Background: Whether Lung ultrasound (LUS) can be used for pathogenic diagnosis is still controversial. This was conducted to test the accuracy and reliability of ultrasound in the diagnosis of pneumonia and to clarify whether ultrasound has diagnostic value for the etiology. Methods: A total of 135 neonatal pneumonia patients with an identified pathogen and 50 newborns with normal lungs in the newborn intensive care unit of 10 tertiary hospitals in China were enrolled. The study ran from November 2020 to December 2021. The infants were divided into various groups according to pathogens, the time of infection, the gestational age, the severity of the disease. The distribution of pleural line abnormalities, pulmonary edema, and pulmonary consolidation, as well as the incidence of air bronchogram and pleural effusion based on LUS, were compared between the above groups and between the pneumonia and healthy control groups. Results: There were significant differences in pulmonary consolidation. The sensitivity and specificity of the diagnosis of severe pneumonia based on the extent of pulmonary consolidation were 83.3% and 85.2%, respectively. The area under the receiver operating characteristic curve for the identification of mild or severe pneumonia based on the distribution of pulmonary consolidation was 0.776. Conclusion: Lung ultrasound has good performance in differentiating the severity of neonatal pneumonia, but cannot be used for pathogenic diagnosis.

A document by Hanshuo Zhang. Click on the document to view its contents.

Introduction Previous generations of CFTR modulation have been shown to temporarily decrease the frequency of culture positivity of P. aeruginosa and other respiratory pathogens. Recently, a three-drug combination Trikafta (elexacaftor/ivacaftor/tezacaftor) was approved for individuals with at least one F508del mutation. There is limited data on the effect of CFTR modulators on bacterial density and CF microbiome. Methods Our study included 2 separate forms of data collection: Firstly, a retrospective chart evaluation of routine respiratory cultures 1.5 years before and after initiation of Trikafta. Respiratory culture density was recorded based upon the growth fraction of standard respiratory plate: none (0/4), scant (1/4), light (2/4), moderate (3/4), and large (4/4). The second data measurement included obtaining next-generation sequencing (NGS) for bacterial and fungal abundance of post-Trikafta initiation patients only. Results There was a significant density decrease in P. aeruginosa (1.5 vs 1.19, p= 0.01), S. aureus (2.47 vs 1.9, p= 0.002), A. denitrificans (1.39 vs,1.14, p=0.02), E. coli (1.09 vs 1.00, p=0.045) before and after initiation of Trikafta. On the NGS the 5 most abundant bacteria after Trikafta initiation were : S. salivarius, S. parasanguinis, R. mucilaginosa, V. atypica, and P. histocola. Conclusion Our study results demonstrate that there is a significant decrease in the density of known CF pathogenic bacteria. NGS post-Trikafta has shown abundance of anaerobic bacteria ( S. salivarius, S. parasanguinis, R. mucilaginosa, V. atypica, and P. histocola) that have been linked to improved clinical lung stability, lower airway inflammation and increased polymicrobial diversity.

The authors herewith present a case of a non-conventional use of endotracheal tube-based IONM in a second-stage total thyroidectomy for metastatic papillary cancer incidentally detected after OPHL Type IIa + ary left for SCC. The use of the IONM in such case was effective avoiding the RLN accidental injury.

Extensive ecological projects, including terracing engineering and vegetation rehabilitation, have been implemented in many water-limited mountains across the world, aiming to combat drought and control water erosion. Nevertheless, due to the complexities of climate, terracing, and vegetation types in actuality, knowledge gaps regarding the role of terracing on water balance remain. Therefore, to better understand the influence of terraces on water budget in a normal (2015) year and dry (2016) year, a field experiment was conducted in a typical dry loess hilly area of China. The effects of adverse grade tableland terraces, fish-scale pits and the natural slope on water content change were analyzed on the slope of Platycladus orientalis by the water-balance technique and equations. The results showed that, compared with natural slope, terraces had higher water budget benefits both in dry year (+ 1.08~12.24 mm) and normal water year (+ 15.71~27.29 mm), and adverse grade tableland terrace had the best performance. Although precipitation was the primary factor affecting water inputs, terraces can significantly increase soil water content. Evapotranspiration and runoff were the main water loss terms, but terrace also can help to reduce runoff water loss. Overall, transformation of terraced fields can optimize the forest structure and improve the eco-benefits at the slope scale.

