Recent advances in cell-free protein synthesis have enabled the folding and assembly of full-length antibodies at high titers with extracts from prokaryotic cells. Coupled with the facile engineering of the E. coli translation machinery, E. coli based in vitro protein synthesis reactions have emerged as a leading source of IgG molecules with non-natural amino acids incorporated at specific locations for producing homogeneous antibody drug conjugates. While this has been demonstrated with extract produced in batch fermentation mode, continuous extract fermentation would facilitate supplying material for large-scale manufacturing of protein therapeutics. To accomplish this, the IgG-folding chaperones DsbC and FkpA, and orthogonal tRNA for non-natural amino acid production were integrated onto the chromosome with high strength constitutive promoters. This enabled co-expression of all three factors at a consistently high level in the extract strain for the duration of a five-day continuous fermentation. Cell-free protein synthesis reactions with extract produced from cells grown continuously yielded titers of IgG containing non-natural amino acids above those from extract produced in batch fermentations. In addition, the quality of the synthesized IgGs and the potency of ADC produced with continuously fermented extract were indistinguishable from those produced with batch extract. These experiments demonstrate that continuous fermentation of E. coli to produce extract for cell-free protein synthesis is feasible and helps unlock the potential for cell-free protein synthesis as a platform for biopharmaceutical production.

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Objective: To explore the impact of risk factors from three different time periods on negative birth experience. Design: Register-based cohort study. Setting: Sweden. Population: Nulliparous women giving birth to singleton, term infants in 2013–2018 (n = 83 335), elective caesarean sections (CS) excluded. Methods: Hierarchical logistic regression was performed to calculate adjusted odds ratios (aOR) with 95% confidence intervals (CIs) in three blocks, each representing risk factors from one of three time periods: I) before pregnancy, II) pregnancy, III) labour. Main Outcome Measurement: Negative birth experience, defined as ratings of ≤ 4 on a ten-point scale. Results: Poor self-rated health (SRH) was the only pre-gestational factor remaining associated with negative birth experience after adjustment for pregnancy- and labour-related factors (aOR 1.22, 95% CI 1.10–1.36). Fear of childbirth and treatment for psychiatric disorder during pregnancy were both associated with negative birth experience (aOR 1.53, 95% CI 1.36–1.73; aOR 1.51, 95% CI 1.35–1.68), as were all labour-related factors included in the model. Women giving birth by operative vaginal delivery or unplanned CS under regional anaesthesia had three-fold higher ORs for rating their overall birth experience as negative (aOR 3.23, 95% CI 2.99–3.50; aOR 3.04, 95% CI 2.77–3.33). The highest OR, 5.38, was seen among women undergoing unplanned CS under general anaesthesia (95% CI 4.52–6.40). Conclusions: The main contributing factors to a negative birth experience are labour-related. Poor SRH, psychiatric treatment and fear of childbirth places the woman in a vulnerable position requiring extra attention.

Lesson OverviewIn this 50-minute lesson, students will learn about how water flows naturally. They will also learn about how man-made or animal-made structures can redirect the flow of water. Standards & ObjectivesK-ESS2-2 Construct an argument supported by evidence for how plants and animals (including humans) can change the environment to meet their needs..K-ETS1-1 Ask questions, make observations, and gather information about a situation people want to change to define a simple problem that can be solved through the development of a new or improved object or toolK-ETS1-3 Analyze data from tests of two objects designed to solve the same problem to compare the strengths and weaknesses of how each performs.CCSS.MATH.CONTENT.2.MD.A.3 Estimate lengths using units of inches, feet, centimeters, and metersResources & MaterialsVideo on Beaver Dams https://www.youtube.com/watch?v=yJjaQExOPPYVideo on Building the Hoover Dam https://www.youtube.com/watch?v=n9Gy_1Ppw5UVideo on How Water Flows https://www.youtube.com/watch?v=RqZbsr32n0cMaterials: bottled water, construction paper, blocks, wire, string, Playdoh, tape, scissors, pipe cleaners, popsicle sticks (a variety of scraps and building supplies)LessonStage 1: Observations & Comparisons (10 min)Watch videos and look at pictures of dams, both man made and those occurring naturally. Compare the sizes, shapes, and materials used. Discuss why humans might build a dam. Discuss what happens to the water flow when a dam is put in place. Question how adjusting the size, shape, or position of the dam could change the flow.Stage 2:  Designing & Building (30 min)Imagine city workers need to adjust the flow of a river to put in new electrical poles. You will need to design a dam that will redirect the river to another location.  Consider what materials you can use that will withstand water flow for this project. Sketch and design a city dam structure. List materials, and design the model.Stage 3 Testing & Reflection (10)Test each design by creating a "river" with water flowing into the structure. Discuss height and direction of water flow. What adjustments need to be made? Which materials worked well for this project. Compare to real-world scenarios: What materials would be needed for a real river?

