1. Latitudinal diversity gradient (LDG) is the increase in species richness towards the equator and is one of the most consistent patterns in biogeography, where current and historical processes contribute to shape the pattern. 2. Despite that LDG patterns have been described for some insects, the underlying mechanisms associated with community assembly and diversification along modern latitudinal diversity gradient pattern remain unknowledge for many groups. 3. Odonata is an old order of insects that originated during the Carboniferous and has diversified through different eras. Here, we defined co-occurrence based on the presence in ecoregions and 1°×1° grid cells of Odonata species in North America NA, to address their species richness, phylogenetic structure, and species diversification rate along the latitudinal gradient. 4. For the whole order, we found the highest species richness at mid-latitudes, while phylogenetic diversity showed a linear positive pattern along the gradient. Our results showed dragonfly assemblages were clustered along all the gradient, suggesting that environmental filtering sorted the assemblages. Whereas damselfly species assemblages were clustered at mid-latitude and overdispersed into both extremes of gradient, probably community assembly is driving by thermal gradients at mid-latitude, by competitive exclusion at south extreme, and by different origins of the biota at the boreal zone. Our results show that apparently most ancestral lineages of Odonata inhabit tropical zones, where diversified and dispersed to the temperate region, although likely also have been diversified into regions of NA, which might be linked with the highest species richness at mid-latitude for both suborders.

Soil oil-pollution is one of the most severe environmental issues at present. Shifts of soil metallome and microbiome are essential indicators for risk assessment and remediation of field soil pollutions, but not well studied undergoing the petroleum contamination. In this research, soil samples were collected from a short-term and long-term petroleum-contaminated oil field. The soil physicochemical properties, metallome, microbial community, and polluted and unpolluted soil network were testified. Results showed that the contents of soil total petroleum hydrocarbon, total carbon, total nitrogen, total sulfur, total phosphorus, calcium, copper, manganese, lead, and zinc were increased by petroleum contamination. In contrast, the soil pH was decreased by petroleum contamination regardless of the pollution duration. Petroleum-contamination also reduced bacterial and fungal α-diversity indices. In contrast, bacterial α-diversity was negatively correlated with soil TPH and EC, and fungal α-diversity was negatively correlated with soil EC. Moreover, the relative abundances of Proteobacteria, Ascomycota, Oleibacter, and Fusarium in soil were increased by petroleum contamination. Network analysis showed that number of links, modules and the network invulnerability decreased in PS, followed by the OS group. These results demonstrate that short-term heavy petroleum contamination can cause shifts in soil physicochemical properties, metallome, and microbiome and assemble a less complex and vulnerable soil microbial network. Moreover, natural restoration can hardly amend soil properties and microbial network structure. This research emphasizes that the uncommonly studied soil metallome may play a vital part in the reaction of soil microbial communities to petroleum-contamination and potential application value of synthetic community in bioremediation.

Soil microbial diversity and community are determined by anthropogenic activities and environmental conditions, which greatly affect the functioning of ecosystem. We investigated the soil bacterial diversity, communities, and nitrogen (N) functional genes with different disturbance intensity levels from crop, transition, to forest soils at three locations in the coastal region of Georgia, USA. Illumina high-throughput DNA sequencing based on bacterial 16S rRNA genes were performed for bacterial diversity and community analyses. Nitrifying (AOB amoA) and denitrifying (nirK) functional genes were further detected using quantitative PCR (qPCR) and Denaturing Gradient Gel Electrophoresis (DGGE). Soil bacterial community structure determined by Illumina sequences were significantly different between crop and forest soils (p < 0.01), as well as between crop and transition soils (p = 0.01). However, there is no difference between transition and forest soils. Compared to less disturbed forest, agricultural practice significantly decreased soil bacterial richness and Shannon diversity. Soil pH and nitrate contents together contributed highest for the observed different bacterial communities (Correlations = 0.381). Two OTUs (OTU5, OTU8) belonging to Acidobacteriales species decreased in crop soils, however, agricultural practices significantly increased an OTU (OTU4) of Nitrobacteraceae. The relative abundance of AOB amoA gene was significantly higher in crop soils than in forest and transition soils. Distinct grouping of soil denitrifying bacterial nirK communities was observed and agricultural practices significantly decreased the diversity of nirK gene compared to forest soils. Anthropogenic effects through agricultural practices negatively affecting the soil bacterial diversity, community structure, and N functional genes.

