Background: Sickle cell disease (SCD) is characterized by both acute and chronic complications that affect the daily lives of patients and lower their quality of life. Objective: To describe the health-related quality of life (HRQoL) and the associated factors in children aged 8 to 17 with SCD attending the paediatric haematology clinic at Kamuzu Central Hospital (KCH) in Lilongwe, Malawi. Methods: A mixed methods cross sectional study was conducted at KCH. Patient data was collected with the aid of a standardized case report form. HRQoL was assessed using PedsQL™ Sickle Cell Disease Module by child’s report. Associations between HRQoL scores and independent variables were evaluated by a linear regression model. In-depth interviews were then carried out and the qualitative data was analyzed using content thematic analysis. Results: A hundred and sixty-three children with SCD were enrolled, 52.1% were females. Their median age was 11.2±2.7 years. The mean global HRQoL score of the children was 62±17.3. The highest scores were in the treatment domain (72.5±15.1) while the lowest scores were in the emotions domain (55.2±28.7). The mean pain score was 58.8±16.3. The factors associated with low HRQoL scores were pain (β-coefficient -6.97 CI (-3.07,-15.58); p value 0.034) and low haemoglobin levels (β-coefficient 2.29 CI (0.65-3.91); p value 0.006 ). Conclusion: The HRQoL of this population is low. Pain and low hemoglobin were significantly associated with low HRQoL scores. A biopsychosocial model of heath care delivery and health campaigns are recommended to improve the HRQoL of the children.

SARS-CoV-2 can infect pets under natural conditions, which raises questions about the risk factors related with susceptibility of these animals to infection. The status of pet infection by SARS-CoV-2 in Mexico it is not well understood. We aimed to estimate the frequency of positive household cats and dogs to viral RNA and antibodies for SARS-CoV-2 during the second wave of human infections in Mexico, and to recognize the major risk factors related to host and pet ownership behavior. We evaluated two study groups, cats and dogs from COVID-19 infected/suspected households (n=44) and those admitted for veterinary care for any reason at several veterinary hospitals in Puebla City, México (n=91). Using RT-PCR, we identified the presence of SARS-CoV-2 RNA in swabs of four dogs (18.2%) and zero cats in COVID-19 infected/suspected households, within this group 31.8% of dogs and 27.3% of cats tested IgG ELISA positive, and neutralizing antibodies were detected in one dog (4.5%) and two cats (9.1%). In the random group, 25.0% of dogs and 43.6% of cats were ELISA positive, only one cat shown neutralizing antibodies (2.6%). We identified no significant hematological and biochemical abnormalities as risk factors, but we found dynamic changes in leukocytes, lymphocytes, albumin/globulin rate, and creatinine. Pet age >4 years old, other pets at home, and daily cleaning of pet dish, were each associated with an increase of SARS- CoV-2 infection (p<0.05). Allowing face lick, sharing bed/food with pets, and owner tested positive or suspected of COVID-19 were not significant risk factors, but time (>4 hours) the owner spent out from home during the lockdown for COVID-19 (OR= 0.37, p= 0.009), and outdoor pet food tray (OR= 0.32, p= 0.011) were negative risks factors of SARS-CoV-2 infection in pets, suggesting that time the owner spends with their pet is an important risk factor.

A child with a maxillary Ewing sarcoma was operated for tumor asportation and reconstruction with free fibula flap. Adequate anticoagulation was achieved with lower doses of heparin and monitored with multiple ACT values. We used NIRS monitoring to avoid hypoperfusion. Post-operative pain relief was guarantited by local anestethic continous infusion.

The incidence of high-grade malignant gliomas (MG) ranges from 35 to 46% of all central nervous system tumors. Despite combined therapy including surgery, radiation and chemotherapy overall five-year survival does not exceed 10%. Our study included 9 patients, median age 10 years (2-19). 3 pts had anaplastic astrocytoma (AA), 4 pts had glioblastoma multiforme (GBM) and 2 pts had diffuse brainstem glioma (BSG). The median time to the first relapse was 12 months, to the second one– 5 months. The protocol of immunotherapy included combined administration of autologous dendritic cell-based vaccine (DV) and repeated intrathecal/intraventricular injections of donor allogenic immunocompetent cells (alloIC) for at least 2 years. Four of 9 pts are alive and well 82, 23, 71 and 67 months after the immunotherapy start (2 pts with GBM in the 3rd and 2nd relapse, and 2 pts with AA in the 1st relapse and 2nd, respectively). Three of them are in CR proved by PET with 11C methionine and free of any therapy for more than 15 months. One pt with 2nd relapse of metastatic GBM is currently in SD status and on immunotherapy for 23 months. Five pts died from disease progression within 2 – 4 months from the start of immunotherapy. Over the period of treatment the pts received a median of 19 (4 to 60) alloIC injections and 16 (2 to 44) DV administrations. Immunotherapy could be an attractive option for treating patients with gliomas irresponsible to conventional therapy and is worthy of further investigation.

The present study uses an estimation and prediction method and characteristic techniques to predict the life of the lubricating oil based on data collected directly from the mechanical or hydraulic system. The collected data is part of a complex data set with 19 lubricating oil status parameters resulting from online measurements on an experiment stand built and operated under conditions similar to those in a mechanical machining company. The data set was collected during six months, continuously validating the data in several 258646 instances for 19 operating parameters. To predict the values of the next steps of a sequence, the Classification Learner Technics has been approached by support vector machines (SVM) models. The answers obtained characterize and equate the training sequences with values changed by a step of the time, and this means that at each stage of the input sequence, the data structure learns to predict the output value at the next time step. To prevent divergence of the forecast, it was necessary to standardize the training data so that it will achieve a zero mean and unit variance. Also, the test data set has been normalized in the same way as training data.

Generation time has previously been the focus of comparative life history analyses. Here we examine three metrics: generation time Tc, reproductive dispersion S (the distribution of ages of reproduction), and damping time τ (time to converge to stable (st)age distribution). We use data on 633 species of animals and plants, and perform phylogenetically corrected analyses. First we find that S varies allometrically and isometrically with Tc. As a result, τ varies allometrically with either Tc or S but not both. Second, we find a trade-off between τ and S, so that τ does not vary isometrically with Tc. This trade-off is a novel demographic component to the relationship between τ, Tc and S that is otherwise partly determined by their similarity as biological times. Our results indicate that species at the slow end of the slow-fast continuum take longer to converge to stable distribution than species with fast life-histories.

