A Real-Time Adaptive Station Beamforming Strategy for Next Generation Phased Array Radio Telescopes.

The next generation phased array radio telescopes, such as the Square Kilometre Array (SKA) low frequency aperture array, suffer from RF interference (RFI) because of the large field of view of antenna element. The classical station beamformer used in SKA-low is resource efficient but cannot deal with the unknown sidelobe RFI. A real-time adaptive beamforming strategy is proposed for SKA-low station, which trades the capability of adaptive RFI nulling at an acceptably cost, it doesn't require hardware redesign but only modifies the firmware accordingly. The proposed strategy uses a Parallel Least Mean Square (PLMS) algorithm, which has a computational complexity of 4N+2 and can be performed in parallel. Beam pattern and output SINR simulation results show deeply nulling performance to sidelobe RFI, as well as good mainlobe response similar to the classical beamformer. The convergence performance depends on the signal-and-interference environments and step size, wherein too large a step size leads to a non-optimal output SINR and too small a step size leads to slow convergence speed. FPGA implementation demonstrations are implemented and tested on a NI FPGA module, and test results demonstrate good real-time performance and low slice resource consumption.

Growth charts for children aged 6-17 years in Shanxi, China: comparison with other cities of China and WHO.

BACKGROUND: Growth charts are an important method for evaluating a child's health, growth, and nutritional status. It is essential to monitor the growth of children and adolescents using growth charts. OBJECTIVES: To present body mass index (BMI)-for-age references reflecting children's growth in Shanxi. We also compare our new data with growth references of other cities of China and World Health Organization (WHO) growth standards. METHODS: A stratified cluster random sampling method was used to recruit 5461 children and adolescents aged 6-17 years. Height and weight were measured and BMI was calculated. The LMS method was used to calculate the percentile values of body mass index by sex and age. Smoothed BMI-for-age growth curves were presented for both sexes and compared with reference data from other cities of China and WHO. RESULTS: BMI centiles increased with age but with different patterns in both boys and girls. The centile curves from the 3rd to the 50th had a slight increase, while a sharp increase was seen from 11 to 17 years in boys and from 6 to 14 years in girls in the higher centiles. In comparison with other cities of China, the values for the 50th percentile are higher than those reported for children from China 2009, Shanghai, Changsha and China 2010 in both sexes. In comparison with WHO growth references, Chinese girls and boys had higher values in all percentiles, whereas curves of girls look roughly the same. The medians for BMI in Shanxi increase linearly from 6 to 17 years in boys. CONCLUSIONS: The BMI percentiles of children aged 6-17 years in Shanxi differed significantly from the growth reference curves of other cities of China and WHO. Recommending the provision of BMI reference curves for local children and adolescents to assess their growth and development and monitor their nutritional status. Early detection of overweight and obesity in children provides a scientific basis for the prevention and control of overweight and obesity in children.

Vena cava leiomyosarcoma surgery results in a retrospective cohort of 41 patients from two centers.

BACKGROUND: Leiomyosarcoma of the vena cava (LMS-VC) is a rare entity with poor oncological outcomes and a lack of histological staging prognostic factors. METHODS: Outcomes of consecutive patients operated on LMS-VC between March 2003 and May 2022, in two specialized sarcoma centers were reported. RESULT: Forty-one patients were identified. Median size of LMS-VC was 9 cm with 68% of complete obstruction. After surgery, severe complication rate was 30%. No postoperative mortality was reported. Microscopic complete excision was obtained for 71% of patients, R1 for 27% and one patient presented an R2 resection. Grade 3 was found in 24%. After a median follow-up of 70 months, 3 years disease-free survival (DFS) and 5 years DFS were 34% and 17%, and 3 years overall survival (OS) and 5 years OS were 74% and 50%. Distant metastasis concerned 54% of recurrences, local 7% and local and distant 5%. Multivariate analysis showed that FNCLCC grade (p < 0.001) and perioperative chemotherapy (p = 0.026) were significant factors for DFS. In multivariate analysis, FNCLCC grade was a significant factor for OS (p = 0.004). DISCUSSION: Perioperative chemotherapy may have a role to play in lowering the risk of recurrence for LMS-VC, particularly in high-grade tumor.

