A document by Sachin. Click on the document to view its contents.

Antibacterial efficacy is significantly affected by the intra- and interspecies interactions. The ubiquitous reciprocal effects in the polymicrobial community especially in polymicrobial infections are crucial to understanding how pathogens adapt and evolve in an ecological context. The parasitism and exploitation behaviors driving the population dynamics of pathogens provide targets to tackle the spread of metabolic dependence of pathogens. In this study, we present the unique vulnerability to the cross-feeding between pathogens and diverse bacteria. Here, we focused on the population dynamics of Haemophilus and Bacillus within the context of bacterial communities, and explored the functional role of Bacillus-derived metabolites in both positive and negative interactions with Haemophilus. We found that Bacillus produces the reduced form of extracellular nicotinamide adenine dinucleotide (NADH) to facilitate the growth of Haemophilus, when nutrients are rich. In turn, the sharp decreased redox state in Bacillus triggers the synthesis of bactericidal compounds to sacrifice Haemophilus, facilitating the survival of Bacillus under restricted resources. Our work demonstrates that the elucidation of how interspecies interactions not only provides new insights into the stochastic progression of polymicrobial infections but also contributes to effective antibacterial prevention and intervention strategies.

Today, integrating AI-enabled algorithmic trading and market prediction services into different financial ecosystems is a high-priority requirement. The design of a reference architecture for these systems is important. Although research exists in this domain, a reliable and comprehensive reference architecture for financial market is needed. This paper proposes a new comprehensive reference architecture for trading systems (RATS) which considers all compulsive components in an auto trading system. The inclusion of AI has been considered as the main component of the RATS. The proposed architecture is described using a combination of a 4+1 View and UML diagrams. By evaluating the proposed reference architecture, the abstraction level has been kept as high as possible. The Architecture Tradeoff Analysis Method (ATAM) has been used to evaluate RATS’s quality attributes, including availability and operational consistency. The results confirm that the RATS effectively covered system attributes such as performance, interoperability, and modifiability for the auto trading systems in the financial market.

Background: Food allergies (FAs) are an increasing public health concern, particularly in children. Oral immunotherapy (OIT) is an emerging treatment strategy under clinical investigation for desensitization of children with FA to food allergens. Dysbiosis of the gut microbiota has been implicated in FAs, and various factors influence its composition; however, the impact of OIT on the gut microbiota remains largely unexplored. Objective: This study aimed to identify the changes in diversity of the gut microbiota following OIT in children with FA. Methods: Thirty children with FA undergoing oral immunotherapy and seven non-allergic controls participated in this study. Fecal samples were collected before and after OIT from children with FA, and once from controls. The gut microbiota was profiled using 16S rRNA sequencing, followed by diversity and differential abundance analyses. Alpha and beta diversities were compared, and differential abundance was assessed. Results: Beta diversity analysis revealed small but significant differences in microbial composition between children with FA before and after OIT, and between controls and children with FA before OIT. Differential abundance analysis showed that OIT induced a reversion of the abundance levels of Bacteroidota and Verrucomicrobiota towards those observed in controls. Conclusion: To our knowledge, this is the first study to investigate the impact of OIT on the gut microbiota in children with different FAs for identifying potential microbial biomarkers, and convincingly demonstrated their interrelation. These findings may help improve and personalize FA treatment.

Summary: A novel multi-port converter topology is introduced for the synchronized integration of photovoltaic (PV) power and a hybrid energy storage system, addressing energy demands in net-zero carbon buildings. This topology, characterized by soft-switching operation and reduced component complexity, multiplexes the leading leg of a phase-shifted full-bridge to interface with both the battery and PV source, thus minimizing power switch count by four and improving energy transfer efficiency. Furthermore, an integrated control scheme is developed to achieve adaptive switching between PV maximum power point tracking (MPPT) and battery voltage-limiting protection via voltage comparators. A high-frequency filter is also integrated to facilitate supercapacitor power management for hybrid energy storage. Experimental results from a prototype converter demonstrate high port efficiency, effective mitigation of shock loads and PV fluctuations on battery performance, and successful adaptive protection switching when the battery voltage limit is exceeded.

IntroductionAmeloblastoma is a benign tumor originating from odontogenic tissue, predominantly found in the maxillofacial region, with several histological subtypes. Hybrid ameloblastoma, first described by Waldron and El-Mofty in 1987, exhibits histological characteristics of both desmoplastic and conventional ameloblastoma.12,The incidence of hybrid ameloblastoma is 1.1% and most commonly occurs in individuals with a mean age of 24.5 years, with a higher prevalence in females compared to males.1 This subtype primarily affects the mandible, with a ratio of 5:3 relative to the maxilla.3Radiographically, hybrid ameloblastoma typically presents with a mixed radiolucent and radiopaque appearance and often has with irregular borders. In some cases, it may also exhibit multilocular radiolucency similar to conventional ameloblastoma.4Histopathologically, hybrid ameloblastoma features both desmoplastic patterns and conventional ameloblastoma patterns, predominantly follicular and plexiform. Although less common, acanthomatous, basal cell, and granular cell patterns may occasionally be observed.3 In this report, we present a case of hybrid ameloblastoma in a 60-year-old male patient, localized to the right mandibular region. This report presents two cases of hybrid ameloblastoma, both presenting with mandibular swelling.

