Challenge Test Research Articles

Application of multi-modal temporal neural network based on enhanced sparrow optimization in lithium battery life prediction

This paper introduces the DeNet-Mamba-DC-SCSSA network, an advanced solution for predicting the Remaining Useful Life (RUL) of lithium-ion batteries, crucial for the safety and efficiency management of electric vehicles. Combining the robust Denoising Enhancement Network (DeNet), the Improved Sparrow Optimization Algorithm (SCSSA), the adept Mamba time-series model, and the proficient Dilated Convolution (DC), this model excels in precise noise handling and sophisticated feature extraction. DeNet diligently refines input data, mitigating noise interference, while Mamba skillfully captures sequential intricacies. DC, on the other hand, adeptly extracts features over varying time scales, ensuring meticulous RUL predictions.The model’s efficacy was rigorously tested on NASA and CALCE datasets and was benchmarked against cutting-edge algorithms. Remarkably, it reduced average RE and RMSE by 48.59% and 21.45%, respectively, showcasing its superior performance and accuracy. Further evaluation on the CALCE dataset against the latest methods affirmed its leading predictive precision and stability.The model’s robustness and practical applicability were further validated using real vehicle data from a new energy vehicle platform. In a challenging test, it accurately predicted the charging capacities corresponding to the mileage of four vehicles with minimal errors: 0.52 Ah, 1.03 Ah, 0.84 Ah, and 0.71 Ah. These results significantly surpassed those of other recent methods, highlighting the model’s exceptional generalizability and potential for real-world applications in electric vehicle battery management.

Can resting lung function predict the response of a person living with motor neuron disease to a hypoxic challenge test?

People living with MND (PlwMND) are at risk of altitude-related hypoxia during flight. The Hypoxic Challenge Test (HCT) determines whether in-flight oxygen is required but can be expensive and inaccessible. To assist with travel recommendations, we investigated the relationship between altitude simulation-induced hypoxemia and baseline lung function. Retrospective audit of clinical database of PlwMND who had HCT and lung function. Pearson's correlation assessed relationships between oxygen saturation at altitude (AltSpO2) and lung function. Univariate logistic regression analysis and receiver operator characteristic (ROC) curves determined associations between lung function and HCT pass or fail. Between 2004-2023, 50 PlwMND were identified (median (IQR) diagnosis to HCT = 11.6 (16.9) months, mean ± SD forced vital capacity (FVC) = 2.4 ± 0.9 liters). Ten patients dropped below 85% SpO2 during testing (HCT fail). Baseline SpO2 was associated with AltSpO2 (r = 0.64) and predicted HCT pass or fail (OR 2.0 [95% CI 1.2-3.4], area under ROC curve (AUC) =0.8 [0.6-1.0]), as did FVC (AUC = 0.8 [0.6-0.9]). PlwMND with a FVC > 2.7L or a resting SpO2 > 97% are likely to pass HCT, whereas all those with FVC < 1L and SpO2 < 92% failed. PlwMND with FVC >2.7L or SpO2 >97% are unlikely to require oxygen or ventilatory supports for airline travel. A FVC below 2.7L will require a HCT to confidently determine HCT outcome, with testing still required for FVC <1L or baseline SpO2 <92%, to provide evidence to the airlines for in-flight respiratory support.

Allergic clinical symptoms and distribution of stimulation index of drug lymphocyte stimulation test for local anesthetics.

The Drug Lymphocyte Stimulation Test (DLST), recognized for its safety as an allergy diagnostic modality, has been acknowledged for its utility in diagnosing drug-induced pathological conditions. However, reports elucidating DLST outcomes concerning local anesthetics are notably scarce. An exhaustive analysis was conducted on the DLST results pertaining to local anesthetics derived from 571 patients presenting with suspected allergies to these specific agents. Remarkably, Stimulation Index (SI) > 1.8 was discerned in 11.4% and 7.8% of patients exhibiting hives or swelling subsequent to the administration of local anesthetics, surpassing the incidence observed in those experiencing post-injection discomfort. Additionally, SI > 3.0 was observed in 3 cases with lidocaine, 3 cases with prilocaine, and 1 case with mepivacaine. The distribution of SI exhibited a non-normal pattern for all three tested local anesthetics. Noteworthy is the case of a singular patient registering an SI of 1.84, who also yielded a positive challenge test, conclusively confirming an allergy to lidocaine. The DLST, holding promise as a potentially invaluable tool in identifying the causative factors behind adverse reactions to dental local anesthetics, lacks sufficient evidence to substantiate its efficacy definitively at present. DLST, coupled with intradermal testing and challenge testing, may be elucidated in patients exhibiting indicators of suspected local anesthetic allergy.

