We report a rare case of liver alveolar echinococcosis with an invasion of the hepaticocaval confluence, inferior vena cava, pericardium, right atrium, atrial septum, and superior vena cava, and its successful treatment by combined heart-liver transplantation

As college courses transition to online instruction in response to COVID-19 incorporating inquiry-based learning is all the more essential for student engagement. However, implementation can prove challenging for instructors. I describe a strategy for inquiry-based learning that is straightforward to apply in a variety of course modalities, including asynchronous and synchronous online courses. I describe an assignment where students explore the developmental basis of morphological evolution. Flowers offer an excellent example to address this concept and are easy for students to access and describe. Students were asked to conduct research on local flowering plants by collecting and dissecting flower specimens to determine their whorl patterns and then generate hypotheses to explain the developmental genetic basis of the patterns identified. This task allowed students to apply their scientific thinking skills, explore nature, and connect their understanding of the developmental basis of evolutionary change to everyday life. I designed this assignment to be completed asynchronously, and it can be easily modified for synchronous online and traditional face-to-face meetings. Incorporating inquiry using readily available, tangible, tractable real-world examples is a pragmatic and effective approach during and beyond COVID-19.

Biological invasions are accelerating, and invasive species can have large economic impacts as well as severe negative consequences for biodiversity and ecosystems. During invasions, species can interact, potentially resulting in hybridization. Here, we examined two Cakile species, C. edentula and C. maritima (Brassicaceae), that co-occur and may hybridize during range expansion in separate regions of the globe. Cakile edentula invaded each location first, while C. maritima established later, apparently replacing the former. We assessed the evidence for hybridization in western North America and Australia, where both species have been introduced, and identified source populations with 4561 SNPs using Genotype-by-Sequencing. Our results indicate that the C. edentula in Australia originated from one region of eastern North America while in western North America it is likely from multiple sources. The C. maritima in Australia were derived from at least two different parts of Europe while the introduction in western North America is from a distinct source. Although morphological evidence of hybridization is generally limited to mixed populations in Australia and virtually absent elsewhere, our genetic analysis revealed relatively high levels of hybridization in Australia (34.13%), and supported the presence of hybrids in western North America (16.18%) and New Zealand. Hybrids might be commonly overlooked in invaders, as identification based solely on morphological traits may represent only the tip of the iceberg. Our study reveals a repeated pattern of invasion, hybridization and apparent replacement of one species by another, which offers an opportunity to investigate the role of hybridization and introgression during invasion.

Objectives: Sudden sensorineural hearing loss (SSNHL) is an emergency disease with undefined pathogenesis in the otolaryngology department. In our previous study, we found patients with SSNHL had lower serum concentration of Matrix metalloprotease 9 (MMP-9) than healthy controls, and the result was accordant with auto-immune diseases. This study aimed to reveal the correlation between changes in serum MMP-9 concentration following treatment with the outcomes of patients and to provide further evidence that immune disorder was the main pathogenesis of SSNHL. Design, setting, and participants: Fifty-two patients with SSNHL, hospitalized in The First Affiliated Hospital of Chongqing Medical University from March 2019 to August 2019, were enrolled. The serum concentration of MMP-9 was detected by enzyme-linked immunosorbent assay (ELISA). Main outcome measure: The mean concentration of MMP-9 before treatment was compared with the post-treatment concentration by the Mann-Whitney U test. The correlations between favorable outcomes of patients and clinical characteristics were measured with the Chi-squared test and binary multiple logistic regression analysis. Results: In treatment responders, mean serum concentration was elevated from 106.85±41.40ng/ml to 144.03±37.65 ng/ml following treatment (P＜0.001), while in non-responders it decreased from 132.09±59.21 ng/ml to 106.82±49.93 ng/ml (P=0.142). Changes in MMP-9 concentration was the only factor associated with favorable outcomes (P=0.008, OR=5.13, 95% CI: 1.53-17.28). Conclusions: Elevated MMP-9 concentration is a potential prognosis biomarker in patients with SSNHL. These findings are in line with auto-immune diseases and indicate immune disorder is mainly pathogenesis in SSNHL. Keywords Sudden sensorineural hearing loss; Matrix metalloprotease 9; Immune disorder; prognosis; Enzyme-linked immunosorbent assay

