Two recent publications in Pediatric Pulmonology had methodological limitations in evaluating exercise-induced dyspnea (EID). Testing that does not include concurrence of dyspnea with an abnormality may provide misleading information to the detriment of the patient. Reproducing the patient’s dyspnea during cardiopulmonary monitoring provides the etiology of at least 7 causes of EID, many of which may not otherwise be identified.

Background and Aim: We aimed to identify risk factors for recurrent mitral regurgitation in two surgical treatment groups: isolated coronary artery bypass grafting (CABG) and CABG combined with mitral valve (MV) repair in patients with moderate ischemic mitral regurgitation (IMR). Methods: A single-centre, prospective, randomised study, which included 76 patients with ICM and moderate mitral regurgitation (MR). Study included two groups: isolated CABG and CABG with MV repair (MVR). Isolated annuloplasty was used to correct mitral insufficiency in the CABG + MVR group. Results: Isolated CABG or CABG combined with MVR in patients with ICM does not lead to a statistically significant decreasing of MR in the long-term period compared to baseline values. However, in one year after surgery, the degree of MR after combined surgery is lower than the initial values. The identification of predictors of the progression of IMR in ICM made it possible to determine the threshold values for the effectiveness of MVR, and the assessment of echocardiographic predictors for annuloplasty helps to choose the right surgical tactic of patients. Conclusions: Coronary revascularization with surgical of IMR in patients with ICM does not increase the number of complications in the early postoperative period compared to the group of isolated CABG. In patients with ICM and moderate MR after isolated CABG, the progression of MR (MR of the 3rd degree, initially 0%, after 12 months 31%, after 36 months 71%; p <0.001) was observed even with an initially moderate expansion of the fibrous ring of the MV.

This case report describes a procedure of retrieval of a leadless transcatheter pacemaker from the right ventricle after device implantation immediately. An 80-year-old man affected by ischemic cardiomyopathy, complete AV block and atrial fibrillation was implanted with a Micra transcatheter pacing system at the median septum of the right ventricle. After tether removal, the leadless pacemaker migrated to tricuspid valve annulus. The device was successfully removed using a snare loop hooked to the proximal retrieval feature of Micra.

Background and Purpose: This study aimed to investigate the safety and efficacy of high-dose vitamin B6 (vB6) for antipsychotic-induced hyperprolactinemia (AIHP) treatment in male patients with treatment-resistant schizophrenia (TRS). Experimental Approach: In this randomized double-blinded controlled study, patients were randomized (1:1) into a control group given aripiprazole (ARI; 10 mg/day) or an intervention group given vB6 (300 mg/12 h for 16 weeks). Prolactin level, psychotic symptoms [Positive and Negative Syndrome Scale (PANSS)], cognitive function [MATRICS Consensus Cognitive Battery (MCCB)], liver function, kidney function, growth hormone level, micronutrient levels, blood lipids, and adverse secondary effects (ASEs)[Treatment Emergent Symptom Scale (TESS) and Barnes-Akathisia scale] were monitored. Key Results: After a 16-week treatment period, the vB6 group showed a 68.1% reduction in serum prolactin levels (from 95.52 ± 6.30 μg/L to 30.43 ± 18.65 μg/L) while the ARI group showed only a 37.4% reduction (from 89.07 ± 3.59 μg/L to 55.78 ± 7.39 μg/L). During weeks 1–4, both treatments reduced prolactin similarly. Subsequently, the ARI effect plateaued, while the vB6 effect remained robust. AIHP reduction efficacy of vB6 was associated with baseline prolactin and triglyceride levels, total vB6 dosage, and education level. Conclusion and Implications: Compared with the ARI group, TRS patients given vB6 showed better attenuation of AIHP, lower ASE scores, and improvements in clinical symptoms and cognitive impairments. These results support further consideration of vB6 as a putative treatment for AIHP.

