Tarsal tunnel syndrome is a focal compressive neuropathy of the posterior tibial nerve or one of its associated branches. Brief mention is made in the literature of the use of corticosteroid injections for this condition. The basic technique of hydrodissection is used for other nerve entrapments and includes identifying the region of nerve compression, and the injection of a fluid medium to dissect between structures or fascial planes. We introduce our treatment protocol using a methylprednisolone/sterile water/ropivacaine hydrochloride injectate mix and peripheral nerve stimulation to a perform hydrodissection technique for tarsal tunnel syndrome.

Caused by age or trauma, collapsed connective tissue can cause nerve entrapment and damage within the tarsal tunnel. Tarsal tunnel syndrome is relatively underdiagnosed. This study presents an intervention targeting damaged tissues surrounding the nerves and replacing the structural cushioning with a Wharton’s jelly tissue allograft. The eight selected patients from four clinical sites had tarsal tunnel-related defects. Patient outcomes were tracked on a 90-day calendar utilizing the Numeric Pain Rating Scale (NPRS) and the Western Ontario and McMaster University Arthritis Index (WOMAC). All patients had failed standard care practices for at least six weeks. Each patient received a Wharton’s jelly tissue allograft to sites around the affected tarsal tunnel. No patients experienced adverse reactions. Percent change calculated from the initial application to the 90-day follow-up showed an improvement of 59.43% in NPRS and a 37.58% improvement in WOMAC. This study provides evidence that WJ allograft applications are safe, minimally invasive, and efficacious for patients who have failed standard care treatments for tissue defects associated with Tarsal Tunnel syndrome. Limitations include the small cohort size and nonblinded nature. The results of this study warrant further research to confirm the efficacy, optimal dose, protocol, and durability of Wharton's jelly.

Dynamic time history analysis is a powerful and effective method to study the seismic response of tunnels, the dynamic time history to analyze the seismic response of the tunnel in the typical subway in this paper. The analysis results show that the overall levelling of the tunnel will not affect the tunnel too much, and the seismic response of the tunnel is mainly related to the relative displacement of the ground around the tunnel. The analysis results show that the internal force of the tunnel and the tunnel inclination have a good linear relationship, and the tunnel inclination can be used to measure the magnitude of the seismic response of the tunnel.

The research on the excavation mechanical properties of underpass tunnels has already had certain results, but fewer of them consider the effects of dynamic and static loads on the excavation mechanical properties of underground tunnels at the same time, especially the lack of research cases of double-line highway tunnels with angled underpasses of existing railway tunnels. In this paper, based on the tunnel project of the new double-line Shiqian Highway Tunnel passing under the Hurong Railway at an oblique angle, the mechanical parameters of the rock body in the cross-tunneling area under the influence of static and dynamic load coupling are obtained by using the disturbance quantification coefficients and the Hoek-Brown criterion based on the method of over-advanced geological prediction and the investigation of the surrounding rock on the palisade face, and the engineering-scale finite element model is constructed and the mechanical characteristics of the excavation in the tunnel of the double-lane highway tunnel passing under the existing railroad under the influence of the static and dynamic loads are analyzed. The results show that: the new tunnel rock movement law for the top of the arch sinking, bottom plate bulging, side wall to move outward, the height and width of the arch and bottom plate arch with the tunnel excavation and increase, the side wall rock displacement effect is smaller; left and right lines of the tunnel disturbed area of the rule of change is similar; the existing tunnel bottom plate displacement is more than the top plate and the left and right side walls by the excavation of the time step influence is larger. Typical profile displacement is mainly determined by the distance from the excavation surface; the new tunnel in the four types of calculation conditions of the rock disturbance angle is the same; the existing tunnel roof and side wall Von Mises stress extreme occurs in the tunnel structure, the bottom plate there are pressure relief and pressure-bearing areas; based on the displacement control criteria, the recommended upper and lower step blasting method.

By repeated unloading and loading of the excavation dynamic and static loads, repeated train dynamic and static loads of multi-factors, the underpass tunnel, cross tunnel engineering influence area rock layer, the existing tunnel structure of the three constitutes a multifaceted structure, multi-factor interaction system. Existing tunnels into the prediction theory model of the new tunnel excavation process of dynamic and static loads, dynamic and static loads of existing tunnels are mostly analyzed individually, the results of synergistic analysis needs to be improved. Based on the theory of the current layer method, the paper comprehensively considers the stiffness of the existing tunnel, the stiffness of the new tunnel, the excavation method load and the existing tunnel load, coupled with Peck's empirical formula, the theoretical model of deformation prediction for excavation of a two-lane highway tunnel under the tunnel through the existing railroad is proposed, and verified and optimized by numerical calculations and monitoring data, which proves the applicability and reliability of the theoretical model in the similar strata and the project promotion.

: Tunnel instability and lining integrity are intimately tied to the creep properties of the surrounding rock. The acquisition of rock mass creep parameters is critical in ascertaining the appropriate timing for lining construction. Nevertheless, creep tests on rock specimens conducted in a controlled setting cannot be straightforwardly extrapolated to rock mass creep analysis. This study performs laboratory-based creep tests on mudstone samples and establishes the corresponding creep constitutive model. Integration of a Mohr-Coulomb element with the Burgers model in series serves to characterise the yield creep behaviour of the rock mass. Additionally, the research outlines a series of 100 orthogonal experiments utilising randomised creep parameters, and formulates a GA-BP neural network inversion model. Employing long-term deformation measurements from the crown and sidewalls of the project site, this study deduces the creep parameters of the mudstone in the investigated tunnel section and examines the prolonged deformation traits of the surrounding rock. Drawing on the deformation traits of the surrounding rock and the forces impacting the primary support and lining structures, this paper evaluates the earliest and latest viable lining casting periods and pinpoints an optimal timing interval for lining implementation. The methodologies employed herein can serve as a benchmark for analogous endeavors internationally.

Tunnel-interchange connecting sections pose significant safety challenges on mountainous expressways due to their high incidence of accidents. Improving road safety necessitates a comprehensive understanding of driver behavior in such areas. This study explores the influences of road characteristics, signage information volume, and traffic conditions on drivers' car-following and lane-changing behavior in tunnel-interchange diverging areas. Utilizing driving data from 25 subjects of 72 simulated road models, driving performance is assessed using Friedman rank test and multivariate variance analysis. The results highlight the significant influence of both connection distance and signage information load on driving behavior. In tunnel-interchange scenarios, the reduction of velocity increased by 62.61%, and speed variability surged by 61.11%, indicating potential adverse effects on driving stability due to the environmental transitions. Decreased connection distances are associated with reduced lane-changing durations, larger steering angles, and increased failure rates. Furthermore, every two units increase in signage information leads to a 13.16% rise in maximum deceleration and a 5% increase in time headway. Notably, the signage information volume shows a significant interaction with connection distance (F=1.60, P=0.045) for most car-following indicators. Hence, the study recommends a maximum connection distance of 700 m and signage information not exceeding nine units for optimal safety and stability.

Research shows that in earthquakes the ground response changes in areas where there are underground cavities. Due to the fact that subways and underground tunnels pass from beneath buildings in urban areas, these changes in ground response have a direct impact on the seismic behavior of structures. In this study, first by model validity and reliability of the results, steel structures modeling was conducted and steel structure behavior was evaluated due to Tunnel-Soil-Structure seismic interaction. Parameters studied are number of stories, soil type, tunnel depth, horizontal tunnel-structural distance and dynamic loading. Considering that one of the most important parameters of structural control is drift and story displacement, so this important factor will be considered. The results show that tunneling has a direct effect on the rate of structural displacement and increases the structural response. Also, the behavior of the structure is affected by the position of the structure at the ground level and the position of the tunnel and this should be considered during the design phase of the structures.

Traversal time in tunneling effect for ultrasonic waves in tapered waveguides is derived considering its analogy with quantum and electromagnetic waves tunneling. If, as traversal time, the so called phase time is considered, the ultrasonic wavepacket shows the equivalent in acoustics of superluminality i.e. the derived velocity , crosses the limit of bulk transverse ultrasonic waves in the medium of the waveguide that is the equivalent of c in the quantum and electromagnetic cases. Graphs clearly illustrating this so called Hartman effect are obtained confirming the experimental results in the three different fields.

Introduction: Birth Asphyxia is a severe condition that includes many potential pathways of occurrence both in utero and during childbirth. We aimed to identify and describe specific macroscopic and microscopic placental injuries in birth asphyxia to serve as a quick tool to stratify a newborn’s potential further evolution, as hypoxic-ischemic encephalopathy can be responsible for neonatal death or severe neurologic sequelae further compromising the affected persons’ quality of life. Materials and methods: We conducted an observational prospective study over 3 years. 62 patients diagnosed with birth asphyxia which had placental histopathological examination performed were enrolled. The control group consisted of 69 term newborns that required neonatal intensive care for at least three days, in the same period, for any other reason and that also had available placental exams. In our study, placental histopathological lesions identified in birth asphyxia have been classified according to Amsterdam Criteria. Results: We analysed data gathered from both groups by applying specific statistical tests for each type of variable and hypothesis. Thus, umbilical cord abnormalities were associated with hypoxic-ischemic encephalopathy in a statistically significant manner when comparing the birth asphyxia group of newborns with the control group. Also, we identified a high statistical level of significance for maternal and fetal vascular malperfusion and the occurrence of hypoxic-ischemic syndrome when comparing the two groups (p = .00). Conclusion: The macroscopic and microscopic placental examination can provide important information on the evolution of the disease in selected newborns according to the identified lesions.

Background: People with Down syndrome (DS) have a trisomy of chromosome 21 and marked deficits in verbal memory but relatively preserved visuospatial perception. Verbal memories are related to semantic knowledge. Little is known about the organization of semantic knowledge in people with DS, which was the aim of this study. Aims: The extent of false memory in people with DS was examined. Possible differences in the number of false memories induced by nominal and verbal themes were examined. Methods and Procedures: In the study phase, ten word lists with semantically related associates were presented. In the recognition phase, participants made judgments on whether each word had been represented previously as semantically related lures, old words, and semantically unrelated new words. Outcomes and Results: Differences in the processing of nominal and verbal theme-related lures were observed among people with DS. When processing nominal theme-related lures, people with DS showed delayed false positives. When processing verbal theme-related lures, people with DS showed no differences compared to controls. Similar patterns have been observed in people with DS when processing nominal theme-related associates and verbal theme-related associates. People with DS have delayed recognition of associates. When processing unrelated words, they showed significantly higher false positives than controls for both nominal and verbal eliciting themes. Further analyses of the themes revealed differences in false positives across syntactic categories among groups. Conclusions and Implications: People with DS showed a delayed recognition of associates and deviance in recognizing unrelated words in the nominal and verbal theme categories. People with DS were delayed in terms of nouns, but deviated with verbs in associated and unrelated words. Additionally, people with DS showed distinct patterns in processing five nominal lures and three verbal lures, suggesting that they formed false memories differently based on distinct syntactic categories. Thus, it was concluded that people with DS develop a deviant semantic structure. Category-based interventions for people with DS should be implemented in order to improve their semantic knowledge through lexical connections.

Wind tunnels are devices that enable researchers to study the flow over objects of interest, the forces acting on them and their interaction with the flow, which is nowadays playing an increasingly important role due to noise pollution. Since the first closed circuit wind tunnel with variable cross-section was built in G¨ottingen, its Prandtl configuration has little change. The wind tunnel with Prandtl configuration has four corners and vanes, more than 50% of the total pressure loss are caused by the corners and vanes. How to reduce the total pressure loss is a world class problem in the wind tunnel design. This study attempts to propose a novel configuration of wind tunnel, where the corners have been replaced by semi-circular tunnel. Sun wind tunnel 2 has only two corners and vanes, while Sun wind tunnel 1 has no corners and vanes at all. It is expected the new wind tunnel can reduce the total pressure loss from 50% to 10%.

Polycystic Ovary Syndrome (PCOS) is the most common endocrine disorder that affects women of reproductive age representing the primary cause of anovulatory infertility. The nonapeptide oxytocin (OT) plays an important role in cognitive, emotional, and reproductive functions in human beings. Oxytocin receptors are expressed in several body parts including the ovaries. Despite this, the possible role played by oxytocin in symptoms of PCOS is not clear. The present systematic review aimed at understanding, the presence of possible oxytocin level alterations in PCOS, the connection between alterations of OT levels and the symptoms of PCOS, and the effect of oxytocin administration in PCOS. After a systematic search in the principal databases, seven studies, five human and two animal, were included. Most of the studies highlighted the role played by oxytocin in fertility issues related to PCOS. Studies that analyzed oxytocin basal levels in PCOS women agreed that PCOS is associated with a reduction in the serum level of oxytocin. Two studies found that in PCOS the serum levels of oxytocin were lower than healthy controls. One human and one animal study agreed about lower levels of PCOS, confirming a possible implication of a dysfunction of OT, in the pathogenesis of PCOS.

The research on the impact of excavation of underpass tunnels has already had certain results, but there is a lack of research cases of double-line highway tunnels with oblique angles underpass the existing railway tunnels, especially the method of determining the area of the impact of the dynamic and static loads of the new tunnels and existing trains to be enriched by considering them at the same time. In this paper, based on the tunnel project of the new double-line Shiqian Highway Tunnel with oblique angles underpass the Hurong Railway in Wanshoushan. By constructing a three-dimensional finite element model and simulating the application of static tunnel excavation load, dynamic blasting load and dynamic train operation load of the existing tunnel, the overall displacement of the existing tunnel and the settlement value of the bottom plate of the track surface by the static tunnel excavation load were analyzed. Then, the stresses, vibration speeds and displacements of the tunnel due to the dynamic blasting loads and the dynamic train operation loads were obtained. The results show that: the area of influence of the static loads of the new tunnel excavation on the existing tunnel is divided into three types of perturbations presenting strong, weak and slight; the area affected by the blasting dynamic load of new tunnel excavation is a circular domain with the datum point in the tunnel section as the center; the area affected by the dynamic load of train operation in the existing tunnel is an ellipse with the center of the track surface of the existing tunnel as the datum; there is an anomalous shape in the area affected by the blasting dynamic load of new tunnel excavation and the area affected by the dynamic load of train operation in the existing tunnel.

