Sigmoid volvulus is one of the rare causes of intestinal obstruction in pregnancy and can result in significantly increased maternal and fetal mortality rates, especially in case of delayed diagnosis. In this report, we present a 34 week-pregnant lady presenting with intestinal obstruction due to sigmoid volvulus and her management.

Several hundred cases of placental hemangiomas have been reported in the literature. However, the umbilical cord is extremely uncommon as a site of occurence.We report the first case of hemangioma of the umbilical cord synchronous to maternal infection with covid-19.We aim to study the clinicopathological characteristics of this singular entity.

Tailgut cyst, a type of retro-rectal cyst, is a rare condition requiring evaluation for malignant transformation. We report a case of squamous cell carcinoma arising in the retro-rectal cyst, in a 51-year-old female who underwent incomplete resection of the cyst and chemo-radiotherapy, subsequently became locally recurred and metastatic.

Haloxylon ammodendron and Haloxylon persicum are important drought-tolerant plants in northwest China. The whole-genome sequencing of H. ammodendron and H. persicum grown in their natural environment is incomplete, and their transcriptional regulatory network in response to drought environment remains unclear. To reveal the transcriptional responses of H. ammodendron and H. persicum to an arid environment, we performed single-molecule real-time (SMRT) and Illumina RNA sequencing. In total, 20,246,576 and 908,053 subreads and 435,938 and 210,334 circular consensus sequencing reads were identified by SMRT sequencing of H. ammodendron and H. persicum, and 15238 and 10135 unigenes, respectively, were successfully collected. In addition, 9794 and 7330 simple sequence repeats (SSRs) and 838 and 71 long noncoding RNAs were identified. In an arid environment, the growth of H. ammodendron was restricted; plant height decreased significantly; and the base and branch diameters became thinner. Hydrogen peroxide (H 2O 2) content and peroxidase activity were increased. Under dry and wet conditions, 11,803 and 15,217 differentially expressed genes (DEGs) were identified in H. ammodendron and H. persicum, respectively. There were 319 and 415 DEGs in the signal transduction pathways related to drought stress signal perception and transmission, including the Ca 2+ signal pathway, the ABA signal pathway, and the MAPK signal cascade. In addition, 217 transcription factors (TFs) and 398 TFs of H. ammodendron and H. persicum were differentially expressed, including FAR1, MYB, and AP2/ERF. Bioinformatic analysis showed that under drought stress, the expression patterns of genes related to active oxygen (reactive oxygen species) scavenging, functional proteins, lignin biosynthesis, and glucose metabolism pathways were altered. This is the first full-length transcriptome report concerning the responses of H. ammodendron and H. persicum to drought stress. The results provide a foundation for further study of the adaptation to drought stress. The full-length transcriptome can be used in genetic engineering research.

It is comprehended that the systems without any limitation on their Zeno action are enthralled in a vast class of hybrid systems. This article is influenced by a new category of non-autonomous second order measure differential problems with state-dependent delay (SDD) and non-instantaneous impulse (NII). Some new sufficient postulates are created that guarantee solvability and approximate controllability. We employ the fixed point strategy and theory of Lebesgue–Stieltjes integral in the space of piecewise regulated functions. The measure of non-compactness is applied to establish the existence of a solution. Moreover, the measured differential equations generalize the ordinary impulsive differential equations. Thus, our findings are more prevalent than that encountered in the literature. At last, an example is comprised that exhibits the significance of the developed theory.

In laparoscopic intersphincteric resection, identifying the dissection layer near the anus is often difficult. We safely proceeded with it, using indocyanine green-containing gauze on the anal side to remove the internal anal sphincter with indocyanine green fluorography.

Title Page Title: Letter to the Editor: ”Urinary TIMP-2 and IGFBP-7 protein levels as early predictors of acute kidney injury after cardiac surgery”.Article type: Letter to the editor.

