Accurate detection of abnormal cells is essential for early screening and precise diagnosis of cervical cancer. Despite the recent advances in deep learning-based methods for cervical cancer detection, their broad clinical applications are hindered by several technical challenges. On the one hand, gradually evolved abnormal cells are visually similar to normal cells. On the other hand, single cells and cell clusters exhibit significant appearance variations, overlooking those between normal and abnormal cells. In order to overcome these challenges, we propose a novel dual-branch multi-granularity hierarchical contrast and cross attention network, called DMCA-Net. Specifically, DMCA-Net utilizes dual branches to detect abnormal and normal cells, respectively. Meanwhile, an inter-cell pair-wise cross-attention (IPCA) is utilized to improve feature embedding learning. The IPCA regularizes the attention learning of abnormal cell features by treating normal cell features as distractors. In addition, DMCA-Net also adopts a multi-granularity hierarchical contrastive learning (MHCL) to enhance the classification ability. Our study indicates that MHCL alleviates the interference of intra-class appearance variations in cervical cell, effectively pulls apart the inter-class distance between different classes of cervical cells at different granularities. Extensive experiments on two publicly available datasets demonstrate that our DMCA-Net outperforms existing methods, achieving state-of-the-art (SOTA) results. Code and additional annotation data are available at https://github.com/zhihuaji/DMCA-Net.
Precise segmentation of the hippocampus is essential for various human brain activity and neurological disorder studies. To overcome the small size of the hippocampus and the low contrast of MR images, a dual multilevel constrained attention GAN for MRI-based hippocampus segmentation is proposed in this paper, which is used to provide a relatively effective balance between suppressing noise interference and enhancing feature learning. First, we design the dual-GAN backbone to effectively compensate for the spatial information damage caused by multiple pooling operations in the feature generation stage. Specifically, dual-GAN performs joint adversarial learning on the multiscale feature maps at the end of the generator, which yields an average Dice coefficient (DSC) gain of 5.95% over the baseline. Next, to suppress MRI high-frequency noise interference, a multilayer information constraint unit is introduced before feature decoding, which improves the sensitivity of the decoder to forecast features by 5.39% and effectively alleviates the network overfitting problem. Then, to refine the boundary segmentation effects, we construct a multiscale feature attention restraint mechanism, which forces the network to concentrate more on effective multiscale details, thus improving the robustness. Furthermore, the dual discriminators D1 and D2 also effectively prevent the negative migration phenomenon. The proposed DMCA-GAN obtained a DSC of 90.53% on the Medical Segmentation Decathlon (MSD) dataset with tenfold cross-validation, which is superior to the backbone by 3.78%.
With a growing older adult population, the number of persons with dementia is expected to rise. Consequently, the number of persons needing decision-making capacity assessments (DMCA) will increase. The COVID-19 pandemic has impacted how we deliver patient care including DMCAs with a much more rapid shift to virtual assessments. Virtual DMCAs offer patients and health care professionals distinct advantages over in-person delivery by improving reach, access, and timely provision of health care. However, questions have arisen as to whether DMCAs can be effectively conducted virtually. This study aimed to determine the characteristics, barriers, and facilitators of conducting virtual DMCA during the COVID-19 pandemic. We conducted an online survey among health care providers who perform DMCAs in Alberta from March 2022 to February 2023. The survey consisted of 25 questions on demographics, preferences, and experience in conducting DMCAs virtually, and risks and barriers to doing virtual DMCAs. The data were analyzed using descriptive statistics. There were 31 respondents with a mean age of 51.1 (SD 12.7) years. The respondents consisted of physicians (45.2%, 14/31), occupational therapists (29%, 9/31), and social workers (16.1%, 5/31), with a majority (93.6%, 29/31) based in Edmonton. The mean number of years of experience conducting DMCAs was 12.3 (SD 10.7), with a median of 8 DMCAs (IQR 18.5) conducted per year. Most respondents conduct capacity interviews, with a majority (55.2%, 16/29) being associated primarily with acute care services. Furthermore, 54.8% (17/31) were interested in conducting DMCAs virtually; however, only 25.8% (8/31) had administered DMCAs virtually. Barriers and facilitators to virtual DMCAs relate to patients' characteristics and environment (such as communication difficulties, hearing or visual impairment, language barriers, ease of use of technology, or cognitive impairment), technology and technical support (need for technical support in both the client's and assessor's sides, the unreliability of internet connection in rural settings, and the availability of high-fidelity equipment), and assessors' ability to perform DMCA's virtually (ability to observe body language, interact with the client physically when needed, and build rapport can all be affected when conducting a DMCA virtually). In terms of implications for clinical practice, it is recommended that the patient or caregiver be familiar with technology, have a stable internet connection, use a private room, not be recorded, use a standardized assessment template, and have a backup plan in case of technical difficulties. Conducting DMCAs virtually is a relatively infrequent undertaking. Barriers and facilitators to adequate assessment need to be addressed given that virtual assessments are time-saving and expand reach.