Students bypass the syllabus to utilize alternate LMS locations for assignment deadlines.

The syllabus is a required document for all courses to provide students with course information, policies, and assignment deadlines. The goals of this study were to investigate students' perception of the role of the syllabus, preferred location of assignment deadlines, and preferred style of receiving deadline notifications. Faculty (n = 14) and students (n = 324) from community colleges through professional schools were invited to participate and complete a survey. We used a mixed-method design of survey questions, and the results demonstrated that students defined a syllabus as both a contract and a learning tool and that it should be flexible. Students ranked assignment deadlines as the most important part of the syllabus, yet a follow-up question indicated that most referred to four distinct locations in their learning management system (LMS) to find these deadlines. Although students preferred to receive deadline notifications on their smartphones, they also wanted to be reminded by faculty in class. This study helps faculty to obtain a glimpse of current student practices. We recommend that faculty communicate with students the role and expected use of the syllabus in their course while emphasizing its use to identify deadlines. This renewed practice will be time well spent to avoid student confusion and missed deadlines.NEW & NOTEWORTHY With the adoption of learning management systems (LMSs), students may no longer rely on the syllabus to locate or confirm assignment deadlines and instead rely on various LMS locations, which may not be accurate. We suggest that faculty consider taking the time to review the role and use of the syllabus on the first day of class to ensure that students know where to access current assignment deadlines to avoid confusion and missed deadlines.

2­D08 mediates notable anticancer effects through multiple cellular pathways in uterine leiomyosarcoma cells.

2',3',4'­trihydroxyflavone (2­D08), a SUMO E2 inhibitor, has several biological functions, including anticancer activity, but its effects on uterine leiomyosarcoma (Ut­LMS) are unknown. The anticancer activity of 2­D08 was explored in an in vitro model using SK­LMS­1 and SK­UT­1B cells (human Ut­LMS cells). Treatment with 2­D08 inhibited cell viability in a dose­ and time­dependent manner and significantly inhibited the colony­forming ability of Ut­LMS cells. In SK­UT­1B cells treated with 2­D08, flow cytometric analysis revealed a slight increase in apoptotic rates, while cell cycle progression remained unaffected. Western blotting revealed elevated levels of RIP1, indicating induction of necrosis, but LC3B levels remained unchanged, suggesting no effect on autophagy. A lactate dehydrogenase (LDH) assay confirmed increased LDH release, further supporting the induction of apoptosis and necrosis by 2­D08 in SK­UT­1B cells. 2­D08­induced production of reactive oxygen species and apoptosis progression were observed in SK­LMS­1 cells. Using Ki67 staining and bromodeoxyuridine assays, it was found that 2­D08 suppressed proliferation in SK­LMS­1 cells, while treatment for 48 h led to cell­cycle arrest. 2­D08 upregulated p21 protein expression in SK­LMS­1 cells and promoted apoptosis through caspase­3. Evaluation of α­SM­actin, calponin 1 and TAGLN expression indicated that 2­D08 did not directly initiate smooth muscle phenotypic switching in SK­LMS­1 cells. Transcriptome analysis on 2­D08­treated SK­LMS­1 cells identified significant differences in gene expression and suggested that 2­D08 modulates cell­cycle­ and apoptosis­related pathways. The analysis identified several differentially expressed genes and significant enrichment for biological processes related to DNA replication and molecular functions associated with the apoptotic process. It was concluded that 2­D08 exerts antitumor effects in Ut­LMS cells by modulating multiple signaling pathways and that 2­D08 may be a promising candidate for the treatment of human Ut­LMS. The present study expanded and developed knowledge regarding Ut­LMS management and indicated that 2­D08 represents a notable finding in the exploration of fresh treatment options for such cancerous tumors.