Case ReportsVitreous hemorrhage possibly due to retinal arterial microaneurysm post-severe acute respiratory syndrome coronavirus 2 vaccinationTatsuya Sakamoto1, Daisuke Nagasato1,2,3*, Hayato Tanaka1, Tomoki Shirakami1, Keigo Murata1, Shunsuke Nakakura1, Toshihiko Nagasawa1, Yoshinori Mitamura3, Hitoshi Tabuchi, MD, PhD1,21Department of Ophthalmology, Tsukazaki Hospital, Himeji, Hyogo, Japan2Department of Technology and Design Thinking for Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Hiroshima, Japan3Department of Ophthalmology, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Tokushima, JapanContributorsTatsuya Sakamoto, MD, E-mail: t.sakamoto@tsukazaki-eye.netDaisuke Nagasato, MD, PhD, E-mail: d.nagasato@tsukazaki-eye.netORCID iD: 0000-0003-3956-9352Hayato Tanaka, MD, E-mail: h.tanaka@tsukazaki-eye.netTomoki Shirakami, MD, PhD, E-mail: t.shirakami@tsukazaki-eye.netKeigo Murata, MD, E-mail: k.murata@tsukazaki-eye.netShunsuke Nakakura, MD, PhD, E-mail: s.nakakura@tsukazaki-eye.netToshihiko Nagasawa, MD, PhD, E-mail: t.nagasawa@tsukazaki-eye.netYoshinori Mitamura, MD, PhD, E-mail: ymitaymitaymita@yahoo.co.jpHitoshi Tabuchi, MD, PhD, EMBA, E-mail: h.tabuchi@tsukazaki-eye.netORCID iD: 0000-0002-9098-0430*Corresponding authorDaisuke Nagasato68-1 Aboshi Waku, Himeji City, Hyogo Prefecture 671-1227, JapanTel: +81 79-272-8555; Fax: +81 79-272-8550E-mail: d.nagasato@tsukazaki-eye.net

\received DD MMMM YYYY \acceptedDD MMMM YYYY Background:About 10% renal cell carcinoma (RCC) patients presented with venous tumor thrombus (VTT) at diagnosis and surgery is the current standard treatment for them. However, there lacks a prognostic model in clinic for these patients after surgery treatment. In this study, we aimed to identify the prognostic factors for RCC patients with VTT after surgery treatment and incorporated them into a predictive nomogram. Methods: Cases of RCC patients with VTT were retrieved from Surveillance, Epidemiology, and End Results (SEER) database. The Kaplan-Meier survival curve was established to depict survival probabilities over time and the log-rank test was used to compare the differences. Propensity score matching (PSM) was used to balance the bias of baseline characteristics between groups. Univariate and multivariate Cox regression analysis were performed to identify prognosis related characteristics. The independent factors were incorporated into the nomogram development for overall survival (OS) prediction. The Harrell’s concordance index (C-index), calibration curve, receiver operating characteristic curve (ROC) and decision curve analysis (DCA) were used to evaluate the performance and clinical utility of the developed nomogram model. Results: We retrieved 11,926 patients of RCC with VTT, 10,213 (85.64%) of them received surgery (surgery group) and the other 1,713 (14.36%) patients were managed non-operatively (no-surgery group). After PSM, OS in surgery group was significantly better than no-surgery group (P<0.001). We identified prognostic indicators and developed a predictive nomogram. The C-index was 0.739 in the training set, 0.749 and 0.739 in the validation set and TCGA validation set respectively. The net benefit of our nomogram was higher than the default strategies across a wide range of practical threshold probabilities. Conclusions: Surgery can significantly improve the prognosis of RCC patients with VTT. A nomogram for OS prediction in RCC patients with VTT after surgery treatment was developed and showed relatively good discrimination and calibration.

Title PageRadicular pain as the initial presentation of Lyme disease, a case report.

\received DD MMMM YYYY \acceptedDD MMMM YYYY Aim: Both anticholinergic burden (ACB) and depression are known to increase fall risk in older persons, next to increasing morbidity and mortality. However, the effect of depression on fall risk associated with ACB is unclear. This is relevant because most antidepressants have anticholinergic effects. The aim of this study was to assess the relationship between ACB and falls, and the impact of depression on this relationship. Methods: We cross-sectionally examined the relationship between both ACB and clinical depression and falls in the past 12 months, in a harmonized cohort of Dutch community dwelling persons (n=7884). For all analyses, we calculated adjusted odds ratios (ORs) and their 95% confidence intervals. We also investigated the impact of depression on the relationship between ACB and falls, by calculating interaction on both an additive and multiplicative scale. Results: Both a high ACB score (≥3) and clinical depression were independently significantly associated with falls in the past 12 months. Additionally, there was a statistically significant interaction (p=0.038) between ACB and clinical depression on fall risk, both on an additive and multiplicative scale (1.13 and 1.44 respectively). Conclusion: In older persons, the presence of clinical depression strengthened the association between ACB and falls. We dissuade bluntly withholding pharmacological treatment to avoid falls, despite the ACB of antidepressants. In case of depression, we recommend considering non-pharmacological alternatives; choose pharmacological interventions with the lowest risk of adverse events; assess and treat other fall risk-factors; and perform multidisciplinary a medication review to minimize (accumulation of) ACB.

