Persistent Episodes Research Articles

The Role of Neuromodulators and Deep Brain Stimulation (DBS) in the Treatment of Refractory Bipolar Disorder

Introduction: Refractory bipolar disorder is a complex psychiatric condition characterized by persistent manic and depressive episodes that do not respond adequately to conventional treatments, such as mood-stabilizing medications and antidepressants. This condition results in severe functional impairment, with a significant impact on patients' quality of life. Objective: To evaluate the role of neuromodulators and deep brain stimulation in the treatment of refractory bipolar disorder, analyzing their efficacy, mechanisms of action, and safety based on recent studies. Methodology: The research followed the PRISMA checklist guidelines for systematic reviews. Searches were performed in the PubMed, Scielo, and Web of Science databases, using the descriptors "refractory bipolar disorder", "deep brain stimulation", "neuromodulators", "treatment", and "therapeutic effects". The selection of articles was restricted to the last ten years. Inclusion criteria were: clinical studies on the use of DBS in refractory bipolar disorder, research investigating neuromodulators as additional therapies, and articles published in English, Portuguese or Spanish. Studies with small sample sizes, non-systematic reviews and articles that did not present relevant data on the therapeutic effects of these interventions were excluded. Results: The results indicated that both DBS and neuromodulators have shown to be promising therapies in the treatment of refractory bipolar disorder. DBS, especially when targeting the nucleus accumbens and other areas involved in emotional regulation, has been shown to reduce symptoms of mania and depression in several clinical studies. Neuromodulators, such as those affecting the dopaminergic and serotonergic systems, have also shown efficacy in some patients, but with less consistent results. Conclusion: Both deep brain stimulation and neuromodulators have shown potential in the treatment of refractory bipolar disorder, showing improvements in symptom control in patients resistant to conventional treatments. However, more long-term clinical studies are needed to consolidate the evidence of their efficacy and safety, in addition to optimizing treatment protocols.

Significance of mitral annulus apparatus morphometry in patients with persistent atrial fibrillation

Abstract Background Few data about mitral valve apparatus components deformation in patients with persistent atrial fibrillation are available. Four-dimensional transesophageal echocardiography (4DTEE) is an ideal imaging technique to evaluate the complex morphology of the mitral valve apparatus. Purpose The study aimed to find some characteristics in patients presenting with persistent atrial fibrillation and if some of them could be indicative of relapse after cardioversion. Methods The study enrolled 133 patients with persistent atrial fibrillation and mild/moderate functional mitral regurgitation (FMR) before cardioversion. 101 of the patients were at the first persistent atrial fibrillation episode, and 32 with relapse. After performing two-dimensional transthoracic echocardiography (2DTTE), the study included only patients with mild/moderate FMR. 4D TEE permitted a detailed examination of the mitral annulus and valve leaflets, using an E95 machine for acquisition and an ECHOPAC 204 for image postprocessing with mitral valve quantification (MVQ) software. The studied measured: annulus area (AA)3D, annulus perimeter (AP), antero-posterior diameter (APD), posteromedial-anterolateral diameter (PM-ALD), commissural diameter (CD), inter-trigonal distance (ITd), non-planar angle (NPa), mitral-aortic angle (MAa), and for the leaflets, morphological measured parameters were: anterior leaflet area (ALA), posterior leaflet area (PLA), anterior leaflet length (ALL), posterior leaflet length (PLL), anterior leaflet angle (ALa), posterior leaflet angle (PLa), tenting height (TH), tenting area (TA), tenting volume), closure line length (CLL). Results 1. We found significant statistic differences between mitral annulus apparatus components in patients with (32) and without relapse (101) after initial cardioversion: AA 3D: 3.12 vs. 11.65 (p=0.003), AP: 13.23 vs. 12.1 (p=0.0001), APD: 3.76 vs. 3.45 (p=0.0003), PM-ALD: 4.21vs 3.93 (p=0.004), CD:4.17 vs. 3.89 (p=0.002), ITd: 2.82 vs 2.74 (p=0.2), NPa: 158.5 vs 155.2 (p=0.09), MAa: 122 vs 120,7 (p=0.5), ALA: 5.73 vs. 5.18 (p=0.006), PLA: 7.04 vs. 6.09 (p < 0.0001), ALL: 2.19 vs. 2.07 (p=0.036), PLL: 1,73 vs. 1,6 (p=0.03), ALa: 15.31 vs. 18.82 (p=0.002), PLa: 21.38 vs. 25.31 (p=0.01), TH: 0.83 vs. 0.63 (p=0.001), TA: 1.63 vs. 1.32 (p=0.007), TV: 2.75 vs. 2.13 (p=0.007). 2. We found correlations between mitral valve leaflets area and coaptation length in atrial fibrillation patients with (ALA: r=0.72, PLA r=0.65) and without relapse. (ALA: r=0.76, PLA r=0.64). Conclusions 1. 4D TEE identified a more significant mitral annulus and leaflet remodeling in atrial fibrillation patients with relapse after initial cardioversion than in atrial fibrillation patients admitted with a first atrial fibrillation episode. 2. Mitral valve leaflets area correlated with the coaptation length. 3. Mitral annulus complex morphology in patients with atrial fibrillation could be essential in predicting relapse after initial cardioversion.Mitral annulus parameters evaluationMitral leaflets parameters evaluation

