Background: New regional techniques can improve pain management after nephrectomy. Methods: This study was a randomized controlled trial conducted at two teaching hospitals. Patients undergoing elective open and laparoscopic nephrectomy were eligible to participate in the trial. A total of 100 patients were divided into a quadratus lumborum block (QLB) group and a control (CON) group. At the end of surgery, but while still under general anesthesia, unilateral QLB with ropivacaine was performed on the side of nephrectomy for patients in the QLB group. The main measured outcome of this study was oxycodone consumption via a patient-controlled anesthesia (PCA) pump during the first 24 hours following surgery; other measured outcomes included postoperative pain intensity assessment, patient satisfaction with pain management, and persistent pain evaluation. Results: Patients undergoing QLB needed less oxycodone than those in the CON group (34.5 mg [interquartile range 23–40 mg] vs. 47.5 mg [35–50 mg]; p<0.001). No difference between the groups was seen in postoperative pain intensity measured on the visual analog scale, except for the evaluation at hour 2, which was in favor of the QLB group (p=0.03). Patients who received QLB were more satisfied with postoperative pain management than the CON group. Persistent postoperative pain was assessed with the Neuropathic Pain Symptom Inventory (NPSI) at months 1, 3, and 6 and was found to be significantly lower in the QLB group at each evaluation (p<0.001). We also analyzed the impact of the surgery type on persistent pain severity, which was significantly lower after laparoscopic procedures than open procedures at months 1, 3, and 6. Conclusions: QLB reduces oxycodone consumption in patients undergoing open and laparoscopic nephrectomy and decreases persistent pain severity months after hospital discharge.

While Spinal Cord Stimulation (SCS) provides satisfaction to almost 2/3 of Persistent Spinal Pain Syndrome-Type 2 (PSPS-T2) patients implanted for refractory chronic back and/or leg pain when not adequately addressed the back pain component, leaves patients in a therapeutic cul-de-sac. Peripheral Nerve field Stimulation (PNfS) has shown interesting results addressing back pain in the same population. Far from placing these two techniques in opposition, we suggest that these approaches could be combined to better treat PSPS-T2 patients. We designed a RCT (CUMPNS), with a 12-month follow-up, to assess the potential added value of PNfS, as a salvage therapy, in PSPS-T2 patients experiencing a “Failed SCS Syndrome” in the back pain component. Fourteen patients were included in this study and randomized into 2 groups (“SCS + PNfS” group/n=6 vs “SCS only” group/n=8). The primary objective of the study was to compare the percentage of back pain surface decrease after 3 months, using a computerized interface to obtain quantitative pain mappings, combined with multi-dimensional SCS outcomes. Back pain surface decreased significantly greater for the ”SCS+PNfS” group (80.2% ± 21.3%) compared to the “SCS only” group (13.2% ± 94.8%) (p=0.012), highlighting the clinical interest of SCS+PNfS, in cases where SCS fails to address back pain.

The research is seeking for the elements of the Authentic Realism approach in five Australian short stories by Julie Keyes, Judith Ebun, Jess Roberts, Airdre Grant, and Margot Titcher, to which an authentic realist reader would respond. The content analysis method is used in searching for the depth and significance of the texts. Several aspects such as a depiction of the characters, strong female characters, the form and language of the text, the relation of the text to the author and experience are taken to obtain the reader's response by way of an Authentic Realism approach. The findings show that the short stories: My Mother’s New Boyfriend, Souvenir, Heartbreak Hotel, Lovers Knot and Someone Else are proof that women have their own perspectives and reactions. The female characters make their own choice themselves devoid of men’s influence. Despite Jim’s idleness, unwaged condition and dependency Mother remains his girlfriend. Mother’s previous boyfriends are mostly similar to Jim’s characteristics. Lynne told Mark that she has a lump in one of her breast and will soon have a mastectomy. Being disappointed and scared to picture Lynne with one breast, and lopsided, Mark decides to leave her. The female character in Lovers Knot enjoys having an unusual sex life with Gary. Her meeting with Jeff is only a break from her routine. In Heartbreak Hotel, Mum seems to be a typical ordinary wife with a moody husband. But it turns out that she is extraordinary for she handles all the problems single-handed including her sex life. Deirdre decides to take her new post in Perth after Paul snubs her. The decisions are theirs. The choice may not be perfect, but the choice is made. The writing style of the texts shows that the authors are experienced and know very well how to use the form and language to communicate with their (women) readers. Since the theme of the texts is mostly about daily life experience, (women) readers will find no difficulty in reading them; they can even share their feelings and experience with the characters in the texts. Moreover, by using authentic realist approach students of the English Department learn more about women's writings.

