t’s time for a fivesome. Commentary to: “The predictive value of five glomerular filtration rate formulas for long-term mortality in patients undergoing coronary artery bypass grafting” Coronary artery disease is an extremely common condition and coronary artery bypass-grafting is still one of the most important therapeutic strategy to treat it. Chronic kidney disease is often affecting patients with CAD. Nevertheless, the literature is still debating what formula estimate the best the glomerular filtration rate in patients undergoing CABG. Indeed, the formulas used in clinical practice have some differences some are more accurate in patients with diabetes, while there are some bias given by age and body mass index. In cardiac surgery, the choice of the most fitting formula to evaluate GFR has important clinical implication and, up to now, three formulas have been compared at most. Eilon Ram et al. present a retrospective study which compares the 5 most used formulas (CG, MDRD, CKD-EPI, Mayo, and IB) to derive GFR to evaluate the one with the best accuracy in predicting long-term mortality. In order to do so, they divided 3744 patients in three groups according to the estimated GFR by means of all 5 formulas: significant CKD according to all formulas, non-significant CKD according to all formulas and discordant results (meaning that at least one formula gave normal GFR and at least one formula gave abnormal GFR). Patients with the highest mortality were the ones with significant CKD according to all formulas.

Title : Submitral Aneurysm: Exploring a Rare PathologyAuthors : Kellen Round BS1, Jake L. Rosen BA1, Colin C. Yost BA1, T. Sloane Guy MD, MBA21Sidney Kimmel Medical College, Thomas Jefferson University, 1025 Walnut St #100, Philadelphia, PA 191072Division of Cardiac Surgery, Department of Surgery, Thomas Jefferson University, Curtis Bldg, Ste 620, 1015 Walnut St Philadelphia, PA 19107Running Title: Submitral Aneurysm Commentary

A document by David Sanders . Click on the document to view its contents.

Insects are the most speciose group of animals and play a central role in ecosystem processes and functioning, yet they are often overlooked in conservation studies. Many studies have reported a dramatic decline of insects globally, where climate change is considered a profound threat; however, how climate change is impacting tropical insects is largely unknown, given most studies are from the temperate region. Here, by considering Bangladeshi butterflies as a case study, I developed climatic suitability maps for 242 species and compared the suitability under current and future (2081-2100) climatic conditions. Overall, the projected future climate could impact 241 of 242 butterfly species (except for Spindasis elima), where 42% species could experience range contraction. Alarmingly, the impact could be significantly more severe among threatened species. While the direction of shift in habitat suitability could be multidimensional, about 65% of species might move north. While the suitability range could expand for about 58%, most threatened species (58%) could experience range contraction. The mean elevation of the suitable habitat could increase by 238%, and again the situation could be more severe for the threatened butterflies (from 42m to 108m). The niche-overlap analysis indicates that about 54% of the realised niche could be altered. Although there might be no significant association between the shift in habitat suitability along the elevational gradient, migratory species could experience a more significant shift than non-migrants. I show that climate change could have a severe impact on Bangladeshi butterflies – depending on Socio-Economic Pathways (ssps), the future climatic condition could be unsuitable for 2 (ssp126) – 34% (ssp585) species. To mitigate insect decline globally, and therefore, to meet the Post 2020 Biodiversity Framework targets, I urge immediate detection of climate change impact on tropical insects and developing effective conservation strategies.

Objectives: To evaluate risks of preterm birth and severe maternal morbidity (SMM) in female adolescent and young adult cancer survivors; assess maternal comorbidity as a potential mechanism; determine whether associations differ by use of assisted reproductive technology (ART). Design: Retrospective cohort Setting: Privately insured females in the U.S. Sample: Female with live births from 2000 to 2019 within OptumLabs®, a U.S. administrative health claims dataset Methods: Log-binomial regression models estimated relative risks of preterm birth and SMM by cancer status and tested for effect modification. Causal mediation analysis based on a counterfactual approach evaluated the proportions explained by maternal comorbidity. Main Outcome Measures: SMM, preterm birth Results: Among 46,064 cancer survivors, 2,440 singleton births, 214 multiple births, and 2,590 linked newborns occurred after cancer. In singleton births, preterm birth incidence was 14.8% in cancer survivors versus 12.4% in females without cancer (aRR 1.19, 95%CI 1.06-1.34); SMM incidence was 3.9% in cancer survivors versus 2.4% in females without cancer (aRR 1.44, 95%CI 1.13-1.83). Cancer survivors had more maternal comorbidities before and during pregnancy; 26% of the association between cancer and preterm birth and 30% of the association between cancer and SMM was mediated by maternal comorbidities. Associations between cancer and outcomes did not differ between ART and non-ART births. Conclusion: Preterm birth and SMM risks were modestly increased after cancer. Significant proportions of elevated risks may be due to increased comorbidities. Prevention and treatment of comorbidities provides an opportunity to improve perinatal outcomes among cancer survivors.

