Artificial subsurface (tile) drainage is used to increase trafficability and crop yield in much of the Midwest due to soils with naturally poor drainage. Tile drainage has been researched extensively at the field scale, but knowledge gaps remain on how tile drainage influences the streamflow response at the watershed scale. The purpose of this study is to analyze the effect of tile drainage on the streamflow response for 59 Ohio watersheds with varying percentages of tile drainage and explore patterns between the Western Lake Erie Bloom Severity Index to streamflow response in heavily tile-drained watersheds. Daily streamflow was downloaded from 2010-2019 and used to calculated mean annual peak daily runoff, mean annual runoff ratio, the percent of observations in which daily runoff exceeded mean annual runoff (TQmean), baseflow versus stormflow percentages, and the streamflow recession constant. Heavily-drained watersheds (> 40 % of watershed area) consistently reported flashier streamflow behavior compared to watersheds with low percentages of tile drainage (< 15% of watershed area) as indicated by significantly lower baseflow percentages, TQmean, and streamflow recession constants. The mean baseflow percent for watersheds with high percentages of tile drainage was 20.9 % compared to 40.3 % for watersheds with low percentages of tile drainage. These results are in contrast to similar research regionally indicating greater baseflow proportions and less flashy hydrographs (higher TQmean) for heavily-drained watersheds. Stormflow runoff metrics in heavily-drained watersheds were significantly positively correlated to western Lake Erie algal bloom severity. Given the recent trend in more frequent large rain events and warmer temperatures in the Midwest, increased harmful algal bloom severity will continue to be an ecological and economic problem for the region if management efforts are not addressed at the source. Management practices that reduce the streamflow response time to storm events, such as buffer strips, wetland restoration, or drainage water management, are likely to improve the aquatic health conditions of downstream communities by limiting the transport of nutrients following storm events.

A 34-year-old woman presented due to progressive painful swelling around the nail of the right index finger. Onychectomy and drainage of the abscess of the affected finger were performed as the inflammation was progressive despite the previous antibiotic therapy. The microbiological culture revealed a ciprofloxacin-susceptible Citrobacter braakii.

We report a spinal metastatic patient with an atypical presentation of inguinal pain. He was managed with L1 laminectomy and posterior instrumentation. After the surgery, his pain was significantly relieved. This study underscores the importance of spinal examination in those with a known tumor.

Abstract: In the present work, the geometric structures, the frontier molecular orbitals and the enthalpy of formation (HOF) of thirty six 1, 2, 4, 5-tetrazine derivatives (FTT) were systematically studied by using the B3LYP/6-311+G* method of density functional theory. Meanwhile, we also predicted the stability, detonation properties and thermodynamic properties of all FTT compounds. Results showed that all compounds have superior enthalpy of formation far exceeding that of common explosives RDX and HMX, ranging from 859kJ·mol-1-1532kJ·mol-1. In addition, the detonation performance (Q = 1426cal·g-1 -1804cal·g-1; P = 29.54GPa - 41.84GPa; D = 8.02km·s-1 - 9.53km·s-1), which is superior to TATB and TNT. It is also concluded that the introduction of coordination oxygen on the tetrazine ring can improve the HOF, density and detonation performance of the title compound, and -NH-NH- bridge and -NHNO2 group are also the perfect combination to increase these values. In view of stability, because of the fascinating performance of D3 (ρ =1.89g·cm-3; D = 9.38km·s-1; P = 40.13GPa)，E3(ρ = 1.87g·cm-3; D = 9.19km·s-1; P = 38.35GPa), F1 (ρ = 1.87g·cm-3; D = 9.42km·s-1; P = 40.23GPa) and F3 (ρ= 1.92g·cm-3; D = 9.53km·s-1; P = 41.84GPa), makes them very attractive to be chosen as HEDMs.

