Infectious diseases of plants, animals and humans pose a serious threat to global health and seriously impact ecosystem stability and agriculture, including food security. In recent years, more serious damage by fungal diseases infecting plants and/or humans, and increased resistance of disease-associated fungi and bacteria to antimicrobial drugs have been reported. In this Special Issue (SI) “Omics Research of Pathogenic Microorganisms”, nine research groups have submitted a total of ten papers where they present and discuss results and insights on ecology, evolution and virulence of disease-associated microbes, host responses and an evaluation of two popular platforms to diagnose and monitor pathogenic microbes in complex microbiome samples. This SI highlights current -omics approaches and software tools that are widely used to study disease-associated microbes, from in vitro cultures to metagenomic samples and host–pathogen interactions. The main insights from the contributions to this SI are summarised below.Lara and colleagues predicted metabolic interactions between bacteria associated with urinary tract infections (UTIs) and showed that a common dietary metabolite may influence population sizes of specific UTI-associated bacteria .Escherichia coli bacteria, clonal interference and mutator phenotypes greatly influenced the rise of resistance to a β-lactam antibiotic [Interactions between bacterial clonal lineages were also one aspect of the study by Ruelens and de Visser, who showed that in vitro, in small populations of tibiotic  in theseSalmonella serotype Derby (S. Derby) and discovered 35 genes that may influence acid stress resistance in S. Derby, including CRISPR-Cas system genes. They validated, via in vitro bioassays, that two predicted operons including two CRISPR-Cas genes contributed to acid tolerance and virulence of S. Derby [Next to antibiotic resistance, acid stress resistance is of considerable relevance to pathogenicity. Gu and colleagues used genomics to predict genes of interest to acid stress resistance of clinical Salmonella enterica (S. Typhi) from Bangladesh for CRISPR-Cas sequence-derived biomarkers associated with antibiotic resistance of endemic isolates [In addition to the abovementioned study by Gu and colleagues, bacterial CRISPR-Cas genes have been reported by diverse research groups to be associated with antibiotic resistance and virulence. Tanmoy and colleagues investigated genomes and metadata of clinical typhoid isolates . Tanmoy isolates  and compisolates .Bacterial epidemiology, especially the sequencing of taxonomically informative ribosomal 16S rRNA gene sequences, greatly benefits from reliable sequencing platforms that can be used in-house, to facilitate the rapid and reliable typing of bacteria present in metagenomic samples. Heikema and colleagues compared Illumina short-read sequencing- and nanopore long-read sequencing platforms for 16S profiling. The authors used Oxford Nanopore sequencing technology (ONT) which has gained popularity for in-house sequencing at various labs. Heikema and colleagues came across potential pitfalls in standard ONT analysis pipelines and recommended validations to further improve reliable applications of long-read sequencing via ONT platforms .Monilinia brown rot fungi that cause economically relevant diseases in stone fruits. They improved the resulting gene models using proteome and transcriptome data and listed 134 genes predicted to encode candidate virulence factors. Vilanova and colleagues assayed five predicted virulence factors and showed that three of these induced necrosis in plant leaf assays, neatly validating their -omics approach to predict fungal virulence factors [Long-read sequencing was employed by Vilanova and colleagues to obtain high-quality genomes of  factors .Amyloodinium parasites infecting the economically relevant fish seabass, to identify candidate virulence factors. Using their data as input in a virulence database, they focused on seven candidate virulence factors of which two were analysed in greater detail. Their transcriptome data provided a reference database for further study of Amyloodinium parasite biology [Two other studies in this SI used transcriptome analysis to study pathogenic microbes and host responses to clinical bacteria. Byadgi and colleagues used transcriptomics of protozoan  biology .Campylobacter jejuni bacteria and an isogenic cas9 gene deletion mutant. The authors identify several DNA damage, inflammatory and cell death pathways that were induced during infection by wild-type C. jejuni, but not during infection by the cas9 gene deletion mutant, corroborating previous work that C. jejuni Cas9 has a role in the virulence of highly virulent C. jejuni strains [Finally, Saha and colleagues used transcriptomics to unravel in vitro changes in gene expression of epithelial cells during the first 4 h of infection by highly virulent, clinical  strains .This SI touches upon the diverse, highly relevant applications of -omics technologies to the study of pathogenic microbes and host–pathogen interactions. The editor hopes that the reports of this SI may further inspire scientists who are considering including -omics approaches in their research.


Coordinated and harmonic (synchronous) ventricular electrical activation isessential for better left ventricular systolic function. Intraventricularconduction abnormalities, such as left bundle branch block due to artificialcardiac pacing, lead to electromechanical “dyssynchronopathy” with deleteriousstructural and clinical consequences. The aim of this review was to describe andimprove the understanding of all the processes connecting the several mechanismsinvolved in the development of artificially induced ventricular dyssynchrony bycardiac pacing, most known as pacing-induced cardiomyopathy (PiCM). The chroniceffect of abnormal impulse conduction and nonphysiological ectopic activation byartificial cardiac pacing is suspected to affect metabolism and myocardialperfusion, triggering regional differences in the activation/contractionprocesses that cause electrical and structural remodeling due to damage,inflammation, and fibrosis of the cardiac tissue. The effect of artificialcardiac pacing on ventricular function and structure can be multifactorial, andbiological factors underlying PiCM could affect the time and probability ofdeveloping the condition. PiCM has not been included in the traditionalclassification of cardiomyopathies, which can hinder detection. This articlereviews the available evidence for pacing-induced cardiovascular disease, thecurrent understanding of its pathophysiology, and reinforces the adverse effectsof right ventricular pacing, especially right ventricular pacing burden(commonly measured in percentage) and its repercussion on ventricularcontraction (reflected by the impact on left ventricular systolic function).These effects might be the main defining criteria and determining mechanisms ofthe pathophysiology and the clinical repercussion seen on patients. According to Kaye etal.16][.Definition 3: a reduction in LVEF ≥ 10% irrespective ofbaseline LVEF. This definition is relevant as it has been used in previouspublications17][.14][. This cutoff point wasrecently reviewed in the current European Society of CardiologyGuidelines31][ attributed to the “inflammatory” (andtoxic?) process triggered by ectopic electrical activation of themyocyte34][.“Conventional” RV pacing  causes myocardial activation almost in reverse tothat which occurs in intrinsic physiological antegrade conduction using theHis-Purkinje system. It causes delayed and abnormal ventricular myocardialactivation  associated with nonphysiological ventricularcontraction vs. 632 with single-chamberventricular rate-modulated (VVIR) pacing29][. RV PiCM is usually defined as LV systolic dysfunctionresulting from electrical and mechanical dyssynchrony caused by RV pacing. RV PiCMis common and occurs in 10-20% of patients exposed to frequent RVpacing46][.Although the follow-up period in the previous cohort was the longest49][. Paced QRS duration ≥ 163 ms was the mostimportant predictor of HF admission17]. ynchrony[61].62][.A systematic review aiming to compile available data included randomized andobservational studies comparing HBP or CRT 67]) and another using RV pacing (successful in 137 of 433patients [32%])Based on these results, can we state that PPS can prevent PiCM and should beroutinely recommended at least on an individualized basis? It could be argued thatthe success of physiological pacing is in part related to the use ofelectrophysiological parameters when performing this technique, which allows properidentification of the target region. Although this procedure is more complex andimplies a potential rise in costs, we propose this debate because we believe thatPiCM is secondary to artificially induced myocardial dyssynchrony by RV pacing. Whywould a patient with preserved physiological pacing of the ventricular syncytium develop 68][.In the context of AF, the Left Ventricular-Based Cardiac Stimulation Post AV NodalAblation Evaluation (or PAVE) study randomized 184 patients undergoing ablation ofthe AV node to receive CRT vs. PPS are needed to consolidate HBP as an initial strategyfor reducing PiCM. Several factors should be considered, including implant-relatedcomplications such as higher capture thresholds and undersensing and tool costs(dedicated leads and sheaths). In addition, some post-implantation factors are ofgreat influence, such as increased battery depletion and premature generatorreplacement (due to higher energy drain), among others. These aspects need to betested in a randomized, controlled setting before PPS can be widely used. There arecurrently several clinical trials comparing PPS vs. RV pacing and,more ambitiously, PPS vs. CRT. The results will demonstrate thetrue value of physiological artificial activation within the context of ACP and thepossibility of significantly reducing PiCM incidence.However, in addition to current studies, further robust clinical trials comparing RVpacing Artificially induced myocardial dyssynchrony by RV pacing leading to PiCM is arecently acknowledged condition. Its potential genesis occurs after RV pacinginitiation  and is probably associated with factors thatare prone to this condition (underlying heart disease or phenotype). It is caused byartificial ventricular dyssynchrony due to artificial electrical cardiac activationof the myocardium only. Its impact on ventricular function and association witharrhythmia and congestive HF should be considered. Therefore, sentinel biomarkerscould be used in the future to identify, prior to implantation, individuals who havea natural tendency to develop artificially induced dyssynchrony. In addition, strictclinical follow-up with evaluation of cardiac function and structure should beperformed periodically . Correction involves using biventricular cardiac pacing or the newphysiological alternatives, via PPS (direct His bundle or left bundle activation),to minimize ventricular dyssynchrony.


