We present a serious case of acute myocardial infarction soon after second vaccination for coronavirus disease 2019. Her pathological findings and intravascular imaging partly unveil how vaccine can cause acute coronary syndrome. It also shows the importance to observe closely high-risk patients of cardiovascular diseases after vaccination.

Title :Identification of gluten and major milk allergens Bos d 5 and Bos d 11 within commercially available honey.To the Editor,Although allergy to honey is rare, there have been documented systemic allergic reactions following ingestion of honey[1]. Interestingly, supplementary bee feeding with mixtures of soybean flour, dried brewer’s yeast (containing high levels of residual gluten from brewing processes), and dry skimmed milk with sugar and water, can be implemented by beekeepers to maintain healthy honeybee colonies[2]. Additionally, there have been reports of mould contamination within beehives[3]. Both factors suggest a potential for gluten and allergenic protein presence in honey, which could account for some of the reported reactions following honey consumption. As such, the aim of this study was to determine if commercially available honey contained undeclared gluten and/or food or mould allergens, and at levels which could present a risk to individuals with hypersensitivities.To investigate this, honey samples (n=40) of UK, EU, Non-EU and blended Non-EU/EU origin were extracted and analysed for gluten using the R5 immunoassay and for major allergen content using quantitative multiplex arrays for allergens from cow’s milk, egg, peanut, soy, hazelnut, cashew and moulds[4] (see online supporting material for methods) .Of the forty samples analysed, it was observed that 11 of the 40 (27.5%) samples contained gluten in the range of 2.5ppm to 13.8 ppm. Positive honey samples categorised by origin are detailed in Table 1 and Figure 1. Out of the 21 non-EU honey samples analysed, 7 were positive for gluten; forming 63.6% of the positive samples. From the 9 UK and 9 EU/non-EU blend honey samples, both had 2 samples positive for gluten, each accounting for 18.2% of the positive samples.Milk allergens Bos d 5 and Bos d 11 were detected in 7% of samples. The positive results ranged from 0.368mg/kg, up to 0.567mg/kg for Bos d 5, and from 0.030mg/kg up to 0.182mg/kg for Bos d 11; with one sample being a blend of EU/Non-EU honey, and two being of UK origin. Samples found to contain Bos d 5 and Bos d 11 were also positive for gluten. Results of the 3 positive samples are shown in Table 1 and Figure 1. No detectable amounts of egg, peanut, soy, hazelnut, cashew or mould allergen was identified in the samples. To our knowledge, this novel study is the first of its kind to identify the presence of milk allergen and gluten within honey. Consumers may take some reassurance in that levels of gluten detected in all samples fell below the current 20ppm ‘gluten free’ threshold[5]. Similarly, in the three samples positive for cow’s milk allergens Bos d 5 and Bos d 11, the levels of milk allergen detected did not exceed the VITAL 3.0 reference dose of 0.2mg of milk protein per serving; a level that should prevent 99% of the allergic population from having a reaction[6] (see online supporting information for VITAL 3.0 calculations). However, for both milk allergen and gluten, caution may be required when considering repeated consumption, leading to accumulating doses. The fact that no allergen contaminants other than milk were identified in the honey samples can offer consumers further reassurances. Current literature does not give reason to suspect contamination from sources other than milk and soy, so it is encouraging the data shows agreement.The findings herein could indicate honey suppliers may wish to undertake allergen testing of their products to offer greater safety to consumers. Moreover, it may be useful for future research to investigate the ability of allergen contaminants to be transferred from bee supplementary feeds to the final product to prevent possible accidental contamination of undeclared allergens.WORD COUNT : 587