The objective was to know the effect of amendments and mulch (pine woodchips) on three planted autochthonous species in two substrates six years after the beginning of the restoration. But because this kind of mulch contained pine cones, pine seedlings appeared after the first year of the restoration; new objectives were added to the initial one: to know if organic amendments influence pine growth among planted vegetation, and if there were competition among planted species, opportunistic species and pines. Essential soil parameters, plant cover and diversity and pine growth were measured and statistically processed with correlation analyses, ANOVA and Detrended Correspondence Analysis. Six years after restoration organic amendments, applied all over the plots contributed significantly to explain the differences on the tested variables. The combined effects of the two substrates and the two organic amendments effectively enhanced soil properties recovery, but they also facilitated the establishment and entry of new species in addition to planted vegetation, driving a differential plant development. The number of pines, as well as their coverage, depended on the interaction between the amendment and the substrate: a) only one amendment favoured the pines and b) the way the amendment works depended on the substrate. Planted vegetation cover and total plant cover from amended plots doubled that of control plots. Results indicate the potential suitability of organic amendments, pine chips mulch and derived opportunistic species for restoring post-mining areas.

Sand dams are simple and effective structures built across ephemeral riverbeds in arid/semi-arid regions to harvest water within sand pores and increase water availability and quality for rural communities. The complex morphological, hydrological, social and economic conditions that make sand dams a beneficial tool for water resilience are largely influenced by the siting phase. Proper location of a sand dam can reduce community’s travel time to water points, reduce water conflicts and increase food security through expansion of irrigated agriculture. On the other hand, a misplacement of sand dams can, at worst, increase disparities in water access and increase local conflicts. To approach a viable siting of sand dams, most projects are developed and delivered with the community through a bottom-up approach. However, in case of large-scale project, remote sensing and biophysical analysis are the dominant approach, leaving the socio-economic component at the margins of the siting strategy and eventually affecting the benefits to local communities. In this paper, we propose a large-scale participatory methodology to sand dams siting, which draws on mixed-methods connecting the conventional top-down biophysical analysis with bottom-up participatory research. We first describe the generic approach developed for sand dams siting in Namibe, a semi-arid region of South-west of Angola, then we draw on our case to propose a generic approach to large-scale participatory siting beyond Namibe.

Aims: Iatrogenic cardiac perforation is an uncommon but potentially fatal complication of invasive cardiac procedures. When non-surgical management fails, urgent cardiac surgery is required. Standard surgical approach is usually through full sternotomy. However, we propose a less invasive and equally effective technique with video-assisted thoracoscopic surgery (VATS).  Methods: This single-center retrospective study in a tertiary hospital identified all patients requiring surgical intervention due to iatrogenic cardiac perforation over a period of 5 years. Patients were grouped by surgical approach, being either sternotomy or VATS. Primary endpoints were length of ICU stay, hospital stay, 30-day mortality and all round mortality. Results: 25 patients were identified: 11 in the sternotomy-group and 14 in the VATS-group. Preoperative baseline characteristics were equal. Significant difference was found for 30-day mortality (p < 0.05). There was no difference for the other endpoints. Conclusions: Video-assisted thoracoscopic surgery is a promising alternative to standard sternotomy for iatrogenic cardiac perforations after invasive cardiac procedures.

