A Rare Case Report of Marjolin Ulcer of the Lower Limb Managed with AmputationDr Suraj KC1*, Dr Rakesh Kumar Gupta1, Dr Abhijeet Kumar1, Dr Bhawani Khanal1, Dr Samiksha Lamichhane2 ,Dr Sanjok Bartaulla1 , Dr Raghav jindal1, Dr Injmamul Haque Raki1* Corresponding Author: Dr Suraj KCDepartment of General Surgery, BPKIHS, [email protected] Rakesh Kumar Gupta:Department of General Surgery, BPKIHS, [email protected] Abhijet Kumar:Department of General Surgery, BPKIHS, [email protected] Bhawani Khanal:Department of General Surgery, BPKIHS, [email protected] Samiksha Lamichhane:Department of Radiodiagnosis and imaging, BPKIHS, [email protected]. Rahul Shrestha:Department of General Surgery, BPKIHS, [email protected]. Sanjok Bartaulla:Department of General Surgery, BPKIHS, [email protected] Injmamul Haque Raki:Department of General Surgery, BPKIHS, [email protected] Raghav JindalDepartment of General Surgery, BPKIHS, [email protected]:Marjolin ulcers are known to develop on chronic wounds and ulcers. Biopsy is indicated for chronically suspicious ulcers with no signs of healing. Metastatic workup is necessary before considering any type of surgery. Amputation, as in our case, is indicated when wide local excision or Mohs surgery cannot be performed. Chemotherapy and radiotherapy are reserved for advanced disease and patients who are not fit for surgery. Introduction: Post-burn wounds or scars have the potential to become chronic and may progress into Marjolin ulcers. While rare, it is important to be vigilant with suspicious wounds that do not show signs of healing. We present a case of a 55-year-old woman who developed a non-healing ulcer on the back of her right foot, covering the Achilles tendon, which ultimately required below knee amputation.Case Report:A 55-year-old woman with a history of hypertension and a flame burn on her right foot two years ago presented to the General Surgery Outpatient Department with a non-healing ulcer and foul-smelling discharge. The ulcer had grown from the size of a coin to 5cm x 5cm, located on the posterior aspect of her right ankle. The ulcer was painless with minimal bleeding, and she had intact distal neurovascular function. She denied any respiratory symptoms, chest pain, cough, or similar ulcers elsewhere on her body. Physical examination and vitals were stable. Upon local examination there was 5 x 5cm ulcer over the lateral malleolus and mass on the posterior aspect of the right Achilles tendon ( figure 1). Routine tests were normal, and a biopsy revealed squamous cell carcinoma. Imaging showed no signs of metastasis. The patient underwent a right below knee amputation, and the postoperative period was uneventful (figure2). She was discharged on the 4th post-operative day. The margins were negative for squamous cell carcinoma. On a follow up, stump was healthy, and she was referred for a prosthesis and rehabilitation. Regular follow-ups were advised under the General Surgery Department.\sout

Nitrogen (N) and phosphorus (P) are important factors controlling biogeochemical cycling in terrestrial ecosystems and significantly affect the decomposition process of litter. However, N and P addition effects on litter decomposition, especially biological pathways in alpine grassland in northwest Sichuan, remain unclear. Therefore, this study explored the response mechanism of Salix cupularis litter decomposition and soil enzyme activity to different exogenous nitrogen and phosphorus additions and the inner relationship, combined with field in situ experiments and laboratory analysis methods. The results showed that: (1) In general, N, P and NP treatments significantly promoted the decomposition of litter, lignin and cellulose, and the addition of NP had a stronger effect in the same concentration level. P addition could alleviate the inhibitory effect of litter decomposition by high N concentration. (2) Litter C, N and P basically showed a sustained release pattern, and NP treatment had the strongest promoting effect. (3) Each treatment significantly increased the activities of soil invertase, cellulase, polyphenol oxidase, urease and phosphatase, and the NP treatment had the best effect. The rate of litter decomposition was significantly influenced by nutrient content as well as soil enzyme activity, where cellulose content and invertase activity may be a key factor controlling the rate of litter decomposition.

