In a conventional furniture design process, the designer develops a number of design alternatives by drawing two dimensional sketches and 3d CAD models to start ideation and exploration. These ways of exploration and conceptualization are sometimes tiring, time taking and complex. Therefore, the designer is able to produce less output with limited results. However, with recent advancements in design simulation, visualization and modelling capabilities, the ways of design exploration and conceptualization have changed. Technological transformations have changed the entire product design and development process in the past years. Today, parametric modeling techniques are changing the role of CAD tools in the furniture design field. In comparison to the conventional CAD tools (direct drafting and modeling techniques) parametric and generative design techniques allow the designer to rapidly and easily generate iterations, providing a flexible way to explore and conceptualize innovative solutions based on specific parameters. Considering the growing transformations this research aims to explore the new language of design - generative design. The study focuses on to integrate generative design and parametric modeling techniques with conventional design process to develop a digital design and development methodology for furniture products.

A 40-year-old man with a chronic kidney disease on dialysis and with a history of several previous tunneled central venous catheters placements with recurrent infections. The CT showed a fistula between the superior vena cava and the right pulmonary artery. We occluded the fistula applying an Amplatzer® Vascular Plug II.

Sacrohysteropexy is a surgical technique employed for the surgical treatment of uterine prolapse when uterine preservation is desired. Vesicouterine fistulae are rare iatrogenic complications of difficult operative childbirth, typically via caesarean section. If further childbearing is planned, uterus-sparing fistula closure in layers, with interposition grafts, has been described. To further decrease recurrence rates, temporary suspension of the uterus away from the fistula site can be achieved via sacrohysteropexy with absorbable biologic graft. The graft eventually resorbs with return of the uterus to its normal pelvic anatomic location.

Objective To evaluate the benefit of performing anorectal studies on all women following primary Obstetric Anal Sphincter Injury (OASI) repair over performing them on symptomatic women only. Design Retrospective observational study. Setting Tertiary maternity unit in the U.K. Population or sample All women followed up in the perineal clinic over 13 years were included. Methods Women who attended perineal clinic between 2007 and 2020 underwent symptom assessment and anorectal studies at 6 weeks and 6 months post-partum. Anorectal studies including endo anal ultrasound (EAUS) and anal manometry (AM) were performed. The anorectal studies of symptomatic women who were the case group, were compared with asymptomatic women who were the control group. Main outcome Results 1,348 women were seen in the perineal clinic over 13 years. 454 (33.7%) women were symptomatic. 894 (66.3%) women were asymptomatic. 313 (35%) asymptomatic women had two abnormal anorectal studies, 274 (31%) had abnormal AM alone and 86 (9.6%) had abnormal EAUS alone. 221 (24.7%) asymptomatic women had normal anorectal studies. Conclusion Almost 70% of women were asymptomatic 6 months following primary OASI repair. Most had at least one abnormal anorectal study result. Selectively performing anorectal tests on symptomatic women would not identify asymptomatic women at risk of future faecal incontinence (FI) following further vaginal birth. Without anorectal study results, women would not receive accurate counselling about the risks of vaginal birth. Anorectal studies should be offered to all women following OASI where resources allow.

Introduction:Malware detection is one of the leading security issues in Network Security paradigm. There exist different malware families. All of the families of malware are even not completely discovered[1]. In case of an unknown malware family of attack detection is various challenging tasks. In the current trend of malware detection used some data mining technique such as classification and clustering. The process of classification improves the process of detection of malware.The chains are cryptographically auditable as they rely on Merkle root value and order-execute architecture in which blockchain network orders the transactions first using a consensus protocol and then executes them in the listed order in allPeer nodes in a sequential manner. The hash in any i th block is computed as Hi =f(inputi, IDi,Timestamp, Hi-1)whereinputi istheinputdocument,IDi is the digital identifier associated with the document, Timestamp is the current timestamp value, and Hi and Hi-1 are the hashes of current and previous blocks, respectively.Section 3 provides the technological aspects of integration of blockchain in MEC and designing of mining as a service (MaaS) in MEC architecture.

