The Xerces Blue (Glaucopsyche xerces) is considered to be the first butterfly to become extinct at global scale in historical times. It was notable for its chalky lavender wings with conspicuous white spots on the ventral wings. The last individuals were collected in their restricted habitat, in the dunes near the Presidio military base in San Francisco, in 1941. To explore the demographic history of this iconic butterfly and to better understand why it went extinct, we sequenced at medium coverage the genomes of four 80 to 100-year-old Xerces Blue specimens and seven historic specimens of its closest relative, the Silvery Blue (G. lygdamus). We compared these to a novel annotated genome of the Green-Underside Blue (G. alexis). Phylogenetic relationships inferred from complete mitochondrial genomes indicate that Xerces Blue was a distinct species that diverged from the Silvery Blue lineage at least 850,000 years ago. Using nuclear genomes, we show that both species experienced population growth during the MIS 7 interglacial period, but the Xerces Blue decreased to a very low effective population size subsequently, a trend opposite to that observed in the Silvery Blue. Runs of homozygosity in the Xerces Blue were significantly greater than in the Silvery Blue, suggesting a higher incidence of inbreeding. In addition, the Xerces Blue carried a higher proportion of derived, putatively deleterious amino acid-changing alleles than the Silvery Blue. These results demonstrate that the Xerces Blue experienced more than 100 thousand years of population decline, prior to its human-induced final extinction.

Children with sickle cell disease (SCD) are at increased risk for severe illness due to severe acute respiratory syndrome Coronavirus 2 (SARS-CoV-2). We describe the successful native lung recovery of a child with SCD referred for lung transplant (LTx) evaluation who was on prolonged veno-venous extracorporeal membrane oxygenation (VV-ECMO). He initially presented with acute chest syndrome complicated by SARS-CoV-2 infection that ultimately required dual-lumen, single bicaval VV-ECMO cannulation for respiratory support. Despite increased risk of hemolysis and thrombosis from SCD and SARS-CoV-2 infection, he was successfully supported on VV-ECMO for 71 days without complications leading to native lung recovery with meticulous management of his SCD therapy. This report provides new insight on our approach to VV-ECMO support in a child with SCD and SARS-CoV-2 infection. With a successful outcome, the patient has returned home but still on mechanical ventilation with LTx still an option if he is not eventually liberated from invasive respiratory support.

Marsupenaeus japonicus is an important marine crustacean species. However, a lack of genomic resources hinders the use of whole genome sequencing to explore their genetic basis and molecular mechanisms for genome-assisted breeding. Consequently, we determined the chromosome-level genome of M. japonicus. In total, 478.42 Gb of genomic sequencing data were obtained using the PacBio platform. A final genome assembly of 1.54 Gb was generated with a contig N50 of 229.97 kb. The 266 Contigs were categorized into 42 chromosomes using high‐throughput chromosome conformation capture (Hi-C) technology, with a scaffold N50 of 38.27 Mb, occupying 95.9% of the genome. We identified 24,317 protein-coding genes in the M. japonicus genome, among which annotation was available for 23,986 genes relying on information regarding known proteins in public databases. M. japonicus is commercially valuable because of its coloration and capability for live transport. A gene involved in heme oxygenase (decyclizing) activity and heme oxidation was identified under positive selection in M. japonicas. The truncated protein had an altered helical structure, which might be responsible for resistance to low oxygen, and even the colorful shell of M. japonicus. The high-quality genome assembly enabled the identification of genes associated with cold-stress and cold tolerance in kuruma shrimp through the comparison of eyestalk transcriptomes between the low temperature stressed shrimp and normal temperature shrimp. The genome assembly presented here could be useful in future studies to determine the genetic changes underpinning the ecological traits of M. japonicus, and provide insights for genome assisted breeding.

