Background and aim: Mitral valve (MV) repair is a well-accepted surgical approach for infective endocarditis (IE). In our hospital, extensive MV reconstruction with fresh autologous pericardium (AP) and artificial chordae (AC) has been performed for patients with profoundly extensive and destructive IE in which valve reconstruction would be extremely challenging, especially in young patients to avoid mechanical valve replacement. Long-term outcome including the future performance of the newly created leaflet has not been established. Methods: Five patients (50 ± 30 years of age; 3 men, 2 women) underwent this procedure from January 2011 to December 2020. In all patients, preoperative cardiac function was good (left ventricular ejection fraction, 70% ± 5%). After complete debridement of the infective valve tissue, the MV was reconstructed with large, fresh, trimmed AP and AC. Results: The reconstructed leaflets were anterior in three patients and posterior in four, and AC were placed in four patients. All patients showed an uneventful postoperative course and were discharged to home 35 ± 5 days postoperatively after completion of intravenous antibiotic therapy. Pre-discharge echocardiography revealed no or trivial mitral regurgitation (MR) in all patients. The mean follow-up period was 7.2 (range, 1.3–9.5) years, and no patients developed recurrence of the IE. The latest echocardiography in four patients showed trivial/mild MR with good leaflet function. One patient developed recurrence of MR, 5 months postoperatively. Conclusions: The short- and long-term outcomes of this procedure were satisfactory. This procedure might be considered as an effective and valuable option, especially in young patients.

Background: Despite major advances in basic and advanced life supports, patients who survived from out of hospital cardiac arrest (OHCA) has still poor prognosis. Several inflammatory parameters have been used to determine early and long-term prognosis in patients with OHCA. C-reactive protein-to-albumin ratio (CAR) is also a novel marker of systemic inflammation. To our knowledge, there is no study evaluating the clinical importance of CAR in OHCA patients. Aims: To evaluate the effect of CAR on mortality in patients with OHCA. Methods: A total of 102 patients with OHCA were included in this study. The study population were divided into two groups as survivor (n = 43) and non-survivor (n = 59) during follow-up. Complete blood cell counts, biochemical and blood gas analysis were recorded for all patients. Neutrophil to lymphocyte ratio (NLR) was calculated as the ratio of neutrophil to lymphocyte. CAR was calculated as the ratio of CRP to the albumin. Results: NLR (P=0.012), CAR (P<0.001) and serum lactate level (P =0.002) were significantly higher whereas lymphocyte (P=0.008) and serum albumin (P<0.001) were significantly lower in non-survivor group compared to survivor group. Multivariate logistic regression analysis showed that NLR (odds ratio [OR]: 1.044, 95% confidence interval [CI]: 1.044-1.437, P=0.013), CAR (OR: 1.971, 95% CI: 1.327-2.930, P=0.001), and lactate level (OR: 1.268, 95% CI: 1.095-1.469, P=0.002) were independent predictors of mortality. Conclusions: We have demonstrated for the first time that CAR was an independent predictor of in-hospital mortality in OHCA patients.

Introduction:To evaluate the efficacy, safety and postoperative outcomes of the BiVap saline vaporization and Twister™ Diode Laser systems with benign prostatic obstruction (BPO) in prostate volüm between 90-150 ml. Methods:In total, we included 131 patients treated with BiVap system (n=68) and Twister system (n=63). Postoperative complications including urinary tract infection, transient hematuria, severe dysuria and fever >38° C, urinary incontinence and urethral stricture were also noted. All patients were evaluated at the postoperative 1st, 3rd, 6th and 12th month and preoperative and postoperative values of IPSS score, QoL score, total PSA, IIEF 15, PVR, Qmax and Qave were compared. Statistical analyses were performed with SPSS version 18. A P-value<0.05 was considered significant. Results:Preoperative demographic characteristics were similar in the 2 groups. There was observed significant improvement for IPSS, Qmax, Qave, PVR, and QoL score by the postoperative first month compared to the preoperative values in both groups. Maximum improvement in the IPSS, Qmax, Qave, QoL score and PVR were achieved at postoperative 6, 3, 12, 3 and 12th months respectively in group 1. In group 2 maximum improvement in the IPSS, Qmax, Qave, QoL score and PVR were achieved at postoperative 6, 3, 6, 6 and 12th months, respectively. There was no significant difference between the two groups in terms of IPSS, Qmax, Qave, QoL score, PSA, PVR, IIEF-EF and IIEF-OS during the 1 year follow-up period postoperatively. Conclusions:BiVap and Twister systems are safe, effective, and useful technique, which can be used in the surgical treatment of BPO between 90-150ml.

