Arteriovenous fistulae (AVF) of the head and neck region are extremely rare, especially those that occur spontaneously. We present the case of a 58 year old female with a spontaneous postauricular AVF causing troublesome pulsatile tinnitus. In this case a simple surgical procedure completely cured the patient of her symptoms.

The authors report a case of ehrlichiosis involving a bone marrow specimen from a patient with chronic lymphocytic leukemia. Since Ehrlichia may cause a lymphohistiocytic reaction in bone marrow specimens, an infectious process may be easily confused with a lymphoid neoplasm, particularly in patients with a history of lymphoid malignancy.

WHO guidance has incorrect recommendation in Oral health care involving AGPs. Air flow plays a key role in mitigating COVID-19 infection since airborne particles travel by air currents.

This case is a unique 49 years old male with clear images of diagnosis angiography, operation field and post operation findings to show total right coronary artery plaque and how full endarterectomy can help patient.

This study aimed to research the effects of forest (Pinus elliottii, slash pine) and shrub (Vitex trifolia) plantation on the soil microbial community in sandification land by using the Illumina Miseq sequencing of 16S rRNA and ITS rRNA genes and combined with the soil properties analysis to explore the driving factors. Finally, the results showed that the dominant bacterial phylum was Chloroflexi, Actinobacteria, Proteobacteria, and Acidobacteria, the shrub and forest plantation significantly increasing the proportion of Acidobacteria, while decreasing the proportion of Proteobacteria. For the fungal community, forest plantation was significantly changing the community structure at the phylum level that shifted from Ascomycota to Basidiomycota, and the ectomycorrhizal fungi take the most abundant with genus Rhizopogon predominant. The soil bacterial Chao1 and Shannon indices were significantly increased after revegetation, while the soil fungal Shannon diversity in the forest land that significantly correlated with soil total organic carbon and C/N was lower than that in the sandy and shrub land (p<0.05). Besides, the bacterial and fungal communities were significantly affected by soil water content among all analyzed soil properties. Our results suggest that the revegetation significantly increasing the soil bacterial diversity that correlated with soil water content, total organic carbon, and available phosphorus, but there was no significant change in community structure. In contrast, slash pine plantation changes the fungal community structure and diversity dramatically, and such changes should be attention because the shift of fungi community structure and diversity may lead to the decline of Pinaceae plantation.

Carotenoids are widely used in functional foods, cosmetics, and health supplements, and their importance and scope of use are continuously expanding. Here, we characterised carotenoid biosynthetic genes of the plant-pathogenic bacterium Pantoea ananatis, which carries a carotenoid biosynthetic gene cluster (including crtE, X, Y, I, B, and Z) on a plasmid. Reverse transcription–polymerase chain reaction (RT-PCR) analysis revealed that the crtEXYIB gene cluster is transcribed as a single transcript and crtZ is independently transcribed in the opposite direction. Using splicing by overlap extension with polymerase chain reaction (SOE by PCR) based on asymmetric amplification, we reassembled crtE–B, crtE–B–I, and crtE–B–I–Y. High-performance liquid chromatography confirmed that Escherichia coli expressing the reassembled crtE–B, crtE–B–I, and crtE–B–I–Y operons produced phytoene, lycopene, and β-carotene, respectively. We found that the carotenoids conferred tolerance to UV radiation and toxoflavin. Pantoea ananatis shares rice environments with the toxoflavin producer Burkholderia glumae and is considered to be the first reported example of producing and using carotenoids to withstand toxoflavin. We confirmed that the carotenoid production of P. ananatis is dependent on RpoS, which is positively regulated by Hfq/ArcZ and negatively regulated by ClpP, similar to an important regulatory network of E. coli (HfqArcZ → RpoS Ͱ ClpXP). We also demonstrated that Hfq-controlled quorum signalling de-represses EanR to activate RpoS, thereby initiating carotenoid production. Survival genes such as those responsible for the production of carotenoids of the plant-pathogenic P. ananatis must be expressed in a timely manner to overcome stressful environments and compete with other microorganisms. This mechanism is likely maintained by a brake with excellent performance, such as EanR.

