Routes to diagnosis of Hypopharyngeal cancer: A Single Centre ExperienceINTRODUCTION In the United Kingdom, hypopharyngeal cancer accounts for 3% of head and neck cancers, with an age standardised reported incidence of 0.63 per 10,000. (1). Cancer of the hypopharynx often presents late. Cardinal symptoms of hypopharyngeal cancer include evidence of a neck mass, sore throat, dysphagia, hoarseness and referred otalgia. Referral pathways in patients with suspected head and neck cancer vary (1). They include but are not limited to referral from a primary care setting, acute presentation to secondary care and inter-departmental referral.In 2015, the National Institute for Clinical Excellence (NICE) established guideline NG12; Suspected Cancer, Recognition and Referral Guidelines, which defined the symptoms indicating a possible head and neck (H&N) cancer that warrant further investigation (2). The two symptoms pertinent to timely referral of hypopharyngeal cancer are persistent hoarseness and neck lump. The Northern Cancer Alliance (NCA) has used the NICE guideline to refine its 2 Week Wait (2WW) proforma to be used by healthcare practitioners when cases of H&N cancer are suspected (3). Symptoms that were originally included on the 2WW proforma, and pertinent to hypopharyngeal cancer, included dysphagia, sore throat and referred otalgia. The NCA proforma does not include these symptoms and only includes those recommended by NICE NG12 guidance. At the request of general practitioners (GPs), ‘unexplained, persistent, unilateral enlargement or ulceration of the tonsil or adjacent soft palate’ were included. The proforma does include a free text box encouraging primary care clinicians to describe concerning symptoms that do not fit with the NICE NG12 symptoms. The other symptoms/signs included on the NCA 2WW proforma relate to oral cavity cancer detection. 2WW proformas vary across regional Cancer Alliances in England, with many including dysphagia, sore throat and otalgia. This study aimed to evaluate routes to diagnosis of hypopharyngeal cancer in a large teaching hospital to establish if the current NCA 2WW proforma is appropriate to capture suspected cases of hypopharyngeal cancer.METHODS Basic settings and patient selection This was an observational case review study of all patients with a diagnosis of hypopharyngeal cancer at a large teaching hospital in England between December 2019- July 2022. The audit was registered and approved by the local hospital trust governance department prior to data collection. A total of 68 patients were identified from a prospective H&N audit database. The patient’s NHS number was used to search the hospitals electronic patient record system.Collected data The following parameters were extracted for each case: patient demographics, referral route, time from initial referral to first appointment, Tumour (T), Node (N), Metastases (M) stage, first treatment modality and socio-economic factors; smoking status and index of multiple deprivation decile which was calculated based on the patient’s postcode. A number from one to ten was generated; 1- most deprived lower-layer super output areas (LSOAs) nationally, 10- least deprived 10% of LSOAs nationally. Information regarding referral criteria was recorded from the NCA 2WW proforma. Practitioners could select one or more of the following categories to instigate the 2WW referral pathway:A persistent, unexplained lump in the neck or parotid region of recent onset.Persistent (not intermittent or fluctuating), unexplained hoarseness (over the age of 45 years).Unexplained, persistent, unilateral enlargement or ulceration of the tonsil or adjacent soft palate.AnalysisDescriptive data was collated on a spreadsheet and analysed. Analysis adhered to STROBE guidelines.RESULTS Of the 68 patients, 34 (50%) presented via a 2WW pathway, all from GP referrals. 23 (34%) were referred on non-2WW pathways: eight patients were referred by their GP on a routine basis, eight same site inter-departmental referrals and seven referrals were from another hospital site (no 2WW proforma). Three referrals were identified through routine departmental follow-up (FU) within ENT. Eight patients presented to the ENT service via an emergency route and were not previously known to the service (Figure 1). Characteristics of the patient group are shown in Table 1.Data on the time from initial referral to first appointment date was available for 50 of the 68 patients. 97% (n=33) of patients referred on the 2WW pathway were seen within 14 days of initial referral date. One patient waited 23 days, having rescheduled their appointment. The median time from initial 2WW referral to first appointment date was nine days (range 2-23 days). Of the 50 patients in total, median time from initial referral to first appointment was 10 days (range 2-117 days).18 patients were lacking data detailing initial referral to first appointment. Eight patients presented via an emergency route and were reviewed by ENT services at the time of presentation. Three patients were identified by routine departmental follow-up, and were lacking an initial referral date. Six patients were referred from other hospital sites with a previous diagnosis of hypopharyngeal cancer and one patient referred on a routine basis from GP was lacking referral documentation.Of the 16 patients referred into ENT services on non-2WW pathways, seven patients presented with dysphagia (44%), five patients presented with odynophagia (31%), two patients presented with a sore throat (13%), one patient presented with globus (6%). One patient was referred after incidental findings on previous imaging (6%). Of those 16 patients, median time from initial referral to initial appointment was 14 days (range 6-117 days). Of those presenting with dysphagia specifically, the mean time from referral to initial appointment was 11 days (range 6-14 days).Of the 34 2WW referrals from general practice, 23 patients were referred with a neck lump, 13 patients with persistent hoarseness and two patients with tonsillar ulceration. For all 2WW referrals, practitioners provided additional clinical information in the ‘reason for referral’ box. 44% of patients presenting via the 2WW pathway with a pre-treatment T category of T4. Analysis of pre-treatment category shown in table 2.26 patients (38%) received palliative radiotherapy as their first treatment modality. Of those referred by the 2WW pathway, 13 (38%) received palliative radiotherapy and four (12%) received radical radiotherapy. Analysis of primary treatment modality categorised via referral route is shown in table 3.DISCUSSION The NCA adopted the NICE NG12 symptom to refine their 2WW suspected cancer referral proforma. Our data suggests that choosing to not include those symptoms that may be suggestive of hypopharyngeal cancer; dysphagia, sore throat and otalgia, does not seem to have negatively impacted on the referral of patients with hypopharyngeal cancer. The majority of patients were seen in a timely manner. McKie et al. (8) evaluated referral patterns and diagnostic efficacy of the UK 2WW pathway, and demonstrated 21.4% of H&N cancers were diagnosed via 2WW pathway. The results from our study showed that half of patients diagnosed with hypopharyngeal cancer were referred on the 2WW pathways. Round et al. (9) demonstrated that over the past decade 2WW referrals for all types of suspected cancer have increased significantly.The ‘reason for referral’ box was populated in 100% of cases. This suggests that if the patient’s general practitioner was sufficiently concerned to detail the patients presenting symptoms, they would do so. Pooled data from previous studies of patients referred with suspected H&N cancer presenting with dysphagia indicated that head and neck cancer was diagnosed in only 5.6% of cases (4,7,8,10). In our study, the patients referred from primary care, via a non-2WW pathway, presenting with dysphagia had a median time from referral to first appointment was 11 days. Even in the absence of a 2WW proforma, this implies that referrals in to our centre were likely marked as urgent by the triaging ENT clinician reviewing these, based on the appropriate information provided by the referring practitioner. Together, these suggest that the 2WW proforma and written communication between primary and secondary care is an effective approach.The 2WW system is a balance of promoting earlier diagnosis with the capacity to investigate patients within 14 days (7). Dysphagia, sore throat and otalgia are clearly concerning symptoms when they occur together and are observed in patients who smoke and/or drink alcohol to excess (1). As individual symptoms, they can be vague and common in nature, overlapping with many of the benign persistent throat symptoms that are commonly assessed in ENT clinics. Patients with these symptoms can overload the capacity of the 2WW referral system thereby potentially delaying the system’s ability to assess higher risk symptoms in a more timely manner (7).Early cancer detection correlates with improved survival rates (5). Previous studies suggest that patients presenting via an emergency route are more likely to present with more advanced disease (5,10). Therefore, emergency presentations with advanced disease remains an area of concern to clinicians. This study highlights the link that patients presenting at a late stage, more commonly present via an emergency route, typically go on to have palliative treatment.CONCLUSION This study suggests that removal of non-NICE guidance H&N symptoms from the NCA 2WW proforma, when combined with an appropriate secondary care triaging system, has not negatively impacted on time from initial referral to diagnosis of hypopharyngeal cancer.