Objectives: This study aims to evaluate the role of speckle tracking echocardiography (STE) to identify myocardial deformation abnormalities in acute rheumatic fever. Methods: Twenty-seven patients and twenty-seven healthy children were studied prospectively. The patients were divided into two subgroups as moderate/severe carditis and mild/no carditis according to valve involvement. The left ventricular global longitudinal strain (LVGLS) and strain rate (LVGLSR), left ventricular global circumferential strain (LVGCS) and strain rate (LVGCSR), and right ventricular global longitudinal strain (RVGLS) and strain rate (RVGLSR) were examined by STE. Results: Left ventricular global longitudinal strain, LVGLSR, LVGCS, LVGCSR, RVGLS and RVGLSR were significantly lower in patients in acute phase of disease than controls. There were no differences in strain and strain rates between patient subgroups before treatment. After acute phase, statistically significant improvements were found in LVGLS, LVGLSR, LVGCSR values of the patients with moderate/severe carditis and LVGLS, LVGCS, LVGCSR, RVGLS, RVGLSR values of the patients with mild/no carditis. The strain parameters of the patients and controls did not differ significantly after the treatment. Conclusions: In acute phase of rheumatic heart disease, patients have reduced left and right ventricular strain and strain rates, which shows improvements after treatment.

This investigation aims to explain the study of heat transfer and entropy generation of magnetohydrodynamic (MHD) viscous fluid flowing through a ciliated tube. Heat transfer study has massive importance in various biomedical and biological industry problems. The metachronal wave propagation is the leading cause behind this viscous creeping flow. A low Reynolds number is used as the inertial forces are weaker than viscous forces, and also creeping flow limitations are fulfilled. For the cilia movement, a very large wavelength of a metachronal wave is taken into account. Entropy generation is used to examine the heat transfer through the flow. Exact mathematical solutions are calculated and analyzed with the help of graphs. Streamlines are also plotted.

Background: Significant TR is common in patients with cardiac disease and because of its prognostic importance, TV came to the spotlight in the last decades. Functional TR is mostly treated when undergoing left-sided valve surgery, whereas idiopathic TR surgery is uncommon. The aim of this study is to compare the durability of tricuspid valve annuloplasty techniques, and to explore the optimal method for TV repair surgery. Methods: 1005 patients who underwent tricuspid valve repair from February 2012 to March 2019, were retrospectively studied. The patients had tricuspid valve repair while receiving surgery for other cardiac conditions. The study population was divided into Suture group (n=483, 48.1%), and Ring group (n=522, 51.9%). Data variation between and within the groups was analyzed with Mann-Whitney U test, Wilcoxon rank-sum test, and Radit analysis. Results: At two-year follow-up, in the Suture group, none/trace TR subjects were 63.9%, and 1.4% had severe TR; In the Ring group were: 63.9% none/trace, and 0.6% severe. Both groups’ two-year follow-up TR status was significantly different with preoperative TR status (p<0.05). At two-year follow-up, Suture group had 63.9% none/trace and 1.4% severe; and Ring group had 63.9% none/trace and 0.6% severe TR and there was no significant difference between the groups (p>0.05). Conclusions: Both annuloplasty techniques have good short-term outcomes. However, suture annuloplasty deteriorates faster than ring annuloplasty, making the latter to be the ideal technique for TV repair.

