Aim Tracheal tubes were placed together with bronchial blocker into trachea, which would result in increased airway resistance and hypoventilation in young children. The aim of this study is to investigate the efficacy and safety of laryngeal mask way (LMA) with the bronchial blocker for OLV in children undergoing thoracoscopic surgery. Methods: Sixty children undergoing thoracoscopic surgery were randomly divided into two groups in this prospective, controlled clinical study. The group A received OLV using the bronchial blocker via LMA, while the group B received OLV using the extraluminal technique of the bronchial blocker. The placement time of LMA and the bronchial blocker was noted. Respiratory mechanic parameters [tidal volume (Vt), compliance of lung (CL) and PETCO2] were recorded. Postoperative complications were also recorded. Results: The placement time was shorter in group A than in the group B (3.9 ± 0.5 vs. 5.2± 0.7 min, P <0.01). Vt and CL 30 min after the initiation of OLV were increased in group A than in group B (97.3±7.4 vs 89.9±7.8 ml, 23.2±2.6 vs 20.3±3.5 ml/cmH2O, P < 0.01, respectively), while PETCO2 in group A were lower compared to the group B (39.4±4.3 vs. 43.5±4.8 mmHg, P = 0.01). At 30 min after the initiation of OLV, PaO2 was higher in group A (236.6±41.0 vs 208.2±45.9 mmHg, P =0.014), while PaCO2 were lower in group A (43.8± 2.5 vs 46.3± 4.1 mmHg, P = 0.006), there were statistical significant differences in PaO2 and PaCO2 between the 2 groups. Conclusions: Use of the bronchial blocker via LMA for OLV takes less placement time and improves ventilation and with fewer complications compared to the extraluminal technique. It provides a novel approach to lung isolation in pediatric thoracic anesthesia．

A document by Xiaoting Song, written on Authorea.

This paper deals with localized waves in the (2+1)-dimensional Caudrey-Dodd-Gibbon-Kotera-Sawada (CDGKS) equation in the incompressible fluid. Based on Hirota’s bilinear method, N-soliton solutions related to CDGKS equation are constructed. For the case N = 5 and N = 6, the exact expression of multiple localized wave solutions comprising lump solitons are obtained by using the long wave limit method. A variety of interactions are illustrated analytically and graphically. The influence of parameters on propagation is analyzed and summarized. The results and phenomena obtained in this paper enrich the dynamic behavior of the evolution of nonlinear localized waves.

A mathematical model is used to study the effect of the magnetic field on the temporary free convection flow of the electrically conductive fluid past the vertical plate under periodic temperature. The governing momentum and energy equations are solved analytically using the homotopy perturbation method. An approximate analytical solution using Homotopy perturbation method and Laplace transform is carried out for temperature profile in case of constant plate temperature. The results are obtained the analytical and limiting case results ones, and a good agreement is achieved. The effect of different physical parameters on transient velocity and temperature, such as Grashof number, magnetic parameter, Prandtl number and temperature frequency, is examined. Also, the local Skin-friction and local Nusselt number coefficients are obtained and analyzed.

Hand and foot syndrome (HFS) is a toxic dermatologic reaction to chemotherapy, commonly described with capecitabine, 5fluouracile, vinorelbine, and cytarabine. Taxanes are less likely to induce HFS, and very few cases reported paclitaxel-induced HFS. We report a serious case of HFS induced by paclitaxel in a breast cancer female.

We also aimed to present our experience about the diagnosis and treatment of our cesarean scar choriocarcinoma case whose tumor was chemoresistant and recurred in four months.

Localised soft tissue swelling as initial presentation in child acute lymphoblastic leukemia (ALL) is extremely rare. We first report one case presenting with clitoris swellings. She was done for an abdominal biopsy from the retroperitoneal mass suspicious of neuroblastoma. Follow-up, she was eventually diagnosed with precursor B cell ALL by bone marrow biopsy, with TCF3-PBX1 fusion gene and additional chromosomal aberrations. After chemotherapy, although the girl had transiently clinical remission, the bone marrow aspirate indicated a poor outcome. Thus, this highly localised presentation is unusual and would hopefully inform clinicians to have a high index of suspicion for ALL.

