Diatoms are important organisms in aquatic ecosystems due to their position as primary producers and, therefore, analyzing their communities provides relevant information on ecosystem functioning. Diatoms have been historically identified based on morphological traits, which is time-consuming and require well-trained specialists. Nevertheless, DNA barcoding approach offers an alternative to overcome some limitations of the morphological approach. Unfortunately, however, only a few studies have compared beta diversity patterns for both DNA barcoding and morphological approaches. Here, we derive a new take on this issue and assess the ecological mechanisms underlying spatial variation in epiphytic diatom metacommunities using a comprehensive dataset from 22 Mediterranean ponds at different taxonomic resolutions. Our results suggest a relatively poor correspondence in the compositional variation between morphology--based and molecular--based approaches. We speculate that the incompleteness of the reference database and the bioinformatics processing are the biases most likely related to the molecular approach whereas the limited counting effort and the presence of cryptic species are presumably the major biases related to morphological approach. On the other hand, we found that both approaches were strongly related to the environmental template, suggesting that epiphytic diatom communities were mainly controlled by species sorting at regional extents. Overall, this work suggests that both molecular and morphological approaches provide complementary information on diatom metacommunity organization and emphasizes the importance of DNA barcoding to addressing empirical research questions of community ecology in freshwaters.

Intracardiac cement embolism(ICE)-related cardiorespiratory complications may be delayed, and in the presence of symptomatic migrating bone cement, surgical retrieval must be considered to prevent progression to constrictive pericarditis and to relieve symptoms. This is the first report describing simultaneous cardiac and lung perforation caused by bone cement located in the right atrium after percutaneous vertebroplasty.

A novel use of a jejunal graft for the successful repair of a colorectal anastomotic dehiscence after a transanal pull-through procedure in two dogs.

Cardiac surgery in patients with hemophilia remains a serious problem due to the risk of bleeding complications. Here, we report successful treatment of mitral valve insufficiency and concomitant atrial fibrillation in a patient with severe hemophilia A.

A document by William Chan. Click on the document to view its contents.

Abstract: In order to study the dynamic fracture properties of FRP strengthened concrete, the three-point bending experiment with different initial crack-depth ratios was carried out under dynamic loading. The effects of crack-depth ratios on the fracture parameters were analyzed. Combined with Pearson Correlation Coefficient formula, the correlation between crack-depth ratios and fracture parameters was quantitatively verified. The conclusions could be drawn that, there are three critical points in the damage process: the crack initiation point, first peak point and ultimate bearing capacity point. With the increase of crack-depth ratio, the crack initiation load decreases, but the first peak load and ultimate load increase first and then decrease. The stress intensity factors of three points also increase first and then decrease. The increment of critical crack-depth ratio and flexibility coefficient are related to crack-depth ratio, which could reflect the effect of crack-depth ratio on the deformation capacity of FRP strengthened concrete.

Abstract Objective To examine the occurrence and independent risk factors for surgical site infection (SSI) after caesarean section (CS). Design A hospital-based case-control study. Setting University Hospital. Population Women who were readmitted with SSI after CS during the years 2014-2016 (n=75). Controls were selected at a ratio of 2:1 (n=148). Methods Cases (women with SSI following CS) and controls (women without SSI following CS) were compared with respect to maternal and pregnancy characteristics using multivariable logistic regression analysis. Main Outcome Measures Anticipated risk factors for SSI. Results The occurrence of SSI requiring rehospitalisation was 0.38% and 5.5% after elective and emergency CS, respectively. Obesity was four times more common in women with SSI than in women without SSI (OR 4.1, 95% CI 1.5-11.3). Signs of infection during labour was almost five times more common (OR 4.7, 95% CI 1.7-13.0). Attempted vaginal delivery by pushing before CS was more than five times more common (OR 5.6, 95% CI 1.3-24.3). Pre-existing psychiatric disease was a significant predictor for SSI. Conclusions Emergency CS was a significant characteristic for SSI. Obesity, signs of infection prior to delivery, attempt of vaginal delivery by pushing before CS and pre-existing psychiatric disease, were independent risk factors for SSI. Women with either of these risk factors should be carefully monitored and evaluated for signs of infection in the postpartum period.

