Cutaneous polyarteritis nodosa is a rare neutrophilic vasculitis. We present two cases that reflect the gamut of this disorder including one case whose delayed diagnosis led to permanent nerve deficit and scarring.

Sternal fractures are commonly due to blunt force trauma and reduction is an invasive surgical procedure typically indicated for refractory pain sternal instability. Retrospective literature. There were various modalities used for treatment and fixation of the sternal fractures.Sternal displacement fractures are traumatic injuries that may require surgical correction.

A 58-year-old woman had gastric cancer treated with nivolumab. Her serum creatinine (Cr) increased to 5.94 mg/dL post two cycles of nivolumab and co-administered with acemetacin. A kidney biopsy showed acute tubular injury (ATI).

Introduction: Congenital diaphragmatic hernia (CDH) is known with high mortality rates and significant pulmonary morbidities. The objective of this study was to describe the histopathological findings of necropsy and clinical manifestations in CDH patients to find the clinicopathological correlations. Methods: We reviewed the postmortem findings with associated clinical characteristics retrospectively in 8 CDH cases from 2017 to2022 July. Results: Of the eight cases, one was bilateral congenital eventration diagnosed by autopsy. Severe pulmonary hypertension with a right to left shunting of large patent ductus arteriosus (PDA) obtained from echocardiogram were most common. And the average time of survive was 46 (8-624) h. According to the autopsy reports, the major pathological lung changes were diffuse alveolar damages (congestion and hemorrhage) and hyaline membrane formation. Notably, although the lung volume was significantly reduced, pulmonary structural dysplasia was not observed at all, presented normal lung development (50%); bilateral (25%) or ipsilateral (25%). Lobulated deformities were accompanied in three (37.5%) cases. All patients exhibited large PDA and a patent foramen ovale with increased right ventricle (RV) volume, and the myocardial fibers were slightly congested and swollen. Pulmonary vessels showed mild to moderate arterial media thickening. Lung hypoplasia and diffuse lung damages reduced gas exchange, meanwhile the PDA and PH caused RV failure, contributed a clinical picture of organ dysfunction, which lead to death. Conclusions: Pulmonary structures have certain heterogeneity in CDH. The arteries’ pathological changes are not consistent with clinical diagnosis. And the adverse outcome may should be due to the cardiopulmonary vicious cycle.

The current system for disclosing financial conflicts of interest (COIs) can be traced back to the “Uniform requirements for manuscripts submitted to medical journals,” published in 1997. Meanwhile, new molecular and genetic therapies are transforming clinical medicine and these therapies have radically altered the financial landscape of drug development. The average price of new drugs has risen sharply, and in niche areas like rare diseases, the cost of new therapies can be stratospheric. Now, even rare or “orphan” diseases are funded by private investment. With high profitability, there is a new pathway for drug development involving unprecedented ties between industry and academia. The potential for COIs has greatly expanded and decisions that were once science-driven have become profit-driven. As a result, the risk that marginally effective, ineffective and even hazardous treatments will make their way to patients has greatly increased. In this editorial, we propose a system built on process-based COIs. This new system would trace the developmental journey of a drug from the lab to patients. All financial ties that institutions and individuals have to the drug would be disclosed at each developmental step. The goal would be to create a healthy skepticism and debate over the studies behind new drugs, restoring a scientific focus to the assessment of drug efficacy. When society’s limited resources are used to pay for drugs whose excessive cost primarily benefits investors and corporations, it derails scientific objectivity, harms patients, and threatens the financial stability of our health care systems.

Addressing the recognised challenges and inequalities in providing high quality health care for rare diseases such as children’s interstitial lung disease (chILD) requires collaboration across institutional, geographical, discipline, and system boundaries. The Children’s Interstitial Lung Disease Respiratory Network of Australia and New Zealand (chILDRANZ) is an example of a clinical network that brings together multidisciplinary health professionals for collaboration, peer learning, and advocacy with the goal of improving the diagnosis and management of this group of rare and ultra-rare conditions. This narrative review explores the multifaceted benefits arising from social learning spaces within rare disease clinical networks by applying the Value Creation Framework. The operation of the chILDRANZ network is used as an example across the framework to highlight how value is generated, realised, and transferred within such collaborative clinical and research networks. The community of clinical practice formed in the chILDRANZ multidisciplinary clinical peer support meetings provides a strong example of social learning that engages with the uncertainty inherent in rare disease diagnosis and management and pays attention to generate new knowledge and best practice to make a difference for children and families living with chILD. This review underscores international calls for further investment in, and support of, collaborative expert clinical networks for rare disease.

