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Background: Phlebectasia is a term used for the dilatation of a vein without tortuosity. Rarely, the condition may affect the internal jugular vein (IJV), causing prominence in the neck, which may be confused with other neck swellings. Clinical Description: A 6-year-old boy presented with bilateral episodic swelling in the neck noticed since 2 years of age and a hoarse voice since 3 years of age. On examination, the neck swelling was soft, cystic, compressible, nontender, and nonpulsatile, increasing in size by all maneuvers increasing intrathoracic pressure. Systemic examination revealed the apex beat was on the right side, and the liver was palpable below the left subcostal margin. Management and Outcome: The workup for tuberculosis was negative, and direct laryngoscopy was normal. X-ray of the chest with abdomen showed dextrocardia and stomach shadow on the right side. Color Doppler revealed nontortuous dilatation of both IJVs. Dynamic computed tomography venography confirmed the diagnosis of bilateral IJV phlebectasia (IJVP). The child was started on speech therapy. The mother was counseled regarding the benign nature of the disease and advised regular follow-up. The child had no complications, and his voice improved with speech therapy at 1-year follow-up. Conclusion: Pediatricians should be aware that IJVP may rarely be the cause of neck swelling associated with hoarseness of voice. Increase in the size of the swelling with Valsalva maneuvers and color Doppler ultrasound helps to confirm the diagnosis.

Abstract To inform clinical trial design and real-world precision pediatric oncology practice, we classified diagnoses, assessed the landscape of mutations, and identified genomic variants matching trials in a large unselected institutional cohort of solid tumors patients sequenced at Dana-Farber / Boston Children’s Cancer and Blood Disorders Center. Tumors were sequenced with OncoPanel, a targeted next-generation DNA sequencing panel. Diagnoses were classified according to the International Classification of Diseases for Oncology (ICD-O-3.2). Over 6.5 years, 888 pediatric cancer patients with 95 distinct diagnoses had successful tumor sequencing. Overall, 33% (n = 289/888) of patients had at least 1 variant matching a precision oncology trial protocol, and 14% (41/289) were treated with molecularly targeted therapy. This study highlights opportunities to use genomic data from hospital-based sequencing performed either for research or clinical care to inform ongoing and future precision oncology clinical trials. Furthermore, the study results emphasize the importance of data sharing to define the genomic landscape and targeted treatment opportunities for the large group of rare pediatric cancers we encounter in clinical practice.

The increasing adoption of renewable energy sources, such as solar power, coupled with the growing popularity of electric vehicles (EVs), has opened up new opportunities for bidirectional power flow between various energy systems. This research paper explores the bidirectional power flow between a solar-integrated grid, electric vehicles, and residential homes. Specifically, it focuses on the benefits, challenges, and potential applications of power exchange between these entities. The paper discusses the technical aspects, economic implications, and environmental considerations of bidirectional power flow, highlighting the potential for enhanced grid stability, energy efficiency, and carbon footprint reduction. Additionally, the study addresses the impact of bidirectional power flow on grid infrastructure, smart grid technologies, and policy frameworks. By shedding light on the interplay between the solar-integrated grid, electric vehicles, and residential homes, this research paper aims to contribute to the advancement of sustainable and intelligent energy systems.

Study area: The study was conducted in the Tankwa Karoo National Park, one of the driest areas in South Africa. Historic overgrazing has resulted in the poor and often degraded state of vegetation in large parts of the Tanqua Karoo region. Aim: This study assessed the spatial variation of vegetation structure and composition in the three main vegetation types namely: Tanqua Karoo (TK), Tanqua Wash Riviere (TWR) and Tanqua Escarpment Shrubland (TES), along an elevational gradient. Method: Using the point intercept survey method, vegetation cover, plant height, species diversity, life forms, proportions of perennials and annuals were examined in 43 sites, widely distributed in these vegetation types. Results: There were 150 vascular plant species belonging to 83 genera and 29 families recorded across all sites. The most diverse vegetation type was TES with 96 species belonging to 61 genera and 26 families. The vegetation structure was comprised mainly of shrubs and dwarf shrubs with a high proportion of leaf and stem succulent species. The mean perennial vegetation cover throughout the study area was 28 and annuals covered 22%, but this cover varied significantly between the vegetation types. The most dominant life forms were chamaephytes, which comprised 64% of all species, with cryptophytes (18%), therophytes (16%) and nanophanerophytes (2%) less abundant. Surveyed sites in the TES showed a clear association with each other but there was an overlap in the species composition and environmental conditions between some TWR and TK sites. This study highlighted the important role of elevation and topography as drivers of vegetation characteristics. Conclusion: The findings from this study can be used as a vegetation baseline to identify and prioritise degraded areas for active restoration in order to limit further degradation. Considering climate change, elevational studies may provide additional insight into species dynamics across landscapes. Taxonomic reference: Plants of Southern Africa Checklist (South African National Biodiversity Institute 2016). Abbreviations: ANOVA = analysis of variance; GPS = Global Positioning System; LFA = Landscape Function Assessment; NDVI = Normalized difference vegetation index; PCA = principal component analysis; PCo-A = principal co-ordinate analysis; TES = Tanqua Escarpment Shrubland; TK = Tanqua Karoo; TKNP = Tankwa Karoo National Park; TWR = Tanqua Wash Riviere.

