Since late 2011, pseudorabies virus (PRV; Suid herpesvirus 1) infection was widely prevalent in vaccinated swine farms in China, and caused tremendous economic losses in the swine industry. To understand the epidemic and biological characteristics of the virus, a total of 1,174 tissue samples were collected from Bartha-K61-immunized swine farms in Henan province of China between 2012 and 2019, and PRV strains were isolated and the complete sequences of gE and gC genes were amplified by PCR. The detection rate of PRV was 15.25% (179/1174), which varied from 6.61% to 25.00% between 2012 and 2019. And 16 PRV isolates were obtained, and could cause clinical symptoms and death in mice. The phylogenetic trees based on the sequences of gE and gC genes showed that the 16 PRV strains in this study at these two phylogenetic trees all clustered to a relatively independent branch altogether with the Chinese variant PRV strains (after 2012), and sequence analysis of the isolates revealed that gE and gC both contained amino acid insertions, substitutions or deletions compared with European-American PRV strains and early Chinese PRV strains (before 2012). In addition, it was the first report that eight strains (8/16) in this study harbored a unique amino acid substitution at site 280 (F to L) of gC gene. In the protection assay, the emulsion containing inactivated PRV NY isolate could provide complete protection against variant NY, and the titer of neutralizing antibodies was 1:82. This study might enrich our understanding of the evolution of variant PRVs as well as pave the way for finding a model virus to develop a novel vaccine based on PRV variants.

Bat communities in the Neotropics are some of the most diverse assemblages of mammals on Earth, with some regions supporting more than 100 sympatric species. This diversity raises the question of how so many species can coexist without apparently competing for resources. Because bats are small, nocturnal, and volant, it is difficult to directly observe their feeding habits, which has resulted in their classification into broadly defined dietary guilds (e.g. insectivores, carnivores, frugivores). Apart from these broad guilds, we lack detailed information about what bats eat and therefore have only a limited understanding of interaction networks linking bats and their arthropod, plant, and vertebrate prey. In this study, we used DNA metabarcoding of plants, arthropods, and vertebrates to infer the diets of 25 species of bats from the tropical dry forests of Lamanai, Belize. We hypothesized that bat diets recovered by metabarcoding would show a more granular structure than implied by the broad guilds to which species have been traditionally assigned. Our results indicate that bat communities from Lamanai can be organized into eight distinct sub-community modules and that bats partition food resources on a finer scale than previously recognized. This study is the most comprehensive treatment to date of Neotropical mammal diets at the community level, and provides a useful framework for testing hypotheses about coexistence and niche differentiation in the context of modern high-throughput molecular data.

In marine environments, paleoceanographic changes can act as drivers of diversification and speciation, even in highly mobile marine organisms. Shearwaters are a group of pelagic seabirds with a well-resolved phylogeny that are globally distributed and show periods of both slow and rapid diversification. Using reduced representation sequencing data, we explored the role of paleoceanographic changes on diversification and speciation in these highly mobile pelagic seabirds. We performed molecular dating, applying a multispecies coalescent approach (MSC) to account for the high levels of incomplete lineage sorting (ILS). We identified a major effect of the Pliocene marine megafauna extinction, followed by a period of high dispersal and rapid speciation. Biogeographic analyses showed that dispersal appears to be favoured by surface ocean currents, and we found that founder and vicariant events are the main processes of diversification. Body mass appears to be a key phenotypic trait potentially under selection during shearwater diversification, and it shows significant associations with life strategies and local conditions. We also found incongruences between the current taxonomy and patterns of genomic divergence, suggesting revisions to alpha taxonomy. Globally, our findings extend our understanding on the drivers of speciation and dispersal of highly mobile pelagic seabirds and shed new light on the important role of paleoceanographic events.

L’acqua è l’elemento fondamentale per la salute dell’uomo, e proprio per questo motivo esso deve essere in grado di recepire sin da subito informazioni sulla tipologia di acqua da consumare in base alle proprie esigenze tramite una lettura consapevole dell’etichetta. Un’importante questione da affrontare è la distinzione tra le acque potabili per il consumo umano e le acque minerali, andando a considerare in entrambe i casi quali sono gli elementi mineralogici in esse contenuti e quali sono i valori standard secondo la normativa nazionale. Lo scopo finale di tale indagine è quello di sottolineare come lo sviluppo delle normative abbia permesso al consumatore una scelta più consapevole dell’utilizzo delle acque minerali imbottigliate.

To determine whether acute cervical spinal cord Injury patients receiving nasoduodenal (ND) feedings achieve better clinical outcomes compared with patients receiving nasogastric (NG) feedings. Supplementary statement: we already know that nasoduodenal feedings seem to bring better clinical outcome for patients with mechanically ventilated ,there is no study on the route of enter feeding in spine cord injury patients ，we don’t know about whether in the which enter feeding route can spine cord injury patients reach better clinical outcome. , our study showed that nasoduodenal feedings achieved had a higher nutritional feeding compliance rate than those who received nasogastric feeding.

