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With the majority of medical journals having a rejection rate of >80% of submitted manuscripts, it does come as a shock and as grief to the author who great expectations before submission. Though the majority of literature available does mention how to overcome the lacunae in the manuscript before considering resubmission in another journal, none addresses the mental agony and setback the author faces and the way to overcome this setback. Every author should develop immunity and also be adequately mentally prepared to overcome this misery.

Aedes albopictus is an important vector of arboviruses and prefers small containers of stagnant water as oviposition sites. One of the mechanisms mosquitoes use to search for suitable oviposition sites is relying on odor cues from prospective sites and their surroundings. The genetic and molecular bases of this behavior are not known for Ae. albopictus. Oviposition site-searching behavior can be separated into 2 stages: container location and water detection. We applied a glue compound to the antennae and the maxillary palps of adult females to mask their ability to detect molecules that may guide them to preferred oviposition sites. Treatment of the antennae significantly reduces the location index (P < 0.001), indicating a decreased ability to find oviposition sites, whereas no significant difference was observed in mosquitoes with maxillary palps treated with the same glue compound (P > 0.05). The detection time, measured as the duration from contact with the water surface to the deposition of the first egg, was extended in mosquitoes with treated antennae or maxillary palps, supporting the conclusion that olfaction is involved in the detection of oviposition site. Transcriptomic analysis identified differentially expressed olfactory-related genes, including obp67, obp56d-like, obp19d-like and obp67-like. RNA interference (RNAi)-mediated knockdown of obp67 and obp56d-like significantly affected the location index and detection time, respectively. Cas9/guide RNA-mediated knockout of obp56d-like resulted in a prolonged detection time, compared with the wild type (P < 0.05). These findings help to elucidate aspects of the olfactory mechanisms involved in Ae. albopictus oviposition site selection, and provide a basis for the development of mosquito surveillance and control strategies.

BACKGROUND: The impact of the His bundle location and distance from the ablation site on ablation efficacy and complication risk remains unexplored. We determined the correlation between age, height, body mass index (BMI), and the His bundle location, and whether the distance between the His bundle and ablation target (DHIS-ABL) affects ablation safety and efficacy.
METHODS: Overall, 346 patients with atrioventricular nodal re-entrant tachycardia (AVNRT) and 96 with atrioventricular re-entrant tachycardia (AVRT) were retrospectively analyzed. The distance between the His bundle and the coronary sinus ostium (DHis-CS), the height of the His bundle (HHIS), and DHIS-ABL were measured. Electrocardiograms were obtained 3 months post-ablation to assess recurrence and complications.
RESULTS: Multiple linear regression showed that HHIS was negatively correlated with age in both groups. In AVNRT patients, DHIS-ABL was associated with age, height, and BMI; DHIS-CS was only negatively correlated with age. In AVRT patients, there was no significant correlation between the DHIS-ABL and age, height, or BMI. The recurrence rates in the AVNRT and AVRT groups were 0.9% and 8.7%, respectively. Subgroup analysis showed that patients with DHIS-ABL ≤ 10 mm had a higher recurrence rate than those with DHIS-ABL > 10 mm (p = .013). The incidence of third-degree atrioventricular block (AVB) complications was 0.2%.
CONCLUSIONS: HHIS was negatively correlated with age but not with height and BMI. The DHIS-ABL correlated with age, height, and BMI in AVNRT patients. A short DHIS-ABL led to a higher rate of supraventricular tachycardia recurrence; whether this affects AVB risk warrants further studies with larger sample sizes.

