Patients presenting with Class III malocclusion often present significant challenges for the orthodontist and restorative clinician. The characteristic anterior crossbite is commonly associated with a maxillo-mandibular skeletal base discrepancy leading to both functional and esthetic issues. Three potential incisal tooth positions are discussed using clinical examples including implants.

Patients with chronic myelogenous leukemia (CML) harboring the T315I mutation who progress to blast phase CML while on ponatinib may be successfully treated with asciminib monotherapy following induction therapy with cytotoxic chemotherapy.

The metacommunity framework has been rarely adopted to investigate the underlying ecological mechanisms shaping microbial communities. With the aid of advanced molecular techniques, we investigated sediment communities of Fungi, Bacteria and Archaea in four Italian show caves aiming to disentangle the effects induced by tourists on species richness and composition from environmental filtering and dispersal driven mechanisms. We modelled community changes against human disturbance ---measured as the distance from the tourist path---demonstrating that the presence of visitors in caves decreases fungal species richness and causes species replacement in Bacteria and Archaea. Environmental filtering affects species richness and composition of Fungi and species richness of Archaea, while a minor role was played by dispersal, influencing only species richness in Fungi. We provide new perspectives on the dynamics of microbial communities under human disturbance suggesting that a proper understanding of the underlying selective mechanisms requires a comprehensive and multi-taxonomic approach.

81-year-old man with a history of Bio-Bentall surgery presented to the emergency department with fever, chills and back pain. Initial physical examination was inconclusive apart from sudden onset of delirium, and investigation showed elevated WBCs, anemia, and neutrophilia. Further studies revealed gram-positive cocci on the initial blood culture, which was then confirmed to be MSSA bacteremia. Subsequently, a TEE showed a peri-aortic abscess, Moderate AR and severe AS with no evidence of endocarditis. Antibiotics were started and urgent abscess drainage was planned. In a hybrid operative setting, a multidisciplinary team of cardiology, and cardiac surgery managed the periaortic graft abscess drainage through a median sternotomy and TAVR. Post-operatively, the complications included bradycardia, and RHF. Six-week course of IV Rifampin, Probenecid and Cefazolin was initiated, and patient was to remain on lifelong Cefadroxil.

Caseous liquefaction necrosis of mitral annular calcifications are rare. Rupture of its capsule may lead to systemic embolization. Surgical management entails Incision and Drainage with either mitral valve repair or replacement.

A document by Dr. Muhammad Shehryar. Click on the document to view its contents.

Background: Urogenital changes associated with menopause are now classified as genitourinary syndrome of menopause (GSM) which includes symptoms of urgency, frequency, dysuria, and recurrent urinary tract infections (UTIs) for which the recommended, treatment is estrogen. However, the association between menopause and urinary symptoms and the efficacy of hormone therapy (HT) for these symptoms is uncertain. Objectives: Our objectives were (1) to define the relationship between menopause and urinary symptoms including dysuria, urgency, frequency, recurrent UTIs, and urge and stress incontinence, and 2) to systematically review the effects of HT for urinary symptoms in peri and post-menopausal women. Search strategy: PubMed, Scopus, and the Cochrane Central Register of Controlled Trials (CENTRAL) were searched until April 2022 Selection criteria: RCTs of peri or postmenopausal women with urinary symptoms including dysuria, frequent UTI, urgency, frequency, and incontinence, in English were included. Data collection and analysis: Two authors reviewed each paper with discrepancies resolved through whole group consensus. Data extracted included: publication date, country, setting, subject number, follow-up, duration, age, race/ethnicity, study design, inclusion criteria, and main findings. Main results: There is insufficient evidence to confirm that menopause is associated with urinary symptoms. The effect of HT on urinary symptoms depends on type. Systemic HT may cause urinary incontinence or worsen existing urinary symptoms. Vaginal estrogen improves dysuria, frequency, urge and stress incontinence, and recurrent UTI in postmenopausal women. Conclusions: Menopause has not been shown to cause urinary symptoms. Vaginal estrogen improves urinary symptoms and decreases the risk of recurrent UTI in postmenopausal women.

