Greater executive functioning (EF) protects against cognitive decline and activities that increase heart rate variability (HRV) can improve inhibitory control. Therefore, EF and HRV play a key role in healthy aging. Attention Restoration Theory and Stress Recovery Theory posit that nature exposure can improve EF and HRV, but older adults are underrepresented in this work. This study addressed this gap by examining how contact with real-world nature (RWN) and virtual reality nature (VRN) affected healthy younger and older adults’ EF, HRV, perceived stress, and affect. Participants ( N = 61) were randomized into an RWN, VRN, or an indoor control condition, and outcomes were assessed before and after 20-minute exposure to the environmental manipulation. We predicted that for both age groups, RWN and VRN would improve EF and affect, increase HRV, and reduce perceived stress compared to the control. Results partially supported hypotheses—RWN only enhanced positive affect and decreased heart rate and perceived stress among younger adults. We discuss insignificant yet interesting trends for cognitive performance and share implications, limitations, and future directions.

Aims: This review provides a landscape of US FDA-approved drugs for liver cancer. The study evaluates these FDA-approved agents’ chemical constituents and pharmacology, as well as the mechanism of action and adverse response profiles, to enhance understanding of their therapeutic efficacy and safety and to draw the need for further analysis to build combination therapy with these drugs. Methodology: A thorough assessment of US FDA-approved drugs for liver cancer required examining the regulatory documents from the FDA and peer-reviewed literature. It examines US FDA-approved drugs for advanced or unresectable liver cancer, including Sorafenib tosylate, Regorafenib, Lenvatinib, Nivolumab, Atezolizumab, Bevacizumab, Cabozantinib-S-Malate, Pembrolizumab, Ipilimumab, Tremelimumab-actl and Ramucirumab. This review covers the analysis of the pharmacological properties of these drugs, focusing on chemical structure, mechanisms of action, clinical efficacy, and corresponding toxicity, to provide a detailed understanding of their function in the treatment of liver cancer. Conclusion: Drugs that are approved by the US FDA for liver cancer have transformed the management of liver cancer, especially in advanced stages while surgery is not feasible. These substances function via a variety of methods, such as immune evasion, angiogenesis, and tumor growth inhibition. However, they are associated with several adverse effects, including hepatotoxicity, tiredness, diarrhea, hypertension, and immune-related consequences. Ongoing discoveries in targeted therapies and immunotherapies provide promise for the enhancement of liver cancer surgery outcomes, with ongoing research into combination therapies and novel therapeutic strategies.

Novel oral anticoagulants (NOACs) have revolutionized anticoagulation therapy by surpassing the limitations of warfarin and providing broader therapeutic effect, fewer drug-food and drug-drug interactions, and elimination of routine coagulation monitoring. However, inter-individual variabilities in drug responses have resulted in recurrent thromboembolic events and bleeding complications. Genetic variations that affect enzymes - CYP3A4/5, CES1, and transporters - ABCB1, ABCG2 were found to have significant impacts on the metabolism and efficacy of NOACs-rivaroxaban, apixaban, and dabigatran. In case of apixaban, CYP3A4*1G and CYP3A4*22 variations affect enzyme activity while ABCB1 C3435T and SULT1A1*3 variants alter P-glycoprotein (P-gp) which is important for drug efflux and bioavailability, influencing apixaban absorption and distribution. Rivaroxaban metabolism, activity and transport are influenced by CYP3A4*22, CYP2J2, ABCB1 (C3435T) and ABCG2 (Q141K) polymorphisms respectively. In case of dabigatran, plasma concentrations are impacted by CES1 gene variants (rs2244613, rs8192935, rs4148738) and ABCB1 polymorphisms (rs4148738, rs2032582, rs1045642), which affect P-gp function, influencing absorption, distribution, and elimination .This review article focuses on the effect of genetic polymorphisms on NOAC pharmacometrics and a possible need for personalized NOAC therapy by integrating results from genome-wide association studies (GWAS) and other genetic studies. The review also highlights the importance of integrating pharmacogenomic data into clinical decision-making to optimize dosing strategies, minimize adverse effects, and enhance treatment efficacy. The review identifies gaps in current knowledge and proposes future research directions to better integrate pharmacogenomics into clinical practice, ultimately improving patient outcomes in anticoagulation therapy. The review suggests possible methods for utilising available genetic information for optimized treatment.

