Introduction: Pulmonary vein isolation (PVI) using radiofrequency (RF) and cryoballoon (Cryo) ablation are standard approaches for rhythm control of symptomatic atrial fibrillation. Both strategies involve scar formation of the left atrium (LA). There have been few studies investigating the differences in residual fibrosis and scar formation in patients undergoing RF and Cryo using cardiac magnetic resonance imaging (CMR).     Methods: The current study is a sub-analysis of the control arm of the Delayed-Enhancement MRI Determinant of Successful Catheter Ablation of Atrial Fibrillation study (DECAAF II). The study was a multicenter, randomized, controlled, single blinded trial that evaluated atrial arrhythmia recurrence (AAR) between PVI alone and PVI plus CMR atrial fibrosis guided ablation. Pre-ablation CMR and 3–6-month post ablation CMR were obtained to assess baseline LA fibrosis and scar formation respectively.     Results: Of the 843 patients randomized in the DECAAF II trial, we analyzed the 408 patients in the primary analysis control arm that received standard PVI. Five patients received combined RF and Cryo ablations so were excluded from this sub-analysis. Of the 403 patients analyzed, 345 underwent RF and 58 Cryo. The average procedure duration was 146 minutes for RF and 103 minutes for Cryo (p = 0.001). The rate of AAR at ~15 months occurred in 151 (43.8%) patients in the RF group and 28 (48.3%) patients in the Cryo group (p = 0.62). On 3-month post CMR the RF arm had significantly more covered fibrosis (3.6% vs. 3.0%, p = 0.04) and scar (8.8% vs. 6.4%, p = 0.001) compared to Cryo. Patients with ≥ 6.5% LA scar on 3-month post CMR had less AAR independent of ablation technique (RF p = 0.009, Cryo p = 0.02). Cryo caused a greater percentage of right and left pulmonary vein (PV) scar (p = 0.04, p = 0.02) and less non-PV scar (p = 0.009) compared to RF. On Cox regression Cryo patients free of AAR had a greater percentage of left PV scar (p = 0.01) and less non-PV scar (p = 0.004) compared to RF free of AAR.     Conclusion: In this sub-analysis of the control arm of the DECAAF II trial, there was no significant difference in the rate of AAR in patients undergoing PVI alone between RF vs. Cryo. Post ablation LA scar ≥ 6.5% predicted freedom from AAR, independent of ablation technique. Cryo formed a greater percentage of PV scar and less non-PV scar compared to RF, which may have prognostic implications.

Microfibrillated cellulose (MFC) with reinforcing effects is a useful building block in the fabrication of flexible and thin supercapacitors. Herein, a hybrid tin oxide-cellulose nanocomposite was hydrothermally produced and coated on MFC thin films to form a supercapacitor. The hybrid tin oxide-cellulose thin films were structurally analyzed using scanning electrode microscopy, Fourier transform infrared spectroscopy and X-ray diffraction. The cellulose thin film with the highest loading of hybrid tin oxide-cellulose nanocomposite exhibited a specific capacitance of 225.88 F/g at 100 mV/s and 486.38 F/g at 20 mV/s in the three-electrode electrochemical system. In addition, it revealed good cyclic stability up to 40 cycles run continuously with 95% cyclic retention. The high specific capacitance and superior cyclic stability could be related to the enhanced charge mobility and ion diffusion between the solid and electrolyte interface. The cellulose thin film coated with flower-like hybrid nanocomposite showed great potential in energy storage.

Aim. To investigate abnormalities in myocardial strain and classic echocardiographic indices and coronary flow reserve (CFR), in younger vs older CKD patients. Methods. Sixty consecutive CKD patients (<60 years old n=30, ≥60 years old n=30) and 30 healthy controls (age- and gender-matched with younger CKD patients) were recruited. An echocardiographic assessment including myocardial strain indices was performed at baseline and following dipyridamole administration in all participants. Results. Younger CKD patients had higher E/e’, left ventricular mass index and relative wall thickness and lower E’ (p<0.005 for all) compared to healthy controls. Older CKD patients had lower E/A and E’ (p<0.05 for both) compared to younger CKD patients; these differences did not remain significant after adjustment for age. CFR was higher in healthy controls compared to younger and older CKD patients (p<0.05 for both) without a significant difference between CKD groups. Dipyridamole-induced changes did not differ significantly among the 3 groups. Conclusions. Compared to healthy controls, impaired coronary microcirculation and left ventricular diastolic function, but not myocardial strain abnormalities, are found in young CKD patients and deteriorate with aging.

