Open dislocation of the ankle and Epstein's superior type of hip dislocation are rare orthopedic injuries. We reported a case of 50 years gentleman with a combination of these two rare orthopedic emergencies without any associated fracture with the newly reported mechanism and management to save limb and its function.

Redo aortic valve surgery for failure of a previously implanted valve is always challenging. In case of small-sized implanted valves, the use of a balloon-expanding Sapien-3 valve can enhance the final effective orifice area, avoid complex annulus enlargement techniques, and can reduce operative time and morbidities. We describe a case where after explanting a failed 19mm St. Jude mechanical aortic valve and further deployment of a 23mm Sapien-3 valve, the left coronary ostia was obstructed by the skirt of the transcatheter prosthesis. After careful removal of a little part of the skirt, we were able to restore the coronary flow and the patient had a favorable outcome.

Both cognitive abilities and dispersal tendencies can vary strongly between individuals. Since cognitive abilities may help dealing with unknown circumstances it is conceivable that dispersers may rely more heavily on learning abilities than residents. However, cognitive abilities are costly and leaving a familiar place might result in losing the advantage of having learned to deal with local conditions. Thus, individuals which invested in learning to cope with local conditions may be more reluctant to leave their natal place. In order to disentangle the complex relationship between dispersal and learning abilities we implemented individual-based simulations. By allowing for developmental plasticity, individuals could either develop a ‘resident´ or ‘dispersal´ cognitive phenotype. In line with our expectations, the correlation between learning abilities and dispersal could take any direction, depending how much time individuals had to recoup their investment in cognition. Both, longevity and the timing of dispersal within lifecycles determine the time individuals have to recoup that investment and thus crucially influence this correlation. We therefore suggest that species´ life-history will strongly impact the expected cognitive abilities of dispersers, relative to their resident conspecifics, and that cognitive abilities might be an integral part of dispersal syndromes.

Background and aim of the study Guidelines on myocardial revascularization indicate for type V myocardial infarction (MI) that postoperative troponin elevations need not be exclusively ischemic but may also be caused by direct epicardial injury. Additional complexity arises from the introduction of high-sensitive troponin markers. The present study attempts to contribute to the understanding of postoperative high-sensitive cardiac troponin T (hs-cTnT) increase. Methods Type of surgery, potential factors affecting the postoperative hs-cTnT increase, and possible thresholds indicative of type V MI were analyzed. Results Among 400 included patients, 2.8% had intervention-related ischemia analogous to the type V MI definition. Receiver-operating characteristics confirmed good discriminatory power for hs-cTnT and creatine kinase myocardial band (CK-MB), with ischemia indicating thresholds for hs-cTnT (1705.5 ng/l) and for CK-MB (113 U/l). The median postoperative hs-cTnT/CK-MB increase differed significantly depending on the type of surgery, with the highest increase after mitral valve and the lowest after off-pump coronary surgery. Regression analysis confirmed Maze procedure (p<0.001), cardiopulmonary bypass time (p=0.03), emergency indications (p= 0.01) and blood transfusion (p=0.02) as significant factors associated with hs-cTnT increase. In contrast, CK-MB increase was also associated with mortality (p=0.002). Intra-pericardial defibrillation was the only ischemia-independent factor additionally associated with proposed thresholds (p<0.001). Conclusions The present results confirm the influence of the type of surgery and other intervention-related parameters on the postoperative hs-cTnT increase. Type V MI-indicating thresholds may require reassessment, especially using high-sensitive markers.

Increasingly, researchers have operationalized AAI derived attachment representations as reflecting individual differences in secure base script knowledge (AAIsbs)—the degree to which individuals show awareness of the temporal-causal schema that summarizes the basic features of seeking and receiving effective support from caregivers when in distress. In a series of pre-registered analyses, we used AAI transcripts recently re-coded for AAIsbs and leveraged a new follow-up assessment of the NICHD Study of Early Child Care and Youth Development cohort around age 30 years (479 currently partnered participants) to assess and compare the links between AAIsbs and traditional AAI coding measures in late adolescence and self-reported romantic relationship quality in adulthood. Higher AAIsbs predicted better dyadic adjustment scores in adulthood, above and beyond other AAI-derived coding measures, and sociodemographic and cognitive functioning covariates. Findings extend previous evidence pointing to the predictive significance of AAIsbs for multiple adult functioning domains.

