Implantable cardioverter-defibrillators are medical devices designed to prevent sudden cardiac death caused by life-threatening ventricular arrhythmias. The purpose of this review is to investigate the most novel approach via an extravascular lead by exploring preliminary data that had been published in the PubMed, Cochrane, and ScienceDirect databases as of October 2024. An Oxford Level of Evidence was assigned to each paper; papers rated Level 4 or higher were included. Of the 727 initial records identified, 25 were included in the final analysis: 11 articles, and 14 abstracts. This data includes analysis of multiple-center studies of efficacy, safety, and complications of such devices and therapeutic use. This review discusses the expectations from clinical applications of extravascular implantable cardioverter-defibrillators and how certain limitations may be addressed.

The Chicken Egg Genotoxicity Assay (CEGA) is an avian egg-based model that utilizes the livers of developing chicken embryo-fetuses to assess the ability of chemicals to produce direct DNA damage. The main goal of the study was to evaluate target tissue exposure and metabolism in the CEGA to assess its suitability as a biologically relevant new approach methodology (NAM) for detecting genotoxic potential of chemicals. An imaging study using two-photon excitation microscopy following administration of a fluorescent dye (acridine orange) verified that chemicals following administration into the air sac of the fertilized chicken egg reach the target organ, liver. Additionally, a metabolism study using liquid chromatography with high resolution mass spectrometry (LC/MS), conducted after administration of benzo[a]pyrene (B(a)P) according to the CEGA protocol, confirmed the formation of sufficient amounts of reactive metabolite(s) responsible for genotoxic effects of a parent compound upon reaching the target tissue. Moreover, RNA sequencing study revealed that B(a)P in embryo-fetal chicken livers significantly upregulated several genes responsible for the activity of CYP1A1 enzyme which is critical for bioactivation of B(a)P. These findings support previous reports in CEGA, where B(a)P produced DNA damage in the liver tissues in the form of strand breaks and adducts. Overall, the findings in the study support the conclusion that the CEGA can be considered a robust potential alternative to animal testing strategy for assessing the genotoxic potential of chemicals

Purpose: Testicular cancer (TC) is the most prevalent malignancy among young men, with its incidence showing an increasing trend. Given its profound impact on male health and societal development, TC represents a significant public health concern. This study leverages the Global Burden of Disease 2021 data to analyze trends in TC and explores associations with key risk factors to inform public health strategies. Materials and Methods: Trends in Disability-Adjusted Life Years (DALYs), prevalence, and mortality from 1990 to 2021 were examined using Joinpoint regression.The Concentration Index is a measure for assessing inequalities across income levels. Spearman correlation was employed to assess the relationships between TC prevalence and related risk factors. Relevant data were sourced from The United Nations Population Division and The Emissions Database for Global Atmospheric Research. Results: Global DALYs showed a modest decline (AAPC = -0.26%), while prevalence increased (AAPC = 1.63%). High-income regions demonstrated reductions in DALYs, whereas middle- and low-income regions faced rising burdens. Urbanization and Environmental Pollution(EP) were significantly correlated with TC prevalence. A major limitation of this study is the lack of more detailed regional data, as well as the absence of a correlation analysis based on the histological types of testicular cancer. Conclusions: Urbanization and pollution are substantial drivers of TC trends, underscoring the need for targeted interventions, particularly in low-resource settings. Urban planning and pollution control should prioritize health outcomes to mitigate the rising TC burden.

Offline multi-agent reinforcement learning (MARL) addresses key limitations of online MARL, such as safety concerns, expensive data collection, extended training intervals, and high signaling overhead caused by online interactions with the environment. In this work, we propose an offline MARL algorithm for radio resource management (RRM), focusing on optimizing scheduling policies for multiple access points (APs) to jointly maximize the sum and tail rates of user equipment (UEs). We evaluate three training paradigms: centralized, independent, and centralized training with decentralized execution (CTDE). Our simulation results demonstrate that the proposed offline MARL framework outperforms conventional baseline approaches, achieving over a 15% improvement in a weighted combination of sum and tail rates. Additionally, the CTDE framework strikes an effective balance, reducing the computational complexity of centralized methods while addressing the inefficiencies of independent training. These results underscore the potential of offline MARL to deliver scalable, robust, and efficient solutions for resource management in dynamic wireless networks.

