Systemic contact dermatitis (SCD) is a condition occurring in previously sensitized individuals after systemic re-exposure to the same or cross-reacting substance. Pigmented systemic contact dermatitis after intake of cobalt containing diet has never been reported.

We report here the complete genome sequence of the Rhizobium rhizogenes (formerly Agrobacterium rhizogenes) strain LBA9402 (NCPPB1855rifR), a pathogenic strain causing hairy root disease. In order to assemble a complete genome we obtained short-reads from Illumina sequencing as well as long-reads from Oxford Nanopore Technology sequencing. The genome consists of a 3,958,212 bp chromosome, a 2,005,144 bp chromid (secondary chromosome) and a 252,168 bp Ri plasmid (pRi1855), respectively. The primary chromosome was very similar to that of the avirulent biocontrol strain K84, but the chromid showed a 724 kbp deletion accompanied by a large 1.8 Mbp inversion revealing the dynamic nature of these secondary chromosomes. The sequence of the agropine Ri plasmid was compared to other types of Ri and Ti plasmids. Thus we identified the genes responsible for agropine catabolism, but also a unique segment adjacent to the TL-region that has the signature of a new opine catabolic gene cluster including the three genes that together encode an opine dehydrogenase. Our sequence analysis also revealed a novel gene at the very right end of the TL-DNA, which is unique for the agropine Ri plasmid. The protein encoded by this gene was most related to the succinamopine synthases of chrysopine and agropine Ti plasmids and thus may be involved in synthesis of the unknown opine that can be degraded by the adjacent catabolic cluster. The available sequence will facilitate the use of R. rhizogenes and especially LBA9402 in both the laboratory and for biotechnological purposes.

The basal zone of glaciers is characterised by physicochemical properties that are distinct from firnified ice because of strong interactions with underlying substrate. Basal ice ecology and the roles that the microbiota play in biogeochemical cycling, weathering, and proglacial soil formation, remains poorly known. We report bacterial diversity and potential ecological roles at three temperate Icelandic glaciers. We sampled three physically distinct basal ice facies (stratified, dispersed, debris bands) and found biological similarities and differences between them; basal ice character is therefore an important sampling consideration in future studies. High abundance of silicates and Fe-containing minerals could sustain the basal ice ecosystem, in which chemolithotrophic bacteria (~23%), especially Fe-oxidisers and hydrogenotrophs, can fix C, which can be utilised by heterotrophs. Methanogenic-affiliated detected sequences showed that silicate comminution-derived hydrogen can also be utilised for methanogenesis. Metabolism predicted by 16S rRNA diversity revealed that methane metabolism and C-fixation are the most common pathways, indicating the importance of these metabolic routes. Carbon concentrations were low compared to other ecosystems, but we report the highest carbon concentration in basal ice to date. Carbon release from melting basal ice may play an important role in promoting pioneering communities establishment and soil development in deglaciating forelands.

In the microbiological diagnosis of bloodstream infections (BSI), blood culture (BC) is considered the gold standard test despite its limitations such as low sensitivity and slow turnaround time. A new FDA-cleared and CE-marked platform utilizing magnetic resonance to detect amplified DNA of the six most common and/or problematic BSI pathogens (Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, and Escherichia coli) is available and may shorten the time to diagnosis and potentially improve antimicrobial utilization. Whole blood samples from hospitalized patients with clinical signs of sepsis were analyzed using the T2Bacteria Panel (T2Biosystems) and compared to simultaneously collected BC. Discrepant results were evaluated based on clinical infection criteria, combining supporting culture results and the opinion of treating physicians. A total of 55 samples from 53 patients were evaluated. The sensitivity and specificity of the T2Bacteria panel was 94% (16 out of 17 detections of T2Bacteria-targeted organisms) and 100%, respectively, with 36.4% (8 of 22) causes of BSI detected only by this method. The T2Bacteria Panel detected pathogens on average 55 hours faster than standard BC. In our study, 9 of 15 patients with positive T2Bacteria Panel results received early-targeted antibiotic therapy, and/or their antimicrobial treatment was modified based on T2Bacteria Panel findings. Given the high reliability, faster time to detection, and easy workflow, the technique qualifies as a point of care testing approach.

In this paper, we study the conditions under which the following symmetric system of difference equations with exponential terms: \[ x_{n+1} =a_1\frac{y_n}{b_1+y_n} +c_1\frac{x_ne^{k_1-d_1x_n}}{1+e^{k_1-d_1x_n}},\] \[ y_{n+1} =a_2\frac{x_n}{b_2+x_n} +c_2\frac{y_ne^{k_2-d_2y_n}}{1+e^{k_2-d_2y_n}}\] where $a_i$, $b_i$, $c_i$, $d_i$, $k_i$, for $i=1,2$, are real constants and the initial values $x_0$, $y_0$ are real numbers, undergoes Neimark-Sacker, flip and transcritical bifurcation. The analysis is conducted applying center manifold theory and the normal form bifurcation analysis.

