Esophagogastric Fistula in an Adult Following Laparoscopic Nissen Fundoplication: A Case Report of Successful Resolution of Fistulization Through Conservative Medical TherapyKaram Karam1, Houssein Chebbo2, Sarah Saleh2, Emanuel-Youssef Dib2, Karim Zodeh3, Lamia Azizi4, Majd Rustom*5[1] Department of Gastroenterology, University of Balamand (UOB), Beirut, Lebanon. Email: karamek7@gmail.com[2] Faculty of Medicine, University of Balamand (UOB), Beirut, Lebanon. Email: Houssein.chebbo@std.balamand.edu.lb[2] Faculty of Medicine, University of Balamand (UOB), Beirut, Lebanon. Email: Sarah.saleh@std.balamand.edu.lb[2] Faculty of Medicine, University of Balamand (UOB), Beirut, Lebanon. Email: emanuelyoussef.dib@std.balamand.edu.lb[3] Department of Gastroenterology, University of Balamand (UOB), Beirut, Lebanon. Email: Karim.zodeh@std.balamand.edu.lb[4] Department of Radiology, University of Balamand (UOB), Beirut, Lebanon. Email: Lamia.azizi@std.balamand.edu.lb[5] Department of Internal Medicine, Division of Gastroenterology, Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University (LAU), Beirut, Lebanon. Email: majd.rustom@laumcsjh.com*CORRESPONDING AUTHOR

The present study measured the anterior cingulate cortex (ACC) and caudate nucleus (CN) volumes of patients diagnosed with obsessive-compulsive personality disorder (OCPD) and compared them with healthy controls with an aim to investigate its neuroanatomy of. The Sociodemographic and Clinical Data Form, Beck Anxiety Scale (BAS), Beck Depression Scale (BDS), and Frost Multidimensional Perfectionism Scale (FMPS) were administered to 18 healthy controls and 16 patients diagnosed with OCPD. Volumetric measurements of the right/left ACC and CNs were performed for all the participants through brain magnetic resonance imaging. There was no significant difference between patients and controls by ACC and CN volumes. BAS, BDS, and FMPS scale scores in the patient group were statistically higher compared to the control group. Volumetric changes in the ACC and CN do not play a role in the pathophysiology of OCPD. Functional imaging techniques may be useful in explaining the likely role of these regions in the etiopathogenesis of the disease.

Exersaucers, stationary activity centers designed as alternatives to mobile baby walkers, have gained widespread popularity among caregivers. However, their potential impact on various aspects of infant development and safety has been a topic of ongoing debate. This review aims to critically examine the existing literature on exersaucer use, evaluating their effects on motor development, language exposure, overall growth, and safety considerations. By synthesizing findings from multiple studies, this article provides a comprehensive understanding of exersaucers and their role in promoting healthy infant development. The review highlights the importance of striking a balance between the convenience offered by exersaucers and the need for adequate opportunities for free movement, physical activity, and caregiver interaction. Recommendations are provided to guide caregivers and healthcare professionals in making informed decisions regarding appropriate exersaucer use within the context of fostering optimal infant growth and well-being.

CASE REPORT

Bacterial laccases exhibit relatively high optimal reaction temperatures and possess a broad substrate spectrum, thereby expanding the range of potential applications for laccase enzymes. This study aims to investigate the molecular evolution of bacterial laccases using computational simulation tools such as AlphaFold2, Metal3D, AutoDockVina, and Rosetta. We isolated a bacterium with laccase activities from fecal samples from a Hermann´s tortoise ( Testudo hermanni), identified it as Klebsiella michiganensis using 16S rRNA sequencing and nanopore genome sequencing, and then identified a sequence encoding a laccase with a predicted molecular weight of approximately 27.5 kDa. Expression of the corresponding, chemically synthesized DNA fragment resulted in the isolation of an active laccase. The enzyme showed considerable thermostability, retaining 21% of its activity after boiling for 30 min. Using state-of-the-art information technology and machine learning techniques, we conducted simulations on this sequence, predicted its copper-ion binding sites, and validated these predictions through site-directed mutagenesis and expression. Subsequently, we performed computer-aided evolution studies on this sequence and found that 90% of the results from simulations exhibited improved performance. In summary, this study not only revealed a novel laccase but also demonstrated an efficient approach for advancing research on the molecular evolution of bacterial laccases using cutting-edge machine learning, next-generation sequencing, traditional bioinformatics approaches, and laboratory techniques, providing an effective strategy for discovering and design new bacterial laccases.

