Acetaminophen (APAP) is a commonly used analgesics and antipyretic agent. The therapeutic or recommended dose of APAP is not associated with adverse effects. However, intentional or unintentional overdose of APAP causes acute liver injury or acute liver failure if treatment is delayed. Currently, APAP-induced liver injury is one of the major causes of acute liver injury in the United States and other western countries. C-Jun N terminal kinase (JNK) implicated in stress-related signaling pathway plays an indispensable role in the mechanism of APAP hepatotoxicity. JNK mediates depletion of mitochondrial glutathione in the metabolic phase and enhances oxidative stress to aggravate liver injury. In addition, JNK plays an important role in APAP-induced apoptosis, necrosis or other forms of cell death. Furthermore, JNK plays a role in regulation of endogenous immune system and aseptic inflammatory responses induced by APAP. However, JNK may promote cell regeneration after APAP-induced cell death. The present review therefore highlights the functions of JNK in APAP-induced liver injury.

Background: Owing to the coronavirus disease 2019 (COVID-19) pandemic, there is a shortage of hospital wards to accommodate the increasing number of patients, especially in intensive care units. Healthcare systems are collapsing in many countries. Therefore, it is necessary to reduce isolation time. Methods: We examined the effect of lopinavir/ritonavir administration in patients with SARS-CoV-2. To assess the viral load, duration and clearance of viable virus; cell culture and RT-PCR were performed in parallel. Results: No viable SARS-CoV-2 could be detected after administration of lopinavir/ritonavir with median time of viable viral clearance being one day after administration. The mean viral load in both upper and lower respiratory tract samples of lopinavir/ritonavir administered group was significantly lower than the group who were not treated with any antiviral agent. The duration of viable viral shedding was shorter in patients with lopinavir/ritonavir treatment compared with those without treatment. Conclusion: This study suggests that lopinavir/ritonavir treatment offers a possible method to reduce isolation time of patients infected with the SARS-CoV-2.

Chronic obstructive pulmonary disease (COPD) is one of the top 3 causes of death worldwide and induces increased economic and social burden. Acute exacerbation of Chronic obstructive pulmonary disease (AECOPD) is associated with disease progression, poor prognosis, and a decline in health-related quality of life. With the deepening of researches, especially large sample investigation and data analysis, more and more factors related to the prognosis of patients with AECOPD have been reported. We reviewed the risk factors associated with poor prognosis in patients with AECOPD including old age, low BMI, obesity, smoking history, severity of disease, previous frequency exacerbation, hypoxaemia, hypercapnia, comorbidities, and microbiology colonization/infection. In contrast, long-term inhalation therapy and pulmonary rehabilitation can improve the patient’s prognosis. The material upon which this review is based was obtained from various published literature searched in PubMed.

Fixed circle problems belongs to a realm of problems in metric fixed point theory. Specifically, it is a problem of finding self mappings which remain invariant at each points of the circle in the space. Recently this problem is well studied in various metric spaces. Our present work is in the domain of the extension of this line of research in the context of fuzzy metric spaces. For our purpose, we first define the notions of a fixed circle and of a fixed Cassini curve then determine suitable conditions which ensure the existence and uniqueness of a fixed circle (resp. a Cassini curve) for the self operators. Moreover, we present a result which prescribed that the fixed point set of fuzzy quasi-nonexpansive mapping is always closed. Our results are supported by examples.

We present the case of a severely symptomatic patient with a malfunctioning aortic bioprosthesis and severe multidistrict atherosclerosis that was addressed to our unit for transcatheter valve-in-valve implantation. The imaging and clinical assessment that led to the selection of the access route is discussed.

