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Medical education is in the process of a pedagogical revolution. Traditional lectures are playing a progressively smaller role, with more of the content being delivered through student‐centered small‐group sessions. Problem‐based learning (PBL) has become a centerpiece of education for many medical schools, in large part because of its focus on the learners identifying their own knowledge gaps. As junior scientists seek faculty appointments in institutions focused on healthcare education, they will find that skills in PBL are valued by the academic community. Among the necessary skills is the capability to lead efforts in PBL case writing. The cases, each of which is a narrative of a patient's experience of disease, are a critical component of the PBL process, as they trigger learners to follow their curiosity and thereby drive learning. In this article, we outline a clear methodology for educators to follow to create new cases. The described steps provide guidance on making each case powerful to learners through creating immediacy and a sense of the patient as a human being. Guidance is also provided to enable case authors to avoid the common pitfalls, including avoiding the introduction of unintended biases and microaggressions. Importantly, guidance is also provided regarding the best practices to incorporate feedback from content experts. Following the steps in our process promotes a methodical approach to case writing that consistently generates a quality product that enriches student learning. [ABSTRACT FROM AUTHOR]

This research aimed to shed light on the concept of the electronic testimony. It explained the electronic testimony's general and specific conditions, and the extent of its validity in criminal proof. Moreover, it examined the obstacles facing the electronic testimony, whether legal or technical, indicating the position of the Jordanian and Emirati legislators on it. The descriptive approach was used and the findings reflected that the Jordanian legislator has permitted conducting electronic testimony in all crimes. Furthermore, it permitted hearing witnesses electronically even if they are abroad. This is based on bilateral and collective agreements and treaties concluded between member states. Significantly, the studied legislators approved hearing the evidentiary testimony of anyone under fifteen years of age. They also permitted resorting to the assistance of a translator in the event that the holder of the electronic testimony is deaf or mute. [ABSTRACT FROM AUTHOR]

Background: Intramuscular hemangioma is a vascular malformation occurring in muscle tissues. It is most common in skeletal muscles of limbs, especially lower limbs in childhood. The intercostal intramuscular hemangioma with sternal invasion is very rare. Case presentation: The 47-year-old female patient was hospitalized due to "suddenly chest pain for 4 days". Chest contrast-enhanced CT indicated bony changes in the sternum, accompanied by soft tissue shadows in the posterior sternum and diaphragmatic angle. After admission, physical examination showed: peristernal tenderness, percussion pain, other no obvious positive signs. PET-CT examination indicated that there was a high possibility of benign sternal changes. No cancer cells were found by sternal puncture. Surgical biopsy was performed and pathological findings were consistent with intramuscular hemangioma. Conclusion: Intramuscular hemangioma with bone invasion is very rare, imaging examination is difficult to indicate obvious evidence, preoperative diagnosis is difficult, complete surgical resection is very important, more personalized treatment should be provided according to the overall situation of the patient. [ABSTRACT FROM AUTHOR]

• Fetal volvulus is a rare and life-threatening condition. • Most cases of volvulus are associated with intestinal malrotation. • This case of fetal intestinal volvulus is idiopathic. • A break in the mesentery was observed, which was attributed to ischemia and hypoxia. Cases of fetal volvulus without malrotation are extremely uncommon and pose a life-threatening condition of acute abdomen. In cases of inadequate intestinal rotation, the narrowing of the attachment of the mesenteric root can easily cause intestinal torsion and consequent local blood circulation disorders within the intestinal tract, leading to aseptic necrosis and simultaneous intestinal perforation, resulting in meconium peritonitis, ascites, anemia, and potentially fetal death. In ultrasound examinations, it may be the preferred examination method for this disease. Ultrasound physicians should improve their understanding of this disease in prenatal diagnosis, as it has important clinical value for obstetric management and neonatal treatment, thereby potentially improving adverse pregnancy outcomes. [ABSTRACT FROM AUTHOR]

Chamorro illustrates how Special Onymic Grammar can be shaped in a given language. It is shown that the rules that determine the morphosyntactic behaviour of common nouns cannot be generalized over onyms. Anthroponyms and toponyms differ markedly from common nouns within the NP and beyond. In addition, there are also structural differences that separate anthroponyms from toponyms so that it makes sense to speak of Special Anthroponymic Grammar as opposed to Special Toponymic Grammar. These differences come to the fore in the domain of pre-nominal markers, the formal distinction of cases, case government in PPs, and the functions of zero-marking. It is shown that the latter phenomenon is prominent with toponyms in journalistic prose where zero-marking competes with the use of the phonologically realized toponymic marker. On the basis of the Chamorro facts, topics for follow-up studies are put forward. [ABSTRACT FROM AUTHOR]