Background Childhood cancer is the sixth leading cause of global cancer burden. Indeed, 90% of childhood cancer cases occur in low-middle-income countries (LMICs), where mortality can be 4-5 times higher than in high income settings. In addition, many LMICs lack data on pediatric oncology for policy development and resource prioritization. In this paper, we describe the state of pediatric cancer care and treatment in Cameroon. Procedure We conducted cross-sectional survey in July 2020, which enabled us to collect data from two hospitals providing pediatric oncology services in Cameroon. We collected data on service availability, human resource capacity, frequent cancer types, treatment dropout, primary reasons for drop out, disclosure of status, and management of oncology data. Result The surveyed hospitals offered both pediatric chemotherapy and palliative care services; however, none offered nuclear medicine or radiotherapy services. In terms of workforce, human resources were grossly lacking in both hospitals. The available ones include one pediatric hemato-oncologist, one medical oncologist, one resident pediatric oncologist, one pediatric surgeon, and 14 oncology nurses and about 40% (18/45) of have received specialty training in oncology. The commonest childhood cancer managed in these facilities, was Burkitt lymphoma, (39, 23%). About 30% of children on chemotherapy abandoned their treatment, primarily due to lack of funds to continue with treatment sessions. In both settings, the capacity to diagnose cancer and provide counselling was limited. In addition, the tools to capture and transmit data varied by facility, resulting to different data set being generated. Furthermore, both facilities, had no schedule and timelines for data reporting. Conclusions Our results suggest that several factors negatively impact proper cancer care and treatment of pediatric Cancers in Cameroon. These include, inadequate human resource capacity, a high proportion of dropouts from chemotherapy due to high cost, and lack of harmonized data collection and reporting tools and systems. Systematically addressing these factors could contribute to improving treatment outcomes for pediatric cancer patients in Cameroon.

