Objective: To classify intraoperative and postoperative complications using the modified Clavien classification system (MCCS) and modified Satava classification system (SCS) and to evaluate the parameters associated with complications in patients undergoing retrograde intrarenal surgery (RIRS) for renal and proximal ureteral stones. Materials and Methods: We performed a retrospective analysis of 949 patients who underwent RIRS for renal stones and upper ureteral stones at two institutions between March2015 and June2020. Intraoperative complications were assessed using SCC and postoperative complications were graded according to MCCS. Univariate and multivariate analyses were undertaken to determine predictive factors affecting complication rates. Results: The female/male ratio of 949 patients was found to be 346 (36.5)/603(63.5). The median stone size was determined as 13 mm. The stone-free rate was 83.6%after the first intervention, and the final stone-free rate was 94.4% after re-procedure. According to SCS, the intraoperative event and complication incidence was 153(16.1%). MCCS revealed postoperative complications in 121(12.8%) patients. Major complications were observed in 18(1.9%) patients. The rate of complications was higher in patients with renal anomalies (9.9% vs 3.9%, p=0.006). Besides, stone localization, size, number and density were associated with the development of complications (p<0.001, p<0.001, p<0.001 and p=0.002, respectively). In addition, the multivariate analysis revealed that for the patients with grade≥3 complications according to MCCS, only stone-free status was a significant predictor of complication development (p=0.044) whereas for those with grade ≥2b complications according to SCS, significant predictors were stone size (p<0.001), stone density (p=0.022), and fluoroscopy time (p<0.001). Conclusion: This study showed that abnormal kidney anatomy, multiple stones, operative time, and stone-free status were reliable predictors of complication development during and after RIRS. Appropriate preoperative management should be planned according to these predictors to prevent intraoperative and postoperative complications.

Abstract Objective: This study was to evaluate the efficacy of rituximab (RTX) versus conventional agents and different RTX dose regimens in the treatment of idiopathic membranous nephropathy (IMN). Methods: After systematically searched associated studies up to 1st December 2020, we performed a fixed and random-effects meta-analysis using the Stata software and evaluated the quality of included studies by the risk of bias scale of the Cochrane collaboration tool. Results: RTX had a higher total remission (TR) (OR = 2.663, 95% CI 1.361 to 5.210, P = 0.004) than conventional therapy for patients at moderate risk for lose of kidney function (pre-study proteinuria < 8 g/d), however, for patients at severe risk (pre-study proteinuria > 8 g/d), there was no significant difference in TR (OR = 0.691, 95% CI 0.064 to 7.423, P = 0.761). In RTX dose studies, standard dose regimen had a better effect of reducing proteinuria than low-dose regimen (Low dose MD = -3.999, 95% CI -6.177 to -1.820; standard dose MD = -5.220, 95% CI -7.160 to -3.279, P < 0.0001). Significant improvement in serum albumin was seen in patients treated with standard dose than low dose regimen (Low dose MD = 0.601, 95% CI 0.052 to 1.150, P = 0.032; standard dose MD = 0.963, 95% CI 0.740 to 1.185, P < 0.0001). Conclusion: For patients with moderate risk IMN, RTX treatment has a higher TR than conventional therapy. Standard dose RTX is more effective than low dose in reducing proteinuria and recovering serum albumin levels.

Pseudosubarachnoid hemorrhage is commonly associated with cerebral edema and can present in cases of severe meningitis or cerebral venous sinus thrombosis. It is important to distinguish these conditions from subarachnoid hemorrhaging to allow for swift appropriate therapy.

Pediatric patients undergoing chemotherapy may present upper airway obstruction due to severe oral mucositis. Although reversible, its clinical course correlates with the course of neutropenia and may be complicated. Thus, airway management in these patients must be determined on an individual case basis.

Facial Nerve palsy is a neurological condition that causes partial or complete impairment of the facial nerve. Bilateral facial nerve palsy is rare with an incidence of 1 per 5,000,000. We report the case of a 34-year-old gentleman who presented with sudden-onset bilateral lower motor neuron (LMN) facial weakness.

