To enhance the catalytic performance of H2SO4-catalyzed alkylation, various catalytic additives have drawn considerable attention. Herein, the effects of deep eutectic solvents additives (DESs) on catalytic performance and interfacial properties of H2SO4 alkylation were systematically investigated using experimental methods and molecular dynamics (MD) simulation. Experimental results indicate that DESs additives with the optimal concentration about 1.0 wt% can efficiently improve C8 selectivity and research octane number (RON) of alkylate. However, DESs additives contribute less to the quality of alkylate at low temperature and to the lifetime of H2SO4. MD results reveal that the phenyl molecules of DESs additives play a major role in enhancing interfacial properties of H2SO4 alkylation, including enlargement of interfacial thickness, promotion of isobutane relative solubility and diffusion to butene, which is probably the main reason for the better quality of alkylate. This work gives a good guideline for the design of novel DESs for H2SO4 alkylation.

A class of time-varying delay distributed parameter systems with input saturation is investigated in this paper. The periodic intermittent control method is adopted to make the system stable in finite time, improve the control performance of the system, and save on control cost. A periodic intermittent controller combined saturated input is designed to ensure the stability of the proposed system in finite time. Lyapunov--Krasoviskii stability theory and Matrix inequality techniques are used to analyze the finite-time stability of the system, and sufficient conditions for the system to be stable in finite time are obtained. Finally, the correctness of the theorems is verified by simulation experiments.

In most HIV models, the emergence of backward bifurcation means that the control for basic reproduction number less than one is no longer effective for HIV treatment. In this paper, we study an HIV model with CTL response and cell-to-cell transmission by using the dynamical approach. The local and global stability of equilibria is investigated, the relations of subcritical Hopf bifurcation and supercritical bifurcation points are revealed, especially, the so-called new type bifurcation is also found with two Hopf bifurcation curves meeting at the same Bogdanov-Takens bifurcation point. Forward and backward bifurcation, Hopf bifurcation, saddle-node bifurcation, Bogdanov-Takens bifurcation are investigated analytically and numerically. Two limit cycles are also found numerically, which indicates that the complex behavior of HIV dynamics. Interestingly, the role of cell-to-cell interaction is fully uncovered, it may cause the oscillations to disappear and keep the so-called new type bifurcation persist. Finally, some conclusions and discussions are also given.

Aim: The risk-benefit profile of angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) in coronavirus disease 2019 (Covid-19) is still a matter of debate. With growing evidence on the protective effect of this group of commonly used antihypertensives in Covid-19, we aimed to thoroughly investigate the association between the use of major classes of antihypertensive medications and Covid-19 outcomes in comparison with the use of ACEIs and ARBs. Methods: We conducted a population-based study in patients with pre-existing hypertension in the UK Biobank. Multivariable logistic regression analysis was performed adjusting for a wide range of confounders. Results: The use of either beta-blockers (BBs), calcium-channel blockers (CCBs), or diuretics was associated with a higher risk of Covid-19 hospitalization compared to ACEI use (adjusted OR, 1.63; 95% CI, 1.40 to 1.90) and ARB use (adjusted OR, 1.50; 95% CI, 1.27 to 1.77). The risk of 28-day mortality among Covid-19 patients was also increased among users of BBs, CCBs or diuretics when compared to ACEI users (adjusted OR, 1.64; 95% CI, 1.23 to 2.19) but not when compared to ARB users (adjusted OR, 1.18; 95% CI, 0.87 to 1.59). However, no associations were observed when the same analysis was conducted among hospitalized Covid-19 patients only. Conclusion: Our results suggest protective effects of blocking of the renin-angiotensin-aldosterone system on Covid-19 hospitalization and mortality among patients with pharmaceutically treated hypertension, which should be addressed by randomized controlled trials. If confirmed, this finding could have high clinical relevance for treating hypertension during the SARS-CoV-2 pandemic.

Primary cutaneous B-cell lymphoblastic lymphoma (PB-LBL) is an exceedingly rare malignant neoplasm in children. Skin lesions may represent the initial sign. Herein, we report a case of a PB-LBL with cutaneous lesions as a primary extranodal involvement, occurring in a 5-year-old infant.

