Objective: To study the impact of COVID 19 pandemic on the prevalence, clinical profile, and pregnancy outcomes of women with severe anaemia. Design: Retrospective Case Control study Setting: Department of Obstertrics ,Tertiary care hospital of Delhi Population:Antenatal women >26 weeks and Hemoglobin<7 gm% Methods: After satisfying inclusion and exclusion criteria, cases were taken for a duration of six months during COVID pandemic, covid cases and controls from period six months post covid. Main outcome measures: Prevalence of anemia, Anemia indices and maternofetal outcome. Results: Total 4031 women delivered in study period compared to 6659 in control period. 74.7% and 51.6% were anaemic in study and control groups respectively (p < 0.001). Mean hemoglobin level was significantly lower in cases compared to the controls. Microcytic hypochromic anemia was most common morphological type of anemia in both groups. Serum ferritin, serum iron, serum B12 and folic acid levels among cases were significantly (p<0.05) lower as compared to controls. Odds of foetal growth restriction was 48% higher among cases as compared to controls. The odds ratio of new-born complications such as low birth weight 2.49 (95%CI: 1.04-5.91) and need for nursery or NICU admission 4.84 (95%CI: 0.48-48.24) was higher in cases as compared to controls. Low birth rate was higher in cases and was found to be statistically significant. Conclusion: India needs to focus on minimizing the indirect effects of the pandemic on the maternal and perinatal outcomes. Funding: none

Glioblastoma multiforme is the most aggressive malignant primary brain tumor. We need to better understand its microenvironment to design effective treatment strategies. Hence, characterization of glioma cells while providing their genetic and phenotypic stability is crucial. Here, we used dielectrophoresis (DEP) to underline the deformational heterogeneity of U87 glioma cell line. We fabricated a gold microelectrode array within a microfluidic channel and applied 3 V pp and 30 kHz to 10 MHz frequencies to generate DEP forces. We analyzed dielectrophoretic movement and deformation of 100 glioma cells. We observed that U87 glioma cells exhibited crossover frequency around 100 kHz - 200 kHz. The mean dielectrophoretic displacements of glioma cells were significantly different at varying frequencies with the maximum and minimum travel distances of 13.22 µm and 1.37 µm, respectively. The dielectrophoretic deformation indexes of U87 glioma cells altered between 0.027 – 0.040. It was 0.036 in the absence of dielectrophoretic forces. When we applied 3 V pp and 30 kHz to 10 MHz frequencies, the mean deformation indexes of the glioma cells did not significantly vary between 30 kHz - 500 kHz. The mean value of the deformation index was 0.028 under the influences of strong positive DEP forces when 500 kHz to 10 MHz were applied.

In this paper, we investigate a size-structured population dynamics model of Daphnia coupled with an unstructured algal food source, where there is a maturation delay in the birth process. Our research focuses on the stability properties of stationary solutions, especially the impact of maturation delay on the asymptotic behavior of system. The existence of the stationary solutions are discussed, and the linear stability results under some biologically conditions are investigated by means of the semigroup theory and the characteristic equation technique. Numerical simulations are performed to verify the theoretical results and display the different impacts of delay in several examples.

Background Up to a quarter of inpatients in high-income countries self-report beta-lactam allergy (BLA), which if incorrect, can increase use of alternative antibiotics that impact on bacterial resistance.. The epidemiology of BLA in low- and middle-income African countries is unknown. Methods Point-prevalence surveys were conducted at seven hospitals (adult, pediatric, government and private-funded, district- and tertiary-level) in Cape Town, South Africa between April 2019 and June 2021. Ward prescription records and interviews were conducted to identify BLA patients. De-labeling was attempted at the tertiary allergy clinic at Groote Schuur hospital. Findings A total of 1486 hospital inpatients were surveyed (1166 adults; 308 children). Only 48 (3.2%) patients self-reported a BLA with a higher rate amongst private- versus government-funded hospitals [6.3% vs 2.8%, p=0.014]. Using the PEN-FAST tool, only 10.4% (5/48) of self reported BLA patients were classified as high risk for true penicillin hypersensitivity. Antibiotics were prescribed to 70.8% (34/48) of self reported BLA patients, with 64.7% (22/34) receiving a beta-lactam. Despite three attempts to contact patients for de-labelling at the allergy clinic, only 3/36 underwent in vivo testing, with no positive results and one patient proceeded toa negative oral challenge. Interpretation Unlike high-income countries, self-reported BLA is low amongst inpatients in South Africa. The majority of self-reported BLA were low risk for type 1 hypersensitivity, but out-patient de-labeling efforts were largely unsuccessful. Funding None