Objectives: We evaluated radiotherapy planning CT-based radiomics for predicting clinical endpoints [tumor complete response (CR), 5-year overall survival (OS), hypohemoglobin, and leucopenia] after intensity-modulated radiation therapy (IMRT) in locally advanced cervical cancer (LACC). Methods: This study retrospectively collected 257 LACC patients treated with IMRT from 2014 to 2017. Patients were allocated into the training/validation sets (3:1 ratio) using proportional random sampling, resulting in the same proportion of groups in the two sets. We extracted 254 radiomic features from each of the gross target volume (GTV), pelvis, and sacral vertebrae in planning CT images. The sequentially backward elimination support vector machine algorithm was used for feature selection and endpoint prediction. Model performance was evaluated using area under the curve (AUC). Results: A combination of 10 clinicopathological parameters and 34 radiomic features achieved the best performance for predicting CR [validation balanced accuracy: 80.79%]. For OS, 54 radiomic features showed good prediction accuracy [validation balanced accuracy: 85.75%], and the threshold value of their scores can stratify patients into the low-risk and high-risk groups (P<0.001). The clinical and radiomic models were also predictive of hypohemoglobin and severe leucopenia [validation balanced accuracies: 70.96% and 69.93%]. Conclusion: This study demonstrated that combining clinicopathological parameters with CT-based radiomics had good predictive value for treatment outcomes and hematologic toxicities to radiotherapy in LACC. The prediction of clinical endpoints prior to radiotherapy may assist the radiation therapists to select the optimal therapeutic strategy with the minimal toxicity and best curative effect.

Objective: We aimed to explore the potential mechanism of pelvic lymph node (pLN) metastasis of cervical cancer (CC) by multiplex immunofluorescence (mIF) and construct a nomogram for preoperative prediction of pLN metastasis in patients with CC. Methods: A series of 90 patients with CC (2009 FIGO, IB1-IIA2) was retrospectively assayed with metastatic pLN or not. Tissue microarray (TMA) were prepared and tumor-infiltrating immune markers were assessed by mIF. Pearson correlation coefficients (R), linear regression and spatial proximity analysis were applied to study the potential mechanism of these markers. Multivariable logistic regression analysis and nomogram were used to develop the predicting model. Results: We concluded that T cells may interact with NK cells and macrophages through PD-1 and PD-L1 to promote pLN metastasis of CC. Multivariable logistic regression analysis and nomogram construct a predictive model and area under curve (AUC) can reach 0.843. By internally validation with the remaining 40 percent of cases, a new ROC curve was emerged and the AUC reaching 0.888. Conclusions: This study presents an immune nomogram, which can be conveniently used to facilitate the preoperative individualized prediction of LN metastasis in patients with CC. Keywords: cervical cancer, multiplex immunofluorescence, nomogram, internally validation

Objective: international validation of the Dutch Delphi consensus study about which anatomical structures that should be taught to ensure safe and competent practice among general gynaecologists. Design: Validation study. Setting: Academic, non-academic teaching and non-academic, non-teaching hospitals worldwide. Population: Gynaecologists and trainees in gynaecology. Methods: The relevance of 123 items included in the Dutch Delphi study was scored on a Likert scale between 1 (not relevant) and 5 (highly relevant). Consensus was defined when  70% of the panellist scored the item as relevant or very relevant and the average rating was  4. Main Outcome Measures: Clinically relevant anatomical structures. Results: A total of 192 gynaecologists and trainees from seven countries (Belgium, Germany, Norway, Oceania, Sweden, United Kingdom and United States) completed the questionnaire. Of the 123 structures, 72 (58.5%) were internationally relevant. When the 72 relevant structures from the international Delphi study were compared with the 86 relevant structures from the Dutch Delphi study, 70 (81.4%) structures matched. Conclusions: This study identified 70 anatomical structures that should be taught for safe and competent practice of general gynaecologists based on national and international validation. The results of our study identify the learning needs (i.e., the content) for an international anatomy curriculum. The development of the curriculum (i.e., the form) can be determined by each country and used to standardize and guide postgraduate training in gynaecology. This is an important step in the era of international teaching and training.