Atrial flutter in lamin cardiomyopathy Michael C Y Nam, MD PhD,Paul B Sparks. MD PhD.Department of Cardiology,Royal Melbourne Hospital,300 Grattan Street,Parkville,Victoria 3050,AustraliaCorresponding author:Michael Chi Yuan NamT: +61393427000E: dr.michael.nam@gmail.comDeclarations of interest: noneFunding: NoneCase PresentationA 40-year-old man with genotype-positive lamin cardiomyopathy attended the EP lab for atrial flutter ablation. He had previously developed AV block and received a dual chamber implantable cardiac defibrillator (ICD) due to presence of significant mid-wall ventricular septal fibrosis seen on cardiac magnetic resonance imaging. He had also undergone successful cavotricuspid isthmus ablation for typical atrial flutter 2 years prior. His cardiomyopathy had progressed, with transthoracic echocardiogram whilst in atrial flutter showing severe LV dilatation with moderate left ventricular systolic dysfunction. Both atria were also severely dilated. His presentation ECG was thought to be consistent with clockwise CTI dependent atrial flutter with reconnection across the cavotricuspid isthmus. However, the atrial flutter appearance was different on presentation to the EP lab (figure 1).Insertion of multipolar EP catheters inserted via the right femoral vein revealed a vertical intracardiac electrogram activation along the coronary sinus (CS) with approximate tachycardia cycle length (TCL) of 240ms (figure 1). Entrainment mapping in combination with 3-D electroanatomical mapping (CARTOTM 3 version 7, Biosense Webster, Irvine, California) was performed to identify tachycardia mechanism and localise the circuit. Proximal CS, Distal CS, and lateral right atrium (RA) were remote to the circuit. Entrainment at the anterior SVC/RA junction and septum were ‘in’, confirming an upper RA reentrant circuit mechanism. During mapping of the upper anteroseptal region, long fractionated signals were seen on the ablation catheter encompassing greater than 50% of the entire TCL seen on both bipoles of the ablation catheter (figure 2). Entrainment confirmed this location to be within the circuit. Catheter pressure during mapping of this region repeatedly terminated the atrial flutter. Differential pacing during sinus rhythm confirmed persistent cavotriscupid isthmus block from the original procedure. The current clinical atrial flutter was easily reinducible with atrial burst pacing from the CS. Patchy regions of low voltage and double electrogram potentials were seen extending adjacent to these complex signals, thereby delineating a channel for reentry. Activation mapping identified the entire TCL within this region. What is the tachycardia mechanism and subsequent ablation strategy?Commentary:The combination of activation and entrainment mapping produced findings consistent with a localised reentrant circuit at the right atrial septum. Therefore the ablation strategy was to create a lesion set at the superior aspect of the circuit starting at the region of electrogram fractionation and extending up to the SVC-RA junction. However, upon delivering the first ablation lesion, there was sudden electrical isolation of the lateral right atrium evidenced by independent electrical activity on a duodecapolar catheter positioned on the lateral RA, and the commencement of atrial pacing from the ICD despite ongoing atrial flutter seen on the CS catheter (figure 3). The anteroseptal RA was still actively within the flutter circuit confirmed by repeat entrainment but catheter pressure to the region of long fractionated low amplitude signals resulted in atrial flutter termination. Further ablation was delivered to complete the line of block to the SVC. Atrial flutter was no longer inducible after completion of the line. The procedure was discontinued at this point given low left atrial appendage filling pressures. The patient subsequently underwent left atrial appendage ligation, epicardial left ventricular pacing implantation, and referral for heart transplantation.Lamin cardiomyopathy is a rare inherited cardiac condition associated with malignant ventricular arrhythmia due to the development of patchy fibrosis characteristic with disease progression (1). Importantly, electrical remodelling and development of arrhythmic substrate appears to occur early in the disease, which may explain why sudden cardiac death often precedes clinical heart failure in this patient population (2). Emerging studies report that such remodelling is not confined to the ventricle, with one group observing extensive atrial scar and slow conduction in their case series of atrial fibrillation ablation in this patient cohort (3). In addition to widespread low voltage in the left atrium prior to ablation and poor long-term procedural success rates, they also reported profound delay in interatrial conduction with spontaneous intraprocedural left atrial appendage dissociation. There have been no reports of segmental RA isolation with a single RF lesion, which reflects the random and extensive nature of endocardial scarring in this form of heart disease. In this case, high density mapping was not performed due to repeated tachycardia termination caused by catheter pressure requiring atrial burst pacing to reinduce. Nonetheless, limited point-by-point combined with entrainment mapping adequately confirmed tachycardia circuit location and provided an ablation strategy. Isolation of the lateral RA from the remaining atria during the first RF lesion of atrial flutter serves as an important reminder that lamin cardiomyopathy results in progressive electrical remodelling of all cardiac chambers.

