Urachal disorders are as uncommon as they are mysterious. Mastering the diagnostic and therapeutic approach of various urachal illnesses, as well as a better understanding of the embryological development of the urinary system, is critical for surgeons (urologists, pediatric surgeons, general surgeons, and general practitioners).

Objectives: The ablation index (AI)-guided high-power ablation for pulmonary vein isolation (PVI) apears to be a novel strategy in treating atrial fibrillation (AF). This study aimed to evaluate the feasibility and safety of superior vena cava isolation (SVCI) by using AI-guided high-power ablation strategy among patients with AF after PVI. Methods: Data from 53 patients with AF were collected. Mapping and ablation of SVC was performed after PVI. The ablation power was set to 45 W and the ablation procedure was guided by AI. The SVC was divided into six segments in a cranial view. Applications and locations of radiofrenquency (RF) was recorded. The RF applications and AI value in different SVC walls were compared and analyzed. Results: SVCI was performed in 46 patients and electrical SVCIs were successfully achieved in all patients with a mean of 7.6 ± 2.9 RF applications. The mean time of SVCI procedure was 9.5±4.5 min. RF applications at anteroseptal wall was 38 (10.8%) points in 20 (43.5%) patients, posteroseptal wall was 74 (21.0%) points in 38 (82.6%) patients, posteral wall was 81 (22.9%%) points in 40 (87.0%%) patients, anteroseptal wall was 72 (20.4%) points in 37 (80.4%%) patients, anterolateral wall was 45 (12.7%) points in 27 (58.7%) patients, anteroseptal wall was 43 (12.2%) points in 23 (50.0%) patients. The mean AI value in septal, posterior and anterior walls was higher than that of lateral wall. There was no complication in any cases. Conclusion: AI-guided high-power ablation is feasible and safe strategy in performing SVCI. The RF applications and AI value in different SVC walls varied.

We present Wong-type oscillation criteria for nonlinear impulsive differential equations having discontinuous solutions and involving both negative and positive coefficients. We use a technique that involves the use of a nonprincipal solution of the associated linear homogeneous equation. The existence of principal and nonpricipal solutions was recently obtained by the present authors in [J. Math. Anal. Appl. 503 (2021) 125311]. As special cases, we have superlinear and sublinear Emden-Fowler equations under impulse effects. It is shown that the oscillation behavior changes due to impulses, in particular impulses acting on the solution itself, not on its derivative. An example is also given to illustrate the importance of the results.

the dramatic increase in demand of global electricity utilization has introduced various environmental and sustainability concerns for Conventional Energy Systems (CES) based on fossil fuels, which driving the global energy manufacturers to adapt new efficient and resilient energy systems. Presently the focus of the scientist and researchers is on the Renewable Energy based and Smart Grid system, which has potential to address the contemporary problems found in conventional energy systems. On the other side , Smart is a new technology, which allows the integration of clean energy sources such as wind, solar, geothermal, hydro, biomass, and tidal energy systems, ensuring energy availability at all times. The quintessential purpose of renewable technologies is to contrive a sustained community. Nevertheless, it has become a challenging concern for centralized energy systems or Smart Grid to integrate and coordinate enormous consignment of expanding users and connections. Consequently, blockchain has emerged as a resilient technology in various industries offering data integrity, trust between parties, data immutability, and secure communication, making it an auspicious technology for decentralized SG and RE criterion. In this research article, a blockchain based energy trade based modal on Peer-to-Peer transactions management presented. The main goal of the research work is to describe energy-trading model based on crypto wallets as a digital currency using smart grid and renewable energies. Moreover, electrical grid technologies, which implemented in blockchain energy based systems, will be analyze. Furthermore, contemporary challenges of industrial and commercial communities employing Renewable Energy found in conventional and centralized energy systems will be address.

Regular follow-up of patients with cardiovascular implantable electronic devices (CIEDs) is a necessary part to optimize the CIED system performance and longevity, which can assess the outcome of CIED, its working conditions and the timely identification of device dysfunction and arrhythmias. Traditional follow-up includes in-person evaluation and remote monitoring. With the development of the 5G cloud support platform, the “5G Cloud Follow-up APP” was designed to realize remote programming of CIEDs, thereby realizing emergency intervention for patients and supplementing deficiencies of traditional follow-up methods. We summarize the utilization, safety, and implications of CIED remote programming.

