chylothorax is a relatively uncommon condition. It is characterized by the presence of chylous rich fluid within the pleural space. Spontaneous chylothorax usually refers to non-traumatic causes most common malignancy and infections. we present a case of a spontaneous chylothorax with evidence of resolution of pleural effusion without detectable cause.

The case report describes a newborn case of ACS based on clinical presentation(s) and microdeletions of 22q11.21 and 11p15.4 using DNA high throughput sequencing analysis. This finding has implications for ACS diagnosis and overcomes the limitations associated with FISH by using the DNA high throughput sequencing across the whole genome.

Although less common compared to postherpetic neuralgia, post herpes itch (PHI) is a known sequela after herpetic infections. PHI usually disappears over weeks to months, requiring only symptomatic management. Rarely, PHI can result in significant debilitation. We report one case of extreme post herpetic itching and review the available literature.

Objective: Cardiac tumors are rare conditions. The vast majority of them are benign yet they may lead to serious complications. Complete surgical resection is the gold standard treatment and should be performed as soon as the diagnosis is made. Median sternotomy (MS) is the standard approach and provides excellent early outcomes and durable results at follow-up. However, minimally invasive (MI) is gaining popularity and its role in the treatment of cardiac tumors needs further clarification. Methods: A systematic literature review identified 12 candidate studies; of these, 11 met the meta-analysis criteria. We analyzed outcomes of 653 subjects (294 MI and 359 MS) with random effects modeling. Each study was assessed for heterogeneity. The primary endpoints were mortality at follow-up and tumor relapse. Secondary endpoints included relevant intra- and post-operative outcomes; tumor size was also considered. Results: There were no significant between-group differences in terms of late mortality (incidence rate ratio (IRR): MI vs. MS, 0.98 [95% CI: 0.25¬–3.82], p = 0.98). Few relapses and redo surgery were observed in both groups (IRR: 1.13[0.26-4.88], p=0.87);( IRR: 1.92 [95% CI: 0.39-9.53], p=0.42); MI was associated to prolonged operation time yet with no effects on clinical outcomes. Tumor size did not significantly differ between groups. Conclusions: Both MI and MS are associated with excellent early and late outcomes with acceptable survival rate and low incidence of recurrences. This study confirms that cardiac tumor may be approached safely and radically with a MI approach.

Soil and nutrient loss play a vital role in eutrophication of water bodies. Several simulated rainfall experiments have been conducted to investigate the effects of a single controlling factor on soil and nutrient loss. However, the role of precipitation and vegetation coverage in quantifying soil and nutrient loss is still unclear. We monitored runoff, soil loss, and soil nutrient loss under natural rainfall conditions from 2004 to 2015 for 50-100 m2 runoff plots around Beijing. Soil erosion was significantly reduced when vegetation coverage reached 20 and 60%. At levels below 30%, nutrient loss did not differ among different vegetation cover levels. Minimum soil N and P losses were observed at cover levels above 60%. Irrespective of the management measure, soil nutrient losses were higher at high-intensity rainfall (Imax30>15 mm/h) events compared to low-intensity events (p < 0.05). We applied structural equation modelling (SEM) to systematically analyze the relative effects of rainfall characteristics and environmental factors on runoff, soil loss, and soil nutrient loss. At high-intensity rainfall events, neither vegetation cover nor antecedent soil moisture content (ASMC) affected runoff and soil loss. After log-transformation, soil nutrient loss was significantly linearly correlated with runoff and soil loss (p < 0.01). In addition, we identified the direct and indirect relationships among the influencing factors of soil nutrient loss on runoff plots and constructed a structural diagram of these relationships. The factors positively impacting soil nutrient loss were runoff (44-48%), maximum rainfall intensity over a 30-min period (18-29%), rainfall depth (20-27%), and soil loss (10-14%). Studying the effects of rainfall and vegetation coverage factors on runoff, soil loss, and nutrient loss can improve our understanding of the underlying mechanism of slope non-point source pollution.

