Although Gallbladder cancer is rare, it is the most common type of biliary tract cancer that could mimic acute cholecystitis symptoms. As it is a poor prognostic and life-threatening condition, diagnosing and treating it as soon as possible is essential.

Lacking comparability among rainfall manipulation studies is still a major limiting factor for generalizations in ecological climate change impact research. A common framework for studying ecological drought effects is urgently needed to foster advances in ecological understanding the effects of drought. In this synthesis, we argue, that the soil-plant-atmosphere continuum, describing the flow of water from the soil through the plant to the atmosphere, can serve as a holistic concept of drought in rainfall manipulation experiments which allows for the reconciliation experimental drought ecology. Using experimental data, we show that investigations of leaf water potential in combination with edaphic and atmospheric drought -- as the three main components of the soil-plant-atmosphere-continuum -- are key to understand the effect of drought stress on plants. Based on a systematic literature survey, we show that especially plant and atmospheric based drought quantifications are strongly underrepresented and integrative assessments of all three components are almost absent in current experimental literature. Based on our observations we argue, that studying dynamics of plant water status in the framework of the soil-plant-atmosphere-continuum can foster comparability of different studies conducted in different ecosystems and with different plant species and can facilitate extrapolation to other systems, species or future climates.

The use of the nasopharyngeal swab as a diagnostic procedure for CoVID-19 infection has become widespread. It is generally accepted as a safe procedure with few data on complications. We describe the case of a patient who developed a CSF fistula after nasal swabbing.

COVID-19 can lead to heart failure (HF) and even cardiac death. The 2’,5’-oligoadenylate synthetase (OAS) gene family is associated with the antiviral immune responses of COVID-19. While the potential association of OAS family with cardiac injury and failure in COVID-19 has not been determined. Hence, in our study, the expression levels and biological functions of OAS gene family in SARS-CoV-2 infected cardiomyocytes dataset (GSE150392) and HF dataset (GSE120852) were determined by comprehensive bioinformatic analysis and experimental validation. miRNAs targeting OAS gene family were explored from Targetscan and HF miRNA database. The potential OAS gene family-regulatory chemicals or ingredients were predicted using Comparative Toxicogenomics Database (CTD) and SymMap database. Results showed that OAS genes were highly expressed in both SARS-CoV-2 infected cardiomyocytes and failing hearts. The differentially expression genes (DEGs) in two datasets were enriched in cardiovascular disease and COVID-19 related pathways, respectively. The miRNAs-target analysis indicated that 10 miRNAs increase OAS genes expression. A variety of chemicals or ingredients were predicted regulating the expression of OAS gene family, especially estradiol. In conclusion, OAS gene family is an important mediator of HF in COVID-19 and may serve as a potential therapeutic target for cardiac injury and HF in COVID-19.

Nonketotic hyperglycemic hemichorea-hemiballismus (NHHH) is an infrequent complication of diabetes mellitus, and rarely occurs in children. We present an adolescent boy with recent diagnosis of type 1 diabetes who presented with hemichorea and brain imaging findings consistent with NHHH. His symptoms resolved with euglycemia and valproic acid after few weeks.

The stay suture technique (SST) helps ensure safe replacement of the tracheostomy tube after accidental decannulation. We describe a patient found to have a retained stay suture in the glottis 2 weeks post-decannulation. It is important to appreciate the possible complications associated with SST, including airway compromise, infection, and laryngospasm.

We report on a young Ghanaian female who was diagnosed with TTP but had ischaemic stroke as initial presentation. She was successfully treated with therapeutic plasma exchange. This case illustrates how TTP can masquerade as ischaemic stroke and the application of PLASMIC score without ADAMTS 13 assay in risk prediction.

Background: Acute type A aortic dissection is associated with a significant perioperative morbidity and mortality. Ascyrus Medical Dissection Stent (AMDS) is a novel bare stent graft developed to be used as an adjunct to standard surgical approach to promote true lumen expansion and therefor enhance aortic remodeling. Patients and Methods: From March 2021 to March 2022, four consecutive patients who presented with acute Debakey type I aortic dissection underwent emergent surgical repair with an inclusion (David) procedure and implantation of an AMDS. We analysed patient’s files prospectively and described the perioperative outcomes. Results: All four device implantations were successful. Overall 30-day mortality was 0 %. Malperfusion that was present in two patients pre-operatively improved after AMDS implantation. At follow up, no aortic reinterventions were needed. No aortic injury related to the device was noted. Favourable changes in aortic true lumen and false lumen dimensions were found in most of our patients but the AMDS was compressed at the isthmus in one patient. Conclusion: AMDS is a reliable and secure device. However, its benefits remain unclear when it comes to a positive remodeling and seems less likelihood comparable to a frozen elephant trunk. The main reason seems to be an insufficient radial force of the AMDS.