In order to explore the possibility of C2HF3Cl2 (R123) for the fire extinguishing agent of aircraft cargo compartment, this paper conducted experimental and theoretical research on the fire extinguishing performance and mechanism of R123, furthermore, the analogous C2HF5 (R125) was compared to explore the in-depth fire extinguishing mechanism. The minimum extinguishing concentration (MEC) of R123 in methane/air flames is 7.31 %, which is lower than 8.91 % of R125. And the experimental results reveal interesting examples of flame height and temperature changed with the addition of R123. The flame height had a phenomenon to increase first and then decrease, in comparison, the flame height kept rising with R125 adding. And the change in height reflected the addition of R123 to affect the movement of the reaction kernel, so that the temperature at different heights changed, but the temperature as a whole showed the tendence of decreasing. In addition, theoretical calculations indicated that R123 and pyrolysis products could affect the combustion reaction, such as CF3CHCl2+H=CF3CHCl+HCl, HCl + OH = Cl + H2O, CF3CH2Cl=CF3+CH2Cl, these fluorine-containing or chlorine-containing groups generated had an excellent effect on the suppression of combustion chain reactions. The in-depth experimental and theoretical study of R123 boost the development of ideal halon replacement in aircraft cargo compartment.

A new PES-C/emodin ultrafiltration membrane was prepared by blending natural emodin with phenolphthalein polyethersulfone (PES-C), and it was used to purify [acanthopanax](javascript:;) [senticosus](javascript:;) injection in this study. For the purified [acanthopanax](javascript:;) [senticosus](javascript:;) injection, its color became lighter and its clarity increased. On the contrary, for [acanthopanax](javascript:;) [senticosus](javascript:;) injection containing macromolecules, its color deepened and its turbidity increased. Thermal stability of the purified [acanthopanax](javascript:;) [senticosus](javascript:;) injection was the best, followed by the original solution of [acanthopanax](javascript:;) [senticosus](javascript:;) injection, and [acanthopanax](javascript:;) [senticosus](javascript:;) injection containing macromolecules was the worst. The finger-print spectrum of the purified [acanthopanax](javascript:;) [senticosus](javascript:;) injection was similar with the original solution of [acanthopanax](javascript:;) [senticosus](javascript:;) injection, the relative peak area of each single peak was greater than 0.95, and the relative peak area of the total peak was greater than 0.96. Compared with the original solution of [acanthopanax](javascript:;) [senticosus](javascript:;) injection, the histamine release amount and cell degranulation rate of [acanthopanax](javascript:;) [senticosus](javascript:;) injection containing macromolecules increased more, while those of the purified [acanthopanax](javascript:;) [senticosus](javascript:;) injection decreased, which reduced the risk of allergic reaction at a certain extent. “Inverse proof” confirmed that the [acanthopanax](javascript:;) [senticosus](javascript:;) injection containing macromolecules had certain liver and kidney toxicity, which indirectly proved that the liver and kidney toxicity of the purified [acanthopanax](javascript:;) [senticosus](javascript:;) injection was effectively reduced.

A 48-year-old woman was diagnosed with right-sided Grade 2 invasive breast carcinoma. Prior to initiation of chemotherapy, transthoracic echocardiogram (TTE) demonstrated normal systolic function with left ventricular ejection fraction (LVEF) 64% and global longitudinal strain (GLS) 21%. Following adjuvant chemotherapy with four cycles of anthracycline, twelve cycles of Paclitaxel, and two cycles of Trastuzamab chemotherapies, TTE demonstrated reduction in LVEF to 56% and GLS of -18% (14% relative reduction compared to baseline). Further investigation revealed recent symptomatic COVID-19 infection coinciding with functional impairment and decision was made to continue Trastuzumab therapy without cardioprotective agents. Subsequent TTE demonstrated improved systolic function, indicating the importance of taking history of significant viral infections during chemotherapy standard of care.

A common approach to assess the efficacy of piperacillin is to firstly measure the total concentration, and to afterwards apply a theoretical unbound fraction of 70% to obtain the unbound concentration. However, hypoalbuminemia is a common phenomenon in critically ill patients, resulting in variations in unbound fraction. Therefore, we aimed to simulate the impact of piperacillin unbound fraction fluctuations on the predictive performance of a population pharmacokinetic model and on dosing recommendations of piperacillin. Unbound factors of 70, 75, 80 and 85% were applied to total concentrations of piperacillin administered by continuous infusion from an external dataset. A validated model was used for assessment of predictive performance and to estimate patient clearance. Dosing simulations were performed to evaluate target attainment. Variation in unbound fraction caused minimal impact on piperacillin clearance and target attainment but revealed to influence model evaluation.