Determination of speed and assessment of conditioning in horses submitted to a lactate minimum test-alternative approaches.

The maximal lactate steady state (MLSS) is a well-known gold standard method for determining the aerobic capacity of athletic horses. Owing to its high cost and complex execution, there is a search for standardized exercise tests that can predict this value in a single session. One of the methods described for this purpose is the lactate minimum test (LMT), which could be more accurate despite being adequate to predict MLSS. This study aimed to examine the impact of training on the speed corresponding to lactate minimum speed (LMS) and to apply new mathematical methods to evaluate the fitness level of horses based on the curve obtained by the LMT. Ten Arabian horses underwent a 6-week training program based on LMS calculated by second-degree polynomial regression (LMSP). In addition, the LMS was also determined by visual inspection (LMSV), bi-segmented linear regression (LMSBI) and spline regression (LMSS). From the curve obtained during the LMT, it was possible to calculate angles α, ß and ω, as well as the total area under the curve (AUCTOTAL) before (AUCPRELMS) and after (AUCPOSLMS) the LMS. The methods for determining the LMS were evaluated by ANOVA, intraclass correlation coefficient (ICC) and effect size (ES) by Cohen's d test. The Pearson correlation coefficient (r) between the proposed LMS determination methods and other mathematical methods was also calculated. Despite showing a good correlation (ICC >0.7), the LMS determination methods differed from each other (p < 0.05), albeit without a significant difference resulting from conditioning. There were reductions in α:ß ratio, angle α, and AUCPOSTLMS, with the latter indicating lower lactate accumulation in the incremental phase of LMT after conditioning, in addition to an improvement in the animals' aerobic capacity. Considering that the most common methods for determining the LMS are applicable yet with low sensitivity for conditioning assessment, the approaches proposed herein can aid in analyzing the aerobic capacity of horses subjected to LMT. The mathematical models presented in this paper have the potential to be applied in human lactate-guided training program trials with a comparable study basis.

Identification of UDP-glucuronosyltransferase (UGT) isoforms involved in the metabolism of Chlorophenols (CPs).

Chlorophenols (CPs) are a group of pollutants that pose a great threat to the environment, they are widely used in industrial and agricultural wastes, pesticides, herbicides, textiles, pharmaceuticals and plastics. Among CPs, pentachlorophenol was listed as one of the persistent organic pollutants (POPs) by the Stockholm convention. This study aims to identify the UDP-glucosyltransferase (UGT) isoforms involved in the metabolic elimination of CPs. CPs' mono-glucuronide was detected in the human liver microsomes (HLMs) incubation mixture with co-factor uridine-diphosphate glucuronic acid (UDPGA). HLMs-catalyzed glucuronidation metabolism reaction equations followed Michaelis-Menten or substrate inhibition type. Recombinant enzymes and chemical reagents inhibition experiments were utilized to phenotype the main UGT isoforms involved in the glucuronidation of CPs. UGT1A6 might be the major enzyme in the glucuronidation of mono-chlorophenol isomer. UGT1A1, UGT1A6, UGT1A9, UGT2B4 and UGT2B7 were the most important five UGT isoforms for metabolizing the di-chlorophenol and tri-chlorophenol isomers. UGT1A1 and UGT1A3 were the most important UGT isoforms in the catalysis of tetra-chlorophenol and pentachlorophenol isomers. Species differences were investigated using rat liver microsomes (RLMs), pig liver microsomes (PLMs), dog liver microsomes (DLMs), and monkey liver microsomes (MyLMs). All these results were helpful for elucidating the metabolic elimination and toxicity of CPs.

Benchmarking antibody clustering methods using sequence, structural, and machine learning similarity measures for antibody discovery applications.

