Successful use of anti-PD-1 antibody to treat multiple metastatic carcinomas in a patient with xeroderma pigmentosum: case report and literature reviewMai Itoyama1, Akihiro Ohara1, Kazuki Yokoyama1, Shun Yamamoto1, Ken Kato1, Taisuke Mori2, Hiroshi Igaki3, Eiji Nakano4,5, Naoya Yamazaki4, Kuniko Sunami6, Chikako Nishigori5,7, Yoshitaka Honma11. Department of Head and Neck, Esophageal Medical Oncology, National Cancer Center Hospital2. Department of Diagnostic Pathology, National Cancer Center Hospital3. Department of Radiation Oncology, National Cancer Center Hospital4. Department of Dermatologic Oncology, National Cancer Center Hospital5. Department of Dermatology, Kobe University Graduate School of Medicine6. Department of Laboratory Medicine, National Cancer Center Hospital7. Hyogo Blood Center, Japanese Red CrossContact (Mai Itoyama):Adress: 5-1-1 Tsukiji, Chuo-ku, Tokyo, JapanEmail: mitoyama@ncc.go.jp

Pemphigus Vulgaris Presenting with Epigastric PainAuthors: Marawan Elmassry MD1, Jerapas Thongpiya MD1, Pitchaporn Yingchoncharoen MD1, Jali Garza MS1, Matthew Soape MD2, Kanak Das MD11Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, TX, USA2Department of Gastroenterology, Covenant Medical Center, Lubbock, TX, USA

Clostridium sordellii: A cause of toxic shock syndrome after a breach in the GI tractSydney Pence,1 Rajshri Joshi,2Kasturi Shrestha31. Ohio University Heritage College of Osteopathic Medicine, 4180 Warrensville Center Rd, Warrensville Heights, OH 44122. Email: sp883713@ohio.edu2. Internal Medicine, Cleveland Clinic Akron General, 1 Akron General Ave, Akron, OH 44307. Email: JOSHIR4@ccf.org3. Infectious Disease, Cleveland Clinic Akron General, 1 Akron General Ave, Akron, OH 44307. Email: SHRESTK2@ccf.org

Rhinoscleroma is a granulomatous infectious disease that typically affects the nasopharynx and upper respiratory tract. Non-endemic (e.g., North American) and laryngeal cases are rare. This case highlights the importance of pathognomonic Mikulicz cells for diagnosis.

Background: Neonatal foals are born essentially agammaglobulinemic and therefore must ingest colostrum or receive immunoglobulins to maintain health. Failure of passive transfer treatment involves administration of equine colostrum, plasma or commercial powdered colostrum (CPC). Anecdotal reports suggest a risk of anaphylaxis associated with plasma transfusion in neonates that received CPC prior to gut closure. Bovine serum albumin (BSA) in CPC may serve as a target for BSA-specific immunoglobulin E (IgE) in donor equine plasma. Objectives: To determine presence of BSA-specific IgE in samples collected post-routine vaccination in healthy horses, horses experiencing adverse vaccine reactions and commercial equine plasma. Study Design: Prospective Observational Methods: Serum was collected from 65 healthy horses at day 0, 14, 28, 90, 180, 270 and 365 post-vaccination, 26 horses after vaccine reaction at day 1, 180 or 270 post-vaccination, 4 horses not vaccinated and 10 horses from a commercial plasma donor herd. BSA-specific IgE was determined using enzyme-linked immunosorbent assay (ELISA). Results: BSA-specific IgE was not detected in non-vaccinated horses and was identified in all vaccinated horses. Younger horses demonstrated higher fold changes in post-vaccination BSA-specific IgE expression compared to older horses. No significant difference in BSA-specific IgE levels between commercial plasma donors and healthy horses was identified. No significant difference in post-vaccination anti-BSA IgE levels between reactor and healthy horses at day 180 and 270 post-vaccination were identified. Main Limitations: Small number of reactor horses at day 180 and 270 post-vaccination with most samples being collected 24 hours. There were no healthy horse samples for 24 hours post-vaccination; therefore, it was not possible to compare the two groups at this timepoint. Conclusions: Horses may express BSA specific IgE following vaccination. There may be risk of hypersensitivity type reaction when veterinarians administer commercial plasma to neonatal foals that have consumed CPC prior to gut closure.

