Pediatric emergency care admissions for somatic symptom disorders during the COVID-19 pandemic.

During the COVID-19 pandemic, children and adolescents with psychiatric disorders experienced an exacerbation of their symptoms with more access to the emergency department (ED). However, little is known about the experience of somatic symptom disorders (SSDs) during the COVID-19 pandemic in children. Therefore, we aimed to compare the rates of pediatric ED admissions for SSDs before and during the COVID-19 pandemic and to understand whether the relative risk of ED admissions for SSDs changed between the two periods. We retrospectively enrolled all children between 4 and 14 years admitted for SSDs in the pediatric ED of Santobono-Pausilipon Hospital, Naples, Italy, from March 11th, 2020, to March 11th, 2021 (pandemic period), and in the same time period of the previous year (pre-pandemic period). We identified 205/95,743 (0,21%) children with SSDs presenting in ED in the pre-pandemic year and 160/40,165 (0,39%) in the pandemic year (p < 0.05). Considering the accesses for age, we observed a relative decrease of the accesses for SSDs over 12 years old (IRR 0,59; CI 0,39-0,88), while we found no differences under 12 years old (IRR 0,87; CI 0,68-1,10).   Conclusion: In this study, we found that despite the massive decrease in pediatric admissions due to the COVID-19 pandemic, somatic symptom disorders' admissions to the pediatric ED increased, suggesting an impact of the pandemic also on pediatric psychiatric disorders. What is Known: • During the COVID -19 pandemic, children and adolescents with a psychiatric disorder experienced exacerbation of their symptoms with more accesses in Emergency Department. What is New: • We found that despite the massive decrease of the pediatric admissions due to the COVID-19 pandemic, somatic symptom disorders admissions in healthy children to the pediatric Emergency Department increased ,suggesting an impact of the pandemic also on the pediatric psychiatric disorders.

Social determinants of health for moderate and severe periodontal disease in rural and urban populations.

OBJECTIVE: We assessed the prevalence of moderate and severe periodontitis and its association with social determinants of health in rural and urban population from the State of Chiapas, in Southern Mexico. MATERIAL AND METHODS: A cross-sectional population-based study was conducted in 2013 comprising people 20 years and older. The determinants were categorized as proximal (age, sex, indigenous origin, diabetes, smoking, diet), intermediate (level of schooling, occupation, medical and dental care), and structural (type of institution of health care provision, residence area). Periodontal status was assessed using the Periodontal Screening and Recording (PSR) Index. RESULTS: In total, 467 persons (72.4% women; mean age 43.0 years [s.d 14.7]) participated. Of them, 76.5% lived in rural areas and 56.7% were of indigenous origin. Participants with moderate and severe periodontitis had a significantly lower toothbrushing frequency (44.1% and 44.8%, respectively), and poorer oral hygiene (90% and 90.3%, respectively) compared with people without periodontitis (29.4% for toothbrushing frequency and 74.5% for oral hygiene). Moderate periodontitis was associated with poor oral hygiene (OR=2.63) and no schooling (OR=1.86). Severe periodontitis was associated with age (OR=1.05), poor oral hygiene (OR=3.99), no schooling (OR=2.08), and the interaction term of rural area and indigenous origin (RM=5.23). CONCLUSIONS: Social determinants of health play an important role in the development of periodontitis. Preventive oral health programs should thus focus on the specific social, economic, and geographical context of the population.

Novel nitrogen plasma doping on CdS/GO compounds and their photocatalytic assessment.

Nitrogen-doping of cadmium sulfide nanostructured compounds was carried out under a nitrogen plasma source to produce CdS-N compounds. Once prepared, it was supported on graphene oxide sheets for producing CdS-N/GO photocatalysts, which were tested in the degradation of lignin and methylene blue (MB) molecules. Photocatalytic reactions were carried out under UV and visible (vis) energy irradiation. To provide insight on the catalytic behavior the CdS, CdS-N, GO, and CdS-N/GO compounds were characterized using different techniques including x-ray diffraction, scanning electron microscopy, Raman, and UV-vis diffuse reflectance spectroscopy. X-ray photoelectron spectroscopy allowed determining the chemical composition in samples. It was observed an outstanding performance in photocatalytic activity tests, attributed to the extended response towards the visible light regime, and the synergistic effect between CdS-N and GO particles. The catalytic activity tests, reveal that the CdS-N/GO compound achieved over 90% lignin degradation and 100% of MB degradation. In addition, a remarkable performance is observed in the CdS-N/GO compound which exhibited stability after performing several reaction cycles.

