We describe two cases of idiopathic VT arising from the postero-septal RVOT in both cases. Each case demonstrates an important learning point and advantage of multi-spline multi-electrode mapping catheters in idiopathic outflow VT. In the first case two dominant PVC morphologies can be clearly seen which we believe originate from a single site of origin with multiple exit sites caused by focal fibrosis. In the second case, focal fibrosis in this region leads to anisotropic conduction of the RVOT in areas of low voltage. We surmise that multi-spline multi-electrode catheters are essential in such cases as extensive point-by-point mapping could significantly prolong procedure time and fail to identify the earliest activation site in the case of anisotropic tissue conduction due to variations in activation latency.

Background: Atrial fibrillation (AF) is a common cardiac arrhythmia that affects millions of people worldwide. We aim to investigate how to improve prognostic value of recurrence for atrial fibrillation patients after cryoablation by non-linear survival models. Methods: In this study, we retrospectively reviewed data from 1023 patients who underwent cryoablation surgery for AF at Fujian Provincial Hospital (FPH). We generated radiomics signatures (RSI) and a clinical signature (CLI) using a non-linear survival model by repeated 10-fold cross-validation. The comprehensive risk score (TCRS) was obtained by linearly weighting the multivariate Cox proportional risk model. Results: The combination of RSI and CLI indicators had a significantly higher area under the curve (AUC) in the ROC curve of the training set (AUC=0.955) compared to the AUC of a single indicator CLI (AUC=0.862). The TCRS showed better prognostic performance compared to the traditional Lasso-Cox models, with AUC of 0.955 vs 0.664. The accuracy of the model was further confirmed by the C-indices of RSI (C-index: 0.8894; 95%CI: 0.8166-0.9621), CLI (C-index: 0.8431; 95%CI: 0.7466-0.9395), and TCRS (C-index: 0.9072; 95%CI: 0.8281-0.9864) in validation set 2. Conclusions: Under a nonlinear survival model, TCRS which combines RSI and CLI indicators has potential as a promising prognostic tool for post-cryoablation AF patients.

A document by Meltem Ozturan. Click on the document to view its contents.

Laminitis associated with hyperinsulinemia a significant cause of morbidity and mortality in horses with equine metabolic syndrome. The diagnosis and management of insulin dysregulation are therefore critical to prevent the development of hyperinsulinemia-associated laminitis. This review article aims to help primary care clinicians manage patients with insulin dysregulation by providing an overview of diagnostics, management strategies and new therapies that are available.

A document by Faisal Nabi. Click on the document to view its contents.

Large acute epidural hematoma from head pin fixation fractureAuthorsVinicius Trindade Gomes da Silva1 – viniciustrindade@hotmail.comLouise Makarem1 - louisemakarem@gmail.comRhuann Pontes dos Santos Silva² - rhuannpontes02@gmail.comManoel Jacobsen Teixeira1 – manoeljacobsen@gmail.comWellingson Silva Paiva1 - wellingsonpaiva@yahoo.com.brInstitutions1 Division of Neurosurgery at University of São Paulo.² Catholic University of Pernambuco, Recife, Brazil.PAIVA et al: EPIDURAL HEMATOMA FROM HEAD PIN FIXATION

Gentamicin (GM) is an aminoglycoside antibiotic with a rapid bactericidal effect in the treatment of many infections. However, its use in high concentrations for more than 7 days causes nephrotoxic side effects. It was aimed to determine the biochemical and molecular activities of resatorvid and alpha lipoic acid (ALA) on GM induced nephrotoxicity in rats. In the study, 34 Wistar albino rats were randomly distributed; Healthy control (n:6), Gentamicin (80 mg/kg, n:7), Gentamicin+Sham (%10 hydroalcoholic solution, n:7), Gentamicin+resatorvid (5 mg/kg, n:7), Gentamicin+ALA (100 mg/kg, n:7). Urinary IL-18, KIM-1 and NGAL levels were statistically decreased by resatorvid treatment, and KIM-1 levels were statistically decreased by ALA treatment compared to the gentamicin group. In addition, urine creatinine was partially decreased by resatorvid and ALA. NRF-2, CAS-3 and NR4A2 expressions were statistically decreased by resatorvid and ALA treatment. Nevertheless, NF-κB was statistically decreased only with resatorvid. The nephrotoxicity that limits the use of gentamicin in infections can reduce by resatorvid in the future. Therefore, it can be used for a longer and more effective in infections.

