Objective: To investigate the appropriate drug therapy based on a novel classification system for adenoids based on their appearance. Methods: We used fiberoptic nasal endoscopy to determine the degree and appearance of adenoid hypertrophy (AH). The adenoids were divided into three types: edematous type, common type, and fibrous type. In adenoid tissues, the eosinophils were counted. Immunohistochemistry and western blot were done to determine the expression of CysLTR1, CysLTR2, CGR-α, and CGR-β in different types of adenoids. Results: 70.67% (106/150) AH patients with AR, and of them 68% (72/106) of adenoids were the edematous type. The expression of CGR-α and CGR-β and eosinophil count were higher in the edematous type but not in common and fibrous types. The expression of the leukotriene receptor was stable in all types. There was a positive correlation between eosinophil count in the blood and in the adenoid tissue. Conclusion: AR was the risk factor for the development of AH. Leukotriene receptor antagonist was an important drug for the treatment of AH. The glucocorticoid was only useful in the edematous type. Therefore, for AH patients with AR, patients with edematous type adenoids and/or patients with increased eosinophils in blood routine choose nasal glucocorticoid combined with leukotriene receptor antagonist is appropriate. On the contrary, leukotriene receptor antagonists alone can be selected to treat AH.

References:1. Alvarado A. A practical score for the early diagnosis of acute appendicitis. Ann Emerg Med. 1986;15(5):557-64.2. Quartey B. Interval appendectomy in adults: a necessary evil? J Emerg Trauma Shock . 2012;5(3):213-6.3. Butt MQ, Chatha SS, Ghumman AQ, Farooq M. RIPASA score: a new diagnostic score for diagnosis of acute appendicitis. J Coll Physicians Surg Pak. 2014;24(12):894-7.4. Arnbjornsson E. Acute appendicitis and dietary fiber. Arch Surg. 1983;118(7):868-70.5. Chan J, Fan KS, Mak TLA, Loh SY, Ng SWY, Adapala R. Pre-operative imaging can reduce negative appendectomy rate in acute appendicitis. Ulster Med J [Internet]. 2020 Jan 1 [cited 2021 Jul 5];89(1):25–8. Available from: https://pubmed.ncbi.nlm.nih.gov/32218624/6. Chong CF, Thien A, Mackie AJ, Tin AS, Tripathi S, Ahmad MA, et al. Comparison of RIPASA and Alvarado scores for the diagnosis of acute appendicitis. Singapore Med J. 2011;52(5):340-45.7. Mohan D, Barnato AE, Rosengart MR, Farris C, Yealy DM, Switzer GE,et al . Trauma triage in the emergency departments of nontrauma centers: an analysis of individual physician caseload on triage patterns. J Trauma Acute Care Surg 2013;74(6):1541–7.8. Huston JM, Kao LS, Chang PK, Sanders JM, Buckman S, Adams CA, et al. Antibiotics vs. appendectomy for acute uncomplicated appendicitis in adults: Review of the evidence and future directions. Surg Infect (Larchmt) 2017;18:527–35.9. Di Saverio S, Podda M, De Simone B, Ceresoli M, Augustin G, Gori A, et al. Diagnosis and treatment of acute appendicitis: 2020 update of the WSES Jerusalem guidelines [Internet]. Vol. 15, World Journal of Emergency Surgery. BioMed Central Ltd.; 2020 [cited 2021 Jul 5]. Available from: https://pubmed.ncbi.nlm.nih.gov/32295644/10. Ambe PC. Negative Appendectomy. It is Really Preventable? Journal of Investigative Surgery. Taylor and Francis Ltd; Vol. 32, 2019 [cited 2021 Jul 5]. p. 474–5. Available from: https://pubmed.ncbi.nlm.nih.gov/29608342/11. Mostbeck G, Adam EJ, Nielsen MB, Claudon M, Clevert D, Nicolau C,et al . How to diagnose acute appendicitis: ultrasound first. Insights Imaging 2016;7(2):255–63.12. Pinto F, Pinto