We represent a case with simultaneous COVID-19 and acute type A aortic dissection. Type A aortic dissection, an aortic catastrophic event, seems to have higher mortality on coexistence with COVID-19.

Aim: Island biogeography theory states that species richness increases with habitat diversity and decreases with isolation from source pools. However, ecological theory must incorporate effects of human activity to explain contemporary patterns of biodiversity. We contemporized island biogeography theory by conceptualizing island trajectories of how species richness changes over time with accelerating land development and economic trade, which increase extinction and immigration rates, respectively. With this contemporized theory, we then articulate and empirically assess expected relationships of native, introduced, and total species richness with natural and anthropogenic metrics of habitat diversity and isolation from source pools. Location: Greater Caribbean region.Time Period: Database finalized in 2020. Methods: We built a database of 1042 native and introduced reptiles and amphibians (herps) for 840 Caribbean islands. For each island, we calculated natural and anthropogenic metrics of island habitat diversity and isolation from source pools and used linear model averaging to assess the expected relationships under the contemporized theory for 15 major herp clades .Results: Natural habitat diversity metrics exhibited positive relationships with native and introduced species richness, strengthening total species richness–area relationships across herp clades. Geographic isolation exhibited negative relationships with native and positive relationships with introduced species richness, weakening total species richness–isolation relationships. Economic area, based on developed land, and economic isolation, based on maritime trade, exhibited negative relationships with native species richness, but positive and negative relationships, respectively, with introduced species richness. Total species richness relationships with these two anthropogenic metrics were strongest in clades with many introduced species. Main Conclusion: A contemporized island biogeographic theory that includes the effects of land development and economic trade on species extinction and immigration explained current Caribbean herp species richness patterns. As human activity continues to accelerate, the contemporized theory we articulate here will increasingly predict island biogeography of the Anthropocene.

We present a rare case of mirror syndrome due to anti-Kpa antibodies, which can be difficult to identify with routine screening tests.

Primary intracranial primitive neuroectodermal tumors (PNETs) are extremely rare malignancies, affects children and adolescents with only 10 cases has been reported over 33 years old. we present a case of PNET in a 36 years old female patient with the chief complaint of aphasia for the first time

Hemolytic crises and aplastic crises in hereditary spherocytosis (HS) are typically triggered by viral infections. We present the case of an adolescent with HS who developed unexpected and life threatening consequences of her hemoglobinopathy as a consequence of anorexia nervosa and severe malnutrition.

We prove the existence and nonexistence of $L^{2}(\mathbb R^3)$-normalized solutions of two coupled semi-relativistic Hartree equations, which arisen from the studies of boson stars and multi-component Bose–Einstein condensates. Under certain condition on the strength of intra-specie and inter-specie interactions, by proving some delicate energy estimates, we give a precise description on the concentration behavior of ground state solutions of the system. Furthermore, an optimal blowing up rate for the ground state solutions of the system is also proved.

The origami technique realizes unique mechanical properties of sheet materials without additional parts. In this study, a self-folded corrugated structure (SCS) is developed based on the reinforcing properties of the origami technique. The corrugated structures are employed as the core material for a high-strength, open-channel sandwich structure. Research on self-folded core materials is scarce; thus, a design concept is proposed, and the mechanical properties of the SCS are evaluated. First, the structural parameters of the SCS fabricated by changing the printing parameters (e.g., linewidth and number of lines/creases), to derive the structural model are determined. The model facilitates the design of an SCS with the desired structure. Thereafter, the mechanical properties of the SCSs are evaluated by conducting three-point bending tests to determine the essential design parameters corresponding to high stiffness. Moreover, SCSs can be stacked without occupying space, thus leading to improved strength. These SCSs fabricated using self-folding paper by ink-jet printing are low cost and eco-friendly. Moreover, they are specialized for rapid design and fabrication, depending on the application. This paper proposes the use of SCS as a novel smart core because it exhibits a high transportation efficiency and stiffness without additional components. Corresponding author(s) Email: ae18081@shibaura-it.ac.jp , hshige@shibaura-it.ac.jp

To highlight the risk of septic complications following a pulmonary embolism (PE), we report the case of an elderly patient, that was hospitalized for a PE, an had progressively worsen his respiratory and septic state. Chest CT slices showed a gangrenous lung segment with an associated pleuropulmonary abscess.

A document by Emily Zeitler. Click on the document to view its contents.

Methaemoglobin results from the oxidation of ferrous to ferric iron in the centre of the haem moeity of haemoglobin. The production of dose-dependent methaemoglobinaemia by 8-aminoquinoline antimalarial drugs appears to be associated with, but is not directly linked to therapeutic efficacy against latent vivax and ovale malarias. Iatrogenic methaemoglobinaemia may be a useful pharmacodynamic measure in 8-aminoquinoline drug and dose optimization.

