Commentary

IntroductionMature cystic teratoma (MCT) of the ovary, as a synonym for the ovarian dermoid cyst, is a benign germ cell tumor. The words “teratoma” and “dermoid” were first described by Leblanc in 1831[1]. The incidence of MCT is 10–20 % of all ovarian tumors. It shows the highest incidence in reproductive age women (range 20 to 40 years) [2,3]. It is a slow growing tumor, and the estimated increasing rate is 1.8 cm per year [4]. Long term recurrence rate is less than 5 % after fertility sparing surgery making it a good option for reproductive age group [5].CaseA 17-year-old girl presented with a history of palpable lump in lower abdomen since two years, gradually increasing in size. Initially she consulted a local practitioner and was told to have an ovarian cyst and advised surgery. However, the patient did not take any treatment for two years. Two months ago, she had an episode of acute abdomen. Diagnostic work-up was done at a tertiary center: ascitic tapping was negative for tuberculosis and malignancy; PET scan was suggestive of ovarian malignancy. She underwent laparotomy but the pelvic mass could not be excised due to dense adhesions with bowel and the abdomen was closed and patient referred to our institute.On examination, she had a 15x15 cm abdomino-pelvic mass, firm to hard in consistency, non-tender, with irregular margins and restricted mobility. Serum tumour markers were as follows: alpha feto-protein-2.6 ng/mL (10-20 ng/mL), beta-hCG-1.2 mIU/ml (<5.0 mIU/ml), lactate dehydrogenase- 182 U/L (140-280 U/L), CA125-16.5 U/mL (<35.0 U/mL), carcinoembryonic antigen-12.2 ng/mL (<2.5 ng/mL), CA19.9- 35 U/mL (<37.0 U/mL). Ultrasonography showed a 10x10 cm hypoechoic lesion arising from the left ovary with internal hyperechoic septae and calcifications. On CECT, a 10x7x10 cm solid-cystic lesion which was FDG-avid on PET scan was seen arising from left ovary with multiple septae and calcifications.With a clinical diagnosis of immature teratoma, she was taken for a staging laparotomy. There was a 15x15 cm irregular cystic mass arising from the left ovary which was densely adherent to anterior abdominal wall, omentum and small bowel. There was no ascites, nor were there any peritoneal deposits. On cut section, the multilocular cyst was found to contain sebaceous material, hair and well-formed bowel-like structures (Fig. 1). Left salpingo-oophorectomy and omental biopsy were done and she made an uneventful recovery.Histopathology confirmed a left ovarian mature teratoma with derivatives from all three germinal layers including skin, bone, respiratory epithelium, intestinal epithelium, nerve bundles, skeletal muscle and glial tissue. Immature elements were absent (Fig. 2, A-F).DiscussionMCT contains components originating from three germ cell layers (ectoderm, mesoderm, and endoderm) with varying ratios of skin, neural, teeth, cartilage, respiratory and intestinal epithelium [3]. They include elements of ectodermal origin in 99–100%, mesodermal origin in 73–93%, and endodermal origin in 32–72% [6-8]. About 7–13 % of MCT cases include intestinal epithelium [7], however, there are only a few cases of ovarian MCT containing complete intestinal structures [9,10].Woodfield et al first reported almost complete development of the gastrointestinal tract in a benign cystic teratoma first containing esophagus to colon [11]. Subsequently only four cases of MCT containing well oriented complete intestinal structure have been reported in the literature and these are described in table 1. In most of them the tumor size was less than 10 cm which in our case was also 10 cm. CEA can be an important marker for predicting presence of intestinal epithelium and to be vigilant for malignant intestinal cancers which was also raised in our case [12,13]. Well differentiated mature neuronal component showed FDG activity misleading the diagnosis as also found in our case [14]. In view of low rate of long term recurrence, fertility sparing