We used long read sequencing data generated from Knightia excelsaI R.Br, a nectar producing Proteaceae tree endemic to Aotearoa New Zealand, to explore how sequencing data type, volume and workflows can impact final assembly accuracy and chromosome construction. Establishing a high-quality genome for this species has specific cultural importance to Māori, the indigenous people, as well as commercial importance to honey producers in Aotearoa New Zealand. Assemblies were produced by five long read assemblers using data subsampled based on read lengths, two polishing strategies, and two Hi-C mapping methods. Our results from subsampling the data by read length showed that each assembler tested performed differently depending on the coverage and the read length of the data. Assemblies that used longer read lengths (>30 kb) and lower coverage were the most contiguous, kmer and gene complete. The final genome assembly was constructed into pseudo-chromosomes using all available data assembled with FLYE, polished using Racon/Medaka/Pilon combined, scaffolded using SALSA2 and AllHiC, curated using Juicebox, and validated by synteny with Macadamia. We highlighted the importance of developing assembly workflows based on the volume and type of sequencing data and establishing a set of robust quality metrics for generating high quality assemblies. Scaffolding analyses highlighted that problems found in the initial assemblies could not be resolved accurately by utilizing Hi-C data and that scaffolded assemblies were more accurate when the underlying contig assembly was of higher accuracy. These findings provide insight into what is required for future high-quality de-novo assemblies of non-model organisms.

A 17-year-old male was admitted for the management of multiple fractures after sustaining blunt thoracic trauma. He was hemodynamically stable and without any cardiac symptoms. He was admitted with fracture of T4 end plate, manubrium and left first rib, right pulmonary contusion, left apical pneumothorax and pneumomediastinum. The patient underwent echocardiography and cardiac CT angiogram for the work up of aortic injury as the patient had new aortic regurgitation murmur, troponin rise and RBBB. He was found to have aortic root rupture, type A aortic dissection and acute severe aortic insufficiency. The patient underwent surgical aortic valve and root replacement with Bentall procedure with good outcome.

The recent emergence of Severe Acute Respiratory Syndrome-Corona Virus 2 (SARS-CoV-2) in late 2019 and its spread worldwide caused an acute pandemic of Coronavirus disease 19 (COVID-19). COVID-19 pathologies are currently under intense scrutiny as its outbreak led to immense and urgent changes worldwide. Although many theories have been introduced on how SARS-CoV-2 enters the host, the ACE-2 receptor is shown to be the primary mechanism of SARS-CoV-2 entry. However, the mechanism behind the establishment and pathology of infection is poorly understood. As recent studies show that host mitochondria play an essential role in virus-mediated innate immune response, in this review, we will discuss, in detail, the entry and progression of SARS-CoV-2 and how mitochondria play a role in the establishment of viral infection and the development of an immune response, whether it is beneficial or not. We will also review the possible treatments that could be used to prevent the surgency of COVID-19 infection with respect to the role of mitochondria. Understanding the mitochondria-mediated SARS-CoV-2 establishment may provide a unique mechanism and conceptual advancement in finding a novel treatment for COVID-19.

Background and Purpose: Based on in vitro data, ivermectin (IVM) has been proposed for the prevention and treatment of COVID-19, a condition for which obesity is a major risk factor. IVM dosage is based on total body weight and there are no recommendations to adjust dosage in obese patients. The objective of this study was to establish, in a canine model, the influence of obesity on the clearance and steady-state volume of distribution of IVM and two analog compounds, moxidectin (MOX) and eprinomectin (EPR). Experimental Approach: An experimental model of obesity in dogs was based on a high calorie diet. IVM, MOX and EPR were administered intravenously, simultaneously in combination, to a single group of dogs in two circumstances, during a control period and when body weight had been increased by 50%. Key Results: In obese dogs, clearance, expressed in absolute values (L/day), was not modified for MOX and reduced for IVM and EPR, compared to the initial control state. When scaled by body weight (L/day/kg), plasma clearance was reduced by 42, 55 and 63%, for MOX, IVM and EPR, respectively. In contrast, the steady-state volume of distribution was markedly increased in absolute values (L) by obesity. Conclusion and Implications: For IVM and MOX, the obese dog model suggests that the maintenance dose should not be adjusted by total body weight in the obese subject but should be based on lean body weight. On the other hand, the loading dose should be computed based on the total body weight of the obese subject.

