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Biochar application is currently considered to be an effective soil organic carbon (SOC) management to prevent land degradation by enhancing SOC stock. However, quantitative information on the impact of biochar application on carbon dioxide (CO2) flux and associated microbial responses is still scarce, especially in degraded tropical agroecosystems. Here, we evaluated the impact of land management (control (C), biochar (B; 8.2 Mg C ha−1), farmyard manure (FYM) (M; 1.1 Mg C ha−1 yr−1), and a mixture of both (BM; 8.2 Mg biochar-C ha−1 and 1.1 Mg FYM-C ha−1 yr−1)) on CO2 flux, SOC stock, microbial biomass C (MBC), and metabolic quotient (qCO2) in degraded tropical alkaline cropland of southern India, based on a 27-month field experiment. Cumulative CO2 flux over the experiment was 2.4, 2.7, 4.0, and 3.7 Mg C ha−1 in the C, B, M, and BM treatments, respectively. Biochar application increased soil moisture and SOC stock, though did not affect CO2 flux, MBC, and qCO2, indicating the limited response of microbes to increased soil moisture because of small amount of SOC. Combined application of biochar and FYM did not increase CO2 flux compared with FYM alone, due to little difference of microbial responses between the M and BM treatments. Additionally, SOC increment (8.9 Mg C ha−1) and the rate of C-input retention in soil (0.78) was most significant in the BM treatment. Hence, the combined application of biochar and FYM could be sustainable land management by efficient increase of SOC stock in the tropical degraded cropland.

Objectives. Neuroblastoma is the most common extracranial tumour in children, and prognosis for refractory and relapsed disease is still poor. Early Phase clinical trials play a pivotal role in the development of novel drugs. Ensuring adequate recruitment is crucial. The primary aim was to determine the rate of participation trials for children with refractory/relapsed neuroblastoma in two of the largest Drug Development European institutions. Methods. Data from patients diagnosed with refractory/relapsed neuroblastoma between January 2012 and December 2018 at the two institutions were collected and analysed. Results. Overall, 48 patients were included. A total of 31 (65%) refractory/relapsed cases were enrolled in early Phase trials. The main reasons for not participating in clinical trials included: not fulfilling eligibility criteria prior to consent (12/17, 70%) and screening failure (2/17, 12%). Median time on trial was 4.3 months (range 0.6-13.4). Most common cause for trial discontinuation was disease progression (67.7%). Median overall survival was longer in refractory (28 months, 95% CI, 20.9-40.2) than in relapsed patients (14 months, 95% CI, 8.1-20.1)) [p=0,034]. Conclusions. Although two thirds of children with refractory/relapsed neuroblastoma were enrolled in early Phase trials, recruitment rates can still be improved. The main cause for not participating on trials was not fulfilling eligibility criteria prior to consent, mainly due to performance status and short life expectancy. This study highlights the hurdles to access to innovative therapies for children with relapsed/refractory neuroblastomas and identifies key areas of development to improve recruitment to early phase trials.

Allergen immunotherapy (AIT) has gained a permanent place in the therapeutic arsenal for the patient with allergy. Particularly, substantial evidence has been established for the efficacy of AIT in allergic rhinitis. A hallmark of AIT is it disease modifying effect resulting in persistent benefit after the treatment has been terminated. Both the subcutaneous and sublingual mode of administration appear to be safe. It is, however, a matter of debate whether AIT can be implemented for patients with asthma. EAACI and GINA guidelines recommend sublingual AIT in house dust mite driven asthma. The question however remains whether the different available forms of AIT should be used for allergic asthma in general.