Flowering time (or heading date in crops) is a critical agronomic trait for rice reproduction and adaptation. The circadian clock is an endogenous oscillator that is involved in controlling photoperiodic flowering. The rice LATE ELONGATED HYPOCOTYL (OsLHY), the core oscillator component of circadian clock, is a homolog of the LHY/CCA1 in Arabidopsis. Here we showed that CRISPR/Cas9-engineered mutations in OsLHY caused late flowering in rice only under long-day (LD) conditions. In the oslhy mutant, the diurnal expression of circadian clock-related genes was seriously affected under both LD and short-day (SD) conditions. Furthermore, the expression of the flowering activators Ehd1, Hd3a and RFT1 was down-regulated and flowering repressors Hd1 and Ghd7 was up-regulated in the oslhy mutant under LD conditions. While the transcripts of flowering-related genes were not dramatically influenced under SD conditions. Dual-luciferase assays showed that OsLHY repressed the transcription of OsGI, Hd1, Ghd7, Hd3a, RFT1 and OsELF3, and activated the transcription of Ehd1. Moreover, the yeast one hybrid assay confirmed that OsLHY directly repressed OsGI, RFT1 and OsELF3 by binding to their promoters, which is consistent with that in Arabidopsis. These results suggested that the OsLHY can promote rice flowering mainly through regulating Hd1 and Ehd1 under LD conditions.

In present paper, an original form of exact analytical solutions was introduced to solve nonlinear evolution equations by means of bilinear neural network method and symbolic computation. We gave high-order rational solutions including high-order lump-type solutions and higher-order rational solutions, periodic wave solutions, breather solutions and two kinds of rogue waves solutions of extended (2+1)-dimensional Calogero-Bogoyavlenskii-Schiff-like equation to exemplify the availability and advantage of the proposed approach which expand exact analytical solutions of nonlinear evolution equations. Meanwhile, physical properties and characters of the solutions were graphically shown through several groups of maps which are determined by special values.

The balance between the immune system and its metabolism is becoming an effective therapeutic alternative in various inflammatory diseases, including organ transplantation. The interaction between the immune and metabolic pathways play a critical role in dictating disease pathology and progression, and the differences in the bioenergetic demands between immune cells enable them to differentiate into effector and regulatory cells. Recent studies have suggested that changes in intracellular metabolic programs control T cell activation, proliferation and differentiation into T effector (Teffs) or T regulatory cells (Tregs), and metabolic differences between Tregs and Teffs can shift the balance toward a more specific immune tolerance in organ rejection. Pharmacological targeting of T cells metabolism affects the balance between effector and regulatory function of T cells.This therapeutic modulation are of great interest in cancer, autoimmunity, and organ transplantation. In this review, we discuss major metabolic pathways that influence the activation, proliferation and differentiation of Tregs, and also special emphasis on liver kinase B1 (LKB1) pathway that provide stability of Tregs. We also highlight how Tregs metabolic regulome and LKB1 signaling pathway relationship contribute to rescue organ transplants from associated injuries and chronic rejection. 

Swine acute diarrhea syndrome coronavirus (SADS-CoV) is a newly identified swine enteropathogenic coronavirus that causes watery diarrhea in neonatal piglets, leading to significant economic losses to the swine industry. Currently there are no suitable serological method to assess the infection of SADV-CoV and effectiveness of vaccines, making an urgent need to exploit effect enzyme-linked immunosorbent assay (ELISA) to compensate for this deficiency. In this study, an indirect ELISA (S-iELISA) based on recombinant spike (S) protein expressed in Baculovirus was developed and evaluated. The reaction conditions of S-iELISA were optimized and cut-off value determined as 0.3711 by analyzing OD450nm values of 40 SADS-CoV-negative sera confirmed by immunoinfluscent assay (IFA) and Western Blot. The coefficients of variation of 6 positive sera within and between runs of S-iELISA were both less than 10% and cross-reactivity assays demonstrated that S-iELISA was non-cross-reactive with other swine viruses’ sera. Furthermore, the overall coincidence rate between IFA and S-iELISA was 97.3% based on testing 111 clinical serum samples. Virus neutralization test with 7 different OD450nm value sera showed that the OD450nm values tested by S-iELISA are positive correlated with virus neutralization. Finally, a total of 300 pig field serum samples were tested by S-iELISA and commercial kits of other swine enteroviruses showed that the IgG-positive for SADS-CoV, TGEV, PDCoV and PEDV were 81.7%, 54%, 65.3%, 6%, respectively. The results suggest this S-iELISA is specific, sensitive, repeatable and can be applied for vaccines evaluation and detection the SADS-CoV infection in swine industry.

