Headwater basins are central for meeting water management and, in humid tropical areas, essential to understand the baseflow, the discharge component that maintains water availability during the dry season, and the stormflow generated from recurrent convective clouds that can lead to flash floods. We 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 (precipitation, streamflow, baseflow, stormflow, soil moisture SM, water table depth WTD), towards providing regional data, to our knowledge, hitherto non-existent, on hydrological response patterns, and variation of stormflow generation with boundary conditions and scale. Precipitation recovered in September and peaked in January concurrently with streamflow. Baseflow responded for most of the streamflow during the dry season and about half in the wettest months, and peaked ahead in March, highly covariated with WTD. In contrast, SM described a longer yearly memory, that recovered 3 months earlier than streamflow, and depleted 2 months latter in March. The monthly scale stormflow responded significantly to rainfall although with low predictability. At the event scale, revealling patterns for all basins showed thresholds of precipitation (≃ 10 mm), SM (≃45% to 57%) and WTD ≃135 cm, below which stormflow was modest. The event stormflow coeficient (eSC) reached up a maximum of 25%, albeit with large variance and little seasonality of the median. Estimates of eSC with double mass and SM thresholds showed pronounced spatial and temporal differences (3.2 to 9.6% in drier conditions and 7.7 to 15.4% wetter conditions). Mean streamflow and runoff coefficient were quite lower at the main basin (21% compared to about ≃32% between sub-basins), where there possibly exists groundwater flux exportation, that discharge on a larger spatial scale, by water exiting the basin without passing through the surface outlet.

Waldmann’s disease (WD) is an exudative intestinal disorder that affects children or young adults, causing protein deficiency, lymphopenia and malabsorption of fat-soluble vitamins. We describe a case of a 19–year-old male with a history of WD since the age of 6 months associated with cutaneous eruption of the scrotum

  Sarah Cordey RM, School of Community Health and Midwifery, THRIVE Centre, University of Central Lancashire, Preston, UK   Gill Moncrieff RM, Research in Childbirth and Health Group, THRIVE Centre, University of Central Lancashire, Preston, UK   Joanne Cull RM, School of Community Health and Midwifery, THRIVE Centre, University of Central Lancashire, Preston, UK   Arni Sarian, School of Medicine, University of Central Lancashire, Preston, UK Deborah Powney, MSc, Research in Childbirth and Health Group, THRIVE Centre, University of Central Lancashire, Preston, UK  Dr Carol Kingdon, PhD, Wirral University Teaching Hospital NHS Foundation Trust, Wirral, UK Dr Claire Feeley, PhD, Research in Childbirth and Health Group, THRIVE Centre, University of Central Lancashire, Preston, UK  Professor Soo Downe PhD, Research in Childbirth and Health Group, THRIVE Centre, University of Central Lancashire, Preston, UK  On behalf of the ASPIRE Covid-19 Team (see Appendix A1) Corresponding Author: Sarah CordeyOver the past two decades there has been a developing staffing crisis in British maternity services (1). A 2021 Health and Social Care Committee Expert Panel report described “persistent gaps in all maternity professions” and proposed that “current recruitment initiatives do not consider the serious problem of attrition in a demoralised and overstretched workforce and do not adequately value professional experience and wellbeing” (2). Reduced staff capacity and excessive workload can have a profoundly detrimental impact on safety for women and babies (3,4). The ongoing impact of the COVID-19 pandemic on the National Health Service (NHS) has led to discussion around the long-term effects on staff from acute staffing shortages, the moral distress of being unable to provide the desired level of care, and the heavy emotional labour of being a front-line healthcare worker during a pandemic. (5)This commentary explores the impact of these factors on maternity staff during the COVID-19 pandemic and reflects on the implications for the future of maternity services design and delivery. The discussion relates to a thematic analysis (6) and NVivo word frequency analysis of in-depth interviews with 28 maternity staff (20 midwives, seven medical staff and one student midwife), 28 heads of service, and 26 women who gave birth during the pandemic, from seven NHS trusts across England. The interviews took place between November 2020 and October 2021 and were collected as part of the Achieving Safe and Personalised maternity care In Response to Epidemics (ASPIRE COVID-19) study. The overall aim of ASPIRE COVID-19 is to determine what worked to provide safe and personalised care maternity during the pandemic, both to optimise care under usual circumstances, and to improve the response to future crises. The analysis resulted in one overarching theme, and three sub-themes, as illustrated in Figure 1. Supporting quotes are shown in Figure 2 and Table S1.