Protective immune-response of Aeromonas hydrophila phage lysate in crucian carp against direct virulent challenge with A. hydrophila-TPS

Aeromonas hydrophila was a common opportunistic pathogen that was widely found in various aquatic environment and could cause multiple infections in humans and animals. The haemorrhagic septicemia and bacterial enteritis in fish triggered by this pathogen led to significant losses in the aquaculture industry. In this study, we aimed to develop a phage lysate vaccine by lysing the A. hydrophila-TPS strain using phage PZY-Ah, which was previously isolated and preserved in the laboratory. First, we focused on optimizing phage lysis conditions, including different host bacteria culture time, phage lysis time, and phage to bacterial ratios. The optimal conditions were established as follows: culturing the A. hydrophila-TPS strain for 6 h, adding phage at a ratio of 1:10, and mixing for 4 h, which resulted in maximum lysis of the host bacteria. Subsequently, we assessed the immune responses of groups receiving formaldehyde-inactivated vaccines compared to those receiving various concentrations of the phage lysate vaccine. Both the TPS-phage lysate and formaldehyde-inactivated vaccine groups exhibited increased levels of specific immune enzymes (ACP, AKP, LZM, SOD, CAT) and cytokines (IL-1β, TNF-α and IFN-γ) in serum, as well as enhanced humoral immunity (IgM, C3 and C4) in crucian carp. Furthermore, challenge tests conducted post-immunization demonstrated that the high concentration of the TPS strain-lysate vaccine group (1 × 108 CFU/mL) achieved the highest immune protection rate at 88.89 %. Overall, the development of the TPS-phage lysate vaccine significantly enhanced the immunity of crucian carp, providing a higher level of protection and establishing a foundation for the research and development of phage-based aquatic vaccines.

Recurrent catatonia in a patient with bipolar disorder and polycythemia: A case report

We report the diagnostic and management challenges encountered in a case of a 57-year-old male patient with bipolar I disorder and comorbid polycythemia secondary to obstructive sleep apnea, who was treated in our inpatient psychiatric unit for suicidal ideation and recurrent catatonia. He was found to have catatonia with a Bush&amp;ndash;Francis Catatonia Rating Scale score of 18. He subsequently exhibited a positive response to the lorazepam challenge test. Before discharge, his daily lorazepam dose was titrated to 6 mg, which led to resolution of catatonic symptoms, and was tapered to discontinuation. During the second hospitalization, the patient&amp;rsquo;s catatonia returned, but due to lorazepam-induced bradycardia, he refrained from taking more than 1 mg of the medication. Divalproex sodium and memantine were initiated as off-label catatonic treatment plus lurasidone for bipolar depression. The patient was also found to have a positive antinuclear antibody titer (1:160). The hemato-immunological abnormalities present in our patient complicated his catatonic condition, underscoring the need to explore medical and neuropsychiatric catatonic factors for accurate diagnosis of this neuropsychiatric syndrome.

Assessment of pediatric patients with suspected nonsteroidal anti-inflammatory drug hypersensitivity

