javascript:void(0) This article deals with bifurcation dynamics and spectral entropy complexity of a nonlinear fractional-order SVIRS epidemic system. Based on the analysis of the disease-free and endemic equilibriums, the forward (supercritical) and backward (subcritical) bifurcations are observed around the critical point of R 0 = 1 , where R 0 represents the basic reproduction number of the system. The complexity of the fractional epidemic system is described by the spectral entropy, and the effect of the order of the fractional derivative on the system is analyzed with the complexity. Numerical simulations are carried out to support the theoretical analysis and to illustrate the bifurcation behaviors.

Modern datacenter networks rely on multi-root tree topologies, to ensure efficient and reliable connectivity. However, traditional traffic engineering solutions like Equal Cost Multiple Path (ECMP) and Weighted-Cost MultiPath (WCMP) often fall short in addressing dynamic and heterogeneous traffic conditions. Specifically, these approaches struggle with asymmetric topologies and the allocation of elephant flows, which require more granular and agile traffic management. This paper introduces MTS-PolKA, a novel traffic splitting mechanism designed to enhance traffic engineering in datacenter networks. MTS-PolKA enables packet-level traffic distribution across multiple paths by embedding a label in the packet header that dictates the traffic division profile. Unlike existing methods that require reconfiguration of network tables at each switch, MTS-PolKA allows for dynamic and simultaneous adjustments across all switches in the path through simple modifications to the packet header. This approach significantly improves the agility and efficiency of traffic management. The implementation of MTS-PolKA on programmable switches using the P4 language, leveraging the Residue Number System (RNS) and M-PolKA architecture, demonstrates its potential through experiments conducted in the Mininet emulator. The results highlight the ability of MTS-PolKA to maintain flow stability, explore network multipaths, and enable rapid reconfigurations of traffic division profiles, enhancing the performance and efficiency of modern datacenter networks.

javascript:void(0) Background: Intraarticular glucocorticoids are widely used in equine practice to treat osteoarthritis (OA) due to their potent antiinflammatory effects. Despite their benefits on diseased joints, glucocorticoids have been shown to be deleterious to normal cartilage. Dose response studies are lacking with no clear guidelines for intraarticular dosages of glucocorticoids in horses. Objectives: To evaluate the in vitro effects of different glucocorticoid doses on cartilage matrix parameters and genetic expression of proinflammatory mediators in an inflammatory milieu to move closer to a clinically relevant intraarticular glucocorticoid doses in horses. Study design: In vitro experimental study Methods: Equine articular cartilage explants were cultured for 3 days in the presence or absence of recombinant human interleukin-1 (rhIL-1) and then treated with three different doses of methylprednisolone sodium succinate (MPS) for 48 hours. Cartilage and media were analyzed for proteoglycan (PG) synthesis and content and PG loss and prostaglandin E 2 levels respectively. Gene expression analysis evaluating the effects of rhIL-1 and MPS as well as glucocorticoid only treated cartilage was performed using Northern blots of total RNA probed with equine specific cDNA probes and rtPCR. Results: MPS maintained cartilage GAG levels in rhIL-1 challenged and unchallenged explants and did not induce increased loss of cartilage PG into media. MPS did inhibit PG synthesis and PGE 2 production dose dependently. mRNA expression of equine stromelysin, IL-1, IL-6 and tissue inhibitor of metalloproteinase (TIMP) were upregulated in explants exposed to rhIL-1 and this effect was significantly downregulated by MPS in both cytokine challenged and in normal cartilage. Limitations: This was an in vitro short term dose response study and clinical efficacy was not evaluated. Conclusions: Higher doses of glucocorticoids are required for chondroprotection in an inflamed joint and lower concentrations of a third to one quarter than that used clinically are beneficial without being detrimental to cartilage.

BACKGROUND: In industrialized countries, the prevalence of intestinal diseases such as inflammatory bowel disease(IBD) increases, and cadmium pollution is one of the common pollutants in industrial production, so we hypothesized that there is an association between cadmium pollution and IBD. OBJECTIVE: To explore whether there is an association between cadmium exposure and symptoms of IBD and chronic diarrhea among US adults using the 2007—2010 NHANES. METHODS: Weighted multivariate logistic regression was used to analyze the relationship between urinary cadmium and IBD and chronic diarrhea symptoms population, and the restricted cubic spline further explained the dose-response relationship between urinary cadmium and IBD and chronic diarrhea symptoms. RESULTS: After adjustment for confounders, participants with higher urinary cadmium levels were more likely to have IBD, chronic diarrhea symptoms (OR 1.77, 95% CI (1.23—2.54), P = 0.001). The Limited cubic spline analysis showed an L-shaped non-linear relationship between urinary cadmium and the risk of IBD, chronic diarrhea symptoms population with a cut off value of 0.042.

