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Introduction Sacrococcygeal teratomas (SCTs) are rare tumors occurring in approximately 1 in 35,000 to 40,000 live births. The Altman classification is used to describe SCTs. There are four types, with type 1 predominantly external through to type IV which is a presacral, completely internal mass. As far as the authors are aware, this is the first study to focus on type IV SCT lesions. Materials and Methods Using ICD-10- AM (The International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, Australian Modification) codes, we identified all patients in the Republic of Ireland with a diagnosis of SCT from 2004 to 2020. The following information was obtained for each patient: gender, time of diagnosis, clinical presentation, method of diagnosis, Altman classification, biomarkers, age at operation, surgical technique, pathology, recurrence, and age at most recent follow-up. Results There were 29 patients in total; 23 females (79%) and 6 males (21%). In total, 16 (55%) were diagnosed antenatally, 4 (14%) at less than 1 month, 4 (14%) less than 1 year, 3 (10%) age 2 to 4 years, and 2 (7%) were aged 5 to 12 years. In addition, 22 (76%) were mature teratomas, 2 (7%) immature teratomas, and 5 (17%) were malignant tumors. There were 6 (21%) type I lesions, 9 (30%) type II, 6 (21%) type III, and 8 (28%) type IV lesions. Conclusion In Altman's original 1974 study, type IV lesions were present in 10% of cases. As a result, this is the most frequently quoted figure. Type IV lesions were present in 28% of cases in our study. We propose that type IV lesions may be more common than the current literature suggests and consequently a higher index of suspicion of their presence should be entertained. [ABSTRACT FROM AUTHOR]

Aortopathy encompasses a spectrum of conditions predisposing to dilation, aneurysm, dissection, or rupture of the aorta and other blood vessels. Aortopathy is diagnosed commonly in children, from infancy through adolescence, primarily affecting the thoracic aorta, with variable involvement of the peripheral vasculature. Pathogeneses include connective tissue disorders, smooth muscle contraction disorders, and congenital heart disease, including bicuspid aortic valve, among others. The American Heart Association has published guidelines for diagnosis and management of thoracic aortic disease. However, these guidelines are predominantly focused on adults and cannot be applied adeptly to growing children with emerging features, growth and developmental changes, including puberty, and different risk profiles compared with adults. Management to reduce risk of progressive aortic dilation and dissection or rupture in children is complex and involves genetic testing, cardiovascular imaging, medical therapy, lifestyle modifications, and surgical guidance that differ in many ways from adult management. Pediatric practice varies widely, likely because aortopathy is pathogenically heterogeneous, including genetic and nongenetic conditions, and there is limited published evidence to guide care in children. To optimize care and reduce variation in management, experts in pediatric aortopathy convened to generate this scientific statement regarding the cardiovascular care of children with aortopathy. Available evidence and expert consensus were combined to create this scientific statement. The most common causes of pediatric aortopathy are reviewed. This document provides a general framework for cardiovascular management of aortopathy in children, while allowing for modification based on the personal and familial characteristics of each child and family. [ABSTRACT FROM AUTHOR]

The article discusses a case of chronic and progressive vomiting in a 1.8-year-old intact male Pug, which was diagnosed with a diaphragmatic hernia. The dog experienced frequent vomiting, leading to significant weight loss and required surgeries to address brachycephalic obstructive airway syndrome. The radiographic findings suggested a hiatal hernia involving the spleen, highlighting the importance of considering abdominal organs other than the stomach in such cases. Advanced imaging modalities like barium esophagram and CT scans can provide more accurate diagnoses and treatment options for hiatal hernias in dogs. [Extracted from the article]

Tebentafusp is a bispecific protein that recently underwent FDA approval for the treatment of metastatic uveal melanoma that functions by redirecting cytotoxic T cells to glycoprotein-100, a protein highly expressed in melanoma. Although clinical trials have demonstrated that rashes are common in the first few days of treatment, little is known about skin reactions that develop later in the treatment course. Herein, we describe a type IV hypersensitivity reaction and vitiligo-like depigmentation that developed six weeks into treatment and discuss the possible mechanisms underlying these reactions. The type IV hypersensitivity reaction resolved without intervention within seven weeks of onset, suggesting that tebentafusp can be safely continued in select patients who develop this cutaneous reaction.

Hydrogen storage cylinder is an important component in high-pressure gaseous hydrogen (HPGH 2) storage system, and plays a key role in hydrogen-powered transportation including land vehicles, ships and aircrafts. Over the past decade, the number of hydrogen fuel cell vehicles (HFCVs) has rapidly increased worldwide. In order to promote the application of hydrogen storage cylinder, guide its design, manufacture, inspection and testing, a series of regulations, codes and standards have been issued. The Chinese national standard, GB/T 42612, for type IV hydrogen storage cylinders has also been issued. This paper first gives a brief overview to these regulations, codes and standards. Furthermore, the specifications including scope, category, filling cycles, service life, materials, design, manufacture, qualification tests and periodic inspections are analyzed and compared. Issues about evaluation method for hydrogen compatibility of non-metallic materials, welded joints of plastic liner, joint between boss and liner are also discussed. Notably, the performance requirements in GB/T 42612 are generally in accordance with the international ones, but the requirements of materials, design and manufacture are more detailed. • The regulations, codes and standards for on-board high-pressure hydrogen storage cylinders are compared. • An in-depth analysis of scope, category, filling cycles, service life, materials, design, manufacture, etc. is provided. • The requirements for materials, design and manufacture in GB/T 42612 are more detailed than the others. • NDT methods for welded joints of plastic liner and joints between plastic liner and metal boss need to be developed. • Effective periodic inspection methods other than visual inspection need to be further researched. [ABSTRACT FROM AUTHOR]

