Bacgrond: acute lymphoid leukemia (ALL) is the most common neoplasm in childhood. The probability of current overall survival is around 90% in developed countries. There are few studies that demonstrate the results in Brazil. This work aims to analyze the results of children with ALL treated at a single institution in Rio de Janeiro. Procedure: retrospective analysis survival study of a cohort of childhood ALL patients treated in Hemorio. Kaplan-Meier and log-rank methods were used for analysis of overall survival (OS) and events free survival (EFS) and the Cox proportional hazards regression model for multivariate analysis. Results: the probability of OS and EFS at 6 years was 52% and 45%. The probability of OS and EFS in 6 years for pacients aged 10-17 years was 31% and 28% and for the younger was 65% and 55% respectively (p<0.001). A probability of OS and EFS in 6 years for patients with more than 100.000 leukocytes/mm3 at diagnosis was 19% and 16% and those with less than 100.000 was 62% (p=0.007) and 55% (p= 0.008). Those who received less than 10 doses of native Echerichia coli asparaginase had a probability of OS and EFS in 6 years of 27% and 21% and that who received at least 10 doses was 74% and 65% (p<0.001). Conclusions: the presence of a high number of adolescents and high-risk patients, as well as many patients who discontinueted the use of asparaginase or any substitute led to a lower probability of OS and EFS in our cohort.

Vitex agnus-castus Linn referred as a small decides tree commonly known as the chaste tree. The fruits of this tree have been used as a therapeutic agent for over 2500 years in ancient Egypt, Greece, Iran, and Rome. The Vitex Agnus belongs to the family of Verbenaceae which encompasses 250 species from all over the world and Vitex is the largest genus of this family. Vitex has many therapeutic and medicinal benefits the German health authorities have approved the utilization of V.agnus castus for treating irregularities of menstruation among females and also associated disorders, mastalgia, and menopausal disorders. Evidence based studies have proved multiple therapeutic and pharmaceutical benefits of this medicinal plant which includes antioxydant, anti-cancer, immunomodulatory antimicrobial, anti-inflammatory, anti-fungal, insect repellent, fracture healing, osteopenic, epileptic, anti-diabetic and it also prevents from nonalcoholic fatty liver disorders. The literature also suggests that there is no drug interaction associated with Vitex. Moreover, the use of V. agnus-castus is contraindicated (or ought to be abstained from) during pregnancy because of hypothetical sentiments and cell examines that displayed progesteronic and estrogenic properties of the plant. This review gives the documentation to researchers to utilise the properties of V. agnus-castus as a powerful natural medication and its wellbeing and satisfactory measurement are examined. Progressed preclinical and clinical examinations for adequately evaluating the security and helpful viability of V. agnus-castus are suggested.

Background: COVID-19, the novel coronavirus has caused a global pandemic affecting millions of people around the world. Although children, including children with cancer, have been found to be affected less commonly and less severely than adults, indirect effects of the pandemic on the diagnosis and treatment of children with cancer have been less described. Methods: A survey was performed in the four largest tertiary pediatric hematology-oncology medical centers in Israel. Clinical and laboratory data were collected from the medical files of patients diagnosed or treated with cancer during April-October 2020. Results: Seventeen patients are described, who had significant delay in diagnosis or treatment of cancer. These represent approximately 10% of all the pediatric cancer diagnosed during the study period in these centers. A main cause of delay was fear of exposure to COVID-19 (fears felt by the patient, parent, physician, or decision-makers at the institution; or the implementation of national guidelines). Delays also resulted from co-infection with COVID-19 and the attribution of the oncologic symptoms to the infection. In addition, treatment was delayed of patients already diagnosed with cancer, due to COVID-19 infection detected in the patient, a family member, or a bone marrow donor. Conclusion: Fear from the COVID-19 pandemic may result in delayed diagnosis and treatment of children with cancer, which may carry a risk to dismal prognosis. It is crucial that pediatricians and patients alike remember that other diseases still prevail and must be thought of and treated in a timely fashion.