Ovarian immature teratoma is a rare tumor during pregnancy. In this disease, the role of adjuvant chemotherapy for initial stage 1, grade 2 and 3 is essential in pregnancy. Two cases of ovarian immature teratoma grade 2 in pregnancy with two different managements and outcomes have been illustrated down below.

When formulating a hydrologic model, scientists rely on parameterizations of multiple processes based on field data, but literature review suggests that more frequently people select parameterizations that were included in pre-existing models rather than re-evaluating the underlying field experiments. Problems arise when limited field data exist, when “trusted” approaches do not get reevaluated, and when processes fundamentally change in different environments. The physics and dynamics of snow interception by conifers, including both loading and unloading of snow, is just such a case. The most commonly used interception parameterization is based on data from four trees from one site, but field study results are not directly transferable between environments. The process varies dramatically between locations with relatively warmer versus colder winters. Here, we combine a comprehensive literature review with a model to demonstrate essential improvements to model representations of snow interception. We recommend that, as a first and essential step, all models include increased loading due to increased adhesion and cohesion when temperatures rise from -3 and 0°C. The commonly used parameters of a fixed maximum value for loading and an e-folding time for unloading are not supported by observations or physical understanding and are not necessary to reproduce observations. In addition to unloading based on physical processes, such as wind or canopy warming, all models must represent melting of in-canopy snow so that it can be unloaded in liquid form. As a second step, we propose field experiments across climates and forest types to investigate: a) a representation of the force balance between adhesion and cohesion versus gravity for both interception efficiency and rates of unloading, b) wind effects during and between storms, and c) lubrication when snow melts. For greatest impact, this framework requires dedicated field measurements. These processes are essential for models to accurately represent the impacts of dynamically changing forest cover and snow cover on both global albedo and water supplies.

Achilles tendon rupture is a well-documented adverse effect of Fluoroquinolones; however, herein we present a case of complete iliopsoas and Achilles, and partial semimembranosus tendon rupture secondary to Levofloxacin.

We extend the well-known Halanay inequality to the fractional order case in presence of distributed delays and delays of neutral type (in the fractional derivative). Both the discrete and distributed neutral delays are investigated. It is proved that solutions decay toward zero in a Mittag-Leffler manner under some rather general conditions. Some large classes of kernels and examples satisfying our assumptions are provided. We apply our findings to prove Mittag-Leffler stability for solutions of fractional neutral network systems of Cohen-Grossberg type.