Background and Objectives: The aim of this study was to determine the job-related and individual features that influence BS and depression levels among dentists working in faculties, oral and dental health centres (ODHC) and private clinics. Materials and Methods: This prospective, cross sectional study was carried out on dentists working in different regions of Turkey. Data were collected using an on-line questionnaire created using Google Forms. The questionnaire consisted of demographic data, Maslach BS Inventory (MBI) and Beck Depression Inventory (BDI) sections. Demographics were age, height, weight, marital status, blood type, gender, monthly income, income satisfaction and having enough free time. The dentists were divided into 3 groups as faculty, private clinic and ODHC according to the institutions in which they worked. Results: Of the total 290 dentists enrolled in the study, there were 172 males and 118 females with a mean age of 36.98±5.6 years. 128 of the dentists worked in faculties, 72 in private clinics and 90 in ODHCs. It was observed that women's EE scores were higher than men's (P<0.05). No statistically significant difference was found between the groups when comparing BS and depression scores according to marital status and blood group (P>0.05). There was no significant relationship between emotional exhaustion (EE), depersonalisation (DP), personal accomplishment (PA) and depression scores according to age, BMI and work experience, age, work experience and BMI (P<0.05). It was found that the EE scores of the dentists working in the faculty and private clinic were lower than those of the dentists working in the ODHC (P<0.05). Monthly income was associated with depression (r = -0.35). Conclusions: This study showed that dentists working in ODHCs had more EE. These findings suggest that there is a need for improvement in the working conditions of dentists, particularly in ODHCs.

Introduction: Carcinoid heart disease is a rare cause of right-sided valvular dysfunction, an important complication in patients with carcinoid syndrome. Objectives: We aim to present our own experience regarding early myocardial dysfunction in patients with carcinoid syndrome. Methods: 64 patients (35-90 year old, 62,5% female, 37,5% male patients) with carcinoid syndrome were evaluated be-tween October 2017 and June 2021. All patients underwent two-dimensional echocardiography with additional tissue Doppler and speckle-tracking techniques. For all patients there were measured urinary level of 5- hydroxyindolacetic acid, serotonin and NT-proBNP values. Results: The following echocardiographic features: global longitudinal strain of both ventricles, mean systolic velocity of the left ventricle, systolic velocity of the free wall of right ventricle, correlated with high values of specific biomarkers: serotonin, and urinary 5-hydroxyindolacetic acid, and also with the presence of hepatic metastases and poorly differentiated tumors. Discussion: In this study we identified several patients with early myocardial dysfunction due to carcinoid syndrome, representing a predictive model of poor prognosis, requiring further investigations. Conclusion: Echocardiographic assessment based on the measurement of systolic velocities, as well as the global longitudinal strain of both ventricles, together with specific biomarkers may contribute to better recognition of carcinoid heart disease in clinical practice, but this needs validation through further studies enrolling larger number of patients.

Molecular transport and quantum tunneling of H2 and H2O molecules through nanoporous gra-phene is studied using computational modeling and first principles density functional theory. It is demonstrated that molecules with sufficiently high kinetic energies can tunnel through the na-nopores. It is also demonstrated that molecules can be trapped in front of the nanopore or behind it. These investigations help us learn the behavior of molecules in and around nanopores of gra-phene. They also help us learn fundamentals of molecular tunneling. We believe, nanoporous gra-phene can play important roles for gas separation and nanofiltration.

new subsonic blower wind tunnel design has been studied both numerically and experimentally, it is also referred to as “blower” wind tunnel. This paper, is initially aimed to address each sequential stage of the wind tunnel design process. Rather than applying the standard method of modelling solely the flow in the test section, a large-scale CFD model of the whole wind tunnel was employed. The loss of every constituent element was calculated and then all the losses are added up to determine the power needed for the wind tunnel operation which is used as “intake fan” boundary conditions in the CFD model. Then, flow uniformity and turbulent intensity measurements in an empty test section using a Pitot-static tube and hot wire anemometer (HWA) were introduced to validate the CFD results. The results showed that flow quality was significantly affected by boundary layer controllers (honeycomb and mesh screens) in the settling chamber and wide-angle diffuser. Investigations were also conducted to evaluate the flow deficit in the wake area behind a convex hump model using HWA. This was additional experimental tests carried out to validate the suitability of the wind tunnel flow aerodynamic research.

We describe electron temperature measurements in the SSX MHD wind tunnel using two different methods. First, we estimate T_e along a chord by measuring the ratio of the C__III 97.7 nm to C_IV 155 nm line intensities using a vacuum ultraviolet monochrometer. Second, we record a biasing scan to a double Langmuir probe to obtain a local measurement of T_e. The aim of these studies is to increase the Taylor state lifetime, primarily by increasing the electron temperature. Also, a model is proposed to predict magnetic lifetime of relaxed states and is found of predict the lifetime satisfactorily. Furthermore, we find that proton cooling can be explained by equilibration with the electrons.

Global public health systems have continuously faced challenges from the advent of novel infectious illnesses, necessitating quick and efficient actions to stop their spread.First discovered in Saudi Arabia in 2012, Middle East respiratory syndrome (MERS) is a viral respiratory disorder caused by the Middle East respiratory syndrome coronavirus (MERS-CoV). Since then, the nation has reported most cases and fatalities related to this sickness, with occasional outbreaks happening in other nations and regions. Severe sickness and high mortality are caused by MERS-CoV, especially in older persons and those with underlying chronic conditions. Through intimate contact, the virus can spread from people to dromedary camels and vice versa. It has sparked multiple epidemics both domestically and abroad in the Middle East, raising the possibility of fatalities and widespread transmission, especially in susceptible groups. The Riyadh region was the main target of the most current MERS-CoV outbreak in Saudi Arabia, which began in 2023 and ended on September 1, 2023, with 312 confirmed cases and ninety-seven fatalities. With the use of published studies and their contributions to the field, we hope to present a thorough overview of the MERS-CoV outbreak in Saudi Arabia in this review of the literature, including its epidemiological investigation, public health response, impact, and lessons learned. In addition to highlighting the importance and continued relevance of this problem, our work suggests ways to lower the risk of MERS-CoV transmission and avert further outbreaks.

Turner syndrome (TS) is caused by a complete or partial absence of an X or Y chromosome, including chromosomal mosaicism, affecting 1 in 2,500 female live births. Sister chromatid exchange (SCE) is used as a sensitive indicator of spontaneous chromosome instability. Cells from mosaic patients constitute useful material for SCE evaluations as they grow under the influence of the same genetic background and endogenous and exogenous factors. We evaluated proliferation dynamics and SCE frequencies of 45,X and 46,XN cells of 17 mosaic TS patients. In two participants, 45,X cells exhibited a proliferative disadvantage in relation to 46,XN cells after 72h of cultivation. The analysis of mean PI showed significant differences between 45,X and 46,XN lineages; however there were no intraindividual differences. On the other hand, mean SCE frequencies showed no differences between the two lineages, but there were intraindividual differences in 5 patients. The absence of mean SCE frequency differences between 45,X and 46,XN lineages may indicate that both were equally unstable, as more than 70% of the 46,XN lineages had an anomalous karyotype. However, 46,XN had a higher mean PI, suggesting that the amount of cells with a karyotype distinct from 45,X may increase with time in mosaic TS women.

Lynch syndrome (LS) is one of the most common hereditary cancer syndrome in human populations, associated with germline variants in MLH1, MSH2/EPCAM, MSH6 and PMS2 genes. The advent of next generation sequencing has proven a significant impact in germline variant detection in the causative genes; however, a large proportion of patients with clinical criteria still receive uncertain or negative results. PMS2 is the least frequent reported gene, associated with up to 15% of LS cases with late-onset disease and low penetrance phenotype; however, the proportion of PMS2-LS cases is considered to be highly underestimated. In this context, we consulted public available databases (ClinVar, LOVD) for missense and intronic PMS2 variants and performed an in silico analysis of the genomic sequence. Splicing bioinformatics tools proven effective in other genes were used to assess both the wild-type DNA sequence and reported genetic variants. Splicing alterations were predicted in silico and using GTEx short-read RNA expression data. Out of the 2384 missense variants discovered, 90% were classified with uncertain significance (VUS). 4.9% of missense variants were shown to have a potential splicing consequence (DS > 0.2) using SpliceAI. As described in the original publication, SpliceAI-visual was proven effective in annotation of short intronic variants (< 50 bp). Four short intronic variants were identified using SpliceAI-visual as potentially splicing disturbing, in spite of using a lower threshold (DS > 0.1). Moreover, we observed that Splicing Regulatory Elements (SREs) may play a fundamental role in alternative splicing in PMS2 gene, ESE motifs being overrepresented in highly expressed exons 5, 11 and 14. Computational analysis performed in our study serves as a valuable filtering step for guiding further RNA sequencing experiments. Additional functional data is necessary to evaluate the significance of our findings.

Weight loss solutions are on the rise, and there is growing interest in natural alternatives to the pharmaceuticals in the market, which are not devoid of relevant side effects. To this end, the objective of the current study is to assess the effects of a botanical-based blend comprised of lemon verbena and hibiscus extracts in weight management, body fat, appetite, lipid, and glucose profiles, in an overweight population, for 90 days. As a result, the volunteers presented significant weight loss in absence of diet, which coincided with decreased body fat. Body fat was assessed by anthropometry, electrical bioimpedance and DEXA scan. Cholesterol levels were also significantly decreased. Satiety assessment revealed that the product contributed to increased feeling of fullness and satisfaction after a meal, compared to the placebo group, which could contribute to the weight loss observed. Blood glucose and blood pressure levels remained unchanged, which was expected as the volunteers were normoglycemic and their blood pressure was in the healthy range. In conclusion, daily supplementation of a botanical-based blend contributes to weight loss in overweight individuals, in absence of diet, while not affecting other parameters that are in the healthy range. This product could be a candidate alternative or add-on to other weight loss products, as part of a healthy lifestyle.

Populational aging is marked by chronic non-communicable diseases, such as metabolic syndrome (MetS). IL-10 and IL-1β are pleiotropic cytokines with multiple biological effects linked to metabolic disorders. This cross-sectional study assessed 193 participants' IL-10 and IL-1β serum levels regarding their role in developing MetS, clinical characteristics, and their IL1B rs1143627 and IL10 rs1800890 variants' genotype frequencies in a population over 60. IL-10 levels correlated weakly with HDL levels and fat mass and inversely with triglycerides, glucose, glycated hemoglobin, and estimated average blood glucose levels. IL-10 levels were also indirectly influenced by the patient's T2DM duration, lean mass amount, and bone mineral content. Participants with altered HDL, elevated serum glucose, raised HbA1c levels, or those over 80 had reduced serum IL-10 levels compared to those with normal levels or other age groups, respectively. Women also had higher serum IL-10 levels than men. Dissimilarity, IL-1β levels correlated directly only with the number of total leukocytes and segmented neutrophils, showing only significant variations with self-reported alcohol consumption. Our study also found that those with the IL10 AA genotype (lower IL-10 levels) had a significantly higher risk of developing MetS. These findings may help direct future research and more targeted therapeutic approaches in older adults.

This paper introduces a method for tunnel point cloud and BIM model integration and cross-section monitoring, providing information to analyse tunnel cross-sections and surrounding rock deformation, and support for tunnel maintenance and reconstruction. Three types of data are processed for the integration: laser scanning point cloud, BIM tunnel model and terrain model from oblique photogrammetry. An adaptive BIM modelling scheme is proposed for tunnels with alien structures. Precise spatial registration of the data sets is conducted by applying singular value decomposition (SVD) algorithm to calculate transformation parameters from the point cloud model to the BIM model. Since the tunnel central line has high-order derivability, a cross-section calculation method based on tangent vector is proposed to obtain the cross-sectional profile of tunnels at any mileage. The proposed method has been verified by applying it to a tunnel reconstruction project. The experiment results show that the tunnel point cloud and the BIM model were highly coincident after the integration. The developed program can effectively get the cross-section of the tunnel at any mileage, and correctly express the spatial relationship between the BIM tunnel, the point cloud of tunnel and the external mountainous terrain.

Due to poor ventilation conditions in the tunnel, if gas pipeline leaks, the consequence of the accident will be more serious. Therefore, before the emergency repair, gas in the tunnel needs to be excharged so as not to explode during the repair process. Therefore, it is necessary to study the ventilation of gas in the tunnel. Based on the computational fluid dynamics (CFD) theory and taking the Yanyingshan tunnel section of China-Myanmar pipeline as an example, this paper uses Fluent software to establish the leakage model of the gas pipeline and fan model in the tunnel and analyzes the influence of different fan locations and number of fans on gas concentration. It can be concluded that: (1) the use of press-in method makes it more efficient to discharge gas out of the tunnel. (2) In order to make ventilation efficient, the fan should be arranged in a higher position and needs to be at a distance from the top of the tunnel. (3) Parallel use of two fans has better ventilation effect than single fan.

UAV has become powerful devices for both practitioners and researchers. In recent years, there has been a substantial growth in the usage of UAV for a wide range of applications in research and engineering. UAV are mostly utilized for image capturing techniques due to their time savings, low cost, minimum field work, and high precision. The purpose of this study is to generate an accurate and reliable 3D modelling process using UAVs photogrammetric technology; hence this study allows the techniques to evaluate the practicability of modelling and mapping inaccessible tunnels using images recorded by UAVs and photogrammetry. As a result, the approach was always employed to depict the true state of the place. This research incorporates three experiments. The first experiment is to build a 3D model using only one-directional light source and evaluate the accuracy of 3D photogrammetric model and conducted at the concrete tunnel. The second one is to build a 3D model of underground sewer tunnel using different light sources one-directional and omni-directional. The last experiment was to build 3D model using an UAV system which is developed based on first and second experiment’s result, evaluate an accuracy of 3D photogrammetric model and conducted at the tunnel named in the research as a “pedestrian tunnel. There is certain limitation in this study such as Adding a payload to a drone changed its weight distribution, which affected its stability. If the payload was not properly balanced, it caused the drone to fly unevenly, making it more difficult to control.