Aims: The Coronary Slow Flow Phenomenon (CSFP) is a syndrome which according to normal or near normal angiography findings is characterized by delayed progression of the injected contrast medium through the coronary vessels. The causes of this disease are unknown. Therefore, the identification of the disease’s pathogen, an effective cure and the long-term prognosis of these patients is still in need of more research. This research attempts to analyze and compare the systolic and diastolic function of the left and right ventricle in people affected by primary Slow Coronary Flow and Normal Coronary Flow. Methods and Results: This case-control study was conducted with the participation of 44 patients undergoing coronary angiography in Qazvin’s Bu Ali Sina Hospital in 2017. The patients were divided in two groups of primary Slow Coronary Flow (33 people) and Normal Coronary Flow (11 people) and the systolic and diastolic function of the left ventricle and the systolic function of the right ventricle was analyzed and compared between the two groups. The frequency of left ventricular systolic and diastolic dysfunction and right ventricular systolic dysfunction was similar and no significant statistical difference was seen between the two groups. Conclusion: In this research the frequency of left ventricular systolic and diastolic dysfunction and right ventricular systolic dysfunction was similar and no significant statistical difference was seen between the two primary Slow Coronary Flow and Normal Coronary Flow groups. Keywords: left ventricular systolic function, left ventricular diastolic function, right ventricular systolic function, Coronary Slow Flow

Pneumatic reactors are an important class of bioreactors widely used in biotechnological processes. The growing interest in these reactors is mainly related to their good mass transfer capacity, as well as lower operating costs, due to the simple mechanical structure. Knowledge of the transport phenomena and hydrodynamics of bioreactors is important to enable definition of the best bioreactor model and operating conditions for a specific bioprocess. Several performance parameters are used to evaluate bioreactors, with the imposed shear being one of the most difficult to quantify. For stirred tanks, the fragmentation of microorganisms has been well correlated with a hydrodynamic parameter called the “energy dissipation/circulation function” (EDCF). However, there have been no estimates of the EDCF for pneumatic bioreactors. The present work proposes a methodology to estimate the EDCF for different pneumatic bioreactors and operating conditions. The difficulty in estimating the EDCF for pneumatic bioreactors is in defining the volume of higher energy dissipation. Here, this was achieved employing the maximal shear rate obtained using computational fluid dynamics simulations. The estimated volume was validated by comparing pellet fragmentation in conventional and pneumatic bioreactors, under conditions that led to similar EDCF values.

ZNC is an ultrahighly active plant immune inducer extracted from the endophyte Paecilomyces variotii that can promote plant growth and enhance plant immunity. Our research aim was to further reveal the trade-off balance between plant growth and immunity by evaluating the mechanisms of ZNC on potato growth, yield, and priming immunity against the oomycete Phytophthora infestans indoors and under field conditions. ZNC sustained the balance between potato growth and resistance to Phytophthora infestans with ultrahigh activity. It induced ROS production, promoted plant growth, yield and quality parameters, enhanced the expression of IAA-related genes, and increased the absorption of N. Moreover, the flg22 and chitin signaling pathways contributed to the ZNC-mediated defense response. Irrigation with ZNC at one of two optimal concentrations of 1 or 10 ng/ml could enhance resistance against potato late blight and marketable yield. Spray application of ZNC onto potato plants significantly reduced the occurrence of potato blight disease and greatly increased potato yield in the field. In summary, ZNC, which is a new ultrahighly active plant inducer, is a kind of green agricultural input with high efficiency and low cost that has excellent potential in agricultural applications.

Incident atrial fibrillation (AF) is common after cavotricuspid isthmus (CTI) dependent atrial flutter (AFL) ablation. Risk factors for development of AF post ablation are not well understood. To identify patients undergoing CTI ablation for AFL most likely to develop AF. We identified 114 patients without history of AF who underwent CTI AFL ablation. We evaluated baseline characteristics, electrophysiology study (EPS) data and echocardiographic data for incidence of AF within 3 years. Incident AF was identified in 46 patients (40%) during 600 + 405 days follow-up. Left atrial volume index (LAVI) was significantly greater in patients who developed AF compared to those that did not (37  12.2 ml/m2 vs 30  13.4 ml/m2, p=.004). EPS data was similar between groups. Area under the receiver operator characteristic curve based on the LAVI for prediction of AF was 0.7 (p = 0.004). Kaplan-Meier estimated incidence of AF was significantly greater in patients with LAVI ≥ 30 ml/m2 than LAVI < 30 ml/m2 (66% vs 27%, p=0.004). Risk of incident AF in patients with LAVI > 40 mL/m2 was similar to that of LAVI 30-40 ml/m2 (67% vs 63%, respectively, p=0.97). In multivariate analysis LAVI remained the sole independent predictor of incidence AF after CTI AFL ablation. LAVI ≥ 30 ml/m2 is associated with significantly increased risk of incident AF following CTI ablation for typical AFL. The utility of elevated LAVI for identifying patients that may benefit from intensified arrhythmia monitoring, or prophylactic AF ablation requires further evaluation.