This study was carried out to optimize formulation for Heracleum Lasiopetalum (golpar) extract nanoencapsulation by response surface methodology (RSM). The primary emulsion was fabricated by (5-10 %) golpar extract (GE), (40-35 %) emulsifier span 80 (EM), and (50-60 %) sunflower oil (SO). The coating materials of nanoencapsulation were the composition of Lepidium sativum seed gum (LSG) and whey protein concentrate (WPC) at different ratios (1:0, 1:1, and 0:1). The yield of nanoencapsulation of golpar extract, particle size, and zeta potential was investigated as responses of RSM. The optimal formulation for nanoencapsulation of golpar extract were SO: 50.46%, GE 9.52%, and EM: 36.30% in LSG, SO: 57.07%, GE: 7.12%, and EM: 30.85% in LSG:WPC, and SO: 54.98%, GE: 9.05%, and EM: 39.87% in WPC coating. In conclusion, the nanoencapsulation of golpar extract prepared with the optimized formulation by RSM ensures the gradual release and sedimentation during storage with nanometric size and high yield of encapsulation. The nanocapsules of golpar extract can be used as a natural antioxidant in food systems.

Leadless Pacemaker Implantation after Lead Extraction for Cardiac Implanted Electronic Device InfectionJamia Kowal, D.O.andGeorge H. Crossley, M.D., F.H.R.S, F.A.C.C.

Sonographic Findings of the Primary Mucoepidermoid Carcinoma of the BreastGui-Wu Chen1, Wen-Qin Liu1, Xiao-Min Liao2, Fen-Fen Yu3, Yu-Huan Xie11Department of Ultrasound, Affiliated Dongguan Hospital, Southern Medical University, Dongguan, China2Department of Pathology, Affiliated Dongguan Hospital, Southern Medical University, Dongguan, China3Department of Radiology, Affiliated Dongguan Hospital, Southern Medical University, Dongguan, ChinaRunning Title: Mucoepidermoid Carcinoma of the Breast

A 34-year-old female presented with several weeks of fever, fatigue, weight loss, abdominal pain and hemoptysis. PE revealed moderate pallor, RUQ pain, mild dyspnea, conjunctival injection and hepatomegaly. The CBC showed anemia, mild leukocytosis, hypoalbuminemia, hypertransaminasemia, presence of nucleated red blood cells. Microsporidium was found in BMA.

We identified here mechanism by which hAEC exert their anti-cancer effects. We showed that vaccination with live hAEC conferred effective protection against murine colon cancer and melanoma but not against breast cancer in orthotopic cancer cell inoculation model. hAEC induced strong cross-reactive antibody response to CT26 cells, but not against B16F10 and 4T1 cells. Neither heterotopic injection of tumor cells in AEC-vaccinated mice nor vaccination with hAEC lysate conferred protection against melanoma or colon cancer. Nanosized AEC-derived exosomes (ADE) induced apoptosis in CT26 cells and inhibited their proliferation. Co-administration of ADE with tumor cells substantially inhibited tumor development and increased CTL responses in vaccinated mice. Our results clearly showed that it is ADE but not the cross-reactive immune responses against tumor cells that mediate inhibitory effects of hAEC on cancer development. Our results highlighted the potential anti-cancer effects of exosomes derived from hAEC.

Background. Kaposiform hemangioendothelioma (KHE) is a rare vascular tumor of infancy commonly associated with Kasabach-Merritt phenomenon (KMP) that includes thrombocytopenia and coagulation dysfunction. Platelet receptor CLEC-2 -tumor cell podoplanin interaction is considered the key mechanism of thrombocytopenia in KMP, however, the effect of long-term exposure to podoplanin on platelet function is unknown. Procedure. Here we examined blood samples from 7 patients with KHE/KMP. Platelet calcium signaling and functional responses to conventional activation and CLEC-2 stimulation were analyzed by continuous and endpoint live cell flow cytometry. Platelet aggregation in response to ADP or rhodocytin was analyzed by low-angle light scattering approach (LaSca). Additionally, ex vivo thrombus formation on collagen was observed in parallel-plate flow chambers. Results. We demonstrate that in KHE/KMP platelet functional responses to strong stimulation were on the lower boundary of age-matched normal ranges, while calcium mobilization and fibrinogen binding upon stimulation with ADP alone were significantly lower than control values. Platelet di-aggregate formation in response to ADP was also diminished in most of the patients. Formation of platelet aggregates in collagen-coated parallel plate flow chambers was also noticeably lower than in the age-matched control group. Calcium mobilization in response to CLEC-2 stimulation was unaltered in the patients and could be blocked by low-molecular-weight inhibitors, 2CP and HB125. Conclusions. While platelet responsiveness in KHE/KMP is moderately altered, platelet CLEC-2 receptors remain functional and respond to inhibition. Therefore, our findings suggest that CLEC-2-targeting molecules are new potential agents in therapeutic management of this life-threatening condition.

