There have been a few case studies showing intra-abdominal abscesses due to retained faecalith post laparoscopic appendectomy. A 29 years-old woman presented with right lateral abdominal wall and pelvic collection due to retained faecalith post interval laparoscopic appendectomy for perforated appendicitis. She underwent exploration for faecalith retrieval successful outcome.

Abstract A case of a supraclavicular cystic mass arising from the brachial plexus and histologically confirmed to be a schwannoma is presented. Due to its low accuracy, FNAC should not be used as an ultimate diagnostic tool. Complete surgical removal while maintaining the nerve trunk was performed.

Bulk SiC phases with tetrahedral arrangements have been identified several decades ago, and have been widely studied due to their potential applications. Until recently, Yaghoubi et al.’s experimental results (Chem. Mater. 2018, 30, 7234) showed that the graphitic SiC with few SiC layers stacking is stable. In this work, we further explore the potential application of graphitic SiC as the Na-ion battery anode via the first-principle simulation. Our results reveal that the theoretical capacity of graphitic SiC reaches up to 1339.44 mAh/g, which is almost the highest among the already known Na-ion battery anodes. Together with the low diffusion barrier, moderate open circuit voltage and excellent electronic conductivity during the sodiation, we propose that the graphitic SiC is a promising material as Na-ion battery anode. More importantly, we find that the intercalation strength of Na ions into C-based multi-layer materials (or the corresponding theoretical capacity, the operation voltage) could be enhanced by increasing the amount of covalent components in Na‒C bonds, which could be realized via doping by atom (such as Li, Be, B, Al, Si or P) with lower electronegativity than that of C atom.

Aim: The purpose of this study is to determine the level of attention between shifts and to make recommendations about the regulation of shifts. Methods:The researchers applied the Hamilton Depression Rating Scale (HAM-D), Hamilton Anxiety Rating Scale (HAM-A), Pittsburgh Sleep Quality Index (PSQI) and Stroop color word interaction test (SCWI) in 72 intensive care workers working in different shifts. Result: The study included a total of 72 participants, including 30 (43.3%) females and 42 (58.3%) males. There were statistically significant differences between the groups in the sub-items of the HAM-D and SCWI test (Table 3). There was a significant elongation in the night shift employees at all times within the SCWI sub-items. A significant height in the number of errors and corrections in the cards applied in the continuation of the test was also determined in the night shift group. Conclusion: This study revealed a significant decrease in the level of attention in the night-shift compared to the day-shift. This increase in attention deficit may also be a preventable cause of increased mortality in the night-shift What is already known about this topic? • Mortality rates in intensive care units are higher than in other clinics. What this paper adds? • Our study reported significantly poor results of the SCWI test in the night-shift compared to the day-shift. The implications of this paper: • This study revealed a significant decrease in the level of attention in the night-shift compared to the day-shift. We believe that it will be beneficial to shorten the shift times, to keep the number of patients per staff at international standards, to set active rest periods and to plan personnel and hours to reduce the lack of attention observed in the night shift. KEYWORDS Attention, healthcare worker, night-shift, intensive care

The grain boundary strengthening effect (GBSE) was investigated for nickel-based superalloy bicrystals with various misorientations under different temperatures and loading directions. The results show that the GBSE is enhanced with the increase of misorientation and insensitive to the temperature. Besides, the loading direction relative to GB also has strong effect on GBSE. On the other hand, the GBSE is often accompanied by GB cracking. The trend of GB cracking is heightened with the increase of misorientation and temperature. However, the trend of GB cracking is reduced strongly when the loading direction transforms from parallel direction to vertical direction.