Hypoxia is considered an important factor in the proliferation and stemness of mesenchymal stem cells (MSCs). This study aimed to obtain large numbers of mouse clonal MSCs (mc-MSCs) and evaluate the effect of hypoxia on the proliferation and differentiation of mc-MSCs. mc-MSCs were cultured on a Cytodex 3 microcarrier in a spinner flask for a suspension culture to increase mass productivity. To produce the hypoxic conditions, CoCl2 and Na2SO3 were used in a low glucose DMEM medium. The hypoxia environment was established using 0.5g/L Na2SO3 with 10μM or 100 µM CoCl2 for 24 hours. As a result, the proliferation of mc-MSCs under hypoxic conditions was 1.56 times faster than the control group over seven days. The gene expression of HIF-1a and VEGFA increased 4.62 fold and 2.07 fold, respectively. Furthermore, the gene expression of ALP, RUNX2, COL1A, and osteocalcin increased significantly by 9.55, 1.55, 2.29, and 2.53 times, respectively. In contrast, the expression of adipogenic differentiation markers, such as PPAR-γ and FABP4, decreased. These results show that the hypoxia environment produced by these chemicals in a suspension culture increases the proliferation of mc-MSCs and promotes the osteogenic differentiation of mc-MSCs.

The metastasis of breast cancer is believed to have a negative effect on its prognosis. Benefiting from the remarkable deep-penetrating and non-invasive characteristics, sonodynamic therapy (SDT) demonstrates a whole series of potential leading to cancer treatment. To relieve the limitation of monotherapy, a multifunctional nanoplatform has been explored to realize the synergistic treatment efficiency. Herein, we establish a novel multifunctional nano-system which encapsulates chlorin e6 (Ce6, for SDT), perfluoropentane (PFP, for ultrasound imaging), and docetaxel (DTX, for chemotherapy) in a well-designed PLGA core-shell structure. The synergistic nanoparticles (CPDP NPs) featured with excellent biocompatibility and stability which primarily enables its further application. Upon low intensity focused ultrasound (LIFU) irradiation, the enhanced ultrasound imaging could be revealed both in vitro and in vivo. More importantly, combined with LIFU, the nanoparticle exhibits intriguing antitumor capability through Ce6 induced cytotoxic reactive oxygen species (ROS) as well as DTX releasing to generate a concerted therapeutic efficiency. Furthermore, this treating strategy actives a strong anti-metastasis capability by which lung metastatic nodules have been significantly reduced. The results indicate that the SDT-oriented nanoplatform combined with chemotherapy could be provided as a promising approach in elevating effective synergistic therapy and suppressing lung metastasis of breast cancer.

ABSTRACT Berberis aristata DC. belonging to the family Berberidaceae, is a shrub used in the alternative medical systems that is native to Northen Himalaya region, Nepal, India and Pakisthan. It is commonly known as “Daruharidra and Chitra”. Berberis aristata DC. is used in Ayurvedic Medicinal system from the beginning of this System. It is widely used as a hepatoproctive, tonic, in urinary disorders, skin diseases, diaphoretic, diuretics and treatment of diarrhoea, Jaundice, Syphilis. Natural source of Berberine is Daruharidra which reduces the inflammation of hepatocytes in liver. The study was aimed to analyze its’ hepatoprotective effect on the basis of Modern scientific evidences and Classical Ayurveda references. Ayurvedic literature describes Daruharidra plant is mainly used in Kamala, Prameha, Kustha, Netra roga, Vrana.