A, Russo A, Cuppolino F, Bracale R, Fonio P, et al . Accuracy of ultrasonography in the diagnosis of acute appendicitis in adult patients: review of the literature. Crit Ultrasound J 2013;5(Suppl 1):S2.13. Kim DW, Suh CH, Yoon HM, Kim JR, Jung AY, Lee JS, et al. Visibility of normal appendix on CT, MRI, and sonography: A systematic review and meta-analysis. Am J Roentgenol . Vol 2018 Sep 1 [cited 2021 Jul 5];211(3):W140–50. Available from: https://pubmed.ncbi.nlm.nih.gov/30040469/14. Alvarado A. A practical score for the early diagnosis of acute appendicitis. Ann Emerg Med 1986;15(5):557–64.15. Kalan M, Talbot D, Cunliffe WJ, Rich AJ. Evaluation of the modified Alvarado score in the diagnosis of acute appendicitis: a prospective study. Ann R Coll Engl 1994;76(6):418–9.16. Díaz-Barrientos CZ, Aquino-González A, Heredia-Montaño M, Navarro-Tovar F, Pineda-Espinosa MA, Espinosa de Santillana IA. The RIPASA score for the diagnosis of acute appendicitis: A comparison with the modified Alvarado score. Rev Gastroenterol Mex . 2018 Apr 1 [cited 2021 Jul 5];83(2):112–6. Available from: https://pubmed.ncbi.nlm.nih.gov/29426650/17. Noor S, Wahab A, Afridi G, Ullah K. Comparing Ripasa Score And Alvarado Score In An Accurate Diagnosis Of Acute Appendicitis. J Ayub Med Coll Abbottabad. 2020 Jan-Mar;32(1):38-41.18. Khan I, Ur Rehman A. Application of Alvarado scoring system in diagnosis of acute appendicitis. J Ayub Med Coll Abbottabad 2005;17(3):41–4.19. Khan S, Usama M, Basir Y, Muhammad S, Jawad M, Khan T, Usman A, Abbas A. Evaluation Of Modified Alvarado, Ripasa And Lintula Scoring System As Diagnostic Tools For Acute Appendicitis. J Ayub Med Coll Abbottabad. 2020 Jan-Mar;32(1):46-50.20. Sulu B. Demographic and Epidemiologic Features of Acute Appendicitis. Append Collect Essays World Rij InTech 2012;169–78.21. Sartelli M, Baiocchi GL, Di Saverio S, Ferrara F, Labricciosa FM, Ansaloni L, et al .  Appendicitis Worldwide (POSAW). World J Emerg Surg. 2018 Apr 16;13:19. doi: 10.1186/s13017-018-0179-0.22. Lopes Vendrami C, Xu X, McCarthy RJ, Shin JS, Goodhartz LA, Horowitz JM, Kim D, et al. Body mass index as an indicator of the likelihood of ultrasound visualization of the appendix in pregnant women with suspicion of appendicitis. Abdom Radiol (NY). 2020 Sep;45(9):2637-2646. PMID: 32514628.23. Kereshi B, Lee KS, Siewert B, Mortele KJ. Clinical utility of magnetic resonance imaging in the evaluation of pregnant females with suspected acute appendicitis. Abdom Radiol (NY). 2018 Jun;43(6):1446-145524. Tsai SH, Hsu CW, Chen SC, Lin YY, Chu SJ. Complicated acute appendicitis in diabetic patients. Am J Surg 2008;196(1):34–9.25. Bach L, Donovan A, Loggins W, Thompson S, Richmond B. Appendicitis in Diabetics: Predictors of Complications and Their Incidence. Am Surg. 2016 Aug;82(8):753-8.Funding disclosure : None to declare

Much of the work on the normalization of RNA-seq data has been performed on human, notably cancer tissue. Little work has been done in plants, particularly polyploids and those species with incomplete or no genomes. We present a novel implementation of GeTMM (Gene Length Corrected TMM) that accounts for GC bias and works at the transcript level. The algorithm also employs transcript length as a factor, allowing for incomplete transcripts and alternate transcripts. This significantly improves overall normalization. The GCGeTMM methodology also allows for simultaneous determination of differentially expressed transcripts (and by extension genes) and stably expressed genes to act as references for qRT-PCR and microarray analyses.

