Traditional palatal and vestibular surgical approaches for removing deeply impacted mesiodens with a crown facing the nasal floor are accompanied by significant complications. Herein, we describe a novel modified intranasal approach to minimize the complications. Also, it can be performed under local anesthesia with proper preoperative workup.

Schizophrenia is associated to somatic disorders especially cardio-vascular and auto-immune. Through this case report, we describe an association with hypertrophic osteoarthropathy (HPO). For this patient it was a paraneoplastic paraneoplastic syndrome secondary to lung cancer. This syndrome is rare but important to recognize since it could hide a life-threatening condition.

Time for action- oxytocin & uterotonics are life-saving AND dangerous: a commentaryDeborah ArmbrusterUnited States Agency for International DevelopmentWashington, DC (currently based in Indonesia)Global Health Bureau/Maternal, Child and Nutrition Office/Maternal and Newborn Division+1 202 746-5453darmbruster@usaid.gov

Background: Respiratory syncytial virus (RSV) is understood to be a cause of significant disease in older adults and children. Further analysis of RSV in younger adults may reveal further insight into its role as an important pathogen in all age groups. Methods: We identified, through laboratory data, adults who tested positive for either influenza or RSV between January 2017 and June 2019 at a single Australian hospital. We compared baseline demographics, testing patterns, hospitalisations and outcomes between these groups. Results: Of 1128 influenza and 193 RSV patients, the RSV cohort was older (mean age 54.7 vs. 64.9, p<0.001) and were more comorbid as determined by the Charlson Comorbidity Index (2.4 vs. 3.2, p<0.001). Despite this, adults under 65 with RSV were equally likely to be admitted compared with their influenza counterparts (70.3% vs. 77.3%, p=0.174). Testing occurred later in RSV hospitalisations as measured by the proportion tested in the emergency department (80.3% vs. 69.2%, p<0.001) and this was strongly associated with differences in presenting phenotype (the presence of fever). RSV was the biggest predictor of 6 month representation, with age and comorbidities predicting this less strongly. Conclusion: RSV is a significant contributor to morbidity and hospitalisation, sometimes outweighing that of influenza, and is not limited to elderly cohorts. Understanding key differences in the clinical syndrome and consequent testing paradigms may allow better detection and potentially treatment of RSV to reduce individual morbidity and health system burden. This growing area of research helps quantify the need for directed therapies for RSV.

Background: Because transcatheter closure of patent foramen ovale (PFO) has become effective for preventing cryptogenic stroke (CS), it is necessary to determine high-risk PFO associated with CS. This study aimed to clarify the importance of direct right-to-left (RL) shunt through the PFO for identifying high-risk PFO. Methods: We analyzed 137 patients with and without CS who were confirmed to have PFO. The timing of RL shunt through the PFO was evaluated by cardiac cycles after right atrium (RA) opacification on saline contrast transesophageal echocardiography. Direct RL shunt was defined as microbubbles crossing the PFO before and at the same time of RA opacification. Results: Cardiac cycles of microbubbles crossing the PFO were shorter in patients with CS than in those without CS (2.0 ± 2.2 vs. 0.5 ± 1.1, P < .01). Direct RL shunt was more frequently observed in patients with CS than in those without CS (77% vs. 29%, P < .01), with a sensitivity of 79% and a specificity of 71% for the association with CS. Multivariate analysis revealed that direct RL shunt was related to atrial septal aneurysm and low-angle PFO. Regarding functional features of PFO, the detection rate of CS was 50% for large RL shunt alone, and was increased to 83% when direct RL shunt was added. Conclusion: Direct RL shunt was associated with CS and had the incremental value in detecting PFO associated with CS for large RL shunt. The timing of RL shunt can be valuable for identifying high-risk PFO.

Airway management of patients with difficult airways is a challenge to the anesthesiologists and awake tracheal intubation is the recommended strategy. A safe, comfortable, unconscious, and satisfied intubation with spontaneous breathing keeping was achieved by intermittent sevoflurane inhalation and the modified spray-as-you-go technique for airway topicalization and intubation.

