Background: Aberrant migration of parathyroid glands from their embryologic origin may result in undescended parathyroid glands. We present a case of an ectopic parathyroid adenoma at the level of the pyriform sinus. Methods: A 41-year-old female was evaluated for primary hyperparathyroidism. Following non-localizing ultrasound and planar sestamibi imaging, the patient underwent

In this study, we reported a patient who presents with multicentric reticulohistiocytosis (MRH)-like clinical feature, but the histology is not compatible with it. Like our patient, a couple of patients described previously also had the dilemma that they could not be classified appropriately into any current histiocytosis entity. Considering the clinical and pathological features together, all these patients had a similar clinical profile: xanthomatous rash, erosive arthritis and histopathological findings showing xanthomized histiocytes. Therefore, we propose a new disease entity - xanthomatous erosive arthritis (XEA), to accommodate these patients that cannot be classified appropriately into the current system.

Case presentation: This case report concerns a 49-year-old woman who developed norethisterone drug -induced cholestasis, a progestin contraceptive, which is quite rare complication generally observed with estrogenic component of combined oral contraceptive pill.

As an important part of the construction industry, rural residential buildings are characterized by low energy utilization, unreasonable structures and low consumption levels, and it is particularly important to study their low-carbon transformation and evaluation system. In view of the many low-carbon transformation needs of rural residential buildings, the existing research results were analyzed in depth, and the coefficient of variation method was used to identify the important factors affecting the low-carbon transformation of rural residential buildings, and the evaluation system of rural residential buildings’ low-carbon transformation was determined by Analytic Hierarchy Process (APH), and the system was used in a rural residential building low-carbon evaluation study. The results show that the influence of “energy use”, “envelope structure” and “economic factors” on the decarbonization of buildings is obvious, with the weights of 36.4%, 24.5% and 19.5% respectively. Among the secondary indicators, “clean energy utilization”, “electricity consumption”, “external wall insulation system” and “window performance” are the most important factors in reducing carbon emissions in rural areas. The most critical influencing factors for the low carbonization level of clean energy in rural residential buildings are “window performance”. Finally, based on the constructed low carbonization evaluation system, we propose a targeted solution strategy to provide a theoretical basis for the establishment of an effective low carbonization evaluation system for clean energy in rural residential buildings.

Bone lesions are rarely reported in Hairy Cell Leukemia (HCL). We report two BRAFV600E mutated HCL patients presented bone lesions at foreground, poor bone marrow involvement and the important role 18F-FDG PET/CT played in their management. We discuss the crucial role that 18F-FDG PET/CT could play in HCL routine practice.

Geographic barriers, such as mountain ranges, impede genetic exchange among populations, promoting diversification and speciation. The effectiveness of these barriers in limiting gene flow varies between lineages due to each species’ unique dispersal modes and capacities. Our understanding of how the Andes orogeny contributes to species diversification comes from well-studied vertebrates and a few insects, neglecting organisms unable to fly or walk long distances. Additionally, although the Andean altitude is usually assumed to be the driver of diversification, it is not often formally tested. This limits our understanding of how landscape changes, particularly altitude, influence population structure. Some arachnids, such as the colorful spider Gasteracantha cancriformis have been hypothesized to disperse long distances via ballooning (i.e., using their silk to interact with the wind). Still, we do not know how the environment and geography shape its genetic diversity. To address this question, we sampled thousands of loci across the distribution of this spider and implemented population genetics, phylogenetic, and landscape genetic analyses. We identified two genetically distinct groups structured by the Central Andes and a third less structured group in the northern Andes that shares ancestry with the previous two. This structure is largely explained by the elevation along the Andes, which decreases in some regions, facilitating cross-Andean dispersal and gene flow. Our findings support that elevation in the Andes plays a major role in structuring populations in South America, but the strength of this barrier can be defeated by organisms with long-distance dispersal modes together with altitudinal depressions

