We report a case in which bilateral atriomegaly allowed the assessment of a mitral bioprosthesis and other cardiac structures through a subscapular retrocardiac view, rarely used in clinical practice.

1. Crambescins are guanidine alkaloids from the sponge Crambe crambe. Crambescine C induces metallothionein genes and nitric oxide is one of the triggers. We assayed in silico, in vitro and, in vivo the effect in comparison with two analogs: crambescine A, and homo-crambescine C 2. HepG2 gene expression was analyzed using microarrays and additionally assays used isolated rat aortic rings. The targets of crambescines were studied in silico. In vivo vasodilation in rats was done by direct measurement. 3. Crambescines C and homo-crambescine C, but not crambescine A, induced metallothioneins transcripts. HepG2 cells with crambescine C increased nitric oxide production. Vasodilation was observed in aortic ring and in vivo after injection in rats. In silico analysis points to eNOS and iNOS as targets of crambescin C and source of nitric oxide increment. 4. Crambescin C effect is mediated through crambescing binding to the active site of eNOS and iNOS. In isolated rat aortic rings CC and HCC induced an endothelium-dependent relaxation related to eNOS activation and an endothelium-independent relaxation related to iNOS activation, hence both compounds increase NO and reduce vascular tone. 5. Crambescin C1 docking studies in iNOS and eNOS active site revealed hydrogen bonding of the hydroxylated chain with residues Glu377 and Glu361, involved in the substrate recognition, and explains its higher binding affinity than Crambescin A1. The later interaction and the extra polar contacts with its pyrimidine moiety, absent in the endogenous substrate, explain its role as exogenous substrate of NOSs and NO production.

Background and Purpose: As a first-line clinical drug, thienopyridines still have many unsatisfactory aspects, such as the low bioavailability of clopidogrel and the high bleeding risk of prasugrel. Our team synthesized deuterium clopidogrel(the patent has been obtained in China) to mitigate the disadvantages of clopidogrel clinical application, including a slow onset, greater influence of gene polymorphism and drug-drug interaction. Experimental Approach: Molecular docking technology was used to analyze the affinity between deuterium clopidogrel and P2Y12 receptor; The levels of active metabolites of deuterium clopidogrel in vivo were detected by HPLC/MS-MS and the activities of main metabolic enzymes was analyzed; Subsequently, platelet aggregation function, thrombus model were used to evaluate the pharmacodynamics of deuterium clopidogrel; Finally, the safety of deuterium clopidogrel were evaluated by blood routine, PT, APTT, bleeding time, serological tests, liver pathological biopsy, liver cell apoptosis and apoptosis-related protein detection. Key Results: The introduction of deuterium makes the binding of clopidogrel to P2Y12 receptor more stable, improves the concentration of active metabolites, reduces the inhibition of major metabolic enzymes including CYP2B6, CYP2C9 and CYP2C19, leading to the better anti-platelet effect without increasing the risk of bleeding, and leads to the decrease in the degree of hepatocyte apoptosis. Conclusion and Implications: In terms of both efficacy and safety, deuterium clopidogrel has a better effect, the present findings render deuterium clopidogrel a promising candidate for clinical application in thromboembolism disease and provides a new idea for the development of this new antithrombotic drug.

Background: Antenatal inflammation is associated with the increasingly severe and negative neurological findings of neonatal ecephalopathy. A reduction in antenatal inflammation reduces neurological damage. The effect of therapeutic hypothermia on inflammation is not clear and remains the subject of research. Aim: The aim of this study was to investigate the inflammatory cell response in neonatal ecephalopathy cases treated with therapeutic hypothermia. Methods: The study included a total of 102 cases, 51 cases diagnosed with perinatal asphyxia and a control group of 51 healthy newborns. Blood samples were taken before therapeutic hypothermia treatment and at the 24th and 72th hours of treatment in patients with perinatal asphyxia. In the control group, blood samples were taken in the first 6 hours postnatally. Results: In the asphytic group, mean leukocyte (p<0.001), neutrophil (p<0.001), and lymphocyte (p=0. 014) values within the first 6 hours were significantly higher than those of the control group. The specificity for leukocyte, neutrophil and lymphocyte (measured before TH) was 80.4%, 88.2% and 60.8%, and sensitivity was 84.3%, 88.2% and 62.7%, respectively. The mean leukocyte, thrombocyte, and neutrophil values during the first 6 hours after delivery were significantly higher than the mean values at the 24th and 72nd hours after TH (p<0.001), and the mean platelet volume values were significantly lower (p<0.001). Conclusion: High leukocyte, neutrophil and lymphocyte values and low thrombocyte count in the first 6 hours of life may be an early sign of perinatal asphyxia and can be used as a marker to start treatment. It is thought that by decreasing the number of inflammatory cells, therapeutic hypothermia reduces the severity of encephalopathy and potentially negative results.

