An electron moving at velocities much lower that the speed of light with a spin, is described by a wave function which is a solution of Pauli’s equation. It has been demonstrated that this system can be viewed as a vortical fluid which has remarkable similarities but also differences with classical ideal flows. In this respect, it was shown that the internal energy of the Pauli fluid can be interpreted, to some degree, as Fisher Information. In previous work on this subject, electromagnetic fields which are represented by a vector potential were ignored, here we remove this limitation and study the system under general electromagnetic interaction. Quantum mechanics is usually interpreted by the Copenhagen school approach. The Copenhagen approach defies the ontology of the quantum wave function and declares it to be completely epistemological (a tool for estimating probability of certain measurements) in accordance with the Kantian  conceptiA non-relativistic quantum equation for a spinor was first introduced by Wolfgang Pauli in 1927 . This eqThe interpretation of Pauli’s spinor in terms of fluid density and velocity variables leads us directly to the nineteenth century seminal work of Clebsch ,27, whicic flows . Yahalomic flows  overcameA fundamental issue in the fluid interpretation of quantum mechanics still remains. This refers to the meaning of thermodynamic quantities. Thermodynamics concepts, such as specific enthalpy, pressure, and temperature are related to the specific internal energy defined by the equation of state as a unique function of entropy and density. The internal energy is a part of any Lagrangian density related to fluid dynamics. The internal energy functional can, in principle, be explained on the basis of the microscopic composition of the fluid using statistical physics. That is the atoms and molecules from which the fluid is composed and their interactions impose an equation of state. However, a quantum fluid has no structure and yet the equations of both the spinless ,6 and spWe will begin this paper by introducing the Eulerian–Clebsch variational principle for a charged fluid  that:In this section, we follow closely the analysis of  with theg takes the form:g is considered to be a field dependent on Let us take an arbitrary variational derivative of the above action with respect to  example , (page 2 example )) for a We shall now show that a velocity field given by Equation (5), such that the functions The reader of this paper might argue that the authors have introduced unnecessary complications to the theory of fluid dynamics by adding three more functions The Lagrangian density X with probability density function (PDF) Let there be a random variable as shown ,39 that m is the particles mass. The Lagrangian density a and phase a leads to the Hamilton Jacobi equation:Quantum mechanics has lost faith in our ability to predict precisely the whereabouts of even a single particle. What the theory does predict precisely is the evolution in time of a quantity denoted “the quantum wave function”, which is related to a quantum particle whereabouts in a statistical manner. This evolution is described by an equation suggested by Schrödinger :26)iℏψ˙6iℏψ˙(26)etations  and, in etations ,13).In writing the Lagrangian density of quantum mechanics in the modulus-phase representation, Equation 30), one notices a striking similarity between this Lagrangian density and that of potential fluid dynamics (fluid dynamics without vorticity), as represented in the work of Clebsch . The con0, one noIf a flow satisfies the condition of zero vorticity in the absence of a magnetic field, i.e., the velocity field =0 in L^ . Taking Going back to the quantum mechanical system described by Equation 30), we introduce the following variable: 0, we intAs explained in the introduction, the quantum Madelung flow does not have a microstructure that will explain its internal energy. To understand the origins of this term let us look at the internal energy of Equation (38), the term appearing in the Lagrangian density has the form:Thus, Schrödinger’s fluid differ from a classical potential flow in that it takes into account Fisher information as a driving force, and its “fluid element” lacks an internal energy, that is, it is truly microscopic and has no structure. Thus, when written explicitly in terms of physical quantities and not mere abstractions, quantum mechanics reveals itself as a theory that takes into account information gain (or loss) as a force of nature. We conclude this section by quoting Anton Zeilinger’s recent remark to the press, that it is quantum mechanics that demonstrates that information is more fundamental than space-time.Schrödinger’s quantum mechanics is limited to the description of spinless particles and its fluid dynamics representation is limited to zero vorticity (for the zero magnetic field case) potential flows. This suggests that a quantum theory of particles with spin may have a fluid dynamics representation which cannot be described solely by using We conclude this section by writing down the equations for the Clebsch–Pauli variables, unfortunately those equations are not very helpful. Taking the variational derivative we arrive at the equations of motion . The term can be written as:In the current work, which is a continuation of previous studies ,38,40, wA fundamental obstacle to the fluid interpretation of quantum mechanics still exist. This is related to the origin of thermodynamic quantities which are part of fluid mechanics in the quantum context. For classical fluid the thermodynamic internal energy implies that a fluid element is not a point particle but has internal structure. The standard thermodynamics notions such as specific enthalpy, pressure, and temperature are derived from the specific internal energy equation of state which in turn assumes the said internal structure. The internal energy is a required component of any Lagrangian density attempting to depict a fluid. The unique form of the internal energy can be derived in principle relying on the basis of the atoms and molecules from which the fluid is composed and their interactions using statistical physics. However, the quantum fluid has no such microscopic structure and yet analysis of both the spinless ,6 and spWe have highlighted the similarities between the variational principles of Eulerian fluid mechanics and both Schrödinger’s and Pauli’s quantum mechanics as opposed to classical mechanics. The former have only linear time derivatives of degrees of freedom while that later have quadratic time derivatives. The former contain terms quadratic in the vector potential It is conjectured that same analogy found between Pauli’s theory and fluid dynamics may be found between Dirac’s relativistic electron theory and relativistic fluid dynamics.It is also conjectured that an Eulerian relativistic fluid once properly defined in terms of a variational principle and augmented by a four dimensional Fisher information term will fully explain Dirac’s relativistic electron theory and inter alia Pauli’s theory as well.To conclude we suggest the following future directions of research:


Virus infection of adrenal glands can disrupt secretion of mineralocorticoids, glucocorticoids, and sex hormones from the cortex and catecholamines from the medulla, leading to a constellation of symptoms such as fatigue, dizziness, weight loss, nausea, and muscle and joint pain. Specifically, varicella zoster virus (VZV) can produce bilateral adrenal hemorrhage and adrenal insufficiency during primary infection or following reactivation. However, the mechanisms by which VZV affects the adrenal glands are not well-characterized. Herein, we determined if primary human adrenal cortical cells (HAdCCs) infected with VZV support viral replication and produce a proinflammatory environment. Quantitative PCR showed VZV DNA increasing over time in HAdCCs, yet no cell death was seen at 3 days post-infection by TUNEL staining or Western Blot analysis with PARP and caspase 9 antibodies. Compared to conditioned supernatant from mock-infected cells, supernatant from VZV-infected cells contained significantly elevated IL-6, IL-8, IL-12p70, IL-13, IL-4, and TNF-α. Overall, VZV can productively infect adrenal cortical cells in the absence of cell death, suggesting that these cells may be a potential reservoir for ongoing viral replication and proinflammatory cytokine production, leading to chronic adrenalitis and dysfunction. Virus infection of adrenal glands is an important, yet under-recognized, cause of adrenal dysfunction. The adrenal glands are part of the hypothalamic-pituitary-adrenal (HPA) axis, which is a major neuroendocrine system that regulates a spectrum of physiological functions. The adrenal gland produces glucocorticoids, mineralocorticoids, and sex hormones in the outer adrenal cortex and catecholamines in the inner adrenal medulla; these hormones regulate metabolism, the immune system, blood pressure, response to stress and other essential functions. Virus infection can disrupt hormone secretion, leading to a constellation of non-specific symptoms such as fatigue, dizziness, abdominal pain, weight loss, nausea, vomiting, and muscle and joint pain.Recent reports indicate that varicella zoster virus (VZV) may be an important pathogen contributing to adrenal disease. VZV is latent in 6% of human adrenal glands  and may 2 in mesenchymal medium containing 5% fetal bovine serum (FBS), 1% mesenchymal stem cell growth supplement, and 1% 100X penicillin-streptomycin (ScienCell). After 24 h, media was changed to media with 0.1% FBS and 1% 100X penicillin-streptomycin and was replenished every 72 h for 7 days, establishing quiescence (qHAdCC). On day 7, uninfected (mock) or VZV-infected qHAdCCs  were used; cell type was confirmed by an immunofluorescence antibody assay showing the presence of glial fibrillary acidic protein  and absence of tyrosine hydroxylase . HAdCCs were seeded at 5000 cells/cmAt 1, 2, and 3 DPI, DNA was extracted from mock- and VZV-infected qHAdCCs using the DNeasy Blood and Tissue Kit per manufacturer’s instructions . DNA was analyzed with custom qPCR primers  corresponding to VZV open reading frame 68 and glyceraldehyde-3-phosphate-dehydrogenase (GAPdH) as described [HAdCCs were plated into 24-well µ-plates  where quiescence was established as above; cells were mock- or VZV-infected then fixed at 3 DPI. Cells were permeabilized then analyzed by IFA as previously described . To confProinflammatory cytokines in conditioned supernatant  were measured using the human proinflammatory panel 1 assay kit  per manufacturer’s instructions. A positive control consisted of supernatant from qHAdCCs treated with lipopolysaccharide  for 24 h.At 3 DPI, mock- and VZV-infected qHAdCCs were lysed in radioimmunoprecipitation assay (RIPA) buffer containing 1x Halt protease inhibitor cocktail  and 50 μg/mL phenylmethylsufonyl fluoride (PMSF). Protein concentration was determined by colorimetrics using Pierce BCA protein assay kit (ThermoFisher Scientific). Seventy µg of protein was resolved by 12% SDS-PAGE and transferred to a polyvinylidene difluoride membrane using a PierceG2 Fast Blotter (ThermoFisher Scientific) at 25 V, 2.5 A, for 7 min. Blots were probed with primary antibodies overnight at 4 °C with rocking, washed, and incubated with secondary antibody for 1 h, at room temperature with rocking. Wash buffer consisted of 0.05% TWEEN 20-PBS. Primary and secondary antibodies were diluted in 2.5% nonfat milk in 0.05% TWEEN 20-PBS. Primary antibodies consisted of 1:1000 rabbit anti-poly (ADP-ribose) polymerase (PARP) that detects both full and cleaved PARP , 1:1000 Caspase-9 , and 1:20,000 β-actin . Secondary antibodies consisted of 1:2500 donkey anti-rabbit HRP  and 1:5000 donkey anti-mouse HRP . Signal was detected using Super Signal West Pico Plus Chemiluminescent Substrate . Blots were stripped, blocked for one