ANGIOEDEMA AS THE PRESENTING SYMPTOM OF SYSTEMIC LUPUS ERYTHEMATOSUSEmily Petrinec, MD1, Ansaam Daoud, MD1,2, Omer Pamuk, MD2University Hospitals Cleveland Medical Center1Department of Medicine, 2Department of RheumatologyContact information:Emily Petrinec: [email protected] Daoud: [email protected] Pamuk: [email protected] Author: Emily PetrinecContact: [email protected]: Department of Medicine, University Hospitals Cleveland Medical Center 11100 Euclid Ave Cleveland, OH 44106Funding/Disclosure:This research received no specific grant or monetary funds from any agency. There are no conflicts of interest for any authors to disclose.Patient Consent:I confirm that the patient(s) detailed in this submission: ANGIOEDEMA AS THE PRESENTING SYMPTOM OF SYSTEMIC LUPUS ERYTHEMATOSUS, CCR3-2024-08-2570 has reviewed and agreed to all conditions of the patient consent form provided by Clinical Case Reports. If the consent form was provided by a different institution, I confirm that consent form meets all specifications as outlined by COPE guidelines. I confirm that I have received the signed consent form from the patient/family member and will be able to produce that signed consent form if requested by the journal.

A document by Kimberly Schuster. Click on the document to view its contents.

In this paper, the damage mechanisms and residual strength prediction models of unidirectional glass-fiber reinforced polymers are investigated by acoustic emission(AE) technique. The material exhibits three damage modes: matrix cracking, fiber fracture, and interface damage. A novel AE descriptor, amplitude/centroid frequency (ACF), is introduced to differentiate interface damage from other damage modes. Moreover, three signal types exhibit a strong clustering effect when correlated with ACF and average frequency. Microscopic damage mechanisms of the samples are observed using scanning electron microscopy and correlated with AE signals. The AE signals are analyzed using machine learning, and the clustering analysis results are used as a training set to obtain classification models using support vector machine (SVM) and K-nearest neighbor (KNN) methods. Leveraging the traditional mechanical regression analysis prediction model, the study achieves prediction of the material’s residual strength post-fatigue through improvement in AE cumulative counting. Additionally, optimization of prediction results can be achieved by a certain kind of signal after clustering. The combination of supervised learning and residual strength prediction models can realize the real-time classification of AE signals and apply them to the prediction of residual strength, which has a significant application value in real-time monitoring.

Background: There is very little information available about the health status of young stallions from the German Warmblood population that will, once licensed, shape the future of the equestrian sport and horse-breeding. Objectives: To evaluate the prevalence of clinical findings at licensing examinations of candidate stallions and the influences of season of birth, age at licensing, year of licensing, and the evaluator on the distribution of recorded findings. Study design: Retrospective observational study Methods: Clinical records of 1655 candidate stallions presented for licensing in 2018–2020 were reviewed. Data were provided by all German Warmblood horse-breeding associations and their official veterinarians. Storage and processing of the records was performed using the German equine health database. Generalised linear models were used to determine the influences of fixed effects (season of birth, age at licensing, year of licensing, evaluator) on main clinical findings. Significance level was set at p < 0.05. Results: No remarks were documented on the clinical examination protocol in 777 of the 1655 horses (47.0 %). Furthermore, 51.9% of those stallions with remarks had only one finding documented. Main abnormalities recorded were skin lesions, enlargements on the limbs, and testicular findings. The distributions of several clinical findings differed significantly between the evaluators. Main limitations: Homogenous study population and retrospective data Conclusion: The clinical part of the licensing examination of German Warmblood candidate stallions presented in 2018–2020 revealed mostly no or only very few findings. Furthermore, the majority of the clinical findings recorded are considered to be of minor clinical relevance, implying an overall favourable clinical health status of the stallions presented.

