Suspended sediment delivery and deposition in proglacial lakes is generally sensitive to a wide range of hydrometeorologic and geomorphic controls. High discharge conditions are of particular importance in many glaciolacustrine records, with individual floods potentially recorded as distinctive turbidites. We used an extensive network of surface sediment cores and hydroclimatic monitoring data to analyze recent flood turbidites and associated sediment transfer controls over instrumental periods at Eklutna Lake, western Chugach Mountains, Alaska. Close to a decade of fluvial data from primary catchment tributaries show a dominating influence of discharge on sediment delivery, with various interconnections with other related hydroclimatic controls. Multivariate fluvial models highlight and help quantify some complexities in sediment transfer, including intra-annual variations, meteorological controls, and the influence of subcatchment glacierization. Sediments deposited in Eklutna Lake during the last half century are discontinuously varved and contain multiple distinctive turbidites. Over a 30-year period of stratigraphic calibration, we correlate the four thickest flood turbidites (1989, 1995, 2006, 2012) to specific regional storms. The studied turbidites correlate with late-summer and early-autumn rainstorms with a magnitude of relatively instantaneous sedimentation 3 to 15 times greater than annual background accumulation. Our network of sediment core data captured the broad extent and sediment variability among the study turbidites and background sediment yield. Within-lake spatial modelling of deposition quantifies variable rates of downlake thinning and sediment focusing effects, and highlights especially large differences between the thickest flood turbidites and background sedimentation. This we primarily relate to strongly contrasting dispersion processes controlled by inflow current strength and turbidity. Sediment delivery is of interest for this catchment because of reservoir and water supply operations. Furthermore, although smaller floods may not be consistently represented, the lake likely contains a valuable proxy record of regional flooding proximal to major population centers of south-central Alaska including Anchorage.

Pangolins in the genus Manis are nocturnal, burrowing, insectivorous mammals listed as Critically Endangered or Endangered by the International Union for Conservation of Nature. Of the eight extant pangolin species worldwide, two species are found in Nepal: the Chinese pangolin (Manis pentadactyla) and the Indian pangolin (Manis crassicaudata). Despite having a great ecological role by controlling the ants or termite population, little attention has been given to the conservation interventions of both species of pangolins found in the Terai region (low land) of Nepal. The present study assesses habitat use and factors affecting the habitat choice of pangolins in low land (Terai), Nepal. The research was focused on Amritdharapani community forest of Chitwan district. Pangolin burrows were used as the indirect signs of pangolin presence. A total of thirty-nine burrows were observed at elevations ranging from 301 to 413 m asl. Burrows were frequently associated with north-west aspects, gentle slope (15º to 20º), moderate canopy cover (51 to 75%), red-colored soil, and acidic soils with pH 6.5 to 7. The burrows were most common in areas with weak human disturbance (i.e. 1500 to 1700 m from settlements), 800 to 1200 m from roads, and with-in 300 m from a water source and with-in 20 m from the nearest termitarium. This study revealed distance to settlement, distance to road, soil pH, and canopy cover as major factors affecting the habitat choice of pangolins in the study area.

Soil moisture signatures provide a promising solution to overcome the difficulty of evaluating soil moisture dynamics in hydrologic models. Soil moisture signatures are metrics that quantify the dynamic aspects of soil moisture timeseries and enable process-based model evaluations. To date, soil moisture signatures have been tested only under limited land-use types. In this study, we explore soil moisture signatures’ ability to discriminate different dynamics among contrasting land-uses. We applied a set of nine soil moisture signatures to datasets from six in-situ soil moisture networks worldwide. The dataset covered a range of land-use types, including forested and deforested areas, shallow groundwater areas, wetlands, urban areas, grazed areas, and cropland areas. Our set of signatures characterized soil moisture dynamics at three temporal scales: event, season, and a complete timeseries. Statistical assessment of extracted signatures showed that (1) event-based signatures can distinguish different dynamics for all the land-uses, (2) season-based signatures can distinguish different dynamics for some types of land-uses (deforested vs. forested, urban vs. greenspace, and cropped vs. grazed vs. grassland contrasts), (3) timeseries-based signatures can distinguish different dynamics for some types of land-uses (deforested vs. forested, urban vs. greenspace, shallow vs. deep groundwater, wetland vs. non-wetland, and cropped vs. grazed vs. grassland contrasts). Further, we compared signature-based process interpretations against literature knowledge; event-based and timeseries-based signatures generally matched well with previous process understandings from literature, but season-based signatures did not. This study will be a useful guideline for understanding how catchment-scale soil moisture dynamics in various land-uses can be described using a standardized set of hydrologically relevant metrics.