surgery was done in the current case as well.ConclusionOccurrence of formed bowel inside a mature cystic teratoma is very rare. Significance of this finding is that the colonic epithelium may be the origin of adenocarcinoma. In cases where the mature cystic teratoma is densely adherent to bowel and has been dissected out after adhesiolysis; the cut section of specimen showing bowel can be alarming to the surgeons.Author’s contributions: All authors contributed to the study conception and design.The first draft of the manuscript was written by SK and all authors reviewed and edited the previous versions of the manuscript. All authors read and approved the final manuscriptConsent for publication: Obtained from the patient’s fatherFunding: Not applicableAvailability of data and material: Not applicableConflicts of interest: There is no conflict of interests among the authorsKey Clinical MessageAbout 7–13 % cases of mature cystic teratoma contain intestinal epithelium but there are only a few reported cases containing complete intestinal structure. We discuss here the case of a 17 year old girl with the above finding and its management.Keywords: bowel, dermoid cyst, intestinal epithelium, mature teratoma, ovaryReferences1. Kim MJ, Kim NY, Lee DY, Yoon BK, Choi D. Clinical characteristics of ovarian teratoma: age-focused retrospective analysis of 580 cases. Am J Obstet Gynecol. 2011;205(1):322. Alotaibi MO, Navarro OM. Imaging of ovarian teratomas in children: a 9-year review. Can Assoc Radiol J. 2010;61(1):23–8.3. Caspi B, Appelman Z, Rabinerson D, Zalel Y, Tulandi T, Shoham Z. The growth pattern of ovarian dermoid cysts: a prospective study in premenopausal and postmenopausal women. Fertil Steril. 1997;68(3):501–5.4. Chang CF, Lin CK. A case of recurrent, bilateral ovarian mature teratoma in a young woman. BMC Womens Health. 2014;14:57–60.5. Templeman CL, Fallat ME, Lam AM, Perlman SE Hertweck SP, O’Connor DM. Managing mature cystic teratomas of the ovary. Obstet Gynecol Surv. 2000;55(12):738–45.6. Marcial-Rojas RA, Medina R. Cystic teratomas of the ovary. A clinical and pathological analysis of two hundred sixty-eight tumors. Arch Pathol.  1958;66:577–5897. Caruso PA, Marsh MR, Minkowitz S, et al. An intense clinicopathologic study of 305 teratomas of the ovary. Cancer.  1971;27:343–348.8. Blackwell WJ, Dockerty MB, Masson JC, et al. Dermoid cysts of the ovary. Their clinical and pathologic significance. Am J Obstet Gynecol.  1946;51:151–172.9. Fujiwara K, Ginzan S, Silverberg SG. Mature cystic teratomas of the ovary with intestinal wall structures harboring intestinal type epithelial neoplasms. Gynecol Oncol. 1995;56:97–101.10. Tang P, Soukkary S, Kahn E. Mature cystic teratoma of the ovary associated with complete colonic wall and mucinous cystadenoma. Ann Clini Lab Sci. 2003;33(4):465–70.11. Woodfield B, Kate DA, Cantrell CJ, et al: A benign cystic teratoma with gastrointestinal tract development. Am J Clin Pathol  1985;83 :236–240.12. Takao M, Yoshino Y, Taguchi A, Uno M, Okada S, Kino N, et al. A case of mature cystic teratoma with intestinal structures harboring intestinal-type low-grade mucinous neoplasm. Int Canc Conf J. 2018; 7(2):59-6413. Makihara N, Ebina Y, Yamasaki Y, et al. Preoperative prediction of malignant transformation arising in a mature cystic teratoma of the ovary. J Minm Invasive Gynecol.  2014;30:112–116.14. Yokoyama T, Takehara K, Yamamoto Y, Okame S, Shiroyama Y, Yokoyama T, Nogawa T, Sugawara Y. The usefulness of 18F-FDG-PET/CT in discriminating benign from malignant ovarian teratomas. Int J Clin Oncol. 2015 Oct;20(5):960-6. doi: 10.1007/s10147-015-0800-0. Epub 2015 Feb 15. PMID: 25681878.15. Nelson, D.B., Hoffman, B.L., Lemeshev, Y. et al. Avoiding the bowel: a report of a mature cystic teratoma displaying fully developed intestinal tissue protruding from an ovarian tumor. Gynecol Surg 8, 223–225 (2011).Table 1: Case reports with intact intestinal segment associated with Mature cystic teratoma