Objective: To assess the outcome of pregnancy after appendectomy, the mode of surgery used, appendectomy rates and complications. Design: A prospective cohort study of pregnant women undergoing appendectomy. Setting: All appendectomies at South Stockholm General Hospital, December 2015 to February 2021. Population: Pregnant women undergoing appendectomy. Methods: Data on preoperative imaging, surgical method, intraoperative findings, microscopic findings, hospital stay, pregnancy, and 30-day complications were prospectively recorded in a local appendectomy register. Results: During the study period, 50 pregnant women underwent appendectomy of 38 199 women giving birth. During the same period 793 non-pregnant women underwent appendectomy and served as controls. No differences in preterm delivery (4.5% vs. 5.6%), small-for-gestational age (2.3% vs. 6.2%), or mode of delivery (cesarean delivery 18.2% vs. 20.4%) were observed between pregnant women with or without appendectomy. There were no cases of perforated appendix in the second half of pregnancy. However, women with gestational age > 20 weeks more frequently had an innocent appendix compared to those operated < 20 gestational weeks (4/11 vs. 2/39, p = 0.005). Laparoscopic surgery was used in 92% of appendectomies < 20 weeks gestation. The appendectomy rate was three times lower during the second half of pregnancy. Conclusion: Appendicitis in pregnancy is not a threat as long as surgery is conducted as soon as possible. Although a low threshold for surgery may increase the risk of finding an innocent appendix, this is outweighed by the lower risk for perforation and serious adverse events such as fetal loss or preterm delivery.

Introduction: For the diagnosis of airway anomalies, bronchoscopy is the gold standard. Infant pulmonary function testing is an emerging modality to assess airways and its utility in diagnosis and monitoring is unexplored in clinical studies. Objectives: To evaluate infant Pulmonary Function Test [Tidal Breathing Flow Volume Loop (TBFVL)] in children with airway anomalies and to correlate with bronchoscopy findings. Methods: We performed a prospective cohort study from July 2018 to April 2020 in children from 0-2 years with physician suspected airway anomalies. We performed TBFVL (graphic pattern and parameters) and bronchoscopy in these children and correlated the results. The primary outcome measure was a graphic pattern of TBFVL in children with laryngomalacia. Secondary outcome measures were bronchoscopy diagnosis of various airway anomalies, graphic pattern in children with airway anomalies other than laryngomalacia, measurement of TBFVL parameters and measurement of change in TBFVL graphic patterns and parameters at six months follow up. We compared TBFVL parameters with controls without airway anomalies. Results: We enrolled 53 children with both Infant Pulmonary Function Tests and bronchoscopy data. Isolated laryngomalacia (28, 52.8%) was the most common airway anomaly, followed by laryngo-tracheomalacia (7, 13.2%), laryngo-tracheo-bronchomalacia (6, 11.3%), and laryngomalacia with subglottic stenosis (4, 7.5%). Among isolated laryngomalacia, pattern 3 (fluttering of inspiratory limb) was most common in TBFVL, followed by pattern 4 (fluttering of inspiratory limb and flattening of expiratory limb) in 13 (46.4) and 8 (28.6%) cases, respectively. There was no strikingly predominant pattern in other groups of bronchoscopy diagnoses. Among TBFVL parameters, the ratio of Ti/Te was significantly high in children with isolated laryngomalacia compared to controls. Compared to controls, the tPTEF/tE was significantly higher in laryngomalacia plus sub-glottic stenosis. At six months of follow-up, clinical symptoms improved significantly, TBFVL pattern 1 (normal) became the most common pattern, and expiratory time increased significantly among TBFVL parameters. Conclusion: A particular type of airway anomaly may have a characteristic graphic pattern in TBFVL. Further, the TBFVL pattern may indicate improvement in the follow-up either spontaneously or after an intervention.

