A 23-year-old woman followed for adult-onset Still’s disease (AOSD) presented fever and chest pain. Clinical examination showed erythematous papules suggestive of flagellate dermatoses. Laboratory findings showed increased Cardiac troponin. Myocarditis due to AOSD was therefore suspected. The patient was treated with prednisone and methotrexate with significant clinical improvement.

Introduction: Acute bronchiolitis (AB) is the main cause of hospitalization in children under two years of age, with a regular seasonality, mostly due to the respiratory syncytial virus (RSV).Objectives: To describe the epidemiology of bronchiolitis hospitalizations in our centre in the last twelve years, and analyse the changes in clinical characteristics, microbiology, and adverse outcomes during the SARS-CoV2 pandemic.Methods: Observational study including patients admitted for bronchiolitis between April 2010 and December 2021 in a Spanish tertiary paediatric hospital. Relevant demographic, clinical, microbiological, and adverse outcome variables were collected in an anonymized database. The pandemic period (April 2020 to December 2021) was compared to 2010-2015 seasons using appropriate statistical tests.Results: There were 2138 bronchiolitis admissions, with a mean of 195.6 per year between 2010-2019 and a 2–4-month peak between November and March. In the expected season of 2020, there was a 94.4% reduction of bronchiolitis hospitalizations, with only eleven cases admitted in the first year of the pandemic. Bronchiolitis cases increased from the summer of 2021 during a six-month long peak, reaching a total of 171 cases. Length of stay was significantly shorter during the pandemic, but no differences were found in clinical and microbiological characteristics or other adverse outcomes.Conclusions: The SARS-CoV2 pandemic has modified the seasonality of bronchiolitis hospitalizations, with a dramatic decrease in cases during the expected season of 2020-2021, and an extemporaneous summer-autumn peak in 2021 with longer duration but similar patient characteristics and risk factors.

Respiratory syncytial virus (RSV) causes annual epidemics of acute respiratory disease in large part because antibody levels fall rapidly after infection. RSV is able to infect cultured dendritic cells (DCs) and persist in these cells. Given the importance of DCs in antigen presentation, RSV infection and persistence is likely to be an evolutionary adaptation that can subvert the host immune response. This study aimed to demonstrate infection and persistence of RSV in lung DCs using an in vivo model of RSV infection. Mice were infected with a modified strain of RSV which expresses a red fluorescent protein (RSV-RFP) when replicating. Clinical symptoms of infection were monitored using weight change and inflammatory cell counts from bronchoalveolar lavage, which were correlated to RSV viral titre (quantitative PCR). Lung tissues were collected at 3, 5, 7 and 21 days post-infection (dpi) to assess leukocyte populations by flow cytometry. Clinical symptoms and RSV viral load peaked at 5 dpi. RSV-RFP was most prevalent in macrophages at 3 dpi and observed in B cells and DCs. At 21 dpi, RSV-RFP remained evident in a subset of conventional DCs (CD103 +CD11b +) even though clinical symptoms and pulmonary inflammation had resolved. This data indicates that RSV infects, replicates in and persists in a sub-population of lung cDCs after resolution of symptoms and clearance of virus from the airways. Understanding the implications of this adaptation is likely to provide crucial insights into the virus’s ability to generate annual epidemics of respiratory disease.

Data from UNICEF on the percentage of pneumonia careseekers were subjected under descriptive and inferential statistical analysis to compare the percentage of pneumonia careseekers in rural and urban areas in developing countries. Prior to the two sample t-test, the data was first subjected to Levene’s test and found that equal variances cannot be assumed so Welch’s test was done. We reject the null hypothesis because the two areas, rural and urban, have a statistically significant difference in sample means, with t= -6.8227 and p = 0.00003858092. A comparison of the individual t-scores of careseekers in urban and rural areas worldwide reveals that more treatment was sought in urban areas compared to rural areas as the years progress. The data was also subjected to linear regression test and it was found that linear relationship exists between rural careseekers and time (p=0.001636), while there is no linear relationship between urban careseekers and time (p=0.07574). Linear relationship is also observed between rural and urban careseekers combined and the year (p=0.02349).

This case illustrates another promising example of the recent advances within pediatric interventional bronchoscopy. As innovative medical therapies continue to make their way into the pediatric realm (e.g. a 1.1-mm flexible cryoprobe has been recently developed by Erbe), opportunities for novel approaches and techniques will continue to present themselves.

