In this article, I propose measures for the positive growth and prevention of potential harms of artificial intelligence (AI) from a philosophical, aesthetic, and sociological perspective on a global scale. Drawing from my extensive background in various technology and AI fields, education, management, and research, I urge thinkers and specialists to reach a consensus on practical solutions to strengthen AI's positive aspects and prevent its risks.

The incidence of ciprofloxacin-resistant Salmonella has increased considerably over the past decade. This study aimed to explore interactions among genetic determinants defining ciprofloxacin resistance in Salmonella including the efflux pump and plasmids. After treatment with PAβN (a resistance nodulation-division efflux pump inhibitor), a decline ranging from 4–32-fold in minimum inhibitory concentration (MIC) was observed in all 18 ciprofloxacin-resistant Salmonella isolates tested. Particularly, all the strains without point mutations changed from resistance to sensitivity. Moreover, the efflux pump is critical for fluoroquinolone resistance development in serovar Enteritidis because of a larger range reduction (16 or 32-fold) caused by the inhibition in the five S. Enteritidis strains carrying a GyrA (Asp87Tyr) mutation with relatively high MICs (8 μg/mL). Genes oqxAB and aac(6′)-Ib-cr located on incompatibility (Inc) F-type plasmids in S. Enteritidis, IncA /C in S. Typhimurium and Inc HI2 in S. Virchow were transferable, while qnrS1 and/or qepA were driven by the Inc A/C type in S. Thompson. Whole-genome sequencing showed that an oqxAB module was detected in the chromosomal DNA of S. Derby. Moreover, the MIC of ciprofloxacin in the transconjugants/transformants remained low (1-4 μg/mL) but was above the breakpoint level, implying that plasmid-borne determinants might confer relatively low-level resistance to allow their host to survive long enough to develop high level resistance. These findings emphasize that both the efflux pump and the transmission of plasmid-borne resistance mechanisms could contribute to the sharp increase in the occurrence of ciprofloxacin resistance and pose a considerable threat to food safety.

Case Report: Reversing Gray Hair Associated With COVID-19: A Coincidence or a Clue?Meijiao Du 1,2, Ying Wang2, Huijuan Fang 1,3, Ying Xie 1,2, Yonglong Xu1,2, Dingquan Yang 2*

Objective: To investigate the prevalence and experience of symptom flares in women with Chronic Pelvic Pain (CPP) as well as their triggers Design: Cross-sectional questionnaire within the Translational Research in Pelvic Pain clinical cohort study. Setting: Women with CPP, with subgroups of women with endometriosis (EAP), interstitial cystitis/bladder pain syndrome (BPS), comorbid endometriosis and interstitial cystitis/bladder pain syndrome (EABP), and those with pelvic pain without endometriosis or interstitial cystitis/bladder pain syndrome (PP). Population or sample: 100 participants across subgroups. Methods: Questionnaire within large cohort study. Main Outcome Measures: The prevalence and characteristics of short, medium and long symptom flares in CPP. Results: 76% of women with CPP experience symptom flares of at least one length (short, medium and/or long). Flares are associated with painful and non-painful symptoms. There is large variation amongst those with CPP for the frequency, duration, symptoms and triggers for these flares. Participants reported flares as stopping them from doing things they would usually do, participants thinking about symptoms of flares as well as flares being bothersome. Conclusions: Flares are prevalent and clinically very important in the context of CPP. More research is needed to elucidate the mechanisms and characteristics underlying flares. Clinical practice should include an enquiry of flares with the aim of finding strategies to lessen their burden. Funding: This project has received funding from the Innovative Medicines Initiative 2 Joint Undertaking under grant agreement No 777500. This Joint Undertaking receives support from the European Union’s Horizon 2020 research and innovation programme and EFPIA Companies.

Security and privacy of conventional homogeneous networks such as MANETs and WSNs have been widely studied in the literature. However, with the emergence of a new generation of non-homogeneous networks, the existing solutions on privacy and anonymity should be re-investigated from a practical point of view. In the internet of things (IoT), sensitive and confidential contents are transferred over machine to machine (M2M) networks. This volume of private data in the M2M networks is like a gold mine of data for adversaries; hence, it is crucial to ensure anonymity and trust of the identities in such networks. The main objective of this article is to provide a comprehensive overview on anonymity-related attacks and the privacy solutions for M2M networks. First, the architecture and characteristics of M2M networks are reviewed and the potential targets of adversaries along with the privacy threats are described. Then, the security solutions to countermeasure the threats and to maintain privacy in M2M networks are categorized and surveyed.

