Clinical manifestations, a series of conventional analyses, and histopathology were used to study these cases retrospectively.The age range of 22 patients with STS was 15 to 78 years. The main clinical manifestations included multiple skin and subcutaneous nodules and scattered red or purplish-red rashes in the lymphoedematous limbs. These patients often showed clinical symptoms such as lymphedema, weakness, emaciation, pain, mass, lymphadenopathy and so on. The positive rates of ultrasonography, MRI and radionuclide imaging were 66.7% (6/9), 92.3% (12/13) and 18.2% (2/11), respectively. The main points regarding active intervention in lymphedema and early diagnosis of STS were summarized.Since this was a retrospective study, the main points summarized by the author need to be further quantified in clinical work to guide the diagnosis of this kind of disease more conveniently. In addition, further clinical trials are needed to evaluate the role of lymphedema in the occurrence and development of malignant tumors.STS can appear in lymphoedematous tissue many years after lymphedema onset. To avoid delays in the diagnosis and therapy of STS, physicians should actively look for signs or symptoms of malignant lymphedema during the follow-up period and promptly manage patients developing problems. The lymphatic system is a part of both the circulatory and immune systems. The lymphatic system has several critical functions in regulating different components of the homeostasis of the body. As a part of the immune system, the lymph system protects the body from infectious and foreign agents and removes waste products and cellular debris from the interstitium of tissues. Lymphedema can be defined as the abnormal accumulation of protein-rich interstitial fluid that occurs primarily as a consequence of malformation, dysplasia, or acquired disruption of lymphatic circulation. Lymphedema can be distinguished as primary and secondary forms. Primary lymphedema is caused by an inherent defect in the lymphatic vessels or lymph nodes. Secondary lymphedema is the result of various aetiologies, such as trauma, infection, persistent inflammation, venous disease, extreme chronic immobility, malignancy, surgery, and radiation therapy.4stewart-treves syndrome (STS) is an angiosarcoma associated with chronic lymphedema and has a poor prognosis due to the high incidence of local recurrence and distant metastasis, with a median survival rate of only 2.5 years.After obtaining institutional review board approval, the authors performed a retrospective review of 22 patients with STS in the Department of Lymphatic Surgery, Beijing Shijitan Hospital, Capital Medical University from May 22, 2007, to December 31, 2018. All patients sought treatment at the centre with lymphedema as the main complaint. The original investigations and treatment for lymphedema were performed, with a referral when the diagnosis of STS was evident.The clinicopathological features of twenty-two patients were analyzed retrospectively, including clinical manifestations, laboratory tests, ultrasonography, Magnetic Resonance Imaging (MRI), radionuclide imaging and pathological diagnosis. All patients were followed up by telephone.SPSS ver. 22.0  was used for all analyses. Survival was calculated using the Kaplan-Meier method. Cases with unreported survival times were excluded from the survival analysis. Survival time was measured from the time of diagnosis to the time of death or the end of follow-up. A p-value of < 0.05 was considered statistically signiﬁcant.The authors performed a retrospective review of 4676 patients with lymphedema between May 22, 2007, and December 31, 2018. A total of 22 patients with Stewart-Treves syndrome with lymphedema were found. The age range was 15 to 78 years (mean age: 52.7 ± 7.2 years) . Three pThe proportion of patients with abnormal tumor markers in this study was 31.3% (5/16), including CA153 (1 case), CA199 (1 case), urinary Ig kappa light chain (2 cases), serum β2-microglobulin (2 cases), urinary Ig lambda light chain (1 case), serum Ig kappa light chain (1 case), urinary β2-microglobulin (1 case), AFP (1 case), CA50 (1 case), and serum Ig lambda light chain (1 case). The prevalence of anemia among patients with Stewart-Treves syndrome was 20.0% (5/25). Some suspicious lesions were investigated with imaging examinations. The positive rates of ultrasonography, MRI and radionuclide imaging were 66.7% (6/9), 92.3% (12/13), and 18.2% (2/11), respectively. Ultrasound examination showed that there were multiple masses in the skin and subcutaneous tissue; 1 case appeared hyperechoic and anechoic, 3 cases appeared unevenly hypoechoic, 1 case appeared unevenly hypoechoic and anechoic, and 1 case appeared to have an equal echo. MRI showed nodules distributed on the surface of the skin, subcutaneous tissue, and some muscles; 6 cases appeared with long T1 and long T2 signals , 1 case All 22 cases were confirmed by pathological diagnosis. Tissue samples were taken from the scattered nodules around the diseased area, including skin and subcutaneous tissue. The histopathologic study showed irregular lumens with infiltrative growth in the dermis and subcutaneous tissue, some lumens fused and communicated with each other, and red blood cells could be seen in some lumens. The epithelium in the lumen was obviously heteromorphic, protruding into the lumen like a tack, and the nucleus was large and darkly stained. In some areas, the tumor cells were solid, with obvious nucleoli, mitoses, bleeding and necrosis. Immunohistochemical staining was positive for CD34, CD31 and D2-40 and negative for CK, EMA and HHV-8. The positivity of Ki-67 was counted as 2%‒90% .Figure 4rd Quartile (Q3) survival was 6 months. The survival rate of amputated patients was significantly higher than that of non-amputated patients (p < 0.05)  . There wStewart-Treves syndrome is a rare angiosarcoma with a poor prognosis. It was first described by Stewart and Treves in 1948 in women with breast cancer treated with radical mastectomy.STS are malignancies that originate from cells with endothelial function and the morphology of blood or lymphatic vessels. In the presence of lymphedema, they grow as plaques or cutaneous and subcutaneous nodules, single or multiple, which may coalesce, with an unknown etiology. Several studies have shown that lymphedema produces local immunosuppression as a result of lymphatic fluid stasis and the relative upregulation of growth factors within the microenvironment. This is thought to be associated with the potential development of malignant disease.12Previous studies and meta-analyses have reported that there are more women than men among patients with STS, the age of onset is generally middle-aged and elderly, and there are a very small number of adolescents under the age of 18. The related pathogenic factors of STS include high BMI (BMI ≥ 28), trauma history, limb disuse, radiotherapy history, malignancy history, and so on.24Given the rising prevalence of lymphedema, physicians should be aware of the possibility of sarcomatous degeneration in lymphedema. There were 19 86.4%) patients over 35 years old in the study, therefore, the occurrence of malignant tumors should be excluded when diagnosed with lymphedema tarda. The peak period for the diagnosis of STS is within six months and one year after lymphedema, suggesting that for patients with long-term chronic lymphedema, it is necessary to carry out close follow-up  to identify malignant lesions as soon as possible. STS has an acute onset and a rapid progression, which results in changes in skin color. It is sometimes accompanied by pain, paraesthesia, paralysis, and weakness.6.4% pati30Although the mechanism has yet to be illustrated, it is widely accepted that lymphedema may induce STS. Active diagnosis and treatment of lymphedema, paying close attention to the development of lymphedema, maintaining limb health and preventing infection are measures that can be adopted to avoid STS.Beijing Municipal Administration of Hospitals’ Youth Programme (QML20150101), Beijing Municipal Administration of Hospitals Incubating Program (PX2020030), Natural Science Foundation of Capital Medical University (PYZ2017158), Beijing Shijitan Hospital Fund Capital Medical University (2019-LB12).Kun Hao: Approval of the final version of the manuscript; Critical literature review; Data collection, analysis and interpretation; Preparation and writing of the manuscript; Statistical analysis; Manuscript critical review.Yuguang Sun: Approval of the final version of the manuscript; Critical literature review; Data collection, analysis and interpretation; Intellectual participation in propaedeutic and/or therapeutic management of studied cases.Yan Zhu: Approval of the final version of the manuscript; Data collection, analysis and interpretation; Statistical analysis.Jianfeng Xin: Approval of the final version of the manuscript; Data collection, analysis and interpretation.Li Zhang: Approval of the final version of the manuscript; Data collection, analysis and interpretation.Bin Li: Approval of the final version of the manuscript; Critical literature review; Data collection, analysis and interpretation; Effective participation in research orientation.Wenbin Shen: Approval of the final version of the manuscript; Critical literature review; Data collection, analysis and interpretation; Intellectual participation in propaedeutic and/or therapeutic management of studied cases; Preparation and writing of the manuscript; Statistical analysis; Manuscript critical review.None declared.


