To assess the association between single, isolated left SVC and coarctation of the aorta. Retrospective review Fetal cardiac centre in London, split across two sites. 24001 fetal cardiac scans performed between April 2005 and March 2020, of which 24 fetuses were found to have isolated single left SVC. Retrospective analysis of clinical reports and outcome data were examined from routinely captured clinical data; this data was compared to gestation-matched references. Presence of aortic arch hypoplasia and/or coarctation of the aorta. 289 fetuses were identified with left SVC, of those 24 (8.3%) had single left SVC with agenesis of the right SVC. 95.8% (23/24) were identified after the introduction of the 3VV to the fetal anomaly screening programme in 2010 of which 58.35 (14/24) were diagnoses after the addition of the 3VT in 2015. All fetuses were successfully delivered without any postnatal complications. None were found to have aortic arch hypoplasia or coarctation of the aorta. Single LSVC does not appear to be associated with CoA and can be considered a benign congenital anomaly. Changes in streaming of flow across the patent foramen ovale, thus maintaining adequate perfusion of the aortic isthmus in fetal life, may be the reasons for not developing coarctation of the aorta. Furthermore, frequency of antenatal scans can be minimized, and postnatal management adjusted accordingly as single LSVC in the absence of right SVC does not appear to result in development of coarctation of the aorta, neither antenatally nor after birth.

Objective: To evaluate patient and clinician views regarding Patient-Initiated Follow-Up (PIFU) in gynaecology and identify subgroups suited to this pathway of care. Design: Cross-sectional survey Setting: Gynaecology Outpatients Department, Sheffield Teaching Hospitals, Sheffield, UK. Population or Sample: Patients and clinicians. Methods: Participants were recruited from gynaecology outpatients, with purposive sampling of diverse groups and clinics. PIFU value and burden were evaluated using patient and clinician surveys (modified QQ-10). Free-text comments were collated. Main Outcome Measures: QQ-10 value and burden scores. Results: 305 patients and 30 clinicians were surveyed. On value and burden scales of 0–100, patients and clinicians attributed high value (mean 77 and 81) and low burden (mean 38 and 45). Greater autonomy was cited in free-text by 85% of patients and 93% of clinicians. Patients attending benign gynaecological sub-specialties attributed highest mean value scores: Endometriosis (84), general gynaecology (83) and vulval clinics (81). Gynaecology oncology patients attributed lowest value (64) and highest burden (51) of all subgroups. Younger patients (<60) were more likely to express preference for PIFU (53%) than older (29%). Conclusions: Patients and clinicians are in favour of selected use of PIFU in Gynaecology. Both surveys found younger patients with benign gynaecological conditions well-suited to PIFU. We recommend offering PIFU to select patients confident in self-monitoring, whilst respecting patient choice so patients are not disadvantaged by this system. Further evaluation of PIFU in women’s health is warranted, including more detailed socio-economic and outcomes assessment. Funding: None Keywords: Patient-Initiated Follow-Up, Women’s Health, Gynaecology, Survey, Self-Monitoring

Primary cardiac angiosarcomas are rare tumors. Here, we report a case of primary cardiac angiosarcoma originating in the left atrium. The tumor resulted in mitral stenosis with regurgitation, tricuspid regurgitation, and severe pulmonary hypertension. After admission, the tumor was surgically removed. During the operation, it was found that the tumor originated from the mitral valve and invaded the valve annulus. How to place the artificial valve after the tumor was removed is the key to the success of the surgery. In this article, we aim to provide insights into the diagnosis, symptoms, and manifestations of primary cardiac angiosarcoma, as well as an alternative approach to intraoperative annulus reconstruction, and emphasize the importance of early diagnosis, treatment, and positive prognosis.

The reported case is a 53-year-old woman with the history of long-standing rheumatoid arthritis who first presented with acute-onset dizziness and gait disturbance, periventricular linear and radial enhancement pattern on MRI and normal CSF analysis, successfully treated with an increase in the dose of oral steroids.

Monochorionic twins (MC) are at increased risk of CHDs, especially acquired CHDs in twin-twin transfusion syndrome (TTTS). Multiple cardiac abnormalities in MC twins with TTTS are to be expected due to cardiac hemodynamic changes. Therefore, more attention to this group of patients should be given regarding heart abnormalities.

