Splenosis is a condition that occurs after splenic rupture. A 29 year-old male patient with a history of splenectomy, was admitted due to multiple vomiting episodes. The diagnostic workup was unable to differentiate between gastric GIST and splenosis. Laparoscopic surgical resection was performed leading to the diagnosis of splenosis.

Gastric cancer was diagnosed with dilation of the main pancreatic duct. SPACE revealed adenocarcinoma, total gastrectomy with distal pancreatectomy were underwent. More case reports are needed to determine whether adjuvant chemotherapy is indicated for patients with PCIS and whether the extent of lymph node dissection can be safely reduced.

L-amino acid deaminase (LAAD, EC 1.4.3.2) catalyzes the deamination of α-amino acids. At present, sustainable enzymatic α-keto acids synthesis remains limited by the low catalytic efficiency of wild-type LAADs. In this study, catalytic mechanism was elucidated, and catalytic distance D1 between the substrate αC-H and the cofactor FAD N(5) was identified as the key factor limiting efficiency of Proteus mirabilis PmiLAAD. Shortening the distance via protein engineering improved catalytic efficiency toward six selected amino acids. The two variants with the best catalytic properties were W1, which exhibited a preference for short-chain aliphatic amino acids and charged amino acids, and W2, which showed a preference for large aromatic amino acids and sulfur-containing amino acids. The mutated residues in the two variants altered the binding pose of the substrate, α-hydrogen was improved to be more perpendicular against the plain of the isoalloxazine ring causing the angle between the substrates’ αC-H, FAD N(5), and FAD N(10) to approach 90°, and thus shortened the distance. Finally, W1 and W2 were cascade in one Escherichia coli cell to obtain strain S3, which exhibited conversion >90% and yield >100 g/L toward all selected substrates. These results provide the basis for improving industrial production of α-keto acids via microbial deamination of α-amino acids.

Objective We assessed the relationship between chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) and erectile dysfunction (ED) using propensity score matching. Methods Data from 8727 middle-aged men who had undergone health checkups were analyzed. The National Institutes of Health Chronic Prostatitis Symptoms Index (NIH-CPSI), the International Index of Erectile Function-5 (IIEF), the Premature Ejaculation Diagnostic Tool (PEDT), testosterone measurement, basic blood chemistry, and metabolic syndrome (MetS) assessment were performed in this study. As in a previous study, the symptoms were classified as “no” if respondents reported no perineal or ejaculatory pain or had an NIH-CPSI pain score of <4, and the symptoms were classified as “moderate to severe” if the pain score was >7. Of the 8727 men considered, 7181 formed the cohort for propensity score matching, including 597 men with moderate to severe prostatitis-like symptoms (case) and 6584 men with no prostatitis-like symptoms (control); ultimately, however, members of the case and control groups were matched at a 1:1 ratio by propensity score. Results After matching, the variables of age, testosterone, PEDT and MetS were evenly distributed between the groups. After matching, the mean IIEF score of the case group was significantly lower than that of the control group (17.2±5.5 vs. 14.7±5.3; P<0.001). Additionally, the severity of ED was significantly greater in the case group (no, mild, mild to moderate, moderate, and severe, respectively: 27.5%, 30.2%, 24.6%, 13.1%, and 4.7% in the control group; 10.7%, 27.0%, 33.0%, 18.9%, and 10.4% in the case group; P<0.001). Finally, the rate of moderate to severe ED was significantly higher in the case group than in the control group (17.8% vs. 29.3%; P<0.001). Conclusion Moderate to severe prostatitis-like symptoms were significantly and independently correlated with ED in middle-aged men.

