Seed germination is critical for successful crop production, and the sensitivity to pH and salt stress depends on the plant’s tolerance mechanisms. In view of the characteristics of calcium-rich and acidic soils in the karst areas of Guizhou Province, China, the effects of pH stress and calcium stress on the seed germination characteristics of three herbages were studied with the goal of exploring and revealing the mechanism of adaptation of the three herbages to an acidic soil environment and providing a theoretical basis for the selection and cultivation of acid-tolerant herbages in southwest China. In this study, six concentration gradients of CaCl2, including 0, 25 mmol/L, 50 mmol/L, 100 mmol/L, 150 mmol/L, and 200 mmol/L, and seven pH gradients, including 4.55, 5.35, 6.61, 7.03, 8.0, and 9.18 were established, respectively. The germination rate, germination potential and germination index of the seedlings were measured for each seed germination and seedling growth stage of orchardgrass, perennial ryegrass, and alfalfa, respectively. The results showed that when the concentration of salt stress began to change, the herbage seeds could adapt to salt stress at an appropriate pH condition. When only the pH value or CaCl2 concentration changes, the increase in pH and CaCl2 will inhibit the growth of shoots and roots. Weak acid can promote the growth of shoots and young roots, while alkaline conditions can inhibit their growth. The effect of a low concentration of CaCl2 was not apparent, while a high concentration of CaCl2 clearly inhibited the plants. The optimal pH and CaCl2 of the bud and root lengths changed after the interaction. In conclusion, there is a substantial difference between pH and calcium salt stress, and the interaction between pH and calcium salt concentration has a substantial influence on the salt and alkali tolerance of the three types of seeds.

Background: Clinical trial simulations and pharmacometric modeling of biomarker profiles for under-represented groups are challenging because the underlying studies frequently do not have sufficient participants from these groups. Objectives: To investigate generative adversarial networks (GANs), an artificial intelligence (AI) technology that enables realistic simulations of complex patterns, for modeling clinical biomarker profiles of under-represented groups. Methods: GANs consist of generator and discriminator neural networks that operate in tandem. GAN architectures were developed for modeling univariate and joint distributions of a panel of 16 diabetes-relevant biomarkers from the National Health and Nutrition Examination Survey (NHANES), which contains laboratory and clinical biomarker data from a population-based sample of individuals of all ages, racial groups, and ethnicities. Conditional GANs were used to model biomarker profiles for race/ethnicity categories. GAN performance was assessed by comparing GAN outputs to test data. Results: The biomarkers exhibited non-normal distributions and varied in their bivariate correlation patterns. Univariate distributions were modeled with generator and discriminator neural networks consisting of two dense layers with rectified linear unit-activation. The distributions of GAN-generated biomarkers were similar to the test data distributions. The joint distributions of the biomarker panel in the GAN-generated data were dispersed and overlapped with the joint distribution of the test data as assessed by three multi-dimensional projection methods. Conditional GANs satisfactorily modeled the joint distribution of the biomarker panel in the Black, Hispanic, White, and “Other” race/ethnicity categories. Conclusions: GAN are a promising AI approach for generating virtual patient data with realistic biomarker distributions for under-represented race/ethnicity groups.

Myrica rubra seed oil (MRSO) is a by-product of comprehensive processing and utilization of myrica rubra and has high nutritional value to human body. However, there are few researches on odor, physicochemical properties, stability, and functional nutrition of MRSO, especially compared with other vegetable oils. The characteristics of MRSO in terms of odor, physical and chemical indicators, fatty acid composition, etc., compared with other vegetable oils were studied in our paper. In addition, Oxidative stability and antiproliferative activity of MRSO were studied. The research showed that MRSO maintained lower free fatty acids content in comparison with the other vegetable oils, and was rich in unsaturated fatty acids and contained 2.48% of C22:2, which was not found in other vegetable oils. MRSO had the greatest effects on inhibiting the growth of HepG-2 and HT-29 by as much as 46% and 57% at 96 h. The findings demonstrated that MRSO is an edible oil with high nutritional value, and can be further processed to obtain oil products with high added value.

We report a case of a 9-year-old girl with Ewing's who was initially thought to have osteomyelitis. As part of osteomyelitis management, an attempt of drilling the cortex has paved the way for the tumor to extend to all thigh compartments which was beyond salvage. Disarticulation was the final result.

