Comprehensive clinical and imaging-based surveillance represents a fundamental aspect in the management of thoracic aortic aneurysms (TAAs), affording the opportunity to identify intermediate-sized TAAs before the onset of worrying symptoms or devastating acute aortic dissection/rupture. Currently, size-based indices are favoured as the major determinants driving patient selection for surgery, as supported by aortic guidelines, although it is recognised that smaller sub-threshold TAAs may still confer substantial risks. Prophylactic aortic surgery can be offered within set timeframes at dedicated aortic centres with excellent outcomes, to mitigate the threat of acute aortic complications associated with repeatedly deferred intervention. In this commentary, we discuss a recent article from the Journal of Cardiac Surgery which highlights important socio-economic disparities in TAA surveillance and follow-up.

Although the process of species formation is notoriously idiosyncratic, the observation of pervasive patterns of reproductive isolation across species pairs suggests that generalities, or “rules”, underlie species formation in all animals. Haldane’s rule states that whenever a sex is absent, rare or sterile in a cross between two taxa, that sex is usually the heterogametic sex. Yet, understanding how Haldane’s rule first evolves and whether it is associated to genome wide barriers to gene flow remains a challenging task because this rule is usually studied in highly divergent taxa that no longer hybridize in nature. Here, we address these questions using the meadow grasshopper Pseudochorthippus parallelus where populations that readily hybridize in two natural hybrid zones show hybrid male sterility in laboratorial crosses. Using mitochondrial data, we infer that such populations have diverged some 100,000 years ago, surviving multiple glacial periods in isolated Pleistocenic refugia. Nuclear data shows that secondary contact has led to extensive introgression throughout the species range, including between populations showing hybrid male sterility. We find repeatable patterns of genomic differentiation across the two hybrid zones, yet such patterns are consistent with shared genomic constraints across taxa rather than their role in reproductive isolation. Together, our results suggest that Haldane’s rule can evolve relatively quickly within species, particularly when associated to strong demographic changes. At such early stages of species formation, hybrid male sterility still permits extensive gene flow, allowing future studies to identify genomic regions associated with reproductive barriers.

Cerebrovascular accident (CVA) is one of the commonest neurological deficits. There is a well-known association between COVID-19 and stroke. We present a case series of Sudanese patients who developed CVA after receiving the AstraZeneca COVID-19 vaccine suggesting a relationship between the vaccine and CVA.

Endoscopic features of gastrointestinal amyloidosis can be nonspecific. In our case, it presented as cat scratch colon, which led to a misdiagnosis as collagen colitis.

Anomalies of the appendix are rare, and one of the rarest is the double appendixes. Most anomalies of the appendix are observed in adults and are discovered incidentally during surgery that does not primarily involve the appendix. It is usually missed, often with life-threatening consequences.

Hordeum murinum induced pustular irritant contact dermatitisKey clinical message: Plant induced contact dermatitis is very rare. We describe the case oftwo siblings with Hordeum murinum induced pustular irritant contact dermatitis.Key words: allergology, Hordeum murinum, contact dermatitis, patch test.We describe the cases of two siblings, aged 8 and 10 years, who consulted with multiple yellowish pustules and well-demarcated erythema on the face (Figure 1). The eruption started a few hours after accidental exposure to a plant, named Hordeum murinum , while they were playing in the garden (Figure 2). The mother mentioned that this had been their first exposure to this plant. There were no other lesions either on the skin or on mucosae. Laboratory findings were without abnormalities. There was no bacterial growth in a culture of a pustular specimen. The patients were treated with a short course of topical corticosteroids. A resolution of the skin lesions was achieved within a few days. Five weeks after the resolution of dermatitis, the patients were patch tested with wetted and pounded leaves and petals of H.murinum.1 Readings were performed on the day (D)2, D4, and D7 and showed negative results.1 So, we diagnosed the patients with H. murinum -induced pustular irritant contact dermatitis.

