A 22-year male presented with complaints of dyspnea. Multimodality imaging revealed a polypoidal right atrial mass with sub-massive pulmonary embolism. The patient underwent urgent surgery. The pathological examination confirmed it as cardiac myxoma. Cardiac myxoma, a most common primary cardiac tumor, is commonly found in the left atrium. The right atrium is an uncommon site and the usual mode of presentation is the tumor or thrombus embolisation to the pulmonary circulation.

Patients with relapsed follicular lymphoma who do not respond to CAR-T have a poor outcome. We present a case of refractory follicular lymphoma who relapsed after two CAR-T infusions and achieved a complete remission after treatment with obinutuzumab and lenalidomide. This represents a promising treatment option in the post-CAR-T setting.

Sayed-Amir Marashi*, Hamideh FouladihaDepartment of Biotechnology, College of Science, University of Tehran, Tehran, Iran.E-mail address: marashi@ut.ac.ir (S.-A. Marashi)

In this article, a COVID-19 transmission mathematical model incorporating vaccination and non-pharmaceutical interventions was formulated and theoretically analysed. Here, the COVID-19 free and endemic equilibrium points, vaccine reproduction number were computed. The derived vaccination reproduction number largely depends on vaccine efficacy for disease eradication to occur. Infection risk is significantly reduced whenever the vaccine intake is greater than one dosage. The simulation results indicate that the administered COVID-19 vaccines and non-pharmaceutical interventions have been effective for the current variants, additional efforts such as a third vaccine booster shot should be considered and implemented to greatly mitigate the risk of the emerging variants of the COVID-19 pandemic.

A 73-year-old man underwent a stage Ⅱ sigmoid colon cancer resection. Careful monitoring was undertaken, and no evidence of metastasis or anastomotic recurrence was noted until 51 months later. Anal examination revealed a pink, firm perianal tumor histologically identified as a metastasis of the colon adenocarcinoma.

In this paper, the compressible quantum model with the given mass source and the external force of general form in three-dimensional whole space is considered. Based on the weighted $L^2$ method and $L^\infty$ estimates, the existence and uniqueness of stationary solutions can be obtained by the contraction mapping principle. By using a general energy method, the nonlinear stability of stationary solutions is studied, and the time decay rates of the solutions are established when the initial perturbation belongs to $\dot{H}^{-s}$ with $0 \leq s < \f32$.

Aim To create a drug safety signalling pipeline associating latent information in clinical free text with exposure profiles to highlight potential adverse drug reactions to single drugs and drug pairs. Methods All inpatient visits of a 500,000-patient sample from two Danish regions, between 18 May 2008 and 30 June 2016. Tokens from clinical notes recorded within 48 hours of admission were operationalised with a fastText embedding. For each of the 10,720 single-drug and drug-pair exposures from doorstep medication profiles, we trained a feed-forward neural network predicting the risk of exposure using embedding vectors as inputs. Results 2,905,251 inpatient visits comprised 13,740,564 doorstep drug prescriptions; the median number of prescriptions was 5 (IQR: 3-9) and in 1,184,340 (41%) admissions patients used ≥5 drugs concurrently. 10,788,259 clinical notes were included, with 179,441,739 tokens retained after pruning. Of 345 single-drug signals reviewed, 28 (8.1%) represented possibly undescribed relationships; 186 (54%) signals were clinically meaningful. 16 (14%) of the 115 drug-pair signals were possible interactions and 2 (1.7%) were known. Conclusion We built a language-agnostic pipeline for mining associations between free-text information and medication exposure without manual curation, by predicting not the likely outcome of a range of exposures, but the likely exposures for outcomes of interest. Our approach may help overcome limitations of text mining methods relying on curated data in English and makes our method appealing in settings that must make sense of non-English free text for pharmacovigilance.

