The Arabian Sea accounts for a small fraction of Tropical Cyclones—about 2% of the annual global mean. However, the damage they might inflict there and along its coastlines, which are thickly populated, is considerable. This study explores the influence of the changes in the vertical profiles of atmosphere and oceanic environment throughout the seasons of March–June (MAMJ) and October–December (OND) in clustering the cyclogenesis over the Eastern Arabian Sea (EAS) next to the Indian West coast in recent decades. Further investigation has been done into the precise contribution of atmospheric and oceanic factors to fluctuations in cyclone intensity throughout the MAMJ and OND seasons separately. Two seasons have been studied independently in order to better understand the distinct influences of the vertical fluctuation of atmospheric factors and the thermal structure of the oceanic subsurface on cyclogenesis. More severe cyclones are caused by high tropical cyclone heat potential, and ocean subsurface warming present in this sea region influences the genesis of storms mostly during MAMJ. On the other hand, mid tropospheric relative humidity and thermal instability influences more on increasing cyclogenesis and its clustering over EAS during OND season. The findings suggest that large-scale oceanic subsurface conditions have a crucial influence on cyclogenesis over EAS through oceanic sensitivity to atmospheric forcing. This cyclone tendency and its clustering over EAS needs attention in terms of forecasting, catastrophe risk reduction, and climate change adaptation due to the security of coastal urban and rural habitats, livelihoods, and essential infrastructure along the coasts. A recent increase in the North Indian Ocean (NIO) Tropical Cyclone (TC) trends poses challenges in forecasting, disaster risk reduction and humanitarian interventions on the densely populated coasts on the ocean rim. As severe cyclonic storms and associated compound hazards are increasing along the west coast of India, it is important to understand regional scale driving mechanisms in devising local adaptation.3. Most studies related to TCs mainly consider the Sea Surface Temperature (SST) to represent the ocean state10 while the subsurface temperatures of NIO has been found not to co-vary with the surface temperatures12. Several studies have reported that TCs interact and intensify after encountering regions of higher TCHP values18. One recent example of such a case in the NIO is that of Very Severe Cyclonic Storm (VSCS) Ockhi (2017) that originated in the Bay of Bengal (BoB)19. During its development stage, cyclone Ockhi encountered anomalously high SST and ocean subsurface temperatures, leading to it’s rapid intensification18. This emphasises the importance of the subsurface ocean temperature, OHC and, by extension of TCHP, to the study of TCs. In light of this, the relative role of each individual potential parameters and TCHP is examined with respect to the changes in TC frequency and intensity over NIO.This paper looks at changes in TC spatial patterns, frequency, and intensity over the Arabian Sea during the pre- and post-monsoon seasons. It considers local Ocean Heat Content  as a driver of Tropical Cyclone Heat Potential  marking the pre-monsoon (and early monsoon) (MAMJ) and October–December (OND) post-monsoon seasons22. Amidst increasing TC activity, post-monsoon events are gaining intensity23. The first recorded post-monsoon Extremely Severe Cyclonic Storm  26. Among the five events in 2019, ESCS Maha coexisted briefly with the Super Cyclonic Storm  and OHC in May and weakening of the summer monsoon circulation have been shown to drive a trend of more ESCS in the AS31. The recent warming trend of the IO34 is most pronounced in its western part36, where the mean summer Sea Surface Temperature (SST) has increased from 26.535. The Indo-Pacific Warm Pool (IPWP), a region where SST remain above 2838. As such, the world oceans were the warmest in 202139.There have been unusual tracks and intensification of storms. For instance, Cyclone Ockhi formed in the southwestern Bay of Bengal on 28 Nov 2017, traversed 2500 km over the Indian Ocean (IO) and the Arabain Sea (AS), rapidly intensifying into a VSCS near the coasts of Sri Lanka, Tamil Nadu, and Kerala39. EEI increases OHC as over 90% of EEI is stored in the ocean, with deep seas increasingly determining the energy budget. The total increase in the OHC of upper 2000 m during 1998–2015 is estimated at 39. In the IO, the abrupt OHC increase accounting for over 70% of the global ocean heat gain in the upper 700 m of the ocean since 2003 has been attributed to increased heat transport from the Pacific Ocean to the Indian Ocean by the Indonesian throughflow (ITF) current40. In this background of general heat gain in the IO, this study looks at its implications for the Eastern AS (EAS).This warming is linked to Earth Energy Imbalance (EEI)—the difference between emitted and reflected solar radiation—that has doubled worldwide between 2005 and 2019The majority of earlier research has generally focused on the overall rising trends in severe cyclonic storms across the whole Arabian Sea basin. The causes of the increased cyclogenesis potential over the Eastern Arabian Sea, however, are the focus of this study. This study also examines how multiple meteorological and oceanic factors contribute to the genesis of cyclones in the Eastern Arabian Sea, as well as how these factors differ and interact with one another during the MAMJ and OND seasons. Additionally, earlier research has included either the spatial trend or the area averaged trend of vertically integrated factors. In order to comprehend the changes in the atmosphere and ocean brought on by climate change and leading to the observed changes in the cyclogenesis over the Eastern Arabian Sea, the vertical variation of the trend at various height levels in the atmosphere and depth levels in the oceans has for the first time been analysed in this study.Cyclone track density and cyclogenesis location during MAMJ and OND season for the period from 1979 TO 2021 are presented in Fig. Figure Figure mentclass2pt{minim43 that have been used for developing Genesis Potential Parameter (GPP) for different ocean basins45. Accordingly, these parameters have been considered in this study and most important parameters, which exhibit significant increasing trend over EAS.We have taken most of the cyclogenesis parameters fromThe Mid-tropospheric RH (MRH) is increasing during both MAMJ and OND, with OND indicating a larger positive trend than MAMJ, significant at 95% confidence level Fig. a. This i46. On the other hand, an increase in 47 and have been used for operational forecasting of cyclone intensification48. Hence, 28 also reported that, an increase in column averaged , a significant element in the air-sea interaction, has received a lot of interest in TC research. The ocean subsurface has, however, received much less attention, particularly when describing the regional variability of the cyclogenesis over the Arabian Sea, because the majority of current TC research studies pay close attention exclusively to the SST and upper ocean heat content to characterise the contribution of the ocean.52 and the temperature of this layer over the Arabian Sea varies significantly on the inter annual time scale.Spatial trend analysis of SST revealed a warming trend all over the Arabian Sea during both MAMJ and OND, except for a small region over west-central AS during MAMJ Fig. c,d. The Area and depth averaged Ocean subsurface temperature from 0 to Figure 3, where they attribute the AS sub-surface warming during OND to the increase in the intensity of the second downwelling Kelvin wave originating in the Equatorial Indian Ocean during October. On the other hand, during pre-monsoon, surface heat flux exhibited an increasing trend since 2000, while vertical entrainment showed a decreasing trend3. This found that the depth of 26Essentially, these findings indicate that the AS sub-surface temperature is on the rise. This is in line with the findings of Albert et al.55, we assume that this oceanic dependence, in addition to the influence of changes in atmospheric state, may influence the genesis of intense cyclones in a changing climate conditions.Large-scale upper-ocean temperature stratification seems to play a significant role in cyclogenesis across the Eastern Arabian Sea (EAS) on seasonal time scale. In line with the past observational studiesThis analysis reveals that, besides SST and ocean heat content in top layers, subsurface temperature profile below 26This finding suggests that since large-scale oceanic subsurface conditions regulate oceanic sensitivity to atmospheric forcing, they play a crucial role in regulating tropical cyclone intensity. As a result, we need to comprehend how the oceans affect cyclone intensity, as well as their influence and magnitude in relation to alterations in atmospheric conditions. Additional evidence for this relationship is provided by ocean subsurface thermal measurements and can be used as potential predictor for seasonal cyclogenesis over EAS basin.44. Moreover, the depth of 2656. However, in order to account the spatial variability in the subsurface temperature and TCHP, spatially varying threshold have been used to modify GPI in the present work.By using the TC Genesis Potential Index (GPI), the influence of the large-scale environmental factors on TC genesis is examined. Thermodynamic state of the atmosphere and the ocean subsurface temperature profile over Eastern Arabian Sea and its link with seasonal GPI has been investigated. The linkage between ocean subsurface and other oceanic or atmospheric parameters which have influence on the cyclogenesis and evolution has been analysed with the help of commonly used GPP index for seasonal and climate change studiesons Fig. b–d. The 44. Fig. 44 while Fig. To better reflect the increasing trend of RH in the mid-troposphere, we used RH averaged over the 850–57. The trend in the area averaged VMAX over EAS shown in Fig. From the analysis of spatial variability in the modified GPI, it is found that, large positive trend is observed and spread over entire EAS. The trend analysis of the time-series of area-averaged modified GPI also exhibit a large and significant positive trend during MAMJ and OND season as compared to GPI trend without including oceanic sub surface influence. This clearly signals the role of including ocean subsurface temperature in the GPI to comprehended the link of ocean subsurface in cyclogenesis under warming scenario. The potential intensity is the maximum steady intensity a storm can reach based on its energy cycle, where mechanical dissipation in the storm’s atmospheric boundary layer balances the heat input from ocean evaporation, multiplied by a thermodynamic efficiencyThe correlation between seasonal mean subsurface water temperature and GPP during the peak TC season (March–June and October–December) from 1979 to 2021 over the Arabian Sea is examined and presented in Fig. Furthermore, subsurface water temperature, which decides the vertical thermal structure of the ocean, may be responsible for the increase in frequency and intensity of TC, which is more evident in the spatial trend of modified GPI after including TCHP in the GPI. The strength of this effect depends on the ocean subsurface thermal