Changes in the thermal structure of lake ecosystems have been documented as a precursor of climate change, but the dynamics of biomass distribution, which fundamentally determines species conservation, have been less studied. An interdisciplinary approach was used to demonstrate the influence of climate-driven changes on the biomass distribution of two species (Gymnogobius isaza and Palaemon paucidens) in Lake Biwa. In field surveys in 2016–2017 (full water circulation) and 2019 (partial water circulation), environmental DNA concentrations of these species were used as proxies for biomass to measure 43 and 47 sites sampled at the lake bottom, respectively. A structural equation model was used to estimate the correlation between species biomass and environmental parameters. The species-environment relationship was applied to species biomass distributions under existing and future environments calculated by the model. Differences between the species were found in their responses to climate change. The biomass distribution of G. isaza will benefit in the future if full water circulation occurs, although it appears to be independent of water circulation at present. Partial water circulation enlarges the distribution area of P. paucidens, but its biomass will be low in the future, regardless of the extent of water circulation. These findings advance the knowledge of how species respond to climate change and suggest special attention should be given to species such as P. paucidens, which is currently abundant but sensitive to climate change. Furthermore, they emphasize the potential application of interdisciplinary methodologies for improved species conservation.

We provide a generalization of Beurling's theorem for the Clifford- Fourier transform and we give some of its applications. Indeed, analogues of Hardy, Cowling-Price and Gelfand-Shilov theorems are obtained in the Clifford analysis setting.

The current research numerically investigates the Marangoni convection in a cylindrical annulus filled with hybrid nanofluid saturated porous media. The interior and exterior walls are subjected to spatially varying sinusoidal thermal distributions with various amplitude ratios and phase deviations. The limits at the top and bottom are adiabatic. To solve the system of non-dimensional governing equations, the finite difference approach is applied. The major goal of the ongoing study is to investigate the impact of the Marangoni convection, amplitude ratio and phase deviation on the fluid flow, thermal characteristics, local and average Nusselt numbers in the hybrid nanofluid filled vertical cylindrical annulus with magnetic effects. The findings indicate that the sinusoidal temperature promotes multicellular flow in the porous annular region. In the annulus with sinusoidal boundaries, the Marangoni number underperforms while the nanoparticle volume fraction outperforms.

In this article, we study the quasilinear Schr\”{o}dinger equation \begin{eqnarray*} \begin{array}{ll} \triangle{u}+V(x)u-\triangle(u^2)u=g(x,u), \ x\in\mathbb{R}^N, \end{array} \end{eqnarray*} where the potential $V(x)$ and the primitive of $g(x,u)$ is allowed to be sign-changing. Under more general superlinear conditions on $g$, we obtain the existence of infinitely many nontrivial solutions by using Mountain Pass Theorem. Recent results in the literature are significantly improved.

Abstract Background. Still now, COVID-19 is a public health concern in both developed and developing countries. Risk perception has been studied in different countries with different population groups. However, there have been few studies conducted risk perception on elderly people and there is no study on elderly people’ in Ethiopia including this study area.This study aimed to assess coronavirus disease low risk perception level and associated factors among the elderly. Methods. To carry out this study among elders in Areka town from 01 August 2021 to 30 August 2021, a community-based cross-sectional study was used. Multi-stage sampling method was applied to select study participants. The data were collected through a structured questionnaire with the mobile application of Open Data Kit mobile(ODK). Results. This study showed that individuals with age range of 65 to 74 [AOR= 4.76, 95% CI (2.35-9.64)], poor practice on preventing coronavirus disease [AOR= 2.39, 95% CI (1.51-3.78), low trust level in medical professionals [AOR=2.44, 95%CI (1.45-4.10)], no history of coronavirus disease [AOR=6.45, 95%CI (2.02-20.58)], poor perceived self-efficacy for preventive practice [AOR=2.25, 95% CI (1.43-3.54)] were identified as associated factors of low risk perception. Conclusions. In the current study area, the perception of risk of coronavirus disease was affected by age, perceived self-efficacy, trust in medical professionals, preventive practice, and history of coronavirus disease. Including Ethiopia, the findings of this study would help for developing countries to generate evidence-based policy decisions for elderly people during COVI-D-19 pandemic and future pandemic(s). Keywords: Associated factors, Coronavirus, Elderly, Ethiopia, Perception

The rheological properties of emulsions gradually change to non-Newtonian fluid characteristics as the dispersed phase volume fraction increase. In premix membrane emulsification, a microporous membrane is used to prepare emulsions at higher production rates and higher volume fractions. The droplet size and droplet size distribution (span) can be precisely controlled, thus easier to study the rheological properties of emulsions. The influence of volume fraction, dispersed phase viscosity, and surfactant concentration were investigated. When the droplet size and span were controlled in a narrow range, the emulsion viscosity increased with dispersed phase viscosity due to energy loss to friction as the droplets become more rigid and less deformable, while the surfactant concentration had no significant influence on the emulsion rheology showing that surfactants mainly affect emulsion rheology through reduction of droplet size.