Artificial propagation and wild release may influence the genetic integrity of wild populations. This practice has been prevalent in fisheries for millennia and is often termed “stocking”. In the Laurentian Great Lakes, walleye populations faced declines from the 1950s to the 1970s, prompting extensive stocking efforts for restoration. By the mid-2010s, walleye populations showed signs of recovery, but the genetic legacy of stocking on population structure at the genomic level remains unclear. Using a dataset of 45,600 genome-aligned SNP loci genotyped in 1,075 walleye individuals, we investigated the genetic impacts of over 50 years of stocking across the Great Lakes. Natural geographic barriers shaped walleye population structure, but pairwise comparisons revealed changes in genetic structure due to stocking from non-native sources also significantly contribute to population structure. Admixture between Lake Erie walleye and walleye from the re-populated Tittabawassee River indicate that stocking may have re-distributed putatively adaptive alleles around the Great Lakes. Genome scans identified FST outliers and evidence of selective sweeps, indicating local adaptation of spawning populations is likely. Notably, one genomic region showed strong differentiation between Muskegon River and walleye from the Tittabawassee River which was re-populated by Muskegon Strain walleye, suggesting admixture and selection both impact the observed genetic diversity. Overall, our study underscores how artificial propagation and translocations can significantly alter the evolutionary trajectory of populations. The findings highlight the complex interplay between stocking practices and genetic diversity, emphasizing the need for careful management strategies to preserve the genetic integrity of wild populations amidst conservation efforts.

A document by maryam sarkardeh. Click on the document to view its contents.

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Background and aims: Complete isolation of the left atrial posterior wall (LAPW) is challenging owing to overlapping epicardial conduction. Peak frequency (PF) is a novel parameter that focuses on near- and far-field electrogram components. In this study, we aimed to determine whether transmural block completion is related to the ablation site PF. Methods: We analyzed 44 consecutive patients undergoing initial LAPW isolation between June 2023 and February 2024. Pre-LAPW isolation and PF maps were obtained using an HD-Grid catheter. In 17 of the 44 patients (Group-1), LAPW isolation was performed conventionally. In the remaining 27 patients (Group-2), PF-guided LAPW isolation was applied based on Group-1 results. Results: In Group-1, the left atrial roof and floor line success rates were 58.8% and 76.5%, respectively. The average PF value in the roof lines of patients with a completed block line was significantly higher than that of the remaining patients (286.6 ± 29.3 Hz vs. 236.1 ± 40.9 Hz, p = 0.012), but the floor lines were similar. In Group-2, relatively high PF values were targeted to achieve complete block of the left atrial roof and floor lines, following the results obtained in Group-1. The left atrial roof line success rates (92.6% vs. 58.8%, p = 0.007), total number of radiofrequency applications (22.7 ± 5.6 vs. 27.6 ± 8.5, p = 0.03), and procedural time (32.6 ± 18.3 vs. 47.9 ± 25.6 min, p = 0.03) differed between Group-1 and Group-2. Conclusion: Using a PF map for determining the optimal ablation line for LAPW isolation by radiofrequency catheter ablation is feasible.

Objective: To systematically review the literature for articles evaluating outcomes of drug-induced sleep endoscopy (DISE) directed tongue surgery in children with prior adenotonsillectomy and persistent or recurrent obstructive sleep apnea (OSA), and to perform a meta-analysis on the polysomnographic (PSG) data. Design: Systematic review and metanalysis in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) statement guidelines. Outcome Measures: Primary, post-operative apnea-hypopnea index (AHI) and lowest oxygen saturation (LSAT); Secondary, surgical response rate. Results: Seven studies (283 patients) met criteria and reported PSG outcome data for the systematic review. The mean ± standard deviation surgical response rate was 70.0 ± 17.0% [95% CI 67.6, 71.6]. Six of the seven studies (270 patients) reported specific pre- and post-operative PSG data included in our meta-analysis. The pre- and post-operative AHI decreased from 9.5 ± 12.1 to 4.2 ± 6.9 events/hr (p < 0.04) with a mean difference (MD) of -5.13 [95% CI -7.13, -3.13], Z-score 5.02 (P<0.00001). LSAT improved from 87.8 ± 5.7 to 90.1 ± 5.1% (p < 0.02) with a MD of 2.71 [95% CI 1.53, 3.89], Z-score 4.51 (P<0.0001). Conclusion: Existing literature demonstrates DISE-directed tongue surgery in children with persistent OSA can reduce AHI by approximately 50%, improve LSAT by nearly 3%, and have an overall positive response to surgery rate of 70%. There is collective evidence that DISE-directed tongue surgery is effective, but there is heterogeneity in reported outcomes influenced by confounding factors. Key Words: Drug Induced Sleep Endoscopy; Pediatric Sleep Apnea; Tongue Surgery

