Combined large cell neuroendocrine carcinoma (LCNEC) and squamous cell carcinoma (SCC) of the H&N is exceptionally rare. We present the case of combined p16 negative SCC and LCNEC of the oropharynx treated with combination chemotherapy. This is the third reported case of combined neuroendocrine carcinoma and SCC of the oropharynx.

Job satisfaction and retention of healthcare staff remains an ongoing issue in many health systems. Huddles have been endorsed as a mechanism to improve patient safety by improving teamwork, collaboration, and communication in teams. This study synthesizes the literature to investigate the impact of huddles on job satisfaction, teamwork, and work engagement in multidisciplinary healthcare teams. Five academic databases were searched to conduct a systematic review of peer-reviewed literature published from January 2000 – January 2020. Articles were included if they (1) featured a daily huddle, were conducted in a healthcare setting, and involved a multidisciplinary team and (2) measured variables including job satisfaction, work engagement, or teamwork. Results were reported in accordance with the Systematic Synthesis Without Meta-analysis (SWiM) and Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. We identified 445 articles of which 12 met the eligibility criteria and are included in this review. All 12 studies found a predominantly positive impact on teamwork and job satisfaction. None of the studies discussed or reported evidence of the impact of huddles on work engagement. This review highlights the value of a daily multidisciplinary healthcare team huddle in improving job satisfaction and teamwork for the healthcare staff involved. However, there is a dearth of high-quality, peer-reviewed evidence regarding the direct impact of huddles on job satisfaction, teamwork and in particular on work engagement. Further research – particularly controlled studies on adoption, implementation, and outcomes for healthcare team culture – is needed to further assess this intervention.

A 22-year-old male presented with chest pain 3 days after his second dose of the COVID-19 vaccine. Cardiac magnetic resonance imaging demonstrated myocardial and pericardial enhancement. Given imaging and clinical findings, he was diagnosed with perimyocarditis. He was treated with a multitude of medications including NSAIDs, colchicine, and steroids. Fortunately, he was able to achieve symptom improvement. Due to COVID-19 vaccination novelty, further research is needed to identify side effects.

Midchannel islands (MCIs) are influential instream geomorphic units generally emerge in lowland rivers. Despite their significant ecomorphological services in the river ecosystem, the flow structures around these self-forming riparian landforms are not fully understood yet. Understanding the flow pattern around these formations enables practitioners to produce cost-effective, sustainable, and eco-friendly river management projects/strategies. From this motivation, the secondary flow pattern around MCIs was analyzed employing RANS based numerical model. Flow around the simplified bodies were simulated to give a more precise analysis regarding flow-island interactions. Once the numerical validation process was completed for the cylinder using an experimental dataset, the validated model was implemented for islands (streamlined island, vertically sloped island (VSI), and realistically sloped island (RSI)). The simulations revealed these findings: 1) The RSI acted like a streamlined object and produced weaker lee-wake vortices with a longer recovery distance. 2) The RSI gained a better streamlined form near the bed than near the water surface due to enhanced elongation. 3) This situation generated highly variable coherent flow structures along the depth behind the MCI. 4) Due to the three-dimensionality of the RSI, the generated large-scale vortices propagated asymmetrically towards sides of the channel rather than remaining around the centerline.

A document by Aurelie Bonin. Click on the document to view its contents.

Historically, the minimality of surfaces is extremely important in mathematics and the study of minimal surfaces is a central problem, which has been widely concerned by mathematicians. Meanwhile, the study of the shape and the properties of the production models is a great interest subject in economic analysis. The aim of this paper is to study the minimality of quasi-sum production functions as graphs in a Euclidean space. We obtain minimal characterizations of quasi-sum production functions with two or three factors as hypersurfaces in Euclidean spaces. As a result, our results also give a classification of minimal quasi-sum hypersurfaces in dimensions two and three.

