The effects of human disturbance on the stability of alpine meadow communities, their diversity–stability relationship, and the underlying mechanisms are still not fully understood. Here, we performed a 12-year-long (2007–2018) two-factor (2 × 3) controlled experiment on Kobresia humilis on the Tibetan Plateau. The manipulations included three clipping levels (no clipping, NC; moderate clipping, MC; heavy clipping, HC) and two fertilization levels (no fertilization, NF; fertilization, F). Our results revealed that the two clipping manipulations significantly increased the temporal stability of alpine meadow communities, whose significant increase was more pronounced under the MC than HC treatment. Moreover, asynchrony effects, portfolio effects, and facilitation interactions were all present in the communities under the six types of experimental treatment combinations. Additionally, a selection effect was detected in the compound communities, demonstrating characteristics that are common to different mechanisms. There were no significant differences in the effects of these mechanisms on community temporal stability between the NC–NF and MC–NF interactive communities. The portfolio effects predominated when clipping intensity was moderate under both fertilization and non-fertilization conditions. By contrast, in the compound communities, the selection effect predominated. In summary, we conclude that in meadow communities that undergo clipping and fertilization disturbances, facilitation interactions and weak interactions make a greater contribution toward maintaining their temporal stability.

Botulinum toxin is widely used in the treatment of temporomandibular disorder symptoms even though consensus on this treatment modality has not yet been reached. Outcome assessment methods described herein could serve as a novel scientific method for the reliable evaluation of the effectiveness of botulinum toxin in further investigations.

We herein report an exceedingly rare case of Evans syndrome with associated tubercular pleural effusion. The patient was initially treated as autoimmune hemolytic anemia. However, the development of thrombocytopenia led to the subsequent diagnosis of Evans syndrome. The co-existence of tuberculosis resulted in additional difficulty during treatment with immunosuppressive medications.

BACKGROUND Adolescent and young adult (AYA) hematopoietic cell transplantation (HCT) survivors are at increased risk of metabolic syndrome and lean body mass (LBM) deficits. Resistance training (RT) is a potential intervention to improve LBM, metabolic fitness and reduce risk of cardiovascular disease. PROCEDURE Eligible participants ages 13-39 years, 80-120 days post-HCT, transfusion independent, and prednisone dose <1 mg/kg/day were approached. Baseline assessments of body composition (DXA), anthropometrics and strength testing were completed and participants were taught a 12-week, home-based RT intervention with weekly remote coaching. Follow-up assessments were at day +200 (FU1) and +365 post-HCT (FU2). Feasibility targets were 1) 60% enrollment of approached patients, 2) 80% completion of weekly phone calls and 3) 80% completion of the RT intervention and FU1 assessments. Acceptability was measured by recommendation of the intervention to an AYA HCT survivor. RESULTS Twenty of 31 (65%) eligible AYAs enrolled. Two participants failed to complete baseline measurements (1=scheduling barriers, 1=passive refusal) and 4 participants who completed baseline assessments did not receive the intervention (2=medical reasons, 2=no longer interested). Of the 13 who received the intervention, 11 (85%) completed FU1 and completed 88.5% of coaching calls. LBM (kg) increased or remained unchanged in 9/9 participants with complete body composition data at FU1 (mean 1.1 kg; 95%CI: 0.4,1.9). All participants who completed FU1 reported they would recommend the intervention to an AYA HCT survivor. CONCLUSIONS A home-based RT intervention in AYA HCT survivors early post HCT is both feasible and acceptable and may maintain or increase LBM.

Background: Cerebral Sinus Venous Thrombosis (CSVT) is one of many side effects encountered during acute lymphoblastic leukemia (ALL) therapy. Due to the rarity of cases, lack of data, consensus management, no recommendations exist to target the population at risk. Methods: This is a retrospective chart review of 229 consecutive patients diagnosed with ALL and aged 1–21 years, treated at the Children’s Cancer Institute (CCI) between October 2007 and February 2017. Results: The incidence of CSVT was 10.5%. Using univariate analysis, increased risk of CSVT was observed with male gender, age >10 years, T-cell immunophenotype, intermediate/high risk disease, maximum Triglyceride (TG) level of > 615 mg/dL, presence of mediastinal mass, and larger body surface area. With multivariate analysis, the only statistically significant risk factors were maximum TG level, body surface area (BSA), presence of mediastinal mass, and risk stratification (intermediate/high risk). Conclusion: Our study was able to unveil TG level of > 615 mg/dL, mediastinal mass, and a larger body surface area as novel risk factors that have not been previously discussed in the literature.