The obliquity of the first metatarsocuneiform joint has long been proposed as a contributing factor in the development of hallux valgus (HV). Several studies have evaluated the medial slope of the distal articular surface of the medial cuneiform relative to its longitudinal axis, commonly described as the distal medial cuneiform angle (DMCA). An increased DMCA has been hypothesized to predispose individuals to HV by altering first-ray biomechanics. The objective of this study is to conduct a systematic review of the literature to determine whether DMCA is a significant risk factor for the development of HV. A systematic literature search was conducted across Ovid, Embase, MEDLINE, and PubMed databases on February 8, 2025, identifying studies published between January 2004 and December 2024. Searches used predefined MeSH terms, including obliquity, angulation, and medial cuneiform, followed by combined-term analysis. English-language full-text articles were screened, and reference lists were reviewed for additional studies. Eligible studies compared DMCA measurements between HV and control cohorts. Where appropriate, pooled effect sizes were calculated using Hedges' g. The review identified a limited number of heterogeneous observational studies evaluating DMCA in HV populations. Meta-analytic synthesis demonstrated a small but statistically significant association between increased DMCA and HV (Hedges' g = 0.19, p = 0.01). However, substantial variability was noted in measurement techniques, radiographic positioning, and definitions of HV severity, limiting comparability across studies. Current evidence demonstrates a statistically significant but small association between increased DMCA and HV. The modest effect size suggests that DMCA alone is unlikely to be a dominant causal factor and should be considered within a multifactorial biomechanical framework. Further high-quality, standardized studies are required to clarify the clinical relevance of DMCA in the pathogenesis of HV.
Specialized training is necessary for health-care providers such as physicians, nurses, and social workers, to be able to accurately perform decision-making capacity assessments (DMCAs). With an increasing demand for flexible, accessible education, there is growing interest in utilizing online training modules to keep health-care providers up to date on current best practices in DMCAs. This study evaluates the effectiveness of online training modules in enhancing clinicians' self-reported knowledge, confidence, and comfort with the core concepts necessary to conduct DMCAs. This was a pretest/posttest study on an online DMCA training. Participants from a regional health authority (Alberta, Canada) took 13 online modules on 15 core DMCA concepts, from March to December 2021. A pretest and a posttest were completed before and after completion of the modules. Agreement to Likert-like items were collected and compared at a group level. Additionally, the ratings were compared with historical data from face-to-face DMCA workshops. A total of 683 pretests and 241 posttests were completed. All 15 posttest ratings were higher (p < .001) than pretest ratings. Compared to the historical face-to-face workshops, the self-reported ratings in the online modules tended to be higher both on pretest and posttest. However, the changes in self-reported ratings from pretest to posttest were similar between the online modules and the historical workshops. Online learning of DMCA concepts can lead to higher self-reported learning posttest to pretest. Furthermore, the changes in self-reported ratings are similar to those observed in face-to-face workshops.