Introduction: Children with a history of bronchopulmonary dysplasia (BPD) may have lower physical activity levels, but evidence to date is based on self-report. This study compared physical activity levels between children born extremely preterm with and without history of BPD, and examined their associations with pulmonary magnetic resonance imaging (MRI) and pulmonary function test (PFT) indices. Methods: This multi-centre cross-sectional study included children aged 7-9 years born extremely preterm, with and without BPD. Children wore a pedometer for one week, then completed the Physical Activity Questionnaire (PAQ), pulmonary MRI, and PFT. Spearman correlations and multivariable linear regression modelling were performed. Results: Of 45 children, 28 had a history of moderate-severe BPD. There were no differences in any physical activity outcomes by BPD status. Higher average daily step count and higher average daily moderate-vigorous physical activity (MVPA) were each correlated with greater forced vital capacity (r=0.41 and 0.58), greater MRI lung proton density at full expiration (r=0.42 and 0.49), and lower lung clearance index (r=-0.50 and -0.41). After adjusting for MRI total proton density and BPD status, a 5% increase in forced expiratory volume at one second was associated with 738 (95%CI: 208, 1268) more steps per day and 0.1 (0.0, 0.2) more hours of MVPA, respectively. Conclusion: School-aged children born extremely preterm have similar physical activity levels to their peers, regardless of history of BPD. MRI and PFT measures suggestive of gas trapping and/or airflow obstruction are associated with lower physical activity levels.

More than 120 million mice and rats are used yearly for scientific purposes. While tracking their motion behaviors has been an essential issue for the past decade, present techniques, such as video-tracking and IMU-tracking have considerable problems, including requiring a complex setup or relatively large IMU modules that cause stress to the animals. Here, we introduce a wireless IoT motion sensor (i.e., weighing only 2 grams) that can be attached and carried by mice to collect motion data continuously for several days. We also introduce a combined segmentation method and an imbalanced learning process that are critical for enabling the recognition of common but random mouse behaviors (i.e., resting, walking, rearing, digging, eating, grooming, drinking water, and scratching) in cages with a macro-recall of 94.55%. Corresponding author(s) Email:  _ hoychan@cityu.edu.hk; xinyueli@cityu.edu.hk; wenjli@cityu.edu.hk  _

Degenerative mitral valve disease is the most common cause for mitral valve surgery in the United States and Europe. Most commonly, a prolapse of the P2 segment of the mitral valve leaflet leads to an impairment of valve coaptation classified as Carpentier Type II. Here we want to present a rare case of an isolated P1 prolapse, which was successfully repaired in a 53-year old female patient.

This report describes a case of aseptic meningitis suspected of having positive ocular globe compression sign in a 33-year-old man who was diagnosed only after repeated lumbar puncture. We highlight the importance of repeat lumbar puncture and the clinical value of ocular globe compression sign in suspecting aseptic meningitis.

Objective: To evaluate the behavior of the viruses responsible for acute respiratory infections before (2016-2019) and after (2020-2021) the start of the circulation of the SARS-CoV-2 virus in pediatric patients treated at a reference center from Barranquilla, Colombia. Materials and methods: An observational descriptive study was carried out, data were obtained reviewing the influenza-like illness and severe acute respiratory infection database in the pediatric population of the sentinel surveillance reference center in the district of Barranquilla during the years 2016 - 2021, applying inclusion and exclusion criteria. Results: During 2016-2019, the average age of individuals was 1.3 (±1.7) years, during 2021 it was 2.3 (±3.5) years. The distribution by sex was similar, predominantly male. August and February were the months with the highest record of symptoms for 2016-2019 and 2021, respectively, the most frequent being cough, fever, shortness of breath, and diarrhea. By 2021 there was higher use of antibiotics and antivirals reported than in 2016-2019. Most patients tested negative for viral detection. When comparing the percentage of viruses detected by age group and years of detection, positivity was lower in 2021 by every age group, and respiratory Syncytial Virus (RSV) was the most frequently detected. Conclusions: There was less virus positivity in viral detection tests in the pediatric population during 2021. RSV persists as the main etiology affecting this population, especially infants. The use of antibiotic therapy in viral infections continues to be a problematic practice in their management. Sentinel surveillance can be strengthened throughout the country.

