A main bearing (MB) preforms the critical role of supporting the rotor and whole drive train in a wind turbine. It endures very heavy and complex load coming from the rotor, meanwhile, high reliability in whole operation life is required for the high cost of MB replacement. Taking a spherical roller bearing (SRB) MB as an example, the paper analyzed complex load characters of a SRB MB configuration and discussed how to simplify the complex load in MB design works, then the key aspects influencing the MB performance were discussed, including raceway performance and shrink fit. Further more, thresholds of raceway contact pressure occurrence, fitting contact pressure and hoop stress were presented based on the state of art experiences. The paper gives an overview of SRB MB design for field operation performance.

Objective: To delineate the natural history of splenic complications other than the loss of splenic function in children with sickle cell disease (SCD), we performed a retrospective chart review of patients with SCD treated at the Texas Children’s Hospital. Methods: We determined the dates of diagnoses of splenic complications, the number of ASSC events, and hydroxyurea treatment in patients with SCD. We also examined the association of hydroxyurea therapy with the onset and severity of ASSC. Results: The cumulative prevalence of splenic complications was 24.7% for splenomegaly, 24.2% for ASSC, 9.6% for hypersplenism, and 5.6% for splenectomy. The cumulative prevalence of all splenic complications was highest in patients with hemoglobin Sβ 0 (69.2%), intermediate in hemoglobin SS (33.3%), low in hemoglobin SC (9.0%), and non-existent in hemoglobin Sβ +. The overall event-rate of ASSC was 8.3 per hundred patient-years. The event-rate was 28.4 in the hemoglobin Sβ 0, 10.9 in hemoglobin SS, and 3.5 in hemoglobin SC Patients with hemoglobin SS and hemoglobin Sβ 0 on hydroxyurea therapy had a significantly higher occurrence of ASSC than those who were not, with event-rates of 14.2 and 3.1, respectively. The event-rate was also higher for children who started hydroxyurea before age 2 years than for those who started after this age (19.8 and 9.2 respectively). Conclusions: The prevalence and severity of splenic problems vary widely between different sickle cell genotypes, with hemoglobin Sβ 0 having the most severe complications. Hydroxyurea therapy is strongly associated with incidence of ASSC, particularly when initiated before two years of age.