Recent taxonomic and molecular phylogenetic studies have shown that Gymnosphaera should be recognized as an independent taxonomic unit at the genus level under the family Cyatheaceae. In this study, the complete chloroplast genomes of the eight species of Cyatheaceae were sequenced, and their phylogenetic relationships were reconstructed using the maximum likelihood, Bayesian inference, maximum parsimony, and neighbor-joining methods, and the characteristics of their simple sequence repeats (SSRs) were compared and analyzed for the first time. The results showed that when Cyatheaceae was divided into three genera,the number, relative abundance, relative density, and GC content of all SSRs and of SSRs of certain unit lengths in the chloroplast genomes of the eight species of Cyatheaceae were genus specific in the whole chloroplast genomes and in their different regions (large single-copy, small single-copy, inverted repeat, intergenic spacer, intron, rRNA gene, and coding sequence regions). The SSRs overall and the single-nucleotide SSRs had significant differences in number, relative abundance, relative density, and GC content between the chloroplast genomes, their intergenic regions, and large single-copy regions. When Cyatheaceae was divided into two genera, only the difference in GC content was significant. Therefore, our results support the restoration of the hierarchical status of Gymnosphaera. This study provides an important basis for the identification of the phylogenetic relationship of Cyatheaceae plants.

Investigation of exophthalmos and blood-colored discharge from the left ventral punctum in a dog was consistent with a conjunctival cyst. 3-D prints of the cyst and surrounding facial bones identified a successful transconjunctival approach without an orbitotomy and patency of the left lacrimal duct was re-established.

BACKGROUND: Despite SARS-CoV-2 immunizations have started in most countries, children are not currently included in the vaccination programs, thus it remains crucial to define their anti-SARS-CoV-2 immune response in order to minimize the risk for other epidemic waves. This study seeks to provide a description of the virology ad anti-SARS-CoV-2 immunity in children with distinct symptomatology. METHODS: Between March and July 2020, we recruited 15 SARS-CoV-2 asymptomatic (AS) and 51 symptomatic children (SY), stratified according to WHO clinical classification. We measured SARS-CoV-2 viral load using ddPCR and qPCR in longitudinally collected nasopharyngeal swabs samples. To define anti-SARS-CoV-2 antibodies we measured neutralization activity and total IgG load (Diasorin). We also evaluated antigen-specific B and CD8+T-cells, using a labelled S1+S2 protein and ICAM expression, respectively. Plasma protein profiling was performed with Olink. RESULTS: Virological profiling showed that AS had lower viral load at diagnosis (p=0.004) and faster virus clearance (p=0.0002) compared to SY. Anti-SARS CoV-2 humoral and cellular response did not appear to be associated with the presence of symptoms. AS and SY showed similar titers of SARS-CoV-2 IgG, levels of neutralizing activity, and frequency of Ag-specific B and CD8+T-cells. Whereas pro-inflammatory plasma protein profile was associated to symptomatology. CONCLUSION: We demonstrated the development of anti-SARS-CoV-2 humoral and cellular response with any regards to symptomatology, suggesting the ability of both SY and AS to contribute towards herd immunity. The virological profiling of AS suggested that they have lower virus load associated with faster virus clearance.

result shows that the blow-up is equivalent to the blow-up of the $L^r-$norms of the solutions for $r$ exceeding some critical value $r_c.$ Under very loose conditions we give the estimation of $r_c,$ relying on a variant of Gagliardo-Nirenberg inequality, and a kind of bootstrap method which is very similar to the Alikakos-Moser iteration procedure.

We present a case of arrhythmia developed after positional change in a patient under general anesthesia, who had peripherally inserted central venous catheter (PICC) inserted by ECG-guided tip confirmation system. We stress the possibility of cardiac arrhythmias related to caudal movement of the PICC catheter upon changes in patient’s position.

Miliaria crystallina is a benign skin condition that follows intense sweating due to excessive exposure to heat, hyperthermia, or humidity. Therefore, it is often observed in intensive care patients, who usually meet these conditions.

This note provides counterexamples to illustrate that Theorem 4 which is proposed by Cornejo, Lobo and Medina [M. E. Cornejo, D. Lobo, J. Medina, Bipolar fuzzy relation equations systems based on the product t-norm. Mathematical Methods in the Applied Sciences. 2019,42(17):5779-5793] is incorrect. The incorrect of Theorem 4 is due to the inaccuracy of the definition of feasible pair. Then we present the correction of the definition of feasible pair to the contention.

