In the first stage, an sEMG encoder is trained via cross-trial mutual information maximization using the sEMG sequences sampled from the same time step but different trials in a contrastive learning manner. In the second stage, the learned sEMG encoder is fine-tuned with the supervision of gesture and hand movements in a knowledge-distillation manner. In addition, we propose a novel network called sEMGXCM as the sEMG encoder. Comprehensive experiments on seven sparse multichannel sEMG databases are conducted to demonstrate the effectiveness of the training scheme sEMGPoseMIM and the network sEMGXCM, which achieves an average improvement of +1.3% on the sparse multichannel sEMG databases compared to the existing methods. Furthermore, the comparison between training sEMGXCM and other existing networks from scratch shows that sEMGXCM outperforms the others by an average of +1.5%.To enhance the performance of surface electromyography (sEMG)-based gesture recognition, we propose a novel network-agnostic two-stage training scheme, called  In human–computer interfaces (HCIs), hand movements commonly offer a natural way for users to interact with the computer . There asEMGXCM  ,8,9 is tsEMGXCM . In this GengNet , Xceptio GengNet . The persEMGPoseMIM  association and invariant information across different trials. In the first stage, inspired by the study of mutual information (MI) [sEMGPoseMIM by comparing the performance of training using the scheme sEMGPoseMIM with that of training from scratch. In addition, the effect of the components of sEMGPoseMIM is verified.Specifically, ion (MI) , we aim ion (MI) . In addiion (MI)  to alignThe main contributions of this paper are summarised as follows.sEMGXCM, that captures the spatial and temporal features of sEMG signals as well as the association across different electrodes. The parameter number of the self-attention layer increases as the number of electrodes increases, so sEMGXCM is utilized for sparse multichannel sEMG signals.We design a new end-to-end convolutional neural network for cross-trial sEMG-based gesture recognition, namely sEMGPoseMIM for cross-trial sEMG-based gesture recognition. Specifically, the first stage is designed to maximize the mutual information between the pairs of cross-trial features at the same time step to produce trial-invariant representations. And the second stage models the cross-modal association between sEMG signals and hand movements via cross-modal knowledge distillation to enhance the performance of the trained network.We present a novel two-stage training scheme called sEMGXCM on the benchmark NinaPro databases is conducted, and the results show the superiority of sEMGXCM for cross-trial gesture recognition. Specifically, compared with the state-of-the-art network, sEMGXCM achieves improvements of +0.7%, +1.3%, +0.5%, +0.3%, +0.3%, +0.6%, and +1.0% on NinaPro DB1-DB7 [sEMGPoseMIM on NinaPro DB1-DB7. The experimental results show the superiority of sEMGPoseMIM for enhancing the cross-trial gesture recognition performance of networks. And the recognition accuracy of sEMGXCM from training it using sEMGPoseMIM is significantly higher than the state-of-the-art method by +1.3%, +1.5%, +0.8%, +2.6%, +1.7%, +0.8% and +0.6% on NinaPro DB1-DB7.A comprehensive evaluation of the proposed network  DB1-DB7 ,21,22,23The sEMG signal is recorded using electrode contact with the skin during the contraction of skeletal muscles , which isEMGPoseMIM is also formulated as multimodal training but is a unimodal evaluation.Besides the input of converted images, Côté-Allard et al.  employs In this work, our target is to learn trial-invariant representations of sEMG signals and make use of multimodal data during the training phase. Recently, mutual information (MI)  has beenTo model the inherent relationship between the sEMG signals and finger movements, cross-modal learning-based methods are reviewed next. We shall focus on the approaches designed for pattern recognition. Hu et al.  performesEMGXCM). Specifically, we demonstrate the architecture of the network and then explain the novelty of sEMGXCM.In this subsection, we present our improved network for cross-trial sEMG-based gesture recognition  or spatW and C denote the time window size and the number of electrodes, respectively. As 1D convolution filters slide over the time axis, the temporal stream shall capture the information across different timestamps. On the other hand, the spatial stream follows the architecture of GengNet [sEMGXCM. Finally, we performed classification with a softmax layer.As shown in  GengNet  as shown GengNet , a four-sEMGXCM, two streams that use 2D and 1D convolutional layers, respectively, to extract spatial and temporal features. In contrast, GengNet only uses 2D convolutional layers and XceptionTime only for 1D convolutional layers. Therefore, sEMGXCM can make use of both spatial and temporal information from the input sEMG signals. In addition to XCM [In the field of image classification, 2D convolutional layers that apply multiple filters, each with different weights, can learn to extract different types of spatial information from images . On the n to XCM , a self-sEMGPoseMIM, shown in In this subsection, we present a novel two-stage training scheme to enhance the networks for sEMG-based gesture recognition. As an instance of hybridization engineering , this trIn this work, mutual information maximization is applied during the training phase to learn a trial-invariant representation, which is significantly different from previous works, in which mutual information is used for channel or feature selection ,47. In ax, we aim to learn an encoder v and a gesture-relevant representation u, while v and u are expected to be disentangled. In other words, two conditional distributions Given an input sEMG sequence t of the i-th trial. For each anchor sEMG sequence, we match a positive sEMG sequence j. Then, an encoder An anchor sEMG sequence Equation :(1)max∑iu and trial-relevant representation v are conditionally independent as they are assumed to be disentangled. To ensure this disentanglement between u and v, a regularization term u and v shall be made mutually exclusive by minimizing this regularization term In fact, the gesture-relevant representation v and u is unavailable in our case. Hence, we utilize a likelihood estimator Q to predict a variational distribution q denotes the estimated possibility likelihood with the estimator Q. Meanwhile, Q is trained to minimize the KL divergence [Considering that the contrastive log-ratio upper-bound MI estimator  is consiEquation .(2)minEvergence  between Equation .(3)minQIn this paper, we assume that Equation  can be sOverall Objectives Given the pairs of input sEMG sequences Equation :(4)minE[To further enhance the discrimination of the representation learned in the first stage, we leverage cross-modal knowledge distillation to model the relationship between sEMG signals and hand movements. Specifically, we utilize a typical knowledge-distillation  method tnce loss  to the oObjectives We denote the input of the Softmax layer in the teacher network and the student network as c and N denotes the number of gestures to be identified. On the other hand, the formulation of KL divergence loss for the two modalities  is given as Equation (Equation .(5)LCE=Equation .(6)LKL=Z into the Softmax layer, respectively. Their formulations are displayed in Equation  aEquation :(7)p(xc)s softer . Then, tWe conducted evaluations on seven sparse multichannel sEMG datasets ,21,22,23We adopt the same data-preparation procedure as the previous work ,9,16 forlization  is leverThe evaluation metric in this paper is cross-trial gesture recognition accuracy, which is the same as ,16. SpecsEMGXCM and training scheme sEMGPoseMIM are implemented with PyTorch, and their codes will be open-sourced online upon acceptance. In the first stage of sEMGPoseMIM, Q consists of two fully connected layers. Q are simultaneously trained, and their learning rates are initialized at 0.001 and 0.005, respectively. The training epochs of Q are both set to 30. In the second stage of sEMGPoseMIM, the architecture of Our network i, we randomly select another trial j and sample from it at time step t to obtain the positive sEMG Next, we present how to generate pairs of sEMG signals of the first stage. We need to align the trials of each subject, due to the fact that the time lengths of trials slightly vary. Note that all the trials of each gesture follow the same dynamic process, which consists of three phases, making, holding, and ending gestures; we can align the trials via their minimum length by dismissing the information of the ending phase. After that, given an anchor sEMG sEMGXCM, on seven sparse multichannel sEMG databases . We train these networks from scratch on these seven datasets using the evaluation metric of cross-trial gesture recognition accuracy. As shown in the parentheses of sEMGXCM outperforms the other three networks. Among these networks, GengNet achieves the lowest cross-trial gesture recognition accuracy, and it exhibits the highest performance on NinaPro DB1 while demonstrating the lowest performance on NinaPro DB3. Compared with the state-of-the-art network , our network sEMGXCM achieves significant improvements of +5.4%, +2.9%, +1.2%, +7.5%, +5.6%, +5.7% and +5.3% on NinaPro DB1-NinaPro DB7.In this part, we conduct a fair comparison between four different networks, GengNet , XceptiosEMGXCM is derived from XCM [sEMGXCM for the specific task of sEMG-based gesture recognition. sEMGXCM achieves higher recognition accuracies than XCM on the evaluated datasets. On the other hand, we leverage the Wilcoxon signed rank test (p < 0.05) on each dataset to demonstrate the significance of the improvements brought by sEMGXCM. And the improvements and p-values (in brackets) are +0.7% (0.0176), +1.3% (0.0067), +0.5% (0.0218), +0.8% (0.0149), +1.1% (0.0097), +0.3% (0.0432) and +0.3% (0.0419), respectively. Thus, we can infer that the additional self-attention layer and the modified spatial stream contributed to the significant improvements.Note that from XCM ; we compsEMGPoseMIM, we trained four networks, GengNet [sEMGXCM, using the training scheme sEMGPoseMIM. The experiments were also conducted on NinaPro DB1-NinaPro DB7, and cross-trial gesture recognition was adopted as the evaluation metric. The comparisons between training from scratch and training via sEMGPoseMIM are displayed in sEMGPoseMIM outperforms the scheme of training from scratch regardless of the network architectures. The improvements achieved by training GengNet using sEMGPoseMIM are +1.1%, +9.2%, +16.0%, +2.6%, +4.9%, +3.7%, and +3.2%. As the performance of GengNet is far from optimal, the improvements brought about by sEMGPoseMIM are much more significant compared with the other three networks. With regard to the other three networks, sEMGPoseMIM could achieve improvements of at least +1.2% on the evaluated datasets. These results indicate the significant effectiveness of the proposed training scheme sEMGPoseMIM.To demonstrate the effectiveness of the proposed training scheme  GengNet , Xceptio GengNet , XCM [14sEMGXCM using the training scheme sEMGPoseMIM with that of existing sEMG-based gesture recognition approaches. This comparison was also conducted on NinaPro DB1-NinaPro DB7, and the evaluation metric of cross-trial gesture recognition accuracy was adopted. As shown in sEMGXCM+sEMGPoseMIM) outperformed the state-of-the-art