Understanding the colonization history and factors associated with changes in distribution and abundance of invasive species is paramount to inform control measures that prevent further spread and facilitate eradication. We investigated spatial patterns in genetic diversity and differentiation of the globally invasive species, the Red Swamp Crayfish (Procambarus clarkii) at a recent invasion front in the Detroit metropolitan area of southeast (SE) Michigan, USA. Genomic data based on collections of 763 individuals from 20 waterbodies and 2675 single nucleotide polymorphism (SNP) loci were used to estimate genetic diversity and spatial genetic structure, and to test hypotheses of gene flow and secondary spread. We identified strong genetic structure, and demographic (coalescent) analysis supported models consistent with multiple introductions from separate genetic lineages. Across the study area, seven genetically distinct clusters were identified. We found evidence of limited dispersal consistent with an isolation-by-distance pattern of gene flow among waterbodies. We also detected evidence of secondary dispersal from early invasive populations consistent with a bridgehead effect. Local landscape features including hydrological features, major land use types, and roads were not predictive of spatial genetic relationships among waterbodies within geographic clusters. Results suggest that the P. clarkii invasion of SE Michigan has proceeded through a combination of repeated introductions and secondary spread at fine spatial scales. The highly anthropogenically developed landscape of the metropolitan Detroit area did not appear to deter movements of P. clarkii, suggesting further spread is likely.

The rise of bacterial resistance is one of contemporary public health’s greatest challenges, driven by multidrug-resistant (MDR) pathogens. Developing effective, cost-efficient therapies to combat such infections is critical. Klebsiella pneumoniae, a gram-negative opportunistic bacterium, causes severe conditions like pneumonia, septicemia, and urinary infections. Bacteriophage therapy, an approach using viruses to target bacteria, is re-emerging as a promising alternative. This study aimed to isolate and characterize lytic bacteriophages with therapeutic potential against antibiotic-resistant K . pneumoniae strains. A water sample from the Porangabussu lagoon underwent chloroform treatment, centrifugation, and filtration. The spot test technique confirmed the presence of bacteriophages, and nucleic acid was extracted. Bioinformatic analysis identified target genes for the identification of K. pneumoniae phages leading to the design of specific primers: cap, and ack. qPCR analyses revealed bacteriophages with therapeutic potential in the water sample. These findings offer promising perspectives for combating MDR K. pneumoniae infections.

Klebsiella pneumoniae is an opportunistic pathogen of great medical relevance due to its high virulence and resistance to antimicrobials. Carbapenem resistance is mediated by carbapenemases and represents a global clinical challenge due to the limited therapeutic arsenal. Transcriptomic assays can elucidate antimicrobial resistance mechanisms and enables the identification of pharmacological targets in extensively drug-resistant (XDR) Klebsiella pneumoniae. This study evaluated the transcriptomic profile of carbapenemase-producing K. pneumoniae after exposure to meropenem and assessed its morpho-functional and metabolic pathway modifications in response to antibiotic treatment. The sensitivity of carbapenemase-producing K. pneumoniae, isolated from the ICU of the University Hospital Walter Cantídio in Fortaleza, CE, was determined by disk diffusion, broth microdilution, and the automated VITEK-2® method. The strain was exposed to subinhibitory concentrations of meropenem and their bacterial growth curve was determined. Total RNA was extracted from bacteria with and without antibiotic treatment at their growth curve log phase. RNA sequencing (RNA-Seq) was performed on a high-throughput MiSeq platform, and differential expression analysis identified both upregulated and downregulated transcripts. Following exposure to meropenem, K. pneumoniae showed increased expression of genes related to the plasma membrane, efflux pumps, and cell wall modifications, as well as genes involved in resistance to polymyxins and changes in energy metabolism, such as glycolysis and fermentation. Furthermore, genes associated with antioxidant systems and oxidative stress response were expressed at elevated levels, indicating a survival mechanism under selective pressure. On the other hand, transcripts associated with protein metabolism and DNA synthesis were downregulated, suggesting a global metabolic reprogramming aimed at cell maintenance under hostile conditions. Thus, exposure to meropenem induced complex adaptations in K. pneumoniae. The results provide valuable insights into the resistance and adaptation mechanisms of this bacterium, highlighting potential targets for new therapeutic strategies.

