Chromosome 4q Deletion Syndrome (4QDS) is a rare chromosomal deletion that presents with various congenital defects that could affect anesthetic management. We present a patient with known 4QDS who underwent successful general anesthetic induction, tracheal intubation, and subsequently, bilateral quadratus lumborum nerve blocks, during laparoscopic inguinal hernia repair surgery.

Pd-catalyzed asymmetric allylic C−H functionalization has emerged as a powerful tool to access chiral, densely functionalized molecules from easily ac-cessible alkenes, enabling the increase of the step- or atom-economy by minimizing functional group manipulations for preparing allylating reagents. Due to the inadequacy of stereoselection strategies, the asymmetric allylic C-H functionalization is still in the early stage. In this essay, we will describe our journey to identification of asymmetric catalytic systems, mechanism of allylic C−H activation, control of stereo- and regioselectivity, and applica-tions in asymmetric synthesis.

Background: Cross-education, a phenomenon where unilateral strength (or skill) training enhances strength (or skill) in the contralateral untrained limb, has been well studied in able-bodied individuals. However, whether non-paretic leg movements can modulate corticomotor excitability (CME) and improve motor control of the paretic leg in stroke remains unclear. Objective: To determine the effects of non-paretic leg movements on corticomotor responses and motor control of the paretic leg in persons with severe stroke. Methods: Seventeen post stroke individuals with severe leg motor impairment performed three 20-min motor trainings using their non-paretic ankle: skill (targeted dynamic movements), strength (isometric resistance), and sham (sub-threshold electrical nerve stimulation). Transcranial magnetic stimulation measured CME of the contralateral pathways from the non-lesioned motor cortex (M1) to the non-paretic tibialis anterior (TA) muscle, ipsilateral pathways to the paretic TA, and transcallosal inhibition (TCI) from the non-lesioned to lesioned M1. Paretic ankle motor control was measured using a reaction time paradigm. Results: CME of the non-paretic TA increased after skill (23%) and strength (19%) training (p<0.01). Ipsilateral CME of the paretic TA (23%) and TCI (36%) increased after skill (p<0.05) but not strength training. Reaction time of the paretic ankle improved after skill and strength training (~12%; p<0.05) and was sustained at 60 minutes. No changes were observed during the sham condition. Conclusion: Our findings may inform future studies for using non-paretic leg movements as a priming modality, especially for those who are contraindicated to other priming paradigms (e.g., brain stimulation) or unable to perform paretic leg movements.

Background Tumor deposits (TD) are considered as Extranodal Extension (ENE) in the AJCC 8th edition of Head and Neck Squamous Cell Carcinoma (HNSCC) TNM staging. Methods We analyzed TDs in patients with HNSCC who underwent surgery and adjuvant radiotherapy ± chemotherapy. Overall Survival (OS) and progression rate were compared to patients with ENE. Results ENE was detected in 50 patients, while TDs in 21. Based on the presence of ENE alone or TDs, the mean time to progression was significant (p<0.005). OS at three years was 55.7% for the whole study group, 60.4% in ENE and 38.4% in TDs. OS difference between the N2a-ENE, N3b-ENE, and the TDs ± ENE group was significant (p=0.05). The hazard ratio between ECs and TDs was Exp (B) 2.296 (p= 0.027). Conclusions The prognostic implication of TDs represents an independent risk factor, and a separate classification might be required.

In this Application Note, a versatile and reliable measurement system for photoelectrochemical investigations is described which aims to assist scientists in obtaining reproducible photoelectrochemical data of high quality, including the solar-to-hydrogen (STH) efficiency. Specifically, it addresses the parameters irradiation quality, reaction temperature and gas measurement. The setup is designed to exclude stray light and uses a solar-grade mirror to reflect the light of a vertical solar simulator on the electrochemical cell. The light quality in the setup (»AAA«, IEC 60904-9) is close to the classification of the solar simulator itself. The temperature in the electrochemical cell is controlled with an external Peltier element and can be kept constant in the range of 20–45 °C. The influence of reaction temperature on the photocurrent of a WO 3 photoanode is demonstrated. The gaseous reaction products are analyzed with a mobile gas chromatograph, using an automated measurement routine with discontinuous sampling from the electrochemical cell. The system is applied to determine the Faraday and STH efficiencies of a copper indium gallium selenide photocathode.

