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This paper presents a fifth-generation (5G) wireless smart antenna for performing both power substation communication (in space domain beam-steering) and electrostatic discharge (in time domain Ultra-high Frequency "UHF" impulse) detection. The same smart antenna used to communicate with other wireless antennas in the switchyard, as well as with the control room, is utilized to cyclically gather data from power apparatus, busbars, and switches where electrostatic discharge (ESD) may occur. The ESD poses a major threat to electrical safety and lifetime of the apparatus as well as the stability of the power system. The same smart antenna on which beam rotation in space-domain is designed by implementing an artificial neural network (ANN) is also trained in time-domain to identify any of the received signals matching the ultra-high frequency band electrostatic discharge pulses that may be superimposed on the power frequency electric current. The proposed system of electrostatic discharge detection is tested for electrostatic pulses empirically simulated and represented in a trigonometric form for the training of the Perceptron Neural model. The working of the system is demonstrated for electrostatic discharge pulses with rising times of the order of one nanosecond. The artificial intelligence system driving the 5G smart antenna performs the dual roles of beam steering for 5G wireless communication (operating in the space domain) and for picking up any ESD generated UHF pulses from any one of the apparatus or nearby lightning leaders (operating in the time domain). [ABSTRACT FROM AUTHOR]

The experimental study is aimed at analyzing photovoltaic module’s thermal and electrical performance (PV) with back surface cooling under Malaysian tropical climate conditions. The performance of a passively cooled PV module integrated with biomaterial (moist coconut fiber) was compared with a photovoltaic thermal (PVT) system with water circulation at the rate of 0.02 kg s-1 and a reference PV module. The study observed that the passively cooled PV module succeeded in reducing the module surface temperature by more than 20%. However, the PVT system reduced the temperature only by less than 17%. The electrical energy efficiency was improved remarkably in the passively cooled PV module by almost 11%, but the PVT system managed to increase the electrical efficiency by 9%, approximately. It can be concluded that nature-inspired coconut fiber-based cooling can be one of the potential alternatives to active cooling methods.

New strategies and market segments considering integrated approaches have emerged as critical components in the energy transition. Agrivoltaics is one approach that has shown a lot of promise for offering advantages in the food-energy-water nexus. The agrivoltaic system involves the installation of photovoltaic panels above agricultural lands to generate electricity while also allowing for crop production. The paper “SWOT and TOWS Matrix Analysis of Agrivoltaic System” comprehensively analyses the potential strengths, weaknesses, opportunities, and threats (SWOT) associated with implementing an agrivoltaic system. This study utilizes a SWOT analysis framework to identify and evaluate the internal and external factors that could impact the implementation and success of the agrivoltaic system. A TOWS matrix analysis is also conducted to formulate strategic recommendations based on the identified SWOT factors. The analysis results reveal that the agrivoltaic system has numerous strengths, including its potential to generate renewable energy, increase crop yield, and provide economic benefits to farmers. However, the system also faces several weaknesses and threats, such as high initial investment costs, land use conflicts, and potential environmental impacts. Based on the TOWS matrix analysis, this study provides strategic recommendations to maximize the potential of the agrivoltaic system while mitigating its weaknesses and threats. These recommendations include adopting a flexible pricing strategy, researching the system’s environmental impact, promoting collaboration between various stakeholders like government agencies, farmers, and energy service companies. Overall, this study provides valuable insights into the potential of agrivoltaic systems and the factors that should be considered when implementing such a system. The findings can help stakeholders make informed decisions and take appropriate actions to ensure the integration of agrivoltaic systems into agricultural practices.

The reliance on grid electricity generated from fossil fuels in many countries continues to contribute to annual CO2 emissions. Implementing renewable energy systems helps reduce the carbon footprint and enhances local grid stability, particularly in areas with high demand where power outages are frequent. This study used the Hybrid Optimization of Multiple Energy Resources (HOMER) software to determine the most cost-effective composition of a Hybrid Renewable Energy System (HRES). Simulation results indicate that a system comprising a 3007 PV array, two 1.5 MW wind turbines, and a 1927 kW converter is most suitable. Combining solar panels and wind turbines remains the most economically feasible option for on-site electricity production. The study demonstrates that installing a hybrid renewable energy system is viable on an academic campus, with an initial investment cost of US $6.58 million and yearly operational costs of US $1.38 million, which is 40.8% lower than the current system. The project payback time is estimated to be 10.11 years. These findings may be used to recommend similar systems in other regions with comparable climatic conditions. The positive monetary effects may incentivize policymakers to implement comparable systems, contributing to a carbon-neutral goal.

With its unique qualities, such as infinite supply, high octane number, and capacity to cut greenhouse gas emissions, alcohol is a viable alternative fuel for SI engines. This review article aims to reveal to readers the effects of alcohol on the performance, combustion behavior, and emission characteristics of SI engines by collecting the outcomes from previous research. This article looks at methanol, ethanol, and butanol fuel qualities. The performance of SI engines with butanol, ethanol, and methanol combined with gasoline is investigated in terms of brake torque, brake power, fuel consumption, thermal efficiency, volumetric efficiency, mean effective pressure, and coefficient of variation under various conditions. Second, in-cylinder pressure, mass fraction burnt, ignition delay, pressure increases, and heat release rates are also used to evaluate the combustion characteristic. Finally, the article discusses pollutant emissions such as CO, CO2, NOx, UHC, and exhaust gas temperature. Methanol, ethanol, and butanol mixed with gasoline increased fuel consumption and lowered spark-ignition engines’ thermal efficiency. When alcohol was combined with gasoline, most research found that CO, NOx, and UHC emissions were reduced due to improved combustion.

