Although difficult to perform a good physical examination in morbidly obese patient, it can still be very valuable like in our patient in whom biopsy of deep lymph nodes seen was benign but superficial lymph node excisional biopsy found due to good physical exam diagnosed diffuse large B-cell lymphoma.
OBJECTIVES: We hypothesized that Therapeutic Drug Monitoring (TDM) decreased drug consumption or accelerated switch of biologics in chronic arthritis patients undergoing TNF-alpha inhibiting (TNFi)-therapy. Primary outcome was dose reduction, secondary outcomes included clinical scores DAS28-CRP or ASDAS-CRP, self-reported outcome and experienced adverse events. METHODS: 48-week prospective, randomized open-label trial investigating TDM in participants (n=239) treated with infliximab (IFX), etanercept (ETN) or adalimumab (ADA), receiving standard of care or standard of care plus TDM, the latter based on serum-trough concentration measurements of IFX, ETN and ADA. Independent of clinical status, adults treated for their rheumatoid arthritis (41%), psoriatic arthritis (20%), or spondylarthritis (39%), were included in a tertiary outpatient clinic. Serum TNFi trough-values were determined at inclusion and every 16 weeks and used proactively in the TDM-group to evaluate whether participants were within the therapeutic window or not, consequently leading to maintained TNFi-therapy, dose-reduction, or switch to other biologics. RESULTS: In comparison to standard of care, TDM reduced doses for IFX (- 12% [CI: -20; -3] p=0.001); ETN (-15 % [-29; 1]; p=0.01) and prolonged the inter-dosing interval in ETN (+ 235 %;[38;432] p=0.02) and ADA (+ 28%;[6; 51] p = 0.04) and accelerated switch of biologics (χ2= 6.03, p=0.01). No group-differences were shown in clinical assessment CRP, DAS28-CRP or ASDAS-CRP, nor in self-reported outcome or experienced adverse events, indicating sustained disease control. • CONCLUSIONS – TDM improved clinical decision making and caused earlier and targeted dose-reduction and accelerated switch of biologics, thereby preventing over- and under medication.
Aim: Drastic changes in fire regimes are altering plant communities, inspiring ecologists to better understand the relationship between fire and plant species diversity. We examined the impact of a 2011 megafire on woody plant species diversity in an arid mountain range in southern Arizona, USA. We tested recent fire-diversity hypotheses by addressing the impact of the fire severity, fire variability, historic fire regimes, and topography on diversity. Location: Chiricahua National Monument, Chiricahua Mountains, Arizona. USA., part of the Sky Islands of the US-Mexico borderlands. Taxon: Woody plant species. Methods: We sampled woody plant diversity in 138 plots before (2002-2003) and after (2017-2018) the 2011 Horseshoe Two Megafire in three vegetation types and across fire severity and topographic gradients. We calculated gamma, beta, and alpha diversity and examined changes over time in burned vs. unburned plots and the shapes of the relationships of diversity with fire severity and topography. Results: Alpha species richness declined and beta and gamma diversity increased in burned but not unburned plots. Fire-induced enhancement of gamma diversity was confined to low fire severity plots. Alpha diversity did not exhibit a clear continuous relationship with fire severity. Beta diversity was enhanced by fire severity variation among plots and increased with fire severity up to very high diversity, where it declined slightly. Main Conclusions: The results reject the intermediate disturbance hypothesis for alpha diversity but weakly support it for gamma diversity. Spatial variation in fire severity promoted variation among plant assemblages, supporting the pyrodiversity hypothesis. Long-term drought probably amplified fire-driven diversity changes. Despite the apparent benign impact of the fire on diversity, the replacement of two large conifer species with shrubs signals the potential loss of functional diversity, emphasizing the importance of intervention to direct the transition to a novel vegetation mosaic.
No standard treatments have been established for airway hemorrhage during cardiopulmonary bypass (CPB). Herein, we describe two cases of catheter-induced pulmonary hemorrhage during cardiac surgery. In each case, massive hemoptysis was observed during cardiopulmonary bypass (CPB) weaning. A bronchial blocker was inserted into the right bronchus, and extracorporeal membrane oxygenation (ECMO) was initiated to reduce pulmonary blood flow, and stabilize the hemodynamics. ECMO significantly reduced bleeding from the pulmonary artery (PA). Both cases had favorable outcomes following the implementation of extracorporeal membrane oxygenation (ECMO). ECMO is effective at controlling PA bleeding during and after cardiac surgery.