Using traditional photosynthesis-intercellular CO2 concentration (A-Ci) response (TACiR) curves to obtain the maximum rates of ribulose-1,5-bisphosphate carboxylase oxygenase carboxylation (Vcmax) and electron transport (Jmax) is time-consuming and labor-intensive. Instead, the rapid A-Ci response (RACiR) technique provides a potential way with high efficiency. However, multiple parameter settings of RACiR technique for different plant life forms remain unclear. Here, we used Li-Cor 6800 to test the applicability and optimum parameter settings of RACiR curves for evergreens and herbs. We set 11 groups of [CO2], i.e., R1 (400-1500 ppm), R2 (400-200-800 ppm), R3 (420-20-620 ppm), R4 (420-20-820 ppm), R5 (420-20-1020 ppm), R6 (420-20-1220 ppm), R7 (420-20-1520 ppm), R8 (420-20-1820 ppm), R9 (450-50-650 ppm), R10 (650-50 ppm) and R11 (650-50-650 ppm), and made contrasts between TACiR and RACiR curves. We found that Vcmax and Jmax calculated by TACiR and RACiR overall showed no significant differences across 11 [CO2] gradients (P<0.05). The efficiency and accuracy of R2, R3, R4, R9 and R10 showed higher superiority than others. Moreover, the accuracy of manual empty chamber correction method was higher than the automatic method. In conclusion, the RACiR technique could be generally used to obtain photosynthetic parameters with higher efficiency than traditional methods for various life forms.

Water supply is one of the largest and most valued ecosystem services from forests. This paper presents a systematization of scientific studies about the effects generated by exotic fast-growing forest plantations of Pinus radiata D. Don and of Eucalyptus spp. on water yield in south-central Chilean watersheds (33 - 41ºS), at different spatial and temporal scales. We compiled scientific studies that have at least one year of observations on small and large catchments and experimental plots. Studies in experimental plots of Pinus radiata plantations show that annual evapotranspiration increase from south (40° S) to north (33° S), while in this northernmost site almost the entire incoming precipitation was evapotranspired, and the percolated water was negligible. Studies of water balance in small catchments document a negative linear relationship between total streamflow and forest plantations coverage. Catchments with forest coverage of Pinus or Eucalyptus spp. store less water than catchments with mixed species, mainly due to high interception loss, more net evapotranspiration and reduced percolation. Forest management can alter the accumulation of water in the catchment (soil and groundwater) and forest cover is the fundamental factor in the dynamics water accumulation. Long-term studies focused on changes in forest coverage from native forest to forest plantations in large catchments located in the Mediterranean area (33 - 38º S) of Chile show a sustained reduction in water yield, especially during summertime.

Making predictions from ecological models – and comparing these predictions to data – offers a coherent approach to objectively evaluate model quality, regardless of model complexity or modeling paradigm. To date, our ability to use predictions for developing, validating, updating, integrating and applying models across scientific disciplines while influencing management decisions, policies and the public has been hampered by disparate perspectives on prediction and inadequate integrated approaches. We present an updated foundation for Predictive Ecology that is based on 7 principles applied to ecological models: make frequent Predictions, Evaluate models, make models Reusable, Freely accessible and Interoperable, built within Continuous workflows, that are routinely Tested (PERFICT). We outline some benefits of working with these principles: 1) accelerating science; 2) bridging to data science; and 3) improving science-policy integration.

Ferredoxin (Fdx) is regarded as the main electron carrier in biological electron transfer and acts as an electron donor in metabolic pathways of many organisms. Here, we screened a self-sufficient P450-derived reductase PRF with promising NADPH reduction activity and 9OHAD production yield and proved the importance of [2Fe-2S] clusters of Fdx-containing oxidoreductase in transferring electrons in steroidal conversion. The truncated Fdx domain in all oxidoreductases, together with mutagenesis data, further elucidated the indispensable role of [2Fe-2S] clusters in the electron transfer process. By adding the independent plant-type Fdx to the reaction system, the AD conversion rate have been significantly improved. A novel efficient electron transfer pathway of PRF+Fdx+KshA in the reaction system rather than KshAB complex system was proposed based on analysis of protein-protein interactions and redox potential measurement. Adding free Fdx created a new conduit for electrons to travel from reductase to oxygenase. This electron transfer pathway provides new insight for the development of efficient exogenous Fdx as an electron carrier.

