A 55-year-old male cancer patient with ICI therapy (PD-1 antibody) started to manifest myasthenia gravis (MG) symptoms, cardiac injury, intermittent third-degree atrioventricular block, and ventricular pause necessitating temporary cardiac pacing. Intravenous steroids and immunoglobulin, pyridostigmine, and mycophenolate mofetil were sequentially initiated and the above symptoms were gradually resolved.

Mini-patches are considered indicators of an ecosystem’s response to interference, particularly those in alpine meadow ecosystems. Thus, monitoring the characteristics of mini-patches can elucidate the organization of an ecosystem’s components, the strategies it employs to survive interference, and the mechanisms whereby it maintains stability. In this research, we used multivariate statistical analysis methods to investigate the characteristics of the plant community and the micro-topography of mini-patches in alpine meadows on the Qinghai-Tibet Plateau from August 2012 to August 2013. Our findings show that (1) mini-patches were distributed in alpine meadows with different levels of degradation and the effects of meteorological characteristics (accumulated temperature above 0°C and accumulation of precipitation) and geographical characteristics (altitude, longitude, and latitude) contributed less than 20% to their distribution and characteristics; (2) alpine meadows maintained aboveground biomass within a certain range under a relative larger range of grazing intensity, illustrating their ability to regulate community structure and components under various intensities of disturbance and showing that alpine degradation could itself counteract grazing disturbance; and (3) overgrazing is the main driver of multi-steady stage coexistence in alpine meadows, as the mini-patches that remain involved in plant community succession function, and as a source of germplasm in the plant community regime shift under different grazing intensities damaged alpine meadows.

Soil microorganisms are the main driving force in soil ecological and biogeochemical processes, such as carbon mineralization, humus formation, and nutrient cycles. Soil erosion may dramatically alter microbial properties. However, it is still unclear how soil microbial characteristics affected by soil erosion. In hilly areas, soil erosion is highly attributed to topographic characteristics such as slope position and slope gradient. Herein, we compared the soil microbial characteristics between different slope gradients and positions in the farmland in the typical black soil area of Northeast China. The relative abundances of major microbial phyla are illustrated. Proteobacteria, Acidobacteria, Gemmatimonadetes, Planctomycetes, and Actinobacteria accounted for 83% of the total bacterial sequences, and Ascomycota, Basidiomycota, and chytridiomycosis accounted for 78% of total fungal sequences in the studied area. Microbial alpha-diversity (Bacteria and Fungi) was similar among the slope gradients or slope positions. The bacterial and fungal community composition was only affected by slope gradient, which was significantly lower in the highest slope gradient level than in others. This study suggests that slope gradient but not slope gradient affecting microbial community composition in the cropland of black soil region.

Background and Purpose Transmembrane Cav2.2 (N-type) voltage-gated calcium channels are genetically and pharmacologically validated pain targets. Clinical block of Cav2.2 (e.g., with Prialt) or indirect modulation (e.g., with gabapentinoids) mitigates chronic pain but is constrained by side effects. The cytosolic auxiliary subunit collapsin response mediator protein 2 (CRMP2) targets Cav2.2 to the sensory neuron membrane and regulates their function. A CRMP2-derived peptide (CBD3) uncouples the Cav2.2-CRMP2 interaction to inhibit calcium influx, transmitter release and pain. Homology-guided mutagenesis of CBD3 revealed an antinociceptive core at A1RSR4. Here, the A1R2 CBD3 dipeptide was identified as critical for Cav2.2 molecular recognition and served as a scaffold for identification of small molecule peptidomimetic allosteric regulators of Cav2.2. Experimental Approach We developed and applied a novel molecular dynamics approach to identify the Cav2.2 recognition motif of the core CBD3 peptide as the A1R2 dipeptide and used its presenting motif to design pharmacophore models to screen 27 million compounds in the open access server ZincPharmer. Of 200 curated hits, 77 compounds were assessed using depolarization‐evoked calcium influx in rat dorsal root ganglion (DRG) neurons. Nine compounds were tested using electrophysiology and one compound (CBD3063) was evaluated biochemically, electrophysiologically, and behaviorally effects in a model of experimental pain: Key Results CBD3063 reduced membrane Cav2.2 expression and currents, inhibited neuronal excitability, uncoupled the Cav2.2-CRMP2 interaction, and reversed mechanical allodynia in rats with spared nerve injury. Conclusions and Implications These results identify CBD3063, as a selective, first-in-class, CRMP2-based peptidomimetic, which allosterically regulates Cav2.2 to achieve analgesia.

