LLMs have shown high capacity to process and generate human-like text across diverse applications, yet their performance often declines in specialized fields where precise terminology and domain-specific context are essential. Addressing this limitation, Semantic Contextual Embedding (SCE) introduces a novel adaptive layer to LLM architectures, tailored to enhance semantic precision in domain-specific language tasks without sacrificing general language comprehension. SCE's embedding structure dynamically adjusts linguistic representations to align with field-specific semantics, enabling refined task adaptability and interpretive accuracy across specialized applications. Through extensive experimentation, SCE demonstrated considerable improvements in interpretive coherence, error reduction, and processing efficiency, particularly in high-stakes fields such as legal and medical applications. These findings suggest that SCE not only enhances model adaptability in domain-intensive contexts but also establishes a scalable pathway for integrating semantic precision within LLMs, thereby contributing a significant advancement in the pursuit of reliable task transfer. Overall, SCE's integration facilitates the application of LLMs in real-world scenarios that demand both linguistic versatility and domain-aligned accuracy, offering practical implications for a wide range of professional fields.

A case of double ANCA negative Granulomatosis with polyangitis:

The Leave management system is an Intranet based application that can be accessed throughout the organization or a specified group/Dept. This system can be used to automate the workflow of leave applications and their approvals. The periodic crediting of leave is also automated. There are features like email notifications, cancellation of leave, automatic approval of leave, report generators etc. in this Tool.

An asymptomatic case of type B dissection developing type A dissection during transferRunning title: Asymptomatic retrograde type A aortic dissectionKayo Sugiyama1, Hirotaka Watanuki1, Masato Tochii1, Katsuhiko Matsuyama11Department of Cardiac Surgery, Aichi Medical University Hospital, 1-1 Yazako Karimata, Nagakute, Aichi, 480-1195, JapanCorresponding author: Kayo Sugiyama, MD, PhDDepartment of Cardiac Surgery, Aichi Medical University Hospital, 1-1 Yazako Karimata, Nagakute, Aichi, 480-1195, JapanTel: +81-561-62-3311, Fax: +81-561-63-6193E-mail: kayotaro3@gmail.com

Introduction:Hypopigmented Mycosis Fungoides(HMF) is the most prevalent form of cutaneous T-cell lymphoma and is classified as a low-grade lymphoproliferative disease. It starts in peripheral epidermotropic T-cells, most especially memory T-cells (CD45RO+), which express the CD4+ immunophenotype and T-cell receptor (TCR) [1], [2].It initially exhibit erythematous patches and/or plaques, which are indicative of the early stages of HMF. Clinically, the patches and plaques are generally seen on sun-protected parts of the body, vary in size and form, and usually have a scaly surface with varying degrees of atrophy [3]. HMF can develop gradually over a number of phases, albeit not all patients experience every stage. Skin disorders arise when malignant T cells migrate from the blood into the skin; the skin cells themselves are not cancerous. Although the exact cause is still unknown, it seems to be caused by long-term antigenic stimulation that causes T-lymphocyte clonal growth and epidermal infiltration. However, it is still unclear what mechanism or components are involved in this antigenic activation. Most frequently, patches appear on the breasts, buttocks, upper thighs, and lower abdomen. They may stay constant throughout time or vanish and then resurface. Some afflicted people develop plaques, the subsequent stage of mycosis fungoides, from patches [4], [5]. MF mostly affects men, with a sex ratio of 1.6:1 to 2:1, and usually strikes people in their late fifties. Most of the patients are Caucasian. The Instituto Nacional de Câncer (INCA) released an estimate for non-Hodgkin lymphomas (NHL) in 2016 that showed 5,210 new cases in males and 5,030 in women [5]. Between 1992 and 2001, 1610 NHL cases were diagnosed in Pakistan’s Department of Pathology at Aga Khan University Hospital. Of these, 133 (8.26%) had cutaneous involvement, while 14.5% were diagnosed as MF. MF contributed 0.86% of total NHLs. The age ranged from 28 to 73 years, with a median age of 52.5 years and a male-to-female ratio of 2.5:1. Four cases had generalized body lesions [6].This case highlights a diagnostic issue since hypopigmented mycosis fungoides (HMF) can resemble other disorders like vitiligo and leprosy. It manifests in a unique way in a young female with darker skin. Since it can mimic benign hypopigmented lesions, HMF is relatively uncommon and frequently misdiagnosed, especially in patients with darker skin. This delay in identification highlights how crucial it is to take MF into account in atypical presentations and how immunohistochemical staining and histological investigation are necessary to confirm the diagnosis in these situations. This case has been reported according to CARE CRITERIA [7].

