Congenital adrenal hyperplasia associated to 11-beta-hydroxylase deficiency is a rare cause of secondary hypertension, usually discovered during childhood; however, a late diagnosis in adults has also been reported. Despite low cortisol levels, accumulated adrenal steroid precursors can activate the glucocorticoid receptor, and thus protect the patient against adrenal crisis.

Leukocytoclastic vasculitis (LCV) is a small-vessel vasculitis characterized by immune complex deposition in the walls of dermal capillaries and venules. With the COVID-19 pandemic, more adults are receiving the MMR vaccine. We report a case of MMR vaccine-related LCV occurring only on the upper extremities with associated conjunctivitis.

Climate change is bringing unforeseen alterations to disturbance regimes, exposing many ecosystems to multiple novel disturbances simultaneously. Despite this, how biodiversity responds to simultaneous disturbances remains unclear, with conflicting empirical results on their interactive effects. Here, we experimentally test how one disturbance (an invasive species) affects the diversity of a community over multiple levels of another disturbance regime (pulse mortality). Specifically, we invade stably coexisting bacterial communities under four different pulse frequencies, and compare their final resident diversity to uninvaded communities under the same pulse mortality regimes. We find that the disturbances synergistically interact such that the invader significantly reduces resident diversity at high pulse frequency, but not at low. This work therefore highlights the need to study simultaneous disturbance effects over multiple disturbance regimes as well as to carefully document unmanipulated disturbances, and may help explain the conflicting results seen in previous multiple-disturbance work.

Lithiasis by fungus ball is a serious complication of candiduria. Our case was a 58 year old man who presented an acute obstructive pyelonephritis. Ultrasound revealed a left ureteral lithiasis. Biological examination revealed Candida parapsilosis. Antifungal was beneficial with good evolution. Broad-spectrum antibiotic therapy is one factor favouring.

Acute airway obstruction is a rare presentation of megaoesophagus. Megaoesophagus is commonly caused by achalasia; however, we present a case of megaoesophagus caused by idiopathic dysmotility disorder. Decompression with a wide bore nasogastric tube avoided a scenario of difficult intubation or emergency front of neck access

Objective The objectives of this study were to determine the prevalence of insulin resistance (IR), dyslipidemia and metabolic syndrome (MS) in children with asthma, aged 10 to 15 years and to determine if these metabolic abnormalities showed an association with asthma symptom control and lung function. Methods We conducted a cross-sectional study at a tertiary centre in north India. Consecutive children with physician diagnosed asthma were enrolled. Asthma symptom control over previous four weeks was assessed as per GINA recommendations. Fasting plasma glucose, serum insulin and lipid levels were estimated. HOMA-IR was used as a marker of IR. Spirometry was performed for assessing lung function. Results Eighty-three children were enrolled. Median (IQR) age was 12.0 (11.0, 13.5) years and mean (SD) BMI z score was -0.42 (1.0). Median (IQR) Homeostasis Model Assessment- Insulin Resistance (HOMA-IR) was 1.65 (1.06, 2.39). Prevalence of IR was 42.3% (95% CI: 31.7-52.9%). Number of children with elevated triglycerides, total cholesterol, and LDL-cholesterol was 4 (4.8%), 4 (4.8%) and 5 (6%), respectively. 67 (80.7%) children had low HDL-cholesterol. Only one subject was found to have MS. Presence of IR and elevation in serum insulin and triglycerides were associated with poorer asthma control, independent of BMI. None of the metabolic parameters were associated with lung function, after adjusting for height. Conclusions A high proportion of children with asthma aged 10-15 years had IR but not MS currently. Increasing serum insulin, triglycerides, and presence of IR were associated with poorer asthma control, after adjusting for BMI.