Monoacylglycerol (MAG) and diacylglycerol (DAG) are two natural components found in most edible oils and fats. Conventional synthesis of MAG and DAG is usually conducted by glycerolysis of triacylglycerol (TAG) at high temperatures (above 200 °C) in the presence of an alkaline catalyst. In this work, the synthesis of MAG and DAG using enzymatic glycerolysis of olive oil was investigated using Tween 80 as surfactant, n-butanol as co-surfactant and the novel lipase in free/liquid formulation Lipozyme TL 100L as catalyst. Experimental design was used to evaluate the effect of enzyme load and reaction temperature on the feedstock conversion. Enzyme load and system temperature were significant variables in the statistical design and the best condition was found at 35 °C, 7.5 vol% of Lipozyme TL 100 and glycerol to oil molar ratio of 2:1 with conversion of TAG at approximately 98 % after 2 h of process. A mathematical model based on the Ping-Pong Bi-Bi mechanism was used to describe the reaction kinetics. The model adequately described the behavior of the system and can be a useful tool for the design of reactors in larger scales.

Background: Myocardial infarction (MI) often results in permanent cardiac tissue necrosis and reduced heart functionality. Even with heart disease being the number one cause of death in the US, there are currently no effective methods of fully regenerating heart muscle post-myocardial infarction. Mesenchymal stem cells (MSCs) are a promising therapeutic option given their multi-potent nature and low host immune reaction. Bioengineered polymeric nanofiber scaffolds provide a structured growing environment and encourage cell elongation. Overview: This study characterizes MSC biology on poly-ε-caprolactone (PCL) nanofiber scaffolds in order to establish electrospun PCL nanofibers as a working biological scaffold for MSC growth, and to exhibit potential for further exploration of PCL nanofiber-grown MSC implants as a treatment for MI. Methods: MSCs were seeded on PCL scaffolds; cell viability was analyzed via XTT, cell apoptosis was analyzed via TUNEL/DAPI staining, and differentiation markers were analyzed via RT-PCR. Results: TUNEL/DAPI staining of confluent MSCs on PCL scaffolds showed low cell apoptosis over time. RT-PCR results showed no amplification of CD40 expression. Conclusion: PCL nanofibers seem to provide a suitable microenvironment for MSC seeding and proliferation. Further Direction: RT-PCR for CD80, CD86, COL1A1 (collagen), aSMA/Acta2 (smooth muscle), Flk1/VEGF2 (endothelial), Sparc (Osteonectin, osteogenic), Adipoq (Adiponectin, adipogenic), Agre-cano (chondrogenic).

This is a “Letter to the Editor” with no abstract.

Recent results suggest that metabolism-mediated stomatal closure mechanisms are important to regulate differentially the stomatal speediness between ferns and angiosperms. However, evidence directly linking mesophyll metabolism and the slower stomatal conductance (gs) in ferns is missing. Here we investigated the effect of exogenous application of abscisic acid (ABA), sucrose and mannitol on gs kinetics and carried out a metabolic fingerprinting analysis of ferns and angiosperms leaves harvested throughout a diel course. Ferns stomata did not respond to ABA in the time period analysed. No differences in the relative decrease in gs was observed between ferns and the angiosperm following provision of sucrose or mannitol. However, ferns have slower gs responses to these compounds than angiosperms. Metabolomics analysis highlights that ferns have higher accumulation of secondary rather than primary metabolites throughout the diel course, with the opposite being observed in angiosperms. Our results indicate that metabolism-mediated stomatal closure mechanism is conserved among ferns and angiosperms and that the slower stomatal closure in ferns is associated to a reduced capacity to respond to mesophyll-derived sucrose and to a higher carbon allocation toward secondary metabolism, which likely modulates both photosynthesis-stomatal movements and growth-stress tolerance trade-offs.

The effects of climate change, soil depletion, a growing world population putting pressure on food safety and security are major challenges for agriculture in the 21st century. The breeding success of the green revolution has decelerated and current programs can only offset the yield affecting factors. New approaches are urgently needed and we propose, “Genome Editing accelerated Re-Domestication” (GEaReD) as a major new direction in plant breeding. By combining the upcoming technologies for phenotyping, omics and artificial intelligence with the promising new CRISPR-toolkits, this approach is closer than ever. Wild relatives of current crops are often adapted to harsh environments and have a high genetic diversity. Re-domestication of wild barley or teosinte could generate new cultivars adapted to environmental changes. De novo domestication of perennial relatives like Hordeum bulbosum could counter with soil depletion and increase soil carbon. Recent research already proved the principle of re-domestication in tomato and rice and therefore laid the foundation for GEaReD.