A breath of fresh air: Does spontaneous breathing and early repair in neonates with very mild congenital diaphragmatic hernia lead to earlier discharge? Dear Editor:We read with great interest the article by Kipfmueller et al. that investigated the feasibility and outcomes of a spontaneous breathing approach (SBA) versus immediate intubation in neonates with prenatally diagnosed very mild CDH and found that it appears to be feasible and beneficial1. The authors present an approach that is quite novel - spontaneous breathing and enteral feeding in the pre-surgical repair phase. We compliment the authors for their attempt to address an issue very relevant to the acute management of CDH. Nonetheless, we feel compelled to highlight some aspects that should be considered for adequate interpretation of their findings.The study’s sample size is quite small (n=24), but the fact that the investigators found statistical significance for numerous associations despite such a small sample size demonstrates the strength of the relationships.  It is a common misconception that statistical significance due to chance (i.e., Type I error) is more likely when the sample size is small, although low power due to the small sample size is actually difficult to overcome2. However, when evaluating Table 1, after matching on observed-to-expected lung-to-head-ratio (o/e LHR), liver position, gestational age at delivery, birth weight, and defect size, we note that prerepair characteristics such as early feeding, Oxygenation Index (OI) and FiO2, and Apgar at 10min are still significantly imbalanced between the SBA and standard treatment groups, which raises concerns about potential confounding. For this reason, we recommend the authors complement the unadjusted analyses they report with multivariable regression analyses that compare SBA versus standard treatment after controlling for Apgar 10, OI and FiO2, although the study sample size of n=24 would typically be considered too small for this kind of multivariable regression analysis. Per the authors, 39 patients met their prenatal eligibility criteria. A better and more meaningful comparison of outcomes would be to compare the 8 patients that underwent SBA versus the remaining 31 patient that met their predetermined ’eligibility criteria’ and did not undergo planed SBA. Using this approach would diminish the potential differences in cohort caused by severity of hernia defect, given the fact that some patients in the standard treatment group required patch repair. In the study, the authors incorporated the post natally determined CDH defect size into the matching process; we would advise against using defect size for matching as it cannot be replicated prospectively.The authors utilized the Mann-Whitney U test and Fisher’s exact test to compare the SBA versus standard treatment groups in terms of quantitative and categorical variables, respectively.  These methods ignore the dependence structure in the data resulting from matching. Although this type of oversight is common, we would recommend analyzing the data differently. Utilizing mixed-effects linear models and generalized estimating equations for quantitative and categorical outcomes, respectively, would appropriately accommodate the clustering of study patients due to matching.We were impressed by the decision to initiate enteral feeding prior to surgery and wonder if this approach could be a gut priming strategy favoring outcomes beyond the need for parenteral nutrition3. However, while novel and potentially beneficial, this strategy carries with it risks and will need to be investigated further before others will choose to adopt such a practice.Overall, the authors tackle an important subject and their findings raise questions on whether routine intubation is beneficial for infants with mild CDH. As SBA infants were compared to those with more severe hernias, the observed differences noted between groups are likely a reflection of the severity of lung hypoplasia and not a result of the intervention. We encourage the authors to further explore this strategy with a larger multicenter study to draw meaningful conclusions from the study results.Clinicians should be cautious of implementing guideline changes based on retrospective studies, as prospective studies do not always validate inferences derived from retrospectives studies, such as permissive hypercapnia to prevent bronchopulmonary dysplasia in extremely low birth weight infants (ELBW)4. Centers that perform early repair could consider an SBA approach for a well-defined cohort of infants with mild CDH, as it appears this can decrease the duration of ventilation and length of hospital stay. However, this precision-based medicine approach would be best evaluated by a prospective study to assess the benefits and risks of implementing this strategy.1. Kipfmueller F, Leyens J, Pugnaloni F, et al. Spontaneous breathing in selected neonates with very mild congenital diaphragmatic hernia.Pediatr Pulmonol. 2024;59(3):617-624.2. Jones SR, Carley S, Harrison M. An introduction to power and sample size estimation. Emerg Med J. 2003;20(5):453-458.3. Ratsika A, Codagnone MC, O’Mahony S, Stanton C, Cryan JF. Priming for Life: Early Life Nutrition and the Microbiota-Gut-Brain Axis.Nutrients. 2021;13(2):423.4. Thome UH, Genzel-Boroviczeny O, Bohnhorst B, et al. Neurodevelopmental outcomes of extremely low birthweight infants randomised to different PCO(2) targets: the PHELBI follow-up study.Arch Dis Child Fetal Neonatal Ed. 2017;102(5):F376-F382.The authors have disclosed no conflicts of interest.

A heteronuclear dual transition metal atom catalyst is a promising strategy to solve and relieve the increasing energy and environment crisis. However, the role of each atom still does not efficiently differentiate due to the high activity but low detectivity of each transition metal in the synergistic catalytic process when considering the influence of heteronuclear induced atomic difference for each transition metal atom, thus seriously hindering intrinsic mechanism finding. Herein, we proposed coordinate environment vary induced heterogenization of homonuclear dual transition metal, which inherits the advantage of heteronuclear transition metal atom catalyst but also controls the variable of the two atoms to explore the underlying mechanism. Based on this proposal, employing density functional theory study and machine learning, 23 kinds of homonuclear transition metals are doping in four asymmetric C3N for heterogenization to evaluate the underlying catalytic mechanism. Our results demonstrate that five catalysts exhibit excellent catalytic performance with a low limiting potential of -0.28 to -0.48 V. In the meantime, a new mechanism, ‘capture-charge distribution-recapture-charge redistribution’, is developed for both side-on and end-on configuration. More importantly, the pronate site of the first hydrogenation is identified based on this mechanism. Our work not only initially makes a deep understanding of the transition dual metal-based heteronuclear catalyst indirectly but also broadens the development of complicated homonuclear dual atom catalysts in the future.

Objective: Peripheral artery disease (PAD) of the lower extremities is a global health concern linked to substantial morbidity and mortality. Nevertheless, research on PAD within health administrative databases remains limited. This study aimed to develop and validate algorithms for the identification of patients with PAD using French health administrative data. Methods: The study was conducted at Bordeaux University Hospital from January 2018 to December 2019. Four algorithms combining International Classification of Diseases, Tenth Revision (ICD-10) codes and procedural codes were created (1: i70.2 code alone, 2: one diagnosis procedural code, 3: two diagnosis procedural codes, 4: one procedural code for revascularization/non-traumatic amputation. PAD status was confirmed through expert review of electronic medical records using consensus criteria. Sensitivity, specificity, and predictive values were assessed for each algorithm. Results: Among 700 randomly selected patients, 12% were diagnosed with PAD. The first algorithm, using the ICD-10 code i70.2, had the highest accuracy (sensitivity: 93%, 95%CI (confidence interval)85-97), specificity: 97%, 95%CI(95-98)). Other algorithms did not significantly improve these metrics. Discussion: This study allows considering that in-hospital coding is reliable for the identification of patients with symptomatic lower limb PAD in health administrative databases. The i70.2 code alone displayed the best performance for the identification of inpatient PAD. International validation studies for PAD algorithms would be needed to ensure that the proposed identification strategy presents with acceptable performances in other settings.