The quantitative identification of nitrate sources is of great significance for the control of non-point source pollution and the comprehensive management of water resources in watersheds. δ 15N-NO 3 - and δ 18O-NO 3 - isotopes combined with the Bayesian isotope mixing model were widely used as effective methods to identify nitrogen sources. In this study, a total of 60 surface water samples and 82 groundwater samples were collected in study area from November 2021 to October 2022, and atmospheric deposition (AD), chemical nitrogen fertilizer (NF), soil nitrogen (SN), and manure and sewage (M&S) were determined as the potential nitrate sources. Source identification by SIAR indicated that in November 2021 the M&S was the main contributor of nitrate to surface water (mean 38.1%), while NF was the main contributor to groundwater (mean 39.8%). In April 2022, NF contributed the most to surface water (38.3%), while groundwater mainly originated from SN (29.4%) and MS (29.8%). The uncertainty analysis showed that the greatest uncertainties were in SN and NF, followed by M&S and AD. Sensitivity analysis showed that the changes in the nitrate isotopic composition of M&S had the greatest effect on the results for δ 15N, whereas only the mean values of oxygen isotope values of AD had a greater effect on the results for δ 18O. The sensitivity analysis results can optimize the sampling scheme and improve the accuracy of the model predictions. Additionally, the contributions of soil nitrogen and nitrogen fertilizer to nitrate in surface water and groundwater reached 58% and 64%, respectively. Therefore, optimizing fertilizer and irrigation management is necessary to improve nitrogen use efficiency in watershed management.

Twin pregnancies in Arabian horses is a major cause of abortion. In all cases when the abortion occurs, it occurs for both fetuses. Unusually in the case described here, which we believe has not previously been documented in Arabian horses, one fetus aborted in undersized and representing an age of 4 months. The other fetus completed the gestation and reached full term followed by birth. The authors postulated that one fetus underwent a stage of diapause like marsupials in a blastocyst stage then re-grew again, followed by abortion. The parentage analysis confirmed that both feti are derived from the same dam and sire stallion.