In this study, the effect of PT with Trichoderma sp. AH on structure of rice wheat (RS) and wheat straw (WS) was investigated. TG/DTG analysis shows that PT could incompletely degrade RS and WS with no significant effect on their group composition. XRD analysis shows that PT could incompletely destroy the crystal structure of RS and WS causing lower crystallinity, which clearly suggests that PT is effective in disrupting the structure. The effect of PT on RS and WS is primarily on cellulose and hemicelluloses decrystallization to amorphous material. XPS analysis shows that PT has some influence on the oxygen- and nitrogen-containing compounds with increasing the relative contents of some oxygen- and nitrogen-containing compounds. PT is an effective preparation for biomass liquefaction by destroying the structure of biomass with minimal loss of carbohydrates.

A document by Qiaoxing Liang, written on Authorea.

Prosthetic valve endocarditis is a rare but serious complication of cardiac valve replacement, and echocardiography plays a fundamental role in its diagnosis and management. However, there is not much information about the use of the 3D transillumination rendering in this context. In this report we present an unusual case of prosthetic valve endocarditis that exemplifies the utility of this new tool.

Photo-enzymatic integrated nanocatalyst which combined biocompatible photocatalytic carrier and OPH is designed to remove OPs. H-TiO2 microsphere is prepared using wrinkled SiO2 as template. Then, Au nanoparticles are loaded on the H-TiO2 to obtain Au-H-TiO2 heterojunction microsphere, which achieved effective use of visible light based on the SPR. The characterization results of Au-H-TiO2 prove that the Au-H-TiO2 has large specific surface area (226.19 m2/g) and narrow band gap (2.68 eV). Adsorption methods are used to prepare OPH@Au-H-TiO2 by immobilizing OPH molecules. The obtained OPH@Au-H-TiO2 can degrade methyl parathion to p-NP by OPH. Then the p-NP is degraded to hydroquinone with low toxicity using Au-H-TiO2. After 2.5 h, methyl parathion is completely degraded, and about 82.64% of the generated p-NP is further degraded into hydroquinone. The fabricated OPH@Au-H-TiO2 has excellent catalytic activity and cycle stability, which is ascribed to the photo-enzyme synergic catalytic effect.

Aim: We aimed to evaluate (immunohistochemically) the YAP expression in breast cancer patients undergoing neoadjuvant chemotherapy and to clarify the relationship between the molecular characteristics, treatment response and survival data and the YAP expression, and hence, to clarify the prognostic significance. Methods: One hundred and four patients who were admitted to Erciyes University Faculty of Medicine after the approval of the Ethics Committee and were diagnosed with Breast Cancer between 2015-2020 and underwent NeoAdjuvant Chemotherapy were included in the study. The diagnoses of these patients were determined by any of the methods of Breast USG, Mammography, Breast MRI and, if necessary, PET/CT, and among pathological samples, Estrogen Receptor (ER), Progesterone Receptor (PR), Human Epidermal Growth Receptor-2 (HER2) and Ki-67 Expression are routinely stained immunohistochemically. In this study, existing immunohistochemical markers were reviewed and also, the relationship of YAP with these biological markers was evaluated by using immunohistochemistry and its effect on prognosis has been investigated. Results: The average age of the patients was 52.37. While YAP was positive in 78 patients (75%), it was negative in 26 patients (25%). In the evaluation after neoadjuvant therapy, pathological complete response (Miller Payne Grade 5 response) in 28 patients (26.9%), relapse in 6 patients (5.8%), and exitus in 6 patients (5.8%) were detected. In the pathological evaluation, invasive Ductal Carcinoma was the most common one observed in 88 patients (84.6%). As a result of the statistical evaluation, no significant result was obtained between the parameters and YAP negative / positive. Conclusion: As a result of staining with additional YAP in patients who were diagnosed with breast cancer and routinely stained with ER, PR, Cerb B2 and Ki-67 in pathology samples, we could not reach a result that would contribute positively to survival. Longer studies to be conducted prospectively will be meaningful.

