Facial synkinesis is the long-term sequela of facial nerve injury that can result in severe deficits in facial expression and function. It is characterized by abnormal involuntary facial movements that accompany voluntary facial expressions. The type and severity of symptoms differ from patient to patient, which makes evaluation and management complex. Given the chronicity of the disease, appropriate evaluation is paramount to effective management. This article will discuss how to effectively evaluate patients in the office and associated treatment.

Title: Cochlear anomaly with preserved hearing - A Clinical Paradox: Our Experience with Two cases

Natural products and natural product-derived compounds have been widely used for pharmaceuticals for many years, and the search for new natural products that may have interesting activity is on going. Abyssomicins are natural product molecules that have antibiotic activity via inhibition of the folate synthesis pathway in microbiota. These compounds also appear to undergo a required [4+2] cycloaddition in their biosynthetic pathway. Here we report the structure of an FAD-dependent reductase, AbsH3, from the biosynthetic gene cluster of novel abyssomicins found in Streptomyces sp. LC-6-2.

Among acid-sensing ion channels (ASICs), ASIC1a and ASIC3 subunits are the most widespread and prevalent in physiological and pathophysiological conditions. They participate in synaptic plasticity, learning and memory as well as in the perception of inflammatory and neurological pain, making these channels attractive pharmacological targets. Sevanol, a natural lignan isolated from Thymus armeniacus, inhibits the activity of ASIC1a and ASIC3 isoforms and has a significant analgesic and anti-inflammatory effect. In this work, we described the efficient chemical synthesis scheme of sevanol and its analogues, which allows us to analyze the structure-activity relationships of different parts of this molecule. We found that the inhibitory activity of sevanol and its analogues on ASIC1a and ASIC3 channels depends on the number and availability of carboxyl groups of the molecule. At the structural level, we predicted the presence of sevanol binding site based on the presence of molecular docking in the central vestibule of the ASIC1a channel. We predicted that this site could also be occupied in part by the FRRF-amide peptide, and the competition assay of sevanol with this peptide confirmed this prediction. Intravenous (i.v.), intranasal (i.n.) and, especially, oral (p.o.) administration of synthetic sevanol in animal models produced significant analgesic and anti-inflammatory effects. Both non-invasive methods of sevanol administration (i.n. and p.o.) showed greater efficacy than invasive (i.v.) one, thus opening new horizons for medicinal uses of sevanol.

Viruses span an impressive size range, with genome length varying a thousandfold and virion volume nearly a millionfold. For cellular organisms the scaling of traits with size is a pervasive influence on ecological processes, but whether size plays a central role in viral ecology is unknown. Here we focus on viruses of aquatic unicellular organisms, which exhibit the greatest known range of virus size. We develop and synthesize theory, and analyze data where available, to consider how size affects the primary components of viral fitness. We argue that larger viruses have fewer offspring per infection and slower contact rates with host cells, but a larger genome tends to increase infection efficiency, broaden host range, and potentially increase attachment success and decrease decay rate. These countervailing selective pressures may explain why a breadth of sizes exist and even coexist when infecting the same host populations. Oligotrophic ecosystems may be enriched in “giant” viruses, because environments with resource-limited phagotrophs at low concentrations may select for broader host range, better control of host metabolism, lower decay rate, and a physical size that mimics bacterial prey. Finally, we describe where further research is needed to understand the ecology and evolution of viral size diversity.

