Objectives: To investigate the cost-effectiveness of preimplantation genetic testing for aneuploidy (PGT-A) versus conventional technology in in vitro fertilization (IVF) from the perspective of the healthcare system in China. Design: Economic evaluation based on a large multi-center randomized trial (CESE-PGS study). Population: Infertile women with a good prognosis for a live birth in China Methods: Following the exact steps in the IVF protocol, a decision tree model was developed, based on the data from the CESE-PGS trial and using cost scenarios for IVF in China. The scenarios were compared for costs per patient and cost-effectiveness. One-way sensitivity analysis and probabilistic sensitivity analysis were performed to confirm the robustness of the findings. Main Outcome Measures: Costs per live birth, Costs per patient, Incremental cost-effectiveness for miscarriage prevention Results: The average costs per live birth of PGT-A were estimated as ¥39230.71, which is about 16.8% higher than that of the conventional group. Threshold analysis revealed that PGT-A would need to increase the pregnancy rate of 26.24% to 98.24% or a cost reduction of ¥4649.29 to ¥1350.71 to achieve the same cost-effectiveness. The incremental costs per prevented miscarriage was approximately ¥45600.23. Probabilistic sensitivity analysis indicated a probability of 97.50% that PGT-A is cost-effective when the willingness to pay was ¥ 21,7113.00 per prevented miscarriage. Conclusions: The present cost-effectiveness analysis demonstrates that embryo selection with PGT‑A is not suitable for routine applications from the perspective of healthcare providers in China, given the cumulative live birth rate (CLBR) and the high costs of PGT‑A.

Objective The role of surgery for patients with advanced ovarian cancer is well established but wide variations in the percentage of patients undergoing surgery exist. Design Observational Study Setting The 19 cancer alliances in England, UK Methods We undertook a comparative analysis to examine the effects of rates of surgery on one and five year disease specific survival across the 19 English Cancer Alliances. We also undertook a propensity score analysis of a single cohort of patients with advanced ovarian cancer to compare patients who did, and did not, undergo surgery as part of their primary management. Main outcome measures Correlations between rates of surgery, demographics, and cancer alliance performance against one and five year survival Results In multivariable analysis, rates of surgery undertaken by a Cancer Alliance remained an independent predictor of both one and five year survival (correlation coefficient 0.81, and 0.70, respectively) although this relationship is likely non linear with optimal rates of surgery still to be defined. Using propensity score analysis a subgroup of patients who gain no benefit from surgery can be identified. Conclusions Overall survival of patients with advanced ovarian cancer is likely to be improved with an increase in overall rates of surgery however there are likely to be optimal maximal rates, above which patients will be disadvantaged. Mechanisms for identifying individual outcome predictions are required.

Spontaneous massive haemothorax is a rare but severe complication seen in children with haemophilia A. It is largely preventable with Factor VIII. prophylactic replacement therapy, and therefore is unusual to be seen as in the described case.

Thyrotoxicosis is a relatively common endocrine disorder. The diagnosis of thyrotoxicosis is upon clinical examination, laboratory, and further investigation. To prevent the thyroid storm is the goal of treatment of patients with thyrotoxicosis especially patients undergoing surgery.

Here we describe the case of a caucasian man referred to our Center for a suspicion of Multiple Myeloma which comprehensive work-up ruled out the presence of plasma cells neoplasm and allowed us to perform a diagnosis of brown tumor (BT).

Orogastric and nasogastric tube are common methods of enteral feeding. While simple, these methods are not free of complications. A rare complication of these feeding methods is the fracture of the tube. This report describes a fracture of an orogastric tube in a 58-year-old stroke patient.

