Corona virus (COVID-19)-related inflammation can promote a pro-thrombotic process and subsequent thrombosis. Right heart chambers thrombus considered an unusual location. We report a 51-year confirmed COVID-19 infection, who presented with chest pain and severe hypoxemia. Echocardiography demonstrated a large mobile right ventricle thrombus protruding into the right ventricle outflow tract. Computed tomography angiography and cardiac magnetic resonance imaging showed the extension of the thrombus into the pulmonary trunk. Continuous intravenous unfractionated heparin infusion resulted in a dramatic clinical and echocardiographic improvement.

As apex predators, pinnipeds are considered to be useful bioindicators of marine and coastal environments. Endemic to a small archipelago in the South Pacific, the Juan Fernandez fur seal (JFFS) is one of the less-studied members of the pinniped family Otariidae. This study aimed to characterise the faecal microbiome of the JFFS for the first time, in order to establish a baseline for future studies of host-microbial-environment interactions and monitoring programs. During two consecutive reproductive seasons, 57 faecal samples were collected from 7 different JFFS colonies within the Juan Fernandez Archipelago, Chile. Bacterial composition and abundance were characterised by sequencing the V4 region of the 16S rRNA gene. The overall microbiome composition was dominated by five phyla: Firmicutes (40 % ± 24), Fusobacteria (30 % ± 17), Bacteroidetes (22 % ± 10), Proteobacteria (6 % ± 4) and Actinobacteria (2 % ± 3). Alpha diversity was higher in Tierras Blancas. However, location was not found to be a dominant driver of microbial composition. Interestingly, the strongest signal in the data was a negative association between the genera Peptoclostridium and Fusobacterium, which explained 29.7 % of the total microbial composition variability between samples. The genus Peptoclostridium has not been reported in other pinniped studies and its role here is unclear, with interpretation challenging due to a lack of information regarding microbiome functionality in marine mammals. As a first insight into the JFFS faecal microbiome, these results contribute towards our understanding of the natural microbial diversity and composition in free-ranging pinnipeds.

Backgrounds: Turmeric (Curcuma longa, Turmeric, Indian saffron) is a widely used herb in China and India. Curcumin, the most active ingredient in this plant, has been shown to have protective effects against ischemia-reperfusion damage. In our study, the effects of Curcumin on vascular endothelium in ischemia-reperfusion injury in the abdominal aorta were investigated. Methods: Fifteen Wistar-albino rats were divided into three groups as sham, control and treatment (Curcumin group). Abdominal aortic ischemia was applied to the control and Curcumin groups for 60 minutes. Curcumin was administered intraperitoneally at a dose of 200 mg / kg to the Curcumin group 5 minutes before reperfusion. Afterwards, a 60-minute reperfusion period was applied to both groups. Total antioxidant capacity (TAC), total oxidant status (TOS) and oxidative stress index (OSI) in blood serum were measured. Aortic endothelial tissue was examined in a histopathological way and endothelial damage was scored and compared. Results: It was observed that TAC, TOS and OSI activities in blood samples were significantly decreased in sham and curcumin groups compared to the control group (p <0.05). There was no difference in vascular endothelial damage scores in Sham, curcumin and control groups (p> 0.05). Histopathological examination revealed no lesions in the curcumin and control groups. Curcumin administration reduces oxidative stress in ischemia-reperfusion injury. Conclusion: It was thought that the aortic tissue was more resistant to I / R damage due to possible perfusion differences. In future studies, the effects of Curcumin on vascular endothelium in ischemia-reperfusion injury will be understood more.

A 77-year-old male (Case R) who had had a previous diagnosis of mild COVID-19 episode, with fever without developing pneumonia or other complications, was hospitalized 57 days later, due to an acute cholangitis. He had a prolonged hospital stay with severe biliary and infectious complications. On Day 23 post-admission, the patient developed a second COVID-19 episode, now severe, with bilateral pneumonia, multiorgan failure, and finally died. Initially, Case R COVID-19 recurrence was interpreted as a reinfection due to the exposure to a patient with whom he had shared the hospital room, who also had a subsequent positive SARS-CoV-2 RT-PCR. However, whole genome sequencing data indicated that both cases were infected by different strains and clarified that case R recurrence corresponded to a reactivation of the strain involved in his first episode. Case R reactivation had major consequences, not only leading to a much more severe second episode, but causing a subsequent transmission to another two hospitalized patients, one of them with fatal resolution.

