Cystic Fibrosis Complicated by Allergic BronchopulmonaryAspergillosis in A Chinese Adolescent: A Case Report and Literature ReviewYuhai Dang1#, Zhenfeng Deng2#, Ke Wang1, Jing Luo1, Chao Wang1, Feiyang Long1, Jinliang Kong1*1 Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Guangxi Medical University, Nanning, China2 Clinical Genome Center, Guangxi KingMed, Nanning, China# Yuhai Dang and Zhenfeng Deng contributed equally to this work.* Correspondence: Jinliang Kong, email: kjl071@163.com

Teaching-Learning based optimization (TLBO) is population-based optimization which is used to solve continuous non-linear optimization problems and multiobjective optimization complications. TLBO algorithm can be categorized into two phases. The Teacher Phase involves learning from the best solution and the learner phase facilitates peer-to-peer learning. An elitist concept is introduced TLBO to solve complex constrainedly optimization complications. Subsequently an enhanced (TLBO) is developed to resolve unconstrained optimization problems. Weighted TLBO is used to increase convergence rate. Quasi-oppositional TLBO algorithm is incorporated to tackle multi-objective optimal reactive power dispatch (ORPD) problem by stability of voltage and reducing actual power loss. The combined heat and power dispatch (CHP) problem is effectively solved using an Oppositional TLBO. Modified TLBO is presented for global numerical optimization. TLBO algorithm successfully resolves the Multi Objective Optimal Power Flow (MOOPF) considering different system requirements. The ORPD problem is addressed using a Double-differential evolution (DDE) algorithm and TLBO collectively. Orthogonal design with a new selection strategy is applied to decrease the number of generations. Through resolution of short-term hydrothermal scheduling (HTS) problems in practical power system, the capability of TLBO is strengthened. A modified teaching factor and mutation operator are introduced into TLBO to adjust the convergence speed. Optimization Ethylene Cracking Furnaces Operation using self-adaptive multi objective optimization is recommended Future research directions for TLBO are developing adaptive parameter, hybridizing TLBO with other optimization techniques and enhancing exploration and exploitation balance.

Developing novel non-fullerene acceptors (NFAs) by modifying A 1-DA 2D-A 1 Y6 molecules is an effective strategy to improve the energy conversion efficiency of organic solar cells (OSCs). To understand the mechanism of regulating the photovoltaic performance by modifying the central fused-ring, end-group and inner-chain segments of Y6, D18:Y6, D18:AQx-2, D18:AQx-18, D18:BTIC-γ-2CN and D18:Z9 OSCs were systematically studied based on extensive quantum chemistry calculations, and the impacts of different chemical groups on molecular properties and photovoltaic performances were analyzed. The substitution of benzothiadiazole in the central fused ring of Y6 with quinoxaline, substituting quinoxaline with phenazine, introducing benzonitriles at the end group and phenyl groups into inner side chains enhance molecular skeleton planarity, slightly elevate the highest occupied molecular orbital energy and the lowest excitation energy, and enlarge light absorption efficiency. Introducing quinoxaline and phenyl groups cause the reduction of electrostatic potential difference between D18 and NFAs, on the contrary, introducing phenazine and benzonitriles induce the opposite effects. Introducing quinoxaline and phenazine generate negligible effects on charge transfer (CT) energies, whereas introducing benzonitrile and the phenyl group increase CT energies. Introducing phenazine and phenyl group generate sufficient energy difference between local excitation and CT to conquer exciton binding. The rate constants calculated using Marcus theory indicate that all molecular modifications of Y6 reduced exciton dissociation rates. However, the introducing benzonitrile increase CT and suppress charge recombination rates. The results reveal the inherent relationship between molecular structure and photovoltaic performance, providing the theoretical basis for design and development of NFAs.

