Background – Obesity is a key precipitating factor in laminitis development and frequent problem in many donkey farms across Europe. Stoic nature of donkeys makes laminitic changes often going unnoticed or mistakenly attributed to hoof neglect. Objectives – To investigate link between obesity, metabolic profile, inflammation, and laminitis, focusing on physical examination and serum biomarkers. Study design – Cross-sectional observational study. Methods – Ten randomly chosen lactating jennies over four years of age, from one farm, being fed with hay and bran, were enrolled in the study. Body condition score (BCS) was assessed using Pearson’s system. Grading scales for fat accumulations and laminitic hoof deformities were developed. Welfare was assessed using AWIN protocol. Blood samples for biochemistry analysis were collected after fasting. Data were presented as median [minimum, maximum] and analysed with MedCalc® software, with p<0.05 considered significant. Results – Laminitic hoof deformities (0.5 [0, 1]), were in strong positive correlation with BCS (7 [4, 8], p=0.008) and fat accumulations (1.5 [0, 2.5], p=0.017). The category of jennies with BCS≥7 had higher insulin than group with BCS<7 ( p=0.044). Insulin (34.86 pmol/L [8.33, 75]) showed positive correlation with glucose (4.12 mmol/L [3.8, 5.4], p<0.001), cholesterol (1.92 mmol/L [1.53, 2.38], p=0.008), and AST (461.6 U/L [379.1, 1037.6], p=0.023). Uric acid (0.20 mmol/L [0.09, 0.62]) showed positive correlation with BCS ( p=0.033) and urea (6.46 mmol/L [3.84, 8.68], p=0.048). Urea levels exceeded reference range in eight, and globulins in all the jennies. Main limitations – Small sample size, unknown gestational state, unawareness of individual food intake. Conclusions – In lactating, normoinsulinaemic and normoglycaemic jennies, over-conditioning is linked to subclinical laminitis. However, clear metabolic link is missing. Increased globulins suggest subclinical chronic inflammation, while the increase in urea and variable levels of UA suggest the need for thorough assessment of proper feeding management.

Understanding the reasons behind churn can help businesses develop effective retention strategies, improve customer satisfaction, and sustain a competitive edge in a highly saturated market like the telecommunication sector. This systematic literature review uncovers the implementation of machine learning algorithms to predict customer churn rates in the telecommunications industry. The review identifies key predictive variables and methodologies that enhance churn prediction accuracy by examining a wide range of studies. The findings highlight the significant role of data integration, particularly the inclusion of real-time and external data sources, in improving model performance. Data quality and privacy issues are also discussed, emphasizing the need for ongoing methodological improvements. The study concludes with recommendations for prospective studies, including the adoption of machine learning approaches like deep learning to refine predictive capabilities further and support robust customer retention strategies in the telecommunications sector.

This paper presents a filtering power divider (FPD) that integrates all-frequency absorptive and isolative functionalities while achieving extended out-of-band suppression. The proposed design employs an absorption-isolation network (AIN), composed of microstrip lines and resistors, to ensure simultaneous reflectionless input operation and high isolation without degrading filtering performance or requiring additional absorption circuits. A cascaded coupled-line (CL) structure facilitates broadband filtering and power division, while parallel half-wavelength stubs enhance out-of-band suppression. Additionally, a π-type defected ground structure (DGS) is incorporated to mitigate high-frequency spurious signals, further extending out-of-band suppression without increasing circuit footprint. Theoretical analysis and parametric optimization are performed to establish impedance conditions for achieving reflectionless operation and optimizing circuit performance. A fabricated prototype, centered at 2 GHz, exhibits a 72% 3-dB bandwidth, input reflection below -10 dB across the entire frequency range, all-band isolation exceeding 21.1 dB, and stopband attenuation greater than 25.2 dB up to 6.8 f 0. These results validate the proposed FPD as a compact and high-performance solution for modern RF front-end applications requiring spectral purity and robust isolation.