1. Fruit bats (Family: Pteropodidae) are animals of great ecological and economic importance, yet their populations are threatened by ongoing habitat loss and human persecution. A lack of ecological knowledge for the vast majority of Pteropodid bat species presents additional challenges for their conservation and management. 2. In Australia, populations of flying-fox species (Genus: Pteropus) are declining and management approaches are highly contentious. Australian flying-fox roosts are exposed to management regimes involving habitat modification, either through human-wildlife conflict management policies, or vegetation restoration programs. Details on the fine-scale roosting ecology of flying-foxes are not sufficiently known to provide evidence-based guidance for these regimes and the impact on flying-foxes of these habitat modifications is poorly understood. 3. We seek to identify and test commonly held understandings about the roosting ecology of Australian flying-foxes to inform practical recommendations and guide and refine management practices at flying-fox roosts. 4. We identify 31 statements relevant to understanding of flying-fox roosting structure, and synthesise these in the context of existing literature. We then contribute contemporary data on the fine-scale roosting structure of flying-fox species in south-eastern Queensland and north-eastern New South Wales, presenting a 13-month dataset from 2,522 spatially referenced roost trees across eight sites. 5. We show evidence of sympatry and indirect competition between species, including spatial segregation of black and grey-headed flying-foxes within roosts and seasonal displacement of both species by little red flying-foxes. We demonstrate roost-specific annual trends in occupancy and abundance and provide updated demographic information including the spatial and temporal distributions of males and females within roosts. 6. Insights from our systematic and quantitative study will be important to guide evidence-based recommendations on restoration and management and will be crucial for the implementation of priority recovery actions for the preservation of these species into the future.

Case summary: The MRI of a 73 year old male patient with paraparesis, showed an intramedullary mass at the thoracic spinal cord extending from T6 to T8. Partial surgical removal was preformed and a biopsy was taken, followed by postoperative radiotherapy.

Across the globe, ecological communities are confronted with multiple global environmental change drivers, and they are responding in complex ways ranging from behavioural, physiological, and morphological changes within populations to changes in community composition and food web structure with consequences for ecosystem functioning. A better understanding of global change-induced alterations of multitrophic biodiversity and the ecosystem-level responses in terrestrial ecosystems requires holistic and integrative experimental approaches to manipulate and study complex communities and processes above and below the ground. We argue that mesocosm experiments fill a critical gap in this context, especially when based on ecological theory and coupled with microcosm experiments, field experiments, and observational studies of macroecological patterns. We describe the design and specifications of a novel terrestrial mesocosm facility, the iDiv Ecotron. It was developed to allow the setup and maintenance of complex communities and the manipulation of several abiotic factors in a near-natural way, while simultaneously measuring multiple ecosystem functions. To demonstrate the capabilities of the facility, we provide a case study. This study shows that changes in aboveground multitrophic interactions caused by decreased predator densities can have cascading effects on the composition of belowground communities. The iDiv Ecotrons technical features, which allow for the assembly of an endless spectrum of ecosystem components, create the opportunity for collaboration among researchers with an equally broad spectrum of expertise. In the last part, we outline some of such components that will be implemented in future ecological experiments to be realized in the iDiv Ecotron. Key words: food webs, biodiversity and ecosystem functioning, mesocosms, biotic interactions, lysimeters, climate chambers

Objectives: This study aimed to compare early and long-term outcomes of redo isolated tricuspid surgery (RITS) after left-sided valve surgery (LSVS). Methods: We retrospectively reviewed 173 patients underwent RITS for severe tricuspid regurgitation after previous LSVS from January 1999 to December 2019. Patients were divided into two groups: RITS by median sternotomy (m-RITS, n = 78) and by totally endoscopic approach (e-RITS, n = 95). Perioperative outcomes and follow-up results were analyzed. Results: There were 19 (11%) in-hospital deaths (14.1% in m-RITS and 8.4% in e-RITS, p = 0.234) that decreased from 16.7% (1999–2014) to 6.9% (2015–2019) (p = 0.044). Tricuspid valve replacement [odds ratio (OR) = 6.778, 95% confidence interval (CI): 1.370–33.549, p = 0.019] and NYHA function class IV (OR = 8.525, 95% CI: 2.153–33.760, p = 0.002) were independent risk factors of in-hospital mortality. The overall 1-, 5-year, 10-year, and 15-year survival rates were 97.2% (95% CI: 94.5–99.9%),80.3% (95% CI: 71.7–88.9%), 59.2% (95% CI: 43.5–75.5%) and 49.3% (95% CI: 27.2–71.4%), respectively. Conclusion: Patients undergoing redo isolated tricuspid valve surgery carry a high risk of early mortality. Satisfactory results are achievable with endoscopic tricuspid valve surgery and repair results in lower surgical mortality than replacement with acceptable residual tricuspid regurgitation.