Keeping in view the conservation of natural resources, the power generation from the solar photovoltaic system is increasing day by day to meet the demand of energy worldwide. There are constraints of availability of space for ground mounted solar PV system for large installations. In some countries water bodies are being utilized to install solar PV system to reduce land use. Few floating systems using plastics have been developed to install a solar panel on it. After extensive literature studies on properties of polyolefins, High-density poly ethylene (HDPE) is found to be better material for this purpose.In order to measure its sustainability, annotation of mechanical properties using bimodal poly ethylene under accelerated weathering condition has been carried out in different intervals till 1152 h, to perceive the lifespan of HDPE material. The change in its mechanical properties like tensile strength, elongation at break, maximum load bearing capacity, impact resistance and hardness were evaluated. It was observed that the tensile strength was reduced from 23.22 MPa to 14.64 MPa after accelerated UV exposure. It was observed that after 1000 h of exposure to accelerated weathering the material still has the tendency to hold a constant load of 637.81 N without rupture, compared to non-weathered sample (955.16 N). The elongation at break was reduced but elongation of 6.24% was maintained after 1152 h of accelerated exposure, which depicts the elasticity of the material, is still maintained. The impact resistance did not show a significant change during this period, the value varies in the range of 13.54–10.06 kJ/m2. However, the hardness was increased from 61 to 66 (Shore D) due to deterioration of low molecular weight polymer present in bimodal PE. It is concluded that the mechanical properties of Biomodal HDPE material after accelerated UV exposure does not have much effect and is safe to bear the load of solar panels and other accessories mounted over it. Further studies can be done using UV stabilized biomodal HDPE. Keywords: Floating system, Biomodal, HDPE material, Mechanical properties

Abstract Background Prediabetes (PreDM) in asymptomatic adults is associated with abnormal circadian blood pressure variability (abnormal CBPV). Hypothesis Systemic inflammation and glycemia influence circadian blood pressure variability. Methods Dahl salt-sensitive (S) rats (n = 19) after weaning were fed either an American (AD) or a standard (SD) diet. The AD (high-glycemic-index, high-fat) simulated customary human diet, provided daily overabundant calories which over time lead to body weight gain. The SD (low-glycemic-index, low-fat) mirrored desirable balanced human diet for maintaining body weight. Body weight and serum concentrations for fasting glucose (FG), adipokines (leptin and adiponectin), and proinflammatory cytokines [monocyte chemoattractant protein-1 (MCP-1) and tumor necrosis factor-α (TNF-α)] were measured. Rats were surgically implanted with C40 transmitters and blood pressure (BP-both systolic; SBP and diastolic; DBP) and heart rate (HR) were recorded by telemetry every 5 minutes during both sleep (day) and active (night) periods. Pulse pressure (PP) was calculated (PP = SBP-DBP). Results [mean(SEM)]: The AD fed group displayed significant increase in body weight (after 90 days; p < 0.01). Fasting glucose, adipokine (leptin and adiponectin) concentrations significantly increased (at 90 and 172 days; all p < 0.05), along with a trend for increased concentrations of systemic pro-inflammatory cytokines (MCP-1 and TNF-α) on day 90. The AD fed group, with significantly higher FG, also exhibited significantly elevated circadian (24-hour) overall mean SBP, DBP, PP and HR (all p < 0.05). Conclusion These data validate our stated hypothesis that systemic inflammation and glycemia influence circadian blood pressure variability. This study, for the first time, demonstrates a cause and effect relationship between caloric excess, enhanced systemic inflammation, dysglycemia, loss of blood pressure control and abnormal CBPV. Our results provide the fundamental basis for examining the relationship between dysglycemia and perturbation of the underlying mechanisms (adipose tissue dysfunction induced local and systemic inflammation, insulin resistance and alteration of adipose tissue precursors for the renin-aldosterone-angiotensin system) which generate abnormal CBPV.

Abstract Background Dysfunction in the endolysosome, a late endosomal to lysosomal degradative intracellular compartment, is an early hallmark of some neurodegenerative diseases, in particular Alzheimer's disease. However, the subtle morphological changes in compartments of affected neurons are difficult to quantify quickly and reliably, making this phenotype inaccessible as either an early diagnostic marker, or as a read-out for drug screening. Methods We present a method for automatic detection of fluorescently labeled endolysosomes in degenerative neurons in situ. The Drosophila blue cheese (bchs) mutant was taken as a genetic neurodegenerative model for direct in situ visualization and quantification of endolysosomal compartments in affected neurons. Endolysosomal compartments were first detected automatically from 2-D image sections using a combination of point-wise multi-scale correlation and normalized correlation operations. This detection algorithm performed well at recognizing fluorescent endolysosomes, unlike conventional convolution methods, which are confounded by variable intensity levels and background noise. Morphological feature differences between endolysosomes from wild type vs. degenerative neurons were then quantified by multivariate profiling and support vector machine (SVM) classification based on compartment density, size and contrast distribution. Finally, we ranked these distributions according to their profiling accuracy, based on the backward elimination method. Results This analysis revealed a statistically significant difference between the neurodegenerative phenotype and the wild type up to a 99.9% confidence interval. Differences between the wild type and phenotypes resulting from overexpression of the Bchs protein are detectable by contrast variations, whereas both size and contrast variations distinguish the wild type from either of the loss of function alleles bchs1 or bchs58. In contrast, the density measurement differentiates all three bchs phenotypes (loss of function as well as overexpression) from the wild type. Conclusion Our model demonstrates that neurodegeneration-associated endolysosomal defects can be detected, analyzed, and classified rapidly and accurately as a diagnostic imaging-based screening tool.