Aims: Premature ejaculation (PE) is a common sexual dysfunction that significantly affects the quality of life of the patient and their partner. We aimed to compare efficacy and safety of the combination therapy with biofeedback-guided pelvic floor exercise therapy (BFT) and dapoxetine 30 mg. Results: Patients were divided into three groups as BFT, dapoxetine 30 mg and combination with BFT and dapoxetine 30 mg. The patients were compared with the intravaginal ejaculatory latency time (IELT) pre-treatment and post-treatment 1st and 3rd months. The mean IELTs of the patients in Group 1 were 40 sec in pre-treatment, 115 sec at the end of the 4th week and 140 sec at the end of the 12th week. The IELT values of the patients in Group 2 were 40 sec in pre-treatment, 145 sec in the 4th week and 170 sec in the 12th week . The IELT values were calculated in Group 3 as 42.5 sec in pre-treatment, 185 sec in the 4th week and 205 sec in the 12th week When the IELT was statistically compared between the groups at 1st and 3rd months, the duration in combination group was found to increase significantly (p < 0.001). Discussion: Pelvic floor muscles play an important role in sexual function. Rehabilitation of pelvic floor muscles provides two-stage efficiency with electrostimulation and physiokinesitherapy; it aims to improve the contractile forces of the perineal muscles and increase the urethral sphicter closure force. Besides, the rehabilitation of pelvic floor muscles allows patients to control the contractions of the right muscle group accompanied by biofeedback Conclusion: Combination therapy with BFT and dapoxetine 30 mg in lifelong PE treatment is a good alternative with low side effect profile and acceptable continuous efficiency

Ecological theory suggests that predators should keep prey populations healthy by reducing parasite burdens. However, empirical studies show that predators often have minimal effects on, or even increase, parasitism in prey. To quantify the overall magnitude and direction of the effect of predation on parasitism in prey, we conducted a meta-analysis of 50 empirical studies. We also examined how key attributes of these studies, including parasite type, study design, and predator interaction type (consumptive vs. non-consumptive) contributed to variation in the predator-prey-parasite interaction. We found that the overall effect of predation on parasitism differed between parasites and parasitoids and that predator interaction type, and whether a predator was a non-host spreader of parasites were the most important traits predicting the parasite response. Our results suggest that the mechanistic basis of predator-prey interactions strongly influences the effects of predators on parasites and that these effects, while context dependent, are predictable.

Ecological science aims for general principles that are transferable, predictive and widely applicable across different local situations. However, natural history, in contrast to ecology, is rife with examples of the particular. In this study, we reject the validity of the general expectation that diversity hot-spots contribute to overall species diversity accordingly to their species richness. In eleven 1-hectare forest plots in four distinct areas across Great Britain, we recorded 550 epiphytic and epixylic lichen species, i.e. 73 % of the presently known British epiphytic flora. Species richness per site was regionally stratified and mirrored by functional diversity, but species composition differed among sites, and was unrelated to the distance between sites. Rare species and species restricted to a single site consistently represented a high proportion of the local species richness. This demonstrated that each site contributed substantially and evenly to the regional and national biodiversity of epiphytic lichens in Britain. Several functional attributes are quite specific to rare species, so further disappearance of rare species would lead to disproportionately high loss of overall functional diversity.

