Unpredictable Evolution Research Articles

Atypical Desmoid Tumor, A Case Report

Desmoid tumors are rare and benign tumors of soft tissues, characterized by local invasion and high tendency to recur despite surgical resection, we study the case of a 19-year-old patient admitted for cervico-facial and parieto-costal swellings, without any significant family history, and we study the CT and magnetic resonance imaging aspects, with an unpredictable and recurrent evolution despite surgical excision, with many studies that affirm the hormonal factor with the progression of the swelling, as well as its decrease in size after menopause for the treatment, there is no consent using the different components, surgery, chemo-radiotherapy with different and uncodified effectiveness.

Policy and practice review consensus statements and clinical guidelines on managing pediatric trauma and orthopedics during the COVID-19 pandemic: a systematic review on the global response for future pandemics and public health crises.

The COVID-19 pandemic has been recognized as an unprecedented global health crisis. Over 7 million mortalities have been documented with many paediatric fatalities. Trauma and orthopaedic care, much like other specialities, were marginalized due to resource allocation during the pandemic which affected paediatric care. This is the first systematic review to centralise and compile the recommended published guidelines from professional bodies in principally English speaking countries on managing paediatric trauma and orthopaedic care. These guidelines will be required to be implemented sooner and more effectively in case of future pandemics with similar impact. A search was conducted on PubMed/MedLine, Cochrane Library and Embase using terms including p(a)ediatric or child* and/or COVID* or coronavirus or SARS-CoV-2 and/or trauma and/or orthop(a)edic* with a simplified MeSH heading [mh] in order to make the search as comprehensive as possible. General terminology was utilized to make the search as exhaustive as possible for this systematic review. Another search was conducted on resources available in the public domain from professional bodies publishing on consensus statements and clinical practice guidelines in countries where English is the principal language managing pediatric trauma and orthopedics. The review adhered to PRISMA guidance. The search revealed a total of 62 results from both databases and professional bodies. Duplicates were removed. This was then reviewed to identify a total of 21 results which fit the inclusion criteria and included within the main analysis. The guidelines from professional bodies were outlined and categorized into aspects of clinical care. The impact of COVID-19 pandemic has compelled for changes in clinical practice and pediatric management. The systematic review highlights the relevant guidelines on service provision for pediatric patients including indications for urgent referrals, surgical prioritization, reasons for follow-up and trauma guidelines. The rationale for care during the unpredictable evolution of the COVID-19 pandemic may have the potential to be translated and replicated in future pandemics of similar significance.

SCLEROSE EN PLAQUE ET GESTION DE LAPTITUDE : A PROPOS DE DEUX CAS SUIVIS AU CENTRE DEXPERTISE MEDICAL DU PERSONNEL NAVIGANT DE RABAT

Multiple sclerosis (MS) is the most common inflammatory demyelinating disease of the central nervous system, with variable manifestations, it evolves in two main forms (relapsing and remitting) with an unpredictable evolution, theprognosis may range from minimal neurological deficit to severe disability. It mainly affects the young population. Several manifestations (organic and psychological) of MS can lead to an overall decrease in flight crew performance. It includes cognitive impairment, fatigue and depression. Episodes of spasms, dysarthria, ataxia, paresthesia, diplopia and also hemiplegia can that can affect flight safety. Disease-modifying therapiescould minimize relapse rates and slow disease progression, but are not free from sometimes major side effects that can compromise flight safety. We report our experience with two cabin crew members affected by MS and fitness management. The different manifestations of MS will be discussed with an emphasis on aeromedical implications.

A variant-informed decision support system for tackling COVID-19: a transfer learning and multi-attribute decision-making approach.

