Background: The optimal treatment of high-risk PE with cardiac arrest is still controversial although various treatment approaches have been developed and improved. Here, we present a serie of patients with high-risk PE showing hemodynamic collapse, who were successfully treated with extracorporeal membrane oxygenation (ECMO) as an adjunct to EKOS™ acoustic pulse thrombolysis. Method: From April 2016 to June 2020, 29 patients with high-risk PE with cardiac arrest were retrospectively included. The mean age was 55.3 ± 9.2 years. Twelve (41.3%) patients were female. All patients had cardiac arrest, either as an initial presentation or in-hospital after the presentation. All patients exhibited acute symptoms, computed tomography (CT) evidence of large thrombus burden, and severe right ventricular dysfunction. Primary outcome was all-cause 30-day mortality. Results: Twenty-two patients survived to hospital discharge, with a mean ICU stay of 9.9 ± 1.6 days (range, 7 to 22 days) and mean length of hospital stay of 23.7 ± 8.5 days (range, 11 to 44 days). Six patients died from refractory shock. Ninety-day mortality was 24.1% (7/29). The Mean ECMO duration was 3.5 ± 1.1 days and the mean RV/LV ratio decreased from 1.31 ± 0.17 to 0.92 ± 0.11 in patients who survived to discharge. The mean tissue plasminogen activator (tPA) dose for survivor patients was 20.5 ± 1.6 mg. Conclusion: Patients with high-risk pulmonary embolism who suffer a cardiac arrest have high morbidity and mortality. APT complemented by ECMO could be a successful treatment option for patients who have high-risk PE with circulatory collapse.

Multisystem Inflammatory Syndrome is a rare and novel clinical presentation described during the evolving Covid- 19 pandemic. The condition is usually presenting as a sepsis-like syndrome leading to secondary multiorgan dysfunction post-COVID-19 infection. Although the syndrome has been mainly described in children, rare adults' form has been similarly described.

Difficulties during surgery are uncommon situations in appendectomy. For granulomatous appendicitis, literature is insufficient about surgical findings. The procedure of a 17-year-old male patient was a struggle due to adhesions. I thought a surgeon could expect granulomatous diseases by evaluating the macroscopic appearance of the appendix during surgical procedure.

Psoriasis is a chronic inflammatory disease with characteristic skin manifestations. Several pathogens can cause flare-ups of psoriasis. The risks of skin infections are increased in patients receiving immunomodulators. A patient with chronic psoriasis presented with human papillomavirus infection and anogenital warts and was treated surgically with acceptable results.

In this paper, the link between combinatorial structures and alternative algebras is studied, determining which configurations are associated with those algebras. Moreover, the isomorphism classes of each 2-dimensional configuration associated with these algebras is analyzed, providing a new method to classify them. In order to complement the theoretical study, two algorithmic methods are implemented: the first one constructs and draws the (pseudo)digraph associated with a given alternative algebra and the second one tests if a given combinatorial structure is associated with some alternative algebra.

In this paper, we investigate vector Lakshmanan-Porsezian-Daniel (VLPD) model which can be used to describe the ultrashort pulses in the birefringent optical fiber. Based on the unified transformation method, the Riemann-Hilbert problem is introduced and initial-boundary value problems of the VLPD model are studied. By solving the formulated matrix Riemann-Hilbert problem, the potential function solutions of the VLPD model can be reconstructed. Moreover, that the spectral functions are not independent but meet the so-called global relation is shown.

The access of drugs into the central nervous system (CNS) is regulated by the blood-brain barrier (BBB) and blood-spinal cord barrier (BSCB). A large body of evidence supports perturbation of these barriers in neurodegenerative diseases, including Alzheimer’s disease and Parkinson’s disease. Modifications to the BBB and BSCB are also reported in amyotrophic lateral sclerosis (ALS), albeit these modifications have received less attention relative to those in other neurodegenerative diseases. Such alterations to the BBB and BSCB have the potential to impact on CNS exposure of drugs in ALS, modulating the effectiveness of drugs intended to reach the brain and the toxicity of drugs that are not intended to reach the brain. Given the clinical importance of these phenomena, this review will summarise reported modifications to the BBB and BSCB in ALS, discuss their impact on CNS drug exposure and suggest further research directions so as to optimise medicine use in people with ALS.

