Comment on: Virtual Reality, e-Learning, and Global Cardiac Surgical Capacity-Building

Woman admitted for COVID-19 respiratory failure requiring intubation, renal failure and rising bilirubin, requiring CVVHD. Due to dropping hemoglobin and platelets, TTP was suspected and empiric plasma exchange initiated. Platelets normalized; she improved; ADAMTS13 level resulted 50.7%, indicating possible benefit of plasma exchange for COVID19 thrombotic microangiopathy despite normal ADAMTS13.

A four-year field experiment was carried out to evaluate an integrated use of saline water for the saline soil reclamation in Hebei Province of North China. A landscape shrub (Caryopteris × clandonensis ‘Worcester Gold’) was cultivated using drip irrigation scheduled by rootzone soil matric potential control at five levels of water salinity (ECi): 0.8, 3.1, 4.7, 6.3, and 7.8 dS·m−1. Soil matric potential control was applied using a threshold of −5, −10, −15, and −20 kPa in the first, second, third, and fourth year, respectively. After four growing seasons, the saline soil (initial ECe value of 27.8 dS·m−1) was reclaimed to slightly saline soil for 0–1 m depth (4.1–7.2 dS·m−1) under drip irrigation with saline water of ECi < 7.8 dS·m−1. The salt leaching efficiency of root zone soil was highest in the first year and lowered year-by-year. The plants strongly responded to the different soil water and salinity regime. Significant decreases in survival rate, plant growth, and shoot dry weight in response to increasing ECi were found. To achieve a relative survival rate of >50%, the threshold salinity of irrigation water for ‘Worcester Gold’ cultivation was 7.8, 7.0, 5.6, and 5.3 dS·m–1, for the first, second, third, and fourth growing season, respectively. It is recommended to use an inter-seasonal evolving matric potential threshold of −10 kPa for dry season of the third year, −15 kPa for rainy season of the third year and dry season of the fourth year, and −20 kPa for rainy season of the fourth year.

1. Animal movement studies are conducted to monitor ecosystem health, understand ecological dynamics and address management and conservation questions. In marine environments, traditional sampling and monitoring methods to measure animal movement are invasive, labour intensive, costly, and measuring movement of many individuals is challenging. Automated detection and tracking of small-scale movements of many animals through cameras are possible. However, automated techniques are largely untested in field conditions, and this is hampering applications to ecological questions. 2. Here, we aimed to test the ability of computer vision algorithms to track small-scale movement of many individuals in videos. We apply the method to track fish movement in the field and characterize movement behaviour. First, we automated the detection of a common fisheries species (yellowfin bream, Acanthopagrus australis) from underwater videos of individuals swimming along a known movement corridor. We then tracked fish movement with three types of tracking algorithms (MOSSE, Seq-NMS and SiamMask), and evaluated their accuracy at characterizing movement. 3. We successfully detected yellowfin bream in a multi-species assemblage (F1 score = 91%). At least 120 of the 169 individual bream present in videos were correctly identified and tracked. The accuracies among the three tracking architectures varied, with MOSSE and SiamMask achieving an accuracy of 78%, and Seq-NMS 84%. 4. By employing these emerging computer vision technologies, we demonstrated a non-invasive and reliable approach to studying fish behaviour by tracking their movement under field conditions. These cost-effective technologies potentially will allow future studies to scale-up analysis of movement across many underwater visual monitoring systems.

Ebstein anomaly, a rare congenital heart disease, is defined as displacement of hinge points of septal or posterior tricuspid leaflets but not anterior leaflet. Here we report a 35 year old lady with an extremely rare pattern of EA with all three tricuspid leaflets displaced downward to the apex.