AIM Ropeginterferon alfa-2b is a new site-specific conjugated 40 kDa branched polyethylene-glycol recombinant interferon (IFN). The aim of the study was to determine its safety, pharmacokinetics (PK) and pharmacodynamic (PD). METHODS Ropeginterferon alfa-2b was evaluated first in human in 48 healthy male volunteers after a single dose subcutaneous injection by either 24, 48, 90, 180, 225, 270mcg of the product or 180mcg of marketed pegylated (peg)-IFN alfa-2a. Within each dosing group, 6 subjects received ropeginterferon alfa-2b and 2 subjects received peg-IFN alfa-2a. RESULTS Dose-related increases in ropeginterferon alfa-2b PK parameters (Cmax, AUC, and AUC0-t) were observed over the dose range 24 to 270mcg. The geometric mean values for these PK parameters of ropeginterferon alfa-2b were higher than that of peg-IFN alfa-2a at the 180mcg dose level of 176%, 166%, and 182%, respectively. Mean PD parameters (Emax, Tmax, and AUC0-t) for ropeginterferon alfa-2b increased with dose for both biomarkers neopterin and 2’, 5’-OAS. Ropeginterferon alfa-2b has similar PD profiles as peg-IFN alfa-2a. The treatment related adverse events are similar between the two study drugs, but the overall incidence was numerically lower for ropeginterferon alfa-2b (83%) than peg-IFN alfa-2a (100%) at the 180mcg dose level. CONCLUSIONS Single subcutaneous dose of Ropeginterferon alfa-2b of up to 270mcg is safe and well tolerated. It displays dose related increase in PK and PD parameters, potentially less frequent injection, and better safety profiles. Ropeginterferon alfa-2b is being developed for diseases in which previous peg-IFN use has been limited by side effects.

1. Silicon mediated plant–herbivore interactions have gained increasing recognition and have now been studied in a wide range of species. Many studies have also considered accumulation of Si by plants as a process largely driven by geo-hydrological cycles. 2. To identify factors driving the water - plant Si - herbivore nexus we analysed the concentration of Si in fibrous tussock sedge (Carex appropinquata), the population density of the root vole (Microtus oeconomus) and the ground water level, over 11 years. 3. The largest influence of autumn Si concentration in leaves (Sileaf) was the level of the current year’s ground water table, which accounted for 13.3% of its variance. The previous year’s vole population density was weakly positively correlated with Sileaf and alone explained 9.5% of its variance. 4. The only variable found to have a positive, significant effect on autumn Si concentration in rhizomes (Sirhiz) was the current year spring water level explaining as much as 60.9% of its variance. 5. We conclude that the changes in Si concentration in fibrous tussock sedge are predominantly driven by hydrology, with vole population dynamics being secondary. Our results provide only partial support for the existence of plant-herbivore interactions, as we did not detect the significant effects of Si tussock concentration on the vole density dynamics. This was mainly due to low level of silification of sedges, which was insufficient to impinge herbivores. Future studies on plant–herbivore interactions should therefore mainly focus on identification of mechanisms and conditions allowing plants to accumulate silica at the levels sufficient to act as an anti-herbivore protection.

Application of electrocautery to a metal guidewire can be used to perform transseptal puncture (TSP). Dedicated radiofrequency guidewires (RF) may represent a better alternative. This study compares safety and effectiveness of electrified guidewires to a dedicated RF wire. TSP was performed on porcine hearts using an electrified 0.014” or 0.032” guidewire under various power settings compared to TSP using a dedicated RF wire with 5W power. The primary endpoint was the number of attempts required to achieve TSP. Secondary endpoints included the rate of TSP failure, TSP consistency, effect of the distance between tip of the guidewire and the tip of the dilator, and effect of RF power output level. Qualitative secondary endpoints included tissue puncture defect appearance, thermal damage to the TSP guidewire or dilator, and tissue temperature using thermal imaging. The RF wire required 1.10 ± 0.47 attempts to cross the septum. The 0.014” electrified guidewire required 2.17 ± 2.36 attempts (2.0x higher than the RF wire; p<0.01), and the 0.032” electrified guidewire required 3.90 ± 2.93 attempts (3.5x higher than the RF wire; p<0.01). Electrified guidewires had a higher rate of TSP failure, larger defects, more tissue charring, higher temperatures, and greater tissue heating. Fewer RF applications were required to achieve TSP using a dedicated RF wire compared to an electrified guidewire. Smaller defects and lower tissue temperatures were also observed using the RF wire. Electrified guidewires required greater energy delivery and were associated with equipment damage and tissue charring.