Objective: To evaluate the cost-effectiveness of insertable cardiac monitors (ICMs) compared to standard of care (SoC) for detecting atrial fibrillation (AF) in patients at high risk of stroke (CHADS2 >2), in the US. Background: ICMs are a clinically effective means of detecting AF in high-risk patients, prompting the initiation of non-vitamin K oral anticoagulants (NOACs). Their cost-effectiveness from a US clinical payer perspective is not yet known. Methods: Using patient data from the REVEAL AF trial (n= 446, average CHADS2 score= 2.9), a Markov model estimated the lifetime costs and benefits of detecting AF with an ICM or with SoC (namely, intermittent use of electrocardiograms [ECGs] and 24-hour Holter monitors). Ischemic and hemorrhagic strokes, intra- and extra-cranial hemorrhages, and minor bleeds were modelled. Diagnostic and device costs were included, plus costs of treating stroke and bleeding events and of NOACs. Costs and health outcomes, measured as quality-adjusted life years (QALYs), were discounted at 3% per annum. One-way deterministic and probabilistic sensitivity analyses (PSA) were undertaken. Results: Lifetime per-patient cost for ICM was $58,132 vs. $52,019 for SoC. ICMs generated a total 7.75 QALYs vs. 7.59 for SoC, with 34 fewer strokes projected per 1,000 patients. The incremental cost-effectiveness ratio (ICER) was $35,452 per QALY gained. ICMs were cost-effective in 72% of PSA simulations, using a $50,000 per QALY threshold. Conclusions: The use of ICMs to identify AF in a high-risk population is likely to be cost-effective in the US healthcare setting.

A differential diagnosis of sudden abdominal pain with scoliosis indicates uterine torsion, a rare condition in clinical practice.

Evolutionary theory predicts that the process of range expansion will lead to differences between core and edge populations in life-history and dispersal traits. Selection and genetic drift can influence reproductive ability, while spatial sorting by dispersal ability can increase dispersal at the edge. However, the context individuals experience (e.g., population density and mating status) also impacts dispersal behavior. We evaluated theoretical predictions for evolution of reproductive life-history and dispersal traits using the range expansion of a biological control agent, Diorhabda carinulata, or northern tamarisk beetle. We found divergence between core and edge populations in fecundity, age at first reproduction, and female body mass. We also show that density and mating status influence dispersal and that dispersal increases at the edge of the range under some conditions. We find support for most predictions about evolution during range expansion, even across a heterogeneous environment, especially when the ecological context is considered.

Prosthetic valve endocarditis is a complication of bacteremia which can cause damage to the prosthetic valve or the tissue to which it was sewn. Extensive tissue damage can result in a loss of anchoring and allow for abnormal valvular motion. Dehiscence can lead to excessive motion of the valve which is termed rocking. Through advances in imaging technology, live 3-dimentional (3-D) transesophageal echocardiography can allow for precise identification of the location of, and amount of dehiscence. We present a 37-year old male with a rocking prosthetic valve demonstrated on 3-D echocardiography and correlated to surgical manipulation.

We described eleven patients positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. The younger age and female gender seem to contribute to poor outcomes possibly. Furthermore, the left ventricle ejection fraction and pro-BNP improvement within the first week of treatment might indicate a good prognosis.

The problem of soil heavy metals (HMs) accumulation from protected cultivation (PC) needs an urgent solution. 132 soil samples from typically high-density PC areas were analyzed for accumulation, risk, and sources of 8 HMs in 16 cities of 8 provinces, China. The soil HMs accumulation characteristics were prominent; Cu, Zn, Pb, Cd, As over-standard (GB 15618-2016) rates reached 15.2, 4.5, 3.0, 27.3, and 2.3%, respectively. The single-factor pollution index indicates that Cd reached slightly contaminated levels in the whole area, while Cu was at a slightly contaminated level only in Yunnan Province. The Nemeiro comprehensive pollution index and the comprehensive quality index suggested that HMs accumulation were at the slightly contaminated levels, with Yunnan province being the most affected and Henan followed. Cu and Zn accumulations are mainly related to frequent input of organic fertilizer, especially livestock manure’s direct return to the field. Therefore, Cu and Zn showed a strong correlation (P＜0.01) with soil organic material (SOM), and their available amounts linearly correlated with the extension of planting years in PC. On the contrary, Pb and Cd amounts are only related (P＜0.01) to soil texture, and their main sources are related to the parent material of soil formation. Moreover, their available amounts did not correlate with the planting years. Our results suggest that long-term and unreasonable PC may lead to soil HMs accumulation. Therefore, appropriate agricultural materials, planting systems, and fertilization methods must be used to effectively avoid the risk of excessive HMs accumulation in the PC soils.