Human activity is increasingly and persistently disturbing nature and wild animals. Affected wildlife adopts multiple strategies to deal with different human influences. To explore the effect of human activity on habitat utilization of Himalayan marmot (Marmota himalayana), habitat utilization patterns of three neighboring marmot populations in habitats affected differently by human activities were recorded and compared. We found that: (1) Distance between reproductive burrows (a represent of reproductive pairs) becomes shorter under the influence of human activities, and more burrows were dug as temporary shelters, resulting in a shorter distance between those shelters as well as shorter distance flee to those shelters, and consequently, shorter flight initiation distance when threatened. More burrows that are closer in the disturbed habitats improve the ability to escape from threats. (2) Reproductive burrow site selection of the species is determined by the availability of mounds in the habitat, and breeding pairs selectively build reproductive (also the hibernation) burrows on mounds, potentially to improve surveillance when basking and the drainage of burrows. Human activities generally drive breeding pairs away from the road to dig their reproductive burrows likely to reduce disturbance from vehicles. However, even heavy human activity exerts no pressure on the distance of reproductive burrows from the road or the mound volume of the high disturbance population, potentially because mounds are the best burrowing site to reproduce and hibernate in the habitat. Marmots deal with disturbance by digging more burrows in the habitat to flee more effectively and building reproductive burrows on mounds to gain better vigilance and drainage efficiency.

Pharmaceutical industry and drugs advertisement is sometimes accused of “creating diseases”. This article assesses and describes the role of that industry in fostering medicalization. First, the notions of medicalization and pharmaceuticalization are defined. Then, the problem of distinguishing between harmful overmedicalization and well-founded medicalization is presented. Next, the phenomenon of disease mongering is explained and illustrated by the case analysis of medicalizing pain and suffering in three contexts: 1) the general idea of medicalizing physical pain, 2) the medicalization of grief, and 3) disease mongering of pseudoaddiction - a condition promoted in order to increase the demand for opioid pain relievers.

Background: Childhood allergic rhinitis (AR) is clinically highly heterogeneous. We aimed to identify distinct subgroups amongst children with AR, and to ascertain their association with patterns of symptoms, allergic sensitization and concomitant physician-diagnosed asthma. Methods: We recruited 510 children with physician-diagnosed AR, of whom 205 (40%) had asthma. Latent class analysis (LCA) was performed to identify latent structure within the data set using 17 variables (allergic conjunctivitis, eczema, asthma, family history of asthma, family history of allergic rhinitis, skin sensitization to 8 common allergens, tonsillectomy, adenoidectomy). Results: A four−class solution was selected as the optimal model based on statistical fit. We labeled AR latent classes as: (1) AR with grass mono-sensitization and conjunctivitis (n=361, 70.8%); (2) AR with house dust mite sensitization and asthma (n=75, 14.7%); (3) AR with pet and grass polysensitization and conjunctivitis (n=35, 6.9%) and (4) AR among children with tonsils and adenoids removed (n=39, 7.6%). Perennial AR was significantly more common among children in Class 2 (OR 5.83, 95%CI 3.42−9.94, p<0.001) and Class 3 (OR 2.88, 95%CI 1.36−6.13, p=0.006). Mild and intermittent AR symptoms were significantly more common in children in Class 3 compared to those in Class 1. AR was more severe in Class 1, compared to other 3 classes, indicating that upper respiratory symptoms are more severe among children with isolated seasonal rhinitis, than in those with rhinitis and coexisting asthma. Conclusion: We have identified 4 phenotypes in school-age children with AR, which were associated with different patterns of clinical symptoms and comorbidities.

Sustainable agronomic practices are tried all over the world to promote safe and eco-friendly crop production. Therefore, in the present study, the effect of seed endophytic bacteria and its consortia on soil biochemical property, soil nutrient, and yield of chickpea (Cicer arietinum L.) under field and pot conditions are investigated. Both the experimental results proved a significant increase in total soil organic carbon (OC), electric conductivity (EC), organic matter (OM), soil nutrient like available N, P and K content and important soil enzymes like dehydrogenase (DHA), beta glucosidase, alkaline phosphate, and urease was observed under the Enterobacter hormaechei BHUJPCS-15 (T1), Enterobacter cloacae BHUJPCS-21 (T2) and combined T3 (consortia of T1 and T2) treatments. Similarly, a significant increase in the grain yield (27-45% and 57-73%) in microbial treatment was found in pot and field experiments, respectively than control. In addition, whereas the higher plant biomass (14-38% and 42-78%) was recorded in the treated plant over the control plant. Similarly, the plant photosynthetic pigment (Chl a, b, total Chl) were also increased in the microbial treated plant than the control untreated chickpea plant. Our present study highlights the significance of sustainable agronomic practices for improving the soil quality and agricultural yield while reducing adverse impacts of chemicals by the use of seed endophytic microbes and their consortia.