Type IV CRISPR systems encode CRISPR associated (Cas)-like proteins that combine with small RNAs to form multi-subunit ribonucleoprotein complexes. However, the lack of Cas nucleases, integrases, and other genetic features commonly observed in most CRISPR systems has made it difficult to predict type IV mechanisms of action and biological function. Here we summarize recent bioinformatic and experimental advancements that collectively provide the first glimpses into the function of specific type IV subtypes. We also provide a bioinformatic and structural analysis of type IV-specific proteins within the context of multi-subunit (class 1) CRISPR systems, informing future studies aimed at elucidating the function of these cryptic systems.

Decimetric continua are commonly observed during long-lasting solar flares. Their frequency boundaries vary with time. We studied frequency boundary variations using the power spectrum analysis. Analyzing five decimetric continua, we found that their power spectra have a power-law form with the power-law index close to the Kolmogorov turbulence index −5/3. The same power index was also found in the power spectra of radio flux variations at frequencies in the range of the frequency boundary variations. Moreover, these frequency boundary variations were highly correlated with the radio flux ones. We interpret these results to be due to turbulent density variations in the reconnection plasma outflow to the termination shock formed above flare loops. In three cases of decimetric continua, we estimated the level of the plasma density turbulence to be 7.6 – 11.2% of the mean plasma density. We think that the analysis of variations of decimetric continua can be used in studies of the plasma turbulence in solar flares. [ABSTRACT FROM AUTHOR]

Type IV paraesophageal hiatal hernias are diaphragmatic hernias that are extremely rare in the pediatric age group in which the stomach and other intra-abdominal organs herniate from the esophageal hiatus of the diaphragm into the mediastinum. Since the defect in the hiatus is large, serious complications such as gastric volvulus may develop in these giant hernias as a result of the passage of a large part of the stomach into the thoracic cavity. Patients may present with atypical clinical manifestations such as growth retardation, not gaining weight, and recurrent pulmonary infections. In this report, two cases in the pediatric age group who were admitted with different clinical course and were diagnosed as type IV paraesophageal hiatal hernia who were successfully treated with surgical intervention are presented.

The ratio of crack initiation and crack propagation life is important from the viewpoint of residual life prediction of mod. 9Cr-1Mo steel welds under Type IV creep damage. Both the creep void density distribution and the failure process with crack initiation/propagation/final failure are predicted for three types of welds in pipes and nozzles, which are compared with experimental results at 650°C. The ratio of crack initiation and final failure life depends on weld type and loading conditions; the ratio is about 0.95 in the cases where redistribution of stress occurs only in the thickness; the ratio is 0.59 ~ 0.65 in the cases where redistribution of stress occurs in both the thickness and circumferential directions of the pipe. Influence of stress ratio (axial vs. circumferential stress) is also predicted for circumferential welds subject to internal pressure/axial load and is compared with experimental results at 650°C. [ABSTRACT FROM AUTHOR]

We study the association of solar Type IV radio bursts with the location of active regions on the Sun during Solar Cycle 24. The active regions associated with moving and stationary Type IV bursts are categorized as close to disk center and far from disk center, based on their location on the solar surface (i.e. ≤ 45 ∘ or ≥ 45 ∘ , respectively). The location of active regions associated with Type IV bursts accompanied with coronal mass ejections (CMEs) are also studied. We found that ≈ 30 – 40% of the active regions are located far from disk center for all the bursts. However, it is found that most of the active regions associated with stationary Type IV bursts are close to disk center (≈ 60 – 70%). The active regions associated with moving Type IV bursts are more evenly distributed across the surface, i.e. ≈ 56 % and ≈ 44 % , close to disk center and far from disk center, respectively. The fact that most of the bursts have active regions close to disk center indicates that these bursts can be used to obtain physical properties such as electron density and magnetic fields of the CMEs responsible for geomagnetic storms. [ABSTRACT FROM AUTHOR]

Background: Paraesophageal hernias (PEHs; types II-III-IV) account for about 5% of all hiatal hernias (HHs). The peculiarity of PEHs is the presence of a herniated sac which contains a more or less important part of the stomach, along with other abdominal organs in type IV PEHs. Surgical treatment is more complex since it requires a reduction not only of the herniated content but also of the "container," namely the sac adherent to mediastinal structures. Since type III and IV PEHs are mostly grouped together as large PEHs, there is a lack of articles in the literature with regards to clear surgical outcomes, as well as management algorithms in type IV PEHs. This study aims to compare outcomes in type IV vs. type III PEHs after surgical repair. Methods: A retrospective study of patients who underwent laparoscopic PEH hernia repair (LPEHR) was conducted in a single institution between 2006 and 2020. Patient baseline characteristics and surgical outcomes were analyzed. Results: A total of 103 patients were included in the analysis. Patients presenting with type IV PEHs (12/103) were significantly older than patients with type III PEHs (91/104) (75.25 ± 7.15 vs. 66.91 ± 13.58 respectively (p = 0.039), and more fragile with a higher Charlson Comorbidity Index (CCI) (4.25 ± 1.48 vs. 2.96 ± 1.72, p = 0.016). Operative time was significantly longer (243 ± 101.73 vs. 133.38 ± 61.76, p = 0.002), and postoperative morbidity was significantly higher in type IV PEH repair (50% vs. 8.8% type III, p = 0.000). Conclusion: Patients with type IV PEHs appear to be older and frailer. The higher incidence of postoperative complications in patients with type IV PEHs should advocate for a precise indication for surgical treatment, which should be performed in centers of expertise. [ABSTRACT FROM AUTHOR]