The epidemiology and impact of persistent Campylobacter infections on childhood growth among children 0–24 months of age in resource-limited settings

Campylobacter is the leading cause of bacterial gastroenteritis worldwide. It is generally associated with an acute gastrointestinal infection causing a self-limiting diarrheal episode. However, there is evidence that persistent/recurrent carriage of Campylobacter also occurs. In hyperendemic settings the epidemiology and consequences of persistent Campylobacter enteric infections is poorly studied. Risk factors for and growth consequences of persistent Campylobacter infections detected by polymerase chain reaction (qPCR) were evaluated with data from the MAL-ED birth cohort study in children 0-24 months of age between November 2009 and February 2012. A persistent Campylobacter infection was defined as three or more consecutive Campylobacter positive monthly stools. Across all study sites, 45.5% (781/1715) of children experienced at least one persistent Campylobacter episode. The average cumulative duration of days in which children with persistent Campylobacter were positive for Campylobacter spp. was 150 days (inter-quartile range: 28-236 days). Children who experienced a persistent Campylobacter episode had an attained 24-month length-for-age (LAZ) score that was 0.23 (95% (CI):-0.31,-0.15) less than children without a persistent Campylobacter episode. Among children who had at least one episode of Campylobacter over a 3-month or 9-month window, persistent episodes were not significantly associated with poorer 3-month weight gain (-28.7g, 95% CI:-63.4g, 6.0g) but were associated with poorer 9-month linear growth (-0.134cm 95% CI:-0.246,-0.022) compared to children with an episode that resolved within 31 days. Persistent/recurrent Campylobacter infection is common among children and has a measurable negative impact on linear growth in early childhood. Funding for this study was provided by the Bill and Melinda Gates Foundation (OPP1066146 and OPP1152146), the National Institutes of Health United States (R01AI158576 and R21AI163801 to MNK and CTP; K43TW012298 to FS; K01AI168493 to JMC; GOL was supported by K01AI145080. This research was also supported in part by USDA-ARS CRIS project 2030-42000-055-00D. The funders had no role in study design, study implementation, data analysis, or interpretation of the results.

Unpacking Challenges within South African Institutions of Higher Learning in Addressing Student Grievances: A Literature Review

The persistent episodes of violence have been a thorn in the flesh of many South African institutions of higher learning. This predicament has tarnished the reputation of these institutions and compromised the overall quality of education provided. Employing a qualitative narrative literature review as the methodology and the theory of anomie, this paper examines and delineates the challenges confronted by higher learning institutions in addressing student grievances. The findings reveal many factors motivating student grievances and subsequent campus protests. These factors encompass administrative and managerial deficiencies in handling student grievances, inadequacies in managing student financial challenges, distorted perceptions among students regarding their rights and responsibilities, and substandard student accommodation and learning facilities. The discourse presented herein aspires to influence a transformation in the operational frameworks of higher learning institutions. The researchers envisage that their insights will diminish instances of violence and catalyse policy shifts to mitigate student exclusion.

Unveiling 3-D evolution and mechanisms of ozone pollution in Changzhou, China: Insights from lidar observations and modelling

Ground ozone (O3) pollution has emerged as a prominent environmental concern in eastern cities of China, particularly during the summer and autumn seasons. However, a comprehensive investigation into the three-dimensional (3-D) evolution characteristics of O3 within complicated urban environments, especially in lake-land environment, is notably scarce. To enhance our understanding of the mechanisms underlying elevated O3 concentrations within a 3-D scale, this study employed an ozone lidar to delineate vertical ozone profiles in Changzhou, a typical city in China with complicated anthropogenic and biogenic emissions and complex land cover. The process analysis tool integrated into the Weather Research and Forecasting with Chemistry (WRF-Chem) model was further utilized to analyze the formation processes of O3. The results unveil a persistent O3 pollution episode lasting over 15 days in Changzhou during the study period, with multiple peaks exceeding 200 μg m⁻³. Notably, O3 predominantly accumulated within the boundary layer, confined below 1.2 km. Both ground and vertical contributions to this pollution were mainly due to local chemical reactions, with a maximum near-surface contribution reaching 19 ppb h−1 and a vertical contribution of 10 ppb h−1 at the height of 900 ± 200 m. Furthermore, episodes of the enhanced O3 concentrations on August 9 and August 26, 2021, were influenced by external advection process. Our study also found that local circulation plays an important role in the accumulation of surface O3 during certain periods. There was a temperature difference between the surface of Lake Tai and the adjacent land, resulting in the formation of lake-land breezes that facilitate the transport of O3 from the lake surface to the terrestrial environment during pollution events. Our study emphasizes the necessity of reducing local pollutant emissions and implementing joint emission controls as the primary strategies for mitigating O3 pollution in Changzhou and the surrounding region.