The impact of parasites on gut microbiota of the host is well documented, but the role of the relationship between the parasite and the host in the formation of the microbiota is poorly understood. Using 16S amplicon sequencing and newly developed methodological approaches, we characterize the gut microbiota of the sympatric pair of whitefish Coregonus lavaretus complex and the associated microbiota of cestodes parasitizing their intestine. The essence of the proposed approaches is, firstly, to use the method of successive washes of the microbiota from the cestode’s surfaces to analyze the degree of bacterial association to the tegument of the parasite. Secondly, to use a method combining the sampling of intestinal content and mucosa with the wash-out procedure from the mucosa to understand the real structure of the fish gut microbiota. Our results demonstrate that the trophic diversification of a sympatric pair of whitefish predetermines a segregation by ecological niches of their respective microbial communities within their intestine. Additional environmental niches for settlement of bacteria in the intestine are formed by the parasitic helminths that caused the restructuring of the bacterial community in infected fish compared to those uninfected. Using the desorption method in Ringer’s solution, we have demonstrated that Proteocephalus sp. cestodes possess their own microbial community which is put together from “surface” bacteria received from the host, bacteria which are weakly and strongly associated with the tegument, and microbiota obtained after removal of the tegument from the cestodes.

We would like to thank the authors for their letter and interest in our manuscript. We appreciate their valuable comments. The authors have raised the following important points: 1. The heterogenicity of our cohort with mitral valve surgery (MVS) 2. Elucidating the characteristics and causes of ventricular arrhythmias (VA) in patients with primary versus secondary mitral disease as well as in those with ischemic versus non-ischemic heart disease 3. The paucity of cardiac magnetic resonance imaging (MRI) as a limitation of the study 4. The need for careful evaluation of patients prior to ablation since most arrhythmias did not originate from the perimitral area.

Background and purpose Carnitine palmitoyltransferase I (CPT1), an integral outer mitochondrial protein and prime decider of fatty acid β-oxidation (FAO) has been considered to be a key therapeutic target against triple negative breast cancer (TNBC) progression and survival. Herein, we have introduced a biotin-functionalized copolymer, (Py-P(PDSMA-co-PEGMA)-b-P(Bt-PEGMA)), CP4 which can actively target CPT1 and block FAO in metastatic TNBC. Experimental Approach CP4 were synthesized using reversible addition fragmentation chain transfer or RAFT polymerization. In silico computation modelling predicted the active binding of CP4 with CPT1. Cell-based Seahorse energy efflux assay investigated the mitochondrial respiration, glycolytic function and overall ATP production rate. FACS analysis checked the mitochondrial membrane potential (ΔΨm), reactive oxygen species (ROS) and cell apoptosis. Real-time quantitative reverse transcription PCR (qRT-PCR) analysed FAO-related protein expression profiles. Antitumor activities were confirmed in female breast cancer (BALB/c) mice model. Key results Negative docking score and Ramachandran plot analyses affirmed the active targeting of CP4 to CPT1. Beside, CP4 has remarkably switched the ΔΨm and produced excessive ROS followed by the reduction in glycolytic function, mitochondrial oxidative phosphorylation, FAO and thereby limited excessive ATP production. In turn, it induced metastatic growth inhibition and apoptotic cell death in TNBC cells. Importantly, CP4 has significantly improved the altered lipid and oxidative stress profiles following excellent tumor regression, and thereby advocated plausible FAO-targeted anticancer therapies. Conclusion and Implications CP4 has the potentiality of being a new age FAO-targeted anticancer therapeutics that may open up a new treatment strategy against breast cancer soon.

We have designed Ti3AlB2 and two new layered ordered double-transition metals MAX compound Ti2ZrAlB2 based on the structure of Ti3AlC2. By first-principles calculations with density functional theory, their structure, phase stability, elastic properties, electronic properties and thermal properties have been further investigated. Results show that they are all energetic, thermodynamically and mechanically stable. The bulk modulus, shear modulus, Young's modulus, Poisson's ratio and Debye temperature were computed to discuss their elastic and thermal properties. Results show that they are all good ductile materials with high melting points. Density of states and electron localization function of these three phases were presented to research the chemical bonds and explore the reason limiting their melting points.

