Documenting patterns of spatio-temporal change in hyper-diverse communities remains a challenge for tropical ecology, yet is increasingly urgent as some long-term studies have shown major declines in bird communities even in relatively undisturbed sites. In 1982, Terborgh et al. quantified the structure and organization of the bird community in a 97-ha. plot in southeastern Peru. We revisited the same plot in 2018 and repeated the same intense combination of methodologies as the original study in order to evaluate community-wide changes. Contrary to the results from studies elsewhere, we found little change in bird distribution and abundance within the plot, although there were some declines related to loss of mixed-species flocks with a high level of species interdependence. This apparent stability suggests that large-scale forest reserves such as Manu National Park may provide the conditions necessary for establishing refugia from at least some of the effects of global change on birds.

Introduction. During left bundle branch area pacing (LBBAP) lead implantation, intermittent monitoring of unipolar pacing characteristics validates LBB capture and can detect septal perforation. We aimed to demonstrate that continuous uninterrupted unipolar pacing from an inserted lead stylet (LS) is feasible and facilitates LBBAP implantation. Methods. Thirty patients (mean age 76 ± 14 years) were implanted with stylet-driven pacing lead (Biotronik Solia S60). In 10 patients (validation-group) conventional, interrupted implantation was performed, with comparison of unipolar pacing characteristics between LS and connector-pin (CP)-pacing after each rotation step. In 20 patients (feasibility-group) performance and safety of uninterrupted implantation during continuous pacing from the LS were analyzed. Results. In the validation-group, LS and CP-pacing impedances were highly correlated (R2=0.95, p<0.0001, bias 12±37Ω). Pacing characteristics from LS and CP showed comparable sensed electrograms and paced QRS morphologies. In the feasibility-group, continuous LS-pacing allowed beat-to-beat monitoring of impedance and QRS morphology to guide implantation. This resulted in successful LBBAP in all patients, after a mean of 1±0 attempts, with mean threshold 0.81 ± 0.4V, median sensing 6.5mV [IQR 4.4-9.5] and mean impedance 624 ± 101Ω, and positive LBBAP-criteria with median paced QRS duration 120ms [IQR 112-152ms] and median pLVAT 73ms [IQR 68-80.5ms]. No septal perforation occurred. Conclusion. Unipolar pacing from the LS allows accurate determination of pacing impedance and generates similar paced QRS morphologies and equal sensed electrograms, compared to CP pacing. Continuous LS pacing allows real-time monitoring of impedance and paced QRS morphology, which facilitates a safe and successful LBBAP lead implantation.

Cavernous transformation of the portal vein (CTPV) is a rare condition characterized by the formation of multiple tortuous tiny blood vessels within and around a portal vein which has been occluded by thrombus. Early diagnosis of CTPV is relevant for timely intervention which could save the liver from non-reversible damage

Abstract Objectives: Treatment for olfactory dysfunction is challenging due to limited therapeutic options. Olfactory training has shown improvement in smell identification, discrimination, and threshold for odor detection. The primary objective is to assess the effect of olfactory training in patients with olfactory dysfunction after pituitary surgery, using functional Magnetic Resonance Imaging (fMRI). Design: This study was designed as a two-arm pilot clinical trial. Setting: Chilean tertiary hospital providing endoscopic pituitary surgery and olfactory evaluation and treatment. Participants: We included two cohorts of subjects: healthy subjects, and patients with post-surgical olfactory dysfunction. Healthy patients were recruited voluntarily at the ENT clinic to assess fMRI testing paradigms and as a control group for the olfactory dysfunction group. Main outcome measures: The main outcome measures were functional activation analysis obtained by fMRI. Olfactory test assessment scores were also obtained during each testing session. Results: 119 patients that underwent an endoscopic transsphenoidal approach were contacted and surveyed for olfactory dysfunction. Twelve patients met inclusion criteria, but six of them declined to participate. Six patients were randomized using computer-generated random numbers. The patients in the trained group showed a significant improvement in the olfactory test results after olfactory training compared to the no-training group (P < 0.05). The group that underwent olfactory training showed more areas of activation after training than in baseline analysis (P < 0.05). Conclusion: Patients that underwent olfactory training showed significant improvement in olfactory testing. fMRI results showed more activated areas in the olfactory training group, which could be compatible with neuroplasticity.

