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This letter to the editor discusses a rare case of a patient with primary myelofibrosis (PMF) who developed pulmonary alveolar proteinosis (PAP). The patient was successfully treated with allogeneic hematopoietic stem cell transplantation (allo-HSCT) and a tailored approach combining low-dose ruxolitinib and radiotherapy. The article highlights the potential of allo-HSCT as a treatment option for PAP and emphasizes the importance of proper management and monitoring of lung conditions before and after transplantation. The successful resolution of both diseases in this case demonstrates the effectiveness of allo-HSCT. [Extracted from the article]

Introduction: To investigate the ultrasound characteristics of recurrent laryngeal nerves (RLNs) during radical surgery for thyroid cancer and to enhance the understanding of RLN ultrasound features. Methods: From October 2021 to December 2022, a prospective study was conducted involving 24 patients scheduled for bilateral thyroid surgery. Near the conclusion of the surgery, intraoperative ultrasonography of the RLN within the tracheoesophageal groove was performed using a 15-7 MHz transducer. The thickness and width of the RLN were measured during the procedure. Results: The internal architecture of the RLN was observed to consist of multiple hypoechoic, parallel, but discontinuous linear hyperechoic areas separated by bands. In the normal RLN group, the diameter of the RLN was relatively consistent, with thickness ranging from 2.20 to 2.71 mm (mean: 2.48 ± 0.14 mm) and width from 1.25 to 1.70 mm (mean: 1.45 ± 0.11 mm). Both weight and the body mass index (BMI) showed a statistically significant correlation with RLN thickness (Weight: r=0.544, P=0.001; BMI: r=0.605, P=0.001). The BMI also showed a statistically significant correlation with the RLN width (r=0.377, P=0.033). In the RLN invasion group, the width of invaded RLNs ranged from 1.9 to 2.3mm(mean: 2.10 ± 0.11 mm), while the width of noninvaded RLNs ranged from 2.6 to 3.2 mm (mean: 2.93 ± 0.20 mm). Conclusions: Ultrasound effectively reveals the structural features of the RLN and enhances sonographers' understanding of RLN characteristics. [ABSTRACT FROM AUTHOR]

Background: The high complexity of systemic autoimmune diseases (SADs) has hindered precise management. This study aims to investigate heterogeneity in SADs. Methods: We applied a joint cluster analysis, which jointed multiple correspondence analysis and k-means, to immunomarkers and measured the heterogeneity of clusters by examining differences in immunomarkers and clinical manifestations. The electronic health records of patients who received an antinuclear antibody test and were diagnosed with SADs, namely systemic lupus erythematosus (SLE), rheumatoid arthritis (RA), and Sjögren's syndrome (SS), were retrieved between 2001 and 2016 from hospitals in Taiwan. Results: With distinctive patterns of immunomarkers, a total of 11,923 patients with the three SADs were grouped into six clusters. None of the clusters was composed only of a single SAD, and these clusters demonstrated considerable differences in clinical manifestation. Both patients with SLE and SS had a more dispersed distribution in the six clusters. Among patients with SLE, the occurrence of renal compromise was higher in Clusters 3 and 6 (52% and 51%) than in the other clusters (p < 0.001). Cluster 3 also had a high proportion of patients with discoid lupus (60%) than did Cluster 6 (39%; p < 0.001). Patients with SS in Cluster 3 were the most distinctive because of the high occurrence of immunity disorders (63%) and other and unspecified benign neoplasm (58%) with statistical significance compared with the other clusters (all p < 0.05). Conclusions: The immunomarker-driven clustering method could recognise more clinically relevant subgroups of the SADs and would provide a more precise diagnosis basis. [ABSTRACT FROM AUTHOR]