Type V Gastric Ulcer: An Unusual Etiology of Gastrosplenic Fistula Associated with Upper Gastrointestinal BleedingMuhammad Nadeem Yousaf MD1, Riyasha Dahal MBBS2, Subeena Phull MD3, Vinayak Aryal MD4, Karun Neupane MD5, Hamza Ertugrul MD6, Ebubekir Daglilar MD71Department of Medicine, Division of Gastroenterology and HepatologyUniversity of Missouri, Columbia, MO, United States2Department of Medicine, Universal College of Medical Sciences, Bhairahawa, Nepal3Department of Medicine, University of Pennsylvania, Philadelphia, PA, United States4Department of Pathology and Laboratory Medicine, MetroHealth System, Case Western Reserve University, Cleveland, OH, United States5Department of Medicine, Jacobi Medical Center/Albert Einstein College of Medicine, Bronx, NY, United States6Department of Medicine, Saint Mary’s Hospital, Waterbury, CT, United States7Department of Medicine, Division of Gastroenterology and HepatologyCharleston Area Medical Center, Charleston, WV, United StatesKeywords: Gastric Ulcers, Gastrosplenic fistula, Gastrointestinal bleeding, NSAIDs, Embolization, Endoscopy.Consent statement: Written informed consent was obtained from the patient to publish this report in accordance with the journal’s patient consent policy.

Disseminated Bacillus Calmette-Guérin (BCG) infection presenting with fever and pancytopeniaMarina Henriques Mendes1, Andreia Pereira Branco1, Sofia Rodrigues Carvalho1, Marta Dalila Martins1, Ana Silva Rocha1, Sofia Garcês Soares1, Diana Pereira Anjos1Corresponding author email:mari[email protected] Hospitalar Tâmega e Sousa

Saline-alkali land is an important component of terrestrial ecosystems and may serve as a carbon sink but its net contribution to the overall terrestrial carbon sink is unknown. Using methods recommended by the IPCC, this study evaluates the impacts of interconverting saline-alkali and non-saline-alkali land on terrestrial carbon stocks by measuring two major carbon pools (soil organic carbon and vegetation biocarbon) in the saline-alkali land of China’s Songnen Plain. Distinct phases in the evolution of the region’s terrestrial carbon stock were delineated, factors contributing to transitions between phases were identified, and effects of changes in the saline-alkali land carbon stock on the overall terrestrial carbon sink were estimated. Between 2005 and 2020, the region’s saline-alkali land carbon stock initially increased, then declined, and finally increased again. However, the overall terrestrial carbon stock decreased by 0.5 Tg (1 Tg=10 9 g), indicating that the increase in the saline-alkali land carbon stock was due primarily to expansion of the saline-alkali land area. The conversion of non-saline-alkali land to saline-alkali land was a carbon-emitting process; consequently, in areas undergoing saline-alkali land change, the lower carbon density bound was equal to the carbon density of unconverted saline-alkali land and the upper bound was equal to the carbon density of unconverted non-saline-alkali land. In general, changes in the carbon stock of saline-alkali land correlated negatively with changes in the overall terrestrial carbon stock. These findings may guide the development of policies for remediating and reclaiming saline-alkali land, especially those relating to land development and carbon sequestration.

Aging brain undergoes multiple structural and functional changes. These may contribute to an increased risk of neurodegenerative disease (NDD) and other age-related diseases, highlighting the importance of assessing deviations from healthy brain aging trajectory. In this human brain study, 50 healthy adults were investigated by functional near-infrared spectroscopy (fNIRS). A resting state single channel multiwavelength fNIRS was measured from the forehead in a supine position. The subjects were divided into four age groups. A machine learning approach was utilized for age group classification by using support vector machine and random forest learners with nested cross-validation. The results suggest brain aging effects being more distinct in the oldest age group and a difference in the brain aging for the subjects of the in-between groups. Our study shows high potential for the use of fNIRS in the analysis of brain aging.

Biologists increasingly rely on computer code to collect and analyze their data, reinforcing the importance of published code for transparency, reproducibility, training, and a basis for further work. Here we conduct a literature review examining temporal trends in code sharing in ecology and evolution publications since 2010, and test for an influence of code sharing on citation rate. We find that there is wide room for improvement in sharing code, as scientists are overwhelmingly (95%) failing to publish their code and that there has been no significant improvement over time. We also determined that there is a significant incentive to share, as we additionally find that code sharing can considerably improve citations, particularly when combined with open-access publication.

Composite nanoparticles with a gold core enveloped by cobalt ferrite nanoparticles show potential for enhanced photothermal therapy. Determining the optimal gold-to-cobalt ferrite nanoparticle ratio, dependent on size, is vital for improving treatment efficiency. We address the urgent need for advancing photothermal therapy through utilising combined plasmon-magnetic composites with potential of controlled directional delivery. Our computational modeling and experimental absorption spectra analysis reveal that adjusting the cobalt ferrite nanoparticle content redshifts the plasmon resonance frequency in gold nanoparticles, which is accompanied by increase in the extinction cross-section. As a result, cobalt ferrite nanoparticle absorption dominates. Our experiments on photothermal response in aqueous solutions of composite nanoparticles of various concentrations demonstrate that 100 μg/ml solution yields a significant temperature increase of ~8.2 K and a photothermal conversion efficiency of ~51%. At this concentration, the composite nanoparticles effectively heat the cell culture medium under photothermal conditions, leading to 22% reduction in cell viability.