Determination of the critical attack angle at which dynamic stall occurs has been a focus of research over the last few decades. This angle is usually determined by solving the Navier-Stokes equations, which includes viscosity, pressure, gravity, and acceleration terms. However, this article predicts the critical attack angle using Euler equations that do not contain viscous terms. The key contribution is the use of the Euler equations to capture the vortices and predict stall dynamics. The Euler equations are integrated and the resulting equations are discretized by the finite volume method. A first-order upwind-based method is used to calculate the convective fluxes at the cell boundaries in the finite volume approach. A NACA 0012 airfoil is chosen for this study at various attack angles with a Mach number of 0.3. Based on the justification of Crocco's theorem, the Euler equations successfully act as Navier-Stokes equations. The vortex patterns are found to behave independently of the artificial dissipation. All the vortices are successfully predicted using the inviscid governing equations. The obtained numerical results are validated by the existing experimental and numerical data.

Relapsed or refractive pediatric B-Acute Lymphoblastic Leukemia (B-ALL) patients have high rates of toxicities and relapse, and novel therapy is needed. We present a case of a 5-year-old male with high-risk B-ALL that was refractive to several re-induction regimens. He was put into MRD-negative remission after re-induction with chemotherapy plus overlapping rituximab, inotuzumab ozogamicin and blinatumomab, termed Mini-Hyper-CVD plus CRIB. This was well tolerated, and he received his transplant and engrafted with no significant infections, toxicities, or sinusoidal obstruction syndrome. This is the first reported use in pediatrics of a condensed sequential immunotherapy/chemotherapy regimen in a pediatric leukemia patient.

B-cell acute lymphoblastic leukemia (B-ALL) is the most common leukemia in the pediatric population, caused by a malignant clonal proliferation of B lymphoid progenitor cells. Identifying new molecular markers related to B-cell development is helpful for investing the pathogenesis of B-ALL, and is potentially important for clinical prognosis. We found that B cells showed the highest expression of glutaminyl-tRNA amidotransferase subunit QRSL1 (QRSL1) compared with other cells during the differentiation and development of hematopoietic stem cells and the expression of QRSL1 also gradually increases with the development of human fetal B-cell. Moreover, QRSL1 expression was higher in the tissues and cell lines extracted from patients with B-ALL than in corresponding control tissues. In the TARGET cohort, EFS and OS decreased in B-ALL with high expression of QRSL1, suggesting that QRSL1 was an independent prognostic factor. And high QRSL1 expression is associated with more bone marrow sites of relapse and TCF3-PBX1 gene fusions. Then analyzing the gene expression of the TCF3-PBX1 gene fusion subgroup, the significantly different gene expression between the QRSL1 low group and QRSL1 high group exhibited enrichment in cell development, suggesting that QRSL1 may participate in leukemic cell development in childhood B-ALL. Therefore, QRSL1 may be a molecule related to B cell development and is associated with molecular subtypes of B-ALL. The high expression of QRSL1 is associated with poor prognosis in patients with B-ALL, showing its potential as a prognostic marker of B-ALL leukemia.

Mesothelioma is a rare and aggressive tumor originating from the serosal lining of the pleural, peritoneal and pericardial cavities. There are very few cases diagnosed with malignant peritoneal mesothelioma reported in childhood. Thanks to the developments in the field of immunotherapy, the prognosis of the disease has improved with the addition of the immune check point inhibitor, an anti-programmed death-1 monoclonal antibody, nivolumab to the treatment of MPM. In the treatment of our case who was diagnosed with diffuse malignant peritoneal mesothelioma at a very early age; cytoreductive surgery, hyperthermic intraperitoneal chemotherapy, platinum and pemetrexed combination chemotherapy and nivolumab were used. Our patient, who has been on nivolumab therapy for 14 months and has been followed up for 20 months since her diagnosis, is still in remission. This case supports the utility of nivolumab in pediatric MPM.