A duplicated middle cerebral artery (DMCA) is a rare variant of the middle cerebral artery (MCA), arising between the anterior choroidal artery and distal end of the internal carotid artery. Despite its rarity, DMCA is clinically significant due to its association with aneurysm formation and high risk of rupture. No case of oculomotor nerve palsy related to DMCA aneurysm has been reported. A 49-year-old woman presented with sudden severe headache (Hunt and Kosnik grade III) and left pupil dilation. Imaging showed a diffuse, left predominant subarachnoid hemorrhage and four aneurysms. Based on the hematoma location and clinical findings, the left DMCA aneurysm was suspected as the rupture point. She underwent left frontotemporal craniotomy with clipping of three aneurysms. Intraoperative evaluation revealed that the DMCA was displaced by perianeurysmal hematoma, compressing the left oculomotor nerve. After aneurysmal neck clipping, removal of the hematoma surrounding the DMCA was performed. Her postoperative course was uneventful and left pupillary dilation returned to normal within a few days postoperatively. This case demonstrates that a hematoma from a ruptured DMCA aneurysm can displace the DMCA and cause oculomotor nerve palsy. Hence, DMCA aneurysm should be recognized as one of the possible causes of oculomotor nerve palsy. https://thejns.org/doi/abs/10.3171/CASE25651.
With an increasing elderly population, the number of persons with dementia is expected to increase and, consequently, the number of persons needing decision-making capacity assessments (DMCA) is too. However, many healthcare professionals do not feel ready to provide DMCAs. Since 2006, we implemented a DMCA Model that includes a care pathway, worksheets, education, and mentoring. The objective of this study was to assess the impact of the utilization of this patient-centered DMCA model on the need for Capacity Interviews. This was a retrospective quality assurance chart review of patients referred for DMCA to the Geriatric Service at the Grey Nuns Community Hospital from 2006-2020. The Geriatric Service is run by Family Physicians with extra training in Care of the Elderly. We extracted patient demographics, elements of the DMCA process, and whether Capacity Interviews were performed. We used descriptive statistics to summarize the data. Eighty-eight patients were referred for DMCAs, with a mean age of 76 years (SD = 10.5). Dementia affected 43.2% (38/88) of patients. Valid reasons for conducting a DMCA were evident in 93% (80/86) of referrals, and DMCAs were performed in 72.6% (61/84). 85.3% (58/68) of referrals identified the need for DMCA in two to four domains, most commonly accommodation, healthcare, and finances. Two to three disciplines, frequently social workers and occupational therapists, were involved in conducting the DMCAs for 67.2% (39/58) of patients. The Capacity Assessment Process Worksheet was used 63.2% of the time. Capacity Interviews were conducted in only 20.7% of referrals. Following the DMCAs, 48.2% (41/85) of those assessed were deemed to lack capacity. This study suggests that the DMCA Model implemented has decreased the need for Capacity Interviews while simultaneously respecting patient autonomy. This is an important finding as DMCAs carried out following this process reduced the need for both a Capacity Interview and declarations of incapacity while simultaneously respecting patient autonomy and supporting patients in their decisions in accordance with the legislation.
Here two Zn(II) coordination polymers [Zn20(DMCA)12]O12 (DMCA = demethylcantharic acid, DMCA-Zn1) and [Zn(DMCA)](H2O)2 (DMCA-Zn2) are synthesized from a broad-spectrum anticancer drug norcantharidin (NCTD) and Zn(NO3)2·6H2O under solvothermal conditions. By mechanical grinding with a biocompatible polymeric surfactant F127, ultrasonic treatment and filtration, DMCA-Zn1 and DMCA-Zn2 can be transformed into stable nanoparticles (DMCA-Zn1 NPs and DMCA-Zn2 NPs) suspended in water with average diameters of around 190 nm and 162 nm for drug delivery. The in vitro evaluation indicates that DMCA-Zn1 NPs and DMCA-Zn2 NPs can enter into HepG2 and Hep3B cancer cells via endocytosis and inhibit their proliferation. Meanwhile they exhibit relatively low toxicity to L927 normal cells. The in vivo evaluation confirms that DMCA-Zn1 NPs and DMCA-Zn2 NPs can more effectively inhibit the growth of Hep3B tumors with relatively few side effects compared with free NCTD. This approach can be extended to other anticancer drugs to construct nanodrug delivery systems for cancer treatment.
