Background: Acute type A aortic dissection (ATAAD) is a life-threatening medical condition requiring urgent surgical attention. It is estimated that 50% of ATAAD die within 24 hours of onset, with the mortality rate is increasing by 1-2% every additional hour without prompt intervention. A variety of ATAAD surgical repair techniques exist which has sparked controversy within the literature, with the main two strategies being proximal aortic replacement (PAR) and total arch replacement (TAR). Nevertheless, the question of which of these two strategies if the more optimal is still debatable. Aims: This commentary aims to discuss the recent study by Sa and colleagues which presents a pooled analysis of Kaplan-Meier-derived individual patient data from studies with follow-up comparing aggressive (TAR) and conservative (PAR) approaches to manage ATAAD patients. Methods: A comprehensive literature search was performed using multiple electronic databases including PubMed, Ovid, Google Scholar, EMBASE and Scopus in order to collate the relevant research evidence. Results: The more aggressive TAR approach for treating ATAAD seems to yield more favourable results including more optimal long-term survival as well as a lower need for reoperation. The frozen elephant trunk (FET) technique can be considered the mainstay TAR technique. Conclusion: It is valid to conclude that TAR with FET is the superior strategy for managing ATAAD patients.

Tracheo-innominate fistula (TIF) is a reported complication of tracheostomy that typically presents with a herald bleed. The phenomenon of an aorto-tracheal fistula has similar pathology and presentation to TIF, but no standard surgical repair. In the manuscript by Musgrove et al. in the Journal of Cardiac Surgery the authors propose a surgical treatment, that is reproduceable for the correct anatomic configuration - an ascending and aortic arch replacement, pericardial patch of the tracheal defect, and omental flap coverage to prevent infection. While this intervention seems a large undertaking for a small defect, it is a safe and durable repair.

Frozen elephant trunk (FET) has in recent times become a mainstay for total arch replacement (TAR) in aortovascular surgery and is indicated in order to treat a spectrum of complex aortic pathologies. However, despite associated excellent post-operative results it is incredibly important to recognise potential adverse complications such as negative aortic remodelling, endoleak and distal stent-graft induced new entry so that outcomes can be further improved. Below we provide commentary on a recent article in the Journal of Cardiac Surgery discussing the topic. Despite the fascinating outcomes of this systematic review and meta-analysis the heterogeneity of the literature regarding these adverse outcomes remains an issue which can only be solved with large multi-centre trials directly comparing graft types as well as indications for surgery.

Security provisioning has become the most important design consideration for large-scale Internet of Things (IoT) systems due to their critical roles to support diverse vertical applications by connecting heterogeneous devices, machines and industry processes. Conventional authentication and authorization schemes are insufficient in dealing the emerging IoT security challenges due to their reliance on both static digital mechanisms and computational complexity for improving security level. Furthermore, the isolated security designs for different layers and link segments while ignoring the overall protection lead to cascaded security risks as well as growing communication latency and overhead. Potential security risks and attacks could lead to catastrophic consequences and cause avalanche-like damages in large-scale IoT networks. This is mainly due to the critical roles of IoT to support a wide variety of vertical applications by connecting tremendous heterogeneous devices, machines and industry processes, as well as cascaded reaction from the enormous parallel interconnection contained in IoT. Moreover, the widely used resource-constrained devices, e.g. sensors, can be compromised easily, thus resulting in widely distributed threats to the IoT network through data injection, spoofing, eavesdropping, and so on. Challenges for Conventional Authentication and Authorization in Large-Scale IoT: The conventional authentication and authorization methods, including key-based cryptography techniques and physical layer key generation techniques, may suffer from their high complexity and long latency, and may be ineffective to adapt to the complex dynamic environment, especially in large-scale IoT networks[1, 2]. Long security induced latency in large-scale IoT. The conventional cryptography techniques require increased overhead and lengthy process for increased level of security, thus leading to high communication and computation overhead, more importantly, long communication latency[3]. These are intolerable for the large-scale IoT network having significantly increasing number of intelligent machines and resource-constrained devices with concurrent communications[4]. Ineffective adaptation to complex dynamic IoT environment. Conventional security solutions may also suffer from cascading risks in complex dynamic IoT scenarios due to their reliance on static binary authentication/authorization mechanisms[5, 6].