We report the clinical, imaging, echocardiography and muscle biopsy findings of a patient presenting by characteristics which have not been reported in previous Melas cases. This is the first reported case of MELAS accompanying with PFO, and the first case of MELAS with the progressive pattern of ischemic lesions.

In plasmid DNA (pDNA) production from Gram-negative bacteria, endotoxin has been known as the major contaminant. The separation becomes difficult due to its ability to form a stable complex with pDNA apart from sharing common properties like surface charge, molecular size, temperature and pH stability. This study focused on the analysis of zeta potential of endotoxin, theoretical number of cation bound per molecule of endotoxin as well as binding tendency of cations towards endotoxin in the presence of pDNA. These analyses were conducted under various experimental conditions such as types of divalent metal cation, cation concentration, pH and incubation time. The analysis of zeta potential at different cation concentrations and pH values showed that Mg2+ had the most significant effect on endotoxin surface charge. The zeta potential of endotoxin reduced by a magnitude of 43.55 mV, from -43.53 mV to 0.02 mV in the presence of 2.0 M Mg2+, and a magnitude of 44.12 mV , from -43.53 mV to 0.59 mV at the lowest pH level. However, in the analysis of theoretical number of cation bound per molecule of endotoxin, Zn2+ showed the highest number (0.6) compared to Ca2+ (0.12) and Mg2+ (0.05). The tendency of Zn2+ to preferentially bind with endotoxins forming larger aggregated structure was also evident in the DNA gel electrophoresis and transmission electron microscopic analysis.

By a discrete space , we mean here a collection of finite or a countable infinite number of vertices which has a graph structure provided by a set of edges (finite or countable infinite in number). In many cases, the varying graph structures (connectivity type problems) are themselves very interesting and important. However, there are some important examples where the study of the intricate role of functions on is essential (example: potential functions, effective resistance, Kirchhoff problem in electrical networks; and escape probability, Dirichlet functions, hitting time in random walks). In this survey article we review a part of the function theory developed by some researchers in this field and present a cohesive narrative. We have placed special emphasis on different discrete versions of the Dirichlet problem, the Neumann problem and the Poisson equation.

Objective: To analyse perceived barriers to access to formal abortion services and the demand for medical abortion in Turkey Design: Mixed-method study Population sample: Pregnant women in Turkey who filled the consultation survey on Women on Web website between 1 January 2013 and 12 October 2020 Method: Our dataset includes anonymized responses of 620 women to the online consultation survey and anonymized email correspondences of 138 women with the WoW help desk. We conducted a cross-sectional analysis of the survey data and a content analysis of email correspondences. Main outcome measures: Perceived barriers to formal abortion services in Turkey Results: The surveyors listed various reasons for requesting an abortion; while 59.68% of them mentioned that they just cannot have a child at this point, financial constraints (49.84%), wanting to finish school (31.77%) and being too young (31.29%) were among the leading reasons. Several barriers to access to formal abortion services were reported; the most frequently cited barriers include cost (48.31%), the need to keep abortion secret from partner or family (42.69%) and unavailability of abortion pills (44.94%). Our qualitative analysis of women’s email correspondences has demonstrated some additional barriers to and concerns over the formal abortion services. These include censorship of abortion information and misinformation, denial of care, concerns over spousal consent, cost, abortion method, trust, and confidentiality. Conclusions: We conclude that despite the legal framework, abortion remains difficult to access and approach for women in Turkey due to legal barriers and concerns over formal abortion services.

Background Childhood cancer survivors face late health problems; despite advances in research, details on risk remain unclear. We describe the methodological aspects of the Dutch Childhood Cancer Survivor Study (DCCSS) cross-sectional clinical study (LATER 2 study). Procedure From the multi-center DCCSS LATER cohort of 6,165 five-year survivors diagnosed 1963-2001, we invited 4,735 eligible in 2016, as well as siblings and parents of survivors. Gaps in evidence identified during development of surveillance guidelines were translated into clinical research questions for 16 outcome-specific sub-projects. The regular care visit to the LATER outpatient clinic forms the backbone of outcome assessment complemented with research-defined measurements (physical examination, diagnostic tests, questionnaires). Furthermore, blood/saliva samples were taken for DNA extraction. Results In total, 2519 (53.2%) survivors participated in the LATER 2 study. Of those participating survivors, 49.3% was female. Median time since childhood cancer diagnosis was 26.9 years (range 14.8 to 54.7 years) and median attained age was 34.4 years (range 15.4 to 66.6 years). Conclusions The high-quality data generated in the LATER 2 study will provide valuable insights into risks of and risk factors for clinical and (psychosocial) health outcomes and factors for early recognition of (psychosocial) health outcomes in long-term childhood cancer survivors. This will contribute to fill in important gaps in knowledge and improve the quality of life and care for childhood cancer survivors.