In this paper, we developed and studied a stochastic HIV model with nonlinear perturbation. Through a rigorous analysis, we firstly showed that the solution of the stochastic model is positive and global. Then, by employing suitable stochastic Lyapunov functions, we prove that the stochastic model admit a unique ergodic stationary distribution. In addition, sufficient conditions for the extinction of HIV infection are derived. Finally, numerical simulations are employed to confirm our theoretical results.

This study presents a novel piezoelectric beam structure for acoustic energy harvesting. The beams have been designed to maximize output energy in areas where the noise level is loud such as highway traffic. The beam consists of two layers (copper and polyvinylidene fluoride) that convert the ambient noise’s vibration energy to electrical energy. The piezoelectric material’s optimum placement have been studied, and its best positon is obtained on the substrate for the maximum yield. Unlike previous studies, which the entire beam substrate used to be covered by a material, this study presents a modest material usage and contributes to lowering the harvester’s final production cost. Additionally, in this study, an electrical model was developed for the sensor and a read-out circuitry was proposed for the converter. Moreover, the sensor was validated at different noise levels at various lengths and locations. The simulations were performed in COMSOL Multiphysics® and MATLAB® and report a maximum sound pressure of 140 dB from 100 dB point sources in an enclosed air-filled cubic meter chamber.

Lacking of systematic evaluations in soil quality and microbial community recovery after different amendments addition limits optimization of amendments combination in coal mine-soils. We performed a short-term incubation experiment over 12 weeks to assess the effects of three amendments (biochar: C; nitrogen fertilizer at three levels: N-N1~N3; microbial agent at two levels: M-M1~M2) based on C/N ratio (regulated by biochar and N level: 35:1, 25:1, 12.5:1) on soil quality and microbial community in the Qilian Mountains, China. Over the incubation period, soil pH and MBC/MBN were significantly lower than unamended treatment in N addition and C+M+N treatments, respectively. Soil organic carbon (SOC), total nitrogen (TN), available nitrogen (AN), available phosphorus (AP), available potassium (AK), microbial biomass carbon (MBC) and microbial biomass nitrogen (MBN) contents had a significant increase in all amended treatments (P<0.001). Higher AP, AK, MBC, MBN and lower MBC/MBN were observed in N2-treated soil(corresponding to C/N ratio of 25:1). Meanwhile, N2-treated soil significantly increased species richness and diversity of soil bacterial community (P<0.05). Principal coordinate analysis further showed that soil bacterial community compositions were significantly separated by N level. C-M-N treatments (especially at N2 and N1 levels) significantly increased the relative abundance (>1%) of the bacterial phyla Bacteroidetes and Firmicutes, and decreased the relative abundance of fungal phyla Chytridiomycota (P<0.05). Redundancy analysis illustrated the importance of soil nutrients in explaining variability in bacteria community composition (74.73%) than fungal (35.0%). Our results indicated that N and M addition based on biochar can improve soil quality by neutralizing soil pH and increasing soil nutrient contents, and the appropriate C/N ratio (25:1: biochar+N2-treated soil) can better promote mass, richness and diversity of soil bacterial community. Our study provided a new insight for achieving restoration of damaged habitats by changing microbial structure, diversity and mass by regulating C/N ratio of amendments

Araucaria araucana is an iconic long-lived endangered tree species exclusively distributed in Southern Chile and Argentina. Araucaria forest ecosystems provide a myriad of ecosystem benefits to local aboriginal Mapuche-Pehuenche communities. Among the main current threats for Araucaria forests are the increasing frequency and severity of wildfires and overgrazing. This study evaluates the effect of uncontrolled livestock grazing on soil quality indicators linked to critical functions relevant to forest regeneration and ecosystem service provision. We also aim to determine a set of soil quality indicators that are sensitive enough to grazing pressure, so they are useful as early indicators of degradation or the effectiveness of restoration practices. This study evaluated twenty soil quality indicators in two contiguous degraded forest areas with contrasting grazing pressure. We observed a substantial shift in forest structure, a reduction in tree coverage on the overgrazed sites. Overgrazing has produced significant deterioration of most soil physical, chemical, and biological quality indicators making soil conditions less suitable for seed germination and sapling establishment. We also observed an alteration in C, N, and P biogeochemical pools. Besides, soil physical indicators alterations suggest changes in these soils' hydrological behavior, potentially reducing water storage, availability, and increasing runoff. We show that uncontrolled grazing in native protected areas degrades soils and forest health, restricting forest regeneration and potentially accelerating erosive processes. Our results emphasized the need for an improved conservation plan for these forests that systematically evaluates and monitors livestock grazing and all its direct and indirect effects, including soil quality.

