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  • Tibetans in exile face a future without the charismatic Dalai Lama

    Tibetans in exile face a future without the charismatic Dalai Lama

    DHARAMSHALA, India (AP) — The Dalai Lama has announced that he intends to reincarnate, paving the way for a successor to take on a mantle stretching back 500 years after his death.

    But as he approaches his 90th birthday, that news hasn’t eased the worries of Tibetan Buddhists who wonder: What will happen when this Dalai Lama is gone?

    For decades, the 14th Dalai Lama has been more than a spiritual leader. He has sustained a nation in exile and managed to build a community that’s kept the Tibetan culture and identity alive. He is the China -reviled spokesperson for a Tibetan homeland that many, like him, can see only from afar. He has received a Nobel Peace Prize and been courted by royalty, politicians and Hollywood stars, helping him draw global attention and support for Tibet.

    An exiled Tibetan prostrates in prayer at the Tsuglakhang temple in Dharamshala, India, Tuesday, July 1, 2025. (AP Photo/Ashwini Bhatia)

    When his death comes, it will pitch the global Tibetan community into uncertainty, perhaps for years. His successor will have to be found through the traditional process of reincarnation. China, whose troops took control of Tibet in 1950, says it will reject anyone chosen without Beijing’s consent.

    Tibetans in India’s Himalayan town of Dharamshala, the Dalai Lama’s home in exile, and scattered around the world fear a new onslaught on their cultural and religious identity.

    “The absence of His Holiness would be a huge setback for the Tibetans,” said Penpa Tsering, the head of the democratically elected Tibetan government-in-exile. “The responsibility lies on us as to how we carry forward the legacy of His Holiness.”

    A long gap

    The Dalai Lama has become one of the world’s most recognizable figures while leading a Tibetan diaspora through their struggle for autonomy and opposition of China’s control of Tibet. He has not named a successor, but he says they will be born in the “free world” — outside China.

    Previous Dalai Lamas have been identified by senior monastic disciples, under strict religious rituals meant to identify their predecessor’s reincarnation. Monks interpret signs, consult oracles and send search committees to Tibetan households looking for a child who exhibits the qualities of the Dalai Lama.

    All of this takes years of effort, leaving a leadership vacuum. Years of religious education and training are needed before the identified successor grows up and takes up full responsibilities as spiritual leader.

    China has already sought to elevate other spiritual figures, particularly Tibetan Buddhism’s No. 2 figure, the Panchen Lama, whose legitimacy is highly contested by many Tibetans at home and in exile.

    Gyaltsen Norbu was installed by Beijing as the 11th Panchen Lama in 1995 after followers of the Dalai Lama recognized a different boy as the Panchen’s incarnation. That boy disappeared soon after.

    Joy and stubbornness

    And there’s no guarantee the successor will have the current Dalai Lama’s charisma, or his ability to balance a sense of joy with the stubbornness needed to counter China.

    “He is a fulcrum, he’s the epitome of the Tibetan movement,” said writer and activist Tenzin Tsundue, who was born in India.

    Tsundue for years has advocated for Tibet’s autonomy. To him, the current Dalai Lama’s absence will be hugely felt.

    Like many other Tibetans, however, his hopes are pinned on the government in exile. “How is home not anything but a genuine human demand?” he added.

    Such concerns are most prevalent in Dharamshala, where a Tibetan community of over 20,000 administers its own schools, hospitals and monasteries and elects its own lawmakers and president. The Dalai Lama handed over his political powers to a democratically elected government in 2011.

    Devotees wait to welcome Tibetan spiritual leader the Dalai Lama at an event celebrating his 90th birthday according to a Tibetan calendar in Dharamshala, India, Monday, June 30, 2025, ahead of his birthday according to the Gregorian calendar on July 6. (AP Photo/Ashwini Bhatia)

    Devotees wait to welcome Tibetan spiritual leader the Dalai Lama at an event celebrating his 90th birthday according to a Tibetan calendar in Dharamshala, India, Monday, June 30, 2025, ahead of his birthday according to the Gregorian calendar on July 6. (AP Photo/Ashwini Bhatia)

    Beijing is likely to appoint its own candidate

    China doesn’t recognize the Tibetan government-in-exile and brands the Dalai Lama a dangerous separatist. It has shunned direct contact with his representatives for more than a decade.

    It has insisted that the Dalai Lama’s successor will be from inside China and must be approved by its government.

    Tibetans in exile have long been wary of the officially atheist Chinese government’s attempts to meddle with the Tibetan Buddhism reincarnation system. They see it as part of Beijing’s plan to tighten its control over Tibet.

    “If they do it, they are actually making a mockery of themselves among the free countries,” said Geshe Lhakdor, a Tibetan Buddhist scholar, calling Beijing’s stance “hypocrisy.”

    Tibetans say they were effectively independent for centuries and accuse China of trying to wipe out Tibet’s Buddhist culture and language. Many of the more than 7 million Tibetans living under Chinese rule accuse Beijing of stifling religious freedoms, changing its ethnic makeup by moving millions of Han Chinese into the region and torturing political prisoners.

    The Chinese government denies these allegations.

    Waning global attention

    For years, governments across the world have feted the Dalai Lama for advocating for Tibetan rights and spreading a message of nonviolence. They have also helped him raise tens of millions of dollars to build Tibetan cultural and religious institutions.

    But Tsundue said that global powers have become more unreliable in their support of the Tibetan cause as China’s influence grows.

    “Everybody has benefited at our cost because they have been trading with China,” Tsundue said. “We are, in a way, a victim of geopolitics.”