Introduction:Stand-alone substrate ablation without baseline ventricular tachycardia (VT) induction and activation mapping has become a standard VT ablation strategy. We sought to evaluate the influence of baseline VT inducibility and activation mapping on ablation outcomes in patients with structural heart disease (SHD) undergoing VT ablation. Methods:This is a single center, observational and retrospective study including consecutive patients with SHD and documented VT undergoing ablation. Baseline VT induction was attempted before ablation in all patients and VT activation mapping performed when possible. Ablation was guided by activation mapping for mappable VTs plus substrate ablation for all patients. Ablation outcomes and complications were evaluated. Results: 160 patients were included (203 VT ablation procedures) and were classified in 3 groups according to baseline VT inducibility: group 1 (non inducible, n=18), group 2 (1 VT morphology induced, n=53), and group 3 (>1VT morphology induced, n=89). VT activation mapping was possible in 35%. After a median follow-up of 38.5 months, baseline inducibility of >1VT morphology was associated with a significant incidence of VT recurrence (42% for group 3 vs. 15.1% for group 2 and 5.6% for group 1, Log-rank p<0.0001) and activation mapping with a lower rate of VT recurrence (24% vs. 36.3%, Log-rank p=0.035). Independent predictors of VT recurrences and mortality were baseline inducibility of >1VT morphology (HR 12.05 IC 95% 1.60-90.79, p=0.016) and LVEF<30% (HR 2.43 IC 95% 1.45-4.07, p=0.001), respectively. Complications occurred in 11.2% (5.6% hemodynamic decompensation). Conclusions:Baseline VT inducibility and activation mapping may add significant prognostic information during VT ablation procedur

We report on a long-term survivor of an atypical teratoid/rhabdoid tumor (ATRT-TYR) as an index patient, who carries a SMARCB1 exon 6 gain inherited from his father. The father was diagnosed with an unusual sequence of a myxopapillary INI1-negative ependymoma and a relapsing BRAF V600 wild type hairy-cell leukemia. He has two yet healthy sisters aged 33 and 38 years carrying the same variant, from which one had lost an infant to a malignant brain tumor. This family highlights the existence of RTPS1-associated SMARCB1 germline alterations with reduced penetrance and extends the spectrum of involved diseases

The soil carbon (C) and nitrogen (N) dynamic was usually considered as a minor change based on a static process in the sealed soil under decades of impervious surface (IS). However, no systematic studies concerning the soil organic carbon (SOC) and nitrogen (SON) dynamic were conducted under IS in contrast with urban vegetation (i.e., forest, grass). Here we utilized fractional distillation of soils as well as stable isotopic analysis to examine soil C&N cycles after 20 and 30 years of vegetation planting and IS construction in Guangzhou and Shenzhen, Pearl River Delta, China. Soil samples including bare soil (CK) and four land use treatments were split into different chemical fractions. Then we analyzed the C&N content, C/N ratio, δ13C, δ15N, C&N recalcitrant indices (RIC, RIN), and the mean residence time (MRT). We found that the soil C&N increased first (i.e., 20 years) because of enhanced C&N stocks in both labile (LP) and recalcitrant pool (RP), and then stabilized or decreased (i.e., 30 years) with the IS ages in both cities. IS had a lower SOC decomposition rate and thus resulted in the five to ten times longer MRT (about 259–465 years) than that in vegetated soils (about 39–55 years). Moreover, the SOC&SON always showed a decoupling relation in labile pools (i.e., LC and LN) in forests in both cities. The study showed the IS remarkably altered the soil C&N dynamics, showing a great difference in SOC&SON fractions composition and turnover compared with vegetation.

Objective: Long-term cost-effectiveness of app-based treatment for female stress, urgency, or mixed urinary incontinence (UI) compared to care-as-usual in primary care. Design: A pragmatic, randomised controlled, superiority trial. Setting: Primary care in the Netherlands from 2015 to 2018, follow-up at 12 months. Population: Women with ≥2 UI-episodes per week, access to mobile apps, wanting treatment. 262 women randomised equally to app or care-as-usual; 89 (68%) and 83 (63%) attended follow-up. Methods: The standalone app included conservative management for UI with motivation aids (e.g., reminders). Care-as-usual delivered according to the Dutch GP guideline for UI. Main outcome measures: Effectiveness assessed by the change in symptom severity score (ICIQ-UI-SF) and the change in quality of life (ICIQ-LUTS-QoL, EQ-5D-5L) on superiority with linear regression on an intention-to-treat basis. Cost-effectiveness and -utility from a societal perspective, based on Incontinence Impact Adjusted Life Years (IIALYs) and Quality Adjusted Life years (QALYs). Results: Clinically relevant improvement of UI severity for both app (-2.17 ± 2.81) and care-as-usual (-3.43 ± 3.6), with a non-significant mean difference of 0.903 (-0.66 to 1.871). Costs were lower for app-based treatment with \euro-161 (95%CI: -180 to -151) per year. Cost-effectiveness showed small mean differences in effect for IIALY (0.04) and QALY (-0.03) and thus larger ICER (-3,696) and ICUR (\euro6,379). Conclusion: App-based treatment is a viable alternative to care-as-usual for UI in primary care in terms of long-term cost-effectiveness. Funding: Dutch Organisation for Health Research and Development (ZonMw: 837001508), sub-funding P.W. Boer Foundation Dutch Trial Register identifier: Trial NL4948 (www.trialregister.nl/trial/4948).

