The treatment of atrial flutter in patients without structural heart disease by transcatheter radiofrequency ablation of the cavotricuspid isthmus and bilateral pulmonary veins has achieved good results. We report three cases of typical atrial flutter treated by surgical radiofrequency ablation. One patient, without structural heart disease, successfully underwent cavotricuspid isthmus ablation and cardioversion. The other two patients, with structural heart disease, underwent cavotricuspid isthmus ablation, partial right atrial ablation and pulmonary vein isolation, but a normal sinus rhythm was not achieved. Therefore, standard maze IV surgery may be the best choice in patients with atrial flutter and structural heart disease.

Rationale: There is a theoretical concern, unconfirmed by population-based challenge data, that clinically-significant immunologically-mediated hypersensitivity occurs between beta-lactams sharing side chains. The population-based “allergy” incidence associated with the use of beta-lactams sharing exact R1 side chains, [ampicillin, cephalexin, and cefaclor (ACC)], with or without a current ACC or sulfonamide antibiotic “allergy” has not been reported. Methods: All courses of ACC and trimethoprim-sulfamethoxazole, used by any Kaiser Permanente California members in 2017 and 2018, with follow-up through January 2019, were identified along with their preexisting antibiotic “allergy” status and all new antibiotic-specific “allergies” reported within 30 days of course initiation. Results: There were 1,167,713 courses of ACC administered to individuals with no sulfonamide antibiotic or ACC “allergy” and 4,771 (0.41%) new ACC “allergies” were reported. There were 130,032 courses of ACC administered to individuals with a sulfonamide antibiotic “allergy” and no ACC “allergy” and 904 (0.70%) new ACC “allergies” were reported. There were 5,958 courses of ACC administered to individuals with an ACC “allergy”, 2,341 who also had sulfonamide antibiotic “allergy”, and 52 (0.87%) new ACC “allergies” were reported. Conclusions: The incidence of new ampicillin, cephalexin, or cefaclor “allergy” reports is minimally and non-specifically increased when a preexisting ACC or sulfonamide antibiotic “allergy” exists over the baseline incidence in the population. This argues against clinically-significant immunologically-mediated cross-reactivity between beta-lactams sharing exact side chains in individuals with pre-existing, but unconfirmed, beta-lactam “allergy”. Any previously reported, even unrelated, antibiotic “allergy” appears to be a risk factor for reporting a new antibiotic “allergy”.

Introduction: The effect of lockdown measures due to COVID-19 pandemic in children with respiratory underlying conditions are still unclear. We analyzed the impact of lockdown measures in the management and evolution of children with asthma and preschool wheeze during the first wave of COVID-19. Matherial and Methods: observational study carried out in children with recurrent wheezing or asthma before and after the implementation of the lockdown by using: a questionnaire aimed to examine pre-existing respiratory disorders, step treatment (according to Spanish Guide for Asthma Management) and level of asthma control before/after lockdown (CAN questionnaire), COVID history and laboratory testing including IgG SARS-CoV-2. Results: we enrolled 475 asthmatic and preschool wheezers (60.6% males), mean age 5.6 years. There were not differences in asthma treatment comparing both periods, since 81.7% maintained the same treatment (p=0.103). According to CAN questionnaire 87.7% remained well controlled during confinement. Nearly a third of children (34.9%) needed reliever treatment, mainly in older children. Determination of IgG SARS-CoV-2 was performed in 233 children (49.1%) of whom 17 (7.3%) tested positive. Seven patients positive to IgG SARS-CoV-2 were assisted in the emergency department and two required hospital admission. Conclusions: During the COVID-19 lockdown most of the children with asthma and recurrent wheezing maintained their preventive treatments unchanged and remained well controlled from their underlying disease. Our results suggest that children that tested positive to IgG SARS-CoV-2 showed significant increase in paediatric hospital admissions and attendances to urgent care settings.

Traditional implantation of left ventricular assist device (LVAD) via median sternotomy can pose significant risks in patients with previous sternotomies. We present a patient with history of multiple cardiac surgeries through median sternotomies now needing LVAD support. To avoid re-entry injury, a HeartMate 3 LVAD was implanted via left thoracotomy with outflow graft anastomosis to the descending thoracic aorta, an unconventional but safe alternative approach to LVAD implantation.

