Good scientific communication is helpful in improvement of cardiovascular health and life due to a number of scientific highlights and conducting the outcomes of both basic studies and clinical trials in cardiovascular disease (CVD). In this article, the author proposed new concepts of scientific communication from conferences/clinical to clinical/conferences (Co2Cl & Cl2Co), discusses related roles in clinical practice and translational studies as well as scientific innovation. Since international scientific conferences or congresses focus on prevention, health promotion, education and training as well as treatment or management and rehabilitation of CVD, Co2Cl & Cl2Co are beneficial to improvement of cardiovascular health and quality of life due to a number of scientific breakthroughs and a series of discoveries in cardiovascular medicine. Both models of Co2Cl & Cl2Co contribute to better cardiovascular scientific communication, excellent clinical practice and translational research as well as better scientific innovation, in particular the pandemic and post-COVID-19 era.

Polyclonal infections are widespread and provide evidence of facilitation, competition, and neutral interactions between parasite clones, even within the same host-parasite system. The outcome of co-infections is usually assessed by parasite infection intensities, while other important fitness-related traits, e.g. larval growth rates, are often ignored. We studied both infectivity and the growth rate of different clones of the common trematode Diplostomum pseudospathaceum in the fish host (Salvelinus malma) and tested how these fitness-related traits changed in double-clone infections compared to single-clone ones. We found that the growth rates of the parasite’s clones were more variable than their infectivity. The relationships of these D. pseudospathaceum traits with host mass were clone-specific. Some clones demonstrated higher infection intensities and growth rates in larger fish. It hints that specialization on different size groups of hosts may occur in this parasite species. In addition, we found positive density-dependent growth (Allee effect), rarely reported for parasites. Interestingly, it was observed only in mixed infections and we discuss the reasons for it. In double-clone infections, both evidence of facilitation and competition between D. pseudospathaceum clones were found. The outcome of co-infections varied not only between genotype combinations but also between tested traits. Clones either ‘cooperated’ when infecting the host or competed when growing. There were no clone pairs, in which interactions changed their type with time or were observed constantly during parasite development.

An extensive literature exists on how environmental conditions, especially temperature, impact animal body sizes. However, there remains considerable discrepancies, and misunderstanding, in the key definitions and concepts of body size used to describe observed impacts across studies. Size can be measured using continuous growth metrics, including von Bertalanffy growth coefficients, or static 'size' metrics, such as population-averaged length or mass, average size-at-(arbitrary)-age, size-at-maturity, adult size, asymptotic size, or the maximum observed size. Critically, these concepts of size are not equivalent, and temperature is likely to affect each in different ways. The use of these disparate size and growth metrics as response variables estimated across different biological scales (individual, population, or community) and empirical contexts (laboratory, field) has led to unnecessary confusion and apparent contradictions among practitioners. Here, we review nine common confusions associated with the measurement of 'size' in fish and other water-breathing ectotherms. We then highlight outstanding knowledge gaps on how temperature and global warming might affect different size metrics. Clarifying concepts, definitions, and applications of body size measures is important as it can help reconcile divergent findings, target future research, and improve our predictions about the warming impacts on wild populations.

ABSTRACT Objective. Our aim was to explore the relationship between vertigo symptoms and the prognosis of hearing indicators in patients with sudden sensorineural hearing loss. Data Source. Eligible studies were identified from the “PubMed”, “EMBASE”, and “Web of Science” databases from January 2000 to September 2023. Study Selection. Studies were selected from all original and retrospective or prospective studies that focused on the relationship between vertigo and hearing prognosis in patients with sudden sensorineural hearing loss. Data Extraction and Synthesis. Observational metrics for data extraction included type of study, number of subjects with or without vertigo, treatment regimen, definition of pure tone hearing thresholds, criteria for hearing improvement, treatment duration, follow-up time, and age distribution of subjects. Meta-analysis was performed using Stata 15 software. Main Outcome and Measure. Association of vertigo symptoms and the prognosis of hearing indicators in patients with sudden sensorineural hearing loss. Results.A total of 4290 patients with sudden sensorineural hearing loss were identified in 23 studies. The hearing recovery rate was 40.8% in the group with vertigo and 53.76% in the group without vertigo. Vertigo was significantly associated with poorer hearing recovery (OR = 2.13; 95% CI, 1.63-2.79; I 2 = 68.3%). Subgroup analyses revealed similar results for medication (OR=2.65; 95% CI, 1.84-3.83; I 2 = 50.8%). However, an attenuated association between vertigo and the prognosis of sudden sensorineural hearing loss was observed in the subgroups treated with drugs combined with hyperbaric chambers (OR= 1.76; 95% CI, 0.75-4.15; I 2 = 84.9%) and drugs combined with intratympanic injections (OR= 1.62; 95% CI, 1.02-2.58; I 2 = 65.6%). Conclusions and Relevance. Our study suggested that vertigo may be a negative factor in sudden sensorineural hearing loss.Based on the results of the subgroup analysis,the combined treatment regimen has better efficacy in patients with sudden sensorineural hearing loss with vertigo.