Anomalous origin of the left circumflex artery from the right sinus of Valsalva with a retro-aortic course is a relatively common abnormality. Although considered benign, the retro-aortic course of the anomalous vessel may be an important consideration in aortic surgery and device closure of atrial septal defects. 2D transthoracic echocardiography can easily help detect this anomalous course in a non-invasive manner. Here, we present the echocardiographic images of a young patient who had come for evaluation of chest pain.

Adenoviral vectors (AdV) are widely used as gene delivery vehicle and vaccine design due to their genetic stability, large transfer gene capacity, production at high titers, remarkable efficacy of transduction, etc. Using of AdV in cancer immunotherapy is one of their important applications. Tumor-associated antigens are overexpressed in cancer cells but cannot able to induce immune responses sufficiently. In this study we described the construction steps of a recombinant AdV expressing human carcinoembryonic antigen (CEA) gene. Furthermore, in order to achieve a high titer of the virus, an efficient transfection is required. Three various transfection reagents including polyethylenimine (PEI), calcium phosphate and DMRIE-C for transfection of the CEA cloned plasmid were compared. Our results showed the PEI had a higher transfection efficiency which was used for transfection of the recombinant plasmid. The virus produced in this study can be applied as a vaccine in cancer immunotherapy for stimulating the immune system against CEA expressing tumors.

We reported a 21-year-old female patient with systemic lupus erythematosus, accomplicated with posterior reversible encephalopathy syndrome and neurogenic pulmonary edema. After hormone pulse and antiepileptic treatment, the patient's consciousness recovered, and the reexamination CT and cerebrospinal fluid examination were basically normal. There was no recurrence later.

Background: The outcome of hematopoietic stem cell transplantation (HSCT) in children and adolescents with refractory or relapsed acute leukemia in nonremission is poor. However, It is uncertain whether an intensitive conditioning regimen can improve the outcomes or not . This retrospective analysis aimed to investigate the outcomes of HSCT with tumor-ablative conditioning regimen (TAC), the safety and efficiency of HSCT using TAC in nonremission acute leukemia . Procedure: Data from the Beijing Aerospace Central Hospital on 44 patients with nonremission acute leukemia (aged <18 years, with blasts 5-98% in bone marrow) who had undergone HSCT between January 2016 and December 2018 were evaluated. Results: Overall, 32 patients died. The median follow up was 1330 days in survival patients, and the 3-year OS and LFS were 27.3%( 95% CI, 14.2% to 40.4% ) and 28.9%（95% CI, 15.4% to 42.4%）. The cumulative incidence of relapse is 59.1% (95% CI, 44.6% to73.6) and non-relapse mortality (NRM) is 18.1%, 95 CI, 12.4%-23.8%). Multivariate analysis showed that relapse was an independent factor affecting OS (HR=4.308 (95% CI: 1.820-10.186,P=0.001) Conclusion: this 3-year retrospective analysis found that salvage HSCT with TAC is an alternative selection on nonremission leukemia, the TAC regimen is a safe and effective regimen. The relapse is still the main cause of death. A larger prospective study is needed to verify the promising study.

Objectives: Coronary slow flow (CSF) is defined as the late progression of applied contrast through coronary arteries. The cardiac electrophysiological balance index (iCEB) reflects the balance between ventricular depolarization and repolarization and provides more information about ventricular arrhythmogenesis (VA) than other electrocardiography (ECG) parameters (QT, corrected QT (QTc), etc.). We aimed to evaluate iCEB in patients with CSF. Material and Methods: We divided the study population into two groups as CSF and control. The CSF group consisted of 100 patients (33 female, 67 male, mean age 52.2 ± 2.6), while the control group consisted of the same number of age and sex-matched patients (35 female, 65 male, mean age 51.7 ± 1.4). ECG parameters of the study population (QRS duration, QT, T wave peak-to-end (Tp-e) intervals, iCEB (QT / QRS), and iCEBc (heart rate corrected QT (QTc) / QRS) rates were calculated and compared between CSF and control groups. Results: Intervals (QT, and QTc intervals) and Tp-e/QTc ratio were greater in the CSF group compared with controls [422.1 ± 12.8 bpm vs 349.4 ± 14.3 bpm, respectively, p< 0.001; 457.0 ± 12.2 bpm vs 378.1 ± 12.3 bpm, respectively, p< 0.001, and 0.19 vs 0.12, respectively, p< 0.001]. ICEB and iCEBc were significantly greater than controls [(4.9 ± 0.4 vs 4.2 ± 0.4, respectively, p< 0.001), (5.7 ± 0.3 vs 4.4 ± 0.3, respectively, p< 0.001)]. Conclusions: ICEB and iCEBc were significantly increased in patients with CSF. This may suggest that CSF may predispose to malign arrhythmias.