This study describes the flow characteristics of solid-solid mixed particles in a cold two-dimensional moving bed. The results indicate that flow characteristics of mixed particles in the quartz sand–coal system are better than those in the cold CFB ash–coal system. The optimized conditions were obtained, θ2 = 20° and a heat carrier to coal ratio of 6:1. As the mixture progressed downstream, secondary separation of the heat carrier and coal become apparent. Furthermore, mixture residence times have been investigated to explore the relationship between regional residence times and to predict accurately the actual pyrolysis progress in pyrolyzer.

Purpose Nephrotoxicity is a major complication of gentamicin (GEN), which is widely used in the treatment of severe Gram-negative infections. As we know, treatment with liraglutide has been shown to reduce oxidative stress. Therefore, we evaluated the potential protective effect of liraglutide against GEN-induced nephrotoxicity in rats. Methods Twenty-eight rats were randomly divided into four groups: control group (Group 1); rats intraperitoneally injected with GEN (100 mg/kg/day; Group 2); rats treated with GEN plus distilled water (Group 3); and rats treated with GEN plus liraglutide (0.6 mg/kg/day; Group 4). After 15 days, the rats were sacrificed, their kidneys taken, and blood analysis performed. Tubular necrosis, interstitial fibrosis and inducible nitric oxide synthetase (iNOS) scores were determined histopathologically in a part of kidneys; malondialdehyde (MDA), reduced glutathione (GSH), E-cadherin and transforming growth factor β1 (TGF-β1) levels were determined in other part of kidneys. Results The GSH levels in renal tissue of only GEN-treated rats were significantly lower than others, and administration of liraglutide to rats significantly increased the level of GSH. The group that was given GEN plus liraglutide had significantly lower MDA, TGF - β1 and E - cadherin levels than that given GEN alone. The rats treated with GEN+liraglutide indicated a less severe tubular necrosis, and their glomeruli maintained a better morphology compared to GEN group. iNOS expression was higher in liraglutide administrated group than the group that was applied only GEN. Conclusion Liraglutide exerts protective effects on GEN-induced kidney damage by reducing oxidative stress in rat model.

The target microbial community in different phases of green waste (GW) composting and lignocellulose transformation mechanism were studied in GW composting by using MiSeq sequencing and PICRUSt tools. The results showed that the composting process could be divided into four phases. In each phase the temperature, microbial genera, substrate and product were different. Each phase of the composting appeared in turn and was unable to jump. Humic acid (HA) and fulvic acid (FA) can regulate the composting process and lignocellulose degradation in the process of composting material transformation. The calefactive phase and the cooling phase are the incubation phase of mesophilic microorganisms. In the calefactive phase, microorganisms decompose small molecular organics such as FA for growth and reproduction; while in the cooling phase, microorganisms degrade HA and FA for growth and reproduction. In the early stage of the thermophilic phase, thermophilic microorganisms decompose HA for growth and reproduction, while in the later stage of the thermophilic phase, microorganisms decompose lignocellulose to produce HA and FA. In the maturation phase, microorganisms synthesize humus using FA, amino acids and lignin nuclei as precursors. In the four phases of the composting, different representative genera of bacteria and fungi were detected. Among which, one bacterial genera, Streptomyces, and two fungal genera, Myceliophthora and Aspergillus, maintained high abundance in all phases of the compost. Correlation analysis showed that some non-filamentous bacteria, actinomycetes and fungi were significantly correlated, indicating that bacteria, actinomycetes and fungi had synergistic effect on the degradation of lignocellulose.

The extramatrical mycelium of ectomycorrhizal fungi (EMF) is an important source of soil carbon. While the importance of recalcitrant compounds in the fungal cell wall has been reported earlier, the contribution of abundant and more labile components, like glucans, and the role of their temporal dynamics during decomposition remains unknown. We examined how the decomposition of EMF mycelium is related to the dynamics of 3 main fungal cell wall components; chitin, melanin, and glucans. Across six EMF species, the initial concentrations of the three components were not a good predictor of necromass loss after 6 weeks. However, the dynamics of chitin concentration during the decomposition process contributed to the weekly necromass degradation, with trends of chitin loss dynamics being dissimilar across the fungal species. In contrast, the dynamics of loss of melanin and glucans was not related to the weekly necromass loss. Given similar total necromass loss across species, we suggest that glucans and chitin are not discriminated by decomposers. This mechanism compensates for the interspecific difference in their initial concentration. Our results indicate that fungal necromass decomposition does not behave similarly to plant litter, while it is critical to soil carbon dynamics.