This research explores the development and effectiveness of a two-wheeled balanced autonomous vehicle. Autonomous vehicles are capable of perceiving their environment and functioning without human intervention, gaining increasing attention due to their advanced automation capabilities. A fully autonomous system demonstrates self-awareness and independent decision-making. These vehicles utilize an array of sensors, actuators, machine learning algorithms, and high-performance processors to execute complex software tasks. The proposed two-wheeled autonomous vehicle achieves self-balancing through mechanisms such as PID or IADRC control systems and enables wireless steering via IoT connectivity using Bluetooth technology. Communication is facilitated through Java-based applications on mobile devices or personal computers. Equipped with radar sensors, the vehicle monitors nearby objects, while video cameras identify traffic lights, road signs, and pedestrians. Lidar technology aids in measuring distances, detecting road edges, and recognizing lane markings, and ultrasonic sensors ensure precise parking by identifying curbs and nearby obstacles. The innovative IADRC control system offers enhanced robustness, superior disturbance rejection, and effective obstacle avoidance. Additionally, the vehicle operates on clean energy, minimizing carbon emissions and contributing to environmental sustainability. Its potential applications include last-mile delivery services and other small-area operations, reinforcing its value as an eco-friendly and versatile solution for modern transportation challenges.

Euphorbia paraikalli, a new succulent species allied to Euphorbia susan-holmesiae Binojk. & Gopalan is described in the present communication. The species differs in its habit, wider and short segments, densely packed whorls of branches, up to 6 wings, larger leaves, trapezoidal glands, capsules with rounded lobes, and brown speckled seeds. E. susan-holmesiae is known only from a single locality in Tirunelveli District, whereas E. paraikalli is found in sporadic populations in the hills that mark the southern boundary of the Deccan Plateau.

Homonyms are names spelling exactly like a name based on a different type that was previously and validly published for a taxon at the same rank (Art. 53.1 of Shenzhen Code). A perpetuation of the use of homonyms can result from original misidentifications which, in turn, are related to lack of the study of the original material. Furthermore, homonyms are valid names (if agree the Arts. 32–45) and they can be re-used to name new taxa at different rank (Art. 55.2). Hence, the study of homonyms is often necessary to avoid disadvantages in Nomenclature and mistakes in Taxonomy. In this paper, the case of Arenaria caespitosa is presented. It was published eight times (from 1790 to 1985) and refer to different taxa (genus to subspecies ranks). Two binomials (referred to Sabulina verna subsp. hercynica) were invalidly published by Ehrhart in 1790 (Arts. 38.1–38.2) and Willkomm in 1863 (Art. 36.1b). The other six names are valid: Salisbury’s A. caespitosa (described in 1796) is illegitimate (Arts. 52.1–52.2) and homotypic with A. balearica; Willdenow’s A. caespitosa (described in 1799 and here lectotypified on LINN-HS816-7-2) is illegitimate (Art. 53.1) and heterotypic with S. verna subsp. hercynica; Vahl’s Arenaria caespitosa [described in 1840 and here lectotypified on C10006116] is currently known as Sagina caespitosa; Philippi’s A. caespitosa (described in 1856 and here neotypified on K000471609) is heterotypic of A. serpens; Muschler’s Arenaria caespitosa (described in 1911 and here neotypified on USM334270) is a heterotypic synonym of A. tetragyna; Kozhevnikov’s Arenaria caespitosa (described in 1985 and here lecotypified on K000723188) is currently known as Thylacospermum caespitosum. Finally, I demonstrated that 1) S. nivalis sensu Nyman is a p.p. synonym of Lange’s S. caespitosa, whereas 2) Reichenbach’s Sabulina caespitosa (here neotypified on the Plate CCVII) is a heterotypic synonym of Sabulina verna subsp. verna.

A clinical case-control study was conducted to screen the influencing factors of patients with coronavirus disease 2019 (COVID-19) and to construct a clinical prediction model to provide a reference for the dynamic assessment of the severity of COVID-19 patients. A total of 410 patients with COVID-19 were included in the study, of which 132 were severe or critical cases. The clinical data of patients were collected, and then variables were screened by lasso regression analysis and 10-fold cross-validation. The screened variables were subjected to multifactorial logistic regression analysis to screen out the independent risk factors of patients with severe or critical illnesses, and the independent risk factors were integrated to construct a nomogram. The receiver operating characteristic curve (ROC), calibration curve analysis, and decision curve analysis (DCA) were used to assess the model efficiency. Five variables, including respiratory rate（R）, systolic blood pressure (SBP), plasma albumin (ALB), lactate dehydrogenase (LDH), and C-reactive protein (CRP), were finally included to construct a clinical prediction model, with an area under the curve (AUC) of 0.86 (CI: 0.82% to 0.90%).