A document by Ricarda Alwaw. Click on the document to view its contents.

Expanded-Access Use of Elamipretide Improves Quality of Life in Patients with Rare Mitochondrial Disorders Characterized by Ophthalmic Symptoms: A Case SeriesSharique Ansari1, Mary Kay Koenig21. Kane Hall Barry Neurology, 1305 Airport Freeway, Bedford, TX, USA2. University of Texas McGovern Medical School, Department of Pediatrics, Division of Child & Adolescent Neurology, Center for the Treatment of Pediatric Neurodegenerative Disease, Houston, TX, USACorresponding Author : Mary Kay Koenig, MD, Mary.k.koenig@uth.tmc.eduCo-author: Sharique Ansari, SAnsari@kanehallbarry.comAcknowledgements: The authors wish to thank the patients and their families for participating, as well as Jamie Dermatis, DPM, and Jim Shiffer, RPh, Write On Time Medical Communications, LLC, for their writing and editorial assistance during the development of this manuscript. Mary Kay Koenig wishes to thank her research nurse, Lindsey Miller, for providing patient support and assisting with administration and education responsibilities.Conflict of Interest Statement: The authors have no conflicts of interest to declare.Data Availability: The data that support the findings of this case report are not publicly available due to the data containing information that could compromise the privacy of the patient, but may be available from the corresponding author upon reasonable request.Ethics Approval Statement: FDA and local IRB review and approval were obtained prior to initiating therapy with elamipretide subcutaneously daily under this EAP.Patient Consent Statement: Written informed consent was obtained from the patients to be included in this study.Funding: Stealth BioTherapeutics provided support in supplying elamipretide for the patients and publishing this case series. The authors confirm independence from the sponsor. The content of the article has not been influenced by the sponsor.Keywords: Elamipretide, Mitochondrial Disease, Cardiolipin, NARP syndrome, CPEOKey Clinical Message: This case series presents the use of elamipretide in two patients with different progressive mitochondrial disorders (chronic progressive external ophthalmoplegia [CPEO] plus and neuropathy, ataxia, and retinitis pigmentosa [NARP] syndrome) characterized by ophthalmic traits. Elamipretide was well tolerated and both patients demonstrated improvement in symptoms while on therapy.

Background: This study aims to comprehensively analyze the phosphatidylinositol-specific phospholipase C (PI-PLC) gene family in Leishmania infantum and Leishmania major genomes. By elucidating the roles of PI-PLC enzymes in parasite biology and their potential as therapeutic targets, the research contributes to understanding molecular mechanisms underlying parasite proliferation and pathogenesis. Methods: Genomic screening, gene structure analysis, phylogenetics, chromosomal distribution, and expression profiling of PI-PLC genes in L. infantum and L. major were conducted. RNA-seq data from susceptible and resistant L. infantum strains to antimony treatment were analyzed to assess gene expression patterns. Molecular docking and molecular dynamics simulations explored Evodone’s interaction within the active sites of proteins 2B4W and 4TYZ. Results: A total of 22 PI-PLC genes were identified in both L. infantum and L. major genomes, characterized by conserved domains and biochemical properties. Phylogenetic analysis revealed evolutionary relationships and clustering patterns of these genes. Chromosomal distribution and expression profiling provided insights into their functional diversity and potential involvement in drug resistance mechanisms. Conclusion: This study highlights the significant roles of PI-PLC enzymes in Leishmania biology and their potential as targets for novel therapeutic interventions. Understanding their involvement in parasite pathogenesis and drug resistance mechanisms could pave the way for developing effective treatments against leishmaniasis.