structure. Thermodynamic state of the atmosphere and the ocean subsurface temperature profile over EAS and its link with seasonal GPI has been investigated. The subsurface ocean environment is not spatially uniform and the coupling between the subsurface ocean and atmosphere above may be distinct over different regions within Arabian Sea basin and increasing trends in the EAS both in original GPI and modified GPI confirms that, EAS is becoming a hot spot for cyclogenesis in recent decades.This study explores the influence of the changes in the vertical profiles of atmosphere and oceanic environment in clustering the cyclogenesis over EAS using observational estimates of thermodynamical profiles of the atmosphere and subsurface ocean during the period 1979–2021. This study also established the link between rising TC activity in the EAS and attempt to comprehend the underlying cause of the clustering and increasing TC activity in EAS during MAMJ and OND Seasons. According to the TC frequency and ACE analyses, there has been an increase in TC activity in the EAS since 1979. In the most recent eras, both seasons have seen a notable increase in the average number of cyclonic systems. The study found a notable rise in mid-tropospheric humidity during both seasons, with OND showing the largest rise. The recent epoch over the EAS during both seasons indicate a positive trend in the vertically averaged mid-tropospheric humidity, which is averaged between 800 and 300 hPa. Compared to MAMJ, the trend is noticeably stronger during OND and is primarily present in central and Southeast AS. According to the area-averaged vertical time-section of RH and the vertical profiles of its trend at each level, the mid-troposphere as a whole is seeing an increase in RH rather than just one specific level. In recent decades, SST has increased throughout the entire basin in both seasons.Thermal instability, as shown by The thermodynamic structure of the upper ocean and lower atmosphere have a significant impact on cyclogenesis over EAS. The main atmospheric regulating elements for the observed rise in cyclogenesis and its clustering in the eastern Arabian Sea are the increase in thermal instability and mid tropospheric humidity. By changing the vertical thermal structure of the ocean as a result of global warming, the subsurface oceanic processes favours the conducive environment for TC generation by extending thermal stratification over deeper layers in the ocean. In general, the relationship between ocean subsurface temperature and the TC activities indicated by GPP across the EAS was the main focus of this work. Simple correlation analysis is performed to describe the association between specific cyclogenesis parameters and GPP, which is a limitation of the procedure. Therefore further investigation is of great importance to evaluate the large-scale environment and governing physical mechanism behind the correlation in detail. Coupled model experiments is necessary to understand complex complementing and offsetting influences of ocean subsurface warming on the atmosphere in the cyclogenesis process. Accurate prediction of TC intensity in these cases probably requires accurate measurement of the upper-ocean thermal structure of the storm environment.Given the population density on the western coast of the Indian peninsula, this study has important implications for forecasting, catastrophe risk reduction, and climate change adaptation. Along with enterprises, essential facilities, and infrastructure, there is a significant concentration of urban and rural habitats along the coast. Small-craft fishing operations and coastal environments are particularly susceptible to storm activity, making artisan fishing particularly vulnerable, especially along its southern boundaries. The report urges development strategies that account for the dangers posed by a changing climate and weather as well as policy and technological initiatives in the areas of storm warning, impact-based local weather services, and localised reliable weather services.The study area encompasses the Eastern Arabian Sea (EAS), along the coast of the Indian peninsula, as depicted in Fig. 58, while the cyclogenesis locations were obtained from Best track data from RSMC New Delhi. TC tracks from Joint Typhoon Warning Center (JTWC) Best-Tracks dataset59 was used for calculating the accumulated cyclone energy (ACE) as its computation require 6 hourly interval data of maximum sustained wind speed. The comparison of IMD and JTWC (figure not shown) shows that, both the independent data sets are in general agreement in terms of count, frequency, intensity and distribution of cyclones over Arabian Sea. The cyclone category used in this manuscript completely follows IMD criteria and we have considered only one category, ie tropical cyclone when maximum sustained wind speed exceeds 34kts. To maintain consistency, we have mainly used IMD data and JTWC is used only to supplement the analysis based on IMD best track data.The frequency of cyclonic systems over the AS were obtained from the Cyclone e-Atlas provided by IMD61. Depth of 2662 to calculate TCHP.The monthly-mean atmospheric parameters and SST at a spatial resolution of P value.For the trend analysis, linear least-squares regression was used, with a two-tailed Wald Test with t-distribution was used to calculate the The study period is restricted from 1979 to 2021 to exclude less-reliable data before the satellite-era and to include the recent data that is currently available. The climatology is calculated from 1979 to 2008 (30 years). Following sections describe the individual atmospheric and oceanic parameters, that have been used to analyse the relative contribution on the cyclogenesis potential during MAM and OND seasons. Area average of any parameter is taken over the area defined as EAS, which is highlighted in Fig. 64. ACE calculated by adding the square of 6 h MSW for all the systems while having an intensity of tropical cyclone or higher  is a parameter indicative of the number, intensity and lifetime of tropical cyclones that form in a given time period66.  is an important oceanic parameter that influences various stages of tropical cyclone life cycle44 is a modified version of the TC Genesis Index by Gray41. GPI is defined as:RH is the relative humidity at 600 hPa (in percent), The Genesis Potential Index (GPI)74. Potential intensity, 73. The Potential Intensity is calculated using the Python module pyPI76. The GPI is further modified following56 by multiplying the GPI with TCHP scaled by 40. However, in order to account the spatial variability in the subsurface temperature and TCHP, spatially varying threshold based on climatology has been used to modify GPI in the present work.Potential Intensity (PI) is the maximum theoretical threshold a storm could attain given the atmospheric and oceanic stateSupplementary Figures.


Background and Objectives: Ventriculoperitoneal (VP) shunt placement is the most common treatment for cerebrospinal fluid diversion. Head and neck pain occurring after a long period following VP shunt insertion is rarely reported. Here, we present a rare case of head and neck pain occurring 2 years after surgery due to irritation of the superficial cervical plexus by the VP shunt. Case Description: A 46-year-old female patient received VP shunt placement surgery. Two years after the surgery, she experienced a left temporal headache with neck pain on the left side, which extended to the left para-auricular and fascial region. Ultrasound (US) scanning revealed that the VP shunt passed within the superficial cervical fascia and through the left sternocleidomastoid muscle (SCM). Additionally, friction of the branches of the superficial cervical plexus and of the greater auricular and lesser occipital nerves caused by the VP shunt was found underneath the lateral border of the SCM. Subsequently, the blocking and hydro-release of the left superficial cervical plexus were performed. After four series of treatments, the patient’s head and neck pain vanished, and the frequency of the headaches was substantially reduced. The patient was regularly followed-up in the outpatient department of neurosurgery. Conclusions: Head and neck pain caused by the malpositioning of a VP shunt catheter with an unusually delayed onset is a rarely reported complication and could be easily neglected. Patients with head and neck pain following VP shunt insertion should be checked using US scanning to identify the potential origin of the pain and receive adequate treatments. Intraoperative US-guided tunnelling is suggested to avoid the malpositioning of the VP shunt catheter. Cerebrospinal fluid (CSF) shunting through ventriculoperitoneal (VP) shunt placement remains the primary neurosurgical operation for patients with hydrocephalus ,2. Altho3) within the left lateral ventricle, with gradually unsteady gait and muscle weakness on the right side , perform a detailed physical examination, and schedule the imaging examinations accordingly. In the present case, the patient experienced headache and neck pain without other neurological symptoms or infection signs and with onset 2 years after VP shunt surgery. Neither shunt infection, shunt obstruction, nor new brain lesions were found, and the symptom did not improve after adjusting the pressure of the VP shunt and administering pain medication. The exact reason as to why the patient’s head and neck pain occurred after a delay of two years is unclear, but the causes of pain were speculated to be related to the VP shunt surgery based on our image findings. This pain was unlikely to be due to the surgery because any surgery-related pain would have happened early after the surgery.In patients who have undergone VP shunt surgery, head and neck pain occurring after such a long delay has never been reported. This problem could be easily overlooked and symptomatically treated with pain medication only. The detailed image analyses revealed the friction of the branches of the superficial cervical plexus and of the greater auricular and lesser occipital nerves by the VP shunt. The superficial cervical plexus originates from C2 to C4′s anterior primary rami . This plMalpositioning of the VP shunt is relatively rare; however, once it occurs, patients may suffer from unpleasant sensations and require further management. C. Lim et al. and R. Shane Tubbs et al. reported four cases of patients who experienced shoulder pain after VP shunt placement surgery. Further images proved the malpositioning of the VP shunts. All of them received revision surgery for repositioning the catheter and experienced relief of their shoulder pain postoperatively ,10. SaeeThe VP shunt has been widely used in the past few decades and is the most common procedure in patients who need CSF diversion ,6. DurinBack to our patient, if the ultrasound-guided treatment had been ineffective and other possible complications had been ruled out, then we would have considered surgery for repositioning their VP shunt.In conclusion, we reported a rare case of malpositioning of a VP shunt, which irritated the superficial cervical plexus, resulting in head and neck pain with an unusually long delayed onset after surgery. Nerve block and hydro-release effectively relieved the pain. Based on the findings of this case, the routine use of US for ensuring the correct positioning of a VP shunt is recommended.


