In this paper, we derive and analyze an extended SIRS-model which includes lockdown policies at the early stages of the pandemic. The latter play a salient role for flattening the curve of infectious diseases such as COVID-19, and is introduced as a model compartment. An error function is reported, which serves as a bridge between the outcomes of the model and available databases; we estimate the values of the model parameters by minimizing the error function. The intervention function, obtained from the equivalent system of the proposed model, and effective reproduction function are also derived to understand the underline scenario of the coronavirus outbreak. We then estimate the epidemiological variables such as susceptible, recovered, lockdown etc. for Canada and three of its provinces, Ontario, Qu\’ebec and British Columbia, significantly affected by the coronavirus. Some improvements, such as spatial dependence or “at risk’‘ vs “healthy” population, will finally be proposed in order to increase the accuracy of the modeling.

Seminal fluid proteins (SFPs) play vital roles for optimizing reproductive success in diverse animals. Underlining their significance, SFP production and transfer are highly plastic, e.g., depending on the presence of rivals or mating status of partners. However, surprisingly little is known about replenishing SFPs after mating. It is especially relevant in multiple mating species, as they would continuously produce and use SFPs throughout their reproductive life. Here we examined the expression pattern of SFP genes after mating in the great pond snail, Lymnaea stagnalis. Our results show that three out of the six SFP genes investigated here were up-regulated after mating, indicating that L. stagnalis replenishes seminal fluid in a protein-specific manner. In addition, we suggest that SFP replenishment is plastic depending on the mating history of female-acting snails. Our results shed light on unexplored aspects of SFP replenishment, thereby expanding the understanding of reproductive strategies in animals.

We present a focused analysis of user studies in explainable artificial intelligence (XAI) entailing qualitative investigation. We draw on social science corpora to suggest ways for improving the rigor of studies where XAI researchers use observations, interviews, focus groups, and/or questionnaires to capture qualitative data. We contextualize the presentation of the XAI papers included in our analysis according to the components of rigor described in the qualitative research literature: 1) underlying theories or frameworks, 2) methodological approaches, 3) data collection methods, and 4) data analysis processes. The results of our analysis support calls from others in the XAI community advocating for collaboration with experts from social disciplines to bolster rigor and effectiveness in user studies.

Resistance evolution, from genetic mechanism to ecological contextRegina S. Baucom1, Veronica Iriart2, Julia Kreiner3, and Sarah Yakimowski41Ecology and Evolutionary Biology Department, University of Michigan, Ann Arbor, Michigan, USA2Department of Biological Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania, USA3Biodiversity Research Centre & Department of Botany, The University of British Columbia, Vancouver, BC V6T 1Z44Department of Biology, Queen’s University, Kingston, ON K7L 3N6CorrespondenceRegina S. Baucom, Ecology and Evolutionary Biology Department, University of Michigan, Ann Arbor, Michigan, 48109.Email: rsbaucom@umich.edu*Authors contributed equallyPesticide use by humans has induced strong selective pressures, reshaping evolutionary trajectories, ecological networks, and even influencing ecosystem dynamics. The evolution of pesticide resistance across weeds, insects, and fungi often leads to negative impacts on both human health and the economy while concomitantly providing excellent systems for studying the process of evolution. In fact, the study of pesticide resistance has been a feature of evolutionary biology since the Evolutionary Synthesis, with Dobzhansky noting in his book The Genetics and Origins of Species (1937) that cyanide resistance in the California red scale constituted the “best proof of the effectiveness of natural selection yet obtained”. Following the pioneering work of James Crow and others in the 1950’s—which greatly expanded our knowledge of the genetics underlying adaptation—the study of pesticide resistance has shed light on a variety of topics, such as the repeatability of phenotypic evolution across the landscape, ‘hotspots’ of evolution across the genome, and information on the number and type of genetic solutions that populations may employ to strong selection pressures.Landscape level approaches have come to the forefront over the last 20 years of resistance evolution research, often taking advantage of the fact that replicated populations of the same species are exposed to the same pesticide. Further, the resistance evolution field is turning more attention to the ecological context within which resistance evolution occurs, likely stemming, at least in part, from an historical focus on fitness costs (Cousens & Fournier-Level 2018; Baucom 2019). This special feature, ‘Resistance evolution, from genetic mechanism to ecological context’ in Molecular Ecology captures the current state of resistance evolution with contributions broadly addressing the question ‘What has the rapid evolution of pesticide resistance taught us about genome dynamics and adaptation as well as the ecological context within which resistance evolution occurs?’ Below, we contextualize the manuscripts in this special issue that provide insight into the state of the art investigations of resistance evolution across various species of insects, weeds and fungi.