The enhancement of methane production is crucial in increasing the self-sufficiency of wastewater treatment plants, and anaerobic digestion (AD) is considered the sustainability driver as it serves as the energy recovery unit. Artificial intelligence techniques provide a way to control the process of AD without requiring knowledge of its nature. The purpose of this study is to examine the use of artificial neural network (ANN) to model the digesters in the wastewater treatment plant in Konya, Türkiye, and to optimize the methane yield and hydrogen sulfide concentration. The constructed model is based on 11 parameters as input features, whereas methane yield and hydrogen sulfide serve as output. The study analyzes the sensitivity of input parameters on output parameters using the ANN model. It utilizes the genetic algorithm to determine the optimal values of input parameters that maximize methane production and minimize hydrogen sulfide. The proposed model was evaluated using the mean-square error (MSE) and correlation coefficient (R) for both training and test sets. The results indicate that the MSE and R are 0.96, 0.94, 0.0048, and 0.0077, respectively. The sensitivity analysis shows that the pH level of thickened sludge has the greatest impact on both outputs. Conversely, the sludge flow rate has the lowest impact on methane, while the volatile fatty acid of the digester has the lowest impact on hydrogen sulfide. Moreover, multiple optimal solutions can maximize methane gas and minimize hydrogen sulfide. Methane yield can be increased up to 27%, with corresponding hydrogen sulfide of 350 ppm.

Aims: The study’s primary objective is to develop machine learning models capable of effectively assessing fetal status through cardiotocography (CTG). Methods: This research entailed the development of 12 machine learning approaches, focusing on quantitative features extracted from fetal heart rate (FHR) and uterine contractions (UC) signals. The performance of these models was evaluated using various metrics, including the quality index, accuracy, sensitivity, specificity, F1 score, area under the receiver operating characteristic curve (AUC), and Brier scores. Additionally, the study involved an in-depth analysis of feature importance with Shapley Additive Explanation (SHAP) values and how different sets of features contributed to enhancing model performance. Results: The Stacking ensemble model emerged as the most effective, outperforming other models, particularly when utilizing a select set of the top 65 features. Key variables in predicting fetal abnormalities were identified as the number of accelerations and decelerations, along with the covariation of Wavelet Coherence Transformed time-frequency images for FHR and UC. The study highlighted the crucial role of feature engineering in boosting the models’ predictive accuracy. Conclusions: The deployment of these machine learning models holds significant potential in aiding clinical decision-making, especially in the early detection of fetal pathological conditions. Representing a significant advancement in fetal health monitoring, these models promise to be invaluable tools for healthcare professionals worldwide, enhancing the standard of prenatal care.

Remaining Useful Life (RUL) has become widely recognized as a key metric for evaluating system reliability within the field of Prognostic and Health Management (PHM). It plays a crucial role in predicting a system’s health status and its expected lifespan. While significant efforts have been directed towards accurately estimating RUL, the process of decision-making regarding health management and potential adjustments to equipment lifespan still poses questions. This study introduces a state-space methodology designed to effectively manage RUL and, thus, the end-of-life of a degrading system, particularly focusing on controlled operation systems. Through an investigation of the relationship between the operational dynamics of the system and its aging process, the study specifically concentrates on regulating the degradation rate experienced during operation. A robust design method of an observer and a controller is presented to effectively govern the degradation trajectory, allowing for the achievement of an acceptable level of deterioration within a desired average lifetime. To demonstrate the performance and practical application of the proposed approach, it is applied to a variable-speed wind turbine with a flexible shaft subjected to torsion effects. The results highlight the benefits of using RUL control as a Health-Aware Control (HAC) strategy, aiming to find an optimal balance between reliability and production objectives. This study makes a valuable contribution to the field of reliability engineering by providing insight into managing the end-of-life of controlled processes suffering from aging. It is showed that the RUL control problem can be conveniently expressed as the problem of controlling a polytopic uncertain system. For this reason, a discrete-time robust LQR controller design is presented for solving the polytopic control design problem.

The COVID-19 pandemic has underscored the importance of waste separation for efficient management, disease control, public health protection, and fostering sustainable communities. This study investigates residents’ waste separation behaviour in Nigeria during the pandemic using an extended Theory of Planned Behaviour (TPB) framework. Analyzing data from 726 residents in Lagos and Oyo states, we found that attitude, perceived behavioural control, subjective norms, and intention significantly predict waste separation behaviour, with attitude emerging as the strongest influence. This highlights the crucial role of individual beliefs in shaping waste management practices. Importantly, past waste separation behaviour positively correlates with the intention to separate during public health emergencies. However, perceived policy effectiveness negatively moderates the link between intention and actual separation behaviour. This study suggests strategies for improved biodegradable infectious waste management to support economic activities. More so, Post-COVID-19 pandemic tailored interventions and policies are crucial to enhancing waste separation behaviour, ultimately promoting public health and sustainable communities in Sub-Saharan Africa, for day-to-day environmental safety or preparedness in the event of future health emergencies.

A document by Daregot Tenessa. Click on the document to view its contents.

