Article type: Case ReportTitle: “Missed” Diagnosis of Mycosis Fungoides: A case reportMahesh Mathur1, Neha Thakur1, Sandhya Regmi1, Supriya Paudel1, Sambidha Karki1, Nabita Bhattarai11Department of Dermatology, College of Medical Sciences Teaching Hospital, Bharatpur, Nepal

IntroductionThe incidence of abdominal wall endometriosis has shown a rising trend, yet malignant transformation of abdominal wall endometriosis remains rare. Literature from both domestic and international sources reports that the incidence of malignant transformation in endometriosis is around 1%, with approximately 80% of endometriosis-related malignancies occurring in the ovaries. The remaining 20% occur outside the ovaries, with only 0.9% occurring at abdominal scar sites[1]. The mechanism of its development is not yet clear. This article reports on a case of clear cell carcinoma of abdominal wall endometriosis and its high-throughput genetic testing results, while also reviewing relevant literature to discuss this disease.

Accidental Clonidine Poisoning in a 4-Year-Old FemaleAbstract A 4-year-old female with accidental Clonidine poisoning presented with respiratory depression and deranged liver function. Early recognition and comprehensive supportive care, including respiratory support, led to a full recovery, underscoring the importance of vigilant monitoring and preventive measures in pediatric poisoning cases.Keywords: Clonidine poisoning, pediatric toxicity, respiratory depression, deranged liver function IntroductionAccidental ingestion of medications in children remains a significant public health concern globally, leading to numerous emergency department visits and hospitalizations each year. Among these, Clonidine, an antihypertensive medication also used in the management of attention deficit hyperactivity disorder (ADHD), presents a unique challenge due to its potent central nervous system and cardiovascular effects [1]. Clonidine acts as an alpha-2 adrenergic agonist, and even a small overdose can lead to severe toxicity in children, including respiratory depression and cardiovascular instability [2].In recent years, there has been an increased awareness of the potential dangers associated with pediatric exposure to antihypertensive medications. The pharmacokinetics of Clonidine in children, combined with their smaller body mass and differences in drug metabolism, can result in a higher risk of adverse outcomes when accidental ingestion occurs [3]. Although cases of Clonidine poisoning are relatively rare, the severity of symptoms often necessitates intensive medical intervention and prolonged hospital stays [4].Despite the serious risks, there is a lack of comprehensive documentation in the medical literature regarding Clonidine poisoning in the pediatric population. Previous case reports have primarily focused on the immediate clinical presentation and management of such cases, often overlooking the long-term outcomes and potential complications [5]. This case report aims to fill this gap by providing a detailed account of a 4-year-old female patient who presented with significant respiratory depression and deranged liver function following accidental Clonidine ingestion.The importance of this case lies in the demonstration of effective supportive care strategies, including respiratory support and continuous monitoring, which led to a favorable outcome. By highlighting the clinical course and management of this case, we hope to contribute valuable insights to the existing literature and guide healthcare professionals in the management of similar cases [6].

Tropical peatlands are characterized by highly organic, heterogeneous, and compressible peat soils. Without sampling and disturbing the soil, peat hydraulic and discharge parameters can be estimated from analyzing the in situ water level rise and recession. Such an analysis allows for the representation of the hydraulic behavior of a peatland from water level, precipitation, and topography data. Water level is measured in several remote tropical peatlands, whereas in situ precipitation is often not. Gridded satellite precipitation products provide an alternative, but are coarse and highly uncertain. Here, we introduce an algorithm for the hydrological parameterization of water level dynamics using satellite-based precipitation, and apply it to a tropical peatland in Brunei, while accounting for representativeness errors in the precipitation data. First, we adapt the rise and recession analysis developed by Cobb & Harvey (2019) for use with Integrated Multi-satellitE Retrievals for the Global Precipitation Measurement mission (IMERG) precipitation estimates. The adapted rise analysis reduces the average error in the slope of the master rise curve with IMERG data from 21% to 3%. The average daily recession overestimation with IMERG data is reduced from 0.45 cm day -1 to 0.18 cm day -1. We also quantify the sensitivity of our rise analysis to precipitation errors using an ensemble of erroneous precipitation time series. Second, the adapted master rise and recession curves are used to fit soil hydraulic and discharge function parameters within the peatland-specific module of the NASA Catchment Land Surface Model. Our method enables the retrieval of accurate hydrological parameters for our case study, and should be tested in other peatland regions and with other satellite-based precipitation products.

