Introduction: Few non-invasive parameters have been identified for predicting atrial fibrillation (AF) recurrence after catheter ablation (CA). This study aimed to assess the association between AF recurrence and atrial late potentials (ALP) measured using P-wave signal-averaged electrocardiography (P-SAECG). Methods and results: Consecutive patients with paroxysmal AF who underwent first CA at our institution between August 2015 and August 2019 were enrolled. P-SAECG was performed before CA. Two ALP parameters were evaluated: root mean square voltage during the terminal 20 ms (RMS 20) and P-wave duration (PWD). Positive ALP was defined as an RMS 20 <2.2 µV and/or a PWD >115 ms. Patients were divided into the Recurrence and Non-recurrence groups based on AF recurrence at the 1-year follow-up after CA. Of 190 patients (age: 65±11 years, 37% women) enrolled in this study, 21 (11%) had AF recurrence. Positive ALP rate was significantly higher in the Recurrence group than in the Non-Recurrence group (86% vs. 64%, P=0.04) despite there being no differences in other baseline characteristics between the two groups. In the multivariate analysis, positive ALP was an independent predictor of AF recurrence (odds ratio: 3.83, 95% confidence interval: 1.05–14.1, P=0.04). Conclusion: Positive ALP on pre-CA P-SAECG was associated with AF recurrence after CA.

Tricuspid valve replacement for infective endocarditis (TVE) in intravenous drug abusers (IVDAs) may pose special clinical challenges, since mechanical prostheses require lifelong anticoagulation therapy, and bioprostheses degenerate over time, especially in young patients. The Inspiris aortic bioprosthesis has been designed to reduce the rate of structural valve deterioration (SVD) and to improve durability. We describe three IVDAs with TVE undergoing tricuspid valve replacement with an inverted Inspiris valve, and discuss the potential advantages of this approach.

The red leopard (Panthera pardus) colour morph is a colour variant that occurs only in South Africa, where it is confined to the Central Bushveld bioregion. Red leopards have been spreading over the past 40 years, which raises the speculation that the prevalence of this phenotype is related to low dispersal of young individuals owing to high off-take in the region. Intensive selective hunting tends to remove large resident males from the breeding population, which gives young males the chance to mate with resident females that are more likely to be their relatives, eventually increasing the frequency of rare genetic variants. To investigate the genetic mechanisms underlying the red coat colour morph in leopards, and whether its prevalence in South Africa relates to an increase in genetic relatedness in the population, we sequenced exons of six colour coat associated genes and 20 microsatellite loci in twenty wild-type and four red leopards. The results were combined with demographic data available from our study sites. We found that red leopards own a haplotype in homozygosity identified by one non-synonymous SNP and a 1 bp deletion that causes a frameshift in the Tyrosinase Related Protein 1 (TYRP1), a gene known to be involved in the biosynthesis of melanin. Microsatellite analyses indicate clear signs of a population bottleneck and a relatedness of 0.11 among all pairwise relationships, eventually supporting our hypothesis that a rare colour morph in the wild has increased its local frequency due to low natal dispersal. This was backed by a high human-induced mortality rate (40%).

Background: COVID-19 vaccine acceptance by the nurses of the future is important to increase the population immunity. Aim: This study aimed to determine the attitudes and concerns of nursing students towards the coronavirus disease-2019 (COVID-19) vaccine, their willingness to be vaccinated, and the factors affecting their willingness in the second wave of the COVID-19 pandemic. Method: This cross-sectional study was conducted between February 1, 2021, to March 30, 2021, using an online questionnaire in 498 nursing students in Turkey. Results: While 64.5% of nursing students had the intention to be vaccinated against COVID-19, 35.5% had no intention to be vaccinated (29.3% hesitant and 6.2% unwilling). Students expressed their attitudes and concerns on the lack of COVID-19 vaccine information (65.7%), its effectiveness (41.6%), safety (45.8%), and side effects (50.8%). Students did not intend to be vaccinated due to insufficient trust in the vaccine effectiveness (84%), the continuous COVID-19 mutation, vaccines side effects (68.9%), and not trusting the supplied vaccine (55.4%). Students’ high education level, high family income perception, previous vaccine rejection, family members with COVID-19 infection, COVID-19 information from official institutions, trusting health professionals’ COVID-19 explanations, and attitudes and concerns toward vaccines for their intention to be vaccinated are the affecting factors (p < 0.05). Conclusions: Nursing students are known to be future healthcare professionals and play a decisive role in counseling individuals in the community on the risks of COVID-19 and the benefits of the vaccine. Therefore, focusing on training that is aimed at increasing vaccine knowledge, eliminating their negative attitudes and concerns, and building confidence in vaccines is necessary.

