During the COVID-19 pandemic, multiple skin manifestations have been described. These include an urticarial rash, morbilliform rash, maculopapular rash, vascular lesions, and varicella-like eruptions. A 30-year-old woman presented with a mild cough, then hives and pruritic rash for 3 days, followed by fever, dyspepsia, and throat pain for one day.

We experienced a case of iatrogenic intramucosal esophageal dissection in a patient who had difficulty inserting a gastric tube. CT is useful for diagnosis.

We report an atypical presentation of a current disease to highlight the importance of making a correct diagnosis of scabies surrepticius in front of any itchy dermatosis especially in elderly patients. The misdiagnosis of this disease results in extensive infestation, especially with the use of corticosteroids.

The future of CABG can be bright if cardiac surgeons will change the paradigm followed so far and will return in history, abandoning the current comfortable life and accepting the burden represented by the cost of innovation, which has a path already mapped out but not sufficiently trodden for guilty lack of commitment.

Title Page:Title: Letter To The Editor: Gastrointestinal complications after cardiac surgery: Incidence, predictors, and impact on outcomesArticle Type: Letter To The EditorCorrespondence: 1. Sapna goindaniContact no: +971 54 344 9435. Email: [email protected]: Peoples University of Medical and Health Sciences For Women (PUMHSW)Address: Flat no 9, building no 10 bastakia building, Al hamriya bur dubai, dubaiORCID: 0000-0003-4906-8463Co-Authors: 2. Roomi rajaContact No: +92-3342946940. Email: [email protected]: Ziauddin University KarachiAddress: Hemilton Courts Block G-1 Flat 408 Near Teen Talwar Clifton KarachiORCID: 0000-0001-9104-3644Co-Authors: 3. Satesh KumarContact No: +92-3325252902. Email: [email protected]: Shaheed Mohtarma Benazir Bhutto Medical College Liyari, KarachiAddress: Parsa Citi Garden East, KarachiORCID: 0000-0001-7975-6297Word Count: 340Conflict of interest : NoneAcknowledgment : NoneDeclaration: NoneDisclosure : NoneFunding : None

Metabolic rate is a trait that may evolve in response to the direct and indirect effects of predator-induced mortality. Predators may indirectly alter selection by lowering prey densities and increasing resource availability or by intensifying resource limitation through changes in prey behaviour (e.g. use of less productive areas). In the current study we quantify evolution of metabolic rate in the zooplankton Daphnia pulicaria following an invasive event by the predator Bythotrephes longimanus in Lake Mendota, Wisconsin, US. This invasion has been shown to dramatically impact D. pulicaria, causing a ~60% decline in their biomass. Using a resurrection ecology approach, we compared the metabolic rate of D. pulicaria clones originating from prior to the Bythotrephes invasion with that of clones having evolved in the presence of Bythotrephes. We observed a 7.4% reduction in metabolic rate among post-invasive clones compared to pre-invasive clones, and discuss the potential roles of direct and indirect selection in driving this change.