Background: Beta-lactam antibiotics are the most common cause of hypersensitivity reactions to medications, followed by nonsteroidal anti-inflammatory drugs (NSAID). Objective: The aim of this study was to classify children with hypersensitivity reactions to nonsteroidal anti-inflammatory drugs (NSAID-H) according to the latest updates. Methods: ENDA recommendations were used to evaluate all patients with suspected NSAID-H. Children were classified as either selective responders (SR) or cross-intolerant based on the results of the drug provocation test (DPT). Results: Sixty-seven patients with suspected NSAID-H were evaluated in this study. NSAID-H was confirmed in 20 patients (29.9%). Among the 20 patients diagnosed with NSAID-H, 15 were classified according to the 2018 EAACI/ENDA Position Paper. Twelve patients (80%) were classified as cross-intolerant and 3 (20%) as SRs. NSAID-H was confirmed in 4 of 37 patients (10.8%) ages &lt;10 years and 16 of 30 patients (53.3%) ages &gt;10 years (p &lt; 0.001). Twelve patients ages &gt;10 years were classified. Cross-intolerance was detected in nine patients (66.6%). In patients &gt;10 years of age, NSAID-induced urticaria/angioedema (NIUA) (16.7%) was the most common type in the group with classifiable cross-intolerant. In addition, NSAID-exacerbated respiratory disease was detected in one patient. Conculsion: Ibuprofen is the most common NSAID-H drug used in children. NIUA is the most common reaction. In pediatric allergy, hypersensitivity to NSAIDs is a challenging diagnostic issue. Hypersensitivity to NSAIDs poses a challenging diagnostic issue in pediatric allergies. The oral challenge test is the main diagnostic tool; however, in clinical practice, performing multiple challenge tests is difficult.

Genomic characterization and probiotic potency of Bacillus velezensis CPA1-1 reveals its potential for aquaculture applications

Biological prevention and control are increasingly applied in sustainable aquaculture, and Bacillus spp. has been revealed to good alternatives to antibiotics. This research examined the probiotic capabilities of Bacillus velezensis CPA1-1 by genomic and phenotypic analysis. The genome sequence showed that B. velezensis CPA1-1 has a 3,925,520 bp chromosome with 46.49 % GC content and 3762 CDSs. And eight clusters of secondary metabolite biosynthesis genes related to antibacterial compounds were predicted in CPA1-1 genome, including surfactin, difficidin, bacillibactin, fengycin, bacilysin, bacillaene, macrolactin H, butirosin A. Besides, the antimicrobial assay indicated that strain CPA1-1 exhibited strong antagonistic capacity against non-O1/O139 Vibrio cholerae GXFL1-4 isolated from diseased Macrobrachium rosenbergii, and MIC of CPA1-1 fermentation broth against GXFL1-4 was 1.0 × 105 CFU/mL. Furthermore, administering CPA1-1 markedly elevated the activities of ACP, AKP, and SOD in M. rosenbergii, and the immune-related genes, including ALF, Crustin, Hemocyanin, Prophenoloxidase, C-type lectin and HSP70, also exhibited higher expression in the CPA1-1 treated groups. Additionally, M. rosenbergii in the test group treated with CPA1-1 could resist non-O1/O139 V. cholerae GXFL1-4 infection by the challenge test. Our study contributed to reveal biocontrol mechanisms of B. velezensis CPA1-1, and demonstrated that CPA1-1 has promise as a probiotic agent for aquaculture.

Evaluating serum periostin and YKL-40 as biomarkers for airway remodeling and hyperresponsiveness in pediatric asthma

BackgroundPeriostin and human chitinase-3-like protein 1 (YKL-40) have been suggested to be involved in the development of airway fibrosis and remodeling. This study aimed to investigate the relationship between serum periostin levels and airway hyperresponsiveness (AHR) and between serum YKL-40 levels and AHR in children with asthma, comparing periostin as a marker for Th2 inflammation and atopy with YKL-40. MethodsThe study involved children aged 6–15 years, comprising 75 with asthma and 29 healthy controls. We measured serum periostin and YKL-40 levels and performed exercise bronchial provocation tests, methacholine challenge tests, spirometry, and FeNO measurements. ResultsCompared to the healthy controls, asthmatic children exhibited significantly elevated levels of periostin (86.7 [71.0–104.0] vs 68.3 [56.0–82.0] ng/mL; P = 0.006) and YKL-40 (29.0 [15.0–39.5] vs 27.7 [14.0–34.1] ng/mL; P = 0.034). The subgroup analysis revealed that periostin levels were significantly higher in the atopic asthma group than in the healthy controls (P = 0.003), but not in the non-atopic asthma group. YKL-40 levels were elevated in both the atopic and non-atopic asthma groups compared to healthy controls (P = 0.012 and P = 0.001, respectively). Serum periostin levels were significantly correlated with the postexerceise maximum percentage decrease in forced expiratory volume (FEV1), as well as with fractional exhaled nitric oxide (FeNO) and blood eosinophil counts, but showed no significant correlation with overall lung function. Conversely, serum YKL-40 levels were significantly linked to the Z score of FEV1 and AHR to methacholine but not with AHR to exercise or FeNO or blood eosinophil count. ConclusionsPeriostin is linked to atopic asthma and correlates with exercise-induced bronchoconstriction, FeNO, and eosinophil counts, highlighting its role in Th2 inflammation. YKL-40 is a general asthma marker, indicating airway remodeling. These findings suggest that targeting these markers can improve personalized treatment strategies for pediatric asthma.