Current research on wax-based oleogels indicates wax esters to be the key component in many natural waxes. This necessitates understanding the properties of pure wax esters to unravel the gelling mechanism in wax-based oleogels. Therefore, wax esters with different carbon numbers and symmetries were studied and characterized regarding their thermal (DSC) and viscoelastic (oscillatory rheology) behavior. Pure wax esters and binary mixtures of wax esters were studied as such and in oleogels formed in combination with medium chained triglyceride oil at WE-inclusion levels of 10 % (w/w). Interpretation of the observations was based on detailed analysis of pre-existing data on crystallographic (SAXS) and thermal properties. It is found that all observations concerning single pure WE’s obey a systematic framework linking molecular make up, crystal structure and behavior. The study on the gelling of four different binary mixtures of wax esters revealed that substantial chain length differences do have the expected consequence of separate crystallization. Mixtures of wax esters with only limited chain length difference reconfirmed earlier speculations on mixing and crystal structure. Applying mixtures of wax esters only differing in their position of the ester bond indicated ideal mixing behavior in the solid phase of the gels. Actually, the data revealed that despite these expected observations in both systems, additional thermal events occur at specific mixing ratios. Their supposed relation to compound formation certainly needs further confirmation. Rheological analysis confirmed that sequential crystallization results in highest firmness values for the systems studied.

Urachal cyst is a rare congenital disorder due to a defect in the obliteration of the urachal duct, usually diagnosed in the first months of life. We report a case of urachal cyst revealed by a Pyogenic granuloma in an adult patient.

Although lungs represent the main target of the SARS-CoV2, the novel virus may affect other tissues. In the pandemic context, unexplained cutaneous ischemic lesions would be suggestive of the infection and should draw attention to a serious course of the disease.

OBJECTIVES To compare the safety and efficacy of del-Nido cardioplegia (DNC) with traditional 4:1 cold blood cardioplegia (CBC) in coronary artery bypass grafting and/or valve surgeries in elderly patients. METHODS The present study is a retrospective case-series study that included 302 consecutive patients aged 70 years and over who underwent on-pump valve surgery and/or CABG. DNC was administered to 90 patients and CBC to 212 patients. After propensity-score matching, 89 pairs were compared. The safety and efficacy were analysed between the two groups. RESULTS Compared with the CBC group (2185.8±582.9ml, P<0.001), the volume of infused cardioplegia was less in the DNC group (1423.6±259.5ml). The DNC group had a lower incidence of postoperative intra-aortic balloon pump (IABP) implantation (1.1% vs 9.0%, RR=0.791, P=0.034) and higher left ventricular ejection fraction (LVEF) at discharge (58.5±9.1% vs 55.7±8.6%, P=0.007). The estimated glomerular filtration rate (eGFR) in the DNC group was higher when the patient was transferred to the intensive care unit (78.2±25.1 ml/min/1.73m 2 vs 69.7±20.2 ml/min/1.73m 2, P=0.021), but no significant differences were identified after 24 hours. The serum lactate values of the DNC group were significantly lower than those of the CBC group (0hrs: 2.8±1.5 vs 3.6±2.0, P=0.001; 3hrs: 3.6±2.7 vs 4.9±2.6, P<0.001; 6hrs: 4.0±3.0 vs 6.1±3.3, P<0.001; 9hrs: 4.4±3.3 vs 5.9±3.6, P=0.004). There were no differences between the two groups in respect of lactate levels at 12 hours and thereafter. Postoperative creatinine kinase-MB concentrations were similar between the two groups. CONCLUSIONS Del-Nido cardioplegia is safe and effective in elderly patients undergoing CABG and/or valve surgery.

Seawater intrusion has become a serious natural disaster in coastal regions around the world. Four shallow groundwater aquifers of Pearl River were sampled to study the changes of groundwater types and microbial communities caused by seawater intrusion. Seawater intrusion caused significantly increased cations (Na+, K+, Ca2+, Mg2+) and anions (Cl-, SO42-, HCO3-), and the groundwater type turned from HCO3-Ca to Cl•HCO3-Na•Ca and Cl•SO4-Na•Mg. The composition and diversity of groundwater geochemistry changes. Gammaproteobacteria species and Alphaproteobacteria species are dominant species, and the salinity of groundwater is the main environment factor that affect the relative abundance. The α-diversity of microbial community in three types groundwater are significantly different (P = 0.002，R2 = 0.959). The correlation between species in class level with different ions were also observed. Aeromonadales, Vibrionales, Alteromonadales and Oceanospirillales have a significant positive correlation with Cl-, SO42-, Na+ and Mg2+ (P < 0.05) in Cl•SO4-Na•Mg type, while in Cl•HCO3-Na•Ca type groundwater, Vibrionales and Oceanospirillales have positive correlations with Cl-, Na+, Ca2+, but negative correlations with HCO3-. Aeromonadales and Alteromonadales are opposite of this. The results demonstrate that groundwater type is the main factors influence the correlation between species and environments, other geophysical factors have weak influence. This shift of shallow groundwater type and microbial community under seawater intrusion were studied for the first time, it is momentous for forward exploration of groundwater microbial ecology in the coastal area under the background of seawater intrusion.