Exosomes derived from mesenchymal stem cells regulate cell migration, proliferation, differentiation, and synthesis of the extracellular matrix. The ultracentrifugation method is the gold standard for exosome isolation with its simple protocol, high exosomal yield, allowing to work with high volume of sample features, but low purity and requirement of specialized equipment. Optimal isolation does not exist yet for obtaining the exosomes derived from mesenchymal stem cells for clinical usage. We hypothesized that magnetic-activated cell sorting may provide, effective and rapid exosomes derived from human mesenchymal stem cells when compared to ultracentrifugation. We, therefore, aimed to compare the efficiency of magnetic-activated cell sorting and ultracentrifugation for human bone marrow mesenchymal stem cell-derived exosome isolation from culture media by protein quantification, surface biomarker analysis, particle size and number analysis, and morphological analysis in vitro. Magnetically activated cell sorting provided a higher purity and amount of exosome when compared to ultracentrifugation. Magnetically activated cell sorting isolated samples exhibited the presence of magnetic beads morphologically. The particle number of the magnetic-activated cell sorting group was higher than the ultracentrifugation. In conclusion, the isolation of exosomes derived from mesenchymal stem cells by magnetic-activated cell sorting presents a quick and reliable method to collect them at high purity for clinical usage.

In this paper, the diffusive nutrient-microorganism model with time delay subject to Neumann boundary conditions is considered. The effect of time delay on the Hopf bifurcation and stability of positive constant equilibrium in the partial differential equation (PDE) and ordinary differential equation (ODE) models are analyzed. By choosing the time delay as the bifurcation parameter, it is found that the positive equilibrium is asymptotically stable when the delay is less than a certain critical value and unstable when the delay is greater than this value. In addition, it is also indicated that Hopf bifurcation occurs when the delay passes through a family of critical values. And then, the formulae to determine the direction of the Hopf bifurcation and the stability of the bifurcating periodic solutions by applying the normal form theory and center manifold theorem for partial differential equation are derived. Finally, to support our analytical results obtained for the ODE and PDE model with time delay, some numerical simulations are also included.

Previous studies have shown that patients with acoustic neuroma (AN) sometimes present with sudden sensorineural hearing loss (SSNHL) as an initial symptom. The purpose of this research was to investigate the clinical characteristics, diagnosis and treatment of AN in patients diagnosed as SSNHL initially. A total of 10 patients presented with SSNHL as the initial symptom and diagnosed as AN by magnetic resonance imaging (MRI) finally were enrolled in this study. Patient demographics, associated complaints (mostly tinnitus and vertigo), severity of hearing loss, audiogram configurations, auditory brainstem response (ABR) and MRI examination were reviewed and analyzed. Treatment outcome and management protocols were also included in this study. These patients exhibited varying severity of hearing loss and a variety of audiogram configurations. All patients showed an abnormal ABR. According to the Koos grading standard, there were 5 grade I (intracanalicular) tumors, 3 grade II tumors and 2 grade III tumors. The treatment outcome revealed that 2 patients exhibited recovery of the average hearing of impaired frequency by more than 15 dB, and 6 patients showed no recovery. Four patients were referred to undergo surgical treatment after being diagnosed with AN, 1 patient accepted stereotactic radiation therapy, and the remaining 5 patients were taken “waiting and scan” strategy. The findings of this study show that hearing recovery after corticosteroid treatment for SSNHL does not exclude the presence of AN and all patients diagnosed as SSNHL initially should undergo MRI and ABR to prevent misdiagnosis and delays in potential treatment.

Differentiating hepatoblastomas (HB) from other congenital benign hepatic tumours prior to surgical management decisions is key. We, herein, present an unusual case of an antenatally diagnosed liver lesion assessed in the neonatal period. Because of its predominantly cystic ultrasound/MRI appearance and borderline alpha-fetoprotein serum levels, the diagnosis of mesenchymal hamartoma was favoured and protocol-based tumor resection was performed. Due to the intra-operative diagnosis of fetal subtype HB with positive resection margins the child had to undergo a second laparotomy. This report raises awareness to an unusual appearance of HB and discusses non-invasive imaging clues to consider atypical appearances of HB pre-operatively as they can have profound implications in patient management.