We consider a discrete double phase problem on integers with an unbounded potential and reaction term, which does not satisfy the Ambrosetti--Rabinowitz condition. A new functional setting was provided for this problem. Using the Fountain and Dual Fountain Theorem with Cerami condition, we obtain some existence of infinitely many solutions. Our results extend some recent findings expressed in the literature.

Introduction: Bradyarrhythmias are an established red flag for storage cardiac conditions including Anderson-Fabry disease (AFD). The prevalence of bradyarrhythmias requiring a pacemaker (PM) and their timing in AFD is unresolved. We evaluated prevalence and predictors of PM requirement in a large AFD cohort, investigating the occurrence of bradyarrhythmias as initial versus late manifestation. Methods: we retrospectively evaluated 82 consecutive AFD patients referred to our multidisciplinary referral centre from 1994 to 2020 with a median follow up of 6.9 years, identifying those requiring pacing. Univariable analysis was performed to identify cardiac features associated with PM implantantion. Results: Five of 82 (6%) AFD patients required PM implantation (5/39, i.e. 13% of those with cardiac involvement), always in the context of advanced cardiomyopathy. In none, bradyarrhythmias were the presenting feature. Indications included sick sinus syndrome in 3 patients, advanced atrio-ventricular block in 2 patients. QRS prolongation during follow up strongly correlated with the onset of bradyarrhythmias. Conclusions: Severe bradyarrhythmias are relatively frequent in patients with AFD cardiomyopathy, but do not represent a mode of presentation, occurring late in the disease course and always in the context of advanced cardiac involvement. Monitoring QRS variations over time may help to identify patients requiring pacing.

Background: It has been well known that overreaction of host immune systems plays a critical role in severe community-acquired pneumonia (SCAP). However, few of previous studies focused on the association between cytokine concentrations in bronchoalveolar lavage fluid (BALF) and SCAP. Object: We examined cytokine concentrations in BALF from children with SCAP and explored predictive value of cytokine concentrations for SCAP. Method: It was a retrospective study. A total of 100 children with SCAP who underwent parallel bronchoalveolar lavage between July 2017 and June 2019 were enrolled. 100 patients with mild community-acquired pneumonia (MCAP) who were admitted to the hospital were matched based on age and sex during the same time period . Basic clinical information were collected. Flow cytometry was used to determine the cytokine concentrations in BALF. Receiver operating characteristic curve was used to analyze their predictive value for SCAP. Result: A total of 106 males and 94 females were included in this study. The results showed that the CRP, PCT, ESR, LDH, and D-dimer were significantly increased in the SCAP group. The SCAP patients also had longer fever duration, hospitalization stays, and higher hospitalization costs. The IL-5，IL-17A，IL-18，and TnF-α in BALF of SCAP group were significantly higher than those in MCAP group. ROC curve analysis demonstrated AUC of those cytokines were all among 0.5~0.7. Conclusion: The IL-5，IL-17A，IL-18，and TnF-α in BALF of children with SCAP group were highe. However, the efficacy of those cytokines in the clinical diagnosis of SCAP is not excellent to be used as a predictor.