Background: Previous studies have investigated the natural course of cow’s milk protein allergy (CMPA) and development of atopic diseases into adolescence. Studies with long term follow-up into adulthood are lacking. The aim of this study was to investigate 1) the natural course of CMPA in a 1-year birth cohort of Danish children from birth until 15 and 26 years of age and 2) the development of atopic diseases in a group of children with CMPA (group A) compared to a random sample of 276 children from the same birth cohort (group B). 
Methods: A birth cohort of 1,749 newborns, was investigated prospectively for the development of CMPA and atopic diseases. During the first year of life and at 18 months and 3, 5, 10, 15, and 26 years of age, questionnaire based interviews, physical examination, skin prick tests and specific IgE testing, and from 10 years also spirometry, were carried out. 
Results: 39 (2,2%) were diagnosed with CMPA. The recovery rate was 87%, 92% and 97% at 3, 5 and 26 years of age. Compared to group B, group A had significantly (p < 0,05) higher prevalence of asthma and rhinoconjunctivitis at 15 years of age and at 26 years of age, group A had significantly higher prevalence of asthma and atopic dermatitis. The follow-up rate was 85% (A) and 70% (B). 
Conclusion: CMPA has a good prognosis regarding recovery rate. CMPA and sensitization in early childhood predict sensitization and persistence of allergic diseases into adulthood.

Objective: To investigate hair cortisol concentrations (HCC) monthly in pregnant women and to explore the effect of parity. Design: Prospective cohort study from gestational week (GW) 26, at childbirth and postpartum. Setting: An antenatal care clinic in southeast Sweden. Sample: 390 pregnant women. Methods: Cortisol was measured using radioimmunoassay in methanol extracts of ground hair samples. Main outcome measures: Hair cortisol concentrations Results: Both primi- and multiparae exhibited an increase in HCC throughout pregnancy. Primiparae had significantly higher HCC in the latter part of the last trimester compared to multiparae (one month p=0.003 and two months p=0.038). The use of psychotropic medication in the first trimester correlated to HCC postpartum (p<0.001). HCC in GW 14-17 were associated with HCC in GWs 18-21 (primiparae and multiparae, p<0.001), GW 22-25 (primiparae p=0.036 and multiparae p=0.033), and two months postpartum (primiparae p=0.049). HCC in GW 18-21 was associated with GW 22-25 among both primiparae (p<0.001) and multiparae (p<0.001) as well as two months prior to childbirth among primiparae (<0.037). In general, all estimates of HCC in pregnancy and postpartum showed a significant association between HCC for a specific month and the HCC in the previous month (all p<0.001), except for the association of HCC among primiparae in GW 22-25 and three months prior to childbirth. Conclusions: Increased cortisol concentrations in hair were observed during pregnancy, which decreased three months prior to childbirth in multiparae. The results indicate a quicker suppression of the hypothalamic CRH production by placenta CRH in multiparous women.

Objective: To evaluate the association between certified nurse midwife (CNM) annual delivery workload and short-term, adverse maternal and neonatal outcomes occurring in vaginal deliveries. Design: A retrospective cohort study Setting: A single tertiary academic center. Population: All single, live vertex term vaginal deliveries between 2006 and 2018 were included Methods: deliveries were categorized into two groups based on the CNM median annual volume of deliveries during the study duration. The “high-volume” and “low-volume” groups included deliveries above and below the median annual delivery volume, respectively as a dichotomous variable. Further analyses were performed for the annual volume by deciles. Main outcomes measures: Short term maternal and neonatal outcomes were compared between “high-volume” and “low-volume” groups and between deciles. Results: During the study period 140,856 deliveries met the study criteria. The median annual deliveries of a single CNM was 152 [114-195]. Maternal and labor characteristics were comparable between the groups. Maternal outcomes were not significantly associated with the CNM’s annual workload. However, neonates delivered by CNMs with “low” annual volume had higher a higher rate of neonatal jaundice (aOR 1.07, 95% CI [1.00-1.14]) and mechanical ventilation (aOR 1.32, 95% CI [1.05-1.66). Conclusion: Adverse perinatal outcomes are only mildly affected by CNM’s annual volume after controlling for the CNM, parturient and neonate’s characteristics. Funding: This study was not funded by any organization.

