Background COVID-19 pandemic, limiting the availability of anesthesiologists, has impacted heavily on the organization of invasive cardiac procedures such as transcatheter atrial fibrillation (AF) ablation. Objective We compared the safety and efficacy of deep sedation with dexmedetomidine administered by electrophysiologists without anesthesiologist supervision, against the standard protocol performed with propofol. Methods We retrospectively included all AF ablation procedures performed in 2020: 23 patients sedated with 1% propofol (2 ml bolus followed by infusion starting at 1 mg/Kg/h), 26 patients with dexmedetomidine (infusion starting at 0.7 mcg/Kg/h). Both groups additionally received 1 mcg/Kg of midazolam as a single bolus and 0.05 mg single boluses of fentanyl prior to ablation on each pair of pulmonary veins (PV). Primary outcomes were oxygen desaturation (<90%) or need for assisted ventilation/intubation, bradycardia (heart rate <45 bpm) and persistent hypotension (systolic blood pressure <90 mmHg). Results Baseline characteristics and hemodynamic variables did not differ between the two groups (all p>0.05). In 8/23 (35%) patients propofol infusion velocity reduction was necessary to maintain the hemodynamic values, compared to 7/26 (27%) with dexmedetomidine. Inter-group comparison of hemodynamic variables during the procedure showed no statistically significant difference, despite a trend in favor of dexmedetomidine (3 respiratory depressions and 3 persistent hypotension episodes with propofol vs. 0 with dexmedetomidine; p = 0.057). Conclusion Deep sedation with dexmedetomidine administered by electrophysiologists without anesthesiologist supervision is safe and effective for AF transcatheter ablation. A trend towards a lower incidence of hypotension and respiratory depression was noted when compared to propofol.

Abstract Objectives: To explore primary care provider (PCP) experiences and practice patterns regarding low back pain (LBP) in females compared to males in the United States. Methods: We used a cross-sectional study design; data was collected anonymously using a 27-item online survey disseminated via email to PCPs working in Ohio. We had 58 responses for analysis, data was analyzed using bivariate and multivariate analyses. Results: Almost 9 out of 10 clinicians reported experiencing LBP. PCPs were not in agreement that LBP is different in women than men. Clinicians with women’s health, osteopathic, or sport’s medicine background were more likely to agree that LBP is different in women than in men. PCPs were more likely to counsel female patients about pelvic floor exercises; however, their intake of present pelvic symptoms in LBP female patients is suboptimal. PCPs were more likely to counsel females for home chores than males. Conclusion: Initial evidence suggests there is a knowledge gap amongst PCPs towards the impact of biological sex on LBP and a bias towards gender roles when counseling patients for home chores or occupational tasks. Further investigation of this knowledge gap and counseling approaches is recommended to better bridge the gender disparity.

Tick and Tick-borne diseases pose a growing threat to human and animal health, which has brought great losses to livestock production. With the continuous expansion of human activities and the development of natural resources, there are more and more opportunities for the human to contact ticks and tick-borne pathogens. Therefore, research on ticks and tick-borne diseases is of great significance. This paper reviews recent progress on tick-borne bacterial diseases, viral diseases, and parasitic diseases in China, which provides a theoretical foundation for the research of tick-borne diseases.

Background Impulse oscillometry is an alternative to measure lung function in preschoolers because is much simpler and can be performed in tidal breathing with minimal patient cooperation. The introduction of new health technologies such as impulse oscillometry raises concerns as if the extra benefit offered outweighs the additional cost compared to spirometry This study aimed to evaluate the cost-effectiveness of impulse oscillometry in preschoolers in Colombia. Methods We conducted a decision tree model to estimate the cost and proportion of correctly diagnosed cases of asthma of impulse oscillometry compared to spirometry in preschooler’s children between 3-6 years old . The analysis was carried out from a societal perspective. Multiple sensitivity analyses were conducted. Cost-effectiveness was evaluated at a willingness-to-pay value of $19,000. Results With impulse oscillometry, the proportion of correctly diagnosed cases was 42%, while with spirometry was 39%. The expected cost estimated by the model for a patient diagnosed with IOS was U$ 174 while with spirometry was U$ 99. The incremental cost-effectiveness ratio estimated in the probabilistic model was US$ 6881. The one-way and probabilistic sensitivity analyses, our base‐case results were robust to variations of all assumptions and parameters Conclusion Impulse oscillometry was found to be cost-effective for the diagnosis of asthma in preschoolers. Our results should stimulate further research to expand the use of this diagnostic test in developing countries.