A four-year field experiment was carried out to evaluate an integrated use of saline water for the saline soil reclamation in Hebei Province of North China. A landscape shrub (Caryopteris × clandonensis ‘Worcester Gold’) was cultivated using drip irrigation scheduled by rootzone soil matric potential control at five levels of water salinity (ECi): 0.8, 3.1, 4.7, 6.3, and 7.8 dS·m−1. Soil matric potential control was applied using a threshold of −5, −10, −15, and −20 kPa in the first, second, third, and fourth year, respectively. After four growing seasons, the saline soil (initial ECe value of 27.8 dS·m−1) was reclaimed to slightly saline soil for 0–1 m depth (4.1–7.2 dS·m−1) under drip irrigation with saline water of ECi < 7.8 dS·m−1. The salt leaching efficiency of root zone soil was highest in the first year and lowered year-by-year. The plants strongly responded to the different soil water and salinity regime. Significant decreases in survival rate, plant growth, and shoot dry weight in response to increasing ECi were found. To achieve a relative survival rate of >50%, the threshold salinity of irrigation water for ‘Worcester Gold’ cultivation was 7.8, 7.0, 5.6, and 5.3 dS·m–1, for the first, second, third, and fourth growing season, respectively. It is recommended to use an inter-seasonal evolving matric potential threshold of −10 kPa for dry season of the third year, −15 kPa for rainy season of the third year and dry season of the fourth year, and −20 kPa for rainy season of the fourth year.

Acute-on-chronic right ventricular failure has a tremendously high mortality rate and pulmonary artery hypertension plays a major role in the progression of secondary right ventricular failure. Here, we report a case of drug-refractory acute-on-chronic right ventricular failure due to primary artery hypertension and a two-step approach of a percutaneous dual-outflow extracorporeal membrane oxygenation support set-up implanted under on-going mechanical resuscitation for immediate biventricular support with a consequent downgrade to right ventricular assist device after left ventricular recompensation.

Iatrogenic Coronary arteriovenous fistula (CAVF) is a rare complication of coronary intervention. Although acquired CAVF during percutaneous coronary intervention (PCI) of chronic total occlusion (CTO) has been reported, CAVF resulting from contrast injection into a right coronary artery (RCA) CTO during diagnostic coronary angiography is very rare.

1. Animal movement studies are conducted to monitor ecosystem health, understand ecological dynamics and address management and conservation questions. In marine environments, traditional sampling and monitoring methods to measure animal movement are invasive, labour intensive, costly, and measuring movement of many individuals is challenging. Automated detection and tracking of small-scale movements of many animals through cameras are possible. However, automated techniques are largely untested in field conditions, and this is hampering applications to ecological questions. 2. Here, we aimed to test the ability of computer vision algorithms to track small-scale movement of many individuals in videos. We apply the method to track fish movement in the field and characterize movement behaviour. First, we automated the detection of a common fisheries species (yellowfin bream, Acanthopagrus australis) from underwater videos of individuals swimming along a known movement corridor. We then tracked fish movement with three types of tracking algorithms (MOSSE, Seq-NMS and SiamMask), and evaluated their accuracy at characterizing movement. 3. We successfully detected yellowfin bream in a multi-species assemblage (F1 score = 91%). At least 120 of the 169 individual bream present in videos were correctly identified and tracked. The accuracies among the three tracking architectures varied, with MOSSE and SiamMask achieving an accuracy of 78%, and Seq-NMS 84%. 4. By employing these emerging computer vision technologies, we demonstrated a non-invasive and reliable approach to studying fish behaviour by tracking their movement under field conditions. These cost-effective technologies potentially will allow future studies to scale-up analysis of movement across many underwater visual monitoring systems.

Ebstein anomaly, a rare congenital heart disease, is defined as displacement of hinge points of septal or posterior tricuspid leaflets but not anterior leaflet. Here we report a 35 year old lady with an extremely rare pattern of EA with all three tricuspid leaflets displaced downward to the apex.

Human activity is increasingly and persistently disturbing nature and wild animals. Affected wildlife adopts multiple strategies to deal with different human influences. To explore the effect of human activity on habitat utilization of Himalayan marmot (Marmota himalayana), habitat utilization patterns of three neighboring marmot populations in habitats affected differently by human activities were recorded and compared. We found that: (1) Distance between reproductive burrows (a represent of reproductive pairs) becomes shorter under the influence of human activities, and more burrows were dug as temporary shelters, resulting in a shorter distance between those shelters as well as shorter distance flee to those shelters, and consequently, shorter flight initiation distance when threatened. More burrows that are closer in the disturbed habitats improve the ability to escape from threats. (2) Reproductive burrow site selection of the species is determined by the availability of mounds in the habitat, and breeding pairs selectively build reproductive (also the hibernation) burrows on mounds, potentially to improve surveillance when basking and the drainage of burrows. Human activities generally drive breeding pairs away from the road to dig their reproductive burrows likely to reduce disturbance from vehicles. However, even heavy human activity exerts no pressure on the distance of reproductive burrows from the road or the mound volume of the high disturbance population, potentially because mounds are the best burrowing site to reproduce and hibernate in the habitat. Marmots deal with disturbance by digging more burrows in the habitat to flee more effectively and building reproductive burrows on mounds to gain better vigilance and drainage efficiency.