Adaptation to derived habitats often occurs from standing genetic variation (SGV). The maintenance within ancestral populations of genetic variants favorable in derived habitats is commonly ascribed to long-term antagonism between purifying selection and gene flow resulting from hybridization across habitats. A largely unexplored alternative idea based on quantitative genetic models of polygenic adaptation is that variants favored in derived habitats are neutral in ancestral populations when their frequency is relatively low. To explore the latter, we first identify genetic variants important to the adaptation of threespine stickleback fish to a rare derived habitat – nutrient-depleted acidic lakes – based on whole-genome sequence data. Sequencing marine stickleback from six locations across the Atlantic ocean then allows us to infer that the frequency of these derived variants in the ancestral habitat is unrelated to the likely opportunity for gene flow of these variants from acidic-adapted populations. This result is consistent with the selective neutrality of derived variants within the ancestor. Our study thus supports an underappreciated explanation for the maintenance of SGV, and calls for a better understanding of the fitness consequences of adaptive genetic variation across habitats and genomic backgrounds.

Symptom distress and decreased quality of life (QOL) among children with cancer are well documented. Research is emerging on the child’s voice in QOL-symptom reports, but existing QOL questionnaires are burdensome and objective biologic markers are lacking. We examined children’s symptoms and QOL from parent and child perspectives and compared the results to one biologic marker (body posture). A cross-sectional secondary analysis of prospective data from children receiving creative arts therapy explored potential associations among demographics with and between QOL measures (PedsQL, Faces Scale, posture). Children (n = 98) ranged in age from 3-17 years (M = 7.8) and were in the first year of cancer treatment. No significant associations were found among the child’s sex, race/ethnicity, socioeconomic status (SES), or distance from hospital and total PedsQL. Older age was associated with worse total PedsQL, pain, nausea, worry, and posture (all ps < .05). Greater worry (β = 0.51) and worse posture (β = 0.41) were the QOL variables most strongly correlated with older age. Poorer posture was associated with worse child PedsQL (total score, nausea, treatment anxiety, cognitive) and parent PedsQL (pain, nausea). Worse scores on the Faces Scale, PedsQL, and posture were all correlated (rs = .21 - .39, all ps < .05). Interventions to improve QOL could target nausea, worry, and older patients. Accuracy and interpretation of symptom distress in children is problematic. The Faces Scale and posture may be suitable, readily obtained measures of QOL in pediatric oncology that hold promise.

Due to the technical barriers between radars and jammers and the poor performance of the traditional detection-jamming shared signal in integrated radar-electronic warfare systems, a new detection-jamming shared signal waveform based on the virtual force field algorithm (VFFA) is proposed in this paper. First, a multi-objective and multi-dimensional characteristic parameter optimization model, based on a virtual force field, is established, and then the design principle of the shared signal is presented in detail. The simulation results show that the detection-jamming shared signal based on the VFFA presents the deceptive jamming of multiple false targets in non-collaborative radar. Further, there is better detection performance with the advantages of multiple pulse repetition frequency (PRF) and pulse accumulation number, which are highly sensitive to the multi-jagged PRF signals emitted by the non-collaborative radar. According to the VFFA described in this paper, the optimum detection-jamming shared signal waveform can be output in real time for specific free space targets, to improve the efficiency of integrated radar and electronic warfare systems.

Endometriosis is a chronic inflammatory disorder resulting in pelvic pain and infertility. The role of T helper 17 (Th17) cells in endometriosis remains elusive. In this study, through detecting CXCR3, CCR4, CCR10, CCR6, interleukin-17 Receptor E (IL-17RE), and CD27, live RORγt-and-IL-17A-expressing Th17 cells were distinguished and sorted from peritoneal fluid (PF) of patients with stage III and IV endometriosis. Furthermore, we found that IL-17RE and CD27 were the labels of heterogeneous PF Th17 subsets, i.e. IL-17RE-CD27- subset, IL-17RE+CD27- subset, and IL-17RE+CD27+ subset. The former two subsets expressed higher IL-17A, GM-CSF, and IL-22 and were more proliferative than the latter subset. RNA-Seq analysis on IL-17RE+ Th17 subset and IL-17RE- Th17 subset revealed up-regulation of genes involved in oxidative phosphorylation and electron transport chain in IL-17RE+ Th17 subset relative to IL-17RE- Th17 subset. Consistently, the IL-17RE+ Th17 subset produced more adenosine triphosphate (ATP) and reactive oxygen species (ROS) than IL-17RE- Th17 subset. In conclusion, this study provides a novel method to detect and isolate live PF Th17 cells from endometriosis patients and unveils the functional and metabolic heterogeneity of PF Th17 subsets. Therefore, it sheds light on the elucidation of molecular mechanisms that modulate the function of pathological Th17 cells in endometriosis.

