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A subset of men with prostate cancer have elevated periprostatic androgens compared with levels in peripheral blood (termed the sneaky T phenomenon), which are associated with poor clinical outcomes after radical prostatectomy. These androgens are of testicular origin and reach the prostate, presumably through venous shunting. Varicocele physiology is accompanied by increased hydrostatic pressure within the pelvic venous system, providing a theoretical mechanistic explanation for the sneaky T phenomenon. These observations suggest a potential role for varicocele in contributing to prostate cancer pathophysiology through sneaky T, which if proved, could be a further indication for varicocele repair. Sneaky T can help to explain the differences in the natural history of benign or malignant prostatic diseases between individuals and could be a tool when deciding on the therapeutic course to take.

In the diagnosis of cardiac disorders Heart sound has a major role, and early detection is crucial to safeguard the patients. Computerized strategies of heart sound classification advocate intensive and more exact results in a quick and better manner. Using a hybrid optimization-controlled deep learning strategy this paper proposed an automatic heart sound classification module. The parameter tuning of the Deep Neural Network (DNN) classifier in a satisfactory manner is the importance of this research which depends on the Hybrid Sneaky optimization algorithm. The developed sneaky optimization algorithm inherits the traits of questing and societal search agents. Moreover, input data from the Phonocardiogram (PCG) database undergoes the process of feature extraction which extract the important features, like statistical, Heart Rate Variability (HRV), and to enhance the performance of this model, the features of Mel frequency Cepstral coefficients (MFCC) are assisted. The developed Sneaky optimization-based DNN classifier's performance is determined in respect of the metrics, namely precision, accuracy, specificity, and sensitivity, which are around 97%, 96.98%, 97%, and 96.9%, respectively.

In most cases, invasive ductal carcinoma (IDC) of the breast is identifiable when it presents with classic infiltrative growth patterns. However, a subset of IDC can present in a very sneaky way, significantly mimicking the appearance of ductal carcinoma in situ (DCIS). In this condition, it is much easier to miss the invasive component without pulling ancillary staining when morphologic findings are extremely compatible with DCIS, especially the diagnosis of DCIS was made on the previous biopsy. Here, we report the case of a 55-year-old female patient who was found to have microcalcifications at the 11:00 o'clock position in the right posterior breast during a routine mammographic examination. A biopsy of the calcification area performed at an outside hospital reported high-grade DCIS (ER+, PR-). Histologic examination of the subsequent mastectomy specimen at our institution showed two separate areas that closely resembled DCIS. Immunohistochemical (IHC) staining showed that all myoepithelial markers-smooth muscle myosin heavy chain (SMMHC), p63, CK5/6, and S100-were retained at the periphery of the expanded acini in one of the areas. Unexpectedly and surprisingly, myoepithelial markers were completely lost at the periphery of a subset of the DCIS-looking acini in another area, a finding that was immunohistochemically consistent with the diagnosis of invasive ductal carcinoma admixed with DCIS. Knowing that invasive ductal carcinoma of the breast can exhibit a DCIS-like morphology, especially in cases where a prior biopsy has already established a diagnosis of DCIS, will enhance the awareness of pathologists to recognize invasive ductal carcinoma that mimics DCIS. In turn, this will prevent misdiagnosis and undertreatment of patients with invasive ductal carcinoma of the breast.

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To describe a rare case of infectious keratitis secondary to Brevundimonas diminuta , a gram-negative bacillus with fluoroquinolone resistance and rare clinical isolation. A 50-year-old man with contact lens overuse presented with a large corneal ulcer and hand motion visual acuity. Initial treatment with fortified topical tobramycin and vancomycin yielded slow improvement, and initial culture grew Staphylococcus epidermidis , Staphylococcus hominis , and Corynebacterium bovis . Therapy was tapered to topical moxifloxacin. Loteprednol was added to reduce corneal inflammation after presumed sterilization. Persistent epithelial defect and worsening infiltrate after 3 weeks prompted repeat culture and corneal punch biopsy. Repeat culture revealed B. diminuta resistant to moxifloxacin. Treatment was modified to tobramycin, and therapeutic penetrating keratoplasty was pursued to prevent further stromal loss. Four months postoperatively, the cornea remained clear without recurrence or neovascularization. To our knowledge, this is the second reported culture-positive case of secondary infectious keratitis with B. diminuta , highlighting its rarity and potential for delayed identification. The atypical response to initial therapy underscores the importance of repeat cultures and corneal biopsy in persistent cases. This case contributes to the growing understanding of rare ocular pathogens, advocating for a vigilant clinical approach.

