Clinical Curiosity

Oxidative and physical stability of 3 and 7% beeswax-candelilla wax (BW-CDW, 1:1) oleogels prepared with flaxseed (FSO), soybean (SBO), and olive oils (OO) were evaluated during storage at 25 and 4 °C. Peroxide values (PV) and conjugated diene values (CDV) of BW-CDW oleogels were lower than bulk oils after storage at 4 °C for 180 days, and those of 7% wax oleogels were lower than 3% wax oleogels indicating the protection effect by oleogelation. In contrast, these oleogels had lower oxidative stability than bulk oils at 25 °C indicating the prooxidant activity of waxes. PV of 7% BW-CDW SBO oleogel increased slower than commercial margarine fat (CMF) at both storage temperatures while its CDV increased faster at 25 °C. Gel strength (firmness and cohesiveness) of oleogels decreased at both temperatures. Gel strength of CMF decreased faster than oleogels at 25 °C while it was steady at 4 °C. Gel strength of OO oleogels dramatically decreased during storage at 4 °C, which was likely due to large oil crystals formed that broke the wax crystal network at 4 °C. Solid wax content and melting enthalpy of oleogels increased indicating that new crystals formed during storage, which, however, did not provide higher gel strength. New spherulite crystals appeared during storage at 4 °C, which might be the reason for decreased gel strength. Overall results indicated that BW-CDW oleogels had the oxidative and physical stability comparable to CMF except for OO oleogels stored at 4 °C.

The main objective of this paper is to realize a Robust-Model Predictive Control (RMPC) to a dynamical inverse proportional system. Inverse proportional systems are presented in some systems involving electronic sensors, among others. However, in modern literature, an RMPC design could not be found for this type of system. Hence, we implement an inverse proportional system using the Van der Pol system and a low-pass filter stage. When designing the RMPC, an inverse proportional system can be viewed as a linear perturbed system with a negative gain on the canal input signal. This is because the RMPC is a statement on the discrete-time framework. Numerical experiments support our main contribution.

A document by Michael Calvin MacCracken. Click on the document to view its contents.

Chimonocalamus is a medium sized genus with distinguished morphological characteristics at the generic level. However, species identification in this genus can be confused due to similar morphological features and overlapped geographical distribution. To clarify the delimitation and confirm the identities of Chimonocalamus species in China, plastomes and nrDNAs of 49 accessions of 10 known species and three putative new species were newly retrieved by genome skimming. Distance-based and tree-based methods were conducted to analyze the species discrimination rate of five datasets. Meanwhile, Skmer method was also exploited. The results indicated that Skmer analyses had the highest discriminatory power with nine species identified (69.23%). The plastomes showed much higher discriminatory success rate than the combination of three standard plastid DNA barcodes which performed worst among the five datasets. According to the tree-based analysis, the C. fimbriatus complex was designated. This complex bears few morphological differences and the species delimitation needs to be further studied at the population level. Nevertheless, the three potentially new species of Chimonocalamus were confirmed by the plastome and nrDNA datasets, and Skmer analysis, together with morphological difference. Herein, we described and illustrated them as new to science, i.e., C. hekouensis Y. X. Zhang, Gui L. Zhang & D.Z. Li, C. hsuehiorum D.Z. Li & Y.X. Zhang, and C. shuangjiangensis D.Z. Li & Y.X. Zhang. Taken together, plastomes and nrDNAs could serve as effective super-barcodes for species discrimination of Chimonocalamus, playing important roles in recognition of cryptic new species, and Skmer analysis can be adopted in molecular identification.