Background Pregnancy and childbirth increase the risk for pelvic floor dysfunction, including sexual dysfunction. So far, the mechanisms and the extent to which certain risk factors play a role, remain unclear. Objectives In this systematic review of literature, we aimed to determine the risk factors for sexual dysfunction in the first year after delivery. Search Strategy We searched MEDLINE, Embase and CENTRAL using the search strategy: Sexual dysfunction AND Obstetric events. Selection Criteria We included original English, comparative studies that used validated questionnaires and the ICS/IUGA terminology for sexual dysfunction, dyspareunia and vaginal dryness. Data Collection and Analysis We assessed the quality and the risk of bias of the included studies with the Newcastle Ottawa Scale. We extracted the reported data and we performed random-effects meta-analysis to obtain the summary Odds Ratios (OR) with 95% Confidence Intervals. Heterogeneity across studies was assessed using the I2 statistic. Main Results We found no significant difference in the odds for both sexual dysfunction and dyspareunia between cesarean section and spontaneous delivery (OR:1.17[0.88-1.57] and OR:0.75[0.53-1.07]) and between operative delivery and spontaneous delivery (OR:1.56[0.87-2.79] and OR:1.35[0.75-2.42]). Anal sphincter injury was associated with increased odds for both sexual dysfunction (OR:3.00[1.28-7.03]) and dyspareunia (OR:1.71[1.09-2.67]). Episiotomy was associated with dyspareunia (OR:1.65[1.20-2.29]) but not with sexual dysfunction (OR:1.90[0.94-3.84]). We retrieved one study of low quality which reported on vaginal dryness and found no significant association with obstetric events.

Objectives - The aim of this study was to evaluate the differences in surgical capacity for head and neck cancer in the UK between the first wave (March-June 2020) and the current wave (Jan-Feb 2021) of the COVID-19 pandemic. Design – REDcap online based survey of hospital capacity. Setting - UK secondary and tertiary hospitals providing head and neck cancer surgery. Participants – One representative per hospital was asked to report the capacity for head and neck cancer surgery in that institution. Main outcome measures – The principal measures of interests were new patient referrals, capacity in outpatients, theatres and critical care; therapeutic compromises constituting delay to surgery, de-escalated surgery and therapeutic migration to non-surgical primary modality. Results – Data was returned from approximately 95% of UK hospitals with a head and neck cancer surgery specialist service. 50% of UK head and neck cancer patients requiring surgery have significantly compromised treatments during the second wave: 28% delayed, 10% have received radiotherapy based treatment instead of surgery and 12% have received de-escalated surgery. Surgical capacity has been more severely constrained in the second wave (58% of pre-pandemic level) compared with the first wave (62%) despite the time to prepare. Conclusions - Some hospitals are overwhelmed by COVID-19 and unable to offer essential cancer surgery, but all have neighbouring hospitals in their region retaining good (or even normal) capacity. It is noteworthy that very few patients have been appropriately re-directed away from the hospitals most constrained by their burden of COVID-19. The paucity of an effective central or regional strategic response to this evident mismatch between demand and surgical capacity is to the detriment of our head and neck cancer patients.