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A major challenge faced by Vibrio cholerae is constant predation by bacteriophage (phage) in aquatic reservoirs and during infection of human hosts. To overcome phage predation, V. cholerae has acquired and/or evolved a myriad of phage defense systems. Although several novel defense systems have been discovered, we hypothesized that more were encoded in V. cholerae given the low diversity of phages that have been isolated, which infect this species. Using a V. cholerae genomic library, we identified a Type IV restriction system consisting of two genes within a 16-kB region of the Vibrio pathogenicity island-2, which we name TgvA and TgvB ( T ype I-embedded g mrSD PI-2). We show that both TgvA and TgvB are required for defense against T2, T4, and T6 by targeting glucosylated 5-hydroxymethylcytosine (5hmC). T2 or T4 phages that lose the glucose modifications are resistant to TgvAB defense but exhibit a significant evolutionary tradeoff, becoming susceptible to other Type IV restriction systems that target unglucosylated 5hmC. We also show that the Type I restriction-modification system that embeds the V genes protects against phage T3, secΦ18, secΦ27, and λ, suggesting that this region is a phage defense island. Our study uncovers a novel Type IV restriction system in tgvAB genes protects against phage T3, secΦ18, secΦ27, and λ, suggesting that this region is a phage defense island. Our study uncovers a novel Type IV restriction system in V. cholerae while highlighting the evolutionary interplay between restriction systems and phage genome modification.IMPORTANCEBacteria are constantly being predated by bacteriophage (phage). To counteract this predation, bacteria have evolved a myriad of defense systems. Some of these systems specifically digest infecting phage by recognizing unique base modifications present on the phage DNA. In this study, we discover a Type IV restriction system encoded in V. cholerae, which we name TgvAB, and demonstrate it recognizes and restricts phage that have 5-hydroxymethylcytosine glucosylated DNA. Moreover, the evolution of resistance to TgvAB render phage susceptible to other Type IV restriction systems, demonstrating a significant evolutionary tradeoff. These results enhance our understanding of the evolution of V. cholerae, which we name TgvAB, and demonstrate it recognizes and restricts phage that have 5-hydroxymethylcytosine glucosylated DNA. Moreover, the evolution of resistance to TgvAB render phage susceptible to other Type IV restriction systems, demonstrating a significant evolutionary tradeoff. These results enhance our understanding of the evolution of V. cholerae and more broadly how bacteria evade phage predation., Competing Interests: The authors declare no conflict of interest.

Microorganisms have developed many strategies in the process of long-term defense against external attacks, one of which is the clustered regularly interspaced short palindromic repeats (CRISPR)/CRISPR-associated proteins (Cas) bacterial immunological system. In this study, the whole genome of 300 strains of Klebsiella was collected, the CRISPR-Cas system in the strains was statistically analyzed, and the types and structures of CRISPR system in Klebsiella were explored, as well as the correlation between CRISPR and mobile genetic elements (MGEs). Through principal component analysis (PCA), we found that Cas gene, plasmids, integron, IS1, IS609, and enzymes of DNA metabolism were closely related to CRISPR-Cas. Compared the structural characteristics of plasmids, the DinG family helicases, Cas6, Csf2, and IS5 were observed near the CRISPR loci in plasmid, which is also confirmed by the results of PCA that they may be important factors affecting the plasmid with CRISPR.

Microorganisms have developed many strategies in the process of long-term defense against external attacks, one of which is the clustered regularly interspaced short palindromic repeats (CRISPR)/CRISPR-associated proteins (Cas) bacterial immunological system. In this study, the whole genome of 300 strains of Klebsiella was collected, the CRISPR-Cas system in the strains was statistically analyzed, and the types and structures of CRISPR system in Klebsiella were explored, as well as the correlation between CRISPR and mobile genetic elements (MGEs). Through principal component analysis (PCA), we found that Cas gene, plasmids, integron, IS 1 , IS 609 , and enzymes of DNA metabolism were closely related to CRISPR-Cas. Compared the structural characteristics of plasmids, the DinG family helicases, Cas6, Csf2, and IS 5 were observed near the CRISPR loci in plasmid, which is also confirmed by the results of PCA that they may be important factors affecting the plasmid with CRISPR. [ABSTRACT FROM AUTHOR]

Type IV CRISPR systems encode CRISPR associated (Cas)-like proteins that combine with small RNAs to form multi-subunit ribonucleoprotein complexes. However, the lack of Cas nucleases, integrases, and other genetic features commonly observed in most CRISPR systems has made it difficult to predict type IV mechanisms of action and biological function. Here we summarize recent bioinformatic and experimental advancements that collectively provide the first glimpses into the function of specific type IV subtypes. We also provide a bioinformatic and structural analysis of type IV-specific proteins within the context of multi-subunit (class 1) CRISPR systems, informing future studies aimed at elucidating the function of these cryptic systems.