Oral Challenge Tests in Children With Reported Beta-Lactam Allergy

Oral Challenge Tests in Children With Reported Beta-Lactam Allergy

Safety and low incidence of anaphylaxis in performing oral drug and food challenges in mastocytosis

BackgroundPatients with mastocytosis (MC) have an increased risk of severe anaphylaxis. They report hypersensitivity reactions to drugs and food, but causality often remains questionable. Most allergy centers avoid oral challenge tests (OCT) in MC patients. ObjectiveTo determine the safety of food and drug OCT in patients with MC. MethodsTo retrospectively evaluate the safety and outcome of challenges to drugs and food including food additives, out of 126 adult MC inpatients, 83 patients had a suspicion of food or drug hypersensitivity and 445 OCTs were performed. History, clinical data and allergy test results highlighting OCTs were analyzed. ResultsOnly 10 of 445 OCTs (2.2%) in 9 patients resulted in anaphylaxis. Drugs elicited reactions in 4/170 (2.4 %) patients: two patients to acetylsalicylic acid (2/39 tested patients, 5.1%), one to tramadol (1/12, 8.3%) and one to flurbiprofen (1/1). Anaphylaxis to food was recorded in 6/275 OCTs (2.2%); two out of 48 (4.1%) to α-gal, two to other foods and two to sulfites. Flushing or diarrhea occurred to histamine in 5/48 (10.4%), but also in 5/50 (10.0%) placebo challenges strongly questioning its relevance. Patients with proven anaphylaxis had more bone marrow MC and higher basal serum tryptase (71.3 vs. 44.3ug/l; p<0.05). ConclusionsChallenge-confirmed food and drug anaphylaxis was rare in MC patients. Results have to be interpreted cautiously as placebo reactions did occur. Severe anaphylaxis was seldom, but may occur and should be met by emergency preparedness.

Well-Being and Performance of Nursery Pigs Subjected to Different Commercial Vaccines Against Porcine Circovirus Type 2, Mycoplasma hyopneumoniae and Lawsonia intracellularis

Background/Objectives: Vaccination is a strategy in pig farming for the control of several pathogens, but commercial vaccines may have detrimental side effects. This study aimed to evaluate the effects of commercial vaccines on the control of porcine circovirus type 2 (PCV2), Mycoplasma hyopneumoniae (Mhp), and Lawsonia intracellularis (L. intracellularis) and their potential side effects on welfare, behavior, acute inflammation biomarkers (C-reactive protein and haptoglobin), and the performance of piglets during the nursery phase. Methods: A total of 240 piglets, both female and castrated males, with an average weight of 6.3 ± 0.9 kg were subjected to four treatments: T1-FLEXcombo® (Ingelvac®CircoFLEX and Ingelvac®MycoFLEX) + Enterisol® Ileitis; T2-FLEXCombo® + Porcilis® Ileitis; T3-Porcilis® PCV M HYO + Porcilis® Ileitis; and T4-FLEXCombo® + 0.9% saline solution. This study measured therapeutic interventions, body condition score, behavioral changes, rectal temperature, and inflammation biomarkers post-vaccination. Results: The T3 group required more therapeutic interventions and exhibited a 23.1% higher incidence of thin body condition (p &lt; 0.05) and 10 times more animals with depressed behavior than T1 (p &lt; 0.05). The piglets vaccinated for L. intracellularis (T2 and T3) had rectal temperatures exceeding 39.7 °C post-vaccination, significantly higher than in T1 (p &lt; 0.05). The T1 animals showed five times more positive behavior traits 24 h after vaccination (p &lt; 0.05). Touch response was 29% lower in the T2 and T3 groups, and the lying down behavior was higher in these groups compared to T1. Additionally, 41.7% of the T3 animals exhibited a sitting posture 48 h after vaccination. Higher serum C-reactive protein and haptoglobin levels were observed in T3 (p &lt; 0.05) at 24 and 48 h post-vaccination. Feed intake was higher in T1 compared to T3 between 29 and 35 days of age. It is important to note that this study did not measure immune responses to the pathogens and did not include challenge tests, and therefore, it does not assess which vaccine is superior in pathogen control. Conclusions: The vaccine programs resulted in similar zootechnical performance. However, T1, T2, and T4 showed better effects on piglet welfare and behavior compared to T3.