We introduce a new approach—acoustic restoration—focusing on the applied utility of soundscapes for restoration, recognizing the rich ecological and social values they encapsulate. Broadcasting soundscapes in disturbed areas can accelerate recolonization of animals and the microbes and propagules they carry; long duration recordings are also ideal sources of data for benchmarking restoration initiatives and evocative engagement tools.

Negative density dependence (NDD) has been accepted as a key mechanism for biodiversity maintenance in natural forests and different lineages of natural enemies (fungus, bacterium, insect and virus) may be involved. Previous NDD related studies usually correlated seedling survival to the density of host-specific pests or pathogens along the distance to conspecific neighbors, and molecular defense responses of focal seedlings to natural enemies were seldomly concerned. By employing community functional genomics strategy, we extracted copy numbers of homologous genes in defense responses from transcriptomic data of 99 tree species and their inherent impacts on seedling survival were evaluated using partial linear regression analysis and general linear mixed-effects models. The community-level transcriptomic gene copy number of defense responses to fungus, insect and virus showed significant negative correlations with survival rates of the seedling community and the species-level gene copy number of defense response to insect significantly correlated with survival rates of top-twenty common seedling species. Moreover, presence of adult neighbors with distinct defense response to bacterial and viral pathogens survival of focal seedlings as predicted by NDD, while presence of seedling neighbors with similar defense response to insect tended to promote survival of focal seedlings which may be driven by insect-mediated biotic filtering or competitive exclusion. We conclude that both gene copy number and dissimilarities to adult and seedling neighbors in defense response to natural enemies determined seedling survival, indicating the critical contributions of molecular defense responses of plants to species coexistence and diversity maintenance in subtropical forests.

The arboreal marsupial Monito del Monte (genus Dromiciops, with two recognized species) is a paradigmatic mammal. It is the sole living representative of the order Microbiotheria, the ancestor lineage of Australian marsupials. Also, this marsupial is the unique frugivorous mammal in the temperate rainforest, being the main seed disperser of several endemic plants of this ecosystem, thus acting as keystone species. Dromiciops is also one of the few hibernating mammals in South America, spending half of the year in a physiological dormancy where metabolism is reduced to 10% of normal levels. This capacity to reduce energy expenditure in winter contrasts with the enormous energy turnover rate they experience in spring and summer. The unique life-history strategies of this living Microbiotheria, characterized by an alternation of life in the slow and fast lanes, putatively represent ancestral traits that permitted these cold-adapted mammals to survive in this environment. Here we describe the ecological role of this emblematic marsupial, summarizing the ecophysiology of hibernation and sociality, actualized phylogeographic relationships, reproductive cycle, trophic relationships, mutualisms, conservation and threats. This marsupial shows high densities, despite presenting slow reproductive rates, a paradox that is explained by the unique characteristics of its three-dimensional habitat. We finally suggest immediate actions to protect these locally abundant but globally threatened species.

The structuration processes of mixed oleogels produced with candelilla wax (CW, 0 or 3%), fully hydrogenated soybean oil (FH, 5-15%), and microcrystalline cellulose (MC, 0-9%) were studied to define their rheological effects. During the cooling CW crystals performed as nucleation sites for FH. The elastic modulus (G’) of oleogels with FH and 3% CW were more than two orders of magnitude higher than those produced with 0% CW. Adding MC to the oleogels increased slightly the G’. Independently of the amount of MC, oleogels structured with increasing amounts of FH and 0% CW showed the elastic properties scaling of colloidal gels. This behavior was lost by adding 3% CW, implying that in mixed FH-CW oleogels, the CW crystal network dominated the oleogel rheology. The flow point and the mechanical reversibility of oleogels and commercial butter (CB) was also determined. CB showed flow points at 44 and 59% strain and mechanical reversibility values of 29 and 35% of G’ measured in a pre-shear step. Adding MC to oleogels structured with FH and 0% CW increased their flow point (37.2%) near those of CB. This effect was not produced in mixed FH-3% CW oleogels. The mechanical recovery of oleogels produced with FH, MC, and 0% CW tend to decrease as the FH content increased. CW and MC did not show a simple concentration–effect relationship for the mechanical recovery. Nonetheless, oleogels structured with 3% CW and 10% FH and 6-9% MC showed mechanical recovery (~60%) close to that of CB.