Background Dietary diversity is crucial for nutritional adequacy, particularly among women of reproductive age who experience increased nutritional needs due to menstruation, pregnancy, and lactation. The significance of dietary diversity becomes particularly pronounced in addressing the prevalent issue of anemia in Rwanda. This anemia may pose significant health risks for both mothers and children and by promoting a diverse and balanced diet, we can take a crucial step in mitigating the adverse effects associated with this condition. Objective This study aims to assess Dietary Diversity, Nutritional Status, and related Factors Affecting Rwandan Women engaged in Agriculture. Methods A cross-sectional study in western Rwanda’s high malnutrition districts, Nyamagabe, Karongi, and Nyabihu, used a multi-stage sampling method. Three farming-based clusters emerged: tea, subsistence, and Irish potatoes. Households with children under five were systematically sampled, with sample size calculated using Taro Yamane’s formula, and data was analyzed in SPSS v25. Results The study included 439 respondents, with an average age of 33.05 years. 359(81.8%) participants had low dietary diversity whereas Nyamagabe had the highest proportion with 39%. 22.1% of participants had mild or moderate anemia with the cutoff below 11.9 g/dl where Karongi had the high proportion with 10.7%, Anemia prevalence was 22.1%, with Karongi having the highest at 10.7%. Head of household Education (AOR=6.4,95%, CI:1.05-39.7), Age of women (AOR=3.03,95%, CI:1.1-7.8), and wealth status (AOR=1.66,95%, CI:0.51-5.4) were associated with higher odds of High dietary diversity. The occupation of women (AOR=0.13,95%, CI:0.001-0.19), reading skills (AOR=0.27,95%, CI:0.1-0.72). and family size (AOR=0.63,95%, CI:0.35-1.1) were, however, associated with lower odds of lower dietary diversity. Conclusion This study of 439 participants revealed significant findings regarding dietary diversity, anemia prevalence, and socio-demographic factors, emphasizing their crucial role in understanding and addressing nutritional status among women in Rwanda.

The morphology of the active layer plays a crucial role in the performance of organic photovoltaics. Although volatile additives are commonly used to manipulate the morphology, their mechanism of action remain poorly understood. In this study, we conducted a systematic exploration of the mechanism of the traditional volatile additive 1-CN in film formation kinetics of typical PM6:Y6 system. We found that 1-CN induces a secondary aggregation effect, improving film morphology and promoting face-on crystalline orientation. Through elucidating its impact on exciton dynamics, we established a link between morphology optimization and increased exciton diffusion length and accelerated charge separation. Our findings unveil the unique mechanism of action of volatile additive, providing a new perspective for improving the morphology and enhancing the performance of organic photovoltaic devices.

1. Introduction:Postpartum autoimmune thyroiditis typically presents within one year following delivery and exhibits a prevalence of 8% in the general population. However, this incidence significantly escalates to 20% among individuals with a history of type 1 diabetes or a familial predisposition to thyroid disorders.(1) Lymphocytic hypophysitis (LH) is a rare condition characterized by inflammation of the pituitary gland that usually affects women during the last trimester of pregnancy or the first six months after delivery. (2) Two autoimmune conditions prominently manifest in connection with pregnancy: postpartum autoimmune thyroiditis and autoimmune hypophysitis. We present an extremely rare incidence of thyroid storm due to postpartum thyroiditis followed by the surprising diagnosis of lymphocytic hypophysitis, leading to panhypopituitarism.

