Predominant Feature Research Articles

Epidemiological investigation of adult emergency infusion adverse drug reactions (EIADR) in Nanjing, China: a prospective cross-sectional study (EIADR II)

ABSTRACT Objective To analyze the clinical characteristics of adverse drug reactions (ADRs) in adults receiving emergency infusions at a tertiary hospital. Methods We conducted a prospective observational cohort study involving 585 adult patients who experienced adverse drug reactions (ADRs) between 20 November 2019, and 20 November 2023, during intravenous infusions in the emergency infusion room of a tertiary hospital. The analysis included patients’ gender, age, type of drugs involved, organ-system involvement, clinical manifestations of ADRs, severity grading of ADRs, and preventability of ADRs. Results The highest percentage of ADRs occurred in the 30–39 age group. Antimicrobials were the most common cause of ADRs, with skin manifestations being the predominant clinical feature. Approximately 23.93% of ADRs were deemed preventable. Conclusion Monitoring ADRs related to antimicrobials is crucial in adult emergency infusions. The 30–39 age group is particularly susceptible to ADRs. Preventive measures and a well-established Electronic Health Record (EHR) system can effectively reduce ADRs incidence.

Bioweathering in monogenetic volcanoes: the case of Xitle in Mexico City

This contribution describes biological weathering features produced by microbial communities growing on rock surfaces denominated biological rock crusts. We provide arguments related to the importance of recognizing rocks as an ecological niche and a review of main recognized bio-weathering processes in basaltic bedrock. We particularly address the features found in the lava flow of the monogenetic volcano Xitle, which is located in the volcanic field of the Sierra del Chichinautzin in the south of Mexico City. We found that the diversity and distribution of organisms within the rock crusts varies depending on the superficial texture and porosity of the lavas. Mosses have a preference for vesicles and crevices, while lichens can establish in smoother and more exposed areas. The predominant biological weathering features we have found associated with these crusts are incrustation, penetration, vesicle infilling, endolithic colonization, fractures, and particle entrapment. It is worth noting that bioweathering features are related to specific biological groups: lichens exert all of the features found, while mosses are mostly associated with particle entrapment and vesicle infilling, and biofilms are related to penetration and endolithic colonization. Therefore, this article discusses the importance of geoheritage conservation in relation to the biodiversity these lavas harbor.

Deep learning-assisted non-invasive pediatric tic disorder diagnosis using EEG features extracted by residual neural networks

Early diagnosis of pediatric tic disorders (TD) is crucial for effective therapeutic intervention and management, which can significantly improve neurological development and psychological well-being from childhood through adulthood. However, current pediatric TD diagnostic methodologies suffer from low specificity and sensitivity, as they rely primarily on the subjective expertise of clinicians. Herein, we demonstrated a non-invasive approach for deep learning-assisted diagnosis of pediatric TD. A residual neural network model was developed to predict TD using electroencephalogram (EEG) signals. The optimized model analyzed preprocessed EEG data to generate diagnostic reports indicating the probability of TD occurrence, thus providing deep learning-assisted support for clinical decisions. The clinical features of EEG signals in pediatric TD are elucidated through extensive analysis. Predictive accuracy of EEG decreases over time, with short-term EEG indicating that right hemisphere EEG activity is a predominant clinical feature of TD. A computer-based application was developed and implemented to calculate the probability of TD based on individual EEG patterns, thereby assisting clinicians with diagnostic decision-making in real-world scenarios. This work not only proposes a non-invasive and accurate approach for TD diagnosis but also contributes to the early intervention and long-term management of neurological and psychological health in affected individuals.