Rationale Ions trapped within a Penning cell (ICR) travel periodic orbits whose frequencies are dependent on their mass-to-charge ratio and the value of the magnetic field passing through the trap. Fourier transformation (FT-ICR) decomposes the signal induced in the detection circuit by the rotation of the ions in the cell after the application of an excitation signal. The result of this transformation is a set of characteristic frequencies. We were curious to see whether, once lowered by division into the humanly audible domain, they could be converted into musical notes representative of each of the trapped ions. Methods Three algorithms, using three different kinds of divisors, either constant or variable, were considered, and the resulting reduced frequencies were compared to those of an equal-tempered chromatic scale, retaining notes with the closest frequencies. Results The method was not specific enough to differentiate observed ions with very close frequencies as is the case for quasi-isobaric ions (ions having the same nominal mass but differing by their exact mass). Only ions with unit mass resolution could be translated into musical notes, and sometimes to the same one, especially at the high-mass end. However, using three-note chords, instead of single notes, different sounds could be attributed to all integer ions from m/z 19 to m/z 299. Conclusion It is possible to assign musical notes to unit mass resolution ions analyzed in a simple FT-ICR instrument and design simple didactic musical melodies.

A document by Naghmeh Kian. Click on the document to view its contents.

Background: Autism spectrum disorder (ASD) and intellectual disability (ID) affect 2-3% of the global population with both conditions having unclear pathophysiology. Little data exists from South Asia examining the association between these conditions and the disturbances in thyroid profile and vitamin-D status. Objective: This study sought to characterize the association between these conditions and serum thyroid-stimulating hormone (TSH) and 25-hydroxycholecalciferol (25(OH)D3) levels, from a resource-limited setting in India. Methods: The present work was a prospective case-control study conducted and reported in accordance with Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines. Children with ASD, children with ID, and age-and-sex matched healthy controls, attending the outpatient clinics of pediatrics and psychiatry in Northern India were included. Primary outcomes were serum TSH and 25(OH)D3 levels, which were measured by chemiluminescent immunoassay and compared using ANOVA. Results: A total of 75 children were included, of which 15 had ASD, 30 with ID, and 30 were controls. There were 44 males and 31 females, with a mean age of 7.01±2.77 years. Mean±SD levels of 25(OH)D3 were significantly lower in ASD (9.53±4.93 IU/mL) and ID (14.39±5.99 IU/mL) compared to healthy controls (16.37±10.68 IU/mL) [p=0.032]. Mean±SD levels of TSH were similar in ASD (2.65±1.96), ID (2.47±2.03), and controls (2.19±1.42), with no significant difference [F-value=0.37; P=0.69]. 8% (N=6/75) of the participants had a raised TSH level. Conclusion: Children with ASD and ID have significantly lower vitamin D3 levels compared to healthy controls. High-quality randomized controlled trials are warranted to further investigate the therapeutic impact of early-life vitamin D supplementation in these indications.

Ecological restoration projects (ERPs) play a crucial role in enhancing ecosystem services, but their impact remains unclear, particularly in fragile mountain ecosystems characterized by high heterogeneity and rapidly varying altitude. Using China’s Taihang Mountains as a case study, we quantified the spatial and temporal changes of water yield, soil conservation, carbon storage, plant diversity and multi ecosystem services index (MESI) from 2000 to 2020, revealed the relationship between ERPs and ecosystem services by correlation analysis and redundancy analysis. The results showed the following: (1) Over a 21-year period, the average values of these ecosystem services were 49.68 mm, 268.71 t/hm 2, 108.91 Mg/hm 2, 0.69, and 1.33, respectively. (2) The increase in ecosystem services due to ERPs varied significantly. For instance, soil conservation showed a growth rate over five times higher than the others, while water yield grew by only 8.1%, and the MESI increased by 15.33 %. (3) Forest land restoration was the most significant types of ERPs, contributing 152,500 hectares of afforestation and a 56.94% improvement in ecosystem services. (4) The dominant factors of ecosystem services varied in different altitude range, in low-elevation area, terrain was the dominate factor, whereas the impact of ERPs was more pronounced in middle-elevation regions. In high-elevation area, vegetation factor was the primary driver. This research provides a theoretical basis for mountain ecosystem management and ecological engineering strategies.