Background Hemophagocytic lymphohistiocytosis (HLH) is a severe systemic hyperinflammation with a high early death rate. The present study retrospectively reviewed the potential relationship between routine laboratory tests and early death in pediatric HLH patients. Methods Sixty-four pediatric HLH patients with complete routine laboratory test results and patient information data were divided into Group D (patients who died within two months of hospitalisation) and Group S (patients who survived for more than two months or were ultimately discharged). Demographic characteristics and routine laboratory data were analysed using the Wilcoxon test, LASSO regression and logistic regression. Results Most of the patients in Group D were under the age of two. Univariate analysis showed that low red blood cell (RBC), low haemoglobin (Hb), low albumin (ALB), low fibrinogen (FIB), prolonged partially activated prothrombin time (APTT), and high lactate dehydrogenase (LDH) were associated with early death in pediatric HLH patients. Among these routine laboratory tests, ALB had the highest area under the curve (AUC). LASSO regression and logistic regression showed that ALB correlated with early death in pediatric HLH patients. Conclusions Our study highlights the importance of routine laboratory tests, especially ALB levels, in predicting early death in pediatric HLH patients. Under the age of 2, multi-organ or system involvement may increase the risk of early death.

This paper investigates the application of novel eye-tracking metrics to assess cognitive load in visual decision-making processes. In particular, it aims to contribute to understanding the cognitive process and developing complementary measures for evaluating visual behavior in neonatal pain assessment. We have carried out an eye-tracking study using the relative Explore-Exploit Ratio proposed and the application of the Task-Evoked Pupillary Response to evaluate pediatrician experts, non-experts, and parents while analyzing frontal facial faces of distinct newborns, before and after painful procedures, from a benchmark dataset considering areas of interest clinically relevant. The Tobii TX300 eye-tracking system recorded this data in a closed room with controlled lighting. Our results disclose that the visual attention described by the traditional metrics may not correspond directly to the respective fixation patterns and pupillary changes quantified for all the sample groups of participants investigated, highlighting statistically significant differences in the visual behavior between experts and non-experts in such vital decision-making tasks

This paper introduces an innovative energy-circuit that fundamentally challenges the established principles of energy conservation. Departing significantly from conventional paradigms, this innovation offers a promising path to address pressing global issues such as the energy crisis and environmental sustainability, while also stimulating scientific inquiry. Contrary to prevailing misconceptions, the paper explicitly rejects the possibility of creating energy from nothing and dismisses the perpetual motion concept as a flawed model. Instead, it presents a novel “energy-circuit” design based on a new principle named “energy-parallel connection” within an electrical short circuit scenario. This configuration defies conventional expectations by producing a measurable electrical current, even in conditions of extremely low resistance, previously considered to result in infinite current. This innovative energy-circuitry marks the first instance of experimentally observed energy creation within a classical electrical system. The implications of this innovative circuit design are far-reaching, with potential applications spanning from self-charging electric vehicles and enhanced microgrid efficiency to facilitating integration of renewable energy sources. This paper not only advances scientific understanding but also provokes philosophical discourse on the evolving nature of scientific inquiry. Ultimately, the proposed “energy-circuit” has the potential to transform energy systems, reducing reliance on finite resources and paving the way for a more sustainable and resilient future.

This article explores the adoption of smart factory models in the automotive industries of Nigeria and Morocco, focusing on the integration of Internet of Things (IoT) and Cyber-Physical Systems (CPS). While these technologies offer significant potential for enhancing operational efficiency, product quality, and competitiveness, their adoption in emerging economies faces substantial challenges, including infrastructural deficiencies, high implementation costs, and a notable skills gap. Through a comparative analysis, the article highlights the progress and obstacles in each country, emphasizing the critical role of public-private partnerships, government support, and targeted education and training programs. The findings suggest that a strategic, phased approach to smart factory implementation, supported by robust infrastructure and regulatory frameworks, is essential for these economies to fully realize the benefits of Industry 4.0. The insights provided aim to inform policymakers and industry stakeholders on effective strategies for promoting digital transformation in manufacturing.

Statin prescription intensity, defined by statin type and dose required to achieve a targeted decrease in plasma low-density lipoprotein-cholesterol (LDL-C), has been involved in statin-associated muscle symptoms (SAMS) development. This study aimed to assess whether muscle function improved differentially according to treatment intensity after two months of statin withdrawal in patients self-reporting SAMS. Patients (53.0±8.4 years [Mean±SD]) undergoing primary cardiovascular prevention were divided in two groups: low to moderate (n=49, targeted plasma LDL-C reduction <50%) and high (n=12, ≥50%). Strength, endurance, and power in extension and flexion of the dominant leg, and handgrip strength were measured using dynamometers. SAMS intensity was assessed using a 0-10 visual analog scale. After withdrawal, repeated-measures analyses showed improvements for 7/8 performance variables (+7.2 to +13.3%, all p<0.05), concomitant with a decrease in SAMS intensity (5.09 to 1.85, p<0.01), with no between-group difference. The improvement of muscle function following withdrawal was not differentiated according to treatment intensity.

