An 18-year-old female patient diagnosed with McCune–Albright syndrome (MAS) developed postoperative acute heart failure with negative findings during preoperative cardiac screening and restricted fluid infusion. Latent cardiovascular involvement of MAS could be a reasonable explanation for the present case.

ABBREVIATIONSCA cannabis allergyCCDs cross-reactive carbohydrate determinantsCI confidence intervalCSA cannabis sativa allergic patientsnsLTP s nonspecific lipid transfer proteinsP+LTP- controls sensitized to pollen without nsLTP sensitizationP+LTP+ controls sensitized to pollen and nsLTPs(r) recombinantsIgE specific immunoglobulin EST skin teststIgE total immunoglobulin EKEYWORDSCannabis allergy, sIgE, total IgE, allergy diagnosis, sIgE-to-total IgE ratioTo the Editor,The most important “diagnostic test” for CA is a detailed history. However, a positive history is no absolute proof of CA, mainly because of physiological effects of cannabis i.e. (rhino)conjunctivitis presence and possibly because of incorrect interpretation or recollection of symptoms by the patients under the drug’s influence. Consequently, clinical suspicion of CA requires confirmatory testing. A cannabis challenge, being excluded for obvious ethical/legal reasons, documentation of CA generally starts with skin testing (ST) or specific IgE-quantification. However, in the absence of a standardized extract for ST, many will use prick-prick tests (e.g., with buds, leaves, seeds)1 2. Crude plant parts or extracts thereof, can contain both genuine and cross-reactive allergenic components. Consequently, positive results of crude extract ST and sIgE should always be interpreted cautiously, as it might merely reflect (cross-) sensitization instead of allergy.Here, we sought to investigate whether serological diagnosis of CA could benefit from an adjustment for tIgE. For this purpose, sIgE-to-tIgE ratios were calculated for sIgE hemp (FEIA, ImmunoCAP ThermoFisher Scientific), sIgE to recombinant (r) Can s 3 and rCan s 5 (Cytometric Bead Assay) as detailed elsewhere 3. A sIgE rCan s 3-to-rPru p 3 and sIgE rCan s 5-to-rBet v 1 ratio was also calculated. Negative sIgE values were excluded, as these cannot benefit from such an adjustment. Patients were selected from our previously published data3 4; cannabis sativa allergic patients (CSA), controls with a pollen but no nsLTP sensitization (P+LTP-) and controls with both pollen and nsLTP sensitizations (P+LTP+) were enrolled.Detailed demographic information is shown in table 1 of our previously published article3. As shown in figure 1, the distribution of the sIgE hemp-to-tIgE ratio and sIgE rCan s 5-to-tIgE differed significantly between controls and CSA. Using a cut-off of 0.02 for sIgE hemp-to-tIgE, it was shown that a specificity of 93% (95% confidence interval (CI), 85-98%) could be reached (table 1). A second, lower cut-off (0.005) can benefit most of the CSA population (sensitivity 77% (95% CI 67-85%)) and retains a relatively good specificity 79% (95% CI 68-87%).For sIgE rCan s 5-to-tIgE, a cut-off of 0.01 could possibly be beneficial. However, small group numbers make it difficult to estimate its true value. The ratio of sIgE rCan s 3-to-tIgE did not show added value (p=0.86).Comparing CSA patients with and without anaphylaxis; no added value was found to identify (a risk of) cannabis related anaphylaxis for any of the explored sIgE-to-tIgE ratios (sIgE hemp-to-tIgE->p=0.104; sIgE rCan s 3-to-tIgE->p=0.416; sIgE rCan s 5-to-tIgE->p=0.84, data not shown).Finally, ratios of similar protein families i.e. sIgE rCan s 3-to-sIgE rPru p 3 and sIgE rCan s 5-to-sIgE rBet v 1 were explored, showing no additional diagnostic value (see figure E1 in the online repository).These results indicate that sIgE-to-tIgE ratios might have a place in the diagnostic approach of CA. In the case of a definite history of cannabis related symptoms we recommend (figure E2) a sIgE hemp assay (sensitivity 82% (95% CI 74-89%) and specificity 32% (95% CI 20-45%)) 3. A negative result significantly reduces the chance of IgE-mediated CA. A positive result should be followed by a sIgE hemp-to-tIgE ratio as it notably increases test specificity. Where available, it is worthwhile using cannabis component resolved diagnostics as it was shown that over two-thirds of CSA who experienced anaphylaxis are Can s 3 sensitized 3. This study is bound by certain limitations; group numbers vary between the different analyses because of insufficient patients’ sera. Additionally, we could not explore sIgE rCan s 2-to-tIgE, sIgE rCan s 4-to-tIgE and sIgE rCan s 4-to-sIgE rBet v 2, because of insufficient group numbers. Finally, there is no guarantee that these results can be extrapolated to other CSA populations or different geographical regions. The results of these study are of a preliminary nature. Repetition of our methods in other, ideally larger populations are feasible to see whether these results can be confirmed and remain intact in different CA populations.FIGURES & TABLESFIGURE 1

