BACKGROUND In sub-Saharan Africa, particularly in Tanzania, the incidence of childhood cancer is 1.4 per 100,000 cases. Many cancer cases in Tanzania are not diagnosed until later stages because limited healthcare institutions are offering cancer-related care and treatment. When cancer manifests in its later stages, it not only reduces the chances of survival but also places a heavy burden on the healthcare system. As a lower-middle-income country, Tanzania faces numerous barriers to providing treatment for childhood cancers. This research aims to study the clinical presentation and types of childhood cancers at Muhimbili National Hospital. By investigating the types of childhood cancers commonly diagnosed and their clinical presentations, the study will provide valuable insights into the challenges of early diagnosis and treatment. The findings could help identify strategies to improve cancer care in Tanzania, ultimately improving survival outcomes and reducing the strain on the healthcare system. METHODS A hospital-based cross-sectional survey using a convenience sampling technique was conducted to assess the presentation and associated factors of childhood cancer. Descriptive statistics were used, and associations among variables were analyzed using the Chi-square (χ 2) test and one-way ANOVA, A p-value of <0.05 was considered statistically significant. RESULTS A total of 141 patients were assessed. The most common types of cancer among children aged 1 to 5 years were blastoma and leukemia. The Sukuma tribe had the highest percentage of patients, and most cases were from Dar es Salaam. The majority of patients presented with masses and abdominal distention. There was a statistically significant association between family history of cancer and the type of cancer, as well as between disease stage and treatment response. Additionally, a significant difference was observed in age distribution across cancer types. However, no statistically significant association was found between the type of cancer and a history of chronic illness or exposure. CONCLUSION Childhood cancer has a high mortality and morbidity rate in Tanzania. Most patients die before the age of five, and many arrive at the hospital with late-stage disease and severe symptoms. Additionally, some patients do not complete treatment, possibly due to financial difficulties or a low level of education among caregivers.

Biomass productivities in shake flasks are often not reproduced in bioreactors for plant cell cultures due to change in hydrodynamics. Considering shake flask biomass productivity as benchmark, this study employs shake flask geometries as a model system to understand hydrodynamic changes with volume and identify suitable scale-up criteria for plant cell cultivations, with minimal cost and time, given their slow growth time, using computational fluid dynamics (CFD) and experiments. Cultivation of Viola odorata cells in increasing flask volumes (250 to 3000 mL) revealed no significant change in biomass productivity. CFD analysis indicated that volumetric oxygen mass transfer coefficient ( kLa), increased up to 1000 mL and then decreased, due to saturation of energy dissipation rates ( kL is a function of energy dissipation rates) and decreasing interfacial area. The unaffected biomass concentration, despite decreased kLa, suggests that kLa may not be a significant scale-up parameter. Instead, maintaining a constant shear environment, indicated by power per unit volume saturation at higher volumes, was proposed as a suitable scale-up parameter for V. odorata cell cultivation in bioreactors. Moreover, the decrease in velocity difference between fluid layers with increased flask volume, indicated that minimizing velocity gradients in bioreactors could help achieve shake flask biomass productivity.

AbstractMedian Arcuate Ligament Syndrome (MALS) is a rare vascular condition where compression of the celiac artery by the median arcuate ligament leads to reduced blood flow, often presenting with postprandial upper abdominal pain, nausea/vomiting and weight loss. We report the case of a 43-year-old female who experienced similar symptoms over three months. MALS frequently mimics other gastrointestinal disorders, resulting in delayed diagnosis; however, imaging modalities such as Doppler ultrasound, computed tomography angiography, and magnetic resonance angiography are valuable diagnostic tools. Laproscopic surgical decompression is the treatment of choice.Keywords: Abdominal ischemia, Celiac Artery Compression, Chronic abdominal pain, Dunbar syndrome, Vascular compression syndrome