INTRODUCTIONMastocytosis represents a clonal, neoplastic proliferation of morphologically and immunophenotypically abnormal mast cells, organized in multifocal clusters, in one or more organ systems.1 It is considered a rare hematological condition, with a prevalence of 1 in 10.000 persons. 2 However, mastocytosis remains underdiagnosed, due to the heterogeneous clinical presentation.3 Based on the site of the clonal proliferation, mastocytosis can be divided into cutaneous mastocytosis and systemic mastocytosis (SM). Cutaneous mastocytosis is generally benign, primarily affects children within the first two years of life, and remits around adolescence. It usually manifests with skin lesions, gastrointestinal cramps, and anaphylaxis. 1,2 SM mainly affects adults. The clonal proliferation involves the bone marrow, the skin, and other organs and it has a chronic evolution, with a poor prognosis.4 Besides skin rashes and gastrointestinal symptoms, patients with SM may experience cardiovascular problems, like an irregular heartbeat; neuropsychiatric 5,6complications including anxiety or depression; osteoporosis due to mast cell infiltration into bones; anaphylaxis and hypotension.The pathophysiology of SM is represented primarily by mutations in the KIT gene, particularly the KITD816V variant, which leads to uncontrolled mast cell proliferation.1, 3, 7The diagnosis of SM usually requires a bone marrow biopsy. A positive diagnosis is based upon the 2016 WHO (World Health Organization) criteria (Table 1): one major and one minor criterion is required, or in the absence of the major criteria, three minor criteria need to be met.1, 2, 3, 7The treatment strategy of SM is highly reliant upon the subtype,3 mast cell leukemia having the worst prognosis out of all the subtypes, with a median survival of 2 months.8 In this regard, easier forms, benefit supportive treatment of mast cell mediator-related symptoms and osteoporosis. Mast cell mediator-related symptoms can be treated with antihistamines, H2-inhibitors, or aggressive treatment with epinephrine, corticosteroids, leukotriene receptor antagonists, or omalizumab in case of anaphylaxis. 9 Osteoporosis prevention and treatment can be done with calcium+D3 supplements, bisphosphonates, or alpha interferon. More advanced forms benefit from cytoreductive therapy, often with Midostaurin because it is currently considered the gold-standard treatment with a response rate of 60% and the best results in the aggressive SM subtype.7 Usually it is well tolerated, and it can also be used as a maintenance therapy after an allogeneic stem cell transplant. There are very few studies that have demonstrated the superiority of allogeneic stem cell transplants over KIT inhibitors. Therefore, this treatment is reserved for cases of SM with severe symptoms that are refractory to standard therapy.3

A document by Ozan Kiyikci. Click on the document to view its contents.

Systemic Inflammatory Response Post Alemtuzumab and Low-Dose Total Body Irradiation in Pediatric Patients with Sickle Cell Disease: A Case SeriesRozalyn Chok1, Katherine Girgulis2, Robert S Nickel3,4, Gregory MT Guilcher2*.Division of Hematology, Oncology, Stem Cell Transplantation, and Regenerative Medicine, Lucile Packard Children’s Hospital, Stanford University, Stanford, California, United States.Section of Oncology/BMT, Alberta Children’s Hospital, University of Calgary, Calgary, Alberta, Canada.Division of Hematology and Division of Blood and Marrow Transplantation, Children’s National Hospital, Washington, District of Columbia, United States.Department of Pediatrics, George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, United States.*Correspondence to:Gregory Guilcher, MD, Section of Oncology/BMT, University of Calgary, Alberta Children’s Hospital, 28 Oki Drive Trail NW, Calgary, AB, T3B 6A8. Email: greg.guilcher@ahs.caText word count: 786 wordsRunning title: SIRS Post TBI in SCD PatientsKeywords: Sickle Cell Disease, Total Body Irradiation, Alemtuzumab, Hematopoietic Stem Cell TransplantFigures: 0Tables: 2