Indian Regional Navigation Satellite System (IRNSS)/NavIC operates in two frequency bands namely L5 band (1176.45 MHz) and S1 band (2492.02 MHz). To navigate over vegetated area or man-made structures or unstructured area, different methods have been used. By utilizing NavIC user receiver along with comparison with GPS leads to accurate navigation and near real time observation for this scenario. Various field surveys have been conducted by keeping one receiver as base station i.e., NavIC receiver kept constant and other receiver used as rover receivers. These base stations depend on the exact coordinates. In this study two fixed NavIC receivers and a rover receiver are used. By solving the distances between fixed points, and also by using the inverse distance weighting method, the error of rover receiver is found. It can be implemented anywhere, therefore local navigation system can be achieved easily.

Early detection of increasing values of intraocular pressure (IOP) due to glaucoma can prevent sever ocular diseases and ultimately, prevent loss of vision. Currently, the need for an accurate, mobile measurement of intraocular pressure is unmet within the modern healthcare practices. There is a potential to utilize soundwaves as a mobile measurement method and therefore, the relationship between IOP and the reflection coefficient of sound waves is investigated. Simulations are conducted using COMSOL Multiphysics to provide theoretical confirmation of the worthiness of the experiment. An experimental demonstrated is presented to further investigate the relationship between the internal pressure of an object and its acoustic reflection coefficient. The experiment exploits the use of hydrostatic pressure to determine internal pressure, and the reflection coefficient is measured and analyzed. An initial experiment is conducted to identify the resonant frequency of the object and the optimal frequency for maximizing reflection. The experiment shows comprehensively that there is a relationship between the internal pressure of an object and its acoustic reflection coefficient, providing a confirmation of the theory that would allow mobile measurements of IOP to be conducted with the use of a smart phone.

In this paper, to economically and fast solve the linear complementarity problem, based on a new equivalent fixed-point form of the linear complementarity problem, we establish a class of new modulus-based matrix splitting methods, which is different from the previously published works. Some sufficient conditions to guarantee the convergence of this new iteration method are presented. Numerical examples are offered to show the efficacy of this new iteration method. Moreover, the comparisons on numerical results show the computational efficiency of this new iteration method advantages over the corresponding modulus method, the modified modulus method and the modulus-based Gauss-Seidel method.

In this work, the study of the Peyrard-Bishop DNA dynamic model equation analytically and numerically will present. The Kudryashov method and modified Kudryashov method are used to nd the solution of the Peyrard-Bishop DNA dynamic model equation analytically. A cubic B-spline collocation method is used to obtain a numerical solution of the Peyrard-Bishop DNA dynamic model equation. A comparison between the results obtained by the analytical methods and the numerical method is investigated. We give some figures to show how accurate the solutions will be obtained from analytical and numerical methods.

In present study, we investigate steady MHD Casson fluid flow effect with stretching porous walls together with thermal radiation amid two equidistant sheets. The heat and mass transport experience on dimensionless parameters Soret and Dufour effect on squeezing flow are interpreted along with the impression of thermal radiation also with heat source/sink. We change the partial differential equations (PDEs) into ordinary differential equations (ODEs) dealing convenient proportionality transformations & after then solve ODEs by Runge-Kutta 4th-order scheme and shooting technology. The sequel of different parameters demonstrated by graph and table of temperature, velocity, and concentration impact. We studied the efficacy of Grashof numbers, Reynolds number, dimensionless Casson fluid parameter, and Hartman/magnetic quantity on velocity, temperature, and on concentration. The skin friction coefficient (Cf), Nusselt number (Nu), and Sherwood number (Sh) are reported and calculated at the end.