Introduction: Patients with chronic obstructive pulmonary disease (COPD) have impaired balance and hence fall more frequently. Easy application of balance evaluation tests can prevent the loss of time in the outpatient clinic for patients with COPD. Therefore, we compared the effectiveness of the Berg Balance Scale (BBS) test, a relatively more recommended but time-consuming test, with easy-to-perform tests such as the Single Leg Stance (SLS), Five Repetition Sit to Stand (5STS), Four Step Square (FSS), and Timed Up and Go (TUG) tests. Methods: A total of 71 patients with COPD and 70 control subjects with matching demographic characteristics were included in the study. All patients undertook pulmonary function tests and their scores of 6-min walk-test (6MWT), modified Medical Research Council (mMRC) dyspnea scale, COPD assessment questionnaire (CAT), and body mass index (B) were recorded. In addition, the severity of airway obstruction (O), the dyspnea severity (D), and exercise capacity (E) (BODE) index scores were measured. All patients with COPD were classified into 4 groups, A to D, based on the GOLD 2017 criteria. All subjects undertook the BBS, SLS, 5STS, Four Step Square Test, and TUG tests. Results: Balance tests revealed increased balance impairment in patients with COPD in comparison with the control subjects (P < 0.05). The BBS, SLS, Four Step Square Test (FSST), and TUG examinations suggested that balance impairment was frequent in Groups C and D patients with COPD (P < 0.05). TUG and FSST had the highest correlation with BBS (r = −0.812 and −0.842 and P <0.001 and <0.001, respectively). The results of TUG and FSST were the closest to those of BBS test. Conclusions: TUG and FSST tests can be applied for the assessment of bodily balance status among patients with COPD in outpatient clinics.

Background: Since the onset of the COVID-19 pandemic, concerns about health-related and economic hazards of the virus, the restrictions imposed by the public health measures, the lack of social interactions, and the financial losses have affected people’s mental health in various ways. People with diabetes are more vulnerable to comorbid mental illness that may interfere with treatment adherence and disease prognosis. This study explores the psychological state of Egyptian patients suffering from diabetes mellitus (DM) during the COVID-19 pandemic. Methods: Egyptian adults with DM were invited to participate through an online survey in the period from April 24 to May 12. The survey included sociodemographic information, questions assessing diabetes status, and general assessment of the psychological health status using the General Health Questionnaire (GHQ-12). Results: In total, 849 participants shared in the survey. 51.4% of the studied population were at risk, while 21.2% were at high risk of psychological distress. There was a statistically significant difference with the non-working group with a mean GHQ-12 score of 17.44, SD= 6.267, SE 0.491, 95% (16.47-18.41), and p-value of 0.01. Regarding the disease precautions, there was a statistically significant difference between home isolation and those who did not home isolate with a mean 16.23 and SD 6.285 compared to a mean 15.32 SD 5.701 p-value 0.028. There was a significantly increased number of 4 or more diabetes complications and comorbidities with a mean 20.60 SD 8.675, SE 2.240, (95% CI 15.80-25.40) with a p-value of less than 0.001 and mainly with hypertension as comorbidity. Conclusion: The current study shows that Egyptian patients suffering from DM are likely to psychological distress amid the COVID-19 pandemic. Risk factors included female gender, non-working, and patients with diabetic complications, particularly hypertension. Further attention to the psychological needs of Egyptian patients with DM amid the COVID-19 is recommended.