Mass cytometry-based identification of a unique T-cell signature in childhood allergic asthma Short title: T-cell signature in paediatric AA

Sloping farmland is an important cultivated land resource and erosion source. Cultivated-layer quality directly affects the soil productivity and erosion resistance of sloping farmland. We aim to select the most effective soil property index to construct a minimum data set (MDS) and use two methods (the weighted additive cultivated-layer quality index (CLQIW) and Nemoro cultivated-layer quality index (CLQIN)) to accurately evaluate the cultivated-layer quality of sloping farmland in purple hilly areas. The total data set (TDS) of 12 soil indexes was screened by principal component analysis (PCA) and correlation analysis, and a MDS was constructed to assess the CLQIW and CLQIN. The results showed that (1) the cultivated-layer soil quality of the MDS comprises cultivated-layer thickness, soil bulk density, saturated hydraulic conductivity, sand, clay, shear strength and soil organic matter. The MDS can accurately reflect the effective soil information (RW2=0.7524, RN2=0.8059) and can replace the TDS in cultivated-layer evaluation. (2) CLQIN-MDS has a higher Ef and lower ER than CLQIW-MDS does, so CLQIN-MDS is better for evaluating the cultivated-layer quality of purple soil of sloping farmland. (3) For the two evaluation methods, the quality classifications of the two small watersheds have similar trends, with most plots in grades II~III (approximately 90%). (4) The main obstacles of the two small watersheds are poor nutrients and low soil shear strength, which can be reasonably controlled by subsoiling combined with biochar. These results can facilitate the construction of reasonable cultivated-layers and improvements in the cultivated-layer soil quality of sloping farmland.

The primary approach to realizing long-term runoff prediction involves combining a hydrological model with general circulation model. Previous studies on the Source area of the Yellow River were all based on the Coupled Model Intercomparison Project Phase 5 (CMIP5) data sets with defects in physical mechanisms. In this paper, the Beijing Climate Center Climate System Model (BCC-CSM2-MR) of CMIP6, which proved to perform well in arid and semi-arid regions, will be used to drive the Soil & Water Assessment Tool (SWAT) model and evaluate its applicability in runoff simulation at Tang Nahai Hydrological Station from 2011 to 2019. The occurrence of the extreme value of runoff, its change trend, and the year of abrupt change of runoff in the four Shared Socio-economic Pathway (SSP) scenarios (SSP1-2.6, 2-4.5, 3-7.0, and 5-8.5) during 2021-2100 were analyzed. The results show that: (1) the runoff simulation evaluation index of SWAT driven by BCC-CSM2-MR in the research area from 2011 to 2019 is excellent, and the runoff simulation in the future is reliable and effective. (2) only the average annual runoff in scenario 5-8.5 (708.5m /s) from 2021 to 2100 was significantly higher than that in 2011-2019. Other scenarios are close to or less than the annual runoff observed. Most importantly, the maximum and minimum annual runoff values under the four scenarios all occurred during 2060-2080, so the attribution analysis of runoff extremum during 2060-2080 is worth further study. (3) it is necessary to evaluate whether the existing reservoirs and hydropower stations in the Yellow River basin can reasonably regulate and utilize the annual runoff under scenario 5-8.5.

Cold regions provide water resources for half the global population yet face rapid change. Their hydrology is dominated by snow, ice and frozen soils, and climate warming is having profound effects. Hydrological models have a key role in predicting changing water resources, but are challenged in cold regions. Ground-based data to quantify meteorological forcing and constrain model parameterization are limited, while hydrological processes are complex, often controlled by phase change energetics. River flows are impacted by poorly quantified human activities. This paper reports scientific developments over the past decade of MESH, the Canadian community hydrological land surface scheme. New cold region process representation includes improved blowing snow transport and sublimation, lateral land-surface flow, prairie pothole storage dynamics, frozen ground infiltration and thermodynamics, and improved glacier modelling. New algorithms to represent water management include multi-stage reservoir operation. Parameterization has been supported by field observations and remotely sensed data; new methods for parameter identification have been used to evaluate model uncertainty and support regionalization. Additionally, MESH has been linked to broader decision-support frameworks, including river ice simulation and hydrological forecasting. The paper also reports various applications to the Saskatchewan and Mackenzie River basins in western Canada (0.4 and 1.8 million km2). These basins arise in glaciated mountain headwaters, are partly underlain by permafrost, and include remote and incompletely understood forested, wetland, agricultural and tundra ecoregions. This imposes extraordinary challenges to prediction, including the need to overcoming biases in forcing data sets, which can have disproportionate effects on the simulated hydrology.