Aim of the study: Given the known synergistic relationship between magnetic field (MF) and cholinergic receptor activation in the cholinergic system, the present study aims to investigate whether the combined use of a static MF and an agonist for nicotinic acetylcholine receptors (nAChR) can preserve motor behavior in ischemic gerbils. Materials & methods: We randomly allocated 72 Mongolian gerbils into nine groups (n=8), distributed according to surgical procedure and treatment. The animals were trained and evaluated on the Rotarod (RR) to assess motor performance. Results: Our main finding was the preservation of motor behavior in the Sham Ischemia + Nicotine + Sham Magnetic Stimulation (Sh+N+SMS) and Ischemia + Nicotine + South Pole (I+N+SP) groups, as evidenced by the results of the RR test. Conclusions: Our findings are consistent with previous literature and provide insight into the mechanism of potentiation, as results showed that adding a nAChR agonist to the MF preserved motor performance in the RR test of ischemic animals.

Abstract Background This study aimed to establish a method to determine tigecycline (TGC) in cerebrospinal fluid (CSF) and serum of 12 patients with Multidrug-resistant acinetobacter baumannii (MDRAB) central nervous system infection (CNSI) and evaluate the correlation of TGC in CSF and serum samples. Methods TGC in CSF and serum was extracted by acetonitrile and detected by HPLC-MS/MS. The separation was performed on the Waters XBridge® BEH Shield RP18 column. This method could achieve the quantification accurately in a very short time. Results For these 12 patients, the trough concentration ranges of TGC in CSF and serum at steady-state were 16.35-53.56 ng/mL and 67.76-211.9 ng/mL. The CSF-to-serum ratio of TGC at steady-state trough concentration was ranged from 21.46% to 44.46%, and the mean value was 31.61 ± 8.13%. The correlation of TGC in CSF and serum was 0.5065. CNSI might have no potential to increase the penetration ability of TGC to CSF. Conclusion The method was validated to be accurate and effective. The correlation between the concentrations of TGC in CSF and serum at steady-state was demonstrated to be positive based on quantification of TGC in bio-samples from 12 MDRAB patients.

Objectives: To evaluate cellular immune responses induced by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccines immunization in population based on HLA-E-restricted CD8 + T cell epitopes identification. Methods: HLA-E-restricted SARS-CoV-2 CD8 + T cell nonamer peptides were predicted with software. HLA-E-transfected K562 cells binding assay was used to screen for high-affinity peptides. IFN-γ enzyme-linked immunospot assay were used to identify HLA-E-restricted epitopes. HLA-E/epitope tetramer was employed to detect the frequencies of epitope-specific CD8 + T cells. Results: Four CD8 + T cell epitopes on spike protein of SARS-CoV-2 restricted by both HLA-E*0101 and E*0103 were identified. HLA-E-restricted epitope specific IFN-γ-secreting CD8 + T cell responses could be detected in individuals vaccinated with SARS-CoV-2 vaccines. Importantly, the frequencies of epitope-specific CD8 + T cell in Ad5-nCoV vaccinated individual were higher than that in individuals vaccinated with recombinant protein or inactivated vaccines. Moreover, frequencies of epitope-specific CD8 + T cells could maintain for at least 120 days after only one dose Ad5-nCoV vaccination. While frequencies of epitope-specific CD8 + T cells decreased in individuals after two doses of Ad5-nCoV vaccination. Conclusions: These findings may contribute to more comprehensive evaluating protective effects of vaccines for SARS-CoV-2, meanwhile may provide information to characterize HLA-E-restricted CD8 + T cell immunity against SARS-CoV-2 infection.

Chronic hepatitis B virus (HBV) infection causes hepatitis, liver cirrhosis and hepatocellular carcinoma. Covalently closed circular DNA (cccDNA) is the transcription template for HBV RNAs and not affected by current treatment options. Effective therapeutics with ability to remove cccDNA need to be developed. Previously, we established an HBV persistence mouse model via hydrodynamic injection of a clinical isolate (BPS) and identified IL-21 as a potent inducer of viral clearance. Here, we aimed to explore the anti-HBV effects of IL-21 messenger RNA (mRNA) delivered by lipid nanoparticle (LNP-IL-21) system. First, LNP-IL-21 was prepared and analyzed for its safety, expression, biodistribution and stability in vitro and in vivo. Next, LNP-IL-21 was injected into two HBV persistence mouse models based on BPS and recombinant cccDNA (rcccDNA) respectively. LNP-IL-21 administration successfully cleared HBV serum markers, and more importantly, BPS replicons and rcccDNA in livers, which was associated with activation of viral specific immune responses. Notably, transfer of peripheral blood mononuclear cells from BPS persistence mice stimulated ex vivo with LNP-IL-21 and viral antigen could induce HBV clearance in recipient mice. These findings suggested that both LNP-IL-21-based gene and cellular therapies provided novel therapeutic strategies against chronic HBV infection.