Mtb genomic diversity and transmission dynamics in Ho Chi Minh City, Vietnam. Here, we expand the scope of this survey by adding a substantial number of additional genomes  and phenotypic drug susceptibility data for the majority of isolates. We aim to explore the prevalence and evolutionary dynamics of drug resistance and our ability to predict drug resistance from sequencing data. Among isolates tested phenotypically against first-line drugs, we observed high rates of streptomycin  and isoniazid resistance  and lower rates of resistance to rifampicin  and ethambutol . Relative to global benchmarks, resistance to STR and INH was predicted accurately when applying the TB-Profiler algorithm to whole genome sequencing data , while resistance to RIF and EMB was predicted relatively poorly . Exploring the evolution of drug resistance revealed the main phylogenetic lineages to display differing dynamics and tendencies to evolve resistance via mutations in certain genes. The Beijing sublineage L2.2.1 was found to acquire de novo resistance mutations more frequently than isolates from other lineages and to suffer no apparent fitness cost acting to impede the transmission of resistance. Mutations conferring resistance to INH and STR arose earlier, on average, than those conferring resistance to RIF and are now more widespread across the phylogeny. The high prevalence of “background” INH resistance, combined with high rates of RIF mono-resistance , suggests that rapid assays for INH resistance will be valuable in this setting. These tests will allow the detection of INH mono-resistance and will allow multi-drug-resistant isolates to be distinguished from isolates with RIF mono-resistance.A previous investigation has elucidated the landscape of Mtb genetic lineage plays in determining the likelihood of resistance evolution. This study offers insight into these questions by assessing the dynamics of resistance evolution in a high-burden Southeast Asian setting with a diverse lineage composition. It demonstrates that there are clear lineage-specific differences in the dynamics of resistance acquisition and transmission and shows that different lineages evolve resistance via characteristic mutational pathways.Drug-resistant tuberculosis (TB) infection is a growing and potent concern, and combating it will be necessary to achieve the WHO’s goal of a 95% reduction in TB deaths by 2035. While prior studies have explored the evolution and spread of drug resistance, we still lack a clear understanding of the fitness costs (if any) imposed by resistance-conferring mutations and the role that  Tuberculosis (TB) remains a global epidemic with one quarter of the world’s population estimated to be infected. The impact of the COVID-19 pandemic on essential TB services has reversed years of progress, with the number of newly diagnosed TB patients falling to 5.8 million in 2020, much less than the estimated 10 million who developed TB  TB cases . In 2018Although the COVID-19 pandemic has set back recent progress, steps toward the WHO END-TB targets have been made. To be able to achieve a 95% reduction of TB deaths by 2035 , modern Mtb isolates by querying databases of confirmed or suspected resistance-conferring variants (Mtb (compared to standardized drug regimens) and to reduce the time before patients receive effective treatment, potentially leading to more favorable treatment outcomes  versus primary  drug resistance within a population.Genomics also provides insight into the emergence, transmission, and overall dynamics of drug resistance in  toolkit –17. Prlineages , 18 and lineages . Others lineages , 17, 18 lineages , 19 to cde novo acquisition of drug resistance and through the transmission of drug-resistant Mtb to new hosts , Vietnam, which has a high frequency of TB, drug resistance, and the Beijing lineage. In a prior study, we collected whole genome sequencing (WGS) data from 1,635 Mtb in HCMC, Vietnam, we analyzed the genomic sequences of N = 2,542 isolates  cultured from TB patients between 2001 and 2013. A subset of these genomes , derived from pulmonary TB (PTB) patients, were published previously  cases  cases , 24. A sM) cases , whereasM) cases , 24. AllMtb lineages and clinical characteristics of patients reiterated prior findings based on a subset of this data set , followed by the East African-Indian Ocean lineage 1 , the European-American lineage 4 , and the Delhi Central Asian lineage 3 ], while lineage 1 showed a higher prevalence amongst males .Our analysis of the genetic diversity of data set . The majMtb sublineage distributions also resembled those of Holt et al. (N = 525) and 1.1.1 (N = 83), which are most frequent in Mainland Southeast Asia (N = 33), which is most frequent in Island Southeast Asia , supporting the deep geographic structure of the lineage.t et al. , althougt et al. –28. Liast Asia , 27;  and Beijing  sublineages , which has a wide global distribution (N = 55)  . We docu(N = 55) . The mosN = 1,786). We assessed phenotypic resistance to three first-line drugs  using mycobacterial growth indicator tubes (MGIT)  and also tested a subset of these isolates using UKMYC5 (N = 267). Isolates were deemed resistant to an antimicrobial if they were classified as resistant by one or both methods. In total, 459 of 1,786 (25.7%) isolates were resistant to INH; 87 of 1,786 (4.9%), to RIF; and 75 of 1,785 (4.2%), to EMB. In total, 3.9%  were MDR  of RIF-resistant isolates were INH sensitive. Streptomycin (STR) resistance, which was tested by MGIT only, was identified in 37.7%  of the tested isolates. Although sample sizes were relatively low, rates of resistance to a number of second-line drugs were found to be high within a global context . Sensitivity values for drugs with fewer than 10 resistant isolates are provided in the Supplementary Material (Table S1). Positive predictive values for these drugs were generally quite high; however, suggesting known resistance markers will be specific for predicting drug resistance in this population .Resistance prediction for second-line drugs was overall poor, suggesting that there may be undiscovered resistance variants in this population  and drug resistance status  as described in the Main Text. In order to incorporate all isolates, genotyping data were used to determine drug resistance profile, although we identified and removed any isolates with discordant phenotype profiles.To compare the transmissibility of isolates with various drug resistance profiles, we calculated the THD statistic , 47. THDWe performed linear regression using the lm function of the stats package of R , modeling the THD statistic as the continuous response variable, and incorporating sublineage and drug resistance status as covariates. Pan_S and L1 were used as the reference levels.To account for population structure, we performed MDS using the “cmdscale” function of the stats package of R . We ran P < 0.05 was considered statistically significant. The overall lineage distribution of Mtb isolates across gender, clinical phenotype, and resistance to the first and second anti-TB drugs was presented as number and percentage (%). Pearson’s χ2 test was performed to investigate the relationship between categorical variables, including lineages and other clinical characteristics, naming gender, clinical phenotype, and drug resistance. It was also utilized to assess the relationship between rates of drug resistance and lineages, as well as resistance and transmission ability. Mann-Whitney U test was employed to test the difference for non-normally distributed variables among lineages, including count of total mutations relative to the number of resistance-conferring mutations and lengths of terminal branches leading to resistance. The association between age and lineage (lineages 1 and 2) was assessed using linear regression. To investigate the prediction accuracy for drug resistance using WGS data, we calculated sensitivity, defined as the proportion of resistant isolates correctly predicted; specificity, defined as the proportion of susceptible isolates correctly predicted; and PPV and negative predictive value.Analyses were done using R version 4.1.1, and two-sided


HER2-positive breast cancers are usually diagnosed from clinical findings, and often in a large size, with extensive microcalcifications, and/or with axillary involvement, which may compromise conservative surgery, both in the breast and in the axilla. Nevertheless, HER2-positive breast cancers are usually good responders to neoadjuvant treatment and most of them disappear, although breast microcalcifications do not always do so, nor is an omission of axilla clearance accepted when the initial involvement was extensive. Therefore, it is of great interest to have accessible clinical tools that allow us to determine, with precision, when complete pathological response occurs. In a population of 132 patients with HER2 breast cancers, we have found that the Ki67 value, hormonal receptors condition, and Magnetic Resonance Imaging findings, performed after primary systemic therapy, permit the selection of those patients in whom the benefits of neoadjuvant can safely be transferred to surgical extension.Human epidermal growth factor receptor 2 (HER2)-enriched breast cancers (BC) present the highest rates of pathological response to primary systemic therapy (PST), but they are also the ones that tend to be larger at diagnosis, with microcalcifications and, often, with axillary involvement. If we do not have a reliable method to predict the degree of response, we may not be able to transfer the benefits of PST to surgery. The post-PST surgery planning is guided by the findings in the magnetic resonance imaging (MRI), whose predictive capacity, although high, is far from optimal. Thus, it seems interesting to find other variables to improve it. A retrospective observational study including women with HER2 BC treated with PST and further surgery was conducted. Information regarding clinical, radiological, and histopathological variables was gathered from a total of 132 patients included. Radiological complete response (rCR) was achieved in 65.9% of the sample, and pathological complete response (pCR), according to Miller and Payne criteria, in 58.3% of cases. A higher Ki67 value, the absence of Hormonal Receptors expression, and an rCR was significantly related to a pCR finding. This information impacts directly in surgery planning, as it permits adjustment of the breast resection volume. Primary Systemic Therapy (PST) is increasingly common in the treatment of breast cancer (BC) because it provides information on the effectiveness of the treatment, has prognostic value , and allUsually, tumors that show higher rates of response to PST, in terms of reduced tumor burden, are also those that have a more aggressive behavior. These are known as triple-negative BC , and especially HER2 positive BC . The latNeoadjuvant therapy in HER2 tumors is based on target drugs  that act by blocking the HER2 cell signaling