Objectives: The objective of this study is to assess quality of the most popular cholesteatoma videos on YouTube using recognized scoring systems and to determine if video quality metrics correlated with video popularity based on likes and views Design: Cross sectional survey of available data Setting: Metadata acquisition using YouTube searches using Australian IP addresses Participants: Three independent neuro-otologists partaking in scoring videos Main outcome measures: Each video was viewed and scored by three independent assessors using both a novel tool to score the usefulness of the video as well as the validated DISCERN scoring tool. Popularity metrics were analyzed and compared to video popularity. Results: A total of 90 YouTube videos were analyzed with an average 55,292 views per video with an average of 271 likes and 22 dislikes. The inter-rater correlation was moderate with Fleiss-kappa score 0.42 [P < 0.01] using a novel scoring tool for cholesteatoma and inter-rater correlation coefficient was 0.78 [95% CI = 0.58 - 0.90] indicating good reliability for DISCERN scores. The overall video quality was poor with higher DISCERN scores found in videos uploaded from Academic Institutions. Conclusions: Informative video quality on YouTube on cholesteatoma is overall of poor quality. Videos with unclassified sources or more dislikes correlated poorly with video quality. Given the increase in patients turning to the internet for information regarding their health conditions, otology and otolaryngology societies should be encouraged to publish high quality YouTube videos on cholesteatoma and other ear conditions.

Background: The Childhood Asthma Management Program study revealed that 25.7% of children with mild to moderate asthma exhibit a loss of lung function. The objective was to assess the trajectories of function by means of serial FEV1 in asthmatic children participating in out-of-hospital follow-up. Methods: A total of 295 children (199 boys) who had undergone at least 10 spirometry tests from the age of 8 were selected from a single-center open cohort. The annualized rate of change (slope) for prebronchodilator FEV1 (percent predicted) was estimated for each participant and three patterns were defined: significantly positive slope, significantly negative slope, and null slope (non-significant P-value in the Pearson test). The standard deviation (SD) of each individual slope was recorded as a variability criterion of FEV1. Results: The median (25th and 75th percentile) age at inclusion and the last visit was 8.5 (8.2, 9.3) and 15.4 (14.8, 16.0) years, respectively. Tracking of function (null slope) was observed in 68.8% of the children, while 27.8% showed a loss of function (negative slope) and 3.4% showed a gain in function (positive slope). The children characterized by loss of function depicted a better initial function and a lower FEV1 variability during their follow-up than children with tracking or gain of lung function. At the last visit, these children were characterized by a lower lung function than children with tracking or gain of lung function. Conclusion: Children with a better initial FEV1 value and less FEV1 variability are more prone to loss of lung function.

Objectives: With recent advances in left ventricular assist device (LVAD) technology, the utilization of LVADs has increased while mortality, cost, and length of stay (LOS) have significantly decreased. This study sought to determine the national trends of surgically implanted biventricular assist devices (BiVADs). Methods: This is a retrospective analysis of the National Inpatient Sample (NIS) database for internal BiVADs (n = 538) and external BiVADs (n = 727) from 2009 to 2015. Results: Utilization of all surgically implanted BiVADs decreased (4.8% per year, p < 0.001), and was driven by a decline in utilization of external BiVADs (9.4% per year, p < 0.001). There was no significant change in BiVAD-associated mortality. However, cost and LOS increased significantly, and these trends were isolated to patients who died during their hospitalization. Patients with internal BiVADs incurred higher cost than external BiVAD patients but were more likely to survive. Conclusions: The decline in surgically implanted BiVAD utilization may be due to an improvement in LVAD technology as well as an increase in the availability of percutaneous temporary circulatory support. Future prospective studies are needed to compare various BiVAD configuration strategies and to optimize BiVAD patient selection and perioperative care.