Abstract Background and Purpose: Anesthetic inhalation induction could be one of the most stressful experiences for children. While, either oral midazolam or nasal dexmedetomidine as premedication remains less than ideal. This study was to assess the efficacy and safety when those two premeds were applied together in children undergoing minor surgeries. Experimental Approach: One hundred and thirty-eight children aged 2-6 years old were randomly allocated into three equal groups based on the premedication routes: Group M with oral midazolam 0.5 mg.kg-1, Group D with intranasal dexmedetomidine 2 μg.kg-1 and Group MD with intranasal dexmedetomidine 1 μg.kg-1 plus oral midazolam 0.5 mg.kg-1, respectively. The primary outcome was the satisfactory compliance rate during inhalation induction with sevoflurane using induction compliance checklist. The secondary outcomes were the preoperative m-YPAS scores when the children arrived in the holding area, sedation level, behavior scores, parental separation anxiety scores, mask acceptance scale (MAS), the incidence of emergence agitation, recovery time and other adverse events. Key Results: Subjects in Group MD showed higher satisfactory compliance rate (n=38, P=0.0049) and satisfactory MAS (n=38, P=0.0049) on anesthesia inhalation induction. Compared to the Group M and D, Subjects in Group MD had significantly shorter onset time to achieve the satisfactory sedation level (P<0.001) and higher sedation score at 20 and 30min after drug administration (P<0.001). Conclusion and Implications: We conclude that combined intranasal dexmedetomidine 1μg.kg-1 and oral midazolam 0.5 mg.kg-1 significantly improved the compliance during inhalation induction with sevoflurane, and had quicker onset to reach satisfactory sedation level in children.

Objective The study used both subjective, Suboptimal Health Status (SHS) concept along with objective, biomarkers of oxidative stress (OS): 8-OHdG, 8-epi-PGF2α and total antioxidant capacity (TAC); and angiogenic growth mediators (AGMs): VEGF-A, sFlt-1, PlGF and soluble endoglin (sEng) for predicting early-onset (EO) and late-onset (LO) preeclampsia (PE) Design A hospital-based longitudinal nested case-control study Setting Obstetrics and Gynaecology Department at Komfo Anokye Teaching Hospital, Ghana Population/Sample Singleton normotensive pregnancies (NTN-P) at baseline W1 (10-20th week gestation) (n= 593) of which 498 (197 developed PE) completed the study. Methods: The overall health status of the NTN-P participants was assessed at W1 and categorised as SHS and optimal health status (OHS) using a validated SHS questionnaire-25. Participants were followed at W2 (21-31st week, mid-pregnancy) and 32-42nd week. Samples were collected and analysed for biomarkers of OS and AGMs at the three-time points. Main Outcome Measures Receiver operative characteristics curve analysis was performed for the single and combined W1 and W2 biomarkers of OS and AGMs for predicting PE and its subtypes (EO-PE and LO-PE) Results Compared to single biomarkers of OS and AGMs, their combined ratios particularly, the W2 8-OHdG/PIGF ratio was a potent biomarker for PE [AUC=0.93]. Additionally, 8-OHdG/PIGF ratio best identified SHS-pregnant women who later developed EO-PE [AUC=0.97] and LO-PE [AUC=0.93]. Moreover, 8-OHdG/PIGF ratio best identified OHS-pregnant women who later developed EO-PE [AUC=0.94] and LO-PE (AUC=0.94). Conclusion Combination of biomarkers of OS and AGMs, particularly, mid-pregnancy 8-OHdG/PlGF ratio is a potent biomarker for PE and its subtypes.

Background: Plants possess a sophisticated hormone signaling system, which includes salicylic acid (SA) and jasmonic acid (JA), to defend itself from herbivores. In addition, this immune system is modulated by nonpathogenic microbes that live asymptomatically within intercellular spaces of host grasses. We investigated the resistance triggered by defense hormones, and that provided by endophyte Epichloë gansuensis against aphid Rhopalosiphum padi, and how the endophyte regulates this tripartite interaction. Methods: Achnatherum inebrians plants, with and without the fungal endophyte Epichloё gansuensis, were grown in the greenhouse of the College of Pasture Agriculture Science and Technology, Yuzhong campus of Lanzhou University (temperature: 24±2 °C, moisture: 76±2% photoperiod:L16:D8 h), were subjected to exogenous application of SA (5 mM, 10 mM, 15 mM) and aphid Rhopalosiphum padi infestation (5 A./plant, 10 A./plant, 15 A./plant). Result: Endophyte induced plant tolerance to the aphid feeding and exogenous SA increased plant shoot biomass, root biomass, plant length and chlorophyll content. Endophyte colonization induces WRKY54 factor that overrides negative effects on plant growth and possibly suppresses SA accumulation. In addition, the endophyte promotes a level of JA that is antagonistic to the SA pathway. By disabling the SA mechanism for herbivore-mediated plant growth inhibition, the endophyte induces plant tolerance to herbivory.

The aim of this work is to develop quantum estimates for q-Simpson type integral inequalities for co-ordinated convex functions by using the notion of newly defined q₁q₂-derivatives and integrals. For this, we establish a new identity including quantum integrals and quantum numbers via q₁q₂- differentiable functions. After that, with the help of this equality, we achieved the results we want. The outcomes raised in this paper are extensions and generalizations of the comparable results in the literature on Simpson’s inequalities for co-ordinated convex functions.