Objectives: To examine the variation in patient’s health outcomes across different type, route, and strength of menopausal hormone therapy (HT). Design: Retrospective case-control study Setting: United States 2007-2020 Population: 10 million women aged 65 or more in US Medicare. Methods: Cox regression models with time-varying type, route, and strength of HT as well as patient characteristics. Main Outcome(s): all-cause mortality; 5 cancers- breast, lung, endometrial, colorectal, ovarian cancers; 6 CV conditions- ischemic heart diseases, heart failure, venous thromboembolism, stroke, atrial fibrillation, acute myocardial infarction; and dementia. Results Estrogen monotherapy (ET) exhibited a significant, 19% (HR=0.81; 95% CI 0.79-0.82), relative risk reduction on mortality. The reduction was greater with estradiol and vaginal/transdermal than conjugated estrogen and oral preparations. ET also exhibited significant risk reductions for all study cancers; breast (15%), lung (13%), endometrial (29%), colorectal (13%) and ovarian (14%). All ET preparations except low-dose slightly increased risk of ischemic heart diseases (1-4%). Both combination therapy and progestogen monotherapy exhibited significantly increased risk of breast cancer (7-14%). Oral ET exhibited moderately increased risk of stroke (6%) and dementia (2%). Conclusions: Among senior Medicare women, the effect of menopausal HT varies by type, route, and strength. The use of estradiol, vaginal/transdermal, and low/medium for menopausal care is safer than its counterparts.

Capital works projects, particularly the modification of coastal rivers, are becoming increasingly significant to economic activities worldwide as a response to climate-driven changes and urbanization. The benefits of channel modification projects can be realized quickly, but the altered movement of sediments in the river channel can lead to unintended morphologic changes decades later. An example of this is the closure of the San Bernard River mouth, located on the central coast of Texas, which was clogged by sediments in the 1990s as a result of two major projects in the area: the diversion of the Brazos River channel (1929) and the construction of the Gulf Intracoastal Waterway (GIWW) (1940s). The objective of this study was to document the delayed geomorphic response to the projects using historical aerial imagery and provide a snapshot of flow pathways in the area using measurements collected in situ. Results showed that the GIWW was the main conduit for river flow as it bisects the San Bernard 2 km inland of its river mouth, reducing discharge in the terminal limb of the river. Due to reduced flow, the river mouth became clogged with wave-transported sediment supplied the Brazos River which had been diverted to within 6 km of the San Bernard. With no connection to the sea, altered sediment and flow pathways have led to numerous hazards and costly corrective dredging projects. To optimize the cost-effectiveness of channel modification projects their long-term impact must be considered as managers continue to adapt to ever-changing coastal zones.

Body condition is a frequently used physiological indicator of avian health and is affected by an array of environmental variables. Although a number of studies have investigated the specific effects of individual weather variables on body condition in birds, few have analyzed the effects of both temperature and precipitation within the context of an extreme weather event such as hurricanes. In this study we examined the relationship between breeding season body condition and daily maximum temperature, daily minimum temperature, and monthly total precipitation for three passerine bird species at the Welder Wildlife Refuge near Rockport, Texas. We also evaluated yearly changes in body condition over a twelve-year period for northern cardinals (Cardinalis cardinalis), painted buntings (Passerina ciris), and white-eyed vireos (Vireo griseus), focusing on the extreme precipitation event of Hurricane Harvey which caused heavy localized flooding. We found that body condition declined with average daily minimum and maximum temperatures, while precipitation had varied, species-specific effects in the three species analyzed. Our results also suggest that northern cardinals experienced a notable reduction in average body condition in the two years following Hurricane Harvey. Taken together, we conclude that short-term precipitation and temperature drivers can be important correlates of body condition in songbirds and that severe weather events may reduce body condition in some bird species.