The impact of mindfulness on academics’ anxiety and search for meaning in life during the COVID-19 pandemic: a preliminary study

A document by Kenneth Thorsen. Click on the document to view its contents.

Introduction:Cyclin dependent kinase (CDK) 4/6 inhibitors are oral drugs that include Abemaciclib, Ribociclib and Palbociclib. These drugs target the CDK4/6, that acts as a converging point for different growth proliferation and growth arrest signals in the cell cycle regulation. CDK 4/6 inhibitors block it, to cause cell growth arrest leading to tumor cell death. These drugs are only used for breast cancer that is hormone receptor positive, in association with an endocrine therapy that varies from anti estrogen, aromatase inhibitors and selective estrogen receptor modulator. Common side effects include hematological toxicity, QT elongation for Ribociclib and digestive toxicity for Abemaciclib. Less common side effects include cutaneous toxicity. In fact, vitiligo-like lesions have been described with the use of Ribociclib.

Title: Monteggia equivalent fracture-dislocation in children: A case report

Ovarian cancer is a leading cause of death among gynecological malignancies, it has a poor prognosis due to its early asymptomatic stage. Early and accurate diagnosis is critical for improving survival rates. While ultrasound is essential in ovarian cancer detection, its effectiveness is limited by operator subjectivity. Advances in artificial intelligence (AI), offer promising solutions for automated ultrasound image analysis, enhancing diagnostic accuracy and consistency. Multi-modal ultrasound provides comprehensive tumor insights. Combining AI with multi-modal ultrasound enables improved risk assessment, precise tumor classification, and individualized treatment planning. This review explores the applications, challenges, and prospects of integrating AI with multi-modal ultrasound, highlighting its potential to transform ovarian cancer diagnosis and advance precision medicine.

Climate change and land-use changes are key drivers of global biodiversity loss. Many species are shifting to higher elevations or latitudes in response to global warming, often encountering unfavorable land-use conditions during the shift. This leads to reduced range size and increased extinction risks, particularly for mountain species, often confined to narrow, high-altitude habitats. Predicting future distributions of mountain species requires an accounting for their bioclimatic responses, detailed topographical distribution, land-use preferences, and ability to colonise new areas via dispersal mechanisms. These elements are rarely considered together over large scales. Here, we projected the future distribution of 32 mountain mammal and 344 non-migratory mountain bird species by 2050 under different emission scenarios (SSP-RCP 1-2.6 and SSP-RCP 5-8.5). Using Species Distribution Models (SDMs) that incorporated topography, climate, and land-use data, we assessed the impacts of global change on species’ ranges across mountain regions worldwide, accounting for realistic dispersal scenarios. Under the high-emissions scenario, species were projected to experience significantly greater range loss compared to the low-emissions scenario, with a difference of 17% of loss for birds and 16% for mammals. The number of species that shift their range also increased, passing from 73 to to 84. The most severe range losses were projected for species located in tropical mountain ranges, while European and North American mountains showed lower losses, highlighting substantial regional differences in vulnerability. When land-use changes were included in the models, projected range losses increased further, particularly under the low-emissions scenario (+2%). Our findings emphasize the importance of considering both climate and land-use changes when assessing biodiversity risks in mountain regions. Our results highlight the urgency of mitigating climate change and managing land use to preserve the unique biodiversity of these areas.

