Introduction. Preliminary data in human suggest that both Intracardiac echocardiography (ICE) and Intravascular ultrasound (IVUS) can be used for real-time information on the left atrial (LA) wall thickness and on the acute tissue changes produced by energy delivery. This pilot study was conducted to compare ICE and IVUS for real-time LA wall imaging and assessment of acute tissue changes produced by radiofrequency (RF), cryo and laser catheter ablation. Methods Patients scheduled for RF, cryoballoon or laser balloon Pulmonary Vein Isolation (PVI) catheter ablation were enrolled. Each pulmonary vein (PV) was imaged immediately before and after ablation with either ICE or IVUS. The performance of ICE and IVUS for imaging were compared. Pre- and post-ablation measurements (lumen and vessel diameters, areas and sphericity indexes, wall thickness and muscular sleeve thickness) were taken at the level of each PV ostium. Results A total of 48 PVs in 12 patients were imaged before and after ablation. Compared to IVUS, ICE showed higher imaging quality and inter-observer reproducibility of the PV measurements obtained. Acute wall thickening suggestive of oedema was observed after RF treatment (p = 0.003) and laser treatment (p = 0.003) but not after cryoablation (p = 0.69). Conclusions Our pilot study suggests that ICE is preferable to IVUS for LA wall thickness imaging at the LA-PV junctions during ablation. Ablation causes acute wall thickening when using RF or laser energy, but not cryoenergy delivery. Larger studies are needed to confirm these preliminary findings.

In this paper, a generalized reaction diffusion equation with delay has been numerically solved by a cubic Bspline Galerkin finite element method. The full discrete numerical process is based on trapezoidal rule. To demonstrate the efficiency of the method, numerical illustrations have been given. Graphs are also displayed in support of the numerical results. Both the theoretical and computational rate of convergence of the numerical method have been examined and found to be in agreement. As it can be observed from the numerical results given in tables and graphs, the proposed method approximates the exact solution very well. The accuracy of numerical scheme is confirmed by computing L2 and L∞ error norms

Aims: In this study, we aimed to evaluate and compare the clinical characteristics, laboratory findings, outcomes of hospitalized patients with and without diabetes along with poorly vs well-controlled diabetes. Methods: A total of 341 hospitalized patients with covid-19 confirmed by RT-PCR and/or chest imaging suggestive of covid-19 infection were retrospectively included in this study. The patients were divided into 2 groups as diabetic (n = 120) and non-diabetic (n = 221). Demographic data, symptoms, comorbidities, laboratory values were recorded. The patients were classified according to the clinical stages defined by guidance of WHO for covid-19. The percentage of patients with severe disease was higher in diabetic group (n = 57) 47.5% compared to non-diabetic group(n=61) 27.8% (p = 0.001). The percentage of patients requiring oxygen therapy was significantly higher in 61 (51.2%) diabetic group than non-diabetic group 65 (29.4%) (p = 0.001).The median time of duration of hospitalization in diabetic group was 8 days, [IQR 6-11.5] that was significantly higher than non-diabetic group 7 days [IQR 5-10] (p = 0.009). The median time of duration of hospitalization in poorly controlled diabetic group was 9 days [IQR 6.00-16.00] that was significantly higher than well-controlled diabetic group 8 days [IQR 6.00-11.00] (p = 0.006). Results: Patients with diabetes were more susceptible to covid-19 infection and the infection was more severe in patients with diabetes compared to patients without diabetes. However, the mortality rate was similar between diabetic and non-diabetic group. Diabetic covid-19 patients without other comorbidities were not prone to severe infection. Conclusion: Patients with diabetes and comorbidities, apart from the glycemic control, should receive intensive monitoring and disease management.