Purpose: Extracorporeal membrane oxygenation (ECMO) is a refractory treatment for acute respiratory distress syndrome (ARDS) due to influenza and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2, also referred to as COVID-19). We conducted this study to compare the outcomes of influenza patients treated with veno-venous-ECMO (VV-ECMO) to COVID-19 patients treated with VV-ECMO, during the first wave of COVID-19. Materials and Methods: Patients in our institution with ARDS due to COVID-19 or influenza who were placed on ECMO between August 1, 2010 and September 15, 2020 were included in this comparative, retrospective study. To improve homogeneity, only VV -ECMO patients were analyzed. The clinical characteristics and outcomes were extracted and analyzed. Results: 28 COVID-19 patients and 17 influenza patients were identified and included. ECMO survival rates were 68% (19/28) in COVID-19 patients and 94% (16/17) in influenza patients (p=0.04). 30-day survival rates after ECMO decannulation were 54% (15/28) in COVID-19 patients and 76% (13/17) in influenza patients (p=0.13). COVID-19 patients spent a longer time on ECMO compared to flu patients (21 days vs. 12 days, p=0.025), and more COVID-19 patients (26/28 vs. 2/17) were on immunomodulatory therapy prior to ECMO initiation (p<0.001). COVID-19 patients had higher rates of new infections during ECMO (50% vs. 18%, p=0.03) and bacterial pneumonia (36% vs 6%, p=0.024). Conclusions: COVID-19 patients who were treated in our institution with VV-ECMO had statistically lower ECMO survival rates than influenza patients. It is possible that COVID-19 immunomodulation therapies may increase the risk of other superimposed infections.

Time: 50 minutesGrade: 11-14Overview: Students will learn different mechanics that help airplanes take off from the ground and apply them by building their own miniature airplanes.

The authors successfully utilize the bidirectional Glenn procedure to palliate late presenting, cyanotic patients with complex congenital heart disease. Additional information regarding preoperative diagnostic testing would be helpful. There is little information regarding patient screening and selection for the procedure. The short term results are satisfactory, however, mid-term and longer follow-up data is lacking. The treatment algorithm suggested by the report might be useful in other settings.

The authors report an exceptionally rare patient with findings of a bicuspid aortic valve in conjunction with a mature cystic teratoma in a middle-aged male presenting for symptomatic chest pain. Surgical resection and valve replacement were performed, confirming the rare cardiac tumor. While certainly interesting, this case highlights the importance of maintaining a broad differential diagnosis and the appropriate work-up, treatment and considerations for such rare pathology.

We have used low-dose prednisone, in conjunction with granulocyte, colony-stimulating factor (G-CSF) and erythropoietin, to treat an elderly patient with myelodysplastic syndrome (MDS) with an excess of blasts. Our findings indicate that such treatment is safe and may be effective in the long term survival of patients with high-risk MDS.

The biosynthesis of anthocyanins has been shown to be influenced by light quality. However, the molecular mechanisms underlying the light-mediated regulation of fruit anthocyanin biosynthesis are not well understood. In this study, we analyzed the effects of supplemental red and blue light on the anthocyanin biosynthesis in non-climacteric bilberry (Vaccinium myrtillus L.). After six days of continuous irradiation during fruit ripening, both red and blue light elevated concentration of total anthocyanins, but especially red light promoted accumulation of delphinidins. Transcriptomic analysis of ripening berries showed that both light treatments up-regulated all the major anthocyanin structural genes, the key regulatory MYB transcription factors and abscisic acid (ABA) biosynthetic genes. However, higher induction of specific genes of anthocyanin and delphinidin biosynthesis alongside ABA signal perception and metabolism were found in red light. The difference in red and blue light signaling was found in NCED, ABA receptor PYL and catabolic ABA-8’hydroxylase gene expression. Red light also up-regulated expression of SNARE domain transporters, which may indicate involvement of these proteins in vesicular trafficking of anthocyanins during fruit ripening. Our results suggest differential signal transduction and transport mechanisms between red and blue light in in ABA- regulated anthocyanin and delphinidin biosynthesis during non-climacteric fruit ripening.

