Planted vegetation is considered one of the most important soil-forming factors in the reclamation of degraded post-mining lands for forestry. The objective of this study was to compare the effect of N-fixing tree species and non-N-fixing species on the organic phosphorus (P org) forms in technosols developing from various substrates. Samples were taken from the uppermost layer (depth 0 – 5 cm) of technosols afforested with black locust ( Robinia pseudoaccaccia), black alder ( Alnus glutinosa), silver birch ( Betula pendula) and Scots pine ( Pinus sylvestris). Samples of the tree foliage and the O horizons were taken as well. The studied technosols developed from Quaternary sands (Sands), fly ashes after lignite combustion (Ashes) and Miocene clays (Clays). The soil samples were measured for the contents of labile (P Olab) and moderately labile organic phosphorus (P Omod), phosphorus contained in fulvic and humic acids (P fulv and P hum, respectively) and residual organic phosphorus (P Ores). The foliage and O horizon samples were measured for the concentrations of C, N and P. The N-fixing trees had higher P concentration in the foliage than non-N-fixing species. However, in the O horizon the highest P concentration was determined under birch and not under N-fixers. The effect of tree species on the organic P (P org) concentrations in the mineral soil was limited with significantly lower P org concentrations under pine. Soil under this species contained less P fulv, P hum and P Ores. However, the percentages of P Olab, P Omod, P fulv, P hum and P Ores in soil P org were nearly the same under all tree species. The largest effect on the P org concentration and on the contents of particular P org fractions was from the substrate type. Sands contained much less P org than the Clays and Ashes but their percentage of P Olab in P org was much higher than in two other substrates. We conclude that N-fixing trees do not affect the concentration of labile organic P and the major factor controlling this P org fraction is the soil substrate quality.

Objectives: Universal implementation of cystic fibrosis (CF) newborn screening (NBS) has led to the diagnostic dilemma of infants with CF screen positive, inconclusive diagnosis (CFSPID), for which there is limited guidance regarding prognosis and standardized care. Rates of reclassification from CFSPID to CF vary and risk factors for reclassification are unknown. We investigated whether clinical characteristics are associated with risk of reclassification from CFSPID to a CF diagnosis. Methods: Children with a positive CF NBS were recruited from two sites in California. Retrospective, longitudinal, and cross-sectional data were collected. A subset of subjects had nasal epithelial cells collected for CFTR functional assessment. Multivariate logistic regression was used to assess the risk of CFSPID-to-CF reclassification. Results: A total of 112 children completed the study (CF=53, CFSPID=59). Phenotypic characteristics between groups showed differences in pancreatic insufficiency prevalence, immunoreactive trypsinogen (IRT) levels, and Pseudomonas aeruginosa (PSA) colonization. Spirometry measures were not different between groups. Nasal epithelial cells from 10 subjects showed 7-30% of wild type (WT)-CFTR function in those who reclassified and 27-67% of WT-CFTR function in those who retained the CFSPID designation. Modeling revealed that increasing sweat chloride concentration (sw[Cl -]) and PSA colonization were independent risk factors for reclassification to CF. Conclusion: Increasing sw[Cl -] and history of PSA colonization are associated with risk of reclassification from CFSPID to CF in a population with high IRT and two CFTR variants. Close follow-up to monitor phenotypic changes remains critical in this population. The role of CFTR functional assays in this population requires further exploration.

Stream channel incision and deposition are common after wildfire, and these geomorphic changes may impact runoff mechanisms and the composition of pre-event and event water in runoff. To investigate this, we monitored discharge and electrical conductivity at 6 nested sites within a 15.5 km 2 watershed in the northern Colorado Front Range that had recently burned, experienced large flooding, and well-documented and significant channel erosion and deposition. Over the study period, the watershed experienced seven precipitation events. For each hydrograph, we separate baseflow from runoff using a new method to characterize and account for the strong diurnal signal in the baseflow. Electrical conductivity is used as a tracer in a two-component end-member mixing analysis to separate the event hydrographs into event and pre-event water. Correlation coefficients were computed between key variables of the hydrologic response (such as runoff ratio, volumes of event and pre-event water) to storm and basin characteristics (including stream channel erosion/deposition, fraction of high/moderate burn severity, precipitation intensity, and antecedent precipitation). The strength and significance of correlations was found to vary seasonally. In the early season, event and pre-event volumes did not vary significantly with basin or storm characteristics. In the late season, antecedent precipitation correlated with a decrease in event runoff (R 2 = 0.34) and total runoff (R 2 = 0.40), increased precipitation intensity correlated with an increase in event runoff (R 2 = 0.48), and local erosion correlated with an increase in pre-event runoff (R 2 = 0.60) and total runoff (R 2 = 0.53). These findings indicate that seasonality and post-fire stream channel erosion influence the makeup of runoff response, most likely through their impact on the gradient of the near-stream groundwater table.