Taxon-specific characteristics and extrinsic climatic and geological forces may both shape population differentiation and speciation. In geographically and taxonomically focused investigations, differentiation may occur synchronously as species respond to the same external conditions. Conversely, when evolution is investigated in taxa with largely varying traits, population differentiation and speciation is complex and shaped by interactions of Earth’s template and species-specific traits. As such, it is important to characterize evolutionary histories broadly across the tree of life, especially in geographic regions that are exceptionally diverse and under pressures from human activities such as in biodiversity hotspots. Here, using whole-genome sequencing data, we characterize genomic variation in populations of six Ethiopian Highlands forest bird species separated by a lowland biogeographic barrier, the Great Rift Valley (GRV). In all six species, populations on either side of the GRV exhibited significant but varying levels of genetic differentiation. Species’ dispersal ability was negatively correlated with levels of population differentiation. Isolation with migration models indicated varied patterns of population differentiation and connectivity among populations of the focal species. We found that demographic histories—estimated for each individual—varied by both species and population but were consistent between individuals of the same species and sampling region. We found that genomic diversity varied by half an order of magnitude across species, and that this variation could largely be explained by the harmonic mean of effective population size over the past 200,000 years. Overall, we found that even in highly dispersive species like birds, the GRV acts as a substantial biogeographic barrier.

Actual rainfall forecast is critical to the management and allocation of water resources. In recent years, deep learning has been proved to be superior to traditional forecasting methods when predicting rainfall time series with high temporal and spatial variability. In this study, the discrete wavelet transform (DWT) and two typical deep learning approaches, namely long-short term memory (LSTM) and dilated causal convolutional neural network (DCCNN), are integrated innovatively and the hybrid model (DWT-CLSTM-DCCNN) is used for monthly rainfall forecasting for the first time. Monthly rainfall time series of four major cities in China (Beijing, Tianjin, Chongqing and Guangzhou) are used as the dataset of DWT-CLSTM-DCCNN. Firstly, two methods of sample construction are used to train DWT-CLSTM-DCCNN and their effects on the model performance are analyzed. Then, LSTM and the dilated causal convolutional network (DCCNN) are established as the benchmark models, and their forecast accuracy is compared with that of DWT-CLSTM-DCCNN. From the results of the evaluation criteria such as mean absolute error (MAE), root mean squared error (RMSE) and Nash-Sutcliffe model efficiency coefficient (NSE) as well as the fitting curve for forecasted rainfall, it can be concluded that the DWT-CLSTM-DCCNN developed in this study outperforms the benchmark models in model accuracy, peak and mutational rainfall capturing ability. Compared with the previous studies, DWT-CLSTM-DCCNN is proven to be better peak capture and more suitable for long-term rainfall forecasting.

Climate change causes fluctuations in temperature and precipitation. As a result, it affects the discharge of rivers, the most important consequence of which is the tendency toward extreme events such as torrential rains and widespread droughts. River discharge is one of the most important climatic and hydrological parameters. Investigating the changes in this parameter is one of the main prerequisites in the management and proper use of water resources and rivers. Most trend detection studies are based on analyzing changes in the mean or middle of the data. They do not provide information on how changes occur in different data ranges. Therefore, to investigate parameter changes in a different range of the data series, various regression models were proposed. Frequentist quantile regression and Bayesian quantile regression models were used to estimate their trend and trend slope in different quantiles of discharge in different seasons of the year for Arazkouseh, Tamar, and Galikesh stations of Gorganroud basin in northern Iran with the statistical period of 1346–1396 (1966–2016). The results show that in most seasons of the year, high discharge rates for all 3 stations have decreased with a steep slope, and only in summer, Tamar and Galikesh stations have had an increasing trend, but low discharge rates have not changed significantly. Spatially, the discharge values at Arazkouseh station have a decreasing trend with a higher slope rate, and in terms of time, the most decreasing trend has been in spring. Comparing the models also shows that the Bayesian quantile regression model provides more accurate and reliable results than the frequency-oriented quantile regression model. In general, quantile regression models are useful for predicting and estimating extreme high and low discharge changes for better management to reduce flood and drought damage.