Pairwise mutualisms are embedded within rich communities of co-occurring species. Mutualism by definition benefits partner species and theory predicts these effects can spill over into broader communities, with consequences for abundance, diversity, and composition. Specifically, positive feedbacks between partner species may shift competitive hierarchies and drive reductions in non-partner species. We used long-term monitoring data spanning 16 years to determine the ant partner species of tree cholla cacti (Cylindriopuntia imbricata), which reward ants with extrafloral nectar in exchange for anti-herbivore defense. We coupled these long-term data with short-term characterization of the ant community via pitfall trapping, which sampled partner and non-partner species across ten plots that varied naturally in cactus density. The long-term data revealed one dominant ant partner (Liometopum apiculatum) and two other less common partners (Crematogaster opuntiae and Forelius pruinosus). In the short-term census, the dominant ant partner occupied more cacti in plots of higher cactus density, and was also found at higher occurrence within the pitfall traps in the high cactus density plots, suggesting strong positive feedbacks that promote ant occurrence where plant partners are available. Despite the consistency of L. apiculatum partnership with cacti through time and the dominance of this partnership in areas of high cactus density, spillover effects from this mutualism appear limited. Of the common ant species, a single non-partner ant species showed a modest reduction in occurrence at high cactus density, possibly in response to increased presence of L. apiculatum. Additionally, the composition and diversity of the ant community in our plots were insensitive to cactus density variation, indicating that positive effects on the dominant ant partner did not have cascading impacts on the ant community. This study provides novel evidence that pairwise mutualisms, even those with strong positive feedbacks, may be limited in the scope of their community-level effects.

We read with interest the aforementioned paper by Al-Zubayer et al. 20211 that investigated the “double” and “triple” burden of non-communicable diseases defined as any two or three of hypertension, diabetes and overweight/obesity, respectively. When the prevalence of individual condition was examined it was found that “Almost 56% had hypertension, 23.4% had diabetes and 24.6% had overweight or obesity”.We think the authors have made errors in their analysis that has resulted in unreliable prevalence estimates of hypertension, diabetes and overweight/obesity, and casting doubt on their estimates of burden of non-communicable diseases. This will cause confusion in the scientific and wider community and at worst, inappropriate allocation of resources to address the artificially elevated burden of diseases. We have identified errors related to the calculation of mean blood pressure, definition of diabetes, and classification of overweight/obesity, as outlined below.Al-Zubayer et al. 2021 state that “interviewers have measured the respondents’ blood pressure and it was taken at the beginning, in the middle and at the end of each interview. The mean value of these measurements was documented as the final result to measure hypertension1”. The Bangladesh Demographic and Health Survey (BDHS) survey did measure blood pressure three times, however, the report states that “The average of the second and third measurements was used to report respondents’ blood pressure values”2. This is a standard practice in research and clinical practice to reduce the possibility of ‘white coat’ hypertension from the first reading. The classification of hypertension based on the mean of all three measurements may have resulted in higher means, and an overestimate of the prevalence of hypertension.The authors also state that “If the fasting plasma glucose values were >6.1 mmol/L (110 mg/dL) and/or taking any medicine for diabetes, then the participant is considered to be diabetic otherwise normal.”1 However, this is an incorrect definition of diabetes because it includes pre-diabetes . Fasting blood glucose in the range 6.1 to 6.9 mmol/L is the level for pre-diabetes, as recommended by the WHO3. It is also not the classification used in the BDHS survey report which states that “Individuals were considered as having raised blood glucose or diabetes if they had a fasting blood glucose (FBG) equivalent level of 7 mmol/L or above at the time of the survey or reported currently taking prescribed medication for their high blood glucose or diabetes”2, which is consistent with the WHO classification3. As a result of including prediabetes, the prevalence of ‘diabetes’ reported by the authors (23.4%) was more than double that reported in the BDHS survey report (10%)2.Al-Zubayer et al. 2021 used the WHO global cut-off for overweight/obesity (BMI ≥25kg/m2). However, we think it would have been more appropriate to use Asian cut-offs (BMI ≥23kg/m2) as suggested by the WHO expert consultation4. This is due to the high risk of type 2 diabetes and cardiovascular disease in Asian people at lower BMIs than the WHO global cut-offs4.We believe these are important misinterpretations, which need to be addressed by the authors.