In this case, we reported a 24-day-old infant with a rare combination of the anomalous origin of coronary artery and the type A interrupted aortic arch, who presented with significant shortness of breath. Besides these anomalies, further cardiac examination including transthoracic echocardiography and CT angiogram revealed ventricular septum defect, patent foramen ovale and patent ductus arteriosus at the same time. Surgical procedures including repair of ventricular septum defect, ligation of patent ductus arteriosus, unroofing of right coronary artery and end-to-side aortic anastomosis were performed to cure the infant. This patient stayed in ICU for few days without any major complications and discharged from hospital at the tenth day after surgery.

A document by Muhammad Ali. Click on the document to view its contents.

Even though circumcision is low-risk, complications may occur, necessitating careful management. Here, we describe a 5-month-and-28-day-old infant who developed necrotizing fasciitis following Plastibell circumcision. This report emphasizes that clinicians should use standard equipment and appropriate-sized rings to prevent these unusual complications following circumcision

Aim: To evaluate clinical practice, neonatologists’ attitudes, the extent of training and accreditation regarding targeted neonatal echocardiography (TnEcho) among Chinese neonatologists. Methods: A web-based questionnaire was emailed to 124 randomly chosen neonatologists at 55 tertiary neonatal intensive care units (NICUs) from all regions of China. The survey covered various aspects of TnEcho, including the characteristics of clinical practice, attitudes towards its usefulness, perceived barriers of implementation and training methods. Results: Survey response rate was 67.7% (84/124). Thirty-six (42.9%) respondents stated that TnEcho was utilized in their NICUs. Most respondents reported use of echocardiography to evaluate hemodynamic significance of the patent ductus arteriosus (PDA, 97.2%), myocardial performance in neonates with sudden cardiorespiratory deterioration (97.2%). The most frequently used parameters to identify hemodynamic significant PDA were ductal size (88.9%) and doppler pattern (91.7%) of transductal flow respectively. Most (83.3%) respondents measured tricuspid regurgitation to assess pulmonary hemodynamics. All respondents positively valued the role of TnEcho in providing timely and longitudinal hemodynamic information to guide cardiovascular support. Lack of experienced practitioners with echocardiography expertise and accredited training programs were perceived to be the major barriers to implementation (82.1% and 81%, respectively). Of concern, most practitioners with TnEcho skills received training in an informal manner through self-directed learning (66.7%) or workshops (66.7%). Conclusions: The use of TnEcho for longitudinal evaluation of infants with hemodynamic stability is growing within Chinese NICUs. There is an urgent need to develop standardized training programs and accreditation for TnEcho which are adapted to the Chinese context.

Rice bran contains an abundance of phytosterols. We have developed “Riceterol EsterTM” (RSE), which consists of a phytosterol ester and fatty acids made from the by-product of extracting oil from rice bran. RSE has been registered as a cosmetic ingredient in rice bran-derived products, and its physical functions, such as its high water retention and emollient effects, are evident, although its biological functions remain poorly understood. In this study, we clarified the biological effectiveness of RSE. Treatment of 0.01% RSE to normal human fibroblasts cell (Hs68) resulted in increased amounts of hyaluronic acid and type III collagen. On the other hand, in the face application test with human volunteers, a significantly reduced amount of trans-epidermal water loss (TEWL) was found in the 8th and 12th weeks. By image analysis, improvements in facial redness and pore troubles were also observed using a visual analog scale (VAS) questionnaire. It is suggested that RSE improves barrier function and maintains the repair of the dermis structure.

Elevated CO2 negatively affects marine fish. In a recirculating aquaculture systems, we exposed juvenile Scophthalmus maximus, a CO2¬-sensitive, high-value species , to CO2 at 0 mg/L (control), or at 8, 16, 24, or 32 mg/L, for 7, 14, 30, or 60 d. Cumulative survival decreased significantly with increasing CO2 , to 68% at 32 mg/L. Weight gain, specific growth rate, and feed conversion rate differed significantly between the control and maximum concentration. CO2 caused histopathological damage. Plasma glutamate pyruvate transaminase and glutamate oxalate transaminase were significantly and substantially elevated at 24 and 32 mg/L CO¬2, relative to the control. At 32 mg/L, hemoglobin was significantly reduced, and methemoglobin significantly elevated , indicating reduced oxygen-carrying capacity. GHR, IGF-1, IGF-1R, and THR expression were substantially lower at 32 mg/L than in the control. For Scophthalmus maximus , these findings indicate that elevated CO2 retards growth, impairs health, and causes metabolic disorders, possibly by impairing liver function.

