Introduction: A major focus in CF care aims to increase weight gain. Rates of overweight and obese people with CF have gradually increased over the past decade. Obesity could be a risk for restriction of lung volumes and airway obstruction as well as increase rates of pulmonary exacerbations in people with CF. Methods: Patients 6 years of age and older were categorized into weight categories based on the CDC definitions. A retrospective chart review was conducted to obtain lung function testing and other outcomes. Results: 107 patients with a median age of 20.6 years were included in this analysis. 8.4%, 64%, 18% and 10% of patients were underweight, normal/healthy weight, overweight and obese respectively. FEV1 and FVC (% predicted) did not differ between patients with weights in the normal range vs. patients in the overweight/obese categories. Linear regression analysis showed a direct correlation between BMI and FEV1 that continued as BMI entered overweight and obese categories in both pediatric and adult patients. Overweight/obese patients did not have increased rates of pulmonary exacerbations compared to those in the normal/healthy weight category. Conclusion: As CF therapies continue to improve, an increasing number of people with CF are exceeding the CDC’s normal weight range. Gaining weight past the normal range does not appear to negatively impact pulmonary health of people with CF. If this trend of increased weight gain continues, it remains to be seen if it will eventually negatively affect lung health.

Buried bumper syndrome (BBS) is a rare serious late complication of percutaneous endoscopic gastrostomy (PEG) where the internal bumper migrates along the stoma tract. BBS is a clinical diagnosis and the role of imaging is to identify the exact site of the migrated internal bumper.

Necrolytic Migratory Erythema (NME) is a rare cutaneous paraneoplastic manifestation of glucagonoma. We report a case of a woman with a 6-year history of delayed diagnosis of Glucagonoma. This case highlights the atypical clinical features of NME which makes the diagnosis difficult.

A document by Rebwar. Click on the document to view its contents.

Purpose Women with atypical hyperplasia (AH) is associated with a higher risk of later breast cancer. However, whether AH found at margins in patients with breast-conserving surgery (BCS) and neoadjuvant chemotherapy (NAC) needs re-excision is not well-defined. The aim of the present study was to evaluate the impact of atypical hyperplasia at the surgical margins on the local recurrence and survival outcomes in breast cancer patients treated with NAC and BCS. Methods A retrospective analysis comparing patients who received NAC with AH and received no re-excision to those without AH at the margins of BCS was performed. Results 323 patients were included in this study. The 5-year rates of ipsilateral breast tumor recurrence (IBTR) were 6% and 4.5% in patients with and without AH, respectively. Distant-metastasis-free survival (DMFS) at 5 years was 81.2% in the AH group, and 88.1% in the no-AH group. No significant differences were observed among the two groups in terms of IBTR, DMFS, or OS. Conclusion Our study suggests that AH involved at the surgical margins of BCS in patients who received NAC does not increase the risk of ipsilateral breast cancer, and there is insufficient evidence for surgeon to further resect AH found at the margins of BCS in these patients.

In our writing, we voice stories of two Australian rivers to convey Indigenous ways of knowing and being. Interweaving academic literature, nature writing and creativity, we craft a story of reconnection that is transformative, action-oriented and potentially political. An open mind, place-intuition and the process of attending can deepen our river relationships, creating a sense of love and communicative connectedness. Paying deep attention, we notice meanings embedded in plain sight, within hearing range of rivers and watery places. Our relationships may be ‘in our faces’ such as the wind, or the air, water or bushes nearby. We communicate across binaries to experience the dissolution of imagined barriers. Feeling, hearing, writing and storytelling can support verbalising of experience, helping to bring to mind place-wisdom. It offers an everyday possibility for people now estranged from their riverine kin. The process uses a post human-centred, common worlds frame to consider the Anthropocene in regenerative ways. It is creative and liberating, and rivers are dying for people to take action by speaking out for and with our greater selves. In this learning journey, we synthesise learnings, hoping to inspire people everywhere to hear the call of rivers, to respond, take action and learn to love their rivers again.

A document by Vincenzo Accurso. Click on the document to view its contents.

