Mycophenolate mofetil (MMF) as an immunosuppressive agent is widely used in the management of Membranous Glomerulonephropathy (MGN). In this report, we describe a 66-year-old male MGN case treated with MMF and revealed acquired sensory-motor axonal polyneuropathy, which is rare and has not been reported before.

The effects of processing intensity, time and particle surface energy on mixing of binary cohesive blends (size ratio 1:2, fine concentration at 10 %) in high intensity vibration system were investigated via DEM simulations. Results show that both increasing processing intensity from 50 to 100 Gs and reducing surface energy from 50 to 0.5 J/m2 lead to a faster mixing rate. Mixing Bond number (〖Bo〗_m) was introduced to capture the effective mixing rate, Rm; higher 〖Bo〗_m corresponding to lower mixing rate. The coefficient of variation, Cv, formed the basis for the mixing quality and Rm, while the mixing action is quantified by the product of Rm and mixing time (Pr,t). Simulation results show that Cv values drop initially, and then rise with Pr,t. Hence, low Pr,t indicates inadequate mixing intensity, while high Pr,t most likely indicates mixture segregation, and therefore too high or too low Pr,t values should be avoided.

To account for the effect of liquid viscosity, the bubble breakup model considering turbulent eddy collision based on the inertial subrange turbulent spectrum was extended to the entire turbulent spectrum that included the energy-containing, inertial, and energy-dissipation subranges. The computational fluid dynamics-population balance model (CFD-PBM) coupled model was modified to include this extended bubble breakup model for simulations of a bubble column. The effect of turbulent energy spectrum on the bubble breakup and hydrodynamic behaviors was studied in a bubble column under different liquid viscosities. The results showed that when the liquid viscosity was < 80 mPas, the bubble breakup and hydrodynamics were almost independent on the turbulent spectrum. At liquid viscosity > 80 mPas, the bubble breakup rate and gas holdup were significantly under-predicted when the inertial turbulent spectrum was used, and when using the entire turbulent spectrum the predictions were more consistent with experimental data.

We encountered a case in which a recurrent condyloma-like papillary tumor was repeatedly treated as condyloma. Therefore, the patient was re-diagnosed and treated for non-invasive cervical papillary squamous cancer (PSCC) with HPV6 infection. To the best of our knowledge, this is the first report of HPV6 infection in PSCC.

We consider an age-size structured cell population model based on the cell cycle length. The model is described by a first order partial differential equation with initial-boundary conditions. Using the theory of semigroups of positive operators we establish new criteria for an asynchronous exponential growth of solutions to such equations. We discuss the question of exponential size growth of cells. We show how to incorporate into our description models with constant increase of size and with target size division. We also present versions of the model when the population is heterogeneous.

A patient presenting with worsening dyspnea and left-sided chest pain underwent heart catheterization, found to have a rare connection between the right and left coronary arteries draining into the left ventricle, consistent with dual coronary-cameral fistula.

Underground coal mining causes land subsidence, a large area of cultivated land is destroyed. The Yellow River interlayer filling reclamation technology is the powerful way to restore cultivated land. Understanding the mechanism of action of interlayers in reconstructed soil filled with Yellow River sediments is essential to achieving sustainable land management in the Yellow River regions. Column experiments and Field experiments were conducted to optimum of interlayers in reconstructed soil with Yellow River sediment for restoring subsided coal mined land. Our findings show that the inclusion of interlayers in the sediment reduced water leakage and moisture evaporation, and improved the water-holding capacity of the material in comparison to conventional reconstructed soil profile (Ck2). When the 30 cm thickness of interlayer, putting 2 interlayers in sediment (T6) was the optimal profile with the highest water-holding capacity. In comparison to CK2, the migration rate of wet front decreases by 32.16%, the cumulative evaporation decreases by 16.29%, the volumetric water content of filling layer (θ_fl) increases by 121.56%, and the water-holding coefficient (CWR) increases by 59.47%. It is also proved by field experiments. The wheat and maize yields of T6 improved 51.84% and 54.80%, respectively, as compared with CK2, that closer to undisturbed farmland (CK1). This study provides a valuable framework for subsided land reclamation regarding the method of placing interlayers into Yellow River sediment for enhancing water retention and productivity.