Abstract Objectives: To investigate the relationship between allergic rhinitis (AR) and dental malocclusion from an otolaryngologic perspective. Design: Retrospective study. Setting: Single tertiary medical center. Participants: Patients (n=217) referred to the otolaryngology department before initiating orthodontic treatment were recruited. Main outcome measures: The frequency and severity of AR symptoms, sinonasal outcome test (SNOT-22) scores, physical examination findings, acoustic rhinometry results, and treatment modalities were retrospectively assessed. Patients with positive skin prick test findings (SPT) (n=173; orthodontic group) were compared with age- and sex-matched patients being treated for AR (AR group). Results: Total 76.5% of the enrolled patients had subjective nasal symptoms, and 93.1% patients showed abnormal physical examination findings: inferior turbinate hypertrophy (82.0%), adenotonsillar hypertrophy (31.8%) or deviated nasal septum (7.4%). The 173 (79.7%) patients with positive SPT results exhibited a significantly higher incidence of rhinorrhoea, sneezing, and inferior turbinate hypertrophy compared to those with negative SPT results. The proportion of patients who underwent pharmacological or surgical treatments was significantly higher among patients with nasal obstruction (92.0%) than among patients without nasal obstruction (36.9%). The frequency and mean visual analogue symptom scores for nasal obstruction, rhinorrhoea, and sneezing, as well as all SNOT-22 domain scores were significantly higher in the AR group than in the orthodontic group. The minimal cross-sectional area measured with acoustic rhinometry showed no significant difference between groups. Conclusion: Patients with dental malocclusion had a high SPT (+) rate and a high prevalence of structural abnormalities of the upper airway. Early intervention may prevent further progression of malocclusion.

In their natural environment, date palms are exposed to chronic atmospheric ozone (O3) concentrations from local and remote sources. In order to elucidate the consequences of this exposure, date palm saplings were treated with ambient, 1.5 and 2.0 times ambient O3 for three months in a free-air controlled exposure facility. Chronic O3 exposure reduced carbohydrate contents in leaves and roots, but this effect was much stronger in roots. Still, sucrose contents of both organs were maintained at elevated O3, though at different steady states. Reduced availability of carbohydrate for the TCA cycle may be responsible for the observed reduced foliar contents of several amino acids, whereas malic acid accumulation in the roots indicates a reduced use of TCA cycle intermediates. Carbohydrate deficiency in roots, but not in leaves caused oxidative stress upon chronic O3 exposure, as indicated by enhanced malonedialdehyde, H2O2 and oxidized glutathione contents despite elevated glutathione reductase activity. Reduced levels of phenolics and flavonoids in the roots resulted from decreased production and, therefore, do not indicate oxidative stress compensation by secondary compounds. These results show that roots of date palms are highly susceptible to chronic O3 exposure as a consequence of carbohydrate deficiency.

Objective: Mask use has a substantial role in reducing the spread of COVID-19 in confined spaces. However, the use of masks is controversial in cases where intense effort is required, such as the treadmill exercise test. Since the majority of subjects undergoing this test are elderly individuals with comorbidities, the safety and reliability of the test are critical matters that must be elucidated in the post-COVID-19 era. In this study, the safety of the treadmill exercise test performed using a mask and the diagnostic reliability of the test were questioned. Method: In our clinic, before March 11, 2020, treadmill exercise tests were performed without a mask; whereas, after this date, patients were supplied with a standard surgical mask during the test. These two groups were compared with regard to various characteristics to assess diagnostic reliability and safety. Results: The diagnostic reliability and the safety of the stress test performed with a mask was found to be similar to that of tests performed without a mask. However, we noted that shortness of breath was more common in the mask-wearing group. Conclusion: The treadmill exercise test performed by wearing surgical masks is safe and its results are reliable for diagnosis.

Abnormal hypothalamic-pituitary-adrenal (HPA) axis has been implicated in major depressive disorder (MDD). The aims of this meta-analysis were to determine the effect and safety profile of HPA-targeting medications for MDD. World of Science and PubMed databases were comprehensively searched up to March 2021. All randomized controlled trials (RCTs) and open-label trials exploring antiglucocorticoid and related medications in patients with depression were included. In the meta-analysis, we identified 16 RCTs and seven open-label studies that included 2972 subjects. Our study suggested that patients with MDD may benefit from mifepristone and V1B receptor antagonist treatments that have tolerable side effects. HPA-based medications are promising for depression treatment. However, additional high-quality RCTs, including head-to-head trials, are needed.

