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CD19+ cell counts and KREC copy numbers were significantly reduced in CVID patients compared to healthy controls as expected. KRECs are quantitative markers for B cell defects. We found low CD4+ cell numbers, recent thymic emigrants, and lymphopenia in some of the patients at diagnosis, which reminds the heterogeneity of CVID's etiology. In this study, a positive correlation was shown between CD19+ cell counts and KREC copy numbers. Low KREC copy numbers indicated B cell deficiency; however, high KREC copy numbers were not sufficient to rule out CVID.There is insufficient information on the role of micronutrient supplementation on the productivity of local breeder cocks in a tropical environment. The target of this research, thus, was to deduce the impact of dietary vitamin A incorporation on semen traits and testosterone concentration of local breeder cocks in a tropical environment. One hundred twenty-eight-matured Nigerian local breeder cocks aged 10-12 months were alloted to 4 groups (n = 32) a control group (A) was fed experimental diet supplemented with vitamin A at 0 IU/kg feed and supplemented groups (B-D) fed commercial poultry diet supplemented with vitamin A at 250, 500 and 750 IU/kg feed for 16 weeks. Every group was replicated 4 times with 16 birds in every a replicate. A quadratic typed optimization function was employed to determine the optimum vitamin A supplementation that statistically improved serum testosterone and semen quality indices in local breeder cocks. Semen profiling and serum testosterone concentration were analysed at week 4wever, other parameters estimated were not significantly influenced. It is concluded that vitamin A supplementation enhanced sperm quality in local breeder cocks.The widespread use of online search engines to answer the general public's needs for information has raised concerns about possible biases and the emerging of a 'filter bubble' in which users are isolated from attitude-discordant messages. Research is split between approaches that largely focus on the intrinsic limitations of search engines and approaches that investigate user search behavior. This work evaluates the findings and limitations of both approaches and advances a theoretical framework for empirical investigations of cognitive biases in online search activities about health-related topics. We aim to investigate the interaction between the user and the search engine as a whole. Online search activity about health-related topics is considered as a hypothesis-testing process. this website Two questions emerge whether the retrieved information provided by the search engines are fit to fulfill their role as evidence, and whether the use of this information by users is cognitively and epistemologically valid and unbiased.Persisting heparin-induced thrombocytopenia (HIT) is characterized by ongoing thrombocytopenia more than 7 days after stopping heparin. It is part of cases referred to as autoimmune HIT (aHIT). In contrast to typical HIT cases, aHIT involves heparin-independent platelet activation mechanism highlighted by a strongly positive functional assay done without heparin. We report the first case of persisting HIT after an elective abdominal aortic aneurysm repair presenting with arterial and venous thrombosis, and describe the potential role of intravenous immunoglobulin in such patients.INTRODUCTION/OBJECTIVES Interstitial lung disease (ILD) is a significant cause of mortality among patients with dermatomyositis (DM) or polymyositis (PM). There are two subtypes of PM and DM often complicated with ILD those with anti-aminoacyl-tRNA synthetase (anti-ARS) antibodies and those with anti-MDA-5-associated amyopathic DM (ADM). Our aim is to clarify the inflammatory and immunological differences between the disorders. METHODS We retrospectively collected consecutive patients with anti-ARS-ILD and those with anti-MDA-5 antibody-positive ADM-ILD. The serum concentration of 38 cytokines was measured using a cytokine panel. The relative risks for anti-MDA-5 antibody-positive ADM-ILD were examined with univariate and multivariate logistic regression models. Spearman's rank correlation coefficient was calculated between cytokine levels and clinical parameters in the disease. Levels of cytokines were compared between anti-ARS-ILD and anti-MDA-5-positive ADM-ILD patients (alive or dead) using Dunnett's test in the inflammatory and immunological features of anti-MDA-5-positive ADM-ILD and anti-ARS-ILD, we performed an observational study to measure serum cytokine concentrations before treatment using a multiplex immunoassay system.• Multivariate logistic regression models revealed that IP-10 was associated with the most significant relative risk for ADM-ILD with anti-MDA-5 antibodies.• Levels of IP-10 were elevated considerably in anti-MDA-5-positive survivors and nonsurvivors compared with the levels in anti-ARS patients.• These results suggest that IP-10 is the most deeply involved in the pathophysiology of anti-MDA-5-positive ADM-ILD.Competency-based medical education is emphasized by institutions overseeing medical school and postgraduate training worldwide. The high rate of preventable errors in medicine underscores this need. Expanding physician competency beyond the domains of patient care and medical knowledge towards goals that emphasize a more holistic view of the healthcare system is one aspect of this emphasis. The Accreditation Council on Graduate Medical Education (ACGME), which oversees postgraduate training programs in the USA, has recently expanded to oversee training programs internationally. The original ACGME Milestones effort unveiled in 2013 was met with skepticism. Nevertheless, other outcomes-based education programs worldwide, including the CanMEDS framework (Canada), Tomorrow's Doctor (UK), and Scottish Doctor (Scotland), have suggested that milestones do offer advantages. Missing from the milestone rollout, however, was collaborative buy-in from multiple stakeholders such as from clinician-educators. Consequently, Milestones version 2 is in development. Specifically, these will address the need for specialty-specific milestones, and the usage of harmonized milestones. A concise history of the push towards outcomes-based medical education is presented and contextualized for physicians who must embrace the transition from teacher-based to learner-based outcomes.