approach CMAM [sEMGPoseMIM.Furthermore, we compared the performance of training ach CMAM , where hsEMGPoseMIM by comparing four training schemes, training from scratch, only on the first stage, only on the second stage, and on both stages . To train sEMGXCM only on the first stage, we fine-tuned the sEMGXCM, whose parameters are initialized in the first stage via cross-trial mutual information maximization. With regard to the second stage, we initialized the sEMG encoder using the Xavier Initialization method and trained the sEMGXCM, as in the second stage.We also validated the effects of each stage in sEMGPoseMIM contributes to its performance improvement. Compared with training from scratch, the cross-trial mutual information maximization in the first stage brought improvements of +0.7%, +0.2%, +2.1%, +0.7%, +0.8%, +0.8% and +0.7% over NinaPro DB1-NinaPro DB7. The effects of cross-modal knowledge distillation in the second stage over NinaPro DB1-NinaPro DB7 are +0.5%, +0.8%, +1.7%, −0.9%, +0.6%, 0.0% and +0.2%. On most datasets except NinaPro DB4 and NinaPro DB6, training only in the second stage outperformed training from scratch. When both stages were utilized, the performance improvements over the evaluated datasets were significant and improvements of at least +1.0% were achieved. These experimental results indicate that both stages of sEMGPoseMIM are essential for enhancing the classification model.As shown in sEMGXCM, we used the GengNet architecture to extract spatial features. The reason why we chose it lies in a good trade-off between the number of parameters and performances on the NinaPro datasets. In addition, GengNet achieved superb performance on high-density sEMG-based gesture recognition [In the proposed network ognition , indicatsEMGXCM largely outperforms classic models, which further indicates the effectiveness of the proposed network.Furthermore, we compared the results of classic models on NinaPro DB1 and NinaPro DB2 in previous works with the experimental results of training four networks to gain a more comprehensive insight. As depicted in , Random sEMGXCM. By capturing the spatial and temporal information of sEMG signals, as well as the correlation across different electrodes , sEMGXCM achieves superior performances on seven sparse sEMG datasets . Additionally, we introduced a novel two-stage training scheme called sEMGPoseMIM to enhance the classification model. Specifically, a trial-invariant representation is learned using mutual information maximization in the first stage. Subsequently, the inherent relation between the sEMG signals and hand movements is modeled via cross-modal knowledge distillation to obtain a more discriminative representation. To the best of our knowledge, mutual information and cross-modal knowledge distillation are for the first time simultaneously employed for sEMG-based gesture recognition. Moreover, our training scheme sEMGPoseMIM is network-agnostic and can be applied to most convolutional networks for gesture recognition based on sEMG.In this paper, we propose a novel end-to-end convolutional neural network for cross-trial gesture recognition based on sparse sEMG signals, namely sEMGXCM and sEMGPoseMIM, we conducted comprehensive experiments on NinaPro DB1-NinaPro DB7. The comparison between sEMGXCM and existing networks for sEMG-based gesture recognition was performed by training these networks from scratch on the seven datasets. The experimental results show that sEMGXCM outperforms the state-of-the-art network for cross-trial gesture recognition based on sparse sEMG signals. Furthermore, the proposed training scheme sEMGPoseMIM is utilized to train four different networks  for validating the effectiveness of sEMGPoseMIM. The results demonstrate that sEMGPoseMIM can bring improvement for cross-trial gesture recognition based on sEMG. Furthermore, an ablation study on the effect of each stage in sEMGPoseMIM was conducted, and the results suggest that every stage is required, as skipping any stage leads to reduced performance.To validate the effectiveness of Our future work will focus on the extension of the proposed training scheme on inter-subject or inter-session sEMG-based gesture recognition, which is much more difficult than cross-trial sEMG-based gesture recognition. We also plan to leverage a more effective approach to model the relationship between sEMG signals and hand movements, such as causal representation learning  and cont


Employing the optimal cutoff of 8.2 mmol/L, elevated CSF lactate resulted in a sensitivity of 81.5% and specificity of 61.5% for sepsis. In exploratory analyses, CSF lactate was also associated with in-hospital mortality with an odds ratio of 1.21 (p = 0.011). Elevated CSF lactate might contribute to early diagnosis of sepsis as well as prognostication in patients with community-acquired bacterial meningitis.Community-acquired bacterial meningitis conveys significant morbidity and mortality due to intracranial and systemic complications, and sepsis is a major contributor to the latter. While cerebrospinal fluid (CSF) analysis is essential in the diagnosis of bacterial meningitis, its predictive utility for detection of sepsis is unknown. We investigated the diagnostic performance of CSF parameters for sepsis defined by the Sepsis-3 criteria in a retrospective cohort of patients with community-acquired bacterial meningitis. Among 103 patients, 69.5% developed sepsis. CSF lactate was associated with sepsis with an odds ratio of 1.11 ( Community-acquired bacterial meningitis, an inflammation of the meninges affecting the pia as well as the arachnoid and subarachnoid space, is a disease with significant morbidity and mortality despite widely established diagnostic and therapeutic procedures . It is tS. pneumoniae, N. meningitidis and L. monocytogenes, which are detected in 72%, 11% and 5% of patients with community-acquired bacterial meningitis, respectively [S. aureus and coagulase-negative staphylococci, are more frequently encountered following invasive procedures. Patients with bacterial meningitis often have an acute or subacute symptom onset [In adult patients, the most prevalent causative pathogens are om onset . This poom onset . Early rom onset . Therefoom onset .Cerebrospinal fluid (CSF) analysis is the mainstay for establishing the diagnosis of bacterial meningitis, which cannot be proven without CSF examination . StandarS. pneumoniae or other bacteria, with the exception of L. monocytogenes [If the diagnosis of bacterial meningitis is established or treatment warrants initiation before a definitive diagnosis can be made, empiric anti-infectious treatment according to published guidelines and the local antibiotic resistance situation should be administered immediately . Followiytogenes ,20.Even in presence of adequate and timely treatment, infection and bacteremia can lead to sepsis, a frequent complication in bacterial meningitis and other infectious diseases with a high risk of multiple organ dysfunction and death. The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3) define sepsis as life-threating organ dysfunction caused by a dysregulated host response to infections . The earDespite being available in virtually all patients with confirmed bacterial meningitis, CSF parameters have not been evaluated as a predictive parameter for presence of sepsis in bacterial meningitis. We here aim to analyze the diagnostic utility of standard CSF parameters for the diagnosis of sepsis as defined by Sepsis-3 and show that elevated CSF lactate was predictive of sepsis in our cohort of adult patients with community-acquired bacterial meningitis.We retrospectively included all consecutive adult patients (age ≥ 18 years) treated at our tertiary university medical center between January 2009 and October 2022 according to the following criteria: diagnosis of community-acquired bacterial meningitis, based on cerebrospinal fluid (CSF) examination with either a proven pathogen or with CSF abnormalities highly suggestive for bacterial meningitis  ,23. CommFollowing lumbar puncture, the CSF was immediately analyzed as part of routine diagnostics using standard methods. CSF glucose content was determined with the hexokinase method, protein content was analyzed with the turbidimetric method, lactate was measured using enzymatic colorimetric assays based on the oxidation of lactate to pyruvate and white blood cell counts were evaluated using flow cytometry. Clinical information, including age, sex, symptoms at admission, infectious focus and agent, immunocompromised state, length of hospital stay and discharge condition, were registered. An immunocompromised state was defined as a history of alcoholism, diabetes mellitus, splenectomy, HIV infection or immunosuppressive medication. Functional outcome on discharge was rated according to the modified Rankin Scale (mRS) and further dichotomized as follows: mortality, mRS 6; favorable outcome, mRS 0 to 2. 2 was not available, the PaO2/FiO2 ratio was substituted by the SpO2/FiO2 ratio as described previously [Sepsis due to community-acquired bacterial meningitis was defined as an increase of the SOFA score of 2 or higher upon admission or until 48 h later . The SOFeviously .The study was reviewed and approved by the Ethics Committee of the Rheinische Friedrich-Wilhelms University Bonn, Bonn, Germany (no. 164/21). Written informed consent for participation was waived in accordance with national legislation and institutional requirements. t-test, Mann–Whitney U test, Fisher’s exact test and chi square test, where appropriate. Univariable logistic regression models were calculated to analyze the utility of CSF parameters for detection of sepsis. Results are presented as odds ratios (OR) with 95% CI. Receiver operating characteristic (ROC) curves were constructed for significant predictors. The area under the curve was determined and the corresponding 95% confidence intervals were calculated as defined by DeLong. Optimal cutoff values were determined with Youden’s J index. The significance level was set to alpha = 0.05 and all analyses were two-sided. Statistical analyses were carried out with R .Standard descriptive statistics were used for all data presented in the manuscript and parameters were compared between groups by student’s S. pneumoniae was the most common pathogen in 42.6% of patients, while no pathogen was identified in 19.4%. An immunosuppressive condition was noted in 29.1% of patients.A total of 103 consecutive patients with community-acquired bacterial meningitis treated at the authors’ institution between January 2009 and October 2022 were included in the analysis. The median age was 60 years  and 47.6% were female. Upon admission, headache was reported in 66.6%, fever in 67.4% and neck stiffness in 58.9%, while an altered consciousness was noted in 64.4% of patients. At least one of these four cardinal symptoms was present in 95.1% and all four were noted in 15.5%. The most frequent focus of infection was mastoiditis, otitis or sinusitis in 32.0%. CSF analysis revealed abnormalities in all patients. The median CSF lactate was 11.4 mmol/L , the median CSF glucose was 17.5 mg/dL , the median protein content was 3284 mg/L  and the median CSF white blood cell count was 2162/μL (350–6297). Among patients where CSF cell differentiation was performed (n = 90), the median CSF lymphocyte count was 203/μL  and the medium absolute CSF neutrophil count was 1279/μL , while the medium relative CSF neutrophil count was 