To predict the remaining useful life for the key structures of heavy-duty railway wagons using condition monitoring data, methods for the coupler body with and without visible cracks were proposed. First, a method based on the delay time and hypothesis testing was proposed, considering the case without visible cracks in the coupler body. Then, for the case of visible cracks, methods based on a hypothetical distribution and support vector regression with the Kalman filter were proposed. Finally, by taking the coupler body monitoring data as an example, the prediction accuracies of the proposed methods were compared. The results indicated that the prediction method that only considers the common characteristics of the research objects had an average relative error of 57.56% for the coupler structure with a long lifespan. Considering the delay time of the current state of the structure and the assumed distribution prediction method, the relative error was reduced to 34.52%, and the remaining useful life prediction value fluctuated sharply with respect to the service mileage. On this basis, considering the performance degradation process of the structure, the change in the remaining useful life prediction value was smoother, and the relative error was 43.67%. The methods for predicting the remaining useful life of railway heavy-duty coupler bodies using condition monitoring data have important theoretical and practical value for improving vehicle safety, reducing maintenance costs, and accurately evaluating the remaining useful life.

Background: Homologous and heterologous SARS-CoV-2 vaccinations yield different spike protein-directed humoral and cellular immune responses. This study aimed to explore their currently unknown interdependencies. Methods: COV-ADAPT is a prospective, observational cohort study of 417 healthcare workers who received vaccination with homologous ChAdOx1 nCoV-19, homologous BNT162b2 or with heterologous ChAdOx1 nCoV-19/BNT162b2. We assessed humoral (anti-spike-RBD-IgG, neutralizing antibodies, avidity) and cellular (spike-induced T cell interferon‑γ release) immune responses in blood samples up to 2 weeks before (T1) and 2 to 12 weeks following secondary immunization (T2). Results: Initial vaccination with ChAdOx1 nCoV-19 resulted in lower anti-spike-RBD-IgG compared to BNT162b2 (70±114 vs. 226±279 BAU/ml, p<0.01) at T1. Booster vaccination with BNT162b2 proved superior to ChAdOx1 nCoV-19 at T2 (anti-spike-RBD-IgG: ChAdOx1 nCoV-19/BNT162b2 2387±1627 and homologous BNT162b2 3202±2184 vs. homologous ChAdOx1 nCoV-19 413±461 BAU/ml, both p<0.001; spike-induced T cell interferon-γ release: ChAdOx1 nCoV-19/BNT162b2 5069±6733 and homologous BNT162b2 4880±7570 vs. homologous ChAdOx1 nCoV-19 1152±2243 mIU/ml, both p<0.001). No significant differences were detected between BNT162b2-boostered groups at T2. For ChAdOx1 nCoV-19, no booster effect on T cell activation could be observed. We found associations between anti-spike-RBD-IgG levels (ChAdOx1 nCoV-19/BNT162b2 and homologous BNT162b2) and T cell responses (homologous ChAdOx1 nCoV-19 and ChAdOx1 nCoV-19/BNT162b2) from T1 to T2. Additionally, anti-spike-RBD-IgG and T cell response were linked at both time points (all groups combined). All regimes yielded neutralizing antibodies and increased antibody avidity at T2. Conclusions: Interdependencies between humoral and cellular immune responses differ between common SARS-CoV-2 vaccination regimes. T cell activation is unlikely to compensate for poor humoral responses. 

In this paper, we establish a new phytoplankton-zooplankton model by considering the effects of plankton body size and stochastic environmental fluctuations. Mathematical theory work mainly gives the existence of boundary and positive equilibria, and shows their local as well as global stability in the deterministic model. Additionally, we explore the dynamics of V-geometric ergodicity, stochastic ultimate boundedness, stochastic permanence, persistence in the mean, stochastic extinction and the existence of a unique ergodic stationary distribution in the corresponding stochastic version. Numerical simulation work mainly reveals that plankton body size can generate great influences on the interactions between phytoplankton and zooplankton, which in turn proves the effectiveness of mathematical theory analysis. It is worth emphasizing that for the small value of phytoplankton cell size, the increase of zooplankton body size can not change the phytoplankton density or zooplankton density; for the middle value of phytoplankton cell size, the increase of zooplankton body size can decrease zooplankton density or phytoplankton density; for the large value of phytoplankton body size, the increase of zooplankton body size can increase zooplankton density but decrease phytoplankton density. Besides, it should be noted that the increase of zooplankton body size can not affect the effect of random environmental disturbance, while the increase of phytoplankton cell size can weaken its effect. There results may enrich the dynamics of phytoplankton-zooplankton models.