Abstract: The aim of this study was to evaluate the role of Charlson comorbidities index (CCI) and cofactors on 2-year mortality in older patients with intertrochanteric fractures. 60 cases with unilateral intertrochanteric fracture were retrospectively analyzed and divided into Low-CCI group (CCI: 1-4) or high-CCI groups (CCI: 5-6). All the patients’ electronic hospital records were reviewed. The preoperative situations (demographic data, comorbidities and fracture conditions), perioperative situations (wait time, operation time, implant choice, blood loss, transfusion or not) and postoperative situations (complications, first time out of bed, function about 1-/2- week and 2-year mortality) were recorded. 51.67% were in low-CCI group and 48.33% in high-CCI group. The survival rates in low- and high-CCI group were 93.5% and 86.2 % respectively. According to the functional results of 1- or 2- week after operation, no significant difference was found (P=0.955, 0.140). Log-rank analysis showed that the main prognostic factors were blood loss, first time out of bed and complication (P<0.05). Multivariate analysis confirmed that complication and first time out of bed were significant factor on survival rate (P=0.029, 0.010). Charlson comorbidities index maybe not the indicator of 2-year mortality in older patients with intertrochanteric fractures. In order to improve the prognosis, more attentions should be paid to reduce the complications and encourage postoperative earlier excise out of bed.

Maternal food restriction (MFR) during pregnancy leads to pulmonary dysplasia in the newborn period and increases susceptibility to diseases, such as asthma and chronic lung disease, later in life. Previous studies have shown that maternal electro-acupuncture (EA) applied to “Zusanli” (ST 36) could prevent the abnormal expression of key lung developmental signaling pathways and improve the lung morphology and function in perinatal nicotine exposed offspring. There is a significant overlap in lung developmental signaling pathways affected by perinatal nicotine exposure and MFR during pregnancy; however, whether maternal EA at ST 36 also blocks the MFR-induced lung phenotype is unknown. Here, we examined the effects of EA applied to maternal ST 36 on lung morphology and function and the expression of key lung developmental signaling pathways, and the hypercorticoid state associated with MFR during pregnancy. These effects were compared with those of metyrapone, an intervention known to block MFR-induced offspring hypercorticoid state and the resultant pulmonary pathology. Like metyrapone, maternal EA at ST 36 blocked the MFR-induced changes in key developmental signaling pathways and protected the MFR-induced changes in lung morphology and function. These results offer a novel and safe, non-pharmacologic approach to prevent MFR-induced pulmonary dysplasia in offspring.

Guidelines suggest the use of antiarrhythmic agents as initial therapy in patients with paroxysmal atrial fibrillation, however using cryoballoon ablation as a first line therapy might have increased efficacy. The safety and efficacy of cryoballoon ablation as an initial therapy has not yet been established. A comprehensive search of multiple databases was performed to find randomized control trials (RCT) that directly compared cryoablation therapy versus antiarrhythmic therapy as initial treatment for patients with atrial fibrillation. A total of three RCTs met the inclusion criteria (724 patients) and were used in the meta-analysis. The primary outcome of our meta-analysis was recurrence of atrial tachyarrhythmias. The secondary outcome evaluated serious adverse events of each therapy. The results showed a statistically significant reduction of recurrence of atrial tachyarrhythmic events in patients receiving cryoballoon ablation compared to antiarrhythmic therapy [Risk Ratio (RR): 0.60, 95% CI (0.49, 0.72), P<0.00001, I2 = 0%]. There was no significant difference in serious adverse events between patients receiving cryoballoon ablation compared to patients receiving antiarrhythmic therapy. [Risk Ratio (RR): 1.19, 95% CI (0.71, 2.00), P=0.52, I2 = 0%]. Our meta-analysis showed that cryoballoon ablation as an initial therapy is more efficacious than drug therapy with antiarrhythmics in patients with atrial fibrillation without an increased risk of serious adverse events. Keywords: Cryoablation, antiarrhythmics, atrial fibrillation, conduction disturbance, meta-analysis.

