Plant diversity and plant-consumer interactions likely interact to influence ecosystem carbon fluxes but experimental evidence is scarce. We examined how experimental removal of foliar fungi, soil fungi and arthropods from experimental prairies planted with 1, 4 or 16 plant species affected instantaneous rates of carbon uptake (GPP), ecosystem respiration (Re) and net ecosystem exchange (NEE). Increased plant diversity doubled plant biomass, in turn doubling GPP and Re, but NEE remained unchanged. Removing foliar fungi increased GPP and NEE, with greatest effects at low plant diversity. After accounting for plant biomass, we found that removing foliar fungi increased mass-specific flux rates by 48% by altering plant species composition and community-wide foliar nitrogen content. However, this elevated NEE effect disappeared when soil fungi and arthropods were also removed, demonstrating ecosystem-scale impacts of interactions among consumer groups. Thus, plant diversity and consumer context determine the effects of plant-fungal interactions on ecosystem carbon fluxes.

Few data are available for estimating the sediment transport rate on a steep slope of grass with different covers. In this study, the artificial simulated rainfall test is used to investigate how rainfall intensity, slope and cover affect the sediment transport rate. Simultaneously, the study establishes a model for the sediment transport rate using shear stress, stream power, unit stream power and unit energy on steep grassland slopes. Results show that the sediment transport rate decreases as the vegetation cover increases, as described by linear or logarithmic equations under different rainfall intensities or slopes. The sediment transport rate increases as an exponential function equation with rainfall intensity, slope and cover with a Nash–Sutcliffe model efficiency (NSE) value of 0.864. The effects of slope steepness are stronger than the effects of rainfall intensity and cover. Regression analyses show that the sediment transport rate can be predicted from the power function equations of shear stress, stream power and unit energy. In addition, the sediment transport rate can be fit to unit stream power with linear equation (NSE = 0.840). However, shear stress, stream power and unit energy perform poorly (NSE = 0.394, NSE = 0.498 and NSE = 0.330, respectively). Further analysis shows that the sediment transport rate is best modelled by a power function equation that includes three factors, i.e. rainfall intensity, vegetation cover and slope. Moreover, unit stream power results in the best model for the sediment transport rate among the different hydrodynamic parameters. The soil erodibility parameter and critical unit stream power of this experiment are 113.59 and 0.216 m·s-1, respectively, which are six times more than those in the bare slope. The measurements and calculations of the sediment transport rate, the calculations of the surface roughness and characteristic considerations of the vegetation for sheet flow should be explored in future research, which are important in improving experimental accuracy and sediment transport rate modelling

Background: Baloxavir marboxil (BXM) is an approved drug that selectively targets cap-dependent endonuclease on PA subunit in the RNA polymerase complex of influenza A and B viruses. Amino acid substitutions at position 38 in the PA subunit were identified as a major pathway for reduced susceptibility to baloxavir acid (BXA), the active form of BXM. Additionally, substitutions found at positions E23, A37, and E199 in the PA subunit impact BXA susceptibility by less than 10-fold. Methods: We comprehensively evaluated the impact of novel amino acid substitutions identified in PA, PB1 and PB2 subunits in BXM clinical trials and influenza sequence databases by means of drug susceptibility and replicative capacity. Results: PA/I38N in A(H1N1) and PA/I38R in A(H3N2) were newly identified as treatment-emergent substitutions in the CAPSTONE-2 study. The I38N substitution conferred reduced susceptibility by 24-fold, whereas replicative capacity of the I38N-substituted virus was impaired compared to the wild-type. The I38R-substituted virus was not viable in cell culture. All other mutations assessed in this extensive study did not significantly affect BXA susceptibility (< 2.4-fold change). Conclusion: These results provide additional information on the impact of amino acid substitutions in the trimeric viral polymerase complex to BXA susceptibility and will further support influenza surveillance.