Background: Atopic dermatitis (AD) is a chronic skin condition impacting quality of life. Allergen recognition via specific IgE triggers immune responses and allergy symptoms. Cross-reactivity may induce auto-IgE responses and worsen AD. We aimed to analyze molecular mimicry between human AQP3 and Aspergillus fumigatus aquaporin, a potential allergen source. Methods: In silico analysis compared human (AQP3) and A. fumigatus aquaporin sequences with 25 aquaporins from allergenic sources. Sequences were obtained from UniProt and NCBI. Phylogenetic relationships and homology-based modeling were performed, with ElliPro predicting conserved antigenic regions on 3D structures. Results: Global identity among aquaporins was 32.6%, but one antigenic site exhibited 71.4% local conservation. Five monophyletic clades (A to E) were formed. Group B showed the highest identity (95%), including 6 mammalian aquaporins, including AQP3. A. fumigatus aquaporin shared the highest identity with Malassezia sympodialis (35%). Both human and A. fumigatus aquaporins featured three linear and three discontinuous epitopes, with a root mean square deviation (RMSD) of 1.006. Conclusion: Possible linear and conformational epitopes on AQP3 were identified. High identity in one antigenic region suggests molecular mimicry between human and A. fumigatus aquaporins, potentially leading to autoreactivity and cross-reactivity. Further in vitro and in vivo studies are needed to confirm these findings.

Stapled peptides are a promising class of molecules with potential as highly specific probes of protein-protein interactions and as therapeutics. Hydrocarbon stapling affects the peptide properties through the interplay of two factors: enhancing the overall hydrophobicity and constraining the conformational flexibility. By constructing a series of virtual peptides, we study the role of each factor in modulating the structural properties of a hydrocarbon stapled peptide PM2 which has been shown to enter cells, engage its target MDM2 and activate p53. Hamiltonian replica exchange molecular dynamics (HREMD) simulations suggest that hydrocarbon stapling favors helical populations of PM2 through a combination of the geometric constraints and the enhanced hydrophobicity of the peptide. To further understand the conformational landscape of the stapled peptides along the binding pathway, we performed HREMD simulations by restraining the peptide at different distances from MDM2. When the peptide approaches MDM2, the binding pocket undergoes dehydration which appears to be greater in the presence of the stapled peptide compared to the linear peptide. In the binding pocket, the helicity of the stapled peptide is increased due to the favorable interactions between the peptide residues as well as the staple and the micro-environment of the binding pocket, contributing to enhanced affinity. The dissection of the multi-facet mechanism of hydrocarbon stapling into individual factors not only deepens fundamental understanding of peptide stapling, but also provides guidelines in the design of new stapled peptides.

Ultrasonographic Manifestations ofMultiple TuberousXanthomas on Bilateral Buttocks with Hypercholesterolemia: One rare case reportDongmei Li a , Lei Wang, MDb ,a University of Electronic Science and Technology, Chengdu 610072, China.b Department of Medical Ultrasound, Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, Chengdu 610072, China.

A mathematical model has been developed for studying the flow of two immiscible fluids under the electrokinetic effects through a circular tube. The proposed model has been divided into two regions: The core region is non-Newtonian (Thixotropic) and the peripheral region is a Newtonian fluid. The non-linear nature of the modified Navier Stokes equation is governed under the electrokinetic effect and solved analytically by taking pressure gradient as constant. The numerical analysis on simultaneous effects of the power-law index, yield stress, structural parameter, consistency index and electro-osmotic on axial velocity and flow rate were discussed and the results were presented graphically. A comparison of axial velocity profiles for certain values of the parameters has been made to obtain the profiles for the power-law-Newtonian model and Newtonian-Newtonian fluid model.

