Riverside Clinical Research

PhenoCam networks are useful for unattended monitoring of ecological dynamics at daily time-steps. Despite extensive networks of PhenoCams in many regions of the world, especially in North America and Europe, there are none in High Mountain Asia (HMA). Standard PhenoCams also require power and internet infrastructures that are not readily available in remote mountain areas such as HMA. Here, we assessed for the first time, the use and effectiveness of low-cost trailcams for high altitude phenological and temperature logging within the Himalayan alpine zone (>4000 m.a.s.l.). The ethos of this approach was to work with local community members in Himalayan villages above the treeline to maintain the PhenoCam systems for year-round operation. Results from this study show variations in phenology between two dominant plant communities - Juniperus spp. and Rhododendron spp. – in two high-altitude villages Dole (4038 m.a.s.l.) and Machermo (4392 m.a.s.l.) in the Khumbu region of Nepal. Juniperus spp. was found to have a longer growing season at higher altitudes (Machermo) compared to Dole. Seasonal temperature variations were demonstrated through temperature data extracted from the trailcam images. This study fills the current gap in our understanding of seasonal variations in phenophase of dwarf plants in the Himalayan alpine zone, but more importantly provides a proof-of-concept for a low-cost, low-carbon and community-maintained methodology to obtain long-term in-situ observations in the remote mountainous regions. While some missions encountered challenges due to user errors, this study underscores the potential for implementing citizen science initiatives in high-altitude Himalayan ecosystems, and demonstrates pathways for doing so.

The capacity of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) towreak havoc on the inflammatory and coagulation pathways via the cytokine storm has led to over 6.3 million fatalities globally. Based on recent data, the mechanism predominately involves the formation of microvascular thrombosis when pertaining to cardiovascular disease. However, a subset of coronavirus disease-2019 (COVID-19)-positive patients present emergently with acute ST-elevation myocardial infarction (STEMI) are found to have severe epicardial thrombosis which is refractory to traditional coronary revascularization. We have noted mortality in these patients presenting to our facility to be as high as 90% and all angiographically confirmed to have thrombus which was refractory to traditional therapy. We present a case series of COVID-19-positive patients presenting with STEMI found to have epicardial thrombus who were treated with different traditional STEMI therapies but with fatal outcomes. Other possible techniques including mechanical thrombectomy, optimizing traditional and nontraditional anticoagulation therapy with the use of early hemodynamic support may prove more efficacious to destroy thrombus and potentially improve mortality.

Benign primary tumors are uncommon, with the majority of these tumors being leiomyomas; schwannomas of the esophagus are rare. Here, we present a case of a 78-year-old woman referred for complaints of intermittent dysphagia with a chest computed tomography scan showing a homogenous mass, compressing the esophagus. Upper gastrointestinal endoscopy revealed a submucosal mass, which was eventually diagnosed as a schwannoma after an endoscopic ultrasound with fine-needle aspiration and subsequent pathologic and immunohistochemical examination. Schwannomas could be managed conservatively.

Subsurface drainage water of agricultural lands collected in tile lines may contain nitrate-nitrogen which serves to pollute surface waters. The objective of the research was to determine quantities and concentrations of nitrate-nitrogen in tile drainage and their relationship to soil, fertilizer input, crop, and time with respect to water applicaiton. The first research phase consisted of extensive monitoring of tile drainage effluents collected in important agricultural areas in California. More intensive investigation of nitrate-nitrogen within a few soil profiles was done during the second phase. Nitrate-nitrogen concentrations were not well-correlated with any measured parameter. The amount of nitrate-nitrogen contained in tile effluent was quite well-correlated with total water discharge and fertilizer nitrogen application. Higher amounts of nitrate-nitrogen were removed from coarse-textured soil profiles as compared to profiles containing a layer of fine-textured material. Some alluvial soils on the west side of the San Joaquin Valley apparently contain significant native nitrogen which contributes both to high nitrate-nitrogen concentrations and total mass emissions in tile effluent. Implications of the research findings to nitrogen and water management to achieve a desired water quality standard are discussed. It appears that the most positive approach to controlling nitrate-nitrogen in irrigated agriculture is through control of leaching.