Harlequin syndrome corresponds to unilateral dysfunction of sympathetic system, characterized by flush and unilateral hyperhidrosis associated with hypo or anhidrosis and paleness of the opposite side. It is, usually, idiopathic. Rarely, it may be associated with compressive organic processes, iatrogenic causes and general diseases. It is a real therapeutic challenge.

Phantosmia is the sensation of a fragrance intermittently or continuously when no odorant trigger is available. Without any further complaints, COVID-19 individuals may experience olfactory hallucination. Phantosmia was unnoticed for a long time sinc

This report describes a case of spontaneous cerebrospinal fluid leak through a narrow canal-like fistula in the lateral wall of the sphenoid sinus, which was managed through rigid reconstruction. Rigid reconstruction of the skull base was performed by fitting a pile-shaped bone into the fistula like the pile-driving technique.

Chris Wymant and an entire armada of scientists published a small paper titled "A highly virulent variant of HIV-1 circulating in the Netherlands." The general media have picked up on this and are giving the impression that HIV is now a more dangerous infection. This is not the fault of the Wymant and colleagues, but it is highly problematic. This more than 30 years old knowledge, which is now published with big headlines outside the medical press as lurid news, is likely to provoke misunderstandings in the general population. A renewed ostracism and stigmatization of the usual risk groups is now a real prospect. The findings presented in the aforementioned paper should have been addressed exclusively to health professionals and should have better never ended up in the hands of commercial media.

Objectives To assess associations between pre-pregnancy BMI and severe maternal morbidity (SMM), perinatal death and neonatal morbidity in twin pregnancies. Design Retrospective cohort study. Setting British Columbia, Canada (2000-2017). Population All twin births at ≥20 weeks’ gestation. Methods We examined associations between pre-pregnancy BMI, categorized as underweight (BMI <18.5m/kg2), normal BMI (18.5m/kg2 BMI <25m/kg2), overweight (25m/kg2 BMI <30m/kg2) and obese (BMI ≥30m/kg2) and adverse maternal and perinatal outcomes, using targeted maximum-likelihood estimation, adjusted for demographics and obstetric history. Outcomes SMM, perinatal death, severe perinatal morbidity. Results Overall, 7770 (368 underweight, 1704 overweight and 1016 obese) women with twin pregnancy were included. The rates of SMM (per 10,000 pregnancies) were: 271.1, 320.4, 270.0 and 225.9 in underweight, normal BMI, overweight and obese women, respectively. Underweight women had higher rates of the composite perinatal adverse outcome (adjusted rate ratio) [aRR] = 1.79, 95%CI = 1.32- 2.43), largely driven by increased rates of severe respiratory distress syndrome, and neonatal death (aRR = 2.81, 95%CI = 1.64-4.83). There was no evidence of elevated risk for perinatal outcomes among overweight and obese women. Conclusions In this population-based study cohort study, we found no evidence of an increased risk of adverse maternal and perinatal outcomes in overweight and obese women with twins; however, infants of underweight women are at higher risk of neonatal death and morbidity. These findings have implications for pregnancy care of women with twin pregnancies, especially those who are underweight. Funding SickKids Foundation (SKF-154852) Keywords: pre-pregnancy obesity, maternal morbidity, perinatal death

The use of cover crops and the adoption of no-tillage are essential conservation practices to increase carbon and nitrogen stocks and increase soil microbial activity. However, in lowland areas cultivated with irrigated rice, there is a large gap on the effects of no-tillage with long-term cover crops on soil attributes, crop responses and the effect of the system fertilization. The aim of this work was to evaluate the long-term adoption of cover crops on soil microbial activity, soil carbon stock and on the response of irrigated rice to system fertilization. Treatments consisted of fallow-conventional, fallow-no tillage, Annual Ryegrass, Oat, Ornithphus micranthus and Lotus cornicultaus. In the sub-plots, system and conventional fertilization per crop were compared. The experiment was conducted in southern Brazil in an Entisol and started in the 1996/97 crop season. Cover crops associated with the use of no-tillage increases basal respiration (+ 31%) of the soil, β-glucosidase activity (+ 259%), and soil carbon and nitrogen stocks. Urease activity increased by an average of 41% in no-tillage under cover crops compared to the conventional system under fallow, with the exception of ryegrass. System fertilization promoted higher dry matter production (+ 130%) in grasses and a lower increase (+ 23%) in winter legumes. The use of long-term cover crops promoted higher rice productivity (+ 9%). In this way, the association of cover crops and no-tillage increases carbon and nitrogen stocks, the biological activity of the soil and makes possible the system fertilization in lowlands, with positive effects on productivity.

