Staphylococcus haemolyticus is an opportunistic human pathogenic bacterium, which constitutes the major part of human skin microflora. This bacterium showed resistance to most of the antibiotics, spread widely in hospitals and cause various infections in human beings. This bacterium has been reported from infected humans, animals and some insects, whereas, this is the first report of Staphylococcus haemolyticus from the scarabaeids in the world. The gut microbiota of white grubs helps in the digestion and assimilation of food such as cellulose, hemicellulose and pectin degradation by producing various enzymes. We have isolated 11 cellulolytic bacteria from the gut of Brahmina coriacea (Hope) grubs, which were collected from different locations of north-western Himalayas. S. haemolyticus was only reported from the grubs of Nauni, Solan region of Himachal Pradesh, India and identified by using 16S rRNA gene sequencing analysis. S. haemolyticus was able to degrade the cellulose in Carboxy Methyl cellulose (CMC) media. This bacterium can be used in industries for the management of agro-wastes, in pulp and paper industry and in biofuel production.

The study of segmenting breast lesions from ultrasound images is crucial to breast cancer diagnosis and treatment. In this study, we propose the Inception-Multi-Scale-Attention U-Net (IMSA-Net) method to address the challenges associated with breast cancer imaging artifacts, tumor morphological alterations, and blurred borders. The IMSA-Net method incorporates the inception module into the downsampling feature extraction section of the U-Net model. This can extract advanced features from the input image and enhance the model’s capability to express complex features. Furthermore, during the feature fusion stage, a multi-scale attention structure is introduced to focus on capturing detailed information during the segmentation process. This enhancement contributes to improving the precision of the segmentation results. To enhance the algorithm’s non-linear factor and mitigate the gradient disappearance problem during training, the Gaussian Error Linear Unit (GELU) activation function is employed, replacing the traditional Rectified Linear Unit (ReLU) activation function. This modification allows for better feature representation and overall model performance. The experimental results demonstrate that the IMSA-Net model’s evaluation metrics of mIoU, Dice, Acc, Precision, and Recall on the breast ultrasound images dataset reached 74.18%, 77.98%, 96.86%, 89.23%, and 66.68%, respectively. These results outperform those of the U-Net model by 2.41%, 2.81%, 0.09%, 0.06%, and 2.82%. Overall, the IMSA-Net method tackles the difficulties related to breast lesion segmentation, assisting in subsequent breast disease diagnosis.

n/a per BJOG Research Letter submission guidelines. + happy to submit an abstract if needed. https://obgyn.onlinelibrary.wiley.com/hub/journal/14710528/preparing-your-manuscripts

Background: 6-Mercaptopurine is a cornerstone of maintenance therapy for pediatric ALL. Response to 6MP is typically determined by the ANC. Therapeutic ANC range while receiving 6MP is between 500-1,500/µL. In addition to desired myelosuppression, 6MP is associated with multiple adverse drug effects. Increased doses of 6MP can lead to therapeutic ANC values; however, patients may experience adverse effects before obtaining therapeutic myelosuppression, often deemed “skewed metabolism.” Allopurinol may potentially correct skewed 6MP metabolism. Procedure: Pediatric patients with ALL with 6MMP and 6TGN metabolites drawn during maintenance therapy were analyzed for allopurinol use. The primary outcome evaluated the percentage of time spent in therapeutic ANC range before and after allopurinol initiation. Additionally, the difference in 6MMP:6TGN ratios before and after allopurinol initiation, incidence of hepatotoxicity, and rates of relapse, were analyzed. Results: Ninety-five patients were included for analysis. Thirty-two (34%) patients received allopurinol. There were no significant differences in baseline demographics between the patients who received allopurinol and those who did not. When comparing ANC values pre- and post- allopurinol initiation, a statistically significant increase in the percentage of time spent in therapeutic range was observed (27% vs. 43%; P=0.03). Additionally, when comparing metabolite ratios pre- and post-allopurinol initiation, a statistically significant decrease in 6MMP:6TGN metabolite ratio values was observed (86.7 vs 3.6; P < 0.0001). Conclusions: Allopurinol significantly increased the percent time in therapeutic ANC range and can be safely utilized to significantly lower the ratio of 6MMP:6TGN metabolites, alleviating the undesirable side effects of 6MMP, and optimizing the anti-leukemic effects associated with 6TGN.

