Brucellosis is a zoonotic disease with high prevalence in the Middle Eastern countries. Psoas abscess is a rare complication of Brucellosis. A combination of antibiotic therapy and drainage is the recommended management. We present a 14-year-old male patient with this complication. He was treated with oral antibiotic without drainage.

Through crosstalk, FLAGELLIN SENSITIVE 2 (FLS2) and RESPIRATORY BURST OXIDASE HOMOLOG D (RBOHD) are involved in regulating the homeostasis of cellular reactive oxygen species (ROS) and are linked to the metabolic response of plants towards both biotic and abiotic stress. In the present study, we examined the metabolome of Arabidopsis seedlings under drought and salt conditions to better understand the potential role of FLS2 and RBOHD-dependent signaling in the regulation of abiotic stress response. We identified common metabolites and genes that are regulated by FLS2 and RBOHD, and are involved in the response to drought and salt stress. Under drought conditions, D-aspartic acid (DAA) and the expression of associated genes, such as ASPARAGINE SYNTHASE 2 ( ASN2), increased in both fls2 and robed/f double mutants. The accumulation of amino acids, carbohydrates, and hormones, such as L-proline, D-ribose, and indoleacetaldehyde increased in both fls2 and rbohd/f double mutants under salt conditions, as did the expression of related genes, such as PROLINE IMINOPEPTIDASE ( PIP), PHOSPHORIBOSYL PYROPHOSPHATE SYNTHASE 5 ( PRS5), and NITRILASE 3 ( NIT3). Collectively, these results indicate that the FLS2-RBOHD module regulates plant response to drought and salt stress through ROS signaling by adjusting the accumulation of metabolites and expression of genes related to metabolite synthesis.

Recombinant adeno-associated virus (rAAV) has established itself as a highly efficacious gene delivery vector with a well characterised safety profile allowing broad clinical application. Recent successes in rAAV-mediated gene therapy clinical trials will continue to drive demand for improved rAAV production processes to reduce costs. Here we demonstrate that small molecule bioactive chemical additives can significantly increase recombinant AAV vector production by HEK cells up to 3-fold. Nocodazole (an anti-mitotic agent) and M344 (a selective histone deacetylase inhibitor) were identified as positive regulators of rAAV8 genome titre in a microplate screening assay. Addition of nocodazole to triple-transfected HEK293 suspension cells producing rAAV arrested cells in G2/M phase, increased average cell volume, and reduced viable cell density relative to untreated rAAV producing cells at harvest.. Final crude genome vector titre from nocodazole treated cultures was >2-fold higher compared to non-treated cultures.. Further investigation showed nocodazole addition to cultures to be time critical.Genome titre improvement was found to be scalable and serotype independent across two distinct rAAV serotypes, rAAV8 and rAAV9. Furthermore, a combination of M344 and nocodazole produced a positive additive effect on rAAV8 genome titre, resulting in a 3-fold increase in genome titre compared to untreated cells.

Cross-sectional imaging approaches expect a key part in assessing depleting mind wounds. Experts regularly choose depleting size and reality in CT and MRI. Separating and recognizing relics is basic in dealing with clinical pictures. Picture and sign taking care of are used to describe tissues inside pictures solidly associated with edges. In CT pictures, a close to home cycle takes a stroke 's manual structure with less precision. This segment presents the utilization of both picture and sign taking care of strategies in the depiction of Brain Stroke field. This part moreover summarizes how to depict the brain stroke using different picture dealing with computations, for instance, ROI based division and watershed procedures.