Background: TFE3 rearranged renal cell carcinoma (TFE3 rRCC) is a rare subtype of RCC involving chromosomal breaks and recombination. Because the rarity, clinical factors affecting the metastasis in TFE3 rRCC are insufficient. The purpose of this meta-analysis is to provide further investigation in this regard. Methods: Pubmed, MEDLINE, Web of Science, EMBASE and Cochrane databases were searched for published studies on the clinical features of TFE3 rRCC. Literature published between May 2004 and December 2023 was searched. Results: A total of 11 studies with 192 subjects were included. Pooled data showed that the number of all female patients was higher than that of males, with a combined OR of 2.45 (95% CI = 1.64-3.66). The incidence of distant metastases (OR = 3.08, 95% CI = 1.06-8.93) and peritoneal metastases (OR = 4.74, 95% CI = 1.19-18.87) were comparable between males and females. Adult females had a higher risk of developing metastases than males, with a combined OR of 4.29 (95% CI = 1.38-13.37), whereas there was no gender advantage in children (OR = 0.30, 95% CI = 0.06 -1.53). Furthermore, the forest plot suggested a significant difference in the probability of distant metastases between paediatric and adult patients (OR = 0.03, 95% CI = 0.01 - 0.07). Conclusions: Adult patients are more likely to develop distant metastases than paediatric patients, with adult females being more likely to develop distant metastases comparing to adult males, indicating that intensified follow-up should be performed on this subgroup in patients with TFE3 rRCC.

Prolonging the age at which women become pregnant is linked to an elevated risk of developing cancer, including salivary gland tumours (SGT). However, awareness of this correlation remains limited. The aim of this study was to analyse the incidence and therapeutic options for SGTs during pregnancy on the basis of multicenter retrospective cohort analysis. The database of 2653 patients with SGTs from major centers in Poland included 1313 women, 300 were aged 16-42 years. 6 patients with SGTs during pregnancy were identified (w malignant, 4 benign). One case of sudden tumour occurrence and doubling of its mass suggested a malignant transformation. A standard diagnostic protocol is recommended during pregnancy with surveillance for benign and surgical resection for malignant SGT, regardless of the pregnancy stage. The risk of malignant transformation of SGT during pregnancy implies the need for resection before planned conception.

A document by Jordan Wallace. Click on the document to view its contents.

Despite a global drop since the middle of the past century, gastric cancer remains the third most common cause of cancer-related deaths worldwide, and the fifth most common kind of cancer diagnosed globally [[1]](#one). The most frequent physical examination finding that indicates advanced illness is a palpable abdominal mass, also, non-specific weight loss, persistent stomach discomfort, dysphagia, hematemesis, anorexia, nausea, early satiety, and dyspepsia are the most typical presenting symptoms for gastric malignancies [[1]](#one), none of which were seen in our case of a patient presenting with solely respiratory complaints that later on, were discovered to be the product of a metastatic gastric adenocarcinoma. In our case, we introduce a 30-year-old male patient who presents with respiratory failure and ARDS in the emergency department, after several tests and continuous follow-up, the patient was discovered to have a widespread atypical lung adenocarcinoma from a metastatic gastric adenocarcinoma.

Background: Anastomotic leakage (AL) is a significant and challenging complication following low anterior resection (LAR) for low rectal cancer. This report presents three cases treated with transanal intersphincteric incision surgery (TROPIS) combined with Kangfuxin liquid (KFL) enema. Case Presentations: We present three patients who underwent a laparoscopic LAR with diverting ileostomy for low rectal cancer. In case 1, a 39-year-old male patient presented two weeks post-discharge with fever and abdominal distension. Digital rectal examination revealed local detachment of the anastomosis. Case 2 was a 74-year-old male who on the fifth postoperative day experienced abdominal pain and high fever, with fecal fluid detected in the pelvic drainage tube. Abdominal CT confirmed AL. Case 3 was a 51-year-old male who, one week post-discharge, visited the outpatient clinic and digital rectal examination indicated AL located approximately 2.5 cm from the anal verge due to a local defect. Since the patient was asymptomatic, this was initially treated conservatively, however, despite one year of follow-up, complete healing was not achieved. All three cases of AL underwent TROPIS combined with Kangfuxin liquid (KFL) enema and completely recovered. Conclusions: The combination of the TROPIS technique and KFL enema appears to be an effective and safe therapeutic regimen for managing AL following LAR for rectal cancer with favorable outcomes, highlighting the potential of this combined approach in managing AL. Further research and clinical trials, however, are warranted to validate these findings.