Resources, such as nitrogen, are widely hypothesized to underlie the expression and evolution of plant defenses to herbivory. However, resource availability can affect selection on plant defense traits in contrasting ways: resource availability can 1) weaken selection on defense traits by reducing the costs of herbivory, or 2) strengthen selection on defense traits by increasing herbivore pressure. Previous studies have compared herbivore resistance in populations across natural resource gradients to infer how resource availability affects the microevolution of plant defenses. However, because these studies do not manipulate resource availability, they are unable to directly test the effects of resources of plant defense trait evolution. We used a three-decade-long nitrogen fertilization field experiment to test how nitrogen availability affects the evolution of an architectural plant defense trait: stem nodding in Solidago altissima. Stem nodding is a genetic dimorphism that helps plants to evade apex-galling herbivores. By comparing the frequency of defensive nodding versus erect morphs in experimentally fertilized or unfertilized plots, we assessed how nitrogen addition affects the evolution of this defense trait. We found that the defensive nodding morph was 3-4 times more common in plots that evolved under nitrogen fertilization compared to those that evolved in unfertilized control plots. This study provides empirical evidence for resource availability driving plant defense evolution and demonstrates that this evolution can occur on time-scales conducive to study at many long-term nutrient fertilization experiments.

Unmanned Aerial Vehicles (UAVs) are expected to fully exploit their maneuvering capabilities to conduct aggressive maneuvers to complete tasks such as racing and aerobatics even in harsh environments. However, most of related works often focus on slow movements only suitable for regular tasks in well-structured environments. This motivates us to propose a highly robust control scheme designed specifically for UAV aggressive maneuvers, encoded by rapid and large changes in either position or attitude. The core of our approach is the data informed incremental dynamics and the quaternion facilitated control scheme. The former facilitates the model-free control that eliminates the requirement to model the complex dynamics at high velocities and accelerations accurately; While the latter avoids potential singularities during large angular changes. In particular, we first utilize one-step-backward data to construct incremental dynamics, a model-free representation of the UAV dynamics. Then, the constructed incremental dynamics serves as the basis for the development of both position-priority and attitude-priority control schemes, wherein the novel quaternion based aggressive maneuver tracking controllers are designed with complete theoretical analysis. The aggressive maneuvers such as roulette, barrel roll, multiple-flip and cobra maneuvers are chosen for tri/quad/hexa/octocopter platforms to evaluate the performance of our proposed position-priority and attitude-priority control schemes, during which the linear velocity up to 20 m/s, the angular changes up to 360 ◦.

Onchocerciasis also known as River Blindness, is a vector-borne disease caused by Onchocerca volvulus and transmitted by infected female blackflies. It affects millions of people globally, with the greatest impact in sub-Saharan Africa. In this study, we develop a deterministic mathematical model that integrates multiple control measures, including Sterile Insect Technique (SIT), mechanical control, chemical control, public health education and ivermectin treatment, to manage the transmission of onchocerciasis. We employ the next-generation matrix method to calculate the blackfly offspring reproduction number N 0 and the basic reproduction number R 0 . Sensitivity analysis, conducted using the normalized forward sensitivity index, highlights the biting rate as the most positive influence on driving onchocerciasis dynamics, while the mortality rate of female blackflies has a significant negative impact on disease containment. To identify the optimal control strategy, we apply optimal control theory, considering five time-dependent controls which are public health education, treatment, mechanical control, SIT and chemical control. Using Pontryagin’s maximum principle, we derive the optimality system for controlling onchocerciasis. By implementing forward-backward Runge-Kutta method in Matlab, we identify the most optimal strategy for controlling, preventing and treating onchocerciasis in both human and blackfly populations. The results suggest that a combined strategy focusing on public health education, treatment and SIT offers the most effective approach for combating onchocerciasis.