Background: The perivascular spaces of the brain are also known as Virchow-Robin spaces (VRSs). Dilated Virchow-Robin spaces in the brainstem are rare and mainly cause symptoms due to obstructive hydrocephalus, less frequently because of their size, mass effect, and impact on eloquent structures., Case Illustration: We present a patient with giant tumefactive VRS with hydrocephalus and neurological symptoms who was treated with endoscopic third ventriculostomy (ETV) followed by microscopic cyst fenestration. On the basis of this observation, we performed a thorough review of the literature to evaluate different treatment options., Results: An 11-year-old girl presented with a headache for 3 months. The patient had a giant tumefactive mesencephalothalamic VRS with triventricular hydrocephalus. She was initially treated with endoscopic third ventriculostomy and multiple cyst fenestration. Symptomatic cyst regrowth required multiple cyst fenestrations via transcallosal transchoroidal (N = 2) and subtemporal approaches (N = 1) at the 2- and 4-year follow-ups. A literature review of these conditions allowed the detection of 12 cases (including our index case), and only 25% (3/12) of the patients underwent cyst fenestration 16.7% (2/12) required endoscopic fenestration and 8.3% (1/12) required microscopic fenestration., Conclusion: Giant mesencephalothalamic dVRSs are rare in the pediatric population. These patients are usually symptomatic due to obstructive hydrocephalus. Surgical options are endoscopic third ventriculostomy, ventricular shunt procedures, or direct cyst fenestration (microscopic or endoscopic). Close follow-up is mandatory owing to the risk of progression of the disease. Cyst fenestration resolves symptoms immediately, as it addresses both hydrocephalus and mass effects due to the cystic lesion in the same setting., Competing Interests: Declarations. Ethics approval: Consent to participate and consent for publication was taken from the patient using written informed consent to publish from the parent. Ethics committee approval was obtained. Conflict of interest: The authors report no conflicts of interest concerning the materials or methods used in this study or the findings specified in this paper. Financial disclosures: Giuseppe Cinalli has performed remunerated presentations for Integra Neurosciences and Braun Aesculap in the last 2 years., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Sodium valproate is used for the management of seizures, status epilepticus, chronic pain syndrome, bipolar, and other affective disorders. Even with an acceptable safety profile, severe idiosyncratic reactions can occur with valproate use. A rare, serious, and life-threatening side effect of valproate is valproate-induced hyperammonemic encephalopathy (VHE). We intend to analyze the clinical presentation, diagnosis, treatment options, and outcome of VHE in neurosurgical patients and review the pertinent literature on this rare sequelae. We retrospectively reviewed patients who developed VHE following valproate use, either for the treatment of epilepsy or for seizure prophylaxis in our centre. We analyzed the demographic details, clinical presentation, diagnosis, management, and outcomes. A total of four patients with a mean age of 26.3 ± 5.1 (range 19 - 32 years). Valproate was prescribed for primary seizure prophylaxis in 2 patients (50%). The commonest etiology for valproate prescription was for brain tumors (3, 75%) followed by drug-refractory epilepsy (DRE) (1, 25%). None of the patients were documented to have urea cycle disorder. The mean daily prescribed dosage of valproate was 1250 ± 559 mg and the mean duration of administration was 13 ± 13.3 months (range 4 months - 36 months). The mean serum NH3 level was 136,5 ± 44.2 µmol/L (range 107 - 212.8) and all patients (4, 100%) had hyperammonemia with a mortality rate of 50% (2 patients). The hyperammonemia was treated by stopping the valproate use (4, 100%) and dialysis (2, 50%). Normalization of ammonia levels led to clinical improvement in 50% (2 patients). Neurological deterioration in the postoperative period is a diagnostic challenge. VHE is a rare and life-threatening sequelae of Valproate-associated Hyperammonemia (VAH) in neurosurgical patients. A high index of suspicion is required due to its ambiguous presentation. Early diagnosis and prompt treatment can change the course of this life-threatening sequelae., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Cervical cancer is preventable, yet it remains the fourth most common cancer in women globally. The highest incidence and mortality occur in low- and middle-income countries (LMICs), where over 70% of women have never been screened, and 58% of the cases are in Asia. While the COVID-19 pandemic caused significant disruptions to cervical screening programs, particularly for LMICs, there were opportunities that emerged from the pandemic that were enablers of program recovery. Stakeholders played key roles in materialising strategy into implementation. Therefore, in this study, we examined the barriers and facilitators to implementing recovery strategies from the stakeholders' perspectives. We interviewed fifteen stakeholders from nine LMICs in the Asia-Pacific region directly involved in the implementation of the cervical screening program. A total of 23 barriers and 21 facilitators were identified, of which seven barriers and nine facilitators related directly to the pandemic. Pandemic-related barriers included movement restrictions, resource diversion, cancelled campaigns and training, deprioritisation of HPV prevention efforts, and a reduced health workforce. Stakeholders concurred that most barriers had predated the pandemic and remained as the pandemic eased. Conversely, the pandemic introduced facilitators such as means for targeted campaigns, improved understanding of viruses, accessible training with online platforms, better PCR testing capabilities, a shift in the government's position towards preventive health services, and openness to HPV testing and self-swabs. The emerging facilitators offered opportunities to address some of the persistent barriers, such as limited cervical cancer awareness and insufficient healthcare providers in screening programs. However, effective implementation of these emerging facilitators requires improved communication and collaboration between policymakers and implementers to accelerate the recovery of screening programs in LMICs. Further work is necessary to align emerging facilitators with the health system goals and resource settings of each country in turning these opportunities into actions., Competing Interests: We have read the journal’s policy and the authors of this manuscript have the following competing interests: SMG is supported by NHMRC APP1197951 Leadership Investigator grant level 3, a member of the advisory board for the nine-valent HPV vaccine of Merck, received an educational grant from Merck for study on HPV and young women through her institution and received Merck lecture fees. SK has served on advisory boards of both Merck & GSK and has received Merck and Roche lecture fees. IIP has received Roche and MSD lecture fees. DAM has received grants from Seqirus, non-financial support and honoraria from MSD, and non-financial support from Roche Diagnostics, not related to this manuscript. LJ has received honorarium from Abbott., (Copyright: © 2024 Lee et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Objectives: Hepatic CEACAM1 expression declines with advanced hepatic fibrosis stage in patients with metabolic dysfunction-associated steatohepatitis (MASH). Global and hepatocyte-specific deletions of Ceacam1 impair insulin clearance to cause hepatic insulin resistance and steatosis. They also cause hepatic inflammation and fibrosis, a condition characterized by excessive collagen production from activated hepatic stellate cells (HSCs). Given the positive effect of PPARγ on CEACAM1 transcription and on HSCs quiescence, the current studies investigated whether CEACAM1 loss from HSCs causes their activation., Methods: We examined whether lentiviral shRNA-mediated CEACAM1 donwregulation (KD-LX2) activates cultured human LX2 stellate cells. We also generated LratCre + Cc1 fl/fl mutants with conditional Ceacam1 deletion in HSCs and characterized their MASH phenotype. Media transfer experiments were employed to examine whether media from mutant human and murine HSCs activate their wild-type counterparts., Results: LratCre + Cc1 fl/fl mutants displayed hepatic inflammation and fibrosis but without insulin resistance or hepatic steatosis. Their HSCs, like KD-LX2 cells, underwent myofibroblastic transformation and their media activated wild-type HSCs. This was inhibited by nicotinic acid treatment which blunted the release of IL-6 and fatty acids, both of which activate the epidermal growth factor receptor (EGFR) tyrosine kinase. Gefitinib inhibition of EGFR and its downstream NF-κB/IL-6/STAT3 inflammatory and MAPK-proliferation pathways also blunted HSCs activation in the absence of CEACAM1., Conclusions: Loss of CEACAM1 in HSCs provoked their myofibroblastic transformation in the absence of insulin resistance and hepatic steatosis. This response is mediated by autocrine HSCs activation of the EGFR pathway that amplifies inflammation and proliferation., Competing Interests: Declaration of competing interest None declared., (Copyright © 2024 The Authors. Published by Elsevier GmbH.. All rights reserved.)