Aim: The aim of this study was to establish a population pharmacokinetic (PPK) model for rivaroxaban in Chinese elderly patients with NVAF to evaluate precision dosing regimens and analyze hemorrhagic risk after rivaroxaban treatment. Method: A population pharmacokinetic model was developed using the nonlinear mixed-effects model (NONMEM). The plasma concentration of rivaroxaban was detected by UPLC-MS/MS method and the gene polymorphisms were detected by Sanger dideoxy DNA sequencing method. A Monte Carlo simulation was performed to evaluate various dosing schemes and different levels of covariates for the target range of therapeutic drug monitoring concentrations (Cmax,ss, Cmin,ss). Exposure of rivaroxaban was simulated and assessed in hemorrhagic risk evaluation. Results: Model-building dataset including 360 plasma concentrations from 180 Chinese elderly patients (median age 81year). A one-compartment population PK model with estimated glomerular filtration rate (eGFR), total bilirubin (TBIL) and ABCB1 rs1045642 as major covariates for apparent clearance were developed. The average probability of target attainment (PTA) of optimal dosing regimens with different covariates levels for targeted Cmax,ss and Cmin,ss were 29.35%-31.30% and 64.91%-65.80%, respectively. 10 mg of rivaroxaban in Chinese elderly patients with normal renal and liver function was appropriate. AUC24,ss was statistically significant associated with the increased risk of the bleeding events (OR 1.0006; 95%CL 1.0003-1.001; p<0.0001). Conclusion: Lower dose is recommended for older patients with renal impairment to avoid overexposure and bleeding events. The population pharmacokinetic model could inform individualized dosing for Chinese older NVAF patients with rivaroxaban anticoagulation therapy.

Objective: Evaluation of the inter-observer and intra-observer agreement for CTG interpretation by NICE guidelines 2017. Design: A hospital-based Prospective observational study. Setting: The study was conducted at a university teaching hospital Sample size: A total of 165 CTG tracings from 165 laboring women were included in the study for interpretation by 6 clinicians with varying levels of experience in the specialty. Methods: 6 clinicians (3 consultants & 3 residents in training) independently interpreted CTG traces using NICE 2017 guidelines twice with a locking period of 3 months between 2 interpretations. Main outcome measure: Fleiss’s kappa and Cohen’s kappa coefficient was employed for ascertaining interobserver and intraobserver agreement using SPSS statistical software. Results: Among all CTG parameters, observed agreement for baseline fetal heart was substantial [k=0.678(0.677-0.679), p<0.0001] but the congruence for variability was only slightly above the chance [0.185 (0.184-0.186), p<0.0001]. Overall kappa coefficient was 0.382 (0.381-0.383) with a p<0.0001 (moderate agreement) for classifying the CTG category. The intra-observer agreement of most senior consultant for baseline was nearly perfect (Kf=0.937) as compared to a kappa coefficient of 0.367 of the junior-most resident. Conclusions: Different CTG interpretation parameters were observed to have varying levels of agreement among clinicians. Where experience was witnessed to improve the agreement, the higher degree of non-congruence in certain CTG parameters like variability, and type of decelerations may perhaps point to the need for further objectivity in defining these parameters.