Objective: We previously described a technique for repair of the myometrial defect at repeat Caesarean section which increases residual myometrial thickness thereby potentially reducing future niche-related complications. Here we describe how this technique can be modified for use for placenta accreta spectrum disorders. Design: Comparison of surgical performance of the modified technique with peripartum hysterectomy in women having repeat Caesarean delivery for placenta accreta Setting: A two year retrospective case control study at a tertiary unit in Singapore. Population: All women with placenta accreta spectrum disorder between December 2019 and October 2021. Methods: After delivery through the isthmocele women either underwent the modified technique which comprised uterine exteriorisation, systematic placental removal initiated from the posterior uterine wall, identification, mobilization and apposition of the boundaries of myometrial defects and repair or peripartum hysterectomy. Main Outcome Measures: Operating time, estimated blood loss and complication rate. Results: Ten women had Caesarean hysterectomy and ten had Caesarean section using the modified approach. Age and gestational age at delivery were similar for the two groups. Women in the modified technique group had had fewer prior Caesarean sections and had a lower body mass index. Operating time, estimated blood loss and need for transfusion were lower in the myometrial repair group but without statistical significance and there were no visceral injuries. There was one bladder injury in the hysterectomy group. Conclusion: The modified approach provides an effective alternative to peripartum hysterectomy with favourable surgical profile and allows uterine conservation with restoration of myometrial thickness.

Parasites form an integral part of food webs, however, mechanistic insights into the role of parasites for energy flow and community dynamics is currently limited by a lack of conceptual studies investigating host-parasite interactions in a community context. In aquatic systems, chytrids constitute a major group of fungal parasites and their free-living infective stage (zoospores) forms a highly nutritional food source to zooplankton. Consumption of zoospores can create an energy pathway from otherwise inedible phytoplankton to zooplankton (“mycoloop”). The impact of such parasite-mediated energy pathways on community dynamics and energy transfer to higher trophic levels is of high importance considering eutrophication and global warming induced shifts to dominance of unfavourable prey such as cyanobacteria. We theoretically investigated community dynamics and energy transfer in a food web consisting of an edible-nonhost and an inedible-host phytoplankton species, a fungal parasite, and a zooplankton species grazing on edible phytoplankton and fungi. Food web dynamics were investigated along a nutrient gradient for two cases: (1) non-adaptive zooplankton species representative for filter feeders like cladocerans and (2) zooplankton with the ability to actively adapt their feeding preferences like many copepod species. For both feeding strategies, the importance of the mycoloop for zooplankton increases with nutrient availability. This increase is smooth for non-adaptive consumers. For a consumer with an adaptive feeding preference, we observe an abrupt shift from almost exclusive preference for edible phytoplankton (dominant prey) at low nutrient levels to a strong preference for parasitic fungi at high nutrient levels. The model predicts that parasitic fungi can contribute up to 50% of the zooplankton diet in nutrient rich environments, agreeing with empirical observations on zooplankton gut content from eutrophic systems during cyanobacterial blooms. Our findings highlight the role of parasite-mediated energy pathway for predictions on energy flow and community composition under environmental change.