The aim of this paper is to give an alternative technique for the derivation of a prior energy estimate. Consequently, this allows to define a natural energy norm of the long-term well-posedness result established by S. Israwi in [2] but for the original system, in which the partial operator ∇× is not involved.

We are presenting a case of Necrobiosis Lipodica disease in a 55 year lady whose diabetes status was not known at the time of presentation in dermatology OPD. Traditionally, the diagnosis is confirmed by histopathological examination (HPE). Dermoscopy can also be used as a noninvasive tool to confirm the diagnosis.

Cysteine (Cys) is the most reactive amino acid participating in a wide range of biological functions. In-silico predictions complement the experiments to meet the need of functional characterization. Multiple Cys function prediction algorithm is scarce, in contrast to specific function prediction algorithms. Here we present a deep neural network-based multiple Cys function prediction, available on web-server (DeepCys) (https://deepcys.herokuapp.com/). DeepCys model was trained and tested on two independent datasets curated from protein crystal structures. This prediction method requires three inputs, namely, PDB identifier (ID), chain ID and residue ID for a given Cys and outputs the probabilities of four cysteine functions, namely, disulphide, metal-binding, thioether and sulphenylation and predicts the most probable Cys function. The algorithm exploits the local and global protein properties, like, sequence and secondary structure motifs, buried fractions, microenvironments and protein/enzyme class. DeepCys outperformed most of the multiple and specific Cys function algorithms. This method can predict maximum number of cysteine functions. Moreover, for the first time, explicitly predicts thioether function. This tool was used to elucidate the cysteine functions on domains of unknown functions (DUFs) belonging to cytochrome C oxidase subunit-II (COX2) like transmembrane domains. Apart from the web-server, a standalone program is also available on GitHub (https://github.com/vam-sin/deepcys)

Thrombocytosis is common in children with sickle cell disease (SCD). Reactive thrombocytosis must be distinguished from myeloproliferative disorder or inherited thrombocytosis syndrome. We present an adolescent with hemoglobin SS and thrombocytosis associated with increased frequency of pain, priapism, and acquired von Willebrand disease.

Endemics co-occur because they evolved in situ and persist regionally or because they evolved ex situ and later dispersed to shared habitats, generating evolutionary or ecological endemicity centres, respectively. We investigate whether different endemicity centres can intertwine in the region ranging from Alps to Sicily, by studying their butterfly fauna. We gathered an extensive occurrence dataset for butterflies of the study area (27,123 records, 269 species, in cells of 0.5x0.5 degrees of latitude-longitude). We applied molecular-based delimitation methods (GMYC model) to 26,557 COI sequences of Western Palearctic butterflies. We identified entities based on molecular delimitations and the most recent checklist of European butterflies and objectively attributed occurrences to their most probable entity. We obtained a zoogeographic regionalisation based on the 69 endemics of the area. Using phylogenetic ANOVA we tested if endemics from different centres differ from each other and from non-endemics for key ecological traits and divergence time. Endemicity showed high incidence in the Alps and Southern Italy. The regionalisation separated the Alps from the Italian Peninsula and Sicily. The endemics of different centres showed a high turnover and differed in phenology and distribution traits. Endemics are on average younger than non-endemics and the Peninsula-Sicily endemics also have lower variance in divergence than those from the Alps. The observed variation identifies Alpine endemics as paleoendemics, now occupying an ecological centre, and the Peninsula-Sicily ones as neoendemics, that diverged in the region since the Pleistocene. The results challenge the common view of the Alpine-Apennine area as a single “Italian refugium”.