Purpose: Colon cancer, one of the three deadliest cancers worldwide, has a high prevalence, especially in developing societies. Recently, our preclinical study demonstrated the strong anti-tumor effects of memantine on colon cancer in rats. This study aimed to investigate the effects of memantine (an NMDA receptor antagonist) in patients with metastatic colon cancer. Patients and Methods: In this randomized controlled clinical trial, 32 patients with metastatic colon cancer were randomized into two arms. The first arm received a chemotherapy regimen and the second arm received a chemotherapy regimen plus memantine 20 mg/day. The tumor size, metastasis, hematological parameters, CEA level, and N/L ratio were measured. Additionally, we assessed the safety and tolerability of this combination and its effect on the quality of life (QoL) of metastatic colon cancer patients. Results: Memantine reduced the colon tumor size in comparison to the control group patients (P=0.04). Also, in the memantine group, the metastasis was lower than in the control group (50% vs 87.5% respectively). Moreover, the memantine-treated group demonstrated reduced levels of CEA (P=0.01) as well as improved some hematological parameters. Also, quality of life was partially improved and no serious adverse effects were reported. Conclusions: Three-month adjuvant therapy with memantine reduces tumor size, metastasis, CEA level, and the N/L ratio, and also causes relative improvement of hematological parameters as well as the quality of life without causing any serious adverse effects. Therefore, memantine could be suggested as an appropriate adjuvant therapy in metastatic colorectal cancer.

Acute lymphoblastic leukemia (ALL) is a rare cause of hypereosinophilia (HE). We present a case of B-ALL and HE-associated lung inflammation to shed light on the diagnostic challenges in this rare entity. Bone marrow examination in the context of persistent HE is crucial, even in the absence of other cellular morphological abnormalities in the peripheral blood. This form of ALL is associated with severe complications and inferior outcome due to HE-induced organ damage, therefore a quick initiation of therapy is essential. Furthermore, reports of higher incidence of thromboembolic complications merit careful monitoring during therapy and evaluation of prophylactic measures.

To harness wind energy resources from the ocean, floating offshore wind turbines (FOWTs) are gaining increasing attention within the industry. In this paper, the impact of platform motion on the aerodynamic characteristics of the FOWT array is numerically investigated. A high-fidelity numerical tool with the Computational Fluid Dynamics (CFD) method is further developed based on the open-source CFD toolbox OpenFOAM by coupling the Actuator Line Model (ALM). The FOWT arrays consisting of three semi-submersible platforms and NREL 5 MW turbines with different arrangements based on tandem and staggered layouts are simulated, and their dynamic response and wake interactions are analysed under regular wave conditions. Results show that in gridded layouts, the downstream turbine experiences the most significant wind velocity reduction due to wake interference, compared with the staggered layouts. In the most common scenarios, the capacity factor of the total system of a tandem layout is 50%, while it is 92% for the staggered layouts. It is also found that whether the third downstream turbine is fixed or not has a minor influence on the time-averaged power output. However, the motion of the turbine, due to the floating platform, significantly influences power fluctuation. In gridded layouts, the downstream FOWT can have up to 25% higher fluctuation amplitude than fixed one, while for staggered layouts, this can reach 80% in the most critical case. It is also observed that strong wind turbulence reduces the impact of platform motion on power fluctuations, especially for the third turbine. By analysing the power output and the platform motion, it is found that the pitch and surge motion of the present OC4 platform have an opposite influence on the power output. Thus, a coupled model considering both degrees of freedom is necessary.

Li-rich Mn-based layered oxides (LMLOs) have been considered as the potential cathode materials to develop high-energy density lithium-ion batteries (LIBs) due to the lower cost and higher capacity. Whereas, LMLOs still face challenges of multiphase interfacial side reaction, structure transformation and microcrack growth, especially the polycrystalline particles. Herein, a high-performance submicron single-crystal-like Li-rich Mn-based layered material was obtained by optimizing lithium content to regulate crystal structure and interface chemistry. Detailed characterization indicates that the regulation of lithium content has a profound effect on the grain size, crystal structure and crystallinity. And the submicron LMLOs with appropriate lithium content exhibit a composite crystal structure composed of long-range ordered layered phase and surface heterogeneous layer, which combines the advantages of structural stability in single-crystal particles and rapid kinetic behavior in polycrystalline particles. Hence, the optimized submicron single-crystal-like LMLOs possess remarkable reversible capacity of 257.7 mAh/g and 143.2 mAh/g at 0.1 C and 10 C, respectively, corresponding to the retention of 85.72% and attenuation of 1.77 mV/cycle after 200 cycles at 1 C, which provides a new insight for the optimization and development of cathodes for rechargeable secondary battery.