A document by Song Xue. Click on the document to view its contents.

ETV6::RUNX1 positive pediatric acute lymphoblastic leukemia frequently has a prenatal origin and follows a two-hit model: a first somatic alteration leads to the formation of the oncogenic fusion gene ETV6::RUNX1 and the generation of a preleukemic clone in utero. Secondary hits after birth are necessary to convert the preleukemic clone into clinically overt leukemia. However, prenatal factors triggering the first hit are still not determined. Here, we explore the influence of maternal factors during pregnancy on the prevalence of the ETV6::RUNX1 fusion. To this end, we employed a nested interventional cohort study ( IMPACT-BCN trial), including 1221 pregnancies (randomized into usual care, Mediterranean diet, or mindfulness-based stress reduction) and determined the prevalence of the fusion gene in DNA of cord blood samples at delivery (n=741) using the state-of-the-art GIPFEL ( genomic inverse PCR for exploration of ligated breakpoints) technique. 6.5% (n=48 of 741) of healthy newborns tested positive for ETV6::RUNX1. Our multiple regression analyses showed a trend towards lower ETV6::RUNX1 prevalence in offspring of the high-adherence intervention groups. Strikingly, corticosteroid use for lung maturation during pregnancy was significantly associated with ETV6::RUNX1 (adjusted OR 3.9, 95%CI 1.6-9.8) in 39 neonates, in particular if applied before 26 weeks of gestation (OR 7.7, 95%CI 1.08-50) or if betamethasone (OR 4.0, 95%CI 1.4-11.3) was used. Prenatal exposure to corticosteroids within a critical time window may therefore increase the risk to develop ETV6::RUNX1+ preleukemic clones and potentially leukemia after birth. Taken together, this study indicates that ETV6::RUNX1 preleukemia prevalence may be modulated and potentially prevented.

In many contexts autism treatment has been facing problems in its application, ranging from quality, uncertainty of methods, accessibility and regulation. Understanding and collectively adapting to them is a valid concern finding activism in multiple directions. This article is inspired by two technical opinions on such treatment methods, emitted by request of the Brazilian Ministry of Health. The present paper is a short reflective piece, not evaluating the treatment interventions themselves, but rather what was absent in the mentioned considerations doing so. It's discussed why the perspective taken, If decontextualized, might cause errors, direct the outcome and miss the institutional root of the issues appointed. Psychology is a field divided by theoretical, methodological and ethical splits, and collectively deciding on a treatment approach for a policy relies on those other aspects as well, such as settling on what will constitute scientific evidence and the internal competition for positions and validity within our institutions. Considering the public health impacts, we conclude by deliberating on reconfigurations which, albeit not completely solving those issues, could redirect us to a better functioning that accounts for the current state of this area of knowledge.

