IntroductionMultiple similarities in the embryogenic epithelial-myoepithelial cell differentiation of the salivary glands and breast tissue allows for overlap of neoplastic development of classically salivary gland tumors in the breast. While biphasic epithelial-myoepithelial lesions of the breast are uncommon and include pleomorphic adenoma, adenoid cystic carcinoma, and benign adenomyoepithelioma, malignant transformation of benign adenomyoepithelioma into epithelial-myoepithelial carcinoma of the breast is extremely rare, with fewer than 50 reported cases in the existing literature over the past four decades [1,2]. Thus far, there have previously been no cases that bring up the possibility of EMC development following the treatment of primary breast cancer in the existing literature.

The use of visual methods in qualitative evidence synthesis (QES) adds a valuable dimension to the synthesis process by enhancing understanding and knowledge generation. This paper provides an overview of common visual methods that support various stages of QES, with a worked example from a Cochrane QES using meta-ethnography. The paper also addresses the involvement of stakeholders, and considerations of equity, diversity, inclusion, and reflexivity in the selection and application of visual methods. The authors utilised a combination of remote and in-person visual methods to initiate and develop their synthesis, involving stakeholders throughout the process. Methods used by the review authors included paper labels, cartoons, infographics, virtual whiteboards, and diagrams. The use of visual methods in the QES facilitated data visualisation, remote analysis meetings, interpretation of extensive data, and meaningful patient and public involvement. QES authors are encouraged to consider the use of visual methods, particularly when involving the public in the synthesis process. Keywords: Qualitative Evidence Synthesis, QES, Meta-ethnography, visual methods

An unusual cause of headache: expanding your differential.

Marine sponges are predicted to be winners in the future ocean due to their exemplary adaptive capacity. However, while many sponge groups exhibit tolerance to a wide range of environmental insults, calcifying sponges may be more susceptible to thermo-acidic stress. To describe the gene regulatory networks that govern the stress response of a calcareous sponge, Leucetta chagosensis (class Calcarea, order Clathrinida), individuals were subjected to warming and acidification conditions based on the climate models for 2100. Transcriptome analysis and gene co-expression network reconstruction revealed that the unfolded protein response (UPR) was activated under thermo-acidic stress. Among the upregulated genes were two lineage-specific homologs of X-box binding protein 1 (XBP1), a transcription factor that activates the UPR. Alternative dimerization between these XBP1 gene products suggests a clathrinid-specific mechanism to reversibly sequester the transcription factor into an inactive form, enabling the rapid regulation of pathways linked to the UPR in clathrinid calcareous sponges. Our findings support the idea that transcription factor duplication events may refine evolutionarily conserved molecular pathways and contribute to ecological success.

Analyzing the temporal dynamics of ecological communities can shed light on coexistence mechanisms and help understand how populations and communities will behave in the face of climate change. However, little is known about how frog communities respond to climate in urban ecosystems, especially in the Global South. Here, we analyzed how frog species richness and abundance are influenced by microclimate both intra- and inter-annually. We surveyed a peri-urban area in central Brazil, monthly for three years. To test the effect of microclimate on species richness and abundance, we used Generalized Additive Mixed-effects Models. We assessed seasonality using circular statistics. We also tested for differences in temporal beta diversity within and among years by estimating species disappearance and temporal rank shift, in addition to a multivariate model-based method to test the effect of year on species composition. Finally, we tested how taxonomic and phylogenetic alpha diversity changed through time using a novel approach based on Hill numbers. We found that species richness varied little among years and was affected only by photoperiod, while species abundance was more variable both between and within years, being mostly affected by humidity, temperature, and photoperiod. Species composition varied little between years, mostly between the first and subsequent years. Conversely, beta diversity was highest within years. Only the effective taxonomic richness changed significantly through time. Our results help not only understand temporal mechanisms that allow species coexistence, but also allow to make inferences about the impact of urbanization on biodiversity in recently urbanized landscapes, showing that species composition in peri-urban sites remains unaltered in a mid-timescale, especially when climate conditions changes little across years.