The aim of this work is to evaluate whether bone marrow (BM) involvement at diagnosis has an impact on treatment outcome in intermediate risk Burkitt Lymphoma (BL) patients or not?

Introduction: Brain tumors in children are the main cause of cancer related death in the pediatric population. Brainstem tumors incidence comprises 10.9% of all brain tumors having the Pediatric Diffuse Intrinsic Pontine Gliomas (DIPG) a fatal prognosis. Some countries have developed a national and international register database, to characterize their population. This study provides a retrospective population-based data to describe the epidemiology of children with DIPG in México from 2001-2021, and assesses the proposed prognostic factors previously described for survival outcome. Methods: Health Institutions from México were invited to fill in a retrospective registry of DIPG patients. Epidemiological, clinical, diagnostic, histopathologic and treatment variables were described. Fisher exact test was used to compare long, and short-term survivors and overall survival was estimated using the Kaplan-Meier Method. Differences between survival curves were evaluated using the Log-rank test and Cox proportional hazards regression analysis. Results: One-hundred and ten patients were included in the analysis. Median age at diagnosis was 7 years. Sixty patients (54.5%) presented with symptoms in less than 6 months being the most frequent ataxia (56.4%). Treatment was offered to 90 patients (81.8%), overall survival at 160 weeks (4 years) was 11.4%, and 16 patients (14.5%) arrived at clinical centers to die. We found no significant survival differences in any of the prognostic factors. Conclusion: This study highlights the need to develop improvement strategies to streamline healthcare processes and enhance quality of care to strengthen our situational diagnosis in Mexico.

Timely and relevant patient and family education can improve quality of life and outcomes for transplant families. Video’s popularity as an education medium has been increasing as the barriers to video production and consumption have decreased. To better understand the usage characteristics our education videos we obtained aggregated video performance statistics from YouTube for the Arabic, English, and Spanish versions of five division created bone marrow transplant educational videos. Comparing video views to patient transplants, considering patient language and transplant date, we found that views per patient by language were highest with Spanish language videos with a mean of 1.17 (range: 0.35 – 1.88), followed by English language videos at 0.96 (range: 0.52-2.41) and Arabic language videos trailed with a mean of 0.37 (range: 0.15-0.58) views per patient. Lifetime average watch percentages across all videos was 65.7% (range: 22.3% - 85.7%), with the non-English videos consistently having lower average viewing percentages. These data give important insights into our education delivery systems and the degree to which our content engages each of our patients and families.

Flower-visiting insects have co-evolved with flowering plants. While it has been shown that floral traits and environmental factors influence insect visitation during the day, it is still unclear how these factors influence their visitation at night. We sampled a montane meadow located near Jilin in northeastern China in July and August of 2019, for 4 nights each month, and two time periods each night. We sampled 94 flower-visiting insect species in total and documented floral traits and ambient factors. We first allocated all the insects to three functional groups (pollination, predation, and herbivory). Most nocturnal insects exhibited predation behavior, and had the highest species turnover rate. We then focused on environmental factors and found that ambient temperature and relative humidity strongly influenced the diversity of flower-visiting insects. In addition, variation partitioning analysis suggested that ambient temperature had a stronger effect on the flower-visiting insects during the early night hours, whereas relative humidity had a stronger effect on them in the later night hours. Finally, focusing on floral traits, most insects preferred flowers with moderately sized corolla diameters (20 to 30 mm). Furthermore, display size had a strong linear correlation with flower-visiting insect species richness and frequency of presence. In sum, our findings suggest that ambient temperature, relative humidity and floral display size strongly regulate the behavior of nocturnal flower-visiting insects.