Backgrounds: Allergen-specific immunotherapy (ASIT) is capable of inducing immune tolerance to the corresponding allergen, thereby enabling treatment of the root cause of the allergic disease. As the treatment course of protein-based vaccines for ASIT is time-consuming, an easily administered epicutaneous anti-allergic DNA-based vaccine is an attractive method, especially during the COVID-19 pandemic. Methods: We established a mouse model allergic to the biting midge, Forcipomyia taiwana, to test the concept of the epicutaneous DNA vaccine. The experiments were designed using two approaches: therapeutic and prophylactic. Mice were patched with 25 μg For t 2 DNA vaccine patches for one hour with a total of three treatments spaced one week apart. Scratch bouts after For t 2 allergen challenge were used as a clinical surrogate of itch and biomarkers for allergic inflammation were examined by ELISA, RT-PCR, and histopathology. Results: We found that after epicutaneous DNA vaccination, the mice significantly improved with respect to allergen-induced scratch. For t 2-specific IgE, mRNA, and protein of IL-13 and eosinophils infiltration in the targeted skin decreased. For t 2-specific -IgG2a and mRNA expression of FOXP3 increased. Conclusions: We demonstrated the first needle-free epicutaneous DNA vaccine patch that is effective in preventing as well as treating biting midge allergy in a murine model. The mice showed improvements in their allergic condition both clinically as well as in allergic inflammation. The mode of this anti-allergic DNA vaccine may have the potential for use in other specific immunotherapies for other allergens.

Background and purpose: Tapentadol (TAP) and oxycodone/naloxone (OXN) are available formulations that potentially offer improved gastrointestinal tolerability. However, real-world studies in chronic non-cancer pain (CNCP) remain scarce. The aim is to analyse their benefit/risk profiles and the influence of pharmacogenetic markers in daily pain practice. Experimental approach: A prospective, controlled study was developed with ambulatory CNCP patients. Cases were treated with TAP (n=204) or OXN (n=180) prescription, and controls other opioids (n=216). Pain intensity and relief, quality of life, morphine equivalent daily doses (MEDD), adverse events (AEs) and hospital admissions were registered. OPRM1 (rs1799971, A118G) and COMT (rs4680, G472A) gene variants were also analysed. Key Results: Cases evidenced a significantly higher pain relief than control did in real-world management. Here, pain intensity and quality of life were predictive values of relief (R2=0.3). OXN achieved greater pain relief under higher 28% MEDD, 15% pregabalin and 8% duloxetine than TAP. Additionally, OXN needed 15-23% more prescription changes. What´s more, OXN presented the highest rate of AEs at 6 (3-9) per person, including a 68% prevalence of constipation and 24% of erythema. COMT-AA showed higher rates of erythema and vomiting, especially in females. Conclusions and Implications: OXN and TAP exhibited optimal benefit/risk profiles for improving pain relief in real-world CNCP. However, increased OXN pain relief conditioned patients for higher MEDDs, constipation side-effects and drug prescription changes than TAP. Further research is necessary to clarify a potential sex-bias in and genetic influence on side-effects.

BACKGROUND: Selective serotonin reuptake inhibitors (SSRIs) have been associated with increased risk of upper gastrointestinal bleeding (UGIB) in older patients, but little is known about the risk associated with individual SSRI drugs and doses. METHODS: We conducted a nested case-control study within a cohort of 9,295 patients aged ≥65 years treated with SSRIs from 2000 to 2013 using claims data of a universal health insurance in Taiwan. Incident cases of UGIB during follow-up period were identified and matched with three control subjects for age, sex, and follow-up duration. Conditional logistic regression was used to estimate odds ratio (OR) of UGIB associated with use of individual SSRI drugs and cumulative dose. RESULTS: UGIB risk increased with the increasing cumulative doses of SSRIs (adjusted OR: 1.28, 95% confidence interval [CI]: 1.02–1.62 for the highest vs. the lowest tertile). Compared with users of other SSRIs, Fluoxetine users were at had an increased risk of UGIB (adjusted OR: 1.25, 95% CI: 1.03–1.50), whereas paroxetine users had 29% decreased odds (95% CI: 0.56–0.91). A dose-response manner was observed between fluoxetine use and UGIB (adjusted OR [95% CI] for tertiles of cumulative dose vs. use of other SSRI classes: tertile 1, 1.04 [0.78-1.39]; tertile 2, 1.25 [0.96-1.63]; tertile 3, 1.44 [1.11–1.87]). The increased risk was only observed among current fluoxetine users. CONCLUSIONS: Among older adults treated with SSRIs, fluoxetine therapy was associated with increased risk of UGIB in a dose-response manner. Careful considerations in treatment dosage are needed when providing care to older people.

