Frontalis Suspension with Autogenous Fascia Lata: A Preferred Technique for Complex Ptosis Cases-Rubén Daniel Pérez López, Corresponding autor, [email protected], Universidad Nacional Autónoma de México. -Aleyra Paola Pérez López, [email protected], Fundación Nuestra Señora de la Luz. I.A.P-César Fernando Gutiérrez Barrios, [email protected], Universidad Nacional Autónoma de México.-Lysette Allende García, [email protected], Universidad Autónoma del Estado de Morelos.

Title: ST elevation myocardial infarction with right coronary aneurysm successfully treated with a drug-coated balloon-only strategyWord count: 493 wordsFirst author: Yu Sugawara, MDDepartment of Cardiology, Yamato-Kashihara Hospital, JapanCorresponding author:Yu Sugawara, MDDepartment of Cardiology, Yamato-Kashihara Hospital81, Ishikawa-cho, Kashihara-shi, Nara-ken, Japan 634-0045Phone +81-744-27-1071Fax: +81-744-27-4609E-mail: [email protected] clinical message:ST elevation myocardial infarction (STEMI) with a coronary aneurysm is rare, thus its treatment is not established. This case suggested that drug-coated balloon angioplasty may be considered for STEMI patients with coronary aneurysms.TextThe incidence of coronary aneurysm ranges from 0.3 to 5.3%.1 ST-elevation myocardial infarction (STEMI) with a coronary aneurysm is rare; hence, no standard therapy and guidelines are established. Drug-coated balloons (DCBs) are innovative devices used in treating STEMI and large vessels (diameters ≥3.0 mm), allowing stent-less procedures with favorable outcome.2, 3We report on a 60-year-old man with hypercholesterolemia hospitalized for STEMI. His past history of Kawaski disease was unclear. Coronary angiography (CAG) demonstrated that the left anterior descending artery (LAD) was mildly ectatic, although no stenosis or occlusion in both LAD and circumflex artery was observed. However, CAG revealed total occlusion of the middle right coronary artery and circular calcified structure (Fig. 1). Thus, urgent percutaneous coronary intervention (PCI) was performed. A 6Fr MachTM1 JR4.0 guiding catheter (Boston Scientific, Marlborough, MA, USA) was placed and a 0.014-inch Sion Blue (Asahi Intecc, Akatsuki Cho, Japan) guidewire was introduced. Following thrombus aspiration and dilatation with a 2.0×15-mm balloon (Ryurei®, Terumo, Aichi, Japan), we employed intravascular ultrasound (IVUS) (OptiCross®, Boston Scientific, Marlborough, MA, USA) (Fig. 2). IVUS revealed a coronary aneurysm and 180-degree calcification at the distal site, plaque, and thrombus at the culprit site. The lumen diameter measured 2.45×2.87 mm, with a minimum lumen area of 5.47 mm2. A 360-degree vessel wall calcification was found at the proximal site, with a lesion length of 15.7 mm (Fig. 2 a-c). We obtained Thrombolysis In Myocardial Infarction (TIMI) grade 2-3 flow. There were small amounts of coronary thrombi at that time. Generally, drug-eluting stent implantation is considered for patients with STEMI. However, this was decided against because IVUS findings showed malapposition occurring in the follow-up period. In terms of lesion restenosis in chronic phase, the DCB strategy is superior to conventional plain old balloon angioplasty strategy. Furthermore, the use of DCB for STEMI is safer than that of 2nd generation drug eluting stents in terms of all-cause mortality and all adverse cardiac events.2Moreover, DCB may be an effective strategic choice in patients with large, de novo coronary lesions.3 Thus, a 3.0×20-mm paclitaxel DCB (SeQuent Please NEO®, Nipro, Osaka, Japan) angioplasty was performed following pre-dilatation with a 3.0×13-mm scoring balloon (Lacrosse aperta NSE®, Nipro, Osaka, Japan) to reduce the risk of target lesion failure. The final CAG revealed TIMI grade 3 flow (Fig. 3). Cardiac coronary computed tomography (CT) following PCI showed a saccular aneurysm with plaques and heavy calcification (Fig. 4). The peak creatine kinase level was 1243 IU/L (normal range, 56-244 IU/L). Echocardiography showed that the ejection fraction was 60% and that cardiac wall motion was almost normal; unfortunately, a right coronary aneurysm could not be detected. This patient was discharged 9 days after admission, and aspirin and warfarin were prescribed in the chronic phase.STEMI with a coronary aneurysm is not common, and its management is challenging. We evaluated the coronary aneurysm with multiple modalities (CAG, IVUS and cardiac CT). DCB angioplasty may be considered for STEMI patients with coronary aneurysms.Key words: Cardiac computed tomography, Coronary aneurysm, Drug-coated balloon, ST-elevation myocardial infarctionAuthor contributionYu Sugawara: Investigation and writing-original draftAcknowledgementsNone.Author and funding disclosures:Yu SugawaraFunding: None.Conflict of interest: The authors declare no conflicts of interest.ConsentThe author has obtained written informed consent from patient.References1. Abou Sherif S, Ozden Tok O, Taşköylü Ö, Goktekin O, Kilic ID. Coronary artery aneurysms: A review of the epidemiology, pathophysiology, diagnosis, and treatment. Front Cardiovasc Med. 2017;4:24. doi.10.3389/fcvm.2017.000242. Merinopoulos I, Gunawardena T, Corballis N, Bhalraam U, Reinhold J, Wickramarachchi U, et al. Assessment of paclitaxel drug-coated balloon only angioplasty in STEMI. JACC Cardiovasc Interv. 2023;16:771–9. doi.10.1016/j.jcin.2023.01.3803. Sciahbasi A, Mazza TM, Pidone C, Samperi S, Cittadini E, Granatelli A. A new frontier for drug-coated balloons: Treatment of “de novo” stenosis in large vessel coronary artery disease. J Clin Med. 2024;13:1320. doi.10.3390/jcm13051320Figure legendsFigure 1. The left anterior descending artery (LAD) shows mildly dilation but no stenosis in both the LAD and circumflex artery. The right coronary angiography revealing occlusion (yellow arrow) and the aneurysm’s silhouette (red arrows).Figure 2. Each line indicating intravascular ultrasound (IVUS) cross-sectional images.a. At the distal site, IVUS showing an aneurysm and calcification.b. Thrombus formation (white arrows) occurring at the culprit site, with a lumen diameter of 2.45×2.87 mm and a minimum lumen area of 5.47 mm2.c. The proximal site vessel exhibiting protrusion outward and 360-degree vessel wall calcification.Lesion measuring 15.7 mm in length (white line).Figure 3. Final angiogram showing a Thrombolysis in Myocardial Infarction grade 3 flow.Figure 4. Cardiac CT demonstrating a saccular aneurysm (red arrows) with plaque and severe calcification (yellow arrows).