Choreoathetoid movements can be caused by a range of conditions. Here, we discuss the case of a 16-year-old male with a history of acute febrile illness who presented with features typical of paroxysmal dystonic choreoathetosis. He arrived at the hospital complaining of a fever that had been present for four days, suggesting a viral etiology, but he did not exhibit any involuntary movements. The routine panel suggests both dengue and typhoid as potential culprits. Consequently, during the ward stay, the patient developed involuntary movements in bilateral upper limbs, lower limbs, and face. Co-infection with both dengue and typhoid is seldom seen, with an increasing number of cases in the recent few years. These situations can sometimes put the treating physician in a difficult situation with respect to management. This case is being discussed because of its rare manifestation caused by a rare co-infection., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Gudibandi et al.)

We report the appearance of supertransient chaos in a single and two-coupled Liénard system with the influence of external periodic force. The existence of transient dynamics in a model is significantly long before it settles into the asymptotic steady state of periodic dynamics understood as supertransient chaos. The two diffusively coupled forced Liénard systems exhibit extremely long transient dynamics when their frequencies of the external forcing are slightly mismatched. Additionally, the coupled system signifies supertransient hyperchaotic dynamics for a specific set of system parameters. This study involves different numerical characterizations, statistical analysis, and hardware implementation using an analog electronic circuit.