IntroductionReal world Time on Treatment (rwToT), also known as real world time to treatment discontinuation (rwTTD), is defined as the length of time observed in real world data (as distinct from controlled clinical trials) from initiation of a medication to discontinuation of that medication1,2. The ending of the treatment can be caused by adverse events, deaths, switches of treatment and loss of follow up. Because time to treatment discontinuation can be readily obtained from electronic medical records, this effectiveness endpoint is convenient to evaluate the efficacy of a drug that is already approved for public use3. It is often used as a surrogate effectiveness endpoint, showing high correlation to progression-free survival and moderate-to-high correlation to overall survival4,5. As rwTTD is an important metric for drug effectiveness, it is routinely reported during the post-clinical trial phase2,4,6–9.Calculation of rwTTD in patient population is often equivalent to constructing a (Kaplan-Meier) KM curve, with each point representing the proportion of patients that are still on treatment at a specific time point 1. Either the entire curve, or mean rwTTD, restricted mean10, or the time point at which a specific portion of the patients (e.g. , 50%) dropping treatment is of interest. Currently, there is no existing machine learning scheme established to predict such a curve, or the midpoint, as the vast majority of the machine learning models have been focused on predicting individuals’ behavior rather than population-level behavior. Such a machine learning scheme, if established, has many meaningful clinical applications. For instance, given observed clinical parameters and outcomes in clinical trials, how do we derive expected time-to-treatment in the real-world? Given the rwTTD for a drug on one patient population, how can we predict the rwTTD when applying this drug to another population (e.g. , for a different disease)?This study establishes a machine learning framework to infer population-wise rwTTD. We showed that population-wise curve prediction differs substantially from aggregating all individuals’ results. Our framework models the population-wise curve and is generic to diverse base-learners for predicting rwTTD. We demonstrated the effectiveness of this framework based on both simulated data and real world Electronic medical records (EMR) data for pembrolizumab-treated cancer populations7,11,12. The study opens a new direction of modeling population-level rwTTD, which has great values for directing post-clinical stage drug administrations. This machine learning scheme will also have meaningful implications to population-based predictions for other problems, as machine learning algorithms have so far been focused on predictions for individual samples.

Ba0.5Sr0.5Co0.8Fe0.2O3-δ (BSCF) membrane can be very effective in hydrogen production from high-temperature water splitting by the in-situ permeation of oxygen through the membrane. However, the BSCF membrane cannot initiate the water splitting reaction at moderate temperature (750-950oC); hence a catalyst is required. Herein, we have developed and evaluated a new BaCexFe1-xO3-δ catalyst. The concentration of cerium was varied to determine its effect on the cubic structure. XRD results confirmed the cubic structure was maintained up to 20 mol% of cerium. The BaCe0.2Fe0.8O3-δ powder was coated as a catalyst on the BSCF membrane and evaluated for hydrogen production in a water-splitting membrane reactor. The obtained results revealed that hydrogen production rate increases with increasing temperature, methane concentration in the sweep gas, and water concentration in the feed gas. The highest hydrogen production rate (0.38μmol/cm2s) was obtained at 925oC using 15% CH4 in the sweep and 55% H2O in the feed.

Due to its toxicity and corrosiveness, it is of enormous significance to efficiently capture and recover sulfur dioxide (SO2) from flue gas and natural gas. Herein, a new type of IL/MIL-0.7 composite was precisely designed to meet this challenge, which exhibits a high adsorption capacity for SO2 (13.17 mmol·g-1) at 298 K and 1 bar while excludes almost completely carbon dioxide (CO2) (0.27 mmol·g-1) and nitrogen (N2) (0.07 mmol·g-1). The high IAST selectivity (at least 11925) of IL/MIL-0.7 for SO2/CO2 can be achieved within the whole test pressure range. In addition, the breakthrough experiment also confirmed the excellent performance of the composite for deep removal of 2000 ppm SO2. Furthermore, the IL/MIL-0.7 composites can maintain excellent performance after four adsorption and desorption circulations and the thermostability can up to ~450 K. Therefore, this stable IL@MOF composite has the potential application as an effective adsorbent for SO2 removal from flue gas.

A document by Nicola Curry. Click on the document to view its contents.

Background: Cervical cancer affects 3,197 women in the UK, and 604000 women worldwide annually, with peak incidence seen between 30-34 years of age. For many, fertility-sparing surgery is an appealing option where possible. However, absence of large-scale data, along with a notable variation in reported outcomes in relevant studies may undermine future efforts for consistent evidence synthesis. Objectives: To systematically review the reported outcomes measured in studies that include women who underwent fertility-sparing surgery for cervical cancer and identify whether variation exists. Search Strategy: We searched MEDLINE, EMBASE, and CENTRAL from inception to February 2019. Selection Criteria: Randomised controlled trials, cohort and observational studies, and case studies of more than 10 participants from January 1990 to date. Data Collection and Analysis: Study characteristics and all reported treatment outcomes. Main results: 104 studies with a sum of 9535 participants were identified. Most studies reported on oncological outcomes (97/104), followed by fertility and pregnancy (86/104), post-operative complications (74/104), intra-operative complications (72/104), and quality of life (5). There were huge variation and heterogeneity in reported outcomes, with only 12% being good quality and 87% being of poor quality. Conclusions: There is significant heterogeneity in the reported outcomes. An agreed Core Outcome Set (COS) is necessary for future studies to effectively harmonise reported outcomes that are measurable and relevant to patients, clinicians, and researchers. This systematic review sets the groundwork for the development of a COS for fertility sparing surgery in cervical cancer. Funding: British Medical Association’s Strutt and Harper Grant.