hour, and probed with the control antibody, β-actin . Western blot products were evaluated in a single image using the Fiji gel analysis tool [t-tests with a False Discovery Rate . Significant differences in viral titer were determined using a 1-way ANOVA with a Tukey’s multiple comparisons test.Statistical analysis was performed using graphing software . Cytokine differences between mock- and VZV-infected qHAdCC supernatant were determined by multiple unpaired Phase-contrast images at 3 DPI showed a cytopathic effect (CPE) in VZV-infected cells, but not in mock-infected cells A. To conMany non-neuronal cell types undergo cell death during VZV infection ,14,15,16Compared to conditioned supernatant from mock-infected qHAdCCs at 3 DPI, supernatant from VZV-infected qHAdCCs showed a significant increase in interleukin (IL)-6  and IL8 ; in addition, IL-12p70, IL-13, IL-4, and tumor necrosis factor (TNF)-α were present in VZV supernatant but absent in mock . No IL-1Herein, we found that VZV infects adrenal cortical cells and produces a proinflammatory environment, in the absence of cell death, under our experimental conditions . Specifically, VZV DNA increased over time, indicative of productive virus infection. When compared to supernatant from mock-infected cells, elevated IL-6 and IL-8 were seen in supernatant from VZV-infected cells. Further, IL-12p70, IL-13, IL-4, or TNF-α were absent in mock-infected qHAdCC supernatant but present in VZV-infected qHAdCC supernatant. Taken together, these observations shed light on the potential clinical manifestation of VZV infection of human adrenal glands.Conditioned supernatant from VZV-infected cells contained elevated IL-6 that can potentially affect adrenal function. While cortisol and aldosterone levels could not be measured in mock- and VZV-infected cells due to paucity of available adrenal cortical cells, elevated IL-6 has been reported to increase plasma cortisol and aldosterone levels in several studies for full review see ref. . SteensbOther cytokines  that may impact adrenal function were seen in supernatant of VZV-infected cells but not supernatant of mock-infected cells. Specifically, IL-4 was found only VZV-infected cells and is associated with increased ACTH-stimulated cortisol release in bovine adrenal cortical cells, which may play an important role in coordinating adrenal response to inflammatory stressors . The relMycobacterium tuberculosis [The absence of VZV-induced adrenal cortical cell death in our study is surprising given that many non-neuronal cells undergo apoptosis during VZV infection ,24. Onlyrculosis . WhetherChronic inflammation of the adrenal gland  can alter production of glucocorticoids and mineralocorticoids, thereby disrupting homeostasis and producing disease such as Addison’s disease, characterized by fatigue, weight loss, gastrointestinal problems, salt cravings, arthralgias and myalgias. Adrenalitis has been primarily attributed to an autoimmune etiology, yet pathogens have also been reported to affect adrenal glands, including HIV, coronaviruses, enteroviruses, and human herpesviruses  ,28,29,30Myalgic encephalomyelitis, similar to COVID-19 long haul symptoms, have been reported following VZV infection. An epidemiological study found that the incidence of chronic fatigue syndrome was higher in zoster versus non-zoster patients . Another


The survival rate of preterm infants is increasing as a result of technological advances. The incidence of intraventricular hemorrhages (IVH) in preterm infants ranges from 25% to 30%, of which 30% to 50% are severe IVH  and probably lead to posthemorrhagic ventricular dilatation (PHVD). Severe IVH and subsequent PHVD have become the leading causes of brain injury and neurodevelopmental dysplasia in preterm infants. This review aims to review the literature on the diagnosis and therapeutic strategies for PHVD and provide some recommendations for management to improve the neurological outcomes. Due to the regional vulnerability of the subependymal germinal matrix and abrupt fluctuations in cerebral blood flow, preterm infants, particularly very premature infants, are prone to developing an intraventricular hemorrhage (IVH). Bleeding usually occurs in the germinal matrix near the ventricular wall and is rich in an immature capillary network. An IVH is also called a germinal matrix hemorrhage-intraventricular hemorrhage (GMH-IVH). Blood cells from an IVH may block Montessori’s foramen, resulting in obstructive hydrocephalus. Moreover, secondary inflammation caused by a hematoma and scarring of the arachnoid villi would bring a cerebrospinal fluid resorption disorder, which would lead to communicating hydrocephalus and eventually to posthemorrhagic ventricular dilatation (PHVD). Studies have shown that between 30% and 50% of severe IVH  casesPHVD usually occurs on the seventh–fourteenth days after an IVH. cUS is a good measurement for diagnosing and following the progression of PHVD according to these three parameters ,12: (1) Currently, there is no consensus on the best time for the intervention of PHVD . Levene A continuous lumbar puncture is the most straightforward treatment for PHVD. It can clear bloody cerebrospinal fluid, reduce cerebrospinal fluid’s proteins and inflammatory factors, and relieve intracranial hypertension. It may be effective for infants with minimal bleeding and mild dilatation. De Vries et al.  conducteDrainage intervention fibrinolytic therapy (DRIFT) involves inserting a catheter into the ventricle and injecting recombinant tissue plasminogen activator (RT-PA), after which artificial cerebrospinal fluid is used, repeatedly flushing the ventricle until the drainage-recovered fluid is not colored . The purWhen continuous cranial ultrasound monitoring indicates progressive dilation or the ventricle dilation does not stop after two to three lumbar punctures, a VAD is often temporarily placed to drain cerebrospinal fluid . The mosStaphylococcus aureus and Staphylococcus epidermidis were the most common pathogens [The subgaleal space is the fibroareolar layer of the scalp between the galea aponeurotica and the periosteum of the cranial bones. Due to its elastic and absorptive capabilities, it can be used as a shunt to drain excess cerebrospinal fluid from the ventricles. A VSG consists of a shunt tube with one end in the lateral ventricles and another inserted into the subgaleal space . The plaathogens . Both VAathogens , and cerathogens . Fountaiathogens  systematIn addition to VAD and VSG as temporary interventions, endoscopic third ventriculostomy (ETV) combined with choroids plexus cauterization ,35, the 3 [A VPS device comprises a ventricular catheter connected to a valve and a distal catheter in the peritoneal cavity. It is a cerebral shunt that can transfer excess cerebrospinal fluid from the lateral ventricles into the peritoneum when the normal outflow is blocked or there is a decrease in fluid absorption . A VPS i3 . Althoug3 . A multi3 . Infecti3 ,50. The 3. Based on the reported therapy experiences, we summarized a flow chart (Based on the therapeutic experience from many clinical institutions, preterm infants, particularly very premature infants with gestational ages < 32 weeks, with severe IVH, should be assessed with cUS twice a week until PHVD stops aggravating. An intervention should be performed when VI > 97th centile + 4 mm, AHW > 10 mm, or TOD > 25 mm. When cerebrospinal fluid drainage is required for more than four weeks, and dilation is still in the aggravated stage, a VPS should be placed if the body weight of the infant is >2 kg, the protein of cerebrospinal fluid is <1.5 g/L, and the red blood cell count of cerebrospinal fluid is <100/mmow chart  for the


Granular cell tumours are usually benign with a 1–2% incidence of malignancy. They are less sensitive to radiotherapy and chemotherapy and are treated by surgical excision. We report a case of a malignant granular cell tumour located at the interventricular septum. Granular cell tumour (GCT) was first described by a Russian pathologist, Abrikossoff, in 1926 [1]. Granular cell tumour (GCT) was first described by a Russian pathologist, Abrikossoff, in 1926 [A 48-year-old woman was diagnosed with a right thigh malignant GCT (8.2 cm) and underwent complete margin-free tumour resection 6 years ago. No chemotherapy or radiation therapy was administered after the first surgery. At the 3-year follow-up, a 0.5 cm right lower lobe lung tumour was observed on chest radiography, which enlarged to 2 cm in 2 years. She underwent a second surgery through a video-assisted thoracoscopic right lower lobe wedge resection, and the histopathology confirmed malignant GCT. After the surgery, she was started on metronomic oral cyclophosphamide. Follow-up computed tomography revealed an abnormal protruding IVS and a 1.9-cm hypodense oval tumour located in the IVS, which increased to 3.1 cm at the ninth-month serial images follow-up  for their contribution to the peer review process of this article.


The primary driver of costs for C/IC pts is hospital length of stay. Studies across multiple infections demonstrate that most clinically stable pts with modest diagnostic & therapeutic requirements can be safely discharged prior to actual HD day. Few studies have assessed if there is an opportunity to accelerate time to HD in pts with C/IC. This study sought to determine the proportion of US hospitalized adult pts with C/IC who received an EC near HD & was potentially eligible for an earlier HD.Candida sp. on a culture consistent with C/IC; ≥3 days of an EC for C/IC; discharged alive; & received an EC near HD (-2 day to HD day). Pts were considerable potentially dischargeable if they met the following 3 criteria & maintained these 3 criteria until HD: resided on a non-ICU hospital ward, taking oral medications, & had no receipt of any diagnostic/therapeutic interventions (insertion of PICC lines were permitted). The difference in hospital days between first potentially eligible HD day & actual HD day was quantified. The proportion of pts that was potentially eligible for an earlier HD was examined overall & by Charlson Comorbidity index (CCI), C/IC, & Candida sp.Design: Retrospective, multi-centered observational study using Premier Healthcare Database (1/2016-4/2019). Study criteria: hospitalized; age ≥ 18 years; C. glabrata (31%) & C. albicans (31%) were the most frequent Candida. sp. Of the 1,008 pts on an EC near HD, 14%, 21%, 29%, & 38% were potentially dischargeable 4, 3, 2, & 1 day(s), respectively, prior to the actual HD day . The proportion of pts who were potentially eligible for HD at least 2 days prior to actual HD day did not vary by CCI score, C/IC, & Candida sp.During study period, 1,599 pts received an EC ≥ 3 days for C/IC & were discharged alive. Of the 1,599 pts, 1,008 (63%) were on an EC near HD. For the 1,008 pts on an EC near HD, the mean (SD) age was 59 (16) years, 52% were male, 40% had a CCI ≥4, 35% were in the ICU on index C/IC culture day, & 64% had C vs IC. Candida sp.Our findings suggest that a high proportion of hospitalized pts with C/IC receiving an EC near the time of HD, had modest diagnostic/therapeutic requirements prior to actual HD day & were potentially eligible for an earlier HD regardless of CCI, infection type, or Thomas Lodise, Jr., Pharm.D., PhD, BioFire Diagnostics: Grant/Research Support|cidara: Advisor/Consultant|cidara: Honoraria|Entasis: Grant/Research Support|Merck: Advisor/Consultant|Merck: Grant/Research Support|Paratek: Advisor/Consultant|Shionogi: Advisor/Consultant|Spero: Advisor/Consultant|Venatrox: Advisor/Consultant Kevin W. Garey, PharmD, MS, Acurx: Grant/Research Support|cidara: Advisor/Consultant|cidara: Grant/Research Support|Paratek: Grant/Research Support|Seres Health: Grant/Research Support|Summit: Grant/Research Support Brian H. Nathanson, Ph.D., cidara: Grant/Research Support|Merck: Advisor/Consultant|Merck: Grant/Research Support.