River channel shifting is the geomorphological process involving the lateral movement of an [alluvial](https://en.wikipedia.org/wiki/Alluvial) [river channel](https://en.wikipedia.org/wiki/Channel_(geography)) across its [floodplain](https://en.wikipedia.org/wiki/Floodplain). Koshi river is characterized by high planform dynamics, especially in the lower reaches. We studied the dynamics of channel planform and shifting through systematic analysis and interpretation of diverse channel configurations using multidate satellite images from 1999 to 2019 of the Koshi River from Chatara to the Nepal-India border. Remote sensing techniques and GIS environment was used for change analysis based on imageries of 1999, 2009 and 2019. The channel shifting was determined by assessing and calculating the transient changes in the planform from the temporal satellite data. The result shows that over the stretch of 48 km, the Koshi River is highly braided with no distinct sub-channel observed. Both the river stretch and braiding are greatest within the southern portion compared to the northern part. Between 1999 and 2019, the area of the water channel is reduced by 24.08 km 2 whereas, the channel bars have increased by 68.08 km 2. The river has experienced a clear shift of the channel toward the west in recent years. The average annual rate of shifting was estimated to be 21.6 m year -1 towards the west and 0.8 m year -1 towards the east, with the overall expansion of the river flood plains. Monitoring of river planform helps in effective river management. This result can be utilized for developing integrated river and land management plans in the Koshi basin.

The optimal design of two-phase flow pipes depends on various variables. Pressure drop and liquid hold-up are essential parameters in the appropriate design of pipes. These parameters can be estimated by numerical simulation of pipes. However, the simulation strongly depends on both phase frictions. Frictions are commonly calculated using friction factors, and various empirical correlations have been proposed to calculate friction factors, but most of these correlations are dependent on the experimental conditions. The present study proposes a semi-empirical friction factor model by modifying an existing model in the literature for stratified two-phase flows. Experimental data from various laboratories are taken to validate the interface shear stress, velocity profile and pressure gradient. Compared with previous models, the predicted velocity profiles and shear stresses are in better agreement with the experimental data.

Practising and solving practical problems often require knowledge and sometimes advanced problem-solving skills in several disciplines simultaneously. The issue generated during the research was developed, involves an understanding of the phenomena of fluid flow, knowledge of the principles and methods of solving heat transfer problems, coupled with those of heat stress, a high level of proficiency and solving the problems of advanced technologies, i.e. solving the issues of the state of tensions and micro-and macro-dimensional deformations. Thus, the problem to be solved here, we have structured it, virtually, in three sub-categories of related issues: Finite Element Analysis of the behaviour of the printing equipment in case of a constant heat flow, having as a subject of study the volume of hot air, in stationary flow as well as in non-stationary flow, using COMSOL MULTIPHYSICS®.

Objective To investigate the detailed procedure and efficacy of multiple targeting CO2 laser ablation (MTLA-CO2) for the treatment of vaginal intraepithelial neoplasia (VaIN) and to obtain a stably high cure rate and low complication incidence. Design Patients with VaIN were recruited and received MTLA. After follow-up, we aimed to find the risk factors affecting the efficacy. Setting Obstetrics & Gynecological outpatients’ department of Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology. Population Fifty-seven cases of LSIL(VaIN1) and 160 cases of HSIL(VaIN2,3). Methods Patients with VaIN were recruited and received MTLA. The detailed clinical data were recorded and the risk factors were analyzed. Main Outcome Measures The pathological cure and HPV clearance. Results The cumulative pathological cure rate was 92.0% and 96.0%, and the cumulative HPV negative rate was 77.5% and 75.5%, for the HSIL(VaIN2,3) and LSIL(VaIN1) groups respectively. Larger areas of lesions (p =0.083) and history of hysterectomy (p =0.037) were independent risk factors for pathological persistence. Menopause (p =0.006) and immunosuppression (p =0.059) were independent risk factors for HR-HPV persistent infection. Condemn use (p =0.002) was a protective factor against HR-HPV infection. It was proposed 3~5 times of laser ablation for HSIL(VaIN2,3) and 2~3 times of laser ablation for LSIL(VaIN1). Conclusions The MTLA for VaIN was effective and well-tolerated. The schematization of MTLA was decided according to the characteristics of VaIN lesions, high-risk factors and surveillance. Funding The National Natural Science Foundation of China (81974410, 81572571, 81630060, 82002769, 81230038). Keywords Laser ablation, targeting, VaIN