MORC2 gene encodes a ubiquitously expressed nuclear protein involved in chromatin remodeling, DNA repair, and transcriptional regulation. Heterozygous mutations in MORC2 gene have been associated with a spectrum of disorders affecting the peripheral nervous system such as Charcot-Marie-Tooth (CMT2Z), spinal muscular atrophy-like (SMA-like) with or without cerebellar involvement, and a developmental syndrome associated with impaired growth, craniofacial dysmorphism and axonal neuropathy (DIGFAN syndrome). Such variability in clinical manifestations associated with the increasing number of variants of unknown significance detected by next-generation sequencing constitutes a serious diagnostic challenge. Here we report the characterization of an in vitro model to evaluate the pathogenicity of variants of unknown significance based on MORC2 overexpression in a neuroblastoma cell line SH-EP or in cortical neurons. Likewise, we show that MORC2 mutants affect survival and trigger apoptosis over time in SH-EP cell line. Furthermore, overexpression in primary cortical neurons increases apoptotic cell death and decreases neurite outgrowth. Altogether, these approaches establish the pathogenicity of two new variants p.G444R and p.H446Q in three patients from two families. These new mutations in MORC2 gene are associated with autosomal dominant CMT and with adult late onset SMA-like phenotype, further increasing the spectrum of clinical manifestations associated with MORC2 mutations.

Cases of aspergillosis superinfection have been reported as acute complications of Covid-19. Here we report a case of combined chronic necrotizing pulmonary aspergillosis, aspergilloma and fibrosing aspergillosis in a 31-year-old woman with a history of Covid-19. This unusual association deserves special attention in a secondary immunocompromised patient after Covid-19.

Systemic juvenile idiopathic arthritis (sJIA, also called Still’s disease) is a rare childhood auto-inflammatory disease with significant morbidity. This case report illustrates the clinical course and highlights diagnostic challenges. FDG-PET/CT imaging may be beneficial in the diagnostic process for some cases, in order to achieve rapid diagnosis and early treatment.

Objective: To evaluate the quality of life in patients treated for submucosal leiomyomas after hysteroscopy myomectomy compared to medical therapy Patients: Patients with symptomatic submucosal leiomyomas from 2014-2017. A total of 69 patients enrolled, with 47 completed. Interventions: Each patient was randomized to (1) oral contraceptive pills/progesterone releasing intrauterine device or (2) hysteroscopic myomectomy using a hysteroscopic tissue removal system. Each patient was to complete the Uterine Fibroid Symptom and Health-related Quality of Life (UFS-QOL) questionnaire at baseline, one month, three months, and greater than or equal to six months after treatment. Measurements and Main Results: Primary outcome was the health-related quality of life (HR-QOL), as reflected from UFS-QOL scores. Contrasts were constructed from a linear mixed-effects model to compare the two treatment groups for changes from baseline in UFS-QOL scores. UFS-QOL scores were similar at baseline between the two treatment groups. There was an overall improvement in all UFS-QOL scores within each group. Higher improvement scores were noted in the surgical group compared to the medical group for almost all UFS-QOL scores. At ≥6 months, in comparison to the medically managed patients, the most considerable score improvements for the surgical group were reported in HR-QOL concern, activities, self-consciousness and symptom severity scores having mean change scores (95% CIs) of 35.3 (22.3 – 48.2), 28.9 (16.3 – 41.5), 28.6 (15.0 – 42.1), and 32.2 (21.5 – 43.0), respectively. Conclusion: Patients with submucosal leiomyomas who received medical or surgical treatment reported similar improvement in overall health related quality of life scores.

Waldmann’s disease / Primary intestinal lymphangiectasia, is an unusual cause of protein losing enteropathy primarily characterized by lymphopenia, hypoalbuminemia and hypogammaglobulinemia. However, variable clinical presentation results in diagnostic dilemma and effective management. We present a toddler diagnosed with Waldmann’s disease managed with high protein diet and medium chain triglycerides supplementation.

A document by Gauthier Toutain. Click on the document to view its contents.