Drinking water sources have higher water quality requirements because of their special uses. Many drinking water sources in the world have been polluted or are being polluted for a long time, resulting in eutrophication. We define the approaches that have been developed in the last 10 years and achieved good effect as innovative restoration approaches. In this paper, the traditional, and frequently used restoration approaches in recent 30 years were briefly reviewed, and the innovative technologies and methods were summarized and evaluated in detail. In light of the impact of COVID-19, we have also put forward rational suggestions on water quality restoration of transboundary rivers to provide scientific reference for global public health safety and protection.

Mountain rivers exert critical ecological effects downstream by retaining or transmitting sediment and nutrients, providing habitat and refuge for diverse aquatic and riparian organisms, and creating migration corridors. River microhabitat heterogeneity (RMH), which plays a key role in ecological restoration and improvement, is sensitive to external disturbances in mountain rivers. However, the effects of RMH, induced by hydro-geomorphological processes, on local macroinvertebrates have not been quantitatively studied. To explore the ecological significance of RMH, we selected five debris flow-dominated mountain rivers (DMR) and five equilibrium sediment transport mountain rivers (EMR) as contrasting examples based on the richness of sediment supply. We measured water depth, flow velocity, and substrate composition in all rivers and proposed a new RMH index (RMHI) for quantitative evaluation of RMH. Macroinvertebrate standing stocks, taxonomic diversity, functional diversity, and functional traits were compared between DMR and EMR. Macroinvertebrate standing stocks in DMRs were about one-third, and α-diversity was half, of those in EMRs. The macroinvertebrate communities exhibited a turnover-dominated pattern in both DMRs and EMRs. Resource availability and utilization efficiency were also smaller in DMRs than in EMRs, which caused a macroinvertebrate community shift from R-strategy to K-strategy. Besides, RMH supported macroinvertebrate α-diversity and functional richness in both DMR and EMR, but debris flow weakened the ecological role of RMH in DMR. Our findings suggested that, in order to maintain the ecological health of mountain rivers, RMHI should be ≥ 8.0. According study results, rivers with greater macroinvertebrate species richness should be managed as a priority for biodiversity conservation by maintaining RMH above its threshold. This could be achieved through the addition of large stones to rivers, which would act to create a large range of riverbed sediment sizes and variable flow regimes, as well as increasing the space available to macroinvertebrates.

Objective: The purpose of this study was to investigate alterations in routine echocardiographic parameters and left atrial(LA) strains in normal LA and large LA groups in end-stage renal disease(ESRD) patients. Methods: Thirty-five age-matched healthy individuals and 82 patients with ESRD, including 52 with LA maximum volume index(LAVmax I)＜34 ml/m2 (normal LA group)and 30 with LAVmax I≥34 ml/m2 (large LA group), were enrolled. LA volumes and longitudinal and circumferential strains were measured using 4-dimensional(D) volume-strain technology. Results: Left ventricular(LV) wall thickness, the Left ventricular mass index(LVMI), peak early diastolic trans-mitral flow velocity/average peak early diastolic mitral annular velocity(E/ E’), and peak systolic dispersion(PSD) were higher in normal LA and large LA group compared with the control group. Mitral valve early diastolic velocity/mitral valve late diastolic velocity(E/A), the early diastolic velocity at the septal mitral annulus(E’ septal), the early diastolic velocity at the lateral mitral annulus (E’ lateral), global longitudinal strain(GLS), left atrial peak longitudinal strain of reservoir function (LASr) and left atrial peak longitudinal strain of conduit function(LAScd) were lower in normal LA and large LA group compared with the control group. Left atrial peak circumferential strain of reservoir function(LASr-c) and left atrial peak circumferential strain of contractile function(LASct-c) were lower in the large LA group compared with the control group. In ESRD patients, LASr-c and LASct-c showed a good correlation with LAVmax I. Conclusions: This study showed that LA longitudinal strains had decreased before LA enlargement. When LA enlargement occurred, the circumferential strains decreased. This may indicate that longitudinal strain changed earlier than circumferential strain in ESRD patients.

Myositis is one of the uncommon adverse events following COVID--19 vaccination, and its mechanism is still unclear. In the hope of aiding in its better understanding, we present a case of myositis following the first dose of the ChAdOx1 nCoV-19 Corona Virus Vaccine, evidenced by serology and MRI.

A document by Hong Liu. Click on the document to view its contents.