Non-invasively collected samples such as sloughed skin has proven viable for genetic analysis using microsatellites and mitochondrial DNA, even when degraded. Next-generation sequencing techniques using single nucleotide polymorphisms (SNPs), offer a favourable alternative for degraded DNA, advancing our capacity to address important evolutionary, ecological and conservation questions for long-term studies of globally distributed species. This study utilised a next-generation sequencing approach for the first time to investigate SNP genotyping on 91 humpback whale (Megaptera novaengliae) sloughed skin tissues from both historical (2001 and 2003) and contemporary (2022) collections. DNA quality and quantity assessments confirmed successful long-term preservation and viability of historical skin tissues (>20 years old) with no significant degradation over time. SNP genotyping using sloughed skin produced reliable SNP markers (i.e., high quantity and quality) applicable for future genetic assessments. Three sex-linked markers associated with maleness were identified, suggesting heterogametic male (XX/YY) sex determination, although these markers alone are not reliable for accurate sexing. This study confirms the viability of SNP genotyping from historical and contemporary sloughed skin samples, supporting a collaborative, non-invasive approach to genetic and conservation research on humpback whales and other wide-ranging species.

Objective: Following the outbreak of the novel coronavirus pandemic, a series of preventive and control measures were adopted by the public, which have had a certain impact on the occurrence of respiratory infectious diseases and changes in their etiology. This article aims to explore the changes in respiratory pathogens among children with respiratory infections during the COVID-19 pandemic and after the comprehensive lifting of restrictions, providing a basis for the clinical diagnosis and treatment of pediatric respiratory infections in the post-pandemic era. Methods: We retrospectively reviewed and analyzed the targeted sequencing results of multiple respiratory pathogens in children with respiratory infections treated at the Children’s Hospital affiliated with Shandong University from January 2022 to December 2023. Results: A total of 16,571 targeted sequencing results of pathogens from children with respiratory infections were included in the analysis (2,810 cases in 2022 and 13,761 cases in 2023). The overall positive detection rates of pathogens in 2022 and 2023 were 95.19% and 96.56%, respectively. The positive detection rates for single pathogens were 16.01% vs. 19.29%, while the rates for two or more pathogens were 79.18% vs. 77.27%. The top three viral pathogens with the highest positive detection rates in both 2022 and 2023 were rhinovirus, parainfluenza virus, and respiratory syncytial virus. In 2023, the top three bacterial pathogens were Streptococcus pneumoniae, Haemophilus influenzae, and Staphylococcus aureus, whereas in 2022, they were Streptococcus pneumoniae, Haemophilus influenzae, and Bordetella pertussis. The positive detection rates of Haemophilus influenzae, Staphylococcus aureus, Mycoplasma pneumoniae, respiratory syncytial virus, adenovirus, influenza A virus, and rhinovirus in 2023 were significantly higher than those in 2022 (all P < 0.05). However, the positive detection rates of Streptococcus pneumoniae, Bordetella pertussis, and parainfluenza virus were significantly lower in 2023 than in 2022 (all P < 0.001). Differences in the positive detection rates of respiratory pathogens were observed across different age groups. Conclusion: Significant changes in the prevalence of certain pathogens occurred during the COVID-19 pandemic and after the lifting of restrictions. It is essential to strengthen long-term monitoring of common respiratory infectious diseases to guide early clinical intervention.

Alpine grasslands have undergone severe desertification due to climate warming and overgrazing. Artificial reseeding has been widely employed for the restoration of these alpine sandy grasslands. However, its effectiveness in enhancing biodiversity, as well as the consistency of responses in aboveground plant diversity and belowground microbial diversity, remains unclear. To investigate the impacts of artificial reseeding on plant and microbial diversity of sandy meadows, we conducted field investigations in alpine grasslands of the eastern Tibetan Plateau that had undergone artificial reseeding, natural restoration, or remained as sandy meadows. The findings revealed that artificial reseeding yields inconsistent restoration outcomes for aboveground plant diversity and belowground soil microbial diversity in alpine sandy meadows, thereby altering the relationship between above- and belowground biodiversity. Artificial reseeding significantly promoted plant diversity in alpine sandy meadows, while its impact on restoring soil microbial diversity was less pronounced. Introducing new plant species through reseeding improved vegetation cover, plant diversity, and fungal richness. In addition, artificial reseeding altered soil properties, such as pH and nutrient content, which in turn influenced the composition and structure of plant and microbial communities. These results have essential implications for regional ecological security and the sustainable development of alpine meadows.