In this paper, it is important to illustrate that, for the LCF of metallic materials, a “stress quantity” calculated based on the linear-elastic analysis of the studied component is taken to be a mechanical quantity, S, to establish a relation of the mechanical quantity, S, to the fatigue life, N, is practicable. Based on the practicability, a prediction equation, for a low/medium/high cycle fatigue life assessment of metallic materials, is proposed. The prediction equation is a stress invariant based one, in which the computation of stress invariant is on the basis of the linear-elastic analysis of the studied component. Using experimental data of plain specimens reported in literature, it is proved that the prediction equation is both accurate and high efficient. In addition, the prediction equation in conjunction with the Theory of Critical Distances and linear-elastic notch mechanics are combined to establish the fatigue life estimation equation of the notched components. Finally, using experimental data of the fatigue life of 16MnR steel, validation verification of the notch fatigue life prediction equation is given.

Chromosomal inversions play a role in the adaptation and diversification of different systems, mainly due to supergenes resulting from recombination suppression. Supergenes are “clusters” of genes in linkage disequilibrium (LD) whose frequencies may be associated with environmental variables. The grasshopper “species complex” Trimerotropis pallidipennis is considered to have several genetic lineages distributed from North to South America in arid and semi-arid high-altitude environments. The southernmost lineage, Trimerotropis sp., bears 4 to 7 putative inversion polymorphisms with clinal variation, possibly allowing adaptation to temperate environments. We analyzed chromosomal, mitochondrial and genome-wide SNP markers in 19 Trimerotropis sp. populations mainly distributed along two altitudinal gradients (MS and Ju). We show that populations across Argentina are formed by two main chromosomally and genetically differentiated lineages: one distributed in the southernmost border of the “Andes Centrales”, adding evidence for a differentiation hotspot in this area; and the other widely distributed in Argentina. Within the latter, genomic architecture analysis revealed four clusters of loci in high LD that correspond to inversions, of which at least one is associated to a chromosomal rearrangement, confirming its status as “true inversion”. We demonstrated the stability of chromosome polymorphisms for more than 20 generations and the occurrence of non-neutral markers associated with inversions and environmental variables. Inversion clines could be the consequence of coupling between extrinsic postzygotic barriers, leading to a hybrid zone, and spatially varying selection along environmental gradients. These results provide a framework for future investigations about candidate genes implicated in the rapid adaptation to new environments.

Hot extremes may adversely impact human health and agricultural production. Owing to anthropogenic and climate changes, the close and dynamic interaction between drought and hot extremes in most areas of China need to be revisited from the perspective of nonstationarity. This study therefore proposes a time-varying Copula-based model to describe the nonstationary dependence structure of extreme temperature (ET) and antecedent soil moisture condition to quantify the dynamic risk of hot extremes conditioned on dry/wet condition. This study proposed a new approach to identify the soil moisture driving law over extreme temperature from the point view of tail monotonicity and nonstationary risk assessment. Owing to the LTI-RTD (left tail increasing and right tail decreasing) tail monotonicity for dependence structure of these two extremes derived from most areas, the driving laws of soil moisture over ET follows DDL1-WDL1 laws (DDL1: drier antecedent soil moisture condition would trigger a higher risk of ET; WDL1: wetter antecedent soil moisture condition would alleviate the occurrence risk of ET). Because of the spatiotemporal divergence of sensitivity index derived from tail monotonicity (SITM), we can conclude that the spatial and temporal heterogeneity of response degree of ET over the variations of antecedent dry/wet conditions is evident. Incorporation of nonstationarity and tail monotonicity helps identify the changes of driving mechanism (laws) between soil moisture and hot extremes. From the comparison of different kinds of nonstationary behaviours over the spatial distribution of conditional probability of ET (CP1), the dependence nonstationarity can impose greater variations on the spatial distribution of conditional risk of ET given antecedent dry condition (CP1).