Background: Infants with Bronchopulmonary Dysplasia (BPD) are often prescribed diuretics before the neonatal intensive care unit (NICU) discharge. It is unknown whether outpatient medication weaning strategies affect duration of home oxygen therapy. Methods: This was a secondary cohort analysis of infants born <32 weeks gestational age with BPD from 2015-2018 discharged from our NICU or regional NICUs, referred to our pulmonary clinic for home oxygen management. We compared three groups: those discharged with no diuretics, diuretics actively weaned (dose decreased) and diuretics passively weaned (dose not adjusted). Results: Out of 125 infants, 116 were included in the analysis. Forty-five infants were discharged without diuretics; 52 infants were discharged with diuretics that were actively weaned; 19 infants were discharged with diuretics that were passively weaned. Infants who were passively weaned spent the most time on home oxygen (median 28 weeks, IQR 16-52; p=0.011); there were no differences in home oxygen duration in infants actively weaned (median 13 weeks, IQR 10-26) versus not on diuretics (median 22 weeks, IQR 12-30, p=0.285). Multivariable adjustment for other illness characteristics associated with duration of home oxygen did not change this finding. Conclusions: Active weaning of diuretics did not prolong duration of home oxygen, in the setting of a standardized clinical guideline for weaning home oxygen in infants with BPD. These data can serve as baseline information to implement and test standardized strategies for outpatient medication management.

Allergic sensitization without detectable specific serum IgE

Understanding population change across long time scales and at fine spatiotemporal resolutions is important for confronting a broad suite of conservation challenges. However, this task is hampered by a lack of quality long-term census data for multiple species collected across large geographic regions. Here, we used century-long (1919-2018) data from the Audubon Christmas Bird Count (CBC) survey to assess population changes in over 300 avian species in North America and evaluate their temporal non-stationarity. To estimate population sizes across the entire century, we employed a Bayesian hierarchical model that accounts for species detection probabilities, variable sampling effort, and missing data. We evaluated population trends using generalized additive models (GAMs) and assessed temporal non-stationarity in the rate of population change by extracting the first derivatives from the fitted GAM functions. We then summarized the population dynamics across species, space, and time using a non-parametric clustering algorithm that categorized individual population trends into four distinct trend clusters. We found that species varied widely in their population trajectories, with over 90% of species showing a considerable degree of spatial and/or temporal non-stationarity, and many showing strong shifts in the direction and magnitude of population trends throughout the past century. Species were roughly equally distributed across the four clusters of population trajectories, though grassland, forest, and desert specialists more commonly showed declining trends. Interestingly, for many species, region-wide population trends often differed from those observed at individual sites, suggesting that conservation decisions need to be tailored to fine spatial scales. Together, our results highlight the importance of considering spatial and temporal non-stationarity when assessing long-term population changes. More generally, we demonstrate the promise of novel statistical techniques for improving the utility and extending the temporal scope of existing citizen science datasets.

Let u, v be the analytic functions on the open unit disk D in the complex plane, \varphi the analytic self-map of D and m a nonnegative integer, n a positive integer that is greater than m. We consider the generalized Stevi\’{c}-Sharma type operator T_{u,v,\varphi}^{m,n}f(z)=u(z)f^{(m)}(\varphi(z))+v(z)f^{(n)}(\varphi(z)) acting from the derivative Hardy spaces into Zygmund-type spaces, and investigate its boundedness, essential norm and compactness in this paper.

We construct a sequence of linear positive operators by means of the Erkus- Srivastava multivariable polynomials which include q- Lagrange polynomial operators discussed in [5] and the Lagrange Hermite polynomial operators considered in [1]. We study the Korovkin type theorems for the constructed operators by using summability techniques of statistical convergence and the power series method. We also define a k-th order Taylor generalization of the multivariable polynomials operator and investigate the approximation of k-th times continuously differentiable Lipschitz class elements.

