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Steam Network Optimisation & CO2 reduction in an Oleochemical Production Complex
Ross Aidan Lee
Kai Seng Koh

Ross Aidan Lee

and 3 more

May 30, 2022
Oleochemical industry has seen massive growth in Southeast Asia since the 1980’s. However, there is a major problem when it comes to energy optimisation strategies for oleochemical plants, which is apparent by the very limited amount of literature reviews available regarding energy optimisation in the oleochemical sector. This paper aims to propose a solution that leads towards the sustainable development of an oleochemical plant using a mathematical approach. The focus of this work is to increase the cost efficiency of the plant as well as reduce its environmental impact. Three case studies were carried out where Case 1 looks into the reutilisation of waste steam, Case 2 regarding the effects of production capacity changes on energy demand, and Case 3 attempts to create a holistic solution. From the three case studies that were carried out, Case 1 allowed for cost savings of 50.82%, while the entirety of Case 3 allowed for cost savings of 29.56%. Case 2 showed the changes in steam demand given an increase or decrease in production that can be linked to seasonal data of palm oil. Case 2 also accounted for safety factors that were applied in Case 3 to create a more holistic solution.
Well-posedness and Continuity Properties of a generalized Degasperis-Procesi equation...
Shaohui  Gui
Min Li

Shaohui Gui

and 2 more

May 30, 2022
In this paper, we obtain the local-in-time existence and uniqueness of solution to the generalized Degasperis-Procesi equation in $B^1_{\infty,1}(\mathbb{R})$. Moreover, we prove that the data-to-solution of this equation is continuous but not uniformly continuous in $B^1_{\infty,1}(\mathbb{R})$
Pelvic pain in transgender people using testosterone therapy: A national survey
Sav Zwickl
Laura Burchill

Sav Zwickl

and 10 more

May 30, 2022
Objective: This descriptive study aimed to assess the prevalence and characteristics of pelvic pain and explore predictive factors for pelvic pain in transgender (trans) individuals using testosterone therapy. Design: Cross-sectional survey. Setting: Online. Sample: Trans people presumed female at birth, using testosterone for gender-affirmation, living in Australia, and aged > 16 years. Methods: Logistic regression was applied to estimate the effect size of the possible factors contributing to pain after starting testosterone. Main Outcome Measures: Prevalence and characteristics of pelvic pain following initiation of testosterone therapy, type and length of testosterone therapy, menstruation history, and relevant sexual health, gynaecological and mental health experiences. Results: Among 486 participants (median age 27 years), 351 (72.4%) reported experiencing pelvic pain following initiation of testosterone therapy, described most commonly as in the suprapubic region and as “cramping”. Median duration of testosterone therapy was 32 months. Persistent menstruation, current or previous history of post-traumatic stress disorder, and experiences of pain with orgasm were associated with higher odds of pelvic pain after testosterone therapy. No associations were observed with genital dryness, intrauterine device use, previous pregnancy, penetrative sexual activities, touching external genitalia, or known diagnoses of endometriosis, vulvodynia, vaginismus, depression, anxiety, or obesity. Conclusions: Pelvic pain is common in trans people following initiation of testosterone therapy. Given the association with persistent menstruation and orgasm, as well as the known androgen-sensitivity of the pelvic floor musculature, further research into pelvic floor muscle dysfunction as a contributor is warranted.
Laparoscopic versus open debulking surgery for advanced epithelial ovarian cancer: An...
Li Deng
Kaijian Ling

Li Deng

and 8 more

May 30, 2022
Objective: To compare the survival and perioperative outcomes of laparoscopic and open debulking surgery for advanced ovarian cancer (EOC). Design: Retrospective cohort study. Setting: Tertiary referral centre. Population: Patients with high-grade serous EOC (FIGO stage III-IV) undergoing debulking surgery between April 2008 and June 2018. Methods: Patients were identified in the hospital database, and their electronic charts were reviewed. The data were evaluated by R software and univariate and multivariate analyses. Main outcome measures: Overall survival (OS), progression-free survival (PFS) and surgical outcomes. Results: There were imbalances in the baseline indexes of ascites volume, Fagotti score and NACT administration between the two groups (P<0.001). After adjustment with the inverse probability of treatment weighting (IPTW) propensity score method, the overall balance of the covariates was improved significantly. The survival analyses both before and after weighting showed that there was no difference in OS or PFS between the two groups. Multivariate Cox regression showed that the surgical approach was not an independent factor for survival. Stratified analyses showed that there was no difference in OS or PFS between the subgroups, regardless of whether they were grouped by treatment strategy (primary and interval debulking) or by reduction effect (R0 and non-R0)). The blood loss volume, complication rate and ICU admission rate were lower in the laparoscopy group than in the open group (p<0.001). Conclusions: Compared with laparotomy, laparoscopic debulking surgery can achieve similar survival outcomes and lead to better perioperative outcomes. However, these outcomes warrant further evaluation in randomized clinical trials.
Brief analysis on the role of RNA-binding proteins in prognosis of endometrial cancer...
Jing He
Lin Han

