26419 research outputs found
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A Painful Diffuse Rash
No full text[Patient presentation]
A 41-year-old male with no past medical history presented with 1 week of ulcers to the left side of his face, followed by several days of a painful rash to the trunk and back after a sexual encounter. The patient denies any fever or previous rash and any illicit drug use. Initial vital signs included a temperature of 97 °F, a heart rate of 89 beats per minute, and blood pressure of 135/79 mm Hg. Physical examination revealed a macular papular rash across his trunk and back (Fig 1) and facial ulcerations with eschar (Fig 2) at the same stage. Laboratory findings showed a white blood cell count of 6.9 K/μL. Testing for human immunodeficiency virus (HIV) syphilis, herpes simplex virus, gonorrhea, and chlamydia was negative. Polymerase chain reaction (PCR) for monkeypox tested positive
A Cross-Sectional Study Investigating the Relationship Between the FTO Gene Polymorphism in Relation to Obesity Traits and Vitamin D Status in Adolescence
No full textBackground and Objective: Obesity affects 18%-25% of adolescents globally and represents a major public health challenge. Genetic factors contribute to obesity susceptibility, with the FTO gene variant rs9939609 consistently associated with obesity in adults; however, evidence in adolescents is limited. This study examined the association between FTO and obesity traits in adolescents and explored potential interactions with vitamin D status.
Methods: In this cross-sectional study, 509 adolescents aged 10-15 years were genotyped for FTO rs9939609. Obesity traits, including BMI, BMI z-score, and waist circumference, were assessed. Associations with genotype were analyzed using an additive genetic model, and potential interactions with vitamin D status were evaluated.
Results: The A allele was significantly associated with higher adiposity: BMI (β = 1.29 kg/m², p = 0.0008) and waist circumference (β = 3.24 cm, p = 0.001). Each additional risk allele increased the odds of having overweight or obesity by 53% (OR = 1.53, 95% CI: 1.19-1.98, p = 0.001). No significant interaction was observed between FTO and vitamin D status (p \u3e 0.05).
Conclusion: This first report from the Arabian Gulf region confirms the association between FTO rs9939609 and adiposity in adolescents, underscoring the contribution of genetic factors to obesity risk in young populations
From Comparison to Integration: Building Energy Simulation Tool Variability and the Case for Intelligent Retrofit Workflows
No full textAs the urgency to address climate change and modernize energy infrastructure grows, the building sector plays a key role in improving energy efficiency and reducing carbon emissions. This study evaluates five energy retrofit strategies for Building 101 at The Navy Yard in Philadelphia, comparing two real-world proposals from energy service companies with three simulation-based packages derived from Building Energy Simulation (BES) tools. The study examined whether advanced BES tools provide greater accuracy and decision-making value compared to simpler alternatives. Electricity savings ranged from 5 % to 40 %, gas savings from 29.7 % to 61 %, and annual cost reductions between 55,383. The most effective package achieved a 40 % reduction in energy use, with a simple payback of 2.8 years, demonstrating strong economic and environmental viability. By directly comparing retrofit outcomes across five independently developed scenarios, each using distinct software, data inputs, and calibration protocols, this study uniquely captures the fragmented reality of energy modeling practice and provides a scalable framework for cross-tool benchmarking. Advanced BES tools produced more detailed outputs but require significant expertise and data, while simpler platforms like Asset Score produced comparable results with lower input demands, making them suitable for early-stage or resource-constrained assessments. The study’s direct comparison across divergent baselines reveals how tool selection influences both technical outcomes and retrofit feasibility. Future research should prioritize AI-driven calibration, digital twins, and adaptive modeling to enhance accuracy, reduce complexity, and support scalable, stakeholder-responsive retrofit planning
Does Fishery Management for Groupers (Teleostei: Epinephelidae) Protect Them Effectively? Context from the IUCN\u27s Red List of Threatened Species