Computational models are increasingly used to investigate and predict the complex dynamics of biological and biochemical systems. Nevertheless, governing equations of a biochemical system may not be (fully) known, which would necessitate learning the system dynamics directly from, often limited and noisy, observed data. On the other hand, when expensive models are available, systematic and efficient quantification of the effects of model uncertainties on quantities of interest can be an arduous task. This paper leverages the notion of flow-map (de)compositions to present a framework that can address both of these challenges via learning data-driven models useful for capturing the dynamical behavior of biochemical systems. Data-driven flow-map models seek to directly learn the integration operators of the governing differential equations in a black-box manner, irrespective of structure of the underlying equations. As such, they can serve as a flexible approach for deriving fast-to-evaluate surrogates for expensive computational models of system dynamics, or, alternatively, for reconstructing the long-term system dynamics via experimental observations. We present a data-efficient approach to data-driven flow-map modeling based on polynomial chaos Kriging. The approach is demonstrated for discovery of the dynamics of various benchmark systems and a co-culture bioreactor subject to external forcing, as well as for uncertainty quantification of a microbial electrosynthesis reactor. Such data-driven models and analyses of dynamical systems can be paramount in the design and optimization of bioprocesses and integrated biomanufacturing systems.

In recent decades, global warming under rising CO 2 significantly influences external organic carbon (EOC) input and drying-rewetting processes in terrestrial ecosystems. However, little is known about how soil CO 2 emissions respond to these perturbations, which provides us with a chance to explore potential factors and variability. In this study, a meta-analysis on the responses of CO 2 emissions with or without EOC input in the soil drying-rewetting cycles (DWC) based on 291 observations (included 33 study sites and 11 variables) has been conducted. The results indicated that i) CO 2 emission with the increase of EOC by 284% relative to without EOC under DWC; ii) The effect size of CO 2 emission was the smallest in the forest (+15%) and the largest in the grassland (+1468%); iii) The CO 2 emission effect sizes were substantially greater in complex substrates (+288%) than in simple substrates (+132%), and iv) longer drought period in a DWC can induce more CO 2 emission. The study suggests that terrestrial CO 2 emission may be multi folds in the long drought-rapid rewetting processes under large input of EOC.

Acharya Balkrishna1,2, Sourav Ghosh1, Srimoyee Banerjee1, Sumit kumar Singh1, Vedpriya Arya1, 2*

Craniopharyngiomas are rare, benign lesions that can be treated with surgery, radiation therapy or a combination of these modalities. They have a propensity for local recurrence but there have also been rare cases reported of ectopic recurrence. Here we present the case of a 12-year-old girl with a recurrence of craniopharyngioma in the spine, which is the second-ever reported case of recurrence outside of the brain in a pediatric patient, and review the 19 reported cases of ectopic recurrence in pediatric patients due to cerebrospinal fluid dissemination.

Currently, myocardial unroofing, coronary artery bypass grafting and percutaneous coronary intervention are chosen as treatments for myocardial bridge. We performed a male patient off-pump unroofing of left anterior descending coronary artery with techniques of minimally invasive surgery through the 4 th intercoastal space. Intraoperative coronary angiography was performed to evaluate residual lesions. Since this treatment strategy does not require full heparinization, it can be expected to reduce the amount of bleeding. This procedure not only has small incision, but also has some major advantages.

Evans syndrome (ES) is a combination of autoimmune cytopenias. Seldom patients with ES have been described as having neurological manifestations. We describe a case of ES presenting as increased intracranial pressure in a 4-year-old boy. This patient failed his routine vision screening and was found to have bilateral papilledema. Labwork: neutropenia, thrombocytopenia, and anemia with warm autoantibody IgG (Direct Coombs IgG 2+, C3 negative, weak para-agglutination). Brain MRI/MRA/MRV: increased intracranial pressure. CT abdomen/pelvis: enlarged paraaortic lymph nodes, without splenomegaly. Bone marrow biopsy/aspirate and LN biopsy: negative for evidence of malignancy or infection. Patient was managed with prednisone and topiramate.

Purpose: Computed Tomography (CT) scan has been well addressed to provide a diagnostic information for patients with prosthetic heart valve dysfunction. However, its role in the assessment of patients with prosthetic paravalvular leakage (PVL) has not been studied thoroughly. So, this study was conducted to assess the feasibility, reproducibility, and accuracy of CT for diagnosis of prosthetic PVL using surgical findings as the reference standard. Materials and methods: This was a prospective cohort study that was conducted on 26 consecutive patients with suspected prosthetic PVL who underwent both transesophageal echocardiography (TEE) and 64-slice ECG-gated CT. The gold standard was the intraoperative findings. Surgery was performed in twenty-six patients. Results: There was an excellent degree of agreement between CT and intraoperative findings for diagnosis, localization of prosthetic PVL. The perimeter of prosthetic PVL measured by CT was strongly correlated with echocardiographic severity of PVL by TEE (Spearman’s Correlation Coefficient, r = 0.83, P value = 0.0014). Conclusion: This study demonstrates that cardiac CT showed comparable diagnostic accuracy to TEE and intraoperative findings for the detection, localization, and assessment of severity of prosthetic PVL. Moreover, CT was shown to be useful in detection of other findings related to prosthetic cardiac valves.

