Introduction Nearly 25% of systemic symptoms of autoimmune disorders are misdiagnosed and mismanaged and often come with flare-ups or complications. The coexistence of multiple rheumatic diseases makes it more challenging regarding both management and diagnosis. Several types of overlap syndrome are documented in the literature. While two or more rheumatic diseases coexist, one disease often is clinically predominant. Rhupus syndrome, which combines the clinical and laboratory aspects of rheumatic arthritis (RA) and systemic lupus erythematosus (SLE), is one of the uncommon and sporadically documented overlaps. SLE and RA are systemic autoimmune rheumatic illnesses that affect multiple organs and systems and have unique clinical and serological traits.  (1)“ Rhupus” was first coined in 1971 to describe patients who satisfy the criteria for both systemic lupus erythematosus(SLE) and rheumatoid arthritis(RA). (2) it has been defined as a deforming and symmetric polyarthritis accompanied by symptoms of SLE and the presence of antibodies such as ant-ds-DNA, anti-smith, and rheumatoid factor with or without ant-CCP antibody. (a)  because of the rarity of the disease the prevalence, pathophysiology, natural history, and radiological and immunological profiles profile of rhupus are poorly described.There is no known etiology causing the disease but there are limited studies suggesting the combined role of genetic, immunological, hormonal, and environmental factors in the progression of the disease. (3) identification of rhupus is very essential owing that their therapy and outcome differ from those patients having RA or SLE alone. (4)We report one such rare case below.Case presentation :

A wideband absorptive frequency-selective reflector (AFSR) based on split-ring resonator (SRR) embedded with chip-resistor is proposed in this letter. A wide absorption band is achieved by the excitation of the multimode resonance by two dipoles. The insertion of SSRs in the dipoles is able to bypass the losses in the passband, thus allowing the structure to open a wide window of transmittance in addition to achieving broadband absorption performance. The upper structure consists of a dipole in series with two SSRs, while the lower structure consists of only one. The upper and lower structures are grouped together and rotated by 90° around the Z-axis to form the final dual-polarization 3D-AFSR. The simulated results demonstrate that, reflection coefficients below -10dB are seen between 6.74 ~ 9.31 GHz and 16.91 ~ 19.61 GHz under normal incidence, with a total fractional bandwidth of 46.8%. It also has a wide reflection band from 10.69 GHz to 15.44 GHz, and the entire profile is 0.17 λL, where λL is lowest operating frequency.

CD100 is a positive regulator for immune responses. In HBV infection, CD100 can regulate T cells and macrophages activation for antiviral responses, raising the possibility that it might become a potential target for the treatment of HBV-related liver cirrhosis. However, the CD100 expression in HBV-related liver cirrhosis and its impact on hepatocytes have yet to be determined. In this study, The CD100 levels in the serum, platelets and immune cells from chronic hepatitis B (CHB) patients were tested. The effects of CD100 stimulation on primary hepatocytes were examined by mRNA-microarray analysis, while the influence of CD100 on extracellular matrix (ECM) deposition was assessed in a hepatocyte and hepatic stellate cell (HSCs) co-culture system. GO and PPI Enrichments were used to evaluate shared genes of CD100-regulated genes and changed genes during HBV-related liver cirrhosis. It is proved that the serum sCD100 and CD100 on platelets, which possess the potential to directly interact with hepatocytes, were down-regulated in CHB patients compared to healthy donors. CD100 expression on platelets was decreased in cirrhotic patients compared with non-cirrhotic patients. CD100 modulated gene expression in primary hepatocytes through plexin B1 and B2 signal transduction, which activated the ERK signaling pathway. The CD100 stimulation induced immune responses in hepatocytes, elevated the expression of TGF-β antagonists and HNF4A-related genes, and inhibited collagen I deposition in the hepatocytes and HSCs co-culture system. The effects may potentially serve as a drug target for the treatment of HBV-related liver cirrhosis.

