Schistosomiasis is a tropical neglected disease commonly associated with rural areas; however, urban schistosomiasis has been reported world-wide, and increasing urbanization is one of the most important demographic shifts of the 20 th and now 21 st centuries. The pattern of urbanization is not uniform so that within the same city the rates and sources of population increase vary. Here we report on the parasite composition in one neighborhood in the metropolitan area of Salvador, Bahia, Brazil. Using epidemiological data and population genetics we find evidence for local transmission and maintenance of Schistosoma mansoni infection within an urban population and little contribution from rural-urban migration. Our findings provide direction for local mitigation strategies and to assist the public living in this neighborhood to interrupt the local transmission cycle.

The field of Artificial Intelligence (AI) in recent years, has proven critical in almost every sector of the economy. Numerous applications have been developed based on the concepts and techniques provided by this field. Every field of great potential continues to draw attention and evolve. As a result, well-defined terminology also plays a key role in the development and evolution of these important fields as AI is no exception. The PRISMA Flow Diagram is used in scanning the retrieved articles from the Scopus database. A total number of 347 articles were obtained as search results based on the research query of which 21 articles provided 34 definitions. A generic definition for Artificial Intelligence is proposed.

Solute-rich clusters, which generally exist stably in solution, are necessary intermediates for the formation of crystal nuclei. Studying the properties of these pre-nucleation species is very important for understanding and controlling the nucleation process of crystals. In this work, clusters as nucleation medium were studied using p-nitrobenzoic acid (PNBA) in acetonitrile as model system, and the observed PNBA clusters were characterized and analyzed by using DLS, NTA and 1H NMR. It was found that the clusters were thermodynamically stable and were spatially heterogeneous mixtures of PNBA monomers, PNBA homodimers and acetonitrile molecules. The existence of dimers is an important factor for the formation and stable existence of clusters. Clusters can be formed under the combined effect of monomer-dimer reaction and diffusion. The spatial distributions of monomer and dimer density at different concentrations were obtained by reaction-diffusion kinetics, and the different effects of filtration on clusters were theoretically explained.

Objective: To evaluate the hemostatic system with ROTEM in patients undergoing surgery for acute type aortic dissection (ATAAD) using elective aortic procedures as controls. Design: This was a prospective, controlled, observational study. Setting: The study was performed at a tertiary referral center and university hospital. Participants: Twenty-three patients with ATAAD were compared to 20 control patients undergoing elective surgery of the ascending aorta or the aortic root. Results: ROTEM (INTEM, EXTEM, HEPTEM and FIBTEM) was tested at 6 points in time before, during and after surgery for ATAAD or elective aortic surgery. The ATAAD group had an activated coagulation coming into the surgical theatre. The two groups showed activation of both major coagulation pathways during surgery, but the ATAAD group consistently had larger deficiencies. Reversal of the coagulopathy was successful, although none of the groups reached elective baseline until postoperative day 1. ROTEM did not detect low levels of clotting factors at heparin reversal nor low levels of platelets. Conclusions: This study demonstrated that ATAAD is associated with a coagulopathic state. Surgery causes additional damage to the hemostatic system in ATAAD patients as well as in patients undergoing elective surgery of the ascending aorta or the aortic root. ROTEM does not adequately catch the full coagulopathy in ATAAD. A transfusion protocol in ATAAD should be specifically created to target this complex coagulopathic state and ROTEM does not negate the need for routine laboratory tests.