Speciation is a fundamental evolutionary process, which results in genetic differentiation of populations and manifests as discrete morphological, physiological and behavioral differences. Each species has had its own evolutionary trajectory, formed by many types of selection pressures and random drift, making the association of genetic differences between the species with the phenotypic differences extremely difficult. In the present study, we have used an in vitro model to analyze in depth the genetic and gene regulation differences between fibroblasts of two closely related mammals, the arctic/subarctic mountain hare (Lepus timidus Linnaeus) and the temperate steppe-climate adapted brown hare (Lepus europaeus Pallas). We discovered the existence of a species-specific expression pattern of 1,623 genes, manifesting in differences in cell growth, respiration, and metabolism. Interspecific differences in the housekeeping functions of fibroblast cells suggest speciation acts on fundamental processes, even in these two interfertile species. Our results help to understand the molecular constituents of a species difference on cellular level, which could contribute to the maintenance of the species boundary

When major emergencies or accidents occur, risk evaluation and prediction are the most important means to reduce the impact of these disasters. Typical risk evaluation uses the failure mode and effects analysis (FMEA) method for failure risk ranking and control. However, when faced with severe special infectious diseases such as COVID-19, there will be many cognitive and information uncertainties that the FMEA method is unable to effectively handle. To effectively deal with the issue of risk evaluation during the COVID‐19 pandemic, this paper integrated the risk priority number and spherical fuzzy sets methods to propose a novel emergency risk evaluation method. In the numerical verification, this paper applied the example of avoiding secondary COVID-19 transmissions in the hospital to explain the calculation procedure and validity of the proposed new emergency risk evaluation approach. The calculation results were also compared with the typical RPN, fuzzy set, and intuitionistic fuzzy set methods. The calculation results showed that the proposed new emergency risk evaluation approach could effectively handle the cognitive and information uncertainties of emergency risk evaluation issues during the COVID-19 pandemic.

The vagina links the organs where gynecologic tumors are located to the outside world. A healthy acidic vaginal environment relies on lactobacilli; a dysregulated vaginal flora is associated with the occurrence, unsatisfactory treatment and poor prognosis of gynecologic malignancies. Using microbial markers to screen the difficult-to-detect characteristics of early tumors may play a key role in prolonging the survival of cancer patients. The discovery of microbes within tumor has led to the consideration of the immunological relevance of internal microorganisms to tumors. This article aims to review the relevance of microorganisms within the above two environments to gynecologic malignancies.

A molecular-level Fluid Catalytic Cracking (FCC)-Gasoline Hydrotreating (GH) process coupling model was established based on the Structure Oriented Lumping (SOL) method to guide the precise control of the hydrocarbon compositions in gasoline. 96 FCC reaction rules and 24 GH reaction rules were formulated, and a reaction network containing about 120,000 reactions was constructed. In order to establish the FCC-GH process coupling model, the effective transfer of composition information between the two processes was realized through the molecular composition matrix of gasoline. The molecular composition matrix of gasoline was obtained according to the classification rules of the molecular composition matrix of FCC products. The conversion laws of hydrocarbon molecules in gasoline were investigated by tracking their generation paths and reaction paths. The influences of reaction conditions on the distribution of hydrocarbons in the product gasoline could be calculated quantitatively by the FCC-GH process coupling model at molecular level.

The recent increase in extreme climatic phenomena has gradually attracted the attention of researchers regarding urban flooding. This paper used a hydrological model combined with the Computational Fluid Dynamics software to assess the drainage efficiency, predict the hydrological processes under different precipitation intensities and establish the relationship between rainfall intensity and inundation depth under extreme rainstorm events. The study proposed several thresholds such as specific rainfall intensities (that is, RI 95% and RI 50%), drainage efficiency, and the limited flow rate of pipes. Based on 2021 July 20, 0:00 to 24:00 precipitation monitoring data from the “7.20 Zhengzhou Rainstorm Extreme Event”, the relationship between rainfall intensity and road-pipe overflow patterns was determined by analyzing these thresholds for different drainpipe diameters and spacings of catchment wells. The results demonstrated the evaluation parameters varied with rainfall intensities and pipe characteristics and revealed the main limitation of drainage efficiency and flow rate of drainpipes. The simulation helped the drainage systems design for different precipitations and proposed several relative suggestions for drainage-system improvements, wherein the diameter of the branch pipes plays a dominant role in coping with extreme rainstorm events.