Key points·      Simultaneous translabyrinthine tumor resection and cochlear implantation is a promising treatment method with hearing rehabilitation for sporadic vestibular schwannomas.·      Size of vestibular schwannoma, distance to the modiolus, residual hearing and promontory stimulation electrical brainstem response audiometry are important preoperative predictive factors for chance of cochlear implantation. ·      Electrically evoked brain stem response audiometry with an intracochlear test electrode is an important additional tool during vestibular schwannoma resection to decide on cochlear implantation.    Sporadic vestibular schwannomas (VS) can be treated using radiation therapy, microsurgical resection, or a wait-and-scan approach. Most VS will require treatment after some period of observation. However, the currently available treatment options carry a high risk of loss of serviceable hearing. Some authors believe that the possibility of cochlear implantation in the setting of VS should completely change the treatment strategy for this disease(1). However, patient outcomes with CIs show a wide variation—with some patients having no auditory perception, while others exhibit open-set speech understanding(2). The intraoperative testing of cochlear nerve function using electrically evoked brainstem response audiometry (eABR) provides a means of objectively assessing cochlear nerve conduction, and has been increasingly applied in this setting(2, 3). In the present study, we aimed to assess outcomes of patients undergoing vestibular schwannoma resection and cochlear implantation, and to develop a new scoring system to preoperatively identify suitable patients for this treatment course. Appropriate preoperative classification of patients can have important impacts on patient counseling and expectations.DesignEach study participant gave their informed consent to participate. The trial was approved by the local ethics committee 1111/2017, and is registered at www.clinicaltrials.gov (NCT03745560). All 17 patients underwent translabyrinthine vestibular schwannoma resection, during which eABR were recorded with an intracochlear test electrode (ITE) before and after tumor resection. In cases with positive responses after complete tumor resection, a cochlear implant (CI) was placed. Overall, ten patients received a CI with a Flex 28 or Flex Standard electrode (MED-EL, Innsbruck, Austria) depending on cochlear duct length. Data availability statement The data that support the findings of this study are available from the corresponding author upon request.SettingThe study was conducted at a tertiary care center.Participants Seventeen patients with unilateral sporadic VS were screened between January 2017 and January 2020 (see Table 1). Inclusion criteria were as follows: sporadic vestibular schwannoma, no ipsilateral functional hearing, desire to undergo cochlear implantation, and general good health. Exclusion criteria were prior treatment for vestibular schwannoma, neurofibromatosis type 2, history of pathology requiring multiple head magnetic resonance imaging (MRI), or history of malignant disease of the head and neck. A lack of functional hearing was defined as ≤50% monosyllable recognition at 80 dB HL. Main outcome measuresThe patients’ preoperative findings and results were re-evaluated to develop a new scoring system for patient selection. All patients underwent MRI of the brain performed using a 3.0 Tesla magnetic resonance (MR) unit (Philips Achieva; Philips Medical Systems, Best, the Netherlands). To visualize the cerebellopontine angle, the MR protocol included a 3D balanced fast field echo sequence that was used for further assessment. Using a picture archiving and communication system (IMPAX; AGFA HealthCare, Bonn, Germany), all MR examinations were anonymized and randomly presented to a neuroradiologist who was not aware of any clinical data. Grading according to four-grade Koos classification system was carried out (4). Additionally, a four level grading system was used to evaluate intrameatal extension towards the modiolus (Table 2).Promontory stimulation eABR was performed with a gold coated rigid electrode with a rounded-bent (hockey stick) tip stimulation probe manufactured by MED-EL (Innsbruck, Austria)  and recorded with the Neuropack, Nihon Kohden, Tokyo. A positive response is defined as a clear wave V reproducible in latency and amplitude. In cases with a wave V that can only be seen at high stimulation intensities or that is not reproducible an unclear response is documented. No identifiable wave V is defined as a negative response.The pure-tone average (4-PTA) was calculated as the mean for each patient, using the results at frequencies of 0.5, 1, 2, and 4 kHz. Monosyllables were measured at 65 and 80 dB HL. Based on these results, patients were categorized in four groups as seen in Table 2. STARD guidelines were followed when reporting the data of this study. ResultsAfter six months of follow-up, ten patients were daily users of the CI. Their mean aided pure-tone average was 38 dB HL, and their mean WRS was 28% at 65 dB, and 52% at 80 dB. Outcomes for individual patients can be seen in Table 3. Nine of the ten patients had open-set speech understanding. The patient without open-set speech understanding has significant hearing loss on the contralateral side and a language barrier. Facial nerve outcomes according to House Brackman (HB) are shown in Table 3. In all cases, the six-month follow-up MRI showed no sign of residual or recurrent tumor. The scoring system Table 2 shows the scoring system that was developed. Besides Koos grading, results of promontory stimulation eABR were included. Our system also evaluated residual hearing, which is an important factor reflecting the state of the nerve and the cochlea before an