Flow characterization and turbulence in the eastern section of the Strait of Magellan, Southern Chile

The Strait of Magellan connects the Pacific and Atlantic oceans in South America’s southern region, and it has been recognized for centuries as an important transoceanic navigation route as well as a unique marine environment with a rich ecological diversity. Evaluations of the impact of human activities in the channel and multiple potential future developments require a better understanding of the physical environment to design sustainable strategies aimed at preserving these characteristics. In this investigation, we study the flow near the Atlantic inlet of the Strait where the dynamics is characterized by the interactions of the tide propagation within two narrows, which are the predominant features of the channel morphology. Tides amplified by the Patagonian shelf generate strong currents through these narrows and control the exchange between the Atlantic and central regions of the Strait. We employ bottom-mounted and vessel-mounted Acoustic Doppler Current Profilers (ADCPs) with tide gauges to analyze the mean flow, tidal propagation, and turbulence, complementing the data with previous available measurements. The analysis reveals residual flows directed toward ebb flow at the channel center and flood near the edges, showing a significant spring-neap variation. Turbulence statistics in the second narrows exhibit a significant variability between ebb and flood, with a balance between production and dissipation observed only during ebb phases.

Strength and ductility of additively manufactured 310 austenitic stainless steel via wire-arc directed energy deposition: The role of columnar grain growth and ductility-dip cracking

This study investigates the underlying factors governing the mechanical properties of single-wall additively manufactured SS 310 austenitic stainless steel via wire-arc directed energy deposition. It demonstrates the predominant microstructural feature in the printed SS 310 stainless steel is the formation of epitaxial large columnar austenite grains, which promotes the occurrence of sub-solidus solid-state ductility-dip cracking (DDC) during the multi-layer additive manufacturing process. While the yield strength and tensile strength of wire-arc additively manufactured SS 310 are comparable to those of wrought annealed AISI 310, the short micro-cracks and the presence of δ-ferrite hinder the work hardening rate and uniform elongation. Additionally, micro-cracks promote void nucleation during the ductile fracture process, resulting in a noteworthy reduction in post-necking elongation and energy absorption capability. The stress-strain behavior of the manufactured part exhibits anisotropy due to the growth of columnar grains, the heterogeneous periodic microstructure, and the orientation of the ductility-dip cracks. To fully harness the potential of wire-arc additive manufacturing as a cost-effective and sustainable manufacturing process, it is imperative to optimize the grain structure and minimize residual stress to eliminate the occurrence of DDC in the production of SS 310 austenitic stainless steel.

Clinical features and rehabilitation outcome after surgical treatment of spinal meningioma.

Retrospective analysis of clinical routine data. Spinal meningioma is a common type of benign spinal tumor. Surgical removal is the standard therapeutic approach. While surgery is generally associated with excellent outcomes, little is known about the rehabilitation outcome of patients with postoperative deficits. Therefore, we aim to describe the clinical features and rehabilitation outcomes of patients after surgical removal of spinal meningioma. Region of Swabia, Bavaria, Germany. We conducted a retrospective analysis of patients with spinal meningioma who underwent a rehabilitation program for patients with non-traumatic spinal cord injury at our department over the past five years. In addition to routine data, we focussed on analysing the Barthel Index, SCIM III score, and ASIA impairment scale before and after rehabilitation. 15 patients were included in the analysis. While most of them only had a few restrictions relevant to activities of daily living, some had severely limited walking ability. The predominant clinical feature was incomplete paraplegia with or without neurogenic bladder and bowel affection. The Barthel Index and SCIM III score demonstrated positive changes in the majority of cases, while alterations in the ASIA impairment scale were observed in a minority. Considering the results of outcome parameters, rehabilitation treatment appears effective for these patients. Nonetheless, further studies with larger patient cohorts are necessary to confirm these findings.

