Objective Hypothesis: Exposure of the patient to a theatre setting prior to surgery reduced the preoperative anxiety and adverse outcomes. Design: Single-center randomized controlled trial Setting: Professorial Gynecology Unit, Colombo South Teaching Hospital, Sri Lanka Sample: 64 adult patients. Methods: The patients were randomized and the intervention arm was given a pre-operative visit with an informative session regarding the surgery. These patients were assessed using an interviewer-administered questionnaire. The Statistical Package for Social Sciences (SPSS-17) was used to analyze the data. Main Outcome measures: Anxiety level before surgery, at the time of surgery and post-surgery, pre-induction parameters, and pain score. Results APAIS average combined anxiety level before the intervention was 10.19 ± 3.872 for the intervention group and 10.53 ± 4.303 for the control. This is on the day of the surgery after the intervention was 8.25 in the intervention group and 8.75 in the control. The reduction of anxiety as per HADS and VAS after surgery for the intervention group was 3.28 and 2.41 respectively, this is for control was 2.72 and 2.28. The pain score at 6 hours after surgery was 5.04 for the intervention group and 6.08 for the control. Conclusion Preoperative theatre visit prior to surgery made no significant difference in the patient’s anxiety, though a trend in reduction of pain and anxiety noted. Trial Registration Sri Lankan Clinical Trial Registry (Registration No: SLCTR/2019/015) https://slctr.lk/trials/slctr-2019-015.

Phenotypic plasticity of the upper critical thermal limits (CTmax) may be crucial for ectotherms when it enables them to respond rapidly to extreme and novel thermal conditions. Although current studies have widely reported on the effect of increasing temperature on the magnitude of the plastic response of ectotherms, little is known about timing of upper thermal acclimation. These temporal components may be adaptive and of major environmental concern, especially under the increasing frequency of episodic heatwaves, predicted by climate change models together with quick habitat conversion. We experimentally studied the temporal acquisition of a greater thermal tolerance by acclimation effect in four species of tropical tadpoles, adjusting the daily variation in the CTmax to an asymptotic function and analyzing its main parameters: asymptotic CTmax (CTmax∞) and acclimation rate of the CTmax (K), under two realistic daily thermal fluctuations: mean daily fluctuation (MF) and extreme hot fluctuation (HF), and under the corresponding constant temperatures, mean constant (MC) and hot constant (HC). The rate of acclimation was higher for constant and hotter conditions, with which the CTmax∞ was reached in a shorter time under these conditions. The time to achieve the CTmax∞ was between one and three days depending on the treatment of acclimation and species. Plastic responses are species-specific and appear to be adaptive to the level of thermal heterogeneity of their breeding environment. Engystomops pustulosus tadpoles, that develop in hot and thermally variable temporary pond had the greatest acclimation. This suggests that species exposed naturally to extreme heat events may exhibit the highest plastic response in acclimation to upper thermal tolerances.

Background: Preoperative left atrial remodeling as Postoperative atrial fibrillation (POAF) predisposing factors could be measured by left atrial volume index (LAVI) and P-wave dispersion. Aim: This study aimed to assess P-wave dispersion and LAVI as preoperative predictors of POAF among patients who underwent Coronary Artery Bypass Graft (CABG). Methods: An analytical retrospective cohort study was performed on patients who underwent CABG. The P-wave dispersion and POAF were evaluated based on documented ECG results. LAVI size was collected from echocardiographic reports. Hazard ratios of P-wave dispersion and LAVI for POAF were analyzed using Cox proportional hazard model. Result: A total of 42 subjects (57±1 years) were included in this study. POAF occurred in 28.6% of patients at a median of 2 days after CABG. P-wave dispersion was significantly longer in patients in whom AF was developed (53.03±3.82ms vs. 44.01±1.98ms, p:0.028), while LAVI difference was not significant. The Cox proportional hazard model showed a significant association between P-wave dispersion and risk of POAF (HR 1.05, CI95%, 1.001-1.103;p=0.048). There was no association between LAVI and risk of POAF (HR1.003, CI 95%, 0.965-1.044;p=0.864). Conclusion: P-wave dispersion is a predictor of POAF in patients who underwent CABG. Risk stratification using P-wave dispersion enables clinicians to identify high-risk patients before CABG surgery.