The aim of the current study was to explore the potential beneficial effect of 3,4-dimethoxycinnamic acid (DMCA), obtained from coffee silverskin (CS) biowaste, on bleomycin-induced lung fibrosis in rats and elucidate its possible underlying mechanisms. Lung fibrosis was induced in rats by a single intratracheal administration of bleomycin. DMCA (25 and 50 mg/kg) and pirfenidone (50 mg/kg) were orally administered. Our results showed that DMCA markedly reduced lactate dehydrogenase activity, total protein content, and total and differential inflammatory cell counts in the bronchoalveolar lavage fluid. DMCA also inhibited oxidative stress and nuclear factor kappa B (NF-κB)-mediated tumor necrosis factor and interleukin-1β production. Furthermore, DMCA markedly downregulated the pulmonary levels of transforming growth factor beta 1 (TGF-β1), SMAD family member 3 (Smad3), and extracellular signal-regulated kinase 1/2 (ERK1/2), concurrently with a marked reduction in collagen-1 expression in the lung. Contrarily, DMCA upregulated lung caveolin-1 expression. These findings were concomitantly accompanied by remarkable improvement in the lung histopathology. In conclusion, DMCA effectively mitigates bleomycin-induced lung fibrosis in rats, which is comparable to pirfenidone, through antioxidant, anti-inflammatory, and anti-fibrotic effects. These beneficial effects are mainly mediated through boosting caveolin-1 expression that halts NF-κB, TGF-β1/smad3, and ERK1/2 signaling pathways.
To investigate the relationship between hallux valgus and the indicators associated with medial cuneiform obliquity measured on feet weight-bearing anteroposterior X-ray films. Based on the feet weight-bearing anteroposterior X-ray films taken between January 2018 and February 2021 and met the criteria, the hallux valgus angle (HVA), intermetatarsal angle (IMA), metatarsus adductus angle (MAA), metatarsus cuneiform angle (MCA), distal medial cuneiform angle (DMCA), and proximal metatarsal articular angle (PMAA) were measured and the morphology of the first tarsometatarsal (TMT) were recorded. According to the HVA, the X-ray films were divided into normal group (HVA<15°) and hallux valgus group (HVA≥15°). The gender, age, sides, IMA, MAA, MCA, DMCA, PMAA, and the morphology of TMT were compared between groups. The influencing factors of HVA and IMA were analyzed by multivariate linear regression analysis. X-ray films of 534 patients (679 feet) met the selection criteria and were included in the study. There were 220 males and 314 females, with an average age of 36 years (mean, 18-82 years). There were 154 cases (168 feet) in the normal group and 403 cases (511 feet) in the hallux valgus group. There were significant differences in gender and age between groups ( P<0.05), and no significant difference in the side ( P>0.05). The IMA, MAA, and MCA in the hallux valgus group were significantly bigger than those in the normal group ( P<0.05); the difference in DMCA between the two groups was not significant ( P>0.05). The TMT morphology of the two groups was mainly curved, and the difference in morphology classification was not significant ( P>0.05). PMAA measurement showed that there were 3 kinds of metatarsal shapes: adductive metatarsal, neutral metatarsal, and abductive metatarsal, the difference in metatarsal shapes between groups was not significant ( P>0.05). The PMAA of abductive metatarsal was significantly bigger in normal group than in hallux valgus group ( P<0.05), there was no significant difference in PMAA of adductive metatarsal between groups ( P>0.05). Multivariate linear regression analysis showed that age, MCA, and DMCA were the influencing factors of HVA ( P<0.05), and age, MAA, MCA, and DMCA were the influencing factors of IMA ( P<0.05). The medial cuneiform obliquity is relatively constant and the DMCA can not be used as the characteristic angle to quantify hallux valgus. The morphology of TMT has no relationship with hallux valgus, while MAA, MCA, and PMAA are all factors to be considered, and MCA can be used as the characteristic angle to quantify hallux valgus. 通过在足负重正位X线片测量与内侧楔骨远端关节倾斜相关的指标，研究其与踇外翻发生及严重程度间的关系。. 