In this paper, we establish a local fractional integral identity on Yang's fractal sets. Using this integral identity, some generalized Hermite-Hadamard type inequalities for generalized harmonically convex function on Yang's fractal sets are obtained. Some applications of these inequalities to special means are given.

Actinobacteria are important cave inhabitants, but knowledge of how anthropization and anthropization-related visual marks affect this community on cave walls is missing. We compared Actinobacteria communities among four French limestone caves (Mouflon, Reille, Rouffignac, and Lascaux) ranging from pristine to anthropized and within Lascaux Cave between marked (wall visual marks) and unmarked areas on walls in different rooms (Sas-1, Passage, Apse, and Diaclase). In addition to the 16S rRNA gene marker, 441-bp fragments of hsp65 gene were used for the identification of Actinobacteria to the species level by Illumina-MiSeq analysis. The hsp65 marker revealed higher resolution for species and higher richness (at 99% OTUs cutoff) than did 16S rRNA assessment which, however, identified more taxa at higher taxonomic ranks. Actinobacteria communities varied between Mouflon and Reille caves (both pristine), Rouffignac and Lascaux (both anthropized). Rouffignac displayed high diversity of Nocardia, pointing to human inputs, and Lascaux exhibited high Mycobacterium abundance, whereas Gaiellales were typical in pristine caves and the Diaclase (the least affected area of Lascaux Cave). Within Lascaux, Pseudonocardiaceae dominated on unmarked walls and Streptomycetaceae (especially Streptomyces mirabilis) on marked walls, raising questions on their possible role in the formation of visual marks. Our results show how the use of the hsp65 marker, well beyond the resolution provided by 16S rRNA sequences, enabled for the first time to document species-level variations of the Actinobacteria community according to the extent of anthropogenic pressure. This approach proved effective when comparing different limestone caves or specific conditions within one cave.

Indian peafowl (Pavo cristatus) attracts people’s attention because of the exclusively dazzling phenotypic characteristics. However, little is known about the phenotypic evolution and phylogeny of Indian peafowl at the whole-genome level. So far, there has been no report on the genetic mechanism of the formation of white feather in white feather peafowl. This study assembled a draft genome of Indian peafowl with a genome size of 1.05 Gb (the sequencing depth is 362×), and N50 of the contig and scaffold was up to 6.2 Mb and 11.4 Mb, respectively. Compared with other birds, Indian peafowl changed in terms of metabolism, immunity, skeletal development and feather development, which provided a novel insight into the phenotypic evolution of peafowl, such as the large body size and feather morphologies. It was confirmed that the phylogeny of Indian peafowl was closer to that of turkey than that of chicken. Specially, it was identified that PMEL was a causal gene leading to the formation of white plumage in blue and white feather peafowl. This study provides a peafowl genome with high-quality as well as a novel understanding in the phenotypic evolution and phylogeny of peafowl among other birds. The results contribute a valuable reference genome to the study of the avian genome evolution. In addition, the discovery of the genetic mechanism of white plumage not only is a breakthrough in the exploration of peafowl plumage, but also provides clues and new ideas for further investigations of the avian plumage coloration and artificial breeding in peafowl.