Key clinical message:  Adrenal schwannomas, though typically benign and often incidentally kndiscovered, can present significant postoperative challenges such as chylothorax and chylous ascites. Early recognition of these complications, characterized by milky discharge from surgical sites, abdominal distention, and pleural effusion, is essential. Effective management requires a multidisciplinary approach, including dietary modifications, pharmacotherapy with somatostatin analogs, and interventions like thoracentesis and paracentesis. This comprehensive care strategy is vital for mitigating symptoms, promoting recovery, and improving patient outcomes.Abstract: Schwannomas originating from the Schwann sheath of peripheral or cranial nerves are rare tumors, commonly found in the head and neck region or extremities. Adrenal schwannomas, however, are exceedingly rare, accounting for less than 1% of all adrenal tumors. Here, we present a case of a 31-year-old Caucasian woman diagnosed with an adrenal schwannoma, which was incidentally discovered during imaging studies for an unrelated issue. Following open adrenalectomy, the patient developed chylous ascites and coexistent chylothorax, posing a diagnostic challenge and necessitating a multidisciplinary approach to management. This case highlights the complexities involved in diagnosing and managing rare adrenal masses and underscores the importance of a thorough clinical evaluation and vigilant postoperative monitoring.Keywords: Adrenal schwannoma, Chylous ascites, Chylothorax, Case report, Multidisciplinary management.Introduction:Schwannomas are rare tumors, originating from the Schwann sheath of the peripheral or cranial nerves. Schwannomas are common in the head and neck region or the extremities; visceral involvement of schwannomas is extremely rare. Only a handful of cases of adrenal schwannomas are reported [1] and overall, adrenal schwannomas make up less than 1% of all adrenal tumors, 1-3% of total schwannomas, and 0.4% of the retroperitoneal tumor [2]. In recent years, the advancements in imaging techniques have resulted in the inadvertent identification of more adrenal tumors, however, it is exceptionally difficult to make a preoperative diagnosis of adrenal schwannoma, and determining whether a tumor is an adrenal schwannoma can only be definitively established by pathologic examination with immunohistochemical staining [3, 4]. Adrenalectomy is the primary method used to manage adrenal tumors, although it can be linked with several complications, despite its generally acknowledged safety. Two rare yet severe complications that may arise following retroperitoneal surgery are chylothorax and chylous ascites [5]. We are presenting a rare patient who was diagnosed with adrenal schwannoma, and post-operatively, the case was complicated with chylous ascites and coexistent chylothorax.Case History/ Examination:A 31-year-old Caucasian woman with an unremarkable medical history, presented to the urology clinic due to a left adrenal mass initially discovered several years ago. Despite a previously unremarkable metabolic workup, recent imaging studies revealed an enlargement of the mass with atypical characteristics, prompting further investigation. Routine blood and hormonal workups, including serum cortisol, dehydroepiandrosterone sulfate (DHEAS), metanephrine, and normetanephrine, along with 24-hour urinary metanephrine and normetanephrine, again were within normal limits. However, due to the progressive increase in size, adrenalectomy was deemed necessary and performed.Subsequent histopathological examination following open adrenalectomy identified the mass as a cellular schwannoma, a rare finding in this location.Although the surgical procedure proceeded smoothly, the patient experienced a transient complication characterized by a milky discharge from one of the surgical incisions, which resolved spontaneously without intervention. However, a month following the surgery, she presented with symptoms of shortness of breath, abdominal distention, and a significant weight gain, prompting readmission to the hospital.Methods (Differential Diagnosis, Investigations and treatment):On readmission, Imaging studies revealed the presence of ascites, omental nodularity, retroperitoneal lymphadenopathy, and a large right-sided pleural effusion, indicative of a potential complication or metastatic spread (Figure 1,2,3). To address these concerns, therapeutic interventions including thoracentesis, and paracentesis were performed, which led to the diagnosis of chylothorax and chythous ascites (Figure 4). The patient was commenced on a high protein, low-fat diet regimen and initiated on somatostatin analog octreotide therapy to manage her symptoms and potentially mitigate further disease progression, and placement of an abdominal drain was performed, facilitating the removal of accumulated fluid. Following these interventions, there was a notable improvement in the patient’s clinical condition, prompting discharge from the hospital.Conclusion and Results (outcome and follow up)After close outpatient follow-up to monitor response to treatment and assess for any recurrence or new developments. This comprehensive approach underscores the complexity of managing rare adrenal masses and highlights the importance of a multidisciplinary approach in ensuring optimal patient outcomes. The case highlights the diagnostic intricacies regarding adrenal schwannoma, emphasizing that it is essentially a diagnosis of exclusion. Despite these challenges, it is imperative to consider adrenal schwannoma in the differential diagnosis of incidentally discovered adrenal masses, as demonstrated in this case. Moreover, the case underscores the importance of maintaining a heightened suspicion for chylous effusion in patients presenting with incision site drainage, as this complication can lead to prolonged hospitalizations and necessitate multiple procedures, as observed in our experience. Thus, clinicians should remain vigilant in recognizing and managing such complications to ensure optimal patient outcomes.Discussion:Schwannomas are tumors that arise from Schwann cells, which are cells that form the myelin sheath surrounding nerve fibers in the peripheral nervous system [6]. Theodore Schwann, a prominent German histologist, and physiologist, first characterized Schwann cells (1810–1882). Later on, Schwannomas was first described by Verocay in 1908 (7, 8), and then in 1920, Nils Ragnar Eugène Antoni identified two contrasting patterns within schwannomas [6].Schwannomas are usually benign [9]. However, it is important to note that between 5-18% of Schwannomas are linked to von Recklinghausen’s disease. When this condition is present, Schwannomas tend to be malignant and have a higher likelihood of appearing in multiple locations.Adrenal Schwannomas are believed to arise from one of the two sets of nerves that innervate the