Purpose: Point-of-care cardiovascular left ventricle ejection fraction (LVEF) quantification is established, but automatic tablet-based stroke volume (SV) quantification with handheld ultrasound devices is unexplored. We evaluated a tablet-based monoplane LVEF and LV volume quantification tool (AutoEF) against a computer-based tool (Tomtec) for LVEF and SV quantification. Methods: Patients underwent handheld ultrasound scans, and LVEF and SV were quantified using AutoEF and computer-based software that utilized either apical four-chamber views (AS-mono) or both apical four-chamber and apical two-chamber views (AS-bi). Correlation and Bland-Altman analysis were used to compare AutoEF with AS-mono and AS-bi. Results: Out of 43 participants, 8 were excluded. AutoEF showed a correlation of 0.83 [0.69:0.91] with AS-mono for LVEF and 0.68 [0.44:0.82] for SV. The correlation with AS-bi was 0.79 [0.62:0.89] for LVEF and 0.66 [0.42:0.81] for SV. The bias between AutoEF and AS-mono was 4.88% [3.15:6.61] for LVEF and 17.46 ml [12.99:21.92] for SV. The limits of agreement (LOA) were [-5.50:15.26]% for LVEF and [-8.02:42.94] ml for SV. The bias between AutoEF and AS-bi was 6.63% [5.31:7.94] for LVEF and 20.62 ml [16.18:25.05] for SV, with LOA of [-1.20:14.47]% for LVEF and [-4.71:45.94] ml for SV. Conclusion: LVEF quantification with AutoEF software was accurate and reliable, but SV quantification showed limitations, indicating non-interchangeability with neither AS-mono nor AS-bi. Further refinement of AutoEF is needed for reliable SV quantification at the point of care.

Interventricular septal dissection (IVSD) is a critical condition characterized by the separation of the intraventricular septum into two layers, forming an intermediate layer with a cystic cavity that communicates with the root of the aorta or ventricle，with extremely low morbidity and high mortality. our study presented a very rare fetal case of IVSD after acute inferior myocardial infarction(MI) , exploring the etiology and pathogenesis of the disease, the key points and the clinical value of ultrasound diagnosis.

This study introduces a novel progressive approximation-aware training (AAT), which efficiently integrates regularization and transfer learning techniques. The primary objective is to capture the inherent characteristics of approximate hardware designs. By considering the accuracy requirements and computational constraints inherent in the application optimizer, AAT strives to achieve an optimal balance between accuracy and power consumption. Initiating with a quantified deep neural network (DNN) model, AAT employs a range of approximation strategies to pinpoint the optimal model space and minimize energy cost. When compared to cutting-edge techniques, our approach provides remarkable energy savings, enhanced resilience against adversarial attacks, and maintains consistent accuracy.

Leveraging the ultra-wideband advantages of the Terahertz (THz) band, Integrated Sensing and Communication (ISAC) facilitates high-precision sensing demands in human smart home applications. ISAC channel characteristics are the basis for ISAC system design. Currently, the ISAC channel is divided into target and background channels. Existing researches primarily focus on the attributes of human target itself, e.g., radar cross-section and Micro-Doppler effect. However, the impact of human target on neither the pathloss characteristic of background channel nor the multipath propagation characteristic of target channel is considered. To address the gap, we conduct indoor channel measurements at 105 GHz to investigate the ISAC channel characteristics with the impact of human target. Firstly, by analyzing the power angular delay profiles with and without human target, we observe the changes in quantity and power of multipath components (MPCs). Then, we propose a parameter called power control factor (PCF) to evaluate the human target impact on pathloss, thereby modifying the existing pathloss model of background channel. Eventually, we extract the MPCs belonging to target channel within target-oriented power delay profile to count the power proportion of each bounce MPCs of the target-Rx link, which supports the necessity of multi-bounce (indirect) paths modeling in target channel.

In this study, a machine tool operating vibration prediction method based on multi-sensor fusion and long short-term memory (LSTM) network is proposed. Machine tool vibration has a significant impact on machining quality, workpiece surface roughness, dimensional accuracy, and tool’s wear. This study combines deep learning technology with industrial applications to achieve high-precision machine tool vibration prediction by fusing multiple sensor data. The real-time data is input into the LSTM model to predict the vibration situation at the next moment. The experimental results show that the method has strong prediction ability for the periodic vibration of the machine tool and the vibration error specific to the machining action. And it can effectively predict machine vibration and improve machining accuracy.