Background and Purpose Alzheimer’s disease (AD) is characterized by deposition of Amyloid-β-peptide (Aβ) plaques, memory impairment and dysfunction of renin-angiotensin system: the regulator arm is decreased whereas the classic Ang-II/III arm is elevated. This study aimed to investigate effect of Ang-(-7) on Aβ40-impaired memory and change of nAChR and mGluR1 sub units in amygdala(AMG) and hippocampus (HC). Experimental Approach In this study, AD model was induced by bilateral intra-amygdaloid injection of 3 nmol/3 µL amyloid beta peptide (Aβ40). Angiotensin (Ang)-(1-7) was injected ICV at 11.1 nmol/0.25 µL/h for 7 days. Memory was evaluated by measuring latency, correct (CC) and error choice (EC) in 8-arm radial maze (RAM) test. The expression of α7, α4 and β2 subunits of the nicotinic receptor (nAChR) and the metabotropic glutamate receptors (mGluR1) group subunits (mGluR1 and mGluR5) in AMG) and HC were analyzed by Western-blotting method. Key Results Aβ40 and Ang-(1-7) displayed differential effects on nAChR, mGluR1 and mGluR5 and RAM. Aβ40 decreased CC, increased EC and prolonged the latency. Ang-(1-7) only decreased Aβ40-induced EC. In AMG, Aβ40 decreased α7, α4nAChR and mGluR5, but increased mGluR1. Ang-(1-7) decreased α7nAChR and mGluR5, but increased mGluR1, an effect increased by Aβ40. In HC, only Ang-(1-7) increased β2 nAChR, an effect decreased by Aβ40. Conclusion and Implications Aβ40 impaired RAM performance and decreased nAChR and mGluR5 especially in AMG but increased mGluR1 in both AMG and HC. Ang-(1-7) improved Aβ40-induced EC, increased β2 nAChR in HC, reversed the Aβ40-reduced α4 nAChR, and furthered Aβ40-increased mGluR1 in AMG.

Up-dosing to 600mg Omalizumab for Chronic Spontaneous Urticaria: More Effective Than 300mg?Short running title: Omalizumab Up-dosing for UrticariaRachel S. Simpson, BScH1, Ariba Quidwai1,2* Jason K. Lee, MD11Toronto Allergists, Toronto, ON, Canada2Western University, London, ON, Canada*Please note Ariba Quidwai has no academic degree achieved at the time of submission.Corresponding Author: Rachel Simpson, Email: rachel.simpson@queensu.ca, Address: 123 Edward St. Suite 920, M5G 1E2, Toronto, ON, Canada, 647-352-2554Conflicts of interest: Jason K. Lee reports receiving research grants, clinical research trial funding, and speaker fees from Novartis, Regeneron, Sanofi, Sanofi Genzyme, AstraZeneca, Genentech, Roche, and GlaxoSmithKline. Rachel S. Simpson does not report any conflicts of interest. Ariba Quidwai does not report any conflicts of interest.Funding Source: This research did not receive any specific grants from funding agencies in the public, commercial, or not-for-profit sectors.Ethics Statement: Study was conducted in accordance with the 2008 Declaration of Helsinki.Keywords: chronic spontaneous urticaria, omalizumab, up-dosing, 600mg, 300mgAbbreviations: Chronic Spontaneous Urticaria (CSU), Immunoglobulin E (IgE), Fragment Crystallizable (FC), Every 4 Weeks (q4wks), Urticaria Activity Scores Over 7 Days (UAS7),Word Count: 598Figures: 0, Tables: 1

Almost all biological models use either the Droop or Monod form to describe the resource-basedgrowth of a living organism. Empirical evidence overwhelmingly suggests the Droop form describesdata more accurately than the Monod form, however, the Monod form is more popular due to itssimplicity. Focusing on phytoplankton, we illustrate the underlying logics behind these two formsvia conceptual comparison, experimental data validation, transient and asymptotic dynamics. Theconceptual illustration provides the primary difference in their mechanisms via a paradox. Datavalidation is tested via field and laboratory experiments. The Droop and Monod forms haveconsistent asymptotic dynamics in closed nutrient, whereas the transient dynamics are significantlydifferent when the nutrient update rate is small. In addition, we decipher Michael Droop's privatelast statements on unifying the Droop and Monod forms as well as simplifying the Droop form.This article aims to guide future model development with any resource-based growth.

Understanding how tree individuals allocate whole-tree total nonstructural carbohydrate (NSC) between growth and storage is key to reveal the response of altitudinal treeline to climate warming. Yet, modellings of total carbon allocation currently ignore local adaptation under cold stress. We used a reciprocal transplant experiment and an experimental warming treatment to identify whether low temperature causes genetic differentiation in treeline species Larix chinensis. The results show that the ratio of nonstructural carbohydrate storage to growth (R-value) which presents an explicit C-based tradeoff of growth-storage is influenced neither by adaptation nor by plasticity. High-elevation trees require a stable proportion of NSC storage to maintain survival, leading to convergence in R-value, while the low-elevation populations show stronger co-gradient plasticity. Warming does not eliminate the advantage of local adaptation in the proportion of NSC storage, supporting the perspective that cold-adapted edge populations do not change heritable variation in carbon allocation under climate warming.