Objective: To review the effect of the COVID-19 pandemic on the presentation of Cervical cancer. Design/ Setting: Retrospective study involving the Regional Cancer Centres in the M62 Group. Methods: Data was collected for two equal time periods. All cervical cancers were included and FIGO 2018 staging was used for the data collection. P values were calculated using binomial hypothesis test for the difference in staging. Time from symptoms to diagnosis was assessed using a normal distribution test. All other calculations were performed using chi-squared test. Statistical significance was considered if p values were <0.05. Main outcome measures: Histology, stage at diagnosis, date of onset of symptoms, investigation and type of treatment. Results: A total of 406 cases of cervical cancer were reviewed; 233 from May – October 2019 (pre-COVID) and 173 between May – October 2020 (post COVID); representing a significant reduction in new cervical cancer diagnoses of 25% post COVID (p<0.001) There was a 42% increase in the delay from start of symptoms to diagnosis Post COVID. Pre COVID, 27% of patients presented with Stage 3 or 4 disease, whilst during COVID this was 38%; statistically significant (p <0.001). When we evaluated the treatments received between the two time periods, this was also statistically significant (chi-squared, p=0.0005). Conclusions: This study has demonstrated a statistically significant increase in the stage of cervical cancer at diagnosis and a change in treatment for cervical cancer following the onset of COVID-19. The implications of this are discussed.

A document by Belen Nigro, written on Authorea.

Paraparetic Guillian-Barre Syndrome is an uncommon variant of GBS. We describe a case of a teenage boy, who developed progressive, symmetric weakness of the lower limbs following an upper respiratory tract infection. Post-infectious, monophasic, acute, symmetric course were suggestive of paraparetic GBS which were further confirmed by CSF, electrophysiologic fndings.

Rationale, aims and objectives: There is a large body of literature from all over the world that describes, analyzes, or evaluates home care models and interventions. The present article aims to identify the practical lessons that can be gained from a systematic examination of that literature. Method: We conducted a three-step sequential search process from which 113 documents were selected. That corpus was then narratively analyzed according to a realist review approach. Results: A first level of observation is that there are multiple blind spots in the existing literature on home care. The definition and delimitation of what constitutes home care services is generally under-discussed. In the same way, the composition of the basket of care provided and its fit with the need of recipients is under-addressed. Finally, the literature relies heavily on RCTs whose practical contribution to decisions or policy is disputable.At a second level, our analysis suggests that three mechanisms (system integration, case management and relational continuity) are core characteristics of home care models effectiveness. Conclusion: We conclude by providing advice for creating effective home care system change through rational and participatory design and evaluation alongside public dialogue about the purpose and future of home care.

A patient with seizure disorder history was referred for right shoulder dislocation. Post-reduction radiographs revealed a large Hill-Sachs deformity. Patient factors were important in determining the treatment.

The morphology variations of the so-called scimitar vein are many and varied. We present a synthesis of 92 published investigations of the overall scimitar syndrome. We reviewed the clinical presentations, diagnostic modalities, surgical approaches, and outcomes. Diagnostic information was provided by clinical presentations, radiographic findings, transthoracic and transesophageal echocardiography, computed-tomographic angiography, magnetic resonance imaging, angiocardiography, and ventilation/perfusion scans. These investigations served to elucidate the origin, course, and termination of the scimitar vein, the intracardiac anatomy, the presence of associated defects, and the patterns of any accompanying pulmonary lesions. In short, they defined the disease prior to surgical intervention. Of the patients described, up to four-fifths presented during infancy, with cardiac failure, increased pulmonary flow, and pulmonary hypertension. Associated cardiac and extracardiac defects, particularly hypoplasia of the right lung, are present in up to three-quarters of cases. Overall operative mortality has been cited between 4.8% and 5.9%. Mortality was highest in patients with preoperative pulmonary hypertension, and those undergoing surgery in infancy. Despite timely surgical intervention, post-repair obstruction of the scimitar vein, intra-atrial baffle obstruction, or stenosis of the inferior caval vein were reported in up to two-thirds of cases. The venous obstruction could not be related to any particular surgical technique. On long term follow-up, one sixth of patients reported persistent dyspnoea and recurrent respiratory infections. Any infants presenting with heart failure, right-sided heart, and hypoplastic right lung should be evaluated to exclude the syndrome. An increased appreciation of variables will contribute to improved surgical management.