The ‘signal-to-noise paradox’ for seasonal forecasts of the winter NAO is often described as an ‘underconfident’ forecast and measured using the ratio-of-predictable components metric (RPC). However, comparison of RPC with other measures of forecast confidence, such as spread-error ratios, can give conflicting impressions, challenging this informal description. We show, using a linear statistical model, that the ‘paradox’ is equivalent to a situation where the reliability diagram of any percentile forecast has a slope exceeding 1. The relationship with spread-error ratios is shown to be far less direct. We furthermore compute reliability diagrams of winter NAO forecasts using seasonal hindcasts from the European Centre for Medium-range Weather Forecasts and the UK Meteorological Office. While these broadly exhibit slopes exceeding 1, there is evidence of asymmetry between upper and lower terciles, indicating a potential violation of linearity/Gaussianity. The limitations and benefits of reliability diagrams as a diagnostic tool are discussed.

Pore fluids are ubiquitous throughout the lithosphere and are commonly cited as the cause of slow-slip and complex modes of tectonic faulting. We investigate the role of fluids for slow-slip and the frictional stability transition and find that the mode of fault slip is mainly unaffected by pore pressures. We shear samples at effective normal stress (σ’n) of 20 MPa and pore pressures Pp from 1 to 4 MPa. The lab fault zones are 3 mm thick and composed of quartz powder with median grain size of 10 µm. Fault permeability evolves from 10-17 to 10-19 m2 over shear strains up to 26. Under these conditions, dilatancy strengthening is minimal. Slow slip may arise from dilatancy strengthening at higher fluid pressures but for the conditions of our experiments slip rate-dependent changes in the critical rate of frictional weakening are sufficient to explain slow-slip and the stability transition to dynamic rupture.

The differences in the functional diversity and species diversity of macroinvertebrates can be based to evaluate the changes in local environment. However, there are little available analysis on the effect mechanism of seasons on the functional characteristics of macroinvertebrate communities in the subtropical region. This work compared the functional feeding groups (FFG) of macroinvertebrates in wet season, normal season, and dry season of 2021 in Jingui River in Shenzhen. This work mainly was aimed to comprehend the connection between the environmental driving elements in the Jingui River and the seasonal distribution of the FFG of macroinvertebrates. The highest species diversity and abundance were found among the collector-gatherers (GC), while the largest biomass was observed among the predators. Overall, the functional diversity of the Jingui River exhibited a significantly seasonal change. In particular, the functional diversity decreased in wet season, implying a stronger disturbance. A multiple regression analysis revealed that the species diversity and stream environmental parameters might account for 12.8% - 72.9% of the functional diversity of macroinvertebrates.

Raptors are apex predators threatened globally by electrocution, collisions, and habitat fragmentation. Most species of raptors are understudied and largely unexplored. Top predators like raptors depend on the sustainability of the ecosystems in which they live and migrate. Knowing how endangered raptors are geographically dispersed, as well as the factors that may influence how they use their habitat, is critical for their protection. This research focuses on Kenya, where there are gaps in knowledge on appropriate habitats and raptor dispersal patterns. With several species of raptors endangered, it is crucial to determine their distribution patterns for management and conservation. To evaluate the size of the realized niches for five Kenyan raptor species at the risk of extinction, we applied species distribution models (SDMs) through an ensembling approach using occurrence data from the Global Biodiversity Information Facility (GBIF) and environmental covariates. These species were: Martial eagle, Secretarybird, Bateleur, Steppe Eagle, and Southern ground hornbill. The five raptors’ distribution within and outside protected areas and the role of key environmental predictors in predicting their distribution was estimated. Our findings indicate raptor distribution in several areas in Kenya that is predominantly in the south-western region, extending into the country’s central region. Martial eagle had the largest niche range amounting to ca.49,169 km2 while the Southern ground hornbill had the smallest niche range amounting to ca.4,145 km2. Secretarybird had the highest distribution outside protected areas at 77.57% followed by the Martial eagle at 76.89%. Significant predictors of raptor species distribution in Kenya were; precipitation during the warmest quarter, precipitation during the driest month, and precipitation during the coldest quarter. Key areas for raptor conservation listed here could serve as foundation for a number of additional Important Bird Areas (IBAs) in Kenya, according to the A1 Global IBA Criterion for species that are globally threatened.