The use of the Radial Artery (RA) as a conduit in coronary artery bypass grafting (CABG) has been steadily increasing since the early 1990’s and based on the most recent data may well become the standard of care for patients with multi-vessel coronary artery disease (CAD) requiring multiple arterial grafts. The TRA approach for cardiac catherization has also increased steadily in use by interventional cardiologists owing to its reduction in bleeding and vascular complications when compared with the femoral approach and is now considered the preferred arterial access. However, prior use of transradial access (TRA) for cardiac catherization is a contra-indication for the use of the RA for CABG because of high rates of structural damage to the vascular wall and potential for graft failure. In this issue of the Journal of Cardiac Surgery Clarke et al. examine the RA of two patients who had TRA for coronary angiography 8 and 12 years prior and note that both patients had chronic injury with dissection and obstruction of the lumen secondary to fibrosis suggesting that TRA causes long-term and irreversible damage rendering them unsuitable as conduits for CABG.

Reintroduction failure after undergoing oral immunotherapy or oral food challenges with cooked eggTo the editor,Food allergy has increased in recent decades currently affecting almost 6% of the european pediatric population (1). Egg is the second leading cause in food allergy (1) and in anaphylactic food reactions (2) among preschool-aged children in Europe. Recent studies have suggested a persistent tendency for egg allergy, estimating that less than 50% of these children can tolerate it by 2 years of age (3). However, up to 70% of egg-allergic children tolerate cooked egg (4). Some studies suggest that regular consumption of cooked egg in these children might increase their probability of tolerating egg in any presentation in the future (5, 6). In the past decades, complete egg avoidance was the recommended treatment in egg allergic patients. This recommendation has an important impact in quality of life of the patients and their families and does not guarantee the prevention of severe reactions due to accidental ingestion of even small amounts of the offending food (2, 7). Oral immunotherapy (OIT) for persistent egg allergy has emerged as an alternative therapy to egg avoidance. Tolerance can be induced by the administration of different egg products and maintained by the regular ingestion of egg several times per week, indefinitely.Previous retrospectives studies had shown, that around 25% of children with negative oral food challenges OFC) did not reintroduce the food at home with a lower successful introduction rate for peanut (32-60%) than for milk (10-22%) or egg (13-29%) (8-10). Aversion and refusal of the food, reactions at home after being tolerated in hospital and fear of reactions were the most reported reasons for peanut reintroduction failure (8-10).As the type of food significantly influences the rate of non-adherence to its regular consumption (9), its causes might be also different depending on the food involved. The aim of our study was to analyze the leading causes of lack of adherence to the regular ingestion of cooked egg after undergoing OIT or an OFC with cooked egg.Egg allergic patients among 2-17 years old, not following the recommendation of maintaining the intake of three eggs per week after undergoing OIT or OFC with cooked egg, were prospectively recruited from the Allergy Service of Hospital General Universitario Gregorio Marañón (Madrid) and Clínica Universidad de Navarra (Pamplona) between January 2019 and May 2020. The patients or their legal representatives, in the case of children under 12 years, fulfilled a questionnaire (supplemental file) regarding demographic and clinical information and the causes of lack of adherence or abandonment of regular intake of cooked egg. The questionnaire was also published in Twitter (Twitter Inc, San Francisco, Calif) and anonymously fulfilled. Qualitative variables were expressed in percentages and quantitative variables were expressed as median and interquartile range (IQR). The study was approved by the Ethics Committee for Investigation of both participating hospitals.Twenty patients were included in the study [55% female; median age: 10.7 years (IQR: 9-16.3)]. Fifteen (75%) were recommended to maintain regular intake of cooked egg after OIT and 5 (20%) after OFC. Patient´s diagnosis of egg allergy was performed by a median age of 14.5 months (IQR: 11-16 months). Median time of egg avoidance before OFC or OIT with cooked egg was 6.1 years (IQR: 3.6-9.4 years).Four (20%) patients referred a frequency intake of two cooked eggs weekly, seven (35%) referred the ingestion of one egg weekly and nine (45%) only consumed breaded/floured foods with egg. The causes of lack of adherence to the regular intake of cooked egg are summarized in the figure. Most of the patients reported poor compliance as they did not like the taste (85%), the texture (70%) or the smell (65%) of egg. Other causes of lack of adherence were being tired of eating the food in the same cooking presentation (55%), the difficulty to find a variety of recipes (50%), reactions at home after tolerance assessment by OFC or OIT (35%), considering the recommended intake excessively frequent (25%), fear of having a reaction (20%), forgetting (20%) and rejection of the appearance of the egg (10%). One out of 20 patients (5%) reported lack of adherence due to interference with other activities such as sports, other food allergies and living with egg allergic relatives.According to our results, the most frequent cause for which patients decreased or stopped the regular ingestion of cooked egg is aversion of the food (related to the organoleptic characteristics of the egg: taste, texture, and/or smell) which is in accordance with other studies performed with other allergens (9, 10). The second cause of poor adherence in our study, was the lack of variety in their cooking preparation which has not been observed in other studies with other foods.While in the case of peanuts, fear of having a reaction is among the first three causes of reintroduction failure (10), this does not seem to be an important cause in the case of egg, being the fifth cause referred by the patients in our study. We therefore believe that it is important to analyze the causes of lack of adherence to regular consumption of a food after having verified its tolerance, depending on the food and the type of presentation in which it is indicated to consume since they seem different and therefore the possible measures on which to act.Our study has some limitations, as the relative small sample group. Time spam between food challenge and completion of the questionnaire is wide and probably those children fulfilling the questionnaire closer to the challenge, did it more correctly. Moreover, we do not have data on the exact timing of failure. The questionnaire is not validated, thus we cannot rule out that the content and way of asking may have influenced the results of our study. In addition, the inclusion criteria in those patients who fullfilled the questionnaire via Twitter could not be verified.In our opinion, strategies to promote regular cooked egg consumption such as providing a variety of recipes for safe consumption with masked egg, suggesting practical recommendations to favor the regular intake or emphasizing in patient education regarding the importance of maintaining the regular consumption of the food could be useful to facilitate compliance in these patients and maintain the acquired tolerance.

