A 48-year-old woman was diagnosed with right-sided Grade 2 invasive breast carcinoma. Prior to initiation of chemotherapy, transthoracic echocardiogram (TTE) demonstrated normal systolic function with left ventricular ejection fraction (LVEF) 64% and global longitudinal strain (GLS) 21%. Following adjuvant chemotherapy with four cycles of anthracycline, twelve cycles of Paclitaxel, and two cycles of Trastuzamab chemotherapies, TTE demonstrated reduction in LVEF to 56% and GLS of -18% (14% relative reduction compared to baseline). Further investigation revealed recent symptomatic COVID-19 infection coinciding with functional impairment and decision was made to continue Trastuzumab therapy without cardioprotective agents. Subsequent TTE demonstrated improved systolic function, indicating the importance of taking history of significant viral infections during chemotherapy standard of care.

A common approach to assess the efficacy of piperacillin is to firstly measure the total concentration, and to afterwards apply a theoretical unbound fraction of 70% to obtain the unbound concentration. However, hypoalbuminemia is a common phenomenon in critically ill patients, resulting in variations in unbound fraction. Therefore, we aimed to simulate the impact of piperacillin unbound fraction fluctuations on the predictive performance of a population pharmacokinetic model and on dosing recommendations of piperacillin. Unbound factors of 70, 75, 80 and 85% were applied to total concentrations of piperacillin administered by continuous infusion from an external dataset. A validated model was used for assessment of predictive performance and to estimate patient clearance. Dosing simulations were performed to evaluate target attainment. Variation in unbound fraction caused minimal impact on piperacillin clearance and target attainment but revealed to influence model evaluation.

A document by Safeer Khan. Click on the document to view its contents.

I read with interest the article by Vendramin and colleagues , reminding us with the 70th anniversary for the first artificial heart valve that was invented by Hufnagel and was first implanted in 1952. This was in an era, where standard heart valve replacement was not feasible, and the heart lung machine was in its very primitive phase to allow such operation to be performed in the way we do it today. This made me dig a bit in the literature and read more in depth about Dr. Hufnagel, one of the most gifted American surgeons and his pioneer work.

Pollution caused by heavy metals in soils and ecosystems is an environmental problematic that requires urgent attention due to the ecological problems that it generates. Forest species can be used to mitigate contamination because of their potential to bioaccumulate contaminating metals. Hence, the aim of this research was to identify tree species with good heavy metal bioaccumulating capacities that can contribute to mitigate pollution. The bioconcentration factor for five forest species, such as: Spanish cedar ( Cedrela odorata L.), cutanga ( Parkia multijuga Benth.), guaba or ice cream bean ( Inga edulis Mart.), guarumo ( Cecropia ficifolia Warb. ex Snethl.) and Amazon tree grape ( Pourouma cecropiifolia Mart.), commonly found in the Ecuadorian Amazon was analysed, based on the relationship between the leaves and soil concentration of the heavy metals. For heavy metal analysis in leaves and soil samples of each plant species, atomic absorption spectrometry was used. The results showed that P. cecropiifolia had the highest bioconcentration factor for lead, C. odorata for cadmium and nickel, and I. edulis had the highest potential for iron and aluminium absorption. Any kind of correlation between the concentration of each element in soil and leaves was found, which shows that the bioaccumulation capacity of the species studied does not determine the concentration of metals in the soil.

Title pageTitle : Letter to the Editor: Long-term results of aortic root replacement for endocarditisArticle type : Letter to the editor

Spontaneous Intramural left atrial hematoma that mimics a primary or metastatic cardiac tumor is a very rare entity. We report a case of a 60-year-old man suffering from chronic myeloid leukemia, who was admitted for prolonged chest pain and fatigue. Transthoracic echocardiography revealed a left atrial mass in close proximity to the posterior mitral annulus and failed to provide an ethiological diagnosis. Surgical management was utilized to outrule the atrial neoplasm and to prevent emboli, obstruction and mitral valve insufficiency. This is the first case in the literature in which robot-assisted minimally invasive surgery was adopted to manage such a rare entity.