We provide parameter dependent version of the Browder–Minty Theorem in case when the solution is unique utilizing different types of monotonicity and compactness assumptions related to condition (S)2. Potential equations and the convergence of their Euler action functionals is also investigated. Applications towards the dependence on parameters for both potential and non-potenial nonlinear Dirichlet boundary problems are given.

ABSTRACT Background: Epistaxis is a mostly self-limiting condition common among children and is rarely severe. In this study, it was aimed to evaluate the incidence, demographic characteristics, causes of bleeding and treatment methods of patients who applied to the Pediatric Emergency Department (PED) with epistaxis, and to determine in which cases a laboratory test should be used. Method: Admitted to Gazi University Faculty of Medicine, PED which provides trauma care and is a tertiary hospital, between January 1, 2019 and December 31, 2019, 452 patients aged 0-18 years who presented with epistaxis to any reason or secondary to systemic disease were analyzed retrospectively. Results: The annual incidence was found 1.23%. The median age was 63 months, 258 of the cases (57.1%) were male. It was found that the cases most frequently applied to the hospital in the autumn months (37.6%). Sixty of the patients (13.3%) had a chronic disease and 54 (11.9%) had a history of drug use. Bleeding time was less than 5 minutes in 75.2% and 84.4% of the bleeding was unilateral. Nasal bleeding is local in 73.4%; 4.7% of them developed due to systemic reasons. The most common cause of epistaxis; while they were trauma at the first 10 years of age, they were idiopathic causes after the age of 10 years. In 434 (96%) of the patients, epistaxis spontaneously stopped and there was no need for additional treatment. Conclusion: As a result of this study, it was concluded that laboratory tests should be performed in cases with chronic disease history, bilateral bleeding, active bleeding and nontraumatic epistaxis. The situation that causes epistaxis in the childhood age group should be determined with a good history and physical examination, laboratory tests should not be used in every patient. Key Words: pediatric emergency, epistaxis, laboratory examinations, complete blood count

Background: We aimed to determine the relationship of ischemia-modified albumin (IMA) with diabetic foot ulcers and its predictive value in the Wagner classification. Methods: Our cross-sectional study was conducted in 120 diabetic foot patients and 60 healthy individuals with similar body mass index and age. Patients with a diabetic foot were classified according to the Wagner classification. Biochemical parameters, C-reactive protein (CRP) and IMA levels were measured in all patients and healthy volunteers. Screening performance characteristics of CRP and IMA were calculated according to Wagner classes and the presence of osteomyelitis. Results: CRP and IMA levels in the patient group were significantly higher than the control group. The highest IMA levels were detected in Wagner grade 5. CRP had higher sensitivity and specificity than IMA in the discrimination of other grades, except for grade 4-5 separation. For Wagner grade 4-5 distinction, IMA had 84.6% sensitivity and 94.7% specificity. Conclusion: IMA may play a role in the pathogenesis of diabetic foot ulcers and had a higher predictive value in discrimination of the Wagner grade 4 and 5. In the management of diabetic foot patients, it may be recommended that IMA is evaluated by clinicians.

Primary cardiac tumors are extremely rare.Most primary tumors are benign,and malignant tumors comprise about 15%1.Angiosarcoma is the most common type of primary cardiac malignant tumors.Compared with the left atrium or ventricle,the tumor prefer to occur in the right atrium or ventricle,especially the right atrium.In this case report,we present the case of a 32-year-old female with cardiac angiosarcoma primary to the right atrial appendage(RAA).

Background: Individuals with cystic fibrosis (CF) and fungal airway infection may present with fungal bronchitis, allergic bronchopulmonary aspergillosis (ABPA) or may appear unaffected despite fungal detection. We sought to characterize people with CF with frequent detection of fungi from airway samples and determine clinical outcomes. Methods: This retrospective study included individuals with CF with ≥ 4 lower airway cultures over a 2-year baseline period and ≥ 2 years of follow-up. We defined two groups: ≤ 1 positive fungus culture (rare) or ≥ 2 positive cultures during baseline (frequent). Clinical characteristics and outcomes were determined. Results: Between 2004-2016, 294 individuals met inclusion with 62% classified as rare and 38% as frequent fungi during baseline. Median follow-up was 6 years (range 2-9 years). Aspergillus fumigatus was the most common fungal species detected. Individuals with frequent fungi were older (13.7 vs. 11.7 yrs, p = 0.02) and more likely to have Stenotrophomonas maltophilia (35% vs 17%, p < 0.001) at baseline, but did not differ in lung function or ABPA diagnosis. During follow-up, those with frequent fungi were more likely to have chronic P. aeruginosa and S. maltophilia. Individuals with ABPA and frequent fungi had the highest rates of co-infection and co-morbidities, and a trend towards more rapid lung function decline. Discussion: Fungal infection in CF was associated with frequent P. aeruginosa and S. maltophilia co-infection even in those without ABPA. Individuals with frequent fungi and ABPA had worse outcomes, highlighting the potential contribution of fungi to CF pulmonary disease.