Background: The effects of infection and developmental adaptations in infancy on the prevalence of subsequent atopy-related diseases at different ages during childhood are not fully determined. This study aims to examine the similarities and differences in the age-specific association of asthma, allergic rhinitis/conjunctivitis, and atopic dermatitis with early life infection (i.e., daycare, older siblings, and severe airway infection) and developmental adaptations (i.e., preterm birth and overweight gain) in children. Methods: In this longitudinal cohort study (n = 47,015), children were followed from 0.5 to 11 years. The potential risks and protective factors, including daycare attendance at 0.5 years, existence of older siblings, history of hospitalization due to cold/bronchitis/bronchiolitis/pneumonia during 0.5–1.5 years, preterm birth, and overweight gain at 1.5 years, were assessed using multivariable logistic regression with adjustments for potential confounders. Results: A negative association was observed between early life daycare attendance and asthma at 5.5–9 years, which disappeared after 10 years. A negative association was also noted throughout childhood between early life daycare attendance and the presence of older siblings with allergic rhinitis/conjunctivitis. However, the association between early daycare and atopic dermatitis was found to be positive during childhood. In contrast, the early life history of hospitalization owing to cold/bronchitis/bronchiolitis/pneumonia was identified to be a risk factor for developing both asthma and allergic rhinitis/conjunctivitis. Preterm birth was a significant risk factor for childhood asthma. Conclusion: Different age-specific patterns were demonstrated in the relationship between early life daycare, severe airway infection, preterm birth, and atopy-related diseases in childhood.