The study takes into account different classes of tunnel boring machines (TBMs), with the aim of identifying correlation models which are meant to estimate, at a preliminary design phase, the construction time of a tunnel and to evaluate the mechanical and operational parameters of the TBMs, starting from the knowledge of the tunnel length and/or the excavation diameter. To achieve this goal, first of all a database was created, thanks to the collection of the most meaningful technical parameters from a large number of tunnels; afterward, it was statistically analysed through Microsoft Excel. In a first phase, forecasting models were identified for the three types of machines investigated, separately for compact rocks (open TBM) and fractured rocks (single and double shield TBM). Then, the mechanical parameters collected through the database were analysed, with the aim of obtaining models that take into account, in addition to the type of TBM, the geological aspect, and the type of rock characterising the rock mass. Finally, the validation of the study was proposed in a real case, represented by the Moncenisio base tunnel, a work included in the new Turin–Lyon connection line. The estimated values were compared with the real ones, in order to verify the accuracy of the experimental models identified.

The surface defects of shield subway tunnel can significantly affect the serviceability of the tunnel structure and may compromise the operation safety. To effectively detect the multiple surface defects, this research employs a tunnel inspection trolley (TIT) based on the mobile laser scanning technique. By conducting the inspection of the shield tunnel on a metro line section, various surface defects are identified by the TIT, including water leakage defect, dislocation, spalling, cross-section deformation, etc. To explore the root causes of the surface defects, the association rules between different defects are calculated via an improved Apriori algorithm. Results show that: i) there are significant differences in different association rules of various surface defects of the shield tunnel; ii) the average confidence of the association rule “dislocation & spalling → water leakage” is as high as 57.78%, indicating that most of the water leakage defects are caused by dislocation and spalling of the shield tunnel in the sections being inspected; iii) the weakest rule appears at “water leakage → spalling”, with the average confidence of 13%. The association analysis can be used in predicting the critical defects influencing the structural reliability and operation safety, such as water leakage, and optimizing the construction and maintenance work for the shield subway tunnel.

The KOSovan Acute Coronary Syndrome (KOS-ACS) Registry is established as a prospective, continuous, nationwide, web-based registry that is operated online. The KOS-ACS registry is designed with the following objectives: 1) to obtain data on the demographic, clinical, and laboratory characteristics of ACS patients treated in Kosovo; 2) to create a national database with information on health care in ACS patients treated in Kosovo; 3) to identify the national features of associations between ACS characteristics and clinical outcomes, including mortality, complications, length of hospital stay, and quality of clinical care; and 4) to propose a practical guide for improving the quality and efficiency of ACS treatment in Kosovo. The Kosovo Society of Cardiology and University of Prishtina will be responsible for the development of the KOS-ACS registry and centralized data analysis at the national level. The KOS-ACS Registry will enroll all patients admitted, at any of the registered clinical centers, with the diagnosis of ACS and who will be clinically managed at any of the Kosovo hospitals. Data on patient demographics, clinical characteristics, previous and hospital drug treatment, and reperfusion therapy will be collected. The type of ACS (Unstable angina, NSTEMI or STEMI) will also be clearly defined. The time from first medical contact to balloon inflation (FMC-to-balloon) and door-to-ballon time will be registered. In-hospital death and complications will be registered. Data on post-hospital primary outcome (MACE: cardiac death, all-cause mortality, hospitalization, stroke, need for coronary revascularization) of patients, at 30 days and 1 year, will be included in the Registry.

The quality and shelf-life of NCS (Non-centrifugal sugar) mainly depend on the moisture content present in it. NCS formed by the current practice of open sun drying contains moisture substantially greater than the acceptable level of 3%. This paper presents the work taken up to design a tunnel dryer to attain require moisture content in granular NCS for various load conditions. Initially, an experimental investigation had been carried out on a laboratory scale dryer to achieve required moisture content (< 3%) for various load conditions. This experimental data was used for validating two drying models and found that one of the models is best suitable for designing an industrial-scale dryer. For various load conditions on each tray and dryer exit temperature, nine different cases were arrived at. The number of trucks, trays, drying time and energy requirements were computed using the suitable theoretical model. Tunnel dryer with a length of 18 m, a height of 1.2 m, a width of 1 m, number of trucks of 18 and 24 number of trays on each truck was found to be the suitable dryer to dry 1 tone of NCS based on the minimum energy requirement of 176.49 MJ, and a minimum drying time of 68 minutes.

Background: The workplace burnout syndrome is often associated with particular aspects of certain job positions, especially those which entail working with people with special needs. The burnout syndrome in healthcare jobs is a serious problem which has grown into an epidemic among healthcare workers and associates. Objectives: The aim of this research is to assess the presence of stress and burnout syndrome at work with healthcare workers, expert workers, professional associates and associates in social service institutions in Belgrade. Material and Methods: This research has been conducted in the form of a cross-sectional study of a representative sample in social institutions in Belgrade. It has been conducted from March to the end of June of 2023. The sample of the study had 491 participants. The questionnaires used were a structured instrument with social-demographic and social-economic characteristics, workplace characteristics, life style characteristics, and the following questionnaires: DASS-21, Copenhagen, Brief Resilience Scale, and Brief Resilient Coping Scale. Results: The end results indicate the following to be significant risk factors for the occurrence of workplace burnout syndrome: overtime (OR=2.62; CI=1.50-4.56), BRS average score (OR=0.28; CI=0.17-0.44), DASS21 D heightened depression (OR=2.09; CI=1.1-4.04), DASS21 A heightened anxiety (OR=2.38; CI=1.34-4.21), DASS21 S heightened stress (OR=2.08; CI=1.11-3.89). The only protective risk factor which stood out was the self-assessment of health levels (OR=0.60; CI=0.42-0.85). Conclusion: Overtime is a significant predictor of workplace burnout. Apart from it, other significant predictors of workplace burnout were heightened depression, anxiety, and stress levels.

(1) Background: Sudden Infant Death Syndrome (SIDS) represents unexplained and sudden deaths during the sleep of infants under one year of age, despite thorough investigation. Screening for prolonged QTc or Long QT Syndrome (LQTS) should be conducted on all newborns to reduce the incidence of SIDS. Neonatal electrocardiogram (ECG) could identify congenital heart defects (CHD) early, especially those not detected at birth. Infants with prolonged QT intervals typically undergo genetic analysis for Long QT Syndrome; (2) Methods: The study involved infants aged 20-40 days, born clinically healthy, with initial ECG screening. Infants with prenatal diagnoses or signs/symptoms of CHD identified immediately after birth, as well as those who underwent ECG or echocardiogram for other clinical or historical indications, were excluded from the study. The data were analyzed using SPSS version 22.0; (3) Results: Of the 42,200 infants involved, 2,245 were enrolled, with 39.9% being males. Subsequently, 164 children (37.8% males) with prolonged QT intervals underwent further diagnostic investigations. Genetic mutations were identified in 11 out of 18 tested children. The most common mutations were LQT1 (54.5%), LQT2 (36.4%), and LQT3 (1 patient). Medications used included propranolol (39.8%), nadolol (22.2%), inderal (11.1%), metoprolol (11.1%), and no treatment (16.7%). The most common abnormalities were focal right bundle branch block (54.5%), left axis deviation (9.2%), and nonspecific ventricular repolarization abnormalities (7.1%). Multiple anomalies were found in 0.47% of children with focal right bundle branch block. Structural abnormalities were associated with specific features in 267 patients (11.9%), primarily isolated patent foramen ovale (PFO) at 61.4%; (4) Conclusions: The screening has proven effective in early diagnosing Long QT Syndrome and other cardiac rhythm anomalies, with additional benefits in detecting mutations and/or QTc prolongations in family members. Identifying other ECG abnormalities and congenital heart malformations further enhances the benefits of the screening.

Molecular analysis of growing teratoma syndrome has not been extensively studied. Here, we report a 14-year-old boy with a growing mass during treatment for a mixed germ cell tumor of the pineal region. Tumor markers were negative; thus, growing teratoma syndrome was suspected. A radical resection via the occipital transtentorial approach was performed, and histopathological examination revealed a teratoma with malignant features. Methylation classifier analysis confirmed the diagnosis of teratoma, and DMRT1 loss and 12p gain were identified by copy number variation analysis, potentially elucidating the cause of growth and malignant transformation of the teratoma. The patient remains in remission after intense chemoradiation treatment as a high-risk germ cell tumor.

Deformation monitoring is beneficial to ensure the service safety of long tunnel. An three-direction (vertical, transverse and axial) deformation estimation method using long-gauge fiber Bragg grating (FBG) sensing technology is proposed and applied to a long tunnel by integrating mechanical analysis and field monitoring during the service state. The key issues of the proposed method for identifying the three-direction deformation are discussed, such as establishing the separation model of coupling strain on cross section, deriving the theory of deformation identification in three directions, and determining the sensor layout of the long tunnel. A major advantage of the proposed method is that the three-direction deformation of the tunnel can be monitored in real time using distributed long-gauge strain sensors. The numerical analysis and field test results verify the feasibility of the proposed method.

In the construction of shield crossing existing mined tunnel without load, it is imperative to develop corresponding design standards that reflect actual engineering force characteristics to ensure the successful completion of tunnel construction. This research uses The MIDAS-GTS finite element software to facilitate the creation of a numerical model of the shield structure for an air-push-over mine tunnel project in Changsha, China, investigating the stress field’s evolution during shield construction, and calculating the maximum positive and negative bending moments and maximum axial forces for different structures and other force states under various construction conditions. This study's findings informed the design and construction optimisation of the shield tunnelling empty-push method. The outcomes of this numerical simulation led to several key findings: (1) The soil density exerted a significantly greater impact on the internal forces of the initial support structure than both the tunnel depth and soil Poisson's ratio. Additionally, a sudden shift in internal forces occurred within the 300-350 mm range when the lining thickness was altered. (2) Factors such as the tunnel depth, soil density, soil Poisson's ratio μ, and lining thickness have a similarly influenced internal forces of the segment and the initial support. Notably, the backfill layer thickness significantly affected the segment’s maximum axial force causing an abrupt change of approximately 300 mm. (3) Under the shield machine equipment’s weight constraint, it is essential to control the guide rail’s thickness, to prevent it from becoming overly large.

In tunnel excavation with boring machines, the tunnel face is supported to avoid collapse and minimise settlement. This article proposes the use of reinforcement learning, specifically the Deep Q-Network algorithm, to predict the face support pressure. The approach is tested both analytically and numerically. By using the soil properties ahead of the tunnel face and the overburden depth as the input, the algorithm is capable of predicting the optimal tunnel face support pressure, adapting to changes in geological and geometrical conditions.

The accurate of model attitude angel plays an important role on the aerodynamic test results in the wind tunnel test. The original method applies the spherical coordinate system transformation to obtain attitude angel calculation. The model attitude angel is obtained by coordinate transformation and spherical surface mapping applying the nominal attitude angel (the balance attitude angel in the wind tunnel coordinate system) indicated by the mechanism. First, the coordinate transformation of this method is not only complex but also difficult to establish the transformed relationship between the space coordinate systems especially after many steps of coordinate transformation, moreover it cannot realize the iterative calculation of the interference relationship between attitude angels; Second, during the calculate process to solve the problem the arc is approximately used to replace the straight line, the angel for the tangent value, and the inverse trigonometric function is applied. Therefore, in the calculation of attitude angel, the process is complex and inaccurate, which can be solved approximately when calculating small attack angel. However, with the advancing development of modern aerodynamic unsteady research, the aircraft tends to develop high or super large attack angel and unsteady research field. According to engineering practice and vector theory, the concept of vector angel coordinate system is proposed for the first time, and the vector angel coordinate system of attitude angel is established. With the iterative correction calculation and avoiding the problem of approximate and inverse trigonometric function solution, the model attitude calculation process is carried out in detail, which validates that the calculation accuracy and accuracy of model attitude angels are improved. Based on engineering and theoretical methods, a vector angel coordinate system is established for the first time, which gives the transformation and angel definition relations between different flight attitude coordinate systems, that can accurately calculate the attitude angel of the corresponding coordinate system and determine its direction, especially in the channel coupling calculation, the calculation of the attitude angel between the coordinate systems is only related to the angel, and has nothing to do with the change order s of the coordinate system, which simplifies the calculation process.

The formulation and analytic solution of a new mathematical model with constitutive curvature for analysis of tunnel ventilation shaft wall is proposed. Based on the Mindlin-Reissner theory for thick shells, this model also takes into account the shell constitutive curvature and considers an expression of the shear correction factor variable (αn) in terms of the thickness (h) and the radius of curvature (R). The main advantage of the proposed model is that it has the possibility to analyze thin, medium and thick tunnel ventilation shafts. As a result, two comparisons were made: the first one, between the new model and the Mindlin-Reissner model without constitutive curvature with the shear correction factor (α_n=6/5) as a constant, and the other, between the new model and the tridimensional numerical models (solids and shells) obtained by finite element method for different slenderness ratios (h/R). The limitation of the proposed model is that it is to be formulated for a general linear-elastic and axial-symmetrical state with continuous distribution of the mass.

A Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is a debilitating chronic disease of unknown aetiology under growing interest now in view of the increasingly recognized post-COVID syndrome as a new entity with similar clinical presentation. We performed the first cross-sectional study of ME/CFS in community population in Russia and then described and compared some clinical and pathophysiological characteristics of ME/CFS and post-COVID syndrome as neuroimmune disorders. Of the cohort of 76 individuals who suggested themselves suffering from ME/CFS 56 subsequently were confirmed as having CFS/ME according to ≥1 of the 4 most commonly used case definition. Of the cohort of 14 individuals with post-COVID-19 syndrome 14 met diagnostic criteria for ME/CFS. The prevalence of clinically expressed and subclinical anxiety and depression in ME / CFS and post-COVID ME/CFS did not differ significantly from that in healthy individuals. Severity of anxiety / depressive symptoms did not correlate with the severity of fatigue neigther in ME / CFS nor in post-COVID ME/CFS, but the positive correlation was found between the severity of fatigue and 20 other symptoms of ME / CFS related to the domains of “post-exertional exhaustion”, “immune dysfunction”, “sleep disturbances”, "dysfunction of the autonomic nervous system", "neurological sensory / motor disorders" and "pain syndromes". Immunological abnormalities were identified in 12/12 patients with ME / CFS according to the results of laboratory testing. The prevalence of postural orthostatic tachycardia assessed by the active standing test was 37.5% in ME / CFS and 75.0% in post-COVID ME/CFS (the latter was higher than in healthy controls, p = 0.02) There was a more pronounced increase in heart rate starting from the 6th minute of the test in post-COVID ME/CFS compared with the control group. Assessment of the functional characteristics of microcirculation by laser doppler flowmetry revealed obvious and very similar changes in ME/CFS and post-COVID ME/CFS compared to the healthy controls. The identified pattern corresponded to the hyperemic form of microcirculation disorders, usually observed in acute inflammatory processes or in deficiency of systemic vasoconstriction influences.