Type IV CRISPR systems encode CRISPR associated (Cas)-like proteins that combine with small RNAs to form multi-subunit ribonucleoprotein complexes. However, the lack of Cas nucleases, integrases, and other genetic features commonly observed in most CRISPR systems has made it difficult to predict type IV mechanisms of action and biological function. Here we summarize recent bioinformatic and experimental advancements that collectively provide the first glimpses into the function of specific type IV subtypes. We also provide a bioinformatic and structural analysis of type IV-specific proteins within the context of multi-subunit (class 1) CRISPR systems, informing future studies aimed at elucidating the function of these cryptic systems. [ABSTRACT FROM AUTHOR]

Objectives: Loeys–Dietz syndrome (LDS) and vascular Ehlers–Danlos Syndrome (vEDS) are genetically heterogeneous heritable disorders of connective tissue. Both are multi-system disorders with dominant vascular pathology and associated gastrointestinal manifestations. Aim: To summarize the abdominal manifestations found in these two disorders in a cohort of patients seen at Mayo Clinic during a period of 25 years. Methods: Data were collected via the advanced cohort explorer (ACE) of Mayo Clinic records from 1994 to 2018 in patients with vEDS or LDS confirmed by genetic testing and/or medical genetics consultation. We extracted information concerning gastrointestinal symptoms, abdominal hernias, and vascular manifestations or complications. Results: We identified and reviewed records of 68 vEDS and 13 LDS patients. Patients were similar in age at diagnosis and gender distribution. Gastrointestinal symptoms were frequently reported in both disorders and largely similar, although altered bowel function was more prevalent in LDS patients. Hernias were present in similar proportions of patients with vEDS and LDS; however, ventral hernias were more frequent and more likely to be postoperative in vEDS than LDS. LDS patients had more arterial aneurysms overall (76.9% LDS vs. 58% vEDS, p = 0.02) and a higher proportion required arterial repair (69.2% LDS vs. 32.7% vEDS S, p = 0.03). Co-morbidities of autonomic dysfunction, psychopathology (most commonly anxiety, depression, adjustment disorder), and allergy were more prevalent in LDS than vEDS. Conclusion: Patients with vEDS and LDS had a propensity for gastrointestinal symptoms, abdominal hernias, and aneurysm formation, but repair for arterial rupture was more prevalent in LDS than EDS. [ABSTRACT FROM AUTHOR]

Clustered Regularly Interspaced Short Palindromic Repeats (CRISPR) are diverse immune systems found in many prokaryotic genomes that target invading foreign DNA such as bacteriophages and plasmids. There are multiple types of CRISPR with arguably the most enigmatic being Type IV. During an investigation of CRISPR carriage in clinical, multi-drug resistant, Klebsiella pneumoniae, a Type IV-A3 CRISPR-Cas system was detected on plasmids from two K. pneumoniae isolates from Egypt (isolated in 2002–2003) and a single K. pneumoniae isolate from the United Kingdom (isolated in 2017). Sequence analysis of all other genomes available in GenBank revealed that this CRISPR-Cas system was present on 28 other plasmids from various Enterobacteriaceae hosts and was never found on a bacterial chromosome. This system is exclusively located on IncHI1B/IncFIB plasmids and is associated with multiple putative transposable elements. Expression of the cas loci was confirmed in the available clinical isolates by RT-PCR. In all cases, the CRISPR-Cas system has a single CRISPR array (CRISPR1) upstream of the cas loci which has several, conserved, spacers which, amongst things, match regions within conjugal transfer genes of IncFIIK/IncFIB(K) plasmids. Our results reveal a Type IV-A3 CRISPR-Cas system exclusively located on IncHI1B/IncFIB plasmids in Enterobacteriaceae that is likely to be able to target IncFIIK/IncFIB(K) plasmids presumably facilitating intracellular, inter-plasmid competition.

Background: Mouse models of mild spinal muscular atrophy (SMA) have been extremely challenging to generate. This paucity of model systems has limited our understanding of pathophysiological events in milder forms of the disease and of the effect of SMN depletion during aging. Methods: A mild mouse model of SMA, termed Smn2B/−;SMN2+/−, was generated by crossing Smn−/−;SMN2 and Smn2B/2B mice. This new model was characterized using behavioral testing, histology, western blot, muscle-nerve electrophysiology as well as ultrasonography to study classical SMA features and extra-neuronal involvement. Findings: Smn2B/−;SMN2+/− mice have normal survival, mild but sustained motor weakness, denervation and neuronal/neuromuscular junction (NMJ) transmission defects, and neurogenic muscle atrophy that are more prominent in male mice. Increased centrally located nuclei, intrinsic contractile and relaxation muscle defects were also identified in both female and male mice, with some male predominance. There was an absence of extra-neuronal pathology. Interpretation: The Smn2B/−;SMN2+/− mouse provides a model of mild SMA, displaying some hallmark features including reduced weight, sustained motor weakness, electrophysiological transmission deficit, NMJ defects, and muscle atrophy. Early and prominent increase central nucleation and intrinsic electrophysiological deficits demonstrate the potential role played by muscle in SMA disease. The use of this model will allow for the understanding of the most susceptible pathogenic molecular changes in motor neurons and muscles, investigation of the effects of SMN depletion in aging, sex differences and most importantly will provide guidance for the currently aging SMA patients treated with the recently approved genetic therapies. Funding: : This work was supported by Cure SMA/Families of SMA Canada (grant numbers KOT-1819 and KOT-2021); Muscular Dystrophy Association (USA) (grant number 575466); and Canadian Institutes of Health Research (CIHR) (grant number PJT-156379).