Latitudinal body size-clines are primarily discussed in the context of thermoregulation, sensu Bergmann. However, body size patterns are ambiguous in ectotherms and this heterogeneity remains poorly understood. We hypothesised that the contrasting effects of thermoregulation and resource constraints obscure latitude–size relationships. Using data for 43% of all odonate species, we tested whether body size increases with decreasing temperature and increasing productivity in phylogenetically and spatially comparative analyses. We found strong but contrasting effects for temperature between Anisoptera and Zygoptera and consistent positive effects for productivity that explained 35%–57% of body size variation. We concluded that temperature, productivity, and conservatism in size-based thermoregulation synergistically determine the distribution of ectotherms, while the taxon-specific importance of these factors can lead to contrasting results and weak latitude–size relationships. Our results reinforce the importance of body size as a determinant of species distributions and responses to climate change.

Introduction: The InPOG-HL-15-01, a multi-centric prospective study used a risk-stratified and response-based approach with a doxorubicin, bleomycin, vinblastine and dacarbazine (ABVD) backbone to treat children with newly diagnosed Hodgkin Lymphoma (HL) and reduce the use of radiation therapy (RT). Children/adolescents with bulky disease or inadequate response at early response assessment (ERA) after 2 cycles of chemotherapy were assigned to receive RT. For ERA, positron emission tomography computed tomography (PET-CT) was recommended but not mandatory in view of limited access. This study aimed to compare the impact of using contrast enhanced computed tomography (CECT) vs PET-CT on treatment decisions and outcomes. Methodology: 396 patients were enrolled and 382 had an ERA at the assigned time point. Results: At ERA, satisfactory response was documented in 277/382 (72.5%) participants and this was significantly higher in PET-CT (151/186, 81.2%) as compared to CECT (126/196, 64.3%) respectively (p value<0.001). Amongst the 203 patients with non-bulky disease (wherein the indication for RT was entirely dependent on ERA), 96/114 (84.2%) and 61/89 (68.5%) patients achieved a satisfactory response according to the PET-CT and CECT (p value=0.008) respectively and hence a lesser proportion of patients in the PET-CT arm received RT. Despite a lower usage of RT the 5 year overall survival (OS) of both groups- ERA based on CECT (91.8%) vs PET-CT (94.1%) was comparable (p value=0.391) and so was the 5 year event free survival (EFS) (86.7 vs 85.5%, p value=0.724). Conclusion: Use of PET-CT as the modality for ERA is more likely to indicate a satisfactory response as compared to CECT and thereby decreases the need for RT in response-based treatment algorithm for HL afflicted children. The reduction in the application of RT did not impact the overall outcome and plausibly would lower the risk of delayed toxic effects.

Specialist species have evolved to fill narrow niches but are especially susceptible to environmental change. With sufficient functional redundancy, ecosystem services can persist without specialists. Grooming behaviors are common in both terrestrial and aquatic organisms. However, in aquatic systems there is a heavy reliance on intraspecific mutualisms where specialist species groom or “clean” parasites off host fishes. Here, we sampled the gut contents of 709 fishes, representing 61 species and including both cleaner and non-cleaner fishes, to compare their consumption of gnathiid isopods, the most common fish ectoparasites. We found that cleaner fishes eat significantly more gnathiids, and eat them more frequently, compared to non-cleaner fishes. Our results highlight the importance of both dedicated and facultative cleaners as consumers of ectoparasites and show that their role cannot be supplanted by generalist consumers. Furthermore, we suggest that different cleaner species act as complementary rather than redundant specialists.