The evolutionary origin of fruits played a pivotal role in promoting the dominance of angiosperms on the Earth. Fruits, derived from the gynoecium after pollination and fertilization, protect and nourish seeds and facilitate their dispersal through diverse mechanisms that are adaptive in different environments. Therefore, understanding the molecular networks underlying fruit development is a prerequisite for elucidating evolutionary mechanisms shaping fruit diversification, and particularly improving crop yield and quality of fruit in response to the rapid climate change in modern agricultural systems. In this article, we offer a comprehensive analysis of fruit classification, emphasizing the intrinsic characteristics and their adaptive dispersal strategies in specific environments. Based on the studies in the model systems such as Arabidopsis thaliana (representing dry fruits) and Solanum lycopersicum, tomato (representing fleshy fruits), we highlight recent advances in identifying novel components of the molecular networks involved in fruit development. We further discuss the evolutionary mechanisms that contribute to fruit diversification in the context of well-established phylogenetic frameworks, with examples from the Brassicaceae and Solanaceae families. Intriguingly, the comparison between studies in Brassicaceae and Solanaceae indicates the core network underlying fruit development is largely conserved in evolution. Finally, we highlight the unresolved questions associated with fruit development and evolution. We propose the future research that integrates multidisciplinary evidence could help to better understand the mechanisms of fruit development and diversification, which ultimately contribute to improve crop yield and quality in practice.

Currently, advanced adiabatic compressed air energy storage (AA-CAES) has been widely used, but the quantitative study of its energy loss is still unresolved. Therefore, the ideal AA-CAES with a round-trip efficiency of 100% is defined to quantify the energy losses in the AA-CAES from the aspects of factors and components, so as to clarify the loss mechanism of AA-CAES. Firstly, 8 energy loss factors affecting the performances of AA-CAES are identified. Then, based on component type, 6 components of AA-CAES are identified. After that, to obtain the system energy flow, the corresponding thermodynamic models are developed. Finally, based on the given operating conditions, the energy losses corresponding to each factor and component are obtained sequentially using univariate analysis, and parametric analysis is carried out. The results show that in terms of energy loss factors, the storage device has the greatest impact on system performance with the compression work increment d E charge of 72.56 MWh and the round-trip efficiency (RTE) of 89.21%. In terms of components, the compressors and turbines have the greatest impact on system performance. Furthermore, there is a synergistic effect among the factors. The effect of different factors acting together is greater than the superposition of individual values.

Professor Jean-François Muller, a distinguished figure in the field of mass spectrometry, made significant contributions to the advancement of analytical chemistry and its applications. As the founding director of the Laboratory of Mass Spectrometry and Laser Chemistry at the University of Metz, JF Muller played a pivotal role in establishing Metz as a leading centre for mass spectrometry research. His pioneering work, particularly in the development of matrix-assisted laser desorption/ionization (MALDI) instrumentation and Fourier Transform Ion Cyclotron Resonance Mass Spectrometry (FTICR MS), has had a profound impact on various scientific disciplines. This article commemorates Pr. JF Muller’s illustrious career and highlights his collaborative efforts with industrial partners such as TOTAL, which led to groundbreaking advancements in MS analysis. I will delve into the key findings of my thesis which focused on instrumental developments for MALDI analysis and imaging, as well as personal reminiscences and the impact of his inspiring mentorship.