UNICENTRIC CASTLEMAN DISEASE AND MICROCYTIC ANEMIA: A CHALLENGING DIAGNOSISAuthors: Kylie Holden1, Olayinka Okeleji2 Miriam B. Garcia2, Mary Austin1, James You3 and David McCall21 Department of Surgery, McGovern Medical School at the University of Texas Health Science Center at Houston (UTHealth Houston) and Children’s Memorial Hermann Hospital, Houston, TX2 Department of Pediatrics, The University of Texas MD Anderson Cancer Center, Houston, TX3 Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX

Objective (69) The occurrence of unpredictable pain crises are the principal determinant of the quality of life for patients with venous malformations (VM). A definite coagulation phenomenon, characterized by an increase in D-dimer levels and the presence of phleboliths within the malformation, has been previously reported. By applying Virchow’s triad and evaluating intralesional samples, our objective is to delineate the coagulation profile and the extent of endothelial dysfunction within the malformation. Methods (42) With the authorization of the Ethics Committee, a research project was undertaken on intralesional and extralesional blood samples from 30 pediatric patients afflicted with spongiform VM. Thromboelastometry analyses were performed using ROTEM ® Sigma, and the concentration of syndecan-1 was determined by ELISA. Results (80) In the ROTEM ® analyses, the A5, A10, and MCF values were below the established reference ranges in the intralesional samples in both the EXTEM and INTEM assays indicating that intralesional clots had significant instability. Furthermore, during the investigation of the delayed fibrinolysis phase using recombinant tissue plasminogen activator (rtPA) in EXTEM analysis, widespread hyperfibrinolysis was observed intralesional. Additionally, analysis of syndecan-1 showed significant differences between extralesional and intralesional levels (p<0.026) and controls (p<0.03), suggesting differences in the state of endothelium. Conclusions (39) For the first time, we developed a comprehensive understanding of the coagulopathic profile of VM and the role of endothelial dysfunction in its pathogenesis. These findings will enable the implementation of targeted therapies based on the individual coagulation profiles.

Introduction: NTRK-rearranged spindle cell neoplasm is an emerging tumor entity. The genetic mechanisms and prognostic implications of this entity are mainly unknown. The corresponding targeting therapy strategies have been widely developed. Method: In this study, we summarized the immunohistochemistry (IHC) and fluorescence in situ hybridization (FISH) characteristics. Also, we have explored the genetic mechanisms and prognostic implications of this entity. Results: We identified two NTRK1-associated gene sub types by consensus clustering. Besides, we established an NTRK1-associated gene prognostic model that predicted the survival of Sarcoma (SARC) based on the TCGA dataset. Two NTRK1-associated genes are related to the prediction of clinical outcomes. Discussion/Conclusion: A new classification system of SARC based on NTRK1-associated gene signatures has been established.

Cognitive Radio Networks (CRNs) represent a cutting-edge solution to the growing problem of limited available spectrum. With the increasing demand for wireless communication services, the efficient utilization of spectrum resources becomes paramount. Green CRNs offer a dynamic and opportunistic approach by intelligently sensing and accessing idle licensed spectrum, known as white spaces focusing on environmentally conscious communication methods. These unoccupied frequency bands, left unused by primary users (PUs), present an opportunity for CRNs to enhance spectrum utilization and alleviate the spectrum scarcity challenge. In the presented study, we concentrate on energy conservation in “Green” CRNs, with a specific focus on base stations (BSs). We suggest an energy-efficient approach that utilizes multiple sleep modes employing an N-policy, with the objective of addressing the growing need for environmentally friendly communication practices. To model the energy-saving process and assess system performance, we employ a semi-Markov process (SMP). Moreover, the paper provides a detailed analysis of performance metrics, encompassing average latency for Secondary Users (SUs), throughput of the system, energy saving factor, and energy consumption.