Background: It is established that ethanol infusion in the vein of Marshall (EIVOM) effectively creates a linear ablation lesion in the mitral isthmus (MI). However, data on the long-term success rates of MI ablation remains limited. Methods and Results: Our cohort consisted of 560 patients with non-paroxysmal atrial fibrillation (AF) who underwent an initial MI ablation. Ablations were performed by only radiofrequency (RF) in 384 patients (RF group) or by RF and EIVOM in 176 patients (EIVOM/RF group). Ethanol of 5 mL was used to perform EIVOM in advance of RF. Following EIVOM, RF pulses were delivered to the lateral MI line. Bidirectional MI block was fully achieved in 353 (first 318, re-do 35) patients of the RF group and 171 (first 128, re-do 43) patients of the EIVOM/RF group (p = 0.09 in the first, 0.10 in the re-do ablation cases). In cases with complete MI line block, recurrent AF or atrial tachycardia (AT) was observed in 130 (37%) patients of the RF group and in 64 (37%) patients of the EIVOM/RF group (log-rank p = 0.12 in the first, 0.30 in the re-do ablation cases). Of the total 194 patients, 112 with drug refractory AF or AT proceeded to the subsequent ablation process. Reconnection of MI block line was observed in 39 (49%) patients in the RF group and 25 (58%) patients in the EIVOM/RF group (p = 0.32). Conclusion: EIVOM effectively ensures MI line block; however, the reconnection rate was similar between the two groups.

OBJECTIVE: Sustained pharyngeal inflation (SPI) with pharyngeal oxygen and nose-close (PhO2-NC) can create positive peak inflation pressure (PIP) inside the pharyngolaryngeal space (PLS). This study measured and compared effects of four different SPI durations in the PLS. METHOD: In this prospective observational study, 20 consecutive infants aged less than 3 years, scheduled for elective flexible-bronchoscopy were enrolled. SPI was performed twice in four different durations (0, 1, 3 and 5 seconds) sequentially in each infant. PIP was measured for each SPI in the pharynx, and simultaneously took images at two locations of oropharynx and supra-larynx. Infants’ demographic details and PIP levels, lumen expansion scores and images of PLS were measured and analyzed. RESULTS: Twenty infants with 40 measurements were collected. The mean (SD) age and weight were 11.6 (9.1) months and 6.8 (2.4) kg, respectively. The measured mean (SD) pharyngeal PIPs were 4.1 (3.3), 21.9 (7.0), 42.2 (12.3) and 65.5 (18.5) cm H2O at SPI duration of 0, 1, 3 and 5 seconds, respectively; which showed significant positive association (p<0.001). At assigned locations, the corresponding PLS images also show significant increase in lumen expansion scores and number of detected lesions with increase in SPI duration (p<0.001). The mean (SD) study time was 5.7 (1.2) minutes. No study related complication was noted. CONCLUSIONS: SPI with PhO2-NC up to 5 seconds is a simple, safe and feasible clinical ventilation modality. It may provide enough PIP to expand the PLS and facilitate flexible-bronchoscopy performance in infants.

The excellent review by Houmsse and Daoud of techniques and methods utilized to protect the esophagus from injury during atrial fibrillation (AF) ablation appropriately concludes that considering the ease of use, minimal side effects, and low costs associated with esophageal protection devices, compelling evidence exists for use of esophageal protection as routine care for AF ablation. Some additional data are available which would warrant inclusion in further consideration of this topic. Three recent studies have demonstrated the inability of LET monitoring to protect the esophagus, whereas meta-analysis of three studies of manual cooling using direct liquid instillation suggests that this approach significantly reduced high-grade lesion formation (OR of 0.39, 95% CI 0.17 to 0.89). Moreover, three studies using a commercially available cooling device FDA cleared for thermal regulation have shown reductions in esophageal lesion severity without degradation in ablation efficacy.