Objective: To explore the safety and feasibility of left bundle branch area pacing (LBBAP) in children. Methods: This study observed 12 children attempted LBBAP from 2019 to 2021 in our department prospectively. Clinical data, pacing parameters, electrocardiograms, echocardiographic measurements and complications were recorded at implant and during follow-up. Results: The 12 patients aged between 3 and 14ys and weighted from 13 to 48kg. 11 patients were diagnosed with third-degree AVB and 1 patient (case 4) suffered from cardiac dysfunction due to right ventricular apical pacing (RVAP). LBBAP was successfully achieved in all patients with narrow QRS complexes. LVEF of case 4 recovered on the 3rd day after LBBAP. The median of LVEDD Z score of the 12 patients decreased from 1.75 to1.05 3 months after implantation (p<0.05). The median of paced QRS duration was 103ms. The median of pacing threshold, R-wave amplitude and impedance were 0.85V, 15mV and 717Ω respectively and remained stable during follow-up. No complications such as loss of capture, lead dislodgement or septal perforation occurred. Conclusions: LBBAP can be performed safely in children with narrow QRS duration and stable pacing parameters. Cardiac dysfunction caused by long-term RVAP can be corrected by LBBAP quickly.

Long amplicon metabarcoding has opened the door for phylogenetic analysis of the largely unknown communites of microeukaryotes in soil. Here, we amplified and sequenced the ITS and LSU regions of the rDNA operon (around 1500 bp) from grassland soils using PacBio SMRT sequencing and evaluated the performance of three different methods for generation of operational taxonomic units (OTUs). The field site at Kungsängen Nature Reserve has drawn frequent visitors since Linnaeus’s time, and its species rich vegetation includes the largest population of Fritillaria meleagris in Sweden. To test the effect of different OTU generation methods, we sampled soils across an abrupt moisture transition that divides the meadow community into a Carex acuta dominated plant community with low species richness in the wetter part, which is visually distinct from the mesic-dry part that has a species rich grass-dominated plant community including a high frequency of F. meleagris. We used the moisture and plant community transition as a framework to investigare how detected belowground microeukaryotic community composition was influenced by OTU generation methods. Soil communities in both moisture regimes were dominated by protists, a large fraction of which were taxonomically assigned to Ciliophora (Alveolata) while 30-40% of all reads were assigned to kingdom Fungi. Ecological patterns were consistently recovered irrespective of OTU generation method used. However, different methods strongly affect richness estimates and the taxonomic and phylogenetic resolution of the characterized community with implications for how well members of the microeukaryotic communities can be recognized in the data.

The classification of AVNRT is based on HA and VA interval. Typical AVNRT is diagnosed in presence of HA ≤70 ms OR VA interval ≤60 ms and HA>70ms or VA >60ms is required to diagnose atypical AVNRT. This might be fallacious in some clinical situations. The septal VA and the “shortest” VA may be also different depending on clinical scenario .

Cutting through the Fat: Relationship Between Comorbidities and Arrhythmias in Hypertrophic Cardiomyopathy Alan Sugrue MBBCh, MSc; David Lin MD, FHRSCardiovascular Division, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PAManuscript word count: 1223Conflicts of interest: noneFunding: noneAddress for Correspondence:David Lin, MDHospital of the University of Pennsylvania3400 Spruce Street9 Founders PavilionPhiladelphia, PA 19104Email: david.lin@pennmedicine.upenn.edu

Ventricular outflow is a common site for idiopathic PVCs and repetitive ventricular arrhythmias. Sites of origin of these arrhythmias may vary from the sites of earliest activation mapped. Better definition of the site of origin can help avoid unnecessary large volume ablation to suppress these arrhythmia.

Sudden sensorineural hearing loss (SSNHL) is uncommon and oftentimes idiopathic. We describe the unique presentation of SSNHL in an HBO chamber employee following a parotidectomy, whose chief complaint was otalgia and aural fullness during dives. She ultimately recovered completely due to timely diagnosis and a high-dose steroid taper.

