Basal serum tryptase:

Paraneoplastic neurologic syndromes (PNS) are rare in pediatrics and are understood to be consequences of cross-reactivity against various neuroendocrine antigens expressed on cancer cells. Here, we report a case of autoimmune encephalitis, a type of paraneoplastic neurologic syndrome that was associated with a case of adrenocortical carcinoma and had some clinical response to immunosuppressive therapy. Adrenocortical carcinoma is a rare tumor with controversial tissue of origin but expresses various neuroendocrine antigens that could be the possible mechanism for this rare yet interesting association.

Ceria nanoparticles (CNPs) is an important typical nanozyme with multiple enzyme mimetic activities, which could facilitate the oxidation of organic dyes in acidic conditions, because of the oxidase mimetic activity. Usually, the regulation of oxidase mimetic activity is focused on the adjustment of the structure, morphology, composition, surface, and other factors of nanozymes. However, the influence of the surrounding environment is not considered, which is very important during the reaction process. In this work, the oxidase mimetic activity of CNPs in buffer solutions including citric acid, acetic acid and glycine buffer solutions was investigated, with the results that carboxyl group in buffer solution could adsorb the CNPs on the surface to promote the oxidase mimetic activity. Due to the chelation with cerium ion, the enhancement is more significant by molecules with polycarboxylic groups, and the enhancement is more efficient by carboxyl molecules in buffer solution, compared with the modification of the carboxyl groups on the surface, because of the easier operation and smaller steric hindrance. From viewpoint of increasing the oxidase mimetic activity of CNPs, the work is expected to provide references for the selection of the reaction system to optimize the oxidase mimetic activity in bio-detection application.

Eleven new seco-guaianolide sesquiterpenoids (1–11) and two new guaianolide dimers (12 and 13), along with five known guaianolide derivatives were isolated from the aerial part of Achillea alpina L. Compounds 1–3 represented three unique 2,3-oxygen inserted guaianolides and 4–8 were five special 3-nor guaianolide sesquiterpenoids. Compounds 9–11 were three novel 1,10-seco-guaianolides, while 12 and 13 were two novel 1,10-seco-guaianolides involved heterodimeric [4 + 2] adducts. The new structures of 1–13 including their absolute configurations were determined by spectroscopic data analysis, combined with quantum electronic circular dichroism (ECD) calculations. To evaluate the hypoglycemic activity of 1–18, glucose consumption was used to investigate in palmitic acid (PA)-mediated HepG2-insulin resistance (IR) cells, and compound 9 displayed the strongest reversal IR activity. A mechanistic study has revealed that the potential compound 9 appeared to be mediated hypoglycemic activity via inhibition of the ROS/TXNIP/NLRP3/caspase-1 pathway.

Flavonoids, contain a benzo-γ-pyrone (C6–C3–C6) skeleton, have been reported to exhibit effective antioxidant ability. This study aimed to compare the antioxidant activities of 7,8-dihydroxyflavone (7,8-DHF) and 7-hydroxyflavone (7-HF) in H 2O 2, LPS, or t-BHP-induced RAW264.7 cells, respectively. The antioxidant capacities of 7,8-DHF and 7-HF were firstly evaluated by 2,2-azinobis-3-ethyl-benzothiazoline-6-sulphonic acid (ABTS), 2,2-diphenyl-1-picrylhydrazyl (DPPH) and ferric reducing antioxidant power (FRAP) assays. Then, ROS, SOD, and MDA productions in H 2O 2, LPS, or t-BHP-induced RAW264.7 cells were tested and compared, respectively. Finally, the antioxidant mechanisms of 7-HF and 7,8-DHF were initially investigated by western blot. Our results showed that 7,8-DHF possessed stronger free-radical scavenging capacity than 7-HF. Both 7,8-DHF and 7-HF suppressed MDA production and ROS accumulation, improved the activity of SOD in H 2O 2, LPS, or t-BHP-induced RAW264.7 cells, respectively. And 7,8-DHF exerted better antioxidant effect than 7-HF, especially in t-BHP-induced oxidative stress. Mechanically, 7,8-DHF prevented the activation of PARP and caspase-3, meanwhile markedly upregulated the expression of HO-1 protein in t-BHP-induced oxidative stress. These results suggested that 7,8-DHF might be served as potential pharmaceutical drug against oxidative stress injury.