88% .S. pneumoniae infection). Sepsis as defined by the Sepsis-3 criteria was present in 69.5% of patients within 48 h. Among these, Sepsis-3 criteria were fulfilled most frequently during the first 24 h . Patients with sepsis more frequently presented with altered consciousness, while the causative pathogen less frequently remained unknown compared to patients without sepsis  per increase in mmol/L, while CSF glucose and protein content as well as CSF cell counts were not , while CSF glucose and protein content as well as CSF cell counts were not (all p > 0.05, To confirm the clinical relevance of these findings, we performed further exploratory analyses constructing logistic regression models, including CSF parameters to predict mortality in our cohort. Here, elevated CSF lactate was associated with in-hospital mortality with an odds ratio of 1.12 (95% confidence interval, 1.03–1.24, We investigated the diagnostic performance of CSF parameters for sepsis in a retrospective cohort of patients with community-acquired bacterial meningitis. Among 103 consecutive patients, approximately 70% developed sepsis according to the Sepsis-3 criteria, most frequently during the first 24 h. CSF lactate was associated with sepsis, while other standard CSF parameters such as glucose and protein levels as well as cell counts were not. The optimal CSF lactate cutoff of 8.2 mmol/L resulted in a sensitivity of 81.5% and a specificity of 61.5%. In patients with bacterial meningitis, CSF analysis is always performed unless contraindicated and measuring lactate concentration is a widely available, cheap and rapid diagnostic test . AccordiLactate is produced during anaerobic glycolysis, which occurs in most tissues and results in conversion of pyruvate to lactic acid by the enzyme lactate dehydrogenase . Since tN. meningitidis and S. pneumoniae can use lactate as a carbon source in absence of glucose, thus sustaining bacterial growth as CSF glucose levels fall rapidly [Of note, elevated CSF lactate levels result from anaerobic central nervous system glycolysis and are independent of serum lactate levels, as the charged ion crosses the blood-brain barrier only very slowly ,31. CSF  rapidly .Although CSF lactate was reported to correlate with protein content and CSF cell counts to some extent in an etiologically heterogeneous cohort, the prognostic impact of other standard CSF parameters is much less pronounced . Lower CSepsis, a frequent complication in bacterial meningitis, conveys significant morbidity and mortality as well as an impaired quality of life among survivors ,40. AccoIn our study, about 70% of patients with community-acquired bacterial meningitis developed sepsis according to the Sepsis-3 criteria. Following the publication of these criteria, we could not identify any other studies reporting the incidence of sepsis among patients with bacterial meningitis. A study from 2006 by the Dutch Meningitis Cohort reported an incidence of sepsis or respiratory failure of 30–50% in pneumococcal meningitis, but without using internationally accepted criteria due to lack of data . The samOutside from bacterial meningitis, more than 250 biomarkers have been evaluated over the last few decades, and while C-reactive protein and procalcitonin as host-response biomarkers are frequently used in clinical care, none of them precisely differentiates between sepsis and sepsis-like syndromes . C-reactThe present study has all limitations of a retrospective single-center analysis. It was performed at a German tertiary academic medical center, which limits generalization, and statistical power is reduced by the sample size. Further, SOFA criteria were evaluated retrospectively. As the diagnostic utility of CSF lactate for prediction of sepsis was evaluated in the context of community-acquired bacterial meningitis, our data do not allow extrapolation of the findings to other diseases associated with elevated CSF lactate. Approximately 70% of patients with community-acquired bacterial meningitis developed sepsis according to the Sepsis-3 criteria. Elevated CSF lactate levels upon diagnosis were associated with sepsis and higher mortality in these patients. To our knowledge, this is the first study to show the importance of CSF lactate in the early detection of sepsis in meningitis. Prospective analyses are warranted to confirm these findings and refine the reported cut-off values.


Drain-associated intracerebral infections are life-threatening emergencies. Their treatment is challenging due to the limited penetration of antibiotics to the site of infection, resulting in potentially inadequate exposure. The emergence of multidrug-resistant pathogens might force the use of off-label intrathecal (IT) doses of antibiotics. We reviewed the literature on general aspects determining intrathecal dosing regimen, using pharmacometric knowledge. We summarised clinical experience with IT doses of antibiotics that are usually not used intrathecally, as well as the outcome of the cases and concentrations reached in the cerebrospinal fluid (CSF). Factors determining the IT regimen are the size of the ventricle system and the CSF drainage volume. With regard to pharmacometrics, pharmacokinetic/pharmacodynamic indices are likely similar to those in non-cerebral infections. The following number (N) of cases were described: benzylpenicillin (>50), ampicillin (1), ceftazidime (2), cephaloridine (56), ceftriaxone (1), cefotiam (1), meropenem (57), linezolid (1), tigecycline (15), rifampicin (3), levofloxacin (2), chloramphenicol (3) and daptomycin (8). Many side effects were reported for benzylpenicillin in the 1940–50s, but for the other antibiotics, when administered correctly, all side effects were minor and reversible. These data might help when choosing an IT dosing regimen in case there is no alternative option due to antimicrobial resistance. The incidence of community-acquired meningitis caused by multi-resistant micro-organisms is still low; however, these infections after neurosurgery might become more prevalent due to the overall rise in antibacterial resistance ,2. InfecBoth the blood–brain barrier and the blood–CSF barrier protect the central nervous system (CNS) from toxic compounds present in the systemic circulation. However, in the treatment of cerebral infections, both barriers complicate the achievement of adequate concentrations of antibiotics at the site of infection. Therefore, in some cases, extremely high intravenous doses have been administered, such as 24 g/24 h cefotaxime, 15 g/24 h meropenem or 8 g/24 h imipenem ,4,5. AnoCurrently, the number of antibiotics that are frequently administered, intrathecally, is limited. Only polymyxin B is registered by the FDA, and the EMA recommends maximum IVT doses of colistin of 125,000 IU ,7. HowevFor several antibiotics, IT use has been reviewed ,9,10. ThAs antibacterial efficacy is dependent on a certain antibiotic exposure that needs to be reached at the site of infection, the amount of antibiotics reaching the CSF as well as the resulting concentration–time profiles in the CSF are of importance. Several factors might be taken into consideration in choosing a dosing regimen for IT administration. Both the blood–brain barrier (BBB) and the blood–CSF barrier (BCSFB) are lipid layers surrounding the CNS aiming to protect the brain from toxic agents present in the systemic circulation. These barriers thereby limit the penetration of antibiotics to the site of infection when treating meningitis or ventriculitis. For example, the penetration of meropenem into the CSF in patients with (suspected) ventriculitis has a mean of only 9–18% ,16, and Meningeal inflammation during infection leads to the opening of tight junctions in the BBB. The level of inflammation, which is more pronounced in meningitis as compared to that in ventriculitis might, for some antibiotics, lead to an increased penetration into the CSF ,18. ThisStreptococcus pneumoniae and Escherichia coli might result in a relatively low permeability, while the penetration into the CSF in infections caused by Haemophilus spp. and Listeria monocytogenes is higher .,82.81,82Quinolones are known to have a potent seizure-inducing activity ,119. OveMycobacterium tuberculosis. Intraventricular doses of 1–2 mg per dose were administered for a prolonged duration without causing serious side effects. In one case, the levofloxacin dose was calculated assuming a CSF volume of 120 mL and a target CSF concentration of 8–10 mg/L [Two cases of intraventricular administration of levofloxacin have been described and summarised in –10 mg/L . During –10 mg/L . Both paChloramphenicol is an antibiotic that is little used in industrialised countries, but it is included in the WHO list of essential medicines to be used for several indications, such as meningitis . Three cIn all three cases that were described in detail, no side effects were reported . But, inDaptomycin is a cyclic lipopeptide that is used to treat infections due to Gram-positive micro-organisms. After systemic administration, daptomycin penetrates poorly into the CSF compartment, due to its low lipophilicity, significant protein binding and large molecular weight, thus resulting in insufficient concentrations to treat intracerebral infections ,121. In Intrathecal administration of the antibiotics described in this review is off-label and is limited to those patients for whom clinicians run out of therapeutic options. When used without administration/preparation errors, and with the exception of benzylpenicillin, the reported side effects are generally mild and reversible. As side effects have been reported after both IV and IT administration, and due to the lack of clear correlation between CSF concentrations and toxicity, it could be questioned whether the administration of extremely high IV doses puts patients at lower risk of side effects compared to IT administration. It is possible that the CSF concentration that is aimed for causes a toxic effect regardless of the route of administration. With the current limited knowledge of PK/PD in the CSF, it is not possible to choose an evidence-based efficacious dosing regimen, and also, routine TDM is not recommended in the literature. Generally, for lipophilic drugs with a molecular weight > 1000 g/mol and hydrophylic drugs with a molecular weight > 400 g/mol, once-daily IT dosing is usually performed . For antA search was conducted in PubMed using the name of the individual antibiotic in combination with ‘intrathecal’ or ‘intraventricular’. References from the papers included were also checked to find missing references. The antibiotics selected were based on those mentioned in the review paper of Nau et al.  as antib