Zinc is an essential micronutrient for all living organisms due to its presence in a large number of proteins, as a structural or catalytic cofactor. In plants, zinc homeostasis mechanisms comprise uptake from soil, transport and distribution throughout the plant to provide adequate cellular zinc availability. Here, I discuss the transcriptional regulation of the response to zinc deficiency and the zinc sensing mechanisms in Arabidopsis, and their evolutionary conservation in land plants. The Arabidopsis F-group basic region leucine-zipper (F-bZIP) transcription factors bZIP19 and bZIP23 function simultaneously as sensors of intracellular zinc status, by direct binding of zinc ions, and as the central regulators of the zinc deficiency response, with their target genes including zinc transporters from the Zrt/Irt-like protein (ZIP) family and nicotianamine synthase enzymes that produce the zinc ligand nicotianamine. I note that this relatively simple mechanism of zinc sensing and regulation, together with the evolutionary conservation of F-bZIP transcription factors across land plants, offer important research opportunities. One of them is to use the F-bZIP-regulated zinc deficiency response as a tractable module for evolutionary and comparative functional studies. Another research opportunity is translational research in crop plants, modulating F-bZIP activity as a molecular switch to enhance zinc accumulation. This should become a useful plant-based solution to alleviate effects of zinc deficiency in soils, which impact crop production and crop zinc content, with consequences for human nutrition globally.

Leaf litter decomposition is a key ecosystem process that serves as a source of energy in stream ecosystems. However, land use change from forest to agricultural land has been reported to negatively affect stream ecosystem functions. Streams exhibit heterogeneity in terms of physical, chemical, biological characteristics and human-related influences. This may in turn affect stream ecosystem functions (e.g., leaf litter decomposition). However, information on the effects of land use and streambed topography on the functioning of many tropical stream ecosystems is still limited. This study assessed the influence of land use (i.e., forest vs agriculture) and streambed topography (i.e., riffles vs pools) on the decomposition rates of Syzygium guineense and Eucalyptus saligna leaf litter in the Kamweti River, Kenya. A total of 400 coarse-mesh litter bags were used to enclose 5 (± 0.05) g of each plant species leaf litter. The leaf litter was incubated in the selected study sites and litter bags were retrieved after 1, 3, 8, 14, 21, 28, 35, 42, 49 and 56 days of incubation. Physico-chemical parameters were also measured in all the sites. Decomposition rates were estimated using the negative exponential decay model. Linear Mixed-effect Models were used to evaluate the effect of land use, streambed topography and plant species on leaf litter decomposition rates. Physico-chemical water parameters differed significantly between the two land uses (all p < 0.05), except for pH and total nitrogen concentration ( p> 0.05). Forested sites ( Syzygium = 0.03 ± 0.004, Eucalyptus = 0.04 ± 0.004) had relatively higher mean leaf litter decomposition rates than agricultural sites ( Syzygium = 0.02 ± 0.004, Eucalyptus = 0.03 ± 0.006), although not significantly different. On the other hand, riffle habitats had significantly higher decomposition rates ( p<0.05) than pool habitats across the two land uses. Streambed topography had a significant effect on decomposition rates of leaf litter, as opposed to land use. Therefore, local scale factors are more important in the decomposition process than catchment scale factors in the Kamweti River. Stream conservation and management efforts should be directed to the local scale factors as opposed to only riparian and catchment factors.

Plant stem cells provide new pools of differentiated cells that form organs and rejuvenate or replace damaged tissues. Protein homeostasis (proteostasis) is required for cell function and viability. However, the link between proteostasis and plant stem cells remained unknown.In contrast to their differentiated counterparts, we found that root stem cells can prevent the accumulation of aggregated proteins even under proteotoxic stress conditions such as elevated temperatures.We also found that root stem cells express high levels of distinct chaperones that maintain proteome integrity. By mimicking this proteostasis network in other cells, we could prevent protein aggregation in differentiated cells and confer resistance to heat stress in plants.Taken together, we think that enhanced proteostasis mechanisms in stem cells could be an important requirement for plants to persist under extreme environmental conditions and reach extreme long ages \cite{Llamas2021}. 

Cesarean section by a transverse uterine fundal incision is applied for patients with placenta previa to reduce blood loss. We describe a case of uterine rupture in a pregnant women with previous cesarean section by its procedure who had recovered from cardiac arrest by multidisciplinary management.