The global impact of the COVID-19 pandemic, characterized by its extensive societal, economic, and environmental challenges, escalated with the emergence of variants of concern (VOCs) in 2020. Governments, grappling with the unpredictable evolution of VOCs, faced the need for agile decision support systems to safeguard nations effectively. This article introduces the Variant-Informed Decision Support System (VIDSS), designed to dynamically adapt to each variant of concern's unique characteristics. Utilizing multi-attribute decision-making (MADM) techniques, VIDSS assesses a country's performance by considering improvements relative to its past state and comparing it with others. The study incorporates transfer learning, leveraging insights from forecast models of previous VOCs to enhance predictions for future variants. This proactive approach harnesses historical data, contributing to more accurate forecasting amid evolving COVID-19 challenges. Results reveal that the VIDSS framework, through rigorous K-fold cross-validation, achieves robust predictive accuracy, with neural network models significantly benefiting from transfer learning. The proposed hybrid MADM approach integrated approaches yield insightful scores for each country, highlighting positive and negative criteria influencing COVID-19 spread. Additionally, feature importance, illustrated through SHAP plots, varies across variants, underscoring the evolving nature of the pandemic. Notably, vaccination rates, intensive care unit (ICU) patient numbers, and weekly hospital admissions consistently emerge as critical features, guiding effective pandemic responses. These findings demonstrate that leveraging past VOC data significantly improves future variant predictions, offering valuable insights for policymakers to optimize strategies and allocate resources effectively. VIDSS thus stands as a pivotal tool in navigating the complexities of COVID-19, providing dynamic, data-driven decision support in a continually evolving landscape.

Online imbalance learning with unpredictable feature evolution and label scarcity

Recently, online learning with imbalanced data streams has aroused wide concern, which reflects an uneven distribution of different classes in data streams. Existing approaches have conventionally been conducted on stationary feature space and they assume that we can obtain the entire labels of data streams in the case of supervised learning. However, in many real scenarios, e.g., the environment monitoring task, new features flood in, and old features are partially lost during the changing environment as the different lifespans of different sensors. Besides, each instance needs to be labeled by experts, resulting in expensive costs and scarcity of labels. To address the above problems, this paper proposes a novel Online Imbalance learning with unpredictable Feature evolution and Label scarcity (OIFL) algorithm. First, we utilize margin-based online active learning to selectively label valuable instances. After obtaining the labels, we handle imbalanced class distribution by optimizing F-measure and transforming F-measure optimization into a weighted surrogate loss minimization. When data streams arrive with augmented features, we combine the online passive-aggressive algorithm and structural risk minimization to update the classifier in the divided feature space. When data streams arrive with incomplete features, we leverage variance to identify the most informative features following the empirical risk minimization principle and continue to update the existing classifier as before. Finally, we obtain a sparse but reliable learner by the strategy of projecting truncation. We derive theoretical analyses of OIFL. Also, experiments on the synthetic datasets and real-world data streams to validate the effectiveness of our method.

Emergence of an unpredictable evolution in a spatial prisoner’s dilemma via a player’s multiple perspectives

Spatial prisoner’s dilemma (SPD) has attracted researchers’ attention as a model of conflict for players. In SPD, players have two different strategies, namely, defectors and cooperators. A defector earns a high payoff from an opponent co-operator while getting nothing from an opponent defector. On the contrary, cooperators promote a win–win relationship between the two cooperators. These mechanisms influence population dynamics in SPD, and many SPD models have been developed. However, little is known about the emergence of an unstable or unpredictable evolution in population dynamics using an SPD model, which may be observed in living systems. In addressing this issue, two SPD models were proposed. In both models, players change the neighborhood definition in accordance with their strategies and sometimes select the rule for this change using probability or local information. Result showed that our models generated characteristic population patterns that may be linked to a self-organized criticality (SOC), a term referring to many systems of interconnected, nonlinear elements that evolve over time into a critical state. In fact, the second model could be spontaneously close to the critical point using local information.

Active mechanical cloaking for unsupervised damage resilience in programmable elastic metamaterials.

