we report the case of a 61-year-old male patient who was admitted with abdominal pain, vomiting and constipation. he had a past medical history of epidermoid lung cancer .computed tomography revealed distended stomach with mural bowel thickening. it was peroperatively two small-bowel metastasis from lung cancer that we resect.

Mutations are the primary source of all genetic variation. Knowledge about their rates is critical for any evolutionary genetic analyses, but for a long time, that knowledge has remained elusive and indirectly inferred. In recent years, parent-offspring comparisons have yielded the first direct mutation rate estimates. Here, we estimated the mutation rate for the guppy (Poecilia reticulata), a model species in ecoevolutionary studies. We sequenced 4 parents and 20 offspring and screened their genomes for de novo mutations. The initial large number of candidate de novo mutations was analysed with a supervised machine learning approach to remove false-positive results. Additionally, candidate de novo mutations were validated using Sanger sequencing, and positively verified variants were used to estimate the mutation rate. The guppy mutation rate (µ = 3.44 × 10-9 per site per generation) is among the lowest directly estimated mutation rates in vertebrates. Similarly, low estimates were obtained for two other teleost fishes. We discuss potential explanations for such a pattern, as well as the utility of machine-learning approaches for standardized across experiments approach to estimate mutation rates.

Introduction: E-cigarette, or vaping, product use-associated lung injury (EVALI) results from inhaling the aerosol of e-cigarettes and has similar clinical features to coronavirus disease 2019 (COVID-19). EVALI case counts since the declaration of the COVID-19 pandemic is unknown. Methods: A retrospective electronic health record chart review of adolescents hospitalized at one institution with EVALI was conducted. Clinical characteristics and hospital course of patients hospitalized during the pandemic were compared to those pre-pandemic. Results: The clinical presentation of adolescents hospitalized prior-to (n=19) and during the COVID-19 pandemic (n=22) were similar with respect to constitutional, respiratory, and gastrointestinal symptoms. All patients hospitalized during the pandemic were tested for COVID-19 at least once. Only one patient had a positive SARS-CoV-2 RT-PCR test result. 31 out of 39 patients treated with corticosteroids had clinical improvement within 24 hours (79%). Patients hospitalized during the pandemic had a shorter median length of stay (5 vs 7 days, p<0.01), and were less often discharged with home oxygen (1 vs 6 patients, p=0.04). Pulmonary function tests improved pre-to post-corticosteroid treatment and post-corticosteroid to follow-up. Conclusions: Eliciting a history of vaping in adolescents presenting with constitutional, respiratory, and gastrointestinal symptoms is important to identify EVALI cases, which have continued throughout the COVID-19 pandemic. A shorter length of stay with less need for mechanical ventilation and home oxygen in adolescents hospitalized during the pandemic may reflect increased familiarity with EVALI characteristics. Corticosteroids led to clinical and pulmonary function improvement.

Climate warming has increased the frequency of extreme heat events, and Zeugodacus cucurbitae , as an important tropical pest,extreme heat tends to change its reproductive strategies.To clarify the reproductive strategies of Z. cucurbitae under the background of high temperature, Z. cucurbitae were exposed to short-term high temperatures of 25°C,33°C,37°C,41°C,and 45°C for 1h in this paper, and effects of these temperatures on the reproduction of Z. cucurbitae in three consecutive generations (F1,F2,and F3 generations) were evaluated, followed by using siRNA to interfere with the expression of Vitellogenin receptor(VgR) gene and evaluated the silencing efficiency of RNAi.The results showed that(1) short-time high temperature was generally detrimental to the reproduction of Z. cucurbitae, but the F1 exposed at 45°C for 1h stimulated its oviposition and when the offspring (F2andF3) were continuously exposed to 45°C-1h short-term high temperature,F3 could not survive.(2) After short-time high-temperature treatment, the injection of siRNA resulted in significant inhibition of VgR gene expression at 24h and72h.The total oviposition quantity, oviposition days, and hatchability of eggs after the interference were significantly lower than the other groups, and the inhibition effect of total oviposition quantity was the most obvious, decreasing by 88.4% and 95.2% at 25°C and 45°C, respectively, compared with the control check (CK). The ovarian development and ovarian diameter were also significantly lower than the other groups. In conclusion, the VgR gene is essential for the regulation of reproduction in Z. cucurbitae.This study can provide a reference for the integrated control of Z. cucurbitae in the high-temperature seas

The implementation of automatic fasteners such as the Cor-knot ® device (LSI Solutions, Inc.) has revolutionized the field of minimally invasive valvular surgery. Nonetheless, paravalvular regurgitation, valvular embolization, and early leaflet perforation are all potential complications which may occur. Late manifestations of leaflet perforation (>5-year post-implantation) are rare. Herein, we discuss a patient who underwent remote Trifecta ® (St. Jude, Inc.) surgical aortic valve replacement (SAVR) presenting with symptomatic critical aortic regurgitation secondary to leaflet perforation from automatically fastened metallic Cor-knot ® sutures.

