A document by Ping Hou. Click on the document to view its contents.

High Levels of Non-Blocking Anti-Interferon and Anti-Cytokine Autoantibodies in Individuals with mRNA Vaccine-Induced Systemic Allergic ReactionsMuge Kalaycioglu MD1,2, Allan Feng1,2, Shaurya Dhingra1,2,3, Muhammad B. Khalid MD4, Kari C. Nadeau MD, PhD5, Paul J Utz MD1,2,6, Pamela A. Frischmeyer-Guerrerio MD, PhD4,61Department of Medicine, Division of Immunology and Rheumatology, Stanford University School of Medicine, Palo Alto, CA2 Institute for Immunity, Transplantation and Infection, Stanford University School of Medicine, Palo Alto, CA3College of Medicine, University of Illinois at Chicago, Chicago, IL4Food Allergy Research Section, Laboratory of Allergic Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD5Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA6These authors contributed equallyCorresponding author: Muge Kalaycioglu, mugekal@stanford.edu, 6508890995Disclosure Statement: PJU was supported by the Henry Gustav Floren Trust, the Stanford Department of Medicine Team Science Program; funding from the Stanford Medicine Office of the Dean (to PJU); and National Institute of Allergy and Infectious Diseases/NIH 1 R01 AI182319-01. PA-FG and MBK were supported by the Division of Intramural Research (grant AI001336), National Institute of Allergy and Infectious Diseases, NIH.Disclosure of potential conflict of interest : The authors declare that they have no relevant conflicts of interest.

Background: Persistent left superior vena cava (PLSVC) is a rare vascular anomaly that can act as a trigger for atrial fibrillation (AF) through its connections with the coronary sinus (CS) and the left atrium. While various ablation strategies have been proposed, thermal energy sources carry a high risk of complications. Pulse field ablation (PFA) offers a promising alternative due to its tissue selectivity and improved safety profile. Case Report: We report the case of a 68-year-old male with persistent AF and a history of prior catheter ablation, including pulmonary vein isolation (PVI) and conservative PLSVC ablation. After experiencing AF recurrence four years post-procedure, the patient underwent repeat ablation. Mapping revealed PV isolation but reconnection of the posterior wall and PLSVC. Ablation was performed using the Pulse Select PFA system (Medtronic), achieving successful posterior wall and PLSVC isolation. No complications occurred, and at six-month follow-up, the patient remained free of arrhythmia recurrence. Discussion: To our knowledge, this is the first reported case of PLSVC isolation using the Pulse Select catheter. Previous reports have described PFA with the FARAPULSE system (Boston), demonstrating its feasibility. The Pulse Select catheter employs a ”skipped bipolar” configuration, delivering energy between non-contiguous electrodes, which may result in slightly deeper lesions compared to conventional bipolar PFA catheters. Conclusion: PLSVC isolation using PFA is a feasible and safe approach that may help prevent AF recurrence. Further studies are needed to validate its long-term efficacy and safety.

A document by Majd El-harasis. Click on the document to view its contents.

The Spanish Purebred Horse (Pura Raza Española, PRE) is a breed that holds high value in Spain with a notable economic impact. The genetic basis of skeletal muscle fiber type traits in the PRE has not been thoroughly studied. We genotyped 151 samples of PRE with data on muscle fiber. This data was derived from previous records of the Muscle Biopathology Laboratory of the University of Cordoba when biopsy samples were taken in 1998 from the right gluteus medius muscle of each horse at depths of two cm (superficial region), four cm (middle region), and six cm (deep region). We assessed sixteen phenotypic muscle fiber type variables and using a chip containing 71,607 markers. Statistical analyses identified of three single nucleotide polymorphisms (SNP) at the genome-wide level displaying highly significant associations that were all repeated in two muscle fiber type traits at 2 cm of depth: the proportion of the myosin heavy chain (MHC) isoforms IIA and IIX ( MHCIIA and MHCIIX). In proximity to these significant SNP, we discovered three genes— ABLIM2, SH3TC1 and HTRA3—providing valuable insights into the genetic factors influencing muscle fiber type traits in the PRE. This study represents a crucial first step towards identifying the genetic factors that influence muscle fiber type traits in the PRE.