A document by Erin Carr. Click on the document to view its contents.

Recent scientific findings spanning the past two decades have prompted a reevaluation of psychedelics, including psilocybin, LSD, and MDMA, as potent tools for mental health treatment. While these substances were historically associated with countercultural movements, concerns and excitement arise as they become commercialized. Based on in-depth interviews of relevant stakeholders of the scene, this study investigates the emergence of the pharmaco-psychotherapy industry and explores the ambiguity between a supposedly ‘impartial scientific community’ and ‘profit-driven pharmaceutical companies’ in the context of Western psychedelia. The paper unveils the intricate network of relationships between researchers, academics, and venture capitalists (VCs), emphasizing the dual role of VCs as financial backers and conduits for regulatory insights and industry knowledge. The study also uncovers the ethical dilemmas faced by scientists in psychedelic medicine, including their mixed interests with private investors, where transformative qualities of psychedelic experience perturb the clear-cut line between objectivity and subjectivity. In particular, researchers’ hesitancy to disclose personal experiences with these substances throughout the interviewing process reflects a shift from the ’illegality’ paradigm to ’intellectual property’ in pharmaceutical innovation. Based on the findings, we suggest a need to reconsider the ethical dynamics in scientific practices, by taking into account the economic preconditions of infrastructural designs, particularly the impact of public/private fundraisers, to whom scientists are likely to make efforts to align with their expectations.

Salvage En Bloc Resection for Refractory Recurrent Pure Testicular Seminoma: A Case Report

Manuscript type: case series

Title:

Title: Foreign Intrusion: Unraveling a Deadly and Rare Cause of HaemobiliaThe author encloses herewith a manuscript entitled Foreign Intrusion: Unraveling a Deadly and Rare Cause of Haemobilia . “for publication in a prestigious journal ”Clinical Case Reports Wiley Online. The Corresponding author of this manuscript is Satheesh Munusamy, Bsc, Respiratory therapist and the authors’ contribution as mentioned below with their responsibility in the research.

This report was produced by an Expert Working Group consisting of UK-based researchers with specialist knowledge of the use of animal models of bone marrow ablation and reconstitution. It aims to facilitate the implementation of the Three Rs (Replacement, Reduction and Refinement), with an emphasis on refinement. Bone marrow ablation and reconstitution procedures are done for a number of different purposes and conducted primarily in mice. These procedures can induce significant suffering, classified as ‘severe’, Category E or Category D/E under European, US and Canadian legislation respectively. Specific animal welfare issues were identified and discussed, and practical measures proposed, with the aim of reducing animal use and suffering.

Youth suicide is a concern world-wide and suicidality, the presence of suicidal ideation or intent, is a critical risk for youth mental health services. This study aimed to determine the prevalence of suicidality in primary care, youth mental health services, along with its correlates and the course of treatment offered to clients. Routinely collected data from Australia’s headspace national youth mental health foundation, which has over 160 centres across Australia providing mental health care to young people aged 12-25 years, were analysed for new clients who started and completed their first episode of care between 1 July 2022 and 30 June 2023. This included 30,437 young people/episodes of care and 74,393 occasions of service. Results showed that suicidality was evident in almost one-quarter of young people, although it was rarely reported as a primary presenting issue. When evident, it was usually identified at first visit. Those most at risk were young people in unstable accommodation, who identified as LGBTIQA+ or who were Indigenous. The findings show that suicidality should be anticipated in young people presenting to primary care mental health settings, and youth services need to be able to competently deal with suicide risk rather than using this as exclusion criteria.

