Two subsequent World Radiocommunication Conferences, held in 2015 and 2019, have concluded the frequency allocation in VHF bands for the two-way maritime VHF Data Exchange System (VDES) via terrestrial and satellite radio frequency links respectively. The modernization and digital evolution of maritime communications was initiated in 1990’s by adopting Automatic Identification Systems (AIS) for ship to shore, ship to ship and shore to ship communications for a variety of applications, targeting safety at sea. The frequency allocation for VDES has been a significant step forward towards achieving the same goal by facilitating solutions for enhanced navigation, broadcasting essential information and many other emerging applications.

Cancer diagnosis using gene expression data is significant research for facilitating early treatment and prevention of cancer. The classification of gene expression data is challenging due to its high dimensionality and smaller number of samples that renders classification a difficult task. Creation of well-defined class boundaries is the aim of every classification algorithm. The Fuzzy min-max (FMM) neural network classifier is known to create good decision boundaries using hyperboxes constructed for each class. In this paper, we explore the General Fuzzy min-max (GFMM) and Enhanced Fuzzy min-max (EFMM) neural network architectures for the classification of lung cancer subtypes from microarray gene expression data. Both GFMM and EFMM are advanced versions of Simpson’s FMM neural network classifier. The GFMM is extremely efficient because it involves very simple operations for hyperbox manipulation, and can handle both labeled and unlabeled data. On the other hand, EFMM proposes three heuristic rules related to hyperbox expansion, contraction and the overlap test, which enhances the learning algorithm. We perform the classification of gene expression data using these two algorithms, then we analyze the performance by visualizing the hyperboxes obtained after training, and compare the accuracies of these classifiers. LASSO is used for selecting the important genes from the high-dimensional gene expression data. After the analysis of the results, we observe that EFMM with LASSO gives the best performance as compared to GFMM, FMM and other machine learning algorithms.

Kimura disease (KD) is a rare condition with a challenging diagnosis because it may be misdiagnosed and not differentiated from other disorders. We reported a 13-year-old patient who presented with growing neck masses and was hospitalized due to the nephrotic syndrome relapse but was eventually diagnosed with KD.

Renal nutcracker syndrome ia a rare cause of chronic pain and hematuria. A literature search was conducted through PubMed. Forty studies and our own series were included in the review, for a total of 73 individual patient cases. NCS is an uncommon cause of hematuria, flank pain, abdominal symptoms

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Heightened impulsivity and compulsivity are often found in association with both dysfunctional everyday behavior as well as with psychopathology. Impulsivity and compulsivity are also linked to alterations in behavioral response inhibition and its electrophysiological correlates. However, they are rarely examined jointly and their effect outside of clinical samples is still disputed. This study assesses the influence and interaction of impulsivity and compulsivity as measured by questionnaires on behavioral performance and event-related potentials (N2, P3a and P3b) in a visual Go/Nogo task. Data from 250 participants from the general population (49% female; age M = 25.16, SD = 5.07; education level: 94% high school or higher; self-reported lifetime diagnosis of any mental disorder: 12%) were collected. We used robust linear regression as well as regression tree analyses, a type of machine learning algorithm, to uncover potential non-linear effects. We did not find any significant relationship between the self-report measures and behavioral or neural inhibition effects in either type of analysis, with the exception of a linear effect of the premeditation scale of the UPPS on behavioral performance. The current sample size was large enough to uncover even small effects. We discuss potential explanations for this current null finding. One possibility is that inhibitory performance was unimpaired in the current sample and that associations between inhibitory performance and self-report measures might only be seen in samples with mental disorders.