Objective: To explore the distribution of time to pregnancy in a Chinese population based on a cross-sectional design. Design: A cross-sectional population-based study. Setting: 8 provinces/municipalities in China between 2010 and 2011. Population or Sample: 25,270 couples aged 20-49 years. Methods: Multistage stratified cluster sampling strategy was utilized to recruit participants from each stratum by district, province/municipality, town/township, and village/street order. Main Outcome Measures: Time to diagnose pregnancy from 17,275 couples “at risk for pregnancy”. Results: In 7,889 couples eligible for analysis, the mean time to pregnancy was 17.2 months (standard deviation, 22.7) with a median of 9 months (25–75th percentile, 3–20 months). Women aged 20–24 years had the highest percentage of pregnancy at 3, 6, 12, and 24 months (23.9%, 42.5%, 58.5%, and 80.4%, respectively). Furthermore, 55.8% (3,413/6,116) and 79.9% (4,885/6,116) of women aged <35 years conceived within 1 year and 2 years, respectively, and the percentage increased by only 8.4% (5,399/6,116, 88.8%) in the third year. Only 30.6% (186/607) and 50.6% (307/607) of women aged ≥35 years conceived within 1 year and 2 years, respectively. Risk factors associated with time to pregnancy were older age, lower educational attainment of couples, higher annual household income, toxic exposure in men, shorter duration of cohabitation, longer menstrual cycle interval, history of abnormal pregnancy, and nullipara. Conclusions: Our study provides a comprehensive estimation of the time to diagnose pregnancy among Chinese couples of reproductive age, providing important information for policy makers, fertility clinicians, and sexual health educators.

Rationale, aims and objectives: Postoperative atrial fibrillation (POAF) is the most common complication occurring after cardiac surgery. Guidelines for the management of this complication are scarce, often resulting in differences in treatment strategy use among patients. The aims of this study were to evaluate the management of POAF in a cardiac surgery department, characterise the extent of its variability and develop a standardised protocol. Methods: Data from patients who underwent cardiac surgeries with subsequent POAF between 1 January 2017 and 1 June 2018 were analysed in this single-centre observational retrospective study. The primary outcome was the difference in the proportions of patients whose first POAF episodes were treated with a rate control (RaC) strategy, a rhythm control (RhC) strategy and both among hospital units (intensive care unit [ICU], intermediate care unit [IMCU] and general ward [GW]). Secondary outcomes included the mean duration of POAF episodes, POAF recurrences, and the management of anticoagulation. Results: Data from 97 patients were included in this study. The POAF management strategy differed significantly among hospital units (ICU: RhC 75.0%, RhC and RaC 19.4%, RaC 0.0%; IMCU: RhC 40.4%, RhC and RaC 34.6%, RaC 13.5%; GW: RhC 22.2%, RhC and RaC 33.3%, RaC 44.4%; p = 0.001). Ninety-five (97.9%) patients converted to sinus rhythm after the first POAF episode; 51.2% of these conversions occurred within 8 h after onset. POAF recurred in 56.7% of patients. Considering all POAF episodes, 83 (85.6%) patients received amiodarone as part of the RhC strategy. Based on these results, a hospital working group developed a standardised protocol for POAF management. Conclusions: POAF management was heterogeneous at our institution. This paper highlights the need for clear practice guidelines based on large prospective studies to provide care according to best practices for all patients undergoing cardiac surgery.