The development of DNA-based methods in recent decades has opened the door to numerous new lines of research in the biological sciences. While their speed and accuracy are clearly beneficial, the sensitivity of these methods has the adverse effect of increased susceptibility to false positives resulting from contamination in field or lab. Here, we present findings from a metabarcoding study on the diet of and food availability for several insectivorous birds, in which multiple lepidopteran species not known to occur locally were discovered. After describing the pattern of occurrences of these non-local species in the samples, we discuss various potential origins of these sequences. First, we assess that the taxonomic assignments appear reliable, and local occurrences of many of the species can be plausibly ruled out. Then, we look into the possibilities of natural environmental contamination, judging it to be unlikely, albeit impossible to fully falsify. Finally, while the pattern of occurrences did not suggest lab contamination, we find overlap with material handled in the same lab, which was undoubtedly not coincidental. Even so, not all exact sequences were accounted for in these locally conducted studies, nor was it clear if these and other sequences could remain detectable years later. Although the full explanation for the observations of non-local species remains inconclusive, these findings highlight the importance of critical examination of metabarcoding results, and showcase how species-level taxonomic assignments utilizing comprehensive reference libraries may be a tool in detecting potential contamination events, and false positives in general.

IASPEI National Correspondent, INSA IUGG-IGU National Committee (e-mail: ajay@ngri.res.in)Summary 

Solar Photo Voltaic system 

Distributed Acoustic Sensing (DAS) is a technology in which a fiber-optic cable is 1 turned into an acoustic sensor by measuring backscatter of light caused by changes in 2 strain from the surrounding acoustic field. In October 2022, 9 days of DAS and co-3 located hydrophone data were collected in Puget Sound near Seattle, WA. Passive data 4 was continuously recorded for the duration and a broadband source was fired from 5 several locations and depths on the first and last days. This dataset provides direct 6 comparisons between DAS and hydrophone measurements, and demonstrates the 7 ability of DAS to measure acoustics signals up to ~500Hz. 8 9

Purpose: This study evaluated the outcome of prognostic features and survival results of the major and minor malignant salivary gland carcinoma (MSGC) histopathologies. Materials and Methods: One hundred-forty patients with major/minor MSGC were registered in databases from 2004 to 2019. The median age of the patients was 57 (18-89). Major MSGC was diagnosed in 81 patients and mostly in the parotid gland (49%). Minor MSGC was diagnosed in 59 patients and often on the hard palate (19%). The most common histopathology is mucoepidermoid carcinoma (MEC)(47%) in major MSGC and adenoid cystic carcinoma (ACC) in minör MSGC (31%). Major MSGC was most diagnosed in the early stages, while the minor MSGC was diagnosed in the advanced stages. Results: Median follow-up is 73 months (5-197). The ten year local control (LC) and the distant metastasis free survival (DMFS) rates were 85% and 76%, respectively. The overall survival rate was 79% (10 years). The local control rates were statistically different in the patients with R1-R2 diseases (p=0.039) and advanced T and N stages (p=0.05, p=0.022, respectively). The presence of microscopic perineural invasion (PNI) was not significant in local recurrence in patients with ACC. Distant metastasis rates were statistically increased in patients with advanced tumor and nodal stages (p=0.031, p=0.003, respectively), R1-R2 disease (p=0.027), high grade (p=0.048), PNI (p=0.006). Conclusions: Advanced tumor and nodal stage, high tumor grade, and surgical margin status are strongly correlated with the worse oncological outcomes. The prognostic significance of microscopic PNI has not yet been clarified.