A major challenge in validating genetic causes for patients with rare diseases (RDs) is the difficulty in identifying other RD patients with overlapping phenotypes and variants in the same candidate gene. This process, known as matchmaking, requires robust data sharing solutions in order to be effective. In 2014 we launched PhenomeCentral, a RD data repository capable of collecting computer-readable genotypic and phenotypic data for the purposes of RD matchmaking. Over the past 7 years PhenomeCentral’s features have been expanded and its dataset has consistently grown. There are currently 1,615 users registered on PhenomeCentral, which have contributed over 12,000 patient cases. Most of these cases contain detailed phenotypic terms, with a significant portion also providing genomic sequence data or other forms of clinical information. Matchmaking within PhenomeCentral, and with connections to other data repositories in the Matchmaker Exchange, have collectively resulted in over 60,000 matches, which have facilitated multiple gene discoveries. The collection of deep phenotypic and genotypic data has also positioned PhenomeCentral well to support next generation of matchmaking initiatives that utilize genome sequencing data, ensuring that PhenomeCentral will remain a useful tool in solving undiagnosed RD cases in the years to come.

DECIPHER (https://www.deciphergenomics.org) is a free web platform for sharing anonymised phenotype-linked variant data from rare disease patients. Its dynamic interpretation interfaces contextualise genomic and phenotypic data to enable more informed variant interpretation, incorporating international standards for variant classification. DECIPHER supports almost all types of germline and mosaic variation in the nuclear and mitochondrial genome: sequence variants, short tandem repeats, copy-number variants and large structural variants. Patient phenotypes are deposited using Human Phenotype Ontology (HPO) terms, supplemented by quantitative data, which is aggregated to derive gene-specific phenotypic summaries. It hosts data from >250 projects from ~40 countries, openly sharing ~40,000 patient records containing >51,000 variants and >172,000 phenotype terms. The rich phenotype-linked variant data in DECIPHER drives rare disease research and diagnosis by enabling patient matching within DECIPHER and with other resources, and has been cited in >2,600 publications. In this paper, we describe the types of data deposited to DECIPHER, the variant interpretation tools, and patient matching interfaces which make DECIPHER an invaluable rare disease resource.

OBJECTIVE: To explore the possibility and application value of extracranial carotid ultrasound in assessing the progress of MMD. METHODS: We retrospectively analyzed the extracranial carotid ultrasound and DSA data of 89 cases of 53 patients with MMD (moyamoya group) and 90 cases of 45 control patients (control group). According to the DSA data of the moyamoya group, collateral circulation patterns’ grade and Suzuki stage were performed. We analyzed the correlation between collateral circulation patterns and Suzuki stage, and compared the difference of hemodynamic parameters between different grades of collateral circulation patterns. RESULTS: (1) As the Suzuki stage increased, the grade of the collateral circulation pattern subsequently increased. (2) Compared with the control group, the PSV of ICA in the moyamoya group was lower (P<0.01)，but the RI value of CCA and PSV of VA was increased (P<0.05). And the differences in hemodynamic parameters of ECA (including PSV and RI) were not statistically different. (3) Comparing hemodynamic parameters between the different grades of collateral circulation patterns of the control group, Grade 2 showed higher PSV of VA compared with Grade 1 (P <0.05); Grade 3 showed lower RI of ECA compared with Grade 1 and Grade 2 (P < 0.05). CONCLUSION: There is a correlation between collateral circulation patterns and Suzuki stage in adult ischemic MMD. There are differences in the hemodynamic parameters of extracranial carotid ultrasound in different grades of collateral circulation patterns. Extracranial carotid ultrasound can assess the progress of MMD in a timely, effective and convenient manner.