Objective: To assess the effect of serial growth scans and optimised fetal weight limits on the risk of stillbirth in low and high-risk maternity populations. Design: Retrospective cohort study Setting: United Kingdom 2015-2020 Population: 1,572,817 singleton pregnancies cared for in maternity units that have implemented the Growth Assessment Protocol (GAP). Methods: Analysis of fully anonymised, prospectively recorded core data from 132 National Health Service institutions. Stillbirth rate and relative risk was assessed according to risk status assigned at booking. We constructed receiver operator curves (ROC) and determined area under the curve (AUC) and optimal centile points using Youden’s Index. Main Outcome: Rate of stillbirth from 24 weeks gestation. Results: The overall cohort included 6569 stillbirths (rate per thousand: 4.18). The rate was higher in pregnancies that had been designated high risk (6.23) than low risk (3.61; RR 1.7, CI 1.6-1.8). High risk pregnancies that did not receive monitoring by serial ultrasound had a stillbirth rate that was more than twice as high than those that did get serial scans as per protocol (11.94 vs 5.64). The optimal centile point for predicting stillbirth was 11.3 for the overall cohort (sensitivity 36.8, specificity 84.1 and AUC 62.3%), 15.2 for low risk pregnancies (sensitivity 35.1, specificity 84.6, AUC 61.3%) and 2.7 for high risk pregnancies (sensitivity 34.2, specificity 88.9, AUC 61.2% ). Conclusions: Serial third trimester growth scans can halve stillbirth risk in pregnancies designated high risk. Optimal fetal size limits for antenatal surveillance are specific to the risk status of pregnancy.

KEY POINTS1.Our population represents a common clinical scenario in which auditory profiles do not determine eligibility for further evaluation.2.Mean VOR gain in the VS group, was significantly lower on the affected side in the three canal planes.3.Refixation saccades in the affected horizontal canal had a significantly higher latency and velocity in the VS group.4. When we categorized the presence of the VIN with mastoid stimulation, we yielded sensitivities of 81.8% and specificities of 73.9% for detecting VS.5.The VIN test causes minor discomfort with high diagnostic accuracy and should be considered before referring for further imaging.

The article on "The HPC Certification Forum" describes the goals and objectives behind a community effort to build a testing and certification system for HPC (high-performance computing) skills.  As the profession of  Research Facilitation grows, there is a clear benefit to having a common testing and certification framework to help define the technical skills needed in the profession. The article motivates the need for this system and encourages further reading in two referenced articles.  Some noticeable aspects of the approach laid out in the article include:This is a volunteer and community driven effort.The authors of the article come from academia and not commercial training,  which lends credibility to the approach.  This is a global effort with contributors in multiple countries. The testing/certification is hierarchical and can be viewed as a smorgasbord of topics that can be tailored to different situations and goals (instead of dictating a one-size-fits-all).Although a good overview, a lack of details in the article makes it difficult for the reader to know exactly what is intended.  For example, when reading the article I found myself asking these general question:Although a few applications were mentioned, the primary audience for the  testing/certification system is unclear. Is it research facilitators?  HPC Users?  System administrators? Software Developers? It may be "all-of-the-above" and the hierarchical nature of the testing is intended to cover everything. However, I have to believe this would make the material unfocused and difficult to categorize. What qualifies as HPC is still an open and often debated question.   How are decisions made as to what should be included and what should be excluded?  How are priorities set?  For example, I did a quick review of the website and noticed there was no reference to High Throughput Computing (HTC), is this intentional?  Is this not HPC?  Who makes that decision?Is there any attempt to define/use a pedagogical framework for building or evaluating the individual assessments?  Quite a bit of research has gone into how to build effective evaluations and it seems shortsighted to build a testing framework without considering this body of work. As a volunteer organization it must be difficult to make final decisions.  How is the group organized?  There is a governance tab on the website with a mention of 'voting rights' but it is unclear how decisions are made.   Is there a benevolent dictator?  A type of peer-review process?  Is everything up to popular vote?  What happens when I want my highly specialized question or topic added to the hierarchy?  What is being done to prevent chaotic growth of the materials?  What is being done to avoid bias?   This is not a one and done project.  I am concerned about the longevity of this approach.  This seems to be a labor of love but I don't see any indication of a long-term strategy.  How is the project funded?   As a volunteer organization only, what efforts are being made to connect with other organizations (ACM, XSEDE, PRACE) to help ensure continuity and growth.  As this article is an introduction to the project and lacks a lot of details, leaving the reader with a lot of questions could be both good and bad.    I think part of the goal of the article is to pique the reader's interest and provide just enough information to consider going out and learning more.  However,  lack of details may leave the reader frustrated.  The following are some suggestions to improve the article: Change the subtitle from "Community-Lead" to "Community-Led"Describe the current state of the project and give a timeline.  How far along is the project? For example, maybe state when version 1.0 of the tests will be available (or some similar metric).  This information is unclear from the article and also unclear from the website.  A description and references to the pedagogical approach to question writing  and selection (if there is one).A clear definition of what it means to be an HPC "practitioner".  Even if the definition is intended to be open, this needs to be clear to the reader.  More examples would be very helpful.  A few sections of the hierarchy were explained but I would like to have seen some example questions.A link to the website in the list of references.          