A two-day-old female Warmblood foal (70 kg) presented with a closed, displaced Salter-Harris type-II fracture of the proximal physis of the left hind first phalanx. For fracture repair four 4.5 mm cortical screws and wire in a figure-of-8 pattern were applied on the lateral and medial aspect of the phalanx, respectively. A 4.5 mm cortical screw was additionally inserted in lag-fashion to engage the lateral metaphyseal spike. Three days postoperatively, medial axis deviation and implant infection were noted and revision surgery was performed. Previous implants were removed and two 4.5 mm transphyseal cortical lag-screws were placed in proximolateral-distomedial and dorsoproximal-plantarodistal direction. Postoperatively, the fracture healed rapidly and the implants were removed 6 weeks later. Nineteen months after implant removal the horse did not show any sign of lameness, despite a shortening of the proximal phalanx compared to the contralateral limb. In cases of postoperative implant instability and infection, implant removal often becomes necessary. However, new implants cannot be placed safely in the previous location. To avoid this problem, this report describes an alternative approach for screw positioning in case of previous implant infection in a Salter-Harris type-II fracture of the proximal physis of the first phalanx.

Background: We assessed whether the association between the risk of cerebrospinal fluid escape (CVE) and specific antiretroviral (ARV) classes, such as protease inhibitors, is due to suboptimal pharmacological profile generated by archived resistance-associated mutations (RAMs). Methods: A retrospective multicentric study on 300 adult people with HIV on antiretroviral therapy (ART) and available historical plasma genotype resistance testing (HGRT) for reverse transcriptase (RT) and protease genes between 2001 and 2021. The odds ratio for demographic, clinic-, and ART-related variables and CVE was estimated by multivariable modelling. HGRT-adjusted central nervous system effectiveness penetration (CPE) score was computed in modelling the risk. Results: Median age, plasma VL, and CD4 count were 49 years, <50 copies/mL, and 310 cells/μL. CVE was detected in 51 participants (17.0%). No difference in CVE prevalence was observed according to ART type, number of ARVs or ARV classes. Participants with CVE had more frequently plasma (52.9% vs 32.1%, p=0.005) and CSF RAMs in RT (n=63, 57.1% vs 28.6%, p=0.029), but not in protease gene. The presence of plasma RAMs in RT associated with increased odds of CVE in adjusted analyses (aOR 3.9, p<0.001) and in models restricted to plasma viral load ≤50 copies/mL (n=202; aOR 4.3 , p=0.003). CVE risk decreased by 40% per each point increase in HGRT-adjusted CPE score in multivariable models (p<0.001). Conclusions: Viruses harboring mutations appear to favor CVE and the impact of single ARV classes or type of ART regimens may lose significance when adjusted for the presence and effect of specific RAMs.

Atrial fibrillation is associated with low-flow state and increased thrombogenicity in the left atrium (LA). Multiple echocardiographic presentations, including thrombosis, sludge, and smoke formation, have been demonstrated in just one biplane transesophageal echocardiographic view, along with normal structures, i.e., pectinate muscles and Coumadin ridge, which are highly educational for cardiologists.

The Clarence River (New South Wales, Australia) was the main transport corridor for the sugar cane industry operating in the area from the 1860s to the 1970s. Using archaeological, documentary and oral historical resources we explore some of the anthropogenic impacts of this industry upon river channels and hydrology, in particular through the deliberate abandonment of obsolete vessels. These deliberately discarded former cane barges have been used as erosion control devices in several areas around the Harwood Island sugar mill, resulting in the accumulation of sediments and the establishment of mangrove environments in what were degraded areas.