Sodium butyrate (NaBu), well-known as a histone deacetylase inhibitor and for its capacity to impede cell growth, can enhance the production of a specific protein, such as an antibody, in recombinant Chinese hamster ovary (CHO) cell cultures. In this study, two CHO cell lines, namely K1 and DG44, along with their corresponding mAb-producing lines, K1-Pr and DG44-Pr, were cultivated with or without NaBu. A SWATH-based profiling method was employed to analyze the proteome. Cells cultured in the presence of NaBu exhibited a reduction in mitosis and gene expression, supported by their culture data demonstrating growth inhibition. The presence of NaBu corresponded to an upregulation of intracellular trafficking and secretion pathways, aligned with an observed increase in mAb production. This upregulation was associated with an elevated glycosylation pathway and a slight alteration in the glycosylation profile of the mAbs. The observed increases in fatty acid oxidation, redox interactions, and lipid biosynthesis are likely attributable to the metabolic effects of NaBu. A comprehensive understanding of the systemic effects of NaBu will facilitate the discovery of strategies to enhance or prolong the productivity of CHO cells.

A document by Trung Le. Click on the document to view its contents.

Halictidae is one of the most diverse bee families, with approximately 3500 species worldwide. This study investigates the taxonomic utility of hind wing venation patterns in distinguishing between genera within the family Halictidae. By examining the intersection areas of specific veins (Rs-M and M+cu) on the hind wings of 75 specimens belonging to the genera Evylaeus and Halictus, comprising 10 and 5 species respectively, an outline-based geometric morphometric technique- elliptical Fourier analysis was employed. This approach allows for the quantification of wing shape through the extraction of Fourier coefficients. Principal component analysis (PCA) was applied to the Fourier coefficient dataset to identify patterns of shape variation and to discriminate taxa. The results demonstrate the effectiveness of this combined analytical framework in achieving successful discrimination, with minimal overlap observed between taxa observed. This study highlights the potential of morphometric methods coupled with multivariate analyses to improve taxonomic resolution within Halictidae bees, thus contributing to the development of semi-automatic identification systems in entomology.

A document by Mohammad Dalili. Click on the document to view its contents.

1. Widely used methods to assess population genetic structure and differentiation rely on independence of marker loci. Following the assumption, the common metrics, for example FST, evaluate genetic structure by averaging across loci. Common metrics do not use information in the associations among loci at the individual level and are often criticized for failing to measure true differentiation even when loci segregate independently. 2. We introduce a new concept to measure β-variation (Effective Number of Different Populations, ENDP). It requires the following steps: (a) calculation of a proper dissimilarity between genetic profiles of all individuals; (b) calculation of suitable pairwise distances between the samples based on the dissimilarities between individuals; (c) calculation of diversity (in terms of Hill numbers) and dispersion of samples based on the pairwise distances between samples; (d) ENDP is then estimated as a combination of the diversity and dispersion. ENDP estimates β-variation independently of within-sample α-variation. This new concept differs from the existing standard where β-diversity is estimated based on the ‘partition of variation’ scheme (beta=gamma-alpha or beta=gamma/alpha). 3. Estimates of ENDP are obtained by evaluating information in the available genetic profiles of individuals including association of loci. Therefore, ENDP can be used even in an absence of panmixia. 4. We illustrate the use of this concept by analyzing the population genetic structure of a sexual species (a trematode parasite) occupying connected populations across a broad geographic area. Analysis is complicated by two coexisting cryptic sister clades and the potentially mixed-mating system of this hermaphroditic parasite.

