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OBJECTIVE: To determine the long-term effects of early postnatal malnutrition and various degrees of catch-up growth on metabolic (serum glucose, leptin, triacylglycerides) and neurodevelopmental parameters (learning and memory) among male and female rodent models, mimicking human preterm infants. STUDY DESIGN: Randomized controlled trial. Place and Duration of the Study: CMH Multan Insitute of Medical Sciences, from September 2021 to December 2021. METHDOLOGY: This study included 142 neonatal Wister rats, stratified into subgroups to mimic the human preterm infant model of postnatal malnutrition and catch-up growth. Metabolic consequences were assessed via serum analysis of glucose, leptin, and triacylglycerides. The neurocognitive comparison was made among subgroups via a passive avoidance test. Gender-specific comparison of all quantitative parameters was made among subgroups. RESULTS: Malnourished rats with accelerated catch-up growth achieved similar weight gain as normally fed rats when provided with adlibitum feeding in both males (p = 0.92) and females (p >0.99). Rats undergoing accelerated catch-up growth exhibited higher fasting serum glucose levels compared to those undergoing no, or normal catch-up growth (p <0.001). Malnourished female rats undergoing accelerated (p = 0.007), or no catchup growth (p = 0.004) exhibited significant deficits in learning and memory as compared to normally fed rats. Female malnourished rats with normal catchup growth exhibited no neurocognitive deficit as compared to normally fed rats (p = 0.08). CONCLUSION: Accelerated catch-up growth effectively addresses somatic growth disparities, while normal catch-up growth offers more favourable metabolic and neurodevelopmental outcomes. Particularly, female malnourished rats exhibited poor neurodevelopment in response to both accelerated and no catch-up growth. Gender-specific variations in neurodevelopment underscore the need for personalised care approaches for preterm nutritional care. KEY WORDS: Growth retardation, Leptin, Extrauterine growth restriction, Malnutrition, Neurodevelopment.

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Linear polarization (LP) and circular polarization (CP) holds paramount importance in Ku, K, and Ka bands for satellite based communication, and remote sensing applications. Satellite based remote sensing applications face challenges like atmospheric attenuation, noise & interference, and signal degradation. Moreover, satellite based communication application demands CP in two distinct, non-adjacent frequency bands with orthogonal polarizations at greater oblique angles, considering the unpredictable incidence angles of electromagnetic (EM) waves. Addressing these challenges, an innovative metasurface polarization converter is proposed to operate efficiently across the Ku-band (13.5-18.0 GHz), K-band (18.0-26.5 GHz), and Ka-band (26.5-38.5 GHz) frequency ranges. The converter achieves left-handed circular polarization (LHCP) in the Ku- and Ka-bands within the frequency ranges of 14.57-15.65 GHz and 27.47-33.85 GHz for y-polarized incident EM waves. Additionally, it provides right-handed circular polarization (RHCP) in the K- and Ka-bands at 17.27-23.92 GHz and 35.87-38.32 GHz for y-polarized incident EM waves. The LP conversion ratio exceeds 95% in the frequency bands of 15.97-16.85 GHz, 24.70-26.65 GHz, and 34.37-35.45 GHz for y-polarized, LHCP, and RHCP incident EM waves, respectively. The metasurface exhibits robust performance up to incidence angles of 45 degrees under oblique conditions. Experimental validation using traditional board-circuit manufacturing demonstrates close agreement between measured co- and cross-polarized reflection coefficients and simulations in the 13.5-18 GHz, and 24-38.5 GHz frequency range. Thin metasurface with a thickness of only 0.64 = 0.013λo mm, the proposed design outperforms existing studies in the literature, establishing its competitive edge in terms of structure and performance.