Chipapillomavirus genus contains the largest number of canine papillomavirus (CPV) types. The Chipapillomaviruses are recognized to cause viral plaques in dogs. These plaques are usually multiple in nature and develop most frequently on the ventrum. In the present case, a dog developed a cluster of viral plaques that was confined to the concave surface of one pinna. Papillomaviral DNA was amplified and found to be a novel CPV type. As the novel type was the 25th PV identified in domestic dogs, the PV was designated CPV25. Many of the cells within the plaque showed PV-induced cell changes, suggesting that CPV25 was the cause of the plaques. As this is the first report of CPV25, this CPV type may rarely infect dogs and may be, at most, an uncommon cause of viral plaques in dogs. While further cases are required, CPV25 may cause canine viral plaques that develop at unusual locations and have atypical histological features.Papillomaviruses (PV) are known to cause a variety of skin lesions in dogs, including hyperplastic papillomas (warts) and viral plaques. There are currently 24 different PV types that are fully characterized in dogs. These PV types are divided into three genera. The ORF L1 showed the highest (83.9%) similarity to CPV15, and phylogenetic analysis revealed the novel PV clustered with the species 3 ChiPVs. The novel PV was designated as canine papillomavirus (CPV) type 25. As CPV25 was not previously detected in a canine viral plaque, this PV type may be a rare cause of skin disease in dogs. However, as plaques that remain confined to the pinna were not previously reported in dogs, it is possible that CPV25 could be more common in plaques from this area of skin. The findings from this case expand the number of PV types that cause disease in dogs. Evidence from this case suggests that, compared to the other canine ChiPV types, infection by CPV25 results in viral plaques in atypical locations with unusual histological features.A 14-year-old West Highland White terrier dog developed multiple raised plaques that were confined to the concave surface of the right pinna. Histology allowed a diagnosis of viral plaque, although the lesions contained some unusual microscopic features. A papillomaviral (PV) DNA sequence was amplified from the plaque using consensus PCR primers. The amplified sequence was used as a template to design ‘outward facing’ PCR primers, which allowed amplification of the complete PV DNA sequence. The sequence was 7778 bp and was predicted to code for five early genes and two late genes. The  ORF L1 is used to classify PVs with greater than 60% similarity, usually within the same genus; PVs with greater than 70% similarity within the same species; and PVs with greater than 90% similarity the same type [ChiPV genus contains the largest number of CPV types, with 14 ChiPV types subdivided into 3 species. PVs within genera typically cause the same lesions in closely-related host species [Papillomaviruses (PVs) are a common cause of hyperplastic, and an uncommon cause of neoplastic, disease in dogs . Papilloame type . There aame type . The Chi species .ChiPV genus [Viral plaques  are uncommon skin lesions of dogs. They typically appear as multiple small and slightly raised dark plaques over the ventrum and on the medial surface of the hind legs. These plaques typically remain small and are only of cosmetic concern. However, in rare cases, plaques can become extensive over the body or progress to neoplasia ,5. CaninPV genus .ChiPV is indicated.Herein, the complete genome of a novel PV type is described. The PV type was amplified from a plaque that developed on the pinna of a dog . The novA 14-year-old spayed female West Highland White Terrier presented with a 2 cm slightly raised flat plaque on the concave surface of the right pinna close to the ear canal. The mass was surrounded by multiple similar small plaques, but no plaques were present elsewhere on the body. A sample of the largest plaque was excised, fixed in formalin, and submitted for histological examination. Histology revealed moderate hyperplasia of the epidermis. Additionally, many of the cells, especially in the granular layer, were enlarged with clear cytoplasm surrounding a shrunken dark nucleus. Smaller numbers of cells contained slightly granular blue cytoplasm. These cell features were consistent with PV-induced cell changes  Neither https://blast.ncbi.nlm.nih.gov/Blast.cgi; accessed on 1 February 2023).A short section of a novel PV type was previously amplified from the lesion using the MY09/11 and CP4/5 consensus primers . The MY0A cotton bud moistened with saline was used to swab the affected area of the medial surface of the right pinna. DNA was then extracted from the swab using the same extraction kit as the fixed samples. PV DNA was amplified using the MY09/11 primers from the swab and sequenced. Outward facing primers were then designed using the sequence amplified using the MY09/11 primers. These primers allowed the circular nature of the PV DNA to be used to amplify the full genomic sequence. The primers  amplified an approximately 7500 bp region of DNA extracted from the swab of the pinnal plaque. The amplification was performed as previously described, and spades 3.15 and Geneious 10.2.6 were used to assemble the short sequences into a single sequence .ORFs, and regulatory sequences were predicted by comparing the novel sequence to this PV type, as previously described [As the novel PV was most similar to CPV15 (Genbank number JX899359), the putative viral genes, Complete genomes of 88 PV types from multiple genera were obtained from GenBank and aligned using MAFFT in Geneious v10.2.6 , and maxORF L1 that was previously amplified from formalin-fixed samples of plaque [Papillomaviral DNA was amplified from the swab of the plaques using the MY09/11 primers. These primers confirmed the presence of the same 357bp section of the ORF E6 was assigned number one in the sequence. As this is the 25th PV type detected in domestic dogs, it was designated CPV25.The complete genome of the CPV was 7778bp, with a GC content of 52.2%. The first nucleotide in the ORFs coding for five early genes  and two late genes  and C-terminal (aa 330–617) ATP-dependent helicase domains. An ATP-binding site (GPPNTGKS) was predicted at aa 454–461. PV DNA replication is dependent on cyclin/cyclin-dependent kinase complexes binding to the E1 protein , and twoORF E4. As in other PVs, this finding was identified in a different translation frame to the ORF E2 region. The CPV25 E4 protein has two proline-rich domains, but does not have a high proline content (15.4%).The CPV25 genome was also found to contain a putative ORF L1 and ORF L2 at 498 aa and 524 aa, respectively. As in other PVs, both L1 and L2 of CPV25 had many positively charged residues (K and R) in the C-terminal end, which are important in gaining entry into a host cell. The L1 protein had a Y-R dipeptide motif at aa 419–421, while the L2 protein had a furin cleavage motif (RXK/R-R) but no C-terminus L1-binding site at aa 488–491 (PXXP motif).The viral capsid proteins are coded by the L1 and L2 proteins. CPV25 was found to have both The CPV25 long-control region (LCR) is 422 bp in length (nt 7357–7778) between L1 and E6. While not coding for a protein, this region regulates transcription of viral genes. The CPV25 LCR contains four putative E2 binding sites, with a consensus sequence ACCN6GGT, at nt 7448, 7484, 7614, and 7691. No E1 binding site was identified.ChiPV genus  with high branch support. The ORF L1 nucleotide sequence of CPV25 is most similar to CPV15, with 83.9% similarity to this PV type , CPV10 (69.5%) and CPV14 (67.8%). In comparison, CPV25 is less similar to the species 1 (CPV12 most similar with 62.3% similarity) and species 2 ChiPVs (CPV4 most similar with 61.1% similarity). When compared to CPV types of other genera, CPV25 has 55.5% similarity to the LambdaPV CPV1 and 54.5% similarity to the TauPV CPV2. Comparison of CPV25 with PVs from other host species revealed the most similarity with Felis catus papillomavirus type 2 (59.1%) and Sus scrofa papillomavirus type 1 (59.1%).The maximum likelihood tree comparing CPV25 with other PV types demonstrated grouping within the PV genus . CPV25 c PV type . The CPVORF L1 was compared to those of other PV types, the only PVs that had greater than 60% similarity were all within the ChiPV genus. As PVs that share over 60% similarity in the ORF L1 are usually within the same genus, this strongly suggests classification of CPV25 within the ChiPV genus. Furthermore, as the CPV25 ORF L1 had the greatest similarity to the CPVs within species 3, it is most likely that CPV25 is the fifth species 3 ChiPV recognized to infect dogs.When the CPV25 ChiPV types [ChiPV, and as PVs within the same genus often result in similar clinical lesions [The detection of CPV25 DNA in the viral plaque could indicate that the plaque was caused by the PV. However, due to the frequency with which PVs are present as asymptomatic infections, simply detecting the PV does not prove that the PV caused lesion development . In the PV types . As CPV2ChiPVs being identified. However, despite the high number of plaques evaluated, CPV25 was not previously detected. While previous studies could have used methods that did not detect CPV25, the lack of previous amplification of this PV type suggests that CPV25 may be a rare cause of viral plaques in dogs. The presently described plaques were also unusual as they were confined to the pinna of the dog. To the authors’ knowledge, plaques in this location were not previously reported in dogs. Different PV types are recognized to preferentially colonize different areas of the body [Since the initial reports of pigmented plaques in 2004 , there hthe body . TherefoThe plaques in the present case were also unusual as they showed histological features that are not generally present in plaques identified at more common locations on the body. These atypical features include greater epidermal hyperplasia, frequent PV-induced cell changes, and a lack of pigmentation. Although it is necessary to identify additional plaques that contain CPV25, evidence from this case suggests that plaques caused by CPV25 may have histological features that are different to those in plaques caused by other CPV types.ChiPV types.The complete PV sequence was derived from a swab of the plaques. This approach was necessary as the diagnostic biopsy sample of the plaque was fixed in formalin and no additional tissue was available from the case. Formalin fixation causes breaks in the DNA strand that prevent larger sections of DNA from being amplified. The detection of CPV25 DNA within the swab suggests a productive infection within the plaque, with viral particles being present within the superficial epidermis. The presence of viral replication within the plaque was also supported by the numerous PV-induced cell changes visible within the lesion. Such florid PV-induced cell changes are rarely present within canine viral plaques, suggesting a higher than normal PV replication in the CPV25-associated plaque. Evaluation of additional plaques containing CPV25 will allow us to determine if this PV type consistently stimulates greater viral replication than other canine While the pathogenesis of canine viral plaques is not fully resolved, they are hypothesized to develop due to an inability of the immune system to suppress replication by PV types that are normally asymptomatically present on the skin’s surface . The preFurther research is required to determine how CPV25 infection alters cell regulation. However, CPV25 is predicted to have a E7 protein with a pRb binding site. As pRb inhibits cell replication, binding this protein could allow increased cell division within infected cells . In addiCPV25 is a novel PV that was identified within a viral plaque of a dog. This PV is the 25th PV fully sequenced from dogs. The presently described plaques were unusual due to their location and their histological features. As CPV25 was not previously identified in a canine viral plaque, this finding suggests the possibility that this PV type has a restricted location on the body and, when CPV25 causes lesion development, the infection results in unusual histological features.


