology enhances the clinical application of echocardiographic methods, including tricuspid annular plane systolic excursion (TAPSE), tissue Doppler imaging (TDI), RV fractional area change (FAC), 3D echocardiography, and RV longitudinal strain. Incorporating embryologic insights provides a more anatomically and physiologically grounded approach to evaluating RV performance, especially in congenital heart disease and right heart failure.

In this paper, we will be detailing a method to embed graphs into the 2-dimensional real plane, R. We will also extend the result to hypergraphs. We will also be examining some of the immediate theory that comes from this.

Child temperament is a predictor of non-verbal ability (i.e., thinking and problem-solving skills that do not fundamentally require verbal language production and comprehension). Given that temperament scores might vary depending on whether the reporter is a parent or a teacher, this study analyzes a) whether those reports are different and b) how each report predicts child non-verbal ability in a non- western, educated, industrialized, rich and democratic (non-WEIRD) sample. The Matrix subtest of KABC-II (a non-verbal ability task widely used in non-WEIRD contexts) was administered to 85 Argentinian children (47 girls, 38 boys) aged 4-5 years, from middle-to-low socioeconomic status homes. Also, the Child Behavior Questionnaire-Very Short Form (CBQ-VSF) was administered to obtain temperament reports from parents and teachers. We found a 6-factor structure for teachers and a 10-factor structure for parents, suggesting a different factor structure of the CBQ-VSF for this sample. Factors from parent’s and teachers’ reports did not correlate. Only factors from teachers’ reports including items from the effortful control dimension, predicted Matrix total score after a Bonferroni correction. No factor from parents’ report predicted non-verbal ability. Our results provide infrequent data from non-WEIRD low-SES populations and suggest that the CBQ-VSF might lack some cross-cultural validity; and that teacher reports’ could have superior dimensional fit versus parent reports. Results should be interpreted considering the low sample size.

Effective weed detection is essential for efficient crop management, reduced herbicide usage, labor savings, sustainable production practices, and improved crop yields in agricultural fields. Weeds compete with plants for vital resources such as nutrients, water, space, and sunlight, which can directly impact plant growth, yield, and overall health. This research proposes a teleoperated mBot robot equipped with a camera and Ultra-Wide Band (UWB) sensors, operated using an M5Stack Core 2 module. The robot captures data from fixed anchors placed around the surveyed area. A convolutional neural network (CNN), implemented through Python code is hosted and run on an Ubuntu instance. The collected data is uploaded to Amazon S3 and EzData via a Wi-Fi network, and after analysis, the system accurately determines the location of weeds. To examine the impact of UWB sensor orientation at various range intervals, the research explored two network configurations to evaluate localization performance. Findings indicate that improved measurement accuracy is achieved by aligning the moving sensor antenna with the anchor antenna’s direction. Additionally, enhancing the number of anchors further enhances localization performance, making it more practical for optimal use. This research highlights the benefits of utilizing the proposed automated system for weed detection, which include improved efficiency, precision, scalability, and environmental sustainability compared to traditional manual weed methods. These outcomes imply that the proposed system has the potential to significantly transform weed detection practices in agricultural fields and landscapes and promote sustainable and efficient production methods.

In 2019, A.J. Paton et al. proposed a new taxonomic combination, transferring Anisochilus carnosus (L.f.) Wall. ex Benth. to Coleus strobilifer (Benth.) A.J. Paton, thereby including Anisochilus eriocephalus Benth. within this broader circumscription. However, a recent comprehensive study conducted in Tamil Nadu, India, re-evaluated species within Anisochilus using an integrative approach. This study deployed various evidences, including leaf epidermal morphology, seed structure, pollen characteristics observed through scanning electron microscopy (SEM), and molecular data derived from sequencing the trnL-trnF, rbcL, and matK regions. The results revealed clear morphological and genetic distinctions between A. eriocephalus and A. carnosus. Specifically, A. eriocephalus is characterized by a terete, glabrescent stem (in contrast to the tetragonal, pubescent stem of A. carnosus), yellow gland-dotted leaves, calyx, and corolla (versus red gland-dotted in A. carnosus), and the presence of gland-tipped trichomes on the lower lip of the corolla (as opposed to simple trichomes). Additionally, the calyx tube in A. eriocephalus is villous, whereas it is pubescent in A. carnosus. Pollen morphology further differentiates the two species: A. eriocephalus exhibits finely reticulate grains with shallow colpi, while A. carnosus displays coarsely reticulate grains with deep colpi. Molecular phylogenetic analysis validated these findings, confirming significant genetic divergence between the two taxa. In light of these evidences, the study proposes a revised taxonomic treatment, reinstating A. eriocephalus under the genus Coleus as Coleus eriocephalus (Benth.) Soosairaj.