Revolutionizing Glioblastoma Immunotherapy Conquering Transport and Biological Challenges, Innovating Combinatorial Approaches for Unprecedented Treatment Success

Abstract: Glioblastomas are the most common primary brain cancer and present many challenges in treatment, with the current standard-of-care treatments yielding a median survival rate of less than 15 months. While immunotherapy against cancer has been very effective in some cancers, its application in glioblastoma has been limited so far. The following review touches upon some of the critical challenges associated with successful immunotherapy in glioblastoma, covering transport-related obstacles presented by the blood-brain barrier, biological complexity within the central nervous system, and the interplay between glioblastoma and immune cells. Ongoing clinical trials testing the efficacy of different immunotherapeutic strategies, including immune checkpoint blockade, vaccination, and adoptive cell transfer, are discussed. These strategies are inherently challenged by the low immunogenicity of glioblastoma, the unique immuneprotective mechanisms of the immune system within the CNS, and the predominant features of the immune-suppressive tumor microenvironment. Current therapeutic modalities reviewed include surgical resection, radiation therapy, and temozolomide-based chemotherapy, with discussions on new forms of approaches to enhance immune activation: vaccines, oncolytic viruses, and adoptive cell therapies such as CAR T cells and NK cells. The perpetual problem of resistance to immunotherapy underlines the need for combination strategies and precise testing within advanced in-vitro and animal tumor models, considering the large variability in glioblastomas.

Pediatric giant cell tumor of bone: a clinicopathological analysis of 35 cases

Objective: To investigate the clinicopathological characteristics of giant cell tumor of bone (GCTB) in children. Methods: A total of 35 cases of GCTB diagnosed at Shanghai Sixth People's Hospital Affiliated to Shanghai Jiaotong University School from 2016 to 2023 were collected, and a retrospective analysis of clinicopathological features and imaging findings was conducted. Results: Pediatric GCTB accounted for approximately 4.6% of total GCTB cases during the study period. There were 11 males and 24 females. The onset age ranged from 9 to 18 years (mean age 15 years, median age 16 years), with 8 cases (8/35, 22.9%) experiencing postoperative recurrence. Twenty-eight cases (28/35, 80%) primarily affected long bones, while 7 cases involved small or irregular bones. Imaging revealed osteolytic changes as the predominant feature, with 3 cases exhibited open physis, one of which had the tumor primarily at the diaphysis without crossing the physis. Histologically, pediatric GCTB resembled adult cases, characterized by mononuclear cells and osteoclast-like giant cells. Seven cases with denosumab treatment demonstrated degrees of giant cell disappearance, increased fibrous tissue and reactive bone proliferation in the stroma. One case was diagnosed as pediatric multicentric GCTB, and three cases as pediatric primary malignant GCTB, with malignant transformation into osteosarcoma. In all 35 cases, mutations in the H3F3A gene were identified, comprising 32 cases with H3.3 p.G34W mutations, one case with H3.3 p.G34V mutation, and 2 cases with H3.3 p.G34L mutations. Notably, the former two categories were successfully validated at the protein level through immunohistochemical staining, utilizing highly specific antibodies tailored for these mutation types: H3.3 p.G34W antibody and H3.3 p.G34V antibody. However, immunohistochemical staining was not available for the last category. Conclusions: Pediatric GCTB predominantly affects females and occurs primarily in long bones, mainly around the knee joint, the majority of tumors predominantly arise in the epiphysis and extend into the metaphysis; however, in cases where the epiphyseal plates are still unclosed, the tumors may be restricted to the metaphysis. Detection of H3F3A gene mutation is crucial for the diagnosis and differential diagnosis of pediatric GCTB.

Structural and optical properties of Eu-doped ZnO epitaxial thin films grown by pulsed-laser deposition

Pulsed-laser deposition was utilized to fabricate Eu-doped ZnO epitaxial films on c-plane sapphire substrates with Eu concentrations ranging from 0.5 to 4.0 at. %. The structural properties were analyzed using x-ray diffraction surface normal radial scans and azimuthal cone scans, which confirmed the epitaxy of the film samples. Reciprocal space mapping was performed on ZnO(101̄1) to visualize the effect of Eu incorporation. X-ray fluorescence mapping confirmed the homogeneous distribution of Zn and Eu, and x-ray absorption near-edge structure spectra directly confirmed the trivalent state of Eu ions. The optical properties were assessed using temperature-dependent photoluminescence (PL). Various defects were identified. With increasing Eu dopant concentration, PL emissions from defects and the Eu 4f-intraband transitions gradually became the predominant features in the PL spectra at low temperatures. Furthermore, PL analysis suggested that Eu ions substituted Zn, occupying sites with lower C3v symmetry due to the distortion caused by Eu incorporation.

