The case highlights an available method to minimize the target volume and reduce the radiation dose by using a temporary catheter, to reduce the long-term risk of radiotherapy for ventricular arrhythmias.

Introduction: Gastric hypomotility (GH) is a major complication of atrial fibrillation (AF) ablation. We aimed to clarify whether additional cryoballoon ablation (CBA) of the left atrial (LA) roof is associated with GH. Methods and Results: This study included 54 patients with non-paroxysmal AF who underwent CBA for pulmonary vein isolation and of the LA roof line. GH was defined according to the results of esophagogastroscopy performed 2 days after ablation. GH was observed in 10 patients. There were significant differences in LA diameter (LAD), right inferior pulmonary vein (RIPV) diameter, and the height of the LA roof from the point where the LA posterior wall and esophagus make contact between patients with (GH+) and without GH (GH–) (LAD: 41.0 [36.3–41.8] mm vs. 46.5 [42.8–50.0] mm, p<0.01; RIPV diameter: 19.7 [19.0–20.5] mm vs. 23.2 [21.2–24.9] mm, p<0.01; height of LA roof: 5.7 [5.1–6.1] mm vs. 8.8 [7.1–11.2] mm for, p<0.01, respectively). Multivariate analysis revealed that LA roof height was a predictor of GH. Moreover, Patient Assessment of Upper Gastrointestinal Disorders-Symptom Severity Index (PAGI-SYM) scores increased significantly 1 week after ablation (from 1.0 [0.0–2.8] to 5.0 [3.0–11.0], p=0.03) in patients with GH. Conclusion: The height of the LA roof may be a predictor of GH after CBA of the LA roof line. Additionally, GH-related symptoms may still appear 1 week after ablation.

ECG findings suggestive of STEMI often lead to emergent left heart catheterization (LHC). Occasionally, non-coronary conditions mimic ECG findings of STEMI resulting in increased risk and expenses from emergent transportation and procedures. While the overall incidence is declining over the last decade given advances in guideline directed medical therapy, this still accounts for a substantial amount of ED visits. We report a case of 1:1 atrial flutter in a patient with dextrocardia presenting as STEMI.

Labyrinth weirs are considered as non-linear weirs which increase the discharge capacity for a certain upstream water surface level. In this study, the effects of dentate and orifice labyrinth weirs on increasing the discharge capacity in three magnification ratios of (weir length to flume width, L/W) 2, 3, and 4 was experimentally investigated. Experiments were conducted in a laboratory flume with length of 15 m, width of 0.8 m, and height of 1 m in different flow discharges of 10 to 90 lit/s. Totally, 9 physical models with a thickness of 3 mm and a height of 15 cm were used. The results showed that for L/W= 2 and H/P= 0.2, the discharge coefficient of orifice-dentate weir and dentate weir are 75.6 and 17.5 percent, respectively, more than the simple labyrinth weir. However, dent and orifice may lose their efficiency in high heads and the discharge coefficient will be close to simple labyrinth weir. The reason for these changes is the flow interference in downstream of weir. Therefore, for H/P = 0.2, by increasing magnification ratio from 2 to 4 in simple, dentate and orifice-dentate labyrinth weirs, the discharge coefficient is decreased by 20.8, 32.6, and 44.7 percent, respectively. This decrease demonstrate that as the weir magnification increases, the efficiency of orifice and dentate on labyrinth weirs will extremely decrease and they will act as a simple labyrinth weir.

Purpose: Listening to music has been used as an intervention during the treatment and the rehabilitation processes. Cardiac surgery is a stressful and fearful for most of the patients. This randomized and controlled trial has assessed the effect of listening to music on the level of surgical fear and anxiety of the patients, who had undergone a cardiac surgery. Methods: This randomized controlled trial consisted of 50 patients in the intervention group and 50 patients in the control group. Two days before the surgery, the intervention group listened to music for about 45 minutes each day (45 min on average). The control group received no music intervention. Patients’ anxiety and surgical fear were measured using the State-Trait Anxiety Inventory and Surgical Fear Scale. Results: It was found that the fear and anxiety levels of the experimental patients who listened to music were lower than the control group, and the difference between the mean anxiety and surgical fear scores before cardiac surgery were statistically significant between the intervention group and control group. Conclusions: It is possible to implement a music listening program in the perioperative time and is well accepted by patients as evidenced by the low anxiety-surgical fear scores. Listening to music as an intervention for patients, who undergone cardiac surgery was feasible. Intervention was highly effective in reducing anxiety and surgical fear levels.