A healthy human tear film constitutes proteins, electrolytes, water, lipids, mucins, and vitamins. The lack of production of tear in the eye leads to dry eye disease(DED) which is also termed as “Sjögren’s syndrome”. Utilizing degree-based topological indices on molecular graphs reveal insights into the physicochemical properties of these drugs, such as polar surface area, polarizability, boiling point, enthalpy, molar refraction, molar volume, molecular weight and complexity are crucial in predicting their efficacy in the treatment. Various studies have been carried out in QSPR/QSAR analysis using linear regression and curvilinear regression. In this article, multiple linear regression is applied to find the correlation between seven physicochemical properties and 11 topological indices for dry eye disease drugs. For the considered properties of drugs under the study, Polarizability has shown significant results with high correlation and least RMSE ( R=0 .996 & RMSE=1 .419) using various significant topological indices. The study is extended to evaluate and rank 22 dry eye disease drugs using Multi-Criteria Decision-Making (MCDM) techniques such as TOPSIS and VIKOR. The analysis revealed that Tacrolimus and Cyclosporine being ranked number 1 and number 22 respectively as identified by TOPSIS and VIKOR.

Abstract Background: Sub-Saharan Africa and Sierra Leone bear one of the world’s highest maternal mortality rates. In rural Sierra Leone, 19% of births occur at home, contributing to high maternal mortality ratios. Objective: To identify characteristics and reasons for home births among women in the rural Mathonkara Catchment area, Sierra Leone. Design: Cross-sectional study. Setting: 23 rural villages in the Mathonkara Catchment Area, Sierra Leone. Population: Women of childbearing age, who gave birth, miscarried or had an abortion between February 1, 2022, and January 31, 2023. Methods: A structured questionnaire assessed birthplaces, demographic characteristics, maternal health indicators, care seeking behaviors and previous experiences of care at health facilities. Main Outcome Measures: Prevalence of home births and associated determinants. Results: 555 women were included. The prevalence of home births stood at 26.67%. Characteristics associated with home births included feeling healthcare workers did not care about your life (AOR=19.11; 95% CI:1.57-799.61), living >1 km from a health facility (AOR=7.15; 95% CI:3.12-16.51), ≤3 antenatal care visits (AOR=4.84; 95% CI:2.37-10.14) and previous home births (AOR=4.17; 95% CI:2.42-7.30). Barriers included nighttime labor, transportation costs and availability and healthcare service costs. Conclusion: The factors influencing home births in rural Sierra Leone are multifaceted. To improve maternal outcomes, it is crucial to address the challenges that impede facility-based births, including quality of care and respectful care at health facilities, distance, economic costs of reaching facilities and transportation challenges such as quality of roads and availability of transportation. Keywords: Maternal Health, Sierra Leone, Home Birth, Antenatal care, Tonkolili

Third Reported Case of Rare Gamma-Globin Variant causing Anemia and Hypoxemia in a NewbornHannah Frederick, BS, Ricki Weisbrot, DNP, CRNP, CPNP-AC, Regina A. Macatangay, MD

Combined hepatocellular carcinoma (cHCC-CCA) is an uncommon primary liver lesion in which aspects of hepatocellular carcinoma (HCC) and cholangiocarcinoma (CCA) are intimately and unequivocally expressed. Its origin is still a topic of debate, given its heterogenicity, molecular profile, gene mutations but also to the complexities of the microenvironment in which it develops and to the pathways that are triggered in the liver in relation to the phenomena of liver damage. Diagnosis and treatment are still a challenge.

Attachment type and threat responses correlate via insecure attachments being more prone to display submissive threat responses and behaviours. Pinning the blame on parenting and childhood experiences for dictating our reactions, especially rape responses and the larger social effect on what contributes to the victim mentality and prevents people from speaking out against attackers. Genetics and the nervous/ parasympathetic nervous system are also looked into as causes for the submissive responses that is found more in women and especially those that are insecurely attached. There is a link between theories such as the critical period for an explanation as to why rape responses may be naturally selective in the same way rape behaviour is, the maladapted or incomplete internal working model therefore may cause a regression to a self soothing primal state which utilises these behaviours for survival.