Facial vascularized composite allotransplantation (FVCA) is an emerging field of reconstructive surgery that represents a dogmatic shift in the surgical treatment of patients with severe facial disfigurements. While conventional reconstructive strategies were previously considered the goldstandard for patients with devastating facial trauma, FVCA has demonstrated promising short- and long-term outcomes. Yet, there remain several obstacles that complicate the integration of FVCA procedures into the standard workflow for facial trauma patients. Artificial intelligence (AI) has been shown to provide targeted and resource-effective solutions for persisting clinical challenges in various specialties. However, there is a paucity of studies elucidating the combination of FVCA and AI to overcome such hurdles. Here, we delineate the application possibilities of AI in the field of FVCA and discuss the use of AI technology for FVCA outcome simulation, diagnosis and prediction of rejection episodes, and malignancy screening. This line of research may serve as a fundament for future studies linking these two revolutionary biotechnologies. Facial vascularized composite allotransplantation (FVCA) is a surgical procedure that involves transplanting composite tissue to patients with devastating and irreversible (mid-)facial defects –4. FVCA While various basic science and translational projects are underway to solve these issues, there is a scarcity of studies elucidating the integration of artificial intelligence (AI) into the field of FVCA. AI refers to computer systems that can learn, infer, synthesize, and perceive information similar to human cognition. AI is commonly established on large data sets that serve as training models to produce mathematical and computational programs; these computational designs are often based on machine learning (ML) and its subsets including deep learning (DL), and neural networks, among other computational methods . More imHerein, we aim to shed light on the application possibilities of AI systems in FVCA and discuss future research directions. This scoping review may provide a fundament to leverage the innovation of FVCA and the limitless learning capacities of AI.Over the past decades, preoperative surgical outcome simulation has become a vital component of comprehensive perioperative patient management . PreoperA 2020 study by Bashiri-Bawil et al. trained an AI-based computer model to visualize postoperative rhinoplasty results using 400 patient images  and 87 facial landmarks. In a testing set of 20 patients, this approach resulted in an accuracy level of >80% . SimilarHowever, such concepts cannot be directly transferred to FVCA, since preoperative outcome simulation needs to integrate the donor's and patient's facial features at the same time. Subsequently, reliable predictions can only be made once the donor is identified. Automated facial landmark recognition systems such as Emotrics  or 3D VECTRA could be used for quick and precise facial measurements , 20. FolThe potential advantages of AI are substantial, particularly for intricate procedures such as FVCA. The degree to which preoperative planning can be detailed and meticulously executed largely predicts the potential success of the outcome.Precision and real-time feedback are essential pillars of contemporary surgical practice. These elements are considerably amplified with the integration of AI into intraoperative image-guidance systems . These aDuring FVCA, the precise fitting of the donor tissue onto the recipient's facial structure is paramount for the success of the procedure , 27. AI Real-time feedback plays a significant role during surgery, a role that might be efficiently fulfilled by AI-integrated intraoperative imaging systems. These systems provide surgeons with real-time data, enabling immediate adjustments to their surgical approach, which can prove invaluable during complex procedures like FVCA . More prDespite distinct advancements in the perioperative patient management including more patient-specific risk profiles, novel biomarkers, and targeted immunosuppressants, allograft rejection persists as a major burden in transplant surgery still affecting more than 15% of solid organ transplant (SOT) patients , 35. MorIn SOT, ML and DNN  have been successfully investigated to identify risk patients for transplant rejection. Thongprayoon et al. performed ML consensus cluster analysis for 22,687 Black kidney transplant recipients identifying four distinct clusters. Interestingly, the authors found that the risk for transplant rejection was significantly increased in highly sensitized recipients of deceased donor kidney retransplants and young recipients with hypertension . In liveAcross the different vascularized composite allograft (VCA) surgery subtypes, 85% of VCA patients experience at least one rejection episode one year post transplantation with more than 50% of cases reporting multiple rejection episodes . Such epCancer represents a widely recognized complication of both SOT and VCA, since there is a two to four-fold elevated risk of malignancies following organ transplant. Remarkably, transplant recipients are at a 100-fold higher risk for developing skin cancer . While tAI technology  has been shown to provide a versatile and precise screening platform for diverse cancer entities and detect mammographic abnormalities with comparable accuracy to radiologists and reduce radiologist workloads –70. Yi eFollowing FVCA, one transplant recipient patient was diagnosed with basal cell carcinoma of the native facial skin six years post-transplant, while another FVCA patient presented with a B cell lymphoma which was treated with rituximab, cyclophosphamide, vincristine, doxorubicin, and prednisolone . DespiteFVCA has emerged as a novel and versatile reconstructive technique to provide adequate therapy for patients with devastating facial wounds and trauma , 87. Whi


Dystonia syndromes are diverse movement disorders characterized by disabling, painful, and sustained involuntary muscle contraction.Various neurosurgical interventions have been trialled for the treatment of dystonia, including peripheral denervation, intrathecal baclofen infusion, and ablating the basal ganglia or thalamus. However, deep brain stimulation (DBS) primarily targeting the globus pallidus internus (GPi) and the subthalamic nucleus (STN) has evolved as a covetable option with the ability to provide personalized, reversible, and titratable neuromodulation. The available literature has recently been reviewedIn the current edition of the Arquivos de Neuro-Psiquiatria, Listik et al.Similarly, intraoperative target selection has been further refined by studies employing stimulation-outcome mapping in large cohorts. Elias et al.Insights into outcome variation in DBS therapy have also come from the functional magnetic resonance imaging literature. Loh et al. demonstrate that optimal DBS programming engages a functional network resulting in sensorimotor cortex deactivation in 15 cervical dystonia patients with GPi-DBS.There is growing scientific evidence demonstrating the safety and efficacy of DBS for the treatment of medically refractory dystonia, however, optimal patient and surgical target selection remains unclear. Here multiple examples are presented that demonstrate how advances in neuroimaging are contributing to the understanding of DBS therapy in dystonia. These advances may lead to improved patient and target selection and DBS programming.


We present the first documented case of a fistula between the treated zone and the appendix after RFA in a patient with HCC. Contrast-enhanced CT and MRI revealed a subcapsular hepatic nodule with image findings of HCC located adjacent to the ascending colon and cecum. An ultrasound-guided core needle biopsy was subsequently performed to distinguish between hepatic metastasis and HCC. Post-RFA imaging identified a low-attenuating ablated area adjacent to an air-filled appendix. The patient later experienced complications, including increased liver enzymes and an abscess at the ablation site. Imaging revealed a fistulous tract between the RFA zone and the appendix. Over the following months, the patient underwent conservative treatment involving intravenous antibiotics and repeated percutaneous drainage, exhibiting eventual symptom relief and an absence of the fistulous tract upon subsequent imaging. This case highlights the rare complications that can arise during RFA due to peculiar anatomical variations, such as a subhepatic appendix, resulting from midgut malrotation and previous surgery. It is imperative for operators to be cognizant of potential anatomical variations when considering RFA treatment, ensuring comprehensive pre-procedural imaging and post-procedure monitoring. This case also emphasizes the potential viability of nonoperative management in complex scenarios in which surgical interventions pose significant risks.