pathway, accompanied in the first cycles by some conventional chemotherapy (mainly taxanes ). This aNowadays, the best way to predict the pathological response to PST is by imaging techniques, especially magnetic resonance imaging (MRI), although their results are far from optimal ,9. ThereThe aim of this study is to find which of the factors available in routine clinical practice can accurately predict, in HER2 BC, pCR after PST so that we can translate these results to surgical planning in de-escalation mode, both in the breast and in the axilla, without missing oncologic safety.Inclusion criteria: women over 18 years of age, with HER2 immunophenotype BC , who recExclusion criteria: patients diagnosed with BC subtypes other than HER2, who underwent primary surgical treatment, who were metastatic, who were males, or who were under 18 years.A retrospective observational study was carried out by analyzing the population of patients fully treated in our center in the period 2016–2020, with the following:The variables studied were age and climacteric status at the time of diagnosis, ethnicity, tumor size per image, focality, laterality, location in the breast, histological differentiation degree (G), hormonal receptors (HR) expression—estrogen receptor (RE) and progesterone receptor (PR)—both in % of positivity, Ki67 value (%) , HER2 BCAfter PST, breast-conservative surgery was performed whenever the residual tumor/breast relationship allowed it. In the axilla, patients without initial axillary involvement, or those cN1 patients who became negative after PST, usually underwent an SLNB, whereas an ALND was performed in those patients cN0 with positive SLNB, in those cN1 patients that did not negativize after PST, or in those with initial cN2-3 axillary involvement.t) when compared to a quantitative variable with normal distribution, and non-parametric tests (Mann–Whitney U) if it does not follow the normal distribution. Subsequently, we used a binary logistic regression to assess the real influence on pCR of each of the individually significant ones. A p value < 0.05 for all variables has been accepted as statistically significant. All this has been done with the support of IBM SPSS Statistic version 26.0 software.We performed the descriptive analysis of all variables. Dichotomous or categorical variables were determined by frequencies and percentages. Quantitative variables were analyzed according to whether they followed a normal distribution (Kolmogorov–Smirnov test). Those with a normal distribution were analyzed with the mean and standard deviation, while those not following a normal distribution were analyzed with the median and interquartile range (IQR). We analyzed the possible relationship of the different variables (independents) with the degree of pathological response to PST according to M&P (dependent variable). Comparisons between the two types of variables will be made using contingency tables (chi-square statistic) when compared to a qualitative variable, parametric tests .A total of 132 patients were included. Main patient and disease characteristics are summarized in Mean age was 52.9 years old . Half were pre- or perimenopausal. Most of them (60.6%) presented as a localized lesion, with a median total size-measured by MR− of 35.0 mm (IQR 25.0–60.0). Initial clinical axillary involvement was detected in 43.2%. After Caucasians, the second-most-frequent ethnic origin of patients was Asian (Philippines).Regarding the histological type, 93.2% were non-special type (NST) invasive BC, histological grade G3 (56.1%), and with a high Ki67 value (58.5%). Regarding the HER2 subtype, the HER2 luminal tumors (HR+) constituted 59.8% (79) of the total, while non-luminal (HR−) constituted 40.2% (53).Complete radiological response (rCR) was observed on post-PST MRI in 65.9% (87) of cases.On the breast, conservative surgery was performed in 69.7% (92) of cases. In the axilla, SLNB was performed exclusively in 66.7% (88), SLNB followed by ALND in 15.9% (21), and direct ALND in 17.4% (23).In the breast, pCR was confirmed in 58.3% (M&P), a value similar to the RCB criteria one (57.8%) in the 102 cases in which it was applicable. The axilla was negative in 78.8% (104) of the patients: 87.2% of those underwent SLNB, and 39.1% underwent ALND at baseline. The SLNB performed on 74 cN0 patients showed metastatic involvement in 8 of them (10.8%), 3 with macrometastases and 5 micrometastases.Most cN-positive patients were negative after PST. Metastatic disease was observed in 25 (43.1%) of them, with signs of partial response (N-C) in 75.0%.p < 0.001) of pCR (83.0%/41.8%) than the luminal HER2 subtype (ER and PR negative status showed higher rates ( subtype a.p < 0.006) to the pCR rate   of 78.2% to the pCR rate (< 0.001) c.We considered two groups within the M&P classification system: on one side the G5 response (pCR) and on the other the rest of categories (G1–G4). No significant differences between both groups were found in regard to most of the variables, with the exception of HR expression (ER and PR), Ki67 value, and radiological response. The results are as follows:Overall, 87.5% (28) of patients initially N+, in whom pCR was observed in the breast also presented pCR in the axilla. Similarly, in 82.4% of the patients with ypN0, a complete response was also described in the breast.Only three variables remained independent after the multivariate analysis: HER2 subtype (HR+/HR−), Ki67 value, and post-PST radiological response. In this way, the PPV of the MRI reaches 97.3% when considering only HER2+/HR− tumors (IC: 84.2–99.9). In the case of HER2+/HR+ tumors, in which PPV is lower (64.0%), this value reaches 81.5% (CI: 61.25–93.0) when considering tumors with Ki67 levels over 30%.In our population, the age variable, unlike what happens in the general population with BC, has a normal distribution and a lower mean, as observed in other studies ,16. ThesMost of the cases were diagnosed by clinical changes and presented a size over two cm, as published in the Novoa study , which mInvasive NST was the most common histological type, as it occurs in most BC subgroups ,17. HighClinical assessment of response to PST is performed using a combination of physical examination and imaging techniques, such as mammography, ultrasound, and MRI . These mMost of our patients underwent breast-conserving surgery in a similar rate to the study by Novoa et al. , but higDue to the different existing criteria to define pCR, comparing results with other studies is sometimes difficult. Some classifications take into account only the absence of the invasive component, whereas others consider the disappearance of the in situ component to be necessary as well. Stricter classifications address not only the response in the breast, but also in the axilla ,5,22,23.The drawback of M&P Is that it does not consider the size of the tumor and does not evaluate axillary lymph node involvement . The RCB scale simultaneously evaluates breast and axilla response and is the only one validated as an independent prognostic factor for survival ,17. ThusIn the axilla, the percentage of patients who were clinically negative (cN0) at diagnosis, but showed some degree of involvement in the SLNB, was lower than that collected by the literature, and are reflective of, rather than progression during PST, the limitations inherent in radiological evaluation.More than half of patients with initial axillary involvement did not have axillary disease after PST. This is one of the great advantages of the neoadjuvant therapeutic approach in these cases, because it allows to avoid unnecessary ALND.We found no significant differences depending on whether the tumors were luminal or not. Other authors , on the Properly identifying, from the clinical variables available at the time of surgical planning, the subgroup of patients with high pCR rates would allow us to correctly indicate less extensive surgeries both in breast and axilla , even whIn our study, we have seen relationships in the three variables mentioned—HER2 subtype, Ki67 value, and degree of radiological response measured by MRI—but in the literature, there is no agreement, except in the last one, about which clinical-pathological parameters can be used as predictors of response to treatment .HER2 subtype. Our pCR rate was higher than that of Novoa et al. , but onlLikewise, several studies indicate that the level of amplification of the HER2 gene is a factor related to achieving a pCR, so that the greater the intensity in amplification, the greater the number of pCR, and the greater benefit in DFS and OS ,29. Finap = 0.001), in the sense that most patients with high Ki67 achieved pCR. There are numerous studies [KI67. In our study, the value of Ki67 is directly related to the degree of pathological response in the breast .Other authors relate pCR to the size of the tumor , the lymIn addition to these predictors usually available in daily clinical practice, there are many others that are still in the research phase: HER2DX, a supervised learning algorithm incorporating tumor size, nodal staging, and four gene expression signatures tracking immune infiltration, tumor cell proliferation, luminal differentiation, the expression of the HER2 amplicon, into a single score , the valMost cases in our population of HER2 BC patients achieved PCR after PST, but there remains a significant percentage with residual tumor. For surgery planning, it is of great interest to have accessible clinical tools that allow us to distinguish between both, in order to be able to offer more conservative surgeries in pCR cases, especially in this type of tumors, which usually have accompanying microcalcifications that do not disappear even if the tumor does.Our study shows that it is possible to predict complete or incomplete pathological response to PST adequately from the value of Ki67, the HER2 subtype, and the degree of radiological response. In HER2/HR− tumors, it is sufficient to know the degree of radiological response (MRI) for an adequate prediction. However, in the case of HER2 luminal tumors, the consideration of the Ki67 value significantly improves the predictive ability of MRI, as the degree of radiological response in these cases has lower diagnostic accuracy.The limitations of our study include the retrospective design and a small sample size, which did not allow us to include more variables in the regression models. Therefore, future prospective studies are needed, with a bigger population and external validation of the predictive model, to confirm its clinical utility.


