Primary rectal lymphoma is the rarest disorder of all primary gastrointestinal lymphomas. The association between Crohn's disease and primary rectal lymphoma is also very rare and there are a few case reports in the literature describing the association between these two diseases.

Polypectomy during pregnancy is known to be a risk for spontaneous late miscarriage or preterm delivery. We managed a 34-year-old pregnant woman with a large cervical polyp without polypectomy, and we administered probiotics including Clostridium butyricum and 17-alpha-hydroxyprogesterone caproate. As a result, she delivered a healthy baby at 38 weeks.

Desmoplastic fibroblastoma is a benign soft tissue tumor of fibroblastic and myofibroblastic origin. The present case report depicts an unusually large desmoplastic fibroblastoma, in a 50-year-old female. The lesion presented on the left side of the face, mimicking a soft tissue malignancy. Keywords: benign, desmoplastic, fibroblastoma, female.

The scale of the structure is a key parameter of the superhydrophobic surfaces. In this work, DLIP are used to fabricate nanostructures on silicon substrates that have been processed with microstructures to make multiscale superhydrophobic surfaces. By adjusting several key process parameters, the depth, spacing, and other geometric shapes of the prepared nanostructures are controlled, and finally the manufacture of multi-scale structures with fixed specifications is realized. In this work, we use DLIP as a fabrication method for nanostructures in multi-scale structures. This method has the advantages of repeatable large-area processing, fast processing speed, high processing accuracy, and controllable structure.

A 44-year-Old Male with Esophageal UlcerQuestion: A 44-year-old male was admitted for acute gastrointestinal bleed, intermittent esophageal dysphagia, and odynophagia. His past medical history was significant for dermatomyositis, for which he was on mycophenolate but had previously received prednisone and methotrexate. The treatment for his dermatomyositis had been complicated by pancytopenia with Hemoglobin 6.8 (13.2 - 16.6 g/dL), platelet 73 (135 - 317 x10(9)/L), and white blood cells 1.9(3.4 - 9.6 x10(9)/L). He underwent esophagogastroduodenoscopy (EGD), which showed a deep esophageal ulcer on the background of diffuse white plaques in the middle third of the esophagus and a non-bleeding large cratered clean-based gastric antral ulcer (Figure 1, A&B). Barium swallow showed a sac-like structure consistent with the ulcer without contrast leakage to suggest a fistula (Figure 1, C). What is the most likely diagnosis?Answer: This is a classic presentation of Cytomegalovirus (CMV) esophageal ulcer. The biopsy of the ulcer revealed positive CMV immunostaining, with negative immunostaining for Herpes simplex virus and fungus. His quantitative CMV DNA was 20400 IU/mL (Reference range Undetected), and his HIV test was negative. CMV predominantly causes opportunistic infection in immunosuppressed patients. It mainly causes gastrointestinal symptoms, with about 12.9% of patients presenting with esophageal disease. Unlike other infectious esophageal ulcers, CMV tends to cause one or more giant (>1cm) ulcers that may be flat, ovoid, or diamond-shaped.

Primary synovial chondromatosis is an uncommon and benign metaplastic condition that usually affects large joints. Though shoulder involvement is scarce, and there are only a few cases in the pediatric population.

A focus of this article is the study of synchronization between nonlinear chaotic systems with fractional order. Here synchronization is achieved by employing optimal control based on active control. As a result of the application of the proposed technique, the synchronization for the pair of chaotic systems amongst the chaos of Lorenz’s system with fractional order and Rössler system with fractional order is successfully investigated. The graphic representation of numerical simulation results shows that controller laws can effectively and reliably synchronize fractional-order chaotic systems.

Wiener et al. brought to light the “splay” 1,2 an interesting new sign of mitral regurgitation, also described in other valvular regurgitations (VR) 3. However, some important considerations should be done on this sign since the true nature of this artefact and its role in echocardiography have not been completely clarified.