\receivedDD MMMM YYYY \acceptedDD MMMM YYYYAllergic Contact Dermatitis Induced by Pure Titanium Implants: A Case ReportAiliang Huang1, Xiaomei Luo1+, Huiqiu Luo1, Huahui Jian1*1 Department of Dermatology, Baise People’s Hospital, Affiliated Southwest Hospital of Youjiang Medical University for Nationalities, Guangxi, China*Corresponding author+These authors contributed equally to this workCorrespondence: Department of Dermatology, Baise People’s Hospital, Affiliated Southwest Hospital of Youjiang Medical University for Nationalities, Guangxi, 53000, ChinaEmail: janehuah@163.comWord count: 639; Total number of figures and tables:1Key Clinical MessageDupilumab has not been previously reported for treating allergic contact dermatitis induced by pure titanium implants. Betamethasone and antihistamines only provided temporary relief. Given the side effects of long-term glucocorticoid use, the treatment plan was adjusted to Dupilumab. Dupilumab resolved symptoms within a week, with no recurrence after three biweekly treatments.KEYCORDS: allergic contact, dermatitis, dupilumab, titanium, case report1 INTRODUCTIONTitanium (Ti) and its alloys are extensively utilized in orthopedic implantation, including joint replacements, due to their superior biocompatibility and favorable strength-to-density ratio(1). To our knowledge, dupilumab has not been previously reported for the treatment of allergic contact dermatitis induced by pure titanium implants.2 CASE HISTORY / EXAMINATIONA 35-year-old male with a history of pure Ti implant surgery for a fracture presented with delayed hypersensitivity. Two weeks postoperatively, the surgical site had healed, and sutures were removed. However, 1.5 months later, erythemas, papule, erosions, exudate, and pruritus developed at the incision site on the right lower leg. Despite a two-week course of oral cefuroxime axetil and topical antibiotics, the rash persisted. No history of similar illnesses, drug or food allergies, and similar family history was reported.On physical examination, vital signs were within normal limits. Diffuse dusky erythema with multiple superficial erosions and erythematous papules, serous exudate, and honey-colored crusts on the skin surface above the implant in the right lower leg;The lesions were localized to the site of the pure titanium implant used in the surgical treatment of the fracture ((Figure 1 a-c).3 DIFFERENTIAL DIAGNOSIS, INVESTIGATIONS, TREATMENTThe differential diagnoses of this clinical presentation include cutaneous infection and disinfectant allergy. The outpatient physician initially suspected a cutaneous infection and prescribed oral antibiotics along with topical antibiotic therapy. However, the skin condition on the patient’s right lower leg did not improve. Subsequent evaluations, including complete blood count, high-sensitivity C-reactive protein, and bacterial culture and identification of skin exudates, revealed no abnormalities, thus failing to support the diagnosis of cutaneous infection. The possibility of disinfectant allergy was also excluded, as the patient’s surgical sutures had been removed, and the use of disinfectants had been discontinued for more than two weeks prior to the onset of the rash.The final diagnosis was allergic contact dermatitis attributed to a pure titanium implant. This conclusion was based on the patient’s development of a rash (erythema, papules, and erosions) 1.5 months after the implantation of a pure titanium device, the rash was localized to the area above the implant, with well-defined margins, and other potential causes such as skin infection and other allergens were ruled out. Given the diagnosis of allergic contact dermatitis, initial treatment with betamethasone and antihistamines provided temporary relief. However, symptoms recurred within five days of discontinuing the medications. Subsequently, the treatment was switched to dupilumab. Within two days of dupilumab treatment, exudation ceased and erythema decreased. By one week post-treatment, the majority of the rash had resolved, and pruritus was significantly alleviated. Dupilumab was continued at biweekly intervals, and after three treatments, the rash and pruritus completely resolved without recurrence (Figure 1 d-f).4 DISCUSSIONNo definitive diagnostic tests for Ti hypersensitivity exist, the diagnosis in this case was largely informed by the 10-point criteria for suspecting metal hypersensitivity from orthopedic implants, which were established in 2011 and include: (i) chronic dermatitis beginning weeks to months after metallic implantation; (ii) an eruption overlying the metal implant; (iii) a morphology consistent with dermatitis (erythema, induration, papules, and vesicles)(1); additionally, the patient exhibited a positive response to corticosteroid-based antiallergic therapy, whereas antimicrobial monotherapy proved ineffective, which is consistent with an allergic diagnosis. But the chronic use of corticosteroids carries potential side effects, such as heightened susceptibility to infections and compromised healing of skin wounds and fractures. Abrocitinib, as indicated in the prescribing information, is associated with an increased risk of thrombosis, given the patient’s history of lower limb fracture surgery, is also at an elevated risk for thrombotic events. Dupilumab was chosen as the treatment of choice. Dupilumab does not impact bone growth and has the added benefit of potentially reducing the frequency of skin infections and the necessity for antibiotic therapy(2, 3). Dupilumab may emerge as a promising alternative for the treatment of treatment-resistant contact dermatitis triggered by implants.AUTHOR CONTRIBUTIONSAiliang Huang: conceptualization, investigation, methodology, resources, writing-original draft, writing-review and editing. Xiaomei Luo: conceptualization, investigation, methodology, resources, writing-original draft. Huiqiu Luo: conceptualization, investigation, methodology, resources. Huahui Jian: conceptualization, methodology, resources, writing-original draft, writing-review and editing.ACKNOWLEDGMENTSThe authors have nothing to report.FUNDING INFORMATIONNo funding source for this work.CONFLICT OF INTEREST STATEMENTThe authors report no conflicts of interest.DATA AVAILABILITY STATEMENTAll necessary data are available in the article itself.ETHICS STATEMENTNo ethical approval is necessary.CONSENTWritten informed consent was obtained from the patient to publish this case report and accompanying images.ORCID:Ailiang Huang: https://orcid.org/0009-0000-4767-6380Huahui Jian: https://orcid.org/0009-0009-4109-9725Xiaomei Luo: https://orcid.org/0009-0005-5378-7059Huiqiu Luo: https://orcid.org/0009-0009-4656-5190References: 1 Fage S W, Muris J, Jakobsen S S, Thyssen J P. Titanium: a review on exposure, release, penetration, allergy, epidemiology, and clinical reactivity. CONTACT DERMATITIS 2016:74 : 323-45.2 Yang N, Ye Y, Shao J, Wu H, Xu Q, Zhu J, Liu J, Li Z. Efficacy of Dupilumab in Children 6 Months to 11 Years Old With Atopic Dermatitis: A Retrospective Real-World Study in China.DERMATITIS 2024: 35 : S39-S46.3 Tsai S Y, Phipatanakul W, Hawryluk E B, Oyoshi M K, Schneider L C, Ma K S. Comparative safety of oral Janus kinase inhibitors versus dupilumab in patients with atopic dermatitis: A population-based cohort study. J Allergy Clin Immunol 2024: 154 : 1195-1203.e3.