Background and aims High-intensity grazing in Mongolian grasslands has led to the general deterioration of biodiversity and ecosystem functioning. Abundant evidence shows that grazing affects the structure and function of grassland ecosystems, especially under overgrazing. Methods We examined the effects of three grazing intensities (0, 1.92, and 3.08 sheep ha-1 a-1) on plant commu-nities, plant and soil C, N and P contents, and plant and soil C:N:P stoichiometry in a desert grassland in different years. Results Grazing did not affect plant coverage, richness, or N:P, and the plant community biomass, litter bio-mass and C:N and C:P were highest under a zero grazing intensity. Soil C:N changed with the year and grazing intensity. However, soil C:P and N:P were higher in 2018 than in 2016 and 2017. Conclusions Our study suggested that grazing promoted the flow of N between plants and the soil, especially at 3.08 sheep ha-1 a-1. Under grazing stress, plants maintained the potential for compensatory growth. Further-more, N was shown to be the limiting fertilizer component for plants growing in this area among the three grazing intensities.

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.

Cryptococcal meningitis is a major opportunistic infection in individuals with HIV. 36-year-old male with a past medical history of AIDSpresented with altered mental status, lumbar puncture performed showed elevated CSF opening pressure of 29 cmH2O and positive CSF and serum cryptococcal antigen, developed seizure, and posterior brain herniation.

Interstitial granulomatous dermatitis (IGD) is an uncommon entity characterized histologically by an interstitial granulomatous infiltrate. Juvenile idiopathic arthritis (JIA) is the most common rheumatic disease of childhood. We describe an infantt with JIA who developed an IGD. Physicians should be aware of this uncommon association.

Knowledge of the persistent state of environmental DNA (eDNA) particles in water and modeling its particle size distribution (PSD) is crucial to refine the eDNA sampling strategy. Previous studies measured eDNA concentrations at different size fractions to infer eDNA PSDs, whereas such discrete PSDs greatly depend on filter pore sizes used and may potentially bias our understanding of eDNA states. Here, I evaluated the Weibull distribution model as a tool for parameterizing eDNA PSDs. First, of the selected models developed for PSDs, the Weibull model was fitted most accurately to the eDNA PSD. Second, the Weibull parameters significantly varied depending on target genetic regions (mitochondrial/nuclear), time passages, and species, which also substantially changed the eDNA capture efficiency at a given filter pore size. According to the results, the higher detectability of multi-copy nuclear eDNA than mitochondrial one could partly be accounted for differences in their PSDs, a larger pore size filter could be suitable to detect the eDNA releases associating incidental events, and the optimum filter pore size for sufficient eDNA detection could be different among the taxa. Although further consideration is needed, this study provided the groundwork for optimizing the strategy of aqueous eDNA sampling, which contributes to efficient biodiversity conservation and ecosystem management.

Endovascular embolization techniques are the preferred treatment modality for the management of direct Carotid Cavernous Fistulas (CCFs).We report two cases of patients treated with SOV approach and retrograde embolization with Precipitating hydrophobic injectable liquid (PHIL) and coils.

Karst springs are the natural outflow of karst water to the surface. These springs occur where the water table can reach the surface unimpeded. This study examines the effect of alluvial deposits with varying thickness and permeability, covering the main outlet (karst spring) of a karst network on karst drainage (e.g., development of the karst water, drainage patterns, conduit-matrix interaction) as a result of a positive base level shift. This was realized with a numerical conceptual model (FEFLOW) of a hypothetical karst aquifer with 6 model configurations (inactive vs. active conduit flow, free vs. confined spring conditions with 20 m and 50 m sediment cover, respectively, with low and high hydraulic conductivity). Conduit flow and coupled conduit-matrix interactions were incorporated into the model with one-dimensional discrete feature elements. The results show that the permeability of the sediments has a more distinctive effect on conduit discharge than their thickness. The conduit network significantly contributes to the drainage even with a fully confined spring outlet. The conduit system acts as a water collector from the matrix in the recharge zone. The buried outlet increases the hydrostatic pressure farther along the conduit, and water is pushed upwards back into the matrix in the vicinity of the stratigraphic contact. Depending on the depositional setting, this results in the evolution of one to multiple new flow systems towards new potential spring sites. The results obtained here provide insight into the likely responses of natural karst systems.