Understanding why some species succeed in naturalizing and invading ecosystems, while others do not, has intrigued scientists since Darwin’s time. The Pre-Adaptation Hypothesis posits that introduced species closely related to natives, and thus ecologically similar, are more likely to establish. This concept aligns with the Climate Matching Hypothesis, which emphasizes environmental similarity between native and invaded regions as a key factor in invasion success. However, conflicting evidence leaves the role of biogeographic origin and climatic affinity in predicting invasion risk unresolved. Here, we examine how biogeographical origin, climatic matching, and inter- and intraspecific pre-adaptation influence the success of congeneric plant species introduced to the Canary Islands, an oceanic archipelago with Mediterranean climatic affinities. We integrated phylogenetic, climatic and occurrence data at two levels: (i) interspecific comparisons of phylogenetic distances and climatic similarity between each introduced species and its closest native counterpart; and (ii) intraspecific analysis of climatic niche dynamics between native and introduced ranges. Most introduced congeneric species originate from the Mediterranean Basin and temperate Europe, with a notable contribution from the Neotropics. While Mediterranean and temperate European introduced taxa were phylogenetically closer to native Canarian species, we found no consistent evidence of pre-adaptation when climatic similarity among congeneric species pairs was also considered. In contrast, intraspecific analyses revealed widespread niche expansion, regardless of origin. However, species from the Mediterranean and Neotropical origin displayed a greater effect on climatic niche stability, suggesting stronger climatic matching. Overall, our findings highlight the prevalence of niche shifts among introduced plant species and underscore the role of climatic niche expansion in facilitating biological invasions. These results have key implications for assessing invasion risks in increasingly disturbed insular regions worldwide.

Arrhythmia is a common life-threatening cardiovascular disorder. Potassium channels play a crucial role in cardiac electrophysiology, and their dysfunction is closely associated with the occurrence and development of arrhythmia. Traditional Chinese medicine (TCM) has a long-standing history in treating various diseases, including arrhythmia and offers a rich source of compounds for anti-arrhythmic drugs. To provide in-depth new insights for the development of novel anti-arrhythmic therapies this review delves into TCM’s effects on potassium channels through multiple ways, including the direct interaction between the active ingredients contained and potassium channels, regulation of the expression of related genes and proteins, intervention in intracellular signaling pathways, and exertion of antioxidant and anti-inflammatory effects. With continued efforts in standardization, research, and integration with Western medicine, TCM is playing an increasingly important role in the treatment of arrhythmia and provides novel options for patients worldwide. Phenomics and pharmacophenomics as well as the artificial intelligence-based GPCR ligand screening system may provide new paradigms and platforms for discovering and developing more antiarrhythmic drugs.

Background: Prescribing cascades occur when new medications are initiated to treat adverse drug reactions (ADRs) caused by an initial medication (index). Although dose reduction of the index medication is often recommended, evidence supporting a dose-dependent relationship is limited. Objectives: To investigate dose-dependent relationships in prescribing cascades where such evidence is currently insufficient or lacking. Methods: A cohort study was conducted using prescription sequence symmetry analysis with data from over 600 Dutch community pharmacies. We assessed 18 prescribing cascades involving ACE inhibitors (ACEIs), statins, antidepressants, calcium channel blockers, and other drug classes. Index medication doses were categorized based on the WHO Defined Daily Dose (DDD) into low (<0.50 DDD), medium (0.50–1.50 DDD), and high (>1.50 DDD). Adjusted sequence ratios (aSRs) were calculated per dose category; aSRs >1 indicated the presence of a prescribing cascade. Results: Twelve of the 18 prescribing cascades showed a dose-dependent relationship. All ACEI-related cascades demonstrated increasing aSRs with higher doses. For example, for ACEI potentially causing cough, followed by various medications in four cascades, aSRs increased from 0.86-2.09 for low doses to 1.29-2.75 for high doses. Dose-dependent relationships were also found for statins, antidepressants, and dihydropyridine calcium channel blockers. No such relationship was observed for cascades involving proton pump inhibitors, diuretics, and non-steroidal anti-inflammatory drugs. Conclusion: Medication dose can play a significant role in prescribing cascades. Clinicians should be aware of potential ADRs at higher doses and consider dose reduction as a strategy to prevent or reverse certain cascades.

Agile software development frameworks such as Scrum promote frequent communication through structured ceremonies intended to foster a shared understanding. However, communication challenges remain a persistent source of process inefficiency, particularly in complex, cross-functional projects. This case study investigates how a lack of common ground contributes to communication-related process loss within Agile settings. Based on semi-structured interviews with experienced Agile team leaders, the study reveals that Agile ceremonies alone are insufficient to ensure effective knowledge sharing and coordination. The findings highlight the need to distinguish communication purposes across stakeholder roles, introducing the concept of role-based communication interfaces as a means of enhancing effective communication. By viewing Agile teams as socio-technical systems, this study identifies targeted strategies to mitigate process loss through structured, purpose-driven communication frameworks. The study contributes to the understanding of how Agile practices can evolve to better address communication challenges, offering practical guidance for improving software development processes in real-world team environments.