Antibodies are proteins produced by our immune system that have been harnessed as biotherapeutics. The discovery of antibody-based therapeutics relies on analyzing large volumes of diverse sequences coming from phage display or animal immunizations. Identification of suitable therapeutic candidates is achieved by grouping the sequences by their similarity and subsequent selection of a diverse set of antibodies for further tests. Such groupings are typically created using sequence-similarity measures alone. Maximizing diversity in selected candidates is crucial to reducing the number of tests of molecules with near-identical properties. With the advances in structural modeling and machine learning, antibodies can now be grouped across other diversity dimensions, such as predicted paratopes or three-dimensional structures. Here we benchmarked antibody grouping methods using clonotype, sequence, paratope prediction, structure prediction, and embedding information. The results were benchmarked on two tasks: binder detection and epitope mapping. We demonstrate that on binder detection no method appears to outperform the others, while on epitope mapping, clonotype, paratope, and embedding clusterings are top performers. Most importantly, all the methods propose orthogonal groupings, offering more diverse pools of candidates when using multiple methods than any single method alone. To facilitate exploring the diversity of antibodies using different methods, we have created an online tool-CLAP-available at (clap.naturalantibody.com) that allows users to group, contrast, and visualize antibodies using the different grouping methods.

LMS-supported HyFlex clinical supervision model: Illuminating perspectives from teacher candidates in the department of English language teaching.

This study presents a HyFlex Clinical Supervision Model supported by a Learning Management System (LMS). The model is designed to facilitate a seamless transition from face-to-face to remote education, particularly in unforeseen circumstances such as the COVID-19 pandemic. The primary aim is to understand the mode preferences of teacher candidates for various aspects of the teaching process, including receiving feedback on lesson plans, structuring teaching sessions, observation, being observed, and receiving feedback after teaching sessions during mentoring activities. The study included 58 fourth-year teacher candidates who were enrolled in English Language Teaching departments across six state universities in five regions in Turkey. Data was collected through an online questionnaire using Google Forms and interviews conducted via Zoom. The study uncovered diverse preferences among teacher candidates with regards to teaching sessions, observation methods, and feedback. The HyFlex clinical supervision model proposed is adaptable to both traditional and remote practicum settings.

Opalski Syndrome and Elucidation of Lateral Medullary Syndrome.

In this case, a 61-year-old patient presented with Horner's syndrome of the left eye, left-sided truncal ataxia, left-sided pain/paresthesia of the face as well as right-sided loss of pain and temperature of the arms and legs. MRI findings displayed a clear 4 mm acute left lateral medullary infarct of the left posterior inferior cerebellar artery (PICA) vascular territory, indicative of lateral medullary syndrome (LMS). The presence of pre-existing medical conditions such as uncontrolled diabetes, late-stage syphilis, and a mechanical aortic valve complicated this clinical picture. The presence of ipsilateral corticospinal deficits in this patient revealed Opalski syndrome, a rare variant of LMS. This case report highlighted the importance of correlating imaging and physical examination of stroke findings.

Urine LMs quantitative analysis strategy development and LMs CWP biomarkers discovery.

Coal workers' pneumoconiosis (CWP) is one of the most common inhalation occupational diseases. It is no effective treatment methods. Early diagnosis of CWP could reduce mortality. Lipid mediators (LMs) as key mediators in the generation and resolution of inflammation, are natural biomarkers for diagnosis inflammatory disease, such as CWP. The UHPLC-MRM technique was used to detect LMs in urine. The metabolic network of LMs in CWP and CT group samples was comprehensively analyzed. Screening for major difference compounds between the two groups. Aimed to contribute to the early diagnosis and treatment of CWP. Urinary levels of 13-OxoODE, 9-OxoODE, and 9,10-EpOME were significantly higher in the CWP group compared with the CT group (P < 0.05). In the model group, the area under the receiver operating characteristic (ROC) for 9-OxoODE,13-OxoODE,9,10-EpOME was 84.4%, 73.3%, and 80.9%, respectively. In the validation group, the area under the ROC was 87.0%, 88.8%, and 68.8% for 9-OxoODE,13-OxoODE,9,10-EpOME, respectively. According to the logistic regression model, the area under the ROC was 80.4% in the model group and 86.7% in the validation group. 13-OxoODE,9-OxoODE,9,10-EpOME could be used as biomarkers for early diagnosis. Significant abnormalities of LOX and CYP450 enzyme pathways were seen in CWP organisms. Changes in the CYP450 enzyme pathway may be associated with PAHs.