Intermittent streams are prevalent worldwide, yet the understanding of drivers of their changing flow patterns remains incomplete. We examined hydrological changes spanning four decades (1982-2020) in Kings Creek, an intermittent grassland stream within the Konza Prairie Biological Station in Kansas, USA. We analyzed gauged data from a U.S. Geological Survey gage on Kings Creek and three upstream sub-watersheds with annual, biennial, or quadrennial burn frequencies, and linked trajectories of woody encroachment to increased evapotranspiration and changes in streamflow. Riparian cover doubled in the annually and biannually burned sub-watersheds, and seven-fold in the quadrennially burned watersheds. We observed significant decreases (84%) in daily discharge and number of annual flow days (55%) at the downstream Kings Creek gage, with similar changes in the sub watersheds. The changing riparian cover, propelled by the regional expansion of woody plants, contributed to decreased streamflow by amplifying actual evapotranspiration (AET). Seasonal assessments underscored the critical influence of late summer conditions (July-September), under which increases in AET were linked to rising temperatures and increased evapotranspiration by riparian cover. Our results highlight the significant hydrological impacts of woody encroachment in grasslands and emphasize the importance of long-term ecohydrological monitoring in unraveling the interplay between climate and vegetation as controls on the hyper-variable flow patterns in this intermittent stream. With global climate change accelerating woody encroachment, predicting, and managing hydrological impacts on the flow of intermittent grassland rivers and streams worldwide requires accounting for the effects of woody riparian vegetation.

Inhibitory learning forms an essential component of extinction learning. Deficits in inhibitory learning could negatively impact extinction learning. Previous research has shown optimizing inhibitory learning has potential to improve extinction. The current study aims to improve inhibitory learning capacity through training inhibitory control to improve extinction. Our results show that training inhibitory control through stop-signal task improves extinction learning as evidenced through better reduction in UCS-expectancy, further it also resulted in reduced subjective arousal ratings during extinction. This effect was persistent and observed 24 hours later during extinction recall. Our findings imply that training inhibitory control assists in forming inhibitory associations during extinction. Further, we also observed elevated physiological arousal in training group during extinction, this explains the better recall of extinction learning during extinction recall phase. Previous research has shown better consolidation of memory under high arousal state. Improving individual capacity to form inhibitory associations enhances extinction, this finding could aid developing interventions for individuals with anxiety disorders, who show deficits in inhibitory learning. Additionally, our results also provide support to retrieval stopping hypothesis of extinction, and highlighting the domain general nature of inhibitory control involved in motoric inhibition and inhibitory processes involved in extinction.

In this work, adaptive hybrid navigation methods for tethered robots in the real-world are investigated for navigation in changing environments. Traditional navigation systems rely on simulations, and therefore overlook complexity and unpredictability of the real application. We present a new way of overcoming these restrictions through a combination of state of the art sensor fusion techniques for reducing sensor noise and variability with soft computing techniques such as fuzzy logic, evolutionary algorithms and neural networks. Next, we propose real time adaptive path planning methods, addressing the problem of moving obstacles and varying tether configuration using optimal control for navigation efficiency. Combination of bug algorithms with soft computing frameworks improves resilience and responsiveness in uncertain contexts. We also suggest sophisticated retrieval methods for efficient tether management after navigation. Through substantial simulations and real world trials, we demonstrate the effectiveness of the proposed strategy, which would significantly boost navigation reliability and system adaptability in complex environments. Results show that our method provides improved tethered robot performance, which guarantees reliable operation in dynamic environments.

Topical corticosteroids are widely used in dermatology for their cost-effectiveness and ability to quickly resolve inflammatory skin disorders. However, their inappropriate use can cause adverse effects, including adrenal axis suppression and systemic manifestations. These effects are rare but more likely to occur in pediatric patients. We report the case of an

Safety and tolerability of a 3-hour build-up phase with Hymenoptera venom depot extracts: preliminary resultsRUNNING TITLEUltrarush venom immunotherapy with depot extractsAUTHORSAlessandro Buonomo1, Roberta Massaro1, David Longhino1, Arianna Aruanno1, Cristiano Caruso1, Eleonora Nucera1, Antonio Gasbarrini21Allergy Department, Fondazione Policlinico Universitario “Agostino Gemelli” IRCCS, Rome, Italy2Department of Internal Medicine and Gastroenterology, Fondazione Policlinico Universitario “Agostino Gemelli IRCCS”, Rome, ItalyKEY WORDSHymenoptera venom allergy; ultrarush venom immunotherapy; build-up phase; side effects.CONFLICT OF INTEREST