Jing He

and 6 more

May 30, 2022
Background Recently, it has been demonstrated that the disturbance of RNA-binding proteins is closely related to the occurrence, progression and prognosis of diseases and cancers. Meanwhile, the role of RBPs in endometrial cancer remains to be explored. Objective To find out the prognostic role of RBPs in endometrial cancer. Methods Unit COX regression analysis, LASSO, multivariate COX regression analysis, Kaplan–Meier survival analysis. Results We obtained endometrial cancer RNA sequencing data and clinical data from TCGA, screened 284 differentially expressed genes that were differentially expressed between cancer tissues and normal tissues, performed functional enrichment analysis on them, and then screened from the differentially expressed genes identified prognostic-related genes (CD3EAP, EPHB6, CIRBP, LTK, ADARB2, RBPMS), developed a prognostic model to examine differences in OS among patients in high- and low-risk cohorts, and constructed a nomogram to predict patient survival rate. Conclusions We use public databases to study that RBPs have certain value in the occurrence and development of endometrial cancer, and can be used as a prognostic marker for endometrial cancer.
A Prospective analytical study of pregnancy outcome in subjects with short birth preg...
Nalabai Suneetha
Nilam Prajapati

Nalabai Suneetha

and 1 more

May 30, 2022
Short birth pregnancy intervals have been associated with adverse maternal outcomes like anemia, pre-eclampsia, eclampsia, puerperal infection and maternal mortality and other morbidities. Fetal outcome is preterm birth, low birth weight, IUGR, fetal or neonatal death. Prevention of short birth pregnancy interval can be achieved by post-partum contraception.
Women’s experiences of primary dysmenorrhea symptoms: A systematic review of qualitat...
Ana Moreno Gómez
Ping Guo

Ana Moreno Gómez

and 3 more

May 30, 2022
Background: Primary dysmenorrhea (PD) has a significant impact on women’s lives, especially among young women who miss school and work due to painful periods. Experiences and how women manage PD have been explored to some extent, but the evidence has not been systematically collated and reviewed to allow health professionals to better understand women’s experiences of and perceptions about PD. Objectives: To synthesize the qualitative evidence related to women’s experiences of PD and associated symptoms. Search strategy: Seven databases (Ovid MEDLINE®, PubMed, Embase, APA Psycinfo, Web of Science, CINAHL and OpenGrey) were searched for relevant papers published in English, Spanish, Greek and Chinese between January 1997 and May 2021. Selection criteria: All studies investigating women’s experiences with PD. The Critical Appraisal Skills Programme (CASP) tool for qualitative studies was used to critically appraise the papers. Data collection and analysis: A data extraction form was developed using JBI template. Findings from the papers were analyzed and synthesized using meta-aggregation. Main results: Sixteen articles were included. Five themes were identified: Experiencing pain and associated symptoms, the psychological dimension of PD, knowledge and support, day-to-day living with PD, and coping strategies. Conclusions: Taboos and deeply rooted beliefs around menstruation can potentially lead to gender inequalities; hence, women’s common concerns and their experiences with PD need to be considered. Training and treatment protocols for health practitioners are needed. Future research should focus on development and testing of protocols for diagnosis, pharmacological and non-pharmacological management and men’s perceptions of menstruation of their lovers.
Landscape genetics across the Andes mountains: Environmental variation drives genetic...
Vanessa Muñoz-Valencia
James Montoya-Lerma

Vanessa Muñoz-Valencia

and 3 more

May 30, 2022
Distinguishing among the mechanisms underlying the spatial distribution of genetic variation resulting from the environmental or physical barriers from those arising due to simple geographic distance is challenging in complex landscapes. The Andean uplift represents one of the most heterogeneous habitats where these questions remain unexplored since multiple mechanisms may interact, confounding their relative roles. We explore this broad question in the leaf-cutting ant Atta cephalotes, a species that is distributed across the Andes mountains, using nuclear microsatellite markers and mtCOI gene sequences. We investigate spatial genetic divergence across the western range of the northern Andes in Colombia by testing the relative role of alternative scenarios of population divergence, including isolation by geographic distance (IBD), climatic conditions (IBE), and the physical barriers presented by the Andes mountains (IBB). Our results reveal substantial genetic differentiation among A. cephalotes populations for both types of markers, but only nuclear divergence followed a hierarchical pattern with multiple models of genetic divergence imposed by the western range. Model selection showed that the IBD, IBE (temperature and precipitation), and IBB (Andes mountains) models, often proposed as individual drivers of genetic divergence, interact and explain up to 33% of the genetic divergence in A. cephalotes. The IBE model remained significant after accounting for IBD, suggesting that environmental factors play a more prominent role than with IBB. These factors, in combination with the idiosyncratic dispersal patterns of ants, appear to determine the hierarchical patterns of gene flow. This study enriches our understanding of the forces shaping population divergence in complex habitat landscapes.
The impact of a universal late third-trimester scan for fetal growth restriction on p...
Adeniyi Aderoba
Christos Ioannou

