Introduction: We aimed to analyse the application of Khorana score in cancer patients. We also tried to evaluate the prescription of primary thromboprophylaxis in cancer patients at risk of venous thromboembolic disease (VTE). Methods: A retrospective observational study on survival of hospitalized patients diagnosed with pulmonary embolism (PE) at the Hospital Central de la Defensa from January 2009 to March 2018. They were stratified into tumour PE (TPE) and non-tumour PE (nTPE). A case-control study was also carried out with TPE patients and non PE cancer patients (nPEC). Results: 108 patients were diagnosed with TPE, 260 nTPE and 324 nPEC. Gynaecological tumours were the most frequent (23.1%), followed by lung, digestive and urological cancer (20.4% each) in TPE group. Death risk was 1,9 times higher in cancer patients (95%CI: 1.23-2.8) (p <0.001). Khorana score was ≥3 points in 9.7% of TPE and 3.1% of nPEC compared to 26.2% of TPE and 9.9% of nPEC with Khorana score ≥2 points (p<0.001). 7.4% of TPE patients received thromboprophylaxis. Khorana score in TPE patients without thromboprophylaxis was ≥3 points in the 9% and ≥2 points in the 24%. Conclusions: There is a trend towards underuse of thromboprophylaxis in our cancer patients and mainly in those with high risk of VTE, as well as poor adherence to the Khorana score. More studies are needed to validate these findings and to optimize predictive strategies in the management of these patients.

In this work, we applied online chlorophyll a fluorescence measurements to monitor the changes in the photochemical parameters both in nitrate-deplete and nitrate-replete cultures of Nannochloropsis oceanica, in addition to biochemical parameters such as growth, lipid, fatty acid, and pigment contents. Under nitrate-replete conditions, growth was promoted along with pigment content, while total lipid content and fatty acid saturation level diminished. Under nitrate-deplete conditions, cultures showed an increased de-epoxidation state of the xanthophyll cycle pigments. Fast transients revealed a poor processing efficiency for electron transfer beyond QA, which was in line with the low electron transport rate due to nitrate depletion. Lipid content and the de-epoxidation state were the first biochemical parameters triggered by the change in nutrient status, which coincided with a 20% drop in the online effective quantum yield of PSII (ΔF/Fm’), and a raise in the Vj measurements. A good correlation was found between the changes in ΔF/Fm’ and lipid content (r=-0.96, p<0.01). The results confirm the reliability and applicability of online fluorescence measurements to monitor lipid induction in N. oceanica.

Recent findings suggest that immunosenescence should not be considered as a unidirectional deterioration, and that the remodeling of the immune system with age could also be adaptive. Longitudinal studies on immunosenescence in wild populations are scarce, and therefore, processes like selective disappearance cannot be easily torn apart from senescence. Using a long-term and longitudinal monitoring of a wild population of Alpine marmots, we aimed to understand within and between individual variation in the immune phenotype with age, in order to improve our knowledge about the occurrence and the consequence of immunosenescence in the wild. We tested, once controlled for a potential selective disappearance, whether individuals’ immune function only decreases as they age, as expected from the disposable soma theory, or whether remodelling of the immune system does occur. Therefore, we recorded the age-specific leukocyte concentration and counts in repeatedly sampled dominant individuals and we tested the potential changes with age as well as their association with survival probabilities. The overall leukocyte concentration was stable with age, but the lymphocyte count decreased, while the neutrophil count increased, over the course of an individual’s life. The leukocyte counts also predicted survival: at a given age, individuals with fewer lymphocytes but more neutrophils were more likely to die. Longitudinal studies, like the present one, are required to properly understand the patterns and consequences of immunosenescence in the wild.