Background: The impact of the increased mitral gradient (MG) on outcomes is ambiguous. Therefore, we aimed to evaluate a) periinterventional dynamics of MG, b) the impact of intraprocedural MG on clinical outcomes, and c) predictors for unfavourable MG values after MitraClip. Methods: We prospectively included patients undergoing MitraClip. All patients underwent echocardiography at baseline, intraprocedurally, at discharge, and after six months. 12-month survival was reassessed. Results: 175 patients (age 81.2±8.2 years, 61.2% male) with severe mitral regurgitation (MR) were included. We divided our cohort into two groups with a threshold of intraprocedural MG of 4.5 mmHg, which was determined by the multivariate analysis for the prediction of 12-month mortality (<4.5 mmHg: Group 1, 4.5 mmHg: Group 2). Intraprocedural MG 4.5 mmHg was found to be the strongest independent predictor for 12-month mortality (HR: 2.33, p=0.03, OR: 1.70, p=0.05) and ≥3.9 mmHg was associated with adverse functional outcomes (OR: 1.96, p=0.04). The baseline leaflet-to-annulus index (>1.1) was found to be the strongest independent predictor (OR: 9.74, p=0.001) for unfavourable intraprocedural MG, followed by the number of implanted clips (p=0.01), MG at baseline (p=0.02) and central clip implantation (p=0.05). Conclusion: MG shows time-varying and condition-depended dynamics periinterventionally. Patients with persistent increased (≥4.5 mmHg) MG at discharge showed the worst functional outcomes and the highest 12-month mortality, followed by patients with an intra-hospital decrease in MG to values below 4.5 mmHg. Pre-interventional echocardiographic and procedural parameters can predict unfavourable postprocedural MG.

We present hereby the case of a 75-year-old woman with a degenerated mitral bioprosthesis and severely reduced left ventricular ejection fraction who underwent a successful trans-septal mitral valve-in-valve (TMViV) replacement using a 29mm Edwards Sapien S3 transcatheter heart valve. We also performed a literature review.

Here we review and extend the equal fitness paradigm (EFP) as an important step in developing and testing a synthetic theory of ecology and evolution based on energy and metabolism. The EFP states that all organisms are equally fit at steady state, because they allocate the same quantity of energy, ~22.4 kJ/g/generation to production of offspring. On the one hand, the EFP may seem tautological, because equal fitness is necessary for the origin and persistence of biodiversity. On the other hand, the EFP reflects universal laws of life: how biological metabolism – the uptake, transformation and allocation of energy – links ecological and evolutionary patterns and processes across levels of organization from: i) structure and function of individual organisms, ii) life history and dynamics of populations, iii) interactions and coevolution of species in ecosystems. The physics and biology of metabolism have facilitated the evolution of millions of species with idiosyncratic anatomy, physiology, behavior and ecology but also with many shared traits and tradeoffs that reflect the single origin and universal rules of life.

Rabies is a global viral zoonosis endemic to South Africa, resulting in fatal encephalitis in warm blooded animals, including humans. The loss of human lives and economic losses in rural areas through loss of livestock are substantial. A review was conducted of all confirmed rabies cases in South Africa from 1993 to 2019, with a total of 11 701 cases identified to species level to assess the wildlife plays in the epidemiology of rabies. A spatiotemporal cluster analysis using a discrete Poisson space-time probability model, accounting for underlying estimated dog and livestock densities, identified 13 significant clusters (p<0.05). These included four long-term clusters lasting more than 8 years in duration and seven short term clusters lasting less than 2 years, with the remaining two clusters being of intermediate length. Outside of these endemic clusters, wildlife outbreaks in the remainder of South Africa were often less than one and a half years in duration most likely due to the rapid decline of wildlife vectors, especially jackals associated with rabies infection. Domestic dogs accounted for 59.8% of cases, with domestic cats (3.2%), livestock (21.1%) and wildlife (15.8%) making up the remainder of the cases. Yellow mongoose (Cynictis penicillate) was the most frequently affected wildlife species, followed by bat-eared fox (Otocyon megalotis), black-backed jackal (Canis mesomelas), meerkat (Suricata suricatta) and aardwolf (Proteles cristatus). Rabies in wildlife species followed different spatial distributions: black-backed jackal cases were more common in the north-western parts of South Africa, yellow mongoose cases more frequent in central South Africa, and bat-eared fox and aardwolf cases were more frequent in southern and western South Africa. Clusters often spanned several provinces, showing the importance of coordinated rabies control campaigns across administrative boundaries, and high-risk areas were highlighted for rabies in South Africa.