The main focus of the current study is to examine the impact of melting heat transfer and chemical reactions on MHD micropolar fluid flow over a sheet that is exponentially stretching and immersed in a porous medium in which the source of heat is not uniform. Also taken into consideration are slip phenomena and thermal radiation. The governing PDEs are converted to a system of ODEs via similarity transformation and the necessary boundary conditions. These nonlinear ODEs are resolved with the help of shooting techniques and an RK-4 iterative strategy. Also, solved this problem using the Bvp4c approach for validating the results of the RK-4 method. Both outcomes are consistent with previously published data. With the help of tables and graphs, we examine the influence of multiple physical parameters on velocity, thermal profile, microrotation, concentration profiles, Nusselt number, Sherwood number, coefficient of skin friction, and Wall couple stress. We see that the temperature distribution and velocity profiles decrease when the melting parameter increases. The temperature profile boost when the heat source parameter is increased.

Jarvis-type model with a flexible parameterization of stress functions can improve the descriptions of physiological behaviour for specific vegetation species. However, it is criticized for the empirically formulated multiplicative equation that can deviate from the mutual impact of intercorrelated stress factors, e.g., vapor pressure deficit (VPD) and air temperature ( Ta). This study proposed a modified Jarvis model by adding reduction factors in the stress functions of VPD and Ta to provide a better description of stomatal conductance. The sap flow data of transpiration rate in a beech forest in the mid-latitude of Centre Europe was used to inversely estimate the stomatal conductance, which facilitated the formulation of stress functions. Taking two recommended parameterization strategies for general deciduous broadleaf forest (DBF) led to severe overestimation of transpiration rate with a maximum value of ~2 mm/day in rainless days, which suggested that the beech forest had rather different stomatal response. With the parameterization using boundary analysis, the unmodified and modified Jarvis model provided the better simulation of transpiration with NSE values of 0.75 and 0.77. The results suggested that modelling transpiration can be improved through a more specific parameterization of stomatal conductance, especially for a vegetation species featuring its own stomatal behaviour that differed from its belonged general vegetation type. Particularly, the modified Jarvis model can further improve the description of stomatal conductance and modelling of transpiration in vegetated areas, especially under dry environment conditions with relatively high VPD.

Optimization and monitoring of bioprocesses requires the measurement of several process parameters and quality attributes. Mass spectrometry (MS)-based techniques such as those coupled to gas chromatography (GCMS) and liquid Chromatography (LCMS) enable the simultaneous measurement of hundreds of metabolites with high sensitivity. When applied to spent media, such metabolome analysis can help determine the sequence of substrate uptake and metabolite secretion, consequently facilitating better design of initial media and feeding strategy. Furthermore, the analysis of metabolite diversity and abundance from spent media will aid the determination of metabolic phases of the culture and the identification of metabolites as surrogate markers for product titer and quality. This review covers the recent advances in metabolomics analysis applied to the development and monitoring of bioprocesses. In this regard, we recommend a stepwise workflow and guidelines that a bioprocesses engineer can adopt to develop and optimize a fermentation process using spent media analysis. Finally, we show examples of how the use of MS has revolutionized the design and monitoring of bioprocesses.

