Objective: To examine the impact of “natural” cesarean deliveries (NCD) on peripartum maternal blood loss. Design: Randomized controlled trial. Setting: Single academic hospital in Afula, Israel, between August 2016 and February 2019. Population or Sample: Term singleton gestations scheduled for a planned CD under spinal anesthesia. Methods: Women were randomized at a ratio of 1:1 to NCD (study group) or traditional CD (control group). Women in the study group watched fetal extraction, had early skin to skin contact, and breastfed until the end of surgery. Neonates in the control group were presented to the mother without direct contact. Blood samples were drawn from all women to determine oxytocin levels using an ELISA kit. Main Outcome Measures: Postpartum hemoglobin (Hb) levels. Results: 214 women randomized, 23 were excluded. There were no significant differences in demographic and obstetric variables between the groups. Postpartum Hb levels were 10.1±1.1 and 10.3±1.3 g/dL in the study and control groups, respectively (P = .19). There were no significant differences in estimated blood loss, and rates of PPH and blood transfusion. Maternal pain scores, satisfaction, and exclusive breastfeeding rate at discharge, were similar. Maternal oxytocin blood levels were 389.5±183.7 and 408.5±233.6 pg/mL in the study and control groups, respectively (P = .96). Rate of composite neonatal morbidity that comprised neonatal hypothermia, hypoglycemia, jaundice, and neonatal intensive care unit admission was higher in the study group. Conclusions: NCD does not affect maternal blood loss. Maternal oxytocin blood levels in NCD and traditional CD are similar.
Objective. To investigate the resuscitative efficacy of haemoglobin vesicles (HbVs) for severe postpartum haemorrhage (PPH) using pregnant rabbits. Design: Animal research study Setting: Animal laboratory, National Defense Medical College, Japan Population: Twenty-five female New Zealand white rabbits at late gestation Methods. Pregnant rabbits underwent caesarean section; uncontrolled haemorrhage was induced by transecting the uterine artery to establish a severe PPH model. During the first 30 min (or until the bleeding volume reached 100 mL), all rabbits received 6% hydroxyethyl starch (HES) infusion. Thereafter, rabbits received any of the three isovolemic fluid resuscitations every 5 min: red blood cells (RBCs) with platelet-poor plasma (RBC/PPP) (vol/vol=1:1, n=8), 6% HES (n=7), or HbVs with 25% human serum albumin (vol/vol=4:1, n=10). After 60 min (or when the bleeding volume reached 200 mL), we performed surgical haemostasis and monitored the rabbit survival for 12 hours. Main Outcome Measures: Survival time for severe postpartum haemorrhage Results. During the first 30 min, all rabbits showed severe anaemia (Hb <6 g/dL) that eventually developed to severe PPH. All rabbits that received only HES infusion died within 6 hours, whereas those that received RBC/PPP transfusion survived. Furthermore, 8 of the 10 rabbits received HbV infusion 6 hours after PPH. Overall survival of HbV group was markedly improved compared with that of HES group (p=0.01) but was significantly worse than that of RBC/PPP group (p<0.01). Conclusions. HbV infusion for severe PPH effectively prevented lethal haemorrhagic shock in a pregnant rabbit model, making it a feasible alternative modality.
The relationships and seasonal-to-annual variations among evapotranspiration (ET), precipitation (P), and groundwater dynamics (total water storage anomaly, TWSA) are complex across the Amazon basin, especially the water and energy limitation mechanism for ET. To analyze how ET is controlled by P and TWSA, we used wavelet coherence analysis to investigate the effects of P and TWSA on ET at sub-basin, kilometer, regional, and whole basin scales in the Amazon basin. The Amazon-scale averaged ET has strong correlations with P and TWSA at the annual periodicity. The phase lag between ET and P (ϕ_(ET-P)) is ~1 to ~4 months, and between ET and TWSA (ϕ_(ET-TWSA)) is ~3 to ~7 months. The phase pattern has a south-north divide due to the significant variation in climatic conditions. The correlation between ϕ_(ET-P) and ϕ_(ET-TWSA) is affected by the aridity index, of each sub-basin, as determined using the Budyko framework at the sub-basin level. In the southeast Amazon during a drought year (e.g., 2010), both phases decreased, while in the subsequent years, ϕ_(ET-TWSA) increased. The area of places where ET is limited by water continues to decrease over time in the southern Amazon basin. These results suggest immediate strong groundwater subsidy to ET in the following dry years in the water-limited area of Amazon. The water storage has more control on ET in the southeast but little influence in the north and southwest after a drought. The areas of ET limited by energy or water are switched due to the variability in weather conditions.