Research participation during undergraduate years has a powerful influence on career selection and attitudes toward scientific research. Most undergraduate research programs in academic health centers are oriented toward basic research or address a particular disease focus or research discipline. Undergraduate research programs that expose students to clinical and translational research may alter student perceptions about research and influence career selection.We developed an undergraduate summer research curriculum, anchored upon a clinical and translational research study developed to address a common unmet needs in neonatal nurseries . Program topics reflected the cross-disciplinary expertise that contributed to the development of this “bedside to bench” study, including opioid addiction, vulnerable populations, research ethics, statistics, data collection and management, assay development, analytical laboratory analysis, and pharmacokinetics. The curriculum was delivered through three offerings over 12 months, using Zoom video-conferencing due to restrictions imposed by the COVID-19 pandemic.Nine students participated in the program. Two-thirds reported the course enhanced their understanding of clinical and translational research. Over three-quarters reported the curriculum topics were very good or excellent. In open-ended questions, students reported that the cross-disciplinary nature of the curriculum was the strongest aspect of the program.The curriculum could be readily adapted by other Clinical and Translational Science Award programs seeking to provide clinical and translational research-oriented programs to undergraduate students. Application of cross-disciplinary research approaches to a specific clinical and translational research question provides students with relevant examples of translational research and translational science. Participation in research and mentorship during undergraduate years is known to have a powerful influence on career selection in scientific and engineering fields –4. UnderIn the following manuscript, we report our experience developing and administering training in clinical and translational research for undergraduate students. Our curriculum aligns with recent definitions of team science, whereby the “strengths and expertise of professionals trained in different fields work together to address scientific challenges” . The novSupport for development of the curriculum was provided through a supplement (NIH P20 GM103429-19S1) to the parent grant that supports the Arkansas IDeA Network of Biomedical Research Excellence (INBRE). The Institutional Development Awards (IDeA) program was established by Congress in 1993 to expand the geographic distribution of National Institutes of Health (NIH) funding to states with historically low rates of federal research funding. The IDeA Networks of Biomedical Research Excellence (INBRE) award program fosters the development, coordination, and sharing of research resources and expertise to expand research opportunities and increase the number of competitive investigators in IDeA-eligible states. The Arkansas INBRE promotes biomedical research with programs for undergraduate students and faculty statewide. The University of Arkansas for Medical Sciences (UAMS) and the University of Arkansas serve as the lead institutions for the Arkansas INBRE, which has impacted nearly all colleges and universities in the state during its 21-year history.The Arkansas INBRE offers a mentored summer research program that provides opportunities for undergraduate students a research experience with established biomedical researchers at the lead institutions. Nearly all host research laboratories focus on basic science approaches and/or early-stage translational or T1 research, traditionally defined as the development and validation of animal models and/or preclinical drug studies. The UAMS CTSA, known as the Translational Research Institute, or TRI, provides resources to expand investigator training across the T1–T4 translational research spectrum. A supplement award to the UAMS INBRE (NIH grant P20 GM103429) provided the opportunity for TRI and the Arkansas INBRE to develop a curriculum for undergraduate students framed upon a clinical and translational research (CTR) study.A representative CTR study supported by institutional funds to develop opioid-related research and INBRE funding provided a framework for creating a unique curriculum for undergraduate students that exposed the students to numerous principles of CTR. Opioid addiction is a common and persistent challenge that has generational effects on the US population . The CTRThe management of opioid dependency in pregnancy has dramatically shifted over the last two decades . The majClinical assessment for NOWS relies on the Finnegan scale  which waThe primary goal of the CTR study was to quantify buprenorphine and its primary metabolite nor-buprenorphine in infants born to mothers receiving buprenorphine for the treatment of opioid dependency in pregnancy. Buprenorphine and norbuprenorphine levels were compared to established clinical scoring for NOWS. The research protocol focused on defining the relationship between measurements of buprenorphine and norbuprenorphine in infant blood samples to the development of NOWS. Prior to the initiation of the clinical research protocol, a new assay for the measurement of buprenorphine and nor-buprenorphine in infant whole blood samples was developed and validated in a CLIA-accredited laboratory. Whole blood samples were extracted using standard supported liquid extraction techniques and analyzed using liquid chromatography tandem mass spectrometry (LC-MS/MS).The clinical research protocol was developed by a clinical pharmacologist with extensive input from a team of pediatric hospitalists working in the neonatal nursery and neonatal intensive care unit. The lead pediatric hospitalists obtained additional consultation from the clinical community, including obstetricians, clinical nursing staff, and pregnant mothers with opioid addition who participated in a support group led by the institution’s Department of Psychiatry. The protocol received approval from the UAMS Institutional Review Board and informed consent from mothers was required. The blood sampling strategy for the clinical research protocol was tailored to accommodate the small circulating blood volume of infants by obtaining samples at times where blood sampling was scheduled for routine clinical monitoring of the infants. Umbilical cord blood samples were collected from infants at the time of delivery and from infants at 24 and 72 hours after birth. Modified Finnegan scores were captured from the Epic electronic health record and downloaded into a study specific REDCap database.Participating students were recruited from Hendrix College . The original program was designed to be a 12-week on-site summer program during which students would rotate in various laboratories and the neonatal nursery. When the COVID-19 pandemic precluded in person meetings, the program was modified to use a Zoom video-conferencing format and was offered during three semesters over a 12-month period. Lecture topics for the curriculum  participated in the program. The median (and range) student age were 21 (19–23) years. Seven of the students identified as White, one identified as Asian, and one identified as both White and Hispanic. The academic year for the participating students was one sophomore, five juniors, and three seniors. After graduation from Hendrix College, all students were planning on attending either medical school or graduate school.Overall, the students were very favorable about their experience, with over two-thirds of participants stating they agreed or strongly agreed that the course met their expectations, they would recommend the course to others, and felt that the course enhanced their understanding of research. Satisfaction was also high for the individual program modules, with all modules being rated as excellent or very good by more than three-quarters of the students. Response frequencies to all the questions asked are shown in The developed CTR curriculum provided new educational materials that were administered by clinical and research faculty who were well versed in the topic areas through their training, experience, and contributions to development of the research study. These faculty participated in either the development  and/or clinical implementation  of the study. The “real world experience” of the CTR study provided a cohesive framework for the curriculum whereby clinical and translational research concepts were illustrated through application of the concepts to a specific research question. Our curriculum could be adapted by other CTSA programs, whereby one (or more) representative clinical and translational research studies are selected as case studies and cross-disciplinary experts involved in study development demonstrate their discipline-specific contributions to the study. Many of the lecture topics reflect core aspects of CTR that are well developed in CTSA programs . Additional curriculum topics for inclusion could be a) an introduction to the clinical context from which the research question was developed, b) exposure to additional scientific content expertise, and c) presentations of research ethics relevant to the representative studies.In open-ended questions provided to the students, they indicated that the strongest component of the curriculum was the cross-disciplinary nature of the program. The curriculum appeared to provide a compelling example to students of how CTR concepts can be applied to solve an unmet need in the clinical care of a vulnerable population . This exWhile our evaluation of the curriculum did not include a learning assessment, the data are particularly noteworthy given that all meetings between students and faculty were conducted virtually as a result of the COVID-19 pandemic. Other groups have demonstrated high levels of satisfaction with summer research programs that were transformed into a virtual format as a result of the COVID-19 pandemic ,22.Finally, summer research programs for undergraduate students have been shown to impact their pursuit of additional training and ultimately their career choices . The rec


In this case report, we present an extremely rare case of isolated aortic valve prolapse causing aortic regurgitation having no association with any comorbid conditions that are commonly seen with aortic valve prolapse. A 27-year-old female patient presented with chief complaints of dyspnea on exertion (New York Heart Association grade III) for 20 days, decreased appetite for 15 days, and a history of significant weight loss for one and a half years. Transthoracic and transesophageal echocardiography revealed a trileaflet floppy aortic valve with prolapsing non-coronary and right coronary cusps, associated with moderate aortic regurgitation. The incidence of aortic valve prolapse is roughly around 1%. Exceptionally, very few cases of isolated aortic valve prolapse with moderate-to-severe aortic regurgitation without any associated pathology have been reported to date. When the aortic valve structures are pulled or pushed down below the imaginary line connecting the sites where the valvular leaflets join to the annulus, i.e., the aortoventricular junction proximally and sinotubular junction distally, showing a backward bowing in the left ventricle (LV), this condition is referred to as aortic valve prolapse. The most often reported consequence of aortic valve prolapse is aortic regurgitation (AR). AR is a condition in which blood streams backward from the lumen of the aorta into the LV during the diastolic phase due to improper closure of the leaflets of the aortic valve. The incidence of aortic valve prolapse is around 1%. Exceptionally, very few cases of isolated aortic valve prolapse with moderate-to-severe AR without any associated pathology have been reported to date. According to one study, 30% of patients with a prolapse of the aortic valve had a bicuspid valve and an aortic valve prolapse in a non-bicuspid valve was mostly co-existent with a mitral valve prolapse. With further studies, more concomitant etiologies have been found to be linked with aortic valve prolapse which include post-inflammatory, degenerative, traumatic, infectious, and idiopathic or unknown causes . HoweverA 27-year-old female patient presented at the cardiology department of a rural tertiary care hospital with chief complaints of dyspnea on exertion (New York Heart Association grade III) for 20 days, decreased appetite for 15 days, and a history of significant weight loss for one and a half years. She had no medically relevant history and had not undergone any surgeries before. Neither had she been on any medications before this visit. There was no history of chest pain, palpitations, syncope, fever, or abdominal pain. She was a non-smoker with no history of cardiovascular diseases in the family. The patient was informed of having been diagnosed with valvular heart disease five years ago but was not on any regular medications. There was no history of rheumatic fever, marfanoid phenotype, or infective endocarditis. Upon general examination, her pulse rate was 128 beats per minute, her blood pressure was 130/90 mmHg, and her respiratory rate was 12 breaths per minute. Cardiac examination showed a tapping apical impulse present in the sixth intercostal space with the presence of parasternal heaving and suprasternal pulsations upon palpation. Upon auscultation, s1 and s2 were heard along with a systolic murmur. An ECG was done which showed sinus tachycardia and left ventricular hypertrophy  was performed for better visualization of the aorta that revealed the aortic valve to have prolapsing non-coronary and right coronary cusps, associated with moderate AR. The aortic root diameter was found to be 20 mm. There was no derangement of other valvular leaflets, i.e., the left coronary cusp of the aortic valve, mitral valve, tricuspid valve, and pulmonary valve appeared to be normal. Her ejection fraction was found to be 55%. There were no visible vegetations of the valve