Adeniyi Aderoba

and 6 more

May 30, 2022
Objective To investigate perinatal mortality, morbidity and obstetric intervention after introducing universal third-trimester ultrasound scan for growth restriction. Design Prospective cohort study Setting Oxfordshire (OUH), UK Population Women with a non-anomalous singleton pregnancy undergoing pregnancy care and term delivery at OUH with an estimated-date-of-birth between 01/Jan/2014 and 30/Sept/2019. Methods Universal ultrasound for fetal growth restriction between 35+0 and 36+6 weeks was introduced in 2016. The outcomes of the next 18631 eligible term pregnancies were compared, using logistic regression, with the previous 18636 who had clinically-indicated ultrasounds only. ‘Screen positives’ for growth restriction were managed according to a pre-determined protocol. Main Outcome Measures Extended perinatal mortality, a composite of mortality or encephalopathy Grade II-III, and expedited birth. Other outcomes included composite adverse outcomes used elsewhere, detection of birthweight (<10th centile) and birth <39+0 weeks. Results Extended perinatal deaths decreased from 1.7/1000 to 1.2/1000 births (aOR: 0.73; 0.43 -1.25); mortality or severe morbidity decreased from 2.9/1000 to 1.9/1000 births (OR: 0.67; 0.44-1.03). Expedited births increased from 35.2% to 37.7% (OR: 1.08; 1.04 – 1.14). Birth prior to 39+0 weeks fell 10.5% (OR 0.89: 0.85 – 0.94). Birthweight (<10th centile) detection using fetal biometry alone was 31.4%, and rose to 40.5% if all abnormal scan parameters were used. Conclusion Introducing a universal ultrasound for growth restriction has limited impact on mortality and severe morbidity, but only small increases in intervention, and less early-term birth, are possible. The detection of birthweight (<10th c) improved where markers of growth restriction are used.
Definition and quantification of 3-dimensional imaging targets to phenotype pre-eclam...
Sammy Hermans
Jacob Pilon

Sammy Hermans

and 7 more

May 30, 2022
Objective: Pre-eclampsia is a severe placenta related complication of pregnancy and aetiological knowledge, with limited early diagnostic and therapeutic options. Phenotyping of native placental three-dimensional (3D) morphology offers a novel approach to improve our understanding of the functional and structural placental abnormalities underlying this clinical syndrome. The aim of this project was to develop a 3D placental imaging protocol using multiphoton microscopy (MPM) and demonstrate quantifiable imaging targets for phenotyping 3D features of pre-eclampsia. Design: Exploratory pilot study. Setting: Single centre, MUMC. Sample: Formalin fixed placental biopsies from: term control (n=3), pre-eclampsia (n=3), preterm birth (n=2), 2nd trimester placenta (n=1), and intra-uterine growth restriction cases without pre-eclampsia (n=2). Methods: Placental slabs were visualised with MPM. Collagen and cytoplasm (based on inherent signal), and fluorescently stained nuclei and blood vessels, enabled the visualization of villous tissue with subcellular resolution. Segmentation based on pixel classification, deep learning, and clustering algorithms were used to generate quantifiable features. Main outcome measures: Trophoblast arrangement, 3D-villous tree structure, syncytial knots, fibrosis, and 3D-vascular networks were identified as imaging targets. Villous morphology, vascular fraction, vascular network (i.e., branchpoint density and diameter), nuclear density, and knot fraction were quantified to describe placental phenotypes. Results: Pre-eclamptic placentas had disorganized trophoblast arrangement, decreased vascular fraction, and altered vessel diameters, compared to control placentas. The developed 3D-methodology indicated that placental vasculature, syncytial knotting, and villous growth are altered in pre-eclampsia. Conclusion: Our preliminary data demonstrate the potential of the developed quantification method for phenotyping pre-eclampsia, to improve future disease stratification.
Exploring of catalytic oxygen reduction reaction activity of lattice carbons of vanad...
Anton Kuzmin
Bagrat Shainyan

Anton Kuzmin

and 1 more

May 30, 2022
The oxygen electroreduction mechanism on the V- and Nb-doped nitrogen-codoped (6,6)armchair carbon nanotube with incorporated MN4 fragment has been studied using the ωB97XD and PBE density functional theory approaches. The metal center in MN4 fragment and the adjacent NC=CN double bond (C2 site) of the support have been revealed as active centers. The metal active centers turned out to be irreversibly oxidized at the first step of ORR affording stable O*, 2O*, or O*HO* adsorbates depending on the applied electrode potential U, that makes them no longer active in ORR. Therefore, the C2 site comes at the forefront in ORR catalysis. Among the metal oxidized forms M(O)N4–, M(O)(O)N4– and M(O)(OH)N4–CNT, the C2 site of the latter turned out to be most active for 4e dissociative ORR. For both metals the last protonation/electron transfer step, HO* + H* = H2O, is the rate-limiting step. The alternative hydrogen peroxide formation is not only thermodynamically less favorable but also kinetically slower than the 4e dissociative ORR route on the C2 site of model M(O)(OH)N4–CNT catalyst.
Xanthomatous erosive arthritis: A new disease entity?
fei sun
Jiapeng Sun

fei sun

and 14 more

May 30, 2022
In this study, we reported a patient who presents with multicentric reticulohistiocytosis (MRH)-like clinical feature, but the histology is not compatible with it. Like our patient, a couple of patients described previously also had the dilemma that they could not be classified appropriately into any current histiocytosis entity. Considering the clinical and pathological features together, all these patients had a similar clinical profile: xanthomatous rash, erosive arthritis and histopathological findings showing xanthomized histiocytes. Therefore, we propose a new disease entity - xanthomatous erosive arthritis (XEA), to accommodate these patients that cannot be classified appropriately into the current system.
Anion Pathways in the NarK Nitrate/Nitrite Exchanger
Nara Lee Chon
Natalie Jean Schultz

Nara Lee Chon

and 3 more

May 30, 2022
The NarK nitrate/nitrite antiporter imports nitrate (a mineral form of the essential element nitrogen) into the cell and exports nitrite (a metabolite that can be toxic in high concentrations) out of the cell. However, many details about its operation mechanism remain poorly understood. In this work, we performed steered molecular dynamics simulations of the anion translocations and quantum-chemistry model calculations of the binding sites to study the wild-type NarK protein and its R89K mutant. Our results confirm the importance of the two strictly conserved binding-site arginine residues (R89 and R305) and two glycine-rich signature motifs (G164–M176 and G408–F419) in anion’s movement through the pore. However, we have not observed large-amplitude global conformational changes of the protein during the anion migration, deviating from traditional models that require such. For the R89K mutant, we find that the anion, especially nitrite, can be slowed down or trapped in the pore due to its competition for a proton with the lysine. Our findings provide a possible explanation on why the arginine-to-lysine mutation, despite preserving the charge, impedes or abolishes the anion transport in such mutants of NarK and other similar nitrate/nitrite exchangers.
A joint weighted power detector for Willie in two-hop covert communication system
Zehan Wan
Ying Huang