Accumulating data from several large, placebo-controlled studies suggests that sodium-glucose transporter 2 (SGLT-2) inhibitors and glucagon-like peptide 1 receptor (GLP-1) receptor agonists offer therapeutic benefits in the management of cardiovascular diseases, regardless of the patient’s diabetic status. In addition to their effects on glucose excretion, SGLT2 inhibitors have a positive impact on systemic metabolism. The aim of this study was to establish a non-invasive preclinical model of metabolic syndrome (MetS) to investigate the effects of novel antidiabetic therapies beyond glucose reduction, independent of obesity. Eighteen healthy adult Beagle dogs were fed an isocaloric Western diet (WD) for ten weeks. Biospecimens were collected at baseline (BAS1) and after ten weeks of WD feeding (BAS2) for measurement of blood pressure (BP), serum chemistry, lipoprotein profiling, fasting blood glucose, glucagon, insulin, NT-proBNP, BUN, creatinine, angiotensins, oxidative stress biomarkers, serum, urine and fecal metabolomics. Differences between BAS1 and BAS2 were analyzed using non-parametric Wilcoxon signed-rank testing with continuity correction. The isocaloric WD model induced significant variations in several markers of MetS, including elevated BP, increased glucose levels, and reduced HDL-cholesterol. It also caused an increase in circulating NT-proBNP levels, a decrease in serum bicarbonate levels, and significant changes in general metabolism, lipids, and biogenic amines. Short-term, isocaloric feeding with a WD in dogs replicates key biological features of MetS while also causing low-grade metabolic acidosis and elevating natriuretic peptides. These findings support the use of the WD canine model for studying the metabolic effects of new antidiabetic therapies independent of obesity.

Background. Controversial evidence suggests a potential association between female genital mutilation (FGM/C) and adverse obstetric outcomes, with type III FGM/C (infibulation) carrying the greatest risk. Objectives: To assess current rate of adverse obstetric outcomes in women with type III female genital mutilation and cutting (FGM/C; infibulation) delivering across different settings worldwide. Search Strategy. Two authors searched relevant literature in the PubMed, Scopus, Embase, and ClinicalTrials.gov databases from inception to Jan 1, 2023, looking for articles reporting outcomes of women with type III FGM/C compared with women with no FGM/C. Selection criteria. Studies were selected if they included the main outcome of postpartum haemorrhage (PPH) or secondary outcomes, which included major conditions affecting maternal-neonatal health during labour and delivery. Data Collection and Analysis: DerSimonian-Laird random effects meta-analysis was performed and pooled effect estimates with corresponding 95% confidence intervals were computed. Heterogeneity was assessed using the I 2 statistic. Meta regression for relevant covariates was performed when data on relevant confounders were available. The Newcastle-Ottawa scale (NOS) was used to assess quality of observational studies. The level of evidence was assessed with the GRADE method. Main Results: 14 observational studies including 15,320 type III FGM/C women and 59,347 controls were eligible. The risk for postpartum haemorrhage was significantly increased in type III FGM/C, in the main analysis (OR 1.83, 95% CI 1.03 to 3.24, I 2=93%), in pooling of data adjusted for confounders (aOR 1.76, CI 1.42 to 2.17, I 2= 0%), and in sensitivity analysis of higher quality studies with NOS≥7 (OR 2.76, CI 1.38 to 5.51, I 2= 95%). Meta-regression showed that nulliparity was significantly and positively associated with postpartum haemorrhage. Similarly, analysis of data adjusted for confounders showed an increased risk of episiotomy in type III FGM/C (aOR 1.56, CI 1.03 to 2.35, I 2= 52%). Sensitivity analysis of studies with NOS≥7 revealed a significant increase for episiotomy (OR 7.53, CI 1.19 to 47.54, I 2= 96%), perineal tears (OR 4.24, CI 1.09 to 16.46, I 2= 66%), prolonged second stage of labour (OR 5.19, 95% CI 1.00 to 26.85, I 2= 66%), and Apgar score less than 7 (OR 4.19, CI 1.64 to 10.70, I 2= 0%). No difference was found regarding obstetric anal sphincter injuries and mode of delivery in these women. Deinfibulation achieved similar obstetric and neonatal outcomes to women who never had type III FGM. The overall quality of the studies was adequate (median NOS score: 7; IQR: 6-8), the level of evidence, according to the GRADE assessment, was low. Conclusions. These results consistently show an increased risk of adverse obstetric outcomes in women with FGM/C type III. Infibulation substantially increases the risk for PPH, particularly in nulliparae.