Rates of late allograft loss have improved slowly in the last decades. Well described traditional risk factors that influence allograft survival include cardiovascular events, rejection, infections and post-transplant neoplasia. Here, we critically evaluate the influence of several non-immunological, non-traditional risk factors and describe their impact on allograft survival and cardiovascular health of kidney transplant recipients. We assessed the following risk factors: arterial stiffness, persistent arteriovenous access, mineral bone disease, immunosuppressive drugs residual levels variability, hypomagnesemia, glomerular pathological alterations not included in Banff criteria, persistent inflammation and metabolic acidosis. Recent high-level evidence confirms the superiority of transplantation in reducing all-cause mortality for most patients with end-stage kidney disease . In the We searched three databases: Medline, EMBASE and Cochrane Library, and included studies from January 2000 to December 2022 with the following terms: “kidney graft survival”, “kidney graft loss”, “failed kidney transplant”, “chronic allograft nephropathy”, “risk factors”, “chronic kidney disease progression”.Late allograft failure is a heterogenous background picture of several multifactorial pathogenic entities that all contribute to kidney dysfunction in transplant patients. Naesens et al. elegantly described data derived from failing grafts: Importantly, one quarter of biopsies exhibit more than one coexisting disease, and almost one third of patients with lost allograft had no specific diagnosis on the last biopsy performed but highlighted the important prognostic capacity of the extent of chronic damage . ConsequRecent efforts have focused on better characterization of allograft loss and described a more complex picture of the multifactorial pathogenic processes. A study conducted by Mayrdorfer et al. examining 303 death-censored graft losses among 1642 transplant recipients discriminated primary failure causes (responsible for more than 50% persistent estimated glomerular filtration rate decrease) from secondary failure causes (contribution to less than 50% estimated glomerular filtration rate decline) and analyzed data in a time-dependent manner. Late allograft failure was mainly attributed to intercurrent medical events, defined as cardiovascular events or infections conducting to prominent decline in renal function, and representing almost 40% of late graft failures. Moreover, antibody-mediated rejection met increasing frequencies with time as a primary failure cause (48.6% of graft failures at more than 10 years from transplant intervention) while T-cell mediated rejection had a sharp decline with transplant vintage. Interestingly, calcineurin-inhibitors toxicity was isolated in only two cases as a primary cause, but it was described as the most frequent secondary cause responsible for graft loss (64 of 240 late graft failures). The authors once again highlighted the multifactorial etiology of transplant failure .The ability to predict the evolution of the transplanted kidney is of great significance and has been the center of some valuable research. Search of prognostic factors begins even before implantation with evaluation of donor quality. Preimplantation histology may provide important clues but clinical decisions of implanting or discarding the kidney based on this data have shown conflicting results. In a recent large multinational study, discarded kidneys due to biopsy alterations could have been offered to patients with improved survival and quality of life. Data shows 70% of implanted similar grafts matched with the refused grafts due to biopsy were functioning at 10 years .Prediction models can be computed by means of artificial intelligence and deep learning models to predict evolution of estimated glomerular filtration rate after kidney transplantation. Raynaud et al. identified, after performing multinomial regression models, seven significant determinants of progression: donor age, estimated glomerular filtration rate, proteinuria, graft scarring, graft interstitial inflammation and tubulitis, microcirculation inflammation and circulating anti-HLA donor specific antibodies. Resulting computed trajectories were significantly associated with progression to allograft loss .Other techniques proved good forecast capability utilizing sequence-to-sequence modelling in order to create a machine learning algorithm-based prediction model that is based on inputting repeated estimated glomerular filtration rate measurements .Recently, an interesting dynamic prediction tool that incorporates histological, immunological and clinical parameters together with repeated measurements of graft function was validated in multiple cohorts and proved superior prediction performance of allograft survival compared to other similar systems. Individualized parameters that altered survival were estimated glomerular filtration rate, proteinuria, delay between transplant and evaluation, Banff categories , mean fluorescence intensity of anti-HLA donor specific antibodies and repeated measurements of eGFR. The iBox system has proved good prediction ability of graft survival and it has been validated as a valuable endpoint in clinical trials in transplantation ,15.Cardiovascular disease has recently gained well-deserved attention since it represents the main driver of comorbidity and mortality in kidney transplant recipients. Pregnant emphasis was attributed to defining and addressing traditional cardiovascular risk factors in improving survival outcomes in this population. Management of these associated relevant comorbidities have been reviewed elsewhere and they do not meet the purpose of this paper  16,17].,17.16,17The association between increased values of arterial stiffness and eGFR decline has been noted in the general chronic kidney disease (CKD) population and suggests that the resulting hemodynamic stress insults the kidney by means of endothelial dysfunction and microvascular ischemia. Chronic inflammation, oxidative stress and overactivation of the renin–angiotensin systems may represent other possible mechanistic underpinnings . Aortic Continuous functioning arteriovenous fistula after kidney transplantation has the potential to worsen the maladaptive remodeling changes in the cardiovascular system and alter kidney function. A meta-analysis addressing the impact of ligating the arteriovenous fistula showed that patients undergoing access occlusion had better cardiac morphological parameters and better kidney allograft function .Furthermore, patency at 5 years was only 61% and arteriovenous fistula-related complications were frequently reaching about 30% of patients. On the other hand, preservation of the vascular access may provide the advantage of an optimal backup strategy if transition to dialysis is needed. Consequently, decisions should be individualized on several parameters, mainly based on renal and cardiac functions and on selecting complications-prone profile of patients .After kidney transplantation, particularly older patients find themselves at an increased risk for pathological fractures. The fractures appear multifactorial in nature  and are associated with unfavorable outcomes, such as subsequent graft loss or mortality. It remains unclear whether only the high end of mineral bone disease spectrum (fractures) is linked to allograft survival decline or if other biologic entities contribute as well .Persistent mineral abnormalities after kidney transplantation mainly include hypercalcemia and hypophosphatemia. Previous severe hyperparathyroidism and high levels of circulating PTH and FGF-23 are established risk factors for altered mineral metabolism post-transplantation. However, impact on outcomes is unclear. As they may not contribute directly to allograft loss and rapid eGFR decline, they are the main drivers of vascular calcifications affecting graft vessels and, interestingly, of tubulointerstitial calcifications on allograft biopsies ,31.Cinacalcet has proven its ability to correct persistent hyperparathyroidism after kidney transplantation and the associated metabolic derangements but without impact on bone mineral density or allograft survival . Data frBiphosphonate therapy in kidney transplant recipients has the clear benefit of improving bone mineral density. Recent studies have proven low rates of adynamic bone disease, strengthening the safety profile of this medication. However, there is no clear data on rates of fractures and there are no benefits or harms related to renal function evolution in kidney transplant recipients .Assessment of pre-transplantation profile of mineral bone disease phenotype may predict survival and high-risk patients. In a cohort of more than 11,000 patients, recipients that exhibited higher levels of pre-transplant serum alkaline phosphatase (>120/U/L) were subject to increased post-transplant mortality. No association was found between circulating PTH or calcium and post-transplant evolution .The negative correlation between graft survival and vitamin D deficiency has been described in an observational manner . InsuffiCurrent therapeutic armamentarium provides means to effectively correct mineral abnormalities in kidney transplant recipients. However, impact of described treatments on graft survival have been insufficiently studied and proved no significant benefits.Excessive immunosuppression contributes to significant complications linked to allograft loss; infections, malignancy and polyoma virus nephropathy account for about one third of graft losses . BecauseInterestingly, another tool available for the evaluation of drug exposure is the time in therapeutic range—addresses the interval of time that a patient is exposed to correct predefined range of values of immunosuppression. Patients with high variability and time in therapeutic range < 40% were at increased risk of de novo donor-specific antibodies and at an estimated four times greater risk of graft loss by 5 years .Hypomagnesemia represents one of the most frequent electrolyte disturbances post-transplantation . SeveralMagnesium deficit exhibits diabetogenic effects and it represents a proven independent risk factor for post-transplant diabetes mellitus ,49. ReceReports on mortality are conflicting and derived from observational retrospective studies. There have been signals of the possible interaction between hypomagnesemia and graft dysfunction . RecentlMagnesium metabolism, however, is important and may have implications in long-term outcomes as it interferes with glycemic alterations, endothelial dysfunction and cardiovascular abnormalities. In addition, correction is cumbersome and magnesium levels may not reflect true stores. No significant trials regarding supplementation and the associated impact on graft function have been conducted .Overall, due to conflicting results and the presence of many confounders, such as the use of CNI, nutritional status, measurement issues, other additional studies addressing this problem will evaluate true impact.The kidney transplant biopsy interpretation is submitted to a well described and standardized score system—Banff classification. Diagnostic entities are established by pathologists after grading several acute and chronic lesions . HoweverDenic et al. conducted a study with repeated biopsies in well-functioning transplant recipients at 5 years post-implantation. Three parameters previously linked to unfavorable graft outcomes were examined: glomerular volume, global glomerulosclerosis and ischemic appearance of glomeruli. All three parameters combine successfully predicted death-censored graft failure at 5 years. Moreover, glomerular ischemia is significantly associated with allograft loss, even after adjustment for Banff scores .Moreover, other recent data highlight the impact of early subclinical inflammation detected on surveillance biopsies on allograft survival. Patients with subclinical inflammation and tubulitis were exposed to a higher hazard of acute rejection and death-censored allograft loss .Implantation of the kidney allograft is often realized in uremic patients exhibiting a state of inflammatory milieu. Moreover, inflammation is enhanced by perioperative events and induced by other stressors. For example, brain death is linked to increased cytokine excretion and ischemia-reperfusion injury can lead to delayed graft function. All forms of rejection are responsible for elevated markers of inflammation, and viral infections could be a source of enhanced cytokine production leading to overreactive innate immunity . AtherosThe persistent inflammatory state is multifactorial and contributes to graft dysfunction by several mechanisms: triggering chronic hypoxia, extracellular matrix deposition and extending graft fibrosis . FurtherMetabolic acidosis identifies as one of the most common complications in kidney transplant recipients. The fall of bicarbonate and pH levels with a decrease in serum partial pressure of carbonic dioxide occurs mainly when the glomerular filtration rate falls under 30 mL/min in patients with chronic kidney disease. This threshold is higher in kidney transplant recipients, showing that metabolic acidosis may occur at higher GFRs in these patients ,64. The Data on allograft survival are pointing to metabolic acidosis as a risk factor for graft dysfunction in the long term. Park et al. conducted a study that showed that low TCO2 concentrations 3 months after transplant are associated with an increased risk of graft loss and death-censored graft failure . FurtherThus, these associations require the application of therapeutic measures to correct acidosis. From this point of view, the data are limited, with most studies focusing on alkali therapy. If supplementation with sodium bicarbonate is effective in patients witch chronic kidney disease, the data in kidney transplant recipients are limited. Schulte at al. evaluated the effect of sodium bicarbonate in kidney transplant recipients with chronic metabolic acidosis. Treatment with sodium bicarbonate was associated with an increased risk of graft failure with no changes in mortality. Authors speculated that the interference with gastric acid pH of oral bicarbonate intake may lead to altered absorption of mycophenolate mofetil. Consequently, patients may be exposed to lower plasma concentrations of mycophenolic acid . The recLong-term survival of kidney allografts is altered mainly by cardiovascular disease, malignancy and infections. However, in order to maximize survival, other relevant pathogenic entities need to be addressed. Care of kidney transplant patients is complex and needs to be centered also on many potential risk factors that can influence long-term survival, consisting of the following: metabolic derangements such as hypomagnesemia, metabolic acidosis and mineral bone disease after transplantation, cardiovascular disease manifesting as arterial stiffness, immunosuppressive drug metabolism and non-adherence, persistent inflammation and glomerular changes not highlighted by Banff criteria. .