Antiphospholipid antibody syndrome (APS) is an autoimmune disorder characterised by thrombosis and the presence of antiphospholipid antibodies (aPL): lupus anticoagulant and/or IgG/IgM anti-β2-glycoprotein I and anticardiolipin antibodies. APS carries significant morbidity for a relatively young patient population from recurrent thrombosis in any vascular bed (arterial, venous or microvascular), often despite current standard of care, which is anticoagulation with vitamin K antagonists (VKA). Platelets have established roles in thrombosis at any site, and platelet hyperreactivity is clearly demonstrated in the pathophysiology of APS. Together with excess thrombin generation, platelet activation and aggregation are the common end result of all the pathophysiological pathways leading to thrombosis in APS. However, antiplatelet therapies play little role in APS, reserved as a possible option of low dose aspirin in addition to VKA in arterial or refractory thrombosis. This review outlines the current evidence and mechanisms for excessive platelet activation in APS, how it plays a central role in APS-related thrombosis, what evidence for antiplatelets is available in clinical outcomes studies and potential future avenues to define how to target platelet hyperreactivity better with minimal impact on haemostasis.

Antiphospholipid syndrome (APS) is characterized by venous or arterial thrombosis and/or adverse pregnancy outcome in the presence of persistent laboratory evidence of antiphospholipid antibodies (aPL). Preeclampsia (PE) complicates about 10-17% of pregnancies with APS. However, only early onset PE (< 34 weeks of gestation) belongs to the clinical criteria of APS. The similarities in the pathophysiology of early onset PE and APS emphasize an association of these two syndromes. Overall, both are the result of a defective trophoblast invasion and decidual transformation at early gestation. Women with APS are at increased risk for prematurity; the reasons are mostly iatrogenic due to placental dysfunction, such as PE or FGR. Interestingly, women with APS have also an increased risk for preterm delivery, even in the absence of FGR and PE and therefore not indicated but spontaneous. The basic treatment of APS in pregnancy is low-dose-aspirin and low-molecular- weight-heparin. Nevertheless, up to 20-30% of women develop complications at early and late gestation despite basic treatment. Several additional treatment options have been proposed, with Hydroxychloroquine (HCQ) being one of the most efficient. Additionally, nutritional interventions, such as intake of vitamin D have shown promising beneficial effects. Curcumin, due to its antioxidant and anti-inflammatory properties, might be considered as additional intervention as well.

In South Sudan, three case-control studies found a positive association between Nodding Syn-drome (NS) and a Mansonella perstans infection. To investigate whether M. perstans could play the primary and sole causal role in the development of NS, we examined blood films of persons with and without epilepsy in rural villages affected by NS in Mahenge, Tanzania, to identify M. perstans infections. Study participants were also examined for onchocercal nodules and skin lesions and tested for the presence of anti-O. volvulus antibodies (Ov16 ELISA). One hundred and thirteen epilepsy cases and 132 controls were enrolled, with a mean age of 28.3 years (interquartile range 22 – 34 years); 125 (51%) were females. Of the persons with epilepsy, 43 (38.1%) met the probable NS criteria. M. perstans infection was absent in all participants, but Ov16 prevalence and oncho-cerciasis-associated skin manifestations were positively associated with epilepsy, including probable NS. Onchocercal nodules in the mothers of cases were also positively associated with epilepsy. In conclusion, in contrast with O. volvulus, M. perstans is likely not endemic in Mahenge and therefore cannot be a co-factor for NS in the area. Hence, this filaria cannot be the primary and sole causal factor in the development of NS.

(1) Background: The stylohyoid syndrome, known as classical Eagle Syndrome (cES), is characterized by calcificatication of the stylohyoid chain with numerous nonspecific symptoms, mainly pain. This study introduces Minimally Invasive Cervical Styloidectomy (MICS). (2) Methods: MICS was performed on sixty-five patients diagnosed with classical Eagle syndrome. Patients underwent meticulous differential diagnosis. Surgical plans were established based on the findings from neck angioCT. (3) Results: The healing process was uneventful without significant complications. The overall success rate was 97.0%, with a follow-up of a minimum of six months. In one case, the surgery did not yield the desired improvement. In one case, a partial relapse of symptoms was observed. (4) Conclusions: MICS is a straightforward and efficient surgical treatment technique for stylohyoid syndrome.

Superior mesenteric artery (SMA) syndrome or Wilkie’s syndrome is a vascular compression disorder that causes abnormal compression of the third portion of the duodenum by the SMA. It has a low incidence rate, higher in young women, and is rarely associated with the Nutcracker phenomenon: a condition of compression of the left renal vein between the SMA and the aorta, which manifests as pain in the left flank and pelvis. Here we report the case of a 54-year-old woman with a history of repeated episodes of abdominal pain caused by the Nutcracker syndrome and Wilkie's syndrome.

In order to master the structure state of subway shield tunnel, reduce the diseases and avoid the potential safety hazards, the lateral convergence deformation of subway shield tunnels should be predicted. For the non-stationarity small sample size of subway shield tunnel lateral convergence deformation value, the existing prediction models have poor performance in terms of accuracy and stability. In this paper, a lateral convergence model of subway shield tunnel based on Kalman algorithm is constructed based on Kalman filtering theory. The model is efficient, adaptive and robust, and can accurately predict the lateral convergence deformation of subway shield tunnel. Taking the horizontal diameter of 200 rings shield segment in the interval section of a subway tunnel as an example, it is proved that the residuals of the Kalman prediction model are small, the residual distribution conforms to the normal distribution, and the prediction effect is great. The model is suitable for the prediction of more than 5 periods of data, and the prediction accuracy of the model is improved with the increase of the number of data periods. In addition, the Kalman model is compared with GM(1,1) model and GM-Markov model, and RMSE and MAPE are introduced as evaluation indexes. The results show that the Kalman model has higher prediction accuracy and is more suitable for predicting the lateral convergence deformation of subway shield tunnel.

Etiological factors involved in myelodysplastic syndrome (MDS) include immunologic, oxidative stress, and inflammatory factors, among others, and these are targets for microRNAs (miRNs). Here, we evaluated whether some miRNs may affect the tumor development comparing untreated and 5-azacitidine (5-AZA) MDS-treated patients. Peripheral blood samples were collected from 20 controls and 24 MDS patients, and selected miRNs related to redox balance and inflammation, including miR-18a, miR-21, miR-34a and miR-146a, were isolated and measured by quantitative real-time polymerase chain reaction (qRTPCR). A differential expression profile of miRNs was detected in untreated MDS patients and 5-AZA group. MiR-18a, miR-21, miR-34a and miR-146a were significantly overexpressed in untreated MDS, compared to controls. However, we did not observe any miRNs profile alteration during the progression of the disease. On the other hand, 5-AZA treatment tends to restore miRNs expression levels. Relating to prognostic risk factors, high risk MDS groups (high IPSS-R, high cytogenetic risk, high molecular risk (HMR) mutations tended to be related with higher expression levels of miR-18a and miR-34a. Higher miRNs expression is correlated with lower glutathione peroxidase activity, while they are related with a higher profile of pro-inflammatory cytokines (IL-2, IL-6, IL-8, TNF-α). Although our study was limited by the low number of MDS patients included, we identified miRNs deregulation involved in the MDS development, that could regulate redox sensors and inflammatory responses. Finally, 5-AZA treatment is related with lower miRNs expression levels in MDS patients.

This study aimed to investigate the efficacy of manual therapy and exercise versus synchronized telerehabilitation with self-manual therapy and exercise in treating Subacromial Pain Syndrome (SAPS). Sixty individuals diagnosed with SPS, aged 18-50 years, were randomly assigned to home exercise (HE), manual therapy (MT), and telerehabilitation (TR) groups. Treatment protocols were administered over 8 weeks and included specific exercises and therapy interventions. Out-come measures included Visual Pain Scale (VAS), shoulder range of motion (ROM) via gonio-metric measurements, Quick Disability Arm-Shoulder-Hand Problems Survey (Q-DASH), and patient satisfaction. Results revealed that both MT and TR groups exhibited reduced pain, in-creased ROM, lower Q-DASH scores, and higher patient satisfaction compared to the HE group. However, no significant differences were found between MT and TR groups in pain levels, ROM, Q-DASH scores, or patient satisfaction. The study concludes that both telerehabilitation and manual therapy effectively alleviate pain and are well-received by patients with SPS. Addition-ally, manual therapy demonstrates superiority in enhancing functional levels compared to exer-cise-based interventions. (Registration: NCT05200130)

Van Wyk Grumbach syndrome refers to the development of peripheral precocious puberty, long-standing hypothyroidism, and gonadal masses; when not diagnosed, an unnecessary gonadectomy may be done; Here we present a case of a 10-year-old girl with Down syndrome, short stature, and vitiligo presented with vaginal bleeding, and a pelvic mass, in whom bilateral gonadectomy was performed. Most cases of Van Wyk Grumbach syndrome present in women, and classic hypothyroidism symptoms always precede the diagnosis; 11% of patients have Down Syndrome, sometimes tumor markers get elevated, and some develop severe symptoms (myopathy, short stature, mental delay, ascites, pericardial effusion, Cullen sign, pituitary hyperplasia, and severe anemia), that respond to levothyroxine treatment; Conclusions: Children with peripheral precocious puberty and gonadal masses, must be studied for hypothyroidism before any radical decision is made. Keywords: Puberty, Precocious; Ovarian Cysts, gonadectomy, Van Wyk Grumbach Syndrome

Balínt Syndrome is an acquired disorder manifesting in the inability to recognize several objects at once (simultagnosia), inaccurate visually guided limb movements despite intact motor function (optic ataxia) and the inability to make accurate voluntary saccades to visual targets despite demonstrating unrestricted range of eye movements (ocular motor apraxia). Here we report the first case of a patient presenting with Balínt Syndrome caused by a platelet-derived growth factor receptor A mutation (PDGFRA)-induced Hypereosinophilic Syndrome (HES).

Predominantly antibody deficiencies (PAD) represent the most common type of primary immu-nodeficiencies in humans, characterized by a wide variation in disease onset, clinical manifesta-tions, complications and outcome. Considering that the prevalence of PAD in Greece is unknown and there is limited knowledge on clinical and laboratory characteristics of affected patients, we conducted a nationwide study, including 153 patients (male/female: 66/87; median age: 43.0 years; range: 7.0-77.0) diagnosed and/or followed-up between April 2007 to September 2023. Furthermore, we classified our cohort into five Groups according to their medical history, im-munoglobulin levels, and CTLA4-mutational status: 123 had common variable immunodeficien-cy (CVID), 12 with CVID-like disease (with a history of a previous B-cell depletion immunother-apy for autoimmune or malignant disease), seven with combined IgA and IgG subclass deficien-cies, five with immune dysregulation syndrome and CTLA4 defects, and six with unclassified hypogammaglobulinemia. We demonstrated a remarkable delay of PAD diagnosis, several years after the onset of related symptoms (median: 9.0 years, range: 0-43.0). Family history of PAD was only 11.8%, with the majority of patients considered sporadic cases. Most patients were diag-nosed in the context of a diagnostic work-up for recurrent infections, or recurrent/resistant auto-immune cytopenias. Interestingly, ten patients (5.6%) had no history of infection, diagnosed due to either recurrent/resistant autoimmunity, or during a work-up of their medical/family history. Remarkable findings included an increased prevalence of lymphoproliferation (60.1%) and atopy (24.2%), while 39 patients (25.5%) developed bronchiectasis and 16 (10.5%) granulomatous dis-ease. Patients with CTLA4 defects displayed a variable clinical phenotype at diagnosis, with four patients diagnosed during a work-up of re-current infections, while one also displayed a massive splenomegaly. Cancer was a common complication in our cohort (25 patients, 16.3%), with B-cell malignancies representing the most common neoplasms (56.7%). Our findings indicate the necessity of awareness about PAD and their complications, aiming for early diagnosis and appropriate management of affected patients

A series of water diversion projects to address the uneven distribution of water resources in China involve the construction of a large number of hydraulic tunnels. As the lining structure that maintains the stability and durability of the tunnels, it is prone to durability damage during the operation process, which in turn affects the water transmission safety and water supply capacity. Therefore, it is important to evaluate the durability of hydraulic tunnel lining structure. Considering the randomness and fuzziness of the factors affecting the durability of hydraulic tunnel lining structure, this paper proposes a comprehensive evaluation model based on the coupling of set-pair analysis and extension. The G1 method and the simple correlation function method are used to determine the subjective and objective weights of the evaluation indexes respectively, and the combination weight is assigned based on the principle of minimum entropy; the set-pair analysis principle is used to establish the linkage affiliation function, calculate the comprehensive linkage affiliation of the object to be evaluated, and the maximum affiliation principle is used to judge the durability level of the hydraulic tunnel lining structure. Finally, taking a section of hydraulic tunnel as an example, the model proposed in this paper is used to calculate its durability grade as Class III, with the set-pair potential SHI(H) = 7.5856, which is consistent with the actual engineering practice, and a comparative study is done in combination with the AHP-Extenics method. It is verified that the evaluation model can scientifically and reasonably evaluate the durability of hydraulic tunnel lining structure, providing a basis for subsequent maintenance and reinforcement.