Background: No study has directly compared the efficacy of nirmatrelvir-ritonavir and azvudine for treatment. The efficacy of these two drugs at high altitudes was compared. Materials and Methods: This was a retrospective cohort research on hospitalized patients with COVID-19 who were treated with nirmatrelvir-ritonavir or azvudine in Tibet between August 1 and September 30, 2022. Results: The electronic health data of 731 patients were retrospectively reviewed. Nirmatrelvir-ritonavir and azvudine groups enrolled 338 and 147 patients, respectively. Among patients with mild, common, and severe (including critical) COVID-19, there was no difference in the median duration of hospitalization between treatment with nirmatrelvir-ritonavir and that with azvudine: 8 (5–10.25) vs. 9 (5–13) (P=0.096); 8 (5–11) vs. 8 (5–13) (P=0.227); and 13 (7–17.75) vs. 10 (7.5–17.5) (P=0.994) days, respectively. Moreover, patients in the nirmatrelvir-ritonavir group had a shorter median time for nuclear acid negative conversions (NANC) than those in azvudine group: 6 (4–9) vs. 10 (6.25–13.75) (P=0.000), 8 (5–12) vs. 10.5 (7–14) (P=0.013), and 7 (5.25–12.75) vs. 15 (7.5–23.5) (p=0.023) days, respectively. Conclusion: Azvudine yielded a longer time for NANC and an equivalent duration of hospitalization and may have comparable efficacy with nirmatrelvir-ritonavir, making it a viable treatment option for COVID-19.