Zehan Wan

and 4 more

May 31, 2022
In this letter, a joint weighted power detector (JWPD) based on maximum a posterior probability (MAP) criteria is proposed for Willie aiming at two-hop covert communication scenario, which is a near optimal detector. Instead of only supervising one single phase, Willie combines the observations of two phases to make joint decision in the proposed scheme. The proposed scheme achieves lower probability of detection error (PDE) than the existing single-phase-detector (SPD) scheme and adding-power-directly-detector (APDD) scheme due to sufficient utilization of the two-phases observations. Numerical results demonstrate the benefit of our proposed scheme.
Quantum Simulation and Dynamics
Rajat Kumar Vishwakarma

Rajat Kumar Vishwakarma

May 31, 2022
Today Quantum Computers have a wide range of applications, one of the prominent is quantum simulation. Simulations are used for many industrial and research purposes. Here we understand how can we simulate three atoms heisenberg model interaction on three qubits using real NISQ(Noisy Intermediate-Scale Quantum Computing) device 'ibmq_jakarta' first we perform simulation by classical method after that we will go on quantum approach,for 3 qubit simulation its represented by 8×8 matrix. This is because there are 2³ = 8 states in the N =3(N represents number of qubits used) system, if the simulation were 50 particles(N=50) then it would be approx 10¹⁵×10¹⁵! Well beyond the capacity of today's classical computers, but for quantum computers this task will require only 15 qubits.
Influence of contamination with diesel oil on sandy loam soil sorptivity
Jerzy Weber
Edyta Hewelke

Jerzy Weber

and 3 more

May 29, 2022
This paper present results on soil contamination with petroleum hydrocarbons (PHs) on soil sorptivity and hydrophobicity under different soil moistures. The micro-infiltrometer method was used in laboratory experiment to determine the soil water repellency index (R) and the water drop penetration time (WDPT) test. The increase in PHs contamination contributed to soil repellency and caused a decrease in water sorptivity. The negative effect of contamination with PHs on soil sorptivity depended on soil moisture and was marked especially clearly after exceeding the critical moisture threshold. However, contamination by PHs did not reveal significant changes when ethanol was used instead of water. The R index and the WDPT test revealed a similar trend, inversely related to the level of soil contamination with PHs. The total amount of water available to plants in non-contaminated soil was 19.04%, while contamination equal to 100 g kg -1 caused a decrease to 6.36%. Hydrophobization of water-conducting pore surfaces by petroleum hydrocarbons severely reduced infiltration and destroyed the existing hydrological system of naturally hydrophilic soil. The almost three-fold decrease in total amount of water has a fundamental influence on increasing the risk of soil drought. The soil water repellency causes a decrease in resistance to droughts and slows the alimentation process of soil water retention. The results obtained indicated that the interrelations presented between the level of PHs contamination, soil sorptivity, water repellency, and soil moisture are key to predicting the environmental effects of contamination and effective soil remediation.
Gully erosion in southeast Nigeria: influence of land-use changes on gully catchment...
Ikenna Osumgborogwu
John Wainwright

Ikenna Osumgborogwu

and 3 more

May 28, 2022
Gully erosion leads to soil loss and poses significant threats to availability of land for cultivation, food security and development of infrastructure. Hydrological changes driven by land-use changes are often identified as drivers of gully erosion. The aims of this paper are to assess the influence of changes in land use on gully catchment hydrology and relate these changes to gully erosion. To achieve these aims, we used The Soil Water and Assessment Tool (SWAT, 2012 version) to assess hydrological changes driven by land-use changes in 22 gully catchments in the Orlu region of southeast Nigeria between 2009 and 2018. In the absence of measured hydrological data, we used a mixed-method approach to validate modelling results: literature review, field observations and focus group meetings. Increase in surface runoff estimates was observed in 21 catchments where reductions in fallow cover were observed. In one catchment where increased fallow was observed, we identified reduction in surface runoff. Surface runoff erosion was identified as a dominant process of gully expansion in the study area, but there was no significant relationship between changes in gullied area and changes in runoff volumes (r 2 = 0.15, p = 0.08). Within-catchment variations in land-use configuration influences surface runoff volumes and pathways, and by extension, gully erosion. This was evident in the slow gully expansion rate/gully reduction identified at gullies with vegetated adjacent lands as opposed to active runoff incision observed in gullies with bare adjacent lands. Therefore, the key finding of this study is that it is important to identify and incorporate the uniqueness of gully catchments in gully management as a successful management technique in a particular catchment may not work in another.
Potential change in the future spatial distribution of submerged macrophyte species a...
Anne Lewerentz
Markus Hoffmann