This is a case report describing a rare condition.A 12-year-old boy had a blood cast of the left bronchial tree from bronchial hemorrhage caused by respiratory foreign body.He underwent rigid bronchoscopy and cast removal.

Objectives: The aim of the study was to identify factors that could influence the repair of eardrum perforation using cartilage graft (or cartilage tympanoplasty) in children. Methods: A cohort of children operated on between January 1998 and December 2012 was reviewed. We have studied the repair rate of the eardrum (anatomical result) and the hearing level with audiometric tests (functional result) at 1 year and 3 years after surgery. These results were correlated with size or location of the perforation, status of the contralateral ear, gender, allergies, cleft palate, craniofacial anomalies, expertise of the surgeon (junior, senior) and perioperative observations (mucosa, glue, etc.). Results: 1240 tympanoplasties were selected from the database, of which 139 ears (127 patients) could be analysed (perforation without concurrent disease, authorisation from patients obtained and sufficient information reported). Mean age at surgery was 9.6 years ± 2.6 (range 4-16). At one year, 129/139 (93%) tympanic membranes were closed and 112/139 (81%) were satisfactory (no residual perforation, nor retraction, cholesteatoma, myringitis or OME). Air-bone gap was < 20 dB in 102/127 ears (80%). At 3 years, the eardrum was closed in 64/66 (97%) ears (reperforation in one case) and 82% were satisfactory. Myringitis occurred in 5% and 9% of cases at one- and three-year follow-up. Surgery before the age of 8 years was the only risk factor of a non-satisfactory result at one-year follow-up (p = 0.024). Conclusions: Long-term results were satisfactory; the only risk factor was surgery before eight years of age. In the child, long-term yearly follow-up is necessary after tympanic perforation.

Since the first description of phloem sap composition nearly 60 years ago, it is generally assumed that phloem sap does not contain nitrate and that there is little or no backflow of nitrate from shoots to roots. While it is true that nitrate can occasionally be absent from phloem sap, there is now substantial evidence that phloem can carry nitrate and furthermore, transporters involved in nitrate redistribution to shoot sink organs and roots have been found. This raises the question of why nitrate may or may not be present in phloem sap, why its concentration is generally kept low, and whether plant shoot-root nutrient cycling also involves nitrate. We propose here that phloem sap nitrate is not only an essential component of plant nutritional signaling but also contributes to physical properties of phloem sap and as such, its concentration is controlled to ensure proper coordination of plant development and nutrient transport.

Aim We aimed to compare the functional results of two different vesicourethral anostomosis (VUA) techniques used in retropubic radical prostatectomy (RRP). Methods A total of 476 patients including the first group with 4 focal VUA at 12-, 3-, 6-, and 9-o’clock positions (n = 288) and the second group with 6 focal VUA at 12-, 2-, 4-, 6-, 8- and 10-o’clock (n = 188) were included in the study. Perioperative data and erectile function and continence status over a 12-month period were compared. Results Demographic and perioperative data were similar between the two groups. The proportion of patients with VUA stricture in the first group was significantly higher than in the second group (5.1% vs 3.2%, p = 0.017). The mean time to stricture development was also shorter in the first group (48.9 vs 74.3 days, p = 0.002). In the second group, the proportion of continent patients at the sixth and twelfth months was higher than the first group (79.3% vs 62.8%, p <0.001; 92.4% vs 81.3%, p = 0.032, respectively). There was no significant difference between the two groups in terms of the proportions of potent patients (p = 0.194 for 6 months and p = 0.351 for 12 months). Conclusions Better continence results can be obtained with the six-focus VUA compared to the four-focus technique. The number of anostomotic sutures in VUA can affect functional results and may be a decisive factor for surgeons who focus on functional results as well as oncological results.