Extramedullary multiple myeloma is seen in advanced and aggressive disease and occurs due to plasma cell infiltration of sites other than the bone marrow. Myelomatous ascites or pleural effusion is seen in less than 1 % of cases and can be differentiated from infectious etiologies based on fluid cytology.

Bangladesh recently faced large outbreaks of both COVID-19 and Dengue fever. A 28-year-old woman suffered from symptoms including hemoptysis as first presentation followed by high-grade fever, sore throat, and fatigue. SARS-CoV-2 was confirmed by RT-PCR and also diagnosed dengue later on.COVID-19 and dengue fever could be a harmful combination.

Unusual tumor of the toeKey clinical message: Giant Cell Tumor is a soft-tissue tumor that has a very low potential for malignant change. Involvement of the phalanges of foot is very rare and only a few cases have been reported.Key words: Dermatology, oncology, Giant cell tumor, bone tumors.A 39-year-old woman presented with complaints of pain and swelling of the left second toe for four months. The mass had been slowly increasing in size over the previous 3 years. On examination, there was diffuse swelling of the left second toe with erythematous and shiny overlying skin (Figure 1). The X-ray showed an osteolytic expansive lesion with cortical destruction in the region of the distal phalanx of the second toe. No calcification or periosteal reaction was observed. Magnetic resonance (MR) images showed a mass measuring 1×1.5 cm that was heterogeneously hypo intense on both T1- and T2-weighted MR images. This mass showed a marked, diffuse and heterogeneous enhancement on the contrast T1- weighted image. Surgical excision of the tumor was performed. Histopathological examination confirmed the diagnosis of Giant Cell Tumor (GCT) (Figure 2). The patient’s postoperative course was uneventful, and no recurrence or metastasis was observed. GCTs are soft-tissue tumors that have a very low potential for malignant change. It account for approximately 6% of all bone tumors.1,2 It typically involves the long bones in young adults. 1,2 Involvement of the phalanges of foot is very rare and only a few cases have been reported.1,2

A 28-year-old female with a chief complaint of right lower limb claudication for two weeks was admitted into the infectious disease ward. Because of the unreversible damage to the head of her right femur, a total hip replacement surgery was suggested for this patient.

Hybrid zones can provide clear documentation of range shifts in response to climate change and identify loci important to reproductive isolation. Using a deep temporal (36-38 years) comparison of the black-capped (Poecile atricapillus) and Carolina (P. carolinensis) chickadee hybrid zone, we investigated movement of the under-sampled western portion of the zone (western Missouri) as well as investigating whether loci and pathways underpinning reproductive isolation were similar to those from the eastern portion of the hybrid zone. Using 92 birds sampled along the hybrid zone transect in 2016, 68 birds sampled between 1978 and 1980, and 5 additional reference birds sampled from outside the hybrid zone, we generated 11,669 SNPs via ddRADseq. We used these SNPs to interpolate spatially and assess the movement of the hybrid zone interface through time, and to assess variation in introgression among loci. We demonstrate that the interface has moved approximately 5-8 km to the northwest over the last 36-38 years, i.e., at only one-fifth the rate at which the eastern portion of the hybrid zone (e.g. Pennsylvania, Ohio) has moved. Temperature trends across the last 38 years reveal that eastern areas have warmed 50% more than western areas in terms of annual mean temperature, possibly providing an explanation for the slower movement of the hybrid zone in Missouri. Using genomic cline analyses, we detected four genes that showed restricted introgression in both Missouri and Pennsylvania, including Pnoc, a gene involved in metabolism, learning and memory, concordant with previous physiological and behavioral findings on hybrids and the parental species.

