Climate change is affecting species and their mutualists and can lead to interaction weakening and loss. Through independent shifts in partner phenology and distribution, climatic stress can separate mutualists, leading to alterations in partner functional traits and fitness. Here, we explored the effects of drying soils and the loss of microbial mutualists via soil sterilization on legume germination success and phenology, focusing on how a loss of mutualisms with soil microbial species can alter legume early life traits. In particular, we assessed the effects of mutualism loss via soil sterilization, increased drought, or introduction to novel soils found beyond the current distributions of two focal legume species in subalpine environments. Through common garden experiments in controlled environments, we found evidence that soil sterilization (and consequent microbial absence) and dry soils caused phenological delays of 2-5 weeks in germination date, likely as a result of interaction loss between legumes and germination-promoting soil microbes, such as mutualistic rhizobia. Delays in germination caused by a mismatch between legumes and beneficial microbes could negatively affect legume fitness through increased plant-plant competition later in the season. Additionally, we found evidence of the presence of beneficial microbes beyond the current elevational range of our focal legumes which may allow for expansion of the leading edge, though harsh abiotic factors in the alpine may hinder this. Alterations in the strength of soil microbe-legume mutualisms may lead to reduced fitness and altered demography for both soil microbes and legumes.

The generalized MHD-Boussinesq equations are studied in this paper. The well-posedness of the strong solutions for the generalized MHD-Boussinesq equations is proved. Asymptotic regularity for the generalized MHD-Boussinesq equations is proved in $H^{\frac{9}{2}}\times H^{\frac{9}{2}}\times H^{\frac{9}{2}}$. The higher regularity for the generalized MHD-Boussinesq equations is proved in $H^{a}\times H^{a}\times H^{a}$ for $a\geq\frac{9}{2}$.

Background: Flow artifact, intrinsic to Magnetic Resonance Angiography (MRA), is dependent on technical parameters and can lead to overinterpretation of stenosis. Degree of cerebrovascular stenosis in pediatric patients with sickle cell anemia (SCA) informs need for chronic transfusion therapy, which may have significant risks. The primary objective of this study was to document any change in stroke prevention therapy that could be attributed to the implementation of a standardized MRA scanning protocol. Procedure: A standardized MRA scanning protocol with an echo time of <5 msec was implemented at Montefiore Medical Center in May 2016. Retrospective chart review identified 29 patients ≤ 21 years with SCA cerebral vasculopathy and an MRA head pre- and post-May 2016. Level of arterial stenosis on MRA, echo time, and treatment plans were documented both pre- and post-implementation. McNemar analysis determined the significance of change in treatment plans before and after implementation of the standardized scanning protocol. Results: Previously seen stenosis was re-classified to a lower degree in 12/29 patients (41%). Notably, 6 patients had a reclassification of vasculopathy leading to discontinuation of chronic transfusion therapy whereas 0 patients required escalation of therapy to chronic transfusions. McNemar analysis showed this difference to be statistically significant (p = 0.042). Conclusion: Minimizing flow artifact with echo time <5msec improves accurate interpretation of true cerebrovascular disease and ensures appropriate treatment plans are in place for stroke prevention. This is especially important when trying to implement “TCD With Transfusions Changing to Hydroxyurea (TWiTCH)” clinical trial results in the real-world setting.

Title Page:Title: Letter to the Editor: Longer-Term Outcomes after Bicuspid Aortic Valve Repair In 142 Patients.Article Type: Letter to the EditorCorrespondence: 1. Roomi RajaContact No: +92-3342946940. Email: [email protected]: Ziauddin University KarachiAddress: Hemilton Courts Block G-1 Flat 408 Near Teen Talwar Clifton KarachiCo-Authors: 2. Satesh KumarContact No: +92-3325252902. Email: [email protected]: Shaheed Mohtarma Benazir Bhutto Medical College Liyari, KarachiAddress: Parsa Citi Garden East, KarachiWord Count: 335

Title Page:Title: Letter To The Editor: Long-Term Renal Function After Venoarterial Extracorporeal Membrane Oxygenation.Article 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. Muhammad Abdullah KhanContact No: +923032992689. Email: [email protected]: Ziauddin University KarachiAddress: House No R 133 Block 11 Gulshan E Iqbal KarachiOrcid: 0000-0002-0653-5060Co-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: 354Conflict of interest : NoneAcknowledgment : NoneDeclaration: NoneDisclosure : NoneFunding : None