A machine-learning-based prognostic strategy is developed in this paper for predicting the remaining useful life (RUL) of high-pressure packing in plunger-type hyper compressors. The proposed strategy applies principal component analysis (PCA) to identify three most important sensors out of 33 that seem relevant to the high-pressure packing. Singular value decomposition (SVD) is then performed with respect to chronological Hankel matrices reconstructed from one of these three sensor data, leakage flow. Normalized correlation coefficient between SVD eigenvalue vectors of chronological data is defined to come up with a health state assessment measurement. In order to enhance the prediction accuracy of RUL of the high-pressure packing, a linear-regression and two-term power series regression algorithms are both integrated into the NN (Neural Network) model. The effectiveness of the method is examined using the averaged difference (over thirteen data set) between the predicting and real failure events. The results showed that a maximum prediction RUL error of the model is less than 15 days and an averaged prediction RUL error is 7.23 days for 13 run-to-failure events. Furthermore, a more recent test was performed using the on-line data to examine the health states of four identical packing.

A mathematical formulation of a Linear Complementarity Problem (LCP) is presented for the 3D mixed beam-solid contact problem with the Mohr-Coulomb friction. The contact problems arising from the pile base and shaft are of linear and nonlinear complementarity problems, respectively. First, the latter is transformed into two LCPs, and then, all the LCPs are recast into a system of Fischer-Burmeister functions. Therefore, the mixed beam-solid contact problem can be solved by Newton’s method. The proposed method is validated by the numerical examples of a pile under axial compressive and tensile loads, which clearly shows that the numerical results are in good agreement with the field test results.

In this paper, we propose an algorithm for solving a two-point boundary-value problem for a linear differential equation with constant delay subject to a nonlinear boundary condition. We derive sufficient conditions for the convergence of the algorithm and for the existence of an isolated solution to the problem under study. A numerical example is provided.

Groundwater-dependent terrestrial ecosystems (GWDTE) have been increasingly under threat due to groundwater depletion globally. Within the past 200 years, there has been severe artificial drainage of low-lying areas in Denmark, leading to a gradual loss of GWDTE nature habitat areas. This study explores the spatial-temporal loss of Danish GWDTE using historically vectorized topographical maps. We carry out geographic information systems (GIS) overlap analysis between different historical topographic maps with signatures of GWDTE starting from the 19 th century up to a current river valley bottom map as a reference period. This is because farmworkers and monks have practiced drainage by ditching since the early middle ages (1100-1200). We then examine the changes in two protected GWDTE habitat types in different periods and different hydrologic spatial locations. Results reveal a decrease in the area of GWDTE over the last 200 years. We attribute this to different human interventions that through e.g., drainage, have impacted the low-lying landscape throughout history. We further conclude that downstream parts of the river network have been exposed to less GWDTE habitat loss than upstream ones. This indicates that upstream river valleys are more vulnerable to GWDTE decline. Therefore, as a management measure, caution should be exercised when designing these areas for agriculture activities using artificial drainage and groundwater abstraction since this may lead to further decline. In contrast, there is a higher potential for establishing constructed wetlands or rewetting peatlands to restore balance.

Segmentina nitida Müller 1774 is a freshwater snail which was formerly widespread throughout England and south Wales. Since the 1840s it has seen a rapid decline in its range which has been attributed to deteriorating water quality due to nutrient enrichment, lowering of water tables and over-management of the ditches in which it resides. Segmentina nitida has therefore been identified as a UK Biodiversity Action Plan (UKBAP) priority species which recommends further research for its conservation. Here we have developed a Taqman based qPCR eDNA assay for the detection of S. nitida at the Stodmarsh National Nature Reserve and compared the results with a manual survey of the ditches at this location. Our eDNA analysis exhibited an observed percentage agreement of 84% with a kappa coefficient of agreement between manual and eDNA surveys of 0.56. Three ditches determined to be negative for Segmentina nitida by eDNA analysis were manual survey positive, and a further two ditches that were negative by manual survey were positive by eDNA analysis revealing the potential for improved overall detection rates using a combination of manual and eDNA methodologies. eDNA analysis could therefore augment manual survey techniques for Segmentina nitida as a relatively quick and inexpensive tool for collecting presence and distribution data that could be used to inform manual surveys and management of ditches.