Interspecific interactions within biofilms determine relative species abundance, growth dynamics, community resilience, and success or failure of invasion by an extraneous organism. However, deciphering interspecific interactions and assessing their contribution to biofilm properties and function remain a challenge. Here, we describe the constitution of a model biofilm composed of four bacterial species belonging to four different genera (Rhodocyclus sp., Pseudomonas fluorescens, Kocuria varians, and Bacillus cereus), derived from a biofilm isolated from an industrial milk pasteurization unit. We demonstrate that the growth dynamics and equilibrium composition of this biofilm are highly reproducible. Based on its equilibrium composition, we show that the establishment of this 4-species biofilm is highly robust against initial, transient perturbations but less so towards continuous perturbations. By comparing biofilms formed from different numbers and combinations of the constituent species and by fitting a growth model to the experimental data, we reveal a network of dynamic, positive, and negative interactions that determine the final composition of the biofilm. Furthermore, we reveal that the molecular determinant of one negative interaction is the thiocillin I synthesized by the B. cereus strain, and demonstrate its importance for species distribution and its impact on robustness by mutational analysis of the biofilm ecosystem.

Amazonia is characterized by very heterogeneous riverscapes dominated by two drastically divergent water types: black (ion-poor, dissolved organic carbonate rich and acidic) and white (nutrient rich and turbid) waters. Recent phylogeographic and genomic studies have associated the ecotone formed by these environments to ecologically driven speciation in fish species. With the objective of better understanding the evolutionary forces behind the Amazonian Teleostean diversification, we sampled 240 Mesonauta festivus from 12 sites on a wide area of the Amazonian basin. These sites included three confluences of black and white water environments to seek for repeated evidences of ecological speciation at these ecotones. Our genetic dataset of 41,268 SNPs is contrasting with previous results and supports a low structuring power of water types. Conversely, we detected a strong pattern of isolation by unidirectional downstream water current and evidence of past events of vicariance potentially linked to the Amazon River formation and salt-water incursions that occurred 2.5 Mya. Using a combination of population genetic, phylogeographic analysis and environmental association models, we decomposed the spatial variance from the environmental genetic variance specifically to assess which evolutive forces have shaped inter-population differences in M. festivus’ genome. Our sampling design comprising four major Amazonian rivers and three confluences of black and white water rivers supports the possibility that past studies potentially confounded ecological speciation with a site effect unrepresentative of the full Amazonian watershed. While ecological speciation admittedly played a role in Amazonian fish species diversification, we argue that neutral evolutionary processes explain most of the divergence between M. festivus populations.

Functional regulation via conformational dynamics is well known in structured proteins, but less well characterized in intrinsically disordered proteins and their complexes. Using NMR spectroscopy we have identified a dynamic regulatory mechanism in the human insulin-like growth factor (IGF) system involving the central, intrinsically disordered linker domain of human IGF-binding protein-2 ( hIGFBP2). The bioavailability of IGFs is regulated by the proteolysis of IGF-binding proteins. In the case of hIGFBP2, the linker domain (L- hIGFBP2) retains its intrinsic disorder upon binding IGF-1 but its dynamics are significantly altered, both in the IGF binding region and distantly located protease cleavage sites. The increase in flexibility of the linker domain upon IGF-1 binding may explain the IGF-dependent modulation of proteolysis of IGFBP2 in this domain. As IGF homeostasis is important for cell growth and function, and its dysregulation is a key contributor to several cancers, our findings open up new avenues for the design of IGFBP analogs inhibiting IGF-dependent tumors.

Increased surface temperatures (0.7℃ per decade) in the Arctic affects polar ecosystems by reducing the extent and duration of annual snow cover. Monitoring of these important ecosystems needs detailed information on snow cover properties (depth and density) at resolutions (< 100 m) that influence ecological habitats and permafrost thaw. As arctic snow is strongly influenced by vegetation, an ecotype map at 10 m resolution was added to a method with the Random Forest (RF) algorithm previously developed for alpine environments and applied here over an arctic landscape for the first time. The topographic parameters used in the RF algorithm were Topographic Position Index (TPI) and up-wind slope index (Sx), which were estimated from the freely available Arctic DEM at 2 m resolution. Ecotypes with taller vegetation with moister soils were found to have deeper snow because of the trapping effect. Using feature importance with RF, snow depth distributions were predicted from topographic and ecosystem parameters with a root mean square error = 8 cm (23%) (R² = 0.79) at 10 m resolution for an arctic watershed (1 500 km²) in western Nunavut, Canada.