We identify a new class of distributional constraints defined as a union of symmetric M-convex sets, which can represent a variety of real-life constraints in two-sided matching settings. Since M-convexity is not closed under union, a union of symmetric M-convex sets does not belong to this well-behaved class of constraints. Therefore, developing a fair and strategyproof mechanism that can handle this class is challenging. We present a novel mechanism for it called Quota Reduction Deferred Acceptance (QRDA), which repeatedly applies the standard Deferred Acceptance mechanism by sequentially reducing artificially introduced maximum quotas. We show that QRDA is fair and strategyproof when handling a union of symmetric M-convex sets, which extends previous results obtained for a subclass of the union of symmetric M-convex sets: ratio constraints. QRDA always yields a weakly better matching for students than a baseline mechanism called Artificial Cap Deferred Acceptance (ACDA). We also experimentally show that QRDA performs better in terms of nonwastefulness than ACDA.

Ion doping is generally an effective strategy for improving the electrochemical performance of electrode materials in protonic ceramic fuel cells (PCFCs). However, the specific mechanism by which the dopant affects proton transfer remains unclear. Inspired by the excellent proton uptake ability of BaCo0.4Fe0.4Zr0.1Y0.1O3−δ, a transition-metal-doped perovskite oxide, we investigate the influence of Zn doping on the proton transport characteristics using first-principles methods. The dopant is revealed to enhance proton conductivity through both distance and directionality effects. Zn substitution at the Zr site facilitates the formation of oxygen defects, and this effect is particularly strong for the first-nearest neighbor oxygen atoms. In addition, interactions between the dopant and adjacent oxygen atoms increase the negative charge density (i.e., alkalinity) of the nearest bonding oxygen atoms, which is conducive to proton uptake. Moreover, the dopant promotes proton migration along adjacent oxygen atoms, with directionality from O34 (Y–O34–Zn) to O23 (Zn–O23–Zr). Our findings demonstrate that Zn-doped BaCo0.4Fe0.4Zr0.05Zn0.05Y0.1O3−δ is a promising oxide material with triple conductivity. This analysis provides a general strategy for efficient doping to optimize proton conductivity in perovskite oxides.

Melkersson–Rosenthal Syndrome(MRS) is defined by three symptoms: orofacial granulomatosis(OFG), facial palsy and fissured tongue.We focus our attention on a patient who came to us with a swelling of the lip.We suspected a MRS. After the positive response to the therapy, we can assume that he suffers from a MRS.

Pulmonary embolism can be a complication following an attempted salvage of a dysfuctional arteriovenous fistula (AVF). We report a case of bilateral pulmonary embolism in a patient with underlying pericardial effusion who, following minimal venotomy and milking of the AVF, developed sudden and significant respiratory distress, and later improved.

Widespread hydrologic alterations have simplified in-stream habitats in rivers globally, driving population declines and local extirpations of many native fishes. Here, we examine how rapid geomorphic change in a historically degraded desert river has influenced habitat diversification and ecosystem persistence. In 2010, a large reach of the degraded and simplified lower San Rafael River (SRR), Utah, was impacted by the formation of a valley plug and began to shift from a homogenous, single-thread channel to a complex, multi-threaded riverscape. We combined field measurements and drone-collected imagery to document habitat changes due to the valley plug. Our results demonstrate that in 2021, the valley plug reach was more diverse than any other stream reach along the SRR, containing 641% more diverse habitat (e.g., pools, riffles, backwaters) than what was measured in 2015. The plug reach also retained water for periods beyond what was expected during seasonal drying, with the total extent of inundation within the riverscape increasing by over 2,800%. Since the formation of the valley plug, riparian habitat has increased by 230% and channel networks have expanded to more than 50 distinct channels throughout the zone of influence. Our results provide evidence of successful self-restoration in a formerly highly degraded reach of desert river, and encourage new methods of desert river restoration. We aim to inform the use of large-scale, disruptive restoration actions like intentional channel occlusions, with the goal of mitigating the impacts of simplification and increasing habitat persistence in the face of exacerbated aridity in the desert Southwest.