Objective: Asthma is a recognized comorbidity in children with sickle cell disease (SCD). It increases risk of acute chest syndrome (ACS), vaso-occlusive episodes, and early mortality. We aim to determine whether evaluation and management of children with sickle cell disease (SCD) and asthma by a pulmonologist reduces rate of asthma exacerbation and ACS. Methods: The study included 192 patients with SCD (0-21 years) followed at Children’s Hospital of Philadelphia Hematology between 01/01/2015 and 12/31/2018 with a diagnosis of asthma, wheeze, or cough. Patients were placed in two groups: those evaluated by a pulmonologist (SCD-A-P) and those not (SCD-A). Rates of emergency department (ED) visits and hospitalizations for asthma exacerbation and ACS were compared between groups and before/after initial pulmonology visit. Results: SCD-A-P (n=70) had lower baseline pulmonary function, hemoglobin, and hematocrit compared to SCD-A (n=122). SCD-A-P had a higher average rate of hospital visits for asthma exacerbation and ACS per year compared to SCD-A: 0.84 [0.56-1.12] versus 0.31 [0.18-0.43], (p<0.001). For SCD-A-P patients with at least one hospital visit (n=48), the average rate decreased from 3.93 [1.57-6.29] before initial pulmonary visit to 0.85 [0.48-1.23] after the visit (p=0.014). Conclusion: SCD-A-P had more severe baseline disease and higher rates of ED visits and hospitalizations for asthma exacerbation and ACS compared to SCD-A, but the rates significantly decreased following pulmonology consultation. These findings support the pulmonologist’s role in the multidisciplinary care of SCD patients. Further studies are needed to help establish evidence-based asthma guidelines for children with SCD.

There is still limited understanding of how waters mix, where waters come from and for how long they reside in tropical catchments. In this study, we used a tracer-aided model (TAM) and a gamma convolution integral model (GM) to assess runoff generation, mixing processes, water ages and transit times (TT) in the pristine humid tropical rainforest Quebrada Grande catchment in central Costa Rica. Models are based on a four-year data record (2016 to 2019) of continuous hydrometric and stable isotope observations. Both models agreed on a young water component of fewer than 95 days in age for 75% of the study period. The streamflow water ages ranged from around two months for wetter years (2017) and up to 9.5 months for drier (2019) years with a better agreement between the GM estimated TTs and TAM water ages for younger waters. Such short TTs and water ages result from high annual rainfall volumes even during drier years with 4,300 mm of annual precipitation (2019) indicating consistent quick near-surface runoff generation with limited mixing of waters and a supra-regional groundwater flow of likely unmeasured older waters. The TAM in addition to the GM allowed simulating streamflow (KGE > 0.78), suggesting an average groundwater contribution of less than 40% to streamflow. The model parameter uncertainty was constrained in calibration using stable water isotopes (δ2H), justifying the higher TAM model parameterization. We conclude that the multi-model analysis provided consistent water age estimates of a young water dominated catchment. This study represents an outlier compared to the globally predominant old water paradox, exhibiting a tropical rainforest catchment with higher new water fractions than older water.