A document by Deniz Cagdas Ayvaz. Click on the document to view its contents.

In the context of the Internet of Things (IoT), reliable and energy-efficient provision of IoT applications has become critical. Equipping IoT systems with tools that enable a flexible, well-performing, and automated way of monitoring and managing IoT edge devices is an essential prerequisite. In current IoT systems, low-power edge appliances have been utilized in a way that can not be controlled and reconfigured in a timely manner. Hence, conducting a tradeoff solution between manageability, performance and design requirements are demanded. This paper introduces a novel approach for fine-grained monitoring and managing individual micro-services within low-power edge devices, which improves system reliability and energy efficiency. The proposed method enables operational flexibility for IoT edge devices by leveraging a modularization technique. Following a review of existing solutions for remote-managed IoT services, a detailed description of the suggested approach is presented. Also, to explore the essential design principles that must be considered in this approach, the suggested architecture is elaborated in detail. Finally, the advantages of the proposed solution to deal with disruptions are demonstrated in the proof of concept-based experiments.

Daylight photoluminescence imaging of crystalline silicon photovoltaic modules is demonstrated for modules embedded in rooftop and utility-scale systems, using inverters to electrically switch the operating point of the array. The method enables rapid and high-quality luminescence image acquisition during the day, unlocking efficient performance and quality monitoring without the need to connect specific electrical hardware or to make any modifications to the system wiring. The principle of the measurement approach is discussed and experimental results from a 10 kW DC residential rooftop system and from a 149 MW DC utility-scale photovoltaic power plant are presented. Measurements were performed using commercial inverters without modifications to the inverter hardware or firmware. In the case of the utility-scale power plant, the daylight photoluminescence image acquisition of modules connected to a central inverter was obtained from a remote piloted aircraft. Data analysis includes the conversion of photoluminescence image data into implied voltage differences.

The type parameter helps in the scattering mechanism analysis and scattering center identification. However, current approximate solution methods based on spectral estimation are noise-sensitive and have poor accuracy. In this letter, a high-precision approach for the type parameter based on the alternating direction method of multipliers (ADMM) is proposed. We use logarithmic transformation to separate the type parameter and the amplitude from the coupling term, and initially obtain the closed-form solution of the type parameter. Then, the regularization term of l2-norm is used for denoising. Finally, a joint optimization model based on ADMM is constructed to effectively estimate the type parameter. Simulation results confirm the high accuracy of the proposed approach.

The time it takes for an ecosystem to recover is a key aspect of environmental disturbance. Conventionally, recovery is defined as a return to the pre-disturbance state, assuming ecosystem stationarity. However, this view does not account for the impact of external forces like climate change. We propose a counterfactual approach, viewing recovery as the state the ecosystem would achieve without the disturbance. This redefines recovery time as the period until the ecosystem reaches its counterfactual state. Through a case study on the greening of the Arctic and Boreal regions, we present evidence demonstrating significant disparities between counterfactual and conventional recovery time estimates. The well-documented greening of the region serves as an external force, introducing non-stationary dynamics that result in a counterfactual recovery time twice as long as the conventional view. We advocate for embracing the counterfactual definition of recovery, as it aligns more realistically with informed decision-making.