Streptomyces sp. MUM 195J: A Promising Probiotic for Controlling Vibrio parahaemolyticus Infection in Aquaculture

Aquaculture is gaining prominence in meeting the increasing global food demand. However, persistent episodes of pathogenic infections have greatly affected production and incurred substantial financial losses to the industry. Regrettably, there is a lack of effective contemporary therapeutic measures to control infectious diseases in aquaculture. The repercussions of antimicrobial resistance have underscored the drawbacks of the contemporary practice of relying solely on antibiotics in disease control. The aquaculture industry needs a safer, environmentally viable, and economically efficient means for disease management. In this regard, this study aims to investigate the effectiveness of mangrove-derived Streptomyces sp. probiotics in controlling Vibrio parahaemolyticus infections. In vitro screenings were undertaken to evaluate the inhibitory activity of five Streptomyces sp. isolates. Subsequently, a series of in vivo trials was conducted, with the Malaysian giant freshwater prawn, Macrobrachium rosenbergii larvae as the animal model. Following that, molecular analyses were employed to examine the changes in gene expression. In essence, Streptomyces sp. MUM 195J emerges as a promising probiotic strain that demonstrates a strong inhibitory effect against V. parahaemolyticus. Its application as a feed additive elevates the survival rate of M. rosenbergii threefold, thus demonstrating efficacy at par with florfenicol antibiotic when challenged with the V. parahaemolyticus pathogen. Besides, Streptomyces sp. MUM 195J elevated the growth rate of M. rosenbergii by 17%. Real-time quantitative polymerase chain reaction (RT-qPCR) analysis revealed that probiotic supplementation elevated the immune function of the animal. Additionally, Streptomyces sp. MUM 195J demonstrates the potential to ameliorate the quality of the rearing water.

Reveal persistent haze pollution episodes in hefei: a perspective from ground-based and satellite observation

Reveal persistent haze pollution episodes in hefei: a perspective from ground-based and satellite observation

Molecular mechanism of Chang Shen Hua volatile oil modulating brain cAMP-PKA-CREB pathway to improve depression-like behavior in rats

BackgroundDepression is a common and complex mental illness that manifests as persistent episodes of sadness, loss of interest, and decreased energy, which might lead to self-harm and suicide in severe cases. Reportedly, depression affects 3.8 % of the world's population and has been listed as one of the major global public health concerns. In recent years, aromatherapy has been widely used as an alternative and complementary therapy in the prevention and treatment of depression; people can relieve anxiety and depression by sniffing plant aromatic essential oils. Acorus tatarinowii and Panax ginseng essential oils in Chang Shen Hua volatile oil (CSHVO) are derived from Acorus tatarinowii and Panax ginseng, respectively, the main medicines in the famous Chinese medicine prescription Kai Xin San (KXS), Then, these oils are combined with the essential oil of Albizia julibrissin flower to form a new Chinese medicine inhalation preparation, CSHVO. KXS has been widely used in the treatment of depression; however, whether CSHVO can ameliorate depression-like behavior, its pharmacological effects, and the underlying mechanisms of action are yet to be elucidated. Study design and MethodsA rat model of chronic and unpredictable mild stimulation (CUMS) combined with orphan rearing was treated with CSHVO for 4 weeks. Using behavioral tests (sucrose preference, force swimming, tail suspension, and open field), the depression-like degree was evaluated. Concurrently, brain homogenate and serum biochemistry were analyzed to assess the changes in the neurotransmitters and inflammatory and neurotrophic factors. Furthermore, tissue samples were collected for histological and protein analyses. In addition, network pharmacology and molecular docking analyses of the major active compounds, potential therapeutic targets, and intervention pathways predicted a role of CSHVO in depression relief. Subsequently, these predictions were confirmed by in vitro experiments using a corticosterone (CORT)-induced PC12 cell damage model. ResultsCSHVO inhalation can effectively improve the weight and depression-like behavior of depressed rats and regulate the expression of inflammatory factors and neurotransmitters. Hematoxylin-eosin, Nissl, and immunofluorescence staining indicated that compared to the model group, the pathological damage to the brain tissues of rats in the CSHVO groups was improved. The network pharmacological analysis revealed that 144 CSHVO active compounds mediate 71 targets relevant to depression treatment, most of which are rich in the cAMP signaling and inflammatory cytokine pathways. Protein-protein interaction analysis showed that TNF, IL6, and AKT are the core anti-depressive targets of CSHVO. Molecular docking analysis showed an adequate binding between the active ingredients and the key targets. In vitro experiments showed that compared to the model group, the survival rate of PC12 cells induced by CSHVO intervention was increased, the apoptosis rate was decreased, and the expression of inflammatory cytokines in the cell supernatant was improved. Western blot analysis and immunofluorescence staining confirmed that CSHVO regulates PC12 cells in the CORT model through the cAMP-PKA-CREB signaling pathway, and pretreatment with PKA blocker H89 eliminates the protective effect of CSHVO on CORT-induced PC12 cells. ConclusionsCSHVO improves CORT-induced injury in the PC12 cell model and CUMS combined with orphan rearing-induced depression model in rats. The antidepressant mechanism of CSHVO is associated with the modulation of the cAMP-PKA-CREB signaling pathway.