To describe treatment using aligners in an adult female patient with dental class II malocclusion associated with crowding. Treatment objectives were achieved in 10 months with patient satisfaction. Combining aligners with appropriate attachment location, geometry and staging are efficacious means of resolving class II malocclusion.

Lifespan is a key attribute of a species’ life cycle and varies extensively among major lineages of animals. In fish, lifespan varies by several orders of magnitude, with reported values ranging from less than one year to approximately 400 years. Lifespan information is particularly useful for species management, as it can be used to estimate invasion potential, extinction risk and sustainable harvest rates. Despite its utility, lifespan is unknown for most fish species. This is due to the difficulties associated with accurately identifying the oldest individual(s) of a given species, and/or deriving lifespan estimates that are representative for an entire species. Recently it has been shown that CpG density in gene promoter regions can be used to predict lifespan in mammals and other vertebrates, with variable accuracy across taxa. To improve accuracy of lifespan prediction in a non-mammalian vertebrate, here we develop a fish-specific genomic lifespan predictor. Addressing previous issues of low sample size and sequence dissimilarity, we incorporate more than eight times the number of fish species used previously (n = 442) and use fish-specific gene promoters as reference sequences. Our model predicts fish lifespan from genomic CpG density alone (measured as CpG observed/expected ratio), explaining 64 % of the variance between known and predicted lifespans. The results demonstrate the value of promoter CpG density as a universal predictor of fish lifespan that can applied where empirical data are unavailable, or impracticable to obtain.

Soil protists are increasingly studied due to a release from previous methodological constraints and the acknowledgement of their immense diversity and functional importance in ecosystems. However, these studies often lack a sufficient depth in knowledge, which is visible in the form of falsely used terms and false- or over-interpreted data with conclusions that cannot be drawn from the data obtained. As we welcome that also non-experts include protists in their still mostly bacterial and/or fungal focused studies, our aim here is to help avoid some common errors. We provide an overview of current terms to be used when working on soil protists, like protist instead of protozoa, predator instead of grazer, microorganisms rather than microflora and terms to be used to describe the prey spectrum of protists. We then highlight some do’s and don’ts in soil protist ecology including challenges related to interpreting 18S rRNA gene amplicon sequencing data. We caution against the use of standard bioinformatic settings optimized for bacteria and the uncritical reliance on incomplete and partly erroneous reference databases. We also show why causal inferences cannot be drawn from sequence-based correlation analyses or any sampling/monitoring, study in the field without thorough experimental confirmation and sound understanding of the biology of taxa. Together, we envision this work to help non-experts to more easily include protists in their soil ecology analyses, and obtain more reliable interpretations from their protist data and other biodiversity data that, in the end, will help to better understand soil ecology.

The rise of sedimentary ancient DNA (sedaDNA) studies has opened up new possibilities for studying pre-historic ecology. The use of sediments to identify organisms even where macroscopic remains are limited or no longer exist is an exciting and potentially ground-breaking area of genomics. There are special considerations however when managing this substrate in Indigenous Australian contexts. Sediments and soils are often considered as waste by-products during archaeological and paleontological excavations, and as such are not typically considered of high value in ethical considerations in traditional western research. Nevertheless, the product of sedaDNA work – genetic information from past fauna, flora, microbial communities, and human ancestors – is likely to be of cultural value for Indigenous peoples. We argue that the integration of Traditional Knowledges into sedaDNA research would a) allow identification of sensitive, secret, or sacred genomic data, and b) improve research outcomes by providing ecological context for species through multi-millennia oral histories.