Background: Adolescent girls in Afghanistan have high levels of food insecurity, yet little is known about their dietary intakes. Therefore, we aimed to study the association between dietary protein intake and anthropometric indices among adolescent girls in Kabul, Afghanistan. Methods: We conducted a cross-sectional study of 380 adolescent girls at 16 government schools from eight randomly sampled zones in Kabul. In July 2019, we assessed dietary intake, body mass index (BMI), physical activity and socio-demographic variables. Binary logistic regression models were used to estimate the associations between different protein sources (plant protein, animal protein and total protein) and stunting, wasting, overweight and obesity. Results: Participant mean age was 14.8±2 years and mean BMI was 19.8±3.6kg/m2. The mean intakes of carbohydrates from plant proteins, animal proteins and total proteins were approximately 59.4±19.6gr/day, 22.3±7.3gr/day and 81.8±27.1gr/day, respectively. Students with more highly educated fathers consumed more plant proteins (P<0.05). Participants had overall high dietary plant protein intake (mean 34.8±22.0g/day), with 66% from grains, cereals and flour. We did not find an association between dietary protein intake and stunting (OR=0.92; CI: 0.55-1.54), wasting (OR= 0.98; CI: 0.55-1.78), overweight (OR=1.18; CI: 0.62-2.25) or obesity (OR=0.84; CI: 0.19-3.58). Conclusion: While prior research suggests that dietary protein intake is associated with improved nutritional and anthropometric indices, dietary protein intake in this study was not associated with stunting, wasting, overweight and obesity. Further investigation is needed on this topic.

In this paper, in order to study the relationship between structure and performance, four new NFA derivatives were designed based on the two reported NFA molecules BO-4Cl and BTP-S2 by replacing the BT unit with a less-electron deficient BTz unit and inserting another ethylene double bond between the central core and the terminal groups. The DFT and TD--DFT calculations were applied to invstigate linear and nonlinear optical properties, such as electronic structure, electronic absorption, reorganization energy and the second-order NLO properties. The investigation demonstrates that they are all narrow bandgap derivatives, the absorption spectrum extends to the near-infrared region and using two ethylene double bond is the most effective way to reduce the energy gap, redshift the maximum absorption peak and the middle absorption band, enhance hole transport ability and weaken electron transport ability and enhance second-order NLO response. Considering the smaller electron and hole reorganization energy and the larger static first hyperpolarizability value, the studied NFA derivatives have great potential to become ambipolar charge transport materials and large second-order NLO materials.

Catalytic oxidation desulfurization of gasoline is a key process for the utilization of petroleum hydrocarbons. However, the inherent mechanism still remains unclear and the kinetic investigation is usually performed in processes with limited mass transfer rates. Herein, the kinetics and mechanism of catalytic oxidation of sodium ethyl mercaptide were investigated with microfluidics. On the basis of eliminating mass transfer resistance, the effects of temperature, pressure, residence time, and gas-liquid flow ratio on the oxidation were assessed. According to the results of UV-vis spectra and binding constant, it was confirmed that the catalytic center was in the form of dimer. A heterogeneous reaction kinetic model was proposed as such. The kinetic parameters close to intrinsic kinetics and corresponding kinetic rate expression were obtained.