Background: Pacemakers are an essential tool in managing bradyarrhythmias. Using the large Nationwide Inpatient Sample (NIS) database, we evaluated complications, trends and mortality rates of pacemakers over 2016 2020. Methods: We utilized International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) coding for our study. We evaluated clinical predictors, complications and mortality of pacemakers using the NIS database. Results: Significant independent Clinical predicators for pacer insertion are: NSTEMI: OR, 1.85; 95% CI, 1.80–1.91; p<0.001, hypertension: OR, 4.26; 95% CI, 4.19–4.34; p<0.001, hyperlipidemia: OR, 3.01; 95% CI, 2.97–3.05; p<0.001, atrial fibrillation/flutter: OR, 4.68 95% CI, 4.62–4.74; p<0.001, diabetes: OR, 1.49; 95% CI, 1.47–1.51; p<0.001, chronic kidney disease: OR, 1.99; 95% CI, 1.97–2.02; p<0.001, smoking: OR, 1.41; 95% CI, 1.31–1.43; p<0.001, COPD: OR, 1.11; 95% CI, 1.09–1.13; p<0.001, valvular heart disease: OR, 5.31; 95% CI, 5.21–5.41; p<0.001, systolic heart failure: OR, 1.98; 95% CI, 1.94–2.02; p<0.001, prior PCI: OR, 2.30; 95% CI, 2.26–2.34; p<0.001, obesity 1.19; 95% CI, 1.17–1.22; p<0.001), history of CABG{:OR, 2.48; 95% CI, 2.43–2.52; p<0.001, STEMI: OR, 1.86; 95% CI, 1.79–1.93; p<0.001, history of cardiomyopathy: OR, 1.90; 95% CI, 1.78–2.03; p<0.001, and endocarditis: OR, 1.77; 95% CI, 1.53–2.04; p<0.001. Pacemaker complication rates is around 2% Mortality around 1.44% Conclusion: We found many predictors for the need of pacemaker insertion. Mortality and complications have remained low over recent years.

Fluoxetine is a widespread antidepressant medication, with side effects, including xerostomia. In search of treatments to reduce discomfort, PBM is one of the alternatives that has proven to be effective. This article aims to demonstrate the clinical evolution of a female patient, L.R.O., 55 years old, who reported severe oral discomfort due to lack of saliva. The selected treatment was the Low Power Laser - EccoFibras with vascular photobiomodulation, in radial artery for 30 minutes, wavelength 660nm and power of 100mW, with 180J energy delivery. After the first treatment session, the patient reported improvement and satisfaction and, due to the unpredictability of psychiatric discharge, she tried to perform weekly applications. With each session, she reported a decrease in symptoms, which encouraged her attendance. With the prevention of xerostomia, the pacient achieved a clear increase in her quality of life, demonstrating that vascular photobiomodulation can be an interesting low-cost non-invasive treatment.

Afghanistan is in a seismically active area and is historically hit by destructive earthquakes. It is located on the edge of the Eurasian tectonic plate, bordered by the northern boundary of the Indian plate, and with the collisional Arabian plate into the South. The Hindukush and Pamir Mountains within Afghanistan are the western extension of the Himalayan orogeny uplifted and sheared by Indian and Eurasian plate convergence. These tectonic activities have created several active deep faults across the country and in the Hindukush-Himalayan region, where high-magnitude earthquakes have historically occurred. Earthquakes in Afghanistan are primarily driven by the relative northward movements of the Arabian plate past western Afghanistan and the Indian plate past eastern Afghanistan as both plates subduct under the Eurasian plate. These tectonic movements caused ground shaking from high to moderate and low from the northeast through the southwest of the country. On June 22, 2022, southeastern part of Afghanistan was hit by a destructive Mw6.2 earthquake. The purpose of this study is to develop an ArcGIS Pro database of compiled geologic faults and regions of heightened seismicity for spatial analyses of earthquake disaster severity across Afghanistan. These spatial analyses place better constraints on the placement of active and historic seismicity along mapped and known active faults for progress in earthquake disaster management. Furthermore, we define current hazards associated with building and infrastructural design and competency given the recurrent and eminent seismicity within Afghanistan and describe possible directions and solutions to mitigate the threat to life and property.