Saprolegnia parasitica is an oomycete responsible for fish disease called saprolegniosis, which poses economic and environmental burden on aquaculture production. Chitin is an essential cell wall component of S. parasitica synthesized by chitin synthase (CHS) enzyme. CHSs are large membrane-integrated enzymes with multiple domains responsible for cellular integration and activation. In saprolegnia, CHS5 of S. parasitica (SpCHS5) contains an N-terminal domain, a catalytic domain of the glycosyltransferase -2 family containing a GT-A fold, and a C-terminal transmembrane domain. In addition, SpCHS5 consists of the MIT (microtubule interacting and trafficking) domain which is crucial for intracellular trafficking of SpCHS5. There is no three-dimensional structure of SpCHS5 is reported yet disclosing the structural details of this protein. We have developed a structural model of full-length SpCHS5 and validated it by molecular dynamics. This model structure will assist on designing antiparasitic drug. Structural GT-A domain and transmembrane contribute stable alpha-helix where MIT domain demonstrate flexible conformation based on phosphorylation sites. From the chitin dynamic movement in the protein cavity, we predicted Asp442, Asp386, Ser541, Tyr379, Asp328, Gln481, Trp485, Tyr645, Thr641, Tyr177 residues as a prominent cavity lining site. Overall, this present work will be helpful to understand the biochemistry of CHS5 and design inhibitors against SpCHS5.

Error-in-variables model (EVM) methods require information about input and output measurement variances when estimating model parameters. In EVM, using replicate experiments for estimating output measurement variances is complicated, because true values of inputs may be different when multiple attempts are made to repeat an experiment. To address this issue, we categorize attempted replicate experiments as: i) true replicates (TRs) when uncertain inputs are the same in replicated runs and ii) pseudo-replicates (PRs) when measured inputs are the same, but unknown true values of inputs are different. We propose methodologies to obtain output measurement variance estimates and associated parameter estimates for both situations. We also propose bootstrap methods for obtaining joint-confidence information for the resulting parameter estimates. A copolymerization case study is used to illustrate the proposed techniques. We show that different assumptions noticeably affect the uncertainties in the resulting reactivity-ratio estimates.

Objective: This study identified the prevalence of miscarriages and perinatal deaths from a community perspective. Design: A population-based, cross-sectional household study. Setting: Sierra Leone (West-Africa) from 2019-2020 Population: Women of reproductive age Methods: Seventy-five randomized clusters were selected, 25 households in each cluster and two random participants from each household. Female participants between 12 and 50 years of age were interviewed about family planning methods and obstetrical history. Main outcome measures: miscarriage and perinatal death Results: A total of 914 women of reproductive age were included. Family planning methods were used by 29% of the women. In total, 2,160 life-time pregnancies were recalled of which 104 (5%, 95% CI 4-6%) resulted in an early pregnancy loss. Eighty-three (80%) were reported as spontaneous abortion, 17% (18) were intentional abortions, of which 9 were induced with medication outside the hospital. The stillbirth rate was 18.5 (95% CI 9-31) per 1000 births and the perinatal mortality rate was 38,4 (95% CI 24-54) per 1000 births calculated over a 5-year period. Conclusion: This study confirms that the perinatal death rate in Sierra Leone exceeds the global average. The miscarriages both spontaneous and intentional, are likely to be underreported. Medical attention should be placed to treat and investigate the causes of miscarriages and perinatal deaths. Improving the use of family planning is needed to decrease the hidden burden of intentional abortions. Funding: Norwegian University of Science and Technology (NTNU) and University of Amsterdam’s Center of Tropical Medicine and Travel Medicine.

Primary invasive breast carcinoma with neuroendocrine differentiation is an uncommon presentation. We hereby report a case diagnosed as invasive ductal carcinoma with neuroendocrine differentiation in a 52-year-old female who presented with a painless right breast lump.

background: Small cell carcinoma of cervix(SCCC) is a rare disease. case: Here, we report 47-year-old patient presenting with abnormal vaginal bleeding diagnosed with SCCC. Patient received multimodality treatment conclusion: Small cell carcinoma of cervix is an aggressive form of cervical cancer with poor prognosis. Optimal treatment remains undefined.