Protamine, an antagonizing agent to heparin, is indispensable for dogs undergoing cardiopulmonary bypass. Protamine-induced hypotension (PIH) during cardiac anesthesia has been reported in humans. The purpose of this study was to describe the hemodynamic effect of protamine administration in dogs during cardiac surgery in clinical cases. Study design: Retrospective, clinical, cohort study. A total of 14 client-owned dogs who suffered heart failure due to medically uncontrolled myxomatous mitral valve disease (MMVD) were included in this study. The severity of MMVD was classified according to American College of Veterinary Internal Medicine staging  and dogs undergoing mitral valve surgery. Records with clinical data for dogs treated between July 2019 to August 2020 were examined for age, sex, breed, body weight, concurrent diseases, hospitalization, anesthetic record, and mortality within 3 months after the operation. PIH was defined as mean arterial pressure (MAP) lowered by 20% of that before protamine infusion. To evaluate the effect of protamine on hemodynamic variables, each of the other values was compared with values at the beginning of protamine infusion. MAP decreased by 41.0 and 45.7% in two dogs (14.3%) compared with pressure before protamine infusion. Others did not show obvious alteration in hemodynamic variables. Epinephrine treatment alleviated hypotension in one dog. Another dog with systemic hypotension concomitant with elevated central venous pressure did not respond to epinephrine treatment and a reboot of extracorporeal circulation was required. Reheparinization and reinstitution of cardiopulmonary bypass successfully resuscitate the second dog. In conclusion, clinicians should alert the incidence of severe hypotension even with slow protamine infusion following canine cardiac surgery. This study also provides two effective treatments for catastrophic hypotension during protamine infusion. Myxomatous mitral valve disease (MMVD) resulting from degeneration of the valve leaflets and chordae tendineae is a common cardiac disorder causing congestive heart failure in dogs, especially in small breeds ,2. SurgiProtamine is commonly used to reverse the anticoagulant properties of heparin after cardiac surgery. However, hemodynamic instability due to protamine is one of the critical complications in cardiac surgery since the administration of protamine is associated with systemic hypotension, which may sometimes be fatal ,7. ProtaSince PIH has been reported in experimental dogs, hypotension may occur when used in clinical cases. However clinical manifestation of protamine reaction is not demonstrated in veterinary medicine. The present study aimed to describe the hemodynamic effect of protamine injection following mitral valve surgery in dogs with spontaneous degenerative mitral valve disease.Fourteen dogs that suffered from MMVD and underwent mitral valvuloplasty were retrospectively evaluated in this study. Data were collected from the medical and anesthetic records of a private clinic specialized in veterinary cardiology  between July 2019 and August 2020. All dogs were monitored for 3 months after the repair of spontaneous mitral valve regurgitation. The severity of mitral valve disease was staged according to the American College of Veterinary Internal Medicine (ACVIM) consensus statement guidelines by Keene et al. [To evaluate the severity of MMVD, conventional echocardiography protocol  was carried out ,13. Dogs–1 SC , fentanyl 5 μg kg–1 IV  and midazolam 0.2 mg kg–1 IV , followed by induction with propofol 6 mg kg–1 IV , and maintained with 1–2 vol% of isoflurane  and propofol. Methylprednisolone  and cefazolin  were injected as anti-inflammatory and antibiotics, respectively. Fentanyl (10 μg–1 kg–1 h) was used as intra operative analgesia. A 4-Fr catheter  was inserted into the right femoral artery and vein to monitor systolic (SAP), mean (MAP), diastolic (DAP) arterial pressures, and central venous pressure (CVP). Then, these catheters were connected to pressure transducers  and pressure information was imaged by a multi-channel monitor . Heart rate was measured by electrocardiogram. Heparin  400 U kg–1 was administered. To perform cardiopulmonary bypass (CPB), the left carotid artery and jugular vein were cut down with a No. 11 scalpel and an 8–14 Fr catheter  was inserted according to the dog’s size. CPB  with a flow of rate 100 mL−1 kg–1 min was used. Activated clotting time  was used for determining the anticoagulant effect of heparin. Aortic root cannula was performed through a purse-string suture from the left lateral side of the ascending aorta. Aortic clamping followed by the administration of cardioplegia  achieved cardiac arrest. The mitral valve was repaired by chordal reconstruction and suture annuloplasty. After the closure of the left atrium, the aorta was unclamped and sinus rhythm was restored spontaneously. Dog weaned from CPB after conducting modified ultrafiltration and confirming the hemodynamic system was stable. Ultrafiltration was performed by previously reported methods [–1 was administered over 30 min using a syringe pump. Norepinephrine and/or dobutamine were administered as needed. Activated clotting time (ACT) was measured after the end of protamine infusion. The surgical procedure is summarized in Fourteen dogs were premedicated with atropine sulfate 0.05 mg kgIn the immediate recovery period, IV fluid therapy including fentanyl was administered and monitoring was performed using an electrocardiogram , pulse oximeter , and a pressure transducer . Invasive blood pressure was measured from dorsalis pedis artery.PIH was defined as mean arterial blood pressure (MAP) lowered by 20% of that before protamine infusion for five min . DefinitMAP nadir during protamine infusion < MAP before protamine infusion × 0.8.–1 was administered over 30 min. If significant hypotension occurred during protamine administration, protamine administration was discontinued and doses of norepinephrine and dobutamine were started to deal with hypotension. Norepinephrine and dobutamine were started from 0.1 μg–1 kg–1 min and 3.0 μg–1 kg–1 min, respectively. When MAP recovered to the value before the administration of protamine, protamine administration was resumed. CPB was started when the administration of protamine induced severe hypotension which could not be dealt with the catecholamine.Protamine 4 mg kg–1 kg–1 min) and dobutamine (first dose 3.0 then 5.0 then 7.0 then 10 μg–1 kg–1 min) were followed.Generally, if hypotension was not improved, the dose of dobutamine and norepinephrine was gradually increased every 5 min. Dosing of norepinephrine (first dose 0.1 then 0.2 μgn = 12) and a hypotensive group where the blood pressure was reduced by 20% after protamine administration (n = 2).According to the effect of protamine on blood pressure, dogs were classified into two groups as follows; a non-hypotensive group .The significance level was set at The result of preoperative echocardiographic variables was shown in –1 kg–1 min was given throughout protamine infusion (0.0–0.1 μg–1 kg–1 min) to the non-hypotensive dogs. The dose of norepinephrine was a two-fold and four-fold increase in the two hypotensive dogs, respectively, compared with the mean dose in the non-hypotensive dogs. Simultaneously, dobutamine was used at a mean dosage of 4 μg−1 kg−1 min in the non-hypotensive group which was increased to 5 μg–1 kg–1 min in the two hypotensive dogs.Dogs were classified into two groups based on their response to protamine administration. In the non-hypotension group, there was no significant change in heart rate, systolic arterial, diastolic arterial mean arterial, and central venous pressure (CVP) during protamine infusion A. The CV–1 kg repeatedly failed to restore cardiovascular collapse. Visually, the myocardium lost its dynamism and hemoglobin saturation. We decided the reboot extracorporeal circulation to avoid life-threatening damage to systemic organs by prolonged hypotensive state. Heparin 400 U–1 kg was added to the extracorporeal circuit before the second cardiopulmonary bypass. After hemodynamic support by an artificial heart-lung system, the heart regained cardiac output, and the blood pressure became stable. A total of 4 mg–1 kg protamine was infused after the end of the second cardiopulmonary bypass . By the third dosing of protamine, administration of all the prescribed amounts was completed (The adverse reaction of protamine in this study was observed as hypotension. PIH was observed in 2 out of 14 dogs (14.3%). The two dogs with PIH exhibited marked signs 10 min after the infusion. In one dog, MAP suddenly decreased from 63 to 25 mmHg for 5 min. MAP nadir was 41.0% compared with the pressure before infusion. Administration of epinephrine at a dose of 10 μgy bypass B. In theompleted C.Data of ACT are summarized in One dog from the non-hypotension group died 6 days after surgery due to cerebral infarction. Two dogs with hypotension did not experience any complications. The overall mortality rate was 7.1% (1/14) at 3 months after surgery.MMVD is the most common cardiac disorder in dogs where surgical interference remains the last resort when medical treatment is ineffective. Despite the invasiveness and long operation time, the successful rate of mitral valvoplasty through open-heart surgery is still the best among other choices. This study demonstrated a clinical response to protamine infusion following open-heart surgery and strategies to combat PIH to enhance the recovery and the outcomes of patients. Clinical and experimental studies demonstrated that the usage of protamine as a heparin-neutralizing agent has a negative impact. This includes increased pulmonary artery pressures, decrease systemic BP, increases myocardial oxygen consumption, increase cardiac output and heart rate, and decreases systemic vascular resistance .Sudden catastrophic hypotension occurred 10 min after the onset of infusion. Epinephrine bolus and reboot of extracorporeal circulation were useful in solving the hemodynamic perturbations. In the current study, two out of 14 dogs experienced a reduction in MAP of more than 20% compared to the pre-infusion period, and 12 out of 14 operated dogs showed no deterioration in the cardiovascular system and did not require additional use of vasoactive medication. In the two affected cases, the sudden cardiovascular collapse may be induced by protamine. As previously observed in other studies in humans ,17, hypoThis study presented two effective treatments for PIH. Epinephrine has been used in humans for treating protamine side effects and is suitable as a first choice . The admThe description of PIH was discussed extensively in this study. Protamine infusion suddenly causes life-threatening hypotension without warning. Protamine infusion must be given slowly and carefully monitored until the end of the administration. Since there is no established treatment, the worst scenario could be avoided by maintaining the cannula in the dog, so that the extracorporeal circulation can be resumed at any time until the end of protamine infusion. To prevent clotting in the extracorporeal circuit, heparin should be added to the circuit and the blood is circulated by using the shunt in the circuit. In human medicine, several studies reported that the administration of methylene blue may be effective for PIH; however, the effect of this drug is still skeptical in veterinary medicine . The small sample size is one of the major limitations for an accurate assessment of incidents, risk factors, and prognosis. Large-scale studies can help identify true prevalence and risk factors. Although re-pump can be the last of the bastion to save a life, this method has a limitation of invasiveness. According to human literature, prolonged cardiopulmonary bypass time increases the probability of complications such as hemolysis, coagulopathy, and inflammatory reactions . FurtherInfusion of protamine effectively antagonized the anticoagulation but was associated with severe hypotension in two dogs. Administration of epinephrine was an effective treatment for hypotension in one dog but not in a second dog. Cardiopulmonary bypass was reinstated in the second dog, which was subsequently successfully weaned to spontaneous circulation. Epinephrine and extracorporeal hemodynamic support can be an effective strategy for catastrophic hypotension during protamine infusion.