A 13-year-old woman was underwent transthoracic two-dimensional echocardiography (2DE), which revealed that only a small anterolateral papillary muscle was observed in the left ventricle (LV). Additional transthoracic three-dimensional echocardiography (3DE) revealed the posteromedial-papillary muscle which has not correctly delaminated from the LV wall and directly connected to the mitral valve leaflets without tendon chordae. She was diagnosed as a parachute-like asymmetric mitral valve rather than a true-parachute mitral valve. It was difficult to understand the precise anatomy evaluated by the 2DE. However, additional 3DE provided helpful information to reveal the exact characteristics of papillary muscle tissue.

In this paper, an valid numerical algorithm is presented to solve variable fractional viscoelastic pipes conveying pulsating fluid in the time domain and analyze dynamically the vortex-induced vibration of the pipes. Firstly, Coimbra variable fractional derivative operators are introduced. Meanwhile, using Hamilton's principle and a nonlinear variable fractional order model, the governing system of equations is established. The unknown functions of the system of equations are approximated with shifted Legendre polynomials. Then, convergence analysis and numerical example investigate the effectiveness and accuracy of the proposed algorithm. Finally, the influences of different parameters on the dynamic response of the viscoelastic pipe are studied. The influencing factors and their ranges of the transient and long-term chaotic states of the pipe are analyzed. In addition, the proposed algorithm shows enormous potentials for solving the dynamics problems of viscoelastic pipes with the variable fractional order models.

Arteriovenous Fistula (AVF) is an exceedingly rare sequelae following arthrocentesis of the temporomandibular joint. This case report discusses a constellation of symptoms, findings, and appropriate management of a patient with a superficial temporal AVF. Several findings in this case, including vertigo, nystagmus, and hearing loss, have not been previously documented.

A comparison study of fatigue behavior in Al-Al and Al-steel refill friction stir spot welding jointHaokun Yang1a*, Detao Cai2,3a, Jiaxin Li1, Chin Yung Kwok1, Yunqiang Zhao3, Yu Li4, Haisheng Liu4, Waiwah Lai11 Smart Manufacturing Division (SMD), Hong Kong Productivity Council (HKPC), Hong Kong 999077, People’s Republic of China2 State Key Laboratory of Advanced Design and Manufacturing for Vehicle Body, Hunan University, Changsha, Hunan 410082, People’s Republic of China3 China-Ukraine Belt and Road Joint Laboratory on Materials Joining and Advanced Manufacturing, China-Ukraine Institute of Welding Guangdong Academy of Sciences, Guangzhou, Guangdong 510650, People’s Republic of China4 Center for Industrial Analysis and Testing, Guangdong Academy of Science, Guangzhou, Guangdong 510650, People’s Republic of Chinaa These authors contribute equallyCorresponding author: Haokun Yang, +852 27885679,[email protected]: Refill friction stir spot welding, Fatigue fracture, Aluminum, Steel

Aim: We aimed to identify dislocation, myelomalacia, and other congenital pathologies that may cause neurological complications arising from the odontoid process in the craniocervical junction (CVJ) of patients who were performed cervical tomography due to various complaints. Materials and Methods: Patients who were performed cervical CT with various complaints between 2010 and 2018 were retrospectively screened and evaluated, from the hospital registry system. Segmentation and fusion anomalies arising from the odontoid process in the craniovertebral junction area, as well as other accompanying pathologies such as subluxation, dislocation, compression to the spinal cord, and myelomalacia were also recorded. An additional 1.5 Tesla cervical MRI was performed for the 12 patients with os odontoideum. Radiological evaluation was performed on the workstation by an experienced radiologist. Results: 2525 patients with cervical CT were included in the study. 67 of these patients had congenital anomalies at the CVJ. 13 of 67 patients had os odontoideum, 38 had Klippel-Feil syndrome (KFS). Atlanto-occipital assimilation (AOA) and KFS often saw together. Only AOA was observed in 16 cases. Neck pain and limitation of movement were the most common findings in patients with congenital anomalies in the CVJ region. Conclusion: Congenital anomalies at the CVJ region, although rare, can cause mortality or morbidity. Cervical CT and MRI studies on the CVJ region should be evaluated carefully by the clinicians due to the risk of various complications.