BACKGROUND: A coordinated care system helps provide timely access to treatment for suspected acute stroke. In Northwestern Ontario (NWO), Canada, communities are widespread with several hospitals offering various diagnostic equipment and services. Thus, resources are limited, and health care providers must often transfer patients with stroke to different hospital locations to ensure the most appropriate care access within recommended time frames. However, health care providers frequently situated temporarily (locum) in NWO or providing care remotely from other areas of Ontario may lack sufficient information and experience in the region to access care for a patient with a time-sensitive condition. Suboptimal decision-making may lead to multiple transfers before definitive stroke care is obtained, resulting in poor outcomes and additional health care system costs.
OBJECTIVE: We aimed to develop a tool to inform and assist NWO health care providers in determining the best transfer options for patients with stroke to provide the most efficient care access. We aimed to develop an app using a comprehensive geomapping navigation and estimation system based on machine learning algorithms. This app uses key stroke-related timelines including the last time the patient was known to be well, patient location, treatment options, and imaging availability at different health care facilities.
METHODS: Using historical data (2008-2020), an accurate prediction model using machine learning methods was developed and incorporated into a mobile app. These data contained parameters regarding air (Ornge) and land medical transport (3 services), which were preprocessed and cleaned. For cases in which Ornge air services and land ambulance medical transport were both involved in a patient transport process, data were merged and time intervals of the transport journey were determined. The data were distributed for training (35%), testing (35%), and validation (30%) of the prediction model.
RESULTS: In total, 70,623 records were collected in the data set from Ornge and land medical transport services to develop a prediction model. Various learning models were analyzed; all learning models perform better than the simple average of all points in predicting output variables. The decision tree model provided more accurate results than the other models. The decision tree model performed remarkably well, with the values from testing, validation, and the model within a close range. This model was used to develop the \"NWO Navigate Stroke\" system. The system provides accurate results and demonstrates that a mobile app can be a significant tool for health care providers navigating stroke care in NWO, potentially impacting patient care and outcomes.
CONCLUSIONS: The NWO Navigate Stroke system uses a data-driven, reliable, accurate prediction model while considering all variations and is simultaneously linked to all required acute stroke management pathways and tools. It was tested using historical data, and the next step will to involve usability testing with end users.

BACKGROUND: Stroke and thromboembolism in nonvalvular atrial fibrillation (NVAF) primarily arise from thrombi or sludge in the left atrial appendage (LAA). Comprehensive insight into the characteristics of these formations is essential for effective risk assessment and management.
METHODS: We conducted a single-center retrospective observational of 176 consecutive NVAF patients with confirmed atrial/appendage thrombus or sludge determined by a pre-ablation transesophageal echocardiogram (TEE) from December 2017 to April 2019. We obtained clinical and echocardiographic characteristics, including left atrial appendage emptying velocity (LAAeV) and filling velocity (LAAfV). Data analysis focused on identifying the morphology and location of thrombus or sludge. Patients were divided into the solid thrombus and sludge groups, and the correlation between clinical and echocardiographic variables and thrombotic status was analyzed.
RESULTS: Morphological classification: In total, thrombi were identified in 78 patients, including 71 (40.3%) mass and 7 (4.0%) lamellar, while sludge was noted in 98 (55.7%). Location classification: 92.3% (72/78) of patients had thrombus confined to the LAA; 3.8% (3/78) had both LA and LAA involvement; 2.7% (2/78) had LA, LAA and RAA extended into the RA, the remained 1.2%(1/78) was isolated to RAA. 98.0% (96/98) of patients had sludge confined to the LAA; the remaining 2.0% (2/98) were present in the atrial septal aneurysm, which protrusion of interatrial septum into the RA. The thrombus and sludge groups showed low LAAeV (19.43 ± 9.59 cm/s) or LAAfV (17.40 ± 10.09 cm/s). Only LA dimension ≥ 40 mm was independently associated with the thrombus state in the multivariable model.
CONCLUSIONS: This cohort study identified rare thrombus morphology and systematically summarized the classification of thrombus morphology. The distribution of thrombus and sludge outside limited to LAA was updated, including bilateral atrial and appendage involvement and rare atrial septal aneurysm sludge. LAAeV and LAAfV were of limited value in distinguishing solid thrombus from sludge.
BACKGROUND: ChiCTR-OCH-13,003,729.

BACKGROUND: With advances in endoscopic submucosal dissection (ESD) technique, an increasing number of the Chinese population are being diagnosed with early gastric cancers (EGCs) at gastric angulus. However, the relationship between gastric angulus and EGCs remains obscure.
OBJECTIVE: We aimed to unveil the unreported location characteristics of gastric angulus in Chinese EGC patients and the correlation between the degree of submucosal fibrosis and ESD outcomes.
METHODS: We retrospectively reviewed the medical records of EGC patients treated with ESD from January 2010 to March 2023. We retrospectively investigated and analyzed 740 EGC patients using multiple analyses.
RESULTS: Following gastric antrum (53.1%), the gastric angulus (21.8%) emerged as the second-most prevalent site for EGCs. It had highest incidence of severe submucosal fibrosis and ulceration than the other parts. Multivariate analysis showed independent associations of submucosal fibrosis at the angulus with ulceration (OR: 3.714, 95% CI: 1.041-13.249), procedure duration (OR: 1.037, 95% CI: 1.014-1.061), and perforation complication (OR: 14.611, 95% CI: 1.626-131.277) (all P < 0.05).
CONCLUSIONS: The gastric angulus demonstrates the highest incidence of severe submucosal fibrosis and ulceration for EGCs identified by ESD. This condition is linked to unfavorable outcomes, typically increased perforation risks and prolonged operation duration. Therefore, meticulous dissection is crucial for patients with EGCs in the gastric angulus.