Purpose: Anti-seizure medications (ASMs) are associated with a variety of adverse events (AEs) that have a significant detrimental impact on quality of life and treatment adherence. The aim of the study was to identify and quantify the AEs of ASMs in persons with epilepsy (PWE) using Liverpool Adverse Events Profile (LAEP), and to determine the feasibility of LAEP for predicting depression in PWE. Methods: After ethical clearance, 309 PWE above 18 years of age, on ASMs, attending epilepsy clinic in neurology outpatient department of All India Institute of Medical Sciences, New Delhi, India, were recruited and evaluated for depression using different assessment tools, and LAEP screening tool was used for adverse event profiling. Results: The mean LAEP scores in PWE were 28.2±6.2 and ranged from 19 to 49. Only 16 PWE had LAEP score ≥45 i.e. had high toxicity. Phenytoin had the highest LEAP score, followed by carbamazepine, levetiracetam, and sodium valproate. As compared to monotherapy, PWE on polytherapy had higher LAEP score (26.7±5.9 vs. 29.03±6.3; p=0.0013). Subjects positive for depression had significantly higher LAEP score than PWE without depression (33.5±6.2 vs. 24.7±3.1; p<0.0001). A strong positive correlation of the LAEP score was observed with depression scores as assessed by different assessment tools, and a LAEP score of ≥28 was recommended to screen PWE for depression. Conclusion: The systematic use of LAEP in epilepsy outpatient settings will allow for better detection and management of ASM’s adverse effects, as well as the identification of PWE at risk of depression.

The Three-Rivers Headwaters Region (TRHR) is crucial to the sustainable development of China and Southeast Asian countries. For various reasons, the sustainability of grassland ecosystems in the region has been seriously challenged. This paper reviews remote sensing-based monitoring and simulation of TRHR grassland ecosystems; quantitative assessment of grassland degradation and its ecological effects; driving factors and mechanisms of grassland degradation; grassland conservation policies and restoration for degraded grassland. The review shows that although TRHR alpine grassland coverage and above-ground biomass of alpine grassland (AG-AGB) have generally increased over the past 30 years, the degradation has not been fundamentally curbed. Grassland degradation significantly reduced the surface soil nutrients and affected their distribution, and also aggravated soil erosion and deteriorated soil moisture conditions. Grassland degradation leads to loss of productivity and species diversity. Its adverse impact on production will reduce the well-being of pastoralists. The “warm and wet” trend of the TRHR climate promotes the restoration of alpine grasslands, but the widespread overgrazing is considered to be the main reason for grassland degradation. However, the two have very complex impacts on grassland, and further research is needed. Since 2000, the TRHR grassland restoration policy has achieved great results, but the formulation of the policy still needs to effectively integrate the market logic and strengthen the understanding of the relationship between ecological protection and cultural protection. In addition, appropriate human intervention mechanisms are urgently needed for the uncertainty of future climate change. It is recommended to implement technologies such as rodent control, light grazing, enclosure, weeding, and fertilization to restore slightly and moderately degraded grasslands. However, for the severely degraded “black soil beach”, it needs to be restored by artificial seeding, and the stability of the plant-soil system needs to be emphasized to establish a relatively stable community to prevent secondary degradation.

Sometimes when there are some restrictions on the random variables of insurance risk model, it is impossible to calculate the exact value of ruin probabilities. For these cases, even finding a suitable approximation, is very important from a practical point of view. In the present paper, we consider the classical insurance surplus model with light tailed claim amount distributions and try to find some inequalities and optimal estimation on the infinite time ruin probability depending on the amount of initial reserve when the assumption of net profit does not hold but there exist some other restrictions on the mathematical functions of random variables of model. The obtained assertions depend on the amount of initial reserve, distribution of nonnegative claim amounts and claim inter-arrival times. Finally, to show the application and effectiveness of results some examples are presented.