Optimal positioning of drainage and return cannulae is critically important for minimizing the recirculation in patients with respiratory failure requiring veno-venous extracorporeal membrane oxygenation (VV ECMO). If a drainage cannula is positioned at a low level of right atrium through the femoral vein, flow disturbance due to drainage chattering can occur when the intravascular volume is insufficient, or intrathoracic or intraabdominal pressure is increased. We report a case in which drainage chattering was eliminated and recirculation were decreased by repositioning the drainage and return cannula in a patient with VV ECMO flow disturbance when intrathoracic pressure was increased.

This is a case of left ventricular pseudoaneurysm with intratumoral thrombus resulting from cardiac radiofrequency surgery. Due to the small size of the tumor, the patient recovered after half a year. This paper introduces in detail the whole process of echocardiography follow-up of pseudo ventricular aneurysm, and emphasizes that bedside echocardiography should be carried out actively when patients have uncomfortable symptoms during the operation.

Despite the significant advances in the numerical solution of nonlinear boundary value problems, most of the existing methods still encounter with a high sensitivity to the initial guess. The aim of this paper is to propose a less sensitive robust numerical scheme for accurate solution of sensitive boundary value problems. For this purpose, an orthogonal collocation approach for discretization of the problem is utilized. Thereby, the problem is converted to the solution of nonlinear algebraic equations. However, due to the difficulties of solving the obtained system of nonlinear equations, particularly in providing the proper initial guess, the obtained system of equations is transferred to an optimization problem in which the values of the solution at collocation points are considered as decision parameters. The method finds good results even using not good initial guess for decision parameters and even using a small number of discretization points. Numerical results of two benchmark examples are presented and the efficiency of the method is reported.

Comprehensive management strategy for cervical cancer screening, cervical lesion diagnosis, and treatment of cervical lesions during the COVID-19 pandemic: Chinese expert consensus

Background Several adjuvant interventions have been evaluated for improving the success rate of external cephalic version (ECV) and reduce the rate of cesarean delivery (CD). Evidence regarding the effect of Nitrous oxide (NO) is limited with inconsistent results on pain score and success rate. Objective To examine the effect of inhaled NO on the success rate and pain score for women undergoing ECV. Search strategy MEDLINE, EMBASE, PubMed, Ovid Medline, ClinicalTrials.gov, the Cochrane Library and Google Scholars from inception till June 2020. Selection criteria Peer-review studies that examined the success rate of inhaled NO use during ECV attempt compared with or without the use of other analgesic agents were eligible for inclusion. Data collection and analysis All ascertained records were screened independently for eligibility by two authors. The study quality scores were evaluated as a source of heterogeneity by fitting meta-regression models to the individual study effect sizes. Results Of the 186 records, two randomized trials and one prospective cohort study (434 in the NO group and 286 in the controls) were deemed adequate for meta-analysis. ECV success rate did not differ significantly between the NO and the controls group (p=0.825; OR 1.036; 95% CI, 0.756-1.419). In addition, the use of NO did not affect pain scores (p=0.457; OR 0.759; 95% CI, -1.240-2.759) and there was no difference in the incidence of CD (p=0.943; OR 1.013; 95% CI, 0.703-1.46). Conclusion Use of NO during ECV is not associated with increase in ECV success rate and does not affect pain score.