Objectives: The treatment outcomes of pediatric obstructive sleep apnea (OSA) are affected by positive airway pressure (PAP) therapy adherence, which may be affected by the type of machine used. Continuous PAP (CPAP) machines deliver a continuous and fixed air pressure level, whereas automatic PAP (APAP) machines automatically adjust the pressure to meet changing needs during sleep. The adherence, tolerance and consistency of OSA-children’s use of CPAP and APAP machines were compared. Study design: One-year, observational cohort study Methods: Twenty-seven OSA children were enrolled. Fourteen (52%) used CPAP, and 13 (48%) used APAP. The adherence, tolerance, and consistency of the PAP usage by the 2 groups were compared. Results: Overall, 11 of the 27 children (41%) showed good PAP adherence. The CPAP patients averaged 4.9 hours of machine usage on the days used, for 60% of days, with 6 of 14 (43%) demonstrating good adherence. In comparison, the APAP patients averaged 3.2 hours for 55% of days, with 5 of 13 (38%) exhibiting good adherence. The 2 groups showed no differences in their adherence, tolerance, or consistency of machine usage (P values, 0.609, 0.720, and 0.816, respectively). Although the adherence of both groups improved in the second six months, it was without statistical significance (P values, 0.400 and 0.724). Age, sex, baseline apnea-hypopnea index, comorbidities, prescribed period, machine type, mask type, and caregiver education-level were not risk factors for poor PAP adherence. Conclusions: No differences in the adherence, tolerance, or consistency of the children’s use of CPAP and APAP were revealed.

Understanding the composition of human immune responses to SARS-CoV-2 and vaccines is essential for predicting protection from infection and determining vaccine efficacy. Here, we explored T-cell immune responses to SARS-CoV-2 and the UK (B.1.1.7) variant of concern (VOC) in infected and vaccinated individuals. In infected patients, CD4+ T-cells demonstrated consistent, robust responses against Spike peptides, while CD8+ T-cells had heterogeneous responses to 5 SARS-CoV-2 proteins. We found 80% of infected and vaccinated individuals showed positive CD4+ T-cell immunity against SARS-CoV-2. Moreover, CD4+/CD8+ T-cell responses to SARS-CoV-2 and the United Kingdom (B.1.1.7) variant are robust and nearly identical in infected and vaccinated individuals. Thus, the UK variant did not interfere with T-cell recognition and elicited responses. These observations will be of critical importance in assessing human immune responses to emerging VOCs.

Objectives: Fever has been recently included in the new 2019 EULAR/ACR classification criteria for Systemic Lupus Erythematosus (SLE). Thus, we investigated the possible association of fever with other clinical disease manifestations. Secondly, we analyzed a panel of 30 SNPs to verify their possible contribution to the pathogenesis of this constitutional symptom. Methods: In this retrospective study we collected clinical/laboratory features in a SLE cohort, including the occurrence of fever (body temperature >37.5°C, excluding infective etiology). A phenotype-genotype correlation analysis was carried out. Results: We evaluated 167 patients (M/F 12/155, median age at the disease diagnosis 30 years, IQR 17; median disease duration 240 months, IQR 156). Seventy patients (41.9%) reported fever, significantly associated with: serositis and hematological manifestations (p=0.02 and p=0.00001, respectively). A significant association between fever and leukopenia (p=0.0029), hemolytic anemia (p=0.04), and thrombocytopenia (p=0.03) was observed. In addition, significantly higher median SDI values were observed in patients with fever in comparison with those without [2 (IQR 3) vs 1 (IQR 2); p= 0.005). The genotype/phenotype analysis showed an association between fever and IRGM rs13361189 (p=0.003; OR 3.89, CI 1.16-13.03), confirmed also in multivariate logistic regression analysis (p=0.028, r=1.39). Conclusions: We identified a specific disease phenotype characterized by fever, hematological manifestations, serositis, and more severe chronic damage. Moreover, we found the association between IRGM rs13361189 polymorphism and the occurrence of inflammatory fever, potentially providing new insights into the role of genetic background in the pathogenesis of SLE-related fever.