Protocol for a double-blind crossover randomised controlled trial to investigate inhalation CHallenge to assess Inducible Laryngeal Obstruction (CH-ILO)

Current ILO diagnosis is dependent on an individual being symptomatic. If results prove citric acid inhalation challenge agent provokes ILO it will provide new insights into neuronal mechanisms and support development of a standardised diagnostic test.IntroductionInducible laryngeal obstruction (ILO) remains a poorly understood condition in part due to lack of understanding about the underlying neuronal mechanisms. Many suffer delayed confirmed diagnosis as no standardised assessment exists. Based on previous work, we propose citric acid (CA) is the most appropriate inhalation agent for inducing upper airway reflex responses, with a view to developing an inhalation challenge test for ILO.Methods and analysisA single-centre, double-blind crossover study. The primary objective is to identify if CA inhalation challenge provokes laryngeal obstruction in patients with confirmed ILO. We will recruit: 10 participants with ILO, 10 with refractory chronic cough (RCC), 10 healthy controls. Each will undergo two inhalation challenges during laryngoscopy, with ascending concentrations of citric acid or saline control; participants will be randomised sequentially by a computer-generated schedule to determine order of delivery. Follow up is a telephone consultation. Randomisation and preparation of challenge agents will be by an unblinded study team member, not involved in data analysis. Challenge agents will only be unblinded on study completion. Log10concentration of CA evoking ILO will be compared between patient groups using a one-way ANOVA, comparing participants with ILO and participants with RCC to healthy controls.ConclusionThis will be the first randomised controlled trial to investigate the role of inhalation challenge as an assessment tool to evoke laryngeal obstruction in patients with confirmed ILO. If results prove citric acid inhalation challenge agent provokes ILO it will provide new insights into neuronal mechanisms and support development of a standardised diagnostic test.

Antilisterial Properties of Selected Strains from the Autochthonous Microbiota of a Swiss Artisan Soft Smear Cheese

High incidences of the foodborne pathogen Listeria monocytogenes have been reported on smear cheeses, and despite increased hygiene efforts, this incidence has remained stable in recent years. Applying antilisterial strains may increase the safety of smear cheeses. To find and test antilisterial strains, we inoculated fresh soft cheeses from nine dairies with the surrogate species Listeria innocua and assessed its growth under standardized ripening conditions. Acetic acid at day 23 (r = −0.66), lactose in fresh cheese (r = −0.63), and glucose at day 10 (r = −0.62), as well as seven amplicon sequence variants (ASVs), were negatively correlated with L. innocua growth. Two of these ASVs were assigned to the genus Leuconostoc of Lactobacillaceae (r = −0.82 and −0.71). Isolates from this family, from Aerococcaceae, and Carnobacteriaceae were characterized according to their inhibitory properties, and those showing antilisterial properties were applied as protective cultures in challenge tests. The combined application of strains of Leuconostoc mesenteroides, Aerococcaceae, and Carnobacteriaceae successfully eliminated low levels of L. innocua in the final products. This is likely explained by antimicrobial compounds, including mesentericin Y105 and acetate, and competition for carbon sources and iron. This study shows a promising way to improve the safety of soft smear cheeses by applying defined protective cultures.

Ethanolic cashew leaf extract: Antifungal activity and its application for shelf-life extension of dried salted tilapia fillets.