The effects of fiscal decentralization on economic growth has been studied with the mixed results. Fiscal decentralization is the innovation to accelerating the rate of economic growth. The target of this study are to identify the financial condition of regency and city governments in java island and to examinate the relationship between fiscal decentralization and local economic growth in java island period 2009-2018. We find that the regency and city governments in Java Island has good financial condition. The result of estimation shows a positive relationship between fiscal decentralization and local economic growth in java island .

Background: Less invasive forms of ventilation have evolved aiming to decrease bronchopulmonary Dysplasia (BPD) morbidity. It is unclear whether changes in ventilation practices have been associated with improvements in respiratory outcomes. Objective: To examine trends of ventilation modes in preterm neonates over the last decade and their impact on BPD. Methods: A retrospective chart review of very low birth weight infants (VLBW) and those born at less than 32 weeks gestation hospitalized during two periods: the years 2012-2013 and 2018-2019. The primary outcome was the prevalence of BPD. Study variables included the mode and duration of ventilation, duration of oxygen need, and perinatal clinical parameters. Results: Four hundred eighty-one infants were enrolled. Between the two study periods, a significant increase was observed in invasive (33% to 47%, p=0.002), and non-invasive ventilation rates (44% to 72%, p<0.001). The average duration of non-invasive ventilation increased significantly (from 9.24 to 14.08 days, p=0.016). The total duration of respiratory support remained unchanged. The overall prevalence of moderate and severe BPD at 36 weeks corrected age remained approximately 40% in preterm infants born at less than 28 weeks gestation. Conclusion: The increasing use of non-invasive ventilation was not accompanied by a reduction in the use of invasive ventilation, nor by a reduced prevalence of BPD. The high prevalence of BPD remains a significant problem in preterm infants born < 28 weeks of age. Other interventions, in addition to less aggressive ventilation, need to be explored.

Depression is classified as a mood disorder. It may be described as feelings of sadness, loss, or anger that interfere with a person’s everyday activities. The symptoms of depression can be experienced differently among men, women, and children differently. Men may experience symptoms: mood, such as anger, aggressiveness, irritability, anxiousness, restlessness, behavior, such as loss of interest, no longer finding pleasure in favorite activities, feeling tired easily, thoughts of suicide, drinking excessively, using drugs, engaging in high-risk activities Women may experience symptoms: emotional well-being, such as feeling sad or empty, anxious or hopelessness, behavior, such as loss of interest in activities, withdrawing from social engagements, thoughts of suicide and irritability, cognitive abilities, such as thinking or talking more slowly. Children may experience symptoms: emotional well-being, such as feelings of incompetence (e.g. “I can’t do anything right”) or despair, crying, intense sadness, behavior, such as getting into trouble at school or refusing to go to school, avoiding friends or siblings, thoughts of death or suicide, cognitive abilities, such as difficulty concentrating, decline in school performance, changes in grades.

When there are obstacles around the target point, the mobile robot cannot reach the target using traditional Artificial Potential Field (APF). Besides, the traditional APF is prone to local oscillation in complex terrain such as three-point collinear or semi-closed obstacles. Aiming at solving the defects of traditional APF, a novel improved APF algorithm named back virtual obstacle setting strategy-APF (BVO-APF) has been proposed in this paper. There are two main advantages of the proposed method. Firstly, by redefining the gravitational function as logarithmic function, the proposed method can make the mobile robot reach the target point when there are obstacles around the target. Secondly, the proposed method can avoid falling into local oscillation for both three-point collinear and semi-closed obstacles. Compare with APF and other improved APF, the feasibility of the algorithm is proved through software simulation and practical application.

A document by Amrapali Tiwari. Click on the document to view its contents.