Introduction: The Coronavirus Disease 2019 (COVID-19) pandemic has had a variable worldwide impact, likely related to country-level characteristics. In this ecological study, we explored the association of COVID-19 case rates (per 100,000 people) and death rates (per 100,000 people) with country-level population health characteristics, economic and human development indicators, and habitat-related variables. Methods: To calculate country-level COVID-19 case and death rates, the number of cases and deaths were extracted from the Johns Hopkins Coronavirus Resource Center for 2020. Country-level population health characteristics, economic and human development indicators, and habitat-related variables were extracted from several publicly available online sources of international organizations. Results were tabulated according to world zones and country economies. Univariate and multivariable linear regression analyses were performed to examine determinants of COVID-19 case rates and death rates. Results: A total of 187 countries and territories were analyzed, with an aggregate COVID-19 case rate of 779 per 100,000 people, a death rate of 19 per 100,000 people, and a case-fatality rate of 2.4%. For country-level population health characteristics, a higher percentage rate of adults with obesity and a higher percentage rate of adults with high blood pressure was independently associated with a higher COVID-19 case rate, and a higher percentage rate of adults with obesity was associated with a higher COVID-19 death rate. For country-level economic and human development indicators, only a higher gross domestic product percentage rate spent on total health expenditure and a higher human development index was independently associated with a higher COVID-19 case rate and death rate. A higher percentage of urban population was independently associated with a higher COVID-19 death rate, whereas a higher income per capita was independently associated with a lower COVID-19 death rate. For country-level habitat-related variables, a higher average household size and a higher percentage rate of population with primary reliance on polluting fuels and technologies was independently associated with a lower COVID-19 case rate and death rate whereas a higher percentage rate of households with at least one-member age 65 years or over was associated with a higher case rate and death rates. Conclusion: This ecological study informs the need to develop country-specific public health interventions to better target populations at high risk for COVID-19, and test environmental interventions to prevent indoor transmission of SARS-CoV-2, taking into consideration population health characteristics, economic and human development indicators, and habitat-related variables that are unique to each country.
Apical multiple muscular ventricular septal defects (VSDs) are difficult to visualize, and closing these VSDs is technically troublesome. For these reasons, the surgical outcome of the lesion is unsatisfactory. Some surgical techniques have been reported to improve the outcome, but they are not definite. We present a case with atrial septal defect, multiple muscular and perimembranous VSDs, and pulmonary hypertension due to high pulmonary blood flow. In the first operation during the infantile period, the patient received closure of the perimembranous and muscular VSD through the right atrium and atrial septal defect closure. However, postoperative pulmonary blood flow was not decreased compared with that of before the operation, and pulmonary hypertension was also not improved. In addition to these lesions, tricuspid valve insufficiency was also observed after the operation. Postoperative computed tomography showed channels of apical muscular VSDs in the apex of the right ventricle. In the second operation, exclusion of apex muscular VSDs using the felt sandwich technique and tricuspid valve repair were performed. After closing multiple muscular VSDs during the operation, pulmonary blood flow was significantly decreased, and pulmonary hypertension was improved as well. After the second operation, postoperative echocardiography and catheter examination showed decreased VSD shunt and pulmonary blood flow, resulting in improved pulmonary hypertension.
The 15 species of small carnivorous marsupials that comprise the genus Antechinus exhibit semelparity, a rare life-history strategy where death occurs after one breeding season. Antechinus males, but not females, age rapidly (demonstrate organismal senescence) during the breeding season and show promise as new animal models of ageing. Some antechinus species are also threatened or endangered. Here, we report chromosome-level genomes of the yellow-footed antechinus Antechinus flavipes. The genome assembly has a total length of 3.2 Gb with a contig N50 of 51.8 Mb and a scaffold N50 of 636.7 Mb. We anchored and oriented 99.7% of the assembly on seven pseudochromosomes and found that repetitive DNA sequences occupy 51.8% of the genome. Draft genome assemblies of three related species in the subfamily Phascogalinae, two additional antechinus species (A. argentus and A. arktos) and the iteroparous sister species Murexia melanurus were also generated. Preliminary demographic analysis supports the hypothesis that climate change during the Pleistocene isolated species in Phascogalinae and shaped their population size. A transcriptomic profile across the A. flavipes breeding season allowed us to identify genes associated with aspects of the male die-off. The chromosome-level A. flavipes genome provides a steppingstone to understanding an enigmatic life-history strategy and a resource to assist the conservation of antechinuses.
Ecosystem degradation is a process during which different ecosystem components interact and affect each other. The microbial community, as a component of the ecosystem whose members often display high reproduction rates, is more readily able to respond to environmental stress at the compositional and functional levels, thus potentially threatening other ecosystem components. However, very little research has been carried out on how microbial community degradation affects other ecosystem components, which hampers the comprehensive understanding of ecosystems as a whole. In this study, we investigated the variation in a soil microbial community through the extinction gradient of an ectomycorrhizal species (Tricholomas matsutake) and explored the relationship between microbial community degradation and ectomycorrhizal species extinction. The result showed that during degradation, the microbial community switched from an interactive state to a stress tolerance state, during which the interactivity of the microbial community decreased, and the reduced community interactions with T.matsutake marginalized it from a large central interactive module to a small peripheral module, eventually leading to its extinction. This study highlights the mechanisms of T.matsutake extinction due to the loss of soil microbial community interactivity, offering valuable information about soil microbial community degradation and the plant ectomycorrhizal species conservation.