Malmström vacuum or Kielland forceps: which causes more damage to pelvic floor?

OBJECTIVE: To determine whether differences exist in the rate of levator ani muscle (LAM) avulsion between women who had undergone either Malmström vacuum delivery (MVD) or Kielland forceps delivery (KFD), allowing for potential confounding factors. METHODS: This was a prospective observational study of nulliparous women undergoing instrumental delivery using Malmström vacuum extractor or Kielland forceps, at two hospital centers in Spain. Fetal head position (anterior, posterior or transverse) and fetal head station (low or mid) were assessed by ultrasound and digital examination, respectively. Avulsion was defined on tomographic ultrasound imaging as an abnormal insertion of the LAM in the three central slices from the plane of minimal hiatal dimensions. RESULTS: In total, 414 patients were included in the study (212 MVD and 202 KFD). We observed a higher rate of LAM avulsion in the KFD group (KFD 49.5% vs MVD 32.5%; P = 0.001). When the results were evaluated according to fetal head position and station, we observed no differences in LAM avulsion. The crude odds ratio (OR) for the difference in avulsion between women in the KFD and MVD groups was 2.03 (95% CI, 1.36-3.03). However, when adjusted for duration of second stage of labor, fetal head circumference and fetal head station, the OR was no longer statistically significant (OR, 2.14 (95% CI, 0.95-4.85); P = 0.068). CONCLUSION: When potential confounding factors are taken into account, the rate of LAM avulsion does not differ between women according to whether they have undergone KFD or MVD. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.

A new vinyl selenone-based domino approach to spirocyclopropyl oxindoles endowed with anti-HIV RT activity.

Herein, we disclose a general and flexible access to spirocyclopropyl oxindoles by a domino Michael/intramolecular nucleophilic substitution pathway with variously substituted vinyl selenones and enolizable oxindoles in aqueous sodium hydroxide solution. The spirocyclopropyl oxindole being a privileged scaffold, some of the synthesized compounds were selected for biological evaluation. Compound showed selective anti-HIV-1 activity thanks to its ability to inhibit the reverse transcriptase.

Characterization of nitrogen substrate limitation on Escherichia coli's growth by parameter identification tools.

Carbon-to-nitrogen ratio (CNR) has shown to be a relevant factor in microorganisms growth and metabolites production. It is usual that this factor compromises the productivity yield of different microorganisms. However, CNR has been rarely modeled and therefore the nature of its specific influence on metabolites production has not been understood clearly. This paper describes a parametric characterization of the CNR effect on the Escherichia coli metabolism. A set of parameters was proposed to introduce a mathematical model that considers the biomass, substrate and several byproducts dynamical behavior under batch regimen and CNR influence. Identification algorithm used to calculate the parameters considers a novel least mean square strategy that formalizes the CNR influence in E. coli metabolism. This scheme produced a step-by-step method that was suitable for obtaining the set of parameters that describes the model. This method was evaluated under two scenarios: (a) using the data from a set of numerical simulations where the model was tested under the presence of artificial noises and (b) the information obtained from a set of experiments under different CNR. In both cases, a leave-one-experiment-out cross-validation study was considered to evaluate the model prediction capabilities. Feasibility of the parametric identification method was proven in both considered scenarios.

Trigonometric characteristics of episiotomy and risks for obstetric anal sphincter injuries in operative vaginal delivery.