Owing to the architected void-filled low-density configurations, metamaterials are prone to defects during the complex manufacturing process, or damages under operational conditions. Recently mechanical cloaking has been proposed to shield the effect of such disorders in terms of homogenized mechanical responses. The major drawback in these studies are that the damage location should be known a priori, and the cloak is designed around that damaged zone before manufacturing. Such postulation does not allow unsupervised damage resilience during the manufacturing and service life of metamaterials by active reconfiguration of the stress field depending on the random and unpredictable evolution of damage. Here, we propose a radically different approach by introducing piezoelectric lattices where the effect of random appearance of any single or multiple disorders and damages with complex shapes, sizes and distributions can be shielded through active multi-physically controlled cloaks by voltage-dependent modulation of the stress fields within the cloaking region. Notably, this can be achieved without breaking periodicity and any additional material in the cloaking region unlike earlier studies concerning mechanical cloaks. The proposed active class of elastic metamaterials will bring a step-change in the on-demand mechanical performance of critically important structural components and unsupervised damage resilience for enhanced durability and sustainability.This article is part of the theme issue 'Current developments in elastic and acoustic metamaterials science (Part 1)'.

Concomitant decrease of E- and A-FABP expression predicts worse survival in urothelial bladder cancer patients

Non-muscle invasive bladder cancers (NMIBC) pTa-pT1 are depicted by a high risk of recurrence and/or progression with an unpredictable clinical evolution. Our aim was to identify, from the original resection specimen, tumors that will progress to better manage patients. We previously showed that A-FABP (Adipocyte- Fatty Acid Binding Protein) loss predicted NMIBC progression. Here we determined by immunohistochemistry the prognostic value of E-FABP (Epidermal-Fatty Acid Binding Protein) expression in 210 tumors (80 pTa, 75 pT1, 55 pT2-T4). Thus, E-FABP low expression was correlated with a high grade/stage, the presence of metastatic lymph nodes, and visceral metastases (p < 0.001). Unlike A-FABP in NMIBC, E-FABP low expression was not associated with RFS or PFS in Kaplan–Meier analysis. But patients of the overall cohort with a high E-FABP expression had a longer mOS (53.8 months vs. 29.3 months, p = 0.029). The immunohistochemical analysis on the same NMIBC tissue sections revealed that when A-FABP is absent, a high E-FABP expression is detected. E-FABP could compensate A-FABP loss. Interestingly, patients, whose original tumor presents both low E-FABP and negative A-FABP, had the worse survival, those maintaining the expression of both markers had better survival. To conclude, the combined evaluation of A- and E-FABP expression allowed to stratify patients with urothelial carcinoma for optimizing treatment and follow-up.

Is central venous catheter in haemodialysis still the main factor of mortality after hospitalization?

BackgroundHaemodialysis is the most frequently prescribed Renal Replacement Therapy modality worldwide. However, patients undergoing this therapy have an unpredictable evolution related to vascular access.ObjectiveTo determine the factors associated with the mortality and hospitalization rate in haemodialysis patients at a third-level care Centre in the Dominican Republic.MethodsThis was an observational and prospective study involving a cohort of 192 haemodialysis patients. The patient selection was non-probabilistic for convenience, and a direct source questionnaire was applied.ResultsOf the 192 patients in the cohort, 103 (53.6%) were hospitalized and evaluated. The most frequent cause of hospitalization was catheter-related bloodstream infections (53.4%). Almost one-third (28.2%) of the hospitalized patients died, mostly due to infections (12.6%). Of those who died 29 patients (90%) had a Central venous catheter (CVC) with a non-tunnelled catheter (NTCVC) (65.5%); having an NTC CVC makes a patient 85.5 times more likely to be hospitalized than patients with arteriovenous fistulas.ConclusionVascular access plays a predominant role in the hospitalization and mortality rates in haemodialysis. Patients with an arteriovenous fistula obtained significantly better outcomes than those with central venous catheters.