Review of: The Pioneering Life of Mary Wortley Montagu, Scientist and Feminist. Biography by Jo Willett. Pen And Sword Books Ltd, Yorkshire-Philadelphia, 2021

Background: Household transmission of SARS-CoV-2 is a driver of the ongoing COVID-19 pandemic. Understanding factors that contribute to secondary infection rates (SIR) can define changing trends and inform public health policies. Methods: The ORegon CHild Absenteeism due to Respiratory Disease Study (ORCHARDS) prospectively monitors respiratory viruses within the Oregon School District (OSD) in southcentral Wisconsin. Households with students who had ≥2 respiratory symptoms were eligible and opted to participate in ORCHARDS. Between October 28, 2020, and May 16, 2022, all household members provided self-collected nasal specimens on days 0, 7, and 14 for SARS-CoV-2 detection using real-time reverse-transcription-polymerase chain reaction. We used logistic regression to investigate individual- and household-level characteristics associated with SARS-CoV-2 transmission. Results: Overall, 127 households comprising 572 individuals (48% female; 52% male; 0.4% non-binary; 77% >18 years) had at least one detection of SARS-CoV-2. The overall SIR was 47% and decreased over time (pre-Delta=72% [95%CI: 58%-83%]; Delta=51% [40%-63%]; and Omicron=41% [36%-47%]. Odds of household transmission were 63% lower during the Omicron period compared to the pre-Delta period (OR=0.36 [95%CI: 0.13-0.94] P=0.037). Greater household density (members/bedroom) was significantly associated with household transmission during the Omicron period (OR=6.8, [2.19-21.37] P=0.001). Index case age, illness severity, and individual symptoms were not significantly associated with odds of household transmission. Conclusions: Greater household density was associated with higher risk of SARS-CoV-2 transmission, but the risk declined over time with subsequent variants. Interplay between variants, prior infection, and individual/household factors may identify modifiable factors (e.g., behavior, vaccination) to reduce future transmission risk.

Purpose: We aim to describe the characteristics of patients with childhood-onset craniopharyngioma and to analyze factors that impair quality of life (QoL) in this population. Methods: multicenter national study including patients treated between 2008-2022, from 2 to 25 years of age diagnosed with craniopharyngioma. QoL was assessed once during patient’s follow-up by age-adapted versions Pediatric Quality of Life Inventory (PedsQL TM) questionnaire. Results: Sixty-six patients were included. Median age at diagnosis was 5 years (IQR 3-8), while median follow-up was 7.4 years (IQR 2.8-9.7). Most craniopharyngioma were suprasellar (93.9%) and 59.7% had hypothalamic involvement (HI). All patients underwent surgery, 44.4% received radiotherapy and 23.6%, intra-cystic therapy. Most frequent long-term complications were visual deficit (72.7%) and endocrine impairment (94.5%). Patients exhibited hypothyroidism requiring hormone replacement (92.4%), hypocortisolism (80.3%), diabetes insipidus (86.4%) and/or growth hormone therapy (50%). When parents evaluated QoL, PedsQL TM median score was 53.8 points out of 100 (IQR 41-71.6). Higher scores were noted when patients assessed their own QoL [median-score 64.8 (IQR 57.3-81.8)], observing statistical-significant differences (p=0.019). QoL was impaired by repeated surgeries (r -0.44; p=0.014), HI [median-score 51.5 (IQR 39-63.8) vs 76.4 (59-84.8); p=0.001], radiotherapy [median-score 51.9 (IQR 38.1-61.3) vs 63.8 (IQR 49-82.5); p=0.02] and longer follow-up (r-0.3; p=0.01). Conclusion: In our study, most patients had significant comorbidities and low overall QoL scores, which was mainly affected by repeated surgery, radiation, and HI. The complex management of these patients requires multidisciplinary teams that can warrant the hypothalamic preservation and prompt intervention to prevent and identify sequelae.