as the growth and popularity of technology has become simultaneous ascend in both impacts and numbers of cyber criminals thanks to the web. For many years, the organization has strived in ways of preventing any attacks from cyber-criminal with advanced techniques. Cybercriminals and intruders are developing a more advanced way to breach the security surface of an organization. Advanced Persistent Threats are also known as APT are new and a lot more sophisticated version for multistep attack scenarios that are known and are targeted just to achieve a goal most commonly undercover activities. this report, there will cover everything I know that tells us about APT with more word and brief explanations

Complete digraphs are referred to in the combinatorics literature as tournaments. We consider a family of semi-simplicial complexes, that we refer to as ``tournaplexes'', whose simplices are tournaments. In particular, given a digraph G, we associate with it a ``flag tournaplex'' which is a tournaplex containing the directed flag complex of G, but also the geometric realisation of cliques that are not directed. We define several types of filtrations on tournaplexes, and exploiting persistent homology, we observe that flag tournaplexes provide finer means of distinguishing graph dynamics than the directed flag complex. We then demonstrate the power of these ideas by applying them to graph data arising from the Blue Brain Project's digital reconstruction of a rat's neocortex.

Objectives: To evaluate atrial fibrillation (AF) recurrence and Sarcoplasmic Endoplasmic Reticulum Calcium ATPase (SERCA) levels in patients treated by epicardial thoracoscopic ablation for persistent AF. Background: Reduced levels of SERCA have been reported in the peripheral blood cells of patients with AF. We hypothesize that SERCA levels can predict the response to epicardial ablation. Methods: We designed a prospective, multicenter observational study to recruit, from October 2014 to June 2016, patients with persistent AF receiving an epicardial thoracoscopic pulmonary vein isolation. Results: We enrolled 27 patients; responders patients (n=15) did not present AF recurrence after epicardial ablation at 1-year follow-up. These patients displayed a marked remodeling of the left atrium, with a significant reduction of inflammatory cytokines, B type Natriuretic Peptide (BNP), and over expression of SERCA as compared to baseline and to non-responders (p<0.05). Furthermore, mean AF duration (HR 1.235 [1.037-1.471], p<0.05), LAV (HR 1.755 [1.126-2.738], p<0.05), BNP (HR 1.945 [1.895-1.999], p<0.05), and SERCA (HR 1.763 [1.167-2.663], p<0.05) were predictive of AF recurrence. Conclusions: Our data indicate that baseline values of SERCA in patients with persistent AF might be predictive of failure to epicardial ablative approach. Intriguingly, epicardial ablation was associated with increased levels of SERCA in responders. Therefore, SERCA might be an innovative therapeutic target to improve the response to epicardial ablative treatments.

Antibiotic failure is one of the most worrying health problems worldwide. Nowadays we are facing an international crisis where several issues are involved: new antibiotics are not being discovered any longer, resistance mechanisms become spread in nearly every clinical isolate of bacteria and the appearance of recurrent infections caused by persistent bacteria complicates the overcoming of infections. In this context, it has been explored new anti-infectious strategies against MDR and persistent bacteria as well as the rescue of FDA-approved compounds (drug repurposing). Among the highlighted new anti-infectious strategies we find anti-microbial peptides, anti-virulence compounds, phage therapy and new molecules. On the other hand, as drugs of repurposing that have been described, we have anti-inflammatory compounds, anti-psychotics, anti-helmintic drugs, anti-cancerous and statins.

