Key Points • CRP reduction at day five of more than 35% from the previous highest concentration post-laryngectomy or laryngopharyngectomy has been proposed to positively predict healing without pharyngocutaneous fistula • Retrospective cohort analysis of 163 patients has not been able to externally validate these findings. • ROC curves and subset analyses have not identified alternative parameters to reach significance • However, there is a non-significant association with decreasing postoperative CRP and healing without fistula. • Multicentre prospective studies to include post-operative procalcitonin could help refine this protocol further.

Introduction Recent guidelines suggest obstructive sleep apnoea (OSA) is not an absolute contraindication for same day discharge following surgery. The aim of this systematic review was to examine the feasibility and safety of day case nasal and/or palatopharyngeal surgery in patients with OSA. Methods We performed a systematic search of PubMed, EMBASE and the Cochrane library. Quality assessment of included studies was done. The protocol of this systematic review was registered with PROSPERO (CRD42021273451). Results A total of 1836 patients from ten observational studies were included. There were 268 (15.4%) nasal surgeries, 738 palatopharyngeal surgeries (42.4%) and 735 (42.2%) combined nasal and palatopharyngeal surgery. The majority of patients had moderate to severe OSA. A total of 860 patients (49.8%) were successfully discharged as day cases. There were no standard criteria for daycase surgery. Post-anaesthetic respiratory events were reported in 86/1750 (4.9%) patients. Oxygen desaturation was the most common respiratory event (83.7%, n = 72). There was no mortality reported. Conclusion Current data suggests day surgery is feasible in carefully selected patients with OSA undergoing nasal and/or palatopharyngeal surgery. Further well-designed prospective studies with an emphasis on the systematic assessment of complications are required to establish safety and daycase criteria.

Neonatal lupus erythematosus (NLE) is a rare autoimmune disease due to a passive transfer of maternal autoantibodies to the fetus. Clinical spectrum is variable and includes skin lesions, cardiac, hematological, or hepatobiliary disorders. We report a NLE case presenting with skin eruption that was initially considered as tinea.

We report a unique case of self-healing collodion baby (CB) that was successfully managed despite the risk of potentially serious complications. Self-healing CB is a rare and distinct outcome of collodion phenotype occurring in approximately 10% of the cases. The outcome depends on the initial assessment and adequate multidisciplinary approach.

Abiotic and biotic factors structure species assembly in ecosystems both horizontally and vertically. However, the way community composition changes along comparable horizontal and vertical distances in complex three-dimensional habitats, and the factors driving these patterns, remain poorly understood. By sampling ant assemblages at comparable vertical and horizontal spatial scales in a tropical rain forest, we compared observed patterns with those predicted according to environmental filtering by microclimate and microhabitat structure. We found that although dissimilarity between ant assemblages increased with vertical distance, the dissimilarity was higher horizontally but was independent of distance. The pronounced horizontal and vertical structuring of ant assemblages across short distances is likely explained by a combination of microclimate and microhabitat connectivity. Our results demonstrate the importance of considering three-dimensional spatial variation in local assemblages and reveal how highly diverse communities can be supported by complex habitats.

A 60-year-old woman with bilateral superficial femoral artery occlusion underwent femoral-popliteal bypass surgery. Six months later, left vascular prosthesis occlusion occurred; 1.5 years later, an occlusive embolus developed in the deep femoral artery. The proximal prosthesis aspect was detached from the native vessel. The limb was salvaged with bypass surgery.

We present a rare case of 45-year-old man with complaints of abdominal pain and features suggestive of intestinal obstruction. CT scan of the abdomen demonstrated a large mesenteric mass in the pelvic region involving the distal segment of jejunum. Surgical excision of the lesion and histo-pathological examination confirmed cavernous hemangioma.

Mucoepidermoid Carcinoma (MEC) it can origin from a mandibular odontogenic cyst. We report the case of a 63-year-old man with MEC of the right retromolar trigonum of the mandibula. We performed a wide mandibular excision and immediate reconstruction with a fibula bone free flap.

The incidence of new-onset seizures, which we defined as de novo seizures occurring within four weeks of receiving any of the FDA-approved Covid 19 vaccinations as reported in patient-reported data compiled in the US Centers for Disease Control and Prevention Vaccine Adverse Events Reporting System Data (CDC VAERS) has not been explored. The VAERS database contains de-identified patient-reported adverse events following vaccinations and represents post-marketing surveillance and analysis of vaccine safety. After adjusting for time at risk, this resulted in estimated incidence rates of 3.19 seizures per 100,000 persons per year for either Pfizer, Moderna or Janssen vaccines and 0.090 seizures per 100,000 persons per year for the influenza vaccine. A data-driven, individualized dataset that is comprehensive and coupled with a longitudinal follow-up in larger numbers of vaccinated individuals is needed to expand on our preliminary findings of vaccine-related seizures. The VAERS database helps in the identification of a safety signal detection and is fundamentally a hypothesis-generating system; the data or results cannot be used to analyze cause and effect.