Development of an Artificial Intelligence System for Distinguishing Malignant from Benign Soft Tissue Tumors Using Contrast-Enhanced MR Images.

The integration of artificial intelligence (AI) into orthopedics has enhanced the diagnosis of various conditions; however, its use in diagnosing soft-tissue tumors remains limited owing to its complexity. This study aimed to develop and assess an AI-driven diagnostic support system for magnetic resonance imaging (MRI)-based soft-tissue tumor diagnosis, potentially improving accuracy and aiding radiologists and orthopedic surgeons. Experienced orthopedic oncologists and radiologists annotated 720 images from 77 cases (41 benign and 36 malignant soft-tissue tumors). Eleven tumor subtypes were identified and classified into benign and malignant groups based on histological diagnosis. Utilizing the standard machine learning classifier pipeline, we examined and down-selected imaging protocols and their predominant radiomic features within the tumor's three-dimensional region to differentiate between benign and malignant tumors. Among the scan protocols, contrast-enhanced T1 weighted fat-suppressed images showed the most accurate classification based on radiomics features. We focused on the two-dimensional features from the largest tumor boundary surface and its neighboring slices, leveraging texture-based radiomic and deep convolutional neural network features from a pretrained VGG19 model. The test data comprised 44 contrast-enhanced images (22 benign and 22 malignant soft-tissue tumors) containing six malignant and five benign subtypes distinct from the training data. We compared expert and non-expert human performances against AI by assessing malignancy detection and the time required for classification. The AI model showed comparable accuracy (AUC 0.91) to that of radiologists (AUC 0.83) and orthopedic surgeons (AUC 0.73). Notably, the AI model processed data approximately 400 times faster than its human counterparts, showcasing its capacity to significantly boost diagnostic efficiency. We developed an AI-driven diagnostic support system for MRI-based soft-tissue tumor diagnosis. While additional refinement is necessary for clinical applications, our system has exhibited promising potential in differentiating between benign and malignant soft-tissue tumors based on MRI.

Systemic lupus international collaborating clinics-2012 and European league against rheumatism/American college of rheumatology-2019 classification criteria for systemic lupus erythematosus associated with childhood-onset auto-immune cytopenia.

Systemic Lupus Erythematosus (SLE) can be diagnosed using the 2012 criteria of the Systemic Lupus International Collaborating Clinics (SLICC) and, more recently, the 2019 criteria of the European League Against Rheumatism/American College of Rheumatology (EULAR/ACR). Hematological involvement is scored differently by these classifications. Our objective was to compare both criteria in a cohort of children with autoimmune cytopenia (AIC)-associated SLE. We included 79 patients with childhood-onset AIC as the first manifestations of SLE. The median age at SLE diagnosis was 14.5years (1.1-21.4years). The SLICC criteria were fulfilled by 76/79 (96%) patients and the EULAR/ACR criteria by 72/79 (91%) patients during follow-up. The SLICC and EULAR/ACR criteria were discordant (not concomitantly fulfilled) in 25/79 (32%) patients. Non-hematological clinical manifestations were more frequently observed in SLE diagnosis when the criteria were concordant (30/54, 56%) than when they were not (5/25, 20%) (p = 0.004). In 16/25 (64%) discordant patients, the SLICC criteria allowed earlier diagnosis of SLE. Finally, the attribution of a maximum weight of 6 to the hematological involvement of the EULAR/ACR criteria increased the sensitivity thereof from 63/79 (80%) to 76/79 (96%) in our population. The SLICC 2012 and EULAR/ACR 2019 criteria do not effectively diagnose SLE in children when AIC is the predominant feature. The SLICC criteria appear to be more effective in this population of SLE patients. An increase in the maximum weight of hematological involvement to 6 increases the sensitivity of the EULAR/ACR criteria for SLE diagnosis in children.