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Protein solubility prediction is useful for the careful selection of highly effective candidate proteins for drug development. In recombinant proteins synthesis, solubility prediction is valuable for optimizing key protein characteristics, including stability, functionality, and ease of purification. It contains valuable information about potential biomarkers or therapeutic targets and helps in early forecasting of neurodegenerative diseases, cancer, and cardiovascular disorders. Traditional wet-lab experimental protein solubility prediction approaches are error-prone, time-consuming, and costly. Researchers harnessed the competence of Artificial Intelligence approaches for replacing experimental approaches with computational predictors. These predictors inferred the solubility of proteins by analyzing amino acids distributions in raw protein sequences. There is still a lot of room for the development of robust computational predictors because existing predictors remain fail in extracting comprehensive discriminative distribution of amino acids. To more precisely discriminate soluble proteins from insoluble proteins, this paper presents ProSol-Multi predictor that makes use of a novel MLCDE encoder and Random Forest classifier. MLCDE encoder transforms protein sequences into informative statistical vectors by capturing amino acids multi-level correlation and discriminative distribution within raw protein sequences. The performance of proposed encoder is evaluated against 56 existing protein sequence encoding methods on a widely used protein solubility prediction benchmark dataset under two different experimental settings namely intrinsic and extrinsic. Intrinsic evaluation reveals that from all sequence encoders, proposed MLCDE encoder manages to generate non-overlapping clusters of soluble and insoluble classes. In extrinsic evaluation, 10 machine learning classifiers achieve better performance with proposed MLCDE encoder as compared to 56 existing protein sequence encoders. Moreover, across 4 public benchmark datasets, proposed ProSol-Multi predictor outshines 20 existing predictors by an average accuracy of 3%, MCC and AU-ROC of 2%. ProSol-Multi interactive web application is available at https://sds_genetic_analysis.opendfki.de/ProSol-Multi.

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Objective: The objective of this systematic review was to describe novel regimens and treatment strategies in neoadjuvant therapy for colorectal cancer (CRC). The aim was to summarize the current advancements in neoadjuvant chemotherapy (NACT) for CRC, including the use of cytotoxic drugs, targeted treatments, and immunotherapy. The analysis aimed to provide insights into the potential benefits and drawbacks of these novel approaches and highlight the need for further research to optimize NACT use in CRC and improve patient outcomes. Methods: From October 20, 2023, to December 10, 2023, a comprehensive literature search was conducted across multiple databases, including PubMed, Ovid, Web of Science, the Cochrane Library, Cumulative Index to Nursing and Allied Health Literature, Embase, and Scopus. Studies addressing the use of and treatment strategies for CRC and neoadjuvant therapies were included. Screening was conducted in two steps, initially by title and abstract and then by full-text articles. English-language articles were considered, while preprints, non-English publications, and articles published as grey literature were excluded from the study. A total of 85 studies were selected for further analysis after screening and filtering. Results: After filtering out duplicates and items that were irrelevant to our research query from the initial database search's 510 results, 397 unique articles were found. Eighty-five studies were chosen for additional analysis after the articles underwent two rounds of screening. Conclusion: The review concluded that neoadjuvant therapy for CRC has evolved beyond conventional approaches and holds promise for improving patient outcomes. Future prospects for advancing neoadjuvant approaches are promising, with ongoing clinical trials investigating the refinement of strategies, identification of predictive biomarkers, and optimization of patient selection. The adoption of novel regimens, precision medicine, and immunotherapy offers opportunities to redefine treatment paradigms and enhance patient care in CRC.