leaflets and no pericardial effusion or clot. The various images of the TEE showing prolapse of the non-coronary cusp and right coronary cusps of the aorta and AR are depicted in Figures The patient was medically managed in the hospital with tablet Met xl 25 mg (metoprolol) and tablet Lasix 20 mg (furosemide) which was indicated due to mild pulmonary congestion as the patient had left heart failure because of moderate AR. The patient was advised further hospital stay for extensive management but her relatives requested discharge due to monetary issues. She was told to revisit for a repeat 2D echocardiography after six months.The anatomical picture of the aortic valve is trileaflet in an individual with no anomalies, consisting of a right, left, and non-coronary cusp. However, in some cases of congenital malformations, where one or more cusps get fused during embryological development, a unicuspid or bicuspid aortic valve can be present . In veryCusp prolapse in the aortic valve can be solitary, with a single or multiple leaflet prolapsing regardless of no alterations in the aortic root, in relation to ascending aortic dilatation, or as the outcome of surgery such as aortic valve-sparing surgeries . There cThe prolapse of the aortic valves can be best diagnosed on a TEE on a mid-esophageal long-axis view of the aortic valve but also requires analysis by surgical inspection. According to Boodhwani et al., the TEE appearance of cusp prolapse shows a reverse or eccentric aortic regurgitant jet opposite to the direction of prolapsing cusp seen in Doppler echocardiography , valve leaflets beneath the level of the annulus of the aorta at the time of diastole, reduced length of coaptation (a measure of overlap between two leaflets) of the aortic leaflet, and the emergence of a fibrous band transversely on the cusp which is prolapsing, both in short and long-axis views, aids in confirming the diagnosis of aortic valve prolapse and localizing its site. This is particularly helpful in cases when the left coronary or non-coronary posterior cusp is prolapsed. The short-axis view also shows an asymmetrical root of the aorta along with redundant tissues. Prolapse of more than one cusp is identified by meticulous echocardiographic evaluation of the movements of every cusp at the time of diastole and is usually linked with a decreased level of cusp coaptation ,14.The criteria for diagnosing aortic valve prolapse involves looking for the retardation of the aortic valve cusps or their point of coaptation toward the ventricle on the left side in the parasternal long-axis view during diastole. Clear visualization of the aortic valve as well as the structures around it, such as the interventricular septum and anterior cusp of the mitral valve, all positioned along the entire length of the root of the aorta and left ventricular outflow tract, are necessary for adequate aortic valve assessment in TEE. The Woldow et al. approach was used to grade aortic valve prolapse. This is how the severity was rated: 1+ for a minor descending displacement or dipping of the coaptation point causing the cusps to straighten during diastole, 2+ for significant bowing below the level of aortic annulus during diastole, and 3+ for the complete protuberance of one or multiple cusps into the left ventricular area during the diastolic phase .As the aortic valve cusp prolapse as a solitary defect is not that prevalent globally, there is insufficient data results of valve repair over the course of time as well as a lack of understanding of preoperative and intraoperative identification of the prolapsing cusps. Thus, despite the availability of repair techniques such as free margin plication, free margin resuspension using 7-0 polytetrafluoroethylene suture, and triangular resection technique to get rid of broadly solidified and fibrotic tissues of cusp from a central portion, total replacement of the aortic valve remains the preferred choice of treatment for almost all patients suffering from severe AR due to cusp prolapse .Despite its extreme rarity, aortic valve prolapse with an absence of any other pre-existing cardiovascular or non-cardiovascular condition can cause AR in a patient. It is best early diagnosed with the help of a TEE. Recognizing aortic valve prolapse holds significance as it opens the door to potential valve repair and replacement.


Cervical spondylotic myelopathy (CSM) is a progressive disease that worsens over time if untreated. However, the rate of progression can vary among individuals and may be influenced by various factors, such as the age of the patients, underlying conditions, and the severity and location of the spinal cord compression. Early diagnosis and prompt treatment can help slow the progression of CSM and improve symptoms. There has been an increased use of magnetic resonance imaging (MRI) methods in diagnosing and managing CSM. MRI methods provide detailed images and quantitative structural and functional data of the cervical spinal cord and brain, allowing for an accurate evaluation of the extent and location of tissue injury. This review aims to provide an understanding of the use of MRI methods in interrogating functional and structural changes in the central nervous system in CSM. Further, we identified several challenges hindering the clinical utility of these neuroimaging methods. Cervical spondylotic myelopathy (CSM) is one of the leading causes of cervical spinal cord (CSC) dysfunction, typically affecting adults aged 50 years or more. The prevalence of CSM is expected to rise worldwide due to the aging population . It is aMagnetic resonance imaging (MRI) has been extensively used to qualitatively and quantitatively understand, diagnose, and monitor pathologies of the spine and recently also in the brain in CSM patients . MRI seqThis review aims to present the utility of MRI methods in assessing the structural and functional changes in the CNS in CSM. The rest of this review is structured as follows. The natural history of CSM is poorly understood, and symptom manifestation among patients varies significantly . TherefoThis section describes MRI methods for quantifying macro-level tissue injury.CSC compression is one of the most common types of tissue injury, resulting from the spinal canal’s narrowing and spinal cord’s compression. Spinal cord compression in CSM can occur at a single or multiple vertebral or spinal levels. These pathologies are visible on a conventional T1 or T2 MRI scan. Studies have shown that the degree of spinal cord compression correlates with the clinical severity of CSM ,22,23,24The anterior-posterior diameter (APD) is calculated as the distance between the anterior and posterior ends of the spinal cord . APD is Maximum spinal cord compression (MSCC) measures spinal cord compression with reference to the normal reference values above and below the site of compression  Figure . MSCC prSignal intensity aberrations of the spinal cord relative to a baseline reference can also be used as a quantitative metric to assess spinal cord injury ,42. SuchThe spinal cord descending tract volumes may be reduced in patients with CSM patients. Moreover, this white matter atrophy may predict disease severity A,B 45]..45]. In There is emerging evidence that structural changes occur beyond the spinal cord in the brain ,47,48,49This section describes MRI methods with the potential to assess tissue injury at a microstructural level.Diffusion tensor imaging (DTI), a subset of DWI, exploits that water molecules diffuse differently along the tissues depending on factors such as the type of tissues, structural integrity, and presence of barriers, etc. A diffusion tensor model can mathematically describe the rate and direction of water diffusion at the level of a voxel  Figure A. SpecifA weighted sum of diffusivities along the three axes of the fibers is given by the apparent diffusion coefficient (ADC), alternatively called the mean diffusivity (MD), which quantifies direction-invariant water diffusion rate  and is aAnother DTI metric, fractional anisotropy (FA), describes the anisotropy of molecular diffusion at the level of a voxel . FA is sDiffusion kurtosis imaging (DKI) is an extension of DTI with a non-gaussian water diffusion profile. It provides information complementary to ADC and FA metrics . For exaFiber tractography (FT) is a graphical variant of DTI used for assessing microstructural tissue changes via post-processing DTI tensor solution and constructing a white matter fiber map of the brain  and spinThere has been a recent increase in the use of model-based DWI methods in CSM, such as diffusion basis spectrum imaging (DBSI)  and neurMT imaging  and myelMWI estimates myelin content by estimating the fraction of tissue water bound to the myelin sheath. This is accomplished by fitting the T2 relaxation curve to a multi-exponential model and identifying the fraction of the signal with a T2 parameter . This MWMRS interrogates disease-related metabolic changes before the manifestation of the abnormality of the tissue at the cellular or organ level is detectable in a routine clinical MRI examination . This spMRS has been used primarily in the human brain , and theFunctional MRI (fMRI) allows noninvasive assessment of the brain  and spinOne emerging application of fMRI is to study the pathophysiology of CSM in the CSC ,125 and In addition to brain fMRI, resting-state spinal cord fMRI has also been applied to CSM. After analyzing the amplitude of low-frequency fluctuations (ALFF) of BOLD signals in the spinal cord, it was found that the BOLD signal increased with the symptomatic severity in CSM patients . This fiThe use of fMRI in CSM is relatively new, but it continues to increase in popularity as imaging methodologies improve. In the future, it could be an integral part of learning about the underlying neuronal mechanisms within the CNS and observing fundamental changes that could lead to successful treatments.The current paper reviewed research that suggests a potential to investigate tissue injury in CSM patients via quantitatively measuring structural and functional changes in the central nervous system. While MRI-based neuroimaging research for CSM has progressed by leaps and bounds in the past two decades, several challenges still exist that are a hurdle to clinical translation, especially in interrogating the spinal cord. The first, and perhaps the biggest challenge, is the anatomy of the spinal cord. The spinal cord has a small cross-sectional area compared to the surrounding structures. These structures consist of significantly different tissues from the spinal cord with different magnetic susceptibility. This significant difference in susceptibility may cause distortions in the magnetic field, resulting in a distorted image and reduced intensity, thus making it challenging to capture small structural details of the spinal cord . ImagingSecond, MRI metrics of the spinal cord are affected by artifacts arising from cardiac and respiratory motion and cerebrospinal fluid pulsation ,135. TheThird, MRI metrics depend on age as described above. Therefore, MRI measurements should be compared in patients with age-matched control participants. When age matching is not feasible, age may be adjusted in multivariate analysis .Fourth, multimodal studies provide more information than is available from a single MRI method. The number of multimodal studies has been increasing recently. It should be considered in designing future studies to assess insults to the spinal cord and brain in CSM patients accurately.Fifth, it is complex and time taking to accurately segment the spinal cord from its surrounding tissues in healthy individuals compared to the brain. It becomes challenging in lesioned areas such as regions of compression. The tissue segmentation becomes even more difficult at the level of the individual spinal cord tract. As a result, studies often perform manual segmentation by one or more experienced radiologists. Even then, they typically include the gray and white matter without discriminating between them. Performing a manual spinal cord segmentation is not only laborious but is also prone to bias and its accuracy depends on the operator’s skill. Recently, the Spinal Cord Toolbox (SCT)  has beenSixth, standardization is needed, especially at the acquisition stage, to increase the reproducibility of experimental findings. Efforts in this direction are being made. For example, the spine generic protocol provides guidance on using either of the three most used 3T MRI machines from Philips, GE, and Siemens . Other eFinally, although the number of studies examining the brain in the context of CSM is increasing, these investigations typically focus on the brain and spinal cord separately. This may be due to the additional time required to perform simultaneous scans of both regions of the central nervous system. Further analysis that compares the structural and functional impairments in both the brain and spinal cord could advance our comprehension of the underlying pathophysiology of CSM.Several promising MRI methods that have not yet been applied to CSM, have been applied to other pathologies of the central nervous system. For example, R2* MRI, which quantifies the iron content in tissues and lesions , has beeWhile the current paper focused on MRI techniques, it should be noted that several non-MRI imaging modalities exist that are clinically used or have shown potential in the diagnosis and management of CSM. One such example is X-ray imaging in 2D  or 3D (iRecently, electrophysiology studies have also shown usefulness in CSM diagnosis and management. For example, nerve conduction investigation helps rule out peripheral nerve abnormalities in myelopathic patients . MoreoveMRI provides a promising suite of methods for investigating the pathophysiology of CSM and for monitoring the effects of therapeutic interventions using structural and functional neuroimaging of the brain and spinal cord. With advances, these methods will likely become an increasingly important tool for diagnosing and managing CSM. However, several challenges must be understood and worked on to help in the clinical translation of these methods.