Background: Inappropriate humidification of inspired gas during mechanical ventilation can impair lung development in extremely low birthweight (ELBW) infants. Humidification depends on multiple factors, such as the heater-humidifier device used, type of ventilation, and environmental factors. Few studies have examined inspired gas humidification in these infants, especially during high-frequency oscillatory ventilation (HFOV). Our objective was to compare humidity during HFOV and intermittent positive pressure ventilation (IPPV), in vitro and in vivo. Methods: In-vitro and in-vivo studies used the same ventilator during both HFOV and IPPV. The bench study used a neonatal test lung and 2 heater-humidifiers with their specific circuits; the in-vivo study prospectively included preterm infants born before 28 weeks of gestation.  Results: On bench testing, mean absolute (AH) and relative (RH) humidity values were significantly lower during HFOV than IPPV (RH = 79.4% ± 8.1% vs 89.0% ± 6.2%, P<0.001). Regardless of the ventilatory mode, mean relative humidity significantly differed between the 2 heater-humidifiers (89.6% ± 6.7% vs 78.7% ± 6.8%, P=0.003). The in-vivo study included 10 neonates (mean ± SD gestational age: 25.7 ± 0.9 weeks and birth weight: 624.4 ± 96.1 g). Mean relative humidity during HFOV was significantly lower than during IPPV (74.6% ± 5.7% vs 83.0 ± 6.7%, P=0.004).  Conclusion: Relative humidity was significantly lower during HFOV than IPPV, both in vitro and in vivo. The type of heater-humidifier also influenced humidification. More systematic measurements of humidity of inspired gas, especially during HFOV, should be considered to optimize humidification and consequently lung protection in ELBW infants.

Arrestins are important scaffolding proteins that are expressed in all vertebrate animals. They regulate cell signaling events upon binding to active G-protein coupled receptors ( GPCR) and trigger endocytosis of active GPCRs. While many of the functional sites on arrestins have been characterized, the question of how these sites interact is unanswered. We used anisotropic network modelling ( ANM) together with our covariance compliment techniques to survey all of the available structures of the non-visual arrestins to map how structural changes and protein-binding affect their structural dynamics. We found that activation and clathrin binding have a marked effect on arrestin dynamics, and that these dynamics changes are localized to a small number of distant functional sites. These sites include α-helix 1, the lariat loop, nuclear localization domain, and the C-domain β-sheets on the C-loop side. Our techniques suggest that clathrin binding and/or GPCR activation of arrestin perturb the dynamics of these sites independent of structural changes.

We described SLE- patient with long- term RHTN, who presented with PRES syndrome, and finally diagnosed as carbamazepine induced HTN. A literature review shows only three patients with neurologic deficit in the context of carbamazepine induced HTN. This is valuable to always exclude drugs effects in RHTN.

When alien species enter new environments, they face new challenges. They encounter new predators, parasites, or pathogenic bacteria, which leads to the rapid evolution of invasive species to adapt to new habitats, where immune-related genes play a significant role. Lithobates catesbeianus is one of the worst invasive species in the world; it rapidly spread worldwide in the 19th century and invaded China in the 1950s. We predicted the possible transmission routes of bullfrogs in China through microsatellite loci and clustered the populations at different points. We studied the adaptive selection and drift reshaping of the genetic structure of an immune genetic major histocompatibility complex (MHC) in invasive bullfrogs in 23 Chinese invasive populations (13 island and 10 mainland sites) and two American populations (Kansas and California). The Chinese bullfrog populations were divided into 6 clusters by microsatellite structure, and the MHC diversity in each cluster was different. The genetic diversity of both microsatellite and MHC genes decreased due to the bottleneck effect and the rate of diversity loss at functional and neutral loci, and there was no significant difference. We found that two MHC alleles were endemic in Chinese populations, which corresponded to distinct functional supertypes. We also analyzed the impact of environmental factors and island effects on the diversity of MHC genes. These results indicate that rapid evolution plays an important role in maintaining functionally important MHC variation during the bullfrog invasion process and provide evidence that low genetic diversity can result in successful invasion.