Background: Allergic asthma (AA), a severe chronic respiratory disease caused by chronic airway inflammation, is characterized by bronchial epithelial barrier dysfunction. The MOTS-c/Nrf2 pathway plays a protective role in various diseases by reducing inflammatory responses. In this study, we hypothesized that the MOTS-c peptide alleviates AA by upregulating Nrf2-induced antioxidant and mitochondrial protective genes. Methods: MOTS-c levels in serum of patients with asthma and healthy volunteers were measured by ELISA. C57BL/6 and Nrf2-knockout (Nrf2 −/−) mice were stimulated with house dust mites (HDM) to establish an asthma model. Hematoxylin and eosin, immunofluorescence, and immunohistochemistry staining were used to assess lung tissue injury and mitochondrial function. BEAS-2B cells were pretreated using 10 μM MOTS-c for 2 h and then treated with HDM (1 μM) for 24 h. The epithelial barrier and mitochondrial function were detected through western blot and real-time quantitative PCR, respectively. Results: MOTS-c levels were lower in serum in patients with asthma than in healthy volunteers. Exogenous supplementation of MOTS-c significantly ameliorated lung tissue damage, inflammation, and oxidative stress caused by HDM. However, MOTS-c reversed the barrier function and mitochondrial damage in AA mice. Furthermore, MOTS-c significantly inhibited inflammation, oxidative stress, and mitochondrial damage in BEAS-2B cells. Mechanistically, MOTS-c attenuates airway barrier damage in AA by inhibiting bronchial epithelial apoptosis via Nrf2. Conclusion: MOTS-c alleviated AA by protecting the barrier function of airway epithelial cells through an Nrf2-dependent mechanism. Therefore, MOTS-c may potentially act as a novel protective agent against AA.

Sympatric morphs provide valuable systems for studying incipient divergence despite incomplete reproductive isolation. In connected waterbodies with spatially heterogeneous habitats, one or more morphs may form metapopulation structures, generating eco-evolutionary dynamics unlike those in single lakes. We studied the phenotypic and genome-wide differentiation in Arctic charr (Salvelinus alpinus) in two Icelandic lakes: Thingvallavatn, known to harbour four distinct morphs, and a smaller downstream lake, Ulfljotsvatn. Our analyses confirm a single origin of charr polymorphism in this system, with all morphs present in both lakes. Relative morph abundances differ between the lakes: PL-charr dominate in Thingvallavatn, whereas LB-charr are most abundant in Ulfljotsvatn. Three morphs, large- (LB-), small (SB-) benthivorous and planktivorous (PL-) charr, are genetically distinct. The system likely forms a source-sink structure for both PL- and SB-charr, though migration rates from Thingvallavatn vary remarkably, resulting in distinct population dynamics. Conversely, LB-char exhibit genetic differentiation between the lakes, suggesting the presence of a separate population in Ulfljotsvatn. While piscivorous (PI-) charr appear genetically similar to PL-charr, evidence suggests hybridization between PI- and LB-charr in both lakes. Moreover, the higher hybridization in the downstream lake likely contributes to the observed erosion of genetic separation between LB- and PL-charr in Ulfljotsvatn. These findings suggest that the complex interplay of habitat heterogeneity and morph-specific migrations shapes the coexistence and eco-evolutionary dynamics of sympatric charr morphs in the connected lakes. Our study highlights the importance of investigating early divergence in spatially complex systems to advance eco-evolutionary research.

The neurobiological and naturally selective roots of autism revolve around the testosterone effect, the extreme male brain theory, and various post-hoc hypotheses that state the advantages of neurodivergence in the ancestral plain. Then reverting to a modern-day context, testosterone and lower-functioning autism cases are on the decline, however, neurodivergence as a whole is on the increase. Papers on the inbreeding of hominid ancestors explain the overlap of neurodivergent genes such as ADHD and autism. Then it comes to an ultimatum that without the inhibition of testosterone, autism returns to its naturally selective roots in an information-based, individualistic society and shows that we as a society must become far more educated and understanding of neurodivergence as it will continue to become increasingly common as we are all integrated into the spectrum.

