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Background Current recommendation for locally advanced cervical cancer includes pelvic external beam radiation therapy (EBRT) with concurrent chemotherapy followed by brachytherapy. Involvement of pelvic lymph nodes is an important prognostic factor in locally advanced cervical cancer and recurrence commonly occurs despite definitive treatment. To date, there is no standard guideline on whether an EBRT boost should be applied to involved pelvic lymph nodes. Our study aims to assess if pelvic EBRT boost would reduce recurrence, benefit survival, and affect associated toxicities. Methods We conducted a retrospective review of locally advanced cervical cancer cases treated with definitive treatment at our institution. Involvement of pelvic lymph nodes were assessed on CT, MRI (> 10 mm or suspicious features) or PET scan (SUVmax > 2.5). EBRT dose ranged from 45 to 50.4 Gy with nodal boost ranging from 3.6–19.8 Gy. Results Between 2008 to 2015, 139 patients with locally advanced cervical cancer underwent treatment. Sixty-seven patients had positive pelvic lymph nodes, of which 53.7% received a nodal boost. Five-year recurrence free survival was 48.6% with vs. 64.5% without nodal boost ( P  = 0.169) and 5-year overall survival in those with positive pelvic lymph nodes was 74.3% with vs. 80.6% without nodal boost ( P  = 0.143). There was no significant difference in toxicity with nodal boost. Conclusions EBRT boost to pelvic lymph nodes does not reduce recurrence or improve survival in locally advanced cervical cancer with lymph node involvement at diagnosis.

We report these first in situ observations of the Noah’s giant clams, Tridacna noae from Christmas Island. On two separate occasions during diving in Christmas Island, we found five unique individuals of T. noae , which were first identified by their mantle ornamentation patterns. These preliminary observations expand geographic range westwards from South China Sea to East Indian Ocean, and are compared with known information on current T. noae geographic distribution.