Based on recent findings in cognitive neuroscience and psychology as well as computational models of working memory and reasoning, I argue that fluid intelligence (fluid reasoning) can amount to representing in the mind the key relation(s) for the task at hand. Effective representation of relations allows for enormous flexibility of thinking but depends on the validity and robustness of the dynamic patterns of argument–object (role–filler) bindings, which encode relations in the brain. Such a reconceptualization of the fluid intelligence construct allows for the simplification and purification of its models, tests, and potential brain mechanisms. Intelligence  constitutes one of the central constructs in psychology, originating from the late nineteenth century . The structure of human intelligence  as well as its predictive power have been a topic of vivid debate  is not feasible, the research on cognitive abilities frequently focuses on fluid intelligence , also cag), with loadings reaching unity  in a valid and robust way, by linking respective elements with the roles that these elements play in the relation(s), using flexible patterns of bindings. Just after the advent of cognitive psychology—a discipline devoted to the understanding of architecture and mechanisms of human cognition using precise experimentation —researchProcessing speed, measured by response times on forced choice tasks, by performance on clerical tasks, and by inspection time, has been considered as a promising candidate from the 1970s onwards . HoweverSince the 1980s e.g., , variousMoreover, in the 1990s, interest in sensorimotor discrimination, initially considered at the dawn of intelligence research , was revWorking memory capacity (WMC), considered in intelligence research around that time, is reflected in the number of briefly maintained and then recalled/recognized items; typically, these are items difficult to articulate or presented under additional load and/or encoding requirements. WMC appears to be the strongest predictor of intelligence e.g., , explainOne could summarize the existing correlational research on ECPs and fluid intelligence as bringing us closer to understanding the cognitive mechanisms underlying the latter construct. Specifically, some potential mechanisms (bare attention and stimulus discrimination) can be discarded, others  should still be considered but require additional research, whereas active maintenance of and access to task-related information, as reflected by WMC, looks as if it is a fundamental mechanism for fluid intelligence. While I agree that correlational studies provided a multitude of results, I see at least three problems in their unequivocal interpretation, and thus applicability for an advancement of fluid intelligence theory.r = .94 dropped to r = .74, that is, as much as 38% of initially shared variance could actually be explained by other factors. First, the strength of relationships between fluid intelligence and its relatively strong predictors, especially working memory, might have been overestimated. For instance, measurement of distinct cognitive abilities may confound their true relations with some contextual factors  that can boost shared variance. In line with this, when Moreover, although most fluid intelligence tests were initially designed as power tests, typical testing conditions  entice researchers to cut original administration times. That only affects the tests’ reliability a little, but may hugely alter their validity , for exaSecond, no cognitive task developed so far can capture a unique “elementary cognitive process”. Claiming that a given task captures a given elementary process, researchers incorrectly transfer the task intended requirements, as typically defined by the task instruction, onto their interpretation (naive model) of the information flow during solving the task, based on coarse-grained psychological concepts. At the same time, theoretical results from computational modeling in psychology and neuroscience show that this information flow needs to be described in terms of much finer-grained entities and their transformations. The picture is also complicated by the fact that the models proposed so far largely differ in how they describe such flow on the fine-grained level. For example, the well-known Stroop task is typically defined in psychometrics as an attention-control task, or a response-inhibition task, which requires blocking word reading while focusing attention on color naming (as asked by the task instructions). In computational cognitive neuroscience, a number of Stroop-like task models have been developed, which assume entities that can hardly match the above high-level description, including such terms as “energy”, “utility”, “activation”, “dimensional uncertainty”, and “inhibitory conductance”, to name only a few. Moreover, these models assume differing mechanisms responsible for effective color naming, including activation spread among concepts, lemmas, and word forms , action An analogous situation pertains to working-memory tasks, with the one exception that they are even more complex than attention control tasks. Actually, from a perspective of cognitive modeling, a, let’s say, complex-span task  is comparably complex, as are some reasoning tasks presumably tapping fluid intelligence . Moreover, there is an ongoing debate about what limits WMC: is it the number of available slots to maintain separate memory objects ; the numThird, it seems that the fact that correlational studies are correlational has been neglected when researchers draw conclusions from the correlations they observe. Even though each statistical handbook notes that correlation between X and Y can, in principle, be caused either by X or Y, or by their reciprocal interaction, as well as by another  variable Z (or more such variables), a superficial simplicity of ECPs relative to intelligence tests  as well as an implicit but ill-conceived reductionist stance has led many researchers to draw causal conclusions that intelligence varies because of ECPs. However, given the findings in cognitive modeling and cognitive neuroscience, it is likely that both X and Y are caused  “map” of relationships between cognitive constructs. However, this very tool seems strongly limited in the depth of fluid intelligence explanation it can yield. In the next sections, I shortly review two alternatives, more process-oriented approaches to developing a theory of fluid intelligence, which may offer insights beyond those offered by the psychometric approach. The first approach examines experimentally the properties of established fluid intelligence tests, trying to discover the crucial requirements of these tests—what minimal cognitive task is sufficient to capture the same variance in fluid intelligence that is captured by the tests used to date. It seems that little is required—just to validly represent a relatively simple relation. The second approach analyzes neurocomputational models of deductive and inductive reasoning in order to identify the sources of intrinsic limitation in representing relations. Typical fluid intelligence tests involve identifying abstract rules governing relatively complex figural stimuli patterns and selecting the response option that best matches these rules. Probably the most widely applied test is Raven’s Advanced Progressive Matrices RAPM; , which pCrucially, discovery of rules seems irrelevant for capturing fluid intelligence. Notably, in many other established fluid intelligence tests, including geometric analogies, paper folding, and necessary arithmetic operations . Both for RAPM  and anotr = .55). However, this correlation remained strong (r = .67) in a variant in which the participants were not given an abstract instruction to organize the symbols into the linear order, but only to decide which relation with the reversed symbols was the same as the relation in one of presented pairs . The correlation held strong (r = .58) when no concept of relation was mentioned, but the participants were just asked to identify exactly the same pair as one presented , and dropped only a little (to r = .46) when the task was to simply match the three-symbol string including a middle slash . The correlation only disappeared when the task was to match unbound pairs of symbols (is “AB” the same as “AB” or “BA”). It was concluded that full-blown abstract reasoning is not needed to capture fluid intelligence, and as little as a single trivial binding of simple information in the mind is critical.Besides the perceptual complexity and response-option diversity of a fluid reasoning test, it is interesting what level of the problem’s scope and abstraction is actually required to tap fluid intelligence. These findings were compatible with the results on the so-called relation-monitoring task developed by Finally, Another source of insight on what is crucial for fluid intelligence comes from the computational models of structured information processing developed in cognitive neuroscience and cognitive psychology. In cognitive neuroscience, the rhythmic activation of neuronal groups encoding task elements was proposed as a mechanism underlying the brain processing of ordered and structured information. Probably the most widely cited iEEG study of the rat brain  showed tInspired by Recent EEG see  and transtructure mapping; relational reasoning; In cognitive modeling, multiple models of problem-solving and reasoning assumed that representing and transforming relations, as well as mapping their structures across situations, is the core process  for the task at hand in a valid and robust way. Such relations could be encoded in the brain by an asynchronous pattern of a required number of correct role–filler bindings. I start to elaborate the above proposal by qualifying more precisely its main three elements: relations, valid, and robust.On the basis of the findings described above, I propose that Relation is defined as a labeled, ordered list (tuple) of arguments. A label identifies a relation and allows other entities to refer to it . In cognitive science and psychology specifically, arguments are more commonly called relational roles, and their values are called fillers , the role of giver assumes a person or a group. The relation’s instance Gave  clearly satisfies this constraint; but, in a creative story on a magic cat in which the constraints can be violated, it would also be acceptable that Gave . However, as many fluid intelligence tests are semantically lean (include meaningless symbols or shapes), the above categorial constraints help little in processing relations. Second, and more important, the relation representation must be structurally consistent within the entire system of relations a person holds , the actors and objects must play the corresponding roles as in Gave, that is, Received . Third, the categorial and structural properties of relations together allow for making multiple inferences. For instance, knowing that “A is above B” and “C is below B”, one can infer that “A is on top”, “C is at bottom”, “B is between them”, etc. However, in order to do so, mental representations of relations need to be ar roles —for inston holds , so whenRow1 . Following the structural consistency principle, it needed to be transformed .Simple fluid intelligence tests may capture fluid reasoning so aptly because they require a valid relation representation. For instance, in the relation-monitoring task, such a representation must include only the last symbols bound correctly to the consecutive matrix positions , such as robust means simply that this representation has to be accessible, as long as it is required during coping with a task. For instance, the relation Row1 cannot break down before the relation Diff is construed (but can be dispensed afterwards). Failure to access the key relation, either