This study presents an analysis and interpretation of all known Indus texts featuring the elephant motif, contextualized within the framework of the Sindhu Alphabet. A corpus of 29 seals from the Indus Valley Civilization, depicting the elephant, was analysed using the Corpus of Indus Seals and Inscriptions: Collections in Pakistan and India. Drawing upon an extensive review of Vedic texts, Sanskrit dictionaries, and other relevant scriptures, plausible meanings and interpretations for the associated inscriptions are proposed. These texts appear to convey royal terminology, encompassing titles, tribal identities, and aspects of administrative and clerical practices. This research aims to serve as a valuable resource for scholars, providing a foundation for further validation or constructive critique.

In this paper, we extend the PNDP braneworld scenario by introducing σ-torsors, a topological invariant of the spinor bundle. We investigate instantons in two-dimensional conformal field theory using the CF T d ↔ AdS d+1 correspondence.

Predicting stock market behavior remains a formidable challenge due to its volatility and multifactorial nature. This paper introduces a novel hybrid framework that integrates machine learning techniques, including Long Short-Term Memory (LSTM) networks and Gradient Boosting Machines, with econometric models like ARIMA and GARCH. By combining the strengths of these approaches, we address non-linear dependencies while ensuring robust time-series analysis.Using a comprehensive dataset of historical stock prices, macroeconomic indicators, and sentiment data, our findings reveal that the hybrid model outperforms traditional standalone methods, achieving up to 20% higher predictive accuracy. This framework not only uncovers critical insights into the interplay between macroeconomic trends and sentiment-driven market shifts but also provides actionable tools for investors and policymakers, bridging the gap between computational intelligence and traditional financial modeling.

Don't take life too seriously. You'll never get out of it alive'.

Elucidating nurses’ work values will contribute to creating a work environment that is consistent with individual nurses’ work values and help them overcome challenging situations. This study aimed to create a short version of the Nurses’ Work Values Scale and verify its psychometric properties and usability among nurses, public health nurses, midwives, and licensed practical nurses. The short version was developed in three steps. In Step 1, a 12-item scale was created from the original 30-item Nurses’ Work Values Scale via a multi-dimensional item response theory based on data obtained from 1587 nurses. In Step 2, we modified the wording of the items and verified the scale’s content validity. In Step 3, we obtained new data from 1220 nurses, public health nurses, midwives, and licensed practical nurses who worked in various settings. Subsequently, we verified the psychometric properties of the 12-item scale. The developed scale made it possible to measure work values among nurses working in hospitals, nursing care facilities, and visiting nursing settings, and also among public health nurses. Simultaneously, the burden of responding to surveys was reduced. Future cross-sectional and longitudinal surveys should use the developed scale and examine a wider range of participants as they may contribute toward accumulating knowledge regarding work values.

We describe the first case of cryoballoon (CB) pulmonary vein isolation (PVI) facilitated by perioperative electroanatomical mapping (EAM) in a patient with dextrocardia due to Kartagener’s syndrome and highly symptomatic paroxysmal atrial fibrillation. Current case report highlights the different advantages of the addition of EAM to CB ablation for AF. This approach is feasible strategy for rhythm control in patients with atrial fibrillation and Kartagener’s syndrome for which medication can be contra-indicated.

Semaglutide, a glucagon-like peptide-1 (GLP-1) analog, extends its half-life by reversibly binding to human serum albumin (HSA). To investigate binding interactions at various fatty acid sites, we performed 1.5 μs conventional molecular dynamics (cMD) simulations and molecular mechanics generalized Born surface area (MM-GBSA) free energy calculations. MM-GBSA results show that the FA3–FA4 site (referred to as FA3) is the most favorable binding site ( = －75.33±15.04 kcal/mol), followed by the FA1 and FA6 sites, consistent with findings from previous two-dimensional nuclear magnetic resonance (2D-NMR) spectroscopy. At the FA3 site, electrostatic interactions predominated, forming the most hydrogen bonds and leading to a more compact structure, with no significant changes in residue-residue contacts compared to HSA without semaglutide. Next, Peptide Gaussian accelerated molecular dynamics (Pep-GaMD) simulations were performed to enhance semaglutide’s flexibility by selectively increasing its potential energy. Key residues, R348 and R485, were identified as crucial for localizing the C18 dicarboxylic acid side chain. These findings provide valuable insights into HSA-Semaglutide binding, potentially guiding the rational design of lipidated albumin-binding peptides in future studies.