1. Recent empirical studies have quantified correlation between survival and recovery by estimating these parameters as correlated random effects with Bayesian multivariate mixed effects models fit to tag-recovery data. In these applications, increasingly negative correlation between survival and recovery indicates increasingly additive harvest mortality. The power of mixed effects models to detect non-zero correlations has rarely been evaluated and these few studies have not focused on a common data type in the form of tag recoveries. 2. We assessed the power of multivariate mixed effects models to estimate negative correlation between annual survival and recovery. Using three priors for multivariate normal distributions, we fit mixed effects models to a mallard (Anas platyrhychos) tag-recovery dataset and to simulated data with sample sizes corresponding to different levels of monitoring intensity. We also demonstrate a method of calculating effective sample size for capture-recapture data. 3) Different priors lead to different inference about additive harvest when we fit our models to the mallard data. Our power analysis of simulated data indicated most prior distribution and sample size combinations resulted in correlation estimates with substantial bias and imprecision. Many correlation estimates spanned the available parameter space (–1,1) and were biased towards zero. Only one prior combined with our most intensive monitoring scenario allowed our models to consistently recover negative correlation without bias. Underestimating the magnitude of correlation coincided with overestimating the variability of annual survival, but not annual recovery. 4) The inadequacy of prior distributions and sample size combinations typically assumed adequate for robust inference represents a concern in the application of Bayesian mixed effects models for the purpose of informing harvest management. Our analysis approach provides a means for examining prior influence and sample size on mixed-effects models fit to capture-recapture data while emphasizing transferability of results between empirical and simulation studies.

The accurate prediction of radio wave propagation is extremely important for wireless network planning and optimization. However, inexact matching between the traditional empirical model and actual propagation environments, as well as the insufficiency of the sample data required for training a deep learning model, lead to unsatisfactory prediction results. Our paper proposes a field strength prediction model based on a deep neural network that is aimed at a tiny dataset composed of the geographic information and corresponding satellite images of a target area. This model connects two pretrained networks to minimize the parameters to be learned. Simultaneously, we construct a convolutional neural network (CNN) model for comparison based on a previous advanced study in this field. Experimental results show that the proposed model can obtain the same accuracy as that of previously developed CNN models while requiring less data.

• The carnivorous pitcher plant Sarracenia purpurea is native to North America, but has been introduced into Europe, where it is now widespread. We have little understanding of how this species functions in its non-native range. Such understanding will provide insight into S. purpurea ecology and support its use as a model system for investigating food webs. We measured pitcher morphology and prey capture by S. purpurea in Britain and Ireland. • Pitchers were removed from different plants at each of six bogs covering the species rage in the UK and Ireland (n = 10 pitchers per site). For each pitcher we counted and identified every prey item and took measurements of morphology. We also compiled prey capture data for existing studies in Europe and North America. • Prey capture characteristics varied between sites in the UK and Ireland. The amount of prey captured varied 2-fold between sites and was partially explained by differences in pitcher size; larger pitchers caught more prey. The primary prey was Formicidae, Diptera and Coleoptera. At the rank of order, prey composition varied between bogs, some contained mainly Formicidae, some mainly Diptera and some a mix. Plants were more specialised in prey capture at some bogs compared to others. There was no overall difference in prey capture (composition or degree of specialism) at the rank of order between plants in Europe compared to those in North America. At the rank of species, prey capture varied between populations even within the same order. • This study demonstrates a large amount of variability between sites in prey capture characteristics. This may reflect different site characteristics and/or plant strategies, will likely impact plant function, and may impact on the inquiline community. In terms of prey capture at the rank of order S. purpurea functions identically in its non-native range. This supports its use as a natural experiment for understanding food webs