BACKGROUND/AIM To evaluate outcomes of concurrent Cox-Maze procedures in elderly patients undergoing high-risk cardiac surgery. MEHODS We retrospectively identified patients aged over 70 years with Atrial Fibrillation (AF) from 2011 to 2017 who had two or more other cardiac procedures. They were subdivided into two groups: 1. Cox-Maze IV AF ablation 2. No-Surgical AF treatment. Patients requiring redo procedures or those who had isolated PVI or LAAO were excluded. Heart rhythm assessed from Holter reports or 12-lead ECG. Follow-up data collected through telephone consultations and medical records. RESULTS There were 239 patients. Median follow up was 61 months. 70 patients had Cox-Maze IV procedures (29.3%). Demographic, intra- and post-operative outcomes were similar between groups although duration of pre-operative AF was shorter in Cox-Maze group (p=0.001). One (1.4%) patient in Cox maze group with 30-day mortality compared to 14 (8.2%) the control group (p=0.05). Sinus rhythm at annual and latest follow-up was 84.9% and 80.0% respectively in Maze group - significantly better than No-Surgical AF treatment groups (P<0.001). 160 patients (66.9%) were alive at long-term follow-up with better survival curves in Cox Maze group compared to No-Surgical treatment group (p=0.02). There was significantly higher proportion of patients in NYHA 1 status in Cox-Maze group (p=0.009). No differences observed in freedom from stroke (p=0.80) or permanent pacemaker (p=0.33). CONCLUSIONS. Surgical ablation is beneficial in elderly patients undergoing high-risk surgery - promoting excellent long-term freedom from AF and symptomatic/prognostic benefits. Therefore, surgical risk need not be reason to deny benefits of concomitant AF-ablation.

BACKGROUND. Histological evaluation has a crucial role in diagnosing hepatic diseases and percutaneous liver biopsy (PLB) is widely chosen for this purpose. We aim to describe its indications, the rate and severity of adverse events (AEs) in an outpatient and ultrasound (US)-guided setting over 5 years. METHODS. This observational, single-center, and retrospective study included patients submitted to PLB between 2015 and 2019. We collected age, gender, coagulation tests, comorbidities, and number of needle passes. The association between the variables and outcomes (pain, mild and serious AEs, hospital admission, surgical treatment, and death) was evaluated using the generalized estimating equations method. RESULTS. We analyzed 532 biopsies in 524 patients (55.3% male) aged 49y (13–74y). Almost 39% had cardiovascular comorbidities and 18% had overweight/obesity. Hepatitis C virus (HCV) chronic infection was the major indication for PLB (47%), followed by autoimmune hepatitis/cholestasis (12.6%), and metabolic dysfunction-associated fatty liver disease (MAFLD) (12.1%). The number of HCV-related biopsies had a remarkable reduction, while MAFLD-related procedures have progressively raised over time. Around 54% of the patients reported pain, which was significantly associated with the female gender (p=0.0143). Serious AEs occurred in 11 patients (2.1%); hospital admission was necessary in 10 cases (1.9%), but no patient required surgical approach and there were no deaths. No significant association was found between the occurrence of AEs and the studied variables (clinical, laboratory, and number of needle passes). CONCLUSION. Real-time US-guided PLB is safe to perform in an outpatient setting and its indications have notably undergone a transition from HCV to MAFLD over the years. New strategies to prevent biopsy-related pain are still needed, especially for females.

The coronavirus disease 2019 (COVID-19) pandemic started over one year ago and produced almost 3.5 million deaths worldwide. We have been recently overwhelmed by a wide literature on how the immune system recognizes Severe Acute Respiratory Syndrome Coronavirus 2 and contributes to COVID-19 pathogenesis. Although originally considered a respiratory viral disease, COVID-19 is recognized as a far more complex, multi-organ-, immuno-mediated-, and mostly heterogeneous disorder. Though efficient innate and adaptive immunity may control infection, when the patient fails to mount an adequate immune response, a high innate-induced inflammation can lead to different clinical outcomes through heterogeneous compensatory mechanisms. The variability of viral load and persistence, the genetic alterations of virus-driven receptors/signaling pathways and the plasticity of innate and adaptive responses may all account for the extreme heterogeneity of pathogenesis and clinical patterns. As recently done for some inflammatory disorders as asthma, rhinosinusitis with polyposis and atopic dermatitis, herein we suggest to define different endo-types and the related phenotypes along COVID-19. Patients should be stratified for evolving symptoms and tightly monitored for surrogate biomarkers of innate and adaptive immunity. This would allow to preventively identify each endo-type (and its related phenotype) and to treat patients precisely with agents targeting pathogenic mechanisms.