With an annual cumulative occurrence of approximately 15,000 in North America, all childhood cancers are rare. Very rare cancers as defined by both the European Cooperative Study Group for Rare Pediatric Cancers (EXPeRT) and the Children’s Oncology Group (COG) fall into two principal categories: those so uncommon (fewer than 2 cases/million) that their study is challenging even through cooperative group efforts (e.g. pleuropulmonary blastoma, desmoplastic small round cell tumor) and those that are far more common in adults and therefore rarely studied in children (e.g. thyroid, melanoma, gastrointestinal stromal tumor). [1](#ref-0001) Treatment strategies for these latter tumors are typically based on adult guidelines, although the pediatric variants of these tumors may harbor different genetic signatures and demonstrate different behavior. If melanoma and differentiated thyroid cancer are excluded, other rare cancer types account for only 2% of the cancers in children aged 0 to 14.[1](#ref-0001) This article highlights several of the most common rare tumor types.

Purpose : Describe clinical characteristics and outcome of Li-Fraumeni-associated osteosarcomas. Methods : TP53 germline pathogenic/likely pathogenic variant carriers diagnosed with osteosarcoma in France between 1980 and 2019 were identified via the French Li-Fraumeni database at Rouen University Hospital. Sixty-five osteosarcomas in 52 patients with available clinical and histological data were included. The main clinical characteristics were compared with data from the SEER (National Cancer Institute’s Surveillance, Epidemiology, and End Results) for patients of the same age group. Results : Median age at first osteosarcoma diagnosis was 13.7 years (range:5.9-36.7). Compared to unselected osteosarcomas, LFS-associated osteosarcomas occurred more frequently in patients <10 years (23% versus 9%) and, when compared with osteosarcomas in patients <25 years were characterized by an excess of axial (16% versus 10%) and jaw sites (15% versus 3%) and histology with predominant chondroblastic component (35% versus 16%) and periosteal subtypes (17% versus 1%). Metastases incidence (25%) was as expected in unselected osteosarcomas. After the first osteosarcoma treatment, the rate of good histologic response (62%) and the 5-year progression-free survival (55%[95%CI:42.6−71.1]) were as expected in unselected series of osteosarcomas whereas the 5-year event-free survival was 36.5%[95%CI: 25.3−52.7] due to the high incidence of second malignancies reaching a 10-year cumulative risk of 55.3%[95%CI:34.3-69.5]. Conclusion : In osteosarcoma, young age at diagnosis, axial and jaw sites, histology with periosteal or chondroblastic subtype and synchronous multifocal tumors should prompt suspicion of a germline TP53 mutation. Standard treatments are effective, but multiple malignancies impair prognosis. Early recognition of these patients is crucial for tailored therapy and follow-up.

Cauchy matrix approach for the discrete Ablowitz-Kaup-Newell-Segur equations is reconsidered, where two ‘proper’ discrete Ablowitz-Kaup-Newell-Segur equations and two ‘unproper’ discrete Ablowitz-Kaup-Newell-Segur equations are derived. The ‘proper’ equations admit local reduction, while the ‘unproper’ equations admit nonlocal reduction. By imposing the local and nonlocal complex reductions on the obtained discrete Ablowitz-Kaup-Newell-Segur equations, two local and nonlocal discrete complex modified Korteweg-de Vries equations are constructed. For the obtained local and nonlocal discrete complex modified Korteweg-de Vries equations, soliton solutions and Jordan-block solutions are presented by solving the determining equation set. The dynamical behaviors of 1-soliton solution are analyzed and illustrated. Continuum limits of the resulting local and nonlocal discrete complex modified Korteweg-de Vries equations are discussed.