Process-based erosion models are efficient tools that can be used to predict where and when erosion occurs. On unpaved roads that have been recognized as important sediment sources, soil loss along road segments should be precisely predicted. This study was performed using the hillslope version of the Water Erosion Prediction Project (WEPP) to estimate soil loss from 20 typical road segments in the red soil region of South China. Terrestrial laser scanning (TLS)-measured soil losses were used to validate the model simulations. The results showed that the WEPP model could reasonably predict the total soil loss in relatively short (less than 100 m) and gentle (slope gradient lower than 10%) road segments. In contrast, the WEPP-simulated soil loss was underestimated for long or steep road segments. Detailed outputs along roads revealed that most of the peak soil loss rates could not be adequately calculated. The linear critical shear stress and the sediment equilibrium theory in the WEPP model for soil detachment simulation might be responsible for the underestimation. Additionally, the lack of upslope flow and the curved road tortuosity were found to be connected to the relatively low efficiency of the model outputs. Nevertheless, the WEPP simulation could accurately fit the trend of soil loss variation along road segments despite underestimation. Furthermore, the simulated results could provide a reliable prediction of the maximum soil loss positions. Therefore, the WEPP model could be adopted to evaluate the erosion risk of unpaved roads in the red soil region of South China.

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 2:1 molar ratio (glycerolysis:oil) 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: The evaluation of solitary lung nodules via FDG PET/CT has high sensitivity for nodules larger than 8 mm and is utilized to exclude lung cancer. Aim: This study aimed to retrospectively explore whether the lesions in patients who underwent F18 fluorodeoxyglucose-positron emission tomography/computed tomography imaging with the staging of the solitary pulmonary nodule and lung mass were within the local imaging area. It also investigated whether a relationship existed between the size of the lung lesion and extrathoracic spread. Materials and Method: Three hundred eight patients histopathologically diagnosed lung cancer were included in this study. All patients lung lesions were measured and patients were classified as four groups according to the size of the lung lesion. In all groups, the F18 FDG PET/CT examination was used to detect liver, adrenal, bone and supraclavicular lymph node metastasis, besides extrathoracic metastasis. Results: Liver, bone and extrathoracic metastasis of group-1 was statistically lower than group-2 (P < 0.001, p<0.01 and P = 0.03, respectively). Liver, extrathoracic, adrenal and bone metastasis of group-3 was statistically lower than the group-4 (P<0.001, P = 0.01, and P = 0.04, p<0.01 respectively). Extrathoracic extension was observed in only one patient in the group-3. In addition liver, adrenal, and bone metastases were not observed in any group-3 patients. Conclusions: PET/CT may be a more appropriate approach to be aplied in cases with nodule diameter ≤20mm. Performing local imaging in patients with a nodule diameter of ≤20 mm could not only reduce radiation exposure but also save radiopharmaceuticals used in PET/CT imaging. Keywords: lung cancer, solitary pulmonary nodule, PET/CT, fluorodeoxyglucos

Purpose: Kidney transplant recipients are prone to metabolic bone diseases and consequent fractures. This study aimed to evaluate the incidence of incipient vertebral fractures, osteopenia, osteoporosis, and the clinical factors associated with incipient vertebral fractures in a group of kidney transplant patients. Methods: Two hundred sixty-four patients (F/M:124/140, 45.3±13 years) who had undergone kidney transplantation between 2008 and 2018 and who were followed up at least one year in third care centers were included in this multicenter retrospective study. Bone mineral densitometry was performed using dual-energy X-ray absorptiometry. Vertebral fractures were assessed semi-quantitatively using conventional thoracolumbar lateral radiography in 202 of the patients. Results: Vertebral fractures were observed in 56.4% (n=114) of the study group. Severe vertebral fractures were observed in 30.7% (n=62) of the patients in vertebral X-ray evaluation. The frequency of osteoporosis was 20.0% (53 of 264 patients), and osteopenia was 35.6% (94 of 264 patients). BMD levels were in the normal range in 40.3% (n=46) of the subjects with vertebral fractures. It was in the osteoporotic range in 20.1% (n=23) and the osteopenic range in 40.3% (n=46). Serum calcium, parathormone vitamin, and creatinine levels were similar between the patients with and without vertebral fractures. Femoral neck BMD was negatively correlated with age (r: −0.21, p<0.001) and positively correlated with body mass index (r:0.29, p<0.001). Vertebral fractures were associated with age, duration of hemodialysis, BMI, femoral neck Z score (R2: 37.8%, p=0.027). Conclusion: BMD was in the normal or osteopenic range in 79.8% in our cohort of renal transplant patients with incipient vertebral fractures. As incipient vertebral fractures can be observed in patients with normal BMD levels in kidney transplant recipients, conventional X-ray screening for vertebral fractures may be beneficial for a proper therapy decision of metabolic bone disease in kidney transplant recipients.

