Refractory IDA and chronic occult bleeding from GI tract could happen due to BRBNS. Clinicians should keep in mind to detect the underlying diseases from GI tract by endoscopy. Precision diagnosis and appropriate intervention could booster to upgrade the quality of life for patients.

Objectives: To compare the endoscopic approach to manage attic cholesteatoma with conventional microscopic technique. Design: Randomized controlled trial. Participants: A total of 190 patients (192 ears) diagnosed with attic cholesteatoma extending to the antrum area (stages Ib and II) were randomly assigned into two groups: one undergoing endoscopic approach and the other undergoing the microscopic technique. Main outcome measures: The two groups were compared in terms of preoperative and intraoperative findings, access to hidden areas expressed in terms of the Middle Ear Structural Visibility Index (MESVI), mean operative time, and postoperative findings. Results: No difference in the parameters of the preoperative and intraoperative findings analyzed (patient age, computed tomography findings, disease stage, and intraoperative cholesteatoma characteristics) was observed between the endoscopic and microscopic groups. The median MESVI for the endoscopic group was better than that for the microscopic group (P<0.05). The mean operating time using the endoscopic approach was less than that using the microscopic approach (P<0.05). The median postoperative pain score in the endoscopic group was lower than that in the microscopic group (P<0.05). No significant difference was found between the two groups in terms of taste sensation, air-bone gap closure at the end of 4 weeks, and vertigo experienced at the end of the first week. When long-term surgical outcomes were assessed 1 year postoperatively, five patients in the microscopic group had recurrence, four had cartilage displacement, three had perforation, and five had retraction pocket formation. In the endoscopic group, four patients had disease recurrence, three had cartilage displacement, two had perforation, and four had retraction pocket formation. Conclusion: Endoscopic management of limited attic cholesteatoma showed definite advantages over the conventional microscopic approach, such as providing better visualization, requiring less postoperative time, subjecting the patients to less pain, and decreasing the incidence of complications.

Systemic mastocytosis is a life-threatening disease in which mast cell mediator release can lead to general symptoms. The most common triggers are stress and pain during labor and delivery. We report the management of labor and delivery in a case with severe systemic mastocytosis by epidural analgesia.

Umbilical cord blood allogeneic hematopoietic stem cell transplantation(UCBT) has been gradually applied in the treatment of patients with blood system diseases. This paper reports a case of a child patient with highly invasive T-cell lymphoma who underwent UCBT after chemotherapy and developed minimal change glomerulopathy after transplantation.

The chalcogen vacancy defects in various transition metal dichalcogenides (TMDCs) have been studied using density functional theory (DFT) calculation. Results reveal that (i) the dissociation energy value depends on both nature of chalcogen and transition metal, (ii) the work function depends marginally on the single or double vacancies, (iii) the defect transforms direct band gap to indirect band gap materials (i.e. the pristine materials show KVKC transition whereas defective materials show ΓVKC) and (iii) the d-orbital of the transition metal plays a vital role in the formation of impurity band.

DNA-barcoding and DNA-based species delimitation are major tools in DNA taxonomy. Sampling has been a central debate in this context, because the geographical composition of samples affect the accuracy and performance of DNA-barcoding. Performance of complex DNA-based species delimitation is to be tested under simpler conditions in absence of geographic sampling bias. Here, we present an empirical data set sampled from a single locality in a Southeast-Asian biodiversity hotspot (Laos: Phou Pan mountain). We investigate the performance of various species delimitation approaches on a megadiverse assemblage of herbivore chafer beetles (Coleoptera: Scarabaeidae) to infer whether species delimitation suffers in the same way from exaggerate infraspecific variation despite the lack of geographic genetic variation that led to inconsistencies between entities from DNA-based and morphology-based species inference in previous studies. For this purpose, a 658 bp fragment of the mitochondrial cytochrome c oxidase subunit 1 (cox1) was analysed for a total of 186 individuals of 56 morphospecies. Tree based and distance based species delimitation methods were used. All approaches showed a rather limited match ratio (max. 77%) with morphospecies. PTP and TCS prevailingly over-splitted morphospecies, while 3% clustering and ABGD also lumped several species into one entity. ABGD revealed the highest congruence between molecular operational taxonomic units (MOTUs) and morphospecies. Disagreements between morphospecies and MOTUs were discussed in the context of historically acquired geographic genetic differentiation, incomplete lineage sorting, and hybridization. The study once again highlights how important morphology still is in order to correctly interpret the results of molecular species delimitation.