Ancient Schwannoma of the Hard Palate Accompanied by Hyponatremia: A Unique Case ReportNima Nikafshar1, Mojde Masoudi2, 3, Siavash Vadaye Kheiri2, 3, Maryam Johari4*1. Private Dentist, Oral Medicine Specialist, Babol University of Medical Sciences, Babol, I.R Iran 2. Student Research Committee, Babol University of Medical Sciences, Babol, I.R. Iran 3. Oral and Maxillofacial Surgery, Babol University of Medical Sciences, Babol, I.R. Iran 4. Oral Health Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, I.R. Iran*Corresponding Author: Maryam Johari, Oral Health Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, I.R. Iran/ johari.mrm@gmail.comKey Clinical MessageThe present case is a unique type of schwannoma presenting pain and uncommon location in a hyponatremic patient. Given that the gold standard treatment for the lesion is excisional surgery, proving the possible association between hyponatremia and neural neoplasms could help with timely diagnosis and appropriate treatment and reduce complications.AbstractBackground and Objective: Schwannoma is a benign neurogenic neoplasm originating from the Schwann cells within the peripheral nervous system. Its incidence is documented at about 25%-45%, Yet its occurrence in the oral cavity is less than 12%. Given that neurogenic neoplasms are a well-documented but uncommon reason for hyponatremia, this is a case report of ancient Schwannoma of the palate, perforating the nasal floor, in an 80-year-old female along with hyponatremia.Case Presentation: An 80-year-old female presented with painful swelling in the anterior maxilla and the nasal floor. She had a history of hyponatremia, high blood pressure, tachycardia, and hypothyroidism. Clinical examination revealed apparent swelling in the buccal vestibule and the midline of the hard palate; the lesion had perforated \RL the palate to the nasal cavity\RL. CBCT radiographs revealed swelling of the soft tissue and erosion in the underlying bone. An excisional biopsy surgery was performed by laser. Microscopic examination showed spindle cell neoplasm composed of cellular areas (Antoni A), nuclear palisading (verocay bodies), and pauci-cellular microcystic areas (Antony B). Some tumoral cells showed nuclear atypia including nuclear enlargement with hyperchromasia with irregular border. Given that, the definitive diagnosis was an ancient Schwannoma.Conclusion: The present case is a unique type of Schwannoma, placed in an uncommon location. It presented pain and more importantly, perforated the hard palate to the nasal cavity.1. IntroductionSchwannoma or neurilemmoma is an uncommon neurogenic neoplasm originating from the Schwann cells within the nervous system. This tumor shows a strong affinity for the head and neck. Also, its incidence is documented at about 25%-45% (1), Yet its occurrence in the oral cavity tract is less than 12% (2). Schwannoma is the most frequent tumor of the peripheral nerve sheath. They are also benign, almost asymptomatic, and well-circumscribed tumors that grow slowly with the peripheral nerves. Moreover, they are commonly solitary tumors (3) on the floor of the mouth or tongue, but their presence in the hard palate is relatively rare (2). Ancient Schwannoma was first described by Ackermann and Taylor as a persistent Schwannoma with degenerative diversions like calcification, cystic formation, tissue necrosis, xanthomatous alterations, vascular hyalinization matrices, and noticeable nuclear atypia, attributed to the tumor growing (4, 5). \RL Besides the ancient type, there are other types such as plexiform, cellular, and epithelioid (6). Immunohistological examinations can be useful in the differential diagnosis of schwannoma from other mimicking lesions (3). Hyponatremia is the most frequent electrolyte disorder and happens when serum sodium concentration is less than 135 mmol/L. Neurogenic neoplasms are a well-documented but uncommon reason for this disorder (7). Although few cases indicate a relationship between schwannoma and hyponatremia (7, 8), it is yet to be discussed, especially in this location. In the current study, we report a rare case of ancient schwannoma of the palate, perforating the nasal floor in an 80-year-old female along with hyponatremia.2. Case presentationAn 80-year-old woman \RL came to an oral medicine specialist in 2023 with the chief complaint of pain in the anterior maxilla and the nasal floor. She had a history of hyponatremia, high blood pressure, tachycardia, and hypothyroidism. In the extra-oral clinical examination of the patient, swelling was observed in the soft tissue of the anterior maxilla and the floor of the nasal cavity (Figure1). Intraoral examination revealed an apparent swelling in the buccal vestibule as well as the midline of the hard palate (Figure2). \RL This lesion was 4x4 mm, lobular, and had a rubber consistency. In the periapical radiograph of the edentulous area (Figure3), no obvious pathology was seen inside the bone. Therefore, a Cone Beam computed Tomography (CBCT) was prepared from the target area for further investigation. In the CBCT images in different plans, the alveolar bone of the anterior maxilla was sound and intact, But the swelling in the soft tissue of the nasal cavity floor was clear (Figure4). In the area of the hard palate, swelling of the soft tissue was seen along with erosion in the underlying bone (Figure5). This lesion perforated the palate to the nasal cavity. According to the radiographic appearance and use of removable complete dentures by the patient, the diagnostic hypothesis was irritating fibroma for the lesion of the hard palate and nasolabial cyst for the anterior maxilla lesion. An excisional biopsy of the lesion was performed by laser11Light amplification by stimulated emission of radiation and the specimen was sent for pathological examinations in formalin. The received specimen consisted of 2 pieces of creamy tissue measuring 2*1*1cm and 0.7*0.7cm and a rhomboid piece of skin tissue 1*0.7cm. Microscopic examination of the received specimen showed spindle cell neoplasm composed of cellular areas (Antoni A), showing nuclear palisading (verocay bodies) and pauci-cellular microsystic areas (Antony B). Miotic activity was not appreciated. Some tumoral cells showed nuclear atypia including nuclear enlargement with hyperchromasia with irregular border. No necrosis was noted (Figure6). The immunohistochemistry analysis was performed and following markers were evaluated: S100 and SOX10 were diffusely positive, CD34 was positive in few cells, SMA and DESMIN were negative and analysis of Ki67 showed low proliferative index. Therefore, the definitive hypothesis was ancient schwannoma. Based