The impact of the mushy zone parameter ( A mushy ) and thermal properties during the solidification of a commercial paraffin-type PCM in a vertical cylinder under T-history conditions was examined numerically. First, the thermal properties of the paraffin-type PCM and its temperature profile during solidification under T-history conditions were experimentally obtained. The solidification process is simulated by using a numerical model and it was conducted via the commercial CFD code ANSYS FLUENT 2022. R2. The enthalpy‒porosity model was employed by the ANSYS FLUENT for solidification and melting. The accuracy of a simulation is highly sensitive to the software inputs and assumptions. Therefore, selecting the correct values for thermal properties and the mushy constant is essential for achieving precise simulation results. To determine the precise boundary conditions, radiative heat transfer between surfaces is considered. The results indicate that, between the four thermal properties, although increasing the thermal conductivity accelerates the solidification rate, the opposite effect is observed with increasing latent heat, density, and specific heat, as higher values of these properties lead to slower cooling. Moreover, the results highlight that choosing the correct mushy zone parameter is crucial for accurate solidification modeling. Although the impact of   A mush on solidification is generally less pronounced because conductive heat transfer dominates compared with the melting process, for paraffin-type PCMs, a higher   A mush value yields results that better align with experimental data, unlike other PCM materials. Furthermore, the shape and progression of the solidification is influenced by the mushy zone parameter and as A mushy increases, solidification in the bottom layers decreases, with the process becoming more concentrated in the layers closer to the cold wall.

In this paper we consider the following equation involving uniformly elliptic nonlocal operator in the upper half space { A 2 s u ( x )= f ( u ( x )) , x ∈ R + n , u ( x ) > 0 , x ∈ R + n , u ( x )= 0 , x ∉ R + n . We first develop a narrow region principle for antisymmetric functions in unbounded domains, in which we assume that u has polynomial growth instead of the usual decay condition u→0 at infinity, which is the improvement of the partial result of Wu-Qu-Zhang-Zhang[Math Meth Appl Sci. 2023;46:3721-3740]. Then we obtain the monotonicity of positive solutions in the upper half space by a direct method of moving planes, which extends the monotonic result of Li[Adv. Nonlinear Stud., 24 (2024), 451-462]. Based on the monotonicity results, we prove the existence of positive bounded solutions for uniformly elliptic nonlocal equation on the whole space. We believe that these methods will also be helpful for equations involving other non local operators.

Wireless charging systems typically operate under variable load conditions and the power required by different loads in space varies. The power required by different loads is different in the space. At different stages of charging, the characteristics of the load may also change. WPT needs to adjust the voltage and power in real time to meet the needs of different voltages and different working conditions. The power transfer power of WPT can be optimized for variable loads. This paper introduces an active adjustable coil receiver with adaptive output power. The active adjustment of the output power is achieved by changing the different positions of the sliding rod in the receiving coil. This design allows the receiver power to remain stable in the range of 3-21 W. Receiver can meet the different power requirements of the load, and is not sensitive to factors such as transmission distance and offset. The system can reduce the complexity of charging and power supply system design, effectively promote the application of wireless power transmission in the field of multi-load equipment.

In this letter, we propose a novel algorithm for sparse L-shaped array that addresses gain/phase uncertainties and off-grid direction of arrival estimation using compressed sensing theory. Firstly, the receiving signal of the sparse array is structured into an Errors in Variables model. Then, a novel algorithm termed IOMP-TLS is proposed for off-grid signal reconstruction and gain/phase uncertainties estimation based on an enhanced greedy algorithm. Finally, the simulations show that our proposed algorithm is superior to many other methods in estimation performance.