Sustainable water management in semi-arid agriculture practices requires quantitative knowledge of water fluxes within the soil-vegetation-atmosphere system. Therefore, we used stable-isotope approaches to evaluate evaporation (Ea), transpiration (Ta), and groundwater recharge (R) at sites in Senegal's Groundnut basin and Ferlo Valley pasture region during the pre-monsoon, monsoon, and post-monsoon seasons of 2021. The approaches were based upon (i) the isothermal evaporation model (for quantifying Ea); (ii) water and isotope mass balances (to partition Ea and Ta for groundnut and pasture); and (iii) the piston displacement method (for estimating R). Ea losses derived from the isothermal evaporation model corresponded primarily to Stage II evaporation, and ranged from 0.02–0.09 mm d-1 in the Groundnut basin, versus 0.02–0.11 mm d-1 in Ferlo. At the groundnut site, Ea rates ranged from 0.01 to 0.69 mm d-1; Ta was in the range 0.55–2.29 mm d-1; and the Ta/ETa ratio was 74–90%. At the pasture site, the ranges were 0.02–0.39 mm d-1 for Ea; 0.9–1.69 mm d-1 for Ta; and 62–90 % for Ta/ETa.  The ETa value derived for the groundnut site via the isotope approach was similar to those from eddy covariance measurements, and also to the results from a previous validated HYDRUS-1D model. However, the HYDRUS-1D model gave a lower Ta/ETa ratio (23.2%). The computed groundwater recharge for the groundnut site amounted to less than 2% of the local annual precipitation. Recommendations are made regarding protocols for preventing changes to isotopic compositions of water in samples that are collected in remote arid regions, but must be analysed days later. The article ends with suggestions for studies to follow up on evidence that local aquifers are being recharged via preferential pathways

We report the case of a teenager with a neurofibromatosis Type 2 (NF2) presenting a locked-in syndrome due to a brainstem ischemic syndrome. The presence of sudden or rapidly worsening onset of neurological deficits in NF2 patients, should evoke this underknown entity and not only tumors as predisposed by NF2.

Objectives— Early screening and dynamic monitoring of pulmonary vascular disease (PVD) in bronchopulmonary dysplasia (BPD) high-risk infants is of great clinical significance. Pulmonary artery acceleration time (PAAT) is a reliable and non-invasive method for assessing PVD in children over 1 year, but to date, few studies have used PAAT to assess pulmonary hemodynamics of preterm infants, especially those with BPD. Through dynamic monitoring the main hemodynamic indicators reflected PVD after birth, this study aimed to assess the value of PAAT in evaluating early PVD in BPD infants. Methods— 81 preterm infants at risk of BPD were divided into BPD and non-BPD groups according to whether BPD occurred. Clinical characteristics, PAAT, right ventricular ejection time (RVET) and other main hemodynamic indicators at 4 different time points after birth were studied and compared. Results— PAAT and PAAT/RVET increased gradually within 72 hours after birth in the BPD group ( P < 0.05), but the curve tended to be flat over time after 72 hours( P > 0.05). At PMA32 and 36 weeks, the PAAT (49.7±4.8 vs.54.8±5.7, P=0.001; 50.0±5.3 vs.57.0±5.3, P=0.001) and PAAT/RVET (0.33 ± 0.04 vs. 0.35 ± 0.03, P=0.001; 0.34 ± 0.03 vs. 0.37 ± 0.04, P = 0.001) in BPD group were significantly lower than those in the non-BPD group. Conclusions— PAAT and PAAT/RVET in the BPD group infants showed different change patterns compared to non-BPD group infants. PAAT can be used as a noninvasive and reliable screening method for screening and dynamic monitoring of PVD in BPD high-risk infants.

Leishmaniasis is a common cause of pancytopenia and hepatosplenomegaly in tropical and sub-tropical regions. A high index of suspicion is required to diagnose and manage patients with leishmaniasis. History of travel should always be elicited in patients with suggestive clinical presentation.

The hemispherical aortic annuloplasty reconstructive technology (HAART) is an internal geometric annuloplasty ring designed to restore a natural elliptical shape to the aortic annulus as part of aortic valve repair. We present 4D flow hemodynamic analysis before and after implementation of the HAART ring in patients undergoing ascending aortic replacement. HAART patients displayed similar or improved flow profiles when compared to a patient undergoing ascending aortic replacement alone.