    Some countries, including the United States, view Beijing’s attempts to control the reincarnation of the Dalai Lama as a violation of religious freedom and Tibetan cultural tradition. Others, like the European Union and India, have maintained a cautious stance to avoid friction with China.

    Penpa Tsering, President of the Tibetan government-in-exile, gestures as he speaks to the Associated Press at his office in Dharamshala, India, Tuesday, July 1, 2025. (AP Photo/Ashwini Bhatia)

    Penpa Tsering, President of the Tibetan government-in-exile, gestures as he speaks to the Associated Press at his office in Dharamshala, India, Tuesday, July 1, 2025. (AP Photo/Ashwini Bhatia)

    Tsering, the president of the government-in-exile, acknowledged this, calling Tibetans’ efforts to keep the issue of Tibet alive “a miracle.”

    He also cautioned that the future depends on the Tibetan people at large.

    Under the Dalai Lama’s “Middle Way” policy, the movement for Tibet’s autonomy has largely been nonviolent. It espouses autonomy under Chinese sovereignty.

    The newly announced succession plan, however, can prompt a reckoning of that policy, and it is unclear how the Dalai Lama’s successor might approach dialogue with Beijing.

    Tsering cautioned that much could change in the coming years. His biggest worry is that the Dalai Lama’s death in exile could trigger a violent response inside Tibet, where in recent years hundreds of monks and others reportedly set themselves on fire in protest against Chinese rule.

    “I hope the Tibetans won’t get radicalized,” he said.


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  • Ignore climate change deniers, says TV naturalist Steve Backshall

    Ignore climate change deniers, says TV naturalist Steve Backshall

    Neve Gordon-Farleigh & Connor Bennett

    BBC News, Suffolk

    John Fairhall/BBC Steve Backshall is pictured smiling and wearing a light coloured T shirtJohn Fairhall/BBC

    Steve Backshall said it was important to recognise climate anxiety

    A television wildlife presenter said climate change “is happening” and people should ignore politicians and public figures who think otherwise.

    Steve Backshall was speaking as a guest at the Youth Climate Conference at Suffolk One Sixth Form College in Ipswich on Tuesday, which gave 250 young people from across the county the opportunity to engage in conversations about the climate.

    Previous speakers at the event includes Chris Packham, Megan McCubbin and activist Scarlett Westbrook.

    He said: “If you hear a politician or public figure trying to throw shade on the simple facts of climate change do not listen to another word they say in public ever again… it is happening.”

    The event featured talks from the charity, Kids Against Plastic, workshops and advice from location environmental groups.

    Known for children’s shows including Deadly 60, Backshall said it was a “great privilege” to share what he has experienced in his career, see how the planet is changing and feel a sense of hope.

    He said: “It’s critical that someone in position recognises that climate anxiety is a real thing… especially for young people there is nothing that takes away your impetus to act, than just a sense it’s all screwed and there’s nothing we can do about it.

    “People need to be empowered. They need to have a sense that they are important and the things they do can make a difference.”

    John Fairhall/BBC Amy Meek on the left sitting down next to Steve Backshall. She is wearing a black T-shirt and has short dark hair. Steve Backshall is also sitting down and he is wearing a grey T-shirt and is holding a microphone.John Fairhall/BBC

    Amy Meek says children play a “pivotal” role in climate change and plastic pollution

    Backshall said: “A young person who is energised, who has a purpose, who has a vision, who thinks they can make a massive change is the most exciting thing to be around on the planet.

    “We hear endlessly about Greta Thunberg. Well there are tens of thousands of Greta Thunbergs in this nation along and 250 possible Gretas right here, sat right here today – the things they could achieve are boundless.”

    The co-founder of Kids Against Plastic, Amy Meek, said young people play a “pivotal part” in tackling climate change and plastic pollution.

    She said: “Young people have this really infectious energy, especially kids who we often discount as being too young to really care about these issue… if we can mobilise that energy and that interest into actual positive action that can have a massive difference.”

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  • If You See These Messages On Your PC, You’re Being Hacked

    If You See These Messages On Your PC, You’re Being Hacked

    Republished on July 3 with reports into a new attack with a different twist.

    There’s a new attack “taking the threat landscape by storm,” and it should have all PC users worried. “While virtually nonexistent a year ago,” this attack has surged to such an extent in recent months that it’s now second only to phishing on the danger list.

    We’re talking so-called ClickFix attacks, in which you are tricked into hacking your own PC when you follow on-screen instructions to fix a technical issue, open a secure file or website, or prove your human through a popup CAPTCHA challenge.

    ForbesPorn Ban Warning For Millions Of iPhone And Android Users

    The latest warning comes from ESET, which says in its new Threat Report that these attacks have now “skyrocketed.” That should maybe be no surprise, given the multiple warnings that have been issued in recent months.

    But what should come as more of a surprise is that these attacks are still claiming countless victims, despite being so easy to detect and avoid — in theory at least.

    ESET warns “payloads at the end of ClickFix attacks vary widely – from infostealers to ransomware and even to nation-state malware – making this a versatile and formidable threat.” It targets different operating systems, but this is really a Windows PC threat.

    ClickFix always works by asking users to copy and paste text into a Run window, thus executing a script. That script can itself be dangerous, but more likely seems benign and actually downloads and runs the malicious script out of sight of the user.

    “By the end of 2024,” ESET says, “attacks using the same social engineering technique flooded the web. Threat actors have been creating fake websites mimicking popular services – such as Booking.com or Google Meet – compromising legitimate websites with fake browser update prompts, fake Cloudflare verifications or reCAPTCHA checks, and distributing links leading to ClickFix pages via email campaigns.”