Two cases of Monkeypox virus infection without detectable cutaneous/mucosal lesionsGiulia Ciccarese1, Giorgia Brucci2,3, Antonio Di Biagio2,3, Francesco Drago4,Bruno Caccianotti5, Sergio Lo Caputo5, Gaetano Serviddio6, Teresa Santantonio51Unit of Dermatology, Department of Medical and Surgical Sciences, University of Foggia, Viale Pinto 1, 71122, Foggia, Italy;2Infectious Diseases Unit, San Martino Policlinico Hospital, IRCCS for Oncology and Neurosciences, Largo R. Benzi, 10, 16132 Genoa, Italy;3Department of Health Sciences (DiSSal), University of Genova, Via Pastore, 1, 16132 Genova, Italy;4Unit of Dermatology, San Martino Policlinico Hospital, IRCCS for Oncology and Neurosciences, Largo R. Benzi, 10, 16132 Genoa, Italy;5Clinic of Infectious Diseases, Department of Clinical and Surgical Sciences, University of Foggia, Viale Pinto, 1, 71122 Foggia, Italy;6C.U.R.E. (University Centre for Liver Disease Research and Treatment), Liver Unit, Department of Medical and Surgical Sciences, University of Foggia, Viale Pinto 1, 71122, Foggia, Italy.Email addresses of the co-authors:giorgia.brucci@libero.it; antonio.dibiagio@hsanmartino.it; francescodrago007@gmail.com; bcaccianotti@ospedaliriunitifoggia.it; sergio.locaputo@unifg.it; gaetano.serviddio@unifg.it; teresa.santantonio@unifg.itCorresponding author : Giulia Ciccarese, MD, PhD, Unit of Dermatology, Department of Medical and Surgical Sciences, University of Foggia, Viale Pinto 1, 71122, Foggia, Italy. Telephone: +390881736093. Email address: giulia.ciccarese@unifg.itKeywords: Monkeypox virus infection, anal pain, risky behaviors, sexually transmitted infections.Data availability statement: data available on reasonable request.Funding statement: this research did not receive founds.Conflict of interest: nonePatient consent statement: obtained.Dear Editor,in our case series of 16 human Monkeypox virus (MPX) infected patients diagnosed from 1th July until 31thAugust 2022 in the Dermatology Unit and in the Infectious Disease Unit of the San Martino Hospital, Genoa, Italy1, two patients had no detectable cutaneous/mucosal manifestations at the time of MPX diagnosis.The first patient was a 37-year-old Italian homosexual man presenting to the Infectious Disease Unit for the pre-exposure prophylaxis (PrEP) against HIV follow-up appointment. He had been complaining of anal pain without anal bleeding or secretions for 5 days and admitted risky sexual behaviors (unprotected sex with casual partners) in the previous two weeks, when he had travelled to Indonesia and France. His stable partner, a 24-year-old Italian homosexual man, complained of sore throat and reported the same risky behaviors. He had not travelled abroad in the last month.At physical examination, the patients had not visible cutaneous/mucosal lesions. They performed a complete sexually transmitted infections (STIs) screening including serology for T.pallidum infection, human immunodeficiency virus (HIV), hepatitis B and C viruses, anal, urethral and oropharyngeal swabs for the search of DNA ofChlamydia Trachomatis , Neisseria gonorrhoeae, Mycoplasma hominis, Mycoplasma genitalium, Ureaplasma urealyticum, Ureaplasma parvum, Trichomonas vaginalis by polymerase chain reaction (PCR) and, lastly, anal and oropharyngeal swabs for the search of MPX DNA by PCR, as previously described2,3. The laboratory investigations resulted all negative, except for the detection of MPX DNA at the oropharyngeal and anal swabs, that resulted positive in both sites and in both patients. The clinical presentation of these patients could be misdiagnosed with other STIs, especially with non-gonococcal proctitis and pharyngitis. Indeed, we suggest considering MPX infection in all at-risk patients presenting with traditional or atypical STIs signs/symptoms to avoid incorrect diagnosis.Unlike the patient with MPX virus infection manifesting as single cutaneous lesion that we recently described4, these two patients had not detectable cutaneous/mucosal lesions but only signs/symptoms of systemic involvement. Indeed, MPX virus traditionally causes a systemic infection: once acquired through close contact with skin/mucosal lesions, large respiratory droplets or fomites, the virus replicates at the inoculation site, then it spreads to the local lymph nodes and subsequently to the bloadstrem (initial viremia), causing the viral spread to other organs. These infection phases represent the viral incubation period, lasting 7-14 days. Signs/symptom onset correlates with a secondary MPX viremia corresponding to 1-2 days of prodromal signs/symptoms (mainly fever and lymphadenopathy) before appearance of skin/mucosal lesions5. Noteworthy, the MPX systemic spread during the acute infection represents a potential threat to the safety of blood transfusion and organ transplantation6.According to one of the largest case series describing MPX related signs and symptoms, presentation of MPX infection without skin/mucosal lesions accounts for about 5% of all cases7. We can speculate that in such cases, as in our patients and in those described by Quattri et al.8, the cutaneous/mucosal MPX viral load was so low to cause only localized, single or even undetectable lesions. Unfortunately, we were not able to quantitatively assess the MPX viral load in the swabs that resulted positive nor in the patient’s blood samples to confirm this hypothesis.In conclusion, MPX infection can represent a diagnostic challenge, especially when it occurs as a single cutaneous lesion of the genito-anal site4,8 or with acute anal or oropharyngeal pain in absence of associated cutaneous/mucosal lesions. Physicians should be aware of the possible atypical and scant manifestations of the disease and, in case of high clinical suspicion, should not exclude MPX infection even if cutaneous/mucosal lesions are undetectable.Authors’ contributions : Giulia Ciccarese, Giorgia Brucci: conceptualization, methodology, writing-original draft; Francesco Drago, Antonio Di Biagio: investigation, resources; Bruno Caccianotti, Sergio Lo Caputo, Teresa Santantonio, Gaetano Serviddio: writing review and editing, supervision.

Context: Computational materials science (CMS) focuses on in silico experiments to compute the properties of known and novel materials, where many software packages are used in the community. The NOMAD Laboratory1 offers to store the input and output files in its FAIR data repository. Since the file formats of these software packages are non-standardized, parsers are used to provide the results in a normalized format. Objective: The main goal of this article is to report experience and findings of using grammar-based fuzzing on these parsers. Method: We have constructed an input grammar for four common software packages in the CMS domain and performed an experimental evaluation on the capabilities of grammar-based fuzzing to detect failures in the NOMAD parsers. Results: With our approach, we were able to identify three unique critical bugs concerning the service availability, as well as several additional syntactic, semantic, logical, and downstream bugs in the investigated NOMAD parsers. We reported all issues to the developer team prior to publication. Conclusion: Based on the experience gained, we can recommend grammar-based fuzzing also for other research software packages to improve the trust level in the correctness of the produced results.