This study examines the middle-income trap hypothesis, a concept widely debated in economic literature. This a situation in which economic growth slows down after reaching a middle level and the country is unable to move into the group of high-income countries for a long time. It occurs when the initial successes of industrialisation gradually become exhausted and new growth incentives are not formed quickly enough. But can we really be certain whether a country has fallen into the “trap”? The latter is not a rhetorical question – of the 92 countries classified as middle-income economies by the World Bank in 2000, 27 have moved into the high-income group. The study aims to systematize numerous definitions of the concept and assess how definitional differences influence conclusions about development paths and income group transitions. An econometric analysis reveals that these differences have minimal impact on the factors affecting transition probabilities, making discussions about the fundamentals of trap formation largely definition-independent. Econometric testing also confirms a long-term relationship between sharp economic slowdowns and upward income transitions. At the same time, the definitional diversity complicates applying the hypothesis to specific countries.

This study introduces an ankle assistive device that supports body weight rather than directly enhancing joint movement. A simplified 3D-printed one-degree-of-freedom prototype operates without an explicit ankle joint. Experiments demonstrated its ability to assist body weight during the push-off phase of walking. With the potential integration of advanced control strategies, this device has significance in gait rehabilitation.

Rice paddy-fields have become increasingly important worldwide as reliable alternative foraging sites for many wading birds due to the rapid loss or degradation of their natural wetland habitats. While assemblage and dispersal patterns of these birds are influenced by spatial distribution of their food resources, foraging activities of some species contribute significantly to natural suppression of some organism harmful to agriculture or human health. This 4-month study investigated how paddy-field management practices influence spatial and temporal linkage between African Openbill Stork distribution and abundance to that of its gastropod mollusc prey resources at Ahero Rice Irrigation Scheme, western Kenya. Regression models predicted African Openbill Stork abundance's positive response to gastropod prey abundance, but negative response to conspecific competition abundance. Stork abundance also increased in response to rice-crop stage, with highest abundances at mid-crop stages, though only marginally due to field-flooding. Contrarily, gastropod abundance increased progressively with rice-crop phases, peaking at transplanting before reducing to stabilization towards crop maturity and harvesting. Paddy-field-block size showed no effect on abundances either Openbill Stork or gastropods. However, paddy block size predicted positive effect on Openbill Stork abundance when interacted with rice growth stage, and with gastropod abundance. Conversely, abundance of competing waterbirds, when interacted with gastropod abundance or rice-crop stage, predicted lower stork abundance, reaffirming negative impact of conspecific competition for stork assemblage. The findings demonstrate the significant role of gastropod food resources in overall distribution and assemblage of African Openbill Stork, impact of conspecific competition, and the crucial indirect influence of anthropogenic field management in shaping these dynamics through agronomic practices especially field flooding control and rice production cycles generally. The results are applicable in designing rice-fields as attractive alternative habitats for Openbill Stork and other waterbirds, to harness their potential contribution to bio-regulating the gastropod vectors of schistosomiasis.