A document by Lillian D. Parker, Ph.D.. Click on the document to view its contents.

Granulomatosis reaction associated with tumor has been designated as sarcoid-like reaction. Very few cases of association of systemic sarcoidosis and neoplasia have been reported. We reported two cases of sarcoidosis and renal cell carcinoma.

Background: This study was conducted to determine the frequency and clinical features of patients who were diagnosed incidentally as having diabetes mellitus (DM) in the emergency department. Aim: Our aim was to investigate the frequency of DM in patients whose high blood glucose levels were detected, and to examine the subsequent treatment these patients. Methods: The participants were selected from among patients who had a glucose level of ≥200 mg/dL and admitted to emergency department with symptoms of hyperglycemia in the past 1 year. Age, sex, presence of chronic disease, and the laboratory blood parameter results of the patients were recorded. We divided the patients into three groups as those who had never been admitted to clinics for treatment, those who were admitted and given treatment, and not given treatment. Results: According to their sexes, 73 (52.1%) were male and 67 (47.9%) were female. It was determined that 86 of the 140 patients included in the study were admitted to clinics for treatment. It was determined that no medication was given to 50 of these patients, but treatment was initiated in 36. Patients with glucose level ≥300 mg/dL were found to be receiving more treatment significantly (p=0.031). Conclusions: In this study, diabetic patients whose blood sugar is between 200-300 mg/dL should be sent to the DM related clinic immediately when diagnosed in the emergency department.

Aims: The effects of the COVID-19 pandemic continue around the world. Imaging methods play an important role in the diagnosis of COVID-19. The aim of this study was to develop a system that would allow for the distinguishing of lesions at different stages of the disease based on similar signs of other viral diseases and monitoring the emergence, progression, and/or remission of lesions in different areas of the lungs. Methods: For the deep learning (DL) system, the thoracic CT images from 1,382 images were reviewed. These belonged to patients whose SARS-CoV-2 RT-PCR tests turned out positive, were diagnosed with COVID-19, and had signs of lung involvement. Of 1,382 images in the dataset, 180 were assigned for testing and 1,202 were assigned for training. Apart from our dataset, 131 images for internal testing and 1,365 images for external testing were used. The trainings were continued to cover 316,000 steps. Results: Internal and external analyses were used to assess the developed model. The internal analysis success rate was 93.12%. For first external analysis we used 85 images. In the first external analysis we assessed a single CT image of each patient who was in the mixed image lists, and the success rate was found to be 70.31%. In the second external analysis, 645 thoracic CT images of patients diagnosed with COVID-19 and 635 images of another patients who had signs of non-COVID-19 diseases were used. We assessed the thoracic CT images with both COVID-19 and non-COVID-19 disease signs. The success rate in the identification of COVID-19 patients was 88.4%. Conclusion: Special modeling systems developed using DL may help accelerate workflow and making the process easier. This is especially important in cases in which fast and accurate assessment is essential for of a large number of patients, as happens in a pandemic.