Background Essential training for emergency adrenaline auto-injector administration alone provides inadequate safeguard in school environments. Recent UK deaths have reinforced the urgency for embedding whole school (WS) allergy awareness to minimise risk. We document development of a practical, flexible WS Food Allergy Awareness Toolkit for UK secondary schools. Methods We used a multidisciplinary participatory action research methodology, involving successive modification and retesting of a pragmatic toolkit in 3 case study schools. A School Allergy Action Group drives WS risk assessment, helping schools gradually implement best practice policy in line with their particular needs. Additional schools self-piloted the resulting toolkit with only remote monitoring. School surveys, based on EAACI guidelines were developed to identify priorities and assess change. Results Effectiveness of the resulting process toolkit, now available online, was independently demonstrated via pre/post intervention questionnaires from 24/10 pupils with food allergy (FA) and 97/6 pupils without FA, respectively. Pearson correlational analysis showed strong negative relationships between Food Allergy Quality of Life Questionnaire (FAQLQ) at T0 and School Support (SS) at T0 (r=-0.8, p<0.01), and between SS and Self-Efficacy (SE) (r=0.73, p<0.05). Mean FAQLQ scores improved between T0 (3.3) and T1 (2.5). SE improved for those with FA (mean difference =1.0). In those without FA, SE (mean difference =0.9) and Attitudes and Knowledge (mean difference =0.7) also improved. Conclusions Full stakeholder involvement in toolkit development encourages usage and therefore improves WS community awareness; reduces risk of reactions; fosters a more accepting societal attitude; and empowers pupils with/without allergies to self-manage effectively.

Background and purpose: TwHF has been used in traditional Chinese medicines for treating CVD. However, the underlying pharmacological mechanisms of the effects of TwHF against CVD remain to be elucidated. The aim of the present study is to reveal the pharmacological mechanisms of TwHF acting on CVD based on a pharmacology approach. Experimental approach: The active compounds were screened by TCMSP according to ADME. The potential targets of TwHF were predicted by SwissTargetPrediction database. The CVD-related therapeutic targets were obtained by the DrugBank, the OMIM database and the GeneCards database. PPI network was constructed by STRING database. GO and KEGG pathway enrichment analyses were performed by R package. The network of drug‐targets-diseases-pathways was constructed by Cytoscape software. Key results: A total of 51 effective ingredients of TwHF and the 178 common targets of TwHF and CVD-related were collected. AKT1, APP, MAPK, PIK3CA and TP53 was identified the core targets involved in the action of TwHF on CVD. Top ten GO and KEGG pathways were identified with a P value ≤ 0.01. Finally, we constructed the network of TwHF-targets-CVD-GO-KEGG. Conclusion and implications: Our results demonstrated that the main active compound of TwHF exerts cardiovascular protective effects and the core targets and pathways associated with the effects of TwHF on CVD. By the construction of the network of TwHF-targets-CVD-GO-KEGG, network pharmacology uncovered the pharmacological mechanisms of the action of TwHF on CVD and indicated a novel perspective to identify the intricate interactions among TwHF, candidate targets and related pathways.