    The ClickFix attack is just a shop window for multiple threats that will be installed on your device if you fall for that initial lure. “The list includes popular infostealers such as Lumma Stealer, VidarStealer, StealC, and Danabot; remote access trojans such as VenomRAT, AsyncRAT, and NetSupport RAT; remote monitoring and management tools such as MeshAgent; post-exploitation frameworks such as Havoc and Cobalt Strike; and cryptominers, loaders, clipboard hijackers, and much more.”

    If you’re not worried yet, then you should be. These attacks are varying rapidly. Hackers are seeking out new lures and testing what works best. The capability is also being farmed out to multiple groups with different malware to deploy. Recent attacks have even “attempted to deploy Interlock (formerly Rhysida) ransomware.”

    ForbesMicrosoft’s Password Change Is Just Days Away—Act Now

    If you ever see a message — however worded — asking you to press the Windows Key + “R” and then “Ctrl+V” to paste and then “Enter,” then your PC is being hacked. Period.

    Do none of those things. Escape or force exit the program. And then reboot your PC. If you think you have fallen into a ClickFix trap, run an antivirus scan on your PC and change all key account passwords. You should also check your financial accounts.

    While ClickFix is synonymous with Windows, there’s now a timely reminder that Mac users are also vulnerable to these tactics — being tricked into running a script on your device that seems to do one thing, when it’s actually hacking you in the background.

    SentinelOne warn that North Korean hackers have been caught targeting victims with various malware payloads, which are installed on machines after users run a script that purports to be a Zoom update ahead of joining a scheduled call.

    “The attack chain begins with a now-familiar social engineering vector: impersonation of a trusted contact over Telegram and inviting the target to schedule a meeting via Calendly. The target is subsequently sent an email containing a Zoom meeting link and instructions to run a so-called ‘Zoom SDK update script’.”

    While most ClickFix attacks are either wrapped in a tech support lure or a fake CAPTCHA challenge, we have seen multiple instances of users being asked to take actions to access a secure website or open a password protected document.

    That fake Zoom script “ends with three lines of malicious code that retrieve and execute a second-stage script from a command-and-control server hosted at support.us05web-zoom[.]forum. This domain name format has been chosen for similarity to the legitimate Zoom meeting domain us05web.zoom[.]us.”

    ForbesGoogle Play Store Warning—Find And Delete All Apps On This List

    Once installed on the user’s Mac, the malware is designed to root our and steal credentials from Arc, Brave, Firefox, Google Chrome and Microsoft Edge browsers, again highlighting the vulnerability in saving passwords in browsers.

    Beyond that, different malware payloads can be tasked with different outcomes. SentinelOne says this shows how threat actors will continually “introduce new levels of complexity for analysts.” As ever, the teams says, “in the cat-and-mouse game of threat and threat detection, when one side innovates, the other must respond.”

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  • Trump touts but Gaza truce still has stumbling blocks – Firstpost

    Trump touts but Gaza truce still has stumbling blocks – Firstpost

    The two sides have publicly rejected the other’s red lines, making compromise difficult even as humanitarian pressure mounts. Trump and international mediators push for a breakthrough, but mutual distrust and shifting priorities are complicating negotiations

    read more

    Hamas has not yet agreed or denied a 60-day ceasefire proposal by the US that President Donald Trump has said Israel has accepted, although Prime Minister Benjamin Netanyahu has not publicly addressed it.

    It is this lack of overall communication and negotiation that is stalling peace in Gaza. Despite US mediation,
    Israel and Hamas remain at odds over key conditions for a proposed 60-day cease-fire and hostage release deal.

    The two sides have publicly rejected the other’s red lines, making compromise difficult even as humanitarian pressure mounts. Trump and international mediators push for a breakthrough, but mutual distrust and shifting priorities, like Israel’s potential focus on rescuing hostages over military victory, are complicating negotiations.

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    ‘Eager to resume talks’

    Meanwhile, Israeli Foreign Minister Gideon Saar has said that the country is eager to resume negotiations with Hamas over a ceasefire agreement “as soon as possible”.

    “There are some positive signs. But our goal is to begin proximity talks as soon as possible,” Saar told reporters, referring to the details of the ceasefire that still need to be agreed upon through diplomacy.

    At the same time, Prime Minister Benjamin Netanyahu on Wednesday vowed to eradicate Hamas. “We will free all our hostages, and we will eliminate Hamas. It will be no more,” he said.

    Hamas said in a statement that it was studying the latest proposals and aiming “to reach an agreement that guarantees ending the aggression, achieving the withdrawal (of Israeli forces from Gaza) and urgently aiding our people in the Gaza Strip”.

    Possible terms of the deal

    A Palestinian source familiar with the ongoing mediated negotiations told AFP that the new proposal on the table shows “no fundamental changes” compared to earlier terms presented by the United States. This suggests that the underlying framework of the talks remains largely the same.

    The source explained that the revised proposal includes a 60-day truce. During this period, Hamas would release half of the Israeli captives still alive in Gaza, in exchange for Israel freeing a number of Palestinian prisoners and detainees.

    As of now, 49 hostages from the 251 captured by Palestinian militants in October 2023 remain in Gaza. According to the Israeli military, 27 of these hostages have already been confirmed dead.