intervention. Further, we identified relation to the modiolus as a predictive factor. Table 4 shows the scoring system applied to the presented patients. DiscussionVarious advancements over recent years have made CI a good option for restoring binaural hearing in patients with VS. Imaging sequences have been improved and CI magnets have been developed to reduce metal artifacts(5) and allow postoperative evaluation of the internal auditory canal and cerebellopontine angle for tumor follow-up(6). Another recent development is the possible use of intraoperative eABR with an ITE, enabling objective assessment of cochlear nerve functionality(2, 3). In the past, the outcome of CIs in the context of VS was considered unpredictable, and many patients did not benefit from this technique. However, the advent of testing systems, such as intraoperative eABR, permits more precise evaluation of possible outcomes. Although simultaneous VS resection and cochlear implantation is possible with only visual assessment of the cochlear nerve(7), eABR measurements are a useful tool for objectifying the surgeon’s assessment. Only two prior studies have described the use of eABR during translabyrinthine VS resection(2, 8). One study included eight patients(8). The other was a pilot study by our research group(2). In this previous manuscript, we demonstrate the intraoperative objective evaluation of the cochlear nerve with eABR, using an ITE, during translabyrinthine VS resection and cochlear implantation(2). Our preliminary results indicated that positive eABR results (clear wave V) seem to be reliable, and to correlate well with CI-aided auditory perception. This thesis was further supported by the results of our present study, in which all patients with positive eABR results and who received an implant showed auditory perception with their CI, and most (90%) even have open-set speech understanding. A remaining major challenge is to identify patients with a high chance of cochlear nerve preservation. Therefore, as a logical next step, the knowledge gained in this study was used to create a grading system with the aim of preoperatively determining candidacy, as was performed herein.Individuals with residual speech understanding were more likely to have positive eABR results, and to receive a CI. These results are in line with the findings of Sanna et al(7). In their study, individuals with good functional hearing underwent translabyrinthine VS resection and cochlear implantation. After tumor removal, surgeons evaluated the cochlear nerve and visually determined whether it was intact(7). Of the nineteen included patients, thirteen were able to receive a CI, of whom 84% use their CI daily or almost daily(7). Another identified predictive factor was the VS extension towards the cochlear modiolus. This anatomic structure also reportedly plays an important role when assessing CI candidacy in cases of malformation,(9) as well as the need of its preservation in intracochlear VSs(10). Obviously, tumor resection is increasingly challenging with greater VS size, reducing the possibility of nerve protection reflected by Koos grading. The last category of our scoring system was promontory stimulation. One issue with promontory stimulation is that it produces a substantial number of artefacts in awake patients. Another problem is that some patients do not tolerate stimulation well, leading to a wide variety of stimulations intensities between different individuals. Artefacts and said stimulation range diminish the interpretation possibilities and reliability of the results. One limitation of the present study was the relatively small sample size on which the scoring system was based. Nevertheless, this study represents the largest group of patients with vestibular schwannomas, in whom eABR was intraoperatively performed. As well as the first study assessing predictive factors for cochlear implantation which can be assessed preoperatively.Overall, our results indicated that patients with a Class I scoring had a very high chance of receiving a CI. Among patients categorized as Class II (6–8 points according to our system), the majority could be implanted, but they had a distinctly worse chance of receiving an implant, and thus careful counseling is essential in these cases. Patients categorized as Class III and IV were not able to be implanted with a CI. ConclusionSimultaneous translabyrinthine VS excision and cochlear implantation using intraoperative eABR measurements is a good option for hearing rehabilitation and provides binaural hearing. Preoperative accurate assessment of the size and extent of VS, audiometric testing, and promontory stimulation eABR improves preoperative patient selection, help manage patient expectations, and predict the possibility of cochlear implantation. References1.         Upadhyay U, Almefty RO, Dunn IF, Al-Mefty O. Letter to the Editor: Save the nerve. J Neurosurg. 2015;123(3):821-2.2.         Dahm V, Auinger AB, Honeder C, Riss D, Landegger LD, Moser G, et al. Simultaneous Vestibular Schwannoma Resection and Cochlear Implantation Using Electrically Evoked Auditory Brainstem Response Audiometry for Decision-making. Otol Neurotol. 2020;41(9):1266-73.3.         Patel NS, Saoji AA, Olund AP, Carlson ML. Monitoring Cochlear Nerve Integrity During Vestibular Schwannoma Microsurgery in Real-Time Using Cochlear Implant Evoked Auditory Brainstem Response and Streaming Neural Response Imaging. Otol Neurotol. 2020;41(2):e201-e7.4.         Koos WT, Day JD, Matula C, Levy DI. Neurotopographic considerations in the microsurgical treatment of small acoustic neurinomas. J Neurosurg. 1998;88(3):506-12.5.         Schwartz N, Rooth MA, Dillon MT, O'Connell BP, Dedmon MM, Huang BY, et al. MRI surveillance following concurrent cochlear implantation in cases of vestibular schwannoma resection. Am J Otolaryngol. 