Background: Helicobacter pylori (H. pylori) is the most common cause of gastric cancer. Growing evidence suggests that the regular arrangement of collecting venules (RAC) can be used as an endoscopic marker to diagnose H. pylori infection. However, data on the diagnostic accuracy of RAC for H. pylori infection are conflicting. We performed a systematic review and meta-analysis of relevant studies to determine the diagnostic accuracy and clinical utility of RAC for the diagnosis of H. pylori infection. Methods: We systematically searched PubMed, Embase, Web of Science, and the Cochrane Library between inception and Oct 29, 2020, for studies that assessed the diagnostic accuracy of RAC for H. pylori infection. Results: The literature search yielded 2921 nonduplicated screened titles, of which 58 underwent full-text review. Fifteen studies, representing a total of 6621 patients, met the inclusion criteria. The area under the summary receiver operating characteristic curve was 0.98 (95% CI 0.96 to 0.99). The pooled estimates for RAC were 0.98 (95% CI 0.95 to 0.99) for sensitivity and 0.75 (95% CI 0.54 to 0.88) for specificity. The pooled positive likelihood ratio (PLR) and negative likelihood ratio (NLR) were 3.8 (95% CI 1.9 to 7.7) and 0.03 (95% CI 0.02 to 0.07), respectively. Conclusions: RAC can be used as an endoscopic marker for exclusion of H. pylori infection. However, it cannot be recommended as a single indicator for the confirmation of H. pylori infection. The conclusion of this study should be treated with caution because significant heterogeneity exists between the evaluated studies.

Objectives: In this study, we aimed to evaluate the haemodynamic changes of laparoscopic adrenalectomy (LA) in geriatric patients with pheochromocytoma (PHEO). To the best of our knowledge, it is the first study evaluating the haemodynamic outcomes of pure LA in this patient population. Methods: Between 2000-2020, data of 350 patients who underwent single-side transperitoneal LA were reviewed retrospectively. Patients with a histopathological diagnosis of PHEO were enrolled and classified into two groups according to their ages at the date of surgery. Older than 65 years were accepted as elderly according to the World Health Organisation recommendations. Results: Overall 54 patients underwent single side LA for PHEO. Fifteen patients were enrolled in the elderly group and 39 in the young group. There were no significant differences regarding the operation site (0.564) and tumour size (0.878). There were no statistically significant differences in terms of perioperative outcomes, such as mean anaesthesia and operation times, blood loss and haemodynamic changes. Regarding postoperative outcomes; there were no statistically significant differences in mean hospitalization and intensive care unit times. In 1 patient in each grade-1 (prolonged ileus, managed with medical treatment) and grade 2 complication (transfusion during surgery) observed in the elderly and young groups, respectively (p=0.498). Conclusion: Laparoscopic adrenalectomy in elderly patients with PHEO is as safe and effective as in younger patients. One of the most important conditions for achieving good perioperative and postoperative outcomes in the elderly patient population with this challenging surgery is the multidisciplinary approach.

Introduction: Due to the high mortality of coronavirus disease 2019 (COVID-19), there are difficulties in the managing emergency department. We investigated whether the d-dimer/albumin ratio (DAR) and fibrinogen/albumin ratio (FAR) predicts mortality in the COVID-19 patients.Methods: A total of 717 COVID-19 patients who were brought to the emergency department from March to October 2020 were included in the study. Levels of d-dimer, fibrinogen, and albumin, as well as DAR, FAR, age, gender, and in-hospital mortality status of the patients were recorded. The patients were grouped by in-hospital mortality. Statistical comparison was conducted between the groups.Results: Of the patients included in the study, 371(51.7%) were male, and their median age was 64 years (50–74). There was in-hospital mortality in 126 (17.6%) patients. The area-under-the-curve (AUC) and odds ratio values obtained by DAR to predict in-hospital mortality were higher than the values obtained by the all other parameters (AUC of DAR, albumin, d-dimer, FAR, and fibrinogen: 0.773, 0.766, 0.757, 0.703, and 0.637, respectively; odds ratio of DAR>56.36, albumin<4.015, d-dimer>292.5, FAR>112.33, and fibrinogen>423: 7.898, 6.216, 6.058, 4.437, and 2.794, respectively). In addition; patients with concurrent DAR>56.36 and FAR>112.33 had an odds ratio of 21.879 with respect to patients with concurrent DAR<56.36 and FAR<112.33.Conclusion: DAR may be used as a new marker to predict mortality in COVID-19 patients. In addition the concurrent high DARs and FARs were found to be more valuable in predicting in-hospital mortality than either separately.Keywords: Covid-19, D-dimer, Fibrinogen, Serum Albumin, in-Hospital Mortality