In this paper, we prove that the following planar Schrödinger-Poisson system with zero mass -Δu+φu=f(u), x∈R^2, Δφ= 2πu^2, x∈R^2, admits a nontrivial radially symmetric solution under weaker assumptions on f by using some new analytical approaches.

The aim of this article is to study the relationships and models among the Van den Dool and Kratz equation, the gas chromatography, and the Bézier curves constructed by aid of the Bernstein polynomials. Another aim of this article is to introduce open problems that contribute to real-world problems involving mathematics, chemistry, and plant biology, including the Van den Dool and Kratz equation, the gas chromatography, and Bézier curves. Searching for the solutions of these problems may have qualities that will create the potential that can enter the field of study of many researchers. As a result of these goals, the usability of Bézier curves was investigated while determining the chemical composition of essential oil obtained from P. Aladaghensis Leblebici. By applying the retention index from the Van den Dool and Kratz equation and evaluating chemical compositions of the essential oil are characterized by gas chromatography-mass spectrometry (GC-MS). The Van den Dool and Kratz equation results have the potential to be used not only in the chemical compositions of the oils, but also in applied mathematics and other fields. Moreover, we construct a new special finite sum. A lower bound and inequality are also given for the finite special sum involving the dead time associated with the isocratic step. Some applications and criticisms are given that include this lower bound and inequality for these sums and its effects on the chemical compositions of essential oil and the Van den Dool and Kratz equation.

SARS-CoV-2 caused one of the most devastating pandemics in the recent history of mankind. Due to various countermeasures, including lock-downs, wearing masks and increased hygiene, the virus has been controlled in some parts of the world. More recently, the availability of vaccines, based on RNA or Adenoviruses, have greatly added to our ability to keep the virus at bay, again in some parts of the world only. While available vaccines are effective, it would be desirable to also have more classical vaccines at hand for the future. Key feature of vaccines for long-term control of SARS-CoV-2 would be inexpensive production at large scale, ability to make multiple booster injections and long-term stability at +4 oC. Here we describe such a vaccine candidate, consisting of the SARS-CoV-2 receptor binding motif grafted genetically onto the surface of the immunologically optimized cucumber mosaic virus, called CuMV TT-RBM. Using bacterial fermenter production and continuous flow centrifugation, the productivity of the production process is estimated to be >2.5 million doses per 1000 liter fermenter run and the vaccine candidate is stable for at least 14 months at 4°C. We further demonstrate that the candidate vaccine is highly immunogenic in mice and rabbits and induces more high avidity antibodies compared to convalescent human sera and antibodies induced are more cross-reactive to mutant RBDs for variants of concern (VoC). Furthermore, antibody responses are neutralizing and long-lived. This, the here presented VLP-based vaccine may be a good candidate for use as conventional vaccine in the long-term.