Objectives To study the patterns of glycemic status in response to steroid administered to women with risk of preterm delivery between 24 weeks and 36 weeks 6 days of gestation in normoglycemic subjects and to evaluate if maternal characteristics predicted the development of hyperglycemia and if Insulin was necessary in the glycemic management Design : longitudinal study Participants : 76 antenatal women, normoglycemic status between 24 weeks and 36 week 6 days of gestation Methods : Antenatal women who screened negative for Gestational Diabetes Mellitus by 75 gm GTT who received Injection Betamethasone for risk of preterm delivery . Fasting and Postprandial blood sugar levels were recorded from day 1 to 7 after steroid administration. Results Forty seven out of seventy six patients had hyperglycemia of varying severity. Among the risk factors associated with hyperglycemia, age>25 years, family history ofdiabetes and hypertension and BMI >25 have statistically significant association with hyperglycemia. Insulin was started in a total of 40 patients of 47 hyperglycemic patients (85.1%). Mean Insulin dosage required for day 1 was9.66 units. Among the 40 patients started on Insulin 15 (37.5 %) had to be continued on Insulin on Day 7 after steroid administration. Conclusion Significant hyperglycemia can occur in normoglycemic women also leading to serious maternal- fetal consequences . Testing of all antenatal patients especially in age group more than 25years, BMI over 25, hypertensive patients, family history of diabetes who are at risk for development of hyperglycemia ie recommended and start insulin accordingly thus preventing complications.