In this paper, we make an effort to establish Lieb's and Lions' type theorems on Heisenberg Group, and then apply them to study the existence of solution for variational problem on Heisenberg group.

Aim A parent-metabolite population pharmacokinetic (popPK) model of iberdomide was developed and the influence of demographic and disease-related covariates on popPK parameters was assessed based on data from three clinical studies of iberdomide (dose range, 0.1 to 6 mg) in healthy subjects (N=81) and subjects with relapsed and refractory multiple myeloma (N=245). Methods Nonlinear mixed effects modeling was used to develop the popPK model based on data from 326 subjects across 3 clinical studies. Results The pharmacokinetics (PK) of iberdomide were adequately described with a two-compartment model with first-order absorption and elimination. A first order conversion rate was used to link the one-compartment linear elimination metabolite model with the parent model. Subject type (multiple myeloma subjects vs. healthy subject) was a statistically significant covariate on apparent clearance (CL/F) and apparent volume of distribution for the central compartment (V1/F), suggesting different PK between subjects with multiple myeloma and healthy subjects. Aspartate aminotransferase (AST), alkaline phosphatase (ALP) and sex were statistically but not clinically relevant covariates on CL/F. Metabolite (M12) PK tracked the PK of iberdomide. The metabolite to parent ratio was consistent across doses and combinations. Conclusion In conclusion, the parent-metabolite population pharmacokinetic model adequately described the time course PK data of iberdomide and M12. Iberdomide and M12 show robust PK exposure, not complicated by demographic factors, combination, hepatic or (mild and moderate) renal impairments. The model can be used to guide the dosing strategy for special patient population and inform future iberdomide study design.

Primary renal osteosarcoma is exceedingly rare tumor with poor prognosis. It has tendency to spread to distant sites . we report the case of a 43-year-old female who presented with flank pain, gross hematuria, weakness and weight loss and was treated with diagnosis of primary renal osteogenic sarcoma

Metastatic intrathyroid thymic carcinoma (ITTC) is a rare cancer that has no effective drugs. Herein, we report that comprehensive cancer mutation analysis revealed amplification of CD274 gene encoding PD-L1. Multiplex immunohistochemistry also clarified the presence of an immunosuppressive microenvironment via a PD-1/PD-L1 pathway in metastatic ITTC.

Understanding the extent to which predators engage in active search for prey versus incidentally encountering them is important because active search can exert a stabilizing force on prey populations by alleviating predation pressure on low-density prey and increasing it for high-density prey. Parturition of many large herbivores occurs during a short and predictable temporal window in which young are highly vulnerable to predation. Our study aims to determine how a suite of carnivores responds to the seasonal pulse of newborn ungulates using contemporaneous GPS locations of four species of predators and two species of prey. We used step-selection functions to assess whether coyotes, cougars, black bears, and bobcats actively searched for parturient females in a low-density population of mule deer and a high-density population of elk. We then assessed whether searching carnivores shifted their habitat use toward areas exhibiting a high probability of encountering neonates. None of the four carnivore species encountered parturient mule deer more often than expected by chance suggesting that predation of young resulted from incidental encounters. By contrast, we determined that cougar and male bear movements positioned them in proximity of parturient elk more often than expected by chance which is evidence of searching behavior. Although both male bears and cougars searched for neonates, only male bears used elk parturition habitat in a way that dynamically tracked the phenology of the elk birth pulse suggesting that maximizing encounters with juvenile elk was a motivation when selecting resources. Our results support the existence of a stabilizing mechanism to prey populations through active search behavior by predators because carnivores in our study searched for the high-density prey species (elk) but ignored the low-density species (mule deer). We conclude that prey density must be high enough to warrant active search, and that there is high interspecific and intersexual variability in foraging strategies among large mammalian predators and their prey.