Hematological evaluation to explain indirect hyperbilirubinemia in a boy with cardiac arrhythmia showed the presence of PIEZO1-related hereditary xerocytosis (HX) [c.6008C>A (p.Ala2003Asp) variant] presenting with compensated hemolytic anemia and splenomegaly. PIEZO1 expression is not limited to erythrocytes and can also be found in other types of cells. It has been shown very recently that PIEZO1 is expressed in cardiomyocytes and chemically prolonging PIEZO1 activation results in cardiac arrhythmias. Since no other causative variants were detected in genes previously associated with cardiac arrhythmias, the arrhythmia was attributed to the PIEZO1 variant underlying HX. Arrhythmias can be fatal and we recommend that cardiac evaluation be part of the examination in patients with PIEZO1-related HX.

Against the backdrop of global warming, marine heatwaves are projected to become increasingly intense and frequent in the future. This trend poses a potential threat to the survival of corals and has the capacity to lead to the destruction of entire coral reef ecosystems. Although many studies have confirmed the resilience of corals to heat stress, but their ability to withstand repeated heatwave events occurring in nature remains unclear. In this study, focusing on physiological and symbiotic microorganism responses, we examined the adaptation and resilience of Turbinaria peltata after repeated exposed to marine heatwaves. In the first heatwave, From physiological perspective, Turbinaria peltata showed the average values of Chl a and endosymbionts increased, while GST, Caspase-3, CAT, and SOD showed significant decreases (p < 0.05) upon repeated exposure to heatwaves compared to the initial exposure. In terms of bacteria, the abundance of Leptospira which functional prediction indicating potential pathogenicity and intracellular parasitism, increased significantly during the initial exposure to the heatwave. In contrast, probiotic bacteria such as Achromobacter arsenitoxydans and Halomonas desiderata, which might related to mobile elements, biofilm formation, stress-tolerant bacteria, Gram-positive bacteria, nitrogen uptake, and nitrate uptake, showed significant increases during the re-exposure to the heatwave. Overall, the results indicate that Turbinaria peltata adapts to marine heatwaves through physiological regulation and changes in the microbial community.

Purpose: Children with bronchiolitis admiteed to the pediatric intensive care unit (PICU) for acute respiratory failure may require respiratory support with non-invasive ventilation (NIV). Enteral nutrition (EN) is associated with a reduction in hospital stay. Even so, guidelines do not specify on how to initiate, increase and maintain EN in these patients. Methods This was a prospective interventional study. Inclusion criteria were patients with bronchiolitis under NIV. A multidisciplinary team created an algorithm to improve EN for critically ill patients with bronchiolitis in need of NIV. In order to assess the protocol implementation, two periods of time were compared: Group 1: without nutrition implementation protocol vs Group 2, once the protocol was implemented. The project aim was to decrease the mean time to EN initation by 50% after the start of NIV. Secondary endpoints were time to reach target calories ( 100 kcal/kg/day), NIV duration, and % of patients with adverse effects. Results Hundred two patients were included in this study. In group 1, Forty eight and 54 in group 2. Statistically significant differences were detected in the main outcome. The mean time until the start of EN decreased from 18.5 hours to 6 hours (p<0.05) Median time to reach calorie goal decreased from 103.5 hours to 48.5 hours (p<0.05). No differences were dettected in other outcomes. Conclusions The implementation of a standardized route for EN in patients with NIV allow a decrease in the time of the start feeds and the time to the goal of caloric enteral nutrition.

Summary    The development of single-cell techniques revolutionized the field of plant biology. It enabled the characterization of cell-specific events in a wide range of species and allowed us to gain novel insights of minute biological processes occurring in complex plant tissues (Cuperus, 2022; Libault et al., 2017). Such novel approach is greatly improving our understanding of plant development, evolution, and physiology. As these techniques gain more attention within the plant research community, there is a rising need for the development of specialized visualization tools that can effectively explore the rich and complex data they produce.    ggPlantmap is an open-source R package with the goal of facilitating the generation of informative ggplot maps from plant images to explore quantitative cell type-specific data. When combined with external quantitative data, ggPlantmap can be used for the visualization and displaying of spatial profiles in distinct parts/cells of the plant (Figure 1). The conceptual workflow is like other ggplot based geographic map packages, such as ggmap (Kahle and Wickham, 2013).