In the last few years, traffic flows are being recorded via the global positioning system over the Internet, which has yet to become ubiquitous. A novel technology for the intelligent transport system is being proposed, which will reduce the congestion that will be unavoidable in the near future. This system uses a magnetic sensor to identify the type of vehicle and the exact number of vehicles in the traffic environment based on the fluctuations in magnetic flux. This information is transmitted to the cloud server via nearby proximity services using clusters. An intelligent agent using gain learning will be implemented in the cloud server to learn real-time traffic flow from multiple sources to predict a valid and optimized route proposal for registered users. This work will be implemented and the implementation results show that the proposed work will achieve an accuracy of 98.36%. Therefore, this intelligent method for VANETs will certainly lead to improved traffic forecast for vehicle transport, it can reduce waiting times in traffic and minimize fuel consumption, and it will create an environmentally friendly environment with reduced carbon dioxide emissions in urban cities. Smart approach to communication This model describes the complete system architecture of the proposed work as shown in Fig. 1. The magnetic sensor is embedded in the vehicle and can retrieve vehicle type information from its coverage area. Such useful information is sent to the cloud server using a cluster header via Proximity Services to determine the traffic flow. Based on this information, a cloud-based agent efficiently provides an optimized route to the registered user. This section deals with clustering and the selection process for cluster head selection procedure, which aims to ensure faster and more reliable communication in a dynamic transport system. Vehicles with other wireless devices such as mobile phones, laptops and other Internet devices connect to a cluster group that is capable of transmitting the data to the cloud server. Clusters consist of a wireless network that provides Pro-Sec proximity services that ensure reliable vehicle communication with the cloud server. Among the units in the cluster, one of the devices is selected as cluster head due to its initial residual energy.

The following is a response to the Letter to the Editor by Cong et al.

Editorial commentary

BJOG commentary for BJOG-21-0466 A core outcome set for the treatment of pregnant women with pregestational diabetes: an international consensus study

Mini-Commentary on Manuscript # BJOG-20-2493A Biomarker for Amniotic Fluid Embolism: The Search ContinuesWord count: 495Research into the pregnancy associated cytokine storm-like condition historically known as amniotic fluid embolism (AFE) has been hampered by a lack of unique diagnostic criteria. In its classic form, the clinical presentation of this condition is unmistakable. In less classic presentations, each of the clinical hallmarks of AFE (depressed ventricular function, lung injury and coagulopathy) may, in isolation, be seen in other obstetric conditions. Indeed, much of the confusion arising from previously published case series purporting to describe women with AFE appears to be the result of the inclusion of patients with other conditions. (Clark SL et al Obstet Gynecol 2014:123: 337-48) Identification of a reliable, objective biomarker specific to AFE is badly needed.It is against this background that the work of Bouvet et al is especially welcome. These investigators examined the use of insulin-like growth factor binding protein -1, a protein found in high concentration in amniotic fluid, as a potential biomarker of AFE in women suspected to have this condition. Unfortunately, the results were negative, leading the authors to question the usefulness of this assay.Although the results were negative, the major importance of this study may be as an example of how to properly conduct a search for AFE biomarkers. These authors avoided several pitfalls that have invalidated most previous biomarker publications. First, they used 2 objective, internationally recognized clinical criteria sets for identifying women with AFE. Their finding that only about half of women suspected to have AFE actually had the condition based on either of the identified criteria sets emphasizes the importance of insisting on inclusion criteria more stringent than “someone thought the patient had AFE,” so common in current literature. Secondly, in their use of women with suspected AFE these investigators avoided another common pitfall in biomarker research, namely the use of normal pregnant women, rather than critically ill women as controls. Presumably the women without AFE had some other form of critical illness. This distinction is particularly important in investigating the potential of various inflammatory mediators as specific markers for AFE.Finally, the authors’ data support 2 additional important conclusions beyond the original intent of the paper. The finding that 100% of AFE patients identified by the SMFM criteria also met the UK diagnostic criteria serve as additional validation of the ability of the former criteria to reliably identify a group of women who, for research purposes, do have the disease, while excluding some others with less typical forms of AFE. (Clark et al, Am J Obstet Gynecol 2016:408-12.) Secondly, the authors’ findings of no difference in levels of ILGFBP-1 in women with and without clinical AFE, despite high levels of this protein in amniotic fluid, supports the current belief that amniotic fluid per se is unrelated to the condition known as amniotic fluid embolism.It is generally accepted by the scientific community that AFE is unpreventable. It is hoped that additional quality research such as that of Bouvet et al may someday change this unfortunate fact.