OVERVIEW A long-term complication of acute myocardial infarction (AMI) is an aneurysm of the left ventricle (LV) resulting mostly in cardiac failure, ventricular tachycardia (VT), and thromboembolic episodes. Post-infarction LV aneurysm results in LV dilatation and abnormal geometry leading to systolic and diastolic dysfunction. Sudden cardiac death often results from VT after AMI. Conventional surgeries like coronary artery bypass alone have been shown to have minimal benefits in patients with cardiac failure. In a prospective 10-year follow-up study on survival after myocardial revascularization for ischaemic cardiomyopathy, Shah et al reported that coronary artery bypass grafting (CABG) alone after ischaemic heart disease and low left ventricular fraction results in relief of angina symptoms. This particular case was quite interesting because of its unusual presentation and also the progression of symptoms with the attendant deterioration of LV function.

Ecological gradients are expected to be associated with structural rewiring of species interaction networks. The study of network structures along geographic and ecological gradients, however, remains marginal because documenting species interactions at multiple sites is a methodological challenge. Using a standardized DNA metabarcoding method applied to feces, we examined how structural properties of plant--orthoptera networks reflecting specialization and resilience vary with elevation. We found an increase in levels of generality and nestedness with decreasing temperature, and the correlation was stronger than in null models. These relationships corresponded to greater robustness and reduced importance of keystone species in alpine habitats. In cold environments, plant--herbivore networks are wired in a way that may reinforce the resilience of the system to species extinction. Documenting ecological networks along ecological gradients allows a better understanding of the influence of climate on the structure of ecosystems.

Wet alpine meadow ecosystems generally act as a significant carbon sink due to their higher rate of photosynthesis than the rate of decomposition. However, it remains unclear whether the low decomposition rate is determined by low temperatures or by nearly-saturated soil conditions. Using five years of measurements from two sites on the Tibetan Plateau with significantly different soil water conditions, we showed that compared to the dry site (which had a deep water table), the much larger carbon sink at the site with a shallow groundwater was mainly caused by the inhibiting effects of the nearly-saturated soil condition on soil respiration rather than by the low temperature. The findings suggested that thawing of frozen soil may partially slow down soil carbon decomposition through increasing soil water. We highlights that a warming-induced shrinking cryosphere may largely affect the carbon dynamics of wet and cold ecosystems through changes in soil hydrology.

Affinity precipitation using stimulus-responsive biopolymers such as Elastin-like Polypeptides (ELPs) have been successfully employed for the purification of monoclonal antibodies. In the current work, we extend these studies to the development of an ELP-peptide fusion for the affinity precipitation of the therapeutically relevant small non-mAb biologic, AdP. A 12-mer affinity peptide ligand (P10) was identified by a primary phage biopanning followed by a secondary in-solution fluorescence polarization screen. Peptide P10 and AdP interacted with a KD of 19.5 µM. A fusion of P10 with ELP was then shown to be successful in selectively capturing the biologic from a crude mixture. While pH shifts alone were not sufficient for product elution, the use of pH in concert with fluid phase modifiers such as NaCl, arginine or ethylene glycol was successful. In particular, the use of pH 8.5 and an arginine concentration of 500 mM enabled > 80% product recovery. The overall process performance evaluated by SDS-PAGE and reversed-phase UPLC analyses, indicated the successful single-step purification of the biologic from an E. coli lysate resulting in ~90% purity and >80% recovery. These results demonstrate that phage display can be readily employed to identify a peptide ligand capable of successfully carrying out the purification of a non-antibody biological product using ELP-based affinity precipitation.