Dealing with RV-oversensing; separate sensitivity settings for brady and tachy sensingPranav Bhagirath MD PhD1, Kyle Beunder BSc1, Vokko van Halm MD PhD11Department of Cardiology, Amsterdam University Medical Center, Amsterdam, the NetherlandsFunding: (None)Disclosures: (None)

Background: Vascular TRPV channels have emerged as important regulators of vascular tone. TRPV1 and endothelin-1 (ET-1) are independently associated with the pathophysiology of coronary vasospasm but the relationship between their vasomotor functions remains unclear. We characterized the vasomotor function of TRPV1 channels in human arterioles and investigated regulation of their vasomotor function by ET-1. Approach: Arterioles were threaded on two metal wires, equilibrated in a physiological buffer at 37 oC and exposed to increasing concentrations of capsaicin in the absence or presence of SB366791 (TRPV1-selective inhibitor) or GF109203X (PKC-selective inhibitor). Some arterioles were preconstricted with ET-1 or phenylephrine or high K+ buffer. TRPV1 mRNA and protein expression in human arteries were assessed. Results: TRPV1 transcripts and proteins were detected in human resistance arteries. Capsaicin (1 µM) induced concentration-dependent constriction of endothelium-intact (35 ± 8 %) and endothelium-denuded (43 ± 11 %) human adipose arterioles (HAA), which was significantly inhibited by SB366791 (0.2 ± 0.1 %). Preconstriction of HAA with ET-1, but not high potassium buffer or phenylephrine, significantly potentiated capsaicin-induced constriction (33 ± 7 % vs 12 ± 8 %). GF109203X significantly inhibited potentiation of capsaicin-induced constriction by ET-1. Conclusion: TRPV1 channels are expressed in the human vasculature and can influence vascular tone of human arterioles upon activation. Their vasomotor function is modulated by ET-1, mediated in part by PKC.. These findings reveal a novel interplay between ET-1 signaling and TRPV1 channels in human VSMC, adding to our understanding of the ion channel mechanisms that regulate human arteriolar tone and may also contribute to the pathophysiology of coronary vasospasm.

Seeds of Lithospermum officinale L. from different climatic zones were analyzed looking for new sources γ-linolenic acid (GLA, 18:3n-6) and stearidonic acid (SDA, 18:4n-3). Cultured B. officinalis was also analyzed with comparative purposes. Analyses were conducted for fatty acid (FA) profiles in the whole seeds and in the neutral and polar lipids by GC; lipid classes by open column chromatography and preparative TLC; and tocopherols, sterols and phenolic compounds by HPLC-DAD, and the later compounds were confirmed by LC-MS. The richest GLA sample was L. officinale from St. Petersburg Botanical Garden (17.9% of total FA), while wild-growing L. officinale from the Rostov region showed the highest percentage of SDA (17.2% of total FA). Total FA content ranged from 11.3 to 20.8% of seed weight. Neutral and polar lipids accounted for ~98 and 2.27% of total lipids. Five neutral lipid classes were identified (% of NL): triterpene esters, 1.3; triacylglycerols, 93.1; free FA, 1.8; diacylglycerols, 1.4; and monoacylglycerols, 2.4. Tocopherols and sterols reached 35.7 and 83.8 mg/100 g seeds; γ-tocopherol was the main tocopherol detected, and Δ5-avenasterol was the predominant sterol. L. officinale seeds contain high amounts of phenolic compounds (389.9 mg/100 g as upper limit), in which rosmarinic acid was the main component. Overall, all data suggest the possibility of using L. officinale seed oil in pharmaceutical and cosmetic formulae and as functional food.