Jamaica Kincaid’s ‘Girl’ and Charlotte Gilman’s ‘The Yellow Wallpaper’ are two stories centered around the experiences of women in society. Through the use of space, they exemplify ways in which society confines women, albeit from different points of view.Kincaid’s ‘Girl’ made its first debut in the New Yorker in 1978. Unlike the typical format of stories, this story takes the form of a single ongoing sentence where the narrator advices a younger girl. The narrator, who comes off as a mother or someone in a position of moral authority over the younger girl, gives a set of rules, while the narratee is barely given an opportunity to express herself.This story buttresses the highly performative aspect of gender and the ‘making of woman’; it is apparent that there is a power dynamic where the addressed is at a disadvantage and thereby confined to the limits of societal expectations, similar to how claustrophobic spaces give little room for movement. In the narrator’s rules, we see the traditional expectations of women in patriarchal societies such as ‘this how to sew on a button’, ‘this is how you set a table for dinner’, ‘this is how you sweep a whole house’ and so forth. Throughout the story, the narrator gives advice that will groom the young woman into the normative ideal woman. These instructions are in line with the social norms of gender where women are expected to cook, clean, take care of the home and be docile. Women are taught in such societies that subservience to men is important and their self-expression should be carefully centred around men’s egos. This can be seen in this story when the narrator emphasizes how the young girl should behave in the presence of men.In the typical binary postcolonial society where men are considered dominant, women inevitably become acquiescent as a direct result of having less social capital. In other words, women are not only regulated in their homes but also on a large scale societally. Such rules and expectations restrict self-expression by requiring women to act in a certain way - no room for personal aspirations or desires outside of tradition. The narratee’s life is being defined with little room for rebellion. The daughter’s first rebuttal ‘but I don’t sing benna on Sundays at all and never in Sunday school’ is ignored to signify that society will not reward compliance as that is what is expected of a woman. The fear of not being the ideal woman is used to keep the narratee in check. As can be seen with the last line, the narrator responds to her question ‘but what if the baker won’t let me feel the bread?’ by saying ‘you mean to say that after all you are really going to be the kind of woman who the baker won’t let near the bread?’.Society is the metaphorical claustrophobic space in this story; women are kept in a box and are expected to stay there by stifling any form of individuality. It is clear that the narrator identifies the potential for frustration from all the restrictions and gives rules that indicate a ‘transgressive potential of performance’ (Janes “Kincaid”). For instance, the narrator mentions “this is how you smile to someone you don’t like too much; this is how you smile to someone you don’t like at all”. In the same way tight spaces give little room for manipulation, this transgressive loophole shows the narrator is aware and understands that gender performance is restrictive. Thus, there is an attempt to incorporate advice that allows for some authenticity. As a reader, one is put in the position of the narratee by being on the receiving end of the advice. With every phrase, the reader feels more locked in and desires begin to feel out of grasp. The momentum and exactitude of the instructions coupled with the judgemental statement at the end, causes one to feel overwhelmed for the symbolic lack of breathing space. This story can be seen as a societal analogy of a tight, crowded and windowless room.On the contrary, Charlotte Gilman’s story involves a concrete physical space. The Yellow Wallpaper was first published in 1892 and was initially interpreted as a horror story . In 1973, 5 years before Kincaid’s Girl was published, readers began to approach this story from a feminist perspective as this was a period when feminist ideals began to surface as a movement. Similar to how the references to weather, landscape, agronomy and cooking provide a sense of rootedness in Girl, The Yellow Wallpaper makes use of descriptors to establish the location of this story. It takes place in a lonely ‘colonial mansion’ that is ‘quite alone, standing well back from the road, quite three miles from the village’ . This lets us know the building is secluded from the busyness of the town, even though she can see people from her window. In the same vein as Kincaid’s girl, there is a power dynamic present between the narrator and her husband who is representative of society.The narrator in this story is seemingly suffering from post-partum depression and her husband, who is a physician, rents an untenanted building for three months to aid her recovery. He chooses the nursery as her room and as aptly described by Loralee MacPike, “the fact that the narrator’s prison-room is a nursery indicates her status in society. The woman is legally a child; socially, economically, and philosophically she must be led by an adult — her husband; and therefore the nursery is an appropriate place to house her” (Janes “Gilman”). The pattern of infantilization is also apparent in her husband’s choice of language. He refers to her as ‘little girl’. Typically, children are not always able to make informed decisions and require constant guidance. By infantilizing his wife, the husband suggests she is incapable of making independent choices and he is in the best position to judge what is in her best interest. When the narrator comments about her appetite to correct the physician’s notion that it is improving, he dismissively replies ‘bless her little heart’. This is the same way the young girl’s statement about not singing benna in Sunday school is dismissed in Kincaid. Both the narrator in The Yellow Wallpaper and the young girl are confined by people with higher societal authority who believe they have the best judgement. Not only is the narrator physically restricted to her physical setting, she is also mentally and expressively restricted by her husband’s stubbornness and gaslighting.There are various facets as to how the setting is a claustrophobic space. In describing the nursery she rests in, she mentions the furniture is ‘inharmonious’, the floor is ‘scratched’, the wallpaper is ‘torn off in spots’ and the sides of the bed posts had been ‘gnawed at’. The interior design of living spaces often have the ability to affect one’s state of mind. The way one would feel discouraged coming home to a messy room after a long day of work, discordant furniture also has the effect of causing one to feel overwhelmed and caged in. This in turn affects mood, behaviour and can cause irritability. This is highlighted when the narrator describes the wallpaper pattern as ‘infuriating’ and ‘torturing’. Her suggestion to move to one of the more visually pleasing rooms downstairs is turned down by her husband. He also monitors her activity within the nursery. When she gets up at night to take a closer look at the wallpaper, he tells her not go ‘walking about like that’ because she’ll get cold. He speaks to her as though she is not a grown woman capable of basic safety. Even within the enclosed physical space, her movement and will are restricted. In contrast with Kincaid’s girl, transgressive action is not encouraged here but the narrator does so regardless — she lies constantly about her thoughts and emotions to her husband to retain some form of authenticity. Although she is confined to such a displeasing space, she would rather it be her than her newborn. This consideration shows she recognizes the impact of such an environment on one’s expression and movement and would not want her child to experience it. Relief from living in a confined space does not stop when one steps out either, because they know they will have to return. This is why when she walks into other parts of the house and when she goes riding, she believes the smell of the wallpaper follows her around.A major part of this story that is significant to the topic of claustrophobic spaces is the yellow wallpaper in the room. At the start of the story, she vividly describes her disdain for the pattern and mentions it commits ‘every artistic sin’. She goes further to label the color ‘repellant, almost revolting; a smouldering unclean yellow’. Eventually, she begins to see what she believes is a woman stuck behind the incongruous pattern of the wallpaper. The narrator states this woman is subdued during the day, which metaphorically suggests how women are expected to be complacent as they go about their daily lives. She states that she sees her during the day on the roads beneath the trees and walking down the lane. I believe this refers to regular women going about their business, but she sees them as submissive women ‘creeping’ around, being careful to remain within societal standards. The only safe haven for eccentricities are in the dark, i.e. the only safe time to pause performative expectations is when no one is watching. It is not until she discovers this entrapped woman that she feels she has something to look forward to. This also shows a potential side effect of claustrophobic spaces. When one is repressed for too long, it can take a mental toll. In this case, the narrator begins to hallucinate.While her narration stops being reliable, the woman stuck in the wallpaper remains relevant as it mirrors her own situation — being stuck in the nursery and confined by poorly informed judgements. She convinces herself that the woman in the wallpaper desires to be freed from its confines and makes it her mission to do so on the last day of their stay. Upon seeing the torn wallpaper, Jennie, her husband’s sister, laughs and says she wouldn’t mind ripping it herself. In a prior scene, she also catches Jennie staring at the wallpaper intently. The two brief moments of solidarity between both women suggests a joint understanding — and empathy on the part of Jennie. It comes off as Jennie subtly acknowledging the enforced domestic state they are both in, but being powerless to do anything. Tight spaces tend to feel like the walls are closing in and the narrator’s frustration peaks when she finally tears apart the wallpaper. Ironically, at the end of the story, she locks herself in but states she ‘got out at last’. This goes to prove her transgressive act of rebellion was the escape she needed.To conclude, both stories contextualize claustrophobic spaces by presenting as the similar realities of women across societies — suppressed, domesticated and often infantilized. Acts of self expression are often rebuked and seen as rebellious. There is little to no room for individuality, just like tight spaces have little room for movement. The same way it gets harder to breathe in tight spaces is the same way women get overwhelmed with the unending societal expectations and judgment.Works CitedJanes, Daniela. ““Jamaica Kincaid, ‘Girl.’” ENG213: The Short Story, 3 June 2020, UTM. Lecture.Janes, Daniela. ““Charlotte Perkins Gilman, ‘The Yellow Wallpaper.’” ENG213: The Short Story, 14 May 2020, UTM. Lecture.Kincaid, Jamaica. “Girl.” PDF. https://www.bpi.edu/ourpages/auto/2017/10/14/55813476/Girl%20Jamaica%20Kincaid.pdfGilman, Charlotte. “The Yellow Wallpaper.” PDF, pp 647–656. http://socrates.acadiau.ca/courses/engl/rcunningham/1413-F09/YellowWallpaper.pdf