Bearing failure in wind turbine gearboxes is one of the significant sources of downtime. While it is well known that bearing failures cause the largest downtime, the failure cause(s) is often elusive. The bearings are designed to satisfy their Rolling Contact Fatigue (RCF) life. However, they often undergo sudden and rapid failure within a few years of operation. It is well known that these premature failures are attributed to different types of surface damage. In that regard, transient torque reversals (TTRs) in the drivetrain have emerged as one of the primary triggers of surface damage, as explained in this paper. The risk associated with TTRs motivates the need to mitigate TTRs arising in the drivetrain due to various transient events. This paper investigates three TTR mitigation methods. First, two existing devices, namely, the torsional tuned mass damper and the asymmetric torque limiter, are studied. Then, a novel idea of open-loop high-speed shaft mechanical brake control is proposed. The results show that while the torsional tuned mass damper and the asymmetric torque limiter can improve the torsional vibration characteristics of the drivetrain, they cannot mitigate TTRs in terms of eliminating the bearing slip risk associated with TTRs. However, the novel approach proposed here can mitigate TTRs both in terms of improving the torque characteristic in the high-speed shaft and reducing the risk of bearing slip. Furthermore, the control method is capable of mitigating TTRs with the mechanical limitations of a pneumatic actuator in terms of bandwidth and initial dead time.

Background While racial disparities in the clinical outcomes of hematopoietic stem cell transplant (HSCT) patients have been explored, racial disparities in quality of life (QoL) during the readjustment phase after transplant has yet to be investigated in pediatric patients. The objective of this study was to examine the role of patient race in QoL at least two years after pediatric HSCT. Procedure We conducted a retrospective chart review of patients under 21 years of age at diagnosis that received an allogeneic transplant at our institution between January 2007 and December 2017. Patient QoL was assessed using the PedsQL TM 4.0 at least two years post-transplant. Patient demographic, treatment, and transplant outcome data were obtained for subsequent analysis, where patient race was categorized as either Black, White, Hispanic, or Native American. Results Data were collected on 86 pediatric patients who underwent HSCT. Forty patients (46.5%) were non-Hispanic White, 29 (33.7%) Hispanic, 10 (11.6%) Black, and 7 (8.1%) Native American. Where preliminary analyses indicated a difference in QoL by patient race, there were no significant differences in physical, emotional, social, and school functioning by patient race after adjusting for transplant characteristics (age at transplant, sex, diagnosis, donor type and conditioning regimen) and determinants of socioeconomic status (insurance type, estimated household income). Conclusions Pediatric patients had comparable QoL, regardless of race, at a median of three years after HSCT in our study cohort.

A one-year-old Belgian warmblood with a previously known history of successfully repaired temporal and parietal bone fracture sustained at 14 days of age was presented for investigation of a recent, acute, and progressive four limbs ataxia. The owner reported a lack of coordination and difficulty getting up with progressing paresis two weeks prior to the presentation. Neurological examination revealed pronounced hypermetria/dysmetria in walk and trot in all four limbs. No evidence of cranial nerve deficit was observed. The horse was in good general condition with unremarkable clinical parameters. Survey lateral radiographs of the cervical spine showed moderate to severe signs of cervical malformation of the vertebral canal and articular process joints, indicating cervical stenotic myelopathy. Cervical computed tomographic (CT) myelography revealed the presence of a dorsal subarachnoid diverticulum causing significant spinal cord compression at multiple locations, with associated osteoarthrosis of the cervical articular process joints. Due to a poor prognosis and warranted surgical outcome, the owner declined further treatment, and the horse was discharged with conservative corticosteroid treatment. The patient was euthanised shortly after the initial presentation due to progressive worsening. To the author’s knowledge, CT myelography findings in a yearling with cervical subarachnoid diverticulum have not been previously published. This case illustrates the usefulness of advanced imaging techniques, such as CT myelography, in combination with static and dynamic radiography to provide a better and more accurate diagnosis.

