Malignancy or dermatophyte infection? The challenges in evaluation of chronic diffuse rashes

Introduction: The purpose of our case presentation is to help understand the use of diagnostic studies in differentiating diffuse rashes with potentially underlying malignant etiology from infectious etiology. A 40 y.o. F with a past medical history significant for anemia presented to the ED with painful rashes that had been getting worse for over 1 year. She mentioned that initially the rash began on her arm around the time when her 2 dogs were being treated for fungal infection and then it started spreading to her chest, back, upper extremities, lower extremities, abdomen, and genital areas as well. She described the rash as flaky and pruritic but denied any associated pain. She admitted to having tried several over-the-counter creams with no improvement. In addition, the patient had recent significant unintentional weight loss. On physical examination, her skin was noted to have brown plaques and patches with excoriations, flaking, and sharp violaceous borders present on her forehead, neck, chest, abdomen, arms, anterolateral thighs, ankles, and feet. They were non-erythematous and non-blanching. The diffuse nature, persentience, and slow growth of these rashes were concerning for an underlying malignant etiology such as cutaneous T-cell lymphoma (mycosis fungoides or Sezary syndrome), Kaposi’s sarcoma, and erythema gyratum repens secondary to GI/GU malignancy. Another differential considered was immunobullous rash secondary to medication reaction. Methods: To work-up the top two differentials for this patient which were lymphoma/malignancy-related rash and skin mycosis, extensive diagnostic work up was done. Imaging included CT scans of the chest, pelvis, and abdomen, and pelvic ultrasound. Additional labs were ordered such as beta-D-glucan level, HIV testing, shave biopsy, lymph node excisional biopsy, and zinc levels. Results: CT of the chest showed enlarged axillary and lateral chest wall lymph nodes. CT of the abdomen and pelvis showed enlarged masslike appearance of the uterus with fluid-filled, displaced endometrial cavity, moderate pelvic ascites, abnormally enlarged inguinal lymph nodes as well as possible retroperitoneal and iliac chain adenopathy. Pelvic U.S. showed enlarged leiomyomatous uterus. Excisional lymph node biopsy did not show presence of malignant cells. Shave biopsy of the rash was negative for fungal stains and showed non-specific dermatitis. Serum beta-D-glucan levels came back significantly elevated at 230 pg/mL (normal range is \u3c60). Blood cultures showed no growth after 5 days. Patient’s zinc level was 32 mcg/dL which is low (normal range is 60-130 mcg/dL). HIV screening was negative.I’m Discussion: The challenge in this case was trying to understand the rashes could be of fungal etiology as they don’t tend to be extensive unless the patient is immunocompromised. According to the results, it seems that the patient most likely has a systemic fungal infection as shown by shave biopsy results, elevated beta-D-glucan levels, and lymph node biopsy negative for malignancy. Patient is currently being treated with antifungals. But, we still cannot rule out malignancy until there is improvement with current treatment regimen and mycosis fungoides can be ruled out by outpatient Hem/Onc follow-up

ReactIE: Enhancing Chemical Reaction Extraction with Weak Supervision

Structured chemical reaction information plays a vital role for chemists engaged in laboratory work and advanced endeavors such as computer-aided drug design. Despite the importance of extracting structured reactions from scientific literature, data annotation for this purpose is cost-prohibitive due to the significant labor required from domain experts. Consequently, the scarcity of sufficient training data poses an obstacle to the progress of related models in this domain. In this paper, we propose ReactIE, which combines two weakly supervised approaches for pre-training. Our method utilizes frequent patterns within the text as linguistic cues to identify specific characteristics of chemical reactions. Additionally, we adopt synthetic data from patent records as distant supervision to incorporate domain knowledge into the model. Experiments demonstrate that ReactIE achieves substantial improvements and outperforms all existing baselines.Comment: Findings of ACL 2023, Short Pape

Hyperbolic Graph Diffusion Model

Diffusion generative models (DMs) have achieved promising results in image and graph generation. However, real-world graphs, such as social networks, molecular graphs, and traffic graphs, generally share non-Euclidean topologies and hidden hierarchies. For example, the degree distributions of graphs are mostly power-law distributions. The current latent diffusion model embeds the hierarchical data in a Euclidean space, which leads to distortions and interferes with modeling the distribution. Instead, hyperbolic space has been found to be more suitable for capturing complex hierarchical structures due to its exponential growth property. In order to simultaneously utilize the data generation capabilities of diffusion models and the ability of hyperbolic embeddings to extract latent hierarchical distributions, we propose a novel graph generation method called, Hyperbolic Graph Diffusion Model (HGDM), which consists of an auto-encoder to encode nodes into successive hyperbolic embeddings, and a DM that operates in the hyperbolic latent space. HGDM captures the crucial graph structure distributions by constructing a hyperbolic potential node space that incorporates edge information. Extensive experiments show that HGDM achieves better performance in generic graph and molecule generation benchmarks, with a $48\%$ improvement in the quality of graph generation with highly hierarchical structures.Comment: accepted by AAAI 202