An improved understanding of pregnancy in women with Turner’s syndrome may save lives!BJOG-21-1221Around 25% of maternal deaths are related to heart disease and up-to 20% of these are the consequence of aortic dissection (Lameijer et al, Neth Heart J (2020) 28:27–36). Connective tissue disorders (e.g. Marfan’s, Loeys-Dietz, Ehlers Danlos), Bicuspid aortic valve, Turner’s Syndrome (TS) and pre-existing coarctations constitute the bulk of aortopathies encountered in pregnancy. Although a true XO karyotype in pregnancy had been rarely encountered historically due to the reduced fertility in these patients, women with a mosaic TS may have normal fertility and in recent years reproductive technologies with oocyte donation have increasingly been used in the sub-fertile TS population. Although pregnancies in such women remain infrequent, the risk of death during pregnancy amongst all women with TS (inclusive of mosaicism) has been reported as high as 2%, 150-200 times greater than the general population. This increased risk has led to the establishment of guidelines for the use of reproductive technologies in these women (Karnis. Fertility Sterility (2012) 98(4),787-91).The rarity of these cases means that available data, even when drawn from multicenter registries, has been relatively sparse. A study of TS patients gathered from ten cardiovascular centres over 12 years evaluated 68 pregnancies (Grewal J, et al. Heart 2021;107:61–66). Although the majority had no structural cardiac disease and no major cardiovascular complications were observed, the adverse obstetric event rate was around 20% with a similar rate for adverse fetal outcomes. Like the present paper (BJOG-21-1221) which reports a larger population, these cases were followed within centres offering a dedicated obstetric-cardiac clinic.Standardized guidelines for preconceptual and perinatal care of these women have improved outcomes, as evidenced by a French study evaluating cohorts from before and after the establishment of such guidance in France (Cadoret et al, EJOGRB(2018) 229,20–25). Whilst these guidelines encourage the care of TS mothers in dedicated obstetric-cardiac centers, this is not always the case; either due to lack of diagnosis of the condition (esp in mosaic cases with milder phenotypes) or lack of appreciation of the risks. The present paper reports only cases followed in cardiac-obstetric centres; without an overall population pregnancy case number it will remain uncertain what proportion of women with TS were followed in an appropriate centre and whether the reported cohort therefore excludes cases with worse outcomes.Although it might be expected that mothers followed within appropriate centres receive optimal care, studies continue to show that this is not always so. In the present cohort only half of the women had a pre-pregnancy cardiac evaluation and 20% had no record of imaging during pregnancy; perhaps reflecting late referral to the tertiary centre. While this remains a high-risk population with risks for both maternal and fetal adverse outcomes with high haemorrhage rates, hypertensive disease rates (~19%) and an SGA rate exceeding 20%, the data from this cohort is reassuring with respect to severe perinatal morbidity. Particularly striking in this cohort was a caesarean rate of 67%.To provide women with TS optimal care, preconceptual evaluation and pregnancy planning with medical optimisation is vital, with subsequent close follow-up in an obstetric-cardiac centre capable of managing whatever complications this cohort might experience, even if rare.Disclosure of InterestRB has no conflicts of interestRB is supported by the CIHR and FRSQ

Background: While prior data have suggested worse outcomes in women after acute type A aortic dissection (ATAAD) repair when compared to men, results have been inconsistent across studies over time. This study sought to evaluate the impact of sex on short- and long-term outcomes after ATAAD repair. Methods: This was a retrospective study utilizing an institutional database of ATAAD repairs from 2007 to 2021. Patients were stratified according to sex. Kaplan-Meier survival estimation and multivariable Cox regression were performed. Supplementary analysis using propensity score matching was also performed. Results: Of the 601 patients who underwent ATAAD repair, 361 were males (60.1%) and 240 (39.9%) were females. Females were significantly older, more likely to have hypertension, and more likely to have chronic lung disease. Females were also significantly more likely than males to undergo hemiarch replacement, while males were significantly more likely than females to undergo total arch replacement and frozen elephant trunk. Operative mortality was 9.4% among males and 13.8% among females, though this was not a statistically significant difference (p=0.098). Postoperative complications were comparable between groups. Kaplan-Meier survival estimates were similar for men and women, and, on multivariable Cox regression, sex was not significantly associated with long-term survival (HR 1.00, 95% CI: 0.73, 1.37, p=0.986). Outcomes remained comparable after supplementary propensity score matched analysis. Conclusion: ATAAD repair can be performed with comparable short-term and long-term outcomes in both men and women.

Botryllus schlosseri, is a model marine invertebrate for studying immunity, regeneration, and stress-induced evolution. Conditions for validating its predicted proteome were optimized using nanoElute® 2 deep-coverage LCMS, revealing up to 4,930 protein groups and 20,984 unique peptides per sample. Spectral libraries were generated and filtered to remove interferences, low-quality transitions, and only retain proteins with >3 unique peptides. The resulting DIA assay library enabled label-free quantitation of 3,426 protein groups represented by 22,593 unique peptides. Quantitative comparisons of a laboratory-raised with two field-collected populations revealed (1) a more unique proteome in the laboratory-raised population, and (2) proteins with high/low individual variabilities in each population. DNA repair/replication, ion transport, and intracellular signaling processes were unique in laboratory-cultured colonies. Spliceosome and Wnt signaling proteins were the least variable (highly functionally constrained) in all populations. In conclusion, we present the first colonial tunicate’s deep quantitative proteome analysis, identifying functional protein clusters associated with laboratory conditions, different habitats, and strong versus relaxed abundance constraints. These results empower research on B. schlosseri with proteomics resources and enable quantitative molecular phenotyping of changes associated with transfer from in situ to ex situ and from in vivo to in vitro culture conditions.