Caudal regression syndrome (CRS) is a congenital abnormality characterized by an incomplete development of the spinal cord (SC) and other abnormalities. We studied a 9-months old CRS child presenting: interruption of SC at L2-L3 level, sacral agenesis, lack of innervation of the inferior limbs (flaccid paraplegia) and neurogenic bladder and bowel. Given the effects of growth hormone (GH) on the proliferation, differentiation and migration of neural stem cells (NSCs), we treated him with GH and rehabilitation, trying to induce the recovery of main sequelae. GMFM-88 test score was 12.31%. After a blood analysis, GH treatment (0.3 mg/day, 5 days/week, 3 months and then 15 days without GH) and rehabilitation commenced. This protocol was followed during 5 years, being the last GH dose 1 mg/day. Blood analysis and physical exams were performed every 3 months initially and every 6 months later. Six months after commencing the treatment GMFM-88 score increased to 39.48%. Responses to sensitive stimuli appeared in most of the territories explored; 18 months later sensitive innervation was complete and the patient moved any muscle over the knees and controlled his sphincters. Three years later he walked with the help of canes, there was plantar flexion and GMFM-88 score was 78.48%. In summary, GH plus rehabilitation may be useful for innervating distal territories, below the level of the incomplete spinal cord in CRS. Most likely, GH acts on ependymal SC NSCs, as the hormone does in the neurogenic niches in the brain.

This paper presents the results of hot smoke tests, conducted in a real road tunnel. The tunnel is located within the expressway S69 in southern Poland between cities Żywiec and Zwardoń. Its common name is Laliki tunnel. It is a bi-directional non-urban tunnel. The length of the tunnel is 678 m and it is inclined by 4%. It is equipped with the longitudinal ventilation system. Two hot smoke tests have been carried out according to Australian Standard AS 4391-1999. Hot smoke tests corresponded to a HRR (Heat Release Rate) equal to respectively 750 kW and 1500 kW. The fire source was located in the middle of the road lane imitating an initial phase of a car fire (respectively 150 m and 265 m from S portal). The temperature distribution was recorded during both tests using a set of fourteen thermocouples mounted at two stand poles located at the main axis of the tunnel on windward. The stand poles were placed at distances of 5 m and 10 m. The recorded data were applied to validate of a numerical model built and solved using Ansys Fluent. The calculated temperature distribution matched the measured values.

Introduction: Acute compartment syndrome (ACS) is a surgical emergency that requires urgent intervention in order to prevent permanent structural damage and irreversible functional disability. The diagnosis of ACS depends on a high index of suspicion, relying on the following diagnostic criteria commonly known as the 5 Ps; Pain, Paresthesia, Paralysis, Pallor, and Pulse-lessness. When the diagnosis is uncertain, intracompartmental pressure greater than 30 mmHg is suggestive of ACS. Case Presentation: We report a case of an underdiagnosed ACS, with a lack of classical presentation in a thirty-seven-years-old male patient with a history of myopathy. The patient was admitted to the emergency room due to direct trauma to his right hip, without a significant Visual Analogue Score. On his hip radiograph a subtrochanteric fracture of the right femur was demonstrated. An additional masked ipsilateral subcapital fracture was detected during the operation. The diagnosis of ACS was made during the operation while relying on the clinical appearance of the thigh and the clinical findings during surgery. Fasciotomies were performed, and open reduction with internal fixation via Proximal Femoral Nail was done. The diagnosis of ACS was confirmed later on, by the biopsy results. Conclusion: This case suggests that myopathy can mask the classical presentation of ACS. Furthermore, the extent of pain complaints and accompanying paresthesia cannot be relied on in this regard and other clinical features should be considered in order to diagnose ACS.

High-precision dynamic positioning of highway vehicles is the foundation and prerequisite for achieving intelligent connected transportation. For the shortcomings of GNSS/INS combination and GNSS/INS/OD combination in tunnel vehicle positioning, this paper proposes a tunnel vehi-cle positioning method of GNSS/INS/OD combination based on lateral distance measurement and lane constraint. Firstly, lateral distance measurement of vehicles inside the tunnel is conducted based on laser radar point cloud data. Secondly, map matching positioning is performed based on lateral distance measurement, odometer, and lane markings. Experimental results demonstrate that for a 4.6 km tunnel, the average absolute error of lateral positioning is 0.294 meters, and the longitudinal positioning error is no more than 0.6 meters, which can effectively meet practical operational requirements.

Drafting formations have been long recognized as highly effective for reducing drag and enhancing athletic performance, particularly in race walking events. The precise spacing and positioning of the race walkers are critical to optimizing the effectiveness of drafting. In this study, the drag reduction of 15 drafting formations is investigated using wind-tunnel experiments and CFD numerical simulations. The results show excellent consistency in drag reduction rate between the two methods, with differences being within 10%. This can be attributed to spacing replacing body shape differences as the primary factor influencing drag reduction. Optimal double, triple, and quadruple drafting formations produce the same results in both wind-tunnel experiments and CFD simulation, resulting in drag reductions of 67%, 66%, and 81% (wind-tunnel) and 65%, 72%, and 85% (CFD). The sources of drag differences in the two methods are discussed from various aspects. The flow field obtained through CFD analysis is used to examine the mechanism of drag reduction, revealing that drafting formations have a significant shielding effect on incoming air, which reduces the number and speed of airflow impacting the core race walker. This shielding effect is identified as the primary cause of drag reduction. Using an empirical model for mechanical power output, optimal double, triple, and quadruple drafting formations enhance sport economy (4.4-5.7%), speed (3.61-4.67%), and performance (173.8-223.3s) compared to race walking alone. The findings can serve as a reference for race walkers' positioning strategy and provide insights for considering drafting formations in various running events.

Sudden variation of aerodynamic loads is the potential source of safety accidents of high-speed train (HST). As a follow-up investigation on the aerodynamic response of a HST that enters a tunnel under crosswind environment, this paper focuses on the transient response of a HST’s safety indices based on the train–track coupling interaction model. Firstly, a wind–train–track coupling dynamic model is proposed by introducing transient aerodynamic loads into the vehicle–track system. Secondly, the temporal evolution of safety coefficients indicates that the train’s safety risk increases during tunnel entry with crosswind. Results show that the derailment coefficients and wheel load reduction rate during tunnel entry are not only larger than those in open air but also those inside the tunnel due to the sudden disappearance of wind excitation at the tunnel entrance. In addition, the characteristic wind curve, which is the wind velocity against the train speed, is presented for application based on the current specification of the safety criteria threshold. The investigation will be useful in assessing the safety risk of a running train subjected to other aerodynamic attacks, such as the coupling effect of infrastructure scenario and crosswind in windy area.

Background: DICER1, cancer predisposition syndrome (CPS), seems to escape timely diagnosis in pediatric patients. Case report 1: A 16-year-old female patient was referred to the endocrinology ward due to a large goiter. Her medical history indicated normal sexual maturation, with menarche occurring at 13.5 years. Over the past 2.5 years, she developed pronounced androgenic symptoms, including a deepened male voice, facial, back and neckline acne, hirsutism, and menstrual irregularities leading to secondary amenorrhoea. A thyroid ultrasound identified a multinodular goiter with cystic-solid lesions containing calcifi-cations. An abdominal ultrasound identified a 5.7x6.9 cm solid mass in the right adnexal region, displacing the uterus to the left. Histopathological examination confirmed a Sertoli-Leydig cell tumor. The patient was subjected to total thyroidectomy. Histopathology revealed benign follicular cell-derived neoplasms. Thyroid follicular nodular disease was diagnosed bilaterally. DNA analysis using NGS, confirmed by the Sanger method, revealed a pathogenic heterozygotic variant c.2953>T [p.Gln985*] in exon 18 of DICER1 gene. Case report 2: A 12-year-old male patient was admitted to the pediatric surgery unit due to a 33 ml goiter. A month prior to admission, the patient discovered a palpable nodule in his neck, accompanied by hoarseness. An ultrasound revealed a multinodular goiter. Molecular analysis revealed a pathogenic heterozygotic variant c.2782C>T [p.Gln928Ter] in exon 17 of DICER1 gene. Subsequently, a total thyroidectomy was performed, and histopathological examination revealed thyroid follicular nodu-lar disease bilaterally. Conclusion: Multinodular goiter, although rare in pediatric population, when accompanied by characteristic ultrasound and histopathological features, and by additional features such as androgen excess, warrants exclusion of DICER1 syndrome.

Individuals with metabolic syndrome have increased risk for developing health conditions, in-cluding cardiovascular diseases and stroke. Modifiable risk factors, such as exercise and diet, are key components in the prevention and control of metabolic syndrome. Specifically, dietary pat-terns and habits are extremely successful in controlling more than one of the metabolic syn-drome risk factors. Meal timing and frequency have been associated with type 2 diabetes, cardi-ovascular diseases, and other chronic conditions. However, there is limited evidence linking metabolic syndrome to meal timing and meal frequency. This review summarizes and discusses how meal timing and frequency impact metabolic outcomes in adults.

Congenital Disorders of Glycosylation (CDG) are a heterogenous group of primarily autosomal recessive mendelian diseases caused by disruptions in the synthesis of lipid linked oligosaccha-rides and their transfer to proteins. CDGs affect multiple organ systems and vary in presentation, even within families. Here we describe a chemically induced mouse mutant, tvrm76, with early onset photoreceptor degeneration. The recessive mutation was mapped to Chromosome 9 and as-sociated with a missense mutation in the Dpagt1 gene encoding UDP-N-acetyl-D-glucosamine:dolichyl-phosphate N-acetyl-D-glucosaminephosphotransferase (EC 2.7.8.15). The mutation is predicted to cause a substitution of aspartic acid with glycine at residue 166 of DPAGT1. Increased expression of Ddit3, and elevated levels of HSPA5 (BiP) sug-gest the presence of early-onset endoplasmic reticulum (ER) stress. These changes were associated with induction of photoreceptor apoptosis in tvrm76 retinas. Mutations in human DPAGT1 cause Myasthenic Syndrome 13 and severe forms of Congenital Disorder of Glycosylation Type Ij. In contrast, Dpagt1tvrm76 homozygous mice present with congenital photoreceptor degeneration without overt muscle or muscular junction involvement. Our results suggest the possibility of DPAGT1 mutations in human patients that present primarily with retinitis pigmentosa with little or no muscle disease. Variants in DPAGT1 should be considered when evaluating cases of non-syndromic retinal degeneration.

With more and more transportation tunnels have been and will be constructed in loess areas in Northwest China with high earthquake potential, the overall stability of portal section under earthquakes actions and the related aseismic countermeasures attracted the attentions from both the scholars and engineers, especially the tunnels in the upper slope connecting the high bridges crossing rivers or valleys. In order to study the dynamic response characteristics and damage evolution of steep loess slope with a tunnel under the earthquake actions, a large-scale shaking table tests were performed on steep loess slope with a tunnel. Wenchuan-tangyu (WT) wave and El Centro (El) wave records were applied on the model to investigate the displacement response and acceleration response of loess slope with a tunnel under the horizontal (X) and the combined action of horizontal and vertical (X-Z) seismic loads, respectively. In particular, three-dimensional non-contact optical measurement techniques were used to obtain the slope surface displacements. The results showed that the main deformation pattern of the slope was horizontal movement and settlement when the seismic wave input was in the X and X-Z directions, respectively. However, the X direction seismic wave had a greater impact on the deformation of the slope, and the tunnel portal slope was destroyed under the action of a large horizontal seismic acceleration finally. Slope failure ahead of a tunnel could be divided into four stages, i.e. elastic deformation stage, plastic deformation accumulation stage, local failure stage, and overall failure stage. The peak ground displacement of X direction (PGDX) and peak ground displacement of Z direction (PGDZ) of the slope surface increased with the increasing of the input peak ground acceleration (PGA) when the input wave was same waveform and same direction. The existence of the tunnel had a great influence on the PGA and the PGA amplification factor (PGAAF) of the soil mass surrounding it. This was because the seismic waves encounter a tunnel surface with clear differences in the physical properties of the medium during their propagation in the slope, thereby forming a strong reflection and refraction effect, and the amplitude changed significantly. Numerical simulation results were basically consistent with the experimental results.

Based on the kinematic approach of the limit analysis and slip-line theories, this paper proposes a new 2D analytical model to evaluate the collapse support pressure to ensure the face stability of a circular tunnel in purely cohesive soils driven by a shield. The normality conditions, the yield criterion and the vertical soil arching effect are considered in the analytical model. Two upper bound solutions corresponding to the ratio of the cover to the diameter (C/D) are derived from considering the mechanisms based on the motion of rigid multi-blocks. Comparisons are made with existing upper and lower bound solutions published in previous articles. The results are close to the solutions of practical engineering. The failure mechanisms proposed in this study provide a better explanation for the failure process in the heading of the tunnel face.

The objective of this study was to analyze the effects of a pulmonary telerehabilitation (TR) program in young adults with post-COVID-19 syndrome. The information of sixteen students' medical files were analyzed and allocated to one of two groups (control=CG/experimental=EG). Twelve TR sessions were performed distantly and asynchronously at the EG patients' homes during 4-weeks. The program included diaphragmatic pattern breathing and aerobic exercises. The parameters: i) vital signs (oxygen saturation "SpO2", heart rate "HR", respiratory rate "RR" and blood pressure "BP"; ii) physical capacity “Sit-to-stand test”; iii) cardiorespiratory capacity “6-Minute Walk Test”; and iv) perceived effort "Borg scale" were assessed in both groups. The statistical analyses showed a significant decrease of RR and HR (p < 0.012) accompanied by a significant increase in SpO2 (p < 0.042), physical (p < 0.012) and respiratory (p < 0.028) capacity. The perceived effort decreased significantly in both groups (CG: p < 0.006; EG p < 0.001) only for physical but not for cardiorespiratory capacity (p < 0.106). There were no statistical changes registered in BP (p > 0.05). The current study suggests that a TR program that involves breathing and aerobics exercises is feasible and effective in treating post-COVID-19 syndrome in young patients.