Soil detachment is one of the most important processes of soil erosion, as it is of great significance for the prevention and treatment of soil erosion in areas subject to seasonal freeze-thaw. However, most previous studies on the effect of freeze-thaw on soil detachment capacity (SDC) of bare soil, little research on SDC under the effect of freeze-thaw and the root system. This study investigated the effects of freeze-thaw and the root system on soil detachment capacity through hydraulic flume experiments to simulate the soil detachment process of two soil types, sand soil and loessal soil, under four treatments, control, freeze-thaw, root system and freeze-thaw + root system. And a prediction model was developed to calculate SDC under the effect of freeze-thaw and the root system. The results illustrated that the SDC of sand soil was higher than that of loessal soil. The SDC of two soils was reduced and increased by the root system and freeze-thaw, respectively, although the former effect was significant (P < 0.05) whereas the latter was not. The effect of freeze-thaw in combination with the root system showed that the root system contributed the majority of SDC variability (99.95%); therefore, inhibition of SDC by the root system played a leading role. When comparing shear stress, unit energy of the water carrying section and unit stream power, stream power was found to be the hydraulic parameter that best predicted SDC (R2¬ > 0.84). The inclusion of root weight significantly improve the accuracy of the SDC prediction model developed by hydraulic parameters. A general model based on stream power and root weight was developed to quantify SDC and was shown to have a high SDC prediction accuracy for both soils treated by freeze-thaw and the root system [NSE = 0.88，R2 = 0.90].
Background and purpose: Ginkgolide C (GGC) isolated form Ginko biloba (Ginkgoaceae) leaf can demonstrate pleiotropic pharmacological actions although. its anti-oncogenic impact in non-small cell lung cancer (NSCLC) model has not been reconnoitered. As signal transducer and activator of transcription 3 (STAT3) cascade can promote tumor growth and survival, we contemplated that GGC may interrupt this signaling cascade to expend its anti-cancer actions in NSCLC. Experimental approach: The effect of GGC on STAT3 activation, associated protein kinases, STAT3-regulated gene products, cellular proliferation, and apoptosis was examined. The in vivo effect of GGC on the growth of human NSCLC xenograft tumors in athymic nu/nu female mice was also investigated. Key results: GGC attenuated the phosphorylation of STAT3 and varying upstream kinases effectively. Exposure to pervanadate modulated GGC-induced down-regulation of STAT3 activation and promoted an elevation in the level of PTP protein. Indeed, silencing of the PTPgene reversed the GGC-promoted abrogation of STAT3 activation and apoptosis. Moreover, GGC exposure significantly reduced NSCLC tumor growth without demonstrating significant adverse effects via decreasing levels of p-STAT3 in mice tissues. Conclusions and Implications: Overall, the findings support that GGC may exhibit anti-neoplastic actions by mitigation of STAT3 signaling cascade in NSCLC.
A novel virus, severe acute respiratory syndrome Coronavirus 2 (SARS-CoV-2), causing coronavirus disease 2019 (COVID-19) worldwide appeared in 2019. Currently, we do not have a medicament that treats the disease. One of the rea-sons for the absence of treatment is related to the scarcity of detailed scientific knowledge of the members of the Coro-naviridae family, including the Middle East Respiratory Syndrome Coronavirus (MERS-CoV). Structural studies of the MERS-CoV proteins in the current literature are extremely limited. We present here detailed characterization of the struc-tural properties of MERS-CoV macro domain in aqueous solution at the atomic level with dynamics. For this study, we conducted extensive replica exchange molecular dynamics simulations linked to a generative neural networks and we use the resulting trajectories for structural analysis. We perform structural clustering based on the radius of gyration and end-to-end distance of MERS-CoV macro domain in aqueous solution with dynamics at the atomic level. We also report and analyze the residue-level intrinsic disorder features, flexibility and secondary structure. Furthermore, we study the pro-pensities of this macro domain for protein-protein interactions and for the RNA and DNA binding. Results are in agree-ment with available nuclear magnetic resonance spectroscopy findings and present more detailed insights into the struc-tural properties of MERS CoV macro domain. Overall, this work further shows that neural networks can be used as an exploratory tool for the studies of CoV family molecular conformational space at the nano level.