Ectodomain shedding, which is the proteolytic release of transmembrane proteins from the cell surface, is crucial for cell-to-cell communication and other biological processes. The metalloproteinase ADAM17 mediates ectodomain shedding of over 50 transmembrane proteins ranging from cytokines and growth factors, such as TNF and EGFR ligands, to signaling receptors and adhesion molecules. Yet, the ADAM17 sheddome is only partly defined and biological functions of the protease have not been fully characterized. Some ADAM17 substrates (e.g. HB-EGF) are known to bind to heparan sulfate proteoglycans (HSPG), and we hypothesised that such substrates would be under-represented in traditional secretome analyses, due to their binding to cell surface or pericellular HSPGs. Thus, to identify novel HSPG-binding ADAM17 substrates, we developed a proteomic workflow that involves addition of heparin to solubilize HSPG-binding proteins from the cell layer, thereby allowing their mass spectrometry detection by heparin-secretome (HEP-SEC) analysis. Applying this methodology to murine embryonic fibroblasts stimulated with an ADAM17 activator enabled us to identify 47 transmembrane proteins that were shed in response to ADAM17 activation. This included known HSPG-binding ADAM17 substrates (i.e. HB-EGF, CX3CL1) and 17 novel HSPG-binding putative ADAM17 substrates. Two of these, MHC-I and IL1RL1, were validated as ADAM17 substrates by immunoblotting.

Landscape genetics is a field dealing with local genetic differences and contributes to strategic conservation planning. Recently, environmental DNA (eDNA) metabarcoding has proven useful not only for detecting species but also for assessing genetic diversity and genetic structure on a large scale such as in phylogeography. However, it remains unclear whether eDNA analysis also has sufficient power to perform the landscape genetics, which focuses on a local scale. To reveal the applicability of eDNA to landscape genetics, we conducted an eDNA metabarcoding analysis of the mitochondrial DNA D-loop region of the fluvial sculpin Cottus nozawae in the upper Sorachi River in Japan and compared the results with inferences based on traditional tissue-based approaches. As a result, the spatial distribution of haplotypes was generally consistent between the eDNA- and tissue-based approaches. In addition, the genetic differentiation statistics calculated using eDNA and tissue samples were highly correlated when compared in the same genetic region. Furthermore, if an inference based on genome-wide SNP data from tissue samples was taken as known truth, the inference by eDNA was not necessarily inferior to the inference by the same region from tissue samples. Finally, we confirmed that analyses using eDNA data can reveal patterns such as isolation-by-distance shown in previous studies on this species, indicating the applicability of eDNA to basic landscape genetics. Even though some limitations remain, eDNA may have great potential for conducting basic landscape genetics.

Psychedelic drugs have profound effects on perception, cognition, and mood. How psychedelics affect neural signaling to produce these effects remains poorly understood. We investigated the effect of the classic psychedelic psilocybin on neural activity patterns and spatial encoding in the retrosplenial cortex of head-fixed mice navigating on a treadmill. The place specificity of neurons to distinct locations along the belt was reduced by psilocybin. Moreover, the stability of place-related activity across trials decreased. Psilocybin also reduced the functional connectivity among simultaneously recorded neurons. The 5-HT2AR (serotonin 2A receptor) antagonist ketanserin blocked the majority of these effects. These data are consistent with proposals that psychedelics increase the entropy of neural signaling, and provide a potential neural mechanism contributing to disorientation frequently reported by humans after taking psychedelics.

Glioblastoma multiforme (GBM) presents a significant obstacle in the field of cancer therapy because of its aggressiveness and limited treatment options. Despite advances in surgical resection, radiation therapy, and chemotherapy, the median survival remains dishearteningly brief at 15 months. This review focuses on the mysterious Glioblastoma stem cells (GSCs), particularly those expressing the CD133 marker, acknowledged for their pivotal role in tumor growth and resistance to conventional therapies. The NOTCH signaling pathway emerges as a promising target. This review explores the NOTCH signaling pathway, a crucial regulator of GSCs, and evaluates inhibitors like gamma-secretase inhibitors (GSI), siRNA, and monoclonal antibodies. While recent trials suggest improved outcomes by integrating GSIs with standard treatments, the challenge persists in sparing CD133-positive cells. This review also emphasizes the role of Chk1 and Chk3 inhibitors in the reversal of radioresistance in CD133+ cells. In summary, this review explores the nuances of NOTCH signaling inhibition in GBM treatment, emphasizing precision in targeting the tumor microenvironment and addressing therapeutic resistance associated with CD133-positive cells.

Alongside models and methods, concepts are one of the building blocks of neuroscientific inquiry. They help researchers to pursue various goals, such as describing novel patterns in the data, situate these patterns in existing models, formulate new models or build explanations, e.g., of how the brain processes sensory information. Often the formation of novel or reinterpretation of existing concepts can signal major shifts in how we understand the brain and investigate it scientifically. Yet not every novel concept or reinterpretation produces such a shift, which raises the question of when concepts succeed or fail to change our understanding of the brain. In this paper, we introduce analytical tools developed by philosophers of science and concepts of brain organization as examples to discuss when introducing novel, reinterpreting existing and replacing outdated neuroscientific concepts succeeds or fails. Our discussion opens up novel avenues for neuroscientists and philosophers to collaborate around the limits of old and prospects of new concepts describing how the brain is organized.