adrenal gland’s medulla; vagus or phrenic nerves. The schwannomas emerge from the medulla and compress the adrenal cortex as they grow [10].Adrenal Schwannomas are more commonly observed in females during the second or fifth decade of life, indicating a tendency towards occurrence in middle-aged women (11). Typically, these tumors do not exhibit any symptoms and are found unexpectedly during imaging studies conducted for unrelated purposes. Retroperitoneal schwannomas are often incidentally discovered during evaluations for nonspecific abdominal pain, typically exceeding 4cm in size at diagnosis. Imaging of a retroperitoneal mass localized to the adrenal region commonly presents a range of potential differentials, including adrenal adenoma, pheochromocytoma, myelolipoma, adrenocortical carcinoma, ganglioneuroma, and adrenal metastasis. Surgical excision remains the gold standard treatment for retroperitoneal schwannomas, providing both diagnostic confirmation and symptom relief [12, 13, 14]. As discussed above, chylous ascites and chylothorax are rare but serious complications that can occur after retroperitoneal surgery [5]. Postoperative chylous ascites (CA) arise due to inadvertent intraoperative injury to the lymphatic system, resulting in the leakage of lymph into the peritoneal cavity. The diaphragm then plays a crucial role in facilitating the absorption of chylous ascites into the thorax and leading to chylothorax [15, 16]. As far as treatment is concerned, in cases like ours, it is advisable to pursue a conservative approach involving a diet high in protein and low in fat, particularly rich in Medium-Chain Triglycerides (MCTs). MCTs are absorbed directly by intestinal cells and transported as free fatty acids (FFA) and glycerol to the liver via the portal vein, bypassing the thoracic duct [17]. Continuous intravenous high-dose somatostatin or its subcutaneous analog octreotide effectively reduces chyle formation in postoperative lymphatic leaks [5]. Alternatively, orlistat, an inhibitor of lipase activity, also shows promise in managing chylous ascites [18]. Other treatment options include peritoneal and pleural taps, chest tube drainage, and abdominal drain placement as performed in our case [17]. Surgical repair is typically considered after a 4-week trial of conservative management, with peritoneovenous shunting reserved for refractory cases [19]. When chyle reaccumulates rapidly in the pleural space despite conservative measures and abdominal surgical repair is not feasible, obliteration of the pleural space should be considered [20].AUTHOR CONTRIBUTIONSAnam Umar: Conceptualization; Data curation; Supervision; writing – review and editing. Amber Faquih: Data curation; writing – review and editing. Muhammad Bilal: Data curation, writing – review and editing. Jeffery Garner conceptualization; writing – review and editing.References:1.    Târcoveanu E, Dimofte G, Bradea C, Moldovanu R, Vasilescu A, Anton R, Ferariu D. Adrenal schwannoma. JSLS. 2009 Jan-Mar;13(1):116-9. PMID: 19366556; PMCID: PMC3015893.2.    Yorita K, Naroda T, Tamura M, Ito S, Nakatani K. Adrenal Schwannoma in an Elderly Man: A Case Report and Literature Review. Intern Med. 2022 Jan 1;61(1):65-69. doi: 10.2169/internalmedicine.7026-21.3.    Ahmed M, Mendha T, Cui LJ, Carlan S, Leveille RJ. A Rare Case of an Adrenal Schwannoma. Cureus. 2023 Jan 12;15(1):e33710. doi: 10.7759/cureus.33710.4.    Shivalingaiah PH, Kumar P, Bajoria S. Adrenal Schwannoma Treated with Open Adrenalectomy: a Case Report. Indian J Surg Oncol. 2018 Mar;9(1):83-85. doi: 10.1007/s13193-017-0715-5.5.    Ramsaran VK, Seeram VK, Cury J, Shujaat A. A Large Pleural Effusion Following Abdominal Aortic Surgery. Case Rep Pulmonol. 2015;2015:254010. doi: 10.1155/2015/254010.6.    Wippold FJ 2nd, Lubner M, Perrin RJ, Lämmle M, Perry A. Neuropathology for the neuroradiologist: Antoni A and Antoni B tissue patterns. AJNR Am J Neuroradiol. 2007 Oct;28(9):1633-8. doi: 10.3174/ajnr.A0682.7.    Rosai J. Tumors and tumorlike conditions of peripheral nerves. In: Rosai and Ackerman’s Surgical Pathology. Edinburgh: Mosby;2004.8.    Alhedaithy AA, Alsayed AM, Al-Sindi KA, Janahi WM. Schwannoma originating in the soft palate: A case report. Int J Surg Case Rep. 2021 Jul;84:106108. doi: 10.1016/j.ijscr.2021.106108.9.    Miyawaki M, Karashima T, Abe M, Takumi Y, Hashimoto T, Kamohara R, Osoegawa A, Sugio K. Giant benign intrathoracic schwannoma: a decade-long progression towards fatality. J Cardiothorac Surg. 2023 Nov 14;18(1):328. doi: 10.1186/s13019-023-02375-2.10. Dell’Aversano Orabona G, Ricci D, Emili I, Serpi F, Ferrara V, Vanzulli A. Adrenal schwannoma: a case report. BJR Case Rep. 2020 Feb 12;6(1):20190044. doi: 10.1259/bjrcr.20190044.11. Janjua A, Sarwar MZ, Naqi SA. Adrenal Schwannoma: A Case Report. Int Med Case Rep J. 2021 Sep 7;14:617-620. doi: 10.2147/IMCRJ.S311777.12.  Mohd Ziauddin SA Sr, Sharma AP, Devana SK, Vaiphei K. Adrenal Schwannoma: Case Description and Diagnostic Pointers of a Rare Disease. Cureus. 2023 Feb 1;15(2):e34485. doi: 10.7759/cureus.34485.13. Ji JH, Park JS, Kang CM, Yoon DS, Lee WJ. Laparoscopic resection of retroperitoneal benign neurilemmoma. Ann Surg Treat Res. 2017 Mar;92(3):149-155. https://doi.org/10.4174/astr.2017.92.3.14914. Zeiger MA, Thompson GB, Duh QY, Hamrahian AH, Angelos P, Elaraj D, Fishman E, Kharlip J; American Association of Clinical Endocrinologists; American Association of Endocrine Surgeons. American Association of Clinical Endocrinologists and American Association of Endocrine Surgeons Medical Guidelines for the Management of Adrenal Incidentalomas: executive summary of recommendations. Endocr Pract. 2009 Jul-Aug;15(5):450-3. doi: 10.4158/EP.15.5.450. PMID: 19632968.15. Sakamoto, S., Takata, N., Noda, Y. et al. Postoperative chylous ascites after total gastrectomy successfully treated using peritoneovenous (Denver) shunt: a case report. surg case rep 8, 92 (2022). https://doi.org/10.1186/s40792-022-01447-016. Do TVC, Cozza J, Ganti S, Depa J. Recurrent Chylous Ascites Leading to Transudative Chylothorax Due to Bi-Ventricular Heart Failure. J Investig Med High Impact Case Rep. 2021 Jan-Dec;9:23247096211026144. doi: 10.1177/23247096211026144.17. Mahajan A, Sankhyan P, Boonpheng B. Bilateral Chylothorax and Chylous Ascites: A Rare Presentation of an Uncommon Disorder. Cureus. 2021 Mar 22;13(3):e14044. doi: 10.7759.18. Chen J., Lin R. K., Hassanein T. Use of orlistat (xenical) to treat chylous ascites. Journal of Clinical Gastroenterology. 2005;39(9):831–833. doi: 10.1097/01.mcg.0000177232.51888.2e.19. Leibovitch I., Mor Y., Golomb J., Ramon J. The diagnosis and management of postoperative chylous ascites. Journal of Urology. 2002;167(2):449–457. doi: 10.1016/s0022-5347(01)69064-5.20. Mares D. C., Mathur P. N. Medical thoracoscopic talc pleurodesis for chylothorax due to lymphoma: a case series. Chest. 1998;114(3):731–735. doi: 10.1378/chest.114.3.731.