Anne Lewerentz

and 4 more

May 31, 2022
IntroductionSubmerged macrophytes provide a broad range of ecosystem services in lakes (Thomaz, 2021). They create habitat for many other species and change the lake environment by binding nutrients or stabilising the sediment. Most importantly, the eco-physiological processes controlling their growth and survival are strongly affected by environmental conditions, as they depend on light availability, nutrient availability, and temperature. However, the accelerating global biodiversity loss, especially of submerged macrophytes, is well documented (Körner, 2002; Phillips et al., 2016; Sand‐Jensen et al., 2000; Zhang et al., 2017) despite evidence of increasing species richness in some lakes (Murphy et al., 2018). The main influencing factors on the change of species richness seem to be global climate and regional land-use changes (Hofstra et al., 2020; Zhang et al., 2017) resulting in changes of light availability (due to changes in water turbidity), nutrient availability, or water temperature. The ways in which climate change influences water temperature, nutrients, and turbidity in lakes are highly complex including direct and indirect effects (Lind et al., 2022). For example, lake water temperature rises due to climate change which can also have indirect impacts on turbidity and nutrients in lakes, as higher temperature can promote algae growth (lower light availability). Therefore, nutrients and turbidity seem to co-vary, while temperature could change independently. However, nutrient content and turbidity can also be influenced by land-use practices (e.g. content and timing of fertiliser on fields), and wastewater treatment management. Overall, the direction and impact of future climate change on submerged macrophytes seems to be more obvious than changes in land use.All these stressors have an effect on the eco-physiological processes of macrophytes (Cao & Ruan, 2015; Reitsema et al., 2018). Hence, changes in these stressors likely affect the geographical distribution of individual species and of species richness of submerged macrophytes. Because of their response to their physio-chemical, geomorphological, hydrological, and biotic surroundings (O’Hare et al., 2018), species can be differentiated into oligo-, meso-, and eutraphentic species by their preference for nutrient conditions (Melzer, 1999). The presence of distinct species can then be an indicator of the water quality and ecological state of the lake (Schaumburg et al., 2004). However, studies on macrophyte species richness distribution remain largely based on observational and correlative studies, while there is a need to understand how simultaneous stressors combine and may result in synergistic effects on biodiversity (Lind et al., 2022). Therefore, it is paramount to assess these potential effects on macrophytes.Process-based models based on first principles and known ecophysiology are better suited to assess biodiversity response from changing conditions than correlative models (Cabral et al., 2017; Dormann et al., 2012; Higgins et al., 2020; Schouten et al., 2020). To predict the potential distribution of species based on environmental factors, process-based models incorporating critical eco-physiological processes are necessary. The application of process-based models describing the growth of submerged macrophytes have a long tradition, already stemming as early as the late 1980s (Best et al., 2001; Collins & Wlosinski, 1989; Herb & Stefan, 2003; Hootsmans, 1994; Scheffer et al., 1993; Wortelboer, 1990). The majority of those models were developed to answer different study questions, however, like the effect of macrophytes on algal blooms (Asaeda & Van Bon, 1997), the effect of varying light regimes (Herb & Stefan, 2003), or their impact on water quality (Sachse et al., 2014). Furthermore, most models were only used and calibrated for one or a few species (Gao et al., 2017; van Nes et al., 2003) and under very specific environmental conditions. None of these models was used to study the macroecological distribution patterns of macrophytes or its response to environmental change. Among the reasons for the delay in applying any of these models to multiple species and under different environmental conditions is the lack of computationally efficient models and empirical data to constrain both eco-physiological and environmental parameters. Hence, applying eco-physiological models to assess the species and richness distribution in both current and future conditions deserves further attention for this neglected group of species.Macrophytes are still underrepresented in trait-based research and in environmental change assessments (Dalla Vecchia et al., 2020; Iversen et al., 2022). Consequently, the determination of a broad range of eco-physiological parameters has yet to be established for most macrophytes. In the case of low trait-based information, applying eco-physiological models to a virtual species pool remains the best alternative to assess impacts of environmental change on macrophytes (Cabral et al., 2017; Dormann et al., 2012). As computational power and methods are evolving (Peréz-Sánchez et al., 2015), experiments with a broad range of randomly selected species within defined functional types can be a way of determining trait combinations (potential species) that allow species to survive and reproduce, as already done for terrestrial plants (Webb et al., 2010; Zakharova et al., 2019). In such applications, the process-based model acts as a performance filter, with the surviving virtual species representing those trait combinations able to cope with the environmental conditions given the considered mechanisms. However, this approach was not yet used for macrophytes.In this study, we tackle two main objectives. First, we address the potential species richness of oligotraphentic, mesotraphentic, and eutraphentic submerged macrophytes under recent environmental conditions. We ask: How many observed and potential species of the species pool can grow in clear, intermediate, and turbid lakes (Q1.1)? Do the potential species richness patterns across the depth follow the observed distribution in all lake types (Q1.2)? Second, we assess scenarios of water temperature increase and water quality change (increase or decrease in both nutrients and turbidity). Here, we ask: In which depth and lake types do we lose or gain oligo-, meso-, and eutraphentic species (Q2.1)? Is this change dependent on eco-physiological traits (Q2.2)?To answer questions Q1.1 and Q1.2, we run random species parameter combinations within the three defined parameter spaces of oligotraphentic, mesotraphentic, and eutraphentic species and analyse the resulting distribution patterns of the growing species by comparing them with the corresponding observed pattern. We expect to find the highest species richness in moderately nutrient rich lakes (Q1.1) (Lewerentz & Cabral, 2021). We hypothesise to find hump-shaped patterns (Q1.2) of species richness along depths (Lewerentz et al., 2021). In general, we hypothesise that we see a higher potential species richness than observed species richness because limiting processes like herbivory have not been modelled (Q1.1 and Q1.2). To answer question Q2.1 and Q2.2, we run scenarios of water temperature increase and scenarios of water quality change for the recent potential species pool. We hypothesise that the studied lakes will lose species under increased turbidity and nutrient conditions but gain species under decreased turbidity and nutrient conditions and under increased water temperature (Q2.1) (Lewerentz & Cabral, 2021). To answer question Q2.2, we determine the plant traits that significantly influence if a species will win or lose habitat within two selected scenarios of turbidity and nutrient decrease or increase. We hypothesise that under increased conditions, high biomass production is the main advantage, as species can grow at high rates even under limited conditions.
Janus kinase-2 signaling mediates apoptosis in rat cardiomyocytes
Daniel Beckles