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PURPOSE: COVID-19 is an infectious disease caused by the SARS-CoV-2 virus. Considering the restricted and enclosed nature of prisons and closed environments and the prolonged and close contact between individuals, COVID-19 is more likely to have a higher incidence in these settings. This study aims to assess the prevalence of COVID-19 among prisoners. DESIGN/METHODOLOGY/APPROACH: Papers published in English from 2019 to July 7, 2023, were identified using relevant keywords such as prevalence, COVID-19 and prisoner in the following databases: PubMed/MEDLINE, Scopus and Google Scholar. For the meta-analysis of the prevalence, Cochrane's Q statistics were calculated. A random effect model was used due to the heterogeneity in COVID-19 prevalence across included studies in the meta-analysis. All analyses were performed in STATA-13. FINDINGS: The pooled data presented a COVID-19 prevalence of 20% [95%CI: 0.13, 0.26] and 24% [95%CI: 0.07, 0.41], respectively, in studies that used PCR and antibody tests. Furthermore, two study designs, cross-sectional and cohort, were used. The results of the meta-analysis showed studies with cross-sectional and cohort designs reported 20% [95%CI: 0.11, 0.29] and 25% [95%CI: 0.13, 0.38], respectively. ORIGINALITY/VALUE: Through more meticulous planning, it is feasible to reduce the number of individuals in prison cells, thereby preventing the further spread of COVID-19.

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OBJECTIVE: This study aimed to investigate perineal wound healing rates following abdominoperineal resection (APR) or extralevator abdominoperineal excision (ELAPE) for rectal cancer, with a focus on identifying associated risk factors and outcomes. METHODOLOGY: A retrospective analysis was conducted on patients undergoing APR or ELAPE for rectal cancer in a tertiary centre between 2013 and 2020. Data on demographics, comorbidities, surgical techniques, and perineal wound outcomes were collected and analyzed using Statistical Package for the Social Sciences (IBM SPSS Statistics for Windows, IBM Corp., Version 27.0, Armonk, NY). Statistical significance was set at p<0.05. RESULTS: A total of 87 patients were included, with a mean age of 64 years and the majority being male (66.7%). Neoadjuvant radiotherapy was administered in 87.4% of cases. Perineal wound complications were documented in 52 cases (59.8%), with major complications observed in 11 cases (12.6%). Healing within six months was achieved in 48 patients (55.2%), while 39 patients (44.8%) developed chronic perineal wounds. Logistic regression analysis revealed omentoplasty as a significant predictor of perineal wound healing rate showing a significant negative association (p=0.0289). CONCLUSION: Perineal wound healing rates following APR or ELAPE varied. While most patients achieved complete healing, chronic perineal wounds presented challenges. Omentoplasty was associated with lower odds of healing, suggesting the need for further investigation into its role. These findings underscore the importance of patient counselling and multidisciplinary management strategies to optimize outcomes in rectal cancer surgery.

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Brucellosis infects humans and animals worldwide but is particularly prevalent in Asia. In many Asian countries, molecular diagnostic tools for accurate molecular diagnostics and molecular epidemiology are lacking. Nonetheless, some countries have conducted in-depth molecular epidemiological studies. The objective of this study was to reveal the genetic relationships, geographic origins, and distributions of Brucella strains across Asia for two primary species, B. abortus and B. melitensis. For this, we systematically searched genotyping data from published studies on the molecular epidemiology of Brucella species for both humans and livestock in Asia. We used data from multilocus sequence typing (MLST), multiple-locus variable-number tandem repeat analysis (MLVA), and whole genome sequencing analysis of Brucella strains. We also analyzed the MLVA genotypes of 129 B. abortus isolates and 242 B. melitensis isolates with known origins in Asia from an online MLVA database using MLVA-11 data in minimum spanning trees and MLVA-16 data in neighbor-joining trees. We found that the B. melitensis East Mediterranean lineage is predominant across the continent, with only a small number of samples from the Africa and Americas lineages, and none from the West Mediterranean lineage. The "abortus C" genotype was the most common group of B. abortus in Asia, with limited genetic variation for this species. Several studies also reported that Near Eastern countries frequently encounter human brucellosis cases of B. abortus from genotypes 42 and 43. Our study highlights the inconsistent collection of genetic data for Brucella species across Asia and a need for more extensive sampling in most countries. Finally, a consistent nomenclature is necessary to define various groupings of strains within a lineage (i.e., clade) so uniform terminology should denote particular genetic groups that are understood by all researchers.