Tacheng tick virus 1 (TcTV-1) was firstly found in a tick bitten patient in Qinghe County (border county of China-Mongolia), Xinjiang Uygur Autonomous Region (XUAR), and further detected in pastured cattle and sheep. Songling virus (SGLV) was isolated in tick-borne patients in Heilongjiang Province (border region of China-Russia) and Inner Mongolia Autonomous Region (border region of China-Mongolia). The aim of this study was to detect TcTV-1, SGLV and Tamdy virus (TAMV, first found in a tick bitten patient from Kyrgyzstan) in great gerbil. A total of 276 great gerbils were collected in Manas County (common county) and Altaw City (border city of China-Kazakhstan), XUAR, northwestern China. The total RNA of individual spleen tissue was extracted, and the viral L segments of TcTV-1, SGLV and TMAV were detected by transcriptase-polymerase chain reaction. The amplification products were cloned and sequenced, and phylogenetic analyses were conducted by MEGA7.0. The results indicated that 2.9% (8/276) and 2.2% (6/276) of spleens were respectively tested positive to the viral L segments for TcTV-1 and SGLV, and TAMV was not detected in these samples. SGLV in great gerbil shared 93.7% (236/252 nt) and 94.0% (78/83 aa) identities to that of SGLV (MT328776) detected in patients in northeastern China. TcTV-1 in great gerbil was the closest to that of TcTV-1 from a patient in China (MK554672) with 98.5% (797/809 nt) and 98.9% (265/268 aa) identities. This is the first molecular evidence for the presence of TcTV-1 and SGLV in great gerbil. SGLV presented highly genetic diversity correlated with their geographical location. Tamdy orthonairovirus surveillance in multiple border regions of China, Kazakhstan, Kyrgyzstan, Russia and Mongolia in more wild animals is necessary.

BACKGROUND Various models of cardiovascular disease that have been used to prove the anti-fibrotic effects of serelaxin. However, whether anti-fibrotic effects of serelaxin are achieved by inhibiting inflammatory response have not been clarified. This research is intended to explore the role of serelaxin in lipopolysaccharide (LPS)-induced inflammation of cardiac fibroblasts (CFs) and elucidated the potential mechanisms. APPROACH Cardiac fibroblasts (CFs) were isolated from the hearts of 3 days neonatal rats. Effects of serelaxin on inhibiting inflammatory response after induction with LPS were examined. Cell proliferation was determined by cell-counting kit-8. The inflammatory cytokines secretion levels of IL-1β, IL-6 and TNF-α, and IL-10 were measured by enzyme-linked immunosorbent assay (ELISA) respectively. The mRNA levels of α-SMA, collagen I/III, MMP-2, MMP-9, IL-1β, IL-6,TNF-α, IL-10, IκBα, p-IκBα, p65 subunit of nuclear factor-kappa B (NF-κB) and peroxisome proliferator-activated receptor-γ (PPAR-γ) were assessed by real-time quantitative PCR (RT-qPCR). The protein levels of α-SMA, collagen I/III, MMP-2, MMP-9, IκBα, p-IκBα, p65, p-p65 and PPAR-γ were examined by Western blotting. RESULTS Serelaxin inhibited LPS-induced IL-1β, IL-6 and TNF-α, α-SMA, collagen I/III, and elevated IL-10, MMP-2 and MMP-9 expression. And, LPS-induced activation of NF-κB pathways was suppressed by serelaxin treatment. Substantially, Further research demonstrated that serelaxin elevated the expression of PPAR-γ and PPAR-γ inhibitor GW9662 could reverse the inhibition of serelaxin on IL-1β, IL-6,TNF-α production. CONCLUSIONS These results suggested that serelaxin alleviates cardiac fibrosis by inhibiting inflammatory products of IL-1β, IL-6 and TNF-α, α-SMA, collagen I/III in LPS-induced CFs by stimulating PPAR-γ which subsequently abolished the expression of NF-κB signalling pathways.

Many studies have showed that climatic and edaphic variables influence the variations of nitrogen isotopes in terrestrial ecosystems. However, the relative importance of climate and soil variables on plant 15N remains unclear, which limits the understanding mechanism of plant 15N variation. In this study, the 15N values of Leymus chinensis (a widespread species) and the corresponding climate and soil variables were investigated from 40 sampling sites in temperate grasslands of northern China. We disentangled and estimated the influences of climatic and edaphic variables on plant 15N through the variable importance in projection (VIP) technology based on partial least squares-regression (PLS) analysis. Results showed that the 8 variables can explain 69%~87% of the variance of plant 15N along the transect, and climatic factors contributed more than edaphic factors (41% vs. 37%). Among the climatic variables, MAP was the most important control variable, which explained approximately 25% of the variation in plant 15N, followed by MAT. As for edaphic factors, soil N had the most significant effect on plant 15N abundance, and its relative contribution was about 15%, followed by SWC and soil δ15N. The relative influences of other variables such as MARH, soil pH and C/N ratios were less important in determining plant δ15N. In addition, a high-performance model for predicting plant δ15N was built by the VIP screening method. Further research should focus on the interaction of climate and soil variables on different scale patterns of nitrogen isotope.