Background: The recently described sensor-crosstalk error in the multiple-breath washout (MBW) device (Exhalyzer D, Eco Medics AG, Duernten, Switzerland) could highly influence clinimetric properties and the current interpretation of MBW results. This study reanalyzes MBW data from clinical routine in the corrected software version Spiroware® 3.3.1 and evaluates the effect on outcomes. Methods: We included nitrogen-MBW data from healthy children and children with CF from previously published trials and ongoing cohort studies. We specifically compared LCI analyzed in Spiroware 3.2.1 and 3.3.1 with regards to i) feasibility, ii) repeatability and iii) validity as outcome parameters in children with CF. Results: (i) All previously collected measurements could be reanalyzed and resulted in unchanged feasibility in Spiroware 3.3.1. (ii) Short- and midterm repeatability of LCI was similar in both software versions. (iii) Clinical validity of LCI remained similar in Spiroware 3.3.1, however, resulted in lower values. Discrimination between health and disease was comparable between both software versions. The increase in LCI over time was less pronounced with 0.16 LCI units/year (95% CI 0.08; 0.24) vs. 0.30 LCI units/year (95% CI 0.21; 0.38) in 3.2.1. Response to intervention in children receiving CFTR-modulator therapy resulted in a comparable improvement in LCI in both Spiroware versions. Conclusion: Our study confirms that clinimetric properties of LCI remain unaffected after correction for the cross-sensitivity error in Spiroware software.

Background: Bronchopulmonary dysplasia (BPD) is characterized by impaired alveolar and microvascular development. Claudin-18 is the only known lung-specific tight junction protein affecting alveolar epithelium development and transdifferentiation. Objective: To explore the changes in claudin-18 expression, alveolar epithelial cell (AEC) marker proteins, the canonical Wnt pathway, and their possible regulatory relationships in a hyperoxia-induced BPD rat model. Methods: The BPD neonatal rat model was established by exposure to hyperoxia (85%). Hematoxylin and eosin (HE) staining was used to confirm the establishment of the BPD model. The mRNA levels were assessed using quantitative real-time polymerase chain reaction, while protein expression levels were determined using western blotting, immunohistochemical staining, and immunofluorescence . Results: As confirmed by HE staining, the BPD neonatal rat model was successfully established. Compared with the air group, claudin-18 and claudin-4 expression decreased in the hyperoxia group. The expression of β-catenin of the Wnt signaling decreased, whereas that of p-GSK-3β increased. Expression of the AEC Ⅱ marker SFTPC decreased initially and then increased, whereas that of the AEC Ⅰ marker Podoplanin increased on day 14 (P < 0.05). Conclusions: Claudin-18 downregulation during hyperoxia may affect lung development and maturation, which may result in hyperoxia-induced BPD. Additionally, claudin-18 is associated with the canonical Wnt pathway and alveolar epithelial transdifferentiation.

Background It is unclear how intensity-modulated radiation therapy (IMRT) impacts long-term risk of second malignant neoplasms (SMNs) in childhood cancer patients. Procedure Patients aged 10 years, many solid SMNs after IMRT in childhood cancer survivors develop in the high dose region. These data serve as a foundation for comparison with other modalities of radiation treatment (e.g., proton therapy).

Myofibroblastic tumour is extremely rare in the larynx, with just over 40 published cases. Despite being a benign tumour, they are tumours with a marked inflammatory character, local destruction and the possibility of degeneration to malignant histological types and with metastatic capacity. Anatomopathological differential diagnosis is fundamental in this cases.