ABSTRACT Background: This study was conducted to investigate the relationship between clinical course and pulmonary artery (PA) diameters in children diagnosed with COVID-19. Method: The study included 62 patients who presented COVID-19 symptoms between March 2020 and April 2021. Group 1 consisted of 32 pediatric patients who were COVID-19 PCR (+), while Group 2 consisted of 30 pediatric patients who were COVID-19 PCR(-). The data were collected retrospectively from medical records. Patients who developed pneumonia due to causes other than COVID-19 and those who had a history of pulmonary hypertension or pulmonary thromboembolism were excluded. The patients were examined based on their Computerized Tomographic (CT) findings, simultaneous whole blood parameters and biochemical parameters. Results: The thoracic CT findings of 18 of the patients in Group 1 were found normal. The CT images of 14 patients showed pulmonary involvement. Among the patients with pulmonary involvement, 8 had moderate pneumonia characterized by a ground-glass pattern, and 6 had severe pneumonia indicated by consolidation and linear opacities. The right pulmonary artery, left pulmonary artery and inferior vena cava (IVC) diameters of the patients in Group 1 were significantly higher than those of the patients in Group 2. Conclusion: The results of this study suggested that increased PA diameters in children diagnosed with COVID-19 may be accompanied by increased inflammation, high vascular resistance, hypoxemia and thromboembolic events. While it is thought that increased PA and IVC diameters are a factor that may indicate clinical deterioration in COVID-19 patients, more comprehensive studies are needed.

Sentinel lymph node mapping in patients with axillary breast carcinoma is technically challenging and poorly described in the literature. We report a patient with primary ectopic breast carcinoma of the axilla in whom concurrent peri-tumoral and intra-tumoral injection of radionuclide tracer allowed for identification and biopsy of sentinel lymph nodes.

Small cell osteosarcoma is a rare sub-type of osteogenic malignant tumors. Rib localization is uncommon. Histological examination is an important step to make the difference with similar tumors like Ewing sarcoma. Surgical resection is the unique curative treatment. Prognosis remains poor even with adjuvant treatment

Abstract Objectives: An association between COVID-19 and anosmia has been demonstrated worldwide. Calcium cations play an essential role in odor transmission, including feedback inhibition. Therefore, it is suggested that reducing intranasal free calcium cations with topical chelating agent pentasodium diethylenetriamine pentaacetate may improve olfactory function in patients with anosmia post COVID-19 infection. Design: Prospective controlled clinical trial to test use of pentasodium diethylenetriamine pentaacetate for post COVID-19 olfactory loss. Setting: ENT Department (Institution blinded for review). Participants: Sixty-six adult patients with history of confirmed COVID-19 and olfactory dysfunction persisted more than 90 days after SARS-CoV-2 negative testing were included. Main outcome measures: Participants were divided into 2 equal groups receiving nasal spray containing either 0.9% sodium chloride or 2% pentasodium diethylenetriamine pentaacetate. Olfactory function was assessed before treatment and 1 month later using the Sniffin’ Sticks test. A carbon paste ion-selective electrode was developed for quantitative analysis of calcium cation concentrations in nasal mucus before treatment and 1 month later. Results: After treatment with pentasodium diethylenetriamine pentaacetate, there was a significant improvement from functional anosmia to hyposmia compared with sodium chloride. In addition, the decrease of calcium concentration was recorded after treatment with pentasodium diethylenetriamine pentaacetate compared with sodium chloride. Conclusion: Based on the results of the proposed study, topical use of pentasodium diethylenetriamine pentaacetate may be a useful therapy for olfactory dysfunction after COVID-19.

Suppliers often offer item-wise price discounts and trade credit to their retailers after receiving an initial payment for the supplied product. This discount is proportional to the total payment done already against the total cost accrued by the retailer. The supplier may also decide to allow the retailer to prepay a random part of the purchasing cost at any random time within the duration that an advance payment is allowed. In order to encourage the customers to increase their orders, the retailer, in turn, offers a trade-credit for a partial amount of the sale price to the customers. In this paper, we focus on the optimal replenishment policies of a retailer that could maximize the retailer’s average profit when he/she is confronted with the supplier’s trade offers of credit and price-discount under a two-layer supply chain management in a stochastic environment. We have obtained some theoretical results from the optimum cycle time and optimum order quantity of the proposed model and numerically analysed with a suitable example to demonstrate the real-life applicability of the model. Finally, sensitivity analyses are made on the significant parameters in order to gain some managerial insights.

In this paper we propose a numerical method for American multi-asset options under jump-diffusion model based on the combination of the exponential time differencing (ETD) technique for the differential operator and Gauss-Hermite quadrature for the integral term. In order to simplify the computational stencil and improve characteristics of the ETD-scheme mixed derivative eliminating transformation is applied. The results are compared with recently proposed methods.