Heavy curcumin consumers apparently had a lower-than-expected COVID-19 death rate. Curcumin modulates angiotensin-converting enzyme expression, which may impair SARS-CoV-2 entry into host cells. Our data show that curcumin provides earlier recovery in acute COVID-19. Curcovid was an observational study conducted from Mar21-May22. Individuals > 18 years, with ≤2 days of symptoms, seen at Emergency Room or Telehealth system with positive SARS-Cov-2 PCR and mild/moderate disease were invited to immediately add a pharmaceutical-grade curcumin formulation (1g/d/10 days) alongside usual care. Primary outcomes were self-reported time to symptom relief and judgement of full recovery. Patients who used curcumin were compared to those who did not add the compound to their treatment regimen (Control). There were 73 and 58 patients in usual care and curcumin groups, respectively; mean age was 44.9 ± 13.9 years-old with 52 (39.7%) male; 3 days after study entry, fewer patients using curcumin had dyspnea (p=0.0164); systolic BP and serum creatinine were lower in curcumin group (p=0.0035 and 0.038, respectively). Time for symptom relief was 6.6±2.4 and 4.2±4 days in control and curcumin groups, respectively (p<0.0001); time for complete recovery was 12.4±5.3 and 7.8±6.7 days in control and curcumin groups, respectively (p<0.0001). No serious adverse events reported in both groups. Early administration of curcumin reduced time for complete recovery in acute COVID-19.

Fagus hayatae Palib. ex Hayata, an endangered East Asian paleoendemic, thrives in Sichuan’s Micang Mountain while surviving fragmented in Taiwan and mainland China. However, the differentiation from congeneric species (e.g., F. engleriana) and its elevational adaptation strategies remain poorly understood. Leaf functional traits, key indicators of plant resource strategies, reveal plants’ ecological adaptation through their interrelationships and environmental responses. In this study, leaf functional trait variation between F. hayatae, F. engleriana and their associated tree species was investigated, with elevational trait syndromes in F. hayatae examined for climate adaptation insights (Micang Mountain Nature Reserve, China). Both F. hayatae and F. engleriana were community dominants with low niche overlap in overall interspecific. Compared to dominant associated tree species, F. hayatae exhibited higher leaf dry matter content (LDMC), specific leaf area (SLA), leaf carbon content (LCC), and leaf phosphorus content (LPC), along with smaller but denser stomata; in contrast, F. engleriana displayed greater stomatal density and resource-acquisition traits, including larger leaf width (LW), leaf area (LA), SLA, and LCC, as well as higher leaf nitrogen content (LNC), but lower LPC. Compared to Fagus engleriana, F. hayatae exhibited larger but more sparsely distributed stomata, along with lower resource-acquisition capacity, as reflected in reduced leaf length (LL), LW, LA, SLA, LCC and LNC. Elevation significantly influenced the leaf functional traits of F. hayatae. At lower elevations, the species exhibited increased LA and SLA, while at higher elevations, it adopted more conservative traits, including reduced LA, SLA, stomatal area (SA), and LPC. These patterns highlight F. hayatae’s greater phenotypic plasticity and its reliance on defense-oriented strategies compared to its sympatric congener F. engleriana. Moreover, along elevational gradients, F. hayatae achieved optimal performance at mid-elevations through coordinated stress-tolerance traits. These findings can provide a scientific basis for the conservation and management of this endangered species.

