A document by Rui Zhou. Click on the document to view its contents.

Presenting with dysphagia and dyspnea, Rapidly worsening lung adenocarcinoma due to Diffusely spreading Lymphangitic carcinomatosis: A case reportSatoshi Tanaka, Ryo Matsubayashi, Shunichi Tamori,Katsuhiko Saito, Satoshi Nomura・Author affiliationsSatoshi Tanaka;Toyama City Hospital, Respiratory medicine.Kanazawa University Hospital, Respiratory medicine.satoshi34444433@gmail.comConceptualization, Investigation, and Writing – original draft.Ryo Matsubayashi;Toyama City Hospital, Respiratory medicine.Kanazawa University Hospital, Respiratory medicine.matsubayashi1120@gmail.comWriting – review & editing.Shunichi TamoriToyama City Hospital, Respiratory medicine.shun.tamori@gmail.comWriting – review & editing.Katsuhiko SaitoToyama City Hospital, Pathology.katsu-s@tch.toyama.toyama.jpWriting – review & editing.Satoshi NomuraToyama City Hospital, Respiratory medicine.sts_nom_kmh08@yahoo.co.jpWriting – review & editing.・Data availability statement; No datasets were generated or analyzed during this case report.・Funding statement; The authors received no specific funding for this work.・Conflict of interest disclosure; The authors declare no conflicts of interest in association with the present study.・Ethics approval statement; None・Patient consent statement; Written informed consent was obtained from the patient’s family.・Permission to reproduce material from other sources; No material from other sources was used for this work.・Clinical trial registration; NoneKey Clinical MessageLymphangitic carcinomatosis is a metastatic disease with a poor prognosis and poorly understood pathophysiology. We present a case of rapidly worsening lung adenocarcinoma with diffusely spreading cancerous lymphangitis in lung, mediastinum, retroperitoneum, and gastrointestinal tract. Our findings suggest cancer dissemination in this patient was predominantly caused by direct lymphatic invasion.Key words; Non-small-cell lung carcinoma, Lymphangitic carcinomatosisCase PresentationA 60-year-old man presented with progressive dysphagia and dyspnea for four days. He had an 80-pack-year smoking history. Chest radiography revealed a tumor in the right upper lung field and bilateral reticulations (Figure 1A). Computed tomography (CT) revealed a tumor in the right upper lobe with bilateral bronchovascular bundle thickening and esophageal wall thickening (Figure 1B). Magnetic resonance imaging (MRI) showed multiple brain tumors. Fluorodeoxyglucose positron emission tomography/CT (FDG-PET/CT) demonstrated FDG uptake in these lesions, as well as in the left adrenal gland, and thoracic and abdominal lymph nodes (Figure 1C). Esophagogastroduodenoscopy (EGD) revealed esophageal stenosis with a relatively smooth epithelium (Figure 2A) and a duodenal ulcer (Figure 2B-left). Upon biopsy, only the duodenum yielded thyroid transcription factor-1 (TTF-1) positive adenocarcinoma cells in the lamina propria mucosae (Figure 2B-right). Endobronchial ultrasound-guided transbronchial biopsy with a guide sheath (EBUS-GS-TBB) of the right upper lobe tumor revealed TTF-1 positive poorly differentiated adenocarcinoma (Figure 2C), which was strongly positive for programmed death-ligand 1 (PD-L1). However, no driver gene abnormality was detected on the OncomineTM Dx Target Test (Thermo Fisher Scientific, Waltham, MA, USA). Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) of the esophagus revealed adenocarcinoma cells (Figure 2D). Based on these findings, the patient was diagnosed with right upper lobe lung adenocarcinoma, cT4N3M1c, cStage IVB (BRA, LYM, ADR, OTH; esophagus and duodenum) (UICC-9th edition) with pulmonary lymphangitic carcinomatosis.Treatments included corticosteroid administration, stereotactic brain irradiation, and percutaneous endoscopic gastrostomy. While the respiratory symptoms temporarily improved, then eventually worsened. Forty days after the first visit, the patient died due to respiratory failure.A pathological autopsy was performed. The right upper lobe tumor consisted of poorly differentiated adenocarcinoma (Figure 3A, upper right). The lymphatic vessels throughout the lungs were enlarged and filled with adenocarcinoma cells, and the stroma surrounding these vessels also contained tumor cells (Figure 3A, lower right). In the esophagus, duodenum, and jejunum, carcinomatous cells were found in all layers, including the lymphatic vessels, while the wall structure was preserved (Figure 3B, C). Apart from the lung and upper gastrointestinal tract, adenocarcinoma was diffusely present in the stroma around the thyroid follicles (Figure 3D), cervical tissue, lymph nodes, pericardium, myocardium (Figure 3E), and adrenal glands (Figure 3F).DiscussionLymphangitic carcinomatosis is a form of metastatic disease characterized by the diffuse spread of malignant tumors through the lymphatic system, which is associated with poor prognosis.1 The pathophysiology is not well understood; however, direct invasion, lymphatic circulation, and hematogenous spread are considered to be possible pathways.2 In this case, adenocarcinoma was detected in the lung, thyroid, pericardium, myocardium, esophagus, duodenum, jejunum, adrenal glands, and brain. Except for the brain, the other cancerous sites were anatomically contiguous. The presence of tumor cells in the lymphatic vessels and stromal tissues suggested that the predominant routes of cancer dissemination in this patient was direct lymphatic invasion. This case is novel as it demonstrates pulmonary lymphangitic carcinomatosis alongside extensive mediastinal, retroperitoneal, and upper gastrointestinal tract invasion, a presentation not commonly associated with lung cancer.AcknowledgementsWe thank Editage (www.editage.com) for the English language editing.References1. Klimek M. Pulmonary lymphangitis carcinomatosis: Systematic review and meta-analysis of case reports, 1970-2018. Postgrad Med . 2019;131(5):309-318. doi: 10.1080/00325481.2019.1595982.2. Al-Bayati M, Al-Jobory O, Abu-Hassan F, Mohammed BU, Yaqoob S, Bazzaz O. Pulmonary lymphangitic carcinomatosis: An atypical presentation leading to discovery of multi-organ metastasis with unknown occult primary malignancy. Cureus . 2022;14(8):e27705. doi: 10.7759/cureus.27705