Vaccines require continuous refrigeration to retain their efficacy as most vaccine components are derived from mammalian or microbial origin which are thermally unstable. Continuous refrigeration, known as the vaccine cold chain, comes at a cost that directly correlates to the standard of infrastructure that is available. A break in the cold chain caused by poor infrastructure can result in direct loss of functionality in these lifesaving medicines. Therefore, several approaches have been suggested to mitigate these losses. Not only will these benefit general healthcare via improved shelf-life but also enhanced resistance to thermal fluctuations and, in some cases, improved drug target localisation. In this minireview, we highlight trends in vaccine thermal stabilisation and look to the future for cold chain logistics.

Objective To explore optimum use of the Odon Device by establishing the optimal device design, describing the ‘usual’ steps for use and setting clinical parameters for device use. Design Qualitative case study methodology was embedded in the ASSIST Study – a feasibility study of the Odon Device. Setting Central Delivery Suite, North Bristol NHS Trust, UK. Population Women who required a clinically indicated assisted vaginal birth. Methods Each case was determined by the single use of the Odon Device and could contain data from one or more of the following: formal observation of the Odon assisted birth, an interview with obstetricians, midwives or women involved in an Odon assisted birth. Data collection and analysis ran iteratively and in parallel enabling rapid dissemination of findings. Main outcome measures Determining the optimal steps for device use, recommendations for optimal device design and defining clinical parameters for device use. Results Optimal steps included applying the device during rather than between contractions, having a flexible approach to the application angle and deflating the air cuff sooner than originally proposed. Three design modifications were proposed. The device can be used under local or regional anaesthetic and is successful with all vertex presentations. It is not successful at assisting birth when the vertex is at station spines. Conclusions Case study methodology facilitated rapid insight into optimum device design, device use and key clinical parameter for successful use. This methodology should be considered whenever innovative devices are introduced to clinical trials and settings.

In this paper, an output-based event-triggered control problem of discrete-time networked control systems (NCSs) subject to bilateral data packet dropouts is investigated. In view of the stochastic sequences of packet dropouts in measurement channels (from sensors to controller) and control channels (from controller to actuators), the NCS is converted into a closed-loop stochastic parameter system. In the aid of a Lyapunov functional based on stochastic variables, sufficient conditions on co-design of event-triggering strategy and exponentially mean-square stability of NCSs are derived. Furthermore, an improved iterative algorithm is given to obtain the dynamic output feedback control law and event-triggering parameters from the nonconvex inequalities. Finally, a numerical example and the corresponding simulation results are given to show the validity and applicability of the developed techniques.

Patients suffering from cataplexies have a highly significant risk of severe injury. This paper discusses (manufacturer-independent) medical devices that should be prescribed to any patient with moderate to severe cataplexy.

Prudent predators catch sufficient prey to sustain their populations but not as much as to undermine their populations’ survival. The idea that predators evolve to be prudent has been dismissed in the 1970s, but the blunt arguments invoked then are untenable in light of modern evolution theory. Evolution of prudent predation has repeatedly been demonstrated in two-species predator-prey metacommunity models. However, the vigorous population fluctuations that these models predict are not widely observed. Here we show that in complex model food-webs prudent predation evolves by a different mechanism. We make testable predictions for empirical signatures of this mechanism and its outcomes. Then we discuss how these predictions are borne out across freshwater, marine, and terrestrial ecosystems. Demonstrating explanatory power of evolved prudent predation well beyond the question of predator-prey coexistence, the predicted signatures explain unexpected declines of invasive alien species, the shape of stock-recruitment relations of fish, and the clearance rates of pelagic consumers across the latitudinal gradient and 15 orders of magnitude in body mass. Specific research to further test and mobilise the utility of this theory is proposed.