Objective: Preeclampsia (PE) is a leading cause of morbidity and mortality in pregnancy. This observational study aims to determine associations between oral and placental microbiome in women with and without preeclampsia and periodontal disease (PD) and evaluate systemic immune responses in patients with and without PE and PD. Population: Fifty-four pregnant patients with and without PE and PD were recruited. The microbiome profiles of both oral subgingival region and placenta were characterized by V4 region of 16S rRNA gene sequencing. Systemic inflammation markers tumor necrosis factor-alpha (TNF-α), C-reactive protein (CRP), lipopolysaccharide binding protein (LBP), interleukins 6 & 8 (IL-6, IL-8) in blood were measured by ELISA. Results: PD significantly increased the risk of PE after adjustments for age, preterm delivery and smoking status (OR=2.26, 95% CI=1.14-4.48, p=0.024). A group of oral associated bacteria Veilonella, Fusobacterium, Haemophilus, Granulicatella, Streptococcus, Gemella and Neisseria in placenta had significantly higher prevalence in women with PE compared to women without PE (53.8% vs 19.0%, p=0.018), the highest prevalence in patients with both PE and PD (58.8%). Relative abundances of Haemophilus, Veillonella and Fusobacterium in oral samples were significantly higher in patient with PE than those without PE. Proinflammation cytokine analysis showed that PE patients with PD had higher blood IL-8 levels than PE patients without PD (p=0.028). Conclusion: Oral-like microbiome was identified in placenta more frequently in patients with PE than those without PE. Placental microbiome is associated with systemic inflammation. High abundances of Haemophilus in oral cavity is associated with increased risk of PE.

Both δ 18O in groundwater and speleothem are inherited from precipitation δ 18O, however, stalagmite δ 18O and groundwater δ 18O do not simultaneously agree with each other in the monsoon regions, especially in the late Pleistocene. The reason remains unclear due to the complex stable isotope systematics in the monsoon affected regions with their controlling factors as well as the possible different recharge dynamics of groundwater and drip water. In this study, we have collected 539 daily precipitation samples throughout 2015 from seven monitoring stations in Beijing, in the northern margin of the East Asian summer monsoon region. Stable isotopes (δ 18O and δ 2H) of these precipitation samples are investigated for the controlling factors of precipitation isotopes, e.g., moisture source, temperature (T), and precipitation amount (P) effects. The δ 18O values in the precipitation decrease from the south to the northwest, which is controlled by the monsoon from the south and continental moisture from the northwest. Consistently, the precipitation exhibits an apparent seasonal variation in δ 18O values. The P effect is significant during the monsoon season, especially when the precipitation events are greater than 5 mm and single moisture source is considered. In contrast, the T effect is significant, with a gradient of 0.4‰ per °C during the non-monsoon season. A Rayleigh distillation model indicates that the moisture source and residual vapor fraction are the two most important factors controlling the δ 18O precipitation patterns in a monsoon region, independent of temperature. Isotopes in groundwater in the late Pleistocene exhibit a significant T effect, implying that the monsoon might not reach Beijing when the groundwater was formed at that time. Furthermore, we highlighted the different recharge mechanisms of groundwater and drip water: lateral flow and direct vertical infiltration make diverse contributions of non-monsoon precipitations to the groundwater and drip water respectively, resulting in that speleothem δ 18O differ from groundwater δ 18O in the late Pleistocene.