Integrated continuous downstream processes with process analytical technology offer a promising opportunity to reduce production costs and increase process flexibility and adaptability. In this case study, an integrated continuous process was used to purify a recombinant protein on laboratory scale in a two-system setup that can be used as a general downstream setup offering multi-product and multi-purpose manufacturing capabilities. The process consisted of continuous solvent/detergent virus inactivation followed by periodic countercurrent chromatography in the capture step, and a final chromatographic polishing step. A real-time controller was implemented to ensure stable operation by adapting the downstream process to external changes. A concentration disturbance was introduced to test the controller. After the disturbance was applied, the product output recovered within 6 hours, showing the effectiveness of the controller. In a comparison of the process with and without the controller, the product output per cycle increased by 27%, the resin utilization increased from 71.4% to 87.9%, and the specific buffer consumption was decreased by 21% with the controller, while maintaining a similar yield and purity as in the process without the disturbance. In addition, the integrated continuous process outperformed the batch process, increasing the productivity by 95% and the yield by 28%.

Cyanobacterial carbonate precipitation induced by cells and extracellular polymeric substances (EPS) enhances the mortar durability. The percentage of cell/EPS attachment regulates the effectiveness of the mortar restoration. This study investigates the cell coverage on mortar and microbially induced carbonate precipitation. Statistical analysis of results from scanning electron and fluorescence microscopy show that the cell coverage was higher in the presence of UV-killed cells than living cells. Cells preferably attached to cement paste than sand grains, with a difference of one order of magnitude. The energy dispersive X-ray spectroscopy analyses and Raman mapping suggest cyanobacteria used atmospheric CO2 to precipitate carbonates.

Background: Transplant patients are known to be at increased risk of developing de novo malignancies (DNM). As heart transplant survival has increased, DNM represent an obstacle to further improving survival. We sought to examine the incidence, risk factors, and prognostic factors of post-transplant DNM. Methods: We studied adult heart transplant recipients from the Organ Procurement and Transplantation Network database (1987-2018). Kaplan-Meier survival analysis was performed to determine annual probabilities of developing DNM, excluding squamous and basal cell carcinoma. Rates were compared to the general population in the Surveillance, Epidemiology, and End Results database. Cox proportional hazards regression was performed to calculate hazard ratios for risk factors of DNM development, all-cause, and cancer-specific mortality. Results: Over median follow-up of 6.9 years, 18% of the 49,361 patients developed DNM, which correlated with an incidence rate 3.8 times that of the general population. The most common malignancies were lung, post-transplant lymphoproliferative disorder, and prostate. Risk was most increased for female genital, tongue/throat, and renal cancers. Male gender, older age, smoking history, and impaired renal function were risk factors for developing DNM, whereas the use of MMF for immunosuppression was protective. Cigarette use, increasing age, the use of ATG for induction and calcineurin inhibitors for maintenance were risk factors for cancer-specific mortality. The development of a DNM increased the risk of death by 40% (p<0.001). Conclusions: Heart transplant patients are at increased risk of malignancy post-transplant, particularly rare cancers. Strict cancer surveillance and attention to immunosuppressive regimens are critical for further prolonging post-transplant survival.

Background: Anaphylaxis is increasing at pediatric age; however, its characterization is hampered by underdiagnosis and underreporting. The aim of this study was to identify the causes of anaphylaxis in children and adolescents in Portugal, thus contributing to a better knowledge of its etiology, clinical manifestations and management. Methods: During a 10-year period a nationwide notification system for anaphylaxis was implemented, with voluntary reporting by allergists. Data on 533 patients under 18 years of age with anaphylaxis were included. Results: Mean age was 8.5±4.9 years, 61% were male; 45% had asthma. Mean age at the first anaphylaxis episode was 5.3±4.7 years (ranging from 1 month to 17 years of age), 63% at preschool age. Most reactions occurred at home (57%). Food-induced anaphylaxis was the leading cause (77%). The main culprit foods were cow’s milk (32%), tree nuts (16%), shellfish (13%), egg (12%), fresh fruits (11%), fish (8%) and peanut (8%). Other causes included drugs (11%), insect-sting (5%), cold-induced anaphylaxis (4%), exercise-induced (2%), latex (1%) and idiopathic anaphylaxis (1%). Most patients (83%) were admitted to the emergency department; only 46% received adrenaline treatment. Recurrence of anaphylaxis occurred in 41% of the patients (3 or more episodes in 21%). An adrenaline autoinjector was used in 9% of the patients. Conclusions: In the Portuguese pediatric population, food is the leading cause of anaphylaxis. Undertreatment with adrenaline and high recurrence of anaphylaxis highlight the need to improve both the diagnosis and the therapeutic management of this life-threatening entity.