Background: Intramuscular hemangioma is a vascular malformation occurring in muscle tissues. It is most common in skeletal muscles of limbs, especially lower limbs in childhood. The intercostal intramuscular hemangioma with sternal invasion is very rare. Case presentation: The 47-year-old female patient was hospitalized due to "suddenly chest pain for 4 days". Chest contrast-enhanced CT indicated bony changes in the sternum, accompanied by soft tissue shadows in the posterior sternum and diaphragmatic angle. After admission, physical examination showed: peristernal tenderness, percussion pain, other no obvious positive signs. PET-CT examination indicated that there was a high possibility of benign sternal changes. No cancer cells were found by sternal puncture. Surgical biopsy was performed and pathological findings were consistent with intramuscular hemangioma. Conclusion: Intramuscular hemangioma with bone invasion is very rare, imaging examination is difficult to indicate obvious evidence, preoperative diagnosis is difficult, complete surgical resection is very important, more personalized treatment should be provided according to the overall situation of the patient. [ABSTRACT FROM AUTHOR]

Case markers and switch-reference markers in the Muskogean languages are often similar in form and can be difficult to distinguish. This paper surveys both phenomena in each branch of the family. It argues that cleft clauses in Proto-Muskogean appeared after noun phrases to indicate focus. These cleft clauses ended in same- and different-subject switch-reference markers. With time, the cleft clauses were reinterpreted as subject and nonsubject case markers. [ABSTRACT FROM AUTHOR]

This article presents a new account of the Stoic theory of case. It argues that cases belong to the Stoic class of lekta and that they play a twofold semantic role. Firstly, they relate words to the world in a process akin to reference. Secondly, they encode syntactic information which captures structural elements of the world, contributing to language's ability to represent reality and its structure by enabling it to capture both objects and the ways in which these objects relate to each other. [ABSTRACT FROM AUTHOR]

This article aims to discuss the issue of the paradigmatic contrast of a given grammatical system as a central stance in structural linguistics. The discussion will be carried out by comparing two different renderings of the system of cases of Lezgi, namely Louis Hjelmslev’s theory, as exposed in his work La catégorie des cas. Étude de grammaire générale (1935, 1937) and Martin Haspelmath’s model, presented in his A Grammar of Lezgian (2011 [1993]). This comparison is not meant to pit their views one against the other, which would be anachronistic, but rather to capitalise on their common object to showcase the differences in the respective stances, laying bare the machinery behind Hjelmslev’s approach and highlighting the conditions of such a description. Further remarks are drawn as consequences.

This case report discusses the clinical presentation, imaging findings, and successful management of a rare case of intussusception in a 6-month-old female infant referred to a regional hospital in Ghana. The patient presented with vomiting, lethargy, fever, and currant jelly stool. Differential diagnoses considered included Merkel diverticulum, volvulus, lymphadenopathy, and hypertrophic pyloric stenosis. Ultrasound imaging revealed a concentric lesion with characteristic signs of intussusception. Ileo-caeco coli intussusception was confirmed as the diagnosis. Surgical management was used for this patient. The postsurgery phase was without any complications. The patient recovered well and was discharged with a switch to oral medications. Infant intussusception is still a disease with a low morbidity rate.

A 40-year-old female arrived with persistent posterior right knee pain, swelling in the popliteal, infrapatellar, anterior calf areas and difficulty walking due to joint stiffness. Multiple hypoechoic collections with internal echoes and debris were discovered in the anterior calf region using ultrasound imaging, which extended from a thick-walled infrapatellar hypoechoic collection with peripheral vascularity. A significant popliteal fossa cyst of comparable appearance was also observed. The results were consistent with a ruptured infrapatellar bursa sac and a popliteal fossa (Baker's cyst). The patient received conservative treatment with anti-inflammatory drugs, leading to the resolution of symptoms after a period of 6 weeks. For patients with more complex cysts, procedures like aspiration and corticosteroid injections under ultrasound guidance may be necessary. Recognizing the condition and using ultrasound for diagnosis and management can lead to successful outcomes.

Abstract A response to the case report by Zhang et al. and supplement another case of giant peritoneal loose body discovered due to abdominal pain. A 68-year-old man was admitted to the hospital with abdominal pain. CT revealed an ovoid mass in the pelvis measuring approximately 11.5 × 8.6 × 7.4 cm. During laparotomy, yellowish-white mass was identified within the pelvis. Histological examination revealed that the mass was hyalinized fibrous connective tissue with focal calcification. We report an extremely rare and interesting case.

Maloof & Associates (M&A), a well-regarded small auditing and accounting firm in Atlanta, kept a close eye on the media buzz surrounding ChatGPT. The partners knew that they must make decisions soon regarding the new technology, but they did not realize how soon until they lost a long-standing and substantial client to a rival that had moved aggressively and publicly to insert AI into their operations. Students, acting the role of consultants, must help M&A understand how ChatGPT and similar tools might be incorporated into the firm’s existing infrastructure, identify potential risks, and identify sources of potential costs and benefits of adopting artificial intelligence-based tools. [ABSTRACT FROM AUTHOR]