Long-term operation of autonomous robots creates new challenges to the Simultaneous Localization and Mapping (SLAM). Varying conditions of the vehicle’s surroundings, such as appearance variations (lighting, daytime, weather, or seasonal) or reconfigurations of the environment, are a challenge for SLAM algorithms to adapt to new changes while preserving old states. When also operating for long periods and trajectory lengths, the map should readjust to environment changes but not grow indefinitely, where the map size should be dependent only on the explored environment area. Long-term SLAM intends to overcome the challenges associated with lifelong autonomy and improve the robustness of autonomous systems. Although several studies review SLAM algorithms, none of them focus on lifelong autonomy. Thus, this paper presents a systematic literature review on long-term localization and mapping following the Preferred Reporting Items for Systematic reviews and Meta-Analysis (PRISMA) guidelines. The review analyzes 142 works covering appearance invariance, modeling the environment dynamics, map size management, multi-session, and computational issues including parallel computing and timming efficiency. The analysis also focus on the experimental data and evaluation metrics commonly used to assess long-term autonomy. Moreover, an overview over the bibliographic data of the 142 records provides analysis in terms of keywords and authorship co-occurrence to identify the terms more used in long-term SLAM and research networks between authors, respectively. Future studies can update this paper thanks to the systematic methodology presented in the review and the public GitHub repository with all the documentation and scripts used during the review process.

Conservative flowering behaviors, such as flowering during long days in summer or late flowering at a high leaf number, are often proposed to protect against variable winter and spring temperatures which lead to frost damage if premature flowering occurs. Yet, due the many factors in natural environments relative to the number of individuals compared, assessing which climate characteristics drive these flowering traits has been difficult. We applied a multidisciplinary approach to ten winter-annual Arabidopsis thaliana populations originating along a wide climactic gradient in Norway. We used a variable reduction strategy to assess which of 100 climate descriptors from their home sites correlated most to their behaviors when grown in common garden and assessed sequence variation of 19 known environmental-response flowering genes. Photoperiod sensitivity inversely correlated with interannual variation in timing of growing season onset (start of favorable spring temperatures). Time to flowering appeared driven by growing season length, curtailed by cold fall temperatures. The distribution of FLM, TFL2, and HOS1 haplotypes, genes involved in ambient temperature response, correlated with growing-season climate. We show that long-day sensitivity and late flowering may be driven not by risk of spring frosts, but by growing season temperature and length perhaps to opportunistically maximize growth.

Background Persons experiencing homelessness face increased risk of influenza as overcrowding in congregate shelters can facilitate influenza virus spread. Data regarding on-site influenza testing and antiviral treatment within homeless shelters remains limited. Methods We conducted a cluster-randomized stepped-wedge trial of point-of-care molecular influenza testing coupled with antiviral treatment with baloxavir or oseltamivir in residents of 14 homeless shelters in Seattle, WA, USA. Residents ≥3 months with cough or ≥2 acute respiratory illness (ARI) symptoms and onset <7 days were eligible. In control periods, mid-nasal swabs were tested for influenza by RT-PCR. The intervention period included on-site rapid molecular influenza testing and antiviral treatment for influenza-positives if symptom onset was <48 hours. The primary endpoint was monthly influenza virus infections in the control versus intervention period. Influenza whole genome sequencing was performed to assess transmission and antiviral resistance. Results During 11/15/2019–4/30/2020, and 11/2/2020–4/30/2021, 1,283 ARI encounters from 668 participants were observed. Influenza virus was detected in 51 (4%) specimens using RT-PCR, (A=14; B=37); 21 influenza virus infections were detected from 269 (8%) of intervention-eligible encounters by rapid molecular testing and received antiviral treatment. 37% of ARI-participant encounters reported symptom onset <48 hours. The intervention had no effect on influenza virus transmission (adjusted relative risk 1.73, 95% CI 0.50–6.00). Of 23 influenza genomes, 86% of A(H1N1)pdm09 and 81% of B/Victoria sequences were closely related. Conclusion Our findings suggest feasibility of influenza test-and-treat strategies in shelters. Additional studies would help discern an intervention effect during periods of increased influenza activity