A 72-year-old man presented with painful enlargement of the scrotum and weight loss. Physical examination revealed that the right testicle and epididymis were hardened and tender. Hematology and chest radiography results were normal. Pelvic computed tomography (CT) revealed bilateral hydrocele and an irregular right testicle and epididymis with peripheral contrast enhancement and central necrotic hypodense portions . Radical,Genitourinary tuberculosis is the second most common form of extrapulmonary tuberculosis after lymph node involvement; however, tuberculous orchiepididymitis is rare. Ultrasound may show focal or diffuse areas of hypoechogenicity in the testicle and epididymis, with increased surrounding vascularity on color Doppler imaging, and a hydrocele. CT usually shows irregular testicular masses with heterogeneous or peripheral contrast enhancement, and a hydrocele, with or without calcification


More than 8 million people contract typhoid annually, resulting in about 100 000 deaths. Despite associated sociopsychological and economic fallouts,,The most frequent co-endemic acute undifferentiated febrile illnesses are flaviviral illnesses, scrub typhus, malaria, leptospirosis and acute viral hepatitis.Several actionable insights emerge from these gaps that are relevant to future diagnostic test development and evaluations. First, investigators must aim to integrate clinical and laboratory results in diagnostic test evaluations. Clinicians are aware that the diagnosis of acute fever requires a combination of several clinical, physiological and contextual parameters. Systematic assessments of the discriminative power of various tests are important to determine the true added value of rapid tests. Second, researchers should use modelling approaches to identify algorithms worth evaluating in trial settings. Models can inform the incremental value and post-test probabilities of rapid diagnostic tests within clinical algorithms based on pretest accuracies of combinations of clinical signs. To improve testing algorithms for multiple pathogens, the global health community needs renewed data mining efforts to inform modelling approaches. Third, implementers should tailor diagnostic test interventions to the needs and preferences of end-users. Guidelines cannot be translated into interventions unless contextualized to specific practice settings. Qualitative studies should therefore be undertaken in high-burden settings to understand drivers of test use and physician-patient preferences to avoid translation failures. Fourth, funders should incentivize diagnostic research. As new infectious challenges emerge, it is important that funding focus does not shift away from this common cause of illness and death.The recent World Health Assembly resolution on strengthening diagnostics capacity


In this issue of the Journal, Guadamuz et al.  considerCancer care delivery research typically aspires to execute intervention studies targeting modifiable clinical and practice-level factors in the care delivery environment , but GuaThe built environment  may particularly predict chronic disease , with hoEarlier research indicated that profit and affluence predict for-profit hospitals’ locations, thus intentionally marginalizing Medicaid and uninsured patients ,25. MoreMultilevel policies may beget care access benefitting cancer prevention and survivorship, but enhanced facility proximity and care reimbursement, although necessary, is likely insufficient for optimizing care for patients residing in low area-level socioeconomic status locales. Health-care organizations and their care teams may create and sustain care equity threats. Workforce conditions, such as unfavorable patient to clinician ratios  potentiaWe encourage hypothesis testing that considers relationships between the built environment, practice norms , and cancer treatment initiation and survival. How might we design studies to test these relationships? Cancer care delivery espouses advancing beyond traditional randomized clinical trial paradigms  to embrace pragmatic trial methods that prioritize external validity and the relevance of community practice . MoreoveGuadamuz et al.  reveal a


On November 7, 2022, dengue virus (DENV), which is not endemic in the continental United States , MCESD, and Arizona Department of Health Services locally acquired mosquitoborne disease response plan, MCDPH and MCESD activated an incident command office on November 10. MCDPH took the following actions: 1) prioritized prospective investigations of health care provider and laboratory reports of DENV and suspected arboviral visits queried from the National Syndromic Surveillance Program's BioSense Platform (BioSense)Aedes aegypti mosquitoes and breeding sites; mosquitoes collected in a professional BG-Sentinel mosquito trapAfter discussions with CDC’s Dengue Branch and Florida Public Health (Coordinated surveillance and response activities identified the first locally acquired human DENV infections in Maricopa County, Arizona. Established partnerships and preexisting plans were essential to mounting a rapid, coordinated response to nonendemic arboviral transmission. MCDPH and MCESD will enhance future surveillance activities to identify and prevent autochthonous DENV transmission, including additional mosquito trap placement around patient residences and public mosquito exposure prevention education.


These on-site sanitation systems, a positivestep toward improved household WASH services, are used by 43% of theglobal population, mainly comprising low- and middle-income countries(LMICs).3 There is an urgent need to expand decentralized(non-sewered system) surveillance as LMICs are currently being overlookedin pandemic prevention as it is currently focused on SARS-CoV-2 wastewaterfrom centralized (sewered) systems.The availabilityand accessibilityof water, sanitation, and hygiene (WASH) services are key in preventingdisease transmission.Wastewater surveillanceof centralized systems presents a vastlydistinct set of challenges compared with fecal sludge surveillance.For example, sewers also contain gray water and sometimes stormwater,and wastewater is commonly sampled as a composite volume over a 24h period, whereas fecal sludge is most commonly grab sampled. Broadeningthe focus of non-sewered sanitation surveillance (NSSS) should accommodatefecal sludge analysis to support globally relevant public health strategies.4 Unfortunately, interest in fecal sludge researchhas been largely limited to a small group of researchers funded bya few core donors. The pandemic has renewed the focus of both scienceand policy. Surveillance of pathogens in fecal sludge may need tobe adapted and could include Vibrio cholerae or poliovirus;however, this should be determined by assessing localized needs. Thepotential of the public health impact in LMICs can be amplified byusing fecal sludge data in addition to clinical data in multipathogendisease surveillance and continuous local monitoring for early warningsof a pandemic.Even before the COVID-19 pandemic, fecal sludge was used as a valuablesource of information for understanding community health.5 but possibly more complex in the Southern Africansanitation field with five decades of human waste research.6 With no formal global network, internationalnonprofit institutions can fill this role by bringing together academicresearch partners and public health officials for interdisciplinaryand collaborative research and increased awareness of NSSS. Such partnershipscan enable these settings to innovatively adapt academic or healthcarelaboratory operations while maintaining high-quality data and alsopromote peer-reviewed literature originating from resource-limitedlaboratory settings.Research partnerships are required to progressfrom individualclinical patient samples  to pooled community samples in terms of fecalsludge. The importance of research partnerships is not new,Timelier and better-quality global epidemiologicaldata sets arerequired for better pandemic preparedness in the future. There isa need in LMICs for the different, but unique, value of NSSS comparedto that of wastewater surveillance, built-in capacity at local laboratoriesthat can include fecal sludge as part of continuous multipathogendisease surveillance, and long-term global research collaborationsfocused on creating systems with data-driven approaches. Challengeswill remain, including importation and lengthy delays in suppliesand equipment (such as polymerase chain reaction primers and probesthat are not manufactured in many LMICs), repurposing existing LMIClaboratory spaces for fecal sludge samples, and limited LMIC accessto biosafety level 3 and 4 laboratories for sample processing, therebylimiting pathogen target lists. We recommend that LMICs navigate throughthese barriers to ensure that fecal sludge surveillance benefits publichealth, generates local policy-relevant information for future pandemicprevention and control, and holistically supports global WASH services.


Recently, an empiric Cone-beam Computed Tomography (CBCT)-guided transarterial embolization (TAE) technique has been investigated for lower gastrointestinal bleeding (LGIB). Although this empirical strategy reduced the rate of rebleeding in hemodynamically unstable patients compared to a ‘wait and see’ strategy, the specified technique is challenging and time-consuming.We present two methods to perform a prompt empiric TAE in LGIB when catheter angiography is negative. Based on the pre-procedural Computed Tomography Angiography bleeding site and using vessel detection and navigation software tools that are integrated in contemporary angiosuites, the culprit bleeding artery could be targeted with only one selective intraprocedural CBCT acquisition.The proposed techniques are promising to reduce procedure time and facilitate the implementation of empiric CBCT-guided TAE in clinical practice when angiography is negative. Empirical transarterial embolization (TAE) is a well-known strategy in interventional radiology (IR). In upper gastrointestinal bleeding, when primary endoscopic hemostasis has failed, endoscopy-directed empiric TAE of the left gastric or gastroduodenal artery is recommended if angiography is negative  and vasopressor requirements upon arrival, subsequent inferior mesenteric Digital Subtraction Angiography (DSA) and CBCT angiography  failed to demonstrate active bleeding. Because of hemodynamic instability and risk of bleeding recurrence, an empirical TAE (illustrated in Fig. 38y old female patient with history of a lateral pancreatojejunostomy after pancreatic trauma was admitted because of recurrent RBPA and one-time hematemesis. Initial upper gastrointestinal endoscopy and CTA could not identify an active bleeding focus. However, because of progressive hemodynamic instability, the patient was transferred the following day to our tertiary referral hospital. A new CTA now did reveal an active bleeding proximally in the Roux-en Y jejunal loop and the patient was immediately transferred to the angiosuite. Nevertheless, superior mesenteric DSA and CBCT failed to identify a bleeding focus. Regarding inaccessibility for endoscopy, empirical TAE (illustrated in Fig. Recent guidelines emphasize the importance of CTA and TAE in the management of active or hemodynamically unstable LGIB (Triantafyllou et al. The use of vessel detection and navigation software could be promising to reduce procedure time and facilitate the implementation of empirical TAE in clinical practice. However, safety and efficacy of this approach should be verified on a larger scale.


Pseudomonas aeruginosa. Fungal infections in MEO are also likely but extremely rare. And conventional microbiology tests is difficult to diagnose.Most of malignant external otitis (MEO) cases reported in the literature are attributed to Aspergillus by metagenomic Next-Generation Sequencing (mNGS) and recovered after comprehensive treatment including operation and voriconazole. The antifungal treatment was delayed due to repeated cultures of secretions being negative and pathological examination showed granulation tissue proliferation with extensive neutrophil infiltration.Two patients were diagnosed with Fungal malignant external otitis (FMEO) due to mNGS might be helpful for patients suspected with FMEO, especially when conventional microbiology tests were negative. Pseudomonas aeruginosa , previously diagnosed otitis externa not responsive to therapy.Aspergillus is also frequently isolated from external auditory canal smears and diagnosis of FMEO should be based on histopathologic confirmation on deep tissue biopsy  for the publication of any potentially identifiable images or data included in this article. Written informed consent was obtained from the participant/patient(s) for the publication of this case report.QW: patient management, data collection, and writing original draft. RH and YZ: patient management and data collection. WZ: review and modify the article. HJ: review and modify the article. All authors contributed to the article and approved the submitted version.