The Nelchina Basin, located west of Glenallen, AK provides important moose (Alces alces) habitat throughout the year. However, previous research in this area has shown that the moose populations appear to be nutritionally limited by the available forage. The Nelchina Basin was deemed an intensive management unit to increase moose populations through predator control efforts and prescribed fires to increase the amount of available forage, including the 2004 Alphabet Hills fire. We quantified the available digestible energy (DE) and digestible protein (DP) during the summer of 2018 and 2019, as well as the winter in between, and availability of forages for moose within the burn perimeter and the adjacent unburned forest during the summer of 2019. We found that total canopy cover of the primary forage species was lower in the burned areas than in the adjacent unburned forest habitats. DP concentration was not significantly different between forested and burned sites, and DE and DP content varied across the summer and winter sampling season. We also found a significant difference in DE and DP across the two sampling years. Although others have shown a positive effect of wildfire for herbivore populations, we found that some areas, including the Alphabet Hills area, may not be suitably adapted to benefit from the quick release of nutrients after fire and may not allocate more resources to biomass as previously expected. This project highlights the importance of research that quantifies both the availability of and the quantity of available food resources for herbivores.

Prevention, the way to go.

Microalgae, historically relevant to aquaculture sector, can effectively contribute to the sustainability in several production chain. The physical and chemical environmental factors play a direct or indirect role in shaping the composition of their intracellular compounds of these organisms. Among these compounds, fatty acids are particularly noteworthy, with various species harboring an extensive array of them. Notably, the marine dinoflagellate Prorocentrum micans excels in the production of essential polyunsaturated fatty acids (PUFA), including DHA and EPA. The objective was to determine which factors contribute to the accumulation of the PUFA in a P. micans strain. A factorial design of 3x3 composed by the following factors: illumination (5, 12.5, 20 µmol photons m-2 s-1), nitrate dose (0, 75, 150 mg ml-1) and inoculum volume (50, 125, 200 ml) was examined to determine the better growth conditions for P. micans. Furthermore, lipid profile and the fatty acids profile were analyzed at the end of the cultivation. The results determined that, maximum averages of DHA (20%) and EPA (1%), in the biomass, were registered in cultures without nitrate, low irradiance (5 µmol photons m-2 s-1) and high volume of inoculum (200 ml). The maximum cell concentration recorded was 3.1×104 cells ml-1, at the end of the culture. So, it can be concluded that the evaluated strain is easily adapted to the culture flow and, the culture conditions to which it was subjected allows its biomass to be considered an interesting alternative as lipid input in aquaculture activity.