Objective: To elucidate the impact of lack of Palivizumab administration during off-season RSV periods on the RSV-related hospitalization among 29-34 weeks of gestational age (wGA) preterm infants. We utilized the summer of 2021 off-season RSV surge during the COVID19 pandemic. Methods: This multi-center retrospective observational study was conducted in 11 medical centers across Israel. We included infants > 1 year-old hospitalized with RSV infection between November 2017-August 2021. Patients were categorized into an in-season admissions group (November-March) and off-season admissions group (April-October). The primary outcome was the proportion of RSV hospitalizations among 29-34wGA infants in relation to total RSV admissions during the same season. Secondary outcomes included clinical severity parameters. Results A total of 3,296 infants were admitted during the RSV season, and 1,044 during the off-season. The proportion of 29-34wGA preemies was significantly higher in the off-season group compared to the in-season group (7% vs 2.1%, p<0.001). In the off-season group, we observed a significantly higher proportion of Jewish individuals (80.1% vs. 59.2%, p=0.001) and higher socioeconomic status (55.1% vs. 45.1%, p<0.001) compared to the in-season group. In the multivariable logistic-regression model, off-season hospitalization odds for 29-34 wGA preemies were significantly higher (2.6-fold, 95% CI:1.8-3.9, p<0.001) compared to in-season, irrespective of demographic covariates. Similar clinical severity parameters was observed between the groups. Conclusions Our results revealed a significantly higher proportion of infants born at 29-34 wGA among those hospitalized during off-season periods compared to in-season periods. These findings highlight the importance of including 29-34 wGA infants into future RSV immunoprophylaxis recommendations.