Atractylodes lancea is a perennial herb containing multiple medicinal ingredients that is currently at risk due to habitat shortages and improper planting. Its cropping method makes Atractylodes lancea affected by allelopathy, due to lack of ventilation. Endophytic bacteria have been reported to be able to increase the growth of hosts in many species. To promote the yield of Atractylodes lancea cropping and explore whether intraspecific allelopathy could be relieved by endophytic bacteria, we designed an airborne signal exchange system and found that ethylene produced by neighboring plants is a chemical agent that decreases the root length and dry weight of nearby Atractylodes lancea, also decreasing the essential oil content at the same time. Our results showed the endophytic bacterium Pseudomonas fluorescens (ALEB7B) was able to suppress the airborne signal of allelopathy by decreasing ethylene emissions. Unlike cases where pathogen or herbivore enhances plant-plant interactions in which decrease the growth of nearby plants, treatment with ALEB7B improves the growth of nearby plants and increases essential oil production of neighbors. These results were further confirmed by transcriptome analysis in pot experiments. Our result revealed that ethylene emitted by Atractylodes lancea has an intraspecific allelopathic effect that can be relieved by the endophytic bacterium Pseudomonas fluorescens by decreasing ethylene emission. This study discovered a new mode how endophytic bacterium promote the growth and essential accumulation.

The iliac vein is an extremely rare site of metastasis for extraskeletal mesenchymal chondrosarcoma (ESMC). Involvement of the veins usually leads to an extremely dismal prognosis.

Compelling evidence for natural selection comes from studying similar adaptations that have evolved in multiple independently colonized populations from shared ancestral variation (parallel evolution). However, finding genomic regions associated with fitness remains challenging due to inadequate control of false positive rates and overly conservative corrections for multiple testing. Using simulations parameterized on empirical data derived from the nine- and three-spined sticklebacks, four approaches to detect genomic regions associated with parallel evolution are compared in high-density genome-wide SNP data; linear mixed model (EMMAX), latent factor mixed model (LFMM), redundancy analysis (RDA) and BayPass. RDA and BayPass were the most conservative followed by EMMAX, and while LFMM was the most powerful, it was also the most prone to false positives, particularly at high levels of background genetic differentiation and low levels of parallelism. Because some methods were sensitive to similar biases, false positives were often shared between them. Using linkage disequilibrium (LD) network-based complexity reduction in combination with EMMAX, the cost of multiple corrections was greatly reduced increasing the power to detect signatures of natural selection relative to single locus- or window-based approaches, with well controlled false positive rates. This approach can further improve our ability to distinguish false positives caused by population demographic history (genome wide effects) from those affected by non-neutral evolutionary processes that affect LD-patterns locally. The outlined approach improves our ability to identify genomic targets of natural selection and pave the path towards better understanding adaptive evolution in the wild.

Background and Purpose: Drug repositioning is a promising strategy that can be applied to treating pulmonary hypertension, especially in the early stages of the disease. In this study, we aimed to evaluate the synergism between metformin and sildenafil in an experimental model of pulmonary hypertension. Experimental approach: A model of pulmonary hypertension induced by a low dose of monocrotaline (30 mg/kg) was implemented in Wistar rats, and three treatment schemes were compared: metformin (100 mg/kg/day), sildenafil (30 mg/kg/day) and combined therapy of metformin and sildenafil. Right ventricular ejection fraction and pulmonary artery acceleration were estimated by echocardiography, right ventricular hypertrophy was measured with the Fulton index, and hemodynamic changes were obtained by right heart catheterization. Hematoxylin Eosin and Masson’s Trichrome stains evaluated vascular wall thickness and pulmonary fibrosis. With immunohistochemistry were evaluated muscularization (Anti-SMA), adhesion of endothelial cells (CD31) and Proliferation (Ki67). In addition, the toxicity of the model was evaluated with liver and kidney tests. Key Results: The therapeutic regimens reduced cardiac remodeling, the addition of metformin to sildenafil treatment was superior to monotherapy, considerably reducing muscularization and proliferation, reaching normal levels. No differences were found in liver protein and enzyme levels between the groups. Conclusion and Implications: Metformin combined with sildenafil was superior to monotherapy in reducing cell proliferation and muscularization of the pulmonary arterioles. Metformin therapy shows promise as an adjunct to standard sildenafil therapy; This research supports proofs of concept in humans and proposes this drug as a repositioning strategy in pulmonary arterial hypertension.

