Aim: Understand the ecological processes that shape community composition in eelgrass meadows along the coast of France at local and regional scales. Location: Northeastern Atlantic. Methods: Combining taxonomic and trait-based approaches with structural equation modeling, we explored the mechanisms governing community assembly in five meadows located over a distance of 800 km along the French coast in the Northeast Atlantic. We assessed the spatial variability of eelgrass-associated invertebrate communities as affected by environmental parameters or morphological traits of the eelgrass and linked these mechanisms to their impacts at local and regional scales through analyses of the taxonomic and functional α and β diversities. We then quantified the direct and indirect effects of environmental factors on macrofaunal structure and composition. Results: Eelgrass meadows locally favored higher species abundance, diversity, and functional traits present in the community relative to nearby bare sediments. At the regional scale, eelgrass diversity was comparable between sites, with high species turnover observed among them, and each site being characterized by different species and different sets of traits. These differences were due in part to morphological traits of the meadows, but the explanatory variables that best explained the differences among the meadows were environmental conditions, including temperature, current velocity, and Δ water level. Main conclusions: Meadows appear to harbor subsets of species from the regional species pool, rather than harboring eelgrass-specific assemblages. The processes that maintain seagrass diversity appear to reflect a seascape-scale meta-community composed of many habitats connected by source-sink dynamics. Given that eelgrass enhances the diversity and abundance of species found in neighboring habitats, conservation programs should consider ecosystem-level protection spanning multiple habitats, including eelgrass, in order to maximize the protection of biodiversity.

This paper considers explicit neutral delay differential equations (NDDE) with piecewise continuous initial functions. We explain how the discontinuities in the solutions arise and present a perturbing scheme, in combination with an adaptive Legendre–Gauss–Radau collocation method, to deal with this type of problems computationally. The pointwise and mean convergence of the continuous solution of the perturbed NDDE to the discontinuous solution of the original NDDE are proved. Our new method for discontinuous NDDEs and the rigorous theoretical analysis provided are particularly important since explicit NDDEs have received little attention in the literature. Numerical results are given to show that the proposed method can be implemented in an efficient and accurate manner.

Nasogastric tube (NGT) use has been common in the immediate postoperative period in surgical patients for decades. Potential advantages include the decompression of gastric contents and the early administration of time-sensitive medications. However, its routine use after cardiac surgery has not been established as a gold standard yet. The NGT use for prevention of post-operative nausea and vomiting has been a matter of debate in literature. Also, NGT use has also been associated with the incidence of some respiratory and gastrointestinal complications and it may be a source of significant pain and discomfort to patients. In this article, we review the current available literature regarding the use of NGT during and immediately after cardiac surgery, with particular emphasis on its potential role in enhanced postoperative recovery.

Changes in the heart allocation system have led to transplant programs traveling greater distances for donor organs. At the same time, several new technologies have emerged to provide improvements in donor organ protection when compared with traditional strategies. These new developments have increased the need for a better understanding of risks associated with donor injury related to various types of ischemia.

In this paper, we define three types of 2-Ruled hypersurfaces in the Minkowski 4-space $\mathbb{E}^4_1$. We obtain Gaussian and mean curvatures of the 2-ruled hypersurfaces of type-1 and type-2, and some characterizations about its minimality. We also deal with the first Laplace-Beltrami operators of these types of 2-Ruled hypersurfaces in $\mathbb{E}^4_1$. Moreover, the importance of this paper is that the definition of these surfaces by using the octonions in $\mathbb{E}^4_1$. Thus, this is a new idea and make the paper original. We give an example of 2-ruled hypersurface constructed by octonion and we visualize the projections of the images with MAPLE program. Furthermore, the optical fiber can be defined as a one-dimensional object embedded in the 4-dimensional Minkowski space $\mathbb{E}^4_1$. Thus, as a discussion, we investigate the geometric evolution of a linearly polarized light wave along an optical fiber by means of the 2-ruled hypersurfaces in a four-dimensional Minkowski space