Current Understanding of Immune Thrombocytopenia: A Review of Pathogenesis and Treatment Options.

The management of immune thrombocytopenia (ITP) and the prediction of patient response to therapy still represent a significant and constant challenge in hematology. ITP is a heterogeneous disease with an unpredictable evolution. Although the pathogenesis of ITP is currently better known and its etiology has been extensively studied, up to 75% of adult patients with ITP may develop chronicity, which represents a significant burden on patients' quality of life. A major risk of ITP is bleeding, but knowledge on the exact relationship between the degree of thrombocytopenia and bleeding symptoms, especially at a lower platelet count, is lacking. The actual management of ITP is based on immune suppression (corticosteroids and intravenous immunoglobulins), or the use of thrombopoietin receptor agonists (TPO-RAs), rituximab, or spleen tyrosine kinase (Syk) inhibitors. A better understanding of the underlying pathology has facilitated the development of a number of new targeted therapies (Bruton's tyrosine kinase inhibitors, neonatal Fc receptors, strategies targeting B and plasma cells, strategies targeting T cells, complement inhibitors, and newer TPO-RAs for improving megakaryopoiesis), which seem to be highly effective and well tolerated and result in a significant improvement in patients' quality of life. The disadvantage is that there is a lack of knowledge of the predictive factors of response to treatments, which would help in the development of an optimized treatment algorithm for selected patients.

Evolutionary Profil of Triple-Negative Breast Cancer and Influence of Histopronostic Factors: Experience of Oncology Department Chu Ibn Rochd Casablanca

Triple-negative breast cancer (TNBC) is a subgroup of breast cancer with hormone receptor and Her2 overexpression absence, accounting for 15%–20% of all breast cancers. Its unpredictable evolution, poor treatment response, and highly invasive nature warrant research interest. The main objective of this study is to assess the evolution of triple-negative breast cancer as a role for histopronostic factors. We present the evolutionary profile of triple-negative breast cancer in the role of histopronostic factors using data from a four-year retrospective study of cases of triple-negative breast cancer collected in the oncology-radiotherapy department at Chu Ibn Rochd Casablanca between January 2015 and December 2019. 232 patients were included, regardless of disease stage. The mean age was 49.54 ± 11.21 years. In 68% of cases, the disease was localized. All metastatic patients (32%) died, with a median survival of 15 months. We analyzed the evolution of triple-negative breast cancer in localized disease as a role for age, tumor size, histological type, SBR grade, lymph node invasion, and vascular invasion, with a median follow-up of 24 months (2 years). In 158 patients in our series with localized disease, local or locoregional recurrence was noted in 16% of cases, metastatic relapse in 10%, and 30% of cases were still in complete remission. Patients aged between 40 and 50 had a higher rate of local and locoregional recurrence. Patients with tumors between 2 and 6 cm in size had a high rate of metastasis and death. Grade SBR III is generally marked by a poor prognosis, with 39 patients having local or locoregional recurrence, 41 patients having metastases, and 15 patients having died. In our series, the greater the lymph node and vascular invasion, the poorer the prognosis, with a higher risk of recurrence and metastasis. These results support the role of early screening, especially for at-risk patients, adequate therapeutic management, and active surveillance of patients with triple-negative breast cancer. New research has shown the effectiveness of immune checkpoint inhibitors and anti-parp in treating advanced triple-negative breast cancer (TNBC), with encouraging findings indicating their potential benefit. Clinical studies including anatomical pathologists, oncologists, and fundamental researchers must be conducted globally to achieve this. Clinical studies involving pathologists, oncologists, and basic researchers are needed worldwide to define new therapeutic strategies for the management of this type of aggressive breast cancer.