INTRODUCTION AND HYPOTHESIS: The objective of this study was to investigate the association between the trigonometric properties of episiotomy in operative vaginal delivery (OVD) and obstetric anal sphincter injuries (OASIS). METHODS: The study included 72 primiparous women who had an OVD and episiotomy. Cases (n = 36) had sustained OASIS at birth, while controls (n = 36) had not. The groups were matched for instrumental delivery. The episiotomy scar was identified and its trigonometric characteristics were measured at 8-12 weeks postpartum. Data were analysed using conditional logistic analysis. RESULTS: The angle of episiotomy behaves as a factor associated with anal sphincter injury, so women with a mediolateral episiotomy and an angle greater than 20° have an 87% less risk of having an OASIS (odds ratio 0.13, 95% confidence interval 0.03-0.58). The study showed that scarred episiotomies at 8-12 weeks after OVD with an angle ≤ 20°, depth and distance between the episiotomy and anus ≤ 15 mm, total upper triangle perimeter ≤ 75 mm, para-anal triangle perimeter ≤ 15 mm and areas between scar and midline ≤ 250 mm(2) were significantly associated with higher risk of OASIS. CONCLUSIONS: When a mediolateral episiotomy is performed in OVD the technique has a strong effect on the occurrence of OASIS. Additional research is needed to determine if the optimal technique for mediolateral episiotomies produces less OASIS than deferring the performance of episiotomy.

Identification of new benzofuran derivatives as STING agonists with broad-spectrum antiviral activity.

The Stimulator of Interferon Genes (STING) is involved in cytosolic DNA sensing and type I Interferons (IFN-I) induction. Aiming to identify new STING agonists with antiviral activity and given the known biological activity of benzothiazole and benzimidazole derivatives, a series of benzofuran derivatives were tested for their ability to act as STING agonists, induce IFN-I and inhibit viral replication. Compounds were firstly evaluated in a gene reporter assay measuring luciferase activity driven by the human IFN-ß promoter in cells expressing exogenous STING (HEK293T). Seven of them were able to induce IFN-ß transcription while no induction of the IFN promoter was observed in the presence of a mutated and inactive STING, showing specific protein-ligand interaction. Docking studies were performed to predict their putative binding mode. The best hit compounds were then tested on human coronavirus 229E replication in BEAS-2B and MRC-5 cells and three derivatives showed EC50 values in the µM range. Such compounds were also tested on SARS-CoV-2 replication in BEAS-2B cells and in Calu-3 showing they can inhibit SARS-CoV-2 replication at nanomolar concentrations. To further confirm their IFN-dependent antiviral activity, compounds were tested to verify their effect on phospho-IRF3 nuclear localization, that was found to be induced by benzofuran derivatives, and SARS-CoV-2 replication in Vero E6 cells, lacking IFN production, founding them to be inactive. In conclusion, we identified benzofurans as STING-dependent immunostimulatory compounds and host-targeting inhibitors of coronaviruses representing a novel chemical scaffold for the development of broad-spectrum antivirals.

Subclinical hypothyroidism and myocardial function in obese children.

BACKGROUND AND AIMS: Pediatric obesity is an important health problem representing a major public health concern worldwide in the last decades. An isolated elevation of Thyroid Stimulating Hormone (TSH) with normal levels of thyroid hormones is frequently found in obese children. It has been named Isolated Hyperthyreotropinemia or Subclinical Hypothyroidism (SCH) and may be considered a consequence of obesity. Evidence exists that SCH is related to impairment of both systolic and diastolic myocardial function in the adult population. The aim of our study is to establish if obesity-related SCH influences myocardial function in children. METHODS AND RESULTS: We examined 34 obese children and adolescents with SCH and 60 obese children with normal TSH levels who underwent Doppler echocardiographic to evaluate myocardial function. Global systolic function as assessed by Ejection Fraction (EF) was comparable between groups, however Right Ventricle pressure global systolic function and pressure were significantly reduced in SCH group. Mitral annulus peak systolic (MAPSE) excursion lateral and MAPSE septum resulted significantly reduced in SCH group. Tissue Doppler imaging peak systolic motion (TDI-S) was reduced in SCH group. Diastolic function also showed significant modifications in SCH group. CONCLUSION: These results suggest possible involvement of cardiac function in obese children with SCH resulting in both abnormal diastolic function and reduced longitudinal systolic function. This new insight into cardiovascular consequences of obesity-related SCH in children could influence clinical approach to such patients by pediatric endocrinologists.

Pulsatile intracranial pressure and cerebral autoregulation after traumatic brain injury.