Background: Postpartum haemorrhage (PPH) is the leading cause of maternal mortality. Uterotonics are the mainstay of PPH prevention. Objectives: To compare the efficacy of misoprostol and oxytocin for the prevention of PPH, and to evaluate the trustworthiness of trials comparing these uterotonics. Search strategy and selection criteria: Seven databases were searched for peer-reviewed literature, meeting the inclusion criteria of randomized controlled trials (RCTs) comparing misoprostol and oxytocin for the prevention of PPH. Data Collection and Analysis: Data were collected by two independent reviewers. Individual participant data (IPD) was meta-analyzed for outcomes PPH≥500mL and PPH≥1000mL. RCTs that did not share IPD were classified as trustworthy or not and were included in an aggregate data meta-analysis according to trustworthiness. Main results: Of 79 eligible RCTs, ten (12.7%) provided IPD, of which six were included. Analysis of IPD showed PPH≥500mL to be significantly higher in the misoprostol than the oxytocin group (2,022 women, aOR 1.84, 95% CI 1.43- 2.34). For PPH≥1000mL, analysis of IPD showed misoprostol and oxytocin were comparable (2022 women, OR 1.14, 95% CI 0.68- 1.91). Of the 69 studies that did not provide IPD, 23 (33.3%) were assessed as trustworthy. Analysis of trustworthy data (IPD and 23 aggregate data RCTs) showed no difference between misoprostol and oxytocin for PPH≥500mL (24,334 women, OR 1.01, 95% CI 0.69- 1.49), while misoprostol significantly increased the risk for PPH≥1000 (25,249 women, OR 1.36, 95% CI 1.16- 1.59). Conclusions: Of 79 RCTs comparing misoprostol and oxytocin for the prevention of PPH, 36.7% met trustworthiness criteria. Analysis of trustworthy data suggests oxytocin is superior to misoprostol for preventing PPH.

A document by Bethany Atkins. Click on the document to view its contents.

Adaptive coding in quantum communication offers a promising approach to enhance the efficiency and reliability of data transmission using quantum superposition, particularly in noisy and error-prone channels. This study investigates the effectiveness of quantum communication combined with adaptive coding for compressed image transmission using Joint Photographic Experts Group (JPEG) codec and High Efficiency Image Format (HEIF) with polar codes at varying rates. To maintain a similar bandwidth, the source coding rates are adjusted according to the channel coding rates. The results show that the adaptive coding based quantum communication system significantly outperforms equivalent classical systems, especially at low signal-to-noise ratios (SNR), achieving Peak Signal-to-Noise Ratio (PSNR) improvements up to 65 dB and Structural Similarity Index Measure (SSIM) values up to 0.9999 for HEIF images and PSNR values up to 58 dB with SSIM values up to 0.9994 for JPEG images. These findings demonstrate the superior robustness and higher image quality of adaptive coding based quantum communication in varying channel noise conditions and bandwidth restricted applications.

Fighting Necrosis with Nature: The Role of Pawpaw in Fournier’s Gangrene Recovery: A Case SeriesDennis Awedam Achio1 , Richmond Buckner1 , Mary Monney-Bortey1, Celestine Tsogbe1 , Natasha Yeboah1, Eunice Wilberforce A. Achio21Urology Unity, University of Ghana Medical Center, Accra, Ghana.2Department of Family Medicine, University of Ghana Medical Center, Accra, Ghana.