Phosphorus (P) is often one of the most limiting nutrients in highly weathered soils of humid tropical forests, which may regulate the responses of carbon (C) feedback to climate warming. Based on a 7-year continuous field warming experiment conducted by translocating microcosm forest ecosystems from a high-elevation site to low-elevation sites, we detected changes in the ecosystem P cycle in response to warming. We report that warming drives sustained plant P demand by increasing P uptake and thus decreasing foliar N:P. This increased plant P content is supplied by multiple processes including enhanced plant P resorption, soil P mineralization and dissolution without changing litter P mineralization and leachate P. These findings suggest that warming may alleviate initial P deficiency and/or limitation of plant growth and contribute to sustaining plant C fixation in these tropical forests.
This paper concerns the impact of stochastic perturbations on the intra-layer synchronization of the duplex networks. A duplex network contains two layers ([1,2]). Different from the previous works, environmental noise is introduced into the dynamical system of the duplex network. We incorporate both the inter-layer delay and the intra-layer delay into the dynamical system. Both of the delays are time-varying. However, the paper  only considered the intra-layer delays and they are assumed as the constants. While the paper  did not consider the inter-layer delay or intra-layer delay. When the system does not achieve automatic intra-layer synchronization, we introduce two controllers: one is the state-feedback controller, the other is the adaptive state-feedback controller. Interestingly, we find that the intra-layer synchronization will achieve automatically if the inter-layer coupling strength $c_1$ is large enough when the time-varying inter-layer delays are absent. Finally, some interesting simulation results are obtained for the Chua-Chua chaotic system with application of our theoretic results, which show the feasibility effectiveness of our control schemes.
Mutualisms are ubiquitous in nature, provide important ecosystem services, and involve many species of interest for conservation. Theoretical progress on the population dynamics of mutualistic interactions, however, has comparatively lagged behind that of trophic and competitive interactions. Consequently, ecologists still lack a generalized framework to investigate the population dynamics of mutualisms. Here, we review historical models of two-species mutualisms from over the last 90 years. We find that population dynamics of mutualisms are qualitatively robust across derivations, including levels of detail, types of benefit, and inspiring systems. Specifically, mutualisms exhibit stable coexistence at high density and destabilizing thresholds at low density. We distinguish between thresholds resulting from Allee effects, low partner density, and high partner density, and their mathematical and conceptual causes. The dynamics of stable coexistence and thresholds in partner density emerge when benefits of mutualism saturate, whether due to intrinsic or extrinsic density dependence in intraspecific, interspecific, or both. These results suggest that there exists a robust population dynamic theory of mutualism that can make general predictions.
Populus has a wide ecogeographical range spanning the Northern Hemisphere, and exhibits abundant distinct species and hybrids globally. Populus tomentosa Carr. is widely distributed and cultivated in the eastern region of Asia, where it plays multiple important roles in forestry, agriculture, conservation, and urban horticulture. Reference genomes are available for several Populus species, however, our goals were to produce a very high quality de novo, chromosome-level genome assembly in P. tomentosa genome that could serve as a reference for evolutionary and ecological studies of hybrid speciation. Here, combining long-read sequencing and Hi-C scaffolding, we present a high-quality, haplotype-resolved genome assembly. The genome size was 740.2 Mb, with a contig N50 size of 5.47 Mb and a scaffold N50 size of 46.68 Mb, consisting of 38 chromosomes, as expected with the known diploid chromosome number (2n=2x=38). A total of 59,124 protein-coding genes were identified. Phylogenomic analyses revealed that P. tomentosa is comprised of two distinct subgenomes, which we deomonstrate is likely to have resulted from hybridization between Populus adenopoda as the female parent and Populus alba var. pyramidalis as the male parent, approximately 3.93 Mya. Although highly colinear, significant structural variation was also found between the two subgenomes. Our study provides a valuable resource for ecological genetics and forest biotechnology.
Celiac disease is a common immune-mediated inflammatory disease of the small intestine caused by sensitivity to gluten. It's commonly associated with various autoimmune disease, but rarely with cardiomyopathy. Our case describes a 33 year old woman presented with exertional dyspnea and fatigue, found to have celiac disease and dilated cardiomyopathy.
