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This review provides an in-depth exploration of portal hypertension (PH) and its implications in various surgical procedures. The prevalence of clinically significant PH is 50% to 60% in compensated cirrhosis and 100% in decompensated cirrhosis. The feasibility and safety of hepatic and nonhepatic surgical procedures in patients with PH has been shown. Adequate preoperative risk assessment and optimization of PH are integral parts of patient assessment. The occurrence of adverse outcomes after surgery has decreased over time in this specific population, due to the development of techniques and improved perioperative multidisciplinary care.

Health-related quality of life (QoL) impairment is common after pulmonary embolism (PE). Whether the severity of the initial PE has an impact on QoL is unknown.

Living liver donation (LLD) has been suggested as a potential solution to reduce the waitlist mortality for liver transplantation (LT) recipients by facilitating living donor liver transplantation (LDLT). Ensuring both donor and recipient safety is a critical aspect of LDLT. An accurate understanding of the complexity and extend of safety outcomes of the donor is imperative to maintain the high-quality standard this medical program requires. This review seeks to outline safety outcome parameters of interest for donors. Early postoperative mortality is very low with no significant differences comparing left lobe to right lobe LLD. Complications most commonly are biliary (leakage or strictures), bleeding, respiratory or pulmonary, gastrointestinal or infectious. Return to full-time work and quality of life are essential parameters in the mid and long term. As evidence continues to accumulate, outcomes may evolve with the expansion of minimal invasive surgery practice and currently laparoscopic approach is recommended in large experienced centers. By offering safer operations that require fewer incisions or liver resections, living liver donations can be further encouraged, and the perception of the procedure can be improved. Rational consideration of the safety of the donor and in-depth discussion and evaluation with the patient is of utmost importance.

Recent evidence suggests a beneficial effect of endovascular thrombectomy in acute ischaemic stroke with large infarct; however, previous trials have relied on multimodal brain imaging, whereas non-contrast CT is mostly used in clinical practice.

ABSTRACTThe relation between religiosity and well-being is one of the most researched topics in the psychology of religion, yet the directionality and robustness of the effect remains debated. Here, we adopted a many-analysts approach to assess the robustness of this relation based on a new cross-cultural dataset (participants from 24 countries). We recruited 120 analysis teams to investigate (1) whether religious people self-report higher well-being, and (2) whether the relation between religiosity and self-reported well-being depends on perceived cultural norms of religion (i.e., whether it is considered normal and desirable to be religious in a given country). In a two-stage procedure, the teams first created an analysis plan and then executed their planned analysis on the data. For the first research question, all but 3 teams reported positive effect sizes with credible/confidence intervals excluding zero (median reported ). For the second research question, this was the case for 65% of the teams (median reported ). While most teams applied (multilevel) linear regression models, there was considerable variability in the choice of items used to construct the independent variables, the dependent variable, and the included covariates.

Unhealthy vascular aging promotes atherogenesis, which may lead to significant internal carotid artery stenosis (CAS) in 5 to 7.5% of older adults. The pathogenic factors that promote accelerated vascular aging and CAS also affect the downstream portion of the cerebral microcirculation in these patients. Primary treatments of significant CAS are eversion endarterectomy or endarterectomy with patch plasty. Factors that determine adequate hemodynamic compensation and thereby the clinical consequences of CAS as well as medical and surgical complications of carotid reconstruction surgery likely involve the anatomy of the circle of Willis (CoW), the magnitude of compensatory inter-hemispheric blood flow, and the effectiveness of cerebral microcirculatory blood flow autoregulation. This study aimed to test two hypotheses based on this theory. First, we hypothesized that patients with symptomatic and asymptomatic CAS would exhibit differences in autoregulatory function and inter-hemispheric blood flow. Second, we predicted that anatomically compromised CoW would associate with impaired inter-hemispheric blood flow compensation. We enrolled older adults with symptomatic or asymptomatic internal CAS (>70% NASCET criteria; n= 46) and assessed CoW integrity by CT angiography. We evaluated transient hyperemic responses in the middle cerebral arteries (MCA) after common carotid artery compression (CCC; 10 s) by transcranial Doppler sonography (TCD). We compared parameters reflecting autoregulatory function (e.g., transient hyperemic response ratio [THRR], return to baseline time [RTB], changes of vascular resistance) and inter-hemispheric blood flow (residual blood flow velocity). Our findings revealed that CAS was associated with impaired cerebral vascular reactivity. However, we did not observe significant differences in autoregulatory function or inter-hemispheric blood flow between patients with symptomatic and asymptomatic CAS. Moreover, anatomically compromised CoW did not significantly affect these parameters. Notably, we observed an inverse correlation between RTB and THRR, and 49% of CAS patients exhibited a delayed THRR, which associated with decreased inter-hemispheric blood flow. Future studies should investigate how TCD-based evaluation of autoregulatory function and inter-hemispheric blood flow can be used to optimize surgical techniques and patient selection for internal carotid artery revascularization.