Background: Chest X-rays are routinely obtained after removal of chest drains in patients undergoing cardiac and thoracic surgical procedures. However, a lack of guidelines and evidence could question the practice. Routine chest X-rays increase exposure to ionising radiation, increase healthcare costs and lead to overutilisation of available resources. This review aims to explore the evidence in the literature regarding the routine use of chest X-rays following the removal of chest drains. Materials & Method: A systematic literature search was conducted in PubMed, Medline via Ovid, Cochrane central register of control trials (CENTRAL) and ClinicalTrials.gov without any limit on the publication year. The references of the included studies are manually screened to identify potentially eligible studies. Results: A total of 375 studies were retrieved through the search and 18 studies were included in the review. Incidence of pneumothorax remains less than 10% across adult cardiac, and paediatric cardiac and thoracic surgical populations. The incidence may be as high as 50% in adult thoracic surgical patients. However, the re-intervention rate remains less than 2% across the populations. Development of respiratory and cardiovascular symptoms can adequately guide for a chest X-ray following the drain removal. As an alternative, bedside ultrasound can be used to detect pneumothorax in the thorax after the removal of a chest drain without the need for ionising radiation. Conclusion: A routine chest X-ray following chest drain removal in adult and paediatric patients undergoing cardiac and thoracic surgery is not necessary. It can be omitted without compromising patient safety. Obtaining a chest X-ray should be clinically guided. Alternatively, bedside ultrasound can be used for the same purpose without the need for radiation exposure.

A 63-year-old male, with a history of coronary artery bypass grafting using bilateral internal thoracic artery grafts, underwent surgical aortic valve replacement. Avoiding the graft injury, we selected the right anterior mini-thoracotomy approach under cardiac arrest with systemic hyperkalemia with remaining bilateral internal thoracic artery grafts open. Deep hypothermia was induced to obtain more reliable myocardial protection. We believe this strategy can be considered as a therapeutic option in patients requiring aortic valve replacement but unsuitable for transcatheter aortic valve replacement.

Thoracic SMARCA4-deficient undifferentiated tumors are rare, with poor prognosis. A 73-year-old man presented to our hospital with dyspnea. Computed tomography-guided biopsy revealed a SMARCA4-deficient undifferentiated tumor. The patient was treated with combination ipilimumab-nivolumab. The tumor reduced in size after two courses.