The growth of Dendrobium nobile is often stressed by zinc. To study the effect of zinc on the growth and biosynthesis of medicinal components, external zinc was regularly sprayed on Dendrobium nobile. The results showed that the net photosynthetic rate, transpiration rate, stomatal conductance, chlorophyll A and B of leaves increased first and then decreased with the increase of zinc concentration. At 400 μmol/L, they reached the maximum value, indicating that a certain dose of zinc could promote the photosynthesis of Dendrobium nobile. When the concentration of zinc was 400 μmol/L, which could promote the synthesis of SOD, the content of APX and AsA reach the maximum. The content of polysaccharide reached the maximum on the 7th day, the content of polyphenols reached the maximum on the 14th day. This result suggests that exogenous zinc can promote the accumulation of active components in Dendrobium nobile, and when the zinc concentration is 400 μmol/L, the promoting effect is greatest. While, it was found that the polysaccharide can combine with zinc well to form polysaccharide-zinc chelate, and transform inorganic zinc into organic zinc, which was stored in the form of polysaccharide-Zn in vivo and reduced the damage to Dendrobium nobile by Zn-stress

Aims: Colon perforation is the most serious complication of colonoscopy, and tends to be considered as malpractice. The aim of this study was to identify the characteristics and causes of medical accidents by analyzing lawsuit cases on colon perforation during colonoscopy. Methods: We collected judgment results that were ruled from 2005 to 2015 using the keyword of ‘colonoscopy’ in the ‘Korea’s Written Judgment Public Reading System’ of the Supreme Court, and extracted the cases of colon perforation. Characteristics of medical accidents and the decisions of courts were analyzed from written judgments. Results: Twenty-two lawsuits were analyzed. Most cases were ruled in favor of the plaintiff (n=20). The allegations against defendants, filed by the plaintiffs, were the performance error (n=22), the improper monitoring after colonoscopy (n=7), and the lack of informed consent (n=8). The median compensation was 9,335.47 US dollar, this is about 130 times the cost of a single colonoscopy in Korea. The greater the intestinal damage, the greater the amount of compensation (p=0.016). The time interval from procedure to diagnosis of perforation was most frequently 24 hours later (n=9). Conclusions: It is important to educate patients fully about the symptoms of colon perforation and to guide them to contact medical institutions immediately when symptoms occur. In addition, doctors should explain sufficiently the possibility of perforation before colonoscopy to the patients, not caregiver, and get an informed consent.

Objectives To investigate the operation time (OT) and the ureteral access sheath (UAS) usage with the infection rates and to determine a cut-off value for OT Methods We retrospectively analyzed the data of the patients who underwent FURS for renal stones larger than 20 mm between 2010 and 2019. The investigated parameters were OT, UAS using, and infection status. The data were analyzed by forming two groups according to whether the OT was less than 60 minutes and more, whether the UAS was used and whether an infection occurred. In addition, independent risk factors that may affect postoperative urinary infection development were also investigated by logistic regression analysis. And, a ROC curve analysis was applied to determine a cut-off value in OT terms, where infection rates increase more. Results A total of 575 patients were enrolled in the study. The rates of the usage UAS and infection were greater statistically in the group for longer than 60 minutes. OT was longer statistically in the infection group than in the group without infection ( 94.1±14.2 and 68.01±23.1, for groups 1 and 2, respectively, p<0.05, Table 2). OT was statistically longer in the UAS group than unused one ( 79.3±24.4 and 66.7±22.4, for groups 1 and 2, respectively, p<0.05, Table 3). ROC analyses revealed a cut-off point of 87.5min for OT in terms of infection rate Conclusion While the infection risk increases when OT exceeds 60 minutes, FURS can be safely performed up to 87.5 minutes with 89% sensitivity and 69% specificity infection risk.