Background: Atrial fibrillation (AF) is common in patients with reduced left ventricle ejection fraction (RLVEF). The impact of concomitant surgical atrial fibrillation ablation (SAFA) in patients with RLVEF is uncertain. The purpose of this study was to assess the outcomes of concomitant SAFA in patients with RLVEF undergoing heart surgery on heart failure (HF) rehospitalization and mortality. Methods: Using a local registry and electronic health records linked with provincial civil register survival data from July 2002 to April 2019, we analyzed treatment and outcomes in a cohort of patients with AF and HF defined by left ventricle ejection fraction (LVEF) ≤ 40%. Health records were used to collect treatment and International Classification of Diseases (ICD 10) codes to determine outcomes. A negative binomial model was used to compare outcomes such as all-cause mortality and rehospitalization for heart failure. Results: The cohort included 682 patients with RLVEF and AF who underwent coronary artery bypass graft and/or valve surgery. A total of 196 patients (29%) underwent concomitant SAFA. After matching, 132 patients with concomitant SAFA were compared to 159 patients who did not undergo concomitant SAFA. At 6.0±3.7 years of follow-up, concomitant SAFA was not associated with lower all-cause mortality (P=0.9861) and reduction in rehospitalizations for heart failure decompensation (P=0.31) compared to patients who did not have concomitant SAFA performed. Post-operatively, concomitant SAFA might be associated with less vasopressor and mechanical support use (p=0.01). Conclusions: Concomitant SAFA during index cardiac surgery is safe but does not reduce mortality or rehospitalizations for HF. The effects of concomitant SAFA in the context of RLVEF needs to be better studied with prospective trials.

Patients suffering retrograde type A dissection after TEVAR for type B dissection are at a higher risk of mortality than their spontanous counterparts and the kind of optimal therapy remains obscure. We present a rare case of successful open surgical repair where distal open anastomosis was accomplished cutting off the un-covered stent portion and suturing a vascular prosthesis to the dissected distal aortic arch including the covered stent part. The clinical course was regular. Immediate and radical repair in the aortic arch may be the adequate response in such instances.

In thiswork,we have computed and implemented one-body integrals concerning gaussian confinement potentials over gaussian basis functions. Then, we have set an equivalence between gaussian and Hooke atoms and we have observed that, according to singlet and triplet state energies, both systems are equivalent for large confinement depth for a series of even number of electrons n = 2, 4, 6, 8 and 10. Unlike with harmonic potentials, gaussian confinement potentials are dissociative for small enough depth parameter; this feature is crucial in order to model phenomena such as ionization. In this case, in addition to corresponding Taylor series expansions, the first diagonal and sub-diagonal Padé approximant were also obtained, useful to compute the upper and lower limits for the dissociation depth. Hence, this method introduces new advantages compared to others.