Background and Purpose: Sex hormones affect heart rhythm by regulating ion channels, but the effect of estrogen on cardiac voltage-gated sodium channel in stress-induced pathological conditions is currently not well defined. In this study, we explored the impact of various concentrations of estrogen and the role of its rapid receptor G protein-coupled estrogen receptor (GPER) on sodium channel function in a simulated cardiac stress model of human induced pluripotent stem cell-derived cardiomyocytes (hiPSC-CMs). Experimental Approach: Isoproterenol treated hiPSC-CMs were pre-incubated with various concentrations of β-Estradiol. Their sodium channel electrophysiological function and action potential were dissected by patch clamp and the content of sodium channel was observed by immunohistochemical method combined with laser scanning confocal microscopy. The GPER-specific effect was determined with agonists G1, antagonists G15 and small interfering RNA and sodium channel electrophysiology was selectively detected. Key Results: Isoproterenol-induced stress increased peak sodium current and late sodium current, and shortened action potential duration but the effects of stress were eliminated by β-Estradiol. Pearson Correlation analysis demonstrated no association between estrogenic effects on sodium currents versus content of sodium channel. Activation of GPER produced similar effects as β-Estradiol, while inhibition of GPER cancelled the effects induced by β-Estradiol. Conclusion and Implications: Estrogen through its rapid signal receptor GPER ameliorated the detrimental effects of β-adrenergic overstimulation like in cardiac stress on sodium channel dysfunction in hiPSC-CMs. These results are of great clinical significance as we need to understand the role of sex hormones in cardiovascular disease.

Many drugs are responsible, through different mechanisms, for peripheral edema. Severity is highly variable ranging from slight edema of the lower limbs to anasarca pictures as in the capillary leak syndrome. Although most often non-inflammatory and bilateral, some drugs are associated with peripheral edema that is readily erythematous (e.g., dopaminergic agonists, pemetrexed) or unilateral (e.g., sirolimus). Thus, drug-induced peripheral edema is underrecognized and misdiagnosed, frequently leading to a prescribing cascade. Four main mechanisms are involved, namely precapillary arteriolar vasodilation (vasodilatory edema), sodium/water retention (renal edema), lymphatic insufficiency (lymphedema) and increased capillary permeability (permeability edema). The underlying mechanism has significant impact on treatment efficacy. This review provides a comprehensive analysis of the main causative drugs by illustrating each pathophysiological mechanism and their management through an example of drug.

Terrestrial biosphere models (TBMs) are extremely sensitive to the parameterization of the Farquhar, von Caemmerer & Berry model of photosynthesis, particularly the apparent maximum carboxylation capacity (Vcmax) of Rubisco. New instrumentation and approaches have enabled the rapid measurement of apparent Vcmax that paves the way for the investigation of diurnal variation in Vcmax and improved understanding of the potential impact on representation of photosynthesis in TBMs. Here we show that reductions in Vcmax over the course of a photoperiod can be as great as 50% and, when incorporated into a model of daily CO2 assimilation, show that net carbon gain can change between -19 and 215% when compared to the current TBM assumption of a constant Vcmax. Given the obvious impact on TBM representation of photosynthesis, we recommend a renewed focus on the measurement of diurnal responses in photosynthetic capacity across biomes to advance understanding and enable model representation of this important phenomenon.

In this paper we examined the potential for choline-based deep eutectic solvents (DESs) for selective extraction of tocol isomers from crude palm oil (CPO) through liquid-liquid extraction. The effect of increasing DES amount on the distribution and selectivity of tocol isomers (α-tocopherol, α-β, γ-, and δ- tocotrienol) were investigated. It was found that tocol isomers are distributed in the order of the hydrophilic power of the tocols, with more tocols of higher polarity distributed more into the stripping phase compared to the less polar tocols. Distribution coefficients for α-tocopherol, α-β, γ-, and δ- tocotrienol were 7.8, 13.1, 19.8, 22.1 and 29.6, respectively, when equal weight of CPO and choline chloride-malonic acid eutectic mixture (DES1) was used. With increasing DES1, the distribution of each tocol isomers also increased, due to the increasing polarity of the stripping phase that attracted more tocols. Selectivity of δ- tocotrienol which is the most polar, were always higher than other isomers (α-tocopherol: 3.81, α-tocotrienol: 2.22, β-tocotrienol: 1.50, γ-tocotrienol: 1.34). This confirmed the role of hydrophilic power of the tocols in selective separation of tocol isomers using DES in this study