Fast approximations of power flow results are beneficial in power system planning and live operation. In planning, millions of power flow calculations are necessary if multiple years, different control strategies, or contingency policies are to be considered. In live operation, grid operators must assess if grid states comply with contingency requirements in a short time. In this paper, we compare regression and classification methods to either predict multi-variable results, e.g., bus voltage magnitudes and line loadings, or binary classifications of time steps to identify critical loading situations. We test the methods on three realistic power systems based on time series in 15min and 5min resolution of one year. We compare different machine learning models, such as multilayer perceptrons (MLPs), decision trees, k-nearest neighbors, gradient boosting, and evaluate the required training time and prediction times as well as the prediction errors. We additionally determine the amount of training data needed for each method and show results, including the approximation of untrained curtailment of generation. Regarding the compared methods, we identified the MLPs as most suitable for the task. The MLP-based models can predict critical situations with an accuracy of 97-98% and a very low number of false negative predictions of 0.0-0.64%.

Virtual Reality for Acute Pain in Outpatient Hysteroscopy: A Randomised Controlled Trial We would like to thank E.Mirza and colleagues for their interest in our study, Virtual Reality for acute pain in outpatient hysteroscopy: A randomised controlled trial.We would like to point out that in light of the fact that the sample size was limited to 40 patients, the interpretation of further subgroup analysis is likely to be limited.On further analysing patients we noted that a total of 7/40 (18%) which included 3 in the Standard Procedure (SP) arm and 4 in the Virtual Reality (VR) arm, had had a previous outpatient hysteroscopy. The mean expected pain scores in the VR and SP groups were comparable (VR group was 6.5 and in the SP group was 7) however the perceived average pain scores were 2.25 and 6.3 respectively. This would suggest that VR might have had a beneficial effect despite a previous experience of OPH.We appreciate that patient’s pain thresholds are variable and that it is a very subjective experience. 2 patients in the VR group reported average pain scores of 0 whilst all patients in the SP group experienced some degree of pain. It is difficult to ascertain how much VR contributed to the experience in the context of the patient’s tolerance to pain. We agree that future studies looking into patients with painful hysteroscopies would most benefit from additional pain relief strategies and would be of immense clinical value.Analgesic intake included paracetamol, non steroidal anti-inflammatory drugs, cocodamol either on their own or in combination and the numbers of patients receiving analgesics was comparable across the two groups. However we do not have data on dosages and how long before the procedure the analgesics were taken. We acknowledge that standardisation of analgesics intake would have helped in understanding the actual impact of VR in pain relief.1,2 We agree with these suggestions for future directions of research in this area and the suggested improvements to methodology.Claustrophobia was not an exclusion criterion in our study and hence one patient was recruited but nevertheless only experienced the intervention of a short period of time before she took the VR goggles off. We note recent studies, which have used VR for treatment of claustrophobia.3,4 The outcomes are normally reported taking an Intention to Treat approach. We repeated a regression analysis after removing the patient in question, and the experimental group still reported significantly lower pain and anxiety scores for those patients receiving the VR intervention.Nandita Deo 1,2Khalid Saeed Khan4Jonathan Mak 4John Allotey3Francisoco Jose Gonzalez Carreras 3Gianpaolo Fusari 5Jonathan Benn 6Imperial College London, UK1Whipps Cross University Hospital, London, UK2The London School of Medicine and Dentistry, London, UK3Queen Mary University, London, UK.4Helix Centre, Imperial College London and the Royal College of Art, London, UK 5School of Psychology, University of Leeds, UK6Corresponding Author- Nandita Deo MBBS, MD, FRCOG, MSc (Health Care and Design)Consultant Obstetrician and GynaecologistWhipps Cross University Hospital, Barts Health NHS Trust,Leytonstone, London, E11 1NRTel: 0044 [email protected]. De Silva PM, Mahmud A, Smith PP, Clark TJ. Analgesia for office hysteroscopy: systematic review & meta-analysis. Journal of Minimally Invasive Gynecology. 2020 Jan;S1553465020300467.2. Ghamry NK, Samy A, Abdelhakim AM, Elgebaly A, Ibrahim S, Ahmed AA, et al. Evaluation and ranking of different interventions for pain relief during outpatient hysteroscopy: A systematic review and network meta-analysis. J Obstet Gynaecol Res. 2020 Jun;46(6):807–27.3. Carl E, Stein AT, Levihn-Coon A, Pogue JR, Rothbaum B, Emmelkamp P, et al. Virtual reality exposure therapy for anxiety and related disorders: A meta-analysis of randomized controlled trials. J Anxiety Disord. 2019;61:27–36.4. Rahani VK, Vard A, Najafi M. Claustrophobia Game: Design and Development of a New Virtual Reality Game for Treatment of Claustrophobia. J Med Signals Sens. 2018 Dec;8(4):231–7.