Introduction: Ultra-high-density mapping for ventricular tachycardia (VT) is increasingly used. However, manual annotation of local abnormal ventricular activities (LAVAs) is challenging in this setting. Therefore, we assessed the accuracy of the automatic annotation of LAVAs with the Lumipoint algorithm of the Rhythmia system (Boston Scientific). Methods and Results: One hundred consecutive patients undergoing catheter ablation of scar-related VT were studied. Areas with LAVAs and ablation sites were manually annotated during the procedure and compared with automatically annotated areas using the Lumipoint features for detecting late potentials (LP), fragmented potentials (FP), and double potentials (DP). The accuracy of each automatic annotation feature was assessed by re-evaluating local potentials within automatically annotated areas. Automatically annotated areas matched with manually annotated areas in 64 cases (64%), identified an area with LAVAs missed during manual annotation in 15 cases (15%), and did not highlight areas identified with manual annotation in 18 cases (18%). Automatic FP annotation accurately detected LAVAs regardless of the cardiac rhythm or scar location; automatic LP annotation accurately detected LAVAs in sinus rhythm, but was affected by the scar location during ventricular pacing; automatic DP annotation was not affected by the mapping rhythm, but its accuracy was suboptimal when the scar was located on the right ventricle or epicardium. Conclusion: The Lumipoint algorithm was as/more accurate than manual annotation in 79% of patients. FP annotation detected LAVAs most accurately regardless of mapping rhythm and scar location. The accuracy of LP and DP annotations varied depending on mapping rhythm or scar location.

While several researchers have suggested that evolution should be explored from the initial years of schooling, little information is available on effective resources to enhance elementary school students’ level of understanding of evolution by natural selection (LUENS). For the present study, we designed, implemented and evaluated an educational activity planned for fourth graders to explore concepts and conceptual fields that were historically important for the discovery of natural selection. Observation field notes and students’ productions were used to analyse how the students explored the proposed activity. Additionally, an evaluation framework consisting of a test, the evaluation criteria and the scoring process was applied in two fourth-grade classes to estimate elementary school students’ LUENS before and after engaging in the activity. Our results suggest that our activity allowed students to effectively link all of the key concepts in the classroom and produced a significant increase in their LUENS. These results indicate that our activity had a positive impact on students’ understanding of natural selection. They also reveal that additional activities and minor fine-tuning of the present activity are required to further support students’ learning about the concept of differential reproduction. We also observed a low level of teleological predictions for both pre- and post-tests.

The purpose of this paper is to analyze a new kind of Hadamard fractional boundary value problem combining integral boundary condition and multipoint fractional integral boundary condition on an infinite interval. By the help of the Bai-Ge's fixed point theorem, multiplicity results of positive solutions are derived for the Hadamard fractional boundary value problem. In the end, to illustrative the main result, an example is also presented.

Interstitial pneumonia with autoimmune features is a concept to identify patients with idiopathic interstitial pneumonia and features suggestive of a connective tissue disease. There is no specific treatment which consists mainly of corticosteroids and immunossupressive agents. Rituximab is an effective rescue therapy for refractory interstitial lung disease.

A document by Pascale Gassant, written on Authorea.

A 56-year-old woman was found to have retroperitoneal hemorrhage secondary to isolated posterior inferior pancreaticoduodenal artery (PIPDA) dissection. She had chronic abdominal pain and celiac artery stenosis, suggesting that PIPDA dissection was associated with celiac artery compression syndrome (CACS). Clinicians may consider CACS as the cause of visceral dissection.

Background and purpose: Regulator of G-protein signal 4 (RGS4) is a signal transduction protein that accelerates intrinsic GTPase activity of Gαi/o and Gαq subunits, suppressing GPCR signaling. Here we investigate whether RGS4 modulates nociceptin/orphanin FQ opioid (NOP) receptor signaling and whether this modulation has relevance for L-Dopa induced dyskinesia. Experimental approach: HEK293T cells transfected with NOP, NOP/RGS4 or NOP/RGS19 were challenged with N/OFQ and the small molecule NOP agonist AT-403, using D1-stimulated cAMP levels as a readout. Primary rat striatal neurons and adult mouse striatal slices were challenged with N/OFQ or AT-403 in the presence of the RGS4 inhibitor, CCG-203920, and D1-stimulated cAMP or pERK responses were monitored. In vivo, CCG-203920 was co-administered with AT-403 and levodopa to 6-hydroxydopamine hemilesioned rats, and dyskinetic movements, striatal biochemical correlates of dyskinesia (pERK and pGluR1 levels) and striatal RGS4 levels were measured. Key results: RGS4 expression reduced NOFQ and AT-403 potency and efficacy in HEK293T cells. CCG-203920 increased N/OFQ potency in primary rat striatal neurons, and potentiated AT-403 response in mouse striatal slices. CCG-203920 enhanced AT-403 mediated inhibition of dyskinesia and its biochemical correlates, without compromising its motor-improving effects. Unilateral dopamine depletion caused bilateral reduction of RGS4 levels which was reversed by levodopa. Levodopa acutely upregulated RGS4 in the lesioned striatum. Conclusions and Implications: RGS4 physiologically inhibits NOP receptor signaling and an RGS4 inhibitor enhances NOP responses. Furthermore, an RGS4 inhibitor improved the antidyskinetic potential of NOP receptor agonists, mitigating the effects of upregulation of striatal RGS4 levels occurring during dyskinesia expression.