We investigated an innovative anti-SARS-CoV-2 immune strategy finalized to oral administration of extracellular vesicles (EVs) inducing an anti-SARS-CoV-2 N CD8+ T cytotoxic lymphocyte (CTL) immune response. We previously reported that the SARS-CoV-2 N protein can be uploaded at high levels in EVs upon fusion with Nefmut, i.e., a biologically inactive HIV-1 Nef mutant incorporating into EVs at quite high levels. Here, we analyze the immunogenic properties in human cells of EVs engineered with SARS-CoV-2 N fused at the C-terminus of either Nefmut or a deletion mutant of Nefmut referred to as NefmutPL. Analysis of in vitro produced EVs proven the uploading of N protein also when fused with truncated Nefmut. Mice injected with DNA vectors expressing each fusion protein developed robust SARS-CoV-2 N-specific CD8+ T cell immune responses. When ex vivo human dendritic cells were challenged with EVs engineered with either fusion products, the induction of a robust N-specific CTL activity, as evaluated by both CD107a and trogocytosis assays, was observed. Through these data we achieved the proof-of-principle that engineered EVs can be instrumental to elicit anti-SARS-CoV-2 CTL immune response in human cells. This achievement represents a mandatory step towards the upcoming experimentations in pre-clinical models.

Objectives : Primary : To determine the rate of occult cervical metastasis in primary temporal bone squamous cell carcinomas (TBSSC). Secondary : to perform a subgroup meta-analysis of the risk of occult metastasis based on the clinical stage of the tumour and its risk based on corresponding levels of the neck Design : A systematic review and meta-analysis of papers searched through Medline, Cochrane, Embase, Scopus and Web of Science up to January 2021 to determine the pooled rate of occult lymph node/parotid metastases. Quality assessment of the included studies was assessed through the Newcastle-Ottawa scale. Setting : Centres around the world that perform surgery for TBSCC Participants : Patients with TBSCC Results : Overall, 9 out of 1034 screened studies met the inclusion criteria, for a total of 907 patients of which 388 had TBSCC. Out of the 191 patients who underwent a neck dissection, 21 had positive lymph nodes giving a pooled rate of occult metastases of 11% (95% CI: 7%-17%). When analysed using the Modified Pittsburg staging system, 21 pT2 cases had a pooled occult metastases rate of 3% (95% CI: 0%-21%), 27 pT3 cases had a pooled occult metastases rate of 12% (95% CI: 1%-60%), and 65 pT4 cases had a pooled occult metastases rate of 14% (95% CI: 7%-25%). Data available showed that most of the positive nodes were in Level II. Conclusion: The rate of occult cervical metastases in TBSCC increases based on the tumour (T) staging of the disease with majority of nodal disease found in level 2 of the neck.

Background There is substantial interest in allergen-specific immunotherapy in food allergy. We systematically reviewed its efficacy and safety. Methods We searched six bibliographic databases from 1946 to 30 April 2021 for randomised controlled trials about immunotherapy alone or with biologicals in IgE-mediated food allergy confirmed by oral food challenge. We pooled the data using random-effects meta-analysis. Results We included 36 trials with 2,126 participants, mainly children. Oral immunotherapy increased tolerance whilst on therapy for peanut (RR 9.9, 95% CI 4.5. to 21.4, high certainty); cow’s milk (RR 5.7, 1.9 to 16.7, moderate certainty) and hen’s egg allergy (RR 8.9, 4.4 to 18, moderate certainty). The number needed to treat to increase tolerance to a single dose of 300mg or 1000mg peanut protein was 2. In peanut allergy, oral immunotherapy did not increase adverse reactions (RR 1.1, 1.0 to 1.2, low certainty) or severe reactions (RR 1,6, 0.7 to 3.5, low certainty). It may increase adverse reactions in cow’s milk (RR 3.9, 2.1 to 7.5, low certainty) and hen’s egg allergy (RR 7.0, 2.4 to 19.8, moderate certainty), but reactions tended to be mild and gastrointestinal. Epicutaneous immunotherapy increased tolerance whilst on therapy for peanut (RR 2.6, 1.8 to 3.8, moderate certainty). Results were unclear for other allergies and administration routes. Conclusions Oral immunotherapy improves tolerance whilst on therapy and is probably safe in peanut, cow’s milk and hen’s egg allergy. However, our review found little about whether this improves quality of life, is sustained or cost-effective.