Ethanolic cashew leaf extract (ECLE) is rich in phenolic compounds with diverse bioactivities and can serve as a safe natural preservative. This study evaluated the antifungal activity and application of ECLE for shelf-life extension of dried salted tilapia fillets. Several extraction methods, antifungal activity, and application of ECLE in dried salted tilapia fillets were investigated. Ultrasonication followed by the Soxhlet extraction resulted in the highest yield (26.78%), total phenolic content (TPC), and total flavonoid content (TFC) (p<0.05). Conversely, the Soxhlet extraction method rendered lower yield (14.35%), TPC, and TFC (p<0.05). NaCl at high concentrations decreased both TPC and TFC in all ECLE samples, demonstrating the decomposition of those compounds induced by NaCl. ECLE obtained via the Soxhlet extraction method exhibited lower minimum inhibitory concentration (MIC) and minimum fungicidal concentration values than those prepared using other extraction methods. Thus, the former showed higher efficacy in inhibiting fungal growth and reducing mycelium growth than others (p<0.05), despite being less effective than potassium sorbate. At 4MIC, ECLE inhibited mycelium growth (56.83%-78.66%) and spore germination (87.5%-100%) after 72h and 10-16h of treatment, respectively. ECLE (4MIC) could inhibit the toxin production of fungi. For the challenge test, in which ECLE at 400 and 600mg/kg was added to dried salted tilapia fillet inoculated with Aspergillus flavus, fungal growth was retarded over 9 days of storage at 25±2°C (room temperature). Thus, ECEL could act as a natural food preservative to prevent fungal contamination. Toxin from fungi could be avoided, and the quality of dried salted fish was maintained. PRACTICAL APPLICATION: Cashew leaf extract rich in polyphenols can inhibit fungal proliferation, reduce mycelium expansion, prevent spore germination, and limit aflatoxin production. The extract canenhance the safety of dried salted fish, especially when contaminated with Aspergillus flavus in the humid atmosphere (80% relative humidity), particularly for small and medium enterprises. Nevertheless, this extract can also be applied in the fish processing industry, in which the synthetic antifungal agent could be replaced by the natural additive.

Associations between Balance Measures and Risk of Fractures in 70-Year-Old Individuals: A Population-Based Cohort Study.

There are uncertainties regarding to what extent poor vision and distracting tasks reduce balance and associate with fracture risk. To investigate the associations between body sway assessed under different visual and multitasking conditions and later risk of fractures in older adults. Cohort study. Umeå municipality, Sweden. N=5,437 community-dwelling 70-year-old individuals who participated in a population-based health examination. Body sway at baseline was measured using a Wii balance board in the lateral and anterior-posterior direction during three different tests, including with eyes open, dual-tasking, and eyes closed. Fractures during follow-up were ascertained using nationwide registers. During a mean (range) follow-up of 4.8 (0.0-10.6) years, 348 women (12.3%) and 149 men (5.7%) sustained a fracture. In women, both anterior-posterior sway velocity (hazard ratio [HR], 1.05 95% CI, 1.01-1.08, per mm/s increase) and variation in sway velocity (HR, 1.05, 95% CI, 1.01-1.09, per standard deviation [SD] increase) during dual-tasking testing were associated with higher risk of fracture after adjustment for covariates. During testing with eyes closed, all measures of lateral sway were associated with the risk of fracture (P<0.01 for all). In men, variation in lateral (HR, 1.03, 95% CI, 1.00-1.07 per SD increase) and anterior-posterior sway velocity (HR 1.05, 95% CI, 1.01-1.10 per SD increase) during dual-tasking testing were associated with higher risk of fracture. Higher body sway velocity and larger variation in sway velocity were associated with higher risk of fractures in both 70-year-old men and women, especially under more challenging testing conditions.

Post-CCSD(T) Thermochemistry of Chlorine Fluorides as a Challenging Test Case for Evaluating Density Functional Theory and Composite Ab Initio Methods.