RATIONALE: Obstructive sleep apnea is highly prevalent in children with asthma, particularly in obese children. The sleep related breathing disorder screening questionnaire has low screening accuracy for obstructive sleep apnea in children with asthma. Our goal was to identify the questions on the sleep related breathing disorder survey associated with obstructive sleep apnea in children with asthma. METHODS: Participants completed the survey, underwent polysomnography and their body mass index z-score was measured. Participants with survey scores above 0.33 were considered high risk for obstructive sleep apnea and those with an apnea hypopnea index ≥ 2 events/hour classified as having obstructive sleep apnea. Logistic regression was used to examine the association of each survey question and obstructive sleep apnea. Positive and negative predictive values were calculated to estimate screening accuracy. RESULTS: The prevalence of obstructive sleep apnea was 40% in our sample (n=136). Loud snoring, morning dry mouth and being overweight were the questions associated with obstructive sleep apnea. A combined model of loud snoring, morning dry mouth and being overweight had positive and negative predictive values of 57.4% and 81.0% respectively, while the composite survey score had positive and negative predictive values of 51.0% and 65.5%. Body mass index z-score had positive and negative predictive values of 76.3% and 72.2%. CONCLUSIONS: The body mass index z-score is useful for obstructive sleep apnea screening in children with asthma and should be applied routinely given its simplicity and concerns that obstructive sleep apnea may contribute to asthma morbidity.

In free-living ecological communities, organismal life histories shape interactions with their environment, which ultimately forms the basis of ecological succession. Individual animals in natural populations tend to host diverse parasite species concurrently over their lifetimes. However, the structure and dynamics of mammalian parasite communities have not been contextualized in terms of primary ecological succession, in part because few datasets track occupancy and abundance of multiple parasites in wild hosts starting at birth. Here, we studied community dynamics of twelve subtypes of protozoan microparasites (Theileria spp.) in a herd of African buffalo. We show that Theileria communities followed predictable patterns of succession underpinned by four different parasite life-history strategies. In contrast to many free-living communities, network complexity decreased with host age. Examining parasite communities through the lens of succession may better inform the effect of complex within host eco-evolutionary dynamics on infection outcomes, including parasite co-existence through the lifetime of the host.

Multijunction solar cells offer a path to very high conversion efficiency, exceeding 60% in theory. Under ideal conditions, efficiency increases monotonically with the number of junctions. In this study, we explore technical and economic mechanisms acting on tandem solar cells. We find that these mechanisms produce limitations that are the more pronounced the greater the number of junction is and, hence, limit the ideal number of junctions, as well as the corresponding efficiencies. Spectral variations induce current losses in series-connected tandem solar cells. For Denver, we find that these losses reduce achievable harvesting efficiencies to 51% for non-concentrated light, and that they restrict the ideal number of junctions to less than nine. Independently operated solar cells suffer from optical losses with similar consequences. Optical efficiencies of 99% restrict the ideal number of junctions to below ten, and reduce achievable efficiencies by more than 10%. Only architectures with a sequential cell illumination are more resilient to these losses. Restricting available materials reveals that a sufficiently low band gap for the bottom cell of 0.9 eV or below is expedient to realize high efficiencies. Economic considerations show that five junctions or less are economically ideal for most conceivable applications.