Interoception, the internal perception of bodily states such as heartbeat and hunger, plays a crucial role in shaping cognitive and emotional states. Given that postural control affects cognitive and emotional processing, exploring postural effects on interoception could help uncover the neural mechanisms underlying its effects on cognition and emotion. In this study, we aimed to investigate how different postures affect interoception by using heartbeat-evoked potentials (HEPs), which are event-related potentials indicative of heartbeat processing in the cortex. The study included 21 healthy male participants. They were asked to sit in a chair (sitting condition) and stand (standing condition) in a relaxed state. Data from 64-channel electroencephalogram (EEG) and electrocardiogram (ECG) were collected. The EEG data were segmented by the R-wave timing detected from the ECG data for HEP analysis. HEPs were calculated by focusing on the 350–500 ms post-R-wave interval in the central and temporal brain regions. A paired t-test was performed to compare HEP amplitudes between the sitting and standing conditions, revealing significantly lower HEP amplitudes in the standing condition than those in the sitting condition (t=2.63, p=0.016, d=0.59). Furthermore, we explored the relationship between HEP changes and physiological changes such as cardiac activity and spontaneous EEG, finding no significant correlations (p>0.05, |r|<0.26). These findings suggest that the decreased HEP amplitudes observed during standing reflect attenuated interoceptive processing probably due to a redistribution of attentional resources from internal to external sensory processing, necessary for maintaining standing posture. Thus, postural differences may influence specific neurophysiological processes linked to interoception.

Movement disorders such as Parkinson’s disease (PD) and cervical dystonia (CD) are associated with abnormal neuronal activity in the globus pallidus internus (GPi). Reduced firing rate and presence of spiking bursts are typical for CD, while PD is characterized by high frequency tonic activity. This research aims to identify the most important pallidal spiking parameters to classify these conditions. We analyzed the single unit activity of the external (GPe) and internal (GPi) segments of the globus pallidus in 11 CD and 10 PD patients who underwent standard DBS implantation. We compared firing rate, firing pattern and oscillatory characteristics of tonic, burst and pause cells and used logistic regression and random forest models to classify patients according to their pallidal activity. In the GPi we discovered prevalence of high firing rate tonic cells in patients with PD, while in dystonia burst neurons with high firing rate were predominant. GPi pause cells were mostly observed in CD patients and exhibited less spike variability compared to PD. Characteristics of neurons and their distribution in the GPe was similar. Logistic regression and random forest models identified spike variability and randomness as the key features for distinguishing between PD and CD, instead of firing rate or oscillation properties. Our study demonstrates that pallidal activity can predict Parkinson’s disease and cervical dystonia with high accuracy. Burst dynamics and characteristics of spiking randomness including entropy appear to be the most meaningful reflections of the neurophysiology of studied diseases.

Background: Basal cell carcinoma (BCC) is the most common skin cancer, representing about 80% of non-melanoma skin cancers. Facial BCCs, particularly infiltrative and recurrent types, present substantial challenges due to their aggressive nature and potential for local recurrence. Objective: This report highlights the surgical and reconstructive challenges in managing recurrent infiltrative BCC of the face over a decade-long clinical course, emphasizing the importance of advanced techniques and multidisciplinary care. Case Presentation: A 78-year-old female first presented in 2013 with an infiltrative BCC on the left anterior chin. Initial treatment involved wide local excision (WLE) and adjuvant radiotherapy, yet the carcinoma recurred. Subsequent recurrences occurred in December 2017 and January 2021, with the latest recurrence in 2023 presenting as a 1 cm lesion at the chin more on the left , accompanied by facial asymmetry and lip drooping due to scar contracture. Surgical Technique: The resection involved extensive removal of the lower lip, exposing the mandible. Reconstruction utilized bilateral Karapandzic flaps for the lower lip and a bilobed rotational flap for the chin defect. Meticulous dissection preserved vital neurovascular structures, ensuring functional and cosmetic restoration. Outcome: Post-operative histology revealed basal cell carcinoma with squamous differentiation, clear margins, and no invasion. The patient showed satisfactory recovery, with functional and aesthetic outcomes meeting expectations. She remains disease-free 18 months post-surgery. Conclusion: This case underscores the complexities in managing recurrent facial BCCs and the necessity for advanced surgical techniques and a multidisciplinary approach to achieve optimal outcomes.