The autoclave functions as a medical device used to sterilize hospital surgical equipment and instruments. Scarcity of electrical power and fossil fuel pollution in hospitals and rural health centers emphasizes the necessity to explore different energy resources for autoclave operation. Such situations require the implementation of Solar autoclaves as an operational alternative. This research explores how well solar-powered autoclaves operate in their capacity to conduct wet sterilization processes. The solar autoclave contains a pressure vessel with Fresnel lens and reflector and porous medium. Aluminum beads exists as low-density porous material that holds unique structural and thermal characteristics. Heat transfer performance improvements through aluminum beads derive from multiple effects which encompass fluid-solid contact mechanisms and porous matrix heat distribution ability followed by fluid-heat transfer. The steam temperature inside the vessel (porous material absorber model II) reaches its peak of 128 °C. The energy efficiency achieving its peak at ɳc 74% coincided with the mid of the day at 1 pm when solar radiation intensity was at its value of 913 W/m2 for solar autoclave (porous material absorber model II) while reached ɳs (25%) for solar autoclave (flat plate absorber model I).

Introduction An unsafe abortion is defined as a procedure for terminating an unintended pregnancy carried out either by a person lacking the necessary skills or in an environment that does not conform to minimal medical standards or both [1]. Illegal abortion continues to be a real public health problem in Niger and other developing countries with a high frequency but underestimated because of its illegal and clandestine nature [1,2]. Each year,73 millions induced abortions happen in the world, of which nearly 45% are unsafe, and 97% occur in underdeveloped countries of sub-Saharan Africa and Central and South Asia [3,4]. It is responsible for significant maternal morbidity and mortality. For example, in Africa, death due to unsafe abortions accounted for about one-third of all maternal mortalities

Elevated CO 2 and nitrogen (N) supply enhance plant drought tolerance, yet their interactive effects on leaf hydraulic-photosynthetic coordination remain unclear. Here, we investigated how CO 2 enrichment and N application regulate stomatal behavior and leaf anatomy to optimize drought adaptation in tomato ( Solanum lycopersicum L.). Field experiments combining CO 2, N, and drought treatments revealed that leaf transpiration decreased nonlinearly with declining root water potential, while elevated CO 2 and N significantly improved leaf water potential and gas exchange. Anatomical analyses demonstrated that stomatal density and chloroplast structure jointly mediated hydraulic conductivity and photosynthetic efficiency. Structural equation modelling suggests that increased CO 2 and N application can mitigate hydrodynamic properties and photosynthesis in tomato under drought stress by modulating leaf stomata and anatomy. These findings highlight the critical role of leaf anatomical plasticity in coordinating hydraulic and photosynthetic responses under combined abiotic stresses, providing mechanistic insights into crop adaptation to future climate scenarios.

Background Smoking cigarettes negatively impacts ovarian reserve and fertility but less is known about the impact of vaping (e-cigarette use). Objectives The aim of this systematic review was to assess the impact of vaping on ovarian reserve and outcomes of assisted reproductive technology (ART). Search Strategy A systematic search of PubMed, the Cochrane database, EMBASE and CINAHL and selected conference abstracts from 2019-2025 was carried out using relevant search terms. Selection Criteria We included experimental and observational studies with human female participants. Vaping was the exposure. Objectively measured ovarian reserve markers and results of ART were outcomes. Studies of animals, males only or pregnant women and review/opinion articles were excluded. Data Collection and Analysis PRISMA guidelines were followed, and studies were assessed with a risk of bias tool. Main Results The initial search yielded 213 articles; three studies met the inclusion criteria. One retrospective review of > 20,000 healthy women of reproductive age and observed a 7.76% reduction in Anti-Müllerian hormone (AMH) levels in vapers compared to non-vapers . Two prospective observational studies on outcomes of intracytoplasmic sperm injection (ICSI) for infertile couples, compared smokers/vapers to non-smokers. One study reported significantly lower AMH levels and fertilisation rates in smokers/vapers but neither study reported a difference in clinical outcomes. Conclusions Vaping appears to reduce ovarian reserve, but it is yet to be empirically proven whether vaping negatively impacts ART outcomes. Funding No funding was provided to carry out this systematic review.