Background: EBUS-TBNA is a frequently used diagnostic method for mediastinal/hilar lymphadenopathies and masses. This procedure is performed with intravenous sedation (IVS). During IVS, patients often develop hypoxemia and nasal oxygen delivery is insufficient in some patients. The aim of this study was to investigate the effect of oxygen application with nCPAP on hypoxemia during EBUS-TBNA. Methods: Patients with EBUS-TBNA indication who did not have any serious heart-lung disease were randomly divided into two groups. One group received only oxygen and the other group received nCPAP+oxygen. Patient characteristics, arterial oxygen saturations, anesthetic agents, CPAP pressures, oxygen concentrations and processing times were recorded during the procedure. Practitioner satisfaction was evaluated at the end. Results: 29 nCPAP+oxygen, 31 oxygen patients were included in the study. There were no significant differences in terms of age, sex, smoking history and presence of additional diseases in two groups. Neck circumference, BMI and STOP BANG questionnaire values were similar. Desaturation time was significantly longer in oxygen group than nCPAP+oxygen group (316±390 sec, 12±118 sec, respectively, p=0,019). Snoring was detected during the procedure in 22 patients in the oxygen group and in 11 patients in the nCPAP group (p=0,01). There were no serious complications in both groups. Practitioner satisfaction was higher in the nCPAP group but this was not statistically significant (p=0,052). Conclusions: Oxygen application by nCPAP during EBUS-TBNA under IVS, significantly reduces desaturation time. Oxygen delivery with nCPAP seems to be a better choice especially for the patients with high Mallampati index.

Objectives: Urinary incontinence (UI) is a common disorder that particularly affects the elderly population worldwide. UI can be associated with poor quality of life (QOL) in this vulnerable population, as it leads to limitation in both their physical and social activities of daily life. Additionally, it has a psychological and economic burden on individuals, health care services and society. This study was performed to measure the frequency of UI among the elderly and to determine its impact on the overall QOL, physical performance and activities of daily living. Participants and Methods: A cross-sectional study was performed in four Primary Health Care centres (PHCs) of El-Obour City. Data collection was done weekly on randomly chosen days. All elders aged 60 or above, who attended the PHCs on those days, were included. Results: The overall frequency of UI was 38% among the studied elderly. UI ranged from mild (12.3%) to moderate (57.9%) and severe (29.8%). Among incontinent participants, the frequency in men was 47.4% and in women was 52.6%. The frequency of stress, urge, mixed and other UI were 7%, 33.3%, 40.4% and 19.3% respectively. Incontinent elderly had significantly lower QOL as regards mental and physical indices than their continent counterparts. UI severity was inversely related to physical performance. Conclusion: UI has a high-frequency rate among the elderly population, and has a significant impact on all aspects of QOL especially their physical performance. Keywords: Urinary Incontinence, ICIQ, Physical Performance, Quality of Life, elderly.

Introduction: Brugada phenocopies are recently introduced as clinical entities with electrocardiographic patterns identical to true congenital Brugada syndrome in individuals, who are asymptomatic and have no other clinical criteria. One of the largest methanol poisoning outbreaks occurred in Iran during March and April 2020. This study aimed to investigate the relationship between Brugada Phenocopy with laboratory data and demographic factors and determine its association with mortality rate in methanol toxicity patients. Method and results: Demographic data such as age, gender, medical history, Glasgow coma scale score, laboratory data, and electrocardiographic data were obtained from 356 patients, who were diagnosed with methanol poisoning and were hospitalized in Faghihi and Namazi Hospitals in Shiraz, southern Iran, during March and April 2020. The follow-up data was gathered to examine the development of any complications or death. A total of 20 (5.6%) patients were admitted with a diagnosis of methanol toxicity and concurrent Brugada-like ECG patterns. Mortality rate, Glasgow Coma Scale Score <3, and blood sugar were significantly higher in the Brugada phenocopies; however, PH, O2 saturation, and calcium were lower among Brugada phenocopies in comparison to methanol toxicity patients with no Brugada pattern (P<0.05). Conclusion: According to the findings of this study, some recognizable ECG patterns and laboratory data may be used as novel prognostic factors of morbidity and mortality. Electrocardiography machines are widely available, and electrocardiograms can easily be obtained and interpreted. This may provide the grounds for caregivers to predict and prevent the incoming death and react more properly and timely.