Title: Learning the Learning Curve of Robotic Coronary Artery BypassAuthors : Saqib Masroor, MD, MBA1, Abdullah Nasif, MD1 1Division of Cardiothoracic Surgery, Department of Surgery, University of Toledo Medical Center Toledo, OH USAManuscript: The Learning Curve of Robotic Coronary Arterial Bypass Surgery: A Report from The STS DatabaseDisclosure : NoneWord Count : 1229Learning the learning curve of robotically assisted coronary artery bypass grafting is important for the advancement of this technique and the improvement in patient outcomes. There have been many reports of single surgeon learning curves.1, 2 But one can argue that they depict one surgeon’s journey, depicting his or her dedication to the field and making generalization to other surgeons difficult, if not impossible.In this issue of the Journal of Cardiac Surgery, Patrick et al, report on their investigation of the Society of Thoracic Surgeons (STS) database for Robotically Assisted Coronary Artery Bypass (RA-CABG) procedures and the beginner surgeon’s learning curve.3Between 2014 and 2018, a total of 1195 RA-CABGs were performed by 114 surgeons, with 74 surgeons performing <5 procedures and only 9 surgeons performing >25 procedures. The median number of cases performed was 2. The patient population was younger and relatively lower risk. The cases included single-vessel as well as multi-vessel Minimally Invasive Direct Coronary Artery Bypass (MIDCAB) in addition to Totally Endoscopic Coronary Artery Bypass (TECAB) and there is no subgroup analysis reported for the different procedures. The authors conclude that the learning curve for procedural success is overcome by the 10th case, even though the curve for reoperation is still steep by the 25th case. Operative mortality however was similar in the two groups. The authors conclude that surgeon experience is an independent predictor of RA-CABG procedural success and that the learning curve consistently flattens after the surgeon’s 10th case. We agree with the first but not the second conclusion. Here is why!In 2013, Prof Mohr’s group in Leipzig reported on the learning curve of minimally invasive mitral valve surgery at their institution over a 17-year period involving 3895 operations performed by 17 surgeons performing their first minimally invasive procedure, using the sequential probability cumulative sum (CUSUM) statistical technique.4 Learning curves were then determined for total operation times, aortic cross-clamp times, and primary outcomes. The mean number of operations per surgeon was 189. The authors reported a learning curve of between 75-125 procedures, with evidence that surgeons needed to perform more than 1 cases per week to maintain good results. Importantly however, patient mortality was not compromised because of the learning curve.To assess the learning curve involved in performing a task, it is important that both the task and the tools needed for the task remain constant. The above publication fulfills both of these criteria. 82 percent of cases were mitral valve repair and 18 percent were mitral valve replacement. The surgical technique and technology used was nearly identical and robotic mitral valve procedures were excluded. The institution had the same leadership over the period, allowing for a very stable work environment as well as a consistent approach including case selection, operative technique etc. As much as possible, every variable was the same, except the variable under investigation-‘the beginner surgeon’. The same group had reported the learning curve for MIDCAB to be between 50-100 cases for 8 surgeons at their institution.5Now let us analyze the report from Patrick et al.3 In this report, the task is not the same and neither are the tools. Single vessel RA-MIDCAB is a less challenging procedure than multi-vessel RA-MIDCAB, with its associated variety of conduit procedures (such as bilateral Internal Mammary Artery (IMA) grafting, Radial Artery T-grafting from Left Internal Mammary Artery (LIMA) to the lateral wall, or aortocoronary Saphenous Vein bypass procedures). TECAB is a totally different beast altogether. Grouping all of them in one learning curve is not a valid assumption. As far as the tools/technique is concerned, some patients had beating heart surgery while others had arrested heart procedures, exposing the Left Anterior Descending Artery (LAD) in MIDCAB is a different task than exposing the lateral wall targets or the stabilizing the LAD endoscopically. Each one of those steps/techniques have their own learning curves.Another shortcoming of this study is the relatively small experience of most of the surgeons in the study. 74 out of the 114 surgeons in the study had < 5-case experience. Moreover, it is not clear what the experience of the surgeons was before embarking on this technique. In the Leipzig study, surgeons with less than 5 cases were excluded from analysis and the 17 surgeons had an experience of at least 40 mitral valve procedures via sternotomy before using the minimally invasive approach.1Finally, the definition of procedural success can be debated. It was defined as an inverse composite of the three primary outcomes - conversion, re-operation, and major morbidity/mortality. While this “procedural success” composite showed a flattening of the learning curve at 10 cases, the reoperation rate was still improving even after 25 cases. A chain is only as strong as the weakest link. If the reoperation rate is still improving after 25 cases, procedural success cannot be declared to have been mastered at 10 cases. Further analysis of the groups of surgeons with < 10 or > 10 cases reveals the procedural success to be 72.9% and 85.3% respectively. 15% failure of procedural success would not be consistent with overcoming the learning curve. We assume that surgeons must strive to continue improving the procedural success until it reaches well into the 90’s percent rate, which would be required for a successful RA-CABG program.The major advantage of a large clinical database such as the Adult Cardiac Surgery Database (ACSD) is the minimization of bias due to its large number of observations. However, for rare procedures such as RA-CABG, that advantage is lost. In fact, with such a small number of observations over such a diverse set of procedures and institutions, ACSD data is not granular enough to explore an individual surgeon’s learning curve because there is no control for numerous other variables at the departmental and institutional level that are not tracked by ACSD. A high-volume center in a steady-state clinical work environment controls for most variables that influence clinical outcomes. The only variable that changes, is the beginner surgeon, and the data thus obtained is more likely to represent the true “learning curve” of the procedure.It is important to have realistic expectations from new technology. Many beginners would embark on this journey, hoping to master the learning curve in 10 cases. And when that expectation is not fulfilled in real life, they might give up altogether on this very useful approach. The number and frequency of operations are important, not just for the surgeons, but even more so, for the rest of the operating room team including anesthesiologists and patient-side assistants. The whole team can be feel discouraged if they continue to have a learning curve beyond 10 or even 20 cases.In conclusion, querying the Adult Cardiac Surgery Database of STS may not be the best way of learning the learning curve of a rare procedure(s). There is a concern that setting an unrealistically optimistic expectation of 10 operative cases to master the learning curve of RA-CABG may be detrimental to the progress of this approach. A high-volume centers’ experience with multiple beginner surgeons may be a better representative of the learning curve of RA-CABG and that study has not yet been done. But based on the learning curves of other similar procedures and our own experience, it is our opinion that the learning curve of RA-CABG would be somewhere between 50 and 100 cases for MIDCAB and another 50-100 for TECAB.