Ablation of Persistent Left Superior Vena Cava in Atrial Fibrillation CaseKey clinical message:This case report discusses the successful ablation of a persistent left superior vena cava (PLSVC) as a trigger for atrial fibrillation. Following cryoballoon ablation and subsequent radiofrequency ablation, the patient experienced no recurrence of atrial fibrillation over a six-month follow-up period, confirmed by monthly ECG and Holter monitoring.Introduction:We report a case of persistent atrial fibrillation (AF) with a persistent left superior vena cava (PLSVC). The patient underwent cryoballoon ablation, improving cardiac function. Six months later, the patient experienced paroxysmal AF and underwent radiofrequency ablation. Intracardiac echocardiography and mapping confirmed PLSVC as the AF trigger. Isolation of the PLSVC successfully terminated AF. No AF episodes occurred during the six-month follow-up.Case Presentation：A 58-year-old female patient was admitted to the hospital on February 22, 2023, due to recurrent palpitations accompanied by shortness of breath that she had experienced for more than three years. The initial electrocardiogram (ECG) indicated atrial fibrillation (AF), and an echocardiogram revealed enlargement of both the left and right atria, along with a decreased ejection fraction (Left Atrial Size [LAS] 50mm, Left Ventricular Diameter [LVD] 55mm, Right Atrial Size [RAS] 39mm, Right Ventricular Diameter [RVD] 35mm, Ejection Fraction [EF] 33%). She underwent her first cryoballoon ablation procedure, after which her heart rhythm returned to normal sinus rhythm.On November 23, 2023, she was readmitted to the hospital due to persistent palpitations that had lasted for over three months. During these episodes, the ECG again showed atrial fibrillation. A follow-up echocardiogram indicated a reduction in the size of both the left and right atria, and the ejection fraction had improved to normal (LAS 39mm, LVD 45mm, RAS 34mm, RVD 29mm, EF 61%).Methods ( Electrophysiological Study and Ablation Procedure )：The patient underwent her first surgery with considerations for heart failure, as her ejection fraction (EF) had decreased, making it difficult for her to tolerate lengthy radiofrequency ablation procedures and intraprocedural saline infusion. Therefore, cryoablation was chosen for treatment. After the procedure, the patient maintained sinus rhythm for six months before experiencing a recurrence of paroxysmal atrial fibrillation.During the patient’s second radiofrequency ablation procedure, pre-operative assessments showed she was in sinus rhythm (Figure 1A). Intracardiac echocardiography (ICE) revealed the presence of a Persistent Left Superior Vena Cava (PLSVC) (Figure 1B). The intracardiac three-dimensional mapping using the Carto 3 system demonstrated electrical reconnection in the left and right pulmonary veins (Figures 1C-F).The ablation steps began with gap ablation within the pulmonary veins, followed by an expansion of the ablation area and linear ablation at the roof (Figure 1G).

A document by Seong-Beom Park. Click on the document to view its contents.

Spontaneous resolution of three hepatic artery aneurysms due to segmental arterial mediolysis in a patient with Sjögren’s syndrome

Among 1550 human immunodeficiency virus (HIV)/Hepatitis B virus (HBV) coinfected individuals receiving antiretroviral therapy (ART) over three years in Guangzhou, China, individuals (8.2%) achieved HBsAg loss. HBsAg loss was positively associated with a longer treatment (median 6.57 years) and a lower HBsAg level (median 645.2 COI) at the baseline. However, HBV pre-genomic RNA (pgRNA), a promising viral biomarker for asserting HBV functional cure, was still detected in 43.9% (44/98) of them, implying an active HBV replication in the HBsAg loss individuals. Our observation suggested that HBsAg loss alone could not reliably predict HBV functional cure in HIV/HBV coinfection.

Fjord systems in the Norwegian Arctic are experiencing an increasing frequency and magnitude of marine heatwaves. These episodic heat stress events can have varying degrees of acute impacts on primary production and nutrient uptake of mixed kelp communities, as well as modifying the biogeochemical cycling in nearshore systems where vast areas of kelp create structural habitat. To assess the impact of future marine heatwaves on kelp communities, we conducted a 23 d mesocosm experiment exposing mixed kelp communities to warming and heatwave scenarios projected for the year 2100. Three treatments were considered: a constant warming (+1.8C from the control), a medium magnitude and long duration heatwave event (+2.8C from the control for 13 d), and two short-term, more intense, heatwaves (5 d long scenarios with peaks at +3.9C from the control). The results show that both marine heatwave treatments reduced net community production whereas the constant warm temperature treatment displayed no difference from the control. The long marine heatwave scenario resulted in reduced accumulated net community production, indicating that prolonged exposure had a greater severity than two high magnitude, short-term heatwave events. We estimated an 11C temperature threshold at which negative effects to primary production appeared present. We highlight that marine heatwaves can induce sublethal effects on kelp communities by depressing net community production. These results are placed in the context of potential physiological resilience of kelp communities and implications of reduced net community production to future Arctic fjord environmental conditions.