Ark shells are commercially important clam species that inhabit in muddy sediments of shallow coasts in East Asia. For a long time, the lack of genome resources has hindered scientific research of ark shells. Here, we reported a high-quality chromosome-level genome assembly of Scapharca kagoshimensis, with an aim to unravel the molecular basis of heme biosynthesis, and develop genomic resources for genetic breeding and population genetics in ark shells. Nineteen scaffolds corresponding to 19 chromosomes were constructed from 938 contigs (contig N50=2.01 Mb) to produce a final high-quality assembly with a total length of 1.11 Gb and scaffold N50 around 60.64 Mb. The genome assembly represents 93.4% completeness via matching 303 eukaryota core conserved genes. A total of 24,908 protein-coding genes were predicted and 24,551 genes (98.56%) of which were functionally annotated. The enrichment analyses suggested that genes in heme biosynthesis pathways were expanded and positive selection of the hemoglobin genes was also found in the genome of S. kagoshimensis, which gives important insights into the molecular mechanisms and evolution of the heme biosynthesis in mollusca. The valuable genome assembly of S. kagoshimensis would provide a solid foundation for investigating the molecular mechanisms that underlie the diverse biological functions and evolutionary adaptations of S. kagoshimensis.

Evapotranspiration (ET) constitutes the largest loss of water from subtropical grassland and wetland ecosystems, yet estimates have high uncertainty at the landscape scale as there is little information on plant water use. A major reason for this is the complexity and expense of field-based ET quantification methods such as agricultural lysimeters and eddy covariance systems. This study developed two different low-cost lysimeters – weighing-type and water level based, to measure ET under controlled conditions for single species as well as mixed grassland and wetland communities. Lysimeters were placed in an open sided shadehouse with a transparent roof to exclude rainfall. ET values were then compared with (i) Actual ET measurements from an eddy covariance tower onsite, (ii) vapor transport-based ET models - FAO Penman-Monteith, Modified Turc and Abtew Simple Radiation models, and (iii) ET data from the Florida Automated Weather Network. Both weighing-type and water level lysimeters showed seasonal patterns and annual magnitudes similar to the other ET methods. Annual ET measurements from weighing lysimeters (881-1278 mm for four plant species, n=5 per species) and water level lysimeters (1085 mm, n = 30) were similar to model estimates (1000-1200mm). Actual ET from eddy covariance was 722 mm for ten months (missing data for February and March), similar to lysimeter measurements for the dominant grass Paspalum notatum (885mm for 10 months). Low-cost lysimeters can easily inform regional ET models/remote sensing data lacking field validation and thus are potentially useful for water resources and ecosystem management in data-poor regions of the world.

People who suffer from cataplexy have a significant risk of injury. This paper discusses (manufacturer-independent) medical devices that should be prescribed to any patient with moderate to severe cataplexy.

Allergic diseases include asthma, atopic-dermatitis, allergic-rhinitis, drug hypersensitivity and food-allergy. During the past years, there has been a global outbreak of allergic diseases, presenting a considerable medical and socioeconomical-burden. A large fraction of allergic diseases is characterized by a type-2 immune response involving Th2 cells, type-2 innate lymphoid cells, eosinophils, mast cells, and M2 macrophages. Biomarkers are valuable parameters for precision medicine as they provide information on the disease endotypes, clusters, precision diagnoses, identification of therapeutic targets, and monitoring of treatment efficacies. The availability of powerful omics technologies, together with integrated data analysis and network-based approaches can help the identification of clinically useful biomarkers. These biomarkers need to be accurately quantified using robust and reproducible methods, such as reliable and point-of-care systems. Ideally, samples should be collected using quick, cost-efficient and non-invasive methods. In recent years, a plethora of research has been directed towards finding novel biomarkers of allergic diseases. Promising biomarkers of type-2 allergic diseases include sputum eosinophils, serum periostin and exhaled nitric-oxide. Several other biomarkers, such as pro-inflammatory mediators, miRNAs, eicosanoid molecules, epithelial barrier integrity, and microbiota changes are useful for diagnosis and monitoring of allergic diseases and can be quantified in serum, body-fluids and exhaled-air. Herein, we review recent studies on biomarkers for the diagnosis and treatment of asthma, chronic-urticaria, atopic-dermatitis, allergic-rhinitis, chronic-rhinosinusitis, food-allergies, anaphylaxis, drug hypersensitivity and allergen-immunotherapy. In addition, we discuss COVID-19 and allergic diseases within the perspective of biomarkers and recommendations on the management of allergic and asthmatic patients during the COVID-19 pandemic.