Purpose: Type A acute aortic dissection (TAAAD) complicated with cerebral malperfusion (CM) is a life-threatening condition associated with high mortality, poor outcomes, and the optimal surgical management remains controversial. The aim of this review was to report the current results of surgical interventions of these patients. Methods: A systematic review was performed using PubMed and MEDLINE search for cases underwent surgical repair for TAAAD with CM. Demographics, neurological symptom, the time from onset of symptoms to operation, operation data, mortality, neurological outcome, and follow-up were reviewed. Results: A total of 363 patients with mean age of 65.7±13 years underwent surgical repair for TAAAD with CM were identified in 12 retrospective studies. In-hospital mortality was 20.1%. Mean duration of follow-up was 40.1 ± 37.6 months. The involved supra-aortic branch vessels were RCCA (n=99), LCCA (n=25) , B-CCA (n=52), CCA (n=131), IA (n=19), and LSA (n=8). Time from onset of neurological symptoms to surgery was 13.3 hours. Antegrade and/or retrograde cerebral perfusion was applied. Postoperatively, improved, unchanged and worsened neurological status was occurred in 54.3%, 27.1%, and 8.5%, respectively in 199 patients. Conclusion: The outcomes of surgical treatment of TAAAD complicated with CM indicate acceptable early mortality and morbidity. It is reasonable to perform lifesaving surgery on these patients. Early central surgical repair and reperfusion of brain may improve the outcomes.

Background: Childhood acute lymphoblastic leukemia (ALL) fortunately has high survival rates, and understanding longer-term implications of therapy is critical. In this study, we aimed to investigate kidney health outcomes by assessing the prevalence of renal dysfunction and hypertension (HTN) in children with ALL at one to five years after ALL diagnosis. Methods: This was a single center, cross-sectional study of children with ALL who were 1-5 years post diagnosis. GFR measurements were calculated, and urine samples were collected to assess for protein/creatinine and albumin/creatinine. Blood pressure (BP) was determined by standard oscillometric technique, and children >6 years of age were eligible for ambulatory blood pressure monitoring (ABPM). Results: Forty-five patients enrolled in the study, 21 completed ABPMs. Fifteen patients (33%, 95% CI: 20-49%) developed AKI at least once. Thirteen (29%, 95% CI: 16-44%) had hyperfiltration, and 11 (24%) had abnormal proteinuria and/or albuminuria. Prevalence of HTN based on clinic measurements was 42%. In the 21 ABPM patients, 14 had abnormal results (67%, 95% CI: 43-85%) with the majority (11/21) demonstrating abnormal nocturnal dipping pattern. . Conclusions: Among children with ALL, there is a high prevalence of past AKI. The presence of hyperfiltration, proteinuria and/or albuminuria at 1-5 years after ALL diagnosis suggest real risk of developing CKD over time. There is a high prevalence of HTN on casual BP readings and even higher prevalence of abnormal ABPM in this group. The high prevalence of impaired nocturnal dipping by ABPM indicates an increased risk for future cardiovascular or cerebral ischemic events.

DARPA formulated the Explainable Artificial Intelligence (XAI) program in 2015 with the goal to enable end users to better understand, trust, and effectively manage artificially intelligent systems. In 2017, the four-year XAI research program began. Now, as XAI comes to an end in 2021, it is time to reflect on what succeeded, what failed, and what was learned. This article summarizes the goals, organization, and research progress of the XAI Program.