COVID-19 has an unpredictable course with substantial percentage of infected patients developing clinical deterioration and increasing health care burden. With no specific treatment or vaccination, the current search is for drugs that can limit the disease progression. Recently Fluvoxamine has been reported to have disease modifying effects in COVID-19. We suggest the hypothesis that short term routine use of Selective Serotonin Reuptake Inhibitors (SSRIs) can prevent clinical deterioration of asymptomatic or mild COVID-19 cases by the following ways: a) anti-inflammatory actions through sigma-1 agonism and reducing release of pro-inflammatory cytokines, b) anti-coagulant action by reducing platelet aggregation, c) specific antiviral and antibacterial effects, d) Immunomodulation through Serotonin pathway and anti-oxidation. The routine short term use of SSRIs can also alleviate the psychological impact of the disease. We hope our hypothesis will encourage future clinical trials to validate the routine use of SSRIs against COVID-19.

Background: Vitamin D deficiency and insufficiency have been associated with poorer health outcomes. Children with cancer are at high risk for Vitamin D deficiency and insufficiency. At our institution, we identified high variability in Vitamin D testing and supplementation in this population. Of those tested, 65% were Vitamin D deficient/insufficient. We conducted a quality improvement (QI) initiative with aim to improve Vitamin D testing and supplementation among children aged 2-18 years old with newly-diagnosed cancer to ≥ 80% over 6 months. Methods: An inter-professional team reviewed baseline data, then developed and implemented interventions using Plan-Do-Study-Act (PDSA) cycles. Barriers were identified using QI tools, including lack of automated triggers for testing and inconsistent supplementation criteria and follow-up testing post-supplementation. Interventions included an institutional Vitamin D guideline, clinical decision-making tree for Vitamin D deficiency, insufficiency and sufficiency, electronic medical record triggers, and automated testing options. Results: Pre-intervention: N=26 patients, four (15%) had baseline Vitamin D testing; two (8%) received appropriate supplementation. Post-intervention: N=33 patients; 32 (97%) had baseline Vitamin D testing; 33 (100%) received appropriate supplementation and completed follow-up testing timely (6-8 weeks post-supplementation). Change was sustained over 24 months. Conclusions: We achieved and sustained our aim for Vitamin D testing and supplementation in children with newly-diagnosed cancer through inter-professional collaboration of hematology/oncology, endocrinology, hospital medicine, pharmacy, nursing, and information technology. Future PDSA cycles will address patient compliance with Vitamin D supplementation and impact on patients’ Vitamin D levels.

A multiple length scale approach to the imaging and measurement of depth filters using X-ray computed tomography is described. Three different filter grades of varying nominal retention ratings were visualized in 3D and compared quantitatively based on porosity, pore size and tortuosity. Positional based analysis within the filters revealed greater voidage and larger average pore sizes in the upstream quartile before reducing progressively through the filter from the center to the downstream quartile, with these results visually supported by voidage distance maps in each case. Flow simulation to display tortuous paths that flow may take through internal voidage were examined. Digital reconstructions were capable of identifying individual constituents of voidage, cellulose and perlite inside each depth filter grade, with elemental analysis on upstream and downstream surfaces confirming perlite presence. Achieving an appropriate pixel size was of particular importance when optimizing imaging conditions for all grades examined. A 3 µm pixel size was capable of representing internal macropores of each filter structure, however for the finest grade an improvement to a 1 µm pixel size was required in order to resolve micropores and small perlite shards. Enhancing pixel size resulted in average porosity measurements of 70% to 80% for all grades.