The encroachment of freshwater territories by invasive species is a global issue with its associated co-existence, displacement and facilitation of native species. The blackchin tilapia, Sarotherodon melanotheron is one of the most successful biological invasive species. Data on its apparent ecological consequences on native species are rare in Nigerian inland waters. Based on stomach contents analyses, diets, feeding strategies, and dietary niche breadths of two sympatric invasive S. melanotheron and native Nile tilapia Oreochromis niloticus populations in a tropical domestic water supply were assessed for possible convergence. Both species exhibited generalist feeding strategies subsisting mostly on algae but fish eggs and larvae were conspicuous preys of S. melanotheron. Dietary niche of S. melanotheron was wider than that of O. niloticus. Dietary niche overlap was high and significant between these sympatric species. These findings imply that competitive feeding interactions-including predations on vulnerable early life stages may potentially promote invasion success of S. melanotheron in Eleiyele Reservoir.

Objective Studies have shown that chronobiological factors may adversely affect glycemic control in patients with type 2 diabetes mellitus (T2DM). Our objective was to assess the association of chronobiological disorders with glycemic control and neonatal birthweight in women with GDM. Design A prospective observational study was conducted. Setting Israel Population 208 women aged 18-45 years with a singleton pregnancy who were randomly selected from among women undergoing follow-up for GDM at the Maternal-Fetal Medicine Unit of a tertiary medical center in 2016 and 2017. Methods Nutrition, sleep, and lifestyle patterns were assessed from onset of GDM until birth along with glycemic control and obstetrical outcomes. Data were collected by structured interview and from the medical files. Main outcome measures Maternal glycemic control and large for gestational age (LGA) neonate. Results Multivariate analyses on a cohort of 208 women revealed suboptimal glycemic control which was associated with a late breakfast (RR=2.26; 95% CI 1.09-4.67). Any 10-g increase in carbohydrate intake in the evening increased the risk 1.19 times for suboptimal glycemic control (RR=1.19; 95% CI 1.003-1.42), and 2.14 times for poor sleep quality (RR=2.14; 95% CI 1.04-4.41). The adjusted relative risk for birthweight above the 85th percentile was associated with excessive of 10-g increase of carbohydrate intake in the morning (RR=1.70; 95%CI 1.30-2.23) and in the evening (RR=1.39; 95% CI 1.16-1.67). Conclusions Chronobiological disorders are associated with suboptimal glycemic control and large-for-gestational-age newborn in women with GDM.

We reported one of the rare, documented cases of a girl with LVNC associated jSLE with a past history of Hashimoto's thyroiditis.Thus, the association between jSLE, and LVNC should be considered, and requires further research in order to find the probable mechanism joining both entities.

We report the clinical, imaging, echocardiography and muscle biopsy findings of a patient presenting by characteristics which have not been reported in previous Melas cases. This is the first reported case of MELAS accompanying with PFO, and the first case of MELAS with the progressive pattern of ischemic lesions.

Background: Cervical squamous cell carcinoma is one of the most common malignant tumors in the clinic. It can metastasize to the lung, bone, and other organs. However, postoperative recurrence and metastasis to the tricuspid valve are infrequent.   Case presentation: A 57-year-old female patient, which had an operation history of squamous carcinoma of the cervix(SCC) one year ago, was admitted to the hospital due to the cervical squamous cell carcinoma recurred and metastasized to the tricuspid anterior and septum’ ventricular surface and the chordae tendineae. The patient underwent surgery in our hospital.Then the positron emission tomography-computed tomography of postoperation revealed cervical squamous cell carcinoma metastasis. Histopathology revealed the squamous carcinoma of the cervix.Moreover, the cardiac tumor reappeared after four postoperation months. The postoperative patients did not receive regular chemotherapy. The short-term effect on the patients was not ideal.  Conclusion: To achieve better treatment results, the multi-mode treatment strategy of surgery, medical treatment, and advanced diagnosis has a significant impact on the survival of these patients.