ABSTRACT Background During the outbreak of COVID-19 many chilblain-like lesions are being increasingly reported. The aim of the study is to evaluate a possible correlation between pernio like skin lesions and SARS CoV2 infection. Methods All patients underwent not only clinical and laboratory tests to evaluate a possible underlying connective disease, but also specific SARS CoV2 investigations such as oropharyngeal swab and IgG-IgM serology. Results Nine patients, all children, were recruited. 6/9 had respiratory and systemic symptoms that preceded cutaneous findings of approximately 2 weeks. The injuries observed were purplish, erythematous and edematous; four children reported subjective symptoms, painful and pruritus localized to the sole of the feet or to the toes, fingers or heels. Concerning blood exams: 3/9 had D-dimer weakly increased, 4 had ANA positivity: two with a title 1:160, one with 1:320 and one with 1:5120 and a speckled pattern. The latter patient had also ENA SS-A positive and FR positivity, confirmed at a second check, so as to allow us to make a diagnosis of connectivity. 4/9 had aPL positivity (IgM). Reactants acute phase were all negative. Oropharyngeal swabs and serology tests for SARS-CoV2 was negative (borderline in one patient for IgM). Conclusions Even if we do not have enough data to prove it, we hypothesize a correlation between chilblain and SARS-CoV2 infection for an increased number of these lesions described and also because such lesions appeared when temperatures were mild and patients were at home in isolation for the lockdown. Many questions remain open about interaction host-virus.

With the enormous platforms available in present days, consumers communicate and interconnect online with web users all around the world to share their experiences. Thus, online platform has become a major source of reviews about different entities. People presently travel frequently around the world for different purposes. Seeking good hotels for accommodation is a prime concern. Customer reviews on hotels help future customers to take decisions about their accommodation as well as help hotel owners to rethink about designing customer facilities. However, many online reviews are biased due to different factors. Many hotel owners come up with attractions like referral rewards, coupons, bonus points etc. to the reviewers to motivate them in writing biased reviews. We have worked on US’s 100 hotel and found 952 incentivized reviews out of 19175 reviews, which is 4.96% of total reviews. A categorization on incentivized reviews is performed as well. Furthermore, hotels are distinguished based on real and incentivized reviews found on them. Results are verified using machine learning algorithms. Random Forest, K-Nearest Neighbor and Support Vector Machine are applied as machine learning algorithms to validate the accuracy of our model and their prediction results are compared. Random Forest outperforms with 94.4% prediction accuracy.

We describe a 12-year-old boy with uncontrolled bronchial asthma, bronchiolitis obliterans and restrictive and obstructive pulmonary disorders in spirometry who became infected with COVID-19. Contrary to the assumptions of other clinical findings, the boy was complaining only one day about body aches while showing no other symptoms. Neither cough, dyspnoea nor fever occurred. This case demonstrates that in particular paediatric patients with pre-existing pulmonary condition such as uncontrolled bronchial asthma and bronchiolitis obliterans can show an uncomplicated course of the COVID-19 disease.

【Abstract】Objective To investigate the clinical effect of bronchoscope alveolar lavage (BAL) combined with different drugs in the treatment of refractory Mycoplasma pneumoniae pneumonia（RMPP）. Methods Eighty-two patients with RMPP who were admitted to Pediatrics of The First People’s hospital of Zhengzhou from July 2017 to July 2019 were retrospective analyzed. All the patients were given BAL. The patients were divided into three groups according to the different drugs added by BLA, namely Budesonide group, Ambroxol+budesonide group, and acetylcysteine+budesonide group. The changes of laboratory examination indexes, the improvement of pulmonary imaging, the total effective rate and the occurrence of adverse reactions were analyzed. Results The laboratory test indexes of the 3 groups were more to improve than that before treatment, the difference was statistically significant. There was no significant difference in white blood cell (WBC), Ｃ-reactive protein(CRP) and erythrocyte sedimentation rate (ESR) among the three groups after treatment. There were significant differences in serum lactate dehydrogenase (LDH) and serum ferritin (SF) among the three groups (P<0.05). The rate of pulmonary imaging absorption and clinical effective rate in acetylcysteine +budesonide group were better than another two groups (P＜0.05) .There were no significant differences in the incidence of adverse reactions among the three groups (P>0.05). Conclusions BLA with acetylcysteine+ budesonide is more effective than another two groups in improving the efficacy of treatment of children with RMPP, it could promote the absorption of the opacity, and reduce the inflammatory response of the lungs.