Our understanding of the regulation of respiration in C4 plants, where mitochondria play different roles in the different types of C4 photosynthetic pathway, remains limited. We examined how leaf dark respiration rates (Rdark), in the presence and absence of added malate, vary in monocots representing the three classical biochemical types of C4 photosynthesis (NADP-ME, NAD-ME and PCK) using intact leaves and extracted bundle sheath strands. In particular, we explored to what extent Rdark are associated with mitochondrial number, volume and ultrastructure. We found that the respiratory response of NAD-ME and PCK type bundle sheath strands to added malate was associated with differences in mitochondrial number, volume, and/or ultrastructure, while NADP-ME type bundle sheath strands did not respond to malate addition. In general, mitochondrial traits reflected the contributions mitochondria make to photosynthesis in the three C4 types. However, despite the obvious differences in mitochondrial traits, no clear correlation was observed between these traits and Rdark. We suggest that Rdark is primarily driven by cellular maintenance demands and not mitochondrial composition per se, in a manner that is somewhat independent of mitochondrial organic acid cycling in the light.

Similar to other cropping systems, few walnut cultivars are used as scion in commercial production. Germplasm collections can be used to diversify cultivar options and hold potential for improving crop productivity, disease resistance and stress tolerance. In this study we explored the anatomical and biochemical bases of photosynthetic capacity in 11 J. regia accessions in the USDA-ARS National Clonal Germplasm Repository. Net assimilation rate (An) differed significantly among accessions and was greater in those from lower latitudes coincident with increases in stomatal and mesophyll conductance, leaf thickness, mesophyll porosity and gas-phase diffusion, and leaf nitrogen, and lower leaf mass and stomatal density. High CO2-saturated assimilation rates led to increases in An under limiting conditions. Greater An was found in lower latitude accessions native to climates with more frost-free days, greater precipitation seasonality, and lower temperature seasonality. As expected, water stress consistently impaired photosynthesis with the highest % reductions in three lower latitude accessions (A3, A5, and A9), which had the highest An under well-watered conditions. However, An for A3 and A5 remained amongst the highest under dehydration. J. regia accessions, which have leaf structural traits and biochemistry that enhance photosynthesis, could be used as commercial scions or breeding parents to enhance productivity.

A computer program has been created that makes it possible to analyze the features of the spatial distribution of Joule heat in two-phase matrix systems with round inclusions. The program uses the finite element method and is implemented in Fortran code. It was found that at certain points of the two-phase medium, the specific power of the Joule heat is determined. The magnitude of the unevenness of the heat distribution exhibits the ability to level. It was found that the location of the points at which the set parameters for a given structure pm are set depends on the ratio between the conduction of the matrix and the inclusion and the local mutual arrangement of the inclusions. The processes of sintering powder materials using electric heating are considered. It was found that as a result of selective sedimentation, the possibility of the formation of anisotropic structures is turned on. The features of the processes of contact electrical materials based on mixtures of copper and tungsten are discussed. It is assumed that the processes of local heating can initiate the sedimentation of copper particles. In this case, groupings of particles can be formed, oriented along the direction of the heating electric current. The possibility of synthesizing materials similar to composite fiber systems is shown. It is proposed to use computer simulation programs to support heat treatment processes using electric heating.

Objectives: In July 2017, Victoria’s largest maternity service implemented a new clinical guideline aimed to reduce the rates of stillbirth at term for South Asian-born women. Here we present the evaluation of the change in care on rates of stillbirth, neonatal and obstetric interventions. Design: Cohort Study Setting: Victoria’s largest metropolitan university-affiliated teaching hospital. Population: All women receiving antenatal care who gave birth in the term period between January 2016 and December 2020. Methods: Differences in rates of stillbirths, neonatal deaths, perinatal morbidities, and interventions after July 2017 were determined. Multigroup interrupted time-series analysis was used to assess changes in rates of induction of labour. Main Outcome Measures: Rates of stillbirths, neonatal deaths, perinatal morbidities, and obstetric interventions. Results: 3506 south Asian-born women gave birth prior to, and 8532 after the change. There was a 64% reduction in term stillbirth (95%CI 87% to 2%; p=0.047) for south Asian-born women after the change in practice from 2.3 per 1000 births to 0.8 per 1000 births. The rates of early neonatal death (3.1 per 1000 vs 1.3 per 1000; p=0.03) and SCN admission (16.5% vs 11.1%; p<0.001) also decreased. There were no significant differences in admission to NICU, Apgar<7 at 5 minutes, birthweight or differences in the trends of induction of labour per month. Conclusions: Fetal monitoring from 39 weeks’ may offer an alternative to routine earlier induction of labour to reduce the rates of stillbirth without causing an increase in neonatal morbidity or obstetric interventions.