The precise isolation and analysis of rare cells from blood are crucial for biomedical research and clinical diagnostics. This review examines recent advancements in magnetic-based separation techniques, focusing on their efficiency in capturing rare cells such as circulating tumor cells (CTCs), circulating fetal cells, and diseased red blood cells (RBCs). These methods use magnetophoresis under external magnetic fields for highly specific isolation with minimal contamination, offering advantages over traditional techniques in speed, cost-effectiveness, and robustness. Magnetic separation is categorized into label-based methods, which use immunomagnetic nanoparticles (IMNs) to target specific cell markers, and label-free methods, which exploit differences in magnetic susceptibility. Both approaches have achieved up to 99% efficiency in isolating diseased RBCs and CTCs. However, challenges remain in improving purity, scalability, and clinical applicability. A key limitation of label-based methods is the need to detach cells from magnetic beads without compromising viability. Label-free technologies, such as magnetic levitation, enable ligand-free separation based on density and susceptibility. Future research should focus on optimizing paramagnetic media, integrating machine learning for enhanced accuracy, and developing high-gradient magnetic fields (~1,000 T/m) to improve efficiency. Advancements in IMNs with stronger magnetic properties will further enhance separation performance, driving clinical translation.

Due to the rapid growth of the Internet of Vehicles (IoV) and the rise of multimedia services, IoV networks' servers and switches are facing resource crises. Multimedia vehicles connected to the Internet of Things are increasing; there are millions of vehicles and heavy multimedia traffic in the IoV network. The network's scarcity of resources results in overload, which, in turn, leads to a degradation of both Quality of Service (QoS) and Quality of Experience (QoE). Conversely, when resources are abundant, it leads to unnecessary energy wastage. Managing IoV network resources optimally while considering constraints such as Energy, Load, QoS, and QoE is a complex challenge. To address this, the study proposes a solution by decomposing the problem and designing a modular architecture named ELQ 2. This architecture enables simultaneous control of the mentioned constraints, effectively reducing overall complexity. To achieve this objective, Network Softwarization and Virtualization concepts are employed. This modern architecture allows dynamically adjusting of the scale of the resources on demand, effectively reducing energy usage. Additionally, this architecture provides some other potentials, such as "the distribution of multimedia traffic among servers", "determining the route with high QoS for traffic", and "selecting a media with high QoE". A real test field is provided by Floodlight Controller, Open vSwitch, and Kamailio Server tools to evaluate the performance of ELQ 2. The findings suggest that the utilization of ELQ 2 holds promise in reducing the count of active servers and switches via effective resource management. Additionally, it demonstrates enhancements in various QoS and QoE parameters, encompassing throughput, multimedia delay, R Factor, and MOS, accomplished through load balancing strategies. As an illustration, the deployment of flows has achieved a commendable success rate of 95% owing to the utilization of SDN-based and comprehensive management practices encompassing all network resources.

TITLE Report from the 2025 Dorothy Russell Havemeyer Foundation meeting on Equine Gastric Ulcer Syndrome (EGUS): Advances in the field. AUTHORS AND AFFILIATIONS Benjamin W. Sykes; b.sykes@uq.edu.au; BW Sykes Consultancy, Coffs Harbour, NSW, Australia. Gayle D. Hallowell: gayle.hallowell@medicine.vet; Medicine Vet Equine Referrals, Melton Mowbray, UK. Frank M. Andrews; fandrews@lsu.edu; Equine Health and Sports Performance, Department of Veterinary Clinical Sciences, School of Veterinary Medicine, Louisianna State University. The full names of the authors, email addresses, and the institutional affiliations where the work was conducted. KEYWORDS N/A FUNDING INFORMATION Dorothy Russell Havemeyer Research Foundation and Boehringer Ingelheim. ACKNOWLEDGEMENTS N/A CONFLICT OF INTERESTS B.W.S. has active consultancy or research engagements with Kelato Australia, Kelato USA, MDS-Vet, MAI Animal Health, and Mayohealth, and within the past 3 years, has provided research, consultancy or educational services for Abbey Laboratories, A-Vet, Health Food Symmetry, Hong Kong Jockey Club, Kentucky Equine Research, and Salfarm Denmark, all of whom have products within the EGUS space. G.D.H. has affiliations with Salfarm Denmark having provided consultancy services; this company has products in the EGUS space. F.M.A. consults and has had funded grants from Boehringer Ingelheim Animal Health, which has medications in the EGUS space. See Section 4.7. If there are none to disclose, please include the following statement below: ‘The authors have declared no conflicting interests’. DATA INTEGRITY STATEMENT N/A ETHICAL ANIMAL RESEARCH N/A INFORMED CONSENT N/A ANTIMICROBIAL STEWARDSHIP POLICY N/A DATA AVAILABILITY STATEMENT Data sharing is not applicable to this article as no new data were created or analysed in this study.