RNA editing is a tightly controlled process by which cytidines are converted to uridines in RNAs transcribed from the chloroplast and mitochondrial genomes in flowering plants. Multiple organellar RNA editing factor (MORF) complex was recently shown to be highly associated with C-to-U RNA editing activity of vascular plant editosome. However, mechanisms by which MORF9 mediates plastid RNA editing to control plant development in response to environmental cues remains obscure. In this study, we found that loss of MORF9 function impaired PSII efficiency, NDH activity, and carbohydrate production, rapidly promoted nuclear gene expression including sucrose transporter and sugar/energy responsive genes, and attenuated seedling development under sugar starvation conditions. Sugar repletion increased MORF9 and MORF2 expression in wild-type seedlings and promoted inefficiency of matK-706C, accD-794C, ndhD-383C and ndhF-290C RNA editing in morf9 mutant. This RNA editing inefficiency was associated with altered cell division in root meristem zone and nuclear gene expression in the morf9 mutant. Using gin2, snrk1, morf9 single and double mutants and overexpression of SnRK1 (KIN10) or HXK1 in the morf9 mutant background demonstrated that RNA editing efficiency of ndhD-383C and ndhF-290C sites was diminished in the gin2/morf9 double mutants, and editing efficiency of matK-706C, accD-794C, ndhD-383C and ndhF-290C sites was significantly diminished in the snrk1/morf9 double mutants. Overexpressing HXK1 or SnRK1 promoted RNA editing rate of matK, accD, ndhD, and ndhF in leaves of morf9 mutants，indicating that HXK1 might be required for MORF9 mediated ndhD-383C and ndhF-290C editing, while SnRK1 may only be required for MORF9 mediated ndhF-290C site editing. Collectively these findings suggest that sugar and/or its intermediary metabolites impair MORF9 mediated plastid RNA editing resulting in derangements of plant root development.

Background: Hispanic people with cystic fibrosis (CF) have decreased life expectancy and earlier acquisition of Pseudomonas aeruginosa compared to non-Hispanic white individuals with CF. Racial and ethnic differences in the airway microbiome of CF may contribute to known health disparity, but have not been studied. The objective was to describe differences in the upper airway microbial community in Hispanic and non-Hispanic white children with CF. Methods: This prospective, observational cohort study of fifty-nine Hispanic and non-Hispanic white children with CF, ages 2-10 years old, was performed at Texas Children’s Hospital (TCH) from February 2019 to January 2020. Oropharyngeal swabs were collected from the cohort during clinic visit. Swab samples underwent sequencing (16S V4 rRNA), diversity analysis, and taxonomic profiling. Key demographic and clinical data were collected from the electronic medical record and the Cystic Fibrosis Foundation Patient Registry (CFFPR). Statistical analysis compared sequencing, demographic, and clinical data. Results: We found no significant difference in Shannon diversity or relative abundance of bacterial phyla between Hispanic and non-Hispanic children with CF. However, a low abundant taxa- “uncultured bacterium” belonging to the order Saccharimonadales was significantly higher in Hispanic children (mean relative abundance=0.13%) compared to the non-Hispanic children (0.03%). Hispanic children had increased incidence of Pseudomonas aeruginosa (p=0.045) compared to non-Hispanic children. Conclusion: We did not find a significant difference in the airway microbial diversity between Hispanic and non-Hispanic white children with CF. However, we found a greater relative abundance of Saccharimonadales and higher incidence of Pseudomonas aeruginosa in Hispanic children with CF.