Breast cancer is one of the most prevalent forms of cancer, affecting approximately 1 in 8 women during their lifetime. Deciding on breast cancer treatment, which includes the choice between surgical options, frequently demands prompt decision-making within an 8-week timeframe. However, many women lack the necessary knowledge and preparation for making informed decisions. Anxiety and unsatisfactory outcomes can result from inadequate decision-making processes, leading to decisional regret and revision surgeries. Shared decision-making and personalized decision aids have shown positive effects on patient satisfaction and treatment outcomes. We introduce Breamy, a prototype mobile health application that utilizes augmented reality (AR) technology to assist breast cancer patients in making more informed decisions. Breamy provides 3D visualizations of different surgical procedures, aiming to improve confidence in surgical decision-making, reduce decisional regret, and enhance patient well-being after surgery. To determine the perception of the usefulness of Breamy, we collected data from 166 participants through an online survey. The results suggest that Breamy has the potential to reduce patients’ anxiety levels and assist them in decision-making.

Pirazol, azot içeren beş üyeli heterosiklik bir bileşiktir, nitrojen atomlarının 1 ve 2 konumlarında konumlandırıldığı yer. halka. Akridin, azot içeren polisiklik aromatik bir bileşik. Bu yeni bir pirazol-akridin türevinin sentezlenmesini amaçlayan çalışma, pirazol ve akridinin yapısal elemanlarını tek bir molekülü, antikanser aktivitesini arttırmak amacıyla. bu pirazol-4-karbaldehit türevi ile siklize edildi sentezlemek için 5,5-dimetilsikloheksan-1,3-dion ve 4-nitroanilin pirazol-akridin türevi (3-ACH). Bileşiğin karakterizasyonu FT-IR, NMR, HPLC-Q-Tof/MS ve element analizleri kullanılmıştır. Bizim araştırma, 3-ACH'nin SH-SY5Y üzerindeki sitotoksik etkisini değerlendirdik doza bağımlı bir şekilde insan nöroblastom hücreleri (50, 100 ve 150 μg/mL) ve zamana bağlı (12, 24 ve 48 saat) WST-1 testi. 3-AKH'nin apoptoz üzerindeki etkileri BAX, Kaspaz-3, Kaspaz-8, Kaspaz-9 proteinlerinin immün boyanması. bu sonuçlar, 3-ACH'nin sitotoksisitesinin dozlarla arttığını ve maruz kalma süreleri. Ayrıca, önemli bir yukarı regülasyon gözlemledik. BAX, Kaspaz-3,-8,-9 proteinlerinin sentezi. Bu bulgular şunu göstermektedir: 3-ACH, SH-SY5Y hücrelerinde apoptozu indükleme potansiyeline sahiptir. hem içsel hem de dışsal yolları aktive etmek, sitotoksik etkilerine katkıda bulunur. Çalışmamız 3-ACH'yi bir umut verici antikanser ajanı.

Land use change-induced, accelerated soil erosion is a main driver of soil organic carbon (SOC) loss. However, soil erosion and SOC loss are not linked linearly because SOC-rich topsoil is eroded at the initial stages of degradation while horizons with lower SOC content are eroded later, but often at higher rates. To assess the contribution of soil erosion to the changing global carbon cycle, it is essential to understand how SOC changes when soil erosion accelerates. On cropland, dynamic replacement of organic carbon (OC) limits the net loss of soil OC stocks and causes a small, but steady flux of C from the atmosphere to soil and onwards landscape sinks. Rangelands, on the other hand, may loose their entire OC pool as a result of soil erosion because soils loose their productivity quickly when affected by erosion, disabling the replacement of SOC. Most rangelands have experienced erosion and degradation during the 20 th century, i.e. at the same time when greenhouse gas emissions from burning fossil fuels also increased. Distinguishing the contributions of rangeland land use change from other sources is essential for understanding the human impact on the global carbon cycle and climate during the 20 th century. The use of small farm reservoirs has been widespread in the South African Karoo during the last century. Many reservoirs have silted up and thus potentially document the soil properties during the period of sediment accumulation. This study tests the potential to reconstruct 20 th century SOC and total nitrogen (TN) change in rangeland soils. Five reservoir sediment profiles were sampled and texture, total organic carbon (TOC), TN and 137Cs of the samples were analysed and compared along the reservoir profiles. The results show that with one exception the oldest sediments contain more TOC and TN than the older ones. This indicates a loss of SOC and TN early after the dams were constructed in the 1920s and 1930s. These distinct changes also illustrate that the small reservoir sediments have the potential to reconstruct the impact of land use, soil erosion and associated SOC change in rangelands.