We previously showed that electric current can cause zebrafish larvae to move towards the anode pole along a microchannel. For a semi-mobile larva, we observed that zebrafish response to electricity depended on the current magnitude. The effects of electric signal direction, voltage magnitude and habituation to repeated exposures to electric pulses were not characterized. Here, this knowledge gap was addressed by exploiting these parameters in a microfluidic device with a head-trap to immobilize a zebrafish larva and a downstream chamber for tail movement and phenotypic characterization of response duration (RD) and tail beat frequency (TBF). We first assessed larvae’s response to electric current direction (at 3µA) and voltage magnitude. Changing the current direction significantly altered the RD and TBF with long and low-frequency responses seen when the anode was positioned at larvae’s tail. The electric voltage drop across the fish body had a significant effect on larvae’s locomotion with long RD and low TBF observed at 5.6V in the range of 1.3-9V. We also demonstrated that the zebrafish locomotor response to repeated 3µA current pulses diminished with dependency on the interstimulus interval. However, the diminished response was fully recovered after a 5-min resting period or introduction of a novel light stimulus (i.e. habituation-dishabituation strategy). Therefore, electric response suppression in zebrafish was attributed to the habituation as a form of non-associative learning. Our microfluidic platform has broad application potential in behavioral neuroscience to study cognitive phenotypes, fundamental studies on the biological roots of electric response, and pharmacological screening.

We propose a dynamic proton exchange membrane fuel cell model for cold start simulation in account for reactant transport, water phase-transfer and electrochemical reactions within catalyst agglomerates. The competition between in-agglomerate concentration loss and coverage of active electrocatalytic surface is shown to create different failure modes for low and high start-up currents. The critical ice fraction of failure was studied for different catalyst layer (CL) thickness and ionomer to carbon ratios (I/C) at 0.4 A cm-2. Thicker cathode CLs allow cold start to proceed with higher ice fractions. In contrast, larger cathode I/Cs causes cold-start failure at lower ice fractions because of reduction of the CL porosity and agglomerate pore sizes that significantly increases the oxygen transport resistance. By utilizing the electro-osmotic drag effect, slightly thick anode CL could act as effective heat sources during cold start at high currents with minimal impact on the nominal cell performance.

The dynamic pH response resulting from acid-base transport of interfacial reactions greatly influences the kinetic performance and process mechanism, but its theoretical foundation is lacked. Herein, a generalized acid-base transport model is established owing to the success in deriving buffer transport equations and is experimentally through the relationships of buffer transport limiting current versus solution pH and buffer concentration (CB). The relationships bring forth the parameter determination methods of buffers with the superiority of facile survey of practical parameter values. Based on model calculations, the dynamic pH response is drawn as a j‒pH diagram to show the buffer transport law in the full pH range, highlighting the rate-limiting effect. The buffer operation principles are graphically presented as CB‒ΔpH diagrams to aid economic buffer applications. This study has laid the foundation for quantification and regulation of dynamic pH response and is of wide interest to the chemistry encompassing interfacial processes.

Abstract: Background: Gastrointestinal complications of this COVID-19 have been reported over the last year. One such manifestation is bowel ischemia. This study thus aims to provide a more holistic review of our current understanding of COVID-19 induced bowel ischemia. Method and Results: A meticulous search was performed using different keywords in PubMed, EMBASE, and Google Scholar. Fifty-two articles were included in our study after applying inclusion and exclusion criteria and performing the qualitative assessment of the studies. A total of 25,702 patients were included in our study after the completion of the qualitative assessment. Discussion: COVID-19 commonly presents in the GIT as diarrhea, vomiting, and nausea. The mechanism of bowel ischemia is associated with the formation of emboli which is related to COVID-19’s high affinity for angiotensin-converting enzyme-2 on enterocytes, affecting the superior mesenteric vessels. Clinically, patients presented with abdominal pain and vomiting. CT angiography of the abdomen and pelvis showed acute mesenteric ischemia. Management was usually initiated with gastric decompression, fluid resuscitation, and hemodynamic support. Surgical intervention was also sought. Conclusion: Mesenteric ischemia presenting in patients with COVID-19 has to be considered when symptoms of severe abdominal pain are present. More research and guidelines are required to be able to triage patients with COVID-19 to suspect mesenteric ischemia and to help in diagnosis and management.