”Coping with Chronic Illness: A Systematic Review of Adaptive Strategies Across Cancer, COPD, Diabetes, and Heart Disease”. Abstract Background: Chronic diseases such as cancer, chronic obstructive pulmonary disease (COPD), diabetes, and coronary heart disease significantly affect individuals’ quality of life. These conditions require adaptive coping mechanisms to manage physical, emotional, and social challenges. This study contributes to public health literature by systematically reviewing and synthesising the coping strategies employed by individuals managing these chronic conditions. Objectives: The review aims to identify, categorise, and compare coping strategies employed by individuals with cancer, COPD, diabetes, and coronary heart disease. It also seeks to explore the personal, familial, and systemic factors that shape these adaptive responses. Methods: A systematic review of peer-reviewed studies published between January 2010 and September 2024 was conducted. Relevant articles were identified through PubMed, Scopus, and PsycINFO, using keywords such as ”chronic disease,” ”coping strategies,” ”cancer,” ”COPD,” ”diabetes,” and ”coronary heart disease.” Thematic analysis was used to synthesise the findings from selected studies. Results: Eight significant themes emerged from the review: maladaptive stress strategies, maintaining “normalcy,” medication use, emotional factors, expanding social networks, therapeutic interventions, complementary therapies, and the influence of religion/music/nature. These themes reflect the complexity and multidimensional nature of coping with chronic diseases. Problem-focused coping (e.g., self-management, goal-setting), emotion-focused coping (e.g., mindfulness, emotional support), and avoidance coping (e.g., denial, disengagement) were commonly employed strategies. Social determinants, including healthcare access, family dynamics, and community support, significantly influenced coping outcomes, with more substantial social support correlating with better psychological resilience and treatment adherence. Conclusion: Effective coping strategies for managing chronic diseases require a comprehensive approach that addresses individual coping mechanisms and the broader social and systemic influences. Interventions should focus on improving healthcare access, enhancing family and community support, and providing tailored psychological resources. Keywords: Chronic disease, coping strategies,

The Taliban's ban on women aid workers in Afghanistan has severely impacted healthcare service delivery, particularly for women and children. The closure of women-led local NGOs and international NGOs with a significant female workforce has created a gap in essential services like maternal and child health. The ban has also led to a reduction in female healthcare workers, further limiting access to care. The situation underscores the importance of women-led NGOs and the need for a power shift and re-imagination of the role of INGOs in Afghanistan to ensure the sustained delivery of essential services in crises.

Introduction: Vaccinations are vital for global health, however since the onset of the COVID-19 pandemic in 2020, there has been a notable decline in maternal vaccine acceptance in Wales, UK. It is a key part of a midwife’s role to promote vaccine uptake in pregnancy. Therefore, gaining an understanding of midwives’ perceptions of the issue is crucial for identifying barriers and facilitators to vaccine uptake in Wales. Methods: A quantitative, cross-sectional descriptive survey was conducted amongst 143 registered midwives working in Wales using the Capability, Opportunity, Motivation – Behaviour (COM-B) approach to identify factors affecting vaccine uptake. Results: Midwives lacked training and confidence to promote vaccines and some noted language barriers as a problem to providing equitable care. Midwives perceived vaccine hesitancy to be high, with 71% saying they thought vaccine hesitancy was common amongst pregnant women and 40% saying they thought it was common amongst their colleagues. Conclusion: A national approach is required to ensure effective vaccination training amongst midwives in Wales, as well as improved availability of language diverse resources. Additional qualitative research is needed in Wales and the UK to further understand vaccine hesitancy and barriers to promoting vaccine uptake in pregnancy.

Background. Understanding the rising speed and magnitude of mental health problems during COVID-19 lockdowns is of particular value to epidemiologists, clinical practitioners, and policy makers. We examine the dynamic changes in depressive symptom severity and associated risk factors during the Shanghai COVID-19 lockdowns in spring 2022. Methods. A cross-sectional data was collected from an online survey conducted between April 15-17, 2022, after nearly one month of the Shanghai COVID-19 lockdowns. The survey included the full set of the Beck Depression Inventory-2, and asked the participants to retrospectively recall the severity of their depressive symptoms in three different time periods: early March (March 1-15), late March (March 16-31), and early April (April 1-15). The survey also included several sociodemographic and health-related questions in these time periods, including the duration of online shopping, work, physical exercise, sleep, and social communication during the lockdown. 652 citizens (212 males) in Shanghai participated in this study. Results. We found that the recalled mild depression (BDI-2 score > 13) increased from 10.1% in early March to 21% in late March, and further to 35.9% in early April. Regression analyses show that lockdown duration and physical restriction jointly contribute to worsening depression. In addition, sleep duration and social communication during lockdown were associated with the severity of depression symptoms. Conclusions. These results highlight the significant depression problems lockdown and call for special attention to early psychological intervention once lockdown is initiated. The limitations of retrospective and cross-sectional evaluations are also discussed.