Introduction Cystic fibrosis (CF) related liver disease (CFLD) manifests as a wide spectrum of hepatobiliary disease and can progress to need liver transplantation. Elexacaftor/tezacaftor/ivacaftor (elx/tez/iva) is a cystic fibrosis transmembrane conductance regulator (CFTR) modulator which has superior efficacy compared to previously approved modulators. Use of elx/tez/iva, should be approached with caution in individuals with CFLD or following liver transplantation due to possible increases in LFTs and drug-drug interactions with several immunosuppressant medications. Objective The purpose of this case series was to explore if the use of elx/tez/iva is safe and tolerable in patients with CF post-liver transplantation. Methods A retrospective case series including patients prescribed elx/tez/iva following liver transplantation and an immunosuppressive regimen consisting of drug therapy metabolized by P-glycoprotein was completed. Results Ten patients at six CF centers with a median age of 22.1 years (range 14-43.4 years) and median time from transplant of 6.9 years (range 0.6-22 years) were included. Most patients (8, 80%) received a reduced or full dose of elx/tez/iva for a mean duration of 10.4 months (range 7-12 months). Fluctuations in LFTs occurred in all patients (10, 100%) and led to therapy discontinuation in two patients (20%). Elx/tez/iva initiation resulted in elevations in tacrolimus trough concentration in 7 patients (70%). Most patients who tolerated elx/tez/iva had symptomatic and quality of life improvement, increased body-mass-index, and maintained or improved lung function. Conclusion Initiation of elx/tez/iva in patients with CF who received a liver transplantation may be safe with clinical benefits.

Castleman disease is a rare, heterogeneous disorder that driven by proinflammatory responses. Human herpes virus-8 has a major role in pathogenesis of multicentric Castleman disease. There is also a subgroup of cases, human herpes virus-8 negative, idiopathic multicentric Castleman disease. The role of primary immunodeficiencies in idiopathic Castleman disease are poorly described. DOCK8 deficiency is a combined primary immunodeficiency. It has a broad clinic spectrum including atopy, autoimmunity and cancer. We present a 10-year-old, DOCK8 deficient patient. He had giant lobular capillary hemangiomas on his neck, iliac and gluteal regions and multiple lymphadenopathies. Abdominal lymph node pathology revealed hyaline vascular type Castleman disease and human herpes virus-8 staining was negative. His lesions were shown to be infected with orf virus. Our case is the first case to relate idiopathic multicentric Castleman disease and DOCK8 deficiency; also, very unusual presentation of orf virus infection in humans.

Bone tumors are a group of histologically diverse diseases which occur across all ages. Two of the commonest, osteosarcoma (OS) and Ewing sarcoma (ES), are regarded as characteristic AYA cancers with an incidence peak in AYAs. They are curable for some but associated with unacceptably high rates of treatment failure and morbidity. The introduction of effective new therapeutics for bone sarcomas is slow, and to date, complex biology has been insufficiently characterized to allow more rapid therapeutic exploitation. This review focuses on current standards of care, recent advances that have or may soon change that standard of care and challenges to the expert clinical research community that we suggest must be met.

Objectives The aim of our study was to identify, in mechanically ventilated neonates <30 weeks GA with clinical evidence of bronchopulmonary dysplasia (BPD), factors likely to be predictive of a first course of systemic dexamethasone leading to extubation within 14 days and remaining extubated for at least 7 days. Methods We studied a retrospective cohort of neonates (23+0-29+6 weeks GA), with evidence of BPD, prescribed their first course of systemic dexamethasone to aid in extubation from mechanical ventilation. The data collected only pertained to the first course of dexamethasone for any given neonate, with the primary outcome of interest of successful extubation within 14 days (i.e., extubated within 14 days of starting dexamethasone and remaining extubated for at least seven days). Binary logistic regression was employed. Results A total of 287 neonates were included. Each additional week of GA at birth led to a 1.53 increase in the odds of successful extubation (95% CI 1.122-2.096, p<0.01). Higher average fraction of inspired oxygen (FiO2) requirements in the preceding 24 hours resulted in a 0.94 decrease in the odds of successful extubation (p<0.05) and higher mean airway pressure (MAP) resulted in 0.76 decrease in odds of successful extubation (p<0.01). Conclusions Mechanically ventilated neonates born at <30 week GA, with evidence of BPD requiring dexamethasone to facilitate extubation, had a lower likelihood of successful extubation by day 14 if at the time of commencing steroids they were less mature at birth, had higher MAPs and higher oxygen requirements.