Background. Because of altered airway microbiome in asthma, we analysed the bacterial species in sputum of patients with severe asthma. Methods. Whole genome sequencing was performed on induced sputum from non-smoking (SAn) and current or ex-smoker (SAs/ex) severe asthma patients, mild/moderate asthma (MMA) and healthy controls (HC). Data was analysed by asthma severity, inflammatory status and transcriptome-associated clusters (TACs). Results. α-diversity at the species level was lower in SAn and SAs/ex, with an increase in Haemophilus influenzae and Moraxella catarrhalis, and Haemophilus influenzae and Tropheryma whipplei, respectively, compared to HC. In neutrophilic asthma, there was greater abundance of Haemophilus influenzae and Moraxella catarrhalis and in eosinophilic asthma, Tropheryma whipplei was increased. There was a reduction in α-diversity in TAC1 and TAC2 that expressed high levels of Haemophilus influenzae and Tropheryma whipplei, and Haemophilus influenzae and Moraxella catarrhalis, respectively, compared to HC. Sputum neutrophils correlated positively with Moraxella catarrhalis and negatively with Prevotella, Neisseria and Veillonella species and Haemophilus parainfluenzae. Sputum eosinophils correlated positively with Tropheryma whipplei which correlated with pack-years of smoking. α- and β-diversities were stable at one year. Conclusions. Haemophilus influenzae and Moraxella catarrhalis were more abundant in severe neutrophilic asthma and TAC2 linked to inflammasome and neutrophil activation, while Haemophilus influenzae and Tropheryma whipplei were highest in SAs/ex and in TAC1 associated with highest expression of IL-13 Type 2 and ILC2 signatures with the abundance of Tropheryma whipplei correlating positively with sputum eosinophils. Whether these bacterial species drive the inflammatory response in asthma needs evaluation.

Accurately constructing membranes based on two-dimensional (2D) materials on commercial porous substrates remains a significant challenge for H2 purification. In this work, a series of tubular 2D MXene membranes are prepared on commercial porous stainless steel substrates via fast electrophoretic deposition. Compared with other methods, such as filtration or drop coating, etc. such preparation route shows the advantages of simple operation, high efficiency for membrane assembly (within 5 min) with attractive reproducibility, and ease for scale-up. The tubular MXene membranes present excellent gas separation performance with hydrogen permeance of 1290 GPU and H2/CO2 selectivity of 55. Furthermore, the membrane displays extremely stable performance during the long-term test for more than 1250 h, and about 93% of the membranes from one batch have exceeded the DOE target for CO2 capture. Most importantly, this work provides a valuable referential significance for other types of 2D materials-based membranes for future application development.

In riparian forests, clear-cutting causes long-lasting changes in both riparian and aquatic biota. In this work, we examined if past clear-cutting events occurred at different times have imprints on riparian forests in a Mediterranean river in central Italy. We carried out a randomized, plot-based vegetation survey of riparian forests in systematically sampled 500 m-long sectors along the whole river, dividing the riparian zone into two internal and two external strips. From historical aerial photos, past clear-cutting events within plots were detected and classified in age classes: i) cut in the past 8 years (recent); ii) cut between 8 and 19 years ago (intermediate); iii) no signs of clear-cutting in the last 19 years (distant). We analyzed the responses of vegetation to clear-cutting and strip position. Alien species richness increased and woody species richness decreased in recently clear-cut areas compared to those with a distant clear-cutting event. Moreover, recently cut woods showed an increase in alien and synanthropic species. Intermediate clear-cut areas had higher levels of invasion by alien species compared to areas with distant cut. Riparian forests of internal strips are impacted by clear-cutting, but seem to recover in 8-19 years thanks to their natural resilience. Conversely, recent or intermediate clear-cutting events did not affect any of the investigated vegetation attributes in the external strips since such forests were already invaded by Robinia pseudoacacia after human disturbance. Our results confirm that clear-cutting events can have long-lasting effects on Mediterranean riparian forests, confirming the vulnerability of river ecosystems to clear-cutting and suggesting the need for more caution in management practices to improve the conservation status of riparian forests.