Owing to the rich water resources, the Dadu River basin is an important hydroelectric resources development area in Sichuan Province over China. The climate change will have a great impact on the runoff change in the Dadu River Basin. The prediction of the future runoff in the Dadu River Basin can effectively improve the utilization rate of water resources, and provide a reference for hydropower dispatching. At first, to reduce the uncertainties from climate model, this paper used Stepwise Clustering Analysis to calibrate and validate the CORDEX regional climate model ensemble data from 1970 to 2005 and projected the climate change trend of Dadu River basin from 2035 to 2065. Then the Dadu River watershed scales of SWAT model was established, using the SWAT-CUP for calibration and verification. Finally, the corrected future climate data are used to drive the SWAT model to realize the future runoff forecast in the Dadu River Basin. The results show that under the scenario of RCP4.5 and RCP8.5, the variation range of rainfall is small, and the maximum and minimum temperatures show an overall increasing trend. The maximum (minimum) temperature will increase about 0.6℃ (1.0℃) under the scenarios of RCP4.5 and 0.9℃ (1.4℃) under the scenario of RCP8.5. Compared with the baseline period, the future (2035-2065) annual runoff under RCP4.5 and RCP8.5 scenarios will increase by about 8.6% and 8.2%, respectively. Under the future climate change, the inter-annual runoff in the Dadu River Basin will change greatly, and the trend of runoff fluctuation is not consistent before and after 2050. Before 2050, runoff changes are small, however, after 2050, runoff changes under the two scenarios will increase by about 12%. On the one hand, this trend may be due to the impact of iceberg melting on runoff caused by temperature changes around 2050, on the other hand, it may be due to the combined effect of local plant evapotranspiration and ecological regulation.

Aims: Habitat richness, i.e. the diversity of ecosystem types, is a complex, spatially explicit aspect of biodiversity, which is affected by bioclimatic, geographic and anthropogenic variables. The distribution of habitat types is a key component for understanding broad-scale biodiversity and for developing conservation strategies. To test which factors are related with habitat richness we used EU habitat distribution data to answer the following questions: i) how do bioclimatic, geographic, and anthropogenic variables affect habitat richness? ii) which category is the most important? iii) how do interactions among these variables influence habitat richness and which combinations produce the strongest interactions? Study area: European Union (excluding Greece) plus the United Kingdom. Methods: We used the distribution maps of 233 terrestrial habitat types defined by the European Environmental Agency, to calculate habitat richness for the EU 10 km x 10 km grid map. We then investigated how environmental variables affect habitat richness, using generalized linear models, generalized additive models and boosted regression trees. Results: The main factors associated with habitat richness were geographic variables, with negative relationships observed for both latitude and longitude, and a positive relationship for terrain ruggedness. Bioclimatic variables played a secondary role, with habitat richness increasing slightly with annual mean temperature and overall annual precipitation. An interaction between anthropogenic variables was important: the combination of increased landscape fragmentation and increased population density strongly decreased habitat richness. Main conclusions: This is the first attempt to disentangle spatial patterns of habitat richness at the continental scale, as a key tool for protecting biodiversity. The diversity of European habitats is correlated withgeography more than climate and human pressure, reflecting a major component of biogeographical patterns similar to the drivers observed at the species level. The interaction between anthropogenic variables highlights the need for coordinated, continental-scale management plans for biodiversity conservation.