Thermal, water, and land cover factors led to contrasting urban and rural vegetation resilience to extreme hot months.

With continuing global warming and urbanization, it is increasingly important to understand the resilience of urban vegetation to extreme high temperatures, but few studies have examined urban vegetation at large scale or both concurrent and delayed responses. In this study, we performed an urban-rural comparison using the Enhanced Vegetation Index and months that exceed the historical 90th percentile in mean temperature (referred to as "hot months") across 85 major cities in the contiguous United States. We found that hot months initially enhanced vegetation greenness but could cause a decline afterwards, especially for persistent (≥4 months) and intense (≥+2 °C) episodes in summer. The urban responses were more positive than rural in the western United States or in winter, but more negative during spring-autumn in the eastern United States. The east-west difference can be attributed to the higher optimal growth temperatures and lower water stress levels of the western urban vegetation than the rural. The urban responses also had smaller magnitudes than the rural responses, especially in deciduous forest biomes, and least in evergreen forest biomes. Within each biome, analysis at 1 km pixel level showed that impervious fraction and vegetation cover, local urban heat island intensity, and water stress were the key drivers of urban-rural differences. These findings advance our understanding of how prolonged exposure to warm extremes, particularly within urban environments, affects vegetation greenness and vitality. Urban planners and ecosystem managers should prioritize the long and intense events and the key drivers in fostering urban vegetation resilience to heat waves.

Cardioversion versus ablation versus 'pace and ablate' for persistent atrial fibrillation in older patients.

Our objective was to compare the efficacy of atrial fibrillation (AF) ablation versus permanent pacemaker (PPM) with atrioventricular node ablation (AVNA) versus direct current cardioversion (DCCV) for persistent AF in patients ≥65 years old. Seventy-seven patients (aged 66-86, mean 75.4 years) with persistent AF were randomised (1:1:1) to AF ablation + amiodarone (± DCCV), PPM with AVNA (+DCCV) or DCCV + amiodarone. The primary end point was persistent AF recurrence, measured with an implanted cardiac monitor or PPM. Cardiopulmonary exercise testing (CPET) was performed at baseline and six months. Symptom questionnaires were completed monthly. Follow-up was 12 months. The primary end point occurred in fewer patients following AF ablation + amiodarone than DCCV + amiodarone (seven patients, 28% vs. 15 patients, 60%; hazard ratio [HR] 0.559, 95% confidence interval [CI] 0.293 to 1.065, p=0.073) with no differences between DCCV + amiodarone and PPM with AVNA (HR 0.990, 95%CI 0.539 to 1.818, p=0.973). AF ablation + amiodarone resulted in a lower AF burden at 12 months compared with DCCV + amiodarone (17.0 ± 37.9% vs. 61.7 ± 48.6%, p<0.0001). Modified European Heart Rhythm Association (EHRA) symptom class improved in all patients (baseline 2.4 ± 0.495 vs. 12-month follow-up 1.84 ± 0.081, p=0.00001). Six-month CPET demonstrated a higher VO2 peak in sinus rhythm (SR) compared with baseline in AF (12.1 ± 4.2 ml/kg/min at baseline to 15.3 ± 4.2 ml/kg/min at six months, p=0.013). In conclusion, in older patients with persistent AF, ablation + amiodarone resulted in a lower AF burden at 12 months than DCCV + amiodarone. There was a non-significant trend toward reduced recurrence of devicedetected persistent AF episodes. All therapies improved symptoms despite DCCV restoring SR in <50% of patients at 12 months. CPET demonstrated improved VO2 peak with SR restoration.