Ethyl levulinate, one of main derivatives of levulinic acid (LA), is of significant potential as platform chemicals for bio-based materials. The esterification of LA was generally carried out in a conventional batch reactor or in a conventional reactive distillation column. However, traditional methods are hard to deal with equilibrium limited reactions and azeotropic issues. Therefore, the reactive-vapor permeation-distillation (R-VP-D) process, which integrated reaction, distillation and membrane dehydration into one single unit, is proposed in this paper and validated in the pilot-scale experiments. A comparative study is made between a pilot-scale RD column with and without vapor permeation membrane module. Owing to the water-selective membrane and the ingenious design of related apparatuses, the R-VP-D process reveal a superiority in LA conversion of 21.9% maximum higher than RD without VP process and removing of product water about 53.6% from VP module, which indicates its promising industrial application in process intensification field.

[Definitive version of this article may be found here] The mitochondrial gene cytochrome-c-oxidase subunit 1 (COI) is useful in many taxa for phylogenetics, population genetics, metabarcoding, and rapid species identifications. However, the phylum Ctenophora (comb jellies) has historically been difficult to study due to divergent mitochondrial sequences and the corresponding inability to amplify COI with degenerate and standard COI ‘barcoding’ primers. As a result, there are very few COI sequences available for ctenophores, despite over 200 described species in the phylum. Here, we designed new primers and amplified the COI fragment from members of all major groups of ctenophores, including many undescribed species. Phylogenetic analyses of the resulting COI sequences revealed high diversity within many groups that was not evident from more conserved 18S rDNA sequences, in particular among the Lobata. The COI phylogenetic results also revealed unexpected community structure within the genus Bolinopsis, suggested new species within the genus Bathocyroe, and supported the ecological and morphological differences of some species such as Lampocteis cruentiventer and similar lobates (Lampocteis sp. ‘V’ stratified by depth, and ‘A’ differentiated by color). The newly described primers reported herein provide important tools to enable researchers to illuminate the diversity of ctenophores worldwide via quick molecular identifications, improve the ability to analyze environmental DNA by improving reference libraries and amplifications, and enable a new breadth of population genetic studies.

Background:Microwave ablation has a great potential to treat primary hyperparathyroidism; but its predictors and the therapeutic efficiency are not clear enough and so the more investigations are required. Aim:The purpose of this study was to explore safety and predictors of the MWA efficacy in patients with primary hyperparathyroidism (PHPT) induced by parathyroid adenoma. Methods: Patients with PHPT treated with MWA were included in this study. Depending on the treatment efficacy, patients divided into two groups as response and no response group. Possible predictors as age, gender, Parathyroid adenoma volume, baseline levels of calcium (Ca), phosphorous (P), alkaline phosphate (ALP), vitamin D and location of parathyroid adenoma and the instrumental parameters which are microwave ablation time and power were compared between two groups. The resulting possible predictors the MWA efficacy exhibiting statistically significant difference was investigated by using logistic regression. Results: Thirty-two patients participated into predictor analysis for MWA efficacy. Comparison of the values of response and no response groups in terms possible predictors revealed only the baseline Ca level as the potential predictor of the efficacy of MWA (P <0.05). Further logistic regression results showed the baseline Ca level as insignificant to construct a mathematical model to predict the efficacy of MWA (P = 0.071). Furthermore, a significant difference in time differences was observed after 1 day of the MWA treatments in the levels of Ca, P, and PHT except than ALP, those of which was 30 days later (P <0.001). Later on, the difference stayed steady until the end of follow up. Conclusions:MWA is an effective and safe therapy for in patients with PHPT caused by parathyroid adenoma. Baseline Ca level has been found as potential but detailed investigations revealed none of the explored factors as predictive for the assessed patients. Keywords:Primary hyperparathyroidism, microwave ablation, predictor, efficacy

Transesophageal echocardiography is mandatory if you do suspect infective endocarditis. By approaching via a small right thoracotomy, vegetectomy and mitral valvuloplasty following severe mediastinitis were successfully accomplished without any complications. 