Somatic mutations of CSF3R gene, encoding the granulocyte colony stimulating factor (G‐CSF) receptor protein, are detected in >60% of cases and have significantly helped to confirm CNL diagnosis. Two classes of CSF3R mutations have been described , but all result in hyperactivation of the down‐stream Janus Kinase (JAK) signaling.). At day 20 from AHSCT, hyperleucocytosis (85.6 G/L) mainly composed of neutrophils reoccurred, without receiving G‐CSF stimulation. BM aspirate showed persistent granular hyperplasia, but BM chimerism analysis surprisingly revealed that cells originated from donor (95% donor XY), arguing for an extrinsic stimulation, and that donor cells did not present the CSF3R T640I SNP (conversely to CSF3R R583H SNP). ELISA showed huge levels of G‐CSF in serum at 18300 pg/mL (N < 40). Serum monoclonal IgA Lambda was still detected (8 g/L) associated with 3% of BM PC. Overexpression of CSF3 mRNA in purified BM CD138+ PC was confirmed by Quantitative Reverse transcription polymerase chain reaction (RTq‐PCR), in favor of G‐CSF production by recipient PC  associated with hyperleucocytosis at 27.9 G/L with neutrophilia 81%) and monocytosis (9%). BM aspirate showed granular hyperplasia (84%) without significant dysplasia nor blast excess and a small percentage of dystrophic PC (1%). BM karyotype revealed a germline t in all metaphases without 1% and moBased on these results, diagnosis was finally revised to reactive neutrophilia to PCD (MGUS), and patient subsequently received bortezomib‐dexamethasone (BD). After three cycles of 21‐days regimen, a drastic reduction of neutrophilia to 9.9 G/L was observed associated with a 32% spleen size reduction and decreased serum monoclonal component . Concomitantly, a 37% serum G‐CSF level reduction was observed after two BD cycles  was misleading, but BM donor cells reproduced the CNL phenotype while being negative for CSF3R T640I SNP, which strongly supports his nonpathogenic role.[Overall, donor leukocytosis after AHSCT with persistent monoclonal IgA lambda originating from recipient PC, nic role., 9. ResuThe hypothesis that CNL and PCD diagnosis could be concomitant inspired a “monoclonal gammopathy‐associated CNL” entity. It is cuFinally, this report describes a correlated response to BD between PB neutrophils, spleen size, monoclonal component, and serum G‐CSF level., 12 ThesCW, CC, MD, SKH, CB, JR, CCL, JMM, AD, JL, and SDB followed the patient. VS performed cytological analysis. SC performed cytogenetic analysis. CM and AR supervised molecular analysis. IP supervised CFU‐G assay. ND and CW performed RTqPCR assay. SB, NB, and BC supervised and performed G‐CSF dosage. CW collected data and interpreted the results. CW wrote the manuscript. CB, JR, CCL, JMM, VS, SC, AR, IP, SB, ND, and SDB revised the manuscript. All authors approved the manuscript.The authors have no conflict of interest.The authors received no specific funding for this work.Institutional review board authorized report. The patient provided informed consent to germline genetic analysis and publication of clinical and genetic data.Supporting InformationClick here for additional data file.Supporting InformationClick here for additional data file.


The objective of this study was to investigate kidney recipients’ experiences within deceased and living donation contexts and, in the latter, by donor relationship type, to identify differences by context and mechanisms by which the relationship with the donor may impact recipients’ psychosocial well-being. Individual interviews were conducted with 12 participants and analyzed using Interpretative Phenomenological Analysis. Three themes emerged: (a) salience of and sensitivity toward sacrifice and loss, (b) honoring the sacrifice by honoring the gift, and (c) relational imbalance mirroring perceived burden of donation. Findings were contextualized in relation to the transplantation literature, and their clinical implications discussed. Kidney transplantation leads to changes in the psychosocial dimension of recipients’ lives in part through the relationship with the donor. A thematic synthesis of qualitative studies on living kidney recipients and donors  reportedBroader-level comparisons of living and deceased donation also point to particularities in ways through which the relationship impacts recipients’ well-being. One study  found thFor our analyses, we chose interpretative phenomenological analysis (IPA), a qualitative approach. IPA attempts to provide rich, detailed examinations of how each person makes sense of major life events. It is an idiographic approach, examining each individual case in depth prior to making more general claims . Thus, tThe research ethics board of the authors’ academic institution and the affiliated, collaborating hospital approved the study. Each participant gave written informed consent prior to the interview date. The first author  conducted one-on-one interviews of 90- and 120-minutes duration from a posture of openness. We selected Zoom, the online cloud-based videoconferencing service to reach participants across Canada. One interview was held over the telephone due to internet connectivity issues.We used a purposive sampling technique, ensuring that we recruited men and women who were at least 18 years old, fluent in English or French, and had undergone kidney transplantation in Canada a minimum of 6 months and a maximum of 10 years prior from a living or deceased donor. The 10-year cap was meant to restrain retrospective bias, and the 6-month lower limit was meant to make sure we selected participants who had time to recover and adjust to the transplantation. Prior to the study, participants had never had contact with the first author. The first author disclosed the purpose of the study to all participants and her pro-donation stance.We recruited participants through the transplant team of the hospital affiliated with the authors’ institution using a list of kidney recipients. We selected recipients transplanted at different timepoints and sent them a recruitment letter. The first author telephoned them 1 week later. Twenty-four did not respond, four expressed interest then ceased communication, and four completed the study. Participants were also recruited via announcements on the Kidney Foundation of Canada’s website and social media platforms. Thirteen recipients contacted us through this channel; three were excluded due to having been transplanted over 10 years prior, two stopped communication, and eight participated. Twelve participants completed the study in total. After the twelfth interview, data saturation was reached. We scheduled the interview upon receipt of completed consent forms and sociodemographic questionnaires sent by mail or email.R = 38–65, SD = 7.54), and range of time since transplantation of 14–91 months  at the time of the interview. Seven had a living donor: two received from a parent , three from a sibling , one from a cousin, and one from a friend. Five had a deceased donor. These participants are presented in Our sample was comprised of 12 participants (8 women and 4 men), with a mean age of 56.85 years , and the relationship with the living, known donor or anonymous, deceased donor pre- and post-transplantation (How would you currently describe your relationship with your living donor? How do you represent your deceased donor?). To record interviews, a digital audio recorder was used. The first author transcribed interviews. Each participant was assigned a pseudonym, and identifying information was deleted from study documents. Participants were not sent study materials.The first author engaged in reflective journaling, recording her impressions, exploring her potential influence on responses, and reflecting on her possible biases in the interpretation of narratives . During The six stages of IPA guided our analyses . As thesThree interrelated themes surfaced from participants’ discourse: (a) salience of and sensitivity toward sacrifice and loss, (b) honoring the sacrifice by honoring the gift, and (c) relational imbalance mirroring the perceived burden of donation. They are meant to capture our finding that the salience of the donor or donor family’s loss seemed to incentivize participants to honor the gift of donation by taking good care of their kidney. The last theme refers to differences in concerns about relational imbalance in the relationship with the donor that seemed to reflect the degree to which sacrifice and loss were salient.It just bothers me that their dad was taken, especially - at any age is awful, but I remember us as teenagers - our dad was there all the time. Especially if they were boys, their father is a role model, and I just think of how much he can help in their upbringing at that time, because high school - I don’t know, it just bothered me when I read that. . . . Maybe she [the donor’s wife] got married, and everything is good. I pray for the best for them all the time, but. . .yeah. The passage below illustrates the central thesis of this paper, that recipients of deceased and living donation are mindful of the donor’s sacrifice, and, for deceased donation recipients only, of the donor family’s loss and sacrifice. In turn, awareness of sacrifice and loss underlies their thoughts and actions. For instance, many recipients of deceased donation expressed sadness over their survival being linked to their donor’s death. The family’s grief and the cost of their decision to honor the donor’s wish to donate surfaced in many accounts:By corresponding with her donor’s wife through her transplant center, Kathryn learned that their children were adolescents at the time of his death. She expresses sorrow for the children’s loss, imagining how it would have affected her at their age. She envisions that the loss is compounded by the donor being of the same sex, thus a crucial model in their development. This process epitomizes projective empathy, which consists of putting oneself in another’s place and imagining what one would feel. Kathryn empathizes with the children to the degree that she seems to experience the sorrow she fears they experienced. Twice she states being “bothered” by their loss, in past and present tense, suggesting the feeling persists. She discloses praying for them, trailing off with “but. . .yeah,” an indication that doubts about their well-being remain.Sensitivity to loss also emerged in other participants’ narratives with variations finetuned to particularities of the donor family’s circumstances. For instance, if the deceased donor was a young person, participants voiced sorrow for their parents’ loss: “The only thing that one of the surgeons shared with me is that the organs were some of the healthiest he’d ever seen. And I kind of deduced from that that maybe it was a younger person. And that the family suffered a horrible loss.” . Several participants thought about the delay in the donor family’s mourning process resulting from surgery having to be completed before a funeral could be held: “I was at the hospital for three days while they did tests on that person. Imagine, the family can’t process their grief for that 3-to-4-day period. It’s a whole process for them, too.” . Taken together, deceased donor recipients demonstrated the tendency to imagine the specific circumstances of the family’s loss and sacrifice and feel sorrow on their behalf.She [donor mother] has high blood pressure. My grandfather, her father, died of a heart attack, so did the transplant team really look at her heart well?. . . She’s older, she could be scared, she deserves her retirement, we did not give her an easy life (laughs). So yeah, for a while I thought, oh, I’ll just wait on the deceased donor list and wait my turn, maybe that’s what I should do. For recipients of living donation, the donor’s sacrifice seemed salient. Type of sacrifice perceived and corresponding concerns varied with donors’ circumstances. For instance, two participants had parent donors of retirement age. Consequently, they expressed guilt rooted in their belief that they forced their parent to donate by virtue of needing a kidney and ultimately deprived them of relaxation at a life stage meant for leisure:Marilyn describes apprehensions about her mother’s offer of donation, recalling factors she interpreted as indicators of the fragility of her health, fear her mother may have felt, and concerns about interrupting her retirement. Her mother’s risk and sacrifice were at the forefront of her thoughts to the point where she considered refusing the offer.It wasn’t a question. I didn’t have to ask [him to donate]. It’s his selflessness, and it’s awe-inspiring. At the heart of everything, you