Title: Reply to “Pro-arrhythmia with Anti-arrhythmic Drugs in Patients with Idiopathic Ventricular Arrhythmia: A Common Problem with Vague Definitions and Complex Interactions”Jacky K. K. Tang MD1 and Marc W. Deyell MD MSC1,2Heart Rhythm Services, Division of Cardiology, University of British ColumbiaCentre for Cardiovascular Innovation, University of British ColumbiaWord Count: 538 (including references)Address for correspondence:Dr. Marc William DeyellHeart Rhythm Services, St. Paul’s Hospital200 – 1033 Davie St.Vancouver, B.C., Canada, V6E 1M7Phone: 604-806-8256; Fax: 604-806-8723Email: [email protected]@MarcDeyellCompeting Interests: Dr. Deyell reports research grants from Biosense Webster and honoraria from Biosense Webster, Medtronic and Abbott.Funding: This work was supported by the UBC Division of Cardiology Academic Practice Plan.Drs. Hasdemir and Payzin have cogently brought up one of the primary challenges in studying patients with frequent premature ventricular complexes (PVCs) and evaluating the impact of therapy. They highlight, based on their prior study,(1) that a group of patients may actually experience a significant increase in PVC burden (>50%) with medical therapy, which obviously raises concerns that this may enhance deleterious effects of PVCs, particularly in the long term.With the advent of ambulatory monitoring, it was recognized early that PVC burden could be highly variable, leading to measurement error when using a 24-hour monitor. This error is highest when performing before-and-after studies of the effect of intervention on PVC burden, using single monitoring periods of 24 hours prior to and after intervention. In particular, spontaneous reductions in PVC burden can overestimate treatment effects. This error can be minimized in two ways, through serial monitoring (repeated measures) or longer-term monitoring (>48h). Indeed, an elegant study by Dr. Mullis and colleagues, using 14 day patch monitors, showed a median absolute day-to-day fluctuation in PVC burden of almost 10% among patients with a high burden of PVC.(2) Thus, an apparent “pro-arrhythmic” effect of a medication may simply reflect inefficacy and expected variation in PVC burden.In our prior work,(3) published in this journal and referenced by Drs. Hasdemir and Payzin, we were also limited by using only 24-hour ambulatory monitors to assess PVC burden. However, we did include a control group on no medical therapy, to mitigate the effect of measurement error, by obtaining an estimate of variation in PVC burden in the absence of therapy. In our study, we observed a “pro-arrhythmic effect” (>50% increase in PVC burden), in 2.5% (1/40) of patients on no medical therapy, 7.5% (4/53) on beta blockers/calcium channel blockers and 11.1%% (3/27) on class I/III antiarrhythmic therapy. Despite the trend, these were not significantly different (p=0.28 and p=0.14 for beta blocker/calcium channel blocker and class I/III antiarrhythmics versus no therapy).This does not negate a potential pro-arrhythmic effect of medical therapy in a minority of patients. However, more definitive proof of a pro-arrhythmic effect, distinguishing this from spontaneous variation in PVC burden, would require demonstration of a decrease in PVC burden with cessation of therapy. This would best be accomplished with a blinded, cross-over trial design.Drs. Hasdemir and Payzin remind us to always critically assess, and reassess, our therapies for patients with frequent PVCs. We must always evaluate whether treatment is warranted (in the majority of cases it is not), and whether patients are at risk for adverse events, particularly from class I and III antiarrhythmics. Frequent PVCs make physicians uncomfortable but we should not rush to treatment and expose patients to unnecessary harm.References:1. Turan OE, Aydin M, Odabasi AY, Inc M, Payzin S, Hasdemir C. Therapeutic Inefficacy and Proarrhythmic Nature of Metoprolol Succinate and Carvedilol Therapy in Patients With Idiopathic, Frequent, Monomorphic Premature Ventricular Contractions. Am J Ther 2021;29:e34-e42.2. Mullis AH, Ayoub K, Shah J et al. Fluctuations in premature ventricular contraction burden can affect medical assessment and management. Heart Rhythm 2019;16:1570-1574.3. Tang JKK, Andrade JG, Hawkins NM et al. Effectiveness of medical therapy for treatment of idiopathic frequent premature ventricular complexes. Journal of Cardiovascular Electrophysiology 2021;32:2246-2253.

This Research Highlight showcases the Research Paper entitled, Big cohort metabolomic profiling of serum for oral squamous cell carcinoma screening and diagnosis, https://doi.org/10.1002/ntls.20210071

After a suspected allergic reactions to first dose of mRNA COVID-19 vaccine, given the PEG skin tests negativity and tolerance in vivo to PEG containing drugs, five patients were vaccinated with the second dose of Pfizer-Biontech undergoing a fractional protocol, with antihistamine premedication, without presenting immediate or delayed reactions.

It is widely acknowledged that population structure can have a substantial impact on evolutionary trajectories. In social animals, this structure is strongly influenced by relationships among the population members, so studies of differences in social structure between diverging populations or nascent species are of prime interest. Ideal models for such a study are two house mouse subspecies, Mus musculus musculus and M. m. domesticus, meeting in Europe along a secondary contact zone. Though the latter subspecies has usually been supposed to form tighter and more isolated social units than the former, the evidence is still inconclusive. Here, we carried out a series of radio-frequency identification experiments in semi-natural enclosures to gather large longitudinal datasets on individual mouse movements. The data were summarised in the form of uni- and multi-layer social networks. Within them, we could delimit and describe the social units (‘modules’). While the number of estimated units was similar in both subspecies, domesticus revealed a more ‘modular’ structure. This subspecies also showed more intramodular social interactions, higher spatial module separation, higher intramodular persistence of parent-offspring contacts, and lower multiple paternity, suggesting more effective control of dominant males over reproduction. We also demonstrate that long-lasting modules can be identified with basic reproductive units or demes. We thus provide the first robust evidence that the two subspecies differ in their social structure and dynamics of the structure formation.