Seasonal epidemics of influenza and the respiratory syncytial virus are the cause of substantial morbidity and mortality among children. During the global COVID-19 pandemic, the epidemiology of these viruses seems to have changed dramatically. In Australia and New Zealand, a significant decrease in both influenza and bronchiolities have been noticed during usual peak seasons. Data from early months of winter seasons in Europe are showing similar trends. This current scenario imposes a reconsideration of the paradigm that toddlers and young schoolchildren are the main drivers of seasonal RSV outbreaks and respiratory epidemics in general. In this paper, we summarize current literature, address current knowledge or role of adults in the respiratory syncitial virus epidemiology, describe the lessons learned from pertussis epidemics and call the international community to better understand the community transmission dynamics of respiratory infections in all age-groups. This can allow the establishment of better and more affordable preventive measures in the whole population level, which can ultimately save millions of child lives.
Background and Purpose: Cholinergic neurotransmission is a key signal pathway in the peripheral nervous system (PNS) and in several branches of the central nervous system (CNS). Despite the fact that it has been studied extensively for a long period of time, some aspects of its regulation still have not yet been established. One is relationship between nicotine-induced autoregulation of acetylcholine (ACh) release with changes in the concentration of presynaptic calcium levels. Experimental Approach: The mouse neuromuscular junction of m. Levator Auris Longus was chosen as the model of the cholinergic synapse. ACh release was assessed by electrophysiological methods. Changes in the calcium transients were recorded using a calcium-sensitive dye. Functional interaction between nicotinic ACh receptors and calcium channels was investigated pharmacologically using specific agonists and antagonists. Key Results: Nicotine hydrogen tartrate salt (considered as a stable form for potential therapeutic delivery of nicotine) effects on the parameters of ACh release from the nerve ending were analyzed. Nicotine application (10 μM) decrease the amount of evoked ACh release, while calcium transient increase in the motor nerve terminal. Both of these effects of nicotine were abolished by the neuronal ACh receptor antagonist dihydro-beta-erythroidine and Cav1 blockers, verapamil and nitrendipine. Conclusion and Implications: Neuronal nicotinic ACh receptors activation decreases the number of ACh quanta released by boosting calcium influx through Cav1 channels. Understanding of mechanisms of autoregulation of ACh release is important for the searching new approaches treat diseases associated with cholinergic dysfunction.
Objective: Migration can lead to a change in the demographic dynamics of host populations in terms of communicable diseases in destination countries. This is a potential public health challenge for health authorities. HBV and HCV infections can lead to the development of chronic liver diseases, cirrhosis and hepatocellular carcinoma, and HIV infection can lead to the development of serious opportunistic diseases. The aim of this study is to evaluate the seroprevalence of HBV, HCV and HIV in Syrian refugees and Turkish patients who were evaluated preoperatively in our hospital. Materials and methods: HBsAg, Anti-HBs, Anti-HBc, Anti-HCV and Anti-HIV results of Syrian refugee and Turkish patients who applied to surgical clinics between 2011-2021 were retrospectively reviewed. Results: The study is comprised of 54446 patients: Turkish patient group (n=20569) and Syrian refugee patient group (n=33877). The Syrian refugee patients had a significantly higher HBsAg seropositivity rate and a significantly lower anti-HBs seropositivity rate than the Turkish patients (p=0.002 and p<0.001, respectively). The anti-HCV and anti-HIV seropositivity rates were similar. The annual preoperative prevalance of HBsAg seropositivity in the Syrian refugee patients tended to significantly decrease gradually from year 2011 to year 2021 (p<0.001 for ≤30 and p=0.001 for >30 years old). Conclusion: As a result, although HBV seroprevalence gradually decreases and HCV and HIV seroprevalence is low; screening, information and treatment programs should be given due importance because of the serious disease potential and preventable conditions with precautions. In addition, preoperative screening of refugee patients coming for major surgery may be important for the safety of healthcare professionals.
Using thin-walled cone-pipe welded joints of stainless steels, fatigue tests under bending loads were carried out. The test data were statistically analyzed with the Benard’s approximation, Gaussian, 2P-Weibull, and 3P-Weibull distributions. Stress–life curves at different failure probabilities by a constant strength scatter band model were obtained. The metallographic structures were investigated, and the stress concentration states were analyzed to elucidate the causes of the strengths and scatters. In the high-cycle fatigue regime, the 2P-Weibull distribution was mostly in agreement with the Benard’s approximation, and the coefficient of determination was 0.9666. The microstructure of the weld metal with a high weld opening angle was mainly ferrite phase with 20% austenite distribution. The crack initiation point was close to the weld interface, but the propagation direction was at a right angle, and initially penetrated the heat affected zone of the cone, leading to the high fatigue strength. The stress concentration factors depended on the weld opening angles, indicating the main factor which affected strengths and scatters.