Talent development in youth football is crucial for clubs, academies, and national associations worldwide. To ensure that talented youths reach their full potential, a comprehensive understanding of the key factors that shape their development is imperative for all stakeholders, including coaches, parents, and sports organizations. This study conducted a systematic literature review (SLR) to identify the key factors influencing talent development in youth football. Methods: After a thorough review process, 27 articles were selected for the final analysis. The SLR examined current research to provide a comprehensive understanding of talent development in youth football. The examination identified seven critical elements that impact talent development: psychological, social, environmental, biological, educational, physical, and mental toughness and resilience. This research highlights the complexity of young football talent development. These results underscore the need for a comprehensive strategy that considers all seven variables. Young athletes, teams, and sports generally stand to gain from these ideas to enhance talent development programs. The potential for enhancing these programs is significant, inspiring a new wave of motivation in the field. Subsequent investigations need to examine the interplay between these variables in various temporal and contextual situations, with a specific emphasis on a comprehensive examination of how sociocultural elements impact talent development pathways. El desarrollo de talentos en el fútbol juvenil es crucial para los clubes, academias y asociaciones nacionales de todo el mundo. Para garantizar que los jóvenes talentosos alcancen su máximo potencial, es imperativo que todas las partes interesadas, incluidos entrenadores, padres y organizaciones deportivas, comprendan en profundidad los factores clave que dan forma a su desarrollo. Este estudio realizó una revisión sistemática de la literatura (SLR) para identificar los factores clave que influyen en el desarrollo de talentos en el fútbol juvenil. Métodos: Después de un proceso de revisión exhaustivo, se seleccionaron 27 artículos para el análisis final. La SLR examinó la investigación actual para proporcionar una comprensión integral del desarrollo de talentos en el fútbol juvenil. El examen identificó siete elementos críticos que impactan en el desarrollo de talentos: fortaleza y resiliencia psicológica, social, ambiental, biológica, educativa, física y mental. Esta investigación destaca la complejidad del desarrollo de talentos en el fútbol juvenil. Estos resultados subrayan la necesidad de una estrategia integral que considere las siete variables. Los atletas jóvenes, los equipos y los deportes en general se benefician de estas ideas para mejorar los programas de desarrollo de talentos. El potencial para mejorar estos programas es significativo e inspira una nueva ola de motivación en el campo. Las investigaciones posteriores deben examinar la interacción entre estas variables en diversas situaciones temporales y contextuales, con especial énfasis en un examen exhaustivo de cómo los elementos socioculturales impactan en las vías de desarrollo del talento. O desenvolvimento de talentos no futebol juvenil é crucial para os clubes, academias e associações nacionais de todo o mundo. Para garantir que os jovens talentosos atinjam o seu máximo potencial, é imperativo que todas as partes interessadas, incluindo professores, pais e organizações desportivas, compreendam em profundidade os factores chave que formam o seu desenvolvimento. Este estúdio realizou uma revisão sistemática da literatura (SLR) para identificar os fatores chave que influenciam o desenvolvimento de talentos no futebol juvenil. Métodos: Após um processo de revisão exaustivo, selecione 27 artigos para a análise final. O SLR examinou a investigação atual para fornecer uma compreensão integral do desenvolvimento de talentos no futebol juvenil. O exame identificou vários elementos críticos que têm impacto no desenvolvimento de talentos: fortaleza e resiliência psicológica, social, ambiental, biológica, educativa, física e mental. Esta investigação destaca a complexidade do desenvolvimento de talentos no futebol juvenil. Estes resultados submetem a necessidade de uma estratégia integral que considere as sete variáveis. Os jovens atletas, as equipas e os desportos em geral beneficiam destas ideias para melhorar os programas de desenvolvimento de talentos. O potencial para melhorar estes programas é significativo e inspira uma nova fonte de motivação no terreno. As investigações posteriores devem examinar a interação entre estas variáveis ​​em diversas situações temporais e contextuais, com especial ênfase num exame exaustivo de como os elementos socioculturais impactam as vias de desenvolvimento do talento.

The aim of this study was to compare kinetics, muscle activation and performance during resistance exercises between internal focus attention instructions, external focus attention instructions and control condition. Thirty (n = 30, mean age = 21.40 ± 0.93 years old) healthy men were recruited as participants and were asked to perform resistance exercises in three conditions; i) internal focus, ii) external focus and iii) control (no focus attention instruction). Participants performed 10RM squat and deadlift assessment in which kinetics, muscle activation and number of repetitions completed were recorded and analyzed during the exercises. Findings of this study revealed that external focus attention instruction produced greater force production and number of repetitions completed while at the same time lower muscle activity compared to the internal focus conditions. To conclude, external focus attention instructions were suggested to be adopted during resistance training due to its effectiveness to make movement more economic while producing greater performance in which will be more advantages for future adaptations.

The removal of macroalgal biomass is critical to the health of coral reef ecosystems. Previous studies on relatively intact reefs with diverse and abundant fish communities have quantified rapid removal of macroalgae by herbivorous fishes, yet how these findings relate to degraded reef systems where fish diversity and abundance are markedly lower and algal biomass substantially higher, is unclear. We surveyed roving herbivorous fish communities and quantified their capacity to remove the dominant macroalga Sargassum ilicifolium on seven reefs in Singapore; a heavily degraded urbanized reef system. The diversity and abundance of herbivorous fishes was extremely low, with eight species and a mean abundance ~1.1 individuals 60 m −2 recorded across reefs. Consumption of S . ilicifolium varied with distance from Singapore’s main port with consumption being 3- to 17-fold higher on reefs furthest from the port (Pulau Satumu: 4.18 g h −1 ; Kusu Island: 2.38 g h −1 ) than reefs closer to the port (0.35–0.78 g h −1 ). Video observations revealed a single species, Siganus virgatus , was almost solely responsible for removing S . ilicifolium biomass, accounting for 83% of the mass-standardized bites. Despite low herbivore diversity and intense urbanization, macroalgal removal by fishes on some Singaporean reefs was directly comparable to rates reported for other inshore Indo-Pacific reefs.