Background Psoriasis is recognized as a refractory skin disease in the modern world. There are no safe and effective pharmacological treatments with few adverse effects for psoriasis. The objective of this study was to identify potential therapeutic targets for psoriasis through the integration of diverse datasets. Methods We integrated drug-available genomic data, human blood cis-eQTL/Cis-pQTL data, skin tissue cis-eQTL data, and psoriasis GWAS aggregated data, and used drug target Mendelian randomization, Steiger filter analysis, and colocalization analysis to verify the causal relationship between psoriasis and drug target genes. In addition, we perform PH-MR analyses to determine the safety of drug target genes at the genetic level. Results MR analysis identified seven drug genes that may be associated with psoriasis. All of these genes were further confirmed by Bayesian co-localization analysis. (PPH4 > 80%). The up-regulation of PSMB9 expression was associated with a lower risk of psoriasis in the blood eQTL dataset (HR:0.827, 95% CL: 0.780-0.877, P=2.491108e-10), blood pQTL dataset (HR:0.071, 95% CL: 0.036-0.141, P=3.521467e-14) and skin eQTL dataset (HR:0.764, 95% CL: 0.701-0.833, P=9.425763e-10).Increased TNF transcription levels may increase the risk of psoriasis in the blood pQTL (HR:2.590, 95%CL: 1.123-5.976, P=2.561598e-02) /eQTL (HR:1.338, 95%CL: 1.213-1.475, P=5.082644e-09). MICA, HSPA1L, AGER, COL11A2 and FOLH1 were verified in skin eQTL dataset and blood pQTL dataset. Increased transcription levels of FOLH1 may reduce the risk of psoriasis in skin eQTL dataset (HR:0.901, 95%CL: 0.849-0.956, P=5.672095e-04) and blood pQTL dataset (HR:0.813, 95%CL: 0.671-0.987, P=3.4118311e-02); Increased transcription levels of MICA may reduce the risk of psoriasis in skin eQTL dataset (HR:0.787, 95%CL: 0.691-0.896, P=1.048889e-02) and blood pQTL dataset (HR:0.864, 95%CL: 1.048889E-02). 0.762-0.981, P=2.360710e-14). Conclusions: Our study suggests that PSMB9, MICA, HSPA1L, AGER, COL11A2 and FOLH1 may be promising targets for the treatment of psoriasis. However, the role of Artenimol in psoriasis needs to be further verified.

This paper investigates the potential applications, benefits, and challenges of utilizing ChatGPT in academic research and the manufacturing sector. Through discussions with academic researchers and industry professionals, the study gathers insights into how ChatGPT is perceived in terms of its utility and ethical implications. Academic participants generally viewed ChatGPT positively, recognizing its ability to assist with tasks such as text processing, translation, and literature review. However, concerns were raised about its limitations in more complex areas of research that demand critical thinking and original insights. Issues such as plagiarism, data leakage, weakening of users' abilities and authorship attribution were also highlighted. In the manufacturing sector, professionals appreciated ChatGPT's efficiency in handling text-based tasks, noting that it could significantly reduce time and cost. However, the provision of incorrect information and the potential for patent infringement were identified as major concerns. The paper concludes by emphasizing the importance of managing these risks, proposing clearer guidelines for the use of ChatGPT in both academic and industrial environments. Ultimately, while ChatGPT can offers substantial benefits, careful regulation and security protocols are essential to ensure its responsible use in these sectors.

It is a challenge to select the “best” recent publications in a field. This is especially so when faced with a feast of outstanding manuscripts across a broad range of topics. I therefore reached out to a Who’s Who of friends and colleagues in pediatric pulmonary and sleep medicine for suggestions, and I was delighted and overwhelmed by the response – please see the Acknowledgements for those who contributed ideas. Overwhelmed, by having to read 77 publications suggested by one or more colleagues and having to winnow the list down to a somewhat reasonable number. I chose to include all papers mentioned by two or more of my colleagues and I then selected the remainder to cover the broad range of our field, based upon my belief that a manuscript represented an important contribution to our understanding and clinical care. What follows are the chosen papers organized by topic area. Given the number of papers that made the final cut, I have briefly summarized each of these manuscripts. I hope that you will find something new and exciting in these publications and that you will have as much fun in reading them as I did.