Since the first report from Cherry Valley ducks on a commercial duck farm in China (2008), duck astrovirus type 1(DAstV-1) -associated duck viral hepatitis (DVH) have been detected in several commercial duck flocks. In the literature, no outbreak of DAstV-1 have been report in China since 2012. Here, the isolation, cultivation and characterization of DAstV-1 isolate are described. One DAstV-1 strain, designated as DAstV-SDZZ, was isolated from a diseased duckling. The isolated astrovirus grew well in the LMH cell line. To determine the entire genomic of the DAstV-SDZZ isolate, next-generation sequencing (NGS) technique was conducted on Illumina HiSeq platform. Complete genome sequence analysis revealed that DAstV-SDZZ isolate was 91.6%-98.7% homology with others DAstV-1 deposited in Genbank. Similar clinical symptoms were successful reproduced by experimental infection study using the DAstV-SDZZ isolate. DAstV-SDZZ is the first DAstV-1 strain whose experimental infection study has been conducted. The present works are likely to provide new insights into the pathogenicity and evolution of DAstV-1 in ducks.

In this paper, a generalized fractional $(q,h)$-Gronwall inequality is investigated. Based on this inequality, we derive the uniqueness theorem and the finite-time stability criterion of nonlinear fractional delay $(q,h)$-difference systems. Several examples are given to illustrate our theoretical result.

This paper is concerned with continuous attractors and attraction basins of a population decoding model with a parameter as a switch. Since an attractor for a model is a equilibrium point of its phase space such that for “many” choices of initial point the model will evolve towards the point, the attractor belongs to the omega-limit sets of theses initial points. Therefore, we can construct the mapping between initial values and omega-limit sets to study the properties of attractors for the model. In this article, firstly, the omega-limit set of each initial value are obtained of the model, and the mapping between the initial values and the omega-limit sets is successfully constructed by the omega-limit set of each initial value for the model. Secondly, applying this mapping, we not only obtain the attraction basin of each attractor and the stability of these attractors, but also find a new sufficient condition of nonzero continuous attractors of this model. Finally, we get bifurcations can occur in which continuous attractors undergo qualitative changes as the model parameter passes through a critical bifurcation value.

We apply the continuation theorem of Mawhin to ensure that a second-order nonlinear difference equation of the form $$\Delta^2 u(k-1) +a(k)u^{n}(k)-b(k)u^{n+1}(k)+c(k)u^{n+2}(k)=0$$ with periodic boundary conditions possesses at least two nontrivial positive solutions, where $n>0$ is a finite positive integer, $\Delta u(k)=u(k+1)-u(k)$ is the forward difference operator and $a(k),b(k),c(k)$ are $T$-periodic functions on $\mathbb{R}$.

The ductile structural adhesives such as a polyurethane adhesive are developed in recent years. This study is intended to measure the fracture toughness under Mode I loading of two-part polyurethane adhesives using double cantilever beam (DCB) tests. Two types of polyurethane adhesives and the effect of adhesive thickness on the fracture toughness are discussed. Plastic deformation of the steel adherends occurred in both adhesives for both adhesive types and thicknesses. Therefore, the arrest load out of consideration of a plastic deformation was evaluated the fracture toughness of the DCB specimens. As a result, the fracture toughness of the polyurethane adhesive is higher for higher tensile modulus and adhesive strength. In addition, the fracture toughness is higher for a larger adhesive thickness. The analytical results based on the triangle cohesive zone model using zero-thickness cohesive elements are agreed with the experimental results.

Fatigue cracks initiated from holes in several zones and structural components of the RRJ-95 aircraft frames were investigated. Using the method of quantitative fractography the crack growth duration in the brackets of the in-service airframe and in the wing panels during full-scale bench tests was estimated the spacing of meso-beach-marks (MBM) and fatigue striations. The applied program of bench test consisted of blocks of variable loads that were equivalent to the wing loading in flight and reproducing schematized flight-cycle. It was shown that the duration of fatigue crack propagation in several structural components of the RRJ-95 aircraft frames was approximately the same as for the crack nucleation duration. The total lifetime is sufficiently long for cracks in the structural components to be detected and reliably monitored with a large operating time interval between adjacent inspections.

Xiaodong Zhang1, MD, PhD, Ruike Yang1 2, MD, Luigi Di Biase1, MD, PhD, FHRS1 Division of Cardiology, Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York2 Division of Cardiology, Department of Medicine, Henan Provincial People’s Hospital, Zhengzhou, ChinaCorrespondence : Dr Luigi Di Biase, Montefiore Medical Center, Albert Einstein College of Medicine, 111 East 210th St, Bronx, NY 10467. E-mail address: dibbia@gmail.com .Keywords : narrow complex tachycardia, dual atrioventricular nodal non-re-entrant tachycardia, dual atrioventricular nodal re-entrant tachycardia, autonomic nervous system

