搜索结果：hidden

Adrenal insufficiency is a life-threatening condition that often presents with non-specific symptoms, complicating diagnosis in elderly patients. We report a case of a 77-year-old man with diabetes mellitus, hypertension and a history of cerebrovascular accident who presented with nausea, vomiting, weight loss and persistent giddiness. Laboratory tests revealed hyponatraemia and low serum osmolality. Further endocrine evaluation showed low morning cortisol, a suboptimal response to the short Synacthen test and suppressed adrenocorticotropic hormone levels confirming secondary adrenal insufficiency. The patient later disclosed recent use of a traditional Chinese medicine suggesting possible hidden glucocorticoid exposure and suppression of the hypothalamic-pituitary-adrenal axis. He improved after initiation of hydrocortisone replacement and discontinuation of the suspected products. This case emphasises the need for greater awareness of the potential adulteration of traditional Chinese medicines with glucocorticoids. It also highlights the critical role of laboratory testing in diagnosing adrenal insufficiency, detecting hidden adulterants and recognising the limitations of immunoassays in interpreting adrenal function tests.

Microbial-derived secondary metabolites (SMs) hold great therapeutic potential but are predominantly discovered from cultured species, representing only a fraction of microbial biodiversity. Advances in metagenomics have unveiled reservoirs of biosynthetic gene clusters (BGCs), but translating genomic sequences into precise chemical structures remains challenging owing to the structural complexity of cryptic BGCs and the context-dependent substrate tolerance and cross-reactivity of modular biosynthetic domains. Here we present DeepSeMS, a transformer-based large language model that accurately predicts secondary metabolite chemical structures from BGC sequences. By encoding biosynthetic genes as functional domains and leveraging a feature-aligned data augmentation, DeepSeMS outperformed existing methods and successfully generated chemically valid predictions for 96.38% of cryptic BGCs. Applying DeepSeMS to a global ocean metagenome, we characterized over 60,000 secondary metabolites, revealing chemical diversity, ecological specificity and considerable biomedical potential, especially as antibiotics. This study underscores the capability of deep learning-driven approaches in revealing hidden biosynthetic potential of Earth's largest, yet largely unexplored, microbial ecosystem.

Epithelial tissues maintain organ integrity while continuously remodeling during morphogenesis, repair, and disease. At high cell densities, these tissues often appear mechanically arrested in a disordered, solid-like state, raising the question of how they retain the ability to reorganize. Here, we show that, unlike thermal glasses, dense epithelial tissues do not exhibit caging behavior but instead behave as a complex fluid. Cells display subdiffusive creep together with Fickian yet non-Gaussian dynamics and compressed exponential relaxation, hallmarks of stress-driven fluidity. This fluidity arises from the tissue's structural and mechanical organization rather than from cell division or extrusion, which only transiently enhance local dynamics. Fast-moving cells organize into collective, anisotropic clusters whose spatial heterogeneity correlates with local structural entropy and soft vibrational modes. Together, these findings reveal a hidden fluidity in densely packed epithelia that supports mechanical stability while preserving the capacity for remodeling during development, wound healing, and early tumor invasion.

Ovarian ectopic pregnancy (OEP) is a rare and life-threatening condition that is typically diagnosed post-rupture. Its diagnosis and management become more complex when it is concurrent with ovarian endometrioma, as the latter may mask the clinical and radiological features of OEP. We report the case of a 28-year-old woman (gravida 2, para 1) who presented with 44 days of amenorrhoea and lower abdominal pain. Transvaginal ultrasound (TVS) revealed an empty uterus, a complex right adnexal mass containing a yolk sac (with synchronous movement with the ovary and a negative "sliding organ sign", raising a strong suspicion of ovarian ectopic pregnancy), and a separate "ground-glass" cystic lesion (consistent with an endometrioma). Corpus luteum blood flow signals were detected in the left ovary. The patient's preoperative haemoglobin concentration was 128 g/L. Diagnostic laparoscopy confirmed a right ovarian pregnancy co-existing with an ipsilateral endometrioma. Both lesions were excised laparoscopically while preserving the ovary. Haemostasis was achieved by primary suturing supplemented with minimal bipolar coagulation to preserve ovarian function. The patient recovered well; her postoperative haemoglobin concentration was 122 g/L, and her menses resumed at 6 weeks post-operatively, which confirmed preserved ovarian function. This case reaffirms a fundamental clinical principle: any reproductive-age woman with a positive pregnancy test, an empty uterus, and an adnexal mass should be presumed to have an ectopic pregnancy, prompting immediate surgical evaluation. In our patient, this principle alone mandated surgery. The transvaginal ultrasound findings (a yolk sac and a negative "sliding organ sign") did not change the need for surgery, but they provided critical preoperative localization of the gestational sac to the ovary. This allowed us to anticipate an ovarian pregnancy, obtain specific consent for ovary-conserving surgery, and plan a suture-dominant haemostatic strategy. To our knowledge, this is the first reported case of pre-rupture diagnosis of an ovarian ectopic pregnancy masked by an endometrioma using these sonographic signs. Clinicians must prioritize the clinical triad; when available, meticulous ultrasound adds precision for fertility preservation.