Whether you benefit from high-quality urban environments, such as those rich in green and blue spaces, that may offer benefits to allergic and respiratory health depends on where you live and work. Environmental inequality, therefore, results from the unequal distribution of the risks and benefits that stem from interactions with our environment. Within this perspective, this article reviews the evidence for an association between air pollution caused by industrial activities, traffic, disinfection-by-products and tobacco/e-cigarettes and asthma in children. We also discuss the proposed mechanisms by which air pollution increases asthma risk, including environmental epigenetic regulations, oxidative stress, and damage, disrupted barrier integrity, inflammatory pathways, and enhancement of respiratory sensitization to aeroallergens. Environmental air pollution is a major determinant of childhood asthma, but magnitude of effect is not shared equally across the population, regions, and settings where people live, work, and spend their time. Improvement of the exposure assessment, a better understanding of critical exposure time windows, underlying mechanisms, and drivers of heterogeneity may improve the risk estimates. Urban conditions and air quality are not only important features for national and local authorities to shape healthy cities and protect their citizens from environmental and health risks, but they also provide opportunities to mitigate inequalities in the most deprived areas where the environmental burden is highest. Actions to avoid exposure to indoor and outdoor air pollutants should be complementary at different levels – individual, local, and national levels – to take effective measures to protect children who have little or no control over the air they breathe.

Papillary thyroid carcinoma (PTC) accounts for the vast majority of thyroid cancer cases. Cerebellar metastasis is rarely the presenting feature. We report a patient presenting with a cerebellar lesion which demonstrated metastatic PTC upon resection, with unusual features including incidental medullary thyroid microcarcinoma without PTC in the main thyroidectomy specimen.

Distinguishing among the mechanisms underlying the spatial distribution of genetic variation resulting from the environmental or physical barriers from those arising due to simple geographic distance is challenging in complex landscapes. The Andean uplift represents one of the most heterogeneous habitats where these questions remain unexplored since multiple mechanisms may interact, confounding their relative roles. We explore this broad question in the leaf-cutting ant Atta cephalotes, a species that is distributed across the Andes mountains, using nuclear microsatellite markers and mtCOI gene sequences. We investigate spatial genetic divergence across the western range of the northern Andes in Colombia by testing the relative role of alternative scenarios of population divergence, including isolation by geographic distance (IBD), climatic conditions (IBE), and the physical barriers presented by the Andes mountains (IBB). Our results reveal substantial genetic differentiation among A. cephalotes populations for both types of markers, but only nuclear divergence followed a hierarchical pattern with multiple models of genetic divergence imposed by the western range. Model selection showed that the IBD, IBE (temperature and precipitation), and IBB (Andes mountains) models, often proposed as individual drivers of genetic divergence, interact and explain up to 33% of the genetic divergence in A. cephalotes. The IBE model remained significant after accounting for IBD, suggesting that environmental factors play a more prominent role than with IBB. These factors, in combination with the idiosyncratic dispersal patterns of ants, appear to determine the hierarchical patterns of gene flow. This study enriches our understanding of the forces shaping population divergence in complex habitat landscapes.

Objective To investigate perinatal mortality, morbidity and obstetric intervention after introducing universal third-trimester ultrasound scan for growth restriction. Design Prospective cohort study Setting Oxfordshire (OUH), UK Population Women with a non-anomalous singleton pregnancy undergoing pregnancy care and term delivery at OUH with an estimated-date-of-birth between 01/Jan/2014 and 30/Sept/2019. Methods Universal ultrasound for fetal growth restriction between 35+0 and 36+6 weeks was introduced in 2016. The outcomes of the next 18631 eligible term pregnancies were compared, using logistic regression, with the previous 18636 who had clinically-indicated ultrasounds only. ‘Screen positives’ for growth restriction were managed according to a pre-determined protocol. Main Outcome Measures Extended perinatal mortality, a composite of mortality or encephalopathy Grade II-III, and expedited birth. Other outcomes included composite adverse outcomes used elsewhere, detection of birthweight (<10th centile) and birth <39+0 weeks. Results Extended perinatal deaths decreased from 1.7/1000 to 1.2/1000 births (aOR: 0.73; 0.43 -1.25); mortality or severe morbidity decreased from 2.9/1000 to 1.9/1000 births (OR: 0.67; 0.44-1.03). Expedited births increased from 35.2% to 37.7% (OR: 1.08; 1.04 – 1.14). Birth prior to 39+0 weeks fell 10.5% (OR 0.89: 0.85 – 0.94). Birthweight (<10th centile) detection using fetal biometry alone was 31.4%, and rose to 40.5% if all abnormal scan parameters were used. Conclusion Introducing a universal ultrasound for growth restriction has limited impact on mortality and severe morbidity, but only small increases in intervention, and less early-term birth, are possible. The detection of birthweight (<10th c) improved where markers of growth restriction are used.