A document by Sowmya Sagireddy. Click on the document to view its contents.

Background Cancer is the leading cause of death among Asian Americans, who face barriers to cancer care. Cancer supportive care needs among Asian Americans remain understudied. Methods We recruited 47 Asian American adults with colorectal, liver, or lung cancer who spoke Chinese, English, or Vietnamese, and were starting or undergoing cancer treatment. We assessed cancer supportive care needs in four domains: cancer information, daily living, behavioral health, and language assistance. Hierarchical cluster analysis was used to identify clusters of participants based on their need profiles to further examine the association between need profiles and quality of life (QoL) assessed by the Functional Assessment of Cancer Therapy (FACT-G). Results Participants (mean age=57.6) included 72% males and 62% spoke English less than very well. Older participants (age >65) and those with annual income <$50K reported higher daily living needs. Men and younger participants (age <50) reported higher behavioral health needs. We found 3 clusters displaying distinct cancer supportive need profiles: Cluster 1 (28% of the sample) displayed high needs across all domains; Cluster 2 (51%) had low overall needs; and Cluster 3 (21%) had high needs for cancer information and daily living. Cluster 1 participants reported lowest QoL. Conclusions Cancer supportive care needs among Asian American patients with colorectal, liver and lung cancer were associated with patient characteristics and QoL. Understanding cancer supportive care needs will inform future interventions to improve care and QoL for Asian American cancer patients.

This study presents a comparative analysis of radar cross section (RCS) simulations using Ansys High-Frequency Simulation Software (HFSS) and MATLAB. The primary objective is to evaluate the accuracy and consistency of RCS calculations performed by these two software tools for metallic cylinders. Metallic cylinders are selected as radar targets due to their well-defined and standardized shapes, which enable easier modeling and comparative analysis. To validate the RCS simulations, actual RCS measurements were conducted on an airport runway. The measurements took place at Kuala Lumpur International Airport (KLIA) using an FOD detection system operating at 93.1 GHz. By comparing the measured RCS data with the simulations results, the agreement and reliability of the simulation techniques were assessed, considering metallic cylinders of six different sizes. The findings indicate that the RCS values obtained from measurements align with the simulation results, exhibiting a similar RCS pattern. Both simulations exhibit minimal discrepancies, ranging between 0.01 to 0.1 dBsm. Through the analysis of the simulation results and measurements, valuable insight were gained regarding the performance and effectiveness of HFSS and MATLAB in predicting RCS values. Consequently, this study contributes to the understanding and validation of RCS simulation techniques and their practical applicability in real-world scenarios.

This article presents a study on the world's first unmanned machine designed for autonomous forestry operations. In response to the challenges associated with traditional forestry operations, we developed a platform equipped with essential hardware components necessary for performing autonomous forwarding tasks. Through the use of computer vision, autonomous navigation, and manipulator control algorithms, the machine is able to pick up logs from the ground and manoeuvre through a range of forest terrains without the need for human intervention. Our initial results demonstrate the potential for safe and efficient autonomous extraction of logs in the cut-to-length harvesting process. We achieved a high level of accuracy in our computer vision system, and our autonomous navigation system proved to be highly efficient. This research represents a significant milestone in the field of autonomous outdoor robotics, with far-reaching implications for the future of forestry operations. By reducing the need for human labour, autonomous machines have the potential to increase productivity and reduce labour costs, while also minimizing the environmental impact of timber harvesting. The success of our study highlights the potential for further development and optimization of autonomous machines in the forestry industry.