Catheter Ablation of Accessory Pathways: Can We Do Better by Using Dual Chamber Mapping ?

Dispersal abilities play a crucial role in shaping the extent of population genetic structure, with more mobile species being panmictic over large geographic ranges and less mobile ones organized in meta-populations exchanging migrants to different degrees. In turn, population structure directly influences the coalescence pattern of the sampled lineages, but the consequences on the estimated variation of the effective population size (Ne) over time obtained by means of unstructured demographic models remain poorly understood. However, this knowledge is crucial for biologically interpreting the observed Ne trajectory and further devising conservation strategies in endangered species. Here we investigated the demographic history of four shark species (Carharhinus melanopterus, Carharhinus limbatus, Carharhinus amblyrhynchos, Galeocerdo cuvier) with different degrees of endangered status and life history traits related to dispersal distributed in the Indo-Pacific and sampled off New Caledonia. We compared several evolutionary scenarios representing both structured (meta-population) and unstructured models and then inferred the Ne variation through time. By performing extensive coalescent simulations, we provided a general framework relating the underlying population structure and the observed Ne dynamics. On this basis, we concluded that the recent decline observed in three out of the four considered species when assuming unstructured demographic models can be explained by the presence of population structure. Furthermore, we also demonstrated the limits of the inferences based on the sole site frequency spectrum and warn that statistics based on linkage disequilibrium will be needed to exclude recent demographic events affecting meta-populations.

Background: To evaluate the efficiency and safety of medium power (MP) holmium laser devices in the enucleation of the enlarged prostate (HoLEP) adenomas compared to high power (HP) laser devices. Methods: Based on the device power used, a total of 120 patients were divided randomly into two groups. While patients in Group 1 were treated with a MP device (50 W) at 39.6-W (2.2J / 18Hz ), patients in Group 2 were treated with HP (100W) device at 42W (1.2J / 35Hz). Peri- and postoperative parameters were well evaluated in both groups with an emphasis on enucleation efficiency and hemoglobin decrease in a comparative manner. Results: Peri- and postoperative parameters as well as functional results were similar in the two groups. The median enucleation efficiency (EE) values in Group 1 and Group 2 were 1.15 (IQR: 0.33-2.2) and 1.11 (IQR: 0.4-2.8), respectively (p=0.775). Hemoglobin decrease values in Group 1 and Group 2 were 1.3 (IQR: 0.1-4) and 1.4 (IQR: 0.4-3.1), respectively (p=0.736). Significant improve in the postoperative functional parameters were noted again in both groups. Conclusion: Our results indicate well that similar to the HP laser devices, effective and safe removal of the enlarged prostate adenomas with MP laser devices (50W) is possible without any technical difficulties, even in patients receiving antithrombotic therapy.

Background: Crimean-Congo hemorrhagic fever (CCHF) is a fatal acute tick-borne viral infection and a substantial emerging global public health threat. This illness has a high case fatality rate of up to 40%. The liver is one of the important target organs of the CCHF virus. Objective: The aim of this meta-analysis to evaluate the correlation between CCHF  and liver injury and draw more generalized inferences about the abnormal serum markers of liver injury such as alanine aminotransferase (ALT), aspartate aminotransferase (AST) in CCHF patients. Methods: A literature search was accomplished for published eligible articles with MEDLINE/PubMed and Embase databases. All eligible observational studies and case series were included from around the world. The inclusion criteria were articles describing liver injury biomarkers AST and ALT amongst patients diagnosed with CCHF. Results: Data from 18 studies, consisting of 1238 patients with CCHF  were included in this meta-analysis. The overall pooled prevalence of at least one raised liver injury biomarker was 77.95% (95% CI, I2 = 88.50%, p < 0.0001). Similarly, pooled prevalence of elevated AST and ALT was 85.92% (95% CI, I2 = 85.27%,  p < 0.0001) and 64.30% (95% CI, I2 = 88.32%,  p < 0.0001) respectively.  Both Egger and Begg-Mazumdar’s tests detected no apparent publication bias in all three meta-analyses(p > 0.05).  Conclusion: These elevated liver injury biomarkers have been identified as significant prognostic factors. Hence, Physicians must recognize and continuously monitor these biomarkers, since these aid early stratification of prognosis and the prevention of severe outcomes in infection with such a high case fatality rate.