This article is reply to the letter to the editor

Backgroud: There is a lack of sufficient evidence regarding efficacy and safety of amlodipine on treating hypertension during pregnancy. Objective: To compare the efficacy and safety of amlodipine with nifedipine on hypertension during pregnancy. Search strategy: PubMed, Embase, Cochrane Library, clinicaltrials.gov, Chinese National Knowledge Infrastructure, Wanfang Database and China Biology Medicine disc were searched from inception to April l5, 2021. Selection criteria: Randomised controlled trials were included. Data collection and analysis: Data extraction was carried out by one researcher and checked by another. Results were reported as risk ratios (RR) for dichotomous outcomes or mean differences (MD) for continuous outcomes, with 95% confidence intervals (CI). Results: Seventeen RCTs were included. Amlodipine was found the efficacy is slightly superior to nifedipine on treating hypertension during pregnancy (RR 1.06, 95% CI 1.01 to 1.10) with a decreased risk for maternal side effects (RR 0.42, 95% CI 0.29 to 0.61). Subgroup analysis found amlodipine can get a better control on SBP (RR -11.68, 95% CI -17.98 to -5.37) and DBP (RR -7.44, 95% CI -13.81 to -1.06) compared with extended release nifedipine. In addition, there was no difference between amlodipine and nifedipine on pregnancy outcomes including caesarean section, premature labour, placental abruption, FGR, fetal distress, neonatal asphyxia. Conclusions: Given the results of this systematic review and meta-analysis, amlodipine can be effectively and safely used for hypertension during pregnancy. Key words: Amlodipine, Nifedipine, Hypertension during pregnancy, Meta-analysis Tweetable abstract: This review found that amlodipine is noninferior to nifedipine in managing hypertension during pregnancy.

Objectives To compare a type 2 diabetes mellitus (T2DM) management clinical guideline from the Caribbean to a selection developed nationally and internationally by agencies/organisations. Methods Seven T2DM management clinical guidelines were selected a priori as a sample of international and high-income country-specific clinical guidelines and compared to the country-specific T2DM management clinical guideline from the Caribbean. Two reviewers independently assessed the content (using a previously piloted data extraction form) and quality using the Appraisal of Guidelines for Research and Evaluation II (AGREE II) tool. Results The Caribbean clinical guideline was found to contain similar levels of T2DM management topics compared to international and high-income country-specific clinical guidelines; however, one country-specific clinical guideline from New Zealand was found to have a substantially lower level of content. The clinical guideline from the Caribbean was found to have low-quality and could not be used in practice; however, only three comparator clinical guidelines were found to have a high-quality and could be recommended for use in clinical practice. A further three comparator clinical guidelines could be used in practice with minor modifications. Conclusion Although the T2DM management clinical guideline from the Caribbean contained a high level of content with regards to relevant topics, it was of insufficient quality to be used in clinical practice. Therefore, an alternative high-quality clinical guideline as identified within this study should be adopted and used within the Caribbean to manage T2DM until a high-quality region-specific clinical guideline is developed.

In this paper, a network stability analysis algorithm is proposed for the uncertain interconnected systems. To reduce the complexity of analysis, compositional certification strategy is adopted, i.e., instead of studying the characteristics of the whole network, the property of subsystems is assessed. The proposed method firstly analyzes a dissipative property of subsystems of the interconnected system. Then, by taking the uncertainty of interconnections into account, a compositional stability criterion is given for stability analysis of the network. Compared with some previous investigations, the presented algorithm has less computation burden, which facilitates the application to large-scale interconnected power systems. Numerical analysis confirms the proposed method can assess the stability of an IEEE 14-bus test system, in the presence of uncertainties.