Aim: Selection within natural communities has mainly been studied along large abiotic gradient, while the selection of individuals within population should occur locally under the play of biotic filter. To better seize the role of the latter, we postulated that the hierarchal nature of environmental selection and the multiple dimension of species trait space needed to be accounted for. Methods: We replicated a natural species richness gradient (from 2 to 16 species) within four contrasted wetlands (bog, fen, meadow, marsh), sampling functional traits from random individuals in communities. Developing a hierarchical distributional modelling, we analyzed the variation of the mean and dispersion of functional trait space at the ecosystem, community and species levels. Key results: We found that the abiotic differences between wetlands, which shaped a plant productivity gradient, selected species in regards with their leaf nutrient conservation / acquisition strategy. Within ecosystems, plant species richness was a strong driver of trait variation among both communities and species. Among communities, it shaped the selection of individuals according to their space occupation and leaf adaptations to light conditions. Demographically, some species used intraspecific trait variation to maintain equally dense populations, while others used it to become dominant in favorable conditions. Main Conclusions: Within ecosystems, variation in biotic conditions selects individuals along functional dimensions that are independent to the ones selected across ecosystems. Because intraspecific variations of light-related traits are related to demographic responses, it offers a way to link the study of species richness and eco-evolutionary dynamics.

Key Points:  COVID-19 often cause prolonged olfactory dysfunction.  This study evaluated the relative burden of the COVID-19-related disease in a single-centered cohort of POD patients.  COVID-19-related POD was diagnosed serologically.  In the COVID-19 era, the local burden of POD increased two-fold.  It is important to use pleiotropic approach and robust measures, when we assess OD.

Population dynamics with complex biological interactions, accounting for uncertainty quantification, are critical for many application areas. However, due to the complexity of biological systems, the mathematical formulation of the corresponding problems faces the challenge that the corresponding stochastic processes should, in most cases, be considered in bounded domains. We propose a model based on a coupled system of reflecting Skorokhod-type stochastic differential equations with jump-like exit from a boundary. The setting describes the population dynamics of active and passive populations. As main working techniques, we use compactness methods and Skorokhod's representation of solutions to SDEs posed in bounded domains to prove the well-posedness of the system. This functional setting is a new point of view in the field of modelling and simulation of population dynamics. We provide the details of the model, as well as representative numerical examples, and discuss the applications of a Wilson-Cowan-type system, modelling the dynamics of two interacting populations of excitatory and inhibitory neurons. Furthermore, the presence of random input current, reflecting factors together with Poisson jumps, increases firing activity in neuronal systems.

A 25 year old presented to the emergency department with a one day history of mildly painful and erythematous swelling of her right upper eyelid that she believed to be a stye. The clinical team noted vesicular lesions located exclusively on the upper eyelid, diagnosed zoster and initiated valacyclovir.

The first-principle calculations is performed to search for the candidate stable structures for Li-In-Se and Li-In-Te system below 100 GPa for exploring nonlinear optical materials. A new structure with semiconductor properties has been successfully predicted, namely R-3m LiInSe2, may be a potential nonlinear optical material. At the same time, the electronic and optical properties confirm that the band gap of Pna21 LiInSe2 is increasing under pressure, indicating that the optical damage threshold is increasing, which provides a new idea for improving the nonlinear optical properties of materials. In addition, the study of bonding properties shows that In atom exhibits negative valence state in the structure with high pressure or increased Li atom content, which is similar to Ga atom.

This paper proposes a joint optimization method for the imaging algorithm and sampling scheme of sparse spotlight syhthetic aperture radar (SAR) imaging based on deep convolutional neural networks. Traditional compressed sensing (CS) based sparse SAR imaging has been widely studied. Deep learning and sparse unfolding networks have been introduced into sparse SAR imaging, but most current works focus only on the imaging stage and simply adopt the conventional uniform or random down-sampling scheme. Considering that the imaging quality also depends on the sampling pattern besides the imaging algorithm, this paper introduces a learning-based strategy to jointly optimize the sampling scheme and the imaging network parameters of the reconstruction module. In a deep learning-based image reconstruction scheme, joint and continuous optimization of the sampling patterns and convolutional neural network parameters is achieved to improve the image quality. Simulation results based on real SAR image dataset illustrate the effectiveness and superiority of the proposed framework.