BACKGROUND: Lung involvement in COVID-19 can be quantified by chest CT scan with some triage and prognostication value. At least 7 CT-severity score (CTSS) systems have been proposed. PURPOSE: We evaluated triage and prognostication performance of seven different CTSSs for COVID-19. MATERIALS AND METHODS: COVID-19, PCR positive patients admitted from February 20th 2020 to July 22nd were included into a retrospective study. Demographic data and clinical data indicating disease severity at presentation and in peak disease severity were recorded. CT images were reviewed and scored according to seven different scoring systems (CTSS1-CTSS7) by two radiologists. Interrater reliability was determined for each CTSS. Then clinical severity of the disease at presentation (for triage) and peak disease severity (for outcome) were compared with CTSSs separately. ROC curves for performance of each CTSS in diagnosing severe/critical disease on admission, severe/critical disease at peak disease severity and critical disease at peak severity were plotted. Areas under the curve (AUCs), best thresholds and corresponding sensitivities and specificities were calculated. RESULTS: 96 patients were included with mean age of 63.6 ± 17.4 years (range: 21-88, median: 67). 57 (59,4%) were men and 39 (40.6%) were women. All CTSSs showed good interrater reliability as calculated intraclass correlation coefficients (ICCs) were 0.764-0.837 for all of the CTSSs. Only three CTSSs showed acceptable AUCs (AUC =0.7) for triage of severe/critical patients. All CTSSs showed acceptable AUCs for prognostication (AUCs=0.76-0.79). Calculated AUCs were not significantly different for triage and for prediction of severe/critical disease but some difference was shown for prediction of critical disease. CONCLUSION: Men are probably affected more frequently than women by COVID19. CTSS performance in triage was much lower than earlier reports and only three CTSSs showed acceptable AUCs. CTSS performed better for prognostic purposes than for triage as all 7 CTSSs showed acceptable AUCs in both types of prognostic ROC curves. Our results are compatible with those of recent studies. There is not much difference among performance of different CTSSs.

Venetoclax is a promising new drug for relapsed or refractory chronic lymphocytic leukemia (CLL). However, venetoclax use had not been reported in severe chronic kidney disease (CKD) patients. We report the first case of relapsed CLL in a severe CKD patient that was successfully treated with venetoclax.

Here we report on a challenging diagnosis of VIAHS in a patient who presented at a very early age with a perianal abscess with fistula formation, fever, aphthous ulcers, bicytopenia, and hematochezia. Marked phenotypic variability can occur, and screening for families should be initiated in those with ADA2 mutation.

We describe two brothers with a truncating variant in EIF2S3 and expand the phenotypic description of MEHMO. Our cases had the previously described facial dysmorphic features, severe microcephaly, hypoglycaemia, hypothyreosis, epilepsy, hypertonus, obesity, micropenis and death due to multiorgan failure. Additionally, we describe hypothermia and reduced umbilical blood flow.

COVID-19 is of uncommon diagnosis in pediatric with their presentation in much of time of a nonspecific entity; here we experienced a case of two years old female with Malaria presented with fever, cough, rhinorrhea, hemoptysis and convulsion diagnosed as COVID-19, complicated with encephalitis, received treatment and improved over weeks.

There have been few reports on the treatment of central nervous system (CNS) acute myeloid leukemia (AML) relapse. This case study demonstrates that bevacizumab may be a viable treatment option when combined with IT chemotherapy as maintenance therapy for those with CNS leukemia.

This case report describes the management of a large iatrogenic ventricular septal defect (VSD) created by the coring device during systemic ventricular assist device (RVAD) insertion in a 16 year-old patient with congenitally corrected transposition of the great arteries. The VSD was closed by bovine pericardial patch and the ventriculotomy was extended laterally to relocate the VAD sewing ring. After RVAD implantation, patient initially remained cyanotic, potentially due to a tiny VSD patch leak with right to left shunting. Hypoxia was successfully corrected by rescue nitric oxide infusion and patient was bridged to transplant after 91 days.

during Ozaki procedure, relocating a valvular commisure could be technically demanding. This novel technique provides an easy tool to achieve valvular simmetry avoiding commisure shifting.