Background: Epizootic lymphangitis (EEL) is a persistent fungal disease affecting equines, yet effective vaccines remain scarce. The newly developed Histoplasma farciminosum ‘8ZH’ vaccine requires safety validation before going into general usage. Objectives: This study aimed to evaluate the biochemical and haematological safety of the H. farciminosum ‘8ZH’ vaccine in foals. Study Design: A controlled, single-blinded trial was conducted using 30 clinically healthy foals, randomly divided into vaccinated (n = 15) and control (n = 15) groups. Methods: Foals in the vaccinated group received a 5 mL intramuscular dose of the H. farciminosum ‘8ZH’ vaccine (2 mg/mL, total 10 mg) with a booster on Day 21. Biochemical (AST, ALT, bilirubin, creatinine, glucose, cholesterol) and haematological (WBC, RBC, haemoglobin, haematocrit) parameters were measured at baseline and at multiple time points over 42 days. Results: No severe adverse effects were observed. AST levels showed a transient increase on Days 14–21 ( p = 0.04) before returning to baseline. WBC counts peaked on Day 14 ( p = 0.03) but stabilized afterward. All measured biochemical and haematological parameters remained within physiological ranges throughout the study. Conclusions: The H. farciminosum ‘8ZH’ vaccine demonstrated a favourable safety profile in foals, with no significant biochemical or haematological disturbances. These findings support its potential integration into EEL control programs, though further long-term studies are planned.

Fire disturbances can trigger biological invasions and reshape landscapes. We develop a spatial stochastic model to analyze the invasion dynamics of fire-adapted species into regions with historically low fire occurrence. The model incorporates two key parameters that characterize positive feedback with fire: post-fire vegetation regrowth and fire spread rates. After fire events, rapid vegetation regrowth facilitates the expansion of invasive species, which in turn increases both fire frequency and intensity. Our results reveal a continuous transition toward native species extinction as fire disturbance becomes the dominant factor in system dynamics. The system shows the highest sensitivity to external fluctuations during this transition phase. Spatial heterogeneity significantly influences the dynamics: notably, native species face higher extinction risk when invasive species are concentrated in a single cluster compared to random spatial distribution. These findings emphasize how spatial patterns of invasion, combined with fire-vegetation feedback, can accelerate native species decline.

1.     Schistosomiasis is a parasitic disease that affects over 250 million people worldwide, with the majority living in rural areas of sub-Saharan Africa. The parasite relies on freshwater snails of the genus Biomphalaria as intermediate hosts. Mapping snail distribution is vital for identifying disease transmission hotspots. However, expert-led monitoring is often constrained by limited resources and restricted access to remote areas, highlighting the need for scalable and cost-effective alternatives.2.     This study evaluates the effectiveness of citizen science in predicting Biomphalaria spp. presence by comparing models built from citizen- and expert-collected data. We tested two scenarios: the first one assumed perfect detection and focused on environmental and geomorphological predictors, while the second accounted for imperfect detection to explore discrepancies between citizen observations and expert-derived detection probabilities.3.     In the perfect detection scenario, the expert and citizen models identified site type and NDVI as significant environmental predictors of snail presence. Although both models demonstrated low marginal R² values (~16-17%), indicating limited explanatory power of broad-scale environmental predictors, conditional R² values exceeded 65%, suggesting that fine-scale, site-specific habitat characteristics are critical determinants of Biomphalaria presence. For the imperfect detection scenario, models showed minimal discrepancies, primarily explained by individual observer variability and differences in sampling effort. Increased sampling effort consistently reduced false negatives and led to unexpected observations of snail presence by the citizens (i.e. observed presence in sites predicted unsuitable by expert model). 4.     Our findings demonstrate that citizen science, when properly structured and statistically accounted for, can generate ecological data with accuracy comparable to expert-led surveys. We highlight the importance of accounting for observer variability, providing calibrated training, and optimizing sampling strategies to enhance data quality. This study presents a transferable and cost-efficient framework for participatory ecological monitoring in resource-limited and under-sampled regions.