Background We sought to delineate the clinical characteristics and imaging manifestations of the COVID-19 patients in a Fangcang shelter hospital in Wuhan. Methods From Feb 11, 2020 to March 8, 2020, the clinical, laboratory and HRCT features of 189 COVID-19 patients (23-74 years, 97 males, 92 females) were retrospectively collected and analyzed. Clinical and radiological data of patients with different sub-groups were compared. Results 127 (67.19%) patients have a BMI higher than 23 kg/m2. The most common symptoms of the patients were fever (154/189, 81.48%), cough (135/189, 71.43%) and fatigue (61/189, 32.28%). The average time for two consecutive negative nucleic acid tests was 15.44±4.50 days. The average time of hospitalization was 17.48±3.93 days. The majority of the patients had a normal white blood cell count (141/178, 79.21%), neutrophil percent (106/178, 59.55%), lymphocyte percent (107/178, 60.11%) and platelet count (162/177, 91.53%). Positive correlations were found between age and CT parameters (p<0.05), BMI and CT parameters (p<0.05) and temperature and CT parameters (p<0.05). Severity of CT parameters were not correlated to time for nucleic acid tests turning negative and duration of hospitalization (p>0.05). Patients with mild CT changes presented with slower recovery by follow-up compared with those more severe on initial (p<0.05). Conclusion Patients with COVID-19 infection usually have respiratory and non-respiratory symptoms and presented with typical ground-glass-opacities and other CT features, which showed significant correlations with age, BMI and highest temperature. Patients with mild opacifications on initial CT presented with slower recovery compared with those who were more severe on initial.

Aerial roots of epiphytic orchids possess a velamen structure that is assumed to assist water uptake and reduce water loss. However, there is still debate over how this dual function is achieved. The discovery of a water-repelling layer that covers the velamen may provide answers. To determine what role this layer plays in velamen function, we examined the structure, chemical composition, gene expression, wettability and water loss prevention of epiphytic orchid roots. Results of our analyses indicate this water-repelling layer is similar to the plant cuticle. Therefore, we have named it the “cuticle-like layer”. Further analysis of epiphytic roots showed that when the velamen was in contact with bark, genes related to cuticle biosynthesis were down-regulated and root hairs developed. Furthermore, in root tissues close to bark, aquaporin gene expression responded positively to water-supply. The functional paradox of the velamen can be explained by a “functional zoning” hypothesis: epiphytic orchid roots are partitioned into spatially-separated regions that prevent water loss and increase water absorption. At different regions of the velamen, water loss is prevented by the development of a cuticle-like layer, and water absorption is increased by the development of root hairs.

Background: A recent survey revealed that most pediatric surgeons use intraoperative fluoroscopy and routine postoperative chest radiography for catheter tip location in central line insertion. The aim of this study is to review all cases of ultrasound-guided central line insertion at a tertiary pediatric center and to evaluate the role of intraoperative fluoroscopy and postoperative chest radiography. Procedure: Retrospective data analysis of children submitted to percutaneous central line insertion under ultrasound control over a 2-year period. Data collected included: age, indication for central venous access, catheter type, usage of intraoperative fluoroscopy and postoperative chest radiography usage, complications, and whether chest radiography dictated any catheter-related intervention. Results: Fifty-five long-term central lines were successfully established. All patients had the catheter tip position confirmed either by intraoperative fluoroscopy (96%), chest radiography (85%) or both (82%). Catheter tip overlying the cardiac silhouette (right atrium) on chest radiography was reported in 4 cases; these findings led to no change in catheter positioning or other catheter-related intervention. There were no catheter-related complications. Conclusions: Percutaneous central line insertion under US-control was safe and effective. Postoperative chest radiography did not dictate any modification of catheter tip positioning after central line placement with ultrasound and fluoroscopic control, thus should not be used routinely.

ABSTRACT Background: COVID-19 was declared a pandemic by the World Health Organization (WHO) on March 11st, 2020. Responses to this crisis integrated resource allocation for the increased amount of infected patients, while maintaining an adequate response to other severe and life-threatening diseases. Though cardiothoracic patients are at high risk for Covid-19 severe illness, postponing surgeries would translate in increased mortality and morbidity. We reviewed our practice during the initial time of pandemic, with emphasis on safety protocols. Methods: From March 11st to May 15th 2020, 148 patients underwent surgery at the Department of Cardiothoracic Surgery of CHUSJ. The clinical characteristics of the patients were retrospectively registered, along with novel containment and infection prevention measures targeting the new Corona Virus. Results: The majority of adult cardiac patients were operated on an urgent basis. Hospital mortality was 1.9% (n = 2 patients). Most of adult thoracic patients were admitted from home, with a diagnosis of neoplasic disease in 60% patients. Hospital mortality was 3.3% (1). Fifteen children underwent cardiothoracic surgery. There was no mortality. The infection prevention procedures applied, totally excluded the transmission of Covid-19 in the Department. Conclusion: While guaranteeing a prompt response to emergent, urgent and high priority cases, novel safety measures in individual protection, patients circuits and pre-operative diagnose of symptomatic and asymptomatic infection were adopted. The surgical results corroborate that it was safe to undergo cardiothoracic surgery during the initial time of Covid-19 pandemic. The new policies will be maintained while the virus stays in the community.