Lithium metal is regarded as the most promising anode for next generation high-energy-density batteries. However, it still suffers from the problems associated with the uncontrollable dendrite growth and infinite volume expansion. Herein, a flexible and insulative polyethylene mesh (PM) has been used to partition the electrochemical reaction area, enhancing the uniformity of Li deposition/dissociation behaviors within localized regions. On the one hand, the insulating mesh can restrict the transport direction of Li+, mitigating “hotspots” induced by Li-ions agglomeration and thereby preventing dendrites formation. On the other hand, after Li deposited in segmented areas, the failure within a single mesh will not affect the performance of the entire electrode, thus improving the long-term stability of the electrode. Nevertheless, the mesh number as well as the thickness of the PM have significant influence on Li deposition/dissolution behaviors. As a result, the PM-40 with a thickness of 0.1 mm demonstrated the best regulation effects: in Cu||Li half-type cell, the PM-40 exhibited excellent cycling stability with an average Coulombic efficiency (CE) of 97.3%. When paired with LiFePO4 cathodes, the PM-40 demonstrated superior long-term cycling stability over 700 cycles with 98.87% capacity retention at 1C. This work effectively improves the uniformity of Li plating/stripping behaviors and electrochemical performance through a highly cost-effective method. Meanwhile, this work paves the way for realizing high-performance anode-free lithium metal batteries (LMBs) through the strategy of confined Li reaction.

javascript:void(0) In this paper, simultaneous vortex and non-vortex based transmission is proposed to enhance capacity by covering multiple users. The system model proposes a cell scenario including new and legacy user equipments (UEs) for backward compatibility and a geometrical transceiver for uniform circular array (UCA) and uniform rectangular array (URA). The proposed scenarios are divided into two different types of transmissions; vortex based, non-vortex based and a simultaneous vortex and non-vortex based. The channel model is approximated by dominant transmission distance. Moreover, modified Bessel function is proposed to derive channel model giving fair divergence effect with elevation angle. The performance of simultaneous vortex and non-vortex based transmissions is derived and simulated in terms of the average capacity (AC), outage probability (OP), and throughput.

Background: House dust mite (HDM) allergy involves IgE and T H2 responses to major and minor allergens. Less is known about the involvement of other immune pathways and the potential role of other HDM proteins in allergic disease. In this study, the association between HDM allergy and immune responses to the HDM proteome was investigated. Methods: The HDM proteome was represented by 40 purified recombinant HDM proteins (19 known allergens and 21 novel proteins). T-cell responses to HDM proteins were determined ex vivo and antibody responses (IgA, IgE, IgG and IgG4) were measured using micro arrays and basophil activation in 21 HDM allergic donors and 16 non-allergic controls. Changes in specific IgE, IgG and IgG4 during SQ HDM SLIT-Tablet immunotherapy was assessed in 38 subjects with allergic asthma. Results: HDM proteins were broadly immunogenic inducing comparable IgG, IgA, and non-T H2 cytokine responses in both allergic and non-allergic individuals. Specific IgE, IgG4 and T H2 cytokine responses were largely restricted to the allergic donors. IgE and IgG4 were primarily directed to known major allergens and overlapping in specificity whereas cellular T H2 responses extended beyond the known HDM allergens. Individual proteins displayed distinct immunological profiles. HDM sublingual immunotherapy increased the levels of specific IgE and IgG4 but did not change the overall pattern of recognition. Conclusion: HDM proteins are highly immunogenic and give rise to complex patterns of immune recognition also in the absence of allergy. This has potential implications for the pathogenesis of HDM allergy and the mode of action of allergy immunotherapy.