Reproduction determines the fitness and is a crucial component of life history. Asexual and sexual reproduction synergistically contribute to the fitness of clonal plants. Extreme warming leads to a periodical sharp rise in temperature and may affect the plant fitness. Few studies have concerned the impacts of extreme warming on the reproductive pattern of clonal aquatic plant and its evolutionary implication. In the present study, the cosmopolitan clonal submerged plant species, Potamogeton crispus L. from four different geographic sources, was subjected to simulated extreme warming. Both asexual and sexual reproductive performances including the recruitment of turions and fruits were evaluated. We found that both geographic source and warming significantly affected the reproductive performances. Although the response of turion number to warming was different for populations from different geographic sources, the turion mass did not decrease under warming. Moreover, warming induced a lower percentage of oligophyllous turions -- the turion with no more than four scale leaves each, and a higher percentage of pleiophyllous turions -- the turion with more than four scale leaves each. Additionally, warming caused a complete loss of sex for three populations. As the scale leaf functions as storage and photosynthetic organ and the scale leaf number is positively correlated with the axillary bud number, P. crispus may select to enhance the sprouting potential of turion to achieve the fitness optimization by enhancing the recruitment of scale leaves and thus larger turions under warming.

Background: Endometriosis can cause subfertility and women may require assisted reproductive technology (ART) to achieve their pregnancy goals. Objectives: To compare ART outcomes following the long GnRH-agonist and GnRH-antagonist controlled ovarian hyperstimulation (COH) protocols in patients with endometriosis. Search Strategy: MEDLINE, Embase, and Web of Science were systematically searched in February 2021. Selection Criteria: Randomised controlled trials (RCTs) and observational studies comparing GnRH-agonist versus GnRH-antagonist COH in women with all stages/subtypes of endometriosis. Data Collection and Analysis: Pooled weighted mean differences and relative risks were calculated using the random effects model. The Risk Of Bias In Non-randomized Studies of Interventions (ROBINS-1) and ROB-2 tools (for RCT) were used for risk of bias assessment. Main Results: 7 studies (1 RCT, 6 observational) with 2,477 patients were included. Meta-analysis of the studies found no difference in the number of oocytes retrieved, clinical pregnancy rates, live birth rates, and gonadotrophin dose required for COH. Fertilization rates were significantly higher with the GnRH-agonist protocol (MD 4.3; 95% CI 0.30–8.29; P = 0.04). The GnRH-antagonist protocol required a significantly shorter COH duration (MD 0.44; 95% CI 0.11 – 0.78; P = 0.01). Studies were of moderate to high risk of bias. Conclusion: Both the long GnRH-agonist and GnRH-antagonist COH protocols generally yield similar ART outcomes. Clinicians should consider, treatment costs, stage/type of endometriosis, and pregnancy goals of their patients when selecting a GnRH-analogue for COH. A well-powered RCT is needed to minimise risk of bias and compare the risk for ovarian hyperstimulation syndrome.

