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Abstract A rare case of coronary artery involvement in a child with Systemic Juvenile Idiopathic Arthritis (sJIA) complicated by Macrophage Activation Syndrome (MAS) is reported. The patient initially received an inaccurate diagnosis of Kawasaki Disease, sepsis, and mycoplasma infection and showed no improvement after Intravenous Immune Globulin (IVIG) treatment. Upon admission, symptoms included diffuse red rash, swelling of the limbs, lymph node enlargement, and hepatosplenomegaly. Post investigations, a diagnosis of sJIA and MAS was confirmed, and treatment involved a combination of hormones (methylprednisolone) and immunosuppressive drugs (methotrexate). The revealed widened coronary artery diameter was managed with a disease-specific treatment plan and prophylactic plus low-dose aspirin anti-coagulation therapy. Under this management, MAS was well controlled, and follow-ups showed normalization of the child’s coronary artery structure and function. This case and the associated literature review underscore the importance of early recognition, diagnosis, treatment, and long-term monitoring for children presenting with sJIA and MAS complicated by coronary artery involvement.

BackgroundKlinefelter’s syndrome (KS) was once considered infertile due to congenital chromosomal abnormalities, but the presence of focal spermatozoa changed this. The key to predict and promote spermatogenesis is to find targets that regulate focal spermatogenesis.ObjectiveTo explore the trend of fertility changes in KS patients at different ages and identify potential therapeutic targets.MethodsBibliometric analysis was used to collect clinical research data on KS from the Web of Science Core Collection (WoSCC) from 1992 to 2022. A cross-sectional study was conducted on 75 KS patients who underwent microscopic testicular sperm extraction (mTESE) from 2017 to 2022 in the real world. The reproductive hormones, testicular histopathology, androgen receptors, insulin-like factor 3 (INSL3) receptors and sperm recovery rate (SRR) were analyzed.ResultsMale infertility, dysplasia, Sertoli cells, Leydig cells, testosterone and spermatogenesis were the research focuses related to KS. Luteinizing hormone (LH), testosterone, and INSL3 were evaluation indicators of Leydig cell function that fluctuate with age. Testosterone and LH peaked at ages 13-19 and 30-45, while INSL3 only peaked at ages 13-19. 27 patients (27/75) recovered sperm through mTESE and experienced SRR peaks at the ages of 20, 28, 34, and 37. The SRR of fibrosis patients was 46.15%, fatty degeneration was 7.14%, and melanosis was 40.00%. The INSL3 and androgen receptors were highly expressed and roughly balanced in focal spermatogenesis.ConclusionAbnormal metabolism of Leydig cells led to imbalanced expression of INSL3 and androgen receptors, which might be a potential target for spermatogenesis in KS.

Cardiovascular involvement is an uncommon but severe complication of Epstein–Barr virus (EBV) infection caused by direct damage and immune injury. Recently, it has drawn increasing attention due to its dismal prognosis. It can manifest in various ways, including coronary artery dilation (CAD), coronary artery aneurysm (CAA), myocarditis, arrhythmias, and heart failure, among others. If not treated promptly, cardiovascular damage can progress over time and even lead to death, which poses a challenge to clinicians. Early diagnosis and treatment can improve the prognosis and reduce mortality. However, there is a lack of reliable large-scale data and evidence-based guidance for the management of cardiovascular damage. Consequently, in this review, we attempt to synthesize the present knowledge of cardiovascular damage associated with EBV and to provide an overview of the pathogenesis, classification, treatment, and prognosis, which may enhance the recognition of cardiovascular complications related to EBV and may be valuable to their clinical management.

Si3N4 ceramic is generally recognized as being difficult to machine due to its hardness and brittleness. It is necessary to control the normal load applied and the machined depth of the abrasive particles in order to eliminate surface/subsurface damage and defects during the grinding or polishing. In this study, scratch experiments were conducted on the polished surface of Si3N4 specimens to investigate the brittle–ductile transformation and the evolution of material removal mechanisms. In addition, the cracking behaviour of Si3N4 ceramic was characterized by indentation tests. The Vickers indentation produced cracks that exhibited good developmental integrity and geometric symmetry. The results indicate that the scratch track can be divided into three stages: the ductile regime, the brittle–ductile coexisting stage, and the brittle fracture regime. The critical loads and the corresponding penetration depths of cracking occurrence in Si3N4 were recorded. The material removal of Si3N4 ceramic was primary attributed to ductile regime removal when the load was less than 9.8 N. Microcrack initiation on the subsurface was observed when the penetration depth of the scratch tip reached 8 μm or the depth of the indentation tip reached 3.2 μm. Microcracks expanded rapidly as the load was further increased, resulting in a brittle fracture of the Si3N4 ceramic.

The performance and syntrophic metabolism of the Anaerobic Membrane Bio-reactor (AnMBR) treating high-lipid kitchen waste slurry under different sludge cycle frequencies were investigated in this study. When the sludge cycle frequencies were 3.6 cycles/h, 9.0 cycles/h and 14.4 cycles/h, the obtained Organic Loading Rates (OLRs) were 10.3 kg-COD/m3d, 12.4 kg-COD/m3d and 18.1 kg-COD/m3d, while the corresponding biogas productions were 190 L/d, 310 L/d and 520 L/d. Moreover, with an increase of sludge cycle frequency, the Chemical Oxygen Demand (COD) removal efficiency improved from 86.2% to 90.4% and 96.3%. Additionally, the higher sludge cycle frequency did not break up the sludge flocs and further affect the syntrophic degradation of the toxic Long-Chain Fatty Acids (LCFAs). Conversely, the higher sludge cycle frequency enhanced LCFA degradation and decreased LCFA accumulation. Meanwhile, under higher sludge cycle frequencies, the abundance of syntrophic Methanobacterium, Syntrophomonas and Clostridium increased and favored the syntrophic metabolism of LCFAs.

The performances of membrane bioreactors (MBRs) were compared in bench-scale sub- merged MBRs treating synthetic wastewater at three Ca:Mg ratios of 3:1, 1:1, and 1:3 with constant divalent cations of 200 mg/L. The dosages of Ca2+ were 150, 100, and 50mg/L, corresponding to Mg2+ of 50, 100, and 150mg/L for Ca:Mg ratios of 3:1, 1:1, and 1:3, respectively. The results showed that Ca:Mg ratio had a slight impact on effluent quality, while membrane fouling was effectively mitigated by enlarging Ca:Mg ratio due to the decline of fouling layer resistance. When Ca:Mg ratio declined from 3:1 to 1:3, the concentration of soluble microbial products (SMP) significantly increased, while the particle size of flocs decreased. SMP and particle size correlated well with the variation of membrane fouling. The carbohydrate in SMP and bound extracellular polymeric substances (BEPS) changed significantly with the decline of Ca:Mg ratio, while the protein in SMP and BEPS varied slightly, suggesting that the divalent cations were more prone to bridging carbohydrate compared with protein. In comparison with Mg2+ ,Ca2+ had a more significant impact on mitigating membrane fouling, because Ca2+ was more beneficial to binding and bridging negatively charged functional groups in extracellular polymeric substances such as carbohydrate. [ABSTRACT FROM AUTHOR]