This paper studies chatter stability of composite cutter bar milling system in rotating coordinate frame. Based on the structural dynamic equation and regenerative milling force model of composite cutter bar in rotating coordinate frame, the continuous distributed chatter analysis model of composite cutter bar milling system is established. The stability of milling system with a rotary symmetric dynamic cutter bar is predicted by using the semi-discrete time domain method. Influences including internal damping, external damping, symmetrical and asymmetric laminates on the stability of milling system are analyzed, and the results obtained in rotating and fixed coordinate frame are compared. It is shown that the results are consistent for symmetrical cutter bar either in the rotating coordinate frame or in the fixed coordinate frame. A new chatter instability zone appears at high rotating speeds due to material internal damping of the rotating composite cutter bar.

Background: In patients with non-sustained tachyarrhythmias, left ventricular (LV) systolic dysfunction is uncommon. The role of catheter ablation (CA) in asymptomatic patients with tachyarrhythmia remains unclear. Case presentation: We report a 20-year-old patient without sustained tachyarrhythmia with a left ventricular ejection fraction of 20% who underwent radiofrequency catheter ablation (RFCA) of anteroseptal accessory pathway. She achieved normalization of left ventricular systolic function noted on echocardiography performed at four weeks post-ablation. Conclusions: Our case highlights significant improvement in LV systolic function after catheter ablation of an “asymptomatic” ventricular preexcitation. Current guidelines do not endorse ablating asymptomatic patients, but careful follow up with serial echocardiograms might be warranted. Prophylactic ablation of those patients with clear evidence of LV dyssynchrony or wide left bundle branch pattern and persistent preexcitation is worth further consideration.

Introduction. The inadvertent lead malposition in the left heart chambers (ILMLH) is an under-recognized event which may complicate implantation of cardiac electronic devices (CIEDs). Methods and Results. We investigated the clinical conditions associated with ILMLH and the treatment strategies in these patients. We made a systematic review of literature and identified 132 studies which reported 157 patients with ILMLH. Mean age of patients was 68 years and 83 were women. ILMLH was diagnosed, on average, 365 days after CIEDs implantation. Coexisting conditions were patent foramen ovale in 29% of patients, arterial puncture in 24%, perforation of the interatrial septum in 20%, atrial septal defect in 16% and perforation of the interventricular septum in 4%. At the time of diagnosis of ILMLH, 46% of patients were asymptomatic, 31% had acute TIA or stroke and 15% had overt heart failure. Overall, 14% of patients were receiving anticoagulants at the time of diagnosis of ILMLH. After diagnosis of ILMLH, percutaneous or surgical lead extraction was carried out in 93 patients (59%), whereas 43 (27%) received anticoagulation. During a mean 9-month follow-up after diagnosis of ILMLH, 4 patients experienced TIA or stroke (3 on oral anticoagulant therapy and 1 after percutaneous lead extraction). Conclusion. ILMLH is a rare complication which is usually diagnosed about one year after CIEDs implantation. An early diagnosis of ILMLH is important. Lead extraction is a safe and effective alternative to anticoagulants.

Cryptococcal meningitis is a major opportunistic infection in individuals with HIV. 36-year-old male with a past medical history of AIDSpresented with altered mental status, lumbar puncture performed showed elevated CSF opening pressure of 29 cmH2O and positive CSF and serum cryptococcal antigen, developed seizure, and posterior brain herniation.

CIED infection is a serious complication and remains the commonest indication for TLE.The patient exist two problems: bilateral venous access infection and pacing dependence. LP provide safe and effective pacing options for patients with device-related infections.