Metabarcoding of environmental DNA (eDNA) is now widely used to build diversity profiles from DNA that has been shed by species into the environment. There is substantial interest in the expansion of eDNA approaches for improved detection of terrestrial vertebrates using invertebrate-derived DNA (iDNA) in which hematophagous, sarcophagous, and coprophagous invertebrates sample vertebrate blood, carrion, or feces. Here, we use metabarcoding and multiple iDNA samplers (carrion flies, sandflies, and mosquitos) to profile gamma and alpha diversity in a dry, tropical forest in the southern Amazon. Our main objectives were to (1) compare diversity found with iDNA to camera trapping, which is the conventional method of vertebrate diversity surveillance and (2) compare each of the iDNA samplers to assess the effectiveness, efficiency, and potential biases associated with each sampler. Carrion flies were the most effective sampler, despite the least amount of sampling effort and the fewest number of individuals captured for metabarcoding, in describing vertebrate biodiversity followed by sandflies. Camera traps had the highest median species richness at the site-level but showed strong bias towards carnivore and ungulate species and missed much of the diversity described by iDNA methods. Mosquitos showed a strong feeding preference for humans as did sandflies for armadillos, thus presenting potential utility to further study related to host-vector interactions.

Early-life telomere length (TL) is associated with fitness in a range of organisms. Little is known about the genetic basis of variation in TL in wild animal populations, but to understand the evolutionary and ecological significance of TL it is important to quantify the relative importance of genetic and environmental variation in TL. In this study, we measured TL in 2746 house sparrow nestlings sampled across 20 years and used an animal model to show that there is a small heritable component of early-life TL (h2=0.04), but with a strong component of maternal inheritance. Variation in TL among individuals was mainly driven by environmental (year) variance, but also brood and parental effects. We did not find evidence for a negative genetic correlation underlying the observed negative phenotypic correlation between TL and structural body size. Thus, TL may evolve independently of body size and the negative phenotypic correlation is likely to be caused by non-genetic environmental effects. We further used genome‐wide association analysis to identify genomic regions associated with TL variation. We identified several putative genes underlying TL variation; these have been inferred to be involved in oxidative stress, cellular growth, skeletal development, cell differentiation and tumorigenesis in other species. Together, our results show that TL is a lowly heritable, polygenic trait which is strongly affected by environmental conditions in a free-living bird.

Background: This study investigates the use of modern machine learning (ML) techniques to improve prediction of survival after orthotopic heart transplantation (OHT). Methods: Retrospective study of adult patients undergoing primary, isolated OHT between 2000-2019 as identified in the United Network for Organ Sharing (UNOS) registry. The primary outcome was one-year post-transplant survival. Patients were randomly divided into training (80%) and validation (20%) sets. Dimensionality reduction and data re-sampling were employed during training. Multiple machine learning algorithms were combined into a final ensemble ML model. Discriminatory capability was assessed using area under receiver-operating-characteristic curve (AUROC), net reclassification index (NRI), and decision curve analysis (DCA). Results: A total of 33,657 OHT patients were evaluated. One-year mortality was 11% (n=3,738). In the validation cohort, the AUROC of singular logistic regression was 0.649 (95% CI 0.628-0.670) compared to 0.691 (95% CI 0.671-0.711) with random forest, 0.691 (95% CI 0.671-0.712) with deep neural network, and 0.653 (95% CI 0.632-0.674) with Adaboost. A final ensemble ML model was created that demonstrated the greatest improvement in AUROC: 0.764 (95% CI 0.745-0.782) (p<0.001). The ensemble ML model improved predictive performance by 72.9% ±3.8% (p<0.001) as assessed by NRI compared to logistic regression. DCA showed the final ensemble method improved risk prediction across the entire spectrum of predicted risk as compared to all other models (p<0.001). Conclusions: Modern ML techniques can improve risk prediction in OHT compared to traditional approaches. This may have important implications in patient selection, programmatic evaluation, allocation policy, and patient counseling and prognostication.