Competence in intimate examinations is expected of all graduating doctors, regardless of gender. These examinations are challenging to teach and learn, with medico-legal and ethical issues surrounding patient consent. Religion, culture, and societal expectations may also impact this. Objectives: to determine if male medical students in countries where Islam is the state religion are disadvantaged during their O&G clinical education. A systematic literature review was performed by searching ‘MEDLIINE’, ‘Web of science’, and ‘Science Direct’. References were manually searched. Studies relating to gender differences in undergraduate O&G clinical education were included. Studies outside of the years 2000-2020 were excluded. Data was extracted and critically appraised. A narrative synthesis method was employed. Nine out of ten studies reported that female students performed more vaginal exams than males during their O&G placement – four studies reported statistical significance, with three being from countries where Islam is the state religion. Five studies reported that females performed more speculum examinations. Six studies reported significance in the number of males who had experienced declined consent to perform intimate examinations. The paper from Malaysia reported a figure higher (93.3%) than any from ‘Westernised’ countries. Four studies reported significance regarding the perception of gender bias from male students. Gender bias is present in O&G undergraduate clinical education. In addition to lower participation and higher refusal rates, male students also perceive gender bias. Religion and culture put male medical students training in countries where Islam is the state religion, at an additional disadvantage to those in ‘Westernised’ countries.

Objective: Effect of the pandemic, and associated disruption of reproductive services, on mental wellbeing of those whose fertility journey was disrupted during the first phase of COVID-19 Design: Web- based cross- sectional study Setting: Not for profit fertility clinic Population: Fertility patients Methods: Web- based cross- sectional study of fertility patients who had an appointment over a 7 week period Main Outcome Measures: Effect of the pandemic on mental wellbeing of those whose fertility journey was disrupted Results: 135 responses were received giving a response rate of 16.3%. 117 responses were analysed following exclusion of incomplete responses. The mean well- being score in our population was 45.03 + 0.796 (n=117), significantly lower than the published average WEMWBS score (P<0.0001). When a gender-based analysis was performed, female fertility patients had a lower score during the period under observation compared to the published average WEMWBS scores (Female: 49.6 + 0.34, n=644 vs 44.4 + 0.88, n=99, P< 0.0001; Male: 50 + 0.43, n=4429 vs 47.3 + 1.81, n=26, P=0.136). There was no significant difference in average well-being score in the 30-39yr category compared to the over 40yr group (44.9 + 0.97 vs 45.0 + 1.39). Participants with children scored higher than those without (46.8 + 1.19 (n=38) vs 44.1 + 1.02 (n=79)). Conclusions: Increased levels of depression and anxiety coupled with added uncertainty of clinic closures and disruption to services have led to a statistically significant lower WEMWBS scores in the fertility population.

Background: Cervical cancer is among the most common gynecological cancers. However, the procedure of radical hysterectomy remains controversial. Objectives: This systematic review and network meta-analysis (registered in PROSPERO: CRD42021231700) aimed to evaluate the efficacy and safety of five approaches to cervical cancer surgery. Search Strategy: We searched PubMed, MEDLINE, Embase, the Cochrane Library, and Web of Science database. Selection Criteria: We select high-quality, non-randomized studies for comparisons of clinical outcomes of adult cervical cancer patients treated with radical hysterectomy including at least one estimate of rate of recurrence, and overall (OS) or progression-free (PFS) survival. Data collection and analysis: We extracted the relevant data and conducted a network meta-analysis to compare clinical outcomes, specifically, operation time (OT), intraoperative estimated blood loss (EBL), length of hospital stay (LOS), number of resected lymph nodes (RLNs), rate of complications, and the rate of recurrence, OS, and PFS among included patients. Main Results: RRH was associated with the lowest EBL volume and LOS, ORH was associated with the shortest OT. VALRH was associated with the greatest number of RLNs and lowest rate of perioperative complications. VALRH was associated with the highest OS and lowest tumor recurrence rates, while LRH was associated with the highest PFS rate. OS, PFS, and tumor recurrence rates did not differ significantly among five surgical approaches. Conclusion: In summary, current evidence appears to demonstrate the presented approaches to cervical cancer surgery have a comparable efficacy, while MIS is associated with improved rates of surgical complications, and a shorter hospital stay.