Zooplankton play a pivotal role in sustaining the majority of marine ecosystems. The distribution patterns and diversity of zooplankton provide key information for understanding the functioning of these ecosystems. Nevertheless, due to the numerous cryptic and sibling species and the lack of diagnostic characteristics for immature developmental stages, the identification of the global-to-local patterns of zooplankton biodiversity and biogeography remains a challenge in different research fields. Here, the spatial and temporal changes in the zooplankton community from the open waters of the southern section of the Gulf of Mexico were assessed using a multilocus sequence analysis and metabarcoding approach based on the genetic information of 18S and cytochrome oxidase c subunit I (COI) genes. Additionally, a multi-scale analysis was implemented to evaluate which environmental predictors may explain the variability in the structure of the zooplankton community. Our finding suggests that the synergistic effects of oxygen, temperature, and longitude (intended as a proxy for still unexplored forces) may explain both spatial and temporal changes in the zooplankton community. Furthermore, the zooplankton distribution likely reflects the coexistence of three heterogeneous ecoregions and a bio-physical partitioning of the studied area. Finally, some taxa were either exclusive or predominant with either 18S or COI data. This may suggest that comprehensive assessments of the zooplankton community may be more accurately met by the use of multi-locus approaches.

Objectives: We aimed to determine the bronchoscopic features of children with severe Mycoplasma pneumoniae pneumonia (SMPP), and correlation with obliterative bronchitis (OB), so as to help early clinical evaluation and treatment of pediatric SMPP. Methods: 213 pediatric SMPP cases admitted to Beijing Children’s Hospital were included. Medical records and bronchoscopic manifestations at different SMPP stages were retrospectively analyzed . Results: Of 213 acute-stage pediatric SMPP patients, bronchoscopy revealed 22 cases (10.3%) with subacute-stage or recovery-stage OB, for an OB incidence rate in cases with mucous embolus of 48.8% (22/47), a significantly higher rate than the rate without mucous embolus (0/166, 0%) (P < 0.001). Notably, the OB incidence rate for children undergoing bronchoscopy within 10 days (9/142, 6.3%) of SMPP onset was significantly lower than in children undergoing bronchoscopy 10 days post-disease onset (13/71, 76.5%) (P < 0.007). Conclusions: In pediatric SMPP patients, airway mucus and debris from epithelial necrosis and exfoliation can block airway subbranches, readily leading to OB.

Objective:High-flow nasal cannula oxygen therapy (HFNC) is a new type of non-invasive respiratory support technique that widely used in pediatric intensive care units (PICUs);however,improper use of HFNC is likely to bring adverse outcomes to critically ill children.Our objective of this study was to identify the risk factors for the failure of HFNC.Study design: Divided the patients into different categories: HFNC success group, a 48h failure group, a 24h failure group, and a 2h failure group.The clinical indexes and the change trend in HFNC before and after treatment were dynamically observed in 67 pediatric patients. Risk factors for HFNC failure were determined using multivariate logistic regression analysis.Results:PRISM III score>4 points and PaCO2>43 mmHg were risk factors for 48h failure (OR were 4.064, 4.516, P<0.05); PaCO2>43 mmHg was risk factors for 24 h failure (OR was 3.152, P<0.05); PRISM III score>6.5 points and PaCO2/PaO2 ratio>0.67 were risk factors for 2 h failure (OR were 27.977, 64.366, P<0.05) and the risk of HFNC failure increased more than 5 times when the PaO2/FiO2 ratio decreased by>28% after 2 h of HFNC treatment, and the invasive mechanical ventilation time was statistically longer in the patients that upgraded from HFNC to invasive respiratory support than that of patients who received invasive respiratory support directly(P<0.05).Conclusions:The PRISM III score, PaCO2 and PaCO2/PaO2 ratio were risk factors for HFNC failure.Totally the shorter the failure time, the higher the values of the risk factors were, and the higher the failure risk of HFNC was. The change in the PaO2/FiO2 ratio before and after HFNC is a warning indicator for early HFNC failure. And early HFNC failure might lead to prolonged invasive mechanical ventilation.

A document by Caroline Komlo. Click on the document to view its contents.