Determining Prosthesis-Patient Mismatch after TAVR: Which is the Best Method?Authors: Cesar E. Mendoza, MD1 and Diego Celli, MD2Affiliations: 1Division of Cardiovascular Disease, Jackson Memorial Hospital, Miami, Florida;2Internal Medicine, University of Miami Miller School of Medicine/Jackson Memorial Hospital, Miami, Florida.Affiliation addresses: 11801 NW 9th Ave, Suite #209 33136 Miami, Florida, United States; 21611 NW 12th Ave 33136, Miami, Florida, United States.Corresponding author: Cesar E. Mendoza, MD; cesar.mendoza2@jhsmiami.org; 1611 NW 12th Ave, East Tower 3019, Miami, Florida 33136.Disclosures: Authors have no relationships with the industry. This work is not under consideration in any other journal.Funding: No grants, contracts, and other forms of financial support were used to perform this manuscript.In the last decade, the medical community has witnessed an accelerated development of multiple devices for the transcatheter management of aortic stenosis. Recently, transaortic valve replacement (TAVR) was granted approval for its use in all types of surgical risk patients underscoring its importance in cardiovascular practice. While evidence has shown non-inferiority of  TAVR versus surgical aortic valve replacement (SAVR) [1], it still has inherent intra- and post-procedural complications, prosthesis-patient mismatch (PPM) is one of them.Since the seminal work published by Rahimtoola in 1978 [2], several studies have investigated PPM. The incidence of PPM after SAVR ranges from 20% to 50% with severe cases having an occurrence rate from 5% to 25%. [3-5]. Severe PPM has been associated with significantly abnormal prosthetic valve echocardiographic parameters and adverse clinical outcomes including a higher risk of mortality [3,5-7]. Although initial studies showed a lower incidence of PPM after TAVR [8, 9], most recent data surprisingly depict an uptrend incidence of PPM with later-generation TAVR prostheses [10]. Regardless of the true global PPM incidence, the number of cases in the severe category remain within robust margins (5% - 36%). Perhaps, more interestingly, the association of TAVR with adverse outcomes is not firm. Indeed, there are conflicting reports, with some studies showing a weak association [11,12], no association [13, 14, 15], or association in particular group of patients [9].PPM occurs when the effective orifice area (EOA) of a normally functioning prosthesis is too small in relation to the patient’s body size and cardiac output requirements, and this diagnosis must be done after ruling out dysfunction of the prosthesis heart valve. Historically, surgical aortic valve replacement was the method of choice in the management of aortic stenosis; as such, surgeons relied on the manufacturer’s predicted EOA charts to aid in the determination of the minimum valve size for any given valve model. The predicted EOA index (EOAi), which is calculated by dividing the reference value for the prosthesis model and size by the body surface area (BSA) of the patient, has been frequently used to identify PPM in the SAVR studies. Similarly, all contemporary TAVR studies have used the same index for the same purpose; but it nevertheless was measured using Doppler-echocardiography data.In this issue of JOCS, Catalano et al report that the utility of EOAi charts to predict PPM after TAVR for native aortic stenosis may be limited. Indeed, they found in their study that the pre-TAVR prediction of PPM  using tables of expected EOA varies significantly from actual PPM measured on intraoperative transesophageal echocardiography using the continuity equation. Although this is a relatively small single-center study, the authors provided information worthy of additional consideration.First, they identified that EOAi charts overestimated the number of patients with PPM for Sapien 3 valves (25.3% predicted versus 13.7% actual) and underestimated the number of patients with PPM for Evolut valves (1.8% predicted versus 11.6% actual), yielding a limited utility for this instrument on pre-operative prediction of PPM in TAVR. Interestingly, a recent publication by Ternacle et al. [16] provides a different perspective on this topic. It reports that the predicted EOAi was found to be useful to reclassify the majority of patients diagnosed with measured PPM following TAVR to no PPM at all. Furthermore, they found that both methods had a different association with hemodynamic outcomes. In this regard, EOAi and mean transprosthetic gradient had a more powerful correlation when using the predicted EOAi versus the measured EOAi. Based on these findings, the Ternacle’s study suggests that the use of measured EOAi grossly overestimates the incidence of PPM. The discrepancy between both studies may be explained by the inherent variability in using different Doppler echocardiography imaging modalities to measure EOA. As Catalano et al rightly pointed out, the prosthesis data acquisition and measurements obtained by intraoperative transesophageal echocardiography in their study may not be comparable with its counterpart transthoracic modality, and this particular difference should be taken into account when interpreting the results above mentioned.Second, it is also clear from Catalano’s study that determining the best method to diagnose PPM following TAVR is paramount, but at the same time troublesome due to several factors. First, the pressure recovery phenomenon, a portion of the transprosthetic pressure gradient lost initially at the vena contracta level that recovers later after the prosthetic valve, is not accounted for by Doppler assessment of the maximum transvalvular flow velocities. This may cause overdiagnosis of PPM after TAVR. Second, measured EOA is influenced by the patient’s hemodynamic condition at the time of the evaluation and by the known technical pitfalls on the acquisition of images and measurement performance. Third, the use of the EOA indexed for body surface area may overestimate the severity of PPM in obese patients (body mass index ≥30 kg/m2).Certainly, Catalano’s study allows for a better discussion on the diagnosis and clinical implications of PPM following TAVR. However, the question of what method is a more accurate parameter to determine PPM remains unanswered. Clearly, further research is needed as TAVR is more frequently performed and new TAVR prostheses become available. Accurate prediction of PPM in this setting will help guide the operator’s decision on proper prosthesis size and type.

Aggregate disintegration is a critical process in soil splash erosion. However, the effect of soil organic carbon (SOC) and its fractions on soil aggregates disintegration is still not clear. In this study, five soils with similar physical and chemical properties and different contents of SOC have been used. The effects of slaking and mechanical striking on splash erosion were distinguished by using deionized water and 95% ethanol as raindrops. The simulated rainfall experiments were carried out in four heights (0.5, 1.0, 1.5, and 2.0 m). The result indicated that the soil aggregate stability increased with the increases of SOC and light fraction organic carbon (LFOC). The relative slaking and the mechanical striking index increased with the decreases of SOC and LFOC. The reduction of macroaggregates in eroded soil gradually decreased with the increase of SOC and LFOC, especially in alcohol test. The amount of macroaggregates (>0.25mm) in deionized water tests were significantly less than that in alcohol tests under the same rainfall heights. The contribution of slaking to splash erosion increased with the decrease of heavy fractions organic carbon (HFOC). The contribution of mechanical striking was dominant when the rainfall kinetic energy increased to a range of threshold between 9 J m-2 mm-1 and 12 m-2 mm-1. This study could provide the scientific basis for deeply understanding the mechanism of soil aggregates disintegration and splash erosion.