The paper Reproducibility of the First Image of a Black Hole in the Galaxy M87 from the Event Horizon Telescope (EHT) Collaboration by Patel et al. describes the steps required to reproduce the M87 black-hole image from data artifacts released by the EHT collaboration.  The paper also gives an overview of the applied software stacks and provides highly valuable containerized environments that enable easy execution of the three imaging pipelines that reproduce the ones from the EHT.  The authors succeed in generating images and compare their products (images and statistics) against the published results, generally finding consistent results. The paper also critically reviews the documentation and reproducibility efforts made by the EHT collaboration itself.I find the paper particularly interesting for two reasons:1.  It significantly lowers the entry barrier to EHT-type work and enables the public to redo the data processing steps behind the iconic black-hole image. Thus it can lead to increased participation in fundamental science and raise public interest in STEM research.2. The work itself is a case study of how to disseminate data and software products in practice and can serve as an example to future efforts.I recommend publications after incorporating the following suggestions, all of which should be straightforward to handle.Major commentsIt should also be stated what this paper is not.  It does not aim at an independent analysis of the EHT data since it only rebuilds the EHT pipelines.  As far as I am aware, parameter choices are adopted from the EHT papers.  It's important to point out this distinction in the paper. There have been several more or less independent analyses of the EHT data products by other groups (Arras et al., 2022; Carilli & Thyagarajan, 2022; Lockhart & Gralla, 2022; Miyoshi et al, 2022) and in particular the Myoshi work has found different results (prompting communications such as https://arxiv.org/pdf/2207.13279.pdf).  It could be easy to mis-quote the paper at hand for an independent analysis of the EHT results (as done by the EHT collaboration on their website(https://eventhorizontelescope.org/blog/imaging-reanalyses-eht-data), which should be avoided.  I recommend adding a paragraph to the introduction where the aforementioned independent analyses are cited and a distinction between reproduction and independent analysis is made explicit.I would like to hear the authors' perspective on how the extensive documentation needed to fully reproduce data products should be disseminated in an academic publishing process.  Surely the research papers themselves are not the right place.  Journals also often request DOIs for supplementary data.  Is this compatible with the containerized approach?  Further, in connection to funding agencies, FAIR principles are often requested (https://www.go-fair.org/fair-principles/) in research data management (RDM) plans.  An additional paragraph (e.g. in the conclusions) connecting this work with the RDM practices imposed by funding agencies and journals will be helpful to evaluate the practicability of the approach followed in this paper.The validation of the data leading to Figure 2 seems insufficient as it merely shows the integrity of the data timestamps, not the data itself.  The authors should comment on why this is sufficient, as the data itself (visibility phases and amplitudes) could still be tampered with.  Perhaps the authors could clarify the scope of the validation.  It is not clear by reading the manuscript how much interaction with EHT members was needed to reproduce the results.  Could the authors please point out where key information was not available in the publications/data release and input was needed?  A comment on reproducing the reproduced results: I have run all four Docker containers successfully but the eht-imaging one missed essential dependencies which I installed by hand (ehtim and matplotlib)... The authors should check their container (or find the one fixed by me here...)Minor commentsIn section "Reproducing the EHT Images", second paragraph, the authors state "... we only report the values with 0% systematic uncertainty". Please clarify to which systematic uncertainties you refer.  It isn't clear if there might be a fundamental problem reproducing systematic uncertainties. Do they need further information that is not available in the data products?  A brief clarification would help.  The DIFFMAP image statistics (Table 2) differs wildly from the original paper.  The corresponding statement in the paper,We also find a larger difference between the original and reproduced values for the DIFFMAP pipeline: this is consistent with the discussion of the different time averaging used in DIFFMAPdoes not clarify. Please expand on your explanation, how does time averaging come into play in DIFFMAP? 

PEG tube placement is a relatively safe procedure; however, complications sometimes occur. Our article will allow readers to visualize the uncommon complication of PEG - a transcolonic misplacement.

Serious complications during hemodialysis (HD) are rarely observed in part owing to more sophisticated devices and experienced staff. However, such complications carry the risk of catastrophic consequences including death. This report highlights major emergencies in three cases that may occurred during HD treatments while alarm mechanisms did not work.

A document by Ridwanulahi Iyanda Abdulganiy. Click on the document to view its contents.

Backround: Mechanical ventilation is associated with mortality/morbidities in preterm infants. Nearly a third of these infants fail extubation and this may increase morbidities. Objective: To evaluate the association of symptomatic patent ductus arteriosus with failure of extubation among preterm infants. Methods: This was a retrospective study on preterm infants (birth weight <1,250 grams and gestational age ≥23weeks) born between January 2009 and December 2016, who were mechanically ventilated and extubated within the first 60 days of age. Results: 360 infants were evaluated, of these, 26% failed and 74% succeeded the initial extubation attempt. On adjusted analysis, symptomatic ductus was associated with an increased risk of extubation failure. Conclusion(s): Presence of symptomatic patent ductus arteriosus was associated with extubation failure. Further investigations are needed to establish whether screening for presence of ductus and treatment of the same, prior to extubation among these infants, improves chances of successful extubation and cardiorespiratory outcomes.