Unveiling vertical ozone variation with UAV-Based monitoring and modeling: A new challenge for city-level ozone pollution control in the pearl river delta region

Ozone distribution and variation within the Planetary Boundary Layer (PBL) present challenges for air quality management. UAV-based ozone profile measurements offer advantages in terms of high vertical resolution throughout the PBL and flexibility. However, previous studies on vertical variation in the Pearl River Delta (PRD) region have rarely focused on measuring the vertical ozone variation during ozone pollution episodes. In this study, we integrated UAV-based monitoring, ground monitoring, and numerical modeling to investigate ozone variation, driving processes, and source regions of pollution episodic period. UAV-based observations during a 2021 ozone episode at rural areas in the PRD region revealed three ozone profiles: increasing, well-mixed, and decreasing with height. Morning profiles showed multiple layers influenced by meteorology, while peak ozone hours exhibited a well-mixed pattern. By integrating the validated numerical model, we found that chemical processes (CHEM) contributed positively to ozone episodes in both rural and urban scenarios, especially at the middle and upper PBL. Horizontal advection (HADV) significantly contributes to the episode in rural cases, while urban cases were significantly affected by vertical diffusion (VDIF). Backward trajectory and source apportionment analyses categorized PRD cities into upwind/non-upwind/local categories, showing ozone pollution originating from both upwind and non-upwind cities at different vertical levels. It is because wind shear influenced diverse source regions, and the transport channel for city-level ozone pollution exhibited daily and vertical changes. Moreover, it could also be contributed by the formed regional mixing ozone layer (ROM Layer) throughout the PBL during persistent ozone episodes, triggered by enhanced CHEM and significantly contributed by the VDIF. The ROM Layer at center cities, influencing ground-level ozone downwind through horizontal transport and vertical exchange. Considering the complex three-dimensional transport of ozone and the ROM Layer phenomenon, city-level management or regional co-control based on simple transport channels may be insufficient. Emissions control measures should cover all cities or target significant emitters to address regional ozone pollution.

Ozone pollution episodes and PBL height variation in the NYC urban and coastal areas during LISTOS 2019

In summer, frequent ozone (O3) episodes occur in New York City (NYC) and coastal areas along Long Island Sound (LIS) due to complex interplay of urban pollutants transport, land-sea breezes, and chemistry. The Long Island Sound Tropospheric Ozone Study (LISTOS) was carried out to address this issue; here we present an integrated analysis of the diurnal variation of planetary-boundary-layer height (PBLH) and O3 in the NYC urban and coastal area during LISTOS in summer 2019. A persistent O3 episode (July 28–31, 2019) is investigated which shows much higher O3 (90–120 ppb with 5-min average maximum) along the North-shore of Long Island (NLI) than the NYC urban and South-shore of Long Island (SLI). We evaluate the PBLH estimate with a multi-platform observation in the complex coastal environment, and compare the PBLH diurnal variation in the NYC urban to coastal areas. The results indicate lower PBLH in the mid-morning and noon in the NLI than the NYC urban area. With the simultaneously measured O3 and PBLH, the integrated O3 content or total content in the PBL defined as the O3 concentrations multiplied by PBLH show good consistency in the urban and NLI coast at noon on July 28–29, 2019. A dense O3 plume, rich in CO, aerosols, black carbon, HCHO and NOx appeared in the PBL as detected from the UMD Cessna research aircraft, satellite TROPOMI and ozonesonde; their coincidently large values imply the combined effects of urban plumes transport, lower PBLH and land-sea breezes in the NLI area. Finally, we evaluated the forecast of O3 and PBLH from the NOAA NAM-CMAQ (12 km grid) and WRF-Chem (1.3 km grid) models with the observations. Both models show good agreement with the observations at the NYC urban site; but at the NLI coastal site, the NAM-CMAQ model forecast indicates a timing bias for the maximum O3 at noon. These results provide insight into the impacts of the sea breeze and urban heat island on air quality.

Evolution of Ozone Formation Sensitivity during a Persistent Regional Ozone Episode in Northeastern China and Its Implication for a Control Strategy.