The 6-kDa early secretory antigenic target of Mycobacterium tuberculosis (ESAT-6) and the 10-kDa culture filtrate antigen (CFP-10), encoded in region of difference 1 (RD1) and secreted by the ESAT-6 system 1 (Esx-1) secretion system, are the most immunodominant and highly M. tuberculosis (MTB)-specific antigens. These attributes are responsible for their primary importance in tuberculosis (TB) immunodiagnosis and vaccine development. Rv3615c [Esx-1 substrate protein C (EspC)], encoded outside RD1, is similar in size and sequence homology to CFP-10 and ESAT-6, suggesting it might be a target of cellular immunity in TB. Using ex vivo enzyme-linked immunospot- and flow cytometry-based cytokine-secretion assay, we comprehensively assessed cellular immune responses to EspC in patients with active TB, latently infected persons, and uninfected bacillus Calmette-Guérin (BCG)-vaccinated controls. EspC was at least as immunodominant as ESAT-6 and CFP-10 in both active and latent TB infection. EspC contained broadly recognized CD4⁺ and CD8⁺ epitopes, inducing a predominantly CD4⁺ T-cell response that comprised functional T-cell subsets secreting both IFN-γ and IL-2 as well as functional T-cell subsets secreting only IFN-γ. Surprisingly, T-cell responses to EspC were as highly specific (93%) for MTB infection as responses to ESAT-6 and CFP-10, with only 2 of 27 BCG-vaccinated controls responding to each antigen. Using quantitative proteomics and metabolically labeled mutant and genetically complemented MTB strains, we identified the mechanism of the specificity of anti-EspC immunity as the Esx-1 dependence of EspC secretion. The high immunodominance of EspC, equivalent to that of ESAT-6 and CFP-10, makes it a TB vaccine candidate, and its high specificity confers strong potential for T-cell-based immunodiagnosis.

Introduction: Currently, most research on RAE in sports is focused on youth and top levels, leaving university athletes, especially in Malaysia, with very little information to work Objective: This study aims to investigate the RAE in more depth by adding variables such as gender, sports category, and the type of higher education school (IPTS/IPTA). Methodology: A quantitative research strategy was used with 4,683 athlete birth dates. The chi-square test showed that SUKIPT 2022 athletes had a high rate of RAE. Results: The distribution of athletes' birth dates over the four quarters of the year exhibited a substantial imbalance, as seen by the chi-square statistic (χ2 (3, N = 4683) = 59.618, p =< .001; V = 0.080). The data shows a strong RAE among players born in the fourth quarter, which could mean an RAE bias. The study also found that RAE was common among all genders and in various sports, including IPTA players. However, there was interesting RAE seen in athletes from private universities (IPTS) (χ2 (3, N = 1372) = 5.429, p =.143). Discussion: The results validate the presence of the RAE within the population of university athletes, indicating that variances in development could potentially impact the selection and performance of athletes. This study enhances the comprehension of the RAE within the university sports domain. It establishes a basis for forthcoming research endeavours to investigate approaches to alleviate RAE and foster equitable athlete growth and selection. Conclusions: The frequency of RAE in athletes competing for the university at the 2022 Higher Education Institution Games (SUKIPT).