”Peritoneal TB: A Challenging Presentation in a Young Woman with Acute Abdominal Symptoms”Samira Dehghani1, Saloomeh Mohammadi2, Atefeh Mahmoudi1, Fatemeh Riyahi Zaniyani3, Sasan Shafiei4, Afrouz Emzaei5, Yasaman Tavakoli6, Roozbeh Narimani Javid7, Athena Behforouz1*1. Preventive Gynecology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran2. Department of Pathology, Mahdieh Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran3. Faculty of Medicine, Islamic Azad University, Tehran Medical Sciences Branch, Tehran, Iran4. Skull Base Research Center, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran5. Hojjat Hospital, Isfahan University of Medical Sciences, Isfahan, Iran6. Student Research Committee, Department of Medicine, Mazandaran University of Medical Sciences, Mazandaran, Iran7. Student Research Committee, Hamadan University of Medical Sciences, Hamadan, IranAbstractIntroduction: Tuberculosis (TB) is a significant health problem worldwide. The rate of active tuberculosis in pregnancy is rising and it is a considerable cause of maternal mortality during pregnancy.Case presentation: This study reports a young woman who was suffering from TB peritonitis, a rare, highly progressive clinical course following the spontaneous abortion of 16-week gestation. She underwent a diagnostic laparotomy that showed several small-scale implants on the peritoneum and viscera. Histopathology revealed chronic caseating granulomas with necrosis. With the possible diagnosis of tuberculosis, anti-mycobacterial therapy was initiated and she received these drugs for 6 months. The patient’s clinical manifestations completely disappeared and the chest CT scan became normal after the treatment.Conclusion: The diagnosis of peritoneal tuberculosis is challenging and it could be made with a combination of CT imaging, explorative laparoscopy, and evaluation of biopsies from specimens and culture or PCR from ascites fluid, or infected tissues.Keywords: TB, peritoneal tuberculosis, extrapulmonary tuberculosis, acute abdomen, pregnancy

IntroductionInfective endocarditis (IE) is a severe and life-threatening disease worldwide (1). However, because of non-specific clinical presentations, confirmation and prescription of effective treatment are sometimes not simple tasks. History may help significantly in the diagnosis of IE; for example, it is more common among drug addicts, particularly Intravenous drug users (2, 3).Approximately 5% of IE cases have negative blood cultures (4, 5), and its risk factors are exposure to slow-growing bacteria such as Bartonella species, fastidious nonbacterial organisms, previous antibiotic use, underlying valvular heart disease, and intracardiac or vascular device or other foreign bodies in contact with the blood (6).Most patients have nonspecific symptoms such as fever, fatigue, and weight loss. In a case series comprising 348 blood culture-negative endocarditis cases from France, almost all the patients had a fever as a presenting symptom. In contrast, about 50 to 70% had symptoms of heart failure, such as exertional dyspnea, and about 50% had insidious weight loss(9).Bartonella spp. is a small, intracellular, gram-negative, and very fastidious rod mainly transmitted by vectors; they are the second most common cause of culture-negative endocarditis. Among the cases of Bartonella endocarditis, two species predominantly implicated in causing culture-negative endocarditis are B. henselae and B. quintana(7).These bacteria have been isolated from many mammalian species, including cats and dogs. It can cause mild infection to severe and life-threatening endocarditis in humans and dogs. In dogs, several Bartonella species have been identified; one of the most common ones is B. henselae.It should be mentioned that in recent years, more cases of culture-negative endocarditis have been reported from developing countries(8).This report presents a case of a patient with culture-negative B. henselae endocarditis from Iran, diagnosed using a combined diagnostic approach that included clinical evaluation, imaging, epidemiology, serology, echocardiography, and transthoracic echocardiography (TTE).Patient InformationThe patient was a 38 years old male, single and unemployed with a history of addiction, who had received care from a treatment camp for six months. He was discharged when he was on methadone maintenance therapy just before his first hospital admission. He was an IV drug abuser with a history of regularly using amphetamine, cocaine, and heroin. He also smoked cigarettes for 20 years. He also exposed that he had unsafe sex and lost contact with dogs and cats.Clinical Findings TimelineThe symptoms onset was 20 days before admission when he had fever and chills besides shortness of breath in the camp. The patient was hospitalized in another care center for five days as a suspected COVID-19 case and he was treated with Remdesivir, but his nasopharyngeal and oropharyngeal COVID-PCR tests were negative. Having been discharged from the hospital, he started using amphetamine again, which deteriorated his condition.This time he was admitted to our center, as a referral center, with severe dyspnea, high fever (40), chills, chest pain, myalgia, and hemoptysis. The patient was ill and, on physical examination, he had tachycardia (Heart rate=107) and tachypnea (Respiratory rate=28), with low blood pressure (90/60), fluctuated oxygen saturation which was less than 92%, normal heart auscultation, no clubbing, no splenomegaly, and no lymphadenopathy. Table 1 summarizes the lab results.