This work develops a model predictive control (MPC) scheme using online learning of recurrent neural network (RNN) models for nonlinear systems switched between multiple operating regions following a prescribed switching schedule. Specifically, an RNN model is initially developed offline to model process dynamics using the historical operational data collected in a small region around a certain steady-state. After the system is switched to another operating region under a Lyapunov-based MPC with suitable constraints to ensure satisfaction of the prescribed switching schedule policy, RNN models are updated using real-time process data to improve closed-loop performance. A generalization error bound is derived for the updated RNN models using the notion of regret, and closed-loop stability results are established for the switched nonlinear system under RNN-based MPC. Finally, a chemical process example with the operation schedule that requires switching between two steady-states is used to demonstrate the effectiveness of the proposed RNN-MPC scheme.

Cervical vagal schwannoma is a rare clinical entity which requires different clinical approach than other neck swellings. Magnetic resonance Imaging is the preferred initial diagnostic test. Complications may arise due to vagal stimulation in unsuspecting open biopsies. Surgical excision with perioperative vagal monitoring is recommended for treatment of vagal schwannomas.

Global changes in diets and frequent natural disasters have induced food production fluctuations, posing challenges to food security. The importance of blue food is attracting unprecedented attention, but research on its role in connection with terrestrial food and its mechanism is currently not available, especially there are significant challenges in how to carry out systematic food research on land and sea integration. Human demand for marine blue food affects cropland ecosystem through the food system and drives changes in its function and causes the loss of food security, while the interactions between land-sea food system and the response of cropland ecosystem resilience to terrestrial and marine food production have not been systematically studied. This study assesses the resilience of cropland ecosystem in coastal China based on early warning signal indicators calculated from net primary productivity (NPP), and analyzes the situation of shocks to production in the land-sea food sector to reveal the impact of green-blue food production on the resilience of cropland ecosystem. The results demonstrate that the marine food fluctuation had a significant impact on the resilience of cropland ecosystem in coastal China. Fujian and Guangdong provinces of China observed a significant decrease in cropland ecosystem resilience, with τ values of 0.27 and 0.07, respectively; the coefficient of variation of seafood production per capita as an essential influence on NPP resilience, with a contribution of 19.53%. The decoupling of blue food from green food in regions of increased cropland NPP resilience contributes to the land-sea food sector mutual complement through stable yields, and buffers the effects of food shocks on the resilience of cropland ecosystem. This study provides new perspectives on coordinating the balance between sustainable development of cropland ecosystem and human well-being.

Context Intraspecific variability (IV) has been proposed to explain species coexistence in diverse communities. Assuming, sometimes implicitly, that conspecific individuals can perform differently in the same environment and that IV blurs species differences, previous studies have found contrasting results regarding the effect of IV on species coexistence. Objective We aim at showing that the larg IV observed in data does not mean that conspecific individuals are necessarily different in their response to the environment and that the role of high-dimensional environmental variation in determining IV has been largely underestimated in forest plant communities. Methods and Results We first used a simulation experiment where an individual attribute is derived from a high-dimensional model, representing “perfect knowledge” of individual response to the environment, to illustrate how a large observed IV can result from “imperfect knowledge” of the environment. Second, using growth data from clonal Eucalyptus plantations in Brazil, we estimated a major contribution of the environment in determining individual growth. Third, using tree growth data from long-term tropical forest inventories in French Guiana, Panama and India, we showed that tree growth in tropical forests is structured spatially and that despite a large observed IV at the population level, conspecific individuals perform more similarly locally than compared with heterospecific individuals. Synthesis As the number of environmental dimensions that are typically quantified is generally much lower than the actual number of environmental dimensions influencing individual attributes, a great part of observed IV might be misinterpreted as random variation across individuals when in fact it is environmentally-driven. This mis-representation has important consequences for inference about community dynamics. We emphasize that observed IV does not necessarily impact species coexistence per se but can reveal species response to high-dimensional environment, which is consistent with niche theory and the observation of the many differences between species in nature.

