An entirely new reconfigurable gripper is designed and shown in this paper. The new gripper comprises six modular fingers, which can be rearranged to form any number of fingers between three and six. CAD, CAM, CAE, and PCB software Fusion 360 was used to design the gripper. Also, the gripper fingers are rotatable, so the finger bases can touch each other side-by-side and form one finger. In addition to showing the reconfigurability of the gripper, several scenarios for grasping different shapes were presented and tested.

Background and Purpose Hepatocellular carcinoma has high ability of vascular invasion and metastasis. Vasculogenic mimicry (VM) is closely related to the metastasis and recurrence of hepatocellular carcinoma (HCC). According to previous research, Chloranthus henryi has anti-tumor effect, but its molecular mechanism in the treatment of HCC has not yet been stated. In our study, we aimed to investigate the effect of the extract of Chloranthus henryi in HCC and its target and molecular mechanism. Experimental Approach In this study, we isolated a chalcone compound from Chloranthus henryi, compound 4, identified as flavokawain A (FKA). We determined the anti-HCC effect of FKA by MTT and identified the target of FKA by molecular docking and CETSA. Hepatoma cells proliferation, migration, invasion, and VM formation were examined using EDU, wound healing, transwell, vasculogenic mimicry, and IF. WB, RT-PCR, and cell transfection were used to explore the mechanism of FKA on hepatoma cells. Tissue section staining is mainly used to demonstrate the effect of FKA on HCC in vivo. Key Results We confirmed that FKA can directly interact with CXCL12 and HCC proliferation, migration, invasion, and VM formation were all inhibited through reversing the EMT progress in vitro and in vivo through the PI3K/Akt/NF-κB signaling pathway. Additionally, by overexpressing and knocking down CXCL12, we got the same results. Conclusion and Implications FKA attenuated proliferation, invasion and metastatic and reversed EMT in HCC via PI3K/Akt/HIF-1α/NF-κB/Twist1 pathway by targeting CXCL12. This study proposed that FKA may be a candidate drug and prospective strategy for HCC therapy.

Apricot kernel skin (AKS) has not been fully utilized except a few used as feed. In this study, the effect of extrusion pretreatment on the extraction yield and acid value of AKS oil (AKSO) was investigated, and the physicochemical properties, the composition of fatty acids and triglycerides, the sn-2 fatty acids distribution, and the content of various active ingredients in AKSO were further analyzed for the first time. The results showed that AKS has 12.10% crude oil. AKSO contains 89.72% unsaturated fatty acids and is rich in tocopherols, phytosterols, squalene and polyphenols. After AKS was extruded, granulated, and extracted with hexane as a solvent, the acid value of AKSO was significantly reduced and the extraction yield was 11.97%, which confirmed its feasibility for the extraction of AKSO. From the point of nutrition and cost-efficiency, AKS is a very promising potential new oil-bearing resource, and AKSO can be used as a nutritional oil in food, medicine or cosmetics.

Abstract Introduction: Despite a larger frequency of OPD patients requiring treatment, why is it not done in OPD should be addressed. Because there is no suction equipment in the ENT OPD, these patients who require suctioning are referred to ENT Emergency Room. This is a source of undue inconvenience for patients. This not only poses a risk to patient safety, but it also has major financial consequences, as well as a negative impact on patient satisfaction, which is a key indicator of treatment quality. Methods: This is a closed-loop audit cycle beginning with recognition of the problem and assessing the magnitude of the problem. Based on the burden of referrals to the MOT, the auditors proposed the changes in practice under hospital OPD guidelines enacted by Pakistan Otolaryngology Association. Results: A significant percentage of 52.5 is requiring ear suction in the first audit cycle. The percentage of patients that had to be referred to ENT OT decreased from 52.5% in the previous audit to a significantly low value of 9.5% in this audit. This clinic’s role is to decrease the burden of referrals, reduce patients’ misery of going to the ER for suctioning, and improve patient satisfaction. Conclusion: Our study discerns the fact that the implementation of some simple protocols will lead to an immense change. The resultant reduction in clinical activity will lead to a reduction in the workload of the doctors too.