Manuscript titleInfection with male and femaleTrichuris trichiuradiagnosed in a non-epidemic areaAuthors: Masaki Inoue1, Marin Ishikawa2, Sho Tanaka1, Xinhan Zhang1, Hiromi Okada3, Takuto Miyagishima11 Department of Gastroenterology, Kushiro Rosai Hospital, Kushiro, Japan.2 Genomics Unit, Keio Cancer Center, Keio University School of Medicine, Tokyo, Japan.3 Department of Surgical Pathology, Kushiro Rosai Hospital, Kushiro, Japan.Corresponding author: Masaki Inoue, MD, PhD, Department of Gastroenterology, Kushiro Rosai Hospital, 13-23, Nakazonocho, Kushiro, Hokkaido 085-8533, Japan.Tel: +81-154-22-7191E-mail: [email protected] statement: Written informed consent was obtained from the patient to publish this report in accordance with the journal’s patient consent policy.Key words: endoscopy, Trichuris trichiura , parasite, whipwormConflict-of-interest statement: We have no financial relationships to disclose.Funding and Acknowledgement details: NoneExplanationA Burmese man in his 20s underwent colonoscopy at our hospital in Japan because of abdominal discomfort. He had come to Japan from Myanmar two years ago and had worked on a pig farm. He had had diarrhea for five months and was taking a drug for controlling intestinal function but had persistent abdominal discomfort. Blood samples showed elevated fractions of eosinophils (white blood cells 7900/μL, eosinophils 15.6%). Colonoscopy (PCF-H290ZI; Olympus, Tokyo, Japan) showed that there were four whipworms including one brown whipworm and three white whipworms in the cecum and ascending colon. The white whipworm was attached to the cecum mucosa ([Fig. 1], [Fig. 2]). The brown one was detected at the ascending colon. Magnified endoscopy and narrow band imaging showed that it had a stripe pattern and that its cranium was burrowing under the colonic mucosa ([Fig. 3]). The whipworms coiled themselves up and wound slowly in response to a stimulus. We removed all of them by using biopsy forceps. Histopathological examination revealed that the brown one was a female whipworm (Trichuris trichiura ) and the three white worms were male ([Fig. 4], [Fig. 5]). The female had a uterus with worm eggs. The egg inspection was negative. After oral administration of Mebendazole, his abdominal discomfort disappeared.T. trichiura 　infection is prevalent in tropical regions and non-epidemic in Japan. T. trichiura is thought to live for one to eight years as an adult [1]. Therefore, the worms that the patient was infected with in Myanmar could have lived for two years in Japan.T. trichiura parasitizes only humans through fecal-oral transmission. In non-epidemic areas, the frequency of endoscopic identification has been increasing due to the increasing number of immigrants from epidemic countries [2]. To prevent infection, it is important to pay attention to sanitary conditions such as soil and water sources [3].References[1] D.E. ElliotIntestinal wormsM. Feldman, L.S. Friedman, L.J. Brandt (Eds.), Sleisenger and Fordtran’s gastrointestinal and liver disease: pathophysiology/diagnosis/management (8th ed), Elsevier, Philadelphia (2006), pp. 2435-2457[2] Lorenzetti R, Campo SM, Stella F, Hassan C, Zullo A, Morini S. An unusual endoscopic finding: Trichuris trichiura . Case report and review of the literature. Dig Liver Dis. 2003 Nov;35(11):811-3. doi: 10.1016/s1590-8658(03)00455-9. PMID: 14674673.[3] Kattula D, Sarkar R, Rao Ajjampur SS, Minz S, Levecke B, Muliyil J, Kang G. Prevalence & risk factors for soil transmitted helminth infection among school children in south India. Indian J Med Res. 2014 Jan;139(1):76-82. PMID: 24604041; PMCID: PMC3994744.Figure 1A white whipworm in the cecum. Histopathological examination revealed that it was a male worm. The other two white whipworms were in the ascending colon.Figure 2A brown whipworm in the ascending colon. Histopathological examination revealed that it was a female worm.Figure 3A picture of the female worm obtained by using narrow band imaging showed that its cranium was burrowing under the colonic mucosa.Figure 4Histopathological image of a male whipworm.Figure 5Histopathological image of the female whipworm.