Objective: This qualitative study explored the barriers towards the uptake of Bilateral Tubal Ligation (BTL) among grand-multiparous women. Study design: The study used an exploratory qualitative methodology. Study Setting: research participants were drawn from the Copperbelt communities. Study Population: Grand multiparous women Methods: Semi-structured interviews were utilised to collect data. Twenty-five semi-structured interviews were held with grand multiparous women who were attending clinics for family planning services. All interviews were audio recorded and transcribed verbatim. A thematic approach underpinned by some aspects of the Silences Framework was utilised for data analysis. Results: The study revealed that barriers to the uptake of BTL included desire to maintain productivity, pressure from spouses, stigmatisation of family planning, safety fears and loss of self-esteem. Conclusion: our findings show that there is need to engage women in communities to make sure that their family planning needs are effectively addressed. Key words: Multiparity, Women, Bilateral Tubal Ligation, Mortality

This research was carried out to consider the effect of different curing methods on the performance of concrete for grade 25 of normal concrete. The objective of this research was to determine the effect of different curing methods on the performance of concrete. This study considers the effect of five curing methods (air curing (B1), water submerged curing (B3), spraying curing (B2), burlap curing (B4) and moist sand curing (B5)) were used to evaluate the strength, carbonation, length change, absorption, and sorptivity of concrete on 3rd , 7th, 14th, 28th and 56th days at hot air temperature (18-390C) and medium air temperature (11.2-32.70C). A total number of 210 cube and 30 prisms samples were cast for all curing methods. The result indicated that water submerged curing was the highest strength of concrete followed by the close burlap, spraying, and moist sand curing methods of concrete. The air curing was the lowest strength of concrete and carbonated concrete in hot and medium air temperatures. The concluded weak positive correlation between the strength and the density of concrete. The strength strong negative correlation with length change, water sorptivity, and water absorption of concrete at hot and medium air temperatures. Finally, the water submerged and moist sand curing techniques were the appropriate techniques for off-site construction of concrete structures; and the burlap & spraying curing were suitable for off-site and on-site construction of concrete structural members in hot and medium environmental conditions.

A document by Manzoor Hussain. Click on the document to view its contents.

Objectives: Influenza is a rapidly spreading acute respiratory infectious disease. This disease has a high prevalence and morbidity. Patients with critical influenza require timely admission. Identifying patients with critical influenza and ensuring early admission for such patients is important. The pediatric early warning score (PEWS) is useful for the timely recognition of critical illnesses. However, evidence supporting the efficacy of the PEWS in assessing critical influenza is limited. This study aimed to explore the usefulness of the PEWS as a predictive tool for critical influenza. Methods: One hundred pediatric patients with influenza were included into this study. Their PEWS scores were measured at the emergency department. Unconditional logistic regression was conducted to investigate the association of each parameter between the mildand critical influenza groups. The PEWS and parameters were compared. Receiver operating characteristic (ROC) curves were analyzed. Results: The difference in the PEWS and mean corpuscular hemoglobin (MCH) levels were significantly different between the two groups. Combinations of the PEWS and MCH achieved an R score of 0.501; the square of the R score was 0.2506, and the area under the curve was 0.791 with a cut-off value of 0.4118. The score of the predictive model made up of the PEWS and MCH was: 2.035+0.18*PEWS-0.073*MCH. When the score was higher than 0.4118, the patients tended to have critical influenza. Conclusion: Our predictive model is helpful in the identification of patients with critical influenza; this will help in ensuring timely admission of such cases, and thereby improving their outcomes.

Background: Epicardial pacemakers are known as an alternative for endocardial pacemakers in some cases such as heart block, and complex congenital heart diseases. Considering recent advances and improvement of epicardial lead subtypes, it is essential to investigate the long-term function of them. In this study, we aimed to assess the sensing and pacing characteristics, and survival of bipolar steroid-eluting and unipolar non-steroid-eluting epicardial pacemakers. Methods: We conducted an entirely concentrated search on the documents of all patients who had undergone epicardial lead implantation in the Shaheed Rajaie Cardiovascular, Medical & Research Center during 2015-2018. Implant, and follow up data were extracted. Kaplan Meier analysis and Weibull regression hazards model were applied for the survival analysis. Results: eighty-nine leads were implanted for 77 patients. Of the total leads, 52.81%, 53.93%, and 47.19% were implanted in children (under-18-year-old), females, and patients with congenital heart diseases, respectively. Bipolar steroid-eluting leads comprised 33.71% of 89 leads. Pacing threshold of unipolar non-steroid-eluting leads that were implanted on the left ventricle and right atrium increased significantly during the follow up to greater records than bipolar steroid-eluting leads. Survival analysis also revealed that bipolar steroid-eluting leads are significantly better in 48-month survival (Weibull HR: 0.13 (95%CI, 0.02-0.99), p-value, 0.049). Age, ventricular location of the lead, and acute pacing characteristics were not associated with survival. Conclusions: Bipolar steroid-eluting epicardial leads have an acceptable survival compared with unipolar non-steroid-eluting, without a significant difference regarding patients age. Therefore, they could be an excellent alternative for endocardial ones.