Purpose: Some studies have suggested a protective role of statins in Head and Neck Squamous Cell Carcinoma (HNSCC) even though the real contribution of statins to morbidity and survival remains unclear. Study Design: Retrospective case-control Methods: The aim of this review is to retrospectively evaluate the oncological protection and the outcome of the statin intake in a population of patients affected by larynx squamous cell carcinoma that underwent total or partial laryngectomy. We analyzed 109 patients with a focus on the percentage of statin intake. Overall survival (OS) was compared between patients underwent total or partial laryngectomy assuming statin or not. Furthermore, we compare statin intake in cancer patients with a population of non-cancer patients. We analyzed if statin intake could be statistically significant in increasing the overall survival. Results: The Kaplan-Meier survival curves for oncologic population assuming statins was 94,7% and 78% for patients that were not assuming statins. The Cox multivariate regression analysis didn’t identify a statistically significant OS benefit with statin intake Conclusion: Statin intake at the time of diagnosis of squamous cell carcinoma of the larynx has shown an improved OS even though statin consumption didn’t appear as a statistically significant variable probably due to the small number of patients analyzed. Another probable cause is the feedback of a medium delay of about ten years in statin assumption compared to the onset of the tumor and the emerged data of a smaller percentage of people assuming statins from the population analyzed, compared to the national medium.

This paper is the last in our trilogy on Twenty-First

Tree intrinsic water-use efficiency (iWUE) has dramatically increased in recent decades in global forests. The rising iWUE can be a result of either enhanced photosynthesis rate (A), or decreased stomatal conductance (gs) or both. The underlying physiological mechanisms are still not well understood. Here, we investigated tree-ring isotopes δ13C and δ18O from two tree species in three altitudinal transects on the Southeastern Tibet. We found that the relationship between iWUE and leaf water 18O (Δ18Olw) was negative at the low-altitude forests but are positive at the treeline, indicating that enhanced photosynthesis was the main driver of the increasing iWUE at the treeline, whereas reduction in stomatal conductance was the prime regulator at the lower-elevation forests. Furthermore, vapor pressure deficit (VPD) and precipitation during the main growing season showed the highest and significant correlations with Δ18Olw at the low-altitude forests, suggesting that gs was strongly controlled by moisture conditions in the growing season particularly in the low-altitude forests. These findings shed light to a better understanding of the regulatory mechanism of iWUE changes under the background of rising atmospheric CO2 and climate change and serve to improve the reliability of ecophysiological modelling.

Objective: To evaluate the reasons for COVID-19 vaccine hesitancy during pregnancy from first-person reports. Design: We used regular expressions to identify publicly available social media posts from pregnant people expressing at least one reason for their decision not to accept COVID-19 vaccine. Setting: WhatToExpect and Twitter. Sample: 1017 posts from 945 pregnant people in WhatToExpect and 435 tweets from 345 pregnant people in Twitter Methods: Two annotators manually coded posts according to the Scientific Advisory Group for Emergencies (SAGE) working group’s 3Cs model of vaccine hesitancy (confidence, complacency, and convenience barriers). Within each theme we created subthemes which emerged from the data. Results: Confidence barriers were the most common (75%) and were related to safety, waiting until after the 2nd trimester, birth or breastfeeding, efficacy, misinformation or mistrust. Complacency barriers were also common (52%) with people stating that they did not need the vaccine because they were taking other precautions, were not at risk or had already had COVID-19. Convenience barriers were the least common (13%) with most of these related to medical advice or eligibility. Some women gave more than one reason for their hesitancy and many of the reasons were inter-linked. Conclusion: The reasons for COVID-19 vaccine hesitancy during pregnancy give a clear picture of the public health messages required. Concerns around safety should be addressed in a sensitive manner. The relative effectiveness of the vaccine as compared with other precautions could be better promoted as could the high-risk nature of a COVID-19 infection during pregnancy.

Organisms are increasingly facing multiple stressors, which can simultaneously interact to cause unpredictable impacts compared to a single stressor alone. Recent evidence suggests that phenotypic plasticity can allow for rapid responses to altered environments, including biotic and abiotic stressors, both within a generation and across generations (transgenerational plasticity). Parents can potentially ‘prime’ their offspring to better cope with similar stressors, or, alternatively, might produce offspring that are less fit because of energetic constraints. At present, it remains unclear exactly how biotic and abiotic stressors jointly mediate the responses of transgenerational plasticity, and whether this plasticity is adaptive. Here we test the effects of biotic and abiotic environmental changes on within- and trans-generational plasticity using a Daphnia-Metschnikowia zooplankton-fungal parasite system. By exposing parents and their offspring consecutively to the single and combined effects of temperature elevation and parasite infection, we showed that transgenerational plasticity induced by temperature and parasite stress influenced host fecundity and lifespan; offspring of mothers that were exposed to one of the stressors were better able to tolerate temperature elevation, compared to offspring of mothers that were exposed to neither or both stressors. Yet the negative effects caused by parasite infection were much stronger, and this greater reduction in host fitness was not mitigated by transgenerational plasticity. We also showed that temperature elevation led to a lower average immune response, but the nature of its relationship with fecundity reversed under elevated temperatures; this suggests that parents that were exposed to parasites can potentially prime their offspring to respond to the joint stressors of both temperature elevation and parasite infection. Together, our results highlight the need to address questions at the interface of multiple stressors and transgenerational plasticity, and the importance of considering multiple fitness-associated traits when evaluating the adaptive value of transgenerational plasticity under changing environments.