Neutral zinc-air batteries (ZABs) are promising candidates for the next-generation power devices with considerably elongated lifetime comparing to conventional alkaline ZABs. However, neutral cathodic oxygen reduction reaction is seriously limited by the mass transfer efficiency of hydroxyl due to insufficient interfacial chemical potential-gradient between catalytic layer and electrolyte. Herein, we highlight that electrochemical oxidation induced surface microenvironment optimization could realize optimal chemical potential-gradient around catalytic sites and bring outstanding neutral ORR activity. The electro-deposited sub-nano Pt decorated surface-microenvironment-optimized Co2N samples (denoted as Pt-SMO-Co2N NWs) possessed 92 mV and 365 mV lower overpotential than commercial Pt/C and pristine Co2N in 0.2 M PBS. As for neutral ZABs, Pt-SMO-Co2N NWs cathode delivers a power density of 67.9 mW*cm−2 and displays negligible decay after nearly 80 hours stability test at 20 mA*cm-2. In depth characterization proposes that remarkable performance improvement originates from optimized microenvironment which increases the surface chemical potential gradient and facilitates proton coupled electron transfer during ORR. We anticipated that such synergetic optimization of microenvironment and intrinsic activity of active sites is an effective strategy which may be extended the catalytic reactions beyond ORR.

This paper presents the integrated machine learning and HEC-RAS models for flood inundation mapping in Baro River Basin, Ethiopia. A predictive rainfall-runoff and spatially distributed river simulation models were developed using Artificial Neural Networks (ANNs) and HEC-RAS respectively. Daily rainfall and temperature data of 7-yrs and Topographical Wetness Index (TWI) with a spatial resolution of 50 x 50m were used to train the ANN in R studio. The integration of the spatial and temporal variability in this paper improved the accuracy of the predictive models integrated with ANN and HEC-RAS. The predictive ANN model was tested with the observed daily discharge of the same temporal resolution and the rainfall-runoff result obtained from the tested ANN model was used as input for the HEC-RAS. The flood event of 2005 was used to verify the accuracy of flood generated in the HEC-RAS model by implementing the Normal Difference Water Index (NDWI). The comparison was made between the flood inundation map generated by HEC-RAS and flood events of different periods based on coverage percentage areas and a good agreement was reached with 96 % overlapped areas. The performance of ANN and HEC-RAS models were evaluated with 0.86 and 0.88 values at the training and testing period respectively. Finally, it was concluded that the integration of a machine learning approach with the HEC-RAS model in developing a flood inundation mapping is an appropriate tool to warn residents in this river basin.

Through a case of IHH complicated consumptive hypothyroidism and literature review, this study highlight better treatment protocol for these rare patients. It is helpful that simultaneous anti-tumor and thyroid replacement make diffuse IHH patients with consumptive hypothyroidism recovery better.

African swine fever (ASF) is one of the most severe infectious diseases of pigs. In this study, a LAMP assay coupled with the CRISPR Cas12a system was established in one tube for the detection of the ASFV p72 gene. The single-strand DNA-fluorophore-quencher (ssDNA-FQ) reporters and CRISPR-derived RNA (crRNAs) were screened and selected for the CRISPR detection system. In combination with LAMP amplification assay, the detection limit for the LAMP-CRISPR assay can reach 7 copies/μl of p72 gene per reaction. Furthermore, this method displays no cross-reactivity with other porcine DNA or RNA viruses. The performance of the LAMP-CRISPR assay was compared with real-time qPCR tests for clinical samples, a good consistency between the LAMP-CRISPR assay and real-time qPCR was observed. In the current study, a LAMP coupled with the CRISPR detection method was developed. The method shed a light on the convenient, portable, low cost, highly sensitive and specific detection of ASFV, demonstrating a great application potential for monitoring on-site ASFV in the field.