Objectives: In this study, we retrospectively reviewed and intended to further compare the treatment outcomes and complications of office transnasal vocal fold polypectomy (TVFP) with those of microplarygoscopic surgery (MLS) for different clinical and histopathological features of broad-based sessile vocal fold polyps. Methods: We retrospectively reviewed the records of 159 consecutive patients with broad-based sessile vocal fold polyps treated by TVFP or MLS. The differences in efficacy and complication between these two surgical techniques were compared according to the different types of vocal fold polyps. Results: Satisfactory outcomes of both TVFP and MLS treatments were reported in patients with edematous, gelatinous and vascular types of vocal fold polyps (p > 0.05). The efficacy of TVFP was slightly worse than MLS in fibrous polys group (p < 0.05). The TVFP-treated patients did not exhibit obvious complications, whereas several MLS-treated patients had suffered different complications. Conclusion: The therapeutic effects of both TVFP and MLS on the treatment of broad-based sessile vocal cord polyps are related to their clinical characteristics and histological types. Satisfactory outcomes are achieved in edematous, gelatinous, and vascular types of polyps after either surgical procedure. TVFP has fewer surgical complications than MLS which can be a preferred option for the treatment of broad-based sessile vocal cord polys at outpatient setting. TVFP also can be an alternative surgery option for patients who could not tolerate general anesthesia or laryngeal suspension. In contrast, MLS has proven to be particularly advantageous in patients who have fibrous type of polyps.

Objectives: Airway reconstruction for laryngotracheal stenosis (LTS) improves dyspnoea. There is little evidence relating to impact upon voice and swallowing. We explored voice and swallowing outcomes in adults with LTS before and after reconstructive surgery. Design: With ethical approval, twenty consecutive LTS patients undergoing airway reconstruction at a tertiary referral center were prospectively recruited. Outcome measures were collected pre-reconstructive surgery, two-weeks post-surgery and up to 4-6 months post-surgery. These included physiological values (maximum phonation time (MPT) and fundamental frequency; penetration-aspiration score, residue score), clinician-reported (GRBAS, functional oral intake score, 100ml Water Swallow Test) and patient-reported outcomes (Voice Handicap Index-10, Reflux Symptoms Index, Eating Assessment Tool, Dysphagia Handicap Index). Results: The observational study identified patient-reported and clinician-reported voice and swallow difficulties pre- and post-surgery; median and interquartile range are reported at each timepoint: Voice Handicap Index-10 23 (8-31); 20.5 (9-33.5), 24.5 (12.5-29); Dysphagia Handicap Index 9 (0-37); 13 (7-44); 15 (4-34); GRBAS grade 1(1-2); 2 (1-2.5); 2(1-2); 100ml Water Swallow Test volume score 16.7 (11.1-20); 14.3 (12.5-16.7); 16.7 (14.3-20.0); 100ml Water Swallow Test capacity score 16.3 ± 9.0; 11.0 ± 4.1; 12.5 ± 2.6. Conclusion: We present the first prospective data on voice and swallowing outcomes in adults with LTS before and after reconstructive surgery. The variability of the outcomes was higher than expected but importantly, for many the voice and swallow outcomes were not within normal limits before surgery. The clinical value of the study demonstrates the need for individual assessment and management of LTS patients’ voice and swallowing.

Background: As secretory phospholipase A2 (sPLA2) was shown to be elevated in patients who progress to severe dengue, it would be important to evaluate the usefulness of therapeutics that inhibit sPLA2 enzymes to prevent progression to severe dengue. Methods: Aqueous and butanol extracts of Tragia hispida, Justicia adathoda and tubers of Cyperus rotundus were screened for the presence of potential sPLA2 inhibitors using a commercial assay measuring sPLA2 activity. Results: Both the aqueous (THA) and butanol extracts (THB) of Tragia hispida had sPLA2 inhibition levels comparable to the levels seen with the commercial sPLA2 inhibitor CAY10590. THB at concentrations of 0.1 µg/µL and 0.2 µg/µL, significantly reduced the sPLA2 activity (p<0.0001) in the sera of dengue patients and the inhibitory activity was significantly higher (p<0.0001) than of CAY10590. Thin layer chromatography of THB showed that it was likely to contain a mixture of flavonoid and phenolic compounds. HPLC displayed peaks at 3.207 min (λmax 222 nm, 272 nm) and 7.972 min (λmax 224 nm, 272 nm) which were most likely to represent phenolics and peaks at 11.883 min (λmax 276 nm, 366 nm) and 16.898 min ( λmax 254 nm, 370 nm) which were most likely to represent flavonoids. Conclusions: T. hispida aqueous and butanol soluble fraction had potent sPLA2 inhibitory activities, which should be further explored for their potential to be used for treatment of dengue.