The Pannonian basin is an extensional back-arc basin that has undergone neotectonic inversion and is currently shortening. The understanding and quantification of present-day deformation processes during this inversion are still incomplete. To this end, we investigate the active deformation of the Circum-Pannonian region via the interpolation of GNSS-derived velocity field and the derivation of the strain rate fields. For the interpolation of the velocity field, we use ordinary kriging, a strochastic interpolation method. Our results show that estimating a strain rate field that is virtually free of short-wavelength noise requires the scaling of the velocity uncertainties, i.e. assuming a minimum standard deviation of 1 mm/yr in our case. The deformation of the Circum-Pannonian region is defined by the 2–3 mm/yr, NNE-directed motion of the Dinarides, and by the 0.5–1.5 mm/yr, WSW to SSW directed motion of the eastern areas (European foreland, East Carpathians, South Carpathians, Transylvanian basin). These opposite-sense motions define a large-scale, on average NE-SW shortening and transpression-type deformation in the Dinarides as well as in the Pannonian basin, while the East and South Carpathians undergo regional N–S extension. Neotectonic structures generally show good agreement with the strain rate field, for example in the Dinarides, Eastern Alps, or in the western Pannonian basin. However, the presence of fault-parallel shortening or biaxial shortening along sinistral neotectonic structures in the central and eastern Pannonian basin show some discrepancy between current geodetic and observed neotectonic deformation. The vertical velocity field shows dominantly 100 and 1000 km wavelength signals, the former is probably related to the response of the Pannonian lithosphere-asthenosphere system to neotectonic basin inversion, while latter can possibly be explained by far-field subsidence patterns induced by the mantle response to melting of the Fennoscandian ice sheet during the current interglacial period.

Carbon fibre reinforced polymer (CFRP) composites are widely applied due to their exceptional specific mechanical properties. The mechanical machining of these composites is often required; however, the existing expertise on the machinability of CFRP composites with fillers is deficient. Therefore, the main aim of the present study is to experimentally investigate the machinability of CFRPs with and without milled carbon fillers. Drilling experiments were conducted in different CFRP structures, and the cutting force and microgeometry were analysed through the analysis of variance (ANOVA) technique. The experimental results show that the fillers have a significant influence on the microgeometry.

Drilling high-strength fibrous polymer composites is challenging mainly due to their machining-induced delamination formation ability. The existing two-dimensional delamination measurement algorithms often require manual operations that make these measurements difficult to reproduce and automate. The main goal of this study is to develop a delamination-measurement method based on image differencing of the conditions before and after drilling, in order to improve the reproducibility of delamination quantification. The novel method was tested by mechanical drilling experiments in unidirectional carbon fibre reinforced polymer (UD-CFRP) composites using solid carbide tools. The developed method can measure the magnitude of drilling-induced delamination automatically.

Acquired hemophilia A (AHA) is a rare severe autoimmune bleeding disorder with significant morbidity and mortality. Although critical for disease control, there is no consensus for the best immunosuppressive regimen. Most authors use steroids first line, followed by other agents for steroid failures. Upfront combined regimens offer the advantage of reduced steroid exposure and toxicity as well as increased efficacy. We retrospectively analyzed data from 32 patients with AHA treated on an identical such institutional protocol: cyclophosphamide 1000 mg on days 1 and 22, dexamethasone 40 mg on days 1, 8, 15, and 22, and rituximab 100 mg on days 1, 8, 15, and 22 (the regimen was termed CyDRi). All patients received at least 1 cycle of CyDRi. If necessary, CyDRi was repeated until remission, no sooner than day 43 of the previous cycle. Bleeding control was rapidly achieved. The median time for bleeding control was 15.5 days (range, 0-429 days; interquartile range, 2.5-29.5 days). Thirty-one (96.8%) of 32 patients achieved durable complete remission (CR); 29 (90.6%) of 32 patients were alive at last follow-up, all of them in CR. The median time to reach first CR was 77 days (range, 19-939 days; interquartile range, 31-115 days). Toxicity and side effects were acceptable and milder than those of commonly used, prolonged steroid therapies. In conclusion, the CyDRi regimen produced markedly higher CR rates and overall survival than currently used sequential regimens. Taken together, CyDRi proved to be an attractive option for the immunosuppression of elderly patients with AHA.