BACKGROUND AND PURPOSE Fluralaner is a novel isoxazoline insecticide with broad insect spectrum, and mainly acts on the insect GABA receptor with unique binding action, but its molecular interaction with insect GABA receptor has not been deeply identified on molecular level according to its selectivity between target (insect) and non-target (mammal) organisms. EXPERIMENTAL APPOACH The potential binding residues (I258T and L275I in TM1; V288I, M298N, G303N and A304S in TM2; G3’M/S, A327S, G336N, M338I and A339F in TM3; M473V and I477D in TM4) were predicted by SYBYL-X 2.1 software, and verified respectively by the site-directed mutagenesis and two-electrode voltage clamp (TEVC) technique. KEY RESULTS In the 11 predicted amino acids, the G3’M has the strongest ability to reduce the sensitivity of recombinant rice stem borer RDL homomeric channel to fluralaner. Compared with the wild-type (WT)-RDL, the G3’M mutation almost completely abolish the binding of fluralaner and avermectin, but not fipronil on recombinant homomeric channel of RDL from several orders of insects in vitro. In addition, the M3’G on rat Mus musculus β2 improved the sensitivity of recombinant heteromeric Mmα1β2-M3’G channel to fluralaner. Our results demonstrated that the glycine at the third position of TM3 determines the action of fluralaner and should be the binding site of fluralaner with RDL. CONCLUSION AND IMPLICATIONS These results would contribute to understanding the molecular interaction of fluralaner with RDL homomeric channel and may be used to guide future modification of isoxazolines to achieve highly selective control of pests with minimal effects on non-targeted organisms.

Microalgae have attracted interests from a range of biotechnology fields due to the variety of valuable bioactive metabolites some species can synthesise. Compounds such as ω3-fatty acids or carotenoid pigments are commercially exploited to provide the materials necessary for product formulations within the pharmacology, nutraceutical or cosmetic sectors. The co-stimulation of several compounds of interest may as such improve the cost-effectiveness of microalgal biorefinery pipelines. This study focused on the microalgal biological model species Phaeodactylum tricornutum (marine diatom) to investigate the effects on lipogenesis and carotenogenesis of combined stressors, here cold temperature shock (from 20 to 10°C) and addition of NaCl salt (5 mg/ml) or the phytohormone abscisic acid (4 mg/l), applied using a two-stage cultivation strategy. Results showed that cold stress with NaCl or phytohormone addition increased the neutral lipid content of the biomass (20 to 35%). These treatments also enhanced the proportions of EPA (22% greater than control) in the fatty acid profile of biomass extracts. In addition, these treatments had a stimulatory effect on carotenogenesis, especially the combination of cold stress with NaCl addition, which returned the highest production of fucoxanthin (33% increase). The gene expression of diacylglycerol acyltransferase (DGAT) and the ω-3 desaturase precursor (PTD15), as determined by real time PCR, were enhanced 4- and 16-fold relative to the control, respectively. In addition, zeaxanthin epoxidase 3 (ZEP3), involved in the xanthophyll cycle, was downregulated at low temperature when combined with abscisic acid. These results highlight the benefits of applying a combination of low temperature and salinity stress, as part of a two-stage cultivation process, to simultaneously enhance the yields of the valuable metabolites EPA and fucoxanthin in Phaeodactylum tricornutum.

Background and purpose: αO-conotoxin GeXIVA[1,2], a natural peptide discovered by our laboratory from Conus generalis in the South China Sea, is a novel nonaddictive analgesic targeting the α9α10 nicotinic acetylcholine receptor (nAChR). This study aimed to elucidate the underlying mechanisms by the disposition and modelling of GeXIVA[1,2]. Experimental approach: The pharmacokinetics (PK) of GeXIVA[1,2] and tissue distribution in rats and dogs were studied. A population pharmacokinetics model and a pharmacokinetic-pharmacodynamic model were developed based on animal data and used to predict the efficacious dose in humans and explain the mechanism. Key results: The intramuscular bioavailability of GeXIVA[1,2] was 11.47% and 13.37% in rats and dogs, respectively. Across experimental doses, the plasma exposure increased approximately in proportion to dose, and the half-life of GeXIVA[1,2] ranged from 5.37±0.99 to 19.65±6.21 min. GeXIVA[1,2] had less extensive tissue distribution. The bound fractions differed in human, rat, and dog plasma, ranging from 55.85±5.10% to 87.64±7.49%. The one-compartment model with the first-order absorption PPK model estimated an efficacious dose of 11.9-30.8 μg·kg-1 in a 70 kg human with bodyweight as a covariant. The inhibitory loss indirect response model combined with an effect compartment adequately described PK-PD relationships. Conclusion and implications: We speculated that GeXIVA[1,2] exerts analgesia by inhibiting the elimination of certain endogenous substances, which may be a key pharmacodynamic biomarker. This is the first report of the disposition of conotoxin-derived therapeutic agents and possible analgesic mechanisms of α9α10 nAChR, which were elucidated by PK studies and modelling approaches.