Background: Many different internal factors have been proven to influence urine production such as age, weight, and quality of sleep. External factors such as consumption of caffeine and fluid consumption have been shown to have an impact on urine production. Aim: To investigate the impact of movement, physical activity, and position on urine production. Methods: This prospective observational study was executed at Ghent University Hospital, Belgium. Study participation was open for anyone visiting the hospital. Participants collected 1 basic and 2 extended 24-hour urine collections and filled in questionnaires concerning their general health and physical activity. Urinary levels of osmolality, sodium, and creatinine were determined. Data on movement, physical activity and position was described. Results: An increase in body movement leads to a significant increase in diuresis during daytime, night-time, and 24 hours (p=0,002, p= <0,001, and p=<0,001, respectively). An increase in body movement leads to a significant decrease in osmolality during night-time and 24 hours (p=0,009, and p=0,004, respectively). However, no significant influence of movement on osmolality was found during daytime (p=0,12). An increase in body movement leads to a significant decrease in creatinine during daytime, night-time, and 24 hours (p=0,001, <0,001, and p=<0,001, respectively). An increase in body movement leads to a significant increase in sodium during daytime (p=0,046) but this was statistically significant during night-time and 24 hours (p=0,32, and p=0,84 respectively). Conclusion: Our study demonstrates a statistically significant association of movement, physical activity, and position with urine production. It would therefore be interesting to explore this association further with the use of new technology to have more accurate data. Here lays a potential role for conservative measurements and lifestyle adaptations in the management of patients with bothersome LUTS and more precisely nocturia.

Commentary on: LAPAROSCOPIC MYOMECTOMY USING LOOP LIGATION FOR GIANT INTRACERVICAL MYOMAS: A NOVEL SURGICAL TECHNIQUE.Authors: Shengke Wang, Dongdong Wang, Qihong Huang, Fujie Zhao.Journal: BJOG: An International Journal of Obstetrics & GynaecologyINTRACERVICAL FIBROID REMOVAL: A MYOMECTOMY REASONED ON BIOLOGICAL BASES .Dr. Andrea Tinelli, MD, Prof, PhDVeris delli Ponti Hospital, Obstetrics and Gynecology Department, Scorrano, Lecce, Italy; Laboratory of Human Physiology,Phystech BioMed School, Faculty of Biological & Medical Physics,Moscow Institute of Physics and Technology (State University), Dolgoprudny, Moscow Region, Russia.Tel: +39-3392074078; E-mail:andreatinelli@gmail.com; ORCID: 0000-0001-8426-8490Anatomically, uterine corpus, isthmus and cervix compose one organ, but functionally they attend different function during pregnancy and labor. The uterine cervix is mainly composed connective tissue and extracellular matrix, that allow the pregnancy to come to an end, up to the onset of labor, when cervical ripening and dilatation occur to deliver the fetus. The cervical innervations and the different neurotransmitters and neuropeptides expression involved in cervical ripening suggest that the cervix plays a key role in pregnancy maintenance, labor initiation, pain and delivery; this can also be supported by previous studies that showed that cervical ripening is also a neuroimmune-mediate inflammatory reaction involveing the hypogastric nerve [Di Tommaso S “et al”, 2017;18(2):140-148].Neuropeptides are signaling peptides that are produced by neural, endocrine and/or immune cells: all of these hormones are involved in a variety of biological processes, not only enhancing uterine contractility and modulating pain trigger, but also possessing anti-inflammatory, antioxidative stress and tumorigenic properties. Particularly, they contribute with changes in muscle contractility, uterine peristalsis and muscular healing and may be involved also in the uterine fibroids’ pathophysiology [Tinelli A “et al”; 2020;21(5):440-442].Uterine fibroids are generally distributed over the body and fundus of the uterus, they are surrounded by a fibroneurovascular network rich of neurotransmitters, the myoma pseudocapsule, a neurovascular bundle separating fibroid from the myometrium, and allowing less bleeding during myomectomy and better subsequent myometrial healing after removal [Tinelli A “et al”; Curr Protein Pept Sci. 2017;18(2):129-139]. For this reason, the correct myomectomy which enucleates fibroid inside its pseudocapsule has been called ”intracapsular” and has remarkable early and late biological - muscular advantages, during and after surgery [Tinelli A “et al”.; JSLS 2012;16(1):119-29].Cervical fibroids are infrequent, but often create significant problems during myomectomy, as, during the removal there can be intraoperative and late complications, such as massive bleeding and scarring fibrosis with all the repercussions on pregnancy and childbirth [Malvasi A “et al”; 2013;29(11):982-8.].Wang “et al” [Wang “et al”; BJOG 2021] proposed their intracervical myomectomy for large intracervical myomectomy on 12 patients, basing on biology of the myoma pseudocapsule. They performed a laparoscopic myomectomy putting a loop ligation along the junction of the pseudocapsule and cervix, pulling the loop it at this position; then, they performed a traction and enucleation within the fibroid wound cavity directly closes the fibroid cavity, with the surrounding vascular network bounded in the knot after ligation of the pseudocapsule without dead space, and preventing injury to nearby tissues.During fibroid enucleation, loop ligation of the pseudocapsule glides along the tumor body and operates within the fibroid wound cavity, with no cervical tissue involved during enucleation. The neurovascular bundles of the fibroid pseudocapsule are protected and spared during myomectomy and the side of the pseudocapsule attached to the fibroid was bound tightly in the loop to achieve hemostasis. This technique results less invasive and would promote fertility in case of cervical myomectomy, not requiring additional pelvic dissection and allowing to operate directly in the cervix sparing adjacent tissues and pseudocapsule.