Photonics/light localization techniques are essential in understanding the structural changes in biological cells/tissues at the nano- to sub-micron scale. It is now known that structural alteration starts at the nanoscale at the beginning of cancer progression. This photonics study examines the molecular-specific nano-structural alterations of chronic alcoholism and probiotic effects on colon cancer using a mouse model of colon cancer. We assessed alcohol-treated and azoxymethane (AOM) with dextran sulfate sodium (DSS)-induced colitis models, including ethanol (EtOH) and probiotic ( L.Casei) treatments separately and together. The confocal images were analyzed using the mesoscopic physics-based Inverse Participation Ratio (IPR) technique to quantify the structural alterations at nano-to submicron scales. Significant enhancement of cancer progression was observed in the alcohol-treated group, and probiotics treatment with alcohol showed substantial reversal of these changes in colon cancer, underscoring the potential of the IPR technique in detecting and monitoring cancer progression.

A substantial fraction of cervical cancers arise in women who test negative for the 14 hrHPV types by standard assays, highlighting the need to investigate additional potential high-risk HPV (phrHPV) for screening efficacy. This study is to evaluate the pathogenic potential of phrHPV types—specifically HPV26, 53, 73, and 82—in a Chinese population. A retrospective study was conducted utilizing clinical data and cervical specimens collected from the Obstetrics and Gynecology Hospital of Fudan University between 2017 and 2025. Extended genotyping assays enabled the detection of a comprehensive panel of HPV types. The associations between individual HPV genotypes and the severity of cervical lesions were systematically analyzed. The results showed that in addition to the 14 most prevalent high-risk HPV types, HPV26, 53, 73, and 82 were identified among Chinese women, exhibiting varied degrees of pathogenic potential. Notably, among single infection cases, the incidence rates of CIN2+ were 21.8% for HPV26 and 18.2% for HPV82, with odds ratios of 2.02 (95% CI: 1.33–3.06) and 3.05 (95% CI: 2.13–4.36) compared to HPV-negative cases, respectively. The severity of cervical lesions displayed significant associations with specific HPV types, and these associations were further influenced by the age at infection. Taken together, extended HPV genotyping offers crucial evidence for advancing precision cervical cancer screening strategies in China. Further large-scale, prospective investigations are warranted to confirm and refine optimal genotype targets for population-based cervical cancer screening.

Drug-induced Acrocyanosis: Highlighting Venlafaxine as a potential culprit

Unmasking Linear psoriasis: A case of ILVEN-like presentation and topical treatment successKeywords: Linear Psoriasis; Inflammatory linear epidermal verrucous nevus

[Abstract] Objective This study aimed to analyze the correlation between preoperative intravenous injection of 10% glucose and early postoperative reduction in serum albumin levels in patients with laryngeal malignant tumors, as well as its influencing factors. Methods A retrospective analysis was conducted on clinical data from 61 patients with laryngeal malignant tumors who received preoperative 10% glucose. Based on whether postoperative serum albumin levels fell below the normal reference range, the subjects were divided into two groups: the experimental group (patients with postoperative hypoalbuminemia) and the control group (patients with normal postoperative albumin levels). Factors such as age, smoking status, lymph node dissection (unilateral or bilateral), pre-existing comorbidities, surgical approach, tumor stage, preoperative albumin, total protein, prealbumin, and globulin levels were analyzed to explore risk factors influencing early postoperative hypoalbuminemia. Results The analysis revealed that 26.23% of the 61 patients who received 10% glucose intervention developed reduced serum albumin levels during the early postoperative period, suggesting a potential association between preoperative glucose infusion and abnormal postoperative protein metabolism. Univariate analysis showed statistically significant differences (P<0.05) between the hypoalbuminemia and normal groups in preoperative albumin, total protein, prealbumin, potassium levels, surgical approach, and smoking status. Multivariate analysis identified preoperative albumin, preoperative potassium levels, and surgical approach as independent influencing factors for postoperative hypoalbuminemia in patients who received 10% glucose preoperatively. Conclusion Preoperative albumin levels, potassium levels, and surgical approach are associated with the occurrence of early postoperative hypoalbuminemia in patients with laryngeal malignant tumors who received preoperative 10% glucose. [Key words] malignant tumor of larynx；Postoperative hypoalbuminemia；Preoperative glucose infusion；Risk factors；Serum albumin