Because of the soft dynamic performance of the fuel cell stack, the battery is usually integrated in the power system in fuel cell hybrid electric vehicles. In this paper, a real time energy management strategy considering thermal constraints based on speed prediction with neuron network is proposed. The main principle of the proposed control strategy is to get the future power requirement with model predictive control based on the historic speed information, and then optimize the objective function according to the state variables. The objective function is set to minimize the equivalent fuel consumption of the vehicle and extend the life span of the fuel cell stack based on thermal constraints. Contrasting with the control strategy without thermal constraints under the WLTC driving cycle, the proposed energy management is 0.9% higher, but the temperature of the fuel cell stack and the battery can be limited within an appropriate range. The total equivalent fuel consumption is 3.9% lower than dynamic programming control strategy, which proves the availability of the proposed control strategy can reduce the equivalent fuel consumption while prolonging the fuel cell stack life span. Hardware in loop (HIL) experiment is implemented to testify the real time application of the proposed control strategy.

This paper continues the series of theoretical reports on friendly AI alignment. Friendly AI alignment is a failsafe alignment capable of operating beyond Artificial General Intelligence threshold, where direct control is not feasible and human safety is threatened. The alignment class is of interest for Artificial Super Intelligence instantiation. This paper presents an information system architecture that can host friendly AI alignment. A sobriquet for the architecture is Serial Comptroller Network (SCN). It implements a human-assisted, uninterpretable approach. The discussion focuses on a minimalistic solution within the framework of the proposed architecture. An assessment for its potential, utility, deficiencies and further improvement options is presented.

Purpose: Low-incidence but serious adverse reactions to antidepressants, such as stroke, have received close attention recently. Many patients start antidepressant treatment at a young age. However, the literature on the stroke risk associated with antidepressants in non-elderly adults remains insufficient. To delineate the stroke risk related to antidepressants among various age groups, class of antidepressants, and indications in adults. Methos: This was a cohort study using the new user approach and included adults aged 18-44 in 2018. 119,751 antidepressant users and 119,751 non-users were matched by age, sex, and date of the initial antidepressant treatment. Antidepressants classified as N06A in the WHO Anatomical Therapeutic Chemical Classification System were selected. The primary endpoint was the first occurrence of stroke within 180 days of the initial antidepressant treatment. Results: Antidepressant use was associated with an increased risk of stroke (HR, 4.33; 95% CI 2.30-8.14). Similar results have also been found among users of TCA and SARI, but there was no significant risk among users of SSRI and SNRI. Among patients without psychiatric disorders (HR, 5.47; 95% CI, 2.58-11.61) or neurological disorders (HR, 4.10; 95% CI, 2.12-7.95), antidepressant users had a significantly higher risk of stroke than non-users. Conclusions: The indication for antidepressants should be carefully assessed within 6 months of the initial treatment to avoid stroke risk, particularly in adults aged 18-44 years. When antidepressants are first indicated, SSRI and SNRI may be safer options.

Background: Sickle cell disease (SCD) presents a formidable healthcare challenge, with stroke being a significant complication. While transcranial Doppler ultrasound (TCD) is the gold standard for stroke risk assessment, its availability is often limited by resource constraints. This study investigates the platelet-neutrophil ratio (PNR) as a cost-effective and accessible alternative for stroke risk assessment in SCD patients. Methods: We conducted a retrospective study of 144 SCD HbSS children at Children’s National Hospital, Washington DC, USA. TCD values were categorized as normal, conditional, or abnormal. PNR was calculated from routine blood tests. Statistical analyses were performed to evaluate the association between PNR and stroke risk. Results: PNR values varied significantly across stroke risk categories: 83.83 (58.15-127.65) for normal, 75.69 (64.89-88.6) for conditional, and 62.57 (28.12-64.47) for abnormal (p = 0.031). After adjusting for age and hydroxyurea intake, a unit increase in PNR was significantly associated with a decreased stroke risk (OR = 0.975, 95% CI: 0.953-0.998, p = 0.0345). PNR demonstrated superior discriminative performance for stroke risk compared to neutrophils and platelets, with AUC values of 0.81, 0.57, and 0.19, respectively. Multivariate analysis confirmed that higher PNR was independently associated with a reduced likelihood of abnormal TCD values (OR = 0.975, 95% CI: 0.953-0.998, p = 0.0345). Conclusion: Our study highlights the potential of the platelet-neutrophil ratio (PNR) as a promising, cost-effective, and accessible alternative for stroke risk assessment in SCD management, offering a more equitable healthcare solution.