Objectives: We aimed to evaluate the trend of HPV infection status in oropharyngeal squamous cell carcinoma (OPSCC) according to various epidemiologic factors in the United States. Design: Retrospective cohort study. Setting: Surveillance, Epidemiology, and End Results (SEER) 2010-2016 database. Participants: A total of 13081 patients with OPSCC were enrolled. Patients were diagnosed with OPSCC primarily in the base of tongue, posterior pharyngeal wall, soft palate, and tonsil between 2010 and 2016 and were tested for HPV infection status. Main outcome measures: We analyzed how the number of OPSCC patients changed according to various demographic factors from 2010 to 2016. Additionally, we forecasted and confirmed the number of HPV (+) and (-) patients with OPSCC using the autoregressive integrated moving average (ARIMA) model. Results: The number of HPV (+) patients with OPSCC has increased over the past 7 years, but the degree of increase varied greatly according to the age, sex, and subsites. The number of HPV (-) patients increased until 2015 in all age groups for each site but did not change or decrease since then. Appropriate ARIMA models were applied to forecast HPV (+) and (-) patients, and the predicted data matched the actual data well. Conclusions: This large population-based study suggests that HPV (+) patients with OPSCC has increased and will continue to increase. However, the trends in HPV infection status in patients differed greatly according to various demographic factors. These results present a direction for establishing appropriate preventive measures to deal with HPV-related OPSCC in more detail.

Background: Intra and post-operative blood loss is a major risk in head and neck (H&N) surgery. Recently the use of tranexamic acid (TXA) has been investigated by multiple studies for reducing intra and post-operative bleeding, however reported results are variable. Objectives: To determine the safety and efficacy of tranexamic acid use in Head and Neck surgery. Methods: Systematic review of MEDLINE, EMBASE, CINAHL, Cochrane Library, PubMed, ClinicalKey and Clinicaltrials.gov according to the PRISMA guidelines. Studies were included if they reported on intraoperative bleeding, volume or duration of post-operative drain or return to theatre rate for post-operative haemorrhage in adult populations following use of TXA. Risk of bias assessment with Cochrane Risk of Bias (RoB2) tool for RCTs and NOS tool for non-randomised studies. Results: 16 studies were identified (114, 407 patients). 8 studies evaluated TXA in major H&N surgery and 8 studies in tonsillectomy. Primary outcomes were reduction in intraoperative or post-operative bleeding. Secondary outcomes included the duration of post-operative drain placement and return to theatre rate. No adverse events were reported in any patients. TXA is effective in reducing intra-operative blood loss in tonsillectomy. However, the effect on post-tonsillectomy haemorrhage was unclear. Insufficient evidence exists of benefit of TXA on intra-operative bleeding in major H&N procedures. Post-operative bleeding rates were substantially reduced in most major H&N studies. The duration of drain placement and risk of blood transfusion was unchanged in most cases. Conclusion: TXA use is safe in H&N patients. Whilst sufficient evidence exists to support the use of TXA in tonsillectomy, insufficient evidence exists to recommend use in major H&N surgery. Key words: Tranexamic acid, Head and Neck surgery, thyroidectomy, tonsillectomy

A numerical analysis on temperature variation effects on the output power (Pout) characteristics of vertical-cavity surface-emitting lasers (VCSELs) is presented in this paper. While previous works in the literature mostly omitting the thermal effects. The effects have investigated according to the temperature dependence (TD) of the VCSEL parameters instead of the well-known Pankove empirical relationship. Also, unlike many previous studies, the thermal effects on the Auger process (C) were taken into account and were not neglected. Besides the temperature, the impact of laser cavity volume (Va (i.e D, L, d)), the injection current (Iinj), and the quality of mirror reflectivity (R) also have investigated. Results showed that the rate of decreasing the Pout with the increase of the temperature has increased with the increase of the D value compared with the L or d value. In contrast, results shown that the TD of the C is affects the VCSEL performance and it is not correct to neglect its influence. Also, results showed that increasing the Iinj value does not lead to a significant increase in the thermal effects on the Pout. On the other hand, increasing the R value will lead to a significant reduction in the thermal effects and it may be dampening its behavior. Conversely, there is no significant effect when the increase in R value is above 95%.