In order to make full use of the potential fatigue crack growth resistance provided by layered architectures, a validated crack path simulation algorithm for crack propagation through different elements of the layered architectures was established. The crack path approaching a material interface was predicted by using the maximum tangential strain (MTSN) criterion and the crack behaviour at the interface was simulated by a developed two-step method (a modified stress-and-energy-based cohesive zone method considering the change in direction of an interface penetrating crack). The crack path simulation by using this algorithm in layered example architectures indicates: 1) there are two criteria zones for the transition between crack deflection and penetration in terms of the relationship between interfacial strength and toughness; 2) the likelihood of a crack deflecting out of the interface will increase with the propagation of an interfacial crack and 3) the architecture difference which affects shielding or anti-shielding behaviour has a significant effect on crack deflection or penetration events.

Background. Pazopanib is an oral angiogenesis inhibitor approved to treat soft tissue sarcoma (STS) but associated with large interpatient pharmacokinetic (PK) variability and narrow therapeutic index. In order to improve its clinical use, this study aimed to define specific threshold of pazopanib trough concentration (Cmin) associated with better progression free survival in STS patients. Methods. In this observational study, pazopanib Cmin was monitored over the treatment course. For the primary endpoint, the 3-month PFS in STS was analyzed with logistic regression. Secondary, we performed exposure–overall survival (OS) in STS (Cox model plus Kaplan–Meier analysis/ log-rank test) and exposure-toxicity analyses. Results. One hundred eighteen patients (95 STS and 23 BS) were eligible for PK/PD assessment. In multivariable analysis, pazopanib Cmin < 27 mg/L was independently associated with a risk of progression at 3 months (OR 4.21, 95% CI [1.47-12.12], p = 0.008). OS was not statistically longer between patients with Cmin > 27 mg/L and those with Cmin < 27 mg/L (log-rank p = 0.07). A higher average of PAZ Cmin over the first 3 months of treatment was associated with a higher risk of grades 3-4 toxicities (40.0 vs 30.5 mg/L (OR 1.05, IC95 [1.01-1.09], p = 0.01) Conclusion. Pazopanib Cmin ≥ 27 mg/L was independently associated with improved 3-month PFS in a large cohort of STS patients. Pharmacokinetically-guided dosing could be helpful to optimize clinical management of STS patients in daily clinical practice.

Purpose We sought to investigate the association between left-sided prosthetic valve dysfunction and gastrointestinal (GI) bleeding. Methods In a retrospective cohort of patients with left-sided prostheses, we identified those who experienced one or more GI bleeds. The latest or chronologically closest echocardiogram to the GI bleed was analyzed by a blinded investigator for prosthetic valve dysfunction. Results Among 334 unique patients, 166 had aortic prostheses, 127 had mitral prostheses, and 41 had both. A total of 58 (17.4%) subjects had GI bleeding events. Patients in the “GI Bleed” group had higher mean ejection fraction (56±14% vs. 49±15%; P = 0.003) and higher prevalence of hypertension, end-stage renal disease, and liver cirrhosis compared to the “No GI Bleed” group. There was a higher prevalence of moderate or severe prosthetic valve regurgitation in the GI Bleed vs. No GI Bleed group (8.6% vs. 2.2%; P = 0.027). Moderate or severe prosthetic valve regurgitation was independently associated with GI bleeding (odds ratio, 6.18; 95% confidence interval, 1.27-30.05; P = 0.024), after adjusting for ejection fraction, hypertension, end-stage renal disease and liver cirrhosis. Paravalvular regurgitation was associated with a higher incidence of GI bleeding compared to transvalvular regurgitation (35.7% vs. 11.9%; P = 0.044). The prevalence of prosthetic valve stenosis was similar between the GI Bleed and No GI Bleed groups (6.9% vs. 5.8%; P = 0.761). Conclusion In a cohort of patients with predominantly surgically placed prosthetic valves, moderate to severe left-sided prosthetic valve regurgitation was independently associated with GI bleeding.