Background: Severe asthma exacerbation is an important comorbidity of the 2009 HIN1 pandemic [A(H1N1)pdm09] in asthmatic patients. However, the mechanisms underlying severe asthma exacerbation remain unknown. In this study, airway hyperresponsiveness (AHR) was measured in paediatric asthma patients infected with A(H1N1)pdm09. We also evaluated AHR in asthmatic mice with A(H1N1)pdm09 infection and those with seasonal influenza for comparison. Methods: AHRs in asthmatic children were defined as the provocative acetylcholine concentration causing a 20% reduction in FEV1.0 (PC20). To investigate the pathophysiology using animal models, BALB/c mice aged 6-8 weeks were sensitized and challenged with ovalbumin. Either mouse-adapted A(H1N1)pdm09, seasonal H1N1 virus (1×105 pfu/20 μL), or mock treatment as a control was administered intranasally. At 3, 7, and 10 days after infection, each group of mice was evaluated for AHR by methacholine challenge using an animal ventilator, flexiVent®. Lung samples were resected and observed using light microscopy to assess the degree of airway inflammation. Results: AHRs in the children with bronchial asthma were temporarily increased, and alleviated by 3 months after discharge. AHR was significantly enhanced in A(H1N1)pdm09-infected asthmatic mice compared to that in seasonal H1N1-infected mice (p<0.001), peaking at 7 days post-infection and then becoming similar to control levels by 10 days post-infection. Histopathological examination of lung tissues showed more intense infiltration of inflammatory cells and severe tissue destruction in A(H1N1)pdm09-infected mice at 7 days post-infection than at 10 days post-infection. Conclusions: Our results suggest that enhanced AHR could contribute to severe exacerbation in human asthmatic patients with A(H1N1)pdm09 infection.

Viruses are the main pathogens responsible for acute upper respiratory tract infections; they spread easily among infants, young children, and the elderly population. The strong spreading capability of such viruses poses great difficulties for clinical diagnosis, treatment, and disease prevention and control. During the current coronavirus disease (COVID-19) pandemic, a clear understanding of the epidemiological characteristics of respiratory tract pathogens is essential for the timely identification of non-COVID-19 respiratory tract infections and enhancement of the efficiency of disease prevention and control. In this study, a total of 2,017 patients with upper respiratory tract infections in Kunming, Yunnan province of China, were included as subjects and divided into the Before COVID-19 and During COVID-19 groups. Differences in the infection rate of 13 common respiratory tract pathogens before and during the COVID-19 pandemic were determined using PCR in conjunction with capillary electrophoresis. Results indicated that the infection rate of respiratory tract pathogens (prevailing pathogens and infection status of different age groups) underwent significant changes after the start of the COVID-19 pandemic. Further in-depth research is required to improve the diagnosis, treatment, prevention, and control of respiratory tract infections.

A document by Manao Kinoshita. Click on the document to view its contents.

Background: The aim of this study was to evaluate diaphragmatic parameters in bronchiolitis patients and identify correlations between clinical and sonographic severity scores and outcomes in order to develop a more objective and useful tool in the emergency department. Methods: Children aged between 1 and 24 months and diagnosed with acute bronchiolitis were included in the study. The Modified Respiratory Distress Assessment Instrument (mRDAI) score was used to quantify the clinical severity of the disease. Lung ultrasound was performed and a bronchiolitis ultrasound score (BUS) was calculated. Diaphragm ultrasound was then performed and diaphragm thickness at the end of inspiration and expiration, thickening fraction, diaphragm excursion (EXC), inspiratory slope (IS), expiratory slope (ES), and total duration time of the respiratory cycle were measured. Results: There were 104 patients evaluated in this study. The mRDAI score and BUS had a significant positive correlation. There was a positive correlation between IS and respiratory rate at admission. As the clinical score increased, IS, ES, and EXC measurements rose and they were positively correlated. Values of IS, ES, and EXC were higher in the moderate-severe group than the mild group for both mRDAI and BUS scores. Inspiratory slope values were correlated with the length of stay in the hospital. Conclusion: Values of IS and ES were correlated with clinical and sonographic severity scores. Moreover, IS was a good predictor of outcome. Diaphragm ultrasound appears to be an objective and useful tool to help the physician make decisions regarding the evaluation and management of bronchiolitis.