1. Kānuka (Kunzea serotina, Myrtaceae) dryland shrubland communities of the lowland plains of South Island (Te Wai Pounamu) New Zealand (Aoteoroa) contain a ground cover largely consisting of mosses, predominantly Hypnum cupressiforme. There has been no previous study of the role of mosses in this threatened habitat which is currently being restored within a contemporary irrigated and intensively-farmed landscape that may be incompatible with this component of the ecosystem. 2. The aim of the present study was to investigate the influence of moss ground cover on hydrology, nitrogen (N) availability and vascular plant interactions, and in relation to nutrient spillover from adjacent farmland. Experimental work was a combination of glasshouse experiments and field-based studies. 3. Extremes of soil temperature and moisture were found to be mediated by the moss carpet, which also influenced N speciation; available N declined with moss depth. The moss layer decreased the amount of germination and establishment of vascular plants but, in some cases, enhanced their growth. Spillover of mineral nitrogen and phosphate from farmland enhanced invasion of exotic grasses which may have benefited from conditions provided by the moss carpet. 4. Synthesis: We found the moss layer to be crucial to ecosystem functioning in these dry habitats with low nutrient substrate. However, when the moss layer is accompanied by nutrient spillover it has the potential to increase exotic weed encroachment. Our results emphasise the importance of non-vascular plant inclusion in restoration schemes but also highlights the importance of mitigating for nutrient spillover.

The grander challenge of pediatric oncology: disparities in access to careJoseph Lubega, M.D., M.S., C.P.E.Baylor College of Medicine6701 Fannin St., Ste. 1510 Houston, TX [email protected]: +1 832 822 4242Fax: +1 832 825 1453Word count: 968Short running title: Disparities in access to pediatric cancer careKeywords: pediatric cancer, disparities, global, minoritiesThe excellent survival of children with cancer in the United States (US) is a grand achievement that has been accomplished mainly through five decades of translating biomedical discoveries to the bedside. However, it obscures the significantly inferior survival of racial-ethnic minorities in the US1, 2, and highlights the unconscionably abysmal survival of children with cancer globally3. Intrinsic differences in epidemiology of prognostically relevant tumor and host biological factors contribute to these survival disparities. However, as demonstrated by the fact that the widest survival disparities occur among children with the most curable cancers and risk-groups2,4, the primary driver of inferior survival among minorities and children globally islack of access to effective pediatric cancer care. Discovery of efficacious therapies was/is the grand challenge to pediatric oncology; ensuring access to effective care for all children in the US and globally is the grander challenge of pediatric oncology.Access to health services is a complex construct that includes5: (1) availability of the services to a specific population, (2) adequate supply of the services to the population, (3) ability to utilize the health services, which includes requisite financial (e.g., medical insurance coverage) and social (e.g., flexibility of work schedule to attend medical appointments) resources, and (4) suitability of the services to the socio-cultural context of all demographic groups in the population. For the majority of the world’s children that develop cancer (~80%) and live in low/middle income countries, infrastructure and expertise for evidence-based pediatric oncology services are simply unavailable or are extremely scanty. On the other hand, racial-ethnic minorities in the US also suffer from lack of access to adequate pediatric oncology care despite the apparent abundance of services – suggesting barriers to utilization and/or suitability of services.In this issue of Pediatric Blood & Cancer , Zheng D.J. et al present an evaluation of access to a psychiatry service that is integrated into a children’s cancer center – the Dana-Farber/Boston Children’s Cancer and Blood Disorders Center (DF/BCH) from 2013 to 2017. The authors examined the relationship between utilization of this psychiatry service and patients’ socio-demographic characteristics. Among a sample of 394 children with cancer that were evaluated, racial/ethnic minorities had 52% lower odds of using the psychiatry service. Household material hardship and household income, two indicators of financial deprivation that may be considered the most obvious determinants of service utilization, did not influence utilization of this psychiatry service. For children who utilized the psychiatry service, 88% were diagnosed with a psychiatric disorder, 76% were given a pharmacological therapy and 62% were given a behavioral intervention for their diagnosis. The high occurrence of a specific diagnosis and therapeutic interventions for the children that used the psychiatry services suggest that this is a highly valuable service for children that are referred.Zheng D.J. et al’s findings demonstrate that availability of services does not equate to access, and that it is often difficult to pin-point the underlying reasons. Although racial-ethnic minorities in the US are associated with financial deprivation, financial indicators did not explain the disparity in utilization of psychiatry services at DF/BCH6. This suggests other utilization or suitability factors were at play. Such factors may include stereotypical beliefs, attitudes, or practices in the interactions between minorities and health providers that negatively influence clinical decision-making and effectiveness7. In this case such stereotypes may influence minority children’s or parents’ rapport with their oncology providers and willingness of parents to report mental or behavior symptoms, and oncologists’ suspicion and threshold to make a psychiatric referral. Other practical social-cultural factors such as language barriers can influence utilization of services even when foreign language translators are used, particularly in the culturally sensitive realm of mental illness and behavioral disorders8.Research to identify and quantify these disparities and their underlying mechanisms is critical to devise effective strategies that will overcome the systemic dynamics that deter minority children from accessing optimal cancer care. In the case of Zheng D.J. et al’s findings, it would be very informative to determine the exact nature of the disparity by evaluating whether, (1) minorities were genuinely less likely to require a psychiatric consultation – a potential difference in disease epidemiology, (2) minorities needed psychiatric services but were not referred – suggesting inferior quality of care, (3) minorities were referred but never followed through on the psychiatric referral – a utilization problem. Mixed methods study designs that complement quantitative data with qualitative insights and involving key players (e.g., providers and minority patients in this case), can unveil critical issues around usability and acceptability that often underly under-utilization of services.Global and US disparities in pediatric cancer care and outcomes epitomize the public health adage that discovery of efficacious biomedical interventions does not automatically translate into improved health services and outcomes for those that need them. Whereas many pediatric oncology researchers are acutely aware of the difficulty to translate research innovations into bedside interventions (aka,“the valley of death”)9, most children/families affected by cancer globally are on the wrong side of a pediatric oncology “death canyon” – a complex milieu of financial, social-cultural, business interests, and health systems barriers that lie between them and the bedside (Figure 1). Enough scientific technologies have made it to the bedside to cure them, but only a few children can make it to the bed.Research that bridges efficacious interventions and their delivery to children with cancer is critically needed. In addition to dedicateddisparities research , hybrid designs that build disparity questions in translational, clinical trials, and epidemiology research are likely to be efficient and even more informative. This requires broadening the scope of research teams and meticulous recruitment of appropriate socio-demographic strata of research participants. For global settings where the landscape of health systems infrastructure and organization and social-cultural norms are very different,implementation research is urgently needed to innovate strategies that will enhance the adoption of pediatric cancer best practices that suit the local context.