Is there a need for a novel algorithm for accessory pathways localization?Malek Nayfeh MD, Marwan M. Refaat MDDivision of Cardiology, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, LebanonRunning Title: Is there a need for a novel algorithm for WPW localization?Words: 572 (excluding the title page and references)Keywords: accessory pathways, Wolff-Parkinson-white, WPW, cardiac arrhythmias, cardiovascular diseases, heart diseases, Inferior Lead DiscordanceFunding: NoneDisclosures: NoneCorresponding Author:Marwan M. Refaat, MD, FACC, FAHA, FHRS, FASE, FESC, FACP, FRCPAssociate Professor of MedicineDirector, Cardiovascular Fellowship ProgramDepartment of Internal Medicine, Cardiovascular Medicine/Cardiac ElectrophysiologyDepartment of Biochemistry and Molecular GeneticsAmerican University of Beirut Faculty of Medicine and Medical CenterPO Box 11-0236, Riad El-Solh 1107 2020- Beirut, LebanonUS Address: 3 Dag Hammarskjold Plaza, 8th Floor, New York, NY 10017, USAOffice: +961-1-350000/+961-1-374374 Extension 5353 or Extension 5366 (Direct)Wolff Parkinson White Syndrome (WPW) affects between 0.1% and 0.2% of the population, causes morbidity due to supraventricular tachycardia (SVT) and can lead to sudden cardiac arrest [1-3]. The management involves localizing the accessory pathway, and then ablating it, by using either radiofrequency (RF) ablation or cryoablation. The electrocardiogram has been useful over the last decades in the localization of accessory pathways, premature ventricular contractions site of origin and pacing sites [4]. Regarding localization of the pathway, following a large study of RF ablation, Fitzpatrick et al described eight anatomical locations of different pathways using fluoroscopic landmarks: Right anteroseptal (RAS), right midseptal (RMS), right posteroseptal (RPS), right anterolateral (RAL), right posterolateral (RPL), left anterolateral (LAL), left posterolateral (LPL) and left posteroseptal (LPS) [5]. Other algorithms such as the Arruda algorithm or the D’Avila algorithm are also used by clinicians [6, 7]. Most of the accessory pathways’ localization algorithms involve assessment of the delta wave vector (Figure 1), some focus more on QRS morphology (Figure 2), and others combine both methods (Figure 3) [8-12]. By using these algorithms, differentiating between right sided and left sided accessory pathways does not generally pose a problem. However, determining the exact location of right and left sided pathways appears to be more challenging.The study of Bera et al. is a retrospective cohort. Twenty-two patients met the inclusion criteria. The aim was to assess the value of inferior lead discordance (meaning a positive QRS in lead II and a negative QRS in lead III) as a predictor of right anterior (RA) and RAL pathway. The authors included participants who had undergone RF ablation and were found to have right sided pathways. They then separated them in two groups based on if they had RA and RAL pathway (group 1) vs other pathways (group 2). The study found that all patients who had RA and RAL pathway had an ECG showing ILD, while 17 out of 18 patients who were in the other locations did not have an ECG with ILD. The sensitivity and specificity of ILD for predicting RAL location are 100% and 95% respectively.The findings in this study are highly relevant because they represent a clear and simple way of localizing RA/RAL pathways. Other algorithms are also extremely helpful but have their limitations especially if they rely on the delta wave polarity and the electrocardiogram is not fully pre-excited. Another advantage to the algorithm used in this study is that it focuses on limb leads, instead of pericardial leads, which are highly susceptible to variability due to possible displacement.This was a well conducted study, but has some limitations, most notably the small sample size of 22, with only 4 being RA and RAL pathways. There are many algorithms that help cardiologists and cardiac electrophysiologists in localizing accessory pathways before ablation, however, none has specifically focused on RA and RAL pathways. With the advances in artificial intelligence and machine learning, more algorithms using them might be developed in the future.Figure LegendsFigure 1: Examples of algorithms that rely on delta wave polarity such as Fitzpatrick (top) [5], Chiang (bottom left) [8] and Arruda (bottom right) [6]Figure 2: Example of algorithms that rely on QRS morphology such as D’Avilla (top left) [7], Taguchi (top right) [9] and St George’s (bottom) [10].Figure 3: Examples of algorithms that rely both on delta waves and QRS morphology, such as Pambrun (top) [11] and Baek (bottom) [12].References:1. Refaat MM, Hotait M, Tseng ZH (2014). Utility of the Exercise Electrocardiogram Testing in Sudden Cardiac Death Risk Stratification. Ann Noninvasive Electrocardiol, 19(4): 311-318.2. Lu, C. W., Wu, M. H., Chen, H. C., Kao, F. Y., & Huang, S. K. (2014). Epidemiological profile of Wolff-Parkinson-White syndrome in a general population younger than 50 years of age in an era of radiofrequency catheter ablation. International journal of cardiology, 174(3), 530–534. https://doi.org/10.1016/j.ijcard.2014.04.1343. Arai, A., & Kron, J. (1990). Current management of the Wolff-Parkinson-White syndrome. The Western journal of medicine, 152(4), 383–391.4. Refaat M, Mansour M, Singh JP, Ruskin JN, Heist EK (2011). Electrocardiographic Characteristics in Right Ventricular Versus Biventricular Pacing in Patients With Paced Right Bundle Branch Block QRS Pattern. J Electrocardiol, 44 (2): 289-95.5. Fitzpatrick, A. P., Gonzales, R. P., Lesh, M. D., Modin, G. W., Lee, R. J., & Scheinman, M. M. (1994). New algorithm for the localization of accessory atrioventricular connections using a baseline electrocardiogram. Journal of the American College of Cardiology, 23(1), 107–116. https://doi.org/10.1016/0735-1097(94)90508-86. Arruda, M. S., McClelland, J. H., Wang, X., Beckman, K. J., Widman, L. E., Gonzalez, M. D., Nakagawa, H., Lazzara, R., & Jackman, W. M. (1998). Development and validation of an ECG algorithm for identifying accessory pathway ablation site in Wolff-Parkinson-White syndrome. Journal of cardiovascular electrophysiology, 9(1), 2–12. https://doi.org/10.1111/j.1540-8167.1998.tb00861.x7. d’Avila, A., Brugada, J., Skeberis, V., Andries, E., Sosa, E., & Brugada, P. (1995). A fast and reliable algorithm to localize accessory pathways based on the polarity of the QRS complex on the surface ECG during sinus rhythm. Pacing and clinical electrophysiology : PACE, 18(9 Pt 1), 1615–1627. https://doi.org/10.1111/j.1540-8159.1995.tb06983.x8. Chiang, C. E., Chen, S. A., Teo, W. S., Tsai, D. S., Wu, T. J., Cheng, C. C., Chiou, C. W., Tai, C. T., Lee, S. H., & Chen, C. Y. (1995). An accurate stepwise electrocardiographic algorithm for localization of accessory pathways in patients with Wolff-Parkinson-White syndrome from a comprehensive analysis of delta waves and R/S ratio during sinus rhythm. The American journal of cardiology, 76(1), 40–46. https://doi.org/10.1016/s0002-9149(99)80798-x9. Taguchi, N., Yoshida, N., Inden, Y., Yamamoto, T., Miyata, S., Fujita, M., Yokoi, K., Kyo, S., Shimano, M., Hirai, M., &amp; Murohara, T. (2013, December 22). A simple algorithm for localizing accessory pathways in patients with Wolff-Parkinson-White syndrome using only the R/S ratio. Journal of Arrhythmia. Retrieved February 10, 2022, from https://www.sciencedirect.com/science/article/pii/S188042761300165810. Xie, B., Heald, S. C., Bashir, Y., Katritsis, D., Murgatroyd, F. D., Camm, A. J., Rowland, E., & Ward, D. E. (1994). Localization of accessory pathways from the 12-lead electrocardiogram using a new algorithm. The American journal of cardiology, 74(2), 161–165. https://doi.org/10.1016/0002-9149(94)90090-611. Pambrun, T., El Bouazzaoui, R., Combes, N., Combes, S., Sousa, P., Le Bloa, M., Massoullié, G., Cheniti, G., Martin, R., Pillois, X., Duchateau, J., Sacher, F., Hocini, M., Jaïs, P., Derval, N., Bortone, A., Boveda, S., Denis, A., Haïssaguerre, M., & Albenque, J. P. (2018). Maximal Pre-Excitation Based Algorithm for Localization of Manifest Accessory Pathways in Adults. JACC. Clinical electrophysiology, 4(8), 1052–1061. https://doi.org/10.1016/j.jacep.2018.03.01812. Baek, S. M., Song, M. K., Uhm, J. S., Kim, G. B., & Bae, E. J. (2020). New algorithm for accessory pathway localization focused on screening septal pathways in pediatric patients with Wolff-Parkinson-White syndrome. Heart rhythm, 17(12), 2172–2179. https://doi.org/10.1016/j.hrthm.2020.07.016.