Anomalous left coronary artery originated from the pulmonary artery (ALCAPA) is a rare cardiac abnormality (incidence: <0.5%). We experienced an extremely rare case of ALCAPA that discovered with the self-reported symptom of epigastralgia for two years, though the abdominal examinations were totally normal. Various echocardiographic and CTA methods were useful for its diagnosis.

Generalisation of dynamical processes across natural systems is difficult because of their complexity and unobserved variables. The hope is that generalisation may be achieved if we model adequately the complexity of systems, and observe them in sufficient detail. Yet, there is still limited support for this claim. We investigate this by looking at the consistency of ecological interactions across three replicates of a three-species prey-predator system, well-observed in an artificial environment, using neural ordinary differential equations. We find that dominant interactions are consistent across the replicates, while weaker interactions are not, leading to different dynamical patterns across replicated systems. Our study hence suggests that generalisation of dynamical processes across systems may not be possible, even in simpler systems in ideal monitoring conditions. This is a problem because if we are not able to make generalisations in a simple artificial system, how can we make generalisation in the real world?

Capripoxvirus, a member of the poxviridae family causes three economically important diseases in ruminants namely, lumpy skin disease (LSD) in cattle, sheeppox in sheep, and goatpox in goats. Albeit non-zoonotic in nature, they have the potential to cause high economic loss among the farmers. Capripoxvirus members share common structural proteins and can rise cross-immunity among them. The present study aimed to design a recombinant chimeric vaccine from immunogenic proteins of these three members to protect all the host species by using immunoinformatics analysis and adding approved adjuvants. The palmitoylated EEV (Extracellular Enveloped Virion) membrane glycoprotein of LSD virus, SPPV-ORF 117 of sheeppox virus, B5R (EEV host range protein) of goatpox virus, and a common protein to all the members, P32, were the major immunodominant proteins used in the present chimeric vaccine construction. Several computational programs were employed to define the most immunogenic regions in selected proteins and different possible adjuvants and universal T-helper agonists were linked to the new construct. The designed vaccine construct was examined for physicochemical properties, immunogenicity and the 3D model was designed by using reliable software. Docking analysis and Molecular Dynamics simulation were carried out to determine the interaction between the designed vaccine and TLR molecules. Consequently, the lowest energy value showed the greater ability of the designed vaccine to interact with TLRs to induce an immune response. Besides appropriate physicochemical properties and acceptable stability in different host cells, the final designed vaccine is expected to have potential in stimulating both the humoral and cellular responses.