Objective: To investigate morbidity associated with minimal invasive hysterectomy in obese women. Design: This is a retrospective cohort study using the National Surgical Quality Improvement Project database from 2014 to 2017. Individuals that underwent a laparoscopic, robotic or vaginal hysterectomy were included in the study. Our primary outcome was the composite morbidity (including surgical site infection, sepsis, pulmonary, thromboembolic, cardiac and renal complications, and death). Our secondary outcomes included length of hospital stay, readmission, reoperation, and other surgical complications. A multivariable logistic regression was performed adjusting for age, race, American society of anesthesiology classification (ASA), smoking, surgical approach and operation time. Setting: Hospitals participating in the National Surgical Quality Improvement Project database. Patients or Participants:  Patients undergoing minimally invasive hysterectomy for benign disease. Measurements and Main Results:  39,368 individuals underwent hysterectomies; 18,767 (47.8%) were obese. Class II obesity or more was associated with increased risk for the primary outcome compared to nonobese women. The difference in the primary outcome primarily was driven by an increased risk of superficial site infection. Class III obesity was associated with increased risk for length of stay. There was no difference in the rate of ureteral/bladder/bowel injury, urinary tract infection, blood transfusion, readmission, surgical site closure or reoperation between obese and nonobese women. Conclusion: The rate of surgical morbidity in obese women undergoing minimally invasive hysterectomy remains higher. It is driven by surgical site infection. Future interventions such as preoperative optimization as well as specific wound care interventions in obese patients should be emphasized

In this paper, we develop and analyze a mathematical model for impetigo transmission dynamics. The basic reproduction number, R0, is calculated using the next-generation matrix approach. The disease-free and endemic equilibrium, as well as the basic features of the model, were investigated. When R0 < 1, the model’s stability analysis reveals that the system is asymptotically stable at disease-free equilibrium both locally and globally. Disease-endemic equilibrium exists when R0 > 1, and the system is asymptotically stable at disease-endemic equilibrium both locally and globally. The long-term behavior of the impetigo model’s steady state solution in a population is investigated using numerical simulations of the model.

Sub-Saharan Africa produces most of the Earth’s cacao. Although pests cause losses of hundreds of millions annually, the role of cacao pest suppressors remains unknown. We used an exclusion experiment to prevent access of bats and birds to cacao trees and quantified how their absence affected arthropod communities, herbivory, and crop yield. Overall, Mealybugs and other hemipteran pests were more abundant in exclosures. Under heavy shade (90%), cacao trees with vertebrate exclosures had 3.9 times fewer flowers and 3.2 times fewer large pods than control trees, corresponding to losses on average of $478 ha-1y-1. Under low shade cover (10%) however, the opposite pattern was evident: exclosures trees had 5.2 times more flowers and 3.7 times more large pods than control trees, corresponding to savings on average of $796 ha-1y-1. Our study demonstrates that the enormous potential of African bats and birds as pest suppressors is dependent on shade tree management.