Understanding the transport of sediments in urban estuaries and their effects on water quality and microorganisms is a convergent challenge that has yet to be addressed especially as a result of natural hazards that affect the hydrodynamics of estuarine systems. This study provides a holistic view of the longitudinal nature and character of sediment in an urban estuary, the Galveston Bay Estuarine System (GBES), under daily and extreme flow regimes and presents the results of water and sediment sampling after Hurricane Harvey. The sediment sampling quantified total suspended sediment (TSS) concentrations, metal concentrations and the diversity of microbial communities. The results revealed the impact of the substantial sediment loads that were transported into the GBES in terms of the sediment grain type, the spatial distribution of trace metals and the diversity of microbial communities. A measurable shift in the percentage of silt relative to historical norms was noted in the GBES after Hurricane Harvey. Not only did sediment metal data confirm this shift and its ensuing impact on metal concentrations; microbial data provided ample evidence of the effect of leaks and spills from wastewater treatment plants, Superfund Sites and industrial runoff on microbial diversity. The research demonstrates the importance of understanding longitudinal sediment transport and deposition in estuarine systems under daily flow regimes, but more critically, following natural hazard events to ensure sustainability and resilience of systems such as the GBES that encounter numerous acute and chronic stresses.

China has carried out many ecological restoration projects in the past. At present, there are large spatial differences in the hydrological effects of forest ecosystems in different regions of the country under heterogeneous conditions, which is not conducive to the macro guidance of ecological restoration projects. Canopy interception is an important link in the water cycle of the ecosystem. This paper attempts to use this index as a bridge to connect the research literature of existing ecological sites, so as to evaluate the differences in water resources distribution in different regions and vegetation ecosystems and analyze the main reasons for the differences. We combined canopy interception rate (I0) and canopy water storage ability (I) to interpret canopy interception, and collected site related geographic, meteorological and ecosystem structure information simultaneously in the literature to build up an original dataset. Analysis on the database showed that the comprehensive interception capacity of vegetation in the south was generally higher than that in the north, which was dominated by shrubs, and that the tree species had interception advantages. Mixed forest showed the best comprehensive interception capacity, while pure tree forest had better interception potential than shrubbery due to its biomass advantage. The actual interception capacity of shrubbery was better than pure tree forest due to the advantages of stand density and the dry climate. Results from the evaluation of canopy interception ability using different indexes were not consistent, meaning that evaluating canopy interception with multiple indexes may be more objective. The study also highlights that the current structural characteristics of shrubby forests in northern China may be counterproductive to mitigating drought, reducing the structural density of a given stand will increase the opportunity for precipitation to reach the surface, thereby increasing the amount of water available to ecosystems in arid areas. Maintaining the healthy growth of mixed forests is still the right choice for humid areas in the south.

Key points: 1. In selected patients, biopsies of oropharyngeal lesions including the tonsils can be performed under local anaesthetic safely. 2. The technique described was found to be well tolerated by the patients and there were no adverse outcomes. 3. Performing these biopsies under local anaesthetic eliminates the morbidity associated with general anaesthesia. 4. Performing these biopsies under local anaesthetic increases operating room availability which is particularly important in the current economic climate and considering the covid-19 pandemic. 5. Performing these biopsies under local anaesthetic is thought to reduce the time from initial consultation to reaching a decision regarding treatment.

Background: The role of asthma as a risk factor for coronavirus 2019 (COVID-2019) morbidity and mortality is inconclusive and not fully understood. The primary objective was to evaluate the association between asthma history and mortality of COVID-19, and the secondary objective was to analyze the risk of COVID-19-related outcomes among patients with asthma compared to those without. Methods: Using clinical epidemiologic data from Korean Disease Control & Prevention, the risk for COVID-19-related morbidity and mortality were compared in patients with asthma and those without asthma among the participants who were confirmed to have COVID-19. A Cox proportional hazards regression model was used for mortality, and a linear regression model was used for morbidity scores. Results: The hazard ratio for death of patients with asthma versus those without was 2.48 (95% confidence interval (CI) 1.21-5.08, P=0.013) and 2.20 (95% CI 1.02-4.76, P=0.045) after full adjustment. The comorbidity of asthma was associated with an increase in the maximal morbidity score of COVID-19 compared to no asthma (estimated value of morbidity score (EV) = 0.44, 95% CI 0.16-0.73, P=0.003). Conclusion: Asthma is associated with an increased risk of mortality and morbidity in the Korean nationwide COVID-19 registry.