Purpose: While much has been written about how distributed networks address internal validity, external validity is rarely discussed. We aimed to define key terms related to external validity, discuss how they relate to distributed networks, and identify how three networks (the US Food and Drug Administration’s Sentinel System, the Canadian Network for Observational Drug Effect Studies [CNODES], and PCORnet, the National Patient Centered Clinical Research Network, initiated and supported by the Patient-Centered Outcomes Research Institute. Methods: We define external validity, target populations, target validity, generalizability, and transportability and describe how each relates to distributed networks. We then describe Sentinel, CNODES, and PCORnet and how each approaches these concepts. Results: Each network approaches external validity differently Sentinel answers regulatory questions in the general US population using data from commercial health plans and Medicare fee-for-service beneficiaries and considers external validity when exploring outliers or performing subgroup analyses to examine potential heterogeneity of treatment effects. CNODES focuses on a Canadian target population but includes UK and US data and thus has to make decisions about which partners can be included in each analysis. PCORnet supports a wider array of studies including randomized trials and often assesses whether a given study will be representative of the wider US population. Conclusions: There is no one-size-fits-all approach to external validity within distributed networks. With these networks and comparisons between their findings becoming a key part of pharmacoepidemiology, there is a need to adapt tools for improving external validity to the distributed network setting.

Background: The Micra Coverage with Evidence Development (CED) Study is a novel comparative analysis of Micra (leadless VVI) and transvenous single-chamber ventricular pacemakers (transvenous VVI) using administrative claims data. Objective: To compare chronic complications, device reinterventions, heart failure hospitalizations, and all-cause mortality after 3 years of follow-up.  Methods: U.S. Medicare claims data linked to manufacturer device registration information were used to identify Medicare beneficiaries with a de novo implant of either a Micra VR leadless VVI or transvenous VVI pacemaker from March 9, 2017-December 31, 2018. Unadjusted and propensity score overlap-weight adjusted Fine-Gray competing risk models were used to compare outcomes at 3 years.   Results: Leadless VVI patients (N=6,219) had a 32% lower rate of chronic complications and a 41% lower rate of reintervention compared with transvenous VVI patients (N=10,212) (chronic complication hazard ratio [HR] 0.68; 95% CI, 0.59-0.78; reintervention HR 0.59; 95% CI 0.44-0.78). Infections rates were significantly lower among patients with a leadless VVI (<0.2% versus 0.7%, P<0.0001). Patients with a leadless VVI also had slightly lower rates of heart failure hospitalization (HR 0.90; 95% CI 0.84-0.97). There was no difference in the adjusted 3-year all-cause mortality rate (HR 0.97; 95% CI, 0.92-1.03).  Conclusion: This nationwide comparative evaluation of leadless VVI versus transvenous VVI de novo pacemaker implants demonstrated that the leadless group had significantly fewer complications, reinterventions, heart failure hospitalizations, and infections than the transvenous group at 3 years, confirming that the previously reported shorter-term advantages associated with leadless pacing persist and continue to accrue in the medium-to-long-term.

Multisystem inflammatory syndrome in children (MIS-C) is a rare, but severe complication of coronavirus disease 2019 (COVID-19). It develops approximately four weeks after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and involves hyperinflammation with multisystem injury, commonly progressing to shock. The exact pathomechanism of MIS-C is not known, but immunological dysregulation leading to cytokine storm plays a central role. In response to the emergence of MIS-C, the European Academy of Allergy and Clinical Immunology (EAACI) established a task force (TF) within the Immunology Section in May 2021. With the use of an online Delphi process, TF formulated clinical statements regarding immunological background of MIS-C, diagnosis, treatment, follow-up, and the role of COVID-19 vaccinations. MIS-C case definition is broad, and diagnosis is made based on clinical presentation. The immunological mechanism leading to MIS-C is unclear and depends on activating multiple pathways leading to hyperinflammation. Current management of MIS-C relies on supportive care in combination with immunosuppressive and/or immunomodulatory agents. The most frequently used agents are systemic steroids and intravenous immunoglobulin. Despite good overall short-term outcome, MIS-C patients should be followed-up at regular intervals after discharge, focusing on cardiac disease, organ damage, and inflammatory activity. COVID-19 vaccination is a safe and effective measure to prevent MIS-C. In anticipation of further research, we propose a convenient and clinically practical algorithm for managing MIS-C developed by the Immunology Section of the EAACI.