We report the case of a 14 y.o girl treated with radiotherapy for an abdominal paraganglioma - rare pediatric abdominal tumor - with macroscopic tumoral residue after initial surgery and bone metastasis at diagnosis. Irradiation of the tumoral residue and adjacent vertebral metastasis was decided in national committee, proton or photon based-irradiations were compared, before choosing helical tomotherapy photonic irradiation to better protect kidneys. Response at three months was mixed, with mild regression on the tumoral residue contrasting with bone progression. The patient is now under screening to enter a prospective phase II trial of peptide receptor radionuclide therapy (PPRT).

Background The Tpeak-end(Tp-e) has not been compared in all 12 ECG leads in healthy adults to determine if the Tp-e varies across leads. If there is variation, it remains uncertain which lead(s) are preferred for recording in order to capture the maximal Tp-e value. The purpose of the current study was to determine the optimal leads, if any, to capture the maximal Tp-e interval in healthy young adults. Methods In 88 healthy adults(ages 21-38 years), including derivation(n=21), validation(n=20), and smoker/vaper(n=47) cohorts, the Tp-e was measured using commercial computer software (LabChart Pro8 with ECG module, ADInstruments) in all 12 leads at rest and following a provocative maneuver, abrupt standing. Tp-e was compared to determine which lead(s) most frequently captured the maximal Tp-e interval. Results In the rest and abrupt standing positions, the Tp-e was not uniform among the 12 leads; the maximal Tp-e was most frequently captured in the precordial leads. At rest, grouping leads V2-V4 resulted in detection of the maximum Tp-e in 85.7% of participants(CI 70.7, 99.9%) vs all other leads (p<0.001). Upon abrupt standing, grouping leads V2-V6 together, resulted in detection of the maximum Tp-e in 85.0% of participants (CI 69.4, 99.9% vs all other leads; p<0.001). These findings were confirmed in the validation cohort, and extended to the smoking/vaping cohort. Conclusion If only a subset of ECG leads will be recorded or analyzed for the Tp-e interval, selection of the precordial leads is preferred since these leads are most likely to capture the maximal Tp-e value.

This study aims to purify and characterize the cholesterol oxidase enzyme extracted from probiotic bacteria isolated from raw cow milk. The bacterial isolate was identified genotypically by 16S rRNA such as Lactiplantibacillus plantarum MF1 and then deposited in GenBank under the accession number MW242720. Cholesterol oxidase from Lactiplantibacillus plantarum MF1 was purified using acetone and Sephadex G 100 column chromatography, yielding enzyme recovery and purification folds of 19.3% and 4.2, respectively. The purity of purified cholesterol oxidase was confirmed using SDS-PAGE, which revealed a single protein band at 51 kDa. The optimal conditions for maximum activity of the purified CHO enzyme produced by Lactiplantibacillus plantarum MF1 were a 30-minute incubation period at 30°C, a substrate concentration of 150 μL in the reaction mixture, and an enzyme concentration of 100 μL in the reaction mixture. The purified cholesterol oxidase was activated by metal ions (CuSO4), whereas it was inhibited by CaCl2, MgSO4, ZnSO4, and MnCl2. After four days of storage at -20 °C, the purified enzyme retained 57% of its initial enzyme activity. The purified enzyme demonstrated an active effect on serum human cholesterol samples, resulting in a 29% reduction.

Background: Anaphylaxis is the more severe form of immediate hypersensitivity. It can be life-threatening and therefore requires fast and appropriate medical management. After a first hypersensitivity phase, a recurrence of symptoms without an elicitor re-exposure may occur, called a biphasic reaction. The aim of this study was to identify biological and clinical predictors of biphasic reactions in patients with anaphylaxis. Methods: We retrospectively compared patients with monophasic anaphylaxis to those with biphasic anaphylaxis from an allergology day hospital in a French university hospital between January 2017 and May 2020. Results: Among the 237 patients, the rate of biphasic reactions was 5.5% (n = 13). The odds of a biphasic reaction was increased with asthma (p = 0.021; odds ratio = 4 [95% confidence interval 1.05-14.81]) and loss of consciousness during anaphylaxis (p = 0.008) as compared with monophasic anaphylaxis. Basal tryptase levels were significantly higher with biphasic than monophasic anaphylaxis (p = 0.009). Conclusions: Asthma and unconsciousness during the first phase of anaphylaxis could be associated with a biphasic reaction . Elevated basal tryptase was linked to biphasic reactions, which should be further explored.