Some would argue that kids aren’t just little adults, but what about their sternums? We are reviewing a manuscript by Horriat, McCandless, and colleagues in the Journal of Cardiac Surgery1 describing their experience with managing sternal wound infections (SWI) after congenital heart surgery. They report encouraging results in 14 patients who required plastic surgery consultation to manage their sternal wounds. The nature of congenital cardiac abnormalities and the necessary steps to repair them leads to physiologic derangements predisposing patients to SWI. Rates of SWI vary and have been reported at 1.53% in this population. There is little guidance on how the management of the congenital cardiac surgery patient should differ from the adult patient.2

In this work, we successfully demonstrated In0.53Ga0.47As/InAs/In0.53Ga0.47As composite channel metamorphic high electron mobility transistors (MHEMTs) on GaAs substrate for the first time. The fabricated MHEMTs with 100 nm gate length exhibited excellent DC and logic characteristics such as VT = -0.13V, gm,max = 949 mS/mm, subthreshold swing (SS) = 84 mV/dec, drain-induced barrier lowering (DIBL) = 89mV/V, and Ion/Ioff ratio = 9.8 X 103 at VDS = 0.5 V. In addition, the device exhibited excellent high frequency characteristics such as fT/fmax = 261/304 GHz at VDS = 0.5 V and these high frequency characteristics is the well-balanced demonstration of fT and fmax in the MHEMT structure on GaAs substrate.

The position sensorless Permanent Magnet Synchronous Motor (PMSM) is widely applied in the field of high reliability, and its driver, the inverter is controlled by closed loop feedback with the three-phase current. For medium and high power PMSM, both safety isolation and detection accuracy of measuring current are extremely significant. This paper presents a method of using Current Transformer (CT) with center taps to measure the high-frequency switch current and of an algorithm to reconstruct the low-frequency three-phase current. The measurement unit and reconfiguration algorithm are then applied to the motor starting stage controlled by the DSP controller TMS320F28335. Lastly, by comparing the waveform of the reconstructed current and one of the inverter phase current, the experimental results show that the proposed reconstruction method is effective.

Giant hydronephrosis (GH) is an uncommon urological disease, and Ureteropelvic junction obstruction (UPJO) is one of the most common in children. Herein, we present a case report of ruptured GH as a neglected UPJO complication in a 2.5-year-old girl with a clinical history of gross hematuria who underwent a nephrectomy.

Background Total Intravenous Anaesthesia (TIVA) with propofol infusion is done by manual co’ntrolled infusion (MCI) or by target-controlled infusion (TCI) devices. This is a comparative study of MCI/TCI administration. Method In this randomized controlled trial, Anaesthesia was induced with propofol 1%, using a target blood concentration of 5 Meg/ml in the TCI group or at a dose of 1.5 mg/kg at an infusion rate of 1200 ml/h in the MCI group. Subsequently, a step-down maintenance regimen (10, 8 and 6 mg/kg/h at 10-min interval) was commenced for the MCI group. Primary outcome was the time to induction of anaesthesia in both groups. Data was analysed using Statistical Package for Social Sciences (SPSS) version 20.0. Results 52 patients were recruited into the study. The duration of induction of anaesthesia in the TCI group compared to the MCI group was (94.62 ± 11.34 sec vs. 79.50 ±16.23 sec, p = 0.001). The induction dose of propofol TCI against MCI was (118.00 ± 22.33 mg vs.133.04 ± 20.58 mg, p = 0.015). Both groups were comparable in terms of total dose of propofol (I 152.92 ± 234.47 mg vs. 1014.97 ± 264.18 mg, p = 0.052), recovery time (8.45 ± 2.13 min vs. 7.86 ± 2.05 min, p = 0.314), haemodynamic parameters and incidence of adverse events. Conclusion Manual controlled infusion was comparable to target controlled infusion for the induction and maintenance of general anaesthesia using propofol; providing similar quality and ease of anaesthesia as a viable option in resource challenged settings.