Objectives In stress echocardiography (SE), dipyridamole (DIP) and dynamic stress (ExSE) are reported as safer than dobutamine stress (DSE). We investigated whether commonly used stressors cause myocardial injury, measured by high sensitivity troponin T (hsTnT). Methods 135 patients (DSE n=46, ExsE n=46, DIP n=43) with negative SE were studied. Exclusion criteria were known ischemic heart disease (IHD), baseline wall motion abnormalities, left ventricle systolic dysfunction/regional wall motion abnormalities, septum/posterior wall ≥13 mm, diabetes, baseline hsTnT level ≥14 ng/L, baseline blood pressure ≥160/100 mmHg, peak pulmonary pressure ≥45mmHg, eGFR <1mL/s/1.73m2, more than mild to moderate valvular disease and dobutamine side effects. HsTnT was measured before and 180 minutes after the test. Results All patients had low pre-test probability of IHD. HsTnT increased in DSE, less so in ExSE, and unchanged in DIP group [9.4 (1.5–58.6), 1.1 (-0.9–15.7), -0.1 (-1.4–2.1) ng/L, p<0.001]. In DSE, hsTnT change was associated with peak dobutamine dose (r=0.30, p= 0.045), test length (r=0.43, p=0.003) and atropine use (p<0001). In ExSE, hsTnT rise was more likely in females (p=0.012) and elderly (>65 years) (r=0.32, p=0.03), no association was found between atropine use (p=0.786) or test length and hsTnT rise (r=0.10, p=0.530). Conclusions DSE is associated with myocardial injury in patients with negative SE, no injury was observed in DIP and only mild one in ExSE. Whether myocardial injury is causative of the higher reported adverse event rates in DSE remains to be determined.

Aim: Renal function is an important covariate to describe variability in clearance of renally eliminated drugs. Estimating glomerular filtration rate (GFR) should account for differences in size, age and body composition consistently when using GFR to determine drug dosage. We aimed to develop a continuous model for renal function from prematurity to adulthood based on models for fat free mass (FFM), creatinine production rate (CPR) and GFR. Methods: A model for fractional FFM in premature neonates to adults was developed using pooled data from 4462 subjects and 2847 FFM observations. Data from 108 subjects with measurements of serum creatinine and GFR were used to construct a model for CPR by assuming that CLcr is equal to GFR. A previously published model for human GFR was updated using the model for fractional FFM and accounting for the effects of maturation and birth. Together these models were used to predict renal function. Results: Girls have a FFM larger than that predicted from adult women based on height, weight and sex. Boys have a FFM lower than adult men predicted FFM until around the onset of puberty, when it approaches adult values. CPR can be predicted using FFM, post menstrual age and sex and avoids discontinuous predictions between neonates, children and adults. The updated model for GFR maturation was used to describe expected normal GFR. Renal function calculated from the ratio of individual CLcr to normal GFR. Conclusion: Continuous models for FFM, CPR and GFR predict renal function independent of age and size.

Differential diagnosis of shock occurring within few hours to percutaneous coronary intervention (PCI) performed to treat acute ST-segment elevation myocardial infarction (STEMI) encompass periprocedural complications and causes of other type, including adrenal crisis (AC), sometimes presenting as Takotsubo syndrome.

The Esophagus Going SteadyTina Baykaner, MD, MPH and Duy T. Nguyen, MDStanford University, Stanford, CA , USA