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Background: Statin therapy is widely utilized for preventing atherosclerotic cardiovascular disease, both as a primary and secondary measure. Despite the American Association for the Study of Liver Diseases' endorsement of statin use in cirrhotic patients, practitioners exhibit hesitancy, primarily due to concerns regarding hepatotoxicity. This study aimed to evaluate statin prescription patterns in cirrhotic patients by primary care physicians (PCPs) and cardiologists through a survey. Methods: A voluntary survey via Survey Monkey with nine objective-type questions was sent to 220 PCPs and 75 cardiologists within Allegheny Health Network. Survey results were collected, and a chi square test was used to compare the two groups. A P value ≤ 0.05 was considered statistically significant. Results: A total of 64 PCPs (29.1%) and 15 cardiologists (20%) completed the survey. Overall, 12.6% did not prescribe statins for primary prevention of atherosclerotic cardiovascular disease in compensated cirrhotic patients. While all cardiologists prescribed statins for secondary prevention, over 50% preferred lower-intensity options. Conversely, 14.1% of PCPs avoided statin prescriptions for secondary prevention. Cardiologists were significantly more inclined to prescribe statins, especially for cirrhosis due to metabolic dysfunction-associated steatotic liver disease compared to PCPs (73.3% vs 45.3%, P = 0.05). Conclusions: Despite increasing evidence favoring use of statins in cirrhosis for improving portal hemodynamics and decreasing ascites, hepatic encephalopathy, the incidence of hepatocellular carcinoma, and mortality, there is still hesitation on the part of prescribers for the fear of worsening liver disease. Wider dissemination of current guidelines and education practices may help to bridge this gap.

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OBJECTIVE: Necrotizing pancreatitis (NP) is a severe form of pancreatitis that often necessitates intensive care and can result in significant morbidity and mortality. This study aimed to investigate racial and gender disparities in palliative care (PC) utilization among mechanically-ventilated patients with NP. METHODS: In this retrospective analysis using the National Inpatient Sample from 2016 to 2020, we investigated 84 335 patients with NP requiring invasive mechanical ventilation, and the utilization of PC services and their disparities based on gender and race. To adjust for potential confounding factors, we employed multivariable logistic regression, ensuring that our findings account for various influencing variables and provide a robust analysis of the data. RESULTS: Among the patients studied, 15.4% utilized PC consultations. Notably, female patients were 12% more likely to utilize PC than their male counterparts (OR 1.1, 95% CI: 1.003-1.2; P = .008). Racial disparities were pronounced: African Americans (OR 0.8, 95% CI 0.7-0.9, P < .001), Hispanic (OR 0.8, 95% CI 0.7-0.9, P = .001), and Asian or Pacific Islander patients (OR 0.74, 95% CI 0.57-0.97; P = .03) had significantly lower odds of utilizing PC compared to White patients. The cohort utilizing PC had a higher in-hospital mortality rate (74.7% vs 24.8%; OR 8.2, 95% CI 7.7-9.2) but a shorter mean hospital stays and lower associated costs. CONCLUSIONS: Our findings indicate significant racial and gender disparities in the utilization of PC for intubated patients with NP, with lower utilization among males and minority populations. These findings emphasize the urgent requirement for comprehensive changes in healthcare protocols.