Introduction: We describe 2 patients with right anteroseptal accessory pathway (ASAP) who developed new cardiomyopathy due to worsening AV node conduction which resulted in more pre-excitation and frequent orthodromic reciprocating tachycardia (ORT). Methods and Results: Case 1: 48-year-old female with a history of normally functioning mechanical mitral valve, CABG, and pre-exitation that worsened after her open heart surgery. She presented with frequent palpitations with documented supraventricular tachycardia (SVT) and found to have a new cardiomyopathy with decrease in ejection fraction (EF) from 55% to 46% with dyssynchrony. Electrophysiological study confirmed a right ASAP and ORT. The pathway was successfully ablated from the antegrade approach after careful mapping. After ablation and six month follow up echocardiogram showed improvement of EF to 54% and the LV dyssynchrony resolved. Case 2: 51-year-old male with a history of frequent SVT with a recent unsuccessful ablations that resulted in worsening pre-exitation, more frequent SVT and new cardiomyopathy (EF from 60% to 40%). He was started on Amiodarone which resulted in significant sinus bradycardia, and intermittent pre-excitation and first degree AV block with no improvement in his ORT events. His Electrophysiology study confirmed ASAP which was successfully ablated from the antegrade approach after careful HIS mapping. After one month follow-up echocardiogram showed an improved ejection fraction to 60%. Conclusion: New cardiomyopathy due to dyssynchrony and symptomatic frequent ORT of right ASAP can develop in the setting of new iatrogenic diminished AV node conduction. Successful ablation will result in LV function recovery to baseline.

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Ventricular arrhythmias are an important cause of morbidity and mortality and come in a variety of forms, from single premature ventricular complexes to sustained ventricular tachycardia and fibrillation. Rapid developments have taken place over the past decade in our understanding of these arrhythmias and in our ability to diagnose and treat them. The field of catheter ablation has progressed with the development of new methods and tools, and with the publication of large clinical trials 1. A 48-year-old male with complex congenital heart disease (CCHD) and reduced LVEF, with the presence of frequent ventricular extrasystoles (VE) from the right ventricular outflow tract (RVOT), which is why he was taken to radiofrequency catheter ablation. The aim of the authors is to describe the technique of ablation of VE of the RV outflow tract in complex congenital heart disease.

A 75-year-old man with atrial fibrillation and III atrioventricular block (AVB) with a slow escape rhythm and right bundle branch block (RBBB) underwent His-bundle pacing (HBP). The procedure was guided by the tricuspid valve annulus (TVA) visualisation technical without His-bundle (HB) potentials recorded and got a low HB capture threshold. The transition from non-selective (NS) -HBP to selective (S) -HBP can be seen during the threshold test. It is possible to achieve HBP without HB potentials recorded in the whole procedure.

Background: Mitral valve apparatus is complex and involves the mitral annulus, the leaflets, the chordae tendinae, the papillary muscles as well as the left atrial and ventricular myocardium. Secondary mitral regurgitation is consequence of regional or global left ventricle remodeling due to an acute myocardial infarction (75% of cases) or idiopathic dilated cardiomyopathy (25% of cases). It is associated with an increase in mortality and poor outcome. There is a potential survival benefit deriving from the reduction in the degree of severity of mitral regurgitation. So the correction of the valve defect can change the clinical course and prognosis of the patient. The rationale for mitral valve treatment depends on the mitral regurgitation mechanism. Therefore, it is essential to identify and understand the pathophysiology of the mitral valve regurgitation. Aim of the study: The aim of this review is to describe the crucial role of transthoracic and trans-esophageal echocardiography, in particular with 3D echocardiography, for the assessment of the severity of secondary mitral regurgitation, anatomy and hemodynamic changes in the left ventricle. Moreover, the concept that the mitral valve has no organic lesions has been abandoned. The echocardiography must allow a complete anatomical and functional evaluation of each component of the mitral valve complex, also useful to the surgeon in choosing the best surgical approach to repair the valve. Conclusions: Echocardiography is the first-line imaging modality for a better selection of patients, according to geometrical modifications of mitral apparatus and left ventricle viability, especially in preoperative phase.

Endocarditis originating from a prior venous cannulation site  is undescribed in the current literature. Infections of the heart pose significant morbidity and mortality to patients, therefore prompt recognition, diagnosis, and treatment are critical. Our patient underwent coronary artery bypass grafting (CABG) and developed a postoperative sternal wound infection with methicillin resistant staphylococcus aureus (MRSA). After failing nonoperative management, redo-sternotomy was performed with atrial wall debridement and patch repair. During this procedure, two unexpected small discrete abscess pockets of the right atrial epicardium were discovered. One of the abscess pockets fistulized into the right atrium and was noted to be at his prior venous cannulation site for cardiopulmonary bypass as evidenced by neighboring prolene suture. The patient had an uneventful recovery  and was discharged home on postoperative day 7. Transthoracic echo was obtained 6 weeks after his second operation and did not show any recurrence of endocarditis. We present a unique case of persistent cardiac infection with a complicated course and management strategy.