Background: Biologic medications, specifically the TNF-α inhibitors, have become increasingly prevalent in the treatment of chronic inflammatory disease (CID) in pregnancy. Objective: To determine pregnancy outcomes in women with CID exposed to biologics during pregnancy. Search strategy: PubMed and EMBASE databases were searched through January 1998-July 2021. Selection criteria: Peer reviewed, English language cohort, case-control, cross-sectional studies, and case series which contained original data. Data collection and analysis: Two authors independently conducted data extraction and assessed study quality. A meta-analysis of proportions using a random-effects model was used to pool outcomes. Linear regression analysis was used to compare the mean of proportions of outcomes across exposure groups using the ‘treated’ group as the reference category. All studies were evaluated using an appropriate quality assessment tool described by McDonald et al. Main Results: 35 studies, 11172 pregnancies, were eligible for inclusion. Analysis showed pooled proportions for congenital malformations: treated 4%(95% CI 0.03-0.4) vs disease matched 4%(0.03-0.05).Preterm delivery treated 12%(0.10-0.14) vs disease matched 10%(0.09-0.12) Severe neonatal infection: treated 5%(0.03-0.07) vs disease matched 5%(0.02-0.07) Low birth weight: treated 10%(0.07-0.12) vs disease matched 8%(0.07-0.09) The pooled Miscarriage: treated 13%(0.10-0.15) vs disease matched 8%(0.04-0.11) Pre-eclampsia; treated 1%(0.01-0.02) vs disease matched 1%(0.00-0.01). No statistical differences in proportions were observed. Conclusion: We demonstrated comparable pregnancy outcomes in pregnancies exposed to biologics, disease matched controls and CID free pregnancies. Overall, women receiving biologics in pregnancy may be reassured regarding their safety.

In a case of mechanical hemolytic anemia following surgical repair of type A aortic dissection, four-dimensional flow magnetic resonance imaging revealed highly elevated turbulent kinetic energy in a stenotic lesion of a replaced ascending aorta. Our findings suggest that turbulent kinetic energy evaluation enables the detection of the origin of mechanical hemolysis.

Xylem embolism resistance varies across species influencing drought tolerance, yet little is known about the determinants of the embolism resistance of an individual conduit. Here we conducted an experiment using the optical vulnerability method to test whether individual conduits have a specific water potential threshold for embolism formation and whether pre-existing embolism in neighbouring conduits alters this threshold. Observations were made on a diverse sample of angiosperm and conifer species through a cycle of dehydration, rehydration and subsequent dehydration to death. Upon rehydration after the formation of embolism, no refilling was observed. When little pre-existing embolism was present, xylem conduits had a conserved, individual, embolism resistance threshold that varied across the population of conduits. The consequence of a variable conduit-specific embolism threshold is that a small degree of pre-existing embolism in the xylem results in an apparently more resistant xylem in a subsequent dehydration, particularly in angiosperms with vessels. While our results suggest that pit membranes separating xylem conduits are critical for maintaining a conserved individual embolism threshold for given conduit when little pre-exisiting embolism is present, as the percentage of embolized conduits increases, gas movement, local pressure differences, and connectivity between conduits increasingly contribute to embolism spread.