Key Clinical MessageEarly recognition of Plummer-Vinson syndrome in patients presenting with dysphagia and iron-deficiency anemia is essential for preventing severe complications. A multidisciplinary approach is vital, particularly when PVS coexists with conditions such as thyro-cardiac disease and acute heart failure.

Because the existing research data cannot fully prove the advantages of single-site Da Vinci robotic surgery (RSS) compared with single-site laparoscopic surgery (LESS) in the treatment of gynecological diseases.We aimed to evaluate the effectiveness and cost of RSS and LESS in the treatment of gynecological diseases.To provide theoretical basis for whether RSS can replace LESS in the treatment of gynecological diseases.A systematic search of three electronic databases for articles published up to December 31st,2023 was performed by computer.After literature screening,data extraction and quality evaluation according to inclusion and exclusion criteria, meta-analysis was performed using RevMan 5.1 software.A total of 16 articles were included, including 14 articles on effectiveness, and 2 articles on cost.Among them,5 studies scored 9 points for quality evaluation,3 studies scored 8 points, and 8 studies scored 7 points.Compared with LESS, RSS was associated with a shorter total operative time for malignant tumor surgery[107 patients MD-24.01 min, 95% CI-32.40 to -15.62,p <0.00001],a less estimated blood loss[107 patients MD-53.60 ml, 95% CI-105.50 to -1.69,p =0.04],and there was no significant differences in postoperative hospital days and postoperative complications between the two groups. However,Subgroup analysis of TOT separately was carried out according to the time of study publication and different single point port and robotic surgical system. After 2020 and for using commercial single point ports other than the Da Vinci dedicated single point port, or using the fourth-generation Da Vinci SP surgical system, while neither total operative time was no significant difference between the two groups[1259 patients MD 16.91 min, 95% CI -9.38 to 43.19,p = 0.21][354 patients MD 34.13 min, 95% CI -16.75 to 85.01,p = 0.19 and 645 patients MD 13.79 min, 95% CI -26.85 to 54.43,p = 0.51,respectively].Therefore,the present meta-analysis supports that comparing with LESS,in gynecological malignant tumor surgery,RSS takes shorter total operation time,less estimated blood loss,and similar efficacy in postoperative hospital days and postoperative complications. Therefore,if the cost of RSS can be reduced,RSS is a feasible surgical method for patients undergoing gynecological malignant tumor surgery.With the fourth generation Da Vinci SP surgical system,the era of single-site robotic surgery may be ushered in after 2020.

The black piranha (Serrasalmus rhombeus), a widely spread species in the rivers of the Amazon basin, plays a vital role as both key predator and important prey. Despite its essential contribution to ecosystem stability, there is a lack of information regarding its genetic diversity and population dynamics in the central Amazon region. As the Amazon continues to undergo environmental changes in the context of growing anthropogenic threats, such knowledge is fundamental for assist in the conservation of this species. This study is the first to analyze the genetic diversity and population structure of S. rhombeus in the central Amazon region using high-resolution genomic data. We employed a Genotyping-by-Sequencing approach with 248 samples across 14 study sites from various tributaries, encompassing diverse water types (black, white and clear water) and characterized by 34 physiochemical parameters. The data reveals low diversity accompanied by pronounced signs of inbreeding in half of the sites and robust genetic differentiation and variation among sites and within-sites. Surprisingly, we also found evidence of higher dispersal capacity than previously recognized. Our analysis exposed a complex and high population structure with genetic groups exclusive to some sites. Gene flow was low and some groups presented ambiguous genealogical divergence index (gdi) signals, suggesting the occurrence of potential cryptic species. Moreover, our results suggest that the the population structure of black piranha appears more influenced by historical events than contemporary factors. These results underscore the need to give greater attention to this keystone species, for which no regulatory framework or conservation strategies is presently in effect.