IntroductionStriae Distensae (SD), a well-recognized phenomenon resulting from dermal scaring, it is usually associated with physiological conditions such as pregnancy, growth spurt, rapid weight loss or gain or iatrogenic causes such as topical or systemic corticosteroid administration1. It is aesthetically troublesome and therapeutically challenging. SD early stages appear as flesh-toned atrophic linear plaques that eventually progress to silvery-whitish atrophic plaques.1,2 Most commonly affect dispensable body areas such as the buttock, lower back, thighs, calves, breast and abdomen.3 Rare secondary changes within SD have been mentioned in the literature, including edema, urticaria, dyspigmentation, ulceration, dehiscence and subcutaneous emphysema. Fluid filling these striae are an unusual finding. Very few cases have been reported discussing this phenomenon.4,5 Upon literature review, it was notable that even in the very few case reports of BSD, almost all the patients were on long-term oral steroids as well as having hypoalbuminemia, except for one patient as demonstrated inTable 1 .4 Herein, we report a case of a 17-year-old girl with nephrotic syndrome who was treated with high dose of corticosteroids presented to the day-care unit with Bullous Striae Distensae.

A Chronic Myeloid Leukemia Patient Presented With an Unusual Relapse in Central Nervous System: A Case ReportMais Musleh, MD1, Qossay Al Husein, MD2

A document by Abeer Elsayed Fayed. Click on the document to view its contents.

The quick development of technological infrastructure has significantly altered how organizations carry on with work. Subscription-based services are among the results of continuous digitization and customer attrition has become a major problem and a threat to all firms. Customer attrition, alternatively referred to as customer turnover, refers to the departure of customers over time, which is facing challenges in various business industries. To increase the customer retention percentage and for the overall profitability of the industry, customer churn must also be reduced. When organizations recognize client attrition, they can take proactive measures to keep customers. Customer attrition is a terminology adopted by different organizations to encapsulate the defection of clients or subscribers to any phenomenon. With the use of big data architecture, notably Spark, this study presents a web application for extracting telecom data. It uses machine learning algorithms like Logistic regression and K-means clustering, evaluates the performance of the models, and combines hard and soft data in order to predict customer churn more accurately. In addition, label selection will be carried out by assessing each feature’s impurity score independently, and cluster classification will be carried out to select the best cluster based on its metrics. The study concentrates on the crucial machine learning methods for calculating client churn. This can include improving customer service, offering loyalty programs, or adjusting pricing strategies.

A document by Petra Fuehrding-Potschkat. Click on the document to view its contents.

This journey traces the transition from a brief dentistry stint to a neuroimmunology exploration. The narrative unfolds through academic pursuits at the University of São Paulo, Brazil, and subsequent doctoral studies, reflecting on the initial idealism that shaped the pursuit of academia. An unexpected postdoctoral experience at the Centre de Physiopathologie de Toulouse Purpan in France introduced me to immunology, leading to an unexpected passion. Here, I explore uncertainties, decisions, and a pivotal move to Belgium, where collaboration with Adrian Liston at VIB-KU Leuven marked a maturity phase. Amid personal milestones like pregnancy and the challenges of balancing parenthood with a burgeoning career, I would like to highlight the crucial role of support systems and a thriving research environment. My journey so far culminates in the establishment of a lab, the pursuit of a permanent position, and the appointment as an assistant professor at KU Leuven.

In order to solve the concerns of the upper computer of the UAV’s limited storage capacity and the challenge of balancing the detection speed and accuracy of prior models, an upgraded real-time target identification approach ideal for insulator defect detection is created. The algorithm is based on the YOLO v7 detection network and uses Wise-IOU to optimize the loss function, ODConv is used in place of the original convolution module to improve feature extraction, channel pruning, and γ coefficient fine-tuning is performed on the model, the network accuracy, speed, and deployment ability are all generally improved. When compared to the original YOLO v7 method, the enhanced algorithm has an average accuracy improvement of 4.4%, a speed improvement of 28.9%, and a volume reduction of 57.7% when tested on the self-created insulator defect data set.

Surgical management can be considered in patients with allergic rhinitis (AR) refractory to drug therapy, posterior nasal neurectomy (PNN) is one of the procedures. We developed a unique and simplified method for PNN, we called modified PNN (MPPN) and investigated the improvement in nasal symptoms after MPNN surgery for allergic rhinitis, other surgical outcomes, and surgical complications. In MPNN, following sufficient coagulation of the mucosa along the base of the inferior nasal turbinate, a full thickness mucoperiosteal incision up to the bony turbinate was performed using energy devices. Surgical manipulations to confirm the posterior nasal nerve, such as elevation of the mucosa, are not necessary with MPNN. MPNN was a simple and safe procedure, and no serious surgical complications were observed. Significant improvement in postoperative nasal symptoms and reduction in medication use compared to preoperative conditions.