Objective: FGM/C can result in short and long-term complications, which can impact physical, psychological and sexual health. Our objective was to obtain descriptive data about the most frequent health conditions and procedures associated with female genital mutilation/cutting (FGM/C) in Swiss university hospital inpatient women and girls with a diagnosis of FGM/C. Our research focused on the gynaecology and obstetrics departments. Design: Cross-sectional study. Setting: Swiss university hospitals (Geneva, Lausanne, Bern, Basel and Zurich). Population: Inpatient women and girls with a primary or secondary coded diagnosis of FGM/C. Methods: Four of the five Swiss university hospitals provided anonymized data on all inpatient women and girls admitted between 2016 and 2018 who had a primary or secondary diagnosis of FGM/C. Main outcomes measures: Primary and secondary diagnoses coded with the International Classifications of Diseases (ICD) and interventions coded in their medical files. Results: Between 2016 and 2018, 207 inpatients had a diagnosis of FGM/C. The majority (96%) were admitted either to gynaecology or obstetrics divisions with few genito-urinary and psychosexual conditions coded. Conclusions: FGM/C coding capacities in Swiss university hospitals are low, and some complications of FGM/C are probably not diagnosed. Pregnancy and delivery represent key moments to identify and offer medical care to women and girls who live with FGM/C. Funding: Swiss Federal Office of Public Health, Swiss Network against Female Circumcision, Caritas Switzerland. Keywords: Female genital mutilation, female genital cutting, female genital mutilation/cutting, international classification of diseases, ICD, coding, Switzerland

Canine parvovirus (CPV) infection is one of the most dangerous infectious diseases in young puppies worldwide. In this study, 192 diarrheal fecal samples were collected from 2019.4~2021.6 for monitoring the molecular prevalence of CPV among dogs by a specific PCR targeted VP2 gene in Southwest China, and 113 samples were detected as parvovirus-positive. Surprisingly, 28/113 (24.8 %) parvovirus-positive strains were identified as feline parvovirus (FPV)-like strains based on the evolutionary analysis of the 567 bp VP2 fragments which contain the aa residue of VP2 323D typical for FPV. To gain insights into the molecular and biological characteristics of these FPV-like viruses in dogs, 6 FPV-like strains were successfully isolated and genome sequenced. Analysis of genomic sequences suggested that the 6 isolates can represent a novel parvovirus in dogs, named FPV-like-1, which have the following characteristics: a. The genomic nucleotide (nt) and individual proteins are most genetically related with FPV instead of CPV. b. The VP2 proteins contain all unique amino acid (aa) residues typical for FPV. c. Compared with the FPV, the VP1 intron and NS1 exhibit some identical unique mutations. These FPV-like-1 strains could hemagglutinate swine erythrocyte at a broad range of PH values between 6.0 and 8.0 and replicate efficiently in MDCK cell line. Moreover, these isolates caused canine systemic infection via oral administration. Analysis of VP2 sequences of CPV available in GenBank revealed that the FPV-like strains had already existed in five countries of China, Vietnam, Pakistan, Thailand, Australia, and have circulated widely among dogs in China.

Background: Intra-arterial chemotherapy (IAC) is increasingly used in managing patients with retinoblastoma. In Australia, IAC is primarily used as a globe-salvage treatment when primary treatment has failed. Methods: A retrospective, single-institution study conducted on consecutive children treated with IAC at the Royal Children’s Hospital, Victoria, Australia between September 2009 to January 2021. Results: Using the Intraocular Classification of Retinoblastoma (ICRB), 16 eyes of 14 children classified as group A (n=1), Group B (n=3), Group D (n=10), or Group E (n=2) were treated with IAC. All but one child received IAC as secondary treatment for relapsed or refractory disease. Successful catheterisation of the ophthalmic artery was achieved in 37/46 (80.4%) procedures. A systemic complication occurred in one child (n=1): radiological evidence of a watershed infarct. Local complications of IAC included conjunctival injection (n=1), forehead rash (n=1), sixth cranial nerve palsy (n=2), ptosis (n=2), hemi-retinal ischaemia (n=1), choroidal ischaemia (n=1), retinal detachment (n=2), and choroidal neovascularisation (n=1). Regional extra-ocular disease occurred in one child. No child had distant metastatic disease and no child died. The overall globe salvage rate was 8/16 (50%): Group A (n=1, 100%), group B (n=2, 66.6%), Group D (n=5, 50%), group E (n=0, 0%). Kaplan Meier analysis of ocular survival following treatment with IAC was 75%, 68% and 53% for 6 months, 1 year and 2 years, respectively. Conclusions: Our experience demonstrates that IAC can be a useful treatment modality for refractory retinoblastoma in globe salvage, with an acceptable side-effect profile.