Appendix 1. Interview Guide

Background: reliable country-specific data on influenza burden play a crucial role in informing prevention and control measures. Our purpose was to provide a comprehensive summary of the available evidence on the burden of seasonal influenza in Italy. Methods: we performed a sys-tematic literature review of articles published until 31 July 2020. PubMed, Embase and Web of Science were searched using terms related to burden, influenza, and Italian population. We in-cluded studies investigating seasonal influenza-related complications, hospitalizations and/or mortality. Results: sixteen studies were included: eight (50%) analyzed influenza-related compli-cations, eight (50%) hospitalizations, while seven (43.8%) influenza-related deaths. Only three studies (19.7%) concerned pediatric age. The synthesis of results showed that patients with chron-ic conditions have an increased risk for complications up to almost three times as compared to healthy people. Hospitalizations due to influenza can occur in as much as 5% of infected people depending on the study setting. Excess deaths rates were over six-fold higher in the elderly as compared to the rest of population. Conclusions: although there are still gaps in existing data, there is evidence of the significant burden that influenza places each year especially on high-risk groups. These data should be used to inform public health decision-making.

The aim of this paper was to compare the prediction performance of three strategies: general global Partial least squares regression (PLSR) using CSSL with and without spiking samples, memory-based learning (MBL) using CSSL with and without spiking samples and general PLSR using only spiking samples to predict soil organic matter in the target area. When using spiked subsets, we also investigated the prediction performance of the extra-weighted subsets. A series of spiking subsets randomly selected from the total spiking samples were selected by conditioned Latin hypercube sampling (cLHS) from the target sites. We calculated the mean squared Euclidean distance (msd) of different spiking subsets with the distribution density function of their vis–NIR spectra only and statistically inferred the optimal sampling set size to be 30. Our study showed that when the number of spiking were lower than 30, the predicted accuracy derived from global PLSR using CSSL spiked with and without extra-weighted samples was greater than the predicted accuracy derived from the general PLSR using the corresponding number of spiking samples only (RMSE 5.57–5.98 v.s. RMSE 6.76). Global PLSR using CSSL spiked with the statistically optimal local samples can achieve higher predicted performance (with a mean RMSE of 5.75). MBL spiked with five extra-weighted optimal spiking samples achieved the best accuracy with an RMSE of 3.98, an R2 of 0.70, a bias of 0.04 and an LCCC of 0.81. The msd is a simple and effective method to determine an adequate spiking size using only vis–NIR data.

Objective: Whether sevoflurane anesthesia is superior to propofol anesthesia in cardiac protection is still unknown. Here, we aim to compare the cardio-/neuro-protective efficacy of sevoflurane and propofol on patients undergoing cardiac surgery. Design: We searched studies based on predefined strategies in MEDLINE, the Cochrane Library, Web of Science and EMBASE. Standardized mean difference (SMD) and relative risk were employed to combine continuous and binary measurements respectively using R packages “metafor”. Subgroup analysis was performed and publication bias was evaluated.. Results: A total of 26 studies were included in our meta-analysis, with 1510 in the sevoflurane group and 1494 in the propofol group. Compared with propofol anesthesia, sevoflurane anesthesia could not significantly reduce the all-cause mortality (OR = 0.79[0.36, 1.74], p-value = 0.564). Although sevoflurane anesthesia was superior to propofol in reducing postoperative cTnI (SMD = -0.93[-1.36, -0.50], p-value < 0.001), such cardio-protection effect would diminish with time since the differences of postoperative 12h and 24h cTnI became insignificant after Bonferroni correction. The results of neuroprotection are rather contradictory and needs further investigation. Conclusion: The sevoflurane anesthesia cannot result in a lower all-cause mortality rate than propofol anesthesia among patients undergoing cardiac surgery despite of its minor protective effects.

