Single-atom catalysts (SACs) offer uniform active sites and exhibit extremely high selectivity towards desired products by ensuring consistent reaction pathways and minimizing the generation of undesired byproducts. Metal atoms interact with their support materials to determine the catalytic activity of SACs. Stronger coordination can enhance stability by preventing aggregation and ensuring the longevity of the isolated active site. The systematic design of next-generation catalysts necessitates a profound understanding and meticulous control of the metal-support synergy within SACs. The strategic integration of dual-atom site catalysts (DACs) and single-atom alloy catalysts has emerged as viable and efficient pathway to optimize catalytic performance. DACs possess flexible active sites that work , resulting in improved catalytic activity, selectivity, and stability. SAAs offer well-defined active sites and enhanced catalytic performance due to the high concentration of single-atom sites and bimetallic synergy. In particular, the neighboring metal single atoms exhibit metal−metal interactions, and the intersite distances of these neighboring atomic sites significantly impact electrocatalytic performance. This comprehensive review meticulously discusses the latest breakthroughs in SACs designed for electrochemical water splitting. We delve into the distinctive structural and electronic attributes of single-site, dual-site, and alloy SAC configurations, elucidating how these features enhance the water splitting reaction rates.

Soil conditioners have great potential in saline soil remediation. However, it is still unclear that how soil conditioners affect cotton photosynthesis to improve cotton resistance to saline and alkaline stresses. Therefore, we used the self-developed soil conditioner was used to clarify whether soil conditioner has a repair effect on cotton photosynthesis under saline and alkaline stresses. The photosynthetic performance and chlorophyll fluorescence characteristics of cotton leaves have increased in PY and PJ. Transcriptome and Proteome analysis results showed that Photosystem II protein, Chlorophyll A-B binding protein, Rubrerythrin and Cytochrome B6-F complex Fe-S subunit were up-regulated in the PY and PJ group. All above changes induced by conditioner application promoted chlorophyll biosynthesis, and regulation of the photosynthetic system. This study will deepen our understanding of the molecular mechanism of soil conditioner regulating cotton photosynthetic, and provide reference for saline and alkaline soil remediation in arid areas.

not-yet-known not-yet-known not-yet-known unknown In this study we performed a comprehensive numerical investigation of the Marangoni convective flow through a Darcy-Forchheimer porous matrix in nanofluids and their hybrid equivalents - hybrid nanofluids. Convection occured predominantly at the liquid-air interface within the porous structure. The governing equations were numerically solved using a finite difference approach, Python was used to obtain the solutions of the differential equations. In this paper, we discuss different important key parameters that qualitatively and quantitatively impact flow and heat transfer properties, respectively. We focused on the effects of porosity and thermocapillarity. The present investigation studied the Marangoni convection in (hybrid) nanofluids of manganese zinc ferrite (MnZnFe 2O 4) and nickle zinc ferrite (NiZnFe 2O 4) with water (H 2O) as a base fluid. Furthermore, the effects of the parameters involved in the Darcy-Forchheimer model on the convective flow, temperature and concentration characteristics are discussed and analyzed methodically. We elucidate the specific results and awareness of areas to improve in thermal management systems, providing useful information with a high potential for the future development of applications in engineering disciplines crucially impacted by heat transfer performance.

Aims: Olanzapine/samidorphan (O/S) is a novel drug for use in schizophrenia in adults, and in bipolar I disorder. We aim to mine and evaluate AE signals created by O/S using the FAERS database. Methods: The reporting odds ratio, proportional reporting ratio, bayesian confidence propagation neural network, and multi-item gamma poisson shrinker methods were used to first demonstrate the relationship of O/S with AEs from May 2021 to June 2024 using the FAERS database. Results: A total of 1964 AE reports of O/S as the “primary suspect” were collected. A total of 70 preferred term signals and 23 system organ classifications were obtained, mainly concentrated in psychiatric disorders (19.30%). The mean time to onset of O/S-related AEs was 17 days. In addition to the known AEs, more than 20 novel potential AEs were identified, such as oedema peripheral, dysarthria, and euphoric mood. Notably, risk signal for suicidal ideation was detected in this study. In addition, some uncommon but relatively strong AE signals were also observed, such as hallucination, auditory, and aggression. Meanwhile, drug screen false positive exhibited extremely high signal intensity. It is suggested that special attention should be paid to these potential AEs when using O/S clinically. Conclusion: In clinical applications, psychiatric diseases should be closely monitored, particularly suicidal ideation. Meanwhile, medical personnel should take precautions to guarantee the safety of clinical use and be vigilant for the incidence of AEs not included in the medication instructions

Authors and affiliations: Julian Campillo Luna, MD, MHS, Department of Emergency Medicine, University of Michigan, Ann Arbor, Michigan, USA; Lauren Hartz, Yale University, New Haven, Connecticut, USA; Christine Ngaruiya, MD, MsC, DTM&H, Department of Emergency Medicine, Stanford University School of Medicine, Palo Alto, California, USA.Keywords: Lyme disease, Dermatology, Emergency Medicine, Bell’s Palsy, CellulitisCorrespondence to:Dr. Julian Campillo Luna1500 E Medical Center Dr.B1-380 Taubman Center, SPC 5305 Ann Arbor, MI 48109United StatesPhone: (650) 723-5111Email: jucampil@med.umich.eduORCID: https://orcid.org/0000-0001-8509-0700Email Addresses of Authors:Julian Campillo Luna: jucampil@med.umich.eduLauren Hartz: lauren.j.hartz@yale.eduChristine Ngaruiya: cngaruiy@stanford.eduMeetings: This work has not been presented elsewhereData Statement: The data used to support the findings of this study are included within the articleFunding Statement: This research was conducted as part of the employment of the authors under the Yale New Haven HospitalConflict of Interest: The authors have no conflicts of interestPatient Consent Statement: Consent was obtained from the patient in preparation of this case report

Challenging Diagnosis of Central Nervous System Tuberculosis with Joint InvolvementAhmet Melih Şahin1, Elif Şen1*, Zehra Akkaya21Ankara University, Department of Pulmonary Diseases, Ankara, Turkiye2Ankara University, Department of Radiology, Ankara, Turkiye