not-yet-known not-yet-known not-yet-known unknown Pulmonary Nocardiosis (PN) and invasive pulmonary aspergillosis (IPA) are opportunistic pulmonary infections with high mortality. Immunosuppressive status is a major risk factor for the development of PN and IPA, but co-infection with Nocardia and Aspergillus is relatively rare.

not-yet-known not-yet-known not-yet-known unknown Roads in cold climate mountains are known to be important vectors in the introduction and spread of non-native plant species. In the same context, mycorrhizal fungi communities are also altered by roads with a known positive effect on arbuscular mycorrhizal (AM) fungi diversity and abundance in disturbed roadsides. However, to what degree these two effects of roads are intertwined and how they are evolving over time is not well understood. In this study we conducted repeated surveys of non-native plants and AM fungi between 2012 and 2022, in the northern Scandes mountains to investigate temporal changes and interactions between roads, mycorrhizal fungi, and non-native plants. We found that the upward spread of non-native plants and lateral spread away from the roadside into the natural vegetation were so far extremely limited, with only two out of 23 non-native species showing an increase in their upper elevational limit. However, non-native plant species cover did increase over the ten year period, especially at lower elevations, and non-native richness increased from 17 to 23 species. Likewise, we saw an increase in AM fungal abundance over the last four years along the roadsides at lower elevations. Furthermore, our results suggest that increases in non-native species are unlikely to be the driving cause of the observed increase in AM fungal abundance, as AM fungi colonization varied independently of non-native species cover dynamics.

Fine roots play a crucial role in many ecological and biogeochemical processes in temperate forests. Generally, fine root biomass is expected to increase during the growing season, when water and nutrient demands are high, but information on seasonality is still scarce. Here, seasonal differences in root length of European beech (Fagus sylvatica L.) were analysed at eight sites within its north-eastern distribution range. Fine roots of mature trees were monitored using minirhizotrons. Scans were taken at the beginning of winter, the end of winter and over the summer for two consecutive years, and analysed automatically by an AI-algorithm (RootDetector). An additional experiment was carried out to show that the RootDetector was unaffected by changes in soil moisture. Root length density was 40 % higher at the beginning of winter and 51% higher at the end of winter than in summer, indicating a net root loss during early summer, which was compensated afterwards during more favourable conditions in autumn. Our study indicates that fine root length in temperate forests is seasonally more variable and, so far, less predictable than previously assumed. Profound information on seasonal variability is important for modelling terrestrial biogeochemical processes and global carbon fluxes.