In recent years, the magnitude and frequency of regional ozone (O3) episodes have increased in China. We combined ground-based measurements, observation-based model (OBM), and the Weather Research and Forecasting and Community Multiscale Air Quality (WRF-CMAQ) model to analyze a typical persistent O3 episode that occurred across 88 cities in northeastern China during June 19-30, 2021. The meteorological conditions, particularly the wind convergence centers, played crucial roles in the evolution of O3 pollution. Daily analysis of the O3 formation sensitivity showed that O3 formation was in the volatile organic compound (VOC)-limited or transitional regime at the onset of the pollution episode in 92% of the cities. Conversely, it tended to be or eventually became a NOx-limited regime as the episode progressed in the most polluted cities. Based on the emission-reduction scenario simulations, mitigation of the regional O3 pollution was found to be most effective through a phased control strategy, namely, reduction of a high ratio of VOCs to NOx at the onset of the pollution and lower ratio during evolution of the O3 episode. This study presents a new possibility for regional O3 pollution abatement in China based on a reasonable combination of OBM and the WRF-CMAQ model.

Anomalous high ozone in the Pearl River Delta, China in 2019: A cause attribution analysis

Surface ozone (O3) pollution in the Pearl River Delta (PRD), especially persistent O3 pollution episodes lasting three days or longer (OPE3), showed an anomalous peak during the autumn of 2019 (bulge-2019). Our research reveals a robust connection between the occurrence of OPE3 events and days with low cloud cover. Specifically, low-cloud days comprised 55% of the total number of OPE3 events in the PRD during the autumn season spanning from 2015 to 2021. Notably, as much as 74% of the bulge-2019 is related to low-cloud days. However, establishing a direct causal link remains challenging. In autumn 2019, an anomalous cyclonic center developed over the Philippine Sea, with anomalous northerly winds on its northwestern flank, leading to anomalous downdraft over South China. This pattern was characterized by stagnant, low relative humidity, intensified solar radiation, and low cloud cover conditions that were conducive to the photochemical formation and accumulation of O3. Further analysis of the relationship between low-cloud days and El Niño–Southern Oscillation shows that eastern Pacific El Niño events are associated with fewer low-cloud days in the PRD in autumn, whereas central Pacific (CP) El Niño events result in more low-cloud days. In addition, the anomalous cyclonic center over the Philippine Sea serves as the crucial atmospheric circulation system connecting CP El Niño and high O3 level over southern China. Therefore, we propose that the increased downdraft of PRD brought by northward tropical cyclones (TCs) during more low-cloud days in 2019 is highly likely the primary cause of the occurrence of the bulge-2019.

Factors predicting seizure outcome after surgical excision of meningioma: SOLID-C guideline for prophylactic AED

BackgroundSeizures are commonly seen among meningioma patients and may cause impaired quality of life. These patients can be effectively treated with surgery. Still, many patients have persistent seizure episodes after surgery. The factors which are associated with worsening of seizure episodes remain critical in improving the quality of life for such patients. In this study, we aim to analyze the clinical and histopathological factors to predict the post excision seizure-outcome in meningioma and need of antiepileptic prophylaxis for these patients. MethodsAdult patients who underwent primary resection of meningioma at our institute between 2007 and 2020 were included in the study. Eligibility criteria were as follows: (i) Surgery for newly-diagnosed biopsy proven meningioma, (ii) Presence of pre-operative seizure (iii) A follow-up period ≥ 12 months. ResultsOf the 1145 patients in this series, 333 patients were recruited in study. The major determinants of prophylactic anti-epileptic were tumour size (S), Oedema (O), location (L), inclusion body (I), antiepileptic drugs (D) and surgical complication (C). The factors independently associated with poor seizure control after surgical resection were presence of brain parenchyma invasion (p < 0.001), pre-operative use of > 2 antiepileptics (p = 0.016) and presence of intranuclear inclusion bodies (p = 0.001). ConclusionsThe identification and consideration of factors associated with prolonged seizure control after surgery may help us to guide treatment strategies aimed at improving the quality of life for patients with meningiomas. Authors have proposed a SOLID-C guideline to avoid the blanket approach of prophylactic AED in patients undergoing for meningioma resection.

Total Lymphoid Irradiation in the Treatment of Heart Transplant Rejection: Single Institution Long-Term Results