Orcinus orca) to quantify patterns of fine-scale foraging movements and their relationships with demography. We reveal striking interpopulation differences in patterns of individual foraging behavior. Females from the endangered Southern Resident (SRKW) population captured less prey and spent less time pursuing prey than SRKW males or Northern Resident (NRKW) females, whereas NRKW females captured more prey than NRKW males. The presence of a calf (≤3 years) reduced the number of prey captured by adult females from both populations, but disproportionately so for SRKW. SRKW adult males with a living mother captured more prey than those whose mother had died, whereas the opposite was true for NRKW adult males. Across populations, males foraged in deeper areas than females, and SRKW captured prey deeper than NRKW. These population-level differences in patterns of individual foraging behavior challenge the existing paradigm that females are the disproportionate foragers in gregarious resident killer whales, and demonstrate considerable variation in the foraging strategies across populations of an apex marine predator experiencing different environmental stressors.In cooperative species, human-induced rapid environmental change may threaten cost–benefit tradeoffs of group behavioral strategies that evolved in past environments. Capacity for behavioral flexibility can increase population viability in novel environments. Whether the partitioning of individual responsibilities within social groups is fixed or flexible across populations is poorly understood, despite its relevance for predicting responses to global change at the population and species levels and designing successful conservation programs. We leveraged bio-logging data from two populations of fish-eating killer whales ( Rapid environmental change may disrupt cost–benefit tradeoffs of foraging strategies in cooperative species, yet whether populations differ in the partitioning of individual responsibilities within social groups is poorly understood. By combining fine-scale movement and sound data from bio-logging tags and demographic data from long-term population censuses, we reveal opposite patterns of individual foraging behavior between killer whale populations with divergent population trajectories, demonstrating variation in the partitioning of foraging responsibilities in an apex marine predator. Orcinus orca , primarily Chinook (O. tshawytscha) and to a lesser extent chum (O. keta) and coho . We also collected prey remains using fine-meshed dip nets  in MATLAB v R2016b  to calibrate sound and movement data based on sensor characteristics and tag orientation on the whale  and the marmap R package  and Fisheries and Oceans Canada (NRKW) to assign demographic variables. These databases contain extensive maternal familial relationships established through field observations and genetic testing  in R v.3.6.3  using thFor the model examining the relationship between the presence of a living mother and the number of prey capture dives by adult males model h, , we addiWe were unable to use available salmon abundance indices due to 1) spatial incongruency between the salmon stocks/regions where these abundance data were sampled and the prey consumed by NRKW and SRKW during our study period and location, 2) issues with sporadic coverage and the degree to which effort had been accounted for in some of the existing salmon indices, and 3) reliability issues with applying widely used salmon data from the Albion Test Fishery situated on the Fraser River e.g., , becauseWe analyzed 186.8 h of dive data from 52 Dtag deployments  or maximizing energy obtained from foraging (optimizing) . For SRKThe finding that adult SRKW males captured more prey if their mother was alive highlights the opposite patterns of foraging behavior we observed for adult males between the two populations. Males require more energy due to their larger size , and theIt is worth considering an alternative, nonmutually exclusive hypothesis related to the role of group leadership by post-reproductive females to explain the increased prey capture by SRKW males with living mothers. Given that post-reproductive females typically lead groups  and thatDifferences in prey abundance and availability between populations could have contributed to the differences in foraging strategies we document here. However, we could not use existing indices of salmon abundance in our analyses because these metrics do not address spatiotemporal uncertainty in the distributions of Chinook salmon returning along one of two paths to the Fraser River. The nuances of migration paths taken are directly related to accurately estimating salmon availability for each population, yet data at this fine-scale spatiotemporal resolution are not currently available. We suggest that future research should elucidate the complex relationships between 1) environmental factors including location, prey distributions, and availability, 2) the behavioral context of the animal at the time of tagging, and 3) differential population-level impacts of anthropogenic pressures, including impacts from tagging and vessel presence, on foraging behavior e.g., , 2021b. This study revealed considerable differences in sex-based and demographic patterns of individual foraging strategies, demonstrating that these strategies are not fixed across two ecologically similar populations of a gregarious marine predator. The total number of prey capture dives and proportion of time capturing prey was female biased in the growing NRKW population, and male biased in the endangered SRKW population. The presence of a calf reduced female foraging activity across populations, but disproportionately so for SRKW females. Adult SRKW males with a living mother exhibited increased foraging behavior, possibly as a compensation strategy to offset their pod’s caloric deficits and/or as an outcome of matriarch-led navigation to areas that promote greater prey capture by their adult sons. Interpopulation differences in individual roles within social groups may have arisen with the loss of key individuals as populations shrink, or may provide small, unbalanced populations experiencing environmental stressors the necessary flexibility to respond to novel and unpredictable environments caused by human-induced rapid environmental change. Indeed, interpopulation variation in individual roles may be an important evolutionary strategy for promoting resilience in the face of change.arad002_suppl_Supplementary_MaterialClick here for additional data file.


To the Editor: Fetal alcohol syndrome (FAS) is characterized by a range of structural birth defects, including facial dysmorphia, central nervous system growth deficits , and prenatal/postnatal growth restriction, which correlate with the magnitude of prenatal alcohol exposure .Due to the development of grossly observable alcohol-induced phenotypes consistent with clinical presentations of FAS, mouse models have become a powerful resource for investigating the development of alcohol-induced dysgenesis . TherefoWe first employed geometric morphometric analyses  to contrFurthermore, our analyses revealed that alcohol-induced changes predominantly centered on the lower portions of the face, including the mandible (lower jaw), maxilla (upper jaw), and positioning of the ear . As in cTo validate our observations, we examined offspring for alterations in established measures of alcohol-induced craniofacial defects . ConsistFinally, we conducted a dose-response analysis, contrasting offspring snout-occipital distance and body weight–normalized brain weights with the parental average daily ethanol dose (g/kg). We identified a significant correlation between both measurements and parental alcohol dose for male offspring across the PatExp and DuelExp treatments . In contIn 1981, the US Surgeon General issued a public health advisory warning that alcohol use by women during pregnancy could cause birth defects. Since this time, maternal alcohol use during pregnancy has remained the sole explanation for alcohol-related birth defects. In contrast, paternal drinking and lifestyle choices remain unexamined. Using a physiologically relevant mouse model, our studies are the first to our knowledge to demonstrate that male drinking is a plausible yet completely unexamined factor in the development of alcohol-related craniofacial abnormalities and growth deficiencies. Our study demonstrates the critical need to target both parents in prepregnancy alcohol messaging and to expand epidemiological studies to measure the contributions of paternal alcohol use on children’s health.


Cell-to-cell communication is a critical process that ensures interaction between adjacent and distant cells to maintain cellular homeostasis in normal physiology and pathophysiological conditions. Two adjacent cells communicate to transfer ions and small molecules via Gap junctions, small selective ion channels. Distant cells establish long-range communication via endocrine/paracrine secretions, extracellular vesicles (EVs) and tunneling nanotubes (TNTs) , that membrane-bound exosomes attached to the plasma membrane of brain endothelial cells (BEC), participate in TNT formation between the cells, and facilitate in vitro blood brain barrier (BBB) genesis. Research has also shown that exosomes released by BECs transfer specific cargo to recipient brain cells (Banks et al., Mentor and Fisher suggested TNT-mediated trans-permeability between BEC cells. Recently another study has shown that thrombospondin-1-containing exosomes released from breast cancer cells promote biogenesis of TNTs (Mahadik and Patwardhan, Another issue is the interplay between exosomes and TNTs to harness synergistic effect on intercellular communication. In this context, the work of In conclusion, the synergistic interplay between exosomes and TNTs in long-range intercellular transfer is rapidly evolving as a promising area of cellular communication. Several important questions have been raised by recent advancements in this emerging field of research. What molecular mechanisms govern their on-demand biogenesis in response to cellular toxicities to rescue pathologies? How are exosomes selectively incorporated into TNTs? Do specific pathophysiological conditions enhance or restrict biogenesis of these intercellular conduits and their functionality? Addressing these questions could provide valuable insights into intercellular communications and their complexities, and will open up new avenues for therapeutic intervention.All authors listed have made a substantial, direct, and intellectual contribution to the work and approved it for publication.


Managed care pharmacists utilize clinical guidelines to assist themin identifying acceptable treatment and management of chronic diseases. For thepast several months, an expert panel representing the National Asthma Education andPrevention Program (NAEPP) has discussed updated asthma guidelines, which couldchange future medication management of patients with asthma.To identify new guidelines for asthma control.Taking control of asthma is a foremost objective in managed care, asnew guidelines are debated, and asthma disease management programs identifymore effective models of asthma disease management. Within an effective asthmadisease management program, managed care practitioners, including but not limitedto physicians and pharmacists, must have a thorough understanding of the mostrecent clinical guidelines as well as current knowledge of the current consensusamong opinion leaders regarding asthma treatment and management. This ongoingeducation is critical in order to allow managed care practitioners to perform theirrole and function within their organizations. With the advent of changing asthmapractice guidelines and processes, managed care practitioners need current informationto recognize and apply guidelines-based asthma control.Appropriate asthma treatment requires adherence to currentmanagement guidelines. Approximately one third of asthmatics will not respondto standard asthma treatment and may even worsen while on therapy. Monitoring,close tracking, and regular evaluation of asthma patients at every health careprovider visit is a strategy that can be utilized to generate improved asthma control.