Objectives: This study aimed to map prescription patterns of pulmonary vasodilator therapy in children with bronchopulmonary dysplasia (BPD). Working hypothesis: Pulmonary vasodilator drug therapy is used in children born preterm suffering from BPD-associated pulmonary hypertension, but patient selection, extent of diagnostics with catheterization and co-morbidities are largely unknown. Study design: A descriptive national registry-based study. Patient selection and methodology: All children below seven years of age who had been prescribed a pulmonary vasodilator during a ten-year period, 2007-2017, born preterm (gestational age, GA <37 weeks) and classified as BPD, were included. Information on prescriptions was retrieved from the Swedish Prescribed Drug Register and information on patient characteristics and comorbidities was retrieved by linkage to national registers held by the National Board of Health and Welfare. Results: In total, 74 children were included, 54 (73%) born at GA 22-27 and 20 (27%) at GA 28-36. Single therapy was most common, N=64 (86.5%), and sildenafil was most frequently prescribed, N=69 (93%). Bosentan, iloprost, macitentan and/or treprostinil were mainly used for combination therapies, N=10 (13.5%). Patent ductus arteriosus (PDA) or atrial septal defect (ASD) was present in N=29 (39%) and N=25 (34%) children respectively, and N=20 (69%) versus N=3 (12%) underwent closure. Cardiac catheterization was performed in N=19 (26%) patients. Median duration of therapy was 4.4 (0.5-14.1, 95% percentiles) months. Total mortality was N=7 (9%). Conclusions: Preterm children with BPD are prescribed pulmonary vasodilators, often without prior catheterization and sildenafil was most common. Diagnostic tools, effects, and drug safety needs further evaluation.

Background: Implanting leadless pacemakers in the right ventricular (RV) apex is prone to causing pericardial tamponade and myocardial perforation. Objective: To investigate the feasibility and safety of right ventriculography-guided implantation of Micra TM leadless pacemaker (Micra) in the RV mid-septum. Methods: 108 consecutive patients who underwent Micra implantation intended in the mid-septum were enrolled and randomized (3:1) into the radiography group (n=81) with assistance of right ventriculography to illustrate the RV septum and the non-radiography group (n=27). All subjects underwent a postoperative computed tomography (CT) scan to determine the Micra location. The Micra location assessed by CT image was compared between the two groups to confirm the accuracy of the intended pacing site. The duration of the procedure, X-ray exposure dose and time were also compared between the two groups. Results: Reconstructed CT 3-D cardiac imaging found the Micra location in the intended mid-septum in 13 patients (48.1%, 13/27) in the non-radiography group and 76 patients (93.8%, 76/81) in the radiography group ( P< 0.0001 between two groups). There was no significant difference in procedure interval between the two groups while the X-ray exposure (564.86±112.44 vs. 825.85±156.12mGy, P < 0.0001), X-ray exposure time (7.79±1.43vs. 12.03±2.86 min, P < 0.0001) and the number of fluoroscopy re-positioning (2.79±1.03, vs. 6.41±1.82, P<0.0001) were significantly less in the radiography group than in the non-radiography group. No implantation-related complications were observed in both groups. Conclusion Right ventriculography increases the accuracy of Micra TM pacemaker implantation in the mid-septum and reduces X-ray exposure.

A theoretical analysis of curved circular and rough porous flat plates is studied for the case of conducting couple stress fluid accounting for viscosity variation and MHD. By using Stochastic Reynold's boundary conditions, the equation for pressure distribution is derived. The results reveal that viscosity variation, couple stress, roughness, MHD increases the load carrying capacities and squeezing time while the existence of a porous region decreases the above characteristics.

Rational structural design and engineering of MOF membranes is promising for energy-efficient separation. Preferred orientation manipulation delegates an effective approach to improve their separation performance, while room-temperature (RT) synthetic protocol is beneficial to foster their industrial batch production. Nevertheless, it remains challenging to fabricate highly oriented MOF membranes at RT; simultaneously, the density of defective sites in the framework, which is assumed to exert significant influence on the separation performance relying on high affinity-interactions between guest molecules and coordinatively-unsaturated open metal sites, should be deliberately tailored. In this study, we achieve RT synthesis of highly (111)-oriented UiO-66 membrane exhibiting high defect density in the framework through employing Zr6O4(OH)4(OAc)12 clusters as zirconium source. Prepared membrane manifests an ideal CO2/N2 selectivity of 46.2, which represents the highest value among pure MOF membranes tested in comparable operating conditions. This protocol is expected be expanded for facile and mild preparation of state-of-the-art MOF membranes.