Kawasaki Disease presentation by an uncommon presentation of torticollis: A case report Hassan Mottaghi Moghaddam Shahri1, Faeze Keihanian2*, Mohammad Hassan Nezafati3, Mohammad Saeid Sasan4

INTRODUCTION: Inappropriate sinus tachycardia (IST) is a common condition with frequently not tolerated beta-blockers or ivabradine and a high rate of complication in ablation strategy; we describe an alternative anatomical approach of sinus node modulation. METHODOLOGY: This retrospective study describes a case series of 6 patients from two centers diagnosed with symptomatic IST undergoing sinus node ablation. RESULTS: The mean age was 40.6 ± 13.9 years; five of the six patients were female, 100% of patients reported heart palpitations, and 66% reported dizziness, the average HR on a 24-h Holter was 93.2 ±7.9 bpm. HR during the first stage of a stress test using a standard Bruce protocol was 150 ±70 bpm, The average HR on 24-hour Holter post-ablation was 75 ± 5.6 bpm, the sinus rate HR during stage 1 of a Bruce protocol exercise stress test was 120 ± 10 bpm. CONCLUSION: This is the first case series reporting the acute and long-term results of a novel anatomical approach for SNM to treat IST targeting the AR under ICE guidance, The novel anatomic ICE-guided catheter ablation approach aimed to identify the earliest activation at the AR with an extension of RF lesions towards its septal region seems effective and safe to modulate the SN in symptomatic patients with IST refractory to medical treatment.

Direct synthesis of layer-tunable and transfer-free graphene on technologically important substrates is highly valued for various electronics and device applications. Here, we report a novel synthesis approach combining ion implantation for a precise graphene layer control and dual-metal smart Janus substrate for a diffusion-limiting graphene formation, to directly synthesize layer-tunable graphene on arbitrary substrates without the post-synthesis layer transfer process. C ion implantation was performed on Cu-Ni film deposited on a variety of device-relevant substrates. Upon thermal annealing to promote Cu-Ni alloying, the pre-implanted C-atoms in the Ni layer are pushed towards the Ni/substrate interface by the top Cu layer due to the poor C-solubility in Cu. As a result, the expelled C-atoms precipitate into graphene structure at the interface facilitated by the Cu-like alloy catalysis. After removing the alloyed Cu-like surface layer, the layer-tunable graphene on the desired substrate is directly realized. ReaxFF was performed to elucidate the graphene formation mechanisms in this novel synthesis approach. Three ordinary devices using as-synthesized graphene were fabricated on Si, SiO2, and glass substrates to demonstrate the graphene quality of our layer-tunable and transfer-free synthesis approach and the excellent performance characteristics of these low-cost manufacturing devices: field-effect transistors, heating devices, and near-infrared photodetectors.

Introduction: Pulsed electric field (PEF) ablation relies on the intersection of a critical voltage gradient with tissue to cause cell death. Field-based lesion formation with PEF technologies may still depend on catheter-tissue contact (CTC). The purpose of this study was to assess the impact of CTC on PEF lesion formation with an investigational large area focal (LAF) catheter in a preclinical model. Methods: PEF ablation via a 10-spline LAF catheter was used to create discrete RV lesions and atrial lesion sets in 10 swine (8 acute, 2 chronic). Local impedance (LI) was used to assess CTC. Lesions were assigned to 3 cohorts using LI above baseline: No Tissue Contact (NTC: ≤∆10Ω, close proximity to tissue), Low Tissue Contact (LTC: ∆11-29Ω), and High Tissue Contact (HTC: ≥∆30Ω). Acute animals were infused with triphenyl tetrazolium chloride (TTC) and sacrificed ≥2hrs post-treatment. Chronic animals were remapped 30 days post-index procedure and stained with infused TTC. Results: Mean (±SD) RV treatment sizes between LTC (n=14) and HTC (n=17) lesions were not significantly different (depth: 5.65±1.96mm vs 5.68±2.05mm, p=0.999; width: 15.68±5.22mm vs 16.98±4.45mm, p=0.737) while mean treatment size for NTC lesions (n=6) was significantly smaller (1.67±1.16mm depth, 5.97±4.48mm width, p<0.05). For atrial lesion sets, acute and chronic conduction block were achieved with both LTC (N=7) and HTC (N=6), and NTC resulted in gaps. Conclusions: PEF ablation with a specialized LAF catheter in a swine model is dependent on CTC. LI as an indicator of CTC may aid in the creation of consistent transmural lesions in PEF ablation.