Background Evidence suggests that there is a link between diabetes mellitus and Vitamin A. Moreover, it has been reported that diabetes induces oxidative stress. Lately, a wide attention has been developed to the protective biochemical function of natural antioxidants contained vitamins, which can reduce the oxidative damage caused by free radical species. Objective To investigate the anti-obesity, anti-diabetic and anti-oxidative effects of vitamin A in streptozotocin (STZ)-induced diabetic mice. Methods Male mice were randomly divided into three groups: Control- nondiabetic, received a normal diet and water; Control-diabetic, received STZ 45mg/kg once intraperitoneally; and Treated-diabetic, received both STZ as before plus Vitamin A (4-IU/day) orally daily for 16 weeks. Food intake, body weight, fat mass, fasting blood glucose, serum insulin, and lipid profile were estimated. Also, superoxide dismutase (SOD), glutathione peroxidase (GPO), catalase (CAT), and malonaldehyde (MDA) were measured. Results Treated diabetic mice with Vitamin A showed a significant improvement in their body weight, fat mass, lipid profile as well as SOD, GPO and CAT compared to Control-diabetic mice. However, Vitamin A caused no significant change on fasting blood glucose and insulin levels. Furthermore, plasma level of MDA was significantly elevated in diabetic mice compared to normal mice. Diabetic mice treated with vitamin A had a significantly reduced level of MDA, suggesting that vitamin A might have a vital role in the protection of tissues from damage by free radicals. Conclusion Supplementation with vitamin A may be a useful treatment strategy for diabetic patients to reduce/prevent the pathological complications of diabetes.

Background and Purpose: The defective colonic mucus barrier is a feature of ulcerative colitis (UC) that enables increased bacterial contact with the epithelium, which triggers mucosal damage, and gastrin has been reported to be able to promote healing through the cholecystokinin 2 receptor (CCK2R) signaling to increase epithelial regeneration and protect against colonic injury. However, the role of gastrin in UC remains unclear. Experimental Approach: Colonic samples from human sections and mouse models using β-arrestin1 wild-type (β-arr1-WT) and β-arrestin1 knockout (β-arr1-KO) littermates, intestinal epithelial cells specific NF-κBp65 deletion (NF-κBp65IEC-KO) and wild-type (NF-κBp65IEC-WT) mice were analyzed. The mucosal injury, goblet cells status, MUC2 expression and bacteria penetration/colonisation were examined, and the effect of gastrin in colitis was also investigated. Key Results: We demonstrate that mucus barrier loss and bacterial colonisation of the crypts were observed in colitis, and exogenous gastrin could restore the mucus barrier, reduce bacterial colonisation of the colonic crypts and alleviate colitis via CCK2R. Furthermore, targeting CCK2R by YF476, β-arrestin1 (β-arr1) deletion or intestinal epithelial NF-κBp65 deficiency breached gastrin-mediated mucus barrier restoration and mucosal protection in colitis. Conclusion and Implications: These data demonstrate that gastrin alleviates mucus barrier loss and bacterial colonisation of the colonic crypts via CCK2R/β-arr1/NF-κBp65 signaling in colitis, and this network may be a potential therapeutic target for UC.

The seven trans-membrane spanning G protein couple receptors(GPCRs) constitute the largest family of FDA approved drug targets to treat numerous human diseases, including metabolic associated disorders. The Melanocortin Receptor Accessory Protein 2 (MRAP2), a small single transmembrane protein broadly expressed in multiple tissues has been defined as a vital endocrine pivot of five melanocortin receptors(MC1R-MC5R) and several other GPCRs in the regulation of central neuronal appetite and peripheral energy homeostasis. However, MRAP2 null mouse model exhibited late onset obesity syndrome without alteration on the eating behavior, a huge phenotypic departure from MC4R KO animals. In this study, we identified GLP1R and MCHR1, the two energy regulators as novel GPCR targets and characterized the specific regions of MRAP2 protein that required for the pharmacological modulation of the intracellular cAMP cascades. The simultaneous inhibitory effect of MRAP2 on the anorectic GLP1R and orectic MCHR1 signaling further elucidated the complex endocrine network of GPCR signaling which may explain the composite metabolic phenotypes of MRAP2 deficiency.

Global climate changes e.g. ocean acidification and warming caused by anthropogenic emission of CO2 are the greatest global threat to coral reef ecosystems. However, compared with the knowledge of Symbiodinium, little is known about the synergistic effects of combined ocean acidification and warming on the coral host and coral-Symbiodinium symbioses. In this study, metatranscriptomic analysis was performed to reveal the response of coral host and its symbiotic Symbiodinium to acidification (A), warming (H) and combined acidification and acidification (AH), using branching A. valida and massive G. fascicularis as models in a laboratory simulation system. RNA-Seq-based differently expressed genes (DEGs), together with coral’s morphological change, suggested the synergistic effects of AH on the coral host and coral-Symbiodinium symbioses, e.g. photosynthesis inhibition and negative effect on nutrients exchange between the host and its Symbiodinium. Particularly, AH showed a far greater impact on coral host than on Symbiodinium. These findings provide novel insights into the molecular mechanism of coral holobionts’ response to future extreme ocean acidification and warming, meanwhile highlight the molecular evidence for the different tolerance of branching and massive corals to environmental changes.