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    With inputs from agencies

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  • A Case Report of Necrolytic Migratory Erythema Associated with Glucago

    A Case Report of Necrolytic Migratory Erythema Associated with Glucago

    Introduction

    NME is a rare disorder associated with multiple diseases, including glucagonoma, chronic pancreatitis, nutritional deficiency, liver diseases, and inflammatory bowel disease. About 70% of cases of glucagonoma may present with NME, therefore NME is an important visual clue for the diagnosis, enabling timely intervention.

    Glucagonoma is an unusual neuroendocrine tumor, derives from the pancreatic alpha cells with an estimated incidence of 1 in 20 million,1 most commonly affecting people in their 50s.2 The main manifestations are weight loss, NME, diabetes, diarrhea, anemia, and neuropsychiatric symptoms. NME is a crucial characteristic of glucagonoma. However, many primary dermatologists lack sufficient knowledge about the disorder, leading to potential misdiagnosis and missed diagnosis. Consequently, we report a case of typical NME combined with glucagonoma diagnosed in 2024 at Dermatology Hospital of Southern Medical University, designed to strengthen the diagnosis and differentiation ability of dermatologists.

    Case Presentation

    The patient was a 41-year-old male who presented with erythema with erosions on both lower limbs, accompanied by malnutrition and mild itching for the past three years. The patient was diagnosed with “eczema” in the local hospital. He had been treated with topical corticosteroids for years with improvement but frequently recurred. One month ago, the lesions gradually spread all over the body, with crusted papules and polycyclic plaques with a map-like margin mainly involving the face, groin, buttocks, and extremities. And his tongue appeared beefy red and fissuring (Figure 1). No nail abnormality was found.

    Figure 1 Clinical appearance. (a) Scattered erythematous seborrheic plaques on the face. (b) Bright red, swollen tongue; multiple fissures; beefy tongue appearance. (c) Well-defined erythema with raised borders and yellow crusting on both inguinal areas and scrotum. (d and e) Multiple erythema and erosion on the buttocks and knees. (f) Well-defined erythema with raised borders and yellow crusting on both ankles.

    Laboratory analysis found a serum glucagon level of more than 128 pmol/L (normal range, 2 to 18 pmol/L). Anti-bp180 and anti-bp230, cortisol levels were negative. A skin biopsy was performed and showed parakeratosis, inflammatory crust, spongiosis, localized necrosis in the upper epidermis, lymphocytes infiltrating peri-follicular and peri-vascular areas, and eosinophilic infiltration (Figure 2). A contrast-enhanced abdominal computed tomographic scan revealed an enhancing pancreatic body tail mass and liver metastases (Figure 3).

    Figure 2 Histological findings of plaque on the left thigh. Parakeratosis, spongiosis, localized necrosis in the upper epidermis. (HE, x 400).

    Figure 3 Enhanced abnormal computed tomography scan. Showing a pancreatic body tail mass (right arrow) and intrahepatic mass (left arrow), confirming glucagonoma.

    Diagnostic Evaluation

    The clinical presentation was characteristic of NME, confirmed by histopathological examination of skin biopsy. In accordance with the known correlation between NME and glucagonoma, serum glucagon levels were found to be significantly elevated. Subsequent abdominal CT demonstrated a pancreatic neuroendocrine tumor, establishing the definitive diagnosis of glucagonoma. Therefore, the diagnosis of NME combined with glucagonoma was made.

    Treatment with microelements such as zinc, Vitamin B, folic acid, antihistamines, and topical corticosteroids. The rash reduced slightly. However, the patient refused surgical treatment for financial reasons.

    Discussion

    Glucagonoma is a neuroendocrine tumor characterized by excessive proliferation of α-cells in the pancreas, with a higher prevalence in women than men. The tumor typically grows slowly and can metastasize. Due to the excessive secretion, glucagonoma syndrome occurs, which may present with NME, weight loss, diabetes, diarrhea, anemia, and neuropsychiatric symptoms.3 NME manifests as scaly, erosive, ring-shaped erythema with the formation of pustules and large blisters. Other manifestations may include nail dystrophy, cheilitis, and stomatitis.

    Given the rarity of NME, reports on the condition are few both nationally and internationally, and a standardized diagnostic criterion has not yet been made. In 2018, Xuechen Cao and Yan Lu reviewed and summarized previous cases and proposed diagnostic criteria for glucagonoma.4 The primary diagnostic criteria(Table-1) include (1) Imaging revealing a pancreatic mass, (2) Elevated plasma glucagon levels (>1000 ng/L), (3) Typical NME manifestations, (4) A history of multiple endocrine neoplasia. Secondary criteria include (1) New-onset diabetes (fasting plasma glucose, oral glucose tolerance test), (2) low serum zinc levels and hypoaminoacidemia, (3) Unexplained weight loss and diarrhea, (4) Cheilitis or glossitis. In this case, the patient met the primary criteria of (1), (2), and (3), as well as the secondary criterion of (4), confirming the diagnosis of NME associated with glucagonoma.

    Table 1 the Diagnostic Criteria and Differential Diagnosis

    Given its rarity and prolonged clinical course, NME is frequently misdiagnosed as eczema. In such cases, dermatologists should maintain a high clinical suspicion for associated systemic diseases. Several conditions can present with NME-like skin rashes, including Acrodermatitis Enteropathica (AE), pemphigus erythematosus(PE), drug eruption, essential fatty acid deficiency, vitamin deficiency-related dermatitis, and pseudoglucagonoma syndrome.