Shiga toxin-producing Escherichia coli (STEC) is a pathotype of E. coli associated with a wide variety of diarrhoea in neonatal calves, causing a global economic loss in the dairy industry with significant zoonotic risks via STEC and intimin-producing STEC, resulting in enteric and systemic illness, including diarrhoea, haemorrhagic colitis (HC), and haemolytic uremic syndrome (HUS) in humans. The presence of multidrug-resistant (MDR) STEC in neonatal diarrhoeic calves represents a significant public health concern and limits available therapeutic options. This study investigated the presence of extended-spectrum β-lactamase (ESBL) and carbapenemase-producing STEC isolates and their genotypic combinations of virulence and resistance genes in diarrhoeal calves. A total of 75 rectal swabs from diarrhoeic calves aged ≤ 12 weeks were sampled from three districts of Bangladesh, screened using selective culture and polymerase chain reaction (PCR), followed by phenotypic antimicrobial susceptibility profiling and phenotypic and genotypic screening for ESBL- and carbapenemase-production. The E. coli isolation rate among diarrhoeic calves was 80% (60/75; 95% CI: 69.17-88.35). PCR screening revealed the presence of stx1, stx2, and eae virulence genes, and the prevalence of E. coli isolates harbouring these virulence genes was 13.33% (10/75; 95% CI: 6.5-23.1). The ten virulent isolates included five stx-positive, four stx/eae-positive and one eae-positive E. coli. All the virulent isolates (100%) were resistant to ciprofloxacin and meropenem; however, eight (80%) of the tested isolates were susceptible to gentamycin, and 60% were susceptible to amoxicillin-clavulanate. All virulent E. coli isolates were MDR. We observed that 5 (50%) of the virulent E. coli isolates were ESBL producers, and 7 (70%) were carbapenemase producers. The results for phenotypes and genotypes of ESBL- and carbapenemase-producing strains were not concordant. At least one ESBL gene was present in nine of the ten virulent isolates examined, including four ESBL phenotype-negative isolates. Carbapenemase-producing genotypes were significantly more common in isolates with multiple virulence genes than in those with a single virulence gene (p = 0.001). To the best of our knowledge, this is the first report on ESBL- and carbapenemase-producing MDR STEC in diarrhoeic calves in Bangladesh.