Daniel Beckles

and 3 more

May 31, 2022
We tested the hypothesis that activation Jak2, which is prominently involved in the up-regulation of the renin-angiotensin system (RAS), constitutes a focal point in relaying signals triggered by a Angiotensin II (Ang II) and hypoxia/reoxygenation separately to cause an enhanced susceptibility of cardiac myocyte to apoptotic cell death. Ang II-treated adult cardiomyocytes in culture exhibited an increased level of apoptosis that accompanied activation of pro-apoptotic as well as anti-apoptotic signaling pathways. We observed increased phosphorylation of Jak2 kinase, Stat1, JNK, with increased expression of Bax protein, followed by an increase in caspase-1 and caspase-3 activity. Activation of these pro-apoptotic pathways was blocked by the Jak2 pharmacological inhibitor, Tyrphostin AG490. We also observed an increase in phosphorylation of cardioprotective pathway components, namely S6 ribosomal protein, and heat shock protein 27 (HSP27). Likewise, the oxidative stress, via the hypoxia/reoxygenation treatment of rat adult cardiomyocytes, produced apoptosis that was dependent upon activation of Jak2. The apoptotic response was not only reduced by Losartan, an inverse agonist of the AT1, receptor, but by treatment with AG490 as well. Taken together, these observations provide clear evidence in favor of Jak2 signaling as mediator of the apoptotic response in cardiomyocytes. However, there was a concomitant induction of cytoprotective signaling that presumably provides a negative feedback to the deleterious effects of the agonist. D
Intraoperative Epicardial Sonography as a Useful Adjunct to Repair of Coronary Artery...
Daniel Beckles

Daniel Beckles

and 4 more

May 31, 2022
C ORONARY ARTERY DISSECTIONS are rare but potentially life threatening. 1,2 They can occur either spontaneously or as a complication of percutaneous coronary interventions. 1,3 Management can be either catheter based or surgical and is determined by the extent of the dissection, hemodynamic status, and the number and extent of the vessels involved. 1,2 The case presented here involves a patient with a catheter-induced dissection of the left anterior descending (LAD) artery, which was managed with off-pump coronary artery bypass graft surgery. The authors highlight the use of epiaortic sonography to image the coronary artery before and after repair. CASE REPORT A 61-year-old man with a past medical history of systemic hyper-tension presented with a 1-month history of exertional chest pain and shortness of breath. A cardiac nuclear stress test showed exercise-induced anteroseptal, apical, and inferoposterior ischemia with a left ventricular ejection fraction of 36%. Coronary arteriography then was performed showing triple-vessel coronary artery disease. There were chronic total occlusions of the right coronary artery and the mid-LAD. The obtuse marginal arteries 1 and 2 also were found to have 50% to 60% stenosis. No obvious collaterals were shown on the coronary angiogram. The patient initially refused coronary artery bypass graft (CABG) surgery. The LAD lesion was crossed with a guidewire, but attempts at angioplasty resulted in an iatrogenic LAD dissection (Fig 1). The procedure was aborted, and the patient was referred for urgent surgery. He remained hemodynamically stable. Intraoperatively, the transesoph-ageal echocardiogram (TEE) showed 1 mitral regurgitation and inferior septal hypokinesis. Upon inspection of the epicardial surface, the midportion of the LAD had a bluish discoloration. An L15-7io epiaortic probe (Phillips Medical, Andover, MA) was placed into a sterile sheath and used to evaluate the vessel. A dissection and intramural hematoma were visualized originating in the midportion of the LAD with no flow in the false lumen (Figs 2 and 3). The LAD was stabilized and opened (Fig 4). The layers of the wall at the site of the arteriotomy were reapproximated to eliminate the false lumen. A left internal mammary artery to LAD anastomosis then was constructed. Repeat ultrasound evaluation showed excellent laminar flow through the anastomosis and in the distal LAD (Fig 5). The right internal mammary artery then was anastomosed to the right coronary artery, and vein grafts were placed to the 2 obtuse marginal arteries. The immediate postprocedure TEE showed no significant change. The patient remained hemodynamically stable with no postoperative electrocardiographic or enzymatic changes and had an uneventful postoperative recovery. He remains asymptom-atic 3 years after surgery. DISCUSSION Coronary artery dissections are a rare but well-recognized life-threatening condition. 1,3-5 They are classified as either spontaneous or catheter-induced. 1,3 These patients typically present in the form of acute coronary syndrome with unstable angina or myocardial infarction with ST-segment changes on the electrocardiogram. 1 Early diagnosis via angiography is of the utmost importance. In this patient, probably because of the pre-existing complete total occlusion of the LAD, ischemic changes did not occur. Catheter-induced coronary artery dissection is a rare but well-recognized complication of percutaneous coronary intervention. The true incidence may be unknown because there is From the Fig 1. A cardiac catheterization image of LAD dissection. Fig 2. Epiaortic sonography visualizes the intramural hematoma and mid-LAD dissection.
Cardiovascular Complications of Modern Multiple Myeloma Therapy: A Pharmacovigilance...
Zaki  Al-yafeai
Mohamed Ghoweba