Habitat loss caused by anthropogenic climate change poses a significant threat to global biodiversity, and behavioural change is often the first line of defence for affected organisms. However, the potential for altered behaviour to moderate the impact of resource loss remains untested. Using a six-year dataset from three reefs in Japan, we investigated the behavioural responses of 23 butterflyfish species to coral habitat loss and recovery. Aggressive behaviours decreased when resources were depleted, consistent with predictions from the economic defendability model. Once coral cover recovered, aggression returned to pre-disturbance levels, demonstrating behavioural flexibility potentially capable of preventing energetic deficits in the short-term. These results underscore the importance of behavioural plasticity in species survival during environmental disturbances and highlight potential ramifications for ecological dynamics at broader scales, such as species coexistence. Our results emphasise the need to understand and conserve behavioural adaptive capacities in the face of ongoing global change.

CO2Fixator is the commercial name of a mix of bacterial strains and a fungal one.  CO2Fixator exploits microbial competition towards bacterial strains, already present in the soil substrate, to avoid the emission of greenhouse gases due to the fermentation of plant residues in the soil. The CO2Fixator transforms agricultural soil into a Carbon Sink  simultaneously improving its quality. Compared to other CO2 capture techniques and systems, such as reforestation, algae cultivation, air filtration or conversion of CO2 into fuel, CO2Fixator can be applied wherever there is soil, whether agricultural or not, including organic waste, sewage sludge and organic fertilizer.  