There are a series of studies on social capital and health promotion. However, little is known the association between health and capital. Based on the previous work “Talents Are Gross Domestic Product”, after briefly introduced the current studies on social capital and health promotion, the author further proposed a novel concept of “Health Is the First Capital” in this article. Together with “shared health is shared prosperity” and “shared health is a higher level of shared prosperity”, these fresh concepts are very beneficial to economic and social development in the globe, in particular the post-COVID-19 era. Moreover, it was confirmed in the United Kingdom (UK), since poor health among working-age people costed the UK economy about £150bn a year. Herein, the “magic polypill”, that is healthy “environment-sleep-emotion-exercise-diet” intervention [E(e)SEEDi] lifestyle, is urgently needed for improving workers’ health and sustainable economic growth and social development in the globe. In conclusion, people should adhere to health first for high-quality economic and social development due to the new concept and theory–“Health Is the First Capital”, at the same time, not only “Health in All Policies” and “Health in All Laws” but also “Health in All Economics” are necessary to further improve global health.

Oluwakemi Odukoya, Hafiz T.A. Khan, Anne Manyande, Raffaella MilaniOluwakemi OdukoyaPhD student in Global HealthCollege of Nursing, Midwifery and HealthcareUniversity of West LondonUnited KingdomEmail: 33118484@student.uwl.ac.uk

Nursing Experience of a Patient Undergoing Limb Amputation Due to Fulminant PurpuraKCM: Early recognition of fulminant purpura and aggressive multidisciplinary care, including psychological support, are critical to mitigating morbidity and enhancing rehabilitation outcomes in adolescents requiring limb amputations due to this devastating condition.

Title: Left Ventricular Outflow Tract Lesion in a Patient with Rheumatic Valvular Disease: MacCallum Plaque?Running title: LVOT Lesion in Rheumatic Disease: A MacCallum Plaque?Maria Gabriela Matta1, Ahmed Reza1, Bradley Hefford1, Atifur Rahman1.1 Department of Cardiology, Division of Specialist Medical Services, Gold Coast Hospital and Health Services, Southport, QLD 4215, Australia.Maria Gabriela Matta ORCID: https://orcid.org/0000-0002-9651-1109Corresponding Author : María Gabriela Matta1 Hospital Blvd, Southport QLD 4215. Australia. email: magabrielama@gmail.comData Availability Statement: The data supporting this case are available upon request from the corresponding author.Funding Statement: No funding was received for this case.Conflict of Interest Disclosure: The author declares no conflicts of interest.Ethics Approval Statement: This is a case image, and ethical approval was not required.Patient Consent Statement: Patient data was anonymised and consent was obtained forthe use of the case report, ensuring confidentiality and compliance with ethical standards.Permission to Reproduce Material from Other Sources: No material from other sources was used in this case.Clinical Trial Registration: NA

Yang et al. developed a novel prognostic model for risk assessment in patients with pulmonary arterial hypertension (PAH), integrating right ventricle-pulmonary artery (RV-PA) coupling and inferior vena cava (IVC) diameter. In a single-center prospective study including 98 patients followed for a median of 26 months, they applied a three-layer echocardiographic model incorporating the tricuspid annular plane systolic excursion/pulmonary artery systolic pressure (TAPSE/PASP) ratio and IVC diameter. Their model demonstrated superior prognostic accuracy (C-index = 0.76) compared to the ESC/ERS 2022 three-strata and simplified four-strata models (C-index = 0.66 and 0.61, respectively). Patients with lower TAPSE/PASP and a dilated IVC exhibited a significantly higher risk of clinical worsening (HR = 15.1, p < 0.001). Despite its potential, the study presents limitations: the cohort predominantly consisted of female patients (84.7%) with PAH associated with congenital heart disease (71.4%). Additionally, IVC diameter is already utilized to estimate right atrial pressure, raising concerns about the added prognostic value of the proposed model. Moreover, while echocardiographic parameters offer a non-invasive assessment, they remain operator-dependent and less precise than gold-standard techniques such as right heart catheterization and cardiac magnetic resonance. Yang et al.’s work provides valuable insights into PAH risk stratification, yet a more comprehensive approach integrating invasive hemodynamic assessment and advanced imaging may enhance prognostic accuracy. Future studies should externally validate the model and explore clustering analyses to improve patient phenotyping, ultimately refining risk prediction and clinical decision-making in PAH.