We report a rare case of solitary subungual malignant melanoma in a female patient who presented with a misaligned nail without accompanying pigmentary changes. The absence of typical clinical and imaging features delayed definitive diagnosis. Both magnetic resonance imaging (MRI) and ultrasound (US) initially suggested a benign lesion, favoring subungual telangiectatic granuloma. However, histopathology ultimately confirmed subungual melanoma with negative Human Melanoma Black-45 (HMB-45) immunostaining. Amelanotic melanomas are particularly prone to misdiagnosis or delayed recognition due to their lack of visible pigmentation. We present a detailed analysis of the imaging and pathological findings, highlighting specific ultrasound characteristics, with the aim of providing a valuable reference for the clinical diagnosis and management of such uncommon cases.

This editorial highlights a groundbreaking study by Enyo Tong and colleagues, published in Atherosclerosis, which examines the global burden of ischemic heart disease (IHD) linked to ambient fine particulate matter (PM2.5) pollution from 1990 to 2021, with projections extending to 2072. Using data from the Global Burden of Disease 2021, the study reveals that middle-income countries, men, and older adults are disproportionately affected. The editorial emphasizes the growing recognition of PM2.5 as a major cardiovascular risk factor-its impact by 2025 is expected to rival that of smoking. It revisits foundational research, including the Harvard Six Cities Study and subsequent influential publications, which established the link between air pollution and heart disease. Key sources of PM2.5 include vehicle emissions, industrial activity, fossil fuel combustion, agriculture, household pollutants, and natural events-most of which are shaped by human behavior and policy. The editorial calls for urgent action to reduce both outdoor and indoor air pollution, integrate pollution-related cardiovascular risks into medical education, and push policymakers to address not only domestic but also cross-border pollution threats.

Candida esophagitis is usually readily identified on routine H&E-stained sections as the infection typically presents with prominent acute inflammation as a clue to search for organisms. However, in some cases, inflammation is absent, and detection of organisms relies on the observation of zones exhibiting parakeratosis with a delicate 'flaky' appearance. Our study aimed to establish a correlation between the histomorphology of oesophageal candidiasis and an associated clinical profile. We reviewed 53 sequential biopsy specimens from patients with Candida esophagitis collected over 1 year. Biopsies were assessed for acute inflammation, intraepithelial lymphocytosis and lymphoid aggregates. Patients' medical records were reviewed for data on age, gender, race, immune status, smoking, corticosteroid use, HIV status and organ transplantation history. Correlations between these factors and histomorphological patterns were assessed using test. Of the 53 biopsies, 20 lacked acute inflammation and 33 had it. 15 biopsies showed both acute and lymphoid inflammation and 5 showed lymphocytosis only. Among 16 smokers, 6 (37%) had acute inflammation and 10 (63%) had parakeratosis. In non-smokers, 24 (71%) had acute inflammation and 10 (29%) had parakeratosis. A significant correlation was found between smoking and absence of acute neutrophilic infiltration (p=0.025), but no other clinical factor was associated with inflammatory patterns. Candida esophagitis can be uninflamed with 'flaky' parakeratosis or associated with acute inflammation or lymphocytosis with or without neutrophilic infiltration. Inflammation was often absent in smokers, suggesting synergistic local immunosuppressive effect is this overall immunosuppressed population.

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Ectopic splenic tissue may arise as either a congenital anomaly or acquired seeding of fragments from a mechanically disrupted spleen. Regardless of the etiology, splenic tissue presenting at unexpected sites may lead to symptomatic or incidentally discovered lesions that may raise clinical suspicion for neoplasia. We present three cases of ectopic splenic tissue that were clinically ominous and necessitated pathologic tissue examination for definitive diagnosis.