Purpose: To investigate the quality of life (QoL) in patients with end-stage renal disease who underwent open or robot-assisted renal transplantation (ORT and RART). Materials and Methods: Patients who underwent ORT and RART at Bakirkoy Sadi Konuk Training and Research Hospital between June 2016 and December 2018 constituted the target population of this study. The patient group was divided into two groups as per the surgical technique (i.e., open vs. robot-assisted). Demographic data, preoperative and postoperative data of all patients were collected prospectively. The QoL of the patients was assessed preoperatively and on the postoperative 30th day. Results: 67 patients who underwent ORT and 60 patients who underwent RART were included. The mean patient age and BMI were calculated as 40,9 ± 11,6 years and 24,4 ± 2,9 kg/m2, respectively. While mean total ischemia time was shorter in the ‘open’ group, incision length, duration of surgical drainage and hospital stay were shorter in the ‘robot-assisted’ group. The physical component scores of the QoL questionnaire revealed that postoperative impairment of quality of life was more significant in the ORT than the RART. Conclusion: Patients who underwent RART have a higher QoL than the patients who were treated with ORT as per their self-reported QoL scores in the early postoperative period. Keywords: End-stage renal disease; Open renal transplantation; Robot-assisted renal transplantation; Quality of life

It was recently reported that due to the COVID-19 pandemic, in the European winter 2020-2021, bronchiolitis had practically disappeared. But early reports from the southern hemisphere (Australia) raised concerns about a late spring / summer peak. After a full winter season and now ending the summer, we report that there was no peak of common respiratory viruses in late spring / summer in South America.

【Abstract】 Background:Cardiac pacemakers are still an effective method for the treatment of atrioventricular block diseases(AVB). Ventricular pacing results in adverse clinical outcome. For patients with atrioventricular conduction system disease, minimization ventricular pacing not be used to reduce the proportion of ventricular pacing and improve cardiac function. Recent studies have shown that His bundle pacing(HBP) can be an effective treatment for patients with atrioventricular block . The purpose of this study was to evaluate the effectiveness of His bundle in patients with AVB. Methods:We searched the studies from Pubmed,Embase and Cochrane Library database to evaluate the application of HBP in patients with AVB. From these studies, we extrated and summarized the related data such as implantation success rate, QRS width, pacing threshold at baseline and follow-up, assessment left ventricular function, complications. Results:This Meta- analysis included eight studies, including 430 patients. The success rate of implantation varied from 65% to 93%. The main indications of HBP were patients with AVB, including patients with atrioventricular node block and intranodal block. Left ventricular function(left ventricular ejection fraction) was not significantly improved during follow-up. The duration of QRS after HBP implantation was more narrow (113±18ms). Compared with the baseline level, the threshold of HBP was not significantly increased during follow-up. During an average of 12 months of follow-up, pacemaker-related complications occurred in 16 patients. Conclusion:Permanent HBP has shown promising results for patients with AVB in small observational studies. Randomized controlled trials are needed to assess the efficacy of HBP in these patients.