Abstract: Diet and trophic niche of Teratoscincus roborowskii was analyzed by pellets analysis technique. A total of 263 pellets of Teratoscincus roborowskii were collected from the Turpan Botanic Garden in Turpan City from July to Octobor, 2016, . Food composition and proportion of Teratoscincus roborowskii were identified by comparative analysis. The number of food components in the fecal samples was identified, and the numeric frequency, biomass ratio and frequency of occurrence of each component were counted and then the monthly Shannon-wiener diversity index, Shannon evenness index and diet niche width were analyzed. The results show that the Teratoscincus roborowskii mainly feed on insects and caper fruit in the Turpan Botanic Garden. Insects are the most common food for the Teratoscincus roborowskii, the frequency of occurrence which in each month is the largest; caper fruit was the most food intake in July and August, and that of insects is the most one on September and October. There are some differences in the composition of food in different months, which may be related to changes of food availability. The results of the feeding habit analysis show that the Teratoscincus roborowskii may play an active role in the dispersal of caper seed.

Morphology-based taxonomic research frequently applies linear morphometrics (LMM) in skulls to quantify species distinctions. The choice of which measurements to collect generally relies on the expertise of the investigators or a set of standard measurements, but this practice may ignore less obvious or common discriminatory characters. In addition, taxonomic analyses often ignore the potential for subgroups of an otherwise cohesive population to differ in shape purely due to size differences (or allometry). Geometric morphometrics (GMM) is more complicated as an acquisition technique, but can offer a more holistic characterization of shape and provides a rigorous toolkit for accounting for allometry. In this study, we used linear discriminant analysis to assess the discriminatory performance of four published LMM protocols and a 3D GMM dataset for three clades of antechinus known to differ subtly in shape. We assessed discrimination of raw data (which are frequently used by taxonomists); data with isometry removed; and data after allometric correction. We found that group discrimination among raw data was high for LMM, possibly inflated relative to GMM when visualised in PCA plots. However, GMM produced better results in group discrimination after the size and allometry treatments. High measurement redundancy in LMM protocols appears to result in relatively high allometry but low discriminatory performance. These findings suggest that taxonomic measurement protocols might benefit from GMM-based pilot studies, because this offers the option of differentiating allometric and non-allometric shape differences between species, which can then inform on the development of the easier-to-apply LMM protocols.

Investigations to niche evolution have received controversial results in recent times, leading to some confusions in ecological studies: competitive exclusion principle (CEP) predicts that closely related species should be adequately divergent; while niche conservatism (NC) predicts that closely related species should be ecologically most similar. In the present study, by using stable isotope to signify trophic niche, we analyzed niche divergences of 57 fishes from a lake (Poyang Lake, central China) at the phylogenetic scale, as well as niche divergences and overlaps of 7 fishes (same subfamliy) at 5 sites of this lake, and comprehensively investigated the concepts of NC and competitive exclusion principle (CEP). The results showed that, NC exists on a large scale (trophic differences showing positive relationships with genetic distances), but not at the local scale (sister species showing larger differences than closely related species, and almost no trophic overlap), where the CEP works better. Besides, trophic convergence was also found between some very distantly related species, leading to the possible limited divergence. We believe these findings will contribute to future theoretical and empirical niche explorations.

Introduction: Pneumopericardium is a dreaded complication in esophageal carcinoma. Case description: We report a case of a 62 year old patient with past history of esophageal cancer with spontaneus pneumopericardium, without hemodynamic compromise. Admission echocardiogram that revealed a pneumopericadium with the presence of the “swirling bubbles” and the “air gap” sign. A small esophagopericardial fistula was postulated as the cause of the pneumopericardium. He underwent esophageal stent placement with resolution of the pneumopericardium. Discussion: Pneumopericardium is usually a sign of marked clinical deterioration in neoplasia and leads to patients’ death few weeks. Here we presented a case, in which a more fortunate and unusual outcome happened.

Background and Purposes: Substantial evidence indicates trace amines can induce vasoconstriction independently of noradrenaline release. However, the mechanism underlying noradrenaline-independent vasoconstrictor responses to trace amines has not yet been established. This study evaluates the role of trace amine-associated receptor 1 (TAAR1) and other biogenic amine receptors in mediating trace amine-induced vasoconstriction. Experimental Approach: Vasoconstrictor responses to β-PEA and the TAAR1-selective agonist, RO5256390 were assessed in vitro in endothelium-denuded aortic rings and third-order mesenteric arteries of male Sprague Dawley rats. Key Results: β-PEA and RO5256390 induced concentration-dependent vasoconstriction of aortic rings but not third-order mesenteric arteries. Vasoconstrictor responses in aortic rings were insensitive to antagonists of 5-HT and dopamine. The murine-selective TAAR1 antagonist, EPPTB, had no effect on either β-PEA or RO5256390-induced vasoconstriction. The α1-adrenoceptor antagonist, prazosin, and the α2-adrenoceptor antagonist, yohimbine, induced a small but significant shift of the β-PEA concentration response curve that could not be ascribed to blockade of α1- or α2-adrenoceptors. Conclusion and Implications: Vasoconstrictor responses to trace amines are not mediated by classical biogenic amine neurotransmitter receptors. Although β-PEA vasoconstrictor responses were insensitive to ETTP, it has low affinity for rat TAAR1. Therefore, we propose that TAAR1 remains the most likely candidate receptor mediating vasoconstrictor responses to trace amines and that prazosin and yohimbine have some affinity for TAAR1.