Background: The novel method of left bundle branch pacing (LBBP) has been reported to achieve better electrical and mechanical synchrony in the left ventricle than conventional right ventricular pacing (RVP). However, its effects on right ventricle (RV) performance are still unknown. Methods: Consecutive patients undergoing dual-chamber pacemaker (PM) implantation for sick sinus syndrome (SSS) with normal cardiac function and a narrow QRS complex were recruited for the study. The pacing characteristics and echocardiogram parameters were measured to evaluate RV function, interventricular and RV synchrony, and were compared among ventricular pacing‐on and native‐conduction modes. Results: A total of 84 patients diagnosed with SSS and an indication for pacing therapy were enrolled. Forty-two patients (50%; mean age 65.50 ± 9.30 years; 35% male) underwent successful LBBP and 42 patients (50%; mean age 69.26 ± 10.08 years; 33% male) RVSP, respectively. Baseline characteristics were similar between the two groups. We found no significant differences in RV function [RV-FAC (Fractional Area Change)%, 47.13±5.69 vs. 48.60±5.83, p=.069; Endo-GLS (Global Longitudinal Strain)%, -28.88±4.94 vs. -29.82±5.35, p=.114; Myo-GLS%, -25.72±4.75 vs. -25.72±5.21, p=.559; Free Wall St%, 27.40±8.03 vs. -28.71±7.34, p=.304] between the native‐conduction or LBBP capture modes, while the RVSP capture mode was associated with a significant reduction in the above parameters compared with the native‐conduction mode (P < .0001). The interventricular synchrony in the LBBP group was also superior to the RVSP group significantly. Conclusion: LBBP is a pacing technique that seems to associate with a positive and protective impact on RV performance.

Objective Examine the characteristics of recent head and neck oncology (H&N) fellowship graduates and assess their current perceptions of career alignment and satisfaction. Methods H&N fellowship graduates from American Head & Neck Society (AHNS)-accredited programs between 2015 to 2020 were surveyed. Two-sample t-tests and analysis of variance tests were used to determine the effect of respondents’ demographics, fellowship characteristics, career preferences, and current practice on their degree of career alignment with expectations and overall job satisfaction. Results Fifty-eight fellowship graduates completed the cross-sectional survey. Fifty-two of all respondents (89.7%) primarily preferred an academic job, of whom 5 (9.6%) went into private practice. Respondents in private practice, those treating general Otolaryngology patients, or those who do not work with residents demonstrated significantly poorer job alignment and career satisfaction compared to those in academic medicine, those only treating H&N patients, or those working with residents, respectively. Discussion The number of desirable academic positions each year may be insufficient for graduating fellows. By setting realistic career expectations, planning for a mixed scope of practice, and integrating resident involvement into private practice groups, H&N providers may ultimately find more fulfillment in their work. These findings could be valuable to fellowship programs in designing training and to future H&N fellows in their career planning. Further studies with higher power would be warranted to identify other indicators of H&N career satisfaction and ways to reduce physician burnout.

Background The decision to conserve or replace the native aortic valve following acute type-A aortic dissection (ATAAD) is an area of cardiac surgery without standardised practice. This single centre retrospective study analysed the long-term performance of the native aortic valve and root following surgery for ATAAD. Methods Between 2009 and 2018 all cases ATAAD treated at Royal Brompton and Harefield NHS Foundation Trust were analysed. Patients were divided into 2 groups: a) ascending aorta (interposition) graft (AAG) without valve replacement; and b) non-valve-sparing aortic root replacement (ARR). Pre-operative covariates were compared, as well as operative characteristics and post-operative complications. Long-term survival and echocardiographic outcomes were analysed using regression analysis. Results In total, 116 patients were included: 63 patients in the AAG group and 53 patients in the ARR group. In patients where the native aortic valve was conserved, 9 developed severe aortic regurgitation and 2 patients developed dilation of the aortic root requiring subsequent replacement during the follow-up period. Aortic regurgitation at presentation was not found to be associated with subsequent risk of developing severe aortic regurgitation or reintervention on the aortic valve. Overall mortality was observed to be significantly lower in patients undergoing AAG (17.5% vs. 41.5%, p=0.004). Conclusions With careful patient selection, the native aortic root shows good long-term durability both in terms of valve competence and stable root dimensions after surgery for ATAAD. This study supports the consideration of conservation of the aortic valve during emergency surgery for type-A dissection, in the absence of a definitive indication for root replacement, including in cases where aortic regurgitation complicates the presentation.