We are interested in the problem of coexistence of many species consuming the same limiting resource. It is clear that a periodically returning optimal limiting resource (i.e. each species consumes its own portion of the limiting resource) supports coexistence. Our theory is that a periodically returning quasi-optimal limiting resource (i.e. each species mainly consumes its own portion of the limiting resource, but also consumes some of other species’ portions) also supports coexistence. To verify our theory, we introduce a natural mathematical model on the population dynamics of many species of plankton consuming a periodically returning quasi-optimal limiting resource. Our numerical simulations show that in this case, these species of plankton can coexist even when the quasi-optimality is quite far away from optimality. This is another mechanism toward the resolution of the paradox of plankton. Field collection of data shows that lake resource of plankton tends to be patchy with each patch mainly consumed by one species but also shared with other species

This study examines the relationship between transformational leadership and job satisfaction among nursing staff in healthcare organizations. The study found that transformational leadership has a positive significant relationship with job satisfaction among nursing staff (r = .670, P<.001). Transformational leadership practices are positively associated with improved nursing staff outcomes such as job satisfaction, productivity, and retention, as well as increased patient satisfaction. The findings of this study highlight the importance of transformational leadership in healthcare organizations and its positive impact on job satisfaction among nursing staff. By implementing transformational leadership practices, healthcare organizations can create a positive work environment that promotes job satisfaction and ultimately leads to improved patient care outcomes. Therefore, healthcare organizations should prioritize the development and implementation of effective transformational leadership styles to promote job satisfaction, loyalty, and productivity among nursing staff. Moreover, involving nursing staff in decision-making processes and increasing their participation can further enhance their satisfaction and performance.

This article briefly introduces and discusses main roles of phosphodiesterase type 5 inhibitors (PDE5i), single and combination treatment, and its long-term tolerability in patients with cardiovascular disease (coronary artery disease) beyond erectile dysfunction. At the same time, the author comments the Mendelian randomization (MR) analysis on PDE5i for ischemic heart disease and mortality in a recent study, as well as anti-tumor functions and applications of PDE5i in cancers, and other clinical uses, particularly combining with healthy lifestyle.

This paper explores the efficiency of various machine learning models for abuse detection in text, comparing traditional models (Logistic Regression, Random Forest, Decision Trees) with advanced deep learning techniques (RNNs, LSTMs, Bi-LSTMs, CNNs) and pretrained transformers (BERT, RoBERTa, DistilBERT, XLNet). The study also investigates hybrid models that combine the strengths of these individual approaches to improve accuracy. By evaluating the performance of these models on abuse detection tasks, the research aims to identify the most effective methods for automatically detecting abusive language in online content, contributing to more efficient content moderation systems.

Neuroscience of Consumer Gamification: The Role of Dopamine in Customer Loyalty

The interaction between polysaccharides and proteins in co-adsorption played a critical role in determining interfacial properties and emulsion stability. This study focused on the regulation mechanism of different concentrations of polysaccharide on the dynamic adsorption behavior of protein particles at the subunit level, and how the interfacial membrane microstructure affected the stability of emulsion. The research demonstrated that Konjac Glucomannan (KGM) and β-conglycinin (7S) formed stable composite through non-covalent interactions such as hydrogen bonding and hydrophobic interactions. Additionally, low concentrations of KGM promoted the unfolding of 7S structures, enhancing the wettability of the 7S-KGM composite by modulating the hydrophilic-hydrophobic balance. The results from interfacial adsorption kinetics and Quartz Crystal Microbalance with Dissipation Monitoring (QCM-D) indicated that KGM could synergistically facilitate the initial diffusion, penetration, and rearrangement of 7S at the oil-water interface thus forming a dense and viscoelastic three-dimensional gel-like multilayer interfacial structure. Notably, high-density adsorption of the 7S-KGM composite at the interface significantly increased the thickness and the protein content of the interfacial layer, enhancing emulsion stability. Finally, The results of dissipative particle dynamics simulations further demonstrated that the synergistic adsorption of KGM enhanced the interfacial adsorption efficiency of 7S, thereby stabilizing the interface more effectively and reducing droplet size. These findings of experiments and simulations provided insights into the mechanisms by which polysaccharides enhanced protein emulsification performance at the subunit level, offering critical guidance for optimizing protein interfacial properties and enhancing emulsion stability.