Vegetation restoration can stimulate changes in soil properties and root traits, which then cause change in rill erosion process (indicated by rill erodibility ( Kr) as well as critical shear stress ( τc)). The present work chose eight typical herbaceous plants, commonly appeared at diverse vegetation succession period on the Chinese Loess Plateau, for discovering how soil properties and root traits affected rill erosion. In total, we collected 240 undisturbed soil samples for flow scouring within the hydraulic flume in the presence of six shear stresses (range, 5.94-18.58 Pa). According to our findings, Kr and τc were 0.015-0.411 s m -1 and 0.050-6.059 pa among eight typical species. Cultivated species have high Kr and low τc, the Kr was 4.70 to 24.28 times greater than other species, and τc was 89.23% to 98.30% less than other species. In addition, plants that had the tap root system had a 4.80-fold increased Kr value compared with those that had the fibrous root system, and τc was 49.78% less than those with fibrous root system. The Kr and τc were affected by root-soil complex, with interaction effects of root and soil being 54.2% and 50.4%, respectively. The Kr decreased with bulk density, soil cohesion, soil organic matter and soil aggregate as power functions, and decreased with root surface area density and root length density being exponential functions. The τc increased with specific root length and bulk density as power functions. Of those above-mentioned soil properties and root traits, Kr was dominantly affected by cohesion and root surface area density, and τc was affected by bulk density and specific root length. Kr was simulated through soil cohesion ( Coh) and root surface area density ( RSAD), and τc were simulated by soil bulk density ( BD) and specific root length ( SRL) as power functions. Our constructed model achieved satisfactory performance.

not-yet-known not-yet-known not-yet-known unknown Developmental plasticity is the capacity of a single genotype to express multiple phenotypes in response to different early-life environments. Such responses are defined by reaction norms, which may vary among individuals or populations. Variation in developmental reaction norms allows natural selection to operate on plasticity and is rarely examined in vertebrates. We quantified variation in embryonic developmental plasticity within and between populations using the brown anole lizard. We captured lizards from two islands in the Matanzas River (Florida, USA) and incubated their eggs under one of two multivariate treatments that mimicked the temperature, moisture, and substrates of nest sites in either a shaded or open habitat. We measured hatchling morphology, performance, and physiology to quantify variation in family-level reaction norms. We observed evidence of family-level variation in reaction norms for morphology but not for performance or physiology, indicating an opportunity for natural selection to shape plasticity in hatchling body size. Overall, the results indicate that multiple abiotic conditions in natural nests combine to increase or reduce phenotypic variation, and that family-level variation in reaction norms provides a potential for natural selection to shape plasticity.

The fatigue damage accumulation behavior of GH4169 superalloy was studied through two-level loading fatigue tests based on an electromagnetic resonance testing machine. A total of 178 experimental data points and 13 S-N curves were obtained. By comparing and analyzing experimental data, the influence of stress and fatigue damage in the first-level loading on the residual fatigue life of the material was studied. The effect of first-level fatigue damage on the residual fatigue life of different second-level stresses was explained. A new fatigue damage accumulation rule was proposed and validated using several nonlinear fatigue cumulative damage models. The results indicate that this rule can serve as a criterion for evaluating the accuracy of fatigue cumulative damage models.

This paper reports the failure analysis of the pinion shaft of a bevel planetary gearbox in the agitator drive system of a petrochemical plant. The shaft failed after 4 years of service. The metallurgical failure analysis and fractographic analysis were conducted by means of standard investigation procedures to seek the failure cause. The analysis included visual examination, fractographic analysis by scanning electron microscope (SEM), chemical compositional analysis by optical emission spectroscopy (OES), and hardness testing. The results showed that the failure of the shaft was initiated by the micro-pits formed on the surface of the keyway by fretting. The crack propagated in fatigue and a relatively small final fracture zone was observed which is indicative of low stress concentration on the shaft at the point of failure. The lower hardness was observed near the crack initiation region which was the probable cause of the initiation of micro-pits. It was concluded that the shaft failed due to anomaly in the shaft design/manufacturing or incompatibility in the hardness of the keyway that resulted in fretting at the contact surface. It was recommended to revise the manufacturing procedures after consultation with the manufacturer.