Numerous unknown factors influence anthrax epidemiology in multi-host systems, especially at wildlife/livestock/human interfaces. Serology tests for anti-anthrax antibodies in carnivores are useful tools in identifying the presence or absence of Bacillus anthracis in a range. These were employed to ascertain if the disease pattern followed the recognized high and low risk anthrax zonation in Zimbabwe and also to establish if anthrax was absent from Hwange National Park in which there has been no reported outbreaks. African lions (Panthera leo) (n= 114) drawn from -free-range protected areas and captive game parks located in recognized high and low risk zones across Zimbabwe were tested for antibodies to anthrax PA antigen using the ELISA immunoassay. A random selection of 27 lion sera samples comprising 17 sero-positive and 10 sero-negative sera were further tested in the species-independent toxin neutralization assay (TNA) in order to validate the former as a surveillance tool for anthrax in African lions. Using the ELISA-PA immunoassay, 21.9% (25/114) of the lions tested positive for antibodies to anthrax. Seropositivity was recorded in all study areas and there was no significant difference (p= 0.852) in seropositivity between lions in high and low risk anthrax zones. Also, there was no significant difference (McNemar’s χ2 = 0.9, p = 0.343) in the proportion of lions testing positive to anti-PA anthrax antibodies on ELISA-PA immunoassay compared to the TNA, with fair agreement between the two tests [Kappa (K) statistic = 0.30; 0.08
Background: New corona virus (COVID-19), as an international health threat poses a challenge to physical and psychological resilience globally. The aim of this survey is to explore the level of awareness, health seeking behaviors and preventive measures towards COVID19 among Najran university students. Methodology: By adopting a convenient sampling technique, a cross-sectional study was carried out at Najran university. A self-reporting electronic questionnaire had been utilized for collecting data. A total of 684 students were voluntary completed the questionnaire. Results: The mean age of the participants was 20.2±14.1, The most cited source for obtaining information about COVID-19 was the social media (51%). Females showed higher level of knowledge and awareness about the symptoms of the disease than males (74.3% vs 69.9%) respectively, although the difference was not significant with (P-value >0.05). In regard to compliance with preventive measures, medical students were significantly aware and complying with various preventives measures towards COVID-19 (P-value <0.05). Moreover, females seem to be very keen in seeking medical advices when needed significantly more than males (P-value<0.05). Almost more than 66% of the respondents know the recommended precautions in terms of wearing masks, not to touch outdoors surfaces directly and avoiding crowded places. 556(81.3%) of the participants believe that they should wear face masks outdoors. 6% of the participants prefer to take some herbs daily in different forms to avoid getting infected with COVID-19. Females had an overall higher mean of tension level towards getting infected than males (mean± SD was 5.61 ±1.65 vs 4.55± 1.63) respectively. Conclusion: It was concluded that our students have high level of knowledge and awareness about COVID-19, beside positive attitudes preventive measures and acceptable health seeking behaviors. It is highly recommended to assess the entire Najran community level of awareness so as to design educational programs when needed.
Aim: The aim of this study was to determine menopausal symptoms, sleep levels, quality of life of women in the premenopausal, menopausal, and postmenopausal period, to increase their knowledge level with training to be provided, to reduce their menopausal symptoms, to improve quality of life and sleep quality, and to enable self-examination of breasts and vulva with training provided. Method: The research was conducted in a public hospital in Eskişehir. The study had a quasi-experimental design. The sample of the research consisted of 36 women aged between 40-65 years. These women were asked to complete the Sociodemographic Characteristics Determination Form, Menopause Rating Scale, Pittsburgh Sleep Quality Index, and Quality of Life Scale (SF-36) when they applied to menopause school. After the forms were completed, the participants were given training. Following training, the scales were re-completed and then women were enabled to perform self-examination of breasts (SEB) and self-examination of the vulva (SEV). The IBM SPSS Statistics 21.0 was used for the analysis. Results: The mean age of the women was 50.66±4.45 and that the mean menopause age was 47.60±3.45. The most frequently described symptom was fatigue (91.7%). It was seen that after the training, the MRS score of the women decreased from 16.83±8.87 to 13.66±8.36; the PSQI score decreased from 14.34±2.64 to 13.81±2.55; the mean Quality of Life (SF-36) scale score increased from 48.74±19.13 to 54.92±17.40. As a result of SEB and SEV performed by the women after the training, it was determined that 5.6% of the women had a breast deformity, that 8.3% had a palpable mass in the breast and that 13.9% detected a vaginal discharge in the vulva examination (p<0.05). Conclusion: It is easier to overcome this period with specific comprehensive training and women are enabled to cope with symptoms more effectively.