The presence of variants of uncertain significance (VUS) in DNA mismatch repair (MMR) genes leads to uncertainty in the clinical management of patients being evaluated for Lynch syndrome (LS). Currently, there is no platform to systematically use tumor-derived evidence alongside germline data for the assessment of VUS in relation to LS. We developed INT2GRATE (INTegrated INTerpretation of GeRmline And Tumor gEnomes) to leverage information from the tumor genome to inform the potential role of constitutional VUS in MMR genes. INT2GRATE platform has two components: a comprehensive evidence-based decision tree that integrates well-established clinico-genomic data from both the tumor and constitutional genomes to help inform the potential relevance of germline VUS in LS; and a web-based user interface (UI). With the INT2GRATE decision tree operating in the backend, INT2GRATE UI enables the front-end collection of comprehensive clinical genetics and tumor-derived evidence for each VUS to facilitate INT2GRATE assessment and data sharing in the publicly accessible ClinVar database. The performance of the INT2GRATE decision tree was assessed by qualitative retrospective analysis of genomic data from 5057 cancer patients with MMR alterations which included 52 positive control cases. Of 52 positive control cases with LS and pathogenic MMR alterations, 23 had all the testing parameters for the evaluation by INT2GRATE. All these variants were correctly categorized as INT2GRATE POSITIVE. The stringent INT2GRATE decision tree flagged 29 of positive cases by identifying the absence or unusual presentation of specific evidence, highlighting the conservative INT2GRATE logic in favor of a higher degree of confidence in the results. The remaining 99% of cases were correctly categorized as INCONCLUSIVE due to the absence of LS criteria and ≥1 tumor parameters. INT2GRATE is an effective platform for clinical and genetics professionals to collect and assess clinical genetics and complimentary tumor-derived information for each germline VUS in suspected LS patients. Furthermore, INT2GRATE enables the collation of integrated tumor-derived evidence relevant to germline VUS in LS, and sharing them with a large community, a practice that is needed in precision oncology.

The interest in performing scientific computations using commercially available cloud computing resources has grown rapidly in the last decade. However, scheduling multiple workflows in cloud computing is challenging due to its non-functional constraints and multi-dimensional resource requirements. Scheduling algorithms proposed in literature use search-based approaches which often result in very high computational overhead and long execution time. In this paper, a Deadline-Constrained Cost Minimisation (DCCM) algorithm is proposed for resource scheduling in cloud computing. In the proposed scheme, tasks were grouped based on their scheduling deadline constraints and data dependencies. Compared to other approaches, DCCM focuses on meeting the user-defined deadline by sub-dividing tasks into different levels based on their priorities. Simulation results showed that DCCM achieved higher success rates when compared to the state-of-the-art approaches.

This study was conducted in El-Abyar area in El-Jabal El-Akhdar region, northeast Libya. The aim was to study the environmental settings and the potential and possibility of establishing a protected area in this important region from a historical, biological, social, and economic point of view. The methodology included an intensive literature review, distribution of 300 questionnaires, soil and water analysis, fauna and flora survey, in addition to extensive field observation during the period from 2011 to 2021. The study highlighted the significant representative state of the study area for the whole El-Jabal El-Akhdar region in terms of environmental conditions and inappropriate anthropogenic pressure. Although the area has been severely degraded due to the arid climate coupled with decades of mismanagement, it still has remarkable ecological and environmental features and there is a feasible possibility of being converted into an effective protected area for biodiversity conservation with sustainable use of its natural resources by the local population (Category VI on the International Union for Conservation of Nature Classification for protected areas). The remaining barriers for which drastic solutions need to be implemented are a lack of awareness, a lack of protected areas guidelines and national perspectives, interest conflict with local people, a lack of constant funding, and failure of legislation enforcement.