Gliricidia sepium (GS) and Petiveriaalliacea (PA) reduced the metallic Au ions to AuNPs.The AuNPs were analyzed as surface-enhanced Raman scattering (SERS)substrates for pyridoxine detection (vitamin B6). UV–vis spectroscopywas carried out to assess the stability of the AuNPs. As a result,absorption bands around 530 and 540 nm were obtained for AuNPs-PAand AuNPs-GS, respectively. Both cases associated it with localizedsurface plasmon resonance (LSPR). In the final stage of the synthesis,to stabilize the AuNPs, carboxymethyl cellulose (CMC) was added; however,LSPR bands do not exhibit bathochromic or hypsochromic shifts withthe addition of CMC. Transmission electron microscopy (TEM) micrographsshow relatively spherical morphologies; the particle diameters weredetected around 7.7 and 12.7 nm for AuNPs-PA and AuNPs-GS, respectively.The nanomaterials were evaluated as SERS substrates on pyridoxine,revealing an intensification in the vibrational mode centered at 688cm–1 associated with the pyridinic ring. Complementarily,different density functional theory functionals were included to obtainmolecular descriptors on the Aun-cluster-pyridoxineinteraction to study the SERS behavior.Gold nanoparticles(AuNPs) were synthesized and stabilizedusingecological strategies: the extracts of the leaves of the plants  To synthesize MNPs, physical, chemical, or biological methodsare used; here, there are two techniques to synthesize nanoparticles:microorganism-mediated synthesis and plant-mediated synthesis.9 Plant-mediated synthesis, also known as biosynthesisor green synthesis, dates back to the 1990s and became known as “greenchemistry”; in this synthesis, the reducing agent for metalions extracts one or more parts of a plant.3 It has quickly become a growing research area and is viable forobtaining MNPs; it is fast and ecologically safe and has promisingresults.10 Reports show different extractionmethods,11 but conventionally, the plantextract can be obtained by boiling the biomass inside a solvent (commonlywater) and filtering the mixture. Countless varieties of plants andparts of plants, such as leaves, fruit, flowers, stems, and roots,have been used for the green synthesis of metallic nanoparticles.Within plant-mediated synthesis, the phytochemicals present in theextracts, such as phenolic components, glycosides, terpenoids, andalkaloids,14 are responsible during and after the synthesis forreducing metal ions and stabilizing the corresponding nanoparticles.However, although the ecological, economic, and biocompatible aspectsrepresent the main advantage of this synthesis technique, the phytocomponentsor their derivatives present in the final product degrade, and theMNPs agglomerate over time,15 precipitatingand losing their nanometric nature. To cancel this effect, the chemicalsynthesis of MNPs uses stabilization elements such as formaldehyde,polyethylene glycol, and oleic acid, among others; however, they cancause harmful environmental effects. So, avoiding the aggregationof the molecules and the stability of the MNP colloids is a fundamentalaspect to guarantee the applicability of the MNPs.16 Therefore, the molar concentration, solvent, proportions,and stabilizing ligands play a fundamental role. In green synthesis,to prevent the aggregation and sedimentation of MNPs, the aggregationmust be totally or partially suppressed; that is, the repulsion forcesbetween particles must compensate for the van der Waals forces. Forthis purpose, one can follow two strategies: steric stabilizationand electrostatic stabilization.17 Stericstabilization involves using macromolecular “brushes”that surround or coat the nanoparticles, which prevent them from gettingcloser. This stabilization is very sensitive to the concentrationof the stabilizing agents since, at low concentrations, the polymersinteract with several particles simultaneously, inducing aggregation,and, when using high concentrations, the free polymers generate depletionforces between the particles, and aggregation may occur.18Within the diversity ofnanomaterials, metallic nanoparticles (MNPs)have been recurrently studied for a range of applications based ontheir physicochemical and biological properties, which differ fromtheir analogue in bulk and are strongly influenced by their metallicnature , due to their sizeand morphology. Catalytic,21 however, these can modify thechemistry of the surface and the electrical, catalytic, and opticalproperties. Natural derivatives such as chitosan,22 hydroxypropylmethylcellulose,23 and other cellulose derivatives such as ethylcellulose25 and carboxymethylcellulose27 have also been used.The latter is mentioned as a reducing agent and stabilizer of MNPs27 and as a matrix to form metallic films28 for biomedical applications.30 Carboxymethyl celluloseor CMC is a linear-chain macromolecular polymer based on covalentbonds of d-glucopyranoses31 due to itshydrosolubility and biocompatibility properties. This research focuseson the use of CMC as a stabilizing and supporting agent for AuNPsand its use for pyridoxine (Pd) (vitamin B6) detection by surface-enhancedRaman scattering (SERS); it also highlights the biocompatibility ofthe SERS analysis with the green synthesis of MNPs, stimulating thepromotion of additional biocompatible mechanisms integrated with thissynthesis methodology for the conservation and applicability of colloidalnanoparticles.32On the other hand, electrostatic stabilizationconsists of thenonaggregation of the nanoparticles due to the potential barrier betweenthe charges generated on the nanoparticle’s surface and thoseof the solution surrounding it. Electrostatic stabilization is a mechanismsusceptible to modifying the charge distribution around the nanoparticle.According to the stabilization of MNPs, fluorides, carboxylates, polymers,and acids have been reported;22.1Gliricidia sepium (GS) and Petiveriaalliacea (PA) plants were selected to prepare theaqueous extracts. First, the leaves of the GS and PA were carefullywashed with deionized water. Next, 16 g of leaves, cut into smallparts, was added in 240 mL of deionized water at 60 °C for 30min, and then the preparations were filtered with a 65 g/m2 Boeco Germany filter paper and preserved until the synthesis ofthe AuNPs.The 2.24 was prepared at 1 mM. First, in a beaker, 2 mLof aqueousextract in 15 mL of H2O was added; 2 mL of the precursorsolution was added later, as shown in HAuCl2.333 After synthesizingthe AuNPs, 1 mL of CMC solution (8 mg/20 mL) was added and vigorouslymixed with magnetic stirring, separated, and quickly placed in waterat room temperature. The CMC powderhas a white or creamy-white color, is soluble in water but insolublein oil and organic solvents, does not cause harm to the human body,is biodegradable, and plays an essential role in many industries,such as laundry, textile, paper, ceramics, paints, food, and medicine.CMC is also used as a viscosity additive, binder, and stabilizer andin packaging development.2.4The UV–visspectra were measured with a VELAB 5100UV spectrophotometer in a wavelengthrange between 200 and 800 nm operated at a resolution of 1 nm. Sampleswere measured by transmission and diluted in deionized water. OneμL of AuNPs was added to 2.5 mL of deionized water.2.5The morphology, phase,and particle size were analyzed through transmissionelectron microscopy (TEM) with high-resolution TEM (HR-TEM) JEOL JEM-2200FS+Csequipped with a spherical aberration corrector in a condenser lensand operated at 200 kV.2.6Raman spectrawere obtained with the LABram HR Evolution Raman spectrometer, Horiba, with an excitation lambda of 780 nm,and selected commercial B6 vitamin (pyridoxine) for the SERS activityanalysis of AuNPs-GS and AuNPs-PA.2.734 The gold clusters Au6, Au8, and Au20 were considered, representing a metallic surface,as well as the Pd molecule with the chemical formula C8H11NO3. The systems interacted until they obtainedthe minimum local energy, guaranteeing only positive frequencies inthe predicted vibrational spectra. Some molecular descriptors madeit possible to determine the affinity between the interacting systems,guaranteeing negative values in the adsorption energy and quantifyingthe degree of electron transfer. These calculations provided informationabout the magnitude and direction of charge transfer between the systems,helping to provide insights into the interactions and electronic effectsinvolved.Density functionaltheory (DFT) was used complementarily to obtain indications of thestructural, electronic, and vibrational behavior. Specifically, LSDA, B3PW91 (Becke’s three parametersincorporating Perdew and Wang’s 1991), and HCTH were used with the basis set LANL2DZ , both included in the Gaussian 09 software.335 Theband around 550 nm is associated with the surface plasmon of the AuNPs-GS. 37 is observed, and a band centered around 550 nm is associated withthe LSPR band of AuNPs-PA. 3.13.239–1 (AuNPs-PA), correspondingto the lowest frequency mode of one of the six stretching modes ofthe pyridine ring.The Pd molecule iscomposed of 23 atoms and 63 normal modes of vibration distributedas follows: 23 modes of stretching, 8 modes of torsion, 3 modes ofdeformation, 8 modes of plane deformation, 8 modes of nondeformationflat, 5 modes of angular flexion, 2 rocking modes, 2 scissors, and4 rocking.6, Au8, andAu20, respectively) to study the interaction with the Pdmolecule, as shown in DFT was used to obtain evidence to address theobserved experimentalbehavior. In this sense, this type of calculation provides structural,electronic, and vibrational analyses of the interaction between systems.For this, we considered small gold species (Au clusters) with planar,solid, and hollow morphologies  and the local minimum energy of the Pdmolecule, respectively.In all the cases analyzed, a minimum local energywas found whenthe interaction distance between the pyridine nitrogen atom and thenearest gold atom was located between 2.08 and 2.1 Å. Similarly,an affinity for gold atoms located in the vertices was observed.Eads values wereobtained for the cases analyzed, revealing an exothermic process,as shown in 41In addition, negative N); this parameter is related to the chargetransfer betweensystems. In addition, it depends on the electronegativity and theglobal hardness and is represented by the Pearson methodcluster and ηcluster are the electronegativityand global hardness parametersfor the cluster, respectively. χpyridoxine and ηpyridoxine are the parameters for the molecule, respectively.An important parameter is the electron transferfraction after the interaction withthe Aun clusters and predicted slightshifts. For the theoretical Pd spectrum, this mode is located at 711cm–1 (Supporting Information). Other authors using the approximation level B3LYP have locateda characteristic vibrational mode of Pd close to 690 cm–1.38The values for Δ–1 after interacting with theAun clustersunder the DFT functionals used in this work. The Raman spectrum thatpresented the most accurate approach for the Au20–Pdinteraction was the LSDA level of approximation, shown in 6–Pd, and Au8–Pd cases is included in the Supporting Information. Experimentally, in this work, the RBM is locatedat 688 cm–1 after interacting with AuNPs, as shownin –1 after interaction withAuNPs.42 Furthermore, recent studies showRaman bands susceptible to electrochemical surface-enhanced Ramanscattering (EC-SERS) located at 690 cm–1.43 On the other hand, semiempirical studies indicatea band associated with the pyridinic ring in vitamin B6 