暂无摘要（点击查看详情）

Tapeworms of the order Caryophyllidea (Cestoda) are widespread parasites of cypriniform and siluriform fishes. Most species occur in suckers (Catostomidae) in the Nearctic, including 4 species of the enigmatic genus Archigetes Leuckart, 1878. Species of this genus can mature in oligochaetes, i.e., may have a monoxenous (direct) life cycle. In this article, Archigetes notemigoni n. sp. is described from the golden shiner Notemigonus crysoleucas (Mitchill, 1814) (Leuciscidae) in Wisconsin. The new species differs from other Archigetes species in having a small (&#x2264;2 mm long), spindle-shaped body with the maximum width at the middle, tapering toward the scolex and posterior end, and a small scolex wider than the neck, with a pair of narrow, deep median loculi on the dorsal and ventral sides and 2 pairs of lateral, very shallow loculi. Phylogenetic analyses suggest that A. notemigoni is closely related to Archigetes sieboldi Leuckart, 1878 and Archigetes vadosus Uhrovi&#x10d;, Oros, Kudlai, Kuchta, & Scholz, 2022. In addition, Hypocaryophyllaeus gilae Fischthal, 1953 from the Utah chub Gila atraria (Girard, 1856) in Wyoming and Biacetabulum oregoni Williams, 1978 from the largescale sucker Catostomus macrocheilus Girard, 1856 in Oregon are placed as new combinations in Archigetes because their morphology, such as the shape of the small body (usually <5 mm in total length), bulboloculate scolex, distribution of vitelline follicles, and shape of the ovary, corresponds to that of Archigetes species. In total, the Nearctic fauna of Archigetes now comprises 7 species: 4 from minnows (Leuciscidae) and 3 from suckers (Catostomidae). In addition, there are 2 undescribed Archigetes morphotypes from Notropis spp. (Leuciscidae) in northern Mexico.

The immunological synapse (IS) is a nanoscale platform that coordinates T cell activation, cytoskeletal polarization, Ca2+ signaling, and the directed secretion of lytic granules. In cancers, an acidic tumor microenvironment (TME; extracellular pHe&#x2009;~&#x2009;6.4-6.8) imposes a biophysical and metabolic stress that could destabilize this interface. Experimental studies indicate that even modest acidification could significantly reduce integrin-dependent adhesion strength, delay actin clearance at the synapse, and suppress store-operated Ca2+ entry, thereby leading to marked decreases in cytokine production and cytotoxic granule release. In parallel, tumor cells often maintain relative intracellular alkalinity by enhancing proton export via transporters such as NHE1, MCT1/4, and CAIX, thereby reinforcing cortical actin "shielding," metabolic resilience, and resistance to perforin-mediated killing. These asymmetric pH adaptations may therefore establish a hidden checkpoint at the IS that favors tumor survival. We synthesize current evidence on pH-dependent regulation of actin dynamics, integrin activation, mitochondrial function, and Ca2+ channels (Orai1/STIM1); highlight key methodological gaps, including the lack of approaches combining real-time intra- and extracellular pH and Ca2+ imaging; and discuss enabling technologies such as microfluidic platforms, genetically encoded pH sensors, and multiparametric single-cell assays. Finally, we outline therapeutic strategies aimed at modulating pH (buffers, inhibitors of NHE1, MCTs, V-ATPases, or CAIX) or engineering pH-resistant effector cells and consider how these approaches could synergize with immune checkpoint blockade, CAR-T cells, and bispecific antibodies. Viewing acidosis as a druggable checkpoint reframes the IS as a bidirectional, pH-tuned system and suggests testable paths to restore antitumor immunity.

Corals maintain complex symbiotic relationships with diverse microorganisms, including fungi, which are often overlooked but represent a critical component of the coral holobiont. This study explores the fungal diversity associated with the tissue and skeleton of the red coral Corallium rubrum, a key species in Mediterranean Marine Animal Forests (MAFs). Using a culture-based approach, we recovered a broad spectrum of fungal diversity, dominated by Ascomycota such as Penicillium, Cladosporium and Aspergillus. The discovery of numerous taxa with known bioactive properties underscores the potential ecological and biotechnological relevance of coral-associated fungi. At the same time, the presence of species such as Aspergillus sydowii, which is considered pathogenic under elevated temperatures, raises concerns about coral vulnerability during increasingly frequent Mediterranean marine heatwaves. These taxa should be further investigated to evaluate their pathogenic potential. Overall, our results expand current knowledge of coral-fungal associations, providing a foundation for future work on their ecological significance, role in coral resilience and potential applications in biotechnology.