Rothia mucilaginosa is an opportunistic agent detected in the upper respiratory tract and oral cavity in humans. Immunocompromised hosts have more risk to develop severe infections. We present a short review and two clinical cases of Rothia mucilaginosa bloodstream infection in children with leukemia, one of them with endocarditis. Both were completely recovered. Predisposing factors for Rothia mucilaginosa infection include profound and prolonged neutropenia, use of central venous catheter, mucositis and high dose steroid. It is important to consider this bacterium as an emerging causative agent of severe infection in immunocompromised patients, especially in the presence of the mentioned factors.

Hypertrophic obstructive cardiomyopathy (HOCM) is one of the more common genetic disorders. The pathophysiology and natural history of the disease have been well studied. Left ventricular outflow tract (LVOT) obstruction and systolic anterior motion (SAM) of the anterior mitral leaflet can result in sudden cardiac death, progressive heart failure and arrythmias. Surgical septal myectomy for HOCM is the standard of care and is routinely performed through a median sternotomy. Septal myectomy has also been performed using the trans-atrial, trans-mitral approach either directly or with robotic assistance. In cases with severe LVOT obstruction in the setting of only mild to moderate proximal septal hypertrophy, intrinsic problems with the mitral valve contribute. Typically, these are hyper-mobile papillary muscles and or excessive height of the anterior mitral leaflet. Combining septal myectomy with reorientation of hyper-mobile anteriorly positioned papillary muscles has shown to prevent SAM and thereby additionally decrease the sub-valvular aortic outflow obstruction. Our extensive experience in both septal myectomy and robotic mitral valve repair has given us a different perspective in approaching the primary mitral regurgitation in HOCM patients where a combined septal myectomy, papillary muscle reorientation and complex mitral valve repair has been safely performed using the less invasive robotic-assisted approach. Our objective here is to discuss the technical aspects of the procedure.

Purpose: To assess the role of image-defined risk factors in clinical practice of neuroblastoma. Methods: A systematic search was conducted to identify articles about IDRFs. Combined overall results were calculated using fixed effects models. Results: The literature search identified 11 articles including 1338 patients for analysis. There was no difference in amplification of MYCN and tumor site (abdominal tumor) between no IDRFs and any IDRFs group, but there was a significant increase of event free survival (OR: 2.43[1.69, 3.49]; P < 0.00001) and overall survival (OR: 3.15[1.68, 5.89]; P = 0.0004) in no IDRFs group. The incidence of complications (OR: 0.21[0.15, 0.30]; P< 0.00001) was higher in patients with any IDRFs. Furthermore, no IDRFs are correlated with higher rate of earlier INSS stage. Conclusions: IDRFs could be an important adjuvant image monitoring method in NB treatment. IDRFs are valuable to evaluate surgical indications for pediatric surgeon, regardless of surgical ability.

Humanity is experiencing the worst global disaster since the Second World War. In deed, Covid19 has affected more than 8,500,000 patients and more than 450,000 have died worldwide. Cardiac surgeons have been able to adapt to the situation by adopting new methods such as remote consultations and telemedicine. This brief communication summarizes the current situation and anticipates the resumption of the elective activity.

We herein present illustrative clinical images of a large intra cardiac thrombus of a 72 year old man presenting with a SARS-CoV-2 viral infection.

A document by Marielena Jakobi. Click on the document to view its contents.