Background: Periodontitis, a prevalent inflammatory disease, leads to the destruction of periodontal tissues, and current treatments often fail to achieve complete regeneration. Stem cell-derived exosomes, nanoscale vesicles mediating intercellular communication, have emerged as a promising cell-free therapeutic approach. This study aimed to investigate the potential of exosomes derived from dental pulp mesenchymal stem cells (DP-MSCs) and folic acid (FA), both individually and in combination, to improve periodontal injury in an in vitro model. Materials and Methods: DP-MSCs were isolated from human deciduous teeth, cultured, and characterized by their differentiation potential into adipocytes and osteocytes, as well as flow cytometry analysis of mesenchymal stem cell markers. Exosomes were extracted from DP-MSC conditioned media and characterized using scanning electron microscopy (SEM) and Bradford assay for protein quantification. Human gingival fibroblasts (hGF) were cultured and subjected to an in vitro injury model by exposure to H2O2. The injured hGF cells were then treated with FA (50 µM) and/or DP-MSC-Exos (20 µg/ml). Expression of anti-inflammatory, antioxidant, apoptotic, and osteogenic genes was measured using RT-qPCR. Results: DP-MSCs exhibited fibroblastic morphology, differentiated into adipocytes and osteocytes, and expressed mesenchymal markers CD73 and CD90. SEM confirmed the spherical structure of the extracted exosomes, and the Bradford assay revealed a protein concentration of 850 µg/ml. In injured hGF cells, treatment with DP-SC-Exos significantly decreased the Bax/Bcl2 ratio (p < 0.0001) and reduced the expression of antioxidant genes CATA, Gpx, and SOD, and RIPK3. FA treatment reduced IL-6 and TNF-α expression, while both FA and DP-MSC-Exos treatments resulted in diminished TGF-β expression. Conclusion: DP-MSC-derived exosomes demonstrated a notable capacity to modulate gene expression in an in vitro periodontal injury model, particularly by reducing apoptotic and antioxidant gene expression. These findings suggest that exosomes hold promise as a potential therapeutic agent for periodontal regeneration, offering advantages over cell-based therapies.

In this study, a novel MoS2/NiO nanoflower decorated with different concentrations NiO nanoparticles (0, 2, 5, 8, and 12 wt%) was synthesized via the hydrothermal method. The FESEM illustrated spherical flower-like morphology for three-dimensional structures of both MoS2 and MoS2/NiO nanocomposite. XRD analysis confirmed the formation of the MoS₂/NiO nanocomposite without any indication of a new phase. Raman spectroscopy of MoS₂/NiO nanoflowers exhibited a shift of the first-order peaks to lower frequencies, indicating n-type doping due to the incorporation of NiO. The electrochemical properties of the nanocomposite were found to be improved due to the incorporation of the NiO nanoparticle into it. The MoS₂/12 wt% NiO offers a specific capacitance of 154.45 F g-1, which is 6.5 times larger than that of the MoS₂ (23.48 F g-1) nanoflower. It exhibited remarkable energy storage capacity and maintained 85% capacitance even after 10,000 charge-discharge cycles. The electrochemical impedance spectroscopy showed that the incorporation of NiO nanoparticles reduced charge transfer resistance, enhancing ion intercalation and electronic conductivity which boosted charge carrier kinetics in the MoS₂/NiO nanocomposite, thereby improving its overall electrochemical performance. The nanostructured MoS₂/NiO, fabricated through a straightforward and low-cost method with enhanced specific capacitance and increased stability, holds promise for developing efficient, eco-friendly, and affordable energy storage devices.