Animal studies have shown that developmental exposures to polybrominated diphenyl ethers (PBDE) permanently affect blood/liver balance of lipids. No human study has evaluated associations between in utero exposures to persistent organic pollutants (POPs) and later life lipid metabolism. In this pilot, maternal plasma levels of PBDEs (BDE-47, BDE-99, BDE-100, and BDE-153) and polychlorinated biphenyls (PCB-138, PCB-153, and PCB-180) were determined at delivery in participants of GESTation and Environment (GESTE) cohort. Total cholesterol (TCh), triglycerides (TG), low and high density lipoproteins (LDL-C and HDL-C), total lipids (TL), and PBDEs were determined in serum of 147 children at ages 6-7. General linear regression was used to estimate the relationship between maternal POPs and child lipid levels with adjustment for potential confounders, and adjustment for childhood POPs. In utero BDE-99 was associated with lower childhood levels of TG (p=0.003), and non-significantly with HDL-C (p=0.06) and TL (p=0.07). Maternal PCB-138 was associated with lower childhood levels of TG (p=0.04), LDL-C (p=0.04), and TL (p=0.02). Our data indicate that in-utero exposures to POPs may be associated with long-lasting decrease in circulating lipids in children, suggesting increased lipid accumulation in the liver, a mechanism involved in NAFLD development, consistent with previously reported animal data.

Since its emergence in March 2020, the SARS-CoV-2 global pandemic has produced more than 65 million cases and one point five million deaths worldwide. Despite the enormous efforts carried out by the scientific community, no effective treatments have been developed to date. We created a novel computational pipeline aimed to speed up the process of repurposable candidate drug identification. Compared with current drug repurposing methodologies, our strategy is centered on filtering the best candidate among all selected targets focused on the introduction of a mathematical formalism motivated by recent advances in the fields of algebraic topology and topological data analysis (TDA). This formalism allows us to compare three-dimensional protein structures. Its use in conjunction with two in silico validation strategies (molecular docking and transcriptomic analyses) allowed us to identify a set of potential drug repurposing candidates targeting three viral proteins (3CL viral protease, NSP15 endoribonuclease, and NSP12 RNA-dependent RNA polymerase), which included rutin, dexamethasone, and vemurafenib among others. To our knowledge, it is the first time that a TDA based strategy has been used to compare a massive amount of protein structures with the final objective of performing drug repurposing

A classical model is presented for persistent currents in superconductors. Their existence is argued to be warranted because their decay would violate the second law of thermodynamics. This conclusion is achieved by analyzing comparatively Ohm's law and the Joule effect in normal metals and superconducting materials. Whereas Ohm's law applies in identical terms in both cases, the Joule effect is shown to cause the temperature of a superconducting sample to \textit{decrease}. An experiment is proposed to check the validity of this work in superconductors of both types I and II.

Organic farming products are fast gaining acceptance from consumers all over the world due to the perceived belief that they are safe for human consumption. In recent years, there has been an increase in the levels of persistent organic and inorganic pollutants in the environment. These pollutants may be found in materials such as sewage sludge, treated wastewater, farmyard manure (human and animal feaces and urine) that are used for organic farming. The present review examined through literature the presence of these emerging pollutants in crops that are cultivated from farming activities practicing organic farming. The review highlighted and documented various pollutants that may be found in crops due to non-compliance with legislation establishing organic farming. The need to develop a robust method for identifying safe products from organic farming was highlighted. The impact of non-compliance and lack of proper education on the peasant farmers practicing backyard farming was also enumerated.

Background and Objectives: Most individuals infected by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) are asymptomatic or have mild symptoms of COVID-19, which usually resolve after few days. Regardless of symptoms, infected people can transmit the virus to others especially on the first days of infection. Quantitative reverse transcription-polymerase chain reaction (RT-qPCR) is used to confirm SARS-CoV-2 infection; some individuals show persistent PCR-positivity after recovering from COVID-19. In this study, 12 individuals who showed persistence of COVID-19 symptoms and of SARS-CoV-2 PCR-positivity were followed-up. Methods: nasopharyngeal samples were collected for SARS-CoV-2 detection by RT-qPCR; clinical and epidemiological data were analyzed. Results: that persistence of SARS-CoV-2 PCR positivity was associated with duration of symptoms (r_s 0.81338), which varied between one and 49 days, with 75% of the individuals reporting symptoms for more than two weeks; 83.33% of cases remained positive after two weeks of onset of symptoms, despite decreases in viral load. Conclusion: neither RT-qPCR test nor a symptom-based approach alone are sufficient to evaluate discontinuation of patient isolation; other factors such as viral loads and symptom severity should also be considered. Additional studies are needed to understand how RT-PCR-positivity is related to symptoms and the risk of viral transmission, and to better support isolation guidelines.