Background: Cystic fibrosis is a common cause of pancreatic exocrine insufficiency. Clinically pancreatic insufficiency is treated as a permanent problem. However, new cystic fibrosis transmembrane conductance regulator (CFTR) protein modulator therapies, like ivacaftor, can change pancreatic function in children. Also, children with residual CFTR function mutations may be pancreatic insufficient in infancy and spontaneously become pancreatic sufficient. Aims: To evaluate the benefit of reviewing pancreatic function, testing and diagnosis, of a cohort and repeat testing to patients with the potential to change function. Methods: all children with cystic fibrosis managed at Perth Children’s Hospital at the end of 2019 were reviewed for pancreatic function testing at diagnosis, genotype and current modulator and pancreatic enzyme replacement therapy use. Children with the potential to change pancreatic function were offered repeat testing. Results: 204 children were included. 11 children were prescribed ivacaftor and four of these became pancreatic sufficient. Five children with a residual CFTR function mutation were pancreatic insufficient at diagnosis. Four became pancreatic sufficient. Conclusion: there is benefit in re-evaluating pancreatic function in children with cystic fibrosis regularly, especially if on ivacaftor or pancreatic insufficient with a residual CFTR function mutation.

Agricultural intensification and land clearing for agriculture has resulted in loss of biodiversity worldwide, land degradation and reduced the quality of ecosystems services that assist agriculture. Vegetative strips such as hedgerows and shelterbelts have the potential to provide ecosystem service benefits that improve agricultural production and environmental sustainability. A complex, interdisciplinary body of evidence exists examining the various social, physical, chemical, biological and ecological effects of vegetative strips. Here we provide an update to a systematic map of evidence regarding the social and environmental effects of vegetative strips within boreal and temperate regions. We track temporal changes in research trends since the previous map published on this topic in 2015. We followed the approach the previous map, searching databases using an identical search string. We used pre-defined eligibility criteria and layered article screening, reporting the reasons for article exclusion. We extracted meta-data and descriptively summarised the results to allow comparison to the previous map, producing an interactive database that serves as a comprehensive and up-to-date map of new evidence on top of the previous findings. We found many trends that were consistent with the previous map, including terminology trends, study regions, vegetative strip type, strip location and measured outcomes. We also found that there were key changes in the publication frequency of studies examining some biodiversity-related ecosystem services. In addition, several knowledge gaps identified in the previous map have been filled. A small number of countries in the Global North continue to drive major changes in publication trends.

Large bird species, such as cranes are involved in human-wildlife conflicts as they often forage in croplands. The Eurasian crane (Grus grus) is a large iconic bird species, protected across Europe, which, thanks to conservation programs and its ability to utilize croplands for foraging, shows a strongly increasing population trend. This exaggerates the already existing conflicts between crop farmers and cranes spilling over to natural habitats, where foraging by large flocks can lead to land degradation. To date, no studies have evaluated the effects of biopedturbation by cranes in grasslands, despite these habitats provide important feeding grounds for this large bird across its whole range. Here we evaluated the effect of biopedturbation by foraging Eurasian cranes on the vegetation of dry grasslands in Hungary. We used indicators of vegetation naturalness, forage quality and floral resource provision to evaluate the ecosystem state from multiple aspects. We sampled 100 quadrats in disturbed patches and 100 in intact grasslands in two seasons and two years (800 observations). We found that cranes created distinct habitat patches with different species composition compared to undisturbed areas. These early-successional patches that increased the plant diversity and floral resources but decreased the area of intact grasslands. Although crane-disturbed patches could provide forage for livestock early in the season, the forage quality of the vegetation became poor later in the year. Given the strong increase of the global crane population, monitoring the landscape-level extent of the disturbed areas, and developing a complex prevention and mitigation strategy would be important.

Background Digital Health Technologies (DHTs) have shown potential to improve health outcomes through improved medication adherence in different disease states1,2. Cystic Fibrosis (CF) requires care coordination across pharmacies, patients, and providers3,4. DHTs can potentially support patients, providers, and pharmacists in diseases like CF, where high medication burden can negatively impact patient quality of life and outcomes. Methods In this prospective cohort study, a CF-specific mobile application (Phlo) was distributed to adults with CF who received care at the University of Utah Cystic Fibrosis Center, used an iPhone, and filled prescriptions through the University of Utah Specialty Pharmacy services. Participants were asked to use Phlo for 90 days with an optional 90-day extension period. Participants completed four surveys at baseline and after 90 days. Changes in patient-reported outcomes, adherence, clinical outcomes, and healthcare resource utilization from baseline to 90 days were tracked. Results Phlo allowed users to track daily regimen activities, contact their care team, receive medication delivery reminders, and share progress with their healthcare team. A web-based dashboard allowed the care team to review reported performance scores from the app. Most patients (67%) said the app improved confidence in and motivation for continuing their regimen. The most important reported benefit of Phlo was having a single location to manage their whole routine. Inpatient hospital admissions decreased from 12 during the baseline period to 7 after the 90-day study period. Conclusions: Phlo is a mobile health technology designed to help patients with CF manage their treatment regimen and improve patient-provider communication.