暂无摘要（点击查看详情）

Ageing-related diseases are increasingly recognized as time-dependent processes characterized by gradual accumulation, fluctuation, and prolonged subclinical deterioration rather than discrete clinical events. However, prevailing geriatric care models remain largely episodic, limiting their capacity to detect early signals of decline and intervene proactively. This review synthesizes longitudinal evidence from epidemiology, ageing biology, and clinical nursing research to reconceptualize geriatric disease as a trajectory-based phenomenon. Geriatric nurses may play a particularly important role in monitoring longitudinal changes in older adults and may contribute to emerging predictive care approaches that aim to anticipate health deterioration and support earlier intervention. By integrating subtle physiological, functional, behavioral, and psychosocial changes over time, nursing practice enables trend-based clinical reasoning that extends beyond task execution toward predictive decision-making. Furthermore, we examine how emerging digital tools and time-series analytics can amplify, but not replace, nursing judgment in anticipatory care. Together, these perspectives position geriatric nursing as a frontline predictive system essential for transforming ageing care from reactive event management to proactive trajectory-informed intervention.

Radioactive cesium-rich microparticles (CsMPs) released from the Fukushima Daiichi Nuclear Power Plant (FDNPP) in 2011 pose a persistent environmental concern, yet their initial atmospheric dispersion has remained poorly constrained. Here we quantify CsMP abundance and radioactive fraction (RF) in 100 surface soil samples collected across Fukushima Prefecture in July 2011 and integrate the results with WSPEEDI atmospheric simulations. CsMP abundance ranged from 0 to 52.3 particles g&#x207b;&#xb9;&#x202f;(dry weight), with RF values of 0-61.85%. The combined analysis identifies a major CsMP formation and release event at &#x223c;03:00 JST on 15th March 2011, producing a plume strongly enriched in CsMPs. Plumes released after 00:00 JST on 16th March contained no detectable CsMPs, indicating that particle formation had ceased by that time. The widespread distribution of CsMPs across Fukushima is therefore attributed primarily to this single plume. Directional variations in CsMP abundance reflect temporal changes in plume composition, with peak concentrations of &#x223c;2070 particles m&#x207b;&#xb3;&#x202f;toward the southwest and &#x223c;4700 particles m&#x207b;&#xb3;&#x202f;toward the northwest. These findings constrain CsMP formation mechanisms and improve reconstruction of radiological dispersion relevant to the long-term environmental risk assessment of nuclear power plants.

Dust storms, while often seen as harmful, can play an unexpected role in enhancing rainfall. Global observations show that 7-day accumulated precipitation after dust storms exceeds dust-free conditions by up to 9.6&#xa0;millimeters. Numerical simulations further confirm that dust particles act as ice nuclei, thereby promoting cloud formation and increasing rainfall through the ice crystal effect. Moreover, in regions with rising anthropogenic aerosols, dusts determine precipitation patterns. While elevated levels of anthropogenic aerosols alone tend to boost weak rainfall, the presence of dust aerosols reduces light precipitation and enhances heavier precipitation. Collectively, these findings reveal a dual role of dust storms in shaping global precipitation patterns while adversely affecting the human living environment. This research establishes a mechanistic framework for understanding how dust affects extreme precipitation at the global scale, advancing predictive capabilities for heavy precipitation.

Transcriptomic data is a valuable resource in precision medicine, providing crucial insights into disease diagnosis and treatment. Differential regulation relationship analysis, focusing on changes in regulatory relationships between different phenotypes, is an essential research direction to elucidate the mechanisms of complex molecular networks. However, many existing studies overlook associations with non-differential genes that exhibit quantitative changes in phenotypes. This study analyzes transcriptomic features by examining correlations among high-dimensional features through feature construction. We define the difference between an mRNA feature's predicted and actual expression as the mqTrans feature and build a predictive model. Three features with no differential expression in the original transcriptomic values across three independent SLE datasets were identified as latent biomarkers. By constructing a PPI network of latent biomarkers and biomarkers at the original expression levels, we explore interactive relationships between genes and discover functional interactions involving the latent biomarker ANXA2 and seven hub genes. In conclusion, mqTrans analysis can uncover essential biomarkers that traditional differential expression analysis often misses.

暂无摘要（点击查看详情）

暂无摘要（点击查看详情）

Unaccredited medical training in Australia represents a substantial yet poorly described component of the clinical workforce. This essay examines the scale, drivers and consequences of unaccredited roles for doctors, patients and health services. The essay concludes with pragmatic system-level reforms to track and move away from unaccredited training to a more efficient alternative.

暂无摘要（点击查看详情）

[This corrects the article DOI: 10.14423/SMJ.0000000000001927.].