Yao Sun, Huiying Zhao, Youzhong An Department of Critical Care Medicine, Peking University People’s Hospital, Beijing, People’s Republic of ChinaCorrespondence: Huiying Zhao; Youzhong An, Peking University People’s Hospital, No. 11 Xizhimen South Street, Xicheng District, Beijing, 100044, People’s Republic of China, Email zhaohuiying109@sina.com; 2211110449@stu.pku.edu.cnAbstract: Guillain-Barré syndrome (GBS) stands out as the most prevalent and severe acute immune-mediated paralytic neuropathy. Approximately 30% of patients experience respiratory failure necessitating admission to the intensive care unit (ICU) and invasive mechanical ventilation. The management of diseases concomitant with acute respiratory distress syndrome (ARDS) poses significant challenges. This case report illustrates the swift development of ARDS in a patient with GBS, explores the utility of the biomarker neurofilament light chain, and highlights the unexpected advantages of proactive ARDS intervention.Keywords: Guillain-Barré syndrome, severe acute respiratory distress syndrome, case, ventilation

Liang Hu,1 Han Wu,1 Jiamin Wang,2 Yang Hu1 1Department of Urology, Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua, People’s Republic of China; 2Department of Intervention, Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua, People’s Republic of ChinaCorrespondence: Yang Hu, Department of Urology, Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua, People’s Republic of China, Email yanghu2024@126.comAbstract: Minimally invasive percutaneous nephrolithotomy (mini-PCNL) maintains a stone clearance rate similar to standard PCNL while reducing blood loss. Bleeding is a complex and serious complication that can arise after PCNL surgery. Pseudoaneurysm (PA) is an uncommon type of delayed bleeding problem, which affects less than 1% of patients after PCNL. The most effective treatment for severe post-PCNL hemorrhage is super-selective renal angiographic embolization (SRAE), but it can fail in some patients and require additional surgical intervention. This report details the case of a male patient, 55 years old, who experienced severe bleeding four times and had three SRAE procedures and one laparoscopic procedure after PCNL. The presence of a renal artery pseudoaneurysm was not initially identified during the first two attempts of angiography due to arterial spasm and a small, undeveloped lesion. This case report is intended to enhance awareness of tiny pseudoaneurysms, emphasizing the importance of avoiding oversight to improve the success rate of embolization.Keywords: super-selective renal angiographic embolization, percutaneous nephrolithotomy, haemorrhage, case

AbstractBackgroundMethodsResultsConclusionsAutoimmune encephalitis (AE) is a group of autoimmune diseases targeting the central nervous system, characterized by severe clinical symptoms and substantial consumption of medical resources. Neuroinflammation plays a crucial role in disease progression, and detecting inflammatory responses can provide insights into disease status and disease severity. The systemic immune-inflammation index (SII), a novel marker of inflammatory status, has been rarely studied in AE.Retrospective analysis of data from AE patients admitted to the First Affiliated Hospital of Zhengzhou University between January 2019 and September 2023 was conducted. Univariate analysis and logistic regression were used to assess the association between SII and patient severity. Nomograms for predicting AE severity were established, and receiver operating characteristic (ROC) curves, concordance index (C-index), calibration curves, and decision curve analysis were employed to evaluate predictive accuracy. Additionally, the Clinical Assessment Scale in Autoimmune Encephalitis (CASE) score was used to assess patient severity.This study enrolled 157 patients, of whom 57 were classified as severe according to the CASE score. SII, cerebrospinal fluid (CSF) cell counts, disturbance of consciousness, and behavioural abnormalities independently associated with the occurrence of severe cases. The C-index of the nomograms was 0.87, indicating strong association with disease severity, as supported by the calibration. Additionally, SII levels were highest within seven days of onset and decreased after one month. In subgroup analyses of different antibodies, SII also associations with severe cases in NMDAR encephalitis.Higher SII levels are associated with an increased likelihood of developing severe AE, peaking within 7 days of disease onset and decreasing thereafter, potentially offering a prognostic marker to assess disease progression early in its course. [ABSTRACT FROM AUTHOR]

Early identification of oral cancer is essential for increasing survival rates and improving the quality of life after treatment. Specialized diagnostic tools such as VELscope, ViziLite, Identafi, and DrOroscope have been created to precisely evaluate the lesions and minimize morbidity. The DrOroscope is a small, easily transportable, and cost-effective diagnostic tool created for the analysis of different premalignant and malignant diseases without requiring invasive methods. In the present case series, a DrOroscope was used. The case series includes oral submucous fibrosis with and without dysplasia and erythroplakia. The image analyses given by the DrOroscope were concordant with the histopathological reports. The DrOroscope can be used as reliable noninvasive supplemental tool along with the comprehensive oral examination in diagnosing potentially malignant disorders, dysplasias, and malignancies. [ABSTRACT FROM AUTHOR]