Background: Opioid-induced hyperalgesia (OIH) is an adverse event after exposure to opioids which would increase pain intensity. The optimal drug to prevent these adverse effects is still unclear. We aimed to perform a network meta-analysis to compare different pharmacological interventions in preventing the increase in postoperative pain caused by OIH. Methods: Several databases were searched independently for randomized-controlled trials (RCTs) comparing different pharmacological interventions in preventing OIH. The primary outcomes were postoperative pain intensity at rest at 24h and the incidence of postoperative nausea and vomiting (PONV). Secondary outcomes included pain thresholds at 24h after surgery, cumulative morphine consumption over 24h, time to first postoperative analgesic requirement, and the incidence of shivering. Results: In all, 33 RCTs comprising 1711 patients were identified. In terms of postoperative pain intensity, amantadine, magnesium sulphate, pregabalin, dexmedetomidine, ibuprofen, flurbiprofen plus dexmedetomidine, parecoxib, parecoxib plus dexmedetomidine, and S (+)-ketamine plus methadone were associated with milder pain intensity than placebo, with amantadine ranked the most effective (SUCRA values =96.2). In terms of the incidence of PONV, intervene with dexmedetomidine or flurbiprofen plus dexmedetomidine means a lower incidence placebo and dexmedetomidine showed the best result (SUCRA values =90.3). Conclusions: Amantadine was identified as the best in postoperative pain intensity as well as non-inferior to placebo in the incidence of PONV. Dexmedetomidine was the only intervention that is superior to placebo in all indicators.

Reproductive Health in Brazil: Where We Are and Why We Stopped: A CommentaryFilho, Agnaldo Lopes da Silva1; Lino, Lara Marina Cruz2; Ramires, Yohanna3; Bueno, Ricardo Luiz Pereira41 Departmentof Obstetrics and Gynecology, Universidade Federal de Minas Gerais (UFMG),BeloHorizonte, Minas Gerais, Brazil; corresponding address: agnaldo.ufmg@gmail.com2 Organon, Brasil; corresponding address: lara.lino@organon.com3 Organon, Brasil; corresponding address: yohanna.ramires@organon.com4 Organon, Brasil; corresponding address: ricardo.bueno@organon.comContribution to the manuscript by each author:Lara Lino – Research, writing and proofreadingYohanna Ramires – Research, formatting, resources, writing, reviewRicardo Bueno – Main theme, concept, project, supervisionAgnaldo Lopes – Concept, validation, and review

In this research article, we construct a q-analogue of the operators defined by Betus and Usta (Numer. Methods Partial Differential Eq. 1-12, (2020)) and study approximation properties in a polynomial weighted space. Further, we modify these operators to study the approximation properties of differentiable functions in the same space and show that the mofidied operators give a better rate of convergence.

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

TITLE PAGE Title: Letter to the Editor: Minimally invasive aortic valve repair using geometric ring annuloplastyArticle type: Letter to the editorCorrespondence : 1. Bilawal NadeemContact: +92-3137562580 Email: bilawal.ranjha@gmail.comInstitute: King Edward Medical University, LahoreAddress: Mianwal Ranjha Dera Allah Wadhaya Tehsil and District Mandi Bahauddin, 50400Words count: 418Conflict of interest: noneDisclosure: noneFunding: none