This study aims to discuss the identification of the C1 nerve root as an effective surgical approach to successfully locate the shunting point of craniocervical junction spinal dural arteriovenous fistula (CCJ-SDAVF) intraoperatively. This study included all patients with CCJ-SDAVF who underwent surgical treatment using the far-lateral transcondylar approach at a single institution from January 2017 to June 2023. Data on patient demographics, clinical and angiographic characteristics of CCJ-SDAVF, surgical details, and treatment outcomes were collected. Follow-up assessments were conducted for all patients until December 31, 2023. The study included a total of 7 patients, comprising 5 men(71.4%) and 2 women (28.6%), with an average age of 57.6 years. Among them, 4 patients (57.1%) developed diffuse subarachnoid hemorrhage(SAH), while 2 patients (28.6%) experienced progressive cervical myelopathy. The shunting points of all CCJ-SDAVFs, which exhibited engorged veins, were identified next to the C1 root. Complete obliteration of CCJ-SDAVFs was successfully achieved in all patients, as confirmed by postoperative angiography one month later. No recurrent CCJ-SDAVFs were observed two years after the operation. Among the patients, 5 (71.4%) experienced good functional recovery, as indicated by an mRS score ranging from 0 to 1, while the remaining 2 patients (28.6%) showed incomplete functional recovery. The surgical interruption of CCJ-SDAVFs is the preferred treatment option, given its high obliteration rate and favorable functional recovery outcomes. We advocate the identification of C1 spinal nerve root as a crucial surgical step to identify the shunting points of CCJ- SDAVFs. [ABSTRACT FROM AUTHOR]

Hypokalemic paralysis is a clinical syndrome characterized by acute flaccid paralysis with concomitant hypokalemia. Complications, such as acute respiratory failure and cardiac arrhythmias, can be fatal. If treated appropriately, the patient can recover without any sequelae. We present a rare case of life-threatening hypokalemic paralysis following the ingestion of an unknown substance. At presentation, her serum potassium concentration was 1.9 mmol/L. A review of the patient's history confirmed the ingestion of barium chloride. She was diagnosed with acute barium poisoning characterized by high serum and urine barium levels. Aggressive potassium repletion was administered intravenously and orally. Her serum potassium concentration dropped to 1.5 mmol/L and peaked at 5.4 mmol/L following treatment. The patient achieved a complete recovery and was discharged without sequelae. Barium can competitively block the potassium inward rectifier channels and interfere with the efflux of intracellular potassium, leading to severe hypokalemia. Our report illustrates a rare presentation of acute barium intoxication and a differential diagnosis indicating hypokalemic paralysis. We also discuss the pathophysiological features and compare the clinical findings with cases of rebound hyperkalemia. [ABSTRACT FROM AUTHOR]

This study effectively synthesized thiazole-4-carbohydrazide (SZCA) and its ionic salt SZCA⋅HClO4 and energetic complex Cu(SZCA)2(ClO4)2 (ECC-1). The new compound SZCA, SZCA⋅HClO4 and ECC-1 were fully characterized through elemental analysis, infrared spectroscopy, 13C NMR spectroscopy and thermal stability analysis. The combustion heat of ECC-1 was measured by oxygen bomb calorimetry, and its detonation performance was predicted by Kamlet-Jacobs formula and EXPLO5, respectively. The mechanical sensitivity of ECC-1 was tested using BAM method. In particular, we comprehensively evaluated the initiation ability of ECC-1 through lead plate destruction experiment and laser initiation experiment. The results show that ECC-1 have a decomposition temperature of 236 °C, exhibits acceptable mechanical sensitivity (impact sensitivity: 3.4 J, friction sensitivity: 4 N), and decent detonation properties (D: 6.6 km s-1, P: 21.3 GPa). And ECC-1 could be initiated by a single-pulse laser (λ: 808 nm, P: 20 W, t: 3 ms), and successfully detonated the next charge, such as RDX and CL-20. [ABSTRACT FROM AUTHOR]