Next-generation sequencing (NGS) has the potential to transform mosquito-borne disease surveillance but remains under-utilized. This study introduces a comprehensive multi-loci metabarcoding-based MX (molecular xenomonitoring) approach to mosquito and arbovirus surveillance, enabling parallel identification of mosquito vectors, circulating arboviruses, and vertebrate hosts from bulk mosquito collections. The feasibility of this approach was demonstrated through its application to a large set (n=134) of bulk field collections. This set was complemented by a number (n=28) of single-species mosquito pools that had previously been screened for viruses using quantitative reverse transcription PCR (RT-qPCR) and metatranscriptomics. Universal alphavirus and flavivirus primer sets were used to screen for arboviruses in the resulting metabarcoding library. Viral amplicons were then indexed and combined with mosquito-specific (ITS2), universal invertebrate (COI), and vertebrate (Cyt b) barcode amplicons prior to sequencing. This approach confirmed the presence of all previously identified mosquito species, as well as those commonly misidentified morphologically, and enabled a degree of quantification regarding their relative physical abundance in each collection. Additionally, the developed approach identified a diverse vertebrate host community (18 species), demonstrating its potential for defining host preferences and, in tandem with the viral screens and associated vector data, understanding disease transmission pathways. Importantly, metabarcoding detected a diversity of regionally prevalent arboviruses and insect-specific viruses, with all three viral diagnostics demonstrating a similar sensitivity and specificity in detecting Ross River virus and Barmah Forest virus, Australia’s commonest arboviruses. In summary, multi-loci metabarcoding is an affordable and efficient MX tool that enables complete mosquito-borne disease surveillance.

Relapsing-remitting multiple sclerosis (RRMS) is defined by elevated IgG/IgA/IgM responses targeting Epstein-Barr Virus (EBV) nuclear antigen 1 (EBNA) and deoxyuridine-triphosphatases (dUTPases) of Human herpsesvirus-6 (HHV-6) and EBV. These responses suggest that the viruses are being replicated and reactivated. An increased prevalence of chronic fatigue syndrome, depression, and anxiety is associated with signs of immune activation in RRMS. Nevertheless, there is a lack of data regarding the association between viral reactivation and neuropsychiatric symptoms of RRMS. This study investigated the IgG/IgA/IgM responses to EBNA, and EBV and HHV-6-dUTPases, in 58 remitted RRMS patients and 63 normal controls. The McDonald criteria were employed to establish the diagnosis of MS. The Expanded Disability Status Scale (EDSS) and the Multiple Sclerosis Severity Score were employed to evaluate disabilities caused by RRMS. We evaluated the scores of the Hamilton Depression (HAMD) and Anxiety (HAMA) Rating Scales, and Fibro-Fatigue (FF) scale. One latent construct was extracted from the EDSS, MSSS, FF, HAMD, and HAMA scores. We discovered that the combined effects of IgG and IgM-HHV-6-dUTPAses accounted for 63.7% of the variance in this construct. Furthermore, the total FF, HAMA, and HAMD scores were substantially associated with the IgG and IgM-HHV-6-dUTPAses, accounting for approximately 38.7% to 51.0% of the variance. The three neuropsychiatric rating scale scores were also significantly correlated with IgA reactivity directed to both dUTPases and IgG/IgA/IgM to EBNA. In conclusion, the reactivation and replication of HHV-6 and EBV significantly contributes to chronic fatigue syndrome, as well as symptoms of depression and anxiety due to RRMS.