Background Combined ONCAB and SAVR is the treatment of choice for concomitant severe aortic stenosis and coronary artery disease not amenable to PCI intervention. Extensive aortic calcification and atheromatous disease may prohibit cardiopulmonary bypass and aortic cross clamping. In these cases Anaortic OPCAB is a Class I (EACTS 2018) and Class IIA (AHA 2021) indication for surgical coronary revascularization. TAVR has similar benefits when compared to SAVR for this population (Partner 2 & 3). Herewith we describe a case series of concomitant Anaortic OPCAB and TAVR via the transfemoral approach for patients with coronary artery and valve disease considered too high risk for traditional CABG and SAVR due to severe aortic disease. Methods/Results Eight patients underwent anaortic OPCAB and transfemoral TAVR during the same anesthetic in a hybrid operating room. Seven patients with multi-vessel disease had anaortic OPCAB via a sternotomy using composite grafts, one patient with LAD disease had anaortic OPCAB using a Da Vinci assisted MIDCAB approach. All patients then had an Edwards Sapien 3 TAVR placed percutaneously via the common femoral artery. There was no thirty-day mortality or CVA in the series and all patients were discharged to home or a rehabilitation facility on day 4-13. Conclusions Combined anaortic OPCAB and transfemoral TAVR is a safe and feasible approach to treating concomitant extensive coronary artery disease and severe aortic stenosis. The aortic no-touch technique provides benefits in the elderly high-risk patients by reducing the risk of post-operative myocardial infarction and cerebrovascular stroke.

Outcomes of operations for total anomalous pulmonary venous connection (TAPVC) have improved.However, postoperative pulmonary venous obstruction (PVO) remains the most significant complication, with high morbidity and mortality. We introduce a window anastomosis technique for repair of supracardiac TAPVC in infants. The mainstay of the surgical technique is to resect the anterior wall of the pulmonary vein confluence(PVC) and part of the posterior wall of the left atrium to form a large and undistorted “window to window” anastomosis.