Shifts in care delivery during the COVID-19 pandemic, particularly from surgical aortic valve replacement to percutaneous aortic valve replacement, may have had adverse outcomes for patients. We analyzed data from the Food and Drug Administration (FDA) Manufacturer and User Facility Device Experience (MAUDE) database, to determine trends in reported malfunctions, injuries, and deaths for transcatheter aortic valve prostheses during the decade 2012 to 2021. We find that reported deaths attributed to transcatheter aortic valve prostheses more than doubled from the pre-pandemic year of 2019 to the pandemic year of 2020. Monthly reported deaths attributed to transcatheter aortic valve prostheses increased by 124%, from 25.0 monthly deaths in 2019 to 55.9 monthly deaths in 2020 (p<0.003). The increased level of deaths persisted in 2021, with 58.3 monthly reported deaths in 2021; the overall increase in deaths from 2019 to 2021 was 133%. We find that reported injuries attributed to transcatheter aortic valve prostheses increased by 25%, from 297.8 monthly injuries in 2019 to 371.4 monthly injuries in 2020 (p<0.03). Finally we find that reported malfunctions attributed to transcatheter aortic valve prostheses increased by 39%, from 40.1 monthly malfunctions in 2019 to 55.7 monthly malfunctions in 2020 (p<0.007). These results suggest an overall increase in adverse events following transcatheter aortic valve prostheses during the pandemic, and indicate a pressing need for further research into short-term and long-term patient outcomes following transcatheter aortic valve prostheses.

Introduction Atrioventricular node (AVN) radiofrequency ablation is a highly effective treatment of atrial tachycardias resistant to other management modalities. There are limited studies that compare different radiofrequency ablation catheters. Our study aimed to compare the effectiveness of several types of ablation catheters in AVN ablation. Methods We identified patients who underwent AVN ablation for different indications at our institution. Data related to patients and procedures were collected through retrospective chart review. The radiofrequency catheters used were: plain non irrigated, externally irrigated (EI), and contact force sensing with 10-20 gm of force in two different settings: low power long duration (LPLD) (30W, 45°C, and 60 sec) and high-power short duration (HPSD) (50W, 43°C, and 12 sec). We compared the different catheters in terms of success rate using logistic regression and lesion time using linear regression. Results We identified 66 patients who underwent AVN ablation, out of which 31 were female (47%). The patients were elderly, with a mean age of 73.27 years. The indications were resistant atrial fibrillation in 74%, atrial flutter in 18%, and other atrial tachycardias in 8% of patients. Types of catheters used were plain non irrigated in 48%, EI in 2%, LPLD in 16%, and HPSD in 34% of patients. All ablation procedures were successful with no immediate post-procedure complications. Regarding lesion time, HPSD was significantly shorter compared to plain catheters by 403.42s[-631.67, -175.17]. Conclusions Radiofrequency ablation of AVN is a highly effective treatment modality for atrial tachyarrhythmias that failed other management methods. While plain catheter, LPLD, and HPSD were equally safe and effective, HPSD catheter had significantly shorter lesion time and thus procedure time.

Leukonychia totalis and partialis are characterized by complete or partial whitening of nail plate. They can be inherited or acquired. Rarely, no cause or associations are found. Here, we report a case of a 17-year-old male with idiopathic acquired true leukonychia totalis and partialis.

A number of neurological disorders have been reported to be associated with celiac disease.We reported the case of a patient aged 43 years presents for choreic movements. All the etiologic report was negative except serology of celiac disease positive etiology and gastric biopsy confirming the disease

In open bite cases, a comprehensive diagnostic differentiation is crucial in determining the best corrective therapy. In non-surgical open bite treatment, fixed appliances, either labial or lingual, are usually employed. With the addition of extra-radicular screws, more sophisticated orthodontic movements may now be performed without the necessity for orthognathic surgery.

Aims: This study aimed to evaluate the efficacy and safety of LVA-guided substrate modification catheter ablation in patients with AF. Methods: Systematic searches of the PubMed, EMBASE, and Cochrane databases were performed from inception to February 2022 for all available studies. The effect estimates were combined with the Mantel–Haenszel random-effects model. Subgroup analyses, sensitivity analysis and meta-regression were performed to explore the sources of statistical heterogeneity. Results: A total of 16 studies involving 1931 subjects (mean age: 61±10 years, 69% male) were identified. All studies included patients with paroxysmal AF, nonparoxysmal AF, or both. At a mean follow-up of 18.9 months, patients who underwent LVA ablation had significantly higher freedom from all-atrial tachycardia recurrence than patients who underwent control ablation (67.6% vs. 48.9%, risk ratios [RR] 0.66, 95% confidence interval [CI]: 0.57-0.76, P<0.001), with 34% relative risk and 18.7% absolute risk reductions in all-atrial tachycardia recurrence. Six studies assessed the incidence of stroke/transient ischemic attacks (TIAs) between the 2 groups. However, no stroke/TIA occurred in most of these studies. Furthermore, the rates of acute procedural complications were not significantly different between the 2 groups (LVA ablation 2.4% vs. control ablation 3.3%, RR 0.56, 95% CI: 0.30-1.07, P =0.08). Conclusion: LVA-guided substrate modification ablation appears to have a significant benefit in improving freedom from all-atrial tachycardia recurrence. Importantly, this benefit is achieved without a significant increase in the rates of acute procedural complications or cerebral thromboembolic events.