Incorporating the magnetic core material in a lumped-element transformer model generally results in a nonlinear network with hysteresis. This network can be solved subsequently in time domain, yielding the transient response of the transformer. To directly obtain the steady-state solution, the method of harmonic balance is superior to such a transient analysis since it is a frequency domain approach capable of handling nonlinearities. For this reason, harmonic balance is derived theoretically and further applied to a dedicated single-phase transformer network based on a mutual and leakage flux approach. The nonlinear network element is represented by an energy-based dry-friction-like hysteresis model depicting the core material of the transformer. Finally, the results of harmonic balance are compared to measurements and the algorithm's efficiency is discussed.

Understanding how different ecological types within a species are formed and sustained is a key question in evolutionary biology. We examine this question through comprehensive resequencing of the genomes in a species of toad-headed agama (Phrynocephalus putjatai) endemic to the northeastern Qinghai-Tibetan Plateau, which exhibits considerable adaptive variation across three distinct habitats: desert, semi-desert, and meadow. We revealed the differentiation of these ecotypes started ~10,000 years ago and identified varying degrees of gene flow among them. The desert and meadow ecotypes originated from the semi-desert ecotype, and subsequently underwent directional selection in two contrasting habitats of desert and meadow. By analyzing the genomic basis of ecotype differentiation, we identified a single ~170-kb locus encompassing two tightly linked MYH genes, which may play a major role in facilitating the rapid adaptation to desert and meadow habitat in P. putjatai. This locus is likely to have experienced recent strong positive selection in both desert and meadow ecotypes and originated prior to their divergence. Our findings provide compelling evidence that the P. putjatai ecotypes recently diverged from a common source, and local adaptation to different habitats involves the sorting of ancestral genetic variation. This study underscores how selection acting on ancestral standing genetic variation can drive rapid local adaptation and diversification despite gene flow.

In freshwater communities, organisms interact in a variety of ways, including predation, competition and parasitism. Parasites are ubiquitous, playing an important role in shaping freshwater communities. Endoparasites live within internal organs of their host, while ectoparasites, also known as epibionts, are confined to the external part of the host’s body. We conducted a series of experiments to examine the relationship between endoparasites and epibionts using the crustacean Daphnia magna as host, the rotifer Brachionus rubens as epibiont and three species of endoparasites. First, we tested host preference of the epibiont between Daphnia infected by endoparasites and uninfected Daphnia. Epibiont were found to attach more to uninfected Daphnia than to Daphnia infected by the yeast Metschnikowia bicuspidata. On the other hand, epibionts attached more to Daphnia infected by the microsporidium Hamiltosporidium tvaerminnensis than to uninfected Daphnia. Second, we examined the effect of epibionts on the infection of Daphnia by endoparasites. Infection prevalence tended to be higher, though not significantly, in the presence of epibionts. For two of the endoparasites, M. bicuspidata and H. tvaerminnensis, infection intensity (i.e., parasite spore production) was higher in the presence of epibionts. The infection intensity of M. bicuspidata and the bacterium Pasteuria ramosa was affected by the time of death of the Daphnia (i.e., virulence). Finally, we examined the effects of endoparasites and epibionts on the survival and offspring production of the Daphnia. Both host survival and offspring production were negatively affected by the endoparasites, while epibionts did not seem to affect the fitness of their host.