Abstract Objective: We investigated the effect of morphological diversity of the tricuspid valve with multiple posterior leaflets on the technical outcomes of tricuspid valve repair. Methods: From April 2016 to November 2020, 141 patients were diagnosed with secondary tricuspid regurgitation associated with left heart disease and underwent tricuspid valve repair. We retrospectively analyzed the clinical and echocardiographic data of patients who underwent both preoperative and postoperative transthoracic echocardiography. We divided the patients into two groups according to the surgical technique used to treat tricuspid regurgitation: ring annuloplasty alone (Group 1, n=109) or additional approximation of leaflet edges (edge-to-edge repair) with ring annuloplasty (Group 2, n=32). We measured the morphological diversity of the tricuspid valve during the operation in all patients. Results: The preoperative tricuspid regurgitation score was higher in Group 2 than in Group 1 (2.1±0.78 vs. 1.6±0.7, respectively; p=0.0046), and Group 2 contained more patients with two posterior leaflets than Group 1 [20 (63%) vs. 36 (33%), respectively; p=0.003]. The univariate and multivariate logistic regression analyses showed that the presence of two posterior leaflets was an independent risk factor for additional procedures during tricuspid valve repair (odds ratio, 2.6; 95% confidence interval, 1.1–6.1; p=0.033). Conclusions: Additional procedures to reduce tricuspid regurgitation were required more frequently in patients with two posterior leaflets of the tricuspid valve. The morphological diversity of two posterior leaflets is a potential risk factor for a more complicated tricuspid repair.

Purpose Pediatric patients with metastatic solid tumors historically have a poor overall survival. Some pediatric patients may still be potentially curable with aggressive local therapy to metastatic disease. The purpose of this study is to report results of the use of SBRT in the treatment of pediatric metastatic disease. Materials and Methods Pediatric patients who received SBRT between the years 2000-2020. Study endpoints included local control (LC), progression free survival (PFS), overall survival (OS), cumulative incidence (CI) of death or local failure and toxicity. The endpoints with respect to survival and LC were calculated using the Kaplan-Meier estimate. The cumulative incidence of local failure was calculated using death as a competing risk. Results 16 patients with 36 lesions irradiated met inclusion criteria. The median OS and PFS was 17 months and 15.7 months, respectively. The 1-year OS was 75%. The 6- and 12-month LC was 85% and 78%, respectively. There were no local failures in lesions receving a BED10≥100 Gy. Patients who had ≤5 metastatic lesions at first recurrence had a superior 1-year OS of 100% versus 50% with >5 lesions. One patient (6.3%) experienced a grade 3 CNS toxicity. Conclusions LC was excellent with SBRT delivered to metastatic disease, particularly for lesions receiving a BED10≥100 Gy. High-grade toxicity was rare in our patient population. Patients with ≤5 metastatic sites have a significantly better OS compared to >5 sites. Future prospective trials with multi-institutional collaboration will be necessary to evaluate appropriate patient selection and the optimal radiation dose regimen.

Knowing the abundance of a population is a crucial component to assess its conservation status and develop effective conservation plans. For most cetaceans, abundance estimation is difficult given their cryptic and mobile nature, especially when the population is small and has a transnational distribution. In the Baltic Sea, the number of harbour porpoises (Phocoena phocoena) has collapsed since the mid-20th century and the Baltic Proper harbour porpoise is listed as Critically Endangered by the IUCN; however, its abundance remains unknown. Here, one of the largest ever passive acoustic monitoring studies was carried out by eight Baltic Sea nations to estimate the abundance of the Baltic Proper harbour porpoise for the first time. By logging porpoise echolocation signals at 298 stations during May 2011-April 2013, calibrating the loggers’ spatial detection performance at sea, and measuring the click rate of tagged individuals, we estimated an abundance of 66-1,143 individuals (95% CI, point estimate 490) during May-October within the population’s proposed management border. The small abundance estimate strongly supports that the Baltic Proper harbour porpoise is facing an extremely high risk of extinction, and highlights the need for immediate and efficient conservation actions through international cooperation. It also provides a starting point in monitoring the trend of the population abundance to evaluate the effectiveness of management measures and determine its interactions with the larger neighbouring Belt Sea population. Further, we offer evidence that design-based passive acoustic monitoring can generate reliable estimates of the abundance of rare and cryptic animal populations across large spatial scales.