Abstract: Aims: The diagnosis of drug-induced liver injury (DILI) is relatively complex, involving a wide variety of drugs. The purpose of this study is to use algorithms to quickly screen DILI patients, count incidence rates and find risk factors. Methods: The Adverse Drug Events Active Surveillance and Assessment System-2 was used to extract the data of hospitalized patients in 2019 according to the set standards, then the RUCAM was used to evaluate patients who meet the standards. A retrospective case-control study was conducted according to suspected drugs, length of hospital stay, height and weight matched controls, and logistic regression was used to find risk factors. Results: Among the 156,570 hospitalized patients, 480 patients (499 cases) of DILI were confirmed, and the incidence of DILI was 0.32%. Anti-infective agents, antineoplastic agents, non-steroidal anti-inflammatory drugs (NASIDs) were the major category of causative drugs causing DILI, and the highest incidence of DILI caused by agent of voriconazole. The latency period and hospital stay of patients with cholestasis was relatively long. Patients with hyperlipidemia (AOR: 1.884), cardiovascular disease (AOR: 1.465), pre-existing liver disease (AOR: 1.827) and surgical history (AOR: 1.312) were likely to be risk factors for DILI. Conclusions: The incidence of DILI in hospitalized patients was uncommon (0.32%), and its pathogenic drugs were widely distributed. LiverTox’s information could assist in the diagnosis of DILI. The incidence of DILI in many drugs was seriously underestimated. It is recommended to focus on patients with hyperlipidemia, cardiovascular disease, pre-existing liver disease, and surgical history.

The analysis of the dynamics of interaction networks (i.e. trophic webs) better capture the state of ecosystem facing a perturbation than individual species dynamics could. We propose a framework that examines network robustness to a given perturbation at the local (species), mesoscale (species directly linked together) and global (network) level, based on traits and the topology of the network. Using the Celtic Sea as an example, we showed that the network was the least robust to the simulated loss of forage taxa and the most exposed taxa to fishing pressure, indicating conservation priority could be focused on these taxa. However estimating the sensitivity to fishing at the taxa ‘level was insufficient to predict the robustness of the network. The network appeared relatively robust to the simulated loss of the most central taxa, suggesting that mesoscale metrics such as centrality, although widely used, are not always adapted to prioritize species conservation.

We describe a patient in whom this anomaly was diagnosed during cardiac catheterization for evaluation of progressive shortness of breath and mild to moderate mitral regurgitation founded on a transthoracic echocardiogram.A 58-year-old hypertensive female was evaluated for progressive shortness of breath. Her physical examination showed a regular heart rate and rhythm, with normal heart sounds with a holosystolic systolic murmur on the 4th intercostal midclavicular line on auscultation. Electrocardiography showed normal sinus rhythm and criteria and possible left ventricular hypertrophy. Stress Echocardiogram showed with no evidence of ischemia preserved left ventricular function with an ejection fraction of 55-60%, with mild to moderate mitral regurgitation. Patient underwent a coronary catheterization for persistent shortness of breath which indicated no evidence of obstructive coronary disease, normal left ventricular function with mild to moderate mitral insufficiency. Angiography of the right coronary artery showed a very large and tortuous artery that collateralizes into the left main system and supplies the entire left coronary artery system. The left main coronary origin was from the pulmonary artery. CTA confirmed the same findings. The recommendations between cardiology and cardiothoracic surgery were to maximize medical therapy and follow up due to lack of myocardial ischemia or severe valvular disease. Currently there are no guidelines or gold standard management for patients with adult form of ALCAPA that present without ischemic burden or for patients with the disease that present asymptomatic with significant coronary collateralization.

Males have the ability to compete for fertilizations through both pre-copulatory and post-copulatory intrasexual competition. Pre-copulatory competition has selected for large weapons and other adaptations to maximize access to females and mating opportunities while post-copulatory competition has resulted in ejaculate adaptations to maximize fertilization success. Negative associations between these strategies support the hypothesis that there is a trade-off between success at pre- and post-copulatory mating success. Recently, this trade-off has been demonstrated with experimental manipulation. Male leaf-footed cactus bugs, Narnia femorata, that lose a weapon by autotomy during development invest instead in large testes. While evolutionary outcomes of the trade-offs between pre- and post-copulatory strategies have been identified, less work has been done to identify proximate mechanisms by which the trade-off might occur, perhaps because the systems in which the trade-offs have been investigated are not ones that have the molecular tools required for exploring mechanism. Here we applied knowledge from a related model species for which we have developmental knowledge and molecular tools, the milkweed bug Oncopeltus fasciatus, to investigate the proximate mechanism by which autotomized N. femorata males developed larger testes. Autotomized males had evidence of a higher rate of transit amplification divisions in the spermatogonia, which would result in greater sperm numbers. Identification of mechanisms underlying a trade-off can help our understanding of the direction and constraints on evolutionary trajectories and thus the evolutionary potential under multiple forms of selection.