2020;41(4):102518.6.         Schwarz-Nemec U, Dahm V, Arnoldner C. Letter to the editor regarding worldwide 1st MED-EL Mi1200 SYNCHRONY cochlear implant magnet removal for MRI image artifact reduction by Wieser et al. Otolaryngology Case Reports. 2019;10(March):43-4.7.         Sanna M, Medina MD, Macak A, Rossi G, Sozzi V, Prasad SC. Vestibular Schwannoma Resection with Ipsilateral Simultaneous Cochlear Implantation in Patients with Normal Contralateral Hearing. Audiol Neurootol. 2016;21(5):286-95.8.         Roberts S, Levin B, Sanli H, Ferch R, Kong K, Eisenberg R. Simultaneous cochlear implantation and removal of acoustic neuroma: implications for hearing. J Laryngol Otol. 2020;134(6):519-25.9.         Grover M, Sharma S, Preetam C, Gupta G, Samdani S, Agarwal S, et al. New SMS classification of cochleovestibular malformation and its impact on decision-making. J Laryngol Otol. 2019;133(5):368-75.10.       Plontke SK. An Improved Technique of Subtotal Cochleoectomy for Removal of Intracochlear Schwannoma and Single-stage Cochlear Implantation. Otol Neurotol. 2020;41(7):e891.    Patient Demographics   ID Age (y) Sex Side 4-PTA   WRS @ 80 dB Contralateral 4-PTAC 1 47 f l 77 dB 20% SSD 6 dB      2 59 m r 68 dB 40% AHL 54 dB 3 55 f l 51 dB 5% SSD 20 dB 4 74 m r 85 dB 0% AHL 48 dB 5 42 f l 68 dB 0% SSD 8 dB 6 61 f l 64 dB 30% SSD 5 dB 7 69 f r ³ 100 dB 0% ³ 100 dB 65 dB 8 59 m r 60 dB 0% SSD 21 dB 9 44 m r 74 dB 0% SSD 6 dB 10 55 f r 49 dB 40% SSD 6 dB 11 56 f l ³ 100 dB 0% SSD 10 dB 12 60 f r 87 dB 0% SSD 16 dB 13 44 m l 75dB 0% AHL 55 dB 14 52 f l ³ 100 dB 0% SSD 25 dB 15 56 f l 40 dB 25% SSD 14 dB 16 62 f r 64 dB 0% SSD 20 dB 17 46 f l ³ 100 dB 0% ³ 100 dB 80 dB Total 55.4 (± 8.9 SD) m = 5 f = 12 l = 9 r = 8 74 dB (± 19 SD) 9% (± 15 SD) SSD = 12 AHL = 3 27 dB (± 23 SD)  Table 1: Age is given in years (y). Gender is described as f (female) or m (male). Puretone average (4-PTA) is calculated as average decibel (dB) hearing level (HL) at the frequencies 500 Hertz (Hz), 1000 Hz, 2000 Hz and 4000 Hz. Word recognition scores (WRS) are calculated using Freiburg monosyllables at (@) 80 dB HL. Hearing of the contralateral side resulted in the diagnoses of single sided deaf (SSD), asymmetric hearing loss (AHL) or bilateral complete hearing loss larger than 100 dB HL (³ 100 dB). Contralateral 4-PTA = 4-PTAC       Scoring System       Category Definition Points Koos Grading Koos 4 0 Koos 3 1 Koos 2 2 Koos 1 3   Extension Transmodiolar extension 0 Infiltration of modiolus 1 Contact with modiolus 2 No contact, no infiltration of modiolus 3   Hearing ³ 100 dB 4-PTA 0 80 < 100 dB 4-PTA 1 < 79 dB 4-PTA 2 > 0% monosyllables, any PTA 3   PS EABR No response 0 Unclear wave V 1 Stable wave V 2       Total Score Class IV 0 - 3 Class III 4 - 5 Class II 6 - 8 Class I 9 - 11   Table 2: Scoring system to identify patients with higher chances of nerve integrity in case of VS resection. A certain amount (0-3) of points are given in four categories. Points are added up and patients are categorized to a certain class which reflects the probability of cochlear implantation after translabyrinthine vestibular schwannoma excision. Promontory stimulation eABR (PS EABR)   Patient Outcomes   ID Koos CI 6-month Follow-up VII 1/2/3/4 yes/no 4-PTA WRS @ 65 dB WRS @ 80 dB HB – POD1 HB – 6 Mo FU 1 2 yes 35 dB 40% 65% 1 1 2 1 yes 30 dB 65% 65% 1 1 3 3 no n.a. n.a. n.a. 5 3 4 3 yes 36 dB 0% 30% 1 1 5 2 no n.a. n.a. n.a. 1 1 6 1 no n.a. n.a. n.a. 1 1 7 2 no n.a. n.a. n.a. 1 1 8 4 no n.a. n.a. n.a. 5 2 9 2 yes 35 dB 0% 20% 1 1 10 2 yes 34 dB 45% 85% 1 1 11 2 no n.a. n.a. n.a. 1 1 12 2 yes 35 dB 10% 45% 2 1 13 2 yes 51 dB n.p. n.p. 1 1 14 1 no n.a. n.a. n.a. 3 1 15 2 yes 33 dB 40% 60% 1 1 16 1 yes 43 dB 20% 40% 1 1 17 2 yes 35 dB 35% 55% 1 1    Table 3: Outcomes of seventeen included patients. The second column shows the size and extension of the vestibular schwannoma according to Koos grading one to four. The third column shows which patients were provided with a cochlear implant (CI) (yes) and which not (no). Column four - Puretone average (4-PTA) in CI aided condition calculated as average decibel (dB) hearing level (HL) at the frequencies 500 Hertz (Hz), 1000 Hz, 2000 Hz and 4000 Hz. Column five and six - word recognition scores (WRS) in CI aided condition are calculated using Freiburg monosyllables at (@) 65 and 80 dB HL. The last two columns show facial nerve function according to House Brackmann (HB) scale 1 to 6 on postoperative day one (POD 1) and at the 6 months follow-up appointment (6 Mo FU). n.p. - not performed due to a language barrier. n.a. – not applicable     Applied Point System   ID Koos Points Modiolus Audio PS eABR Points CIass CI 1 2 2 3 n.p. ³ 7 £ II yes 2 3 3 3 2 11 I yes 3 1 2 3 2 8 II no 4 1 3 1 2 7 II yes 5 2 2 2 2 8 II no 6 3 1 3 2 9 I no 7 2 0 0 1 3 IV no 8 0 1 2 2 5 III no 9 2 3 2 2 9 I yes 10 2 3 3 2 10 I yes 11 2 1 0 0 3 IV no 12 2 3 1 1 7 II yes 13 2 3 2 2 9 I yes 14 3 1 0 2 6 II no 15 2 3 3 2 10 I yes 16 3 2 2 2 9 I yes 17 2 2 0 2 6 II yes Results  0 - 3 0 - 3 0 - 3 0 - 2 0 - 11 I - IV yes/no  Table 4: Point system applied to the presented seventeen patients. Every column represents one of the categories and points given. Koos - Koos classification, Modiolus - extension (in connection to the Modiolus), Audio - audiometric results, summation of pure tone average and word recognition score) and PS eABR - promontory stimulation electrically evoked auditory brainstem response. In total, there are four categories. Points reflects the sum of all points. Class is the resulting group each patient is categorized into, according to amount of points. Patient 1 did not undergo PS eABR, which does not allow for a complete classification. CI – cochlear implant: yes if they were provided with a CI, no if no CI was placed. N.p. – not performed  