In this paper, with the purpose of improving the mechanical behavior of DeepCwind semi-submersible floating offshore wind turbine (FOWT) platform mooring lines, nonlinear catenary cables of platform are divided into multi-segments and intermediate buoy. The mathematical formulations of the dynamic equation acted on the cable with buoys are described. Present study is employed to the OC4-DeepCwind semi-submersible FOWT platform. It is designed for 200-meter water depth with mooring lines consist of three catenary steel chain cables that have an angle of 120 degrees to each other. The dynamic response of multi-segment catenary mooring line with different buoys radiuses and different positions along the cables were investigated. The full-scale platform was modeled in ANSYS-AQWA software and the simulations are performed in harsh offshore. The tension, strain, anchor uplift, cable uplift for different buoy radiuses and its position along cable are presented and discussed. Moreover, platform motions at three directions (surge, heave and pitch) are also analyzed. It is concluded that by correct selection of the buoy volume and position along cable, the tension of the cable may be reduced up to 45%. By incorrect selection of the buoy, the results will cause adverse effects.

Pharmaceutical industry and drugs advertisement is sometimes accused of “creating diseases”. This article assesses and describes the role of that industry in fostering medicalization. First, the notions of medicalization and pharmaceuticalization are defined. Then, the problem of distinguishing between harmful overmedicalization and well-founded medicalization is presented. Next, the phenomenon of disease mongering is explained and illustrated by the case analysis of medicalizing pain and suffering in three contexts: 1) the general idea of medicalizing physical pain, 2) the medicalization of grief, and 3) disease mongering of pseudoaddiction - a condition promoted in order to increase the demand for opioid pain relievers.

Abstract Background Pakistan has already encountered intense opposition to polio vaccination due to myths and misinformation, now the unfavorable opinions of COVID-19 vaccinations among the population would have catastrophic consequences for attempts to end the pandemic. Methods A web-based cross-sectional study was conducted in the general population of Sindh, Pakistan in January 2021. 31 items based on vaccines availability, safety, and myths, the questionnaire was designed and randomly distributed through a google form link. Results were analyzed using descriptive and Chi-square tests. Results A total of 774 responses were recorded from 23 districts of Sindh, Pakistan. The majority of participants (n=00, 00.0%) were not aware of the presence of the COVID-19 vaccine in Pakistan. Results found the significant relationship of conspiracies and myths with an education level of participants, to make Muslims infertile, illiterate showed (Yes n=45, No=27) while postgraduate (Yes n=11, No=88) (χ2 = 109.6, P> 0.000). Participants showed doubt about the safety of vaccines, (Yes n= 464, 59.9%, No= 310, 40.1%). Other responses related to side effects of the vaccine were also highly significant, participants showed that vaccine side effects (Yes n= 462, 59.7%, No= 312, 40.3%), Pregnant or breastfeeding women should not get vaccinated (Yes n= 468, 59.8%, No= 311, 40.1%) and people with underlying conditions should not get vaccinated (True n= 389, 50.3%, False= 385, 49.7%). Conclusion The proportion of varying public doubts in vaccines’ safety and efficacy and the presence of myths, conspiracies will be a major barrier to vaccine uptake.