Camelina sativa is an important oilseed due to its potential in the production of biodiesel and bioproduct. To investigate the water deficit– induced effects and PGPB on the growth and seed composition of Camelina “Soheil cultivar”, an experiment was programmed in three levels 100, 75 and 50%FC and the presence of Micrococcus yunnanensis as plant growth- promoting bacteria during the reproductive phase. The results showed under water deficient silique and seed number and silique length decrease coincided with the increase of seed weight. Also the decrease of oil content associated with the increased protein and total carbohydrate content. Carbon to nitrogen ratio and oil content were in a line and the nitrogen to sulphur ratio positively correlated to protein content. In seeds, the increase of Mn and P associated with the decrease of Fe and Zn. The highest proportion of fatty acid was related to poly unsaturated fatty acid in particular linolenic acid. The increase of poly unsaturated fatty acid and saturated fatty acid coincided with the decrease of mono unsaturated fatty acid under water deficit stress. The antioxidant capacity and total phenol content had an increasing trend with limited water. PGPB application resulted in the increase of seed weight, seed and silique number, nutrients uptake and the increase of protein. Also, PGPB increased antioxidant capacity and total phenol. PGPB decreased oil content but it had various effects on fatty acid profiles. In general, PGPB had significant effect on remobilization nutrients from soil to developing seed and following metabolites synthes

Cannabis sativa is an extraordinarily versatile species. Hemp and its cousin marijuana, both C. sativa, have been used for millennia as a source of fibre, oil and for medicinal, spiritual and recreational purposes. Because the consumption of Cannabis can have psychoactive effects, the plant has been widely banned throughout the last century. In the past decade, evidence of its medicinal properties did lead to the relaxation of legislation in many countries around the world. Consequently, the genetics and development of Cannabis as well as Cannabis-derived products are the subject of renewed attention.Here, we review the biology of C. sativa, including recent insights from taxonomy, morphology and genomics, with an emphasis on the genetics of cannabinoid synthesis. Because the female Cannabis flower is of special interest as the site of cannabinoid synthesis, we explore flower development, flowering time well as the species’ unique sex determination system in detail. Furthermore, we outline the tremendous medicinal, engineering, and environmental opportunities that Cannabis bears. Together, the picture emerges that our understanding of Cannabis biology currently progresses at an unusual speed. A future challenge will be to preserve the multi-purpose nature of Cannabis, and to harness its medicinal properties and sustainability advantages simultaneously.

Background: Coronavirus (COVID-19) pandemic has brought adjustments to ophthalmology clinics, especially vitreoretinal clinics where examinations and procedures are performed in close contacts. Screening and surgery prioritization policy are essential to maintain safety for medical personnel and patients. Aim: To present implementation of screening and surgery prioritization policy in a tertiary ophthalmology referral center in Indonesia. Methods: Safety protocol was implemented in Kirana Eye Center, Cipto Mangunkusumo Hospital, Jakarta, Indonesia from April 2020 to prevent COVID-19 spread. Initial screening consisted of temperature checking, hand hygiene, and questionnaire of COVID-19 signs and symptoms, was performed to patients and caregivers. Those with sight-threatening emergencies were prioritized. Sight-threatening surgical cases were also prioritized. Records of patients in vitreoretinal clinic and operating room were taken on April 2020. Data on diagnosis and procedures was analysed. Results and discussion: There were drastic declines in the number of patients allowed entry to the clinic and patients underwent surgery. There was approximately 80% decrease of patients coming into the clinic with total of 314 patients during March 2020. Most of these patients were pre-existing patients followed up after surgery, patients with diabetic retinopathy and retinal detachment (RD). Most cases managed surgically were RD. Most carried out procedure was vitrectomy, endolaser, and silicone oil tamponade. Conclusion: Our protocol of safety has been successful in reducing patients coming in to our facility but still manage to treat those with sight-threatening conditions. Our protocol may be a model for developing countries. Keywords: COVID-19, vitreoretinal clinic, public health, health policy Word count: 248