Arthritis is a common clinical feature of systemic lupus erythematosus (SLE) and is usually non-erosive as opposed to rheumatoid arthritis (RA). While RA synovial pathology has been extensively studied, little is known about the pathophysiology of lupus arthritis. Here, we aimed to explore the cytokine and cellular compartments in synovial fluids of SLE patients with arthritic manifestations. Acellular synovial fluid and paired serum samples from SLE patients (n=17) were analyzed with cytokine bead array for T helper associated cytokines. From two SLE patients, synovial fluid mononuclear cells (SFMC) were analyzed by multiparameter flow cytometry to dissect T cell, B cell, monocyte and dendritic cell phenotypes. SLE-derived SFMC were further stimulated in vitro to measure their capacity for producing IFN and IL-17A. All patients fulfilled the ACR 1982 classification criteria for SLE. Clinical records were reviewed to exclude the presence of comorbidities such as osteoarthritis or overlap with RA. IL-17A and IL-6 levels were high in SLE synovial fluid. A clear subset of the synovial CD4+ T cells expressed CCR6+, a marker associated with Th17 cells. IL-17-production was validated amongst CD4+CCR6+ T cells following in vitro stimulation. Furthermore, a strong IFN production was observed in both CD4+ and CD8+ cells. Our study shows high IL-17A and IL-6 levels in synovial fluids of patients with lupus arthritis. The Th17 pathway have been implicated in several aspects of SLE disease pathogenesis and our data points to Th17 involvement also for lupus arthritis.

Background: To describe how parents and families of children with cancer evaluate the benefits and risks of using social media (SM) and how they navigate disagreements between oncologists’ advice and information found on SM. Procedure: Parents of children who had been previously diagnosed with cancer, and who had used SM for a purpose related to that child’s health were recruited through SM sites and nonprofit organizations across the U.S. and were invited to complete questionnaires about their experiences using SM; a subset of participants also completed a follow-up in-depth interview. Open-ended responses and interviews were analyzed using thematic analysis. Results: 90 parents completed written questionnaires; 21 completed follow-up interviews. 70% described experiencing a situation in which information shared on SM conflicted with information provided by their child’s oncologist. Although 86% discussed it with the oncologist and 70% described the response as positive, 78% retained negative feelings about the experience. Openness to discussing SM, honesty, transparency and humility regarding the limits of medicine, and shared decision-making regarding information found on SM were connected with reported trust in the oncologist. Conclusions: Parents offered valuable insights regarding their experiences navigating SM, including 8 recommendations for how pediatricians might approach discussing parental SM use. Future studies will evaluate the utility of these recommendations for pediatric clinicians.

Introduction: Despite eradication and control measures applied across Europe, bovine tuberculosis (bTB) remains a constant threat. In Belgium, after several years of bTB disease freedom status, routine movement testing, as currently practiced, revealed itself inadequate to detect some sporadic breakdown herds. The aim of this study was to strike the balance between cost and effectiveness of different surveillance system components to identify sustainable alternatives for early detection and substantiation of freedom of bTB while maintaining acceptance of these amongst the different animal health stakeholders. Methods: Stochastic iteration model was built to simulate, first, the expected current surveillance system performance in terms of sensitivity and specificity of detection. These results were then descriptively compared to observed field results. Secondly, the cost and effectiveness of simulated alternative surveillance components were quantified. To measure impact of key assumptions (i.e. regarding diagnostic tests and true prevalence), sensitivity analysis was performed. Results: Discrepancies between the predicted and observed performance of bTB surveillance in Belgium were observed. Secondly, simulated alternatives revealed that targeted IFN-γ as well serological testing with Antibody ELISA towards risk herds would enable increasing the overall cost and effectiveness of the Belgian bTB surveillance system. Sensitivity analysis showed that results remained constant despite modification of some key assumptions. Discussion: Performance of current bTB surveillance system performance in Belgium was questionable. This exercise highlighted that not only sensitivity, but specificity is a key driver for surveillance performance. The quantitative and participative conceptual framework revealed itself a useful tool to allow evidence-based decision making regarding future tuberculosis surveillance in Belgium, as required by the international standards.