The present study evaluates the influence of type 2 diabetes (T2D) on important CYP450 isoforms and P-glycoprotein (P-gp) transporter activities before and 3 months after intensifying treatment regimen of 40 patients. Results have been compared with 21 non-T2D healthy participants (control group). CYPs and P-gp activities were assessed after administration of Geneva cocktail. Mean metabolic ratios (MR) for CYP2B6 (1.81±0.93 vs. 2.68±0.87), CYP2C19 (0.420 ± 0.360 vs. 0.687 ± 0.558), and CYP3A4/5 (0.487 ± 0.226 vs. 0.633 ± 0.254) significantly decreased in T2D subjects compared to control group (p<0.05). CYP2C9 (0.089±0.037 vs. 0.069±0.017) activities slightly increased in diabetic subjects and no difference was observed for CYP1A2 (0.154±0.085 vs. 0.136±0.065), CYP2D6 (1.17 ± 0.56 vs. 1.24 ± 0.83) and P-gp activities in comparison with control group. Three months after intensifying treatment regimen, MRs of CYP2C9 (0.080 ± 0.030) and CYP3A4/5 (0.592 ± 0.268) have shown a significant improvement and were not statistically different compared to control group (P>0.05). Several covariables such as inflammatory markers (IL-1β and IL-6), genotypes, diabetes- and demographic-related factors were considered in our analyses. Our results indicate that low chronic inflammatory status associated with T2D modulates CYP450 activities in an isoform specific manner.

In this paper, we report a rare case of asymptomatic multiple intradural, extramedullary spinal hydatidosis; accidentally diagnosed in a patient with signs and symptoms of a true protruded disc. Although quite rare, vertebral hydatidosis should always be considered as a differential diagnosis for spinal presentations, particularly in endemic areas.

4-Methylbenzylidene camphor (4-MBC) is a photo-absorbing UV filter, which can be absorbed into the circulation and cause systemic effects. 4-MBC is found extensively in the environment and measurements suggest bioaccumulation in human tissues. 4-MBC is continued to be released in the environment despite the growing knowledge about its potential endocrine and reproductive disrupting effects. 4-MBC interfers with various processes, such as placental development, spermatogenesis, and inflammatory cascades. Previous reviews mention 4-MBC as one of the several UV filters but here we focus on 4-MBC only. We cover the potential effects on human health regarding systemic and molecular effects, with the focus on reproduction. We also cover the potential bioaccumulation and interactions with receptor systems, such as the estrogen receptors β and α, and progesterone receptor, and analyze 4-MBC´s effects on mRNA expression and protein expression. Furthermore, 4-MBC is reported to act with inflammatory pathways by activating p38 MAPK and NF-κB, leading to the production of inflammatory TNF-α and IL-6. In conclusion, 4-MBC has wide ranging effects in different models while there is more research warranted to detail the mechanism of action, long-term effects at low doses and the potential interaction with many pathways and other pollutants.

In this paper, an uncertain disturbance rejection control problem for the affine system in the presence of asymmetric input constraints is addressed using an event-triggered control method. The disturbance rejection control is converted to an H ∞ optimal control problem, and a Zero-sum game-based method is proposed to solve this H ∞ optimal control problem. To deal with the input constraints, a new cost function is proposed. The event-triggered controller is updated only when the triggering condition is satisfied, which can reduce the computational complexity.In order to obtain a controller that minimizes the performance index function in the worst-case disturbance, we use a critic-only network to solve the Hamilton-Jacobi-Isaacs(HJI) equation, and the critic network weight is tuned through a gradient descent method with the historical state data. The stability of the closed-loop system and the uniform ultimate boundedness of the critic network parameters are proved by the Lyapunov method. Two numerical examples are provided to verify the effectiveness of the proposed methods.

We report a case of incidental detection of severe aortic coarctation, severe secundum atrial septal defect, and bicuspid aortic valve in an active-duty military service member. A single complex minimally invasive procedure successfully corrected his coarctation and atrial septal defect allowing this patient to continue military service.