Objective: To run a systematic review and meta-analysis of related studies on body mass index (BMI) and the risk of death among pulmonary hypertension (PH) patients, as well as, to shed light on the shape and strength of the dose-response association. Methods: Studies published up to Jun 2021 in scientific databases such as Scopus, and PubMed as well as Google Scholar were searched. Cohort studies that reported risk estimates for at least two categories of BMI or per certain increase in BMI in relation to mortality in PH patients were included. Summary relative risks were determined with random effects models. Non-linear relationship was discovered with dose-response analysis. Results: All in all, 15 cohort studies were selected. The number of participants was 127215 out of which 73999 were reported dead. The relative risks (RRs) of mortality for participants with highest BMI were 0.72 (95% confidence interval (CI), 0.57–0.90; I2=97.3%, n=9) in comparison with the reference category. The summary RR for mortality per a 5-unit increment in BMI was 0.83 (95% confidence interval 0.77 to 0.89; I2=75.6%, n=9) among PH patients. There was a non-linear dose-response relation between BMI and mortality in PH patients (Pnon-linearity <0.001), with the lowest risk being at BMI 32-38 kg/m2. Conclusion: higher BMI is related to decreased risk of mortality among PH patients and the lowest point of the curve was seen at BMI 32-38.

Background: The empirical basis for a quantitative assessment of the disease burden imposed by long-COVID is currently scant. We aimed to assess the disease burden caused by long-COVID in Japan. Methods: We conducted a cross sectional self-report questionnaire survey. The questionnaire was mailed to 530 eligible patients, who were recovered from acute COVID-19 in April 2021. Answers were classified into two groups; participants who have no symptom and those who have any ongoing symptoms that lasted longer than four weeks at the time of the survey. We compared health-related quality of life scores estimated by the EQ-5D-3L questionnaire between these two groups after adjusting basic characteristics of the participants by propensity score matching. Results: 349 participants reported no symptoms and 108 reported any symptoms at the time of the survey. The participants who reported any symptoms showed a lower value on a Visual Analogue Scale (median 70 [IQR 60-80]) and on the EQ-5D-3L (median 0.81 [IQR 0.77-1.0]) than those reporting no symptoms (median 85 [IQR 75-90] and 1.0 [IQR 1.0-1.0], respectively). After adjusting for background characteristics, these trends did not change substantially (Visual Analog Scale: median 70 [IQR 60-80] vs 80 [IQR 77-90], EQ-5D-3L: median 0.81 [IQR 0.76-1.0] vs 1.0 [IQR 1.0-1.0]). Conclusions: Due to their long duration, long-COVID symptoms represent a substantial disease burden expressed in impact on health-related quality of life.

A very large percentage of pipeline failures is attributed to scouring around pipelines. If the depth of scour becomes significant, the stability of the pipeline may be endangered, with a consequent risk of damage and failure. The effect of Froude number and horizontal blade installed under submerged pipelines on scour controlling at a direct laboratory flume was experimentally studied. Experiments were carried out on four pipe diameters, four blade lengths, and two horizontal placement modes for the lower blade at three Froude numbers were considered under clear-water conditions. At the end of each experiment, the length and depth of scour beneath the pipe were measured. According to the results, increased Froude number, the relative blade length and the location of the lower blade affect the scour depth around the pipe. The relative scour depth and length increase with the increase in Froude number. In all cases, the use of a longitudinal blade caused an increase in the percentage of scour depth reduction around the submerged pipe. For a pipe with a diameter of 3.1 cm, the use of a blade with a relative length of 0.81 at Fr=0.24 in the center and under of the pipe reduced the scour depth by 58% on average as compared to the pipe without a blade. Furthermore, with both the pipe and the blade under it, the maximum increase in the scour length by 19% was obtained with a relative blade length of 0.81 and a pipe diameter of 3.1 cm at Fr=0.24.