Background: The newly developed mRNA-based COVID-19 vaccines can provoke anaphylaxis, possibly induced by polyethylene glycol (PEG) contained in the vaccine. The management of persons with a history of PEG allergy, or with an allergic-like reaction after the first dose remains to be defined.  Methods: We studied two cohorts of individuals: one pre-vaccination, the second post-vaccination. Skin testing was performed with COVID-19 mRNA vaccines. Upon negative skin test, a two-step (10%-90%) vaccination protocol was performed. Positive skin tests were confirmed with basophil activation tests (BAT). Vaccine-sensitized patients were offered a five-step induction protocol. Results: We identified 187 patients with high-risk profiles for developing anaphylaxis. In parallel, among 385’926 doses of vaccine, 87 allergic-like reactions were reported to our division for further investigations: 18/87 (21%) were consistent with anaphylaxis, 78/87 (90%) were female, and 47/87 (54%) received the BNT162b2 mRNA vaccine. Vaccine skin tests were negative in 96% and 76% in the pre- and post-vaccination cohorts, respectively. A two-step vaccination was tolerated in 232/236 (98%) of individuals with negative tests. Four individuals experienced acute asthma exacerbation during the two-step challenge. Vaccine-positive skin tests were consistently confirmed by BAT; CD63 and CD203c expression was selectively inhibited with ibrutinib, suggesting an IgE-dependent mechanism. Finally, 13 sensitized patients were successfully vaccinated with a five-step vaccination protocol. Conclusion: A two-step 10%-90%-vaccination protocol can be safely administered upon negative skin testing. Yet, it should be delayed in individuals with poorly controlled asthma. Importantly, mRNA vaccine sensitized individuals may receive a five-step vaccination protocol.

This paper investigates the linear quadratic regulator(LQR) problem of linear stochastic systems with Markovian jump. Firstly, two iterative algorithms are proposed for solving the corresponding coupled algebraic Riccati equa- tions (CAREs) based on the general-type Lyapunov equation derived from linear stochastic systems. It is verified that the second algorithm adding an adjustable factor converges faster than the first one without it. Secondly, a monotonic convergence theorem is established for the proposed iterative algorithms under certain initial conditions. In the end, a numerical example is given to verify the efficiency of the proposed algorithms.

Aim Depolarization-blocking drugs (DB-drugs) used for cardiac disease increase the risk of cardiac arrhythmia (ventricular tachycardia/ventricular fibrillation[VT/VF]) and out-of-hospital cardiac arrest (OHCA) in specific patient groups. However, it is unknown whether drugs for non-cardiac disease that block cardiac depolarization as off-target effect increase the risk of OHCA on a population level. Therefore, we aimed to investigate OHCA-risk of non-cardiac DB-drugs in the community. Methods We conducted a population-based case-control study. We included OHCA-cases from an Emergency Medical Services attended OHCA-registry in the Netherlands (ARREST:2009-2018), and age/sex/OHCA-date matched non-OHCA-controls. We calculated adjusted odds ratios (ORadj) of use of non-cardiac DB-drugs for OHCA, using conditional logistic regression. Stratified analyses were performed according to first-registered rhythm (VT/VF or non-VT/VF), sex and age (≤50, 50-70, or ≥70 years). Results We included 5,473 OHCA-cases of whom 427 (7.8%) used non-cardiac DB-drugs, and 21,866 non-OHCA-controls of whom 835 (3.8%) used non-cardiac DB-drugs, and found that non-cardiac DB-drug use was associated with increased OHCA-risk when compared to no-use (ORadj1.6[95%-CI:1.4-1.9]). Stratification by first-recorded rhythm revealed that this applied to OHCA with non-VT/VF (asystole) (ORadj2.5[95%-CI:2.1-3.0]), but not with VT/VF (ORadj1.0[95%-CI:0.8-1.2];P-value interaction<0.001). The risk was higher in women (ORadj 1.8[95%-CI:1.5-2.2] than in men (ORadj1.5[95%-CI:1.2-1.8];P-value interaction=0.030) and at younger age (ORadj≥70yrs1.4[95%-CI:1.2-1.7];ORadj50-70yrs1.7[95%-CI:1.4-2.1];ORadj≤50yrs3.2[95%-CI:2.1-5.0];P-value interaction<0.001). Conclusions Use of non-cardiac DB-drugs is associated with increased OHCA-risk in the general population. This increased risk occurred in patients in whom non-VT/VF was the first-registered rhythm, and it occurred in both sexes, but more prominently among women, and more strongly in younger patients (≤50 years).