As the field of stem cell-based therapies continues to evolve, the ability to monitor the regenerative capacity of stem cell following delivery to target tissues has become increasingly relevant. While Bromodeoxyuridine (BrdU) and green-fluorescent protein (GFP) labeling techniques are often used, limited knowledge exists regarding their effects on the regeneration capacity of stem cells. In order to further understand the impact of these techniques in a clinical scenario, porcine adipose stem cells (ASCs) were derived, cultured and subsequently labeled with BrdU or GFP using transfection (GFP-t) or infection (GFP-i) by lentivirus, followed by investigation of downstream labeling effects on ASCs proliferation, differentiation, colony formation, secretion of regenerative cytokines, growth factors and healing ability. Neither BrdU nor GFP labeling led to gross morphological changes in adipose stem cells. Both groups of GFP labeled cells maintained a high percentage of signal intensity for at least 28 days, with a decrease in cell proliferation ability in the GFP-i group. In contrast, BrdU labelling began displaying weaker signal strength after 7-days of experiments. Both tracers negatively affected osteogenic and adipogenic differentiation of ASCs, causing decrease in the secretion of the regeneration markers VEGF and TNF-α. In contrast, in-vitro wound healing ability of labeled ASCs and secretion of IL-8, IL-10, and TGF-β was not affected by either method. Our results demonstrate that BrdU labelling may be more effective for short-term in-vitro studies due to the relative ease of preparation and shorter lifespan of the tracer signal. Contrarily, for studies with a longer duration, GFP labeling of cells by transfection provides more durable and stable signal. While further studies are needed, our results indicate that labelling mode can alter regeneration capacity of stem cells and should, therefore, be optimized prior to clinical translation experiments.

Background: The role and benefit of yittrium-90 (Y-90) remain in question amongst patients with metastatic chemo-refractory colorectal liver metastases (CRLM). We aim to report a complete experience and outcomes following lobar, segmental, combination administration, and repeated Y-90 radioembolizations utilizing a minimal prescribed dose in the treatment of CRLM. Methods and Results: This is a retrospective analysis of all patients who underwent Y-90 radioembolization of CRLM at a single institution. Tumor response was evaluated using a modified RECIST criteria 2-6 months post-radioembolization. Progression-free survival (PFS) was the primary outcome of interest. Tumor response, conversion to resectable disease, and overall survival (OS) were analyzed as a secondary outcomes. 4 rectal and 7 colonic adenocarcinoma CRLM patients with significant previous systemic therapy exposure were included. The median tumor number and size was 3 and 4.0 cm, respectively. 7 segmental and 12 lobar radioembolizations were performed (range 1-6 per patient) with a mean administered activity of 22.1 mCi. Tumor regression occurred in 71.4% of cases with 4 complete radiographic responses. The median hepatic PFS was 5.5 months. The median OS from the time of primary cancer diagnosis and initial Y-90 was 3.2 and 1.2 years, respectively. 18% of initially unresectable patients were converted to surgically resectable. Conclusions: Y-90 results in reliable tumor regression and repeated radioembolizations are safe when conservative doses are utilized in a multidisciplinary setting. This study supports the ‘neoadjuvant’ use of Y-90 to allow for the conversion of borderline resectable patients to resectable. The results suggest that Y-90 maybe associated with an OS benefit in chem-refractory CRLM patients.

Introduction:Necrotizing Fasciitis (NF) is an aggressive, life threatening, soft tissue infection with an incidence of 0.5 – 1.5 cases per 100,000 population [1]. It is usually due to synergetic polymicrobial infection. Most common causes of NF are trauma, urinary tract disease and perineal abscess [1]. Treatment involves early surgical debridement of infected tissue followed by broad-spectrum antimicrobial therapy and supportive measures [2]. However only few cases of NF associated with intestinal diseases such as perforated colon cancer have been reported [1]. We present a case of colonic cancer complicated by NF of the thigh.

This study aimed to explore the neural mechanism underlying high-altitude (HA) adaptation and deadaptation on perceptual processes in lowlanders. Eighteen healthy lowlanders were administered a facial S1-S2 matching task that included incomplete face (S1) and complete face (S2) photographs, combined with ERP technology. Participants were tested shortly before they went to HA at sea level (Test 1), twenty-five days after entering HA (Test 2), one week (Test 3) and one month (Test 4) after returning to lowlands. Compared with sea level baseline, shorter latencies of P1 and N170 and larger amplitudes of complete face N170 were found in HA. After returning to sea level, compared with HA, the amplitude of the incomplete face P1 was smaller after one week and the complete face was smaller after one month. The right hemisphere N170 amplitude was larger after entering HA and one week after returning to sea level compared to baseline, but it returned to baseline after one month. Taken together, the current findings suggest that HA adaptation increases visual cortex excitation to accelerate perceptual processing. More mental resources are recruited during the configural encoding stage of complete faces after HA exposure. The perceptual processes affected by HA exposure is reversible after returning to sea level, but the low-level processing stage is different between incomplete and complete faces due to neural compensation mechanisms. The configural encoding stage in the right hemisphere is affected by HA exposure and requires more than one week but less than one month to recover to baseline