Colorectal cancer (CRC) remains a significant health concern in the world. The existing standard of care guidelines for CRC surveillance falls short of effectively and timely detecting recurrence or metastasis. In recent years, circulating tumor DNA (ctDNA) has emerged as a promising material for minimal residual disease (MRD) detection. In this paper, we provide an exhaustive review of the methods utilized for MRD detection via ctDNA, present evidence supporting the potential of ctDNA MRD as a valuable biomarker in clinical applications, and engage in a discussion regarding ongoing ctDNA MRD based clinical trials in CRC. Lastly, we offer insights into future prospects of ctDNA-based MRD methodological advancements and clinical research. It’s foreseeable that more sensitive, flexible, and economic MRD detection methods will emerge with the deeper research on cfDNA genomics, fragmentomics, methylomes, and nucleosome imprinting. At the same time, MRD-guided intervention study will evolve for revolutionizing the treatment paradigm of CRC.

In the context of generative AI’s rapid advancement across various industries, training models require large and comprehensive datasets to improve AI models, yielding more accurate and realistic outputs. This increased demand has reshaped the landscape of data accessibility and economics, particularly with Application Programming Interfaces (APIs). This shift has led to data providers and social media platforms enforcing new access restrictions. Such changes have created significant barriers for researchers, especially those in social science research, in acquiring data. This article addresses these issues by evaluating alternative data collection methods, focusing on their application in social research. It critically examines the strengths and weaknesses of these methods, underscoring their practicality and reliability. As AI continues to transform industries, this paper provides a vital guide for researchers, data analysts, and businesses to navigate the evolving dynamics of data collection, particularly in the context of social research.

For distinguished contributions to psychophysiology: Christopher J. Patrick

Licuala ferruginea Becc., a tropical forest understorey palm, is observed to have fruits that appear red in colour when unripe, turning pink, then white, purple and finally black in colour as they ripen. We monitored 13 fruiting palms in rainforest fragments and recorded the consumption of fruits by animals via camera traps. We also documented the fruiting phenology of two palms in the nursery. In the rainforest fragments, a Cream-vented Bulbul (Pycnonotus simplex) was observed plucking a mature purple fruit from a L. ferruginea palm, before flying away with the fruit in its beak. This was the only bird that was observed feeding on the mature fruit. A range of mammals, dominated by edge species such as the Long-tailed Macaque and Wild Boar, were observed to consume L. ferruginea fruits indiscriminately across all five colour stages, thereby limiting the dispersal of the fruits. Forest bulbul gape sizes also matched the fruit size, suggesting that forest bulbuls are the likely dispersers of the palm in the original forest where edge species are not in high densities. We further posit that the initial phase of red fruits, with high contrasting red reflectance against a green foliage background, might be a form of early advertisement to birds. The fruit then turns pink and white, which have high green reflectance and is less contrasting, thereby reducing the conspicuity of the fruit. This allows the fruit to ripen with high fructose and glucose content, and turn purple and black, which are known visual cues for birds. This study provides indicative support for the dispersal syndrome hypothesis and highlights the potential effects of forest fragmentation on plant-frugivore interactions. Keywords: Licuala, Arecaceae, dispersal syndrome, fruit, bulbul, reflectance

Root rot caused by Macrophomina phaseolina (Tassi.) is a common soil-borne disease in black gram, and its management with chemicals showed persistent toxicity and soil degradation. The existing bioagents, such as talc formulation, lead to leaching and are less productive. Hence, developing liquid bioformulation is essential to contain the disease and maximize the yield. Therefore, the current study aims to investigate the efficacy and survivability of liquid formulation of Trichoderma asperellum (Tv1 LF), metabolites against root rot of black gram, and their growth promotion. The results showed that the vigor index 4025.00 with a spore load of 1X108 cfu/ml was recorded for growth promotion and spermophere study @ 5ml /kg of seeds with Tv1 LF. The treatment T8 significantly reduced the incidence (9.1%) against control (74.3%), with an increased biomass index in the glasshouse condition. There are 32 mVOCs profiled during the tri-trophic interaction in black gram roots, and they were up or down-regulated, Viz., Mollugin, Pentadecanoic acid, Cyclopropaneoctanoic acid 2-octyl-, methyl-ester, Rhodopin, Dodecanoic acid, 1,2,3-propanetriyl ester involved in pathways like jasmonic acid, glyconeogenic and act as acyl-CoA: acyltransferase-2 inhibitor. The results of this study confirmed that Tv1 LF performed better in growth promotion and managing root rot of black gram.