Anthropogenic Hazards and Their Impact Upon the Historical Cultural Landscape in Roșia Montană Area

Anthropogenic Hazards and Their Impact upon the Historical Cultural Landscape in Roșia Montană Area. The cultural landscape is a result of the continuous human actions of satisfying the communities’ various needs and the response of the natural system, in its attempt to balance its components in relation to the modelling factor - the human society. Thus, the cultural landscape displays the imprint of the infinite possibilities of the human and natural joint manifestation, sometimes hazards bringing their own contribution to the shaping of the cultural landscape. Hazards, whether natural or anthropogenic, are unforeseen phenomena in terms of space or time of their manifestation, and most often have considerable negative consequences. In particular, anthropogenic hazards, which are directly or indirectly related to human activities, appear mainly as a manifestation of the resilience of natural elements in the cultural landscape, as a complex system. Thus, major interventions, such as mining in Roșia Montană area (an activity that had been lasting for over 2000 years) in relation to the unpredictable evolution of the social, economic, technological and political context (on local, national and global level) have favoured the manifestation of some unforeseen events with a negative connotation such as: complex pollution, depreciation of the living standards (in Roșia Montană area mostly due to the cessation of mining activities), demographic aging, etc. The complex analysis of these implications in the above-mentioned area allows us to outline an eloquent assessment of the present state of the local cultural landscape and to identify the opportunities of systemic resilience. These include: the awareness of the planning, protection and conservation of the local historical cultural landscape as a primary need, restoration of the cultural landscape (through the aesthetic rehabilitation of degraded cultural elements), the implementation of projects that target the sustainable development of Roșia Montană, as a source of identity and sustainable development, the tourism conversion of activities, etc. Keywords: Roșia Montană, cultural landscape, historical cultural landscape, anthropogenic hazards, mining, gold deposits.

An Abdominal Textiloma Simulating an Intestinal Tumour: A Case Report

The textiloma, being an inflammatory granuloma that is secondary to a foreign body left involuntarily at the level of the operative site with an unpredictable evolution, constitutes a relatively rare postoperative complication, with a misleading clinical-radiological presentation, as well as potentially serious complications and forensic proceedings involving the responsibility of the surgeon. Although surgery is the means of choice to confirm the diagnosis and to treat the disease, taking serious preventive measures remains the only solution to avoid this type of incident. We report the case of an intestinal tumor syndrome revealing an abdominal textiloma.

Distributed, Dynamic and Recursive Planning for Holonic Multi-Agent Systems: A Behavioural Model-Based Approach

In this work, we propose a new distributed, dynamic, and recursive planning approach able to consider the hierarchical nature of the holonic agent and the unpredictable evolution of its behaviour. For each new version of the holonic agent, introduced because of the agent members obtaining new roles to achieve new goals and adapt to the changing environment, the approach generates a new plan that can solve the new planning problem associated with this new version against which the plans, executed by the holonic agent, become obsolete. To do this, the approach starts by generating sub-plans capable of solving the planning subproblems associated with the groups of the holonic agent at its different levels. It then recursively links the sub-plans, according to their hierarchical and behavioural dependency, to obtain a global plan. To generate the sub-plans, the approach exploits the behavioural model of the holonic agent’s groups, thereby minimising the computation rate imposed by other multi-agent planning methods. In our work, we have used a concrete case to show and illustrate the usefulness of our approach.

Comprehensive analysis reveals potential therapeutic targets and an integrated risk stratification model for solitary fibrous tumors

Solitary fibrous tumors (SFTs) are rare mesenchymal tumors with unpredictable evolution and with a recurrence or metastasis rate of 10-40%. Current medical treatments for relapsed SFTs remain ineffective. Here, we identify potential therapeutic targets and risk factors, including IDH1 p.R132S, high PD-L1 expression, and predominant macrophage infiltration, suggesting the potential benefits of combinational immune therapy and targeted therapy for SFTs. An integrated risk model incorporating mitotic count, density of Ki-67+ cells and CD163+ cells, MTOR mutation is developed, applying a discovery cohort of 101 primary non-CNS patients with negative tumor margins (NTM) and validated in three independent cohorts of 210 SFTs with the same criteria, and in 36 primary CNS SFTs with NTM. Compared with the existing models, our model shows significantly improved efficacy in identifying high-risk primary non-CNS and CNS SFTs with NTM for tumor progression.Our findings hold promise for advancing therapeutic strategies and refining risk prediction in SFTs.

