Abstract Background: Atrial fibrillation (AF) is the most common cardiac arrhythmia following coronary artery bypass grafting (CABG). We hypothesized that measures of left atrial (LA) function would be useful in predicting AF in patients undergoing CABG. Methods and Results In the study, 611 patients were included after CABG. All patients had echocardiograms performed preoperatively and LA functional measurements were assessed. These measurements were LA maximum volume index (LAVmax), LA minimum volume index (LAVmin) and LA emptying fraction (LAEF). The endpoint was AF occurring >14 days after surgery. During the follow-up period of a median of 3.7 years, 52 (9%) developed AF. The mean age was 67 years, 84% were male and the average left ventricle ejection fraction was 50 %. No differences were observed between the patients developing AF and those who did not develop AF. No functional LA measurements were significant predictors of AF in the whole CABG population. However, in patients with normal-sized LA (n=532, events: 49), both LAEF and LAVmin were univariable predictors of AF. When the functional measurements were adjusted for the CHADS 2 score, both LAVmin (HR=1.07 (1.01-1.13), p=0.014 ) and LAEF (HR: 1.02 (1.00-1.03, p= 0.023)), remained significant predictors. Conclusion No echocardiographic measurements were significant predictors of AF after CABG. In patients with a normal LA size, LAVmin as well as LAEF were significant predictors of AF. Keywords: atrial fibrillation; cardiac surgery; left atrium; echocardiography

Buffer strips continue to feature in the management of agricultural runoff and water pollution in many countries. Existing research has explored their efficacy for reducing environmental problems in different geoclimatic settings but, the evidence on the efficacy of different vegetation treatments is less abundant than that for other buffer strip characteristics, including width, and is more contradictory in nature. With policy targets for various environmental outcomes including water or air quality and net zero pointing to the need for conversion of agricultural land, the need for robust experimental evidence on the relative benefits of different vegetation types in buffer strips is now renewed. Our experiment used a replicated plot scale facility to compare the efficacy of 12 m wide buffer strips for controlling runoff and suspended sediment loss during 30 sampled storms spanning 2017-2020. The buffer strips comprised three vegetation treatments; a deep rooting grass ( Festulolium cv. Prior), a short rotation coppice willow and native broadleaved woodland trees. Over the duration of the monitoring period, reductions in total runoff, compared with the experimental control, were in the order: willow buffer strips (49%); deciduous woodland buffer strips (46%); grass buffer strips (33%). The corresponding reductions in suspended sediment loss, relative to the experimental control, were ordered: willow buffer strips (44%) > deciduous woodland buffer strips (30%) > grass buffer strips (29%). Given the three-year duration of our new dataset, our results should be seen as providing evidence on the impacts during the establishment phase of the of the treatments.

In many parts of South Africa, soil erosion rates are high, and likely to be exacerbated by the longer droughts and more intense rainfall that are predicted in long-term regional climate change scenarios. Suspended sediment loads (SSL) and yields (SSY) are accepted means of expressing and comparing sediment transport and soil erosion rates. Land care and water security initiatives in South Africa require these data to provide benchmarking, and trajectories of change. International researchers began in the 1970s to investigate SSL estimation approaches. These investigations typically used near-continuous turbidity data from installed probes as a surrogate for sampled SS, and auto-samplers to monitor SS concentration and develop sediment rating curves. Biophysical and socio-economic conditions in South Africa differ markedly from the northern hemisphere environments where foundational studies were conducted. SSL estimations in South Africa are associated with extreme hydrological regimes, remote study areas and lack the resources required to collect and analyse representative SS data. There is a dearth of measured SS data, and of observed SSL and SSY for South African catchments. Using measured SS data from the Tsitsa River catchment (Eastern Cape, South Africa) we found that a discharge-weighted interpolation estimator was more appropriate than regression estimators, and that SSY responses to biophysical factors were in some ways more similar to northern hemisphere norms than expected. Lack of technical, infrastructural, human and financial resources were our main constraints to monitoring and estimating SSY. Our findings highlight the challenges of, and provide some guidance for, estimating directly measured SSL in the southern Africa region and inform future research in resource scarce areas.