Background Children are important in community-level influenza transmission. School-based monitoring may inform influenza surveillance. Methods We used reported weekly confirmed influenza in Allegheny County during the 2007, and 2010-2015 influenza seasons using Pennsylvania’s Allegheny County Health Department all-age influenza cases from health facilities, and all-cause and influenza-like illness (ILI)-specific absences from nine county school districts. Negative binomial regression predicted influenza cases using all-cause and illness-specific absence rates, calendar week, average weekly temperature and relative humidity, using four cross-validations. Results School districts reported 2,184,220 all-cause absences (2010-2015). Three one-season studies reported 19,577 all-cause and 3,012 ILI-related absences (2007, 2012, 2015). Over seven seasons, 11,946 confirmed influenza cases were reported. Absences improved seasonal model fits and predictions. Multivariate models using elementary school absences outperformed middle and high school models (relative mean absolute error (relMAE)=0.94, 0.98, 0.99). K-5 grade-specific absence models had lowest mean absolute errors (MAE) in cross-validations. ILI-specific absences performed marginally better than all-cause absences in two years, adjusting for other covariates, but markedly worse one year. Conclusions Our findings suggest seasonal models including K-5th grade absences predict all-age confirmed influenza and may serve as a useful surveillance tool.

Mollisols are of major importance for food security worldwide but are increasingly degraded by soil erosion. Mollisols in Northeast China have been converted into agricultural use only since the nineteenth century, but gullies are widely distributed. Gully erosion history, rates and causes in this region remained unclear. We chose a study area with landforms and land-use history typical for the central Mollisol region of Northeast China to estimate the initiation years and rates of gully erosion from 1968 to 2018 by using aerial and satellite imageries. The outlet fan deposits of a large gully system were dated by Caesium-137 (137Cs) and artefacts. Local farmers were interviewed to verify the results. Gully volumes were measured by structure-from-motion technique using photos taken from an unmanned aerial vehicle. Our results showed that gully systems had already appeared on the steep slopes and along unpaved roads in 1968. They had become larger and more complex in 2018 by upslope retreat of the main gullies and side gully formation. Gully incision started in the 1950s and 1960s, when the original grassland and forest were completely converted into arable land. From 1968 to 2018, the gully density increased from 1.2 to 2.3 km km-2 and the gully heads retreated at speeds from 1.5 to 2.5 m yr-1. The soil loss from gully erosion ranged from 25.7 to 44.7 Mg yr-1 ha-1. These data demonstrate the severity of gully erosion in the Mollisol region of Northeast China and underline the importance of appropriate countermeasures.