Pedestrian crossing intention prediction based on computer vision plays a pivotal role in enhancing the safety of autonomous driving and advanced driver assistance systems. In this paper, we present a novel multi-modal pedestrian crossing intention prediction framework leveraging the transformer model. By integrating diverse sources of information and leveraging the transformer's sequential modeling and parallelization capabilities, our system accurately predicts pedestrian crossing intentions. We introduce a novel representation of traffic environment data and incorporate lifted 3D human pose and head orientation data to enhance the model's understanding of pedestrian behavior. Experimental results demonstrate the state-of-the-art accuracy of our proposed system on benchmark datasets. [ABSTRACT FROM AUTHOR]

Carbapenemase-producing organisms (CPOs) present a major threat to public health, demanding precise diagnostic techniques for their detection. Discrepancies among the CPO tests have raised concerns, partly due to limitations in detecting bacterial diversity within host specimens. We explored the impact of an unbiased colony selection on carbapenemase testing and assessed its relevance to various tests. Using the FirstAll method for unbiased colony selection to reduce bias, we compared the results from different methods, namely the modified carbapenem inactivation method/EDTA-modified carbapenem inactivation method (mCIM/eCIM), the Carba5, the CPO panel, and the multiplex PCR (MPCR). We compared the FirstAll method to the conventional colony selection for MPCR with seven CPO species. In addition, we evaluated the test performance on seven CPO species using MPCR as a reference and the FirstAll method as the colony-selection method. The results revealed that the selections from the FirstAll method have improved rates of carbapenemase detection, in comparison to approximately 11.2% of the CPO isolates that were noted to be false negatives in the conventional colony-selection methods. Both the Carba5 test and the CPO panel showed suboptimal performance (sensitivity/specificity: Carba5 74.6%/89.5%, CPO panel 77.2%/74.4%) in comparison to the FirstAll method. The Carba5 test provided specific carbapenemase class assignments, but the CPO panel failed in 18.7% of the cases. The Carba5 test and the CPO panel results correlated well with ceftazidime–avibactam minimal inhibitory concentrations (MICs). The concordance for Class A/D with MICs was 94.7% for Carba5 and 92.7% for the CPO panel; whereas for Class B, it was 86.5% for Carba5 and 75.9% for the CPO panel. In conclusion, FirstAll, as the unbiased colony-selection method, was shown to impact carbapenemase testing. With FirstAll, the diagnostic performance of both the Carba5 and the CPO panel was found to be lower. Furthermore, the utilization of ceftazidime–avibactam guided by either the CPO panel or Carba5 was appropriate. [ABSTRACT FROM AUTHOR]

Background: Benign prostatic hyperplasia (BPH) is a prevalent condition in aging males, leading to bladder outlet obstruction (BOO) and associated urinary symptoms. With increasing life expectancy, the incidence of BPH and its co-morbidities, like inguinal hernia, has risen. This study explores the efficacy of combining transurethral resection of the prostate (TURP) and inguinal hernioplasty in a single surgical session to address both conditions, potentially reducing the need for multiple hospitalizations and surgical interventions. Methods: This retrospective study at Chi Mei Medical Center included patients from 2014 to 2023 who underwent concurrent TURP and inguinal hernioplasty. A total of 85 patients met the criteria defined for this study. Preoperative, intraoperative, and postoperative characteristics were meticulously documented. Outcomes evaluated included the duration of the surgery, incidence of intraoperative and postoperative complications, duration of Foley catheterization, length of hospital stay, and treatment efficacy. Additionally, we conducted a comparative assessment of the surgical outcomes between two distinct techniques for inguinal hernia repair: open hernioplasty and laparoscopic hernioplasty (LH). Results: In 85 patients who met the criteria, the mean age was 71.1 ± 7.8 years. The study reported no significant intraoperative complications, and postoperative care was focused on monitoring for blood loss, infection, and managing pain. The average postoperative hospital stay was 2.9 ± 1.0 days and the mean duration of catheterization was 51.6 ± 16.7 h, with a minimal complication rate observed during the one-year follow-up. A significant reduction in both operative duration and catheterization interval was observed in patients undergoing LH as opposed to those receiving open hernioplasty. Conclusion: Concurrent TURP and inguinal hernioplasty effectively manage BOO due to BPH and inguinal hernias with minimal complications, suggesting a viable approach to reducing hospital stays and surgical interventions. Laparoscopic techniques, in particular, offer benefits in operative efficiency and recovery time, making combined surgery a feasible option for selected patients. [ABSTRACT FROM AUTHOR]