Pine barren and sandplain ecosystems are unique, globally rare ecosystems whose open-canopied vegetation structure supports a unique assemblage of plants and animals. They occur almost exclusively on deep, sandy soils, and require periodic disturbances to prevent succession to forest. Though these ecosystems, and the unique species that live in them, are rare today, they once occupied a larger area of coastal and interior New York and New England. In order to better understand pine barren and sandplain distribution in the past, and the potential for restoring them in the future, we mapped the distribution of soils in New York State that can support these ecosystems. We quantified soil percent sand and soil depth of 156 known high quality remnant pine barren and sandplain ecosystems to calculate threshold soil characteristics. We then mapped all soils in the state that were at least as sandy and deep as the threshold values we calculated. The total area of our map of potential soil conditions was over 9,500 km2, made up of forested (57%), urban (26%), agricultural (13%) and open (4%) land cover. Nearly 7,000 km2 – almost 20 times the area of known, high quality remnant ecosystems – of land was forested, agricultural, or open land. Existing examples of pine barren and sandplain ecosystems were mostly embedded within much larger matrices of forest, agriculture, and urban land cover that shared the distinctive soil conditions. The presence of extensive soils in coastal and interior New York that, with the appropriate disturbance regime, have the potential to host pine barren and sandplain ecosystems offers a new perspective on these ecosystems’ distribution in the past – and about how to better align restoration and conservation to preserve the future.

Social determinants of health (SDoH) are associated with stark disparities in cancer outcomes, but systematic SDoH data collection is currently absent from oncology clinical trials. Trial-based SDoH data are essential to ensure representation of marginalized populations, contextualize outcomes, and identify health-equity intervention opportunities. We report the feasibility of the first pediatric oncology multicenter trial-embedded SDoH investigation. Among 448 trial participants, 392 (87.5%) opted-in to the embedded SDoH study; 375 (95.7%) completed baseline surveys, with high longitudinal response rates (87.2-92.8%) over 24-months of therapy. Trial-embedded SDoH data collection is feasible and acceptable, and must be consistently included within future oncology trials.

In this paper, we study the existence of global $L^2$-constrained minimizers related to the following Kirchhoff type equation: $$ -\left(a+b\ds\int_{\R^N}|\nabla u|^2\right)\Delta u-f(u)=\lambda u,~~~x\in \R^N,~\lambda\in\R,$$ where $N\leq3$, $a,$ $b>0$ are constants, $f(u)$ is a general $L^2$-subcritical nonlinearity. By using the concentration compactness principle, we prove the sharp existence and nonexistence of global $L^2$-constraint minimizers.

Since a polyvalent strategy has recently been assumed to be adopted by Deinococcus radiodurans that can generate various resistance against many different detrimental sources of oxidative damage (e.g. reactive oxygen species, heavy metal ions and ionising radiation), investigating more than one restorative metabolic activities and their interrelation of the very same entities of Deinococcus radiodurans is of great significance for exploring its polyextremophile nature, which will be insightful for obtaining fundamental generic insights into life sustainability. Herein, we apply mainly fluorescence microscopy and back reflection microscopy to visibly assess the respective activities of superoxide radical generation and silver ion metabolism for individual Deinococcus radiodurans. Strikingly, only a minority (<20%) of the bacteria which show low superoxide radical levels is revealed to exhibit considerable formation of silver nanoparticles whilst those containing more superoxide radicals all show minimum silver ion metabolism. The discovery of the strong negative correlation for the small subpopulation between the two visualised different metabolic activities not only provides direct experimental evidence in terms of bacterial functionality for the inferred survival regime of the extreme microbe, but also suggests a new way of chemically examining biology from the perspective of inter-functional relationship.