Infant cardiac fibroma is a rare but life-threatening condition, characterized by anatomical complexity and postoperative recurrence risks, posing significant challenges in clinical management. This article presents a case of a 3-month-old male infant managed with multimodal contrast-enhanced ultrasound (CEUS) combined with transthoracic echocardiography (TTE), enabling precise preoperative assessment, real-time intraoperative navigation, and dynamic postoperative surveillance. CEUS effectively identified tumor microcirculation patterns, guided subtotal resection decisions, and facilitated early detection of residual lesions and cardiac dysfunction. Supported by a review of recent literature, this case highlights the innovative role of CEUS in infant cardiac tumor management.

Monoculture of Eucalyptus urophylla × E. grandis negatively impacts soil and forest ecosystems. Mixed plantations with thinning practices are proposed to improve soil fertility, though their effects on soil carbon (C), nitrogen (N), and microbial functions are not well known. We conducted an experiment on Eucalyptus forests (Planted in 2008) with varying thinning intensities (D1=no-thinning, D2=60%, D3=70%, D4=85%) and stand types (Pure Forest-PF) and Mixed ForestMF) to assess soil quality at depths of 0-20 and 20-40 cm. Results showed significant improvements in soil physical properties, including total, dissolved, particulate, and resistant organic carbons, light fraction carbon, and microbial biomass carbon, with increases of 65%, 97%, 149%, 111%, 87%, and 30% in D3 and MF treatments compared to PF. Additionally, total nitrogen (TN), nitrate nitrogen (NO3 －-N), ammonium nitrogen (NH4 +-N), and microbial biomass N significantly increased in D3 under MF treatment. Thinning up to 70% enhanced soil enzyme activities and populations of cellulose-decomposing and ammonifying bacteria in MF. Positive correlations were found between soil physiochemical properties and these bacteria. Our findings suggest that mixed plantations in Eucalyptus forests enhance soil functions, structure, biochemical attributes, and nutrient cycling, informing forest management in subtropical regions.

Global change processes are linked to the emergence of infectious pathogens in wildlife and heightened risk of zoonotic spillover into humans and domestic animals. Explanations for this relationship focus heavily on macroecological and behavioural mechanisms that generate novel transmission pathways. However, changes in land use and climate can also alter within-host microbial processes to foster pathogen evolution. Anthropogenic landscapes and climate change can impact host physiology, nutrient availability, temperature, and exposure to chemical pollutants. In experimental systems, each of these stressors can alter microbial interactions and evolution, including the acquisition of virulence genes. These altered interactions are hypothesized to remodel host-associated microbiomes into 'pathobiomes', microbial communities primed for pathogen evolution. We develop a conceptual framework that synthesizes the mechanisms by which environmental change influences within-host processes and pathogen evolution, distilling mechanistic pathways that link anthropogenic landscapes to within-host dynamics and pathogen emergence from microbiomes. We draw evidence from a wide range of host and pathogen systems, with a particular focus on opportunistic bacterial pathobionts-microbes that span the mutualist-pathogen continuum and whose evolution of virulence is often dependent on interactions with cohabiting microbes. Our framework highlights the need for research that integrates the impacts of environmental change on within-host processes to advance our understanding of pathogen emergence. Microbial surveillance methodologies, including highresolution metagenomics, tracking of mobile genetic elements, studying microbial stress responses, building isolate biobanks, and conducting in vitro experiments on microbial communities will be essential for elucidating the role of microbial interactions in pathogen evolution and emergence across environmental gradients. Identifying the mechanistic pathways that drive microbiome-to-pathobiome transitions is fundamental to developing mitigation strategies targeting pathogen emergence, spread, spillover, and spillback.G

Smoking is the main cause of chronic obstructive pulmonary disease and is associated with corticosteroid resistance. Given the paucity of data on human lung preparations, macrophages (LMs) and parenchymal explants (LPEs) were exposed to cigarette smoke extract (CSE) in the presence or absence of lipopolysaccharide (LPS). Moreover, LMs and LPEs were treated with budesonide prior exposure to CSE or LPS. The levels of cytokines (TNF-α and IL-6) and chemokines (CCL2, CCL4, CXCL1, CXCL5, and CXCL8) in the supernatants were measured using ELISAs. In LMs, exposure to CSE for 24 h was not associated with significant difference in the production of cytokines and chemokines, with the notable exception of greater CXCL8 production. The results were generally the same for LPEs. CSE exposure did not potentiate the LPS-induced production of the cytokines and chemokines and even tended to reduce this production in LMs and LPEs. Lastly, CSE exposure inhibited budesonide’s anti-inflammatory activity in LMs but not in LPEs. The present results extend the literature data on the cigarette smoke’s in vitro inflammatory effects and its inhibition of corticosteroid efficacy in human lung preparations. Our findings question the relevance of these lung preparations with regard to the long-term toxicity of smoking and the corticosteroid resistance observed in smokers and in patients with COPD.