Understanding what governs grassland biodiversity across different spatial scales is crucial for effective conservation and management. However, current evidence often focuses on single sampling grain sizes, leaving the mechanisms of biodiversity drivers and their scale-dependency unclear. Here, we investigated the impact of climate, soil properties, abiotic disturbance, and land use on plant diversity across fine spatial scales in various grassland types. We collected spatially explicit data on species presence, relative cover, and total community cover at two grain sizes (α- and γ-diversity) to assess the mechanisms driving scale-dependent diversity patterns (β-diversity). In our study, the most influential factors of plant diversity at both scales (grain sizes) were climate variables, followed by soil humus content, litter cover, and soil pH. The effects of soil and litter were primarily driven by the response of rare species, while climate and grazing effects were driven by locally common species. The strength of most of these effects varied between spatial scales and therefore affected β-diversity. We identified three key mechanisms through which these drivers affect the scale-dependency of biodiversity: total plant cover, species relative cover (commonness or rarity of species and species evenness in the community), and species intraspecific aggregation. Climate effects operated through changes in species relative cover and intraspecific aggregation. Soil humus influenced β-diversity by altering the total cover of the plant community and by increasing intraspecific aggregation, resulting in stronger effects of soil productivity on plant diversity at larger than smaller spatial scales. Microhabitat patchiness by litter altered distributions in the relative cover of species due to reduced asymmetric competition, and affected the total cover of the plant community. Our results underscore the importance of incorporating the scale-dependency of biodiversity drivers in conservation efforts, management strategies, and analyses of global change impacts, which would enhance our ability to predict potential biodiversity change.

s:In order to provide serious game products centered on players’ contextual experiences, a game-guided design approach incorporating learning methods is proposed.Firstly, a targeted Learning Mechanics-Game Mechanics Model (LM-GM Model) is established based on the educational objectives of the game and relevant mature paradigms, and then the indicators in the model are evaluated for relevance, and screened to obtain the design elements that are initially in line with the theme and educational objectives of the game. Secondly, using fuzzy Kano model to design the questionnaire to get the demand classification, taking the essential demand as the core design element, extracting the expectation demand and excitement demand to filter and sort again, and calculating the contextual experience satisfaction index.Finally, a network information security game is used as a design case to verify the feasibility and superiority of the game-guided design method.The experimental results show that the game guidance design method based on the elements of contextual experience can better help the development of serious games, effectively improve the player satisfaction of the game, and can provide a design method for other similar products.

not-yet-known not-yet-known not-yet-known unknown The digitalization of healthcare is being transformed through the integration of IoT, cloud environments, and blockchain technology, significantly enhancing security and infrastructure robustness. This study conducts a systematic review of over 200 articles on blockchain-enabled healthcare systems, analysing current applications, security threats, cyber-attacks, and system challenges, along with proposed solutions. Despite blockchain’s potential to revolutionize medical data handling, sharing, and processing, our findings reveal persistent issues: 17 security threats compromising privacy and data integrity, 21 cyber-attacks impacting security and quality of service, and 16 system problems such as node compromise, scalability, efficiency, regulatory challenges, computation speed, and power consumption. We propose a layered architecture for future healthcare infrastructure, categorizing issues within this framework and evaluating existing solutions. Our comparative analysis demonstrates the superiority of this architecture in terms of security, trustworthiness, and efficiency over traditional systems. Real-world case studies and a comparative evaluation of blockchain protocols and consensus mechanisms offer deeper insights into their applicability in IoMT and healthcare. This review provides a comprehensive perspective on enhancing e-healthcare services through improved security and privacy, addressing regulatory and ethical challenges. By mapping out limitations, future scopes, and emerging trends, we aim to foster the development of robust, trustworthy, and privacy-preserving healthcare systems.

not-yet-known not-yet-known not-yet-known unknown Background: Pediatric immunocompromised patients are at an increased risk of severe respiratory syncytial virus (RSV) infection. Here, we aimed to describe the clinical course and outcomes of RSV infection in immunocompromised children. Methods: This single-center study was conducted at St. Jude Children’s Research Hospital in immunocompromised children ≤21 years old, who had a positive RSV clinical test in the clinic or hospital from 2007 to 2019. Demographic and clinical characteristics, laboratory values, delays in the treatment of patients’ underlying conditions, and outcomes were extracted from the patients’ electronic medical records. Multivariate models were constructed to identify risk factors predictive of severe RSV LRTI. Results: In total, 391 patients were included. Most children (86%) were > 2 years of age, with a median age of 5 years. Acute lymphoblastic leukemia (ALL) was the most common underlying disease. Most patients presented with upper respiratory tract infections (n = 335; 85.7%). Approximately 6% of patients progressed to lower respiratory tract infections. More than half (58.8%) of the patients were hospitalized, and therapy for the underlying disease was modified or delayed due to RSV infection in one-third of the patients. Severe RSV infections were observed in 62 patients (15.9%). All-cause mortality was reported in 10 patients (2.6%), with three RSV-related deaths (0.7%). Conclusions: A high proportion of immunocompromised children with RSV infection require hospitalization. Hospitalization was observed in those aged >2 years, and an overall treatment delay for the underlying disease occurred in one-third of the patients. The burden associated with RSV in immunocompromised children is high irrespective of age and has direct and indirect consequences on their cancer treatment plans.

not-yet-known not-yet-known not-yet-known unknown Background: Globally, infections account for 10% of new cancer cases, and cancer can compromise the immune system, increasing the risk of infections. With advances in cancer treatment, widespread use of immunotherapy, and prolonged survival of cancer patients, the coexistence of tuberculosis (TB) and cancer is becoming increasingly common in clinical settings. Aim: This review aims to explore the interaction between tuberculosis (TB) and tumors, particularly lung cancer (LC), and to identify appropriate clinical management approaches. Results: LC patients with a history of TB have higher adjusted risk ratios for both all-cause and cancer-specific three-year mortality compared to those without a history of TB. TB may elevate the risk of developing tumors through mechanisms such as chronic inflammation, altered immune responses, and DNA damage. Conversely, cancer patients, whether due to the disease itself or immune dysfunction caused by anti-tumor treatments, may be more susceptible to TB. The coexistence of TB and tumors presents significant challenges in clinical management, making the development of treatment strategies and quality-of-life improvements crucial. Conclusion: There is a close relationship between TB and cancer, with TB potentially serving as a risk factor for cancer, and cancer influencing susceptibility to TB. Effective clinical management is essential to enhance treatment strategies and improve the quality of life for patients with both TB and cancer.

Note: Fullerenes are identified according to the number of atoms in their structure. A letter C is used to name fullerenes, which represents the carbon atom in their structure. Fullerenes are among the materials that many nano materials are based on. Their unique structural and electronic properties, as well as their use in various fields such as electronic applications such as making nano electrodes used in special electrical circuits , nano photonics in nano solar cells and nano absorbers of specific wavelengths.