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection may produce a systemic disease, the coronavirus disease-19 (COVID-19), with high morbidity and mortality. Even though we do not fully understand the interaction of innate and adaptive immunity in the control and complications of the viral infection, it is well recognized that SARS-CoV-2 induces an immunodepression that impairs the elimination of the virus and favors its rapid dissemination in the organism. Even less is known the possible participation of inhibitory cells of the innate immune system, such as the myeloid-derived suppressor cells (MDSCs), or the adaptive immune system, such as the T regulatory cells (Tregs). That is why we aimed to study blood levels of MDSCs as well as lymphocyte subpopulations including Tregs, and activated (OX-40+) and inhibited (PD-1) T lymphocytes in patients with COVID-19 in comparison with data obtained from control donors. We have found that 12 hospitalized patients with COVID-19 and no health history of immnosuppression had a significant increase in the number of peripheral monocytic MDSCs, but not Tregs, as well as an increase in the number of inhibited or exhausted T cells, whereas the number of activated T cells was significantly decreased compared with that from 20 healthy controls. Moreover, there was a significant negative correlation (- 0.791) between the number of M-MDSC and the number of activated T cells. Therefore, SARS-Cov-2 seems to recruit MDSCs, and these inhibitory cells may contribute to the immunosuppression observed in patients with COVID-19.

Coronaviruses were first discovered in the 1960s. The severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) was identified as the cause of coronavirus disease 2019 (COVID-19) in China and subsequently, across the globe. As COVID-19 causes serious public health concerns across the world, investigating the characteristics of SARS-CoV-2 and its interaction with the host immune responses may help to provide a clearer picture of the way this pathogen causes disease in some individuals. Interestingly, SARS-CoV-2 exhibits a 80% sequence homology with SARS-CoV-1 and 96–98% homology with coronaviruses isolated from bats. Therefore, the experience acquired in SARS and MERS epidemics may improve our understanding of the immune response and immunopathological changes in COVID-19 patients. Here, we have reviewed the immune response (including the innate and adaptive immunities) against the SARS-CoV, MERS-CoV, and SARS-CoV-2 pathogens to improve our understanding of the concept of the disease, and enlighten the scope for developing vaccines and medicines for the treatment of COVID-19 patients.

Acute undifferentiated leukemia (AUL) is a rare subtype of leukemia that expresses no lineage-specific markers; no optimal treatment for AUL has been established. Here, we report a 16-year-old female with CD22-positive refractory AUL who responded well to inotuzumab ozogamicin (InO). Minimal residual disease negativity was achieved using InO, followed by HLA-mismatched unrelated bone marrow transplantation (BMT). Although grade II veno-occlusive disease/sinusoidal obstruction syndrome occurred, it improved immediately. She remained disease-free at 10 months post-BMT, without severe complications (grade III–IV). This case demonstrates the feasibility of a treatment strategy using InO against CD22-positive AUL.

Causal relations among variables may change significantly due to different control strategies and fault types. Off line-based knowledge is not adequate for fault diagnosis. In this work, a fault diagnosis framework is proposed based on information solely extracted from process data. Variable correlation under normal condition is extracted by mutual information to obtain a threshold for random noises. Once a process deviation is detected, each pair of variables with mutual information beyond this threshold are further investigated by time delayed mutual information (TDMI) analysis, so as to determine the causal logic between them, which is represented as fault propagation paths, can be tracked all the way back to the root cause. The proposed method is applied to a simulated process, Tennessee Eastman process and a practical industrial process. The results show that the fault propagation path can be objectively identified, together with the root cause.