选择2018年1月—2021年2月符合标准的足负重正位X线片，测量踇外翻角（hallux valgus angle，HVA）、第1-2跖骨间夹角（intermetatarsal angle，IMA）、跖内收角（metatarsus adductus angle，MAA）、第1跖楔夹角（metatarsus cuneiform angle，MCA）、内侧楔骨远端关节倾斜角（distal medial cuneiform angle，DMCA）、第1跖骨近端关节倾斜角（proximal metatarsal articular angle，PMAA）；记录第1跖楔关节（first tarsometatarsal，TMT）关节面形态。根据HVA将患者分为正常组（<15°）与踇外翻组（≥15°），比较两组患者年龄、性别、侧别、IMA、MAA、MCA、DMCA、PMAA以及TMT关节面形态。多元线性回归分析HVA、IMA的影响因素。. 534例（679足）患者X线片符合选择标准纳入研究。其中，男220例，女314例；年龄18～82岁，平均36岁。根据HVA分组，正常组154例（168足），踇外翻组403例（511足）。两组患者性别及年龄比较，差异均有统计学意义（ P<0.05）；侧别比较差异无统计学意义（ P>0.05）。踇外翻组IMA、MAA、MCA均大于正常组（ P<0.05），DMCA与正常组比较差异无统计学意义（ P>0.05）。两组TMT关节面形态均以曲面为主，差异无统计学意义（ P>0.05）。经测量PMAA发现第1跖骨存在内收型、中立型和外展型3种形态，组间分型比较差异有统计学意义（ P<0.05）。正常组外展型PMAA大于踇外翻组（ P<0.05），内收型PMAA组间差异无统计学意义（ P>0.05）。基于679足资料的多元线性回归分析显示，年龄、MCA、DMCA为HVA的影响因素（ P<0.05），年龄、MAA、MCA、DMCA为IMA的影响因素（ P<0.05）。. 内侧楔骨远端关节倾斜程度相对恒定，DMCA不能作为量化踇外翻的特征性角度，TMT关节面形态与踇外翻无明显关系；MAA、MCA、PMAA参与了踇外翻形成，而且MCA可以作为量化踇外翻程度的特征性角度。.
Digital melting curve analysis (dMCA) represents a breakthrough technology for multiplexed nucleic acid detection within limited fluorescence channels, utilizing thermal melting imaging postdigital PCR. However, conventional dMCA suffers from accuracy degradation across broad temperature ranges and resolution limitations due to defocusing-induced fluorescence deviations. To overcome these constraints, we propose a novel deep learning-enabled dMCA platform based on a single-shot adaptive point-spread function (PSF) attention refocusing model (SAPAR-dMCA), autofocusing the digital PCR microarray without electromechanical motion. Our platform achieves a ±400 μm depth-of-field via PSF self-calibrating and modulation, reducing fluorescence intensity deviation within microwells by 2.76-fold compared with state-of-the-art methods. Experimental validation demonstrates significantly enhanced multiplex identification accuracy (from 38.0 to 92.3%) across a 46.0 °C melting temperature span, with the coefficient of variation reduced from 3.16 to 0.78%. Applied to respiratory pathogen detection, SAPAR-dMCA attains 0.9 °C resolution based on melting temperature differentiation. This work establishes SAPAR-dMCA as a precise and robust platform for digital multiplex nucleic acid analysis, featuring unprecedented temperature range adaptability and high resolution. Our methodology paves the way for ultramultiplexed gene profiling and precision medicine advancement.
It has been reported on the relationship between the medial cuneiform bone morphology, especially in terms of obliquity, and the severity of hallux valgus (HV), however, no consensus has been obtained. On the other hand, there are no reports on the relationship between the difference in height between the medial and intermediate cuneiforms and the severity of hallux valgus. The purpose of this study was to clarify the relationship between the medial cuneiform bone morphology and the severity of HV. The authors retrospectively analyzed 200 feet of 116 patients who had a weightbearing anteroposterior foot radiograph taken between April 2017 and July 2022 and diagnosed with HV. Measurements included the hallux valgus angle (HVA), the intermetatarsal angle (IMA), the distal medial cuneiform angle (DMCA) and the cuneiform first-second length (C1-2D). HV groups were classified into one of three groups: mild (15 ≦ HVA<30°, 9 < IMA<13°), moderate (30 ≦ HVA<40°, 13 ≦ IMA≦20°) and severe groups (HVA≧40°, IMA>20°), and the relationship to DMCA or the difference in height between the medial and intermediate cuneiforms was analyzed. A total of 163 feet of 93 patients were included in this study. There were significant correlations between the HVA and the DMCA (r = 0.47, p <0.001) or the C1-2D (r = 0.64, p <0.001). There was no significant difference in DMCA between the mild and moderate groups (p = 0.14). On the other hand, significant differences in C1-2D were observed between the three groups (mild-moderate; p <0.001, moderate-severe; p = 0.03, mild-severe; p <0.001). IMA was also positively correlated with the DMCA (r = 0.30, p <0.001) or the C1-2D (r = 0.47, p <0.001). However, the DMCA (p = 0.07) and the C1-2D (p = 0.39) did not differ significantly from IMA between the moderate and severe groups. The difference in height between the medial and intermediate cuneiforms, referred to as C1-2D, is closely associated with the HVA. The C1-2D may influence the progression of HV and be a novel radiographic parameter that indicates severity of HV.