Security experts have demonstrated numerous risks imposed by Internet of Things (IoT) devices on organizations. Due to the widespread adoption of such devices, their diversity, standardization obstacles, and inherent mobility, organizations require an intelligent mechanism capable of automatically detecting suspicious IoT devices connected to their networks.

Background Data on the factors that trigger repetitive non-reentrant ventriculoatrial synchrony (RNRVAS) are limited. We hypothesize that loss of atrial capture may trigger RNRVAS. We aimed to use an atrial threshold test to observe the development of RNRVAS upon loss of atrial capture in patients with implantable cardiac electronic devices (CIED). Methods Patients with DDD mode CIEDs [177 patients, 67.5 ± 14.8 (70) years; 70 women] were included. Atrial threshold test was done in DDD mode at a rate at least 10 beats above the basal heart rate, with an AV delay of 300 ms (range 250 - 350). A multivariable logistic regression model was used to assess the independent predictors of RNRVAS. Results RNRVAS was observed in the 69 of 177 patients (39.0%). In patients with VA conduction, incidence of RNRVAS increased to 76.7%. The patients with RNRVAS were younger than those without RNRVAS ( P = .038). History of complete AV block, any AV node conduction defect ( P < .001) and ventricular pacing ratio ( P = .001) were significantly higher and VA conduction ( P < .001) significantly less in patients without RNRVAS than in patients with RNRVAS. History of complete AV block ( P = .009) and ventricular pacing ratio ( P = .029) appeared as independent factors indicating decreased risk of RNRVAS  development.  Conclusion In this study we demonstrated that loss of atrial capture results in RNRVAS in one third of patients with a CIED in DDD mode, and in three fourths of those with VA conduction under certain predisposing CIED settings.

Aim: Advanced age is an important risk factor for adverse events during procedural sedation. Remimazolam is safe and effective in adults’ gastroscopy sedation. The ideal dose and availability for elderly patients are not well known. We aim to investigate its 95% effective dose (ED95) for elderly patients undergoing gastroscopy, and to assess its safety and efficacy, with propofol as the comparison. Methods: The trial consists of two parts, patients who are over 65 and scheduled for elective outpatient painless gastroscopy were enrolled. In the first part, Dixon’s up-and-down methodology was used to determine the ED95 of remimazolam and propofol for inhibiting body movement during gastroscopic insertion, in combination with 0.2μg/kg remifentanil. In the second part, patients in each group received 0.2μg/kg remifentanil and the ED95 dose of the study drug for sedation induction, adding supplemental doses to maintain sedation depth when necessary. The primary outcome was the incidence of adverse events. The secondary outcome was the recovery time. Results: The ED95 of remimazolam and propofol induction dose were 0.204mg/kg [95% CI (0.175–0.390) mg/kg] and 1.994 mg/kg [95% CI (1. 739–5.955) mg/kg] respectively in gastroscopy. Adverse events were reported in 40.6% of patients in the remimazolam group and 83.1% in the propofol group (p<0.001), whereas the remimazolam group showed a higher incidence of hiccup(p=0.017). A shorter time to awakening (p<0.05) in the remimazolam group was observed. Conclusion: For elderly patients undergoing gastroscopy, the ED95 dose of remimazolam is a safer alternative than propofol when inducing the same sedation depth.

Soil microbial communities play an essential role in riparian ecosystems, which commonly consist of a few abundant taxa and numerous rare taxa. However, relatively little is known about the community assembly processes of abundant and rare taxa, and how these respond to fluctuating environments. In this study, patterns and drivers of the assembly processes for abundant and rare bacterial and archaeal subcommunities in a riparian zone were determined. Results showed that the community structures of abundant and rare bacteria and archaea exhibited a consistent variation along the riparian elevation, which was highly associated with flooding frequency. Rare taxa were phylogenetically more closely clustered, but occupied narrower niche breadths than abundant taxa. The community assembly of abundant and rare bacteria was driven respectively by dispersal limitation and variable selection; undominated processes and dispersal limitation dominated abundant archaeal community, while rare archaea was primarily governed by homogeneous selection. Soil moisture and ratio of time soil was submerged to exposed to air were the two most decisive factors for the assembly processes of both rare bacteria and abundant archaea. The assembly processes of rare bacteria were also significantly associated with soil NH4+, Fe2+ and Fe2+/Fe3+, while rare archaea were significantly associated with C/N and total carbon. Here, flooding may influence community assembly processes by shaping soil niches and imposing disturbances. Overall, this study reveals divergent assembly processes for abundant and rare subcommunities in the riparian zone, which is essential knowledge to further elucidate the stability and maintenance of ecosystem functions under changing environments.