The nervous system processes sensory information through a hierarchical structure with multiple processing stages. The convergent-divergent connectivity pattern has been shown to efficiently convey information about external stimuli. In addition, there are abundant downstream connections, as well as horizontal connections within and between layers, which facilitate high-level processing and modulate the response of the nervous system to external stimuli, both as a function of the temporal and spatial context and the current state of the system .Proper brain function relies on the integration of information processed in local circuits, and it is a key question to understand how the brain integrates the multitude of local processes throughout its anatomy. Communication between brain regions involves the transfer of electrical activity coded in different local neural populations, which is quantified by statistical relationships between brain areas derived from brain imaging or electrophysiological recordings. This communication, known as "functional connectivity" ,3. The eThe flexibility of information routing and effective connectivity stems from the multistability of neuronal network dynamics. This means that a single structural connectivity pattern can result in a variety of dynamic states, each with a unique pattern of communication. Collective neuronal oscillations are believed to play a role in dynamic communication between brain regions by modulating the exchange of phase information between connected areas through adjustments in the phase relations. ,5. This Special Issue delves into the intricacies of communication and information processing within neuronal circuits and systems. The articles explore how various structural organizations of brain circuits can impact their dynamics and functionality, as well as the role of brain oscillations in regulating sensory processing, motor functions, and inter-brain communication. The following sections provide a comprehensive overview of the papers published in this Special Issue.How information propagates during sleep–waking cycles was tackled by Farhad Razi and co-workers . In thisA model of the early visual system was developed by Alejandro Santos-Mayo and co-workers . In thisThe mechanisms of flexible information sharing supported by noisy oscillations was studied by Powanwe and Longtin . The autThe optimal input representation in neural systems operating at the edge of chaos was investigated by Morales and Muñoz . The autThe functional interaction between the entorhinal cortex input and theta activity in the hippocampus was studied by López-Madrona and Canals . The autPost-scratch locomotion in cats was studied by Tapia and co-workers . The stuThe relation between EEG and synaptic fickleness was studied by Pretel and co-workers . This stThe self-organized structuring of recurrent neuronal networks was considered by Miner and co-workers . The stuDistinct locomotor behaviors in Drosophila larva were studied by Gowda and co-workers . The aut


The COVID-19 pandemic disproportionately affected racial and ethnic populations within the United States, creating a distinct set of circumstances that exacerbated barriers to research participation for underrepresented communities. This article aims to provide a rationale that validates the impact of the COVID-19 pandemic on these groups and suggests strategies for participant recruitment while sharing lessons learned from our own laboratory. By understanding the barriers that limit the recruitment of intended populations, researchers can implement culturally sensitive strategies and work towards a more inclusive body of literature with improved participation from underrepresented racial and ethnic populations. Previous literature has suggested that individuals are less likely to participate in face-to-face research (not remote) during the COVID-19 pandemic.7 Researchers must acknowledge these barriers and employ strategies to improve representation across all racial and ethnic backgrounds. This article aims to 1) provide rationale validating the deleterious impact of COVID-19 on the recruitment of racial and ethnic diverse populations; 2) suggest strategies for authentic recruitment of these communities despite existing barriers; 3) describe our own laboratory practices and lessons learned.Native American populations experienced a death rate that was almost five times higher than national averages.2.8 Increased racial and ethnic participation in research ensures findings can be applied to diverse populations, a need that is growing with the continued diversification in the US.3 This not only helps reduce the gap in the literature but could also answer warranted ethnic-specific questions that are currently unavailable due to insufficient data or sample sizes of racial and ethnic minorities.9Despite mandates such as the Revitalization Act of 1993, enacted by the National Institutes of Health (NIH), underrepresentation in research persists for many communities, contributing to ongoing disparities.10 Both cases exploited vulnerable communities through a lack of informed consent and denial of treatment for a curable disease.10 These abuses of marginalized populations operated under the guise of scientific racism, or the manipulation of scientific practices to justify the dehumanization and enslavement of Black people.11 Contemporary examples of scientific racism continue to intensify mistrust by failing to acknowledge health disparities created by racism.11 These malpractices question the integrity of biomedical research, stressing the importance of recognizing the historical and contemporary roles that reinforce mistrust.11 Our intention should be to improve the trustworthiness of science research by properly interpreting findings within the context of structural racism.11One of the largest barriers to participation in research studies is the individual’s perception of the scientific community. Many racial and ethnic populations experience a deep mistrust of scientific and medical communities. This is an adaptive response to chronic inequity, stemming from times of slavery and reinforced by more recent events such as the Tuskegee syphilis study and the Havasupai Trials.3.5 The pandemic disproportionately affected these groups in a few ways. Comorbidities that are common in racial and ethnic communities, such as hypertension and diabetes mellitus, and an increased likelihood of living in densely populated neighborhoods contributed to a higher risk of COVID-19 exposure and infection.5 As a result, these populations were more hesitant about participating in research that would expose them further to an increased risk of COVID-19 infection.The COVID-19 pandemic introduced unique challenges that further complicated the recruitment of underrepresented populations in research.12 Media coverage often overlooked the underpinnings that led to disparities in COVID-19 infection and hospitalization, such as resource deficits, inadequate access to healthcare and testing, and pre-existing vaccine hesitancy prior to COVID-19.12 Despite efforts to include communities of color, there was ultimately a lack of diversity in COVID-19 vaccine clinical trials which reinforced vaccine hesitancy. This further fueled the existing mistrust of science within racial and ethnic underrepresented communities.12 Ultimately, these events increased the difficulty of recruitment for communities of color, as individuals lacked confidence in institutional research.Mistrust of the scientific and medical communities was also heightened by the COVID-19 pandemic.4.3 Our ongoing NIH-funded research attempts to quantify insulin status and determine its relationship with endothelial function and blood pressure regulation in Hispanic and Latine individuals. This project began in the Fall of 2020 which limits our ability to assess the difficulty of recruitment prior to the COVID-19 pandemic. However, soon into the recruitment process, we realized we would need to adjust our strategies to specifically address the unique challenges posed by the COVID-19 pandemic, especially considering our target population’s higher risk of COVID-19 infection.14 We focused on addressing two key factors that impact recruitment success: safety and trust building. Within trust-building strategies, we highlight community-based participatory research and authentic community engagement.Recruitment and retention of communities of color and other underrepresented populations in research have gained attention in recent years.Safety is a top priority for participants and staff. We implemented COVID-19 precautions, as recommended by the Centers for Disease Control and Infection (CDC), and communicated these measures to participants through consent documentation, verbal explanations, and our laboratory website. Additional personal protective equipment (PPE) was used while participating in tests (e.g. exercise), that raised respiration or depth to avoid the spread of a potential viral load. Taking these steps and providing these protocols helped subjects feel more comfortable participating in our research.14 The community-based participatory research (CBPR) approach is one model that promotes partner-led recruitment by involving community and academic leaders in the research process.1 This model can add diversity to a research team to better represent the desired recruitment population while redirecting the dialogue to originate from a trusted member of the community. Ultimately, research needs to be conducted in a culturally respective manner with the understanding that building trust takes time and transparency in intent and methods is of the utmost importance.15 To help preserve the longevity of the relationship, findings should be returned to foster true partnership and sharing of data.15 We applied this model by working with a local entrepreneurial center that aims to provide opportunities for community members to gain an additional source of income. Building this relationship required our team to consistently honor our commitments to them and provide assistance as needed. After a foundation of trust was established, we were able to ask prominent leaders in the organization to help recruit and spread the word about our project. This shifted the perception of our laboratory from being outside of the community to being a part of the community, allowing our target population to feel more comfortable participating in our research.Building trust requires persistent efforts focused on community engagement and trust-building between research staff and the public.10 By actively illustrating a willingness to help the community, we were able to foster specific community relationships that were needed to conduct research.7 We approached this through acts of service: attending local events, offering free blood pressure screenings, and providing bilingual pamphlets to help explain the importance of healthy blood pressure. We found that free blood pressure screenings were (and are) necessary and appreciated, especially with limited access to free or low-cost services since the COVID-19 pandemic. We took engagement a step further and volunteered in a few projects to restate our commitment to serving the community beyond research. Projects such as filling sandbags for flash-flooding  or distributing food at the local family food center taught the importance of listening to community needs. As a response, we started attending our local Diversity Council meetings to further practice active listening.Authentic community engagement can also help rebuild trust between the community at large and a research institution.Despite additional challenges posed by the COVID-19 pandemic, our engagement efforts were positively received, evidenced by the increased enrollment of participants in our study. However, since the study is still ongoing, it is difficult to predict the ending impact and how that may be reflected in our study participants. Our laboratory intends to return to the community after the completion of the study and share significant findings so that future studies can build on the relationship already established. While our strategies were (and are) focused on recruiting the Hispanic/Latine population, we believe these lessons can be applied broadly to other communities. It is ultimately the responsibility of the researcher to understand the barriers limiting an intended recruitment population and implement culturally sensitive strategies to overcome them. By doing so, we can work towards a more inclusive body of literature and improve participation for underrepresented communities.