Objectives: We aim to analyze long-term voice outcomes and Quality of Life (QoL) in patients undergoing Open Partial Horizontal Laryngectomy Type II (OPHL Type II) and to compare them to those obtained by patients undergoing Total Laryngectomy (TL) with voice prosthesis (VP). Design: Cross-sectional cohort study Setting: patients undergoing surgery for advanced laryngeal cancer, assessed during the usual follow-up consultations at the Phoniatric Unit (February 2020-December 2020). Participants: Forty-five patients were enrolled and divided into two groups: OPHL Group and TL Group. Main outcomes measures: Maximum phonation time, INFV0 scale, I-SECEL, UWQoL-V4 and MDADI questionnaires were used to assess the long-term outcomes. Results: Voices of patients undergoing OPHL Type II were worse than those of laryngectomized patients with VP. Nevertheless, scores in voice and dysphagia-related QoL were comparable and scores in the Social domain of QoL were better in OPHL group. Conclusions. OPHL Type II allows an acceptable voice recovery and a satisfactory QoL.

OBJECTIVE Little is known about the efficacy of using artificial intelligence to identify laryngeal carcinoma from images of vocal lesions taken in different hospitals with multiple laryngoscope systems. This multicenter study was aimed to establish an artificial intelligence system and provide a reliable auxiliary tool to screen for laryngeal carcinoma. Study Design: Multicentre case-control study Setting: Six tertiary care centers Participants: The laryngoscopy images were collected from 2179 patients with vocal lesions. Outcome Measures: An automatic detection system of laryngeal carcinoma was established based on Faster R-CNN, which was used to distinguish vocal malignant and benign lesions in 2179 laryngoscopy images acquired from 6 hospitals with 5 types of laryngoscopy systems. Pathology was the gold standard to identify malignant and benign vocal lesions. Results: Among 89 cases of the malignant group, the classifier was able to evaluate the laryngeal carcinoma in 66 patients (74.16%, sensitivity), while the classifier was able to assess the benign laryngeal lesion in 503 cases among 640 cases of the benign group (78.59%, specificity). Furthermore, the CNN-based classifier achieved an overall accuracy of 78.05% with a 95.63% negative prediction for the testing dataset. Conclusion: This automatic diagnostic system has the potential to assist clinical laryngeal carcinoma diagnosis, which may improve and standardize the diagnostic capacity of endoscopists using different laryngoscopes.