One of the factors determining drug quality in bitter fennel is the types and quantities of fatty acids stored in the seeds. We measured the fatty acid content of 50 Iranian fennel landraces. Fatty acid concentration of the 50 fennel landraces ranged from 9.5 to 23% of seed mass, and the highest amounts of fatty acid content among the early maturing races belonged to Hamedan and Arak (19.5 and 18.5%, respectively), among the medium maturing races to Marvdasht, Kohn and Meshkin Shahr (23, 20.5 and 19%, respectively), and among the late-maturing races to Sari (21%). The highest fatty acid yields belonged to Fasa (65.3 ml/m2) among the early maturing races, Meshkin Shahr and Moqhan (92.5 and 85.4 ml/m2) among the medium maturing races, and Sari (71.4 ml/m2) among the late-maturing races. The main compositions of fatty acids, measured in twelve of the landraces, were oleic acid (52-64%), linoleic acid (26-39%), palmitic acid (0.3-4.1%), stearic acid (1.3-2.4%), linolenic acid (0.6-3.6%) and myristic acid (0.35-1.07%). It was observed that landraces with high oleic acid content originated from regions with a dry and warm climate, while landraces with high linoleic acid content originated from regions with a humid and cool climate. Understanding relationships between the fatty acid profile and landrace origin climate may improve the efficiency of identifying landraces with specific fennel chemotypes. In conclusion, these results indicate that some of these fennel landraces have the potential to be complementary sources of certain fatty acids, such as oleic and linoleic acids.

Background and aim Carcinoid heart disease is a rare, acquired heart valvular disease affecting mainly the right chambers. Cardiac surgery is the only definite symptom relieving option and has significantly transformed patient short and midterm prognosis. In this study, we aim to retrospectively analyze the postoperative outcomes of patients with carcinoid syndrome after heart valve surgery. Methods Data was retrospectively collected for patients referred to our institution for carcinoid heart disease and operated between 2013 and beginning of 2021. Results 8 patients underwent heart valve replacement with 1 having quadruple valve surgery, 3 patients had both tricuspid and pulmonary valves changed while 4 had only tricuspid valve replacements ; 3 patients had mechanical prostheses. 3 deaths occurred during the follow-up till date with 2 inside the perioperative period. No case of valvular complications was reported. Mean ICU and hospital stay were 9,4 days (range 1-39) and 23,5 days (range 10-52) respectively. 2 patients needed postoperative dialysis, 1 needed re-intubation and no patient required extracorporeal life support. The mean time period from diagnosis to valve surgery was 16,6 months (range 1-60). Follow-up (2-84 months) showed excellent postoperative clinical status with NYHA 1 in all patients. Conclusions Timely heart valve surgery in patients with close multidisciplinary monitoring is associated with good midterm survival rates and low perioperative valvular complications. Patients should be considered for surgery the soonest possible irrespective of the number of valves concerned as functional status improves drastically in most patients.

At present, how to use low-cost and superior algorithms to obtain high-resolution 3D range image is the focus of lidar research. In this letter, the low-resolution Gm-APD lidar is combined with the high-resolution ICCD lidar to obtain the registered low-resolution range image and high-resolution intensity image. This letter proposes an improved image guidance algorithm. The algorithm uses a Markov random field model to define a global energy function. This function combines the distance fidelity term and the regularization term to obtain a high-resolution 3D range image by solving the optimization model. The experimental results show that compared with the traditional algorithms, the algorithm improves the resolution of the range images, the edge of the reconstructed image is sharper than the regional similarity guidance algorithm, and the image quality evaluation index has the better value.