Cystic fibrosis (CF) and primary ciliary dyskinesia (PCD) are chronic pulmonary conditions. In this review we focus on neuropsychological aspects of CF and PCD in children. Since studies conducted on children with asthma, sleep disturbed breathing (SBD), and studies on animal models describe specific cognitive impairments and suggest that intermittent hypoxia might be the pathophysiological mechanism. Main question of this systematic review is following: “Is neuropsychological functioning of children with CF and PCD specific?”. The database MedlineComplete was searched during September 2021 for each condition using specified key word combinations. We included studies in English, dealing only with pediatric population and papers published in academic journals within the last 10 years (2011-2021). We excluded case reports and studies using non-valid psychological methods or focusing on specific socio-economic populations. Applying these criteria, we acquired 5 studies in CF and 3 studies in PCD, out of them one study examined the association between cognitive impairment and oxygen desaturation levels. Five studies were scored high, and three studies were scored moderate level of evidence according to PRISMA and COCHRANE quality criteria. It can be concluded that the overall IQ of CF and PCD pediatric patients remains intact. However, impairments in specific cognitive functions, e.g., attention, memory or executive function have been described. Number of studies exploring neuropsychological functioning, especially in association with somatic aspects, in CF and PCD patients is not robust and further investigation is needed.

In response to: Spurr R, Ng E, Onchiri FM, Rapha B, Nakatumba-Nabende J, Rosenfeld M, Najjingo I, Stout J, Nantanda R, Ellington LE. Performance and usability of a new mobile application for measuring respiratory rate in young children with acute lower respiratory infections. Pediatr Pulmonol. 2022 Aug 22. doi: 10.1002/ppul.26125.

Human hydatid disease occurs after infection with Echinococcus granulosus, mainly involved liver and lung. Here we reported a 48-year-old woman, who presented to our hospital with intermittent chest pain. Transthoracic echocardiography, Enhanced CT and MRI of heart were performed, revealed the cyst located at the interventricular septum near the right ventricular apex. Other organs including lung and liver were not involved. The cyst was successfully removed, while postoperatively pathological biopsy confirmed the infection of Echinococcus granulosus, thus, she was finally diagnosed as isolated cardiac hydatid cyst.

Over the last few years cardiac changed radically and so has the average age of the heart disease population progressively increased. Mitral valve surgery has a significant margin for progress in conservative vs replacement strategy. Mitral disease due to insufficiency in the elderly population has historically suffered from lower repair rates but deficiency alone should not limit repair operations in a specialized environment ensuring good survival.

This paper investigates the metric dimensions of the polygonal networks, particularly, of subdivided honeycomb network as well as Aztec diamond network. The polygon is any two-dimensional shape formed by straight lines. Triangles, quadrilaterals, pentagons and hexagons are all representations of polygons. For instance, hexagons help us in many models to construct honeycomb network (HCN (n)), where n is the number of hexagons from a central point to the borderline of the network. Subdivided honeycomb network (SHCN (n)) is obtained by adding additional vertices on each edge of HCN (n). An Aztec diamond network (AZ N (n)) of order n is a lattice comprises of unit squares with center (a, b) satisfying |a | + |b| ≤ n. In this work, our main aim is to establish the results to show that the metric dimensions of SHCN (n) and AZ N (n) are 2 and 3 for n = 1 and n ≥ 2, respectively. In the end, some open problems are listed with regard to metric dimensions for k -subdivisions of SHCN (n) and AZ N (n).

A document by Anthony Dorr. Click on the document to view its contents.

The present work argues the involvement of zinc chelation ability of some non-steroidal anti-inflammatory drugs as an additive mechanism able to increase their efficacy against COVID-19.