Introduction Pulmonary vein isolation using radiofrequency catheter ablation is the standard of care for patients with drug-refractory atrial fibrillation. The purpose of this pilot study was to examine the local unipolar electrogram (UEGM) modification characteristics of the different target areas of left atrium and the associated ablation index parameters during pulmonary vein isolation procedure. Methods The study analyzed ten patients who underwent pulmonary vein isolation using radiofrequency energy at our Centre in 2021. The local electrophysiological properties and ablation parameters of 15 designated areas of interest in the left atria targeted by radiofrequency catheter ablation were collected. Results Out of the ten patients, six were men (mean age 66 years) and the majority (n=8) had paroxysmal atrial fibrillation. UEGM modification was observed in every studied RF ablation lesion. The mean time to achieve the UEGM modification in the posterior wall was shorter than that of the anterior wall( 8.9 seconds vs 11.1 seconds, respectively). The time to achieve the UEGM modification for every target was significantly shorter than delivered ( p<.001). Conclusion This study demonstrated that during pulmonary vein isolation using radiofrequency energy, local UEGM modification, representing a real-time surrogate of transmural lesion creation, is achieved in significantly shorter time reaching the conventional Ablation Index-guided approach in current practice.

Equine coital rash (ECE) is a highly contagious benign disease that induces lesions on the external genitals, and it is caused by the equine herpesvirus type 3 (EHV-3). The disease is globally distributed and affects only equids. However, its presence in Chile has not been documented from a genetic point of view. Here, we performed PCR screenings for EHV-3 in genital lesions of external genitals in four horses belonging to a riding station at Bulnes, Ñuble Region, Chile. We sequenced a fragment of the glycoprotein g ( gG) gene of this alphaherpesvirus, from three horses which signology compatible with ECE. The sequences were identical between them and 99.7% similar to a haplotype of EHV-3 detected in Brazil. A phylogenetic analysis pointed that our consensus sequence forms a clade with homologue isolates obtained from Japan, Russia and Brazil. Our results show the presence of EHV-3 for the first time in horses with ECE in Chile.

Understanding what drives the vast variability in species range size is still an outstanding question. Among the several processes potentially affecting species ranges, dispersal is one of the most prominent hypothesized predictors. However, the theoretical expectation of a positive dispersal-range size relationship has received mixed empirical support. Here, we synthesized results from 84 studies to investigate in which context dispersal is most important in driving species range size. We found that dispersal traits -- proxies for dispersal ability -- explain range sizes more often in temperate and subtropical regions than in tropical regions, when considering multiple components of dispersal, and when investigating a large number of species to capture dispersal and range size variation. In plants, positive effects of dispersal on range size were less often detected when examining broad taxonomic levels. In animals, dispersal is more important for range size increase in ectotherms than in endotherms. Our synthesis emphasizes the importance of considering different aspects of the dispersal process -departure, transfer, settlement-, niche aspects and evolutionary components, like time for range expansion and past geological-environmental dynamics. We therefore call for a more integrative view of the dispersal process and its causal relationship with range size.