The stability of plant biomass production in the face of environmental change is fundamental for maintaining terrestrial ecosystem functioning, as plant biomass is the ultimate source of energy for nearly all life forms. However, most studies have focused on the stabilizing effect of plant diversity, neglecting the effect of soil biodiversity, the largest reservoirs of biodiversity on Earth. Here we investigated the effects of plant and soil biodiversity on the temporal stability of biomass production under varying simulated precipitation in grassland microcosms. Soil biodiversity loss reduced temporal stability by suppressing asynchronous responses of plant functional groups. Greater plant diversity, especially in terms of functional diversity, promoted temporal stability, but this effect was independent of soil biodiversity loss. Moreover, multitrophic biodiversity, plant and soil biodiversity combined, was positively associated with temporal stability. Our study highlights the importance of maintaining the biodiversity of multiple trophic levels for sustainable biomass production.

The Vero cell line is the most used continuous cell line in viral vaccine manufacturing. This adherent cell culture platform requires the use of surfaces to support cell growth, typically roller bottles or microcarriers. We have recently compared the production of rVSV-ZEBOV on Vero cells between microcarrier and fixed-bed bioreactors. However, suspension cultures are considered superior with regards to process scalability. Therefore, we further explore the Vero suspension system for rVSV-vectored vaccine production. Previously, this suspension cell line was only able to be cultivated in a proprietary medium. Here, we expand the adaptation and bioreactor cultivation to a serum-free commercial medium. Following small scale optimization and screening studies, we demonstrate bioreactor productions of highly relevant vaccines and vaccine candidates against Ebola virus disease, HIV and COVID-19 in the Vero suspension system. rVSV-ZEBOV, rVSV-HIV and rVSVInd-msp-SF-Gtc can replicate to high titers in the bioreactor, reaching 3.87 × 107 TCID50/mL, 2.12 × 107 TCID50/mL and 3.59 × 109 TCID50/mL, respectively. Further, we compare cell specific productivities, and the quality of the produced viruses by determining the ratio of total viral particles to infectious viral particles