A document by Isabella Annesi. Click on the document to view its contents.

In this study, a theoretical investigation of the photoinduced charge transfer (CT), electron injection, regeneration and Non-linear optical (NLO) of the A1-A4 structures were carried out for optoelectronic applications based on tetrahydroquinoline (C1-1) dye. Besides, a detailed assessment of the association among the electronic structures, chemical hardness, spectral and photovoltaic (PV) presentation were defined in DSSCs. Furthermore, this exploration purposes improved the electron-injection procedure, as well as the light-harvesting efficiency (LHE) of the dyes. For the research purpose, PO3H2, CONHOH, SO2H and OH (A1-A4) chromophores effects among the tetrahydroquinoline moieties related via a thiophene group were used as the electron acceptor group. The density functional theory (DFT) and time-dependent DFT (TD-DFT) calculations were executed on the designing dye molecules. The presentation of three functional groups (Becke’s three-parameter and Lee-Yang-Parr (B3LYP), coulomb-attenuating method-B3LYP (CAM-B3LYP) and Head-Gordon model (ωB97XD) were analyzed maximum absorption peak for C1-1. Here, TD-ɷB97XD with the 6-31G(d) combined functional and basis set were provided reliable effects to the C1-1. Therefore, newly designed A1-A4 dyes in absorption spectra were followed by TD-ɷB97XD method. Among these results, A1 dye displays red-shift and higher molar extinction coefficient than the other dyes and C1-1. It is specified that the PO3H2 have better PV properties, compared to literature. The NLO belongings of the A1-A4 sensitizers were derived in the polarizability and first-order hyperpolarizability. The calculated value of A1 dye has best for NLO presentation. The theoretically outcomes were intensely recommended that molecular proposal of the sensitizer has a vital role for the optoelectronic properties.

The present work focuses on the synthesis and characterization of four hydrazone derivatives. The structures of the synthesized compounds were determined through spectroscopic techniques via., EI MS, &1H NMR. The experimental results demonstrate that the obtained compounds successfully synthesize and screened for DPPH free radical scavenging activity, ferrous ion-chelating activity, ferric ion reducing activity, total antioxidant activity, and hydroxyl radical scavenging activity. Density Functional Theory (DFT) calculations were carried out by the Gaussian 09 package by using a hybrid density functional B3LYP (at 6-31G, 6-311G, and 6-31G++(d,p) basis sets) to investigate the electronic, molecular structures and provide useful spectroscopic and structural information. The computational data obtained from 1H NMR calculations were quite compatible with the experimental results. DFT calculations optimized the molecular geometry and estimated the highest occupied molecular orbital (HOMO) and lowest unoccupied molecular orbital (LUMO) energy of these compounds. Additionally, the charge transfer within the molecule and favorable sites for the electrophilic and nucleophilic attack was explored. Furthermore, the frontier molecular orbital (FMO) calculations were used to calculate different reactivity parameters, i.e., ionization potential, electron affinity, electronegativity, chemical hardness, chemical softness, and electrophilicity index.

This article used three diversion power stations with different operating years along Dicun stream of the source of Jiulong River to study the riparian plant community and discussed the impact of power station development on riparian plants. The results showed that:(1)There were significant differences in the plant diversity of herbs, shrubs and trees among all sample plots in the study area (P < 0.05).(2) The species number of the second and third diversion power stations with longer operation time was larger than that of the fourth diversion power station with short operation time.(3) The water-borne plants were concentrated in the herb layer in the influence area of the diversion power station, and the Richness, Shannon- Wiener, Simpson and Pielou indexes of water-borne plants in the study area were significantly different (P < 0.05). (4) The appearance of diversion power station leaded to the change of environmental factors, and the river depth and flow rate had significant positive correlation with the diversity index of riparian plants and water water-borne plants (P < 0.05). In general, with the increase of the operation time of the power station, the surrounding riparian plant will form a new stable community.

In this paper, a theoretical analysis model and two simulation methods are applied to characterize the quasi-static and fatigue delamination of composite laminate with uneven thicknesses. The test data of partially reinforced double-cantilever beam (DCB) were used as benchmark to verify the analysis model and simulation, and cohesive zone models (CZMs) and virtual crack closure technique (VCCT) are used in simulation. It’s shown that the partially reinforced DCB has a unique double-peak load-displacement relationship, and produces instability development during the delamination. By comparing the results of simulation and experiment, it is found that the simulation based on the exponential CZM can simulate the delamination process of partially reinforced DCB under both quasi-static and fatigue loading; while VCCT method will generate a straight delamination front edge in the area of reinforcement, and lost the micro-damage of the previous loading step between load steps, and result in an incorrect delamination behavior.