Recycling mixed polyolefin plastics is a significant challenge due to the limitations in sorting and degraded mechanical properties of blends. Nonreactive compatibilization by adding a small amount of polymeric additive is a widespread approach to restoring the performance and value of recycled plastics. Over the past several decades, synthetic advances have enabled access to low-cost copolymers and precision architectures for deepening the understanding of compatibilization mechanisms in semicrystalline polyolefins. This review covers the design parameters of a polymeric compatibilizer, the testing of blends, the synthetic methods of producing economically viable additives, and surveys the literature of blends of compatibilized HDPE, LLDPE, LDPE, and iPP. From this, readers should gain a comprehension of the polymer mechanics, synthesis, and macromolecular engineering of processable polyolefin blends, along with the field's future directions. [ABSTRACT FROM AUTHOR]

Aim: A growing body of evidence has shown that attachment styles and death attitudes have a significant impact on empathy. This study aimed to explore the precise role of death attitudes in the relationship between attachment styles and empathy levels among trainee nurses. Methods: A total of 626 Chinese trainee nurses with different attachment types were enrolled, and their attachment styles, death attitudes, and empathy levels were assessed using the Revised Adult Attachment Scale, the Death Attitude Profile-Revised, and the Jefferson Scale of Empathy-Healthy Professionals, and finally, data from 566 participants were included for statistical analysis. Results: We found that among trainee nurses with secure attachment type, fear of death, approach acceptance, escape acceptance, and neutral acceptance (-) mediated the relationships between attachment-related avoidance/anxiety and their overall empathy levels and all its dimensions; in the preoccupied type, only neutral acceptance (-) mediated the relationships between attachment-related avoidance and their overall empathy levels and compassionate care; and in the fearful type, only fear of death mediated the relationship between attachment- related avoidance and compassionate care. Furthermore, in the secure type, neutral acceptance attenuated the negative predictions of attachment-related avoidance on overall empathy level and perspective taking. Conclusion: Attitudes toward death played different mediating and moderating roles in the relationship between attachment styles and empathy among trainee nurses with different attachment types. In addition to acculturated empathy-specific training, targeted education related to death for trainee nurses with different attachment types is needed to prevent their compassion fatigue. [ABSTRACT FROM AUTHOR]

Based on the ideas of coordination and design chemistry, we propose a new strategy to balance the energy and sensitivity conflict by synthesizing dual anion structures in the realm of energetic complex compounds. Therefore, a novel solvent-free complex, [Ni(4-PDCA)2(NO3)2](ClO4)2 (ECCs-1), which has a six-coordinated octahedral structure and contains dual anions, was synthesized. The structure was identified by IR, EA and single-crystal XRD. To the best of our knowledge, it is the first reported dual anion structure that exhibits excellent insensitivity with acceptable thermal stability and detonation performance. [ABSTRACT FROM AUTHOR]

Clostridium septicum infections are highly predictive of certain malignancies in human patients. To initiate infections, C. septicum spores must first germinate and regain vegetative growth. Yet, what triggers the germination of C. septicum spores is still unknown. Here, we observe that C. septicum germinates in response to specific bile salts. Putative bile salt recognition genes are identified in C. septicum based on their similarity in sequence and organization to bile salt-responsive csp genes in Clostridioides difficile. Inactivating two of these csp orthologs (cspC-82 and cspC-1718) results in mutant spores that no longer germinate in the presence of their respective cognate bile salts. Additionally, inactivating the putative cspBA or sleC genes in C. septicum abrogates the germination response to all bile salt germinants, suggesting that both act at a convergent point downstream of cspC-82 and cspC-1718. Molecular dynamics simulations show that both CspC-82 and CspC-1718 bear a strong structural congruence with C. difficile's CspC. The existence of functional bile salt germination sensors in C. septicum may be relevant to the association between infection and malignancy. Two new bile salt germinant-responsive genes, which exhibit sequence and structural similarity to Clostridioides difficile cspC, have been identified in the cancer-associated bacteria Clostridium septicum. [ABSTRACT FROM AUTHOR]