Background: It is well documented that laboratory mice bred and maintained in ultra-hygienic specific pathogen-free (SPF) barriers display reduced richness and complexity of microbiota compared with wild mice. The laboratory mice profoundly lack lung parenchymal mast cells. Hence, we aimed to investigate the lung distribution of mast cells in free-living feral mice. Methods: Feral house mice were trapped in South-Eastern Norway and Hemtabad, West Bengal, India. C57BL/6 laboratory mice were bred in a purposefully built, closed environment with bedding material obtained from the natural environment with wild rodent infestation in order to normalize the gut microbiota of these laboratory mice to that of the wild mice, and the offspring were collected for study at 8 weeks of age. Results: Mast cells were easily identified at a substantial density in the lung parenchymal tissues of feral mice from both Norway and India, which stands in clear contrast to the rare distribution of lung parenchymal mast cells in the conventional laboratory SPF mice. Consistently, wild mice also expressed higher pulmonary levels of stem cell factor, a critical growth factor for mast cell survival. Higher levels of histamine were recorded in the lung tissues of the wild mice. Interestingly, “naturalized” C57BL/6 laboratory mice which spent their entire life in a semi-natural environment developed lung parenchymal mast cells at an appreciable density. Conclusion: Our observations support that environmental factors, possibly through modulation of microbiota, may impact the tissue distribution of mast cells in mouse lung tissues.

Climate change has been associated with a higher incidence of combined adverse environmental conditions that can promote a significant decrease in crop productivity. However, knowledge on how a combination of stresses might affect plant development is still scarce. MicroRNAs (miRNAs) have been proposed as potential targets for improving crop-productivity. Here, we have combined deep-sequencing, computational characterization of responsive miRNAs and validation of their regulatory role in a comprehensive analysis of melon’s response to several combinations of four stresses (cold, salinity, short day, and infection with a fungus). Twenty-two miRNA families responding to double and/or triple stresses were identified. The regulatory role of the differentially expressed miRNAs was validated by quantitative measurements of the expression of the corresponding target genes. A high proportion (ca. 60%) of these families (mainly highly conserved miRNAs targeting transcription factors) showed a non-additive response to multiple stresses in comparison with that observed under each one of the stresses individually. Among those miRNAs showing non-additive response to stress-combinations, most interactions were negative suggesting the existence of functional convergence in the miRNA-mediated response to combined stresses. Taken together, our results provide compelling evidences that the response to combined stresses cannot be easily predicted from the study individual stresses.

Background Nocturnal enuresis is a common symptom in children with sickle cell disease (SCD). Risk factors for development of enuresis are currently unknown. An early manifestation of SCD-associated kidney damage is glomerular hyperfiltration. We test the hypothesis that in a pediatric SCD cohort, individuals with hyperfiltration are more likely to have nocturnal enuresis when compared to children without hyperfiltration. Procedures To assess the relationship between nocturnal enuresis and hyperfiltration, we retrospectively evaluated children with SCD enrolled in the Evaluation of Nocturnal Enuresis and Barriers to Treatment among Pediatric Patients with SCD study (PEESC; NCT01959958) and prospectively identified children who reported nocturnal enuresis and were enrolled in the longitudinal cohort study Sickle Cell Clinical Research and Intervention Program (SCCRIP, NCT02098863). Results Nocturnal enuresis occurred in 46.5% of PEESC participants and was more frequent in participants with HbSS/HbSβ0-thalassemia and in male participants. We did not identify an association between hyperfiltration from three to five years of age with the later development of enuresis. Hyposthenuria was not associated with enuresis. Conclusions Severe SCD genotypes and male sex were associated with nocturnal enuresis after age 5 years. However, we could not identify additional renal or hematologic predictors associated with the diagnosis of nocturnal enuresis. Future studies should incorporate non-renal risk factors into studies that predict development of enuresis.

The actual industrial processes are always accompanies by many non-Gaussian behaviors due to the systems complexity. These behaviors are fractional order characteristics, which are very difficult to analyze by traditional analysis methods. This paper presents a detail fractional order theory analyses based on the fractional order characteristics present in industrial process. Initially, the -stable distribution is employed to fit the probability density distribution of the data and the auto correlation function is applied to find the long range dependence characteristic hidden in the process. Next, a re-scaled range method and multifractal detrended fluctuation analysis method is applied to analyze the fractional order features of the process in detail. Then, a fractional auto-regressive integrated moving average model (FARIMA) is proposed to predict accurately of the time series based on the fractional order characteristic of the system. Experimental results show that the superiority for prediction model with fractional order thinking.