Regulation of the thermal performance of electrical components is a key aspect. Phase-change materials can be incorporated into a fin heat sink (FHS) to enhance thermal management by maintaining a stable temperature. Three types (square, triangular, and circular) of aluminum FHSs of different configurations are investigated numerically in this paper. Studies are conducted with and without PCMs. Paraffin wax, stearic acid, and polyethylene glycol are used as PCMs to find the best combinations for thermal cooling and to determine the impact of using PCMs in the heat sinks. The results obtained show that, by adding PCMs, temperature rise can be delayed, and polyethylene glycol performs better than other PCMs. Moreover, the square fin heat sink increases the thermal regulation period. As the height of the fins increases from 10 mm to 16 mm, thermal efficiency increases. Hence, the findings of this paper would be beneficial for effective thermal management in the electronic industry.

Warring the increasing incidence of Parkinson’s disease (PD) requires better characterized animal models, in particular of the PD prodrome. Since pesticide are well-established triggers of Parkinsonism, we now undertook a detailed characterization of the time dependent onset of behavioral and neurochemical alterations after the repeated daily i.p. administration to adult male rats of a low dose of rotenone (2.75 mg/kg) during weekdays for 21 days. The onset of motor (bradykinesia in the open field test) and coordination deficits (balance in the rotarod and rearing in the open field) occurred after 14 days of exposure to rotenone, linked to a nigrostriatal dopaminergic degeneration and increased accumulation of alpha-synuclein, which are key features of PD. Moreover, we identified several modifications pre-dating the onset of PD-like motor symptoms, encompassing gastrointestinal alterations and a modified whole-body composition together with olfactory dysfunction and memory and emotional impairments, which were typified by: i) a delayed gastric emptying of liquids (13CO2 analysis), which was evident from the third day of rotenone administration and was aggravated over subsequent days; ii) a loss of total, visceral and subcutaneous body fat and dehydration (bioimpedance spectroscopy); iii) olfactory dysfunction (discrimination test and food buried test). The characterization of this prodrome period in this robust model of PD offers a unique window of opportunity to investigate the pathophysiological mechanisms of PD onset and to devise and test novel neuroprotective strategies.

not-yet-known not-yet-known not-yet-known unknown Abstract This review examines the association between early life exposure to phthalates in human males and Leydig cell endocrine function. A systematic search was performed in PubMed and EMBASE, identifying 17 studies for analysis. Association scores weighted for number of phthalates and subjects were calculated for luteinizing hormone (LH), testosterone, testosterone/LH ratio, and insulin-like factor 3 (INSL3). The scores ranges from full consistency of positive (score = 1), through inconsistent (score = 0), to negative/inverse (score = -1) associations. LH and early life phthalate exposure showed a statistically significant weighted phthalate association score of 0.18. Testosterone showed largely null results, while testosterone/LH ratio showed a negative association, both not statistically significant. A rise in LH, and decrease of testosterone/LH ratio, indicates that early life phthalate exposure results in a demand for a larger LH stimulus to produce the same amount of testosterone, and perhaps a decreased function of the Leydig cells, that manifests with the onset of high testosterone production in puberty and adulthood. A non-statistically significant decrease in INSL3, with a weighted phthalate association score of -0.29 supports this finding. An early life phthalate exposure induced decline in Leydig cell function, could possibly impact the spermatogenesis and adult male fertility.

Prey abundance is recognized as a key component for the recovery of the tiger ( Panthera tigris) population. Long-term monitoring is imperative for understanding the trends in prey populations and helps assess the management interventions. We provide data on the tiger prey populations that include chital ( Axis axis) , chousingha ( Tetracerus quadricornis) , nilgai ( Boselaphus tragocamelus), sambar ( Rusa unicolor), and wild pig ( Sus scrofa) from Kawal Tiger Reserve (KTR) for a period between 2010–2022. We conducted our study using 28 permanently marked transects in a systematic survey design with a random start. The trends in the principal tiger prey populations were also compared across the years. The chital population has shown a significant rise but sambar, nilgai, and chousingha populations were consistent with a slight increase. The wild pig population was typically showing extreme fluctuations. We used the prey-biomass and prey-abundance-based models to predict the ecological carrying capacity of tigers. Based on the prey availability at KTR, we predicted that the reserve could potentially support more than 30 tigers in its core area. However, in the past 10 years, tigers have failed to recolonize KTR despite the movement of 11 tigers from the source sites of which only 2 were females. Therefore, we suggest that establishing a breeding tiger population may need restocking, focusing on the females, and maintaining connectivity with the tiger landscapes in neighbouring Maharashtra State having Protected Areas with a healthy source population. After being declared a tiger reserve in 2012, the level of protection in KTR has increased but the anthropogenic stressors are yet to be fully dealt with. Our long-term monitoring study has systematically documented the trajectory of prey populations and we predicted a significant increase in the carrying capacity of tigers in the Core of KTR.