Probiotics play diverse roles in promoting health and well-being, encompassing gut microbiota balance, digestive health, immune function, gut barrier integrity, metabolic health, and mental well-being. With the beneficial effects of probiotics, individuals can support gastrointestinal health, boost immune function, and reduce the risk of various diseases. These probiotics compete with pathogens and support gut and immune homeostasis to help in the prevention and cure of gastrointestinal disease, immune disorders, diabetes, obesity, cancer and allergic disorders, etc. Probiotic-rich foods and supplements into the diet offer a proactive approach to maintaining overall health and optimizing the functioning of the gut microbiota. Probiotics help to maintain immune homeostasis and decrease the risk of inflammatory disorders and allergic conditions. Several probiotic strains are available on the market and are being consumed in the form of foods, supplements, or drugs for health benefits. Lactobacilli, Bifidobacteria, and Bacillus species are common probiotic strains.

Abstract:                                                                                                                                                                            Background:  The association between body mass index (BMI) and frailty in the context of leadless pacemaker (LPM) implantation remains underexplored.                                                                                   Objective: This study aims to investigate the relationship between BMI, frailty, and outcomes in patients who underwent LPM implantation.                                                                                                     Methods: Data from the National Inpatient Sample (NIS) from 2018-2021 was analyzed for patients who underwent LPM implantation. Patients were categorized into five BMI groups: underweight, normal weight, overweight, obese, and morbidly obese. Frailty was assessed using the Hospital Frailty Risk Score (HFRS).                                                                                                                                         Results: The study included a weighted cohort of 8,865 patients who underwent LPM implantation. Among frail patients (n=6120), mortality occurred in 5.0% of obese individuals compared to 7.5% in non-obese individuals (aOR: 0.763, 95% CI: 0.601-0.968). Frail, obese patients showed reduced risks of venous thromboembolism (aOR: 0.760, 95% CI: 0.565-0.943), the need for blood transfusions (aOR: 0.826, 95% CI: 0.690-0.988), and pericardial complications (aOR: 0.778, 95% CI: 0.564-0.925), but demonstrated elevated risks of renal complications (aOR: 1.284, 95% CI: 1.132-1.458) and device removal/revision (aOR: 2.121, 95% CI: 1.943-2.345).                                                                                                                                                                                                Conclusion: This study demonstrates that frail, obese patients who underwent LPM implantation, exhibited a lower risk of mortality, pericardial complications, venous thromboembolism (VTE), and the need for blood transfusion compared to non-obese individuals, despite facing a higher likelihood of renal complications and device-related issues. Keywords: BMI, Frailty, cardiovascular outcomes, leadless pacemaker, obesity, in-hospital mortality, National Inpatient Sample (NIS)Abbreviations: BMI: Body Mass Index; LPM: Leadless Pacemaker; NIS: National Inpatient Sample; TVP: Traditional Transvenous Pacemaker; HCUP: Healthcare Cost and Utilization Project; AHRQ: Agency for Healthcare Research and Quality; ICD-10: International Classification of Diseases, Tenth Revision; CM/PCS: Clinical Modification/Procedure Coding System; CIED: Cardiovascular Implantable Electronic Device; VTE: Venous Thromboembolism; CVA: Cerebrovascular Accident; HFRS: Hospital Frailty Risk Score; aOR: adjusted Odds Ratio; OR: Odds Ratio; CI: Confidence IntervalIntroduction:The advent of leadless pacemaker technology represents a significant advancement in the field of cardiac electrophysiology, offering a less invasive alternative to traditional transvenous pacemakers.1,2 LPMs, designed to be directly implanted into the right ventricle without the need for transvenous leads, mitigate many complications associated with conventional devices, such as infections, lead dislodgement, and venous thrombosis.3 Since their FDA approval in 2016, these devices have gained widespread acceptance, particularly among patients unsuitable for conventional pacemakers due to their enhanced safety and efficacy profiles.4 Patients requiring LPMs often present with a complex array of health issues, including multiple comorbidities and varying levels of frailty.5 Frailty, marked by decreased physiological reserve and heightened vulnerability to external stressors, is associated with higher rates of hospitalization, disability, and mortality.6 This condition poses significant challenges in cardiovascular treatments, impacting procedural outcomes and healthcare costs. Thus, accurately assessing frailty is crucial for optimizing patient outcomes in LPM implantations. However, the evaluation of outcomes following LPM implantation must also consider Body Mass Index (BMI), a prevalent health metric based on weight-to-height ratio. Although BMI is instrumental in assessing overall health risks across various conditions, its relationship with frailty, particularly in the context of cardiac interventions, is nuanced and not fully elucidated.7 Drawing on data from the National Inpatient Sample (NIS) spanning 2018 to 2021, this study explores how BMI interacts with frailty to affect clinical outcomes in patients receiving LPMs. By dissecting these dynamics, the research seeks to enhance our understanding of how frailty and BMI together impact patient care, aiming to refine clinical strategies and optimize outcomes in this vulnerable population.Methods:This study employed a retrospective cohort design using data from the National Inpatient Sample (NIS) spanning the years 2018 to 2021. The NIS database, maintained by the Healthcare Cost and Utilization Project (HCUP), represents the largest publicly available all-payer inpatient healthcare database in the United States, encompassing approximately 20% of all hospital discharges and providing a representative sample of the U.S. inpatient population. Patients who underwent leadless pacemaker implantation were identified by the ICD-10 procedure code 02HK3NZ. Patients with incomplete data on Body Mass Index (BMI), as well as those under 18, were excluded from the study. Patients were stratified into five BMI categories: Underweight (≤ 19.9), Normal weight (20-24.9), Overweight (25-29.9), Obese (30-34.9), and Morbidly Obese (≥ 35). Frailty was assessed using the Hospital Frailty Risk Score (HFRS), formulated by Gilbert et al.8 The HFRS applies an ICD-10 algorithm to administrative health data to derive a weighted frailty score between 0.1 and 7.1, based on 109 clinical indicators. Frailty status in patients was then grouped into three predefined risk levels: low risk for scores less than 5, intermediate risk for scores between 5 and 15, and high risk for scores exceeding 15. This categorization is based on established protocols in previous research utilizing the NIS database.9-11 Outcomes assessed were in-hospital mortality, removal/revision, mechanical complications, infection/inflammation, venous thromboembolism (VTE), pericardial complications, renal complications, bleeding complications, and the need for blood transfusion. Pericardial complications included non-infective acute pericarditis, non-inflammatory pericardial effusion, non-traumatic hemopericardium, cardiac tamponade, and unspecified pericardial complications. Renal complications included acute kidney injury. Bleeding complications covered periprocedural bleeding, post-procedural anemia, and hemoperitoneum/retroperitoneal bleeding. Additionally, a detailed analysis was conducted to assess frailty across BMI categories. For baseline demographics and comorbid conditions, selected comorbidities from the Elixhauser index were analyzed. Patient demographics and clinical characteristics were summarized using descriptive statistics. Continuous variables were presented as means with standard deviations, while categorical variables were summarized as frequencies and percentages. The statistical significance was evaluated using Pearson chi-square tests for categorical variables and ANOVA for continuous variables. In the assessment of primary and secondary outcomes, binary logistic regression models were developed. Additionally, frailty and obesity were dichotomized, classifying patients as frail (HFRS ≥ 5) or non-frail (HFRS < 5) and as obese (BMI ≥ 30) or non-obese (BMI < 30). This approach aligns with BMI and frailty categorizations used in previous studies.12,13 Adjusted (aORs) and crude odds ratios (ORs) with 95% confidence intervals (CIs) were calculated for all regression models. Each model included adjustments for age, sex, and Elixhauser comorbidities, as detailed in Table 1. Data analysis was performed using SPSS software (version 26.0; IBM Corp, Armonk, NY). A p-value of less than 0.05 was considered statistically significant. All relevant ICD-10 PCS/CM codes used for statistical analysis and baseline demographics are provided in Supplemental Table 1 (S1).Results:In the analysis of clinical outcomes detailed in Table 2, the following results were observed within the frail patient cohort: Mortality was lower in obese patients (5.0%, n=200) compared to non-obese patients (7.5%, n=160) (aOR: 0.763, 95% CI: 0.601-0.968, p=0.026). The incidence of venous thromboembolism (VTE) was lower in obese patients (4.0%, n=160) compared to non-obese patients (7.3%, n=155) (aOR: 0.760, 95% CI: 0.565-0.943, p=0.007). The need for blood transfusions was lower in obese patients (10.6%, n=425) compared to their non-obese patients (14.2%, n=300) (aOR: 0.826, 95% CI: 0.690-0.988, p=0.036). Pericardial complications occurred less frequently in obese patients (4.4%, n=175) compared to non-obese patients (4.7%, n=100) (aOR: 0.778, 95% CI: 0.564-0.925, p=0.009). Bleeding complications showed no statistical significance (aOR: 0.947, 95% CI: 0.797-1.102, p=0.432). Renal complications were more prevalent in obese patients (47.1%, n=1885) compared to non-obese patients (37.5%, n=795) (aOR: 1.284, 95% CI: 1.132-1.458, p<0.001). Similarly, within the non-frail cohort, renal complications were higher in obese patients (10.9%, n=235) compared to non-obese patients (4.2%, n=25) (aOR: 1.837, 95% CI: 1.758-1.975, p<0.001). Furthermore, the prevalence of removal/revision was greater in obese patients (2.0%, n=80) than in non-obese patients (0.7%, n=15) (aOR: 2.121, 95% CI: 1.943-2.345, p<0.001). In the non-frail cohort, all secondary outcomes, except for renal complications, lacked statistical significance.In the dichotomized binary logistic regression model detailed in Table 3, frail patients comprised 78.1% (2,120) of the non-obese group and 65% (4,000) of the obese group (aOR: 0.591, 95% CI: 0.124-0.739, p = 0.001). Conversely, non-frail patients accounted for 21.9% (595) of the non-obese group and 35% (2,150) of the obese group.Mechanical complications and infection/inflammation were not reportable according to the National Inpatient Sample (NIS) dataset guidelines, which prohibit the reporting of data where the number of cases is less than 11, as mandated by the Healthcare Cost and Utilization Project (HCUP) standards. Discussion:                                                                                                                           In this nationally representative cohort, our findings are as follows: (I) Frail, obese patients who underwent leadless pacemaker implantation (LPM) exhibited a reduced risk of mortality. (II) Frail, obese patients exhibited a reduced risk of pericardial complications, venous thromboembolism (VTE), and the need for blood transfusion compared to non-obese patients. (III) Frail, obese patients demonstrated an elevated risk of renal complications and removal/revision compared to non-obese patients.Previous studies have consistently demonstrated that frailty increases the risk of complications associated with cardiac implantable electronic devices (CIEDs). Diaz et al. found that frailty is a significant predictor of mortality in patients who underwent LPM implantation, with the risk markedly increasing when the Hospital Frailty Risk Score (HFRS) exceeds five points.14 Moreover, frailty has been associated with higher rates of both cardiac and non-cardiac comorbidities, further elevating the overall risk of mortality.15 Regarding BMI, studies have typically demonstrated a linear correlation wherein higher BMI is associated with an increased risk of cardiovascular complications.16,17 However, an "obesity paradox" has been noted, suggesting that higher BMI may be linked to improved clinical outcomes. For example, a study by Almani et al., analyzing NIS data from 2016-2018, revealed that obese patients who underwent transvenous pacemaker (TVP) insertion exhibited lower inpatient mortality rates compared to their non-obese counterparts.18 Furthermore, research by Attanasio et al. indicated that obese patients (BMI > 30) experienced significantly fewer major complications compared to non-obese patients (BMI < 30) during CIED implantation.19The clinical implications of frailty and BMI are profound, serving as strong predictors of mortality and major complications.20,21 Research exploring the interplay between BMI and frailty is extensive. For instance, Jayanama et al. examined a cohort of 29,937 middle-aged to older adults, discovering that overweight or obese individuals exhibited elevated levels of frailty.22 Similarly, Tajik et al. investigated the relationship between frailty and high BMI with the risk of heart failure, concluding that the coexistence of high BMI and frailty exacerbates the risk of developing heart failure.23 In contrast, our results showed that frail, obese patients undergoing LPM implantation exhibited a reduced risk of mortality. This observation is somewhat consistent with literature assessing all-cause mortality, although specific studies on cardiovascular complications are scarce. For example, Watanabe et al. conducted a prospective study involving 10,912 adults aged 65 and older, which revealed an inverse relationship between higher BMI and all-cause mortality.24 Several physiological mechanisms may underpin these relationships. Increased adiposity might buffer the adverse effects of frailty and procedural stress, while the larger metabolic reserves in obese patients could provide a crucial support during the perioperative phase.25 Additionally, Adipose tissue secretes various adipokines, such as leptin, which could counteract chronic low-grade inflammation commonly seen in frail individuals, contributing to better clinical outcomes.26Many studies have indicated an elevated risk of pericardial issues (pericarditis, pericardial effusion, etc.) in patients who underwent LPM implantation compared to traditional pacemakers.5,27-29 For instance, In an observational cohort study by Piccini et al., patients with LPMs experienced significantly higher pericardial complications compared to those with TVPs.30 Our study revealed that frail, obese patients exhibited a reduced risk of pericardial complications following LPM implantation. This highlights the necessity for further research to elucidate the underlying mechanisms behind this potentially protective effect. It is important to note that our data is not designed to analyze such mechanisms, making this an essential focus for future investigations. A study by Alhuarrat et al., using NIS data from 2016 to 2019, aimed to evaluate the differences in procedural complications and in-hospital outcomes between LPM and TVP implantation. Analyzing a cohort of 7,780 patients, the study identified a higher risk of VTE and an increased need for blood transfusions in the LPM group.31 Furthermore, in a retrospective study of 89 patients, Hayashi et al. noted the development of deep vein thrombosis (DVT) in 13.5% of patients post-LPM implants.32 Our study shows that frail, obese patients exhibited a reduced risk of VTE and need for blood transfusion. The LPM procedure uses a large bore sheath for device implantation that can result in prolonged immobilization, potentially increasing the risk of DVT and a need for blood transfusion in the elderly and frail population.33,34 Our results suggest that obesity might mitigate these risks, offering a valuable insight into the protective effect obesity may play within frail individuals undergoing LPM.It is essential to recognize the benefits associated with the minimally invasive nature of the LPM procedure, particularly the reduction of procedural and post-procedural complications. A notable study from the Micra post-approval registry highlighted several advantages of LPMs over TVPs. Over three years, LPMs showed a 53% reduction in major complications, mainly due to fewer lead dislodgements and less frequent system revisions. At a 36-month follow-up, the rate of system revisions was significantly lower for LPMs compared to transvenous systems (3.2% vs. 6.6%).35 Despite these advantages, our findings demonstrate that frail, obese patients face higher risks of device revision/removal. The technical challenges of implanting the LPM in obese patients, such as difficulties in accessing vascular sites and securing the device may contribute to a higher likelihood of complications. Furthermore, renal complications, which we defined as acute kidney injury, showed an elevated risk in frail, obese patients. This prevalence may stem from the higher volume of contrast used during implantation or the inclusion of patients with pre-existing renal insufficiency. Further research is warranted to identify the contributing factors and to develop strategies to enhance the safety and efficacy of LPM devices within this vulnerable population.LimitationsNotably, several limitations are inherent to the NIS database. First, the use of ICD codes for identifying diseases and procedures could lead to inaccuracies, despite the Agency for Healthcare Research and Quality's (AHRQ) stringent measures to reduce miscoding and maintain data integrity. Second, the NIS is limited to inpatient admissions and does not include outpatient data or longitudinal follow-up, which limits insights into long-term outcomes and readmission patterns. Third, the database does not distinguish among various leadless pacemaker models, such as Micra and Aveir, hindering comparative analyses of outcomes across these devices. Fourth, the NIS does not capture critical details such as medications and specific procedural data, including steps involved in the leadless pacemaker implantation process, such as operator experience, use of intraprocedural imaging, and contrast utilization. Lastly, the absence of detailed patient-level data, such as lifestyle factors, precludes a more comprehensive risk stratification and understanding of the interactions between BMI, frailty, and LPM outcomes. ConclusionOur study demonstrates that frail, obese patients showed reduced risks of mortality, pericardial complications, venous thromboembolism (VTE), and the need for blood transfusion compared to non-obese patients. However, this group exhibited elevated risks of renal complications and device removal/revision. These observations indicate a potential protective effect of higher BMI in frail individuals undergoing LPM implantation. Future research should aim to elucidate the mechanisms behind these protective effects and optimize implantation strategies. Moreover, tailored patient management that considers both BMI and frailty is essential for enhancing clinical outcomes in this population. Acknowledgements: None  References:1.           