PURPOSE: To observe the effect of phacoemulsification and intraocular lens (IOL) implantation with or without lens capsular tension ring (CTR) on retinitis pigmentosa (RP) combined with cataract patients. DESIGN: Retrospective cases series study. METHODS: 63cases (84 eyes) of RP with cataract were collected including 30 males and 33 females. Phacoemulsification with 3.0mm clear corneal incision was performed in all the patients. IOL+CTR implantation was performed in 44 eyes, and only IOL implantation was performed in 40 eyes. All cases were followed up at 1 week and 1, 3, 6 months after the surgery to compare the best corrected visual acuity (BCVA), intraocular pressure (IOP), corneal endothelial cell count and complications before and after the surgery. RESULTS: all surgery were successfully completed by the same physician, and IOL and CTR were all implanted in capsule without complications. The BCVA at 6 months after surgery was 0.91±0.88 LogMAR. It improved a little compared with the BCVA(1.3±0.7LogMAR) before surgery and there was a signifcant difference in statistic(P=0.003). Four cases of capsule contraction syndrome(CCS) occurred in no CTR implantation group and there was no CCS in CTR group. There was signifcant difference in statistic about the incidence of CCS between two groups(P=0.047). CONCLUSIONS: Phacoemulsification for RP combined with cataract is safe and reliable, and CTR implantation is helpful to reduce the complications caused by capsule contraction.

Abstract: The continuously increasing trend of large-tree growth challenges the assertion of the unimodal pattern in classical growth theories. Here, we considered the effect of changes in functional traits on growth and extended classical growth equations (i.e., Gompertz and logistic curves) to reconcile this contradiction. We speculated that under the combined effect of allometric scaling and growth plasticity, tree growth trajectories likely follow different unimodal curves before and after different stages, showing a cascade characteristic. The increasing growth trend may be related to the appearance of a larger-scale unimodal curve in the late stage of growth, which depends on some changes in functional traits relative to tree size. To test this hypothesis, we measured tree growth in four plots across the subalpine Abies fabri forest belt on Gongga Mountain in the eastern Tibetan Plateau of China, and then analyzed the relationship of tree growth with important functional traits (i.e., leaf and stem economics and morphological traits). Our results indicate that the ideal and average growth dynamics of Abies fabri follow a unimodal curve with a cascade characteristic. On the individual-scale, cascading growth is more obvious, where the length and height of unimodal curves both increase with tree size, but may be still constrained by hydraulic constraints and tree longevity. This makes sense, because as trees grow, there is an increase in the relative volume of the crown and a decrease in the relative amount of sapwood, resulting in greater carbon accumulation. The results of this study imply the potential for significant improved carbon sequestration capacity of large trees in the later growth period. This model also offers a practical way to link traits and growth performance.

Laparoscopy has been found to result in aerosolization of blood borne viruses and so a more cautious approach has been taken during the pandemic and more attention given to safe deflation of the pneumoperitoneum. We have used a heat and moisture exchange filter to deflate the abdomen as an alternative to a smoke evacuation device. These filters are known to reduce the transmission of microbes and other particulate matter in breathing systems and are readily available in the anaesthetic room.

Rationale: In renal impairment, the pharmacokinetic properties of the drug are altered, and the systemic clearance is reduced. The current study aimed to assess the optimization of antibiotics dosing in renally impaired patients in a healthcare setting. Methodology: A prospective study was conducted on in-patients in the nephrology department, prescribed with antibiotics in a tertiary care hospital. The creatinine clearance was calculated by Cockroft-Gault and Jelliffe method. The dose appropriateness was cross-checked using standard databases and literature from the manufacturer data. Results: Of 139 participants 112 (80.6%) had CKD and 27(19.4%) had AKI. Urinary tract infection was most common. Monotherapy (62) was the most preferred choice, followed by dual in (43) and triple in (7%). A positive clinical outcome of 79.1% was achieved. Cefoperazone-sulbactam was most widely used antibiotic. The mean difference in creatinine clearance was 4.55ml/min in AKI patients. Conclusion: Dose appropriateness is a significant factor in achieving favorable clinical outcomes.