Responses to Ventricular Overdrive Pacing during Wide QRS Tachycardia: What is the Mechanism?Wentao Gu MD1, Xinping Luo MD1, Jian Li MD1, Jinjin Zhang MD1, Nanqing Xiong MD1*1. Department of Cardiology, Huashan Hospital Fudan University, 12 Wulumuqizhong Road, Jing’an District, Shanghai 200040, China*Corresponding author: Nanqing Xiong MD, Department of Cardiology, Huashan Hospital Fudan University, 12 Wulumuqizhong Road, Jing’an District, Shanghai 200040, China. E-mail: huashancardio@163.comKey words: wide QRS complex tachycardia, ventricular overdrive pacing, supraventricular tachycardia, AV reentrant tachycardia, orthodromic His activationFunding: (None)A 35-year-old female presenting with recurrent palpitation was referred for electrophysiology study. Short episodes of narrow QRS tachycardia could be recorded on ECG (Figure 1). During electrophysiology study, the tachycardia could be readily induced with atrial pacing or programmed atrial extrastimuli, but usually terminated in seconds, making it difficult to perform diagnostic maneuvers. When it spontaneously changed to a wide QRS tachycardia, a burst of ventricular overdrive pacing (VOD) was delivered which turned it back to the narrow complex one (Figure 2). What can be learned from the response?The first 4 beats in this tracing showed wide complex tachycardia (WCT) with right bundle branch block (RBBB) morphology and 1:1 ventriculo-atrial ratio. Candidates for diagnosis could be ventricular tachycardia, supraventricular tachycardia (SVT) with RBBB, bundle branch reentrant tachycardia and preexcited tachycardia. An H-V interval of 53ms approximating that during sinus rhythm excluded ventricular tachycardia from myocardium and preexcited tachycardia. The last 4 beats were clinical narrow complex tachycardia with the same cycle length, H-V interval and atrial activation sequence (earliest A at CS7-8) as the WCT, highly indicating that the WCT was SVT with functional RBBB caused by continuous concealed activation from left bundle branch before VOD peeled back the refractoriness of the right bundle branch in the following beats. In addition, A right-sided accessory pathway (AP) was unlikely given the same H-A interval (127ms, measured to CS7-8) with and without RBBB [1].The middle 4 beats demonstrated progressive change in QRS, from fusion to probable fully-paced morphology during VOD. The 3rdbeat advanced the subsequent A without atrial activation change, indicating the presence of a septal AP. However, post-pacing interval (PPI) was 125ms over tachycardia cycle length (TCL) with V-A-H-V response, which argued against AV reentrant tachycardia (AVRT) utilizing a septal AP. Note that His signal was found after the 3rd and the 4th stimulating artifact. Considering the extremely short interval between the 3rd artifact and the subsequent His (17ms), it could hardly be a retrograde His, but was activated in an orthodromic direction instead. A progressively increased A-H interval after the 2nd, 3rd and 4thpacing suggested decremental conduction in AV node before orthodromic His capture. When atrium was entrained, anterograde conduction to the His bundle during VOD supported the diagnosis of AVRT and excluded AV nodal reentry [2]. The long PPI was associated with the delay of the first return His-V following VOD-induced decremental AV nodal conduction. The corrected PPI-TCL was 78ms after subtracting the difference between the first return A-H and tachycardia A-H from PPI [3]. The AP was successfully ablated at left posterior septum, which rendered the tachycardia non-inducible.

Introduction Data on antibody response following COVID-19 in kidney transplant recipients is scarce. We performed a cross-sectional study to investigate antibody response to COVID-19 among kidney transplant recipients. Design We recruited 46 kidney transplant recipients with RT-PCR confirmed COVID-19 and 45 recipients without COVID-19 history. We also constructed two control groups (COVID-19 positive and negative) from a historical cohort of health care workers. We used age and sex-based propensity score matching to select eligible subjects to control groups. We measured SARS-Cov-2 IgG levels quantitatively using the Abbott ARCHITECT system. An antibody level above 1.4 S/C defined positivity. Results Transplant recipients with COVID-19 had a higher BMI, and COVID-19 history in a household member was more common than that of the transplant recipient without COVID-19. IgG seropositivity rate (69.6% vs 78.3%, p=0.238) and median IgG level (3.28 [IQR 0.80-5.85] vs 4.59 [1.61-6.06], p=0.499) were similar in COVID-19 positive transplant recipients and controls. There was a trend toward lower antibody levels in kidney transplant recipients associated with a longer duration between RT-PCR and antibody testing (r=-0.532, p<0.001). Conclusion At the early post-COVID-19 period, transplant recipients have an antibody response that is similar to controls. However, antibody levels and associated immunity should be closely observed with longer follow-up durations.

There is strong desire among healthcare workers (HCWs) to use proper personal protective equipment (PPEs) due to their close proximity with COVID-19 patients. Jordan has no data on compliance and adherence to these infection prevention control (IPC) guidelines.Aim: Investigating HCWs’ level of perceived compliance and barriers with PPEs, as well as influencing factors, to identify strategies to be implemented in order to address the rise in healthcare worker infection rates. Methodology: This was a cross-sectional correlational study conducted over one month period during the ‘second wave’ surge. It consists of HCWs from various hospital sectors who admit COVID-19 patients in Jordan’s three major geographical areas. A nonrandom convenient sample was recruited to complete a self-administered predesigned tool via online. Results: Of the 285 recruited participants, 36.1% had previously been diagnosed with COVID-19. Around 71% received training on PPEs use. The perceived compliance was good for (PPEs) usage (mean 2.60 ± 1.10). A significant higher compliance level was correlated with previous diagnosis with COVID-19, working with patients diagnosed with COVID-19and having a direct contact with a family member older than 45 years old (p<0.01). The main perceived barriers to the use of PPEs during patient care were: unavailability of full PPEs every time they needed (35% ), interference with their ability to provide patient care (29%), no enough time to comply with the rigors of PPEs (23.2%) and working in emergency situation (22.5%). With regards to perceived barriers those working with patients diagnosed with COVID-19 reported significantly higher levels of barriers and those who reported having a direct contact with a family member older than 45 years old showed significantly higher level of barriers.Conclusion: To limit further transmission, a series of interventions in healthcare organizations are required, including prioritization of PPE procurement, training, and monitoring to ensure adequate resources for IPC