New conceptual and technological developments bring neuroscientists closer to other disciplines, and to other fields in neuroscience with different traditions, despite having overlapping interests. While some neuroscientists may underrate the potential benefits of successful interdisciplinary collaborations, some may be unaware of the typical difficulties of such collaborations or not trained in skills that render them fruitful. Here, we illustrate how interdisciplinary interactions have long been part of neuroscience, although they are often challenging, because neuroscientists may be confronted with concepts, assumptions, and interpretative horizons that differ from their own. This can lead to misunderstanding and little mutual appreciation. Using the historical development of brain imaging techniques, we distinguish different types of interdisciplinary interactions and illustrate some of their benefits. In addition, we present challenges at the interface between traditional laboratory-type approaches and those of clinical or computational neuroscience, and of ecological field experiments. To address these, we invite neuroscientists to consider philosophers as collaboration partners with complementary expertise, which includes special consideration of language use, underlying assumptions and proficiency in conceptual analysis. This expertise can be used by neuroscientists to increase their understanding and to address some difficulties in interdisciplinary interactions more effectively. The benefits of these interactions can be expected to outweigh some challenges in the dialogue with philosophers. Importantly, neuroscientists can choose between reading philosophical literature, participating in joint events with philosophers, and integrating philosophers into neuroscience projects. This may allow neuroscientists to explore unforeseen possibilities to improve or initiate collaborations with scientists from other fields and disciplines.

The Spanish Pharmacovigilance System for Medicines for Human Use (SEFV-H) is responsible for recording and evaluating adverse reactions suspected to be due to the medicines. The aim of this study was to review all reports of suspected adverse drug reaction (ADRs) in the SEFV-H database derived from the gender-affirming hormone therapy (GAHT). For this purpose, we consulted the Andalusian Centre for Pharmacovigilance (CAFV) and used three search algorithms to select only those reports derived from hormone therapy used by trangender people. A total of 21 reports were obtained, 13 corresponding to masculinizing therapy with testosterone and 8 corresponding to feminising therapy with estradiol and cyproterone acetate. Most of these reports were of non-severe symptoms. Skin and subcutaneous tissue disorders, neoplasms, psychiatric, vascular, gastrointestinal and nervous system disorders were the most common suspected ADRs. The median age was 23.6 years for masculinising therapy and 27 years for feminising therapy. More reports are needed to represent transgender people in the GAHT, and it is important to involve health professionals and the general population in pharmacovigilance efforts. Plain Language Summary In Spain, the body responsible for the evaluation of adverse reactions due to medication, or adverse drug reactions (ADRs), is the Spanish Pharmacovigilance System for medicinal products for Human Use (SEFV-H). The aim of this study was to analyse suspected ADRs associated with gender-affirming hormone therapy, a treatment used by transgender people to align their physical characteristics with their gender identity. In order to do this, a search was carried out in the SEFV-H database. A total of 21 reports of ADRs due to sex-affirming hormone therapy were identified. Of these, 13 involved masculinizing therapies with testosterone and 8 feminizing therapies with oestradiol and cyproterone. Most of the adverse reactions reported were not serious, with the most frequent being skin disorders, neoplasms, psychiatric, vascular, and gastrointestinal disorders. The median age of the affected individuals was 23.6 years for those receiving masculinizing therapy and 27 years for those on feminizing therapy. The limited number of reports available in the SEFV-H database limits the ability to draw definitive conclusions about ADRs associated with this type of treatment. Therefore, it is essential to encourage the involvement of healthcare professionals in pharmacovigilance activities to better assess the safety of medications used in gender-affirming hormone therapy.

Since 2000, centers across Central America have shared treatment guidelines for Wilms tumor, using histology (anaplasia present or absent) and tumor stage to stratify patients into low, intermediate, and high-risk groups. Weekly virtual tumor board meetings involving local and international experts were held to ensure consistent treatment assignments. We analyzed data from 367 children with unilateral tumor treated per these guidelines. Five-year abandonment-sensitive event-free and overall survival estimates were: low-risk 82% ±3.8% and 86% ±3.6%, intermediate-risk 50% ±3.4% and 60% ±3.4%, and high-risk 36% ±7.6% and 45% ±7.9%. Survival outcomes were suboptimal, primarily due to advanced disease in fragile children at presentation and abandonment of treatment.