“Too Much of a Good Thing”: Inadvertent Acetaminophen Overdose in a Low-Weight Elderly PatientTheodore Joseph Miller1,2, B.S., Linda Qiu1,2, B.S., Andrew Nevin1,2, M. Ed, M.D., Ronald Williams1,2, M.D., and Wilbert Beachy1,2, M.D.Affiliations:Pennsylvania State College of Medicine, Hershey, PA1, Milton S. Hershey Medical Center, Hershey, PA2Corresponding Author: Theodore Joseph Miller, tmiller51@pennstatehealth.psu.eduIntroduction:Acetaminophen toxicity is a significant cause of acute liver failure (ALF), particularly in vulnerable populations with impaired metabolism. We present a case of an 89-year-old woman with frail habitus and no prior liver disease, who developed ALF after receiving standard adult acetaminophen dosing for acute pain. Despite adhering to recommended dosing guidelines, the patient’s advanced age, low body weight, and diminished metabolic capacity predisposed her to toxicity. Prompt treatment with N-acetylcysteine facilitated recovery. This case underscores the need for individualized acetaminophen dosing in at-risk populations, emphasizing a weight-based approach to mitigate preventable complications from standard dosing presumed to be safe.Therapeutic misadventure with acetaminophen (“Tylenol”) is not an uncommon phenomenon. In fact, inadvertent poisoning with Tylenol is a common cause of iatrogenic liver failure and the second most common cause of liver transplantation worldwide (1). Considerations of acetaminophen for acute pain, therefore, must appropriately weigh therapeutic outcomes along with the patient-specific risk factors. This is doubly true in individuals who have impaired ability to metabolize acetaminophen or physiologically diminished clearance capacity, glucuronidation ability, and glutathione production (2). These predisposing factors, including elderly status, frail habitus, cognitive decline, decreased metabolic capacity due to genetic factors, certain medications, herbs, or supplements that engage CYP2E1, or alcohol depletion of glutathione stores, create unfavorable conditions for acetaminophen metabolization. This heightens the subsequent risk for supratherapeutic overdosing on standardized adult regimens. We present a case of acute synthetic liver failure (ALF) after standard adult acetaminophen dosing for acute pain in an elderly female patient without any pre-existing liver disease.Case History/Examination:An 89-year-old woman was presented to the emergency department with a chief concern of lethargy and abdominal pain. Vital signs were notable for a temperature of 36.3°C and a low normal blood pressure at 108/53 with a weight of 34.3 kg. Laboratory evaluation revealed a WBC of 12.95 K/uL, a Cr of 1.75 mg/dL which represented an acute kidney injury, and with acute hepatocellular liver injury (bilirubin: 1.4 mg/dL; ALP: 112 units/L) with (AST: 931 units/L, ALT: 640 units/L). Acetaminophen level was 45 ug/mL with a lactate of 2.8 mmol/L.The patient’s medical history was notable for osteoporosis, dementia, and complete heart block s/p pacemaker. Of note, she had been recently evaluated in the emergency department and diagnosed with uncomplicated cystitis and started on scheduled Tylenol 1,000 mg every eight hours and cephalexin.The patient was admitted to the internal medicine service. N-acetylcysteine (NAC) was started upon admission. The patient developed acute liver failure after admission, becoming encephalopathic and demonstrating worsening transaminitis (AST: 4,321 units/L, ALT: 2,541 units/L) as well as signs of synthetic liver failure with an INR/PT of 3.1 and 32.0, respectively.The patient continued to receive NAC for 12 days. Transient melanotic-appearing stools were noted with stable Hgb and no blood transfusion requirements, which was treated with pantoprazole IV BID. Albumin infusions were initiated to support her volume status as she developed worsening AKI, ultimately plateauing at 3.03 and likely representative of ATN which eventually improved and fully resolved with supportive care and diuresis. Her transaminases reached a nadir of ALT: 126 and AST 38. She was eventually discharged safely to an inpatient subacute rehabilitation facility with an arrangement for strength rehabilitation.Differential Diagnosis:Differential diagnosis included drug-induced liver injury versus undifferentiated shock leading to perfusion-related liver injury. Acetaminophen toxicity was strongly suspected given a history of doses of acetaminophen reaching nearly 30 mg/kg/dose and a presenting toxic acetaminophen level.Conclusion and Results:Acetaminophen is a commonly available, over-the-counter analgesic-antipyretic that is generally safe at recommended doses and with therapeutic dosing dependent on a patient’s weight, age, and clinical status (3). Metabolic processing of acetaminophen typically leads to almost complete renal excretion, with approximately 5% becoming metabolized via cytochrome P450 complexes into N-acetyl-p-benzoquinoneimine (NAPQI) (4). As demonstrated in Figure 1, small amounts can be rapidly conjugated with hepatic glutathione to form nontoxic, urine-soluble compounds, yet the accumulation of NAPQI can be hepatotoxic and occurs with large acetaminophen doses due to the rate-limited reduction by glutathione. When left unnoticed and untreated, overwhelming NAPQI production from acetaminophen toxicity can subsequently progress to acute liver failure, which is marked by hepatic encephalopathy (4). Temporal criteria of less than 26 weeks, along with no prior history of cirrhosis or liver disease, must also exist for an ALF diagnosis - a diagnosis that carries a substantial morbidity and mortality risk (5, 6).Figure 1: Metabolic Processing Flowchart of Acetaminophen

Introduction: Fetal Growth Restriction (FGR) is associated with placental dysfunction. Placental Growth Factor (PlGF) can help in the prediction and timely diagnosis of FGR. This study aimed to evaluate the association between FGR, PlGF, and perinatal outcomes. Methods: Retrospective cohort of 292 patients. The primary exposure was maternal PlGF levels. Primary outcomes were fetal growth, abnormal sonographic placental morphology, preeclampsia, fetal demise (IUFD), preterm birth (PTB) < 34weeks, low birth weight, neonatal admission to NICU and placental pathology findings. Results: Normal-grown fetuses had longer pregnancies when compared to FGR pregnancies. Low PlGF levels were statistically significant and almost 5-fold higher among pregnancies with compromised fetal growth. There were 12.5-fold chance of IUFD in fetuses with compromised growth. Low birthweight was over ten times higher in growth-restricted fetuses. PTB < 34w and neonatal admission to NICU were also increased among patients with compromised fetal growth. Abnormal sonographic placental morphology was associated with fetal growth restriction. Preeclampsia was not associated with compromised fetal growth in this cohort. Abnormal placental pathology was increased 7-fold in growth-restricted fetuses. Conclusion: PlGF for the management of high-risk cases with compromised fetal growth is useful. The results confirm that compromised fetal growth is representative of placental dysfunction, associated with or without preeclampsia. In this context, PlGF testing has the potential to improve healthcare outcome in obstetrical care, especially in remote or low-resource settings.