Plant–soil feedback (PSF), regulated by both mycorrhizae and soil pathogens, is a primary mechanism maintaining high tree diversity in the tropics. But how warming may affect PSF is not well understood. We conducted warming experiments on seedling survival of a rhizobia-associated species (Ormosia semicastrata) carrying coevolved host-specific soil-borne pathogens and an ectomycorrhizal fungi-associated species (Cyclobalanopsis patelliormis) immune to soil-borne pathogens. We found elevated temperature lowered seedling mortality of O. semicastrata, but had no detectable effect on C. patelliormis seedlings. This indicates that warming weakened the negative PSF on O. semicastrata but did not affect the positive PSF on C. patelliormis. The differential warming effects on seedling mortality of species with different microbial associations imply that global warming could lead to change in tropical tree composition. Our study also predicts that global warming would undermine the role of the JC effect in maintaining tree species diversity in the tropics.

The study was carried out to assess the population size and distribution of diurnal large wild mammals in southern Great Rift Valley, Ethiopia. The study area was stratified into four habitat types; such as riverine forest, and ground-water forest, grassland, and bushland. Samples of animals were surveyed through the transect method. The total number of mammals belonging to the 15 different species was 1681 and 1245 during the wet and dry seasons. The Burchell’s zebra, Anubis baboon, Vervet monkey, and Grant’s gazelle were the most abundant species; while, Abyssinian hare and Bush duiker were the least abundant species. The highest mammalian species has been supported by the bushland habitat followed by open grassland, riverine forest, and ground-water forest in both seasons. Despite the park is home to various types of mammalian species, the management plan of the park should consider getting sustainable benefits from the mammalian species in the future.

Exploring and clearly defining the level of taxonomic identification and quantification approaches for diversity and biomonitoring studies are essential, given its potential influence on the assessment and interpretation of ecological outcomes. In this study, we evaluated the response of benthic macroinvertebrate communities to the restoration or construction of gravel bars conducted in the dam-impacted Trinity River, with the non-dam influenced tributaries serving as the reference sites. We aim to evaluate the performance of different taxonomic and numerical (i.e., abundance vs. presence/absence data) resolutions of DNA metabarcoding with consequent comparison to morphology-based identification and how it affects assessment outcomes. DNA metabarcoding detected 93% of the morphologically identified individuals and provided finer taxonomic resolution. We also detected significant correlations between morphological sample abundance, biomass, and DNA metabarcoding read abundance. We observed a relatively high and significant congruence in macroinvertebrate community structure and composition between different taxonomic and numerical resolutions of both methods, indicating a satisfactory surrogacy between the two approaches and their varying identification levels and data transformation. Additionally, the community-environmental association were significant for all datasets but showed varying significant associations against the physicochemical parameters. Furthermore, both methods identified Simulium spp. as significant indicators of the dam-impacted gravel bars. Still, only DNA metabarcoding showed significant false discovery rate proving the method’s robustness compared to morphology-based identification. Our observations imply that coarser taxonomic resolution could be highly advantageous to DNA metabarcoding-based applications in situations where the lack of taxonomic information, e.g., poor reference database, might severely affect the quality of biological assessments.

Understanding the impacts and constraints of climate change on the potential geographic distribution of wild Akebia trifoliata is crucial for its sustainable management and economic development as a medicinal material or fruit. In this study, according to the first-hand information obtained on-the-spot investigation, the geographic distribution and response to climate factors of Akebia trifoliata were studied by the MaxEnt model and ArcGIS. The genetic diversity and population structure of 21 natural populations of Akebia trifoliata were studied by SSR markers. The results showed that precipitation and temperature were the two most important climatic factors that restrict the geographic distribution of Akebia trifoliata. Under the current climate scenario, the suitable growth regions of Akebia trifoliata in China were 91.7-121.9 °E and 21.6-37.5 °N. Combined with the evolutionary relationship and prediction results, 21 populations of Akebia trifoliata tended to migrate to the north. In the scenarios (SSP2-4.5, SSP3-7.0, and SSP5-8.5) of higher greenhouse gas emission concentration, the distribution area of Akebia trifoliata continued to expand, while in the low concentration greenhouse gas emission scenario (SSP1-2.6), the distribution area of Akebia trifoliata remained stable. The distribution center of Akebia trifoliata in China will shift to high latitude regions with the increase of temperature in the future. The results evaluated the impact of climate factors on the spatial distribution of wild Akebia trifoliata, displayed the possible changes of geographical distribution of Akebia trifoliata under different climate scenarios, and provided scientific evidence for durative protection and supervise of Akebia trifoliata.