BACKGROUND: Strong correlation between mean intracranial pressure (ICP) and its pulse wave amplitude (AMP) has been demonstrated in different clinical scenarios. We investigated the relationship between invasive mean arterial blood pressure (ABP) and AMP to explore its potential role as a descriptor of cerebrovascular pressure reactivity after traumatic brain injury (TBI). METHODS: We retrospectively analyzed data of patients suffering from TBI with brain monitoring. Transcranial Doppler blood flow velocity, ABP, ICP were recorded digitally. Cerebral perfusion pressure (CPP) and AMP were derived. A new index-pressure-amplitude index (PAx)-was calculated as the Pearson correlation between (averaged over 10 s intervals) ABP and AMP with a 5 min long moving average window. The previously introduced transcranial Doppler-based autoregulation index Mx was evaluated in a similar way, as the moving correlation between blood flow velocity and CPP. The clinical outcome was assessed after 6 months using the Glasgow outcome score. RESULTS: 293 patients were studied. The mean PAx was -0.09 (standard deviation 0.21). This negative value indicates that, on average, an increase in ABP causes a decrease in AMP and vice versa. PAx correlated strong with Mx (R (2) = 0.46, P < 0.0002). PAx also correlated with age (R (2) = 0.18, P < 0.05). PAx was found to have as good predictive outcome value (area under curve 0.71, P < 0.001) as Mx (area under curve 0.69, P < 0.001). CONCLUSIONS: We demonstrated significant correlation between the known cerebral autoregulation index Mx and PAx. This new index of cerebrovascular pressure reactivity using ICP pulse wave information showed to have a strong association with outcome in TBI patients.

Imaging Diagnosis of Perianal Leiomyoma: A Case Report.

A leiomyoma is a benign mesenchymal neoplasm that usually develops where smooth muscle is present. In this report, we present the case of a 75-year-old woman who sought medical attention due to pelvic organ prolapse and urinary incontinence, and without defecatory symptoms. Both pelvic floor ultrasound and magnetic resonance imaging (MRI) examination showed a well-defined mass in the ischioanal fossa, eventually diagnosed as a perianal leiomyoma. It is considered a rare entity because of its location involving the anal sphincter and clinical features. We describe the ultrasonographic and MRI findings of this perianal leiomyoma, together with differential diagnoses and immunohistochemical characterization.

[Clinical and bacteriological profile in patients with knee tumor arthroplasty and early periprosthetic infection]. / Perfil clínico y bacteriológico en pacientes con artroplastía tumoral de rodilla e infección periprotésica temprana.

INTRODUCTION: At the national and international levels, there are few studies on early knee tumor periprosthetic infection. We present a review of patients operated by knee tumor arthroplasty, obtaining information on the clinical and bacteriological profile of early tumor periprosthetic infections. MATERIAL AND METHODS: Observational, retrospective and descriptive study, review of patient records with knee tumor replacement, from 1 January 2013, to 31 December 2017 and minimum follow-up of 2 years. RESULTS: 35 patients with average age 32. Left knee 71.4%, 77.1% distal femur, 54.2% was osteosarcoma. Complications in 82.8% of patients, prosthetic retention 62.8%; periprosthetic infection accounts for 34.2% of early complications in 90% of cases. Osteosarcomas and GCT had early infection in equal proportion (44%). The most common comorbidity was overweight/obesity at 66%, smoking by 55%. 55% of infected patients received chemotherapy. 58% of the isolated bacteria were Staphylococcus sp. 83.3% of bacteria showed antibiotic resistance. 66% of infected patients required radical management. CONCLUSIONS: Early periprosthetic infection represents a devastating pathology in our institution. Prosthetic retention is achieved at 66%. In our unit the bacteriological profile is resistant.

INTRODUCCIÓN: A nivel nacional e internacional son pocos los estudios sobre infección periprotésica tumoral temprana en rodilla. Presentamos una revisión de pacientes operados por artroplastía tumoral de rodilla, obteniendo información sobre el perfil clínico y bacteriológico de las infecciones periprotésicas tumorales tempranas. MATERIAL Y MÉTODOS: Estudio observacional, retrospectivo y descriptivo. Revisión de expedientes de pacientes operados con artroplastía tumoral de rodilla del 01 de Enero de 2013 al 31 de Diciembre de 2017 y seguimiento mínimo de dos años. RESULTADOS: 35 pacientes con edad promedio de 32 años, rodilla izquierda 71.4%, 77.1% afección en fémur distal, 54.2% reportado osteosarcoma. Complicaciones en 82.8% de pacientes, retención protésica 62.8%; la infección periprotésica representa 34.2% de las complicaciones de forma temprana en 90% de casos. Osteosarcomas y TCG presentaron infección temprana en igual proporción (44%). La comorbilidad más común fue sobrepeso/obesidad en 66%, tabaquismo en 55%; 55% de pacientes infectados recibió quimioterapia (neoadyuvante o adyuvante), 58% de las bacterias aisladas fueron Staphylococcus sp. 83.3% de bacterias mostraba resistencia, 66% de pacientes infectados requirió manejo radical. CONCLUSIONES: La infección periprotésica temprana representa una patología devastadora en nuestra institución. Se logra retención protésica en 66%. En nuestra unidad el perfil bacteriológico es resistente.