It is increasingly recognized that the autonomic nervous system (ANS) is a major contributor in many cardiac arrhythmias. Cardiac ANS can be divided into extrinsic and intrinsic parts according to the course of nerve fibers and localization of ganglia and neuron bodies. Although the role of extrinsic part has historically gained more attention, the intrinsic cardiac ANS may affect cardiac function independently as well as influence the effects of the extrinsic nerves. Catheter based modulation of the intrinsic cardiac ANS is emerging as a novel therapy for management of patients with brady and tachy arrhythmias resulting from hyperactive vagal activation. However, distribution of intrinsic cardiac nerve plexus in the human heart and the functional properties of intrinsic cardiac neural elements remain insufficiently understood. The present review aims to bring the clinical and anatomical elements of the ICANS together, by reviewing neuroanatomical terminologies and physiological functions, in order to guide the clinical electrophysiologist in the catheter lab, and to serve as a reference for further research.

Objective: It is very important to accurately assess the transannular patch (TAP) in the surgical treatment of tetralogy of Fallot（TOF）. Methods: 130 patients who were diagnosed with TOF and underwent TOF repair. 112 cases were included in this study. They were divided into TAP group and no TAP group; the values of pulmonary annulus and aortic annulus were measured. GA ratio, PAI, PAAI, the pulmonary annulus Z-score and main pulmonary artery (MPA) Z-score were calculated to do statistically analyze. Results: A total of 112 patients were included in the study.62 cases (55.8%) did not transannular patch, 50 cases (44.2%) undergoing transannular patch. The pulmonary annulus Z-score, main pulmonary artery Z-score and PAI in TAP group were smaller than those in no TAP group (P < 0.05). ROC analysis showed that when the cutoff value of pulmonary annulus at -1.98 ,the area under curve (AUC) was 0.88, the sensitivity was 80%, the specificity was 71%; when the cut-off value of PAI at 0.53 ,AUC was 0.85, the sensitivity was 75%, the specificity was 80%; when the cutoff value of GA ratio at 0.55 ,AUC was 0.85, the sensitivity was 76%, and the specificity was 80%. The area under the PAAI curve (AUC) was 0.85, the sensitivity was 76%, and the specificity was 79%. Conclusion: The predictive effect of pulmonary annulus index as a simple and effective predictor of TAP in TOF radical operation is the same as that of pulmonary annulus Z-score.

Background LIVE (Less Invasive Ventricular Enhancement) with Revivent TC™ is an innovative therapy for symptomatic ischemic Heart Failure (HF). It is designed to reconstruct a negatively remodeled left ventricle (LV) after an anterior myocardial infarction (MI) by plication of the scar tissue. Its indications are specific and, as with any other structural heart intervention, the success of the procedure starts with appropriate patient selection. We aim to present the indications of the technique, crucial aspects in patient selection and individual case planning approach. Methods and Results After clinical evaluation, transthoracic echocardiography is the first imaging modality to be performed in a potential candidate for the therapy. However, definitive indication and detailed case planning rely on late gadolinium-enhanced cardiac magnetic resonance imaging or multiphasic contrast-enhanced cardiac computed tomography. These imaging modalities also assist with relative or absolute contra-indications for the procedure. Individual assessment is done to tailor the procedure to the specifics of the LV anatomy and location of the myocardial scar. Conclusion LIVE procedure is a unique intervention to treat symptomatic heart failure and ischemic cardiomyopathy after anterior MI. It is a highly customizable intervention that allows a patient-tailored approach, based on multimodality imaging assessment and planification.

The pathophysiological response following spinal cord injury (SCI) is characterized by a complex cellular cascade that limits regeneration. Biomaterial and stem cell combination therapies have shown synergistic effects, compared to their interventions independent of each other, and represent a promising approach towards regaining function after injury. In this study, we combine our polyethylene glycol (PEG) cell delivery platform with lentiviral-mediated overexpression of the anti-inflammatory cytokine interleukin (IL)-10 to improve embryonic day 14 (E14) spinal progenitor transplant survival. PEG tubes loaded with lentivirus encoding for IL-10 were implanted immediately following injury into a mouse SCI hemisection model. Two weeks after tube implantation, mouse E14 spinal progenitors were injected directly into the integrated tubes, which served as a soft substrate for cell transplantation. Together, the tubes with the IL-10 encoding lentivirus improved E14 spinal progenitor survival, assessed at two weeks post-transplantation (four weeks post-injury). Mice receiving IL-10 lentivirus-laden tubes had on average 8.1% of E14 spinal progenitors survive compared to 0.7% in mice receiving transplants without tubes, an 11.5-fold difference. Surviving E14 spinal progenitors gave rise to neurons when injected into tubes. Additionally, axon elongation and remyelination was observed, in addition to a faster rate of functional recovery in mice receiving anti-inflammatory tubes with E14 spinal progenitor delivery. This system affords increased control over the transplantation microenvironment, offering the potential to improve stem cell-mediated tissue regeneration.