Prosthetic aortic valve dehiscence is an uncommon complication of prosthetic valve endocarditis that may occur in patients who have undergone aortic valve replacement (AVR). The concurrent presence of aortic root pseudoaneurysm may further complicate the clinical presentation through the external compression of coronary arteries. Thus, patients may present with clinical features of coronary ischemia. Echocardiogram and coronary angiography are useful in establishing diagnosis. Treatment involves a multidisciplinary approach involving cardiologists, infectious disease specialists, and cardiothoracic surgeons. The authors of this study discuss a 51-year-old male who presented with anginal chest pain and was found to have a new left bundle branch block, elevated troponins, and left main coronary artery compression complicating aortic root aneurysm. He ended up requiring a re-do AVR, repair of the pseudoaneurysm, and coronary artery bypass graft. Prosthetic aortic valve infection with dehiscence is a major complication in patients with prior valve replacements . This coA 51-year-old male was referred from an outside facility on account of dyspnea, anginal chest discomfort and elevated troponins. His medical history was significant for intravenous (IV) drug use, hepatitis C, and multiple cerebrovascular accidents (CVAs) that necessitated patent foramen ovale closure. His cardiac history was significant for infective endocarditis-related valve dysfunctions status-post bio-prosthetic aortic valve replacement (AVR) and mitral valve repair with an annuloplasty ring.His vital signs included a blood pressure of 130/74 millimeters of Mercury, a pulse rate of 86 beats/minute, and a temperature of 98.6 degrees Fahrenheit. Examination findings were notable for crackles on lung auscultation. Initial lab results showed an elevated high-sensitivity troponin I level of 327 picogram per milliliter (pg/ml) (reference range 3-58 pg/ml). Rapid plasma reagin was negative. Computed tomography (CT) of the lungs suggested pulmonary septic emboli. Electrocardiogram (ECG) showed sinus rhythm and a new left bundle branch block (LBBB) that was not present on an ECG obtained three months earlier. Both ECGs are shown in Figures The cardiology service was consulted. A transthoracic echocardiogram (TTE) was performed and showed an abnormal prosthetic aortic valve function with rocking motion, prosthesis stenosis with peri-valvular regurgitation, pseudo-aneurysm of the aortic root, and ejection fraction of 25%. A transesophageal echocardiogram (TEE) was pursued and showed prosthesis stenosis, high sense of aortic valve more than 180 degrees detached with severe perivalvular regurgitation, and sewing ring dehiscence in the prosthetic aortic valve. It also showed a 4.7 cm by 4.3 cm aortic root pseudoaneurysm communicating with the aortic sinus  was subsequently performed and showed external compression of the left main coronary artery (LMCA) and proximal left circumflex artery from the pseudoaneurysm as shown in Figure The aortic root pseudoaneurysm was believed to be the cause of the external pressure on the LMCA as demonstrated in the coronary angiogram; coronary artery bypass graft (CABG) was thus not planned initially. The plan, however, changed during the aneurysmal repair when the patient developed elevated pulmonary artery (PA) pressure and a visibly distended heart. CABG with saphenous vein graft to the left anterior descending artery was therefore performed. PA pressure normalized after the CABG. The dehiscent aortic valve is shown in Figure Unlike an atherosclerotic disease, external compression of the LMCA is a much less common cause of coronary ischemia. Etiologies include pulmonary artery in the setting of primary pulmonary hypertension, perivalvular abscess of the aortic valve, aneurysm of the aortic root, and left ventricular aneurysm -4. PatieProsthetic valve endocarditis (PVE) can result in valve dehiscence and mycotic aortic root aneurysm . The incThe diagnosis is usually made using echocardiography. It is important to remember that a negative TEE does not rule out the presence of vegetation. Large vegetation is a later event and the detection of smaller vegetation by a transesophageal echocardiogram (TEE) can be challenging due to the shadowing effect and reflection of the prosthetic material . MoreoveThe current case faced a distinctive complication involving compression of the left main coronary artery and proximal left circumflex artery by the aortic root pseudoaneurysm. ECG showed LBBB which was concerning for acute coronary syndrome necessitating coronary angiogram. LHC will usually show the area of external compression of the LMCA like in our patient. Surgical treatment of the aneurysms relieves the mechanical compression of the coronary arteries. Surgical management for PVE is not without challenges with some series reporting mortality rates of 20-60% and infection recurrence rate of about 7% . Long-teAortic root aneurysm causing external compression of LCA is an important but unusual cause of myocardial ischemia. Patients may be asymptomatic or present with chest pain and dyspnea. Management requires a multi-disciplinary approach. Since the clinical presentation is varied, clinicians need to be aware of the various presentations and challenge of variation in anatomic structure observed in management of such patients. Therefore, this is an important differential diagnosis to consider in the right clinical scenario: patients with PVE and aneurysmal aortic root, especially those with minimal to no atherosclerotic risk factors.


We also found that youth-reported positive parenting buffered against the association between childhood stress and decreased hippocampal volumes  such that youth who experienced high levels of childhood stress and who reported increased levels of positive parenting did not exhibit smaller hippocampal volumes. Our work identifies positive parenting as a resilience factor buffering youth against the deleterious impact of stressful childhood experiences on problem behaviors and brain development. These findings underscore the importance of centering youth perspectives of stress and parenting practices to better understand neurobiology, mechanisms of resilience, and psychological well-being.Childhood stress has a deleterious impact on youth behavior and brain development. Resilience factors such as positive parenting (e.g. expressions of warmth and support) may buffer youth against the negative impacts of stress. We sought to determine whether positive parenting buffers against the negative impact of childhood stress on youth behavior and brain structure and to investigate differences between youth-reported parenting and caregiver-reported parenting. Cross-sectional behavioral and neuroimaging data were analyzed from 482 youth  who participated in an ongoing research initiative, the Healthy Brain Network (HBN). Regression models found that youth-reported positive parenting buffered against the association between childhood stress and youth behavioral problems ( Childhood stress (e.g. the death of a loved one or illness) can have a negative impact on mental health and well-being; it is therefore critical to investigate resilience factors that might protect against stress. We consider positive (i.e. warm and supportive) parenting as a buffer against the impacts of childhood stress on youth behavior problems and corticolimbic structure. Youth perceptions of positive parenting moderated the association between childhood stress and (i) youth behavioral problems and (ii) hippocampal volumes. No significant associations emerged from interactions with caregiver-reported positive parenting or amygdala volumes. We conclude that positive parenting may function as a key resilience factor protecting youth from the deleterious impact of stressful experiences and that youth perspectives are critical to understanding how life stress shapes neurodevelopment and behavior.Stress in childhood and adolescence can significantly compromise mental health and well-being . A growiResilience factors such as relationships with caregivers can significantly protect against the many deleterious developmental outcomes associated with childhood stress, with more positive caregiver–child connections being associated with better adjustment and fewer problem behaviors among youth , 13. Varslower amygdala growth over time for youth experiencing high levels of positive parenting and high stress, accelerated amygdala growth for youth experiencing high levels of positive parenting and less stress, and no significant effects of stress and parenting on hippocampal volumes  and typically focus on stressful contexts (i.e. socioeconomic disadvantage) and not the actual experience of stress . We were particularly interested in investigating differences between youth versus caregiver perceptions of positive parenting, predicting stronger interactive effects for youth reports of positive parenting compared with caregiver reports.α > 0.7, as detailed in our Data from 482 participants  between the ages of 10–17 years with T1-weighted structural images were analyzed from the ongoing Healthy Brain Network (HBN) research initiative , a checklist measuring family-, community-, and school-based stressors . Due to Youth report and caregiver report of positive parenting were measured using the positive parenting subscale from the Alabama Parenting Questionnaire (APQ) . For eacYouth behavioral functioning was operationalized by the Youth Self-Report (YSR) Total Raw Score. The YSR is a well-validated and widely used 112-item instrument for problem behaviors across the internalizing and externalizing spectrums among children aged 11–18 .High-resolution T1-weighted anatomical MRI scans were collected from four sites in the New York City area. We performed standard-processing approaches from FreeSurfer (version 7.1) and excluded participants with low-quality images and high-motion scans . Regression models examined the interactions of stress and parenting in predicting youth behavioral problems and included sex, age, and scanning site as covariates. We fit linear mixed-effects models (LMEMs) for each brain region of interest  due to potential variations in research sites and scanners. LMEMs included a random effect of the imaging site and sex, age, and estimated total intracranial volume as covariates. We ran separate models testing interactions between negative life events and a) youth-reported positive parenting and b) caregiver-reported positive parenting for each brain region of interest. For significant interaction terms, we conducted simple slope analyses . Across models, we tested for differences between any significant and nonsignificant interaction terms (see N = 226)   anerms see  and psycerms see . We ran pproach) .Descriptive statistics are found in Table β = 0.14, Praw < 0.001, Pcorrected = 0.017) and a significant main effect of positive parenting . We also found a significant interaction between negative life events and positive parenting . Simple slope analyses indicated that the association between negative life events and behavioral problems was significant at lower  and average  levels of positive parenting, but not at high levels of positive parenting. There was no relation between stress and behavioral problems when youth were exposed to the highest levels of positive parenting, suggesting a buffering effect. We considered a similar model examining the interaction between stress and positive parenting on behavioral problems using caregivers as the informant of positive parenting. We found no buffering effect of positive parenting against the association between stress and behavioral problems using the caregiver report measure of positive parenting. Models without interaction terms and caregiver report measures of behavioral problems and negative life stress can be found in the We first considered the moderating effect of youth-reported positive parenting on the association between negative life events and youth-reported behavioral problems Fig. . Resultsβ = −0.07, Praw = 0.029, Pcorrected = 0.042) on the total hippocampal volume. As predicted, there was a significant interaction between youth-reported positive parenting and stress . There was no effect of youth-reported negative life events on hippocampal volumes for participants reporting above-average positive parenting. This finding underscores the stress-buffering role of positive parenting given that reports of negative life events had a negative association with hippocampal volumes only in the presence of below-average and average levels of positive parenting, and not in the presence of above-average positive parenting. Sensitivity analyses testing left and right hippocampal volumes individually can be found in the We next considered the moderating effect of youth-reported positive parenting on the association between negative life events in childhood and hippocampal volumes  on total hippocampal volume. We tested differences between interaction terms for our two models   on total amygdala volume. There were also no interactive effects between negative life events and youth-reported positive parenting on total amygdala volume .There was not a significant main effect of negative life events (N = 226). In this subsample, adding the presence of a mental health diagnosis was not significantly associated with the total hippocampal volume.We constructed additional models to determine the robustness of our effects see . These aWe ran additional analyses examining associations with several markers of socioeconomic status given connections between socioeconomic status and hippocampal volumes. Results indicated that the potentially comorbid and stressful experience of the socioeconomic environment did not account for observed effects of negative life events and positive parenting on youth behavioral problems and hippocampal volumes see . To accoWe found three major results: (i) negative life events and youth perceptions of positive parenting are associated with behavioral problems, (ii) negative life events are significantly associated with smaller hippocampal volumes, and (iii) positive parenting moderates this association such that youth who reported high levels of positive parenting did not show smaller hippocampal volumes even with increasing levels of stress. Only youth perspectives of positive parenting interacted with childhood stress (measured through negative life events) to predict hippocampal volumes; caregiver report of positive parenting was not related to neurobiology as either a main effect or in an interaction with stress. Such findings underscore the importance of including youth as reporters of their own experiences to better understand consequences for neurodevelopment and behavior . We did Our results underscore well-replicated connections between exposure to childhood stress and smaller volumes in the hippocampus , 32. ThePositive parenting can provide youth with a stable environment to learn social skills, feel supported, and practice cognitive and behavioral regulation. Other work examining interactive effects between childhood stress and parenting on brain volumes has not found evidence of a buffering effect of parenting, instead suggesting that warm and supportive parenting was a compounding positive force in the context of low stress . In contThe protective effect of parenting against the deleterious neurobiological impacts of stress may function through modulating biological and socioemotional processes such as hypothalamic–pituitary–adrenal (HPA) axis responsiveness, cortisol reactivity, and self-regulation. Longitudinal work has found that parenting influences HPA axis and cortisol reactivity, which in turn impacts hippocampal volume during development . In addir = 0.22) between youth and caregiver reports of positive parenting in this sample aligns with previous work establishing small to moderate correlations between youth and caregiver reports of behavioral and emotional functioning , suggesting that the observed interaction between childhood stress and youth-reported positive parenting on hippocampal volumes in our larger sample is not explained by comorbid psychopathology. Similarly, we considered associations with various operationalizations of socioeconomic status considering that socioeconomic disadvantage can be an experience of stress that has been associated with altered corticolimbic structure  for consistency in findings (We note several limitations that could serve as important directions for future research. First, we report significant associations that are small in magnitude, with effect size estimates indicating that childhood stress at below-average parenting explains 0.06% of the variance in youth behavioral problems; similarly, childhood stress at below-average parenting explains 0.02% of the variance in total hippocampal volumes. Youth behavioral problems and total hippocampal volumes were also not significantly associated in our supplemental analyses. Of note, we did find a significant association between youth behavioral problems and left hippocampal volumes (detailed in our findings  and apprfindings .Our findings have implications for understanding the impact of childhood stress as well as the factors that buffer youth against the noxious consequences of stress. Given the critical role of the hippocampus in memory and goal-directed behavior, alterations in this structure may create vulnerabilities for later negative outcomes. While additional research is needed to clarify complex relations between stress, parenting, and the brain, our data provide insight into how environmental forces may interact to influence neurobiology.pgad145_Supplementary_DataClick here for additional data file.