Editorial comment on the Special Issue “Omics in Food Allergy”Riccardo Castagnoli1,2, Ivan Taietti1,2,*, Agnes Sze-Yin Leung3, Philippe Eigenmann41. Pediatric Unit, Department of Clinical, Surgical, Diagnostic, and Pediatric Sciences, University of Pavia, Pavia, Italy2. Pediatric Clinic, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy3. Department of Paediatrics, Faculty of Medicine, The Chinese University of Hong Kong, China4. Pediatric Allergy Unit, Department of Pediatrics, Gynecology and Obstetrics, University Hospitals of Geneva, Geneva, SwitzerlandORCID:Riccardo Castagnoli: 0000-0003-0029-9383Ivan Taietti: 0000-0002-0372-523XAgnes Sze-Yin Leung: 0000-0001-8249-4478Philippe Eigenmann: 0000-0003-1738-1826Corresponding author:Ivan Taietti, MD;Pediatric Unit, Department of Clinical, Surgical, Diagnostic, and Pediatric Sciences, University of Pavia, 27100 Pavia, Italy.ivan.taietti@gmail.com; +39 340 7092400.Food allergy (FA), defined as an adverse reaction to food mediated by the immune system, is a significant public health issue with increasing prevalence over the past decades. Although FA affects up to 10% of children, the precise mechanisms underlying FA development and persistence remain inadequately understood1. Food immunotherapy has been successful in increasing the threshold of tolerance in individuals with persistent FA (desensitization), and in a subset, sustained unresponsiveness (remission) can be achieved. A combination of environmental and genetic factors is considered to be involved in the tolerance induction to food allergens. However, to date, it has been difficult to fully dissect the complexity of the biological determinants involved in FA.The emergence of “omics” sciences, including genomics, transcriptomics, proteomics, and metabolomics, is revolutionizing the basic and translational research approach, allowing for the comprehensive study of biological processes through analyzing and integrating multiple datasets from various biological perspectives.Moreover, epigenetic studies that evaluate the role of gene expression modifiers are deepening our understanding of the interaction between genetic predisposition and environmental influences.The Special Issue “Omics in Food Allergy” aims to present current knowledge and future perspectives in the field of FA through the lenses of omics sciences.Chun et al. and Lehmann et al. provide a detailed overview of epigenetic mechanisms involved in FA, including DNA methylation and microRNA (miRNAs)2,3. DNA methylation refers to the covalent addition of a methyl group, typically to a cytosine in a CpG dinucleotide in DNA. This limits access for transcription, frequently in the promoter region, leading to reduced gene expression. Moreover, miRNAs are small RNAs transcribed from intergenic or intronic genomic loci that decrease gene expression by mRNA degradation and translational inhibition. Of note, Chun et al. described two different approaches in investigating FA mechanisms: (i) the epigenome-wide research approach and (ii) candidate-gene investigations. The epigenome-wide research approach identified genomic regions differently methylated and regulated, involved in FA causation, antigen presentation, T cell development, and reaction severity. Candidate-gene investigations focused on Th1, Th2, T regulatory, and innate genes of interest in FA, highlighting the importance of methylation changes in specific candidate genes. In this context, for cow’s milk allergy (CMA), the attention is focused on novel genetic loci involved in Th1/Th2 differentiation pathways and potential B-cell dysfunction4. Of note, miRNA seems to be involved in CMA as demonstrated by the downregulation of mi193a-5p, a post-transcriptional regulator of IL-4 expression, in infants with CMA5. Moreover, methylation levels in peripheral blood mononuclear cells for IL-4, IL-5, IL-10, and IFN-γ negatively correlate with their respective serum cytokine concentrations and vary according to CMA status (active, resolved, or non-CMA). Finally, Chun et al. reviewed ongoing research aimed at finding DNA methylation predictors of food challenges. Initial work based on the concept of epigenetic markers as biomarkers of disease and treatment demonstrated promise for applying DNA methylation markers to potentially improve how we assess and manage patients with FA, but further validation in larger cohorts and work to practically translate such biomarkers to clinical practice is advocated2.Metabolomics may reflect the integration of genetic, transcriptomic, and proteomic variations with environmental factors, thus reflecting molecular processes of diseases. A metabolome approach would facilitate the identification of surrogate metabolite markers correlating with the disease activity and prognosis. Lee et al. reported an updated overview of metabolomics’s current application in the FA field. Alterations to the gut microbiota induced by Western dietary patterns are likely to profoundly affect host immunity and play a significant role in FA. Metabolites of interest include short-chain fatty acids (SCFAs), bile acid metabolites, and tryptophan metabolites due to their essential roles in normal immune development and homeostasis. SCFAs appear to be reduced in FA patients. Of note, it has been shown that bacterial SCFAs could protect against FA as a consequence of a high-fiber diet in mice. Accordingly, a reduction in Bifidobacterium during infancy, with a consequent reduction in SCFA levels is associated with an increased risk of allergy6. In peanut allergy, oral dysbiosis, reduced oral SCFA levels, and increased oral mucosal Th2 cytokine secretion characterize patients affected, and low fecal SCFAs at a young age could raise the risk of developing FA. Bile acid levels in stool seem to be involved in FA development and persistence, but blood level measurements are advocated to better characterize their role. Moreover, sphingolipids may modulate the function of invariant natural killer T cells and contribute to maintaining intestinal balance and protecting against FA through the modulation of the mast cells’ responsiveness. Sphingolipid dysmetabolism is involved in FA development as a consequence of immune dysregulation in modulating the differentiation of regulatory T cells and Th17 cells that is relevant in FA. Interestingly, some fecal sphingolipids seem to confer protection against FA while reduction of other of them seems to be associated with increased risk of FA, likewise the reduction in serum sphingolipids. Unfortunately, no definitive evidence is available to distinguish whether the sphingolipids modulating this FA effect are dietary or microbial-derived. Metabolites of tryptophan from kynurenine and indole pathways are linked to the function of the intestinal barrier and mucosal immune responses (mainly T regulatory cells) and contribute to intestinal homeostasis. A reduction in these pathways is linked to multiple FA in children. To date, the role of omega-3-polyunsaturated fatty acids metabolites is not clearly defined in FA. However, 17-hydroxy-docosahexaenoic acid (17-HDHA) has been reported to inhibit IgE production by B cells and to suppress the differentiation of naïve B cells into IgE-secreting cells7.The gut microbiome (GM) and its metabolic product, as previously mentioned, play an important role in FA development. TheBifidobacteriaceae family and bacteria of theLactobacillales order are consistently reported lower in CMA children. At the same time, the Firmicutes phylum, primarily associated with the Clostridia class, is consistently increased in mice and human studies. It seems discordant with the observation that infants with resolved CMA were reported to have enrichedClostridia class at 3-6 months but with non-conclusive data. However, Savova et al. showed that GM with enriched Clostridiaclass, reduced Lactobacillales order, and reducedBifidobacterium genus is associated with CMA in early life. Emerging evidence shows that prebiotics, probiotics, and symbiotics, may be a promising adjuvant in promoting tolerance acquisition. ElevatedBifidobacterium genus and reduced Clostridia class members were consistently observed post-treatment with Bifidobacteriumstrains probiotics or after lactose-supplemented extensively hydrolyzed formula (EHF) treatment strategy but with decreased levels ofLactobacillus genus in those treated with Bifidobacteriumstrains probiotics. Gaps remain in understanding the relationship between microbiome and immune response and between transcriptomics (including genes related to the immune response) and GM. In vivo ,Bifidobacterium bifidum has been shown to reduce allergy symptoms, lower serum IgE and raise IgG2 levels, decrease the pro-inflammatory cytokines (TNFα, IL- 1β, and IL-6), and increase the anti-inflammatory cytokine IL-10 in CMA-patients8. Recently, fiber diet has been shown to modulate the disease course of FA through diet-driven changes in the GM9. It is necessary to conduct further research on the impact of GM on FA development and persistence.Lastly, oral immunotherapy (OIT) may provide an active treatment that enables to increase the amount of food that the patient can intake without reaction during treatment (i.e., desensitization), and reduces the risk of potential life-threatening allergic reaction in the event of accidental ingestion10 Unfortunately, there are still significant gaps in understanding the immune mechanisms following OIT, but increasing knowledge about transcriptional pathways associated with its outcomes is available to date11. Ashley et al.12 show that OIT-induced remission of FA is linked to the anergic T cell state mediated by anergy of memory T cells associated with mantained T regulatory cell activity. Suppression of the Th2 transcriptional signals in Th2A-like cells was linked to desensitization following OIT. Moreover, the dampened Th2 and Th1 signatures in effector cells are linked with FA remission, while baseline inflammatory signals in Th1 and Th17 effector cells were associated with poorer outcomes following OIT. Type I interferons were recently identified as potential regulators of remission following OIT because of their key role in the suppression of the Th2 antigen response through regulatory action on GATA3 and the high-affinity IgE receptor. Moreover, an early transient increase in TGF-β producing cells one year into treatment seems to be associated with good clinical outcomes. In addition, persistent activation of FOXP3, expressed by T regulatory cells, may be a critical requirement for lasting persistence of remission12.Comprehensive multi-omics studies are essential to understand FA mechanistically, as highlighted by this Special Issue. “Omics” studies of FA are of great interest as they allow for a thorough understanding of the complexity of FA development and therapeutic outcomes. This has a fundamental impact on approaches to precision medicine.