Objective To study the preferences and risk tolerance of women suffering from deep endometriosis (DE) with bowel involvement when they have to choose between conservative or surgical. Design Labelled Discrete Choice Experiment (DCE). Setting Dutch academic and non-academic hospitals and online recruitment. Population or Sample A total of 169 patients diagnosed with DE of the bowel. Methods Baseline characteristics and the fear for surgery were collected. Women were asked to rank attributes and choose between hypothetical conservative (medication) or surgical treatment in different choice sets (scenarios). Each choice set offered different levels of all treatment attributes. Data were analysed by using multinomial logistic regression. Main Outcome Measures The following attributes; effect/or risk on pain, fatigue, pregnancy, endometriosis lesions, mood swings, osteoporosis, temporary stoma and permanent intestinal symptoms were used in this DCE. Results In the ranking osteoporosis is the least important attribute, while in the DCE, a lower chance of osteoporosis is one of the most important drivers when choosing a conservative treatment. Women with previous surgery show less fear for surgery compared to women without surgery. The low anterior resection syndrome is almost equally important for patients as the chance of pain reduction. Pain reduction has higher importance than improving fertility chances even in women with a future child wish. Conclusions The risk of suffering from LARS as a result of treatment is almost equally important as the reduction of pain symptoms. Women with previous surgery experience less fear for surgery compared to women without a surgical history.

The amount of sediments transported by a river is very difficult to estimate, however this parameter has an important influence on channel geometry. It is possible to estimate the bedload transport rate per unit width of a river channel by measuring bedform profiles’ migration distance (Δl) in time (Δt) and depth of bedload in motion (hb). Another method is instrumental measurements using bedload traps and empirical formulas. Sentinel-1 images at mid latitudes have a temporal resolution of 2–3 days and spatial resolution of 25 m, which allows them to be used on large rivers. The research area in this paper is the Lower Vistula River from km 814 to km 820, where seven alternate sandbars were selected. The coast lines of the sandbars were delineated on Sentinel-1 images taken during two low flow periods 2018.08.04–09.26 and 2019.07.01–08.31 with similar discharges at low flow phase on the hydrograph. From water stage observations at the Chełmno and Grudziądz gauge stations, water elevations were assigned to every coast line of the alternate sandbars. The centers, volumes and longitudinal profile of the alternate sandbars were calculated. Average daily movement of the sandbars in the period 2018.08.04–2019.07.01 was calculated as 0.97 m·day˗1. Similar alternate sandbar movement velocities were obtained from a study of Sentinel-2 optical satellite images and hydro-acoustic measurements on the Lower Vistula River. Having the height of the alternate sandbars and velocity of movement, it was possible to calculate the rate of the bedload transport as qb = 5 kg·s˗1·m˗1. This value is similar to results of empirical formulas accepted for use on large lowland rivers in Poland: Goncarov – 5 kg·s˗1·m˗1, Samov – 3 kg·s˗1·m˗1; Meyer-Peter and Müller – 9 kg·s˗1·m˗1; Skibiński (1976) – 15 kg·s˗1·m˗1. The novelty of this research is showing the use of Sentinel-1 images for the study of river channel dynamics and calculation of bedload transport.