In this paper we used the newly developed optimal approach namely Optimal Auxilary Function Method (OAFM) for the solution of the Falkner-Skan equation with heat transfer. The constitutive equations obtained from Navier-Stokes equations are converted into a set of nonlinear Ordinary Differential Equations (ODEs) with the help of a similarity transformation. For the solution of the obtained ODEs with boundary conditions is solved by OAFM. The OAFM along with convergence is studied in detail. The effects of the physical parameters are discussed with the help of tabular data and graphs. The reliability and effectiveness of the method is achieved by comparing the results available in the literature.

Urban cats live in cities like humans and humans affect their life intentionally or unintentionally. Waste production is only one of the human effects on the urban cat ecosystem. The waste produced by human supply some of the food needed by urban cats. This descriptive - estimation research is the first study in the world to measure the cats’ weight to investigate the effect of the increase or decrease in urban wastes on physical status of cats. In the first phase of the research (Spring 2016-Winter 2017) in Tehran, we found that the average volume of the collected wastes had increased by 14% and the average weight of cats in the mentioned period had increased 1%. The 9.5% decrease in the waste volume in Autumn 2016 had led to the decrease in the average weight of cats in Winter 2017. The male cats were more affected by the decrease in waste volume.

Introduction: Integration of electroanatomical map (EAM) with preacquired three-dimensional (3D) cardiac images provides detailed appreciation of the complex anatomy of the left atrium (LA) and pulmonary vein (PV). High-density (HD) multi-electrode mapping catheters have enabled creating more accurate EAM reflecting real-time volume-rendered LA-PV geometry during atrial fibrillation (AF) ablation. However, no study has compared the outcomes of AF ablation using HD-EAM versus 3D-merged map. We aimed to investigate the procedural and clinical outcomes of AF ablation with HD-EAM (HD-EAM group) versus 3D-merged map (Merge group). Methods: One hundred patients (59.5±11.5years, 53% with paroxysmal AF [PAF]) were randomly assigned (1:1) to HD-EAM or Merged group. HD multi-electrode mapping and contact force (CF)-sensing catheters were used to create virtual LA-PV chamber and to perform wide antral circumferential ablation (WACA), respectively. Results: The two groups showed no significant differences in baseline characteristics and procedural data including ablation time, fluoroscopy time, LA voltage, and CF. PV isolation with a single WACA line was achieved in 21 (42%) and 27 (54%) patients in the Merge and HD-EAM groups, respectively (P=NS). CF was significantly lower in lesions with gap than lesions without gap after a single WACA (7.3±7.3 g vs. 16.0±8.3, respectively, P<0.001). During the 12-month follow-up, no significant difference in AF recurrence was observed between two groups, irrespective of AF type. In multivariate analysis, non-PAF was an independent risk factor for AF recurrence. Conclusion: Integration of 3D cardiac imaging did not improve procedural and clinical outcomes. HD-EAM provides an accurate real-time LA geometry.

A 95-year-old woman with no prior cardiac history presented with symptomatic complete atrioventricular block. She underwent temporary cardiac pacing via the cervical vein, but a pacing lead could not be introduced via the usual route because of a mediastinal tumor. A leadless pacemaker (MicraTM; Medtronic, Minneapolis, MN) was implanted on the right ventricular septum via the right femoral vein. The procedure time was 40 minutes without any complication. The implantation of a leadless pacemaker was useful to improve the symptoms of a super-elderly woman with mediastinal tumor.