BACKGROUND: Few studies have examined survival in relapsed childhood acute lymphoblastic leukemia (ALL) in resource-limited countries. The aims of this study were to evaluate the incidence, prognostic factors, and survival of relapsed childhood ALL in Thailand. METHODS: The medical records of patients with ALL aged <15 years in the major tertiary care institution in Southern Thailand between January 2000 and December 2019 were retrospectively reviewed. The Kaplan-Meier method was used to depict the overall survival (OS). RESULTS: A total of 472 patients with ALL were enrolled. The incidence of relapsed ALL was 32.8%. Of the 155 relapsed patients, 131 (84.5%) and 24 (15.5%) had B-cell and T-cell phenotypes, respectively. One hundred thirteen (72.9%) and 42 (27.1%) patients had early and late relapses, respectively. The most common site of relapse was bone marrow in 102 patients (65.8%). One hundred twenty-eight (82.6%) and 27 (17.4%) patients received or refused the relapse chemotherapy, respectively. The 5-year OS of all relapsed patients was 11.9%. The 5-year OS among the patients with early relapse was significantly lower than in the patients with late relapse (5.3% vs. 29.1%, respectively, p <0.0001). Site and immunophenotype were not associated with survival of relapsed ALL. The patients who refused chemotherapy had a median survival time of 3.1 months. CONCLUSION: The relapse rate was one third of patients with ALL. The 5-year OS was 12% and patients who refused chemotherapy had a median survival time of 3 months.

It has been almost 50 years since Mike Bonell’s foundational work in the humid tropics, kickstarting the field of tropical hydrology. In order to expand on this work and build a more generalized hydrological understanding of steep rainforest catchments, we studied the seasonal and inter-annual evolution of hydrological response from two catchments with similar characteristics to those studied by Bonell. Both hydrometric and water stable isotope data were collected at relatively high frequencies during one wet season (Thompson Creek) and a three-year period (Atika Creek). The longer dataset spans a wide range of environmental conditions experienced in the humid tropics, including events that cover the wetting-up transitional period of the wet season, ENSO events and tropical cyclones. Both catchments displayed fast streamflow response to rainfall with the shallow upper soil profile responding quickly to rainfall at Atika Creek. New findings from this study include the importance of pre-event water (>50%) for overall event flows, especially when the catchment was wet. Rainfall, surface runoff and groundwater isotope compositions varied between rainfall events with the most complex mixing plots observed for multi-peak events that occurred at the start of the wet season and after a dry period within the wet season. Inter-annual variability in catchment hydrology reflected changing ENSO conditions and the 2020-21 La Ninã wet season was characterized by several tropical cyclone events which generated the most 18O-depleted rainfall and streamflow isotope values. Our findings highlight the requirement for high frequency multi-source sampling to accurately interpret catchment behavior. We propose a conceptual model to describe the seasonal evolution of streamflow response in steep rainforest catchments.

A maturing body of evidence suggests that anthropogenic impacts on river-wetland corridors may be greater and more widespread than previously recognized. We applied the Geomorphic Grade Line (GGL) method to define pre-Anthropocene valley surfaces within segments of the 42-kilometer Entiat River Valley (ERV) of the North Cascade Mountains, USA. We developed GGL-relative elevation models (GGL-REMs) by subtracting, from high-resolution digital elevation data, a detrending surface based on relic fluvial features of the valley floor. We validated the GGL-REMs using surficial geologic maps, C 14-dated soil profiles, and the identifiable remnants of historic dams. We interpreted these data in the context of settlement land use practices including channelization, large wood removal, and beaver ( Castor canadensis) trapping. Our analysis indicates that since the early 20 th century, the river has incised more than two meters in many areas. This triggered a rapid state and process change, wherein unconfined and partially-confined valleys transitioned from net deposition to erosion and transport environments. The distribution of river types shifted from ecologically rich river-wetland corridors towards simpler, single-threaded channels common in confined valleys. The effects of this state change on salmon productivity were profound. Results from the Entiat and other locales indicate that GGL-REMs can be used to help define the fluvial process-form domains, including the vertical dimension needed to guide valley floor restoration. These tools can be used to envisage pre-degradation riverscapes, especially when used in concert with other datasets. Once the pre-Anthropogenic conditions of rivers like Entiatqua have been recognized, the case for restoring lost river-wetland corridors to unlock their ecological potential becomes compelling.