Title Page:The Phenotypic Spectrum of the Cornelia de Lange-like “Alazami-Yuan Syndrome” : A Case Report of the 7th Diagnosed Individual and Review of the Literature

Molecular diagnostics have revolutionized viral disease diagnosis in clinical settings, offering rapidity, sensitivity, and specificity. Nigeria’s diverse burden of viral diseases, coupled with resource limitations and underreporting, underscores the critical need for efficient molecular diagnostics. The article traces the progressive trajectory of molecular diagnostics in Nigeria, including the establishment of Lassa virus detection, containment of the Ebola virus outbreak, and the pivotal role of the Nigeria Center for Disease Control (NCDC). It also highlights the impact of the COVID-19 pandemic on expanding molecular diagnostics infrastructure. Despite these advancements, challenges such as limited testing capacity, skilled personnel shortages, and inadequate funding persist. The article recommends measures to address these challenges, emphasizing the transformative potential of molecular diagnostics in viral surveillance and management. Overall, it underscores the importance of strategic planning and concerted efforts to enhance the utilization of molecular diagnostics in Nigeria’s healthcare system.

Seasonal snow cover is vital for mountain hydrological systems, influencing spring floods, late summer flows, and aquifer recharge. As climate change progresses, understanding snow dynamics becomes increasingly essential for water resource management and future mitigation planning. The research explores how emerging rock boulders affect the melting patterns of Subarctic alpine snowpack using thermal infrared time-lapse imagery, drone-based photogrammetry, and terrestrial laser scanning. These methods evaluate the spatial and temporal variability of snow surface temperature and topography. Findings reveal that boulders accelerate snowmelt in their vicinity during the ablation season, with snow surface thermal characteristics shaped by local terrain and meteorological conditions. The fastest rates of ablation occur during periods of mild weather with no precipitation. The multimethod approach highlights the necessity of comprehensive techniques to understand snowpack ablation in heterogeneous environments, as meltwater from snow around boulders can significantly influence local hydrological processes.