No full textWorldwide, groupers (Epinephelidae) are commercially valued fishes, which also play key ecological roles on tropical and subtropical reefs. In 2007 and 2016, the IUCN\u27s Groupers and Wrasses Specialist Group assessed all 160+ grouper species, with 17 of these being identified as threatened in 2016 and the major threat factor being overexploitation. Our present study aimed to identify whether management measures (MMs) for previously assessed groupers were established, whether these measures aligned with IUCN\u27s Red List categories, and whether they effectively protect grouper populations. Experts in grouper biology and management assigned scores per grouper species based on the extent to which MMs were in place and effective throughout these species\u27 geographic ranges. Simple 4-level scores (0–3) were used to indicate the extent to which a MM was in place and how effective it was considered to be over the global distribution of each species. Of the 50 species scored, which included almost all threatened species, 97 % showed no/extremely limited/limited use of MMs, while only 3 % showed widespread/extensive use of MMs. Only 2 % of species showed highly/very effective scores for management, while 98 % showed limited/extremely limited/ineffective scores or no MMs in place. The MMs and their effectiveness were not commensurate with IUCN extinction risk levels. Overall, fishery management implemented for groupers by governments needs to be substantially improved, basic biological studies on many species are urgently required, fishing effort needs to be reduced, and regular biological and fishery monitoring conducted to evaluate the need for, and outcomes of, management. Although not all grouper species form spawning aggregations, recommendations are given to increase the protection of aggregating grouper species, in combination with well-placed Marine Protected Areas
Skeletal Muscle Myofiber Development in Non-Human Primate Offspring Deprived of Estrogen in Utero
No full textIntroduction: We previously showed that baboon offspring born to mothers deprived of estrogen during the second half of gestation exhibited insulin resistance prior to and after the onset of puberty. Moreover, the size of skeletal muscle myofibers and the number of microvessels important for delivery of insulin/glucose to myofibers were lower in near-term fetuses deprived of estrogen during pregnancy, and myofiber capillarization remained reduced in post-pubertal offspring deprived of estrogen in utero. However, it remains to be determined whether skeletal muscle size is restored to normal in animals deprived of estrogen in utero after the onset of puberty/gonadal estrogen production. Methods: To answer this question, the current study quantified the size and number of slow and fast fibers in biopsies of vastus lateralis skeletal muscle obtained from post-pubertal female baboon offspring 9–12 years old, born to mothers who were untreated (n = 7) or treated during the second half of gestation with letrozole (n = 6; suppressed maternal and fetal estrogen by \u3e90%) or letrozole plus estradiol benzoate (n = 3). Results: Results indicated that skeletal muscle slow and fast fiber growth in female offspring appeared to occur by hypertrophy and that respective size of fibers after the onset of puberty was similar in offspring born to mothers who were untreated or deprived of estrogen in utero. Conclusions: Postnatal myofiber hypertrophy likely reflects the impact of the pubertal surge in and continued exposure of offspring myofibers to ovarian estrogen and is restored to normal in post-pubertal female offspring deprived of estrogen in utero
Impacts of Offshore Wind Energy Development on the Commercial Sea Scallop Fishery
No full textThe Atlantic sea scallop (Placopecten magellanicus) fishery on the Northeast U.S. continental shelf generates approximately USD 500 million ex-vessel revenues annually, making it one of the most valuable single species fisheries in the United States. Wind energy development is planned for key areas on the U.S. Mid-Atlantic shelf where the Atlantic sea scallop fishery operates, creating novel challenges in managing trade-offs between traditional users like fisheries and new users like offshore wind energy. An agent-based modeling framework that integrates spatial dynamics in Atlantic sea scallop stock biology, fishing fleet behavior, and federal management decisions, was implemented to investigate how offshore wind energy infrastructure may directly affect the Atlantic sea scallop fishery. The effect of current and planned wind energy lease areas on Atlantic sea scallop was evaluated with simulations that restricted Atlantic sea scallop fishing in lease areas, transiting lease areas by the fishing fleet, or both. The relative effects of these restrictions were measured against a simulation without any restrictions.