In 2017, the hepatobiliary surgery team at the Royal Hospital in Oman performed the first successful liver transplant surgery. This medical achievement was the first of a sequence of multiple successful liver transplant surgeries performed in the country. Blood management in liver transplant surgeries can be challenging. In this article I will address some of the strenuous challenges related to blood management in this patient population and discuss the use of rotational thromboelastometry (ROTEM) to mitigate these challenges.It is well known that patients with liver disease have a rebalanced hemostasis due to the impaired synthesis of both the coagulation factors and pro-coagulant factors. Interestingly, some studies demonstrated an increased endogenous thrombin potential (ETP) in patients with liver cirrhosis1. Hence, it is now well known that this group of patients requires special attention when it comes to blood management.For many years, international normalized ratio (INR) has been used by clinicians to evaluate the hemostatic activity, or as a predictor of bleeding in patients with liver disease. INR is one of the commonly used conventional coagulation assay that has been developed to standardize warfarin monitoring across laboratories. This simple test has many limitations that make it an extremely poor predictor of bleeding in this group of patients. For instance, INR is designed to test the extrinsic and common coagulation pathway factors (i.e Factor VII, X, V, II, and fibrinogen). INR does not take into account the effect of the endogenous anticoagulants such as protein C and protein S which are also reduced in patients with liver disease. Therefore, INR provide only limited information about the hemostatic activity2.The practise of transfusing plasma to correct (normalize) INR prior to invasive procedure in liver disease patients is an exercise of futility. In patients with minimally elevated INR (1.1 – 1.8), transfusing plasma to correct INR resulted in median change of INR of 0.07 only. A significant change in INR was only observed when INR is above 53,4. In their most recent guidelines, the society of interventional radiology recommended that INR is not applicable in patients with liver disease who are attending low risk interventional radiology (IR) procedure. The society also recommended that INR of <2.5 is acceptable for liver disease patients attending high risk IR procedures5.Patients undergoing liver transplant surgeries are exposed to an incredibly challenging hemostatic environment and blood management in these patients is crucial. Depending on conventional coagulation testing (INR and PTT) to guide blood management in these patients results in an inappropriate transfusion of red cells and plasma and therefore increasing the risk of adverse transfusion reactions as well as volume overload6. One of the perhaps not widely known fact about blood transfusion is that the cost of delivering a unit of red cells to a patient can range from 522 to 1183 US dollars, and the cost of delivering a unit of plasma is approximately 409 US dollars7.Newer technologies like ROTEM have been proven to be associated with significantly reduced amount of blood product transfusion in bleeding patients. Thromboelastography (TEG) is another older viscoelastic testing that can also be used in this population. However, compared to TEG, ROTEM provides additional information about the entire hemostatic activity8. ROTEM is a point of care viscoelastic testing that is performed on whole blood samples collected in trisodium citrate tube (the regular blue top coagulation tube). There are several assays that can be performed on ROTEM, such as EXTEM and FIBTEM. ROTEM results are demonstrated in graph that shows both the coagulation process and fibrinolytic activity. The graph comprises of different parameters as shown in the figure 1. The shape of ROTEM graph can indicate several coagulation abnormalities. Therefore, an appropriate blood product can be transfused accordingly.There is tremendous evidence to support the use of ROTEM-based algorithms (flow charts) to guide transfusion management. Most of the literature in this field comes from cardiothoracic surgeries, but liver transplant surgeries, trauma and obstetrics are other fields in which ROTEM-guided blood management was shown to be effective. In liver transplant surgeries, the use of ROTEM was associated with 39% reduction in plasma transfusion in patients with mildly elevated INR (1.1-1.8). The median number of plasma units transfused in liver transplant surgeries reduced significantly from 6 units pre-ROTEM to 2 units post-ROTEM. This significant reduction was also observed with red cell transfusion9.ROTEM also has other advantages. It has a fast turnaround time as it takes approximately 15 minutes for the results to be ready. Once the test is started, the results are demonstrated in the form of ROTEM graph immediately. Also, the results can be accessed remotely. If the test is performed in the laboratory, the results can be viewed in any regular screen in the operation room or anywhere else using a special ROTEM portal that is accessed through a password-protected link.The use of ROTEM-guided blood management is also cost effective. Although ROTEM test may be slightly more expensive than performing a coagulation profile, the associated reduction in plasma and red cell transfusion counterbalances the testing cost. Leahy MF et al., reported saving of approximately 18 million dollars between 2008 and 2014 after the implementation of ROTEM in their patient blood management10.In conclusion, liver transplant surgeries require unique patient blood management strategy. The use of conventional coagulation testing in these surgeries results in an inappropriate and overutilization of blood products. ROTEM-based algorithms are proven to be associated with reduced red cell and plasma transfusion. ROTEM is an essential component of any liver transplant program. The first stages to implement this technology can be challenging, but with a collaborative effect, the final result will be astonishing.

A document by Angélica Diniz. Click on the document to view its contents.

Background and Purpose: Traumatic brain injury (TBI) remains a leading cause of mortality and morbidity in young adults. The role of iron in potentiating neurodegeneration following TBI has gained recent interest since iron deposition has been detected in the injured brain in the weeks to months post-TBI, in both the preclinical and clinical setting. A failure in iron homeostasis can lead to oxidative stress, inflammation and excitotoxicity; and whether this is a cause or consequence of the long-term effects of TBI remains unknown. Experimental approach: We investigated the role of iron, and the effect of therapeutic intervention using a brain-permeable iron chelator, deferiprone, in a controlled cortical impact mouse model of TBI. An extensive assessment of cognitive, motor and anxiety/depressive outcome measures were examined, and neuropathological and biochemical changes, over a 3-month period post-TBI. Key Results: Lesion volume was significantly reduced at 3 months, which was preceded by a reduction in astrogliosis and a preservation of neurons in the injured brain at 2 weeks and/or 1-month post-TBI in mice receiving oral deferiprone. Deferiprone treatment showed significant improvements in neurological severity scores and locomotor/gait performance, and cognitive function, and attenuated anxiety-like symptoms post-TBI. Deferiprone reduced iron levels, oxidative stress and altered expression of neurotrophins in the injured brain over this period. Conclusion and Implications: Our findings support a detrimental role of iron in the injured brain and suggest that deferiprone (or similar iron chelators) may be promising therapeutic approaches to improve survival, functional outcomes and quality of life following TBI.

The storage effect is a general explanation for coexistence in a variable environment. The generality of the storage effect is both a strength — it can be quantified in many systems — and a challenge — there is not a clear relationship between the abstract conditions for storage effect and species’ life-history traits (e.g., dormancy, stage-structure, non-overlapping generations), thus precluding a simple ecological interpretation of the storage effect. Our goal here is to provide a clearer understanding of the conditions for the storage effect as a step towards a better general explanation for coexistence in a variable environment. Our approach focuses on dividing one of the key conditions for the storage effect, covariance between environment and competition, into two pieces, namely that there must be a causal relationship between environment and competition, and that the effects of the environment do not change too quickly. This finer-grained definition can explain a number of previous results, including 1) that the storage effect promotes annual plant coexistence when the germination rate fluctuates, but not when the seed yield fluctuates, 2) that the storage effect is more likely to be induced by resource competition than apparent competition, and 3) that the spatial storage effect is more probable than the temporal storage effect. Additionally, our expanded definition suggests two novel mechanisms by which the temporal storage effect can arise: transgenerational plasticity, and causal chains of environmental variables. These mechanisms produce coexistence via the storage effect without any need for stage structure or a temporally autocorrelated environment.