Imbalance between nitric oxide and dopamine may underly aggression in acute neurological patients.

The neurochemical basis of aggressive behavior in humans is not fully understood. In this study we explored the relationship between aggressiveness (as measured by the Overt Aggression Scale), cognitive performance (as measured by the Mini Mental State Examination), and biochemical markers of dopamine neurotransmission (homovanillic acid, HVA) and nitric oxide synthesis (nitrite plus nitrate, NO(x)) in cerebrospinal fluid from 70 patients with acute brain disorders, mainly brain infections. Aggressive behavior and cognitive performance showed an inverse correlation. NO(x)/HVA ratio was inversely correlated to aggressive behavior, and positively correlated to cognitive performance. A subanalysis with antipsychotic-naïve patients confirmed those results. The balance between nitric oxide and dopamine could be related to the cognitive control of aggressive impulse.

Rare malignant tumors of the scalp: a report of four cases, their treatment and a review of the literature.

BACKGROUND AND OBJECTIVES: Malignant tumors occurring in the scalp are not common and when asymptomatic or small in size, may be covered by hair and neglected by the patient, leading to a potential risk of delay in detection and resulting in poorer outcomes. MATERIALS AND METHODS: In our Departments in the last five years more than 200 malignant tumors of the scalp have been operated on. In this article we take into consideration four rare malignant tumours of the scalp taken from this study: a giant recurrent sebaceous carcinoma, a lung cancer metastatic lesion, a malignant melanoma and a breast cancer metastasis. RESULTS: The four patients with rare malignant tumours have been operated with good results. DISCUSSION: These four cases represent an important lesson for the plastic surgeon to learn: in the case of the presence of unusual, ulcerated/pigmented lesion of the scalp or in the case of alopecia we must consider the possibility of a tumour.

Melkersson-Rosenthal syndrome associated with Down syndrome.

We present a clinical case of Melkersson-Rosenthal (M-R) syndrome associated with Down syndrome. No evidence of this association is described in the literature. We also present a technique for the macrocheilia treatment of lower lip caused by M-R syndrome in a patient with Down syndrome. This patient during pediatric age had many events of facial nerve paralysis and edematous episodes of lower lip with unknown etiology. This technique is based on a wedge full thickness central excision of the lower lip and on a transversal lozenge excision in the vermilion portion with orbicular muscle to reverse the chin-labial corner. The results are an agreeable aspect of the lip and physiological digestive and phonetic processes. The technique is safe and simple and the aesthetic functional result is very good. In our case, the postoperative complication is caused by an insufficient collaboration of the patient and it is solved in three weeks.

Photocatalytic performance of nitrogen doped ZnO structures supported on graphene oxide for MB degradation.

In the present work, the photocatalytic efficiency of a novel system based on ZnO doped with nitrogen (ZT) and supported on graphene oxide (GO) is investigated. ZnO synthesis and their N doping were carried out in a microwave reactor using thiourea as nitrogen source, while the GO was prepared through a variation of the Hummers' method. Structural, morphological and photochemical characterization of the developed material was performed by X-ray diffraction (XRD), UV-Vis spectroscopy, energy dispersive spectroscopy (EDS), scanning electron microscopy (SEM), analysis by X-ray photoelectron spectroscopy (XPS) and Raman spectroscopy. The compounds were used to photodegrade the methylene blue molecule, which confirms the efficiency of nitrogen doped supported system compared to pristine ZnO. The degradation percentage of MB under UV energy using nitrogen-doped ZnO/GO, in a time of 35 min, reached 98% degradation; while using visible light 93% of degradation was reached.

Ophthalmic features of spinocerebellar ataxia type 7.