Establishment and application of reference equations for FEF50 and FEF75 in the Chinese population.

Background: Reference equations for forced expiratory flow at 50% and 75% of forced vital capacity (FVC) (FEF50 and FEF75) in the Chinese population are lacking. It is of great importance to establish equations covering most age groups and to study their applicability in clinical practice. Methods: Using the lambda-mu-sigma (LMS) method, reference equations for FEF50 and FEF75 were constructed based on pulmonary function data from healthy subjects collected from January 2007 to June 2010 at 24 centers throughout China. Differences between the established equations and extraneous equations were compared using standardized means (Z values) and percentage errors (PE). The proportion of small airway dysfunction (SAD) defined by the present equations was calculated. The Fisher precision probability test and the Mann-Whitney test were used to analyze the magnitude of changes in small and large airway indices after bronchodilator inhalation in patients with suspected asthma and chronic obstructive pulmonary disease (COPD). Results: Reference equations for FEF50 and FEF75 were established based on data from 7,115 healthy individuals (aged 4 to 80 years, 50.9% female, height between 95 and 190 cm). The present equations (all Z values were -0.0 and PE ranged from 2.0% to 4.2%) showed advantages over the European Community for Steel and Coal (ECSC) equations in 1993 (with Z values ranging from -0.7 to -0.2 and PE ranged from -23.4% to -4.5%). A total of 4,356 patients with suspected asthma (51.1% female; a mean age of 45.4 years) and 6,558 patients with suspected COPD (10.1% female; a mean age of 65.0 years) were included. The present equations defined 95.7% and 99.9% of SAD in these patients. After bronchodilator inhalation, greater mean improvement rates in small airway indices were observed both in patients with suspected asthma [mean ± standard deviation (SD) =48%±47%] and in patients with suspected COPD (mean ± SD =20%±30%) (P<0.05). Conclusions: The reference equations for FEF50 and FEF75 established in this study should be considered for use in China. Further studies are needed to validate their value in the diagnosis of some chronic respiratory diseases.

Normative reference data for intracranial volume in children: The results of CT volumetry.

BACKGROUND: Intracranial volume (ICV) is an important indicator of the development of the brain and skull in children. At present, there is a lack of ICV growth standards based on large infant and children samples. Our aim was to assess the normal range of the ICV variation in Russian children using a modern automatic system for constructing the endocranial cavity (Endex) and to provide growth standards of the ICV for clinical practice. METHODS: High-resolution head CT scans were obtained from 673 apparently healthy children (380 boys and 293 girls) aged 0-17 years and transformed into the ICV estimates using the Endex software. The open-source software RefCurv utilizing R and the GAMLSS add-on package with the LMS method was then used for the construction of smooth centile growth references for ICV according to age and sex. RESULTS: We demonstrated that the ICVs estimates calculated using the Endex software are perfectly comparable with those obtained by a conventional technique (i.e. seed feeling). Sex-specific pediatric growth charts for ICV were constructed. CONCLUSIONS: This study makes available for use in clinical practice ICV growth charts for the age from 0 to 17 based on a sample of 673 high-resolution CT images.

Development of specific growth charts for children with Fanconi anemia.