Multisystem inflammatory syndrome in children (MIS-C) associated with coronavirus disease 2019 (COVID-19) has been described to partially overlap with Kawasaki disease (KD) with regard to clinical symptoms, but they are unlikely to share the same disease entity. We conducted a systematic review and meta-analysis to characterize the laboratory parameters of MIS-C compared with those of KD and Kawasaki disease shock syndrome (KDSS). Databases were searched for studies on laboratory parameters of MIS-C (hematology, inflammatory markers, cardiac markers and biochemistry) through May 31, 2021. Twelve studies with 3073 participants yielded 969 MIS-C patients. In terms of hematology, MIS-C patients had lower levels of leukocytes, absolute lymphocyte count and platelet count (PLT) than KD patients and had similar absolute neutrophil count (ANC) and hemoglobin (Hb) levels. In terms of inflammatory markers, MIS-C patients had higher levels of C-reactive protein, D-dimer and ferritin than KD patients and had similar levels of procalcitonin and ESR. In terms of cardiac markers, MIS-C patients had higher CPK levels than KD patients. The levels of NT-proBNP, troponin and AST were not significantly different between MIS-C and KD patients. In terms of biochemistry, MIS-C patients had lower levels of albumin, sodium and ALT and higher levels of creatinine than KD patients. In addition, MIS-C patients had lower levels of PLT, Hb and ESR and higher levels of ANC than KDSS patients. Measurement of laboratory parameters might assist clinicians with accurate evaluation of MIS-C and further mechanistic research.

A patient with late in COVID-19 pneumonia presented peripheral cystic features on chest computed tomography, which were spontaneously resolved with no antibiotic therapy or surgery. Physicians should pay attention to follow up the late phase of COVID-19 pneumonia for better understanding its etiologies and clinical course in the convalescing period.

This is a type of manuscript that does not require an abstract

Increased circulating CRTH2+Tregs are associated with asthma control and exacerbation Short running title:Increased circulating CRTH2+Tregs among patients with asthmaTeerapol Chantveerawonga, Sasipa Sangkangjanavanicha,b, Chirawat Chiewchalermsria,c, Panitan Pradubpongsaa, Wat Mitthamsiria, Sarawut Jindaratd, Ming Wange, Mübeccel Akdisf, Milena Sokolowskaf, Cezmi A. Akdisf, Atik Sangasapaviliyaa, Tadech Boonpiyathada,faDivision of Allergy and Clinical Immunology, Department of Medicine, Phramongkutklao Hospital, Bangkok, Thailandb Division of Allergy, Immunology and Rheumatology, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, ThailandcDepartment of Medicine, Panyananthaphikkhu Chonprathan Medical Center, Srinakharinwirot University, Nonthaburi, ThailanddDepartment of Pharmacology, Phramongkutklao College of Medicine, Bangkok, ThailandeDepartment of Otolaryngology, Head and Neck Surgery, Beijing TongRen Hospital, Capital Medical University, and the Beijing Key Laboratory of Nasal Diseases, Beijing Institute of Otolaryngology, Beijing, ChinafSwiss Institute of Allergy and Asthma Research (SIAF), University of Zurich, and the Christine Kühne-Center for Allergy Research and Education (CK-CARE), Davos, Switzerland

Objectives: To determine the cost-effectiveness of auditory brainstem response prior to MRI (ABR-MRI) compared to standalone MRI to diagnose vestibular schwannoma. Design: A state transition decision-analytic model was developed to simulate costs and effects (quality-adjusted life years) for both treatment strategies for patients suspected of a vestibular schwannoma. Model input was derived from literature, hospital databases, and expert opinions. Scenario and sensitivity analyses addressed model uncertainty. Results: Over a lifetime horizon, ABR-MRI resulted in a limited cost-saving of \euro68 or \euro98 per patient (dependent on MRI sequence) and a health loss of 0.005 QALYs over standalone MRI. ABR-MRI, however, did miss patients with other important pathology (2% of the population) that would have been detected when using standalone MRI. Calculating the incremental cost-effectiveness ratio resulted in \euro14,203 or \euro19,550 saved per lost QALY if ABR-MRI was used instead of standalone MRI. The results were sensitive to the detection rate of vestibular schwannoma and health-related quality of life of missed patients. Conclusion: The cost-saving with ABR-MRI does not seem to outweigh the number of missed patients with VS and other important pathologies that would have been detected when using standalone MRI.