    AE: it is a rare, recessively inherited disorder associated with zinc metabolism abnormalities, typically presenting in infancy with symptoms such as eczema-like dermatitis, crusting, bullae, and pustules, commonly affecting the extremities and perioral areas.5 Additional symptoms include hair loss, diarrhea, stomatitis, photophobia, nail dystrophy, abnormal hair texture, growth retardation, and emotional disorders. Especially common in artificially fed infants, with few in adulthood.6 The serum zinc level is always low.7

    PE: the lesions appear as erythematous patches, often found on the face, neck, chest, and other areas, and may have an irregular shape with unclear borders. It may also present in a linear or ring-shaped pattern, with associated vesicles and bullae. Mucosal involvement, such as oral ulcers, throat pain, and ocular inflammation, may also occur. The disease progresses rapidly, with vesicles easily rupturing to form ulcers, and lesions may spread to adjacent skin, occasionally accompanied by secondary infections. Hematoxylin-eosin stain (HE) typically shows superficial epidermal acantholysis, usually located in the granular layer or upper epidermis. Spongiosis and dermal eosinophilic infiltration can be observed, and DIF typically reveals antibodies between epidermal keratinocytes as well as scattered granular deposits of antibodies along the basement membrane zone (BMZ).8

    Drug Eruption: it manifests in various clinical forms, with severe reactions presenting as generalized erythema, vesicles, and erosion. Drug eruption usually has a clear history of drug exposure before the onset of the rash, typically resulting from a non-anticipated inflammatory response affecting the skin and/or mucous membranes as a result of drugs entering the body through oral ingestion, inhalation, injection, suppositories, or topical absorption.2 It often shows a clear response to corticosteroid therapy.

    The pathogenesis of NME remains unclear. Hyperglucagonemia is believed to play a significant role, because excessive glucagon secretion induces amino acid metabolic dysregulation, culminating in hypoaminoacidemia and consequent impairment of epidermal protein synthesis. And surgical removal of glucagonomas or somatostatin analogs can control the skin rash.6,9 Additionally, hypoaminoacidemia, micronutrient depletion, and deficiencies in essential fatty acids and zinc should also be considered, as nutritional support and topical zinc therapy have been used to improve symptoms.10 Surgical resection is considered the only curative treatment.11 If left untreated, glucagonomas may metastasize to distant organs such as the liver and lungs, leading to progressive clinical deterioration and ultimately life-threatening complications. Surgical options include simple excision (for tumors <2 cm) with regional lymphadenectomy, pancreaticoduodenectomy with regional lymphadenectomy, distal pancreatectomy, and splenectomy. However, over half of glucagonomas are metastatic at diagnosis, with liver metastasis being the most common.12 Liver transplantation is considered a potential treatment for patients with liver metastasis. Transarterial chemoembolization (TACE), radiofrequency ablation, and surgery combined may offer advantages in resecting isolated metastatic tumors. Pharmacological treatments for glucagonoma include chemotherapy, somatostatin analogs, and targeted molecular therapies.13 Molecular targeted therapy: Agents such as sunitinib and everolimus inhibit specific molecular aberrations within tumors, thereby significantly prolonging progression-free survival (PFS).14

    Conclusion

    NME mainly presents a chronic course, but the recurrent rash seriously affects the patient’s quality of life. The lesions in our case are characterized by generalized erythema with erosions, which are easily misdiagnosed as pemphigus, eczema, and drug eruption, highlighting the importance of precise imaging to exclude pancreatic tumors, when facing similar conditions. Since NME might be the only clue for the early detection of this tumor, it is very important to correctly diagnose. This requires collaborative efforts from dermatologists, endocrinologists, gastroenterologists, and oncologists. This interdisciplinary approach is essential for the timely diagnosis and management of this rare condition. All in all, this case underscores the importance of recognizing NME as a dermatologic marker for systemic malignancies, necessitating collaborative care for timely diagnosis and treatment.

    Ethics Statement

    The publications of images were included with the patient’s consent.

    Consent Statement

    The patient had given written informed consent for the publication of his clinical details. Institutional approval is not required for this case study.

    Acknowledgments

    The authors would like to thank the patient for participation in this study.

    Author Contributions

    All authors made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis and interpretation, or in all these areas; took part in drafting, revising or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work.

    Funding

    This work was supported by The “Set Sail” Program for Young PhD Researchers in Basic and Applied Medical Research (SL2023A04J02432).

    Disclosure

    The authors report no conflicts of interest in this work.

    References

    1. He S, Zeng W, Geng S, Jia J. Glucagonoma syndrome with atypical necrolytic migratory erythema. Indian J Dermatol Venereol Leprol. 2021;87(1):49–53. doi:10.4103/ijdvl.IJDVL_588_18

    2. Yang WJ, Hu HH, Guo H, Li JH. Generalized migratory erythema in an elderly woman Necrolytic migratory erythema. J Dtsch Dermatol Ges. 2022;20(2):231–234. doi:10.1111/ddg.14664

    3. Liu JW, Qian YT, Ma DL. Necrolytic migratory erythema. JAMA Dermatol. 2019;155(10):1180. doi:10.1001/jamadermatol.2019.1658

    4. Cao X, Yan L. 坏死松解性游走性红斑临床研究进展. 中华医学杂志. 2018;98(33):2694–2696. doi:10.3760/cma.j.issn.0376-2491.2018.33.019

    5. Maverakis E, Fung MA, Lynch PJ, et al. Acrodermatitis enteropathica and an overview of zinc metabolism. J Am Acad Dermatol. 2007;56(1):116–124. doi:10.1016/j.jaad.2006.08.015