Objective: The aim of this study was to evaluate the diagnosis of sarcopenia by abdominal tomography, prevelance and prognosis in critical patient admitted to intensive care unit(ICU). Methods: It was planned as a retrospective observational study. Patients older than 40 years of age with abdominal tomography who needed to be in the ICU were included. Muscle mass was measured by abdominal tomography. All patients were divided into two groups as sarcopenic and non-sarcopenic according to the measurement results. We compared the prognosis and clinical features of patients with and without sarcopenia. Results: Fifty five(59%) of all patients were found as sarcopenic and 70.8% over 70 years of age. The length of stay in ICU and in hospital were 27.8 ± 29.7 and 33.0 ± 31.2 days in sarcopenic patients, 15.1±17 and 23.8±21.3 days in nonsarcopenic patients respectively(p <0.05). Thirty day mortality was found 49.1% in patients sarcopenic(<0.05). SMI was found lower over aged 70 years(p <0.05). Conclusions: Sarcopenia was associated with the increasing of 30 day mortality, a prolongation in the lenght of stay in ICU and hospital. Therefore, we believe that awareness about sarcopenia will be important in order to shorten the mortality and lenght of stay in ICU.

What is Known and Objective: Currently, the safety and efficacy of Holmium Laser Enucleation of Prostate (HoLEP) in patients with large prostates (>100 ml) who are at high risk for Thromboembolic Events (TE) and receiving Antithrombotic Therapy (AT) are controversial. This study aims to characterise the safety and efficacy of the HoLEP in patients with large prostates (>100ml) at high risk for TE resuming AT in the early post-operative period.Methods: We have reviewed retrospective data for 378 patients with large prostates treated with the HoLEP for symptomatic benign prostatic hyperplasia between December 2016 and July 2020. One hundred thirty-four of the patients had been receiving AT. Antiplatelet (AP) therapy was maintained. Patients taking vitamin K antagonists and new oral anticoagulants stopped taking the drug 5 and 2 days before the HoLEP, respectively. Postoperatively, anticoagulants (AC) were resumed within 24 hours. In patients receiving AT, we have determined “pre-operative, peri-operative, and post-operative” parameters, functional outcome, and adverse events for the 3 months after the operations. Subsequently, we have compared the results of 203 patients without AT.Results and Discussion: Patients receiving AC and AP were older (p=0.015) and had a higher median ASA score (p<0.001). Objective-voiding parameters (Qmax, PVR) and urinary symptoms (IPSS, QoL) improved in the three groups (p<0.001). Median enucleation and morcellation efficiencies were 1.58 (IQR:0.87-3.13) and 5 (IQR:1-8.08), median catheterisation and hospitalisation time was 2 days (IQR:2-3) and 3 days (IQR:3-4), respectively. The peri-operative results were similar in the three groups. Overall, one patient in the AP group required blood transfusion at 4 days postoperatively due to clot retention and significant haemoglobin decrease (p=0.216). There was no adverse TE in any patient within the 3-months postoperatively.What is new and Conclusion: In cases with large-sized prostates posing a high risk of bleeding as well as TE, the HoLEP procedure could be applied without leaving AP agents in a safe and highly efficient manner. Additionally, this procedure could be performed following the cessation of AC treatment with the chance of a quite early initiation of these agents to limit properly the potential risk of TE.

A 67-year-old woman with a history of mechanical valve replacement; after the dental procedure, she developed dyspnea, malleolar edema, and fever. The 2D transesophageal echocardiogram (TEE) showed no evidence of valve obstruction, mild paravalvular leak, and no vegetations. In the 3D TEE, the presence of masses suggestive of vegetations on the auricular surface of the prosthesis was suspected which were more precisely defined with transillumination rendering. This technique allowed us to observe with precision the vegetations that were not visualized with traditional methods. This highlights its usefulness in patients with prosthetic valves where infective endocarditis is a serious complication.