A major challenge faced by Vibrio cholerae is constant predation by bacteriophage (phage) in aquatic reservoirs and during infection of human hosts. To overcome phage predation, V. cholerae has evolved a myriad of phage defense systems. Although several novel defense systems have been discovered, we hypothesized more were encoded in V. cholerae given the relative paucity of phage that have been isolated which infect this species. Using a V. cholerae genomic library, we identified a Type IV restriction system consisting of two genes within a 16kB region of the Vibrio pathogenicity island-2 that we name TgvA and TgvB ( T ype I-embedded g mrSD-like system of V PI-2). We show that both TgvA and TgvB are required for defense against T2, T4, and T6 by targeting glucosylated 5-hydroxymethylcytosine (5hmC). T2 or T4 phages that lose the glucose modification are resistant to TgvAB defense but exhibit a significant evolutionary tradeoff becoming susceptible to other Type IV restriction systems that target unglucosylated 5hmC. We show that additional phage defense genes are encoded in VPI-2 that protect against other phage like T3, secΦ18, secΦ27 and λ. Our study uncovers a novel Type IV restriction system in V. cholerae , increasing our understanding of the evolution and ecology of V. cholerae while highlighting the evolutionary interplay between restriction systems and phage genome modification., Competing Interests: Declarations of interest: none

Hiatal hernias, protrusions of abdominal viscera through the esophageal hiatus, are classified into four types. Types I and II involve ascent of the stomach without affecting the gastroesophageal junction. Types III and IV involve the gastroesophageal junction. Type IV specifically may have stomach as well as other abdominal organ involvement, such as pancreas or omentum. Among these types, type IV is the most complex and rare form, accounting for only 0.1% of all cases of hiatal hernias. This report presents a case of a type IV hiatal hernia involving the lesser omentum and a significant portion of the stomach in an 86-year-old male cadaver with a history of mediastinal surgery. To our knowledge, this presentation in a cadaver has not previously been reported in the literature.  This case highlights classification inconsistencies in the literature, particularly regarding type IV hiatal hernias. It is unclear given the current classification system, whether this presentation would be considered a type III or type IV hiatal hernia as it fits both criteria and there are several interpretations of the criteria of a type IV hiatal hernia. Inconsistencies in the classification system may impede standardization of care. This report highlights the need for a more precise classification system that better accounts for anatomical changes and clinical presentation., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2024, Alvarez et al.)

Hereditary sensory and autonomic neuropathies (HSAN) are rare genetic syndromes of unknown etiology. They are seen in early childhood and are categorized into six different types by their symptoms. HSAN type 4 demonstrates autosomal recessive transmission pattern, with such major characteristics as loss of sense of pain, self-mutilation, anhydrosis and mental retardation. Sympathetic innervations are deficient despite the existence of sweat glands. Sufferers are hypotonic without any tendon reflexes, and neuro-motor development is retarded. In some cases tactile sensation and vibration may be intact. Biting injuries due to lack of pain sensation cause laceration, ulceration and scarring of the tongue, lips and other parts of oral mucosa. Tooth luxation and severe dental attrition have been observed. This case report presents oral and dental findings, surgical treatments and prosthetic rehabilitation of an 11- year-old boy with HSAN type 4.

Ehlers-Danlos Syndrome comprises a heterogeneous group of heritable connective tissue disorders resulting from various gene mutations. We present an unusual case of vascular Ehlers-Danlos Syndrome with distinctive physical characteristics and a cardiomyopathy with features suggesting isolated left ventricular non-compaction. The cardiac features represent the first report of a cardiomyopathy associated with a mutation in the COL3A1 gene. This case also illustrates the multi-system nature of Ehlers-Danlos Syndrome and the complexity of managing patients with the vascular subtype. [ABSTRACT FROM AUTHOR]

From the standpoint of evaluating Type IV creep damage in the fine-grained heat affected zones (FGHAZ) of welded joints, an analysis method combining continuum damage mechanics (CDM) and a cavity nucleation model is proposed and applied to the creep testing of simulated-FGHAZ notched bars of mod. 9Cr-1Mo steel at 650°C. The Perrin-Hayhurst CDM model is adopted, which considers both softening by precipitate coarsening and damage by creep cavities. For the cavity nucleation model, a proposal by Gonzalez and Cocks is employed, which considers the randomness of grain-boundary-facet orientations in a polycrystalline material and gives a nucleation rate that is a function of the creep strain rate and a tri-axiality factor. The critical value of the damage parameter, corresponding to the initiation of micro cracks due to the coalescence of creep cavities, is expressed in terms of a critical value of the number density of creep cavities as determined from grain-boundary-resistance model simulations by the present authors. Creep rupture experiments have been conducted for circumferentially notched bar specimens with two kinds of notch acuities. The applicability of the combined CDM and cavity nucleation model is demonstrated by comparing the distribution of creep cavities observed experimentally with the simulation results. The final rupture life of the circumferentially notched bar specimens was also predicted to within a factor of two.