Abstract Backgrounds: Mutations in DNA-binding domains of STAT1 lead to delayed STAT1 dephosphorylation and afterwards gain-of-function. The clinical phenotype is broad and can include chronic mucocutaneous candidiasis and/or combined immunodeficiency. Objectives: We report a case of 7-year old female patient. She had recurrent pneumonia since infancy and she was hospitalized several times. She had persistant lymphopenia with normal immunoglobulin levels and lymphocyte subsets. Findings: STAT1 mutation was defined by next generation Sequencing PID panel. Despite the antifungal therapy, oxygen requirement continued, methylprednisolone and Janus-associated kinase (JAK) inhibitor (ruxolitinib) was started as therapy. Immunodysregulatory features of disease improved after Janus kinase inhibitor treatment. Conclusion: In patients with STAT1 GOF defect, ruxolitinib treatment may be effective for interstitial lung disease if hematopoietic stem cell transplantation can not be performed.

Background: Computer simulation model demonstrated that atrial fibrillation (AF) driver attached to the patchy fibrosis assessed by late gadolinium enhancement magnetic resonance imaging (LGE-MRI). However, it has not been well elucidated in patients with persistent AF. The aim of this study is to investigate whether radiofrequency (RF) application on the patchy LGE site (PLS) could terminate AF or convert to atrial tachycardia (AT) and improve the rhythm outcome. Methods: A total of 31consecutive persistent AF patients with PLS were enrolled (PLS ablation group, mean age: 69 ± 8 years, mean left atrial diameter: 42 ± 6 mm). AF direct termination or AT conversion during RF application on the PLS were defined as favorable response. The rhythm outcome was compared between the PLS ablation group and the propensity matched conventional ablation group. Results: Favorable response was found in 15 (48%) of 31 patients (AF termination in 7, AT conversion in 8 patients). AF recurrence at 12 months follow-up was significantly less in the PLS group as compared to the control group (4 (13%) of 31 patients vs. 11 (35%) of 31 patients, log-rank p = 0.019). In patients with favorable response, AT recurred in 1 (7%) of 15 patients but AF. Conclusions: The PLS ablation could terminate AF or convert to AT in half of the patients and improve the rhythm outcome as compared to the conventional ablation. No AF recurrence was documented in patients with a favorable response.

INTRODUCTION: Malignant ventricular arrhythmias (MVA) are often the main cause of sudden cardiac death (SCD), especially in patients with pre-existing coronary artery disease (CAD). The identification of factors associated with SCD in this clinical setting is important and might help physicians in identifying this high risk group of patients. We evaluated the association between 12-lead ECG ventricular repolarization parameters and the induction of MVA on the electrophysiological study (EPS). METHODS AND RESULTS: 177 patients [mean age 65±10.1yo, 83.6% male, mean LV ejection fraction (LVEF) 37.5±13.6%] were analyzed. For each 10ms increment in the QT interval, an increase of 7% in MVA inducibility was observed. The QT cut-off point of 452 ms had and accuracy of 0.611 for predicting MVA (p=0.011). Male gender (OR=4.18, p=0.012), LVEF < 35% (OR=2.32, p=0.013), amiodarone use (OR=2.01, p=0.038) and prolonged QT (OR=1.07, p=0.023) were independent factors associated with MVA. QT > 452ms in patients with ventricular dysfunction was associated with significant increased risk of MVA (OR=5.44, p=0.0004). In patients with LVEF ≥ 35%, QT dispersion (QTd) was significantly higher in those with inducible MVA. QTd > 20ms had an accuracy of 0.638 in predicting MVA, with 81.3% negative predictive value (95% CI 63-92.1%). CONCLUSION: QT interval was an independent factor associated with MVA in patients with CAD. The combination of ventricular dysfunction and prolonged QT interval was associated with a 5-fold increase of MVA induction. Male gender, amiodarone use and decreased LVEF were also associated with increased risk of inducibility of MVA on the EPS.

Toxoplasmosis is a disease caused by T. gondii, a protozoa which affects humans and animals and is widely distributed worldwide. In humans, there is great concern due to the serious consequences that can occur in the infection of pregnant women and the newborn. The early diagnosis of gestational toxoplasmosis is important for treatment to be carried out in order to prevent vertical transmission or reduce damage. The diagnosis can be made through the detection of antibodies in pregnant women or neonates and PCR of amniotic fluid. Previous studies have also reported PCR of the placenta as a good diagnostic test. Our study evaluated the detection of T. gondii DNA in placenta samples from parturients seen at the University Hospital of Santa Maria, Southern Brazil and treated during the pregnancy. We performed PCR in forty samples and five were positive, representing 12.5%. When correlating the treatment time and the detection of DNA in the placentas, no significant result was found. The prevalence of positive samples was lower than in other studies in the literature. The data reaffirm the importance of carrying out the analysis of the placenta. Key words: Placenta, PCR, toxoplasmosis.