Anagrus nilaparvatae is an important egg parasitoid wasps of rice pests rice planthopper. Based on the powerful olfactory system of sensing chemical information in nature, A. nilaparvatae shows complicated life activities and behaviors, such as feeding, mating and hosting. In this study, we constructed a full-length transcriptome library and further to identify the characteristics of olfactory binding proteins, the first participant in the olfactory system. Through full-length transcriptome sequencing, splicing, assembly, and data correction by Illumina, we obtained 163.59Mb of transcriptome data and 501,179 items of annotation information, and performed GO functional classification of unigenes of the transcriptome. We analyzed the sequence characteristics of olfactory binding protein genes, and 8 genes (AnilOBP2, AnilOBP9 AnilOBP23, AnilOBP56, AnilOBP83, AnilCSP5, AnilCSP6 and AnilNPC2) were identified. After sequence alignment and conserved domain prediction, the 8 proteins were consistent with the typical characteristics of OBPs, CSPs and NPC2s in insects. The phylogenetic tree analysis showed that the 8 genes share low homology relationship with other species in Hymenopteran. Finally, RT-qPCR was used to analyze the expression responses of the 8 genes in different genders and stimulated by volatiles. The relative expression levels of AnilOBP9, AnilOBP26, AnilOBP83, AnilCSP5 and AnilNPC2 in males were significantly higher than those in female, while the relative expression levels of AnilCSP6 were opposite. The expression levels of AnilOBP9 and AnilCSP6 were significantly altered by the stimulation of β-caryophylene, suggesting the two genes may be related to host searching. In this study, the transcriptome data of parasitoid wasps A. nilaparvatae could provide a reference for the molecular biology research of the parasitoids, and the identification and analysis of olfactory binding proteins not only help us further clarify the physiological characteristics and parasitic mechanism of the parasitoids, but also promote the utilization of natural enemy resources.

Background: Determination of the prognostic factors which affects the mortality and morbidity in COVID-19 patients, has an importance in terms of planning the treatment and follow-up strategy. Material and Method: Patients who had COVID-19 diagnosis via microbiologically and/or radiologically between March and October 2020 in a tertiary-care university hospital were recorded retrospectively. Only adult patients (≥18 years) with clinical spectrum of moderate, severe and critical illness were included in the study according to National Institutes of Health (NIH) guideline. A p value of less than 0.05 was considered significant. Ethical committee approval was given from the Uludag University with decision number 2020-22/11. Also, the permission from Republic of Turkey, Ministry of Health was given. Results: A total number of 257 patients were included in the study. 30-day mortality rate was recorded as 14.4%. In univariate analysis; age, chronic renal failure, malignancy, cerebrovascular disease, number of comorbidities >2, dyspnea, cough, NIH severe and critical illness, oxygen saturation, respiratory rate, systolic and diastolic blood pressure, qSOFA, GCS, MEWS, SOFA, CURB-65, CCI, CRP, procalcitonin, CK, D-dimer, lymphocyte and thrombocyte levels, neutrophile-to-lymphocyte ratio, AST, albumin, hemoglobin, CK-MB, fibrinogen, LDH and potassium levels were found as statistically significant (p<0.05). In logistic regression analysis one point increase of SOFA (p<0.001, OR:1.861, 95%CI:1.403-2.468) and CURB-65 scores (p=0.002, OR:2.484, 95%CI:1.401-4.406) were found as statistically significant for 30-day mortality. In mortal patients, there were significant difference between the baseline, day 3, 7 and 14 results of D-dimer (p=0.01), Ferritin (p=0.042), leucocyte (p=0.019) and neutrophile count (p=0.007). Conclusion: In our study, SOFA and CURB-65 scores on admission were associated with mortality and these score systems might be useful tools for the prognosis in COVID-19 patients.In addition to this, D-dimer, Ferritin, leucocyte and neutrophile counts were significantly increased during the follow up in patients with mortality.