The progressive reappearance of the Zika virus (ZIKV) infection since October 2013 and its circulation in >70 countries and territories (from French Polynesia to Brazil and other countries in the Americas, with sporadic spread in Europe and the East) has long been reported as a global public health emergency. ZIKV is a virus transmitted by arthropods (arboviruses), mainly by Aedes mosquitoes. ZIKV can also be transmitted to humans through mechanisms other than vector infection such as sexual intercourse, blood transfusions, mother-to-child transmission. The latter mode of transmission can give rise to a severe clinical form called Congenital Zika Syndrome (CZS) which can result in spontaneous abortion or serious pathological alterations in the fetus such as microcephaly, neurological and orofacial anomalies. In this study, beside a succinct overview of the etiological, microbiological, epidemiological aspects and modes of transmission of Zika virus infection, we have focused our attention on the pathogenetic and histopathological aspects in pregnancy and the pathogenetic and molecular mechanisms that can determine microcephaly, and consequently the clinical alterations, typical of the fetus and newborns, in a subject affected by CZS.

In the context of the Korean building structure standard KDS2022, wind loads can be readily calculated in terms of the along-wind, across-wind, and torsional components, based on a single wind direction. However, this approach falls short in accurately and safely evaluating the impact of winds from various directions. Therefore, in this study, we developed a Wind Load Calculation Program (WCP) capable of predicting wind loads with relative precision during the preliminary design phase. First, wind tunnel tests were conducted to identify the essential factors necessary for calculating wind loads and the variables influencing these factors. The building shape considered was a square, and the wind force coefficients and power spectral density were measured by combining 4 ground roughness values, 11 side ratios (), 4 aspect ratios (), and wind directions ranging from 0° to 90°. Subsequently, a generalized formulation was devised to facilitate wind load calculations across diverse conditions and a method for calculating load combination coefficients, considering response correlation and load simultaneity, was presented. Finally, the wind loads obtained from the wind tunnel tests were compared with those predicted by the WCP using an actual project model.

Recently L-shaped tunneling field-effect-transistor (LTFET) has been introduced to overcome the thermal subthreshold limit of conventional metal-oxide-semiconductor field-effect-transistors (MOSFET). In this work, shortcoming of LTFET was investigated. It was found that corner effect present in LTFET effectively degrades its subthreshold slope. To get rid of corner effect a new type of device with dual material gates is presented. The new device termed as DG-LTFET gets rid of the corner effect and results in a significantly improved subthreshold slope of less than 10 mV/dec, and an improved ON/OFF current ratio over LTFET. In this work DG-LTFET was evaluated for different device parameters, and bench-marked against LTFET. This work presents an optimum configuration of DG-LTFET in terms of device dimensions and doping levels, to get the best subthreshold, ON current and ambipolar performance from the DG-LTFET.

Down Syndrome (DS) is a chromosomal disorder due to the presence of an additional chromosome 21 that causes intellectual deficit and physical anomalies and predisposes patients to develop infections throughout their lives. Pneumonias are more serious in patients with DS, requiring hospitalization, and represent an important cause of mortality in this population. Cytomegalovirus (CMV) causes widespread and serious infections in immunocompromised individuals, affecting the respiratory tract and, causing interstitial pneumonia, is associated with a high mortality rate. However, CMV-induced pneumonia is not reported in DS patients. The prevalence and severity of CMV respiratory infections in subjects with DS is unknown. This case describes a 50-year-old female patient suffering from DS who developed extensive bilateral pneumonia with severe respiratory failure which required hospitalization in intensive care, intubation and mechanical ventilation after approximately 10 days of empiric antibiotic and anitimycotic therapy for fever, cough and dyspnea. The patient was diagnosed with CMV pneumonia and recovered after treatment with Ganciclovir. To the best of our knowledge, this is the first reported case of CMV pneumonia in a patient with DS. This case aims to highlight that CMV pneumonia in individuals with DS can be a life-threatening condition. It also clarifies the importance of early diagnosis of infections from opportunistic pathogens such as CMV to ensure timely and efficient treatment.

Symptoms attributed to the gastrointestinal manifestations of multi-system disorders play an important role in the long-term management of these conditions. Gastrointestinal complications of a variety of connective tissue disorders have been studied and there is an increased interest in the incidence and prevalence of these symptoms. Descriptions of the occurrence of gastrointestinal complications in Marfan syndrome have appeared infrequently in the medical literature. In this review article we focus on both structural and functional gastrointestinal pathology that may occur in patients with Marfan syndrome.

The continuous advancement of Artificial Intelligence (AI) technology depends on the efficient processing of unstructured data, encompassing text, speech, and video. Traditional serial computing systems based on the von Neumann architecture, employed in information and communication technology development for decades, not suitable for the concurrent processing of massive unstructured data tasks with relatively low-level operations. As a result, there arises a pressing need to develop novel parallel computing systems. Recently, there has been a burgeoning interest among developers in emulating the intricate operations of the human brain, which efficiently processes vast datasets with remarkable energy efficiency. This has led to the proposal of neuromorphic computing systems. Of these, Spiking Neural Networks (SNNs), designed to closely resemble the information processing mechanisms of biological neural networks, are subjects of intense research activity. Nevertheless, a comprehensive investigation into the relationship between spike shapes and Spike-Timing-Dependent Plasticity (STDP) to ensure efficient synaptic behavior remains insufficiently explored. In this study, we systematically explore various input spike types to optimize the resistive memory characteristics of Halfnium-based Ferroelectric Tunnel Junction (FTJ) devices. Among the various spike shapes investigated, the square-triangle (RT) spike exhibited good linearity and symmetry, and a wide range of weight values could be realized depending on the offset of the RT spike. These results indicate that the spike shape serves as a crucial indicator in the alteration of synaptic connections, representing the strength of the signals.

Wave is a common environmental load that often causes serious damages to offshore structures. In addition, the stability for the submarine artificial slope is also affected by the wave loading. Although the landslide of submarine slopes induced by the waves has received wide attention, the research on the influence of solitary-wave is rare. In this study, a 2-D integrated numerical model is developed to investigate the stability of the foundation trench under the solitary wave loading. The Reynolds-Averaged-Stokes (RANS) equations are used to simulate the propagation of a solitary wave, while the current is realized by setting boundary inlet/outlet velocity. The pore pressure induced by the solitary wave is calculated by Darcy’s law and the seabed is characterized by Mohr-Coulomb constitutive model. Firstly, the wave model is validated through the comparison between analytical solution and experimental data. The initial consolidation state of slope under hydrostatic pressure is achieved as the initial state. Then, the factor of stability (FOS) for the slope corresponding to different distance between wave crest and slope top is calculated with the strength reduction method. The minimum of FOS is defined as the stability index for the slope with specific slope ratio during the process of dynamic wave loading. The parametric study is conducted to examine the effects of soil strength parameters, slope ratio and current direction. At last, the influence of upper slope ratio in a two-stage slope is also discussed.

The stability assessment of aged tunnel linings were mainly evaluated based on the visual inspection, and the Tunnel-lining Crack Index (TCI) is one of the most widely used tunnel lining health assessment indexes in Japan. However, the intersection and distribution of cracks, which can influence the stability of tunnel lining greatly, were not considered in the TCI. A new method was proposed for the health assessment of tunnel lining, which evaluate the lining states according to the fractal dimension of cracks. Based on the machine vision-based method, the crack image can be extracted efficiently. The fractal dimension of lining cracks in one span can be obtained in a few minutes. A series of comparative tests and field tests were conducted to evaluate the validity of this new method. The comparative tests confirmed that fractal dimension can characterize the density, width, and distribution of cracks. The results also certificated that the influence of crack width is larger than the crack density. The intersection of cracks, which will increase the risk of lining collapse, can also increase the fractal dimension, whereas the TCI keep constant. The fractal dimensions of tunnel lining cracks were obtained according to the digital inspection test of Hidake Tunnel in Japan for all the 65 spans. Moreover, the TCI was obtained through statistical methods. The correlation between fractal dimension and TCI of tunnel lining was studied. The significance of the new evaluation index is that it can identify some unusual spans of tunnel lining and provide a basis for further internal testing. As a complement to the conventional visual inspection method, the fractal dimension of the cracks is a promising health assessment index.

Given that metabolic syndrome, along with obesity as one of its key components, remains one of the leading yet insufficiently addressed public health issues, what contributes to the development and maintenance of the disorder must certainly attract the attention of professionals and scientists. Precisely because of this phenomenon, eating patterns associated with metabolic syndrome should be studied and attempts should be made to uncover patterns in occurrence. The aim of this study is to review the literature and consider the connection between metabolic syndrome and eating patterns such as emotional and compulsive eating, as well as through the lens of food addiction. Furthermore, we have attempted to uncover the role of psychiatry and psychotherapy in the treatment of metabolic syndrome and delve into the complexity of recognizing these patterns and emphasize the importance of a multidisciplinary approach in the treatment of metabolic syndrome.

Gilbert's syndrome (GS) is a common hereditary condition characterized by mild increases in serum bilirubin levels due to inherited defects in bilirubin metabolism. This review, based on data from peer-reviewed articles and journals spanning from 1977 to January 2024, provides a comprehensive overview of over four decades of research on GS. Early studies primarily focused on defining the clinical and genetic characteristics of the syndrome, laying the foundation for subsequent investigations. More recent research has delved into the genetic mechanisms underlying the reduced expression of bilirubin UDP-glucuronosyltransferase, which has significantly enhanced our understanding of the pathogenesis of GS. Furthermore, recent studies have shed light on the clinical implications of GS, including its association with non-alcoholic fatty liver disease and mortality risk, highlighting the complex interplay between genetic factors, bilirubin metabolism, and clinical outcomes. Despite its generally benign nature, thorough research is essential to fully understand the impact of GS on patients' lives. This review emphasizes the importance of ongoing research to deepen our understanding of GS and its broader implications.

The most frequent cause of cardiac failure globally is ischemic heart disease, with chemothera-py-related cardiovascular side effects emerging as the second most frequent cause. Cancer therapy can result in acute cardiac events, such as coronary artery spasm, acute myocardial infarction, thromboembolism, myocarditis, bradycardia, tachyarrhythmias, atrio-ventricular blocks, QT pro-longation, torsades de pointes, pericardial effusion and hypotension, as well as chronic conditions, such as hypertension, systolic and diastolic left ventricular dysfunction presenting clinically as heart failure or cardiomyopathy. In cardio-oncology, when referring to cardiac toxicity and cardiovas-cular hypersensitivity, there is a great deal of misunderstanding. When a dose-related cardiovas-cular side effect continues even after the causative medication is stopped, it is referred to as cardi-otoxicity. A fibrotic response is the ultimate outcome of cardiac toxicity, which is defined as a dose-related cardiovascular adverse impact that lasts even after the causative treatment is stopped. Cardiotoxicity can occur after a single or brief exposure. On the other hand, the term cardiac or cardiovascular hypersensitivity describes an inflammatory reaction that is not dose-dependent, can occur at any point during therapy, even with very low medication dosages, and can show up as Kounis syndrome. It may also be accompanied by anti-drug antibodies and tryptase levels. In this comprehensive review, we present the current views on cardiac toxicity and cardiovascular hypersensitivity, together with the reviewed cardiac literature on the chemotherapeutic agents inducing hypersensitivity reactions. Cardiac hypersensitivity seems to be the pathophysiologic basis of coronary artery spasm, acute coronary syndromes such as Kounis syndrome and myocardi-tis caused by cancer therapy.

Throughout this paper the effects of injuries on athletes are highlighted in different aspects. Exertional compartment syndrome is a specific injury related to athletes that is thoroughly explored in this paper through an analysis of the anatomy, symptoms, diagnosis and treatments of the syndrome. Exertional compartment syndrome is an exercise-induced muscle and nerve condition that causes pain, swelling as well as disability in the affected muscles of the lower leg. This syndrome commonly develops in young athletes involved in sports with excessive running and repetitive impact such as track and field, soccer, basketball and lacrosse. Exertional compartment syndrome is commonly misdiagnosed as other less severe injuries such as shin splints, which is symptomatic of pain along the tibia bone of the lower leg caused by overuse. The misdiagnosis of exertional compartment syndrome allows the syndrome to worsen and intensify resulting in the only effective treatment to be fasciotomy, a surgical procedure to release the pressure within the compartment of the lower leg. There is no definitive protocol developed for patients after fasciotomy is performed. Athletes experiencing similar symptoms after surgery are usually treated for their symptoms rather than the syndrome as a whole, which does not have a high degree of success. The development of a definitive protocol utilizing the techniques of manual therapy, mobility stretching and corrective strength training can improve the adverse effects of exertional compartment syndrome as well as restore functionality to the athlete. Raising awareness of this syndrome in athletics will be effective in treating the athlete early on in order to avoid severe effects and invasive procedures.

Both Stevens Johnson Syndrome (SJS) and toxic epidermal necrolysis (TEN) are main injurious cutaneous medication reactions that mostly affect the epidermis and mucus membranes. TEN and SJS affecting nearly 1 or 2/1,000,000 people per year, and can recognized as medical crises since they may be deadly. Mucocutaneous discomfort, hemorrhagic erosions, erythema, and more or less severe epidermal separation that appear as ulcer and patches of dermic loss are their defining characteristics. The sole difference between TEN and SJS at this time is the degree of skin detachment, making them two extremes of a spectrum of severe cutaneous adverse drug reactions (cADRs). In the majority of cases, drugs are considered as the principal reason of SJS/TEN, but herpes simplex virus and Mycoplasma pneumoniae infections are also recognized causes, along with lesser number of cases in which the cause is still unknown. Among the drugs with a "high" likelihood of producing TEN/SJS are carbamazepine (CBZ), trimethoprim-sulfamethoxazole, phenytoin, aminopenicillins, allopurinol, cephalosporins, other sulfonamide antibiotics, quinolones, phenobarbital, and NSAIDs of the oxicam variety. There is strong genetic evidence for SJS and TEN in Han Chinese due to the substantial association between the human leukocyte antigen (HLA-B*1502) and SJS brought on by CBZ. The diagnosis is made mostly based on clinical symptoms and the histological study of a dermal biopsy. Pemphigus vulgaris, bullous pemphigoid, linear IgA dermatosis, paraneoplastic pemphigus, disseminated fixed bullous drug eruption, acute generalized exanthematous pustulosis (AGEP), and staphylococcal scalded skin syndrome (SSSS) are among the differential diagnoses. The management of patients with SJS/TEN is complicated by the high risk of mortality, necessitating early diagnosis, estimation of the SCORTEN prognosis, identification and discontinuation of the causative drug, specialized supportive care, and high-dose injectable Ig therapeutic interventions. The reported fatality rates for SJS are 1-5% on average and 25-35% for TEN; it can be even higher in patients who are elderly or who have a significant amount of epidermal detachment on their skin. More than 50% of TEN patients who survive the disease experience long-term consequences.