Aim: To evaluate clinical vertebral fractures after denosumab discontinuation in patients with breast cancer. Methods: To evaluate the occurrence of clinical vertebral fractures after denosumab discontinuation, we conducted a retrospective chart review to identify patients with a history of breast cancer who were treated with denosumab between June 1, 2010 and July 18, 2018 at Memorial Sloan Kettering Cancer Center. We identified 335 postmenopausal female patients and one male patient with nonmetastatic breast cancer who received at least two doses of denosumab (60 mg) and had received their final denosumab injection at least 6.5 months earlier. Results: The median age of patients was 62 years (54–69). Patients received between two and 13 denosumab doses before drug discontinuation. The majority of patients (310; 92.3%) were also treated with aromatase inhibitors. Of the 194 patients with baseline bone-density data, 50 (25.8%) had normal bone density, 97 (50.0%) had osteopenia, and 47 (24.2%) had osteoporosis. The median follow-up duration from the last denosumab dose was 18.5 months (12.5–23.5). We identified one case of spontaneous vertebral fractures after denosumab stoppage. We found no cases of osteonecrosis of the jaw or atypical femur fracture. A majority of patients (88%) had a gap in denosumab dosing. Conclusions: Patients with breast cancer—especially those taking aromatase inhibitors—taking denosumab should be warned of the risks of delaying denosumab. Larger prospective studies are needed to fully evaluate the risks of stopping or delaying denosumab

Introduction       Belonging to the group of nitrated polycyclic aromatic hydrocarbons (NPAH), this 1-nitropyrene (1-NP) molecule, shown in Figure 1, often comes out as a dominant by-product of incomplete combustions from coal, diesel engines from mobile and stationary sources, cigarette smoke, cooked meat products and biomass burning. Aside from its dispersion in the atmosphere with concentrations arriving up to 57 pg/m3 in the air over urban and suburban areas, these hydrocarbons can deposit to ambient fine particulate matter (PM 2.5) which can spread towards inland bodies of water to be accumulated by aquatic species and then also reach towards human health mainly by inhalation, thereby posing respiratory risks. In fact, it has been listed as an International Agency for Research on Cancer (IARC) Group 2A carcinogen which indicates probable carcinogenicity and high respiratory health risk to humans [1].

A 30-year-old man, who had no travel history to COVID-19 prone areas whereas he had the characteristics signs and symptoms of COVID-19. Chest X-ray and rRT-PCR revealed his confirmed COVID-19. This study recommends the early identification and management of COVID-19.

Key Clinical Message: In patients presenting with hyperinsulinaemic hypoglycaemia with a non-pancreatic neuroendocrine tumour, the diagnosis of an ectopic insulin-secreting tumour should be considered, and investigated further with confirmatory insulin staining.

For a lot of commercialization and globalization processes, oftentimes numerous amounts of different wastes are generated and are disposed to the environment. This is a result of the high-growth industrialization and ever-increasing population growth. These demands are deemed inevitable in terms of meeting up the demands progress and developments. One of the recipients of these pollutant disposal is the soil, which limits its potential as a domestic and agricultural resource once it saturates the toxic chemicals and endangers the welfare of life, from microorganisms, plants, animals, and humans. Identified toxic contaminants include chlorinated solvents, petroleum hydrocarbons, polynuclear aromatic hydrocarbons, ketones, inorganic nitrogen (NO3-, NH4+), Tt, Pu, Np, Cr, U and other heavy metals.

Three COVID-19 cases were simultaneously confirmed as deep venous thrombosis (DVT). Ultrasound-guided IVCF implantation is an effective method that can be considered as a precautionary strategy for preventing lethal pulmonary embolism occurrence, especially for critical DVT-COVID-19 patients who are not suitable to be transferred to a routine X-ray operation room.