Toon LT, Roberts PR. The Micra Transcatheter Pacing System: past, present and the future. Future Cardiol. Dec 2023;19(15):735-746. doi:10.2217/fca-2023-00932.           Bassareo PP, Walsh KP. Micra pacemaker in adult congenital heart disease patients: A case series. J Cardiovasc Electrophysiol. Nov 2022;33(11):2335-2343. doi:10.1111/jce.156643.           Xu F, Meng L, Lin H, Xu W, Guo H, Peng F. Systematic review of leadless pacemaker. Acta Cardiol. May 2024;79(3):284-294. doi:10.1080/00015385.2023.22765374.           Meredith A, Naaraayan A, Nimkar A, Acharya P, Aziz EF. The Rise of Leadless Pacemaker Utilization in United States. Am J Cardiol. Sep 1 2021;154:127-128. doi:10.1016/j.amjcard.2021.06.0055.           Boveda S, Higuera L, Longacre C, et al. Two-year outcomes of leadless vs. transvenous single-chamber ventricular pacemaker in high-risk subgroups. Europace. Mar 30 2023;25(3):1041-1050. doi:10.1093/europace/euad0166.           Dovjak P. Frailty in older adults with heart disease. Z Gerontol Geriatr. Oct 2022;55(6):465-470. Frailty bei älteren Erwachsenen mit Herzerkrankung. doi:10.1007/s00391-022-02079-77.           Bhardwaj PV, Rastegar V, Meka R, Sawalha K, Brennan M, Stefan MS. The Association Between Body Mass Index, Frailty and Long-Term Clinical Outcomes in Hospitalized Older Adults. Am J Med Sci. Sep 2021;362(3):268-275. doi:10.1016/j.amjms.2021.04.0048.           Gilbert T, Neuburger J, Kraindler J, et al. Development and validation of a Hospital Frailty Risk Score focusing on older people in acute care settings using electronic hospital records: an observational study. Lancet. May 5 2018;391(10132):1775-1782. doi:10.1016/s0140-6736(18)30668-89.           Chin M, Kendzerska T, Inoue J, et al. Comparing the Hospital Frailty Risk Score and the Clinical Frailty Scale Among Older Adults With Chronic Obstructive Pulmonary Disease Exacerbation. JAMA Netw Open. Feb 1 2023;6(2):e2253692. doi:10.1001/jamanetworkopen.2022.5369210.        Turcotte LA, Heckman G, Rockwood K, et al. External validation of the hospital frailty risk score among hospitalised home care clients in Canada: a retrospective cohort study. Age and Ageing. 2023;52(2)doi:10.1093/ageing/afac33411.        Rosario BH, Quah JL, Chang TY, et al. Validation of the Hospital Frailty Risk Score in older adults hospitalized with community-acquired pneumonia. Geriatrics & Gerontology International. 2024;24(S1):135-141. doi:https://doi.org/10.1111/ggi.1469712.        Ajibawo T, Okunowo O. Higher Hospital Frailty Risk Score Is an Independent Predictor of In-Hospital Mortality in Hospitalized Older Adults with Obstructive Sleep Apnea. Geriatrics. 2022;7(6):127. 13.        Held C, Hadziosmanovic N, Aylward PE, et al. Body Mass Index and Association With Cardiovascular Outcomes in Patients With Stable Coronary Heart Disease – A STABILITY Substudy. Journal of the American Heart Association. 2022;11(3):e023667. doi:doi:10.1161/JAHA.121.02366714.        Diaz-Arocutipa C, Calderon-Ramirez PM, Mayta-Tovalino F, Torres-Valencia J. Association between frailty and in-hospital outcomes in patients undergoing leadless pacemaker implantation: A nationwide analysis. Heart Rhythm O2. Feb 2024;5(2):85-94. doi:10.1016/j.hroo.2023.12.00715.        Wilkinson C, Rockwood K. Frailty assessment in the management of cardiovascular disease. Heart. Nov 24 2022;108(24):1991-1995. doi:10.1136/heartjnl-2022-32126516.        Khan SS, Ning H, Wilkins JT, et al. Association of Body Mass Index With Lifetime Risk of Cardiovascular Disease and Compression of Morbidity. JAMA Cardiol. Apr 1 2018;3(4):280-287. doi:10.1001/jamacardio.2018.002217.        Lopez-Jimenez F, Almahmeed W, Bays H, et al. Obesity and cardiovascular disease: mechanistic insights and management strategies. A joint position paper by the World Heart Federation and World Obesity Federation. European Journal of Preventive Cardiology. 2022;29(17):2218-2237. doi:10.1093/eurjpc/zwac18718.        Almani M, Usman M, Qudrat Ullah M, Fatima N, Yousuf M, Edigin E. Impact of obesity on the clinical outcomes of patients undergoing pacemaker insertion during hospitalization: An analysis of the United States National Inpatient Sample. European Journal of Preventive Cardiology. 2021;28(Supplement_1)doi:10.1093/eurjpc/zwab061.30019.        Attanasio P, Lacour P, Ernert A, et al. Cardiac device implantations in obese patients: Success rates and complications. Clinical Cardiology. 2017;40(4):230-234. doi:https://doi.org/10.1002/clc.2265020.        Matsue Y, Kamiya K, Saito H, et al. Prevalence and prognostic impact of the coexistence of multiple frailty domains in elderly patients with heart failure: the FRAGILE-HF cohort study. Eur J Heart Fail. Nov 2020;22(11):2112-2119. doi:10.1002/ejhf.192621.        Marengoni A, Zucchelli A, Vetrano DL, et al. Heart failure, frailty, and pre-frailty: A systematic review and meta-analysis of observational studies. Int J Cardiol. Oct 1 2020;316:161-171. doi:10.1016/j.ijcard.2020.04.04322.        Jayanama K, Theou O, Godin J, Mayo A, Cahill L, Rockwood K. Relationship of body mass index with frailty and all-cause mortality among middle-aged and older adults. BMC Med. Oct 24 2022;20(1):404. doi:10.1186/s12916-022-02596-723.        Tajik B, Voutilainen A, Sankaranarayanan R, et al. Frailty alone and interactively with obesity predicts heart failure: Kuopio Ischaemic Heart Disease Risk Factor Study. ESC Heart Failure. 2023;10(4):2354-2361. doi:https://doi.org/10.1002/ehf2.1439224.        Watanabe D, Yoshida T, Watanabe Y, Yamada Y, Miyachi M, Kimura M. Frailty modifies the association of body mass index with mortality among older adults: Kyoto-Kameoka study. Clinical Nutrition. 2024/02/01/ 2024;43(2):494-502. doi:https://doi.org/10.1016/j.clnu.2024.01.00225.        Hainer V, Aldhoon-Hainerová I. Obesity Paradox Does Exist. Diabetes Care. 2013;36(Supplement_2):S276-S281. doi:10.2337/dcS13-202326.        Brydon L. Adiposity, leptin and stress reactivity in humans. Biol Psychol. Feb 2011;86(2):114-20. doi:10.1016/j.biopsycho.2010.02.01027.        Alhuarrat MAD, Kharawala A, Renjithlal S, et al. Comparison of in-hospital outcomes and complications of leadless pacemaker and traditional transvenous pacemaker implantation. Europace. Aug 2 2023;25(9)doi:10.1093/europace/euad26928.        El-Chami MF, Bockstedt L, Longacre C, et al. Leadless vs. transvenous single-chamber ventricular pacing in the Micra CED study: 2-year follow-up. Eur Heart J. Mar 21 2022;43(12):1207-1215. doi:10.1093/eurheartj/ehab76729.        Cantillon DJ, Dukkipati SR, Ip JH, et al. Comparative study of acute and mid-term complications with leadless and transvenous cardiac pacemakers. Heart Rhythm. Jul 2018;15(7):1023-1030. doi:10.1016/j.hrthm.2018.04.02230.        Piccini JP, El-Chami M, Wherry K, et al. Contemporaneous Comparison of Outcomes Among Patients Implanted With a Leadless vs Transvenous Single-Chamber Ventricular Pacemaker. JAMA Cardiol. Oct 1 2021;6(10):1187-1195. doi:10.1001/jamacardio.2021.262131.        Alhuarrat MAD, Kharawala A, Renjithlal S, et al. Comparison of in-hospital outcomes and complications of leadless pacemaker and traditional transvenous pacemaker implantation. EP Europace. 2023;25(9)doi:10.1093/europace/euad26932.        Hayashi T, Shishido KS, Moriyama NM, Tobita KT, Murakami MM, Saito SS. Deep vein thrombosis after leadless pacemaker implantation. European Heart Journal. 2022;43(Supplement_2)doi:10.1093/eurheartj/ehac544.47933.        Okabe T, Afzal MR, Houmsse M, et al. Tine-Based Leadless Pacemaker: Strategies for Safe Implantation in Unconventional Clinical Scenarios. JACC: Clinical Electrophysiology. 2020/10/01/ 2020;6(10):1318-1331. doi:https://doi.org/10.1016/j.jacep.2020.08.02134.        Gupta S, Cho K, Papagiannis J, Tisma-Dupanovic S, Borsa J. A novel technique for extraction of a leadless pacemaker that embolized to the pulmonary artery in a young patient: A case report. HeartRhythm Case Rep. Oct 2020;6(10):724-728. doi:10.1016/j.hrcr.2020.07.00235.        El-Chami MF, Garweg C, Clementy N, et al. Leadless pacemakers at 5-year follow-up: the Micra transcatheter pacing system post-approval registry. European Heart Journal. 2024;45(14):1241-1251. doi:10.1093/eurheartj/ehae101  Figure LegendFigure 1: Diagram of patient sample selection that details inclusion and exclusion criteria from initial NIS admissions to a final weighted sample.