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This paper identifies and critiques a tendency for public health risk communication to be 'sneakily' persuasive. First, I describe how trends in the social and health sciences have facilitated an approach to public health risk communication which focuses on achieving behaviour change directly, rather than informing people's decisions about their health behaviour. I then consider existing discussions of the merits of informing versus persuading in public health communication, which largely endorse persuasive approaches. I suggest such accounts are unsatisfying insofar as their definitions of persuasion often fail to recognise its directional nature and the distorting effect this has on the total picture of the evidence. I re-characterise persuasion as directional influence aimed at achieving a particular outcome in the recipient and acknowledge that persuasive influence may also be manipulative. I then contrast this with (non-directional) information provision. I suggest that much persuasive public health risk communication is 'sneaky': it appears to be informative, but in fact presents a distorted picture of the evidence (in accordance with my characterisation of persuasion). I argue that such sneakily persuasive public health risk communication is unethical on the basis that it fails to adhere to the norms of cooperative communication.

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Brain-Computer Interfacing (BCI) has shown promise in Machine Learning (ML) for emotion recognition. Unfortunately, how data are partitioned in training/test splits is often overlooked, which makes it difficult to attribute research findings to actual modeling improvements or to partitioning issues. We introduce the "data transfer rate" construct (i.e., how much data of the test samples are seen during training) and use it to examine data partitioning effects under several conditions. As a use case, we consider emotion recognition in videos using electroencephalogram (EEG) signals. Three data splits are considered, each representing a relevant BCI task: subject-independent (affective decoding), video-independent (affective annotation), and time-based (feature extraction). Model performance may change significantly (ranging e.g. from 50% to 90%) depending on how data is partitioned, in classification accuracy. This was evidenced in all experimental conditions tested. Our results show that (1) for affective decoding, it is hard to achieve performance above the baseline case (random classification) unless some data of the test subjects are considered in the training partition; (2) for affective annotation, having data from the same subject in training and test partitions, even though they correspond to different videos, also increases performance; and (3) later signal segments are generally more discriminative, but it is the number of segments (data points) what matters the most. Our findings not only have implications in how brain data are managed, but also in how experimental conditions and results are reported.

Gram-negative Bartonella species are facultative intracellular bacteria that can survive in the harsh intracellular milieu of host cells. They have evolved strategies to evade detection and degradation by the host immune system, which ensures their proliferation in the host. Following infection, Bartonella alters the initial immunogenic surface-exposed proteins to evade immune recognition via antigen or phase variation. The diverse lipopolysaccharide structures of certain Bartonella species allow them to escape recognition by the host pattern recognition receptors. Additionally, the survival of mature erythrocytes and their resistance to lysosomal fusion further complicate the immune clearance of this species. Certain Bartonella species also evade immune attacks by producing biofilms and anti-inflammatory cytokines and decreasing endothelial cell apoptosis. Overall, these factors create a challenging landscape for the host immune system to rapidly and effectively eradicate the Bartonella species, thereby facilitating the persistence of Bartonella infections and creating a substantial obstacle for therapeutic interventions. This review focuses on the effects of three human-specific Bartonella species, particularly their mechanisms of host invasion and immune escape, to gain new perspectives in the development of effective diagnostic tools, prophylactic measures, and treatment options for Bartonella infections.

Male spotted bowerbirds (Ptilonorhynchus maculatus) build and defend a structure of sticks and straw-the bower-decorated with colourful objects to attract mates during the breeding season. Specific non-territorial, subordinate males are tolerated by resident males at bowers over multiple breeding seasons. Prior research showed that these male-male associations exhibit attributes of coalitionary behaviour and that subordinate males gain delayed benefits from associating with bower owners, namely future bower inheritance. Yet, it remained unclear whether subordinate males may additionally gain direct fitness benefits from attending established bowers. Here, we report on four separate instances of sneaky copulations (or attempts of copulating) by subordinate males at resident males' bowers. Multiple non-resident males disrupted the ongoing copulations between the bower owner and a receptive female, and these events were followed by violent aggressive interactions. These observations shed new light on same-sex social dynamics in spotted bowerbirds and support the hypothesis that subordinate males are sexually mature individuals that occasionally obtain access to females while attending established bowers. We discuss these findings in light of the literature on male courtship coalitions and agonistic behaviour in bowerbirds, and highlight further aspects of subordinate behaviour that require empirical investigation.