Density dependence in reproduction plays an important role in stabilising population dynamics via immediate negative feedback from population density to reproductive output. Although previous studies have shown that density dependence is associated with strong spacing behaviour and social interaction between individuals, the proximal mechanism for generating density-dependent reproduction remains unclear. In this study, we investigated the effects of density-induced stress on reproduction in root voles. Founder population enclosures were established by introducing six (low density) and 30 (high density) adults per sex into per enclosure (four enclosures per density in total) during the breeding season from April to July 2012 and from May to August 2015. Faecal corticosterone metabolite (FCM) levels, reproductive traits (recruitment and the proportion of reproductive condition), and founder population numbers were measured following repeated live-trapping in both years. The number of founders was negatively associated with recruitment rates and the proportion of reproductive conditions, displaying a density-dependent reproduction. FCM level was positively associated with the number of founders. The number of founder females indirectly affected the proportion of reproductive females in 2012 and recruitment in 2015 through their FCM levels; the effect of the number of male founders on the proportion of reproductive condition was mediated by their FCM level in 2012, but the effect was not found in 2015. Our results showed that density-induced stress affected density-dependent reproduction and that density-induced stress is one ecological factor generating density-dependent reproduction.

A vector’s susceptibility and ability to transmit a pathogen— termed vector competency—determines disease outcomes, yet the ecological factors influencing tick vector competency remain largely unknown. Ixodes pacificus, the tick vector of Borrelia burgdorferi (Bb) in the western U.S., feeds on rodents, birds, and lizards. Unlike rodents and birds which are reservoirs for Bb and infect juvenile ticks, lizards are refractory to Bb and cannot infect feeding ticks. Additionally, the lizard bloodmeal contains borreliacidal properties, clearing previously infected feeding ticks of their Bb infection. Despite I. pacificus feeding on a range of hosts, it is undetermined how the host identity of the larval bloodmeal affects future nymphal vector competency. We experimentally evaluate the influence of larval host bloodmeal on Bb acquisition by nymphal I. pacificus. Larval I. pacificus were fed on either lizards or mice and after molting, nymphs were fed on Bb-infected mice. We found that lizard-fed larvae were significantly more likely to become infected with Bb during their next bloodmeal than mouse-fed larvae. We also conducted the first RNA-seq analysis on whole-bodied I. pacificus and found significant upregulation of tick antioxidants and antimicrobial peptides in the lizard-fed group. Our results indicate that the lizard bloodmeal significantly alters vector competency and gene regulation in ticks, highlighting the importance of host bloodmeal identity in vector-borne disease transmission and upends prior notions about the role of lizards in Lyme disease community ecology.

Developing odontoma is a rare mixed odontogenic tumor that can arise with other odontogenic lesions. The association of COC with ameloblastic fibro-odontoma is extremely rare. We report an extremely rare case of developing odontoma arising from a calcifying odontogenic cyst in a 17-year old girl.

Appendix adenocarcinoma associated with ulcerative colitis (UC) is extremely rare. Pathological examination of a man with 6-year history of UC revealed a primary appendix adenocarcinoma mixed with adenoma component. Dysplasia was not identified. The adenoma-carcinoma sequence, but not the dysplasia-carcinoma sequence, might be involved in this UC-associated appendix adenocarcinoma.

Transcatheter Aortic Valve Implantation (TAVI) has emerged over the last decade and has become a viable treatment option for those with severe symptomatic aortic stenosis (AS). The numbers of TAVI that are being performed in centres across the world is rising rapidly, and revolutionising treatment for AS and steering away from the need for open heart surgery. TAVI has been targeted for those who are deemed high risk to undergo open heart surgery such as the elderly, frail, or those with multiple co-morbidities. General anaesthesia (GA) has been used to facilitate TAVI especially when the procedure was in its infancy. The use of GA comes with its own set of risks such as haemodynamic compromise, risk for aspiration, longer procedure time and post-operative nausea and vomiting. These side effects and or complications may not be tolerated well in those who are elderly or have numerous co-morbidities. This article seeks to understand the outcomes of patients who undergo TAVI with the support of sedation and local anaesthesia (LA) in comparison to those who received GA.

We present a case series of three patients that underwent myocardial contrast echocardiography (MCE) in the setting of recent chest pain, as paradigmatic examples of the usefulness of contrast-echocardiography with very-low mechanical index imaging in the context of rest wall motion assessment. Moreover, we analysed the pertinent literature about the use of rest MCE in the context of chest pain of unknown origin, showing its diagnostic and prognostic impact. We think that MCE could play a key role in detecting chest pain subtended by previously unknown CAD. For example, in pts without significant ECG modifications or in whom high sensitivity troponins show only borderline increase (still below the upper limit) or have no clearly significant delta. In such cases the more sensitive evaluation of WM powered by MCE could add diagnostic information, above all in pts with severe CAD but apparently normal WM at standard echocardiography.