Background: Uniformity and compliance with clinical practice guidelines (CPGs) for use of palivizumab in preventing severe RSV infection in Australian high-risk infants remain unclear. Methods: An online survey was conducted across the Australian and New Zealand Neonatal Network (ANZNN) to determine clinical practices around palivizumab. A literature search was also performed to identify and compare national and international guidelines. Results: Sixty-five of 422 ANZNN members completed the survey. Respondents included 61 senior medical staff of consultants/staff specialists (78%) and four nursing staff (6%). Infants most likely to be recommended palivizumab included preterm infants born <29 weeks gestational age (GA) (30%), children with chronic lung diseases (CLD) born <32 weeks GA (40%), and with hemodynamically significant heart disease (35%). Many respondents (53%) stated that CPGs for palivizumab were developed locally. Twenty guidelines (10 international and 10 domestic) were obtained in total; 16(80%) recommended palivizumab use in preterm infants, 16(80%) recommended use in infants with CLD, 17(85%) congenital heart disease (CHD) and six (30%) bronchopulmonary dysplasia (BPD). Eight (40%) guidelines provided specific recommendations for immunocompromised infants. Canada, Western Australia, and American Academy of Paediatrics provided recommendations for Indigenous children. Frequency and dosage of palivizumab was universal across all CPGs. None of the international guidelines obtained were from low- or middle-income countries. Conclusions: Standardisation of CPGs may improve clinical decision making around use of palivizumab in high-risk infants.

Purpose: Persistent pulmonary hypertension of the newborn (PPHN) is a disease with potential serious morbidity and mortality. Inhaled iloprost, a stable analogue of prostacyclin, has recently been used as a therapeutic option. However, there are no clinical guidelines on the use of iloprost, specifically for neonates. This study aimed to suggest the use of inhaled iloprost as a rescue therapy for PPHN based on our experience. Methods: This was a retrospective study. The data from medical records of 6 newborns (3 late preterm, 3 term), diagnosed as persistent pulmonary hypertension of the newborn and had received inhaled iloprost from December 2019 to April 2022 were collected. Demographic and clinical features, dosing regimen, changes in oxygenation index, echocardiographic findings and mortality were evaluated. Results: The inhalation dose was 2-4 mcg/dose, and 3-48 inhalations per day were applied over 2-7 days. Inhaled iloprost was effective in all patients. No side effects attributable to inhaled iloprost and no mortality was recorded. Conclusion: Our experience suggests that inhaled iloprost can be used as a first­-line therapy in newborn infants with PPHN when inhaled nitric oxide is not available, although there are large fluctuations in oxygenation index due to setting.

This paper concentrates on an interaction scattering problem between the time-harmonic electromagnetic waves and an unbounded periodic elastic medium. The uniqueness results of the interaction problem are established for small frequencies or all frequencies except a discrete set in both the absorbing and non-absorbing medium, and then the existence of solutions is derived by the classical Fredholm alternative. The perfectly matched layer (PML) method is proposed to truncate the unbounded scattering domain to a bounded computational domain. We prove the well-posedness of the solution for the truncated PML problem, where a homogeneous boundary condition is imposed on the outer boundary of the PML. The exponential convergence of the PML method is established in terms of the thickness and parameters of the PML. The proof is based on the PML extension and the exponential decay properties of the modified fundamental solution.

Sea kelp and potassium Humate are two amendments commonly used in the agronomy and crop science industries to improve germination and root development. This study evaluated different concentrations of Sea kelp and potassium Humate in rehabilitating coal tailings. The aim was to evaluate the growth potential of Cynodon dactylon and to set norms for coal tailings about Sea kelp and potassium Humate . Four different concentrations of each ameliorant were applied to the coal tailings, where the pH, of the medium was measured and for the grass specie, germination, survivability, and growth performance were measured. First, it was deduced that these amendments positively affected the establishment and survivability of Cynodon dactylon on the coal tailings. Secondly, it was found that the application of Sea kelp and K-Humate had a buffering effect on the reacidification of coal tailings. The highest concentration of Sea kelp and the agricultural norm for potassium Humate showed the highest buffering capacity.