Soluble Complex of Basil Seed and Xanthan Gum with Whey Protein Concentrate

Background: Evidence suggests controversial results based on the antibacterial and anti-inflammatory effects of azithromycin (AZI) in the treatment of childhood asthma. This study was to further evaluate the efficacy and safety of AZI in childhood asthma. Methods: We searched PubMed, Embase (via Ovid), Cochrane Library, China National Knowledge Infrastructure, Chinese Scientific Journals database, WANFANG, and Chinese Biomedical Literature database from inception to November 11, 2020. Randomized controlled trials (RCTs) of AZI versus placebo or one positive control drug, AZI plus anti-asthma drugs (AADs) versus the same AADs, and AZI plus AADs versus placebo or one positive control drug plus the same AADs were included. Primary outcomes were number of exacerbations (NoE); score of clinical tools to assess asthma control after treatment; number of days to relieve symptoms with β2 agonist (DBA); post-treatment lung function indicators, including FEV1% of predicted value (pFEV1%), FVC% of predicted value (pFVC%), FEV1/FVC% of predicted value (pFEV1/FVC%), and PEF% of predicted value (pPEF%). Secondary outcomes were post-treatment fractional exhaled nitric oxide (FENO); post-treatment eosinophil counts in sputum (sEOS) or blood (bEOS); author self-reported outcomes related to asthma (AROs); and adverse events (AEs). Results: 61 eligible reports from 59 studies were finally included. AZI plus AADs shows no statistically significant difference in NoE (RR = 0.49; 95% CI, 0.07 – 3.26; P = 0.05) and sEOS (MD = -1.13%; 95% CI, -3.54% – 1.29%; P = 0.36) compared to AADs alone. The post-treatment C-ACT score was improved after AZI plus salmeterol and fluticasone (SF) treatment compared to SF alone (MD = 2.97; 95% CI, 2.39 – 3.54; P < 0.001). Results from three studies which could not be meta-analyzed showed that AZI may reduce DBA compared to placebo. AZI combined with AADs could improve post-treatment pFEV1% (AZI + glucocorticoid (GC) vs GC: MD = 6.92%; 95% CI, 1.47% – 12.37%; P = 0.01. AZI + leukotriene receptor antagonist (LTRA) vs LTRA: MD = 24.88%; 95% CI, 21.47% – 28.29%; P < 0.001. AZI + GC + BA vs GC + BA: MD = 12.40%; 95% CI, 9.72% – 15.08%; P < 0.001), pFEV1/FVC% (AZI + GC vs GC: MD = 10.24%; 95% CI, 6.44% – 14.03%; P < 0.001. AZI + GC + BA vs GC + BA: MD = 9.05%; 95% CI, 5.66% – 12.44%; P < 0.001. AZI + BA vs LTRA + BA: MD = 14.48%; 95% CI, 11.84% – 17.12%; P < 0.001), and pPEF% (MD = 7.00%, 95% CI, 2.53% – 11.47%; P = 0.002), but not improve pFVC% (MD = -10.37; 95% CI, -20.86% – 0.12%; P = 0.05), compared to AADs alone. Post-treatment bEOS was significantly higher in the AZI group than in the traditional Chinese medicine compound granules group (MD = 0.07×109/L; 95% CI, 0.05×109 – 0.09×109; P < 0.001). No statistically significant difference in bEOS after treatment with AZI plus montelukast (MON) and loratadine (LOR) compared to MON and LOR (MD = 0.03×109/L; 95% CI, -0.06×109 – 0.12×109; P = 0.50). Meanwhile, AZI combined with AADs did not increase AEs (RR = 0.76; 95% CI, 0.51 – 1.13; P = 0.17). Conclusions: AZI was beneficial in improving some clinical symptoms and lung functions in childhood asthma. AZI did not increase AEs when combined with AADs.

This study was conducted at Algadarif State Area, east of the Sudan latitudes 12ᵒ 17/, longitudes 34ᵒ 36/ E, which aimed to build a database of the morphometric of 26 properties from a 176 basin, this done through analyzing a digital elevation model ( DEM ) by using a group of geographical data systems programs, which integrated to result in a large number of morphometric variances and measurements. They are represented in the programs ArcMap 10.4.1 as basic programs and other supportive programs like excel. The study was done for the purpose to understand its hydrologic significances and consequently understanding the water movement on the surface of the base. The study depended on the data of the digital elevation model accurately 30 m in addition to a group of maps and satellite images. Adoption of Algadarif State upon automatic agriculture who leads to needing to know a lot about conditions, nature and description runoff water for the rain to know the different characteristics for basins to draw the water map of the State, recognition of cadastral characteristics and formal properties, identify the histological properties and water drainage network characteristics. Arc gis was installed on a windows 10 computer and loaded the digital elevation model for the experiment site from earth explorer, the DEM file was only used. Work was done by Arc Hydro Tools within the Arc GIS.