As the Coronavirus Disease 2019 (COVID-19) outbreak spread, evidence has emerged that gender and race would bear a disproportionate impact on the morbimortality of COVID-19. Here, we conducted a retrospective observational study using the TabNet/DATASUS platform of the city of São Paulo. COVID-19 records from March 2020 thru December 2021 were included, and we evaluated the temporal trends of confirmed cases and case fatality rate by gender and ethnicity. Statistical analysis was performed using the R-software and the BioEstat-software, considering p<0.05 significant. From March/2020 to December/2021, 1,315,160 COVID-19 confirmed cases were recorded (57.1% females), and 2,973 deaths were due to COVID-19. Males presented higher median mortality (0.44% vs 0.23%; p<0.05) and ICU admission rates (0.34% vs 0.20%; p<0.05). Men were also associated with a higher risk of death (RR=1.28; p<0.05) and a higher chance of requiring ICU care (RR=1.29; p<0.05). The black ethnicity was associated with a higher risk of death (RR=1.19; p<0.05). White patients were more likely to require ICU admission (RR=1.13; p<0.05), whereas browns were associated with a protective effect (RR=0.86; p<0.05). Further, men presented a higher chance of death than women across the three major ethnic groups: whites (RR=1.33; p<0.05), blacks (RR=1.24; p<0.05), and browns (RR=1.35; p<0.05). In this study of COVID-19 in São Paulo, men were associated with worse outcomes, including in the three major ethnicities in the population. Blacks exhibited a higher risk of death, whites were more likely to require intensive care, and browns were at protection from ICU hospitalization.

Rapid economic development can pose a threat to the biodiversity of tropical countries. In Laos, this is manifested by the conversion of natural forests into plantations, even though this area is one of the biodiversity hotspots of Southeast Asia. Beetle communities can be good indicators of the impact of anthropogenic pressure on natural ecosystems. In this study, we analyzed for the first time a countrywide inventory of Coleoptera to assess the ecological and anthropogenic drivers of beetle communities in Laos. We examined beetle communities (described at the family level) across the country, located in distinct habitat types, in order to understand the impact a rapid increase in human activities has on the region’s biodiversity. We found that beetle abundance had declined in plantations compared to natural forests. At the same time, we observed fewer beetle families in plantations overall, but at the scale of sampling sites there was no difference in local diversity compared to natural forests, suggesting a homogenization of beetle communities in anthropogenic habitats. Although results are certainly sensitive to our coarse classification of beetle specimens into families, the negative impact of the conversion of natural tropical forests into agriculture area can still be clearly demonstrated. Our findings highlight that it is possible to make use of unstructured large-scale inventories to explore how beetle communities responds to landscape changes induced by human activities. We suggest that sampling beetle communities can be used as an ecological indicator to monitor anthropogenic impacts on tropical ecosystems.

Species boundaries are difficult to establish in groups with very similar morphology. As an alternative, it has been suggested to integrate multiple sources of data to clarify taxonomic problems in taxa where cryptic speciation processes have been reported. This is the case of the harvest mouse Reithrodontomys mexicanus, which has a problematic taxonomy history as it is considered a complex species. Here, we evaluate the cryptic diversity of R. mexicanus using an integrative taxonomy approach in order to detect candidate lineages at the species-level. The molecular analysis used one mitochondrial (cytb) and two nuclear (Fgb-I7 and IRBP) genes. Species hypotheses were suggested based on three molecular delimitation methods (mPTP, bGMYC, and STACEY), and cytb genetic distances values. Skull and environmental space differences between the delimited species were also tested to complement the discrimination of candidate species. Based on the consensus across the delimitation methods and genetic distance values, four species were proposed, which were mostly supported by morphometric and ecological data: R. mexicanus clade I, R. mexicanus clade IIA, R. mexicanus clade IIIA, and R. mexicanus clade IIIB. In addition, the evolutionary relationships between the species that comprise the R. mexicanus group were discussed from a phylogenetic approach. Our findings present important taxonomic implications for Reithrodontomys, as the number of known species for this genus increases. Furthermore, we highlight the importance of the use of multiple sources of data in systematic studies to establish robust delimitations between species considered taxonomically complex.

This is a case of a 37-year-old man suffering from worsening exertional dyspnea detected left artial myxoma 92×43 mm. Radical mass resection and mitral annuloplasty were performed simultaneously. Giant left atrial myxoma causing mitral regurgitation through mitral annulus dilatation without affecting leaflet function is rarely reported.