SGLT2 inhibitors act to induce glucosuria and have been shown to be efficacious in the treatment of type II diabetes mellitus but have also been shown to positively affect cardiovascular conditions and some benefitting kidney function. SGLT2i have shown to be effective in more advanced conditions but may eventually be a treatment in more general metabolic dysfunction. Metabolic syndrome is a clinical diagnosis for establishing risk for ischemic heart disease and diabetes. The prevalence of type II diabetes mellitus, heart disease, and severe vascular events steadily increased over recent decades. In addition to the established benefits of diet and exercise, SGLT2 inhibitor therapy may be able to aid in the treatment of metabolic syndrome from its proven cardiovascular and anti-hyperglycemic benefits. Pharmacologic modeling in canines is also considered, as they present with similar diagnoses and offer a model that shares many of the characteristics of humans in metabolic dysfunction.

This observational study was ordered by the Medical Practitioners’ Chamber in Warsaw. The objective of the study was to evaluate the health status of physicians in relation to their occupational duties. Professional burnout was considered relative to different features of personality. This study was initially carried out from 2005–2008, but further analysis of burnout and personality was carried out from 2017–2018. The research tools were anonymous, validated questionnaires. The sample size was based on the size of the population— the registry of the Regional Chamber of Medical Practitioners— and literature on burnout prevalence. The respondents’ work places were randomly selected from the Mazovian District register. The test on burnout was completed by 378 respondents, while 62 subjects completed a personality test. Results showed that burnout syndrome was an occupational problem for healthcare workers. Professional burnout affected as many as 42% of respondents(n = 158). It affected two age groups in particular: physicians up to 31 years old and individuals aged 41-50. Moreover, neuroticism was found to be significantly related to burnout syndrome. In conclusion, burnout syndrome is common among medical practitioners, and neuroticism may be correlated with burnout syndrome.

Meier–Gorlin syndrome (MGS) is a rare genetic developmental disorder that causes primordial proportional dwarfism, microtia, absent or hypoplastic patellae and other skeletal anomalies. Overlapping skeletal symptoms make MGS difficult to diagnose clinically. We describe a 3-year-old boy with short stature, recurrent respiratory infections, short-rib dysplasia, tower head and facial dysmorphisms who was admitted to the Tomsk Genetic Clinic to verify a clinical diagnosis of Jeune syndrome. Clinical Exome sequencing revealed two variants (compound heterozygosity) in the ORC6 gene: c.2T&gt;C(p.Met1Thr) and c.449+5G&gt;A. In silico analysis showed the pathogenicity of these two mutations and predicted a decrease in donor splicing site strength for c.449+5G&gt;A. An in vitro minigene assay demonstrated that variant c.449+5G&gt;A causes a complete skipping of exon 4 in ORC6 gene. The parents asked for urgent prenatal testing for MGS for the next pregnancy, but it ended in a miscarriage. Thus, this case report may help to prevent MGS misdiagnosis in the future. We also performed in silico and functional analyses of ORC6 mutations and developed a restriction fragment length polymorphism and haplotype-based short-tandem-repeat assay for prenatal genetic testing for MGS. These findings should elucidate MGS aetiology and improve the quality of genetic counselling for affected families.

Aim: To analyze a single center's experience with Short Bowel Syndrome/ Chronic Intestinal Failure (SBS/CIF) in adult patients treated with Home Parenteral Nutrition (HPN). Materials and methods: In the last thirty years, 13 patients with SBS/CIF were included in an HPN program. Results: Between 1992 and 2023, 13 patients were included in an HPN program. The primary underlying pathology was acute mesenteric ischemia. The median age of the starting HPN was 44 years old. Most are submitted to several surgeries of extensive intestinal resection with posterior intestinal reconstruction. Five of the 13 patients have died while on HPN for a median of 42 months. The causes of death HPN-related were catheter sepsis, endocarditis with cardiac failure, or hepatic failure. One patient died due to underlying pathology: pelvic abscesses and bleeding related to radiotherapy. Eight patients remain alive with a median time of HPN of 173 months. During the HPN support, the most frequent complications were venous catheter infection and venous territory thrombosis. None of the eight patients alive have hepatic failure. Two patients recently started teduglutide, with good tolerance, and need reduction of HPN support. All these eight patients have a satisfactory quality of life (parenteral support needs range between five to two nutrition bags per week). Conclusion: HPN remains the gold standard of SBS/CIF treatment, although Teduglutide may reduce HPN needs and HPN complications and provide a better quality of life. An HPN multidisciplinary healthcare group support is essential to ensure these patients' survival and quality of life. Keywords Short bowel Syndrome, Chronic Intestinal failure, Home Parenteral Nutrition, Teduglutide, Complications of Parenteral Support.

Fragile X syndrome (FXS) is the most frequent monogenic form of autism spectrum disorder (ASD). Autistic FXS is caused by loss of the fmr1 gene product, the fragile X mental retardation protein (FMRP), triggering physiological and behavioral abnormalities. It is correlated with clock components for behavioral circadian rhythm. Mutation of this gene causes the disturbances in sleep patterns and circadian behavior commonly observed in patients with autistic FXS, accompanied by frequent dysregulation of melatonin synthesis and melatonin-dependent signaling. These changes impair vigilance, learning and memory, and are also linked to autistic behavior including the abnormal anxiety response. However, although several possible causes, symptoms, and clinical features of ASD have been investigated, the correlation between an altered circadian rhythm and autistic FXS has not been extensively studied. Recent works have highlighted the impact of melatonin on the nervous, immune, and metabolic systems. Even though utilization of melatonin for sleep disorder in ASD has been considered in clinical research, further studies should be aimed at its neuroprotective role in ASD during developmental period. In this review, we focus on the regulatory circuits involved in melatonin dysregulation and circadian system disruption in those with autistic FXS. Additionally, we discuss the neuroprotective effect of melatonin intervention. This may improve neuroplasticity and physical capability. We also review the underlying molecular mechanisms, and suggest that melatonin may be a useful novel treatment for autistic FXS, countering the adverse effects of circadian variation.

Deep ultraviolet (DUV) light emitting diode (LED) at emission wavelength of 254 nm is inevitable to replace the conventional toxic mercury UV Lamp as demanded by Minamata Convention of 2020. Both the conventional DUV LEDs (C-LED) and tunnel junction (TJ)-based UVC LEDs are suffering from high operating voltages, low hole injection efficiency and efficiency droops. Therefore, p-AlGaN and n-AlGaN layers-based TJ is one of the most promising parts of optical devices and has been widely utilized as carrier tunneling in DUV LEDs to mitigate both the contact resistance for Ohmic contact and low hole injection efficicny at 254 nm emission. Here an approach is presented to electrically manipulate the quantum tunneling probability by exploiting the transported carriers at the interface of n-AlGaN/p-AlGaN TJ with moderate Si and Mg-doping levels and optimized thickness. As a result, the Augur recomination rate was sucesfully suppressed and quite high radiative recombination rates were achived in the 254nm TJ-based DUV LEDs, which is attributed the improved holes injection toward the MQWs when compared to C-LED. The internal-quantum efficiency (IQE) of approximately ~ 88% in the TJ-based LED with zero efficiency droop is achived, which is 1.3 times greater than the IQE of approximately ~ 66% in the C-LED with efficiency droop of 53%. Based on our known knowledge, this is the highest reported IQE (88%) at emission wavelength of 254 nm in the AlGaN TJ-based LED with efficiency droop of 0%. It was found that the light output powers (LOP) of TJ-LED increases linearly under the varying current density, whereas in the case of C-LED the LOP changes nonlinearly under varying current density. This is attributed to the lower Augure recombination rate in the MQWs of TJ-based DUV LED. The operating voltages were remarkable reduced from 20 V to 5.4 V under 200 mA operation, which is attributed to the thickness and doping optimization in TJ and better selection of realively lower Al-content in the contact-layer. The demonstrated TJ-based DUV LEDs opens the door to epitaxial growth of high-performance UV emitters in MOCVD and MBE for a plethora of biomedical applications.

Rockburst is a hazardous phenomenon in deep tunnels influenced by geological structural planes like faults, joints, and shear planes. Small-scale shear-plane-like structures have damaging impact on the boundaries of the tunnel, which accumulate high stresses. Such a shear plane was exposed in the side wall of the right headrace tunnel in the Neelum-Jehlum Hydropower Project. This project is constructed in the tectonically active Himalayas with high stress conditions. A shear plane combined with high stress conditions is very dangerous in deep excavations. The influence of a shear zone on rockburst occurrence near a tunnel is studied. The FLAC3D explicit code simulated the shear zone in the right tunnel, revealing that the stresses are concentrated near the shear zone, with no stress concentration in the left tunnel, which has neither shear zone nor rockburst. Rock mass was displaced near this shear zone even before excavation. Modeling results confirm that the side wall shear zone of the tunnel has a major influence on rockburst occurrence. A shear slip along this plane released huge amounts of energy, causing human fatalities and property damage. A numerical simulation validates the actual conditions and helps us understand the phenomenon of stress concentration near the shear zone and its impact during deep tunneling.

Full-scale/model test comparison studies to validate the traditional ABL wind tunnel simulation technique are reviewed. According to the literature review, notable discrepancies between full-scale measurement results and model test results were observed by most performed comparison studies, but the causes of the observed discrepancies were not revealed in a scientific way by those studies. In this regard, a new research scheme for future full-scale/model test comparison studies is proposed in this article, which utilizes the multiple-fan actively controlled wind tunnel simulation technique. With the new research scheme, future full-scale/model test comparison studies are expected to reasonably disclose the main problems with the traditional ABL wind tunnel simulation technique, and the technique can be improved correspondingly.

The EULAR Sjögren's Syndrome Disease Activity Index (ESSDAI), EULAR Sjogren’s Syndrome Patient Reported Index (ESSPRI), and other patient-reported outcomes (PROs), such as the visual analog scale (VAS) for symptoms and EULAR sicca score (ESS), are used to assess the disease activity of primary Sjögren’s syndrome (pSS). Recently, Clinical ESSDAI (ClinESSDAI) and Clinical Trials ESSDAI (ClinTrialsESSDAI) were developed for objective clinical disease activity indexes. However, the relationship of ClinESSDAI and ClinTrialsESSDAI with PROs as well as that between ESSPRI and other PROs and the objective parameters of glandular function in pSS have not been established. Herein, we investigated the correlation of ESSPRI and other PROs with the objective parameters of glandular function and the relationship of PROs with ClinESSDAI and ClinTrialsESSDAI in 66 patients with pSS. Correlations were calculated with Spearman’s correlation coefficient. ClinTrialsESSDAI was correlated with ESSPRI, dryness (ESSPRI-Dryness), fatigue, and pain domains of ESSPRI, VAS for oral dryness (oral-VAS), and patient’s global assessment. Although ESSPRI did not correlate with the objective parameters of glandular function, ESSPRI-Dryness, ESS, and oral- and ocular-VAS did. These results suggest that ESSPRI-Dryness, ESS, and VAS for symptoms, but not ESSPRI, reflect the glandular dysfunction and that ClinTrialsESSDAI correlates with PROs for dryness in pSS.

Metabolic syndrome (MetS) refers to the group of several interconnected risk factors that collectively double the risk of cardiovascular disease. Epilepsy is linked to MetS across all age groups, though its prevalence differs across various studies. This can be understood from the perspective of seizure-related metabolic abnormalities, long-term antiepileptic drugs (AEDs) use, and a more sedentary lifestyle due to epilepsy. The factors that are considered in developing MetS for patients with epilepsy (PWE) are age, residence, level of physical activity, food intake status, epilepsy subtype, epilepsy duration, current (AEDs) use, drug responsiveness status, body-mass index (BMI), total cholesterol and LDL-cholesterol levels. A deeper understanding of the epilepsy-AED-MetS connection and the exploration of lifestyle interventions hold the promise of significantly improving the overall health and well-being of PWE. Clinicians managing PWE should closely monitor various risk factors for developing MetS and consider them when selecting AED treatment.

Treacher Collins syndrome (TCS) is a rare congenital disorder characterized by craniofacial abnormalities due to underdeveloped facial bones. In addition to physical deformities, TCS also presents with several neurological disorders resulting from facial defects and brain malformations. This paper reviews the neurological manifestations of TCS with a focus on facial nerve paralysis, neurodevelopmental delay, intellectual disability, and autism spectrum disorder. Facial nerve hypoplasia leads to an inability to control facial muscles and expressions. Neurodevelopmental delays in motor function and language acquisition are commonly reported in infants with TCS due to hearing loss, facial impairments, poor nutrition, infections, and structural brain changes. Intellectual disability with below average IQ is also more prevalent in TCS, affecting about one third of patients. Brain imaging reveals abnormalities like white matter hypoplasia, cortical atrophy, and reduced grey matter volume which likely contribute to cognitive deficits. Additionally, the rate of autism spectrum disorder is significantly higher in TCS compared to the general population. The reasons are unclear but may involve hearing loss, facial dysmorphisms, and socio-emotional processing centers in the brain. Management is multidisciplinary, focusing on early interventions like speech, physical, feeding, and behavioral therapy to maximize developmental and functional outcomes. Further research on the neurological pathophysiology of TCS is needed to better elucidate the mechanisms linking craniofacial defects with adverse neurodevelopmental consequences.

Prediction and early detection of atrial fibrillation (AF) remain a permanent challenge in everyday practice. Timely identification of an increased risk for AF episodes (which are frequently asymptomatic) is essential in the primary and secondary prevention of cardioembolic events. One of the noninvasive modalities of AF prediction is represented by the electrocardiographic P-wave analysis. This includes the study and diagnosis of interatrial conduction block (Bachmann`s bundle block). Bayés’ Syndrome (named after its first descriptor) denotes the association between interatrial conduction defect and supraventricular arrhythmias (mainly AF) predisposing to cardioembolic events. Our short review presents an update of the most important data concerning this syndrome: brief history, main ECG features, pathophysiological background and clinical implications.