Purpose: Chemotherapy-induced nausea and vomiting (CINV) is a common side effect of cancer treatment. The factors influencing CINV in breast cancer patients remain unclear. In this study we developed a nomogram for predicting the occurrence of CINV in this group using prospective clinical data from multiple sources Methods: We pooled data from several studies conducted in China on CINV caused by emetogenic chemotherapy. Demographic and clinical variables of 334 breast cancer patients at Hunan Cancer Hospital (training set) were analyzed to identify factors associated with CINV by multivariate logistic regression and construct a prediction nomogram. The external validation set comprised an additional 66 patients. The reliability of the nomogram was assessed by bootstrap resampling, and C-index and receiver operating characteristics curve (ROC) analyses were carried out to assess its discriminatory power. Results: Four risk factors were associated with CINV: history of CINV, chemotherapy target regimen, metastasis, and symptoms of distress. The C-index was 0.69 (95% confidence interval [CI], 0.63–0.75) for the training set and 0.83 (95% CI, 0.73–0.93) for the validation set. The area under the ROC curve indicated that the model had a specificity of 68.5% and 86.1% and sensitivity of 57.7% and 56.7%, for the training and validation sets, respectively. Calibration curves showed good concordance between predicted and actual occurrence of CINV. Conclusions: The developed nomogram can reliably predict the occurrence of CINV in breast cancer patients based on 4 variables, which can aid in clinical decision-making.

Background Bacterial retrograde infection caused by decreased saliva secretion is the main cause of recurrent acute suppurative parotitis (RASP) in children. Allergies inhibit saliva secretion. Therefore, we designed this study to identify the relationship between food allergy and RASP in children. Methods This study is a prospective, open-label, two-arm randomised cohort study of food allergy is an inducement for RASP in children. We will enrol children, who are under 14 years with serum IgE positive with ASP and 2 or more recurrent episodes within a year. Participants will be randomised in a 1:1 ratio to usual care or anti-allergic treatment with telephone follow-up for 1 year. The primary objective is to compare the difference of recurrence times in 2 groups. Results The numbers of recurrence before and after the intervention of the interventional group were significantly different, while the numbers of recurrence before and after the intervention of the control group were not significantly different. There were significant differences in the numbers of recurrence after intervention between the interventional group and the control group, while there were no significant differences in age and the numbers of recurrence before intervention. The correlation coefficient between food allergy and childhood RASP was 0.817 (p=0.000). Conclusions Food allergy is significantly correlated with childhood RASP. Avoiding food allergies can significantly reduce the recurrence of RASP

A document by Antoine Badaoui. Click on the document to view its contents.

Objectives: Numerous tasks carried out in the otolaryngology clinic increase the chances of developing injury among practitioners. To mitigate this, we aim to observe the risk of musculoskeletal injury in practitioners when carrying out common procedures. We observe the performance of the Dix-Hallpike manoeuvre, deducing whether technique has an impact on the likelihood of developing injury. Design: Participants were asked to perform the Dix-Hallpike manoeuvre as they normally would in clinic, on departmental colleagues. Data that was collected included chosen preference of position when carrying out manoeuvre, level of seniority of practitioner and risk of musculoskeletal injury to practitioner. Setting: Simulated outpatient department; St John’s Hospital, Edinburgh. Participants: Otolaryngology consultants and trainees with clinic commitments, having regularly performed the Dix-Hallpike manoeuvre. Main outcome measures: Risk of musculoskeletal injury was measured using the validated Rapid Upper Limb Assessment (RULA) tool. Results: 3 consultants and 7 trainees were included in this study performing on average 4 Dix-Hallpike’s during the study period – totalling 40 attempts. The median RULA score was 4 for the sitting position, compared to 6 for standing (p<0.0001). There was similar statistical significance when consultants and trainees were evaluated separately. Conclusions: A doctor’s wellness is of great importance to facilitate long-term job satisfaction and productivity. It is important to improve conditions for the practitioner in the otology clinic, and one factor is procedural technique. Further work is needed to raise ergonomic awareness amongst otolaryngology surgeons.

Background. Hereditary Hemochromatosis (HH) is a genetic condition associated with a systemic iron overload. Heart failure is an important cause of mortality. It has been demonstrated early stages of systolic and diastolic left ventricular dysfunction in previous studies. The aim of the study is to compare the left atrial (LA) function between asymptomatic HH patients and a control group using 2D speckle tracking. Methods. Prospective study. LA strain, LA strain rate and LA volumetric parameters during the reservoir, conduit and contraction phases were studied. The LA Stiffness Index was calculated by the ratio between E/e and LA reservoir strain. Results. 30 patients with HH (90% males, 47 ± 18 years old) and 30 healthy controls (85% males, 45 ± 13 years old) were included. LA volume was similar in both groups. No differences were observed in LA ejection fraction (EF), LA passive EF and LA active ejection fraction between both groups. On the contrary, the HH group had lower LA strain during the reservoir (31.5 ± 6.5% vs 38.3 ± 7.9%; p=0.002), and conduit phases (-18 ± 7% vs -23.3 ± 6.4%; p=0.01) and lower LA conduit strain rate (-1.7 ± 0.7 seg-1 vs -2.1 ± 0.5 seg-1; p=0.02) than controls. The LA stiffness index was significantly higher in the HH group (0.25 ± 0.9 vs 0.19 ± 0.6; p=0.01). Conclusions. Early abnormalities in the LA function could be detected by using 2D speckle tracking study despite no evidence of changes in atrial size or volumetric parameters.

In this work, a mathematical Covid-19 epidemic transmission network model is investigated for the study of the virus spread dynamics. The purpose is to present a sensitivity-based estimability analysis as well as an accurate parameter identification approaches for reliable mathematical modeling. The most sensitive parameters of the model are identified using a local sensitivity approach, these sensitivities are then used within an orthogonalization algorithm to assess the estimability of the unknown parameters from available data. A database of newly reported infected and recovered people in China is used. The most estimable model parameters are identified, their accuracy is assessed by computing confidence intervals and their numerical values are also used to compare the model predictions to real data. The Pearson Product-Moment coefficient is computed. Its high values show the accuracy of the new model parameterization and the importance of the used sensitivity-based estimability approach.

Introduction: We analyzed the influence of the QRS duration (QRSd) to left ventricle (LV) end-diastolic volume (LVEDV) ratio on the clinical outcome of cardiac resynchronization therapy (CRT) in HF patients with small body size and New York Heart Association (NYHA) classification III/IV. Methods and Results We enrolled 114 patients with advanced heart failure (NYHA class III/IV, and LV ejection fraction > 35%) who received a CRT device, including those with left bundle branch block (LBBB) and QRSd ≥ 120 ms (n = 60), non-LBBB and QRSd ≥ 150 ms (n = 30), and non-LBBB and QRSd of 120-149 ms (n = 24). Over a mean follow-up period of 65 ± 58 months, the incidence of the primary endpoint, a composite of all-cause death and hospitalization for heart failure, showed no significant intergroup difference (43.3% vs. 50.0% vs. 37.5%, respectively, p = 0.72). Similarly, among 104 patients with QRSd/LVEDV ≥ 0.67 (n = 54) and QRSd/LVEDV < 0.67 (n = 52), no significant differences were observed in the incidence of the primary endpoint (35.1% vs. 51.9%, p = 0.49). Nevertheless, patients with QRSd/LVEDV ≥ 0.67 showed better survival than those with QRSd/LVEDV < 0.67 (14.8% vs. 34.6%, p = 0.0024). Conclusion: Advanced HF patients with a higher QRSd/LVEDV ratio showed better survival in this small-body–size population. Thus, the risk is concentrated among those with a larger QRSd, and patients with a relatively smaller left ventricular size appeared to benefit from CRT.

In this paper, we consider the following fourth-order elliptic equations of Kirchhoff type with critical growth in $\R^N$: $$ \Delta^2 u-\left(1+b\int_{\R^N} |\nabla u|^2 dx\right)\Delta u+V(x)u =\lambda f(u)+|u|^{2^{**}-2}u, \quad x\in\R^N, $$ where $\Delta^2 u$ is the biharmonic operator, $2^{**}=2N/(N-4)$ is the critical Sobolev exponent with $N\ge 5$, $b$ and $\lambda$ are two positive parameters, and $V(x)$ is the potential. By using a main tool of constrained minimization in Nehari manifold, we establish sufficient conditions for the existence result of nodal (that is, sign-changing) solutions.