Background: Peripartum cardiomyopathy (PPCM) is a potentially life-threatening pregnancy-associated disease marked by left ventricular dysfunction and heart failure (HF). Clinical findings of HF are often masked by the normal physiological changes seen in pregnancy, making the diagnosis challenging. Furthermore, postpartum hemorrhage followed by massive blood transfusion may mask the diagnosis of PPCM or worsen the decompensated HF. Case Description: We report a 35-year-old postpartum gemelli woman with a history of massive postpartum hemorrhage due to atonia uteri and Disseminated Intravascular Coagulation, complain of shortness of breath and fever. The patient received a massive blood transfusion for her massive postpartum hemorrhage. Physical examination revealed tachypnea and bilateral rales at lung bases. Chest radiographs showed cardiomegaly, right pleural effusion, and early lung edema. The echocardiography showed a decrease in left ventricular systolic function with ejection fraction of 41%, diastolic dysfunction, and global hypokinetic. She was diagnosed with PPCM, acute lung edema, pleural effusion, and pneumonia. Patient was treated with Furosemide continuous pump, Spironolactone, Bisoprolol, Valsartan. Her dyspnea greatly decrased with diuresis and antibiotic. She was discharged with HF medication continued.Discussion: Women with PPCM typically present with symptoms of HF and signs of congestion. History of massive blood transfusion at first can mask the diagnosis of PPCM due to the possibility of Transfusion Associated Circulatory Overload, which also has signs of congestion. Massive blood transfusion can increase preload and may worsen the decompensated HF. Conclusion: The presence of massive transfusion in a patient with PPCM can be challenging in diagnosing PPCM itself and the unpredictable course of decompensated HF in peripartum mothers. Due to its high mortality rate without proper treatment, prompt investigation is essential in improving maternal survival.

Commentary:

In order to study the dynamic response of adjacent buildings in the process of tunnel blasting excavation, taking Yangjia tunnel blasting through a five-story frame structure residential building as an example, the propagation law of blasting seismic wave was analyzed by using HHT method through on-site blasting monitoring. Then, the ALE algorithm in ANSYS/LS-DYNA software was used to establish a three-dimensional numerical model based on the surrounding rock-cutting section-structure coupling to study the dynamic response of adjacent buildings under the blasting vibration of tunnel. The results show that the HHT analysis method can clearly describe the energy distribution of vibration signals in the time and frequency domain. The energy carried by the blasting vibration signal is corresponding to the detonating section, and the maximum energy appears in the cutting section, which further verifying that the vibration effect caused by the cutting hole blasting is the strongest. In the process of tunnel blasting, the dynamic responses of beams, columns and exterior walls of adjacent buildings are not consistent and show different variation rules along the height direction. In addition, the stress centralization mainly occurs in the exterior wall of the building, the joint of the exterior wall and the column, the joint of the exterior wall and the beam, and the joint of the exterior wall and the floor and other non-weight bearing area, indicating that these parts are more likely to damage and crack in the process of tunnel blasting.

BACKGROUND: Neurocognitive deficits are an important late effect in survivors of acute lymphoblastic Leukemia(ALL). Data from low middle income countries is scarce and highly influenced by biological and cultural variations. Such data would be useful for highlighting the importance of early intervention in an already disadvantaged population. PROCEDURE: 70 consecutive survivors of childhood ALL were evaluated for neurocognitive deficits by the Indian adaptation of Wechsler Intelligence Scale for Children-Fourth Edition(WISC-INDIA). Prevalence of neurocognitive deficits was calculated based on Full Scale Intelligence Quotient(FSIQ) and scores in discrete domains like Verbal Comprehension, Perceptual Reasoning, Working Memory and Processing Speed were calculated and compared to baseline characteristics, chemotherapy and radiation dose received. RESULTS: The mean FSIQ was 86.1 ± 20.5, with significant neurocognitive deficit(FSIQ <90) being prevalent in 50%(95% CI 38% to 62%) of the cohort. The proportion of survivors with deficits in individual domains of verbal comprehension, perceptual reasoning, working memory and processing speed were 49%, 50%, 47% and 44% respectively. The odds of having deficits in neurocognitive function was higher when a child belonged to lower socioeconomic strata, had parents with less than primary school education and whose birth order was higher(All p<0.05). Age at diagnosis, current age at assessment, receiving lower or higher dose of radiotherapy, high dose methotrexate or cytarabine did not have a direct impact on neurocognitive function. CONCLUSIONS AND RELEVANCE: The current need is to develop country specific neurocognition assessment tools to initiate early screening and develop culturally appropriate preventive and rehabilitative interventions.