Bacterial endophytes are a promising source of novel fibrinolytic enzymes with unique metabolic pathways and desirable characteristics that may not be present from conventionally explored sources. This study aimed to characterize fibrinolytic enzymes from selected endophytic bacteria isolated from papaya (Carica papaya L.) leaves and the genes encoding the enzymes. A strain BFP1 (InaCC-B1657) that showed the highest fibrinolytic activity was identified as Bacillus cereus based on the phylogenetic analysis of the 16S rRNA sequence. The enzyme exhibited optimum activity at 50°C and pH 7.0, and remained stable until 80°C and pH 6 - 10 for 24 h. The assay of metal ions and inhibitors on the fibrinolytic enzyme activity found that adding Cu2+ stimulated, while Fe2+ reduced the activity. PMSF and TPCK inhibited the enzyme activity, while adding EDTA and EGTA increased the activity. These suggest that the fibrinolytic enzymes belong to the serine protease group. Of the 21 proteases/peptidases determined from the 5,257,484 base pairs (bp) genome, minor extracellular protease Vpr and S8 family peptidase genes were found related to the fibrinolytic enzyme activity. The Vpr gene has a molecular weight of 98.5 kDa. The subtilase domain (peptidase S8 family) and the catalytic triad subtilase active sites (Asp204, His237, and Ser531) were detected. A prediction of physicochemical characteristics of the Vpr gene showed that the enzyme is hydrophilic and exhibited alkali-halo tolerant and thermo tolerant over a broad range of temperatures.

High-altitude hypoxia affects respiratory, central nervous, cardiovascular, and endocrine systems. These outcomes affect the expression of cytochrome P450 (CYP), the most important family of metabolic enzymes in the body involved in the metabolism of both exogenous and endogenous substances. Hypoxia influences CYP expression and activity, mediating changes in drug and endogenous substance metabolism, with endogenous substance metabolites playing a substantial role in controlling high-altitude diseases. However, the mechanisms that regulate CYP changes under hypoxic conditions and the effects of CYP changes on drug and endogenous metabolism remain unclear. We examined how CYP expression and function change during hypoxia and how they are controlled by nuclear receptors, epigenetic modifications, cytokines, and gut microbiota during hypoxia. This was done to understand how CYP affects the metabolism of drugs and endogenous substances, such as arachidonic acid, vitamins, and steroid hormones during hypoxia, and to determine how CYP and its metabolites are involved in the pathophysiology of diseases linked to high-altitude hypoxia.

Abstract Rodents are the most commonly used experimental models for studying liver structure and function. Detailed knowledge of the liver lobe structure is essential for such studies, yet the biliary system in rodents has not been comprehensively described. This study utilized intravenous injection of indocyanine green (ICG) combined with ligation of the common bile duct, causing extrahepatic bile ducts to appear emerald green under natural light. We observed that bile duct branch of each lobe frequently drained into the superior common bile duct near the gallbladder. Additionally, no previous studies have successfully ligated the portal vein of the left lateral lobe (LLL) in mice, a critical step for models such as portal vein ligation (PVL) or associating liver partition for staged hepatectomy (ALPPS). Using ICG staining and observing liver vasculature under a 25× microscope, we categorized the portal vein of the LLL into four types. Most mice exhibited a distinct portal vein branch for the LLL and left middle lobe (LML), contrary to observations in rats. By selecting the generally and fully exposed type, surgeons or technicians skilled in micromanipulation can successfully ligate the portal vein of the LLL using our method. On postoperative day 3 (POD 3), the LLL remained fresh and alive without apparent necrosis, and the weight ratio between the future liver remnant (FLR) and body, along with positive Ki67 nuclear staining, was significantly enhanced, indicating that ligating the portal vein of the LLL induces liver regeneration.

This study introduces an adaptive restricted controller designed to address the path-tracking challenge encountered by an autonomous quadrotor aerial vehicle navigating through confined spaces. The quadrotor dynamics are represented mathematically using quaternions, facilitating the development of the adaptive control strategy. The proposed controller incorporates an adaptive state-dependent gain to regulate the quadrotor's motion within permissible airspace. Utilizing a gain auto-tuning approach, the controller ensures convergence of the quadrotor trajectory to a predefined reference path, effectively managing both the position and orientation of the vehicle under quaternion dynamics. The control design integrates a direct barrier dead-zone controlled Lyapunov function, explicitly considering state restrictions. This function validates convergence to the reference path and derives the necessary state-dependent gains for the adaptive controller. Numerical evaluations demonstrate the efficacy of the proposed adaptive controller in achieving superior tracking performance compared to conventional state feedback controllers. Furthermore, the controller ensures compliance with full-state constraints, offering a promising solution for real-world applications. Experimental validation in a setup with predefined state restrictions further confirms the effectiveness of the proposed approach, exhibiting improved tracking characteristics over the proprietary controller installed in the quadrotor.