Plant phenology is manifested in the seasonal timing of vegetative and reproductive processes, but also has ontogenetic aspects. The adaptive basis of seasonal phenology has been considered mainly in terms of climatic drivers. However, some biotic factors as likely evolutionary influences on plants’ phenology appear to have been under-researched. Several specific cases of putative biotic factors driving plant phenology are outlined, involving both herbivores and pathogens. These illustrate the diversity of likely interactions rather than any systematic coverage or review. Emphasis is on woody perennials, in which phenology is often most multi-faceted and complicated by the ontogenetic aspect. The complete seasonal leaf fall that characterises deciduous plants may be a very important defence against some pathogens. Whether biotic influences drive acquisition or long-term persistence of deciduousness is considered. In one case; of leaf rusts in poplars, countervailing influences of the rusts and climate suggest persistence. Often, however, biotic and environmental influences likely reinforce each other. The timing and duration of shoot flushing may in at least some cases contribute to defences against herbivores, largely through brief periods of ‘predator satiation’ when plant tissues have highest food value. Wide re-examination of plant phenology, accommodating the roles of biotic factors and their interplays with environments as additional adaptive drivers, is advocated, towards developing and applying hypotheses that are observationally or experimentally testable.

DNA metabarcoding is routinely used for biodiversity assessment, especially targeting highly diverse groups for which limited taxonomic expertise is available. Various protocols are currently in use, although standardization is key to its application in large-scale monitoring. DNA metabarcoding of arthropod bulk samples can be either conducted destructively from sample tissue, or non-destructively from sample fixative or lysis buffer. Non-destructive methods are highly desirable for the preservation of sample integrity but have yet to be experimentally evaluated in detail. Here, we compare diversity estimates from 14 size sorted Malaise trap samples processed consecutively with three non-destructive approaches (one using fixative ethanol and two using lysis buffers) and one destructive approach (using homogenized tissue). Extraction from commercial lysis buffer yielded comparable species richness and high overlap in species composition to the ground tissue extracts. A significantly divergent community was detected from preservative ethanol-based DNA extraction. No consistent trend in species richness was found with increasing incubation time in lysis buffer. These results indicate that non-destructive DNA extraction from incubation in lysis buffer could provide a comparable alternative to destructive approaches with the added advantage of preserving the specimens for post-metabarcoding taxonomic work.

Pallister-Hall syndrome is a very rare genetic disorder. The diagnosis is usually suspected at the young age when a hypothalamic hamartoma is associated with polydactyly. We report the case of an 18-year-old man in whom the diagnosis of PHS was made during his hospitalization for acute adrenal insufficiency.

Recent revisions to the definition of the “waters of the United States” (WOTUS) have considerably altered how wetlands are federally regulated under the Clean Water Act. The two most recent modifications to WOTUS, the Clean Water Rule (CWR) and the Navigable Waters Protection Rule (NWPR), represent two opposing approaches to the federal wetland policy. Despite their implementation, the impacts of these rules on the regulation of wetlands have as of yet been poorly characterized at broad spatial scales. Using New York State (NYS) as a case study, we evaluated the jurisdictional statuses of more than 373,000 wetlands under the CWR and the NWPR to assess the landscape-scale effects of WOTUS re-definitions. We found that statewide and within each of NYS’s hydrologic regions, the NWPR protects fewer wetlands and less total wetland area than the CWR. The efficacy of the two regulations varied considerably in space across NYS, highlighting the need for comprehensive, nationwide assessments of wetland policy outcomes. We also observed that both rules produced non-uniform patterns in jurisdiction across a range of landscape positions and wetland sizes, preferentially protecting large wetlands close to the stream network. This effect was particularly pronounced under the NWPR, which excludes all geographically isolated wetlands from protection. Our findings in NYS emphasize the existence of unique patterns in protected wetlands across spatial scales, highlighting the value in applying geospatial analyses to evaluate environmental policy.

Bradyarrhhtmias can cause low cardiac output (CO) state despite normal left ventricular ejection fraction and normal stroke volume. CO defined as product of the heart rate (HR) and SV. Cardiorenal syndrome (CRS) type I can be a consequences of Low CO state secondary to slow HR