The secondary flow is deflected under pressure and superimposed on the main flows. This research investigated its characteristics, including velocity gradient, vorticity, shear stress, and Reynolds stress in unpressurized circular pipes, through physical experiments and Computational Fluid Dynamics numerical simulations. Combining numerical simulations with the physical experiments under three flow rates (30 m 3/h, 35 m 3/h, and 40 m 3/h) and width–perimeter ratios ( Wr = 0.43, 0.4, and 0.35), the experimental data demonstrate the secondary-flow propagation in unpressurized circular pipes. The secondary flows manifest as deviations of velocities, substitutions of secondary vortices, and flips of shear stresses, which present decay tendencies and are negligible at 52 times the pipe diameter. The secondary flows are driven by the velocity gradient or Reynolds stress, the dominance of which shifts with the increase of diffusion distance. The secondary flow turbulence is reduced and smoothing when the width–perimeter ratio reaches a threshold (approximately Wr = 0.40) because of Dean vortices collisional depletion.

Using annual water balance analyses may mask intra-annual variability in runoff generation, which could limit our understanding of the similarities and differences between water- and energy-limited catchments. This may be especially limiting in comparisons between catchments close to the threshold between water- and energy-limitation. For this study, we examined runoff generation as a function of catchment storage in four watersheds, with focus on two that exist close to these thresholds to identify how year-to-year variability in storage resulted in intra-annual variations of runoff generation efficiency. Specifically, we focused on one energy-limited catchment in the humid subtropics and one water-limited in a Mediterranean climate. We used measured and calculated daily water balance components to calculate variations in the relative magnitude of daily storage. We isolated precipitation events to draw connections between storage and runoff generation at intra-annual scales and compared our findings to the same metrics in two intensely energy-limited landscapes. We observed distinct stages in daily storage across water years in watersheds at the threshold, where systems experienced wet-up, plateau, and dry-down stages. During the wet-up, precipitation was partitioned to storage, and runoff ratios ( RR) were low. In the plateau, storage was filled, precipitation was partitioned to runoff, causing high RRs. During the dry-down, storage decreased as precipitation was partitioned to evapotranspiration and runoff, causing low RRs. The critical role of evapotranspiration during the growing season resulted in relatively higher RRs during the wet-up than during the dry-down for a given storage value. Thus the same storage amount was partitioned to evapotranspiration or runoff differently throughout the year, depending on the storage stage. Despite their different positions on opposite sides of the threshold, the similarity between the two focus catchments suggests a potential characteristic behavior of systems at the threshold common to both humid and semi-arid landscapes.

The hyporheic exchange below dune-shaped bedforms has a great impact on the stream environment. One of the most important properties of the hyporheic zone is the residence time distribution (RTD) of flow paths in the sediment domain. Here, we evaluate the influence of dimensionless sediment depths d b * = 2 π d b / λ where λ is the dune wavelength and different values of dimensionless groundwater underflow values u b * (similar to dune migration celerity), on the shape of the hyporheic exchange RTD. Empirical RTDs were generated, over a range of combinations between d b *     and u b *   values, from numerical particle tracking experiments in which 10000 particles were released over a flat domain. These empirical RTDs are represented by different distributions over the range of d b *     and u b *   . A Fréchet RTD is the best fit for deep beds ( d b *   >3.2) and negligible underglow ( u b * <0.1). A LogNormal RTD is often the best representation for u b * ≤ 0 . 8 , while a Gamma RTD performs better for larger values of u b * . In general, a LogNormal RTD provides a good representation of the empirical RTDs in all cases, as it is identified as either the best or the second-best fitting distribution according to the Anderson-Darling test. The parameters of these analytical distributions vary with d b *     and u b * , and this dependence is graphically represented in this work. These results contribute to our understanding of the physical and mixing processes underpinning hyporheic exchange in streams and paves the way for a quick evaluation of its potential impact on nutrient and contaminant processing (e.g., based on the magnitude of the Damköhler number).