In recent years, a number of clinical studies and animal experiments have confirmed that dietary fiber affects blood glucose metabolism by regulating intestinal flora. However, the correlation between dietary fiber and insulin resistance and the intermediate metabolites of insulin resistance are not completely clear. Water soluble cellulose (SDF) can selectively promote the growth and activity of some beneficial bacteria, so as to enhance the proliferation and function of beneficial bacteria. In the analysis of intestinal microbial population change, compared with Chow group, the relative abundance of Prevotella and bacteroides in feces of HFD group was significantly higher and Roseburia was significantly lower; Compared with HFD group, the relative abundance of Prevotella in F-HFD group decreased significantly, indicating that Prevotella may be an intestinal target microorganism for SDF to improve insulin resistance (IR) in rats fed high-fat diet. Based on the related metabolites of Prevotella, we detected the contents of branched chain amino acids (BCAAs) in serum of rats in each group. The results showed that the content of BCAAs in serum of chow group was significantly lower than that of HFD group. Correlation analysis showed that BCAAs was significantly positively correlated with IR and glucose tolerance, positively correlated with Prevotella, and negatively correlated with oscillospira and Roseburia. Therefore, SDF may reduce the production of BCAAs by regulating the abundance of Prevotella in the intestinal flora of rats fed with high-fat diet, so as to reduce IR.

Objective To explore the value of speckle tracking echocardiography (STE) with low dose dobutamine stress echocardiography (LDDSE) for evaluation of viable myocardium (VM) in the acute ST-elevation myocardial infarction (STEMI) patients with or without type 2 diabetes mellitus (DM). Methods Eighty-five hospitalized patients with regional wall motion abnormalities (RWMA) according to routine echocardiography in STEMI, thirty patients with type 2 DM. All of them were underwent STE associated with LDDSE (STE-LDDSE) prior to coronary angiography and percutaneous coronary intervention (PCI). Every segment image was acquired and evaluated by wall-motion analysis. The images of STE-LDDSE were analyzed quantitatively for peak-systolic strain (S) and strain rate (Sr), the short axis of radial strain (RS), radial strain rate (RSr), circumferential strain (CS), circumferential strain rate (CSr) and the long axis of longitudinal strain (LS), longitudinal strain rate (LSr) by using the QLAB software. All patients underwent PCI within one week after completing STE-LDDSE examination, and echocardiograms were reviewed at 1, 3, and 6 months after surgery. Results A total of 183 regional wall motion abnormalities (RWMA) were detected in the DM group, of which 117 (63.93%) segments were viable myocardium; 357 RWMA were detected in non DM patients, of which 248 (69.47%) segments of viable myocardium were detected by echocardiography. The sensitivity, accuracy, and specificity of STE-LDDSE in detecting viable myocardium in DM group were 70.94%、77.45%、87.88% ; 92.31%、72.73% and 85.25% for LS and LSr. In the non DM group, the sensitivity, specificity, and accuracy of LS and LSr were 68.95%、92.66%、76.19% ; 77.42%、88.07% and 80.67%, respectively. Further parallel diagnostic tests were conducted on LS and LSr parameters. The sensitivity, specificity, and accuracy of detecting viable myocardium in the DM and non DM groups were 84.62%、45.45%、70.49%, 66.53%、63.30% and 65.55%, respectively, at rest; They were 84.62%、45.45%、70.49%, 66.53%、63.30% and 65.55%, respectively, during low dose dobutamine stress. Conclusion STE-LDDSE has a high value of detecting VM. Parallel diagnostic test for LS and LSr is the best choice in detecting VM in the patients with STEMI and is more sensitive for the patients with type 2 DM. It will be more effectively to guide the further treatment and to evaluate the prognosis of the STEMI patients.