Objectives: To determine the time to ventilator liberation and decannulation after tracheostomy placement in children with bronchopulmonary dysplasia (BPD) and pulmonary hypertension. Methods: A prospective cohort study included all children (<18 years old) who underwent tracheostomy between 2015 and 2021 with or without a diagnosis of BPD. The primary outcome measures were times to mechanical ventilator liberation, tracheostomy decannulation, or death with tracheostomy in place. Patient demographics, associated comorbidities, and outcomes were compared between groups. Results: A total of 318 children met inclusion with a median (interquartile, IQR) age at tracheostomy of 6.9 (IQR: 4.1 – 49.2) months and 54% (N=170) were male. A diagnosis of BPD was made for 43% (N=136) and this group was younger at tracheostomy placement (5.2 vs. 24.5 months, P<.001) and more often had pulmonary hypertension (65% vs. 24%, P<.001) than children without BPD. Children with BPD spent a median of 2.92 years (IQR: 1.60 – 4.03) on mechanical ventilation compared to 1.84 years (IQR: 0.84 – 3.60) for children without BPD ( P=.003). Unadjusted estimation of time to decannulation was longer for children with BPD (HR=0.92, 95% CI: 0.62 – 1.38). The adjusted survival analysis for time to mortality included pulmonary hypertension as a variable of significance (aHR= 2.5, 95% CI: 1.43 – 4.40). Conclusion: The presence of BPD is associated with an increased duration of mechanical ventilation and time to tracheostomy decannulation. Pulmonary hypertension is associated with an increased mortality risk among this vulnerable population of children.