Abstract: After several years with sobering experiences with electrogram-based AF ablation approaches, Seitz et al present with the VX1 software a reliable tool to map and ablate spatio-temporal dispersion. The presented multicenter study in persistent AF patients was conducted in 1 expert and 7 satellite centers with a total of 17 operators, using the VX1 software to detect and subsequently ablate spatiotemporal dispersion. While the AF termination rate (88%) and the freedom from AF in 12 months FU (82%) was very encouraging, the VX1 software, using AI enhanced electrogram adjudication, achieved very similar results in all centers, regardless of the centre’s or the operator’s experience. Thus, the biggest criticism of electrogram-based ablation strategies, i.e. the lack of reproducibility in “non-expert” centers, seems to be finally addressed.

Abstract Background and Purposes: Although trace amines, including β-phenylethylamine (β-PEA), cause vasoconstriction, they also induce endothelial nitric oxide release via an unknown mechanism. This study evaluates the cellular site of action and receptors mediating β-PEA-induced vasodilation. Experimental Approach: In vitro vasodilator responses to β-PEA were assessed using aortic rings and third-order mesenteric arteries of male Sprague-Dawley rats. Key Results: β-PEA-induced concentration-dependent vasodilation of pre-constricted aortic rings and third-order mesenteric arteries were partially sensitive and insensitive to endothelium removal, respectively. In aortic rings vasodilator responses to β-PEA were unaffected by EPPTB, a selective antagonist of murine trace amine associated receptor 1 (TAAR1), or antagonists of β2-adrenoceptors and muscarinic acetylcholine M3 receptors. The inhibitor of uptake-2 transport, decynium-22, abolished β-PEA-induced vasodilation revealing a vasoconstrictor response. Conclusion and Implications: Vasodilator responses to β-PEA do not involve cell surface receptors. We propose that β-PEA utilises uptake-2 transporters to gain access to an intracellular site. Although the identify of the intracellular site is unknown, the mechanism is similar to that previously reported where intracellular TAAR1 medated responses in HEK293 cells. Vasodilatation is the dominant response to trace amines of mesenteric vessels whereas in the aorta, it opposes vasoconstriction.

Leukocytoclastic vasculitis is an entity that has been associated with drugs, infections, cryoglobulinemia. We are presenting a 55-year-old female who presented with a painful and pruritic rash localized in the abdomen and lower extremities that started one week after initiated atorvastatin as treatment of hyperlipidemia.

The sodium dependent SLC13 family transporters comprise of the five genes SLC13A1, SLC13A2 (NaDC1), SLC13A3 (NaDC3), SLC13A4 and SLC13A5 (NaCT). Among them the three NaDC1, NaDC3 and NaCT are sodium dependent transporters such as di-carboxylates (succinate, malate, α-ketoglutarate) and tricarboxylates (citrate). The mouse and the human NaCT structures have still not been crystallized, the information to the structures is taken from the related bacterial transporter of VcINDY. Citrate in the cytosol works as precursor for the fatty acid synthesis, cholesterol, and low-density lipoproteins. The excess citrate from the matrix is translocated to the cytosol for fatty acid synthesis through these receptors and thus controls the energy balance by downregulating the glycolysis, tricarboxylic acid (TCA), and fatty acid breakdown. These transporters play an important role in regulating various metabolic diseases including cancer, diabetes, obesity, fatty liver diseases and CNS disorders. These di and tricarboxylate transporters are emerging as new targets for metabolic disorders such as obesity and diabetes. The mutation in the function of the NaCT causes several neurological diseases including neonatal epilepsy and impaired brain development whereas mutation of the citrate present in the liver may provide positive effect. Therefore, continued efforts from the earlier work on citrate transporter are required for the development of citrate inhibitors. In this review the structure, function, and regulation of the NaCT receptors are discussed. The review also highlights citrate role in diagnosing diseases such as cancer, diabetes, fatty liver, and diabetes. The therapeutic perspective of synthetic inhibitors against NaCT receptors are succinctly summarized.