Diagnosing intracardiac masses poses a complex, multimodal challenge. We present the case of a 72-year-old woman with a history of rheumatic fever leading to mitral stenosis and a previous mitral valve commissurotomy who reported fatigue, weakness, and palpitations over the past three months. Echocardiography revealed a tumor (53 × 40 mm) in the enlarged left atrium, attached by a wide base to the left atrium wall, exhibiting variable densities. Computerized tomography identified a heterodense mass (53 × 46 × 37 mm) with similar attachments. Angiography showed two branches from the circumflex artery intricately associated with the mass. Despite unsuccessful embolization of the mass’ blood supply, surgical intervention including mitral valve replacement, tricuspid valve annuloplasty, and tumor removal was pursued. Pathohistological analysis confirmed the mass as a thrombus. During the postoperative follow-up, the patient presented with no complaints. Follow-up echocardiography indicated the normal function of the mechanical mitral valve prosthesis and the absence of intracardiac masses. While it remains unknown whether this neovascularization is specific to patients with severe mitral valve disease, this case highlights the diagnostic challenges of differentiating between thrombi and tumors in the context of mitral valve disease. It illustrates the critical role of multimodal imaging in elucidating the anatomical and functional relationships within the heart, thereby guiding accurate diagnosis and effective treatment.

Objective: High blood pressure and proteinuria play major roles in chronic kidney disease (CKD), a high-mortality condition that affects millions of people. Reactive oxygen species (ROS) produced by NADPH oxidases are implicated in many pathophysiological processes including hypertension and CKD. Apocynin (APO) shows the anti-oxidative activity by inhibiting the assembly of NADPH oxidase and overproduction of ROS. The aim of this study was to investigate the effects of apocynin on oxidative stress, blood pressure and kidney function in normotensive rats with CKD induced by 5/6 nephrectomy through ligation of renal poles (Nx-L). Design and method: Male Wistar rats were divided into three groups. One group was control (sham surgery) and two other groups underwent two-step surgical procedure of 5/6 nephrectomy induced by ligation of renal poles. Unlike conventional Nx which leads to high mortality due to hemorrhage in or after surgery, here we induced Nx by ligation of the upper and lower poles (leads to necrosis of these poles) of left kidney after removal the right kidney one week later. After 4 weeks from this procedure, control and model group (Nx-L) received vehicle, while Nx-L+APO received apocynin 20 mg/kg/day (i.p.) for 4-week-period. Mean blood pressure (MAP), proteinuria, and oxidative stress marker (thiobarbituric acid reactive species-TBARS) in plasma and urine were measured. Results: In model group we observed significantly increased MAP (121,13±2,01vs.94,88±4,13mmHg, p<0.001), plasma creatinine (55,4±1,3vs. 41,3±2,3μmol/l, p<0.001), and proteinuria (0,036±0,006vs.0,017±0,001mg/min/kg, p<0.01) levels compared to those in control. Furthermore, significant increase of plasma TBARS level (5,47±0,77vs.2,75±0,52nmol/ml, p<0.01) and urine TBARS excretion (1,10±0,06vs.0,86±0,04nmol/min/kg, p<0.01) were detected in model compared to control. Interestingly, APO treatment significantly reduced blood pressure to the level of control (83,88±5,14vs.94,88±4,13mmHg). APO significantly reduced urine protein loss (0,024±0,002vs.0,036±0,006mg/min/kg, p<0.05) and plasma creatinine level (49,9±1,5vs.55,4±1,3μmol/l, p<0.05) as well as reduced plasma lipid peroxidation (2,19±0,26vs.5,47±0,77nmol/ml, p<0.001) in comparison to model group. Conclusions: Our results show that APO treatment prevents blood pressure rising and ameliorates kidney function in rats with 5/6 nephrectomy trough improvement of systemic oxidative status. Therefore, NADPH oxidase presents a potential therapeutic target in this form of kidney disease.