Background: Despite continued efforts, the majority of patients with valvular heart disease (VHD) remain undiagnosed and untreated. This study aimed to assess the adoptability and accuracy of point-of-care handheld echocardiographic assessments (POCE) in the primary care setting. Methods: Eleven previously untrained primary care providers were trained to use the Vscan Extend (GE, WI) POCE to assess VHD, left ventricular function (LVEF), and major extra-cardiac findings. Their assessments were compared to those of 3 blinded expert readers. A total of 180 assessments were evaluated using Kappa statistics (κ) together with their estimated standard error, p-value, and 95% CI bounds. Results: Identical or nearly identical agreement between previously untrained primary providers and expert readers was evident for the diagnosis of tricuspid regurgitation, mitral regurgitation, pericardial effusion, volume status. These agreements were strongest in apical long axis (κ =1, p<0.001) and parasternal long and short axis views (k>=0.82 p<0.001), though agreement remained robust in apical 4-chamber views (k>=0.76). The agreements in LVEF assessment were identical in the apical long axis view (κ =1, p<0.001) and robust in the remaining 3 views (κ>=0.66, p<0.001). The assessments of aortic stenosis (parasternal/long, κ =0.42, and parasternal/short, κ =0.47, both p<0.001) were weak in their agreement. Conclusion: Compared to expert echocardiography readers, the untrained providers’ use of POCE for VHD shows high user adoptability and diagnostic accuracies in the primary care setting.

Objectives: To determine the immediate post-operative course and outcome of pediatric patients with complicated acute mastoiditis (CAM) undergoing simple mastoidectomy. Study Design: A retrospective chart review of children diagnosed with CAM who underwent a mastoidectomy during 2012-2019. Setting: Tertiary care university hospital. Participants: 33 patients were divided into two groups: 17 patients with subperiosteal abscess (SPA) alone- single complication group (SCG) and 16 patients with SPA and additional complications (sigmoid sinus vein thrombosis, perisinus fluid/abscess, epidural abscess)-multiple complications group (MCG). Main Outcome Measures: post-operative data were collected. Demographics, microbiology data, inflammatory parameters, hospitalization length, and POF pattern were recorded, compared, and analyzed. Results: Of 162 acute mastoiditis patients, 33(20.4%) underwent surgery due to CAM; 17(51%) and 16(49%) belonged to the SCG and MCG, respectively. 6/17(35.3%) SCG patients experienced POF vs. 12/16(75%) in the MCG (P=0.012). At post-operative day 2 (POD2), 10/13(77%) febrile patients belonged to MCG and 3/13(23%) to SCG (P=0.013). POF was recorded until POD6 in both groups. Seven patients, all from MCG with POF, underwent second imaging with no new findings; A total of 18 positive cultures were reported. Fusobacterium necrophorum counted for 8/18(44.5%) of all positive cultures, 7/9(77.8%) in the MCG vs. 1/9(11.1 %) in the SCG, P=0.004. Streptococcus pneumoniae was reported only in SCG (5/9, 55.5%, vs. 0/9, P=0.008). Conclusion: Post-mastoidectomy fever due to CAM is not unusual and seems to be a benign condition for the first 5-6 days following surgery. MCG patients are more prone to develop POF. F. necrophorum is more likely to be associated with MCG, and S. pneumoniae is common in SCG patients. Keywords: Mastoiditis, post-operative fever, complications, microbiology

Molecular level insights into the mechanism and thermodynamics of CO oxidation by a (TiO2)6 cluster have been obtained through density functional calculations. Thereby, we have considered as an example, two different structural isomers of (TiO2)6 with the purpose of understanding the interplay between local structure and activity for the CO oxidation reaction. Active sites in the two isomeric forms were identified on the basis of global and local reactivity descriptors. For the oxidation of CO to CO2 we considered both sequential and simultaneous adsorption of CO and O2 on (TiO2)6 cluster through the ER and LH mechanisms, respectively. Three different pathways were obtained for CO oxidation by (TiO2)6 cluster, and the mechanistic route of each pathway were identified by locating the transition-state and intermediate structures. The effects of temperature on the rate of the reaction was investigated within the harmonic approximation. The structure-dependent activity of the cluster was rationalized through reactivity descriptors and analysis of the frontier orbitals. Finally, we also considered the effects of a support, i.e., graphene, on the oxidation mechanism.