Anthropogenic activities are leading to changes in the environment at global scales, and understanding these changes requires rapid, high-throughput methods of assessment. Pollen DNA metabarcoding and related methods provide advantages in throughput and efficiency over traditional methods, such as microscopic identification of pollen and visual observation of plant-pollinator interactions. Pollen DNA metabarcoding is currently being applied to assessments of plant-pollinator interactions and their responses to land-use change such as increased agricultural intensity and urbanisation, surveillance of ecosystem change, and monitoring of spatiotemporal distribution of allergenic pollen. In combination with historical specimens, pollen DNA metabarcoding can compare contemporary and past ecosystems. Current technical challenges with pollen DNA metabarcoding include the need to understand the relationship between sequence read and species abundance, develop methods for determining confidence limits for detection and taxonomic classification, increase method standardisation, and improve of gaps in reference databases. Future research expanding the method to intraspecific identification, analysis of DNA in ancient pollen samples, and increased use of museum and herbarium specimens could open further avenues for research. Ongoing developments in sequencing technologies can accelerate progress towards these goals. Global ecological change is happening rapidly, and we anticipate that high-throughput methods such as pollen DNA metabarcoding are critical for assessing these changes and providing timely management recommendations to preserve biodiversity and the evolutionary and ecological processes that support it.

Dissimilatory sulfite reductase is an ancient enzyme that has linked the global sulfur and carbon biogeochemical cycles since at least 3.47 Gya. While much has been learned about the phylogenetic distribution and diversity of DsrAB across environmental gradients, far less is known about the structural changes that occurred to maintain DsrAB function as the enzyme accompanied diversification of sulfate/sulfite reducing organisms (SRO) into new environments. Analyses of available crystal structures of DsrAB from Archaeoglobus fulgidus and Desulfovibrio vulgaris, representing early and late evolving lineages, respectively, show that certain features of DsrAB are structurally conserved, including active siro-heme binding motifs. Whether such structural features are conserved among DsrAB recovered from varied environments, including hot spring environments that host representatives of the earliest evolving SRO lineage (e.g., MV2-Eury), is not known. To begin to overcome these gaps in our understanding of the evolution of DsrAB, structural models from MV2.Eury were generated and evolutionary sequence co-variance analyses were conducted on a curated DsrAB database. Phylogenetically diverse DsrAB harbor many conserved functional residues including those that ligate active siro-heme(s). However, evolutionary co-variance analysis of monomeric DsrAB subunits revealed several False Positive Evolutionary Couplings (FPEC) that correspond to residues that have co-evolved despite being too spatially distant in the monomeric structure to allow for direct contact. One set of FPECs corresponds to residues that form a structural path between the two active siro-heme moieties across the interface between heterodimers, suggesting the potential for allostery or electron transfer within the enzyme complex. Other FPECs correspond to structural loops and gaps that may have been selected to stabilize enzyme function in different environments. These structural bioinformatics results suggest that DsrAB has maintained allosteric communication pathways between subunits as SRO diversified into new environments. The observations outlined here provide a framework for future biochemical and structural analyses of DsrAB to examine potential allosteric control of this enzyme.

Both in medicine and in psychiatry, it’s essential to thoroughly identify the cases in which it is necessary to intervene therapeutically, and justify a sick leave or make forensic interpretations, among others. Therefore, it is important to find a general concept and definition for medical and psychiatric disorders. Boorse, develops one of the most widespread models of medical disorder that aspired to be value-free and that was based in medical dysfunction. But values appear implicitly or explicitly with a deeper analysis of this concept. On the other hand, there is the overtly value laden (harm) component that has been used in the definition of disorder, defended as essential by several authors over the time, once symptoms and their consequences (disability, distress) have been considered as a priority in medicine. In this article, we intend to review, through a conceptual analysis, the proximity between the concepts of mental and physical disorders regarding the presence of values, and to propose a way to deal with the different kinds of values that might be present. It is concluded that values are present in the main concepts that have been used to define medical or psychiatric disorder. What is essential is to understand what is descriptive and what is value and to try to avoid moral values.