The present study describes and analyzes the morphosyntactic expression of the Southern Zazaki Ezafe – a linking element in the nominal domain common among Iranian languages. This morpheme is used to link modifiers (i.e. adjectives and possessors) to their head nouns as follows: n-ez1 mod1-ez2 mod2-ez3 mod3. Southern Zazaki, like other languages of the Kurdish region (and unlike, e.g. Persian) reflects phi-features (and case) of the head noun on each Ezafe morpheme in a noun phrase. This paper is focussed around two morphosyntactic puzzles that arise in Southern Zazaki. First, while the Ezafe marker in general reflects the case of the entire DP, the presence of a possessor produces invariant oblique case, regardless of the case value assigned to the DP externally (Paul, Ludwig. 2009. Zazaki. In Gernot Windfuhr (ed.), The Iranian languages, 545–586. Routledge; Todd, Terry Lynn. 2002. A grammar of Dimili. Also known as Zaza. Stockholm: Iremet Forlag; Toosarvandani, Maziar & Coppe van Urk. 2014. The syntax of nominal concord: What Ezafe in Zazaki shows us. Proceedings of NELS 43(2). 209–220 i.a.). Second, Southern Zazaki uniquely employs a separate series of "D-form" Ezafe morphemes in certain syntactic contexts (Keskin, Mesut. 2010. Zazaca üzerine notlar (Notes on Zazaki). In Şükrü Aslan (ed.), Herkesin Bildiugi Sır: Dersim. Iletisim, 221–244; Paul, Ludwig. 2009. Zazaki. In Gernot Windfuhr (ed.), The Iranian languages, 545–586. Routledge; Todd, Terry Lynn. 2002. A grammar of Dimili. Also known as Zaza. Stockholm: Iremet Forlag; Werner, Brigitte. 2018. Forms and meanings of the Ezafe in Zazaki. In Saloumeh Gholami (ed.), Endangered Iranian languages. Reichert Verlag i.a.). This study aims to provide a cohesive analysis of Ezafe in Southern Zazaki both with respect to its general phi- and case-sensitive realizations, as well as the distribution of D-forms. [ABSTRACT FROM AUTHOR]

Xeroderma pigmentosum is a rare autosomal recessive genodermatoses characterized by a deficiency in nucleotide excision repair. Erythropoietic protoporphyria is a rare inherited metabolic disease caused by the perturbation of heme. Xeroderma pigmentosum-erythropoietic protoporphyria is exceedingly rare. Hereby, we firstly report a young Chinese patient of xeroderma pigmentosum Group A with erythropoietic protoporphyria carrying an XPA Met214AsnfsTer7 frameshift mutation and a homozygous splicing mutation, c.315-48T>C, in the proband's intron3 of FECH. [ABSTRACT FROM AUTHOR]

AbstractThere is a lack of research that investigates the risk factors of cycling in low- and middle-income countries. We present descriptive epidemiology of crashes that involved at least one fatal cyclist, over a three-year period (2016–2018) in Delhi, India. Next, we used an unmatched case-control approach to identify road design risk factors of cycle fatalities. Cases were road segments with at least one cycle fatality, and controls were those with none. We developed logistic regression models with cases and controls as binary outcomes to estimate the odds ratio of site characteristics. There were 167 crashes involving at least one cyclist fatality over the study period. Fatal cyclists were almost all males. They were less likely to be children or young adults and less likely to be residents of high-income localities, compared to the general population. One in ten crashes included more than one occupant on a cycle and 5% of fatal victims were pillion riders. Seventy percent crashes occurred at midblock, and majority were backend collisions. Regression shows that road width, traffic speed, and volume of heavy vehicles have strong positive effects on the fatality risk of cyclists. These results can inform strategies to design interventions for safety of cyclists. [ABSTRACT FROM AUTHOR]

This work explores the coupling of person-split nominative objects with anomalous subjects (Jahnsson's Rule (JR), Person-Case Constraint (PCC)). In Breton, split-nominative objects spread from an Icelandic-like combination with oblique subjects of unaccusatives, to Finnish-like combinations with subjects of transitives in constructions like the imperative, and then retreated piecewise. These changes admit of externalist sources, such as frequency entrenchment and analogy over clitic forms, but are bounded by persistent coupling of split-nominative objects with anomalous subjects, and disfavour external sources for it like ambiguity avoidance. An approach is set out through constraints on φ-dependencies, their relationship to case and licensing, and their interaction with grammaticalisable partial φ-specification, building on other work on JR/PCC. The anomalies of the restricting subject are analysed as person-only specification, and extended from quirky obliques to pronouns minimal in absence of number + n/N: imperative pro and human impersonals. The ineffability or accusative of the restricted persons is analysed through the integration of dependent case into Φ/Case theory but apparent syntactic variation is modelled through externalisation. [ABSTRACT FROM AUTHOR]

Anhedonia and motivational impairments are cardinal features of depression, against which conventional antidepressants demonstrate limited efficacy. Preclinical investigations and extant clinical trial data substantiate the promise of opioid receptor modulators in addressing anhedonia, depression, and anxiety. While synthetic opioid agents like dezocine are conventionally employed for analgesia, their distinctive pharmacological profile has engendered interest in their potential antidepressant properties and translational applications. Herein, we present a case in which persistent bupropion treatment was ineffective. However, the incidental administration of a single low-dose intravenous injection of dezocine resulted in a rapid and sustained amelioration of depressive symptoms, particularly anhedonia and motivational deficits. Our findings posit a potentially novel role for the "legacy drug" dezocine. [ABSTRACT FROM AUTHOR]