    6. van Beek AP, de Haas ER, van Vloten WA, Lips CJ, Roijers JF, Canninga-van Dijk MR. The glucagonoma syndrome and necrolytic migratory erythema: a clinical review. Eur J Endocrinol. 2004;151(5):531–537. doi:10.1530/eje.0.1510531

    7. Zou P, Du Y, Yang C, Cao Y. Trace element zinc and skin disorders. Front Med Lausanne. 2022;9:1093868. doi:10.3389/fmed.2022.1093868

    8. Hobbs LK, Noland MB, Raghavan SS, Gru AA. Pemphigus erythematosus: a case series from a tertiary academic center and literature review. J Cutan Pathol. 2021;48(8):1038–1050. doi:10.1111/cup.13992

    9. Zhang M, Wang S. 胰体尾切除术成功治愈坏死松解性游走性红斑1例. 中国皮肤性病学杂志. 1–5. doi:10.13735/j.cjdv.1001-7089.202402049

    10. Chen L, Guo X, Huihui W, Sun W, Ding H. 营养缺乏所致坏死松解性游走性红斑样皮损. 临床皮肤科杂志. 2022;51(05):282–285. doi:10.16761/j.cnki.1000-4963.2022.05.008

    11. John AM, Schwartz RA. Glucagonoma syndrome: a review and update on treatment. J Eur Acad Dermatol Venereol. 2016;30(12):2016–2022. doi:10.1111/jdv.13752

    12. Adams DR, Miller JJ, Seraphin KE. Glucagonoma syndrome. J Am Acad Dermatol. 2005;53(4):690–691. doi:10.1016/j.jaad.2005.04.071

    13. Remes-Troche JM, García-de-acevedo B, Zuñiga-Varga J, Avila-Funes A, Orozco-Topete R. Necrolytic migratory erythema: a cutaneous clue to glucagonoma syndrome. J Eur Acad Dermatol Venereol. 2004;18(5):591–595. doi:10.1111/j.1468-3083.2004.00981.x

    14. Öberg K. Management of functional neuroendocrine tumors of the pancreas. Gland Surg. 2018;7(1):20–27. doi:10.21037/gs.2017.10.08

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  • AI voice startup ElevenLabs plots global expansion, eventual IPO

    AI voice startup ElevenLabs plots global expansion, eventual IPO

    Founded in 2022, ElevenLabs is an AI voice generation startup based in London. It competes with the likes of Speechmatics and Hume AI.

    Sopa Images | Lightrocket | Getty Images

    LONDON — ElevenLabs, a London-based startup that specializes in generating synthetic voices through artificial intelligence, has revealed plans to be IPO-ready within five years.

    The company told CNBC it is targeting major global expansion as it prepares for an initial public offering.

    “We expect to build more hubs in Europe, Asia and South America, and just keep scaling,” Mati Staniszewski, ElevenLabs’ CEO and co-founder, told CNBC in an interview at the firm’s London office.

    He identified Paris, Singapore, Brazil and Mexico as potential new locations. London is currently ElevenLabs’ biggest office, followed by New York, Warsaw, San Francisco, Japan, India and Bangalore.

    Staniszewski said the eventual aim is to get the company ready for an IPO in the next five years.

    “From a commercial standpoint, we would like to be ready for an IPO in that time,” he said. “If the market is right, we would like to create a public company … that’s going to be here for the next generation.”

    Undecided on location

    Founded in 2022 by Staniszewski and Piotr Dąbkowski, ElevenLabs is an AI voice generation startup that competes with the likes of Speechmatics and Hume AI.

    The company divides its business into three main camps: consumer-facing voice assistants, integrations with corporates such as Cisco, and tailor-made applications for specific industries like health care.

    Staniszewski said the firm hasn’t yet decided where it could list, but that this decision will largely rest on where most of its users are located at the time.

    “If the U.K. is able to start accelerating,” ElevenLabs will consider London as a listing destination, Staniszewski said.

    The city has faced criticisms from entrepreneurs and venture capitalists that its stock market is unfavorable toward high-growth tech firms.

    For example, Deliveroo, whose shares tanked nearly 30% when the company went public, was recently acquired by U.S. food delivery rival DoorDash for close to $4 billion.

    Meanwhile, British money transfer firm Wise last month said it plans to move its primary listing location to the U.S.,

    Fundraising plans

    ElevenLabs was valued at $3.3 billion following a recent $180 million funding round. The company is backed by the likes of Andreessen Horowitz, Sequoia Capital and ICONIQ Growth, as well as corporate names like Salesforce and Deutsche Telekom.

    Staniszewski said his startup was open to raising more money from VCs, but it would depend on whether it sees a valid business need, like scaling further in other markets. “The way we try to raise is very much like, if there’s a bet we want to take, to accelerate that bet [we will] take the money,” he said.

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  • AI sewers in Sussex help prevent flooding, Southern Water says

    AI sewers in Sussex help prevent flooding, Southern Water says

    Artificial Intelligence (AI) deployed in the sewer system has helped prevent West Sussex homes from flooding, Southern Water says.

    AI learns the normal behaviour of sewers and can tell the difference between morning and evening rushes, rain in the system, and a blockage forming.

    Digital sensors in a sewer at East Lavington near Petworth on 16 June spotted a blockage caused by a fatberg which was then tackled before gardens and homes flooded with wastewater.

    “We’re spotting hundreds of potential blockages before it’s too late,” said Daniel McElhinney, proactive operations control manager at Southern Water.

    According to Southern Water, blocked sewers are the single biggest cause of pollution incidents, but AI has now cut internal flooding by 40% and external flooding by 15%.