Objective Neuroblastic tumors are the most common malignant extracranial solid tumors of childhood. A small subgroup presents chronic incoercible diarrhea due to the tumor’s production of vasoactive intestinal peptide (VIP). The hypothesis of an occult tumor is not always considered, which delays and impairs treatment. We aim to identify these patient’s characteristics and help alert health professionals to the hypothesis of a neuroblastic tumor in children with chronic diarrhea refractory to the usual approach. Methods We carried out an epidemiological study on all retrievable reports of neuroblastic tumors between 1975 and 2021 described in the MEDLINE, EMBASE, and LILACS databases. Patient information was classified into categories, and we performed a descriptive analysis. Results We analyzed 96 cases. 83 (86.5%) cases had diarrhea prior to the diagnosis of the neoplasm; 49 (51%) were ganglioneuroblastomas; 69 (71.8%) were abdominal and 50 of the 60 patients (98%) with reported acid-base disorders had hypokalemia. When serum VIP was reported, values varied between 1 to 20 times the upper reference limit. 72 (75%) patients underwent complete tumor resection and overall survival rate was 70%. C onclusion VIP production by neuroblastic tumors is related to cell differentiation and better prognosis. Such children often require intensive hospital support to reverse the malnutrition and acid-base disorders related to this paraneoplastic syndrome. Its early diagnosis and treatment significantly change the prognosis and quality of life. We therefore suggest screening for neuroblastic tumors when health professionals encounter unmanageable chronic secretory diarrhea in children with no defined etiology in the usual investigations.

Parasite-host interactions have been investigated in-depth for years, leading to the discovery of numerous methods by which parasites communicate with and influence their host. One notable effect of these interactions is the ability of parasites to modulate the host immune system, presumably as an adaptation to allow for parasite survival and evasion of the host's defenses. While described in virtually all parasites, many investigations have focused on parasitic helminths, given their endoparasitic nature, resulting in a potentially longer-lasting host interaction as compared to ectoparasites, and given the extensive pathology associated with many helminth infections. Adaptations range from mechanical methods such as mucus production or elaboration of protective barriers, to more molecular means, such as the excretion of immunomodulatory products including proteins and extracellular vesicles. Here, we provide an overview of the immunomodulatory mechanisms utilized by parasitic helminths. We will begin with a brief introduction of the history of parasite-host interactions, followed by current research related to the host immune response to endoparasites, and helminth-host immunomodulation studies. We will conclude with a brief overview of the future directions of this research, and implications of these findings as related to human and animal health.

Polyvinyl butyral boasts many applications, yet its synthesis often suffers from oversizing agglomeration, resulting in limited product purity, and thus large energy consumption and waste emission for purification. This study for the first time demonstrates that incorporating NaNO 3 as additive can prevent the oversizing agglomeration to offer high-purity and finely sized polyvinyl butyral product. NaNO 3 functions as a removable and recyclable dispersant to enable uniform acetalization of polyvinyl alcohol with n-butanal in acidic aqueous media at ambient temperatures. The salting-in effect of NaNO 3 diminishes the hydrophobic interaction of n-butanal and polymers, improving the media dispersion and preventing the agglomeration runaway. In contrast to conventional systems, the NaNO 3-assisted synthesis at ambient temperature offers multiple benefits, including suppression on by-products, energy conservation, reduction on emission and reusability of the post-acetalization medium. This finding offers a valuable complementary strategy for PVB synthesis and deserves exploration in massive production.