Photosymbiodemes are a special case of lichen symbiosis where one lichenized fungus engages in symbiosis with two different photosynthetic partners, a cyanobacterium and a green alga, to develop two distinctly looking photomorphs. We investigated differential gene expression in photosymbiodemes of the lichen Peltigera britannica at different temperatures representing mild and putatively stressful conditions and compared gene expression of thallus sectors containing cyanobacterial photobionts with thallus sectors with both green algal and cyanobacterial photobionts. Firstly, because of known ecological differences between photomorphs, we investigated symbiont-specific responses in gene expression to temperature increases. Secondly, we quantified photobiont-mediated differences in fungal gene expression. High temperatures expectedly led to an upregulation of genes involved in heat shock responses in all organisms in whole transcriptome data. As expected, the expression of genes involved in photosynthesis was increased in both photobiont types at 15 and 25 °C. The green algae exhibited thermal stress responses mainly at 25 °C, the fungus and the cyanobacteria already at 15 °C, demonstrating symbiont-specific responses to environmental cues and symbiont-specific ecological optima. Furthermore, photobiont-mediated differences in fungal gene expression could be identified, with upregulation of distinct biological processes in the different morphs, showing that interaction with specific symbiosis partners profoundly impacts fungal gene expression.

In this letter, the underlying physics of threshold voltage (Vth) instability and the eventual device failure mechanism of 100V Schottky p-GaN gate high electron mobility transistors (HEMTs) under repetitive short-circuit (SC) stress with varied drain voltage (VDD= 40-70V) and SC pulse duration (TSC=10 μs & 20 μs) is studied. In the lenient SC stress with lower SC energy (e.g. SC stress @ VGS=6 V, VDD=40-70 V, TSC=10 μs), the devices exhibit significantly positive Vth shift while the Vth instability shows positive dependence with the stressed drain voltage and the repetitive SC pulses. For device stressed at VDD=70 V with 150 SC pulses, a substantial ΔVth as high as +0.68 V is observed. Such a prominent Vth instability is induced by the electron trapping in the p-GaN gate region during the SC events, which also results in the suppressed gate and drain leakage current after SC stress. In the more stringent SC stress (VGS=6 V, VDD=70 V, TSC=20 μs) with much higher corresponding SC energy, the device failed due to the drain electrode burned out initiated by the significantly high SC energy during the SC events.

Biologic Pathways For Chronic Spontaneous Urticaria And Their Regulation By Benralizumab

HbA1c enzymatic method has been considered as a popular method for determination of blood glucose. In this study, the methods for decreasing the formation of Fructosyl Peptide Oxidase (FPOX) inclusion bodies in E. coli and secretion of the enzyme into periplasmic space using PelB signal peptide were investigated. Recombinant FPOX was mainly expressed as inclusion bodies. The inclusion bodies of FPOX were only soluble in urea 8 M, while was not soluble in any of used concentrations of DMSO solvent. By freeze-thawing method, the inclusion bodies was soluble in urea 8 M, but was not soluble in urea 0.5 M. By using the stabilizers on solubility of rFPOX we found that the effect of sorbitol was higher than arginine. The rFPOX was successfully secreted in the periplasmic space using PelB signal peptide that shown the amount of periplasmic protein in shuffle was higher than of BL21. For rFPOX activity, TMB was used as coloring agent for the first time in HbA1c enzymatic method as peroxidase substrate. In conclusion, FPOX inclusion bodies are heterogenous in size and can be decreased using signal peptide. The Freeze-thawing method can be used to solubilize FPOX inclusion bodies at lower concentrations of urea.

A 61-year-old woman with a low thromboembolic risk was scheduled to undergo pulmonary vein isolation (PVI) for paroxysmal atrial fibrillation. Transthoracic echocardiography showed no cardiac structural abnormality. Intracardiac echocardiography (ICE) identified a small left atrium mass attached to the atrial septum and the procedure was stopped before the transseptal puncture; the surgically resected tumor was cardiac myxoma. ICE is a reliable imaging modality to exclude left atrial thrombus. However, unusual and unexpected cardiac structures also prevent performing PVI, which pre-procedural transesophageal echocardiography could identify. Imaging options should be further discussed to improve patient care and safety.