The Digital Elevation Model (DEM) of a watershed is one of the most important inputs in most hydrological analyses and plays a key role in the accurate prediction of various hydrological processes. Comprehensive knowledge of the impact of different DEM sources on the performance of a model is essential before utilizing the model. In this study, we evaluated the influence of TOPO1:25000, ASTER, and SRTM DEMs, as input, on the performance of the Soil and Water Assessment Tool (SWAT) model for the prediction of surface runoff. We also investigated the effect of the resolution of the studied DEM sources on the accuracy of the SWAT model in the estimation of runoff. The second objective of this study was to identify the most influential and the least impactful input parameters on the performance of the SWAT model. We studied the Zarrineh River watershed in Iran as a case study to compare the effect of the aforementioned DEM types and DEM resolution on the output of the SWAT model. The outcomes of the study demonstrated that influential parameters on predicted runoff as well as a few watershed parameters, such as reach lengths, reach slopes, number of sub-basins, and the number of hydrologic response units (HRU), differs noticeably when the DEM source and resolution changes. It was also observed that simulated results over-predict the runoff during low precipitation periods and under-predict the runoff during high precipitation months, and the accuracy of the simulated results decreases by reducing the DEM resolution. The results showed that the SWAT model had the best performance when the TOPO1:25000 DEM was used as the input source. Low-resolution DEMs are available to a wider range of researchers. The outcomes of the current study can be employed to estimate the impact of low-resolution input data on the simulated result as well as substantially reduce the computation time by decreasing the input DEMresolution with only a minor reduction of accuracy.

Maintenance of genome stability is quintessential feature for all living organisms. The simplest aldehyde formaldehyde and UV-B radiation, two environmental toxic factors, cause DNA damage, affect genome stability, subsequently growth and development across kingdoms. However, the interrelationship of genotoxicity caused by formaldehyde and UV-B remains fragmented in plants. Here, we show that mutants lacking one aldehyde detoxifying enzyme, alcohol dehydrogenase 2 (ADH2, also named GSNOR/FALDH), are hypersensitive to low dosage UV-B radiation or UV-B radiation-mimetic chemical in seedling and root growth. The defects are not caused by the alteration of UV-B sensing, secondary metabolites flavonoid accumulation, or ROS accumulation, rather are UV-B-induced genotoxicity. Increased DNA damage response genes and comet assay tail, cell cycle arrest upon exposure to UV-B provide direct evidence for DNA damage in gsnor mutant. Pharmacological analyses show that the susceptibility to genotoxic stresses is caused by the increased DNA crosslink which results from the enhanced endogenous formaldehyde in gsnor while UV-B promotes the production of formaldehyde. This implies formaldehyde clearance through GSNOR plays a critical role in response to environmental genotoxic stress and interplay between formaldehyde and UV-B exacerbates genome instability.

The conversion of natural forests to planted forests has become a global trend, and the practice has wide-ranging effects on soil. This study aimed to explore the differences in soil water movement after the conversion of evergreen and deciduous broad-leaved mixed forests (natural forest, NF) to Chinese fir (Cunninghamia lanceolate (Lamb.) Hook.) plantations (CFP, 20–21 years old). Soil samples from five layers (0–5, 5–10, 10–20, 20–30, and 30–50 cm) were collected from NF and CFP before and after rainfall event in the Peng Chongjian watershed, Jiangxi Province. The physical properties of the soils, including the mean and coefficient of variation (CV) of soil moisture content and the soil particle composition, were determined in both forest types. The δD of soil water and the litter water-holding capacity were also measured. The results showed that the variation ranges of moisture content in each soil layer after the rainfall was 21.13%–49.40% in CFP and 21.33%–43.87% in NF. There were no significant differences in soil bulk density or porosity; the clay and silt contents were significantly increased in topsoil, while the sand was significantly decreased (P < 0.05). After the rainfall, soil water in CFP responded more promptly than NF. In the process of infiltration, the contribution of rainfall to soil moisture gradually decreased with increasing soil depth. Topsoil (0–5 cm) in NF responded promptly to rainfall, but the response showed a lag effect with the increase of soil depth. With the extension of infiltration time, the contribution of precipitation to deep soil gradually increased. The results showed that the soil did not degrade after the conversion of NF to CFP, a significant guiding result for plantation cultivation.