Horizontal gene transfer via plasmids is important for the dissemination of antibiotic resistance genes among medically relevant pathogens. Specifically, the transfer of IncHI1A plasmids is believed to facilitate the spread of antibiotic resistance genes, such as carbapenemases, within the clinically important family Enterobacteriaceae. The microbial community of urban wastewater treatment plants has been shown to be highly permissive towards conjugal transfer of IncP1 plasmids. Here, we tracked the transfer of the P1 plasmid pB10 and the clinically relevant HI1A plasmid R27 in the microbial communities present in urban residential sewage entering full-scale wastewater treatment plants. We found that both plasmids readily transferred to these communities and that strains in the sewage were able to further disseminate them. Furthermore, that R27 has a broad potential host range, but a low host divergence. Interestingly, although the majority of R27 transfer events were to members of Enterobacteriaceae, we found a subset of transfer to other families, even other phyla. Indicating, that HI1A plasmids facilitate horizontal gene transfer both within Enterobacteriaceae, but also across families of especially Gammaproteobacteria, such as Moraxellaceae, Pseudomonadaceae and Shewanellaceae. pB10 displayed a similar potential host range as R27. In contrast to R27, pB10 had a high host divergence. By culture enrichment of the transconjugant communities, we show that sewage strains of Enterobacteriaceae and Aeromonadaceae can stably maintain R27 and pB10, respectively. Our results suggest that dissemination in the urban residual water system of HI1A plasmids may result in an accelerated acquisition of antibiotic resistance genes among pathogens.

Introduction Understanding the impact of scoliosis surgery on lung function is important for counseling patients about risks and benefits of surgery. We prospectively compared the trends in lung function test (LFT) results prior to and after scoliosis surgery in children with neuromuscular diseases, or dysmorphic syndromes. We hypothesized a stabilization. Methods We prospectively included children with neuromuscular or syndromic scoliosis able to perform LFTs. We studied (Forced) Vital Capacity ((F)VC), the ratio of Forced Expiratory Volume in 1 second (FEV1) and FVC, and Peak Expiratory Flow (PEF). Preoperative LFT results were compared with results 3-4 months after surgery. The mean monthly change in LFT results up to 2 years after surgery was compared with the preoperative natural history using linear mixed effects models. Results We included 43 patients. No significant change was observed in absolute values of (F)VC, FEV1/FVC and PEF prior to and after surgery. Median standardized VC, FVC and PEF decreased significantly after surgery from 59 to 58%, 60 to 51% and 61 to 53% respectively. The monthly rate of change in FVC was -0.13 % (95% CI -0.42 to 0.17) prior to surgery and -0.20% (95% CI -0.42 to 0.03) after surgery, mean difference -0.07 (95% CI -0.46 to 0.31; p=0.36). Conclusion No stabilization of lung function 3-4 months after scoliosis surgery was observed in children with neuromuscular and syndromic scoliosis with restrictive lung function disease. The effect of surgery on the rate of lung function decline remains inconclusive.

Compartment modeling (CM) is a well-known approach for computationally affordable, spatially-resolved hydrodynamic modeling of unit operations. Recent implementations use flow profiles based on CFD simulations, and several authors included microbial kinetics to simulate gradients in bioreactors. However, these studies relied on black-box kinetics, that do not account for intra-cellular changes and cell population dynamics in response to heterogeneous environments. In this paper, we report the implementation of a Lagrangian reaction model, where the microbial phase is tracked as a set of biomass-parcels, each linked with an intra-cellular composition vector and a structured reaction model describing their intra-cellular response to extracellular variations. A stochastic parcel tracking approach is adopted, in contrast to the resolved trajectories used in prior CFD implementations. A penicillin production process is used as a case-study. We show good performance of the model compared to full CFD simulations, both regarding the extra-cellular gradients and intra-cellular pool response, provided the mixing time in the CM matches the full CFD simulation; taking into account that the mixing time is sensitive to the number of compartments. The sensitivity of the model output towards some of the inputs is explored. The coarsest representative CM requires a few minutes to solve 80 hours of flow time, compared to approx. 2 weeks for a full Euler-Lagrange CFD simulation of the same case. This alleviates one of the major bottlenecks for the application of such CFD simulations towards analysis and optimization of industrial fermentation processes.