The coordinated development and agglomeration of the digital and manufacturing sectors have reached widespread consensus. However, its potential environmental impacts remain underexplored. To bridge this gap, utilizing the panel data of China's prefecture-level cities from 2006 to 2021, this paper analyzes the spatiotemporal evolution of digital and manufacturing industry co-agglomeration (DMCA), and then investigates the environmental impact and mechanisms of DMCA, using urban air pollution as a case study. It delves into the mechanism and heterogeneity from dual perspectives of geographical and virtual agglomeration. Key findings include: First, DMCA level in China has steadily increased, with higher concentrations in the Eastern and Central regions, especially in core urban clusters and economic belts. Second, DMCA significantly mitigates urban air pollution by leveraging its positive environmental externality, a result validated through robustness and endogeneity tests. Meanwhile, the impacts exhibit asymmetry, spatial heterogeneity, and nonlinear effects. Third, industrial upgrading, technological innovation, energy transition and factor allocation are verified as primary mediating channels through which DMCA mitigates urban air pollution, and environmental regulation is also verified as a positive moderating effect. Last but not the least, the differentiated of digital and manufacturing virtual agglomeration on urban air pollution are further investigated, particularly in the mechanisms and differentiated pathways of production intensification and lifestyle digitalization. This study enriches the theoretical framework concerning on industrial co-agglomeration, providing policymakers with critical insights to enhance the synergistic effect and positive environmental externalities of DMCA.
Volar finger contractures can be challenging for plastic surgeons. The dorsal metacarpal artery perforator (DMCAP) flap is frequently used to cover bones, tendons, and neurovascular structures in the dorsum of the hand after trauma and burns as an alternative to grafts and free flaps. We aimed to report volar finger defect reconstruction with expanded DMCAP flap. A 9-year-old male patient applied to our clinic with the complaint of inability to open the second finger of the left hand after an electrical burn that caused proximal and distal interphalangeal joints flexion contractures. Reconstruction was planned for the patient with a two-session expanded first DMCAP flap. A 16 mL 5 × 3 cm tissue expander was placed in the prepared area from the vertical incision in the first session. The tissue expander was inflated with 4 mL of isotonic solution. The DMCA area was enlarged 6 weeks later by giving 22 mL of isotonic solution. After the pedicle dissection, the 9 × 3 cm DMCAP flap was elevated by dissection over the paratenon. With 180° of rotation, the left-hand second finger was adapted to the 6 × 2 cm defect area on the volar face. The flap donor site was closed primarily. The operation was terminated by placing the hand on a protective splint. There were no complications in the flap in the postoperative 6 months. The patient was referred to the physical therapy and rehabilitation department. As a result, an expanded DMCAP flap may cover volar tissue defects up to the distal phalanx. This report may present the first case in which volar finger contracture reconstruction was performed with an expanded first DMCAP flap after an electrical burn in a pediatric patient.