Contraceptive Importance: A Case Report on Invasive Mole and Lung Metastasis in Perimenopausal Women after an unplanned pregnancy

This paper focuses on investigating the general Cauchy q-distribution from a probabilistic perspective. The uniqueness of these distributions lies in their probability density function (pdf), cumulative distribution function (cdf), mean, and variance. By leveraging the q-variable change theorem, we characterize the general Cauchy q-distribution.

Rapid species radiations driven by sexual selection present challenges to species delimitation due to limited ecological and morphological divergence among taxa. Combining multilocus genomic markers with morphometric analyses can provide insights into taxonomy and evolutionary history in such groups. We examine three grasshopper species of the genus Chorthippus, which radiated primarily through behavioral isolation via divergence in male calling songs, the main diagnostic species trait. Our study clarifies evolutionary relationships among five taxa classified by song: species (C. biguttulus, C. brunneus), subspecies (C. mollis mollis, C. mollis ignifer), and aberrant forms (C. brunneus ab. ticino). Morphometric analyses reveal that wing morphology follows the differentiation in male calling song, serving as proxy for distinguishing species groups. However, genomic analyses show greater divergence than expected between subspecies with the mollis song type and there seems to be cryptic diversity within C. mollis ignifer. Furthermore, local varieties with intermediate traits are genetically identical to C. brunneus, rejecting a hypothesis of hybrid origin. These findings demonstrate that song and wing morphology aid in delimiting taxa but are unreliable indicators of lineage diversity, underscoring the need for integrating genomic markers with morphometrics to understand the taxonomic and evolutionary history of radiations driven by sexual selection.

We describe a case of a 14-year-old girl with B-Cell Acute Lymphoblastic Leukemia who developed delayed severe neurotoxicity in her first blinatumomab cycle. Clinical features included encephalopathy and focal neurological deficits. MRI and CSF findings were consistent with immune-mediated neuroinflammation. Following discontinuation of blinatumomab and initiation of dexamethasone therapy, the patient made a complete neurological recovery within five days. This case underscores the potential for delayed onset of blinatumomab-associated neurotoxicity, emphasizing the importance of clinical vigilance beyond the commonly observed early infusion period. Early recognition, prompt cessation of therapy, and initiation of corticosteroids are critical for full neurological recovery.

Background: Clinical trial (ClTr) participation is associated with improved childhood cancer outcomes, but significant socioeconomic and sociodemographic disparities in trial enrollment exist. Identifying modifiable barriers to participation such as household material hardship (HMH) and limited health literacy (HL), is essential to improving ClTr access. We compared differences in caregiver-reported barriers to pediatric oncology ClTr participation across socioeconomic status (SES) and racial/ethnic groups through a nationwide anonymous online survey of caregivers of children with cancer. We also explored associations between caregiver HL, HMH, and barriers to trial participation. Procedures: English- and/or Spanish-speaking caregivers of children diagnosed with cancer in the last 5 years completed the Research Participation Survey – Caregiver (RPS-C) to assess barriers to ClTr participation, the validated Health Literacy Survey-12 (HLS 19-Q12) health literacy assessment, and the WellRx questionnaire measuring HMH. Results: Of the 59 participants, 64% were socioeconomically under-resourced, 52.5% identified as racially/ethnically underrepresented, and 62% reported their child had not participated in a ClTr. Under-resourced caregivers reported higher RPS-C barrier scores than adequately resourced caregivers ( z=3.18, p=0.001). There were no significant differences in barrier scores across underrepresented vs represented racial/ethnic groups ( p=0.203). Lower HL (ρ=˗0.557, p<0.001 ) and higher HMH (ρ = 0.562, p = 0.006) were associated with higher barrier scores. The most frequently identified barrier was difficulty understanding study risks (>90%). Conclusions: Under-resourced SES, HMH, and lower HL were associated with increased barriers to ClTr participation. Caregivers described modifiable barriers that could be targets for intervention to improve ClTr participation and reduce disparities in childhood cancer outcomes.