This article deals with the electromagnetohydrodynamic Casson Nanofluid flow induced by a stretching Riga plate in a non-Darcian porous medium under the influence of internal energy change, Arrhenius activation energy, chemical reaction, and Melting heat transfer. The flow motion is induced as a result of the introduced mechanism that capable of controlling or assisting a weakly hydromagnetic fluid flow process called the Riga plate. In most of the literature, the thermophysical properties of the fluid are assumed to be constant. However, this present study bridges this gap by assuming that viscosity, conductivity, and diffusivity are all temperature-dependent. Also, the exponential decaying Grinberg term is used as a resistive force in this investigation due to the electromagnetic properties of the Riga plate in the momentum conservation equation. The resulting coupled nonlinear ordinary differential equations are solved by optimal homotopy analysis method (OHAM) and validated with Galerkin weighted residual method (GWRM). The results reveal that; Casson fluid exhibits a solid characteristic when yield stress is more than the shear stress, also the chemical reaction parameter reduces the nanoparticle volume fraction. Moreover, this article includes some future recommendations.

In this paper, we prove the existence of the weak solution for a second-order parabolic equation with a nonlinear diffusion term and present the finite difference method to solve it. We prove the existence of the approximate solution and the generalized solution.Then we provide the difference scheme to approximate the temporal derivatives and spatial derivative. The numerical results show that the proposed difference scheme is simple, easy to implement with high accuracy. In addition, the implicit scheme could be employed while the long-time behavior is considered.

In connection with the technological progress of mankind, the assessment of the impact of radiation on the human body and in particular on the brain and its cognitive functions is an important task. First of all, the relevance of such a task arises from the introduction of radiation therapy for brain tumors and radiation protection during manned flights beyond the Earth's magnetosphere. The crew and passengers on high-altitude air flights are also exposed to cosmic rays to some extent. We developed a neural network model of working memory based on biophysical conductivity to study radiation-induced disorders and found how known dose-dependent changes in the main parameters of neurons affect the spatiotemporal dynamics of the network. It turned out that radiation-induced changes in the properties of synaptic receptors lead to a loss of stability of specific activity patterns. This instability occurs at very low doses of heavy charged ions, but not for protons.

This paper proposes a comprehensive fishing strategy that takes into consideration the population density of fish and its current growth rate, which provides new ideas for fishing strategies. Firstly, we establish a phytoplankton-fish model with the impulsive feedback control depending on the density and rate of change of the fish. Secondly, the complex phase and impulse sets of this model are divided into three cases, then the Poincare map for the model is defined, and analyzed the properties of Poincare map. In addition, the sufficient and necessary conditions for the global asymptotic stability of the order-1 periodic solution and existence condition of order-k periodic solution are discussed. The action threshold depends on the density and rate of change of the fish, which is reasonable than earlier studies. The analysis method proposed in this paper also plays an important role in the analysis of impulse models with complex phase sets or impulse sets.

Induction of labor in the second trimester with facioscapulohumeral muscular dystrophy: a case report and literature reviewHongxia Li (PhD), Rongna Song (MD), Xiaoyuan Sun (MD), Xiaoyan Xu (MD), Yue Yang(PhD)Department of Obstetrics and Gynecology, Civil Aviation General Hospital, Beijing, ChinaCorrespondences to Dr Hongxia Li (PhD), Department of Obstetrics and Gynecology, Civil Aviation General Hospital, Beijing, 100123, China, E-mail: lihongxiapd@sina.comIntroduction: The aim of this literature review and case report was to point out the relationship between FSHD and induction of labor in the second trimester. Here we report a case of pregnancy-associated FSHD. FSHD is one of the most common forms of muscular dystrophy with a distinctive pattern of skeletal muscle weakness and a wide spectrum of disease severity. Patient Concerns: The case of a 24-year old pregnancy woman patient with FSHD was reported. Outcomes and Conclusion: the symptoms of FSHD did not worsen during pregnancy, the contraction of uterine smooth muscle was not affected.Keywords: FSHD, pregnancy, induction of labor, second trimester，case report