Spectroscopy imaging machine learning for crop stress.” By exploring these cutting-edge research findings we can gain valuable insights into the application of these technologies to enhance agricultural resilience productivity.Crop stress poses a huge challenge to food security necessitating innovative approaches for early detection monitoring management of stress. In recent years the integration of spectroscopy imaging machine learning techniques has emerged as a promising avenue for detecting various types of crop stress. This editorial work introduces recent publications within the field included in the Research Topic “Xiao et al. focused on the use of visible and near-infrared spectroscopy combined with deep learning to estimate leaf nitrogen concentration in cotton leaves. The study employed random frog, weighted partial least squares regression and saliency map to select characteristic wavelengths. The models based on convolutional neural network showed excellent performance for both qualitative and quantitative prediction of leaf nitrogen. These findings highlight the potential of deep learning and visible and near-infrared spectroscopy within accurate and real-time assessment of cotton leaf nitrogen content, enabling farmers to make applicable fertilization decisionsWu et al. employed an unmanned aerial vehicle (UAV) to obtain multispectral images of a rice canopy and analyzed the response of multispectral reflectance features and physiological parameters including net photosynthetic rate (Pn), plant height (PH), and SPAD to different nitrogen treatments or leakage conditions at various growth stages of the crop. The study extensively analyzed the correlation between vegetation indices (VIs), texture indices (TIs), and Pn based on UAV multispectral images. The techniques and findings presented in this paper provide valuable insights within field-scale photosynthetic monitoring in rice cultivation and improve stress detection and yield prediction.Choudhury et al. introduces two innovative algorithms, namely VisStressPredic and HyperStressPropagateNet, to predict the onset and propagation of drought stress in plants using camera-captured image sequences in visible light and hyperspectral modalities. The algorithms analyze visible light sequences at discrete intervals and utilize a deep neural network and hyperspectral images to propagate stress over time, which demonstrate a strong correlation between soil water content and the percentage of stressed plants. These algorithms are evaluated on a dataset of cotton plant image sequences and offer valuable support for studying abiotic stresses in diverse plant species, promoting sustainable agricultural practices.Hu X. et al. propose a novel approach called Class-Attention-based Lesion Proposal Convolutional Neural Network (CALP-CNN), utilizing a class response map to locate the main lesion object and identify discriminative lesion details in visual light images. Through a cascade architecture, CALP-CNN effectively handles complex background interference and misclassification of similar diseases. Experimental results on a self-built dataset demonstrate CALP-CNN achieves good classification performance and outperforms the existing fine-grained image recognition methods, highlighting its efficacy in field identification of strawberry diseases.Hu Y. et al. presents an enhanced encoder-decoder framework based on DeepLab v3+ analysis of images to accurately identify crops with diverse planting patterns. The network utilizes ShuffleNet v2 as the backbone for feature extraction and incorporates a convolutional block attention mechanism to fuse attention features across channels and spatial dimensions. The enhanced network achieves significant improvements and requires fewer parameters and computational operations compared to other networks. This study demonstrates the effectiveness of Deep-agriNet in identifying crops with different planting scales, making it a valuable tool for crop identification in various regions and countries.The combination of spectroscopy, imaging, and machine learning has a high potential for improving crop stress analysis and management. By utilizing these technologies, we can enhance our understanding of crop stress dynamics, develop precise and targeted stress detection methods, and improve decision-making processes for farmers. Ongoing research, technological advancements, and collaborative efforts are necessary to unlock the full potential of spectroscopy, imaging, and machine learning in mitigating crop stress and ensuring global food security.The author confirms being the sole contributor of this work and has approved it for publication.


A 60-year-old male patient underwent coronary angiography for acute myocardial infarction. Angiograms revealed significant multivessel disease and an abnormal branch arising from the proximal right coronary artery and extending backwards, likely to the right lung A. Both iIsolated DOPA is a rare vascular malformation that may remain undiagnosed until advanced age, often manifesting with nonspecific symptoms such as recurrent bronchopneumonia, haemoptysis, and dyspnea.,Lack of a connection between the main and affected branch PA, resulting from the involution of the ventral sixth aortic arch, led to the erroneous definition of unilateral pulmonary artery agenesis.•Chest radiograph may provide relevant clues to the diagnosis of DOPA.•CTPA is the method of choice for noninvasive diagnostic confirmation.•Key diagnostic findings are a well-formed but hypoplastic pulmonary artery and a ductal diverticulum on the aortic arch or the base of an epiaortic vessel.Interestingly, DOPA could be suspected by jointly considering the anomalies detected by coronary angiography and chest radiograph. Despite not providing direct visualization of DOPA, these diagnostic modalities could offer subtle but important clues to this rare malformation, ultimately confirmed by CTPA.


Gastrointestinal cancers represent a major challenge to public health. Pancreatic cancer is the most lethal cancer among all gastrointestinal cancers. Most patients cannot meet the criteria of resection at diagnosis, indicating these patients will have dismal prognosis.Neoadjuvant chemotherapy helps some patients regain the opportunity of radical resection. An optimal regimen of chemotherapy is one that maximizes the anti-tumor efficacy while maintaining a relatively manageable safety profile. The development of surgical procedures further improves the outcomes of these patients.Combination therapies in a multidisciplinary manner that involves modified chemotherapy regimen, radical resection, and intestine auto-transplantation may provide the currently best possible care to patients with locally advanced pancreatic cancer. Gastrointestinal cancers account for around 25.8% of newly diagnosed cancers annually. Among them, pancreatic cancer is the most lethal cancer, with a 5-year overall survival rate of only around 12%. There are more than 495,700 new cases of pancreatic cancer each year [Liang and colleagues proposed a modified FOLFIRINOX regimen, consisting of 85% oxaliplatin, 75% irinotecan, and zero fluorouracil bolus . This moThe modified FOLFIRINOX regimen was also applied as a neoadjuvant treatment to borderline resectable pancreatic cancer (BRPC) and locally advanced pancreatic cancer (LAPC) for downstaging and creating surgical opportunity. According to the LAPACT trial that applied gemcitabine plus nab-paclitaxel to LAPC, the neoadjuvant induction therapy achieved a 15% conversion rate of radical resection . The medThe expanded surgical resections after neoadjuvant therapy are critical to the improvement of the radical resection rate in LAPC. For LAPC involving the pancreatic body/tail and the celiac trunk, radical resection can be achieved by the modified Appleby procedure . This group is one of the leading groups that focus on intestine auto-transplantation and liver cancer surgery , 8. As fLiang’s integrated treatment strategy by combining modified FOLFIRINOX with sequential radical resection has established an excellent model of multimodal treatment against pancreatic cancer, and extended criteria of surgical resectability, which would benefit more pancreatic cancer patients at locally advanced stages. The success of this strategy implies that for pancreatic cancer patients, especially those who cannot meet the resectability criteria, the combination of modified chemotherapy and surgical intervention would provide an increased survival benefit. Furthermore, the interim analysis of a prospective phase 3 clinical trial  conducted by Liang’s group , compariIn summary, gastrointestinal cancers represent a major challenge to public health. Most patients cannot meet the criteria of resection at diagnosis, indicating these patients will have dismal prognosis. Neoadjuvant chemotherapy helps some patients regain the opportunity of radical resection. The development of surgical procedures further improves the outcomes of these patients. Combination therapies in a multidisciplinary manner that involves modified FOLFIRINOX regimen, radical resection plus intestine auto-transplantation, targeted therapy and immunotherapy may provide the best possible care to patients with LAPC.The modified FOLFIRINOX regimen is currently an optimal treatment option for pancreatic cancer patients. Combination of the modified FOLFIRINOX regimen, radical resection, and intestine auto-transplantation provides the currently best possible survival benefit for those who have otherwise lost the opportunity of surgery. The addition of immunotherapy, targeted therapy, and radiotherapy may further increase the efficacy of the combination therapy.