Diagnosis of testicular cancer > 10 weeks after its initial manifestation was associated with less favorable survival . Multivariate logistic regression analysis identified two independent predictors of the delayed diagnosis, age > 33 years  and residence in the countryside , with another two parameters, the lack of a regular intimate partner  and the feeling of shame , being at the verge of statistical significance. All the factors mentioned above should be considered during planning social campaigns aimed at the early detection of testicular malignancies, along with improving the quality and trustfulness of Internet-based information resources.The aim of the present study was to identify the reasons behind the delayed diagnosis of testicular cancer in a group of Polish males diagnosed with this malignancy in 2015–2016. The study included data from 72 patients aged between 18 and 69 years. Based on the median time elapsed to the testicular cancer diagnosis, the study patients were divided into the timely diagnosis group (diagnosis within 10 weeks from initial manifestation,  Testicular cancer is the most common malignancy diagnosed in younger males (20–44 years of age), with the yearly number of new cases estimated at 71,000 worldwide and 1200 in Poland . HoweverLike in the case of other malignancies, a key to the early diagnosis of testicular cancer is the awareness of its early manifestations and appropriate screening . TypicalImportantly, testicular cancer, a malignancy occurring at a relatively younger age, has a detrimental effect on male reproductive health. According to the literature, more than 50% of men diagnosed with testicular cancer present with oligospermia already before the implementation of any treatment. While the chances of fathering a child after purely surgical treatment of the malignancy are relatively higher (90%), the probability of conceiving a baby by patients who received adjuvant chemotherapy after being diagnosed with late-stage testicular cancer decreases dramatically, down to 48%. Hence, in many testicular cancer survivors, having offspring will require assisted reproductive technology, which further increases the economic burden of the disease ; survival b.The present study identified two factors, age > 33 years and living in the countryside, as the independent predictors of delayed diagnosis of testicular cancer. Another two factors, the lack of a regular intimate partner and the feeling of shame, were shown to be closely related to the diagnostic delay, although none of them reached the threshold of statistical significance on multivariate logistic regression analysis. Not surprisingly, the delayed diagnosis turned out to be associated with worse OS in testicular cancer.The further in-depth analysis demonstrated that respondents older than 33 years significantly more often than the younger participants mentioned the lack of adequate knowledge/negligence of symptoms as a reason for the diagnostic delay. Males aged > 33 years are usually occupationally active and have their own families. Published evidence suggests that being overloaded with both job- and family-related duties, such persons frequently postpone referral to a physician despite the presence of potentially alarming symptoms; this can lead to a diagnostic delay . MoreoveAside from older age, living in the countryside was another significant determinant of delayed diagnosis. One would expect the limited availability of healthcare resources as the main reason for the delayed diagnosis among countryside dwellers, consistent with some published data . HoweverThe results of the present study highlighted an essential role of a spouse/intimate partner in earlier diagnosis of testicular cancer. Many previous studies demonstrated that having a permanent intimate partner can constitute a significant determinant of timely diagnosis in both male and female malignancies ,32,33,34Importantly, patients from the delayed diagnosis group significantly more often than their timely diagnosis counterparts mentioned the Internet as a primary source of information about testicular cancer. This finding points to a growing problem of seeking medical information from unverified Internet resources instead of referring to a specialist ,11,12,13In the present study, the delayed diagnosis of testicular cancer had an unfavorable impact on the clinical stage of the malignancy, which in turn negatively affected the OS. Diagnostic delay is an established determinant of unfavorable outcomes in testicular cancer and other malignancies ,39,40. TTo summarize, the results of the present study show clearly that the knowledge of testicular cancer symptoms among Polish males is insufficient, with men with some specific sociodemographic backgrounds presenting more severe gaps in this matter than others. One key to addressing the problem in question is to popularize the practice of testicular self-examination. Only by being familiarized with the normal appearance of their testicles at an early age and self-examining them regularly every month can males detect potential abnormalities early and seek medical advice promptly. Aside from being aware of the early manifestations of testicular cancer, males should also realize the potential consequences of detecting the malignancy at more advanced stages. These include not only markedly lower chances of survival in patients in whom testicular cancer was diagnosed at the stage when systemic spread had already occurred but also a detrimental effect of systemic anticancer treatment on fertility. Only strong healthcare awareness combined with adequate access to healthcare resources may prevent diagnostic delay in testicular cancer and the consequences thereof, not only clinical but also economic ones.This study has some potential limitations. First, this was a single-center study with a relatively small sample size. Thus, the results presented herein should be verified in a larger, population-based study. A larger study, including male respondents with more variable sociodemographic backgrounds, would allow us to verify the findings presented herein and perhaps identify some additional factors contributing to the delayed diagnosis of testicular cancer. Second, we retrospectively analyzed available data included in the survey and hence were unable to consider some other well-known determinants of diagnostic delay in cancer patients, such as economic status ,21. ThirTimely diagnosis of testicular cancer can be delayed due to the older age of the patient, residence in the countryside, lack of an intimate partner, and/or feeling of shame. All those factors should be considered during planning social campaigns aimed at the early detection of testicular malignancies, along with improving the quality and trustfulness of Internet-based information resources.