Antibiotics are commonly prescribed to treat a variety of bacterial infections. As with all medications, hypersensitivity reactions may occur and clinicians should be able to recognize them accurately and recommend appropriate management. Antibiotic related hypersensitivity reactions may be one of four different types: Type I reactions, which are IgE mediated and may lead to anaphylaxis; Type II reactions that are antibody-mediated and may result in thrombocytopenia, neutropenia, or hemolytic anemia; Type III reaction that involves an immune complex formation such as vasculitis; and Type IV reactions that consist of four subtypes and typically include a rash of varying level of severity with or without systemic signs and symptoms. Herein, we describe the mechanisms of different types of allergic reactions to commonly prescribed antibiotics and offer recommendations for management. Further, we briefly refer to antibiotic reactions that mimic hypersensitivity reactions but are not immune mediated, such as pseudoallergies and serum sickness-like reactions.

Summary Introduction With proven oncological safety and improved aesthetic outcomes, the Type IV or “Wise pattern” skin-sparing mastectomy (SSM) is a procedure that is being performed with increasing frequency. Unfortunately, it is also associated with an increased risk of complications. The purpose of this investigation was to determine the complications associated with direct-to-implant and two-step tissue-expander breast reconstruction following Wise pattern SSM. Methods Systematic electronic searches were performed using PubMed, MEDLINE, and Embase databases. Search terms used were those for studies reporting complications following breast reconstruction using direct-to-implant and two-step tissue-expander approaches following Wise pattern SSM. Included studies were graded for their risk of bias. Pooled descriptive statistics on overall complication rates, skin flap necrosis, delayed wound healing, hematoma, and infections were performed for both procedures. Other complications specific to each procedure were also reported. Results A total of 16 articles met the inclusion criteria for this investigation, representing 561 direct-to-implant or two-step breast reconstruction procedures. For direct-to-implant reconstructions, the pooled complication rate was 30%, while for those using tissue expansion, it was 20.3%. Rates of skin flap necrosis (9.70%, 4.69%), delayed wound healing (2.77%, 0.78%), infection (2.54%, 3.91%), seroma (1.15%, 4.68%), and hematoma (0.92%, 0.78%) were calculated for direct-to-implant procedures and two-step tissue expansion, respectively. Conclusion Following Wise pattern SSM, direct-to-implant reconstruction appears to be associated with an increased rate of overall complications and skin flap necrosis. Modification of the procedure through the placement of a de-epithelialized dermal flap may help limit delays in wound healing and infection. Future investigations that report complication rates for SSM should present data that are segregated according to the type of procedure and the method of reconstruction. [ABSTRACT FROM AUTHOR]

Utilising the random-fracture-resistance model of grain boundaries, micro-macro combined creep damage simulation was applied to the prediction of the distribution of small defects in the FGHAZ (fine-grained heat-affected zone) of longitudinal welds in an actual-size elbow of modified 9Cr-1Mo (9Cr-1MoVNb) steel subject to internal pressure at 923 K. Based on the simulation results, a prediction scheme for the final rupture life of welds was considered using the damage mechanics concept together with effective stress. The applicability of nonlinear fracture mechanics was also discussed, assuming the initial crack length determined from the microscopic simulation results. The results thus obtained are summarized as follows: As the simulation results showed, the peaks of small defect density in the subsurface could be predicted, corresponding well with the observed results. Final failure life prediction based on the damage mechanics concept was found to be applicable, by considering both the final failure surface connecting the weakest grain boundaries and the effective stress against this surface. The fracture mechanics approach was also found applicable when assuming the initial crack length from the high peaks of the simulated small defects in the last stage of creep life. [ABSTRACT FROM AUTHOR]

Welds of high-temperature pressurised components act as preferential sites for creep damage accumulation and will frequently be the life limiting feature. Type IV failures, where cracking occurs between the heat affected zone (HAZ) and parent material, are of particular concern in power station components. Typically damage will be characterised by locally high strain rates in the HAZ and local grain boundary separation leading to crack initiation and growth. A potential drop creep monitoring technique is suggested and demonstrated on cross-weld creep test specimens to be sensitive to both strain and cracking. The technique can be implemented as an array, discretizing a larger area into local measurements, providing contextual information and enabling the identification of local increases in damage. The influence of strain and cracking can be effectively separated to indicate crack initiation. The proposed sensor has very simple and robust high-temperature hardware lending itself to in-situ measurements in the field. [ABSTRACT FROM AUTHOR]

Utilising the random-fracture-resistance model of grain boundaries, micro-macro combined creep damage simulation was applied to the prediction of the distribution of small defects in the FGHAZ (fine-grained heat-affected zone) of longitudinal welds in an actual-size elbow of modified 9Cr-1Mo (9Cr-1MoVNb) steel subject to internal pressure at 923 K. Based on the simulation results, a prediction scheme for the final rupture life of welds was considered using the damage mechanics concept together with effective stress. The applicability of nonlinear fracture mechanics was also discussed, assuming the initial crack length determined from the microscopic simulation results. The results thus obtained are summarized as follows: As the simulation results showed, the peaks of small defect density in the subsurface could be predicted, corresponding well with the observed results. Final failure life prediction based on the damage mechanics concept was found to be applicable, by considering both the final failure surface connecting the weakest grain boundaries and the effective stress against this surface. The fracture mechanics approach was also found applicable when assuming the initial crack length from the high peaks of the simulated small defects in the last stage of creep life. [ABSTRACT FROM PUBLISHER]

This manuscript presents the results of a multi-lateral international activity intended to understand how to execute a cycle stress test as specified in a chosen standard (GTR, SAE, ISO, EIHP …). The purpose of this work was to establish a harmonized test method protocol to ensure that the same results would be achieved regardless of the testing facility. It was found that accurate temperature measurement of the working fluid is necessary to ensure the test conditions remain within the tolerances specified. Continuous operation is possible with adequate cooling of the working fluid but this becomes more demanding if the cycle frequency increases. Recommendations for future test system design and operation are presented. [ABSTRACT FROM AUTHOR]

Competing Interests: Disclosures None.