Recently, several reports have emerged describing the long-term consequences of COVID-19 that may affect multiple systems, suggesting its chronicity. As further research is needed, we conducted a longitudinal observational study to report the prevalence and associated risk factors of long-term health consequences of COVID-19 by symptom clusters in patients discharged from the Temporary COVID-19 Hospital (TCH) in Mexico City. Self-reported clinical symptom data were collected via telephone calls over 90 days post-discharge. Among 4670 patients discharged from the TCH, we identified 45 symptoms across eight symptom clusters (neurological; mood disorders; systemic; respiratory; musculoskeletal; ear, nose, and throat; dermatological; and gastrointestinal). We observed that the neurological, dermatological, and mood disorder symptom clusters persisted in >30% of patients at 90 days post-discharge. Although most symptoms decreased in frequency between day 30 and 90, alopecia and the dermatological symptom cluster significantly increased (p<0·00001). Women were more prone than men to develop long-term symptoms and invasive mechanical ventilation also increased the frequency of symptoms at 30-days post-discharge. Overall, we observed that symptoms often persisted regardless of disease severity. We hope these findings will help promote public health strategies that ensure equity in the access to solutions focused on the long-term consequences of COVID-19.

Tuberculosis (TB) is the primary cause of death by a single infectious agent; responsible for around two million deaths in 2016. A major virulence factor of TB is the ability to enter a latent or Non-Replicating Persistent (NRP) state which is presumed untreatable. Approximately, 1.7 billion people are latently infected with TB and on reactivation many of these infections are drug resistant. As the current treatment is ineffective and diagnosis remains poor, millions of people have the potential to reactivate into active TB disease. The immune system seeks to control the TB infection by containing the bacteria in a granuloma, where it is exposed to stressful anaerobic and nutrient deprived conditions. It is thought to be these environmental conditions that trigger the NRP state. A number of in vitro models have been developed that mimic conditions within the granuloma to a lesser or greater extent. These different models have all been utilised for the research of different characteristics of NRP Mycobacterium tuberculosis, however their disparity in approach and physiological relevance often results in inconsistencies and a lack of consensus between studies. This review provides a summation of the different NRP models and a critical analysis of their respective advantages and disadvantages relating to their physiological relevance.

Topological Data Analysis (TDA) refers to a collection of methods that find the structure of shapes in data. Although recently, TDA methods have been used in many areas of data mining, it has not been widely applied to text mining tasks. In most text processing algorithms, the order in which different entities appear or co-appear is being lost. Assuming these lost orders are informative features of the data, TDA may play a significant role in the resulted gap on text processing state of the art. Once provided, the topology of different entities through a textural document may reveal some additive information regarding the document that is not reflected in any other features from traditional text processing methods. In this paper, we introduce a novel approach that hires TDA in text processing in order to capture and use the topology of different same-type entities in textural documents. First, we will show how to extract some topological signatures in the text using persistent homology-i.e., a TDA tool that captures topological signature of data cloud. Then we will show how to utilize these signatures for text classification.

Dietary contaminants are often an over-looked factor in the health of zebrafish. Typically, water is considered to be the source for most contaminants, especially within an aquatic environment. For this reason, source water for zebrafish recirculating systems is highly regulated and monitored daily. Most facilities use reverse osmosis or de-ionized water filtration systems to purify incoming water to ensure that contaminants, as well as pathogens, do not enter their zebrafish housing units. However, diets are rarely tested for contaminants and, in the case of manufactured zebrafish feeds, since the product is marketed for aquaculture or aquarium use it is assumed that the feed is acceptable for animals used for research. The following provides examples as to how contaminants could lead to negative effects on development and behavior of developing zebrafish.

We present a new computing package Flagser, designed to construct the directed flag complex of a finite directed graph, and compute persistent homology for flexibly defined filtrations on the graph and the resulting complex. The persistent homology computation part of Flagser is based on the program Ripser [2], but is optimised specifically for large computations. The construction of the directed flag complex is done in a way that allows easy parallelisation by arbitrarily many cores. Flagser also has the option of working with undirected graphs. For homology computations Flagser has an Approximate option, which shortens compute time with remarkable accuracy. We demonstrate the power of Flagser by applying it to the construction of the directed flag complex of digital reconstructions of brain microcircuitry by the Blue Brain Project and several other examples. In some instances we perform computation of homology. For a more complete performance analysis, we also apply Flagser to some other data collections. In all cases the hardware used in the computation, the use of memory and the compute time are recorded.