We reported a case of a 3-month-old infant presented with supravalvular aortic stenosis with congenital right coronary artery deficiency. According to cardiovascular CT results, Doty technique was adopted to restore the aortic root geometry under cardiopulmonary bypass. An angioplasty was performed to establish right coronary blood flow at the same time. The patient had no abnormal cardiac symptoms after surgery.

Methodological and technological improvements are continually revolutionizing the field of ancient DNA. Most ancient DNA extraction methods require the partial (or complete) destruction of finite museum specimens, which disproportionately impacts small or fragmentary subfossil remains, and future analyses. We present a minimally destructive ancient DNA extraction method optimized for small vertebrate remains. We applied these methods to detect lost mainland genetic diversity in the large New Zealand diplodactylid gecko genus Hoplodactylus, which is presently restricted to predator-free island sanctuaries. We present the first mitochondrial genomes for New Zealand diplodactylid geckos, recovered from 19 modern, six historic/archival (1898 to 2011) and 16 Holocene Hoplodactylus duvaucelii sensu latu specimens, and one modern Woodworthia sp. specimen. No obvious damage was observed in post-extraction micro-CT reconstructions. All ‘large gecko’ specimens examined from extinct populations were found to be conspecific with extant Hoplodactylus species, suggesting their large relative size evolved only once in the New Zealand diplodactylid radiation. Phylogenetic analyses of Hoplodactylus samples recovered two genetically (and morphologically) distinct North and South Island clades, probably corresponding to distinct species. Finer phylogeographic structuring within Hoplodactylus spp. highlighted the impacts of Late-Cenozoic biogeographic barriers, including the opening and closure of Pliocene marine straits, fluctuations in size and suitability of glacial refugia, and eustatic sea-level change. Recent mainland extinction obscured these signals from the modern tissue derived data. These results highlight the utility of minimally destructive DNA extraction in genomic analyses of less well studied small vertebrate taxa, and the conservation of natural history collections.

Background: In France, each year, influenza viruses are responsible for seasonal epidemics leading to 2-6 million cases. Influenza can cause severe disease that may lead to hospitalization or death. As severe disease may be due to the virus itself or to disease complications, estimating the burden of severe influenza is complex. The present study aimed at estimating the epidemiological and economic burden of severe influenza in France during eight consecutive influenza seasons (2010-2018). Methods: Influenza-related hospitalization and mortality data and patient characteristics were taken from the French hospital information database, PMSI. An ecological approach using cyclic regression models integrating the incidence of influenza syndrome from the Sentinelles Network supplemented the PMSI data analysis in estimating excess hospitalization and mortality (CépiDc – 2010-2015) and medical costs. Results: Each season, the average number of influenza-related hospitalizations was 18,979 (range: 8,627-44,024), with an average length of stay of 8 days. The average number of respiratory hospitalizations indirectly related with influenza (i.e., influenza-associated) was 31,490 (95% CI: 24,542-39,012), with an average cost of \euro141 million (range: 54-217); 70% of these hospitalizations and 77% of their costs concerned individuals ≥ 65 years of age (65+). More than 90% of excess mortality was in 65+ subjects. Conclusions: The combination of two complementary approaches allowed estimation of both influenza-related and associated hospitalizations and deaths and their burden in France, showing the substantial impact of complications. The present study highlighted the major public health burden of influenza and its severe complications, especially in 65+ subjects.