Objectives: To examine the cyclic fatigue resistance and surface topography of TruNatomy (TN; Dentsply Sirona, Maillefer, Ballaiges, Switzerland) and ProTaper Gold (PTG, Dentsply Tulsa Dental Specialties, Tulsa, OK, USA) nickel-titanium rotary files and to evaluate the presence of alterations to the surface topography following instrumentation in simulated curved canals . Materials and Methods: Twenty-four nickel-titanium instruments; twelve each of TN and PTG file systems were tested for cyclic fatigue resistance. All the files were rotated in a simulated root canal with a standardized diameter, angle of curvature, and a radius of curvature of a specific cyclic fatigue testing device until fracture occurred. Time to fracture was recorded for each instrument in each group in seconds. The fractures instruments were subjected to atomic force microscopy analysis. Average roughness and root mean square values were chosen to investigate the surface features of endodontic files. The mean values and standard deviation were then calculated. Data was analyzed using Mann Whitney U test. Results: The Time taken to fracture was marginally higher in PTG instruments in comparison to the TN file systems. The PTG files exhibited higher surface roughness when compared with the TN files (p < 0.05). Conclusions: The TN file system had a higher cyclic fatigue resistance than PTG. The cyclic fatigue causing the file breakage did affect the surface topography of the files. The PTG files showed a higher level of surface porosity value than the TN files.

APS is an autoimmune disease in which patients are at increased risk of thrombosis and/or pregnancy complications. CAPS is a form of severe APS with multisystemic involvement and microvascular thrombi. Both entities are treated with anticoagulation and multimodal immunotherapy regimens. We present two APS cases in which patients did not meet criteria for CAPS, but needed CAPS-like treatment to stop the progression of thromboses. This case series stresses the importance of stringent follow-up in APS to ensure regression of thromboses. They also emphasize the need of aggressive immunotherapy in refractory APS.

Rheumatoid arthritis (RA) is a chronic, severe inflammatory disease, characterized by progressive bone, cartilage, and joint destruction.miRNAs are epigenetic regulatory mechanisms that participated in broad and long-term changes in gene expression and involved in various pathophysiological pathways related to several autoimmune diseases such as RA. The regulated expression of miRNAs in synovia, T cells, or Peripheral blood mononuclear cells (PBMCs) from RA patients is associated with inflammation, angiogenesis, osteoclastogenesis, innate immunity, and cartilage synthesis. This work is designed to analyze the expression of certain miRNAs in PBMCs of 30 RA patients compared to 20 healthy controls using quantitative real-time polymerase chain reaction (qRT-PCR). Selected miRNAs were categorized into 3 main groups: miRNA participating in the inflammatory response (miR-16, miR-146a, and miR-155), miRNA participating in the angiogenesis process (miR-17 - miR-221 and miR-222) and muscle-specific myomiR (miR-133b and miR-206). The data showed significant elevation in the fold change expression levels of all studied miRNAs in PBMCs of RA patients as compared with those in healthy controls. The receiver operator characteristic curve (ROC) curve analysis of miR-206 showed the best sensitivity and specificity value among studied miRNAs (70% sensitivity and 85% specificity). Our results suggest that the elevated expression of tested miRNAs might be involved in RA pathology including inflammation, angiogenesis, and bone affection leading to joint destruction and bone deformity. A better understanding of the role of these miRNAs will enable a new advanced strategy to ameliorate disease progression in RA.