Aim: The aim of this study is to investigate the anxiety levels of healthcare workers (HCWs) in hospitals in Istanbul, which is one of the cities most affected by the COVID-19 pandemic. Methods: The study was conducted online with 177 HCWs (127 doctors, 31 nurses, 15 paramedics, 4 health technicians) due to the pandemic. Beck Anxiety Invantory (BAI) was used for anxiety levels. Results: The anxiety levels of HCWs were found as 48% “minimal”, 23.7% “mild”, 17.5% “moderate”, 10.7% “severe”. The mean BAI score of other HCWs is from doctors (15.94 ± 12.776 vs 9.53 ± 8.868), the mean BAI score of women is from men (14.07 ± 10.899 vs 7.61 ± 8.681), for those who have no children, the mean BAI score is from those with a child (13.77 ± 11.713 vs 9.66 ± 9.260), and the mean BAI score of those who were over 65 years old or had a relative with chronic disease at home was higher than the others (14.11 ± 9.752 vs 10.44 ± 9.752) (p <0.05). The mean BAI score of those who did not examine COVID-19 patients were higher than the examiners (11.47 ± 10.693 vs 1.23 ± 10.394), and the mean BAI score of night shift workers (12.42 ± 11.063 vs 9.515 ± 9.255) than the others (p> 0.05). Conclusion: Healthcare workers actively working during the COVID-19 pandemic have high levels of anxiety. Working conditions of health workers should be improved and psychosocial support activities for them should be implemented continuously.

In the fermentation of Monascus, in addition to the production of various beneficial active substances, such as monacolin K and Monascus pigments, citrinin is also produced, resulting in renal toxicity. Therefore, its wide application is restricted. Exploring safe and reliable methods to reduce citrinin in Monascus products is of great significance to further expand their application range. This study investigated the effect of genistein on the production of the fungal toxin, citrinin, and pigments by solid fermentation of the filamentous fungus Monascus aurantiacus Li AS3.4384, which is widely used in food and medicine. With the addition of 2.0 g/L genistein, citrinin production decreased by approximately 50%, while pigment production increased by 23%. With addition of 2.0 g/L genistein dissolved in dimethyl sulfoxide, citrinin production decreased by 96.2%, and pigment production decreased by 26.3%. With the addition of 2.0 g/L genistein and 0.06 g/L baicalein, citrinin production decreased by 87.9%, and pigment production decreased by 35.5%. Therefore, the synergistic effect of genistein and baicalein may provide a new method to reduce Monascus citrinin production in industry.

Aim: Asthma prevalence in Australian children is amongst the highest in the world. Monoclonal antibody treatments (biologics) are the fifth step in the Global Initiative for Asthma guidelines to treat severe asthma. Our retrospective cohort study aimed to evaluate the treatment effect of biologics for children with severe asthma at Sydney Children’s Hospital, assess adherence to treatment and explore attitudes toward home administration using prefilled injection devices. Method: We collected data for patients <18 years-old receiving biologics to compare asthma control six months pre and post initiation of that therapy. We used participant and parent surveys to assess perceived change in asthma control and attitudes to home injections. Results: 11 patients were recruited. Six months post biologic treatment there was a mean reduction in FeNO by 45% and ACQ-5 by 50% (p<0.01). 3 of the 6 patients requiring regular steroids ceased this treatment. The mean number of hospitalizations and oral steroid courses decreased by 17% and 29% respectively, though this was not statistically significant (p>0.05). We found no significant change in FEV1. Adherence was high. 73% of patients and carers perceived slightly/much better asthma control on biologics and 73% of carers indicated they would be slightly/much happier with home injections. Conclusion: We conclude that biologic treatment leads to improved asthma control in Australian children eligible for and prescribed this therapy. Whilst adherence is high with health center based injections, carers are interested in home injections to reduce burden of care.