Mainstem bronchial atresia (MBA) is a rare and fatal entity with no survivors reported to date. We describe a neonate born at 36 weeks gestational age (GA) with right MBA who underwent successful slide tracheobronchoplasty at 32 days of life. It is theorized that during fetal life a transient fistulous connection developed, allowing right lung decompression and left lung development.

By comparing the outpatient volume of pediatric patients and the outpatient volume of respiratory tract infections in Chongqing Maternal and Child Health Care Hospital from 2017 to June 2020, the changes in the outpatient volume of pediatric patients and the outpatient volume of respiratory tract infections during COVID-19 were summarized and analyzed, so as to provide basis for disease prevention.

To the editor:Hypereosinophilic syndrome is a diverse group of disorders with eosinophilia and end-organ damage. Any organ system may be involved, cardiopulmonary and neurologic diseases being the most common causes of morbidity and mortality1. HES is more commonly seen in adults but has been reported in pediatric population as well. Formerly pediatric patients who present with marked eosinophilia (1500/mm3) for at least 6 months’ duration without other known causes of eosinophilia and with evidence of organ involvement used to be diagnosed as HES. Recently the International Cooperative Working Group on Eosinophil Disorders (ICOG-EO) defined HES as blood hypereosinophilia (HE) or tissue HE associated with HE-related organ damage irrespective of time (precluding the absence of an alternative diagnosis for the organ dysfunction)2 . 2019 ended with the emergence of a novel coronavirus, SARS-Co-V2, leading to a pandemic with a high attack rate causing COVID-19 disease. Since the beginning of pandemic pulmonary findings defined for COVID-19 are considered to be pathognomonic hence, chest tomography is suggested to be superior to polymerase chain reaction tests in the diagnosis of adult COVID-19 patients3.16 -year- old female referred with the diagnosis of COVID-19 pneumonia and myocarditis. She had worsening cough for the last 10 days, initially diagnosed with pneumonia and started on antibiotics. Upon becoming dyspneic and feverish she was hospitalized. Computed tomography (CT) of the chest was reported to be suggestive of COVID-19 with bilateral peripheral consolidation areas and nodules with surrounding ground glass appearance (Figure 1a,b). Her COVID-19 PCR was negative for 3 times during this 10-day course of illness. Echocardiography revealed findings consistent with myocarditis. She was started on favipravir and intravenous immunoglobulin (IVIG) and referred to our hospital for potential extracorporeal membrane oxygenation (ECMO) requirement. On admission, her physical examination revealed tachycardia, tachypnea and hypoxia, subcostal and suprasternal retractions and bilaterally diminished breath sounds, no hepatosplenomegaly was present.Laboratory findings were white blood cell count (WBC) 29200 /mm3(4100-11200), absolute eosinophil count (AEC) 16370 /mm3 (100-500), hemoglobin (Hb) 12.5 g/dl (11.7-15.5 ) , thrombocyte count 406 000/ mm3(159000-388000), peripheral blood smear revealed 68% eosinophils. Cardiac enzymes were elevated; brain natriuretic peptide (BNP) 725.4 pg /ml (0-100), troponin -I 3769.5 ng/l (8.4-18.3), creatinine kinase myocardial band (CK-MB) 26.1µg/l (0.6-6.3) , alanine transferase (ALT) 31U/l, (<39)aspartic acid transferase (AST) 44 U/l (<56). Electrocardiogram (ECG) was at sinus rhythm, with normal PR and QT intervals. The voltages were suppressed, and there was no negative T-waves. Echocardiogram was repeated confirming myocarditis with a hypokinetic area on the apex of left ventricle. COVID PCR test repeated and found to be negative on two occasions obtained at 24 hours interval. She had been diagnosed with asthma for the last 2 years with frequent attacks and was on combined formoterol and budesonide inhaler treatment. There was no history of sinusitis or rash. Abdominal ultrasonography was normal. Stool examination revealed no parasites, there was no history of drugs. CMV, Herpes, EBV, Hepatitis B and C, Parvovirus serology and PCR were negative. Anti-neutrophil cytoplasmic antibody (ANCA) was also negative and total Ig E was 1796 mg/dl (1.31-165), Vitamin B12 level was 227ng/L (200-590). Bone marrow aspiration revealed increased numbers of eosinophilic precursor cells (14% eosinophilic metamyelocytes) as well as mature eosinophils (34%) with no malignant cell and no cytogenetic abnormalities (Figure 1). Bone marrow biopsy showed a normocellular marrow with increased eosinophilic precursors, except reticulin fibrosis and mast cells. Flow cytometric evaluation showed no atypical population, JAK2V617F mutation was negative, and leukemia defining translocations including BCR/ABL1, CBFB/MYH11 were negative. Clonal hyper-eosinophilia associated rearrangements including PDGFRA, PDGFRB, FGFR1 were also negative. Upon re-evaluation of chest CT with these clinical and laboratory findings, radiology department stated that HES or Churg-Strauss should be considered as potential diagnoses as well as COVID-19 (Figure 2). CT-angiography showed no findings of vasculitis or vascular occlusion.The patient was given high flow oxygen support, started on teicoplanin, meropenem and clarithromycin, carvedilol, enalapril and pulse methyl prednisolone treatments. On the 5th day of treatment WBC and AEC declined to 8200 /mm3 and 0 /mm3respectively. Corticosteroid dose was tapered gradually; at the end of 4 weeks WBC and AEC were 14300/mm3 and 0/mm3 respectively. After treatment, control chest CT showed regression of lung involvement findings ( Figure 3).Since December 2019 the whole world is struggling with a novel corona virus pandemic and COVID-19, the disease it leads to. With a high attack rate and so many deaths, it is quite understandable that COVID-19 has become number one priority diagnosis in everyday practice. The sensitivity and practicality of molecular tests has been an issue since the beginning of the pandemic and chest CT is claimed to be more accurate than PCR 4 in the diagnosis of COVID-19 which seems to set a bias in the interpretation of chest CTs. On the other hand, whether CT is superior in diagnosis of COVID-19 in pediatric patients who experience viral pneumonia more frequently compared to adults is yet to be determined. Whether there is a pandemic or not one has to remember that the art and creativity of medicine is to evaluate every symptom and sign on a patient-based approach in order to make the correct diagnosis.