With the swift progression of information technology, time series forecasting has become increasingly vital across various domains including finance, energy, and transportation. Traditional Recurrent Neural Networks (RNNs) and Long Short-Term Memory (LSTM) networks face challenges with long sequences, necessitating more advanced analytical approaches. Capitalizing on the efficiency of the Transformer architecture in processing lengthy sequences, this study introduces the FCA-Transformer model. This novel model integrates a feature pyramid and cross-attention mechanism to enhance predictive accuracy and computational efficiency. The FCA-Transformer constructs a feature pyramid to capture multi-scale time series features, ensuring comprehensive feature representation. Its cross-attention mechanism promotes deep interaction across sequences, effectively harnessing complex time series correlations, thus surpassing traditional models’ analytical constraints. The model’s cross-scale integration strategy further deepens the understanding and utilization of diverse time series information. Through rigorous ablation and comparative studies, the abstract verifies the pivotal role of the feature pyramid and cross-attention in improving forecasting performance. The FCA-Transformer has proven to outperform current top models, showcasing its exceptional predictive capabilities. Additionally, its successful application to an atypical physical examination dataset demonstrates the model’s robustness and broad applicability, signifying its potential for a wide range of forecasting tasks.

Objective To describe the modes of delivery among confirmed cases of fetal macrosomia and compare maternal and obstetric outcomes between cases of macrosomia where labor was induced due to prenatal suspicion and cases of unexpected macrosomia with spontaneous labor. A secondary objective was to compare labor induction outcomes with expectant management as the control group.   Design Retrospective multicenter observational study.   Setting Three university hospital centers in a French region over a five-year period (2017–2023).   Population or Sample Women delivering singleton babies at term (>37 weeks of gestation) with a birth weight exceeding 4,000 grams and complete electronic medical records.   Methods Statistical analyses included Chi-square, Student’s t-test, and multivariate logistic regression to adjust for confounders, with significance set at p < 0.05. Maternal data (age, BMI, parity, diabetes) and fetal data (sex, birth weight, APGAR score, umbilical cord pH, complications such as shoulder dystocia) were analyzed. Primary outcome: mode of delivery. Secondary outcomes: maternal complications (postpartum hemorrhage, perineal tears) and neonatal outcomes (APGAR, umbilical cord pH).   Main Outcome Measures Mode of delivery and associated maternal/neonatal outcomes.   Results Among 4,300 births with confirmed macrosomia, labor induction was associated with higher cesarean section risk (OR 4.46, 95% CI 3.9–5.1) and postpartum hemorrhage (OR 2.18, 95% CI 1.87–2.54) compared to spontaneous labor. Risk of cesarean was reduced when induction was compared with expectant management (ORs 2.43 and 1.85 at 38 and 39 weeks, respectively). Multiparity reduced cesarean and hemorrhage risks. No significant differences in perineal tears or shoulder dystocia were observed. Neonatal outcomes, including APGAR scores, were similar across groups.   Conclusions Labor induction in confirmed fetal macrosomia is associated with higher cesarean and maternal complication risks compared to spontaneous labor. However, these risks are reduced when compared with expectant management.   Funding No specific funding was declared for this study.   Key words induction of labor, macrosomia, multicentric

The human gut microbiome, an essential component of the human digestive tract, is influenced by various elements including geographical location, ethnic background, dietary patterns, and genetic makeup. Geographical location, in particular, plays a significant role, as different regions in China exhibit distinct and unique bacterial groups. Furthermore, the impact of ethnicity on the composition of the gut microbiota should not be overlooked. In China, with its 56 ethnic subgroups, there exists an ethnic-specific clustering of gut microbiota, which contributes to a diverse range of microbial resources due to the presence of numerous minority groups. The relationship between gut microbiota and various diseases is an increasingly investigated area. Ethnic-specific gut microbiota can result in differences in disease incidence, and individuals from different ethnic groups may display variations in their gut microbiota when experiencing the same disease. The objective of this study is to present a comprehensive overview of the distinctive gut microbiome profiles across various regions and ethnic groups within China. This research highlights the unique characteristics of the gut microbiome among these minority populations and investigates the correlations between specific gut microbes and associated health conditions, a subject that remains underexplored in the current literature. This information will provide a basis for personalized medicine and the development of disease diagnostic models utilizing gut microbiota as biomarkers, thereby enabling more effective treatment plans and health management strategies.