How adult tissue-specific stem cells with indicated markers contact the adjacent lineage with indicated markers is of significance to be studied. Novel methods bring future findings. Recent advances in lineage tracing, synthetic receptor systems, proximity labeling, and transcriptomics have enabled easier and more accurate cell behavior visualization and qualitative and quantitative analysis of cell-cell interactions than ever before. These technological innovations have prompted researchers to re-evaluate previous experimental results, providing increasingly compelling experimental results for understanding the mechanisms of cell-cell interactions. This review aimed to describe the recent methodological advances of dual enzyme lineage tracing system, the synthetic receptor system, proximity labeling, single-cell RNA sequencing and spatial transcriptomics in the study of adult tissue-specific stem cells interactions. An enhanced understanding of the mechanisms of adult tissue-specific stem cells interaction is important for tissue regeneration and maintenance of homeostasis in organisms.Adult tissue-specific stem cells play a dominant role in tissue homeostasis and regeneration. Various   Adult tissue-specific stem cells interactions can be viewed as communication modalities that play a central role in regulating cell behavior and function .In this paper, we first discuss the methods for studying adult tissue-specific stem cells interactions in two directions: bioinformatics analysis and visualization analysis. Specifically, these techniques or methods include lineage tracing, synthetic receptor systems, proximity labeling, and transcriptome analysis. In addition, there are few systematic descriptions of the mechanisms of stem cell interactions. Therefore, this paper also combs the biological understanding of adult tissue-specific stem cells interactions. We do not provide a summary assessment of all relevant literature, and references throughout the text tend to be more illuminating examples. Based on the latest literatures, stems cells referred in this review focus on adult tissue-specific stem cells.in vivo single-cell analysis because of its efficiency and spatiotemporal specificity  during long bone formation is clearly illustrated  to regenerate the bronchoalveolar junction region after an injury has been demonstrated using dual-recombinase-activated lineage tracing (DeaLT) system, reiterating previous findings . Applyinustrated . It has ustrated . In lungustrated . Updatedustrated .Based on the Cre: Dre dual recombinase reporter system, Lingjuan We also note the contribution of optogenetic genetic engineering to the content of our work, which is widely used to study and control cells and has been previously described . OptogenInspired by the natural cell-signaling paradigm, researchers have implemented artificially designed synthetic receptor systems to manipulate signal translation to control cellular functions, including artificially tunable cellular sensing and subsequent transcriptional responses . The devThe synNotch receptor system, which detects cell-cell contact, was developed during the development of synthetic receptor systems . The synDrosophila model  genetically engineered to be expressed in decoy cells to transfer the markers to prey cells . This laThe FucoID protocol installs the glycosyltransferase directly onto the decoy cell without gene expression on the cell membrane . This enProtocols using photocatalysts have greater temporal control and remote manipulation than enzymatic proximity-labeling systems . These pin situ studies of cellular interactions in animal models  act as alveolar adult tissue-specific stem cells in response to injury . AT2 celin vivo  triggers EphB2 signaling attenuation in adjacent radial neural stem cells (rNSCs) through direct cell contact, leading to rNSC activation and the generation of new neurons . Conversin vitro . TranscrInteractions between immune cells and stem cells have also been reported. The fate of intestinal stem cells (ISC) is regulated by adhesion signals from immune cells . BindingThe paracrine effects of stem cells are also influenced by the cell-cell contact between stem cells and other cells. For example, the immunomodulatory effects of MSCs are enhanced upon contact with pro-inflammatory macrophages . AdditioMoreover, immune cell function is affected by intercellular contact between stem cells and immune cells. This may be due to the secretion of cytokines that affect stem cells . There aStem cells can also regulate immune cell functions through paracrine and intercellular contacts . TGF-β Min situ.”In bone marrow tissue, bone marrow regeneration after radiation clearance is inseparable from the transfer of mitochondria from hematopoietic stem cells to bone marrow mesenchymal stromal cells through intercellular contacts . HematopMechanical signals include both the structure and properties of the ECM and forces generated by the cell through various connections . This inDrosophila, the proliferation and differentiation of all stem cells that ectopically express Piezo are promoted by a mechanism that is inseparable from calcium signaling (Mechanically gated Piezo1 channels are expressed in both neural stem cells and astrocytes and regulate adult neurogenesis . In Drosignaling . Piezo1 ignaling . Furtherignaling . During ignaling . When thignaling . Adult mignaling . The NotWnt and Src-YAP signaling cooperate to drive intestinal regeneration . Additiovice versa in favor of endocrine cell fate (Physical signaling with tunable properties that act immediately and locally is an object of interest to regulate the differentiation of stem cells into specific lineages . The ECMell fate . MSCs arell fate . Smallerell fate . The intell fate . Moreoveell fate . The intell fate .Indeed, numerous researchers have shed a light on how mechanical information affects cell behavior. We are currently studying the mechanisms underlying stem cell interactions to improve the application of stem cells in regenerative medicine. To systematically and precisely elucidate these mechanisms, technologies with higher spatial and temporal resolutions, more realistic simulations of the stem cell microenvironment, and more specific stem cell population differentiation and tracing are required. This demand has led to many powerful technologies that elucidate the mechanisms of stem cell interactions. We discuss how lineage tracing, synthetic receptors, proximity labeling and transcriptome data analysis tools can be applied in the study of CCI. The techniques presented in this paper include but are not limited to using stem cells as research models, and using non-stem cells as research models has complementary and reference significance. In addition, we note some other techniques. For example, SPEAC-seq based on CRISPR-Cas9 with microfluidic microarrays to identify cell signaling pathways . It provThe study of stem cell interactions is in a rapidly evolving stage, especially in the context of rapid iterative updates in biotechnology. Although, the biological understanding of stem cell interactions sorted out in this paper is not sufficient to elaborate a comprehensive picture of stem cell behavior during mammalian development or injury repair, it contributes to a complete description of stem cell interaction mechanisms in the future.


Cerebrovascular injuries resulting from frontobasal head trauma represent a range of imaging and clinical presentations. Severe cerebrovascular injuries such as vessel transection commonly present with profound neurological deficits and are often easily identified with routine imaging. However, small intimal injuries and dissections may be challenging to detect and may be clinically silent or masked by additional injuries in the setting of polytrauma. The onset of symptoms and complications from cerebrovascular injuries may be delayed from the time of initial presentation, and failure to recognize and diagnose these injuries may result in devastating outcomes if management is delayed. In this case report, we present a case of frontobasal craniofacial trauma that resulted in an anterior cranial fossa dural arteriovenous fistula (ACF-dAVF) and supraclinioid segment internal carotid artery (ICA) pseudoaneurysm.  Vascular injuries have been identified in 8.5% of skull base fractures in some case series, particularly when the sella turcica-sphenoid sinus complex and the petrous carotid canal are involved ,2. ResulDural arteriovenous fistulas (dAVF) are uncommon vascular lesions with abnormal connections between arteries and leptomeningeal veins or a dural venous sinus . They maTraumatic intracranial aneurysms represent fewer than 1% of all intracranial aneurysms . AlthougA 45-year-old male presented with extensive frontobasal and craniofacial injury after an all-terrain vehicle (ATV) rollover. Initial trauma computed tomography (CT) scans depicted bilateral naso-orbito-ethmoid complex fractures with fracture planes extending to the bilateral sphenoid sinus walls. Multi-compartmental intracranial hemorrhage, including subarachnoid hemorrhage and hemorrhagic contusions with basifrontal predominance, were also present. Subsequent CT angiography (CTA) of the neck revealed vessel wall irregularities and non-flow limiting stenosis involving the left supraclinoid ICA, and prominent cortical veins along the right ACF Figures , 2. The Cerebrovascular injury from blunt trauma can be subtle and difficult to detect at initial presentation. It can be stratified using a five-point scale Biffl cerebrovascular arterial injury grading scale based on the severity of vessel injury from mild intimal injury (Grade I) to vessel transection (Grade V) Table  11]. Gr. Gr11]. In this case, the patient developed an ACF-dAVF within three days of the initial encounter, which is to our knowledge the first case report of a patient presenting with this condition within one month of the initial injury. In ACF-dAVFs, the cribriform plate is commonly the fistula point, in which afferent arterial supply arises from the distal ophthalmic artery and both anterior and posterior ethmoidal arteries, and venous drainage occurs through frontal cortical veins into the superior frontal sinus or posteriorly into the cavernous sinus or basal vein of Rosenthal ,15. In tTraumatic intracranial aneurysms may be true or false aneurysms. True aneurysms have preserved adventitia and partially disrupted and damaged intima, internal elastic lamina, and media, whereas false aneurysms/pseudoaneurysms result from disruption of all arterial wall layers and are contained by adjacent hematoma and perivascular connective tissues . In partThis report is a description of a rare case of ACF-dAVF and ICA pseudoaneurysm that developed in the days following significant frontobasal craniofacial trauma as an opportunity to discuss the clinical presentation and associated imaging findings of these lesions, and to provide a better understanding of the pathogenesis and management of these and related post-traumatic cerebrovascular injuries and complications.