Security experts have demonstrated numerous risks imposed by Internet of Things (IoT) devices on organizations. Due to the widespread adoption of such devices, their diversity, standardization obstacles, and inherent mobility, organizations require an intelligent mechanism capable of automatically detecting suspicious IoT devices connected to their networks.

Security provisioning has become the most important design consideration for large-scale Internet of Things (IoT) systems due to their critical roles to support diverse vertical applications by connecting heterogeneous devices, machines and industry processes. Conventional authentication and authorization schemes are insufficient in dealing the emerging IoT security challenges due to their reliance on both static digital mechanisms and computational complexity for improving security level. Furthermore, the isolated security designs for different layers and link segments while ignoring the overall protection lead to cascaded security risks as well as growing communication latency and overhead. Potential security risks and attacks could lead to catastrophic consequences and cause avalanche-like damages in large-scale IoT networks. This is mainly due to the critical roles of IoT to support a wide variety of vertical applications by connecting tremendous heterogeneous devices, machines and industry processes, as well as cascaded reaction from the enormous parallel interconnection contained in IoT. Moreover, the widely used resource-constrained devices, e.g. sensors, can be compromised easily, thus resulting in widely distributed threats to the IoT network through data injection, spoofing, eavesdropping, and so on. Challenges for Conventional Authentication and Authorization in Large-Scale IoT: The conventional authentication and authorization methods, including key-based cryptography techniques and physical layer key generation techniques, may suffer from their high complexity and long latency, and may be ineffective to adapt to the complex dynamic environment, especially in large-scale IoT networks[1, 2]. Long security induced latency in large-scale IoT. The conventional cryptography techniques require increased overhead and lengthy process for increased level of security, thus leading to high communication and computation overhead, more importantly, long communication latency[3]. These are intolerable for the large-scale IoT network having significantly increasing number of intelligent machines and resource-constrained devices with concurrent communications[4]. Ineffective adaptation to complex dynamic IoT environment. Conventional security solutions may also suffer from cascading risks in complex dynamic IoT scenarios due to their reliance on static binary authentication/authorization mechanisms[5, 6].

Hypoxia has profound and diverse effects on aerobic organisms, disrupting oxidative phosphorylation and activating several protective pathways. Predictions have been made that exposure to mild intermittent hypoxia may be protective against more severe exposure and may extend lifespan. Both effects are likely to depend on prior selection on phenotypic and transcriptional plasticity in response to hypoxia, and may therefore show signs of local adaptation. Here we report the lifespan effects of chronic, mild, intermittent hypoxia (CMIH) and short-term survival in acute severe hypoxia (ASH) in four clones of Daphnia magna originating from either permanent or intermittent habitats, the latter regularly drying up with frequent hypoxic conditions. We show that CMIH extended the lifespan in the two clones originating from intermittent habitats but had the opposite effect in the two clones from permanent habitats, which also showed lower tolerance to ASH. Exposure to CMIH did not protect against ASH; to the contrary, Daphnia from the CMIH treatment had lower ASH tolerance than normoxic controls. Few transcripts changed their abundance in response to the CMIH treatment in any of the clones. After 12 hours of ASH treatment, the transcriptional response was more pronounced, with numerous protein-coding genes with functionality in mitochondrial and respiratory metabolism, oxygen transport, and, unexpectedly, gluconeogenesis showing up-regulation. While clones from intermittent habitats showed somewhat stronger differential expression in response to ASH than those from permanent habitats, there were no significant hypoxia-by-habitat of origin or CMIH-by-ASH interactions. GO enrichment analysis revealed a possible hypoxia tolerance role by accelerating the molting cycle and regulating neuron survival through up-regulation of cuticular proteins and neurotrophins, respectively.