    Proprioception, the ability to perceive one’s own configuration and movement in space, enables organisms to safely and accurately interact with their environment and each other. The underlying sensory nerves that make this possible are highly dense and use sophisticated communication pathways to propagate signals from nerves in muscle, skin and joints to the central nervous system wherein the organism can process and react to stimuli. In a step forward to realize robots with such perceptive capability, we propose a flexible sensor framework that incorporates a novel hybrid modeling strategy, taking advantage of computational mechanics and machine learning. We implement the sensor framework on a large, thin and flexible sensor that transforms sparsely distributed strains into continuous surface shape. Finite element (FE) analysis is utilized to determine sensor design parameters, while an FE model is built to enrich the morphological data used in the supervised training to achieve continuous surface reconstruction. A mapping between the local strain data and the enriched surface data is subsequently trained using ensemble learning. This hybrid approach enables real-time, robust and high-order surface shape reconstruction. The sensing performance is evaluated in terms of accuracy, repeatability, and feasibility with numerous scenarios, which has not been demonstrated and reported on such a large-scale (A4-paper-size) sensor before.

To associate specimens identified by molecular characters to other biological knowledge, we need reference sequences annotated by Linnaean taxonomy. In this paper, we 1) report the creation of a comprehensive reference library of DNA barcodes for the arthropods of an entire country (Finland), 2) publish this library, and 3) deliver a new identification tool based on this resource. The reference library contains mtDNA COI barcodes for 11,275 (43%) of 26,437 arthropod species known from Finland, including 10,811 (45%) of 23,956 insect species. To quantify the improvement in identification accuracy enabled by the current reference library, we ran 1,000 Finnish insect and spider species through the Barcode of Life Data system (BOLD) identification engine. Of these, 91% were correctly assigned to a unique species when compared to the new reference library alone, 85% were correctly identified when compared to BOLD with the new material included, and 75% with the new material excluded. To capitalize on this resource, we used the new reference material to train a probabilistic taxonomic assignment tool, FinPROTAX, scoring high success. For the full-length barcode region, the accuracy of taxonomic assignments at the level of classes, orders, families, subfamilies, tribes, genera, and species reached 99.9%, 99.9%, 99.8%, 99.7%, 99.4%, 96.8%, and 88.5%, respectively. The FinBOL arthropod reference library and FinPROTAX are available through the Finnish Biodiversity Information Facility (www.laji.fi). Overall, the FinBOL investment represents a massive capacity-transfer from the taxonomic community of Finland to all sectors of society.

Northeast China(NEC) is the main grain-producing area in China, but soil degradation is severe due to the long-term use of conventional tillage(CT). It is necessary to restore soil fertility, maintain crop yield, and enhance sustainability using conservation tillage in NEC. However, the integrated effects of conservation tillage on crop yield and SOC under different conditions in NEC are still unclear. Using 70 peer-reviewed papers, we assessed the crop yield and SOC sequestration effect, and their relationship under no-till(NT), ridge tillage(RT), and subsoiling tillage(ST) in NEC. The results indicated that in areas with a mean annual temperature (MAT) < 3℃, yield under NT was significantly lower than CT by 3.7% whereas RT and ST were higher than CT by 0.8% and 13.1% (P<0.05). RT generally had a similar effect on yield as NT, but RT did not have a negative impact on yield in colder regions, indicating that this may be a more suitable conservation tillage practice in these areas. ST may be used in rotation with other tillage measures to maintain crop yield if necessary. NT could increase SOC concentration by 24.1%, 43.9%, and 17.4% under high MAT (>6℃), low mean annual precipitation (MAP) (<500mm), and continuous cropping, respectively. The mean SOC sequestration rate under NT, RT, and ST was 0.953, 0.099, and 0.101 Mg C ha-1 yr-1, respectively. Overall, the implementation of different conservation tillage measures in NEC can enhance crop yield as well as carbon sequestration, indicating its potential to be popularized in NEC.