Rim M. HarfouchDepartment of microbiology and biochemistry, Faculty of pharmacy, Al Sham private university, Latakia, Syria.Correspondence Autho’s E-mail: r.h.foph.lat@aspu.edu.sy

Ecological community structure ultimately depends on evolution producing community members. To understand how macroevolutionary processes shape communities, we surveyed Anolis lizard assemblages across elevations on Jamaica and Hispaniola, neighboring Caribbean islands similar in environment, but contrasting in evolutionary richness. The impact of diversification on local communities depends on available opportunities for speciation within or between ecologically distinct sub-regions. Where opportunities abound, as in the vast lowlands of both islands, communities converge in species richness and average morphology. But community structures diverge in the highlands. On Jamaica, where limited highland area restricted diversification, communities remain depauperate and consist largely of elevational generalists. In contrast, a unique fauna of high-elevation specialists evolved in the expansive Hispaniolan highlands, augmenting highland richness, and driving islandwide turnover in community composition. Accounting for disparate evolutionary opportunities may illuminate when regional diversity will enhance local diversity and help identify the causes of convergent versus divergent community structure.

Chromobacterium haemolyticum is a fatal gram-negative bacterium, which had been found that has the ability to infect human. In this study, we detected a nonpigmented, β-hemolytic gram-negative bacillus from fecal samples of piglets with severe diarrhea and death. Analysis of the 16S rRNA gene sequence indicated it was most closely related to Chromobacterium haemolyticum, however only with 79% identities, indicating that this bacterium may be a new type of Chromobacterium haemolyticum. Diarrhea was reproduced in experimental pigs with one of the isolates strains, designated GDHYZ30 strain. Intramuscular injection of the GDHYZ30 strain can cause death of the piglets, and irrigated challenge induced piglets diarrhea. To further elucidate the mechanism of pathogensis of this bacterium, whole genome sequencing was used to analyze and annotate the GDHYZ30 strain. The full-length genome of the strain was 4785117bp, the G+C content was 62.67%, and it encoded 4398 genes, in which 57 drug resistance genes, and 390 virulence factors were included. It is worth noting that this novel Chromobacterium haemolyticum has been isolated from several other pig farm water samples and pig feces samples with unexplained diarrhea. To our knowledge this is the first report that a novel Chromobacterium haemolyticum as a new pathogen causing diarrhea and death in piglets and transmiting through water sources. And the genetic characteristics of the bacteria are analyzed by whole gene sequencing, which provides a reference for the prevention of human and animal infections and food safety.