The aim of this study is to evaluate the sleep behaviors of healthcare professionals working in secondary and tertiary hospitals in a large population in Turkey and to show how sleep quality is affected during the pandemic process by using the easily applicable Jenkins sleep scale (JSS). Methods The population of this cross-sectional descriptive study consists of two pandemic hospitals (2nd level state hospital and 3rd level university hospital) determined in Kahramanmaraş province. Data were collected between 03.08.2020 and 30.09.2020 with responses to online survey questions. The security of the data was assigned to SurveyMonkey enterprise. In our questionnaire, we asked subjective sleep quality (poor, moderate, high), sleep time (<24:00 and ≥24:00), time to fall asleep (minutes), total sleep time (hours), and medication use (sleeping pills). We also used Jenkins Sleep Scale Turkish version (JSS-TR) to assess sleep quality and the Epworth sleepiness scale (ESS) for increased daytime sleepiness. Results Healthcare workers who participated in our survey reported that they started to go to bed later, fell asleep later (mean: 41.75±35.35 minutes), their total sleep time (mean: 6.67±1.88 hours) was shortened, and they needed medication to sleep more (%5.7) after the COVID-19 pandemic. During the COVID-19 pandemic, bedtime behavior after 24:00 decreased from 80.1% to 43.9% of those who previously went to bed before 24:00. For those who went to bed after 24:00 before, it increased from 19.9% to 56.1%.In addition, sleep quality as assessed by subjective and JSS significantly deteriorated after the COVID-19 pandemic. Excessive daytime sleepiness increased. Those with ESS>10 before COVID-19 were 3.9%, post- COVID-19 ESS>10 14.1% (p<0.001). Conclusion The COVID-19 pandemic has significantly adversely affected the sleep behavior and sleep quality of healthcare professionals. The JSS is an easily applicable scale for assessing sleep quality in large population studies.

Aim: Preoperative inferior vena cava collapsibility index (IVCCI) is effective in evaluating the volume status. We hypothesized that IVCCI-guided fluid management would reduce the incidence of postspinal anaesthesia hypotension in patients undergoing non-cardiovascular, non-obstetric surgery. Methods: A receiver operating characteristic (ROC) curve was used to determine the diagnostic value of IVCCI for predicting hypotension after induction of spinal anaesthesia and to calculate the cut-off value. Based on the cut-off variation value, the following prospective randomized controlled trial aimed to compare the incidence of postspinal anaesthesia hypotension between the IVCCI-guided fluid administration group and the standard fluid administration group. Secondary outcomes included the rate of vasoactive drug administration, the amount of fluid administered, and the incidence of nausea and vomiting. Results: ROC curve analysis revealed that IVCCI had a sensitivity of 83.9%, a specificity of 76.3%, and a positive predictive value of 84% for predicting postspinal anaesthesia hypotension at a cut-off point of >42%. The area under the curve (AUC) was 0.834 (95% confidence interval: 0.740–0.904). According to the cut-off variation value of 42%, the IVCCI-guided group exhibited a lower incidence of hypotension than the standard group (9 [15.3%] vs. 20 [31.7%], P=0.032). Altogether, 11.9% of the patients in the IVCCI-guided group and 27.0% of the patients in the standard group required a vasoactive drug at least once (P=0.036).Total fluid administered was lower in the IVCCI-guided group than in the standard group (330 [0–560] mL vs. 345 [285–670] mL, P=0.030). Prespinal ultrasound scanning of the IVCCI provides a reliable predictor of hypotension following spinal anaesthesia at a cut-off point of >42%. IVCCI-guided fluid management before spinal anaesthesia can reduce the incidence of hypotension following spinal anaesthesia.

The set of associative and commutative hypercomplex numbers, called the perfect hypercomplex algebras (PHAs) is investigated. Necessary and sufficient conditions for an algebra to be a PHA via semi-tensor product (STP) of matrices are reviewed. The zero sets are defined for non-invertible hypercomplex numbers in a given PHA, and characteristic functions are proposed for calculating zero sets. Then PHA of various dimensions are considered. First, classification of 2-dimensional PHAs are investigated. Second, all the 3-dimensional PHAs are obtained and the corresponding zero sets are calculated. Finally, 4- and higher dimensional PHAs are also considered.