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vHPvSD ablation represents a quantum leap from the RF settings that have traditionally been used in electrophysiology. If used to its full potential, it may improve procedural efficiency by reducing ablation and procedure times. However, with great power comes great responsibility; we need to ensure that we use it judiciously and safely.

Catheter based cardioneuroablation is increasingly being utilized to improve outcomes in patients with vasovagal syncope and functional atrioventricular block. There is now increasing convergence amongst enthusiasts on its various aspects, including patient selection, technical steps, and procedural end-points. This pragmatic review aims to take the reader through a step-by-step approach to cardioneuroablation: we begin with a brief overview of the anatomy of intrinsic cardiac autonomic nervous system, before focusing on the indications, pre- and post-procedure management, necessary equipment, and its potential limitations.

Through the comprehensive analysis of ab initio and experimental results of a large number of diatomic systems, the systematic deviation of ab initio method in vibrational energies prediction caused by physical/mathematical simplification is located. A joint ab initio and machine learning method based on information across molecules is proposed to deal with the problem. Starting from an ab initio model, and then systematically modifying it through machine learning, the vibrational energies prediction of many diatomic systems (SiC, HBr, NO, PC, N2, SiO, O2, ClF, etc.) have been improved, and significantly surpassed the more complex ab initio model. In addition to the improvement of accuracy, the new method also greatly reduces the computational expense, and is applicable for the systems without experimental data.

We numerically study how the interactions between surface, subsurface, and rainfall create complex runoff behavior in a headwater-dominated high elevation, mountainous catchment in East River Watershed, Colorado, USA. In order to understand the effect of surface--subsurface interactions on the hydrological response, we compare model variations with different soil permeability. We compute hydrographs, hydrological indices, and spatio-temporal distributions of hydrological variables. The indices and distributions are then linked to the hydrograph at the outlet of the domain. Our results show that changing surface--subsurface interactions trigger different flow regimes, connectivity dynamics, and runoff generation mechanisms inside the catchment, and hence, affect the distributed hydrological response. Increased surface--subsurface interaction leads to a higher degree of connectivity in the catchment. Temporal dynamics of both distributed and aggregated hydrological response did not change significantly, which may be because the structural connectivity of the catchment remained untouched. Our results indicate that in higher order catchments, the effect of changes in distributed hydrological response may not always be observable through aggregated hydrological signatures.

Title pageTitle: Letter to the Editor: Aortic valve repair in patients with ventricular septal defectArticle type: Letter to the editorDeepak RajaniContact: +923350326757 Email: rajanideepak0@gmail.comInstitution: Shaheed Mohtarma Benazir Bhutto Medical College Liyari,KarachiAddress: Maira garden,Garden west, KarachiCo-author: Zoaib Habib TharwaniContact: +923343975434 Email: zoaibhabib@hotmail.comInstitution: Dow University of health Sciences (DUHS), Dow Medical College, KarachiAddress: Al-Yasrab, Garden East, KarachiSatesh KumarContact:+92-3325252902 Email: Kewlanisatish@gmail.comInstitution: Shaheed Mohtarma Benazir Bhutto Medical College Liyari,KarachiAddress: Parsa citi near police headquarter Garden East Karachi