Respuesta al tratamiento y características de los pacientes con pioderma gangrenoso atendidos en una institución de referencia en Antioquia, Colombia, entre 2015 y 2021

IntroductionPyoderma gangrenosum (PG) is an autoinflammatory neutrophilic dermatosis that affects mainly in women, and it is associated with other autoimmune such as inflammatory bowel disease and rheumatoid arthritis. Data about its epidemiology in Latin America, and specifically in Colombia, is scarce. MethodologyA characterization of patients with PG through a cross-sectional study was conducted. The patients were attended in the dermatology service in a tertiary level institution, from January 2015 to December 2021. It included the registries of patients with the diagnosis and whose medical records had complete data about autoimmune comorbidity and laboratory. Results22 patients with PG were analyzed, it was found that the mean age of presentation was 50 years and mainly in women, the most common variant was ulcerative, and the most frequent location was the lower limbs. Half of the patients presenting as a single lesion and mostly with ulcerative lesion with undermined edges and less than 10 cm in size. A total of 22.7% of cases were related to autoimmune disease. Patients were managed with topical, systemic steroid and other systemic immunomodulators, with satisfactory response in 77.3% of them. ConclusionsFamily physicians and dermatologists should become familiar with this entity since it has an unpredictable evolution and prognosis. It is of great importance to recognize, diagnose and treat the disease properly and early.

Material selection in making electrochemical impedance spectroscopy sensor for electrolyte thickness measurement in marine atmosphere

In this work, the material of the electrochemical impedance spectroscopy based (EIS-based) sensor was optimized to achieve in-situ electrolyte layer thickness (hs) monitoring under marine atmosphere. Results show that the sensor made by easy-corrosion materials not only can induce the high-frequency dispersion in EIS curves, but also cause unpredictable evolution of electrolyte conductivity, leading to an inaccurate measurement of hs. Nevertheless, the Ni sensor with a thin and corrosion-resistant oxide film can eliminate those distractions and achieve accurate hs response in dynamic environments. Finally, methods for optimizing EIS-based sensor were summarized, which paves a new way for hs monitoring.

Preclinical evaluation of PHH-1V vaccine candidate against SARS-CoV-2 in non-human primates

SARS-CoV-2 emerged in December 2019 and quickly spread worldwide, continuously striking with an unpredictable evolution. Despite the success in vaccine production and mass vaccination programs, the situation is not still completely controlled, and therefore accessible second-generation vaccines are required to mitigate the pandemic. We previously developed an adjuvanted vaccine candidate coded PHH-1V, based on a heterodimer fusion protein comprising the RBD domain of two SARS-CoV-2 variants. Here, we report data on the efficacy, safety, and immunogenicity of PHH-1V in cynomolgus macaques. PHH-1V prime-boost vaccination induces high levels of RBD-specific IgG binding and neutralizing antibodies against several SARS-CoV-2 variants, as well as a balanced Th1/Th2 cellular immune response. Remarkably, PHH-1V vaccination prevents SARS-CoV-2 replication in the lower respiratory tract and significantly reduces viral load in the upper respiratory tract after an experimental infection. These results highlight the potential use of the PHH-1V vaccine in humans, currently undergoing Phase III clinical trials.