Quarrying generates significant changes in the grasslands, by reducing ecological functions, reducing connectivity, impairing biodiversity, and degrading soil. Unlike other forms of destruction such as agriculture or urbanization, mining is characterized by eliminating soil and exposing the bedrock, facilitating groundwater contamination processes. Quarrying in Pampean grassland has been expanding for a century and little is known about the extent and distribution of quarries over the native environment. In this work, we analyze the spatiotemporal variation of quarrying activity on the Highland grassland in the Tandilia mountains of Argentina. Based on Landsat 5, 7, and 8 satellite imagery, from 1996 to 2022, and using QGIS software, we identified the location and extension of quarries, and we analyzed their change through time. Quarries covered 6428 ha, which was originally part of the Pampean grassland. The number of open quarries increased by 129%, from 69 in 1996 to 158 in 2022, and the area used for this activity increased by 172%, with a greater expansion being detected in the last ten years. At least 87 quarries were abandoned in 2022. Quarries are often abandoned without any kind of remediation, leading to further ecosystem deterioration. The current extension of quarrying activity (active and abandoned quarries) reduced the connectivity and a significant area (5.2%) of the Highland grassland of the Tandilia Mountains. Grassland conservation planning should include quarrying as a significant threat, and management actions must be considered to reduce its impact.

Background: SARS-CoV-2 infection has been extensively documented since the onset of the pandemic, particularly in the adult population. However, there is a lack of evidence describing the phenotypic manifestations of the disease in the pediatric population. We aimed to characterize the clinical phenotypes of SARS-CoV-2 infection in hospitalized children. Methods: The EPICO study is a multicenter cohort conducted between April 2020- November 2021, involving 55 institutions in Spain and 13 institutions in Colombia. Hospitalized children aged 29 days to 17 years with confirmed SARS-CoV-2 infection were included to determine the disease´s evolution, severity factors, and outcomes. Cluster analysis was conducted to characterize clinical phenotypes. Results: A total of 2318 patients from Colombian and Spanish institutions were included. The population was 55% male, with infants being the largest group (36%). Five distinct phenotype clusters emerged, differing significantly in clinical and epidemiological characteristics. Cluster 1 (26.57%) consisted of infants without comorbidities, with low PICU admission and mortality rates. Cluster 2 (18.5%) had respiratory comorbidities, high co-detection, and mortality rates. Cluster 3 (11.51%) showed fever, gastrointestinal symptoms, and high PICU admission. Cluster 4 (32.09%) had mild unspecific symptoms and low mortality. Cluster 5 (11.3%) included adolescents without comorbidities, with low co-detection and hospitalization rates. Comparable findings were observed in both countries. Conclusion: Our study successfully identified distinct patterns of clinical and epidemiological characteristics associated with SARS-CoV-2 infection in hospitalized pediatric patients. These findings may help shape future guidelines and improve risk stratification in children.

Background: Despite advancements in vaccination and the transition from pandemic to endemic, SARS-CoV-2 continues to pose a medical challenge, particularly among children. In this context, imaging diagnostics, such as chest x-rays, are crucial to the initial treatment of patients. This study aims to characterize the radiological findings in pediatric patients with confirmed SARS-CoV-2 infection in Colombia between April 2020 and November 2021, as well as their potential association with intensive care admission. Methods: In Colombia, a multicenter cohort comprised patients aged 29 days to 17 years with confirmed SARS-CoV-2 infection and chest X-ray administered within 72 hours of hospitalization. In two separate groups, four radiologists evaluated the images. A fifth radiologist reviewed all the X-rays; and subsequently, these readings were used to calculate the kappa coefficient and to resolve discrepancies among the other radiologists. The results were compared to admission to intensive care. Results: Analysis was conducted on 392 patients with a mean age of 2 years, the majority of whom (42%) were infants. Sixty-eight percent of the radiographs had normal results. Peribronchial thickening and interstitial opacity were the most common aberrant findings (59%), followed by alveolar opacity (12%). 88 percent of findings were bilateral. The most common association between peribronchial thickening and intensive care admission was ventilatory failure. Interobserver agreement was low for peribronchial thickening (kappa = 0.1), but higher for consolidations and alveolar opacities (kappa = 0.4 and 0.5, respectively). Conclusion: In pediatric patients with SARS-CoV-2, radiological findings are nonspecific and interobserver agreement is minimal. Although consolidation and alveolar opacities demonstrated greater concordance, they were not associated with clinical differences; therefore, chest radiography is not considered useful for determining the severity of COVID-19 in children.