For many patients with severe Covid-19 disease of the pre-Omicron era, recovery is far from over with the end of acute symptoms. The authors of this paper have reviewed the currently available studies and conclude that Long-Covid appears to be a serious, sometimes even life-threatening syndrome. However, it seems to have good prospects for full recovery with multidisciplinary and evidence-based post-treatment care, which is, however, still lacking in Europe and North America. The Omicron variant appears to be a game changer in this regard as well. So far it seems that Long Covid is no common consequence of Sars-2-Omicron Disease.

1. Prairie dogs (Cynomys sp.) are considered keystone species and ecosystem engineers for their grazing and burrowing activities (summarized here as disturbances). As climate changes and its variability increases, the mechanisms underlying organisms’ interactions with their habitat will likely shift. Understanding the mediating role of prairie dog disturbance on vegetation structure, and its interaction with environmental conditions through time, will increase knowledge on the risks and vulnerability of grasslands. 2. Here, we compared how plant taxonomic and functional diversity metrics, along with community-weighted trait means (CWM), respond to prairie dog disturbance across grassland types and seasons in a conservation priority, semiarid grassland of Northeast Mexico. 3. Our findings suggest that functional metrics and CWM analyses responded to interactions between prairie dog disturbance, grassland type and season, whilst species diversity and cover measures were less sensitive to the role of prairie dog disturbance. Contrary to previous studies, we found weak evidence that prairie dog disturbance has a negative effect on vegetation structure, except for minimal effects on C4 and graminoid cover, which depend mainly on season. Grassland type and season explained most of the effects on plant functional and taxonomic diversity as well as CWM traits. Furthermore, we found that leaf area as well as forb and annual cover increased during the wet season, independent of prairie dog disturbance. 4. Our results provide evidence that prairie dog disturbance is less important than grassland type and that environmental effects have a stronger role than grazing and animal disturbances on vegetation. We argue that a focus on disturbance and grazing effects is misleading, and instead attention is needed on the relationships between vegetation and environmental conditions which will be critical to understand semi-arid grassland dynamics in the region. In addition, explicit management strategies to mitigate climate change would need to consider these relationships

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

Correspondence: Mikaela I Poling, 8501 Arlington BLVD, Ste 420, Fairfax, VA 22031, USA; Tel. +1 304-460-9038; Fax +1 703-207-2002; E-mail: research@duplastics.comAuthor Contributions: Both authors contributed equally.Acknowledgments: We thank CM Poling, M Pócket, BR Honour, and ES Tu. This manuscript is dedicated to the memory of Calvin Yang, formerly of the 2nd Battalion, 27th Infantry Regiment “Wolfhounds” of the US Army, who lost his life to complications of posttraumatic stress disorder several years after serving.Conflict of Interest: The authors have no financial or other competing interests to disclose.Funding: This work was unfunded.Word Count: 809 (Body)

Coronavirus disease 2019 (COVID-19) vaccination is reportedly safe and effective. The histologic features of post-COVID-19 vaccination myocarditis are unknown. We present a 77-year-old Japanese woman who was diagnosed with eosinophilic myocarditis using endomyocardial biopsy, 7 days after receiving the second dose of BNT162b2 COVID-19 vaccine. Methylprednisolone pulse therapy was effective.

A 42-year-old male patient diagnosed with Wellens syndrome, the angiography showed the narrowing not only in left anterior descending artery but also in other arteries. Cardiac electrical storm can occur without complete revascularization and it can be managed successfully with the infusion of amiodarone and lidocaine in different veins.