Background: TMS-007, an SMTP family member, modulates plasminogen conformation and enhances plasminogen-fibrin binding, leading to promotion of endogenous fibrinolysis. Its anti-inflammatory action mediated by soluble epoxide hydrolase inhibition contributes to the efficacy. Evidence suggests that TMS-007 can effectively treat experimental thrombotic and embolic strokes with a wide time window while reducing hemorrhagic transformation. Aims: To evaluate the safety, pharmacokinetics, and pharmacodynamics of TMS-007 in healthy volunteers. Methods: A randomized, placebo-controlled, double blind, dose-escalation study, administered as a single intravenous infusion of TMS-007 in cohorts of healthy male Japanese subjects. There were 6 cohorts planned, but 5 were completed. In each cohort (n = 8), individuals were randomized to receive one of 5 doses of TMS-007 (3, 15, 60, 180, or 360 mg; n = 6) or placebo (n = 2). Results: TMS-007 was generally well-tolerated, and no serious adverse events attributed to the drug. A linear dose-dependency was observed for plasma TMS-007 levels. No symptoms of bleeding were observed in brain MRI analysis, and no bleeding-related responses in laboratory testing were found. The plasma levels of the coagulation factor fibrinogen and the anti-fibrinolysis factor 2-antiplasmin levels were unchanged after the TMS-007 dosing. A slight increase in the plasma level of plasmin-α2-antiplasmin complex, an index of plasmin formation, was observed in some subjects who received 360 mg of TMS-007 (≈ 6 mg kg−1). Conclusions: TMS-007 is generally well-tolerated and exhibits favorable pharmacokinetic profiles that warrant further clinical development.

Background: The long duration of IMV for premature infants connected to adverse clinical complications. It has been proven that noninvasive ventilation (NIV) improved the weaning process. Noninvasive neurally adjusted ventilatory assist (NIV-NAVA) is a new type of NIV, and its effects on weaning are a subject of debate in clinical practice. To compare NIV-NAVA and conventional NIV as weaning modes in preterm neonates, this article was preformed. Methods: Cochrane Library, Embase, PubMed, Scopus, and Web of Science were comprehensively searched. Published reports were screened and assessed based on predetermined inclusion and exclusion criteria. The Cochrane Risk of Bias tool and the Newcastle-Ottawa Scale were used to evaluate the quality of reports and bias. Review Manager 5.3 was used in the meta-analysis. Trial sequential analysis (TSA) was used to avoid false-positive or false-negative conclusions caused by constantly updated data. Results: Six studies ( n = 265) were included. Preterm infants who underwent NIV-NAVA had a lower weaning failure comparing with conventional NIV (risk ratio 0.37, 95% confidence interval 0.21–0.67, p = 0.001). In TSA the cumulative Z‑curve crossed monitoring boundary for the benefit of NIV-NAVA indicated that NIV-NAVA might improve extubation failure. With respect to the rates of related adverse clinical events, there was no statistically significant difference between the NIV-NAVA group and the conventional NIV group in forest plots. Conclusion: The current meta-analysis suggests that NIV-NAVA may reduce the rate of extubation failure compared to conventional NIV.

Objectives: Intralobar pulmonary sequestration (ILS) is rare and its optimal clinical management remains ambiguous. This study aimed to introduce our ten-year experience in clinical management of ILS. And the application of our novel surgical method, thoracoscopic anatomical lesion resection (TALR) on ILS was introduced. Materials and Methods: Patients with ILS who received treatment between December 2010 and December 2020 were included in this study, retrospectively. A binary logistic regression model was used to assess risk factors for preoperative symptoms. Intraoperative and postoperative outcomes were compared between the thoracoscopic lobectomy and lung-sparing surgery groups. Results: A total of 112 patients were included in this study. Age and maximum cyst diameter were risk factors for preoperative symptoms. Lung-sparing surgery proved to be safe and feasible with no residual lesions. Conclusions: The overall prognosis of early thoracoscopic surgery for ILS was good. Lung-sparing surgery, especially TALR could be used as a first-line surgery for ILS. It may resolve the long-standing controversy over whether surgery for asymptomatic patients with ILS.

