Hematological involvement in sarcoidosis is widely presented by lymphopenia and splenomegaly. However, the auto-immune hemolytic anemia associated to sarcoidosis is exceptionally reported in the literature. In this report we describe a novel observation of this situation.

The influence of pre-strain on the tensile and fatigue properties of a dual phase DP600 was studied. The material was pre-strained by uni-axial tension in rolling and transverse direction. Thereafter, specimens were cut from the deformed plates in parallel or orthogonal to pre-strain direction. It was found that pre-strain increases yield and tensile strength. Results suggested that strain path change primarily affects the elastic-plastic transition during early stage of reloading. Pre-strained specimens showed an increase in high cycle regimes as a consequence of yield strength increment, irrespective of imposed pre-straining direction. A modified stress life equation which accounts for pre-strain was proposed and showed good agreement with experimental data. Bake hardening enhanced both tensile and high cycle fatigue resistance. Walker equation was successfully fitted to account tensile mean stress. In low cycle fatigue, negligible influence of pre-strain was observed due to cyclic softening and residual stress relaxation.

Trauma or surgery to the lower limbs can cause fat from the marrow within the leg bones to enter the bloodstream and form an embolus. However, if there is cerebral involvement without any pulmonary or dermatological manifestations at diagnosis, it could delay identifying cerebral fat embolism (CFE).

Acclimations of Oreochromis mossambicus to hypersalinity were conducted with multiple rates of salinity increase and durations of exposure to determine the rate-independent maximum salinity limit and the incipient lethal salinity. Quantitative proteomics of over 3000 gill proteins simultaneously was performed to analyze molecular phenotypes associated with hypersalinity. For this purpose, a species- and tissue-specific data-independent acquisition (DIA) assay library of MSMS spectra was created. From these DIA data, protein networks representing complex molecular phenotypes associated with salinity acclimation were generated. O. mossambicus was determined to have a wide “zone of resistance” from approximately 75g/kg salinity to 120g/kg, which is tolerated for a limited period with eventual loss of organismal function. Crossing the critical threshold salinity into the zone of resistance corresponds with blood osmolality increasing beyond 400 mOsm/kg, significantly reduced body condition factor, and cessation of feeding. Gill protein networks impacted by hypersalinity include increased energy metabolism, especially upregulation of electron transport chain proteins, and regulation of specific osmoregulatory proteins. Cytoskeletal, cell adhesion, and extracellular matrix proteins are enriched in networks that are sensitive to the critical salinity threshold. Network analysis of these patterns provides deep insight into specific mechanisms of energy homeostasis during salinity stress.

Purpose: Poly-medicated patients, especially those over 65, have increased. Multiple drug use and inappropriate prescribing increase drug-drug interactions, adverse drug reactions, morbidity, and mortality. This issue was addressed with several CDSS alerts. Health professionals have not followed these systems due to their poor alert quality and incomplete databases. Methods: Recent research shows a growing interest in using Text Mining via NLP to extract drug-drug interactions from unstructured data sources to support clinical prescribing decisions. NLP text mining and machine learning classifier training for drug relation extraction were used in this process. Results: In this context, the proposed solution allows to develop an extraction system for drug-drug interactions from unstructured data sources. The system produces structured information, which can be inserted into a database that contains information acquired from three different data sources. Conclusion: The architecture outlined for the drug-drug interaction extraction system is capable of receiving unstructured text, identifying drug entities sentence by sentence, and determining whether or not there are interactions between them.

Alzheimers disease (AD) is a common neurodegenerative disease. The histopathological changes of AD include amyloid β-protein (Aβ) deposition, tau tangles, neuroinflammation and neurodegeneration. Some of the pathological changes could be shown in vivo by positron emission tomography (PET) and magnetic resonance imaging (MRI) biomarkers which play a key role in diagnosing AD. Fluorodeoxyglucose positron emission tomography (FDG-PET) can reflect and predict dysfunction. Aβ-PET was sensitive for the diagnosis of early AD but cannot distinguish the severity of AD. Tau-PET can compensate for the deficiency of Aβ-PET. Tau tangles were positively correlated with the severity of AD, and also associated with cognitive impairment. Probes targeting neuroinflammation of AD have been developed, but further study is needed to validate its effectiveness. Conventional MRI performs high tissue contrast that can show structural changes and has been routinely applied in clinical practice, such as evaluation of cerebral atrophy. Advanced MRI sequences (such as DTI、ASL、MRS、BOLD and QSM) that can provide additional information beyond structure that includes brain microstructure, blood perfusion, metabolite concentration, brain activity, connections and networks between brain regions, iron deposition, etc. The integrated PET and MR may improve the diagnostic efficiency of AD.