Background: Simultaneous atrial fibrillation (AF) catheter ablation and left atrial appendage closure (LAAC) is sometimes recommended for both rhythm control and stroke prevention. However, the advantages of intracardiac echocardiography (ICE) guidance for this combined procedure have been scarcely reported. To evaluate the clinical outcomes and safety of ICE guided LAAC within a zero-fluoroscopy catheter ablation procedure. Methods and Results:From April 2019 to April 2020, 56 patients with symptomatic AF underwent concomitant catheter ablation and LAAC. ICE with a multi-angled imaging protocol mimicking the TEE echo windows was used to guide LAAC. Successful radiofrequency catheter ablation and LAAC was achieved in all patients. Procedure-related adverse event rate was 3.6%. During the 12-month follow-up, 77.8% of patients became free of arrhythmia recurrences and oral anticoagulants were discontinued in 96.4% of patients. No ischemic stroke occurred despite two cases of device-related thrombosis versus an expected stroke rate of 4.8% based on the CHA2DS2-VASc score. The overall major bleeding events rate was 1.8%, which represented a relative reduction of 68% versus an expected bleeding rate of 5.7% based on the HAS-BLED score of the patient cohort. The incidence of iatrogenic atrial septal defect secondary to a single transseptal access dropped from 57.9% at 2 months to 4.2% at 12 months TEE follow-up. Conclusion:The combination of catheter ablation and LAAC under ICE guidance was safe and effective in AF patients with high stroke risk. ICE with our novel protocol was technically feasible for comprehensive and systematic assessment of device implantation.

Object: Investigate the value of transesophageal echocardiography (TEE) in perimembranous ventricular septal defect (PmVSD) closure via a left parasternal ultra‐minimal trans intercostal incision in children. Methods: From January 2015 and December 2020, 212 children with PmVSD were performed device occlusion via an ultraminimal intercostal incision. TEE is used throughout the perioperative period, including TEE assessment, TEE-guided localization of the puncture site, TEE guidance. All patients were followed up using transthoracic echocardiography for over 6 months. Results: A total of 207 cases successfully occluded, the successful rate was 97. 64%. one hundred and forty-five patients had single orifice, and 62 patients had multiple orifices in the AMS. During the operation, the surgeon readjusted the device or replaced the larger device in 17 cases. After operation, there were 19 cases of slight residual shunts, 13 cases of pericardial effusion and 4 cases of pleural effusion. And all were back to normal during the 4- month follow-up period. Mild mitral regurgitation was presented in 1 patient and remained the same during the follow-up period. No other complications were found. Conclusions: TEE was used to evaluate and determine the defect in PmVSDs with an concentric occluder via a left parasternal ultra‐minimal trans intercostal incision. TEE guidance and immediate postoperative efficacy evaluation are of great value, which can effectively guide the treatment of PmVSD occlusion.

Objectives Pulmonary atresia (PA) with ventricular septal defect (VSD) and systemic-pulmonary collateral arteries (SPCA’s) has a variable anatomy with regard to the pulmonary vasculature, asking for an individualized surgical treatment. A protocol was applied consisting of staged unifocalization and correction. Methods Since 1989 39 consecutive patients were included (median age at first operation 13 months). In selected cases a central aorto-pulmonary shunt was performed as first procedure. Unifocalization procedures were performed through a lateral thoracotomy. Correction consisted of shunt takedown, VSD closure and interposition of an allograft between the right ventricle and the reconstructed pulmonary artery. Postoperatively and at follow up echocardiographic data were obtained. Results In 39 patients 66 unifocalization procedures were performed. Early mortality was 5%. Seven patients were considered not suitable for correction, four of them died. One patient is awaiting further correction. Correction was done successfully in 28 patients. Operative mortality was 3% and late mortality 11%. Median follow-up after correction was 19 years. Eleven patients needed homograft replacement. Freedom from conduit replacement was 88%, 73% and 60% at 5, 10 and 15 years respectively. Right ventricular function was reasonable or good in 75 % of the patients. Conclusions After complete unifocalization 30/37 patients (81%) were considered correctable. The main reasons for palliative treatment without correction were pulmonary hypertension and/or inadequate outgrowth of pulmonary arteries. Staged approach of PA, VSD and SPCA’s results in adequate correction and good functional capacity. RV function after correction remains reasonable or good in the majority of patients.