Bio-based materials play a significant role in developing efficient engineering materials because of availability, recyclability and eco-friendliness. Products from Borassus flabellifer are found in both urban and rural locations in Bangladesh, and its fruits, leaf stems, and leaves are utilised in domestic applications, while some, mainly the fruit shells (husk), are discarded as agricultural waste. The objective of this study is to characterise the physical and chemical properties of the Borassus husk fibre experimentally, and it has been found that the density of the husk fibre is 0.74 g/cm 3, water absorption is 47.25%, moisture regain is 4.41%, and porosity is 34.58%. Scanning electron microscopy (SEM) analysis reveals cross-linked, non-uniform, cylindrical tubular fibers. Fourier transform infrared spectroscopy (FTIR) confirms the presence of hemicellulose, cellulose, lignin, and other components, aligning with the composition of natural bio-fibers such as jute, sisal, and flax. This indicates the material’s potential as an alternative natural fiber for lightweight engineering applications.

Background: Equine exertional rhabdomyolysis (ER) syndrome is a myopathy characterised by repeated episodes of muscle fibre damage induced by exercise. Whilst ER syndrome is heritable, previous studies have not identified causal variants nor pathophysiological mechanisms. The disorder has welfare and financial implications, but despite this, a performance advantage has been identified in susceptible racing Standardbreds. Objectives: To assess whether artificial selection and inbreeding are associated with increasing susceptibility to ER syndrome in horses. Study design: Case-control study. Methods: We used genetic data from 33 Connemaras (CP) and 94 Warmbloods (WB) to calculate Wright’s fixation index (F ST), runs of homozygosity (ROH), genomic inbreeding, and to model inbreeding depression both within and across the two breeds. Results: Signatures of selection were identified both in WB and across breeds; CP had elevated F ST values across the genome, indicating a higher degree of differentiation. When using a hierarchical F ST model, a greater degree of differentiation was captured when disease state was nested within breed. ROHs in ER WBs were associated with an overrepresentation of cyclic AMP signalling pathway genes, and a greater proportion of large (>16Mb) ROHs were identified in ER-susceptible WBs, indicative of recent inbreeding. ER WBs had significantly higher (U=1414.0, p=0.018) inbreeding coefficients (F ROH) than controls, however inbreeding depression models did not have good predictive ability. Main limitations: Small sample size, particularly for inbreeding depression modelling and within CP, and results present associations rather than proven causality. Conclusions: In summary, ER appears to have different genetic background in different breeds, with potential contributing effects of artificial selection in CP and of inbreeding in WB. Although a difference in inbreeding between WB cases and controls was observed, a specific effect of inbreeding depression was not supported.

Genomic data offers valuable insights into population history and species divergence, but interpreting complex evolutionary processes remains challenging, particularly in cases of recent divergence and ancestral polymorphism. This study addresses the taxonomic and evolutionary complexities of two endemic Hogna spider species from Madeira, H. maderiana from Porto Santo and H. insularum from Madeira, Desertas, Bugio, and Porto Santo, which exhibit mitochondrial gene tree discordance and ambiguous morphological boundaries. Using ddRADseq genomic data, population genomic analyses, and coalescent-based demographic analyses, we aim to determine whether these two nominal species represent a case of early divergence with unsorted molecular markers due to incomplete lineage sorting (ILS), if they are hybridising within the contact zone on the island of Porto Santo, or if they represent a single species exhibiting extreme morphological polymorphism. Our genetic structure analyses suggested three potential genetic clusters, one for each nominal species and one compatible with hybridisation between the two species on Porto Santo Island. However, demographic modelling and D-statistics rejected gene flow, instead supporting the existence of a third independent lineage in Porto Santo. The lack of genetic separation between these lineages likely reflects short recent divergence and unsorted ancestral polymorphisms. Our findings highlight the challenges of inferring hybridisation solely based on population structure analyses, which may lead to an overestimation of gene flow. This study highlights the importance of integrating demographic modelling and genetic data to resolve complex evolutionary histories and emphasizes the need for careful interpretation of genomic data to avoid misattributing gene flow.