Habitat divergence among close relatives is a common theme in ecology. While recent studies have frequently found that the abundance and diversity of plant species are regulated by soil microbes, little is known whether soil microbes can also affect the habitat distributions of plants. To fill in this knowledge gap, we investigated whether interactions with soil microbes restrict habitat distributions of closely related oaks (Quercus spp.) in eastern North America. We performed a soil inoculum experiment using two pairs of sister species that show habitat divergence: Quercus alba (local species) vs. Q. michauxii (foreign), and Q. shumardii (local) vs. Q. acerifolia (foreign). To test whether host-specific soil microbes are responsible for habitat restriction, we investigated the impact of local sister live soil (containing soil microbes associated with local sister species) on the survival and growth of local and foreign species. Secondly, to test whether habitat-specific soil microbes are responsible for habitat restriction, we also examined the effect of local habitat live soil (containing soil microbes within local sister’s habitats, but not directly associated with roots of local sister species) on the seedlings of local and foreign species. We found that local sister live soil decreased the survival and biomass of foreign species’ seedlings while increased those of local species, which supports the roles of host-specific microbes in mediating habitat exclusion. In contrast, local habitat live soil did not differentially affect the survival or biomass of the local vs. foreign sister species, providing no support for the roles of habitat-specific microbes. Our study indicates that soil microbes associated with one sister species can suppress the recruitment of the other host species, contributing to habitat partitioning of the closely related oaks. Our findings emphasize that considering the complex interactions with soil microbes is essential for understanding habitat distributions of closely related plants.

In this paper, we will prove that all non-trivial solutions of $f’‘+A(z)f’+B(z)f=0$ are of infinite order, where we have some restrictions on entire functions $A(z)$ and $B(z)$.

The blacklegged tick, Ixodes scapularis, is a vector of Borrelia burgdorferi sensu stricto (s.s.), the causative agent of Lyme disease, part of a slow-moving epidemic of Lyme borreliosis spreading across the northern hemisphere. There are well-known geographic differences in the vectorial capacity of these ticks associated with genetic variation. Despite the need for detailed genetic information in this disease system, previous phylogeographic studies of these ticks have been restricted to relatively few populations or genetic loci. Here we present the most comprehensive phylogeographic study of I. scapularis conducted by using 3RAD and surveying 353 ticks from 33 counties throughout the range of I. scapularis. We found limited genetic variation among populations from the Northeast and Upper Midwest, where Lyme disease is most common, and higher genetic variation among populations from the South. We identify four genetic clusters of I. scapularis that are consistent with four major geographic regions, plus a distinct Central Florida group. In regions where Lyme disease is increasing in frequency, the I. scapularis populations genetically group with ticks from historically highly Lyme-endemic regions. Finally, we identify ten variable DNA sites that contribute the most to population differentiation. These variable sites cluster on one of the chromosome-scale scaffolds for I. scapularis and are within identified genes. Our findings illuminate the need for additional research to identify loci causing variation in the vectorial capacity of I. scapularis and where additional tick sampling would be most valuable to further understand disease trends caused by pathogens transmitted by I. scapularis.

Life-history strategies play a critical role in susceptibility to environmental stresses for scleractinia coral. Metabolomics, which is regarded as the ultimate response of biological systems to genetic and environmental changes, is competent for the characterization of species’ biological traits. In this study, we combined untargeted mass spectrometry metabolomics and molecular networking to characterize the differential metabolic pathways between Pocillopora meandrina, one of the dominant species in South China Sea (SCS) with the life-history strategy of “competitive”, and Seriatopora hystrix, one of the nondominant species with the life-history strategy of “weedy” in SCS. The results show that lyso-PAF, DGCC, aromatic amino acids, and sulfhydryl compounds were more enriched in P. meandrina, whereas new phospholipid, de-PG DHC, MAG, FA (C<18), peptides, and guanidine compounds were more enriched in S. hystrix. The metabolic pathways involving immune response, energy metabolism, cellular membrane structure regulation, oxidative stress system, secondary metabolite synthesis, and et al. were speculated to relate to coral’s physiological traits, which finally resulted in the faster growth rate of P. meandrina and more robust environmental adaptability of S. hystrix. This study contributed to understanding of the potential molecular traits underlying life-history strategies of different coral species.

A document by Marcin Moniuszko. Click on the document to view its contents.

Genomics data analysis requires efficient tools to address the vast amount of data generated by current next-generation sequencing technologies. K-mer counting works face difficulties in balancing high memory overhead with statistical precision. We designed a high-frequency k-mer statistical computation based on the Space Saving algorithm and a novel hash table structure, which reduces the memory overhead by 46\% while ensuring high computational efficiency.