Transseptal puncture for atrial fibrillation ablation is a safe and common procedure, however, complications, such as cardiac tamponade, are possibly fatal if not recognized and treated. Our goal is to report a case in which management of an inadvertent puncture of the posterior wall of the left atrium was accomplished using an unusual technique, followed by successful pulmonary vein isolation, and without the need of subsequent subxiphoid puncture.

Objective: This study was designed to assess red blood cell (RBC) transfusion frequency in very-low-birth-weight (VLBW)infants and to understand the relationships between the number of transfusions and the composite risk of bronchopulmonary dysplasia (BPD), retinopathy of prematurity (ROP), and mortality. Method: VLBW infants admitted from May 2017 – July 2019 were retrospectively analyzed. Relationships between gestational age (GA), birth weight (BW), numbers of transfusions, and comorbidities were evaluated through Pearson correlation analyses. The relationship between factors of interest (Model 1: GA, BW, comorbidities; Model 2: number of transfusions) and composite risk was assessed via a logistic regression approach. Results: Overall,408 VLBW infants were enrolled, of whom 74% underwent at least one RBC transfusion. Infants with a GA<30 weeks, a BW<1,250 g, and comorbidities were more likely to require RBC transfusion. Number of transfusions was related to the risk of analyzed composite outcomes, with risk correlating with undergoing >3 transfusions (OR: 3.275, 95% CI: 1.707–6.275). Conclusion:We found that undergoing > 3 RBC transfusions was related to an increased risk of BPD, ROP, or death in VLBW infants.

We analyze the system of reaction-diffusion equations of Fitzhugh-Nagumo (FHN) type on open bounded convex domains $\mathcal{D} \subset \mathbb{R}^{d} (d \leq 3)$ with Robin boundary conditions. Classical Faedo-Galerkin approach \cite{lions1969quelques} and compactness arguments are utilised to show the existence, uniqueness, and continuous dependence on initial data of weak and strong solutions. Moreover, we introduce a complete case study for the application of this approach to Fitzhugh-Nagumo system.

The sufficient condition of the existence of solutions to some superlinear p-Laplacian impulsive differential equations with nonhomogeneous Neumann boundary conditions is obtained. We get two theorems via variational methods and corresponding critical-points theorems. To reveal the value of obtained theorems, two examples are presented combining with the Newton-iterative method.

The expanding knowledge of the variety of synthetic genetic elements has enabled the construction of new and more efficient genetic circuits and yielded novel insights into molecular mechanisms. However, context dependence, in which interactions between proximal (cis) or distal (trans) elements affect the behaviour of these elements, can reduce their general applicability or predictability. Genetic insulators, which mitigate unintended context-dependent cis-interactions, have been used to address this issue. One of the most commonly used genetic insulators is a self-splicing ribozyme called RiboJ, which can be used to decouple upstream 5’ UTR in mRNA from downstream sequences (e.g., open reading frames). Despite its general use as an insulator, there has been no systematic study quantifying the efficiency of RiboJ splicing or whether this autocatalytic activity is robust to trans- and cis-genetic context. Here, we determine the robustness of RiboJ splicing in the genetic context of six widely divergent E. coli strains. We also check for possible cis-effects by assessing two SNP versions close to the catalytic site of RiboJ. We show that mRNA molecules containing RiboJ are rapidly spliced even during rapid exponential growth and high levels of gene expression, with a mean efficiency of 98%. We also show that neither the cis- nor trans-genetic context has a significant impact on RiboJ activity, suggesting this element is robust to both cis- and trans-genetic changes.