Background: By December 2021, administration of the third dose of COVID-19 vaccinations coincided with the spread of the Omicron variant in Europe. Questions had been raised on protection against infection conferred by previous vaccination and/or infection. Method: Our study population (n = 252,433) included all those in the COVID-19 vaccination registry in Malta who were vaccinated with only 2 doses equivalent by 15th December 2021, and not vaccinated with an additional dose by 8th March 2022, and alive by 8th March 2022. Data were then matched with the national testing database (all RT-PCR/Rapid Diagnostic Tests - RDT tests) until 8th March. We collected vaccination status, vaccine brand, vaccination date, infection history, and age. Using logistic regression, we examined different combinations of vaccine dose, prior infection status and time, and the odds of infection during the Omicron period (December 15th, 2021 onwards). Results: Results found that participants infected with Sars-Cov-2 prior to the Omicron wave had a significantly lower odds of being infected with the Omicron variant. Additionally, the more recent the infection and the more recent the vaccination, the lower the odds of infection. Receiving a third dose within 20 weeks of the start of the Omicron wave in Malta offered similar odds of infection as receiving a second dose within the same period. Conclusion: Time since vaccination is a strong determinant factor against infection, as was previous infection status and the number of doses taken. This finding reinforces the importance of future booster dose provision especially to vulnerable populations.

Background: The introduction of the frozen elephant trunk (FET) technique for total arch replacement (TAR) has revolutionized the field of aortovascular surgery. However, although FET yields excellent results, the risk of certain complications requiring secondary intervention remains present, negating its one-step hybrid advantage over conventional techniques. This systematic review and meta-analysis sought to evaluate controversies regarding the incidence of FET-related complications, with a focus on aortic remodeling, distal stent-graft induced new entry (dSINE) and endoleak, in patients with type A aortic dissection (TAAD) and/or thoracic aortic aneurysm. Materials and methods: A comprehensive literature search was conducted using multiple electronic databases including EMBASE, Scopus, and PubMed/MEDLINE to identify evidence on TAR with FET in patients with TAAD and/or aneurysm. Studies published up until January 2022 were included, and after applying exclusion criteria, a total of 43 studies were extracted. Results: A total of 5068 patients who underwent FET procedure were included. The pooled estimates of dSINE and endoleak were 2% (95% CI 0.01-0.06, I 2 = 78%) and 3% (95% CI 0.01-0.11, I 2 = 89%), respectively. The pooled rate of secondary thoracic endovascular aortic repair (TEVAR) post-FET was 7% (95% CI 0.05-0.12, I 2 = 89%) whilst the pooled rate of false lumen thrombosis at the level of stent-graft was 91% (95% CI 0.75-0.97, I 2 = 92%). After subgroup analysis, heterogeneity for dSINE and endoleak resolved among European patients, where Thoraflex Hybrid and E-Vita stent-grafts were used (both I 2 = 0%). In addition, heterogeneity for secondary TEVAR after FET resolved among Asians receiving Cronus (I 2 = 15.1%) and Frozenix stent -grafts (I 2 = 1%). Conclusion: Our results showed that the FET procedure in patients with TAAD and/or aneurysm is associated with excellent results, with a particularly low incidence of dSINE and endoleak as well as highly favorable aortic remodeling. However the type of stent-graft and the study location were sources of heterogeneity, emphasizing the need for multicenter studies directly comparing FET grafts. Finally, Thoraflex Hybrid can be considered the primary FET device choice due to its superior results.

The final version of this article is published at Molecular Genetics and Genomics, and is available online at https://doi.org/10.1007/s00438-023-02010-8.