Ecosystem management aims at providing many ecosystem services simultaneously. Such ecosystem multifunctionality can be limited by trade-offs and increased by synergies among the underlying ecosystem functions (EF), which need to be understood to develop targeted management. Previous studies found differences in the correlation between EFs. We hypothesised that correlations between EFs are variable even under the controlled conditions of a field experiment and that seasonal and annual variation, plant species richness, and plot identity (identity effects of plant communities such as the presence and absence of functional groups and species) are drivers of these correlations. We used data on 31 EFs related to plants, consumers, and physical soil properties that were measured over 5 to 19 years, up to three times per year, in a temperate grassland experiment with 80 different plots, constituting six sown plant species richness levels (1, 2, 4, 8, 16, 60 species). We found that correlations between pairs of EFs were variable, and correlations between two particular EFs could range from weak to strong correlations or from negative to positive correlations among the repeated measurements. To determine the drivers of pairwise EF correlations, the covariance between EFs was partitioned into contributions from plant species richness, plot identity, and time (including years and seasons). We found that most of the covariance for synergies was explained by species richness (26.5%), whereas for trade-offs, most covariance was explained by plot identity (29.5%). Additionally, some EF pairs were more affected by differences among years and seasons and therefore showed a higher temporal variation. Therefore, correlations between two EFs from single measurements are insufficient to draw conclusions on trade-offs and synergies. Consequently, pairs of EFs need to be measured repeatedly under different conditions to describe their relationships with more certainty and be able to derive recommendations for the management of grasslands.

The 3,4-dihydroxyphenylalanine (DOPA) melanin is one of important virulence factors for Cryptococcus neoformans, which may trigger immune responses in the host. It is worth exploring the genetic function of C. neoformans, by which we may derive more antifungal strategies. Therefore, we established two systems that were constructed quickly and easily for the knock-down/knock-out of LAC1 gene: RNA interference (RNAi) and clustered regularly interspaced short palindromic repeats (CRISPR)-Cas9. The RNAi system used pSilencer 4.1-CMV neo plasmid and short hairpin RNA to realize the effective transcriptional suppression. The CRISPR-Cas9 system used the PNK003 vectors to obtain a stable albino mutant strain. The results of phenotype, qRT-PCR, Transmission Electron Microscope (TEM) and spectrophotometry were used to assess the ability of melanin production. As a result, the RNAi system displayed attenuation of transcriptional suppression when the transformants continuously passed on new plates. However, the transcriptional suppression of long loop in short hairpin RNA were more powerful and lasted longer. The CRISPR-Cas9 system constructed an albino strain completely without the ability to produce melanin. Considering the weakening of transcriptional suppression, we recommend using a long loop for the RNAi system and 1st or 2nd passage of knockdown strains for the subsequent studies. Besides, the different capacities of melanin production might be useful for exploring the linear relation between melanin and immunoreaction of the host. In addition, we recommend applying the PNK003 vectors to other serotypes of C. neoformans for quick screening of possible trait-regulating genes because of its easy construction and valid knockout effect.

This article presents a high-efficiency circularly polarized slotted waveguide leaky wave antenna at the W band. A linearly polarized beam-steering antenna is designed by creating an array of longitudinal slots on the WR-10 waveguide and to achieve circular polarization, a single-layer polarization converter has been used. A new technique has been proposed to enhance the overall efficiency of the antenna. The wall thickness of the waveguide containing the radiating slots is reduced to increase the overall radiation efficiency of the provided antenna. The gain of the prototype antenna is above 20 dBi in the intended operating band from 92 GHz to 98 GHz. Furthermore, the antenna provides an average half-power beamwidth (HPBW) of 3.2° in the elevation plane and a cross-polarization below -18 dB in the main beam direction. Attributed to robust structure, reliable fabrication, and simple antenna configuration as well as its superior performance, the proposed structure is a strong candidate for various W band applications.