Background: Although the treatment for childhood hematological cancers such as acute lymphoblastic leukemia (ALL) has improved, there are problems involving a decrease in motor functional capacity and health-related quality of life (HRQOL) during and after cancer treatment. Physical therapy (PT) is expected to positively impact motor functional capacity and HRQOL in patients, but the optimal time for intervention is unknown. Procedure: This study evaluated the effect of inpatient PT intervention in pediatric patients with hematological cancer undergoing treatment at a single tertiary hospital. Participants were assigned to two groups that started PT before or after initial treatment (early PT or late PT, respectively). We evaluated the exercise tolerance of participants using the six-minute walking distance (6MWD) and differences in the HRQOL of participants and their mothers using the Pediatric Quality of Life Inventory (PesdsQL) questionnaire at (1) admission, (2) the end of initial treatment, and (3) discharge. Results: Thirteen pediatric patients (61.5% ALL, aged 7–13 years) included. Significant improvements were observed in PedsQL in the early PT cohort but declined in the 6MWD and PedsQL in the late PT (all p<0.025). The changes in PedsQL scores for the patients and their mothers were similar. No adverse events related to PT during treatment were identified. Conclusion: Early PT intervention is an effective alternative to intensive rehabilitation care. Data suggest that early rather than late-PT participation can result in significant functional gains in locomotion and HRQOL in pediatric patients with hematologic and oncologic conditions during hospitalization.

Remote and hybrid modes of instruction have been employed as alternatives to in-person instruction as part of mitigation efforts in response to the COVID-19 pandemic. Little is known about whether instructional mode in a given school district may impact transmission in the surrounding community. Utilizing weekly case counts by zip code from August – December 2020, we employed a generalized estimating equations approach to estimate the association between instructional mode of the public school district and emergent COVID-19 cases in Cuyahoga County, Ohio. Of 51 zip codes, 37 are contained largely within a single district; of the 20 included school districts, 7 employed only remote instruction (RI) and 13 used some non-remote instruction (NRI) (2-15 weeks). Districts attempting NRI had lower average Social Vulnerability Index (SVI) (0.32 versus 0.73). Weekly incidence increased in all zip codes from August to peaks in late November to early December before declining. The zip code cumulative incidence within school districts that employed some NRI was higher than in those offering only RI (risk ratio = 1.12; risk difference = 519 per 100,000), a contrast to relatively lower pre-study incidence in NRI zip codes (incidence rate ratio of study: pre-study period = 6.12 (NRI) versus 3.59 (RI)). The mean effect (incidence rate ratio) for NRI on emergent cases 2 weeks after mode exposure, controlling for SVI was significant only for high SVI zip codes 1.30 (p<0.001). NRI may be associated with increased community COVID-19 incidence. Vulnerable communities may need more resources to open schools safely.

The fluid dynamics of tea infusion with teabag have been studied in detail with Computational Fluid Dynamics (CFD) technique. Three-dimensional transient CFD studies were undertaken on the tea infusion, and hydrodynamic characteristics of the teabag motion in a cup were analyzed. The transient motion of the teabag was modeled with the frame of reference and the flow through a swelled tea bed was captured with a porous media approach. The standard k-ε turbulence model was implemented to model the turbulence. The influence of bed voidage and particle size was also investigated on the flow through the teabag. The increase in the pulse velocity resulted in a higher flow-through teabag. The predicted X-velocity was compared with experimental data measured by ultrasonic velocity profile, and a good agreement was obtained. The estimated flow through teabag for a cycle with the developed CFD model was compared with the previously published one-dimensional mathematical model.

Background and Purpose: Abdominal aortic aneurysm (AAA) is a lethal disease without available medicine for treatment. As COX-2 and NF-κB are promising targets against AAA, eugenol, a novel candidate as a dual-target on COX-2 and NF-κB, was unearthed and evaluated it efficiency against AAA progression. Experimental Approach: AAA model was established using porcine pancreatic elastase (PPE) plus 3-aminopropanonitrile (BAPN). Dual-binding of eugenol with COX-2 and NF-κB was verified by molecular docking. The efficiency of eugenol against AAA progression was evaluated by hematoxylin-eosin staining and orcein staining. The downregulations of eugenol on COX-2 and NF-κB were detected by immunohistochemistry and western blot. The administration route of eugenol was further evaluated. Key Results: Based on the results of AAA progression, AAA model was confirmed to be set up at day 5 after PPE and BAPN induced, then the 5th day was defined as the starting time point for eugenol treatment. With AAA progression, macrophage infiltration, up-regulation of COX-2 and NF-κB was detected. After massive screening and molecular docking, eugenol was chosen because of its dual targets on COX-2 and NF-κB. Eugenol blocked AAA expansion and protected the integrity of aortic structure in a dose-dependent manner. Furthermore, the down-regulation of eugenol on COX-2 and NF-κB was further confirmed in vivo. Finally, high oral bioavailability was found as another advantage of eugenol. Conclusion and Implications: On the basis of dual-targets against COX-2 and NF-κB, high efficiency and oral bioavailability endowed eugenol great potential for future AAA therapy. KEYWORDS Abdominal aortic aneurysm, Eugenol, NF-κB, COX-2