Background: There is a lack of tools to holistically quantify the response to monoclonal antibodies (mAbs) in severe uncontrolled asthma (SUA) patients. The aim of this study was to develop a valid score to assist specialists in this clinical context. Methods: The score was developed in 4 subsequent phases: (1) elaboration of the theoretical model of the construct intended to be measured (response to mAbs); (2) definition and selection of items and measurement instruments by Delphi survey; (3) weight assignment of the selected items by multicriteria decision analysis (MCDA) using the Potentially All Pairwise RanKings of all possible Alternatives (PAPRIKA) methodology via the 1000Minds software; and (4) face validity assessment of the obtained score. Results: Four core items, with different levels of response for each of them, were selected: “severe exacerbations”, “oral corticosteroid use”, “symptoms” (evaluated by Asthma Control Test: ACT) and “bronchial obstruction” (assessed by FEV1 % theoretical). “Severe exacerbations” and “oral corticosteroid maintenance dose” were weighted most heavily (38% each), followed by “symptoms” (13%) and “FEV1” (11%). Higher scores in the weighted system indicate better response and the range of responses runs from 0 (worsening) to 100 (best possible response). Face validity was high (intraclass correlation coefficient: 0.86). Conclusions: The FEOS score (FEV1, Exacerbations, Oral corticosteroids, Symptoms) allows clinicians to quantify response in SUA patients who are being treated with mAbs.