Pollination is an important ecological process. However, the needs of plants and pollinators are not always met. Pollen limitation commonly reduces seed set and bees often experience nectar dearth. Using a theoretical cost-benefit optimization model we show that natural selection acting at the level of individual plants and pollinators will result in positive feedback that exacerbates pre-existing imbalances between nectar supply and demand. When pollinators are scarce plants will be selected to produce more nectar to outcompete other plants in attracting pollinators, and when pollinators are abundant plants will be selected to produce less nectar. We encourage the testing of this novel hypothesis and propose several ways of doing this via comparative study and experimental manipulation. We also suggest that evidence for seasonal variation in foraging conditions provides preliminary empirical support. If our hypothesis is correct it means that pollination faces a particular challenge in balancing nectar supply with demand.

Ketamine is a dissociative anesthetic agent, with excellent analgesic properties and a favorable safety profile. Although it acts predominantly through NMDA receptor antagonism, numerous other molecular targets have been characterized, rendering anti-inflammatory, anti-depressant, and thus expanding its scope for new clinical applications. The noticeable safety of ketamine in children enables its widespread use in pediatric oncology, chiefly for procedural sedation. Its value for chronic pain management in children with cancer is being increasingly recognized but requires more evidence. The topical use of ketamine is largely in investigational stages.. Rational medical use of ketamine is largely free from significant long-term neurological side effects but may have some troublesome short-term effects such as vomiting, palpitations, urinary retention, and hallucinations. This review will provide a brief account of the pharmacology of ketamine and primarily focus on the relevant aspects of ketamine in pediatric oncology.

Soil salinity has today become a highly disastrous phenomenon that is responsible for crop failure worldwide and specially in countries with low farmer incomes and food insecurity. Soil salinity is often caused due to water accumulation in fields due to unscientific flood irrigation wherein plants intake the water leaving salts behind. It is, however, the sub-surface soil salinity that affects the plant growth. These salts in sub-surface soil get trapped in root nodules of plants and prevent further water intake. There have been very few studies conducted for sub-surface soil salinity estimation. Hence this study aims to estimate sub-surface soil salinity (at 60 cm depth) for early stage of wheat crop growth in a simplified manner using freely available satellite data, which is a novel feature and prime objective in this study. The study utilizes Sentinel-1 SAR (Synthetic Aperture RADAR) data for backscatter coefficient generation, Sentinel-2 multispectral data for NDSI (Normalised Differential Salinity Index) generation and on ground equipment for direct collection of soil electrical conductivity. The data were collected for two dates in November and December 2019 and one date for January 2020 during the early stage of wheat crop growth. The dates were selected keeping in mind the satellite pass over the study area of Rupnagar on the same day. Ordinary Least Squares regression was used for modelling which gave R2-statistics of 0.99 and 0.958 in training and testing phase and root mean square error of 1.92 in modelling for soil salinity estimation.