The present research aimed to develop a new conceptual framework to predict land degradation (LD) susceptibility based on net primary production and machine learning domains. The annual NPP maps related to 2001-2020 were obtained using MOD17A3 and the trend of NPP changes was taken into account to investigate the occurrence and non-occurrence sites of land degradation in a region under the semi-arid climate in Iran. An inventory map of LD was generated based on occurrence and non-occurrence locations of degradation. The locations were randomly separated as the training (70%) and testing (30%) dataset to evaluate the goodness-of-fit and predictive efficiency of models. Next, fifteen geo-environmental factors including temperature, precipitation, slope, aspect, altitude, land use, normalized difference vegetation index, normalized difference salinity index, vegetation soil salinity index, normalized difference moisture index, visible and shortwave infrared drought index, electrical conductivity and sodium adsorption ratio of groundwater, groundwater table, and annual depletion of groundwater resources were selected as LD predictive variables. Four advanced machine learning techniques were performed to model LD susceptibility. Finally, the predictive efficiency of the applied models was measured utilizing the area under the ROC curve and true skill statics. The results indicated that the random forest model, with AUC = 0.84 and TSS = 0.64, showed the highest efficiency for predicting LD in our area of study followed by BRT, CART, and SVM. This study successfully proposed a new LD modeling framework based on the trend of NPP changes and can be used in different parts of the world.

Fournier's gangrene, a rapidly progressive necrotizing fasciitis of the perineum and external genitalia remains a medical-surgical emergency. The authors present a case of coverage of a scrotal loss of substance with testicular exposure by a medial fasciocutaneous flap in a fifty years male patient.

A 38-year-old female developed chronic joint pain one month after testing positive for SARS-CoV2. Physical examination revealed warmth and tenderness of the wrists and small joints of the hands. Rheumatoid factor and anti-CCP were elevated. Hands MRI showed synovitis of small joints. The patient was diagnosed with rheumatoid arthritis (RA).

Abstract Background This study aimed to evaluate whether changes in practice and patient behaviour due to the covid-19 pandemic impacted the presentation, management, and outcomes of patients with deep neck space infections (DNSI). Design Retrospective cohort study including all adults presenting to the otolaryngology department at a tertiary UK centre with a DNSI during the first 12 months of the covid-19 pandemic (n = 27), and those from the previous 12 month period (n = 26). Patients with peritonsillar abscess which did not involve deep neck spaces radiologically were excluded. Results The covid-19 pandemic cohort tended to present later after onset of symptoms (5.96 days vs 3.25 days, p = 0.0277), have abscess formation rather than inflammation only (77.8% vs 34.6%, p < 0.01), and develop complications (33.3% vs 7.7%, p = 0.0394). Not reaching statistical significance, the covid-19 pandemic cohort also had larger volume abscess (25.18cm3 vs 14.5cm3, p = 0.291), longer hospital stay (14.48 days vs 6.35 days, p = 0.114), and longer intensive care stay (7.88 days vs 1.78 days, p = 0.0992). Non-significant changes were noted in management, with the covid-19 pandemic cohort being seven times more likely to undergo tracheostomy (25.9% vs 3.8%, p = 0.0504), and more likely to undergo transcervical drainage (37% vs 19.2%, p = 0.224) and hot tonsillectomy (11.1% vs 0%, p = 0.236). Conclusion This study demonstrates the covid-19 pandemic led to delayed presentation and more severe infection, requiring more radical management in patients with DNSI.