Predators are widely recognized for their irreplaceable roles regulating the abundance and altering the traits of lower trophic levels. Predators also have irreplaceable roles in shaping community interactions and ecological processes via highly localized pathways, irrespective of their influence on prey density or behavior. We synthesized empirical and theoretical research describing how predators have indirect ecological effects confined to discrete patches on the landscape, processes we have termed patchy indirect effects of predation. Predators generate patchy indirect effects via three main pathways: generating and distributing prey carcasses, creating biogeochemical hotspots by concentrating nutrients derived from prey, and killing ecosystem engineers that create patches. In each pathway, the indirect ecological effects are limited to discrete areas with measurable spatial and temporal boundaries (i.e., patches). Our synthesis reveals the diverse and complex ways that predators indirectly affect other species via discrete patches, ranging from mediating scavenger interactions to interspecific parasite/disease transmission risk, and from altering ecosystem biogeochemistry to facilitating local species biodiversity. We also show how existing multi-scale ecological frameworks (metapopulation, meta-ecosystem, and patch dynamics concepts) offer insight into the mechanisms underlying the formation of these patches within ecosystems. We then provide basic guidelines on how these effects can be quantified at both the patch and landscape scales, and discuss how these predator-mediated patches ultimately increase landscape heterogeneity and contribute to ecosystem functioning. Whereas density- and trait-mediated indirect effects of predation generally occur through population-scale changes, patchy indirect effects of predation occur through individual- and patch-level pathways. Our synthesis provides a more holistic view of the functional role of predation in ecosystems by addressing how predators create patchy landscapes via localized pathways, in addition to influencing the abundance and behavior of lower trophic levels.

Leadless pacing systems have revolutionized the field of electrophysiology given its low complication rates and almost non-existent rate of infections compared to traditional pacemakers. These devices boast resistance to infections given its unique features; however, as described in this report, device related infection from these leadless devices is still possible. In patients with leadless pacing system that are persistently bacteremic in the future, evaluation of the device with transesophageal echocardiogram or intracardiac echocardiography should be performed and if vegetation is noted on the device, device extraction should highly be considered, along with empiric intravenous antibiotics. Lastly, new leadless device should not be re-implanted within 2 weeks of the removal of the infected device to prevent seeding of the new device.

Objective To investigate associations of early and middle adulthood physical activity (PA) with symptoms of pelvic floor disorders (PFD), i.e. stress urinary incontinence (SUI), urge urinary incontinence (UUI), fecal incontinence (FI), constipation or defecation difficulties (CDD), and feeling of pelvic organ prolapse (POP) among middle-aged women. Design A cross-sectional, observational study with retrospective physical activity assessment. Setting University Research Laboratory. Sample A random population sample of 1098 47-to-55-year-old Finnish women. Methods PA history, current PA, and demographical and gynaecological variables were assessed using self-report questionnaires. Logistic regression analyses were applied to study associations of past and current PA with PFDs. Associations of demographical and gynaecological variables with PFDs were studied and their potential confounding effect was controlled in multiple logistic regression models. Main outcome measures Structured questionnaire-assessed retrospective physical activity history at the age of 17–29, current physical activity at middle age, and prevalence of SUI, UUI, FI, CDD and POP. Results Current PA was not independently associated with the occurrence of the PFDs. Middle-aged women with early adulthood history of competitive sports were more likely to experience UUI (OR 2.161, 95% CI 1.102–4.237, p=0.025) but not SUI, FI or POP, while women with history of regular PA were more likely to experience FI (OR 4.405, 95% CI 1.049–18.493, p=0.043) but not other PFDs. Conclusions Competitive sports during early adulthood may increase the risk of UUI at middle age. The history of regular PA may increase the risk of FI. Keywords Pelvic floor function, exercise, menopausal women

Pyogenic granuloma (PG) is an inflammatory hyperplasia that arises in response to various stimuli such as low-grade local irritation, traumatic injury, or hormonal factors. It may occur at any age, with the highest incidence in the 2nd and 5th decades of life. Women are more frequently affected due to the increased levels of circulating hormones, oestrogen and progesterone. The most common site for oral PG is the gingiva. In this report, a case of PG of the gingiva with severe bone loss is presented.