The pre-ejection period (PEP) is a widely used cardiac parameter in psychophysiological research that reflects the duration between the onset of ventricular depolarization and the opening of the aortic valve and is an established marker of sympathetic nervous system activity. While many algorithms for automated PEP extraction from electrocardiography (ECG) and impedance cardiography (ICG) signals have been proposed in the literature, they have not been systematically compared against each other. This lack of standardized algorithm comparisons is due to the absence of open-source algorithms and annotated datasets for evaluating PEP extraction algorithms. To address this issue, we introduce PEPbench, an open-source Python package with different Q-peak and B-point detection algorithms from the literature that can be combined to form comprehensive PEP extraction pipelines, and a standardized framework for evaluating PEP extraction algorithms. We use PEPbench to systematically compare 90 different algorithm combinations. All combinations are evaluated on datasets from two different studies with manually annotated Q-peaks and B-points, which we make publicly available as the first datasets with reference PEP annotations. Our results show that the algorithms can differ vastly in their performance and that the B-point detection algorithms introduce a considerable amount of error. Thus, we suggest that automated PEP extraction algorithms should be used with caution on a beat-to-beat level as their error rates are still relatively high. This highlights the need for open and reproducible benchmarking frameworks for PEP extraction algorithms to improve the quality of research findings in the field of psychophysiology. With PEPbench, we aim to take a first step towards this goal and encourage other researchers to engage in the evaluation of PEP extraction algorithms by contributing algorithms, data, and annotations. Ultimately, we hope to establish a community-driven platform, fostering innovation and collaboration in the field of psychophysiology and beyond.

In this paper, a new optimization method for airfoils is proposed. The geometrical shape of the airfoil is characterized by PARSEC parametric technique, and the aerodynamic and structural optimization of DU35-A17 with 35% relative thickness is carried out by combining the analytical means of Computational Fluid Dynamics (CFD) and the computational function of MATLAB program, taking NREL 5MW wind turbine blade as the object of study according to the position of the airfoil in the blade. After comparison, the optimized airfoil not only achieves an improvement in aerodynamic performance but also reduces the airfoil area by 10.7% and increases the lift coefficient by 7.11%. The optimized airfoil is then substituted into the same position on the blade for lamination design. The optimized blade results in a 66 kg reduction in mass, a 1.9032 m decrease in blade tip displacement, and a 34 MPa reduction in maximum load. Comparing the 8th mode vibration shapes before and after blade optimization, the vibration is improved, allowing the blade to better cope with complex operating conditions.

In today’s world, an overwhelming amount of written content is available, making it impractical to convert everything into Braille due to the high costs and large volume. This limits access to vast amounts of scholarly material for the visually impaired. To address these challenges, this project introduces a compact, smart device that allows visually impaired users to access printed text effectively and efficiently. The device uses a camera-based assistive methodology and is implemented on a Raspberry Pi platform, making it a cost-effective and portable solution. The system combines Optical Character Recognition (OCR) and Text-to-Speech (TTS) technologies. The OCR module captures images of printed text through a camera, converting them into machine-readable text, which is then summarized in both English and Hindi using a generative AI model (Gemini). The summarized text is further converted to speech using Google Text-to-Speech (gTTS), enabling users to listen to the key points of the text in both languages. This system enhances accessibility and comprehension by providing a flexible, multilingual solution for the visually impaired, allowing them to access printed materials through real time audio playback. This type of system can be very useful for blind persons in their day to day life and can enjoy their life.