1. Microsatellite genotyping is an important genetic method for a number of research questions in biology. Given that the traditional fragment length analysis using polyacrylamide gel or capillary electrophoresis has several drawbacks, microsatellite genotyping-by-sequencing (GBS) has arisen as a promising alternative. Although GBS mitigates many of the problems of fragment length analysis, issues with allelic dropout and null alleles often remain due to mismatches in primer binding sites and unnecessarily long PCR products. This is also true for GBS in catarrhine primates where cross-species amplification of loci (often human derived) is common. 2. We therefore redesigned primers for 45 microsatellite loci based on 17 available catarrhine reference genomes. Next, we tested them in singleplex and different multiplex settings in a panel of species representing all major lineages of Catarrhini and further validated them in wild Guinea baboons (Papio papio) using faecal samples. 3. The final panel of 42 microsatellite loci can efficiently be amplified with primers distributed into three amplification pools. 4. With our microsatellite panel, we provide a tool to universally genotype catarrhine primates via GBS from different sample sources in a cost- and time-efficient way, with higher resolution, and comparability among laboratories and species.

Background and Purpose Inactivation of Cys674 (C674) in the sarcoplasmic/endoplasmic reticulum Ca2+ ATPase 2 (SERCA2) by causing the accumulation of intracellular Ca2+ to activate calcineurin-mediated nuclear factor of activated T-lymphocytes (NFAT)/NF-κB pathways, resulted in the phenotypic modulation of smooth muscle cells (SMCs) to accelerate angiotensin II-induced aortic aneurysm. Our goal was to investigate the mechanism involved. Experimental Approach We used heterozygous SERCA2 C674S knock-in (SKI) mice, where half of C674 was substituted by serine, to represent partial irreversible oxidation of C674. The aortas of SKI mice and their littermate wild-type mice were collected for RNA sequencing, cell culture, protein expression, luciferase activity and aortic aneurysm analysis. KEY RESULTS Inactivation of C674 inhibited the promoter activity and protein expression of PPARγ, which could be reversed by inhibitors of calcineurin or NF-κB. Overexpression of PPARγ2 inhibited the phenotypic modulation of SKI SMCs. Pioglitazone, the activator of PPARγ, blocked the activation of NFAT/NF-κB, inhibited SMC phenotypic modulation, and ameliorated angiotensin II-induced aortic aneurysms in SKI mice. CONCLUSIONS AND IMPLICATIONS The inactivation of SERCA2 C674 promotes the development of aortic aneurysm by disrupting the balance between PPARγ and NFAT/NF-κB. Our study highlights the importance of C674 redox status in regulating PPARγ to maintain aortic homeostasis.

The loops of modular polyketide synthases (PKSs) serve diverse functions but are largely uncharacterized. They frequently contain amino acid repeats resulting from genetic events such as slipped-strand mispairing. Determining the tolerance of loops to amino acid changes would aid in understanding and engineering these multidomain molecule factories. Here, tandem repeats in the DNA encoding 949 modules within 129 cis-acyltransferase PKSs were catalogued, and the locations of the corresponding amino acids within the module were identified. The most frequently inserted interdomain loop corresponds with the updated module boundary immediately downstream of the ketosynthase (KS), while the loops bordering the dehydratase (DH) were nearly intolerant to such insertions. An analysis of the loops bordering the acyl carrier protein (ACP) reveals they are relatively short (14±6 residues), that they resist large increases in length, and that ACP may rely on acyltransferase (AT) accessing a conformation like that observed through electron microscopy of the pikromycin PKS. From the 949 modules, no repetitive sequence loop insertions are located within ACP, and only 2 reside within KS, indicating the sensitivity of these domains to alteration.

Juvenile nasopharyngeal angiofibroma (JNA) is a tumor occurs only in 0.05% of all head and neck tumors. We report a multisystemic approach combining study methods and collaboration with radiologist of a 16-years old male patient, diagnosed with a JNA measured 2x3x5 cm with retarded diagnosis who received endoscopic surgery management

There are various complications of PICC, bloodstream infection is well known, but the formation of guidewire knots during PICC insertion is rarely reported. Considering the risk of vascular injury in our case, surgical guidewire removal was performed. Although rare, it is necessary to recognize proper treatment for these complications.