Bayesian inference is a tool for treating uncertainty, combining data and prior information from multiple sources and formats into updateable models, often of considerable complexity. Attention is increasingly being paid to the use of Bayesian inference in the study of host-pathogen systems, in which complex networks of between-individual interactions operate across a hierarchy of ecological strata. Despite growing interest, the adoption of hierarchical systems-models by ecologists remains rudimentary. Bayesian inference has been applied to wildlife disease networks at a population level, and to epidemiological diagnostic regimes at an individual level, but there exist very few attempts to integrate models and data that link individual-, group-, population-, landscape- and assemblage-levels of wildlife disease systems. Furthermore, the use of Bayesian techniques at an individual level has been limited, yet this is vital for uncovering the fine-scale interactions and latent variables typical of disease networks. This review explores the use of Bayesian hierarchical models in the study of host-pathogen systems, identifying the future research required to achieve the desired “whole-system” approach. We argue that the complexities and uncertainties underlying disease processes are best described within a Bayesian framework, contending that although the infrastructure to craft complex Bayesian hierarchical models exists, the actual application of these methods is limited within wildlife disease research.

Government policies face challenges whenever it is implemented or proposed. The ordinary Ghanaian always feels the down side of government policies. This paper ponders on the government of Ghana proposed electronic levy on mobile money transactions which was announced in the 2022 budget on November 17, 2021. Using the concept of sentiment analysis and Twitter data, we have carefully studied this government policy from the perspective of the ordinary citizen. Aside from conducting a non-bias examination, a full data analysis has also been performed on the data to further expound the reasons associated with the discontentment among people in the country. The results showed that data on sentiments are enormous on social media (twitter) and it serves as means for people to share their views. Our analysis depicted that phase five recorded the highest number of data, thus, 18,423 data with 24.43%, 59.29%, and 16.28% been positive, neutral and negative respectively. In our results, phase one recorded the least amount of data with 8.93%, 89.29%, 1.78% been positive, neutral and negative respectively in a total of 1,400. In the full data analysis on 38,771 tweets, 25.50%, 59.02%, and 15.48% were positive, neutral, and negative respectively.

Introduction: Anisomyopia (anisometropic myopia) is defined as an inter-ocular (cycloplegic spherical equivalent) difference greater than one dioptre between eyes among myopic individuals.1,2 Though the prevalence of anisomyopia among children is rare, a recent population-based study showed an increased prevalence (5.3%).3 Among Asian young adults and the severity of anisomyopia increased with older age, larger interocular axial length difference and higher cylindrical power.4 Often it is associated with amblyopia and aniseikonia (unequal image sizes) and may disrupt the binocular vision.5As both eyes of anisomyopic twins are subjected to similar genetic and environmental conditions, it is difficult to identify the factors responsible for causing the differences in refractive status between eyes. So it is important to understand the clinical characteristics and available interventions to manage the condition. As anisomyopia is not very common, the genetic element of this disorder has not been studied in siblings so far. Herein, I present a case report which elucidates the defining clinical characteristics and management of anisomyopia in identical twins.The objective of prescribing spectacle correction is correcting the uncorrected refractive error which helps in improving the visual acuity or binocular vision or a combination of both.6 To the best of our knowledge very limited guidelines are available prescribing anisometropia using spectacles. Since anisomyopia is very rare this might be the reason for the limited or non-availability of prescribing guidelines. This case report describes how a pair of identical twins with anisomyopia was managed for anisomyopic refractive errors.