Bruna M. Santos PhD1,2; Glauce C. Nascimento PhD1,3; João F. Pedrazzi PhD 4; Danyelle Silva-Amaral MS1 ; Mariza Bortolanza PhD3; Grant T. Harris BS2; Luiz G. S. Branco PhD 1,3*, Elaine Del Bel PhD1,3,4*1 Department of Physiology, Medical School of Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP, Brazil.2Thermoregulation and Systemic Inflammation Laboratory (FeverLab), St. Josephs’ Hospital and Medical Center, Phoenix, AZ, USA.3 Department of Basic and Oral Biology, Ribeirão Preto Dentistry Faculty, University of São Paulo, Ribeirão Preto, SP, Brazil.4 Neuroscience Graduate Program, Medical School of Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP, Brazil.*Corresponding Authors :Elaine Del Bel ; email:eadelbel@usp.br; Department of Basic and Oral Biology, Dental School, University of São Paulo (USP), Ribeirão Preto, SP, 14040-904, Brazil.Luiz GS Branco ; email: branco@forp.usp.br ; Department of Basic and Oral Biology, Dental School, University of São Paulo (USP), Ribeirão Preto, SP, 14040-904, Brazil.Text (3692 words)- (Up to 3700 words excluding of abstract, legends, and references)Running title: The anti-inflammatory effect of H2 in LIDKey words: 6-Hydroxydopamine, Parkinson’s disease, neuroinflammation; striatum; systemic inflammationThe authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.Funding sources: Grant GCN [#88882.317597/2019-014, National Council for Scientific and Technological Development (PNPD-CNPq), Brazil]. Grant JFP [#88887.341956/2019-00, Programa Nacional de Pós-doutorado, Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (PNPD/CAPES)]. Grant MB [#88887.334730/2019-00, Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)]. Grant LGSB [#2016/17681-9, São Paulo Research Foundation (FAPESP), Brazil. Grant EDB [#2017/243044-0, São Paulo Research Foundation (FAPESP), Brazil]; [# 88881.198836/2018/01, Coordenação de Aperfeiçoamento de Pessoal de Nível Superior and Deutscher Akademischer Austauschdienst (CAPES/DAAD – 2019-2024), Brazil and Germain], [#88887.192409/2018-01, Coordenação de Aperfeiçoamento de Pessoal de Nível Superior and Comitê Francês de Avaliação da Cooperação Universitária com o Brasil (CAPES/COFECUB- 2019-2024), Brazil and France.], [#302434/2019-04, National Council for Scientific and Technological Development (CNPq), Brazil].Abstract (226 words)Background: L-3,4-dihydroxyphenylalanine (L-DOPA)-induced dyskinesia is a side effect of Parkinson’s disease treatment and it is characterized by atypical involuntary movements. A link between neuroinflammation and L-DOPA-induced dyskinesia has been documented. Molecular hydrogen has neuroprotective effects in Parkinson’s disease models and has a major anti-inflammatory effect.Objective: To test the hypothesis that molecular hydrogen inhalation reduces L-DOPA-induced dyskinesia.Methods: 15 days after 6-hydroxydopamine lesions of dopaminergic neurons were made (microinjection into the medial forebrain bundle), chronic L-DOPA treatment (15 days) was performed. Rats were exposed to molecular hydrogen (2% gas mixture, 1h) or air (controls) before L-DOPA injection. Abnormal involuntary movements and locomotor activity were conducted. Striatal and plasma samples for molecular and morphological evaluations were collected after the abnormal involuntary movements analysis.Results: Molecular hydrogen inhalation attenuated L-DOPA-induced dyskinesia. The gas therapy did not impair the improvement of locomotor activity achieved by L-DOPA treatment. Display of abnormal involuntary movements was positively correlated with plasma IL-1β and striatal TNF-α levels and negatively correlated with striatal IL-10 levels. H2 inhalation reduced activated microglia in the lesioned striatum, which is consistent with the observed reduced pro-inflammatory cytokines levels.Conclusions and implications: Prophylactic molecular hydrogen inhalation decreases abnormal involuntary movements in a preclinical L-DOPA-induced dyskinesia model. The molecular hydrogen antidyskinetic effect was associated with decreased striatal and peripheral inflammation. This finding has a translational importance to L-DOPA-treated parkinsonian patients’ well-being.IntroductionSeveral motor and non-motor debilitating symptoms of Parkinson’s disease (PD) are generated by dopamine (DA) depletion. Levodopa (L-DOPA) is recognized as the most effective and well tolerated drug for PD treatment. However, long-term L-DOPA therapy has been associated with the development of abnormal involuntary movements referred to as L-DOPA-induced dyskinesia (LID)1. The development of dyskinesia represents a serious side effect that negatively affects quality of life of people with PD, and is also associated with both motor, including an increased risk of postural imbalance and trauma from falls, and non-motor operations, particularly, fluctuations in mood and cognitive performance2–4. Although various compounds have been used for treating LID, their success has been limited3.The pathogenesis of LID is associated with non-physiological stimulation of DA receptors using L-DOPA, which combined with the reduction of gamma-aminobutyric acid transmission pale-thalamic activity, generates neuronal hyperactivity in the striatum5–9. Moreover, recent studies suggest that astrocyte and microglia activation increase pro-inflammatory cytokines production, contributing to the appearance of LID10,11. In addition, excessive levels of glutamate and dopamine in the striatum feed this inflammatory environment, favoring LID12,13. A key unmet medical need for the PD community is a strategy for ameliorating LID10,14,15.Despite the fact that neurodegenerative disorders and associated consequences have been consistently related to central nervous system (CNS) derangement, they also have a strong associative component with environmental factors16. Given the evidence of the profound influence of the periphery producing environmental signals to the CNS, the periphery-brain axis has been increasingly explored within the neurodegenerative disorders such as Alzheimer’s and PD17,18. One of the peripheral influences that has been implicated in the neurodegenerative disorders outbreak and progression is the peripheral immune system19. Intestinal inflammation, for example, is remarkably observed in patients with PD20,21. Gut microbiota related to PD clinical phenotype produces an improper ratio of sub-products with anti-inflammatory agents such as short-chain fatty acids and molecular hydrogen (H2)22,23.Studies have shown that H2 may protect the brain from various neuronal conditions, including neurological emergencies and neurodegenerative diseases24-26. H2 in rodents protects mesencephalic dopaminergic neurons from 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MTPT)24and 6-hydroxydopamine (6-OHDA)25 induced degeneration. Several lines of evidence indicate that neuro-immune function and behavior are influenced by H226–28. Accumulating studies indicate that H2 not only has antioxidant29,30 but also anti-inflammatory properties31–33. However, there are no previous studies addressing the putative H2 benefits on LID.Hence, we tested the hypothesis that H2 inhalation reduces L-DOPA-induced dyskinesia in an animal PD model. We evaluated the effect of H2 inhalation on abnormal involuntary movements (AIMs) in PD rats treated with L-DOPA. Moreover, we evaluated the role of H2 in pro-inflammatory [tumor necrosis factor (TNF)-α, interleukin (IL)-1β, IL-6, interferon (IFN)-ϒ, and anti-inflammatory (IL-10) cytokine levels in the plasma and striatum of PD-lesioned rats treated with L-DOPA. Finally, we examined whether H2 inhalation influenced the morphology of striatal astrocytes and microglia in PD-lesioned rats chronically treated with L-DOPA.2.0. Materials and Methods More detailed description of our experimental procedures can be found in the Supplementary Methods.2.1. Animals Male Wistar rats (200-250 g, n = 65; USP-RP, SP, Brazil) were used. The experimental protocol followed the Ethical Principles in Animal Research delineated by the guidelines for the care and use of mammals in Neuroscience and Behavioral Research and was approved by the Ethics Committee on the Use of Experimental Animals of the University of São Paulo (#2016.1.667.58.4).2.2. Dopaminergic lesion with neurotoxin 6-hydroxydopamine Rats were anesthetized with 2,2,2-tribromoethanol (250 mg kg-1 ip) and fixed into the stereotaxic apparatus. The incisor bar was set at 3.3 mm below the interaural line. Rats received one injection of 2.0 μl 6-OHDA into the left medial forebrain bundle as described by Gomes et al., 20085 (6-OHDA - 2.5 µg µl-1 in 0.9% NaCl supplemented with 0.02% ascorbic acid, 1 μL min-1).Motor asymmetry was assessed 15 days after the lesion of the nigrostriatal pathway by apomorphine-induced rotational behavior analysis (0.5 mg kg in 0.9% NaCl, subcutaneous, Sigma) (Figs. 1C and 2D)34. The lesion was confirmed histologically at the end of the behavioral tests (described below) by tyrosine hydroxylase (TH) immunohistochemistry in the striatum and substantia nigra (Figs.1D and E). L-DOPA treatment started two days after the apomorphine-induced rotational test.2.3. H2 administration All animals were adapted to the chamber with ambient air at a flow rate of 2.4 L/min, one day before the experiments. On the experimental day, animals were exposed to 2% H2-mixture (21% of O2 balanced with N2) or Air-mixture (0% H2; 21% O2 N2-balanced) for 1 hour at the same flow rate as the training day. Continuous monitoring of H2 concentration in the chamber was made possible by using a gas analyzer to verify the H2 outflow from the chamber. The tested concentration of H2 in the mixture (2%) was chosen due to the consistent and repeatable anti-inflammatory effect observed in previous studies29,32,33.2.4. L-DOPA-induced abnormal involuntary movements analysisRats were subjected to chronic L-DOPA (20 mg kg plus benserazide 5mg kg, orally by gavage) administration for 15 days (once a day) to induce a stable expression of dyskinesia14. Animals showing AIMs scores greater than 10 and severity grading greater than 2 on at least one AIMs subtype during the effect of L-DOPA were selected for the behavioral study30-32. Rats were monitored individually for orofacial and limb dyskinesia, and axial dystonia or AIMs using a rat dyskinesia scale34–37. This scale considers the severity and amplitude of the axial, limb and orolingual AIMs (the scores ranged from 0 to 4) (for review see Cenci and Lundblad 200738). A dyskinesia time curve was generated by plotting global AIMs scores from each monitoring time individually for an entire testing session (180 min).2.5. Actimeter test To evaluate possible motor effects of the treatments, the spontaneous locomotor activity of each animal was individually assessed in a photoelectric actimeter (Actitrack, Panlab, Barcelona, Spain). The apparatus consists of a square arena (45 x 45 x 20 cm) equipped with 16 photocells that detect horizontal movement and 16 photocells that detect vertical movement. Thus, the locomotor activity was obtained from recording the number of interruptions of the photoelectric cells during 5 minutes. The amount of rearings was counted using total vertical activity movements.2.6. Plasma and striatum sampling The animals were euthanized by decapitation 1 hour after L-DOPA or its vehicle administration. The trunk blood was rapidly collected in heparin-coated tubes and subsequently centrifuged at 3,500 rpm for 20 min at 4°C. The brain was removed, and the rostral and medial portion of the striatum (rostral: 1.7 mm and medial: 0.7 mm from bregma) was carefully excised, frozen by submersion in dry ice chilled isopentane and The medial-caudal (medial: 0.7 mm and caudal: -0.8 mm and from bregma) portion of the striatum was collected and post-fixed in tamponade paraformaldehyde (4%) for immunohistochemistry preparation.2.7. Measurement of plasma and striatal cytokines levels The inflammatory profile of the target samples was evaluated using a high sensitivity enzyme-linked immunosorbent assay (Luminex). Luminex assay was conducted using Luminex Magpix technology (Austin, TX, USA) according to manufacturer guidelines (LXSARM - 05, R&D, Minnesota, MN, USA)39.2.8. Immunohistochemistry Serial coronal sections throughout the mediocaudal extent of the striatum (Bregma +2.76mm, Interaural 11.76mm – Bregma -2.28mm, Interaural 6.72mm) were cut (25 µm) using a freezing microtome (Leica, model CM1850). Immunohistochemistry was performed in these sections using a standard peroxidase-based method5 to quantify TH, glial fibrillary acidic protein (GFAP) and OX-42 (CD11b/c equivalent protein of microglia). The sections were incubated overnight at room temperature with the primary antibodies (Suppl. Table 1): anti-TH; anti-GFAP or anti-OX-42, followed by 2 h of incubation with biotinylated secondary antibody (1:250, Vectastain). The chromogen used was diaminobenzidine (Sigma-Aldrich, St. Louis, MO, USA) and the slices were mounted on slides and cover slipped for microscopic observations. Digital images were obtained using a Leica microscope (Leica Microsystems Launches Leica FW4000 - Cambridge, UK) under 20x (for TH optical density and OX-42/GFAP number of cells quantification) or 40x (for OX-42/GFAP morphology) objectives. The quantification of the brain area was measured using the ImageJ system (ImageJ, RRID: SCR_003070,National Institutes of Health - NIH; Schneider et al., 201240). Analysis of microglia (OX-42) and astrocyte (GFAP) immune labeling morphology was conducted as described by Giocanti-Auregan et al. (2016)41 using Fiji algorithms (RRID: SCR_002285) and a generated skeleton image. The parameters analyzed were the number of cells (per 0.1mm2), branches, the number of intersections or branching points, and the mean process length42.