Pretilachlor is a chloracetanilide herbicide whose acute intoxication in humans via ingestion has been rarely reported. We report a case of suicidal ingestion of the herbicide with similar clinical manifestations of organophosphate toxicity. Awareness among clinicians regarding such mimickers is the key to proper management of the patient.

Aim: To describe the clinical characteristics and outcomes of severe COVID-19 adult patients, with the exploration of risk factors for mortality in the hospital. Methods: This study included 20 adult patients diagnosed with COVID-19 in the ICU of DHQ Hospital Faisalabad (Pakistan) and were categorized into the survival group and death group according to the outcome. We retrieved demographics, clinical manifestations and signs, laboratory indicators, treatment measures, and clinical outcomes from the medical record, and summarized the clinical characteristics and outcomes of these patients. Results: The average age of patients was 70 ± 12 years, of which 40% were male. They were admitted to the ICU 11 days after the onset of symptoms. The most common symptoms on admission were cough (19 cases, 95%), fatigue or myalgia (18 cases, 90%), fever (17 cases, 85%), and dyspnea (16 cases, 80%). Eleven (55%) patients had underlying diseases, of which hypertension was the most common (11 cases, 55%), followed by cardiovascular disease (4 cases, 20%), and diabetes (3 cases, 15%). Six patients (30%) received invasive mechanical ventilation and continuous renal replacement therapy and eventually died. Acute heart injury was the most common complication (19 cases, 95%). Ten (50%) patients died between 2 and 19 days after admission to the ICU. Compared to dead patients, the average body weight of surviving patients was lower (61.70± 2.36 vs 68.60±7.15, P = 0.01), Glasgow Coma Scale score was higher (14.69±0.70 vs 12.70±2.45, P = 0.03), with fewer concurrent shocks (2 vs 10, P = 0.001) and acute respiratory distress syndrome (2 vs 10, P = 0.001). Conclusion: The mortality rate is high in patients with critical COVID-19 disease. Lower Glasgow Coma Scale, higher body weight, and decreased lymphocyte count appear to be potential risk factors for the death of COVID-19 patients in the ICU.

Asthma assessment by spirometry is challenging in children as forced expiratory volume in one second (FEV1) is frequently normal at baseline. Bronchodilator (BD) reversibility testing may reinforce asthma diagnosis but FEV1 sensitivity in children is controversial. Ventilation inhomogeneity, an early sign of airway obstruction, is described by the upward concavity of the descending limb of the forced expiratory flow-volume loop (FVL)s, not detected by FEV1. The aim was to test the diagnosis ability of FVL shape indexes as β-angle and forced expiratory flow at 50% of the forced vital capacity (FEF50)/peak expiratory flow (PEF) ratio, to identify asthmatics from healthy children in comparison to “usual” spirometric parameters. Seventy-two asthmatic children and twenty-nine controls aged 8 to 11 years were prospectively included. Children performed forced spirometry at baseline and after BD inhalation. Parameters were expressed at baseline as z-scores and BD reversibility as percentage of change reported to baseline value (Δ%). Receiver operating characteristic curves were generated and sensitivity and specificity at respective thresholds reported. Asthmatics presented significantly smaller zβ-angle, zFEF50/PEF and zFEV1 (p≤0.04) and higher BD reversibility, significant for Δ%FEF50/PEF (p=0.02) with no difference for Δ%FEV1. zβ-angle and zFEF50/PEF exhibited better sensitivity (0.58, respectively 0.60) than zFEV1 (0.50), and similar specificity (0.72). Δ%β-angle showed higher sensitivity compared to Δ%FEV1 (0.72 vs 0.42), but low specificity (0.52 vs 0.86). Quantitative and qualitative assessment of FVL by adding shape indexes to spirometry interpretation may improve the ability to detect an airway obstruction, FEV1 reflecting more proximal while shape indexes peripheral bronchial obstruction.