Introduction: Contact force (CF) catheters provide feedback confirming adequate tissue contact for optimal lesion size and minimal complications. CF ablation catheters have resulted in decreased procedure times and improved outcomes for ablation of atrial fibrillation in adults. There is limited data evaluating CF use for accessory pathway (AP) ablation or in pediatric patients. The aim of our study was to compare a cohort who underwent AP ablation with a CF catheter to historical controls, evaluating for differences in procedure times, number of lesions, and outcomes. Methods: A retrospective chart review of CF ablation cases at Children’s Wisconsin performed between June 2015 to April 2018 was compared to a historical control cohort of traditional radiofrequency (RF) ablations between June 2012 to June 2015. 43 patients with APs underwent 49 CF ablation procedures (18 males, 13.6 ± 3 years old) and a control cohort consisted of 77 procedures in 69 patients (38 males, 12.4 ± 4 years). Results: The groups did not differ significantly on procedure time (CF 2.01 ± 0.48 hr, control 1.53 ± 0.48 hr, p = 0.37), or total lesions administered (CF and control 7 ± 6 lesions, p = 0.89). CF cases showed a trend toward improvement in acute success (98% CF, 90% controls, p = 0.15) though with increased recurrence compared to controls (13% CF, 5% controls, p = 0.16), neither being statistically significant. Conclusion: Our study suggests that ablation outcomes using CF are comparable to traditional RF ablation in pediatric patients with APs.
Background: Echocardiography derived myocardial performance may be impaired.Objectives: To evaluate cardiac involvement including cardiac biomarkers, echocardiographic findings in patients with COVID-19 and to explore the effect of cardiac impairment on short-term outcome.Methods: This study cohort was conducted from February 9, 2020, to March 28, 2020, in a single center at Wuhan Leishenshan Hospital. 213 patients whose echocardiography were included. Demographic data, laboratory results, echocardiographic findings were analyzed. Results:Among 213 patients confirmed with COVID-19,150 non-critical patients and 35 critical patients were discharged. 28 critical patients needed invasive mechanical ventilation, 16 of whom died during the hospitalization, and another 12 patients were transferred for continued treatment with tracheotomy. The incidence of cardiovascular complications including acute myocardial injury, arrhythmia and acute myocardial infarction was higher in critical group . A total of 108 patients had abnormities on echocardiography. 26(12.2%) patients have presented the signs of pulmonary hypertension and the presence of pulmonary hypertension in critical group was higher than that in non-critical group The cardiac biomarkers at admission in critical patients were significantly higher compared with non-critical patients.Multivariate analysis showed high-sensitivity cardiac troponin I elevation and echocardiographic signs of pulmonary hypertension ere independent risk factors of adverse outcome.CONCLUSIONS: The elevation of cardiac markers and echocardiographic signs of pulmonary hypertension are risk factors of adverse outcome in patients with COVID-19. It’s meaningful to combine echocardiography with cardiac markers to evaluate the prognosis of patients with COVID-19.
Rabbit haemorrhagic virus (RHDV) is a highly infectious and fatal pathogen to rabbits. Classic RHDV is mainly pathogenic to adult rabbits; however, it is not lethal to young rabbits. Since 2010, a RHDV variant has become prevalent in Europe and the Australian continent. This variant, which was named RHDV2 (GI.2/RHDVb), is highly infectious and fatal to both adult and young rabbits; moreover, its host range is broader than that of classic RHDV (GI.1/G1-6). In May 2020, the first RHDV2 case in China was reported. Here, we report and describe the first RHDV2 case in China. We amplified its complete genome sequence (named SC20-01 strain). The phylogenetic tree showed that the SC20-01 strain is mostly related to two strains isolated in Europe, which indicated that it might have spread from Europe to China. Moreover, Recombination Detection Program software showed that the SC20-01 strain is a G6/RHDV2 recombinant strain. Animal experiments showed that the SC20-01 strain is a highly fatal pathogen to specific-pathogen-free (SPF) rabbits and induces typical clinical symptoms of RHD. Our findings highlight RHDV2 emergence in China and its potential to spread widely. There is a need for more attention on the RHDV2 threat in China and the development of new diagnostic methods and vaccines for preventing the spread of RHDV2.
Significant controversy exists in the management of type A aortic dissections with aortic arch involvement. There is a substantial variability in approaches to this complex problem ranging from simply replacing the ascending aorta to total arch replacement with frozen elephant trunk -- all of which balance the competing interests of reducing operative risk and reducing risk of reintervention. The diversity of clinical details, variability of surgical experience, and lack of significant randomized data make a consensus approach to these patients unlikely. However, it is important to understand the risks and benefits of each technique, and herein we evaluate the outcomes of each. Our approach to these patients has been to reserve arch replacement for those who have arch aneurysmal disease, imminent risk of rupture, or cerebral malperfusion, and perform a hemiarch replacement in all other scenarios with arch involvement. Such approach is easily taught, safe, and reproducible while focusing more on survival rather than long-term freedom from reintervention.