This paper aims to highlight the similarities between Arabic and some Semitic languages concerning their case systems, whether at the level of case alignment or at the level of case paradigms, as well as certain grammatical phenomena such as case syncretism . The paper also reveals the similarities among Semitic languages regarding the functions represented by each grammatical case, with a particular focus on the accusative case. It endeavors to move beyond merely describing the data to providing an explanation of the source of this accusative case . This paper illustrates that Semitic languages belong to a nominative-accusative alignment pattern, where case interacts with the number system. Most Semitic languages share the use of the same case markers. Additionally, many of them redundantly mark their functions (case and agreement). The data reveal that pronouns in these languages achieve morphological case, similar to what is found in Arabic, in contrast to the hypothesis advocated by Arab grammarians. As for the multiplicity of accusative functions in these languages, we have shown, following Maling's (2009) and Rizzi's (1997) cartographic approach, that the accusative case spreads within the lower domain governed by the verb, encompassing all such functions ". [ABSTRACT FROM AUTHOR]

ObjectiveThe Clinical Assessment Scale for Autoimmune Encephalitis (CASE) is a novel tool tailored specifically for evaluating the severity of autoimmune encephalitis (AE). However, its application in severe AE patients is limited. This study aimed to evaluate the reliability and validity of the CASE and explore its clinical significance in a severe AE cohort.MethodsThe relevant clinical characteristics, laboratory data, and prognosis of patients diagnosed with severe AE between April 2017 and April 2023 were collected. The CASE and modified Rankin scale (mRS) were performed at admission, discharge, and 1-year follow-up, respectively. The reliability of CASE was validated by calculating the Cronbach’s alpha value. The validity was evaluated by calculating the Spearman’s rank correlation with the corresponding mRS. Univariate and multivariate logistic regression were utilized to identify risk factors for poor prognosis.ResultsA total of 140 patients were recruited for the study. The CASE scale presented great internal consistency, with Cronbach’s α value of 0.768 for the total score. The Spearman’s rank correlation analysis revealed strong criterion validity between CASE and mRS, with coefficients of 0.68, 0.92, and 0.95 at admission, discharge, and 1-year follow-up, respectively (all p < 0.001). ROC analysis identified CASE score at admission served as a promising predictive marker for clinical response to treatment, with an AUC of 0.67 (95% CI: 0.57-0.77, p = 0.003). The optimal cut-off point was 22.5. At 1-year follow-up, 72/140 (51.4%) patients achieved good functional status (mRS, 0-2). Multivariate logistic regression confirmed that higher CASE scores on admission and older age at onset were associated with poor short-term as well as 1-year prognosis, respectively. In addition, no clinical response to treatment (OR = 40.499; 95% CI: 7.077-231.746, p < 0.001) and longer duration of hospitalization (OR = 1.071; 95% CI: 1.017-1.128, p = 0.010) were associated with poor function states at 1-year follow-up.ConclusionThe CASE has proven suitable for evaluating disease severity and prognosis in severe AE patients. Besides, CASE score, age at disease onset, hospital stays, and response to immunotherapy are identified as independent risk factors for unsatisfactory prognosis in severe AE patients.

Limb-girdle muscular dystrophies (LGMD) constitute a heterogeneous group of genetic disorders characterized by progressive muscle weakness and atrophy, predominantly affecting the muscles of the pelvic and shoulder girdles. LGMD R27, linked to biallelic pathogenic variants in the JAG2 gene, was recently described, and to date, only 27 cases has been published in three reports. Here, we present two siblings exhibiting a severe clinical phenotype of LGMD R27, associated with a novel JAG2 homozygous frameshift variant [c.3467_3470dup, p.(Pro1158AlafsTer22)] results in truncated protein with 21 amino acid substitution within the cytoplasmic domain of the Jagged2 protein.

BackgroundRestrictive cardiomyopathy (RCM) is a rare cardiomyopathy often characterized by normal or reduced ventricular chamber volume and bi-atrial enlargement, caused mainly by mutations in the myonodal gene. It has a low incidence, non-specific clinical manifestations, rapid progression, and lack of specific treatment, with heart transplantation usually being the ultimate treatment.Methods and resultsThis case reports a case of a 2-year-2-month-old boy located in Yunnan Province, China, who was admitted to the hospital with a 2-month history of orofacial bruising, aggravated by a 1-week history of bilateral eyelid swelling. After admission, electrocardiogram showed bi-atrial enlargement, echocardiography suggested bi-atrial enlargement with right and left ventricular diastolic hypoplasia, and cardiac magnetic resonance showed bi-atrial dilatation and possible localized myocardial fibrosis. A de novo heterozygous mutation (c.574C > T, p.Arg192Cys) in the TNNI3gene was identified by whole exome sequencing and verified by Sanger sequencing. The patient’s family opted for conservative treatment after diagnosis, but the patient died suddenly 2 months after diagnosis.ConclusionThis study identified a case of RCM due to TNNI3 mutation, emphasizing the importance of cardiac MRI and genetic testing in the clinical diagnosis of RCM and the need for heart transplantation. The study also revealed the possible heterogeneity of TNNI3 mutations across ethnic and geographic backgrounds, suggesting that long-term studies of genetic mutations should be strengthened in the future to promote the development of precision treatment strategies for cardiomyopathy.