PurposeTo analyze the relation between ophthalmologic and motor changes in spinocerebellar ataxia type 7 (SCA7).Patients and methodsThis was a case series study. Sixteen SCA7 patients underwent a comprehensive ophthalmic examination, including ocular extrinsic motility testing, color vision test, and optical coherence tomography of the optic nerve and macula. Changes in the corneal endothelium, electroretinographic patterns, and a complete neurologic evaluation using the Scale for the Assessment and Rating of Ataxia (SARA) were evaluated. Correlations of endothelial cell density (ECD) with number of CAG repetitions and the SARA scores were estimated.ResultsAll patients showed various degrees of visual impairment mainly due to macular deterioration. Notably, they also presented decreased ECD. Pairwise correlations of ECD with number of CAG repeats and severity of motor symptoms quantified with the SARA scores were inverse (r=-0.46, P=0.083 and r=-0.64, P=0.009, respectively). Further analyses indicated an average ECD decrease of 48 cells/mm2 (P=0.006) per unit of change on the number of CAG repeats, and of 75 cells/mm2 (P=0.001) per unit of change on the SARA scores.ConclusionsThe results agree with previous ophthalmological findings regarding the widespread effect of SCA7 mutation on the patient's visual system. However, the results also show a significant negative correlation of decreased ECD with both CAG repetitions and SARA scores. This suggests that motor systems could degenerate in parallel with visual systems, although more research is needed to determine whether the degeneration is caused by the same mechanisms.

Antioxidant capacity and protein oxidation in cerebrospinal fluid of amyotrophic lateral sclerosis.

BACKGROUND: The causes of Amyotrophic Lateral Sclerosis (ALS) are unknown. A bulk of evidence supports the hypothesis that oxidative stress and mitochondrial dysfunction can be implicated in ALS pathogenesis. METHODS =: We assessed, in cerebrospinal fluid (CSF) and in plasma of 49 ALS patients and 8 controls, the amount of oxidized proteins (AOPP, advanced oxidation protein products), the total antioxidant capacity (FRA, the ferric reducing ability), and, in CSF, two oxidation products, the 4-hydroxynonenal and the sum of nitrites plus nitrates. RESULTS: The FRA was decreased (p = 0.003) in CSF, and AOPP were increased in both CSF (p = 0.0039) and plasma (p = 0.001) of ALS patients. The content of AOPP was differently represented in CSF of ALS clinical subsets, resulting in increase in the common and pseudopolyneuropathic forms (p < 0.001) and nearly undetectable in the bulbar form, as in controls. The sum of nitrites plus nitrates and 4-hydroxynonenal were unchanged in ALS patients compared with controls. CONCLUSION: Our results, while confirming the occurrence of oxidative stress in ALS, indicate how its effects can be stratified and therefore implicated differently in the pathogenesis of different clinical forms of ALS.

Soil erosion and significance for carbon fluxes in a mountainous Mediterranean-climate watershed.

In topographically complex terrains, downslope movement of soil organic carbon (OC) can influence local carbon balance. The primary purpose of the present analysis is to compare the magnitude of OC displacement by erosion with ecosystem metabolism in such a complex terrain. Does erosion matter in this ecosystem carbon balance? We have used the Revised Universal Soil Loss Equation (RUSLE) erosion model to estimate lateral fluxes of OC in a watershed in northwestern Mexico. The watershed (4900 km2) has an average slope of 10 degrees +/- 9 degrees (mean +/- SD); 45% is >10 degrees, and 3% is >30 degrees. Land cover is primarily shrublands (69%) and agricultural lands (22%). Estimated bulk soil erosion averages 1350 Mg x km(-2) x yr(-1). We estimate that there is insignificant erosion on slopes < 2 degrees and that 20% of the area can be considered depositional. Estimated OC erosion rates are 10 Mg x km(-2) x yr(-1) for areas steeper than 2 degrees. Over the entire area, erosion is approximately 50% higher on shrublands than on agricultural lands, but within slope classes, erosion rates are more rapid on agricultural areas. For the whole system, estimated OC erosion is approximately 2% of net primary production (NPP), increasing in high-slope areas to approximately 3% of NPP. Deposition of eroded OC in low-slope areas is approximately 10% of low-slope NPP. Soil OC movement from erosional slopes to alluvial fans alters the mosaic of OC metabolism and storage across the landscape.