Objective: We explored the usefulness of speckle-tracking imaging (STI) to assess cardiac function in fetal congenital heart disease in the early second trimester. Method: A total of 152 pregnant women with a singleton pregnancy who underwent early fetal echocardiography at the ultrasound department of our hospital were randomly selected. There were 40 fetuses with congenital heart disease (case group) and 112 healthy fetuses (control group). STI was performed in both groups to measure fetal left ventricular (LV) and right ventricular (RV) endocardial-myocardial global longitudinal strain (GLSendo), time to peak longitudinal strain (TTPS), fractional area change (FAC), and LV ejection fraction (LVEF). These parameters were compared between the two groups, and correlation analyses were performed. Results: There were no significant differences in fetal LVEF and RVFAC between the case and control groups. The LV GLSendo and RV GLSendo were lower in the case group ( P < 0.05). The LV TTPS and RV TTPS were negatively correlated with fetal heart rate in both groups.After heart rate correction, the TTPS in the case group was longer than in the control group. Conclusion: STI may be useful to quantitatively evaluate fetal myocardial deformation and function in the early second trimester.

Software as a service (SaaS) is a concept that has been around for approximately four to five decades now and is known as software as a service. It has been recognized for a long time that an organization's competitiveness when it comes to implementing new technologies into its systems, processes, and products has long been an area that attracts attention and promotes the development of an organization. There are a number of positive aspects to this area, which attract attention and contribute to its growth.

Background: Vonoprazan-based regimens are anticipated to have higher Helicobacter pylori eradication rates than PPIs. Aim and objective: to compare between the effectiveness of two 14-day regimens; one based on vonoprazan and the other on esomeprazole, to eradicate H. pylori. Patients and methods: Participants were determined to have active H. pylori infection and were either untreated or had previously received therapy were randomly assigned to either the VAL group (vonoprazan 20 mg bid, amoxicillin 1000 mg bid, plus levofloxacin 500 mg once day) or the EAL group (Esomeprazole 20 mg bid., amoxicillin 1000 mg bid., and levofloxacin 500 mg once daily). After 4-6 weeks following the end of the therapy, an H. pylori antigen test was used to determine the degree of eradication. Results: A number of 122 individuals were randomly assigned to either the VAL (n = 61) or EAL (n = 61) groups, and 118 patients were successful in completing the study. The eradication rates of H. pylori were found to be 97.7 percent for the VAL group and 68.5 percent for the EAL group, respectively (P = 0.031). All adverse treatment-related occurrences were minor and did not differ substantially between the two groups, such as nausea and vertigo. Conclusions: The VAL regimen was well tolerated and led to increased eradication rates; as a result, VAL may be thought of as a powerful regimen for treating H. pylori, particularly in nations with high levels of antibiotic resistance.

Hyperbaric oxygen should not be used routinely for carbon monoxide poisoning: CONDavid N. Juurlink, MD, PhDDepartments of Medicine, Pediatrics, and Health Policy, Management and Evaluation, University of Toronto, the Ontario Poison Centre, and Sunnybrook Research InstituteWord count: 2036

Aim: ST-segment elevation myocardial infarction (STEMI) is usually caused by a rupture in the atherosclerotic plaque, followed by platelet aggregation which ultimately leads to acute coronary artery occlusion. In this study, we investigated the effect of maintenance dose of Eptifibatide (intravenous drug of GP IIb/IIIa inhibitor) in patients with STEMI who underwent primary percutaneous coronary intervention (PPCI). Methods: 264 patients who had acute chest pain suggestive of STEMI were entered in the study. All patients received the same dose of bolus dose of eptifibatide. Then the patients were randomly divided into two groups, one group (n=147) received a maintenance dose of intravenous eptifibatide (infusion of 2g/kg/min) and the other group (n=117) did not receive this treatment. All patients were evaluated 1 and 3 months after the start of treatment in terms of predicted outcomes. Results: The occurrence of three-month MACE between the case and control groups did not have a statistically significant difference (28.6% versus 35.0% ; P-value: 0.286). Re-hospitalization occurred in 10 patients (6.8%) from the case group and 30 patients (25.6%) from the control group, which was statistically significant (P-value: 0.000). Also, investigations showed that the rate of re-infarction (P-value: 0.024) and target lesion revascularization (P-value: 0.003) was significantly lower in the group that received Eptifibatide infusion. Conclusion: Eptifibatide maintenance dose infusion in patients who undergo PPCI in the context of STEMI, does not significantly reduce MACE, although it does significantly reduce re-hospitalization and re-infarction. It also does not increase the risk of bleeding and cerebrovascular events.