Controlling soil evaporation during the seasonal freeze–thaw period has important practical significance for alleviating the water shortage in northern China. To investigate the influence of different irrigation times on soil evaporation during the freeze–thaw period, a series of field soil evaporation experiments of bare soil and sand mulch treatments with six different irrigation times were conducted. Soil evaporation characteristics during the three freeze–thaw stage were determined, and the major factors influencing soil evaporation were analyzed using the Random Forest model. The results showed that the cumulative soil evaporation of bare soil irrigated at different times during the freeze–thaw period was 43.1–50.37 mm, which was 33.8%–56.4% higher than that of bare soil without irrigation, and soil evaporation decreased by 10.4%–39.2% after the addition of mulched sand. Shortly after irrigation, surface sand mulch exhibited a weak inhibitory effect on soil evaporation in the stable freezing stage and later thawing stage. Sand mulch with irrigation in the early unstable freezing stage had the most positive effect on soil moisture preservation, with 80.95% of the irrigation water stored in the soil during the freeze–thaw period. Simultaneously, the surface soil moisture content was the major factor affecting evaporation in irrigated treatments in the unstable freezing stage and stable freezing stage; surface soil temperature, surface soil moisture content, and average air temperature were the major factors affecting soil evaporation, and surface soil moisture content had the greatest contribution to soil evaporation in the thawing stage. The results suggest that the addition of irrigation water early in the winter along with sand mulch in agricultural fields may be a beneficial practice to reduce water stress in arid and semi-arid areas.

Recent work indicating that feralisation is not a simple reversal of domestication has raised questions about the predictability of evolutionary change across replicated feral populations. In the present study we compare genes and traits of two independently feral populations of chickens (G. gallus) inhabiting archipelagos in Pacific and Atlantic regions to test for evolutionary parallelism and/or divergence. First, we confirm purported differences in these two populations’ ancestries are corroborated by genetic and phenotypic analyses. Indeed, whereas Pacific (Kauaii) chickens recently outcrossed with wild relatives, our genetic data from Atlantic (Bermuda) chickens is more consistent with solely domestic origins encompassing diverse G. gallus breeds. Next we used genome scans to contrast the targets of feralisation (selective sweeps) between the two independently feral populations. Two sweep loci were shared between these focal populations and this overlap is inconsistent with a null model in which selection targets are randomly distributed throughout the genome. The larger set of sweep loci from the two feral genepools were also found to govern traits that were heavily modified during G. gallus’ domestication (e.g. the nervous system and behaviour, metabolism, and reproduction). Assessment of SNPs using allelic differences and SNP annotation led to candidate SNPs for further investigation for five of the genes present. Our findings suggest that a subset of feralisation loci are shared across independently-established populations, raising the possibility that feralisation involves some degree of parallelism or convergence, though a clearer understanding of possible ‘feralisation syndromes’ will require elucidating genotype-phenotype relationships in any populations being compared.