This study aims to use Perturbed-Chain Statistical Associating Fluid Theory (PC-SAFT) to describe the phase behavior of systems containing DESs and ILs. The DESs are based on Tetrabutylammonium chloride ([N4444]Cl) and Tetrabutylammonium bromide (TBAB) as hydrogen bond acceptors, and levulinic acid (LevA) and Diethylene Glycol (DEG) as hydrogen bond donors in the mole ratio of 1:2 and 1:4, respectively. The predicted phase equilibrium data from PC-SAFT has been compared to those from COSMO-RS and NRTL predictions. ILs studied in this work are low viscosity ether-functionalized pyridinium-based ILs [EnPy][NTf2] and [CmPy][NTf2], while 1-(2-methoxyethyl)-1-methylpyrrolidiniumbis(trifluoromethylsulfonyl)-amide) ([COC2mPYR][NTf2]) and 1-propyl-3-methylimidazolium bis{trifluoromethylsulfonyl}imide ([Pmim][NTf2]) were used for the study of the LLE systems with n-heptane + thiophene and n-hexane + ethylbenzene, respectively. In the last part, mixtures of linear alkanes and perfluoroalkanes have been studied to predict the phase behavior of perfluoroalkylalkanes with their linear alkane counterparts and comparisons have been made against SAFT-Mie pair potential.

A new type of composite tridimensional rotational flow sieve tray is proposed. The flow pattern and operation domain of the tray were defined and divided by the image shooting method, combined with the standard deviation of the pressure difference sequence. There are membrane--drip column and foam--embolic flow in the TRST area of the internal packing--type tray, while bubbly and milk froth-ribbon flow are present in the packing area of the external packing-type tray. This study focused on the influence of the tray structure parameters on the pressure drop. Under the experimental operating conditions, the dry pressure drop was within 160 Pa, while the wet pressure drop was within 900 Pa. Under the same structural parameters, the internal packing--type pressure drop of the tray was higher than that of the external packing-type tray. A mathematical model of the pressure drop between dry and wet trays was established.

Background: Guidelines encourage oral pharmacologic antispasmodic therapy for patients receiving a radial artery conduit during coronary artery bypass grafting. We review our experience with radial artery conduits without the postoperative use of calcium channel blocker therapy. Methods: A single-center, retrospective review patients undergoing isolated coronary artery bypass grafting with at least one radial artery conduit over a three-year period was performed. Patient demographic, operative, and post-discharge data were collected. Development of angina or angina equivalent symptoms, imaging suggestive of radial conduit failure, or percutaneous intervention to the territory grafted by a radial artery was considered to represent graft failure. Patients were evaluated for primary outcomes through 90 days postoperatively and followed for 1 year overall. Results: 264 adult patients underwent first-time, isolated coronary artery bypass grafting with use of a radial artery conduit. Three patients were observed to have radial graft occlusions during the first 90 days, all of which were attributed to technical issues. No patients required addition of a calcium channel blocker & no additional patients underwent imaging or intervention for radial graft failure during 1 year of follow up. Conclusions: Avoidance of postoperative calcium channel blocker therapy in patients receiving a radial artery graft was not associated with a high incidence of imaging-confirmed or clinically suggested conduit failure.

Infectious complications have been shown to increase the morbidity of venous-venous extracorporeal membrane oxygenation (VV-ECMO) population, including the use of right ventricular assist devices. We aimed to evaluate our VV-ECMO population for ECMO related bloodstream infections (E-BSI) and characteristics that affect risk and overall outcomes. We report a low infection rate of 2.7%. We postulate our low BSI rate may be due to our use of perioperative antimicrobials as well as a majority of our cannulations occurring in the operating room. Further investigation into trends, risks, and outcomes related to E-BSI is needed.

Objective: To synthesise existing qualitative research exploring the experiences of parents caring for children with cancer during the end-of-life phase, and the factors that influence parental decision making when choosing the location of end-of-life care and death for their child. Results: This review included 15 studies involving 460 parents of 333 children and adolescents who died from progressive cancer. Where reported, the majority (58%) of children died at home or in a hospital (39%), with only a small fraction dying in a hospice. Factors impacting decision-making for location of care included the quality of communication and the quality of care available. Themes related to choosing home for end-of-life care and death included: honouring the child’s wishes, familiarity of home, and parents’ desire to be their child’s primary carer. Preference for location of death in hospital included trust in hospital staff, practical logistics and the safety of the hospital environment.

Sub acute combined degeneration (SACD) is a myelopathy associated with vitamin B12 deficiency. Vitamin B12 deficiency may present with neurological and/or hematological features - neurological features commonly presenting at a later stage than hematological changes. Our case is an unusual presentation of SACD without anemia