Purpose: Predicting Bronchopulmonary dysplasia (BPD) to assess the risk-benefit of the therapy is necessary due to the side effects of medications. We developed and validated an instrument for predicting BDP and compared it with an instrument currently used in neonates born in a Brazilian hospital. Methods: Retrospective cohort of patients born between 2016 and 2020, with gestational ages (GA) between 23 and 30 weeks. Predictive equations were elaborated using methods of selection of component variables: stepwise, conditional inference tree, Fisher’s exact test and all the collected variables; 70% of the sample was randomly selected for the construction of risk prediction equations, and the remaining 30% were used for their validation, application and comparison with the National Institute of Child Health and Human Development (NICHD) instrument published in 2011, currently used in that institution. Sensitivity, specificity, and predictive values of the equations were calculated. Results: The equation that used variables whose p-value was lower than 5% in Fisher’s exact test (clinical chorioamnionitis, GA, birth weight, sex, need for surfactant, patent ductus arteriosus, late-onset sepsis, inspired fraction of oxygen, and respiratory support) presented the best results: specificity of 98% and positive predictive value of 93%. Our instrument allowed applying the prediction to small-for-gestational-age (SGA). The currently used calculator applied to our population had a specificity of 93% and a positive predictive value of 75% and could not be applied to SGA patients. Conclusion: Our tool has a higher specificity and positive predictive value than the foreign instrument and is suited for SGA.

Pyroptosis is a type of programmed lytic cell death mechanism associated with the activation of inflammasomes and inflammatory caspases, proteolytic cleavage of gasdermin proteins (GSDMA-E and PJVK), resulting in the formation of pores in cellular membranes such as plasma membrane and mitochondrial membranes. Here, I show that GSDMC expression was increased, GSDME (DFNA5) and PJVK (DFNB59) expression were decreased in uterine corpus endometrial carcinoma (UCEC) cells compared to normal endometrial cells. Total percentage of patients affected by mutations in gasdermin family of genes was the highest in UCEC compared to other cancer types. The highest mutation percentage among the members of the protein family was observed for GSDME which also showed the most significant difference in the mRNA expression among other family members between tumor and normal samples, possibly pointing to its relatively higher importance in the pathogenesis of UCEC. Gasdermin family of genes (except GSDMA) had higher transcript levels in serous endometrial adenocarcinoma than in endometrioid endometrial adenocarcinoma, demonstrating the histotype-dependent expression of the most of gasdermin genes in UCEC. Transcript levels of certain gasdermin family members also differed based on residual tumor status and histologic tumor grade; however, the expression of any gasdermin genes did not change depending on menopause status. This study suggests that a better mechanistic understanding of pyroptotic cell death in uterine corpus endometrial carcinoma might help identify novel therapeutic targets for the management of this gynecological malignancy.

Objective: Describe antibiotic utilization pre- and post-widespread utilization of highly effective CFTR modulator therapy at a single pediatric CF center. Design: In October 2019, the United States Food and Drug Administration approved elexacaftor/tezacaftor/ivacaftor (ETI), a highly effective CFTR modulator therapy, for people with CF (pwCF). We performed a single-center, retrospective review of PO and IV antibiotics prescribed for pulmonary exacerbations (PEx) between 1/1/2017 and 12/31/2022. Results: Of the 193 pwCF included, 69 (36%) received a course of IV antibiotics in the pre-ETI period compared to 44 (23%) in the post-period. Oral antibiotic courses decreased from 174 (90%) to 141 (73%) individuals. The median combined IV and PO treatment courses per individual decreased from 3 to 2. The percent of individuals treated for resistant organisms including methicillin-resistant Staphylococcus aureus (46% to 32%) and Pseudomonas aeruginosa (40% to 28%) also decreased from the pre- and post-ETI period. Conclusions: This single center experience indicates a dramatic decrease in PO and IV antibiotics used to treat PEx among pwCF in the post-ETI period.