The oxygen electroreduction mechanism on the V- and Nb-doped nitrogen-codoped (6,6)armchair carbon nanotube with incorporated MN4 fragment has been studied using the ωB97XD and PBE density functional theory approaches. The metal center in MN4 fragment and the adjacent NC=CN double bond (C2 site) of the support have been revealed as active centers. The metal active centers turned out to be irreversibly oxidized at the first step of ORR affording stable O*, 2O*, or O*HO* adsorbates depending on the applied electrode potential U, that makes them no longer active in ORR. Therefore, the C2 site comes at the forefront in ORR catalysis. Among the metal oxidized forms M(O)N4–, M(O)(O)N4– and M(O)(OH)N4–CNT, the C2 site of the latter turned out to be most active for 4e dissociative ORR. For both metals the last protonation/electron transfer step, HO* + H* = H2O, is the rate-limiting step. The alternative hydrogen peroxide formation is not only thermodynamically less favorable but also kinetically slower than the 4e dissociative ORR route on the C2 site of model M(O)(OH)N4–CNT catalyst.

In this study, we reported a patient who presents with multicentric reticulohistiocytosis (MRH)-like clinical feature, but the histology is not compatible with it. Like our patient, a couple of patients described previously also had the dilemma that they could not be classified appropriately into any current histiocytosis entity. Considering the clinical and pathological features together, all these patients had a similar clinical profile: xanthomatous rash, erosive arthritis and histopathological findings showing xanthomized histiocytes. Therefore, we propose a new disease entity - xanthomatous erosive arthritis (XEA), to accommodate these patients that cannot be classified appropriately into the current system.

This paper present results on soil contamination with petroleum hydrocarbons (PHs) on soil sorptivity and hydrophobicity under different soil moistures. The micro-infiltrometer method was used in laboratory experiment to determine the soil water repellency index (R) and the water drop penetration time (WDPT) test. The increase in PHs contamination contributed to soil repellency and caused a decrease in water sorptivity. The negative effect of contamination with PHs on soil sorptivity depended on soil moisture and was marked especially clearly after exceeding the critical moisture threshold. However, contamination by PHs did not reveal significant changes when ethanol was used instead of water. The R index and the WDPT test revealed a similar trend, inversely related to the level of soil contamination with PHs. The total amount of water available to plants in non-contaminated soil was 19.04%, while contamination equal to 100 g kg -1 caused a decrease to 6.36%. Hydrophobization of water-conducting pore surfaces by petroleum hydrocarbons severely reduced infiltration and destroyed the existing hydrological system of naturally hydrophilic soil. The almost three-fold decrease in total amount of water has a fundamental influence on increasing the risk of soil drought. The soil water repellency causes a decrease in resistance to droughts and slows the alimentation process of soil water retention. The results obtained indicated that the interrelations presented between the level of PHs contamination, soil sorptivity, water repellency, and soil moisture are key to predicting the environmental effects of contamination and effective soil remediation.