Aim Currently, the population in the world is rapidly increasing due to technological developments and convenient access to health services. Due to comorbidities in elderly patients, hip fractures are frequently observed after exposure to environmental trauma. To reduce pain during positioning in spinal anesthesia, fascia iliaca compartment block (FICB) can be applied easily and reliably. Material and Method Our study included 100 patients undergoing operations due to hip fracture and administered spinal anesthesia after FICB. The group with FICB accompanied by ultrasound (USG) had the blockage needle advanced to the compartment under the fascia iliaca and 15 mL bupivacaine + 10 mL 2% lidocaine was administered. Sitting position was given for spinal anesthesia 20 minutes later and procedure duration and NRS scores were recorded. In the group with FICB completed with the landmark method (LAND), the spina iliaca anterior superior (SIAS) and pubic tubercle were connected with a line. The same amount of local anesthetic was administered to the external 1/3 portion of this line with the double pop technique. Procedure durations and NRS scores were recorded. Results There was no statistically significant difference between the groups in terms of NRS scores (p>0.05). There was a statistical difference found in terms of FICB administration durations (p<0.05). Conclusion FICB administered both with USG and using the anatomic landmark method provides sufficient analgesia for the positioning stage of spinal anesthesia at similar levels. However, imaging of structures with ultrasound will provide more reliable blockage when there is access to the device and no time problems.

Objectives: To evaluate clinical outcomes of multidisciplinary vascular access support team (VAST) and the value of the service to critical care teams. Design: Prospectively collected data. Material and methods: All patients requiring vascular access at St Thomas’ Hospital, London over a 5-week period during the first wave of the pandemic in the UK. At the end of study period, online anonymised questionnaire administered to critical care team members, including nursing and medical professionals, to evaluate their experience of the service. Results: 122 patients aged 52.1 ± 13 years with high rate of pre-existing co-morbidities, underwent line insertion including 190 catheters (central venous n=182, arterial n=8). Median (range) number of 5 (0-17) lines were placed per day in patients of whom 90% tested positive for Severe Acute Respiratory Syndrome Coronavirus-type 2 pathogen (SARS-CoV-2). A single line was inserted in 146 out of 172 patients (76.8%) and n=36 patients (18.9%) ‘double puncture’ technique used. 45 line insertions (24%) had complications with minor [bleeding (n=19), line infection (n=10)] and 2 lines (1%) with major complication. The survey respondents, n=54 professionals, highlighted ease of referral and timely access placement (>90% responses); with agreement that VAST service saved them precious time and allow them to focus on other jobs. Conclusions: We describe the successful deployment of a multidisciplinary vascular access team with low complication rates and high rates of satisfaction. We recommend similar models can be considered by health services to optimise patient care and ICU management.

Cryptosporidium parvum is a major zoonotic pathogen responsible for outbreaks of severe diarrhea in humans and calves. Almost all investigations of cryptosporidiosis outbreaks caused by C. parvum have focused on its IIa subtype family in industrialized nations. From December 2018 to April 2019, approximately 200 neonatal calves on a large cattle farm in Hebei Province, China presented watery diarrhea and over 40 died. To investigate the cause of the outbreak, 179 and 223 fecal specimens were collected during and after the diarrhea outbreak from the farm, including 40 and 56 from neonatal calves, respectively. Among them, 18 fecal specimens from ill calves during the peak of the outbreak were analyzed for four common enteric pathogens using enzymatic immunoassay (EIA), 75 additional specimens from neonatal calves were tested for rotavirus by EIA, and all specimens were analyzed for Cryptosporidium spp. using PCR and sequencing techniques. Of the initial 18 specimens from sick calves, ten were positive for C. parvum, five for rotavirus, and one for coronavirus. The overall prevalence of rotavirus in neonatal calves was 20.0% (15/75), with no significant differences during (21.6% or 8/37) and after (18.4% or 7/38) the outbreak. In contrast, the prevalence of C. parvum was significantly higher during the outbreak (60.0%, 24/40) than after the outbreak (30.4%, 17/56). C. parvum infection was associated with the occurrence of watery diarrhea in neonatal calves (odds ratio = 11.19), while no association was observed between C. bovis infection and diarrhea. All C. parvum isolates were identified as subtype IIdA20G1. Older animals were infected with C. bovis, C. ryanae, C. occultus, and C. andersoni. This is one of the few reports of outbreaks of severe diarrhea caused by C. parvum IId subtypes in calves. More attention should be directed toward preventing the dissemination of C. parvum in China.

African swine fever (ASF) has spread across many countries in Europe since the introduction into Georgia in 2007. We report here on the first cases of ASF in wild boar detected in Germany close to the border with Poland. In addition to the constant risk of ASF virus (ASFV) spread through human activities, movements of infected wild boar also represent a route of introduction. Since ASF emerged in Western Poland in November 2019, surveillance efforts, in particular examination of wild boar found dead, were intensified in the regions of Germany bordering with Poland. The first case of ASF in wild boar in Germany was therefore detected by passive surveillance and confirmed on 10th September 2020. By 24th September 2020, 32 cases were recorded. Testing of samples from tissues of carcasses in different stages of decomposition yielded cycle threshold values from 18 to 36 in the OIE-recommended PCR which were comparable between the regional and national reference laboratory. Blood swabs yielded reliable results, indicating that the method is suitable also under outbreak conditions. Phylogenetic analysis of the ASFV whole-genome sequence generated from material of the first carcass detected in Germany, revealed that it groups with ASFV genotype II including all sequences from Eastern Europe, Asia and Belgium. However, some genetic markers including a 14 bp tandem repeat duplication in the O174L gene were confirmed that have so far been detected only in sequences from Poland (including Western Poland). Epidemiological investigations that include estimated postmortem intervals of wild boar carcasses of infected animals suggest that ASFV had been introduced into Germany in the first half of July 2020 or even earlier.