Quantifying and understanding catchment sediment yields is crucial both from a scientific and environmental management perspective. To deepen the understanding of land use impacts and climate change on sediment load, we explore mechanisms of the suspended sediment yield formation in the Northern Caucasus during the Anthropocene. We examine how sediment flux of various river basins with different land-use/landcover and glacier cover changes during the 1925-2018 period. Our analysis is based on observed mean annual suspended sediment discharges (SSD, kg·s−1) and annual fluxes (SSL, t·yr−1) from 33 Roshydromet gauging stations (Russia). SSL series have been analyzed to detect statistically significant changes during the 1925-2018 period. The occurrence of abrupt change points in SSD was investigated using cumulative sum (CUSUM) charts. We found that SSL has decreased by −1.81% per year on average at most gauges. However, the decline was not linear. Several transition years are expected in the region: increasing trends from the 1950s and decreasing trends from 1988-1994. Correlation analyses showed that variation in SSL trend values is mainly explained by gauging station altitude, differences in land use (i.e., the fraction of cropland), and catchment area. Nonetheless, more accurate quantifications of SSL trend values and more refined characterizations of the catchments regarding (historical) land use, soil types/lithology, weather conditions, and topography may reveal other tendencies.

Microbially influenced corrosion (MIC) may contribute significantly to overall corrosion risks, especially in the gas and petroleum industries. In this study, we isolated four Prolixibacter strains, which belong to the phylum Bacteroidetes, and examined their nitrate-respiration- and Fe0-corroding activities, together with two previously isolated Prolixibacter strains. Four of the six Prolixibacter strains reduced nitrate under anaerobic conditions, while the other two strains did not. The anaerobic growth of the four nitrate-reducing strains was enhanced by nitrate, which was not observed in the two nitrate-non-reducing strains. When the nitrate-reducing strains were grown anaerobically in the presence of Fe0 or carbon steel, the corrosion of the materials was enhanced by more than 20-fold compared to that in aseptic controls. This enhancement was not observed in cultures of the nitrate-non-reducing strains. The oxidation of Fe0 in the anaerobic cultures of nitrate-reducing strains occurred concomitantly with the reduction of nitrite. Since nitrite chemically oxidized Fe0 under anaerobic and aseptic conditions, the corrosion of Fe0- and carbon-steel by the nitrate-reducing Prolixibacter strains was deduced to be mainly enhanced via the biological reduction of nitrate to nitrite, followed by the chemical oxidation of Fe0 to Fe2+ and Fe3+ coupled to the reduction of nitrite.

Objective To describe the characteristics and outcomes of women with inherited bleeding disorder during pregnancy and birth. Design Retrospective cohort study. Setting Tertiary care hospitals, NSW and Victoria Australia. Population 100 women with inherited bleeding disorders, who birthed 134 live infants from 132 pregnancies. Methods Data was retrospectively obtained from the patient and neonatal medical records. Descriptive analysis was used to report maternal and pregnancy characteristics, birth and neonatal outcomes. Main outcome measures Factor replacement, neuraxial analgesia use and complications, post-partum haemorrhage and neonatal complications. Results PPH occurred in 22% of deliveries with primary PPH occurring in 20% and secondary PPH in 4% of births. 48% of PPHs were classified as major. PPHs occurred across the spectrum of IBD and was evenly distributed between women who had “normalised” their factor levels in pregnancy compared to those requiring factor at the time of birth. An obstetric cause was identified in more than half of PPHs. Conclusions Women with inherited bleeding disorders can deliver safely and receive neuraxial analgesia without complication when best practices are adhered to. PPH appears to occur at higher rates than the general population despite adequate factor levels or planned replacement. Whilst an obstetric cause was demonstrable in the many cases, these findings raise concern over the current definition of “adequate” factor levels at the time of birth.

1. We focused on 175 patients operated on for otosclerosis. There were 89 in group 1 (preoperative 4000 Hz BC threshold better than 2000 Hz) and 86 in group 2 (preoperative 2000 Hz BC threshold better than 4000 Hz). 2. Preoperatively, there was no significant difference in terms of average bone conduction (BC) thresholds, average air conduction (AC) thresholds and air-bone gap (ABG) between the two groups. 3. Three months and 1 year after surgery, group 1 had better audiometric outcomes than group 2 in terms of average AC and BC thresholds and ABG. 4. Postoperative BC gain was better in group 1 than group 2, particularly at 500 Hz, 1000 Hz and 2000 Hz. 5. When the 4000 Hz BC threshold was preoperatively impaired (group 2), it was not worsened after stapes surgery. This was not the case in group 1.

This is response to a letter, so it does not contain structured abstract.

Parenchymal sparing surgical (PSS) strategy allowed to plan a one-stage systemic extended posterior right sectionectomy with resection of the dorsal subsegment S1 in patient with 11 bilobar CRC metastases. PSS liver surgery has the greatest potential for implementation in modern medicine conditions.