This Manuscript delves into a deeper understanding of the fundamental concept of electrolysis, detailing the main types of Electrolyzers and conducting a meticulous analysis of their advantages and disadvantages. Additionally, this work presents a thorough examination of DC-DC and AC-DC converters, which are crucial in applications aimed at the production of green hydrogen, illustrating their functionality and applicability in great detail. Furthermore, the manuscript explores the diversity of power electronic systems employed in the production of green hydrogen, emphasizing the critical role of converters in this context. The investigation extends to effective strategies for integrating these technologies, aiming to optimize the green hydrogen production process. This study intends to be a significant contribution to the advancement of knowledge in sustainable technologies, highlighting power electronics as a fundamental vector in electrolysis, promoting the generation of renewable energies, and reinforcing the commitment to a greener and more sustainable future.

To the Editor of the Journal of Cardiovascular Electrophysiology, We read with great interest the article the recent publication titled ”Impact of Artificial Intelligence Arrhythmia Mapping on Time to First Ablation, Procedure Duration, and Fluoroscopy Use” by Fox et al [1]. The study investigates the effectiveness of AI-driven arrhythmia mapping in reducing time to first ablation, procedure duration, and fluoroscopy use in patients undergoing cardiac ablation. The authors conducted a retrospective analysis of 28 patients treated with traditional methods and compared the outcomes with those of 28 patients treated using the new AI mapping technology. They observed significant improvements in procedural efficiency and safety with the AI approach. While the results presented are promising, several aspects of the study deserve careful consideration to understand its full impact and limitations. First, the retrospective design of this study introduces potential biases, such as selection bias and information bias.Patients were not randomized, which could lead to differences between the control and experimental groups that are not related to the intervention. RCTs are needed to validate these findings and minimize these biases. Second, the study relies on historical controls, comparing patients treated with traditional methods in the past to those treated with AI mapping more recently. These temporal differences could introduce confounding variables, making it unclear whether the improvements are due to the AI mapping or other advancements in the field. Furthermore, the study does not provide detailed information on the specific AI algorithms used for arrhythmia mapping.Understanding the underlying technology is crucial for assessing the broader applicability of the results. Different AI models may have varying levels of effectiveness, and their performance can be influenced by the quality and type of data used for training and validation [2]. Finally, the study’s findings may not be generalizable to all clinical settings. The patient population, procedural techniques, and operator expertise at the study site may differ from those at other institutions. Further studies involving multiple centers and diverse patient populations are needed to confirm the broad applicability of the results. While the study by Fox et al. provides promising evidence of the benefits of AI in arrhythmia mapping, critical evaluation of the study design and methodology reveals several limitations that need to be addressed. Further prospective,randomized controlled trials are essential to validate these findings and ensure the robustness and generalizability of AI applications in clinical practice. This study represents an important step towards integrating AI into routine clinical practice, with the potential for significant improvements in patient outcomes and procedural efficiency. Sincerely, Federico Guerini References 1. Fox SR, Toomu A, Gu K, Kang J, Sung K, Han FT, Hoffmayer KS, Hsu JC, Raissi F, Feld GK, McCulloch AD, Ho G, Krummen DE. Impact of artificial intelligence arrhythmia mapping on time to first ablation, procedure duration,and fluoroscopy use. J Cardiovasc Electrophysiol. 2024 May;35(5):916-928. doi: 10.1111/jce.16237. Epub 2024 Mar 4. PMID: 38439119. 2. Loeffler SE, Trayanova N. Primer on Machine Learning in Electrophysiology. Arrhythm Electrophysiol Rev. 2023 Mar 28;12:e06. doi: 10.15420/aer.2022.43. PMID: 37427298; PMCID: PMC10323871.