The establishment of SPAC (Soil-Plant-Atmosphere Continuum) stations is essential for comprehensive monitoring of land-atmosphere interactions and ecological and hydrological processes. This paper introduced the current limitations of existing observation networks, which often rely on single-aspect observations, leading to insufficient data for a holistic understanding of SPAC dynamics. We recommend leveraging machine learning, remote sensing, and other technologies to upgrade current weather and soil moisture stations into quasi-SPAC sites with estimated carbon and water flux data. Additionally, new SPAC sites should be strategically located in regions sensitive to future climate change and climate risks, as projected by models such as CMIP6. These enhancements will improve the robustness of observational data in better constraining process-based models, and in enhancing the accuracy of data-driven methods, ultimately advancing global ecological and hydrological studies.

Objective To prospectively determine the nature of adnexal masses diagnosed during pregnancy, and investigate whether ultrasound was a reliable means of assessing these. Design A single centre prospective observational cohort study. Setting A large tertiary referral London Hospital. Population Pregnant women with an adnexal mass detected at or prior to the 12-week routine antenatal ultrasound. Methods A detailed ultrasound by a level II ultrasound practitioner at the time of detection; at 12 weeks; 20 weeks and 6 weeks postpartum. Main outcome measures Subjective impression of mass; International Ovarian Tumour Analysis simple rules classification; resolution and intervention rate; incidence of complications related to the mass. Results The incidence was 1%. 274 participants were included. Subjective impression was: simple 75.9%; dermoid 29.1%; endometrioma 6.6%; haemorrhagic 3.3%; para-ovarian 2.6%; torted simple 0.7%; decidualized endometrioma 0.4%; fibroma 0.4%; theca luteal 0.4% and borderline ovarian tumour: 0.7%. There was a significant reduction in the volume at each scan (P <0.0001). 74.2% of masses resolved spontaneously. Surgery was performed in 14/274: 2 antenatally, 6 at Caesarean Section and 6 post-partum. In 5/247 (2%) there was complication due to the mass. Using IOTA simple rules, 272/274 (99.3%) (p<0.0001) were classifiable. Only 1/274 (0.4%) had malignant features as per IOTA (p=0.05). As there was no confirmed malignancy, the accuracy of IOTA simple rules could not be calculated. Conclusion Adnexal masses in pregnancy are uncommon and the majority spontaneously resolve. Malignancy is rare, as are complications. In the absence of concerns regarding malignancy or cyst accident, there is no need for additional monitoring of these masses during pregnancy.

Background: Tyrosine kinase inhibitor (TKI) and rivaroxaban co-administration is common for patients with cancer and venous thromboembolism. However, the drug–drug interactions (DDIs) between epidermal growth factor receptor (EGFR) TKIs and rivaroxaban remain uncertain. Methods: DDIs were investigated in vitro and in vivo. In vitro experiments were conducted using rat liver microsomes, and rivaroxaban metabolites were tested to identify the two TKIs that exhibit the most significant DDIs. The type of inhibition was investigated using Lineweaver-Burk plots. For in vivo experiments, eighteen rats were randomly divided into three groups and pretreated with CMC-Na together with avitinib or gefitinib, or with CMC-Na alone for 7 d. On day 8, rivaroxaban was orally administered to each group. Blood samples were collected at various time points, and plasma rivaroxaban was quantified. Molecular docking was performed to explore the mechanism of DDIs. Results: Avitinib and gefitinib showed the most potent inhibitory effects among multiple EGFR TKIs and inhibited rivaroxaban metabolism in a mixed model of noncompetitive and uncompetitive inhibition. The area under the drug-time curve and maximum plasma concentration of rivaroxaban were significantly higher following avitinib and gefitinib pretreatment, while the apparent volume of distribution and clearance rates were significantly lower. Our molecular docking analysis revealed that these two drugs may inhibit rivaroxaban metabolism by overlapping with its binding site on CYP3A4 and CYP2D6. Conclusion: These findings confirm the presence of DDIs between EGFR TKIs and rivaroxaban. Avitinib and gefitinib significantly inhibit rivaroxaban metabolism, and their co-administration may aggravate the risk of bleeding.