Introduction: Guidelines recommend using a pulse oximeter rather than arterial blood gas (ABG) for COVID-19 patients. However, significant differences can be observed between oxygen saturation measured by pulse oximetry (SpO2) and arterial oxygen saturation (SaO2) in some clinical conditions. We aimed to assess the reliability of pulse oximeter in patients with COVID-19 Methods: We retrospectively reviewed ABG analyses and SpO2 levels measured simultaneously with ABG in patients hospitalized in COVID-19 wards. Results: We categorized total 117 patients into two groups; in whom the difference between SpO2 and SaO2 was 4% (acceptable difference) and >4% (large difference). Large difference group exhibited higher neutrophil count, C-reactive protein, ferritin, fibrinogen, D-dimer and lower lymphocyte count. Multivariate analyses revealed that increased fibrinogen, increased ferritin and decreased lymphocyte count were independent risk factors for large difference between SpO2 and SaO2. The total study group demonstrated the negative bias of 4.02% with the limits of agreement of −9.22% to 1.17%. The bias became significantly higher in patients with higher ferritin, fibrinogen levels and lower lymphocyte count. Conclusion: Pulse oximeters may not be sufficient to assess actual oxygen saturation especially in COVID-19 patients with high ferritin and fibrinogen levels and low lymphocyte count low SpO2 measurements.

Aim of the study: Subconjunctival hemorrage (SCH) is a frequent bleeding manifestation and a common cause of visits to the primary care. Trauma in young patients and vascular damage such as hypertension in the elderly are the most common causes of SCH and the prevalence of hematological diseases is less than 1%. We aimed to evaluate the prevalence of congenital or acquired bleeding disorders in patients with once or recurrent SCH. Methods used to conduct the study: It is a retrospective study and included fifty-two patients with SCH whose etiologic factor was not detected. Hemostatic tests were studied in 52 patients (25 male and 27 females). All patients included were evaluated for congenital or acquired bleeding disorder and SCH with once and those with 2 or more were compared for the laboratory results. Results of the study: Type I von Willebrand disease (vWD) was diagnosed in one patient with recurrent SCH and one patient with single SCH (3.8%). The prevalence of patients with type 1 vWD in the study was not statistically significant when compared with the frequency of vWD in the normal population. Fibrinogen level was found to be statistically higher in patients who had SCH once than those who had recurrent SCH. But fibrinogen level was in normal range in all patients. Conclusions drawn from the study and clinical implications: There was no increase in the incidence of congenital or acquired bleeding disorder in SCH compared to normal population. For this reason it was thought that there was no need for evaluation for bleeding disorders in spontaneous SCH.

Machine learning and artificial intelligence (AI) in medicine has arrived in medicine and the healthcare community is experiencing significant growth in its adoption across numerous patient care settings. There are countless applications for machine learning and AI in medicine ranging from patient outcome prediction, to clinical decision support, to predicting future patient therapeutic setpoints. This commentary discusses a recent application leveraging machine learning to predict one year patient survival following orthotopic heart transplantation. This modeling approach has significant implications in terms of improving clinical decision making, patient counseling, and ultimately organ allocation and has been shown to significantly outperform preexisting algorithms. This commentary also discusses how adoption and advancement of this modeling approach in the future can provide increased personalization of patient care. The continued expansion of information systems and growth of electronic patient data sources in healthcare will continue to pave the way for increased use and adoption of data science in medicine. Personalized medicine has been a long-standing goal of the healthcare community and with machine learning and AI now being continually incorporated into clinical settings and practice, this technology is well on the pathway to make a considerable impact to greatly improve patient care in the near future.