Simulations indicated that wind energy lease areas have minor impacts on the present-day fishery, with changes in days fished, landings per unit effort, and total fishing trips under 5% with impacts varying across development scenarios and fishing ports. These results suggest offshore wind development may have limited impacts on fishing. However, these changes can be magnified by the value of the Atlantic sea scallop fishery, resulting in substantial economic impacts. Imposed restrictions on fishing location and transiting lease areas resulted in spatial shifts in fishing trips, with larger changes associated with the larger proposed wind lease area footprints, particularly in the southern part of the Atlantic sea scallop range. The largest negative effect of wind restrictions was the reduction in Atlantic sea scallop biomass outside of the lease areas (similar to 4-9%), likely due to effort displacement, even though the total stock biomass remained relatively unchanged. The simulation results highlight the need for a holistic approach to assessing the complex interactions between offshore wind energy lease areas, Atlantic sea scallop stock dynamics, and fishing vessel transit routes to accurately identify and address potential impacts. This information is critical for fishers and managers to assess mitigation approaches and serves as a valuable tool for future planning amid interactions between commercial fisheries, the offshore wind energy industry, and changing environmental conditions
Donor-Derived Cell-Free DNA in Antibody-Mediated Rejection: An Analysis of the Surveillance HeartCare Outcomes Registry
No full textBackground
Donor-derived cell-free DNA (dd-cfDNA) has emerged as a biomarker for antibody-mediated rejection (AMR), but its performance characteristics have not been evaluated in a large contemporary heart transplant population.
Objectives
The study aimed to characterize the incidence and timing of biopsy-proven AMR and evaluate the performance characteristics of dd-cfDNA for AMR.
Methods
The authors included 2,240 subjects from the SHORE (Surveillance HeartCare Outcomes Registry) registry transplanted between 2017 and 2022 with verified biopsy, dd-cfDNA, echocardiographic, and donor-specific antibody (DSA) data. They evaluated the performance characteristics of dd-cfDNA for AMR and the incidence of AMR in different clinical contexts.
Results
AMR was present in 2.6% of biopsies with significant variability depending on the clinical context: AMR occurred in 1.1% of biopsies with normal graft function and no DSAs vs 20.4% of biopsies with known DSA and graft dysfunction. In patients with neither DSA nor graft dysfunction, the incidence of AMR was 0.7% for dd-cfDNA levels \u3c 0.20%, 1.2% for levels between 0.20% and 0.49%, and 6.7% for dd-cfDNA levels ≥0.50%. In patients with known DSA but no graft dysfunction, the incidence of AMR was 1.4% for dd-cfDNA levels \u3c 0.20%, 4.8% for levels between 0.20% and 0.49%, and 15.5% for dd-cfDNA levels ≥0.50%.
Conclusions
The authors document significant context dependent variability of AMR incidence and the utility of dd-cfDNA in predicting biopsy yield. These data complement prior studies on the interpretation of peripheral gene expression profiling and dd-cfDNA for rejection monitoring and should further obviate the need for surveillance biopsies
Acute Aortic Dissection Masquerading as Testicular Torsion: A Case Report
No full textIntroduction: Aortic dissection is a rare but life-threatening condition with a high mortality rate if diagnosis is delayed. Aortic dissection classically presents with sudden-onset, sharp pain in the chest or back. However, atypical presentations can also occur, which could lead to a delay in diagnosis.
Case Report: A patient initially presented to the emergency department (ED) with left testicular pain ongoing for several hours. On examination, he had tenderness in the left lower quadrant abdomen and left testicle. A testicular ultrasound revealed decreased blood flow to the left testicle, raising concern for testicular torsion. The patient was taken to the operating room, where no torsion was found, and he was subsequently discharged home. Several days later, the patient returned to the ED with worsening pain radiating to the back. A computed tomography revealed an acute type A aortic dissection extending to the iliac arteries. He was transferred for surgical repair and discharged 12 days later.
Conclusion: While acute aortic dissection (AAD) typically presents with chest or back pain, atypical presentations can occur. When initial findings do not fully explain a patient’s symptoms, AAD should remain on the differential. This case highlights an uncommon presentation of AAD initially mimicking a testicular torsion