Introduction: SLE is a chronic autoimmune rheumatic disease that is caused by autoantibodies and immune complexes for unknown reasons and causes damage to cells and organs. The aim of this study was to evaluate the association of ANA panel antibody with clinical manifestations in patients with SLE Methods: This retrospective cross-sectional study was performed on 110 patients with SLE. Clinical manifestations were evaluated according to ACR and SLICC criteria. In serum, the surface of ANA Profilling antibody was examined Results: There was no significant relationship between ANA profiling tests and disease manifestations. Except for the Anti-Ds DNA test, which was significantly associated with the clinical manifestations. (P <0.05). The results obtained from the logistic regression model show that none of these variables age, sex, malar rash, discoid, oral ulcer, nephritis and arthritis have a significant effect on the outcome Anti-U1RNP / Sm (RNP / Sm), Anti-RO- 52 recombinants, Anti-La / SS, Anti-SM not available (P > 0.05) Only age at onset has a significant effect on Anti SSA-Ro 60 (SSA) and Anti-Ds DNA tests. That is, on average, for each year of increasing the duration of the disease, the chance of a positive chance is about and about 16% increases for both tests. No significant correlation was observed with other test results at baseline. Conclusion: The present study shows an increase in the age of onset of the disease and also a decrease in the percentage of renal disorders compared to the study of the previous two decades in Iran.

Disulfide bond reduction occurred now and then during a recombinant protein manufacturing. Their reduction often led in the loss of batches. Various prevention measures were developed. Their implementation in a manufacturing inevitably increases its operation complexity and even might impact its product qualities and process performances. For monoclonal antibody, a decrease in main peak and an increase in acidic peak were observed when air sparging, a reduction prevention measure, was applied during a harvested cell culture fluid (HCCF) hold in the literature (Mun et al., 2015) and in our lab and at-scale manufacturing. The change in the filterability of HCCF was noticed as well in our lab and at-scale manufacturing when air sparging or air overlay was applied. It is highly desirable to apply a reduction measure only if necessary and to apply no strong measure if a moderate one works. The reduction occurrence is determined both by the reduction sensitivity of a recombinant molecule and by the reduction power of HCCF. The reduction power of HCCF varies largely and depends on cells, lysis level, growth stage, and culture conditions. The method of the quantitative risk assessment of disulfide bond reduction was reported here. The quantitative assessment is realized by comparing the reduction sensitivity of a recombinant molecule with the reduction power of its HCCF.

The Covid-19 pandemic has caused the closure of many clinics and wards, some of which have been equipped for the management and care of ill patients. In the last year, many countries have adopted a common plan to contain hospital infections by limiting the execution of respiratory function tests (TFR), including spirometry, exclusively to urgent / necessary cases. All the recommendations of the major scientific societies regarding the use of spirometry in the Covid era were formulated in spring 2020, in the initial stages of the pandemic. Currently, the continuous acquisition of knowledge about Covid-19 and the vaccination of healthcare personnel, allows us to face a new phase of the pandemic, in which it is possible for us to adapt our lifestyle and health procedures in order to reduce the risk of contagion in the hospital setting. In the following article, we have reported the recommendations of major international and national respiratory societies, emphasizing the need for a review considering new scientific advances. In addition, we shared our work experience at the Pediatric Respiratory Disease Clinic of University of Campania ‘Luigi Vanvitelli’ during the last months of the pandemic.

Objective To describe the implementation and outcomes of an Eye Movement and Desensitisation Reprocessing (EMDR)-treatment-program for women with Posttraumatic stress disorder (PTSD) after childbirth. Design Prospective cohort-study with pre- and post measurements. Setting A large university hospital in the Netherlands. Population Women who gave birth to a living child at least 4 weeks ago, with a PTSD diagnosis, or severe PTSD-symptoms combined with another DSM-5 diagnosis, who provided written informed consent. Methods The intervention applied was EMDR, an evidence-based psychotherapy for patients with PTSD. Main Outcome Measures The PTSD Checklist for DSM-5 (PCL-5) was administered before and after treatment. Trauma history was assessed before treatment with the Life Events Checklist for the DSM-5 (LEC-5), the Childhood Trauma Questionnaire (CTQ-SF) and the Childbirth Perception Scale (CPS). Results Forty-four women were referred, 26 met the inclusion criteria. After treatment, none of the women met the criteria for diagnosis of PTSD anymore after on average 5 weekly sessions of EMDR-treatment. These outcomes are extra promising, as they were achieved in quite a complex group of women with relatively high psychiatric comorbidity (64%) and high rates of previous mental health treatment (80%). Conclusions Implementing an EMDR-therapy treatment program for women with after childbirth PTSD in the context of a large academic hospital is feasible and effective. Key factors for success include a close collaboration between the relevant hospital departments and a thorough case conceptualisation addressing the aetiology of the PTSD. Funding No external funding. Keywords Posttraumatic Stress Disorder after childbirth, EMDR-therapy, Psychiatry, Implementation.