Reversible cerebral vasoconstriction syndrome (RCVS) is a clinicoradiological syndrome characterized by segmental vasoconstriction of cerebral arteries with resolution in most patients within 1 to 3 months. It has been known to be a benign uniphasic reversible illness but cases of fulminant RCVS with mortality have also been reported. The symptoms can be varied with presentations like transient ischemic attack (TIA), ischemic stroke (IS), intracerebral hemorrhage (ICH), subarachnoid hemorrhage (SAH), and posterior reversible encephalopathy syndrome (PRES). We report a postpartum female with RCVS with radiological features of ICH, SAH, atypical PRES, and atypical clinical presentation as well. RCVS can be frequently missed unless there is a high index of suspicion. Hence clinicians should be aware of the typical and the atypical presentation of RCVS along with the radiological findings with the potential complications. Early suspicion and detection in the emergency help in recovery and reducing morbidity.

Genomic profiles of tumors are often unique and represent characteristic mutational signatures defined by DNA damage or DNA repair response processes. The tumor-derived somatic information has been widely used in therapeutic applications, but it is grossly underutilized in the assessment of germline genetic variants. Here, we present a comprehensive approach for evaluating the pathogenicity of germline variants in cancer using an integrated interpretation of somatic and germline genomic data. We have previously demonstrated the utility of this integrated approach in the reassessment of pathogenic germline variants in selected cancer patients with unexpected or non-syndromic phenotypes. The application of this approach is presented in the assessment of rare variants of uncertain significance (VUS) in Lynch-related colon cancer, hereditary paraganglioma-pheochromocytoma syndrome, and Li-Fraumeni syndrome. Using this integrated method, germline VUS in PMS2, MSH6, SDHC, SHDA, and TP53 were assessed in 16 cancer patients after genetic evaluation. Comprehensive clinical criteria, somatic signature profiles, and tumor immunohistochemistry were used to re-classify VUS by upgrading or downgrading the variants to likely or unlikely actionable categories, respectively. Going forward, collation of such germline variants and creation of cross-institutional knowledgebase datasets that include integrated somatic and germline data will be crucial for the assessment of these variants in a larger cancer cohort.

The harsh environmental conditions coupled with a long history of overgrazing have altered the ecology of the arid Tanqua Karoo rangelands in South Africa, which necessitates rehabilitation. However, a suitable method for monitoring rangeland function over time is required for sustainable management. In this study, vegetation characteristics and landscape function indices were used to rate and compare rangeland conditions in 43 sites distributed among three vegetation types: Tanqua Karoo, Tanqua Wash Riviere, and Tanqua Escarpment Shrubland, which occupy different landscapes in the Tankwa Karoo National Park. The results showed low values of vegetation volume (mean of 10.1 m3 per 100 m−2) and low vegetated patches (mean of 29% patches vs 71% fetches). The overall landscape function indices (soil stability, water infiltration, and nutrient recycling) were low and amounted to 55%, 28%, and 17%, respectively. Amongst the various examined landscapes, the escarpment had the highest values of most of the measured landscape functionality parameters, and the open plains had the lowest values. This revealed high heterogeneity of soil properties and vegetation characteristics amongst the different vegetation types, mainly influenced by altitudinal gradients. The higher-lying landscapes on the escarpment are relatively more functional and more susceptible to improvement when compared to the lower-lying landscapes on the plains. The landscape functionality approach (LFA) approach demonstrated that some of the examined vegetation types had insignificant improvement in landscape functionality likely not to improve in the near term due to existing low patchiness, higher fetch space and low LFA indices coupled with the low annual rainfall of the region. The landscape functionality approach has provided a suitable benchmark for assessing and monitoring the diverse vegetation types in this arid part of the world.