Aim: The adverse events of the CKD4/6 inhibitor abemaciclib are known to be dose dependent. However, its pharmacokinetics vary among individuals. Abemaciclib is reported to be transported by P-glycoprotein (P-gp) and the breast cancer resistance protein (BCRP). Therefore, we evaluated whether ABCB1 and ABCG2 gene polymorphisms could be pharmacokinetic predictive factors of abemaciclib. Methods: A total of 45 patients with breast cancer able to take abemaciclib (150 mg twice daily) for 2 weeks were evaluated to determine the association among abemaciclib concentrations, adverse events, and ABCB1 1236T>C, 2677G>T/A, 3435C>T, and ABCG2 421C>A gene polymorphisms. Results: The trough concentrations of abemaciclib were higher in the group with grade 2 or greater neutropenia, anemia, and thrombocytopenia as compared with the group with grades 0 or 1. No significant association was observed between ABCB1 1236T>C, 3435C>T, and ABCG2 421C>A gene polymorphisms and abemaciclib concentrations. However, in ABCB1 2677G>T/A polymorphisms, the concentrations of abemaciclib tended to be higher in the homozygous group (AA + AT) as compared with that in the wild-type and heterozygous group (GG + GA + GT) [222.8 (80.5–295.8) ng/mL vs. 115.8 (23.6–355.2) ng/mL, P = 0.11]. Hence, the ABCB1 2677G>T/A homozygous group had a significantly higher incidence of abemaciclib withdrawal and dose reduction within 4 weeks as compared than the wild-type and heterozygous group (67% vs. 33%, P = 0.03). Conclusions: The gene polymorphism of ABCB1 2677G> T/A might be a predictor of the pharmacokinetics and tolerability of abemaciclib.

Objective: The aim of the study was to analyze the impact of rupture size on surgical outcomes of ventricular septal rupture. Methods: During a 15-year period, from Jan 2006 to Dec 2020, 112 patients underwent repairs of postinfarction ventricular septal rupture. Data were collected on clinical, angiographic, and echocardiographic findings; operative procedures; early morbidity and mortality; and survival time. Univariable and multivariable analyses were performed to identify risk factors of 30-day mortality. Results: Thirty-day mortality was 7.1% for the whole cohort. The mean survival time estimate was 147.2 (95% Cl 135.6-158.9) months, with a 3-year survival rate of 91.2% and a 5-year survival rate of 89.0%. Multivariable analysis regarded rupture enlargement gradient as an independent risk factor of 30-day mortality. The ROC curve indicated that rupture enlargement gradient predicted 30-day mortality with high accuracy. Conclusions: Delayed surgery could be considered for patients who respond well to aggressive treatment. Rupture enlargement gradient is an independent risk factor for postoperative 30-days morality of delayed VSR repair and has good predictive power for the prognosis of VSR patients.

Background and aims: The type 2 diabetes mellitus (T2DM) is a common comorbidity of chronic hepatitis C (CHC). This study intended to investigate the impact of direct-acting antiviral agents (DAAs)-induced sustained virological response (SVR) on glycometabolism in CHC patients with T2DM. Methods: We searched PubMed, Scopus, Web of Science, and Embase up to July 7th, 2021. Studies reporting the association between DAA-induced SVR and glycometabolism in diabetic patients were retained. Changes in glycated hemoglobin (HbA1c) and fasting plasma glucose (FPG) levels before DAA treatment and after SVR were conducted meta-analyses with random-effects models. Results: 1371 potentially relevant articles were screened. Our analysis included 16 studies with data for 5024 patients. A significant improvement was noted in glycemic control in SVR group, with a mean HbA1c reduction of 0.57% (95% CI: 0.46–0.69%; I2=72.8%) and FPG reduction of 22.28mg/dL (95% CI: 13.35–31.21mg/dL; I2=96.18%). Conversely, changes of HbA1c in non-SVR group were a mean increase of 0.03% (95% CI: -0.15–0.22%; I2=68.75%). Subgroup analyses about HbA1c and FPG classified by study type both showed decline of the two indicators after SVR, and especially a reduction of HbA1c, 0.52% (95% CI: 0.39–0.65%; I2=73.5%) in retrospective study subgroup and 0.70% (95% CI: 0.54–0.87%; I2=36.15%) in prospective study subgroup, indicating lower heterogeneity in prospective studies. Egger’s test suggested publication bias in impact of DAAs on FPG, and no publication bias in impact on HbA1c. Sensitivity analyses confirmed robustness of the results. Conclusion: The glyco-metabolic control improved in terms of HbA1c and FPG level after DAA-induced SVR. However, further large and well-designed prospective cohort studies are still warranted and a prolonged follow-up is needed.