Title:Tranexamic acid-associated fatal status epilepticus in a paediatric patientAuthor:Dr Santosh Patel MD, FRCA, PG Dip (Med Edu)Consultant AnaesthetistDepartment of anaesthesiaTawam hospitalAl AinUnited Arab EmiratesCorrespondence address: as above.Email: [email protected]: No source of funding to declareConflicts of interest: Nothing to declareDear Editor,I have read with interest a case report and literature review published in the British journal of pharmacology on tranexamic acid (TXA) associated SE in a 4-year child who underwent tonsillectomy.1 I would like to congratulate the authors for reporting the case despite the fatal outcome. Considering that the use of TXA is expanding to minimise blood loss in a wide range of surgeries, an evidence-based therapeutic approach for its associated seizures is of paramount importance.The authors described in their report (also mentioned in Table 2) and concluded that general anaesthetics, propofol and halogenated inhaled anaesthetics are considered the first line of management of TXA-associated seizures due to their direct activity at glycine receptors. In support of their statement, they have quoted three references (references 35,45,46 in their report). However, in their articles, the authors did not recommend the use of general anaesthetics (propofol and halogenated inhalational anaesthetics) as the first line of treatment for TXA-related seizures. It is valuable to point out to the readers that their conclusion is not valid and needs clarification and correction.TXA-associated hyperexcitability of neural networks is because it is a competitive antagonist of glycine and GABAA receptors.2 Following IV TXA administration, not all seizures progress to status epilepticus. Although TXA-related seizures commonly manifest as generalised tonic-clonic activity, focal seizures have been reported; which are not an indication for the use of general anaesthetics. Refractory status epileptics (RSE) and super RSE are uncommon following IV TXA although this is a common feature following intrathecal TXA.3Propofol’s anticonvulsant, hypnotic, sedative and anaesthetic effects are mediated via multiple complex molecular mechanisms, including modulation of GABAA and glycine receptors. GABAA receptor modulation by propofol has distinct dose-dependent effects likely involving multiple sites of action; clinical concentrations of propofol potentiate GABA-activated currents, increase open channel frequency, and reduce the rate of desensitization, while intermediate concentrations directly activate GABAA channels, and even higher concentrations inhibit receptor function.4Propofol can cause neuroexcitatory effects, including tonic-clonic seizures, particularly during the start or weaning from propofol infusion.5 Among the various mechanisms that have been proposed for these neuroexcitatory symptoms are antagonism of glycine and dopamine receptors, hyposensitization of GABAergic pathways and dysregulated inhibition of NMDA glutamate receptors.6Its use is associated with side effects, including hypotension (and the associated use of vasopressors) and respiratory depression. With prolonged infusion, propofol infusion syndrome (PIS) may occur, which may contribute to morbidity and mortality of RSE. Children are more susceptible to developing this complication. Propofol infusion therapy is not recommended as the first line of treatment for TXA-associated seizures, and its use is reserved for severe cases in children.Inhalational anaesthetics are beneficial for the control of seizure activity via inhibition of NMDA excitotoxicity and potentiation of inhibitory functions of GABAA and glycine receptors. However, it is essential to highlight that there are several limitations to the use of inhalational anaesthetic agents. First, the only clinical evidence of their use is from the minimal number of case reports. Second, TXA-related seizures often manifest in the postoperative period in the recovery room or in ICU, where delivery and scavenging of inhalational agents via ventilator may not be feasible. Third effective end-tidal concentration and optimal therapeutic duration are not known. Finally, in higher concentrations, they cause cardiac depression and cerebral vasodilation. Therefore, their use is limited as salvage therapy for the management of TXA-associated RSE and super RSE.In summary, the authors’ conclusion is incorrect, and clinicians should follow currently available evidence-based professional guidelines to manage TXA-associated status epilepticus.8,9References:1. Aboul-Fotouh S, Habib MZ, Magdy SM, Hassan BEE. Tranexamic acid-associated fatal status epilepticus in a paediatric non-cardiac surgery: A case report and literature review. Bri J Clin Pharmacol 2022;1-6. doi:10.1111/bcp.152962. Lecker I, Wang D, Whissell P, et al. Tranexamic acid-associated seizures: causes and treatment. Ann of Neurol 2015;79(1):18-26. doi:10.1002/ana.245583. Patel S, Robertson B, McConachie I. (2019). Catastrophic drug errors involving tranexamic acid administered during spinal anaesthesia.Anaesthesia ,74(7),904-14 https://doi.org/10.1111/anae.146624. Platholi J, Hemmings H. (2022). Effects of general anesthetica on synaptic transmission and spasticity. Currt Neuropharmacol2022;20(1):27-54. doi: 10.2174/1570159X19666210803105232.5. Walder B, Tramèr MR, Seeck M. (2002). Seizure-like phenomena and propofol: a systematic review. Neurology 2002; 58(9):1327-32. 10.1212/wnl.58.9.13276. Pantelakis L, Alvarez V, Gex G, Godio M. Severe neuroexcitatory reaction: A rare and underrecognized life-threatening complication of propofol-induced anesthesia. The Neurohospitalist2021;11(1):49-53. doi: 10.1177/1941874420929536.7. Godec S, Gradisek MJ, Mirkovic T etal. Ventriculolumbar perfusion and inhalational anesthesia with sevoflurane in an accidental intrathecal injection of tranexamic acid: unreported treatment options. Reg Anesthe Pain Med 2022;47(1):65-68 10.1136/rapm-2021-1024988. Nelson SE, Varelas PN. Status epilepticus, refractory status epilepticus, and super-refractory status epilepticus. Continuum (Minneap Minn). 2018;24(6):1683-1707.9. Vossler DG, Bainbridge JL, Boggs JG etal.. Treatment of refractory convulsive status epilepticus: a comprehensive review by the American Epilepsy Society Treatments Committee. Epilepsy Curr.2020;20(5):245-64.

The Rumpel-Leede phenomenon is when the distal dermal capillaries of an extremity rupture in response to local mechanical pressure, such as an inflated blood pressure cuff or a compression band, disrupting the capillary membrane. This article presents an image of the rumpel-leede phenomenon after transulnar percutaneous coronary intervention.

Background: As elective surgical services recover from the COVID-19 pandemic a movement towards day-case surgery may reduce waiting lists. However, evidence is needed to show that day-case surgery is safe for many ENT operations including endoscopic sinus surgery (ESS). We aimed to investigate the safety of ESS in England. Methods: This was an observational, secondary analysis of administrative data. Participants were all patients in England undergoing elective ESS procedure aged ≥ 17 years during for the five years from 1st April 2014 to 31st March 2019. The exposure variable was day-case or overnight stay. The primary outcome was emergency readmission within 30 days post-discharge. Results: Data were available for 49,223 patients operated on across 129 NHS hospital trusts. In trusts operating on more than 50 patients in the study period, rates of day-case surgery varied from 100% to 20.6%. Rates of day-case surgery increased from 64.0% in 2014/15 to 78.7% in 2018/19. Day-case patients had lower rates of 30-day emergency readmission (odds ratio 0.71, 95% confidence interval 0.62 to 0.81). For secondary outcomes measures, there was no evidence of poorer outcomes for day-case patients. Outcomes for patients operated on in trusts with ≥80% day-case rates compared to patients operated on in trusts with <50% rates of day-case surgery were similar. Conclusions: ESS can safely be performed as day-case surgery at current rates. There is a potential to increase rates of day-case ESS in England, especially in departments that currently have low rates of day-case ESS.