Satyrium is an endangered and rare genus of plant that has various pharmacodynamic functions. In this study, MaxEnt default parameters were adjusted by the ENMeval package. Optimized MaxEnt models were used in analyzing potential geographical distributions under current and future climatic conditions (the 2050s and 2070s) and dominant environmental variables influencing their geographic distribution. The results provided reference for implementation of long-term conservation and management approaches for the species. The results showed the area of the total suitable habitat for S. ciliatum in China is 32.51 × 104 km2, the total suitable habitat area for S. nepalense in China is 61.76 × 104 km2, and the area of the total suitable habitat for S. yunnanense in China is 89.73 × 104 km2 under current climatic conditions. The potential suitable habitat of Satyrium is mainly distributed in Southwest China. The major environmental variables influencing the geographical distribution of S. ciliatum were isothermality (bio3), temperature seasonality (bio4), and mean temperature of coldest quarter (bio11). Environmental variables such as isothermality (bio3), temperature seasonality (bio4), and precipitation of coldest quarter (bio19) affected the geographical distribution of S. nepalense; and environmental variables such as isothermality (bio3), temperature seasonality (bio4), and lower temperature of coldest month (bio6) affected the geographical distribution of S. yunnanense. The distribution range of Satyrium was extended as global warming increased, showing emissions of greenhouse gases with lower concentration (SSP1-2.6) and higher concentration (SSP5-8.5). According to the study, the distribution of suitable habitat will shift with a change to higher elevation areas and higher latitude areas in the future.

Involution of a rapidly involuting congenital hemangioma is an unknown cause of neonatal ascites. As involution phase is completed by 14 months after birth, conservative management with diuretics and drainage is possible and may avoid surgical resection.

Background: Acute type B aortic dissection (TBAD) is a rare condition that can be divided into complicated (CoTBAD) and uncomplicated (UnCoTBAD) based on certain presenting clinical and radiological features, with UnCoTBAD constituting the majority of TBAD cases. The classification of TBAD directly affects the treatment pathway taken, however, there remains confusion as to exactly what differentiates complicated from uncomplicated TBAD. Aims: The scope of this review is to delineate the literature defining the intervention parameters for UnCoTBAD. Methods: A comprehensive literature search was conducted using multiple electronic databases including PubMed, Scopus, and EMBASE to collate and summarize all research evidence on intervention parameters and protocols for UnCoTBAD. Results: A TBAD without evidence of malperfusion or rupture might be classified as uncomplicated but there remains a subgroup who might exhibit high-risk features. Two clinical features representative of “high risk” are refractory pain and persistent hypertension. First line treatment for CoTBAD is TEVAR, and whilst this has also proven its safety and effectiveness in UnCoTBAD, it is still being managed conservatively. However, TBAD is a dynamic pathology and a significant proportion of UnCoTBADs can progress to become complicated, thus necessitating more complex intervention. While the “high risk” UnCoTBAD do benefit the most from TEVAR, yet, the defining parameters are still debatable as this benefit can be extended to a wider UnCoTBAD population. Conclusion: Uncomplicated TBAD remains a misnomer as it is frequently representative of a complex ongoing disease process requiring very close monitoring in a critical care setting. A clear diagnostic pathway may improve decision making following a diagnosis of UnCoTBAD. Choice of treatment still predominantly depends on when an equilibrium might be reached where the risks of TEVAR outweigh the natural history of the dissection in both the short- and long-term.