Partial discharge (PD) is one of the major causes of insulation accidents in oil-immersed transformers, generating a large number of signals that represent the health status of the transformer. In particular, acoustic signals can be detected by sensors to locate the source of the partial discharge. However, the array, type, and quantity of sensors play a crucial role in the research on the localization of partial discharge sources within transformers. Hence, this paper proposes a novel sensor array for the specific localization of PD sources using COMSOL Multiphysics software 6.1 to establish a three-dimensional model of the oil-immersed transformer and the different defect types of two-dimensional models. \"Electric-force-acoustic\" multiphysics field simulations were conducted to model ultrasonic signals of different types of PD by setting up detection points to collect acoustic signals at different types and temperatures instead of physical sensors. Subsequently, simulated waveforms and acoustic spatial distribution maps were acquired in the software. These simulation results were then combined with the time difference of arrival (TDOA) algorithm to solve a system of equations, ultimately yielding the position of the discharge source. Calculated positions were compared with the actual positions using an error iterative algorithm method, with an average spatial error about 1.3 cm, which falls within an acceptable range for fault diagnosis in transformers, validating the accuracy of the proposed method. Therefore, the presented sensor array and computational localization method offer a reliable theoretical basis for fault diagnosis techniques in transformers.

BACKGROUND: The dental healthcare private sector in Riyadh city has been growing rapidly over the past few years; however, there is a lack of information on the accessibility and spatial distribution of private dental healthcare facilities (PDHFs) in the area. This study aimed to evaluate the spatial distribution of PDHFs in Riyadh city in relation to population density in each sub-municipality.
METHODS: The current information regarding the number, location, and operability of PDHFs in Riyadh city was obtained from the Ministry of Health. A total of 632 operating PDHFs were included with the precise location plotted on Quantum Geographic Information System software (version 3.32.1, Essen, Germany) using Google Earth. Four levels of buffer zones-1 km, 3 km, 5 km, and >5 km-were determined. The population statistics and mean monthly individual income per district were gathered from Zadd.910ths. Microsoft Excel (version 16.0, Microsoft, Redmond, WA, USA) and RStudio software (version 4.1.3, Posit Software, PBC, Boston, MA, USA) were used for additional data analysis.
RESULTS: There was an overall ratio of one PDHF per 9958 residents in Riyadh city. Olaya and Maather sub-municipalities had the largest PDHF-to-population ratios: (1:4566) and (1:4828), respectively. Only 36.3% of the city\'s total area was within a 1 km buffer zone from a PDHF. There was an overall weak positive correlation between the number of PDHFs and the total area in each sub-municipality (r = 0.29), and the distribution of PDHFs was uneven corresponding to the area (G* = 0.357).
CONCLUSIONS: There was an uneven distribution of PDHFs in Riyadh city. Some areas were underserved while others were overserved in several sub-municipalities. Policy-makers and investors are encouraged to target underserved areas rather than areas with significant clustering to improve access to care.

BACKGROUND: Sarcopenia is a progressive and systemic skeletal muscle disorder associated with an increased risk of hospitalization and adverse effects on survival. This study aims to investigate the prevalence and related risk factors of sarcopenia in people living with HIV using the revised European Working Group on Sarcopenia in Older People (EWGSOP2) definition.
METHODS: This cross-sectional study comprising 379 patients with confirmed HIV infection evaluated the appendicular skeletal muscle mass by employing the bioelectrical impedance analysis method. Muscle strength and functional mobility were analyzed using the five-time sit-to-stand test and the timed \"Up and Go\" test.
RESULTS: The prevalence rates of pre-sarcopenia and sarcopenia among people living with HIV were 3.4 % and 2.1 % according to the revised EWGSOP2 definition. Advanced age (Odds Ratio 1.07, p = .03), lower body mass index (Odds Ratio 0.79, p = .012) and CD4+ T-cell count below 500/μl (Odds Ratio 2.22, p = .007) were identified as significant factors associated with sarcopenia. Sarcopenia was also identified as a significant correlate of frailty (p < .001).
CONCLUSIONS: This is the first study examining the prevalence of sarcopenia in people living with HIV according to the revised EWGSOP2 clinical algorithm. Advanced age, lower body mass index and a poor immune status are determined as promoting factors of sarcopenia. Sarcopenia significantly correlates with frailty. Standardized clinical algorithms are essential for reliable sarcopenia diagnosis in people living with HIV in order to promote intervention strategies and to prevent adverse health outcomes.