Background: Childhood allergic rhinitis (AR) is clinically highly heterogeneous. We aimed to identify distinct subgroups amongst children with AR, and to ascertain their association with patterns of symptoms, allergic sensitization and concomitant physician-diagnosed asthma. Methods: We recruited 510 children with physician-diagnosed AR, of whom 205 (40%) had asthma. Latent class analysis (LCA) was performed to identify latent structure within the data set using 17 variables (allergic conjunctivitis, eczema, asthma, family history of asthma, family history of allergic rhinitis, skin sensitization to 8 common allergens, tonsillectomy, adenoidectomy). Results: A four−class solution was selected as the optimal model based on statistical fit. We labeled AR latent classes as: (1) AR with grass mono-sensitization and conjunctivitis (n=361, 70.8%); (2) AR with house dust mite sensitization and asthma (n=75, 14.7%); (3) AR with pet and grass polysensitization and conjunctivitis (n=35, 6.9%) and (4) AR among children with tonsils and adenoids removed (n=39, 7.6%). Perennial AR was significantly more common among children in Class 2 (OR 5.83, 95%CI 3.42−9.94, p<0.001) and Class 3 (OR 2.88, 95%CI 1.36−6.13, p=0.006). Mild and intermittent AR symptoms were significantly more common in children in Class 3 compared to those in Class 1. AR was more severe in Class 1, compared to other 3 classes, indicating that upper respiratory symptoms are more severe among children with isolated seasonal rhinitis, than in those with rhinitis and coexisting asthma. Conclusion: We have identified 4 phenotypes in school-age children with AR, which were associated with different patterns of clinical symptoms and comorbidities.

Background: The role of the gut microbiome in the onset and development of atopic dermatitis (AD) has been postulated. Therefore, we investigated the gut microbial compositions in infants with and without AD, and compared it to the gut bacterial flora of their mothers. Methods: This was a prospective and cross-sectional study. Among 44 pairs of mothers and children, we selected infants who were born via full-term normal vaginal delivery and that had no history of antibiotic or probiotic use, and infection during the first three months of life. The 15 pairs, consisting of nine healthy infants and six AD infants, were included in this study. Fecal samples of mothers and infants were analyzed within 30 days of delivery and at 12 months of age. Microbes in the fecal samples of mothers and infants were subjected to analysis of 16S rRNA amplicon sequencing. Results: Abundance of specific taxonomic groups was notably different, but microbial diversity and phylogenetic distances were not significantly different in either maternal or infant groups according to the presence of infant AD. A total of 12 species were selected as differential species in infants with AD compared to healthy infants. Six species were significantly different in the mothers of infants with AD compared to the mothers of healthy infants. Akkermansia muciniphila was only detected in healthy infants and their mothers. Conclusions: These data indicated that the presence of Akkermansia muciniphila in mothers and children after vaginal delivery is associated with the onset and development of AD.

Abstract Objective: To evaluate the discriminative ability of laboratory abnormalities between general mycoplasma pneumoniae pneumonia (GMPP) and refractory MPP (RMPP) in children. Methods: An electronic search in PubMed, Web of Science, Embase, and Cochrane Library was performed to identify studies reporting on laboratory abnormalities in children with GMPP and RMPP. Data were independently extracted by two reviewers. Meta-analyses within the random-effects model were used to synthesize data. Effect sizes were calculated as standardized mean differences (SMD) or weighted mean difference (WMD). The Newcastle-Ottawa Scale (NOS) was used to assess the methodologic quality of included studies. Results: Twenty-one articles (3,877 patients) comparing laboratory findings between patients with GMPP and RMPP were eligible for this meta-analysis. Patients with RMPP had significantly increased neutrophils, CD8+ lymphocytes, lactate dehydrogenase (LDH), aspartate aminotransferase (AST), D-dimer, total IgA, total IgM, as well as decreased lymphocytes, hemoglobin, and albumin. Multiple inflammatory biomarkers (C-reactive protein [CRP], procalcitonin [PCT], erythrocyte sedimentation rate [ESR], ferritin, interleukin [IL]-6, IL-10, IL-17, IL-18, interferon-γ [IFN-γ], and tumor necrosis factor-α [TNF-α]) were also markedly elevated in RMPP patients. Conclusions: Elevated levels of CD8+ lymphocytes, LDH, AST, D-dimer, total IgA, total IgM, inflammatory biomarkers (CRP, PCT, ESR, ferritin, IL-6, IL-10, IL-17, IL-18, IFN-γ, and TNF-α), and lower lymphocytes, hemoglobin, and albumin are associated with RMPP and thus may be used as early identification or even prediction of RMPP in children. Keywords: Child; Refractory Mycoplasma pneumoniae pneumonia; clinical chemistry; meta-analysis