Comment on Pediatr Blood Cancer. 2022;e29589. Standardizing the surgical management of benign ovarian tumors in children and adolescents: A best practice Delphi consensus statement.Matthew J. Murray1,2, Nigel J. Hall3, Sara Stoneham4, Anthony Penn5, Mark Brougham6, James C. Nicholson1,7; on behalf of the Children’s Cancer and Leukaemia Group (CCLG) Germ Cell Tumour (GCT) Special Interest Group (SIG).1 Department of Paediatric Haematology and Oncology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, CB2 0QQ, UK2 Department of Pathology, University of Cambridge, Tennis Court Road, Cambridge, CB2 1QP, UK3 University Surgery Unit, Faculty of Medicine, University of Southampton, Southampton SO16 6YD, UK4 Department of Paediatrics and Child Health, University College Hospital London NHS Foundation Trust, London, UK5 Department of Paediatric Oncology, Royal Manchester Children’s Hospital, Oxford Road, Manchester, M13 9WL, UK6 Department of Paediatric Oncology, Royal Hospital for Children & Young People, 50 Little France Crescent, Edinburgh bio Quarter, Edinburgh, EH16 4TJ, UK7 Department of Paediatrics, University of Cambridge, Cambridge University Hospitals NHS Foundation Trust, Cambridge, CB2 0QQ, UKConflict of interest statement : the authors declare no conflicts of interest.We read with interest the article from Braungart and colleagues, discussing management of young females with benign ovarian tumors [1]. This is important and timely, and we agree with the need for clarity in management of this under-investigated group. As the authors note, published evidence to support decisions is limited, so in certain areas, guidance may have to rely on expert opinion. The authors emphasize the importance of multidisciplinary team (MDT) discussion to optimise management and risk-stratification [1]. They highlight the importance and safety of ovarian-sparing-surgery in benign tumors, to preserve fertility and avoid long-term effects including premature ovarian failure [1].However, important aspects of their methodology are unclear. The denominator (number of experts approached to be involved) and response rate is not stated. The standard thresholds for accepting Delphi statements is >70% votes in support from >60% of experts in each voting round [2], as used in Delphi studies undertaken by the authors here [3,4]. Furthermore, there is no indication of level of support for statement(s) not reaching the 70% threshold. Moreover, they list specialties involved without defining numbers in each group, preventing assessment of the work’s objectivity and relative representation. Frequent criticisms of Delphi method work are poor questionnaire/statement design, compounded by inadequate definition/ selection of experts [5]. For example, ‘the inclusion of other clinicians… may be appropriate to provide an alternative clinical view, particularly when the study is expected to have an impact beyond a particular specialist field’ [5]. Of particular note, the study states that a ‘…. Delphi panel was instigated that included… pediatric oncologists representing CCLG Germ Cell Tumour Group’ [1]. Unfortunately, there was no pediatric oncologist involvement from the group in formulating the statements for discussion. Subsequently, only one was invited to participate in the Delphi itself, once the statements had been finalized. Furthermore, there was no patient/parent representation in the Delphi process, crucial to involve for a benign disease, with issues regarding surgical approach, fertility, and the burden of proposed ultrasound follow-up.The surgical guidance is useful; however, a size cut-off for minimally invasive surgery is specified, without supportive evidence [1]. Another incongruity is for tumor marker follow-up (section 2.3, bullet 7) if they were elevated preoperatively; by definition this group should have had normal markers at diagnosis (section 2.1, first paragraph) [1]. In the follow-up section (2.3), bullet-points 3-5 are most contentious as no evidence is presented for dictating time-interval to scan, and a recent systematic review looking at this indication, which concluded, based on available evidence, that ‘routine surveillance… should certainly be considered’ and suggested annual ultrasound [6], was overlooked. In addition, no reference is provided here to existing guidelines [7]. The recommended two-year interval between ultrasounds [1] is therefore neither evidence-based nor considers the patient/parent opinion. Furthermore, there is no justification for gynecologic fertility referral following ovarian-sparing-surgery where subsequent ultrasound shows normal ovarian reserve bilaterally. Consequently, terms relating to specific aspects that ‘should’ include/be undertaken/performed are inappropriate. Suggesting that ‘a reasonable strategy that could be considered might be as follows…’ would be a better approach.In summary, attempts to improve the management of young females with benign ovarian tumors are laudable. Some of the surgical recommendations made should help to streamline care. However, a representative group of key stakeholders were not included in the Delphi method and most of the follow-up recommendations cannot be justified based on use of a limited group of experts with limited supporting evidence. What is required is a wider collaborative approach, including GCT, surgical, gynecologic, radiology, and importantly patient groups, to answer these questions more robustly, preferably with international collaboration. This will also ensure appropriate clinician engagement, minimise inconsistencies in management and optimise outcomes for this patient group.

Soil salinity is a serious threat in arid and semi-aridagro-ecosystem of India,which is directly influenced the soil physical properties. Therefore, understanding the dynamic nature of salinity is key to implement suitable management practices for improving the fertility of saline soils. In this context, field experiments were conducted in saline soil, comprising five treatments of control (no amendments and chemical fertilizer), recommended dose nitrogen, phosphorus and potassium (N-P-K) fertilizers @ 60:30:30 kg ha-1 (100 % RDF), rice straw compost (RSC) @ 14 Mg ha-1, gypsum enriched compost (GEC) @ 14 Mg ha-1, and municipal solid waste compost @16 Mg ha-1 (MSWC) for three consecutive years (2012 to 2015). Results revealed that composts and chemical fertilizer application in saline soil had brought significant improvement in soil organic carbon (SOC), soil aggregate stability indices, soil water retention, transmission characteristics, and pore size distribution. This improvement in soil physical properties imparted into better soil physical environment and significant reduction in soil salinity (75%) was reported with application of MSWC. Multivariate analysis indicated that mean weight diameter (MWD) and retension pores (RP) were the main two soil physical properties that help to reduce soil salinity. Improved soil environment in compost amendated treatments broght significantly higher grain yield of mustard and pearl millet was observed with MSWC as compared to control. Organic amendments significantly improved the soil physical environment.