In solid organ transplantation biologicals like recombinant therapeutic proteins, monoclonal antibodies, fusion proteins and conjugates are increasingly used for immunosuppression, desensitization, ABO incompatibility, antibody mediated rejections and atypical hemolytic uremic syndrome. For some of these drugs this represents off-label use; and the evidence to define their role in current therapies and the evidence for their clinical benefit may be sparse. Biologicals are large molecules compared to traditional drugs, and the processes that define their pharmacokinetics are different. Validated drug assays that can be applied in clinical routine are to a large extent available. Dosing is currently mostly standard -either fixed doses or adjusted according to body size; and when drug concentrations have been measured, large variability in distribution and elimination has been demonstrated. This opens for the proposal to identify optimal concentration ranges, establish PK/PD models for interpretation and guidance, leading to model informed precision dosing. Extrapolation of the results from use of these drugs on other indications may provide some of the necessary information. For drugs like alemtuzumab, eculizumab, rituximab, tocilizumab and belatacept there may be a potential for model informed precision dosing. However, for all of these the challenge is to perform studies that are properly designed to provide evidence for beneficial outcome related to the individualization of treatment. This calls for collaboration within the transplantation and TDM community.

1. Fucoid forests are areas dominated by marine brown seaweed in the taxonomic order Fucales that, like the better-known marine foundation species - corals, kelps, seagrasses, salt marshes, and mangroves - are threatened by anthropogenic stressors. 2. Fucoid forests are fabulous and important because they, like the better-known marine foundation species (i) span large areas, bioregions, and ecosystems, (ii) provide ecological functions such as high productivity and biodiversity, and (iii) support a variety of ecosystem services including habitat for commercial fishery species, food for humans and cultural values. 3. Fucoid forests are, based on a new citation analysis, forgotten worldwide, because they are described orders of magnitude less than the better-known marine foundation species, in ecology and marine biology textbooks, in Google Scholar and Scopus databases over scientific literature, and in recent reports and reviews about seaweed forests. 4. Fucoid forests would be less forgotten if more people acknowledge their biological importance and societal value more often and equate their importance to that of the better-known marine foundation species. Perhaps name-recognition would also improve if fucoids are unified under a non-taxonomic common name across teaching, research, management, and conservation, like the better-known marine foundation species. We agree with the marine scientists that have used ‘rockweed’ as such a common name to describe all fucoids, but other seaweed-experts disagree because they (a) do not agree fucoids are forgotten, (b) dislike common names or (c) argue rockweed should only describe fucoid species in the family Fucaceae.

Splenic artery steal syndrome after liver transplantation: A case series and review of literatureAssim Saad Eddin, MD1 ;Abhiram Kamaraju, MBBS1; Umar Ramzan, BS2, Jay Yu, MD1 ;Surbhi Dadwal, MBBS1; Laroia Sandeep, MD11.University of Iowa Hospitals and Clinics, Department of Radiology, Iowa city, Iowa, United States2.Northwestern University Feinberg school of medicine, Chicago, Illinois, United StatesCorresponding author:Dr. Assim Saad EddinDepartment of Radiology, University of Iowa hospitals and clinicsEmail: assim-saadeddin@uiowa.edu

Case reportHalim et al

Functional significance of RSNs is examined via simultaneous EEG-fMRI studies on the basis of relation of RSNs with different frequency bands of EEG and EEG based microstate analysis. In this study we try to identify RSNs from microstates of cortical surface maps of BOLD signal. In addition the scale-free dynamics of these map sequences were also examined. The structural and resting state functional MRI images were acquired on a 3T scanner with three different fMRI acquisition protocols from 7 subjects. Microstate segmentations from EEG, fMRI and simulated data were performed using Cartool software for each subject separately. Wavelet-based fractal analysis was performed on map sequence time series and the Hurst exponent (H) was calculated. By using HRF deconvolved fMRI time series, the effect of HRF (Hemodynamic Response Function) was on fMRI-derived microstates was tested. fMRI map sequence has a system having a memory system smaller than 16s. When HRF was deconvolved, the duration of the memory of the system was reduced to 4s. On the other hand, the results of simulation data indicated that these systems are specific to resting state BOLD signal. Similar to EEG microstates, fMRI also has microstates and both of them have scale-free dynamics. fMRI microstates dynamics have 2 different components, one is related to HRF and the other independent from HRF. The significance of fMRI microstates and their relation with RSNs are needed to further studied.