Rabies is an acute, progressive, and incurable viral encephalitis. The patient was a 13-year-old boy that the Cerebrospinal fluid PCR for rabies and covid-19 test was positive. In emergencies such as the Covid-19 epidemic, an animal disease monitoring strategy should be considered in infectious disease control programs.

Fixed drug eruption is a cutaneous drug reaction which recurs at the same site when the individual is exposed to the causative drug, characterized by single or multiple round sharply demarcated erythematous-to-violaceous patches. Here, we report a patient with generalized non-bullous fixed drug eruption following mRNA-based Pfizer-BioNTech COVID-19 vaccine.

Population pharmacokinetic (PK) and pharmacokinetic- pharmacodynamic (PK-PD) models were used to quantify the exposure-response (E-R) relationship between nalbuphine exposure and 2 widely used rating scales for itch: the Numerical Rating Scale for the subject’s ‘average’ itch experience (NRS-AV) and the Worst Itch (WI-NRS), with 24-hour recall. Simulations based on the model E-R relationship were used to support dose selection for future clinical investigations and were evaluated with a target of reducing the 7-day average of the 24-hour WI-NRS by at least 30% from baseline in the majority of the analysis population. Data from two clinical trials (NCT02373215: 9 healthy subjects; NCT02174419: 62 subjects with PN), in patients with Prurigo Nodularis (PN) with moderate to severe itch who received treatment with either of 2 doses of Nalbuphine ER versus placebo, were used for the analysis. A two-compartment PK model with serial zero and first-order oral absorption was used to describe drug exposure. A sigmoidal maximum effect (Emax) model with a placebo effect was used to model the itch response endpoints (NRS-AV, WI-NRS). The PK/PD model adequately predicted the exposure-related reduction in both NRS-AV and WI-NRS over time with approximately 63% and 27% of Emax, respectively. Exposures associated with 80% of Emax were achieved in about 78% of the patients at 162 mg BID compared to 35% at 81 mg BID. Simulated dose-response indicated that 108 and 162 mg BID doses result in the highest proportion of patients achieving at least a 30% reduction in NRS-AV and WI-NRS, respectively.

Introduction: As left bundle branch pacing (LBBP) is more likely physiological pacing，which has emerged as a novel pacing strategy that uses the native conduction system to improve ventricular synchrony with stable pacing parameters. Operation process of the lead implanation was performed relatively complex, [lack](javascript:;) [of](javascript:;) a [standard](javascript:;) operation may lead to serious consequences. Recently, we encountered a case of the lead helix was winding the tricuspid chordae. Radio frequency ablation effectively solved this problem without causing serious complications. It is an effective and reliable method to solve the problem of electrode winding chordae. This case provided more clinical experience in handing the operative complications.

Background: Isoproterenol, a non-specific beta agonist, is commonly used during electrophysiology studies (EPS). However, with the significant increase in the price of isoproterenol in 2015 and the increasing number of catheter ablations performed, the cost implications cannot be ignored. Dobutamine is a less expensive synthetic compound developed from isoproterenol with a similar mechanism to enhance cardiac conduction and shorten refractoriness, thus making it a feasible substitute with a lower cost. However, the use of dobutamine for EPS has not been well-reported in the literature. Objective: To determine the site-specific effects of various doses of dobutamine on cardiac conduction and refractoriness and assess its safety during EPS. Methods: From February 2020 to October 2020, 40 non-consecutive patients scheduled for elective EPS, supraventricular tachycardia, atrial fibrillation, and premature ventricular contraction ablations at a single center were consented and prospectively enrolled to assess the effect of dobutamine on the cardiac conduction system. At the end of each ablation procedure, measures of cardiac conduction and refractoriness were recorded at baseline and with incremental doses of dobutamine at 5, 10, 15, and 20 mcg/kg/min. For the primary analysis, the change per dose of dobutamine from baseline to each dosing level of dobutamine received by the patients, comparing atrioventricular node block cycle length (AVNBCL), ventricular atrial block cycle length (VABCL) and sinus cycle length (SCL), was tested using mixed-effect regression. For the secondary analysis, dobutamine dose level was tested for association with relative changes from baseline of each electrophysiologic parameter (SCL, AVNBCL, VABCL, atrioventricular node effective refractory period (AVNERP), AH, QRS, QT, atrial effective refractory period (AERP), ventricular effective refractory period (VERP), using mixed-effect regression. Changes in systolic and diastolic blood pressures were also assessed. The Holm-Bonferroni method was used to adjust for multiple testing. Results: For the primary analysis there was no statistically significant change of AVNBCL and VABCL relative to SCL from baseline to each dose level of dobutamine. The SCL, AVNBCL, VABCL, AVNERP, AERP, VERP and the AH, and QT intervals all demonstrated a statistically significant decrease from baseline to at least one dose level with incremental dobutamine dosing. Two patients (5%) developed hypotension during the study and one patient (2.5%) received a vasopressor. Two patients (5%) had induced arrhythmias but otherwise no major adverse events were noted. Conclusion: In this study, there was no statistically significant change of AVNBCL and VABCL relative to SCL from baseline to any dose level of dobutamine. As expected, the AH and QT intervals, and the VABCL, VERP, AERP and AVNERP all significantly decreased from baseline to at least one dose level with an escalation in dobutamine dose. Dobutamine was well-tolerated and safe to use during EPS.