Background There is scarcity of information about the cumulative live birth rates(CLBRs) and time to live birth(TTLB) between progestin primed ovarian stimulation protocol(PPOS) and long GnRH agonist protocol. Objective To compare CLBRs and TTLB in women with normal ovarian reserve following PPOS with long GnRH agonist protocol. Methods A total of 995 women who underwent IVF using either PPOS (n=509) or GnRH antagonist (n=486) ovarian stimulation at the discretion of the attending physicians. The primary outcome measure was the CLBRs within 18 months from the day of ovarian stimulation. Results Both groups had almost comparable demographic and cycle stimulation characteristics except for duration of infertility which was shorter in the PPOS group. CLBRs after one complete IVF cycle including fresh and subsequent FET cycles within 18 months follow up were significantly lower in the PPOS group compared that in the long agonist group 206/509 (40.5%) and 307/486 (63.2%), respectively (odds ratio (OR): 0.641; 95% CI: 0.565-0.726). The average TTLB was significantly shorter in the long agonist group compared to the PPOS group (P < 0.01). In Kaplan-Meier analysis, the cumulative incidence of ongoing pregnancy leading to LB was significantly higher in the long agonist compared in the PPOS group (P < 0.001). Cox regression analysis revealed stimulation protocol adopted was strongly associated with the CLBRs after adjusting other confounding factors (OR =1.917 (1.152-3.190), P=0.012). Conclusion PPOS offers no advantage over conventional protocol in women with a normal ovarian reserve undergoing IVF. Keywords: PPOS, long GnRH agonist protocol, IVF, CLBRs, TTLB

Patients who have undergone upper aerodigestive tract (UADT) cancer surgery are a real challenge in prosthetic rehabilitation. Many clinicians tend to shift towards an implant-supported prosthesis. Thus, we first reviewed a specific type of implant rehabilitation: the connecting bars. Then two clinical cases are described in this article.

A document by Richard Thalappillil, written on Authorea.

WeChat and access to wireless communication may offer a continuum of care following medical and surgical intervention. This cardiac surgery research study evaluates the process of parental education and social support following pediatric cardiac surgery utilizing standard of care compared to telehealth.

A document by Sheikh Mohammed Irfan, written on Authorea.

Abstract Objective: Although various guidelines have been established for the management of antithrombotic therapy during surgical treatments, surgical tracheostomy (ST) under continued antithrombotic therapy (CAT) remains a challenge. We investigated the risk factors for complications after ST by focusing on CAT use during ST. Method: Patients’ medical records from 2009 to 2020 were reviewed in this retrospective study. We selected patients who underwent ST at the Department of Otolaryngology of the University of Tokyo Hospital. Patient demographics, complications, and blood test values were recorded and statistically analyzed to identify the risk factors for postoperative complications. Results: We identified 288 patients (median age: 64 years; 184 men [64%]), among whom 40 (median age: 67 years; 29 men [73%]) underwent CAT. Although the patients undergoing CAT had significantly higher values of activated partial thromboplastin time (p = 0.002) and prothrombin time-international normalized ratio (p = 0.006) than those of antithrombotic naïve patients, no statistically significant intergroup differences were observed in the risks of bleeding, infection, or subcutaneous emphysema. Instead, ST under local anesthesia (p = 0.01) and ST for airway emergency (p = 0.02) significantly increased the risk of early postoperative complications. Conclusion: The results of the present study suggest that ST under CAT can be safely performed without any increased risk of postoperative complications. Nevertheless, surgeons should be extra cautious about early complications after ST under local anesthesia without intubation or ST for airway emergency. Key points: 1. We aimed to investigate the risk factors for complications after ST by focusing on CAT use during ST. 2. Patients undergoing CAT had significantly higher values of APTT and PT-INR than those of antithrombotic naïve patients. 3. ST under CAT can be safely performed without any increased risk of postoperative complications. 4. ST under local anesthesia and airway emergency was a risk factor for complications after ST. 5. Among the complications, subcutaneous emphysema was significantly more frequent in ST under local anesthesia and under airway emergency.