Seafood is highly nutritive and has an excellent source of proteins, vitamins, minerals, and essential polyunsaturated fatty acids such as Eicosatetraenoic acid (ETA) and Docosahexaenoic acid (DHA) from the n-3 series (omega-3). Due to great nutritive value and large health benefits, their consumption has been increasing continuously. Sometimes but significantly, in a small number of individuals consumption of seafood often leads to adverse reactions like a food allergy. It is a global public health issue in regards to food safety that decline the quality of life and may endanger the lives in severe cases. Seafood allergen can induce hypersensitive immune responses due to their ingestion, skin contact, and inhalation. Recent advancement in the food processing sector implies a great focus on the identification of food allergens by developing a rapid and user-friendly method to assess risk through proper labeling of foods and proper management. According to recent European Union regulations, food producers are advised to declare the presence of foods that are potentially allergic ingredients and highlight them by proper labeling. These efforts enable consumers’ health to be guaranteed. There are various techniques for detection such as DNA-based, Aptamer based, and protein-based. These are more efficient and reliable detection methods for seafood allergen and will ensure the food safety and health of the consumer.

Interspecific interactions and movement are key factors that drive the coexistence of metapopulations in heterogenous landscapes. Yet, it is challenging to understand these factors because separating movement from local population processes relied on capture-based data that are difficult to collect. Recent development of spatially explicit dynamic N-mixture models (SEDNMs) made it possible to draw inference on local population growth and movement using count data of unmarked populations. Here, we further developed SEDNMs to account for interspecific interactions and both false positive and false negative observation errors. Simulations showed that the models provide unbiased parameter estimates regardless of the ecological system (competition, predator-prey), observation process (binomial, Poisson), and sampling situation. Case studies further demonstrated the capabilities of these models in revealing important ecological processes including competition, predator-prey interactions, movement patterns, and differential habitat preferences. The flexible structures of these models make them highly adaptive and relevant in population and community ecology.

Background: The basophil activation test (BAT) has high accuracy to diagnose peanut allergy (PA) and can reduce the need for oral food challenges (OFC); however, so far it has not been incorporated in clinical practice. Methods: We compared two BAT methodologies, their performance in two separate laboratories, their diagnostic utility and impact of BAT in clinical-decision-making in a specialised centre. Results: 102 children being assessed for PA were tested on BAT (72 allergic, 30 sensitised tolerant). There was little internal variation (CV<15%) and a very strong correlation (Rs>0.95) between BAT performed across laboratories. The 2 BAT methods were correlated but not interchangeable and 19% of cases had opposite results. The in-house BAT method (IH-BAT) was superior, as demonstrated by its better diagnostic performance (area under the ROC curve 0.929/0.957 versus 0.892/0.895 for CD63/CD203c), lower number of non-responders (4% versus 14%), lower background basophil activation (4% versus 9%) and less need for oral food challenges (29/12 versus 37/20 for OFC/positive OFC). BAT was feasible and well-accepted by clinicians: no patient with positive BAT was referred for OFC; only 37% of all tested patients needed an OFC and 14% of these (5% of total) reacted during OFC, which corresponded to 72/89% decrease in OFC/positive OFC, respectively, with the integration of BAT in the diagnostic work-up for peanut allergy. Conclusions: The BAT is a robust test that can reliably be transferred between laboratories; however, different BAT methods are not interchangeable. BAT was well integrated in the clinical decision-making process in a specialised centre.