Background and purpose: Although the exact pathogenesis of idiopathic pulmonary fibrosis (IPF) is still unknown, the transdifferentiation of fibroblasts into myofibroblasts and the production of extracellular matrix components such as collagen, triggered by alveolar epithelial cell injury, are important mechanisms of IPF development. In the lungs of IPF patients, apoptosis is less likely to be induced in fibroblasts than in alveolar epithelial cells, and this process is involved in the pathogenesis of IPF. Experimental approach: We used a library containing approved drugs to screen for drugs that preferentially reduce cell viability in LL29 cells (lung fibroblasts from an IPF patient) compared with A549 cells (human alveolar epithelial cell line). Key results: After screening, we selected eperisone, a central muscle relaxant used in clinical practice. Eperisone showed little toxicity in A549 cells and preferentially reduced the percentage of viable LL29 cells, while pirfenidone and nintedanib did not have this effect. Eperisone also significantly inhibited transforming growth factor-β1-dependent transdifferentiation of LL29 cells into myofibroblasts. In an in vivo study using ICR mice, eperisone inhibited bleomycin (BLM)-induced pulmonary fibrosis, respiratory dysfunction, and fibroblast activation. In contrast, pirfenidone and nintedanib were less effective than eperisone in inhibiting BLM-induced pulmonary fibrosis under this experimental condition. Finally, we showed that eperisone did not induce adverse effects in the liver and gastrointestinal tract in the BLM-induced pulmonary fibrosis model. Conclusion and implications: Considering these results, we propose that eperisone may be safer and more therapeutically beneficial for IPF patients than current therapies.

Assessing the Natural Killer (NK) cells in Dendritic Cell (DC) vaccine immunotherapy of 4T1 cell-induced breast cancer in Balb/C mice, we watch the expression of killer activation receptors NKp46, NKG2D, and inhibitory killer cell immunoglobulin-like receptor (KIR) Ly49G2, NKG2A/C/E and the interleukins (IL) 2, 10, 12, 17, tumor necrosis factor alpha (TNF-α) and interferon gamma (IFN-γ). 30 Balb/C mice divided into untreated, or control experimental group (GI), untreated induced tumor group (GII), and the DC treated vaccine-induced tumor group (GIII). Bone marrow from donor mice was collected to produce the vaccine. The 25-day experiment comprised tumor volume measurements and at the end of the treatment protocol mice were euthanized for removal of the spleen and evaluation of tumor infiltration by flow cytometry of the receptors NKp46, NKG2D, Ly49G2 and NKG2A/C/E and the cytokines. Our results showed that mice treated with the DC vaccine reduced the expression of inhibition receptors Ly49G2D/NKG2A/C/E in the spleen and tumor infiltrate (p=0.0001), with increased fluorescence intensity of splenic IL-10, IL-2, IL-12, IL-17, TNF-α and IFN-γ-producing NKp46/NKG2D cells (p=0.0001), intratumoral TNF-α and IFN-γ-producing by NKp46/NKG2D cells (p=0.0001). We demonstrated that immunotherapy with DC can alter the profile of NK cells by directly influencing them into an antitumor response due to reduced expression of inhibition receptors and increased production of cytokines such as IL-2, IL-12, TNF-α and IFN-γ by cells. Also, the activation of receptors confers NK cells the ability to reverse tumor-induced immunosuppression, stimulating the immune system to eliminate tumor cells.

Regulatory T (Treg) cells maintain immune homeostasis by inhibiting abnormal/overactive immune responses to both autogenic and nonautogenic antigens. Treg cells play an important role in immune tolerance, autoimmune diseases, infectious diseases, organ transplantation, and tumor diseases. Treg cells have two functional characteristics: T cell anergy and immunosuppression. Treg cells remain immune unresponsive to high concentrations of interleukin-2 and anti-CD3 monoclonal antibodies. In addition, the activation of Treg cells after TCR-mediated signal stimulation inhibits the activation and proliferation of effector T cells. In the process of tumor development, Treg cells accumulate locally in the tumor and lead to tumor escape by inducing anergy and immunosuppression. It is believed that targeted elimination of Treg cells can activate tumor-specific effector T cells and improve the efficiency of cancer immunotherapy. Therefore, inhibition/clearance of Treg cells is a promising strategy for enhancing antitumor immunity. Here, we review studies of cancer immunotherapies targeting Treg cells.