on the review of articles in which the association of schwannoma in the mediastinal area and hyponatremia was observed, neurology consultation and brain CT were prescribed. The one\RL-year follow-up showed no recurrence \RL (Figure7).3. Differential DiagnosisDifferential diagnosis for the present lesion could include a number of benign neoplasms. The most likely diagnosis could be benign tumors of salivary glands such as adenoma. fibroma and, lipoma are other possibilities which are respectively benign tumors of connective tissue and adipose tissue. Residual cystic lesions could appear similarly. malignant neoplasms such as oral squamous cell carcinoma of the bone and salivary gland carcinoma, could rarely s how benign manifestations (9). There are so many systemic conditions associated with hyponatremia that can cause oral lesions as well. Congestive heart failure can lead to hyponatremia and fluid overload that can cause edema in the face and oral cavity potentially mimicking an oral mass. Hypothyroidism is also associated with hyponatremia due to impaired water excretion which can lead to myxedema. On the other hand, patients with hypothyroidism have an increased risk of developing benign tumors in the oral cavity. Adrenal insufficiency can lead to electrolyte imbalances and various oral manifestations and hyperpigmentation of the oral mucosa which might be mistaken for an oral mass (10).4. DiscussionAs was discussed, schwannoma is benign and usually asymptomatic, but its etiology is still unknown (11). Moreover, schwannoma of the oral cavity is most presented in the soft tissue, especially the tongue, and intraosseous tumor is the most rare location for it (12). Given that the current case is located in the hard palate and perforated the nasal floor, it is almost unique. Ancient schwannoma can be presented in all ages, but it is more regular between the age of 10-40 years old, affecting women slightly more (2). In this case, the lesion occurred in an 80-year-old female, which is somehow noticeable. The presence of pain or other discomforts is not common but related to the location toward the nerve or the size of the lesion. The absence of symptoms can be a reason for the transformation to the ancient type (2). In this case, pain was a chief complaint, unlike many other cases. Song et al. (7) reported the resolution of hyponatremia after the removal of schwannoma. In the current study, the patient is suffering from ancient schwannoma along with hyponatremia, As a result, the possibility of an association between these two conditions should be investigated in future studies. From the histopathological aspect, this tumor is composed of spindle cells along with eosinophilic cytoplasm and a round to oval nucleus noticeable on cellular areas, as Antoni A, and myxoid with hypocellular areas as Antoni B. Verocay bodies are also eosinophilic formations as a characteristic mark In the Antoni A fields (2, 13). Antony A, Antony B and verocay bodies were obvious in this case, like many other cases. Also, nuclear atypia including nuclear enlargement, hyperchromasia, and irregular border were other noteworthy findings of this case. Thus, immunohistochemistry analysis was performed to avoid misdiagnosis. Immunohistochemical analysis is a valuable approach to confirm the diagnosis. In this case, S100 was diffusely positive, like the case of Kardouni et al. (4), as a marker of focal spindle-shaped cells. They also recognized CD68, as a marker of histiocytes. Moreover, According to the Gainza-Cirauqui et al. report (2), the CD34 marker is usually negative, in contrast to this case. The gold standard treatment for this tumor is complete excision surgery (2). According to Kardouni et al., no ancient Schwannoma of the oral cavity has been shown malignant transformation (2), as was this case.5. ConclusionAncient \RL Schwannoma is usually a benign tumor, thus the presence of pain as well as nasal perforation in this case is noteworthy and indicates the importance of timely diagnosis and appropriate treatment. Given that ancient Schwannoma, especially in this location, is uncommon and also considering the manifestation of pain, which is not common, the necessity of careful investigation of similar cases is felt so that surgical intervention can be performed at the right time and possible complications can be avoided.References1. Venkatasamy R, Singh ASM, Arasu K, Husain S, Mianxin C. Nasal Septal Ancient Schwannoma: Ancient and Rare. Cureus. 2023;15(8).2. Gainza-Cirauqui ML, Eguía-Del Valle A, Martínez-Conde R, Coca-Meneses JC, Aguirre-Urizar JM. Ancient schwannoma of the hard palate. An uncommon case report and review. Journal of clinical and experimental dentistry. 2013;5(1):e62.3. Eroglu YM, Emre IE. Ancient schwannoma of the nose: Case report and literature review. Journal of Oral and Maxillofacial Surgery, Medicine, and Pathology. 2018;30(6):508-14.4. Kardouni Khoozestani N, Motiee-Langroudi M, Salehi A, Ranji P. Intraosseous ancient Schwannoma: A rare case in the mandible and a literature review. Rare Tumors. 2021;13:20363613211026480.5. Choudry HA, Nikfarjam M, Liang JJ, Kimchi ET, Conter R, Gusani NJ, et al. Diagnosis and management of retroperitoneal ancient schwannomas. World Journal of Surgical Oncology. 2009;7:1-5.6. Kodama S, Okamoto T, Suzuki M. Ancient schwannoma of the nasal septum associated with sphenoid sinus mucocele. Auris Nasus Larynx. 2010;37(4):522-5.7. Song SH, Sim GA, Baek SH, Seo JW, Shim JW, Koo JR. Syndrome of inappropriate antidiuretic hormone secretion (SIADH) associated with mediastinal schwannoma. Electrolytes & Blood Pressure. 2017;15(2):42-6.8. Bernreuther C, Flitsch J, Lüdecke DK, Hagel C. OCTOBER 2007 CASE 2: A 61‐YEAR‐OLD MAN WITH HYPONATREMIA. Brain Pathology. 2008;18(2):283.9. Fonseca Raymond J D, Eric R. Carlson D, MD, FACS, Gregory M. Ness D, FACS. ORAL AND MAXILLOFACIAL SURGERY. third ed. Fonseca RJ D, editor: ELSEVIER; 2017. 989 p.10. Miller C, Rhodus NL, Treister NS, Stoopler ET, Kerr AR. Little and Falace’s Dental Management of the Medically Compromised Patient-E-Book: Little and Falace’s Dental Management of the Medically Compromised Patient-E-Book: Elsevier Health Sciences; 2023.11. Shilpa B. Ancient schwannoma-a rare case. Ethiop J Health Sci. 2012;22(3):215-8.12. Gainza-Cirauqui ML, Eguía-Del Valle A, Martínez-Conde R, Coca-Meneses JC, Aguirre-Urizar JM. Ancient Schwannoma of the hard palate. An uncommon case report and review. J Clin Exp Dent. 2013;5(1):e62-5.13. Lopez J, Ballestin C. Intraoral schwannoma. A clinicopathologic and immunohistochemical study of nine cases. Archives d’anatomie et de cytologie pathologiques. 1993;41(1):18-23.Declarations

