An Unusual Case of Tertiary Syphilis Behaving Like Tongue Squamous Cell Carcinoma.

Syphilis may present with a myriad of oral manifestations in the primary, secondary, and tertiary stages, and may be confused with malignancy. Despite a rise in the incidence of syphilis, tertiary syphilis is exceedingly rare. Tertiary syphilis gummas usually affect the hard palate, while tongue involvement is very rare. A 55-year-old male with extensive smoking and alcohol use was referred for malignancy evaluation with an ulcerative mass creating a tongue cleft, and a positron emission tomography scan suggestive for malignancy. Biopsy results demonstrated no carcinoma but histology demonstrated granulomatous inflammation. Further laboratory results demonstrated elevated rapid plasma reagin titers with Treponema pallidum immunoglobulin G antibodies present. The patient was diagnosed with tertiary syphilis, received appropriate antibiotic therapy, and had healing of the tongue with a persistent cleft. Syphilis may mimic many disease processes. As such, it is important to include this disease in the differential of an unusual tongue lesion. An oral lesion may be the first sign of infection

A randomized sham-controlled study of pulmonary vein isolation in symptomatic atrial fibrillation (The SHAM-PVI study): Study design and rationale

INTRODUCTION: Pulmonary vein (PV) isolation has been shown to reduce atrial fibrillation (AF) burden and symptoms in patients. However, to date previous studies have been unblinded raising the possibility of a placebo effect to account for differences in outcomes. HYPOTHESIS & METHODS: The objective of this study is to compare PV isolation to a sham procedure in patients with symptomatic AF. The SHAM-PVI study is a double blind randomized controlled clinical trial. 140 patients with symptomatic paroxysmal or persistent AF will be randomized to either PV isolation (with cryoballoon ablation) or a sham procedure (with phrenic nerve pacing). All patients will receive an implantable loop recorder. The primary outcome is total AF burden at 6 months postrandomisation (excluding the 3 month blanking period). Key secondary outcomes include (1) time to symptomatic and asymptomatic atrial tachyarrhythmia (2) total atrial tachyarrhythmia episodes and (3) patient reported outcome measures. RESULTS: Enrollment was initiated in January 2020. Through April 2023 119 patients have been recruited. Results are expected to be disseminated in 2024. CONCLUSION: This study compares PV isolation using cryoablation to a sham procedure. The study will estimate the effect of PV isolation on AF burden

Stringy Toda Cosmologies

We discuss a particular stringy modular cosmology with two axion fields in seven space-time dimensions, decomposable as a time and two flat three-spaces. The effective equations of motion for the problem are those of the $SU(3)$ Toda molecule, and hence are integrable. We write down the solutions, and show that all of them are singular. They can be thought of as a generalization of the Pre-Big-Bang cosmology with excited internal degrees of freedom, and still suffering from the graceful exit problem. Some of the solutions however show a rather unexpected property: some of their spatial sections shrink to a point in spite of winding modes wrapped around them. We also comment how more general, anisotropic, solutions, with fewer Killing symmetries can be obtained with the help of STU dualities.Comment: 22 pages, latex, no figures. Several minor typos correcte

Contextual factors among indiscriminate or larger attacks on food or water supplies, 1946-2015

This research updates previous inventories of malicious attacks on food and water to include data from 1946 through mid-2015. A systematic search of news reports, databases and previous inventories of poisoning events was undertaken. Incidents that threatened or were intended to achieve direct harm to humans, and that were either relatively large (number of victims > 4 or indiscriminate in intent or realisation were included. Agents could be chemical, biological or radio-nuclear. Reports of candidate incidents were subjected to systematic inclusion and exclusion criteria as well as validity analysis (not always clearly undertaken in previous inventories of such attacks). We summarise contextual aspects of the attacks that may be important for scenario prioritisation, modelling and defensive preparedness. Opportunity is key to most realised attacks, particularly access to dangerous agents. The most common motives and relative success rate in causing harm were very different between food and water attacks. The likelihood that people were made ill or died also varied by food/water mode, and according to motive and opportunity for delivery of the hazardous agent. Deaths and illness associated with attacks during food manufacture and prior to sale have been fewer than those in some other contexts. Valuable opportunities for food defence improvements are identified in other contexts, especially food prepared in private or community settings

Paget's disease of bone in two medieval skeletons from Poulton Chapel, Cheshire, UK

Paget's disease of bone (PDB) is a chronic, metabolic disease disrupting normal bone turnover and is reported as one of the most common bone diseases after osteoporosis. PDB is characterised by excessive bone remodelling resulting in bone enlargement, fragility, deformity and additional complications. Typically, PDB affects one or a few bones of the axial skeleton and is commonly recorded in older individuals (over 55 years of age) affecting more males than females. Although PDB has been reported worldwide, there is a high concentration of reported cases in the UK, with a regional hotspot in the northwest of England. This study reviews an adult male (SK463) and female (SK750) with skeletal lesions of PDB from Poulton Chapel, Cheshire. Full macroscopic and radiographic analysis has identified the skeletal distribution of PDB, with up to 75% of both skeletons affected. SK463 presents noticeable anterior bowing to both tibiae, likely the result of PDB. AMS radiocarbon dating and stable isotope analysis performed on teeth samples confirmed that both individuals' dates were medieval, had a mixed/varied diet and were local to the northwest of England. This research adds to the emerging paleopathological literature on PDB, while providing additional support for the identification of a geographical hotspot observed in contemporary populations