Sustainable agronomic practices are tried all over the world to promote safe and eco-friendly crop production. Therefore, in the present study, the effect of seed endophytic bacteria and its consortia on soil biochemical property, soil nutrient, and yield of chickpea (Cicer arietinum L.) under field and pot conditions are investigated. Both the experimental results proved a significant increase in total soil organic carbon (OC), electric conductivity (EC), organic matter (OM), soil nutrient like available N, P and K content and important soil enzymes like dehydrogenase (DHA), beta glucosidase, alkaline phosphate, and urease was observed under the Enterobacter hormaechei BHUJPCS-15 (T1), Enterobacter cloacae BHUJPCS-21 (T2) and combined T3 (consortia of T1 and T2) treatments. Similarly, a significant increase in the grain yield (27-45% and 57-73%) in microbial treatment was found in pot and field experiments, respectively than control. In addition, whereas the higher plant biomass (14-38% and 42-78%) was recorded in the treated plant over the control plant. Similarly, the plant photosynthetic pigment (Chl a, b, total Chl) were also increased in the microbial treated plant than the control untreated chickpea plant. Our present study highlights the significance of sustainable agronomic practices for improving the soil quality and agricultural yield while reducing adverse impacts of chemicals by the use of seed endophytic microbes and their consortia.

As testimony of the engineering development during the industrial revolution, old riveted bridges are maintained by several policies worldwide and in some cases because of their historical importance protected. A main concern of these policies is preserving their structural integrity, which depends on a fatigue assessment of their components and assemblies. In these structures, the stress ratio considerably affects the fatigue strength, but the actual standards do not consider this fact. Some deterministic models have been proposed in order to overcome this issue. However, they are based on restrictive and empirical assumptions. Moreover, no statistical considerations are made, although fatigue strength is a random variable. In this paper, the suggested models are studied and then enhanced by statistical considerations. Finally, a statistical fatigue strength model as function of the stress ratio is proposed and applied on riveted specimens from old German Bridges and newly manufactured specimens of steel S235.

Ethyl levulinate, one of main derivatives of levulinic acid (LA), is of significant potential as platform chemicals for bio-based materials. The esterification of LA was generally carried out in a conventional batch reactor or in a conventional reactive distillation column. However, traditional methods are hard to deal with equilibrium limited reactions and azeotropic issues. Therefore, the reactive-vapor permeation-distillation (R-VP-D) process, which integrated reaction, distillation and membrane dehydration into one single unit, is proposed in this paper and validated in the pilot-scale experiments. A comparative study is made between a pilot-scale RD column with and without vapor permeation membrane module. Owing to the water-selective membrane and the ingenious design of related apparatuses, the R-VP-D process reveal a superiority in LA conversion of 21.9% maximum higher than RD without VP process and removing of product water about 53.6% from VP module, which indicates its promising industrial application in process intensification field.

Nickel-rich LiNi0.8Co0.1Mn0.1O2 (LNCM811) is a promising lithium-ion battery cathode material, whereas the surface-sensitive issues (i.e., side reaction and oxygen loss) occurring on LNCM811 particles significantly degrade their electrochemical capacity retentions. A uniform Li2ZrO3 coating layer can effectively mitigate the problem by preventing these issues. Instead of the normally used weak hydrogen-bonding interaction, we present a covalent interfacial engineering for the uniform Li2ZrO3 coating on LiNi0.8Co0.1Mn0.1O2 materials. Results indicate that the strong covalent interactions between citric acid and Ni0.8Co0.1Mn0.1(OH)2 precursor effectively promote the adsorption of ZrO2 coating species on Ni0.8Co0.1Mn0.1(OH)2 precursor, which is eventually converted to uniform Li2ZrO3 coating layers of about 7 nm after thermal annealing. The uniform Li2ZrO3 coating endows LNCM811 cathode materials with an exceptionally high capacity retention of 98.7% after 300 cycles at 1 C. This work shows the great potential of covalent interfacial engineering for improving the electrochemical cycling capability of Ni-rich lithium-ion battery cathode materials.