because of failure to construe it or to maintain it after construal, likely leads to a failure on the task.The condition that relation representation has to be The power to represent relations in a valid and robust way potentially provides an individual with crucial flexibility in dealing with cognitive tasks, because relational representations can encode arbitrary knowledge structures of any form. Especially, they enable novel structures, including ones which are not possible in the real word (“a mouse bigger than an elephant”), underlying innovative and creative thinking. This very flexibility stems from the fact that relational roles can, in principle, be paired with any fillers see . MoreoveThe effective maintenance of relation representations may drive individual differences in fluid reasoning, because evidence from cognitive neuroscience and cognitive modeling suggests that processing relations in a valid and robust way is very difficult for such a biological system as the human brain. Specifically, if the oscillatory models of working memory and reasoning are right, the relation representation requires the maintaining of an arbitrary and precise pattern of dynamics: representation of a given relational role and corresponding filler must be maintained in synchrony, while consecutive role–filler bindings must be active asynchronously. Both data from brain recordings  and compThe above proposal should not be treated as a novel theory of fluid intelligence, just as a working hypothesis. In the present state of cognitive (neuro)science, we still await more precise data and models on how humans process relations, which are not easily extractable from the black box of the human mind. Even though psychometrics (new simple fluid intelligence tests), brain imaging , and cognitive modeling  provided initial cues for the conceptualization of fluid intelligence in terms of flexible relational representations, future research is needed to develop a causal theoretical model explaining how dynamic patterns in the brain could translate into relational representations, which themselves would translate into the processing of cognitive tasks (including fluid intelligence tests) that, in turn, translates into academic, professional, socioeconomic, and life status. However, even not being such a theory, the current proposal helps to purify the fluid intelligence construct and develop new ways of its scientific pursuit.Even though a direct method to observe how relations are represented in the brain is still lacking , severarelation appeared a century ago in eduction of relations and correlates , seems compatible with the current proposal, yet it is formulated in a much more abstract way. Moreover, this theory primarily pertains to the development of relational processing, instead of the adult differences in it. Finally, relational frame theory , which dIn short, the present proposal claims that neither the process of integrating the bindings into the complete relational representation nor the available relational complexity of such a representation are crucial for individual differences in fluid reasoning, even though they may contribute to some of its variance. By contrast, such differences primarily reflect the validity and robustness of the more basic role–filler bindings representing relations. Inability to maintain, validly and robustly, such bindings in the brain/mind, as a result, limits the construal and processing of relation representations, even simple ones. In this work, I focused on the importance of relation representation and processing for the construct of fluid intelligence. I argued that when inessential features of fluid intelligence tests are abstracted away, the process captured by these tests amounts to representing the key relation(s) in the valid and robust way. Based on my review of neurocognitive data and models, this ability may itself be rooted in the parameters determining the maintenance of arbitrary patterns of dynamic bindings linking consecutive arguments of a relation with the roles played by them. These arbitrary, dynamic bindings potentially allow substantial flexibility of  thinking. How valid and robust representations of relations one can maintain due to valid and robust bindings, may determine a fluid intelligence level one displays. Validation of this proposal requires novel precise data and models, with the future integration of findings from cognitive neuroscience and psychology with computational models of working memory and reasoning. The proposal can potentially help to reconceptualize fluid intelligence towards a more process-oriented construct (theory), as compared to the traditional correlational approaches considered to date. Although such a complex phenomenon as fluid intelligence definitely cannot be reduced to a single factor, the idea of relation representation may purify this very phenomenon and stipulate new lines of research.


B = 0 and strong mass suction This study is aimed to explore the magneto-hydrodynamic Carreau fluid flow over a stretching/shrinking surface with a convectively heated boundary. Temperature-dependent variable thermophysical properties are utilized to formulate the problem. The flow governing equations are obtained with boundary layer approximation and constitutive relation of the Carreau fluid. The shooting method is utilized to obtain graphical and numeric outcomes. Additionally, initial guesses are generated with the help of Newton’s method. The effect of Weissenberg number, Magnetization, stretching ratio, Prandtl number, suction/blowing parameter, and Lewis number is obtained on velocity, temperature and species continuity profile and analyzed. Shear stress rates and Nusselt number outcomes under body forces influences are present in tabulated data and discussed. It is observed that in absence of magnetization force,  Heat transfer enhancement using different physical configurations and fluids has been an interesting topic for researchers over the last two decades. Many scientists have given much attention to this field due to its wide range of applications in industrial and engineering processes. Production of rubber, colloidal suspension of fluid, glass production, and spinning of metal are some examples of its applications. Likewise, the term “nanofluid” was first coined by Chio and Eastman in the year 1995. They discovered in their research how to increase the thermal conductivity of base fluid by dispersing metallic or non-metallic non-meter-sized particles in it. The formed mixture was given the name nanofluid. The thermal conductivity of the formed mixture was found to be enhanced. Recently, another category of fluids has surfaced known as “hybrid nanofluids”. In these types of fluids, instead of one, two nano-meter sized nano-particles, metallic or non-metallic, are dispersed into the host base liquid. This innovation has immensely enhanced the thermal conductivity of fluids consequently as a result high heat transfer rates and reduced shear stress rates are achieved. Mandal et al.  investigHiemenz  studied Prilepskii et al.  employedAkbar and Nadeem  investigAbdou and El-Zahar  demonstrDevi and Kandasmy  analyzedSalahuddin et al.  investigThe current study is aimed to examine convective heat transfer in classical non-Newtonian Carreau fluid under influence of variable thermophysical properties.Rehamn et al.  conductex-direction. Here Consider a non-linearly stretchy sheet with a uniform 2-D in-compressible viscid flow of an electrically conducting fluid. Meanwhile, the plate has been stretched with the velocity Equation of continuity ,55(1)∂uMomentum Equationsrq relation [Energy Equation without relation ,55(3)u∂Species continuity equationT stands for fluid temperature, D denotes thermal diffusivity. Temperature dependent thermal conductivity and viscosity have major possibilities in such a field as magneto-electro resonance [The dynamic viscosity is represented by esonance . We are The effect of variable thermal conductivity and viscosity are represented by taken as ,55:(6)u=Here, In this section the flow governing Equations (1)–(4) along with boundary conditions (6) are converted into dimensionless equations. For this purpose, we define the following similarity transformations:Now, converted boundary conditions are as follows:In the above equations The shear stress and heat flux are the physical quantities of engineering interest. Here, after utilizing the boundary layer approximation (BLA) and constitutive relation for Carreau fluid, following relations represent wall shear stress and wall heat flux, respectively.The skin friction and Nusselt number given bySkin friction and Nusselt number in dimensionless form are defined as follows:Formulate the flow governing equation in the presence of body forces with help ofGeneral Naiver-Stokes and boundary layer approximation. Additionally, utilizing the constitutive relations of Carreau fluid.Transform the achieved flow governing equations into ordinary differential equations using suitable similarity transforms.Introduce a set of new variables to convert the ordinary set of differential equations into an initial value problem.Calculate the initial guesses using Newton’s method and simulate the problem employing shooting method.Set the tolerance of numerical solution in MATLAB and Code the whole problem.Finally, achieve graphical results for different profiles. Obtain numeric outcomes for shear stress rate and Nusselt number.Different numerical methods have been used by scientists over the years to obtain reliable and effective results of the problem. Abou-zeid  tackled The following notions have been used to transform the above non dimensional flow equation along with the boundary equations.The following set of ordinary differential equations are obtained by using the above set of notations.The boundary conditions are defined as follows:The missing conditions The Stopping criteria for the Newton’s method is set as:Here, in this section, the outcomes of the influence of distinct study parameters are presented. Different study profiles namely: velocity, temperature and concentration are observed under the varying effect of thermal conductivity, viscosity, magnetization force, Weissenberg number, Lewis number, Prandtl number and mass suction influence for both stretching and shrinking surface. The analysis of outcomes is conducted here along with discussion on achieved outcomes. The shear stress rates and Nusselt number under the varying impression of study parameters are presented in tabulated data set and elaborated in discussions.B = 2,3 denotes the stretching in surface and B = −2,−3 describe the shrinking in surface. It is observed that under increment in power law index in case of stretching surface the motion of Carreau fluid has decreased. Whereas, in shrinking case the velocity has increased with augmentation in power law index. It is worth noting here that thickness of associated momentum boundary of Carreau fluid has expanded in case of shrinking while it has contracted in the case of stretching (See hing See b. FigureThe increment in power law index increases velocity profile for shrinking surface whereas decline has been observed in motion for stretching.High suction reduces the fluid motion for stretching and shrinking. Velocity profile decreased with augmentation in viscosity of fluid. Velocity profile has increased with the increase in Weissenberg number.Increasing the magnetization force has decreased motion of fluid for stretching surface and opposite behavior has been observed for shrinking. Additionally, the increment in highly non-linearity parameter increases the fluid motion for stretching/shrinking.Increment in non-linearity parameter decline the temperature profile sharply.Temperature profile increases with increase in Prandtl number consequently, thermal boundary layer thickness of the fluid expands.Temperature profile has increased with augmentation in viscosity and declination has been observed with increment in Lewis number.Temperature profile is the increasing function of variable thermal conductivity parameter.Nusselt number have increased with increment in non-linearity and suction influence. Minimal shear stress rate is observed under the increasing power law index.In this article, the effect of magneto-hydro-dynamic effect on the Carreau fluid flow over a non-linear stretching/shrinking surface is addressed with convective heat transfer. The variable thermo-physical properties are incorporated. Additionally, flow governing equation are solved numerically with the shooting method in MATLAB and Newton’s method is used to obtain the initial guesses. Moreover, the major outcomes of our study can be summarized as follows:


Acute neurologic complications from Varicella-Zoster-Virus reactivation occur in both immunocompromised and immunocompetent patients. In this report, we describe a case of a previously healthy immunocompetent boy who had received two doses of varicella vaccine at 1 and 4 years. At the age of 12 he developed acute aseptic meningitis caused by vaccine-type varicella-zoster-virus without concomitant skin eruptions. VZV-vaccine strain DNA was detected in the cerebrospinal fluid. The patient made a full recovery after receiving intravenous acyclovir therapy. This disease course documents another case of a VZV vaccine-associated meningitis without development of a rash, i.e., a form of VZV infection manifesting as “zoster sine herpete”. Varicella-Zoster-Virus (VZV) is a member of the herpesvirus family causing varicella during primary infection. Live attenuated varicella vaccines, derived from the Oka strain of VZV, have clinical efficacy for the prevention of varicella . The USAReactivation of latent VZV genomes from neuronal cell in sensory ganglia, e.g., of the dorsal root and trigeminal nerve results in viral spread along axons and herpes zoster (shingles) which is typically characterized by a vesicular rash limited to a specific dermatome and unilateral radicular pain. Recent studies indicated that vaccinated children have a significantly lower incidence of herpes zoster than unvaccinated children ,9,10. Ac®) and four (Priorix-Tetra®) years. Cardiac, pulmonary and abdominal examination findings were normal. Magnetic resonance imaging findings were normal. At admission, laboratory analysis of cerebrospinal fluid showed a slight increase of total protein-level (628 mg/L) and lactic acid-level (2.27 mmol/L) as well as a mild to moderate pleocytosis (CSF leukocyte count 2.91 × 108 cells/L). Blood counts revealed a transient lymphocytopenia and a neutrophilia. Results of serum chemistry, including measurements of liver enzyme levels , were normal. Enzyme immunoassays were positive for VZV-specific IgM- and IgG-antibodies, indicating active VZV infection including VZV reactivation [A healthy 12-year-old boy presented to the emergency department with history of severe headache for 2 days, photophobia and vomiting, but no fever. The night before hospitalization symptoms intensified and neck stiffness occurred. There was no history of recent contact with sick people or exposures to varicella. The patient’s immunization status was complete. According to national vaccination recommendations the child had received two documented doses of varicella vaccine at the age of one  and negative for enterovirus and herpes simplex virus by real-time polymerase chain reaction; culture results were negative for bacteria.Differentiating wild-type VZV strains from the Oka vaccine strain can be achieved only by molecular genotyping methods. The development of PCR based methods for VZV strain differentiation has been hampered by the fact that the VZV genome is highly conserved. However, a number of single nucleotide polymorphisms (SNPs) have been described that differentiate Oka-derived VZV vaccine strains from wild-type VZV strains ,26,27,28Altogether, the SNP profile fully matched with the nucleotide sequence of Oka/Merck varicella vaccine strain as published by Tillieux et al. . On thisExtensive and detailed immune diagnostics revealed normal numbers, percentages and ratios of leukocytes, lymphocytes, monocytes, granulocytes and peripheral T and B cell subsets, including CD4- and CD8- T cells. The analysis was carried out in the Institute of Laboratory and Transfusion medicine at the Helios Hospital Schwerin  and Varilix®/Priorix-Tetra® (GSK) significantly differ in their vaccine/wt allele frequency [® rather than Priorix-Tetra® which was used as a second dose. A limitation of our study is the limited number of SNPs analyzed and their location within the VZV genome. Recombination between wt VZV strains is widely documented, raising the theoretical possibility that the reactivating VZV genome in our patient might have been originated from a recombination event of the Merck vaccine strain and a superinfecting wt VZV strain. The very existence and clinical relevance of VZV vaccine strain recombination events is a matter of recent debate [Based on the presence of single nucleotide polymorphisms (SNP) profiles in various VZV open reading frames (ORF) including ORF 62 coding for the transactivating major immediate early protein diagnostic differentiation of vaccine-type VZV from wt VZV can be achieved ,47,48. Mrequency . The GSKrequency . The genrequency . Both fit debate ,51 Recent debate . Such coThe reported case challenges the common notion that skin manifestations represent a reliable clinical indicator for VZV disease and suggests considering VZV a possible cause of aseptic meningitis in suspected cases with varicella vaccination history. One may speculate that attenuated VZV strains could tend to produce incomplete clinical pictures without rash due to their impairment in replication and spread. Appropriate testing to identify VZV in CSF and sequence analysis in future cases will be important to establish the incidence of this probably rare vaccine complication.


Varicella zoster virus reactivation after COVID-19 vaccination has been reported in older or immunocompromised adults. We report zoster meningitis from live-attenuated varicella vaccine reactivation in an immunocompetent child after COVID-19 vaccination. This type of case is rare; COVID-19 and varicella vaccines remain safe and effective for appropriate recipients in the pediatric population. Results of gram stain and cultures were negative. Cerebrospinal fluid and vesicular lesions were PCR-positive for VZV and were determined to be the vOka strain by the Centers for Disease Control and Prevention using a VZV fluorescence resonance energy transfer PCR. A cerebrospinal fluid viral meningoencephalitis antibody panel with >30 targets detected only VZV antibodies . The ePlex respiratory pathogen panel PCR  was positive for only rhinovirus/enterovirus, presumably representing recent infection. Other studies, including those for HIV, herpes simplex virus, SARS-CoV-2, and QuantiFERON-TB, were negative. Immunologic  studies revealed no underlying immunodeficiency. Exome sequencing performed using the Agilent SureSelect Clinical Research Exome XT kit  and an Illumina HiSeq 2500  established no clinically important variants. The patient was treated with intravenous acyclovir for 10 days and recovered uneventfully.Laboratory studies revealed levels of leukocytes, platelets, C-reactive protein and transaminases within reference ranges. The cerebrospinal fluid had a leukocyte level of 252 cells/mmThe incidence of uncomplicated herpes zoster (HZ) in vaccinated children is rare: an estimated 48 cases/100,000 person-years compared with 230 cases/100,000 person-years in unvaccinated children, a 79% reduction (HZ reactivation is more frequent in adults, particularly in the elderly, because of waning of cellular immunity, and among immunocompromised persons. Changes in the immune status after COVID-19 vaccination has been postulated to lead to VZV reactivation (In conclusion, COVID-19 and varicella vaccines are extremely effective and safe in preventing disease in children. However, to ensure appropriate patient care, clinicians must be aware that rare sequelae, such as HZ reactivation, zoster meningitis, or both, might also occur.


False codling moth is a polyphagous pest that could be introduced and establish in Australia. This moth may threaten many commercial horticultural and agricultural production crops in Australia by damaging a wide range of agricultural crops including avocados, guavas, peaches, citrus, grapes, cotton, roses and some solanaceous crops. Since false codling moth has caused considerable financial loss to rose growers through damage to agricultural crops and horticultural products as well as the costs associated with its control and eradication in some African countries, it is prudent to predict likely establishment regions in Australia. The predictions were generated using a Species Distribution Model named Maxent. Results not only considered the climatic suitability but also overlaid the prediction maps with presence of susceptible hosts. The predictions indicated a range of near-ocean regions across Australia that were potentially suitable habitats. These results provided preliminary insight into the potential for false coding moth to establish in Australia. This research is valuable as the economic impact of this pest could be serious, with prediction and early detection key to preventing the establishment and spread of false codling moth across Australia.Thaumatotibia leucotreta (Meyrick) (Lepidoptera: Tortricidae), the false codling moth. The detection of T. leucotreta is quite difficult due to the cryptic nature of the larvae during transportation and is therefore a concern for Australia. This insect is a known pest of agriculturally important crops. Here, Maxent was used to assess the biosecurity threat of T. leucotreta to Australia. Habitat suitability and risk assessment of T. leucotreta in Australia were identified based on threatened areas under suitable climatic conditions and the presence of hosts in a given habitat. Modeling indicated that Australia is vulnerable to invasion and establishment by T. leucotreta in some states and territories, particularly areas of western and southern Australia. Within these locations, the risk is associated with specific cropping areas. As such, invasion and establishment by T. leucotreta may have serious implications for Australia’s agricultural and horticultural industries e.g., the fruit and vegetable industries. This study will be used to inform the government and industry of the threat posed by T. leucotreta imported via the cut flower industry. Targeted preventative measures and trade policy could be introduced to protect Australia from invasion by this pest.Kenya and some other African countries are threatened by a serious pest  Australia is a net agricultural exporter, with the gross value of agricultural production exceeding $66 billion in 2020–2021 [At the same time, Australia is an importer of horticultural products. From 2019–2020, the Australian export of fresh cut-flower produce was valued at AUD8.4 million while import produce was valued at AUD74.2 million . Kenya iThaumatotibia leucotreta (Meyrick) (Lepidoptera: Noctuidae), also known as false codling moth, is a European Union quarantine pest. T. leucotreta is a known pest of agriculturally important crops, including avocados, guavas, peaches, citrus, grapes, cotton, some solanaceous crops and roses [T. leucotreta has been deemed a priority pest by many countries, with pathways of human-assisted spread, such as passenger luggage and imported fresh products [T. leucotreta is native to sub-Saharan Africa [T. leucotreta is present but restricted in Israel [Thaumatotibia leucotreta is considered a significant economic pest in