Current approaches to characterize the mutational profile of CFTR are based on targeted mutation analysis (TMA) or whole gene studies derived from short-read next generation sequencing (NGS). However, these methods lack phasing capability which, in certain scenarios, can provide clinically valuable information. In the present work, we performed near-full length CFTR using Single-Molecule Real-Time Sequencing to produce haplotype resolved data from F508del homozygous and F508del compound heterozygous individuals. This approach utilizes target enrichment of the CFTR gene using biotinylated probes, facilitates multiplexing samples in the same sequencing run, and utilizes fully-automated bioinformatics pipelines for error correction and variant calling. We show a remarkable conservation of F508del haplotype, consistent with the single gene founder effect, as well as diverse mutational profiles in non-F508del alleles. By the same method, 105 single nucleotide polymorphisms exhibiting invariant linkage to F508del CFTR (which better define the founder haplotype) were identified. High level homology between F508del sequences derived from heterozygotes, and those obtained from homozygous individuals, demonstrate accuracy of this method to produce haplotype resolved sequencing. The studies provide a new diagnostic technology for detailed analysis of complex CFTR alleles linked to disease severity.

Natural wetland along the coasts of Yellow and Bohai seas provided key stopover sites for migratory waterbirds. However, these wetlands are facing land loss. Understanding how natural wetlands loss influence habitat is an important step for habitat management. Using species distribution model to report changes in area of suitable habitat, and the effects of natural wetland loss on habitat for 80 waterbird species attributed to four functional categories (shorebird, duck, heron, gull), between 2000 and 2015 in the Yellow and Bohai seas. Of 1794.8 km2 of coastal wetland lost to development between 2000 and 2015, most represented tidal flats converted into aquaculture and salt pan habitat, or for construction. Consequently, habitat for 73 of these 80 species has decreased in area over this time period. Generally, the proportional decline in habitat suitable for species of duck was less than it was shorebirds, herons and gulls. The proportional loss of tidal flat habitat that formerly represented suitable habitat for shorebirds, herons and gulls was also significantly higher than it was for ducks. Because more species of duck exploit aquaculture and salt pan habitat converted from tidal flats than do shorebird, heron and gull species, such conversion of tidal flats pose a greater threat to shorebirds, herons and gulls than they do to ducks. Preventing further reclamation of tidal flats and managing artificial wetlands are priorities for waterbirds conservation, especially for the species ducks.

The wild tomato species Solanum chilense is divided in geographically and genetically distinct populations that show signs of defense gene selection and differential phenotypes when challenged with several phytopathogens, including the oomycete causal agent of late blight Phytophthora infestans. To better understand the phenotypic diversity of this disease resistance in S. chilense and to assess the effect of plant genotype vs. pathogen isolate, respectively, we evaluated infection frequency in a systematic approach and with large sample sizes. We studied 85 genetically distinct individuals representing nine geographically separated populations of S. chilense. This showed that differences in quantitative resistance properties can be observed between but also within populations at the level of individual plants. Data also did not reveal clear indications for complete immunity in any of the genotypes. We further evaluated the resistance of a subset of the plants against P. infestans isolates with diverse virulence properties. This confirmed that the relative differences in resistance phenotypes between individuals were mainly determined by the plant genotype under consideration with modest effects of pathogen isolate used in the study. Thus, our report suggest that quantitative resistance against P. infestans in natural populations of a wild tomato species S. chilense is likely not the result of specific adaptations of hosts to the pathogen but of basal defence responses that depend on the host genotype and are pathogen isolate-unspecific.

The vast majority of solid-liquid mixing studies have focused on high Reynolds number applications with configurations and impeller geometries adapted to this type of regime. However, the mixing of particles in a viscous fluid is an essential element of many contemporary industries. We used the CFD-DEM model previously developed in our group to investigate solid-liquid mixing with close-clearance impellers in the laminar regime of operation. We compared different geometries that is, the double helical ribbon, anchor, Paravisc$^{TM}$, and Maxblend$^{TM}$ impellers. We investigated the impact of fluid viscosity and compared the results with those obtained with the pitched blade turbine, a more commonly used impeller, based on power consumption for equivalent mixing states. This study highlights that the higher the viscosity of the fluid, the more interesting it is to use close-clearance impellers for their ability to generate a strong shear stress and a strong bulk flow in the entire vessel.

A bubble column was investigated as a method to achieve a desired and controllable rate of evaporation of a pharmaceutical solution in continuous processing mode. Applying a developed thermodynamic model to predict the rate of evaporation, all predicted values achieved accuracies within the bounds of instrumentation errors. The model accounted for the measured effect of reduced vapor pressure caused by dissolved solids as a function of their concentration. A general method to obtain accurate measurement of this effect is introduced and applied, improving the accuracy of model predictions. Predicting the rate of evaporation using the developed model, consistent and repeatable evaporation rates ranging from 0.7–6.9 g/min were achieved. Applying the column as a controllable evaporator, the concentration of a dilute feed stream was increased in a single equilibrium stage and coupled to a crystallizer. The configured system achieved a steady state of controllable operation over a duration of 5 hours

During the coating and drying of thin polymer-particle composites, the particle geometry has a big impact on the prediction of concentration profiles in the dry film. In this work, a plate-like geometry is used to evaluate the mass transport of the particles with the aspect ratio as a variable. The experimental determination of the viscosity and sedimentation rates allows to simulate concentration profiles in the wet film while drying. A previous simulation model was automatized to describe the drying of the plate-like particles-polyvinyl alcohol-water material system using COMSOL with the initial concentration, aspect ratio, Péclet number, and Sedimentation number as input parameters. The results are summarized in drying regime maps, which show an increase of the evaporation regime, when the aspect ratio decreases due to lower particle mobility. This shows the importance of the geometry while predicting the particle distribution in the dry film and designing coating and drying processes.