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Colonoscopy is a reliable diagnostic method to detect colorectal polyps early on and prevent colorectal cancer. The current examination techniques face a significant challenge of high missed rates, resulting in numerous undetected polyps and irregularities. Automated and real-time segmentation methods can help endoscopists to segment the shape and location of polyps from colonoscopy images in order to facilitate clinician's timely diagnosis and interventions. Different parameters like shapes, small sizes of polyps, and their close resemblance to surrounding tissues make this task challenging. Furthermore, high-definition image quality and reliance on the operator make real-time and accurate endoscopic image segmentation more challenging. Deep learning models utilized for segmenting polyps, designed to capture diverse patterns, are becoming progressively complex. This complexity poses challenges for real-time medical operations. In clinical settings, utilizing automated methods requires the development of accurate, lightweight models with minimal latency, ensuring seamless integration with endoscopic hardware devices. To address these challenges, in this study a novel lightweight and more generalized Enhanced Nanonet model, an improved version of Nanonet using NanonetB for real-time and precise colonoscopy image segmentation, is proposed. The proposed model enhances the performance of Nanonet using Nanonet B on the overall prediction scheme by applying data augmentation, Conditional Random Field (CRF), and Test-Time Augmentation (TTA). Six publicly available datasets are utilized to perform thorough evaluations, assess generalizability, and validate the improvements: Kvasir-SEG, Endotect Challenge 2020, Kvasir-instrument, CVC-ClinicDB, CVC-ColonDB, and CVC-300. Through extensive experimentation, using the Kvasir-SEG dataset, our model achieves a mIoU score of 0.8188 and a Dice coefficient of 0.8060 with only 132,049 parameters and employing minimal computational resources. A thorough cross-dataset evaluation was performed to assess the generalization capability of the proposed Enhanced Nanonet model across various publicly available polyp datasets for potential real-world applications. The result of this study shows that using CRF (Conditional Random Fields) and TTA (Test-Time Augmentation) enhances performance within the same dataset and also across diverse datasets with a model size of just 132,049 parameters. Also, the proposed method indicates improved results in detecting smaller and sessile polyps (flats) that are significant contributors to the high miss rates.

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In the era of global energy crises and the pressing concern of fossil fuel depletion, the quest for sustainable alternatives has become paramount. The current study aims to optimize biodiesel extraction from a combination of waste cooking oil (WCO) and sesame seed oil (SSO) through response surface methodology (RSM) and artificial neural network (ANN). The cold flow properties of biodiesel produced from WCO are a major obstacle to the commercial use of biodiesel. On the other hand, SSO possesses better oxidation stability and cold flow properties. A mixture of waste cooking oil (i.e. 70 % by volume) and sesame seed oil (i.e. 30 % by volume) has been prepared for biodiesel production via a microwave-assisted transesterification process. For biodiesel yield optimization, the interaction among the operating parameters is developed by RSM, whereas biodiesel yield is predicted by ANN. The operating parameters include reaction speed, RPM (100-600 rpm), reaction time (1-5 min), methanol to oil ratio (8:1-12:1 v/v), and catalyst concentration (0.1-2 % w/w). The highest biodiesel yield of 94 % is found at a reaction speed of 350 rpm, reaction time of 3 min, catalyst concentration of 1.05 w/w, and methanol to oil ratio of 10:1. Furthermore, it is discovered that when estimating biodiesel production rate depending on reaction constraints, ANN shows lower comparative error compared to RSM. The results show that ANN outperforms RSM in terms of percentage improvement when it comes to biodiesel production prediction.

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Objective: Intermittently scanned continuous glucose monitoring (isCGM) has revolutionised the care of people with diabetes but its uptake and benefits in older adults are not well known. We examined the impact of isCGM (Freestyle Libre, FSL) on glycaemic outcomes in younger (⩽65 years) and older adults (>65 years) with diabetes. Design and methods: In total, 2260 adult patients registered on the Libreview account at University Hospitals Birmingham NHS Foundation Trust, UK, were included. Inclusion criteria: all patients with type 1 and type 2 diabetes aged >18 years, use of isCGM >6 months, scanning at least 6 times/day. Demographics, diabetes history and glycaemic outcomes (time in range (TIR), time above range and time below range (TBR), estimated HbA1c, HbA1c at start and at end of study) were collected by accessing electronic patient records and Libreview. Outcomes were compared between age groups ⩽65 or >65 years old. Results: Most patients were of Caucasian ethnicity (⩽65 years 68%, >65 years 73%) and had type 1 diabetes. Mean duration of diabetes was 19.5 years (range 0-65 years) and 34.5 years (range 0-79 years) for ⩽65 and >65 years, respectively. Only a quarter of those ⩽65 years achieved (219/943; 23.2%) their age specific TIR target compared to 69% (78/113) of those >65 years cohort, while 70.1% (663/946) of ⩽65 years and 40.7% (46/113) of >65 years achieved their age-specific TBR target. When the less strict ⩽65 years TBR target was applied, 75% (85/113) of >65 years cohort achieved this. Conclusion: FSL use was associated with improved glycaemic outcomes across all age groups. Individualised targets may be needed to improve TBR in those aged >65 years.