A 30-year-old man with a structurally normal heart was referred to us with a 2-year history of recurrent episodes of rapid paroxysmal palpitations. A few episodes required hospitalization and were terminated with intravenous diltiazem. During electrophysiology (EP) study done twice before in other hospitals, the patient was diagnosed as typical atrioventricular nodal reentrant tachycardia (AVNRT) and underwent radiofrequency ablation of the slow pathway. However, the episodes recurred.  Because of the patient’s persistent symptoms, an EP study was performed again. Tachycardia was easily induced using atrial extrastimuli, ventricular extrastimuli and with rapid atrial pacing.

In the French Mediterranean plain, the northern extreme of its native range, the Iberian grey shrike, Lanius meridionalis, predominantly feeds on arthropods. Its type of loral plumage plays a key role in protecting its eyes while transporting large prey. The aims is to understand the role played by feathers in protecting the animal from various types of defensive prey. We combine an inspection of large insect prey types found on larders with a review of bird specimens found in museum collections to examine the morphometric characteristics of rictal feathers and culmen. In addition, precision photographs are used to observe the posture of the plumage in natura. We could identify four categories of protective feathers: clustered bristles, semi-bristles, semi-plumes distributed in the loral area, and semi-plumes above the eyes. Our results suggest that the Iberian grey shrike has a complex structure of loral feathers, specific to its foraging activity and prey types. In France, local species have longer beaks than their Spanish counterparts which suggests a more insect-based diet.

CT-imaging vs. high-density mapping in ischemic cardiomyopathy VT ablation: in whom do we trust?Thomas Fink, MD1, Vanessa Sciacca, MD1, Philipp Sommer, MD11Clinic for Electrophysiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen, Germany.Disclosures: PS is advisory board member of Abbott, Biosense Webster, Boston Scientific and Medtronic.Funding: (None)

Pipeline flow visualization of cemented tailings backfill slurry (CTBS) improves the safety and stability of transportation. High turbidity and low resolution make it difficult for conventional methods to monitor the particle distribution state of CTBS in a short period of time. Particle tracking technology (PTT) is used to simulate and investigate the flow characteristics of CTBS pipeline, combine with theoretical analysis to construct a CTBS pipeline visualization model, elaborate the particle distribution state when CTBS flows in the pipeline, and explore the effects of pipe diameter (PD), flow velocity (FV) and tailings gradation (TG) on the particle distribution. The results show that particle tracking technology is better applied to investigate the particle transport distribution characteristics of CTBS tailings. Three concepts of particle accumulated gravity Ga, static friction angle θ and diameter dividing line are defined, and the transport pipe is divided into light wear zone, medium wear zone and heavy wear zone. The increase in pipe diameter increases the content of fine particles at the pipe wall and the thickness of the lubrication layer becomes larger, which improves the safety and stability of CTBS transport. The increased flow velocity reduces the settling phenomenon of large size particles and improves the transport efficiency, which increases the pipeline transport resistance. The wider the range of tailings gradation and the smaller the ratio of the number of large size tailings to small size tailings, the more suitable the tailings are for pipeline transportation as a backfill aggregate.

African swine fever (ASF) is a high-consequence transboundary disease of domestic and wild swine often characterized by high case mortality rates. On July 29, 2021, the Dominican Republic announced the African swine fever virus (ASFV) had been detected in samples collected in early- to mid-July 2021. Retrospective testing of samples collected as part of a collaborative surveillance project between the United States and the Dominican Republic identified ASFV in samples collected as early as May 13, 2021. These detections represent a new outbreak of ASF in the Dominican Republic, which had been declared free of the disease since 1981. Overall, 73 whole genomes of ASFV were sequenced from clinical samples received during the outbreak across 18 provinces. The genomic sequence data have been deposited in public databases to support and expand global data sharing on this impactful disease. While the sequences show a high degree of nucleotide identity to publicly available ASFV genomes from Europe and Asia, they are genetically distant from genomes in the public repositories by at least 8 previously undescribed single nucleotide polymorphisms.