Background and Purpose: While the prevalence of breast cancer metastasis in the brain is significantly higher in triple-negative breast cancers (TNBCs), there is a lack of novel and/or improved therapeutic approaches for these patients. Here, we explore the role of monoacylglycerol lipase (MAGL) in tumor growth and colonization in the brain. Experimental Approach: MAGL inhibitor AM9928 was selected for these studies due to its high specificity (hMAGL IC50 = 9nM). The effects of AM9928 on TNBC adhesion and transmigration across a 3D culture with human brain microvascular endothelial cells (BMECs) and the secretion of chemokines/cytokines were examined. The effects of AM9928 on TNBC tumor growth and tumor colonization in vivo in the brain were performed using TNBC mice models. Key Results: The residence time based on NMR time course data for AM9928 is 46 hours indicating prolonged pharmacodynamic effect. AM9928 blocked TNBC cell adhesion and transmigration across HBMECs in a 3D culture. AM9928 inhibited the secretion of IL-6, IL-8, and VEGF-A from TNBC cells and from HBMECs cultures exposed to TNBC-derived exosomes. Using in vivo studies of syngeneic GFP-4T1-BrM5 mammary tumor cells, AM9928 inhibited tumor growth in the mammary fat pads and attenuated blood-brain barrier (BBB) permeability changes, resulting in reduced TNBC colonization in the brain. Together, these results demonstrate inhibition of TNBC tumor growth and brain colonization by AM9928 and support the potential clinical application of MAGL inhibitors as a novel treatment for TNBC.

Background: Tacrolimus (TAC), an important immunosuppressant for liver transplantation, has a narrow therapeutic index and large individual differences in pharmacokinetics. Ascitic fluid is commonly drained after liver transplantation. However, the distribution of TAC in ascitic fluid and the influence of drained ascitic fluid on whole-blood TAC are unclear. Methods: The ascitic fluid samples from twenty liver transplant recipients who were received TAC treatment within 12h after the transplantation surgery were collected for consecutive 24h in different days after the surgery. The distribution of TAC in ascitic fluid were evaluated by using a sensitive UPLC-MS/MS method. Chromatographic separation was achieved on an Agilent ZORBAX Eclipse Plus Phenyl-Hexyl column (2.1×100mm, 3.5μm). Mass spectrometry was performed in multiple reaction monitoring (MRM) conditions of transitions m/z 821.4→768.5 for TAC. Results: The concentrations of TAC in ascitic fluid samples range from 0.2 to 3.0 ng/mL, accounting for 1.19-31.87% of whole-blood TAC concentrations. A linear mixed model showed a statistically significant positive correlation between the steady-state trough blood concentration of TAC (C0) and the corresponding amount of TAC excreted in the ascitic fluid for 24 consecutive hours, especially after normalization by the daily dose per unit body weight (D/W). Conclusions: These data suggested that the distribution of TAC in ascitic fluid has great individual differences. The whole-blood TAC concentration, D/W and other confounding factors may contribute to the excretion of TAC in ascitic fluid, but the influence of TAC excretion in drained ascitic fluid on the whole-blood TAC concentration is negligible.

As an important candidate nuclear fuel in the future advanced nuclear energy system, actinide nitrides have attracted many scholars’ attention due to their good thermal conductivity and economic safety. In this research, DFT and TST are used to reasonably predict the formation process of actinide nitrides, and the detailed reaction mechanism was obtained, including two dehydrogenation channels and a new isomerization channel. The results show that the HPa-NH2 structure is the lowest energy point in the whole reaction, and the dehydrogenation path of the planar structure is the lowest energy path of the system. In addition, a series of topological analyses are to analyze the bond formation behavior during the reaction in depth. Finally, considering the one-dimensional tunneling effect, the variational transition state method (VTST) is used to predict the reaction rate constant in the range of 298K to 2000K. The results show that the one-dimensional tunneling effect has less influence on the reaction, and the planar dehydrogenation channel is more easy to happen. This research is very important for the systematic understanding of actinide compounds and the properties of the materials related to the compounds, and can provide theoretical data comparison for subsequent related experimental studies on protactinium imines.