Diamond-Blackfan anemia (DBA) is a congenital erythroid hypoplasia. Classical anemia is a normochromic or macrocytic anemia with reticulocytopenia. Patients with DBA are usually diagnosed and receive transfusion in the first year. We report a patient who presented with microcytic anemia and congenital malformations. The patient suffered a sudden aggravation of disease during adolescence and received first transfusion at 13 years of age. Exome sequencing eventually led to a diagnosis of DBA with a mutated RPL5 gene. In conclusion, this case demonstrates a confused manifestation of non-classical DBA and sudden aggravation of disease in natural course of DBA.

Ineffective selection of therapeutic drugs during an urgent situation leads to failure for COVID-19 treatment in large clinical trials, resulting in wasting time and cost. We aimed to demonstrate the utility of physiologically-based pharmacokinetic (PBPK)/pharmacodynamic (PD) modeling to support the withdrawal of chloroquine and ritonavir-boosted lopinavir (LPV/r) for COVID-19 treatment. The developed whole-body PBPK models were validated against clinical data. Model validation was performed using acceptable methods. The inhibitory effect was calculated to demonstrate drug efficacy. Various regimens of chloroquine and LPV/r for COVID-19 treatment in different clinical trials were used for a simulation. The risk of cardiotoxicity following high dose chloroquine administration was assessed. The effect of lung pH on drug concentrations in epithelial lining fluid (ELF) following a high dose of chloroquine and LPV/r was evaluated. The whole-body PBPK models were successfully developed (AAFEs of 1.2-fold). The inhibitory effect (%E) of chloroquine following high dose regimens in both ELF and bronchial epithelial cells (BEC) were lower than 2 and 1%, respectively. The corresponding values for the high dose of LPV/r were 40 and 2%, respectively. The risk of prolonged QTc in the population was higher than 20%. In addition, the %E of chloroquine was increased to 76% at pH 5.6 and decreased to 0.13% at pH 7.5. The change in pH in ELF had no influence on LPV/r concentrations. PBPK/PD modelling supports the withdrawal of chloroquine and LPV/r for COVID-19 treatment as an effective tool for the selection of therapeutic drug regimens in urgent situation.

The value of fundic gland polyps in the diagnosis of HP infection:a meta analysis

The present numerical investigation carried out to obtain the dimensions and parameters for thermal performance optimization of miniature heat sink devices using hybrid nanofluid. Microchannels and minichannels of the surface area of 1x1cm2 and 4x4cm2 were optimized. Water and 1% vol. fraction of Al2O3-MWCNT (50:50)/water hybrid nanofluid was used as coolants. In this study, the heat sinks are thermally optimized on a numerical basis by using basic governing equations, applying boundary conditions and assumptions, and carrying out the optimization scheme. Also, the effect of pressure drop with friction factor, Nusselt number, heat transfer coefficient, and fin efficiency of channel walls on Reynolds number are studied, and comparative analysis is accomplished. Results revealed that a heat sink with lower total thermal resistance would consume more pumping power. However, the thermal performance of the coolant is improved by hybrid nanofluids with a marginal rise in the pumping power

Second Salvage Hematopoietic Cell Transplant in a Sickle Cell Disease Presenting with Acquired Hypoplastic Anemia of Donor Marrow

We present a case of 72-year-old patient, who underwent a 10 years ago a total vaginal hysterectomy, was admitted for transvaginal bowel evisceration. This affection is an exceptional complication of pelvic surgery. There is no gold standard surgical approach but exploratory laparotomy is mandatory in case of bowel necrosis.