Aims: Clinical evidence indicates that innate immune cells may contribute to the onset and outcome of acute coronary syndrome (ACS). Our prospective study aimed at analysing neutrophil phenotypes in ACS and their role in predicting 1-year major cardiovascular events. Methods: Blood neutrophil phenotypes were analysed by flow cytometry. Differential blood cell count and plasma levels of soluble markers were recorded at admission and at 6-month follow-up. Results: 108 patients categorized in chronic stable coronary artery disease (n=37), unstable angina (UA) (n=19), Non-ST-Elevation Myocardial Infarction (NSTEMI) (n=25), and ST-Elevation Myocardial Infarction (STEMI) (n=27) were included. STEMI and NSTEMI patients displayed higher neutrophil count and neutrophil-to-lymphocyte ratio (NLR) than stable and UA patients (P<0.0001), which normalized at 6-month after MI. STEMI patients were characterized by elevated percentages of band cells in low-density neutrophils (P=0.007) and in high-density neutrophils (P=0.019) compared to the other patients. Multivariable logistic regression analysis revealed that plasma levels of total MPO was associated with STEMI when compared to stable (OR: 1.434; 95% CI: 1.119-1.837; P<0.0001), UA (1.47; 1.146-1.886; P=0.002), and NSTEMI (1.213; 1.1-1.134; P=0.0001) patients, while increased neutrophil SSC signal intensity was associated with NSTEMI compared to stable patients (3.828; 1.033-14.184; P=0.045). Based on multivariable Cox regression analysis, elevated plasma levels of PCSK9 and low-density neutrophil percentage predicted 1-year outcome independently of cardiovascular risk factors (c-index: 0.915; IQR: 0.908-0.929). Conclusions: Changes in neutrophil phenotype are concomitant to ACS. These changes may differ between STEMI and NSTEMI. They may also contribute to ACS risk and patient outcome.

Loss-of-function mutations of the spermine synthase gene (SMS) result in Snyder-Robinson Syndrome (SRS), a recessive X-linked syndrome characterized by intellectual disability, osteoporosis, hypotonia, speech abnormalities, kyphoscoliosis, and seizures. As SMS catalyzes the biosynthesis of the polyamine spermine from its precursor spermidine, SMS deficiency causes a lack of spermine with an accumulation of spermidine. As polyamines, spermine and spermidine play essential cellular roles that require tight homeostatic control to ensure normal cell growth, differentiation, and survival. Using patient-derived lymphoblast cell lines, we sought to comprehensively investigate the effects of SMS deficiency on polyamine homeostatic mechanisms including polyamine biosynthetic and catabolic enzymes, derivatives of the natural polyamines, and polyamine transport activity. In addition to decreased spermine and increased spermidine in SRS cells, ornithine decarboxylase activity and its product putrescine were significantly decreased. Treatment of SRS cells with exogenous spermine revealed that polyamine transport was active, as the cells accumulated spermine, decreased their spermidine level, and established a spermidine-to-spermine ratio within the range of wild type cells. SRS cells also demonstrated elevated levels of tissue transglutaminase, a change associated with certain neurodegenerative diseases. These studies form a basis for further investigations into the leading biochemical changes and properties of SMS-mutant cells that potentially represent therapeutic targets for the treatment of Snyder-Robinson Syndrome.

Insulin resistance is a prominent pathophysiologic syndrome in a plethora of metabolic disorders including obesity, prediabetes, type 2 Diabetes Mellitus (Ten et al., 2007), impaired glucose tolerance, dyslipidemia, polycystic ovary syndrome and hypercoagulability (Smith & LeRoith, 2004). It is strongly associated with obstructive sleep apnea, hypoventilation syndrome, pancreatitis, nonalcoholic fatty liver disease, steatohepatitis, cirrhosis, gall bladder disease, multiple cancers (breasts, uterus, cervix prostate, kidney, colon, esophagus, pancreas and liver), stroke, cataracts, coronary heart disease, and hypertension. It is also associated with causation of abnormal menses, infertility, polycystic ovary syndrome, osteoarthritis, phlebitis and other venous diseases. Insulin resistance is thought to be caused by intrinsic and extrinsic factors that contribute to its development. Once present, insulin resistance affects the metabolism, behavior, physical appearance and has lasting effects. This paper will review the latest evidence in development of insulin resistance, its pathogenesis and manifestation and its relation to other conditions. The final aim is to raise awareness of its role on diet, metabolic, genetics and microbiome.

Due to the proliferation of genetic testing, pathogenic germline variants predisposing to hereditary hematological malignancy syndrome (HHMS) have been identified in an increasing number of genes. Consequently, the field of HHMS is gaining recognition among clinicians and scientists worldwide. Patients with germline genetic abnormalities often have poor outcomes and are candidates for allogeneic hematopoietic stem cell transplantation (HSCT). However, HSCT using blood from a related donor should be carefully considered because of the risk that the patient may inherit a pathogenic variant. At present, we now face the challenge of incorporating these advances into clinical practice for patients with myelodysplastic syndrome (MDS) or acute myeloid leukemia (AML) and optimizing the management and surveillance of patients and asymptomatic carriers, with the limitation that evidence-based guidelines are often inadequate. The 2016 revision of the WHO classification added a new section on myeloid malignant neoplasms, including MDS and AML with germline predisposition. The main syndromes can be classified into three groups. Those without pre-existing disease or organ dysfunction; DDX41, TP53, CEBPA, those with pre-existing platelet disorders; ANKRD26, ETV6, RUNX1, and those with other organ dysfunctions; SAMD9/SAMD9L, GATA2, and inherited bone marrow failure syndromes. In this review, we will outline the role of the genes involved in HHMS in order to clarify our understanding of HHMS.

Introduction: Obstructive Sleep Apnea (OSA) is a respiratory condition identified by the partial or complete obstruction of the upper air passages during sleep. These episodes can lead to complications in neurobehavioral and cognitive domains and cardiovascular issues, especially in children. The involvement of OSA in ocular health during adulthood has been reported, but it remains a topic of debate in pediatric cases. Objective: This review aims to analyze the correlation between OSAS and ocular health in children. Specifically, it investigates the effects of OSA on ocular structures and conditions and explores potential improvements through treatment. Subjects and Methods: The research employed three search engines: PUBMED/MEDLINE, SCOPUS, and WebOfScience. After initial identification, 120 irrelevant articles were excluded. Of these, 10 pertained to the adult population, and 110 focused on the pediatric population. Following a careful selection process and the application of enrollment criteria, six relevant articles were included, all in English, focusing on the effects of OSA on children's eyes. Among these, three studies explored correlations with choroidal alterations, while three investigated retinal and optic nerve changes. Two studies analyzed post-otorhinolaryngological intervention ocular changes. Results: OSA leads to increased intraocular pressure and reduced optic nerve thickness in adults, but treatment alleviates this condition. An immediate correlation between OSA and optic nerve thickness in children does not readily emerge, although age appears to play a role. Pediatric patients with OSA exhibit corneal anomalies and an increase in optic nerve thickness, possibly due to intermittent hypoxia. Studies indicate that OSA can influence retinal vascular density in children, with an increase observed after treatment and reduced choroidal thickness in cases of adenotonsillar hypertrophy. Conclusion: This literature review has highlighted how OSA in children can significantly impact ocular health, with observed alterations in the optic nerve, choroid, retina, and cornea. While the direct correlation with the optic nerve may not always be evident, OSA can elevate intraocular pressure and lead to structural changes. However, treatment appears to bring about improvements. The necessity for regular monitoring to detect potential adverse effects underscores the importance of promptly addressing childhood OSA.

Abstract: Background and Objectives: A growing number of epidemiologic studies have found that diabetes mellitus may increase cancer risk and is implicated in numerous other metabolic and inflammatory disorders. The increase in pro-inflammatory cytokines plays a major role in insulin resistance and leads to hypoalbuminemia, and micro- and macrovascular diabetes complications, including kidney disease and anemia. This study aimed to investigate the utility of CEA, CRP, serum albumin level, hemoglobin, and LDH as biomarkers for cancer risk and the biological implications of diabetes on the evolution and prognosis of oncological patients. Material and methods: We conducted a retrospective, longitudinal, observational study, on a total group of 434 patients, 217 diagnosed with a form of cancer and with type 2 diabetes as a comorbidity, and the other 217 – control group, without diabetes. These patients were admitted to the oncology clinic. In subgroups, the same number of patients was considered, depending on the location of the oncological pathology. Anemia, hypoalbuminemia, elevated lactate dehydrogenase, glycated hemoglobin, and C-reactive protein levels are more pronounced in subjects with type 2 diabetes and cancer. Conclusions: The presence of diabetes negatively affects the clinical and biological prognosis of cancer patients.

Embryologically, the left brachiocephalic vein (LBV) originates as an anastomotic channel between the right and left anterior cardinal veins 1 . This positions the LBV between the manubrium sterni anteriorly and the innominate artery posteriorly 2 . This pattern of adjacency of the aorta to the LBV is unique to mammals and results from a quirk of evolution 3 . With age, the ascending aorta unfolds, elongates and dilates 4 . Simultaneously, there is a change in the thoracic geometry that reduces the thoracic volume primarily from disc height loss and kyphosis 5 . These transitions progressively compress the LBV. Normally this compression is circumvented via collateral pathways and "Blood finds a way" 6 . However, traversing these circuitous pathways comes at a cost and can result in delayed transit times and venous congestion. While it is possible that compression of the LBV in the setting of adequate collateral channels may fail to provoke any pathologic sequelae, we propose a phenomenon in which such compression in the setting of inadequate collateral circulation may lead to a state of pathologic venous congestion. This anatomic anomaly and its associated clinical features, if identified, can offer a new avenue for treatment options for some of the hitherto unexplained neurologic disorders.

(1) Background: Metabolic syndrome is a strong predictor of cardiovascular disease thus the objective of the study was to verify the prevalence of metabolic syndrome in farmers, as well as to verify the association with sociodemographic, work and lifestyle factors. (2) Methods: Cross-sectional, observational study, carried out with 790 individuals. For the diagnosis of metabolic syndrome, the National Cholesterol Education Program's Adult Treatment Panel III (NCEP-ATP III) and International Diabetes Federation (IDF) criteria were used. Pearson's chi-square test and binary logistic regression were used to verify factors associated with metabolic syndrome (3) Results: The prevalence of MS according to the IDF criteria was 16.3% overall, with 9.7% of women (95% CI: 6.66–16.16) and 6.6% of men (95% CI: 5.17–11.97). According to the NCEP/ATP III criterion, it was 12.3% overall, with 7.5% corresponding to women (95% CI: 6.62 – 13.13) and 4.8% to men (95% CI: 3.5 – 8.70). With regard to the conditions that make up metabolic syndrome, it was found that high density lipoprotein, high blood pressure and high waist circumference were the most prevalent. (4) Conclusions: The prevalence of metabolic syndrome is considerable in the population when compared to other regions, both rural and urban, in Brazil.

Repeated desaturation of oxyhemoglobin, micro-arousals, which are typical in obstructive sleep apnea syndrome (OSAS), have negative effects on the health of patients, leading to a wide range of complications such as cardiovascular (arterial hypertension, pulmonary hypertension, chronic heart failure, arrhythmias, myocardial infarction) cerebrovascular (strokes), metabolic (insulin resistance, obesity, diabetes mellitus, metabolic syndrome), gastrointestinal (non-alcoholic liver disease), urinary (chronic renal failure), neuropsychiatric complications and a wide range of malignancies. This in turn has a multilateral effect on familial, occupational and social life, as well as increasing the risk of road traffic accidents or accidents at workplace. Awareness, timely screening and prevention of complications play an important role in the diagnosis and treatment of comorbid conditions. This review focuses on comorbidities in OSAS and the effect of CPAP therapy on their prognosis.

Takotsubo syndrome (TTS), recognized as stress’s cardiomyopathy, or better as left ventricular apical balloon syndrome in the recent years, is a rare pathology, described for the first time by Japanese researchers in 1990. TTS is characterized by an interindividual heterogeneity in onset and progression, and by the strong predominance in postmenopausal women. The clear causes of these TTS features are uncertain, given the reduced understanding of this intriguing syndrome until now. However, the increasing frequency of TTS cases in the last years, and particularly correlated to SARS-CoV-2 pandemic, leads us to imperative necessity both of a complete knowledge of TTS pathophysiology for identifying biomarkers facilitating its management, and targets for specific and effective treatments. The suspect of a genetic basis in TTS pathogenesis has been evidenced. Accordingly, familial form of TTS has been described. But a systematic and comprehensive characterization of the genetic or epigenetic factors significantly associated with TTS is lacking. Thus, we, here, conducted a systematic review of literature before June 2021, to contribute to identify potential genetic and epigenetic factors associated with TTS. Interesting data were evidenced, but of reduced number and with diverse limitations. Consequently, we concluded further work is needed to address the gaps discussed, and probably a clear evidence may arrive using multi-omics investigations.

To reduce the risk factors for mortality, the paper has focused on the assessment of the socioeconomic, clinical, physical, biophysiological, and biochemical characteristics of Down's syndrome which can be affected by the type of nutrition system, toxicity, and ecological footprint. Patients were males with trisomy 21 diagnosed by karyotype test and assessed by clinical examinations. Samples were collected from different biofluids. The physicochemical analyses of the biomatrix samples were performed and these properties had compared to findings of healthy males and age-matched controls. Duraphat application was proved effective for their oral treatment and saliva was the optimum biomarker for detecting malnutrition. Patients were hypersensitive to Cu while the Mn content in blood and hair was considered an expression to the degree of epileptic condition and chronic seizure development. The ecological footprint was 5.6 gha and carbon footprint was recognised in food poverty habits. These can be reduced by eating more plant-based proteins and fibre-rich foods with low saturated fats and sodium. The findings provide an up-to-date reference for expected developmental outcomes in children with DS in terms of biophysicochemistry. The genetically sensitive intervention is affected by heredity factor and sensitivity to toxics. Down's syndrome is encouraged to live green-hipster life.