Introduction Detail 3D mapping have been useful for effective radiofrequency catheter ablation. Rhythmia system can create the atrio-ventricular dual chamber mapping, which reveals the atrial and ventricular potentials all at once in the same map. The aim of this study was to investigate the utility of Rhythmia system for catheter ablation of accessory pathways (AP). Methods From July 2015 to August 2020, 111 patients underwent ablation of APs. The dual chamber mappings were created in 50 patients [median age 15 (10-54), 32 male(64.0%)], while 61 patients underwent the radiofrequency (RF) ablations with conventional single chamber 3D mappings. The background characteristics and procedure details were compared between the dual chamber mapping group and conventional single chamber mapping group. Results The number of RF application [1 (1-3) vs 3 (1-6), p=0.0023], RF time [9.2 (2.0-95.7) vs 95.6 (4.1-248.7), p=0.0023], RF energy [248.4 (58.7-3328.2) vs 2867.6 (134.2-7728.4), p=0.0115] were significantly lower in dual chamber group. Fluoroscopy time [19.9 (14.2-26.1) vs 26.5 (17.7-43.4), p=0.0025], and fluoroscopy dose [52.5 (31.3-146.0) vs 119.0 (43.7-213.5), p=0.0249] were also significantly lower than in single chamber mapping group. Conclusion The dual chamber mappings were useful for effective ablation with reducing the radiation exposure.

Medical Algorithm: Diagnosis and Managemen of Humoral ImmunodeficienciesAnna Šedivá1, Tomáš Milota1, Jiří Litzman2, Isabella Quinti3, ESID Clinical Working Party, EAACI Primary Immunodeficiency Working Group, Stephen Jolles4Department of Immunology, 2nd Faculty of Medicine Charles University, V Uvalu, University Hospital in Motol, Prague, Czech RepublicFaculty of Medicine, Masaryk University Brno, Czech Republic; Department of Clinical Immunology and Allergology, St Anne´s University Hospital, Brno, Czech RepublicDepartment of Molecular Medicine, Sapienza University of Rome, Rome, ItalyImmunodeficiency Centre for Wales, University Hospital of Wales, Cardiff, UKFor ESID Clinical Working Party:Isabelle Meyts, Department of Pediatrics, Leuven University Hospitals, Leuven, BelgiumSiobhan Burns, Institute of Immunity and Transplantation, University College London, London, United Kingdom; Department of Immunology, Royal Free London NHS Foundation Trust, London, United KingdomAuthor´s contributions:AS prepared the concept and wrote the manuscript, TM edited Figures and wrote the manuscript, JL designed Figures and revised manuscript, IQ designed Figures and revised the manuscript, IM revised manuscript, SB revised manuscript, ST edited Figures and wrote the manuscript.

Introduction: We aimed to investigate whether a modified implantation method facilitating a fully open umbrella can reduce the pericardial effusion/pericardial tamponade (PE/PT) rate after left atrial appendage closure (LAAC) with the LAmbre device compared with the conventional method (CM) in patients with non-valvular atrial fibrillation (NVAF). Methods and results: Patients with NVAF who received either isolated LAAC or combined catheter ablation and LAAC using the LAmbre device at the First Affiliated Hospital of Wenzhou Medical University from January 2018 to December 2019 were enrolled. CM was used for device implantation in the initial 59 patients, while a modified method (MM) was used in the remaining 165 patients. Successful implantation was achieved in 98.3% of patients in the CM group and in 98.8% in the MM group. A higher rate of a fully open umbrella (98.8% vs 69%, P<0.001), less requirement for recapture (46% vs 62.1%, P=0.036), and a lower incidence of delayed PE/PT (1.2% vs 8.6%, P=0.005) were found in the MM group compared with in the CM group. All of the five delayed PT events occurred in patients with combined treatment. An umbrella that was not fully open was the only factor associated with delayed PE/PT events in a multivariable Cox model. Conclusions: LAAC with the LAmbre device using an MM significantly increases the rate of a fully open umbrella and decreases the requirement for recapture and the incidence of delayed PE/PT. This method is more effective in patients with combined treatment.