Introduction: Focal activation is believed to be an atrial fibrillation (AF) driver; however, little is known about whether all focal activations are necessary for AF persistence. The purpose of this study was to assess the electrical nature of focal activation and identify high-priority focal activations using a novel mapping system (CARTOFINDER). Methods: Thirty-five patients with persistent AF who underwent catheter ablation were assessed. Cycle length (CL) and CL standard deviation (CLSD) on unipolar recordings and voltage amplitude and electrogram morphologies on bipolar recordings were evaluated at all points of interest. The most frequent CL at each mapping site was defined as the dominant CL. We identified dominant focal activations (DFAs) that had a shorter dominant CL on the integrated CARTOFINDER map. The effect of elimination of DFAs on AF maintenance was assessed by the composite endpoint (termination to sinus rhythm, organization of the rhythm to atrial tachycardia, and AF CL slowing). Results: In all, 450 focal activations were identified among 10,868 points, and 50.4% of focal activations were DFAs. Focal activations showed relatively long CL and regularity with short CLSD. Most focal activations showed an isoelectric baseline and were located outside of the fractionated electrogram area. Both DFAs and non-DFAs were typically observed in normal voltage range. Elimination of DFAs was achieved in 19 (54.3%) patients, with a remarkable impact on AF maintenance (68.4% vs. 25.0%, p = 0.018). Conclusions: DFAs may play an important role in AF maintenance and could be an attractive therapeutic target for AF.

Background: Povidone-iodine (PVP-I) is an antiseptic and a disinfectant with broad-spectrum antimicrobial activity against various pathogens. However, it is unclear whether PVP-I nasal instillation can suppress mucosal inflammation in non-eosinophilic chronic rhinosinusitis (CRS) mice. Objective: This study aimed to explore the anti-inflammatory effects and underlying molecular mechanism of PVP-I on lipopolysaccharide-stimulated airway epithelial cells and investigate whether nasal instillation of PVP-I can suppress mucosal inflammation in non-eosinophilic CRS mice. Methods: Inflammation-related molecules in the nasal epithelial cells and non-eosinophilic CRS mice were measured by enzyme-linked immunosorbent assay, western blotting, quantitative real-time polymerase chain reaction, immunoprecipitation, and histopathological analysis (hematoxylin and eosin staining, immunohistochemistry, and periodic acid‑schiff staining). Results: PVP-I blocked expressions of various inflammation-related molecules, such as NLRP3, NF-κB-p65, caspase-1, and IL-1β; induced translocation of NF-κB to the nucleus; and promoted assembly of NLRP3/ASC complexes in the nasal epithelial cells and non-eosinophilic CRS mice. Notably, PVP-I strongly blocked the receptor interaction of TLR4 and MyD88 in the epithelial cells of nasal mucosa. Conclusion: We demonstrated that PVP-I significantly attenuated inflammatory molecules and cytokines via blocking the formation of TLR4 and MyD88 complexes during LPS-induced mucosal inflammation in non-eosinophilic CRS.