Therapeutic applications of synthetic mRNA were proposed more than 30 years ago, and are currently the basis of one of the vaccine platforms used at a massive scale as part of the public health strategy to get COVID-19 under control. To date, there are no published studies on the biodistribution, cellular uptake, endosomal escape, translation rates, functional half-life and inactivation kinetics of synthetic mRNA, rates and duration of vaccine-induced antigen expression in different cell types. Furthermore, despite the assumption that there is no possibility of genomic integration of therapeutic synthetic mRNA, only one recent study has examined interactions between vaccine mRNA and the genome of transfected cells, and reported that an endogenous retrotransposon, LINE-1 is unsilenced following mRNA entry to the cell, leading to reverse transcription of full length vaccine mRNA sequences, and nuclear entry. This finding should be a major safety concern, given the possibility of synthetic mRNA-driven epigenetic and genomic modifications arising. We propose that in susceptible individuals, cytosolic clearance of nucleotide modified synthetic (nms-mRNAs) is impeded. Sustained presence of nms-mRNA in the cytoplasm deregulates and activates endogenous transposable elements (TEs), causing some of the mRNA copies to be reverse transcribed. The cytosolic accumulation of the nms-mRNA and the reverse transcribed cDNA molecules activates RNA and DNA sensory pathways. Their concurrent activation initiates a synchronized innate response against non-self nucleic acids, prompting type-I interferon and pro-inflammatory cytokine production which if unregulated, leads to autoinflammatory and autoimmune conditions, while activated TEs increase the risk of insertional mutagenesis of the reverse transcribed molecules, which can disrupt coding regions, enhance the risk of mutations in tumour suppressor genes, and lead to sustained DNA damage. Susceptible individuals would then expectedly have an increased risk of DNA damage, chronic autoinflammation, autoimmunity and cancer. In light of the current mass administration of nms-mRNA vaccines, it is essential and urgent to fully understand the intracellular cascades initiated by cellular uptake of synthetic mRNA and the consequences of these molecular events.

The fall armyworm (FAW) Spodoptera frugiperda has invaded Jiangxi Province, Southeast China for the past three years. Although the FAW displays a very wide host range, one of its main host plants in Jiangxi Province is still field corn. This study systematically investigated the effects of food plants (corn, peanut, soybean and sugarcane) on life-history traits of FAW and tested the leaf contents of the total flavonoids, reducing sugars, sucrose and C/N ratio. We found that the FAW fed on corn leaves showed significantly shorter larval and pupal development times, larger body weight, higher growth rate, lower weight loss, smaller SSD, shorter preoviposition period and higher fecundity than those fed on peanut, soybean and sugarcane leaves. The pupal development stage was significantly longer in males than females, showing a protogyny phenomenon. Food plants changed the relationships between larval development time and pupal weight and between fecundity and longevity. The corn leaves showed significantly higher contents of reducing sugars and sucrose, lower content of the total flavonoids, and a moderate C/N ratio, suggesting that the corn leaf tissues are more nutritive. These findings may help us to understand why the FAW mainly infests corn plants and may be critical for the development of strategies to predict infestation levels.

Recientemente, diversos estudios clínico-experimentales han encontrado que los pacientes con depresión presentan los componentes característicos de una inflamación. Además, se ha sugerido que la asociación entre inflamación y depresión podría ser bidireccional. Esto se debe a que los comportamientos resultantes de un episodio depresivo tienen el potencial de actuar como vías mediadoras que conducen a una mayor inflamación.  En este trabajo se usan datos de la Encuesta Nacional de Salud y Nutrición 2018 de México para estudiar esta asociación en adultos mayores a 20 años. Utilizando modelos econométricos, se encuentra evidencia estadística de que la inflamación y la depresión están asociados positivamente. Además, se encuentra que los síntomas de depresión están positivamente asociados con la edad, que es más prevalente en mujeres que en hombres y que los habitantes de la zona centro de México son más propensos a sufrir de depresión significativa que los habitantes del resto del país y, específicamente, a los de la Ciudad de México, al igual que los habitantes de zonas rurales. Los resultados aquí obtenidos no solo tienen implicaciones para el tratamiento de la depresión, sino que proporcionan una herramienta para la toma de decisiones en el sector salud.Palabras clave: Depresión; Inflamación; ENSANUT; Modelos Probabilísticos