Three COVID-19 patients who were received lopinavir/ritonavir plus favipiravir got to improved without any severe adverse events. Two patients harboring high fever, severe pneumonia and respiratory failure obtained dramatic improvement. The combination therapy might be a treatment option; earlier therapy onset may have needed to avoid lung sequela.

Background The efficacy and safety of PCSK-9 inhibitors were confirmed by several clinical trials, but its effectiveness in routine clinical practice in China is unknown. Objective To describe the real world effectiveness of initiated with PCSK-9 inhibitors combined with statins compared with statins among patients with very high risk of ASCVD and underwent percutaneous coronary intervention (PCI). Methods This is a prospective study, enrolled patients from 32 hospitals between January to June 2019. The lipid control rate and incidence of cardiovascular events over 6 months were compared between two groups. A propensity score-matched analysis was used to balance two groups on confounding factors. Survival analysis using Kaplan-Meier methods was applied for cardiovascular events. Results In a total of 3063 patients, 89.91% had received moderate or high-intensity statin therapy before PCI, but only 9.47% had LDL levels below 1.4mmol/L at baseline. In the PSM selected patients, LDL level was reduced by 42.57% in PCSK-9 inhibitor group and 30.81% (P<0.001) in statins group after 6 months. The proportion of LDL≤1.0mmol/L increased from 5.29% to 29.26% in PCSK-9 inhibitor group and 0.23% to 6.11% in statins group, and the proportion of LDL≤1.4mmol/L increased from 10.36% to 47.69% and 2.99% to 18.43% (P<0.001 for both). PCSK-9 inhibitor significantly reduced the incidence of cardiovascular events versus statins treatment (2.07% vs 8.29%, HR, 0.24, 95% CI, 0.12-0.51). Conclusion In the real world, PCSK-9 inhibitors combined with statins could significantly reduce LDL levels and risk of cardiovascular events among patients with very high risk of ASCVD.

The kinetics of hydrodenitrogenation (HDN) was studied in an isothermally high-throughput reactor over three kinds of catalysts (CoMo, NiMo, NiMoW) to produce ultra-low sulfur diesel. The influences of reaction temperature, reaction pressure, volume ratio of H2 to oil and space time were systematically investigated to obtain kinetic parameters. By analyzing the reaction mechanism, two-lump kinetic model considering the influence of self-inhibition was proposed for the HDN reaction of diesel oil, and Levenberg-Marquard optimization method was used to estimate the model parameters. The model could well predict the evolution of nitrogen-containing compounds concentration along the axial length of reactor. Based on the two-lump kinetic model, the simulation on the HDN activity of various catalyst stacking schemes is close to the experimental data, which proves the model is applicable for catalyst stacking system. And the concentration of nitrogen-containing compounds was predicted for the catalyst gradation model of different loading sequences.

Understanding the factors controlling the relative abundance, distribution, and diversity of organisms is a fundamental challenge in ecology. For plants and animals, macroecological rules have been developed that describe these large-scale distributional patterns and attempt to explain the underlying physiological and ecological processes behind them. Similarly, microorganisms exhibit patterns in relative abundance, distribution, and diversity across space and time, yet it remains unclear the extent to which microorganisms follow macroecological rules initially developed for macroorganisms. With rapid advancements in sequencing technology, we have seen a recent increase in microbial studies that utilize macroecological frameworks. Here we review and synthesize these macroecological microbial studies with two main objectives: (1) to determine to what extent macroecological rules explain the distribution of host-associated and free-living microorganisms, and (2) to understand which environmental factors and stochastic processes may explain these patterns among microbial clades (archaea, bacteria, fungi, protists) and habitats (host-associated and free living; terrestrial and aquatic). Our review is the first, to our knowledge, that examines whether or not the same environmental drivers contribute to similar trends to macroecological studies when rules are upheld for microorganisms. Further, we outline several outstanding questions and recommendations for future studies in microbial ecology.