By employing the Nikiforov-Uvarov functional analysis (NUFA) method, we solved the radial Schrodinger equation with the shifted Morse potential model. The analytical expressions of the energy eigenvalues, eigenfunctions and numerical results were determined for selected values of the potential parameters. Variations of different thermodynamic functions with temperature were discussed extensively. Different quantum information theories including Shannon entropy, Fisher information and Fisher-Shannon product of the shifted Morse potential were investigated numerically and graphically in position and momentum spaces for ground and first excited states. The quantum information theories considered satisfied their corresponding inequalities including Bialynicki–Birula–Mycielski, Stam–Cramer–Rao inequalities and the Fisher–Shannon product relation.

Identification of uncommon clinical features of Herpes simplex virus encephalitis (HSVE) reduces its sequels and mortality. Vertigo has not been reported as the only neurologic presentation of HSVE. This article describes a patient with vertigo as the first neurologic symptom of HSVE and explains possible pathophysiological mechanisms of this manifestation.

For acute cholecystitis in patients with left ventricular assist devices, the use of percutaneous transhepatic gallbladder drainage to calm inflammation before planned laparoscopic cholecystectomy may be helpful in safely adjusting anticoagulation and in performing safe laparoscopic cholecystectomy, as demonstrated in this case.

A document by Sarvnipun Kaur. Click on the document to view its contents.

This paper presents a thorough methodology for the voltage assessment of pilot offshore wind project in Shandong province, China. The results presented in this paper can be considered as the milestone of the offshore wind research in Shandong since there is still no grid codes for offshore wind power plant grid connection in the local electrical power grid. It mainly consists of three parts. In the first part, a detailed model of the offshore wind farm created in the DIgSILENT PowerFacotry simulation platform is presented, including wind turbines, power converters, transformers, submarine cables and relevant control schemes. In the second part, nonlinear time-domain simulations were performed to analyse the wind farm’s active power, reactive power, and voltage conditions under different wind scenarios. Based on the simulations results, a dynamic reactive power compensation system was proposed, and the consequence of the reactive power compensation was also demonstrated using nonlinear time-domain simulations.

Microbiota play essential roles in nitrogen (N) cycling in freshwater river ecosystems. However, microbial functional groups associated with N cycling (especially denitrification) in freshwater rivers under anthropogenic disturbance are still poorly understood. Here, we studied the impacts of different land-use types on denitrification-related microbial communities in Weihe River, Hanjiang River, and their tributaries, in the Qinling Mountains, China. The major land-use types in the three river areas were divided into natural (forest, shrub, grassland, and open water) and anthropogenic (agricultural and urbanized land) types. A landscape survey of microbiota in the river water and sediment was carried out with extensive sample sources based on deep 16S rRNA gene sequencing, which yielded operational taxonomic units for predicting functional groups. With increases in proportions of agricultural and urbanized land areas, electrical conductivity, total N, ammonium-N, and nitrate-N all increased in water samples. Conversely, microbial diversity exhibited a decreasing trend in water samples, whereas the relative abundance of denitrification-related functional groups increased, with increases in the proportions of agricultural and urbanized land areas. The relative abundances of denitrification- and human-related microbial functional groups in sediment samples were distinctively higher in Weihe River (mainly under agriculture and urbanization), when compared with those of Hanjiang River and Qinling tributaries (dominated by forests). The results indicate that anthropogenic land-use types, such as agricultural and urbanized land, result in simple microbial community structure and stimulate microbe-mediated denitrification in freshwater rivers.

The 2019 novel coronavirus (2019-nCoV) is a respiratory pathogen able to cause a wide spectrum of disease, transmitted through the air and by droplet spread when an infected person sneezes or by contact with contaminated objects.