Currently available vaccines are safe but, potentially, any vaccine can cause an allergic reaction and albeit very rare, anaphylaxis can occur. Although its rarity, the precise diagnostic management of a suspected anaphylaxis post-vaccination is of paramount importance due to the risk of a potential serious reactions after re-exposure, while, a misdiagnosis might lead to an increase in the number of children that interrupt vaccinations resulting in an unjustifiably individual and collective risk of loss of protection against immune preventable diseases. Especially, in the light that most cases of suspected allergy to a vaccine are not effectively confirmed in up to 85% of the patients referred for an allergy evaluation and patients can continue vaccination with the same formulation and tolerance of the booster doses The patient assessment has to be done by an allergist or an immunologist expert in the vaccine field to select subjects at risk of allergic reactions and to perform the correct procedures for vaccine hypersensitivity diagnosis and management, in order to guarantee safe immunization practices. Aim of this review is to provide a practical and safe management in the clinical settings of the allergic patient which have to undergo immunization practices, both to manage children with a suspected allergic reaction to a vaccine both children with history of allergy to a vaccine component.

The conflict in Ukraine, which started when Russia invaded and violated its sovereignty, has led to the country's worst war since the annexation of Crimea in 2014. The war has resulted in a significant number of casualties, displaced millions of people, and damaged the healthcare system, which was already struggling before the conflict. The neurosurgical field, in particular, has been severely affected, with infrastructure and healthcare systems routinely demolished or interrupted in conflict zones, making fundamental medical operations unavailable to victims of armed conflict. As a result, neurosurgeons have been compelled to conduct surgeries outside of their areas of competence, in makeshift settings or under challenging conditions, with limited access to materials and equipment. The war has also severely damaged specialized neurosurgery facilities, causing a severe shortage of crucial supplies and equipment. To address the challenges facing neurosurgery care in Ukraine, it is essential to rebuild and repair the damaged neurosurgical centers and provide them with the necessary equipment and supplies to successfully administer neurosurgical treatments. Training programs for neurosurgeons and other medical specialists must also be organized to manage complex neurosurgical problems under difficult conditions.

We report a case of a postmenopausal woman presenting with lower abdominal pain and vaginal bleeding. She went through a maximal debulking surgery and the pathological biopsy revealed hepatoid carcinoma of the ovary (HCO). Immunohistochemical assay demonstrates SALL4 as an indicator to differentiate HCO from Hepatocellular carcinoma (HCC).

Background: Left bundle area branch pacing (LBBP) is a novel conduction system pacing method to achieve effective physiological pacing and an alternative to cardiac resynchronization therapy (CRT) with biventricular pacing (BVP) for patients with heart failure and reduced ejection fraction (HFrEF). Objective: To review current data comparing BVP and LBBP in patients with HFrEF and indication CRT. Methods: We searched PubMed/Medline, Web of Science, and Cochrane Library from the inception of the database to November 2022. All studies that compared LBBP with BVP in patients with HFrEF and indications of CRT were included. Two reviewers performed the study selection, data abstraction, and risk of bias assessment. We calculated risk ratios with the Mantel-Haenszel method and mean difference with inverse variance using random effect models. We assessed heterogeneity using the I 2 index, with I 2 > 50% indicating significant heterogeneity. Results: Ten studies (9 observational studies and 1 randomized controlled trial; 616 patients; 15 centers) published between 2020 and 2022 were included. We observed a shorter fluoroscopy time [mean difference (MD) 9.68, 95% CI 4.49-14.87, I 2=95%, P<0.01, minutes] as well as a shorter procedure time (MD 33.68, 95% CI 17.80-49.55, I 2=73%, P<0.01, minutes) during implantation of LBBP CRT compared to conventional BVP CRT. LBBP was shown to have a greater reduction in QRSd (MD 25.13, 95%CI 20.06-30.20, I 2= 51%, P<0.01, milliseconds) a greater left ventricular ejection fraction (LVEF) improvement (MD 5.80, 95% CI 4.81-6.78, I 2=0%, P<0.01, percentage) and a greater ventricular end-diastolic diameter (LVEDD) reduction (MD 2.11, 95% CI 0.12-4.10, I 2=18%, P=0.04, millimeter). There was a greater improvement in New York Heart Association function (NYHA) class with LBBP (MD 0.37, 95% CI 0.05-0.68, I 2=61%, P=0.02).LBBP was also associated with a lower risk of a composite of heart failure hospitalizations and all-cause mortality [Risk ratio (RR) 0.48, 95% CI 0.25-0.90, I 2=0%, p=0.02] driven by reduced heart failure hospitalizations (RR 0.39, 95% CI 0.19-0.82, I 2=0%, p=0.01). However, all-cause mortality rates were low in both groups (1.52% vs. 1.13%) and similar (RR 0.98, 95%CI 0.21-4.68, I 2=0%, p=0.87). Conclusion: Compared to BVP, LBBP is associated with, a greater improvement in LV systolic function, and a lower rate of heart failure-related hospitalization. Dedicated randomized controlled trials and larger patient populations are needed to further elucidate the long-term safety and efficacy of LBBP CRT.

In the production of biopharmaceuticals depth filters followed by sterile filters are often employed to remove residual cell debris present in the feed stream. In the back drop of a global pandemic, supply chains associated with the production of biopharmaceuticals have been constrained. These constraints have limited the available amount of depth filters for the manufacture of biologics. This has placed manufacturing facilities in a difficult position having to choose between running processes with reduced number of depth filters and risking a failed batch or the prospect of plants going into temporary shutdown until the depth filter resources are replenished. This communication describes a modeling based method that leverages manufacturing scale filtration data to predict the depth filter performance with a reduced number of filters and an increased operational flux. This method can be used to quantify the acceptable level of area reduction before which the filtration process performance is affected. This enables facilities to manage their filter inventory avoiding potential plant shutdowns and reduces the risks of negative depth filter performance.