A miniaturized wideband and directional antenna is proposed for 4G base station applications. To improve the front-to-back ratio, and miniaturization of the proposed antenna, a metal cavity reflector is designed. One cross-shaped and four rectangular slots are etched at the center and edge of the radiating patch respectively to improve the isolation. The coupling feeding is achieved by Y-shaped stubs printed on the top of the substrate. Moreover, the prototype of the antenna was fabricated and tested. The measured results show that the antenna achieves a bandwidths ( s11<-10 dB) of 50.4% from 1.63 GHz to 2.73 GHz. And an average isolation and front-to-back ratio (FBR) between the two ports is about 30 dB and 20 dB whereas the cross polarization level maintains lower than -12 dB across the entire operating band. The half-power beam width (HPBW) of around 79±3° and average gain of 8.0±1.0 dBi during the operating band are also obtained. Due to the metal cavity, compared with other antennas of the same type, the proposed antenna has a smaller size. The antenna has a wide bandwidth, high isolation, stable radiation patterns, ideal FBR and smaller size, so it is suitable for 4G base station applications.

Based on the brain signals, decoding the gait features to make a reliable prediction of action intention is the core issue in the brain computer interface (BCI) based hybrid rehabilitation and intelligent walking aid robot system. In order to realize the classification and recognition of the most basic gait processes such as standing, sitting and quiet, this paper proposes a feature representation method based on the signal complexity and entropy of signal in each brain region. Through the statistical analysis of the parameters between different conditions, these characteristics which sensitive to different actions are determined as a feature vector, and the classification and recognition of these actions are completed by combing support vector machine, linear discriminant analysis and logistic regression. Experimental result shows that the proposed method can better realize the recognition of the above-mentioned action intention. The recognition accuracy of standing, sitting and quiet of 13 subjects is higher than 81%, and the highest one can reach 87%. The result has significant value for understanding human’s cognitive characteristics in the process of lower limb movement and carrying out the study of BCI based strategy and system for lower limb rehabilitation.

This letter presents a 4-level Pulse Amplitude Modulation (PAM-4) Feed Forward Equalizer (FFE) with a novel Internal-Node-Charge-Controlled 1-Unit Interval Pulse Generator (INCC 1UIPG). Partially segmented architecture and tailless 1-stage front-end are chose to reduce the overall load capacitance for better bandwidth and power performance. The proposed INCC 1UIPG adopts a 2-stage structure and precisely controls the internal nodes, reducing average transition time by ~30% compared with the prior works. The wider bandwidth and the faster transition edge allow the implementation of the equalizer working at 128Gbps with a 0.39pJ/bit power efficiency and an area of 0.014mm2 in 65nm CMOS, which advance the state-of-the-art with a mature technology.

Objective:To gain insight into the real experiences of post-traumatic growth of thyroid cancer patients and to provide reference for optimizing postoperative care measures for thyroid cancer patients.Design: a qualitative study.Methods:Using a phenomenological study method in qualitative research, 15 patients within six months after radical thyroid cancer surgery in our hospital from March to April 2022 were interviewed in a semi-structured manner by purposive sampling, and the data were analyzed using the Colaizzi 7-step method.Results: Two first-level themes were summarized: (1) post-traumatic growth facilitators for thyroid cancer patients (cognitive processing, positive coping strategies, multiple sources of support); and (2) post-traumatic growth experiences for thyroid cancer patients (personal changes, improved relationships).Conclusion: Post-traumatic growth can occur in thyroid cancer patients after surgery, and healthcare professionals should guide patients’ positive psychology and tap into their inner positive potential in order to promote healthy recovery and improve the quality of life of thyroid cancer patients.

A 48-year-old male diagnosed with Acute promyelocytic leukemia (APL) started on all-trans retinoic acid and arsenic trioxide, developed typical symptoms of differentiation syndrome, and improved dramatically on steroids. Hence, any APL patient started on chemotherapy, needs to be monitored closely for developing differentiation syndrome and to start steroid upon suspicion.