An intuitionistic multi-objective programming problem with interval-valued trapezoidal neutrosophic (IVTN) and multi-choice interval type has been considered in this paper. The coefficients of objective functions and parameters of the left side of the constraints are in the multi-choice environment, and the right-hand side of the constraints are in IVTN number type. The formulated problem’s multi-choice parameters were transformed into the deterministic form using the binary variable transformation technique. A procedure is defined to change the IVTN number into the deterministic form. Then, intuitionistic fuzzy programming with two different scalarization models has been used to achieve each membership goal’s highest degree and obtain a satisfactory decision-making solution. Finally, a numerical case study for production planning is explored to validate the work’s efficiency and usefulness.

In the present note, we give the generalization of α-Baskakov Durrmeyer operators depending on a real parameter ρ>0. We present the approximation results in Korovkin and weighted Korovkin spaces. We also prove the order of approximation, rate of approximation for these operators. In the end, we verify our results with the help of numerical examples by using Mathematica.

Background: We aimed to assess the impact of regional heterogeneity on the severity of COVID-19 in Japan. Methods: We included 27,865 cases registered between January 2020 and February 2021 in the COVID-19 Registry of Japan to examine the relationship between the National Early Warning Score (NEWS) of COVID-19 patients on the day of admission and the prefecture where the patients live. A hierarchical Bayesian model was used to examine the random effect of each prefecture in addition to the patients’ backgrounds. In addition, we compared the results of two models; one model included the number of beds secured for COVID-19 patients in each prefecture as one of the fixed effects, and the other model did not. Results: The results indicated that the prefecture had a substantial impact on the severity of COVID-19 on admission. Even when considering the effect of the number of beds separately, the heterogeneity caused by the random effect of each prefecture affected the severity of the case on admission. Conclusions: Our analysis revealed a possible association between regional heterogeneity and increased/decreased risk of severe COVID-19 infection on admission. This heterogeneity was derived not only from the number of beds secured in each prefecture but also from other factors.

Background: The study aimed to evaluate the enhanced three-dimensional brain volume magnetic resonance imaging (3D-BRAVO) in the diagnosis of Tolosa-Hunt syndrome (THS). Methods: we described 21 patients with THS and their case records including clinical syndromes and neuroradiologic features by conventional MRI and enhanced 3D-BRAVO. Results: 19 patients showed enhancement in the cavernous sinus through 3D-BRAVO. 16/19 had ipsilateral enhanced lesions involved 4-10 continuous slices in cavernous sinus on 3D-BRAVO scan. Both local size enlargements and enhancement in the cavernous sinus were found in 3 patients. The rest 2 patients performed negative results on neither conventional MRI nor enhanced 3D-BRAVO. Conclusions: enhanced 3D-BRAVO imaging demonstrated a high detection rate in the cavernous sinus, which may promote our understanding of Tolosa-Hunt syndrome.

Aim: In this study we aimed to investigate diagnostic usefullness and optimal cut-off values of monocyte, mean platelet volume (MPV), eosinophil, neutrophil lymphocyte ratio (NLR), platelet lymphocyte ratio (PLR), monocyte lymphocye ratio (MLR), red blood cell distribution width (RDW) in laboratory confirmed Covid-19 cases with and without pneumonia who were totally healthy before being infected with Covid-19. Materials and Methods: Data of a total 10000 patients who were admitted to hospital with complaints apropriate with Covid-19 in six months (March–Agust 2020) interval and underwent SARS-CoV-2 Polymerase Chain Reaction (PCR) investigated. Out of 10000 patients we included only previosly healthy 174 patients with Covid-19 pneumonia, 144 SARS-CoV-2 positive but no pneumonia and SARS-CoV-2 PCR negative 156 healthy controls. The laboratory results and demographic findings were collected from patient files retrospectively before undergiong treatment for Covid-19. Results: We found wbc levels lower in Covid-19 patients with pneumonia (p <0.001 vs healthy), as well as neutrophil (p <0.001 vs healthy), Monocyte (p <0.001 vs healthy and Covid-19 without pneumonia), Eosinophil (p <0.001 vs healthy and Covid-19 without pneumonia) and Platelet count (p <0.001 vs healthy). MLR remained higher in patients without pneumonia (p <0.001 vs Covid-19 with pneumonia and healthy controls) as well as PLR (p <0.001 versus Healthy). Conclusion: In the light of the obtained results, decrease in wbc, neutrophil, monocyte and eosinophil levels support the diagnosis of Covid-19 pneumonia on the other hand increase in MLR and PLR may indicate Covid-19 without pneumonia. Keywords: Covid-19 pneumonia, esoinophil, monocyte