Multiomics Studies on Metabolism Changes in Alcohol-Associated Liver Disease.

Metabolic dysfunction in the liver represents a predominant feature in the early stages of alcohol-associated liver disease (ALD). However, the mechanisms underlying this are only partially understood. To investigate the metabolic characteristics of the liver in ALD, we did a relative quantification of polar metabolites and lipids in the liver of mice with experimental ALD using untargeted metabolomics and untargeted lipidomics. A total of 99 polar metabolites had significant abundance alterations in the livers of alcohol-fed mice. Pathway analysis revealed that amino acid metabolism was the most affected by alcohol in the mouse liver. Metabolites involved in glycolysis and the TCA cycle were decreased, while glycerol 3-phosphate (G3P) and long-chain fatty acids were increased. Relative quantification of lipids unveiled an upregulation of multiple lipid classes, suggesting that alcohol consumption drives metabolism toward lipid synthesis. Results from enzyme expression and activity detection indicated that the decreased activity of mitochondrial glycerol 3-phosphate dehydrogenase contributed to the disordered metabolism.

9182 Metastatic Extra-Gastrointestinal Stromal Tumor Presenting As Hypoglycemia

Abstract Disclosure: O. faour: None. D. John: None. S.K. Suryanarayanan: None. A.A. Rizvi: None. Introduction: Non islet cell tumor hypoglycemia (NICTH) is a rare paraneoplastic syndrome seen in association with solid abdominal tumors of mesenchymal and epithelial origin. We report a case of metastatic extra-gastrointestinal stromal tumor (E-GIST) presenting with severe hypoglycemia as its initial manifestation. CASE DESCRIPTION: A 46-year-old patient was found to have a blood glucose of <45 mg/dl during a routine clinic visit with her primary care physician. Although she was asymptomatic, she was sent to the emergency room (ER) for further evaluation. She had a history of prediabetes managed by lifestyle modification. She has been experiencing multiple episodes of hypoglycemia previously which fulfilled the Whipple’s triad in the preceding months. These hypoglycemic episodes included loss of unconsciousness, falls in the shower with head injury, and several hospital visits. Serum glucose in the ER was 14 mg/dl and hypoglycemia persisted despite continuous dextrose solution. Physical examination was notable for a distended, non-tender abdomen and cervical lymphadenopathy. CT scan showed a 15 cm mass in the liver, multiple large masses in the mesentery, and a 11 cm lesion in the left pelvis. There were enlarged lymph nodes in the abdomen, chest, and neck. Serum chemistries drawn when the patient was hypoglycemic revealed potassium level of 2.7 mg/dl (3.5-5.5) an insulin level of <1.0 mIU/L (5-25), C-peptide <0.1 ng/mL (0.5-2), cortisol 13.8 mcg/dL (5-25), and insulin-like growth factor-2 (IGF-2) was 270 ng/mL (38-267). The IGF-2/IGF-1 molar ratio was 3.4 (normal <3:1). The sulfonylurea drug screen came back negative. Upper and lower endoscopies were unrevealing. Biopsy of the liver lesion showed cytology and immunohistochemical findings consistent with a epithelioid metastatic extra-gastrointestinal stromal tumor. A provisional diagnosis of NICTH was made. The patient responded well to intravenous glucose, oral carbohydrate intake and high-dose corticosteroids. She was subsequently started on therapy with the tyrosine kinase inhibitor (TKI) imatinib. Discussion: Paraneoplastic hypoglycemia is often seen in association with metastatic epithelial and mesenchymal tumors. IGF-2 and incompletely processed pro-IGF-2 activates autocrine, paracrine, and endocrine pathways that lead to tumor growth, fasting hypoglycemia, rarely of acromegalic features. Treatment with octreotide, diazoxide, and glucagon is generally ineffective, while glucocorticoid use and surgical intervention are helpful in ameliorating the hypoglycemia. Tumor-directed therapy with TKIs, primarily imatinib, appears promising in achieving remission. Our case is a clinical reminder that hypoglycemia secondary to NICTH can be the predominant presenting feature in patients with underlying E-GIST. Presentation: 6/3/2024