Background We explored whether hospital-based surveillance is useful in detecting severe acute respiratory infection (SARI) clusters and how often these events result in outbreak investigation and community mitigation. Methods During May 2009– December 2020, physicians at 14 sentinel hospitals prospectively identified SARI clusters (i.e., ≥2 SARI cases who developed symptoms ≤10 days of each other and lived <30 minute walk or <3 km from each other). Oropharyngeal and nasopharyngeal swabs were tested for influenza and other respiratory viruses by rRT-PCR. We describe the demographic of persons within clusters, laboratory results, and outbreak investigations. Results Physicians identified 464 clusters comprising 1,427 SARI cases (range 0–13 clusters per month). Sixty percent of clusters had three, 23% had 2, and 17% had ≥4 cases. Their median age was 2 years (interquartile [IQR] 0.4–25) and 63% were male. Laboratory results were available for the 464 clusters a median 9 days (IQR = 6–13 days) after cluster identification. Less than one in five clusters had cases that tested positive for the same virus: RSV in 58 (13%), influenza viruses in 24 (5%), HMPV in 5 (1%), HPIV in 3 (0.6%), adenovirus in 2 (0.4%). While 102/464 (22%) had poultry exposure, none tested positive for influenza A(H5N1) or A(H7N9). None of the 464 clusters led to field deployments for outbreak response. Conclusions For 11 years, none of the hundreds of identified clusters led to emergency response. The value of this event-based surveillance might be improved by seeking larger clusters, with stronger epidemiologic ties or decedents.

Hepatic arteriovenous malformation mostly occurs as a manifestation of hereditary hemorrhagic telangiectasia. Clinical symptoms include hyperpulsatile heart failure, hepatic encephalopathy, and ascites. We present a case of hepatic arteriovenous malformation and atrial septal defect causing heart failure.

Primary effusion lymphoma (PEL) is a rare non-Hodgkin lymphoma confined exclusively to body cavities without detectable tumor masses. The term PEL-like is an entity similar to PEL in clinical presentation but without relation to human herpesvirus 8 (HHV8). We report a case of HHV8- and EBV-negative primary effusion-based lymphoma.

Host-parasite interactions can cause strong demographic fluctuations accompanied by selective sweeps of resistance/infectivity alleles. Both demographic bottlenecks and frequent sweeps are expected to reduce the amount of segregating genetic variation and therefore might constrain adaption during coevolution. Recent studies, however, suggest that the interaction of demographic and selective processes is a key component of coevolutionary dynamics and may rather positively affect levels of genetic diversity available for adaptation. Here, we provide direct experimental testing of this hypothesis by disentangling the effect of demography, selection, and of their interaction in an experimental host-parasite system. We grew 12 populations of unicellular algae (Chlorella variabilis) that experienced either growth followed by constant population sizes (3 populations), demographic fluctuations (3 populations), selection induced by exposure to a virus (3 populations), or demographic fluctuations together with virus-induced selection (3 populations). After 50 days, we conducted whole-genome sequencing of each algal population. We observed more genetic diversity in populations that jointly experienced selection and demographic fluctuations than in populations where these processes were experimentally separated. In addition, in those 3 populations that jointly experienced selection and demographic fluctuations, experimentally measured diversity exceeds expected values of diversity that account for the cultures’ population sizes. Our results suggest that eco-evolutionary feedbacks can positively affect genetic diversity and provide the necessary empirical measures to guide further improvements of theoretical models of adaptation during host-parasite coevolution.

Multiple approaches in recent years have been implemented to address the persistent shortage of heart donors, including a recent modification of UNOS heart allocation system, expanding donor acceptance criteria, and adoption of novel techniques to utilize hearts from donors with circulatory death. The opioid epidemic has resulted in an exponential increase in deaths in the United States in recent years, particularly affecting younger adults. A recent analysis of UNOS database by Jenser et al. reveals a relative underutilization of heart donors with cardiovascular mechanism of brain death which provide similar long-term survival as donors with other mechanisms of brain death, highlighting the potential role of these donors to provide life saving cardiac allografts and mitigate the persistent shortage of hearts for transplantation.