Background: There is a lack of systematic review exploring the effectiveness of Enhanced Recovery After Surgery (ERAS) in hysterectomy in promoting better recovery. Objectives: To synthesize the best available evidence of the effectiveness of ERAS intervention in promoting better recovery of shortened length of hospital stay (primary outcome), lower readmission, and complication rates (secondary outcomes) among patients undergoing hysterectomy due to benign conditions as compared to conventional perioperative care. Search Strategy: Seven electronic databases were searched from the date of inception to December 2020. Selection Criteria: Randomized controlled trials, cohort studies, or quasi-experimental studies published in English examining the effects of ERAS for women diagnosed with benign gynecologic diseases and underwent either abdominal or laparoscopic hysterectomy were included. Data Collection and Analysis: Two reviewers independently conducted database search, data extraction, and methodological quality assessment. Meta-analyses were performed for all outcomes. The overall quality of evidence was assessed using GRADE. Main Results: Nine studies were included in this review. Meta-analysis showed a statistically significant reduction in length of hospital stay (SMD = -0.76, 95% CI [-1.06, -0.46], Z = 4.72, p < .00001), readmission rate (RR = 0.65, 95% CI [0.44-0.96]; Z = 2.16, p = .03) and complication rate (RR = 0.61, 95% CI [0.48-0.77]; Z = 4.17, p < .0001), with high certainty of evidence. Conclusions: The effectiveness of ERAS in improving recovery indicates that hospitals could adopt the protocol to improve patients’ health and wellbeing. Future studies can focus more on standardizing the protocol’s elements.

We experienced a case of pregnancy after hysterosalpingogram and residual lipiodol in the extraperitoneal space. Initially, we suspected a metallic remnant, however, analysis by mass spectrometer confirmed that it was a remnant of lipiodol.

Nephrotic syndrome may be the first clinical manifestation of neoplasms, such as paraneoplastic syndrome. Several studies have been identified the association of cancer with nephrotic syndrome, although laboratory and histological markers that correlate the presence of NS and melanoma, are still needed.

Sinus histiocytosis with massive lymphadenopathy (Rosai–Dorfman disease) being a rare benign proliferative self-limiting disease of the cells of macrophage-histiocyte family is of unknown etiology and presents with massive lymphadenopathy. We are hereby reporting a case of RDD presenting with massive bilateral cervical and submandibular lymphadenopathy, diagnosed by histocytopathology.

The global pandemic caused by a single-stranded RNA (ssRNA) virus known as the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is still at its peak, with new cases being reported daily. Though the vaccinations are done on a massive scale, the frequent mutations in the viral gene and resilience of the future strains could be more problematic. Therefore, there is always a need for new compounds to be available for therapeutic studies. We carried out the present research to discover potential drug compounds against the SARS-CoV-2 main protease. A total of 16,000 drug-like small molecules from the ChemBridge database were virtually screened to obtain the top hits. As a result, 1032 hits were selected based on their docking scores. Next, these structures were prepared for molecular docking, and each small molecule was docked into the active site of the Mpro. Only those compounds with strong interactions with the active site residues and had the highest docking score were subjected to molecular dynamics (MD) simulation. The post-simulation analyses were carried out using the in-built GROMACS commands to gauge the stability, flexibility, and compactness. Principal component analysis (PCA) and hydrogen bonding were also calculated to observe trends and affinity of the drugs towards the target. Among the five top compounds, C1, C3, and C4 revealed strong interaction with the target’s active site and remained highly stable throughout the simulation. We believe the predicted compounds in this study could be potential inhibitors in the natural system and must be considered for further practice.