Proper conceptual framework of community assembly is critical for understanding biodiversity patterns. In this work, we raised the concepts, ‘predominant/ assistant trait’, to characterize distinct trait roles in the processes of community organizing. We further incorporated them into previous theoretical understanding. Upon this theoretical basis, we presented a case study with two rodent datasets in the Hengduan Mountains, China. Due to weak phylogenetic signal and extraordinary habitat heterogeneity, we detected most of the rodent communities appeared random at both phylogenetic and morphological facets, which have prevented us to identify the role of morphological attributes and major process structuring rodent communities. We inferred that the variations in trait role, trait conservatism and habitat heterogeneity are major noise confounding our understanding on community assembly. Based on theoretical modification and empirical demonstration, this work has offered a novel and comprehensive perspective to understand the patterns of phylogenetic and trait-based community structure.

The angiotensin-converting enzyme 2 (ACE2) is a type I integral membrane protein (amino acids 805) that contains a transmembrane domain (amino acids 740-763) and extracellular region (ectodomain). The extracellular region is composed of a metalloprotease zinc-binding site (amino acids 374-378, HEMGH) that is the single catalytic domain of the ACE2. The ACE2 ectodomain undergoes shedding by a disintegrin and metalloproteinase domain‐containing protein 17 a protease up-regulated in heart failure (HF) consequently releases a soluble form of ACE2. Increasing soluble ACE2 levels are associated with HF, adverse cardiac remodelling and correlated with B-type natriuretic peptide levels. The spike protein (S) of severe acute respiratory syndrome coronavirus 1 (SARS-CoV) attaches the virus to its cellular receptor ACE2. The structural analysis demonstrated that S subunit 1 (S1) and the C-terminal domain of the SARS-CoV-2, otherwise known as the receptor-binding domain, bound to soluble ectodomain protein of human ACE2. The construction of a fusion protein consisting of the extracellular domain of human ACE2 linked to the fragment crystallisable region (Fc) domain of human IgG1 (ACE2-Ig), the ACE2 variant in which two active-site histidines have been altered to asparagines (mACE2-Ig), and the inhibition of metalloproteinase with chelator agents that removes zinc that leads disrupting the catalytic site of the ACE2 ectodomain which is indispensable for the Covid-19 attachment could be another promising potential therapeutic approach.

Objective: Determine the strengths and weakness of a symptomatic screening for COVID-19 in pregnant women. Analyze the clinical presentation, management and outcomes. Design: Descriptive retrospective observational study. Setting: Mancha-Centro Hospital (Spain) Population: Symptomatic pregnant women with confirmed diagnosis of COVID-19. Methods: Between the 12th of March and 17th of April 2020, all the symptomatic pregnancies were screened with diagnostic test for SARS-CoV-2. Data collection was done by reviewing the medical records and telephone interviews. Main outcomes measures: Clinical characteristics, management, treatment, and obstetric and neonatal outcomes. Results: 20 patients with positive COVID-19 diagnostic test out of thirty-four suspected. The most common symptoms were fever 70%, cough 65% and myalgia 35%. A unique symptom of presentation in 20% of the cases. COVID-19 pneumonia was diagnosed in 30% by chest X-ray and one case had pulmonary embolism associated diagnosed by CT-Scan. Thromboprophylaxis was indicated in 16/20 patients. Eight women finished their pregnancy during the observation period. Type of birth: 25% natural birth, 12.5% assisted vaginal delivery and 62.5% caesarean section. We had three severe cases, two of them with intensive care support. All neonates had negative test for COVID 19 infection. Conclusions: We recommend universal screening of all pregnant woman for COVID-19 during the pandemic because of the limits of the symptomatic screening seen in this studio and the ratio of asymptomatic pregnancies with positive test for COVID-19 recently published. Funding: No funding. Keywords: COVID-19, pregnancy, screening, outcomes, symptoms, delivery.