Key Points Inverted papillomata are benign sinonasal tumours with high recurrence rates. Inverted papillomata recurrence is increased if operated on by a non-fellowship trained rhinologist. Inverted papillomata recurrence can be detected earlier in cases managed by specialist rhinology services. Inverted papillomata should be managed through a clear treatment pathway for sinonasal tumours. Other risk factors associated with increased recurrence include Krouse stage 3 and involvement of the frontal or maxillary sinuses.

Design and Economic evaluation of high voltage transmission line is a complicated process.This paper presents the design process of a 765 KV 100 km long Moheshkhal - Madunaghat transmision line .This study investigates the power transfer capability, line parameters, locational marginal price, and losses.These values are based on analytical methods. A six-bundule conductor model is developed using 30 - 60 - 90 triangle properties. AC optimal power flow is used to validate a three bus test system and evaluate the techno-economic benefits of the 765 KV transmission line. The system load forecast is built based on GDP elasticity method. Two types of conductors ,a cardinal and a tern, are used. The results show that compared to the hexa bundle tern conductor, the bundle of six cardinal ACSR conductor is better for a propesed transmission line. The conductor surface gradient is permissible limit to suppress the audiable noise. Several plausible case studies are examined.The study indicates enhancing the Matarbari- Madughat 400 KV line to 765 KV after 2035.

Lesbians, gays, bisexuals, and transgender individuals have persistent obstacles pertaining to their sexual orientation and gender identity, including but not limited to discrimination, prejudice, assault, limited access to healthcare, and inadequate social support. The present study investigates whether there are racial-ethnic differences in the physical and mental health (MH) of sexual and gender minorities (SGMs). Data from 28,345 adults who participated in the 2020 Behavioral Risk Factor Surveillance System answered questions regarding sexual orientation (SO), transgender identity (TI), physical health (PH), and MH. SO, and TI were associated with overall general health, acute MH, acute PH, and specific chronic conditions. SO, and TI were associated with acute MH, PH chronic conditions, and overall general health, but not acute PH. Bisexuals had more chronic conditions than heterosexuals and worse acute MH than heterosexuals. SO, and TI strongly predicted acute PH and MH status respectively. These findings can assist healthcare providers in developing strategies to reduce health disparities among SGMs.

The dyes with the aggregation-induced emission (AIE) properties are significant for a wide range of studies. However, the existing AIE dyes still lack a readily tunable fluorescence switch. Herein, we described a type of structurally distinct dye family (named as XD dyes) with AIE properties. Significantly, the new XD dyes exhibit the advantageous feature over the traditional AIE fluorophores by possessing the intrinsic spirocyclization as a regulatable fluorescence switch. The AIE properties of XD dyes were examined by the spectroscopic studies, particle size analysis, transmission electron microscope, scanning electron microscope, and solid fluorescence. Furthermore, the quantum chemical calculation, molecular dynamics simulation and recombination energy calculation provide the insights into the structural characteristics and the aggregation process of XD dyes. The development of this unique class of dyes could afford new perception and insights for the development of supreme functional fluorescent dyes and probes.

Every year, more and more women are diagnosed with breast cancer, making it the most frequent malignancy among women. Obesity has been recognized as one of the key risk factors for breast cancer development. Although the exact mechanisms by which obesity promotes breast cancer progression remain unclear, several have been identified as likely contributors: insulin resistance, chronic inflammation and inflammatory cytokines, adipokines, and sex hormones. Several disorders, including obesity and breast cancer, have been shown to have altered microRNA (miRNA) expressions, although the implications of miRNAs in obesity-linked breast cancer are just now becoming clear. Obese cancer patients may benefit from using miRNAs as therapeutic targets and noninvasive indicators for diagnosis and prognosis. Recent research has shown that some foods and other dietary components may inhibit the development of cancer and obesity by influencing the production of microRNAs. In this review, we compile the most recent data available on microRNAs (miRNAs) and the molecular targets they regulate in obesity-related breast cancer. Here, we discuss the protective functions of miRNAs in obesity-related breast cancer and the mechanisms by which dietary variables affect miRNA expression. New therapeutic options for the treatment of obesity-associated breast cancer are needed to lessen the disease's prevalence, hence this review was conducted in that spirit.