The present work studies the inverse scattering transformation (IST) of the inhomogeneous fifth-order defocusing nonlinear Schrodinger (ifoNLS) equation with zero boundary conditions (ZBCs) and non-zero boundary conditions (NZBCs). Firstly, the bound-state (BS) solitons of the ifoNLS equation with ZBCs are derived by generalization of the residue theorem and the Laurent’s series for the first time. Then combining with the robust IST, the matrix Riemann-Hilbert (RH) problem of the ifoNLS equation with NZBCs are revealed. Based on the resulting RH problem, a new higher-order rogue wave (RW) solution of the ifoNLS equation are found by the modified Darboux transformation. Finally, some corresponding graphs are given by selecting appropriate parameters to further discuss the unreported dynamic behavior of the BS solitons and RW solutions, which have not been reported before.

Microwave-assisted catalytic oxidation for desulfurization of coal tar pitch (CTP) was carried out with hydrogen peroxide as oxidant and FeCl3 as catalysts under acidic conditions of formic acid. The effects of different conditions on the desulfurization effect of the CTP were studied. The results showed that the method was an effective way to remove the sulfur in the CTP. The optimal condition of desulfurization in the CTP was obtained and the desulfurization rate of the CTP could reach 50.7%. The mechanism of FeCl3 catalyzed oxidative method was that the Fenton-like phenomenon occurred in the reaction system, which produced strong hydroxyl radicals. The free radicals can react with sulfur in the CTP, promoting the sulfur removal of the CTP. The results of XPS analysis showed that the sulfur in the CTP mainly existed in the form of thiophene sulfur and sulfoxide sulfur, which can be removed significantly with the method.

Light Cycling Oil (LCO) from an FCC industrial unit has low qualities with low cetane number and high contents of aromatics, sulfur and nitrogen. However, LCO can make valuable products like gasoline or BTX through hydrotreating or hydrocracking. To understand the comprehensive qualities of LCO is very significant to carry out the correct and quick adjustments of process parameters for the related units. As many as 127 LCO samples were taken from different FCC industrial units and then sent to the analytical lab for obtaining complete information about LCO properties. A mathematical model, which is able to predict the comprehensive qualities of LCO based on the routine or daily lab analysis with limited data like density and distillation fractions, was developed. The mathematical equations presented can be easily used to calculate related LCO properties for researchers or engineers.

Pulmonary arterial hypertension (PAH) is a chronic disease that is characterized as mean pulmonary artery hypertension (mPAP) > 25 mmHg. PAH is caused by progressive obliteration of small pulmonary arteries due to known or unknown etiologies. The effect of traditional therapy is suboptimal because it can only improve symptoms but cannot cure the disease, and therefore, scientists have turned their attention to stem cell therapy for efficacious treatments. In recent years, accumulating evidences have demonstrated that endothelial progenitor cells (EPCs) and mesenchymal stem cells (MSCs) are closely related with the occurrence of PAH and have the ability to prevent and reverse this disease. In this review, we turn our attention to a novel therapy for PAH, stem cell therapy, through comparing effect of preclinical research on cells and animals and evaluating the feasibility and potential difficulties of clinical application.