Objective(s): This review assesses Continuous Positive Airway Pressure (CPAP) therapy’s effectiveness in reducing cardiovascular disease (CVD) risk in obstructive sleep apnea (OSA) patients, particularly its impact on hypertension and nonfatal cardiovascular events in non-sleepy individuals. Data Sources: This systematic searched across Embase, PubMed, and Medline, from inception up to April 10th, 2025. Methods: We identified relevant studies focusing on CPAP’s cardiovascular effect on non-sleepy OSA patients. The analysis included randomized controlled trials (RCTs), observational studies, and excluded non-English articles or those not addressing direct CV-outcomes. Results: Out of 12 studies, findings were mixed: Blood Pressure (BP): CPAP may lower BP in some moderate-to-severe OSA patients, though results varied. Cardiac Function: Evidence suggests improvements in cardiac function and structure, including left ventricular ejection fraction and mass index, in some patients. Cardiovascular Incidence and Mortality: The effect of CPAP on reducing CV-events and mortality was inconsistent, with some studies noting benefits in adherent patients, while others found no significant impact. Conclusion: CPAP therapy shows potential benefits for cardiovascular health in non-sleepy OSA patients, including BP-reduction and cardiac function improvement. However, the impact on more severe CV-outcomes requires further investigation. CPAP remains an important treatment for OSA, emphasizing the need for adherence and early intervention for optimal outcomes.

This paper introduces BILA Core 1.0, a 16-bit Reflex Machine Architecture and bitstream programming model tailored for real-time, resource-constrained embedded systems. Integrating CVNSS 4.0—a phonetic-structured Vietnamese script standard—binary Morse mapping for semiotic instruction encoding, and a Huffman-rooted compression tree, BILA Core achieves deterministic execution latency under 120 ns, a 12.5% reduction in instruction size compared to fixed-width code, and a 40% performance gain over Forth interpreters. Implemented as a co-processor on an ESP32 microcontroller, BILA Core establishes a foundation for safe, symbolic, and reflexive microcontroller-based systems.

Objectives: To describe the evolution and outcomes of our graded skull base repair protocol in endoscopic pituitary surgery. Methods: Retrospective cohort study of 406 consecutive patients who underwent endoscopic pituitary surgery for adenoma at our institution. The repair protocol underwent two modifications across three study periods. From 2013 to 2016, protocol was based solely on the grade of intraoperative cerebrospinal fluid (CSF) leaks. Between 2017 and 2019, sellar diaphragm descent was incorporated. Since 2020, preoperative risk factors such as obesity, previous surgeries, and prior irradiation were included, influencing the materials used in skull base repair. Results: Postoperative CSF leak rate decreased across study periods; 12.5% (14/112), 6.2% (7/113) and 2.2% (4/181), respectively. This difference was statistically significant between the first and last period. Overall, CSF leak incidence was 6.2% (25/406), CNS infection 0.7% (3/406) and mortality rate 0.2% (1/406). Among study periods, intrasellar fat graft utilization increased from 44.6% (50/112), 77.9% (88/113) and 84.0% (152/181). Vascularized flaps were employed in 20.5% (23/112), 52.2% (59/113), and 47.5% (86/181). Nasoseptal flap was the predominant choice. Dural substitute use decreased progressively: 81.2% (82/112), 55.4% (51/113), and 7.2% (13/181). Conclusions: The learning curve and refinement of our graded skull base repair protocol resulted in a substantial reduction in postoperative CSF leak rate. The presence and magnitude of intraoperative CSF leaks, diaphragm descent, and preoperative risk factors for postoperative CSF leaks were essential for guiding skull base reconstruction following pituitary surgery.