A response to the case report by Zhang et al. and supplement another case of giant peritoneal loose body discovered due to abdominal pain. A 68-year-old man was admitted to the hospital with abdominal pain. CT revealed an ovoid mass in the pelvis measuring approximately 11.5 × 8.6 × 7.4 cm. During laparotomy, yellowish-white mass was identified within the pelvis. Histological examination revealed that the mass was hyalinized fibrous connective tissue with focal calcification. We report an extremely rare and interesting case. [ABSTRACT FROM AUTHOR]

Epidermolysis bullosa (EB) is a rare hereditary cutaneous disorder inherited mainly in an autosomal dominant fashion.1 It consists of a group of conditions that cause the skin to be fragile and blister easily. EB has been classified into three types namely; simplex, junctional and dystrophic2. Although all three types of EB have different causes, their symptoms are similar, manifesting as painful blisters and sores. Epidermolysis bullosa is a very rare condition but may probably be more common in clinical practice than reported in literature, especially in places like Nigeria where there is under reporting of clinical cases. To the knowledge of the authors, there are few reported cases in Nigeria. 3, 4, 5 and none from Bayelsa State in the delta region of the country. We herein present a case of epidermolysis bullosa simplex (Dowling Meara type) in a 35 day old infant. This case is reported with the aim of increasing awareness of its existence in Nigeria and Bayelsa State in particular.

Introduction. The case, which is a semantic and grammatical category, appears in natural languages in the most unexpected way. A word or phrase that has a substantive unit at its core receives an inflection (internal or external) in one case or another, which can be expressed both explicitly and implicitly, and has a grammatical meaning. In this case, inflection can be accompanied by a preposition that has a lexical meaning. These case indicators, morphological and syntactic, organize the main or secondary substantive part of the sentence, i.e. are related to the category of space. The number of cases today is still the subject of scientific debate. Methodology and sources. The present study is based on analizing the views of various scientists on the category of case, with special attention to the theory of L. Hjelmslev. According to this theory, the maximum possible number of cases in natural language is 216. In order to provide a purely formal calculation of the possible number of cases, which would be at the same time independent on the earlier views, the article represents the substantive part of the sentence as a semifinitive multiplied by a specifier (proto-specifier). These statements are prescribed by the binomiality idea, having been developed since 1993 at ETU. Results and discussion. The generally accepted division of sentence parts into main and secondary ones leads us to dividing all possible cases into direct cases (for subject) and indirect cases (for secondary substantive parts). Thus, the direct case can be obtained by a simple transformation from any indirect case, i.e. the space specifier goes back to the spatial proto-specifier. The space proto-specifier represents external space added to substantive mass. The substantive semifinitive is a substantive mass multiplied by internal space. As the binomiality idea prescribes, substantive masses can be in four states, while substantive semifinitives can be in six states. Thus, the number of possible case forms should be equal to 24. Conclusion. According to classical physics, space is three-dimensional, so grammatical space, both external and internal, should also, obviously, be considered three-dimensional. This means that four states of substantive mass and six states of substantive semifinitives can be in each of the three dimensions. Thus, the maximum possible number of cases may indeed reach 216. It should be noted that L. Hjelmslev derived the number 216 in a completely different way, by dint of much deeper reasoning. In the future, it would be interesting to compare L. Hjelmslev’s binary oppositions with the constituents of substantive parts of sentence.

OBJECTIVES: This study aimed to estimate the validity of self-reported information on ever-night shift work among women with and without breast cancer and illustrate the consequences for breast cancer risk estimates. METHODS: During 2015–2016, 225 women diagnosed with breast cancer and 1800 matched controls without breast cancer employed within the Danish hospital regions during 2007–2016 participated in a questionnaire-based survey. Their reported night shift work status was linked with objective payroll register day-by-day working hour data from the Danish Working Hour Database and the Danish Cancer Registry. For the breast cancer patients and their matched controls, we estimated sensitivity and specificity for ever-working night shifts using the payroll data as the gold standard. We also used quantitative bias analysis to estimate the impact on relative risk estimates for a hypothetical population. RESULTS: For breast cancer patients, we observed a sensitivity of ever-night shifts of 86.2% and a specificity of never-night shifts of 82.6%. For controls, the sensitivity was 80.6% and the specificity 83.7%. Odds ratio for breast cancer in a hypothetical population decreased from 1.12 [95% confidence interval (CI) 1.03–1.21] to 1.05 (95% CI 0.95–1.16) when corrected by the sensitivity and specificity estimates. CONCLUSION: This study shows that female breast cancer patients had slightly better recall of previous night shift work than controls. Additionally, both breast cancer patients and controls recalled previous never-night shift work with low specificity. The net effect of this misclassification is a small over-estimation of the relative breast cancer risk due to night shift work.

Abstract: This paper argues that case assignment is impossible in configurations that parallel generalized improper-movement configurations. Thus, like improper movement, there is “improper case.” The empirical motivation comes from (i) the interaction between case and movement and (ii) crossclausal case assignment in Finnish. I propose that improper case is ruled out by theBan on Improper Case: a DP in [Spec, XP] cannot establish a dependent-case relationship with a lower DP across YP if Y is higher than X in the functional sequence. I show that this constraint falls under a strong version of theWilliams Cycle(Williams 1974, 2003, 2013; van Riemsdijk and Williams 1981) and is derived under Williams’s (2003, 2013) analysis of embedding.