The inland lakes in the Tibetan Plateau (TP), with closed catchments and minimal human disturbance, are important indicators to climate change. However, examination of the spatiotemporal patterns of the Tibetan lake changes, especially for water level variation, was usually limited by inadequate measurement accessibility. This obstacle has been remedied by the developing satellite altimetry observations. The more recent studies revealed the growth tendency of lakes in the central TP had been decelerated or reversed during the period 2010-2016. It has not been systematically investigated whether the deceleration or hiatus would last in the following years thus far. This study aims to combine the traditional and recently-advanced altimetry observations to update our understanding of Tibetan lake changes in recent years. The results reveal that water level changes of the 22 examined lakes showed abrupt rises during the period 2016-2018, but the onsets and magnitudes of the rises varied among the lakes. During the study period, the water level of the nine lakes in the northern TP displayed a drastic rising trend with an average rate of 0.82 m/a. In the central TP, the lake level changes were generally divided into two categories. The water levels for the lakes in the western CTP rose rapidly, while in the eastern CTP, the lake water levels rose slowly with an average rising rate less than 0.40 m/a. The water levels for lakes in the northeastern TP and northwestern TP kept a stably rising tendency. According to the results of climate analysis, the spatial differences of the lake level rise rates were primarily caused by the spatial and temporal changes of precipitation over the TP, which may be related to the large-scale atmospheric circulation affected by the El Niño and La Niña events.

Background: Mesenteric malperfusion is a complication with a higher risk of in-hospital mortality because diagnosing mesenteric ischemia before necrotic change is difficult, and when it occurs, the patient’s condition has worsened. Although it contradicts the previous consensus on central repair-first strategy, the revascularization-first strategy was found to be significantly associated with lower mortality rates. The aim of this study is to present our revascularization-first strategy and assess the postoperative results for acute aortic dissection involving mesenteric malperfusion. Methods: Among 58 patients with acute type A aortic dissection at our hospital between January 2017 and December 2019, mesenteric malperfusion was noted in six. Four hemodynamically stable patients underwent mesenteric revascularization with endovascular intervention in a hybrid operation room before central repair, and two hemodynamically unstable patients underwent central repair before mesenteric revascularization. Results: No in-hospital mortality was recorded. All four patients with mesenteric revascularization-first strategy recovered with no symptoms related to mesenteric ischemia. Two patients with central repair-first strategy developed paralytic ileus for 1 week; one of them needed explorative laparotomy, but no patients needed colon resection. Conclusion: The revascularization-first strategy in cases of acute type A aortic dissection with mesenteric malperfusion may achieve favorable results. However, in cases with other-major organ malperfusion or having hemodynamically unstable status, the appropriate strategy is controversial. Close evaluation of mesenteric perfusion using multiple modalities and prompt revascularization are mandatory in these complicated cases. A hybrid operation room provides an ideal environment for this revascularization-first strategy.

The Middle and Lower Reaches of the Yangtze River (MLRYR) region, which has humid subtropical climate conditions and unique plum rain season, is characterized by a simultaneous high-frequency urban flooding and reduction in groundwater levels. Retrofitting the existing buildings into green roofs is a promising approach to combat urban flooding, especially for a densely developed city. Here, the application potential of the Green Roof System (GRS) and the Improved Green Roof System (IGRS) that designed to divert overflowing water from green roofs to recharge groundwater were analyzed in such a densely developed city, Nanchang, China. The performances of the GRS and the IGRS were evaluated using the United States Environmental Protection Agency (USEPA) Storm Water Management Model (SWMM). The simulation results show that in single precipitation events about 41-75% of precipitation could be retained in the GRS depending on precipitation intensity. In 10- and 100-yr precipitation events, the flooding volumes in the GRS region are 82% and 28% less than those of Traditional Roof System (TRS), respectively. For the first time, the influence of GRS on the hydraulic condition of CSS / SWS (Combined Sewage System / Storm Water System) is analyzed, which is a direct reflection of the effect of GRS on alleviating urban flooding. Recognizing the limitation of SWMM, five methods have been used to comprehensively analyze the evapotranspiration process of GRS. The evapotranspiration of the GRS retained water could account for 39% of annual precipitation. Although the IGRS could lead to a higher immediate flood loading (about 20-27%) than the GRS, it could divert more precipitation (more than 10% of the annual precipitation) into the greenbelts, thus significantly increase groundwater recharge. We may conclude that the widespread implementation of both the GRS and the IGRS in Nanchang and other densely developed cities in the MLRYR region could significantly reduce surface and peak runoff rates. In particular, the IGRS can provide more hydrological benefits than the GRS under the same climate conditions.