No abstract - Extinction is a natural process and every species on this planet has an expiration date except Homo sapiens because we are extending our expiry at the cost of other species (Brook and Alroy 2017, Pimm et al. 2014, Ceballos et al. 2015). In contrast, biodiversity loss is not natural but a global issue and it is not caused by the globalization, but as a result of human activities at the global level (Pimm et al. 2014, Ceballos et al. 2015). Eventually, severe biodiversity losses lead to anthropogenic die-off and extinction of naturally occurring species (Pimm et al. 2014, Ceballos et al. 2015, DeVos et al. 2014). The previous, current and future extinction rates have been estimated using a variety of measures and their estimation methodologies vary (to be between 100 to 10,000 times higher than the natural extinction rate) but they clearly demonstrate that current extinction rates are far above than the “background” rates (Brook and Alroy 2017, Pimm et al. 2014, Ceballos et al. 2015, DeVos et al. 2014, Lamkin and Miller 2016). Aggravatedly, population declines and extirpations are appearing to be more graving than species extinction and negative cascading consequences on ecosystem services (Ceballosa et al. 2020). Substantial information is available on over-exploitation of natural resources by humans in the globalization perspective (Ceballosa et al. 2020, Millennium Ecosystem Assessment, 2005, Groom et al. 2006, Ehrnfeld 2003) and we have lost an estimated US$ 4-20 trillion per year in ecosystem services owing to land-cover change and US$ 6-11 trillion per year from land degradation during 1997 to 2011 (OECD 2019). Such loss also leads to an increased disease risk (Gilbert 2010) and recent coronavirus pandemic (COVID-19) might be one of the similar consequences.

Homo sapiens is possibly the most ecologically plastic animal species ever, capable to overcome climatic variability beyond its physiological limits by means of culture. This adaptability has a strong cultural component which required the development both new technologies and major social changes sometimes in our distant past1,2. Highly contentious archaeological evidence suggests these innovations may have predated the emergence of our own species3. Here we studied climate niche width evolution in Homo, using fine-detailed palaeoclimatic data while controlling for phylogenetic effects. Our results point to sudden widening of the climatic niches exploited by Homo starting with the emergence of H. heidelbergensis. From the Middle Pleistocene, Homo ceased to be confined to physiologically suitable regions, despite progressive harshening of global climatic conditions. These results suggest cultural modernity, and its associated technological advancements, including habitual use of fire and clothing, appeared before the emergence of our own species.

Understanding African swine fever virus (ASFV) transmission in a population is essential for strategies to minimize virus spread during an outbreak. ASFV can survive for extended periods of time in animal products, carcasses, and the environment. Recent studies have shown that wild boar demonstrate interest in carcasses at an advanced stage of decay and in the soil where the remains of wild boar once were. While ASFV nucleic acids have been found in the environment around infected farms, data on the survival of the virus in soil are scarce. We investigated different soil matrices spiked with ASFV-positive blood from infected wild boar to see if ASFV can remain viable in the soil beneath infected carcasses. Moreover, we tried different mitigation strategies that could be used in affected regions. As expected, ASFV genome detection was reliably possible over the full range of sampling days. Soil pH, structure, and ambient temperature played a significant role for the stability of infectious ASFV. Infectious ASFV was demonstrated in specimens originating from sterile sand for at least three weeks, and from ordinary beach sand for up to two weeks. In yard soil, infectious ASFV was demonstrated for one week, and in soil from a swampy area for three days. Virus was not recovered from two acidic forest soils. All risk mitigation experiments with citric acid or calcium hydroxide resulted in complete inactivation in our experimental setup. In conclusion, stability of infectious ASFV is almost non-existent in forest soils but rather high in sandy soils. However, given the high variability, treatment of carcass collection points with disinfectants should be considered for additional risk reduction. In this respect, biocidal nature and occupational safety have to be considered.