“Management fashion” is a term used to describe the study of how certain management concepts became popular and adopted by organizations. The research aims to evaluate why JCI accreditation is seen as a fashion in the health sector in Turkey and to understand how it is adopted by organizations in response to institutional pressures. The research combines in-depth interviews, content analysis and analysis of certification indicators. The findings of the research show that JCI has become a management fashion in Turkey, and this is the first study to address the issue of JCI as a management fashion from the perspective of institutional theory and is one of the first studies to show that managerial fashion can be studied through certifications.

Monochorionicity in the absence of TTTS is not associated with an increased risk of adverse neurodevelopment at 5 years of age.Richard N Brown, MBBS, FRCOG, FACOGDirector of Obstetrics and Maternal Fetal Medicine, McGill University, McGill University Health Centre, Montreal, CanadaCorrespondence AddressRichard Brown, Division of Maternal Fetal Medicine, McGill University Health Centre, 1001 Decarie Blvd, Montreal, Canada H4A 3J1Richard.brown@mcgill.caDisclosures: noneDespite stabilising twin pregnancy rates over the last two decades, as much as one birth in 30 is a twin birth. With twin preterm birth rates being as high as 60% (Martin et al, National Vital Statistics Reports;2019:68), prematurity represents the major factor influencing overall perinatal outcomes in twins. Monochorionicity (MC), with its attendant unique complications (including twin-to-twin transfusion syndrome (TTTS) and selective fetal growth restriction (sFGR)), represents another major risk factor for adverse perinatal outcome in twinning. MC complications contribute to the increased perinatal death rate evident in MC twins compared to dichorionic (DC) twins, as well as the greater premature birth rates [often iatrogenic] amongst MC twins. The potential for neurological harm associated with TTTS is now well understood, whilst in comparison that associated with growth discordance / sFGR or monochorionicity itself, remains less well established.Existing data have suggested increased rates of long-term neurodevelopmental deficits in MC twins overall and especially in those with growth discordance. Perinatal care of twins has improved significantly since data from cases followed in the 90’s reported an 8-fold greater risk of cerebral palsy (CP) in MC twins over DC twins, with this being 19-fold higher in MC twins with discordant growth (Adegbite et al AJOG 2004,190:156-63). A 37% rate of neurological damage has been reported even in the normally grown twin of an sFGR pair, when the co-twin has abnormal Dopplers; however, this was based on neuro-imaging findings within the first month and a half of life (Gratacos et al Ultrasound Obstet Gynecol 2004;24: 15-63). More recent data has shown a difference in mild neurological morbidities only, but follow-up, at a median of 24 months, ranged broadly from 12 months to 7 years (Rustico et al Ultrasound Obstet Gynecol 2017,49, 387-93). Despite the limitations of the available outcome data, such information underpins counselling in MC gestations complicated by sFGR. The question “will my twins be OK in the end?” remains one that is not easy to answer with confidence.The EPIPAGE2 cohort has the advantage of representing a more recent large national cohort of preterm births, recruited over a single year and with long term follow-up data. The sub-analysis presented here (Horau et al BJOG 2023, TBC), addresses the association of chorionicity and neurodevelopmental outcomes of prematurely delivered twins (22-34 weeks) at early school age (5 ½ years). The comprehensive testing likely paints a more realistic picture of the neurodevelopmental and neurobehavioural status of MC twins than these prior studies.Within the described population, 24% of twins were MC. The 20% of these complicated by TTTS were excluded from the outcome analysis given the known impact of TTTS. Growth discordance of 20% or more was found in 26.2% of the MC twins compared with 11.8% of the DC twins. In the context of a population with over a quarter of MC twins displaying significant growth discordance, the results are encouraging. Although fewer (68%) of MC twins were alive at discharge compared to DC twins (78%), the severe CP rates at 5 years were equivalent at around 1%. Amongst survivors there were no differences in the neuro-developmental or neuro-behavioural assessments between the MC and DC twins; with adverse outcomes seemingly therefore being linked principally to prematurity rather than chorionicity or growth discordance itself.