Objectives . This study aims to investigate the sensitivity of microscopy, culture and polymerase chain reaction on three gastric aspirates (GAs) in the microbiological confirmation of active pulmonary tuberculosis (TB) and to identify possible changes in sensitivity derived from the collection of a different number of aspirates.  Methods.  Children with clinical and radiological diagnoses of active pulmonary TB who underwent three GAs between March 2007 and June 2019 were retrospectively evaluated. Clinical, radiological, and microbiological data were collected. The sensitivity of microbiological tests on GAs was calculated. Moreover, differences in sensitivity according to age and radiological pattern were investigated. Results.  Overall, 156 children with active pulmonary TB were enrolled with a median age of 51.5 (IQR: 25.2–113.2) months. Microbiological investigations on the first GA showed a sensitivity of 34% (95%CI 26.7, 42), the cumulative sensitivity of first and second GAs was 40.4% (95%CI 32.7, 48.5) and of the three GAs was 47.4% (95%CI 39.8, 55.2). The collection of three GAs leads to an overall increase in sensitivity of the first GA by 13.4% (95%CI 2.8, 24.1%; p=0.014). Moreover, the increase in sensitivity was significantly higher in children  < 4 years of age and in those with uncomplicated TB (p=0.008).  Conclusions.  Performing a higher number of GAs increases the sensitivity of microbiological confirmation of active pulmonary TB, particularly in children ≤ 4 years and with an uncomplicated radiological pattern.

Aims: Beta-2 agonists are the standard of care for asthmatic patients. Racemic albuterol and levalbuterol are two of the most commonly used bronchodilators of this category. Although their efficacy has been tested excessively, their effects on heart rate remain debatable by many conflicting articles in the medical literature. This review aims to summarize all available data in the literature concerning the effects of Racemic Albuterol versus Levalbuterol on heart rate in asthmatic children. Methods and Results: Our search covered five different databases: PubMed, SCOPUS, Wiley Online Library, Web of Science, and Cochrane Library. We included clinical trials investigating heart rate in asthmatic pediatric patients; either as a primary or secondary outcome. The primary outcome was heart rate changes. Secondary outcomes were respiratory rate, FEV1 peak percent changes, potassium serum levels, SpO2 peak changes, asthma score, and adverse effects. Eight clinical trials were included; seven of them were eligible for meta-analysis. In a dosing ratio of levalbuterol: albuterol =1:4, levalbuterol showed better outcomes on heart rate changes when compared with racemic albuterol (mean difference=-5.97, p=0.02). However, this difference was dose-dependent as it vanished with equivalent dosing of levalbuterol: albuterol =1:2. Levalbuterol also had a better effect on FEV1 changes (mean difference=3.72, p=0.003). However, there was no statistically significant difference between the two drugs regarding changes in respiratory rate, SpO2 , asthma score ,or adverse effects. Conclusion: Levalbuterol and racemic albuterol have almost the same effect on heart rate in asthmatic children when they are used in equivalent dosing (levalbuterol: albuterol =1:2).

In this research, we apply a very powerful and relatively simple technique called Fuzzy ( F) transform to solve fractional fuzzy problem with respect to fuzzy valued functions. This approach allows to transform a fractional fuzzy differential equations to the system of algebraic equations. A solution to this algebraic system gives the appropriate parameters of the inverse F-transform. Hence, we can estimate the approximate solution of the original problem.

A 57-year-old man suffered chest pain during the COVID-19 pandemic, but he delayed medical treatment due to fear of infection. Four months later, symptoms chest tightness and shortness of breath appeared. Electrocardiogram (ECG) revealed old myocardial infarction; color sonography and myocardial CT revealed apical myocardial defect. He refused surgery and percutaneous transcatheter closure, and follow-up observation. After 22 months, the symptoms of chest tightness and shortness of breath aggravated. He recovered after percutaneous transcatheter closure, and was discharged. This case shows delayed closure is one of the possible options for the patients without severe organ dysfunction or hemodynamic disturbance.

Texas A&M University recently completed a set of Automated Precision Phenotyping (APP) Greenhouses that incorporate robotic systems for automated collection of advanced sensor-based plant phenotypes. Transiting the length of a greenhouse is a gantry beam, on which a rolling truck provides a second axis of motion along the gantry. Attached to the truck is a 3.0-m long robotic arm that is controlled to position a sensor head at virtually any position relative to any plant in a greenhouse. The robotic arm can be programmed to operate quickly and safely in complicated scanning patterns to enable data collection on all plants in the greenhouse within a time window of a few hours, ensuring consistent conditions during data collection. The sensor head includes a high-speed multispectral camera and eventually a Raman spectrometer. Relative to phenotyping greenhouses at other institutions, the APP Greenhouses have the advantage of maximum flexibility in configuration of plants in the greenhouses, in positioning of sensors relative to the plants, and in the types of sensors used, making research capabilities in the APP Greenhouses truly unique. Preliminary data have been collected on sorghum and maize plants. Four-band multispectral images have been collected daily, scanning the side of each plant from top to bottom. Preliminary software development is directed at automated image stitching to create a full side-view image of each plant, from which consistent metrics can be automatically calculated, such as plant height, stalk diameter, leaf angle, etc.