Aim: We aimed to examine fetal cardiac output (CO) in patients who recovered from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Materials: This prospective study included 48 pregnant women recovered from SARS-CoV-2 infection and 50 control cases. SARS-CoV-2 infection was diagnosed by polymerase chain reaction (PCR) test in patients. Fetal echocardiographic evaluations were performed at 24-37 weeks of gestation in pregnant women who recovered from the infection and control group. Results: The median value of ultrasound evaluation was 34 (2.6) weeks of gestation in the recovery from the SARS-CoV-2 infection (RSI) group, and 32 (7.6) weeks in the control group (p=0.565). Left cardiac output (LCO) z score was significantly lower in the RSI group than the control group (p=0,041). LCO and combine cardiac output (CCO) z score were significantly lower in the severe disease group than mild, moderate disease groups, and controls (p=0,019 and p=0,013). CCO (mL/min/kg) was decreased in the severe disease group when compared with control and mild disease groups (p=0,044). Fetal distress, preterm delivery rate, and neonatal intensive care unit (NICU) admission were found to be higher in the severe disease group compared to the control group (p=0,010, p=0,009, and p<0,001 respectively). Conclusion: In the present study, fetal cardiac output in pregnant women with recovery from SARS-CoV-2 infection was found significantly decreased, especially in whom had severe diseases. Placental dysfunction and inflammatory cytokines might cause fetal cardiac changes. Further studies could be clarified on the impact of SARS-CoV-2 infection on fetal cardiac function.

Left atrioventricular valve aneurysm is rare. We present a rare case of partial atrioventricular septal defect with an extremely thin left atrioventricular valve aneurysm mimicking valve perforation. The preoperative echocardiography demonstrated severe left sided atrioventricular valve regurgitation on the “cleft” and leaflet perforation. But in per-operative, we discovered a left sided atrioventricular valve aneurysm instead of valve perforation. The “cleft” edge and a aneurysm were closed.

OBJECTIVE: Our goal is to describe the association between total quantitative blood loss (QBL) and risk of obstetric hemorrhage-related morbidity (OBH-M) in order to assess utility of the current definition of obstetric hemorrhage (OBH). DESIGN: Retrospective cohort study. SETTING: Urban safety-net hospital in Boston, Massachusetts. POPULATION or SAMPLE: Deliveries at our institution over a two-year period. METHODS: We categorized deliveries into ten equally sized deciles based on QBL and compared the proportion with OBH-M in each. Among the two deciles with the highest proportions of OBH-M, we stratified deliveries into seven groups of ascending intervals of 250cc QBL. Finally, we compared the positive predictive value (PPV) of the standard definition of OBH (QBL ≥ 1000cc) to a definition extrapolated from our stratified analysis. MAIN OUTCOME MEASURES: The primary outcome was proportion of deliveries within each QBL decile affected by OBH-M. The secondary outcome was PPV. RESULTS: We found a significant increase in OBH-M from decile 9 (895-1201cc QBL) to decile 10 (1205-8325cc QBL) (p<0.001). In our stratified analysis, we found QBL of 1500cc to be an inflection point for an increased proportion of OBH-M. Our secondary analysis showed an increased PPV for OBH-M using QBL of 1500cc (20.5%) compared to that of QBL 1000cc (9.8%). CONCLUSIONS: Our findings suggest that a higher QBL threshold than the currently accepted definition of OBH is more predictive of OBH-M.

Known case COVID-19 is with the appearance of acute kidney injury with no previous history. Pathology studies mainly showed histological findings are consistent with thrombotic microangiopathy. With a high prevalence of comorbidities such as acute kidney injury, patients could suffer from severe forms of COVID-19.

Drug exposure is the most common cause of severe cutaneous reactions. Toxic epidermal necrolysis, erythroderma, drug rash with eosinophilia and systemic symptoms, acute generalized exanthematous pustulosis and drug induced vasculitis are the common cutaneous drug reactions which can have severe morbidity and evenmortality. Antiepileptics are among the drugs incriminated.

Recurrent post-tonsillitis erythema annulare centrifugum is a recently described entity in two adults with recurrent annular lesions and centrifugal evolution following tonsillitis. We present two cases of recurrent post-tonsillitis erythema annulare centrifugum in children.

A document by Sergio Bonini. Click on the document to view its contents.