Deciphering ovarian torsion: insights from CT imaging analysis.

In the milieu of emergency medicine, pelvic and lower abdominal pain present recurrently, with ovarian torsion posing a formidable diagnostic quandary amid multifarious etiologies. Given the burgeoning reliance on CT in acute care settings, it invariably assumes primacy as the principal imaging modality. This study endeavors to elucidate the CT imaging manifestations encountered by surgically confirmed ovarian torsion patients and utilizing CT to differentiate necrosis. A retrospective analysis (January, 2015- April, 2019) utilizing hospital archives was conducted on patients diagnosed with ovarian torsion, post-surgery. Inclusion criteria encompassed patients who underwent CT examinations within one week of diagnosis. A large array of CT findings encompassing midline orientation, uterine deviation, intraovarian hematoma/mass, and multiple others were systematically documented. 90 patients were diagnosed with ovarian torsion- 53 (59%) had CT within one week of diagnosis, 41(77%) underwent a CT with IV contrast and 12 (23%) without IV contrast. Mean age was 43 years (range 19-77 years), with near equal distribution of involvement of each ovary. Mean maximum ovarian diameter was 11.7 ± 6.3cm (4.2-34.8cm). Most common imaging features include the presence of thickened pedicle (43/53, 81%), midline ovary (41/53, 77%), presence of thickened fallopian tube (31/49, 63%), and ipsilateral uterine deviation (33/53, 62%). Based on contemporaneous imaging report, torsion was diagnosed in 25/ 53 studies giving a sensitivity of 47%. Enlarged ovarian dimensions (> 3.0cm), thickened vascular pedicle or fallopian tube, midline ovarian disposition with ipsilateral uterine deviation, and the presence of a whirlpool sign emerged as predominant CT imaging features in surgically confirmed ovarian torsion cases, serving as pivotal diagnostic aides for radiologists. Concomitant pelvic free fluid and intraovarian hematoma signify necrotic changes, indicative of ischemic severity and disease progression.

Breast Cancer: The Psychological Impact of Diagnosis, Treatment, and Remission.

Breast cancer affects millions of people worldwide. With physical manifestations being the predominant feature of management, healthcare professionals can overlook the psychological toll that the disease can have on the patients and their support network. This literature review examines the vast multi-factorial approach that must be taken when managing breast cancer patients from initial screening to diagnostic investigations, treatment, and remission. A literature search in PubMed from January 2000 to April 2024 was executed. Data sets in the studies filtered during the literature search were collected and analysed, looking not only at the data itself but also the entirety of the study. This included its limitations and possible biases.From screening, the possibility of cancer as a diagnosis can trigger mixed emotions including fear, depression, and anxiety. During diagnostic, patients may find themselves subject to fear of negative body image evaluation and fear of judgment. Medical professionals must be prepared to support the patient when they experience these feelings. The treatment stages can be the most difficult for the patient as side effects and complications of treatment can impact their lives in numerous ways, making management challenging. These include pain, sexual dysfunction, and alopecia. Overall, the analysis of the selected literature showed areas in clinical practice that can be optimised when providing psychological support for a patient's cancer diagnosis, management, and treatment. Being able to counsel prior to the presentation of these, and ideally prevent unnecessary cases of these can substantially increase a patient's quality of life during treatment. This literature review hopes to identify and promote awareness and further implementation of support systems by healthcare professionals.