Introduction:Brucellosis is a zoonotic infectious disease with a wide range of manifestations including malaise, anorexia, fever, and profound muscular weakness, as described by Marston in 18601. It is caused by the Gram-negative coccobacillus, Brucella, and remains endemic in some developing countries, such as Iran. There are 6 types of brucella that 4 of which include Brucella melitensis, Brucella abortus, Brucella canis, and Brucella suis were recognized as pathogens involving humans. Brucella melitensis was described as the most common and virulent pathogen worldwide. The first case of ocular brucellosis in a human being was described by Lemaire in 1924 2, presented with bilateral optic neuritis and external ophthalmoplegia in a patient with brucella meningitis.Ocular manifestations of acute and chronic infection include anterior and posterior uveitis, panuveitis, keratitis, conjunctivitis, papillitis, cataract, maculopathies, glaucoma, and ocular muscle paresis. Modern treatments of ocular brucellosis, intraocular as well as systemic antibiotics, have improved the prognosis of the disease3. Herein, we present a patient with endogenous endophthalmitis caused by Brucella Melitensis (B.Melitensis), which is very rare and unusual.

As a result of a warming global climate, understanding how organisms adjust their behaviour to environmental thermal conditions has become an increasingly important question in animal biology. Temperature-driven adjustments in parental care are potentially important due to their repercussions on offspring size, quality and survival. In 2015 and 2016 we monitored 70 zebra finch (Taeniopygia castanotis) breeding attempts in the wild. We recorded the frequency of parental visits to the nest together with mean maximum ambient temperature experienced between day 7 and 14 of the nestling period. We found that for each increase of 1 °C in the daytime temperature there was a 1% reduction in the hourly rate of parental visits. Our data suggest that nestlings may receive less food under thermally challenging conditions, which is consistent with recent studies that demonstrate offspring are smaller when reared during periods of high temperature. Understanding the behavioural drivers that may contribute to the production of smaller offspring in the heat could prove useful to forecast long-term consequences for fitness triggered by climate change.

The biopharmaceutical industry is still running in batch mode, mostly because it is a highly regulated industry sector. In the past, sensors were not readily available and in-process control was mainly executed off-line. The most important product parameters are quantity, purity and potency besides adventitious agents and bioburden. There is increasing economic pressure on time-to-market and also on the environmental sustainability of biopharmaceutical manufacturing. New concepts for manufacturing using disposable single-use technologies and integrated bioprocessing will dominate the future of bioprocessing. In order to ensure the quality of pharmaceuticals initiatives such as Process Analytical Technologies, Quality by Design and Continuous Integrated Manufacturing have been established. The vision must be that these initiatives together with technology development pave the way for process automation and autonomous bioprocessing without any human intervention. Then a real-time release would be realized leading to a highly predictive and robust biomanufacturing system. The steps toward such automated and autonomous bioprocessing are reviewed in context of monitoring and control. Starting from statistical treatment of single and multiple sensors, establishing soft sensors with predictive chemometrics and hybrid models. A scenario is described how to integrate soft sensors and predictive chemometrics into modern process control. This will be exemplified by selective downstream processing steps such as chromatography and membrane filtration, the most common unit operations for separation of biopharmaceuticals.

Background: Longitudinal strain is helpful in discriminating between cardiac amyloidosis and other causes of left ventricle hypertrophy. We aimed to compare left atrial strain between light chain cardiac amyloidosis (AL-CA) and hypertensive heart disease (HHD). Methods: Echocardiography was performed at 21 consecutive AL-CA patients, 56 HHD patients and 21 controls who were enrolled in the current study between April 2018 and January 2021. Echo PAC workstation was employed to analyze LA strain of all the participants. Standard echocardiographic parameters and LA strain parameters were compared between AL-CA and HHD patients. ROC curves were employed to assess the discriminating ability of LA strain. Results: LASr and LASct were significantly lower (21.03 vs 26.17, P =0.009, and 12.11 vs 15.51, P=0.009, respectively) in AL-CA group than those in HHD group, whereas LAScd and SD-TPS were similar between the two groups (P=0.17 and P=0.27, respectively). The cutoff points of LASr and LASct for discriminating between AL-CA and HHD were 19.53% and 11.34%, respectively. Conclusions: AL-CA patients had marked reductions in LASr and LASct. LA strain had additional value in differentiating AL-CA from HHD patients.