Aim: The Norwegian Association for Clinical Pharmacology in their National Guidelines decreased therapeutic range (TR) of topiramate (TPM) from 5-20 mg/L to 2-10 mg/L. The objective of this study is to ascertain which TR produces better clinical outcomes. Methods: Data source were request forms for routine therapeutic drug monitoring of TPM. Concentration dependent adverse drug reactions (ADRs) were evaluated in 1,721 samples taken pre-dose. Seizure frequency analysis was performed in 294 samples of monotherapy. Statistics: Prism 5.0, GraphPad Instatt: Mann–Whitney U test for median plasma level (PL). χ2-test for seizure frequency and for distribution of PL according to TR 5-20 mg/L and intervals <2, 2-5, 5-10, 10-20, >20 mg/L. Results: Better seizure control was found in children both in whole cohort (without seizure 49% vs 37% adults), as well as in monotherapy (56% vs 44%), in children with PL 5-20 mg/L vs 5 mg/L (65% vs 44%) and in children with PL 5-10 mg/L vs <2 mg/L. Seizure-free children had higher PL than those with seizure yearly: median (lower, upper quartile) [mg/L]: 5.5 (3.4-6.5) vs 4.7 (4.3-7.95). No difference was found in adults. Seizure control was poorer in all patients with PL <2 mg/L compared to 5-10 mg/L; and 10-20 mg/L; further in PL within 5-10 mg/L vs 10-20 mg/L; and in the period 2003-2005. ADRs reported in 38 samples (2.8%) were without relation to PL. Conclusions: Change of TR is not recommended.

Alcohol use disorder (AUD) is one of the most common but still poorly treated psychiatric conditions. Developing new treatments requires a better understanding of the aetiology of symptoms and evaluation of novel therapeutic targets in preclinical studies. Recent developments in our understanding of the reinforcement-based cognitive biases (RBCBs) that contribute to the development of AUD and its treatment offer new opportunities for both clinical and preclinical research. In this review, we first briefly describe psychological and cognitive theories that implicate various aspects of reinforcement sensitivity in the development, maintenance, and recurrence of alcohol addiction. Furthermore, in separate sections, we describe studies investigating RBCBs and their neural, neurochemical, and pharmacological correlates, and we discuss possible interactions between RBCBs and trajectories of AUD. Finally, we describe how recent translational studies using state-of-the-art animal models can facilitate our understanding of the role of reinforcement sensitivity and RBCBs in various aspects of AUD.

Managing plastic waste is a global challenge that challenges our ecosystem’s health due to its high production rate and non-biodegradability. However, it is necessary to ensure that PWs are properly managed to reduce the environmental pollution associated with their incineration and dumping in landfills. This study explores the possibility of utilizing polyethylene terephthalate (PET) waste bottles and river sand to produce floor tiles. The flammability, abrasion resistance, mechanical strength, and strong acid/base resistance of the produced PET-based floor tiles were investigated as well as the micro-structural interface of the PET plastic waste and sand. The PET waste was used at different proportions (100 %, 90 %, 70 %, 50 %, and 30 %) by sand weight. The assessment of the materials’ physical and mechanical properties has shown that, in terms of material density, strength, abrasion, and flame resistance, the floor tiles produced with 30% PET content performed better than those produced with the other PET contents. It showed the highest compressive strength value (19.72 N/mm2). The observed compressive strength values in this study were significantly higher than the recommended 28-day residential concrete value of 17 N/mm2; p<0.05. From the obtained results, the PET floor tiles showed poor water absorption performance compared to pure cement and ceramic floor tiles (The lowest water absorption value of 0.12 % was found in tiles made of 100 % PET waste). Microscopic analysis of the interface region (plastic-binder) showed adhesion between the plastic and sand components of the PET-based floor tiles, as well as voids in direct proportion to the PET content. The PET floor tiles also showed good resistance to acid and base solutions of different strengths. In conclusion, PET waste bottles can be used as cement replacement to produce durable and abrasive resistant floor tiles for both residential and commercial uses.