The existence of Nepal’s holy river, Bagmati, which flows through the Kathmandu valley’s core metropolitan, has been menaced by many anthropogenic threat. It is necessary to identify such stressors to restore them. This research focuses on determining river water quality to analyze the Bagmati River System’s spatial biological health. Benthic macroinvertebrates were used as biological indicators in this investigation. Benthic macroinvertebrates were sampled from upstream to downstream using a multi-habitat sampling approach during the post-monsoon period (Oct-Dec, 2021). The Ganga River System Biotic Score/Average Score per Taxa (GRSBIOS/ASPT) was used to assess river water quality. From the sampling of 21 sites, a total of 5839 individual BMIs from 51 families and 11 orders were recorded. According to the findings, Gastropoda, Hirudinea, and Lepidoptera were found to be infrequent throughout the stretch, while Trichoptera was the dominant order followed by order Diptera. The distribution of species abundance throughout the stretch was not found normal (p=2.439e-08). Upstream was seen accounting for more than 30% of all the families, making upstream rich in taxonomic richness, which steadily decreased from midstream to downstream. The results show that facultative taxa are widely distributed in both upstream and midstream, but sensitive taxa are mostly found in upstream and in small numbers in the midstream. There are no signs that facultative and sensitive taxa exist in downstream. Downstream was fully dominated by pollution-tolerant species. According to classification performed using GRSBIOS/ASPT, the upstream river within Shivapuri Nagarjun National Park of the Bagmati River System are clean and are categorized as Class I, whereas rivers from the boundaries of the protected area to downstream are categorized as Class IV-V with few sites as Class II and Class III, indicating that they are extremely polluted. Water resource managers should utilize the study’s findings to assess and restore the water’s quality using biological indicators.

The use of sensors in AI is increasing. Sensors are used to collect data and help AI make sense of the world around it. They can be used for various purposes, such as monitoring the environment, gathering information about people or things, and navigating vehicles. The sensors are not only used for collecting data but also for controlling the actions of a machine or system. They can also be used to trigger an event when a particular condition is met. Today, most robots need three main types of senses, Sight, Hearing, and Touch. For AI to be able to “see,” “listen,” or “feel physical objects,” it has to use some sensor. This paper aims to explore the history of the sensors and technologies used for computers or AI to sense its environment. The technologies used for seeing include cameras and lidar sensors. A combination of speech recognition and microphones allows AI to “listen,” and tactile sensors are used to “feel” physical objects. AI can also be used to aid humans. For example, AI can be used to understand the sounds in the environment and use it to develop active noise cancellation, which can prevent hearing loss.

Aquagenic Palmar Wrinkling is a rare, transient disorder induced by brief contact with water. It has been noted in cystic fibrosis patients. We describe a unique case of a 17-year-old male with no history of cystic fibrosis, who presented with shriveled palms and multiple whitish papules following brief water immersion.

Background. Population-level estimates of hospitalisations for physical disease in recently treated populations of childhood cancer survivors are limited. In the Australian context, the long-term effects of childhood cancer on survivors and the health system are unclear. We examined the trends in primary hospitalisations for physical disease in a whole-population cohort of 5-year childhood cancer survivors (CCS) diagnosed in Western Australia (WA) from 1982-2014. Methods. We examined hospitalisation records for 2938 CCS and 24 792 matched ‘non-CCS’ controls, discharged from 1987-2019. Andersen-Gill Cox regression models for recurrent events were used to examine hospitalisation risk. Mean cumulative counts were used to examine hospitalisation burden by time since diagnosis and attained age. Negative binomial regression models were used to examine the annual percentage change (APC) in hospitalisations. Results. We identified a higher risk of hospitalisation for all-cause (HR=1.8, 95%CI 1.6-2.0) physical disease in CCS than controls. Compared to controls, hospitalisation risk was highest for second malignant neoplasms (HR=13.2, 95%CI 9.9-17.6) and blood diseases (HR=5.6, 95%CI 1.8-17.1) in CCS. Characteristics associated with higher hospitalisation rates included female gender, diagnosis with malignant bone tumours, cancer diagnosis age between 5-9 years, multiple childhood cancer diagnoses, higher comorbidity, high socio-economic deprivation, and geographic remoteness. The APC in hospitalisations differed between groups (CCS APC=-3.8%; controls APC=2.4%, p<0.05). Conclusions. A higher risk of hospitalisation for physical disease was observed in CCS compared with children not diagnosed with cancer, with the risk continuing to increase up to 30 years post-diagnosis. These findings emphasise the need for continued specialised care and additional research to understand the unmet needs in this population.