Xylem is a main road in plant long-distance communication. Through xylem plants transport water, minerals and myriad of signaling molecules. With the onset during early embryogenesis, the development of xylem tissues relays on hormone gradients, activity of unique transcription factors, distribution of mobile miRNAs and receptor-ligand pathways. These regulatory mechanisms are often interconnected and all together contribute to the plasticity of water conducting tissue. Remarkably, root xylem carries water to all above-ground organs and therefore influences all aspects of plant growth. Because of the global warming and increasing water deficit, we need to come up with solutions for the crops of the future. It is clear that structure of water conducting elements directly impacts water transport within the plant. Among plant pathogens- vascular wilts attacking xylem -are the most harmful. Our knowledge about xylem anatomy and rewiring ability could bring the solutions against these diseases. In this review we summarize the recent findings on the molecular mechanisms of xylem formation with a special attention to the cellular changes, and cell wall rearrangements that are necessary to create functional capillaries. We emphasize the impact of abiotic factors and pathogens on xylem plasticity and discuss multidisciplinary approach to model xylem in crops.

Molecular Ecology News and Views - Perspective on Jacobs and Elmer (2021) “Alternative splicing and gene expression play contrasting roles in the parallel phenotypic evolution of a salmonid fish”

Theory predicts that sexual selection should aid adaptation to novel environments, but empirical support for this idea is limited. Pathogens are a major driver of host evolution and, unlike abiotic selection pressures, undergo epidemiological and co-evolutionary cycles with the host involving adaptation and counteradaptation. Because of this, populations harbor ample genetic variation underlying immunity and the opportunity for sexual selection based on condition-dependent “good genes” is expected to be large. In this study, we evolved populations of Drosophila melanogaster in a 2-way factorial design manipulating sexual selection and pathogen presence, using a gram-negative insect pathogen Pseudomonas entomophila, for 14 generations. We then examined how the presence of sexual selection and the pathogen, as well as any potential interaction, affected the evolution of pathogen resistance. We found increased resistance to P. entomophila in populations that evolved under pathogen pressure, driven primarily by increased female survival after infection despite selection for resistance acting only on males over the course of experimental evolution. This result suggests that the genetic basis of resistance is in part shared between the sexes. We did not find any evidence of sexual selection aiding adaptation to pathogen, however, a finding contrary to the predictions of “good genes” theory. Our results therefore provide no support for a role for sexual selection in the evolution of immunity in this experimental system.

Objective: No effective treatment has yet been found for SARS-cov-2, which caused a pandemic outbreak in 2019. It is crucial to detect the progression of Covid-19 in patients as early as possible. Fibrinogen to albumin ratio (FAR) has been used as a new inflammatory marker. We aimed to find out whether the use of the FAR ratio as a predictor of mortality in Covid-19 patients provides clinical benefit. Materials and Methods: Data from 590 patients with Covid-19 from 15/03/2020 to 15/01/2021 in medicine wards and intensive care units (ICU) were retrospectively analyzed. Demographic data and other laboratory markers were collected from the electronic medical records. Relationship between FAR ratio was investigated between patients in the survivor/non-survivor patients. Findings: The mean FAR levels in patients who were non survivor was 24.44±30.3 (n:272 and 11.29±6.29 (n:275) (p:0.000) in patients survivor COVID-19 infection. In ROC curve for FAR, the threshold FAR that may pose a risk for mortality was determined as 13.84 ((AUC: 0.808(0.771-0.844)); 74.9% Sensitivity, 74.6% Specificity; p:0.000 )). Result: As a result of this study, increased FAR were found to be important markers in determining the mortality levels in Covid-19 patients. What is already known about FAR ratio: The fibrinogen albumin ratio is a value that has been used to determine the prognosis, especially in malignancies. [32] In a recent study 91 Covid-19 patients were analyzed 22 patients with severe disease higher FAR ratio compare to mild disaese [36] What does this article add about FAR ratio in Covid-19 patients: It has been concluded that the FAR ratio, which is used in diseases such as malignancy, hypertension, and coronary syndrome as a marker of disease progression, can be used as a mortality indicator in Covid-19