The optimal treatment and molecular landscape of recurrent clear cell carcinoma of the vulva (VCCC) are unknown. No reported data exist regarding the efficacy of anti-programmed death 1 (PD-1) immune checkpoint inhibition in VCCC. We report on a patient with chemotherapy-refractory recurrent VCCC, who was found to have high tumor programmed death-ligand 1 (PD-L1) combined positive score (CPS), and subsequently experienced a durable partial response (PR), after treatment with off-label fifth-line pembrolizumab. A forty-year-old Filipino woman presented to our center with recurrent VCCC that had progressed on multiple prior lines of cytotoxic chemotherapy. She had a large 25 cm fungating left groin tumor causing marked lower limb lymphedema, pain and limited mobility. PD-L1 CPS by immunohistochemistry was 45. She was treated with off-label pembrolizumab monotherapy and had a dramatic clinical, biochemical and radiological partial response. The progression-free survival of this patient's VCCC after treatment with pembrolizumab, defined as the time from initiation of pembrolizumab until disease progression (by Response Evaluation Criteria in Solid Tumors (version 1.1)), was 8 months. While receiving pembrolizumab, she was diagnosed with concurrent secondary myelodysplastic syndrome with excess blasts (MDS-EB), thought to be related to her prior exposure to multiple lines of cytotoxic chemotherapy. This eventually progressed to acute myeloid leukemia (AML), leading to her demise. Overall survival from time of initiation of pembrolizumab till death was 16 months. Pembrolizumab was active in this patient with chemotherapy-refractory VCCC which harbored high PD-L1 CPS. Further studies to determine the role of immune check-point blockade in the treatment of VCCC are warranted.

Background: The optimal treatment and molecular landscape of recurrent clear cell carcinoma of the vulva (VCCC) are unknown. No reported data exist regarding the efficacy of anti-programmed death 1 (PD-1) immune checkpoint inhibition in VCCC. We report on a patient with chemotherapy-refractory recurrent VCCC, who was found to have high tumor programmed death-ligand 1 (PD-L1) combined positive score (CPS), and subsequently experienced a durable partial response (PR), after treatment with off-label fifth-line pembrolizumab. Case Presentation: A forty-year-old Filipino woman presented to our center with recurrent VCCC that had progressed on multiple prior lines of cytotoxic chemotherapy. She had a large 25 cm fungating left groin tumor causing marked lower limb lymphedema, pain and limited mobility. PD-L1 CPS by immunohistochemistry was 45. She was treated with off label pembrolizumab monotherapy and had a dramatic clinical, biochemical and radiological partial response. The progression-free survival of this patient's VCCC after treatment with pembrolizumab, defined as the time from initiation of pembrolizumab until disease progression (by Response Evaluation Criteria in Solid Tumors (version 1.1)), was 8 months. While receiving pembrolizumab, she was diagnosed with concurrent secondary myelodysplastic syndrome with excess blasts (MDS-EB), thought to be related to her prior exposure to multiple lines of cytotoxic chemotherapy. This eventually progressed to acute myeloid leukemia (AML), leading to her demise. Overall survival from time of initiation of pembrolizumab till death was 16 months. Conclusion: Pembrolizumab was active in this patient with chemotherapy-refractory VCCC which harbored high PD-L1 CPS. Further studies to determine the role of immune checkpoint blockade in the treatment of VCCC are warranted. Keywords: vulvar cancer, immune check-point blockade, immunotherapy, clear cell carcinoma

Conservative management is typically recommended for postpartum diastasis of the pubic symphysis, despite significant functional disability and chronic pain associated with this condition. With a reported incidence of 1:500, the authors describe diagnosis and management controversies with an additional review of relevant literature related to the management of this orthopedic condition. The case is of a 27-year-old woman diagnosed with 5.5-cm diastasis of the pubic symphysis after spontaneous vaginal delivery of a 5 lb 5 oz infant. She underwent early orthopedic surgical correction via open reduction and internal fixation. The patient achieved pain-free ambulation within 3 months of surgery, and returned to full activity at 6 months. Postpartum diastasis of the pubic symphysis is typically treated conservatively; however, the authors illustrate that early orthopedic consultation and intervention at diastasis greater than 5 cm may improve recovery and functional outcome. [ Orthopedics. 2016; 39(2):e367–e369.]