This article focuses on the parameter estimation problem in wireless sensor networks (WSNs) under adversarial attacks, considering the complexities of sensing and communication in challenging environments. In order to mitigate the impact of these attacks on the network, we propose a novel AP-DLMS algorithm with adaptive threshold attack detection and malicious punishment mechanism. The adaptive threshold is constructed using the observation matrix and network topology to detect the location of malicious attacks, while the standard reference estimation is designed to obtain the estimated deviation of each node. To mitigate the impact of data tampering on network performance, we introduce the honesty factor and punishment factor to combine the weights of normal nodes and malicious nodes respectively. Additionally, we propose a new probabilistic random attack model. Simulations are conducted to investigate the influence of key parameters in the adaptive threshold on the performance of the proposed AP-DLMS algorithm, and the mean square performance of the algorithm is analyzed under various attack models. The results demonstrate that the proposed algorithm exhibits strong robustness in adversarial networks, and the proposed attack model effectively demonstrates the impact of attacks.

Vesicoureteral reflux (VUR) is defined as the urine backflow from the urinary bladder to the pyelo-caliceal system. In contrast, intrarenal reflux (IRR) is the backflow of urine from the renal calyces into the tubulointerstitial space. VURs, particularly those associated with IRR can result in reflux nephropathy when accompanied by urinary tract infection (UTI). The prevalence of IRR in patients with diagnosed VUR is 1–11% when using voiding cystourethrography (VCUG), while 11.9–61% when applying the contrast-enhanced voiding urosonography (ceVUS). The presence of IRR diagnosed by VCUG often correlates with parenchymal scars, when diagnosed by a 99mTc dimercaptosuccinic acid scan (DMSA scan), mostly in kidneys with high-grade VURs, and when diagnosed by ceVUS, it correlates with the wide spectrum of parenchymal changes on DMSA scan. The study performed by both ceVUS and DMSA scans showed IRRs associated with non-dilated VURs in 21% of all detected VURs. A significant difference regarding the existence of parenchymal damage was disclosed between the IRR-associated and IRR-non-associated VURs. A higher portion of parenchymal changes existed in the IRR-associated VURs, regardless of the VUR grade. That means that kidneys with IRR-associated VURs represent the high-risk group of VURs, which must be considered in the future classification of VURs. When using ceVUS, 62% of places where IRR was found were still unaffected by parenchymal changes. That was the basis for our recommendation of preventive use of long-term antibiotic prophylaxis until the IRR disappearance, regardless of the VUR grade. We propose a new classification of VURs using the ceVUS method, in which each VUR grade is subdivided based on the presence of an IRR.

Abstract International education is Australia’s largest services export, and third largest export altogether, generating between $22 billion and $40 billion per year over the last few years. Higher education represents half of this ‘market’ with over 25 % of students being from overseas. Despite the important role that international students play in the fabric of Australian society and specifically in higher education, the findings from our linguistic ethnographic study of international students at an Australian university showed that the English language learning needs of these students were frequently unmet. Using James Scott’s theory of official and hidden transcripts, we reveal that students reported feeling that their “English is not good enough” and assumed personal ‘(ir)responsibility’ for this outcome. In this broad English Medium Instruction (EMI) context, where English is not the first language, but it is used as the language of instruction and as the lingua franca amongst international students, English-dominant perspectives acted to marginalise international students, impacting their academic performance and confidence for social networking. In this paper, we describe the shifts in higher educational policy in Australia over the last few decades to provide context to the current neoliberal educational climate for international students. We draw on principles of social justice to examine the present-day system and argue that Australian universities need to shift from an EMI by default model to a genuine EMI offering.