peel back all life layers and things like that, he’s my brother and I’m his sister. And we might not see eye-to-eye on life decisions, but we’re still family and you’re going to do right by your family. Recipients of sibling and cousin donors also mentioned the donor’s sacrifice. However, most central to their narratives was the ease with which they inscribed the donation into the context of their family values. Expressions of sorrow or guilt over cost and sacrifice seemed absent, illustrated by Andrea’s passage about her brother’s offer of donation:Andrea was astonished by her brother’s immediate resolve to be her donor. She repeats that he offered without being asked, suggesting admiration and disbelief resurface while recounting the story. The donation is interpreted as an action extending from their familial bond and congruent with their family values. Andrea did not express perceived risks to which her brother could be exposed, contrasting with Marilyn’s account.She saved my life. You don’t forget that, right? She didn’t just give me something expensive, she gave me a part of herself at cost and risk. There’s always a risk for her now. She only has one kidney. So yeah, she’s definitely family. For Laura, the perceived risk incurred by her close friend and donor was prominent, echoing narratives of participants with parent donors:By exposing herself to “cost and risk,” her friend’s status shifted to that of family member. The salience of her donor’s sacrifice thus drove her perception of a more profound bond between them. Taken together, themes of sacrifice, cost and risk emerged for recipients in both donation contexts, attuned to particularities of the donor’s circumstances.Now I think it’s probably time that I do thank them for the gift that they have given, or their family member gave. Mainly to be able to say thank you for the 5 years and the potentially more that I would get. And to maybe build the relationship from here [via annual written correspondence] so that they can appreciate the gift they gave. And I have started finally last year, just before the 5-year mark, to write that thank you letter. Maybe partially I wanted to be sure that the kidney was going to be stable. I was maybe afraid of the connection and building the connection and then something happening to the kidney. Cognizance of the donor’s sacrifice and, in deceased donation, of the family’s loss, seemed to incentivize all participants to honor their kidney by taking care of it so that the donation would not be in vain:Caroline waited to accumulate evidence of the transplant’s success before writing the donor family a letter, hinting at her motive to protect them from the possibility of kidney failure because it would have been seen as rendering their sacrifice futile. Caroline now wishes for regular communication with the family “so that they can appreciate the gift they gave,” showcasing her incentive to demonstrate that the donor’s sacrifice served a purpose through the transplant’s success. Her reflections and decision-making around communication with the family, from staying silent to reaching out, seem based on sensitivity to their loss and desire to assuage it.I told myself, maybe the letter will bring back sad feelings for them, but at least they know that it served something: the donation was a success. Honestly, the letter I wrote was much more for them than for me. . . . If they wanted to meet, I would do it, but I wouldn’t ask because I’m scared of knowing the whole scope of the person’s background. Other participants also expressed concerns about the donor family:By considering how her letter could awaken their feelings of grief, Helen demonstrates sensitivity towards the donor family, like Caroline. She eventually wrote to them, led by the belief that the benefit they stood to gain from learning their gesture was not in vain would override the risk of exacerbating grief. Helen states wanting to assuage their loss and being willing to subvert her preference for anonymity by meeting them should they request it. In summary, taking care of the donor family by sharing the gift’s success emerged in the discourse of many recipients of deceased donation.It comes back to the word that I used, stewardship. I don’t own it. It’ll always partly be a part of the donor. Part of the donor is in me. So I don’t own it, but I’m the steward of it. I’m taking care of it for the person who unfortunately isn’t around to take care of it anymore. . . . I find myself incredibly lucky to have a part of someone else that’s keeping me alive. In a sense, I’m really just taking care of it. I think that propels me to do a better job of taking care of it. I think that’s a pretty high calling. As with Caroline and Helen, Erich’s thoughts revolve around his donor’s family’s loss, and his decision to write them was linked to his wish to offer them some modicum of comfort: “I know they suffered a horrible loss. And I just wanted to let them know that it was appreciated. I was really kind of hoping I might, in some way, assuage that loss.” However, he reported thinking about his deceased donor more often than Caroline and Helen did, and wishing to give back to him:Erich views himself as extremely fortunate to have received his donor’s kidney, stating his view that it will always belong to his donor as an extension of the latter. Erich defines his part in this equation as the kidney’s guardian. In turn, this responsibility seems to symbolize taking care of his donor, infusing Erich’s actions with the underlying meaning and purpose of giving back  transcending his own benefit.The kidney represents the sacrifice that Chloe made for me. I recognize that it’s a gift I received and the sacrifice she made to give it to me. So I don’t want to go out in public and risk getting sick, and potentially dying [from COVID-19] and not getting the use of the kidney that was intended when it was given to me. It’s definitely a driving factor in my decisions. Nathaniel, who received a kidney transplantation from his sister, expressed an overlapping view:We see echoes of Erich’s account regarding the view of oneself as the kidney’s guardian to honor the donor’s sacrifice rather than being solely for one’s own benefit. Altogether, among recipients of living and deceased donation, caring for the kidney and the success of the transplant carried the meaning and purpose of honoring the donor’s sacrifice, and, for some, giving back to the donor.I said to myself, maybe I would feel indebted. And maybe they would feel that I should be indebted towards them. Also, if I had socio-affective problems, I could fall in love with them and want to be part of their family, when in reality that’s not my mindset whatsoever. I appreciate anonymity. It’s a gesture of pure generosity, right? They gave without expecting anything in return, they don’t even know to whom they donated. The family could live in the same neighborhood as me or be people I’ve already come across or spoken to. It remains mysterious, and it’s very good like that. When I think about it, it’s in a positive way. I’m happy to imagine them without knowing them. Due to the emotional weight inherent to the notion of the donor’s sacrifice, and of the donor family’s loss among deceased donation recipients, participants expressed concerns about an imbalance in the imagined relationship with the deceased donor family or in the relationship with the living donor. Relational imbalance emerged as a key concern among participants in our sample, whether they detected it in their relationship or anticipated its occurrence in the future. Recipients with deceased donors voiced concerns about relational imbalance linked to the risk that the donor family would expect them to demonstrate indebtedness, and corresponding feelings of obligation that could arise. Recipients of living donation expressed concerns about relational imbalance that seemed to reflect the degree to which they perceived the donation to be a burden to their donor, and corresponding guilt and indebtedness. Below, Giuseppe shares his thoughts on hypothetically meeting his deceased donor’s family:Yeah, I think about the donor, possibly every day. Sometimes I feel he’s looking over me. ‘Cause I’ve had things happen to me in my life, I sometimes always have thought, was it him that saved me or helped me? Is he my protector? . . . He’s given me this gift, and it’s making me happy and giving me all the emotions that I could ever imagine because I’m alive. And I can’t see the person that has given it to me. It’s like I don’t know who I’m feeling all this love for. But it’s strong. And maybe that’s why I feel sometimes that, if the anonymous thing wasn’t so strict, like if I had a picture that I could keep in my purse, then I would know who I’m feeling all kinds of strong emotions for. But right now, I’m blind, and I don’t know who I’m feeling it for. Giuseppe perceives risks inherent to meeting the donor family stemming from their expectations of indebtedness. Unique to his account was the risk he expressed of developing loving feelings towards them. As his reflection unfolds, he underscores admiration for and the magic inherent to the altruism underlying anonymous deceased donation. For these reasons, he prefers to preserve anonymity. Most recipients of deceased donation also perceived anonymity as protection from risks related to relational imbalance, and a way of preserving the magic of donation. As such, they all voiced satisfaction with anonymity, with the exception of Kathryn:In perceiving her donor as her guardian angel, attributing positive outcomes to his benevolent influence, Kathryn’s attachment to him takes a different form than that of other participants. Her longing to gain more information to define the figure for whom she experiences strong affection is central to her discourse. The notion of risks involved in becoming acquainted with the donor family, related to relational imbalance or other, did not surface.The donation modified the relationship temporarily because I felt enormously indebted. I didn’t know how to react to the gift given to me. So I distanced myself a bit. My father felt it, and we had a good talk where he told me, ‘Stop being ridiculous. It’s not a gift I’m giving you, it’s a gift I’m giving myself.’ He wanted his son to live. So that changed my point of view and I felt better afterwards. But for several months, I felt bad to have forced someone to do this for me. To ask him, who had almost never been to the hospital, to undergo surgery, was something that troubled me, to force someone to do this. It’s like I felt less capable of looking him in the eye, as if I couldn’t tell him a big enough thank you. For both recipients of living donation with parent donors, relational imbalance was felt, detailed here by Tobias:Tobias experienced overwhelming feelings of indebtedness and guilt post-transplantation, stemming from the sacrifice surrounding the donation and his perception of forcing his father to donate. These feelings overpowered him to the point of rendering avoidance of his father, to whom he had always been close, his only recourse. Their relationship moved forward once his father reframed the donation as having benefited himself through saving his son, enabling relational symmetry to be restored. Marilyn was likewise concerned about the impact of relational imbalance on her relationship with her donor mother. Guilt and indebtedness led to self-imposed pressure to be excessively agreeable towards her mother, which conflicted with her wish to remain genuine. Marilyn cited the absence of her mother’s over-involvement and coercion in her post-transplantation kidney care as factors that facilitated her authenticity in their relationship.I told her there is no equality here. She was very clear that she didn’t want or need anything. And I know her to be completely authentic, and that was her heart. That was the process, to simply talk about it, not leave it unsaid. . . . It wasn’t something I could earn or give enough back. And that’s what drove me to talk about it, because I knew we needed to, because I didn’t want anything to destroy our friendship, and if that was there, that need to pay back, that would have destroyed it. ‘Cause it wouldn’t have been authentic’. Laura, whose donor was her close friend, also experienced feelings of indebtedness that threatened to destabilize their relationship:Laura is explaining, like Tobias and Marilyn, how imbalance in her relationship with her donor threatened to compromise it. As with Tobias, whose father mitigated perceived imbalance by explaining that the gesture served him, open communication was the solution; in