Triaging a patient to colposcopy v. watchful waiting using current and prior HPV type and cytology result will help focus care on those at highest risk, and avoid overtreatment of women at low risk of cancerSarah Feldman MD MPHDivision of Gynecologic Oncology, Department of Obstetrics and GynecologyHarvard Medical SchoolBrigham and Women’s Hospital75 Francis StreetBoston, Ma [email protected] have no conflicts of interest to disclose.The findings by Gustafson, et al, that the rate of CIN2+ (high grade cervical precancers) was significantly higher in LLETZ specimens (32.4%) than in biopsies (14.7%) in Danish women age 45+ with type 3 transformations zone (ie part of the upper limit of the transformation zone is not visible) is based on a thoughtful analysis. Patients were screened and managed by Danish guidelines which included predominantly cytology based screening during the period of study, for all but women aged 60-64 (and some up to 69), with HPV testing only being offered to some women ages 30-59. Although the HPV test used in the study (Cobas) automatically provides HPV16 and 18 genotyping, this information was not used for triage. In this study all women underwent colposcopy and diagnostic LLETZ at the same visit. Although the Denmark guidelines recommend blind 4 quadrant biopsies for those without a visible lesion, endocervical curettage, which is a part of many other guidelines (Perkins RB, et al 2019 ASCCP risk-based management consensus guidelines for abnormal cervical cancer screening tests and cancer precursors. J Low Genit Tract Dis 2020;24:102–31), is not offered in Denmark. Although the diagnostic LLETZ picked up more CIN2+ than biopsy alone, as the authors state, the majority of women would not have needed the LLETZ if their risk could have been better predicted.Can we use currently available technology and information to more effectively and safely triage patients to detect and treat high grade lesions but avoid aggressive and costly treatment for the majority? Many studies have suggested that knowledge of a patients past screening history in addition to current results, in particular knowledge of the HPV status over time, whether HPV16 or 18 are present, as well as the severity of the cytology smear can help clarify who is at highest risk and who can be followed. (Egemen D, et al. Risk estimates supporting the 2019 ASCCP risk-based management consensus guidelines. J Low Genit Tract Dis 2020 Apr;24:132–43, Smith MA, et al. National experience in the first two years of primary human papillomavirus (HPV) cervical screening in an HPV vaccinated population in Australia: observational study. BMJ. 2022 Mar 30;376)The underlying risk of the population studied affects the results and any downstream conclusions. In this case, the population studied had been predominantly screened by cytology, until the final screen, which was predominantly by HPV. Multiple studies have shown that HPV based screening has a better sensitivity than cytology alone and a reassuring result has as a more reliable negative predictive value than cytology, especially when lesions are in the endocervical canal or not fully visible. A prior negative or positive screen with an HPV based test might have aided in risk assessment and triage in this cohort. Adding p16ki67 staining to the initial cytology would also help to predict long term risk of high grade dysplasia, determining who could be followed and who treated. (Clarke MA, et al Five-Year Risk of Cervical Precancer Following p16/Ki-67 Dual-Stain Triage of HPV-Positive Women. JAMA Oncol. 2019 Feb 1;5(2):181-186.) Finally, an endocervical curettage, even with a brush, might have better sampled the endocervical canal and is less painful and costly than four blind biopsies.Despite some of the limitations of the study, which the authors outline well, there is an important message-the CIN2+ rate in this older cohort of women is high- and if we are to prevent cervical cancer among older women, screening with HPV before exiting screening, and appropriately evaluating and treating women at risk of high grade dyspasia or cancer is essential.

Modern chemical processes need to be operated around different operating conditions to optimize plant economy, in response to dynamic supply chains. As such, the process control system needs to handle a wide range of operating conditions whilst optimizing system performance and ensuring stability during transitions. This article presents a reference-flexible nonlinear model predictive control approach using contraction based constraints. Firstly, a contraction condition that ensures convergence to any feasible state trajectories or setpoints is constructed. This condition is then imposed as a constraint on the optimization problem for model predictive control with a general (typically economic) cost function, utilizing Riemannian weighted graphs and shortest path techniques. The result is a reference flexible and fast optimal controller that can trade-off between the rate of target trajectory convergence and economic benefit (away from the desired process objective). The proposed approach is illustrated by a simulation study on a CSTR control problem.

The aortic sinuses of Valsalva are an important ablation site in non-ischemic substrates and in patients with idiopathic ventricular arrhythmias. Siontis and colleagues have demonstrated that these sites should also be considered for ablation in patients with infarct-related inferior axis VT. Low voltage in the aortic sinuses of Valsalva or in the sub-aortic region should prompt further evaluation of these regions for ablation.

An 81-year-old man initially underwent right hepatic lobectomy for liver cancer and was pathologically diagnosed with combined hepatocellular and cholangiocarcinoma (CHC). At 13 months after resection, multiple lymph node metastases were observed. We started atezolizumab plus bevacizumab (Atez/Bev), achieving a 7.5-month progression-free survival. Atez/Bev might exhibit efficacy for CHC patients.

Objectives: To explore the effect of intranasal administration of rh-bFGF on postoperative chronic rhinosinusitis with nasal polyps(CRSwNP) patients. Design: A prospective, randomized, controlled, double-blinded trial. Setting and Participants: 75 hospitalized patients who met the criteria of primary bilateral CRSwNP were enrolled from March 2020 to January 2021. Main outcome measures: Visual analogue scale, 22 item Sino-Nasal Outcome Test ,Lund-Kennedy system, and Scanning electron microscopy and Quantitative real-time PCR. Results: 75 patients with CRSwNP were randomly divided into three groups, and 72 patients completed the 1-month medication regimen and 1 year follow-up. Rh-bFGF nasal spray and drop application reduced general nasal VAS scores within two weeks after ESS compared to the control group. In contrast, only rh-bFGF nasal drops reduced SNOT-22 scores at 2 weeks and 1 year compared to the control group. A significant reduction in the endoscopic L-K score was observed in the rh-bFGF nasal spray and drop group compared to the control group. This is primarily because rh-bFGF promotes cilia growth in the nasal mucosal epithelium after the operation, as illustrated by scanning electron microscopy and expression of CP110, Tap73 and Foxj1 mRNA. For eosinophilic CRSwNP, the general VAS score of rh-bFGF nasal drops was more obviously reduced compared to the control group after ESS. A similar trend was observed for L-K score. Conclusions: Rh-bFGF nasal-drops and sprays can quickly and effectively relieve postoperative symptoms and improve long-term prognosis of patients with CRSwNP. Moreover, rh-bFGF nasal-drops are also an effective method for postoperative patients with eosinophilic CRSwNP.