A Generic Transferable EEG Decoder for Online Detection of Error Potential in Target Selection

Reliable detection of error from electroencephalography (EEG) signals as feedback while performing a discrete target selection task across sessions and subjects has a huge scope in real-time rehabilitative application of Brain-computer Interfacing (BCI). Error Related Potentials (ErrP) are EEG signals which occur when the participant observes an erroneous feedback from the system. ErrP holds significance in such closed-loop system, as BCI is prone to error and we need an effective method of systematic error detection as feedback for correction. In this paper, we have proposed a novel scheme for online detection of error feedback directly from the EEG signal in a transferable environment (i.e., across sessions and across subjects). For this purpose, we have used a P300-speller dataset available on a BCI competition website. The task involves the subject to select a letter of a word which is followed by a feedback period. The feedback period displays the letter selected and, if the selection is wrong, the subject perceives it by the generation of ErrP signal. Our proposed system is designed to detect ErrP present in the EEG from new independent datasets, not involved in its training. Thus, the decoder is trained using EEG features of 16 subjects for single-trial classification and tested on 10 independent subjects. The decoder designed for this task is an ensemble of linear discriminant analysis, quadratic discriminant analysis, and logistic regression classifier. The performance of the decoder is evaluated using accuracy, F1-score, and Area Under the Curve metric and the results obtained is 73.97, 83.53, and 73.18%, respectively

ACVIM consensus statement on the diagnosis of immune-mediated hemolytic anemia in dogs and cats

Immune-mediated hemolytic anemia (IMHA) is an important cause of morbidity and mortality in dogs. IMHA also occurs in cats, although less commonly. IMHA is considered secondary when it can be attributed to an underlying disease, and as primary (idiopathic) if no cause is found. Eliminating diseases that cause IMHA may attenuate or stop immune-mediated erythrocyte destruction, and adverse consequences of long-term immunosuppressive treatment can be avoided. Infections, cancer, drugs, vaccines, and inflammatory processes may be underlying causes of IMHA. Evidence for these comorbidities has not been systematically evaluated, rendering evidence-based decisions difficult. We identified and extracted data from studies published in the veterinary literature and developed a novel tool for evaluation of evidence quality, using it to assess study design, diagnostic criteria for IMHA, comorbidities, and causality. Succinct evidence summary statements were written, along with screening recommendations. Statements were refined by conducting 3 iterations of Delphi review with panel and task force members. Commentary was solicited from several professional bodies to maximize clinical applicability before the recommendations were submitted. The resulting document is intended to provide clinical guidelines for diagnosis of, and underlying disease screening for, IMHA in dogs and cats. These should be implemented with consideration of animal, owner, and geographical factors

MSMEG_2731, an Uncharacterized Nucleic Acid Binding Protein from Mycobacterium smegmatis, Physically Interacts with RPS1

While the M. smegmatis genome has been sequenced, only a small portion of the genes have been characterized experimentally. Here, we purify and characterize MSMEG_2731, a conserved hypothetical alanine and arginine rich M. smegmatis protein. Using ultracentrifugation, we show that MSMEG_2731 is a monomer in vitro. MSMEG_2731 exists at a steady level throughout the M. smegmatis life-cycle. Combining results from pull-down techniques and LS-MS/MS, we show that MSMEG_2731 interacts with ribosomal protein S1. The existence of this interaction was confirmed by co-immunoprecipitation. We also show that MSMEG_2731 can bind ssDNA, dsDNA and RNA in vitro. Based on the interactions of MSMEG_2731 with RPS1 and RNA, we propose that MSMEG_2731 is involved in the transcription-translation process in vivo

Time and Encoding Effects in the Concealed Knowledge Test

Although the traditional “lie detector” test is used frequently in forensic contexts, it has (like most test of deception) some limitations. The concealed knowledge test (CKT) focuses on participants’ recognition of privileged knowledge rather than lying per-se and has been studied extensively using a variety of measures. A “guilty” suspect’s interaction with and memory of crimescene items may vary. Furthermore, memory for crimescene items may diminish over time. The interaction of encoding quality and test delay on CKT efficiency has been previously implied, but not yet demonstrated. We used a response-time based CKT to detect concealed knowledge from shallow and deep study procedures after 10-min, 24-h, and 1-week delays. Results show that more elaborately encoded information afforded higher detection accuracy than poorly encoded items. Although classification accuracy following deep study was unaffected by delay, detection of poorly elaborated information was initially high, but compromised after 1 week. Thus, choosing optimal test items requires considering both test delay and initial encoding level