contrast with Tobias, Laura, and her donor acknowledged the inevitability of asymmetry in their relationship to salvage it. Paradoxically, relational imbalance needed to be accepted to prevent Laura’s indebtedness from jeopardizing their relationship. Overall, similarities and subtle differences in relational challenges and ways of resolving them emerged between participants.If I tell somebody about my transplant, it’s like, I got this from my sister. That’s the kind of family I come from. It’s an opportunity to brag a bit about my family and the generosity and kindness. I think about it as, I’m pretty darn lucky that I’ve got this, and that I’ve got the family that I’ve got. . . . It represents, for me, some of the family that I have, and the values that my family has. Recipients of sibling donors did not mention relational imbalance. The donation appeared to be more assimilable into their relationship than for other donor types, allowing gratitude and admiration to be their focus:For Ramira, the kidney holds significance that goes beyond her donor, symbolizing her close-knit family and their love for one another. Similarly, for other participants who had received from siblings, appreciation for the donor was predominant in narratives. Indebtedness, guilt, and relational imbalance did not surface.Vanessa’s account differed from others in certain ways. Her kidney’s functioning had not yet stabilized, and she had experienced numerous complications post-transplantation. Her narrative included a focus on whether her kidney’s performance would stabilize, and frustration with the medical team’s lack of transparent and empathic communication with her and her potential donor at the time.The primary objective of the present study was to explore kidney recipients’ transplantation experiences with a focus on the donor relationship. Its secondary objective was to explore similarities and divergences between deceased and living directed donation contexts and, within the latter, by type of donor relationship. We adhered to the 32-item Consolidated Criteria for Reporting Qualitative Studies COREQ; , as wellThe first theme showcases that participants’ narratives often focused on the sacrifice, risk, and cost surrounding donation sustained by the donor and/or donor family. Perceived risk and cost varied according to donors’ circumstances. Deceased donation recipients were prone to sadness for the donor’s death and to imagining their family’s loss in detail, consistent with studies reporting kidney recipients’ expressions of grief for the unknown, deceased donor , and worIn the first theme, differences appeared between recipients of living donation with parent and friend donors, and those with sibling and cousin donors with concerns about sacrifice, risk and cost of donation emerging in the former group only. Narratives of participants in the latter group echoed that of a kidney recipient with a spouse donor in Studies cite the donor’s sacrifice, physical cost of donation, and perceived ongoing risk to the donor as potential factors underlying higher levels of guilt reported by living kidney recipients compared to those of deceased donation . Our resThe idea that honoring the gift is partly incentivized by the wish to honor the sacrifice involved in donation echoes prior research, such as While regulations governing Canadian transplant centers at the time of the interview did not permit recipients and donor families to meet, the idea of a meeting stirred up concerns about relational imbalance for most deceased donor recipients, notably that the family would expect them to demonstrate indebtedness. Relational imbalance was a reason for preference to maintain anonymity expressed by most participants and consistent with previous studies reporting satisfaction with anonymity among most donors and recipients . One parAmong recipients of living donation, the degree of relational imbalance perceived or apprehended, and corresponding indebtedness and guilt, were related to perceived risk incurred by donors. Recipients of sibling and cousin donors did not mention imbalance as an emergent relational issue post-transplantation, but recipients of parent and friend donors did. Their concerns regarding relational imbalance were tied to self-imposed pressure to show gratitude, replicating recipients’ reports from previous studies . ParticiThis study had some limitations. By expanding the outer bracket of time since transplantation to 10 years, the potential of retrospective bias to influence responses was greater. This choice was made to recruit participants across Canada via the Kidney Foundation of Canada, who tended to have a longer time since transplantation than participants recruited through the hospital. Moreover, in including 12 participants, our sample surpassed the recommended limit of 10 by authors of IPA . We tookThis study sheds light on recipients’ transplantation experience, focusing on the relationship with the donor and exploring variances by donation context  and donor type. Findings underscore salience of the burden of donation and recipients’ related sense of responsibility to demonstrate that the donation wasn’t in vain. Among deceased donation recipients, this led to susceptibility to being influenced by the donor family’s wishes. Narratives of participants with living donors emphasized concerns about relational imbalance mirroring perceived burden of donation and corresponding guilt and indebtedness, apart from recipients of sibling or cousin donors. Anonymity was described as protection from issues with the deceased donor family related to relational imbalance. One participant reported being insufficiently informed and supported by healthcare practitioners, fueling distress and persistent preoccupation with events surrounding the transplantation. Future studies should investigate whether themes and associations we have drawn between them emerge in other participant groups and under which circumstances. Examining whether salience of the burden fuels guilt and indebtedness stemming from a sense of inflated responsibility, and whether these feelings exacerbate focus on the burden would be of value as they would inform interventions focused on breaking this self-reinforcing loop. This topic is relevant for recipients of deceased and living donation. In the latter, investigating circumstances in which the burden is felt most strongly (e.g. donor type), and helpful coping mechanisms would be of clinical relevance. A finetuned understanding of these issues would contribute to delivery of support informed by recipients’ collective challenges and would ultimately strengthen post-transplant care.Our findings have implications for clinical work aiming to improve psychosocial well-being of kidney transplant recipients. We recommend that transplant teams engage in open dialogue with recipients and, where applicable, with donors before transplantation about potential strategies to mitigate feelings of responsibility, indebtedness, and guilt. Moreover, even though most participants reported adaptive coping, psychological challenges emerging from narratives emphasize the need for accessible psychological services. Psychological interventions could address key themes of guilt, indebtedness, and responsibility, in addition to challenging perceptions around the perceived heavy burden of donation and providing alternative ways of framing the donation. We recommend that health care professionals and transplant center regulations address recipients’ need for more information about the donor or to meet the deceased donor family, while maintaining awareness of their vulnerability to being influenced by the donor family’s wishes.Click here for additional data file.sj-docx-1-hpq-10.1177_13591053221149780 for The psychosocial adjustment of kidney recipients across donation contexts by Sophia Bourkas and Marie Achille in Journal of Health PsychologyClick here for additional data file.sj-docx-2-hpq-10.1177_13591053221149780 for The psychosocial adjustment of kidney recipients across donation contexts by Sophia Bourkas and Marie Achille in Journal of Health PsychologyClick here for additional data file.sj-docx-3-hpq-10.1177_13591053221149780 for The psychosocial adjustment of kidney recipients across donation contexts by Sophia Bourkas and Marie Achille in Journal of Health PsychologyClick here for additional data file.sj-docx-4-hpq-10.1177_13591053221149780 for The psychosocial adjustment of kidney recipients across donation contexts by Sophia Bourkas and Marie Achille in Journal of Health Psychology


Mythimna loreyi Duponchel (Noctuidae) is reported on several gramineous hosts worldwide. It attacks particularly maize and reduces yields significantly. It is a native species in East Asia and found in the Near and Middle East, Australia and Africa. Recently, this insect emerged in Tunisia. It was detected abundantly during surveys carried out as part of a research project on the invasive insect pest Spodoptera frugiperda threatening maize, sorghum and other cereal crops in Africa. This work carried out the first investigations on its morphological and molecular identification, distribution, population density and damage in Tunisia. Surveys were carried out in four regions in the north and south of Tunisia where mostly maize and sorghum were planted . Morphological characterization was based on male genitalia. Molecular identification was determined based on mitochondrial cytochrome oxidase I sequences (mtCOI). Field-collected data included adult monitoring using traps, infestations, and incidence of the pest. Correlations with whether parameters were studied. Overall, our results indicated that M. loreyi was well established in all prospected areas in Tunisia. Therefore, a control program is needed to manage this pest. Additionally, the threat of this insect on strategic cereal crops in Tunisia (wheat) should be further investigated.M. loreyi was abundant in all prospected areas, with total adult captures reaching 4779 and 9499 moths on sorghum and maize, respectively, during 2020. Moreover, the mean infestation percentage reached its maximum during August at 31.05% and 20.69% for the Jendouba and Bizerte regions, respectively, while the highest infestations were observed in the Gabes and Nabeul regions during July, with respective mean values of 13.54% and 21.35%. In addition, results revealed that the highest pest incidence occurred in the Gabes region, with values of 11.1 ± 0.47 and 5.7 ± 0.48 during 2020 and 2021, respectively. Additionally, results pointed out that M. loreyi achieved two summer generations in the different localities of Tunisia. Overall, this study provides basic insights into the ecology and population biology of M. loreyi, which are required to establish an effective pest control program.Surveys were conducted during 2020 and 2021 to study the emerging lepidopteran pests inflicting cereals in Tunisia, with specific emphasis on maize and sorghum crops. A species was collected from traps placed in the Jendouba, Bizerte, Nabeul and Gabes regions. Thus, this study carried out first report on its identification, distribution, population density and damage. Results showed that  Mythimna (= Leucania) loreyi  (Noctuidae) is commonly called the Loreyi leaf worm, cosmopolitan rice armyworm, rice cutworm, cereal armyworm, or false armyworm [Arundo donax, Avena sativa, Oryza sativa, Pennisetum purpureum, Saccharum officinarum, Sorghum bicolor, Triticum aestivum, Triticum durum and Zea mays), two Solanaceae species  and one Fabaceae species (Cicer arietinum) [M. loreyi has emerged in Africa, Australia, the Middle East and Asia [The maize caterpillar armyworm ,4. This armyworm . It undearmyworm ,7. It isietinum) ,10,11. Mand Asia .M. loreyi infests particularly maize and reduces yields significantly when attacks occurred just before silking and pollination. Likewise, Qian et al. [M. loreyi, leading to the best biological performances . Earlier, Kornosor [M. loreyi is a leaf feeder that invades maize from early growth stages (2–4 leaves) to pollen shedding and induced severe losses mainly on late-sown maize. Similarly, Sertkaya and Bayram [M. loreyi caused substantial economic damage to Z. mays. Additionally, Guo et al. [M. loreyi usually occurred together with the closely related species Mythimna separata  and caused considerable damage to host plants. Caterpillars bore into host plants and attacked the developing flower spikes. Moreover, Hirai et al. [M. loreyi induced significant losses on crop production.Kornosor  reportedn et al.  indicateKornosor  cited thd Bayram  indicateo et al.  reportedi et al.  cited thMythimna loreyi attacks