Soil microbial biodiversity plays a fundamental role in regulating dryland ecosystem multifunctionality, being influenced by various environmental factors, particularly plant cover and soil properties. However, the complex interactions among soil microbial communities, plant communities, and soil physicochemical properties in desert steppe ecosystems remain inadequately understood. To address this knowledge gap, we examined the relationships between aboveground plant communities and soil environmental parameters (including nitrate nitrogen, pH, cation exchange capacity, and effective phosphorus) and their influence on the diversity and community structure of soil bacteria, archaea, and fungi across 37 desert steppe sites in a typical northern China’s dryland region. Our results showed that bacterial diversity exhibited significant variation among plant communities, with notably higher diversity in Stipa breviflora-dominated soils compared to Peganum harmala-dominated soils. The microbial communities were characterized by dominant phyla: Acidobacteriota (21.5%) in bacteria, Crenarchaeota (97.3%) in archaea, and Ascomycota (82.1%) in fungi. Bacterial diversity was significantly correlated with soil pH, available potassium, and carbonate content, while archaeal diversity showed strong correlations with ammonium nitrogen, available phosphorus, carbonate content, and cation exchange capacity. Fungal diversity, however, exhibited significant correlation only with available phosphorus. Environmental factors explained varying degrees of community structure variations, with the highest explanatory power for archaea (66.1%), followed by bacteria (49.0%) and fungi (32.8%). Structural equation modeling revealed that plant communities influenced bacterial communities primarily through modifications in soil pH and cation contents. These findings underscore the critical role of plant communities and soil properties in shaping soil microbial diversity patterns. Given the essential function of biodiversity in ecosystem processes, we propose that soil microbial diversity serves as a valuable indicator for monitoring and assessing degradation in desert steppe ecosystems.

Ampelopsis grossedentata is a unique plant species native to China. This study utilizes 193 geographical distribution data points and 34 environmental variables, including bioclimate, altitude, and radiation, to simulate the potential suitable distribution areas and changing characteristics of A. grossedentata under three future climate scenarios using the maximum entropy (MaxEnt) model alongside the BCC-CSM2-MR, EC-Earth3-Veg, and GISS-E2-1-G models. The results indicate that: (1) The prediction accuracy of the MaxEnt model is relatively high, with AUC values ranging from 0.917 to 0.956. TSS values is 0.884. (2) The six key environmental variables influencing the distribution of A. grossedentata are precipitation in the driest month, precipitation in the driest season, annual rainfall, monthly average radiation in May, altitude, and lowest temperature in the coldest month. The thresholds for these key environmental variables in the highly suitable distribution areas are as follows: 35–90 mm for the precipitation in the driest month, 130–300 mm for the precipitation in the driest season, 1200–1850 mm for annual rainfall, 14,000–15,400 KJ·m -2·d -1 for the monthly average radiation in May, below 1100 m for altitude, and 4.0–9.0 ℃ for the lowest temperature in the coldest month. (3) Under the SSP126 scenario, the areas classified as highly and moderately suitable for A. grossedentata can be expanded, with the total suitable distribution areas projected to reach a maximum of 1.781 million km 2 between 2081 and 2100. The SSP245 scenario is less effective than SSP126 in increasing suitable distribution areas but outperforms the SSP585 scenario, particularly in enhancing highly suitable distribution areas in Guangdong, Fujian, and Hunan, increasing moderately suitable distribution areas in Yunnan and Taiwan, and degrading moderately suitable distribution areas in central Sichuan and eastern Zhejiang to a lowly suitable status. Under the conventional development scenario SSP585, some highly suitable distribution areas in Yunnan, Guangxi, Hunan, Guizhou, and Jiangxi are expected to transition into moderately suitable distribution areas, while the moderately suitable distribution areas in Hainan may degrade to low suitability. The total suitable distribution area in China is projected to be at its lowest historical level from 2061 to 2080. (4) From 2041 to 2100, the total suitable distribution area for A. grossedentata increases only under the SSP126 climate scenario, while it decreases under the SSP245 and SSP585 scenarios. The centroid of the total suitable distribution area shifts according to different climate scenarios. Under the sustainable development scenario SSP126, the centroid moves 87 km from the current border of Hunan and Guangxi to the south of Hunan Province in an easterly direction. In contrast, under the regional development SSP245 and conventional development SSP585 scenarios, the centroid shifts 28–64 km northward, remaining primarily at the border of Hunan and Guangxi.