Introduction: Cryptogenic stroke comprises about 25% of all ischemic strokes. Depending on modality and duration of ECG monitoring, subclinical atrial fibrillation (AF) is detectable in 2.7-30% of cryptogenic stroke patients. Hypothesis: Extended ECG monitoring after cryptogenic stroke has not been studied in the African American (AA) population. This retrospective study aims to study the incidence and risk factors of subclinical AF in African Americans. Methods: We retrospectively reviewed 96 patients who received implantable loop recorders (ILR) for detecting subclinical atrial fibrillation after cryptogenic stroke. In the vast majority of patients, the ILR was implanted during index hospitalization. Binary univariate and multivariate analyses were performed to determine predictors for AF detection. Results: AF was detected in 29% of patients (28/96) at 1000 days. All AF that was detected was exquisitely paroxysmal and ranged in duration between 0.05-103 minutes (mean 8.4 minutes with SD= 22.1 minutes). Binary univariate analysis revealed the use of non-dihydropyridine calcium-channel blockers to be associated with decreased odds of AF detection. Multivariate analysis found coronary artery disease diagnosis to be associated with increased odds of AF detection. Fifty percent of the events in the AF group were detected within the first 36 days of loop recorder implantation. Conclusions: AF detection in our population occurs very early after index stroke and at significantly higher rates that reported before. Baseline characteristics have a poor predictive ability for the detection of AF. These findings emphasize the need for pre-discharge ILR implantation to improve AF detection in all patients with cryptogenic stroke.

Background: Metabolic syndrome (MetSyn) is an important late effect of childhood cancer. The combination of rising obesity and high prevalence of under-nutrition at diagnosis, make this a unique population to study in LMIC (lower middle-income countries). Method: Children <18 years of age at cancer diagnosis, in a single-centre in a LMIC, who were disease free and had completed treatment at least 2 years prior to study were included. MetSyn was defined using International Federation for Diabetes criteria for Asian Indians. Univariate and multivariable analyses were carried out to evaluate the influence of risk factors on MetSyn. Delta BMI (body mass index) was further studied using receiver operating characteristic curve. Results: A high prevalence of MetSyn (12.2%), central obesity (33%), and dyslipidemia (61.8%) was found in a cohort of 500 childhood cancer survivors (CCS) at a mean follow-up age of 17 years. Logistic regression analysis revealed male gender, OR 2.4(1.1-5.4), older age at diagnosis >10 years, OR 2.9(1.6-5), longer survival duration >10 years, OR 2.2(1.3-3.8), high BMI at diagnosis OR 3.2(1.5-6.9), high delta BMI >50, OR 3.15(1.7-5.9) and cranial RT among children <5 years with acute lymphoblastic leukemia, OR, 5.5(1.5-2), to be independent predictors of MetSyn. Delta BMI (>50) strongly predicted MetSyn among patients who were under-weight or normal at diagnosis (OR, 12.5,1.7-92). Conclusion: Our CCS are at high risk of MetSyn and its components at an early age. Monitoring delta BMI during follow-up can be useful for screening CCS at risk for this modifiable late effect of cancer treatment.

Objective: Improved ethical sensitivity allows ethical decision making and understanding of vulnerable people. The fact that the midwifery profession requires an intervention in the private and intimate areas of the woman like childbirth makes it more important for midwives to have moral sensitivity. Therefore, it was aimed to determine the moral sensitivity of midwives working in the delivery room. Methods:This descriptive study was conducted with midwifery who were actively work in the delivery room. Results:The mean score of the midwives was 3.05 and the moral sensitivity of the midwives was moderate. Religious belief has not been shown to be effective in their decisions. According to the moral sensitivity scale, the subtitle in which midwives were the most insensitive was conflict. Conclusions: Moral sensitivity of the midwives was moderate. Moderate moral sensitivity can lead to uncertainty in midwives’ behavior towards ethical issues. Therefore, more importance should be given to increasing the moral sensitivity of midwives by using different methods in ethics education. Keywords: Midwifery, medical ethics, moral status, moral education, ethical dilemma, What’s already known about this topic? There is not enough studies with midwives working in delivery rooms Their moral sensitivities vary Factors affecting moral sensitivity vary. What does this article add? Evaluation of the moral sensitivity of midwives working in delivery rooms Relation between the moral education and moral sensitivity Importance of ethics course in midwifery curriculum