The Geostationary Synthetic Aperture Radar (GEO SAR) concept aims at defining an Earth Observation system able to provide regional coverage with large swaths and subcontinental access with a very short revisit time by exploiting the unique characteristics of the GEO orbit. These peculiar characteristics make GEO SAR suitable for imaging and interferometry of fastevolving large-scale phenomena, such as ground motion or water  vapor. The design of the orbit for a GEO SAR is discussed to provide, at one time, wide imaging capability, compensation for the huge power loss due to the distance, and short interferometric revisit. In particular, interferometry imposes constraints on the repeatability of the orbit that are far more restrictive than the control required for telecommunication satellites. Here, two different specific control approaches are proposed to ensure small normal baselines and to maximize angular band overlap between subsequent acquisitions. The first one is based on four control maneuvers per orbit period that exploits tangential, normal, and radial burns, whereas the second one reduces to three the required daily maneuvers that are performed only in tangential and normal directions. The latter assures accurate motion repetition while saving the required ΔV .

The asymptotic stability of the one-dimensional attraction-repulsion chemotaxis system is concerned with in this paper. First of all, we get the globally bounded classical solutions of the system with initial data ( u 0 , v 0 , ω 0 ) ∈ ( W 1 , ∞ ( Ω ) ) 3 . Next, by constructing an appropriate Lyapunov function, we also show that the solutions converge exponentially to the constant steady state ( u ̵̄ 0 , α β u ̵̄ 0 , γ δ u ̵̄ 0 ) if ξγ χα > max { β δ , δ β } . It is worth mentioning that Jin and Wang (2015) showed that the solutions converge algebraically to the constant steady state under conditions β= δ and ξγ− χα<0, and our results filled the gap in the ξγ− χα>0.

javascript:void(0) This study presents a novel predator-prey model that integrates disease dynamics within the prey population, using a Susceptible-Infected (SI) framework. The model introduces two control variables: one aimed at reducing disease transmission among prey and another focused on managing predator population levels. A logarithmic penalty cost function is employed to penalize reductions in prey and predator populations, reflecting the heightened ecological risks associated with low population sizes. The system is described by a set of differential equations that model the interactions between susceptible prey, infected prey, and predators under the influence of these control measures. The goal is to minimize the cost function over a specified time horizon, ensuring ecosystem stability while effectively managing disease spread and predator numbers. Our results provide insights into optimal control strategies that maintain ecological balance, offering a framework applicable to real-world wildlife management and conservation scenarios.

Objective: To systematically analyze whether COVID-19 vaccination increases the risk of lymphoma. Methods: Data were retrieved from five databases, including PubMed, BMJ, Web of Science, Cochrane Library, and CDC (Centers for Disease Control and Prevention). Comprehensive searches of relevant articles in the databases were conducted to enhance search accuracy. Articles and references were further screened to improve retrieval precision. Data extraction and analysis were subsequently performed. Results: A total of 143 cases of post-COVID-19 vaccination lymphoma were identified, including 11 cases from 9 articles and 132 cases of vaccine adverse events. Systemic analysis revealed that among the cases, 53.8% were female, with a median age of onset at 62 years (range: 9-99 years). The most commonly implicated COVID-19 vaccines were mRNA vaccines, with Pfizer-BioNTech accounting for 51.7% and Moderna for 42.7%. Adenovirus vector vaccines, including ChAdOx1 nCoV-19 (0.7%) and vAd26.COV2.S (4.2%), were the next most prevalent. Approximately 45.7% of patients developed lymphoma within 30 days of vaccine administration. Non-Hodgkin lymphoma constituted the majority of pathological types (71.3%). Conclusion: The administration of the COVID-19 vaccine may potentially elevate the associated risk of lymphoma incidence.

javascript:void(0) Background and Objectives: Dermatofibromas (DF) are common benign skin lesions with unclear etiology, possibly reactive or tumoral. This study aims to evaluate the incidence of DF misdiagnosis and correlate histopathological findings with clinical interpretations. Methods: The extraction for this retrospective study was conducted from 8035 excisions performed between 2016 and 2022 by 9 physicians. A total of 50 cases with conclusive histopathological diagnoses of DF and 33 clinical cases of DF were identified. A p-value of <0.05 was considered statistically significant. Results: The clinical arm included 33 cases, with 7 having DF in the differential diagnosis. The mean age for a confident DF diagnosis was 57.86 years, compared to 44.35 years for a probable diagnosis (p=0.023). Diagnosis accuracy was 69% for certain cases vs 43% for probable cases. DF on legs had higher clinical uncertainty, 6/7 vs 9/26 (p=0.016). In the histopathological arm of 50 patients, lesions on lower extremities had higher correct diagnosis rates (p=0.024) and were least accurate on the torso (p=0.009). Conclusions: DF can pose a challenge even for experienced clinicians. Location is crucial as DF may escape diagnosis in less common areas. Patient’s age and physician’s expertise induce uncertainty.