Background: The SPPiRE cluster randomised controlled trial (RCT) found that a GP delivered medication review that incorporated screening potentially inappropriate prescriptions (PIP), a brown bag review and a patient priority assessment, resulted in a significant but small reduction in the number of medicines and no significant reduction in PIP. Objective: To explore the experiences of GPs and patients engaged in the SPPiRE intervention and the potential for system wide implementation.Design: Mixed methods process evaluation; quantitative data was collected from the SPPiRE intervention website and qualitative data via semi-structured interviews.Setting and participants: 51 general practices throughout Ireland, and 404 participants with multimorbidity aged ≥65 years, prescribed ≥15 medicines participated in the RCT. Qualitative data was collected with purposive samples of intervention GPs (18/26) and patients (27/208).   Methods: Quantitative data was analysed descriptively, qualitative data thematically and both were integrated using a triangulation protocol.Results: The analysis generated three themes, intervention implementation, mechanisms of action, and both were underpinned by the theme of context. One fifth of patients had no review, primarily due to insufficient GP time. The brown bag review component resulted in the most medication changes, particularly stopping a medicine. GPs felt it easier to change medicines if the patient was well known to them, and patients were generally receptive to change. GPs identified lack of integration into practice software systems and resources as barriers to future implementation.Conclusion: Consideration of implementation of successful interventions is key to informing policy and integration into clinical practice. GPs and patients viewed the intervention positively, but implementation will depend on resourcing and integration into practice software systems.Trial registration number: ISRCTN12752680

Triose-phosphate utilization (TPU) limits the maximum rate at which plants can photosynthesize. However, TPU is almost never found to be limiting photosynthesis under ambient conditions for plants. This, along with previous results showing adaptability of TPU at low temperature, suggest that TPU capacity is regulated to be just above the photosynthetic rate achievable under the prevailing conditions. A set of experiments were performed to study the adaptability of TPU capacity when plants are acclimated to elevated CO 2 concentrations. Plants held at 1500 ppm CO 2 were initially TPU limited. After 30 hours they no longer exhibited TPU limitations but they did not elevate their TPU capacity. Instead, the maximum rates of carboxylation and electron transport declined. A timecourse of regulatory responses was established. A step increase of CO 2 first caused PSI to be oxidized but after 40 s both PSI and PSII had excess electrons as a result of acceptor-side limitations. Electron flow to PSI slowed and the proton motive force increased. Eventually, non-photochemical quenching reduced electron flow sufficiently to balance the TPU limitation. Over several minutes rubisco deactivated contributing to regulation of metabolism to overcome the TPU limitation.

Pheochromocytoma occurs in 1 in every 50,000 hypertensive pregnant lady. Antenatal diagnosis is critical to reduce maternal and perinatal mortality rates. Here, we describe a patient diagnosed with pheochromocytoma at 35 weeks with an atypical presentation of right flank pain and seizures, her preoperative optimization and intra-partum surgical management.

In view of the massive load data ofoilfield distribution network contains various types of outliers, which is not conducive to load prediction, electric energy decision-making, dispatching and production, it is very necessary to identify and correct abnormal loads to improve the validity and reliability of load data and establish a safe, efficient and sustainable power system.Based on the above reasons, this paper proposes a data anomaly identification and scene generation method combining boxplot and generative adversance network (WGAN). This method firstly uses boxplot method to complete anomaly identification of active power, reactive power, current and other data of oilfield grid.Then, wasserstein-based generative Adversation network (WGAN) algorithm was used to achieve data fitting and generation, which provided data support for subsequent long-and-short Term Memory (LSTM) based load prediction model. Finally, the effectiveness of the proposed algorithm and model was verified by an example of an oilfield power grid.Through the intelligent identification, sequence generation and load prediction of oil field load data, the purpose of deep mining and analysis of oil field production behavior is realized.