As quintessential cultural symbols in traditional shadow puppetry, artistic motifs encapsulate profound historical narratives and serve as vital conduits for intangible cultural heritage preservation. However, this craft confronts existential threats from digital entertainment proliferation and practitioner attrition. To address these challenges, this study proposes CSPMotifsGAN, an enhanced CycleGAN framework for constructing a motif dataset through three-stage processing: adaptive denoising, hierarchical classification, and multi-branch feature extraction (contour, texture, color). By integrating adversarial loss, cycle-consistency loss, and identity preservation loss, the model effectively resolves color distortion and textural degradation inherent in conventional CycleGAN. Experimental results demonstrate significant improvements: Fréchet Inception Distance(FID), Peak Signal-to-Noise Ratio(PSNR), and Structural Similarity Index(SSIM), validated through both subjective evaluations and statistical analysis.

Quantum algorithms have evolved from early proofs-of-concept to hundreds of specialized methods promising computational speed-ups in fields such as chemistry, cryptography, optimization, and machine learning. This Systematic Mapping Review (SMR) analyzes 262 algorithms published between 2000 and April 2024, adhering to PRISMA guidelines. We searched Scopus, IEEE Xplore, Web of Science, and arXiv, screened 1,245 candidate papers, and extracted detailed metadata for qualifying algorithms. A two-dimensional taxonomy organizes algorithms by problem class and application domain. Bibliometric analyses reveal that simulation and variational optimization dominate, quantum machine learning (QML) shows the fastest growth, and significant gaps exist in quantum control, error correction, and domain-specific optimization. We discuss these trends and propose research directions emphasizing hardware-aware design and exploration of novel problem structures.

IntroductionMyelofibrosis is an uncommon and chronic hematologic malignancy that causes the bone marrow to gradually undergo fibrosis, impairing hematopoiesis in the marrow, leading to extramedullary hematopoiesis, especially in the liver and spleen. This condition falls under the category of myeloproliferative neoplasms(MPN), a type of hematopoietic stem cell disorder.(1) The four most common types of myeloproliferative neoplasms are essential thrombocythemia (ET), polycythemia vera (PV), chronic myeloid leukemia (CML), and primary myelofibrosis (PMF). Among them, CML is BCR-ABL1  positive; however, the remaining three types are BCR-ABL1 negative. (2) The pathophysiology of PMF entails mutations in genes such as MPL, CALR, and JAK2, which result in aberrant signaling pathways that encourage the growth of megakaryocytes and eventually fibrosis. (3) A variant of MF known as idiopathic primary myelofibrosis (PMF) is identified after ruling out secondary causes, including polycythemia vera, essential thrombocythemia, or reactive fibrosis. PMFs do not have a prior MPN.(4) PMF is acknowledged as a relatively rare condition worldwide, with an estimated yearly incidence of one case per one million people. Both sexes are almost equally affected, and it most frequently happens in the 6th to 7th decade of life. Approximately 66 is the median age at diagnosis. (5)Elevated inflammatory cytokines have been linked to PMF-related constitutional symptoms, such as fever, night sweats, and lethargy. Besides this shortness of breath, abdominal discomfort, and easy bruising can also be seen in idiopathic PMF because of anemia, splenomegaly, and low platelet count, respectively. (6)Since PMF is rare and its symptoms are vague, diagnosing it in younger people is difficult.The purpose of this case report is to emphasize how crucial it is to take PMF into account when making differential diagnoses for fever in endemic areas, in younger patients, in order to encourage timely diagnosis and treatment. By presenting this case, we aim to raise awareness of PMF, particularly in young patients, and how it can be masked by infectious disease in endemic regions.

A document by Nan Jian. Click on the document to view its contents.

Untitled Document Generated on Sun May 4 03:58:08 2025 by LaTeXML

Objective To quantify the probabilities of HPV-persistence, viral clearance, or treatment at 24 months in women with CIN2 managed conservatively; describing the determinants of the decision for conservative management, losses to follow-up, and histological findings in treated women. Design Prospective single-arm intervention study. Setting HPV-based pilot screening in Vallecamonica-Sebino, Italy. Population Women with biopsy-confirmed CIN2. Methods Women with CIN2 assessed as low-risk by gynecologists were proposed for conservative management, those who refused received treatment, those who accepted were followed up with HPV, cytology, and colposcopy at 6, 12 and 24 months, then if lesion persisted, treatment was recommended. Competing-risk models were used for investigating the determinants of viral clearance and log-binomial models for the determinants of decision for conservative management and loss to follow up. Main outcome measures Clearance, treatment, or HPV-persistence at 24 months; decision for conservative management and follow-up losses. Results 180 out of 352 women with CIN2 chose conservative management. Within 24 months, 40.6% of women (95% CI 32.8-48.8%) achieved viral clearance, 43.9% (95% CI 35.9-52.1%) underwent delayed treatment, and 15.5% (95% CI 10.2-22.2%) remained HPV-positive. Younger age, immediate colposcopy referral, low-grade cytological and grade I colposcopy were associated with the conservative management decision. Women diagnosed during subsequent screening rounds were more likely to achieve viral clearance (Hazard Ratio 1.95 (95% CI 1.11–3.40)) and had better adherence to follow-up tests. Two cases of invasive carcinoma were identified in treated women. Conclusions Women diagnosed in later HPV screening rounds are more suitable candidates for safe and effective conservative management.