The initial conditions (e.g., soil moisture content) of the hydrological model, which is usually obtained from the warm-up of the hydrological modeling, significantly impact the simulation efficiency. However, spending the valuable data in warm-up instead of calibration and validation is luxurious. In order to improve hydrological simulation efficiency in the case of no warm-up phase, this paper proposes a methodology to fill the gap via improving the initial conditions of the hydrological model using an alternative global soil moisture dataset. Specifically, three soil moisture (SM) variables of the initial conditions from the Block-wise use of the TOPMODEL (BTOP) model and EAR5-Land reanalysis data were adopted and conducted correlation analysis. Several traditional curve-fitting functions and the state-of-art technical, long-short term memory (LSTM), were applied to develop the relationship between BTOP and EAR5-Land SM variables in the Fuji and Shinano River Basin, Japan. Furthermore, four configured hydrological simulations evaluated the benefits of the proposed methodology for improving the initial conditions. As a result, LSTM outperforms the traditional curve-fitting method in constructing the relationship between variables in time and space. Moreover, the hydrological simulation cases using the initial conditions related to the SM from the ERA5-land performs better than the case without the warm-up phase, and the simulated discharge process approaches the “optimal” case with the warm-up phase. It is confirmed that the proposed methodology helps improve the initial conditions of the hydrological model using reanalysis soil moisture data.

African swine fever (ASF) is a highly contagious viral disease of suids that causes significant economic damage. The summer peaks and river courses have triggered the hypothesis that vectors may be involved in the transmission of the virus. The aim of our study was to evaluate the risk factors associated with the presence of ASFV DNA in hematophagous dipterans and to analyze the relevance of Ct values of the positive samples in ASF outbreaks in Romania, as an indication for the viral load. The current study included 99 pools of stable flies ( Stomoxys calcitrans) and 278 pools of biting midges ( Culicoides spp.), collected in June-September 2020, from 30 outbreaks of ASF in domestic swine from backyard farms (BF), type A farms (TAF) and commercial farms (CF). All extracted DNA was tested for the presence of ASFV genome using a real-time PCR protocol. Ct values of 39.53 and below were considered as positive. The blood meal source was identified in the hematophagous insects by using a PCR protocol targeting the mitochondrial gene cytochrome c oxidase subunit 1. Data were analyzed using R software v. 4.0.5. In total, 2978 insects ( S. calcitrans n= 198 and Culicoides n=2780) were collected in 19 outbreaks out of the 30 sampled farms. Ten species of biting midges were identified. The total number of insect pools showed significant differences according to the month of sampling, with a higher number of pools collected in August and September. Overall, 137 pools out of the 377 examined were positive for the presence of ASFV DNA. There was a higher viral DNA load in farms where pigs were present at the moment of sampling compared to farms where pigs were already culled, in S. calcitrans compared to Culicoides spp. and in CF and TAF compared to BF.

The Zinc sulfide (ZnS) sample was synthesized using Zinc acetate dihydrate, and thiourea as ingredients by the hydrothermal reaction without using any dispersants and surfactants were used in the reaction process. The product composition and morphology were confirmed by XRD and SEM. The experimental results showed that after hydrothermal reaction at 150℃ for 8 h, the as-obtained ZnS microspheres diameter was about 3μm. Then, ZnS microspheres were used as photocatalyst, and the photocatalytic degradation rate of methylene blue solution reached 91.1% after ultraviolet light irradiation for 150 min.

Background Antenatal corticosteroids (ACS) are recommended in threatened preterm labour to improve short term neonatal outcome. Preclinical animal studies suggest detrimental effects of ACS exposure on offspring cardiac development; their effects in humans are unknown. Objectives To systematically review the human clinical literature to determine the effects of ACS on offspring cardiovascular function. Main results Twenty-six studies including 1921 patients were included, of which most were cohort studies of mixed quality. The type of ACS exposure, gestational age at exposure, dose and number of administrations varied widely. Offspring cardiovascular outcomes were assessed from one day to 36 years postnatally. The most commonly assessed parameter was arterial blood pressure (18 studies), followed by echocardiography (8 studies), heart rate (5 studies), electrocardiogram (ECG, 3 studies) and cardiac magnetic resonance imaging (MRI, 1 study). There were no clinically significant effects of ACS exposure on offspring blood pressure. However, there were insufficient studies assessing cardiac structure and function using echocardiography or cardiac MRI to be able to determine an effect. Conclusions Administration of ACS is not associated with long-term effects on blood pressure in exposed human offspring. The effects on cardiac structure and other measures of cardiac function were unclear due to the small number of studies, study heterogeneity and mixed quality. Given the emerging preclinical evidence of harm following ACS exposure, there is a need for further research to assess central cardiac function in human offspring exposed to ACS. Keywords: Antenatal corticosteroids, ACS, cardiovascular, offspring, blood pressure