Background and Purpose Neutrophils and the release of neutrophil extracellular traps (NETs) play important roles in the pathogenesis of RA. However, IgD, which was abnormally higher in RA, has not been studied for its pathological role in neutrophil activation and NETs formation. Experimental Approach Peripheral blood of RA patients and healthy controls were collected and adjuvant-induced arthritis (AA) rat models were established. Body weights, the severity of arthritis of AA rats were monitored regularly. After being stimulated with IgD, expression of FcδR on neutrophils and NETs formation were analyzed with multiple approaches such as flow cytometry, scanning electron microscopy, western blot, and qPCR. IgD-Fc-Ig were used to block interactions between IgD-FcδR. Additionally, the effect of IgD-induced neutrophils or NETs on FLS was assayed. Key Results As a specific marker of NETs, the level of citrullinated histone H3 was positively correlated with sIgD and FcδR in RA patients. IgD enhances the release of NETs by activating neutrophils. IgD-Fc-Ig could significantly reduce NETs formation and FcδR expression on neutrophils in vitro. In vivo, IgD-Fc-Ig treatment significantly regulates the neutrophil activity and NETs formation. IgD-Fc-Ig could restrain IgD-induced neutrophil activation and NETs formation, thus inhibiting FLS proliferation. Conclusions and Implications Neutrophils were activated by IgD, which suggests that neutrophils play a role in inducing FLS proliferation in RA patients who have abnormally higher IgD levels, there by increasing the severity of the disease. Blocking FcδR inhibited neutrophil activation and may represent an additional attractive novel therapeutic strategy for the treatment of RA.

Abstract: Background: Fluid overload (FO) and acute kidney injury (AKI) after CABG surgery are due to multiple perioperative etiologies associated with high failure to rescue rates (FTR) and associated with poor outcomes  1-,3. Diuretics, fluid restriction, ultrafiltration (UF) and renal replacement therapies are the treatment modalities implemented as monotherapy or in combination to address this severe complication. There is limited data on the use of simplified UF therapy as a fluid management strategy in post-operative cardiac surgery patients. Methods: A retrospective review of our post operative isolated CABG patients was done from Jan 1 st, 2020 to July 31 st, 2021. Those subjected to a simplified UF protocol incorporating Goal Directed Therapy (GDT) to treat fluid overload and/or acute kidney injury were evaluated for 30-day survival and readmission rates. Results: A total of 254 isolated CABG procedures were performed during this period. Ultrafiltration was used in 17 (6.7%) patients. The 30-day mortality for the entire CABG cohort was 5/254 (2.0%) patients and in the UF group 0/17 (0%). The mean age of UF therapy patients was 65.8 years (Range 41-89). The mean Society of Thoracic Surgeons STS mortality score of UF patients was 5.7% (Range 0.6-50.0). The 30-day survival for the 17 patients placed on UF therapy was 100% and their readmission rate was 2/17 (11.7%). Conclusions: The use of ultrafiltration in this patient population with relatively high STS scores provided a safe and effective modality to manage fluid balance but further studies are needed.

Background and Purpose: Psoriasis is an immune-associated disease, however, the pathogenesis of psoriasis remains unclear. We investigated the mechanism of IL-35 in psoriasis treatment. Experimental Approach: PASI and Baker scores were used to evaluate the Imiquimod-induced psoriasis mouse model. Flow cytometry is used to detect changes in immune cells and to select target cells. The changes of inflammatory factors were detected by ELISA. Adoptive transfused was used to demonstrate the effect of the corresponding cells. Key Results: IL-35 expression in patients with psoriasis was significantly increased. The number of myeloid-derived suppressor cells (MDSCs) in patients was also significantly increased. Similar results were obtained in mice with imiquimod (IMQ)-induced psoriasis. IL-35 had potent immunosuppressive effects on psoriasis model mouse, leading to a decrease in the total number of MDSCs and its subtypes in the spleen and psoriatic skin lesions. The level of inducible nitric oxide synthase (iNOS) secreted by MDSCs also decreased significantly; however, there was no difference in the level of IL-10 in MDSCs. Adoptive transfer of MDSCs from IMQ-challenged mice weakened the effect of IL-35. When MDSCs were isolated from iNOS knockout mice that were established with IMQ and transfected into IMQ-induced WT mice, there was no significant difference in psoriasis area and severity index scores between IL-35 + iNOS-/–MDSC and IL-35 treatment groups. Conclusions and Implications: IL-35 plays an important immunosuppressive role in psoriasis by inhibiting the counts of MDSCs expressing iNOS. This study may serve as a new therapeutic strategy for patients with chronic psoriasis or other cutaneous inflammatory diseases.