Key Clinical Message: Primary gastric diffuse large B‐cell lymphoma (DLBCL), a rare malignancy linked to Helicobacter pylori (HP) infection, in this case regressed to low‐grade lymphoma and then achieved complete remission after HP eradication (HPE), highlighting this unique interim change and the potential of HPE as an effective treatment for early‐stage cases. Primary gastric diffuse large B‐cell lymphoma (DLBCL) is a rare malignancy. Like gastric mucosa‐associated lymphoid tissue (MALT) lymphoma, HP infection is implicated in lymphomagenesis and has thus emerged as a therapeutic target. Studies have demonstrated the sustained efficacy of HP eradication alone for limited‐stage primary gastric DLBCL. This report presents the case of a 53‐year‐old woman with stage IE gastric DLBCL who received triple therapy for HP eradication and experienced an interim histological transformation to MALT lymphoma, ultimately achieving complete pathologic remission. HP eradication therapy may represent a viable treatment option for patients with early‐stage primary gastric DLBCL. [ABSTRACT FROM AUTHOR]

Karyopherin α 2 (KPNA2, importin α1), a transport factor shuttling between the nuclear and cytoplasmic compartments, is involved in the nuclear import of proteins and participates in cellular processes such as cell cycle regulation, apoptosis, and transcriptional regulation. However, it is still unclear which signaling regulates the nucleocytoplasmic distribution of KPNA2 in response to cellular stress. In this study, we report that oxidative stress increases nuclear retention of KPNA2 through alpha serine/threonine‐protein kinase (AKT1)‐mediated reduction of serine 62 (S62) phosphorylation. We first found that AKT1 activation was required for H2O2‐induced nuclear accumulation of KPNA2. Immunoprecipitation and quantitative proteomic analysis revealed that the phosphorylation of KPNA2 at S62 was decreased under H2O2‐induced oxidative stress. We showed that cyclin‐dependent kinase 1 (CDK1), a kinase responsible for KPNA2 S62 phosphorylation, contributes to the localization of KPNA2 in the cytoplasm. AKT1 knockdown increased KPNA2 S62 phosphorylation and inhibited CDK1 activation. Furthermore, H2O2‐induced AKT1 activation promoted nuclear KPNA2 interaction with nucleophosmin 1 (NPM1), resulting in attenuation of NPM1‐mediated cyclin D1 gene transcription. Thus, we infer that the AKT1‐CDK1 axis regulates the nucleocytoplasmic shuttling and function of KPNA2 through spatiotemporal regulation of KPNA2 S62 phosphorylation under oxidative stress conditions. [ABSTRACT FROM AUTHOR]

Uncontrolled terpenoid emissions from forest trees in Japan may have contributed to high O3 concentrations observed in urban and suburban areas. To estimate ozone formation via a series of reactions between NOx and terpenoids using atmospheric chemistry models, it is important to produce terpenoid emission inventories by collecting all reported emission data for the major tree species in Japan and examining their reliability. In this review, we first describe three different plant terpenoid emission types, i.e., isoprene-emitting type, monoterpene-emitting type with storage tissues and organs, and monoterpene-emitting type without storage tissues and organs. Second, we describe various methods for measuring plant terpenoid emissions, including a recently developed simplified method, and explain their reliability. We emphasized that applicable measurement methods depend on the terpenoid emission types. Data obtained using static chamber methods should not be considered because they have the highest uncertainty resulting from normal chamber materials that are not specific to terpenoid measurements and lack humidity control. Finally, we show the absolute values of the collected emission rates and describe their variability. The deciduous oak species, Quercus serrata and Quercus mongolica var. crispula, and bamboo species, Phyllostachys pubescens and Phyllostachys bambusoides, are strong isoprene emitters. Among the monoterpene emitters, four evergreen broadleaf trees, including three Quercus species, had the highest basal emission rate (BER). The monoterpene storage type conifers Larix kaempferi and Pinus densiflora have relatively lower BERs. Emission data are not available for Castanopsis cuspidata, and seasonal changes in emission rates have not been reported for several major tree species in the top 20 rankings. Within species, the reported emission rates of some tree species differed by threefold. These differences may be attributed to the reliability of the measurement and analytical systems, tree age, leaf morphology, environmental conditions, and genetic diversity. We emphasize the need for reliable measurements to achieve a more precise terpenoid emission inventory for major tree species in Japan. [ABSTRACT FROM AUTHOR]