Introduction: Osteogenesis Imperfecta (OI) is a rare genetic disorder characterized by increased bone fragility and recurrent fractures. OI is classified into types I-IV based on clinical features, with the majority of cases attributed to mutations in the COL1A1 and COL1A2 genes encoding type I collagen. Case Presentation: Here we present the

Case presentation:A 28-year-old male known to have beta thalassemia major blood transfusion-dependent, maintained on iron chelators for secondary hemochromatosis presented with bilateral lower limb edema, scrotal, and penile edema of 1 week duration and respiratory distress. He was found to have acute kidney injury and metabolic acidosis secondary to hemolysis and uric acid nephropathy with Uric acid level of 22.3 mg/dL and LDH of 454 IU/L creatinine of 0.6 mg/dL (baseline 0.25 mg/dL). We present his case for the unusual finding of edema of the urethral meatus, as shown in figure 1, with penoscrotal edema in the setting of volume overload.The patient was admitted to the hospital for monitoring in the intensive care unit for his acidotic state and volume status. Patient tolerated diuresis using Lasix, electrolyte derangements were corrected, he was administered allopurinol for his hyperuricemia, and oxygen was administered via nasal canula and BiPAP. He was discharged after monitoring, proper diuresis, and return of creatinine to baseline levels.Patients with Beta thalassemia major are dependent on regular blood transfusions, especially early in life. These patients may develop cardiomyopathy or pulmonary hypertension due to volume overload secondary to these transfusions commonly manifested by bilateral lower limb edema. (1) As the condition worsens, edema may manifest in other regions such as ascites in the abdomen and peno-scrotal edema.It is essential in patients with kidney injury to rule out post-renal causes such as acute urinary retention as it may contribute to the volume status of the patient as reported in the literature. (2) Yet there are no reports on the unusual involvement of the urethral meatus in penile edema such as that seen in our patient in the setting of volume overload in Beta thalassemia major.Management of such cases vary in terms of the severity of the kidney injury, its chronicity, and severity of volume overload. Edema of the urethral meatus may indicate a more severe form of volume overload compared to only lower extremity edema.

