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Congenital infiltrating lipomatosis of the face (CILF) is a rare, congenital, nonhereditary facial overgrowth due to post-zygomatic activating mutations in PIK3CA gene. It is unilateral and involves hypertrophy of both the soft and hard tissue structures on the affected side of the face. This commonly results in early eruption of the teeth, hypertrophy of the facial bones, macroglossia, and proliferation of the parotid gland. Less than 80 cases of CILF have been reported in the literature so far. Treatment modalities include liposuction and surgical excision. However, since the hallmark of CILF is mutation in the PIK3CA gene, PI3K inhibitors may play a therapeutic role in CILF. We report a case of an 8-year-old boy with recurrent CILF of the scalp and nose, with PIK3CA H1047R mutation. We discuss the differential diagnoses, clinical outcomes, and management of this rare entity.

Introduction: The control and prevention of lead exposure are widely discussed topics that seem to be current health concerns for the next decades. Ingestion of lead into the human body can cause toxicity which can be acute or chronic. Possible sources of lead exposure can be, among others, water, food, drugs, and food supplements. The lead content in drugs is a strictly controlled parameter worldwide. The different Pharmacopoeias (European, British, USA) provide information about the limits for lead in every drug substance and also about the tests that should be performed. Regulation of food supplements does not require obligatory analytical control. Often, these products are not monitored to ensure the quality. At the same time, during the last two decades, the global use of dietary supplements has increased manifold. Aim: This study aimed to analyse the presence of lead in food supplements used for weight control. Materials and methods: We have analysed 30 different samples of food supplements for lead content. These supplements are all sold as weight loss products. The method of analysis consists of determination the lead concentration in food supplements using inductively coupled plasma mass spectrometry. Results: We found that 4 of the analysed samples provide a lead intake of between 2.339 and 2.88 μg per day. The lead content in the other 26 samples was not significant. Conclusions: The regulation of food supplements is rather liberal and loose. Often the exact amount of the main ingredients is not properly labeled and the purity of these products is not controlled. Food supplements are used by consumers of different ages and with different medical conditions. Our recommendation is that the lead content should be obligatorily monitored and indicated on the label of every food supplement. This would be especially useful for the prevention and control of lead exposure worldwide.

Abstract In the present paper we construct novel non-topological, spontaneously scalarized neutron stars in multi-scalar Gauss–Bonnet gravity with maximally symmetric target space, and nontrivial map $$\varphi :spacetime \rightarrow target\ space$$ φ : s p a c e t i m e → t a r g e t s p a c e . The theory is characterized by the fact that for some classes of coupling functions the field equations allow solutions with trivial scalar field, which coincide with the general relativistic ones. For a certain range of parameters those solutions lose stability and new branches of solutions with nontrivial scalar field bifurcate from the trivial branch. For a given set of parameters, those branches are characterized by the number of zeros of the scalar field, and they are energetically more favorable than the general relativistic ones.

The article presents the main aspects of the banking credit contract exercise in Moldova and Russia. Author highlights the importance of the regulation of credit law, including the regulation of bank lending, drawing on the experience of countries that have incorporated such legal structures into national legislation, doctrinal findings and challenges and expectations of modern economic processes.

Abstract We are investigating universal relations between different normalisations of the moment of inertia and the compactness of neutron stars in slow rotation approximation. We study the relations in particular class of massive scalar-sensor theories with self-interaction, for which significant deviations from General Relativity are allowed for values of the parameters that are in agreement with the observations. Moment of inertia-compactness relations are examined for different normalisation of the moment of inertia. It is shown that for all studied cases the deviations from EOS universality are small for the examined equations of state. On the other hand the scalarization can lead to large deviations from the general relativistic universal relations for values of the parameters that are in agreement with the current observations that can be potentially used to set further test the scalar-tensor theories.

Abstract Binary pulsar observations and gravitational wave detections seriously constrained scalar–tensor theories with massless scalar field allowing only small deviations from general relativity. If we consider a nonzero mass of the scalar field, though, significant deviations from general relativity are allowed for values of the parameters that are in agreement with the observations. In the present paper we extend this idea and we study scalar–tensor theory with massive field with self-interaction term in the potential. The additional term suppresses the scalar field in the neutron star models in addition to the effect of the mass of the scalar field but still, large deviations from pure GR can be observed for values of the parameters that are in agreement with the observations.