Coronavirus disease (COVID-19) is caused by SARS-CoV2 virus, which causes serious respiratory illness such as pneumonia and lung failure. It was first reported in Wuhan, Hubei, China in December 2019 and rapidly spread globally, becoming a pandemic infection in March 2020. Although symptoms highly heterogenous (from absence of manifestations to severe respiratory acute failure), patients with metabolic associated diseases often resulted in worse COVID-19 outcomes. This study aims to investigate the association between metabolic diseases and COVID-19 severity, defining the possible molecular mechanisms that possibly determine the link between the two diseases and the worsening of COVID19 phenotype. In particular, we will define the role of the main biological processes that may function connecting metabolic alterations to SARS-CoV2 infection; hyperglycemia, immune system deregulation, ACE-2 receptor modulation, inflammatory response. The impact of metabolic disorders on the prognosis of COVID-19 have major implications in public health especially for countries affected by a high incidence of metabolic diseases.

Aims This study aimed to explore the relationship between voriconazole trough concentration (Ctrough) and toxicity, identify the factors significantly associated with voriconazole pharmacokinetic parameters and propose an optimised dosing regimen for patients with liver dysfunction. Methods The study prospectively enrolled 51 patients with 272 voriconazole concentrations. Receiver operating characteristic (ROC) curves were used to explore the relationship between voriconazole Ctrough and toxicity. The pharmacokinetic data was analysed with nonlinear mixed-effects method. Dosing simulations stratified by TBIL (TBIL-1: TBIL < 51 μmol/L; TBIL-2: 51 μmol/L ≤ TBIL < 171 μmol/L; TBIL-3: TBIL ≥ 171 μmol/L) were performed. Results ROC curve analysis revealed that voriconazole Ctrough of ≤ 5.1 mg/L were associated with significantly lower the incidence of adverse events. A one-compartment pharmacokinetic model with first-order absorption and elimination was used to describe the data. Population pharmacokinetic parameters of clearance (CL), the volume of distribution (V) and oral bioavailability (F) were 0.88 L/h, 148.8 L and 88.4%, respectively. Voriconazole CL was significantly associated with total bilirubin (TBIL) and platelet count. The V increased with weight. Patients with TBIL-1 could be treated with loading dose of 400 mg every 12 hours (q12h) for first day and maintenance dose of 100 mg q12h intravenously or orally. TBIL-2 and TBIL-3 patients could be treated with loading dose of 200 mg q12h and maintenance doses of 50 mg q12h or 100 mg once daily (qd) and 50 mg qd orally or intravenously, respectively. Conclusions TBIL-based dosing regimens provide a practical strategy for voriconazole maximizing treatment outcomes.