Background: Serological tests are a powerful tool in the monitoring of infectious diseases and the detection of host immunity. However, manufacturers often provide diagnostic accuracy data generated through biased studies and the performance in clinical practice is essentially unclear.  Objectives: We aimed to determine the diagnostic accuracy of various serological testing strategies for (a) identification of patients with previous coronavirus disease-2019 (COVID-19) and (b) prediction of neutralizing antibodies against SARS-CoV-2 in real-life clinical settings.  Methods: We prospectively included 2’573 consecutive health-care workers and 1’085 inpatients with suspected or possible previous COVID-19 at a Swiss University Hospital. Various serological immunoassays based on different analytical techniques (enzyme-linked immunosorbent assays, ELISA; chemiluminescence immunoassay, CLIA; electrochemiluminescence immunoassay, ECLIA; lateral-flow immunoassay, LFI), epitopes of SARS-CoV-2 (nucleocapsid, N; receptor-binding domain, RBD; extended RBD, RBD+; S1 or S2 domain of the spike [S] protein, S1/S2), and antibody subtypes (IgG, pan-Ig) were conducted. A positive real-time PCR test from a nasopharyngeal swab was defined as previous COVID-19. Neutralization assays with live SARS-CoV-2 were performed in a subgroup of patients to assess neutralization activity (n=201).  Results: The sensitivity to detect patients with previous COVID-19 was ≥85% in anti-N ECLIA (86.8%) and anti-S1 ELISA (86.2%). Sensitivity was 84.7% in anti-S1/S2 CLIA, 84.0% in anti-RBD+ LFI, 81.0% in anti-N CLIA, 79.2% in anti-RBD ELISA, and 65.6% in anti-N ELISA. The specificity was 98.4% in anti-N ECLIA, 98.3% in anti-N CLIA, 98.2% in anti-S1 ELISA, 97.7% in anti-N ELISA, 97.6% in anti-S1/S2 CLIA, 97.2% in anti-RBD ELISA, and 96.1% in anti-RBD+ LFI. The sensitivity to detect neutralizing antibodies was ≥85% in anti-S1 ELISA (92.7%), anti-N ECLIA (91.7%), anti-S1/S2 CLIA (90.3%), anti-RBD+ LFI (87.9%), and anti-RBD ELISA (85.8%). Sensitivity was 84.1% in anti-N CLIA, and 66.2% in anti-N ELISA. The specificity was ≥97% in anti-N CLIA (100%), anti-S1/S2 CLIA (97.7%), and anti-RBD+ LFI (97.9%). Specificity was 95.9% in anti-RBD ELISA, 93.0% in anti-N ECLIA, 92% in anti-S1 ELISA, and 65.3% in anti-N ELISA. Diagnostic accuracy measures were consistent among subgroups.  Conclusions: The diagnostic accuracy of serological tests for SARS-CoV-2 antibodies varied remarkably in clinical practice, and the sensitivity to identify patients with previous COVID-19 deviated substantially from the manufacturer’s specifications. The data presented here should be considered when using such tests to estimate the infection burden within a specific population and determine the likelihood of protection against re-infection.

Objective Our objective was to test the hypothesis that in-hospital respiratory viral infections (RVI) would be significantly lower in a cohort of patients with established bronchopulmonary dysplasia in the SARS-CoV-2 era when compared to historical controls. Study Design On April 1, 2020, we implemented a universal infection prevention bundle to minimize the risk of nosocomial SARS-CoV-2 transmission in a dedicated BPD intensive care unit. We performed a retrospective cohort study and included patients with established BPD, as defined by the 2019 Neonatal Research Network criteria, admitted to our center who underwent real-time polymerase-chain-reaction RVI testing between January 1, 2015 and March 31, 2021. We excluded patients re-admitted from home. We compared to number of tests performed, the proportion of positive tests, and the distribution of viral respiratory pathogens in the pre- and post-SARS-CoV-2 eras. Results Among 176 patients included in the sudy, 663 RVI tests were performed and 172 (26%) tests were positive. The median number of tests performed, measured in tests per patient per month, in the SARS-CoV-2 era was not significantly different compared to the pre-SARS-CoV-2 era (0.45 vs 0.34 tests per patient per month, P = 0.07). The proportion of positive RVI tests was significantly lower in the SARS-CoV-2 era when compared to the pre-SARS-CoV-2 era (0.06 vs 0.30, P<0.0001). No patients tested positive for SARS-CoV-2 in the SARS-CoV-2 era. Conclusions Infection prevention measures developed in response to the SARS-CoV-2 pandemic may reduce the risk of RVIs in hospitalized patients with established BPD.