The insulin receptor is a membrane protein responsible for regulation of nutrient balance and therefore an attractive target in the treatment of diabetes and metabolic syndrome. Pharmacology of the insulin receptor involves two distinct mechanisms, (1) activation of the receptor by insulin mimetics that bind in the extracellular domain and (2) inhibition of the receptor tyrosine kinase enzymatic activity in the cytoplasmic domain. While a complete structural picture of the full-length receptor comprising the entire sequence covering extracellular, transmembrane, juxtamembrane and cytoplasmic domains is still elusive, recent progress through cryoelectron microscopy has made it possible to describe the initial insulin ligand binding events at atomistic detail. We utilize this opportunity to obtain structural insights into the pharmacology of the insulin receptor. To this end, we conducted a comprehensive docking study of known ligands to the new structures of the receptor. Through this approach, we provide an in-depth, structure-based review of human insulin receptor pharmacology in light of the new structures.

Background: The aim of this study is to investigate the impact of COVID-19 related treatment delay on subcutaneous immunotherapy (SCIT) efficacy in patients with allergic rhinitis (AR). Methods: The study was performed in 643 patients with SCIT appointments between February 1 and May 31, 2020. The clinical assessment, performed at baseline (V0) and one year later (V1), included visual analogue scale (VAS); daily symptom score (dSS); daily medication score (dMS); combined symptom and medication scores (CSMS); quality of life (QoL); self-rating anxiety scale (SAS); and self-rating depression scale (SDS) for each patient. Results: At V0, 249 patients were treated on schedule, and 394 were delayed (7 ± 4.68 weeks). Among them, 319 patients (105 on schedule, and 214 delayed) also completed the assessments at V1, with the absence of 25.39% patients due to completion of SCIT, and 25.35% patients were withdrawal. The results of all assessments were within the normal range for all patients at V0 and V1, with the exception of a slightly higher SDS score (56.13) at V0. In the SCIT delayed group. there was a significant positive correlation between the length (weeks) of the delay and SDS score, and this was significantly higher in patients with poor control of nasal symptoms. Conclusions: This study showed the long-term efficacy of SCIT for AR patients, including those who have had to delay normal therapy due to the COVID-19 outbreak. The psychological status of SCIT patients in response to lockdown of hospital services during this critical period should be considered.

NSTI caused by E. coli monomicrobial infection is an extremely severe condition with high mortality. This report presented a case of monomicrobial NSTI caused by E. coli with septic shock in a patient with alcoholic liver cirrhosis and mentioned both pathogen virulence factors and host susceptibility factors.

Acquired left ventricular pseudoaneurysm is a rare disorder that occurs after acute myocardial infarction. We present a 55 year-old male patient with a nonruptured pseudoaneurysm after acute MI presenting with severe mitral regurgitation. After resection of sac-like lesion, the defect was 5 cm diameter posterolaterally left ventricular. The aneursym was repaired with pericardium patch to maintain cardiac geometry that diminishes mitral regurgitation without intervention to mitral valve.

In this paper, we consider the following coupled Schr\”{o}dinger system with doubly critical exponents, which can be seen as a counterpart of the Brezis-Nirenberg problem $$\left\{% \begin{array}{ll} -\Delta u+\lambda_1 u=\mu_1 u^5+ \beta u^2v^3, & \hbox{$x\in \Omega$}, \\ -\Delta v+\lambda_2 v=\mu_2 v^5+ \beta v^2u^3, & \hbox{$x\in \Omega$}, \\ u=v=0,& \hbox{$x\in \partial\Omega$}, \\ \end{array}% \right.$$ where $\Omega$ is a ball in $\R^3,$ $-\lambda_1(\Omega)<\lambda_1,\lambda_2<-\frac14\lambda_1(\Omega)$, $\mu_1,\mu_2>0$ and $\beta>0$. Here $\lambda_1(\Omega)$ is the first eigenvalue of $-\Delta$ with Dirichlet boundary condition in $\Omega$. We show that the problem has at least one nontrivial solution for all $\beta>0$.