Complicate case of Plasmodium vivax in a child from Saint-Louis, SenegalDoudou Sow 1*, Aminata Sall2, Aminata Lo3, Demba Makalou4, Sara Lodholz5, Markus Esser5, Claudia Demarta-Gatsi6, Jean Louis Ndiaye3.Service de Parasitologie-Mycologie, UFR Sciences de la Santé, Université Gaston Berger de Saint Louis, Sénégal ;Service de Pédiatrie, Centre Hospitalier Régional de Saint-Louis, Sénégal ;Service de Parasitologie-Mycologie, UFR Sciences de la Santé, Université Iba Der Thiam de Thiès, Sénégal ;Service d’Hématologie, UFR des Sciences de la santé, Université Gaston Berger de Saint Louis, Sénégal ;Merck KGaA, EF-SM-LH8 Molecular Biology, Frankfurter Strasse 250, 64293 Darmstadt, GermanyGlobal Health Institute of Merck, Ares Trading S.A., Route de Crassier 1, 1262 Eysins, Switzerland, a subsidiary of Merck KGaA, Darmstadt, Germany

Title PageMcConnell’s Sign in Acute Chest Syndrome: A Case ReportAmeena Syed1, Sajid Shaik2, Rakesh K. Shah3, Veneeza Humayun4, Luis Afonso5.1. Internal medicine, Orlando school of Osteopathic Medicine, Orlando, USAEmail: ameenasyed@gmail.com2. Internal Medicine, Saint Vincent Hospital, Worcester, USAEmail: sajith81095@gmail.com3. Internal Medicine, Wayne State University Detroit Medical Center, Detroit, USAEmail: shahrakesh.med@gmail.com4. Premedical Student, University of Central Florida, Orlando, USAEmail: veneezahumayun7@gmail.com5. Cardiology, Wayne State University / Detroit Medical Center, Detroit, USAEmail: lafonso@med.wayne.eduConflict of Interest: None to disclose.Funding Information: None to disclose.Consent: Informed written consent was obtained from the patient to publish this report in accordance with the journal’s patient consent policy.

Title: rapidly expanding infraorbital cellulitis in a 44-years-old female: case report and management strategies

Apnoeic oxygenation with humidified high-flow nasal oxygen is a recognised anaesthetic technique for patients undergoing endoscopic head and neck surgical procedures This oxygenation technique has been proven to be both safe and effective, whilst allowing unobstructed access to the surgical field The impact of the chosen oxygenation technique on operating theatre productivity has not been measured in this field previously Apnoeic oxygenation with high-flow nasal oxygen was associated with reduced overall time in the operating theatre suite and reduced time in the post-anaesthesia care unit, when compared to procedures performed with a microlaryngoscopy tube Future work will involve grouping patients together by oxygenation technique to maximise improvements in operating theatre productivity and increase patient throughput

A document by Ilai Guendelman. Click on the document to view its contents.

Carbon (C) is regarded as a possible light element in the Earth’s outer core; however, its abundance in this region remains a subject of controversy. Here, we applied first-principles molecular dynamics (FP-MD) simulations to calculate the density (ρ), thermodynamic properties, and sound velocity (VP) of liquid iron-carbon (Fe-C) alloys (Fe-X wt% C, X = 0, 2.1, 4.7, 7.6, and 11.2) under the outer core conditions (~136-330 GPa, 4000-6000 K) to explore the composition of the outer core. Compared with seismic observations, roughly 5.1-6.6 wt% C alloyed with Fe can explain the outer core’s ρ deficit, while 2.9-3.7 wt% C aligns with the seismological VP. Given this discrepancy, we extended our investigation to the iron-carbon-oxygen (Fe-C-O) ternary alloy to provide a more in-depth understanding of the Earth’s outer core composition. The results reveal that certain Fe-C-O models (i.e. Fe-7.3 wt% O, Fe-6.5 wt% O-0.3 wt% C, and Fe-5.3 wt% O-1.1 wt% C) can satisfy seismic observations under some possible geothermal profile of the outer core. The ‘optimal’ models which can match the seismic data consistently exhibit O-rich characteristics consistently, with the maximum C content is 1.5 wt% and the minimum O content is 4.7 wt%. In conclusion, the findings in this work offer some possible C and O reserves in the Earth’s outer core, which benefits to the composition prediction of the outer core.