Introduction: Cardiac biomarkers have been proposed as a new tool to improve risk stratification of serious arrhythmic events in patients with heart failure (HF) beyond estimates of left ventricular ejection fraction. Growth differentiation factor (GDF)-15, a stress-induced cytokine, has been found to correlate with markers of myocardial fibrosis and adverse clinical outcomes, but its role as a predictor of arrhythmic events in patients with nonischemic HF is uncertain. Methods and Results: A prospective observational study was conducted in 148 nonischemic patients with HF who underwent comprehensive clinical and laboratory evaluation, including measurement of serum GDF-15. The study endpoints were serious arrhythmic events (which included appropriate implantable cardioverter-defibrillator therapy and sudden cardiac death) and all-cause mortality. Mean age of the cohort was 54.8±12.7 years, and mean left ventricular ejection fraction (LVEF) was 27.4±7.5. During a mean follow-up time of 42 months, arrhythmic events occurred in 28 patients (19%), and 40 patients (27%) died. An increase in serum GDF-15 (log-transformed) correlated linearly with a higher risk of serious arrhythmic events (HR 1.14, 95% CI 1.01-1.28, p=0.03) even after adjustment for other potential clinical predictors (HR 1.16, 95% CI 1.02-1.32, p=0.02). GDF-15 was also strongly and independently associated with all-cause mortality (HR 1.17, 1.05-1.31, p=0.004). Conclusion: In this cohort of nonischemic HF patients on optimized medical treatment, serum GDF-15 levels were independently associated with major arrhythmic events and overall mortality. This biomarker may add prognostic information beyond LVEF to better stratify the risk of sudden death in this particular population.

Device rounds

Supported Pt catalysts were considered to have excellent activity and stability in the catalytic combustion of chlorinated VOCs, which, however, face challenges on the transformation to pilot application. Herein, we prepared a series of Pt catalysts and coated them on honeycomb cordierites uniformly to prepared monolithic catalysts. The effects of different coating methods (washcoating, one-pot synthesis, or impregnation), supports (TiO2 or HZSM-5) and additives (Co3O4 or CeO2) on the catalytic performance were investigated. The advantage of the washcoating method is that the active phase of catalysts worked as a unit, which means a stronger interaction between them. In this research, the Pt-Co/HZSM-5 prepared by the washcoating method exhibited the best activity in the catalytic oxidation of dichloromethane (T50=260 ºC and T90=335 ºC) and showed stability for at least 48 hours (at 90% conversion). Such an excellent performance was attributed to the abundant Oads species and high BET surface area.

Sequential model-based design of experiments (MBDOE) is used to select operating conditions for new experiments in a batch-reactor that produces bio-based poly(trimethylene) ether glycol (PO3G). These Bayesian A-optimal experiments are designed to obtain improved estimates of the 70 fundamental-model parameter estimates, while accounting for the model structure and for data from eight previous industrial batch-reactor runs. Settings are selected for three decision variables: reactor temperature, initial catalyst level, and initial water concentration. If only one new experiment is conducted, it should be run at high temperature, with relatively high concentrations of catalyst and initial water. When two new runs are conducted, one should use an intermediate catalyst concentration. The effectiveness of the proposed MBDOE approach is tested using Monte-Carlo simulations, revealing that the selected experiments are superior compared to new experiments selected randomly from corners of the permissible design space.

Acute myocardial infarction (AMI), which represents the main public health issue around the world. Pro-angiogenesis has become one of the treatment methods for AMI. Studies have shown that mir-133a plays an important role in the angiogenesis process of AMI patients, but its mechanism is not clear.We hope to investigate the mechanism of mir-133a-induced damage to human umbilical vein endothelial cells (HUVECs) by transcriptome analysis, and explore its potential as a novel diagnostic and therapeutic target of AMI.RTq-PCR was used to detect the expression of miR-133a in peripheral blood of AMI patients and normal people. Mir133a over-expression promoted proliferation and migration ability of HUVEC.Transcriptome data was subsequently analyzed by a series of the bioinformatic approaches.GSEA enrichment analysis revealed 9 pathways with the most significant differences, two of which were the NF-κB signaling pathway and NOD-like receptor signaling pathway, both of them were closely associated with AMI. In addition, CXC8/IL1β genes were identified as the key hub genes covering the two pathways.The data of this study reveals that abnormal expression of miR-133a may cause endothelial injury. The potential mechanism is that miR-133a causes abnormalities of NF-κβ signaling pathway and NOD-like receptor signaling pathway. In particular, the two genes CXC8/IL1β are down-regulated by miR-133a.This indicates the potential of miR-133a as a diagnostic biomarker and molecular target to improve the treatment of AMI.