We report a case of an advanced refractory Gastric AD which responded favourably to a combination regimen of AGI and other chemotherapy agents which were selected on the basis of multi-analyte tumor profiling. The treatment was well tolerated with transient manageable adverse events and yielded radiological partial response.

In this research, enrichment factor (EF) and pollution load index (PLI) were utilized to estimate the features of enrichment and contamination of PTEs in farmland soil. Furthermore, combining the spatial distribution characteristics of potentially toxic elements (PTEs) and positive matrix factorization (PMF) to distinguish and quantify the sources of PTEs in farmland soil, and then the potential ecological risk (PER) and human health risk (HHR) model based on PMF are applied to quantify the ecological and human health risks from different sources. Taking Puning District as an example, four sources of PTEs in farmland soil were quantitatively allocated. For ecological risk, the study area is at moderate ecological hazard level, and industrial activities were the greatest contributor. The mean E_r^i of Hg were 69.82, reaching medium ecological risk level. For human health risks, both adults and children have no evident non-carcinogenic risk in the study area. And natural source was the largest contributor to non-carcinogenic risk, followed by agricultural activities. With regard to carcinogenic risk, tolerable risks of soil PTEs in the study area were limited not only for adults but also for children. Furthermore, compared with adults, the health risks of children, whether non-carcinogenic or carcinogenic, were higher than those of adults, and the trends in health risks for children and adults were similar. A comprehensive scheme combining source contribution and risk assessment is conducive to quantitatively assess ecological risks, health risks and priority pollution sources, thereupon provide effective suggestions for protecting human health and preventing and controlling pollution.

Paravalvular leak (PVL) is uncommon but can lead to severe complications after surgical or transcatheter aortic valve replacement. Clinical complications such as heart failure, haemolysis and infective endocarditis can be catastrophic results if not treated in promptly. It is, therefore, vital that PVLs are diagnosed early using various imaging modalities. Different approaches have been studies in managing PVL’s; of late, there is an increased interest in the use of minimally invasive procedures such as the transcatheter aortic valve closure procedure due to the decreased occurrence of further operations. This review discusses the classification of PVLs, diagnostic approaches and the available management options.

The magnitude and spatial heterogeneity of snow deposition are difficult to model in mountainous terrain. Here, we investigated how snow patterns from a 32-year (1985 – 2016) snow reanalysis in the Tuolumne, Kings, and Sagehen Creek, California Sierra Nevada watersheds could be used to improve simulations of winter snow deposition. Remotely-sensed fractional snow-covered area (fSCA) from dates following peak-snowpack timing were used to identify dates from different years with similar fSCA, which indicated similar snow accumulation and depletion patterns. Historic snow accumulation patterns were then used to 1) relate snow accumulation observed by snow pillows to watershed-scale estimates of mean snowfall, and 2) estimate 90 m snow deposition. Finally, snow deposition fields were used to force snow simulations, the accuracy of which were evaluated versus airborne lidar snow depth observations. Except for water-year 2015, which had the shallowest snow estimated in the Sierra Nevada, normalized snow accumulation and depletion patterns identified from historic dates with spatially correlated fractional snow-covered area agreed on average, with absolute differences of less than 10%. Watershed-scale mean winter snowfall inferred from the relationship between historic snow accumulation patterns and snow pillow observations had a ±13% interquartile range of biases between 1985 and 2016. Finally, simulations using 1) historic snow accumulation patterns, and 2) snow accumulation observed from snow pillows, had snow depth coefficients of correlations and mean absolute errors that improved by 70% and 27%, respectively, as compared to simulations using a more common forcing dataset and downscaling technique. This work demonstrates the real-time benefits of satellite-era snow reanalyses in mountainous regions with uncertain snowfall magnitude and spatial heterogeneity.