Abstract A case can be made for stochastic germination and interactions among germinating spores as beneficial germination strategies in uncertain environments. However, there is little data on how widespread, species-specific or diverse such phenomena are. Focusing on Streptomycetes, a platform was developed for quantification of germination and early growth within communities of spores. We found that the germination process is stochastic at three levels: spores vary in their germination times, mycelium networks grow at different rates, and a fraction of germlings stall their growth shortly after germination. Furthermore, by monitoring how these stochastic properties are affected by spore density and chemicals released from spores, germination interactions were quantified for four species. Stochastically germinating spores were frequently promoted or inhibited by compounds released by spores from the same or different species, and all species had distinct interaction profiles. The spatial distribution patterns were important with clusters of spores behaving differently than individual spores. Aged spores exhibited higher dormancy but could efficiently geminate in the presence of chemicals released during germination. All interactions were specific to germination and only weakly affected growth rates. This work suggests that stochastic germination is commonly affected by the community context and species have adapted diverse germination strategies.

How did chemicals first become organized into systems capable of self-propagation and adaptive evolution? One possibility is that the first evolvers were chemical ecosystems localized on mineral surfaces and composed of sets of molecular species that could catalyze each other’s formation. We used a bottom-up experimental framework, chemical ecosystem selection (CES), to evaluate this perspective and search for surface-associated and mutually catalytic chemical systems based on the changes in chemistry that they are expected to induce. Here, we report the results of preliminary CES experiments conducted using a synthetic “prebiotic soup” and pyrite grains, which yielded dynamical patterns that are suggestive of the emergence of mutual catalysis. While more research is needed to better understand the specific patterns observed here and determine whether they are reflective of self-propagation, these results illustrate the potential power of CES to test competing hypotheses for the emergence of protobiological chemical systems.

Goitre recurrence is a common problem following subtotal thyroid gland resection for multinodular goitre disease. The aim of our study was to trace out the ultrastructure of the thyroid gland of man after primary and redo operations for struma nodosa. We undertook the task to study the fine ultrastructural changes taking place in the stromal part of the gland. For ultrastructural examination we used routine transmission electron microscopy. The electron microscopy has been made on Hitachi H-500 microscope Our main goal was to compare the ultrastructural characteristics of the thyroid gland in two different groups - patients with primary disease and patients with recurrence.The results from our research showed that in the first group the stroma was presented by one or two rows of cells in the septum or in small groups in the interfolicular space. Studies by electron microscopically showed that the cells of the stroma had the ultrastructural characteristics of fibroblasts, but there was an increased number cisterne of Granular endoplasmic reticulum, well developed Goldgi complex, as well as relatively small amount of vesicles and vacuoles. The examination of the specimens from the second group showed a much thicker stroma between the follicles. There was an increased amount of stromal cells and collagen bundles in the interfolicular space. The proteoglycan complexes in the extracellular matrix were rarely situated.Our results suggest that the connective tissue of the thyroid gland reacts faster to the changes of the structure of the gland than the epithelial cells of the follicles.

Soil grains harbor an astonishing diversity of Streptomyces strains producing diverse secondary metabolites. However, it is not understood how this genotypic and chemical diversity is ecologically maintained. While secondary metabolites are known to mediate signaling and warfare among strains, no systematic measurement of the resulting interaction networks has been available. We developed a high-throughput platform to measure all pairwise interactions among 64 Streptomyces strains isolated from several individual grains of soil. We acquired more than 10,000 time-lapse movies of colony development of each isolate on media containing compounds produced by each of the other isolates. We observed a rich set of such sender-receiver interactions, including inhibition and promotion of growth and aerial mycelium formation. The probability that two random isolates interact is balanced; it is neither close to zero nor one. The interactions are not random: the distribution of the number of interactions per sender is bimodal and there is enrichment for reciprocity--if strain A inhibits or promotes B, it is likely that B also inhibits or promotes A. Such reciprocity is further enriched in strains derived from the same soil grain, suggesting that it may be a property of coexisting communities. Interactions appear to evolve rapidly: isolates with identical 16S rRNA sequences can have very different interaction patterns. A simple eco-evolutionary model of bacteria interacting through antibiotic production shows how fast evolution of production and resistance can lead to the observed statistical properties of the network. In the model, communities are evolutionarily unstable--they are constantly being invaded by strains with new sets of interactions. This combination of experimental and theoretical observations suggests that diverse Streptomyces communities do not represent a stable ecological state but an intrinsically dynamic eco-evolutionary phenomenon.