Optimization of hybrid dynamic systems typically involves characterizing switching times and mode sequences. Operating autonomous hybrid systems with varying event timings presents multiple challenges. Complexity often arises from optimal mode sequence determination, making optimization of the corresponding hybrid automaton more difficult. An experimental autonomous hybrid dynamic system experiencing switching due to choked flow conditions is presented. Implementing gradient-based optimization algorithms may be difficult due to complex switching patterns of the hybrid dynamic systems. To mitigate this, an approximation of the Heaviside step function is applied to transform the hybrid switching functions to a continuous and smooth forms. Using the Control Vector Parameterization (CVP) approach and evaluating gradients using the variational method, an open-loop time-optimal control problem is presented. Modeling and control methods are demonstrated using an experimental two-tank air system. The optimal control formulation can include constraints to avoid specific undesirable modes of operation.

Abstract: Introduction: Germ cell tumors (GCT) encompass a wide variety of neoplasms with varying clinical behavior dependent on histology, staging, and site. GCT remain relatively uncommon in the pediatric population and most patients have a favorable prognosis. However, the well-established co-occurrence of primary mediastinal GCT (PMGCT) and acute myeloid leukemia (AML) has a dismal prognosis with few reported patients achieving sustained remission. Case presentation: An 18 y.o. male was concurrently diagnosed with PMGCT and AML, type M7. Cytogenetic analysis revealed a complex set of chromosomal alterations along with homozygous deletion of TP53. His concurrent oncologic processes were managed with a variety of chemotherapy regimens, complete surgical resection of the mediastinal mass, and hematopoietic stem cell transplant (HSCT). He is one of few patients with concurrent PMGCT and AML able to achieve remission with no evidence of disease nearly 5 years after completion of treatment. Conclusion: The rare, but well-identified, association between PMGCT and concurrent or subsequent AML has a dismal prognosis. Modern genetics sequencing has identified common aberrations, including i(12p), trisomy/tetrasomy 8, TP53, and PTEN mutations. With this knowledge, it may allow for future tailoring of therapy to improve the predicted outcome of patients with PMGCT and AML.

This brief report describes the use of adjuvant granulocyte transfusion therapy to successfully treat antibiotic refractory proctitis with perirectal abscess in a child with very severe aplastic anemia (vsAA). She was not expected to have imminent neutrophil recovery, which by current practice guidelines is a prerequisite for the consideration of granulocyte transfusion; however, the risk of bowel perforation potentially hastened by conditioning and/or engraftment precluded curative hematopoietic stem cell transplantation, presenting a significant treatment conundrum. This case highlights an expanded clinical indication for granulocyte therapy in a uniquely vulnerable patient population.

Background: Limited information is available on the use of omalizumab (OMA) updosing since its introduction as a second-line therapy in chronic spontaneous urticaria (CSU) in 2014. Practical guidelines from health authorities are lacking, and the specific characteristics of patients requiring higher doses remain unknown. Our objectives were to characterize the patterns of OMA updosing (defined as changes in dose and/or injection intervals), to identify the predictive factors associated with updosing, and to improve CSU management. Methods: We conducted a prospective, multicentric, real-life, observational study, including patients diagnosed with CSU and starting OMA. The data were collected at 0, 3, 6 and 9 months. The primary endpoint was the frequency of OMA updosing at 3 months. The secondary endpoints included an analysis of updosed patients’ profile, and an assessment of OMA efficacy and safety. Results: We included 153 patients. Twenty percent of patients at M3 were updosed, and 27% in total during the 9-month follow-up. Practitioners mainly chose to increase the frequency of injections (66%). At baseline, the updosed patients were more likely, to have inducible urticaria (50% vs. 33%, p=0.046), more severe CSU (UCT 3 vs. 4, p<0.001; DLQI 14 vs. 11, p=0.040), a lower lymphocyte count (1894 vs. 2100, p=0.026) and IgE below 70 UI/mL (65% vs. 45%, p=0.039). The side effects of OMA were not more frequent after updosing. Conclusion: One in five patient underwent updosing within just three months. OMA updosing is frequent in particular in cases of severe disease, inducible urticaria and low IgE blood levels.