Type of manuscript: Case reportTitle: Cogan Syndrome presenting with giant pseudoaneurysm of ascending aorta for surgery facilitated by deep hypothermic circulatory arrest.

\received DD MMMM YYYY \acceptedDD MMMM YYYY In order to clarify the prevalent species of Gasterophilus (Diptera, Oestridae) in Mongolian horses from different regions and their phylogenetic relationships, A total of 215 third-instar larvae (L3) of Gasterophilus sp. were collected from slaughterhouses in Hohhot, Erdos, Tongliao, and Hulunbeier, the habitats of Mongolian horses in China, in January 2023. Morphological observations were conducted using light microscopy and scanning electron microscopy, and the mitochondrial cytochrome b (cytb) gene was extracted through PCR. For the amplified cytb gene of Gasterophilus sp. from Mongolian horses, relevant gene comparisons were conducted using BLAST in GenBank.Using MEGA6.0, a Clustal W comparison was conducted on the cytb gene of Gasterophilus sp. from Mongolian horses and the homologous cytb sequences of 10 related species from GenBank, and a phylogenetic tree was constructed. The results indicate that the distribution of dorsal spines on the pseudocephalon and the characteristics of the oral cristae of the third-instar larvae of Gasterophilus sp. are consistent with the morphology of the third-instar larvae of Gasterophilus pecorum. BLAST results showed that the cytb gene of Gasterophilus sp. from Mongolian horses had a high identity score of 96.63-99.34% with Gasterophilus pecorum (NC029812) from GenBank. The phylogenetic tree shows that the mitochondrial cytb genes of Gasterophilus sp. from Mongolian horses are separated from 6 other Gasterophilus species in GenBank, as well as those of other species of Hypodermatidae, Cuterebridae, and Calliphoridae. In conclusion, the Gasterophilus sp. collected from Mongolian horses in this study was identified as Gasterophilus pecorum based on morphological and molecular data. The phylogenetic tree shows a certain genetic distance between Gasterophilus sp. reported in GenBank and the one identified in this study.

Background: The utilization of health research evidence is essential for informed decision-making, especially in health planning and achieving Universal Health Coverage (UHC). However, limited information exists regarding its use in health planning in Lower Middle-Income Countries (LMICs), including Tanzania. This study assessed the current use of health research evidence and factors influencing its utilization among health planning teams. Methods: A descriptive qualitative approach was used to examine determinants of evidence use in health planning. Data were collected through six focus group discussions and 34 in-depth interviews with planning team members from regional, council, and health facility levels. The COM-B model (Capability, Opportunity, Motivation) was applied to assess factors influencing evidence use, and thematic analysis was conducted on the transcribed data. Findings: While participants reported using available planning guidelines, the use of health research evidence in planning was low. Capability barriers included inadequate knowledge and skills for evidence-based planning. Opportunities included planning guidelines supporting evidence use, research coordinators, policymaker-researcher interactions, and infrastructure like computers and the Internet; however, access to knowledge translation tools was limited. Motivation was influenced by incentives such as extra duty allowances, promotions, and professional development opportunities. Conclusion: The use of health research evidence in planning processes in Tanzania is low, influenced by capability, opportunity, and motivation factors. Enhancing capacity-building, fostering collaboration, strengthening policy support, and improving infrastructure are recommended. Future research should evaluate the effectiveness of these interventions and their impact on healthcare planning and delivery. Efforts were made to minimize social desirability and selection biases.