Blue-green spaces composed of water and green spaces have certain ecological, economic, and social benefits for urban development. Many evaluation index systems have been developed to evaluate the health status of urban ecosystems. However, in these evaluation index systems, blue and green spaces are separately evaluated without considering the synergistic effect between water and green spaces in the ecosystem, thus affecting the unified planning and construction of cities. Therefore, based on existing studies, the development process of the blue-green space evaluation index system is divided into three stages: supply service evaluation stage, adjustment service evaluation stage, and cultural service evaluation stage in order to deeply discuss the development path of the blue-green space evaluation index system. The single blue and green evaluation index systems are compared from the perspectives of index selection and evaluation content. Moreover, the characteristics of conventional evaluation methods are discussed in order to propose an applicable evaluation index system and evaluation method of blue-green spaces for evaluating the degree of blue-green integration of cities. The review provides the basis for urban planning and ecological restoration.

Introduction: Recently, a novel non-thermal ablation modality, Pulse Field Ablation (PFA), has been introduced in clinical practice. Case report: Because there were multiple recurrences of ischemic stroke despite adequate anticoagulant therapy , a 64-year-old male was admitted to AF PFA and concomitant left atrial appendage (LAA) closure. An intense smoke effect was detected in the LAA and a cerebral protection device (CPD) was positioned. Catheter AF PFA and LAA closure were performed. One little thrombus had been collected into the CPD at the end of procedure. Conclusion: Combined procedure seems to be safe and feasible.

Background: As transcatheter aortic valve replacement (TAVR) procedures become more widely available, there is a growing need to monitor and evaluate postoperative outcomes accurately. The energy loss index (ELI) of the ascending aorta has been commonly used to examine the agreement between the echocardiographic and Gorlin measurement of the aortic valve area. Objectives: This project aims to demonstrate a link between ELI values and mortality following implanted TAVR valves and determine an ELI cutoff value associated with post-TAVR events. Method: We retrospectively reviewed patients undergoing TAVR from 2012 – 2017. We calculated ELI values for patients immediately postoperative after a TAVR procedure. Using Receiver-Operator Characteristic and Cox Regression analyses, we identified a cutoff value to distinguish between high and low-risk patients. Results: This study showed ELI ≤ 1.34 (hazard ratio, 1.783; 95% confidence interval 1.231-2.583, p=0.002) as representative of patients with a high risk of mortality post-TAVR. Additionally, post-TAVR, ejection fraction increased by 3.5 percent (p<0.001), and the aortic valve effective orifice area increased by 1.25 cm squared (p<0.001) while the mean transvalvular gradient decreased by 33.6 mmHg (p<0.001) and the peak transvalvular gradient decreased by 49.7 mmHg (p<0.001). Conclusion: ELI is an additional prognostic factor that should be considered during risk assessment before TAVR. This study shows that patients with ELI ≤ 1.34 had decreased cumulative survival post-TAVR. These patients had a fivefold increased risk of death following TAVR.

INTRODUCTION

Pediatric thyroid cancer is rare in children, however incidence is increasing. Papillary thyroid cancer and follicular thyroid cancer are the most common subtypes, comprising about 90% and 10% of cases respectively. This manuscript provides consensus imaging recommendations for evaluation of pediatric patients with thyroid cancer at diagnosis and during follow-up.

Angioimmunoblastic T-cell lymphoma (AITL) is an uncommon subtype of Peripheral T-cell lymphomas (PTCLs) in children with less than 20 cases reported in the literature. In this paper, we present a case of AITL in a three years old male with Ataxia-Telangiectasia which regressed spontaneously without any therapy. A comprehensive review of the literature regarding treatment and outcome of pediatric patients with AITL has been also discussed in this article.

A document by Yalda Abrishami. Click on the document to view its contents.

Dams alter many aspects of riverine environments and can have broad effects on aquatic organisms and habitats both upstream and downstream. While dams and the associated reservoirs can provide many services to people (hydropower, recreation, flood control, navigation, etc.), they can negatively affect riverine ecosystems. In particular, hydropeaking dams affect downstream fish habitats by increasing variability in discharge and temperature. To assess the effects of Harris Dam on the Tallapoosa River, AL, operating under an adaptive management plan implemented in 2005, we sampled fish for community and diet analyses from four sites on the river: three in the regulated region downstream of the dam, and one unregulated site upstream. Fish were collected every other month using boat/barge electrofishing. We used Shannon’s H, nonmetric multidimensional scaling (NMDS), a multiresponse permutation procedure (MRPP), and indicator species analysis to quantify patterns in fish assemblage structure and determine how assemblages varied among sites. NMDS and MRPP indicated significant fish assemblage differences among sites with the tailrace fish assemblage being distinct from the other downstream sites, and sites becoming more similar to the upstream, unregulated site (relative to fish assemblages) with distance downstream of the tailrace. The tailrace fish assemblage included higher proportions of rheophilic species that may be better suited for variable and/or high flows. Altered fish assemblages demonstrated continued effects of Harris Dam on the downstream aquatic systems, particularly close to the dam. These effects may indicate further mitigation should be considered depending on conservation and management goals.