Distal middle cerebral artery (dMCA) aneurysms are very rare. Most ruptured dMCA aneurysms lead to subarachnoid hemorrhage (SAH) coexisting with intracerebral hematoma (ICH), resulting in a deteriorating state. The risk factors of rupture of dMCA aneurysms remain unknown. To elucidate the risk of rupture, we studied differences between 4 ruptured and eleven unruptured dMCA aneurysms. We retrospectively analyzed patients diagnosed with a dMCA aneurysm according to the maximum size of the aneurysm, aspect ratio, and aneurysm size to vessel size (size ratio). Four patients presented with SAH coexisting with ICH, resulting in a midline shift, caused by rupture of the dMCA aneurysm. The median aspect ratio of ruptured and unruptured dMCA aneurysms was 2.38 and 1.65, respectively, with no significant difference. The median maximum diameter of ruptured and unruptured dMCA aneurysms was 2.98 and 3.78 mm, respectively, with nonsignificant difference. The median size ratio of ruptured and unruptured dMCA aneurysms was 3.13 and 1.84, respectively, being significant difference (P < 0.02). The outcomes of 4 patients having ruptured dMCA aneurysm were as follows: one patient died due to the initial attack, and the others were severely disabled due to cerebral infarction caused by vasospasm. Distal MCA aneurysms, even if they are small, may be likely to rupture leading to SAH complicated by ICH and result in a poor neurological state and unfavorable outcomes. We recommend aggressive treatment for dMCA aneurysms considering morphological factors such as the size ratio even if they are small and unruptured.
Spray-coated wide-bandgap perovskite solar cells offer a low-cost, highly scalable, and substrate-adaptive fabrication approach, holding significant promise for applications in perovskite-based tandem solar cells. However, the uncontrollable volatilization process and the randomly distributed nucleation sites lead to increasingly severe surface roughness and defect formation in the perovskite films as the number of spray-coated layers increases. Here, a solid-phase cyanoacetamide compound, N,N-dimethyl-2-cyanoacetamide (DMCA), is employed to induce lattice reorganization on the surface of spray-coated perovskite films. DMCA molecules bearing bifunctional groups enter and intercalate into the perovskite lattice by coordinating their carbonyl groups with Pb2+ and forming hydrogen bonds between their cyano groups and formamidinium (FA+), thereby generating a liquid intermediate state. Upon subsequent heating, DMCA molecules exsolve from the perovskite lattice resulting in lattice reconstruction. Consequently, both surface roughness and defect density are substantially reduced. The optimized wide-bandgap (1.67 eV) solar cells fabricated via spray-coating method deliver a high open-circuit voltage of 1.23 V and achieve a record power conversion efficiency (PCE) of 22.56%. Unencapsulated devices exhibit operational stability, maintaining nearly constant efficiency over 1200 h of maximum power point (MPP) tracking under continuous illumination.
In this study, we aim to evaluate the anti-diabetic potential of Thunbergia mysorensis leaves methanolic extract (MeL) using inhibitory assays for α-glucosidase (AG), α-amylase (AM) (carbohydrate digestive enzymes) and aldose reductase (AR) (an enzyme involved in the polyol pathway responsible for glycation). In addition to antidiabetic studies, antioxidant studies were also performed due to the fact that reactive oxygen species (ROS) are produced by various pathways under diabetic conditions. Hyperglycemia induces ROS by activating the glycation reaction and the electron transport chain in mitochondria. The MeL effectively inhibited the enzymes (AG IC50: 27.86 ± 1.0, AM IC50: 12.00 ± 0.0, AR IC50: 4.50 ± 0.09 μg/mL) and showed effective radical ion scavenging activity during the antioxidant assay (DPPH EC50: 30.10 ± 0.75, ABTS EC50: 27.25 ± 1.00, Superoxide EC50: 35.00 ± 1.50 μg/mL). Using activity-guided repeated fractionation on a silica gel column chromatography, two compounds including 3,4-dimethoxy benzoic acid (DMBA) (101 mg) and 3,4-dimethoxy cinnamic acid (DMCA) (87 mg) with potent anti-diabetic activity were extracted from the MeL of T. mysorensis leaves. Both DMBA (IC50 AG: 27.00 ± 1.05, IC50 AM: 12.15 ± 0.10, IC50 AR: 4.86 ± 0.30 μg/mL) and DMCA (IC50 AG: 27.25 ± 0.98, IC50 AM: 12.50 ± 0.20, IC50 AR: 5.00 ± 1.00 μg/mL) were subjected for enzyme inhibition. Since both compounds significantly inhibited AM, enzyme kinetics for AM inhibition