Background: In response to the aging population, increasing prevalence of chronic diseases, rising healthcare costs, and lifestyle changes in Iran, the importance of home health care (HHC) has grown significantly. This study aims to explore alternative scenarios for the development of HHC services in Iran’s health system by 2030 to address these emerging challenges effectively. Methods: This study employed a multi-method approach to scenario planning with a qualitative design, which was conducted in 3 phases from 2018 to 2020. In the first phase, a list of driving forces was extracted using qualitative views, two focus group discussions, and literature review. In the second phase, all factors identified in the previous phase were examined in terms of degree of uncertainty and cross- impact analysis, and three critical uncertainties were extracted. In the third phase, based on three critical uncertainties, four future scenarios of HHC were formulated, validated and scenario strategies were presented. Results: The results indicate three critical uncertainties, including “governance of HHC in the health system”, “economic conditions” and “spread and penetration rate of technology in society” based on which, three scenarios with the names “For Politics, for Power”, “For politics, for people” and “For people, for prosperity” were compiled. Conclusion: The development of HHC in Iran faces significant ambiguities and complexities. Therefore, it is essential to focus developmental efforts on three key areas: governance of HHC within the health system, the spread and penetration of technology in society, and economic conditions.

\received DD MMMM YYYY \acceptedDD MMMM YYYY This study aims to contribute to the contemporary challenge of optimizing urban spaces by developing a sustainable solution to attenuate the parking problem in crowded cities. With the cities having modicum parking spaces compared to the escalating number of cars, this paper represents a meticulous design and development of a Compact Automated Parking System (CAPS), employing a vertical-rotary mechanism to maximize spatial efficiency. A functional prototype has been fabricated with seamless integration of Internet of Things (IoT) technology. This system enables users to remotely access the information of availability of parking spaces and park their car via secured smart cards, enhancing both comfort and security. The system presented in this paper is capable of storing 16-20 cars in the surface area typically required for just 2 cars. Engineered for resilience, the structure brings a lightweight sustainable solution. While the prototype in this paper uses Pulley-belt mechanism to lift cars, it can alternatively be accomplished with a Chain-sprocket system also. Furthermore, the utilization of the Blynk IoT platform ensures a user-friendly interface. Moreover, A highly calibrated control system facilitates smooth and precise operation. The performance of this system is evaluated through time and user based metrics and brought satisfactory results. The integration of automated vertical-rotary mechanism and IoT can be considered a novelty compared with existing systems. By and large, this innovative solution expects a paradigm shift in the domain of urban parking.

In this letter, we propose a novel, fast model for detecting fire flames and smoke using object detection and 3D classification, referred to as FastFireDet3D. This model uses NanoDet to quickly identify potential areas representing fire and smoke, followed by a novel 3D classification model based on a spatio-temporal convolutional neural network (STCNN). This two-step process allows for efficient and accurate detection. The average processing time for FastFireDet3D is approximately 40-90 ms when run on a CPU, and it achieves an accuracy improvement of 3.45% over traditional Convolutional 3D (C3D) models.

In recent years, synthetic aperture radar (SAR) technology is investigated for automotive applications. SAR images via matched filter suffer from noisy background, sidelobe artifacts and low resolution. Sparse imaging methods have the potential to restore the images. However, the conventional unweighted ℓ₁ regularization method restores the SAR images with systematically underestimated amplitude and inconsistent supper-resolution factor. In this paper, we propose a reweighted ℓ₁ regularization method for SAR image restoration. Our method is supposed to simultaneously enhance weak scatterers and suppress sidelobes even in the case of SAR image with wide dynamic range of RCS. Real data experiments are carried out to verify the feasibility and effectiveness of the proposed method.

Background: Bundle branch reentrant ventricular tachycardia (BBR-VT) is a rare form of VT occurring in patients with structural heart disease (SHD). Rarely, it can also occur in the absence of SHD. Understanding its clinical and electrophysiologic (EP) properties and outcomes post-catheter ablation (CA) is crucial. Objective: We describe a case series of patients diagnosed with BBR-VT regarding clinical and EP characteristics, as well as long term follow-up after CA. Methods: All cases of BBR-VT that were diagnosed during EP study in our lab were evaluated. Clinical characteristics and EP findings were described. Results: Sixteen patients (12/16 male; mean age 50±21) with BBR-VT were studied from 2009-2020, with a mean follow-up of 70±16 months. Notably, nearly half (7; 43%) had no SHD. Patients without SHD (7; 43%) had Steinert dystrophy (3/7), SCN5A mutations (2/7), ajmaline-induced (1/7) or idiopathic BBR-VT (1/7). We suggest an algorithm for the evaluation of patients with BBR-VT without SHD. The induced BBR VT had a mean cycle length of 322±22 ms, was well tolerated in 10/16. A RBB CA was performed with an 8 mm solid-tip catheter. The HV interval increased from 72±9 to 100±23 ms. One patient developed total AV block. After the procedure, either a dual chamber pacemaker (10/16) or an ICD (3/16) was implanted. No patient presented VT recurrence. Conclusion: Although traditionally associated with patients with dilated cardiomyopathy, our study demonstrates that nearly half of BBR-VT cases occur in patients with structurally normal hearts. Once these patients are identified, Steinert’s disease should be considered as a potential underlying condition. . In the absence of ocular abnormalities, genetic testing may be warranted, particularly in the attempt to identify SCN5A mutations. Right bundle branch ablation is effective in most cases; however, device implantation is often required to ensure optimal long-term management.