1 | INTRODUCTIONThe ecosystem on the Tibetan Plateau is extremely fragile, and its ability to resist disturbance and regenerate is weak (Cui & Graf, 2009). The temperature of the Tibetan Plateau has been constantly increasing due to global warming, and the rate of warming on the plateau is higher than that in other parts of China (Cui & Graf, 2009; Piao et al., 2004). The study of the spatial and temporal distribution characteristics of vegetation and its climate response on the Tibetan Plateau is significant for deepening the understanding of trends in the ecological effects of climate change on vegetation degradation.The impact of climate change on vegetation occurs at different spatial and temporal scales, and it is difficult to meet the requirements for monitoring changes at regional or global scales with traditional monitoring methods (Pang et al., 2017). With its rapid development, remote sensing technology has realized the long-term monitoring of the dynamic changes in vegetation cover in certain regions, which has improved data availability for research on vegetation responses to climate (Potter & Brooks, 1998). In particular, widely available vegetation index data from the Moderate-Resolution Imaging Spectroradiometer (MODIS) and Advanced Very High Resolution Radiometer (AVHRR) are very useful for the successful assessment, detection, and depiction of landscape conditions and their responses to climate variations at both global and regional scales (Guo et al., 2014).Although NDVI data are strongly related to plant phenological variables and climatic parameters, these relationships are ecosystem-dependent, and can be highly site-specific (Prasad et al., 2008; Mingguo & Veroustraete, 2004) and vary widely in different ecosystems, such as soil ecosystems (FARRAR et al., 1994) and vegetation ecosystems (White et al., 1997). At present, most studies have examined the relationship between climate and vegetation at different scales, which reflects the spatial distribution of vegetation activity changes. Due to stratified heterogeneity, considering the property information (i.e., vegetation type, land cover type, etc.) of each pixel is very useful for understanding the mechanisms of the effect of climate on vegetation. Therefore, it is important to study the relationship between vegetation and climate factors at subregional scales. Among the many potential spatial scales for studies, it is most reasonable to explore climatic effects on different vegetation ecosystems (i.e., at the vegetation type scale). The response of different grassland systems to climate change can vary greatly (Li et al., 2018). The same type of vegetation will often have a similar climate environment and similar response mechanisms to climate factors.For a long time, temperature and water stress have been the primary considerations in studies on climate factors affecting vegetation activity (Wang et al., 2014). As research progresses, an increasing number of climate factors are being taken into account. Sunlight, i.e., solar radiation, provides an energy source for vegetative photosynthesis. On the Tibetan Plateau, sunshine has a more significant impact on vegetation in the southeast region of the plateau (Wang et al., 2014). The lack of radiation observation sites may be the main reason why the influence of radiation is rarely considered in studies, but the sunshine percentage may be a feasible replacement. The relative humidity can reflect the dry and wet conditions of an area to some extent and can have interactive effects with vegetation (Lin et al., 2013). Minimum temperature resistance can be a significant influencing factor on vegetation activity (Prasad et al., 2008; Woodward & McKee, 1991).The effect of precipitation on vegetation shows significant lag (Pang et al., 2017). Many studies have been carried out on the lag in the effect of precipitation on vegetation growth, indicating that the lag time of the climate factors that affect vegetation growth varies among different vegetation ecosystems and growth stages (Sivakumar, 1988; DAVENPORT & NICHOLSON, 1993; Capecchi et al., 2008; Philippon et al., 2005; Martiny et al., 2005). In addition to precipitation, some studies have been conducted on lag effects of other climate factors on vegetation. Piao. (2003) analyzed the monthly average NDVI variation and found that NDVI in April or May was significantly correlated with the temperature in February. Wen et al. (2017) analyzed the regional differences in the lag time of effects at the pixel scale, concluding that there was regional heterogeneity in the amount of lag in the effects of both precipitation and temperature. Revealing the lag in the effects of climate factors on vegetation is significant for understanding the ecological mechanisms of vegetation change.In this study, long-term GIMMS (Global Inventory Modeling and Mapping Studies) NDVI data and the precipitation, average temperature, average minimum temperature, average maximum temperature, relative humidity, sunshine percentage data from the same period were collected to study the spatial and temporal variation patterns of vegetation on the Tibetan Plateau and the ecological mechanisms of the response of vegetation to climate factors from 1985 to 2015. Based on the 1:1,000,000 vegetation type data for China, ten vegetation domain types and pure pixels for each type of vegetation were selected as the study area to reduce errors due to the coarse spatial resolution of NDVI. Because these climate factors affect vegetation activity in different ways and the relationships among them are also complex, stepwise regression was adopted, which can reduce the effects of collinearity between independent variables to some extent. Moreover, instead of simply using the meteorological data from the same period as the NDVI data, the regression equation for NDVI and meteorological data in the period when vegetation activity was the most strongly correlated with meteorological factors was calculated.