To accurately analyze and evaluate the comparison and selection of multi-index and multi-route highway route schemes and address the disadvantages of traditional scheme evaluations, we focus on the economic costs of construction and improve on previous qualitative and quantitative analysis. A comprehensive weight and intelligent selection algorithm are introduced into the optimization of highway route schemes. This paper presents an evaluation index system for highway route schemes based on the full life cycle and considering technology, the ecological environment, the social environment and the economy. We propose an evaluation system for highway route schemes based on a comprehensive weight. Additionally, an optimization method for highway route schemes based on the TOPSIS model is studied. Finally, the optimal highway route scheme is obtained by calculation. According to the results of the research, the construction of evaluation indexes directly influences the results of the scheme evaluation. When established operations, management and maintenance indexes are based on the full life cycle, the evaluation results are more accurate. In addition to avoiding the defects of a single weighting method, the comprehensive weight vector uses subjective data as well as expert opinion. In addition, the comprehensive weight vector introduces a preference coefficient so that analysers can determine a scheme based on the accuracy of subjective and objective information and requirements. This method uses a large number of evaluation populations to evaluate schemes, and the result is more objective.

Myositis ossificans (MO) is a rare disease in which ossification develops in the muscle or soft tissue. MO traumatica is recognized by ossification of the soft tissues after acute or repetitive trauma, burns, or surgical procedures. In the head and neck region, masseter is most commonly involved muscle.

CFTR modulators (CFTRm) were introduced recently but they are already profoundly changing Cystic Fibrosis (CF) landscape. This survey was conducted in 2018 to evaluate how their perception and use evolved in Italy, with focus on factors that could influence physician treatment decisions. Response rate was 75.6% and the majority of physicians (81%) had been working in CF for over 5 years. While traditional parameters such as lung function and nutritional status remain key evaluation criteria in relation to initiation and monitoring of CFTRm, pulmonary exacerbations ranked at least at the same level of importance in both pediatric and adolescent/adult patients homozygous for F508del, as well as those with residual function mutations. Increasing interest is shown for tools that can help detect early manifestations of disease such as Lung Clearance Index and imaging. Patient-related outcomes, such as ability to conduct daily activities, are also deemed relevant in decision to start and continue CFTRm. Physician decision to initiate treatment according to clinical presentation was similar in all groups, showing that more importance was given to severity/instability of disease rather than mutation type or age range. A relatively low percentage of physicians would treat asymptomatic patients, in particular very young or those with residual function mutations, showing reluctance to treat early in some patient groups in the absence of clear manifestations of CF. Increasing experience with CFTRm will allow to gain more long term evidence and will help shape new guidelines.

Objective: To investigate the association between maternal apolipoprotein A-1 (ApoA-1), apolipoprotein B (ApoB), ApoB/ApoA-1ratio and preterm birth (PTB). Design: Observational survey. Setting: Guangdong Women and Children Hospital, China Samples: 5986 pregnant women. Method: Data were extracted from the information system of Guangdong Women and Children Hospital. Maternal serum ApoB, ApoA-1 and ApoB/ApoA-1 ratio were categorized into tertiles. Logistic regression models were performed to evaluate the odds ratios and 95% confidence intervals for PTB. Main outcome measures: PTB (gestational age < 37 weeks) Results: Of the study participants, the rate of preterm birth was 5.7% (n= 344). Compare with individuals in the lowest tertile, the adjusted ORs of PTB was 1.41 (95% CI: 1.07-1.87) for individuals in the highest tertile of ApoB and 1.35 (95% CI: 1.03-1.78) for those in the highest tertile of ApoB/ApoA-1. The association of ApoB/ApoA-1 and PTB was more relevant among women with pre-pregnancy BMI ≤ 24 kg/m2, age at delivery ≥ 35 years or those who were multiparous. Conclusions: Elevated maternal ApoB level and ApoB/ApoA-1 ratio during mid-pregnancy were related to increased risk of PTB. Monitoring serum apolipoprotein levels may help to prevent preterm birth. Funding: The study was funded by grants 2019FYH003 from Chinese Center for Disease Control and Prevention. Keywords: Apolipoprotein A-1, Apolipoprotein B, Apolipoprotein B/Apolipoprotein A-1, Preterm birth Tweetable abstract：Maternal mid-pregnancy ApoB level and ApoB/ApoA-1 ratio were associated with PTB.