Background and Purpose: Obesity is a complex condition where a low-grade chronic inflammation and gut dysbiosis contribute to the development of the related metabolic dysfunctions. Nowadays, its management of such disease implies drastic changes in lifestyle and different anti-obesity drugs. Unfortunately, most of them present limited effectiveness and important side effects. Therefore there is an urgent demand for more effective and safer strategies for obesity management. In this sense, probiotics are emerging as a promising therapy. Different probiotics have demonstrated beneficial effects on this condition, increasing the interest in the development of probiotic treatments. Lactobacillus fermentum CECT5716 has shown anti-inflammatory effects and capacity to modulate microbiota composition in different experimental models. Experimental Approach: L. fermentum CECT5716 (5x108 CFU/mice/day) was evaluated in a model of high fat diet-induced obesity in mice. Key results: L. fermentum exerts anti-obesity effects, associated with its anti-inflammatory properties and amelioration endothelial dysfunction and gut dysbiosis. The probiotic restores Akkermansia sp. abundance and reduced Erysipelotrichi class and Clostridium spp presence as well as increased Bacteroides proportion. Conclusion and Implications: This probiotic represents a very interesting approach. Our findings describe, for the first time, the ability of this probiotic to ameliorate experimental obesity through microbiome modulation, affecting different bacteria that have been reported to play a key role in the pathogenesis of obesity. Therefore, this suggests a potential use of L. fermentum CECT5716 in clinical practice, also taking into account that probiotic treatments have demonstrated to be relatively safe and well tolerated.

INTRODUCTION: The aim of this study is to evaluate the effect of acute, iatrogenic right arm ischemia and reperfusion on microcirculation using tissue perfusion markers like central venous oxygen saturation, lactate, the difference between central venous and arterial CO2 pressure, Near-infrared spectroscopy, and biomarkers like sialic acid, malondialdehyde, advanced oxidative protein products in aortic surgery with moderate hypothermia. METHODS: Adult patients undergoing ascending aorta repair with antegrade cerebral perfusion via axillary artery participated in the study. Blood samples were collected from the radial artery, internal juguler vein, right arm cubital vein and left arm cubital vein and analysis were performed at five intraoperative time points. Blood samples for biomarkers were obtained at three intraoperative time points. RESULTS: Right arm venous oxygen saturation are significantly lower than left arm and central venous. Right arm lactate levels are significantly higher than left arm and central venous lactate levels. Somatic right arm near-infrared spectroscopy values are significantly lower than somatic left arm. There are no significant differences for biomarkers throughout the time points. CONCLUSIONS: We have concluded that well-known markers such as central venous oxygen saturation and lactate reflect the results of ischemia-reperfusion faster, and are more valuable than novel biomarkers. Near-infrared spectroscopy is a promising monitor in terms of providing information about tissue oxygenation. However, oxidative stress biomarkers seem to be far from following the results of ischemia-reperfusion damage in an instant or short time, moreover, their costs are high and laboratory studies take time.

Paravalvular leak (PVL) after mitral valve replacement is the most common type of nonstructural prosthetic valve dysfunction. While most patients with only mild-moderate PVL are asymptomatic, those with severe PVL can present with heart failure and hemolysis, leading to significant morbidity and mortality. Surgical correction has remained the gold standard therapy for symptomatic PVL; however, for high surgical risk patients, percutaneous approaches have emerged as an alternative management. With the emergence of transcatheter mitral valve-in-valve techniques for failed bioprosthesis and rings, valve-in-valve PVL is being encountered more frequently and is identified as a challenging entity. We present a case of a symptomatic patient with a moderate – severe valve-in-valve PVL after two mitral valve replacements who then underwent a transcatheter mitral valve-in-valve-in-valve implantation with a 29mm Edwards® SAPIEN3 valve via transseptal approach. This unique case highlights the complexity of this clinical entity and recognizes three-dimensional transesophageal echocardiography as a tool to guide valve-in-valve PVL closures.

Constrictive pericarditis (CP) characterized by the presence of a thick, fibrotic and/or calcified non-compliant pericardium limits diastolic filling and forces one side of the heart to fill at the expense of the other side. CP results in right heart failure and even reconstruction of the heart, especially for CP caused by tuberculosis (TB). As the leading cause of CP, TB is affecting the management of CP from many aspects, which contributes to high morbidity and mortality. The purpose of this manuscript is to: (1)Review the etiology, epidemiology, pathophysiology, diagnosis, treatment of tuberculosis constrictive pericarditis (TBCP); (2)Review animal models for CP or pericarditis through different methods; (3)Remind us that more research should be done for TBCP.