Objective: This study aimed to develop deep learning (DL) models for differentiating between eosinophilic chronic rhinosinusitis (ECRS) and non-eosinophilic chronic rhinosinusitis (NECRS) on preoperative computed tomography (CT). Methods: A total of 878 chronic rhinosinusitis (CRS) patients undergoing nasal endoscopic surgery were included. Axial spiral CT images were pre-processed and used to build the dataset. Two semantic segmentation models based on U-net and Deeplabv3 were trained to segment sinus area in CT images. All patient images were segmented using the better-performing segmentation model and used for training and validation of the transferred efficientnet_b0, resnet50, inception_resnet_v2, and Xception neural networks. Additionally, we evaluated the performances of the models trained using each image and each patient as a unit. The precision of each model was assessed based on the receiver operating characteristic curve. Further, we analyzed the confusion matrix, accuracy, and interpretability of each model. Results: The Dice coefficients of U-net and Deeplabv3 were 0.953 and 0.961, respectively. The average area under the curve and mean accuracy values of the four networks were 0.848 and 0.762 for models trained using a single image as a unit, while the corresponding values for models trained using each patient as a unit were 0.853 and 0.893, respectively. The generated Grad-Cams showed good interpretability. Conclusion: Combining semantic segmentation with classification networks could effectively distinguish between patients with ECRS and NECRS based on preoperative sinus CT images. Furthermore, labeling each patient to build a dataset for classification may be more reliable than labeling each medical image.

Canopies shape net precipitation patterns, which are spatially heterogeneous and control soil moisture response to rainfall. The vast majority of studies on canopy water fluxes were conducted in forests, whereas grassland canopies are often assumed to be spatially homogeneous, therefore likely not inducing patches of heterogeneity at and below the soil surface. Yet, some studies on short-structured vegetation, such as grasslands, proposed the importance of canopy-induced heterogeneity for net precipitation, but systematic investigations on the effects on soil wetting patterns are missing. Therefore, in this study, we investigated soil moisture response to rainfall in a managed temperate grassland by exploring the individual impacts of spatially varying throughfall, vegetation height and antecedent soil moisture status on the soil wetting patterns. We applied linear mixed effects models to disentangle the role of grassland canopy versus abiotic drivers. The spatial average soil water response showed that less and less water was stored in the upper parts of the soil as the growing season progressed and the soils dried, indicating bypass flow. Spatial variation of grass height was a significant driver of soil wetting patterns along with precipitation and antecedent soil moisture status. Soil wetting was suppressed in locations with tall canopy, although surprisingly this was not directly related to throughfall patterns. Instead, our results suggest that seasonally drier conditions and grassland stemflow kick off preferential flow. Ultimately, our results confirm that spatial variation of the canopy affects soil moisture wetting patterns not only in forests and indicate a strong influence of preferential flow on soil water patterns.

Title:Letter to Editor:Re: Impact of analysis technique on our understanding of the natural history of labour

Background: Inhaler technique (IT) knowledge among healthcare providers is poor. The aim was to improve PED healthcare providers’ IT technique by carrying out an education intervention, and sustain it for 6 months. Methods: open-label, quasi-experimental, prospective and unicentric study. Healthcare professionals working at the Pediatric Emergency Department (PED) were enrolled. The study was developed in three phases: baseline evaluation and education intervention (P1) and reevaluation 1 month (P2) and 6 months (P3) after the education intervention. Participants fulfilled an eight-question theoretical test. Practical skills were evaluated by demonstrating IT in all three phases. The education intervention consisted in a verbal explanation of IT followed by a demonstration of IT with metered-dose inhaler using a mannequin. Results: 84 healthcare providers (medical residents, nurses and nursing assistants) were involved. In the theoretical questionnaire, the mean score at baseline was 4.4/8 (SD 1.7) improving to 6.3/8 (SD 1.2) in P2 and 6.47/8 (SD 1.1) in P3. In the IT evaluation for children <7 years old, the score improved from 5.7/7 (SD1.3) to 6.5/7 in P2 and 6.7/7 in P3 (p<0.001). For children >7 years old, the mean score of IT at baseline was 3.1/10 (SD 4), which improved to 7.4/10 (SD3) and 8.2/10 in P2 and P3 respectively (p<0.001). Only laboral category influenced results at baseline. Conclusion: Healthcare providers’ theoretical knowledge and practical skills on IT are low. The education intervention performed is a useful strategy to ameliorate IT among healthcare providers.