Despite advancement in therapy and management, left ventricular thrombus (LVT) after anterior myocardial infarction (MI) is sporadically encountered and remains associated with a very high risk of major cardiovascular events and mortality. Cardiac magnetic resonance (CMR) is considered the gold standard technique for LVT detection, but it is a time consuming and expensive test not available in all centers, especially when repeated exams are necessary. Transthoracic echocardiography represents a useful tool to screen for LVT and to identify predictors of high risk of developing LVT. The advances in ultrasound technology and the use of contrast agents may potentially help clinicians to identify LVT and the use of sequential echocardiography for each patient with acute MI complicated by LVT may provide an opportunity to quantify regression and its correlation with outcomes to tailor the management of these patients. Hence, this narrative review focuses on the added value of echocardiographic-guided LVT management in patients with recent anterior MI to reduce mortality and morbidity excess related to LVT based on current evidence.

Experimental studies were conducted on the dynamic fracture behavior of AISI 5140 steel over a wide range of loading rates. True stress-strain relations of the steel were measured under different strain rates, and a dynamic constitutive model was then expressed with the strain-hardening term and the strain-rate hardening term. Fracture tests were investigated under quasi-static condition, instrumented Charpy impact condition and Hopkinson pressure bar impact condition. Fracture toughnesses corresponding to each test condition were also determined. Fracture characteristics were analyzed with observations of the fracture appearances. It was found that the fracture toughness decreased significantly with the increasing loading rate, and the fracture mechanisms of the steel at various loading rates were brittle fractures characterized by river markings and secondary cracks. Based on the fracture assessment method of the CEGB R6 procedure, the effects of the strain rate and the loading rate on the assessment curve were discussed.

Purpose: Some patients who undergo robot-assisted laparoscopic radical prostatectomy (RARP) continue to experience long-term urinary incontinence (UI). This study aimed to evaluate easily obtainable factors that can predict long-term UI following RARP. Materials and Methods: A total of 315 patients who underwent RARP for localized prostatic cancer were analyzed. We separated the patients into two groups, namely, the Continence group and the Incontinence group, according to the presence or absence of UI at 12 months after surgery, and we compared the patients’ characteristics and operative data to identify clinical signs associated with long-term UI. Additionally, correlations between these factors and postoperative urethral function were evaluated. Urinary continence was defined as both the use of 0 pads/per day and <2 g of urine lost using the 24-h pad weight test. Results: Of 315 patients, 250 (79.4%) achieved urinary continence and 65 (20.6%) had UI. Age, storage-related lower urinary tract symptoms before surgery, nerve-sparing surgery, and the 24-h urine loss immediately after urethral catheter removal significantly affected long-term UI after RARP. Multivariate logistic regression analyses revealed that the 24-h urine loss after catheter removal was a significant predictor of long-term UI. Receiver operating characteristic curve analysis identified a urine loss of 330 g/day as the optimal cutoff value, which yielded 92% sensitivity and 84% specificity, and it showed significant correlations with postoperative urethral function and the time to recover urinary continence. Conclusion: The 24-h urine loss immediately after urethral catheter removal may be the most reliable and useful predictor of long-term UI following RARP.

The global pandemic of new Coronavirus disease (COVID-19) is a grave threat to both physical and mental health. We must be mindful of the consequences of psychological effects that caused by COVID-19 in healthy population and people with psychiatric problems (Asmundson et al., 2020). In many countries, health anxiety was reported, which is characterized by catastrophic interpretations of bodily sensations and physical changes, which generates dysfunctional beliefs about health and illness, may lead to different clinical symptoms and disorders. Recently, the outpatient department of Xiangya, Changsha, received a couple of patients with tinnitus when onset is related to stress or anxiety due to COVID-19 pandemic. We report a case of tinnitus in a patient with anxiety and insomnia related to COVID-19 and recover rapidly after psychiatric intervention and therapy.