Background: The surgical management of pediatric unilateral Wilms’ tumor (uWT) remains a subject of ongoing debate, particularly regarding the criteria for lymph node (LN) sampling. To address this, we implemented a modified radical nephrectomy (MRN) technique, incorporating ipsilateral perivascular lymph node dissection following nephrectomy to optimize the surgical approach. This study evaluates the safety and feasibility of MRN in the treatment of uWT. Methods: We retrospectively analysis of 105 uWT cases treated with MRN between January 2016 and June 2023. Clinical characteristics, treatment regimens, and patient outcomes were assessed. Results: All 105 patients underwent MRN successfully. Of these, 48 had upfront surgery, while 57 received neoadjuvant chemotherapy. Following nephrectomy, regional LN dissection was performed, with a median of 9 nodes removed. Lymph node metastasis was identified in 6 patients (5.7%). Tumor spillage occurred in 6 cases, predominantly during upfront surgery. Surgical complications were noted in 6 patients, all of which were managed conservatively. Recurrence was observed in 8 patients, including two local recurrences. The 3-year event-free survival and overall survival rates were 91.3% and 95.6%, respectively. Conclusion: The MRN technique demonstrated both safety and feasibility in the surgical treatment of pediatric uWT, with manageable postoperative complications. The findings suggest that MRN provides enhanced access for surgeons and facilitates more accurate staging, beyond the goal of simply removing the recommended number of LNs. This approach may improve both staging accuracy and long-term outcomes in pediatric uWT.

Thrombocytopenia is a common challenge in the neonatal intensive care unit, traditionally managed with platelet transfusions. However, transfusions are associated with significant risks, including increased mortality and neurodevelopmental impairment. This case series highlights the use of romiplostim, a thrombopoietin receptor agonist, in three neonates with thrombocytopenia. Each case demonstrated notable improvements in platelet counts without adverse events, reducing dependency on transfusions. These findings underscore romiplostim's potential as a safer alternative for managing neonatal thrombocytopenia. This report advocates for further research to explore romiplostim's efficacy and safety in this vulnerable population, emphasizing its promise in improving neonatal outcomes.

A Case of Idiopathic Multicentric Castelman’s Disease-TAFRO SyndromeMelda Berber Hamamcı1, Şule Yeşil1, Meltem İleri1 ,Emre Çapkınoğlu1 , Nergiz Öner 1 , Ali Fettah1, Gürses Şahin21Division of Pediatric Hematology and Oncology, Department of Pediatrics, Ankara Etlik City Hospital, Turkey2Division of Pediatric Hematology and Oncology, Department of Pediatrics, Ankara Dr Sami Ulus Training and Research Hospital, Turkey*Correspondence to: Melda Berber Hamamcı, MD, Division of Pediatric Hematology and Oncology, Department of Pediatrics, Ankara Etlik City Hospital, Varlık neighbourhood, Halil Sezai Erkut Street, Yenimahalle 06170 Ankara, Tel.: +90 5054781137,E-mail: meldaberber@hotmail.comText word count: 939Brief running title: A Case of Idiopathic Multicentric Castelman’s Disease-TAFRO SyndromeKey words: TAFRO Syndrome, tocilizumab, Idiopathic Multicentric Castelman’s Disease,Tables:2Figures:1

The pursuit of sustainable and renewable energy has directed researchers to explore microalgae and black soldier flies as potential sources for biodiesel production. This study focused on the commercial viability of co-culturing these two organisms for biodiesel, highlighting their symbiotic relationship. Microalgae harness sunlight through photosynthesis to produce chemical energy, while black soldier flies contribute essential nutrients and biomass. This synergy aids in carbon dioxide fixation and sustainable biodiesel production. Through optimized culture conditions and extraction processes, the researchers achieved impressive lipid yields and conversion rates, rendering biodiesel production economically feasible. This paper examines the energy implications and scalability of this novel biodiesel production system, suggesting that co-culturing microalgae and black soldier flies presents a promising approach to overcoming energy constraints. This innovative technology holds significant potential for advancing sustainable energy solutions and meeting global energy demands.