Hemorrhoids are the most common perianal disease, but current observational studies have yielded inconsistent results in investigating the etiology. Our further exploration of the etiology will help prevent the disease. We conducted a two-sample bidirectional Mendelian randomization (MR) analysis using publicly available genome-wide association studies (GWAS) statistics from multiple consortia. The inverse-variance weighted (IVW) method was used for the primary analysis. We applied four complementary methods, including weighted median, weighted mode, MR-Egger regression, and Cochrane’s Q value, to detect and correct the effects of horizontal pleiotropy. Genetically determined constipation (OR = 0.97, 95% CI: 0.91-1.03, P = 0.28) and diarrhea (OR = 1.00, 95% CI: 0.99-1.01, P = 0.90) did not have a causal effect on HEM but stool frequency (OR = 1.28, 95% CI: 1.05-1.55, P = 0.01), waist-to-hip ratio adjusted for BMI (OR = 1.11, 95% CI: 1.06-1.64, P = 1.59×10 -5), and order Burkholderiales (OR = 1.09, 95% CI = 1.04–1.14, p = 1.63×10 -4) had a causal effect on. Furthermore, we found a significant causal effect of constipation on HEM in the reverse MR analysis (OR = 1.21, 95% CI: 1.13-1.28, P = 3.72×10 -9). The results of MR-Egger regression, Weighted Median, and Weighted Mode methods were consistent with those of the IVW method. Horizontal pleiotropy was unlikely to distort the causal estimates, as indicated by the sensitivity analysis. Our MR analysis reveals a causal association between stool frequency and waist-to-hip ratio with HEM, despite variations in results reported by observational studies. Unexpectedly, we found a relationship between the order Burkholderiales in the gut flora and HEM, although the mechanism is unclear.

MultipleCutaneousMyxofibrosarcoma on the Right Arm：Clinicopathological Features andDifferential Diagnosis

Bicuspid aortic valve is the most common congenital heart defect. Transthoracic echocardiogram is the initial tool to assess and diagnose this condition, however, transesophageal echocardiogram with 3D modalities, including transillumination have a better anatomical and functional evaluation of the valve, allowing to classify the bicuspid aortic valve according to the position of the raphe and assess the main vessels for complications or exclude other cardiovascular diseases.

Most scientist agree that subjective tinnitus is the pathological result of an interaction of damage to the peripheral auditory system and central neuroplastic adaptations. Here we investigate such tinnitus related adaptations in the primary auditory cortex (AC) 13 days after noise trauma induction of tinnitus by quantifying the density of the extracellular matrix (ECM) in the AC of Mongolian gerbils (Meriones unguiculatus). The ECM density has been shown to be relevant for neuroplastic processes and synaptic stability within the cortex. We utilized a mild monaural acoustic noise trauma in 9 gerbils to induce tinnitus and a sham exposure in 3 control animals. Tinnitus was assessed by a behavioral response paradigm. Four of the trauma animals did show tinnitus 13 days after trauma (T), the remaining 5 trauma (NT) and the 3 control animals (C) did not show the percept. The ECM density 13 days after trauma was quantified using immunofluorescence luminance of Wisteria floribunda lectin-fluoresceine-5-isothiocyanate (WFA-FITC) on histological slices of the primary AC, relative to the non-auditory brainstem as a reference area. We found that the WFA-FITC luminance of the AC of NT animals was not significantly different from that of C animals. However, we found a significant increase of luminance in T animals’ ACs compared to NT or C animals’ cortices. This effect was found exclusively on the AC side contralateral to the trauma ear. These results point to a process of stabilization of synaptic connections in primary AC, which may be involved in the chronic manifestation of tinnitus.