Wildfires and heatwaves have recently affected the hydrological system in unprecedented ways due to climate change. In cold regions, these extremes cause rapid reductions in snow and ice albedo due to soot deposition and unseasonal melt. Snow and ice albedo dynamics control net shortwave radiation and the available energy for melt and runoff generation. Many albedo algorithms in hydrological models cannot accurately simulate albedo dynamics because they were developed or parameterised based on historical observations. Remotely sensed albedo data assimilation (DA) can potentially improve model performance by updating modelled albedo with observations. This study seeks to diagnose the effects of remotely sensed snow and ice albedo DA on the prediction of streamflow from glacierized basins during wildfires and heatwaves. Sentinel-2 20-m albedo estimates were assimilated into a glacio-hydrological model created using the Cold Regions Hydrological Modelling Platform (CRHM) in two Canadian Rockies glacierized basins, Athabasca Glacier Research Basin (AGRB) and Peyto Glacier Research Basin (PGRB). The study was conducted in 2018 (wildfires), 2019 (soot/algae), 2020 (normal), and 2021 (heatwaves). DA was employed to assimilate albedo into CRHM to simulate streamflow and was compared to a control run (CTRL) using off-the-shelf albedo parameters. Albedo DA benefited streamflow predictions during wildfires for both basins, with a KGE coefficient improvement of 0.18 and 0.20 in AGRB and PGRB, respectively. Four-year DA streamflow predictions were superior to CTRL in PGRB, but DA was slightly better in AGRB. DA was not beneficial to streamflow predictions during heatwaves. These results show that albedo DA can reveal otherwise unknown albedo and snowpack dynamics occurring in remote glacier accumulation zones that are not well simulated by model predictions alone. These findings corroborate the power of observational tools to incorporate near real-time information into hydrological models to better inform water managers of the streamflow response to wildfires and heatwaves.

Background: This study evaluated the utilization and outcomes of postcardiotomy mechanical circulatory support (MCS). Methods: This was a retrospective, single institution analysis of adult cardiac surgery cases that required de novo MCS following surgery from 2011-2018. Patients that were bridged with MCS to surgery were excluded. The primary outcomes were early operative mortality and longitudinal survival. Secondary outcomes included postoperative complications, and five-year all-cause readmission. Results: 533 patients required de novo postcardiotomy MCS, with the most commonly performed procedure being isolated coronary artery bypass grafting (29.8%). Median cardiopulmonary bypass and cross clamp times were 185 (IQR 123-260) minutes and 122 (IQR 81-179) minutes, respectively. A total of 442 (82.9%) of patients were supported with intra-aortic balloon pump counterpulsation, 23 (4.3%) with an Impella device, and 115 (21.6%) with extracorporeal membrane oxygenation. Three (0.6%) patients had an unplanned ventricular assist device placed. Operative mortality was 29.8%. Longitudinal survival was 56.1% and 43.0% at 1- and 5-years, respectively. Survival was lowest in those supported with ECMO and highest with those supported with an Impella (P<0.001). Freedom from readmission was 61.4% at 5-years. Postoperative ECMO was an independent predictor of mortality (HR 5.1, 95% CI 2.0-12.9, P<0.001), but none of the MCS types predicted long-term hospital readmission after risk adjustment. Conclusions: Postcardiotomy MCS is associated with high operative mortality. Even patients that survive to discharge have compromised longitudinal survival, with nearly only half surviving to 1-year. Close follow-up and early referral to advanced heart failure specialists may be prudent in improving these outcomes.

Most proteins function by forming complexes within a dynamic interconnected network that underlies various biological mechanisms. To systematically investigate such interactomes, high-throughput techniques including CF-MS have been developed to capture, identify, and quantify protein-protein interactions (PPIs) in large-scale. Compared to other techniques, CF-MS allows the global identification and quantification of native protein complexes in one setting, without genetic manipulation and overexpression. Furthermore, quantitative CF-MS can potentially elucidate the distribution of a protein in multiple co-elution features, informing the stoichiometries and dynamics of a target protein complex. In this issue, Youssef et al. (Proteomics 2023, XX, XXXX-XXXX) combined multiplex CF-MS and an in-house algorithm to study the dynamics of the PPI network for Escherichia coli grown under ten different conditions. While the results demonstrated that while most proteins remained stable, the authors were able to detect disrupted interactions that were growth condition-specific. Further bioinformatics analyses also revealed biophysical properties and structural patterns that govern such a response.

with other laboratory and clinical investigations. Early and accurate diagnosis of inherited conditions generally leads to better medical care for patients and their families, with improved knowledge of the natural history of the condition and early intervention. It is therefore essential that equitable access to such testing is established for indigenous and isolated populations, in order to further narrow the health disparity gap. Although supported by funding from a few sources, this study signals a success for the Silent Genomes Project, with one of the cases having been identified by whole genome sequencing within that project, after negative whole exome sequencing. Furthermore the study has potential life-changing clinical consequences and provides starting points for possible interventions for respiratory medicine in the Inuit population. These include increased awareness of the possibility of PCD in patients presenting with neonatal respiratory distress, bronchiectasis or otitis media leading to early intervention; and in conjunction with Inuit organizations and public health officials, targeted analysis of the DNAH11 variant in the population with the possible introduction of newborn screening for PCD.