centered at692 cm–1.44However, it was located between678.7 and 727.0 cmN and the enhancementin the Pd RBM after interaction with the Aun clusters suggest that there is a significant chemical influenceon the SERS effect observed in this system.TheRBM in pyridinic ring molecules is a susceptible mode for theSERS effect. The shifts in the vibrational modes and intensities reflectthe modification of the chemical environment around the adsorbed molecule.That is, the favorable Δ4G. sepium and P. alliacea. The optical absorption spectra of thesynthesized nanoparticles revealed absorption bands for the nanoparticlesaround 530 nm. The phytocomponents coumarin in GS and narcissin inPA are mainly responsible for the reduction of metal ions. The opticalabsorption spectra of the AuNP samples show that CMC does not produceadditional bands of those already existing in the sample, and theLSPR bands do not show blueshift or redshift; therefore, it is consideredthat in this synthesis, CMC produces a matrix or surrounding effectof the nanomaterial preventing aggregation. The TEM micrographs revealrelatively spherical nanoparticles with average diameters of ≈7.7and ≈12.7 nm for AuNPs-GS and AuNPs-PA, respectively. Also,in the micrographs, it is possible to appreciate the crystalline planesof the nanoparticles and the matrix effect of CMC on the AuNPs. TheSERS analysis shows enhancements of two different vibrational bandsof the Pd molecule. The Raman band, enhanced at 688 cm–1 by the AuNPs-PA platform, was attributed to the pyridine ring stretchingmode. Complementarily, the DFT functionals employed attributed a moresignificant intensification of the Pd RBM mode after interaction withthe Aun groups and predicted slight changes.In the theoretical spectrum of Pd, this mode is located between 696and 711 cm–1, while in the experimental study carriedout here, it is located between 694.7 and 726.5 cm–1 after the interaction with the Aun clusters.In this research, the greensynthesis of gold nanoparticles wascarried out. The gold nanoparticles were synthesized with the extractof the leaves of


Extensive spinal epidural abscess (SEA) is an exceptional and threatening condition that requires prompt recognition and proper management to avoid potentially disastrous complications. We aimed to find key elements of early diagnosis and rational treatments for extensive SEA.Staphylococcus epidermidis was detected in the purulent material from this abscess.A 70-year-old man complained of intense pain in the cervical-thoracic-lumbar spine that radiated to the lower extremity. Laboratory test results revealed a marked increase in all indicators of infection. The spinal magnetic resonance imaging (MRI) revealed a ventral SEA extending from C2 to L4. Owing to the patient's critical condition, laminectomy, drainage, and systemic antibiotic therapy were administered. And the multidrug-resistant Postoperative MRI revealed diminished epidural abscess, and the clinical symptoms were dramatically and gradually relieved after two rounds of surgery and systemic antibiotic therapy involving the combination of ceftriaxone, linezolid, and rifampicin.A comprehensive emergency assessment based on neck or back pain, neurological dysfunctions, signs of systemic infection, and MRI are important for early diagnosis of extensive SEA. Further, the combination of laminectomy, drainage, and systemic antibiotic therapy may be a rational treatment choice for patients with SEA, especially for extensive abscess or progressive neurological dysfunction. A recAccording to Reihsaus et al. , only 1%Staphylococcus epidermidis was successfully treated at our department. Herein, we analyze and discuss the diagnosis and treatment experience.In August 2022, a case of extensive SEA spanning the cervical-thoracic-lumbar region caused by 2.A 70-year-old man was admitted to the hospital with a visual analog scale (VAS) score of 7 and a body temperature of 38.5°C due to acute discomfort in the cervical-thoracic-lumbar spine that radiated to the lower extremity. He had back and neck pain for two weeks, which restricted the spine's range of motion, affected his lower limbs, and caused physical weakness. He reported a history of diabetes mellitus and underwent lumbar discectomy and transpedicular screw fixation (L4/5) 4 months previously.On admission, the muscle power was 3/5 in the left lower extremity but normal in the other extremities. Reflexes were reduced in the quadriceps and ankle jerks. The left straight leg raise test result was positive at 30°. Negative pathological reflexes were observed in the upper and lower extremities along with neck stiffness and positive Brudzinski signs.9/l), erythrocyte sedimentation rate , and C-reactive protein  levels, suggesting a severe infection. Blood culture results were negative. Magnetic resonance imaging (MRI) confirmed extensive SEA from C2 to L4 and a spondylodiscitis at the L3/4 segment  and rifampicin (0.6 g/day) based on the antibiotic sensitivity profile of the bacteria. Seven days after surgery, the patient's lower back pain persisted, with a VAS score of 6, and the muscle power was 4/5 in the left lower extremity. Twelve days after surgery, re-examination of the spinal MRI showed that the abscess volume was slightly reduced and the pressure in the purulent cavity was relieved. However, mixed-high signals appeared in the lumbar incision on T2-weighted imaging, indicating aggravation of local infection  for drainage . In totanfection .To further relieve spinal cord compression and clean up local infection and necrotic tissue of the original lumbar incision, hemilaminectomy was performed again at the center of C6/7 and L3/4 on the 14th day after the first surgery. During surgery, part of the C6/7 lamina was removed, the posterior longitudinal ligament was broken through, a ventricular drainage tube was inserted into the caudal sides along the ventral side, and about 3 ml of purulent fluid was drained. The abscess was repeatedly irrigated with saline. The incision was repeatedly and carefully douched with iodine solution and saline with vancomycin, and a negative-pressure drainage vessel was retained outside the epidural space. Thereafter, the original lumbar incision was opened again, and the local necrotic tissue was cleaned. L3/4 right hemilaminectomy was performed, and a ventricular drainage tube was guided cephalad along the ventral side. Approximately 6 ml of purulent fluid was drained, and the purulent cavity was repeatedly irrigated with saline. The intervertebral infection and lesion tissues were cleaned again; gentamicin sulfate (4 ml) and vancomycin-loaded calcium sulfate (10 ml) were added to sterile water (6 ml); the mixture was converted into artificial bone granules, approximately 3 mm in size, and implanted into the L3/4 intervertebral space. Finally, the incisions were closed after the negative pressure drainage vessel was retained.After surgery, linezolid (0.6 g/day) and rifampicin (0.6 g/day) were continued for anti-infection therapy. Blood and drained pus cultures were negative three days after the second surgery. Twelve days after the second surgery, pain was relieved, with a VAS score of 2, and the muscle power remained 4/5 in the left lower extremity. Re-examination of the spinal MRI showed that the abscess in the spinal canal had almost disappeared, and the compression was significantly relieved . The sch3.SEA can be secondary to bacteremia caused by any factor , of whicS. epidermidis, and other pathogens have also been discovered  and surgical treatment for SEA. Most reports are retrospective, single-center case studies, or case reports. Many retrospective studies have selection bias, i.e., patients in the conservative treatment group have smaller abscesses and better initial neurological functional statuses than those in the surgical treatment group . There iS. aureus (including MSSA and MRSA), and three were infected by Streptococcus. In total, 19 patients chose laminectomy and epidural catheter irrigation, but internal fixators were not used to stabilize their spines. Only two patients chose abscess puncture irrigation and drainage exclusively. Ultimately, most patients' extremity power significantly improved. Herein, most patients underwent multi-segment laminectomies and epidural catheter irrigation and drainage. Catheter irrigation reduced severity of the infection, stopped the spread of the inflammation, and successfully released spinal cord compression  lack of experienced clinicians prevented timely diagnosis and treatment, causing rapid progression of the disease and the spread of abscess; (2) in the first operation, only single-segment laminectomy and abscess drainage were performed, and drainage was insufficient; (3) during the surgery, laminectomy was performed and the pedicle screws were removed, and vancomycin-loaded calcium sulfate was implanted in the intervertebral disc. It remained unclear if instability of the spine in the later period would still require long-term follow-up observation; (4) the abscess was not continuously irrigated with antibiotics after surgery; and (5) the patient was placed on bed after surgery with his head elevated and his foot lowered to utilize gravity for further drainage, but this also caused pus accumulation in the lumbar incision aggravating the infection at that site. Therefore, the case can be used as a reference for early diagnosis, improving the treatment plan, and avoiding future issues.4.Early diagnosis is the key to treating extensive SEA. For patients with back pain who may be suspected with this disease, a comprehensive emergency assessment should be performed immediately. For patients with neck or back pain, spinal cord degeneration, neurological dysfunction, or signs of systemic infection, ESR, CRP, blood culture, and MRI should be performed immediately. Based on neurological tests and medication therapy failure, surgical techniques should be considered if SEA is discovered during imaging. For extensive SEA with clear diagnosis, decompression treatment should be performed at an early stage, when neurological symptoms, spinal cord signal changes, or extensive compression occur. The mode and scope of decompression should follow the principles of fully relieving spinal cord compression and draining purulent secretions with minimal trauma. For patients without neurological symptoms or those with known pathogens who respond to antibiotic treatment, surgical treatment may not be required, but this approach must be undertaken cautiously because neurological dysfunction may be aggravated or become fatal at any time. The treatment duration should be comprehensively evaluated, combining results from the patient's clinical manifestations, laboratory indicators , and imaging examination. Administering broad-spectrum intravenous antibiotics immediately and ongoing medical attention are crucial part for treating extensive SEA. All patients with acute exacerbation should have early surgical intervention for extensive SEA as an adjuvant therapeutic option.