Eryngium maritimum L. (Apiaceae) is a geophyte that inhabits in the dunes of the Mediterranean and Atlantic. In Northern Europe, it is considered a highly endangered species due to reproductive problems, while in the Mediterranean, populations are in a good state of conservation. Although it is a highly entomophilous species, there is little literature on its pollinators. The aim of this study is to analyse the role played by E. maritimum in the dune pollination network of the Balearic Islands. For this purpose, two populations located in the North and South of Mallorca were chosen, in which diurnal transects were carried out to observe and capture pollinators on 15 plant species during the anthesis period of E. maritimum. In parallel, an analysis of the flowering period of 10 of these plant species was carried out to identify periods of competition. A total of 82 pollinator species were found, belonging to 30 different families. Eryngium maritimum is a strongly generalist species, with a total of 46 pollinator species. Functionally, Teucrium dunense and Helichrysum stoechas are functionally the most similar species to E. maritimum. However, analysis of phenology suggests that these three species have been able to decouple their blooms to avoid competition. The present study shows that E. maritimum plays a key role in the dune pollination network, being its anthesis located at the end of the dune flowering season, when there are no functionally similar species in flower.

ABHISHEK KUMARer.abhisngh827@gmail.com

Gracilaria chilensis is the main cultivated seaweed in Chile. The low genetic diversity observed in the Chilean population has been associated with the over-exploitation of natural beds and/or the founder effect that occurred during the post-glacial colonization from New Zealand. How these processes have affected its evolutionary trajectory before farming and incipient domestication is poorly understood. In this study, we used 2,232 SNPs to assess how the species evolutionary history in New Zealand (its region of origin), the founder effect linked to transoceanic dispersion and colonization of South America, and the recent over-exploitation of natural populations have influenced the genetic architecture of G. chilensis in Chile. The contrasting patterns of genetic diversity and structure observed between the two main islands in New Zealand attest to the important effects of Quaternary glacial cycles on G. chilensis. ABC analyses indicated that Chatham Island and South America were colonized independently near the end of the Last Glacial Maximum and emphasized the importance of coastal and oceanic currents during that period. Furthermore, ABC analyses inferred the existence of a recent and strong genetic bottleneck in Chile, matching the period of over-exploitation of the natural beds during the 1970s, followed by rapid demographic expansion linked to active clonal propagation used in farming. Recurrent genetic bottlenecks strongly eroded the genetic diversity of G. chilensis prior to its cultivation, raising important challenges for the management of genetic resources in this incipiently domesticated species.

Objectives. Viral bronchiolitis represents one of the main cause of hospitalization for children in developed and incoming countries. Nasal High Flow (NHF) oxygen therapy improves oxygenation and reduces respiratory drive by enhancing carbon dioxide wash-out. However, little is known about physiological effects of noninvasive helmet-Continuous Positive Airway Pressure (h-CPAP) and NHF on respiratory Work Of Breathing (WOB) in bronchiolitis. Objective of the study is to measure Esophageal Pressure Time Product*minute (PTPes*min-1) as a surrogate for WOB in acute bronchiolitis during NH at different flow rates in comparison with conventional h-CPAP. Pressure Rate Product, physiological parameters and gas exchange were considered as secondary end-points. Methods. This is a physiological randomized crossover-study comparing four 20-minute trials: oxygen therapy delivered by non-fitting mask, NHF2l/Kg, NHF3l/Kg, h-CPAP 7cmH2O. Results. Were enrolled ten children with bronchiolitis needing noninvasive respiratory support. PTPes*min-1, Respiratory Rate and Pressure Rate Product decreased progressively from h-CPAP compared to NHF3l/kg, NHF2l/kg and oxygen mask (p<0.01 for all parameters). SpO2:FiO2 increased during h-CPAP versus NHF3l/kg, NHF2l/kg and oxygen mask (p<0.01). Transcutaneous carbon dioxide tension was affected by increasing flow rate showing a progressive reduction at NHF3l/kg, NHF2l/kg and during h-CPAP compared to oxygen mask (p<0.001). Conclusions. h-CPAP was associated with a reduction in WOB and with a better oxygenation compared to oxygen mask and NHF trials; 2) NHF trials improved oxygenation and reduced the carbon dioxide tension compared to oxygen mask 3) NHF3l/kg does not offer advantages compared to NHF 2 l/kg in improving oxygenation and carbon dioxide wash-out.