Many investigations of plant defense theory fail to address how trajectories of trait evolution vary across levels of biological organization, even though the processes that shape trait correlations have the strong potential to shift within versus across species, as well as in different environmental and ecological contexts. In this work, we tested for correlations between multiple defensive traits (secondary chemistry, carbon to nitrogen ratio, domatia, leaf toughness, trichomes, and pearl bodies) across a common garden of twenty-one Vitis species and eighteen genotypes of the species Vitis riparia to identify when and where patterns of defense trait evolution persist or break down across biological scales. Additionally, we asked whether Vitis defense trait investment correlates with environmental variables as predicted by plant defense theory, using environmental metrics for each Vitis species and V. riparia genotype from the GBIF and WorldClim databases. We tested for correlations between defense trait investment, herbivore palatability, and environmental variables using phylogenetically informed models. Beyond a few likely physiological exceptions, we observed a lack of correlations between defense traits at both intra- and interspecific scales, indicating that these traits evolve independently of each other in Vitis rather than forming predictable defense syndromes. We did find that select traits vary with proximity to the equator, demonstrating support for plant defense theory’s prediction of higher investment in defenses at more equatorial environments for some, but not all, defense traits. Overall, our results challenge commonly held hypotheses about plant defense evolution, namely the concept of syndromes, by demonstrating that strong correlations between defense traits are not the prevailing pattern both across and within Vitis species. Our work also provides the first comprehensive evaluation of the evolutionary divergence in approaches that Vitis, a genus with significant agricultural value, have evolved to defend themselves against herbivores.

Background Use of medications to treat attention-deficit/hyperactivity disorder (ADHD) is increasingly prevalent among women of reproductive age, but little is understood about their potential cardiometabolic effects in pregnancy. We aimed to examine associations between ADHD medication use and cardiometabolic conditions during pregnancy (gestational hypertension, preeclampsia, and gestational diabetes) and the pharmacological treatment thereof. Methods Linking statewide hospital and dispensing data, we conducted a population-based matched cohort study of women who gave birth between January 2014 and June 2021 in New South Wales, Australia (n=312,697). We compared the incidence of cardiometabolic conditions and cardiometabolic medication use during pregnancy among women who used ADHD medications during pregnancy (n=336) with a 1:10 matched cohort of unexposed women, and with women who used ADHD medications in the 12 months before pregnancy (n=252). We used Poisson regression models to calculate risk ratios (RR) and 95% confidence intervals (CI), adjusting for sociodemographic and pregnancy-related factors. Results Compared with unexposed women, women who used ADHD medications during pregnancy had an increased risk of gestational hypertension (adjusted RR:1.76, 95% CI:1.20-2.57) and gestational diabetes (aRR:1.41, 95% CI:1.09-1.82), with slightly elevated risk estimates for preeclampsia (aRR:1.30, 95% CI:0.82-2.05) and cardiometabolic medication use (aRR:1.40, 95% CI:0.97-2.01). Compared with women who used ADHD medications before pregnancy only, risk estimates attenuated for all outcomes except gestational diabetes (aRR:1.76, 95% CI:1.06-2.93). Conclusions Women using ADHD medications had an elevated incidence of cardiometabolic conditions during pregnancy, but it remains unclear to what extent this is attributable to medications rather than the underlying ADHD.

The TYK2:p.Pro1104Ala (rs34536443) hypomorph variant has been associated with protection against numerous autoimmune disorders. Thus, its mechanism of action becomes of great interest. Here, consistent with the participation of activated immune cells in autoimmunity, we show that the variant regulates the levels of immune cells, and is associated particularly with higher levels of T and B lymphocytes, and especially the naïve (non-activated) compartment. Also, consistent with a protective function in autoimmunity, regulatory CD4+ T cell level was increased. Thus, this variant decreases the immune activation, protecting from autoimmunity. Our work identifies the cellular mechanism regulated by the TYK2:p.Pro1104Ala variant and supports TYK2 as a therapeutic target in autoimmunity.

A planar low profile 1 x 4 antenna array with a parasitic element is proposed and experimentally investigated for mm-wave 5G applications. The four-element array realizes an overall board size of 24 x 18.85 x 1.57mm3. The proposed prototype with a copper thickness of 0.05mm is fabricated on a single layer of Rogers substrate RT/Duroid 5880 having a dielectric constant of 2.2. A gain of 11.94dB has been achieved by this design for the four-element array configuration which was only 5.23dB for the single element design. The simulated bandwidth of the design achieved is 6.208GHz in the range of 27.723GHz to 33.931GHz which is considered to cover certain frequency componenets of n257 band of FR2 5G NR spectrum and some frequency ranges of Ka Band. The prototype has been fabricated and measured for different parameters and the measured and simulated results find a good agreement between each other. Further, the array provides the directional beam with half power beam width (HPBW) of 45 degree with a peak value in the direction of -30 degree. The broadband, high gain performance and simple deign of the developed antenna array finds its application in future millimeter wave 5G communications.