Understanding landscape connectivity has become a global priority for mitigating the impact of landscape fragmentation on biodiversity. Link-based methods traditionally rely on relating pairwise genetic distance between individuals or demes to their landscape distance (e.g., geographic distance, cost distance). In this study, we present an alternative to conventional statistical approaches to refine cost surfaces by adapting the Gradient Forest (GF) approach to produce a resistance surface based on multiple environmental variables. Used in community ecology, Gradient Forest is an extension of random forest (RF), and has been implemented in genomic studies to model species genetic offset under future climatic scenarios. By design, this adapted method, resGF, has the ability to handle multiple environmental predictors and is not subjected to traditional assumptions of linear models such as independence, normality and linearity. Using genetic simulations, our RF-based approach was compared to other published methods using univariate and multivariate scenarios. Additionally, two worked examples are provided using two previously published datasets. This machine learning algorithm has the potential improve our understanding of landscape connectivity and can inform long-term biodiversity conservation strategies.

Central nervous system involvement in Burkitt lymphoma is a frequent complication, affecting less than 10% of patients with the endemic form, 10%–20% with the non-endemic form, and 20%–30% with the immunodeficiency-associated form. Here we discuss the distinct clinical features, diagnostic approach and chemotherapeutic treatment of three cases in our institution.

Uganda lies within the drier end of the natural distribution range of Coffea canephora and contains unexplored genetic material that could be drought-adapted and useful for developing climate-resilient varieties. Using experimental treatments, (i) ample and (ii) restricted-water, response of 148 genotypes were studied comprising wild, feral and cultivated C. canephora. Biomass allocation, standing leaf area and leaf area growth data were collected. Linear mixed effect models and PCA were used to analyse effect of drought on genotypes from different: (i) cultivation status, (ii) genetic groups and (iii) locations. We assessed the relationship between drought tolerance for relative growth rate in leaf area (RGRA), total number of leaves (TNL), total leaf area (TL) and total leaf dry weight (TLDW) of genotypes at final harvest. Restricted-water reduced RGRA across genetic groups (3.2 – 32.5%) and locations (7.1 – 36.7%) but not cultivation status. For TNL, TL and TLDW, genotypes that performed well in ample-water performed worse under restricted-water, indicating growth-tolerance trade-off. Drought tolerance in RGRA and TNL were negatively correlated with wetness index suggesting some degree of adaptation to local climate. Findings indicate a growth-tolerance trade-off within this tropical tree species and drought tolerance of Uganda’s C. canephora is somewhat associated with local climate.

Abstract Light is a necessary environmental factor for plant growth and development. HY5 (ELONGATED HYPOCOTYL 5), regarded as a crucial transcriptional factor for regulating hypocotyl, was clearly in Arabidopsis thaliana, but its regulatory mechanism in non-heading Chinese cabbage (NHCC) has not been understood. In this study, we used BcHY5 as a bait to screen two BcB-box (BBX) proteins, BcBBX21, and BcBBX25, and applied multiple genetic and biochemical approaches to identify the roles of BcHY5 and two B-BBX proteins. Overexpression of the two BBX proteins in Arabidopsis was used to investigate their functions. BcHY5 can bind the G-box of pro BcMYBH and inhibit BcMYBH transcription. BcHY5 can form a complex with BcBBX21, which promotes BcHY5’s regulation of BcMYBH and increases the transcription inhibition of BcMYBH, resulting in the shorter hypocotyl. BcBBX25 can interact with BcHY5 to release the inhibition of BcMYBH by BcHY5 , allowing the hypocotyl to return to normal. The C-terminal exchange confirmed that the interaction between BcBBXs and BcHY5 was determined by the two B-box domains of the N-terminal and the opposite effect of BcBBXs on BcHY5 was caused by C-terminal difference. The current results demonstrate the fine-tuned regulation of hypocotyl length via transcriptional regulation of BcMYBH by BcHY5-associated proteins and provide insights into Cruciferous hypocotyl length.

Interstitial granulomatous dermatitis (IGD) is an uncommon entity characterized histologically by an interstitial granulomatous infiltrate. Juvenile idiopathic arthritis (JIA) is the most common rheumatic disease of childhood. We describe an infantt with JIA who developed an IGD. Physicians should be aware of this uncommon association.