High-dose methotrexate (HD-MTX) is a key drug in the treatment of various cancers. Massive fluid infusion is necessary during HD-MTX therapy to ensure proper methotrexate excretion. There are no reports on the safety of HD-MTX therapy in patients with congenital solitary kidney (CSK). A 5-year-old male child with CSK and B-cell precursor acute lymphoblastic leukemia was treated with four cycles of HD-MTX therapy. HD-MTX therapy was safely administered without delayed MTX excretion or renal dysfunction. This case showed that HD-MTX therapy was well tolerated by a pediatric patient with CSK.

Background: Pneumonia is a common complication of influenza and closely related to mortality in influenza patients. Early prediction of poor prognosis in patients with influenza-associated pneumonia is important for reducing mortality. The present study examines cytokines as predictors of the prognosis of influenza-associated pneumonia. Methods: This study included 101 inpatients with influenza (64 pneumonia and 37 non-pneumonia patients). 48 cytokines were detected in the serum samples of the patients and the clinical characteristics were analyzed. The correlation between them was analyzed to identify predictive biomarkers for the prognosis of influenza-associated pneumonia. Results: Seventeen patients had poor prognosis and developed pneumonia. Among patients with influenza-associated pneumonia, the levels of 8 cytokines were significantly higher in those who had a poor prognosis: interleukin-6 (IL-6), interferon-γ (IFN-γ), granulocyte colony-stimulating factor (G-CSF), monocyte colony-stimulating factor, monocyte chemoattractant protein-1 (MCP-1), monocyte chemoattractant protein-3, Interleukin-2 receptor subunit alpha and Hepatocyte growth factor. Correlation analysis showed that the IL-6, G-CSF, IFN-γ, and MCP-1 levels had positive correlations with the severity of pneumonia. IL-6 and G-CSF showed a strong and positive correlation with poor prognosis in influenza-associated pneumonia patients. The combined effect of the two cytokines resulted in the largest area (0.927) under the receiver-operating characteristic curve. Conclusion: The results indicate that the probability of poor prognosis in influenza patients with pneumonia is significantly increased. IL-6, G-CSF, IFN-γ, and MCP-1 levels had a positive correlation with the severity of pneumonia. Importantly, IL-6 and G-CSF were identified as significant predictors of the severity of influenza-associated pneumonia.

Background This study aimed to assess the effect of Heart-Type Fatty Acid-Binding Protein (H-FABP), Creatinine Kinase (CK) and Homocysteine (Hcy) in determining the severity of acute poisoning. Methods 224 poisoning patients were divided into four observed groups: CO, alcohol, pesticide and drug, 50 health people as control group were included in this study. The patients were diagnosed moderate or severe acute poisoning. Blood samples were collected at the time of admission and the H-FABP, CK and Hcy of serum were tested at the time point. Results All the four observed groups of patients, the average H-FABP, CK and Hcy levels were significantly higher than those of the control group. We found H-FABP combined with CK had a statistically correlation between the moderate and severe of acute CO and pesticide poisoning, H-FABP combined with Hcy had a significantly correlation between the moderate and severe of acute alcohol poisoning, H-FABP combined with CK and Hcy had a significantly correlation between the moderate and severe of acute drug poisoning. ROC curve showed that the combination of three biomarkers could improve the diagnostic ability of the type and severity of acute poisoning. Conclusions These results indicate that changes in specific biomarkers (H-FABP combined with CK and Hcy) have potential on determining the type and the severity of acute poisoning. These findings can contribute for further research aiming a stronger model to be used in clinical practice.

Microbial thermal adaptation will lead to a weakening of the positive feedback between climate warming and soil respiration. The thermal adaptations of microbial communities and fungal species has been widely proven. However, studies on the thermal adaptation of bacterial species, the most important decomposers in the soil, are still lacking. Here, we isolated six species of widely distributed dominant bacteria and studied the effects of constant warming and temperature fluctuations on those species. The results showed that both scenarios caused a downregulation of respiratory temperature sensitivity (Q10) of the bacterial species, accompanied by an elevation of the minimum temperature (Tmin) required for growth, suggesting that both scenarios caused thermal adaptation in bacterial species. Fluctuating and increasing temperatures are considered an important component of future warming. Therefore, the inclusion of physiological responses of bacteria to these changes is essential the prediction of global soil-atmosphere C feedbacks.