The nuclear ribosomal DNA Internal Transcribed Spacer (ITS) region is used as universal fungal barcode marker, but it is often missing significant DNA barcoding gap between sister taxa. Here we tested reliability of protein coding low-copy genes as alternative markers. Mock communities of three unrelated agaric genera (Dermoloma, Hodophilus and Russula) representing lineages of closely related species were sequenced by Illumina platform targeting ITS1, ITS2, the second largest subunit of RNA polymerase II gene (rpb2) and the transcription elongation factor 1-alpha gene (ef1-α) regions. The representation of species and their relative abundances were similar in all tested barcode regions, despite lower copy number in protein coding markers. ITS1 and ITS2 required more sophisticated sequence filtering because they produced a high number of chimeric sequences requiring reference-based chimera removal and had higher number of sequence variants per species. Clustering of filtered ITS sequences showed in average higher number of correctly clustered units at best fitted similarity thresholds, but these thresholds were very different among genera. Best fitted thresholds of low-copy markers were more consistent among genera but species resolution was frequently missing due to low intraspecific variability. At some thresholds we observed multiple species lumped together and, at the same time, species split in multiple partial clusters, which should be taken into consideration when assessing best clustering thresholds and taxonomic identity of clusters. For best taxonomic resolution and better species detection, we recommend to combine different markers and to apply additional reference-based sorting of clusters.

Triangular Lunulae in Papillon-Lefèvre Syndrome_ A Case Report

IntroductionForeign body aspiration (FBA) is common at both extremes of age and is a potentially life-threatening event(1). Advanced age, alcohol intoxication, psychiatric illness, seizure disorders, stroke, neuromuscular disorders, sedative or hypnotic drugs, and chronic debilitating conditions predispose the elderly to FBA(2). Common foreign bodies (FBs) aspirated include metallic objects, organic substances, dentures, chicken or fish bones, and peas(3). FBA in the elderly poses a diagnostic and therapeutic challenge due to several factors. These include the masking of respiratory symptoms post-aspiration, atypical imaging findings, the patient’s inability to recall the aspiration event, and the challenges encountered during bronchoscopy(4). FBA usually follows a choking event, often during feeding. The patient might present with dyspnea, hemoptysis, cough, a fall in oxygen saturation, anxiety, etc.(5). The signs and symptoms depend on the size of the foreign body and the level of obstruction. Small objects lodged in distal airways seldom produce acute symptoms, while the opposite is true for larger FBs lodged in larger airways. Stridor is present if FBs are lodged in trachea(6). FBA results in collapse/hyperinflation of lungs aerated by the airway. If there is chronic obstruction, obstructive pneumonia, bronchiectasis, and lung abscess can develop(2). FBs generally lodge in the right middle and lower lobe bronchi(4). FBA causing acute airway obstruction and respiratory failure requiring urgent intervention.

Background: The JPLT3-S (Japanese study group for Pediatric Liver Tumors) 3 study, conducted cisplatin (CDDP) monotherapy for young children (< 3 years old) with standard risk hepatoblastoma (HB) evaluated central review system in Japan. In the previous JPLT2 study, cases with resectable tumors without any annotation factors in the PRETEXT classification (standard risk HB) showed favorable outcomes by the therapies consisted of CDDP and pirarubicin, but showed toxicities and late complications. In this JPLT3-S trial, less intensity regimen consisted of CDDP alone were evaluated in the young children (< 3 years old) with standard risk HB. Methods: Patients who were less than three years of age, who had PRETEXT I, II, or III HB without any annotation factors (e.g., E1, E1a, E2, E2a, H1, N1, P2, P2a, V3, and V3a) were eligible for inclusion in this study. In this trial, we introduced central radiological and pathological reviews of all patients. The primary outcome was 3-year progression-free survival (PFS). Results: A total of 38 patients (23 female) were included. The median patient age was 12 (range, 2-34) months. Two patients discontinued treatment because of progressive disease, and five patients discontinued treatment for other reasons. The 3- year PFS rate was 93.9% (95% confidence interval [CI], 86.4 to 100). All 38 patients survived (follow-up period 38-98 months), and the OS rate was 100% (confidence interval, 100). There were no cases with late complication without ototoxicity. Conclusion: CDDP monotherapy regimen is feasible in young patients with localized HB classified by central review.