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With the anticipated foliar application of nanoparticles (NPs) as a potential strategy to improve crop production and ameliorate heavy metal toxicity, it is crucial to evaluate the role of NPs in improving the nutrient content of plants under Lead (Pb) stress for achieving higher agriculture productivity to ensure food security. Herein, Brassica napus L. grown under Pb contaminated soil (300 mg/kg) was sprayed with different rates (0, 25, 50, and 100 mg/L) of TiO2 and ZnO-NPs. The plants were evaluated for growth attributes, photosynthetic pigments, leaf exchange attributes, oxidant and antioxidant enzyme activities. The results revealed that 100 mg/L NPs foliar application significantly augmented plant growth, photosynthetic pigments, and leaf gas exchange attributes. Furthermore, 100 mg/L TiO2 and ZnO-NPs application showed a maximum increase in SPAD values (79.1%, 68.9%). NPs foliar application (100 mg/L TiO2 and ZnO-NPs) also substantially reduced malondialdehyde (44.3%, 38.3%), hydrogen peroxide (59.9%, 53.1%), electrolyte leakage (74.8%, 68.3%), and increased peroxidase (93.8%, 89.1%), catalase (91.3%, 84.1%), superoxide dismutase (81.8%, 73.5%) and ascorbate peroxidase (78.5%, 73.7%) thereby reducing Pb accumulation. NPs foliar application (100 mg/L) significantly reduced root Pb (45.7%, 42.3%) and shoot Pb (84.1%, 76.7%) concentration in TiO2 and ZnO-NPs respectively, as compared to control. Importantly, macro and micronutrient analysis showed that foliar application 100 mg/L TiO2 and ZnO-NPs increased shoot zinc (58.4%, 78.7%) iron (79.3%, 89.9%), manganese (62.8%, 68.6%), magnesium (72.1%, 93.7%), calcium (58.2%, 69.9%) and potassium (81.5%, 68.6%) when compared to control without NPs. The same trend was observed for root nutrient concentration. In conclusion, we found that the TiO2 and ZnO-NPs have the greatest efficiency at 100 mg/L concentration to alleviate Pb induced toxicity on growth, photosynthesis, and nutrient content of Brassica napus L. NPs foliar application is a promising strategy to ensure sustainable agriculture and food safety under metal contamination.

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This study aims to develop a nonparametric mixed exponentially weighted moving average-moving average (NPEWMA-MA) sign control chart for monitoring shifts in process location, particularly when the distribution of a critical quality characteristic is either unknown or non-normal. In literature, the variance expression of the mixed exponentially weighted moving average-moving average (EWMA-MA) statistic is calculated by allowing sequential moving averages to be independent, and thus the exclusion of covariance terms results in an inaccurate variance expression. Furthermore, the effectiveness of the EWMA-MA control chart deteriorates when the distribution of a critical quality characteristic deviates from normality. The proposed NPEWMA-MA sign control chart addresses these by utilizing the corrected variance of the EWMA-MA statistic and incorporating the nonparametric sign test into the EWMA-MA charting structure. The chart integrates the moving average (MA) statistic into the exponentially weighted moving average (EWMA) statistic. The EWMA-MA charting statistic assigns more weight to recent w samples, with weights for previous observations decling exponentially. Monte Carlo simulations assess the chart's performance using various run length (RL) characteristics such as average run length (ARL), standard deviation of run length (SDRL), and median run length (MRL). Additional measures for overall performance include the average extra quadratic loss (AEQL) and relative mean index (RMI). The proposed NPEWMA-MA sign control chart demonstrates superior performance compared to existing nonparametric control charts across different symmetrical and asymmetric distributions. It efficiently detects process shifts, as validated through both a simulated study and a real-life example from a combined cycle power plant.