This study investigates the fatigue behavior of AlSi9Cu3 aluminum die-cast alloy after pre-exposure to accelerated environmental conditions (pre-corrosion). The research highlights the significant impact of corrosion, particularly localized corrosion within the microstructure, on the fatigue strength of this alloy. It introduces a numerically efficient fatigue assessment method for pre-corroded specimens, employing fracture mechanics principles. The investigations reveal the significance of considering short crack propagation in fatigue assessment especially for small corrosive defects. Polished specimens were exposed to an acidic aqueous salt solution to simulate accelerated real-world corrosive conditions. Experimental fatigue tests revealed a 34 % reduction in long-life fatigue strength for pre-corroded surface condition compared to polished condition. Numerical simulations, which treated corrosion as a crack-like surface imperfection, were used to estimate fatigue life and fatigue limit. These simulations provide conservative estimates for the examined initial flaws equal to the maximum corrosion depth. The variation in long-life fatigue strength for all examined flaw geometries ranged from 13.7 % above to 22.2 % below the experimentally determined fatigue strength of the pre-corroded surface. These findings highlight the necessity of incorporating short crack propagation in fatigue assessments, particularly for small corrosive defects, to ensure the reliability and safety of components in corrosive environments.

In this paper, we tackle the challenging problem of multi-target cross localization within a novel distributed high-frequency surface wave radar (HFSWR). This system consists two transmitter-receiver pairs, each of which can correspondingly generate a set of Range-Doppler measurements. By associating the Range-Doppler measurements from the same target, the individual target location can be derived using the associated measurements. However, when multiple targets are involved, it is unknown which measurements originate from the same target, leading to ambiguities in the measurement-to-measurement association. False associations can result in the ghosts, ultimately degrading the overall system performance. To deal with the ghosts, we propose a three-stage deghosting method that incorporates the geometric characteristics of the system, the velocity features of the targets and the motion features of the targets across multiple frames. ̵‌The simulation results demonstrate the effectiveness of our proposed method compared with the other investigated deghosting algorithms. Our proposed approach exhibits robust target detection capability while significantly reducing both the OSPA error and the cardinality error.

A document by Joowon Lee. Click on the document to view its contents.