Repositioning of remdesivir and tenofovir against COVID-19 has shown only partial evidence of improving clinical outcomes, in clinical trials and observational studies respectively. The rationale behind this inconsistent efficacy remains unknown. Here, we developed an ensemble docking approach for the active triphosphate forms of both antivirals with the SARS-CoV-2 polymerase and the RNA chain complex, under the hypothesis that clinical observation could rely on the specificities of the drug-target interaction. Our model framework allowed accurate reconstruction of the remdesivir ensemble, which presented the strongest binding affinity and pose stability close to the natural counterpart dATP. We further observed a set of features of the tenofovir complex that suggests functional yet suboptimal interaction, likely resulting in limited viral inhibition in the absence of high intracellular concentration at target tissues. Our findings provide rationale for the mixed effectiveness of tenofovir-based compounds against SARS-CoV-2 and underscore the relevance of the intracellular availability of the nucleotide analogues relative to viral tropism.

Objective To explore the pregnancy experience and mental state of women undergoing fetal surgery due to twin-to-twin transfusion syndrome. Design A mixed methods study collecting: both quantitative and qualitative data Setting The Affiliated Shengjing Hospital of China Medical University Population Women undergoing fetoscopic surgery due to Twin-to-twin transfusion syndrome Main Outcome Measures Quantitative data was collected using the Impact of Event Scale-Revised questionnaire, the Self-Rating Anxiety Scale, and the Pregnancy Stress Scale. Qualitative data was collected using a semi-structured interview Results The emotional reaction of women undergoing fetoscopic surgery due to twin-to-twin transfusion syndrome was long-term, and the adverse emotions did not diminished over time. After surgery, patients were constantly worried about the health of the fetuses,and the lack of disease information will aggravate their uncertainty and worry. Twin transfusion syndrome may also cause a post-traumatic stress reaction in women, but for protecting the surviving fetuses ,they utilized positive ways to regulate negative emotions, so postoperative worry about fetuses did not cause them much anxiety. Conclusion Gestational emotional reaction of women undergoing TTTS fetoscopic surgery is complicated. According to our research , optimizing the referral system and strengthening disease information support could be a good way for clinical staff to improve these women’s mental state during pregnancy and avoid emotion to fluctuate violently,especially for people with weaker fertility.

Objective The aim of this study is to develop ddPCR based-assay for detecting alpha (0)-thalassemia (SEA) and beta-thalassemia (HbE and 41/42 (-CTTT) from cell-free fetal DNA (cffDNA) extracted form maternal plasma. Design Feasibility study using sample collected from prenatal clinic. Setting Thailand. Population 46 couples who were identified to be carriers of alpha or beta thalassemia. Method Cell-free DNA from 46 singleton pregnant women were isolated and quantified using ddPCR with specially designed probes for each target allele. Allelic copy number (CNV) calculation and likelihood ratio test were used to classify the most likely fetal genotypes. Classification performances were evaluated against ground truth fetal genotypes obtained from conventional amniocentesis. Main outcome measures Concordance with fetal genotyping results from invasive technique. Sensitivity and specificity of ddPCR-based assays. Results CNV analysis of SEA deletion accurately classify fetal genotypes in 20 out of 22 cases with an AUC of 0.98 (95% sensitivity and 91% specificity) for the prediction of Hb Bart’s hydrops fetalis. Application of sequential probability ratio tests to detect HbE and 41/42 correctly classified 12 out of 24 cases (10 out of 16 HbE and 2 out of 8 41/42) and provided inconclusive for 7 cases. Conclusion We showed that ddPCR-based analysis of maternal plasma is an accurate and effective NIPD for SEA deletion. Although the performance of ddPCR-based assay on HbE and 41/42 mutations is still not high enough for clinical application, our work should serve as a good foundation for future works in this field.