Severe asthma patients have a higher likelihood of emergency department visits and hospitalizations when there is a change in their preferred inhaled corticosteroid. Working to keep their preferred ICS consistent is crucial in reducing overall health care costs.

BACKGROUND: Lymphopenia is a hallmark of multisystem inflammatory syndrome in children (MIS-C). We aimed to characterize lymphocyte subsets’ shifts and their correlations with other severity markers of MIS-C. METHODS: In this prospective cross-sectional study, we performed peripheral lymphocyte phenotyping in 32 patients with MIS-C. We analyzed lymphocyte subsets at three time-points of the disease: the acute (A), convalescent (B), and recovery (C) phases. Based on age-normalized lymphocyte counts, we distinguished two groups of patients: “the mild” and “the severe”. In addition, we examined differences between these groups regarding other severity markers. RESULTS: In phase A, 84% of children had lymphopenia. Decreased absolute counts of CD3, CD4, and CD8 cells were observed in, respectively, 88%, 72%, and 84% of patients. The natural killer cells were decreased in 63% and CD19 in 59% of children. “The severe” group had significantly higher procalcitonin and troponin I levels and lower platelets and albumin. Moreover, “the severe” group had hypotension more frequently (73% vs. 20%, p=0.008). In phase B, all lymphocyte counts increased, and 32% of children had lymphocytosis. The increase of CD3, CD4, and CD8 counts correlated with some laboratory severity markers (hemoglobin, procalcitonin, D-dimer, lactate dehydrogenase, N-terminal prohormone of brain natriuretic peptide, albumin), but not with steroid use. In phase C, most children had normal lymphocyte counts. CONCLUSIONS: Substantial shifts in lymphocyte counts during MIS-C apply most to T lymphocytes and correlate with the disease severity markers, particularly hypotension prevalence. A proportion of children with MIS-C develops transient lymphocytosis during convalescence.

A comparison study of fatigue behavior in Al-Al and Al-steel refill friction stir spot welding jointHaokun Yang1a*, Detao Cai2,3a, Jiaxin Li1, Chin Yung Kwok1, Yunqiang Zhao3, Yu Li4, Haisheng Liu4, Waiwah Lai11 Smart Manufacturing Division (SMD), Hong Kong Productivity Council (HKPC), Hong Kong 999077, People’s Republic of China2 State Key Laboratory of Advanced Design and Manufacturing for Vehicle Body, Hunan University, Changsha, Hunan 410082, People’s Republic of China3 China-Ukraine Belt and Road Joint Laboratory on Materials Joining and Advanced Manufacturing, China-Ukraine Institute of Welding Guangdong Academy of Sciences, Guangzhou, Guangdong 510650, People’s Republic of China4 Center for Industrial Analysis and Testing, Guangdong Academy of Science, Guangzhou, Guangdong 510650, People’s Republic of Chinaa These authors contribute equallyCorresponding author: Haokun Yang, +852 27885679,hkyang@hkpc.orgKeywords: Refill friction stir spot welding, Fatigue fracture, Aluminum, Steel

The S-N equation is one of the most important equations in fatigue model investigation. A majority of fatigue models, including multiaxial fatigue model and mean effect models, are established on the basis of the S-N equation. Obviously, an accuracy of the S-N equation is very important. Taking into account that the S-N equation is, in fact, an empirical one in which the material constants are determined by numerical fitting fatigue experimental data, in this paper, the S-N equation can be improved, by further processing these fatigue experimental data, to present a new type of S-N equation that is more accurate than the S-N equation. The new type of S-N equation is called a similar S-N equation in this paper. By using a large number of experimental data of metallic materials reported in literature, an accuracy of the similar S-N equation has been proven.