P39 MANAGEMENT OF A CASE OF LAST REMAINING PATENT VESSEL

Abstract A 72–year–old hypertensive, dyslipidemic and smoker (20 cig/day) gentleman was admitted to the emergency department for pulmonary edema. Past medical history included COPD, anterior MI treated with PCI and stenting of proximal LAD 5 years back, recent TIA. He was admitted to cardiac intensive care unit and treated with CPAP, IV furosemide and norepinephrine. Echocardiogram showed severe ventricular dysfunction (LVEF 20%) and severe functional mitral regurgitation; lab tests pointed out mild troponin elevation (50 ng/L) and high levels of BNP (1300 pg/mL). After stabilization, he underwent coronary angiography: in–stent CTO of LAD, critical stenosis of distal LM and ostio–proximal LCX (last remaining patent vessel, LRPV); hypoplastic RCA. At the end of angiography, new episode of pulmonary edema that required treatment with inotropes, CPAP and diuretics. Considering hemodynamic instability and high surgical risk (combined STS 37%), the Heart Team decided to proceed to PCI with mechanical circulatory support with Impella CP. From left radial access we achieved advancement of JR4 guiding catheter with guide extension in right common iliac artery. We performed angiography and then put a coronary guidewire in superficial femoral artery to facilitate right femoral access (angio–guided). From this femoral access we implanted Impella CP device. From left radial access we performed PCI: cannulation with JL 3 guiding catheter, wiring with Sion Blue ES guidewire, pre–dilatation with NC balloons until 3.0 mm diameter, stenting of LM–LCX with 1 DES 4.0/32 mm, post–dilatation with NC balloons (4.5 and 5.0 mm diameter). Good angiographic result; IVUS examination revealed good expansion and apposition of stent. Femoral access was closed with 2 Perclose Proglide. Patient was then monitored in cardiac intensive care unit, with clinical improvement and without complications. 10 days after PCI the patient, asymptomatic, was discharged. The echocardiogram displayed betterment of contractile function (LVEF 28%) and of mitral regurgitation (now moderate). At 4–month follow–up visit, patient is paucisymptomatic (NYHA class II), without angina episodes, with good quality of life in guideline–directed optimal medical therapy. Critical disease of LRPV is a severe condition, with unpredictable evolution and poor prognosis. PCI of LRPV in HFrEF patients is an high–risk PCI scenario in which mechanical circulatory support with Impella can prove to be essential.

Influenza A viruses in gulls in landfills and freshwater habitats in Minnesota, United States.

Introduction: The unpredictable evolution of avian influenza viruses (AIVs) presents an ongoing threat to agricultural production and public and wildlife health. Severe outbreaks of highly pathogenic H5N1 viruses in US poultry and wild birds since 2022 highlight the urgent need to understand the changing ecology of AIV. Surveillance of gulls in marine coastal environments has intensified in recent years to learn how their long-range pelagic movements potentially facilitate inter-hemispheric AIV movements. In contrast, little is known about inland gulls and their role in AIV spillover, maintenance, and long-range dissemination. Methods: To address this gap, we conducted active AIV surveillance in ring-billed gulls (Larus delawarensis) and Franklin's gulls (Leucophaeus pipixcan) in Minnesota's natural freshwater lakes during the summer breeding season and in landfills during fall migration (1,686 samples). Results: Whole-genome AIV sequences obtained from 40 individuals revealed three-lineage reassortants with a mix of genome segments from the avian Americas lineage, avian Eurasian lineage, and a global "Gull" lineage that diverged more than 50 years ago from the rest of the AIV global gene pool. No poultry viruses contained gull-adapted H13, NP, or NS genes, pointing to limited spillover. Geolocators traced gull migration routes across multiple North American flyways, explaining how inland gulls imported diverse AIV lineages from distant locations. Migration patterns were highly varied and deviated far from assumed "textbook" routes. Discussion: Viruses circulating in Minnesota gulls during the summer breeding season in freshwater environments reappeared in autumn landfills, evidence of AIV persistence in gulls between seasons and transmission between habitats. Going forward, wider adoption of technological advances in animal tracking devices and genetic sequencing is needed to expand AIV surveillance in understudied hosts and habitats.