TITLE: Post-infectious bronchiolitis obliterans in children after the end of the COVID-19 pandemic.To the Editor,Bronchiolitis obliterans (BO) is a rare disease in which the main characteristic is chronic obstruction of the small airways. Post-infectious is the most common cause in children, mainly due to adenovirus (ADV), followed by other viruses such as respiratory syncytial virus (RSV), influenza or parainfluenza. Histologically, inflammation and fibrosis of the terminal bronchioles occurs, with total or partial obliteration of their lumen. The diagnosis of post-infectious bronchiolitis obliterans (PIBO) relies on a compatible clinical history of previous respiratory infection, usually severe, followed by chronic symptoms such as cough, tachypnea, intercostal retractions, hypoxemia and/or pathological auscultation with bilateral or unilateral fine crackles. Computed tomography (CT) of the lungs shows signs of mosaic perfusion pattern, with or without bronchiectasis, and pulmonary function tests with fixed airflow obstruction1. Treatment consists of a combination of anti-inflammatory drugs, oxygen therapy, bronchodilators, respiratory physiotherapy and antibiotics in case of acute infections2.Different authors have described their PIBO cases, highlighting ADV as the main microorganism involved. The highest incidence and prevalence are found in different South American countries with an Amerindian population, such as Argentina, probably related to the presence in these individuals of a characteristic HLA haplotype (DR8-DQB1*0302). The prevalence of PIBO reported in patients developing the disease with severe pneumonia was 30.3% in the province of Jilin, China, after an epidemic outbreak of ADV that occurred in the period from 2018 to 20203. To date, the increase in the number of PIBO cases after the end of the COVID-19 pandemic and the lockdown measures imposed to stop its spread remains unpublished for any geographic area.The epidemiological, etiological, clinical, diagnostic and evolutionary characteristics of 18 pediatric cases with PIBO over a period of 15 years in our center (January 2008 to January 2023) are described. Using the Shapiro-Wilk test, we described quantitative variables as mean and standard deviation (SD) when having a normal distribution, and median and interquartile range (IQR) if they corresponded to non-parametric variables.Of 18 patients diagnosed with PIBO, most are male (67%) and Caucasians (90%). Regarding the causal infection, it occurred at a median age of 1.76 years (IQR 0.96-3.02), with the time interval between October 2022 and January 2023 having the highest number of cases (10 cases) (Figure 1). The most frequent symptoms were cough (100%), fever (94%) and respiratory distress (94%); 100% were diagnosed with bronchitis and 71% with bronchitis and pneumonia. In 11 cases (61%) ADV was isolated as a causal agent, and in the remaining 7 cases ADV could not be confirmed (not analyzed in 5 and unknown in 2). The most frequent findings on chest radiography were pulmonary hyperinflation with unilateral (47%) or bilateral (33%) infiltrate. Hospital admission was required in 94%, out of which 11% were serious infections admitted to the Intensive Care Unit (ICU). Hospitalization time was 9 days (IQR 6.3-14.8 days). Treatment of acute infection was with short-acting beta2-agonist (SABA) nebulization (100%), systemic corticosteroids (SCS) (79%), antibiotics (93%) and oxygen therapy (93%). Two patients required non-invasive mechanical ventilation and 1 endotracheal intubation with invasive mechanical ventilation (IMV).The characteristic clinical history (persistent obstructive respiratory symptoms after a severe infectious condition) and typical radiological findings (mosaic perfusion pattern on CT of the lungs) is the basis for diagnosis. The median age at diagnosis was 3.10 years (IQR 1.89-6.34), with a median time between the causal infection and diagnosis in the entire sample of 1.21 years (IQR 0.65-3.38) and of those infected in 2022-23 of 0.65 years (IQR 0.48-0.78). The most frequent clinical finding after the acute infection was persistent pathological lung auscultation (89%) and recurrent bronchitis (61%). All cases showed a mosaic perfusion pattern on CT of the lungs, 83% bilateral and 17% unilateral (Swyer-James syndrome). A valid forced spirometry test was possible in 56%, all of them showing an obstructive airflow pattern defined by a Z-Score lower than –1.64 (lower limit of normality) of the forced expiratory volume in 1 second (FEV1)/forced vital capacity (FVC) (FEV1/FVC ratio). The mean Z score (±SD) values of forced spirometry are FVC -1.75 (±1.59); FEV1 -3.25 (±1.22); FEV1/FVC -2.66 (±0.59); and the forced expiratory flow at 25-75% (FEF25-75%) is -3.34 (±0.68). The maintenance treatments they received are inhaled corticosteroids (ICS) (28%); ICS with long-acting bronchodilators (LABA) (56%), oral azithromycin (56%); leukotriene-receptor antagonist (78%); SABA rescue inhalers (100%) and 11% do not receive any maintenance treatment. The median course of the disease is 1.30 years (IQR 1.21-8.18).In summary, most cases with PIBO diagnosed in our center had the causal infection with less than 2 years of age, with ADV being the main virus involved, isolated or in coinfection with other viruses such as RSV. Seventeen patients required hospital admission and the most common diagnosis was bronchitis with bilateral pneumonia. Two patients required admission to the ICU due to severe respiratory failure, one of them requiring orotracheal intubation. The basis of the diagnosis is persistent symptoms after the initial infectious condition, supported by the involvement of ADV and an obstructive pattern in spirometry. CT of the lungs with mosaic perfusion pattern served as diagnostic confirmation in all patients. No lung biopsy was required in any of them. The time from the initial injury to the diagnosis of PIBO in our series is approximately 1 year with a disease progression time of 1.3 years. The treatments used, the most in the chronic phase, are ICS with or without LABA, montelukast and oral azithromycin. Only one patient currently requires home oxygen therapy (Table 1).The authors would like to highlight the significant increase in the number of pediatric cases of PIBO in our geographical area, the Autonomous Community of Aragón (Spain), during the months of October 2022 to January 2023 after the end of health restrictions for the recent COVID-19 pandemic. This phenomenon to our knowledge in not published or documented by other authors. Of the 18 cases, 7 had the initial infection related to ADV during this period, and in 2 patients the involvement of ADV is unknown. We are unable to demonstrate in our center an increase in the incidence of serious ADV infections after the COVID-19 pandemic. Regardless, we believe that, as has happened with other microorganisms such as Streptococcus pyogenes group A4 or RSV5, the end of COVID-19 restrictions has led to the appearance of more aggressive infections, in atypical epidemic seasons, a phenomenon known as “immunity debt”6. A recent hypothesis is that children born during the COVID-19 pandemic, where there was a clear decrease in the circulation of viruses, lowered physiological development of immunity due to minimal contact with these infectious agents. After returning to “normality”, the usual infections have appeared in greater numbers and aggressiveness. Analyzing the subgroup of patients infected after the pandemic, all of them were born during the lockdown periods (2020-2022), the disease began at an age of 1.35 years, and the time until diagnosis was shorter than in the total number of patients, 0.65 years. Another interesting fact extracted from our series is that, unlike what other authors describe, most of our patients did not require oxygen therapy for more than 60 days, so we believe that this criterion is not essential for the diagnosis, relying more on other variables such as persistent pathological lung auscultation and subsequent severe bronchitis.