The power input and gas-liquid mass transfer rank among the most important industrial fermentation process parameters. The present study analyzes the power input and gas hold-up as a function of the flow regime, impeller diameter, and rheological properties in a pilot scale reactor (160 L) equipped with four Rushton impellers. This leads to four dimensionless numbers for predicting measurements in pilot and industrial bioreactors (110 and 170 m3) with a standard deviation of 7 % to 29 %. This is unparalleled for the underlying aerated and non-Newtonian fermentation broths. Several existing correlation equations are discussed to be dissatisfying (up to 130 % deviation), and might be sufficiently valid only within scale or for small scaling factors. The introduced approach predicts adequately accurate over three orders of magnitude. Based on these encouraging results, we identified the Galilei number and the power concept as the central elements in combination with the consequent dimensional analysis for an efficient scaling betweeen pilot and industrial scale.

Slope direction affects permafrost degradation because of its influence on the surface energy balance. The ground thermal difference between slopes of differing aspect is known, however there are few detailed reports on differences in soil temperature, humidity, and radiation from slopes in permafrost areas that caused permafrost degradation. In this study variations in air and ground thermal regime were compared at two sloping sites with opposing aspect in a permafrost region of the Qinghai-Tibetan Plateau (QTP). The results indicate that air temperatures (Ta) were similar at both sites in September 2016-19. However, ground temperatures, including the ground surface temperature (Ts), the temperature near the permafrost surface (Tps), and the permafrost temperature at 5.0 m depth (Tg), and soil moisture content within the active layer differed greatly between sites. The mean annual Ts, Tps, and Tg over three years (2016-19) were 1.3-1.4 ℃ higher at the sunny slope than at the shady slope. The near-surface soil moisture content during the thawing season was 10-13% lower at the sunny slope (~22-27%) than the shady slope (~35-38%), and was significantly and negatively correlated with ground temperature. Shortwave downward radiation (DR) at the sunny slope was higher than at the shady slope. However, net radiation (Rn) was lower at the sunny slope due to the greater surface albedo at the site. The results highlight a complex spatial pattern of ground thermal conditions in mountainous permafrost regions, help define the climate-permafrost relation in the region, and for understanding permafrost degradation on a local scale.

In communities structured by body size, coexistence can occur through combinations of ontogenetic changes in competitive ability and dietary niche. Using stable isotopes, we examined ontogenetic niche shifts in Trinidadian guppies (Poecilia reticulata) and killifish (Rivulus hartii) in three types of natural communities (both species with predators, KGP; both without predators, KG; killifish only, KO) and four experimental KG communities, initiated with KGP guppies and KO killifish between 13 and 45 years ago. In all communities, killifish occupied higher trophic positions and changed their diet (δ^13 C) with body size. Only KGP guppies displayed an ontogenetic niche shift. The KG guppies displayed a significant difference in trophic niche from KGP guppies, a character displacement that can facilitate coexistence with killifish. In the experimental communities, the guppy trophic niche was intermediate between those in KGP and KG communities, indicating that evolution has driven the niche shift in KG guppies.

Likelihood of new allosteric sites for glycolytic enzymes, phosphofructokinase (PFK), glyceraldehyde-3-phosphate dehydrogenase (GADPH) and pyruvate kinase (PK) was evaluated for bacterial, parasitic and human species. Allosteric effect of a ligand binding at a site was revealed on the basis of low-frequency normal modes via Cα-harmonic residue network model. In bacterial PFK, perturbation of the proposed allosteric site outperformed the known allosteric one, producing a high amount of stabilization or reduced dynamics, on all catalytic regions. Another proposed allosteric spot at the dimer interface in parasitic PFK exhibited major stabilization effect on catalytic regions. In parasitic GADPH, the most desired allosteric response was observed upon perturbation of its tunnel region which incorporated key residues for functional regulation. Proposed allosteric site in bacterial PK produced a satisfactory allosteric response on all catalytic regions, whereas in human and parasitic PKs, a partial inhibition was observed. Residue network model based solely on contact topology identified the ‘hub residues’ with high betweenness tracing plausible allosteric communication pathways between distant functional sites. For both bacterial PFK and PK, proposed sites accommodated hub residues twice as much as the known allosteric one. Tunnel region in parasitic GADPH with the strongest allosteric effect among species, incorporated the highest number of hub residues. These results clearly suggest one-to-one correspondence between the degree of allosteric effect and the number of hub residues in that perturbation site, which increases the likelihood of its allosteric nature.