Background: Treatment intensification has improved survival in patients with hepatoblastoma (HB); however, these treatments are associated with an increased risk of late effects including second malignant neoplasms (SMNs). Data is limited regarding SMNs following HB treatment. Methods: Cases of SMNs following treatment for HB reported in the literature and from personal communication were analyzed to further assess this late effect. Results: Thirty-eight patients were identified. Median age at diagnosis of HB was 16 months (range: 3 to 168 months). All patients had received a platinum agent, and almost all had anthracycline exposure. Of 12 patients with a known history of liver transplantation for primary resection of their HB, the majority had post-transplant lymphoproliferative disorder (PTLD) (n=7). The most common SMNs reported were non-PTLD hematopoietic malignancies (n=19). Solid tumors were seen in 12 patients: peripheral neuroectodermal tumor/Ewing sarcoma (3); and one each for renal cell carcinoma, nephroblastoma, colorectal carcinoma, thyroid carcinoma, medulloblastoma, clear cell sarcoma-like tumor, hepatocellular carcinoma, osteosarcoma, and malignant schwannoma. Of 36 patients with data, nineteen survived. Conclusions: SMNs following HB treatment were seen in patients with anthracycline (and cisplatin) exposure, hereditary tumor predisposition syndromes, and/or history of liver transplantation. Hematopoietic malignancies were the most common SMN reported in this cohort and were diagnosed earlier than other SMNs. Prospective collection of data via a companion late effects study or international registry could be used to further evaluate rates and risks of SMNs as well as tumor predisposition syndromes in patients treated for HB.

Langerhans-cell histiocytosis (LCH) is a condition characterized of an inadequate function and proliferation of this cells. Clinical presentation can be variable depending on the site of affection. The most common sites of affection are bones, skin and lymph nodes; however, this histiocytic disorder can arise in virtually any organ system, making it challenging to diagnose. In this case report we describe a 6-month-old with an atypical and unique presentation of multisystemic LCH: skin involvement and pericardial effusion. We highlight the importance of clinical suspicion among physicians when symptoms of several systems appear, especially when skeletal or skin systems are affected.

Objective: Acute Lymphoid Leukemia (ALL) is the leading childhood cancer with high mortality and morbidity. Studies have suggested an association of epigenetic transformations with prognosis, recurrence, and immunophenotypes of ALL. SOCS1 and SOCS3 are tumor suppressors inhibiting JAK/STAT signaling pathway and the resultant aberrant cell proliferation. We aimed to assess the methylated status of these genes in patients with ALL, using bone marrow and peripheral blood samples. Materials and Methods: 18 patients with ALL and 13 children with no malignancies were included. Using Bisulfite conversion, quantitative multiplex methylation-specific PCR and 2^(-∆∆Ct) formula, the methylated DNA in the promoters of SOCS1 and SOCS3 were measured. Results: ALL patients had higher mean methylation in SOCS1 promoter and lower mean methylation in SOCS3 promoter, compared to the control group. However, neither of these mean differences were statistically significant. Conclusion: This finding can set the foundation for further large-sample studies with the use of healthy children as the control group to strengthen the hypothetical association of the methylation status of SOCS1 and SOCS3 with ALL.

Objective: Refine the programme theory for OptiBreech Care Design: Concurrent mixed methods implementation process evaluation Setting: 6 NHS hospitals in England participating in the OptiBreech 1 Feasibility Study Sample: 15 women planning a vaginal breech birth at term and 6 breech lead midwives Methods: Outcomes were recorded on case report forms and descriptively analysed. Interviews were recorded, transcribed and analysed using the Theoretical Framework of Acceptability. Iterative analysis informed subsequent interviews and the on-going process of implementation across sites. Main Outcome Measures: Acceptability of service delivery models and their outcomes. Results: Actively recruiting Trusts implemented services through a dedicated clinic and/or a proficient intrapartum support service, organised and provided primarily by a Breech Specialist Midwife. While we identified challenges, this model has achieved 93% fidelity to the intervention’s goal of ensuring attendance of OptiBreech-trained professionals at vaginal breech births, and it is highly acceptable to women. Our initial suggested model of a multi-disciplinary team composed of 5 obstetricians and 5 midwives does not appear feasible, due to very low overall current breech experience levels and the context of current pressures on NHS services. Conclusions: Appointment of a Breech Specialist Midwife, whose role is to co-ordinate a dedicated clinic, training and a proficient intrapartum care team, appears to be highly acceptable to women. This model appears to be a feasible implementation strategy, in order to test the safety and effectiveness of OptiBreech Care in a clinical trial, but further work needs to be done to develop sustainability.