Purpose: Acute type A aortic dissection (ATAAD) is a dissection involving the ascending aorta within 14 days of symptom onset. Acute myocardial ischemia is associated with short-term mortality in patients with ATAAD. However, its relevance to ATAAD’s surgical timing and prognostic implications is unknown. Methods: This retrospective study enrolled 277 patients at our tertiary center between March 1997 and January 2019 and investigated their admission electrocardiograms. Twenty-one patients with left ventricular hypertrophy or left bundle branch block were excluded, and the records of 256 patients eventually underwent data collection, review, and multivariate analysis. Results: In patients with acute myocardial ischemia, the incidence of aortic root involvement, acute coronary involvement, and preoperative stroke was significantly higher. Acute myocardial ischemia was unassociated with 30-day or in-hospital mortality in patients who underwent surgery within 7 h of symptom onset. However, it was independently associated with the 30-day mortality and postoperative stroke when the 7-hour window had elapsed. Conclusions: As a time-dependent surgical prognosticator in ATAAD, acute myocardial ischemia was unassociated with short-term mortality in patients surgically operated within 7 h of symptom onset. Conversely, it was an independent factor for the 30-day mortality and postoperative stroke when the 7-hour window had elapsed.

Objective Functional tricuspid regurgitation(FTR) levels can vary over time and its longitudinal changing patterns may predict right ventricular dysfunction(RVD) risk. We aim to identify different trajectories of FTR in those who received mitral valve replacement(MVR) and investigate the association between longitudinal trajectory groups and RVD risk in a cohort study. Methods and results A prospective cohort study, reported usual FTR levels at baseline in 2005–2015 and the participants of MVR have been followed up for 5~6 years, approximately every one years, and so far, the data have been collected across five subsequent phases. Five-year longitudinal trajectories of FTR were identified using group-based trajectory modelling(GBTM). We identified 3 distinct trajectories using a GBTM, labeled by initial value and changing pattern: stable group(258/378, 68.2%), increasing-slow group(67/378, 17.6%) and increasing-fast group(53/378, 14.2%). Treating the stable group as the reference, the age- and sex-adjusted odds ratio(OR) was 25.84 (95% confidence interval, 11.78-56.65) for the increasing-slow group and 139.94(95% confidence interval, 45.47-430.68) for the increasing-fast group by logistic regression model. After adjustment for every potential confounding factors, the OR is 14.21(95% confidence interval, 4.36-46.33)、49.34(95% confidence interval, 8.88-273.87) respectively. Conclusions The longitudinal trajectories of worsening FTR were mostly associated with increased risk of RVD outcomes, which is independent of other factors including FTR levels. These findings have implications for intervention and prevention of RVD among individuals who received MVR.

Our study shows a possible link between OCD and catatonia. Studies are needed in order to determine the pathophysiology of catatonia and the mechanism of ECT so that more beneficial therapeutics can be developed. A combination of ECT and antidepressants with ERP therapy for recurrent catatonia with OCD has efficacy

Lignocellulose is the most abundant natural biopolymer on earth and a potential raw material for the production of fuels and chemicals. However, only some organisms such as bacteria and fungi produce the necessary enzymes to metabolize it. In this work we detected the presence of extracellular cellulases in the genome of five species of Scenedesmus. These microalgae grow in both, freshwater and saltwater regions as well as in soils, displaying highly flexible metabolic properties. The comparison of sequences of the different cellulases with hydrolytic enzymes from other organisms by means of multi-sequence alignments and phylogenetic trees showed that these enzymes belong to the families of glycosyl hydrolases 1, 5, 9 and 10. In addition, most of these presented a greater similarity of sequence with enzymes from invertebrates, fungi, bacteria and other microalgae than with cellulases from plants; and the 3D modeling data obtained showed that both the main structures of the modeled proteins and the main amino acid residues implicated in catalysis and substrate binding are well conserved in Scenedesmus enzymes. We propose that these cellulase-producing phototrophic microorganisms could act as catalysts for the hydrolysis of cellulosic biomass fueled by sunlight.