Enhanced Recovery after Surgery (ERAS) protocol has been developed and practiced for various surgical procedures to improve outcomes in the postoperative period. We hereby present our experience of ERAS for a large cohort of patients undergoing total joint arthroplasty (TJA).We implemented the ERAS program at The Third Affiliated Hospital of Shanghai University from January 2020 and retrospectively compared outcomes of patients undergoing total knee or hip arthroplasty before and after the implementation of the program. ERAS protocol consisted of the use of patient education, blood management, multimodal analgesia, antiemetics, shorter fasting time, no patient-controlled analgesia, early physical therapy, and reduced use of catheters and drains.There were 94 patients in the study group (ERAS) and 113 patients in the control group (non-ERAS). We noted a statistically significant reduction in the incidence of postoperative nausea/vomiting, lowered pain scores, reduced length of hospital stay and better functional outcomes with both total knee and hip arthroplasties in our study cohort.ERAS protocol can bae effectively implemented for patients undergoing TJA. The use of ERAS leads to better postoperative outcomes and shortened hospital stay. Patients with debilitating joint diseases make a significant portion of patients visiting an orthopedic clinic. Not surprisingly, total joint arthroplasty (TJA) has become one of the commoner surgical procedures in clinical practice. A large proportion of TJAs consists of either total hip arthroplasty (THA) or total knee arthroplasty (TKA).4The Enhanced Recovery After Surgery (ERAS) protocol was initially advocated by a Danish surgeon Kehlet H in 1997.A retrospective study with a control group was designed to assess the efficacy of the ERAS program on patients undergoing THA/TKA. The ERAS program was introduced in our institute in July 2021 and we included all patients undergoing THA/TKA in this program as the study group (July 2021 to December 2022). The control group consisted of patients undergoing THA/TKA before the introduction of ERAS (January 2020 to June 2021) we retrieved the institutional medical records of all patients undergoing THA/TKA from January 2020 to June 2021. The records were De-identified to maintain patient confidentiality. The data obtained after the intervention was compared to the data obtained retrospectively from past records.Institutional ethical committee approval was obtained before beginning the study . Informed written consent was obtained from all patients for the surgical procedures.- Patients had no serious underlying medical comorbidities.- Those undergoing THA/TKA for the first time.- Who were mentally sound to understand the study plan and follow the instructions, and were cooperative to perform various exercises before and after the operation.- Had support from family members- Whose complete medical records were available and they completed regular follow-up up to three months after surgery.We excluded patients with serious medical comorbidities, those with poor cognitive ability, on long-term anticoagulant therapy and those undergoing revision THA/TKA.In the control group, the patients were included a few days before the surgery. Standard surgical protocols were followed. Surgery was done under general, spinal, or epidural anesthesia. Post-operative drainage was used in most patients. No standard pain control method was used and pain management was at the discretion of the treating physician. Progressive physiotherapy was carried out and patients were discharged to a rehabilitation center.For the ERAS group, the surgery protocol involved initial interaction with the surgeon which was complemented by a joint replacement educational program. Patients were screened for iron deficiency anemia and treated accordingly. A detailed surgery information document was prepared and handed over to all patients. Patients were admitted a few days before surgery and the discharge date was predetermined. Preoperative fasting time was reduced. As a part of the blood-sparing strategy, tranexamic acid was given preoperatively as an intravenous agent and continued postoperatively in oral form. Preemptive analgesia in the form of buprenorphine transdermal patch 5mg was applied to the subclavian pectoralis major muscle in all patients. Patient-controlled analgesia (PCA) was omitted instead a fixed dose of multimodal pain regimen was used. Intra articular injection of a cocktail of tranexamic acid 1.2g, morphine 10mg, ropivacaine 75mg and epinephrine 0.5mg was also used after the surgery for postoperative pain and hemorrhage control.The use of anti-emetics was also standardized. The use of drains was restricted and if used they were removed as soon as possible. Early walking was encouraged in the recovery room. Similarly, early intake of fluids was encouraged. Intravenous fluid therapy was withdrawn in 6-8 hours and the patient was returned to the ward. Oral antimicrobial therapy was then initiated. All patients were encouraged to do active self-rehabilitation with the aid of the physiotherapist in the initial stage. Discharge time was endorsed by the operating surgeon on the first postoperative day itself.st and 3rd postoperative days), Hospital for special surgery (HSS) knee rating scale, and Harris score recorded at one week, one month and three months.Pre-operatively, we collected information on patients’ demographics, history of diabetes, patient diagnosis, side of THA/TKA, type of anesthesia, pre-operative length of stay (LOS), fasting hours before surgery, and hemoglobin (Hb) and glucose levels before surgery. Outcome data consisted of days of catheterization post-surgery, use and duration of the wound drainage tube, time to oral intake post-surgery, the requirement of blood transfusion, Hb and glucose levels, post-operative nausea and vomiting (PONV), incidence of venous thromboembolism (VTE), pain scores, postoperative LOS, range of motion (ROM)  between the two groups. Most patients in both groups underwent surgery under spinal and epidural anesthesia. However, peripheral nerve blocks were more frequently used in the control group. Ten patients in both groups underwent surgery under general anesthesia with or without peripheral nerve blocks. The preoperative LOS did not differ significantly between the two groups. The fasting time for both solids and liquids was significantly shorter in the study as compared to the control group. Pre-operative Hb and glucose levels did not differ significantly between the two groups.Similarly, for THA, there was no difference in the age, gender, and percentage of diabetics between the two groups. Spinal and epidural anesthesia was more commonly used in the study group while GA was frequently used in the control group. Fasting time before surgery was significantly shorter in the study group. There was no difference in baseline Hb and glucose levels. Postoperative outcome data for TKA patients is presented in While the drains were removed in 2-3 days in all patients, the duration of the presence of a drainage tube was significantly shorter in the study as compared to the control group. All patients in the study group were able to drink clear fluids within two hours of surgery while the corresponding figure was only 59.6% in the control group. PONV was significantly reduced in the study group. Blood transfusion was needed in 16% of patients in the study group and 15.8% of patients in the control group with no statistically significant difference. VTE events were noted in one patient in the study group and six in the control group but the difference was not statistically significant. The postoperative LOS was significantly shorter in the study as compared to the control group. Patients in the study group had significantly better ROM on both the first and third postoperative days. The HSS score was also significantly higher in the study group at all three follow-up times .Postoperative outcome data for THA patients are presented in In the past decade, there has been a spurt in the use of ERAS protocols across several different surgical specialties with the sole purpose of boosting patient recovery and optimizing surgical outcomes with a minimal increase in healthcare expenditure. The ERAS set of guidelines was initially developed to streamline perioperative care so that it could improve patient satisfaction and reduce the rate of complications. Indeed, there have been numerous reports and randomized controlled trials (RCTs) supporting the use of ERAS protocols in non-TJA procedures.10Ni et alIn our experience of 207 cases, we too noted better outcomes with the implementation of the ERAS protocol in our healthcare setup. To be precise, we noted a reduced incidence of PONV, improved pain scores, reduced hospitalization time, and better functional outcomes with both THA and TKA in our study cohort. Similar outcomes have been reported by previous studies on TJA. Picart et alA similar statistically significant reduction in LOS was also noted by Christelis et al18While the evidence supports the implementation of ERAS for TJA procedures, it is important to note that there are several elements to the ERAS with different healthcare systems adopting different components based on individual feasibility.Indeed, not all of these ERAS components were implemented in our healthcare setup with few elements missed out like use of carbohydrates in the perioperative period, minimally invasive surgery, and sleep management; but we managed to execute most of the major elements thereby improving patient outcomes. Chen et alOur study was retrospective in design with a historical control group which made it prone to bias. Another limitation was that sample size of the study was not large. Thirdly, we were unable to analyze data on complication rates, infection rates, and readmission rates due to the lack of availability of data. Lastly, we were able to assess functional outcomes only for the first six months. Long-term data would be provided better evidence.Nevertheless, the current study supplements evidence from medical literature that ERAS protocol can lead to better patient outcomes in patients undergoing TJA. These finding assume clinical significance as these easy to implement protocols can be adopted in any healthcare setup resulting in improved patient satisfaction after TJA surgery.ERAS protocol can be effectively implemented for patients undergoing TJA. ERAS led to a significant reduction in the incidence of PONV, reduced pain scores, and better functional scores in both THA and TKA.XZ and LC: Conceived and designed the study.FH, ZH and HZ: Collected the data and performed the analysis.XZ and LC: Were involved in the writing of the manuscript and are responsible for the integrity of the study.All authors have read and approved the final manuscript.


Cartilage and osteochondral lesions of the first metatarsophalangeal (MTP-1) joint are characterized by pain during weight bearing and walking. The lesions often require surgical intervention(s). Arthroscopic bone marrow stimulation may be considered the preferred operative intervention for small lesions. Technological advances, patient preferences, and economic considerations combine to foster the development of minimally invasive needle arthroscopic procedures. This technical note presents and highlights our minimally invasive surgical technique for needle arthroscopic treatment through bone marrow stimulation for osteochondral lesions of the MTP-1 joint. Video 1 presents a standardized approach to needle arthroscopy of the first metatarsophalangeal joint using the needle arthroscopy system for osteochondral lesions of the first metatarsophalangeal joint through a step-by-step approach. Over the years, possibilities for metatarsophalangeal (MTP) joint arthroscopy have evolved from diagnostic inspection to interventional procedures.The study was conducted in agreement with the 1964 Helsinki Declaration and its later amendments. Ethical approval by our institution’s review board was not required.,The needle arthroscopy equipment  is divided into two parts: the sterile disposable handpiece set and the portable video console. A semirigid, zero-degree needle arthroscope, sharp and blunt obturators, and appropriate sheaths are included in this handpiece set.The patient is positioned in a supine position on a standard operating table, with the foot at the edge of the bed. The surface anatomy of the foot is marked out, including the metatarsal head and the base of the proximal phalanx, as well as the portal locations . Dependi,To ensure adequate visualization of the first MTP joint, portal placement is essential. The dorsomedial and lateral portals are located and marked. First, the dorsomedial portal is made. The skin is prepared with a 2-mm stab incision, a 2.2-mm diameter cannula is then loaded with a blunt obturator, and the cannula is penetrated through the joint capsule and entered intra-articularly. Slight noninvasive distraction may be helpful in achieving intra-articular positioning . The obtA thorough inspection of the MTP-1 joint can now be performed. Holding the arthroscope distally on its camera tube and with a pencil grip will aid in maintaining stability with this delicate equipment. The inspecting is initiated with the assessment of macroscopic evaluation of the metatarsal head, proximal phalanx, medial and lateral gutters, as well as the joint capsule ; Video 1In case of the presence of an (osteo)chondral defect of the metatarsal head, the intervention is started by probing the cartilage borders in order to determine stability and size of the lesion. Any loose chondral flaps are resected, after which debridement of the lesion with a 2-mm diameter shaver blades/burrs or a 3-mm shaver blade takes place just until healthy borders of the surrounding cartilage are reached . HyperplIf needed, a final lavage can be performed to clear any debris. The joint is then aspirated to dryness, and all instruments are removed. Sterile wound closure strips or a simple band-aid can be used for wound closure, and a pressure band-aid may be added for comfort and additional hemostasis if required. Postoperatively, because of the minimal invasiveness of the needle arthroscopy procedure, direct passive and active range of motion exercises are encouraged to the patient, and the patient is advised to progressively initiate weight bearing of the foot, as tolerated.,,,Cartilage and osteochondral lesions of the first metatarsophalangeal joint of the foot are characterized by pain during weight bearing and walking.,,,,Various needle arthroscopic techniques have been performed in multiple joints for diagnostic and therapeutic approaches.4When considering needle arthroscopy for patients with MTP-1 problems, it is important to consider potential pitfalls and disadvantages . The intIn conclusion, the technique presented here provides a standardized approach for needle arthroscopy of the first MTP joint, which facilitates a safe, uniform, and beneficial adoption of this emergent technique.