Social comparison is an important process that affects an individual’s self-assessment and subjective well-being. Previous studies have observed abnormal social comparison tendencies among depressed individuals, which may account for their social avoidance behavior. In this study, we asked participants to finish a simple gambling task with a friend, during which they could observe the outcome of their choice and that of their friend’s simultaneously (which were pseudorandomly determined). Behavioral measures and event-related potentials (ERP) elicited by outcome presentation (including the P2, feedback-related negativity, and P3 components) were recorded and analyzed. The whole sample consisted of a depression tendency (DT) group and a non-depressive control group, which were divided according to individual scores on Symptom Checklist-90 and Self-Rating Depression Scale. Compared to the controls, the DT group was generally in a more negative mood both before and after the experiment, as demonstrated by Positive Affect and Negative Affect Scale data. No between-group difference was detected regarding participants’ relationship closeness with their friend (as measured by the Inclusion of Other in the Self Scale) or self-reported outcome satisfaction. In contrast, the influence of depression on the P2 and FRN was significant. Specifically, the P2 elicited by self-win was larger in the controls than the DT group; also, it was sensitive to friend’s outcome in the DT group but not the control group. Finally, the FRN was sensitive to self-outcome in the DT group only when their friends had won. In our opinion, these results could be interpreted according to the relationship between depression and low self-esteem: compared to non-depressive ones, depressed individuals’ self-assessment is more susceptible to other people’s status, indicating more vulnerable self-esteem.

IntroductionCongenital melanocytic nevi (CMN) denote benign melanocytic proliferations, affecting approximately 1 to 2% of newborns, with a higher prevalence observed among Asian and Black children1,2. Manifesting either at birth or within subsequent weeks, these nevi typically manifest as light brown to black patches or plaques, varying in size and distribution across the body. Classification commonly stratifies CMN into small (< 1.5 cm), medium-sized (1.5 to 19.9 cm), and large or giant (20 cm or greater) lesions 3,4. Described as ’garment or bathing trunk’ nevi, large lesions are infrequent, with an incidence ranging from 1:200,000 to 500,000 births and a notable female predilection3. They are often deeply pigmented, accompanied by moderate hair growth, and frequently associated with scattered satellite lesions. While the hairy component, present in 95% of cases, tends to become more prominent in late childhood, the nevus itself typically pales at this stage 1.Giant nevi may exhibit associations with several comorbidities, including neurocutaneous melanosis, diffuse lipomatosis, structural brain malformations, skull bone hypertrophy, limb atrophy, skeletal asymmetry involving soft tissue hyper- and hypoplasia, von Recklinghausen’s disease, and vitiligo 5. The likelihood of neoplastic transformation is directly proportional to CMN size, with an estimated incidence ranging from 6% to 12% over one’s lifetime 6. The emergence of firm nodules warrants vigilant attention, with differential diagnoses encompassing proliferative nodules and malignant melanoma 4. Malignant transformation within giant CMN predominantly occurs in axial locations, with extremity lesions presenting lower risk, and satellite nevi exhibiting negligible risk 6.The cornerstone of treatment for large congenital melanocytic nevi remains surgical excision, often employing staged excision and subsequent resurfacing via skin grafts, tissue expanders, or flaps for giant lesions 5. In this report, we document a case involving a male adolescent presenting with a giant congenital nevus accompanied by lipomatosis localized to the right flank.

Infant object exploration affords rich opportunities for learning across the first years of life. During object play, infants use different combinations of fingers, different roles for each hand, and will deconstruct object parts—these fine-grained differences comprise the construct manipulation complexity (MC). In this paper, we characterized the development of MC in a longitudinal design. Ninety typically developing infants were assessed for MC at six monthly visits from 9-14 months of age from a battery of eight objects. Guttman analyses found that MC is cumulative, meaning that infants can do the most complex manipulation skill if they are able to also do all the lower ranked manipulation skills. The order from least complex to most complex was: (1) bimanual manipulation, (2) bimanual manipulation with distinct roles for each hand, (3) object deconstruction, and (4) independent digit movement. These results introduce a new framework for describing fine motor skills involved in infant manipulation.