Background: Amniotic fluid volume and color are crucial for fetal health assessment and postnatal prediction. Oligohydramnios and meconium-stained amniotic fluid increase the likelihood of poor neonatal outcomes Method: A comparative prospective cross-sectional study was conducted at the Obstetrics and Gynaecology Department of teaching hospitals affiliated with J.J.M. Medical College, Davangere, from March 2021 to August 2022. 100 term pregnant women in active labor were enrolled in the study. Clinical and ultrasonographic assessments were performed to evaluate the Amniotic Fluid Index (AFI), non-stress test (NST) reactivity, properties of the amniotic fluid, and neonatal outcomes were recorded. Results: Maternal age exhibited a significant correlation with meconium-stained liquid (p=0.026). The non-reactivity of NST was significantly higher in the meconium-stained liquor groups (thin: 50%, thick: 33%) compared to clear liquor (16%) (p=0.011). A low AFI of <8 cm was observed more frequently in the thin meconium-stained liquid (75%) than in the clear (54.67%) and thick meconium-stained groups (22.2%). Thick meconium staining demonstrated significantly lower mean APGAR scores at 1 minute (5.89±0.98) compared to the thin (6.47±2.05) and clear liquor (6.87±1.21) (p=0.007). NST, AFI, and liquor color showed significant correlations with cesarean delivery, NICU hospitalization, and infant morbidity. The predictive sensitivity for neonatal problems was 77.78% for liquor volume, 80% for liquor hue, and 81.82% for NST. Conclusion NST, AFI, and amniotic fluid color affect fetal health. Oligohydramnios, abnormal NST, and meconium-stained amniotic fluid increase the risk of surgical delivery and lower APGAR scores.

The extent and nature of the overlap between visual imagery and visual perception have been debated over the past century. Can visual imagery result in presumably automatic physiological responses such as the pupillary light reflex (PLR)? Laeng & Sulutvedt (2014) reported pupillary responses to dark and bright imagined scenarios. Based on such findings, Kay, Keogh, and Pearson (2022) proposed using the magnitude of imagery-induced PLR as a measure of the ability to generate vivid imagery. We aimed to replicate Kay et al.’s (2022) findings on the PLR response in visual imagery. Ninety-five normally sighted participants were asked to view 16 stimuli in four luminance levels and then imagine the previously seen stimulus. Pupillary responses were measured during both the perception and imagery periods. The PLR response was examined by comparing the pupil diameter in the two darker luminance conditions against that in the two brighter conditions. The PLR response was statistically significant in both the perception and imagery periods (perception: F(1,94) = 598, p < .001; imagery: F(1,94) = 14.7, p < .001). Statistically significant bivariate correlations were consistently observed among the self-report questionnaires (VVIQ, OSIVQ, and SUIS) and the trial-by-trial vividness ratings, suggesting a shared mechanism underlying the subjective evaluation of imagery vividness. However, we could not replicate Kay et al.’s (2022) findings on the association between trial-by-trial vividness ratings and the magnitude of PLR response during the imagery periods. Our results indicate that while pupillary responses may reflect the presence of visual imagery, they do not consistently track the vividness of that imagery. This study highlights the potential of pupillometry as an objective measure of visual imagery but underscores the need for further validation and refinement to improve its reliability and applicability.

Title Page:Title: Thiazide-Induced Acute Interstitial Pancreatitis in a 55-Year-Old Male: A Rare Adverse Drug Reaction

A document by Hashim Mohammad. Click on the document to view its contents.