Haemoproteus parasites  are widespread pathogens of birds, with a rich genetic (about 1900 lineages) and morphospecies (178 species) diversity. Nonetheless, their life cycles are poorly understood. The exo-erythrocytic stages of three Haemoproteus majoris  lineages have been previously reported, each in a different bird species. We aimed to further study and compare the development of five H. majoris lineages—hCCF5, hCWT4, hPARUS1, hPHSIB1, and hWW2—in a wider selection of natural avian hosts. A total of 42 individuals belonging to 14 bird species were sampled. Morphospecies and parasitemia were determined by microscopy of blood films, lineages by DNA-barcoding a 478 bp section of the cytochrome b gene, and exo-erythrocytic stages by histology and chromogenic in situ hybridization. The lineage hCWT4 was morphologically characterized as H. majoris for the first time. All lineage infections exclusively featured megalomeronts. The exo-erythrocytic stages found in all examined bird species were similar, particularly for the lineages hCCF5, hPARUS1, and hPHSIB1. Megalomeronts of the lineages hWW2 and hCWT4 were more similar to each other than to the former three lineages. The kidneys and gizzard were most often affected, followed by lungs and intestines; the site of development showed variation depending on the lineage. Haemoproteus species  are parasites of birds and found on all continents except Antarctica [tarctica ,2. Thesetarctica ,3.Haemoproteus parasites, with the gametocytes developing in the erythrocytes [Plasmodium and Leucocytozoon [Haemoproteus tissue stages remained scarce. Recent studies reported exo-erythrocytic stages of several Haemoproteus species [Anemia is an acknowledged symptom caused by hrocytes ,5. Howevcytozoon , and res species ,13,14,15Haemoproteus spp. were found in histological slides of birds confirmed positive by blood film microscopy and/or DNA barcoding, despite extensive searches [Most reports of exo-erythrocytic stages are either from hosts found naturally dead ,10,11,15searches ,14,15. b (cyt b) gene [H. majoris [H. tartakovskyi [http://130.235.244.92/Malavi/ (accessed on 25 June 2023). [Haemosporidian parasites are investigated and characterized genetically by the amplification and sequencing of a 478 bp DNA-barcode region of the mitochondrial cytochrome  b) gene . Morphos b) gene ,17,18. H majoris ,19 and Hakovskyi  . ).Haemoproteus majoris is a species of interest among the Haemoproteus parasites, with several lineages  ,19)Haemodatabase ). A sixtdatabase , but it parasite ), its vePHYBOR04 ), and itPHYBOR04  developebilatrix ), and alH. majoris and to investigate and provide a comparative analysis of the exo-erythrocytic stages of different H. majoris lineages  in different host species and in different seasons. Patterns of development within this parasite species were investigated in regard to the exo-erythrocytic stages’ morphology, distribution, and localization.We aimed to clarify the identity of hCWT4 as Birds caught at the Ornithological Station, Ventes Ragas, Lithuania , were sampled and investigated for haemosporidian parasites beginning in May 2016 to 2019, 2021, and 2022 (spring) and in September 2020 (autumn). Birds were additionally caught using mist nests in the Labanoras Forest, Lithuania , in June 2018 and 2019 (spring) and July 2020 (summer). Blood was collected by puncturing the branchial vein of the bird. A drop of blood was immediately used to prepare at least three blood films, which were air-dried and fixed with absolute methanol  tube forH. majoris, as observed by microscopic examination, were euthanized, and internal organs were collected; brain, heart, lungs, liver, kidneys, spleen, and skeletal muscles were collected from birds of all years, and trachea, esophagus, gizzard, intestine, pancreas, and reproductive organs were additionally collected from birds collected in 2019 to 2022. The organs were fixed in 10% formalin and later embedded in paraffin wax.One blood film per individual bird was immediately stained for 15 min with a 30% Giemsa solution and examined for approximately 10 min with an Olympus CX26 microscope  to determine potential infections in captured birds in the field. This procedure enabled the selection of targeted infected birds and the release of all other individuals at the study sites. The remaining blood films were stained with a 10% Giemsa solution for 1 h. Birds infected with Phoenicurus ochruros) found dead in Lithuania (54°52′58.4″ N 25°25′38.6″ E) with a skull fracture was frozen and brought to the P. B. Šivickis Laboratory of Parasitology, Nature Research Centre, Lithuania. In October 2021, one long-tailed tit  found dead at the Ventes Ragas Ornithological Station, was frozen until dissection. Both birds were dissected, the heart was pressed to a glass slide to prepare a blood film, little pieces of organs were collected in 96% EtOH and stored at +4 °C, and the organs were fixed in formalin for 24 h, washed in distilled water for 1 h, transferred to 70% EtOH, and processed as the other samples. In July 2021, one black redstart  at ×1000 magnification .https://www.adobe.com/products/indesign.html (accessed on 25 June 2023)) was used to prepare the gametocytes figure.Images of the parasites were taken using the same microscope equipped with an Olympus DP70 digital camera and AnalySIS FIVE software . The software Adobe InDesign CS6 , and investigated for exo-erythrocytic stages using ×100, ×200, and ×400 magnifications with an Olympus BX41 or BX51 microscope . S), which targets the 18S ribosomal RNA of Haemoproteus parasites, was used to confirm the generic origin of the observed tissue stages [Chromogenic in situ hybridization (CISH) was applied on additional sections, at least one per individual, following the original protocol ,25. A gehttps://www.coreldraw.com/en/) was used to prepare the figures. (accessed on 9 November 2022)Pictures of the tissue stages were taken using the camera DP12 with the software DP-SOFT or the camera UC90 with the software cellSens , respectively. The software CorelDraw 2019  were also counted and reported. It is to be noted that very young megalomeronts can be found on up to three sequential sections of organs, but most often, one very young megalomeront was observed in only one section. Other, bigger megalomeronts are most often observed on several sequential sections. However, not all sections investigated were sequential. Therefore, the detection of megalomeronts is biased greatly for big megalomeronts compared with very young megalomeronts. Due to the fact that the actual shape  of megalomeronts is difficult to predict, the choice was made to not try to distinguish the real number of the bigger megalomeronts.For all bird individuals single-infected with Haemoproteus and Plasmodium parasites and HAEMFL/HAEMR2L for Leucocytozoon parasites. A negative control (ddH2O) and a positive control (sample known to be infected with Plasmodium and Leucocytozoon parasites) were used in all PCRs to check for possible contamination and efficiency of the PCR. PCR products were run on 2% agarose gel. Positive PCR products were sequenced in both directions with the Big Dye Terminator V3.1 Cycle Sequencing Kit and the ABI PRISMTM 3100 capillary sequencing robot  or sent for sequencing to Microsynth . One sample was subjected to cloning of the 18S ribosomal RNA of parasites following the protocol of a previous study [DNA extractions were done using the SET-buffer-stored blood following the ammonium acetate protocol  or the Dus study .https://www.geneious.com, last accessed on 9 November 2022) or Bioedit (https://bioedit.software.informer.com last accessed on 9 November 2022). Sequences were subjected to BLAST searches in MalAvi database [https://www.ncbi.nlm.nih.gov/genbank/, last accessed on 9 November 2022) to determine the lineages. Sequences obtained from infections with no more than two lineages from the same genus were deposited in GenBank OR143042–OR143096 . Chromatograms were checked for possible mixed infections (more than one peak for a base) using the software Geneious Prime 2022.0.2  and histological preparations  were deposited to the Nature Research Centre, Vilnius, Lithuania. Vouchers of blood and histological preparations (accessions G466275-G466294) were deposited at the Queensland Museum, Brisbane, Australia.H. majoris infections were dissected  whose blood films were negative or not usable (from dead birds). One H. majoris infection was found in co-infection with Leucocytozoon sp. and eleven with other Haemoproteus spp., as confirmed by microscopy  in the 478 bp cyt b barcode region  were found in 10 birds, 1 in hCCF5, 1 in hCWT4, 5 in hPARUS1, 1 in hPHSIB1 lineage infections, and 2 in enlarged . The hosenlarged .Inflammatory reactions were observed around some megalomeronts. The inflammatory infiltrates were predominantly lymphohistiocytic, and only occasionally were single heterophils seen. Inflammation was present around seemingly intact megalomeronts, where the intensity could vary between single inflammatory cells B and sevIndividuals infected with the same parasite lineage and a similar intensity of parasitemia often featured megalomeronts  but not H. majoris, the kidneys and the gizzard were most commonly affected by megalomeronts, followed by the lungs and intestine, even though 10 birds had not their intestine and gizzard collected and investigated  (The number of section) .hPARUS1 lineage was sampled in spring, summer, and autumn and displayed exo-erythrocytic stages differently. Megalomeronts were seen in all seasons, however, with different frequencies . In spriHaemoproteus, very young megalomeronts were found in two individuals in spring and in four individuals in autumn. More of these very young megalomeronts were found in individuals in autumn (26 found in 21 positive sections out of 304 sections of the kidneys investigated) than in spring (3 found in 20 positive sections out of 31 sections of the kidneys investigated). In spring, more than 1 big megalomeront was found per section, adding up to more than 90 megalomeronts  in the kidneys in 20 positive sections out of 31, while in autumn, 11 big megalomeronts were found in the 304 investigated sections of kidneys.In hPARUS1 single infections of H. majoris, as determined by PCR-based testing and the obtained cyt b sequences  than the other very young megalomeronts (<20 µm in largest diameter). However, the slightly enlarged host cell nucleus was still visible in the former D.Some of the megalomeronts found in sample ‘20 Sp’ co-infected with the lineages hPHSIB1 and hWW2 E looked Fringilla coelebs (sample ‘1 Sp’) where microscopic examination identified the presence of H. fringillae in blood films. Positive CISH signals with the Haemo18S probe were observed for these meronts, confirming their Haemoproteus origin  were found in a s origin G insert.F. coelebs (‘3 Sp’) in a blood vessel of the lungs, and positive CISH signals were observed for the corresponding parasites seen in H&E-stained sections  were found in sections H,I. The sections I insert.H. majoris in different avian host species. Megalomeronts developed in the examined bird individuals during single infections. This is the first comparative study that addresses the exo-erythrocytic development of different lineages of one Haemoproteus species in different avian hosts, providing opportunities to address possible patterns of development in avian haemoproteids. This study also identified the lineage hCWT4 as another lineage of H. majoris; this contributes to better understanding the intra-species genetic diversity of this widespread Haemoproteus species. The main result of this study is the report and comparative analysis of the exo-erythrocytic stages  for five lineages  of H. majoris by Križanauskienė et al. [H. majoris infections, including all hCWT4 infections and the co-infections with several other Haemoproteus species. The lineages hPARUS1, hPHSIB1, hCCF5, and hWW2 were identified as ė et al. , but theė et al. . In our H. majoris lineage hPARUS1, and megalomeronts were found to develop in the kidneys of eight, in the lungs of three, in the liver of two, and in the heart, spleen, pancreas, and gizzard of one bird  and their structure was similar to that of the megalomeronts previously reported in the kidneys, liver, lungs, and spleen of a single P. major [H. majoris hPARUS1.Twelve birds were infected with one bird . The megP. major . This coH. majoris lineage hPHSIB1 [P. sibilatrix (S. atricapilla and P. sibilatrix), while the third individual  was found dead and no information on gametocytes was available. It is thus difficult to know if the intestine is one of the organs most commonly affected by hPHSIB1 infections or if this is only the case for the kidneys. No individuals were found infected with the lineage hPHYBOR04 of H. majoris, for which megalomeronts were described in the kidneys of a Turdus pilaris [A previous report identified the kidneys and the intestine as sites of development of  hPHSIB1 . In our bilatrix . It shou pilaris . As was  pilaris ) and hPH pilaris .H. majoris lineage hCCF5 was mostly found in Fringilla coelebs. Megalomeronts were found to develop mainly in the lungs, pancreas, and gizzard , even though the gizzard and intestine were not collected in 9 out of 15 birds. The kidneys were sampled and examined from all birds, but no