Association between asthma and clinical mortality/morbidity in COVID-19 patients using clinical epidemiologic data from Korean Disease Control & PreventionHyo-Geun Choi1, Jee Hye Wee2, So Young Kim2, Joo-Hee Kim3, Hwan Il Kim3, Ji-Young Park3, Sunghoon Park3, Yong Il Hwang3, Seung Hun Jang3, and Ki-Suck Jung31 Departments of Otorhinolaryngology-Head & Neck Surgery, Hallym UniversitySacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea2 Department of Otorhinolaryngology-Head & Neck Surgery, CHA Bundang Medical Center, CHA University, Seongnam, Korea3 Division of Pulmonary, Allergy, and Critical Care Medicine, Department ofMedicine, Hallym University Sacred Heart Hospital, Hallym University Collegeof Medicine, Anyang, Korea

Nitrous oxide is an increasingly popular recreational drug. However recurrent or prolonged use can be associated with nitrous oxide toxicity, with numerous reports of harm documented in the literature. Nitrous oxide irreversibly binds and inactivates vitamin B12, which is an important co-factor in metabolic pathways involved in DNA and myelin synthesis. Toxicity is therefore associated with vitamin B12 deficiency-related syndromes, primarily involving haematological and neurological systems. As a ‘legal high’, nitrous oxide use has attracted repeated health warnings from experts. An awareness and understanding of the pathophysiology and management of nitrous oxide toxicity is therefore important for clinicians. We discuss the case of a 29-year old man presenting with nitrous oxide-induced sensorimotor neuropathy and review the existing literature surrounding toxicity.

The efficient computation of molecular integrals and their derivatives is a crucial step in molecular property evaluation in modern quantum chemistry. As an integral tensor decomposition technique, the density-fitting (DF) approach becomes a popular tool to reduce the memory and disk requirements for the electron repulsion integrals. In this study, an application programming interface (API) framework, denoted (MFW), for the computation of molecular integrals and their first derivatives, over contracted Gaussian functions, for the density-fitted methods is reported. The MFW is free software and it includes overlap, dipole, kinetic, potential, metric, and 3-index integrals, and their first derivatives. Furthermore, the MFW provides a smooth approach to build the Fock matrix and evaluate analytic gradients for the density-fitted methods. The MFW is a C++/Fortran hybrid code, which can take advantage of shared-memory parallel programming techniques. Our results demonstrate that the MFW is an efficient and user-friendly API for the computation of molecular integrals and their first derivatives.

Background: Childhood acute lymphoblastic leukemia (ALL) is the most common pediatric malignancy. The onset of obesity during childhood ALL has been well established and is associated with inferior survival rates and increased treatment-related toxicities. This pilot study sought to determine if a dietary intervention is feasible and minimizes weight gain during the initial phases of treatment for ALL. Methods: Participants were recruited from four institutions, fluent in English or Spanish, between 5-21 years old, and enrolled within three days of starting induction therapy. Participants were counseled for six months to follow a low glycemic diet. Dietary and anthropometric data were collected at baseline, end of induction, and end of month six (NCT03157323). Results: Twenty-three of 28 participants (82.1%) were evaluable and included in the analysis. Dietary intake of several nutrients targeted by the nutrition intervention declined (sugar, P = 0.003 and glycemic load, P = 0.053). We also observed a persistent increase in total vegetables across each timepoint (P = 0.015) and by the end of the intervention (P = 0.033). Importantly, we did not observe an increase in body mass index z-score during induction or over the six-month intervention period. Most families found the nutrition intervention easy to follow (60%) and affordable (95%) despite simultaneous initiation of treatment for ALL. Conclusions: A six-month nutrition intervention initiated during the initial phase of treatment for childhood ALL is feasible and may prevent weight gain. Our preliminary findings need to be confirmed in a larger clinical trial.

Shwachman–Diamond syndrome with Shwachman–Bodian–Diamond syndrome (SBDS) biallelic variants is a rare disorder that predisposes the carrier to malignant hemopathies but solid-cancer predisposition is poorly known. Among 155 cases entered in the French Severe Chronic Neutropenia Registry, three were identified original with malignant solid tumors (ovary, breast and esophagus). All cancers occurred in the fifth decade and, despite being at localized stages at diagnosis, they were rapidly fatal thereafter. No cancer was observed in the 14 HSCT survivors post transplantation. Based on our experience and the literature, age >40 years was the only apparent risk factor.