Introduction Arteriovenous fistulas (AVFs) are a form of arteriovenous malformations clinically characterized by anomalous communications between arterial and venous systems that bypass the normal anatomic capillary beds (1). Broadly it can be divided into two forms based on the cause: acquired or congenital. Surgery, penetrating trauma, and percutaneous catheterization are the most common causes of acquired AVFs. Rarely AVFs can be formed in the absence of a clear cause and are called spontaneous AVFs which are rare with very few case reports in the literature (2-4). The anatomy of the fistula depends on the location in the body and where the causative factor was applied. Greater than 50% of traumatic AVFs happen in the lower extremity, and about one-third occur in the femoral vessels, while 15% take place in the popliteal vessels but AVF can occur at any site (5-8).AVFs present clinically with progressively growing pulsatile mass on each respective site associated with or without complications including infection, thrombosis, aneurysm, hypertension, and heart failure demanding timely intervention (9).

A document by Simeon Mengistu. Click on the document to view its contents.

Recurrent unilateral periorbital cellulitis: Case report on challenges in differential diagnosis between periorbital cellulitis and idiopathic orbital cellulitis in the absence of inflammatory markersVera Gulácsy1,*, Mohamed Mahdi2,3, Tibor Kalmár4, Marianna Csenki4, Csaba Bereczki4, Hajnalka Szabó 41 Department of Pediatrics, Fejér County Szent György University Teaching Hospital, Székesfehérvár, Hungary.2 Infectology Clinic, University of Debrecen Clinical Center, Debrecen, Hungary.3 Department of Biochemisstry and Molecular Biology, University of Debrececn, Debrecen, Hungary.4 Department of Pediatrics and Pediatric Health Center, Albert Szent-Györgyi Health Centre, University of Szeged, Szeged, Hungary.* Corresponding author VG, email: vpiegl-gulacsy@mail.fmkorhaz.hu

The Guarantee Trusted Bank (GT Bank) at Opera Square, Accra, currently faces challenges in accurately counting and monitoring customers entering and exiting the bank premises, leading to operational inefficiencies and safety concerns. Additionally, the current system for counting and monitoring customers through both a CCTV and physical approach in the bank is prone to errors and cannot collect and store data for future planning. Security personnel also lack knowledge of the exact number of daily visitors and struggle to determine the exact timing of incidents during working and closing hours. This study aims to explore the weaknesses of the current detection and counting system at the GT bank and proposes solutions to address these issues. The primary solution involves the implementation of a computerized human detection and counting system, designed to accurately detect and count individuals who enter and exit the GT bank’s branch premises. To achieve this goal, a qualitative methodology is employed. Our qualitative method involved interviewing participants using relevant open-ended questions, which motivated them to express their thoughts and views openly with no limitations. The analysis of quantitative data illustrates the difficulties faced by the current system in detecting and counting customers in the bank. Furthermore, the research participants are willing to accept our proposed system, which would improve the current counting and monitoring system used by the bank. Our proposed system utilizes computer vision and deep learning algorithms through the use of a single-shot multi-box detector (SSD) to identify human figures in video feeds. By introducing the proposed system within the GT bank, it can improve the overall customer experience. One implication for decision-makers involves the designation of specialized personnel responsible for system maintenance and troubleshooting, thereby assisting in routine checks and upkeep to prevent system downtime and maintain continuous operation.

Key Clinical MessageInternal jugular phlebectasia is a rare disease that typically presents with a lateral cervical lump but may also cause isolated tinnitus. Vascular investigations should be a part of every tinnitus workup, especially in children. The tinnitus associated with jugular phlebectasia can be cured by ligation of the internal jugular vein.