not-yet-known not-yet-known not-yet-known unknown Detailed knowledge of transcriptional responses to environmental cues is impossible without single cell (SC) resolution data. We performed two SC RNAseq experiments surveying transcriptional profiles of females and males of Daphnia magna, a freshwater plankton crustacean which is both a classic and emerging new model for eco-physiology, toxicology, and evolutionary genomics. We were able to identify over 30 distinct cell types about half of which could be functionally annotated. First, we identified ovaries- and testis-related cell types by focusing on female- and male-specific clusters. Second, we compared markers between SC clusters and bulk RNAseq data on transcriptional profiles of early embryos, circulating hemocytes, midgut, heads (containing brain, eyes, muscles, and hepatic caeca), antennae II, and carapace. Finally, we compared transcriptional profiles of Daphnia cell clusters with orthologous markers of 250+ cell types annotated in Drosophila cell atlas. This allowed us to recognize striated myocites, gut enterocytes, cuticular cells, as well as 5 different neuron types, including photoreceptors. One well-defined cluster showed a significant enrichment in markers of both hemocytes and fat body of Drosophila, but not with bulk RNAseq data from circulating hemocytes, allowing us to hypothesize the existence of non-circulating, fat body-associated population of hemocytes in Daphnia. On the other hand, the circulating hemocytes express numerous cuticular proteins suggesting their role, in addition to macrophagy, in wound repair. The baseline SC resource presented here will be useful for a variety of researchers using Daphnia to answer in-depth questions in ecophysiology, toxicology and biology of adaptation to changing environment.

According to the existing facts, COVID-19 is prone to infection for a long time, and attacks the immune system, and the immunity of the population continues to decline. Decreased immunity has a limit (immune deficiency), which can cause opportunistic infections, tumors and other problems. In addition, myocarditis and neurological problems should not be ignored. In this paper, we guess that the virus invasion of cells is the result of the interaction of proteins on the membrane. Epidemiology predicts that the symptoms related to COVID-19 are follow by a biased normal distribution, which is at the bottom, and further outbreaks will occur in the future. We also mentioned measures that should be taken now (Promote detection of immunity, such as CD4 cell counts).

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not-yet-known not-yet-known not-yet-known unknown 1 Introduction: Endometriosis is a medical condition where endometrial-like tissue grows outside the uterine cavity. Though different studies show different etiology, its growth is regulated by hormones and is associated with menstruation. In females, it is the most common cause of chronic pelvic pain. The estimated prevalence of it in women of reproductive age group is about 12%. And about 15-25% of it is found in women with infertility problems.(1) The most common sites of its involvement are ovaries, uterosacral ligaments, pouch of Douglas, rectosigmoid colon, bladder and distal ureter. The abdominal wall is the most frequent site of extra-pelvic endometriosis (4%) and is often linked to surgical scars from previous gynecologic procedures such as cesarean sections, hysterectomies, hysterectomies, tubal ligations, or myomectomies.(2) Though the abdominal wall is the most common site of extra-pelvic endometriosis, its occurrence in the anterior abdominal wall is rare. When it does occur, it presents as a palpable lesion associated with cyclical pain and a history of abdominal surgery, particularly cesarean section (CS).(3) Only around 0.03-0.4% of cesarean section surgeries develop the rare complication of surgical scar endometriosis. Because of its rare occurrence, there is a high rate of misdiagnosis, often being mistaken for hematomas, hernias, granulomas, abscesses, neuromas, or even neoplastic tissues. And a high level of clinical suspicion is required to diagnose iatrogenic scar endometriosis in women who present with abdominal pain and have a history of abdominal surgeries.(4) Here, we report a case of cesarean scar endometriosis in a 27-year-old woman presented with cyclical abdominal pain, occurring two years after a cesarean section adhering to SCARE guidelines 2020.(5) 1 Introduction:

not-yet-known not-yet-known not-yet-known unknown Aim: To establish whether the initial positive effect of nusinersen (NUS) on respiratory outcomes in the first year of treatment was maintained in children with Spinal Muscular Atrophy (SMA) type 2 and to further define the effect on children with type 3 treated over 3 years. Methods: A prospective observational study of children with type 2 and 3 beginning NUS in Queensland, Australia between June 2018 – December 2020 was undertaken. Investigations conducted included age-appropriate lung function and polysomnography. Lung function data for two-years preceding NUS initiation was retrospectively collected. Change in lung function/polysomnography was assessed using mixed effects linear regression. Results: 24 of 30 children with type 2 and 3 SMA (14 males; 0.4-17.3 years) were included (type 2 n=12; type 3 n=12). No child had respiratory-related admissions during the period of study. For type 2, annual decline in FVC z-score pre-treatment was -0.75 (95% CI: -1.14, -0.39, p<0.001), and for the first 3 years on NUS was -0.20 ([95% CI: -0.33, -0.06, p=0.01] difference p=0.008). For type 3 minimal change was seen: pre-NUS and post FVC z-scores -0.20 (95% CI: -1.00, 0.61 p=0.05) and -0.46 (95% CI:-0.88, -0.04 p=0.40) respectively (difference p=0.46). Mean change in total apnoea-hypopnoea indices (total AHI) in type 2 tended to reduce -1.75 (95% CI: -4.95-0.9, p=0.24); type 3 appeared to remain stable (-0.39 [95% CI: -1.1-0.33, p=0.28). One child with type 2 ceased NIV due to normalisation of total AHI and gas exchange. Conclusion: Nusinersen lung function (FVC-z-scores) stability seen in the first year was maintained over 3 years and the total AHI tended to improve in type 2, but the long-term effects in type 3 are less clear.

Objective: A significant increase in Parvovirus B 19 (B19V) infections has been reported in the last months in some European countries. This outbreak could be highly detrimental for pregnant women, considering the capacity of the virus to harm the fetus. However, the magnitude and spread of this outbreak is yet unclear. There is the need for more evidence from other areas and focusing on pregnancy. Methods: Pregnant women with B19V infection who were managed in a referral hospital located in Milan, Northern Italy were reviewed. The primary aim was recording the frequency of ascertained cases of B19V infection in the period January-July 2024 and comparing these data to the frequencies recorded in the previous 9 years (2015-2023). The secondary aim of the study was comparing the severity of the infections in these two periods. Results: The number of B19V infections markedly increased in the first 7 months of 2024. Until 2023, the number of cases per year were below 7, with no cases reported in 2020-2022, while in the period January-July 2024, the number raised to 59 (p<0.001). Maternal characteristics and fetal outcomes before and after January 2024 did not differ. Conclusions: Italy is also involved in the ongoing outbreak of B19V infection and pregnant women are exposed to this threat. Public health authorities must promptly engage to monitor the situation and consider the possibility to introduce universal screening and global preventive measures, at least up to the end of the surge.

As cyber threats proliferate with increasing sophistication, the timely and accurate generation of security documents adherent to Common Criteria (CC) standards becomes imperative. This study continues the trajectory set by previous research on CCGenTool, which simplifies the creation of Security Target documents, and elevates it through the integration of Llama2, a cutting-edge Large Language Model (LLM), aimed at enhancing justifications for security objectives within CC documentation. Bringing this advancement to fruition, This research employed Parameter-Efficient Fine-Tuning (PEFT) strategies such as Low-Rank Adaptation (LoRA), optimizing Llama2 without compromising its pre-trained complexity. Adopting an extensive dataset of 692 items derived from various Protection Profiles efficiently annotated for relevance and contextuality—the split designated 70% to train the model while reserving 30% for evaluation purposes. By facilitating a sophisticated fine-tuning protocol that allowed tailor AI outputs closely aligned with industry-specific requirements. Benchmark results exhibit commendable performance: in tests contrasting this research fine-tuned LLM against GPT-3.5 utilizing GPT-4 as an analytical frame, it shows that the result is more towards Llama2 in 25 instances against only seven for GPT-3.5; both models’ outcomes converged in quality 18 times. These findings accentuate how AI can assist not only in safeguarding against emerging cyber threats but also caters to the dynamic landscape where up-to-date CC documentation is crucial for effective defense strategies. By intelligently abbreviating complex document production processes entailed in cybersecurity measures, this innovation confers upon developers a significant advantage—reducing barriers and expediting compliance timelines amidst evolving digital risks.