Allergic diseases include asthma, atopic-dermatitis, allergic-rhinitis, drug hypersensitivity and food-allergy. During the past years, there has been a global outbreak of allergic diseases, presenting a considerable medical and socioeconomical-burden. A large fraction of allergic diseases is characterized by a type-2 immune response involving Th2 cells, type-2 innate lymphoid cells, eosinophils, mast cells, and M2 macrophages. Biomarkers are valuable parameters for precision medicine as they provide information on the disease endotypes, clusters, precision diagnoses, identification of therapeutic targets, and monitoring of treatment efficacies. The availability of powerful omics technologies, together with integrated data analysis and network-based approaches can help the identification of clinically useful biomarkers. These biomarkers need to be accurately quantified using robust and reproducible methods, such as reliable and point-of-care systems. Ideally, samples should be collected using quick, cost-efficient and non-invasive methods. In recent years, a plethora of research has been directed towards finding novel biomarkers of allergic diseases. Promising biomarkers of type-2 allergic diseases include sputum eosinophils, serum periostin and exhaled nitric-oxide. Several other biomarkers, such as pro-inflammatory mediators, miRNAs, eicosanoid molecules, epithelial barrier integrity, and microbiota changes are useful for diagnosis and monitoring of allergic diseases and can be quantified in serum, body-fluids and exhaled-air. Herein, we review recent studies on biomarkers for the diagnosis and treatment of asthma, chronic-urticaria, atopic-dermatitis, allergic-rhinitis, chronic-rhinosinusitis, food-allergies, anaphylaxis, drug hypersensitivity and allergen-immunotherapy. In addition, we discuss COVID-19 and allergic diseases within the perspective of biomarkers and recommendations on the management of allergic and asthmatic patients during the COVID-19 pandemic.

The salmonid-specific fourth vertebrate whole-genome duplication (Ss4R) occurred ~80 million years ago in the ancestor of all salmonids and provides a unique opportunity to study the evolutionary history of the duplicated genome. Study of the genome of Brachymystax lenok tsinlingensis might be particularly insightful given that this is the only Brachymystax species with a published salmonid genome. Here, we present a high-quality chromosome-level genome assembly for B. l. tsinlingensis and found that the salmonids have a unique GC content and codon usage, have undergone a whole-genome duplication event and a burst of transposon-mediated repeat expansion, have a slower evolutionary rate, and possess specific expanded gene families and unique positively selected genes. Generally, the B. l. tsinlingensis genome could provide a valuable reference for the study of other salmonids as well as aid the conservation of this endangered species.

Anthropogenic withdraw of groundwater and climatic drought results in the decline of groundwater depth that, in turn, severely limits the water availability for phreatophytic vegetation in arid regions. In this study, a small xeric, phreatophytic tree Haloxylon ammodendron (C.A. Mey.) was investigated to understand the influence of depth to groundwater (DGW) on hydraulic traits and on the trade-off between drought tolerance and leaf area increment. A suite of traits including leaf water potential, pressure–volume (P–V) curves, Huber value, assimilation branch growth, and osmotic regulation substance were measured across five sites with DGW ranges from 3.45 to 15.91 m. Our results indicate that H. ammodendron was subject to greater water stress with increasing DGW, as indicated by decreased predawn (Ψpd) & midday (Ψmd) branch water potential. We also found that growth rate declined as Huber value increased with increasing DGW in the early growing season (EGS). Solute sugar, as a major osmotic substance, drives decreases in osmotic potential at full turgor, and thus constrains assimilation branch growth with increasing DGW in EGS. Therefore, osmotic adjustment accompanied with water potential regulation (Ψpd－Ψmd) and plasticity of Huber value allows this phreatophyte to absorb water from deeper soil layers and tolerate drought. However, these adaptive adjustments cannot fully compensate for nonoptimal water conditions as growth rate continued to decrease as DGW increased in EGS and even became negative in the late growing season (LGS) at almost all sites. Our results provide an insight into how H. ammodendron responds and adapts to changes DGW in a region experiencing hydrological and climatic drought. Greater depth of groundwater had a significant effect on H. ammodendron and may have similar effects for other non-riparian phreatophytic plants in arid regions.