The present study describes the activities performed to test a new method for measuring the mobility of polycyclic aromatic hydrocarbons (PAHs) in the solid phase of sediments within the context of environmental pollution risk assessment. The method is based on the design of a new configuration (new materials) of the commercial passive sampler Chemcatcher as probe for predicting the bioavailability of persistent organic pollutants in marine sediments (or in water saturated soils).

Null-flux Electro-dynamic suspension (EDS) system promises to be one of the feasible high-speed maglev systems above 600 km/h. On account of its greater current-carrying capacity, superconducting magnet can provide super-magnetomotive force that is required for null-flux EDS system and cannot be provided by electromagnets and permanent magnets. There is already a relatively mature high-speed maglev technology with low temperature superconducting (LTS) magnets as the core, which works in the liquid helium temperature region (T≤4.2 K). 2-Generation high temperature superconducting (HTS) magnet winded by REBa2Cu3O7−δ (REBCO, RE=rare earth) tapes works above 20 K region and do not need to count on liquid helium which is rare on earth. This paper designed HTS no-insulation closed-loop coils applied for EDS system and energized with persistent current switch. The coils can work at persistent current model and has premier thermal quench self-protection. Besides, a full size double-pancake module was designed and manufactured in this paper, and it was tested in liquid nitrogen. The double-pancake module’s critical current is about 54 A and it is capable of working at persistent current model, whose average decay rate measured in 12 hours is 0.58%/day.

Flaviviruses replicate in membranous factories associated with the endoplasmic reticulum (ER). Significant levels of flavivirus polyprotein integration contribute to ER stress and the host cell may exhibit an Unfolded Protein Response (UPR) to this protein accumulation, stimulating appropriate cellular responses such as adaptation, autophagy or cell death. These different stress responses support other antiviral strategies initiated by infected cells and can help to overcome viral infection. In epithelial A549 cells, a model currently used to study the flavivirus infection cycle and the host cell responses, all three pathways leading to UPR are activated during infection by Dengue virus (DENV), Yellow Fever virus (YFV) or West Nile virus (WNV). In the present study, we investigated the capacity of ZIKA virus (ZIKV) to induce ER stress in A549 cells. We observed that the cells respond to ZIKV infection by implementing an UPR through activation of the IRE1 and PERK pathway without activation of the ATF6 branch. By modulating the ER stress response, we found that UPR inducers significantly inhibit ZIKV replication. Interestingly, our findings provide evidence that ZIKV could manipulate the UPR to escape this host cell defence system. Since incomplete UPR could lead to unresolved and persistent ER stress, we found that ZIKV infection was associated with an abnormal accumulation of viral envelope proteins, which were aggregated with non-native disulfide bridges. As the presence of these “amyloid like” protein polymers may be cytopathic, our observations provide new insights into specific neuropathologies associated with ZIKA virus infections.

To assess the presence of organochlorine pollutants (OCP) in Alaskan sub-Arctic latitudes, we analyzed ice core and meltwater samples from Jarvis Glacier, a polythermal glacier in Interior Alaska. Jarvis Glacier is receding as atmospheric warming continues throughout the region, increasing opportunity for OCP transport both englacially and into the proglacial watershed. Across all meltwater and ice core samples we identify the pesticides DDT, DDE and DDD, α- HCH and ϒ-HCH. OCP concentrations in ice core samples were highest at the 7-14 m depth (0.51 ng/L of DDT) and decreased gradually approaching the bedrock at 79m. Meltwater concentrations from the proglacial creek slightly exceeded concentrations found in the ice core, potentially indicating aggregate OCP glacial loss, with peak OCP concentration (1.12 ng/L of DDD) taken in July and potentially associated to peak melt. Ongoing use of DDT to fight Malaria in Asia, and the extended atmospheric range of HCH may account for concentrations in near-surface ice, correlating with use and atmospheric transport. The opportunity for biota bioaccumulation of OCPs, or human uptake of OCPs from glacial meltwater, may increase as glacial melt continues.