Objective. Hyperechoic lung images are largely detected prenatally but their underlying etiology is still poorly defined. The aim of the study was to determine the concordance between pre and postnatal diagnosis of prenatal hyperechoic lung images. Design. Retrospective monocentric study Setting. University Hospital of Necker-Enfants malades from January 2009 to December 2018 Population. All fetuses with prenatal hyperechoeic lung images. Methods. Prenatal ultrasound evaluation was performed by a fetal medicine specialist. Postnatal diagnosis was based on CT-scan. Pre- and postnatal features were retrieved from medical charts. Main outcome measures. Accuracy of the prenatal diagnosis in the identification of the malformations and the prediction of postnatal symptoms. Results. 75 patients were included. Main prenatal diagnoses were bronchopulmonary sequestrations (BPS) (n=24-32%), pulmonary cystic malformations (PCM) (n=19-25%), congenital lobar emphysemas (CLE) (n=15-20%). Mediastinal shift was observed in 18 cases (24%); in utero intervention was required in 2. For BPS, the prenatal detection of a systemic arterial supply had a sensitivity of 96%, a specificity of 83%, a PPV of 77% and an NPV of 98%. For PCM, the prenatal detection of a cystic component had a sensitivity of 69%, a specificity of 69 %, a PPV of 67% and a NPV of 71%. All 16 neonates with prenatal isolated mediastinal shift were asymptomatic at birth. Seven neonates (CLE=5, BPS=1, BC=1) showed respiratory distress that were not predicted prenatally. Conclusions. Hyperechoic lung malformations reflect a heterogeneous group of lesions. Symptoms at birth are present in 9% and cannot be predicted by prenatal features.

Objectives: Small for gestational age (SGA) neonates are at increased risk for adverse outcomes, which is also common in pregnancies with preterm prelabor rupture of membranes (PPROM). The primary outcome was to compare the diagnostic accuracy for neonatal SGA by the Hadlock and the FMF charts in our cohort, followed by the ability to predict composite severe neonatal outcomes. Methods: This study was a secondary analysis of a prospective cohort of pregnancies with PPROM from 2015 to 2018, from 23 to 36 completed weeks of gestation. Sensitivity, specificity, and positive and negative predictive values were compared as well as receiver operating curves (AUC). Results: Of the 106 women who met inclusion criteria, 48 (45%) screened positive with the FMF fetal growth chart and 22 (21%) screened positive with the Hadlock chart. SGA was diagnosed in 12 infants (11%). Both fetal growth charts had a comparable diagnostic accuracy and were statistically significant predictors of SGA, Hadlock: AUC: 0.76, RR 7.6 95% CI (2.5- 23), FMF: AUC: 0.76 RR 1.8-13.3 95% CI (1.8 – 99.3). Both growth standards were poor predictors of severe neonatal outcomes. Conclusion: The Hadlock and the FMF fetal growth charts are accurate predictors of SGA in pregnancies complicated by PPROM. The FMF fetal growth chart may result in a two-fold increase of positive screens, potentially increasing fetal surveillance. We acknowledge the need for more diverse studies to corroborate our results and identify the optimal fetal growth standard to detect SGA and severe neonatal outcomes in pregnancies with PPROM.

Objective: To develop an artificial intelligence (AI) model to detect congenital central nervous system (CNS) malformations in fetal cerebral-cranial ultrasound images, and to assess the efficacy of this algorithm in improving clinical doctors’ diagnostic performance. Design: Retrospective, multicenter, diagnostic study Setting: Three Chinese hospitals Population: a cohort of 2397 fetuses with CNS malformations and 11316 normal fetuses. Methods: AI model was developed by training on 37450 images from 15264 fetuses and testing on 812 images from 449 fetuses. Three groups of doctors (trainee, competent, expert) were equipped with the AI system to test its enhancement of diagnosis performance. Main outcome measures: Diagnostic performance of AI model and that of doctors. Comparison of performance between AI model and doctors, and doctors with and without AI assistance. Results: The performance of AI model was comparable to that of expert in identifying 12 types of CNS malformations in terms of accuracy 79.8% (95% CI 77.0-82.6% ) versus 78.9% (95% CI 75.2-85.2% ), sensitivity 78.4% (75.3-81.3%) versus 77.5% (73.7-81.4%) , specificity of 94.4% (86.2-98.4%) versus 93.0% (84.1-100.0%), and AUC 0.864 (0.833-0.895) versus 0.853 (0.800-0.905). This AI model improved doctors’ diagnostic performances, the trainee group received maximum improvement, whose diagnostic performance advanced to the level of expert group in terms of accuracy (80.2%, 95% CI 75.0-85.3% ) and AUC (0.872, 95% CI 0.861-0.882 ). Conclusions: Our AI system achieved a high diagnostic performance comparable with that of experienced doctors and can support unexperienced doctors by improving their diagnostic accuracy to an expert-level.