The multi-axial creep strength of circumferential welds in power piping, including failure mode and failure life against a wide range of stress ratios and stress levels, was newly examined in this paper. The creep rupture behaviour of modified 9Cr–1Mo steel (9Cr–1Mo–VNb steel; ASME P91) pipe with a circumferential weld subject to combined internal pressure and axial load was experimentally investigated at 650 °C. The test results, with several kinds of stress ratios of macroscopic axial and hoop stress can be summarised as follows. Along with the increased stress ratio (axial/hoop), both failure location and failure mode changed from a base metal failure caused by hoop stress to an FGHAZ (fine-grained heat affected zone) failure due to axial stress. The stress ratio where the failure mode changed was ‘0.8’. Strength reduction in FGHAZ failure by axial stress should be considered in the structural design of circumferential welds. A series of FEM creep analysis was carried out to discuss the relation of the failure mode to both the local stress distribution and the damage. The failure mode variation along with the increase in the stress ratio is also discussed based on simplified ductile creep failure analysis. [ABSTRACT FROM PUBLISHER]

Seam-welded elbows and straight pipe of the same size as actual high temperature reheat piping for boiler applications were manufactured, and internal pressure creep testing was conducted. Uniaxial creep testing was also performed in order to compare creep damage behaviours. Comparing the observed creep damage evolution and stress analysis results, a creep damage estimation method was discussed. Creep damage distribution varied depending on ovality in the cross sections of the seam-welded elbows. It is important that FEM models for creep analysis incorporate measurement results for the cross-sectional shape of seam-welded elbows. Using the nominal stress of the specimens and the average creep rupture data from small size uniaxial welded joint tests, a simplified prediction method was discussed, which is applicable to creep rupture time prediction for both large creep specimens and seam-welded elbows. [ABSTRACT FROM PUBLISHER]

The type Ⅳ secretion system (T4SS) of H. pylori encoded by cag pathogenicity island mediates the injection of the toxin CagA, which is considered as a paradigm for bacterial carcinogenesis. T4SS is generally composed of a set of proteins, the majority of which still remain unclear. In this study, we have identified CagI, one of the T4SS proteins, which interacted with CagA and played an important role for CagA stability. [ABSTRACT FROM AUTHOR]

Ehlers-Danlos syndrome (EDS) encompasses a group of rare genetic connective tissue disorders. The vascular type (type IV) poses the most serious risk to patients. Diagnosis is usually difficult, especially if patients lack a family history. Life-threatening vascular emergency such as dissection or rupture can be the first presenting symptom. Management of the disease can pose a clinical challenge due to the emergency of presentation, tissue friability, and lack of clear management recommendations. We report a unique case of a 40-year-old man who presented with a ruptured celiac artery and a strong family history of EDS. This case highlights the difficulties and complications associated with treating this uncommon and serious disease. [ABSTRACT FROM AUTHOR]

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Laparoscopic repair of paraesophageal hernia is safe and feasible and can provide comparable results for patients with type IV paraesophageal hernia. We report a rare case of mediastinal seroma in an 80-year-old gentleman who had a giant type IV paraesophageal hernia and was eventually admitted to our hospital for elective laparoscopic repair and recovered very well after surgery with resolution of the atelectatic lungs and air-fluid collection in his chest.

Lipoprotein [a] (Lp[a]) is a cholesterol-rich lipoprotein resembling LDL to which a large polymorphic glycoprotein, apolipoprotein [a] (apo[a]), is covalently coupled. Lp[a] usually exists as a free-standing particle in normolipidemic subjects; however, it can associate noncovalently with triglyceride-rich lipoproteins in hypertriglyceridemic (HTG) subjects. In this study, 10–78% of the Lp[a] present in five HTG subjects was found in the triglyceride-rich lipoprotein (TRL) fraction. The Lp[a]-TRL complex was resistant to dissociation by ultracentrifugation (UCF) alone, but was quantitatively dissociated by UCF in the presence of 100 mM proline. Of this dissociated Lp[a], 70–88% was in the form of a lipoprotein resembling conventional Lp[a]. Incubation of Lp[a]-depleted TRL with native Lp[a] resulted in a reconstituted Lp[a]-TRL complex that closely resembled the native isolates in all examined properties. Complex formation was inhibited by several compounds in the order proline > tranexamate > ε-aminocaproate >> arginine > lysine. Neither plasminogen nor LDL inhibited binding of Lp[a] to TRL. We observed the preferential binding of Lp[a] containing higher apparent molecular weight apo[a] polymorphs to TRL both in native and reconstituted Lp[a]-TRL complexes. A disproportionate amount of Lp[a] was bound to the larger TRL particles. Although most apo[a] bound to TRL was in the form of conventional Lp[a] particles, lipid-free recombinant apo[a] was observed to bind TRL. These results provide unequivocal evidence of the existence of an Lp[a]-TRL complex under pathophysiologic conditions. The metabolic fate of the Lp[a]-TRL complex, which is more abundant in hypertriglyceridemia, may be different from that of conventional Lp[a], and may contribute uniquely to the progression or severity of cardiovascular disease.—Gaubatz, J. W., R. C. Hoogeveen, A. S. Hoffman, K. G. Ghazzaly, H. J. Pownall, J. Guevara, Jr., M. L. Koschinsky, and J. D. Morrisett. Isolation, quantitation, and characterization of a stable complex formed by Lp[a] binding to triglyceride-rich lipoproteins. J. Lipid Res. 2001. 42: 2058–2068.