Objective. Pediatric oncology survivors are at risk for executive function (EF) and working memory (WM) deficits, which can be measured via performance-based measures or rating scales. Previous studies have shown these measurement methods to be weakly correlated. This study aimed to describe parent rated EF and performance-based working memory (PBWM) in pediatric cancer survivors; examine change in EF and PBWM across time; and investigate the relationship between parent rated WM and PBWM. Method. The sample included 59 patients (50 brain tumor, 9 Leukemia) diagnosed in childhood (Mage=6.92 years; SD=4.12) seen twice for clinical neuropsychological evaluation. PBWM was examined via the auditory working memory scale from a Wechsler intelligence measure or Differential Ability Scales-II. Parents completed the BRIEF/2 as a measure of global EF (GEC), metacognitive skills (MI/CRI), and behavioral regulation (BRI). Results. MI/CRI and GEC at Time 1 were significantly above the mean (p<.01), while PBWM did not differ from the normative mean. GEC, MI/CRI, and BRI were significantly higher than the normative mean at Time 2 (p<.05). PBWM was both clinically and statistically elevated (p<.001). There was a significant change across time in GEC, MI/CRI, and PBWM (p<.05), but not BRI. PBWM was only weakly correlated with the BRIEF WM subscale at Time 1 and Time 2 (all p>.05). Conclusions. Multiple measures of EF should be considered when providing diagnoses and recommendations for pediatric cancer survivors. Furthermore, given declines across time, findings document need for continued monitoring and re-assessment of pediatric survivors as they get further out from treatment.

Objective: To evaluate objective and subjective outcomes of patients who underwent sacrocolpopexy using autologous rectus fascia to provide more data regarding non-mesh alternatives in pelvic organ prolapse surgery. Design: Cohort study with retrospective and prospective data. Setting: A single academic medical center. Population: Women who underwent abdominal sacrocolpopexy using autologous rectus fascia between January 2010 and December 2019 Methods: Patients were recruited for a follow-up visit including completing the Pelvic Floor Distress Inventory (PFDI) and Pelvic Organ Prolapse Quantification (POPQ) exam. Demographic and clinical characteristics were collected. Main Outcome Measures: Composite failure, anatomic failure, symptomatic failure, and retreatment. Results: During the study period, 132 women underwent sacrocolpopexy using autologous rectus fascia. Median follow-up time was 2.2 years. Survival analysis showed that composite failure was 0.8% (CI 0.1-5.9%) at 12 months, 3.5% (CI 1.1-10.7%) at 2 years, 13.2% (CI 7.0-24.3%) at 3 years, and 28.3% (CI 17.0-44.8%) at 5 years. Anatomic failure was 0% at 12 months, 1.4% (CI 0.2-9.2%) at 2 years, 3.1% (CI 0.8-12.0%) at 3 years, and 6.8% (CI 2.0-22.0%) at 5 years. Symptomatic failure rate was 0% at 12 months, 1.3% (CI 0.2-9.0%) at 2 years, 2.9% (CI 0.7-11.3%) at 3 years, and 13.1% (CI 5.3-30.3%) at 5 years. Retreatment rate was 0.8% (CI 0.1-5.9%) at 12 months and 2 years, 9.4% (CI 4.2-20.3%) at 3 years, and 13.0% (CI 6.0-27.2%) at 5 years. Conclusions: Autologous rectus fascia sacrocolpopexy may be considered a safe and effective alternative for patients who desire to avoid synthetic mesh.