Zaki Al-yafeai

and 4 more

May 28, 2022
Background: Multiple myeloma accounts for over 15% of hematological malignancies. In attempt to tackle this malady, the FDA approved four drugs in 2015 which has propagated further development of new anti-multiple myeloma since. However, the health safety of these new agents is still ill-defined. The aim of this study is to delineate the cardiovascular adverse events of these drugs. Methods: We searched the cardiac adverse events of the newly approved FDA drugs since 2015 using the U.S. Food and Drug Administration Adverse Events Reporting System database (FAERS). We calculated the reporting odds ratio (ROR) with 95% confidence for four drugs that have the highest incidence of cardiovascular adverse events. Results: Among the medications that have approved for MM Between 2015-2020, four novel drugs showed the highest incidence of cardiotoxicity. ROR (95% CI) for atrial fibrillation due to elotuzumab, Ixazomib, daratumumab, and panobinostat compared to other FAERS drugs was 5.8 (4.4-7.7), 1.9 (1.5-2.3), 4.8 (4.2-5.6), and 5.7 (4.1-8.1), respectively. The ROR (95% CI) for cardiac failure was 8.2 (6.4-10.5), 4.7 (4.1-5.4), 5.8 (4.9-6.7), and 5.6 (3.8-8.1) and ROR (95% CI) for coronary disease was 2.7 (1.9-3.9), 2.7 (2.3-3.2), 2.3 (1.9-2.8), and 4.6 (3.2-6.6) due to elotuzumab, Ixazomib, daratumumab, and panobinostat versus all other drugs in FAERS. Conclusions: Our results demonstrated that the newly approved antimyeloma therapy (elotuzumab, Ixazomib, daratumumab, panobinostat) are significantly associated previously unknow cardiotoxicity. These results warrant further studies and highlight the importance of considering the cardiac history of patients with multiple myeloma when utilizing these novel agents.
Adapting an integrated acute respiratory infections sentinel surveillance to the COVD...
Manal Fahim
Hanaa Abu ElSood

Manal Fahim

and 12 more

May 28, 2022
Introduction: An integrated surveillance for acute respiratory infections (ARIs) was established 2016 at network of 19 governmental hospitals to identify causes of ARIs in Egypt. In response to COVID-19 pandemic, WHO requested surveillance adaptation to address the emerging challenges. This report aims at describing Egypt experience in adapting ARI surveillance to COVID-19 pandemic. Surveillance methods: WHO case definitions are used to identify ARI patients. NP/OP swabs collected for influenza testing by RT-PCR at central laboratories. Data collected by interviewing patients for demographic and clinical information and entered at sites. During COVID-19 pandemic, the first two outpatients daily and every fifth admitted patient were enrolled. Patients COVID-19 clinical data and testing for SARS-CoV-2 by RT-PCR were added. Results: Between January 2020-April 2022, 18,160 patients were enrolled including 7,923(43.6%) outpatients and 10,237(56.4%) admitted. Of them 6,453(35.5%) tested positive including 5,620(87.1%) SARS-CoV-2, 781(12.1%) influenza and 52(0.8%) SARS-CoV-2/influenza coinfection. SARS CoV-2 caused 95.3% of admitted cases and 65.4% of outpatients. Influenza subtypes included A/H3 (55.7%), Flu-B (29.1%), H1/pdm09 (14.2%). Compared to influenza, SARS-CoV-2 infections prevail in elderly, warm weather, and urban governorates. SARS-CoV-2 caused more hospitalization, longer hospital stay, more severe course and higher case fatality than influenza (16.3 vs 6.6%, p<0.001). Conclusion: Egypt ARI surveillance was successfully adapted to COVID-19 pandemic and effectively describe clinical characteristics and severity of circulating viruses. Surveillance reported re-emergence of influenza viruses with severe course and high fatality. Maintaining ARI surveillance is essential to monitor respiratory viruses activity for guiding clinical management and preventive and control measures.
Epidemiology, disease severity and outcome of SARS-CoV-2 and influenza viruses co inf...
Manal Fahim
Wael Roshdy

Manal Fahim

and 10 more

May 28, 2022
Background: Co-circulation of influenza and SARS-CoV-2 (SARS-CoV-2/Flu) represent public health concern as it may worsen the severity and increase fatality from COVID-19. An increase in number of patients with coinfection was recently reported. We studied epidemiology, severity, and outcome of SARS-CoV-2/Flu coinfections seen at Egypt acute respiratory (ARI) surveillance eight hospitals to better describe disease impact and guide effective preventive measures. Methods: Every fifth patient admitted and first two outpatients seen daily with ARI are enrolled. Standardized questionnaire is used to interview patients who provide nasopharyngeal swabs to be tested weekly at the central laboratory for SARS-CoV-2 and influenza by RT-PCR. Data of all patients with coinfection extracted from surveillance database and descriptive analysis performed for demographics, clinical course, and outcome. Results: Of 18,160 patients enrolled January 2020-April 2022, 6,453(35.5%) were positive for viruses including 52(0.8%) coinfection. Of them 36(69.2%) coinfected with FluA/H3, 9(17.3%) Flu-B and 7(13.5%) FluA/H1. Patients’ mean age was 33.2±21, and 55.8% were males, 20(38.5%) hospitalized, mean hospital days (6.7±6). At hospital 14(70.0%) developed pneumonia, 6(30.0%) ICU admitted, and 4(20.0%) died. Hospitalization rate among coinfection with Flu-B and FluA/H3 was (55.6 and 41.7%), mean hospital days (8.0±6 and 6.4±6), pneumonia (40.0 and 80.0%), ICU admission (40.0 and 26.7%), and death (20.0% for both), while no patients hospitalized with A/H1. Conclusions: An increasing number of SARS-CoV-2/Flu coinfection identified in Egypt with severe course and high fatality. Patients coinfected with Flu-B and FluA/H3 had severe disease than A/H1. Monitoring disease severity and impact is required to guide preventive strategy.
Fluvoxamine for COVID-19 outpatients: for the time being, we might prefer to curb our...
Vladimir Trkulja