High-grade physeal fractures, such as Salter-Harris types III, IV, and V fractures, are rare pediatric injuries observed disproportionately in teenage males. Such fractures are at high risk for complications such as growth retardation and arrest, arthrofibrosis, and post-traumatic arthritis. Consultation with the orthopedic specialist is imperative to ensure appropriate imaging, management, and potential transfer to a pediatric specialty hospital. The authors present a case of a 15-year-old male who sustained a Salter-Harris IV fracture of the distal femur extending from the intercondylar notch to the metadiaphysis from a motocross accident., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Van Nispen et al.)

Background: GmrSD is a modification-dependent restriction endonuclease that specifically targets and cleaves glucosylated hydroxymethylcytosine (glc-HMC) modified DNA. It is encoded either as two separate single-domain GmrS and GmrD proteins or as a single protein carrying both domains. Previous studies suggested that GmrS acts as endonuclease and NTPase whereas GmrD binds DNA. Methods: In this work we applied homology detection, sequence conservation analysis, fold recognition and homology modeling methods to study sequence-structure-function relationships in the GmrSD restriction endonucleases family. We also analyzed the phylogeny and genomic context of the family members. Results: Results of our comparative genomics study show that GmrS exhibits similarity to proteins from the ParB/Srx fold which can have both NTPase and nuclease activity. In contrast to the previous studies though, we attribute the nuclease activity also to GmrD as we found it to contain the HNH endonuclease motif. We revealed residues potentially important for structure and function in both domains. Moreover, we found that GmrSD systems exist predominantly as a fused, double-domain form rather than as a heterodimer and that their homologs are often encoded in regions enriched in defense and gene mobility-related elements. Finally, phylogenetic reconstructions of GmrS and GmrD domains revealed that they coevolved and only few GmrSD systems appear to be assembled from distantly related GmrS and GmrD components. Conclusions: Our study provides insight into sequence-structure-function relationships in the yet poorly characterized family of Type IV restriction enzymes. Comparative genomics allowed to propose possible role of GmrD domain in the function of the GmrSD enzyme and possible active sites of both GmrS and GmrD domains. Presented results can guide further experimental characterization of these enzymes. [ABSTRACT FROM AUTHOR]

C* is usually used to describe the creep crack growth. ASTM E1457 allows C* to be calculated from creep load line displacement rate. However in components it is difficult or impossible to measure load line displacement rate. Therefore for the components C* must be determined by finite element methods or reference stress concepts. Estimates of C* obtained by reference stress methods will depend on the collapse mechanism adopted and therefore several estimations are proposed. This paper presents a numerical study of non-linear fracture mechanics parameter predictions under elevated temperature for axially oriented external surface crack in cylinder. Comparison of C* calculated from FE analysis and different reference methods is conducted. The values of C* obtained from the API579 net section solution are also found to be slightly conservative and give the closest agreement to the F.E. contour integral C*. In addition, the comparison between C* of homogeneous material and TYPE IV cracking is conducted. The difference between homogeneous material and TYPE IV cracking is almost negligible and therefore the reference stress solutions for homogenous material could be applied to estimate C* for TYPE IV cracking. [ABSTRACT FROM AUTHOR]

Objective To compare the sequential healing at immediately loaded implants installed in a healed alveolar bony ridge or immediately after tooth extraction. Material and methods In the mandible of 12 dogs, the second premolars were extracted. After 3 months, the mesial roots of the third premolars were endodontically treated and the distal roots extracted. Implants were placed immediately into the extraction sockets (test) and in the second premolar region (control). Crowns were applied at the second and third maxillary premolars, and healing abutments of appropriate length were applied at both implants placed in the mandible and adapted to allow occlusal contacts with the crowns in the maxilla. The time of surgery and time of sacrifices were planned in such a way to obtain biopsies representing the healing after 1 and 2 weeks and 1 and 3 months. Ground sections were prepared for histological analyses. Results At the control sites, a resorption of the buccal bone of 1 mm was found after 1 week and remained stable thereafter. At the test sites, the resorption was 0.4 mm at 1-week period and further loss was observed after 1 month. The height of the peri-implant soft tissue was 3.8 mm both at test and control sites. Higher values of mineralized bone-to-implant contact and bone density were seen at the controls compared with the test sites. The differences, however, were not statistically significant. Conclusions Different patterns of sequential early healing were found at implants installed in healed alveolar bone or in alveolar sockets immediately after tooth extractions. However, three months after implant installation, no statistically significant differences were found for the hard- and soft-tissue dimensions. [ABSTRACT FROM AUTHOR]