Background: In applied psychophysiology, bootstrapping procedures are often used to classify individuals into one of two or more independent states (e.g., high risk vs low risk). Although the number of iterations required for a reliable bootstrap test is not universally agreed upon, some research (Rosenfeld et al., 2017b) suggests that 100 iterations is a sufficient number to obtain reliable results when analyzing P300 from a concealed information test. However, no study to-date has evaluated the diagnostic consistency of the 100 iterations test across repeated examinations. Methods: We evaluated the precision of the 100 iteration test by repeating the test 100 times per participant in a sample of 81 participants. The test was designed to classify participants as either knowledgeable or not knowledgeable of critical information related to a mock crime. Results: We found that the test provided variable classifications in approximately a quarter of our sample (n = 19/81 or 23%), specifically when a participant’s score presented near the diagnostic cutpoint. Moreover, the test’s diagnostic results varied by as much as +/-15%, in certain cases. Conclusion: Although the test provided reliable results for the majority of our sample, this was not true for a notable number of cases. We recommend that researchers report the variability of their diagnostic metrics and integrate this variability when classifying individuals. We discuss several simple examples of how to take variability into account when making classifications, such as by calculating the probability of one classification state over another given the data.

Rationale: The structures of organometallic complexes determine their stable functioning in product performance. Electrospray ionization-mass spectrometry (ESI-MS) is used in studying metal complexes, but it exhibits limitations in analyzing labile organometallics. Therefore, identifying a method of detecting unstable organometallics and evaluating their stabilities is necessary, providing a theoretical basis for material selection and performance evaluation. Methods: The standard complexes Zn(BTZ) 2, Fe(acac) 3, and Sn(Oct) 2 were analyzed using nanoelectrospray ionization-quadrupole orbitrap MS (nanoESI-MS) and compared with ESI-MS. Alkylamine-Ag + complexes were analyzed using nanoESI and collision-induced dissociation MS/MS (CID-MS/MS). Breakdown plots of the ion relative abundances against collision energies expressed in terms of the center-of-mass were constructed according to the obtained product ion spectra. Quantum chemical calculations based on density functional theory were performed to calculate the binding energies between the alkylamines and Ag +. Results: The molecular ions of the three standard complexes were only detected using nanoESI-MS, which confirmed the suitability of soft nanoESI for use in detecting unstable organometallics. The gas-phase stabilities of the amine-Ag + complexes, as estimated using the breakdown plots constructed by plotting the data obtained via nanoESI and CID-MS/MS, were consistent with the established theories, previous studies, and binding energies calculated using computational methods. Conclusions: NanoESI-MS is suitable for detecting labile organometallics and enables the structural analyses of unknown organometallic additives. A novel approach based on nanoESI and CID-MS/MS was developed to determine the gas-phase stabilities of organometallics, enabling their quantification and comparison and providing a technical basis for product improvement, which is essential in developing industrial materials.

This work elucidates the control of integrating non-minimum phase system via series cascade scheme with fractional-order P.I. (Proportional–Integral) plus D (Derivative) controller. The traditional Internal Model Control (IMC) is adopted for inner loop controller design. The feedback D controller is synthesized with the outer loop process model, which shows the work’s universality. The outer loop controller is suggested in the IMC framework after accountability of fractional-filter and inverse response compensator. This combination is revealed to enhance performance without compromising the robustness. The Riemann sheet principle is explored to compute the stability of the suggested controller. The sensitivity analysis has asserted the robustness. More importantly, the optimal value of controller settings is achieved via the Teaching Learning Based Optimization (TLBO) algorithm. This TLBO algorithm uses an objective function that minimizes Integral Square Error (ISE). Two illustrative problems are utilized to examine the recommended control structure’s virtue.