Many feature selection algorithms primarily give importance to identifying relevant features and eliminating redundant features. This hybrid work determines the significant features, based on the estimated feature sensitivities and the degree of relevance between the feature and target outcome. The majority of works currently in existence employ mutual information (MI) to calculate the degree of information between two variables. By scaling the range of the MI to [0,1], Symmetrical Uncertainty (SU) can be viewed as the normalized MI. In this proposed work, Symmetrical Uncertainty-Relevance (SU-R) is used to measure the relevance between each feature and the target outcome. Less significant features are iteratively eliminated starting from discarding the least ranked feature identified using the combination of SU-R and PFS Analysis.To evaluate how well our proposed method identifies important features, model’s performance using metrics like F1 score and accuracy. This hybrid work identified the best 450 significant features out of 754 in the Parkinson’s disease dataset, and the top 150 features out of 562 in the smart phone dataset. The efficacy of the SVM classifier with the selected number of significant features with the proposed hybrid PF and SU-R technique outperforms the SVM when applied with existing feature selection met

Abstract Aim: To assess cardiac event incidence and trends by sex and age in young patients on psychopharmacological treatment in Sweden. Methods: This nationwide incidence study encompassed data from Swedish registers (2006–2018). Patients aged 5–30 years were exposed to one or more psychotropic medications (attention deficit hyperactivity disorder medications, antihistamines, selective serotonin reuptake inhibitors, other antidepressants, anxiolytics, antipsychotics, hypnotics/sedatives). Annual incidences, trends, and mean incidences of cardiac events (cardiac arrest, arrhythmias, fainting/collapse, sudden death) and recurrent events were calculated. Results: Among those exposed (n=875,430, 2,647,957 patient-years, 55% female), 26,750 cardiac events were identified. The mean annual incidence of cardiac events and first-ever events were 0.98% and 0.80%, respectively, showing significant upward annual trends of 4.26% and 2.48%, respectively (p<0.001). The highest incidences were among females aged 15–19 years (1.50%) and those exposed to polypharmacy (1.63%), anxiolytics (1.53%), or antihistamines (1.27%). The mean annual incidences of cardiac arrest and arrythmias, for both sexes, were 0.01% and 0.51%, respectively. Fainting/collapse accounted for about half of all events, occurring more often in females. The pattern of rising annual incidence remained after excluding fainting/collapse. In all, 21.1% of events were recurrent. Sudden death occurred in thirteen patients. Conclusions: The mean annual incidence of cardiac events among young patients receiving psychopharmacological treatment was low, 0.98%, with an upward trend of 4.26% annually. Incidence was highest in females and patients exposed to polypharmacy. Our study highlights the need for more knowledge regarding the possible association between exposure to psychopharmacological treatment and cardiac events.

Aim: This study aimed to analyse the initiation adherence phase to lipid-lowering therapy for primary prevention of cardiovascular disease in a Spanish population aged 70 years or older. The secondary objective was to identify the determinants of initiation and early discontinuation. Methods: Observational study conducted in the CARhES (CArdiovascular Risk factors for HEalth Service research) cohort. People aged 70 and older with a first prescription of a lipid-lowering drug and without a previous Major Adverse Cardiovascular Event were selected (2018-2021). Data on sociodemographics, clinical conditions, drugs and use of health services were collected from clinical and administrative electronic databases. The study population was classified into: non-initiation, early discontinuation (i.e., discontinuation after the first dispensing) and initiation with more than one dispensing. Their characteristics were compared. Determinants of initiation and early discontinuation were explored. Results: Among the 15,019 people studied, 80.2% initiated the medication, 11.2% showed an early discontinuation and 8.6% were non-initiators. An older age or conditions such as dementia, diabetes or depression reduced the likelihood of initiation, while obesity and a high pharmacological burden increased it. People over 90 of age or those prescribed a statin in combination were more likely to have an early discontinuation. Conclusion: Non-initiation and early discontinuation are common among older people prescribed lipid-lowering drugs as primary prevention of cardiovascular disease by the first time. The presence of chronic pathologies other than cardiovascular ones should be considered when assessing whether or not to prescribe these drugs in the elderly.

There is considerable evidence documenting associations between tobacco smoking, including initiation, maintenance, and relapse of addiction, with diminished cardiovascular responses to acute psychological stress. However, less is known about how smokers respond to repeated stress across time. The current study examined patterns of cardiovascular reactivity and adaptation to recurrent stress among abstinent smokers, smokers who continued to smoke at their normal rate, and non-smokers. Smokers were randomly assigned to one of two conditions; ad libitum (n = 42), or 24h abstinence (n = 61); and non-smokers (n = 43) provided comparative referencing. Across the two laboratory sessions, participants (n = 149) were asked to complete a modified version of the trier social stress test (TSST), while monitoring systolic and diastolic blood pressure, and heart rate activity. Results showed that while non-smokers had elevated cardiovascular reactivity to begin with, they showed a greater capacity to habituate to recurrent stress across sessions. The data also suggest that smokers displayed attenuated cardiovascular reactivity to acute psychological stress and showed little habituation to repeated stress. In adjusted models, smokers exhibited less systolic blood pressure tolerance to stress. This poorer response profile in smokers may be a potential mechanism that leads to further cardiotoxic effects on health. Key words: Smoking, cardiovascular reactivity, habituation, stress