Background: Traumatic brain injury (TBI) is a leading cause of morbidity in all age groups worldwide. Decompressive craniectomy (DC) is a salvage procedure in patients with TBI. The outcome and quality of life following DC is questionable. Basal cisternostomy (BC) has been proposed to reduce edema and lead to brain relaxation. It was initially used as an adjunct in TBI patients, thereby improving outcomes. With gaining popularity among neurosurgeons, BC was used as a standalone approach in TBI patients. This network meta-analysis aims to analyze the role of BC either as an adjunct or as a standalone approach in managing TBI patients., Methods: A comprehensive search of electronic databases (PubMed and SCOPUS) was performed using the search strategy using the field terms and medical subheading terms (MeSH Terms) to retrieve studies describing the role of BC in patients with TBI either as an adjunct with DC or standalone treatment and their outcome., Results: Thirty-one articles were selected for full-text review and 18 articles were selected for the final analysis. BC alone group was found to have minimum in-hospital mortality (odds ratio [OR], 0.348; 95% credible interval [CrI], 0.254 to 0.477) followed by DC combined with BC group (OR, 0.645; 95% CrI, 0.476 to 0.875). DC combined with the BC group was found to have a minimum duration of mechanical ventilation (OR, 0.114; 95% CrI, 0.005 to 2.451) followed by the BC alone group (OR, 0.604; 95% CrI, 0.024 to 15.346). DC combined with the BC group were found to have the maximum Glasgow Outcome Scale score (OR, 1.661; 95% CrI, 0.907 to 3.041) followed by the BC alone group (OR, 1.553; 95% CrI, 0.907 to 3.041)., Conclusions: Our analysis showed that BC alone was associated with lower in-hospital mortality rates in TBI patients. DC with BC had decreased the requirement of mechanical ventilation. However, larger multi-centric studies from other parts of the world are required to confirm these findings., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Background: Intracranial mesenchymal chondrosarcoma (IMC) is a rare malignant tumor in pediatric population. IMC can present as extra- or intra-axial lesion in pediatric patients, though the former is commoner causing raised intracranial pressure (ICP). Radiological diagnosis is a challenge in these cases, as is it difficult to differentiate these from other extra-axial neoplasms due to the wide differential diagnosis in pediatric population. We aim to systematically review the literature and present a rare case of extraskeletal intracranial mesenchymal chondrosarcoma treated with safe maximal resection., Methods: A systematic review of literature was conducted in accordance with PRISMA guidelines. PubMed and Scopus databases were queried using the search terms, "primary intracranial chondrosarcoma", "extraskeletal mesenchymal chondrosarcoma", "mesenchymal chondrosarcoma" and "pediatric". Presentation, surgical management and outcome of a 15-year-old male with an extraskeletal IMC are also described., Results: The search yielded 25 articles which met the inclusion criteria. These published records consisted of 33 IMC cases with mean age at presentation of 9.81 ± 5.2 years (range 2 months to 18 years). Frontal region was the commonest locations (11, 33.3%). Most common presentation was headache (14, 42.4%). All patients underwent surgical intervention: gross total resection (20, 60.6%), subtotal resection (9, 27.3%) and no extent mentioned (4, 12.1%). No adjuvant therapy was received in 15 patients (45.5%). On latest follow-up, 11 patients (33.3%) are on remission, 5 patients (15.2%) are symptom free, 3 patients (9.1%) had recurrence, 2 patients (6.1%) had metastasis and 9 patients (27.3%) expired., Conclusion: IMC is a rare entity in pediatric population with imaging findings which are non-characteristic leading to its diagnostic challenge. It can masquerade as other extra-axial intracranial neoplasm (meningioma or hemangiopericytoma). Combination of clinico-radiological and pathological examination can help in accurate diagnosis.  Safe Maximal resection followed by radiotherapy is the preferred treatment strategy., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

The anterior inferior cerebellar artery (AICA) supplies the middle cerebellar peduncle, lower pons, upper medulla, and anterior inferior cerebellum. Ischemia in the AICA can cause the lateral inferior pontine syndrome. AICA syndrome is characterized by facial sensory loss and weakness, Horner syndrome, prolonged vertigo, audio-vestibular loss, and cerebellar signs. Many studies on AICA territory infarcts have demonstrated the rarity of complete AICA syndrome. In all cases of AICA territory infarcts, involvement of the middle cerebellar peduncle was observed, with the seventh cranial nerve (facial nerve) being the most frequently involved cranial nerve, vertigo was the most common presenting symptom, and atherosclerosis was the most common etiology. This case report aims to investigate the occurrence of middle cerebellar peduncle infarcts that mimic Bell's palsy, highlighting the importance of accurate diagnosis and appropriate management in such cases. Recognizing the unique characteristics and clinical presentation of middle cerebellar peduncle (MCP) infarcts is essential for distinguishing them from more common conditions like Bell's palsy, thereby ensuring timely and effective treatment., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. SRM Medical College Hospital and Research Centre issued approval NA. The investigator has got an approved consent from the patient to use the face of the patient in the image (Figure 1), as masking the identity in this case representing Bell's phenomenon will hide the findings. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Pandian et al.)

Background: Primary non-Hodgkin's lymphoma with multiple extra- and intra-calvarial extensions without systemic spread in an immunocompetent patient is extremely rare. They masquerade commonly as meningioma and can present as mass lesions with raised intracranial pressure., Case Description: We report one such case of primary diffuse large B-cell lymphoma (DLBCL) in a young female involving the scalp, dural involvement in the right frontal region, left parietal, and posterior fossa and mimicking both clinically and radiologically as meningioma. She was managed surgically. Histological examination showed features suggestive of DLBCL (germinal center type). She was planned for adjuvant therapy. However, at 2 months following surgery, she succumbed due to systemic involvement of the disease., Conclusion: DLBCL is seen rarely in neurosurgical practice. They can present as tumors with adjacent extra- and intra-cranial masses. They pose a diagnostic challenge as it can be easily confused with meningioma. Tumor resection is performed to confirm diagnosis and in patients who present with raised intracranial pressure. Chemotherapy is the preferred treatment, and adjuvant therapy should be started early., Competing Interests: There are no conflicts of interest., (Copyright: © 2024 Surgical Neurology International.)

Background: The role of insulin resistance in hepatic fibrosis in Metabolic dysfunction-Associated SteatoHepatitis (MASH) remains unclear. Carcinoembryonic Antigen-related Cell Adhesion Molecule1 protein (CEACAM1) promotes insulin clearance to maintain insulin sensitivity and repress de novo lipogenesis, as bolstered by the development of insulin resistance and steatohepatitis in AlbuminCre + Cc1 fl/fl mice with liver-specific mouse gene encoding CEACAM1 protein (Ceacam1) deletion. We herein investigated whether these mice also developed hepatic fibrosis and whether hepatic CEACAM1 is reduced in patients with MASH at different fibrosis stages., Methods: AlbuminCre + Cc1 fl/fl mice were fed a regular or a high-fat diet before their insulin metabolism and action were assessed during IPGTT, and their livers excised for histochemical, immunohistochemical and Western blot analysis. Sirius red staining was used to assess fibrosis, and media transfer was employed to examine whether mutant hepatocytes activated hepatic stellate cells (HSCs). Hepatic CEACAM1 protein levels in patients with varying disease stages were assessed by ELISA., Results: Hepatocytic deletion of Ceacam1 caused hyperinsulinemia-driven insulin resistance emanating from reduced hepatic insulin clearance. AlbuminCre + Cc1 fl/fl livers showed inflammation, fibrosis and hepatic injury, with more advanced bridging and chicken-wire hepatic fibrosis under high-fat conditions. Media transferred from hepatocytes isolated from mutant mice activated control HSCs, likely owing to their elevated endothelin1 content. Interestingly, hepatic CEACAM1 levels were lower in the livers of patients with MASH and declined gradually with advanced fibrosis stage., Conclusions: Hepatic CEACAM1 levels declined with progression of MASH in humans. The phenotype of AlbuminCre + Cc1 fl/fl mice assigned a key role to CEACAM1 loss from hepatocytes in hepatic fibrosis independently of other liver cells., (© 2024 The Authors. European Journal of Clinical Investigation published by John Wiley & Sons Ltd on behalf of Stichting European Society for Clinical Investigation Journal Foundation.)