•Upfront triple combined immunosuppressive regimen (CyDRi) produces very high remission rates and survival in elderly AHA patients.•High efficacy of CyDRi is combined with low toxicity and good tolerability.

Hypothalamic agouti-related peptide and neuropeptide Y-expressing (AgRP) neurons have a critical role in both feeding and non-feeding behaviors of newborn, adolescent, and adult mice, suggesting their broad modulatory impact on brain functions. Here we show that constitutive impairment of AgRP neurons or their peripubertal chemogenetic inhibition resulted in both a numerical and functional reduction of neurons in the medial prefrontal cortex (mPFC) of mice. These changes were accompanied by alteration of oscillatory network activity in mPFC, impaired sensorimotor gating, and altered ambulatory behavior that could be reversed by the administration of clozapine, a non-selective dopamine receptor antagonist. The observed AgRP effects are transduced to mPFC in part via dopaminergic neurons in the ventral tegmental area and may also be conveyed by medial thalamic neurons. Our results unmasked a previously unsuspected role for hypothalamic AgRP neurons in control of neuronal pathways that regulate higher-order brain functions during development and in adulthood.

This is the first study investigating qSOFA as a predictor for clinical outcomes in EGS. A new modified qSOFA (qadSOFA) was developed. The AUROC of qSOFA and qadSOFA for mortality was 0.715 and 0.859, respectively with an optimal cut-off value identified as qadSOFA≥3.

Objective: To describe a case of idiopathic cricopharyngeal achalasia (CPA) in a pediatric patient with acute onset of dysphagia managed conservatively with supportive care.Methods: Sixteen-month-old boy presented with acute onset of gagging and coughing with feeding. His exam was notable for a well-appearing child with pooling of oral secretions and coarse breath sounds. Plain film series did not show radio-opaque foreign body (FB) and an esophagram demonstrated an endoluminal filling defect of the cervical esophagus and aspiration of contrast. He was taken to the operating room for urgent endoscopy but no FB or food impaction was observed. He had persistent symptoms that required further evaluation and a multidisciplinary team approach. Bedside laryngoscopy did not reveal any abnormalities. Modified barium swallow (MBS) study revealed upper esophageal sphincter (UES) dysfunction, consistent with cricopharyngeal achalasia. Repeat upper endoscopy with biopsies demonstrated mucosal irritation overlying the UES but histologic studies were negative for infectious causes.Results: He was treated with supportive care, including nasogastric feedings for nutrition supplementation as he was unable to tolerate oral feedings without aspiration. Over the course of 3 months after discharge, his symptoms resolved and repeat MBS was normal.Conclusion: CPA is a rare cause of dysphagia in the pediatric population. Conservative management with supportive care is a reasonable approach in cases with acute onset in otherwise healthy children without underlying medical problems.

Lakes can be important sources of the potent greenhouse gas nitrous oxide (N2O) to the atmosphere, but to what extent abiotic processes may contribute to lacustrine N2O production remains uncertain. We assessed pathways of N2O production and reduction in the water column of meromictic and iron‐rich Lake La Cruz, Spain, including chemodenitrification‐induced N2O formation via the reaction of reactive nitrogen (N) (e.g., NO2−) with ferrous iron (Fe[II]). In the oxic waters (~8–10 m), N2O concentrations above atmospheric equilibrium were associated with comparatively low δ15N‐N2O, high δ15N‐NH4+, and high N2O 15N‐site‐preference (SP) values (up to ~29‰), suggesting N2O production by nitrification. N2O concentrations were highest (23–33 nM) near the depth of oxygen depletion (~11–14.5 m), likely due to production by nitrifier denitrification and/or denitrification, as indicated by decreasing SP values (as low as 12‰). Further below (~14.5–17 m), N2O consumption was indicated by increasing SP values and a δ18O‐vs.‐δ15N relationship (1.8–2.9) typical for stand‐alone N2O reduction. The coupled N‐vs.‐O isotope signatures thus highlight the spatial, redox‐dependent separation of incomplete and complete denitrification. In incubations with sterile‐filtered lake water and 15N‐labeled or unlabeled substrate, NO2−was reduced by Fe2+to N2O, even at low nitrite concentrations (5 μM NO2−). In the water column, the spatial separation of NO2−and Fe(II) during our samplings appears to preclude elevated rates of chemodenitrification, but during periods of overlapping NO2−and Fe(II) in Lake La Cruz, and potentially in other lakes, its distinct N2O δ18O‐vs.‐δ15N relationship of ~1 : 1, as experimentally determined, could help to detect it.