Vladimir Trkulja

May 28, 2022
Fluvoxamine for COVID-19 outpatients: for the time being, we might prefer to curb our optimismVladimir TrkuljaRunning head : Fluvoxamin and COVID-19 outpatientsKey words : fluvoxamine, COVID-19, outpatients, hospitalizationsVladimir Trkulja, MD, PhDDepartment of PharmacologyZagreb University School of MedicineŠalata 1110000 Zagreb, Croatiae-mail: vladimir.trkulja@mef.hrNumber of words: 613Number of figures/tables: 1To the Editor,A rather elaborate pharmacodynmics rationale 1 and sound pharmacokinetic reasoning 2 support the use of fluvoxamin in early phases of the COVID-19 disease. Two recent meta-analyses, 3, 4 both based on the same three randomized placebo-controlled trials, emphasized the benefit of early fluvoxamine treatment in non-vaccinated adult symptomatic mild COVID-19 outpatients in terms of a reduced risk of disease deterioration over subsequent days. In the first of the meta-analyzed trials, Stop COVID 15, primary outcome was hospitalization or incident hypoxemia needing oxygen treatment within 15 days. The trial was rather small, particularly for a binary outcome (fluvoxamine 2x100 to 3x100 mg/day over 15 days, n=80; placebo n=72) and recorded only 6 events (all with placebo) 5. Stop COVID 2 6followed the same design/outcome, and was stopped at an advanced stage for operational reasons but did not indicate any benefit [incidence 11/272 (4.0%) fluvoxamin vs. 12/275 (4.4%) placebo)]. The meta-analytical pooled estimates 3, 4 were dominated by the results of the TOGETHER trial 7 (fluvoxamine 2x100 mg/day, 10 days) that reported a marked relative reduction in the risk of the primary outcome (emergency room stay of at least 6 hours or hospitalization; over 28 days): 79/741 (11.0%) vs. 119/756 (16.0%), RR=0.69 (95% CrI 0.53-0.90) 7. By far the most events were hospitalizations, but no clear-cut benefit was obvious in this respect [75/741 (10.0%) vs. 97/756 (13.0%), OR=0.77 (0.55-1.05)7]. The meta-analysis by Lee et al.3 focused on hospitalizations and reported a 25% relative risk reduction by a frequentist method (RR=0.75, 95%CI 0.58-0.97), while the Bayesian analysis (weakly informative neutral prior) indicated somewhat more uncertainty (RR=0.78, 95%CrI 0.58-1.08; 81.6% probability of RR ≤0.90) 3. Guo et al.4 employed only frequentist pooling to indicate a marked benefit regarding “study-defined outcomes” (RR=0.69 95%CI 0.54-0.88) and somewhat more uncertainty regarding “hospitalizations” (RR=0.79, 95%CI 0.60-1.03) 4. In the meantime, a report was pubslihed of a randomized placebo-controlled trial conducted in 2020 in Korean outpatients (∼10 days of fluvoxamine 2x100 mg/day)8. It was stopped early for operational reasons8, and the primary outcome (as in Stop COVID trials) was observed in 2/26 treated and 2/26 placebo patients8. Figure 1 depicts meta-analysis of “study-defined primary outcomes” and of “hospitalizations” that uses the same frequentist and Bayesian methodology as used by Lee et al.3 except that (i) it includes the Korean data8 and (ii) employs Hartung-Knapp-Sidik-Jonkman correction shown to yield the least biased confidence interval coverage with small number of trials considerably varying in size9: (a) uncertainty about the benefit regarding “study-defined outcomes” (Figure 1A) is indicated by both the frequentist and Bayesian intervals extending to >1.0 and prediction intervals extending well >1.0. Probability of at least 10% relative risk reduction is 90.0%; (b) uncertainty about the benefit regarding “hospitalizations” (Figure 1B) is even more obvious, with estimate intervals exceding >1.10 (and further extended predictions intervals), with only 73.8% probability of at least 10% relative risk reduction. If one were to disregard two small trials with a few events (and, hence, fragile estimates that could have been by chance, at least in part) 5, 8, for the time being one would be looking at Stop COVID 2 and TOGETHER trial. This means 86/1013 hospitalization events with fluvoxamine vs. 109/1031 events with placebo, and a considerable uncertainty about any practically relevant effect: (i) frequentist RR=0.803 (95%CI 0.422-1.530); (ii) Bayesian RR=0.840 (95%CrI 0.613-1.170) and only 67.4% probablity of at least 10% relative risk reduction. Hopefully, the on-going trials (depicted in ref. 3) will resolve this uncertainty, but presently we might prefer to be cautios rather than overtly optimistic about the actual extent of benefit conveyed by early fluvoxamine treatment in COVID-19 outpatients.
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