A document by Daiane Cecconello. Click on the document to view its contents.

Background: Takotsubo cardiomyopathy (TC) is defined as a temporary and reversible systolic abnormality of the left ventricle’s apical area resembling myocardial infarction (MI) in the nonexistence of coronary artery disease (CAD)[1].Only a few cases have been reported after cardiac operations or after pericardiocentesis. Aims: To emphasize the need to be aware of the possibility of the occurrence of this potentially fatal complication after cardiac surgery. Materials and methods: A-66-year old man underwent pericardiectomy.Postoperative he endured TC and progressed exacerbation of hemodynamic instability.finally, he had to be supported by intra-aortic balloon pump（IABP),extracorporeal membrane oxygenation（ECMO). Results: Patient’s left ventricle function recovered fully in two weeks. Discussion: we discussed the pathogenesis and treatment of postoperative TC. Conclusion:TC has to be carefully considered in differential diagnosis in case of acute left ventricle dysfunction following cardiac surgery. Keywords: pericardiectomy; takotsubo cardiomyopathy.

Objective: Behçet’s syndrome (BS) is a systemic vasculitis with several clinical manifestations. Neutrophils hyperactivation mediates vascular BS involvement, via a massive production of reactive oxygen species (ROS) and the release of neutrophil extracellular traps (NETs). We investigated neutrophil-mediated mechanisms of damage in non-vascular BS manifestations and explored in vitro the effects of colchicine in counteracting these mechanisms. Methods: NETs and intracellular ROS production was assessed in blood samples from 80 BS patients (46 with active non-vascular BS, 34 with inactive disease) and 80 healthy controls. Moreover, isolated neutrophils were incubated for 1 hour with an oxidating agent (2,2′-azobis (2-amidinopropane) dihydrochloride; 250nM), and the ability of pure colchicine pre-treatment (100ng/ml) to counteract oxidation-induced damage was assessed. Results: Patients with active non-vascular BS had remarkably increased NET levels [21.2 (IQR 18.3-25.9) mU/ml] compared to patients with inactive disease [16.8 (13.3-20.2) mU/ml] and to controls [7.1 (5.1-8.7) mU/ml], p<0.001]. Also, intracellular ROS tended to be increased in active BS, although not significantly. In active non-vascular BS, NETs correlated with neutrophils ROS production (p<0.001) and were particularly increased in patients with active mucosal (p<0.001), articular (p=0.004), and gastrointestinal symptoms (p=0.006). On isolated neutrophils, colchicine significantly reduced oxidation-induced NET production and cell apoptosis, though not via an antioxidant activity. Conclusion: Neutrophil-mediated mechanisms might be directly involved in non-vascular BS, and NETs, more than ROS, might drive the pathogenesis of mucosal, articular and intestinal manifestations. Colchicine might be effective to counteract neutrophils-mediated damage in BS, although further studies are needed.

ABSTRACTFear of snakes known as Ophidiophobia or Ophiophobia is a powerful and abnormal fear of snakes. A lot of psychologists, physicians and evolutionists have been fascinated by this primeval innate human emotion. Be that as it may, snakes still not are paid enough attention to adequately as agents of human sickness; also, the logical bits of knowledge given by the clinical phenotype of human envenoming have been disregarded for quite a while. Over an era of research has given that snake venom can be rich integration of pharmacologically active proteins, various protein derivatives and peptides. In this way, due to snake bite every person envenomed turns into a whiz try, giving out insight into the pathophysiological and humanitarian test. The logical investigation of snake bite can be a part of activities of venom chemicals, while exhibiting a therapeutic clinical toxicology, that sub forte of toxicology that manages the impacts of characteristic poisons and toxins of microbial, plant and animal inception on people and domesticated animals, especially their counteractive action, conclusion, treatment, the study of disease transmission, and pathophysiology.