A design strategy towards stable fluorenyl radicals (FRs) is established by introducing donor-π-radical (D-π-R) conjugation between amine N atoms and FR centers through phenyl or 9-anthryl moieties. Four FRs with or without N atom containing protecting groups were designed and synthesized for comparison. X-ray crystallographic analysis displayed planar fluorenyl skeletons of CDP-FR and MA-FR, which form large dihedral angles with protecting groups. Even though, the increased bond-order of C-C and C-N bond be-tween radical center and N atoms by Wiberg bond analysis of all FRs confirmed the D-π-R conjugation. Time-dependent DFT calcula-tions based on frontier molecular orbital analysis further revealed the contribution of D-π-R structures as donor-acceptor effect on the lowest energy absorptions of carbazole and diphenylamine substituted CDP-FR and DPAA-FR. Therefore, beneficial from D-π-R conjugations, CDP-FR and DPAA-FR showed better photo-stability than TP-FR and MA-FR. Our study here provides a new strategy to design and synthesize persistent stable monoradicals.

The Maluku islands, known to possess rich biodiversity, are home to a wide variety of plant and animal species. During a botanical exploration in Aketajawe-Lolobata National Park, located on Halmahera Island, Musa balbisiana Colla, an unrecorded wild banana, was identified. This species had not previously been observed on the island. The results showed a detailed description of the species, including the distribution, habitat, color plates, and DNA barcodes.

The flowering phenology of P. atrodentata in the Himalayan area was examined to determine their trends. Historic data from herbarium specimens during the last century indicate that the blooming period in P. atrodentata has advanced by 16 ± 9.02 days, compared to its typical flowering time. In the meantime, P. atrodentata has been classified as Near Threatened. Furthermore, lectotypes have been assigned to the names in accordance with the regulations outlined in the International Code of Nomenclature for algae, fungi, and plants to establish the correct application of the name.

The spore morphology and perispore ornamentation of 14 plants of Hypodematium of China were carefully observed and photographed under light microscope (LM) and scanning electron microscope (SEM) in this paper for the first time. The results showed that the perispore ornamentation of all species of the Hypodematium that were divided into six types by SEM were as follow: H. sinense, H. hirsutum, H. glanduloso-pilosum, H. confertivillosum, H. chingii, H. jianxiuii and H. zhangii with tuberculate ornamentations; H. squamuloso-pilosum with tuberculiform-rugulates ornamentations; H. fordii and H. shandongense with ringed and semi-ringed ornamentations; H. crenatum and H. gracile with ridged ornamentations; H. mengshanensis with auricular ornamentations; H. guilinense with reticulate ornamentations. These characteristics were stable in the intra-species with significant differences between interspecies. It not only provides an palynological important scientific basis for species identification and interspecific classification, but also provides a new data for the establishment of palynology of ferns, and provides a scientific basis for the biodiversity of Hypodematium, which is of great significance for the exploitation and conservation of its resources.

Autophagy is a process of engulfing cytoplasmic proteins or organelles, thereby fulfilling cells’ metabolic needs and the renewal of specific organelles. Given its key roles in tumor progression, autophagy has attracted tremendous attention in cancer therapies. Notably, there is a megatrend to integrating autophagy regulation into mainstream treatments. This review focuses on autophagy-targeting nanomedicine (ApT-NM) to modulate autophagy in tumor therapy, including the unmodified and functionalized nanoparticles that target tumors by carrying autophagy modulators. On the one hand, it can reverse treatment resistance by inhibiting protective autophagy, and on the other hand, it can promote the death of cancer cells through type II apoptosis by inducing autophagy. Moreover, advanced nanoplatforms combining various treatments (such as chemotherapy, radiotherapy, photothermal therapy, and photodynamic therapy, etc.) have also been summarized. Last, the future perspectives and directions for ApT-NM research are provided, hoping to emphasize this rising filed and promote the development of ApT-NM.