Patients with Fanconi anemia (FA) are often perceived to have poor growth when general population growth curves are utilized. We hypothesize that FA patients have unique growth and aimed to create FA-specific growth charts. Height and weight data from ages 0 to 20 years were extracted from medical records of patients treated at the Fanconi Anemia Comprehensive Care Clinic at the University of Minnesota. Height, weight, and BMI growth curves were generated and fitted to reference percentiles using the Lambda-Mu-Sigma method. FA-specific percentiles were compared to WHO standards for ages 0-2 and CDC references for ages 2-20. In FA males, the 50th height- and weight-for-age percentiles overlap with the 3rd reference percentile. In FA females, only the 50th height-for-age percentile overlaps with the 3rd reference percentile. For weight, FA females show progressive growth failure between 6 and 24 months followed by stabilization around the 50th percentile. The FA BMI-for-age percentiles show similar patterns to the weight-for-age percentiles but have different timing of onset of adiposity rebound and broader variability in females. Growth in FA patients follows a different trajectory than available normative curves. FA-specific growth charts may be useful to better guide accurate growth expectations, evaluations, and treatment.

LMS-based continuous pediatric reference values for soluble receptor activator of nuclear factor kappa B ligand (sRANKL) and osteoprotegerin (OPG) in the HARP cohort.

Soluble RANKL (sRANKL) and osteoprotegerin (OPG) are regulators of osteoclast differentiation and activation, but adequate pediatric reference values are lacking. Here we provide LMS (Lambda-Mu-Sigma)-based continuous pediatric reference percentiles for sRANKL, OPG and sRANKL/OPG ratio that will allow calculation of standardized patient z-scores to assess bone modeling in children. PURPOSE: Soluble receptor activator of nuclear factor kappa B ligand (sRANKL) and osteoprotegerin (OPG) are regulators of osteoclast differentiation and activation and thus bone metabolic turnover in children. Adequate pediatric reference values for their serum/plasma concentrations are lacking. The development of Lambda-Mu-Sigma (LMS)-based continuous reference percentiles for laboratory parameters allow improved data interpretation in clinical practice. METHODS: A total of 300 children aged 0.1-18 years (166 boys) were enrolled in the HAnnover Reference values for Pediatrics (HARP) study. sRANKL and OPG were assessed by ELISA. LMS-based continuous reference percentiles were generated using RefCurv software. RESULTS: LMS-based percentiles were established for sRANKL, OPG and sRANKL/OPG ratio, which were all found to be age-dependent. sRANKL and sRANKL/OPG associated with sex. In boys, sRANKL percentiles were highest during infancy, followed by a continuous decline until the age of 7 years and a second peak around age 12-13 years. In girls, a continuous, slow decline of sRANKL percentiles was noticed from infancy onwards until the age of 13 years, followed by a rapid decline until adulthood. OPG percentiles continuously declined from infancy to adulthood. The percentiles for sRANKL/OPG ratio paralleled those of sRANKL. Serum concentrations of sRANKL correlated with OPG and serum phosphate z-scores, while OPG concentrations inversely associated with standardized body weight, BMI, and urinary phosphate to creatinine ratio (each p < 0.05). CONCLUSION: This is the first report of LMS-based continuous pediatric reference percentiles for sRANKL, OPG and sRANKL/OPG ratio that allows calculation of standardized patient z-scores to assess bone metabolic turnover in children.

Terracotta: A tool for conducting experimental research on student learning.

For researchers seeking to improve education, a common goal is to identify teaching practices that have causal benefits in classroom settings. To test whether an instructional practice exerts a causal influence on an outcome measure, the most straightforward and compelling method is to conduct an experiment. While experimentation is common in laboratory studies of learning, experimentation is increasingly rare in classroom settings, and to date, researchers have argued it is prohibitively expensive and difficult to conduct experiments on education in situ. To address this challenge, we present Terracotta (Tool for Education Research with RAndomized COnTrolled TriAls), an open-source web application that integrates with a learning management system to provide a comprehensive experimental research platform within an online class site. Terracotta automates randomization, informed consent, experimental manipulation of different versions of learning activities, and export of de-identified research data. Here we describe these features, and the results of a live classroom demonstration study using Terracotta, a preregistered replication of McDaniel et al. (Journal of Applied Research in Memory and Cognition, 1(1), 18-26, 2012). Using Terracotta, we experimentally manipulated online review assignments so that consenting students alternated, on a weekly basis, between taking multiple-choice quizzes (retrieval practice) and reading answers to these quizzes (restudy). Students' performance on subsequent exams was significantly improved for items that had been in retrieval practice review assignments. This successful replication demonstrates that Terracotta can be used to experimentally manipulate consequential aspects of students' experiences in education settings.