Objectives: Female sex is considered a risk factor for mortality and morbidity following cardiac surgery. This study is the first to review the UK adult cardiac surgery national database to compare outcomes following surgical coronary revascularisation and valvular procedures between females and males. Methods: Using data from National Adult Cardiac Surgery Audit (NACSA), we identified all elective and urgent, isolated coronary artery by-pass grafting (CABG), aortic valve replacement (AVR) and mitral valve replacement/repair (MVR) procedures from 2010-2018. We compared baseline data, operative data and outcomes of mortality, stroke, renal failure, deep sternal wound infection, return to theatre for bleeding and length of hospital stay. Multivariable mixed-effect logistical/linear regression models were used to assess relationships between sex and outcomes, adjusting for baseline characteristics. Results: Females, compared to males, had greater odds of experiencing 30-day mortality (CABG OR 1.76, CI 1.47-2.09, p<0.001; AVR OR 1.59, CI 1.27-1.99, p<0.001; MVR OR 1.37, CI 1.09-1.71, p=0.006). After CABG, females also had higher rates of post-operative dialysis (OR 1.31, CI 1.12-1.52, p<0.001), deep sternal wound infections (OR 1.43, CI 1.11-1.83, p=0.005) and longer length of hospital stay (Beta 1.2, CI 1.0-1.4, p<0.001) compared to males. Female sex was protective against returning to theatre for post-operative bleeding following CABG (OR 0.76, CI 0.65-0.87, p<0.001) and AVR (OR 0.72, CI 0.61-0.84, p<0.001). Conclusion: Females in the UK have an increased risk of short-term mortality after cardiac surgery compared to males. This highlights the need to focus on the understanding of the causes behind these disparities and implementation of strategies to improve outcomes in females.

Recently, in Pakistan, several cases of mysterious dengue-like illness are being reported. We present a case of a 52-year-old female presenting with a history of continuous fever, documented up to 104 F, for five days. The symptoms were associated with headache, nausea, retro-orbital headache, arthralgia, and myalgia.

Square loop and square slot are the simplest and commonly used elements of frequency selective surfaces (FSSs) providing bandstop and bandpass responses, respectively. Despite it is already known that employment of a double square slot structure presents a tunable stopband between two passbands, it is not clear which parameters of the structure are crucial for tunning the inbetween stopband. We propose an analysis of a double square slot FSS considering its element as a parallel connection of square slot and square loop predicting two geometrical parameters of the constituent square loop are crucial for tunning the inbetween stopband. The stopband is tunable by changing geometrical parameters of the constituent square loop and does not depend on geometries of the constituent square slot. The validity of this analytical prediction is verified by full wave EM simulation results.

To validate the experimental results of Part-1, we conducted a two-phase flow simulation of imbibition of a wetting liquid through 2D microstructures made of ellipses of varying aspect ratios. The flow simulation in the particulate microstructures, characterized by low (ellipse) aspect ratio, produced somewhat even micro-fronts, thus replicating the sharp fronts at the visual (macroscopic) scale observed in Part-1. Whereas simulations in the fibrous microstructures produced highly uneven micro-fronts, suggesting the formation of semi-sharp or diffuse visual fronts. Increasing the porosity from 50% to 70% resulted in solid-phase clustering and led to further increase in the unevenness of micro-fronts, pointing to purely diffuse visual fronts. The evolution of the saturation plots along the flow direction, obtained from area-averaging of fluid-distribution plots, pointed to diffusing of sharp fronts with time. The predictions matched our previous experimental observations, i.e., the particulate media create sharp fronts while the fibrous media create semi-sharp/diffuse fronts.

A document by Markus Gonser. Click on the document to view its contents.

The scale-up of bioprocesses is still one of the major obstacles in biotechnological industry. Scale-down bioreactors were identified as valuable tools to investigate the heterogeneities observed in large-scale tanks in laboratory-scale. Additionally, computational fluid dynamics (CFD) simulations can be used to gain information about fluid flow in tanks used for production. Here we present the rational design and comprehensive characterization of a scale-down setup, in which a flexible and modular plug-flow reactor is connected to a stirred tank bioreactor. With the help of CFD the mixing time difference between differently scaled bioreactors were evaluated and used as scale-down criterium. Additionally, it was used to characterize the setup at conditions were experiments could technically not be performed. This was the first time a scale-down setup was tested on high cell density Escherichia coli cultivations to produce industrial relevant antigen-binding fragments (Fab). Reduced biomass and product yields were observed during the scale-down cultivations. Additionally, the intracellular Fab fraction was increased by using the setup. The results show that including CFD in the design and characterization of a scale-down reactor can help to keep a connection to production scale and also gain intensive knowledge about the setup, which enhances usability.

A 75-year-old man was admitted with a diagnosis of diabetic ketoacidosis and hyperkalemia. During the treatment, he developed refractory hyperkalemia. Following our review, diagnosis of pseudohyperkalaemia secondary to thrombocytosis was made. We report this case to remind the importance of clinical suspicion of this phenomenon to prevent its serious consequences.