Background: Multiple myeloma accounts for over 15% of hematological malignancies. In attempt to tackle this malady, the FDA approved four drugs in 2015 which has propagated further development of new anti-multiple myeloma since. However, the health safety of these new agents is still ill-defined. The aim of this study is to delineate the cardiovascular adverse events of these drugs. Methods: We searched the cardiac adverse events of the newly approved FDA drugs since 2015 using the U.S. Food and Drug Administration Adverse Events Reporting System database (FAERS). We calculated the reporting odds ratio (ROR) with 95% confidence for four drugs that have the highest incidence of cardiovascular adverse events. Results: Among the medications that have approved for MM Between 2015-2020, four novel drugs showed the highest incidence of cardiotoxicity. ROR (95% CI) for atrial fibrillation due to elotuzumab, Ixazomib, daratumumab, and panobinostat compared to other FAERS drugs was 5.8 (4.4-7.7), 1.9 (1.5-2.3), 4.8 (4.2-5.6), and 5.7 (4.1-8.1), respectively. The ROR (95% CI) for cardiac failure was 8.2 (6.4-10.5), 4.7 (4.1-5.4), 5.8 (4.9-6.7), and 5.6 (3.8-8.1) and ROR (95% CI) for coronary disease was 2.7 (1.9-3.9), 2.7 (2.3-3.2), 2.3 (1.9-2.8), and 4.6 (3.2-6.6) due to elotuzumab, Ixazomib, daratumumab, and panobinostat versus all other drugs in FAERS. Conclusions: Our results demonstrated that the newly approved antimyeloma therapy (elotuzumab, Ixazomib, daratumumab, panobinostat) are significantly associated previously unknow cardiotoxicity. These results warrant further studies and highlight the importance of considering the cardiac history of patients with multiple myeloma when utilizing these novel agents.

Fluvoxamine for COVID-19 outpatients: for the time being, we might prefer to curb our optimismVladimir TrkuljaRunning head : Fluvoxamin and COVID-19 outpatientsKey words : fluvoxamine, COVID-19, outpatients, hospitalizationsVladimir Trkulja, MD, PhDDepartment of PharmacologyZagreb University School of MedicineŠalata 1110000 Zagreb, Croatiae-mail: [email protected] of words: 613Number of figures/tables: 1To the Editor,A rather elaborate pharmacodynmics rationale 1 and sound pharmacokinetic reasoning 2 support the use of fluvoxamin in early phases of the COVID-19 disease. Two recent meta-analyses, 3, 4 both based on the same three randomized placebo-controlled trials, emphasized the benefit of early fluvoxamine treatment in non-vaccinated adult symptomatic mild COVID-19 outpatients in terms of a reduced risk of disease deterioration over subsequent days. In the first of the meta-analyzed trials, Stop COVID 15, primary outcome was hospitalization or incident hypoxemia needing oxygen treatment within 15 days. The trial was rather small, particularly for a binary outcome (fluvoxamine 2x100 to 3x100 mg/day over 15 days, n=80; placebo n=72) and recorded only 6 events (all with placebo) 5. Stop COVID 2 6followed the same design/outcome, and was stopped at an advanced stage for operational reasons but did not indicate any benefit [incidence 11/272 (4.0%) fluvoxamin vs. 12/275 (4.4%) placebo)]. The meta-analytical pooled estimates 3, 4 were dominated by the results of the TOGETHER trial 7 (fluvoxamine 2x100 mg/day, 10 days) that reported a marked relative reduction in the risk of the primary outcome (emergency room stay of at least 6 hours or hospitalization; over 28 days): 79/741 (11.0%) vs. 119/756 (16.0%), RR=0.69 (95% CrI 0.53-0.90) 7. By far the most events were hospitalizations, but no clear-cut benefit was obvious in this respect [75/741 (10.0%) vs. 97/756 (13.0%), OR=0.77 (0.55-1.05)7]. The meta-analysis by Lee et al.3 focused on hospitalizations and reported a 25% relative risk reduction by a frequentist method (RR=0.75, 95%CI 0.58-0.97), while the Bayesian analysis (weakly informative neutral prior) indicated somewhat more uncertainty (RR=0.78, 95%CrI 0.58-1.08; 81.6% probability of RR ≤0.90) 3. Guo et al.4 employed only frequentist pooling to indicate a marked benefit regarding “study-defined outcomes” (RR=0.69 95%CI 0.54-0.88) and somewhat more uncertainty regarding “hospitalizations” (RR=0.79, 95%CI 0.60-1.03) 4. In the meantime, a report was pubslihed of a randomized placebo-controlled trial conducted in 2020 in Korean outpatients (∼10 days of fluvoxamine 2x100 mg/day)8. It was stopped early for operational reasons8, and the primary outcome (as in Stop COVID trials) was observed in 2/26 treated and 2/26 placebo patients8. Figure 1 depicts meta-analysis of “study-defined primary outcomes” and of “hospitalizations” that uses the same frequentist and Bayesian methodology as used by Lee et al.3 except that (i) it includes the Korean data8 and (ii) employs Hartung-Knapp-Sidik-Jonkman correction shown to yield the least biased confidence interval coverage with small number of trials considerably varying in size9: (a) uncertainty about the benefit regarding “study-defined outcomes” (Figure 1A) is indicated by both the frequentist and Bayesian intervals extending to >1.0 and prediction intervals extending well >1.0. Probability of at least 10% relative risk reduction is 90.0%; (b) uncertainty about the benefit regarding “hospitalizations” (Figure 1B) is even more obvious, with estimate intervals exceding >1.10 (and further extended predictions intervals), with only 73.8% probability of at least 10% relative risk reduction. If one were to disregard two small trials with a few events (and, hence, fragile estimates that could have been by chance, at least in part) 5, 8, for the time being one would be looking at Stop COVID 2 and TOGETHER trial. This means 86/1013 hospitalization events with fluvoxamine vs. 109/1031 events with placebo, and a considerable uncertainty about any practically relevant effect: (i) frequentist RR=0.803 (95%CI 0.422-1.530); (ii) Bayesian RR=0.840 (95%CrI 0.613-1.170) and only 67.4% probablity of at least 10% relative risk reduction. Hopefully, the on-going trials (depicted in ref. 3) will resolve this uncertainty, but presently we might prefer to be cautios rather than overtly optimistic about the actual extent of benefit conveyed by early fluvoxamine treatment in COVID-19 outpatients.