Characteristics of Severe Asthma Clinic Patients With Eosinophilic Granulomatosis With Polyangiitis

BackgroundEosinophilic granulomatosis with polyangiitis (EGPA) is a rare form of anti-neutrophil cytoplasm antibody (ANCA)-associated vasculitis associated with varying clinical presentations and overlapping multiorgan involvement. Asthma is a predominant feature of EGPA, typically in its prodromal phase, often severe and precedes vasculitic complications. However, there is paucity of studies describing the prevalence and characteristics of EGPA in the asthma population. ObjectiveWe aim to describe the clinical and serological characteristics and longitudinal therapeutic outcomes of patients with EGPA in the severe asthma (SA) cohort. MethodsRetrospective study of patients with EGPA attending the multidisciplinary SA clinic in a tertiary hospital from 2011 to 2023 was conducted. Baseline demographics, organ manifestations, biological markers, lung function and therapeutic outcomes were assessed. Results23 out of 596 patients in the SA registry were identified to have EGPA. Median time interval between asthma and EGPA diagnosis was 10 years (range 2.5 to 32 years). Almost all patients (95.7%) had peak blood eosinophil count of >1.0 x 109/L (range 0.47 – 14.08 x 109/L). Upper airway involvement was the most detected manifestation in addition to asthma, followed by neuropathy and renal involvement. Patients who were treated with biologic therapy were significantly younger, had more upper airway, renal, pulmonary involvement and lower five factor score (FFS). ConclusionThe prevalence of EGPA in the SA population was 3.9% in our cohort. Its diagnosis requires high clinical suspicion in patients with SA and blood eosinophilia, prompting stringent evaluation for extrapulmonary manifestations and multidisciplinary involvement.

A multi-center, randomized, double-blind, sham-stimulation controlled study of transcranial magnetic stimulation with precision navigation for the treatment of multiple system atrophy

BackgroundMultiple system atrophy (MSA) is recognized as an atypical Parkinsonian syndrome, distinguished by a more rapid progression than that observed in Parkinson’s disease. Unfortunately, the prognosis for MSA remains poor, with a notable absence of globally recognized effective treatments. Although preliminary studies suggest that transcranial magnetic stimulation (TMS) could potentially alleviate clinical symptoms in MSA patients, there is a significant gap in the literature regarding the optimal stimulation parameters. Furthermore, the field lacks consensus due to the paucity of robust, large-scale, multicenter trials.MethodsThis investigation is a multi-center, randomized, double-blind, sham-controlled trial. We aim to enroll 96 individuals diagnosed with MSA, categorized into Parkinsonian type (MSA-P) and cerebellar type (MSA-C) according to their predominant clinical features. Participants will be randomly allocated in a 1:1 ratio to either the TMS or sham stimulation group. Utilizing advanced navigation techniques, we will ensure precise targeting for the intervention, applying theta burst stimulation (TBS). To assess the efficacy of TBS on both motor and non-motor functions, a comprehensive evaluation will be conducted using internationally recognized clinical scales and gait analysis. To objectively assess changes in brain connectivity, functional magnetic resonance imaging (fMRI) and electroencephalography (EEG) will be employed as sensitive indicators before and after the intervention.DiscussionThe primary aim of this study is to ascertain whether TBS can alleviate both motor and non-motor symptoms in patients with MSA. Additionally, a critical component of our research involves elucidating the underlying mechanisms through which TBS exerts its potential therapeutic effects.Ethics and disseminationAll study protocols have been reviewed and approved by the First Affiliated Medical Ethics Committee of the Air Force Military Medical University (KY20232118-F-1).Trial registrationChinese Clinical Trial Registry ChiCTR2300072658. Registered on 20 June 2023.

The Overlooked Role of Humin in Dark Hydroxyl Radical Production during Oxygenation.