Background and Purpose: Astrocytic nuclear factor erythroid-derived 2-related factor 2 (Nrf2) is a potential therapeutic target of ischemic preconditioning (IPC). Icariside Ⅱ (ICS Ⅱ) is a naturally occurring flavonoid derived from Herba Epimedii with Nrf2 induction potency. This study was designed to clarify whether ICS Ⅱ simulates IPC neuroprotection and to decipher if the astrocytic-Nrf2 is contributed to ICS Ⅱ preconditioning against ischemic stroke. Experimental Approach: Mice with transient middle cerebral artery occlusion (MCAO)-induced focal cerebral ischemia and oxygen-glucose deprivation (OGD)-injured primary astrocytes were used to explore the neuroprotective of ICS Ⅱ preconditioning. Additionally, Nrf2-deficient mice were pretreated with ICS Ⅱ to determine whether ICS Ⅱ exerts its neuroprotection by activating Nrf2. Key results: ICS Ⅱ pre-treatment dramatically mitigated the cerebral injury in ischemic stroke mice along with restoring long-term recovery. Furthermore, proteomics screening identified Nrf2 is a crucial gene evoked by ICS Ⅱ stimulation and is required for the anti-oxidative effect and anti-inflammatory effect of ICS Ⅱ. Most interestingly, ICS Ⅱ directly bound with Nrf2 and reinforced the transcriptional activity of Nrf2 after MCAO. Moreover, ICS Ⅱ pre-treatment exerted cytoprotective effect on astrocytes after lethal oxygen-glucose deprivation insult via promoting Nrf2 nuclear translocation and mediating OXPHOS/NF-κB/ferroptosis axis. While, abrogated neuroprotection in Nrf2-deficient mice and astrocyte potently supports Nrf2-dependent neuroprotection of ICS Ⅱ. Conclusions and implications: ICS Ⅱ preconditioning confers robust neuroprotection against ischemic stroke via astrocytic Nrf2-mediated OXPHOS/NF-κB/ferroptosis axis, it is concluded that ICS Ⅱ will be serve as a promising Nrf2 activator to rescue ischemic stroke.

Complete agenesis of the permanent canines in the maxilla and the mandible is extremely rare and has only been reported twice. Studies have shown that the incidence of missing canines is more in females. This report describes a sporadic case of congenital absence of maxillary (bilateral) and mandibular (bilateral) canines.

The subfamily Typhlocybinae is a ubiquitous, highly diverse group of mostly tiny, delicate leafhoppers. The tribal classification has long been controversial and phylogenetic methods have only recently begun to test the phylogenetic status and relationships of tribes. To shed light on the evolution of Typhlocybinae, we performed phylogenetic analyses based on 28 newly sequenced and 19 previously sequenced mitochondrial genomes representing all currently recognized tribes. The results support the monophyly of the subfamily and its sister group relationship to Mileewinae. The tribe Zyginellini is polyphyletic with some included genera derived independently within Typhlocybini. Ancestral character state reconstruction suggests that some morphological characters traditionally considered important for diagnosing tribes (presence/absence of ocelli, development of hind wing submarginal vein) are homoplastic. Divergence time estimates indicate that the subfamily arose during the Middle Cretaceous and that the extant tribes arose during the Late Cretaceous. Phylogenetic results support establishment of a new genus, Subtilissimia Yan & Yang gen. nov., with two new species, Subtilissimia fulva Yan & Yang sp. nov. and Subtilissimia pellicula Yan & Yang sp. nov. (Typhlocybinae: Typhlocybini); but indicate that two previously recognized species of Farynala distinguished only by the direction of curvature of the processes of the aedeagus are synonyms, i.e., Farynala dextra Yan & Yang, 2017 equals Farynala sinistra Yan & Yang, 2017 syn. nov. A key to tribes of Typhlocybinae is provided.

Introduction Anomalous aortic origin of coronary artery (AAOCA) is the second leading cause of sudden cardiac death in children and young adults. Intramural-interarterial course is the most frequent anatomic variation and coronary unroofing is widest adopted for surgical management. Symptoms recurrence is described regardless of the technique used. This study aims to describe how an anatomic patient-centered approach aimed to restore a normal coronary artery take-off is associated with symptoms resolution. Methods From 2008 to 2021, 25 patients were operated on for an AAOCA at a median age of 20 years. Nineteen patients had a right AAOCA and six had left AAOCA. Intramural course was present in 18 patients. Seventy-six percent were symptomatic. No episodes of aborted sudden cardiac death before surgery was described in the population. Surgical technique used were coronary unroofing in 18 patients, coronary neo-ostioplasty in 3, coronary re-implantation in 3 and main pulmonary artery re-location in one. Results No hospital mortality or re-operation was observed in our experience as well as major complications related to surgery. Mean hospital length of stay was 8.5 days. None of patients reported symptoms recurrence at follow-up. Young athletes returned to play competitive sport. Postoperative computed-tomography scan evaluation showed a general improvement of the take-off angle. Conclusions AAOCA requires a patient anatomic-based surgical management. There is not a single surgical technique that can fits all anatomic subtype of AAOCA. Surgical techniques may be selected on the base of the preoperative images and intraoperative findings. In our experience this policy is associated with no symptoms recurrence.