Aims: Left bundle branch pacing (LBBP) upgrade can improve cardiac function and clinical outcomes in patients with pacing-induced cardiomyopathy (PICM), but the specific value especially compared with the level before right ventricular pacing (RVP) in patients with PICM and non-pacing-induced cardiomyopathy (Non-PICM) is still unknown. Methods: This study retrospectively enrolled 108 patients with LBBP upgrade (38 patients with PICM and 70 patients with Non-PICM). PICM patients were defined as patients who had a normal left ventricular function and a > 10% decrease in LVEF after RVP, among patients experiencing > 40% RVP, when other organic heart diseases were excluded. Non-PICM patients were defined as patients requiring pacemaker upgrades with non-decreased cardiac function reasons, such as battery exhaustion, pacing system infection, and right ventricular lead failure. All upgrade patients experienced three stages: before RVP (Pre-RVP), before LBBP upgrade (Pre-LBBP), and after LBBP upgrade (Post-LBBP). QRS duration (QRSd) , lead parameters, echocardiographic indicators, and clinical outcomes evaluation were recorded at multiple time points. Univariable analysis of variance and Mann-Whitney U-tests for repeated measures were used to assess the effects of the LBBP upgrade. Results: At the follow-up of 12 months, for PICM patients, left ventricular ejection fraction (LVEF) significantly increased from 36.6 ± 7.2% at Pre-LBBP to 51.3 ± 8.7% after LBBP upgrade (P < 0.001), and left ventricular end-diastolic diameter (LVEDD) significantly decreased from 61.5 ± 6.4mm at Pre-LBBP to 55.2 ± 6.5mm after LBBP upgrade (P < 0.001), besides, New York Heart Association (NYHA) classification improved from 3.16 ± 0.82 at Pre-LBBP to 1.76 ± 0.88 after LBBP upgrade (P < 0.001), but they all failed to restore the level of the initial status before RVP (LVEF: 51.3 ± 8.7% vs 60.3 ± 7.6%, P < 0.001) (LVEDD: 55.2 ± 6.5mm vs 49.7 ± 6.1mm, P < 0.001) (NYHA:1.76 ± 0.88 vs 1.11±0.31, P < 0.001). Furthermore, for PICM patients, the number of moderate-to-severe heart failure (HF) (NYHA III-IV) and diuretics used after the LBBP upgrade also could not restore the level before RVP (P = 0.002 and P = 0.004). At the follow-up of 12 months, Non-PICM patients after the LBBP upgrade had no significant improvement in LVEF, LVEDD, NYHA classification (LVEF: P = 0.521; LVEDD: P = 0.383; NYHA classification: P = 0.279) and no difference compared with Pre-RVP (LVEF: P = 0.559; LVEDD: P = 0.952; NYHA classification: P = 0.942). Conclusion: LBBP upgrade effectively improved the cardiac function and clinical outcomes in PICM patients but failed to restore the functional levels before RVP. For Non-PICM patients, the cardiac function and clinical outcomes after the LBBP upgrade had no significant difference when compared to Pre-RVP and Pre-LBBP.

An 88-year-old man underwent a dual chamber pacemaker implantation for complete heart block. Post procedure 12-lead electrocardiogram showed some abnormal findings. The reader is challenged to identify the abnormalities and then explain the mechanism of these findings. The discussion then guides the reader with the explanation.

Jujube is one of the popular fruits that possess high nutritional components and have economic value. Grading of jujube is a post-harvest process applied in the fruit industry for the tasks like fruit quality check, fruit species identification, price labelling, edibility duration estimation, safety, etc. This research investigates into the suggested 7-layer CNN model and two classical models (i.e., VGG16 and AlexNet) for grading jujube fruits according to their stages of maturity. Primarily, jujube of four different maturity grades was identified on the field and collected from the field manually and their images were captured through a machine vision system. Further, image pre-processing and augmentation were performed to get the training/testing-ready dataset. Finally, a 7-layer CNN model was deployed and grading performance was examined over the original and augmented dataset using performance metrics of precision, sensitivity, and F1-measure. Furthermore, the model’s classification accuracy was compared to that of classical models, where the proposed model surmounts both the classical models. Results reveal that the proposed model attained a high grading accuracy of 99.44% and 97.53% over the augmented and original dataset respectively. Also, the computation time and training parameters count were reduced to almost one-tenth and one-third of that of VGG16 and AlexNet models. Results advocate that the classical model could be replaced with the proposed models and can be further investigated for other fruits for better classification accuracy, reduced parameters and reduced computational time.