Introduction: Individuals with hearing disorders such as tinnitus often experience high levels of stress, anxiety, depression, and decreased sound tolerance. These factors may be related to maladaptive autonomic regulation, affecting their response to acute stress. Heart rate variability (HRV) is a reliable measure of autonomic activity, but its interaction with psychological factors is not well understood. Objectives: The aim was to develop a multimodal stress induction protocol in a non-clinical population and to determine how psychological factors influence physiological responses. Methods: Electrocardiograms were recorded from 30 healthy young adults during three stress tasks: mental arithmetic, noise exposure, and a cold pressor test. Heart rate (HR) and root mean square of successive differences (RMSSD) were used to index autonomic activity. Participants also completed questionnaires on perceived stress, noise sensitivity, anxiety, and depression to examine relationships with HRV. Results: All tasks produced significant time-dependent effects on HRV features, but to different extents. Mental arithmetic produced the largest increase in HR and decrease in RMSSD. In contrast, the noise task showed a significant decrease in HR without a change in RMSSD, suggesting that the task induced relaxation. In the CPT, females showed increased HR but a decrease in RMSSD, whereas males showed the reverse pattern. Psychological factors significantly interacted with HRV dynamic changes during mental and noise tasks, but not during CPT. Conclusions: HRV responses to acute stress are non-stationary and influenced by psychological factors. Thus, this protocol presents an original approach to study autonomic activity in stress-related conditions such as tinnitus.

Immunotherapy for hepatocellular carcinoma (HCC) often does not achieve the desired results. Immunogenic cell death (ICD) has significant potential to trigger the body’s immune response against tumors, offering a hopeful strategy to improve immunotherapy for HCC. Arsenic trioxide (ATO), which induces ICD, may markedly increase the effectiveness of programmed cell death protein 1 (PD-1) inhibitors in the therapy of HCC. However, the complex mechanisms behind this synergistic effect are not yet fully understood. This study aims to elucidate the functions and mechanisms of ATO in HCC and to explore its potential to enhance immunotherapy for HCC. The results showed that ATO dose-dependently reduced the viability of HCC cells. Concurrently, ATO treatment led to an increase in ROS levels and induced ERS, which activated ICD-related damage associated molecular patterns (DAMPs). As a result, this process prompted dendritic cell maturation and enhanced the tumor immune microenvironment. ATO treatment increased the immunogenicity of HCC cells, allowing them to function as both prophylactic and therapeutic vaccines against HCC and to augment anti-tumor immunity. Finally, ATO was found to improve the effectiveness of PD-1 inhibitors in treating HCC in vivo. Therefore, we conclude that ATO effectively bolstered the body’s immune response by triggering ROS/ERS-mediated ICD, which significantly enhanced the therapeutic effectiveness of PD-1 inhibitors against HCC.

; Introduction: A 22-year-old male with no prior cardiovascular history presented with frequent symptomatic ventricular premature contractions (VPCs) with multiple QRS morphologies despite bisoprolol treatment. Results: The coupling intervals progressively increased from VPC1 to VPC3, and VPC2 was the most frequent (VPC1: 9.3%, VPC2: 30.2%, VPC3: 0.5%). The earliest activation site was identified at the left-right coronary cusp junction. Single ventricular extrastimuli with variable coupling intervals from this site successfully reproduced QRS morphologies identical to VPC 1-3. Conclusion: The findings revealed the utility of unique pace-mapping technique in cases of VPCs with multiple morphologies.

Introduction Early detection and intervention in psychotic disorders are public health issues that have led to the creation of specific care systems in France, the visibility of which is still debated. Moreover, these services are often concentrated in adult rather than child psychiatry, which may increase the duration of untreated psychosis. Methods The main objective of this study was to take stock of the care provided in the adolescent unit of the Candélie hospital (Lot-et-Garonne, France) in 2023 and the proportion of adolescents aged over 15 diagnosed with a mental health condition at risk who were followed up. The second objective was to propose an experimental approach to improving care for this group of patients by introducing an advanced practice nurse. Results The results of the retrospective study carried out in 2022 show that staffing levels and care units in adolescent medicine are saturated. Depending on the system, between 19% and 39% of patients are classified as mentally vulnerable. The construction of an Ishikawa diagram highlights three major issues on which the advanced nurse practitioner could intervene: support for one of the systems under particular pressure (RESEDA), the resumption of part of the medical activities given the shortage of doctors, and the child psychiatry-adult psychiatry relay. Conclusion Restructuring existing systems to include initial consultation and monitoring of these adolescents and their families by advanced practice nurses would reduce the duration of untreated psychosis and allow earlier intervention with these adolescents.