Letter to EditorTo the EditorEgg-allergic children have higher ovomucoid (OVM)-specific IgD (sIgD) levels compared to the atopic controls.1 Within the egg-allergic group, children with higher levels of OVM-sIgD have a decreased risk of anaphylactic reactions. Ovalbumin (OVA)-sIgD increases in egg-allergic children desensitized by oral immunotherapy (OIT) but not in children unresponsive to OIT or with sustained unresponsiveness to OVA challenge.2 The natural development of tolerance and the acquisition of sustained unresponsiveness by OIT in egg-allergic children are associated with an increase in OVM-specific IgG4 (sIgG4) levels and a decrease in OVM-specific IgE (sIgE) levels.3 To elucidate the potential role of IgD in the outgrowing of egg allergy, we analyzed levels of egg white (EW)-, OVM-, and OVA-sIgD and sIgG4 in sera from 57 egg-allergic children (28 avoided all forms of egg in the diet (complete avoidance of egg: CAE), 18 were able to ingest at least 1/32 cooked whole egg but not one cooked whole egg (partial avoidance of egg: PAE), and 11 outgrew egg allergy (OGE)) and 23 healthy non-egg allergic children (non-egg allergy: NEA) (Table S1). The study was approved by The Research Ethics Committee of University of Fukui (#20110052), and written informed consent was obtained from the parent or guardians.EW-, and OVM-sIgE levels measured using ImmunoCAP (Thermo-Fisher Inc., MA) were higher in the CAE group, followed by the PAE, OGE, and NEA groups (Fig 1, Fig S1). The CAE group exhibited lower serum levels of EW- and OVA-sIgD compared to the NEA group and the PAE group, respectively, and had the lowest OVM-sIgD serum levels among all groups, suggesting that OVM-sIgD levels are associated with outgrowing egg allergy. We observed the lowest serum levels of EW-, OVA-, and OVM-sIgG4 in the CAE group, followed by the PAE and OGE groups. The ratio of OVM-sIgD to OVA-sIgD increased as children outgrew egg allergy, whereas the ratio of OVM-sIgG4 to OVA-sIgG4 did not change. Thus, the production of OVM-sIgD differs from OVM-sIgG4 as children naturally outgrow egg allergy.High-affinity, but not low-affinity, IgE is known to cause anaphylaxis.4 High-affinity IgE is derived from memory IgG1+ B cells, whereas low-affinity IgE is derived from naïve IgM+IgD+ B cells. Considering class switching pathways, switching direction from IgM to IgD, and from IgG1 to IgE or IgG4, elevated OVM-sIgD levels might be associated with low-affinity OVM-sIgE levels as children outgrow egg allergy, resulting in hypo-responsiveness to OVM.A recent study found that OVM-sIgE avidity was more effective at differentiating clinically reactive egg-allergic patients from those tolerant of heated egg compared to EW-sIgE.5 The ratio of OVM-sIgE to OVM-sIgD or sIgG4 in the CAE group was significantly higher compared to the PAE, OGE, and NEA groups (Fig 2). Receiver operating analysis revealed that the ratio of OVM-sIgE to OVM-sIgD discriminated non-tolerant from partially-tolerant egg-allergic patients with the largest area under the curve (AUC = 0.965) compared with levels of OVM-sIgE or the ratio of OVM-sIgE to OVM-sIgG4. The optimal cutoff for the ratio of OVM-sIgE to OVM-sIgD had 86.5% sensitivity and 96.4% specificity to identify high-risk subjects (Table S2).There are several limitations to this study. First, there was a small number of patients. Second, all children were only challenged with heated egg and were instructed to avoid egg of any form if they tested positive with less than 1/32 cooked whole egg. Finally, there was a lack of trajectory of sIgD levels during natural tolerance development.In conclusion, the ratio of OVM-sIgE to OVM-sIgD is a useful marker to identify high-risk egg-allergic patients capable of ingesting a low-dose of cooked whole egg who might be a good candidate for low-dose OIT.

In this study, the impact of integrating four different sea surface temperatures (SST) datasets on the accuracy of the Weather Research and Forecasting (WRF)-Hydro system to simulate hydrological response during two catastrophic flood events triggered by the changes in SST is investigated. The selected events occurred over Eastern Black Sea (EBS) and Mediterranean (MED) regions of Turkey, where complex geographical characteristics exist and flash flood occurrences are associated with climatic conditions. Three time-varying and high-resolution external SST products (GHRSST, Medspiration, and NCEP-SST) and one coarse-resolution SST product (ECMWF-SST and GFS-SST for EBS and MED regions, respectively) already embedded in the initial and boundary condition dataset of WRF model are used in deriving near-surface weather variables through WRF. Using these meteorological inputs, the flood hydrographs of topographically complex small catchments located over EBS and MED regions are derived by a calibrated WRF-Hydro model coupled one way with WRF 3-km nest domain. After the proper event-based calibration performed to the WRF-Hydro using hourly and daily streamflow data of small catchments in both regions, model simulations for independent SST events are conducted to assess the impact of SST-triggered precipitation on simulated extreme runoff. The calibrated model over both regions revealed significant improvement in flood hydrographs. Some localized and temporal differences in the occurrence of the flood events with respect to observations depending on the SST representation are noticeable. The high-resolution SST dataset cases (Medspiration and GHRSST) show error reduction up to 20% and increase in correlation from 0.3 to 0.8 with respect to the coarse SST in simulated runoffs of the EBS region. The error reduction reached 35% after the calibration. The same high-resolution SST data revealed the exact match with the observed runoff peak after 100 m3/s reductions obtained with calibration in the MED region.