Humin, endowed with abundant redox functional groups, can be reduced anaerobically under dark. When reduced humin encounters O2, the possibility of ·OH formation arises. However, the exploration of ·OH generation mediated by humin has not been comprehensively conducted. The study found that O2 oxidized the reduced humin, generating 8.61 μmol/g of ·OH. After isolating humin using the methyl isobutyl ketone (MIBK) method, the lipid component was identified as the primary contributor to ·OH generation. Subsequent polar separation revealed that the lipid fraction extracted from the ethanol-water mixture with a volume ratio of 7:3 (LFEW7:3) played the most significant role in ·OH production. Further characterization confirmed that the simultaneous presence of aromatic C═C and C═O were the predominant features contributing to the ·OH generation. The ·OH generation experiments with humin-pyridine analogue compound demonstrated that polycyclic pyridine N (≥3 rings) played a significant role in promoting the ·OH generation. Most importantly, the study compared the ·OH production by humin and homologous humic acid, indicating that ·OH generated by humin was higher than that of humic acid. Overall, these affirmative findings manifested the overlooked role of humin in ·OH production and offered valuable insights into the mechanism of ·OH generation by humin in the dark.

Clinical characteristics of Chinese children with EV-D68-associated pneumonia: A single-center retrospective analysis.

Human enterovirus D68 (EV-D68) has been associated with an increase in mild-to-severe pediatric respiratory diseases in western countries. However, the prevalence and clinical characteristics of EV-D68-associated pneumonia in China remain understudied. Between January 2022 and January 2024, 28 patients with EV-D68-associated pneumonia were enrolled. We described the prevalence, demographic, and clinical characteristics of patients with EV-D68-associated pneumonia. Among the 28 enrolled patients, the male-to-female ratio was 1.5:1, and the average age at onset was 4.6 ± 2.7 years. Four (14.3%) required intensive care support. Monoinfection occurred in 11 cases (39.3%), while coinfections were seen in 17 cases (60.7%). 82.1% of patients had a history of one or more atopic diseases. The primary symptoms of EV-D68-associated pneumonia included cough (100%), wheezing (53.6%), and fever (53.6%). Radiologically, patchy opacity was the predominant feature, observed in 72.7% of cases. No statistically significant differences were found in symptoms, laboratory tests, or imaging findings between the monoinfection and coinfection groups. Except for one case who developed quadriplegia sequelae, all patients had a favorable prognosis. EV-D68 is not a common pathogen for community-acquired pneumonia in China. It mainly affects young children, particularly those with atopic constitution. The overall prognosis is favorable, although neurological complications are rare and may lead to severe sequelae. This study is the first investigation into the prevalence and clinical characteristics of EV-D68-associated pneumonia in China.

Improved multi-focus image fusion using online convolutional sparse coding based on sample-dependent dictionary

Multi-focus image fusion merges multiple images captured from different focused regions of a scene to create a fully-focused image. Convolutional sparse coding (CSC) methods are commonly employed for accurate extraction of focused regions, but they often disregard computational costs. To overcome this, an online convolutional sparse coding (OCSC) technique was introduced, but its performance is still limited by the number of filters used, affecting overall performance negatively. To address these limitations, a novel approach called Sample-Dependent Dictionary-based Online Convolutional Sparse Coding (SCSC) was proposed. SCSC enables the utilization of additional filters while maintaining low time and space complexity for processing high-dimensional or large data. Leveraging the computational efficiency and effective global feature extraction of SCSC, we propose a novel method for multi-focus image fusion. Our method involves a two-layer decomposition of each source image, yielding a base layer capturing the predominant features and a detail layer containing finer details. The amalgamation of the fused base and detail layers culminates in the reconstruction of the final image. The proposed method significantly mitigates artifacts, preserves fine details at the focus boundary, and demonstrates notable enhancements in both visual quality and objective evaluation of multi-focus image fusion.