Chronic subdural hematoma primarily affects the elderly, and its morbidity increases with the global rise in the elderly population. Atorvastatin, commonly prescribed for hypercholesterolemia and atherosclerosis, has shown therapeutic promise for chronic subdural hematoma, although its mechanism remains unclear. This study employs network pharmacology and r everse transcriptionquantitative polymerase chain reaction to analyze and preliminarily verify atorvastatin's potential mechanism in treating chronic subdural hematoma. Analysis identified 19 potential targets of atorvastatin in chronic subdural hematoma treatment. Enrichment analysis revealed that these target genes predominantly regulate inflammation, angiogenesis, and coagulation/fibrinolysis. From the 19 target genes, matrix metalloproteinase 2, matrix metalloproteinase 9, interleukin-6, C-X-C motif chemokine ligand 8, and serpin family E member 1 were selected to verify atorvastatin's effect. Reverse transcription-quantitative polymerase chain reaction demonstrated that atorvastatin significantly suppressed the expression of these genes in human umbilical vein endothelial cells (p<0.01). These findings partially elucidate atorvastatin's potential mechanism in treating chronic subdural hematoma, offering r esearch insights and a foundation for further study. [ABSTRACT FROM AUTHOR]

Summary: Time history analysis is sometimes used in an estimation of the wind‐induced response of a tall building. However, time history analysis for the wind‐induced behavior by the ensemble‐averaging wind force costs much computation time. This paper provides a reliable prediction method for the wind‐induced response of the viscoelastic (VE)‐damped system considering its frequency dependency coupling with frame damping effect with frequency spectral method. VE damper used in high‐rise buildings can dissipate energy from excessive vibration induced by seismic or wind excitation. Fractional derivative (FD) model of VE dampers can express VE frequency dependency clearly, but it is computationally complicated. The herein proposed prediction method is based on frequency spectral method and evaluated wind‐induced responses of the single degree of freedom (SDOF) VE‐damped system with a FD VE damper subjected to the respective 1st modal along‐ and across‐wind force. The maximum error of wind‐induced responses of the VE‐damped system, such as the root mean square value of responses, the total input energy, and the total energy dissipation, is within 5%. In summary, the proposed method had high accuracy in the prediction of wind‐induced responses of the VE‐damped system considering its frequency dependency with the coupling effect of frame damping. [ABSTRACT FROM AUTHOR]

The autonomy of patients is generally recognized in practice and theory. However, there are many controversies on whether patients have the right of euthanasia, according to which they could choose the way of death of their own will, due to the traditional culture and emphasis on the priority of the tight of life. This essay recognizes that the right to euthanasia can be positively recognized in the light of the principle of human dignity and the right to autonomy, but its application should be subject to the principle of legal reservation and should be expressly regulated by the legislature. Although the case at hand is a dispute on whether the medical treatment is in accordance with medical practice, the court held that if the legal procedure is followed, the patient (and his legal representative) can choose to refuse the invasive intubation treatment in accordance with the right to autonomy, and accordingly there is no responsibility for the medical treatment, which is a substantial demonstration of respect for the patient's right to euthanasia. [ABSTRACT FROM AUTHOR]