Cities are among the most extreme forms of anthropogenic ecosystem modification and urbanization processes exert profound effects on animal populations through multiple ecological pathways. Increased access to human associated food items may alter species’ foraging behavior and diet, in turn modifying the normal microbial community of the gastrointestinal tract, ultimately impacting their health. It is crucial we understand the role of dietary niche breadth and the resulting shift in the gut microbiota as urban animals navigate novel dietary resources. We combined stable isotope analysis of hair and microbiome analysis of four gut regions across the gastrointestinal tract to investigate the effects of urbanization on the diet and gut microbiota of two sympatric species of rodent with different dietary niches; the omnivorous large Japanese field mouse (Apodemus speciosus) and the relatively more herbivorous grey red-backed vole (Myodes rufocanus). Both species exhibited an expanded dietary niche width within the urban areas potentially attributable to novel anthropogenic foods and altered resource availability. We detected a dietary shift in which urban A. speciosus consumed more terrestrial animal protein and M. rufocanus more plant leaves and stems. Such changes in resource use may be associated with an altered gut microbial community structure. There was an increased abundance of the presumably probiotic Lactobacillus in the small intestine of urban A. speciosus and potentially pathogenic Helicobacter in the colon of M. rufocanus. Together, these results suggest that even taxonomically similar species may exhibit divergent responses to urbanization with consequences for the gut microbiota and broader ecological interactions.

Aims Theophylline clearance in patients with chronic liver diseases (CLDs), chronic hepatitis (CH) and liver cirrhosis (LC), was evaluated by population pharmacokinetic (PPK) analysis. Methods PPK analysis included 433 minimum steady-state concentrations from 192 Japanese bronchial asthma patients and was performed using NONMEM. The severity of LC was assessed by the Child-Pugh (CP) class and model for end-stage liver disease (MELD) score. Results Two final models (CP and MELD models) were obtained, and described apparent theophylline clearance (CL/F) as follows: CP model: CL/F=0.0473×0.874CH×0.697CPA×0.592CPB×0.441CPC, MELD model: CL/F=0.0472×0.876CH×0.687MELD < 10×0.568MELD 10-14×0.487MELD 15-19×0.417MELD 20-24×0.328MELD ≥ 25. The CP model showed that mean CL/F in patients without CLDs, and with CH, and LC with CP class A, B, and C was 0.0473, 0.0413, 0.0330, 0.0280, and 0.0209 L/h kg-1, respectively. The MELD model predicted that CL/F in patients without CLDs, and with CH, and LC with a MELD score of < 10, 10-14, 15-19, 20-24, and ≥ 25 was 0.0472, 0.0413, 0.0324, 0.0268, 0.0230, 0.0197, and 0.0155 L/h kg-1, respectively. Conclusions CL/F in various stages of LC was evaluated and a change in CL/F was highly dependent on the severity of CLDs in both models. The MELD model classified LC into 5 categories, and subdivided CP class C patients into 3 further categories. The MELD model provided a more accurate and precise description of CL/F than the CP model, particularly in high-severity LC patients.

The physiological shifts during pregnancy predispose women to a ten-fold higher risk of developing sepsis, a life-threatening condition characterised by a maladapted host-response to infection. We present a comprehensive synthesis of maternal immunity during pregnancy, addressing whether altered set-points in immune homeostasis lower the tipping point for sepsis. This close interconnection between maternal immunity and sepsis makes clinical diagnosis highly challenging and translates to delayed antibiotics or overuse. We propose further understanding of the maternal immune set-point changes are vital for tailoring the right diagnostic tools for maternal sepsis and may unravel pathophysiological pathways that predispose an individual to sepsis.

This research analyzes the measurement of fetal stomach and urinary bladder in healthy fetuses in the second and third trimester of gestation based on the database of the tertiary center from 2016 to 2019. The fetuses were selected for the study group in case they presented normal biometry and normal cardiac structure and function, no extracardiac malformation and no extracardiac anomalies and their gestational age was between 14th week  up to the 40th week of gestation. The normograms from the analysis are presented. The size of the fetal stomach and urinary bladder  (S/UB index) increases with gestational age on a 1:1 basis.Conclusions: The average size of the stomach in healthy fetuses between the 14 – 40 th week of gestation was  18 mm (8 – 40 mm) , the average urinary bladder measurement was 17 mm (15 mm – 42 mm) and the fetal stomach to urinary bladder index (S/UB index) was constant:  1.26 (0.09 – 3.93). These are simple measurements that be implemented in daily practice for fetal ultrasound assessment