Optimizing thermal management in electronic components is a critical challenge to ensure reliability and performance in modern technologies. This study investigates an innovative cooling system that integrates Nano-Encapsulated Phase Change Materials (NEPCM) with coupled convection-radiation mechanisms, aiming to address these challenges. The system analyzed consists of a partitioned cavity containing three circular blocks that generate heat varying over time and between blocks, attached to a conductive plate. This plate divides the cavity into two distinct regions: an open section cooled by natural convection and surface radiation, and a porous closed section filled with a combination of NEPCM and a liquid host fluid. The host fluid, water, is enhanced with nanoparticles to improve the thermal performance of the system. Numerical modeling, conducted using the Galerkin finite element method, evaluates the cooling efficiency across a range of parameters, including melting temperature ( 300  K ≤ T f ≤ 315  K ) , Darcy number   ( 10 - 5 ≤ Da ≤ 10 - 2 ) , emissivity ( 0 . 1 ≤ ɛ ≤ 0 . 9 ) , Stefan number ( 0 . 4 ≤ Ste ≤ 1 ) , cavity inclination angle (-90° ≤ α ≤ 90°), nanoparticle volume fraction ( 1 % ≤ φ ≤ 6 % ) , as well as the thickness and displacement of the separation plate ( 0 . 04 cm ≤ e ≤ 0 . 24 cm ; 2 . 7 cm ≤ d ≤ 3 . 6 cm ) . The findings reveal that the maximum temperatures of the blocks can vary significantly, with reductions exceeding 7% when key parameters, such as Darcy number and cavity inclination angle, are optimized. In contrast, other parameters have a more limited influence, resulting in variations not exceeding 2%. These insights highlight the importance of selecting appropriate parameters for enhanced thermal management in electronic applications.

Human Herpesvirus 8 (HHV8) also called Kaposi’s Sarcoma-associated herpesvirus (KSHV) is endemic worldwide. It is particularly pathogenic in immunocompromised patients. HHV8 related disease is a rare but dreaded complication in Solid Organ Transplant (SOT) recipients. Particularly donor-derived HHV8 infections can be life threatening and have a high mortality rate. Early recognition is crucial and therefore screening of the highest risk SOT patients could lead to better outcomes. We conducted a pilot study on the seroprevalence of HHV8 in our donor and recipient populations, to calculate the risk for HHV-8 related infections and to evaluate our current screening strategy. A total of 144 donors and 145 recipients were tested with the Indirect fluorescence assay for HHV8 Lytic IgG antibody. Seroprevalence in donors was 2.8% and 10.3% in recipients. This gives a 2.5% chance of donor positive/recipient negative (D+R-) combination, of whom a minority will develop symptomatic disease. Based on this data screening does not seem to be warranted in our center. Further multicenter studies are necessary to gain better insight in risk for symptomatic HHV8 infection in our SOT patients.

Drug resistance to Human Immunodeficiency Virus (HIV) is a major factor in treatment failure. Although this resistance is mostly related to drug exposure, treatment-naïve patients living with HIV have also been shown to develop primary drug resistance. Resistance monitoring before treatment prevents the first-line antiretroviral therapy (ART) failure and improves treatment outcomes. Very few data are available on the prevalence of HIV drug-resistance in Tunisia, especially among ART-naïve patients. This study aimed to investigate HIV-1 drug resistance patterns among ART-naïve Tunisian and African individuals. The study cohort included 77 treatment-naïve PLHIV who visited the HIV Center of Monastir to initiate ART. Viral RNAs were partially sequenced in the RT and PR regions using Sanger sequencing. Subtypes and Drug Resistance mutations (DRMs) were determined using the Stanford HIV Database. HIV-1 subtying revealed the predominance of the CRF02_AG, followed by the subtype B. 12,9% of variants were shown to have at least one Surveillance DRM (SDRM) in the PR/RT region. Most observed resistance cases (60%) were noted for RT inhibitors, with K103N the most involved SDRM-inducing resistance to first and second generation NNRTs (efavirenz, nevirapine, and rilpivirine). In the PR gene, resistance was found in four samples on 46 and 85 codons, affecting the sensitivity for Atazanavir and Lopinavir drugs. This study provides the first baseline information for pre-treatment drug resistance surveillance of HIV-1 variants in Tunisia, and shows considerable mutations, which may impede patient management.