was performed. The compounds also showed effective antioxidant potential (DPPH EC50: 30.50 ± 0.99, ABTS EC50: 27.86 ± 0.16, Superoxide EC50: 36.10 ± 0.24 μg/mL), and DMCA (DPPH EC50: 31.00 ± 1.00, ABTS EC50: 28.00 ± 0.25, Superoxide EC50: 36.25 ± 0.37 μg/mL). Further, to elucidate the role of DMBA and DMCA in enzyme inhibition and stability at the molecular level, both compounds were subjected for in silico enzyme inhibitory studies using molecular docking simulation, molecular dynamics (MD) simulation, and binding free energy calculations. Compared to AR and AG, AM was the most significantly inhibited enzyme (DMBA: -6.6 and DMCA: -7.8 kcal/mol), and compounds combined with AM were subjected to MD simulation. Both compounds were stable in the binding pocket of AM till 100 ns and chiefly use Van der Waal's energy to bind. Compared to the controls, both DMBA and DMCA had a higher efficiency in the inhibition of target enzymes in vitro and in silico. The presence of DMBA and DMCA is more likely to be associated with the potential of MeL in antihyperglycemic activity. This bio-computational study indicates DMBA and DMCA as potential lead inhibitors of AM and could be used as effective anti-diabetic drugs in the near future.
Morphologic variations of the cerebral arterial circle are often recorded through imaging and cadaveric studies; however, the combinations of such variants remain rare. The current imaging report emphasizes a unique case identified through magnetic resonance angiography (MRA) of a 56-year-old male, revealing the coexistence of a (unilateral) duplication of the right middle cerebral artery (dMCA) with a (bilateral) duplication of the right and left superior cerebellar arteries (dSCA). The right dMCA (1.5 mm) originated directly from the right internal carotid artery, accompanying the typical right MCA (2.5 mm). In addition, the right and left SCA arose in duplicate patterns, with morphologic variations in origin relative to the posterior cerebral arteries. These findings contribute to the limited reports of concurrent arterial duplications within the cerebral arterial circle. Recognition of such rare variations is crucial for accurate diagnosis and surgical planning, especially in procedures involving aneurysm treatment or stroke intervention. Advanced imaging modalities like MRA and CTA remain essential in identifying these anomalies and guiding clinical decision-making.
Duplicated middle cerebral artery (DMCA) aneurysms are rare, and their management can be challenging owing to their unique anatomical configuration and altered hemodynamics. We herein present a case of a large DMCA aneurysm that recurred 3 years after initial coil embolization. The patient underwent surgical clipping but experienced postoperative hemorrhage, which required the placement of a flow diverter as salvage treatment. This case highlights the potential for DMCA aneurysm recurrence and the importance of considering multiple treatment modalities.
A comprehensive theoretical study was conducted on the thermal Curtius rearrangement of N,N-dimethylcarbamoyl azide in its syn and anti conformations, examining both concerted and stepwise pathways in the gas phase and various solvents. The syn conformer is consistently more stable than the anti conformer by 7.99-10.05 kcal mol-1 and rearranges via a single transition state along a concerted, exergonic pathway to form N,N-dimethylamino isocyanate. The anti conformer undergoes a two-step conversion through an intermediate, with an endergonic first step followed by an exergonic second step. In the gas phase, the concerted pathway dominates, proceeding 101-104 times faster than the stepwise mechanism, while in highly polar solvents the stepwise pathway becomes favored due to solvent effects on relative rates, with NBO analyses providing a rationale for the solvent-dependent rate variations. Potential energy profiles were analyzed at the B3LYP/6-311++G(2d,d,p) level within the electron localization function framework, combined with bonding evolution theory and Thom's catastrophe theory. The concerted pathway proceeds through eight structural stability domains (syn-DMCA:8-CF†TSC†F†E CC†-0:DMAI + N2), whereas the stepwise pathway involves five and eight domains in its first and second steps (anti-DMCA:5-C†CF†C†TS-0:NI + N2 and NI:8-FC†TSFEFCC†-0:DMAI), highlighting the role of the nitrene intermediate. Topological and electronic analyses reveal pronounced asynchronicity in both the concerted mechanism and the second step of the stepwise pathway.