Multinucleate cell angiohistiocytoma is a rare, benign, usually asymptomatic fibrohistiocytic and vascular proliferation which occurs predominantly on the extremities of middle aged women. Histology shows characteristic multinucleate cells and is indispensable for diagnosis.

Objective: Peripartum cardiomyopathy (PPCM) diagnosis made by excluding identifiable causes of heart failure (HF) and occurs end of the pregnancy or during the postpartum period of five months. It presents a clinical HF spectrum with left ventricular systolic dysfunction. Background: The purpose of this study is to retrospectively evaluate the clinical characteristics, cardiac magnetic resonance (CMR) imaging features, and end-points consisting of left ventricle recovery, left ventricular assist device implantation, heart transplantation, and all-cause mortality. Method: Outpatient HF records between 2008 to 2021 were screened. Thirty-seven patients were defined as PPCM. Twenty-five patients had CMR evaluation at the time of diagnosis, and six patients were re-evaluated with CMR. Results: The mean age was 30.5±5.6 years, and the mean LVEF was 28.2±6.7%. In thirteen(35.7%) patients, LVEF recovered during the follow-up course. The median recovery time was 281(IQR [78-358]) days. LVEF on CMR was 35.3±10.5, and three patients exhibited late gadolinium enhancement(LGE) patterns. Sub-endocardial and mid-wall uptake pattern types were detected. 18(75%) patients met the Petersen left ventricle non-compaction cardiomyopathy(LVNC) criteria. Patients with NC/C ratio lower than 2.3 had lower LVEDVi and LVESVi (124.9±35.4,86.4±7.5, p=0.003;86.8±34.6,52.6±7.6, p=0.006), respectively. The median follow-up time was 2129 (IQR [911-2634]) days. The primary endpoint-free one-year survival was 88.9%(event rate 11.1%), and five-year survival was 75.7%(event rate 24.3%). Conclusion: In a retrospective cohort of PPCM patients, 35.7% of patients’ LVEF recovered, and the primary end-point of free-five-year survival was 75%. Twenty-five patients were assessed with CMR; three of four met the Petersen CMR-derived LVNC at initial evaluation.

Objective: This study was conducted to determine the effect of virtual reality used during hysterosalpingography on perceived pain, anxiety, fear, physiological parameters, and satisfaction in women. Design: A randomized controlled trial design was used in the study. The CONSORT statement was used to report the findings. Methods: The study was conducted between April 26 and June 30, 2022. Patients were randomized into two groups (the virtual reality=31, the control group=31). Main outcome measures: Anxiety was evaluated using the State Anxiety Inventory; pain, fear, satisfaction were evaluated using the Visual Analogue Scale; the temperature, pulse, blood pressure, and oxygen saturation were followed up. Results: The difference between the virtual reality group and the control group in terms of their mean pain and fear scores during hysterosalpingography and 15 minutes after hysterosalpingography was statistically significant. The difference between the mean anxiety scores of the groups was statistically insignificant. The difference between the groups in terms of satisfaction with the hysterosalpingography procedure was statistically significant. There was no statistically significant difference between the groups in terms of their physiological parameters just before, immediately after, and 15 minutes after the hysterosalpingography procedure. Conclusions: In this study, it was determined that the use of virtual reality during the hysterosalpingography procedure reduced pain and fear, increased satisfaction, but did not affect anxiety and vital signs. In addition, women’s satisfaction with the use of virtual reality was high.