A document by Christos Iavazzo. Click on the document to view its contents.

1 Understanding the effect of ground types on foraging movements of ground-dwelling arthropods is a key step to managing their spatial distribution as required for successful conservation biological control. Indeed, fine movements at the centimetre scale can strongly influence the foraging ability of pest predators. However, because RFID or harmonic tracking techniques are not yet suitable for small species and video tracking focuses on uniform and light backgrounds, foraging movements have rarely been studied in relation to ground types. 2 We present a method to track a ground-dwelling arthropod (the earwig Euborellia caraibea) at night, walking on two contrasted ground types : bare soil and soil partly covered with a stratum of banana plant residues allowing individuals to hide periodically. 3 The tracking of individuals within these ground types was achieved by infrared light, tagging individuals, video treatments and semi-automatic cleaning of trajectories. We tested different procedures to obtain segments with identical durations to quantify speeds and sinuosities. These procedures were characterised by the junction time gap between trajectory fragments, the rediscretisation time of trajectories, and whether or not to use interpolation to fill in missing points in the trajectories. 4 Earwigs exhibited significantly slower and more sinuous movements on soil with banana plant residues than on bare soil. Long time gaps for trajectory junction, extended rediscretisation times and interpolation were complementary means to integrate concealed movements in the trajectories. The highest slowdown in plant residues was detected when the procedure could account for longer periods under the residues. 5 These results suggest that earwigs spent a significant amount of time concealed by the residues. Additionally, the residues strongly decreased the earwigs’ movement. Since the technical solutions presented in this study are inexpensive, easy to set up and replicate, they represent valuable contributions to the emerging field of video monitoring.

Introduction: The aim of this study was to establish the most accurate and up-to-date anatomical knowledge of PVs ostia variations, diameters and ostial area, in order to provide physicians, especially heart and thoracic surgeons with exact knowledge concerning this area. Materials and methods: Major online medical databases such as PubMed, Embase, Scopus, Web of Science and Google Scholar were searched to gather all studies in which the variations, maximal diameter and ostial area of the PVs were investigated. During the study, the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. Additionally, The Critical Appraisal Tool for Anatomical Meta-analysis (CATAM) was used to provide the highest quality findings. Reults: The most common ostia variation is classical one, containing left superior pulmonary vein (LSPV), left inferior pulmonary vein (LIPV), right superior pulmonary vein (RSPV) and right inferior pulmonary vein (RIPV). Mean diameters and ostial areas of each pulmonary vein were established in general population and in multiple variations considering method of gathering the data and geographical location. Conclusion: Significant variability in PV ostia is observed. Left-sided PVs have smaller ostia than corresponding right-sided PVs, and the inferior PVs ostia are smaller than superior. The size of the LCPV ostium is the largest among all analyzed veins, while the ostium of RMPV is the smallest. It is hoped that the results from this meta-analysis will help clinicians in planning and performing procedures that involve pulmonary and cardiac area.