Aim: Cannabis-based medicines are gaining interest and being explored for new therapeutic indications, many of which commonly affect older medical patients. As most previous studies of the population pharmacokinetics of cannabinoids have been performed in healthy adults, this study aimed to investigate the population pharmacokinetics of THC and its active metabolite 11-hydroxy-Δ9-tetrahydrocannabinol (THC-OH) in older medical patients with poor appetite. Methods: We administered two fixed doses of Sativex® oromucosal spray to 20 patients, each dose consisting of 2 or 3 sprays (2.7 mg THC and 2.5 mg cannabidiol per spray), with a dosing interval of four hours. Blood samples were collected for up to eight hours to obtain plasma concentration-time data for non-linear mixed-effects modeling. Population pharmacokinetic models were developed for THC and THC-OH sequentially, resulting in a combined parent-metabolite model. Results: We found a one-compartment model and a two-compartment model to be the best fits for THC and THC-OH, respectively, with apparent clearance of THC through conversion to THC-OH (765 L/h) and other pathways (162 L/h). Absorption of THC was modeled with a delay through three transit compartments. The inter- and intra-individual variability on pharmacokinetic parameters was generally large (CV% = 40.2-152%). Using the parent-metabolite model, it was investigated whether physiological characteristics such as kidney function and body composition influence THC pharmacokinetics. Conclusion: the parent-metabolite model describes and quantifies the pharmacokinetics of oromucosally administered THC in older medical patients with poor appetite. The covariate analysis did not show any clinically significant effect on pharmacokinetic parameters of THC or THC-OH.

Wellens syndrome is a pattern of ECG T-wave changes associated with severe, proximal left anterior descending artery (LAD) arterial stenosis. The diagnostic criteria for Wellens syndrome were history of chest pain, mild or no elevation of myocardial enzymes, mild or no elevation of ST segment, no disappearance of prethoracic R wave,

The incorporation of rare earth metals into transition metal-based catalysts markedly improves their adsorption properties toward intermediates during coupled glycerol electro-oxidation and hydrogen evolution reactions. However, direct f-d electron hybridization often induces Fermi surface instability, limiting catalytic durability. To address this, we propose a novel strategy involving Dy and S co-doped NiMoO 4, where 4f-2p-3d gradient orbital coupling is introduced alongside sulfur vacancies (Sv) via Ar plasma etching. This approach simultaneously reduces the catalyst’s work function and mitigates interfacial charge accumulation, yielding bouquet-like Dy-doped NiMoO 4 with abundant Sv (Sv/Dy-NiMoO 4/NF). The optimized catalyst demonstrates remarkable performance in glycerol electrooxidation-coupled hydrogen production, achieving an exceptionally low hydrogen evolution overpotential of 29 mV at 10 mA cm -2 while simultaneously maintaining a cell voltage of just 1.39 V in membrane electrode assembly operation. This configuration provides a 260 mV reduction in potential compared to conventional overall water splitting, while additionally enabling the co-production of high-value formate as oxidation products. Experimental and theoretical analyses reveal that Sv optimize the electronic microenvironment, strengthening the adsorption of OH* and glycerol* intermediates. This work not only advances the design of high-efficiency electrocatalysts for energy-saving hydrogen production but also provides a sustainable route for co-producing valuable chemicals.

Despite some control efforts, Taenia solium cysticercosis/taeniasis (TSCT) continues to be prevalent in many low-income countries of sub-Saharan Africa, Latin America and Asia. Due to increased international interaction, the risk of infection also increases in high-income countries (HICs) and middle-income countries (MICs). Community knowledge and awareness of the problem is important to influence change in risky behaviours and hence controlling the parasite. This systematic review assessed the effectiveness/impact of health education interventions in the control of TSCT to influence future disease control strategies. Papers published up to June 2024 were searched using PubMed and Google search engines. Studies which evaluated interventions involving health education to improve knowledge, attitudes and practices (KAPs) to change behaviours regarding TSCT were included. Initially, a total of 392 studies were found, and 371 were excluded, leaving 21 publications. Behavioural changes and decreases in disease prevalence were difficult to evaluate in the 21 studies reviewed, but most concluded that health education, developed with community participation, improved KAPs, changed behaviour, and decreased disease prevalence in the short term.