LETTER TO EDITOR

Changing landscape of complex lead extractions: need for patient tailored use of armamentarium for very old leads Arif Elvan, MD, PhD, FESC, FEHRAIsala Heart Centre, Diagram Research, Zwolle, The NetherlandsFunding: NoneConflict of interest: NoneThe numbers of implanted cardiovascular implantable electronic devices (CIED) and leads increased tremendously in the past decades due to an expansion of indications and progressive ageing of the population. The increased demand for complex transvenous lead extractions (TLE) is mainly related to a higher relative incidence of CIED infections, malfunction of leads and the increased need for upgrading or revision of devices. Moreover, the landscape of lead extraction is changing in time with a relative increase in the proportion of old leads with a dwell time of ≥10 years (1, 2). The growing impact of these complex TLEs on the utilization of the health care system has driven dedicated invasive cardiac electrophysiologists and engineers to improve strategies and tools to enable operators to perform lead extractions in a safe, effective and patient-centered way, minimizing risks of morbidity and mortality. We all know that chronically implanted leads may develop extensive fibrous or calcified adhesions around the surrounding structures and require more complex extraction techniques. Of note, the ageing of leads is associated with decreased procedural and clinical success rates and increased risk of lead extraction related complications (1, 2, 3). Currently, the techniques and armamentarium used in the extraction of leads include traction, counter traction, locking stylets, telescoping sheaths, and powered rotational mechanical and laser sheaths.In this issue of the Journal of Cardiovascular Electrophysiology, Issa (4) investigated success and complication rates of complex TLE of very old leads, defined as leads with a dwelling time of ≥20 years compared with younger leads. The indications for TLE were mainly related to pocket (58.9%) and systemic infections (33.9%), and in a minority of patients TLE was performed for other non-infectious indications. Although clinical success was very high in the current study (97.1%), this high clinical success implicates that small residual parts were regarded as a satisfactory result, while non-extracted remnants can be of clinical importance, especially in patients with lead endocarditis. Therefore, the complete procedural success constitutes an important metric rather than clinical success, particularly in patients with infectious TLE indications, in whom extraction of the whole system without any remnants should be the ultimate procedural endpoint.Furthermore, in the study by Issa (4), patients were treated by a single experienced lead extraction specialist in a high-volume center. The results of this study cannot be extrapolated to less experienced operators or low volume centers. This study underlines the necessity of concentrating lead extractions to high-volume centers to provide the best care for these patients. Some single center series reported very low complication rates, which does not reflect potential complications that might be encountered during a complex lead extraction procedure, especially when performing extraction of very old leads with a dwelling time of ≥20 years. It seems reasonable to advocate that all lead extractions should be reserved to experienced centers with a thoracic surgeon standby during complex lead extraction procedures. It is, to my personal opinion, important to emphasize this issue instead of giving space for low volume centers to perform some of the expected “easy” lead extractions.Moreover, in the study by Issa (4), the laser sheath was the primary extraction tool used in the majority of the ≥20 years old leads and mechanical sheaths or femoral snares were only used after failure of laser sheaths. Complete procedural success was lower in the group of patients with very old leads compared with leads with a dwelling time of less than 20 years (90.7% versus 98.5%). However, angiography of the subclavian vein was not a standard routine procedure in all patients. It seems reasonable to incorporate venous angiography as a standard procedure in the workup for TLE (5). Of note, the complexity of the TLE in the group with leads less than 20 years old was very heterogeneous. It is remarkable that 55% of the leads required complex extraction techniques, whereas 45% of these leads could be extracted with manual traction only in this group of patients with less than 20 years old leads, highlighting the nonbinary nature of the extent of adhesions of aging leads to surrounding structures. Despite advances in lead extraction techniques, extraction of older leads in a safe and effective way remains challenging. Issa (4) demonstrated that complex TLE can be performed successfully and safely by a skilled and experienced operator in a specialized center. The rate of major complications was 5.6% including 1 death. These results are in line with previous publications (5, 6, 7).This latter study (4) underlines the importance of the use of combination of multiple extraction tools in enhancing procedural success rates. Especially in leads with a dwelling time of ≥20 years, there is an increased risk of extraction failure or incomplete success. Issa (4) primarily used laser sheaths while others used the powered mechanical sheath as the primary extraction tool. Several reports describing the results of case series were published on the success and complication rates of lead extractions with the use of mechanical sheaths (5, 6. 7). These studies described the results of case series. Moreover, Migliore et al (7) reported that complex lead extractions using the Evolution RL bidirectional rotational mechanical sheaths and ancillary tools in a systematic stepwise approach were effective and safe.The use of dedicated extraction tools and techniques yielded reported major adverse event rates of 2-3% with a mortality of 1% in previous studies (3, 5, 6, 7). In some previous reports, only powered mechanical sheaths were used with comparable results (5, 6, 7). The currently available armamentarium for complex lead extractions including laser sheaths, powered mechanical rotational sheaths and femoral snares enables operators to tailor the procedure in order to enhance procedural and clinical success rates. However, there is a lack of direct comparative data regarding risks and benefits of laser sheath compared with powered mechanical sheaths and femoral snares.Issa (4) performed analyses of retrospective data which should be regarded as exploratory and hypothesis generating. Nevertheless, this study provides data and conveys messages that are important to the clinical practice. The main finding is that transvenous extraction of leads with a dwelling time ≥20 years is associated with a considerable risk of major complications, even in the hands of an experienced operator and in the setting of a high-volume center. This study highlights the need for concentration of complex lead extractions to a selected number of highly specialized centers.Although, direct comparison of the available strategies and techniques has not been performed yet, these studies need to be performed in the near future. Clinicians need guidance based on firm evidence regarding comparative efficacy or safety of bidirectional powered mechanical sheaths and laser sheaths and femoral snares.There are no randomized trials comparing different extraction strategies. The current recommendations are based on outcome data derived from various case series.Therefore, international collaboration, merging of databases and ultimately randomized trials are crucial to gain more insight and to better delineate the incremental values of the available lead extraction tools and techniques.The innovations in the field of complex TLE techniques and tools will continue. In the meantime, the extraction of chronically implanted leads remains a complex procedure associated with major complications including mortality, mandating concentration to specialized centers and standardized metrics for monitoring procedural and clinical outcomes.