High-frequency AC field (100-300 kHz), which could generate tumor treating fields (TTFields) has been FDA-approved for glioblastoma multiforme (GBM) treatment. How to design a high-frequency AC field with low input battery (3.7 V) power is important for outdoor stimulation with a long treatment time.This study utilizes an LCLC step-up resonant circuit integrated with a linear isolated transformer (LCLLC) to generate a 200 kHz AC field using low DC input. Theoretical circuit analysis investigated the excitation inductance’s impact on voltage gain under capacitive bio-loads. An experimental prototype was developed based on selected parameters, generating 200 kHz AC waveforms (66 V output, voltage gain: 17.8) with 5.1 W input power from a 3.7 V battery, sustaining 8.7-hour operation. Coupled insulated electrodes demonstrated high-efficacy AC field delivery. CCK-8 assays confirmed that generator stimulation significantly inhibited U251 glioblastoma cell proliferation. The theoretical analysis showed that the adjustment of excitation inductance of linear isolated transformer in LCLLC circuit could benefit to achieve a high voltage gain with low input power. This work developed a low-power 200 kHz AC field generator powered by 3.7 V DC batteries, achieving high voltage gain (17.8) and significant cell proliferation inhibition, enabling portable tumor-treating field applications.

Objectives: To evaluate the relationship between peak estradiol levels on the ovulation trigger day and reproductive outcomes in IUI cycles. Design: A retrospective cohort study. Setting: China. Sample: The cohort consisted of 7525 IUI cycles during the period 2019-2023. Methods: We used data from three institutions. Outcomes included live birth, clinical pregnancy, miscarriage, ectopic pregnancy, multiple pregnancy, preterm birth and neonatal growth parameters. Statistical analyses, including multivariate stepwise regression and mediation analysis, were conducted to evaluate estradiol’s impact on outcomes. Main Outcome Measures: The miscarriage rate and live birth rate with low peak estradiol levels. Results: The highest estradiol quartile exhibited higher live birth (13.5%, P < 0.001) and clinical pregnancy rates (17.3%, P = 0.004). Conversely, the lowest estradiol quartile had increased miscarriage risk (OR = 2.15, P = 0.012) and reduced live birth rates (OR = 0.60, P = 0.070). Specifically, non-letrozole cycles increased miscarriage risk (OR = 4.30, P = 0.005) and decreased live birth rates (OR = 0.31, P = 0.010), whereas no significant impact was observed in letrozole cycles. Estradiol significantly mediated the effect of ovulation stimulation type on reproductive outcomes, with a suppression effect observed (PM = 180.5%). Funding: Medical Research Fund of Guangdong Province (A2024003), and Xinjiang Support Rural Science and Technology Program in Guangdong Province (KTPYJ 2023014). Conclusions: Higher estradiol levels on the ovulation trigger day enhance live birth and clinical pregnancy rates. Low estradiol levels, especially in non-letrozole cycles, are associated with higher miscarriage risks and poorer reproductive outcomes.

Objective: To determine the awareness and desirability of pregnant women attending antenatal clinic of University of Ilorin Teaching Hospital (UITH), Ilorin UITH for companionship in labour Design: A descriptive cross-sectional study Setting: The study was conducted at the antenatal clinic in the department of Obstetrics and Gynaecology, University of Ilorin Teaching Hospital (UITH), Ilorin, Kwara State, Nigeria. Population: The study populations were pregnant women who attended Antenatal Care (ANC) services of the UITH. Methods: Data was collected through interviewer administered questionnaire between Jan to March 2022 and data was analyzed with SPPS IBM version 24 Main Outcome Measure: Awareness and desirability for companionship in labour. Utilization of companion in labour Results: Most of the respondents (57.2%) were aware of companionship in labour. Majority of the respondents (88.7%) had desire for companionship in labour though only few of them (18%) had companionship in their previous deliveries) or knew someone who had it before. All those who had companionship in their previous deliveries expressed satisfaction with it. Most of those who desired to have their delivery at facilities with provision for companionship in labour (63.7%) would prefer it even at an additional cost of care. Conclusion: The findings of this study showed that most of the respondents were aware of companionship in labour and majority of them desired it but its utilization is low.