Foraging by consumers acts as a biotic filtering mechanism for biodiversity at the trophic level of resources. Variation in foraging behaviour have cascading effects on abundance, diversity, and functional trait composition of the community of resource species. Here we propose diversity at giving-up density (DivGUD), when foragers quit exploring a patch, as a novel concept and simple measure to quantify these effects at multiple spatial scales. In experimental landscapes, patch residency of wild rodents decreased local α-DivGUD (via elevated mortality of species with large seeds) and regional γ-DivGUD, while dissimilarity among patches in a landscape (ß-DivGUD) increased. Thus, DivGUD provides a framework linking theories of adaptive foraging behaviour with community ecology allowing to investigate cascading indirect predation effects across multiple trophic levels e.g. the ecology-of-fear framework; feedbacks between functional trait composition of resource species and consumer communities; and effects of inter-individual differences among foragers on the biodiversity of resource communities.

Inflammatory Myofibroblastic Tumor is usually a benign tumor of mesenchymal origin that is rarely found in the larynx. This case explores the unique laryngeal location and presentation of this tumor as well as the challenging radiographic and histologic findings.

Introduction Caregivers of hemodialysis patients may experience stress, depression, fatigue, and decreased quality of life. This study aimed to examine the caregiver burden and related factors in patients’ caregivers under dialysis treatment. Method Our study was conducted between February and April 2019 in the Hemodialysis Unit of our Hospital Internal Diseases Clinic. Eighty-three people providing primary care to patients who had received hemodialysis service for at least three months were included in the study. The socio-demographic data of the caregivers were recorded. Care burden was evaluated by Zarit Burden Interview (ZBI) and dependency status with Katz Activities of Daily Living (ADL) instrument. Quality of life was evaluated with the 36-Item Short Form Survey (SF-36). Results The mean age of 183 caregivers included in the study was 46.35 ± 24.20 years; 67.5% of them were female. The mean ZBI score of the caregivers was 32.5 ± 14.4. Care burden was observed to be absent or very mild in 20.5% of the caregivers, mild-moderate in 57.8%, moderate-heavy in 19.3%, and heavy in 2.4%. The care burden was higher in those who felt insufficient to provide care or did not receive help from other family members for patient care (p<0.05). Besides, if the hemodialysis frequency was more than three times a week, the care burden was higher (p=0.003). Care burden was higher in functionally dependent patient (p=0.013). ZBI was negatively correlated with the SF-36 subscales, except for the physical function subscale (p<0.05). Conclusion The care burden was high in primary caregivers of hemodialysis patients. The care burden was higher in caregivers of patients with bedridden, high frequency of hemodialysis, and low quality of life. In addition to hemodialysis patients’ routine treatment, it may be appropriate to develop support groups and new care approaches for caregivers to reduce the care burden.

COVID-19 has introduced a monumental challenge to the routine delivery of healthcare and protection of healthcare professionals. Conditions that are life threatening and need urgent intervention add another layer of complexity. This brief report reviews the management of a large cardiac fibroma found in the setting of COVID-19.

Aim: To evaluate the effect of adding dry needling treatment to conventional rehabilitation on pain, range of motion, and functionality on hemiplegic shoulder pain. Methods: A total of 38 patients with hemiplegic shoulder pain were divided into two groups. A multimodal rehabilitation protocol including physical therapy methods and exercise treatments was applied to both groups (5 sessions per week for a total of 15 sessions). In addition to the rehabilitation, three sessions of dry needling treatment were applied for dry needling group. Pain with visual analog scale, range of motion with a goniometer, functionality was evaluated by quick disability of the arm, shoulder, and hand and fugl meyer assessment upper extremity. Evaluations were made before treatment, after treatment, and at the third month of treatment. Results: Patients aged from 30-60 years (mean±SD=53.1± 5.3). The average duration of HSP was 6.7±1 months. While a significant improvement was observed in both groups in all parameters after the treatment, a statistical superiority was found in the dry needling group (p<0.05). At the 3rd month follow-up, there was no difference in pain and functionality parameters between the groups, while flexion and abduction measurements were higher in the dry needling group (p <0.05). Conclusion: Adding dry needling treatment to conventional rehabilitation did not show any difference except for some joint range of motion measurements in the subacute period.