    The water company says it has about 32,000 sewer lever monitors that can check on flows and spot anything out of the ordinary which might indicate a blockage or leak.

    Mr McElhinney said: “Most customers do not realise the average suburban sewer is only the diameter of an orange or a tennis ball.

    “It doesn’t take much cooking fat to combine with other ‘unflushables’ such as sanitary products, wet wipes or even ear cleaning sticks, to form a fatberg,” he added.

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  • The Moon shares the sky with Spica

    The Moon shares the sky with Spica

    Trundling along the ecliptic in Virgo, our satellite hangs near the bright star Spica in the evening sky.

    The Moon now passes 0.8° south of Spica at 6 P.M. EDT, with the pairing visible as evening twilight falls. (As with Mars earlier this week, some parts of the world will see Spica disappear behind the Moon in an occultation — this time, southern South America will get that view.)

    By 9:30 P.M. local daylight time, the Moon sits to the lower left of Spica in the southwest. The star, which glows at magnitude 1.0, is an incredibly hot, massive star more than 10 times the mass of our Sun, shining with a piercing blue-white light that’s lovely through binoculars or any telescope. Take some time to enjoy the Moon under magnification as well, skimming along the terminator delineating lunar night from day, now centered on the nearside at First Quarter. 

    Sunrise: 5:36 A.M.
    Sunset: 8:32 P.M.
    Moonrise: 2:12 P.M.
    Moonset: 12:41 A.M.
    Moon Phase: Waxing gibbous (59%)
    *Times for sunrise, sunset, moonrise, and moonset are given in local time from 40° N 90° W. The Moon’s illumination is given at 12 P.M. local time from the same location.

    For a look ahead at more upcoming sky events, check out our full Sky This Week column. 

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  • A star exploded twice — First-ever image reveals its cosmic fingerprint

    A star exploded twice — First-ever image reveals its cosmic fingerprint

    For the first time, astronomers have obtained visual evidence that a star met its end by detonating twice. By studying the centuries-old remains of supernova SNR 0509-67.5 with the European Southern Observatory’s Very Large Telescope (ESO’s VLT), they have found patterns that confirm its star suffered a pair of explosive blasts. Published today, this discovery shows some of the most important explosions in the Universe in a new light.

    Most supernovae are the explosive deaths of massive stars, but one important variety comes from an unassuming source. White dwarfs, the small, inactive cores left over after stars like our Sun burn out their nuclear fuel, can produce what astronomers call a Type Ia supernova.

    “The explosions of white dwarfs play a crucial role in astronomy,” says Priyam Das, a PhD student at the University of New South Wales Canberra, Australia, who led the study on SNR 0509-67.5 published today in Nature Astronomy. Much of our knowledge of how the Universe expands rests on Type Ia supernovae, and they are also the primary source of iron on our planet, including the iron in our blood. “Yet, despite their importance, the long-standing puzzle of the exact mechanism triggering their explosion remains unsolved,” he adds.

    All models that explain Type Ia supernovae begin with a white dwarf in a pair of stars. If it orbits close enough to the other star in this pair, the dwarf can steal material from its partner. In the most established theory behind Type Ia supernovae, the white dwarf accumulates matter from its companion until it reaches a critical mass, at which point it undergoes a single explosion. However, recent studies have hinted that at least some Type Ia supernovae could be better explained by a double explosion triggered before the star reached this critical mass.

    Now, astronomers have captured a new image that proves their hunch was right: at least some Type Ia supernovae explode through a ‘double-detonation’ mechanism instead. In this alternative model, the white dwarf forms a blanket of stolen helium around itself, which can become unstable and ignite. This first explosion generates a shockwave that travels around the white dwarf and inwards, triggering a second detonation in the core of the star — ultimately creating the supernova.

    Until now, there had been no clear, visual evidence of a white dwarf undergoing a double detonation. Recently, astronomers have predicted that this process would create a distinctive pattern or fingerprint in the supernova’s still-glowing remains, visible long after the initial explosion. Research suggests that remnants of such a supernova would contain two separate shells of calcium.

    Astronomers have now found this fingerprint in a supernova’s remains. Ivo Seitenzahl, who led the observations and was at Germany’s Heidelberg Institute for Theoretical Studies when the study was conducted, says these results show “a clear indication that white dwarfs can explode well before they reach the famous Chandrasekhar mass limit, and that the ‘double-detonation’ mechanism does indeed occur in nature.” The team were able to detect these calcium layers (in blue in the image) in the supernova remnant SNR 0509-67.5 by observing it with the Multi Unit Spectroscopic Explorer (MUSE) on ESO’s VLT. This provides strong evidence that a Type Ia supernova can occur before its parent white dwarf reaches a critical mass.

    Type Ia supernovae are key to our understanding of the Universe. They behave in very consistent ways, and their predictable brightness — no matter how far away they are — helps astronomers to measure distances in space. Using them as a cosmic measuring tape, astronomers discovered the accelerating expansion of the Universe, a discovery that won the Physics Nobel Prize in 2011. Studying how they explode helps us to understand why they have such a predictable brightness.

    Das also has another motivation to study these explosions. “This tangible evidence of a double-detonation not only contributes towards solving a long-standing mystery, but also offers a visual spectacle,” he says, describing the “beautifully layered structure” that a supernova creates. For him, “revealing the inner workings of such a spectacular cosmic explosion is incredibly rewarding.”

    This research was presented in a paper to appear in Nature Astronomy titled “Calcium in a supernova remnant shows the fingerprint of a sub-Chandrasekhar mass explosion.”