Abstract: Backgraound: Transcatheter aortic valve implantation (TAVI), with its improved valve technologies will also be an option for patients in the near future and improved operator experience. Cerebrovascular events are among the most feared complications of TAVI, since they cause high morbidity and mortality. Case: After the patient with EuroSCORE II = 8.6% was considered to be at high risk in terms of surgery, the decision to perform TAVI was taken. The valve (Medtronic 26 mm) was successfully placed during the 110 min procedure. Blood loss was 140 mL, no red blood cell (RBC) transfusion and catecholamines requirements were present, no VF (ventricular fibrillation) and cardiac tamponade were observed and post procedure left ventricular ejection fraction (LVEF) was 60%. At the end of the procedure, the BIS value of the patient was 70, regression in the Glasgow Coma Score (GCS = 12), anisocoria in the pupils (R = 2 mm < L = 4 mm) and motor loss in the right arm (3/5) and right leg (3/5) were detected. Modified Rankin scale (mRS) was evaluated as 4. Conclusions: The neurological complication rate of up to 80% during and in the days following the procedure, the long recovery period after embolism, the possibility of being a nursing patient and even the risk of death, remind us that the TAVI procedure and the sedation given during the procedure should never be underestimated. Keywords: Transcatheter aortic valve implantation, cerebral embolism, complications, neuroradiology, monitorized anaesthesia care, aort stenosis.

Ischemia-mediated ventricular rupture is a rarely encountered process in the era of early percutaneous revascularization. Contained rupture, or pseudoaneurysm often occurs as a result of pericardial adhesions. Even more uncommon is the presence of associated infection involving the rupture. We present the case of a patient with an infected intrapericardial thrombus in the setting of a left ventricular free wall rupture who underwent successful repair.

The mirid bugs Stenotus rubrovittatus and Trigonotylus caelestialium, which cause pecky rice, have become a threat to rice cultivation in Asia. Damage caused by these pests has rapidly become frequent since around 2000 in Japan. Their expansion pattern is not simple, making it difficult to manage them by prediction. Some insects with wide distributions have locally adapted variations in life-history traits. We performed laboratory rearing experiments to assess the geographical scale of intraspecific variations in life-history traits of S. rubrovittatus and T. caelestialium. These were aimed at increasing the accuracy of occurrence estimates and the number of generations per year. These results were compared with previous research, and differences in development rates were observed between populations of different latitudes, but not of the same latitude. Finally, plotting the timing of adult emergence and the potential number of generations per year on maps with a 5-km grid revealed that they differed greatly locally at the same latitude. These maps can be used for developing more efficient methods of managing mirid bugs in integrated pest management.

An adult male with alcoholic cirrhosis presented with acute blood loss anemia, hypotension and a painful bruise over his body's left side. He denied any trauma or falls. Computed tomography of the chest showed left chest wall hematoma. Emergent angiography with successful embolization of the left intercostal artery was performed.

The molecular basis of phenotypic convergence, a key topic in evolutionary biology and ecology, has been investigated especially between species. However, it remains unclear whether mutations in the same or different positions of the same gene, or in different genes underlie phenotypic convergence within species. A classic example of convergence is the transition from outcrossing to selfing in plants, illustrated by the repeated shift from heterostyly to homostyly. Heterostyly is characterized by the reciprocal position of male and female sexual organs in two (or three) distinct, incompatible floral morphs, while homostyly is characterized by a single, self-compatible floral morph. Primula has long served as the prime model for studies of heterostyly and homostyly. Here, we elucidate the phenotypic and molecular origins of homostyly in P. vulgaris and its microevolutionary consequences by integrating microsatellite analyses of both progeny arrays and natural populations characterized by varying frequencies of homostyles with DNA sequence analyses of the gene controlling the position of female sexual organs (CYPᵀ). We found that: homostyles evolved repeatedly from short-styled individuals in association with different types of loss-of-function mutations in CYPᵀ and, consequently, short-styled individuals occur at lower frequencies than long-styled individuals across populations with all three morphs; the shift to homostyly promotes a shift to selfing; and intra-population frequency of homostyles is positively correlated with selfing rate and inbreeding level, increasing genetic differentiation among populations. These results elucidate the connections between the genotypic and phenotypic levels of convergence and the effects of contrasting floral morphologies on reproductive strategies.

First described in 1965 by Johnson and Wilcox, partial absence of the tricuspid valve (TV) associated with a ventricular septal defect(VSD) is a very rare malformation.(1) Heart failure secondary to severe TV regurgitation results in-utero fetal compromise. (2) We present here a fetus with partial absence of the tricuspid valve with conoventricular septal defect.