Carbon stock options to mitigate climate change have become a major area of interest across the globe. Climate change is a global issue, and every possible way to mitigate it, is being explored. Afforestation and ecosystem restoration activities are widely adopted to improve the potential of the land in carbon storage. The Kerala State Action Plan on Climate Change proposed the ‘Trees outside forests (Tof)’ as an effective mechanism to mitigate climate change. Due to its discrete distribution and non-uniformity, there are fewer attempts to measure the potential of these systems. This study tried to determine and compare the carbon (C) stock potential of the three “Trees outside forest (Tof)” conditions prevailing in the Palakkad district, Kerala. The carbon stock by standing biomass and soil of four sites of undisturbed natural vegetation, monoculture plantation, and home garden was estimated using allometric equations and computations. The natural vegetations was found to have a higher carbon stock potential (238.58 Mg ha -1) compared to monoculture plantation and human habitat. Also, natural vegetation’s soil organic carbon content was much higher than monoculture plantations and home gardens. The study also estimated the soil deterioration index of each land use compared to the natural vegetation and barren land. The results of the study suggested that land use has a great influence on soil quality and carbon stock potential. Proper management of these Tof systems can enhance their productivity and contribute accountable support towards mitigating climate change.

Many cellular processes and organismal behaviors are time-dependent, and asynchrony of these phenomena can facilitate speciation through prezygotic and postzygotic reinforcement mechanisms. The Mojave and Sonoran desert tortoises (Gopherus agassizii and G. morafkai, respectively) reside in adjoining deserts with distinct seasonal rainfall patterns and they exhibit asynchronous winter brumation and reproductive behaviors. We used whole genome sequencing of 21 individuals from the two tortoise species and an outgroup to understand genes potentially underlying these characteristics. Eighty percent (80%) of the mutations in the most diverged 1% of the genome (FST ≥ 0.63) mapped to putatively non-functional flanking regions. Diverged genes with putatively functional variation showed extensive mutations in regulatory elements, particularly in predicted promoter regions. Clusters of genes relating to UV nucleotide excision repair, mitonuclear, and homeostasis functions had mutations in these diverged regions. Genes mediating chronobiological (cell cycle, circadian, and circannual) processes were also among the most highly diverged regions (e.g., XPA and ZFHX3). Promoter mutations had significant enrichment of genes related to regulatory machinery (ARC-Mediator complex, HDACs) suggest transcriptional cascades driven by regulatory divergence may underlie the behavioral differences between these species, leading to asynchrony-based prezygotic isolation. Further investigation revealed extensive expansion of respiratory and intestinal mucins (MUC5B, MUC5AC) within Gopherus, particularly G. morafkai. This expansion could contribute to differential Mycoplasma agassizii infection rates between the two species, as mucins help clear bacterial infections. Overall, results highlight that evolution of transcription regulation, apart from protein changes, might play an important role in the divergence and reinforcement during speciation.