We analyze a diffuse interface model that couples a viscous Cahn-Hilliard equation for the phase variable with a diffusion-reaction equation for the nutrient concentration. The system under consideration also takes into account some important mechanisms like chemotaxis, active transport as well as nonlocal interaction of Oono’s type. When the spatial dimension is three, we prove the existence and uniqueness of global weak solutions to the model with singular potentials including the physically relevant logarithmic potential. Then we obtain some regularity properties of the weak solutions when t>0. In particular, with the aid of the viscous term, we prove the so-called instantaneous separation property of the phase variable such that it stays away from the pure states ±1 as long as t>0. Furthermore, we study long-time behavior of the system, by proving the existence of a global attractor and characterizing its ω-limit set.

Background: Surgical or percutaneous occlusion of the left atrial appendage (LAA) is increasingly used for thromboembolic protection in atrial fibrillation. Incomplete LAA closure may increase risk of thrombosis and thromboembolism, and therefore approaches to address residual communications are needed. Objective: To analyze the technique of closing an incompletely occluded LAA and subsequent patient outcomes. Methods: We performed a retrospective analysis of 5 consecutive patients who presented for completion of LAA closure. Results: Four patients were male, mean age 75, average CHA2DS2-VASc score 5.4, and four had prior surgical LAA ligation. One patient had previously had a WATCHMAN device placed for whom a 3D printed model was created from preprocedural imaging data to guide Amplatzer occluder device selection for closure. The residual LAA communication maximal diameter averaged 6.2 mm (range 5-8mm). In 4 of 5 cases, an ablation catheter was used to enter the LAA. The residual LAA communication was closed with either an Amplatzer occluder (n=3) or a WATCHMAN device (n=2). No procedural complications occurred, and no residual leak remained afterwards. No neurologic events occurred during follow up (average 603 days, range 155-1177 days). Anticoagulation or dual antiplatelet therapy was stopped following a transesophageal echo (TEE) ³ 6 weeks after the procedure demonstrated no residual communication in 4 of 5 patients, and after 20 weeks in the fifth patient without a follow up TEE. Conclusion: Large residual LAA communications after LAA occlusion attempts can be successfully and safely closed percutaneously using either Amplatzer occluder devices or WATCHMAN devices.

Aim: Forests play a key role in regulating the global carbon cycle, a substantial portion of which is stored in aboveground biomass (AGB). It is well-understood that biodiversity can increase the biomass through complementarity and mass-ratio effects, and the contribution of environmental factors and stand structure attributes to AGB was also observed. However, the relative influence of these factors in determining the AGB of Quercus forests remains poorly understood. Location: Temperate Quercus forests in northeastern China. Methods: Using a large dataset retrieved from 523 permanent forest inventory plots across Northeast China, we examined the effects of integrated multiple tree species diversity components (i.e., species richness, functional and phylogenetic diversity), functional traits composition, environmental factors (climate and soil), stand age, and structure attributes (stand density, tree size diversity) on AGB based on structural equation models. Results: We found that species richness and phylogenetic diversity both were not correlated with AGB. However, functional diversity positively affected AGB via an indirect effect in line with the complementarity effect. Moreover, the community-weighted mean of specific leaf area and height increased AGB directly and indirectly, respectively; demonstrating the mass-ratio effect. Furthermore, stand age, density, and tree size diversity were more important modulators of AGB than biodiversity. Main conclusions: Our study highlights that biodiversity-AGB interaction is dependent on the regulation of stand structure that can be even more important for maintaining high biomass than biodiversity in temperate Quercus forests.