Dear Editor, We read with great interest the article recently published in Journal of Cardiovascular Electrophysiology, “Left atrial appendage dimension predicts elevated brain natriuretic peptide in nonvalvular atrial fibrillation” by Cook JA. et al. 1 The authors have studied the relation between Brain natriuretic peptide (BNP) elevations and left atrial appendage measurements in patients who referred for left atrial appendage (LAA) occlusion in patients with nonvalvular atrial fibrillation (AF). BNP release is largely from the ventricles and it is also dynamically dependent on myocardial stretch and fluid volume status. However, it seems difficult to prove that BNP levels are directly related to the LAA measurements. Correlating BNP elevation only with left atrial or LAA measurements means ignoring left ventricular strain. Considering that these patients were referred for LAA occlusion and had a high CHA 2DS 2-VASc score, and not taking heart failure with preserved ejection fraction into account may lead to errors in interpreting the results. Moreover, it should be evaluated that the left atrial appendage may undergo remodeling or enlargement as a result of the left ventricular end-diastolic pressure increase. In this case, although the study is valuable, remains a cross-sectional study and a snapshot of the correlation of BNP and LAA. Second, it should be disclosed whether patients have paroxysmal or chronic AF and how long the patient has had AF. A relationship was established between LAA dimensions and BNP in the study, it is essential that the duration of AF should be considered and subgroup analyses should be evaluated if possible, since AF has a significant effect on BNP release. We appreciate this study and believe that a more detailed evaluation including left ventricular evaluation and prospectively monitored LAA and BNP would yield more realistic results. In addition, we think that it would be useful to evaluate midregional pro-A-type natriuretic (MR-proANP) in LAA studies, which is specific to the left atrial enlargement and similar physiology to BNP. 2

In this study, a generalized nonlinear local fractional Lighthill-Whitham-Richards (LFLWR) model has been developed. The local fractional variational iteration method (LFVIM) solves and analyzes the proposed model. Numerous works have been described in past to address linear LWR and linear LFLWR models. This research highlighted on generalized nonlinear LFLWR model and LFVIM is employed to derive non-differentiable solutions of the suggested model. The existence and uniqueness of the resolution of LFLWR model have also been established. Furthermore, several exemplary instances are discussed to demonstrate the success of implementing LFVIM to the proposed model. The numerical simulations for each of the cases have also been shown. Additionally, the obtained solutions of the suggested model have been compared with the solutions of the classical LWR model with non-differentiable conditions in few examples. The study demonstrates that the employed iterative scheme is quite efficient and can be utilized for obtaining the non-differentiable solution to proposed generalized nonlinear LFLWR model of traffic flow.

The 18O enrichment (Δ 18O) of leaf water affects the Δ 18O of photosynthetic products such as sucrose, generating an isotopic archive of plant function and past climate. However, uncertainty remains regarding how leaf water compartmentation between photosynthetic and non-photosynthetic tissue affects the relationship between Δ 18O of bulk leaf water (Δ 18O LW) and leaf sucrose (Δ 18O Sucrose). We grew Lolium perenne (a C 3 grass) in mesocosm-scale, replicated experiments with daytime relative humidity (RH 50 or 75%) and CO 2 level (200, 400 or 800 μmol mol -1) as factors, and determined Δ 18O LW, Δ 18O Sucrose and morpho-physiological leaf parameters, including transpiration ( E leaf), stomatal conductance ( g s) and mesophyll conductance to CO 2 ( g m). The Δ 18O of photosynthetic medium water (Δ 18O SSW) was estimated from Δ 18O Sucrose and the equilibrium fractionation between water and carbonyl groups (ε bio). Δ 18O SSW was well predicted by theoretical estimates of leaf water at the evaporative site (Δ 18O e) with adjustments that correlated with gas exchange parameters ( g s or total conductance to CO 2). Isotopic mass balance and published work indicated that non-photosynthetic tissue water was a large fraction (~0.53) of bulk leaf water. Δ 18O LW was a poor proxy for Δ 18O Sucrose, mainly due to opposite Δ 18O responses of non-photosynthetic tissue water (Δ 18O non-SSW) relative to Δ 18O SSW, driven by atmospheric conditions.