Background: Beta-lactam antibiotics are the most frequent drug family to cause allergic reactions. Herein, we examined the frequency of confirmed allergies to beta-lactam, as well as the sensitivity and negative predictive value (NPV) of skin testing in an adult population referred to a university allergy clinic in Switzerland. Methods: This is a retrospective analysis of the clinical records of patients who were investigated for a label of allergy to beta-lactam (penicillin, cephalosporin or carbapenem) between January 1 st 2011 and December 31 st 2018. Results: 582 patients were identified with a documented allergy to beta-lactam and 477 patients were systemically investigated by skin tests and/or drug challenge to confirm or rule out allergy. 262 patients reported a history of immediate reactions, 137 of delayed reactions, and 114 of unknown reactions. 88 (18.4%) patients had confirmed to any beta-lactam antibiotics; 64 (13.4%) with an immediate- and 24 (5%) with a delayed-type reaction. Most frequently identified allergy was penicillin (65 patients), followed by cephalosporin (21 patients) and carbapenem (2 patients). NPV of skin tests for all beta-lactam were 97.7% and 92.5% for immediate- and delayed-type reactions, respectively, and 96.3% and 92.1% when only penicillin was considered. Systemic allergic reaction occurred in 0.6% of skin tests and in 3.1% of drug challenges. Conclusions: Only 18% of patients with beta-lactam allergy label have a confirmed allergy and non-allergic patients can be safely delabelled through allergic workup based on skin tests and drug challenge. This approach supports the policy of saving second-line antibiotics through systemic allergy work-up.

Introduction: Hodgkin’s lymphoma is one of the treatable types of blood cancer. Autologous bone marrow transplantation is used as one way to treat this disease. Neutropenic fevers are treated with antibiotics and antifungals; including amphotericin B. Adverse effects and hypersensitivity to Liposomal Amphotericin, Ambisome, are very few compared to conventional amphotericin. Case report: In this case, we noticed hypersensitivity reactions to the Ambisome, represented by an increase in body temperature, a drop in blood pressure, hypo-oxygenemia, in addition to an increase in the heart rate. Case management: The patient was treated with injections of hydrocortisone, Chlorpheniramine, and normal saline, in addition to giving oxygen, he is improved. Conclusion: In spite of the few cases that have recorded hypersensitivity reactions to the Ambisome, it is necessary to conduct an allergy test and to monitor the patient well when giving the Ambisome, especially in the first dose.

Exaggerated sexually-selected traits, occurring more commonly in males, help individuals to increase reproductive success, but are costly to produce and maintain. These costs on the one hand may improve population fitness by intensifying selection against maladapted males, but on the other hand may increase the risk of extinction under environmental challenge. However, the impact of sexually selected traits on extinction risk have not been investigated experimentally. We used replicate populations of a male-dimorphic mite, Rhizoglyphus robini, to test if prevalence of an elaborate, sexually-selected weapon affected the risk of extinction under gradual temperature increase (20C per generation). As temperature increased, individual survival decreased, but this effect was much more dramatic in populations with high weapon prevalence, compared to populations in which weapon expression was low. Consequently, the former was significantly more prone to extinction than the latter, with 75% vs 8% populations going extinct, respectively. Extinctions occurred despite partial suppression of the weapon expression at increased temperature, and were not explained by increased male mortality. Our results provide the first, to our knowledge, experimental evidence demonstrating dramatic effect of elaborated sexual traits on the risk of extinction under environmental challenge.