Ablation of the vein of Marshall (VOM) by dehydrated ethanol (DE) is an important method for completely blocking the mitral isthmus (MI). Before DE ablation of the VOM, Marshall angiography should be performed so that the contrast medium is inevitably exposed to DE. Here, we present a case of DE ablation of the VOM. When iodixanol was exposed to DE, some [floccule](javascript:;) embolized the lumen of the over-the-wire (OTW) balloon dilatation catheter and led to the impossibility of DE ablation. Then, we performed in vitro experiments: iodixanol, not iomeprol, produced many stable white floccules when it encountered DE. Our report showed that iodixanol is not an [appropriate](javascript:;) contrast for DE ablation of the VOM. However, if there is no other alternative contrast, the following methods might be used to address the problem: ⑴ diluted iodixanol (iodixanol: normal saline 1:1) could be used for VOM ablation; or ⑵ the lumen of the OTW could be flushed by NS after VOM angiography, and then DE injection could be performed.

Introduction: The ablation index (AI)-guided high-power ablation for pulmonary vein isolation (PVI) appears to be a novel strategy in treating atrial fibrillation (AF). This study aimed to evaluate the feasibility and safety of superior vena cava isolation (SVCI) by using an AI-guided high-power ablation strategy among patients with AF after PVI. Methods and Results: Data from 53 patients with AF were collected. Mapping and ablation of SVC were performed after PVI. The ablation power was set to 45 W and the ablation procedure was guided by AI. The SVC was divided into six segments in a cranial view. Applications and locations of radiofrequency (RF) were recorded. The RF applications and AI values in different SVC walls were compared and analyzed. SVCI was performed in 46 patients and electrical SVCIs were successfully achieved in all patients with a mean of 7.6 ± 2.9 RF applications. The mean time of the SVCI procedure was 9.5±4.5 min. The RF applications were located on different walls (anteroseptal anterior wall, 20/46 sites [43.5%]; posteroseptal wall, 38/46 sites [82.6%]; posterior wall, 40/46 sites [87.0%]; anterior walls, 37/46 sites [80.4%]; anterolateral wall, 27/46 sites [58.7%]; posterolateral wall, 23/46 sites [50%]). The mean AI value in septal, posterior, and anterior walls was higher than that of the lateral wall (392±28 vs 371±37, P < 0.001). There was no complication in any cases. Conclusion: AI-guided high-power ablation is a feasible and safe strategy for performing SVCI. The RF applications and AI value in different SVC walls varied.

We present a case of a man who had chronic otitis media caused acute bacterial meningitis due to Streptococcus pneumoniae. The neuroimaging indicated thick exudates in the CSF spaces. Our patient's CSF consisted of frank pus. The CSF white blood cell count was highly elevated, not reported in prior literature.

The Coronary Sinus Marshall Structure:

Ovarian torsion in pregnancy is an emergency, but it is frequently misdiagnosed because of its nonspecific symptoms. We report a pregnancy with ovarian torsion, which was previously misdiagnosed as acute appendicitis in 33-year-old G2P1 woman with the last menstrual period at 8--10 weeks.

We present a unique case of laparoscopically resected gastric adenocarcinoma with concurrent lanthanum deposition. Lanthanum depositions occasionally appear similar to carcinomas on endoscopy. and surgical resection should be considered for such concurrent carcinoma. Furthermore, more research is needed to clarify the relationship between carcinogenesis and lanthanum deposition.

Various conditions, including infections, can cause telogen effluvium (TE). One of them is coronavirus disease 2019 where hair loss usually begins between two and twelve weeks after the illness. Here, we present the case of a 17-year-old girl with having a history of such attacks since childhood.