Objectives: Data on intraoperative three-dimensional derived right ventricular free-wall strain (3D-RV FWS) is sparse. We sought to evaluate the normal range of intraoperative 3D-RV FWS in patients scheduled for coronary artery bypass graft (CABG) surgery and compare to conventional echocardiographic parameters. Design: Prospective observational study. Setting: Single university hospital. Participants: 150 patients with preserved left and right ventricular function and sinus rhythm, without significant heart valve disease or pulmonary hypertension undergoing isolated onpump CABG surgery, with an uneventful, complication-free intraoperative course. Interventions: 3D-RV FWS analysis and conventional echocardiographic assessment of right ventricular function were performed intraoperatively in anesthetized and ventilated patients using transesophageal echocardiography (TEE). All echocardiographic measurements were performed under stable hemodynamic conditions and predefined fluid management without any vasoactive support or pacing. Measurements and Main Results: We used TomTec 4D RV-Function 2.0 software for assessment of 3D-RV FWS and three-dimensional right ventricular ejection fraction (3D-RV EF). Philips QLAB 10.8 was used to evaluate tissue velocity of the tricuspid annulus (RV S´), tricuspid annular systolic excursion (TAPSE), and RV fractional area change (FAC). Assessment of 3D-RV FWS was feasible in 95% of patients. No included patient experienced a serious perioperative complication. In our group of patients, median values with interquartile range (IQR) for 3D-RV FWS and 3D-RV EF were - 25.2 (IQR -29.9 - -21.8) and 46.3% (IQR 41.0 - 50.1%), respectively. RV FAC, RV S´ and TAPSE accounted for 39.7% (IQR 34.5 - 44.4%), 14.8cm/s (IQR 11.8 - 19.0cm/s) and 22 mm (IQR 20-25mm). Normal range (2.5% to 97.5% percentile) for 3D-RV FWS was -37.1 to -12.8. There was no relevant correlation of 3D-RV FWS to postoperative outcome in this group of CABG patients. Conclusion: We present distribution values for intraoperative 3D-RV FWS and conventional parameters of RV function assessment in a healthy on-pump CABG patient population without serious perioperative complications. We observed no correlations of these parameters with any of the outcome parameters considered. Therefore, we consider these values to be intraoperative TEE-assessed normal values that can be expected in onpump CABG patients.

Feeding habit determines the digestive tract structure and intestinal microflora. However, the relationship among feeding habit, digestive physiology intestinal, and microbial diversity of omnivorous, herbivorous, filter-feeder and carnivorous fish reared in the same pond has not been compared. This study compared the digestive enzyme activities, intestinal morphology and intestinal microflora of omnivorous (Carassius auratus), herbivorous (Ctenopharyngodon idellus), carnivorous (Siniperca chuatsi) and filter-feeder (Shizothorax grahami) and predicted the potential functions of specific microflora on different nutrients. Twelve intestine samples were collected from each of the four fishes from Dianchi Lake. The composition and diversity of microbial communities were determined by using high throughput sequencing of 16S rDNA. The results showed that the filter-feeder fish had significantly higher protease but lower amylase activities in the intestine than herbivorous. The carnivorous fish intestine had more microvilli branches and complex structures than other fish species in the order carnivorous > herbivorous > filter-feeder > omnivorous. The diversity of intestinal microflora was higher in omnivorous and followed the order omnivorous > herbivorous > filter-feeder > carnivorous. Acinetobacter species and Bacteroides species were the most dominant flora in carnivorous and herbivorous fish, respectively. Acinetobacter johnsonii, Acinetobacter lwoffii and Pseudomonas stutzeri might help the host to digest protein, while Bacteroidetes species may help the host to digest cellulose. Taken together, feeding habit determines the digestive enzyme activities, intestinal tissue morphology and differential colonization of fish intestinal flora. The knowledge obtained is useful in designing appropriate approaches for feed formulation and feeding practices in for fish.

The sea otter (Enhydra lutris) population of Southeast Alaska has been growing at a higher rate than other regions along the Pacific coast. While good for the recovery of this endangered species, rapid population growth of this apex predator can create a human-wildlife conflict, negatively impacting commercial and subsistence fishing. Previous foraging studies throughout the sea otter range have shown they will reduce invertebrate prey biomass when recolonizing an area. The goal of this study was to examine and quantify the energetic content of sea otter diets through direct foraging observations and prey collection. Our study area, Prince of Wales Island in southern Southeast Alaska, exhibits a gradient of sea otter recolonization, thus providing a natural experiment to test diet change in regions with different recolonization histories. Sea otter prey items were collected in three seasons (spring, summer, winter) to measure caloric value and lipid and protein content. We observed 3,523 sea otter dives during the spring and summer. A majority of the sea otter diet consisted of clams. Sea otters in newly recolonized areas had lower diet diversity, higher kcal/gram intake rates, and higher energetic intake rates. Females with pups had the highest diet diversity and the lowest energetic intake rates (calories per gram consumed). Sea otter energetic intake rates were higher in the fall and winter vs. spring and summer. Sea cucumber energy and lipid content appeared to correspond with times when sea otters consumed the highest proportion of sea cucumbers. These caloric variations are an important component of understanding ecosystem level effects sea otters have in the nearshore environment.