We read with great interest the article by Vetrugno et al. who reported the important association of preoperative diastolic dysfunction (DD) and early liver allograft dysfunction.[1](#ref-0001) We salute the authors on this detailed and important investigation, and would like to highlight several points. First, the authors provide the cohort analysis of donors’ and recipients’ demographic variables (Table 1, Ref[1](#ref-0001)), however statistical comparative analysis of the three study groups and these variables is absent. Moreover, additional, important demographic variables (e.g., ethnicity, presence of trans jugular intrahepatic portosystemic shunt; hepato-pulmonary syndrome, porto-pulmonary hypertension, pretransplant hospitalization or vasopressors; QT interval) and intraoperative variables (e.g., hemoglobin, coagulative and thromboelastographic parameters, arrhythmias, immunosuppression, and post-reperfusion syndrome and vasopressors) were not included in the groups’ analysis (Table 4, Ref[1](#ref-0001)). These parameters are predictive of postoperative major adverse cardiac events and unfavorable transplant outcomes.[2,3](#ref-0002) Lastly, an association does not imply causation,[4](#ref-0004) and both DD and early graft dysfunction may have an independent, common origin like cirrhotic cardiomyopathy.[5](#ref-0005) An adjustment for cofounders is, therefore, mandatory; regrettably, the omission of a multivariable analysis from the study obfuscates the interpretation of the observed association. Presumably, DD results in early allograft rejection and dysfunction via the attendant elevated pro-inflammatory cytokines, or increased venous pressure and hepatic allograft congestion.[6](#ref-0006) Postoperative cardiac variables (e.g., troponins, sono- and electrocardiography, venous and pulmonary pressures) and allograft biopsies were not reported in the study, but may direct clinicians to mitigating interventions to improve outcomes in liver allograft recipients with DD.

This work considers a seeded fesoterodine fumarate (FF) cooling crystallization and presents the methodology and implementation of a real-time machine learning modeling-based predictive controller to handle batch-to-batch (B2B) parametric drift. Specifically, an autoencoder recurrent neural network-based model predictive controller (AERNN-MPC) is developed to optimize product yield, crystal size, and energy consumption while accounting for the physical constraints on cooling jacket temperature. Deviations in the kinetic parameters are considered in the closed-loop simulations to account for the B2B parametric drift, and two error-triggered online update mechanisms are proposed to address issues pertaining to the availability of real-time crystal property measurements and are incorporated into the AERNN-MPC to improve the model prediction accuracy. Closed-loop simulation results demonstrate that the proposed AERNN-MPC with online update, irrespective of the accessibility to real-time crystal property data, achieves a desired closed-loop performance in terms of maximizing product yield and minimizing energy consumption.

We reported an association between SARS-CoV-2 infection and Guillain-Barre´ syndrome (GBS). From 37 patients with GBS, Previous SARS-CoV-2 infection clues, including fever, cough, and diarrhea were recorded in 18 patients. Among them, SARS-CoV-2 IgG was detected in 7 patients, considered confirmed cases. SARS-CoV-2 PCR was positive in just 1 patient.

Hemophagocytic Lympho-histiocytosis (HLH) is a rare life-threatening condition characterized by widespread activation of the immune system leading to tissue damage all over the body.

Myositis ossificans circumscripta (MOC) is a benign, self-limiting heterotopic ossification in the subcutaneous fat, tendons, muscles, and nerves. It is commonly due to trauma and is frequently encountered in the arm, shoulder, thigh, and hand which are prone to trauma. Non-traumatic MOC arising from the abdominal muscles is extremely rare