Tunable Diode Laser Absorption Spectroscopy (TDLAS) has been widely applied in in situ and real-time monitoring of trace gas concentrations. In this paper, an advanced TDLAS-based optical gas sensing system with laser linewidth analysis and filtering/fitting algorithms is proposed and experimentally demonstrated. The linewidth of the laser pulse spectrum is innovatively considered and analyzed in the harmonic detection of the TDLAS model. The adaptive Variational Mode Decomposition-Savitzky Golay (VMD-SG) filtering algorithm is developed to process the raw data and could significantly eliminate the background noise variance by about 31% and signal jitters by about 12.5%. Furthermore, the Radial Basis Function (RBF) neural network is also incorporated and applied to improve the fitting accuracy of the gas sensor. Compared with traditional linear fitting or least squares method (LSM), the RBF neural network brings along the enhanced fitting accuracy within a large dynamic range, achieving an absolute error of below 50 ppmv (about 0.6%) for the maximum 8000 ppmv methane. The proposed technique in this paper is universal and compatible with TDLAS-based gas sensors without hardware modification, allowing direct improvement and optimization for current optical gas sensors. Tunable diode laser absorption spectroscopy (TDLAS) is a popular technical route in optical gas sensing. A narrow linewidth laser beam with good monochromaticity is used to scan the specific gas absorption line, then obtains the gas concentration according to the change of scanning laser power ,2. It haIn the digital processing of TDLAS-based gas sensors, various filters, and denoising algorithms were employed ,10,11,12In this paper, we proposed and experimentally demonstrated an advanced TDLAS-based optical gas sensor with laser linewidth analysis and improved filtering/fitting algorithms. The linewidth of the laser pulse spectrum is innovatively considered and analyzed in the harmonic detection of the TDLAS model. In the experimental setup, the adaptive VMD-SG filtering algorithm is developed and introduced for the raw data processing and could significantly eliminate the background noise and signal jitters, compared to original signals or using a conventional wavelet algorithm. Furthermore, the Radial Basis Function (RBF) neural network is also incorporated and applied to improve the fitting accuracy of the gas concentration. Compared with traditional linear fitting and least squares means (LSM) fitting, the RBF neural network brings along enhanced fitting accuracy within a large dynamic range, obtaining an absolute error of below 50 ppmv for the maximum 8000 ppmv methane. Hence, the proposed technique in this paper is universal and compatible with TDLAS-based gas sensing without hardware modification, allowing direct and effective improvement and optimization for current optical gas sensors.For diode lasers used as optical sources in TDLAS, the output spectrum normally exhibits a narrow linewidth with certain broadening. The linewidth broadening caused by different physical broadening mechanisms is varied, such as natural broadening, collision broadening, and Doppler broadening. In practice, the spectral lines of gases are often affected by combinations of these broadening mechanisms, while collision broadening, and Doppler broadening are basically considered in this work.The distributed feedback (DFB) laser is widely used in TDLAS systems because of its narrow linewidth, tunability, and low cost . The outI0 and the attenuated outgoing light is tI, as shown in Formula (1), then:α is the absorption coefficient or extinction coefficient, which is the unique property of matter; C is the concentration, and l is the optical path.The theoretical basis of TDLAS is the Beer–Lambert law , giving TDLAS modulates the output wavelength of the laser by using the characteristic that the output wavelength of the laser changes with the injection current and scans the specific gas absorption spectrum with a narrow linewidth laser beam with good monochromaticity. The wavelength modulation spectroscopy (WMS) with harmonic detection is often employed in TDLAS. The first or second harmonics based on WMS are generated and detected. The TDLAS system diagram is schematically shown in Modeling and simulation of the TDLAS sensor was established by using the Simulink software, mainly including the laser modulation module, the gas absorption module, and data processing module, as shown in In the simulation and modeling of TDLAS, the laser source was often regarded as an ideal straight line or rectangular spectrum, and the influence of laser spectral shape and linewidth were ignored in the literature. Therefore, the laser spectral shape and linewidth are introduced into the TDLAS system in this paper to explore the influence on harmonics.iv is the linewidth of the Gaussian spectrum function and M is the molar mass of the light-absorbing material.The normalized Gaussian spectrum is regularly used to approximate the laser spectral broadening, as shown in the formula:The interaction between the laser spectrum and gas absorption is schematically shown in In the modeling, the parameters are set as follows temperature of 296 K, gas pressure of 1 atm, methane concentration of 0.1% in volume, and the optical path of 10 cm. The influence of laser linewidth on the harmonic waveform in the TDLAS system is analyzed and shown in The experimental setup of the TDLAS-based gas sensor is schematically shown in In view of the limited SNR due to low concentration or environmental interference, this paper proposed the improved VMD-SG algorithm to reduce the signal noise floor. It is acknowledged that the wavelet denoising algorithm is frequently employed in signal processing. Hence, it is also considered in this work for comparison.VMD originated from EMD and overcomes the end effect of the EMD algorithm, and the difficulty in determining the stopping standard of screening iteration of eigenmode function and modal aliasing. It has an adaptive and non-recursive modal variation for non-stationary and nonlinear signals. Additionally, the SG filter could be combined to deal with high-frequency data with limited SNR. The method of combining the VMD algorithm with the SG filter to reduce noise has been reported in earthquake monitoring and ship radiation denoising ,11. HereConventionally, the number of modal components K in VMD needs to be adjusted manually, and it is physically challenging to balance the time consumption and accuracy in VMD. When the value of K is extended, the difference between the center frequencies of adjacent modal components is small, which may cause modal repetition and increase the calculation time. If the value of K is slight, the signal cannot be completely decomposed, which will affect the accuracy of subsequent detection. Considering the major variation of different modes lies in the central frequency and its correlation with the original signal, it is feasible to realize the automatic adjustment of K by using the modal sample entropy and central frequency to represent and feedback the sequence complexity. Therefore, this work proposes the adaptive process of K value in the VMD-SG algorithm, as shown in By using the adaptive VMD in the experiment, the decomposed and reconstructed signal from the PD is shown in By using the above-mentioned adaptive VMD-SG algorithm, the gas sensing experiment is carried out with four concentrations of methane: pure nitrogen (methane free), 800 ppmv, 1000 ppmv, and 1200 ppmv. The background noise signals (in μV level) of the TDLAS system were measured for 30 min, as shown in The stability of the gas sensor is also demonstrated experimentally. In the TDLAS-based gas sensors, it is always required to accurately derive the generated harmonics with the gas concentration. Normally, it is calibrated by a fitting curve between the harmonics data and standard gas concertation. Due to the system noise and unexpected disturbance, this relationship rarely forms an ideal linear equation or simple nonlinear functions. Generally, the least square method (LSM) fitting is often used to obtain the concentration inversion relationship. This paper proposes an RBF neural network algorithm instead of LSM to achieve a more accurate fitting.The RBF neural network Is a feedforward neural network with local approximation ability. The network is generally composed of three layers: the input layer composed of input data, the hidden layer, and the output layer of nonlinear processing neurons, as shown in In order to verify the accuracy, 68 groups of gases with different concentrations were prepared by using the gas blender. A total of 34 groups were selected as training data, while the other 34 groups as test data. The raw data and the LSM fitting and RBF neural network fitting are illustrated for comparison, as shown in In this paper, the advanced TDLAS-based optical gas sensor was proposed and experimentally demonstrated. The spectral linewidth of the laser source was first considered and analyzed, showing improved sensitivity with narrow linewidth. The adaptive VMD-SG filtering algorithm was developed for the raw data processing to reduce the noise floor from 213 μV to about 113 μV and simultaneously enhance the stability of the system. By using this VMD-SG algorithm, the high-frequency signal jitter was eliminated to about 1% in the experiment. Furthermore, the RBF neural network was also investigated to improve the gas concentration fitting and inversion. Compared to the conventional LSM fitting, it allows favorable inversion accuracy and reduced fitting errors (below 50 ppmv) with concentrations up to 8000 ppmv. The proposed techniques in this paper are universal and compatible with TDLAS-based gas sensing without any hardware modification, allowing straightforward optimization for current optical gas sensors.


Chronic kidney disease (CKD) is a life-threatening disease associated with an increased risk of end-stage renal disease, cardiovascular disease, and premature death. Due to the rise in the ageing population and its risk factors, such as obesity, diabetes mellitus and hypertension, the prevalence of CKD has been increasing rapidly in recent years. CKD is projected to become the fifth most common cause of death globally by 2040 . AlthougHuang S et al. provided a contribution by investigating the role of megakaryocytic leukemia 1 (MKL1), a master regulator of myofibroblast activation , the most common genetic cause of CKD with the formation of cysts in the kidneys. Extensive genetic studies from patients and animal models have identified several causal ADPKD genes, with about 85% of ADPKD cases associated with PKD1 mutation . The comHuang C et al. demonstrated the therapeutic effects of umbilical cord MSC (UC-MSC) in lupus nephritis. Their results showed that treatment with UC-MSC significantly improved kidney function and alleviated podocyte injury in MRL/Ipr mice, which had the similar effect with the treatment of methylprednisolone, a standard care for lupus nephritis  after repeated administration of MSCs . ExtensiCollectively, the research topics highlighted the recent progress in the development of new treatments for CKD. The increasing knowledge in this field will enhance the translation of research findings from the bench to the bedside and ultimately lead to the successful clinical application of new therapeutic strategies for the treatment of CKD.