We present a focused analysis of user studies in explainable artificial intelligence (XAI) entailing qualitative investigation. We draw on social science corpora to suggest ways for improving the rigor of studies where XAI researchers use observations, interviews, focus groups, and/or questionnaires to capture qualitative data. We contextualize the presentation of the XAI papers included in our analysis according to the components of rigor described in the qualitative research literature: 1) underlying theories or frameworks, 2) methodological approaches, 3) data collection methods, and 4) data analysis processes. The results of our analysis support calls from others in the XAI community advocating for collaboration with experts from social disciplines to bolster rigor and effectiveness in user studies.

Resistance evolution, from genetic mechanism to ecological contextRegina S. Baucom1, Veronica Iriart2, Julia Kreiner3, and Sarah Yakimowski41Ecology and Evolutionary Biology Department, University of Michigan, Ann Arbor, Michigan, USA2Department of Biological Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania, USA3Biodiversity Research Centre & Department of Botany, The University of British Columbia, Vancouver, BC V6T 1Z44Department of Biology, Queen’s University, Kingston, ON K7L 3N6CorrespondenceRegina S. Baucom, Ecology and Evolutionary Biology Department, University of Michigan, Ann Arbor, Michigan, 48109.Email: [email protected]*Authors contributed equallyPesticide use by humans has induced strong selective pressures, reshaping evolutionary trajectories, ecological networks, and even influencing ecosystem dynamics. The evolution of pesticide resistance across weeds, insects, and fungi often leads to negative impacts on both human health and the economy while concomitantly providing excellent systems for studying the process of evolution. In fact, the study of pesticide resistance has been a feature of evolutionary biology since the Evolutionary Synthesis, with Dobzhansky noting in his book The Genetics and Origins of Species (1937) that cyanide resistance in the California red scale constituted the “best proof of the effectiveness of natural selection yet obtained”. Following the pioneering work of James Crow and others in the 1950’s—which greatly expanded our knowledge of the genetics underlying adaptation—the study of pesticide resistance has shed light on a variety of topics, such as the repeatability of phenotypic evolution across the landscape, ‘hotspots’ of evolution across the genome, and information on the number and type of genetic solutions that populations may employ to strong selection pressures.Landscape level approaches have come to the forefront over the last 20 years of resistance evolution research, often taking advantage of the fact that replicated populations of the same species are exposed to the same pesticide. Further, the resistance evolution field is turning more attention to the ecological context within which resistance evolution occurs, likely stemming, at least in part, from an historical focus on fitness costs (Cousens & Fournier-Level 2018; Baucom 2019). This special feature, ‘Resistance evolution, from genetic mechanism to ecological context’ in Molecular Ecology captures the current state of resistance evolution with contributions broadly addressing the question ‘What has the rapid evolution of pesticide resistance taught us about genome dynamics and adaptation as well as the ecological context within which resistance evolution occurs?’ Below, we contextualize the manuscripts in this special issue that provide insight into the state of the art investigations of resistance evolution across various species of insects, weeds and fungi.

The use of the Radial Artery (RA) as a conduit in coronary artery bypass grafting (CABG) has been steadily increasing since the early 1990’s and based on the most recent data may well become the standard of care for patients with multi-vessel coronary artery disease (CAD) requiring multiple arterial grafts. The TRA approach for cardiac catherization has also increased steadily in use by interventional cardiologists owing to its reduction in bleeding and vascular complications when compared with the femoral approach and is now considered the preferred arterial access. However, prior use of transradial access (TRA) for cardiac catherization is a contra-indication for the use of the RA for CABG because of high rates of structural damage to the vascular wall and potential for graft failure. In this issue of the Journal of Cardiac Surgery Clarke et al. examine the RA of two patients who had TRA for coronary angiography 8 and 12 years prior and note that both patients had chronic injury with dissection and obstruction of the lumen secondary to fibrosis suggesting that TRA causes long-term and irreversible damage rendering them unsuitable as conduits for CABG.

Background: reliable country-specific data on influenza burden play a crucial role in informing prevention and control measures. Our purpose was to provide a comprehensive summary of the available evidence on the burden of seasonal influenza in Italy. Methods: we performed a sys-tematic literature review of articles published until 31 July 2020. PubMed, Embase and Web of Science were searched using terms related to burden, influenza, and Italian population. We in-cluded studies investigating seasonal influenza-related complications, hospitalizations and/or mortality. Results: sixteen studies were included: eight (50%) analyzed influenza-related compli-cations, eight (50%) hospitalizations, while seven (43.8%) influenza-related deaths. Only three studies (19.7%) concerned pediatric age. The synthesis of results showed that patients with chron-ic conditions have an increased risk for complications up to almost three times as compared to healthy people. Hospitalizations due to influenza can occur in as much as 5% of infected people depending on the study setting. Excess deaths rates were over six-fold higher in the elderly as compared to the rest of population. Conclusions: although there are still gaps in existing data, there is evidence of the significant burden that influenza places each year especially on high-risk groups. These data should be used to inform public health decision-making.