Preterm neonatal survival: what is the role of prognostic models?Elizabeth M McClure, PhD1Robert L Goldenberg, MD21Social, Statistical and Environmental Sciences, RTI International, Durham, NC2Columbia University, New York, NYEven before the 1960’s and the introduction of the specialty of neonatology, and continuing to the present, numerous efforts have been made to understand the relationship between newborn birthweight and the risk of mortality. (1) With the development of neonatal intensive care units (NICUs), attention to survival rates and neurologic outcomes among those at the lowest birthweights and gestational ages (GA) has grown. (2) Defining the lower limits of GA or birthweight associated with the neonatal outcomes is important for clinicians, families, and others to inform appropriate decision-making and clinical care.To predict newborn survival, numerous models have been developed to estimate risk at specific birthweights and/or GAs. To date, more than 35 have been published, almost exclusively from high-income countries with advanced NICU care. In a study published recently, van Beek et al sought to validate one of these predictive models from the United Kingdom (UK), deemed to be among the highest quality, with the objective of assessing its value for clinical use. (3)Van Beek et al used an independent Dutch population to validate survival among very preterm infants using the UK model’s parameters. Because they found relatively good performance, the authors’ concluded that the model could inform daily clinical practice. However, the generalizability of their results, especially to other populations differing by ethnicity or socioeconomic status, is questionable. The parameters for the model quality focused on birthweight, GA, and gender, but many other metrics (including the racial diversity, quality of care, etc.) were limited. In particular, the interventions available and utilized for obstetric and neonatal care were not specified, which would be important for their goal of clinical use of the model. Importantly, the quality of obstetric care is not considered. (4) Both the availability and quality of specific obstetric and neonatal interventions in any given setting may be among the most important factors impacting survival.Especially important for clinical considerations, long-term outcomes, including severe disabilities, were not addressed. Concerns about neurodevelopmental outcomes in infants at the lower limits of birthweight and GA are as or more important to parents and caregivers than survival. (5) It is thus unclear how this – or virtually any other model - can be useful for “daily clinical practice”.A better strategy to inform clinical care is for individual health-care facilities to maintain neonatal survival and neurological outcome statistics. These types of data within a specific context may be more helpful to physicians, including obstetricians and neonatologists, who often, together with parents and caregivers, make decisions related to interventions prior to delivery or during NICU care. Newborn outcomes, especially at the extreme lower limits of birthweight and GA, remains an area of intense interest. While models may provide some supportive information, it is difficult to imagine that these will ever replace clinical decisions informed by actual outcome data from the specific facility.Conflicts of interest: The authors declare no conflicts of interest.References:1. Goldenberg RL, Nelson KG, Dyer RL, Wayne JB. The variability of viability: the effect of physicians’ perceptions of viability on the survival of very low birth weight infants. Am J Obstet Gynecol 1982; 143:678-84.2. Bottoms SF, Paul RH, Mercer BM, MacPherson CA, Caritis SN, Moawad AW. Obstetric determinants of neonatal survival: antenatal predictors of neonatal survival and morbidity in extremely low birth weight infants. Am J Obstet Gynecol. 1999 80(3 Pt 1):665-9.3. Van Beek P.E, Groenendaal F, Onland W, Koole S, Dijk PH, Dijkmanet KP et al. Prognostic model for predicting survival in very preterm infants: an external validation study. BJOG (in press)4. Goepfert AR, Goldenberg RL, Hauth JC, Bottoms SF, Iams JD, Mercer BM Obstetrical determinants of neonatal neurological morbidity in < or = 1000-gram infants. Am J Perinatol. 1999;16(1):33-42.5. Iams JD, Mercer BM. National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network. What we have learned about antenatal prediction of neonatal morbidity and mortality. Semin Perinatol 2003:247-52.