Aims: We have previously shown that 2-dimentional strain is not a useful tool for ruling out acute coronary syndrome (ACS) in the emergency department (ED). The aim of the present study was to determine whether in patients with suspected ACS, global longitudinal strain (GLS), measured in the ED using 2-dimensional strain imaging, can predict long-term outcome. Methods: Long-term (median 7.7 years [IQR 6.7-8.2]) major adverse cardiac events (MACE; cardiac death, ACS, revascularization, hospitalization for heart failure or atrial fibrillation) and all-cause mortality data was available in 525/605 patients (87%) enrolled in the Two-Dimensional Strain for Diagnosing Chest Pain in the Emergency Room (2DSPER) study. The study prospectively enrolled patients presenting to the ED with chest pain and suspected ACS but without a diagnostic ECG or elevated troponin. GLS was computed using echocardiograms performed within 24 hours of chest pain. MACE of patients with worse GLS (> median GLS) was compared to patients with better GLS ( median GLS). Results: Median GLS was -18.7%. MACE occurred in 47/261 (18%) of patients with worse GLS as compared with 45/264 (17%) with better GLS, adjusted HR 0.87 (95% CI 0.57-1.33, P=0.57). There was no significant difference in all-cause mortality or individual end-points between groups. GLS did not predict MACE even in patients with optimal 2-dimensional image quality (n=164, adjusted HR=1.51, 95% CI 0.76-3.0). Conclusions: GLS did not predict long-term outcome in patients presenting to the ED with chest pain and suspected ACS, supporting our findings in the 2DSPER study.

Herein, we present a new surgical approach for vibrant soundbridge implantation in advance of the plastic reconstruction of the auricle in patient with unilateral microtia-atresia and highlight the importance of cooperation between otologists and plastic surgeons in the performance of this technique.

During geographical expansion of a species individual colonizers have to confront different ecological challenges, and the capacity of the species to broaden its range may depend on the total amount of adaptive genetic variation supplied by evolution. We set out to test whether the distribution of loci under selection along a contrasting environmental gradient can be turned into a model that accurately predicts a species' range. If positive, this may shed light on the genetic source of adaptive limits that shape range boundaries. We sampled five populations of the western Mediterranean lizard Psammodromus algirus that inhabit a noticeable environmental gradient of temperature and precipitation. We used 21 SNPs putatively under selection to correlate the genotypes of 95 individuals with environmental variation among their populations, using 1x1 km2 grid cells as sampling units. By extrapolating the resulting model to all possible combinations of alleles, we inferred the locations that were theoretically suitable for the species. The inferred distribution range overlapped to a large extent with the realized range of the species, including an accurate prediction of internal gaps and range borders. Our results suggest an adaptability threshold determined by the amount of genetic variation available that would be required to warrant adaptation beyond a certain limit of environmental variation. These results support the idea that the expansion of a species' range may be ultimately linked to the arising of new variants under selection.

In this paper, we study a fractional order time delay for nonlinear financial system. By using Laplace transformation, stability and Hopf bifurcation analysis have been done for the model. Furthermore, numerical simulation has been carried out for better understanding of our results.

Clinical ImagesTitle: Twenty-years’ use of expanded polytetrafluoroethylene sheet for an artificial cardiac pacemakerKenji Yorita1*, Junichi Takahashi2, Kazutoshi Tano3, Yoichi Ichikawa3, Nobumasa Hamaguchi4, Wataru Yasui51Department of Diagnostic Pathology, Japanese Red Cross Kochi Hospital, Kochi-city, Kochi, Japan2Department of Internal Medicine, Japanese Red Cross Kochi Hospital, Kochi-city, Kochi, Japan3Department of Cardiovascular Surgery, Japanese Red Cross Kochi Hospital, Kochi-city, Kochi, Japan4Department of Thoracic Surgery, Japanese Red Cross Kochi Hospital, Kochi-city, Kochi, Japan5Department of Internal Medicine, Yusuhara Hospital, Kochi-city, Kochi, JapanThe authors report no conflict of interest, financial or otherwise.＊Corresponding Author: Kenji Yorita, M.D., Ph.D.,Department of Diagnostic Pathology, Japanese Red Cross Kochi Hospital, 1-4-63-11, Hadaminamimachi, Kochi-city, Kochi 780-8562, JapanTel: +81-88-822-1201Fax: +81-88-822-1056E-mail: [email protected] : expanded polytetrafluoroethylene sheet, cardiac pacemaker, foreign body