The mRNA COVID-19 vaccine and COVID-19 infection caused by the SARS-CoV-2 virus may be immunologic triggers for the development of thrombotic thrombocytopenic purpura (TTP). There is not yet literature that discusses TTP induced by COVID-19 vaccination or infection in pediatric or adolescent patients. We describe 4 adolescents presenting with TTP (both de novo and relapsed disease) following administration of the Pfizer COVID-19 vaccine or after COVID-19 infection. Our observations demonstrate that the Pfizer-BioNTech mRNA vaccine and COVID-19 infection can act as triggers for the development/relapse of both congenital and acquired TTP.

Welcome to this Special Issue, entitled Voicing Rivers. As an editorial group (Figure 1), it has been a great privilege to read and consider responses to our call for contributions and share with readers, authors and reviewers involved in this journey. We invited proposals for articles and creative work to focus on stories of, by, from and for rivers, from a variety of perspectives. This Special Issue has been a collaborative project involving nearly 20 rivers and over 50 people. We thank contributors, reviewers and the River Research and Applications journal editor and staff.

Bladder exstrophy is a rare and complex malformation. Often associated with diverse deformations, an accurate diagnosis is a must for adequate management. In the African setting, especially in a remote area, delivery rarely occurs within a healthcare structure thus reducing the chance of an early diagnosis.

We discuss the existence and nonexistence of a local and global-in-time solution to the fractional problem $$ ¥begin{cases} ¥partial_t^{¥alpha}u=¥Delta u+f(u) & x¥in¥Omega,¥ 01$ one has $|f(¥xi)-f(¥eta)|¥le C(1+|¥xi|+|¥eta|)^{p-1}|¥xi-¥eta|$ for all $¥xi, ¥eta¥in ¥R$. Particular attention is paid to the doubly critical case $(p,r)=(1+2/N,1)$.

RATIONALE, AIMS, AND OBJECTIVES: This study aims to investigate how reported comprehension of the Medicare program and its prescription drug benefits affects cost-related medication nonadherence (CRN) among Medicare beneficiaries with cardiovascular disease (CVD) risk factors. METHODS: This cross-sectional study used the 2017 Medicare Current Beneficiary Survey Public Use File data and included Medicare beneficiaries aged ≥ 65 years who reported having at least one CVD risk factor (i.e., hypertension, hyperlipidemia, diabetes, smoking, and obesity) (n=2,821). A survey-weighted logistic model was used to examine associations between lack of difficulty understanding the Medicare program and its prescription drug benefits and CRN, controlling for beneficiaries’ demographic (e.g., age) and clinical characteristics (e.g, comorbidities). This study further analyzed five subgroups based on the type of CVD risk factors involved. RESULTS: Among Medicare beneficiaries with CVD risk factors, 14.4% reported CRN. Medicare beneficiaries with CVD risk factors who reported difficulty understanding the overall Medicare program and its prescription drug benefits were more likely to report CRN, compared to those who reported easy understanding of the overall Medicare program (OR=1.49; 95% CI=1.09, 2.04; p<0.001) and its prescription drug benefits (OR=2.01; 95% CI=1.51, 2.67; p<0.001). Similar results were obtained for the subgroups with obesity, hypertension, or hyperlipidemia. CONCLUSIONS: Perceived lack of difficulty understanding the Medicare Program and its prescription drug benefits has a positive impact on CRN reduction among Medicare beneficiaries with CVD risk factors, especially those with obesity, hypertension or hyperlipidemia. Monitoring and enhancing Medicare beneficiaries’ overall understanding of the Medicare program may reduce CRN.