Acute cardiac allograft rejection is a major cause of morbidity and mortality post-transplant. Total lymphoid irradiation (TLI) has been shown to cause long-lasting alterations in lymphocyte sub-sets, and thereby induces a state of partial response that is useful to prevent organ transplant rejection. In our previous report, treatment with TLI resulted in decreased episodes of acute rejection and steroid dosage requirements for up to 9.1 years post cardiac transplantation. In this study, we report an update on the short- and long-term effects of TLI in the treatment of cardiac transplant rejection. We performed a retrospective analysis of patients with intractable cardiac allograft transplantation evaluated in the department of radiation oncology at our institution over 23 years (1998-2021). Cardiac allograft rejection was defined as multiple or persistent episodes of rejection despite aggressive immunosuppressive therapy. The prescribed dose was 8 Gy in 10 fractions to be delivered over 5 weeks. All episodes of pathologic acute cardiac rejection, duration of immunosuppression, and episodes of acute infection requiring treatment before and after TLI were documented. Overall survival (OS) was analyzed using Kaplan-Meier method. The median time to first cardiac allograft rejection and the median time to first acute rejection was monitored. Of the 29 patients included, 21 (72.4%) had ISHLT grade 1R, 5 (17.2%), grade 2R, and 2(6.9%) grade 3R rejection. Rejection grade was unknown for 1 patient. The mean number of acute rejections after transplant was 14.4 episodes per patient (range 1-44) with median time to first rejection of 0.63 months. The median radiation dose was 8 Gy (range 7.2-8 Gy) delivered over a mean of 31 days. Treatment was stopped early in 2 (6.5%) patients (after 7.2 Gy and 7.9 Gy) for severe bone marrow suppression and drop in CD4 counts, respectively. The number of rejections dropped from 14.2 to 3.97 per patient over a median time of 29.0 months vs 28.1 months pre and post TLI (p = 0.01). The frequency of ISHLT acute grade 3R rejections decreased from 0.58 to 0.06 episodes per patient pre and post TLI (p = 0.02). Immunosuppressant requirements decreased from 2.83 before TLI to 2.69 after TLI (p = 0.71). Infection rates per patient were 0.71 pre TLI and remained at 0.63 post TLI. Treatment was well tolerated with 4 (13.8%) grade 2 or higher radiation toxicity. Median follow up was 76.3 months. Median and 3-year OS were 53.4 months and 60.9%, respectively. TLI is a safe and effective treatment for control of intractable cardiac rejection. The episodes of acute rejection and immunosuppressant requirements are decreased, but with long-term follow up, these patients continue to experience rejection. However, TLI lowers the frequency of ISHLT moderate to severe rejection episodes for up to 6.4 years. There was no increased risk of severe infections and there were only minimal short- and long-term grade 2 or higher radiation toxicities.

Impacts of urban expansion on meteorology and air quality in North China Plain during wintertime: A case study

The North China Plain (NCP) is one of the areas with a fast urbanization rate. The proportion of urban areas has increased from 1.78% in 2000 to 6.70% in 2015 in the NCP. Urban expansion induce variations in air pollutants are mainly determined by changes in meteorological conditions and atmospheric physicochemical processes. A persistent severe wintertime particulate pollution episode is simulated using the WRF-Chem model to investigate the impacts of land use/cover change on air quality in the NCP. Sensitivity simulations demonstrated that the urban expansion increases the near-surface temperature by approximately 0.2 °C, and further the development of the planetary boundary layer height by approximately 1.6%, but decreases the relative humidity by 0.4% on average. The near-surface O3 concentrations are increased by 2.2%, but the PM2.5 concentrations are decreased by 2.4% on average in the NCP. The near-surface concentration of NO2, SO2, and CO decrease by 4.5%, 2.2%, and 2.7%, respectively. The decrease in PM2.5 concentrations is approximately 8.9% in urban areas. Although urban expansion increases anthropogenic emissions of air pollutants, it alleviates particulate pollution to some degree, particularly in urban areas.

Formation pathways and source apportionments of inorganic nitrogen-containing aerosols in urban environment: Insights from nitrogen and oxygen isotopic compositions in Guangzhou, China

Air quality issues caused by PM2.5-induced persistent extreme haze episodes have become increasingly serious in urban environments in recent years. Secondary water-soluble inorganic sulfate (SO42−), nitrate (NO3−) and ammonium (NH4+) ions are the major components of PM2.5. However, the contributions of inorganic nitrogen species, especially nitrate, to PM2.5 have greatly increased during haze episodes in many cities in China. Therefore, better understanding of their emission sources and formation pathways holds the key to controlling urban PM2.5 pollution more efficiently and effectively. In this study, water-soluble ionic characteristics and isotopic compositions and sources of NH4+ and NO3−, as well as NO3− formation pathways were determined in PM2.5 aerosol samples collected in Guangzhou, China, during 2015–2018. The PM2.5 concentrations varied from 30.5 to 189.8 μg⋅m−3 and their mean values were highest in spring (111.1 μg⋅m−3) and lowest in summer (63.5 μg⋅m−3). The δ15N–NH4+ and δ15N–NO3- values ranged from +4.5 to +20.2‰ and from +4.8 to +14.8‰, respectively, with their mean values being highest in winter (14.0‰ and 9.5‰, respectively) and lowest in summer (10.4‰ and 7.1‰, respectively). The seasonal δ15N variability was mainly attributed to isotopic equilibrium fractionation, and partly due to the changes in NH3 and NOx sources. The average δ18O–NO3- value of 63.0‰, ranging seasonally from +58.6‰ in summer to +68.0‰ in spring, suggests that NO2 +⋅OH pathway played a vital role (70.3–85.9%) in NO3− formation. The Bayesian isotope mixing model results revealed fossil fuel combustion sources as dominant sources of atmospheric NH3 and NOx. This study suggests that more effort should be devoted to reduce NH3 and NOx from combustion-related processes and highlights the importance of δ18O–NO3- analysis for exploring variations of nitrate formation pathways in urban atmospheres.