Case report: Anomalous ovarian ectopic pregnancy presenting in the second trimesterValerie Bloomfield MD1, Stacey Rogers MD1, Bryon DeFrance MD2, Nicholas Leyland MD11 Department of Obstetrics and GynecologyMcMaster University1280 Main Street WHamilton, Ontario L8S 4K12 Division of Maternal Fetal MedicineDepartment of Obstetrics and GynecologyMcMaster University1280 Main Street WHamilton, Ontario L8S 4K1Corresponding author: Dr Nicholas Leyland; email: leylann@mcmaster.ca; Department of Obstetrics and Gynecology; McMaster University, 1280 Main St. W., HSC-2F39 , Hamilton, ON, L8S 4K1Word count: Abstract: 119 words; Text: 1272 words; Figures: 1

Aim: The aim of this study is to evaluate the effect of repositioning maneuvers on quality of life, vertigo symptoms and dizziness in patients diagnosed with BPPV through Dix-Hallpike and Head Roll maneuvers. Methods: The study included 67 patients diagnosed with BPPV through Dix- Hallpike and Head Roll maneuvers. The vertigo dizziness imbalance scale, dizziness handicap inventory and visual analog scale were applied before and one week after repositioning maneuvers (to those whose nystagmus completely disappeared). Results: A statistically significant difference was determined in the scores obtained from the Dizziness Handicap Inventory (physical, functional and emotional and total scores), Vertigo Imbalance Scale (Quality of life and Symptom scores) and visual analog scale after repositioning maneuvers (p<0.05). Conclusion: This study revealed the positive effects of repositioning maneuvers on quality of life, vertigo symptoms and dizziness in patients with BPPV.

Cylindrical electromagnets are used in various industries. The geometric structure and circular symmetry of these electromagnets reduce flux leakage and increase their efficiency. In this paper, a precise magnetic equivalent circuit for the cylindrical electromagnet is presented and its permeance relations are proved. In order to evaluate the proposed model, the magnetic field in different parts of the cylindrical electromagnet was calculated and compared with the simulation results. The highest error between the results of the two methods is related to the calculation of the magnetic field under the coil, which is equal to 3%. Also, the platform of a laboratory crane was built using a cylindrical electromagnet. The results of the lifting force measurement in comparison with the results of the analysis of the proposed model show an error of less than 2%, which indicates the high accuracy of the proposed model.

The multi-point Taylor polynomial, which is the general, unique and of minimum degree ($mk+m-1$) polynomial $P_{k,m}(x)$ which interpolates a function’s derivatives in multiple points is presented in its explicit form. A proof that this expression satisfies the multi-point Taylor polynomial’s defining property is given. Namely, it is proven that for a k-differentiable function $f$ and a set of different m-points $\{a_1,…,a_m\}$, this polynomial satisfies $P^{(n)}_{k,m}(a_i) = f^{(n)}(a_i)\quad \forall \, i = 1,…,m\quad \&\quad \forall \, n = 0,…,k$. A discussion regarding previous expressions presented in the literature, which mostly consisted in recursion formulas and not explicit formulas, is made.

In this paper, we consider the dispersionless B type Kadomtsev-Petviashvili (dBKP) equation through quasi classical limit of BKP equation. We investigate the existence of one-parameter point transformations in which the dBKP equation remains invariant by admitting a five-dimensional Lie algebra. For the admitted Lie symmetries, we calculate the one-dimensional optimal system, a necessary analysis to perform the reduction process. Using this, we obtain various closed-form similarity solutions for the dBKP equation. In addition to this, we also derive the associated conservation laws of this equation through Ibragimov’s method.

In 2009, Bell and Stelljes described a method for constructing a class of solvable arbitrage-free models for stock prices. As a result, a second-order partial differential equation that is similar to the classical Black-Scholes equation was yielded and two solutions of the equation were given. Later in 2016, Sinkala extended this result using the Lie symmetry analysis. In this paper, Sinkala's work is extended to a time fractional arbitrage-free stock price model using the Lie symmetry analysis. Employing the algorithmic package developed by Jefferson, the determining equations of the fractional model are solved. Finally an optimal system and some examples of invariant solutions are presented.