all parts of maize plants except the roots [M. loreyi population dynamics in the field [he roots . Newly hhe roots . It is che roots , althoughe field .M. loreyi [M. loreyi can develop, survive and lay eggs at temperatures ranging between 18 and 30 °C. Furthermore, temperature has greatest influence on insect multiple life-history variables, seasonality, insect activity and population dynamics in the field [In this regard, previous research indicated that climatic parameters such as temperature, relative humidity, rainfall, and wind speed significantly influenced the population dynamics of . loreyi . Further. loreyi . Accordi. loreyi , M. lorehe field .M. loreyi generations varied from one country to another; for Korea, one generation has been observed against two generations in the Netherlands, North America, and Costa Rica [M. separata caused greater damage to crops. Similarly, these authors demonstrated that study of insect densities could extend our knowledge of the agricultural pest’s biology and assist to develop appropriate management strategies.The number of sta Rica . In the sta Rica . Additiosta Rica  indicatesta Rica  showed tZ. mays and Sorghum sp. in Tunisia. Additionally, the threat from this noctuid has become pronounced during the years 2020 and 2021 due to climate change, like increase in temperature. Consequently, there was an urgent need to identify this insect pest and investigate its population biology in different regions and various local climatic conditions. We focused in the present work on its morphological and molecular identification, distribution, population density and damage assessment. Moreover, we aimed to evaluate the influences of climatic parameters on seasonal fluctuation of M. loreyi and to highlight their potential importance in the improvement of pest management programs in Tunisia.Maize and sorghum are secondary cereal crops in Tunisia with limited planting areas, mainly used to ensure fodder production ,27. To tM. loreyi was conducted for two years, 2020 and 2021, in Z. mays crops in four regions of north and south Tunisia where maize is planted . Two fields were chosen in each region, where no pesticides or chemical fertilization were applied.The survey for M. loreyi was reported in Description of surveys’ localities of Meteorological data of each site were taken from the nearest meteorological station to the sampled fields . Mean moThe Gabes region, located in southeastern Tunisia, presented monthly average temperatures around 10 to 12 °C in winter against 30 °C in summer. Moreover, Jemai et al.  reportedFor the Bizerte region, temperature varied between 7 °C as a minimum and 31 °C as a maximum during winter and summer, respectively. The annual average rainfall was between 510 and 638 mm .Since maize and sorghum are grown in Tunisia as summer crops, regular sampling was conducted during the period from June until September of each season. For immature insect stages, 30 leaves were weekly and randomly sampled from 30 host plants. Samples were taken to the laboratory and examined under a binocular magnifying glass to determine the number of eggs, larvae and pupae.The adult population was monitored with plastic funnel traps baited with sex pheromone components as lures ,32. More®, Russel IPM®, Ltd., Flintshire, UK, Universal moth trap) suspended about 1.5 m above the ground and installed in the fields (Spodoptera frugiperda (Smith 1797) sex pheromone  was employed and was replaced every 4 to 6 weeks depending on weather conditions. S. frugiperda sex pheromone lures were used as the initial objective of the surveys was to monitor the presence of this insect. In fact, this work is a part of a research project conducted through a consortium of many African countries and aims to develop an IPM program against the FAW for sustainable food security in Africa that was initiated after the invasion of this pest in Africa occurring first in 2016 in Nigeria. Catch records were taken weekly.Adult moths were monitored using pheromone funnel traps, moth catchers or buckets  [M. loreyi normally occurs in the soil, this stage was deliberately excluded from the survey. Moreover, sprayed fields were excluded from the survey.Survey for 10–15 m) . The numSamples were carefully examined to determine the total number of infested leaves and the number of pre-imaginal stages on each infested leaf .(1)PestTo identify the specimens, the abdomen was boiled in 10% KOH for approximately ten minutes. Then, the macerated abdomen was kept in 70% alcohol. After that, the genitalia were stained in 1% chlorazol black which was dissolved in 30% alcohol and cleared in 70% alcohol. Finally, specimens were identified according to Rungs .The DNA was extracted from five samples. DNA from each individual sample (leg) was isolated using the chelex 100 resin method as described by Otim et al. . Before Polymerase chain reaction of all the moth adult samples was carried out as explained by Otim et al.  using prw/v) agarose gels  stained with 5 μL of ethidium bromide, visualized under UV light to confirm the presence of the amplicon and photographed using a digital camera in U: GENIUS3 gel documentation system .The mitochondrial DNA cytochrome c oxidase subunit 1 (mtCOI) gene of all the samples was amplified by polymerase chain reaction (PCR) using the LCO1490 and HCO2198 primer set in a 25 μL volume per reaction. The PCR mixture consisted of 16.25 μL of nuclease-free water , 2.5 μL of 10× Dream Taq green buffer, 0.5 μL deoxynucleotide triphosphate (dNPTs) (10 mM) (Thermo Fisher Scientific Inc.), 1 μL of each primer (10 Pmol/μL), 0.25 μL of Dream Taq DNA polymerase (Thermo Fisher Scientific Inc.), 2.5 μL of 5% Tween 20  and 1 μL of the template DNA. The PCR thermocycling conditions were performed in a Biometra thermocycler  as follows: 94 °C (2 min) for initial denaturation, followed by 35 cycles of 94 °C (30 s), 52 °C (35 s) and 72 °C (45 s) and a final extension step at 72 °C for 10 min. Post PCR reactions were stored at 4 °C until time for sequencing. PCR products were visualized by electrophoresis in 1× TAE buffer 1.5% . The sequences were then aligned in MEGA 7 [After sequencing, the sequence trace files were processed using pregap 4 and gap 4 . After pn MEGA 7  and the p ≤ 0.05 using Duncan’s test. Comparisons were made between regions and crop seasons using one-way ANOVA followed by the Duncan test. Sampling data of each developmental stage of M. loreyi during the two seasons 2020 and 2021 were analyzed using generalized linear models (GLM). When necessary, data were transformed by common logarithm to meet the assumption of normality. To establish the relationships between weather parameters and M. loreyi flight activity, Bravais-Pearson «r» coefficient was calculated.Statistical analyses were performed in order to understand data using the SPSS statistical software version “20” . For eggMythimna: the Female body (♀) measured about 14 mm  were sequenced. Maximum-likelihood inference resulted in our samples (5 and 7) . Table 2Infestation percentage was evaluated during plant growth. The infestation was determined based on the total number of infested leaves per total number of collected leaves.In 2020, the infestation reached its maximum during August with mean percentages of 31.05% and 20.69% for Jendouba and Bizerte, respectively, while the highest infestations were observed in the Gabes and Nabeul regions during July . In 2021M. loreyi was determined based on the mean number of the immature stage . For the assessment of M. loreyi incidence, results indicated that Jendouba was the region where the incidence of the insect was the most important  along the cycles of host crops. Results showed that flight activity depends on different parameters such as region and capture period. Moreover, the highest numbers of captured adults have been observed during July and August on maize, with captures reaching 1383 moths during 2020 for the Jendouba region against 3681 moths during 2021. However, the results reported in M. loreyi was first observed at the beginning of June, which coincides with Zea mays vegetative stage. The number of captured adults increased as the crop developed, reaching its maximum in July (corn cob formation stage). The number of emerging adults varied significantly with locality . In addition, statistical significant differences were observed between the two years .From June until September (the period during adults flying), the females laid their eggs on the maize leaves. During July and August, the egg numbers were higher than those registered during June and September for the Jendouba and Bizerte regions. Though for the Nabeul and Gabes regions, the highest number of eggs was observed during June.Larval activity was monitored during July and August. A significant increase in the larval population was observed during the first two weeks of August . The firZea mays) and (Zea mays and Sorghum sp.). The results revealed that M. loreyi occurred on both crops and that the captures depended on the region and the crop. The total numbers of captured adults were 100, 1578, 91 and 29 on maize during 2020 and 1220, 24, 26 and 25 during 2021, respectively, for the Jendouba, Bizerte, Gabes and Nabeul regions against 1112, 3126, 61 and 62 during 2020 and 237, 0, 4 and 0 during 2021 on sorghum for Jendouba, Bizerte, Gabes and Nabeul.The total monthly number of adult moths captured in the four regions of Tunisia from June to September during 2020 and 2021 is illustrated on p ≤ 0.00). Moreover, significant differences have been detected between crops . Additionally, the interaction between region X crops showed significant differences .Statistical analysis revealed high significant differences between regions in relation to total numbers of captured adults . However, no significant correlations have been observed between captured adults and humidity and rainfall  influenced negatively M. loreyi emergence. Our research is in accordance with previous work, which noted that insect pest population dynamics were highly dependent on climatic parameters [M. loreyi is becoming one of the most serious grain pests in Africa. M. loreyi presents multiple generations per year [M. loreyi populations could complete two generations at 30 °C. Moreover, obtained data showed significant differences on the number of captured adults between years and between months, which could be related to climatic conditions. These results can be supported by other studies that revealed the significant effect of abiotic factors like temperature on the life cycle, emergence and oviposition of insects [M. loreyi under field conditions. Additionally, the outcomes of other research conducted by Hong et al. [M. loreyi.Usually, insect population dynamics are subjected to various environmental factors, like temperature , which imergence . Our worrameters ,48. Simirameters  and Kirirameters , indicatper year . In the per year  revealed insects . Likewisg et al.  indicateM. loreyi caused substantial damage, with a 31.05% infestation rate during 2020 in the Jendouba region. In this regard, previous works pointed out the importance of pest damage on crop losses and yield reduction. Indeed, it was demonstrated that 100% of crop losses occurred if control measures were not taken at suitable times [M. loreyi varied through the time and differed from one region to another. The lowest infestation and pest incidence were recorded in the Gabes region during September. These results could be discussed by other works, which demonstrated that adverse climatic parameters that insects encounter in the field are usually transient and could motivate insects to migrate to other regions [Noctuid species are considered among the most dangerous pests to maize . Our resle times . Further regions ,54.M. loreyi attacked both crops, maize and sorghum, and that the captures depended on the region and the crop. Similarly, Kara et al. [M. loreyi is a severe pest of gramineous crops that specifically reduced yields in maize plants. However, total numbers of captured adults in sorghum fields were less compared to the captured adults on maize. In this context, Singh and Chaudhary [M. loreyi species had moderate performance on sorghum crops.On the other hand, results demonstrated that a et al.  reportedhaudhary  indicateM. loreyi is well distributed in Tunisia and has a seasonal abundance that depends on host plants and regions. Moreover, this research documented the impact of temperature on adult captures and consequently on population dynamics. Thus, ecological, environmental and phenological factors must be further investigated to manage this pest population.This study revealed that