Designed as potential cytotoxic agents a series of 6-substituted 2,3-dihydro-1H-pyrrolo[3,2,1-ij]quinoline derivatives were synthesized by using a Bischler type reaction. The methodology involved the cyclodehydration of 2-(3,4-dihydroquinolin-1(2H)-yl)-1-alkyl/aryl ethanones in the presence of p-TSA under ultrasound irradiation. A number of compounds were prepared using this methodology and tested for their in vitro anti-proliferative properties against cancer (leukemia) and non-cancerous cell lines. Some of the compounds showed promising and selective cytotoxic effects toward leukemia cells. Keywords: Pyrrolo[3,2,1-ij]quinoline, Cyclodehydration, Ultrasound, Cytotoxicity

Cortical laminar necrosis (CLN) is a radiological and neuropathological finding which requires thorough evaluation for hypoxic, metabolic, infective, and toxic causes. Hypoxic, metabolic, and toxic etiologies for CLN have been frequently reported in past, but infective causes have never been systematically enumerated and limited literature is available for the same. We describe a case of tubercular meningitis (TBM) presenting clinically with focal visual seizures and radiologically as CLN. It was also challenging to rule out other etiologies for CLN before attributing it to TBM. To emphasize, CLN as a radiological finding needs an approach and detailed evaluation for etiological diagnosis.

Happiness is one of the main topics that dominates the discourse of ethical philosophy. The concept of happiness began to be discussed from the emergence of philosophy in classical Greece to the present day in both Western and Islamic perspectives. This study aims to analyze the views of scholars in debating the topic of happiness. This study is a descriptive study using a qualitative systematic literature review method. The main source of data collection for this study is by highlighting previous works obtained from Scopus and Web of Science (WoS) online databases and it is also supported by data obtained from Google Scholar. The analysis was done based on Preferred Reporting Items for Systematic Reviews and Meta-Analyzes (PRISMA). The results of the SLR analysis identified fifteen (15) articles featuring discussions on the topic of happiness among scholars, among them Plato, Aristotle, Thomas Aquinas, Maimonides, and Jeremy Bentham representing the West and Ibn Sina, al-Ghazali, al-Farabi, Ibn Miskawayh, HAMKA, al-Attas, and Said Nursi representing Islamic scholars. The findings also highlighted three main elements discussing the topic of happiness, namely the spiritual, intellectual, and material elements. These three elements are not discussed in a balanced way in Western civilization causing confusion in uniting various views, but in Islam, although scholars’ opinions differ, they are however united in the principle of revelation that balances the three elements to explain the topic of true happiness. This study is important from the point of view of understanding the topic of happiness traced from the history of thought of scholars.

Abstract Objective This study aims to eliminate Mycoplasma spp. contamination from laboratory stocks of Chlamydia spp. by in vivo passage or by plaque assay. Results We have described two methods of eliminating Mycoplasma contamination from Chlamydia laboratory stocks. We conclude that Mycoplasma species commonly contaminating chlamydial stocks do not survive passage in mice. Chlamydia may also be derived Mycoplasma-free by plaque assay.

We report a 40-year-old diabetic female with acute headache and case of skull base defect causing pneumocephalus. The highlights of the present case are acute clinical presentation, extensive radiological findings, and rare skull base defect in frontoethmoidal recess.

Contrast-induced acute kidney injury (CI-AKI) is an important consideration in patients undergoing cardiac catheterization. There has been a continuous strive to decrease morbidity and improve procedural safety. This review will address the pathophysiology, predictors, and clinical management of CI-AKI with a concise overview of the pathophysiology and a suggested association with left atrial appendage closure. Minimizing contrast administration and intravenous fluid hydration are the cornerstones of an effective preventive strategy. A few adjunctive pharmacotherapies hold promise, but there are no consensus recommendations on prophylactic therapies.

This study investigated bioactive extracts of Polyalthia debilis (Annonaceae) with antimicrobial, antimalarial and cytotoxic activities. Extensive chromatographic isolations provided azafluorenone alkaloids; onychine (1) and 7-methoxyonychine (2) together with a mixture of β–sitosterol and stigmasterol. The two alkaloids were isolated from the P. debilis for the first time. Isolated fractions containing a mixture of triterpenoids (C7, C8 and C9) exhibited the most potent antimicrobial activity against many bacterial strains with minimum inhibitory concentration of 64 μg/mL. Fractions with antimalarial and cytotoxic activities were also observed. The findings suggest the potential use of P. debilis in medicinal applications.