Persistent Pulmonary Hypertension of the Newborn (PPHN) is defined as a failure of the normal circulatory transition after birth. PPHN manifests as a progressive and potentially fatal hypoxemic respiratory failure. The condition is associated with a persistent increase in pulmonary vascular resistance and reduced blood flow in the pulmonary vessels without an accompanying congenital heart defect. The abnormalities in pulmonary circulation lead to right-to-left shunting through the foramen ovale and usually also through the ductus arteriosus, with resultant hypoxemia, which manifests clinically as cyanosis. Management options in PPHN include optimal lung inflation, oxygenation, prevention of acidosis, stabilization of blood pressure, sedation and pulmonary vasodilator therapy. While inhaled nitric oxide (iNO) is the most commonly used treatment option, alternative methods can be used whenever is unavailable or contraindicated. We report three cases of severe PPHN, in which due to the lack of adequate response to intravenous MgSO4, the patients were switched to milrinone.

Chronic urinary schistosomiasis may lead to obstructive uropathy, contracted bladder secondary to ureteral calcific fibrosis. Appropriate surgical intervention , guided by renal function, bladder capacity and meticulous follow-up may lead to excellent long term urogenital outcomes , following simple cystectomy with orthotopic continent neocystoplasty

African Swine Fever Virus (ASFV) causes a deadly disease of pigs which spread through southeast Asia in 2019. We investigated one of the first outbreaks of ASFV in Lao Peoples Democratic Republic amongst smallholder villages of Thapangtong District, Savannakhet Province. In this study, two ASFV affected villages were compared to two unaffected villages. Evidence of ASFV-like clinical signs appeared in pig herds as early as May 2019, with median epidemic days on 1 and 18 June in the two villages, respectively. Using participatory epidemiology mapping techniques, we found statistically significant spatial clustering in both outbreaks (P < 0.001). Villagers reported known risk factors for ASFV transmission  such as free-ranging management systems and wild boar access  in all four villages. The villagers reported increased pig trader activity from Vietnam before the outbreaks; however, the survey did not determine a single outbreak source. The outbreak caused substantial household financial losses with an average of 9 pigs lost to the disease, and Monte Carlo analysis estimated this to be USD 215 per household. ASFV poses a significant threat to food and financial security in smallholder communities such as Thapangtong, where 40.6% of the district’s population are affected by poverty. This study shows ASFV management in the region will require increased local government resources, knowledge of informal trader activity and wild boar monitoring alongside education and support to address intra-village risk factors such as free-ranging, correct waste disposal and swill feeding.

Under a microgrid based (bottom-up) restoration strategy, considering a disaster related outage, the local generation is required to energize and supply the unaffected part of the network. Considering 100% renewable generation, only hydro based generation systems, if well equipped, can be able to blackstart and re-energize the network. Wind Energy Conversion Systems (WECSs) have been restricted to the latter stages of restoration due to their source intermittency and non-dispatchability and in order for them to participate in the initial restoration stages, voltage and frequency support auxiliary devices are required. This paper investigates the capability of a hybrid windfarm to participate in the initial stages of restoration similar to a conventional blackstart unit: Re-energization of the various network components and pick up of load. The auxiliary equipment in this case is a dump load to absorb excess power produced by the windfarm and a synchronous condenser to provide a stable voltage reference required for normal operation of the WECS. Firstly, the nominal range of operation is determined with an additional pitch control mode linking the dump load power to individual WECSs introduced for frequency control. Flicker and harmonics are investigated in determination of the hosting capacity. Studies are undertaken to investigate energization of transformers, underground cables, overhead lines and other non-blackstart units (including other WECSs). Consideration is given to Type 1 and Type 3 WECSs to investigate the capability of a non-inverter and inverter based WECS. MATLAB/Simulink has been used as the simulation platform due to its modelling flexibility.

Abstract Objectives: There is no study in the literature that patients with clinically-proven PET were evaluated by Valsalva CT. We aimed to evaluate the merit of Valsalva computed tomography (CT) in patients who had clinically-proven patulous Eustachian tube (PET). Design: Case-series Setting and participants: We recruited patients with clinically-proven PET. Participants: Main outcome measures: All participants underwent temporal bone CTs while they were performing the Valsalva maneuver in the supine position. Standard axial plane CT images, along with multiplanar reconstruction and 3D Air volume rendering, were used to visualize the ET in its entirety. Results: Three patients (2 females, one male) with a total of 6 ears were included in the study. All patients had suggestive symptoms of PET, including aural fullness, aerophony, and autophony and underwent clinical examination and audiologic tests. In all ears, the whole Eustachian tube could be visualized with Valsalva CT. Conclusion: For the first time, we demonstrated the merit of Valsalva CT in visualization of the Eustachian tube in its entirety in patients with clinically diagnosed PET.