Background: The interplay between COVID-19 pandemic and asthma in children is still unclear. We evaluated the impact of COVID-19 on childhood asthma outcomes. Methods: The PeARL multinational cohort included 1,054 children with asthma and 505 non-asthmatic children aged between 4-18 years from 25 pediatric departments, from 15 countries globally. We compared the frequency of acute respiratory and febrile presentations during the first wave of the COVID-19 pandemic between groups and with data available from the previous year. In children with asthma, we also compared current and historical disease control. Results: During the pandemic, children with asthma experienced fewer upper respiratory tract infections, episodes of pyrexia, emergency visits, hospital admissions, asthma attacks and hospitalizations due to asthma, in comparison to the preceding year. Sixty-six percent of asthmatic children had improved asthma control while in 33% the improvement exceeded the minimal clinically important difference. Pre-bronchodilatation FEV1 and peak expiratory flow rate were improved during the pandemic. When compared to non-asthmatic controls, children with asthma were not at increased risk of LRTIs, episodes of pyrexia, emergency visits or hospitalizations during the pandemic. However, an increased risk of URTIs emerged. Conclusion: Childhood asthma outcomes, including control, were improved during the first wave of the COVID-19 pandemic, probably because of reduced exposure to asthma triggers and increased treatment adherence. The decreased frequency of acute episodes does not support the notion that childhood asthma may be a risk factor for COVID-19. Furthermore, the potential for improving childhood asthma outcomes through environmental control becomes apparent.

Background: Antiepileptic drugs (AEDs) are widely used for the treatment of epilepsy, but they can be associated with the development of mainly delayed/non-immediate hypersensitivity reactions (HRs). Although these reactions are usually cutaneous, self-limited and spontaneously resolve within days after drug discontinuation, sometime HRs reactions to AEDs can be severe and life threatening. Aim: This paper seeks to show examples on practical management of AEDs HRs in children starting from a review of what it is already known in literature. Results: Risk factors include age, history of previous AEDs reactions, viral infections, concomitant medications and genetic factors. The diagnosis work-up consists of in vivo (Intradermal testing and Patch testing) and in vitro tests [serological investigation to exclude the role of viral infection, lymphocyte transformation test (LTT), cytokine detection in ELISpot assays and granulysin (Grl) in flow cytometry]. Treatment is based on a prompt drug discontinuation and mainly on the use of glucocorticoids. Conclusion: Dealing with AEDs HRs is challenging. The primary goal in the diagnosis and management of HRs to AEDs should be trying to accurately identify the causal trigger and simultaneously identify a safe and effective alternate anticonvulsant. There is therefore an ongoing need to improve our knowledge of HS reactions due to AED medications and in particular to improve our diagnostic capabilities.

Background: Current guidelines for the management of asymptomatic hypertension (HTN) in the inpatient setting recommend the use of oral antihypertensives. However, in clinical practice, intravenous (IV) antihypertensives are commonly utilized with little supporting evidence. The objective of this study was to evaluate literature examining the safety/efficacy of IV hydralazine and labetalol in hospitalized patients with non-emergent, asymptomatic HTN. Methods: The PRISMA guidelines were utilized to structure the systematic review. A search strategy composed of drug-, inpatient-, and HTN-related terms was conducted utilizing PubMed, Embase, and Scopus databases through May 2020. Full-text, English-language articles describing IV labetalol and/or hydralazine use for non-emergent HTN in an inpatient setting that focused on clinical outcomes (i.e. vitals, adverse effects, healthcare utilization) were included. Identified studies were screened/extracted using DistillerSR by two reviewers at each stage, and studies were evaluated qualitatively for the presence of bias. Results: From 3362 records identified in the search, a final set of 10 articles were identified. Four studies focused on labetalol (40%), five studies on hydralazine and labetalol (50%), and one study on hydralazine (10%). The included studies presented a variety of outcomes, but several trends were identified, including reduction in average blood pressure in eight (80%) studies, a risk of adverse effects in six (60%), and increased length of stay in one (10%). Discussion: The studies identified in this review raise concerns regarding the safety of IV hydralazine and labetalol in non-emergent HTN. Despite relatively broad clinical experience with these drugs, experimental investigations regarding their utility are recommended.