A narrative review based on the case of a patient presenting an atypical symptomatology of an atraumatic splenic rupture induced by rivaroxaban. An emergency splenectomy had to be performed. This complication is rare but increasing since the popularity of direct oral anticoagulants and the diagnosis is often delayed.

We present a rare case of 45-year-old man with complaints of abdominal pain and features suggestive of intestinal obstruction. CT scan of the abdomen demonstrated a large mesenteric mass in the pelvic region involving the distal segment of jejunum. Surgical excision of the lesion and histo-pathological examination confirmed cavernous hemangioma.

Fungal bioprosthetic valve endocarditis is regarded as a rare, fatal disease. Severe aortic valve stenosis due to vegetation in bioprosthetic valves was also rare. Because biofilm formation is a factor related to persistent infection, the best outcomes for endocarditis are achieved in patients treated surgically with concomitant antifungal medications.

Spin projected wave functions are known as generalizations of the Hartree-Fock wave function. Among them, the Half-Projected Hartree-Fock (HPHF) model represents a good compromise between the restricted (RHF) and unrestricted (UHF) Hartree-Fock methods. The HPHF wave function is a nearly pure wave function of spin and recovers a small part of the spin correlation energy. This paper reviews the history of the HPHF theory, not only from the conceptual point of view but also providing a compilation of the publications of this method over the years until now. In addition, the extension of the HPHF method to the calculation of non-orthogonal excited states to the ground state will be treated. The variational collapse during the calculation of singlet excited states with the same symmetry as the ground state is avoided by orthogonalizing the excited orbital to the corresponding occupied orbital. As an example, the potential energy surface of the S0 ground and 1S1(n, π∗) first excited state of the formic acid HCOOH are calculated. Formic acid exhibits complex energy surfaces with respect two large amplitude motions, the torsional rotation of the O-H group and the waving out-of-plane angle of the H atom. In the excited state, the molecule adopts a pyramidal structure. The obtained energy results are fitted to curves that can be used for the calculation of the theoretical spectrum.

Let $\mathcal{S}$ be the Sierpi\’nski gasket in $\mathbb{R}^2$ and $\mathcal{S}_{0}$ denote the boundary of $\mathcal{S}$. In this paper, we study the following non-homogeneous $p$-Laplacian equation \begin{align*} -\Delta_p u &= \lambda |u|^{q-2} u + f \text{~in}\; \mathcal{S}\setminus\mathcal{S}_0\\ u &= 0\;\mbox{~on}\; \mathcal{S}_0, \end{align*} where $p$, $q$, $\lambda$ are real numbers such that $\lambda >0$, $1

Cryptococcosis is an invasive, opportunistic, fungal infection that predominantly effects the respiratory tract and central nervous system in immunocompromised patients. It is classically associated with defects in cellular immunity such as acquired immunodeficiency syndrome. Here we describe a case of life-threatening laryngitis, endobronchitis and pneumonia due to Cryptococcus neoformans in a teenager with hypogammaglobulinaemia. To the best of our knowledge, no previous cases of laryngeal cryptococcosis have been reported in the paediatric population.

Predictive coding framework posits that our brain continuously monitors changes in the environment and updates its predictive models, minimizing prediction errors to efficiently adapt to environmental demands. However, the underlying neurophysiological mechanisms of these predictive phenomena remain unclear. The present study aimed to explore the systemic neurophysiological correlates of predictive coding processes during passive and active auditory processing. Electroencephalography (EEG), functional near-infrared spectroscopy (fNIRS) and autonomic nervous system (ANS) measures were analyzed using an auditory pattern-based novelty oddball paradigm. A sample of thirty-two healthy subjects was recruited. The results showed shared slow evoked potentials between passive and active conditions that could be interpreted as automatic predictive processes of anticipation and updating, independent of conscious attentional effort. A dissociated topography of the cortical hemodynamic activity and distinctive evoked potentials upon auditory pattern violation were also found between both conditions, whereas only conscious perception leading to imperative responses was accompanied by phasic ANS responses. These results suggest a systemic-level hierarchical reallocation of predictive coding neural resources as a function of contextual demands in the face of sensory stimulation. Principal component analysis permitted to associate the variability of some of the recorded signals.

An Unusual Cause of Chronic Diarrhea in a Young Patient – Diagnostic Challenge

A 31 year old man with a past medical history of hyperthyroidism presented to the hospital in thyroid storm and cardiogenic shock. He was found to be in severe biventricular failure and with the use of biventricular impella support had a full recovery without significant comorbidity.