Mini commentary on BJOG-21-0823: Pregnancy outcomes in women with Budd-Chiari syndrome or portal vein thrombosis - A multicentre retrospective cohort study.Budd-Chiari syndrome (BCS) and portal vein thrombosis (PVT) are rare thrombotic disorders which can affect females of reproductive age. Physiological changes in pregnancy may result in or exacerbate pre-existing known portal hypertension related issues associated with these conditions. These conditions may also present de-novo in pregnancy with acute onset ascites or variceal haemorrhage. Both in pregnancy and in the non-pregnant state, in those with established disease, in general, the overall balance of risk, favours continued anticoagulation.The study by Wiegers et al. has shown favourable maternal and foetal outcomes once greater than 20 weeks gestation is reached in patients with BCS and/or PVT. However, the risk of preterm birth and early pregnancy loss remains. These results are in keeping with the recent study by Andrade et al. (Journal of Hepatology 2018; 69: 1242-1249) looking at pregnancy outcomes from 24 pregnancies in 16 women with idiopathic non-cirrhotic portal hypertension (INCPH). Rautou et al. (Journal of Hepatology 2009; 51: 47-54) reviewed 24 pregnancies in 16 women with BCS and also reported similar findings. Taken as a whole, these results support the concept that patients with vascular liver disease can achieve favourable pregnancy outcomes but warrant careful consideration in pregnancy.Preconception counselling is a crucial opportunity to optimise patients with vascular liver disease who are considering pregnancy. This can be achieved in a multidisciplinary forum with input from obstetricians, haematologists and hepatologists. It is useful to identify those women with significant portal hypertension and varices before pregnancy so that appropriate surveillance and eradication with endoscopic band ligation and/or prophylaxis with beta blockers is undertaken. If pregnancy is achieved before surveillance, then a second trimester endoscopy for those with significant portal hypertension should be performed. In patients with portal and mesenteric vein thrombosis, magnetic resonance imaging of the pelvis may be needed to assess for the presence of abdominal wall/pelvic varices. This stratifies the risk of a variceal bleed and allows planning of the mode of delivery (caesarean, vaginal or assisted vaginal delivery). Wiegers et al. reported 2 variceal bleeds in pregnancy but did not find a significant association with adverse maternal outcomes, though this may be related to the low number of patients. Andrade et al. also reported 2 variceal bleeds including 1 patient with PVT without adequate endoscopic prophylaxis who required a portosystemic shunt. This outlines the need for appropriate screening and portal hypertension management according to findings.The majority of patients with BCS and PVT have an underlying pro-thrombotic tendency and the intra-partum and the post-partum periods are associated with thrombotic events. Vitamin K antagonists are historically the commonest anticoagulation used in BCS and PVT which should be switched to low molecular heparin ideally before conception. The use of anticoagulation is more common in patients with BCS and PVT than in INCPH (38/45 women in BCS and/or PVT compared to 4/16 in INCPH). 4 out of 6 women with BCS and/or PVT who experienced post-partum haemorrhage (PPH) were on anticoagulation. 2 patients with INCPH had PPH whilst on anticoagulation which may be confounded by the thrombocytopenia and type-2 error. In the study by Rautou et al., 17/24 pregnancies received anticoagulation and the 4 women who experienced post-partum bleeding (vaginal or intrauterine/parietal haematoma) were on anticoagulation which includes one woman with an ectopic pregnancy. No maternal deaths were reported in the three studies and the continued use of anticoagulation when indicated is safe and appropriate.The mode of delivery did not affect the risk of PPH in the three studies. The mode of delivery should be decided based on the individual risk profile taking into account the severity of portal hypertension, distribution of venous thrombosis, presence of coagulopathy and thrombocytopenia, obstetric indications and the presence of oesophageal or abdominal wall/pelvic varices.The live birth rates may be lower in patients with BCS compared to PVT (75% versus 82% after excluding first trimester pregnancy loss) but due to the low number of patients it remains difficult to interpret the results in this study. In the study by Andrade et al., all 18 pregnancies reaching 20 weeks gestation were delivered with 2 infant deaths (both preterm births). Rautou et al. reported 16/17 live births in pregnancies reaching 20 weeks gestation.To conclude, patients with BCS and PVT after 20 weeks gestation and appropriate planning can have a reasonable expectation for delivery and successful outcomes. Preconception counselling and antenatal care with multidisciplinary input is key to achieving this goal.