Objectives To study effects of physiotherapist-guided pelvic floor muscle training on pelvic organ prolapse (POP) early postpartum period. Design Assessor-blinded, randomized controlled trial. Setting Physiotherapy Clinic, Reykjavik. Sample Eighty-four primiparous women with a singleton delivery. Methods Participants were screened for eligibility 6-13 weeks postpartum. Women randomized to the training group conducted 12 weekly individual sessions with a physiotherapist, starting on average 9 weeks after childbirth. Outcomes were assessed after the last session (short-term) and at 12 months postpartum (long-term). The control group received no instructions after the initial assessment. Main outcome measures Self-evaluated POP symptoms by the Australian Pelvic Floor Questionnaire. Results Forty-one and 43 women were randomized to the training and control groups, respectively. At recruitment, 17 (42.5%) of the training and 15 (37%) of the control group reported prolapse symptoms (p=0.6). Five (13%) from the training and 9 (21%) controls were bothered by the symptoms (p=0.3). There was a gradual decrease in the number of women with symptoms and no significant short-term (p=0.08 at 6 months) or long-term (p=0.6 at 12 months) differences between the groups regarding rates of women with POP sympoms. No difference was between groups regarding bother in the short (p=0.3) or longer term (p=0.4). Repeated measure analyses using Proc Genmod in SAS did not indicate a significant effect of the intervention over time, p>0.05. Conclusions There was an overall decrease in postpartum symptoms of POP and bother during the first year. Physiotherapist-lead pelvic floor muscle training did not change the outcomes.

Invasive predatory species are frequently observed to cause evolutionary responses in prey phenotypes, which in turn may translate into evolution of the prey’s population dynamics. Research has provided a link between rates of predation and the evolution of prey population growth in the lab, but studies from natural populations are rare. Here we tested for evolutionary changes in population dynamics parameters of zooplankton Daphnia pulicaria following invasion by the predator Bythotrephes longimanus into Lake Kegonsa, Wisconsin, US. We used a resurrection ecological approach, whereby clones from pre- and post-invasive periods were hatched from eggs obtained in sediment cores and were used in a 3-month growth experiment. Based on these data we estimated intrinsic population growth rates (r) and carrying capacities (K) using theta-logistic models. We found that post-invasion Daphnia maintained a higher r and K under these controlled, predation-free laboratory conditions. Thus, whereas previous experimental evolution studies of predator-prey interactions have demonstrated that genotypes that have evolved under predation have inferior competitive ability when the predator is absent, this was not the case for the Daphnia. Given that our study was conducted in a laboratory environment and the possibility for genotype-by-environment interactions, extrapolating these apparent counterintuitive results to the wild should be done with caution. However, barring such complications, we discuss how selection for reduced predator exposure, either temporally or spatially, may have led to the observed changes. This scenario suggests that complexities in ecological interactions represents a challenge when predicting the evolutionary responses of population dynamics to changes in predation pressure in natural systems.

Pseudoaneurysm of ascending aorta following cardiac surgery is a very rare and life threatening entity due to risk of exsanguination from its rupture. This is a case report of a 39 year old male patient who presented with impending rupture of ascending aorta pseudoaneurysm following mitral valve replacement. He underwent urgent reoperation under femoro-femoral cardiopulmonary bypass and deep hypothermic circulatory arrest. The pseudoaneurysm was excised and repaired with pericardial patch. He was discharged after an uneventful postoperative course.

Background and Purpose: (S)-ketamine induced rapid-acting antidepressant effects have revolutionized pharmacotherapy of major depression, however this medication produces also psychotomimetic effects including timing distortion. In contrast, (R)-ketamine appears to produce less of dissociative effects, but its antidepressant actions were less studied. It has been suggested that opioid receptors are involved in the antidepressant effect of ketamine. In addition, recent report suggests that while (S)-ketamine induced time underestimation, the (R)-isomer did not affect timing. Experimental approach: (R)- and (S)-ketamine, and fluoxetine as a positive control were tested in the differential-reinforcement-of-low-rate (DRL) 72-s schedule of reinforcement in male rats following naloxone pretreatment. Several DRL classic metrics as well as peak deviation analyses served to determine antidepressant-like actions and those associated with timing. Key Results: Antidepressant-like effect of (S)-ketamine (30-60 mg/kg) resembled fluoxetine (2.5-10 mg/kg) actions. Fluoxetine and (S)-ketamine increased reinforcement rate and peak location, suggesting increased performance, reduced premature responses, suggesting time underestimation and decreased Weber’s fraction, suggesting increased timing precision. In contrast, (R)-ketamine (60 mg/kg) increased reinforcement rate and peak location without affecting premature responses. Only fluoxetine decreased burst responses, suggesting decreased impulsivity. Naloxone pretreatment did not block ketamine enantiomers’ actions, but unexpectedly, increased fluoxetine’ performance. Conclusions & Implications: Fluoxetine’ and (S)- but not (R)- ketamine induced time underestimation could be associated with their antidepressant effects. The potentiation of DRL performance of fluoxetine by naloxone was unexpected and warrants further clinical studies.