Letter to the editor

The main aim of this paper is to study hyponormal and dissipative correct restrictions and extensions as well as their applications to differential operators.

Underground coal mining will inevitably cause land ponding in high groundwater table, which will affect the land sustainable development. However, the traditional reclamation (TR) is poor in land rate. Thus, finding a suitable reclamation approach is crucial to alleviate the conflicts between coal exploitation and land protection. In this paper, taking Guqiao Coal Mine of China was seriously affected by mining-induced ponding as an example. Firstly, dynamic distribution of surface subsidence and land damage from 2007 to 2017 was revealed base on concurrent mining and reclamation (CMR). Second, the land-water layout of five reclamation schemes (no reclamation, TR, CMR I, CMR II and CMR III) were simulated. Then, and the dynamic filling elevation model and filling thickness model were constructed. Finally, the sequence of earthwork allocation was optimized. The results revealed that: 1) reclaimed land area: CMR III > CMR II > CMR I > TR > no reclamation; 2) The digging depth is directly proportional to earthwork volume and land area, and inversely proportional to water area, but with increase of digging depth, the increase in the reclaimed land area relatively slowed down; 3) CMRs had reclaimed 426.31~637.82 ha and 259.62~471.13 ha more than the no reclamation and TR respectively. Compared with the no reclamation and TR, CMRs can increase the proportion of reclaimed land by 33.77~50.52% and 20.57~37.32% respectively. The research results provide a reference to increase the reclamation rate of mining areas in the high phreatic table.

Cow's milk allergy non-responsive to amino acid-based formula must raise suspicion of Immune dysregulation, polyendocrinopathy, enteropathy, X-linked syndrome. This is a potentially fatal disease associated with food allergy, sometimes leading to diagnostic delay. In our case, early diagnosis and management provided life-saving therapy.

ABSTRACT Objectives: To investigate the relationship between nurse-nurse collaboration and patient safety attitudes in inpatient care. Methods: This was a cross-sectional study. In the study, the sample universe was determined by the known sampling method and a total of 160 nurses working in inpatient clinics of a public hospital between January-March 28, 2020 were included in the study. The data were collected using the “Personal Information Form”, “Nurse-Nurse Collaboration Scale” and “Patient Safety Attitude Questionnaire”. Descriptive statistics, t-test, ANOVA, correlation, and linear regression analysis were used to analyze the data. Results: The mean scores of the nurse-nurse collaboration (78.55 ± 8.86) and patient safety attitude (162.68 ± 20.59) found to high level. It was revealed that the nurses’ higher level of collaboration with increasing work experience. Patient safety attitudes, job satisfaction, safety climate and perceptions of management of the manager nurses were higher than those of clinical nurses. Nurse-nurse collaboration has a statistically significant effect on patient safety attitude of nurses. The results show that %24 of the change in patient safety attitude in nurses could be explained by nurse-nurse collaboration. Conclusions: It was determined that, the nurse-nurse collaboration was significantly associated with patient safety attitudes. Our findings provided new evidence that it could be argued that, as the level from nurse-nurse collaboration increase, the level on patient safety attitude of nurses will increase. This study proposes that improving nurse-nurse collaboration should be regarded as a significant strategy that would increase patient safety. Key Words: collaboration, hospital, inpatient, patient safety, nursing

An 86-year-old man with end-stage renal disease on hemodialysis with an arteriovenous fistula in his left upper extremity presented to his hemodialysis session with thrombosis of his arteriovenous fistula. The patient underwent surgical thrombectomy. The patient later showed evidence of peripheral embolization and livedo reticularis. Transthoracic and transesophageal echocardiograms revealed a large thrombus (5x2 cm) in the left atrium prolapsing to the right atrium via a patent foramen ovale and another thrombus (white arrow) adherent to the apical wall of the right ventricle. The thrombus in the left atrium was intermittently crossing the mitral valve and entering the left ventricle.