Objective: To find the association of leptin-receptor gene(LEPR) polymorphism with gestational diabetes mellitus (GDM) and its role in altered leptin levels, insulin resistance, and dyslipidemia in GDM. Design & Setting: This prospective cross-sectional study was conducted in Justice KS Hegde Hospital, Mangalore, India. 100 GDM patients and 100 gestational age and BMI matched normal glucose tolerant pregnant women were recruited as cases and controls. Method: Genotyping of leptin-receptor (LEPR)Gln223Arg was performed by PCR-RFLP. Fasting blood sugar, leptin, insulin, C-peptide, and lipid profile were performed. Various insulin-resistance models were constructed using suitable formulae. Results: No significant association was found between leptin-receptor gene polymorphism and leptin levels, insulin-resistance in GDM. However, Odd’s ratio showed that individuals with A allele were at 1.25 times higher risk of developing GDM. HOMA-B cells significantly varied among Lep-R genotypes, values being double in AA genotype, compared to AG, ten times higher in AA compared to GG. The value was four times higher in AG compared to GG. Conclusion: It could be concluded from the study that, there are no significant association between leptin receptor, LEPR Gln223Arg alleles and gestational diabetes, leptin levels, and insulin resistance. However, subjects with the ‘G’ allele for LEPR at higher risk of hyperleptinemia. C–peptide based insulin resistance models were elevated in GDM patients. The study can establish a cycle of gene polymorphism altering leptin levels, which in turn can alter insulin secretion and insulin resistance, contributing to dyslipidemia of pregnancy and gestational diabetes.

Objectives To profile patients’ characteristics, in-hospital results and recurrence rates after radiofrequency ablation of atrial fibrillation (RAAF) in South America through a systematic review and meta-analysis of observational data. Methods We comprehensively searched for papers published in peer-reviewed medical journals and for abstracts presented in medical conferences of the region from January 1st, 2010, through June 29th, 2020. We included single-centre studies from South America with ≥10 patients receiving RAAF, excluding those reports aimed to specific populations such as permanent atrial fibrillation, patients with structural cardiopathy, or re-do procedures. Results Twenty-seven cohorts from 5 countries pooling 3909 patients were included in a random-effects meta-analysis. Pooled estimates for patients characteristics were age 57.6 years (95% CI 55.7-59.5), male gender 71.5% (95% CI 67.0%-75.6%), hypertension 54.2% (95% CI 45.4%-62.8%), paroxysmal atrial fibrillation 79.8% (95% CI 71.3%-94.5%), CHAD2 score 1.2 (95% CI 0.5-1.9). Pooled estimate rate of acute procedural success was 91.1% (95% CI 82.2-95.8%; I2 87.5%), and those of in-hospital complications were: stroke 0.6% (95% CI 0.3-1.2%; I2 0%), cardiac tamponade 2.3% (95% CI 1.4%-3.7%; I2 46.3%), hematoma 3.5% (95% CI 2.0-6.1; I2 57.0%), pseudoaneurysm 1.2% (95% CI 0.6-2.3; I2 0%), arteriovenous fistula 2.5% (95% CI 1.6-4.1; I2 0%), with no cases of oesophageal-atrial fistula nor death. Pooled estimate for arrhythmia recurrence (excluded 3-months blanking period) at 12 months was 19.9% (95% CI 17.0-23.1), at 24 months 26.9% (95% CI 21.7-32.8) and at 36 months 29.9% (95% CI 22.5-38.4). Conclusion In-hospital results of RAAF in South America were worse than published international registries, even when included populations profile was of lower risk as reflected in younger age and less prevalence of non-paroxysmal AF. Late and very late recurrence rates were appropriate. This study provides a real-life framework for the analysis of the performance of this technology in the region.