BackgroundEstimating surgical case duration accurately is an important operating room efficiency metric. Current predictive techniques in spine surgery include less sophisticated approaches such as classical multivariable statistical models. Machine learning approaches have been used to predict outcomes such as length of stay and time returning to normal work, but have not been focused on case duration.ObjectiveThe primary objective of this 4-year, single-academic-center, retrospective study was to use an ensemble learning approach that may improve the accuracy of scheduled case duration for spine surgery. The primary outcome measure was case duration.MethodsWe compared machine learning models using surgical and patient features to our institutional method, which used historic averages and surgeon adjustments as needed. We implemented multivariable linear regression, random forest, bagging, and XGBoost (Extreme Gradient Boosting) and calculated the average R2, root-mean-square error (RMSE), explained variance, and mean absolute error (MAE) using k-fold cross-validation. We then used the SHAP (Shapley Additive Explanations) explainer model to determine feature importance.ResultsA total of 3189 patients who underwent spine surgery were included. The institution's current method of predicting case times has a very poor coefficient of determination with actual times (R2=0.213). On k-fold cross-validation, the linear regression model had an explained variance score of 0.345, an R2 of 0.34, an RMSE of 162.84 minutes, and an MAE of 127.22 minutes. Among all models, the XGBoost regressor performed the best with an explained variance score of 0.778, an R2 of 0.770, an RMSE of 92.95 minutes, and an MAE of 44.31 minutes. Based on SHAP analysis of the XGBoost regression, body mass index, spinal fusions, surgical procedure, and number of spine levels involved were the features with the most impact on the model.ConclusionsUsing ensemble learning-based predictive models, specifically XGBoost regression, can improve the accuracy of the estimation of spine surgery times.

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Several languages allow for hyper-raising, a structure in which a DP that is interpreted as the subject of a finite complement clause is spelled-out as the subject of the matrix clause. Hyper-raising challenges certain core concepts of syntactic theory related to movement and locality. Various proposals have been made for analysing these structures, the main difference being whether the final position of the DP results from movement or not. It has often been assumed that European Portuguese, in contrast to Brazilian Portuguese, does not allow hyper-raising, or only allows it in very limited contexts. In this paper, we present empirical data extracted from written corpora and experimental results attesting to the production and acceptance of hyper-raising structures by a number of native speakers of European Portuguese. We contribute to identifying the contexts that favour hyper-raising in this variety and outline a preliminary analysis to explain what leads these speakers to produce and accept hyper-raising, while many others systematically reject it. In our proposal, this difference results from the properties of the embedded functional heads T and C, and the way in which their formal features are checked. Specifically, we propose that those speakers dissociate Case features from person-number features. [ABSTRACT FROM AUTHOR]

The use of direct oral anticoagulants (DOACs) in breastfeeding women is currently challenging due to limited safety data for breastfeeding infants, and there have been no previous studies on the drug concentration in breastfeeding infants. We treated 2 patients (one case was twin pregnancy) with venous thromboembolisms in breastfeeding women administered rivaroxaban at our institution. Blood samples from the mothers and breastmilk samples were collected at time 0 and 2 h after the rivaroxaban administration, breastfeeding was conducted 2 h after the rivaroxaban administration, and blood samples from the infants were collected 2 h after breastfeeding (4 h after maternal rivaroxaban administration). The milk-to-plasma (M:P) ratios were 0.27 in Case 1 and 0.32 in Case 2. The estimated relative infant dose (RID) was 0.82 % in Case 1 Children 1 and 2, and 1.27 % in Case 2. The rivaroxaban concentration in the infant plasma was below the lower limit of quantification in all infants. In addition, even in the high-exposure case simulation based on 5 days of breastfeeding in Case 2, the infant plasma concentration level was below the lower limit of quantification. At 3 months of follow-up, breastfeeding was continued, and all infants grew and developed without any health problems including bleeding events. The current case series showed that there were no pharmacokinetic or clinical concerns for breastfeeding women or breastfed infants, and provides support for rivaroxaban as a safe treatment option for these patients. • Direct oral anticoagulants (DOACs) are challenging in breastfeeding women. • We administered rivaroxaban in 2 breastfeeding women with venous thromboembolism. • There were no pharmacokinetic concerns on rivaroxaban for breastfeeding women. • Rivaroxaban might be a potential option for breastfeeding women with infants. [ABSTRACT FROM AUTHOR]

The article informs about the validity of self-reported night shift work among women with and without breast cancer, highlighting its impact on breast cancer risk estimates. Topic include study reveals that breast cancer patients had slightly better recall of previous night shift work compared to controls, with both groups showing low specificity in recalling never-night shift work, resulting in a small overestimation of the relative breast cancer risk associated with night shift work.