Temporal Characteristics of Penetration and Aspiration in Patients with Severe Dysphagia Associated with Lateral Medullary Syndrome.

To assess the severity and timing of penetration and aspiration (PA) of severe dysphagia after lateral medullary syndrome (LMS) and its association with temporal characteristics. We performed videofluoroscopic swallowing studies (VFSS) in 48 patients with LMS and severe dysphagia and 26 sex- and age-matched healthy subjects. The following temporal measures were compared between groups: velopharyngeal closure duration (VCD); hyoid bone movement duration (HMD); laryngeal vestibular closure duration (LCD); upper esophageal sphincter (UES) opening duration (UOD); stage transition duration (STD) and the interval between laryngeal vestibular closure and UES opening (LC-UESop). The association between temporal measures and Penetration-Aspiration Scale (PAS) scores was analyzed. Differences in timing measures were compared between subgroups (safe swallows, and swallows with PA events during and after the swallow). PAS scores ≥ 3 were seen in 48% of swallows (4% occuring before, 35% occurred during and 61% after the swallow) from the LMS patients. Significantly longer STD and LC-UESop were found in the patients compared to the healthy subjects (p < 0.05). Significant negative correlations with PA severity were found for HMD, LCD, and UOD. Short UOD was the strongest predictor with an area under the receiver-operating-characteristic curve of 0.66. UOD was also significantly shorter in cases of PA after the swallow (p < 0.01). Patients with LMS involving severe dysphagia exhibit a high frequency of PA (mostly during and after swallowing). PA events were associated with shorter UOD, HMD, and LCD. Notably, shortened UOD appears to be strongly associated with PA.

Pathology of hereditary renal cell carcinoma syndromes: Tuberous sclerosis complex (TSC).

Tuberous sclerosis complex (TSC) is an autosomal dominant genetic disease characterized by hamartomatous tumors involving multiple organs such as the brain, skin, heart, lung and kidney. TSC is caused by inactivating mutations in TSC1/TSC2, which encodes hamartin and tuberin, respectively, and forms a complex that regulates mechanistic target of rapamycin complex 1 (mTORC1), resulting in cell overgrowth and oncogenesis. Since a leading cause of morbidity and mortality in TSC relates to chronic kidney disease and the ability to preserve renal function, this review describes the important pathologic findings in TSC-associated renal neoplasms and their correlating sporadic counterparts. The most common renal tumor in TSC patients are AMLs, followed by a heterogeneous spectrum of renal epithelial tumors, which may provide clues to establishing a diagnosis of TSC.

The multiple reference range of mean uterine artery pulsatility index for natural and in vitro fertilization singletons during 11-14 gestational weeks.