Multiple myeloma (MM) is an incurable plasma cell neoplasm. MM-specific alterations in methylation status cause gradual epigenetic changes and lead to pre-MM disease states, such as Monoclonal Gammopathy of Undetermined Significance (MGUS) and Smoldering MM (SMM). The communication between MM cells and the bone marrow (BM) stromal cells serves a pivotal role in MM development by supporting transformed cell growth and proliferation. MM cells are known to modify the BM microenvironment through secretion of exosomes, which enhances disease progression by the induction of angiogenesis, immune suppression as well as drug resistance. This form of intercellular communication is thought to be mediated by several types of cargo molecules prevalent in exosomes, including microRNAs (miRNAs). The main obstacle in the treatment of MM is the difficulty in eliminating the residual cancer cells. Even if there are multiple treatment options, none is curative, and remissions have an unpredictable relapse onset. We attempt to address the two hurdles in terms of the difficulty in predicting the duration of remission and the challenge which currently remains out of reach, treatment regiments which guarantee cancer-free bone marrow.

Drought can profoundly alter freshwater ecosystems. Although the impacts of drought on freshwater fish have received increasing attention, our understanding of the response of fish gut microbes to drought event remains limited. We combined approaches focusing on community assembly processes and microbial core network to investigate the dynamic interactions between fish gut microbes and external environment during drought and recovery periods, and assessed the resistibility of fish gut microbes at different periods. We found that drought would decrease the diversity of fish gut microbes and affect the composition and function of microbial communities in fish gut. The exchange of microbes in fish gut and external environment compensated for the decline of gut microbial resistibility during drought. In addition, the effects of drought on fish propagated through trophic cascades. The compensation mechanism of fish gut microbes during drought reflects the adaptability of fish to different environments. Our study highlights the dynamic interactions between microbes in fish gut and external environment, and provides a new perspective for understanding the adaptability of fish to extreme environments.

The gut microbiota contributes to host health by facilitating nutrient uptake, digestion, energy metabolism, intestinal development, vitamin synthesis, and immunomodulation, and plays an important role in the growth and reproduction of the animal itself. Considering the paucity of research on the gut microbiota of wild snakes, this study focused on bamboo pitviper (Viridovipera stejnegeri) populations from Anhui, Guizhou, and Hunan, with multiple fecal samples collected from each population (six, five, and three, respectively). Total microbial DNA was extracted from the fecal samples using metagenomic next-generation sequencing and differences in gut microbial composition, abundance, and carbohydrate-active enzymes (CAZymes) were analyzed among the three populations. Results showed no significant variance in the α-diversity of the gut microbes across the three populations, while principal coordinate analysis revealed significant differences in gut microbe composition. The four most abundant phyla in the gut microbiota of V. stejnegeri were Pseudomonadota, Bacteroidota, Actinomycetota, and Bacillota, while the four most abundant genera were Salmonella, Citrobacter, Bacteroides, and Yokenella. Linear discriminant analysis effect size demonstrated notable differences in gut microbial abundance among the three populations. Marked differences in CAZyme abundance were also observed across the microbial communities. Future studies should incorporate diverse ecological factors to evaluate their influence on the composition and function of gut microbiota. This integrated approach, alongside detailed functional analysis of microbiota, should deepen our understanding of gut microbial dynamics in wild snakes.