There is increasing evidence and recognition that Lyme borreliosis, and other associated tick-borne diseases (LB/TBD) cause mental symptoms. Data was drawn from databases, search engines and clinical experience to review current information on LB/TBD. LB/TBD infections cause immune and metabolic effects that result in a gradually developing spectrum of neuropsychiatric symptoms, usually presenting with significant comorbidity and may include developmental disorders, autism spectrum disorders, schizoaffective disorders, bipolar disorder, depression, anxiety disorders (panic disorder, social anxiety disorder, generalized anxiety disorder, posttraumatic stress disorder, intrusive symptoms), eating disorders, decreased libido, sleep disorders, addiction, opioid addiction, cognitive impairments, dementia, seizure disorders, suicide, violence, anhedonia, depersonalization, dissociative episodes, derealization and other impairments. Screening assessment followed by a comprehensive psychiatric clinical exam relevant to patient’s complaints and findings with a thorough history, mental status exam, review of systems, neurological exam, physical exam, a knowledgeable interpretation of laboratory findings, pattern recognition and clinical judgment facilitate diagnosis. Psychotropics and antibiotics may help improve functioning and prevent further disease progression. Awareness of the association between LB/TBD and neuropsychiatric impairments and studies of their prevalence in neuropsychiatric conditions can improve understanding of the causes of mental illness and violence and result in more effective prevention, diagnosis and treatment.

Fabric phase sorptive extraction (FPSE) combines the advanced material properties of sol–gel derived microextraction sorbents and the flexible and permeable fabric support to create a robust, simple and green sample preparation device. It simultaneously improves the extraction sensitivity, and the speed of the extraction by incorporating high volume of sponge-like porous sol–gel hybrid inorganic–organic sorbents into permeable fabric substrates that is capable of extracting target analytes directly from simple to complex aqueous sample matrices. For the first time, this technique was applied to the trace level determination of selected polycyclic aromatic hydrocarbons (PAHs) in environmental water samples using a non-polar sol–gel C18 coated FPSE media. Several extraction parameters were optimized to improve extraction efficiency and to achieve high detection sensitivity. Validation tests of spiked samples showed good linearity for four selected PAHs (R² = 0.9983–0.9997) over a wide range of concentrations (0.010-10 ng/mL). Limits of detection (LODs) and quantification (LOQs) were measured at pg/mL levels, 0.1–1 pg/mL and 0.3–3 pg/mL, respectively. Inter- and intra-day precision tests showed variations of 1.1–4.1% for four selected PAHs. Average absolute recovery values were in the range of 88.1–90.5% surpassed the recovery prediction model, with relative standard deviations below 5%. The developed FPSE-HPLC-FLD protocol was finally applied to analyze 8 environmental water samples. Out of four selected PAHs, fluoranthene (Flu) and phenanthrene (Phen) were the most frequently detected in four samples, at concentration levels of 5.6–7.7 ng/mL and 4.1-11 ng/mL, respectively followed by anthracene (Anth) and pyrene (Pyr) in two samples. The newly developed FPSE-HPLC-FLD protocol is simple, green, fast and economical, with adequate sensitivity for trace levels of four selected PAHs and seems to be promising in routine monitoring of water quality and safety.

Data science is facing the following major challenges: (1) developing scalable cross-disciplinary capabilities, (2) dealing with the increasing data volumes and their inherent complexity, (3) building tools that help to build trust, (4) creating mechanisms to efficiently operate in the domain of scientific assertions, (5) turning data into actionable knowledge units and (6) promoting data interoperability. As a way to overcome these challenges, we further develop the proposals by early Internet pioneers for Digital Objects as encapsulations of data and metadata made accessible by persistent identifiers. In the past decade, this concept was revisited by various groups within the Research Data Alliance and put in the context of the FAIR Guiding Principles for findable, accessible, interoperable and reusable data. The basic components of a FAIR Digital Object (FDO) as a self-contained, typed, machine-actionable data package are explained. A survey of use cases has indicated the growing interest of research communities in FDO solutions. We conclude that the FDO concept has the potential to act as the interoperable federative core of a hyperinfrastructure initiative such as the European Open Science Cloud (EOSC).

Three patients with multi-year histories of relapsing and remitting Lyme disease and associated co-infections despite extended antibiotic therapy were each given double dose dapsone combination therapy (DDD CT) for a total of 7-8 weeks. At the completion of therapy, all three patients major Lyme symptoms remained in remission for a period of 25-30 months. In conclusion, Double dose dapsone therapy could represent a novel and effective anti-infective strategy in chronic Lyme disease/PTLDS, especially in those individuals who have failed regular dose dapsone combination therapy (DDS CT) or standard antibiotic protocols. A randomized, blinded, placebo-controlled trial is warranted to evaluate the efficacy of DDD CT in those individuals with chronic Lyme disease/PTLDS.