Abstract Background: We sought to investigate whether adherence to a more plant-based, and less animal-based, diet is associated with visceral adiposity, lipid accumulation product (LAP), and triglyceride-glucose index (TyG) in Iranian adults. Methods: This cross-sectional study was conducted on 270 adults aged between 18-75 years old. We created three plant-based diets. including an overall plant-based diet index (PDI), hPDI, and uPDI based on tertiles regarding the intake of animal- or plant-based food items obtained from a semi-quantitative food-frequency questionnaire. Results: Higher hPDI was significantly associated with lower body mass index (BMI) (P-value = 0.01), lower waist circumference (P-value<0.001), and lower waist-hip ratio (P-value<0.001). A significant increase was found for high-density lipoproteins (HDL) (P-trend <0.001) with a significant decrease for LAP (P-value = 0.03) in those with higher adherence to hPDI. Moreover, greater adherence to PDI was associated with a significant increase in diastolic blood pressure (DBP) (p-value=0.01) and fat free mass (FFM) (p-value=0.01). There were no significant associations between PDIs and TyG and VFA. Conclusion: We found that a higher hPDI score was significantly associated with better anthropometric measurements. A significant increase was found for HDL and a significant decrease was found for LAP on hPDI. However, a higher PDI score was significantly associated with higher DBP and higher FFM.

Biomonitoring of complex heterogeneous environments is highly challenging. Fish in deep water bodies occupy different habitats, therefore a combination of survey methods has traditionally been used. Environmental DNA (eDNA) metabarcoding is a novel monitoring tool that can overcome spatial heterogeneity in a highly sensitive and entirely non-invasive manner. However, taxon detection probability is dependent on real-time environmental variables. In this study, three reservoirs were sampled in two seasons using a spatiotemporally distributed sampling design covering major environmental gradients. In all sampling campaigns, 31 fish taxa were detected which exceeded expectations. Data reliability was confirmed by a tight positive correlation between individual taxon scores derived from gillnet sampling and eDNA site occupancy. Analyses confirmed anticipated trends, such as the highest number of taxa were observed in the largest water body, and more taxa were detected in inflows and littoral regions compared to open water. The most important factors for fish distribution were temperature, age and trophic status (expressed as total Chlorophyll a concentration) of water bodies. Taxon detection reflected ecological niches of individual species, e.g. warm water wels catfish (Silurus glanis) and cold water salmonids. This study provides further evidence that eDNA metabarcoding is suitable for ecological study in heterogeneous environments and may substitute conventional fish sampling techniques.

Both aquatic and terrestrial biodiversity information can be detected in riverine water environmental DNA (eDNA). However, the monitoring effectiveness (i.e., the proportion of aquatic and terrestrial biodiversity information detected in riverine water eDNA samples) is unknown. To investigate the monitoring effectiveness, we introduced the concept of watershed biological information flow (WBIF) and proposed that the monitoring effectiveness depended on the transportation effectiveness of the WBIF. Then, the monitoring effectiveness could be assessed in the WBIF framework. Here, we conducted a monitoring effectiveness assessment case study in a watershed on the Qinghai-Tibet Plateau according to analysis of the bacterial operational taxonomic unit (OTU) assemblages detected in riverine water eDNA samples and riparian soil eDNA samples during three seasons. The results showed that (1) the downstream-to-upstream monitoring effectiveness: only 76% of the bacterial OTUs could be detected 1 km downstream in spring and more than 97% and 96% could be detected in summer and autumn, respectively. (2) The river-to-land monitoring effectiveness: more than 62% of the bacterial OTUs in riparian soil eDNA samples could be detected in adjacent riverine water eDNA samples on rainy summer days and 16% and 48% could be detected on cloudy spring and autumn days, respectively. These results suggested that riverine water eDNA was viable for simultaneously monitoring aquatic and terrestrial bacterial biodiversity and that rainy days in summer or autumn were suitable sampling times on the Qinghai-Tibet Plateau. More studies on monitoring effectiveness in other taxonomies and in other watersheds with different climatic conditions are needed.