[Definitive version of this article may be found here] The mitochondrial gene cytochrome-c-oxidase subunit 1 (COI) is useful in many taxa for phylogenetics, population genetics, metabarcoding, and rapid species identifications. However, the phylum Ctenophora (comb jellies) has historically been difficult to study due to divergent mitochondrial sequences and the corresponding inability to amplify COI with degenerate and standard COI ‘barcoding’ primers. As a result, there are very few COI sequences available for ctenophores, despite over 200 described species in the phylum. Here, we designed new primers and amplified the COI fragment from members of all major groups of ctenophores, including many undescribed species. Phylogenetic analyses of the resulting COI sequences revealed high diversity within many groups that was not evident from more conserved 18S rDNA sequences, in particular among the Lobata. The COI phylogenetic results also revealed unexpected community structure within the genus Bolinopsis, suggested new species within the genus Bathocyroe, and supported the ecological and morphological differences of some species such as Lampocteis cruentiventer and similar lobates (Lampocteis sp. ‘V’ stratified by depth, and ‘A’ differentiated by color). The newly described primers reported herein provide important tools to enable researchers to illuminate the diversity of ctenophores worldwide via quick molecular identifications, improve the ability to analyze environmental DNA by improving reference libraries and amplifications, and enable a new breadth of population genetic studies.

A document by Hailey Hildebrand. Click on the document to view its contents.

Background:Microwave ablation has a great potential to treat primary hyperparathyroidism; but its predictors and the therapeutic efficiency are not clear enough and so the more investigations are required. Aim:The purpose of this study was to explore safety and predictors of the MWA efficacy in patients with primary hyperparathyroidism (PHPT) induced by parathyroid adenoma. Methods: Patients with PHPT treated with MWA were included in this study. Depending on the treatment efficacy, patients divided into two groups as response and no response group. Possible predictors as age, gender, Parathyroid adenoma volume, baseline levels of calcium (Ca), phosphorous (P), alkaline phosphate (ALP), vitamin D and location of parathyroid adenoma and the instrumental parameters which are microwave ablation time and power were compared between two groups. The resulting possible predictors the MWA efficacy exhibiting statistically significant difference was investigated by using logistic regression. Results: Thirty-two patients participated into predictor analysis for MWA efficacy. Comparison of the values of response and no response groups in terms possible predictors revealed only the baseline Ca level as the potential predictor of the efficacy of MWA (P <0.05). Further logistic regression results showed the baseline Ca level as insignificant to construct a mathematical model to predict the efficacy of MWA (P = 0.071). Furthermore, a significant difference in time differences was observed after 1 day of the MWA treatments in the levels of Ca, P, and PHT except than ALP, those of which was 30 days later (P <0.001). Later on, the difference stayed steady until the end of follow up. Conclusions:MWA is an effective and safe therapy for in patients with PHPT caused by parathyroid adenoma. Baseline Ca level has been found as potential but detailed investigations revealed none of the explored factors as predictive for the assessed patients. Keywords:Primary hyperparathyroidism, microwave ablation, predictor, efficacy

Abstract Purpose: To assess the accuracy and efficacy of ROPScore scoring system an ancillary method to predict the severity of retinopathy of prematurity (ROP) in very low birth weight (VLBW) premature infants. Methods: The medical records of 131 premature babies having a birth weight  1500 gram and gestational age (GA) ≤ 30 weeks were included in this study. The ROPScore was calculated for each baby at six weeks of life using an Excel spreadsheet (Microsoft®). Area under curve (AUC) analysis was used in both any stage of ROP and type-1 (severe) ROP to ascertain the cut-off points for the scoring model. Sensitivity, specificity, positive predictive values (PPV) and negative predictive values (NPV) of the scoring system with the calibrated cut-off points were analyzed. Results: The sensitivity of the ROPScore scoring system was 88.5% ( 95% CI 79-94) and 100% (95% CI 82-100) was for predicting any stage and type-1 retinopathy of prematurity, respectively. The PPV and NPV of the models were 62% and 74.1% for any stage of ROP and those of were 50% and 100% for type-1 ROP, respectively. In ROC analysis, the mean AUCs of ROPScore model was statistically significant compared than BW and GA for predicting type -1 ROP (p < 0.001). Conclusion: This study indicated that ROPScore scoring model with customized cutoff levels might be a useful method for early prediction of premature retinopathy, particularly in type-1 (severe) ROP. In addition, this model may also reduce the number of eye examinations which are essential for detecting the retinopathy of prematurity