Introduction: Patients who have had a nephrectomy usually have a previous history of renal dysfunction or are at risk for kidney failure due to tissue loss during surgery. In this study, we aimed to retrospectively evaluate the factors affecting acute renal function in nephrectomy surgeries under sevoflurane anesthesia. Method: Demographic data of patients, case type, surgery type, duration of anesthesia, intraoperative lactate level, and postoperative complications of patients who underwent nephrectomy in our clinic were reviewed. Renal function was compared with the levels of urea, creatinine and estimated glomerular filtration rate (eGFR) in the preoperative (2 day before surgery) and postoperative period (day 2). Results: The mean age of the patients 58.2 ± 13.02, duration of anesthesia 166.24 ± 53.01/min, pre-operative eGFR 84.71 (67.69-90.0), and postoperative eGFR 65.09 (47.91-87.44) were respectively. When the pre- and postoperative renal functions of the patients were compared, the statistically significant results were those of urea (p: 0.01), creatinine (p:0.01), and GFR (p:0.01). The factors affecting GFR decrease were age (p:0.01) and case type (p:0.01). Conclusion: The incidence of acute renal failure is increasing in nephrectomy surgeries, especially in radical ones. Age and case type are effective in causing eGFR decrease.

This study focuses on mechanism and kinetics in catalytic hydrodenitrogenation(HDN) of quinoline under hydrothermal conditions (300, 350 and 400°C), in which 30% Ni-Ru/γ-Al2O3 serves as catalyst and formic acid(FA) is used for in-situ H2 generation. The major products were 1,2,3,4 tetrahydroquinoline, dehydroquinoline, aniline, methyl aniline, 2-hexene, toluene. The quinoline conversion rate followed first-order kinetics, and the activation energy was 41.72 kJ/mol. A kinetic model based on the reaction network of hydrodenitrogenation of quinoline clearly captures all of the trends in the data and fits the temporal variation of all major products. Results reveal that 1,2,3,4-tetrahydroquinoline→dehydroquinoline→2-hexene is the main quinoline HDN route. Reaction rate analysis illustrates deamination is the main denitrogenation pathway. Sensitivity analysis demonstrated that the production of aniline derivatives inhibits yield of quinoline derivatives. TEM characterization indicates that nickel and ruthenium metal are uniformly distributed on the supporter, which was confirmed by XRD and XPS characterization as well.

Complex cranial vault reconstruction (CCVR) for repair of craniosynostosis is a procedure associated with high risk of bleeding and resultant coagulopathy. The goal of this study was to describe lab parameters in a cohort of pediatric patients undergoing CCVR and identify if standard hematologic and coagulation laboratory results could predict blood loss. We found that standard hematologic and coagulation laboratory parameters predicted intraoperative and postoperative blood loss, but provided limited mechanistic information to improve our understanding of coagulopathy in craniofacial surgery. Future laboratory-based studies would be useful in providing a comprehensive model of coagulopathy in this population.

Objective: Recently, long non-coding RNAs (lncRNAs) and microRNAs (miRNAs) have been identified as essential biomarkers during development of malignancies. This study was performed to study the roles of lncRNA opa-interacting protein 5 antisense transcript 1 (OIP5-AS1) and miR-92a in ovarian cancer (OC). Methods: OIP5-AS1, miR-92a and integrin alpha 6 (ITGA6) expression in OC tissues and cells was assessed. The screened OC cells were respectively with OIP5-AS1 silenced vector, miR-92a mimic/inhibitor or depleted or restored integrin alpha 6 (ITGA6) vector. The viability, migration, invasion and apoptosis of the cells were determined and the levels of epithelial-mesenchymal transition (EMT)-related proteins were also measured. The interactions between OIP5-AS1 and miR-92a, and between miR-92a and ITGA6 were confirmed. Results: OIP5-AS1 and ITGA6 were upregulated while miR-92a was downregulated in OC. MiR-92a was a target of OIP5-AS1 and ITGA6 was targeted by miR-92a. Inhibited OIP5-AS1 or ITGA6 or elevated miR-92a repressed EMT, viability, migration and invasion, and promoted apoptosis of OC cells. These effects that induced by silenced OIP5-AS1 could be reversed by miR-92a inhibition while those that induced by up-regulated miR-92a were reduced by restored ITGA6. Conclusion: OIP5-AS1 silencing promoted miR-92a to repress proliferation and metastasis of OC cells through inhibiting ITGA6.