Background: It is not known whether the optimal Atrioventricular delay (AV opt) varies between left ventricular (LV) pacing site during endocardial biventricular pacing (BiVP) and may therefore needs consideration. Methods: We assessed the haemodynamic AV opt in patients with chronic heart failure undergoing endocardial LV lead implantation. AV opt was assessed during atrio-biventricular pacing (BVP) with a “roving LV lead”. Up to four locations were studied: mid lateral wall, mid septum (or a close alternative), site of greatest haemodynamic improvement and LV lead implant site. The AV opt was compared to a fixed AV delay of 180ms. Results: Seventeen patients were included (12 male, aged 66.5 +/- 12.8 years, ejection fraction 26 +/- 7%, 16 left bundle branch block or high percentage of right ventricular pacing (RVP), QRS duration 167 +/-27 ms). In most locations (62/63), AV opt increased systolic blood pressure during BiVP compared with RVP (relative improvement 6 mmHg, IQR 4-9mmHg). Compared to a fixed AV delay the haemodynamic improvement at AV opt was higher (1mmHg, IQR 0.2-2.6mmHg, p<0.001). Within most patients (16/17), we observed a difference in AV opt between pacing sites (median paced AV opt 209 ms, IQR 117-250). Within this range, the haemodynamic impact of these differences was small (median loss 0.6 mmHg, IQR 0.1-2.6mmHg). Conclusion: Within a patient, different endocardial LV lead locations have slightly different haemodynamic AV opt which are superior to a fixed AV delay. The haemodynamic consequence of applying an optimum from a different lead location is small.

This Supporting Information includes information regarding the magnetic field of the actuator magnet, MR-LF-S (which has the same geometry as MR-LF and a soft compartment), and a table comparing MR-LF to other small-scale, flexible magnetic crawler robots.  Corresponding author email:   yong.kong@utah.edu

Three-dimensional (3D) electromagnetic (EM) parametric modeling and implementation of miniaturized lumped-element power divider (PD) based on symmetrical configuration is investigated. The system design and schematic diagrams of PDs are firstly demonstrated, subsequently, the 3D EM field and field-circuit co-simulation models of PD utilizing computer simulation technology (CST) and advanced design system (ADS) tools are detailedly presented. Finally, one prototype is fabricated and measured. Simultaneously, the gain of the PD is -3.96 dB @ 100 MHz and the experimental curve is in excellent agreement with the simulation. As a conclusion, the novel design methodology applied in PD has important practical engineering value, which can be also applied in millimeter-wave (mmW) circuit.

We sought to assess effect of plant environmental adaptation strategies and evolutionary history and quantify the contribution of ecological processes to community assembly by measuring functional traits and phylogenetic composition in local forest community. We selected 18 dominant tree species in a Lithocarpus glaber–Cyclobalanopsis glauca evergreen broad-leaved forest and measured nine leaf functional traits and phylogenetic data of each species. We analyzed the variation in traits and trade-off relationships, tested phylogenetic effects on leaf functional traits, explored the influence of phylogeny and environment on leaf functional traits, and distinguished the relative effects of spatial and environmental variables on functional traits and phylogenetic compositions. The results showed the following: (i) Leaf traits had moderate intraspecific variation, and significant interspecific variation existed especially among life forms. (ii) Significant phylogenetic signals were detected only in leaf thickness and leaf area. The correlations among traits both supported “the leaf economics spectrum” at the species and community levels, and the relationships significantly increased or only a little change after removing the influence of phylogeny, which showed a lack of consistency between the leaf functional trait patterns and phylogenetic patterns. We infer the coexistent species tended to adopt “realism” to adapt to their habitats. (iii) Soil total potassium and phosphorus content, altitude, aspect, and convexity were the most critical environmental factors affecting functional traits and phylogenetic composition. Total environmental and spatial variables explained 63.38% of the variation in functional trait composition and 47.96% of the variation in phylogenetic structures. Meanwhile, the contribution of pure spatial factors was significantly higher than that of the pure environment. Neutral- theory-based stochastic processes played dominant roles in driving community functional trait assembly, but niche-theory-based determinative processes such as environmental filtering had a stronger effect on shaping community phylogenetic structure at a fine scale.