The hemostatic effect of palliative radiation therapy (RT) for unresectable gastric cancer is unclear. We performed palliative RT (20 Gy in 5 fractions or 30 Gy in 10 fractions) in 7 consecutive patients with bleeding. The number of blood transfusions decreased significantly post-RT, supporting the hemostatic effect of palliative RT.

Rhinogenic optic neuropathy with hemianopia caused by sinusitisKosuke Oka, M.D., Ph. D.1, Wataru Ando2, Hideharu Hagiya, M.D. Ph. D1., Takaya Higaki, M.D., Ph. D.3and Fumio Otsuka, M.D., Ph.D.11Department of General Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-8558, Japan;2Okayama University Medical School, Okayama 700-8558, JapanKey words: Cat scratch disease, lymphadenopathy and subcutaneous abscess3Department of Otolaryngology-Head & Neck Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesKey words : Rhinogenic optic neuropathy and temporal hemianopiaCorresponding author : Kosuke Oka, M.D., Ph.D.Department of General Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama 700-8558, Japan.Tel: +81-86-235-7342 Fax: +81-86-235-7345E-mail: [email protected] clinical messages :A patient complained of acute right vision loss and headache. A computed tomography scan revealed sinusitis in the right ethmoid sinus that was compressing the optic nerve and emergency endoscopic sinus surgery was performed.

An adult male with no history of trauma visited an emergency outpatient clinic for idiopathic progressive cervical swelling. We report a case in which, from the results of contrast　enhanced computed tomography examinations, the neck was urgently opened and the carotid artery was reconstructed to save his life.

In this paper, a class of stochastic fractional differential equations (SFDEs) with impulses is considered. By virtue of the Monch’s fixed point theorem and Banach contraction principle, we explore the existence and uniqueness of solutions to the addressed system. Furthermore, with the aid of the Jensen’s inequality, Holder inequality, Burkholder-Davis-Gundy inequality, Gronwall-Bellman inequality and some novel assumptions, the averaging principle of our considered system is obtained. At the end of this paper, an example is provided to illustrate the theoretical results.