Objectives: To assess the efficacy, tolerability and clinical outcome of high dose IV Vitamin C administration in patients with Acute respiratory distress syndrome (ARDS). Design: A prospective, randomized, controlled, open-label study. Setting: Intensive Care Unit of Embaba-Chest Hospital, Cairo, Egypt. Patients: Forty clinically and radiologically diagnosed cases of eligible ARDS patients were randomized to either, Group 1 (Control); 20 patients received conventional ARDS management, or Group 2 (Test); 20 ARDS patients received IV Vitamin C 10 g on two divided doses, both for 10 days. Interventions: Vitamin C, Interleukin 8 (IL8) and nuclear factor erythroid 2–related factor 2 (NRf2) levels together with PaO2/FiO2 were all measured for both groups at baseline and after 10 days. Main Results: Groups were comparable at baseline. After 10 days of Vitamin C administration, a significant increase (P<0.001) in levels of Vitamin C, NRf2 and PaO2/FiO2 together with a significant decrease (P<0.001) in IL8 was noted in test versus control group. Number of patients weaned off mechanical ventilation MV was significantly higher in test versus control groups (15 versus 6, p=0.004, respectively). Survival and occurrence of side effects were comparable between groups. Conclusions: Administration of 10 g IV Vitamin C in 2 divided doses daily for 10 days in ARDS patients improved lung functions, pulmonary oxygenation, oxidative stress and inflammatory markers and weaning off MV and reduced IL8 levels. Vitamin C was tolerable with no significant side effects or drug interactions reported throughout the 10 days-treatment. (Clinicaltrials.gov Registration number: NCT03780933)

The genus Fritillaria is an extremely complicated group in phylogeny and taxonomy, which contained numerous medicinal species. Both traditional characteristic-based taxonomy and standard DNA barcodes (ITS, trnH-psbA and rbcL) are difficult to effectively delimit its species boundaries. Here, we generated a large dataset of chloroplast genomes from multiple accessions per species of Fritillaria to test and evaluate their effectiveness in species discrimination. Moreover, phylogenetic inference and divergence time estimation were performed based on the new sequences and published chloroplast genomes. The results showed that only F. cirrhosa could not be correctly discriminated in all species by using complete plastomes, which suggested that they could enhance species discriminatory resolution, but was not omnipotent. Furthermore, four regions (ycf1, matK-trnG-GCC, rpoC1 and matK) gained remarkably higher resolution than that of other plastid regions, but only matK might be suitable to identify Fritillaria species in consideration of their lengths. Phylogenetic inference showed that the subgenus Fritillaria of China was divided into four major clades, and taxonomic delimitation of F. omeiensis and F. hupehensis in Flora of China (2000) might be questionable and needed further revision. Molecular dating demonstrated that both origin and divergence of subgenus Fritillaria, as well as its four major clades, were significantly associated with geological and climatic fluctuations during the Middle to Late Miocene. This study would enrich case studies of super-barcoding and provide new insights on speciation, lineage diversification and biogeography of the genus Fritillaria.

Objective: Our aim is to assess the knowledge, attitude, and behaviors of pregnant women about COVID-19. Material and Method: This cross-sectional survey study was performed on pregnant women in their second and third trimester between the November-December 2020. The participants completed a questionnaire consisting of 5 parts. Demographic data of pregnant women, their knowledge, attitude, and risk perceptions toward COVID-19, their practices and worries about COVID-19, and what they knew about pregnancy were assessed. The answers were calculated as a percentile and mean. Results: A total of 1011 participants were included in the statistical analysis. Of the participants, 98.5% knew that COVID-19 was transmitted through close contact. Of the participants, 47.5% extremely trusted healthcare workers in fighting against the COVID-19 pandemic. Affection and respect for healthcare workers during the pandemic increased by 89.1% of the participants. Of the participants, 50.6% were intending to decrease their antenatal visits during the COVID-19 pandemic and 39.4% thought that their baby may be infected after birth. Conclusion: The measures taken can be applied with high awareness of COVID-19. Sufficient training, in that case, can be done through communication routes such as information and public service announcements.