Grass carp (Ctenopharyngodon idella) is an important economic and ecological freshwater fish. Grass carp is a highly adaptive and has been introduced around the world, making it a good model to explore genomic divergence in diverse ecosystems. Habitat colonization often requires extensive adaptation to cope with environmental challenges from temperature and light variations; however, the associated genomic mechanisms underlying evolution are unclear. To evaluate the genetic diversity and selective adaptation in this species, we improved the draft genome of female grass carp using a fine genetic map and performed whole-genome resequencing to generalize genetic differentiations and variations among eight populations across its distributional range in Asia. Population structures analysis using principal component, linkage disequilibrium decay, and admixture analyses revealed that the Asian grass carp comprises two independent and genetically distinct populations, which might have resulted from geographical distributions with contrasting environments. The South Asia population exhibited reduced genetic diversity and a distinct population structure compared with those of the China and Vietnam populations. Genome selected sweep analysis revealed many diverged genomic regions containing genes enriched for the nervous system and epigenetic diversity-related genetic variation. Finally, among 27 candidate genes located in selected regions, the oxytocin gene had the highest Fst value, and is involved in parturition, social behavior, growth, and developmental processes, possibly contributing to the local adaptation of South Asia grass carp. Our results suggested that grass carp genomic divergence has been triggered and maintained by geographic isolation, revealing the genomic basis of adaptation in this species.

Sickle cell disease is the most prevalent inherited blood disorder in the world, with significant morbidity and mortality. Patients often have recurrent painful vaso-occlusive episodes, and the American Society of Hematology gives a conditional recommendation for the use of regional anesthesia for acute sickle cell pain management. This scoping review summarizes the current evidence and identifies gaps for future research. Our screening process is outlined, and articles that mentioned the use of regional anesthesia for acute sickle cell crises were included. We present and interpret our results and highlight opportunities for future investigation.

The COVID19 pandemic is the latest example of the profound socio-economic impact of the Emerging Infectious Disease (EID) crisis. Current health security measures are based in a failed evolutionary paradigm that presumes EID is rare and cannot be predicted because emergence requires the prior evolution of novel genetic capacities for colonizing a new host. Consequently, crisis response through Preparation for previously-emerged diseases and Palliation following outbreaks have been the only health security options, which have become unsustainably expensive and unsuccessful. The Stockholm Paradigm is an alternative evolutionary framework suggesting host changes are the result of changing conditions that bring pathogens into contact with susceptible hosts, with novel genetic variants arising in the new host after infection. Host changes leading to EID can be predicted because pre-existing capacities for colonizing new hosts are highly specific and phylogenetically conservative. This makes EID Prevention through limiting exposure to susceptible hosts possible. The DAMA (Document, Assess, Monitor, Act) protocol is a policy extension of the SP that can both prevent and mitigate EID by enhancing traditional efforts through adding early warning signs and predicting transmission dynamics. Prevention, Preparation and Palliation comprise the 3P framework, a comprehensive plan for reducing the socio-economic impact of EID.

Infraocclusion of a primary molar is a relatively common occurrence which seldom leads to serious complications, particularly when the succedaneous permanent tooth is present. Despite the relative infrequency of unfavourable outcomes, an infraoccluded primary molar may be associated with other dental anomalies, including hypodontia.

Metasurface is a new type of electromagnetic material based on the generalized Snell theorem . It can achieve different reflection and incidence effects from natural materials, which has attracted extensive attention in the field of electromagnetics. In this paper, a one-dimensional metasurface is designed and simulated which can change the reflected electromagnetic wave beam. The additional phase difference on the metasurface unit is controlled by 1 bit coding to control the direction of the reflected wave beam. Combined with the Deep Q Network algorithm in the reinforcement learning tool, the coding corresponding to the beam meeting the target direction is found.

A document by Uroosh Tariq Khanzada. Click on the document to view its contents.