Quantum chemistry plays a key role in exploring the chemical properties of highly reactive chlorine polyfluorides compounds (ClFn). Here, we investigate the thermochemical properties of ClFn species (n = 2-6) by means of high-level thermochemical procedures approximating the CCSDT(Q) and CCSDTQ5 energies at the complete basis set limit. We consider total atomization energies (TAEs), Cl-F bond dissociation energies (BDEs), F2 elimination energies (F2 elim.), ionization potentials (IPs), and electron affinities (EAs). The TAEs have significant contributions from post-CCSD(T) correlation effects. The higher-order triple excitations, CCSDT-CCSD(T), are negative and amount to -0.338 (ClF2), -0.727 (ClF3), -0.903 (ClF4), -1.335 (ClF5), and -1.946 (ClF6) kcal/mol. However, the contributions from quadruple (and, where available, also quintuple) excitations are much larger and positive and amount to +1.335 (ClF2), +1.387 (ClF3), +2.367 (ClF4), +2.399 (ClF5), and +3.432 (ClF6) kcal/mol. Thus, the contributions from post-CCSD(T) excitations exceed the threshold of chemical accuracy in nearly all cases. Due to their increasing hyper-valency and multireference character, the ClFn series provides an interesting and challenging test case for both density functional theory and low-level composite ab initio procedures. Here, we highlight the limitations in achieving overall chemical accuracy across all DFT and most composite ab initio procedures.

An adaptive 6-dimensional floating-search multi-station seismic-event detector (A6-DFMSD) and its application to low-frequency earthquakes in the East Eifel Volcanic Field, Germany

We introduce a seismic event detector that applies signal analysis in the time and frequency domains. Signals are searched for with matching coincidences at neighbouring recording stations in space and time. No a priori waveform information is needed for the Adaptive 6-Dimensional Floating-search Multi-station Seismic-event Detector (A6-DFMSD). It combines a short / long time average algorithm (STA/LTA), frequency range selection, energy envelope matching, and backprojection techniques to find a robust detection model. As a challenging test example, the new detector is tuned and applied to a dataset with five months of microearthquake (ML < 2) recordings in the East Eifel Volcanic Field (EEVF), Germany. There, both magmatic and tectonic earthquakes occur in a depth range between 3 km and 43 km. A6-DFMSD detected 4.3 times as many events as were already known and it discovered a previously unknown event cluster. After manual localization and classification of the events, we show that A6-DFMSD finds events of different origins: tectonic, magmatic, atmospheric, and anthropogenic. In particular, low-frequency (LF) earthquakes of magmatic origin with a complicated waveform coda are very well identified. We suggest that seismological networks monitoring local seismicity in similar target zones would benefit from the use of A6-DFMSD to allow the detection of a wide range of different seismic signals.

Release of sputum neutrophil granules is associated with pulmonary function and disease severity in childhood asthma

BackgroundMyeloperoxidase (MPO) and human neutrophil lipocalin or neutrophil gelatinase-associated lipocalin (HNL/NGAL) are stored in neutrophil granulocytes and secreted upon activation of the cells. They have been proposed to reflect the degree of inflammation in the airways. However, their role as potential markers of disease severity in childhood asthma remains unknown. This study investigated the relationship between the expression of MPO and HNL/NGAL and childhood asthma.MethodsA total of 83 pediatric patients with asthma and 59 controls were enrolled. Using enzyme-linked immunosorbent assays, the human MPO and HNL/NGAL levels were measured in sputum supernatants. Assessments including spirometry, methacholine challenge test, and atopy test were conducted.ResultsNo difference in sputum neutrophil counts was observed between pediatric patients with asthma and controls. However, sputum MPO and HNL/NGAL levels were significantly higher in patients with asthma than in controls (p = 0.021 and p < 0.001, respectively), especially in patients with moderate-to-severe persistent asthma. In patients with asthma, sputum MPO and HNL/NGAL levels showed a positive correlation with sputum neutrophil counts (MPO, r = 0.433, p < 0.001; HNL/NGAL, r = 0.584, p < 0.001) and with each other (r = 0.628, p < 0.001). Moreover, sputum HNL/NGAL level demonstrated better ability to accurately reflect current pulmonary function, airway inflammation, and limitations than MPO level in this study.ConclusionsSputum MPO and HNL/NGAL levels, which reflect neutrophil activation in airways, were increased in pediatric patients with asthma. Moreover, sputum MPO and HNL/NGAL may serve as appropriate assessment indicators of asthma severity in pediatric patients.