Background: Autonomous pharmacist prescribing was legally introduced in Switzerland in 2019 with the reclassification from prescription medication to pharmacist prescribing of 105 medications for sixteen indications. Its aim was to limit medical consultations and healthcare costs. Objectives: To evaluate the clinical relevance of the pharmacy prescribing medications compared to the over-the-counter medications (OTCs) and to evaluate its implementation into daily practice. Methods: A comparison was undertaken by clinical pharmacists to evaluate chemical and galenical equivalences between pharmacy prescribing medications and OTCs using compendium. ch and pharmavista. ch. Then, a scoping review was carried out in October 2021 to determine clinical relevance according to clinical guidelines' recommendations. Clinical relevance was completed by determining if pharmacy prescribing medications were part of a homogeneous therapeutic class (no differences in efficacy and safety considered in clinical guidelines, but rather inter-molecular differences) that included an OTC medication. To identify the most clinically relevant pharmacy prescribing medications, first-line treatments were considered. The implementation into daily practice in Swiss community pharmacies was evaluated through an online questionnaire distributed via e-mail from the national pharmacists' association and LinkedIn ® . It included 15 questions divided in: pharmacy demographics, experience on pharmacy prescribing, use of prescribing medications and opinion about the them. Results: Of the 105 pharmacy prescribing medications, 20 (19.0%) were first-line treatments without OTC equivalences. Six of them were OTCs reclassified for safety reasons. Ten medications (9.5%) showed a negative clinical relevance (they were not first-line therapeutic options to support pharmacist when managing patients or considered as to be avoided) compared to the OTCs available. For the questionnaire, 283 pharmacists from the German (40.3%), French (37.1%) and Italian-speaking regions (16.9%) answered. In the previous 6 months, 41.7% pharmacies had delivered 10-50 medications and 30.0% between 1 and 10 medications. In situations where patients could be equally treated with a pharmacy prescribing medication or OTC (with an identical OTC, similar OTC or an OTC for the same therapeutic group): 75.6%, 74.9% and 84.8% of pharmacists, respectively, would have chosen OTCs because it required less documentation and it did not require patients' payment for the service. In addition, pharmacists' lack of training was also mentioned as barrier for providing the service. Conclusion: Most pharmacist prescribing medications do not present clinical advantages compared to OTCs. In addition, other barriers for implementation were also pharmacists' training and patient medications costs., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Amador-Fernández, Botnaru, Allemann, Kälin and Berger.)

Purpose: Microneurosurgical techniques have greatly improved over the past years due to the introduction of new technology and surgical concepts. To reevaluate the role of micro-neurosurgery in brain metastases (BM) resection in the era of new systemic and local treatment options, its safety profile needs to be reassessed. The aim of this study was to analyze the rate of adverse events (AEs) according to a systematic, comprehensive and reliably reproducible grading system after microneurosurgical BM resection in a large and modern microneurosurgical series with special emphasis on anatomical location., Methods: Prospectively collected cases of BM resection between 2013 and 2022 were retrospectively analyzed. Number of AEs, defined as any deviations from the expected postoperative course according to Clavien-Dindo-Grade (CDG) were evaluated. Patient, surgical, and lesion characteristics, including exact anatomic tumor locations, were analyzed using uni- and multivariate logistic regression and survival analysis to identify predictive factors for AEs., Results: We identified 664 eligible patients with lung cancer being the most common primary tumor (44%), followed by melanoma (25%) and breast cancer (11%). 29 patients (4%) underwent biopsy only whereas BM were resected in 637 (96%) of cases. The overall rate of AEs was 8% at discharge. However, severe AEs (≥ CDG 3a; requiring surgical intervention under local/general anesthesia or ICU treatment) occurred in only 1.9% (n = 12) of cases with a perioperative mortality of 0.6% (n = 4). Infratentorial tumor location (OR 5.46, 95% 2.31-13.8, p = .001), reoperation (OR 2.31, 95% 1.07-4.81, p = .033) and central region tumor location (OR 3.03, 95% 1.03-8.60) showed to be significant predictors in a multivariate analysis for major AEs (CDG ≥ 2 or new neurological deficits). Neither deep supratentorial nor central region tumors were associated with more major AEs compared to convexity lesions., Conclusions: Modern microneurosurgical resection can be considered an excellent option in the management of BM in terms of safety, as the overall rate of major AEs are very rare even in eloquent and deep-seated lesions., (© 2023. The Author(s).)