Objective:  Anaplastic Lymphoma Kinase ( ALK) gene gain-of-function point mutation leading to its overexpression has recently been identified and targeted in neuroblastoma (NB). We evaluated ALK gene mutation and its protein expression in cases of NB on fine needle aspiration biopsy (FNAB). Material and Methods: FNAB diagnosed cases of NB (n=56) were evaluated with cell blocks for MYCN amplification and ALK protein expression by Fluorescence in-situ hybridization and immunocytochemistry respectively. MGG stained smears (n=22) were used for Next generation sequencing (NGS) analysis using the Cancer Hotspot panel (version2) on Ion Torrent S5 platform. Staging and risk assignment as per International Neuroblastoma Risk Group (INRG) was performed and managed. All the parameters were correlated with overall survival. Results: ALK protein showed cytoplasmic expression in 65% of cases and did not correlate with MYCN amplification (p=0.35), INRG groups (p=0.52), and overall survival (p=0.2); however, ALK+ poorly differentiated NB showed better prognosis (p=0.02). ALK negativity was associated with poor outcome by Cox proportional hazard model (hazard ratio=2.36). ALK gene, exon 23 missense mutations (F1174L) were seen in 2/21 cases with an allele frequency of 8% and 54%. Both these cases showed ALK protein expression and died of disease within 1 and 17 months respectively. A novel IDH1 exon 4 mutation was also detected. Conclusion:  ALK expression is a promising prognostic as well as a predictive marker in advanced NB along with traditional prognostic parameters. FNAB smears are suitable for NGS and ALK gene mutation confers a poor prognosis.

Rapid influenza diagnostic tests (RIDTs) have variable sensitivity. In a community-based population of kindergarten through 12th grade (K-12) students, we assessed factors that may influence RIDT performance using 2,368 paired results from Sofia® Influenza A + B fluorescent immunoassay and reverse transcription polymerase chain reaction (RT-PCR). RIDT sensitivity and specificity were 76.1% (95% CI: 72.8—79.1) and 97.2% (96.2—97.9), respectively. Factors associated with sensitivity included runny nose (OR=3.0, p<0.001), nasal congestion (1.59, p=0.045), days from symptom onset (per day; 0.75; p<0.001), myalgia (0.61; p=0.014), age (per 5 years; 0.55; p=0.001), and detection of another virus (0.50; p=0.043). Understanding these factors can aid in interpreting negative results.

A 60-year-old woman with breast invasive ductal carcinoma underwent FDG PET/CT scan for cancer staging. A synchronous colon cancer was detected incidentally. After resection of colon cancer, she received CCRT for breast cancer. Marked therapeutic response was found throughout the follow-up period. Also, there was no evidence of cancer recurrence.

In this paper, we are interested in the following Schrödinger-Poisson system { − ε p ∆ p u + V ( x ) | u | p − 2 u + ϕ | u | p − 2 u = f ( u )+ | u | p ∗ − 2 u in R 3 , − ε 2 ∆ ϕ = | u | p in R 3 , where ε>0 is a parameter, 3 2 < p < 3 , ∆ p u = div ( | ∇ u | p − 2 ∇ u ) , p ∗ = 3 p 3 − p , V : R 3 → R is a positive function with a local minimum and f is subcritical growth. Based on the penalization method, Nehari manifold techniques and Ljusternik-Schnirelmann category theory, we obtain the multiplicity and concentration of positive solutions.

Counterparty sentiment and major uncertain factors always affect credit risk contagion in credit risk transfer (CRT) market. In order to effectively analyze credit risk contagion, this paper proposes a stochastic credit risk contagion model considering sentiments, in which the stochasticity is driven by Lévy process. Based on the Lyapunov function method, sufficient condition of finite-time stability is derived. The impacts of counterparty sentiment and Lévy process on credit risk contagion are analyzed. To effectively control credit risk contagion, the stochastic credit risk control model is established, and the optimal control strategy is given by using Pontryagin’s maximum principle. Numerical simulating results show the correctness and effectiveness of the theory.