Background: puerperal sepsis is a common cause of maternal mortality worldwide. Quick Sequential Organ Failure Assessment (q-SOFA) is a bedside tool which is composed of three components: respiratory rate, systolic blood pressure and level of consciousness, A score of ≥ 2 indicates that the patient is having sepsis & at risk of poor outcome. Objectives: To calculate the q-SOFA for postpartum patients admitted with infection and to correlate this with critical care unit admission & patient outcome. Methods: An observational, prospective cohort hospital-based study. It was conducted in Omdurman Maternity Hospital from October 2018-to March 2019. The study included 59 postpartum patients who were diagnosed with postpartum infection; their q-SOFA score was calculated on admission and then on daily basis, to detect their in-hospital mortality and morbidity. The data was analyzed using SPSS, using Pearson Chi-square which was significant at P value of 0.05. Results: Fifty-nine participants were involved, mean age was 28years.Those who delivered by cesarean section was 54.3%, 33(55.9%) developed surgical site infection. Five patients (8.5%) died and 54 (91.5%) discharged. 17(28.8%) were admitted to critical care unit. q-SOFA score was calculated & correlated to critical care unit admission & fate of the patient using Pearson Chi-square which was found to be significant 0.01 and 0.001, respectively (P value of 0.05).Conclusion: q-SOFA is a useful tool in detecting infected patients at risk of poor outcome and death. If the score ≥2 patients need to be, admitted to critical care unit

Phenological shifts are well-documented in the ecological literature. However, their significance for changes in demography and abundance is less clear. We used 27 years of citizen science monitoring to quantify trends in phenology and relative abundance across 89 butterfly species. We calculated shifts in phenology using quantile regression and shifts in relative abundance using list length analysis and counts from club trips. Elongated activity periods within a year were the strongest predictor of increases in relative abundance. These changes may be driven in part by changes in voltinism, as this association was stronger in multivoltine species. Some species appear to be adding a late-season generation while other species appear to be adding a spring generation, revealing a possible shift from vagrant to resident. Our results emphasize the importance of evaluating phenological changes throughout species' activity periods and understanding the consequences for such climate-related changes on viability or population dynamics.

Background Aortoesophageal fistula (AEF) is a rare but life-threatening condition. Secondary AEF is a complication of previous surgery, and can be more critical and challenging than primary AEF. The number of cases of secondary AEF is increasing due to increasing number of thoracic endovascular aortic repair (TEVAR) performed. Although TEVAR has become a successful alternative surgical strategy for thoracic aortic aneurysms, secondary AEF after TEVAR may occur because of severe adhesion between the esophagus and residual thoracic aortic wall. Methods This study analyzed six patients with secondary AEF who were treated at Tokyo Medical University Hospital between 2011 and 2016. These participants included four patients who had undergone TEVAR and two who had undergone total arch replacement. Results Open surgical repair was completed in two patients who had undergone total arch replacement. TEVAR alone was performed in two patients who had undergone TEVAR. Combined repair of TEVAR as a bridge to open surgery was planned for two patients who had undergone TEVAR. However, reconstruction of the aorta and esophagus could not be completed in these patients due to severe adhesions, and they died during hospitalization. Conclusions Definitive open repair was successfully performed in patients with secondary AEF after total arch replacement. However, in the patients with secondary AEF after TEVAR, severe adhesion between the aorta and esophagus led to difficulty in performing a successful definitive open repair. The strategy for secondary AEF should, therefore, be decided considering the etiology of secondary AEF.