Resection or exclusion of scars following a myocardial infarction on the LAD territory started even before the beginning of the modern era of cardiac surgery. Many techniques were developed, but there is still confusion on who did what. The original techniques underwent modifications that brought to a variety of apparently new procedures that, however, were only a “revisitation” of what described before. In some case old techniques were reproposed and renamed, without giving credit to the surgeon that was the original designer. Herein we try to describe which are the seminal procedures and some of the most important modifications, respecting however the merit of who first communicated the procedure to the scientific world.

Studies on land degradation and development (LDD) and the underlying factors can help land restoration. In this study, the LDD of Hainan Island from 2000 to 2018 were measured by change vector analysis using the normalised difference vegetation index and net primary productivity (NPP). The underlying factors of LDD were selected from seven potential factors (nature factors: mean annual temperature, mean annual drought intensity, human disturbances: gross domestic product (GDP), population, population urbanisation, accumulated afforestation area, construction area) based on structural equation modelling. The results showed that 1) the degree of land-use changes into water area and construction land were higher than for the other land-use types; 2) Compared to 2000, the most serious degradation occurred in 2015, which accounting for 68.98% of the total land degradation as well as more than three-quarters of the land degradation in all surveyed years was driven by NPP; 3) The proportion of land degradation (PLD) was negatively correlated with the mean value of the land degradation and development (MLDD) in the period of five years, 2000-2018 (P<0.01); 4) The key influencing factors of PLD were temperature, accumulated afforestation area, population urbanisation, in 2000–2005, 2005–2010 and 2010–2018, respectively; 5) The key influencing factors of MLDD were temperature, GDP, population urbanisation, in 2000–2005, in 2005–2010 and in 2010–2018, respectively. Therefore, to minimise land degradation it is necessary to limit the speed of population urbanisation occurs and to improve the island environment’s adaptability to extreme climates.

The use of whole-genome sequencing (WGS) has accelerated the pace of gene discovery and highlighted the need for open and collaborative data sharing in the search for novel disease genes and variants. GeneMatcher (GM) is designed to facilitate connections between researchers, clinicians, health-care providers and others to help in the identification of additional patients with variants in the same candidate disease genes. The Illumina Clinical Services Laboratory offers a WGS test for patients with suspected rare and undiagnosed genetic disease and regularly submits potential candidate genes to GM to strengthen gene-disease relationships. We describe our experience with GM, including criteria for evaluation of candidate genes, and our workflow for the submission and review process. We have made 69 submissions, 36 of which are currently active. Ten per cent of submissions have resulted in publications, with an additional 14 submissions part of ongoing collaborations and expected to result in a publication.

IntroductionOxygen is one of the most common and inexpensive treatment components in today’s world of modern medicine. It is the most essential medicinal gas available in majority of the hospitals and highly beneficial when used in appropriate amounts. However, it must be acknowledged that too much of anything tends to do more harm than good, and even oxygen therapy is no exception.When one talks about oxygen, hypoxia and hypoxemia are two such terminologies often encountered and used interchangeably. It is of paramount importance to note that these two terminologies, though they may overlap are not synonymous. Hypoxia is a state of insufficient amount of oxygen in the tissues whereas hypoxemia is a decreased amount of oxygen content in the blood. Hypoxemia may often go unnoticed, and when homeostatic mechanisms no longer compensate, can lead to hypoxia.(1)With the ongoing COVID-19 pandemic, oxygen utilization has been on the rise worldwide, with some countries often experiencing scarcity in such crucial times.(2) The goal of oxygen therapy in COVID-19, as with any other form of respiratory illness, is to treat hypoxia. The WHO has classified severe COVID-19 to have saturations less than 90% and thus warranting supplemental oxygen therapy.(3) In an effort to treat the hypoxia, prolonged oxygen therapy may lead to pathophysiological processes associated with increased levels of hyperoxia-induced reactive oxygen species (ROS) which may readily react with surrounding biological tissues causing protein denaturation and breaking down of nucleic acids into strands.(4) Here, we describe a case of a patient with COVID-19 treated at our hospital.