Variants at the SLC30A8 locus are associated with type 2 diabetes (T2D) risk. The lead variant, rs13266634, encodes an amino acid change, Arg325Trp (R325W), at the C-terminus of the secretory granule-enriched zinc transporter, ZnT8. Although this protein-coding variant was previously thought to be the sole driver of T2D risk at this locus, recent studies have provided evidence for lowered expression of SLC30A8 mRNA in protective allele carriers. In the present study, we examined multiple variants that influence SLC30A8 allele-specific expression. Epigenomic mapping has previously identified an islet-selective enhancer cluster at the SLC30A8 locus, hosting multiple T2D risk and cASE associations, which is spatially associated with the SLC30A8 promoter and additional neighboring genes. Here, we show that deletion of variant-bearing enhancer regions using CRISPR-Cas9 in human-derived EndoC-ßH3 cells lowers the expression of SLC30A8 and several neighboring genes and improves glucose-stimulated insulin secretion. While downregulation of SLC30A8 had no effect on beta cell survival, loss of UTP23, RAD21, or MED30 markedly reduced cell viability. Although eQTL or cASE analyses in human islets did not support the association between these additional genes and diabetes risk, the transcriptional regulator JQ1 lowered the expression of multiple genes at the SLC30A8 locus and enhanced stimulated insulin secretion. [ABSTRACT FROM AUTHOR]

In this paper we discuss the emergence of novel agreement patterns of the bipartite reciprocal markers (BRM) jedan drugi (Serbian) and l’un(o) l’altro (Italian), both meaning ‘each other’. In Serbian, the most conclusive evidence of an ongoing change comes from novel case agreement patterns, where the first element of the BRM no longer agrees in case with the antecedent. For Italian, the absence of agreement on the first part (l’un) is understood to be a result of grammaticalization, accompanied by other symptoms such as semantic weakening. The major problems for this view are gender agreeing plural BRMs, and the fact that agreeing BRMs in general do not seem to be ‘less reciprocal’. [ABSTRACT FROM AUTHOR]

Aims The aim of the study is to identify the disease's trend over the months and years, and the demographic and environmental factors of the patients, in which Crimean Congo Hemorrhagic Fever is an infectious zoonotic tick-borne disease that causes non-hemorrhagic and hemorrhagic symptoms, has been present in Iraq since 1979, but its prevalence has greatly increased since 2021. Instrument & Methods In this retrospective cross-sectional study, 957 confirmed patients from all over Iraq (except the Kurdistan region) from 2021 to 2023 were included. The study was conducted from October 2023 to March 2024, and the data were collected from the Iraqi Communicable Disease Control Center. Findings The trend of cases has elevated in 2021, 2022, and 2023 as 19, 374, and 564 cases, respectively, with a peak during May, June, and July. The age of most patients ranged from 20-49 years, with a mean of 35.8±15.3 years and a higher percentage of males (58.3%). Most patients lived in rural areas (45.6%) and were from south Iraq, particularly Dhi Qar governorate (33.3%). Occupationally, the housewives recorded the higher exposure (35.7%). The higher environmental risk factor was the exposure to raw or uncooked meat (58.7%). The case fatality rate was 16.5%. Conclusion The disease has a seasonal trend, and most Crimean Congo Hemorrhagic Fever patients were males of economically active age living in rural areas in the south of Iraq. Contact with animals and their products was the higher environmental risk factor, and housewives recorded higher occupational exposure. [ABSTRACT FROM AUTHOR]

Copyright of Turkey Journal of Theological Studies is the property of Turkey Journal of Theological Studies and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Grammaticalization has long been understood as a process that takes place gradually, but within it, discrete and abrupt changes take place. This tension has been reconciled by claiming that the semblance of a gradual process is given by different parts of a construction undergoing changes at different points in time. Focusing on synchronic microvariation as gradience, this article discusses cases of clitic loss in four Romance varieties (Brazilian Portuguese, Raeto-Romance, some northeastern Italo-Romance varieties, and French), and identifies common patterns in the cells of the paradigms that are most vulnerable to the process of loss. Relating the grammatical and semantic properties of these cells to established typological hierarchies, the paper explores how general cognitive principles can account for the key properties of gradualness and gradience and, ultimately, language change. [ABSTRACT FROM AUTHOR]

A small number of gastrointestinal smooth muscle tumors are caused by leiomyoma, which are uncommon in the colon. Typically, these tumors are benign and asymptomatic. They typically affect middle-aged and older populations. They are uncommon, making up about 3% of gastrointestinal leiomyomas. During a screening colonoscopy, a 52-year-old Saudi male revealed a little, 5-mm ascending colon polyp in this case report. The polyp was transported to the pathology laboratory after being removed using a hot snare polypectomy. The histopathology report confirmed the size of the polyp (5 mm), single, firm, gray-white, polypoid 0.5 cm nodule, and the findings were consistent with inflamed submucosal leiomyoma with inflamed and ulcerated surface. No findings are suggestive of malignant changes. In conclusion, A rare benign tumor, intestinal leiomyoma, can mimic several smooth muscle tumors, especially adnexal masses, making diagnosis difficult. Though nonspecific radiological abnormalities are conceivable, huge size and extra-colic growth increase the likelihood of a diagnosis. Computed tomography (CT) can help identify benign leiomyoma from leiomyosarcoma, but tissue diagnosis is best. Histoimmunopathology is crucial to diagnosis. Small and large colonic leiomyoma polyps can be treated by snare polypectomy and wide surgical excision with follow-up. For some leiomyosarcoma patients, surgery, radiation, and chemotherapy are the main treatments.