This study evaluates an innovative tertiary stress management intervention that combines 0.1 Hz coherent breathing with blue light exposure using the ÉOS device. Conducted through a randomized-controlled crossover double-blind design in a workplace-based laboratory setting, the intervention’s effects on subjective stress, sleepiness, positive and negative affect along with heart rate variability (HRV) and EEG metrics were assessed using linear mixed-effect models. The intervention significantly reduced subjective stress by 31.23% (CI 21.41 % and 41.83 %), decreased sleepiness by 0.84 points (SE 0.17), and increased positive affect by 1.85 points (SE 0.54). No significant effect was found on negative affect. The findings suggest that integrating coherent breathing with blue light exposure can effectively mitigate acute stress and enhance mood without inducing sleepiness, potentially benefiting workplace performance. This study contributes to the understanding of stress management by demonstrating the potential of combined coherent breathing and blue light to improve well-being and performance in occupational environments. Future research should also compare interventions individually, explore long-term effects, and utilize diverse populations to further validate these findings.

Aim: Traditional Chinese medicine (TCM) health tourism is a key emerging force in China’s health tourism industry. However, issues like illegal practices and poor service quality have hindered its development. This study aimed to establish a standardized evaluation system to ensure service quality. Methods: Evaluation items were extracted from literature and industry standards. Using the Donabedian model (Structure-Process-Outcome), an analytic hierarchy process and a two-round Delphi method with 13 experts were applied. Expert reliability was tested, and empirical analysis validated the system. Results: A system with 3 dimensions (Structure 0.489, Process 0.289, Outcome 0.223), 8 first-level items, and 29 second-level items was developed. Key indicators included Performance and Safety (0.107), Service Planning (0.092), and Staff Disposition (0.070). Expert response rates were 76.92% and 100%, and the evaluated hospital scored 93.4 (three stars). Conclusions: The system clarifies access criteria and quality standards for TCM health tourism, guiding consumer choices and promoting industry development through regulation and resource allocation.

Across two datasets featuring sustained attention tasks, we confirm that increased random respiratory variability during task performance is associated with increased sigh frequency, and that sighs reset this variability. We further identify novel influences on sigh frequency: First, the degree of respiratory phase-locking to task stimuli positively correlates with both sigh frequency and increased respiratory random variability. Second, sigh frequency was higher with fixed stimulus intervals and lower with variable intervals, suggesting that dynamic and more engaging task conditions reduce sighing. Third, paced breathing reduces sigh frequency compared to spontaneous breathing, despite similar inspiratory volume variability – challenging prior claims that restrictive breathing increases sighing. This reduction may stem from increased task engagement during paced breathing, reducing the need for variability-resetting sighs. Fourth, variability analysis before and after sighs confirms that sighs reset respiratory variability, supporting the resetter hypothesis of sigh function, but we found no improvement in subjective focus or task performance, suggesting that sigh-induced attentional benefits may be context-dependent. Fifth, we demonstrate for the first time in humans that sighs co-occur with changes in pupil diameter, implicating noradrenaline-related arousal mechanisms. Sigh-related pupil dynamics differed between groups, suggesting interactions with both task structure and breathing patterns. Overall, our findings highlight the sensitivity of sigh frequency to respiratory phase-locking and task demands. The link between sighs and pupil responses suggests a broader role for the respiratory system in modulating arousal. Future research should further explore how respiration interacts with cognitive engagement, and noradrenaline-driven attentional shifts.

Background: Small supernumerary marker chromosomes (sSMC) constitute a rare group of structural chromosomal abnormalities characterized by additional genetic material that cannot be identified by conventional banding cytogenetic. The incidence of (sSMC) is extremely rare and most are expected to have no clinical phenotypic abnormalities. Advanced cytogenetic modalities are crucial for sSMCs