Guillain–Barre’ syndrome (GBS) is an acute inflammatory and immune-mediated demyelinating disease of peripheral nervous system (PNS). Macrophages playing a central role in its animal model, experimental autoimmune neuritis (EAN) has been well-accepted. Additionally, NF-κB inhibitors has been used to treat cancers and showed beneficial effects. Here we investigated the therapeutic effect of M2 macrophage and NF-κB pathway is correlated with macrophages activation in experimental autoimmune neuritis (EAN) in C57BL/6 mice. We demonstrated that M2 macrophage transfusion can alleviate the clinical symptoms of EAN by reducing the proportion of M1 macrophage in the peak period, inhibiting the phosphorylation of NF-κB p65. The NF-κB inhibitor (BAY-11-7082) could alleviate the clinical symptoms of EAN and shorten the duration of symptoms by reducing the proportion of M1 macrophages and the expression of pro-inflammatory cytokines. Consequently, BAY-11-7082 exhibits strong potential as a therapeutic strategy for ameliorating EAN by influencing the balance of M1/M2 macrophages and inflammatory cytokines.

COVID-19 has been associated with both transient and persistent systemic symptoms that do not appear to be a direct consequence of viral infection. The generation of autoantibodies has been proposed as a mechanism to explain these symptoms. To understand this phenomenon in more detail, we investigated the frequency and specificity of clinically relevant autoantibodies in 84 individuals previously infected with SARS-CoV-2, suffering from COVID-19 of varying severity in both the acute and convalescent setting. These were compared with results from 32 individuals who were on ITU for non COVID reasons. We demonstrate a higher frequency of autoantibodies in the COVID-19 ITU group compared with non-COVID-19 ITU disease control patients and that autoantibodies were also found in the serum 3-5 months post COVID-19 infection. Non-COVID patients displayed a diverse pattern of autoantibodies; in contrast, the COVID-19 groups had a more restricted panel of autoantibodies including skin, skeletal muscle and cardiac antibodies. Our results demonstrate that severe COVID-19 induces a pattern of autoantibodies that may correlate with and contribute to the immune pathology associated with the long-term sequelae of infection.

Abstract Aims: Recurrent pregnancy loss (RPL) is usually defined by two or more consecutive clinical miscarriages, which causes psychological trauma for couples. In this study, we aimed to investigate the predictive role of Fibrinogen to albumin ratio (FAR) in patients with RPL. Methods: Pregnant women in their first trimester of pregnancy were included in the study and divided in to two groups as RPL patients (n:44) and patients with no previous recurrent miscarriage (n:60) as control group. Demographical parameters and routine blood parameters (fibrinogen, D-dimer, fibrinogen to albumin ratio (FAR), neutrophil to lymphocyte ratio (NLR), platelet count, main platelet volume (MPV), and red cell distribution width (RDW) values) were compared between the RPL group and the control group. Results: The groups were determined to be statistically different in regards to gravidity and parity (p<0.05). The difference between the groups was statistically different in regards to fibrinogen (mg/dl), albumin (g/dl), FAR (%), NLR (%), RDW-coefficient of variation (CV) (%), RDW-standard deviation (SD) (fL), and platelet counts (10-3/ uL). However, MPV (fL) and D-dimer (ug/L) levels were similar in both groups. The receiver operating characteristic (ROC) curve analysis revealed that the NLR levels were 84.1% sensitive and 75% specific with a cut-off value of 4.27 and the FAR levels were 79.5% sensitive and 88.3% specific with a cut-off value of 105.69 for predicting RPL. Conclusion: Our results indicate that the FAR and NLR levels seem to be effective parameters for predicting RPL with high sensitivity and specificity.

In this case report we describe how to recycle the Left Internal Thoracic Artery (LITA) when misused but not damaged. 8 years after a Left Anterior Small Thoracotomy followed by LAD stenting for STEMI in 1st post-operative day, a 67 years old woman had a NSTEMI with angiographic evidence of intra-stent re-stenosis with a perfectly patent LITA, harvested only from the 4th to the 6th intercostal space. During redo surgery, LITA was harvested as a pedicle from the anastomosis to the 4th intercostal space and primarily from the 1st to the 4th intercostal space. Special attention was paid at the level of the 4th intercostal space where the vessel was stuck to the sternum: a 15 blade was used being scissors or cautery too dangerous. At the end of harvesting, the LITA was full-length available for a new coronary anastomosis on LAD, distal to the previous one.