Explaining food web dynamics, stability, and functioning depend substantially on understanding of feeding relations within a community. Bulk stable isotope ratios (SIRs) in natural abundance are well-established tools to express direct and indirect feeding relations as continuous variables across time and space. Along with bulk SIRs, the SIRs of individual amino acids (AAs) are now emerging as a promising and complementary method to characterize the flow and transformation of resources across a diversity of organisms, from microbial domains to macroscopic consumers. This significant AA-SIR capacity is based on empirical evidence that a consumer’s SIR, specific to an individual AA, reflects its diet SIR coupled with a certain degree of isotopic differences between the consumer and its diet. However, many empirical ecologists are still unfamiliar with the scope of applicability and the interpretative power of AA-SIR. To fill these knowledge gaps, we here describe a comprehensive approach to both carbon and nitrogen AA-SIR assessment focusing on two key topics: pattern in AA-isotope composition across spatial and temporal scales, and a certain variability of AA-specific isotope differences between the diet and the consumer. On this basis we review the versatile applicability of AA-SIR to improve our understanding of physiological processes as well as food web functioning, allowing us to reconstruct dominant basal dietary sources and trace their trophic transfers at the specimen and community levels. Given the insightful and opportunities of AA-SIR, we suggest future applications for the dual use of carbon and nitrogen AA-SIR to study more realistic food web structures and robust consumer niches, which are often very difficult to explain in nature.

HIV can be associated with cardiovascular complications. We highlight unusual presentation of HIV patient with MI and stroke. 30 year old HIV male presented with MI complicated by stroke. Recovered within 5 days with anti-ischemic and diuretics. Screening tests for unusual presentations prevent fatal complications of common diseases.

Incomplete obliteration of urachus during the fetal period can lead to urachal abnormalities, such as urachal sinus. Therefore, it should be considered as a significant differential diagnosis in abdominal pain or umbilical discharge patients. This article presents a young patient with a urachal sinus mimicking umbilical pilonidal sinus symptoms.

This study updates information on the evolution of glacier shrinkage in Cocuy-Güican mountains since the maximum glacier extent of the Little Ice Age (LIA), and presents the first mass balance data of Ritacuba glacier since 2009, that is compared to the available mass balance for the Conejeras Glacier (Los Nevados National Park). This study also discusses the hydrological significance of Colombian glaciers which is still largely unknown because of the very limited information available. Glaciers in Cocuy-Güican covered 13.2 km2 in 2019 that compared to the 127.8 km2 during the maximum LIA represents a shrinkage of 89.7%. Glacier cover observations in 1955, 1994, 2010 and 2019, reveal that the rate of ice loss was the largest from 1994 to 2010 (0.59 km2 yr-1) and was then more than halved from 2010 to 2019 (0.34 km2 yr-1). This slowdown in glacier retreat is in line with a moderate negative mass balance measured for 2009-2019, with an accumulated loss of 1,766 mm w.e. The progressive confinement of glaciers to higher elevation and optimal topographic context together with a lack of recent marked climatic anomalies, could explain that Cocuy-Güican glaciers have temporally reached near equilibrium state condition. This is in stark contrast with Conejeras glacier where 47,000 mm w.e. has been lost in the same period. The available data on runoff and isotopic traces of streamflows and precipitation suggest a primary control of precipitation on the hydrological variability of the high elevated sites, compared to glacier melt water.

We report a case of primary malignant melanoma of the esophagus.

Glomus tumours are infrequent benign tumours originate from the glomus body and can be found anywhere in the body. We report the case of a 61 year-old patient who presented with massive upper GI bleeding secondary to an ulcerated gastric glomus tumour that eventually treated with surgical wedge resection.

Availability of suitable nectar and pollen resources is a limiting factor for pollinator survival, with both overall resource quantity and quality, along with provision throughout the season, being critical. Yet, our understanding of how the selection of floral resources changes over time, and how this relates to floral availability within the landscape is limited. To fill this knowledge gap, we characterise floral use by honeybee (Apis mellifera) colonies, in a diverse horticultural and agricultural landscape, from April to September, over two years, using pollen DNA metabarcoding of honey samples. We compared the pollen found to the availability of host plants within the surrounding landscape using floral surveys. Honeybees used a total of 143 plant taxa, but only 10 of these were determined as major sources (>10% of total sequence reads in any month) and total plant use represented a small proportion of the available floral resources (23% of genera). Distinct patterns of diet specialisation were identified in June and August, where colonies diverged in their floral preferences before re-aligning in July and September. Following optimal foraging theory, these patterns represent periods of resource limitation. Honeybees showed a preference for flowering trees in the spring, followed by shrubs and herbs in summer and used native and near-native plants more than horticultural plants, as major food sources. DNA metabarcoding allows an increased ecological insight into floral resource use by honeybees and highlights the importance of providing continuous and sufficient floral resources throughout the year.