Psychogenic nonepileptic seizures (PNES) are a common and highly disabling form of Functional Neurological Disorder (FND). The diagnosis of PNES could be missed or delayed in various clinical scenarios, including where patients present with concurrent musculoskeletal/neurological findings. This case report examines these pitfalls and their prevention.

Aim Determine seasonal, annual and decadal patterns of abundance in reptile populations and assemblages occupying an isolated urban bushland remnant Location Bold Park (~338 ha), Perth, Southwestern Australia Time period 1986-2021 Major taxa studied: Squamate reptiles Methods Fenced pitfall trapping in four sampling sites representing different habitats and fire history over the primary reptile activity period and 35 consecutive years; trapping regime was modified for the last 28 years. Results The location occurs in one of 35 global biodiversity hotspots and has a Mediterranean climate experiencing a 15% decline from the century average rainfall over the last 50 years. Twenty-nine species were recorded, with 16 captured in 32 or more years and accounting for nearly 97% of all captures; the six most common for 81%. Three taxa became locally extinct. Activity predominates in warmer and dryer months (October to April), peaking in November December. Species richness remained relatively constant between years with around 73% of known taxa captured annually. Assemblage structure didn’t change when analysing presence/absence data but shifted through five statistically significantly assemblages analysing relative abundance data. Over the last 28 years relative abundance was significantly and positively correlated with annual rainfall residuals for the three years preceding annual sampling, resulting in significant changes in total assemblage structure and significantly similar patterns in four sample sites; presence/absence data indicated minor assemblage structure changes. Main conclusions Annual species number remained relatively constant but relative abundance illustrated significant temporal changes in assemblage structure over decades; presence/absence did not. The modeled relationship between relative abundance and annual rainfall residuals for the three years preceding annual sampling is supported by known ecological responses and reptile demographics within this Mediterranean climate. Maintenance of urban biodiversity should consider impacts of a significantly drying climate exacerbating the extinction debt already inherent in isolated bushland populations.

Key Points • CRP reduction at day five of more than 35% from the previous highest concentration post-laryngectomy or laryngopharyngectomy has been proposed to positively predict healing without pharyngocutaneous fistula • Retrospective cohort analysis of 163 patients has not been able to externally validate these findings. • ROC curves and subset analyses have not identified alternative parameters to reach significance • However, there is a non-significant association with decreasing postoperative CRP and healing without fistula. • Multicentre prospective studies to include post-operative procalcitonin could help refine this protocol further.

Introduction Recent guidelines suggest obstructive sleep apnoea (OSA) is not an absolute contraindication for same day discharge following surgery. The aim of this systematic review was to examine the feasibility and safety of day case nasal and/or palatopharyngeal surgery in patients with OSA. Methods We performed a systematic search of PubMed, EMBASE and the Cochrane library. Quality assessment of included studies was done. The protocol of this systematic review was registered with PROSPERO (CRD42021273451). Results A total of 1836 patients from ten observational studies were included. There were 268 (15.4%) nasal surgeries, 738 palatopharyngeal surgeries (42.4%) and 735 (42.2%) combined nasal and palatopharyngeal surgery. The majority of patients had moderate to severe OSA. A total of 860 patients (49.8%) were successfully discharged as day cases. There were no standard criteria for daycase surgery. Post-anaesthetic respiratory events were reported in 86/1750 (4.9%) patients. Oxygen desaturation was the most common respiratory event (83.7%, n = 72). There was no mortality reported. Conclusion Current data suggests day surgery is feasible in carefully selected patients with OSA undergoing nasal and/or palatopharyngeal surgery. Further well-designed prospective studies with an emphasis on the systematic assessment of complications are required to establish safety and daycase criteria.

Neonatal lupus erythematosus (NLE) is a rare autoimmune disease due to a passive transfer of maternal autoantibodies to the fetus. Clinical spectrum is variable and includes skin lesions, cardiac, hematological, or hepatobiliary disorders. We report a NLE case presenting with skin eruption that was initially considered as tinea.