Deuterated water has been applied in hydrogeological tracer tests in recent years. However, there is a contradiction about the conservativeness of artificial deuterium (D/2H). In this study, what circumstances HDO behaved truly conservatively were investigated through laboratory-scale experiments via comparing the widely used tracer chloride (Cl-). And reasons for the non-conservativeness of HDO were discussed comprehensively for the first time. In addition, the advection-dispersion equation (ADE) and dual-domain mass transfer (DDMT) equation were employed to describe the breakthrough curves (BTCs) of tracers. HDO behaved conservatively when it transported in the porous media with high permeability (approximately K > 1m/d), and ADE could describe BTCs successfully. While hysteresis effect of HDO expressed in the media with low permeability. And the lower the permeability of the porous media, the stronger the hysteresis effect. DDMT was more suitable for demonstrating BTCs in low permeability media. Hydrogen bonds between HDO and H2O, the isotopic exchange effect, and the dual-domain model of the media all could lead to the hysteresis effect. The retardation factor (R = 1.712) was used to describe transporting behaviors of HDO in clay firstly. And the threshold hydraulic conductivity (Kcr) and the proportion of immobile regions of HDO were greater than that of Cl-, while dispersion coefficients of HDO were smaller. These could provide further considerations for using deuterium in hydrogeological tracer tests.

Flow regimes are critical for determining physical and biological processes in rivers, and their classification and regionalization traditionally seeks to link patterns of flow to physiographic, climate and other information. There are many approaches to, and rationales for, catchment classification, with those focused on streamflow often seeking to relate a particular response characteristic to a physical property or climatic driver. Rationales include such topics as Prediction in Ungauged Basins (PUB), helping with experimental approaches, and providing guidance for model selection in poorly understood hydrological systems. While scale and time are important considerations for classification, the Annual Daily Hydrograph (ADH) is a first-order easily visualized integrated expression of catchment function, and over many years is a distinct hydrological signature. In this study, we use t-SNE, a state-of-the-art technique of dimensionality reduction, to classify 17110 ADHs for 304 reference catchments in mountainous Western North America. t-SNE is chosen over other conventional methods of dimensionality reduction (e.g. PCA) as it presents greater separability of ADHs, which are projected on a 2D map where the similarities are evaluated according to their map distance. We then utilize a Deep Learning encoder to upgrade the non-parametric t-SNE to a parametric approach, enhancing its capability to address ‘unseen’ samples. Results showed that t-SNE was an effective classifier as it successfully clustered ADHs of similar flow regimes on the 2D map. In addition, many compact clusters on the 2D map in the coastal Pacific Northwest suggest information redundancy in the local hydrometric network. The t-SNE map provides an intuitive way to visualize the similarity of high-dimensional data of ADHs, groups catchments with like characteristics, and avoids the reliance on subjective hydrometric indicators.

The results of a meta-analysis are more than just the reported odds ratio, 95% confidence interval, and P value. Of equal importance is the fine print of the study which should include assessment of risk of bias, certainty in evidence, and heterogeneity in the individual point estimates and confidence intervals. These areas all have influence on the quality of the data in the analysis. Reading and understanding the fine print is important.

Switching to a new host plant is a driving force for divergence and speciation in herbivorous insects. This process of incorporating a novel host plant into the diet may require a number of adaptations in the insect herbivores that allow them to consume host plant tissue that may contain toxic secondary chemicals. As a result, herbivorous insects are predicted to have evolved efficient ways to detoxify major plant defenses and increase fitness by either relying on their own genomes or by recruiting other organisms such as microbial gut symbionts. In the present study we used parallel meta-transcriptomic analyses of Altica flea beetles and their gut symbionts to explore the contributions of beetle detoxification mechanisms versus detoxification by their gut consortium. We compared the gut meta-transcriptomes of two sympatric Altica species that feed exclusively on different host plant species as well as their F1 hybrids that were fed one of the two host plant species. These comparisons revealed that gene expression patterns of Altica are dependent on both beetle species identity and diet. The community structure of gut symbionts was also dependent on the identity of the beetle species, and the gene expression patterns of the gut symbionts were significantly correlated with beetle species and plant diet. Some of the enriched genes identified in the beetles and gut symbionts are involved in the degradation of secondary metabolites produced by plants, suggesting that Altica flea beetles may use their gut microbiota to help them feed on and adapt to their host plants.