Objective: This research was to develop a pharmacist-led intravenous-to-oral antibiotic switching therapy notification system through the Plan-Do-Study-Act (PDSA) concept. Method: The study was a three-step action research. First, we performed a situation analysis and developed a system with the PDSA concept. Third, we evaluated the outcome before and after applying the system in two target groups: group 1 (physicians in Khon Kaen Hospital involved in the system development) and group 2 (pneumonic patients admitted in two pediatric wards). The system’s development was divided into two phases. In phase I, data was collected from January to March 2020 before developing. In phase II, after the system had been developed, data from September to November 2020 was collected. The development of the system was evaluated using value-stream mapping (VSM), time measurement, the rate of switching intravenous to oral, length of intravenous therapy, and length of stay display using descriptive statistics (percentages). Results: Developing the model system by increasing access to essential information and integrating a drug information service technology on dispensing helped reduce total process time from 95 minutes to 88 minutes and reduced total lead time from 175 to 159 minutes before and after applying the system. The overall time reduction was 16 minutes, which increased the activity ratio between total lead time and process time from 54.28% to 55.34%. The development system also reduced the length of intravenous therapy and length of stay. Conclusion: The PDSA concept allowed step-by-step analysis, and identification of areas for improvement on the workflow and dataflow. Integrating a drug information service technology to rapidly screen patients who pass the criteria can help reduce the time-consuming process. This system can be used to develop a localized system and extend to the organization to reflect areas that need to be improved, suggested in the form of policies.

Introduction Tuberous sclerosis complex (TSC) is characterized by hamartomas or angiofibroma in various organs, and numerous papules or nodules that are typically located on the cheeks, nose, and chin specifically. External auditory canal (EAC) involvement of TSC was not reported and is a challenging issue due to external otitis and conductive hear loss besides aesthetical complaint. This report aimed to examine the effectiveness of surgery for the functional and aesthetic management of the TSC for EAC involvement. Patient and Method A 31-year-old male patient with left auricular mass and ear fullness was presented. The patient’s history and family history were compatible with TSC. On physical examination, the total obstruction of EAC was detected due to TSC angiofibroma. Surgical excision and meatoplasty with preauricular fasciocutaneous island flap performed to manage EAC angiofibroma. The pathology specimen was histopathologically diagnosed as angiofibroma. Conclusion Auricula and EAC involvement in TSC related angiofibroma a rare and specific pathology due to the aesthetic and functional feature of the ear. Surgical excision for this clinical entity provides satisfactory management even if it was not routinely recommended for other skin lesions.

Root-sprouting (RS) clonal herbs are reported to be better adapted to severe disturbance than other clonal species, and their investments in clonal and storage organs are smaller than those in rhizomes. RS ability seems advantageous, so why is it not more common among plants? In a pot greenhouse experiment, we subjected two closely related clonal herbs differing in RS ability (RS Inula britannica and rhizomatous I. salicina) to severe biomass removal and looked for potential barriers to RS. We confirmed RS only in the already reported RS species I. britannica. However, RS was not boosted by disturbance in this RS species, i.e., the number of root buds and sprouts was not affected by biomass removal. Aerobic root respiration did not differ between the RS and non-RS species, and the phytohormone profiles differed significantly more between the RS and non-RS species than between the injured and non-injured individuals. The common hypothesis, however, never tested, that RS is facilitated by a low auxins to cytokinins content ratio was supported. Our results suggest that intrinsic phytohormone regulation is behind RS ability. Injury-causing phytohormonal imbalance seems to be less important, at least in spontaneously RS species such as I. britannica.

Based on Newton’s method and interpolation method, we establish two iterative methods for solving the nonlinear equations by using n+1 evaluations of the function(or the first derivative) per iteration. Analysis of convergence shows that our methods arrive at the optimal order of convergence 2^n, where the n is any a nature number. This work also proves the conjecture of Kung-Traub (J.ACM643-651,1974) for constructing multipoint optimal iterations.