The management of Borderline Personality Disorder (BPD) is limited to psychological intervention along with pharmacotherapy. It is now evident that chronodegeneration is one of clinical phenotype in BPD individuals, therefore, the use of chronotherapeutics in BPD is developing day by day. Therefore, we assess the chronotherapeutics either individually or in combination with conventional therapeutic interventions to conclude the best possible therapy for improvement of the BPD symptomatology. A systematic electronic literature search of PubMed, Google Scholar, Cochrane Central Register of Control Trials, Clinical Trials Registry (ClinicalTrials.gov), APA PsycNET and BMJ evidence-Based Medicine was conducted between 2000-2022. In these data bases, search terms describing borderline personality disorder, and circadian rhythm restoration were combined with the term of treatment. From five selected studies, there are three types of chronotherapeutic interventions that were practiced, as bright light therapy, physical exercise and triple chronotherapy. Our included 4 out of 5 studies concluded chronotherapy as a successful adjunctive therapy with pharmacotherapy and/or psychotherapy in amelioration of BPD traits especially depression (Mean Hamilton depression rating scale score decreases from 19.5 to 7.2) and suicidal ideation (Mean Columbia suicide severity rating scale score decreases from 19.5 to 7.2). One of our selected study on physical exercise proved no significant effect on BPD when compared with control group. According to our explored literature, chronotherapy particularly bright light therapy might be a safe and effective addition to conventional therapeutic interventions. It is principally effective for patients in which depression is present as a co-morbidity or as a sign of BPD.

I read with interest the article by Vendramin and colleagues , reminding us with the 70th anniversary for the first artificial heart valve that was invented by Hufnagel and was first implanted in 1952. This was in an era, where standard heart valve replacement was not feasible, and the heart lung machine was in its very primitive phase to allow such operation to be performed in the way we do it today. This made me dig a bit in the literature and read more in depth about Dr. Hufnagel, one of the most gifted American surgeons and his pioneer work.

Pollution caused by heavy metals in soils and ecosystems is an environmental problematic that requires urgent attention due to the ecological problems that it generates. Forest species can be used to mitigate contamination because of their potential to bioaccumulate contaminating metals. Hence, the aim of this research was to identify tree species with good heavy metal bioaccumulating capacities that can contribute to mitigate pollution. The bioconcentration factor for five forest species, such as: Spanish cedar ( Cedrela odorata L.), cutanga ( Parkia multijuga Benth.), guaba or ice cream bean ( Inga edulis Mart.), guarumo ( Cecropia ficifolia Warb. ex Snethl.) and Amazon tree grape ( Pourouma cecropiifolia Mart.), commonly found in the Ecuadorian Amazon was analysed, based on the relationship between the leaves and soil concentration of the heavy metals. For heavy metal analysis in leaves and soil samples of each plant species, atomic absorption spectrometry was used. The results showed that P. cecropiifolia had the highest bioconcentration factor for lead, C. odorata for cadmium and nickel, and I. edulis had the highest potential for iron and aluminium absorption. Any kind of correlation between the concentration of each element in soil and leaves was found, which shows that the bioaccumulation capacity of the species studied does not determine the concentration of metals in the soil.

Title pageTitle : Letter to the Editor: Long-term results of aortic root replacement for endocarditisArticle type : Letter to the editor

Spontaneous Intramural left atrial hematoma that mimics a primary or metastatic cardiac tumor is a very rare entity. We report a case of a 60-year-old man suffering from chronic myeloid leukemia, who was admitted for prolonged chest pain and fatigue. Transthoracic echocardiography revealed a left atrial mass in close proximity to the posterior mitral annulus and failed to provide an ethiological diagnosis. Surgical management was utilized to outrule the atrial neoplasm and to prevent emboli, obstruction and mitral valve insufficiency. This is the first case in the literature in which robot-assisted minimally invasive surgery was adopted to manage such a rare entity.

Latitudinal body size-clines are primarily discussed in the context of thermoregulation, sensu Bergmann. However, body size patterns are ambiguous in ectotherms and this heterogeneity remains poorly understood. We hypothesised that the contrasting effects of thermoregulation and resource constraints obscure latitude–size relationships. Using data for 43% of all odonate species, we tested whether body size increases with decreasing temperature and increasing productivity in phylogenetically and spatially comparative analyses. We found strong but contrasting effects for temperature between Anisoptera and Zygoptera and consistent positive effects for productivity that explained 35%–57% of body size variation. We concluded that temperature, productivity, and conservatism in size-based thermoregulation synergistically determine the distribution of ectotherms, while the taxon-specific importance of these factors can lead to contrasting results and weak latitude–size relationships. Our results reinforce the importance of body size as a determinant of species distributions and responses to climate change.