megalomeronts were found during hCWT4 infections  and were seen only in one out of seven hWW2 infections. This differs compared with the previously reported sites of development of megalomeronts in hPARUS1, hPHSIB1, and hPHYBOR04 infections , while megalomeronts of hPARUS1, hPHSIB1, hCCF5, and hPHYBOR04 infections possessed interconnected cytomeres of a bigger size . The mo compare . This co compare . This di compare E, and thHaemoproteus parasites and suggesting low ribosomal content in mature stages [Haemoproteus parasites [H. majoris lineages  and five times in autumn (two positive and three negative in this study). The individuals sampled in spring contained the largest number of megalomeronts, with up to four organs affected, while fewer individuals were affected by megalomeronts in autumn, with only one to two organs affected (and at a lesser intensity). These seasonal differences in the maturation of the tissue stages might result from a different parasite-load strategy in the host. In Europe, spring is characterized by the active transmission of Haemoproteus parasites [Haemoproteus parasites are present in their host during winter, as gametocytes are rarely seen in blood films. A small number of young megalomeronts might be enough to initiate exo-erythrocytic development and relapse in spring, but their size and presence might also harm the host as inflammatory reactions are observed. Very young megalomeronts, due to their smaller size, might have a lesser influence on the host, but as their CISH signals were deep purple, active development and growth still occur. It is unknown whether the parasite can slow down its development and persist during winter.Megalomeronts of itive in ), once iHaemoproteus majoris is a generalist parasite [cyt b barcoding sequence. The lineage hCWT4 is closer to hWW2 and hPHYBOR04, with a 1 bp difference (0.2 %), whereas hPARUS1, hPHSIB1, and CCF5 have more differences from the other lineages (differences range from 2 to 6 bp). It seems probable that megalomeronts are the main and probably only tissue stage during H. majoris infections. The morphological similarities of megalomeronts and the sites of their development seem to reflect their genetic distances (hCWT4/hWW2 vs. hCCF5/hPARUS1). parasite  with sixHaemoproteus species in regard to their exo-erythrocytic development. It is thus difficult to speculate if the slight differences in morphology and site of development between the H. majoris lineages are due to the generalist features of this parasite or are due to lineage-specific features, or both. It would be interesting to study additional multi-lineage species, such as H. tartakovskyi, H. lanii, and H. balmorali, to explore intraspecific variation of exo-erythrocytic development. Only one parasite closely related to H. balmorali, H. attenuatus, has been reported to develop meronts in the lungs of its host [This is the first study which analyzed more than two lineages belonging to one its host . An inveH. pastoris infection in Sturnus vulgaris [H. pastoris, nine organs were reportedly affected by the parasites [H. majoris lineages and hosts, megalomeronts were found in ten organs . H. majoris infections were found to be co-infected with other Haemoproteus spp., and other exo-erythrocytic stages were found. These exo-erythrocytic stages were meronts of small sizes following the capillaries of the lungs , which would increase the resolution of exo-erythrocytic stages belonging to different parasite species.Finally, two birds with he lungs G, and thmbbellus  of one is study, ,12). DeeH. majoris haemosporidian parasite by adding the lineage hCWT4 to this morphospecies. Only megalomeronts were observed developing in all examined single H. majoris infections, strongly suggesting that meronts might be absent in this parasite. Megalomeronts were also found in mixed infections of several H. majoris lineages, while meronts were only found in cases of mixed infections of H. majoris and other Haemoproteus species. The following findings are worth more attention.This study extends knowledge about the lineage diversity of the widespread H. majoris megalomeronts, with hPARUS1 megalomeronts most commonly found in the kidneys; hCCF5 in the lungs, intestine, and kidneys; hCWT4 in the gizzard; and hWW2 in the heart and gizzard. Megalomeronts were also found in those organs for the other lineages (but at a lower intensity). The morphology of all reported H. majoris megalomeronts was mostly similar in all lineages, with some minor differences in hCWT4 and hWW2 infections. Very young megalomeronts were found for four of the H. majoris lineages. The parasitemia intensity could not be associated with the presence of megalomeronts in organs. However, megalomeronts were more often found in birds from spring than from autumn, with more developing and mature megalomeronts in spring and more very young stages in autumn. It would be interesting to investigate other generalist and specialist parasite species in different avian hosts across different seasons to better understand the pattern of their development and to make sure how the exo-erythrocytic development depends on the parasite lineage, the host species, and the season. It would also be interesting to see if very young megalomeronts can be found in the host during the winter period, possibly as dormant stages responsible for relapses in spring.The organs were found to be differently affected by


Wolfram syndrome is a rare, multisystemic, progressive, and autosomal-recessive genetic disease, characterized by diabetes mellitus and diabetes insipidus, optic nerve atrophy, deafness, and other neurological signs. The diagnosis is usually based on history and clinical manifestations but genetic tests are necessary for confirmation. Currently, there are no treatments available to cure or delay disease progression. This report describes a case of a 23-year-old male diagnosed with Wolfram syndrome who presented to the emergency department with several episodes of loss of consciousness. This case reinforces the need for an early diagnosis of obstructive and central apneas, respiratory failure, and dysphagia, in order to prevent and treat the complications of this disease and to improve patients’ quality of life. Wolfram syndrome (WS) is a multisystemic progressive and autosomal recessive genetic disease, whose main clinical features are diabetes insipidus, diabetes mellitus(DM), optic nerve atrophy, deafness, and urinary tract problems -5. It afWFS1) and Wolfram Syndrome 2 (WFS2) [WFS1 encodes a transmembrane glycoprotein in the endoplasmic reticulum (ER) named wolframin that serves as a calcium channel [WFS1 in the lung, heart, brain, pancreatic β-cells, and placenta [Studies have identified two genes responsible for WS: Wolfram Syndrome 1 (2 (WFS2) ,7. The W channel ,5. This  channel ,5. Thereplacenta ,5. AutosCIDS2) gene [CISD2 encodes the protein named small intermembrane endoplasmic reticulum protein, which has a central role in the exchanges between endoplasmic reticulum and mitochondria, in the regulation of mitochondrial homeostasis, and in the activation of apoptosis and autophagy [WS type 2, a rare and neurodegenerative type of WS, is caused by mutations in the CDGSH iron-sulfur domain-containing protein 2 (S2) gene ,5. CISD2utophagy ,8. This utophagy . Patientutophagy ,3.WFS1 [Lately, there have been reports of dominant disease with or without DM, atypical forms of disease related to one or two mutations in WFS1 . CurrentWFS1 . TherefoWFS1 .In this case report, we describe a case of a patient with WS that presented to the Emergency Department (ED) due to several episodes of loss of consciousness. Loss of consciousness is one of the most common reasons for admission to the ED. It is essential to make a detailed characterization of the episode to discriminate between differential diagnoses .This article was previously presented as a meeting poster at the World Sleep 2022 on March 14, 2022.WFS1 gene: c.482G>A (p.Arg161GIn) in exon 5, and c.1066T>C (p.Ser356Pro) in exon 8. The family members were asymptomatic and their genetic study was negative.We report the case of a male patient diagnosed with diabetes mellitus at the age of six years old. When the patient was eight years old, he was also diagnosed with diabetes insipidus, cognitive development delay (intelligence quotient 70), hypersomnolence, bilateral optic nerve atrophy, primary hypogonadism with testicular atrophy, neurogenic bladder, and hydroureteronephrosis. At that time, he was medicated with insulin glargine, insulin glulisine, oxybutynin, tamsulosin, and desmopressin. With the suspicion of WS, a genetic test was made, which identified the following homozygous variants in the When he was 23 years old, the patient was admitted to the ED with a three-week-long dysphagia for solids and liquids and several episodes of loss of consciousness. These episodes occurred several times during the permanence in the ED and they were accompanied by ocular retroversion, trunk stiffness, and short-lasting distal limb myoclonias. All of the episodes were associated with lip cyanosis, paradoxical breathing followed by absence of respiratory movements, and severe hypoxemia, with apparent superior airway obstruction. The patient recovered spontaneously after approximately two minutes. Blood analysis and electrocardiogram were normal. Blood gas analysis, carried out with supplemental oxygen (fraction of inspired oxygen (FiO2) of 40%), showed type 2 respiratory insufficiency - pH 7.35, partial pressure of oxygen (PaO2) 65mmHg, partial pressure of carbon dioxide (PaCO2) 50mmHg, serum bicarbonate (HCO3) 27.4mmol/L, arterial oxygen saturation (SaO2) 91%. Chest computed tomography (CT) showed a pulmonary infiltration in the left superior lobe and a consolidation in the right inferior lobe , bilevel positive airway pressure (BPAP) spontaneous timed (ST) mode, with expiratory positive airway pressure (EPAP) of 7cmH2O and inspiratory positive airway pressure (IPAP) of 15cmH2O, respiratory frequency of 13cpm, with FiO2 45% and oronasal mask. In the first four days, the NIVM was maintained continuously and after that, the patient was under NIMV only at night.Brain magnetic resonance imaging (MRI) Figure  showed cDuring hospitalization, the patient was evaluated by a doctor of physical medicine and rehabilitation who confirmed the dysphagia for solids and liquids and a percutaneous endoscopic gastrostomy was performed. The patient was also submitted to a type III sleep study, with supplemental oxygen Figure . A mild After medical discharge, in order to better clarify the clinical case, split-night polysomnography was performed Figure  a month Therefore, the polysomnography was compatible with the diagnosis of severe obstructive sleep apnea and hypoventilation during sleep. The study confirmed that correction of respiratory events and oxygen saturation level was obtained with the application of NIMV in BPAP ST mode, with EPAP of 8cmH2O and IPAP of 15cmH2O, respiratory frequency of 14cpm, minimum inspiratory time of half a second, and maximum inspiratory time of two seconds. There was no need for supplemental oxygen and a good adaptation was obtained to the ventilatory mode, to the established pressures, and to the oronasal interface.During reassessment at the consultation after medical discharge, the patient presented good adherence to the ventilator with effective correction of respiratory events. He improved considerably since the initiation of NIMV. In two years of follow-up, the patient maintained adherence to NIMV, with effective correction of respiratory events. Nocturnal oximetry, performed without supplemental oxygen, revealed an average SpO2 of 98%. The patient had good symptomatic control, denied dyspnea, and there were no other episodes of hospitalization due to respiratory pathology or new episodes of loss of consciousness.WS, sometimes referred to as DIDMOAD  due to its main clinical features as an autosomal-recessive genetic disorder, was first described in 1938 by Wolfram and Wagener . They deDMis often diagnosed around six years old . It is oWFS1 gene-induced deafness, Friedreich ataxia, Alström syndrome, and Bardet-Biedl syndrome [The diagnosis of DMand optic nerve atrophy before 16 years old raises the suspicion of this diagnosis ,5. Furthsyndrome ,11.The main goals for WS treatment are stopping the progression of the disease and replacing damaged tissues ,7. Some Patients with WS have a poor prognosis ,2. Most This case reports a patient with WS1, a rare disorder that manifests early in life, progressing with brain stem atrophy, bulbar dysfunction, and respiratory failure. Although the disease can cause seizures, other manifestations such as obstructive and central apneas are more common. The early diagnosis of the disease and the treatment with NIMV in patients with respiratory failure or with central and obstructive apneas is essential.Furthermore, it is essential to assess swallowing capacity for early detection of dysphagia and placement of endoscopic percutaneous gastrostomy, to prevent episodes of aspiration pneumonia, one of the main causes of mortality. This case reinforces that it is crucial to have a multidisciplinary approach in order to be able to prevent and treat the complications of this disease and to try to maintain the best possible quality of life for such patients.