In fishes, maternal size typically influences the number of offspring. Although this size-fecundity relationship often varies among species and is considered to be a consequence of the coevolution of life-history traits, the genetic basis of such size-fecundity relationships remains unclear. We explored the genetic basis underlying this size-fecundity relationship in two small medaka species, Oryzias latipes and O. sakaizumii. Our findings showed that O. sakaizumii has a higher fecundity than O. latipes, and quantitative trait locus analysis using interspecific F2 hybrids showed that chromosome 23 is linked to the size-fecundity relationship. In particular, the genes igf1 and lep-b in this region are known to be associated with life-history traits. Because O. sakaizumii is distributed at higher latitudes and has a shorter spawning season than O. latipes in the wild, we propose that adaptation to high latitudes is responsible for the relatively high fecundity observed in O. sakaizumii. We also discuss the potential ecological ramifications by the evolution of increased fecundity in this species.

Objective To understand the maternity experiences of women living in areas of high ethnic diversity and social deprivation. Design An anonymous self-reported on-line survey incorporating demographic, clinical outcome and validated tool (Experience of Maternity Care) questions, and free text responses. Setting A large urban NHS Trust in Northwest England Sample Postnatal women, living in eight postcodes identified as areas of high socio-economic deprivation and ethnic diversity. Methods Quantitative data was collected and analysed using appropriate statistics. Free text responses were coded and thematically analysed. Main outcome measures Experience of Maternity Care scores and free text themes. Results Sixty-four percent of the sample identified as from an ethnic minority. Black women (42/68, 62%) were more likely (p=0.003) to attend their first antenatal visit at 12 or more weeks’ gestation compared to White (69/87, 79%) or Asian women (127/150, 85%). Black (p=0.004) and multiparous (p=0.012) women were more likely to report a positive postnatal experience. Most women were positive about the care they received overall, but responses to specific questions revealed concerns related to some aspects. Most (82%) respondents did not mind being looked after during labour and birth by midwives or doctors they had not met before. Themes from free text responses included continuity of care, respectful care, communication, early labour care and access to timely pain relief. Conclusions Using a targeted approach ensured an ethnically diverse sample and despite overall positive experiences of maternity care, negative experiences reflect similar themes previously identified within UK maternity care.