Background: Direct stimulation and diffusion tensor imaging/tractography are established techniques that assist in complex surgery for lesions in the eloquent area of the central nervous system., Objective: To continuously map the corticospinal tract (CST) by direct stimulation during brainstem surgery and to explore the association between direct brainstem stimulation and the shortest distance from the stimulation point to the CST (DS-to-T)., Methods: We prospectively enrolled 30 consecutive patients for microsurgical resection of lesions within or in proximity to the brainstem between January 2019 and August 2021. Direct stimulation with initially 2 mA was performed for mapping and monitoring the motor fiber tracts. To evaluate CST status and measure DS-to-T, postoperative diffusion tensor imaging/tractography was used. Preoperative and postoperative modified Ranking Scale and motor function were evaluated to assess the clinical outcome., Results: Intraoperative direct brainstem stimulation was successfully performed in all patients with a total of 909 stimulation points. One patient experienced a temporary neurological deficit postoperatively. Mapping of the CST was achieved in 5 patients. DS-to-T was ≤4 mm when motor-evoked potential responses were positive under 2 mA stimulation and ≤2 mm under 1 mA. Overall sensitivity and specificity for this association were 84.7% and 100%, respectively., Conclusion: This study further supports the paradigm for continuous CST monitoring and mapping through direct brainstem stimulation. The relationship between stimulation intensity and DS-to-T in brainstem surgery could help surgeon's better estimate the safe edge intraoperatively., (Copyright © Congress of Neurological Surgeons 2022. All rights reserved.)

•The TUG test and the 6WT are feasible to apply in ambulatory patients with spinal cord affection.•The objective measurement of functional impairment resembled the functional status of four patients in this pilot study.•The TUG test and the 6WT may detect and quantify functional decline and/or improvement resulting from spinal cord affection.•Modern smartphone app-based technology may help to accurately quantify impairment, which is key for decision-making and evaluating the efficacy of interventions., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2022 The Authors.)

The world currently faces the novel severe acute respiratory syndrome coronavirus 2 pandemic. Little is known about the effects of a pandemic on non-elective neurosurgical practices, which have continued under modified conditions to reduce the spread of COVID-19. This knowledge might be critical for the ongoing second coronavirus wave and potential restrictions on health care. We aimed to determine the incidence and 30-day mortality rate of various non-elective neurosurgical procedures during the COVID-19 pandemic. A retrospective, multi-centre observational cohort study among neurosurgical centres within Austria, the Czech Republic, and Switzerland was performed. Incidence of neurosurgical emergencies and related 30-day mortality rates were determined for a period reflecting the peak pandemic of the first wave in all participating countries (i.e. March 16th-April 15th, 2020), and compared to the same period in prior years (2017, 2018, and 2019). A total of 4,752 emergency neurosurgical cases were reviewed over a 4-year period. In 2020, during the COVID-19 pandemic, there was a general decline in the incidence of non-elective neurosurgical cases, which was driven by a reduced number of traumatic brain injuries, spine conditions, and chronic subdural hematomas. Thirty-day mortality did not significantly increase overall or for any of the conditions examined during the peak of the pandemic. The neurosurgical community in these three European countries observed a decrease in the incidence of some neurosurgical emergencies with 30-day mortality rates comparable to previous years (2017-2019). Lower incidence of neurosurgical cases is likely related to restrictions placed on mobility within countries, but may also involve delayed patient presentation.

Previous investigations about the running shoe design demonstrated a relationship between the geometry of the shoe sole, the ground reaction forces and the foot movements during impact. Thus, the question arised in which way this relationship would influence the internal forces. The purpose of this investigation was to model the impact situation and to simulate different sole geometries in order to calculate the internal forces and the pronation velocity. The results show that the geometry has a small effect upon the joint forces, but a very high effect on the pronation velocity. As a consequence, the joint forces changed only by 10% or less, but the load of the structures which are stressed by pronation is increased up to 200%. Thus, the control of the initial pronation is much more important in current running shoe design than the shock-absorption.