Kenya and other African counties as its impact on agricultural areas threatens local and export crop production including vegetables, fruits and flowers, as well as reducing the export of capsicums, roses and avocados to the EU and around the world. The pest also has a negative impact on Kenya citrus production [T. leucotreta is now classified as not only a production pest, but also regulated as a phytosanitary pest with declared ‘zero tolerance’ [Thaumatotibia leucotreta is typically polyphagous and can cause feeding damage to over 107 host species and subspecies, both cultivated and wild [T. leucotreta has low natural dispersal ability across the landscape, it is able to move long distances via human-mediated pathways [nd roses ,7,8. In products . T. leucn Africa  and Isran Africa . Currentn Israel ,7 and wan Israel . Thaumatoduction . The ecolerance’ . This colerance’ . Thaumatand wild ,16,17,18pathways . Many hopathways ,21. Thispathways .T. leucotreta can include a range of symptoms, such as chewing, exit holes and frass eventually resulting in yield reduction [T. leucotreta is that infestation symptoms are often difficult to detect. In the case of roses, the flower buds can appear to be undamaged during early infestation [Damage caused by eduction , and infeduction . A furthestation .T. leucotreta as a Union quarantine pest listed in Part A of Annex II of Commission Implementing Regulation ((EU)2019/2072) and listed as priority pests in Commission Delegated Regulation ((EU)2019/1702) [T. leucotreta in the export of cut flowers [T. leucotreta interceptions in the EU over recent years with the most noticeable interception increases reported in roses [T. leucotreta in cut flowers from Kenya between 2005 and 2017, however, there were 37 detections in 2018, 39 in 2019, 51 in 2020, 50 in 2021 and 9 until June of the current year, 2022 [In 2004, the European Commission declared 19/1702)  and the 19/1702) . Kenya r flowers . There har, 2022 .T leucotreta can enter diapause [T. leucotreta may pass into a “chill coma” at temperatures of 3 °C–7 °C, becoming dormant, and ceasing feeding and other activity. However, Moore et al. [T. leucotreta at temperatures 1, 2 and 3 °C for 19, 20 and 24 days. Huisamen et al. [T. leucotreta fitness (spontaneous behavior and flight ability) based on simulating lower-temperature transportation. The shipping temperatures for cut flowers sent to Australia is 4 °C [There is no evidence that diapause ,26,27. Bdiapause , howevere et al.  obtainedn et al.  reported is 4 °C . To ensu is 4 °C . As suchT. leucotreta is a tropical pest, it is known to be active during winter nights in South Africa, indicating that the pest has a greater tolerance to low temperatures compared with the codling moth, Cydia pomonella [T. leucotreta is mostly considered to be particularly vulnerable under continuing cold conditions, however, regions with a greater diurnal fluctuation range tends to favor the pest overwintering even under cold conditions. As the pest may be able to complete more than one generation during the summer period, this may allow transient populations to survive [T. leucotreta may also be a threat to more temperate countries. Venette [T. leucotreta, particularly in the southern and south-western United States [T. leucotreta as a high risk as it is assumed to be capable of establishing itself in Australia and is considered a serious biosecurity threat, particularly to a wide range of crops across tropical and sub-tropical areas [While omonella . Moreoveomonella  identifi survive . This su Venette  forecastd States . Given id States  and Unitd States ,33, Austal areas .T. leucotreta, determining the accurate geographic area that is most likely threatened by potential establishment is essential for effective monitoring and management. Species Distribution Models (SDMs) are a useful tool for predicting the potential distribution of species [Given the threat posed by  species  based on species . In this species , was sel species . Compare species  as well  species .T. leucotreta in pomegranate plantations in Israel. The global mean surface temperature is becoming warmer along with the global long-term warming trend identified by NASA’s Goddard Institute for Space Studies (GISS) [T. leucotreta.Climate change is another concern with SDMs prediction in the future. Climatic changes cause the change in greenhouse gases which may affect the distribution of the pest . Levi-Zas (GISS) . The incT. leucotreta into Australia and the potential for its establishment, T. leucotreta represents a clear and present threat to Australia’s agricultural and horticultural sectors. As post-border detections of T. leucotreta inevitably increase, this research seeks to provide information to biosecurity managers, industry and government departments on the potential regions that are likely to support the infestation and establishment of this pest with the specific aims: (i) to estimate the potential geographic distribution of T. leucotreta in Australia, along with the strength of habitat suitability and (ii) to identify the most important environmental predictors that drive the establishment range of T. leucotreta.In light of the biosecurity concern of an incursion by T. leucotreta .This research aims to guide development of early detection methods, monitoring systems and other phytosanitary interventions that will assist with the biosecurity management of T. leucotreta were collected from currently available distribution records obtained from a range of sources: Global Biodiversity Information Facility ); Centre for Agriculture and Bioscience International ); and European and Mediterranean Plant Protection Organization ).The occurrence data for T. leucotreta in this study are shown in T. leucotreta, were managed using a bias grid file created by ‘ENMeval’ package [The total 89 occurrence points used for the modeling of  package  in RStud package ,45. This package . This pr package  and have package ,48.T. leucotreta population development as eggs of T. leucotreta have a higher mortality rate at temperatures below 13 °C [T. leucotreta for temperatures above 10 °C for egg laying and an optimal temperature for colonization of 25 °C [Climate is one of the most important factors driving the distribution of phytophagous insects . In mostow 13 °C  and cessow 13 °C . This reow 13 °C  researchow 13 °C ,54. As sow 13 °C , accordiow 13 °C  study. Tof 25 °C ,32,51.Collinearity is a common problem when statistical models are used to estimate the relationship between one response variable and a set of predictor variables . To reduModels were processed using the ‘Maxent’ platform (Version 3.4.1). The two parameters that have the greatest influence on model accuracy are ‘feature classes’ and ‘regularization multiplier’ (RM) . FeatureThis study considered both threshold-independent metrics and threshold-dependent metrics to evaluate and select the optimal model. Area under the curve (AUC) of the receiver operating characteristic (ROC) curve  is a thrThe final optimal model chosen for this study included the threshold dependent metric ‘Delta AIC’ at 0 with a good AUC value (0.954 ± 0.020). The threshold independent metric of the optimal model shows a low omission rate of 0.03 as well as a low value of omission rate (10%) of 0.15. The optimal model used in this study included six climatic variables: bio4, bio6, bio7, bio13, bio17, bio19 and DDA10 (degree days > 10 °C). All feature classes: linear, quadratic, product, threshold and hinge (LQPTH) were included. The ‘regularization multiplier’ (RM) value was set at 3.Based on the output of the most optimistic model, ArcMap 10.6  was usedT. leucotreta to establish in Australia, the areas of potential species invasion considered both climatic habitat suitability and host range [T. leucotreta is a polyphagous pest, its host range could be much wider than currently known. This research incorporates the extent of possible hosts using the horticultural and agricultural land use data from ‘Australian land use and management classification’ [T. leucotreta superimposed on host land use. In addition, the potential establishment area (hectares) of each state or territory was estimated using ArcMap and Excel.To identify the potential for st range ,18, as wst range . Given tication’ . AccordiThe Maxent model’s internal Jackknife test and contribution percentage were both used to identify the relative importance of different environmental variables and the relative contribution that each variable made to the model ,70. JackT. leucotreta in Australia  and tropical north-eastern Australia (Qld) extended along the coast and passed through the whole coastal area of temperate eastern Australia (NSW) to temperate southern Australia (Vic.). Moderate and low areas also cover the eastern coastal area of temperate southern Australia (SA), the northern part of tropical north Australia (NT) and some northern regions of temperate southern Australia (Tas.) , Table 3ucotreta , Table 2T. leucotreta in Australia. Based on the optimum model, Bio7  had the highest contribution (31.2%) to T. leucotreta’s habitat distribution, of the environmental factors assessed, as well as the highest permutation importance (67.3%). Bio4  (20.9%) and DDA10 (Degree days above 10 °C) (17.9%) also had an important contribution, but with more limited permutation importance . The lowest contributions were from Bio17 , and Bio19   .The results of the Jackknife test showed that Bio4  had the highest training gain , as wellThe variable response curve for Bio7  showed that the mean temperature range had an important impact on habitat suitability . The higThaumatotibia leucotreta  is polyphagous and able to remain active throughout the year, assisted by a “green bridge” created by alternating susceptible crops. As T. leucotreta does not diapause, there is a probability of the pest arriving alive with goods at importing countries as a result of chill coma [T. leucotreta in the EU for a number of different commodities for the period of 2020 to 2022 [T. leucotreta in Australia with Maxent modeling.ill coma . There w to 2022 . This is to 2022 ,73,74. HT. leucotreta in Australia as published by previous studies where the areas were largely focused on tropical and sub-tropical regions [T. leucotreta’s habitat preference included not only tropical but also temperate climatic zones. Given that much of Australia’s horticulture is in temperate areas, with warm summers and cold winters (mean temperature of the coldest month between −3 °C–18 °C) [T. leucotreta is greater than previously stated.In this study, suitable habitats were identified in not only tropical and sub-tropical regions, but also in temperate areas across Australia. This result changes the risk area profile for  regions . The res regions , who staC–18 °C) ,76 alongC–18 °C) , this stT. leucotreta within the Mediterranean climatic regions of Australia is not surprising as they are also consistent with the more recent findings by Loomans [T. leucotreta was highlighted by its introduction and establishment in Israel [T. leucotreta have been found in Mediterranean climatic regions in South Africa [T. leucotreta that included establishments close to the Mediterranean coast in North Africa, the Near East and Europe [The predicted establishment of  Loomans . The suin Israel . Added th Africa ,32,77. Ah Africa  also sumd Europe .T. leucotreta. While Bio6 (Minimum temperature of coldest month) had a lower contribution, it is still relatively important because of its higher training gain for modeling. The higher training gain demonstrated by Bio6 reflects the importance of this variable in determining the model and predicted distribution of T. leucotreta. This outcome concurs with EPPO [T. leucotreta strongly relies on the pest’s ability to overwinter and survive under the lowest temperature period of the year. It also