The chronic nature of chronic myeloid leukemia (CML) has a negative impact on patients’ health-related quality of life (HRQOL) and the need for prolonged oral tyrosine kinase inhibitors (TKIs) poses a risk to low or non-adherence overtime. This systematic review seeks to analyze HRQOL outcomes and adherence to TKIs among pediatric, adolescent and young adult (AYA) patients with CML. Full-text screening ultimately led to the inclusion of 12 articles focused on HRQOL, patient reported outcomes (PRO) and medication adherence. There was heterogeneity in the findings among the included studies, especially in HRQOL and PROs. TKIs adherence ranged from 45-78% using self-report and 58-100% using medical and pharmacy records. Increased TKI adherence was significantly associated with better clinical outcomes, including overall survival. Our findings could inform efforts to develop behavioral interventions to optimize TKI adherence and improve HRQOL outcomes among AYA patients with CML.

Our understanding of the drivers of parasite community structure is compromised by poor sampling and historical focus on one host-one parasite systems. Yet parasites are ubiquitous and co-infections are common. This study aimed to identify how a range of drivers (connectivity, region, host-parasite interactions, parasite-parasite interactions) contribute to structuring endoparasite metacommunities. Within-host to landscape level patterns of malacosporean myxozoans infecting dormant propagules (statoblasts) of the freshwater bryozoan, Cristatella mucedo, were characterised. Large-scale databases were used to develop a metric for waterbird connectivity based on species turnover. Overall infection prevalence, assessed by PCR, was associated with high waterbird turnover at the site level, providing evidence that ongoing waterbirds act as parasite dispersal vectorsmovements promote parasite persistence and proliferation. RFLP analysis revealed eight malacosporean infection profiles. Traits of both hosts (e.g. habitat preferences) and parasites (e.g. transmission success) were linked with impacts of hydrological connectivity. Flooding regimes, nutrient enrichment from agriculture landscapes, and waterbird abundance were linked with regional impacts. Co-infections within tiny statoblasts (up to four) were common. Uninfected statoblasts were larger and there was no detectable difference in sizes of statoblasts with single vs. multiple infections. Co-occurrence analysis identified positive associations between four malacosporean taxa. The lack of negative associations suggests no competition amongst malacosporeans infecting statoblasts. There was no evidence that host-parasite interactions result in local adaptation of parasites to host clones. Hydrologically isolated sites had greater malacosporean diversity and enhanced levels of overall infection prevalence and co-infection, suggesting that such sites are malacosporean hotspots. Our study provides novel insights on the complex factors that can structure parasite communities in freshwater invertebrate hosts across the UK.

Background: Patients with autoimmune disorders are highly susceptible to infections including cytomegalovirus leading to serious complications ranging from asymptomatic to severe systemic diseases. Case presentation: The first case was a 44-year-old woman with systemic lupus erythematosus referred to the Rheumatology ward due to a necrotizing ulcer on the hand finger and multiple ulcerative lesions on her lips and tongue. She had pancytopenia and positive results for both herpes simplex virus and cytomegalovirus PCR (CMV-PCR); she was treated with Ganciclovir and ultimately recovered. The second case was a 55-year-old man, a known sarcoidosis case, admitted to the hospital due to lower extremities weakness and intraoral ulcers. The lab findings revealed leukopenia and elevated levels of ESR and CRP. Viral markers were all negative except for the CMV-PCR test. EMG-NCV showed subacute axonal motor polyneuropathy in the lower limbs. Due to the high titers of CMV, he was treated with Ganciclovir and the symptoms improved dramatically. Conclusion: CMV infection in rheumatic patients may lead to rare manifestations that can be misdiagnosed as a flare of the underlying disease.