Aim High alpine regions are threatened but understudied ecosystems that harbor diverse endemic species, making them an important biome for testing the role of environmental factors in driving functional trait-mediated community assembly processes. We tested the hypothesis that plant-soil feedbacks along a climatic and elevation gradient influence plant community assembly through shifts in habitat suitability, which drive plant functional, phylogenetic, and spectral diversity. Location In a high mountain system (2400-3500 m) of Región Metropolitana in the Chilean Andes (33°S, 70°W). Methods We surveyed vegetation and spectroscopic reflectance (400-2400 nm) to quantify taxonomic, phylogenetic, functional, and spectral diversity at five sites from 2400 m to 3500 m elevation. We characterized soil attributes and processes by measuring water content, carbon and nitrogen, and net nitrogen mineralization rates. Results At high elevation, colder temperatures reduced available soil nitrogen, while at warmer, lower elevations, soil moisture was lower. Metrics of taxonomic, functional, and spectral alpha diversity peaked at mid-elevations, while phylogenetic species richness was highest at low elevation. Leaf nitrogen increased with elevation at the community level and within individual species, consistent with global patterns of increasing leaf nitrogen with colder temperatures. Main conclusions The increase in leaf nitrogen, coupled with shifts in taxonomic and functional diversity associated with turnover in lineages, indicate that the ability to acquire and retain nitrogen in colder temperatures may be important in plant community assembly in this range. Such environmental filters have important implications for forecasting shifts in alpine plant communities under a warming climate.

IntroductionHuman tuberculosis (TB) is primarily caused by Mycobacterium tuberculosis. Pulmonary disease occurs in 70-90% of the patients being the most commonly affected sites. The standard therapeutic regimen for TB as recommended by World Health Organization (WHO), consists of two months of the intensive phase, and four months of the continuation phase. The intensive-phase drugs include isoniazid (H) 5 mg/kg, rifampin (R) 10 mg/kg, ethambutol (E) 15 mg/kg, and pyrazinamide (Z) 25 mg/kg. Then isoniazid and rifampin are continued for the next four months. In the cases of resistance to isoniazid, treatment with a combination of rifampin, ethambutol, pyrazinamide, and a quinolone antibiotic such as levofloxacin (Lfx) is performed for a total of six months [1-3]. Drug-induced hepatitis is the most well-known complication of anti-TB treatment. Other adverse events include anorexia, vomiting, abdominal pain, peripheral neuropathy, thrombocytopenia, renal reactions, and skin rashes [4]. Here, we reported a rare complication of levofloxacin which was used as a second-line agent for TB treatment.

Resting state electroencephalographic (EEG) activity in schizophrenia (SZ) is frequently characterized by increased power at slow frequencies, and/or a reduction of peak alpha frequency. Here we investigated the nature of these effects. As most studies to date have been limited by reliance on a priori frequency bands which impose an assumed structure on the data, we performed a data-driven analysis of resting EEG recorded in SZ patients and healthy controls (HC). The sample consisted of 39 chronic SZ and 36 matched HC. The EEG was recorded with a dense electrode array. Power spectral densities were decomposed via Varimax-rotated principal component analysis (PCA) over all participants and for each group separately. Spectral PCA was repeated at the cortical level on cortical current source density computed from standardized low resolution brain electromagnetic tomography. There was a trend for power in the theta/alpha range to be increased in SZ compared to HC, and peak alpha frequency was significantly reduced in SZ. PCA revealed that this frequency shift was due to the presence of a spectral component in the theta/alpha range (6-9 Hz) that was unique to SZ. The source distribution of this component involved mainly prefrontal and parahippocampal areas. Abnormal low frequency resting EEG activity in SZ was accounted for by a unique theta/alpha oscillation. Other reports have described a similar phenomenon suggesting that the neural circuits oscillating in this range are relevant to SZ pathophysiology.