Background: This study was aimed to investigate evaluation of health literacy, behavioural and psychosocial characteristics in coronary artery patients. Methods: This study was carried out between March 2019 and March 2020 with 275 coronary artery patients aged ≥50 years in Kastamonu State Hospital. Clinical, behavioural characteristics, Turkish Health Literacy Scale-32 and Beck Depression Inventory were used to collect the data. Results: General health literacy index score was 31.7 and the prevalence of limited health literacy was 59.3%. Depressive symptom was found to be 33.4% in moderate/severe level. Limited health literacy was 58.3% among ≥65 years old, while it was 41.7% in the 50-64 age group (p<0.05). Adequate health literacy was 62.5% in males and 37.5% in females (p<0.05). Adequate health literacy was 2.8 fold higher among 50-64 age group, 3.1 fold higher among men, 3.4 fold higher among married and 5.3 fold higher among those who believe in the necessity of individual protective practices have more adequate health literacy levels (p<0.05). Health check-up, utilizing health service, cigarette and alcohol use, exercise and nutrition were the significant behavioural factors for health literacy levels (p<0.05). Mild level of depressive symptoms was more common among limited health literate patients. Conclusion: Health literacy was poor among coronary artery patients and behavioural and psychosocial variables were differed with health literacy levels. In order to develop cardiovascular health among these patients, health literacy-based interventions should be adopted to in coronary artery clinics especially for risky groups. Keywords: Coronary disease, coronary artery disease, health literacy, risk factors, life style, depression, patients

Background: Dyspepsia is a common problem and is frequently caused by gastro-oesophageal reflux disease (GORD) or gastritis. It is also related to cancer of upper Gastrointestinal tract as well as gastric stasis due to bowel obstruction. Subcutaneous Ranitidine was used subcutaneously with success in Palliative care. However, it is now withdrawn globally due to its association with cancer due an element in its composition. This paper presents the data from its use and argues that medications like Ranitidine should be allowed in Palliative care as these achieve comfort for patients at the end of life and Palliative care professionals should be consulted while withdrawing such drugs. Aims: To observe the response of dyspeptic pain in patients with malignant diseases when they are unable to tolerate oral medications. Patients and Methods: Prospective study of 22 consecutively admitted patients with Ranitidine syringe driver over one year period. Results: Out of 22, there were 13 males and 9 females with an average age of 68 years (range= 46 to 81). They were diagnosed to have Gastric cancer (10), Oesophageal cancer (6) or Malignant Bowel obstruction (6). Pain was recorded by Numeric Rating Scale (NRS 0 –10, with 0 being no pain). 4/22 started Ranitidine subcutaneously 50 mg whereas 18/22 were started on 150 mg. Other medications used in same syringe driver were Metoclopramide, Cyclizine, Haloperidol, Midazolam, Hyoscine Butyl Bromide, Octreotide or Levomepromazine. 10/22 reported improvement in NRS (2 – 8 drop). 4/22 improved on non-verbal assessment as they were too poorly to score. It was not possible to record response in 6/22. 2/22 continued to have same degree of pain. Local skin reactions were noted in 4/22 patients. Conclusion: Patients with dyspeptic pain may respond to Subcutaneous Ranitidine when oral route is not appropriate. Ranitidine can be mixed with most medication in Syringe driver. Local reactions or side-effects were not clinically significant. It is a useful medication in Palliative care but its withdrawn has now caused a vacuum in symptom management.

Threadfin porgy (Evynnis cardinalis) is an important commercial fishing target of bottom trawl fisheries in the northern South China Sea. It is mainly threatened by overexploitation and listed as endangered in the IUCN Red List. To investigate E. cardinalis population demographic history and genetic structure, fragments of the mitochondrial cytochrome c oxidase subunit I gene were sequenced for 162 individuals collected from Beibu Gulf, South China Sea. In total, 44 different haplotypes were identified, and the dominant widespread haplotype was found in all 11 sampling sites. Across the dataset, nucleotide diversity was low but haplotype diversity was high. Low pairwise comparisons of ΦST and high gene flow between all sampling sites revealed a genetically homogeneous population structure in Beibu Gulf, which indicated a single panmictic stock of E. cardinalis in this area. The star-like haplotype network, unimodal mismatch distribution, and significantly negative Tajima’s D and Fu’s Fs values indicated recent population demographic expansion of E. cardinalis. The mismatch distribution and Bayesian skyline plot results indicated that E. cardinalis from Beibu Gulf experienced colonization and demographic expansion during the late Pleistocene due to sea level fluctuations.