Soil gravel content strongly affects ecological restoration; however, the response and mechanism of plant traits to soil gravel content under the sensitive and fragile natural environment of Qinghai-Tibet Plateau remains unclear. Herein, soils with three gravel content (10%, 30%, 50%) in the southeastern Tibetan Plateau were selected, and three plant species ( one indigenous specie of Elymus dahuricus (Ed), and two introduced ones of Festuca elata ( Fe) and Medicago sativa ( Ms)) were used in seven planting patterns with different proportions ( Fe, Ed, Ms, Fe + Ed (1:1), Fe+ Ms (2:1), Ed + Ms (2:1), Fe+ Ed+ Ms (2:2:1)). Plant traits, phytochemical properties and soil stoichiometric characteristics were measured to explore the interactive effects of soil gravels and plant species on vegetation restoration. Average plant height, coverage, shoot biomass and total biomass were most affected by plant species (F=277~611, p<0.01), followed by gravel content (F=90~195, p<0.01) and their interaction (F=5~51, p<0.05); root biomass was most affected by gravel content (F=130, p<0.01). Among plant species, shoot and root biomass, total biomass overall decreased in the order of Fe+Ed+Ms˃Fe˃Fe+Ms˃Fe+Ed˃Ms˃Ms+Ed˃Ed. Plant total biomass, shoot biomass, root biomass and shoot/root ratio among different soils overall decreased in the order of low˃ high˃ medium gravel contents. All plant species were restricted by soil nitrogen except for Ed and Ed+ Ms (N:P>14). In addition, average plant height, coverage, shoot biomass and total biomass were separately negatively and positively correlated with bulk density and total porosity (r=-0.88~-0.96 and 0.78~0.91, p<0.05), so did for total nitrogen, total phosphorus, organic carbon, C:N and N:P of shoot fraction and rhizosphere soils (|r|=0.69~0.97, p<0.05), indicating that gravel content affects plant growth through bulk density and nutrients. Therefore, optimizing the configuration of soil properties (mainly nitrogen and compactness) and plant species (isecologic niche plants) is an effective strategy for ecological restoration in the Qinghai-Tibet Plateau.

A document by Huiwen Gao. Click on the document to view its contents.

Concern about possible cross sensitivity between cefazolin and penicillin leads to restrictions on the use of penicillin in patients with cefazolin hypersensitivity reactions and no history of penicillin allergy. Our study aims to document the prevalence of penicillin cross sensitivity in this patient cohort. Sixty-eight adult patients who were seen at our clinic with confirmed cefazolin hypersensitivity reactions during the ten-year study period (2009–2018) were investigated for allergy to penicillin. Demonstration of penicillin tolerance was by a combination of penicillin skin testing, penicillin drug provocation testing (DPT) and community exposure to penicillin. There were no positive penicillin DPTs or reported reactions to penicillins in the community in our cohort. There were six false positive penicillin skin test results. Four patients were lost to follow up. We conclude that allergy to penicillin is uncommon in patients with confirmed hypersensitivity to cefazolin. Penicillin skin testing in this cohort of patients is time consuming, costly, and unreliable with a significant rate of false positives which may lead to patients being inappropriately labelled as penicillin allergic.

Integrated Demand Response (IDR) as a crucial method for maintaining supply-demand balance and realizing the local consumption of distributed energy in Regional Integrated Energy System (RIES), has become a hot research topic. However, existing studies on IDR have two main shortcomings: they fail to consider the coupling relationship between response power and carbon emission quota in complex scenarios during regional transactions; and when customizing incentive strategies for consumers within regions, they overlook the fatigue characteristics of consumers. Therefore, this paper establishes an inter-regional coupled transaction mechanism of response power-carbon emission quota under complex scenarios. The incorporation of a response fatigue function enables the proficient representation of consumer response fatigue characteristics. Additionally, this paper proposes an adaptive iterative step size-based bargaining method to determine the optimal transaction price. The effectiveness of the proposed model is verified by simulation results: it not only reduces the total costs and carbon emission of IESP but also improves consumer benefits. The proposed bargaining method enhances bargaining efficiency.