    The team is composed of P. Das (University of New South Wales, Australia [UNSW] & Heidelberger Institut für Theoretische Studien, Heidelberg, Germany [HITS]), I. R. Seitenzahl (HITS), A. J. Ruiter (UNSW & HITS & OzGrav: The ARC Centre of Excellence for Gravitational Wave Discovery, Hawthorn, Australia & ARC Centre of Excellence for All-Sky Astrophysics in 3 Dimensions), F. K. Röpke (HITS & Institut für Theoretische Astrophysik, Heidelberg, Germany & Astronomisches Recheninstitut, Heidelberg, Germany), R. Pakmor (Max-Planck-Institut für Astrophysik, Garching, Germany [MPA]), F. P. A. Vogt (Federal Office of Meteorology and Climatology – MeteoSwiss, Payerne, Switzerland), C. E. Collins (The University of Dublin, Dublin, Ireland & GSI Helmholtzzentrum für Schwerionenforschung, Darmstadt, Germany), P. Ghavamian (Towson University, Towson, USA), S. A. Sim (Queen’s University Belfast, Belfast, UK), B. J. Williams (X-ray Astrophysics Laboratory NASA/GSFC, Greenbelt, USA), S. Taubenberger (MPA & Technical University Munich, Garching, Germany), J. M. Laming (Naval Research Laboratory, Washington, USA), J. Suherli (University of Manitoba, Winnipeg, Canada), R. Sutherland (Australian National University, Weston Creek, Australia), and N. Rodríguez-Segovia (UNSW).

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  • Nerve-Sparing Cystectomy Preserves Sexual Function

    Nerve-Sparing Cystectomy Preserves Sexual Function

    Cystectomy is a major surgery that requires the removal of the bladder and the creation of a urinary diversion. It’s a component of treatment for many patients with bladder cancer and may be an option for patients with other conditions, like neurogenic bladder and fistula repair. Now, surgeons at Cleveland Clinic are increasingly using nerve-sparing techniques for cystectomy that preserve sexual function and quality of life without compromising cancer treatment.

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    “There’s been a shift in the urologic cancer community in terms of prioritizing quality-of-life outcomes without compromising cancer treatment,” says Nima Almassi, MD. “Historically, cystectomy has been performed with a wide resection to maximize oncologic treatment and avoid positive margins and cancer recurrence.”

    Prospective studies have shown that patients generally report positive quality-of-life outcomes across most domains following cystectomy, with a few exceptions. Body image, especially for patients who need a stoma, urinary function, and sexual function tend to be areas where patients report a decreased quality of life. For men undergoing cystectomy, a wide (non-nerve sparing) resection will cause severe erectile dysfunction. Nerve-sparing cystectomy represents one method of potentially improving quality of life outcomes for men undergoing surgery.

    Postoperative sexual outcomes in men and women

    Urologic oncologists like Dr. Almassi say that many patients don’t need to sacrifice their sexual function because of treatment. For male patients undergoing cystectomy, erectile dysfunction (ED) is a very common side effect, but nerve-sparing cystectomy can help temper it.

    The Cleveland Clinic team has also been focused on improving the bladder cancer experience in women, which includes evaluating similar nerve-sparing and organ-sparing techniques to preserve reproductive anatomy and obviate surgical menopause and sexual dysfunction. Prospective studies ongoing at Cleveland Clinic have shown that women who undergo vaginal-sparing cystectomy appear to have less prolapse than women, but the data are still early when it comes to sexual function.

    Patient selection is key

    Patients eligible for this type of surgery have a good baseline ED and are motivated to preserve it. Additionally, they must be free of specific disease characteristics that could complicate oncologic control, such as cancer abutting or involving the neurovascular bundle. Preoperative MRI imaging can guide patient selection.

    Similarly, aggressive subtypes of bladder cancer with high risk of being locally advanced may not be suitable for a nerve-sparing surgical approach. “In this case, we would not recommend nerve-sparing out of concern it could compromise cancer control,” says Dr. Almassi.

    A positive institutional experience

    Nerve-sparing cystectomy requires the surgeon to dissect the neurovascular bundles off the bladder and prostate. “We have found that this has yielded much better erectile function in patients after surgery without compromising oncologic outcomes. For all patients who we’ve deemed eligible for this, we have not had positive surgical margins,” notes Dr. Almassi.

    Using validated questionnaires, patients report their erectile function about every three months for a year. The team is finding that around six months postoperatively, most patients experience only mild ED, and that remains consistent. Even three months following the surgery, he says, patients typically are recovering well but are often not yet sexually active at this time.

    “Most patients’ erectile function ends up returning to within three points on a 25-point scale from their preoperative baseline, suggesting erectile function can recover to similar levels to what it was before surgery.”

    Part of the center’s protocol is starting patients on tadalafil, and they may still be using it when function is assessed postoperatively, Dr. Almassi remarks.

    The Cleveland Clinic team opts for a robotic approach, owing to better visualization and access to the neurovascular bundle. However, performing this technique with open surgery is also achievable in experienced hands. “The way the field has transitioned, fewer surgeons in high volume centers perform open cystectomy,” he explains.

    A call for screening candidates

    “Optimizing quality of life for our patients is a major focus for our group. Studies show that sexual function declines after cystectomy. We have an opportunity to safely personalize a surgical technique in select patients to help preserve functional outcomes,” says Dr. Almassi. “We certainly encourage our colleagues to consider screening patients who may be good candidates.”

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