A document by Natalia A. Virts. Click on the document to view its contents.

A document by Abiodun John Ologunowa. Click on the document to view its contents.

Offshore wind has an important role in achieving net zero targets and is a vital contributor to addressing the energy crisis. Continued expansion in offshore wind is driving industry and governments across the world to explore deeper and more exposed sites. Standard wind measurements using meteorological masts are more challenging, or even impractical at such sites. As a result, floating LIDAR and physics-based mesoscale models are increasingly being deployed as cost-effective solutions for resource assessment. This study investigates the performance of a meso-microscale coupled Weather Research and Forecasting model by comparing against using 15-months of in-situ wind data collected from two floating LiDAR systems deployed in the Celtic Sea, Southwest UK. Wind speed measurements from model and measurement were compared directly. Vertical wind speed gradient estimates, chosen to quantify how the two data sets predicted wind shear, were also compared, along with estimates of energy generation, as predicted by the two data sets. At approximate turbine hub height (150 m), the model predicted mean wind speeds are 2.38% and 2.81% lower than the measurements and 4.96% and 4.51% lower at the P95 wind speed, for the two measurement locations. However, the differences are greater at wind speeds faster than the turbine cut-out speed. The inverse is true at for windspeeds, below the turbine cut-in speed, where model predicted wind speeds are greater than the measurements. As these high and low wind speeds do not contribute to energy generation, the differences between model-predicted and measurement-predicted energy production are smaller, with model estimates lower by 0.56% and 1.32% for the two measurement sites. Model calculated wind speed gradients were notably different from the measurement-calculated wind speed gradients. In particular, the 90 th percentile value is 35% lower than that predicted by measurements. Attempts to account for this when calculating energy generation suggested that the model estimates were lower than measurements by a much lower margin of 0.6% and 1.37%for the two floating LiDAR locations. This work identifies differences between numerical model predictions and floating Lidar measurements for a proposed offshore wind site. Of the parameters considered, the energy production estimates show the least difference. This helps inform studies looking to accurately evaluate wind resource at more exposed sites. However, usage of wind data that specifically relies on accuracy for large or small wind speeds, such as engineering design, or weather window calculations will be required to consider the impact of the observed differences on their results.

Background A 32-year-old Filipino female with rheumatoid arthritis and lichen planus of low activity was admitted following a five-week period of painful oral mucosal and cutaneous bullae and erosions over her prior lichen planus lesions following her first Moderna COVID-19 vaccine. Skin biopsy revealed lichenoid dermatitis.. Systemic workup failed to show

Museum specimens offer a unique and powerful tool for understanding the impact of anthropogenic change on populations over time. Morphological traits can be impacted by many different environmental variables that are difficult to separate from one another as potential driving factors. Comparative analyses among similar species jointly experiencing change in the same environmental variables can help pinpoint the selective pressures driving temporal morphological change. We assessed temporal change in bill size, tarsus length, and body size between six species of songbirds from the San Francisco Bay Area over the past 150 years. Proxies for body size (wing and tarsus length) exhibited idiosyncratic temporal changes among species. In contrast, we found a significant increase in bill surface area across all but one species. Quantile regression analyses on bill size variation additionally revealed that temporal increases over the past century have been driven by increases in the largest bill sizes in some species, but increases in the smallest bills over time in others. The climate variables best explaining temporal change in bill size also differed among species with some species responding more to changing summer variables (e.g. maximum annual temperature) and others in response to a changing winter climate. These results together suggest that different sympatric, resident bird species may be experiencing temporal morphological change in response to selective pressures experienced at different seasons. Our finding provides support for the season of critical thermal stress hypothesis that suggests variation in functional traits will be shaped by the season that imposes the greatest selective force on a population. Overall, this study has important implications for future research on the role of bills in thermoregulation and for conservation efforts based on the adaptive capacity of birds to respond to climate change.