The water and rapid chloride permeabilities were measured. SEM analysis of the microstructure was also performed. The coarse aggregates used were dolomite (control) and recycled concrete aggregate, incorporating different mineral admixtures, including ground, granulated blast slag, granite, and nanosilica. It was found that the slump values of the dolomite concrete decreased compared with recycled aggregate concrete. Compared to the control mix produced with the recycled aggregate, the slump value of the concrete mixes created with the recycled aggregate increased by approximately 11.1% with the addition of binary cementing materials of 1% NS. The results also indicate that the concrete mix containing the recycled aggregate had the highest compressive strength, tensile strength, and flexural strength compared to that of the dolomite aggregate. Regarding the compressive strength, the addition of 1% NS and 15% slag improved the physico-mechanical properties of the recycled aggregate concretes compared to the other mixes after curing in tap water. Compared to the other mixes, the concrete mix containing 1% NS and 15% slag had a comparatively dense and compact microstructure.In this work, the effects of recycled concrete aggregate, modified with mineral admixtures and nanosilica, on the mechanical properties and performance of concrete after curing in tap water for 28 and 90 days were investigated. The compressive (ƒ Solid waste pollution is currently one of the most pressing issues because of its detrimental effects on the environment, public health, and the global economy. Therefore, it is vital to effectively utilize and recycle various solid wastes for the creation of building materials, etc. ,2. The p2 is completely negligible, and nanosilica promotes the growth of Si chains, thereby forming denser structures. Moreover, nanoscale CNS and C-S-H particles fill the voids between hydrates, thus refining the pore size, increasing the complexity of pores, and improving the microstructure of ITZ, contributing to improved impermeability [According to earlier studies, the addition of industrial wastes like slag, aluminum, and granite to concrete reduces production costs and carbon emissions while also adding new qualities, including improved mechanical capabilities and durability. Many contemporary concrete mixtures are altered using admixtures which enhance the microstructure and lower the concentration of calcium hydroxide produced via cement hydration (CH) by consuming it in a pozzolanic reaction. The fine particle size of the pozzolanic materials found in the concrete mixes creates an abundance of nucleating sites for the precipitation of hydration products. Nanosilica additions improve the mechanical properties (compressive strength) of the resulting cement paste when compared to the addition of microsilica. In the case of nanosilica, the consumption of Ca (OH)eability ,8,9.2) and the calcium hydroxide (CH) created during the cement hydration process. In addition, the refined grains’ physical effects enable dense filling within the cement specimens and decrease the wall effect in the zone where the paste meets the fine and coarse aggregate [Concrete specimens are more homogeneous due to this technique. This results from the reaction between the pozzolanic material’s amorphous silica  and slag (GBFS), combined with recycled aggregate, were studied and evaluated for use in the creation of concrete ,16.Compressive strength, rupture modulus, and shrinkage tests were carried out as part of an experimental program that manufactured concrete using the substitutes of recycled coarse aggregate with ratios of 0%, 50%, and 100%; slag (GBFS) with ratios of 0% and 50%; and fly ash (FA) with ratios 0% and 50%. According to the study’s findings, the addition of more recycled aggregate boosted the concrete’s strength. The quality of the recycled material, as well as the mixing technique, may be related to this performance. High-quality recycled concrete may be produced by mixing recycled coarse aggregates, fly ash, and slag ,18,19.Several studies ,21 examiThe impact of using leftover ceramic aggregate in concrete, both coarse and fine, on the strength of concrete was investigated. According to the findings, the concrete produced using ceramic aggregate waste exhibited an enhanced flexural strength, compressive strength, STS, and elastic modulus. . Equal a2O3) and salts) is composed of a mixture of free metal and non-metal materials. Along with metal oxides produced from the molten alloy, aluminum nitrides and carbides may also be present [Aluminum dross  entered concrete through water or sea winds carrying salt ions that eroded the concrete [The concrete industry can positively impact the environment through the recycling of construction debris, reducing demand for landfill space, conserving resources, saving energy, and reducing pollution, as academics have suggested ,32,33,34concrete ,43,44,45This study thoroughly examined the impacts of recycled aggregates and mineral admixtures  on the physical and mechanical properties of concrete specimens. We utilized typical values for the cement replacement levels in concrete mixes: 15% slag, 10% granite, 1.5% aluminum waste, and 1% nanosilica. The aim of this research was to produce sustainable concrete and lower carbon emissions using local waste materials in Egypt, such as slag, granite powder, nanosilica, and aluminum waste as a replacement for cement and recycled aggregate from old concrete as a replacement for coarse aggregate (dolomite).−), as a contaminant, served as the fine aggregate. Portland cement CEM1-42.5 N, supplied by the Suez cement business in Suez, Egypt, was used in this work. The used cement met the Egyptian Standard Specifications (4756-1/2007). The mechanical and physical properties of the used cement were confirmed through laboratory testing at the Housing and Building National Research Center (as per E.S.S No. 2421/2005), which indicated that it was suitable for concrete work. The measured properties of the cement used in this study are presented in (1)(Egyptian Standard Specification No. 1109 2002).(2)(Egyptian Code of Practice for Reinforced Concrete No. 203 2017).(3)(ASTM C637 2009).A 180 kg pan mixer was used to combine the aggregates, binder material, superplasticizer, and water in order to create concrete. The mixing process involved combining the aggregates for approximately 2 min, adding half the water volume in 15 s, combining the ingredients for 3 min, distributing the binder material and superplasticizer over the aggregate in the pan, and mixing for 30 s. The remaining water was added within the next 30 s after restarting the mixing process. Due to the high surface energy of nanoparticles, they are mixed in a number of stages . After aFresh mixtures were slump-tested for workability, According to ASTM C511, the cubes were cured and subjected to strength tests at 28 and 90 days, as per EN 196-1:2016. A 2500 kN Avery Denison machine, as shown in ASTM C1202 states that a cylindrical specimen of 50 × 100 mm is submerged in a 30% NaCl solution for a chloride permeability test, as shown in Samples from the chosen specimens were taken, processed, and tested under TGA/DTG. Testing was performed on the selected samples of dried paste using a TGA-50 thermal analyzer. The analysis was carried out after completing a compression test at the age of 28 days. A sample of approximately 50 mg (−53 µm) was used with a heating rate of 20 °C/min up to 1000 °C in a dynamic nitrogen atmosphere. The TGA investigations revealed the decomposition of the cement hydrates through diminishing increments on the TGA curves and endothermic peaks on the derivative TGA. The slump test is the simplest way to determine workability. In The tensile strength values of the concrete mixes were evaluated at days 28 and 90. The depth of water penetration under pressure indirectly determines water permeability. According to ASTM C1202-C97, the cylinder specimens underwent RCPT, and after 6 h of applying 60 volts, the Coulombs representing the total charge passed was observed. 2 generation.All chosen samples underwent evaluation at temperatures ranging from 25 °C to 1000 °C. After 28 days of hydration, the TGA/DTG curves of OPC, OPC-1N, OPC-1N-1.5Al, OPC-1N-10G, and OPC-1N-15S were obtained, as displayed in (1)The slump value of dolomite concrete decreases as compared to recycled aggregate concrete. However, the addition of 1% NS binary cementing material increases the slump value of the concrete mix produced with recycled aggregate by approximately 11.1%.(2)The concrete mix with recycled aggregate has higher compressive, tensile, and flexural strength than dolomite aggregate because the recycled aggregate’s physical and mechanical characteristics improve upon interlocking with cement paste.(3)The strength increase is paired with a decrease in chloride penetration, indicating that microcracking affects both chloride penetration and compressive strength.(4)The inclusion of nanosilica and mineral admixtures in recycled aggregate concrete improves its mechanical strength.(5)The micrographs show that concrete mixes with recycled aggregate and mineral admixtures have a more compact microstructure compared to normal dolomite concrete due to an increased C-S-H phase and hydration products.This paper presented an experimental study on the performance of recycled aggregates and mineral admixtures with respect to their mechanical and microstructural properties. The study investigated the materials’ compressive, flexural, and tensile strengths, chloride penetration, and microstructure. The findings provide fundamental knowledge, as follows: