Title:

Rationale, aims and objectives: To determine current practices, attitudes and demands of Chinese anesthesiologists regarding depth of anesthesia (DoA) monitoring. Method: An anonymous online survey was randomly distributed to 8,556 anesthesiologists. Results: The overall response rate was 47% (4,037 respondents). Only 9.1% (95% confidence interval, 8.2%-10.0%) of the respondents routinely use DoA monitors. The main factors influencing the utility of DoA monitors were poor anti-interference ability (56.0%, 54.5%-57.6%), inability to bill insurance or high cost (55.5%, 54.0%-57.0%), limited accuracy (47.9%, 46.3%-49.4%) and inability to monitor analgesic effects (35.7%, 34.2%-37.1%). Academic respondents (91.5%, 90.3%-92.7%) primarily used DoA monitoring to prevent awareness, whereas nonacademic respondents (88.8%, 87.4%-90.2%) primarily used DoA monitoring to guide the delivery of anesthetics. In total, the respondents who had not used a DoA monitor and experienced awareness (61.7%, 57.8%-65.6%) was significantly greater than those who had used one or several DoA monitors (51.5%, 49.8%-53.2%). However, most respondents (95.7%, 95.1%-96.3%) demanded improvements in the accuracy of the monitors for DoA monitoring and a broad application in patients of all ages (86.3%, 85.2%-87.4%), analgesia monitoring (80.4%, 79.2%-81.6%) and all types of anesthetics (75.6%, 74.3%-76.9%). In total, 65.0% (63.6%-66.5%) of the respondents believed that DoA monitors should be combined with EEG and vital sign monitoring, and 53.7% (52.1%-55.2%) believed that advanced DoA monitors should include artificial intelligence. Conclusions: Academic anesthesiologists primarily use DoA monitoring to help prevent awareness, whereas nonacademic anesthesiologists use DoA monitoring to guide the delivery of anesthetics. Regardless of whether a DoA monitor is used, anesthesiologists believe that DoA monitoring could help to reduce the incidence of awareness. Anesthesiologists demand high-accuracy DoA monitors incorporating signals of EEG, multiple vital signs and antinociceptive indicators. DoA monitors with artificial intelligence may represent a new direction for future research on DoA monitoring.

Objective: To explore the difference between bilevel positive airway pressure (BiPAP) and nasal continuous positive airway pressure (NCPAP) as respiratory support after extubation in infants underwent cardiac surgery. Methods: A retrospective analysis was performed on 83 infants who underwent repair of atrial septal defect (ASD) or ventricular septal defect (VSD) in our hospital from January 2020 to December 2020. According to ventilation mode, the patients were divided into BiPAP group (n=42) and NCPAP group (n=41). Blood gas index, PaO2/FiO2, non-invasive ventilation time, extubation failure rate, total enteral feeding time, and complications of the two groups were measured before the treatment and at 6 h, 12 h and 24 h after treatment. The two groups were compared using repeated-measure analysis of variance (ANOVA) and t-test analysis. Statistical significance was considered to be P < 0.05. Results: At 6 h, 12 h and 24 h after treatment, PaO2/FiO2 in BiPAP group was significantly higher than that in NCPAP group (P<0.05). At 12 h and 24 h after treatment, PaCO2 in BiPAP group was significantly lower than that in NCPAP group (P<0.05). There was no statistically significant differences in non-invasive ventilation time, extubation failure rate, total enteral feeding time, and complications between the two groups (P>0.05). Conclusion: Both BiPAP and NCPAP can be used to improve the ventilation of infants underwent repair of ASD or VSD, while BiPAP is more beneficial to improve oxygenation and correct carbon dioxide retention.

Abstract Objective To explore the predictive indicators of plastic bronchitis (PB) in children with refractory Mycoplasma pneumoniae pneumonia (RMPP). Methods Retrospective analysis of children who were hospitalized in Tianjin Children’s Hospital from December 2018 to January 2020 who met the RMPP diagnostic criteria and were treated with bronchoscopy and alveolar lavage. Collect and compare the clinical medical records of the two groups of children, and use Logistic regression analysis to find the predictive indicators for the occurrence of PB in children with RMPP. Results ①The incidence of hypoxemia in group II was higher, the days of fever was longer, hospital stay was longer, and radiological manifestations were more serious (P<0.05).②The use rate of gamma globulin in group II was higher, and the hormone dose was higher (P<0.05).③The levels of WBC, CRP, LDH, FER, D-D dimer, PLT, PCT, IL-6, AST and percentage of neutrophils in peripheral blood in group II were higher than those in group I (P<0.05). The percentage of lymphocytes in group II was lower than that in group I (P <0.05). ④The ROC curve and Logistic regression analysis showed that the days of fever, N%, CRP and LDH were independent risk factors for the occurrence of PB in children with RMPP. The cut-off values of days of fever, N%, CRP and LDH were 11.5 days, 68.4%, 45.5 mg/L and 559U/L respectively. Conclusions The days of fever≥11.5days, N%>68.4%, CRP>45.5mg/L, LDH>559U/L are predictors of PB in children with RMPP.

To find out the comprehensive nursing regulation against COVID-19 epidemic in hematology department. Normalized regulation preventing epidemic was set up by improving management of accompany nursing and optimizing the process of admitting to hospital, which include special nursing measures preventing hematology patients with fever during the epidemic; dual quarantine methods for patients with low leukocyte; blood catheter nursing; improving nursing for patients with anemia or low blood platelet. All staff in our department were not infected by COVID-19, and no patients were confirmed, quality of nursing were excellent,100% satisfaction were got both in the staff and patients, the process of admitting and routine work in department were normally running. Awareness of risk is essentially for nurse who practice frontline nursing in hematology ward especially facing the outbreak of epidemic, we should immediately take action against the pandemic to reduce the infection and alleviate the loss.

Introduction: Stillbirth is a significant global public health issue, with approximately 98% occurring in low- and middle-income countries. The Solomon Islands is a Pacific nation with poor perinatal outcomes and very little previous research investigating stillbirth. Methods: We conducted a retrospective cohort study investigating all stillbirths at the National Referral Hospital in Honiara, Solomon Islands, between January 2017 and December 2018. Causes of stillbirth and risk factors were classified on review of available case files. Results: Over two years, there were 341 stillbirths and 11,056 total births at the National Referral Hospital (30.8 stillbirths per 1000 births). Cause of death was documented for 198 and 142 full case files were available. Most stillbirths occurred antenatally (n=170/198) and 62% were at preterm gestations (<37 weeks). Low birthweight (<2500g) was present in 59% (n=84/142) and preventable maternal conditions, including hypertensive disorders and syphilis, were present in 42% (n=59/142) of cases. Acute events caused 46% of intrapartum deaths and 92% of these had inadequate intrapartum monitoring. Conclusion: Our study is the first to investigate causes of stillbirth in the Solomon Islands. We found a large proportion of preventable stillbirths and significant gaps in documentation. This highlights the importance and feasibility of a national registry. There is an urgent need for targeted training in data collection, improved quality of antenatal and intrapartum care and community awareness to reduce preventable stillbirths in the Asia-Pacific.

Porcine parvoviruses (PPVs) and porcine circoviruses (PCVs) infect pigs worldwide, with PPV1-7 and PCV2 infections common in pigs. Although PPV7 was only identified in 2016, co-infection of PPV7 and PCV2 is already common and PPV7 may stimulate PCV2 replication. PCV3, a novel type of circovirus, is prevalent worldwide and believed to cause reproductive disorders and dermatitis nephrotic syndrome. In recent studies, pigs were commonly infected with both PCV3 and PPV7. Our objective was to investigate co-infections between PPV7 and PCV3 in samples from swine on farms in Hunan, China, and assess potential impacts of PPV7 on PCV3 viremia. A total of 399 porcine serum samples, negative or positive for PCV3, were subjected to real-time PCR to detect PPV7; of these samples, 190 were from farms with long-standing histories of reproductive failure (RF) and were selected to determine whether PPV7 affected PCV3 viremia. Among 209 serum samples, 23% (48/209) were positive for PPV7 and the PPV7-positive rate was significantly higher in PCV3 positive serum (31.4%) than negative serum (14.4%). Among 190 serum samples, 45.1% (28/62) were positive for PPV7 and PCV3 and the PPV7-positive rate was significantly higher in PCV3 positive RF-serum (51.2%) than in non-PCV3 RF-serum (34.8%); furthermore, there was a higher PPV7 prevalence (55%) in PCV3-positive aborted fetus samples. In addition, the Ct value of PCV3 in PPV7 positive samples was significantly lower than that in PPV7 negative serum samples. Based on our findings, we concluded that PPV7 may stimulate PCV3 replication.

Objectives: The novel Coronavirus (SARS-CoV2) adversely affects cardiac status and may cause arrhythmias. The objective of this study is to describe the case of a 41 year-old female presenting to the emergency department with Right ventricular outflow tract (RVOT) ventricular tachycardia; as well as to appraise and compare etiologies proposed in the literature with our case. Methods: The study design is a case report and review of the literature. A PubMed/Medline search was conducted including studies published in peer-reviewed journals between December, 2019 and November, 2020. Papers discussing the relationship between COVID-19 and cardiac arrhythmias were included, excluding the pediatric population and papers with major confounding factors to the predisposition of cardiac arrhythmias. Results: 6 papers were included in the qualitative synthesis. These papers discussed different mechanisms by which COVID-19 can cause arrhythmias. These results were compared with the findings in our case in an attempt to better understand the etiology behind our case of RVOT-VT. Proposed etiologies included ACE2-mediated direct damage of cardiomyocytes, raised serum CRP levels, and raised systemic inflammatory markers and activation of the Ca2+/Calmodulin protein kinase I. Conclusion: The lack of associated comorbidities and risk factors in our patient highlights the unique challenge of identifying the clinical sequelae of COVID-19. Proposed pathophysiologies in the literature were not applicable to our case, highlighting the need for clinical monitoring in patients, and the need for further research on the topic.

Objectives: To compare the neonatal morbidity of caesarean sections (CS) performed after conversion from neuraxial (NA) to general anaesthesia (GA) with CS performed under GA from the outset, and to assess whether the increase in DDI in urgent and extremely urgent cases with conversion from NA to GA increased the risk of neonatal morbidity. Design: Retrospective cohort study. Setting: University-affiliated hospital. Population: All CS performed under GA between 2015 and 2019. Methods & main outcome measures: Our main criteria used for assessing neonatal morbidity were: neonatal pH <7.10 and/or an Apgar score at 5 minutes <7. A multivariate regression analysis was performed to adjust for gestational age, birth weight, indication of CS. Results: We included 284 patients: 116 had a conversion from NA to GA (group 1) and 168 had GA from the outset (group 2). There was no significant difference in the rate of neonates having a pH<7.10 and/or Apgar score <5 between groups 1 and 2 (17.5% Vs 26.3%, p=0.08, respectively). Multivariate analysis showed that neonatal morbidity was comparable between the two groups (OR=1.58; 0.83-3.05). In very urgent CS, the mean decision-to-delivery interval (DDI) was 3 minutes longer in group 1 compared to group 2 (17 min vs 14 min, respectively), and there was no significant difference in neonatal pH and/or Apgar <7 at 5 minutes between the two groups (aOR=1.4; 0.5-4.3). Conclusion: The neonatal outcomes were comparable between CS performed after conversion from NA to GA and under GA from the outset, even in very urgent CS.

Title: The need for a new style of tele-fetal diagnosis with cloud storage in the post-COVID-19 eraAuthors :Yuto Maeda, MD2-12-13-201, Takanawa, Minato-Ku, Tokyo 108-0074Medical Governance Research Institute, Tokyo, JapanAkihiko Ozaki, MD, PhD57 Kaminodai, Kamiyunagaya-cho, Jyoban, Iwaki city, Fukushima, JapanDepartment of Breast Surgery, Jyoban Hospital of Tokiwa Foundation, Iwaki, Fukushima, JapanTetsuya Tanimoto, MD1-2-27, Shinonome-honmachi, Minami-ku, Hiroshima-shi, Hiroshima, JapanMNES Inc., Hiroshima, JapanYasuteru Shimamura, MD, PhD1-2-27, Shinonome-honmachi, Minami-ku, Hiroshima-shi, Hiroshima, JapanMNES Inc., Hiroshima, JapanTakahiro Nobuzane, MD, PhD7-1, Mikawa-cho, Naka-ku, Hiroshima-shi, Hiroshima, JapanKatsuki Ladies Clinic Hiroshima Chuo-dori, Hirosima, JapanTakahumi Katsuki, MD, PhD7-1, Mikawa-cho, Naka-ku, Hiroshima-shi, Hiroshima, JapanKatsuki Ladies Clinic Hiroshima Chuo-dori, Hirosima, JapanNaoyuki Kitamura, MD, PhD1-2-27, Shinonome-honmachi, Minami-ku, Hiroshima-shi, Hiroshima, JapanMNES Inc., Hiroshima, Japan

Objectives: To assess the risk of adverse pregnancy outcomes associated with fetuses with a smaller or larger than expected crown-rump length (CRL). Design: Retrospective cohort study Setting: A single center in South Korea Population: A total of 960 healthy women who conceived after in vitro fertilization. Methods: We constructed reference charts for CRL measurements between 11 and 13+6 weeks of gestation according to the gestational age. Small and large fetal CRLs were defined as CRLs below the tenth and above the ninetieth centiles, respectively. Multiple logistic regression was used to determine the risk of adverse pregnancy outcomes associated with a small or large fetal CRLs. Main Outcome Measure: Adverse pregnancy outcomes including preterm delivery, low birth weight, smaller-than-gestational-age (SGA), larger-than-gestational-age (LGA), macrosomia, and gestational diabetes. Results: A smaller than expected CRL was associated with an increased risk of SGA (adjusted odds ratio [aOR], 2.79; 95% confidence interval [CI], 1.53–5.08; p < 0.001) and preterm delivery before 34 gestational weeks (aOR, 6.48; 95% CI, 1.36–30.79; p = 0.019). A larger than expected CRL was associated with an increased risk of LGA, even after adjustment for well-known risk factors of macrosomia (aOR, 3.67; 95% CI, 2.04–6.59; p < 0.001), and a decreased risk of gestational diabetes (aOR, 0.10; 95% CI, 0.01–0.76; p = 0.026). Conclusions: A larger than expected CRL at 11 to 13+6 weeks’ gestation is independently associated with the development of LGA neonates and could be used as a predictor of excessive fetal growth.

This work presents a dynamic model for Unipol® polypropylene fluidized bed reactor (FBR) using Aspen Polymer Plus® with industrial data. The model was developed by routing recently developed corresponding steady-state model into Aspen Dynamics®. Industrial operational scenarios of the plant FBR were utilized for model validation. The previous steady-state analysis focused on reaching the optimum operating scheme. However, neglecting the time factor may lead to inadequacy in application. Upon, the current dynamic model was used to identify process constraints obstructing process improvement. An automated HAZOP study based on process control system protection layer analysis was applied. This quantitative study illustrated that reduction of superficial gas velocity by 10% to apply the scheme recommended by the steady-state analysis may cause hazardous consequences and increase waste production. Thus, revamping the existing FBR cooling system is essential for applying the recommended scheme while ensuring safety and cleaner production in the process.

Background: Bovine Spongiform Encephalopathy (BSE) is an emerging zoonotic disease of cattle associated with prion protein (PrPsc) transmitted via meat and bone meal (MBM). Although Bangladesh did not experience a BSE outbreak but the country could not export animal products to developed countries as has not yet been declared BSE free country by OIE due to lack of scientific risk evaluation for BSE. The objectives was identification of hazard, release and exposure pathways of prion protein through MBM and analysis of risk for the occurrence of BSE in Bangladesh. Methods: The scientific data were reviewed, hazards were scheduled and surveys were conducted - on livestock production system, import of MBM and its use to identify the hazards present in Bangladesh context. The analysis was done by the “OIE Risk Analysis Framework 2006 and European Union (EU) Scientific Steering Committee (SSC) 2003”. From the historical reviews, import of MBM and its use was identified, as external hazards. Results: The analysis revealed that, this hazards had negligible or moderate risk, for the introduction of infectious PrPsc as Bangladeshi cattle are vegetarian cattle. No milk replacer was used and use of slaughtered waste in the animal feed industry is absent. Un-consumable bones are processed to produce bone chips, fertilizers and bone meal for poultry feeds. Scrapie was never prevalent in Bangladesh. Therefore, risk from the internal challenge was negligible in Bangladesh for the occurrence of BSE. This prevented the propagation of BSE infectivity and eliminated BSE infectivity from the system very fast, if that was present. Conclusion: It was concluded that, introduction of PrPsc into cattle population of Bangladesh through MBM was very negligible. Key Words: MBM, risk assessment, risk analysis, BSE

Aim This is the first review to summarize the population pharmacokinetic studies of oxcarbazepine and explored the significant covariates that may have an impact on the dosage regimen and clinical use of oxcarbazepine. Methods PubMed and Embase databases were searched before 31 October 2020, and references of all selected studies were further screened to identify the pertinent population pharmacokinetic studies of oxcarbazepine. Relevant information about the identified population pharmacokinetic studies was summarised, and the quality of the reports was evaluated. Moreover, studies among infant, children, and adult patients were compared. Results Twelve studies were included: seven studies enrolled paediatric patients only; two enrolled both paediatric and adult patients; and two enrolled adult patients only. The apparent clearance per weight for children (median: 0.0505 L/h/kg, range: 0.016-0.084) and infants (0.078 L/h/kg) were higher than that for adults (median: 0.036 L/h/kg, range: 0.029-0.06). Furthermore, children had a larger variation on clearance compared to adults. Weight, co-administration with enzyme-inducing antiepileptic drugs, and renal function were found to significantly affect clearance of 10-hydroxycarbazepine. Conclusion The oxcarbazepine dose regimen was dependent on weight, co-administration with enzyme-inducing medications, and renal function. Further study is essential to explore the pharmacodynamics in epilepsy patients and pharmacokinetics of oxcarbazepine in infants.

Here, Als3-Th-cell-epitope （Als3 epitope） was connected to the N-terminal of TRAP by flexible linker, and the Als3-Th-cell-epitope-TRAP (ATT) proteins were prepared, then, the ATT proteins plus freund’s adjuvant were inoculated in mice to evaluate Als3 epitope to increase the immunogenicity of TRAP. To strengthen the immunogenicity of ATT protein, the proteins plus the novel combined adjuvants of MDP, CpG and FIA were immunized in mice. After the booster immunization, the results showed that the mice immunized with ATT protein plus Freund’s adjuvant exhibited significantly higher level for IFN-γ, IL-4, IL-10 and IL-17A, and displayed the stronger humoral immune response against TRAP than the control groups, importantly, the survival rate of these mice was significantly higher than the control groups. In addition, the mice immunized with ATT protein plus CpG+MDP+FIA adjuvants exhibited significantly higher level for IFN-γ and IL-17A than other groups, and the level of IgG antibody against TRAP was higher than other groups, moreover, the survival rate of these mice was obviously higher than other groups. These data suggested that the immune protection triggered with ATT was significantly stronger than TRAP or TRAP+Als3 epitope did, which indicted Als3 epitope significantly enhanced the immune responses triggered with TRAP through their fused forms of expression. Additionally, these data manifested that ATT plus the novel combined adjuvant, MDP, CpG and FIA, induced the strongest immune response and protection against S.aureus among all the groups, revealing the synergistic effect on different adjuvant. This study provides an important reference for the further development of a new effective vaccine against S.aureus.

Abstract: Evidence-based medicine (EBM) is an excellent reference for the guide of clinical decisions, through which medical practice can be improved. As an important part of Traditional Chinese medicine, acupuncture functions as a complex treatment system instead of rigid, linear or mechanical organizations, and its complexity is exactly the source of innovation. How does EBM affect acupuncture innovation? EBM helps acupuncture research to be under control, while it may be the great excuse to put barriers to the innovation for acupuncture treatment.

Abstract: The use of facemasks has played an important role in the prevention of COVID-19. However, inappropriate use of facemasks also brings people certain problems. Therefore, the reasonable use of facemasks is a necessary measure to protect oneself and others in the current epidemic prevention and control.

In this work, we introduce a new three-dimensional chaotic differential dynamical system. We find equilibrium points of this system and provide the stability conditions for various fractional orders. Numerical simulations will be used to investigate the chaos in the proposed system. A simple linear control will be used to control the chaotic oscillations. Further, we propose an optimal control which is based on the fractional order of the system and use it to synchronize the new chaotic system.

Altered physiologic function of prion is one of the proposed mechanisms of neurodegeneration through perturbed activities of PrPC.Experimental studies reported the link between sequence variation in the functional domains of prion protein and scrapie disease development .This study highlights how variants could potentially affect the prion protein dynamics i.e. conformational flexibility, ligand binding affinity, solvent accessibility and probability score of amyloid forming hotspot sequences. Secondary structures were predicted using The MINNUS server-POLYVIEW-2D.3D structure Residue specific ligand binding probability and secondary structure were predicted using I-Tasser online server.SDM prediction pipeline to assess the potential effect of variants. Amyloidogenicity propensity of hotspot heptapeptides were predicted using Multiple Instance Learning Based Amyloid Prediction (MILAMP) online pipeline VRQ PrP diplayed broken helix flanked by strand and it has has more strand percentage than ARR PrP.All hotspot sequences containing the resistant variant at 136 and 171 codons were predicted to have lower amyloid propensity.The ligand residue was predicted to be buried in VRQ but exposed in ARR

: In this study electrospinning method was used to prepare nanofiber of chitosan polymer and polyethylene oxide (PEO) solution. Also marshmallow extract as a useful medicinal plant was loaded to it in different concentrations .Optimal electrospinning conditions included a feed rate of 0.5 ml / h, a voltage of 10 kV, a needle-to-collector distance of 200 mm and a collector rzzzotation speed of RPM200. SEM images of nanofibers prepared with marshmallow extract loaded show a network structure of non-woven fibers with no spheres and the difference between the mean diameters of their fibers was not significantly different (P = 0.315). Viscosity measurements show that the lowest viscosity is related to 2.5% chitosan solution and 10% marshmallow extract, which is significantly less than chitosan solution alone (P <0.0001). The highest electrical conductivity is related to Chitosan solution of marshmallow extract is 20% and PEO is 2.5%. On the other hand, increasing the concentration of the extract in the nanofibers increases the surface tension and the tensile test shows that the difference in the mean mechanical tension between the study groups was significantly different (P = 0.011) .The FTIR study of the prepared nanofibers shows no reaction Between marshmallow extract and chitosan and polyethylene oxide, which leads to the production of new compounds, did not occur. It was a mixture of biomaterials. Drug release was also performed by calculating the area under the curve.

COVID-19 pandemic period, where are the seasonal viruses? Jean-Michel Mansuy1, Maximin Bourcier1, Pauline Trémeaux1,*, Chloé Dimeglio1,2, Jacques Izopet1,21 – Toulouse University Hospital, Virology department, Toulouse, France2 - INFINITy; Toulouse Institute for Infectious and Inflammatory Diseases, INSERM UMR1291 / CNRS UMR5051 / Université Toulouse III, Toulouse, France* corresponding author, Dr Pauline Trémeaux: Virology department, Toulouse University Hospital, 31059 Toulouse France. Phone +33 5 61 77 71 34; Fax + 33 5 61 77 22 45; e-mail: tremeaux.p@chu-toulouse.frShort running title: seasonal viruses during COVID-19 outbreakThe whole world has been struggling to cope with the SARS-CoV-2 pandemic since the beginning of 2020.The measures initially used to combat the epidemic were non-pharmaceutical, such as physical distancing, mask wearing, tightened basic hygiene, quarantine and even curfews because no effective antiviral molecule had been identified and no specific vaccines yet developed. These measures were applied, accepted, and effective to varying degrees, depending on the country.Their application did reduce the transmission of SARS-CoV-2 and decreased the virus reproductive number R0. However, the epidemic flared up from time to time and new waves of epidemic appeared, undoubtedly due to non-compliance and/or the partial lifting of containment measures such as curfews and movement restriction.Such measures effectively control the transmission of other viral pathogens with or without respiratory tropism (1,2), as has been demonstrated in the Southern Hemisphere. Australia and New Zealand have had extremely low incidences of influenza since mid-April 2020 (3). But few data are available on the circulation of respiratory syncytial viruses (RSV) and rhinoviruses during the SARS-CoV-2 pandemic as the surveillance networks are more concerned with influenza.Our university hospital has been monitoring these three types of virus for the past 10 years. We have found that RSVs are first detected at the beginning of winter, usually between weeks 40 and 43 (the second half of October) while influenza viruses appear later, from mid-December to early January. Unlike these viruses, rhinoviruses are endemic throughout the year and their prevalence in winter varies from 20 to 35% in our area depending on the year.The circulation of flu, RSV and rhinoviruses during the first winter in which SARS-CoV-2 was controlled using only non-pharmaceutical methods was quite special. The effectiveness of these measures seems to depend on the prior circulation of the particular virus.The measures were effective for influenza viruses and RSV, whose circulation is only epidemic (i.e. not detected prior to winter). They were not detected even in children under 6 years old, who are currently exempt from wearing a mask and continue to go to school in France. In contrast, the response of rhinoviruses, which circulate all year round, was quite different. Their prevalence was stable, and the figures were the same as in previous years. However, the patients who tested positive for rhinoviruses were younger than those identified during past winters. The ages of those patients infected during the winter 2020/2021 (median: 1.21, IQR [0.17;4.28]) differed significantly from those of patients infected during the two previous winters (2018/2019 and 20109/2020; median: 1.82, IQR [0.24;60.25], p=0.01 by Wilcoxon).The reasons for these differences in prevalence are difficult to pinpoint and probably multifactorial, each of varying importance. Virus tropism could be determinant, with flu and RSV preferentially targeting the lower respiratory tract and rhinoviruses propagating in the upper tract. The longer infectious period of rhinoviruses could be partially responsible for them being more infectious than RSV despite the fact that their R0 was lower than that of RSV (4). We believe that the differing responses of viral epidemic episodes to non-pharmaceutical control measures should be known and fully understood in order to design defenses against future viral epidemics.1 - Sakamoto H, Ishikane M, Ueda P. Seasonal influenza activity during the SARS‐CoV‐2 outbreak in Japan. JAMA. 2020;323:1969‐1971.2 - Wu D, Liu Q, Wu T, Wang D, Lu J. The impact of COVID‐19 control measures on the morbidity of varicella, herpes zoster, rubella and measles in Guangzhou, China. Immun Inflamm Dis. 2020;8(4):844–846.3 - Olsen SJ, Azziz-Baumgartner E, Budd AP, et al. Decreased Influenza Activity During the COVID-19 Pandemic — United States, Australia, Chile, and South Africa, 2020. MMWR Morb Mortal Wkly Rep 2020;69:1305–1309. DOI:http://dx.doi.org/10.15585/mmwr.mm6937a64 - Julie A. Spencer, Deborah P. Shutt, Sarah K. Moser, Hannah Clegg1,Helen J. Wearing, Harshini Mukundan, and Carrie A. Manore Epidemiological parameter review and comparative dynamics of influenza, respiratory syncytial virus, rhinovirus, human coronavirus, and adenovirus. medRxiv preprint doi:https://doi.org/10.1101/2020.02.04.20020404

We present a case of Aortic valve atresia (AVA) with type C interrupted aortic arch (IAA) in a neonate with absent left ventricle and mitral valve atresia. The hemodynamics of the lesion has been discussed with an illustrative cartoon.

We modified our leak-proof puncture technique for the aspiration of giant ovarian cyst contents while strengthening the punctured cyst wall. After making the minilaparotomy incision, we lined a sterile gauze with the cyst surface, applied instant cyanoacrylate glue, and attached a plastic wrap over a wound retractor. The adhesion side was reinforced by the gauze and was difficult to split when aspirating the cyst contents. We then drew the cyst outside the body and performed cystectomy or oophorectomy under a narrow field of direct vision. This technique is easy and cost effective for the resection of giant ovarian cystic tumors.

Abstract Spontaneous coronary artery dissection (SCAD) is considered one of the rare causes of acute coronary syndrome. It’s been related to many predisposing factors mostly connective tissue disorders, fibromuscular dysplasia in particular, traumatic and atherosclerosis as the most common etiologic factor. It occurs predominantly more in women & is been associated with stress & pregnancy. Here we present a rare case of coronary artery dissection extending to left main coronary artery in 33 years old women post elective cesarean section.