The mutualistic lifestyle of pollinating fig wasps and fig trees provides an excellent model for studying ecological and adaptive evolution issues. Transposable elements (TEs), as an important component of the genomes, are powerful driver for organisms to adapt to environment. Here, the genomic TEs of six pollinating fig wasps and five non-pollinating fig wasps were analyzed in the characteristics of composition and their effects on genome size, the historical burst patterns and their association with effective population size and paleoclimate changes, to infer the role of TEs in environmental adaptation in fig wasps. Compared with non-pollinators, pollinators’ TEs showed a significantly different burst state with less types and amount, shorter lengths, and lower contents in the genomes. The recent smaller effective population size and contractive demography failed to cause pollinators to accumulate more TEs, while the large number of TEs accumulated in non-pollinators positively correlated with their population expansion. The major TEs burst peaks in the history of pollinators highly overlapped with the warmer times in the Coolhouse in geological history. TEs located in the major peak period were mostly inserted near genes related to environment information processing such as Circadian entrainment pathway, and might act as CRMs (cis-regulatory modules) to regulate the conjunctive genes in response to paleoclimate changes in pollinators. These results revealed the molecular basis of the fig wasp’s response to changes in the syconia microenvironment and paleoclimate macroenvironment from the perspective of genomic TEs.

Persistent organic pollutants (POPs) have been studied to accumulate in the food chain and detected in the boody of organisms such as amphibians. These pollutants are known to cause and promote growth of cancer. The details of POPs to cancer-linked protein interaction are essential for understanding the role in POPs toxicity. In this study, an in silico modeling was performed using homology modeling (SWISS-MODEL) and molecular docking (SwissDock) between the POPs (2,2',4,4',5,5'-Hexachlorobiphenyl (PCB153), 2,2',4,4'-Tetrabromodiphenyl ether (PBDE47) and 4,4'-Dichlorodiphenyl dichloroethylene (4,4'DDE)) and cancer-linked proteins (angiopoietin-related protein 7 (angptl7), annexin a2 (anxa2), SWI/SNF-related, matrix-associated, actin-dependent regulator of chromatin, subfamily A, member 2 (smarca2) and tumor protein (p53)) from western clawed frog (Xenopus tropicalis). The quality of the 3D models of angptl7, anxa2, p53 and smarca2 for X. tropicalis were assessed to verify the reliability and suitability for further molecular docking simulation using ERRAT and Molprobity. The molecular docking analysis revealed hydrophobic interactions of PCB153, PBDE47 and 4,4'DDE to binding pockets of all cancer-linked proteins. PCB153, PBDE47 and 4,4'DDE were bound to the same binding pocket in angptl7 and smarca2. Meanwhile, 4,4' DDE in anxa2 and p53 were bound to different binding pockets. PBDE47 had the highest binding energy in angptl7 (-6.98) and anxa2 (-7.32) while 4,4'DDE had the highest binding energy in p53 (-7.12) and smarca2 (-7.08). These in silico results showing POPs interacting directly with cancer-linked proteins via hydrophobic interaction may lead to alteration of the functions of cancer linked proteins involved in proliferation, invasion, and control of tumor cells.

Although the leaf-height-seed (LHS) scheme states that plant height and leaf area are closely correlated with seed mass; phylogeny, genome size, growth form, and leaf N may also explain variations in seed mass. Till now, there has been little information on the relative contributions of these factors. We compiled data consisting of 1071 plant species from the literature to quantify the relationships between seed mass, explanatory variables and phylogeny. Strong phylogenetic signals of these explanatory variables reflected inherited ancestral traits of the plant species. Without controlling phylogeny, growth form and leaf N are associated with seed mass. However, this association disappeared when accounting for phylogeny. Plant height, leaf area, and genome size showed consistent positive relationship with seed mass irrespective of phylogeny. Using partial R2s, phylogeny explained 50.89% of the variance in seed mass, much more than plant height, leaf area, genome size, leaf N, and growth form explaining only 7.39%, 0.58%, 1.85%, 0.06% and 0.09%, respectively. Our study is the first to disentangle the contributions of phylogeny and plant attributes to the variance in seed mass, providing a novel avenue for better understanding variation in traits across plant species.