Although hepatoblastoma constitutes most of hapetic tumours in chidren, other types of tumors are often observed in older patients. We report a case of a 10-year-old Japanese boy with a transitional hepatic tumour consisting of both hepatoblastoma and hepatocellular carcinoma. After surgery and chemotherapy with cisplatin and pirarubicin, the tumour regressed, however, new tumours in the liver evolved with element of hepatocellular carcinoma. He died as a result of hepatic failure afte lenvatinib and drug-eluting transcatheter arterial chemoembolisation 18 months after diagnosis. Examinations of a panel of genomic alterations did not identify any therapeutic targets.

Introduction: Necrotising otitis externa (NOE) is a severe infection of the external auditory canal and the incidence in the UK has risen dramatically in recent years. Treatment options for NOE remain contentious and can confer substantial risks. Osteomyelitis at other anatomical sites has shown promising outcomes when treated with early debridement and short-course antimicrobial therapy. Application of this paradigm in NOE may offer distinct advantages for patients but this remains to be demonstrated. Methods: A prospective cohort analysis of patients with NOE admitted to Sunderland Royal Hospital between January-September 2019. Previous treatment, examination findings, medical history, relevant microbiology and imaging results were document. Results: A total of eight patients were included (age 58-87, male:female 6:2). Most (6/8) patients had type 2 diabetes; 5/6 had poor glycaemic controls (HbA1c > 48mmol/mol). 4/8 patients had undergone previous ear syringing. Pain was present on average for 40 days prior to admission (range 14-60 days). Otoscopy and CT findings were highly variable between cases. Most (5/8) patients grew P. aeruginosa on bacterial swabs. 5/8 patients were treated with short course antimicrobial therapy (3/8 prolonged). 5/8 received early surgical debridement. 7/8 patients were successfully treated – 1 patient died of concurrent haematological malignancy. Conclusion: A standardised protocol for NOE has facilitated a consistent approach to treatment at our centre. Selected cases have good outcomes with short course antimicrobial therapy and early surgical debridement, but this analysis was not powered to determine statistical significance. A randomised trial with more patients would confirm non-inferiority of short course antimicrobial therapy and early surgical debridement in NOE.

Epidemic diseases contiguously propagate between propitious substances, along with sub-rosa characteristics specifically contiguousness and replication speed may expound ferocity of epidemic diseases such as COVID-19. Most likely, due to high contiguous velocity; in very short time COVID-19 may have become global pandemic disease and key menace to manhood. Deterrence of propagation may help in devastate virus transmogrify using instantaneous traceability of individualized health activities and trackability of public footprints using smart devices, radiography, and social networks.

Background: Transannular patch, which results pulmonary insufficiency (PI), is usually required during repair of Tetralogy of Fallot (TOF). In this study, we compared 3 types of pulmonary valve reconstruction techniques during transannular repair of TOF. Methods: Between February 2014 and January 2018, 50 patients with TOF underwent total repair with transannular patch. These patients were divided into three groups. In group 1, (n= 15), a single gluteraldehyde treated autologous pericardial monocusp (standard method) was reconstructed. In group 2, (n= 16) Nunn’s bileaflet pulmonary valve reconstruction technique was used with autologous pericardial patch. In group 3, (n= 19), Nunn’s bileaflet technique was performed with expanded polytetrafluoroethylene (e-PTFE) membrane. Outcomes of the patients with early and mid-term competency of the pulmonary valves were analyzed. Results: All three pulmonary valve reconstruction techniques were significantly effective in early postoperative period. Freedom from moderate to severe PI were 73.3%; 100% and 89.4% respectively. Mortality, duration of intensive care unit and hospital stay were similar between the groups. The mean follow-up period was 17.5±13.0 (3 to 57) months. Freedom from moderate to severe PI decreased to 40%; 81.2% and 73.7% respectively at the end of the follow-up period. Presence of moderate to severe PI was significantly higher in group 1 (p: 0,018 between group 1 and 2, p: 0,048 between group 1 and grup 3). Conclusions: All three pulmonary valve reconstruction techniques provided competent pulmonary valves. Nunn’s bileaflet technique had better outcome at midterm. This technique has a potential to delay right ventricular dysfunction at long-term.