This supporting information includes supplemental figures, movies, additional results, and the key steps in the neural network training algorithm.   Corresponding author Email:   yyang60@jhu.edu (Y.Y.)     libome@tsinghua.edu (B.L.)

In this study, the CeO2-WO3/TiO2-n catalyst was synthesized by co-precipitation method with citric acid and the selective catalytic reduction (SCR) performance of citric acid modified CeO2-WO3/TiO2 catalyst was studied. The results demonstrated that compared with CeO2-WO3/TiO2 catalyst, CeO2-WO3/TiO2-6% catalyst has been widened about 30°C in the temperature range of 80% and 90%, respectively, and the highest denitration efficiency was 98.83% at 350°C. Additionally, citric acid formed complex with WO3 and CeO2 and three carboxylic acid groups can improve the stability of WO3 to inhibit the growth of TiO2 and CeO2 crystallites, thus promoting the dispersion of CeO2 and the formation of Ce-O-W solid solution. Furthermore, the strong interaction between CeO2 and WO3 in CeO2-WO3/TiO2-6% catalyst will release more Oα and Ce3+. Citric acid promoted the interaction of unsaturated W atoms and hydroxyl groups adsorbed on unsaturated W atoms, thus providing more Lewis and Brönsted acid sites on the catalyst surface

This study was conducted to determine some physicochemical characteristics and bioactive compounds of Turkish pine nut cold pressed oil. The moisture content, total protein amount and crude oil yield of the pine nut were 3.18%, 31.46% and 35.58% respectively. The fatty acid profile, tocopherol and sterol contents of this oil were characterized. Linoleic acid (46.39%) was found to be the predominant fatty acid followed by palmitic (6.3%), stearic (3.5%), gadoleic (0.81%), linolenic (0.58%), eicosadienoic (0.49%), oleic (37.73%), behenic (0.13%), palmitoleic (0.1%), margaric (0.08%), myristic (0.06%) and heptadecenoic acid (0.05%). Regarding tocopherol composition, α-tocopherol (174.48 µg/g), γ-tocopherol (485.92 µg/g) and α-tocotrienol (2004.65 µg/g) were major ingredients in the pine nut oil. Regarding sterol composition, pine nut oil was determined to have remarkably high content of β-sitosterol (76.15%). The other sterols present in the oil were campesterol (15.60%), sitostanol (6.46%), D-5,24-stigmastadienol (1.43%) and ergosterol (0.36%). The most abundant triacylglycerol (TAG) was LLL (trilinolein) (11.5867%) followed by OLnL (Oleolinolenolinolein) (0.7302%), PLnL (Palmitolinolenolinolein) (0.1422%) and PoLL (Palmitoleodilinolein) (0.0826%).

A male passenger arriving at Nanning Wuxu Airport in Guangxi on an international flight from Jakarta, Indonesia, was found to be positive for SARS-CoV-2 nucleic acid on a routine test at the airport on June 8 2021. The passenger was sent to Fourth People’s Hospital of Nanning immediately for further isolation and observation. On the day of admission, the test for SARS-CoV-2 nucleic acid of nasopharyngeal swabs, pharyngeal swabs and sputum specimens were positive (CT values of N gene and ORF1ab gene were between 20 and 30). After 8 weeks of hospitalization, the patient’s test for SARS-CoV-2 nucleic acid of all specimens turned to negative. We isolated a SARS-CoV-2 variant strain from the nasal swab of the patient, and then we found that the genome sequence of the variant strain had 13 base deletions and 38 nucleotide mutations compared with that of the Novel Coronavirus Wuhan strain after sequencing, comparison and analysis. The deletions and mutations of the variant strain resulted in four amino acid deletions and 30 amino acid mutations. Furthermore, we found that the variant strain was similar to those from Indonesia, South Korea and The United Kingdom after conducting BLAST analysis on GISAID platform, among them, hCOV-19 /Indonesia/ Ji-ITD-43591N /2021 was the most similar, with 99.98% similarity and only 8 base differences. The maximum likelihood phylogenetic tree was constructed taking the Wuhan strain as the root and including most the reference sequence contained most of the epidemic strains. The result showed that the strains isolated in our laboratory belonged to Delta strain.