According to prevailing theory, sexually reproducing animals adapt to different environments by the production of phenotypic variation from the standing genetic variation and selection of the most suited phenotypes. Contrary to all expectations, asexually reproducing animals can also inhabit broad ranges of geographical latitudes, altitudes and habitats, despite virtual genetic identity. Recent whole genome analyses of differently adapted clonal populations and genetically impoverished invaders revealed that they can use epigenetic variation instead of genetic variation to stably adapt to different environments. The required phenotypes are produced from the same DNA sequence via changes in gene expression, which is trigged by strong environmental cues and mediated by environment-sensitive epigenetic mechanisms like DNA methylation. Habitat-specific epigenetic fingerprints were maintained over subsequent years, pointing at the existence of epigenetic ecotypes. Obviously, all animals can produce different phenotypes from the same DNA sequence, but in asexually reproducing populations, genetically impoverished invaders, sessile taxa and species with long generation times it is apparently of prime importance. In contrast to beneficial genetic mutations and meiotic gene combinations that require many generations to be established in a population, environmentally-induced epigenetic changes and subsequent alterations in gene and phenotype expression affect population members synchronously in the first exposed generation, providing an ideal means for fast, directional adaptation to changing conditions. The production of different phenotypes from the same genome in response to different environmental cues via epigenetic mechanisms is also suitable to explain the “general-purpose genotype” and the “genetic paradox of invasion”.

Performing peripherally inserted central catheters for children with bilateral bidirectional Glenn shunt, Fontan circulation and persistent left superior vena cava differs from those with normal central venous anatomy. This study presents two PICC procedures for a toddler with this condition to demonstrate an accurate PICC approach for such children.

A document by Patrick Reeves. Click on the document to view its contents.

In this paper, by introducing two meaningful auxiliary variables, a mixed finite volume element scheme for the time-fractional damping beam vibration equation is established. The scheme can keep the local conservation of physical quantity and reduce the computational cost. Then the stability and convergence of the scheme are analyzed, and numerical examples show its effectiveness. In the end, we test the value of different sets of parameters to observe the influence of damping coefficient and order of fractional derivative on the model. The results of this paper can be used for modeling the damping of the viscoelastic structures.

The retroperitoneal may be affected by variety of infectious, inflammations and tumors including benign or malignant ones. Although primary malignant tumors are the most prevalent tumors in this anatomic area, metastatic and invasive tumors rarely involve retroperitoneum. Gastrointestinal stromal tumors (GISTs) counted the most common tumors with invasion the retroperitoneum

Various root-colonizing bacterial species can promote plant growth and trigger systemic resistance against aboveground leaf pathogens and herbivore insects. To date, the underlying metabolic signatures of these rhizobacteria-induced plant phenotypes are poorly understood. To identify core metabolic pathways that are targeted by growth-promoting rhizobacteria, we used combinations of three plant species and three rhizobacterial species and interrogated plant shoot chemistry by untargeted metabolomics. A substantial part (50-64%) of the metabolites detected in plant shoot tissue was differentially affected by the rhizobacteria. Among others, the phenylpropanoid pathway was targeted by the rhizobacteria in each of the three plant species. Differential regulation of the various branches of the phenylpropanoid pathways showed an association with either plant growth promotion or growth reduction. Overall, suppression of flavonoid biosynthesis was associated with growth promotion, while growth reduction showed elevated levels of flavonoids. Subsequent assays with twelve Arabidopsis flavonoid biosynthetic mutants revealed that the proanthocyanidin branch plays an essential role in rhizobacteria-mediated growth promotion. Our study also showed that a number of pharmaceutically and nutritionally relevant metabolites in the plant shoot were significantly increased by rhizobacterial treatment, providing new avenues to use rhizobacteria to tilt plant metabolism towards the biosynthesis of valuable natural plant products.