This study investigates the emergence of extreme events in a complex variable dynamical system. In the absence of an external forcing, the model exhibits nearly Hamiltonian dynamics. When we set the system to a nearly conservative state and perturb it with external forcing, the formation of the onset of the extreme events was detected. By applying nullcline analysis and the system's vector field, we explored the underlying mechanism that leads to extreme events. Furthermore, we have conducted a thorough investigation to show the dynamic origins of extreme amplitude events and their transitions. The hardware electronic experiment is used to validate the numerical results of the onset of extreme events, and the results obtained are in good agreement with one another., (© 2024 Author(s). Published under an exclusive license by AIP Publishing.)

Magnetite mining is a significant contributor to land deterioration as well as HM-based soil contamination. The characteristics of magnetite mine tailing were examined in the present study, in addition to the positive and sustainable restoration strategy with Bougainvillaea glabra under the influence of Thiobacillus ferroxidance. The traits of test soil analysis findings demonstrated that the majority of the parameters exceeded the allowable limits (For instance: HMs such as Cr, Cu, Zn, Pb, Fe, and Co were found to be 208 ± 2.3, 131.43 ± 1.6, 185.41 ± 3.3, 312 ± 5.11, 956 ± 5.3, and 26.89 ± 2.43 mg kg -1 respectively). T. ferroxidance exhibited impressive HMs tolerance for as much as 800 g mL -1 concentrations of Cr, Cu, Zn, Pb, Fe, and Co. To prevent HMs toxic effects, the HMs contents in test soil were decreased by diluting with normal soil in the ratios of Ex-3 and Ex-2. A typical greenhouse study was carried out to assess the phytoremediation ability of B. glabra across six setups for experiments (Ex-1 to Ex-6). According to the findings of this research, the HMs tolerant T. ferroxidance from Ex-3 and Ex-2 had an outstanding impact on the growth, biomolecules level (such as chlorophylls: 65.84 & 41.1 mg g -1 , proteins: 165.1 & 151.1 mg g -1 , as well as carbohydrates: 227.4 & 159.3 mg g -1 ) as well as phytoremediation potential of B. glabra on magnetite mine soil. These findings indicated that a mixture of B. glabra as well as T. ferroxidance might serve as a valuable sustainable agent for removing HMs from contaminated soil., Competing Interests: Declaration of competing interest 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., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Background The SARS-CoV-2 pandemic has underscored the multifaceted impact of the virus on human health, extending beyond the respiratory system to involve other organ systems, including the endocrine system. Emerging evidence suggests a notable interaction between COVID-19 and thyroid function, characterized by alterations in thyroid hormone levels and structural changes within the gland. This study aims to explore the association between thyroid density on CT imaging and lung involvement in patients with COVID-19, potentially offering new insights into the systemic effects of the virus. Methodology A retrospective cross-sectional analysis was conducted on 1,066 patients with COVID-19 who underwent chest CT scans without contrast at Government Medical College, Omandurar Government Estate, Chennai, which was designated as the COVID-19 care center from April to June 2021. Thyroid density and lung involvement were quantitatively assessed, and their correlation was analyzed using descriptive and inferential statistics, including the Kruskal-Wallis H test and Shapiro-Wilk test for normality. Results The study population predominantly exhibited normal thyroid density (749, 70.3%), followed by altered (212, 19.9%), nodular (104, 9.8%), and a single instance (0.1%) of absent thyroid density. Despite variability in lung involvement across different thyroid density categories, statistical analysis revealed no significant association between thyroid density and the extent of lung involvement in patients with COVID-19. Conclusions This study found no significant correlation between thyroid density and lung involvement in patients with COVID-19, suggesting that thyroid density on CT imaging may not serve as a reliable marker for lung involvement in this population. Further research is warranted to explore the complex interactions between COVID-19 and thyroid function, as well as the potential implications for patient management and prognosis., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2024, Balasubramaniam et al.)