Deflazacort-induced Steven-Johnson syndrome: a case report and literature review

Objective: To summarize the clinical features and outcomes of deflazacort-induced Steven Johnson syndrome (SJS)-toxic epidermal necrolysis (TEN) to raise awareness among patients with Duchenne muscular dystrophy (DMD), neurologists as well as other deflazacort users. Methods: The clinical data of a boy with DMD who had SJS induced by deflazacort treated at the Department of Rheumatology & Clinical Immunology of Tianjin Children's Hospital in July 2024 was analyzed retrospectively. Taking "deflazacort" "Steven-Johnson syndrome" "toxic epidermal necrolysis" in Chinese or English as the keywords, literature was searched at CNKI, Wanfang, China Biomedical Literature Database and PubMed up to July 2024. The clinical characteristics, treatment and outcomes of deflazacort-induced SJS-TEN were summarized. Results: A 12-year-old boy was admitted with a 3-day history of rash. He was diagnosed with DMD at the age of 3 and had been treated with prednisolone since the age of 8. Forty-four days before admission, the patient started deflazacort to replace prednisolone. Three days before admission, progressively worsening erythematous maculopapular rashes, blisters and skin peeling (8% body surface area), oral mucosal erosion, and exudative conjunctivitis occurred, thus deflazacort was discontinued. Complete remission of SJS was achieved after treatment with intravenous immunoglobulin (IVIG, total 1.4 g/kg), 2 doses of etanercept (0.9 mg/kg, once), subcutaneous injection and intravenous methylprednisolone (0.7 mg/(kg·d)). Based on the literature, there were 5 reports in English while none in Chinese, altogether 7 cases were reported. All the patients were male, aged 3-45 years. Duration of deflazacort exposure was 2-8 weeks. Dermatology diagnosis of our case was SJS, and 5 cases were TEN. One patient was diagnosed with exudative erythema multiforme, and subsequent deflazacort oral challenge test was positive. Treatment included methylprednisolone or dexamethasone in 5 cases, IVIG in 6 cases, etanercept in 3 cases and cyclosporine in 1 case. All patients recovered completely. Conclusion: The synthetic corticosteroid deflazacort can cause rare but severe adverse reactions such as SJS-TEN, which needs close monitoring and prompt recognition and management.

Reliability and validation of an electronic penicillin allergy risk-assessment tool in a pregnant population

BackgroundPenicillin allergy adversely impacts patient care, yet most cases do not have true allergies. Clinicians require efficient, reliable clinical tools to identify low risk patients who can be safely de-labeled. Our center implemented the FIRSTLINE electronic point-of-care decision support tool to help non-allergist practitioners risk stratify patients with penicillin allergy. We sought to explore the reliability and validity of this tool in relation to allergist assessment and actual patient outcomes. We additionally compared it with two other published stratification tools, JAMA and PENFAST, to assess ability to accurately identify low risk patients appropriate for direct oral challenge.MethodsIn this single-center, retrospective, observational study, 181 pregnant females with self-reported penicillin allergy between July 2019 to June 2021 at BC Women’s Hospital, Vancouver, Canada were used to assess the reliability and validity of all three tools. Physician-guided history of penicillin use and symptoms were used for scoring. Results and recommendations were compared to actual patient outcomes after clinician decision for direct oral challenge or intradermal tests. We compared the performance of JAMA, PENFAST and FIRSTLINE.Results181 patients were assessed. 176/181 (97.2%) patients were deemed not allergic. Each risk stratification tool labelled majority of patients as low risk with 88.4% of patients PENFAST 0–2, 60.2% of patients JAMA low risk, 86.7% of patients FIRSTLINE very low risk.ConclusionWe demonstrate that our point-of-care electronic algorithm is reliable in identifying low risk pregnant patients, as compared to an allergist assessment. To our knowledge, this is the first study to provide direct comparison between multiple decision support tools using the same population, minimizing participant bias. Providing clinical algorithms to risk stratify patients, can enable healthcare professionals to safely identify individuals who may be candidates for direct penicillin oral challenges versus needing referral to specialists. This increases the generalizability and efficiency of penicillin allergy de-labeling.