Hydrothermal vents have been key to our understanding of the limits of life, and the metabolic and phylogenetic diversity of thermophilic organisms. Here we used environmental metagenomics combined with analysis of physicochemical data and 16S rRNA gene amplicons to characterize the sediment-hosted microorganisms at the recently discovered Auka vents in the Gulf of California. We recovered 325 metagenome assembled genomes (MAGs) representing 54 phyla, over 30% of those currently known, showing the microbial community in Auka hydrothermal sediments is highly diverse. 16S rRNA gene amplicon screening of 224 sediment samples across the vent field indicates that the MAGs retrieved from a single site are representative of the microbial community in the vent field sediments. Metabolic reconstruction of a vent-specific, deeply branching clade within the Desulfobacterota suggests these organisms metabolize sulfur using novel octaheme cytochrome-c proteins related to hydroxylamine oxidoreductase. Community-wide comparison between Auka MAGs and MAGs from Guaymas Basin revealed a remarkable 20% species-level overlap, suggestive of long-distance species transfer over 400 km and subsequent sediment colonization. Optimal growth temperature prediction on the Auka MAGs, and thousands of reference genomes, shows that thermophily is a trait that has evolved frequently. Taken together, our Auka vent field results offer new perspectives on our understanding of hydrothermal vent microbiology.

Hydrothermal vents have been key to our understanding of the limits of life, and the metabolic and phylogenetic diversity of thermophilic organisms. Here we used environmental metagenomics combined with analysis of physicochemical data and 16S rRNA gene amplicons to characterize the sediment-hosted microorganisms at the recently discovered Auka vents in the Gulf of California. We recovered 325 metagenome assembled genomes (MAGs) representing 54 phyla, over 30% of those currently known, showing the microbial community in Auka hydrothermal sediments is highly diverse. 16S rRNA gene amplicon screening of 224 sediment samples across the vent field indicates that the MAGs retrieved from a single site are representative of the microbial community in the vent field sediments. Metabolic reconstruction of a vent-specific, deeply branching clade within the Desulfobacterota suggests these organisms metabolize sulfur using novel octaheme cytochrome-c proteins related to hydroxylamine oxidoreductase. Community-wide comparison between Auka MAGs and MAGs from Guaymas Basin revealed a remarkable 20% species-level overlap, suggestive of long-distance species transfer over 400?km and subsequent sediment colonization. Optimal growth temperature prediction on the Auka MAGs, and thousands of reference genomes, shows that thermophily is a trait that has evolved frequently. Taken together, our Auka vent field results offer new perspectives on our understanding of hydrothermal vent microbiology.

ABSTRACTEnvironmental operators perform their activities in accordance with the relevant legal provisions; however, this does not mean that they operate at their technological optima using the operational information available. The possible negative effects (odor, noise, etc.) of a sub-optimal operation can be felt first and foremost by those living in the immediate vicinity of the given object. It would be important to make effective use of these citizens feedback (quickly to revealing the root causes) thus minimize negative environmental impact of operations. The solution proposed in this paper is a portal called EnviroMind, which allows citizens feedback to be recorded in an easy, immediate, and structured way via a form and on the other hand, it provides a real-time graphical odor transmission model output in a dashboard to operators. Using this portal as a monitoring system the magnitude of the odor effect could be reduced and a smaller area around the industrial object could be affected. In a landfill monitoring pilot project where this monitoring system was used the decrease in the number of indicated odor observations was 85% and the decrease in maximal distance from landfill to odor detection positions was 45%. It is proposed to use EnviroMind monitoring system for all industrial objects which have a significant odor effect on the environment, because by using it we can make the odor effect visible to operators in real time, thus, the reaction time for solving the problem can be minimized.Implications: monitoring is available online to the surrounding community, the affected population, so that quick responses and interventions are available; in the knowledge of the current technological activity carried out on the site its expected odor effect in the area can be determined, whether a protected area can be reached and what odor concentration is expected; in every 15 minutes model results to accurately track expected odor emission values; possibility of intervention, stopping or modification of the technology steps. Experience and main achievements of portal operation in a landfill monitoring pilot project from recent 3 years: the decreasing number of odor perceptions (the decrease in the number of indicated observations was 85%) and the cessation of odor effects in certain areas (and the decrease in maximal distance from landfill to odor detection positions was 45%).