In this study, an improved three-dimensional human thermoregulation model was developed. A stratified model of the segmented human geometry was introduced, characterizing distinct tissues and organs to activate their specific thermal responses and interactions. The main trunk geometry was modified to improve reliability and support applications such as personal cooling systems. The model accounted for heat transport via blood arteries and emphasized changes in skin thermal conductivity to simulate vasodilation and vasoconstriction mechanisms. Additionally, the thermal effects of direct solar radiation on the human body were integrated into the mathematical framework. The model was validated using documented experimental data across various hot and cold environmental conditions and compared with recent three-dimensional models. Results demonstrated that the enhanced model achieved better agreement with experimental data than existing unstratified segmented models. Improved stratification captured temperature variations across adjacent tissue layers, providing more accurate peripheral and core temperature distributions. A case study investigated strenuous military tasks performed under extreme heat, yielding significant medical insights. This advanced stratified anatomic model serves as a robust tool for predicting human thermoregulation during diverse activities, offering detailed core and skin temperature distributions. Furthermore, the modified sweepable geometry may enhance numerical methodologies for future three-dimensional studies.

Bleomycin (BLM), a chemotherapeutic agent commonly used in cancer treatment, is associated with oxidative stress and testicular toxicity, leading to impaired reproductive health. Hesperidin (HES), a citrus-derived flavonoid with strong antioxidant properties, has the potential to counteract these adverse effects. This study aimed to evaluate the protective effects of HES against the reproductive toxicity induced by BLM, focusing on oxidative stress, sperm characteristics, and histological changes in the male reproductive system. Thirty-two rats were divided into four groups: Control, BLM, HES, and BLM+HES. BLM was administered intraperitoneally at 10 mg/kg twice a week, while HES was given orally at 50 mg/kg/day for 30 days. The findings revealed that BLM induced significant oxidative stress by promoting lipid peroxidation and impairing antioxidant defense mechanisms in the testis. Additionally, BLM treatment caused a marked decline in sperm motility, an increase in abnormal sperm rates, and severe histopathological damage in testicular tissue. However, co-administration of HES significantly mitigated these adverse effects by improving oxidative balance, restoring sperm quality, and reducing histopathological injuries. In conclusion, HES demonstrated potential in alleviating BLM-induced reproductive toxicity, suggesting its therapeutic role in protecting against chemotherapy-induced male infertility.

Introduction: Cervical cancer is the second highest cause of cancer-related deaths in women in Nigeria. Human papillomavirus (HPV) infection, particularly types 16 and 18, causes 95% of this burden. In 2023, Nigeria first incorporated the HPV vaccine into its Expanded Program on Immunization. While the federal and state governments led the program, community and partners quickly addressed gaps. This study estimated the financial costs of HPV vaccine introduction in Nigeria, examining Bayelsa (southern) and Taraba (northern) states. Methods: The study employed a mixed-methods approach, combining quantitative (days worked and doses administered) and qualitative (stakeholders’ insights) data. Results: The two states achieved high coverage (Bayelsa, 74%; Taraba, 78%), close to the ambitious 80% national target. The total financial cost per fully vaccinated girl was also similar, at $6.04 (Bayelsa) and $6.02 (Taraba). Antigen cost $4.99 (82.6% to 83.0%) per girl and operations cost $1.05 (17.4%) and $1.03 (17.0%) in the respective states. Transportation, logistics and data tool costs were the largest proportion of the operational cost (Bayelsa, 38.1%; 39.0%, Taraba). Service delivery (Bayelsa, 22.2%; Taraba, 22.4%), and the advocacy, communication, and social mobilization activities (ACSM) costs (Bayelsa, 20.0%; Taraba, 20.5%) also represented notable operational cost drivers. Vaccine procurement costs substantially exceeded operational costs in both states. Discussion: The states’ initial intensive campaign strategy with community and partners’ continual collaboration in planning and implementation proved effective in quickly achieving high coverage. These states’ success in introducing HPV vaccine through a campaign strategy can serve as a useful model for other countries.

A document by YANCHAO YIN. Click on the document to view its contents.

The feedback nonlinear output-error system is a special nonlinear system, the existence of the memoryless nonlinear block on the feedback channel leads to the difficulty of the parameter estimation. Combining the hierarchical identification principle with the auxiliary model identification idea, we derive an auxiliary model-based hierarchical stochastic gradient algorithm. In order to further improve the convergence rate and parameter estimation accuracy, an auxiliary model-based hierarchical multi-innovation stochastic gradient algorithm is proposed by using the multi-innovation identification theory. Furthermore, the convergence properties of the proposed algorithms are analyzed through the stochastic process theory. Finally, the experimental results indicate the effectiveness of the proposed algorithms.