Background: Pediatric cervical kyphosis is a distinct entity with diverse etiology (congenital, syndromic, traumatic, metabolic or neoplastic). Surgical correction in pediatric population is challenging due to their growing spine and low blood volume., Purpose: To analyse their presentation, surgical techniques and outcome of pediatric cervical kyphosis and systematically review the pertinent literature., Design: Retrospective study., Patient Sample: 16 patients aged ≤ 18 years who underwent correction for cervical kyphosis between 2009 and 2021., Outcome Measures: Nurick's grading, mJOA score and Global cobb's angle., Methods: Clinical parameters (Nurick grading and mJOA score) were noted from database on admission and on follow-up at 6 months. Radiological parameters of assessment included Global Cobb's angle. The C2-C7 Cobb angle was the angle of C2 vertebra lower end plate and C7 vertebra lower end plate. For C1-2 kyphosis, anterior border of C1 and anterior border of C2 angle was taken. Radiographic parameters were studied on CT and radiographs of cervical spine to assess for stability, the degree of deformity correction and fusion status at 6 months follow-up., Results: 16 patients with mean age of 14.2 ± 3 years (9 syndromic, 4 post-traumatic, 2 metabolic and 1 post-laminectomy). All underwent surgical correction, 6 underwent Antero-posterior spinal fusion, 6 underwent Posterior spinal fusion and 4 underwent Anterior spinal fusion. There was significant clinical improvement postoperatively with-Nurick grade (pre vs. post: 2.8 vs. 1.8, p = 0.004), mJOA score (pre vs. post: 11.3 vs. 14, p = 0.003). There was significant deformity correction of Cobb's angle from 40.7 ± 26.5° to 14.9 ± 10° (p = 0.001). Early complications included intraoperative hemodynamic instability (3) and wound complication (1). Mean follow-up was 76.9 ± 59.3 months., Conclusion: Pediatric cervical kyphosis is a debilitating condition which are managed surgically. Approach has to be individualized to the pathology and good results can be achieved. Patients should be screened for syndromic association and followed-up regularly., (© 2024. The Author(s), under exclusive licence to Scoliosis Research Society.)