Background and Purpose: Anxiety disorders associated with pain are a common health problem. However, the underlying mechanisms remain poorly understood. We aimed to investigate the role of paraventricular nucleus (PVN)-central nucleus of the amygdala (CeA) oxytocinergic projections in anxiety-like behaviours induced by inflammatory pain. Experimental Approach: Complete Freund’s adjuvant (CFA)-induced inflammatory pain model was used to induce the anxiety-like behaviours. Chemogenetic, optogenetic and fibre photometry recordings were used to modulate and record the activity of the oxytocinergic projections of the PVN-CeA. Key Results: Inflammatory pain induced anxiety-like behaviours in mice accompanied by decreased activity of PVN oxytocin neurons. Chemogenetic activation of PVN oxytocin neurons prevented pain-related anxiety-like behaviours, whereas inhibition of PVN oxytocin neurons induced anxiety-like behaviours in naive mice. PVN oxytocin neurons projected directly to the CeA, and microinjection of oxytocin into the CeA blocked anxiety-like behaviours. Inflammatory pain also decreased the activity of CeA neurons, and optogenetic activation of PVNoxytocin -CeA circuits prevented anxiety-like behaviour in response to inflammatory pain. Conclusion and Implications: Our study suggests that oxytocin has anti-anxiety effects and provides novel insights into the role of PVN-CeA oxytocin projections in the regulation of anxiety-like behaviours induced by inflammatory pain.

Atrial dissection is an uncommon entity after cardiac surgery. There is not an extensive knowledge about pathophysiology, clinical presentation and management. We report the case of a 65 year-old male who after triple myocardial revascularization bypass suffered a left atrial dissecition. We chose a conservative manegement and close follow up.

Chimeric Antigen Receptor T-cells represent a breakthrough in personalized cancer therapy. In this strategy, synthetic receptors comprised of antigen recognition, signaling, and stimulatory domains are used to reprogram T-cells to target tumor cells for destruction. Despite the success of this approach in refractory B-cell malignancies, optimal potency of CAR T-cell therapy for many other cancers, particularly solid tumors, has not been achieved. NK cells are powerful cytotoxic lymphocytes specialized in recognizing and dispensing with changed cells, and in coordinating versatile anti-tumor immunity.NK cells are as a rule practically depleted within the tumor microenvironment. In like manner, current investigate endeavors center on exactness designing of CAR T-cells with routine CRISPR-Cas9 frameworks or novel editors that can introduce craved hereditary changes with or without presentation of a double-stranded break into the genome. These instruments and methodologies can be specifically connected to focusing on negative controllers of T-cell work, coordinating helpful transgenes to particular genomic loci, and producing reproducibly secure and powerful allogeneic widespread CAR T-cell items for on-demand cancer immunotherapy. The revelation and improvement of the CRISPR/Cas9 innovation offer an adaptable and proficient gene-editing capability in tweaking different pathways that intercede NK cell fatigue and in outfitting NK cells with novel chimeric antigen receptors to particularly target tumor cells. Despite the tall productivity in its gene-editing capability, trouble within the conveyance of the CRISPR/Cas9 framework remains a major bottleneck for its restorative applications, especially for NK cells.This review assesses a

This case report describes the multidisciplinary orthodontic treatment of an adult female with a skeletal Class III malocclusion, extensive root absorption in the incisors, and a mesially impacted and excessively rotated canine, treated using clear aligners without application of temporary anchorage devices.

A document by Pimporn Puttawibul. Click on the document to view its contents.