Objective: Patient-Centered Outcomes Research (PCOR) and Comparative Effectiveness Research (CER) focusing on pediatric cancer surgery are insufficient. To address this need, the authors aimed to create an evidence-based PCOR agenda for children with solid tumors. Methods: Between September 2021 and October 2022, the Pediatric Surgical Oncology Research Collaborative (PSORC) advocacy group, composed of 25 physicians and 25 nonmedical patient/parent stakeholders, developed a research agenda culminating in an in-person meeting. Stakeholders included parents of children treated for solid tumors, survivors of childhood cancers, patient advocates, and pediatric oncology (medical and surgical) providers. A multisource five-component framework was used to develop the roadmap: 1) Education, 2) Topic Generation, 3) Gap Analysis and Systematic Review, 4) Value of Information (VOI) Analysis, and 5) Peer Review. Topic generation involved both physician and stakeholder meetings, focus groups, generating a word cloud, and a survey sent to 48 solid tumor disease and advocacy support groups representing over 1000 families. VOI analysis and peer review were conducted in person with 50 participants (25 stakeholders/25 physicians). Descriptive and thematic results are presented. Results: A systematic review identified only a single surgical PCOR report addressing pediatric solid tumors. Gap analysis demonstrated that surgeons’ goals focused primarily on improving surgical outcomes, whereas stakeholders’ concerns centered on surgeon skill/expertise, second opinions, pain, healing, and communication. The word cloud session identified several key issues: lack of family resources, pain, enhanced recovery, and communication. Important thematic PCOR questions from the survey focused on patient/family lack of knowledge, overwhelming predicaments, immediate surgical treatment options, and shared decision-making between families and surgeons. VOI analysis, peer review, and voting inferred that the primary PCOR agenda should aim to develop a question aid for families/caregivers that increases parent knowledge, engagement, and comfort with cancer surgery and tests the impact of shared decision-making for second opinions to increase parent comfort and participation in the child’s cancer treatment. Conclusions: Surgical PCOR is lacking and needed to enhance interactions between surgeons and patients/families with pediatric solid tumors. There is a significant discrepancy in the topics and prioritization of PCOR between pediatric surgeons and families. Identifying, understanding, and addressing gaps between patients/families and surgeons may lead to a robust patient-informed research agenda.

A rare case of multiple myeloma in a 14-year-old patientAlejandra Cervantes-Dominguez MS*1, Lindsay Zumwalt MD*1, Adiva Sahar MD3, Anish Ray MD2, Karen Albritton MD21 Anne Marion Burnett School of Medicine at Texas Christian University2 Department of Pediatric Oncology, Cook Children’s Medical Center3 Texas A&M College of Medicine*These authors contributed equally to this workWord Count: Abstract: 114, Main text: 845Keywords: pediatric multiple myeloma, plasma cell neoplasm, next-generation sequencing, IGH-MAFA, minimal residual diseaseCorrespondence to: Alejandra Cervantes-Dominguez, Anne Marion Burnett School of Medicine at Texas Christian University. 1100 W Rosedale St, Fort Worth, TX 76104.Email: a.m.dominguez@tcu.edu Phone: 786-862-3676This manuscript is an original work and has not been previously published in whole or in part and is not being considered for publication elsewhere.All authors have read the final manuscript, have approved the submission to the journal, and have accepted full responsibilities pertaining to the manuscript’s delivery and contents.There are no ethical, copyright or disclosure issues. There are no conflict of interest to disclose. There has been no funding received for this work from any of the following: National Institutes of Health (NIH); Welcome Trust; Howard Hughes Medical Institute (HHMI); and other(s)

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Melanoma is a very serious skin cancer. Finding it early is really important for successful treatment. In a study, researchers created a computer program called a 4-layer Convolutional Neural Network (CNN) to automatically detect melanoma. They used images from a dermatoscope, a special tool doctors use to examine skin. This program correctly identified melanoma 85.2% of the time. It also had a high score of 0.89 in AUC-ROC, showing it was good at diagnosing the disease. The study also looked at other performance measures like precision, recall, and F1-score. When experts compared this CNN to older machine learning methods, they found CNNs are very effective for detecting melanoma. However, it is still hard to identify melanoma in its early stages.