Abstract Objective: To analyse the role of surgery along with antimicrobials to improve clinical outcomes in treating refractory cases of skull base osteomyelitis (SBO). Study design and setting: A prospective comparative study in a tertiary care centre with 70 SBO patients meeting eligibility criteria. Participants: The study population comprised 35 patients refractory to systemic antimicrobials of at least four weeks duration who later underwent surgery in addition to medication (surgical group). They were compared with a medical group that responded to medications alone. Main outcome measures: The outcome variables studied were the resolution of clinical features (pain, discharge, radiology, and inflammatory markers), culture yield, and total duration of treatment. Results: According to our study, relief of pain was faster in the surgical group(1.66 against 4.57 months) with statistical significance (p< 0. 001). Relief of symptoms (p< 0.001), radiological improvement (p= 0.001), and normalizing of inflammatory markers (p<0.001) were better in the surgical group than in the medical group. The duration of treatment was an average of 9. 2 months in the surgical group compared to 11.3 months in the medical group (p= 0.019). Microbial culture from deep tissue sampling was positive in 24 surgical patients (68.57%). Conclusion: The treatment response to surgery and antimicrobials in treating refractory cases of SBO was better than the group who responded to antimicrobials alone. Surgery provided higher microbial yield resulting in culture-specific antimicrobials. The surgical group observed faster relief of symptoms, reduced hospital stay, and total treatment duration.

The information exchange methods currently used in the field of vehicle inspection are not in harmony with the social information construction environment, which hinders the interaction and flow of information. On the other hand, because a large amount of data collected by different types of sensors must be transmitted to edge computing nodes, dynamic vehicle detection will lead to network congestion and affect the calculation of edge computing nodes. Therefore, optimizing the data transmission between vehicles and edge computing nodes is a new challenge, which needs to be solved in the practical application of dynamic vehicle detection architecture based on edge computing. In this paper, we have considered the data requirements of dynamic vehicle detection in different environments, analyzed the optimization objectives and constraints, and proposed deviation detection and greedy algorithms to solve the problem of MILP solving the problem of long time and insufficient practical application, and evaluated the performance of the algorithm through simulation experiments using SUMO, a traffic flow simulation tool, and PreScan, a vehicle simulation test software. The results show that greedy algorithm is more suitable for practical application than deviation detection algorithm. The implementation of this system can improve the efficiency of vehicle detection and management, and has good application value.

Over the last three to four decades, Therapeutic Drug Monitoring (TDM) has shaped itself as therapeutic drug management (TDM), an integral component of precision medicine. The practice of TDM is not extensive in India, despite being one of the fastest growing economies in the world. It is currently limited to a few academic medical centers and teaching hospitals. Apart from the immunosuppressive drugs, several other therapeutic areas like anticancer, antifungals, antibiotics and antitubercular have demonstrated great potential to improve the patient outcomes in the Indian settings. Factors like higher prevalence of nutritional deficiencies, tropical diseases, widespread use of alternative medicines, unalike pharmacogenomics, and sparse population specific data available on therapeutic ranges of several drugs, makes in the population of this subcontinent unique regarding the relevance of TDM. Despite the impact of TDM in clinical science and it’s widespread application, TDM has failed to receive the attention it deserves in India. This review intends to bring out a strength-weakness-opportunity and threats (SWOT) analysis for TDM in India so that appropriate steps for fostering growth of TDM could be envisioned. The need of the hour is creation of a cooperative group including all the stake holders like TDM professionals, clinicians and the government and devising a National Action Plan to strengthen TDM. Nodal TDM centres should be established and pilot programs should be rolled out for identifying the thrust areas for TDM in the country, capacity building and creating awareness to integrate TDM into mainstream clinical medicine.

We report a case of cerebral fat embolism (CFE) that could be identified only by susceptibility weighted imaging (SWI). Collection and analysis of previous case reports of CFE revealed utilization of SWI in less than one third of suspected cases, despite its known diagnostic ability for CFE.

We present the case of a 70-year-old man diagnosed with acute myelomonocytic leukemia, albeit that his leukemic blasts at initial presentation had scant cytoplasm, inconspicuous cytoplasmic granules, and morphologically mimicked lymphoblasts. We would like to raise the recognition that acute myelomonocytic leukemia can actually present with atypical blast morphology.