demonstrated the close relationship between ‘low-temperature mortality’ of T. leucotreta and ‘winter mean monthly lowest average temperature’ [T. leucotreta. This verified the development threshold of T. leucotreta based on its biological characteristics from previous studies [This research demonstrated that temperature-related variables generally contributed more to the model than precipitation-related variables. This finding is supported by EPPO . For exaerature’ . The majerature’  ‘Hardine studies ,32,51.T. leucotreta establishment. The response curve of Bio13 (Precipitation of wettest month) and Bio17 (Precipitation of driest quarter) indicated the highest suitability of an area for T. leucotreta establishment occurred when the total mean rainfall was relatively low. This implies that high rainfall is not as favorable to T. leucotreta establishment. This is similar to Daiber [T. leucotreta populations as heavy rainfall has been shown to kill T. leucotreta eggs. However, low rainfall does not mean an absence of rainfall, as extremely dry conditions have been reported to have a negative impact on T. leucotreta development, with drought likely to limit population growth [T. leucotreta, as the pest cannot avoid drought by passing into diapause. Similarly, Daiber [Precipitation-related factors can also impact on o Daiber ,80 who rn growth . These rn growth  regardin, Daiber  identifiT. leucotreta is recognized as a tropical pest thriving in warm and moist conditions, with a requirement for humidity from precipitation. In addition, host plants are an essential requirement for T. leucotreta establishment and spread. The findings were confirmed in this study, where the entire central region of Australia’s desert zone [T. leucotreta.According to the previous findings, ert zone  has no cT. leucotreta be introduced. This research identified a number of agricultural habitats that are highly suitable to T. leucotreta establishment in Australia. These included the south-west of Western Australia (from latitude 32° S to 35° S with longitude 115° E to 125° E) and the south-eastern part of South Australia (from latitude 36° S to 40° S with longitude 136° E to 140° E), both temperate and Mediterranean climates. Additional high suitability areas were also predicted in the Western Australian Wheatbelt (center from latitude 32° S with longitude 118° E), which are consistent with previous predictions [The most important finding of this study is the confirmation that temperate areas of Australia are at risk should dictions .In addition to climate, Australian land use is also an important factor for consideration, given that the presence of susceptible host material is essential. Extensive areas containing susceptible hosts are present in eastern NSW and south-west WA. In contrast, south-east Qld, east Vic. and south-east SA all have a relatively small proportion of land with suitable hosts. The NT and east Tas. have limited areas with susceptible hosts.Thaumatotibia leucotreta is not able to move long distances independently, so areas growing susceptible perennial hosts will be more suitable than seasonal hosts. However, if there are surrounding alternative susceptible seasonal hosts growing at other times of the year, the risk of establishment will increase, as hosts are available for longer periods. To provide a sensible determination of where this pest might spread, it is necessary to consider both climate suitability and presence of susceptible crops. The overlay map precisely analyses the possibility of establishment of T. leucotreta in Australia and indicates that the areas exposed to the highest likelihood of establishment are mostly confined to the states of Western Australia and South Australia.T. leucotreta. The Bunbury region of WA has the second largest susceptible area . This region has a diverse agricultural production sector [T. leucotreta can be active the whole year, where the climate is suitable, it can be assumed that agricultural production around Albany, Margaret River, Manjimup and Bunbury are under threat from T. leucotreta establishment.In Western Australia, there are large areas implicated in the agricultural surrounds across the City of Albany in the Great Southern region . The region around Albany is a significant contributor to Australian agricultural production and includes horticulture and viticulture industries, with susceptible cultivated capsicum, sweet corn, beans, peas and fruits such as avocados, wine grapes as well as some cut flowers . These an sector , with hin sector . Industrn sector . These rn sector . Given sT. leucotreta. in the Fleurieu Peninsula . These areas include Cape Jervis, Victor Harbor and Kangaroo Island, all with high value annual production of grapes and citrus [In South Australia (SA), there are large areas predicted to be highly susceptible to d citrus . Limestod citrus .T. leucotreta could be considered as one of the variables in predicting the potential establishment and distribution of the pest. Pest biology is an important factor impacting the distribution of pests through the interaction between the pest and its enemies [T. leucotreta include parasitoids and predators. Trichogrammatoidea cryptophlebiae Nagaraja, the African egg parasitoid. is one of the natural enemies of T. leucotreta and has been used as an effective biological control agent against the pest [Agathis bishop (Nixon) [Anoplolepis custodiens (Smith) and Pheidole megacephala (Fabricius), both have been proven to attack the larvae and pupae of T. leucotreta in citrus orchards [T. leucotreta such as the egg predators, Orius sp., the larval predator, Rhynocoris albopunctatus (Stål) and the egg/larval mite predator Pediculoides sp. [Wang et al.  suggeste enemies . Naturalthe pest ,88,89,90 (Nixon) . Major porchards ,92. Addiides sp. ,94,95.T. leucotreta. The effectiveness of biological control is sensitive to some abiotic factors [T. cryptophlebiae are sensitive to broad spectrum chemical pesticides and their improper application [P. megacephala, were introduced into Australia [T. leucotreta.Lehmann  identifi factors , parasitlication . Even soustralia  and compustralia  and slowT. leucotreta in Australia compared to previous reports. The outcome not only verified the potential areas from previous research but also discovered and further enlarged the potential areas. These results contribute towards a more accurate assessment of risks posed by T. leucotreta to agriculture and horticulture. Potential invasion areas identified in this study may be underpredicted, attributable to insufficient or the absence of data for accurately determining the cold tolerance of T. leucotreta [This research using Maxent modeling has predicted a different habitat suitability for ucotreta .T. leucotreta exist across Australia, in which there are both a suitable climate and cropping. The poor natural dispersal ability of T. leucotreta could confine the spread of the pest to the vicinity of cropping areas permitting eradication. The pest’s polyphagous nature could allow it to infest alternating crops within restricted areas. Early detection is therefore key to preventing potential spread.Areas likely to favor the establishment of T. leucotreta. The pest’s increasingly frequent interception in the EU, before the global outbreak of the coronavirus pandemic, COVID-19, hit the international fresh cut-flower market, highlights the growing threat regarding T. leucotreta’s introduction into Australia via imported fresh cut-flowers from Kenya, and the potential for it to establish itself in high-value agricultural production areas in Australia. The findings of this research show the importance of improving offshore and onshore quarantine inspections. To increase inspection vigilance at borders, the next step should consider not only cut flowers from Kenya, but also other imported commodities that could be infested with T. leucotreta attributable to its polyphagia. It is also imperative to establish a range of effective import treatments, such as cold treatment or fumigation, early warning monitoring systems, along with published eradication plans with trap monitoring around susceptible facilities identified by this study and awareness training for inspectors and the community.Large economic losses have been reported from many areas in sub-Saharan Africa and Israel, due to the damage caused by


Science. 2019; 363:288). To characterize the nature of antibody protection against CMV after HCT, we tested pre-HCT sera in a cohort of CMV D-R+ allogeneic HCT recipients from the pre-letermovir era using VirScan, a technology that measures pathogen-specific humoral immunity (IgG) at the epitope level.There is renewed interest in CMV-specific humoral immune protection due to recent murine data suggesting that strain-specific antibodies may inhibit CMV cell-to-cell spread  in the first 8 weeks post-HCT.Patients (age 0-70 years) who received 1Figure 1) and the effect appeared more pronounced in adults . High (≥ 4th quartile vs. 1st quartile), pre-HCT CMV antibody epitopes were associated with an increased risk of any CMV reactivation  and at >150 IU/mL  after adjusting for age, HLA-matching, and pre-HCT T-cell depletion ( >150 IU/mL only).170 CMV D-R+ HCT recipients were tested a median of 26 days (range 7-37 days) prior to HCT and had a median of 37 CMV antibody epitopes . The cumulative incidence of CMV reactivation was higher in patients with greater pre-HCT CMV antibody epitopes at each evaluated PCR threshold (We observed a paradoxically increased risk of CMV reactivation in patients with high pre-HCT CMV VirScan scores. It is possible that pre-HCT CMV-specific humoral immunity as measured by VirScan is reflective of the burden of latent CMV or that CMV-specific antibodies may mediate antibody-dependent enhancement after HCT and thus facilitate reactivation. Future studies are needed to validate our findings in diverse cohorts and to elucidate the underlying mechanism of increased VirScan scores and associated risks of CMV reactivation.Rachel A. Bender Ignacio, MD, MPH, Abbvie: Advisor/Consultant|SeaGen: Advisor/Consultant Joshua A. Hill, MD, Allovir: Advisor/Consultant|Allovir: Grant/Research Support|Covance/CSL: Advisor/Consultant|CRISPR: Advisor/Consultant|Deverra: Grant/Research Support|Gilead: Grant/Research Support|Karius: Advisor/Consultant|Karius: Grant/Research Support|Merck: Grant/Research Support|Octapharma: Advisor/Consultant|OptumHealth: Advisor/Consultant|Oxford Immunotec: Grant/Research Support|Pfizer: Advisor/Consultant|Symbio: Advisor/Consultant|Takeda: Advisor/Consultant Geoffrey Hill, M.D., FRACP, FRCPA, Applied Molecular Transport: Grant/Research Support|Compass Therapeutics: Grant/Research Support|Generon Corporation: Advisor/Consultant|Heat Biologics: Grant/Research Support|iTeos Therapeutics: Advisor/Consultant|iTeos Therapeutics: Grant/Research Support|Laevoroc Oncology: Grant/Research Support|NapaJen Pharma: Advisor/Consultant|Neoleukin Therapeutics: Advisor/Consultant|Serplus Technology: Grant/Research Support|Syndax Pharmaceuticals: Grant/Research Support Michael J. Boeckh, MD PhD, Allovir: Advisor/Consultant|Amazon: Grant/Research Support|Ansun Biopharma: Grant/Research Support|EvrysBio: Advisor/Consultant|Gates Ventures: Grant/Research Support|Gilead Sciences: Advisor/Consultant|Gilead Sciences: Grant/Research Support|GlaxoSmithKline: Advisor/Consultant|GlaxoSmithKline: Grant/Research Support|Helocyte: Advisor/Consultant|Janssen: Advisor/Consultant|Janssen: Grant/Research Support|Kyorin Pharmaceuticals: Advisor/Consultant|Merck: Advisor/Consultant|Merck: Grant/Research Support|Moderna: Advisor/Consultant|Moderna: Grant/Research Support|Regeneron: Grant/Research Support|ReViral: Advisor/Consultant|Symbio: Advisor/Consultant|Takeda: Grant/Research Support|Vir Biotechnology: Advisor/Consultant|Vir Biotechnology: Grant/Research Support.