Coexisting gallbladder stones, common bile duct stones and Clonorchis sinensis infection is rare. Most radiologists and surgeons have low awareness and diagnostic suspicion of C. sinensis infection before opting for surgery.

Mini-commentary on BJOG- 19-1590.R1: Obstetric outcomes of twin pregnancies presenting with a complete hydatidiform mole and coexistent normal fetus: A systematic review and meta-analysis

We are hopeful that CTFR modulation does have a positive impact of bone health, but we have concerns about this study design being used to support the hypothesis.

FEV 1/FVC normally decreases through childhood, increases briefly during early adolescence, and then declines throughout life. The physiology behind this temporary increase during early adolescence is not well understood. The objective of this study was to determine if this pattern also occurs in children with asthma. Design: Single-center, cross-sectional, retrospective analysis of pulmonary function tests (PFTs) obtained over a 5-year period in children 5 to 18 years of age with persistent asthma. Results: 1,793 patients satisfied all inclusion and exclusion criteria. Mean age (± SD) was 10.4 ± 3.8 years. 48% were female. Mean FEV 1 /FVC was 0.83 ± .09. FEV 1 /FVC in children with persistent asthma declined from age 5 to age 11 by 5.7 % compared to 7.3% in healthy girls, and 5.8% compared to 9.4% in healthy boys. FEV 1/FVC increased by 1.2% until age 16 in children with asthma, compared to 2.2% in healthy girls, and 2.5% compared to 2.3% in healthy boys. The ratio was lower in obese children with asthma at all ages but demonstrated the same curvilinear shape as in healthy children. In absolute terms, FEV 1 grew proportionately more than FVC during early adolescence, so the ratio of FEV 1/FVC increased during that period. The curvilinear shape of the curve remained in postbronchodilator testing, though significantly blunted. Conclusions: The “Shepherd’s Hook” pattern in the FEV 1/FVC curve is preserved in children with persistent asthma. This was also true in obese patients with asthma, although their FEV 1/FVC ratios were lower throughout all stages of childhood and adolescence.

Extracorporeal life support (ECLS) is an expanding technology for patients in cardiogenic shock. Most patients requiring ECLS can be managed with percutaneous veno-arterial (VA) femoral cannulation. Despite sufficient extracorporeal circulatory support, an unclear number of patients develop left ventricular distension which can result in increased wall tension and stress as well as worsening pulmonary edema. Indications to vent the left ventricle can be controversial. When venting is indicated a number of additional procedures may be considered including inotropic support, intra-aortic balloon pump, Impella, balloon atrial septostomy, or placement of a transseptal cannula. We present a unique case of a femoral VA Extracorporeal membrane oxygenation (ECMO) as bridge to transplant (BTT) with left-sided venting using a Bio-medicus NextGen cannula (Medtronic) with a transseptal approach.

57-year-old man presented with a 3-month history of fatigue, fever and increasing abdominal pain.He had completed treatment for follicular lymphoma and JAK2 positive myeloproliferative disorder 2 months previously. This case demonstrates therapeutic and diagnostic rationale for open splenectomy in, to our knowledge, one of the largest recorded spleens

Surgery for extensive thoracic aortic aneurysms is challenging. We report the case of a young woman with Takayasu’s arteritis who developed aortic dissection and was successfully treated with our novel extended arch repair method, which we termed “parabronchial approach”. Surgery was performed via a simple sternotomy. The left pulmonary artery was compressed caudally by a surgical assistant arm typically used for coronary artery bypass grafting. This method simplified the creation of a distal anastomosis to the descending aorta behind the left bronchus. Postoperative computed tomography revealed a distal anastomosis at the sixth thoracic vertebra . This parabronchial approach could reduce the frequency of choosing a highly invasive approach and can be a potential minimally invasive approach in cases requiring extensive thoracic aortic aneurysm repair.