Introduction : Pulmonary involvement is the main prognostic factor in children with spinal muscular atrophy (SMA). Nusinersen, a new treatment modality, is being evaluated in recent studies, although the respiratory part has not yet been clarified. We aimed to reveal the effects of nusinersen on the respiratory functions of patients with spinal muscular atrophy (SMA). Methods : In this single-center randomised study, conducted between June 2020/July 2021, patients with SMA were evaluated before and during nusinersen therapy. Data were collected on respiratory status, nutritional support, motor involvement, and other comorbidities that may affect the disease prognosis. Results : Patients with the number of 43 (18 type1, 12 type2, 13 type3) with a mean age of diagnosis of 10 months (range 1.5-192) and 24 months (3-219) at the start of nusinersen therapy were included. An improvement in respiratory status was noted in six patients between the second and third assessment. SMN2 copy numbers were significantly associated with better prognosis. Early initiation of nusinersen was significantly correlated with reduced hospital admissions. Nutritional support and weight gain were remarkable in the ventilatory supported group. A significant improvement was observed in motor functions, and chop-intend scores were statistically significantly higher in non-tracheostomized group (p<0.005). Conclusion : We think that nusinersen’s effect may be significant with early initiation and continuation of treatment. Improvements in respiratory functions noted in our study require to be supported with future long-term studies considering the overall genetic and environmental status, even the cost-effectiveness,to make a global consensus on nusinersen therapy.

The surgical ventricular restoration is an evolution of treatment of left ventricle aneurysm. The aetioloy of left ventricle aneurysm and the dilated post AMI cardiomiopaty is the same; the difference is in the extension of scarred tissue and in the quality of remote zone. Because in this anatomical situation the geometry of left left ventricle can be deeply affected, it can very difficult to have point of reference as position of apex or papillary mussles. Using a sizer and combine different surgical thecniques allow to rebuilt a ventricle with appropriate volume and shape.

Epicardial surgical clip is showed to be a safe and effective tool in order to achieve a complete left atrial appendage (LAA) exclusion thus reducing the risk of stroke in patients with atrial fibrillation. Historically, other methods as surgical ligation, internal oversewing or external stapling showed to be largely uneffective with an incidence of LAA residual flow ranging from 25% to 35% thus, increasing per se 5- to 10-fold the risk of stroke. Epicardial LAA exclusion by means of external clip could be potentially released under transesophageal echocardiographic guidance thus increasing the procedural success rate of complete closure with no residual stump left.

Interference patterns in the scattering of positrons and electrons by diatomic homonuclear molecules are ab initio calculated. Our results are compared to model potential calculations with incident particles in twisted and plane wave states. All calculations are obtained in the first Born approximation framework. The comparison of the elastic differential cross sections shows how an ab initio description of the electronic molecular structure influence the interference minima structure. The origin of such patterns are also discussed.

Riparian zones represent an important ecosystem providing a range of functions and services important to humans—e.g., biodiversity support, a reduction in erosion risk, or the transport of pollutants from the surrounding landscape to watercourses. At the same time, it is, unfortunately, an environment that has been often subjected to significant pressure during the agricultural cultivation of the landscape or the development of industrial and residential activities of human society. Thus, a large number of riparian ecosystems have disappeared or degraded. The assessment of the overall ecological status of riparian habitats constitutes an important source of information for the needs of watercourse management and landscape planning in the riparian landscape, the aim of which should be to maintain good status or to improve the current unsatisfactory state of these habitats. However, in order to reliably evaluate the current ecological status of the landscape, it is necessary to have information on the reference status, i.e., a potentially natural status that would prevail without human influence. For this purpose, a methodology that can determine the potential natural status of riparian zones in Central European conditions was developed. In this study, it was found that approximately a quarter (26 %) of all river basins in the Czech Republic reach very low environmental values of the potential natural status of riparian zones and, conversely, approximately 29 % of river basins are expected to develop significantly above average riparian zone quality if we neglect human impact.

An elderly female with multiple comorbidities presented with acute onset of severe urinary retention immediately following placement of an intrathecal morphine pain pump. This case highlights the need to closely monitor chronic pain patients with complex medical histories who may be uniquely predisposed to opioid-mediated severe urinary retention.