Introduction: The InPOG-HL-15-01, a multi-centric prospective study used a risk-stratified and response-based approach with a doxorubicin, bleomycin, vinblastine and dacarbazine (ABVD) backbone to treat children with newly diagnosed Hodgkin Lymphoma (HL) and reduce the use of radiation therapy (RT). Children/adolescents with bulky disease or inadequate response at early response assessment (ERA) after 2 cycles of chemotherapy were assigned to receive RT. For ERA, positron emission tomography computed tomography (PET-CT) was recommended but not mandatory in view of limited access. This study aimed to compare the impact of using contrast enhanced computed tomography (CECT) vs PET-CT on treatment decisions and outcomes. Methodology: 396 patients were enrolled and 382 had an ERA at the assigned time point. Results: At ERA, satisfactory response was documented in 277/382 (72.5%) participants and this was significantly higher in PET-CT (151/186, 81.2%) as compared to CECT (126/196, 64.3%) respectively (p value<0.001). Amongst the 203 patients with non-bulky disease (wherein the indication for RT was entirely dependent on ERA), 96/114 (84.2%) and 61/89 (68.5%) patients achieved a satisfactory response according to the PET-CT and CECT (p value=0.008) respectively and hence a lesser proportion of patients in the PET-CT arm received RT. Despite a lower usage of RT the 5 year overall survival (OS) of both groups- ERA based on CECT (91.8%) vs PET-CT (94.1%) was comparable (p value=0.391) and so was the 5 year event free survival (EFS) (86.7 vs 85.5%, p value=0.724). Conclusion: Use of PET-CT as the modality for ERA is more likely to indicate a satisfactory response as compared to CECT and thereby decreases the need for RT in response-based treatment algorithm for HL afflicted children. The reduction in the application of RT did not impact the overall outcome and plausibly would lower the risk of delayed toxic effects.

Specialist species have evolved to fill narrow niches but are especially susceptible to environmental change. With sufficient functional redundancy, ecosystem services can persist without specialists. Grooming behaviors are common in both terrestrial and aquatic organisms. However, in aquatic systems there is a heavy reliance on intraspecific mutualisms where specialist species groom or “clean” parasites off host fishes. Here, we sampled the gut contents of 709 fishes, representing 61 species and including both cleaner and non-cleaner fishes, to compare their consumption of gnathiid isopods, the most common fish ectoparasites. We found that cleaner fishes eat significantly more gnathiids, and eat them more frequently, compared to non-cleaner fishes. Our results highlight the importance of both dedicated and facultative cleaners as consumers of ectoparasites and show that their role cannot be supplanted by generalist consumers. Furthermore, we suggest that different cleaner species act as complementary rather than redundant specialists.

1. Recent empirical studies have quantified correlation between survival and recovery by estimating these parameters as correlated random effects with Bayesian multivariate mixed effects models fit to tag-recovery data. In these applications, increasingly negative correlation between survival and recovery indicates increasingly additive harvest mortality. The power of mixed effects models to detect non-zero correlations has rarely been evaluated and these few studies have not focused on a common data type in the form of tag recoveries. 2. We assessed the power of multivariate mixed effects models to estimate negative correlation between annual survival and recovery. Using three priors for multivariate normal distributions, we fit mixed effects models to a mallard (Anas platyrhychos) tag-recovery dataset and to simulated data with sample sizes corresponding to different levels of monitoring intensity. We also demonstrate a method of calculating effective sample size for capture-recapture data. 3) Different priors lead to different inference about additive harvest when we fit our models to the mallard data. Our power analysis of simulated data indicated most prior distribution and sample size combinations resulted in correlation estimates with substantial bias and imprecision. Many correlation estimates spanned the available parameter space (–1,1) and were biased towards zero. Only one prior combined with our most intensive monitoring scenario allowed our models to consistently recover negative correlation without bias. Underestimating the magnitude of correlation coincided with overestimating the variability of annual survival, but not annual recovery. 4) The inadequacy of prior distributions and sample size combinations typically assumed adequate for robust inference represents a concern in the application of Bayesian mixed effects models for the purpose of informing harvest management. Our analysis approach provides a means for examining prior influence and sample size on mixed-effects models fit to capture-recapture data while emphasizing transferability of results between empirical and simulation studies.

The accurate prediction of radio wave propagation is extremely important for wireless network planning and optimization. However, inexact matching between the traditional empirical model and actual propagation environments, as well as the insufficiency of the sample data required for training a deep learning model, lead to unsatisfactory prediction results. Our paper proposes a field strength prediction model based on a deep neural network that is aimed at a tiny dataset composed of the geographic information and corresponding satellite images of a target area. This model connects two pretrained networks to minimize the parameters to be learned. Simultaneously, we construct a convolutional neural network (CNN) model for comparison based on a previous advanced study in this field. Experimental results show that the proposed model can obtain the same accuracy as that of previously developed CNN models while requiring less data.