Juliano Sarmento Cabral1, Alma Mendoza-Ponce2,3, André Pinto da Silva4,5, Johannes Oberpriller6, Anne Mimet7, Julia Kieslinger8, Thomas Berger9, Jana Blechschmidt1, Maximilian Brönner8, Alice Classen10, Stefan Fallert1, Florian Hartig6, Christian Hof7, Markus Hoffmann11, Thomas Knoke12, Andreas Krause13, Anne Lewerentz1, Perdita Pohle8, Uta Raeder11, Anja Rammig13, Sarah Redlich10, Sven Rubanschi7, Christian Stetter14, Wolfgang Weisser7, Daniel Vedder1,15,16,17 , Peter H. Verburg18, Damaris Zurell191 Ecosystem Modelling, Center for Computational and Theoretical Biology (CCTB), University of Würzburg, Klara-Oppenheimer-Weg 32, 37074, Würzburg, Germany2 Research Program on Climate Change, Universidad Nacional Autónoma de México, Mexico City, Mexico3 International Institute for Applied Systems Analysis, Laxenburg, Austria4 Department of Ecology and Genetics, Animal Ecology, Evolutionary Biology Centre, Uppsala University, Uppsala, Sweden5 Centre for Ecology, Evolution and Environmental Changes (cE3c), Faculdade de Ciências, Universidade de Lisboa, Lisbon, Portugal6 Theoretical Ecology Lab, University of Regensburg, Universitätsstraße 31, 93053 Regensburg, Germany7 Technical University of Munich, Terrestrial Ecology Research Group, Department of Life Science Systems, School of Life Sciences, 84354 Freising, Germany8 Institute of Geography, Friedrich-Alexander University Erlangen-Nuernberg, Wetterkreuz 15, 91058 Erlangen, Germany9 Land-Use Economics in the Tropics and Subtropics, Hans-Ruthenberg Institute, Hohenheim University, Hohenheim, Germany10 Department of Animal Ecology and Tropical Biology, Biocentre, University of Würzburg, Am Hubland, 97074 Würzburg, Germany11 Technical University of Munich, Limnologische Station Iffeldorf, Chair of Aquatic Systems Biology, Department of Life Science Systems, School of Life Science,Hofmark 1-3, 82393 Iffeldorf, Germany12 Technical University of Munich, Institute of Forest Management, Department of Life Science Systems, School of Life Sciences, 58354 Freising, Germany13 Technical University of Munich, Land Surface-Atmosphere Interactions, Department of Life Science Systems, School of Life Sciences, 85354 Freising, Germany14 Agricultural Production and Resource Economics, School of Life Sciences, Technical University of Munich, 84354 Freising, Germany15 Helmholtz Center for Environmental Research - UFZ, Department of Ecosystem Services, Permoserstr. 15, 04318 Leipzig, Germany16 Institute of Biodiversity, Friedrich Schiller University Jena, Dornburger Straße 159, 07743 Jena, Germany17 German Centre for Integrative Biodiversity Research (iDiv) Halle-Jena-Leipzig, Puschstr. 4, 04103 Leipzig, Germany18 Institute for Environmental Studies, VU University Amsterdam, De Boelelaan 1111, 1081 HV Amsterdam, The Netherlands19 Ecology & Macroecology, Inst. for Biochemistry and Biology, University of Potsdam, Am Neuen Palais 10, 14469 Potsdam, GermanyArticle type: review/perspective

For parameter and state estimation problems, when observation is sparse and has large error covariance, the estimation results tend to have bias and lead to inaccurate forecasts further. To reduce the bias, we propose to construct a proposal density function with a smaller covariance for the particle filter by conditionally iterating the ensemble transform Kalman filter. First an ensemble is obtained by the ensemble transform Kalman filter. If the distance between the current model forecast (background) and the ensemble members is larger than a predefined threshold then repeats applying the ensemble transform Kalman filter to generate a new model forecast ensemble. Finally, update the weight of ensemble members with the particle filter. We use deep residual neural networks to learn a surrogate model of the assimilation process and combine it with data assimilation method to obtain better forecasts. Experiments results show that our method can effectively reduce the bias compared to the ensemble transform Kalman filter and weighted ensemble transform Kalman filter, especially in case of sparse observations. The results also show that when the observation frequency is low, using a deep residual neural network as surrogate model to generate data for the assimilation process gives more accurate state forecasts than conventional data assimilation method.

Cancer is one of the major health-related issues affecting the population worldwide and subsequently accounts for the second-largest death. Genetic and epigenetic modifications in oncogenes or tumor suppressor genes affect the regulatory systems that lead to the initiation and progression of cancer. Conventional methods, including chemotherapy/radiotherapy/appropriate combinational therapy and surgery, are being widely used for theranostics of cancer patients. Surgery is useful in treating localized tumors, but it is ineffective in treating metastatic tumors, which spread to other organs and result in a high recurrence rate and death. Also, the therapeutic application of free drugs is related to substantial issues such as poor absorption, solubility, bioavailability, high degradation rate, short shelf-life, and low therapeutic index. Therefore, these issues can be sorted out using nano lipid-based carriers (NLBCs) as promising drug delivery carriers. Still, at most, they fail to achieve site targeted drug delivery and detection. This can be achieved by selecting a specific ligand/antibody for its cognate receptor molecule expressed on the cancer cell surface. In this review, we have mainly discussed the various types of ligands used to decorate NLBCs. A list of the ligands used to design nanocarriers to target malignant cells specifically has been extensively undertaken, and the approved ligand decorated lipid-based nanomedicines with their clinical status has been explained in tabulated form to provide a wider scope to the readers regarding ligand coupled NLBCs.