Background American Society of Reproductive Medicine and American Society of Clinical Oncology emphasize the importance oncofertility counseling. Survivors often report inadequate attention to this crucial aspect of care. Balancing timely treatment initiation with oncofertility counseling presents challenges including cost, age at diagnosis, information overload, and time constraints. Procedures We performed chart abstraction of 265 pediatric patients diagnosed at University of Rochester Medical Center (January 1 st 2015 - May 31 st 2022). Hematologic malignancies made up 37.65% of the population. Median age was 7 with male predominance (56.2%). The majority of patients were Caucasian (80.7%). Results Only 12.5 % of the population had an oncofertility visit with reproductive endocrinology or urology and 42.4% had documented counseling with their oncology team. Sexual health was discussed in 2.6% of patients and 12.1% of patients had documented Tanner staging. Hematologic malignancy patients had a lower time to therapy (4.2 days) compared to extracranial solid tumors (14.8 days) and CNS tumors (97.8 days) when outliers were removed. Longer time to therapy trended towards significance for oncofertility visits and there was no statistical difference in oncofertility vists or primary team counseling rates based on disease severity. Conclusions The time before chemotherapy initiation is a unique barrier to oncofertility counseling for pediatric patients with malignancy. While most patients will have retained fertility on current protocols, patients with high risk of relapse will receive therapy more likely to threaten fertility. The results of this study indicate targeted intervention prior to relapse for this population may be a more feasible approach.

Selecting the most appropriate time series forecasting method for real-world tasks is challenging, as performance can vary significantly depending on dataset characteristics. Since proving the universal superiority of any forecasting method is impractical, a structured evaluation framework is essential. This paper proposes a DoE framework for the comparative evaluation of time series forecasting methods using synthetic data. The framework offers a versatile evaluation workflow adaptable to diverse forecasting techniques and begins with user input to incorporate prior knowledge and select candidate methods. Using Design of Experiments (DoE) techniques—such as factorial designs or response surface methodology —the framework defines key experimental factors and generates synthetic time series datasets tailored to different forecasting scenarios. Model training and evaluation are performed using appropriate performance metrics. Results are then summarized, enabling rigorous, reproducible, and context-aware model comparison. A case study comparing two methods on a problem of forecasting the total oil & grease (TOG) illustrates the framework’s flexibility and practical utility.

Background Proteasome inhibitors (PIs) are FDA-approved to treat adult malignancies. The PI, Bortezomib (BTZ), has been used off-label in pediatric patients but its safety profile in these patients has yet to be systematically assessed. We sought to review the pediatric safety profile of BTZ based on published clinical articles which we compared to publicly available adult safety data from drug insert. Methods PubMed and the Cochrane Database were searched up through September 2024. We included published clinical studies that reported adverse events (AEs) which included clinical trials, clinical studies (>10 patients), and clinical series/case reports (≤10 patients). Extracted pediatric safety data was compared to reported adult safety profile from BTZ drug insert. Results We found that pediatric patients treated with BTZ reported lower incidence of peripheral neuropathy and gastrointestinal toxicity compared to adults. Rates of bone marrow suppression and infection in pediatrics were comparable to or higher than those observed in adults, though these incidences were comparable or lower when pediatric patients with leukemia were excluded. Limitations There was heterogeneity in reporting of different AEs and not all categories were comparable to published adult AEs. Many studies were small case series or reports which did not allow for more quantitative analysis. Conclusions BTZ has an acceptable safety profile for use in pediatric patients. Antibacterial and antifungal prophylaxis should be considered given the high rate of infections.