The aim of this paper was to compare the prediction performance of three strategies: general global Partial least squares regression (PLSR) using CSSL with and without spiking samples, memory-based learning (MBL) using CSSL with and without spiking samples and general PLSR using only spiking samples to predict soil organic matter in the target area. When using spiked subsets, we also investigated the prediction performance of the extra-weighted subsets. A series of spiking subsets randomly selected from the total spiking samples were selected by conditioned Latin hypercube sampling (cLHS) from the target sites. We calculated the mean squared Euclidean distance (msd) of different spiking subsets with the distribution density function of their vis–NIR spectra only and statistically inferred the optimal sampling set size to be 30. Our study showed that when the number of spiking were lower than 30, the predicted accuracy derived from global PLSR using CSSL spiked with and without extra-weighted samples was greater than the predicted accuracy derived from the general PLSR using the corresponding number of spiking samples only (RMSE 5.57–5.98 v.s. RMSE 6.76). Global PLSR using CSSL spiked with the statistically optimal local samples can achieve higher predicted performance (with a mean RMSE of 5.75). MBL spiked with five extra-weighted optimal spiking samples achieved the best accuracy with an RMSE of 3.98, an R2 of 0.70, a bias of 0.04 and an LCCC of 0.81. The msd is a simple and effective method to determine an adequate spiking size using only vis–NIR data.

Horizontal gene transfer via plasmids is important for the dissemination of antibiotic resistance genes among medically relevant pathogens. Specifically, the transfer of IncHI1A plasmids is believed to facilitate the spread of antibiotic resistance genes, such as carbapenemases, within the clinically important family Enterobacteriaceae. The microbial community of urban wastewater treatment plants has been shown to be highly permissive towards conjugal transfer of IncP1 plasmids. Here, we tracked the transfer of the P1 plasmid pB10 and the clinically relevant HI1A plasmid R27 in the microbial communities present in urban residential sewage entering full-scale wastewater treatment plants. We found that both plasmids readily transferred to these communities and that strains in the sewage were able to further disseminate them. Furthermore, that R27 has a broad potential host range, but a low host divergence. Interestingly, although the majority of R27 transfer events were to members of Enterobacteriaceae, we found a subset of transfer to other families, even other phyla. Indicating, that HI1A plasmids facilitate horizontal gene transfer both within Enterobacteriaceae, but also across families of especially Gammaproteobacteria, such as Moraxellaceae, Pseudomonadaceae and Shewanellaceae. pB10 displayed a similar potential host range as R27. In contrast to R27, pB10 had a high host divergence. By culture enrichment of the transconjugant communities, we show that sewage strains of Enterobacteriaceae and Aeromonadaceae can stably maintain R27 and pB10, respectively. Our results suggest that dissemination in the urban residual water system of HI1A plasmids may result in an accelerated acquisition of antibiotic resistance genes among pathogens.

Introduction Understanding the impact of scoliosis surgery on lung function is important for counseling patients about risks and benefits of surgery. We prospectively compared the trends in lung function test (LFT) results prior to and after scoliosis surgery in children with neuromuscular diseases, or dysmorphic syndromes. We hypothesized a stabilization. Methods We prospectively included children with neuromuscular or syndromic scoliosis able to perform LFTs. We studied (Forced) Vital Capacity ((F)VC), the ratio of Forced Expiratory Volume in 1 second (FEV1) and FVC, and Peak Expiratory Flow (PEF). Preoperative LFT results were compared with results 3-4 months after surgery. The mean monthly change in LFT results up to 2 years after surgery was compared with the preoperative natural history using linear mixed effects models. Results We included 43 patients. No significant change was observed in absolute values of (F)VC, FEV1/FVC and PEF prior to and after surgery. Median standardized VC, FVC and PEF decreased significantly after surgery from 59 to 58%, 60 to 51% and 61 to 53% respectively. The monthly rate of change in FVC was -0.13 % (95% CI -0.42 to 0.17) prior to surgery and -0.20% (95% CI -0.42 to 0.03) after surgery, mean difference -0.07 (95% CI -0.46 to 0.31; p=0.36). Conclusion No stabilization of lung function 3-4 months after scoliosis surgery was observed in children with neuromuscular and syndromic scoliosis with restrictive lung function disease. The effect of surgery on the rate of lung function decline remains inconclusive.