Background The COVID-19 pandemic has reduced clinical volume with a negative impact on trainee education.   Methods Survey study of Otolaryngology trainees in North America, during the COVID-19 pandemic in April 2020.  Results Of 216 respondents who accessed the survey, 175 (83%) completed the survey. Respondents reported a universal decrease in clinical activities (98.3%). Among participants who felt their program utilized technology well, there were significantly decreased concerns to receiving adequate educational knowledge (29.6% vs. 65.2%, p=0.003).  However, 68% of trainees still expressed concern in ability to receive adequate surgical training. In addition, 54.7% of senior trainees felt that the pandemic had a negative impact on their ability to secure a job or fellowship after training. Conclusions Trainees universally felt a negative impact due to the COVID-19 pandemic.  Use of technology was able to alleviate some concerns in gaining adequate educational knowledge, but decreased surgical training remained the most prevalent concern.

Aims The extent to which augmentation of heart function mirrors the increased metabolic demands of the peripheral musculature is not well characterised. The details of ventricular augmentation may provide insight into determinants of cardiac efficiency for optimal exercise performance. The aims were to establish how much of the variability in exercise performance could be explained by myocardial recruitment, and which parameter of systolic function was most closely related to exercise performance. Methods and results Untrained volunteers were recruited prior to training for the London Marathon. All performed a cardiopulmonary exercise test combined with stress echocardiography. Systolic and diastolic longitudinal velocities (S’ and E’), ejection fraction (LVEF), stroke volume (SV) and strain were obtained throughout exercise. Continuous S’ showed a strong correlation with absolute VO2 (rho=0.83;p<0.0001). Only SV and S’ were predictive of VO2peak. LVEF and E’ as well as both global longitudinal and circumferential strain showed no correlation. The systolic efficiency slope (SES) was calculated by determining the individual regression lines for VO2 and S’. A moderate relationship between the SES and VO2peak was observed for both septal S’; r=0.57;p<0.001 and lateral S’, r=0.53;p<0.001). Conclusion A detailed description of myocardial function is described; linear for S’ and E’ and a plateau for EF and GLS. S’ during exercise is a better predictor of exercise performance than LVEF, SV or GLS. The SES slope was able to predict VO2peak suggesting the process driving systolic velocity and its augmentation is a key determinant of exercise ability.

Background: Effector cells assays provide an overall measure of responsiveness to allergen, but the lack of reliable, high-throughput assays limits the clinical utility of this approach. The aim of this study was to develop a high-throughput Basophil Activation Test (BAT), based on human progenitor cell-derived basophils (PCB), and to investigate the role of PCB activation test (PCBAT) in allergy diagnosis. Methods: PCBs were differentiated from CD34+ progenitor cells, and sensitized with sera from subjects sensitized to cat (n=35, 17 subjects clinical reactivity validated), peanut-allergic (n=30, 15 subjects clinical reactivity validated), peanut-sensitized but tolerant subjects (n=13). Sensitized PCBs were then stimulated with a range of concentrations of the corresponding allergens and degranulation was measured using CD63 expression on flow cytometry. Results: Following passive sensitisation of the mature PCB (2D7+/FcεRI+/CD117-/HLADR-) with serum and stimulation with allergen, we saw a dose-dependent increase in CD63 expression which was allergen specific. In subjects sensititsed to cat there was a positive correlation between PCBAT area under curve (AUC) versus specific IgE (sIgE) to cat (p=0.001) and versus airway responsiveness to inhaled cat allergen (p=0.026). There was a significant negative correlation between PCBAT AUC for peanut allergen and response to oral food challenge test to peanut - subjects with higher PCBAT AUC reacted to a lower dose on the oral food challenge to peanut (p=0.001), and had higher sIgE to Ara h 1 (p=0.007). All peanut tolerant subjects showed no reaction to peanut on PCBAT. Conclusion: PCBAT may confer a powerful alternative tool in allergy testing.