Abstract Objective: This study assessed cervical cancer screening uptake and its associated factors among reproductive-age women in Jimma university medical centre. Design, Setting and Population: A community-based cross-sectional study was conducted in Jimma University Medical Centre among randomly selected 905 reproductive-age women. Method and outcome measures: Data were collected using face-to-face interviews using a structured questionnaire. Descriptive summaries of data were done using descriptive statistics. Binary logistic regression was used for the analytical study. Adjusted odds ratio and 95% confidence interval were respectively used to measure statistical associations and their statistical significance. Results: 905 women participated in the study making the response rate 96.79%. Only 83 (9.2%) women had ever been tested for cervical cancer. Being Muslim (OR=0.36, 9% CI; 0.15-0.88), not being head of household (OR= 0.23, 95% CI; 0.08-0.67), lack of knowledge of cervical cancer (OR=0.26, 95% CI; 0.09-0.74), lack of a favorable attitude towards cervical cancer screening (OR=0.13, 95% CI; 0.04-0.49), not listening to radio (OR=0.23, 95% CI; 0.07-0.74) were negatively associated with uptake of cervical cancer screening, whereas, none ever use of contraceptive (OR=2.92; 95% CI: 1.10-7.72) was positively associated with uptake of the screening. Conclusion: The rate of cervical cancer screening uptake from the current study is unacceptably low. Streamlining and strengthening curriculum integration and extracurricular health education intervention on cervical cancer giving due emphasis to Muslim-dominated communities and contraceptive users are recommended. Due emphasis should also be given to mass-media expansions and increasing coverage of health education to promote cervical cancer screening. Funding: None

The Nowadays Science of Physics states that when an external Force is exerted on any Massive Body it causes an Acceleration of this Massive Body according to Newton's Second Law of Motion, F=ma. But, if that Massive Body Accelerates according to Newton's Second Law of Motion, F=ma, this also implies, as will be presented in this paper, that all the Work done by this external Force, which is also all the Energy exerted on this Massive Body, is already converted to the Kinetic Energy that that Massive Body acquires, or, in other words, is already manifested and embedded in the Kinetic Energy that that Massive Body acquires, because of the above-mentioned external Force which was exerted on it. However, if an external Force is exerted on an Electrically Charged Massive Body, what was presented above might need modifications.

Tachy-brady: What is the Risk of Progression and the Role of Monitoring?Lamont Sharp, DOInternal Medicine Resident, Trinity Health Muskegon, Lamont.Sharp@trinity-health.orgJohn M. Meek, DOCardiologist, Trinity Health Muskegon, John.Meek@trinity-health.org

Atypical Presentation of Guillain-Barré Syndrome with Pandysautonomia Mimicking Parkinsonism and Cardiac SyncopeRua Alsaeed, MD 1 , Nabel Rajab Basha, MD2 , Sangharsha Thapa, MD 1,3 , Jin Li , MD 11Department of Neurology, Westchester Medical Center, New York Medical College, Valhalla, NY, USA2 Department of Medicine , Westchester Medical Center, New York Medical College, Valhalla, NY, USA.3 Kathmandu University School of Medical Sciences, Dhulikhel, NepalCorresponding Author :Sangharsha Thapa, MDEmail ID:sangharsachhetri@gmail.comKathmandu University School of Medical Sciences, Dhulikhel, Nepal

TitleA Case of Tracheostomy Cuff Malfunction: a case reportManuscript TypeCase ReportAuthors and Affiliations

Hidden in the Bones: A Rare Extra-nodal Musculoskeletal Presentation of Diffuse Large B-Cell LymphomaManuscript TypeCase ReportAuthors and AffiliationsDr R AbduljabbarJunior Clinical Fellow Department of Medicine Royal Glamorgan Hospital Llantrisant, Wales, UK Email: reem.abduljaabbar@wales.nhs.uk

It is a foregone conclusion that the presence of rivalry between states increases the likelihood and frequency they will experience conflict and war. Recent research has shown that territorial disputes, an important causal mechanism for rivalry onset, influences citizens’ willingness to fight. However, the relationship between state rivalry and individuals’ willingness to fight remains unexamined. Drawing from Social Identity Theory and Prospect Theory, I argue that citizens in states which have rivals are socialized into rivalry. Utilizing World Values Survey along with the Peace Data dataset, I show there is a strong, positive correlation between the presence of rivalry between states and the willingness of citizens in those states to fight for their country. Moreover, I find the effect is stronger among individuals in states that either have an identity claim with or share a border with a rival. Further tests using different rivalry taxonomies reveal the results are robust.  Key words: Willingness to fight, rivalry, contiguity, war, democracy, national pride