Objectives: This study investigated the role of internalized shame as a mediator in the relationship between perfectionism and non-suicidal self-injury (NSSI), and examined whether this mediated relationship is moderated by distress tolerance. Methods: A sample of 408 university students completed measures assessing NSSI, perfectionism, internalized shame, and distress tolerance. Data from 216 participants (mean age = 22.18 years, 69.4% female) who reported experiencing NSSI in the past year (i.e., in 2022) were analyzed. Results: The results indicated that internalized shame mediated the relationship between functional-dysfunctional perfectionism and NSSI. Furthermore, distress tolerance moderated the relationship between internalized shame and NSSI. Finally, the mediating effect of internalized shame in the relationship between functional-dysfunctional perfectionism and NSSI was also moderated by distress tolerance. Conclusions: These findings suggest that perfectionism contributes to NSSI through internalized shame, with distress tolerance acting as a protective factor. This study highlights the importance of addressing both internalized shame and pain tolerance in interventions targeting individuals at risk of NSSI owing to high levels of perfectionism. Keywords: NSSI (non-suicidal self-injury), perfectionism, internalized shame, distress tolerance

Objectives: The rapid evolution of the treatment landscape for non-small cell lung cancer (NSCLC) indicates a need to assess real-world treatment patterns in clinical practice in the US. This study aims to describe treatment patterns and patient characteristics taking into account new drug entities and newly emerging biomarkers for NSCLC. Methods: A descriptive cohort study was conducted using a specialized electronic health record data for NSCLC. Patients who initiated NSCLC treatment following diagnosis of advanced NSCLC (stage IIIB/IIIC/IV) from 01/01/2015-12/31/2021 were identified. Baseline characteristics and treatment patterns were described; continuous variables were described as mean and standard deviation (SD) and categorical variables as proportions. Results: Of 8,811 patients identified with advanced NSCLC, 67.9% had non-squamous cell carcinoma, 22.5% had squamous cell carcinoma, and 9.6% had an unknown histology. The majority of patients (78.7%) were treated at community hospitals, while 13.4% were treated at academic centers, and 7.9% had an unknown treatment setting. Most patients (59.0%) were aged 65 years or older, and 47.3% were female. There were 22 patients (0.2%) with documentation of NSCLC but no identified guideline-recommended line of therapy (LoT). Among all patient, 51.6% received a second line of therapy (LoT2), and 26.4% received third-line therapy (LoT3). For stage IIIB/IIIC patients, the five most common first-line therapies (LoT1), accounting for 83.2% of all LoT1, included traditional platinum-based chemotherapy or pembrolizumab. In stage IV patients, the five most common LoT1, comprising 64.4% of all LoT1, were pembrolizumab either as monotherapy or combined with other platinum-based chemotherapeutic agents. Conclusions: Traditional platinum-based chemotherapy was the most common LoT1 for stage IIIB/IIIC patients, while the extensive use of immunotherapy (IO) was found in stage IV patients and in later lines of treatment in stage IIIB/IIIC patients. The growing use of IO indicated that new evidence was rapidly adopted among NSCLC patients.

This study proposes a predictive model for evaluating corporate cultural characteristics and assessing cultural similarity between companies using publicly available corporate review data. In the context of mergers and acquisitions (M&A), cultural fit has been recognized as a critical factor influencing post-merger success. However, cultural evaluations are often constrained by limited access to internal company data. To address this challenge, we fine-tune open- and closed-sourced large language models (LLMs) with Parameter-Efficient Fine-Tuning (PEFT) techniques, specifically Low-Rank Adaptation (LoRA), to analyze employee reviews and generate assessments aligned with the Denison & Ko Organizational Culture Framework. The model predicts cultural characteristics across four key traits—Mission, Consistency, Involvement, and Adaptability—and their twelve sub-dimensions, providing both textual evaluations and quantitative ratings. Our results demonstrate that fine-tuned GPT-4o outperforms other models in generating accurate cultural evaluations and ratings. This research contributes to improving the objectivity and scalability of cultural fit assessments in M&A processes and highlights the potential of LLMs in extracting actionable insights from unstructured corporate review data.