• The carnivorous pitcher plant Sarracenia purpurea is native to North America, but has been introduced into Europe, where it is now widespread. We have little understanding of how this species functions in its non-native range. Such understanding will provide insight into S. purpurea ecology and support its use as a model system for investigating food webs. We measured pitcher morphology and prey capture by S. purpurea in Britain and Ireland. • Pitchers were removed from different plants at each of six bogs covering the species rage in the UK and Ireland (n = 10 pitchers per site). For each pitcher we counted and identified every prey item and took measurements of morphology. We also compiled prey capture data for existing studies in Europe and North America. • Prey capture characteristics varied between sites in the UK and Ireland. The amount of prey captured varied 2-fold between sites and was partially explained by differences in pitcher size; larger pitchers caught more prey. The primary prey was Formicidae, Diptera and Coleoptera. At the rank of order, prey composition varied between bogs, some contained mainly Formicidae, some mainly Diptera and some a mix. Plants were more specialised in prey capture at some bogs compared to others. There was no overall difference in prey capture (composition or degree of specialism) at the rank of order between plants in Europe compared to those in North America. At the rank of species, prey capture varied between populations even within the same order. • This study demonstrates a large amount of variability between sites in prey capture characteristics. This may reflect different site characteristics and/or plant strategies, will likely impact plant function, and may impact on the inquiline community. In terms of prey capture at the rank of order S. purpurea functions identically in its non-native range. This supports its use as a natural experiment for understanding food webs

Aim: Selection within natural communities has mainly been studied along large abiotic gradient, while the selection of individuals within population should occur locally under the play of biotic filter. To better seize the role of the latter, we postulated that the hierarchal nature of environmental selection and the multiple dimension of species trait space needed to be accounted for. Methods: We replicated a natural species richness gradient (from 2 to 16 species) within four contrasted wetlands (bog, fen, meadow, marsh), sampling functional traits from random individuals in communities. Developing a hierarchical distributional modelling, we analyzed the variation of the mean and dispersion of functional trait space at the ecosystem, community and species levels. Key results: We found that the abiotic differences between wetlands, which shaped a plant productivity gradient, selected species in regards with their leaf nutrient conservation / acquisition strategy. Within ecosystems, plant species richness was a strong driver of trait variation among both communities and species. Among communities, it shaped the selection of individuals according to their space occupation and leaf adaptations to light conditions. Demographically, some species used intraspecific trait variation to maintain equally dense populations, while others used it to become dominant in favorable conditions. Main Conclusions: Within ecosystems, variation in biotic conditions selects individuals along functional dimensions that are independent to the ones selected across ecosystems. Because intraspecific variations of light-related traits are related to demographic responses, it offers a way to link the study of species richness and eco-evolutionary dynamics.

Key Points:  COVID-19 often cause prolonged olfactory dysfunction.  This study evaluated the relative burden of the COVID-19-related disease in a single-centered cohort of POD patients.  COVID-19-related POD was diagnosed serologically.  In the COVID-19 era, the local burden of POD increased two-fold.  It is important to use pleiotropic approach and robust measures, when we assess OD.

Population dynamics with complex biological interactions, accounting for uncertainty quantification, are critical for many application areas. However, due to the complexity of biological systems, the mathematical formulation of the corresponding problems faces the challenge that the corresponding stochastic processes should, in most cases, be considered in bounded domains. We propose a model based on a coupled system of reflecting Skorokhod-type stochastic differential equations with jump-like exit from a boundary. The setting describes the population dynamics of active and passive populations. As main working techniques, we use compactness methods and Skorokhod's representation of solutions to SDEs posed in bounded domains to prove the well-posedness of the system. This functional setting is a new point of view in the field of modelling and simulation of population dynamics. We provide the details of the model, as well as representative numerical examples, and discuss the applications of a Wilson-Cowan-type system, modelling the dynamics of two interacting populations of excitatory and inhibitory neurons. Furthermore, the presence of random input current, reflecting factors together with Poisson jumps, increases firing activity in neuronal systems.

A 25 year old presented to the emergency department with a one day history of mildly painful and erythematous swelling of her right upper eyelid that she believed to be a stye. The clinical team noted vesicular lesions located exclusively on the upper eyelid, diagnosed zoster and initiated valacyclovir.