Iliac artery injuries from gunshot wounds are very rare and lethal injuries associated with high mortality rate. Concurrent ballistic external iliac artery and bladder injuries resulting in an acute ilio-vesical shunt or fistula and discovered at the time of presentation are extremely rare.

A 2-year-old racing Thoroughbred gelding in training was presented with moderate (6/10) right hindlimb lameness unresponsive to regional anaesthesia of the right hind limb. Gamma scintigraphic examination revealed severe, focal, increased radio-pharmaceutical uptake over the dorsal aspect of the right 18th rib, which had an abnormal contour. Ultrasonographic examination of this area confirmed the presence of a complete, displaced fracture of the proximal aspect of the right 18th rib. Local infiltration with local anaesthetic around the 18th right rib (10ml cranial and 10ml caudal to the fracture site) abolished the right hindlimb lameness. A diagnosis of rib fracture causing moderate ipsilateral hindlimb lameness was made. The horse returned to walking exercise after 12 weeks of rest and was reported to be sound on the same limb 12 months after presentation. Caudal rib fractures should be considered as possible cause of hind limb lameness. Local diagnostic anaesthesia around the fracture site can aid localise the origin of lameness.

Penile self-mutilation is an infrequent form of self-harming behavior seen primarily in patients with schizophrenia spectrum disorders and rarely reported in those with major depressive disorders. We herewith present a major depression related case of penile self-mutilation successfully managed by macroscopic penile re-implantation performed 8 hours after the incident.

In this work, a modified polyurethane adhesive (PUA) was prepared to realize a convenient encapsulation strategy for lead efficient sedimentation and for attachable perovskite solar cells (PSCs). The modified PUA can completely self-healing within 45 minutes at room temperature and it has a lead ion blocking rate of 99.3% in the dripping experiment. The PUA film can directly contact with the metal electrode surface with a slight efficiency improvement from 23.96% to 24.15%. The thermal stability of 65℃ and humidity stability of 55% RH is superior to the encapsulated devices with polyisobutylene. The PUA film has strong adhesion to flexible substrate, and the initial efficiency of flexible perovskite module (17.2%) encapsulated by PUA remains 92.6% within 1825 h. These results suggest PUA encapsulation route is universal for rigid and flexible PSCs with enhanced stability and low lead hazardous. Moreover, it was found that the flexible PSCs can be well attached to varied substrates with PUA, providing a facile route for the attachable PSCs in various scenarios without additional encapsulation and installation.

Capillary Refill Time (CRT) assesses peripheral perfusion in resource-limited settings. However, the repeatability and reproducibility of CRT measurements are limited for individuals with darker skin. This paper presents quantitative CRT measurements demonstrating good performance and repeatability across all Fitzpatrick skin phototypes. The study involved 22 volunteers and utilized controlled compression at 7 kPa, an RGB video camera, and cocircular polarized white LED light. CRT was determined by calculating the time constant of an exponential regression applied to the mean pixel intensity of the green (G) channel. An adaptive algorithm identifies the optimal regression region for noise reduction, and flags inappropriate readings. The results indicate that 80% of the CRT readings fell within a 20% range of the expected CRT value. The repetition standard deviation was 17%. These findings suggest the potential for developing reliable and reproducible quantitative CRT methods for robust measurements in patient triage, monitoring, and telehealth applications.

For patients with acute ischemic stroke, histological quantification of thrombus composition provides evidence for determining appropriate treatment. However, the traditional manual segmentation of stained thrombi is laborious and inconsistent. In this study, we propose a label-free method that combines optical diffraction tomography (ODT) and deep learning (DL) to automate the histological quantification process. The DL model classifies ODT image patches with 95% accuracy, and the collective prediction generates a whole-slide map of red blood cells and fibrin. The resulting whole-slide composition displays an average error of 1.1% and does not experience staining variability, facilitating faster analysis with reduced labor. The present approach will enable rapid and quantitative evaluation of blood clot composition, expediting the preclinical research and diagnosis of cardiovascular diseases.

Global warming has been affecting human health, including direct mortality and morbidity from extreme heat, storms, drought and indirect infectious diseases. It is not only “global” but extremely “personal” – it is a matter of life and death for many of us. In this perspective, we propose the use of wearable technologies for localized personal thermoregulation as an innovative method to reduce the impact on health and enable wider adaptability to extreme thermal environments. The start-to-art thermoregulation methods and wearable sensing technology are summarized. In addition, the feasibility of thermoregulation technology in preventive medicine for promoting health under climate change is comprehensively discussed. Further, we provided an outlook on health-oriented closed loop that can be achieved based on parallel thermoregulation and multiple data inputs from the physiological, environmental, and psychological cues, which could promote individuals and the public to better adapt to global warming.