Vaping associated lung injury (EVALI) has increased in prevalence after first being noted in an outbreak among teenagers in 2019. Vaping involves the use of a heating device to aerosolize a product, typically nicotine or more recently, cannabinoids. Products that contain cannabinoids, such as CBD oil, are being used more as these products are easy to obtain and are typically less expensive. The clinical manifestations of EVALI are widespread and include respiratory symptoms as well as cardiogenic, gastrointestinal, and constitutive symptoms. EVALI rarely presents with hemoptysis as one of the main presenting symptoms, especially in an adolescent. This case will discuss EVALI with associated hemoptysis in a teenager secondary to vaping cannabinoid oil.

Rationale: Animal models suggest pre-eclampsia (Pre-E) affects alveolar development, but data from humans are lacking. Objective: Assess the impact of Pre-E on airway function, diffusion capacity, and respiratory morbidity in preterm and term infants born from mothers with Pre-E. Methods: Infants born from mothers with and without Pre-E were recruited for this study; term and preterm infants were included in both cohorts. Respiratory morbidity in the first 12 months of life was assessed through monthly phone surveys. Raised volume rapid thoracoabdominal compression and measurement of diffusion capacity of the lung to carbon monoxide (DLCO)) were performed at 6 months corrected age. Results: There were 146 infants in the Pre-E cohort and 143 in the control cohort. The Pre-E cohort was further divided into non-severe (N=41) and severe (N=105) groups. There was no significant difference in DCLO and DLCO/aveolar volume amongst the three groups. Forced vital capacity was similar amongst the three groups, but the non-severe Pre-E group had significantly higher forced expiratory flows that the other two. After adjusting for multiple covariates including prematurity, the severe Pre-E group had a lower risk for wheezing in the first year of life compared to the other two. Conclusions: Pre-E is not associated with reduced DLCO, lower forced expiratory flows, or increased wheezing in the first year of life. These results differ from animal models and highlight the the complex relationships between Pre-E and lung function and respiratory morbidity in human infants.

Background: Cardiac ablation catheters are small in diameter and pose ergonomic challenges that can affect catheter stability. Significant finger dexterity and strength are necessary to maneuver them safely. We evaluated a novel torque tool to reduce muscle activation when manipulating catheters and improve perceived workload of ablation tasks. The objective was to evaluate measurable success, user perception of workload, and muscle usage when completing a simulated ablation task with and without the use of a catheter torque tool.Methods: Cardiology attendings and fellows were fitted with surface electromyographic (EMG) sensors on 6 key muscle groups in the left hand and forearm. A standard ablation catheter was inserted into a pediatric cardiac ablation simulator and subjects navigated the catheter tip to 6 specific electrophysiologic targets, including a 1-min simulated radiofrequency ablation lesion. Time to complete the task, number of attempts required to complete the lesion, and EMG activity normalized to percentage of maximum voluntary contraction were collected throughout the task. The task was completed 4 times, twice with and twice without the torque tool, in semi-randomized order. A NASA Task Load Index survey was completed by the participant at the conclusion of each task.Results: Time to complete the task and number of attempts to create a lesion were not altered by the tool. Subjectively, participants reported a significant decrease in physical demand, effort, and frustration, and a significant increase in performance. Muscle activation was decreased in 4 of 6 muscle groups.Conclusion: The catheter torque tool may improve the perceived workload of cardiac ablation procedures and reduce muscle fatigue caused by manipulating catheters. This may result in improved catheter stability and increased procedural safety

Planar antenna arrays of a balanced structure are of great importance in many applications due to their features including low-profile, wideband and high polarisation purity. However, feeding such antennas adds great complexity in terms of manufacturing and reduces the performance due to production of common mode propagation. A method for feeding such antennas using coplanar waveguide on a thin substrate is proposed. Not only does it terminate the antenna of a balanced structure with a single-ended feed but it also enables impedance transformation. The design was an attempt towards a completely printed front-end that incorporates the antenna elements and their feeding circuits on bendable substrates. The electromagnetic performance has been validated with a dual polarized prototype and its prospect for ultrawideband arrays e.g., 5G sub-6 GHz or square kilometre array, was explored.