TitleStaphylococcus aureus subcapsular splenic abscess and associated empyema in the setting of tocilizumab therapy: A case report

Arthrogryposis, Renal dysfunction, Cholestasis (ARC) Syndrome with A Novel Mutation in two siblings

The pseudospark switch works in the left branch of Paschen curve with low gas pressure, which has the advantage of short electrode breakdown time (<10ns), large pulse current (>100kA), and long lifetime, etc. High pulse repetition frequency (PRF) pseudospark switch has important applications in food processing, sewage treatment, high energy laser system, sonar syste, and other fields, the pseudospark switch with a PRF of kHz-level is needed. This paper focuses on the pseudospark switch with double-pulse trigger structure, and the corresponding relationship between the two trigger voltages and current is calculated respectively, and the influence of the two pulses on the trigger process is analyzed. Then the pseudospark switch with this structure is tested with the anode voltage of 10kV for different voltage and gas pressure. The results show that the minimum trigger voltage is only 100V, and the switch can work stably with high repetition frequency.

This paper studies the coverage path planning and path following problems for an underwater biomimetic robotic fish to finish the deep-sea net cage water quality monitoring. Firstly, with a focus on minimizing total path length, repetition rate, and turning occurrences to enhance path coverage efficiency and reduce energy consumption, we propose a novel coverage path planning strategy. This strategy incorporates DQN, a reward function, and a rewrite strategy inspired by RRT*. Secondly, a high-performance path-following method, which takes into account robot performance, is designed to cope with adverse conditions in net cages. Finally, the simulation and field experiments demonstrate significant improvements over existing methods and the effectiveness in practical applications, showcasing its applicability in aquaculture management. The proposed algorithm offers valuable insights into optimizing coverage path planning for underwater robots in practical scenarios.

Background Asthma is a heterogenous airway disease characterized by multiple phenotypes. Unbiased identification of these phenotypes is paramount for optimizing asthma management. Objectives To identify and characterize asthma phenotypes based on a broad set of attributes using a novel machine learning approach in a representative sample of Swedish adults. Methods Deep learning clustering was used to derive asthma phenotypes in a sample of 1,895 subjects aged 16-75, drawn from the ongoing West Sweden Asthma Study. The algorithm integrated 47 variables encompassing demographics, risk factors, asthma triggers, pulmonary function, disease severity, allergy, and comorbidity profiles. The optimal clustering solution was selected by combining statistical metrics and clinical interpretation. Results A four-cluster solution was determined to reliably represent the data, resulting in distinct phenotypes described as: (1) troublesome, late-onset, non-atopic asthma with smoking ( n=458, 24.2%); 2) female-dominated early adult-onset asthma ( n=545, 28.7%); 3) adult-onset asthma with high inflammation ( n=358, 18.9%); and 4) early-onset, mild, atopic asthma ( n=534, 28.2%). The phenotypes also differed with respect to demographics, risk factors, asthma triggers, pulmonary function, symptom profiles, and markers of inflammation. Current asthma was more common in phenotypes with later age of asthma onset than phenotypes with early onset. Conclusion Four clinically meaningful asthma phenotypes, distinguishable by age of onset, severity, risk factors, and prognosis, were found in Swedish adults. This provides a setting for future research to profile the immunological basis of the phenotypes, and further our understanding of their pathophysiology, therapeutic possibilities, future clinical outcomes, and societal burden.

A document by Tea Mladenić. Click on the document to view its contents.