Objective: Since the emergence of coronavirus disease, health care professionals in high-risk environments are mandated to wear N95 respirators for prolonged periods. The effect of this prolonged use on cardio-respiratory variables and gas-exchange is poorly defined. The objective of the current study was to determine gas exchange abnormalities and physiological changes among healthcare workers during a 4-hour emergency department (ED) shift while wearing the N95 respirator. Methods: This was a single-center prospective observational study that consisted of medical staff working at the Sheba Medical Center ED. Physiological effects and gas exchange variables were obtained under normal breathing conditions and after 4-hour shifts while continuously wearing an N95 respirator. Comparisons of paired measurements were performed using a non-parametric Wilcoxon matched-pairs signed-rank test. Results: Forty-one subjects were included in the study. Prolonged N95 respirator use was associated with a significant decline in plasma pH [7.35mmHg vs. 7.34mmHg, P=0.02], PvO2 [23.2 mmHg vs. 18.6 mmHg, P<0.001] and a concurrent increase in EtCO2 [32.5mmHg vs. 38.5mmHg, p<0.0001]. PvCO2 and bicarbonate levels did not differ. No significant change was observed for heart rate or oxygen saturation. Conclusion: Using an N95 respirator for prolonged periods by healthcare professionals may provoke changes in gas exchange. The clinical significance of these changes in terms of symptoms or longer-term health status is unknown and remains to be determined. Key Words: N95 Respirator, Physiological effects, SARS CoV 2.

Immunoglobulin A (IgA) is important in biological defense mainly in the mucosal area and has pathogenic and inflammatory roles in various diseases. IgA activates not only inflammatory but also structural cells including airway epithelial cells and fibroblasts. The current study aimed to validate the effect of IgA on bronchial smooth muscle cells (BSMCs), which are another type of cell involved in airway remodeling and responsiveness. Results showed that monomeric IgA (mIgA) induced interleukin (IL)-6, IL-8, and monocyte chemoattractant protein (MCP)-1 production, and enhanced cell proliferation, collagen gel contraction, and BSMC migration. Among previously reported receptors for mIgA, BSMCs expressed TfR/CD71. Transfection with small interference RNA (siRNA) against TfR/CD71 partially inhibited cytokine and chemokine production promoted by mIgA-stimulated BSMCs. Moreover, the mitogen-activated protein kinase (MAPK), phosphatidylinositol 3-kinase (PI3K)/Akt, and nuclear factor-κB (NF-κB) pathways were activated via mIgA stimulation in BSMCs. Thus, mIgA may activate BSMCs and exacerbate inflammatory lung diseases including asthma.

The patient presented with a chief complaint of lower extremity pain was found to be positive SARS-CoV-2 test. Contrast-enhanced computed tomography scans showed endocarditis, vasculitis and lower extremity ischemia. Despite we treated the patient with dexamethasone, the patient died.

Acute limb ischemia is considered one of the most demanding acute vascular pathologies requiring immediate intervention as it is associated with morbidity and mortality.The Rutherford classification for acute limb ischemia is a helpful management guide, as defined by the Society for Vascular Surgery and the International Society for Cardiovascular Surgery.Recently, the popularity of percutaneous interventions has been reflected in this guideline-classification and has been an important step in the treatment of acute limb ischemia.However, surgical and medical treatment options should not be overlooked.We know that right diagnosis and management in emergency department is vital part of this process.That's why, in this case report, we discussed what should do and what should not do in a patient with acute lower extremity ischemia in the light of this guideline-classification.