Supratentorial extra-ventricular ependymoma (SEE) are extremely rare in pediatric population and have varied presentation based on size, location, epicentre and compression on neurovascular structure. The authors report a 7-year-old girl presenting with seizure, who had a lobar SEE on MRI scan, successfully treated by microsurgical resection and adjuvant therapy., (© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Background: Non-chordomatous bony tumors of the clivus are extremely rare. Site, extent, and aggressiveness of tumor limits the extent of resection. It poses challenge to the neurosurgeons due to the complexity of anatomy. There is paucity of literature exclusively on non-chordomatous bone tumors of the clivus in young adults., Objectives: To analyze the clinical presentation, imaging findings, surgical approach, complications, and outcome of primary clival bony tumors in young adults., Methods: We retrospectively reviewed children and young adults with primary clival bony tumors excluding chordoma who underwent surgical resection between years 2010 and 2023 in our center. We analyzed the demographic details, imaging findings, operative variables, perioperative complications, length of stay, complications, and outcome at latest follow-up., Results: The mean age was 17.5 ± 1.73 years (range 16 to 19 years). Headache was the presenting complaint in all four patients (100%). The mean duration of symptom was 7.25 ± 3.2 months (range 5 to 12 months). The tumor was localized in clivus in all four patients (100%). The mean length of stay in hospital was 30.5 ± 13.48 days (range 11 to 40 days). All patients underwent surgical treatment. Surgical approaches used were anterior approach in four patients (100%). Gross total excision was performed in one patient (25%), sub-total excision was performed in two patients (50%), and tumor decompression was performed in one patient (25%). Of these, three were designated as having benign tumors and one had a malignant tumor. There was no perioperative mortality. There was one mortality (25%) on 2 months follow-up due to tumor progression. Three patients (75%) had improved symptomatically at latest follow-up. Two patients (50%) received adjuvant chemoradiotherapy. The mean follow-up was 38 ± 39.29 months (range 2 to 72 months)., Conclusion: Non-chordomatous bony tumors of the clivus are rare and often underestimated. Surgery is the treatment of choice. Tumor consistency and adhesion to critical neurovascular structures precludes gross total resection. Various approaches are in the armamentarium. Approach to be decided based on the expertise of the neurosurgeon to achieve safe maximal resection. Multidisciplinary approach is mandatory for streamlined management. Adjuvant therapy is decided based on the residual tumor following surgery., (© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Breast cancer is the most common cancer among women across the globe. In order to treat breast cancer successfully, it is crucial to conduct a comprehensive assessment of the condition during its initial stages. Although mammogram screening has long been a common method of breast cancer screening, high rates of type I error and type II error results as well as radiation exposure have always been of concern. The outgrowth cancer mortality rate is primarily due to delayed diagnosis, which occurs most frequently in a metastatic III or IV stage, resulting in a poor prognosis after therapy. Traditional detection techniques require identifying carcinogenic properties of cells, such as DNA or RNA alterations, conformational changes and overexpression of certain proteins, and cell shape, which are referred to as biomarkers or analytes. These procedures are complex, long-drawn-out, and expensive. Biosensors have recently acquired appeal as low-cost, simple, and super sensitive detection methods for analysis. The biosensor approach requires the existence of biomarkers in the sample. Thus, the development of novel molecular markers for diverse forms of cancer is a rising complementary affair. These biosensor devices offer two major advantages: (1) a tiny amount of blood collected from the patient is sufficient for analysis, and (2) it could help clinicians swiftly select and decide on the best therapy routine for the individual. This review will include updates on prospective cancer markers and biosensors in cancer diagnosis, as well as the associated detection limitations, with a focus on biosensor development for marker detection., Competing Interests: Declaration of Competing Interest 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., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Introduction: Multiple synchronous spinal extradural arachnoid cysts are extremely rare in children and can lead to cord compression and disability. Multiple spinal extradural arachnoid cysts (SEDACs) in children with immature and growing spine need to be studied separately from multiple SEDACs in adults with mature and fully grown spine because of multiple surgical limitations in children (blood loss, surgery duration, long-term spinal stability after long segment exposure, etc.)., Material and Methods: We planned a non-systematic literature review of similar cases described in literature to analyse the pattern of presentation, management, and outcome of this surgically curable disease., Results: A total of 28 cases of paediatric multiple SEDACs in the age range of 5 months to 17 years and mean age of 11.54 years were analysed. Exposure was achieved by laminectomy in 9, laminoplastic laminotomy in 13, laminectomy in first surgery followed by laminoplasty in second surgery (re-exploration) in 1, hemilaminectomy in 2, and technique "not reported" in 3 children. Complete/near-complete recovery was seen in 27 (96.42%) children. Postoperative spine deformity was reported in 7 (25%) children and was progressive in 2 children during serial follow-up., Conclusions: Symptomatic multiple synchronous SEDACs in children is a rare surgically curable condition. Sincere attempt to find out a dural defect in all cysts is a very important step in multiple SEDAC surgery. Total cyst wall excision with closure of all dural defects is the gold standard treatment for symptomatic cases. Laminoplasty is preferred for excision of multiple SEDACs in children to prevent postoperative spine deformity during long-term follow-up. Long serial follow-up for postoperative spine deformity is necessary., (© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Background: Spinal deformities are common in Marfan syndrome (MFS). They usually involve the thoraco-lumbar spine but rarely involves the cervical spine. Kyphosis is the common spine deformity of the cervical spine and mandates surgical correction as they are at risk of neurological deterioration since they are refractory to conservative management. Few studies of surgical correction of spine deformity included cervical deformity., Objectives: To analyze the challenges faced during surgery, clinical and radiological outcome, and complications following surgical correction for cervical kyphosis in Marfan syndrome., Methods: We identified that 5 patients with a diagnosis of MFS with cervical kyphosis who underwent fusion surgery between the years 2010 and 2022 were reviewed, retrospectively. We analyzed the demographic details, radiological parameters, operative variables (blood loss and nuances), perioperative complications, length of stay, clinical and radiological outcome, and complications following fusion surgery for cervical kyphosis in MFS., Results: The mean age of patients was 16.6 ± 4.72 years (range, 12-23 years). The average kyphotic vertebra involved is 3 ± 0.7 bodies (range 2-4) with 2 patients with thoracic deformity. All patients underwent surgical deformity correction. All patients improved clinically with Nurick grade (pre vs. post: 3.4 vs. 2.2) and mJOA (pre vs. post: 8.2 vs. 12.6). There was significant deformity correction from 37.48° to 9.1°. Mean blood loss encountered was 900 ± 173.2 ml. Perioperative complications: wound complication with CSF leak (1). Late complications: ventilator dependence (1) and junctional kyphosis (1). Mean length of hospital stay was 103 ± 178.9 days. All patients were doing symptomatically better after mean follow-up of 58 ± 28.32 months. One patient is bedridden and hospitalized., Conclusion: Cervical kyphosis is a rare spine deformity in patients with MFS, and they usually present with neurological deterioration mandating surgical correction. Multidisciplinary approach (pediatrics, genetics and cardiology) is required for systematic evaluation of these patients. They should be evaluated with necessary imaging to rule out associated spinal deformity (atlanto-axial subluxation, scoliosis, and intraspinal pathology like ductal ectasia). Our results suggest better surgical outcome in terms of low operative complications with neurologic improvement in MFS patients. These patients require regular follow-up to identify late complications (instrument failure, non-union, and pseudarthrosis)., (© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Background COVID-19, caused by the SARS-CoV-2 virus, has presented an unparalleled challenge and a profound learning curve globally. Among the myriad of investigative tools, CT scans of the chest have become instrumental in assessing the magnitude of lung involvement in the pathogenesis of this disease. Objectives This study aimed to evaluate the distribution and patterns of lung involvement depicted in the CT chest scans of COVID-19 patients admitted to a specialized tertiary care center located in a southern state of India. Methods With clearance secured from the Institutional Ethics Committee, an analytical cross-sectional study was conducted. It encompassed CT chest images from all symptomatic COVID-19 patients within the designated study center during the specified study timeline. Subsequent data analysis ensued. Results Among the 1066 COVID-19 patients evaluated, ground-glass opacities (GGO) were the predominant lung involvement pattern. Distinct patterns, such as GGOs combined with solid consolidation or atelectasis, were noted, with the highest mortality linked to GGOs paired with pneumomediastinum (PM). Data underscored a direct correlation between the extent of lung involvement and patient prognosis, with specific lung regions, namely the right apical, right posterior, right superior basal, left superior lingular, and left inferior lingular segments, showing frequent involvement. Conclusion Amidst the pandemic, our study emphasizes that ground-glass opacities on CT scans are robust indicators of COVID-19 in RT-PCR-positive patients. Early identification can enhance patient management, with findings highlighting a strong link between lung involvement and prognosis. This insight aids in refining patient triage, while further research is warranted to delve deeper into variations in lung involvement and guide treatment advancements., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2024, Balasubramaniam et al.)

Introduction: Intracranial myeloid sarcoma is a rare extramedullary presentation of acute myeloid leukemia (AML). It can involve the meninges and ependyma presenting as extra-axial mass lesion. Rarely, it can also invade the brain parenchyma. It is commonly seen in children. It is usually misdiagnosed due to its close resemblance to other intracranial tumors (meningioma, metastasis, Ewing's sarcomas, and lymphoma). These are underdiagnosed if they precede the diagnosis of leukemia., Case Report: A 7-year-old boy with isolated intracranial myeloid sarcoma who presented with raised intracranial pressure (ICP) which was successfully managed by surgical excision., Conclusion: Isolated intracranial myeloid sarcoma is a rare presentation of AML. Leukemia can be diagnosed early during the postoperative period and can be started on therapy timely. These patients requires regular follow-ups (clinical, laboratory and radiological) to detect relapses early., (© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)