Abstract Background: It is still unclear if and to what extent antenatal or early postnatal vitamin D supplementation would affect the development of allergic diseases later in life. Objective: This study aimed to quantify the effect of antenatal or early postnatal vitamin D supplementation on allergic diseases in life. Methods: MEDLINE(PubMed), EMBASE(OVID), and The Cochrane Central Register of Controlled Trials, and Google Scholar were searched up to March 01 2020.We included only randomized controlled trials. Two reviewers independently extracted data and assessed the certainty in the body of evidence. Results: The search yielded 1251 studies. Eight RCTs were included in the systematic review, which suggests that Vitamin D supplementation for pregnant women and infants may not decrease the risk of developing allergic diseases such as asthma and/or wheezing, eczema, allergic rhinitis, lower respiratory tract infection or food allergies. Conclusions: Limited information is available addressing primary prevention of allergic diseases after Vitamin D supplementation and its potential impact remains uncertain. Keywords: Allergy, Prevention, Systematic review, Vitamin D

Hereditary angioedema due to C1 inhibitor deficiency (C1-INH-HAE) is a rare disease. Few states in developing countries have an adequate management of HAE, but none of them belongs to the former USSR area. This study analyses data from C1-INH-HAE patients from Belarus. Data about clinical characteristics, genetics, access to diagnosis and treatment were collected from 2010 by the Belarusian Research Center for Pediatric Oncology, Hematology and Immunology in Minsk. A questionnaire about attacks, prophylactic (LTP) and on-demand therapy (ODT) was administered to patients. We identified 64 C1-INH-HAE patients belonging to 26 families, 27 (42.2%) of which were diagnosed in the last 3 years. The estimated minimal prevalence was 1:148000. Median age at diagnosis was 29 years, with diagnostic delay of 19 years. Thirty-eight patients answered a questionnaire about therapy. Seventeen (44.7%) underwent ODT: 6 (15.8%) with appropriate treatments, and 11 (28.9%) with inappropriate treatments. Nine (23.6%) used LTP with attenuated androgens and twelve (31.5%) recovered spontaneously. Thirty-two patients answered a questionnaire about attacks and triggers: 368 angioedema attacks were reported, with an average of 10 attacks per year. We found 24 different SERPING1 variants: 9 missenses, 6 in splice sites, 6 small deletions, 2 nonsense, 1 large deletion; 7 have not been previously described. De novo variants were found in 11 patients. C1-INH-HAE diagnosis and management in Belarus is improved as seen from the high number of new diagnosis in the last 3 years. Next steps will be to reduce the diagnostic delay and to promote the LTP and OTD.

This note is part of the collection of quick notes, corresponding to short writings on diverse topics of everyday use in the Atmospheric Sciences and Geophysical Fluid Dynamics.This note shows some properties of the Levi-Civita Symbol, which is extremely useful in tensor manipulations, greatly simplifying the vectorial calculations related to the vector product between vectors. These notes are based on chapter 1 of the excellent book by \citet{Sepulveda_2009}.

This research was aimed at understanding the psychology of citizens to get tested and to follow prevention measures when they show COVID-19 symptoms. It analyses the monetary and psychological perspective. It was found that 75% of the symptomatic individuals did not follow isolation measures, and  80% of symptomatic participants chose to not test, solely based on the decreased severity of symptoms.  7 respondents showed severe symptoms but restrained themselves from taking a test due to the high cost of testing for Covid-19. 

Arabidopsis Casparian strip membrane domain proteins (CASPs) form a transmembrane scaffold to recruit lignin biosynthetic enzymes for Casparian strip (CS) formation. Compared with Arabidopsis, rice root is more complex with a CS of the exodermis and sclerenchyma and a CS that does not block propidium iodide entry into the stele. Rice CASP1 is highly similar to AtCASPs, but it is not required for CS formation. Its mutation results in early leaf senescence and fewer tillers and does not change the CS structure and permeability. OsCASP1 is mainly located in the nuclear membrane. Its expression is concentrated in the root stele and at small lateral root tips and can be induced by salt stress. OsCASP1 mutation causes ectopic suberin deposition in small lateral roots and ion imbalances in the plant. Homeostatic disorder induces nutrient recycling and accelerate leaf senescence. To our knowledge, OsCASP1 is the first CASP to be described in the nuclear membrane; it modulates suberin deposition and does not involve CS formation, representing a novel regulatory mode of CASPs.