Objective: To assess whether, in those requiring ongoing uterine stimulation after cervical ripening with oral misoprostol and membrane rupture, augmentation with low dose oral misoprostol is superior to intravenous oxytocin. Design: Open-label, superiority randomised trial Setting: Government hospitals in India Population: Women induced with oral misoprostol for hypertensive disease in pregnancy and requiring ongoing induction after membrane rupture Methods: Participants received misoprostol (25mcg orally two hourly) or titrated oxytocin through an infusion pump. Main Outcome Measure: Caesarean birth Results: 520 women were randomised and the baseline characteristics were comparable between the groups. The caesarean section rate was not reduced by the use of misoprostol (misoprostol 32.3% vs oxytocin 27.3%; adjusted odds ratio 1.226 (95% CI 0.81-1.85, p=0.33)). There were no differences in rates of hyperstimulation, fetal heart rate abnormalities, or maternal side effects, although the geometric mean time from randomisation to birth was 31 minutes longer with misoprostol. Fewer babies in the misoprostol arm were admitted to the special care unit (10 vs 21 in the oxytocin group) and there were no neonatal deaths in the misoprostol group, compared to 3 in the oxytocin arm. Women’s acceptability ratings were high in both study groups. Conclusion: Following cervical preparation with oral misoprostol and membrane rupture, the use of ongoing oral misoprostol for augmentation did not significantly reduce caesarean rates compared to oxytocin. The method, however, was safe for both mother and baby.

Detecting RNA molecules within their natural environment inside intact arthropods has long been challenging, particularly in small organisms covered by a tanned and pigmented cuticle. Here, we have developed a methodology that enables high-resolution analysis of the spatial distribution of transcripts of interest without having to dissect tiny organs or tissues, thereby preserving their integrity. We have combined an in situ amplification approach based on Hybridization Chain Reaction, which enhances the signal-to-noise ratio, and a clearing approach that allows the visualization of inner organs beneath the cuticle. We have implemented this methodology for the first time in Hemiptera, mapping two salivary aphid ( Acyrthosiphon pisum) transcripts, the effector c002 and the salivary sheath protein SHP. With a multiplex approach, we could simultaneously detect different mRNAs in whole-mount pea aphid head-thorax samples and show that they were distributed in distinct secretory cells of salivary glands.

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【Abstract】Ovarian Sertoli-Leydig cell tumors (SLCTs) are extremely rare ovarian sex cord-stromal tumors, predominantly secreting testosterone and occasionally manifesting with elevated estrogen levels, such as abnormal uterine or postmenopausal bleeding. This report details a 57-year-old postmenopausal woman with vaginal bleeding. Laboratory findings indicated mildly suppressed follicle-stimulating hormone and elevated estradiol. Female tumor markers showed no abnormalities. The transvaginal ultrasound revealed thickened endometrial lining accompanied by cystic echoes, cystic echoes in the left ovary, and no definitive mass observed in the right ovary. Postoperative pathology revealed atypical endometrial hyperplasia, a serous cystadenoma in the left ovary, and a moderately differentiated SLCT in the right ovary. Surgical approach: Total hysterectomy, bilateral adnexectomy, and omentectomy were performed laparoscopically. Five months postoperatively, the patient’s follicle-stimulating hormone levels were significantly elevated, and estradiol levels markedly decreased. Transvaginal ultrasound showed no occupying lesions in the pelvic cavity. This case underlines the importance of recognizing elevated hormone levels as potential indicators of SLCTs when imaging is inconclusive, highlighting the need for early detection and treatment.

Background: The adenoid cystic carcinoma (ACC) barely arises in sites other than the salivary glands. Its presentation in the hypopharynx previously diagnosed as squamous cell carcinoma (SCC) is entirely unexpected. Case Presentation: A man was presented with a hypopharyngeal mass revealed by electronic laryngoscopy. Multiple biopsies pathologically showed well to moderately differentiated SCC. Six months after definitive concurrent chemoradiation, his endoscopy showed a recurrent mass in the same region before and pathology of gastroscopic biopsy showed moderately differentiated SCC of esophagus. The mass was removed after radical dissection. Histologic examination showed sheets and cords of tumor cells with basophilic matrix in hypopharynx known as ACC and moderately differentiated esophageal SCC. Conclusion: The documentation of metachronous ACC arising in hypopharynx following previous SCC would further supports the concern about multicomponent tumors in hypopharynx which is crucial in clinical practice.