Associations Among Suicidal Ideation, White Matter Integrity and Cognitive Deficit in First-Episode Schizophrenia

Objective: The study was aimed to investigate the possible associations among suicidal ideation, brain white matter (WM) integrity and cognitive deficit in first-episode schizophrenia (FES) using diffusion tensor imaging.Methods: The sample contained 18 FES patients with suicidal ideation (SI+), 45 FES patients without suicidal ideation (SI–) and 44 healthy controls. The Calgary Depression Scale for Schizophrenia was used to measure the suicidal ideation and depression symptoms. The whole brain WM integrity and three domains of cognitive function: working memory, verbal comprehension as well as processing speed were compared between the three groups.Results: Compared with SI–, SI+ showed preserved WM integrity as indicated by significantly higher factional anisotropy (FA) or lower mean diffusivity (MD) in multiple WM tracts, and higher FA coupled with lower MD in bilateral posterior corona radiata. Compared with SI−, SI+ were more depressed and had less cognitive deficit in working memory and verbal comprehension. The fiber tracts in bilateral posterior corona radiata connect to the precuneus as shown by probabilistic tractography, and their WM integrity disruptions were found to be positively associated with the cognitive deficits in the FES patients.Discussion: Preserved WM integrity may be a risk factor for suicidal ideation in FES patients. One possible explanation is that it contributes to preserved cognitive function, especially in working memory and verbal comprehension, which may be associated with greater insight and could lead to increased depression and suicidal ideation. The posterior corona radiata and the precuneus may be linked to the related biological processes

Biomimetic lipid-bilayer anode protection for long lifetime aqueous zinc-metal batteries

The practical application of rechargeable aqueous zinc batteries is impeded by dendrite growth, especially at high areal capacities and high current densities. Here, this challenge is addressed by proposing zinc perfluoro(2-ethoxyethane)sulfonic (Zn(PES)2) as a zinc battery electrolyte. This new amphipathic zinc salt, with a hydrophobic perfluorinated tail, can form an anode protecting layer, in situ, with a biomimetic lipid-bilayer structure. The layer limits the anode contact with free H2O and offers fast Zn2+ transport pathways, thereby effectively suppressing dendrite growth while maintaining high rate capability. A stable, Zn2+-conductive fluorinated solid electrolyte interphase (SEI) is also formed, further enhancing zinc reversibility. The electrolyte enables unprecedented cycling stability with dendrite-free zinc plating/stripping over 1600 h at 1 mA cm−2 at 2 mAh cm−2, and over 380 h under an even harsher condition of 2.5 mA cm−2 and 5 mAh cm−2. Full cell tests with a high-loading VS2 cathode demonstrate good capacity retention of 78% after 1000 cycles at 1.5 mA cm−2. The idea of in situ formation of a biomimetic lipid-bilayer anode protecting layer and fluorinated SEI opens a new route for engineering the electrode–electrolyte interface toward next-generation aqueous zinc batteries with long lifetime and high areal capacities

First detection of Rickettsia aeschlimannii in Hyalomma marginatum in Tibet, China

Hyalomma marginatum is an important arthropod vector in the transmission of various zoonoses. The aim of this study was to identify the tick-borne pathogens (TBPs) maintained in Hy. marginatum in Tibet and to estimate the risk of human tick-borne diseases. Adult Hy. marginatum ticks (n = 14) feeding on yaks were collected. The individual DNA samples of these ticks were sequenced with metagenomic next-generation sequencing to survey the presence of TBPs. TBPs in individual ticks were identified with nested polymerase chain reaction (PCR) combined with DNA sequencing. The presence of Rickettsia , Anaplasma , and Ehrlichia in individual ticks was indicated by the taxonomic profiles at the genus level, but only Rickettsia aeschlimannii (100%, 13/13) was further detected in the ticks by nested PCR. This study provides information on the microbial communities of Hy. marginatum in Tibet, China, and provides the first report of R. aeschlimannii found in Hy. marginatum in Tibet. The results of this study indicated that yaks in Tibet are exposed to R. aeschlimannii