Background: There is emerging evidence to support pre-emptive thoracic endovascular aortic repair (TEVAR) intervention for uncomplicated type B aortic dissection (unTBAD). Pre-emptive intervention would be particularly beneficial in patients that have a higher baseline risk of progressing to complicated TBAD (coTBAD). There remains debate on the optimal clinical, laboratory, morphological and radiological parameters which would identify the highest-risk patients that would benefit most from pre-emptive TEVAR. Aim: This review summarises evidence on the clinical, laboratory, and morphological parameters that increase the risk profiles of unTBAD patients. Methods: A comprehensive literature search was carried out on multiple electronic databases including PubMed, EMBASE, Ovid and Scopus in order to collate all research evidence on the the clinical, laboratory, and morphological parameters that increase the risk profiles of unTBAD patients Results: At present, there are no clear clinical guidelines using risk-stratification to inform the selection of unTBAD patients for TEVAR. However, there are noticeable literature trends that can assist with the identification of the most at-risk unTBAD patients. Patients are at particular risk when they have refractory pain and/or hypertension, elevated C-reactive protein (CRP), larger aortic diameter and larger entry tears. These risks should be considered alongside factors that increase the procedural risk of TEVAR to create a well-balanced approach. Advances in biomarkers and imaging are likely to identify more pertinent parameters in future to optimise the development of balanced, risk-stratified treatment protocols. Conclusion: There are a variety of risk profiling parameters that can be used to identify the high-risk unTBAD patient, with novel biomarkers and imaging parameter emerging. Longer-term evidence verifying these parameters would be ideal. Further randomized controlled trials and multicentre registry analyses are also warranted to guide risk-stratified selection protocols.

Proptosis is a frequent presenting symptom/ sign of many pediatric malignancies. Acute onset proptosis is an oncological emergency that can endanger vision if not treated promptly. Appropriate treatment must be instituted only after investigating for the underlying etiology. Here we report a 6-year-old developmentally delayed boy who presented with recent onset bilateral proptosis. Clinical examination followed by radiological evaluation suggested scurvy to be the underlying cause and vitamin C supplementation lead to prompt reversal of proptosis. The relevant literature has been reviewed and presented here to apprise the pediatric oncologists about this rare but easily treatable cause of proptosis.

TITLE: Letter to the Editor: Association between time to therapeutic INR and length of stay following mechanical heart valve surgeryARTICLE TYPE: letter to the editor

Background: Primary pericardial synovial sarcoma is an extremely rare malignant invasive tumor with dismal prognosis. Methods: We herein report a case of a 29-year-old woman of Chinese descent, who was admitted to our hospital with a fever and subsequently diagnosed to have primary pericardial synovial sarcoma. Results: A giant mass was found on transthoracic echocardiography. Computed tomography and magnetic resonance imaging identified a giant pericardial mass compressing the left atrium. Ultrasound-guided biopsy confirmed a monophasic synovial sarcoma. The patient refused further treatment and died 22 months later. Conclusion: We report a rare case of primary pericardial synovial sarcoma, which generally has a poor prognosis. Molecular genetic analysis may greatly contribute to the definite diagnosis.

Background: Complications and outcomes after TAVI differ considerably between men and women. Methods: We searched the Cochrane Library, PubMed, Embase, and the Web of Science from January 2000 to January 2022. Gender-related articles reporting complications and mortality after TAVI were identified. This meta-analysis analyzed differences between women and men in postoperative outcome measures, early survival, and one-year survival. Results: There were 18 studies, a total of 80632 patients, enrolled in our systematic review and meta-analysis, including 37775 men and 42857 women. Comprehensive analysis showed significant differences in gender in complications and early and medium-term results after TAVI. Men had a significantly lower risk of major bleeding (RR, 0.67; p=0.001), major vascular complications (RR, 0.66; p=0.0002), and stroke (RR, 0.84; p=0.008). Although the short-term survival rate of men is slightly higher than that of women (RR, 0.83; p＜0.00001), the prognosis is poor in mid-term survival (RR, 1.08; p=0.02). Conclusions: The medium-term survival rate for men after TAVI is lower than for women, despite men having a lower risk of major bleeding, major vascular complications, and stroke.

A 58-year-old female with a past medical history of aortic and mitral valve replacement performed 14 years ago, presented with dyspnea and palpitation. No stroke or embolic event was documented. She was under routine follow up for anticoagulation with effective levels of internal normalized ratio. Transthoracic echocardiography revealed a large freely mobile round mass moving freely in the left atrium (LA), which was partially prolapsing in to the left ventricle (LV) (Video 1). The both mechanical valve prosthesis were normally functioning while the native tricuspid valve was severely regurgitating. As institutional review board approval was not applicable for this report, an informed consent was obtained from the patient and underwent surgical removal via the transseptal approach. The spherical pink colored and smooth surfaced mass seemed as an organized thrombus formed in layers with a viscous central zone with palpation (Figure 1). The tricuspid valve was repaired using the band annuloplasty technique. Histological examination of the mass revealed features consistent with thrombus. Post-operative course was uneventful and patient was discharged on sixth postoperative day.