Purpose Successful utilization of anatomical templates in the evaluation of diffusion-weighted neuroimaging-studies requires accurate registration of intra-individual datasets. We investigated the feasibility of structural MRI image registration onto single-shot and read-out segmented echo-planar diffusion-weighted imaging variants for use in tractographic samplings of the visual system, in particular the optic nerve. Methods Slab volumes of the optic nerve pathway from thirteen volunteers were acquired and preprocessed. Three neuroradiologists marked landmarks (ROIs, regions of interest) on two diffusion-weighted and one structural dataset. Structural ROIs were respectively registered (6/12 degrees of freedom, DOF) onto single-shot (ss-EPI) and readout-segmented (rs-EPI) volumes. All six ROI/FOD (fibre orientation distribution) combinations underwent a targeted tractography task (MRtrix3: iFOD2). Results Inter-rater reliability for ROI-placement was highest in VIBE images (0.66 to 0.95, mean 0.85) and lower in both ss-EPI (mean 0.77) and rs-EPI (0.46 to 0.84, mean 0.64). Sufficient FOD generation in the optic nerve was successful in 12/26 of all cases for ss-EPI volumes (46.2% of cases) and in 18/26 for rs-EPI volumes (69.2%). Spatial shift of VIBE-drawn ROI-coordinates after 6-DOF registration was highest for ss-EPI-targets (medians: 1.15 to 1.4 mm; rs-EPI 0.82 to 0.93 mm), whereas 12-DOF registration caused less spatial shifts (ss-EPI: 0.64 to 1.03 mm; rs-EPI: 0.58 mm to 0.79 mm). Tractography results revealed no significant differences between ss-EPI and rs-EPI sequences on cases with mutual generation of sufficient FODs (n=10). Conclusion Structurally-placed ROIs (highest inter-rater reliability) with 6-DOF registration onto rs-EPI targets (highest FOD-generation rate) seems most suitable for white matter template generation.

Background: Methamphetamine use disorders (MAUD) can substantially jeopardize public security due to their high-risk social psychology and behavior. Given that the dopamine reward system is intimately associated with MAUD, we investigated the association of single nucleotide polymorphisms (SNPs), as well as methylation status of DRD4, COMT genes and paranoid, motor impulsive symptoms in MAUD patients. Methods: A total of 189 MAUD patients participated in our study. Samples of peripheral blood were used to detecte for 3 SNPs and levels of 35 CpG units of methylation in the DRD4 gene’s promoter region, 5 SNPs and 39 CpG units in the COMT gene. Results: MAUD patients with rs1800955 C allele have a lower percentage of paranoid symptom than those with rs1800955 TT. Individuals with paranoid symptom exhibited reduced methylation degree at particular DRD4 CpG2.3 unit. The interaction of the DRD4 rs1800955 C allele and the reduced DRD4 CpG2.3 methylation degree resulted in the lower occurrence of the paranoid symptom. Meanwhile, those with COMT rs4818 CC allele have lower motor impulsivity scores in MAUD patients, but greater COMT methylation levels in the promotor region and methylation degree at COMT CpG 51.52 unit. Therefore, based only on COMT rs4818 CC polymorphism, there was a negative correlation between COMT methylation and motor impulsivity scores in the MAUD patients. Conclusions: Our results found that the combination of SNP genotyping and methylation status of the DRD4 and COMT genes may serve as biological indicators to evaluate the prevalence of relatively high-risk psychotic symptoms in MAUD patients.

Purpose: This study aimed to evaluate the influence of DRG-based hospital payment system approach on implementation of inpatient treatment. Methods: This study was largely based on retrospective analysis of DRG-based hospital payment data from third-class hospital for the period of October 2021 to February 2022 including determination of diagnosis groups with most significant balance of payment loss and corresponding departments, development of pathways to DRG-based inpatient treatment, pre-checking of prescriptions, in process education of clinical pharmacists and case follow up, comments and penalty measures. The rational drug use, drug income proportion and DRG-related medical services capability assessment (manageable number of DRGs, CMI, average hospital stay, time consumption index and resource consumption index) of departments with loss were compared before and after intervention. Results: Data analysis revealed that BR23 (cerebral ischemic stroke with accompanying diseases or complications) balance of payments loss was most significant with higher average drug income proportion than such in groups of balance of payments surplus. The Neurology Department BR23 demonstrated significant balance of payment deficit. Therefore, the ischemic stroke drug clinical treatment pathway was successfully developed and after intervention, prescription errors counted 14.14, therefore demonstrated 6.89% decrease and at the same time medicines consumption rate was 27.17% with 9.43% decrease. The number of manageable number of DRGs increased by 3, CMI increased by 0.14, average length of stay decreased by 0.8 days, time consumption index and resource consumption index decreased by 0.11 and 0.18 respectively. Conclusion: DRG-based hospital payment management of inpatient treatment provided theoretical support for DRG code-based reimbursement cost control and scientific cost control and has improved quality management of hospital service.