To the EditorReply to Stefano Miceli SopoFirst of all we want to thank for giving us an opportunity to reply to this correspondence (1), acknowledging the correspondence authors important point about the recommendation of introducing well-cooked, but not raw or uncooked pasteurized hen’s egg as part of complementary feeding.We agree that the evidence-base is sparse, with just two trials about cooked egg contributing to the low to moderate certainty evidence in our review (2) and guideline (3). These studies were in different populations (4, 5). We highlighted these points in the guideline, and the subgroup analysis from the Perkin study (6) was used only as supporting material, and for estimating the amount of egg that could be used. It is correct that the Natsume study included infant at higher risk due to eczema, but that was the case for both groups, and outcome was assessed by controlled challenges as described in the systematic review (2).As set out in the guideline, the process took into account expert insight weighing up benefits and harms, costs, feasibility, standard practice and patient preferences, in addition to published evidence. Weighing up all of these factors, the task force decided that the potential benefits outweighed potential harms in the case of well-cooked egg. One relatively large study found a 29% absolute decrease in the proportion of high risk infants with egg allergy at 1 year when very small amounts of egg were introduced (RR 0.22, 95% CI 0.08 to 0.54) (4). And two trials found no adverse effects (4, 5). It is likely feasible for many families to introduce well-cooked egg as part of complementary feeding, including in baked goods. The potential benefits do not outweigh the harms for uncooked egg, so the task force did not suggest trying this approach.The task force included representatives from many countries and specialties, and followed a robust process when reviewing evidence and debating potential recommendations. As the correspondence authors note, this recommendation is in line with other key guidelines. Whilst the correspondence authors may not agree with specific recommendations, the process used to debate and vote on them was systematic and took into account perspectives from across the world, including those from organisations representing patients and their families. Furthermore, a public consultation process sought feedback prior to publication, which further reinforced consensus about this recommendation.As is the case with all guidelines, the EAACI food allergy prevention guideline provides suggestions for clinicians to consider, alongside the needs of individual patients and local contexts and customs. The guideline is not prescriptive and does not override clinical judgement ad individual circumstances. Given the lack of likely harm, the convenience of this approach and best available evidence to date, the task force stands by its suggestion that clinicians in countries where egg allergy is an issue discuss with families the potential and desire to introduce small amounts of well-cooked egg into the infant diet when appropriate as part of complementary feeding. This need not be from the beginning of complementary therapy and the amounts may be very small.The guideline suggests half of a well-cooked, small egg twice a week, which may be in the form of a hard-boiled egg, well-cooked egg pasta, bread or baked goods, for example (p. 850). There is no evidence of significant harm, and it is likely that infants in many parts of the world may be exposed to egg in their diet anyway. There is no need to avoid this to prevent egg allergy, and in the opinion of the EAACI task force, introducing it may have benefits.Susanne Halken, Professor a, ProfessorAntonella Maria Muraro b, ProfessorGraham Roberts c, ProfessorDebra de Silva d, ProfessorOn behalf of On behalf of the EAACI Prevention Guideline Task Forcea Hans Christian Andersen Children’s Hospital, Odense University Hospital, Odense, DenmarkbDepartment of Women and Child Health, Food Allergy Referral Centre Veneto Region, Padua University Hospital, Padua, Italyc Clinical and Experimental Sciences and Human Development in Health, Faculty of Medicine, University of Southampton, Southampton, UK. NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK. The David Hide Asthma and Allergy Research Centre, St Mary’s Hospital, Newport, UKdThe Evidence Centre Ltd, London, UKReferencesStefano Miceli Sopo, Dario Sinatti, Francesco Mastellone, Giulia Bersani, Mariannita Gelsomino. Comment on Halken et al. Pediatr Allergy Immunol . 2022de Silva D, Halken S, Singh C, et al. Preventing food allergy in infancy and childhood: systematic review of randomised controlled trials. Pediatr Allergy Immunol . 2020;31(7):813-826Halken S, Muraro A, de Silva D, et al. EAACI guideline: Preventing the development of food allergy in infants and young children (2020 update). Pediatr Allergy Immunol. 2021;32(5):843-858.Natsume O, Kabashima S, Nakazato J, et al. Two-step egg introduction for prevention of egg allergy in high-risk infants with eczema (PETIT): a randomised, double-blind, placebo-controlled trial. Lancet. 92 2017;389(10066):276-286.Perkin MR, Logan K, Tseng A, et al. Randomized trial of introduction of allergenic foods in breast-fed infants. N Engl J Med. 2016;374(18):1733-1743.Perkin MR, Logan K, Bahnson HT, et al. Efficacy of the enquiring About Tolerance (EAT) study among infants at high risk of developing food allergy. J Allergy Clin Immunol. 2019;144(6):1606-1614.

This paper presents the enhancement of Legendre Optimum low pass filters in terms of reusability and bandwidth, based on the variable or programmable memristance of memristors. Two low pass filters, of third and fifth order, operating in the radio frequency range, and designed using the insertion loss method are presented. At 600 KHz and at 110 MHz, two MS memristor models, of the non-linear ion drift class is incorporated into the filter circuits in turn and their memristances varied such that R_off- R_on decreases monotonically and R_off- R_on>0. Results show a bandwidth enhancement of up to 100 KHz at 600 KHz, and up to 19MHz at 110MHz. This study also examines the effect of the simultaneous versus asynchronous variation of the memristance of the pair of memristors introduced into the filter circuits, as well as increase in filter order.

Roger S Taylor DO1, Nnennaya U Opara MD, MPH1, 2 , Taylor Simmerman DO11Emergency Medicine, Charleston Area Medical Center, Charleston, USA2Institute for Academic Medicine, Charleston, TX, USA Corresponding authors : Nnennaya U Opara, Nnennaya.opara@camc.org Charleston Area Medical Centre 3200 MacCorkle drive.SE Charleston, WV 25304IntroductionAccording to the Centers for Disease Control and Prevention (CDC), cases of non-injury emergency department (ED) visits for which abdominal pain was the chief complaint increased by 31.8% from 2000 (5.3 million) to 2008 (7 million), constituting a 7.6% rise, and continue to increase [1]. Small bowel obstructions account for 2% of all patients presenting to the ED with abdominal pain [2] and may have many different etiologies, although the most common is tissue adhesions from previous abdominal surgeries, followed by hernias [3]. Herein, we present a case of abdominal pain secondary to a rare cause of bowel obstruction.Case presentationA 70-year-old Caucasian woman presented to the ED with the chief complaint of abdominal pain. Symptoms had started two days prior with intermittent dull abdominal pain, constipation, and dysuria. Over-the-counter laxatives seemed to alleviate constipation at that time; however, the other symptoms worsened, prompting the patient to meet with her primary care physician (PCP). She denied nausea or vomiting. The patient’s medical history was negative for surgery and she denied the use of tobacco, alcohol, or illicit drugs. Her family history was non-contributory. The PCP ordered a plain abdominal X-ray, which showed a possible small bowel obstruction, and the patient was immediately advised to visit the ED for further evaluation.InvestigationsPhysical examination revealed mild pain on palpation of the entire abdomen. Computed tomography (CT) of the abdomen and pelvis with intravenous (IV) and oral (PO) contrasts revealed a 2.7-cm gallstone in the terminal ileum with dilated loops of the small bowel in the right lower quadrant, indicative of gallstone ileus [fig1].