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AIM: This study aimed to assess the feasibility and effectiveness of the pectoral nerves (PECS) II block in facilitating cardiac implantable electronic device (CIED) insertion in a sample of 120 patients, with a focus on the percentage of cases completed without additional intraoperative local anesthesia. METHODS: PECS II blocks were performed on the left side using ultrasound guidance in all 120 patients. Feasibility was assessed by the proportion of cases completed without the need for extra intraoperative local anesthetic. Secondary outcomes included the amount of additional local anesthetic used, intraoperative opioid requirements, postoperative pain scores, time to first postoperative analgesia, analgesic consumption, patient satisfaction, and block-related complications. RESULTS: Of the 120 patients, 78 (65%) required additional intraoperative local anesthetic, with a median volume of 8.2 mL (range 3-13 mL). Fifteen patients (12.5%) needed intraoperative opioid supplementation. Nine patients (7.5%) required postoperative tramadol for pain relief. In total, 98 patients (81.7%) reported high satisfaction levels with the procedure. CONCLUSIONS: The PECS II block, when combined with supplementary local anesthetic, provided effective postoperative analgesia for at least 24 h in 120 patients undergoing CIED insertion. While it did not completely replace surgical anesthesia in most cases, the PECS II block significantly contributed to a smoother intraoperative experience for patients.

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Single-cell omics technologies can measure millions of cells for up to thousands of biomolecular features, enabling data-driven studies of complex biological networks. However, these high-throughput experimental techniques often cannot track individual cells over time, thus complicating the understanding of dynamics such as time trajectories of cell states. These "dynamical phenotypes" are key to understanding biological phenomena such as differentiation fates. We show by mathematical analysis that, in spite of high dimensionality and lack of individual cell traces, three time-points of single-cell omics data are theoretically necessary and sufficient to uniquely determine the network interaction matrix and associated dynamics. Moreover, we show through numerical simulations that an interaction matrix can be accurately determined with three or more time-points even in the presence of sampling and measurement noise typical of single-cell omics. Our results can guide the design of single-cell omics time-course experiments, and provide a tool for data-driven phase-space analysis.

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A 78-year-old man with history of chronic lymphocytic inflammation with pontine perivascular enhancement responsive to steroids (CLIPPERS) syndrome, moderate persistent asthma, pansinusitis, and upper airway cough syndrome presented to the sleep medicine clinic for evaluation of sleep-disordered breathing. Brain MR imaging showed lesions in the pons and midbrain. Diagnostic polysomnography was remarkable for central sleep apnea.

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A rare subtype of autoimmune encephalitis consists of antibodies targetting the alpha-amino-3-hydroxy-5- methyl-4-isoxazolepropionic acid receptor in the central nervous system. We describe the clinical presentation and autoimmune profile of the first case of alpha-amino-3- hydroxy-5-methyl-4-isoxazolepropionic acid receptor encephalitis with concurrent anti-acetylcholine receptor antibodies in Pakistan. The patient was a 58-year-old male who presented with the characteristic symptoms of limbic encephalitis with memory loss, irritability, agitation, and confusion. Antibodies against the alpha-amino-3-hydroxy- 5-methyl-4-isoxazolepropionic acid receptor were detected in both serum and cerebrospinal fluid by indirect immunofluorescence. Computerised tomography of the chest showed an anterior mediastinal mass. The patient was treated with high dose Methylprednisolone and five sessions of plasma exchange. There was a short period of improvement; however, the patient now continues to exhibit irritability, aphasia, confusion, and memory loss. Video-assisted thoracoscopic surgery for mediastinal mass resection and histological testing was planned, however after review by the interventional radiologist the associated risks were deemed too high to proceed with the procedure and biopsy was not done.

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