Aim: To determine role of pharmacists in an antibiotic stewardship program (ASP) for febrile neutropenic patients. Methods: A prospective study in four medical wards at Thammasat University Hospital between August 2019 and April 2020. Two medical wards were designated as the pharmacist-driven ASP group and two other medical wards were designated as a control group. Our primary outcome was to compare appropriate use of target antibiotics between the pharmacist-driven ASP group and control group. Results: The results showed 90 febrile neutropenic events in 66 patients. Choice of an appropriate antibiotic was significantly higher in the pharmacist-driven ASP group than the control group (88.9% versus 51.1%, p<0.001). Furthermore, there was greater appropriateness of the dosage regimen chosen as empirical therapy in the pharmacist-driven ASP group than in the control group (97.8% versus 88.7%, p=0.049) and proper duration of target antibiotics in documentation therapy (91.1% versus 75.6%, p=0.039). Although the pharmacist-driven ASP did not affect 30-day infectious diseases-related mortality and length of stay (p=0.810 and 0.267, respectively), multivariate analysis showed that pharmacist-driven ASP and infectious diseases consultation had favorable impact on 30-day infectious diseases-related mortality in chemotherapy induced febrile neutropenic patients (OR 0.082, 95%CI: 0.009-0.762, P = 0.028). Conclusions: Our study demonstrated that clinical pharmacists could implement an antibiotic stewardship program for febrile neutropenic patients. Pharmacist-driven ASP could be a great opportunity to improve antibiotic appropriateness in febrile neutropenic patients.

Background: Dysregulation of eicosanoids is associated with asthma and a composite of oxylipins, including exhaled LTB4, but their potential utility in monitoring the therapeutic outcomes has not been comprehensively assessed. Objectives: We aimed to examine the levels of major eicosanoids representing different metabolic pathways in exhaled breath condensates (EBCs) of children with asthma during exacerbation and after treatment. Methods: Levels of 6 exhaled eicosanoid species in asthmatic children and healthy subjects were evaluated using ELISA. Results: In addition to those previously reported, including LTB4, LTE4, LXA4 and PGE2, the levels of exhaled 15-HETE, but not TXB2, showed significant difference between asthmatics (N=318) and healthy controls (N=97). When the asthmatic population was stratified into different severity groups, the severe group was characterized by significantly lower levels of 15-HETE and 15-HETE/LTB4 ratio, as compared to the mild and control groups. Receiver Operating Characteristic (ROC) analyses revealed similar distinguishing power for the level of exhaled 15-HETE and those of FEV1 and FeNO. Analysis of asthmatics (N=75) during exacerbation and convalescence showed significant improvement in lung function (FEV1; p<0.001), but not FeNO, concomitant with significantly increased levels of 15-HETE (p<0.001) and reduced levels of TXB2 (p<0.05) after therapy, particularly for those who at the top 30% level during exacerbation. Further, decreased LTB4 and LXA4 at convalescence were noted only in those at the top 30 percentile during exacerbation. Conclusion: The exhaled 15-HETE was found to discriminate childhood asthma while decreased levels of exhaled TXB2 and increased levels of 15-HETE were prominent after treatment.

EXPECTANT MANAGEMENT OF PLACENTA ACCRETA SPECTRUM DISORDERS - AN EXPERIENCE WITH 12 CASES: A CASE SERIESAUTHOR AND CORRESPONDING AUTHOR - Dr Ashakiran Thavarsingh Rathod1 - MBBS, MS (OBG), MRCOGCO AUTHOR - Dr Geetha Shivamurthy2 – MBBS, MD (OBG)1-Assistant Professor in Obstetrics and Gynecology, Vani Vilas Hospital attached to Bangalore Medical College and Research Institute, Bangalore, Karnataka, India.Address – No 620, A4 Block, Krishna Block, National Games Village, Koramangala, Bangalore, 560047. Karnataka, India.Email – tr.ashakiran@gmail.comPhone number - +91 98450410842 -Professor in Obstetrics and Gynecology and Medical superintendent, Vani Vilas Hospital attached to Bangalore Medical College and Research Institute, Bangalore, Karnataka, IndiaAddress – No 43, Samrudhi nilaya, 9th main, A sector, New town Yelahanka, Bangalore 560064, Karnataka, IndiaEmail - dr.geethashiva007@gmail.comPhone number - +91 9448446635