Aim Indications for medicines are poorly recorded in prescriptions at our hospitals. Indications are ‘optional’ on paper prescriptions but can be mandated in electronic prescriptions. As part of an initiative to improve indication documentation for antimicrobial medicines, a prospective controlled study of compulsory indications for antibacterial medicines was undertaken. Our aim was to assess the effect of making indications compulsory in an electronic prescribing and administration (ePA) system. Methods Compulsory indications on prescriptions were implemented in our tertiary hospital ePA system for eight antibacterial medicines. The proportion of ‘credible indications’ following the intervention for these medicines was compared with 23 antibacterial medicines with pre-existing (positive control) and 71 without (negative control) compulsory indications. Documented indications for all antibacterial medicines four weeks before and after implementation of compulsory indications were extracted from the ePA system and manually classified as ‘credible indication’, ‘other text’, ‘rubbish text’, or ‘blank’. Results The proportion of ‘credible indications’ for the intervention group had an absolute increase of 64.8%, from 12.5% (270/2166) to 77.3% (1684/2179). In the intervention group ‘rubbish text’ increased by 1.3% (from 0.05% to 1.3%), ‘other text’ increased from 5.4% to 15.3%, and ‘blank’ decreased from 82.1% to 6.1%. For antibacterials with no compulsory indication ‘credible indications’ increased from 22.0% (793/3611) to 46.0% (1667/3621), and in those with pre-existing compulsory indications from 80.3% (191/238) to 83.2% (183/220). Conclusion Implementation of compulsory indications for antibacterial medicines in the ePA system increased ‘credible indications’ substantially with a small increase in ‘rubbish text’.

Objective: To evaluate subsequent menstrual, fertility and psychological outcomes after uterine compression sutures. Design: Prospective cohort study Setting: Tertiary obstetric unit (6000 deliveries per year) Population: Women with primary postpartum hemorrhage successfully treated with uterine compression sutures (n=80). Methods: Women were followed-up in postnatal clinic for two years after delivery. Subsequent pregnancies were identified by territory-wide computer registry and telephone interviews. Women with postpartum hemorrhage treated with uterotonic agents only were chosen as controls. Main outcome measures: Prevalence of menstrual abnormality, adverse pregnancy outcome and psychological disturbance. Results: In our cohort, 87.9% of women had return of menses within six months. Two Asherman’s syndrome were diagnosed. Majority of women had similar menstrual patterns as before. Among 23 subsequent pregnancies, no significant difference in outcome was demonstrated. However, more omental or bowel adhesion (37.5% vs 8.8%, p=0.007), recurrence of hemorrhage (68.8% vs 7.5%, p<0.001) and repeat compression sutures (12.5% vs 0%, p=0.024) were seen in women with previous compression sutures. Over half of the couple declined future fertility with 38.2% of women recalled unpleasant memory and 22.1% reported life-long adverse impact especially tokophobia. Conclusion: Women with history of uterine compression sutures had similar menstrual and pregnancy outcomes compared to those who did not have sutures. However, they had higher risk of visceral adhesion, recurrence of hemorrhage and repeat compression sutures next pregnancy. Couple was more susceptible to negative emotional impact. Keywords: Uterine compression sutures, B-lynch suture, Hayman suture, Cho suture, pregnancy, menstruation, fertility, psychological impact.

Objective: Observational studies have described associations between obesity and adverse outcomes of pregnancy. Mendelian randomization (MR) takes advantage of the ‘natural’ genetic randomization to risk of an exposure such as body mass index (BMI) to study the effects of the exposure on outcomes. Similar to randomization in a clinical trial, this limits the potential for confounding and bias. Design: A two-sample MR study. Setting: Summary statistics from published genome wide association studies (GWAS) in European ancestry populations. Population or Sample: Instrumental variants for body mass index (BMI) were obtained from a study on 434,794 females. Female-specific genetic association estimates for outcomes were extracted from the sixth round of analysis of the FINNGEN cohort data. Methods: Inverse-variance weighted MR was used to assess the association between BMI and all outcomes. Sensitivity analyses with weighted median and MR-Egger were also performed. Results: A 1-SD increase in BMI was associated with higher risk of pre-eclampsia (OR 1.68, 95%CI 1.46-1.94, p=8.74x10-13), gestational diabetes (OR 1.67, 95%CI 1.46-1.92, p=5.35x10-14), polyhydramnios (OR 1.40, 95%CI 1.00-1.96, p=0.049). There was evidence suggestive of a potential association with higher risk of premature rupture of membranes (OR 1.16, 95%CI 1.00-1.36, p=0.050) and postpartum depression (OR 1.12, 95%CI 0.99-1.27, p=0.062). Conclusions: Higher maternal BMI is associated with marked increase in risk of pre-eclampsia, gestational diabetes and polyhydramnios. The relationship between BMI and premature rupture of membranes and postpartum depression should be assessed in further studies. Our study supports efforts to target BMI as a cardinal risk factor for maternal morbidity.