A proliferation in environmental DNA (eDNA) research has increased the reliance on reference sequence databases to assign unknown DNA sequences to known taxa. Without comprehensive reference databases, DNA extracted from environmental samples cannot be correctly assigned to taxa, limiting the use of this genetic information to identify organisms in unknown sample mixtures. For animals, standard metabarcoding practices involve amplification of the mitochondrial Cytochrome-c oxidase subunit 1 (CO1) region, which is a universally amplifyable region across majority of animal taxa. This region, however, does not work well as a DNA barcode for plants and fungi, and there is no similar universal single barcode locus that has the same species resolution. Therefore, generating reference sequences has been more difficult and several loci have been suggested to be used in parallel to get to species identification. For this reason, we developed a multi-gene targeted capture approach to generate reference DNA sequences for plant taxa across 20 target chloroplast gene regions in a single assay. We successfully compiled a reference database for 93 temperate coastal plants including seagrasses, mangroves, and saltmarshes/samphire’s. We demonstrate the importance of a comprehensive reference database to prevent species going undetected in eDNA studies. We also investigate how using multiple chloroplast gene regions impacts the ability to discriminate between taxa.

Hyperactivation of NLRP3 inflammasome contributes to the neuroinflammation in autoimmune disorders, but the underlying regulating mechanism remains to be elucidated. We here demonstrate that mice lacking thymic stromal lymphopoietin receptor gene (Tslpr-/-) exhibit significant decreases in experimental autoimmune encephalitis (EAE) score, reduced CD4+ T cells infiltration, and restored expression of myelin basic protein (MBP) in the brain after induction of EAE by injection of myelin oligodendrocyte glycoprotein35-55 (MOG35-55) . TSLPR signals through Janus Kinase 2 (JAK2) to activate NLRP3. Tslpr-/- mice of EAE show decreased phosphorylation of JAK2 and expression of NLRP3 in the brain. In wild type (WT) mice after induction of EAE, inhibition of JAK2 by ruxolitinib inflammatory and CD4+ cell infiltration, decreased expression of NLRP3, and restored BMP expression in the brain. Ruxolitinib also decreased levels of IL-1β and TSLP in brain of EAE mouse when compared to that without ruxolitinib treatment. Further results with NLRP3 inhibitor MCC950 in EAE mouse of WT verified the proinflammatory role of NLRP3 by showing decreased inflammatory cells and CD4+ T cells, restored MBP expression, and declined levels of IL-1β and TSLP in the brain. In patients with anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis we found increased level of NLRP3 and IL-1β in CSF when compared to that in control subjects. These findings highlight TSLP as a prospective target for treating JAK2-NLRP3 axis-associated autoimmune inflammatory disorders.

Brain tumors and brain metastases induce changes in brain tissue remodelling that lead to immunosuppression and trigger an inflammatory response within the tumor microenvironment. These immune and inflammatory changes can influence invasion and metastasis. Other neuroinflammatory and necrotic lesions may occur in patients with brain cancer or brain metastases as sequelae from treatment with radiotherapy. Glioblastoma (GBM) is the most aggressive primary malignant brain cancer in adults. Imaging methods such as positron-emission tomography (PET) and different magnetic resonance imaging (MRI) techniques are highly valuable for the diagnosis and therapeutic evaluation of GBM and other malignant brain tumors. However, differentiating between tumor tissue and inflamed brain tissue with imaging protocols remains a challenge. Here, we review recent advances in imaging methods that have helped to improve the specificity of primary tumor diagnosis versus evaluation of inflamed and necrotic brain lesions. We also comment on advances in differentiating metastasis from neuroinflammation processes. Recent advances include the radiosynthesis of 18F-FIMP, an L-type amino acid transporter 1 (LAT1)-specific PET probe that allows better differentiation between tumor tissue and inflammation compared to previous probes; and the combination different advanced imaging protocols with the inclusion of radiomics and machine learning algorithms.