The ability to distinguish among the subspecies of Pasteurella multocidaisolates is important epidemiologically; however, classification at the subspecies level based on the results of conventional biochemical tests (fermentation of sorbitol and dulcitol) is reportedly not accurate in all cases. Therefore, we developed a rapid, multiplex PCR assay to differentiate among the 3 subspecies of P. multocida. The PCR assay includes the P. multocidaspecies–specific primers KMT1SP6 and KMT1T7 as an internal amplification control, with a newly designed gatD(galactitol-1-phosphate-5-dehydrogenase)-specific primer pair (unique for subsp. gallicida), and primers targeting a 16S rRNA gene region specific for subsp. septica. The subspecies specificity of the PCR was demonstrated by applying the test to a collection of 70 P. multocidaisolates, including the Heddleston serovar reference strains; all isolates and strains were assigned correctly. The PCR assay is a sensitive, specific, and highly effective method for the identification of P. multocidasubspecies, and an alternative to biochemical test–based differentiation. A possible relationship was noticed between P. multocidasubspecies and lipopolysaccharide (LPS) genotype; all but one of the subsp. gallicidastrains were isolated only from avian hosts and represented L1 LPS genotype. Subsp. multocidaand subsp. septicaisolates were classified into 5 and 4 different LPS genotypes, respectively, of which L3 was the only LPS genotype shared between these 2 subspecies.

Nonlinear and unbalanced loads introduce distortions to the power network in the form of harmonics and asymmetric load conditions. Through the rising penetration of residential renewable plants, energy is fed back into the grid. By shaping the output of those power converters the distortions can be mitigated. The technique of shunt active power filtering allows the instantaneous compensation of a dedicated nonlinear load, by measuring its distorted consumption. The goal of this article is to present an extension to this method which allows to compensate for a given area utilizing the advanced metering infrastructure in a smart grid. Given a compensation unit, instantaneous voltage measurements are collected from neighboring consumers. By utilizing the model of the distribution line, a linear Kalman filter allows the estimation of the phase currents. These values replace the dedicated nonlinear load measurements, and by compensating for line currents, the power quality of a given transformer area is improved. Analyzing the model based approach against real world like scenarios and elaborating the robustness shows the potential for real world applicability.

Distribution systems with advanced metering infrastructure offer many opportunities for fault detection. A novel approach is presented in this paper for local fault diagnosis in neighbour area networks by utilizing data concentrators. A lightweight local diagnostic function is presented based on first engineering principles. It is shown that from four phasor measurement unit data, a fault can be detected between buses and fault parameters can be evaluated. The diagnosis of a neighbour area network is accomplished as a sequential application of the local method. Edge cases and limitations of the method are explored. The applicability of the method is demonstrated on a real world case study. By introducing threshold values for the fault parameters, the results fulfill the engineering expectations.

We present a case of the rare Kikuchi–Fujimoto disease (KFD) in a 14-year-old patient admitted to UCLA Medical Center with fever, weight loss, and pancytopenia. Physical examination revealed tender subcutaneous nodules and cervical lymphadenopathy. A lymph node biopsy showed findings consistent with KFD. The skin biopsy showed mild superficial dermal edema with neutrophil-predominant inflammation. In addition, rare atypical monocytoid cells were seen. This histologic finding of a Sweet-like morphology has not been reported previously in the literature in association with KFD. The differential diagnosis included Sweet syndrome arising in association with KFD, underlying connective tissue, and an infectious etiology.

The current gold standard for evaluation of the surgical result after intracranial aneurysm (IA) clipping is two-dimensional (2D) digital subtraction angiography (DSA). While there is growing evidence that postoperative 3D-DSA is superior to 2D-DSA, there is a lack of data on intraoperative comparison.