Abstract Insect population dynamics are the result of an interplay between intraspecific competition, trophic interactions and external forces such as weather conditions, but studying how these processes combine to determine population change is challenging. We investigate mechanisms of population dynamics in a natural, low density insect population. Eggs and larvae of the noctuid moth, Abrostola asclepiadis, develop on its host plant during summer. The population density, and mortality, was closely monitored throughout this period during 15 years. Densities fluctuated between one and two orders of magnitude. Egg -- larval developmental time varied substantially among years, with lower survival in cool summers with slower development. This was presumably due to the prolonged exposure to a large guild of polyphagous arthropod enemies. We also found a density dependent component during this period, that could be a result of intraspecific competition for food among old larvae. Dynamics during the long period from pupation in late summer through winter survival in the ground to adult emergence and oviposition the next year displayed few clear patterns and more unexplained variability, thus giving a more random appearance. The population hence shows more unexplained or unpredictable variation during the long wintering period, but seems more predictable over the summer egg-larval period. Our study illustrates how weather - via a window of exposure to enemies and in combination with density-dependent processes - can determine the course of population change through the insect life cycle.

[1] Faculty of Economics and Administrative Sciences, Mugla Sitki Kocman University, 48000 Mugla, Turkey. E-mail: dicleozdemir@mu.edu.tr

Yellow nail syndrome is a rare lymphatic abnormality without a clear pathogenesis. Hereby, we report A 70-year Sudanese female who presented with recurrent cough, recurrent lower limb swelling and yellowish nail discoloration diagnosed as yellow nail syndrome but unfortunately passed away due to acute respiratory distress syndrome (ARDS).

This case series describes use of a combination of Lymphaticovenular anastomosis (LVA) and sclerotherapy to treat cystic lymphatic malformations with satisfactory results. In the first case, the patient presented with persistent lymphocele after resection surgery. Our second and third cases presented with cystic lymphangioma in the subclavicular and thigh regions.

Occupational cutaneous squamous-cell carcinoma has an increased incidence, but rarely suspected. When located in an uncovered skin area, it is closely linked to polycyclic aromatic hydrocarbons exposure. However, single pulmonary anthracosis nodule is rarely described in the literature. The association of both diseases due to the same exposure remains uncommon.

We estimated the seasonal patterns of evapotranspiration (ET) using measured field data in a typical headwater basin and four sub-basins, in subtropical climate region of Serra da Mantiqueira/South-East Brazil, with a multi-instrument hydrometeorological set (standard weather station variables, discharge, soil moisture, and surface-atmosphere turbulent fluxes), towards providing regional data, to our knowledge, hitherto non-existent, of independent ET from micrometeorological methods (eddy covariance EC and Bowen ratio BR), energy balance closure corrections, and water budget based modelling, to discuss the magnitude and seasonality of the most accurate ET possible to be obtained. We had an unsatisfactory closure of the energy balance for the EC method, and the BR method likely also did not meet satisfactory estimates, as both suffered from the non-ideal conditions of the experimental site imposed by secondary atmospheric circulations. The comparison of the mean annual ET among 3 correction methods with the water budget showed an agreement in the range from 2.6 to 2.9 mm d −1, that was particularly met by the approaches of Mauder et al. (2013) and Twine et al. (2001), of 2.8 mm d −1. These corrections respected upper limits of potential evapotranspiration. Nighttime corrections were not applied, that possibly explains how daily totals of the H + LE sum overestimated about 9% of the available energy, that led to an overestimated ET of roughly less than 5% by those corrections. The seasonal variability of ET ranged from the minimum of 1.3 mm d-1 in July, and high fluxes in the wet season of about 3.5 mm d-1. The maximum H flux in September indicated how the onset of rainfall and the quick response of soil moisture recovery prevented H to increase onwards on the rhythm of radiation. Soil moisture appeared to play a key role in not only ET but in controlling the energy partition.