Background: Ultrasonography of the uterine artery (UtA) in the first and second trimesters of pregnancy can assess uterine-placental blood perfusion and guide early clinical prevention. Establishing normal ranges of the UtA pulsatility index (UtA-PI) at 11-14 weeks of pregnancy is helpful for the early identification of high-risk pregnant women and improving the prognosis. This study aimed to establish a reference range of UtA-PI based on crown-rump length (CRL) for spontaneous and in vitro fertilization (IVF) singleton pregnancy during 11-14 weeks, respectively. Methods: A prospective study was performed at Peking Union Medical College Hospital. Healthy, low-risk women with a singleton pregnancy at 11-14 gestational weeks were consecutively recruited for this study from December 2017 to December 2020. All participants underwent routine prenatal ultrasound examination. The CRL of the fetus and the UtA-PI were measured in both uterine arteries, and average values were calculated. The LMS method was used to fit the percentile (P)5, P10, P25, P50, P75, P90, and P95 curves of the UtA-PI value of spontaneous and IVF singleton pregnancy with CRL changes, respectively. Results: A total of 1,962 pregnant women with normal fetuses were included in this study, including 1,792 pregnancies conceived naturally and 170 IVF fetuses. The UtA-PI reference range in the spontaneous pregnancy group was consistently higher than that in the IVF group during 11-14 weeks, and showed a statistically significant difference in UtA-PI for spontaneous and IVF pregnancies (P<0.001). According to the LMS method, each percentile curve of UtA-PI decreased with the increase of CRL in both the natural pregnancy group and the IVF group. The P95 range of UtA-PI for pregnant women with naturally conceived and IVF pregnancy was 2.74 to 2.11 and 2.50 to 1.94, respectively. The overall change of UtA-PI differentials of the two groups showed a downward trend and decreased slightly with the increase of CRL. Conclusions: This study provided a single-center, large sample of data and constructed a CRL-based reference value of UtA-PI for spontaneous and IVF singleton pregnancy, which provides a reliable basis for early UtA evaluation and early clinical decision-making during 11-14 gestational weeks.

Concordant GRADE-3 Truncal Ataxia and Ocular Laterodeviation in Acute Medullary Stroke.

Background: Severe truncal ataxia associated with an inability to sit up without assistance (STA grade 3) is frequent in patients with central acute vestibular syndrome (AVS) involving the brainstem or cerebellum. When these patients have nystagmus, central HINTS excludes peripheral lesions; however, additional localization and lateralization signs are helpful, not only to resolve the peripheral versus central vestibular lesion dilemma, but to zero in on a precise lesion localization/lateralization to the lateral medulla, the most common ischemic lesion localization associated with an initially false-negative stroke MRI. Methods: This is a study of AVS patients with additional inclusion criteria: grades 2 or 3 ataxia with an eventual diagnosis of medullary stroke (MS), either involving the lateral medulla (LMS) or the medial medulla (MMS), and horizontal (h) gaze paralysis was the main exclusion criteria. All patients sat on the side of the bed or stretcher, with assistance if needed. A general neurologic examination followed in the sitting position, the testing protocol included the head impulse, spontaneous nystagmus, and skew deviation (HINTS) tests, followed by observation of the effect of brief 3-5 sec eyelid closure on ocular position, and saccade and pursuit eye movement tests. If they could sit, the protocol included the ability to stand with a wide base, then a narrow base, the Romberg test, and tandem gait. Radiographic lesion localization and horizontal gaze deviation concluded the protocol. Results: A total of 34 patients met the entry criteria, 34 MS (13 in the lateral medulla, 12 previously described, and 1 new patient), and 1 new MMS. Among them, n = 10/12 had grade 3 ataxia, and 3 (1 new patient) had grade 2 ataxia. In addition, overt ocular laterodeviation (OLD) was present in thirteen of them (35.3%). All OLD patients had gaze deviation and ipsilateral saccade and truncal lateropulsion, 1 medial medulla stroke patient had grade 3 truncal contrapulsion and contralateral hemiparesis without OLD, n = 20/21 patients with LMS without OLD had grade 3 truncal ataxia, and 1 had grade 2 truncal ataxia. Discussion: AVS patients with severe truncal ataxia (inability to sit without assistance) potentially have brainstem, cerebellum, or subcortical lesions. All patients had central HINTS; however, simultaneous direction-concordant STA 3 and OLD provided greater lateral medulla localization specificity, affecting the ipsilateral medulla. Future work to explore a practical posterior circulation stroke scale that includes HINTS, STA, and OLD will potentially select cases for thrombolysis even in the event of initially false-negative imaging.