Introduction United Kingdom medical graduates can apply for speciality training after completing a two-year internship (Foundation Training). Post-foundation training application requirements vary depending on speciality but fundamentally require key skills such as teaching, research, and leadership. We investigated whether medical student demographics impact their familiarity with post-graduate training pathways and application process. Methods This was a cross-sectional study using a Bristol Online Survey. All UK medical students were invited to answer a range of questions on their demographics and perceived familiarity with Post-Foundation Training Pathways (PFTPs) and Post-Foundation Application Process (PFAP). The data was collected between March 2022 and April 2022 and exported for further analysis. Statistical analysis was conducted in Stata v.17.1 using Chi-square tests. Results 850 students from 31 medical schools took part. Male students were found to be more familiar with PFTPs and PFAP compared to female students (p<0.001). Similarly, students from Black, Asian, Mixed Ethnic (BAME) backgrounds expressed significantly lower familiarity (p<0.001) with PFAP compared to their white counterparts. Younger participants reported lower familiarity with PFAP (p<0.001). Students from a medical background expressed a significantly higher familiarity with PFTPs and PFAP (p<0.001). Conclusion The impact of gender, ethnicity, age group and medical background on medical students’ self-reported familiarity with PFTP and PFAP are significant. Further studies are required to evaluate the impact of demographics on tested knowledge of PFTPs and PFAP and whether this impacts success rate at post-foundation applications.

Visual context modulates perception of local orientation attributes. These spatially very localised effects are considered to correspond to specific excitatory-inhibitory connectivity patterns of early visual areas as V1, creating perceptual tilt repulsion and attraction effects. Here, orientation misperception of small Gabor stimuli was used as a probe of this computational structure by sampling a large spatio-orientation space to reveal expected asymmetries due to the underlying neuronal processing. Surprisingly, the results showed a regular iso-orientation pattern of nearby location effects whose reference point was globally modulated by the spatial structure, without any complex interactions between local positions and orientation. This pattern of results was confirmed by the two perceptual parameters of bias and discrimination ability. Furthermore, the response times to stimulus configuration displayed variations, that further provided evidence of how multiple early visual stages affect perception of simple stimuli.

HBV remains a public health concern. Blood donors screened for HBsAg along with AST/ALT could play a key in providing safe blood products. We investigated the features related to HBV infection among rejected blood donors in Luanda, Angola. This was a cross-sectional study conducted with 164 rejected donors. Donors were screened for HBsAg from March to May 2022. Overall, 63.4% tested positive for HBV. Mean age of the HBV-positive (29.2±8.02) was lower than the HBV-negative (33.9±10.0) (p<0.001). Donors between 20–40 years (OR:2.34, p=0.045), females (OR:1.40, p=0.516), residents in urbanized areas (OR:1.23, p=0.530), low educational (OR:1.54, p=0.458), unemployed (OR:1.65, p=0.271), and unmarried (OR:1.41, p=0.616), might be likely to contract HBV. AST/ALT ratio was higher in HBV-infected (2.07±1.42) than in HBV-uninfected (1.90±1.14). About 20% of HBV-positive were classified as having acute liver disease, while 80% with chronic liver disease, based on AST/ALT ratio. Age ranged from 20-40 years (OR:1.97, p=0.305), females (OR:1.61, p=0.557), donors from non-urbanized (OR:1.69, p=0.557), a low educational (OR:1.64, p=0.571), and unemployed donors (OR:1.81, p=0.289) were likely to develop chronic liver disease. Our findings indicated the failure of viral hepatitis control measures. Authorities should consider including HBV nucleic acid testing to ensure early identification of HBV in Angola.

Commentary:Herpes simplex virus and SLE: though uncommon yet with significant implicationsNaim Mahroum1, Abdulrahman Elsalti1, Yehuda Shoenfeld21International School of Medicine, Istanbul Medipol University, Istanbul, Turkey.2Zabludowicz Center for autoimmune diseases, Sheba Medical Center, Ramat-Gan, Israel.Running title : Commentary: Herpes simplex virus and SLE: though uncommon yet with significant implicationsKeywords – Autoimmunity, infection and autoimmunity, systemic lupus erythematosus, human herpes viruses, herpes simplex virus