Two Common Diagnostic Challenges of Juvenile Myelomonocytic LeukemiaJinjun Cheng MD PhD1,3,4*, Sarah Harney MD1, 2, David Jacobsohn MD1, 2, Reuven Schore MD1,2*Center for Cancer and Blood Disorders, Children’s National Hospital, Washington, DCDepartment of Pediatrics, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USADivision of Pathology and Laboratory Medicine, Children’s National Hospital, Washington, DCDepartments of Pathology and Pediatrics, The George WashingtonUniversity School of Medicine and Health Sciences, Washington, District of Columbia, USA

Background: No safety study has been conducted regarding PRP usage in cervical facet joints Objectives: To determine whether intra- and/or peri-articular injections of PRP in cervical facet joints in the horse is safe. Study design: Prospective, multi-centre, safety study Methods: PRP was injected via ultrasound guidance into the cervical and/or cervicothoracic facet joints in horses with diagnosed cervical complaints. Data recorded for each case included: breed, sex, age, primary reason for treatment, list of which facet joints were injected, the volume of PRP injected, whether the PRP was injected intra-articular or peri-articular, gauge of needle used. Data was collected at three time points: prior to treatment, 48 hours after treatment and a minimum of 30 days after treatment. At each time point, owners/trainers were asked to assess the level of pain the horse was suffering on a 0-10 (no pain to worst) scale. At the final evaluation the owners/trainers were also asked if the treatment met their expectations on a 0-5 scale. Results: No adverse events were reported. The average pain scores prior to treatment, at 48 hours, and at 30 days were 3.8, 3.4 and 1.1 respectively (see Figure 2). At no point did any horse have an increase in their reported pain level. Main limitations: Since PRP is not classified as a drug it does not come with a label indicating items such as dosage or route of administration. Thus, methodologies will vary amongst veterinarians. Conclusions: PRP appears to be safe for cervical and/or cervicothoracic facet joint injections in the horse. Evidence for efficacy was also recorded by means of owner/trainer reporting that the injections overwhelmingly met their expectations.

IntroductionAmeloblastoma is a benign tumor originating from odontogenic tissue, predominantly found in the maxillofacial region, with several histological subtypes. Hybrid ameloblastoma, first described by Waldron and El-Mofty in 1987, exhibits histological characteristics of both desmoplastic and conventional ameloblastoma.12,The incidence of hybrid ameloblastoma is 1.1% and most commonly occurs in individuals with a mean age of 24.5 years, with a higher prevalence in females compared to males.1 This subtype primarily affects the mandible, with a ratio of 5:3 relative to the maxilla.3Radiographically, hybrid ameloblastoma typically presents with a mixed radiolucent and radiopaque appearance and often has with irregular borders. In some cases, it may also exhibit multilocular radiolucency similar to conventional ameloblastoma.4Histopathologically, hybrid ameloblastoma features both desmoplastic patterns and conventional ameloblastoma patterns, predominantly follicular and plexiform. Although less common, acanthomatous, basal cell, and granular cell patterns may occasionally be observed.3 In this report, we present a case of hybrid ameloblastoma in a 60-year-old male patient, localized to the right mandibular region.

Zoonotic diseases account for 75% of emerging infectious diseases, posing significant global health challenges. Understanding the complex host-pathogen interactions is crucial for effective disease management. This study constructs and analyses a global bipartite network of zoonotic bacteria and their domestic mammal hosts, aiming to explore how domestication time and phylogenetic relationships influence network structure. The network, consisting of 24 domestic mammal species and 51 zoonotic bacterial species, reveals a non-random structure with high nestedness and low modularity. Results indicate that the richness of zoonotic bacteria per host is positively correlated with domestication time but not with phylogenetic distance from humans. These findings suggest that early-domesticated species act as ”sinks” for newly exposed zoonotic bacteria, driven by preferential attachment dynamics. This network-level insight provides a valuable framework for predicting and managing zoonotic disease transmission, emphasising the importance of targeted interventions for highly connected host species.

IntroductionOdontogenesis is governed by a series of intricate molecular interactions, and any disruption in these processes can lead to neoplasms specific to the jaws, known as odontogenic tumors. Because these tumors originate from various components of the tooth - forming apparatus, they typically exhibit significant histopathological diversity.1In the 5th edition of the WHO classification of odontogenic tumors and cysts of the jaws (2022), a new entity called adenoid ameloblastoma has been introduced under the category of benign epithelial odontogenic tumors, marking a significant update in the classification of odontogenic lesions.2 This tumor is rare, with fewer than 50 cases reported in the literature to date.3 The term ”adenoid ameloblastoma with dentinoid” was first introduced by Branon in 1994. The use of the term ”ameloblastoma” reflects the presence of ameloblast - like cells, alongside stellate reticulum - like cells, which shows positive expression for calretinin, indicating neoplastic ameloblastic epithelium. In adenoid ameloblastoma, the ameloblast-like cells do not express BRAF p.V600E, which is typically found in conventional ameloblastoma. This lack of BRAF mutation raises questions about their relationship, leading to the classification of adenoid ameloblastoma as a distinct entity under benign epithelial odontogenic tumors.4 Historically, various terms have been used to describe similar histopathological features, including atypical plexiform ameloblastoma with dentinoid, 5 hybrid ameloblastoma and adenomatoid odontogenic tumor, 6 and adenomatoid odontogenic tumor originating in unicystic ameloblastoma.7Adenoid ameloblastoma, typically observed in the 4th decade of life, shows a slight predilection for females. It can occur at various sites without a specific predilection. Clinically, it generally presents as a painless swelling.8 Radiographically, the majority of these tumors appear as unilocular radiolucencies, though occasional foci of radiopaque areas may also be present. 9 The key histopathological criteria for diagnosing adenoid ameloblastoma include the presence of ameloblastoma-like components, duct-like structures, morules, and cribriform architectures. Additionally, clear cells, eosinophilic dentinoid material, and focal areas of ghost cell keratinization may also be observed. 2 Differential diagnoses for this tumor include aggressive adenomatoid odontogenic tumor, clear cell odontogenic carcinoma, odontogenic carcinoma with dentinoid, ameloblastic carcinoma, adenomatoid odontogenic tumor with inductive changes, and various histopathological subtypes of ameloblastoma. 2, 10 Treatment options typically involve surgical excision, enucleation, and sometimes radiotherapy.1

Modern software development requires constant code evolution, often leading to a misalignment between evolving source code and its associated test suite. This lack of synchronization can impact software quality and longevity. This research investigates the factors influencing test co-evolution and its impact on software development practices. Our methodology involved analyzing the evolution of test code proportions, employing clustering techniques to identify distinct evolution patterns, and classifying projects based on their level of test co-evolution using the Pearson Correlation Coefficient. Our findings revealed five distinct test evolution patterns, highlighting diverse approaches to integrating testing within development workflows. Furthermore, high test co-evolution correlated significantly with smaller development teams and a lower frequency of corrective and multi-maintenance activities, indicating a potential link between consistent test updates, early defect detection, and improved code quality.