In 1921, Otto Stern conceived the idea for an experiment that would decide between a classical and a quantum description of atomic behavior, as epitomized by the Bohr-Sommerfeld-Debye model of the atom. This model entailed not only the quantization of the magnitude of the orbital electronic angular momentum but also of the projection of the angular momentum on an external magnetic field-the so-called space quantization. Stern recognized that space quantization would have observable consequences: namely, that the magnetic dipole moment due to the orbital angular momentum would be space quantized as well, taking two opposite values for atoms whose only unpaired electron has just one quantum of orbital angular momentum. When acted upon by a suitable inhomogeneous magnetic field, a beam of such atoms would be split into two beams consisting of deflected atoms with opposite projections of the orbital angular momentum on the magnetic field. In contradistinction, if atoms behaved classically, the atomic beam would only broaden along the field gradient and have maximum intensity at zero deflection, i.e., where there would be a minimum or no intensity for a beam split due to space quantization. Stern anticipated that, although simple in principle, the experiment would be difficult to carry out-and invited Walther Gerlach to team up with him.

The volume of scientific publications is ever increasing, making it difficult for scholars to publish papers that can capture the readers’ attention. An obvious way to attract readership is by making a truly significant discovery; yet another way may involve tweaking the language to overemphasize the novelty of results. Using a dataset of 52,236 paper abstracts published between 1997 and 2017 in 17 ecological journals, we found that the relative frequency of the use of novelty terms (e.g., ‘groundbreaking’, ‘new’) almost doubled over time. Conversely, we found no such pattern with the use of confirmatory terms (e.g., ‘replicated’, ‘reproducibility’). We argue that, while increasing research opportunities are triggering advances in ecology, the writing style of authors and publishing habits of journals should better reflect the inherent confirmatory nature of ecology.

Designing an effective blended learning strategy requires carefully considering the right blend for different learning objectives. Blended learning is more than just blending in-person and online instruction. Finding the best-blended learning methodologies to achieve various desired learning outcomes is the tricky part. To address this issue, blended learning designers use a model of criteria as a guideline. The common challenges are matching the developed model with a conceptual framework and understanding the efficiency of the developed model. Therefore, formative assessment methods, such as expert review, one-on-one evaluation, and field testing, were used to address these study concerns. The goal of this paper is to present an overview of the methods and models for selecting the best-blended learning approach. It also highlights the need for further investigations to address students, teachers, and institutional challenges in blended learning.

Oceanic islands are among the most transformed ecosystems in the world, with many having experienced major biotic changes through the combined effects of species extinctions and introductions. We map global patterns of taxonomic and functional change in 64 oceanic island bird assemblages and investigate whether these patterns can be explained by either island characteristics (geography, climate) or anthropogenic factors (human occupation, connectivity). The Hawaiian and Mascarene islands stand out as hotspots of taxonomic and functional change, but all islands changed taxonomically and functionally, mostly gaining species but losing functional richness. Island isolation and aridity can explain some of the observed variation in levels of change, but anthropogenic factors have a stronger effect. Remote humid islands have a stronger susceptibility to assemblage turnover and should be prioritized for conservation through the protection of native species and their ecosystems, and by preventing further introductions.

A document by Shahad Alhazmi. Click on the document to view its contents.

Chronic Diarrhea as a Presentation of Behçet’s DiseaseMarawan Elmassry MD1*, Sayed Matar MD2, Jerapas Thongpiya MD1, Pitchaporn Yingchoncharoen MD1, Mostafa Abohelwa MD1, Sameer Islam MD31-Department of Internal Medicine, Texas Tech university Health Sciences Centre, Lubbock, TX, USA.2- Department of Pathology, Brigham and Women Hospital, Harvard Medical School, Boston, MA, USA.3- Department of Gastroenterology and Hepatology, Texas Tech university Health Sciences Centre, Lubbock, TX, USA.*Corresponding Author: Marawan Elmassry MDTexas Tech University Health Sciences Centre at Lubbock, Texas, USA.3601 4th street, Lubbock, TX 79430.Telephone/ Fax: +1-806-773-2831E-mail: Marawan.elmassry@ttuhsc.eduConflict of interest: The authors have no financial conflicts to disclose.Patient’s consent: Written informed consent was obtained from the patient to publish this report in accordance with the journal’s patient consent policy.