Functional Outcomes and Safety Profile of Trans-Foveal Subthreshold Micropulse Laser in Persistent Central Serous Chorioretinopathy.

Our study evaluated visual function changes after subthreshold micropulse laser (SML) treatment in persistent central serous chorioretinopathy (CSC) and SML safety profile. We conducted a prospective study including 31 fovea-involving CSC patients. The natural course was observed for the first 3 months, SML was performed at 3 months, and SML effectiveness was observed at 6 months. At all three clinical visits, optical coherence tomography (OCT), best corrected visual acuity (BCVA), contrast sensitivity (CS) in five spatial frequencies (1.5, 3.0, 6.0, 12.0, and 18.0 cycles per degree (cpd)), microperimetry (MP), and multifocal electroretinography (mfERG) were performed. The SML safety profile was evaluated with functional and morphological parameters. In the cohort of all CSC patients treated with SML, the statistically significant average improvement was observed in BCVA (p = 0.007), CS-1.5 (p = 0.020), CS-3.0 (p = 0.050), CS-12.0 (p < 0.001), CS-18.0 (p = 0.002), CS (CS-A) (p < 0.001), MP in the central ring (MP-C) (p = 0.020), peripheral ring (MP-P) (p = 0.042), and average retinal sensitivity (MP-A) (p = 0.010). After the SML treatment, mean changes in mfERG amplitudes and implicit times in our cohort were not statistically significant. No morphological or functional adverse effects of SML treatment were observed. SML treatment in persistent CSC episodes leads to significant functional improvement and has an excellent safety profile.

Clinical and Epidemiologic Features of Cryptosporidium-Associated Diarrheal Disease Among Young Children Living in Sub-Saharan Africa: The Vaccine Impact on Diarrhea in Africa (VIDA) Study

As part of the Vaccine Impact on Diarrhea in Africa (VIDA) Study, we examined the prevalence, clinical presentation, and seasonality of Cryptosporidium in children to understand its relative burden after the introduction of rotavirus vaccine. VIDA was a 3-year, age-stratified, matched case-control study of medically attended acute moderate-to-severe diarrhea (MSD) in children aged 0-59 months residing in censused populations at sites in Kenya, Mali, and The Gambia. Clinical and epidemiologic data were collected at enrollment, and a stool sample was tested for enteropathogens by quantitative PCR. An algorithm was created based on the organism's cycle threshold (Ct) and association with MSD to identify the subset of Cryptosporidium PCR-positive (Ct <35) cases most likely to be attributed to MSD. Clinical outcomes were assessed at 2-3 months after enrollment. One thousand one hundred six (22.9%) cases of MSD and 873 controls (18.1%) were PCR positive for Cryptosporidium; 465 cases (42.0%) were considered attributable to Cryptosporidium, mostly among children 6-23 months. Cryptosporidium infections peaked in The Gambia and Mali during the rainy season, while in Kenya they did not have clear seasonality. Compared with cases with watery MSD who had a negative PCR for Cryptosporidium, cases with watery MSD attributed to Cryptosporidium were less frequently dehydrated but appeared more severely ill using a modified Vesikari scale (38.1% vs 27.0%; P < 0.001), likely due to higher rates of hospitalization and intravenous fluid administration, higher prevalence of being wasted or very thin very thin (23.4% vs 14.7%; P < 0.001), and having severe acute malnutrition (midupper arm circumference <115 mm, 7.7% vs 2.5%; P < 0.001). On follow-up, Cryptosporidium-attributed cases had more prolonged and persistent episodes (43.2% vs 32.7%; P <0 .001) and linear growth faltering (change in height-for-age z score between enrollment and follow-up: -0.29 vs -0.17; P < 0.001). The burden of Cryptosporidium remains high among young children in sub-Saharan Africa. Its propensity to cause illness and further impact children longer term by compromising nutritional status early in life calls for special attention to enable appropriate management of clinical and nutritional consequences.