Surveys of patterns of genetic variation in natural sympatric and allopatric populations of recently diverged species are necessary to understand the processes driving intra and interspecific diversification. The South American moths Cactoblastis cactorum, Cactoblastis doddi and Cactoblastis bucyrus are specialized in the use of cacti as host plants. These species have different distribution ranges and differ in patterns of host plant use. However, there are areas in which their ranges overlap, as in northwestern Argentina, where they are largely sympatric. Using a combination of genome-wide SNPs and mitochondrial data we investigated the phylogeographic patterns of these cactophilic moths and searched for footprints of hybridization. Additionally, we evaluated a moth population feeding on Cleistocactus baumannii, a plant never reported as a host for the genus. We identified three well delimited species and detected signs of historical gene flow. Our survey also revealed intraspecific geographic structure in both C. doddi and C. cactorum and showed that the moth population feeding on C. baumannii may be considered as conspecific to C. bucyrus. Overall, our results indicated historical events of genetic interchange occurred in Cactoblastis cactophagous moths, but host plants likely played an important role during divergence limiting gene flow across species.

Post renal transplant patients are generally immunosuppressed and remain at a higher risk for getting bacterial and viral infections. Most of these patients are taking immunosuppressive medications, including steroids. This case series highlights the clinical outcomes and characteristics of 8 post renal transplant patients who acquired COVID-19.

Submersion and exposure from the operation of the Three Gorges Reservoir (TGR) can alter soil properties and plant characteristics at different elevations of the water level fluctuation zone (WLFZ), possibly influencing soil detachment capacity (Dc), but the vertical heterogeneity of this effect is uncertain. Soil samples were taken from 6 segments (5 m elevation per segment) along a slope profile in the WLFZ of the TGR to clarify the vertical heterogeneity of Dc. Scouring experiments were conducted at 5 slope gradients (17.63%, 26.79%, 36.40%, 46.63%, and 57.74%) and 5 flow rates (10, 15, 20, 25, and 30 L min–1) to determine Dc. The results indicate that the soil properties and biomass parameters of the WLFZ are strongly affected by elevation. Dc fluctuates with increasing elevation, with maximum and minimum average values at elevations of 145-150 m and 165-170 m, respectively. Linear equations accurately describe the relationships between Dc and hydrodynamic parameters. τ, ω, and E perform much better than U. Furthermore, a clear improvement is seen when using the general index of flow intensity to estimate Dc. Dc is significantly negatively correlated with MWD (p < 0.05) and organic matter (p < 0.01) but not significantly correlated with other soil properties (p > 0.05). At elevations of 145-150 m and 170-175 m, rill erodibility was greater than at other elevations. The critical hydraulic parameters were highest in the 165-170 m segments, both showing obviously fluctuation in the vertical direction of slope surface. This research highlighted the vertical heterogeneity of the soil detachment and was helpful to understand the mechanisms of soil detachment processes in the WLFZ of the TGR.

Children with malignant mediastinal masses have increased thrombotic events (TE). We examined primary thromboprophylaxis in reducing TE. Eligible subjects were started on enoxaparin thromboprophylaxis and compared to a cohort without. There were 15 TEs among 76 subjects for an incidence of 19.7%. Mediastinal compression directly led to TE, (M-TE) in 9.2% of subjects requiring 2-fold longer duration of therapeutic anticoagulation. Primary thromboprophylaxis revealed a trend towards reduction in M-TE although not statistically significant. The M-TE subjects had greater superior vena caval compression at diagnosis (p=0.033). We conclude that strategic thromboprophylaxis guided by monitoring dynamic vascular compression can improve TE outcomes.

We report the case of a woman with schizoaffective disorder, killing her child under the effect of an impulse motivated by Capgras syndrome in a strange crime scene including evisceration and enucleation. This case help to better understand the association between misidentification syndromes and homicide and to promote preventive measures.