Background: Peripheral arterial disease (PAD) is highly prevalent and has a well-known association with diabetes. It is still unknown if diabetes worsens clinical outcomes after lower extremity revascularization (LER). Research question: What is the impact of diabetes on clinical outcomes in patients with PAD undergoing LER. Goals: In this meta-analysis, we assessed the effect of diabetes on mortality, major limb amputation, and major adverse cardiovascular events (MACE) in patients with PAD following endovascular or open LER during the perioperative period and within 30 days of follow-up. Methods: We performed a systematic search of PubMed, Embase, and Cochrane databases to December 2023, including studies that compared the clinical outcomes of patients with diabetes and without diabetes following LER procedure. Review Manager 5.4 was used for statistical analysis. I 2 statistics were used to examine heterogeneity. A random-effects model was applied to all analyses. Results: Of the 3,810 articles screened, five observational studies with 55,444 patients were included. A total of 51.13 % had diabetes. There was no significant association between diabetes and mortality (RR 0.96; 95 % confidence interval (CI) 0.74 - 1.26; I 2 = 69%; P = 0.79; Figure 1A). However, diabetes was associated with a significantly increased risk of major limb amputation by 50% (RR 1.50; 95 % CI 1.03 - 2.21; I 2 = 94%; P = 0.04; Figure 1B), and an 18% significantly higher risk of experiencing MACE (RR 1.18; 95 % CI 1.08 - 1.29; I 2 = 0%; P = 0.0005; Figure 1C). Conclusion: Our findings suggest that diabetes is associated with an increased risk of major amputation and MACE but not with mortality in patients following LER.

Conditioning before allogeneic hematopoietic stem cell transplantation (AlloHSCT) increases the tissue injury signal IL-33 in fibroblastic reticular cells (FRC). Released IL-33 directly stimulates donor CD4 T cells to prime IL-12-independent Type 1 T helper cell (Th1) differentiation and expansion. Tissue stroma upregulates IL-33, but a role for IL-33 in sustaining the pathogenic donor Th1 responses causing GVHD is unclear. We compared B6 mice with inducible ST2 deletion (R26-CreERT2xSt2fl/fl) to wildtype (WT) R26-CreERT2 as T cell donors in a lethal GVHD model (B6 to BALB/c). Donor ST2 deletion at days 10-14 post AlloHSCT increased CD4 T cells Foxp3 expression with reciprocal decreases in Tbet expression in both the lymphoid organs and target tissues. Sustained IL-33 signaling also maintained donor T cell TCF1 expression. Ablating ST2 after GVHD development improved clinical scores and promoted recipient weight gain. How bioactive IL-33 is released from nuclear sequestration remains undefined. RNAseq analysis suggested that IL-33 stimulates T cell granzyme B (GzmB) expression and B6 GzmB deficient (Gzmb-/-) donor T cells displayed reduced activation and expansion similar to ST2 deficient CD4 T cells. In contrast to GzmBWT, anti-IL-33 antibodies had no impact on GzmBKO T cell responses. Thus, cross-talk between donor T cells and IL-33+ stroma orchestrates the T cell identities that are critical to sustain the pathogenic CD4 T cell responses causing GVHD.

Due to their advantages—longer internal force delay compared to bulk materials, resistance to harsh conditions, damping of a wide frequency spectrum, insensitivity to ambient temperature, high reliability and low cost—granular materials are seen as an opportunity for the development of high-performance, lightweight vibration-damping elements (particle dampers). The performance of particle dampers is affected by numerous parameters, such as the base material, the size of the granules, the flowability, the initial prestress, etc. In this work, a series of experiments were performed on specimens with different combinations of influencing parameters. Energy-based design parameters were used to describe the overall vibration-damping performance. The results provided information for a deeper understanding of the dissipation mechanisms and their mutual correlation, as well as the influence of different parameters (base material, granule size and flowability) on the overall damping performance. A comparison of the performance of particle dampers with carbon steel and polyoxymethylene granules and conventional rubber dampers is given. The results show that the damping performance of particle dampers can be up to 4 times higher compared to conventional bulk material-based rubber dampers, even though rubber as a material has better vibration-damping properties than the two granular materials in particle dampers. However, when additional design features such as mass and stiffness are introduced, the results show that the overall performance of particle dampers with polyoxymethylene granules can be up to 3 times higher compared to particle dampers with carbon steel granules and conventional bulk material-based rubber dampers.