Fungal species have numerous important functions in the environment. Where these functions occur will depend on how fungi are spatially distributed, but spatial structures of fungal communities are largely unknown. This is especially true in hyperdiverse tropical tree canopy systems, which are understudied using high-throughput sequencing technology. Here we explore fungal communities in a Costa Rican tropical rainforest canopy, with a focus on local-scale spatial structure and substrate specificity of fungi. We sampled 135 locations across five tree branches and identified fungi from four substrate types: outer host tree bark, inner bark, dead bryophyte tissue, and living bryophytes. Samples were located between one centimeter and eight meters apart. Fungal community composition and diversity varied among substrate types, even when multiple substrates were in direct contact. Fungi were most diverse in living bryophytes, with 39% of all fungal OTUs found exclusively in this substrate, and the least diverse in inner bark. Fungal communities had significant positive spatial autocorrelation and distance decay of similarity only at distances less than one meter. Similarity among samples declines by half in less than ten centimeters, and even at these short distances, similarities are low with few OTUs shared among samples. These results indicate that community turnover is high and occurs at very small spatial scales, with any two locations sharing very few fungi in common. High heterogeneity of fungal communities in space and among substrates may have important implications for the distributions, population dynamics, and diversity of other tree canopy organisms, including epiphytic plants.

Background: Thyroid autoimmunity in pregnant women has been associated with negative outcomes. Objective: To evaluate the effect of levothyroxine therapy on pregnancy outcomes compared with placebo or no treatment in women without overt hypothyroidism who are TPOAb and/or TgAb-positive. Search Strategy: Ovid MEDLINE, EMBASE, CINAHL, Cochrane Database of Systematic Reviews, and Cochrane Central Register of Controlled Trials were searched from 1980 to April 17, 2019. Selection Criteria: Pre-specified criteria for inclusion were: randomized trials of levothyroxine versus control (placebo or no treatment) among women with positive TPOAb or TgAb who were pregnant or considering conception. Data Collection and Analysis: Pre-specified data elements were extracted and where appropriate, meta-analyses were conducted. Main outcomes include pregnancy achieved, miscarriage, preterm delivery and live birth. Main Results: From 2,812 citations, 79 citations were identified for full text review. Of these, six trials (total of 2,263 women) were included for qualitative and quantitative analyses. Risk of bias was deemed low for only one trial. There was no significant difference in the relative risk (RR) of pregnancy achieved (RR 1.03; 95% CI 0.93, 1.13), miscarriage (RR 0.93; 95% CI 0.76, 1.14), preterm delivery (RR 0.66; 95% CI 0.39, 1.10), or live births (RR 1.01; 95% CI 0.89, 1.16) in thyroid autoimmune women treated with levothyroxine compared to controls. Conclusion: Among pregnant women or women planning conception, with thyroid autoimmunity, there is a lack of evidence of benefit for levothyroxine use. Recommendations to use levothyroxine in this setting need to be reconsidered.

Due to it is potential application in the field of high energy density materials, how to stabilize cyclopentazolate anion (cyclo-N5-) has attracted many interests theoretically and experimentally. Therefore, a series of ion salts containing [cyclo-N5]- were synthesized and studied. The instability of [cyclo-N5]- is caused by the five lone pairs of electrons localized on five neighbored N atoms. In this work, we expect if the [cyclo-N5]- can be stabilized by the coordination with acidic ligands, by weakening the multi repulsion from the lone pairs to stabilize the [cyclo-N5]-. The two compounds of [N5(BH3)5]-, and [N5(AgCN)5]- have been designed and compared based on the Lewis acid-base theory. [N5(H2O)5]- is designed to evaluate the effect of hydrogen bond in the stabilization. For all the structures, we study the bonding properties and thermal stabilities based on the analysis of electronic structures and Car-Parrinello molecular dynamics (CPMD) simulations. The results indicate it is a effective method to stabilize [cyclo-N5]- by introducing the Lewis acid. Our insights on [cyclo-N5]- compounds with high thermal stability under ambient conditions will provide a new idea for the research and synthesis of new high energetic [cyclo-N5]- series compounds.