During the first phase of COVID-19 pandemic in Italy, several strategies have been taken to deal with the pandemic outbreak. The Regional Authority of Lombardy remodeled the hospitalization system in order to allocate appropriate resources to treat COVID-19 patients and to identify “Hub/Spoke” hospitals for highly specialized medical activities. The Hubs hospitals were required to guarantee full time evaluation of all patients presenting with cardiovavascular diseases with an independent pathway for patients with suspect or confirmed COVID-19 infection. San Raffaele Hospital was identified as Hub for cardiovascular emergencies and the Vascular Surgery Department was remodeled to face this epidemic situation. Surgical treatment was reserved only to symptomatic, urgent or emergent cases. Large areas of the hospital were simultaneously reorganized to assist COVID-19 patients. During this period, 135 patients were referred to San Raffaele Vascular Surgery Department. COVID-19 was diagnosed in 24 patients and, among them, acute limb ischemia was the most common cause of admission. At this time, the COVID-19 trend is in decline in Italy and the local authorities reorganized the health care system in order to return to normal activities avoiding new escalations of COVID-19 cases. Several strategies have been taken to ensure the safety of the San Raffaele hospital, and maintaining potentially suspected patients with COVID-19 separated from other patients. The aim of this paper is to report the remodeling of the Vascular Surgery Department of San Raffaele Hospital as regards the strategies of preparation, escalation, de-escalation and return to normal activities during the COVID-19 pandemic.
Introduction: Self-medication has been very popular and globally prevalent for a long time. Aim: This research aims to present pharmacists’ engagement in the process of self-medication in the Sarajevo Canton. Methods: A total of 312 respondents completed an anonymous questionnaire-based survey. The first group (165 respondents) was surveyed in the pharmacy after buying a non-prescription drug, and the second group (147 respondents) outside the pharmacy. Results: The most commonly purchased drug was paracetamol, whereas headache was dominant amongst health conditions for which treatment respondents intended to use the purchased drug. A belief that respondents could cure themselves was the most common answer when asked why they had not visited a doctor, whereas previous experience with the purchased drug prevailed as an answer when asked from whom they had gotten information about the adequacy of the purchased drug for their health problem. Respondents mostly bought drugs for themselves. Pharmacists instructed 65% of respondents on how to take the purchased drug and checked whether 55% of respondents bought an appropriate drug for their health problem. Only 25% and 29% of respondents were informed about the adverse effects and potential contraindications or interactions of the purchased drug, respectively. According to 45% of respondents, pharmacists spent up to one minute in a conversation with them about the purchased drug. Conclusion: In the Sarajevo Canton, pharmacists should be more actively involved in the process of self-medication and provide the necessary advice to patients consuming non-prescription drugs. Further research is needed to create a clearer picture.
Acute myocardial infarction (AMI) is a common medical condition that requires appropriate revascularization in a timely manner. Percutaneous revascularization (PR) was the first line treatment option when feasible. Limited data is available comparing PR to surgical revascularization (SR) in the AMI setting. Study population was extracted from the 2016 Nationwide Readmissions Data using International Classification of Diseases, tenth edition codes for AMI, PR, SR, and procedural complications. Endpoints included in-hospital all-cause mortality, length of index hospital stay (LOS), stroke, acute kidney injury, bleeding, blood transfusion, acute respiratory failure, and total hospital charges. The study identified 45,539 discharges with a principal admission diagnosis of AMI who had either PR or SR as a principal procedure. Single vessel revascularization was performed in 67.8% (93.1% had PR versus 6.9% had SR, p<0.01). Multivessel revascularization was performed in 32.2% (64.8% had PR versus 35.2% had SR, p<0.01). In comparison to SR, PR was associated with higher in-hospital all-cause mortality (P<0.01), shorter LOS (p<0.01), and lower incidence of post-procedural stroke (p<0.01), acute kidney injury (p<0.01), bleeding (p<0.01), need for blood transfusion (p<0.01), acute respiratory failure (p<0.01), and total hospital charges (p<0.01). In a subgroup analysis, SR mortality benefit persisted in patients who had multivessel revascularization, but not in single vessel revascularization. In patients presented with AMI, PR was associated with higher in-hospital all-cause mortality but lower morbidity, shorter LOS, and lower total hospital charges than SR. However, the mortality benefit of SR was seen in multivessel revascularization only, and not in single vessel revascularization.