A new manifestation of Cutaneous Pili MigransDear Editor: Cutaneous Pili Migrans is a rare skin disease first reported by Yaffee in 1957,it manifests as a creeping rash caused by hair shafts embedded in the superficial layers of the skin[1].To date, over 50 cases have been reported worldwide, and most cases have been reported in Asia[2].This report details a unique case involving a 40-year-old man who presented with Cutaneous Pili Migrans on the scrotum, characterized by a distinctive ring-like pattern.This atypical manifestation is rare, with limited literature addressing similar presentations. A 40-year-old man presented to the dermatology department after discovering a black ring of material beneath the epidermis of his scrotum.He reported no a history of trauma and did not experience any discomfort.There was no similar history reported among his family members. Physical examination revealed an annular, thick black hair shaft clearly visible beneath the epidermis of the scrotum,with slight inflammation at the center of the lesion(Figure 1).Dermoscopic examination showed a black annular hair shaft embedded below the epidermis,with any hair follicles and minimal inflammation in the surrounding skin（Figure 2).Based on the patient’s pertinent medical history and examination findings, we diagnosed the condition as Cutaneous Pili Migrans.Since it was asymptomatic, the patient requested conservative treatment. At the one-month follow-up, the lesion had resolved with no signs of recurrence. Our review of existing literature indicates that most reported cases of Cutaneous Pili Migrans present as a black line . In contrast, our case exhibited a black ring formation—a phenomenon not previously documented. While this is a rare finding, it would not be unusual for any hair bearing area with occlusion to develop this presentation, albeit rarely published. It is also plausible that the curly nature of the hair fibres in the scrotum could be inked with the ring presentation as opposed to curvilinear pattern in terminal hair shafts from the scalp or elsewhere, when exogenous or ingrown hairs that can take a different morphology. Additionally, typical rash locations in other cases include the soles of the feet, neck, legs, and abdomen, with no reports of lesions on the scrotum. This case enhances our understanding of Cutaneous Pili Migrans and may offer new insights for similar clinical presentations. Inflammation is rare in most cases of exogenous causes of Cutaneous Pili migrans and treatment involves removal of the hair shaft. In our case, the patient healed without any treatment.Inflammation is the body’s immune response that serves as a natural defense against damaged cells, pathogens, and harmful stimuli. Most inflammatory responses facilitating self-healing without specific treatment.This explains the spontaneous resolution observed in our case. Differential diagnosis of Cutaneous Pili Migrans is essential and includes Cutaneous Larval Migrans, interdigital pilonidal sinus, creeping eruption due to parasitic infections, and pseudofolliculitis barbae[3]. It is particularly important to distinguish Cutaneous Pili Migrans from Cutaneous Larval Migrans, as the two conditions share similarities[4]. Cutaneous Pili Migrans typically moves linearly in one direction, presenting as erythematous eruptions that are linear or wavy. In contrast, Cutaneous Larval Migrans can migrate in any direction, with lesions often appearing serpiginous or tortuous[5]. Additionally, lesions of Cutaneous Larval Migrans are characterized by intense itching and redness, lacking the distinct black line seen in Cutaneous Pili Migrans, which may be asymptomatic or painful[4].

Communities of insects around the world consist of unique sets of species that have evolved under different historical processes of assembly and lineage diversification. Whole-community phylogenetics can partition the shared and uniquely derived evolutionary history at sites. We used mitochondrial genome sequences of >1000 species each from two assemblages of Coleoptera (beetles) in distantly situated tropical lowland rainforest of Malaysia and Panama for phylogenetic reconstruction and community ecological analysis. Assemblages were entirely distinct at species level but were surprisingly similar at family level in their overall composition and relative species richness, despite a high degree of phylogenetic clustering that implied independent evolution. Inclusion of species poor lineages reduced the level of community clustering in parallel in both sites, indicating lineage-specific factors to determine species richness and their effect on local community composition. In conclusion, relative species richness in local community composition and global clade sizes are connected, in part due to biotic exchange in deep time, but more likely because of intrinsic rates of diversification unique to each clade (family), thus making assembly composition more predictable, i.e. the ‘evolutionary tape’ would be similar wherever a new assemblage of tropical-forest Coleoptera arises.