Background and purpose: The thromboxane A2 receptor (TP) plays an eminent role in the pathophysiology of endothelial dysfunction and cardiovascular disease. Moreover, its expression is reported to increase in the intimal layer of blood vessels of cardiovascular high-risk individuals. Yet it is unknown, whether TP upregulation per se has the potential to affect the homeostasis of the vascular endothelium. Experimental approach and key results: Here we report that increasing endothelial expression of both human TP isoforms induces endothelial cell tension and aberrant cell morphology, affects focal adhesion dynamics and inhibits the angiogenic capacity of human endothelial cells in vitro and in vivo, whereas TP knockdown exerts opposing effects. Combined global transcriptome, lipidomic, functional live-cell and validating expression analyses reveal that endothelial TP upregulation induces cyclooxygenase-2 in a Gi/o and Gq/11-dependent manner, thereby promoting its own activation via the auto/paracrine release of TP agonists, such as prostaglandin H2 or prostaglandin F2 but not thromboxane A2. Consequently, this TP-dependent angiostatic feedback loop is disrupted by pharmacological TP or cyclooxygenase-2 inhibition and by genetic reconstitution of prostaglandin H2-metabolizing prostacyclin synthase even in the absence of functional prostacyclin receptor expression. Further mechanistic analyses of downstream TP effectors disclose that the TP induces endothelial cell tension, focal adhesion dysregulation and angiostatic effects via a ROCK-LIMK2-myosin II-dependent signal transduction pathway and downregulates important mediators of endothelial cell homeostasis, e.g. VEGFR-2. Conclusions and implications: Our work uncovers a previously unrecognized mechanism, by which pathological endothelial upregulation of the TP could directly foster endothelial dysfunction, vascular rarefaction and systemic hypertension.

Influenza viruses are highly variable pathogens that infect a wide range of mammalian and avian species. According to the internal conserved proteins (nucleoprotein: NP, and matrix proteins: M), these viruses are classified into type A, B, C, and D. Influenza A virus in swine is of significant importance to the industry since it is responsible of endemic infections that lead to high economic loses derived from poor weight gain, reproductive disorders, and the role it plays in Porcine Respiratory Disease Complex (PRDC). To the date, swine influenza virus (SIV) diagnosis keeps on being based in complex and expensive technologies such as RT-qPCR. In this study, we aimed to improved actual tools by the implementation of new bioreceptors molecules; aptamers. First, three different aptamers have been selected using the recombinant NP of Influenza A virus expressed in insect cells, as target. Then, these molecules have been used for the development of an Enzyme-Linked AptaSorbent Assay (ELASA) in combination with specific monoclonal antibodies for Influenza A detection. A total of 171 field samples (nasal swabs) have been evaluated with the newly developed assay obtaining a 79.7 % and 98.1 % sensitivity and specificity respectively, using real time RT-PCR as standard assay. These results suggest that the assay is a promising method that could be used for Influenza A detection in analysis laboratories facilitating surveillance labours.

Many modifications have been incorporated to original Shirodkar technique to make the procedure an easy one whilst maintaining its efficacy. Anecdotal evidence suggest that use of vasoconstrictors before dissecting bladder base during Shirodkar method could be helpful. We performed aqua dissection using diluted vasopressin during modified Shirodkar cerclage in selected patients who required modified Shirodkar method. Our experience shows that judicious use local injection of diluted vasopressin to perform aqua dissection during modified Shirodkar is a safe and efficacious method and would increase the overall quality of the technique by reducing the blood loss and enhancing plane of dissection.

Wolff-Parkinson-White pattern on alternate beats: what is the mechanism?Short title : Alternating WPW Key words: preexcitation; accessory pathway; alternate beats; supernormal conduction; refractory periodVincenzo Carbone, MD Outpatient Cardiology, Naples (Italy)Ferdinando Ferrara, MD Outpatient Cardiology, Salerno (Italy)Antonio Cassese, MD Outpatient Cardiology, Naples (Italy)Giovanni Carbone, MD Department of Translational Medical Sciences, University “Federico II”, Naples (Italy)

Rationale, aims, and objectives: This study aims to determine the effectiveness of structured education and follow-up in the management of perceived milk insufficiency and increasing the baby’s amount of milk intake among breastfeeding mothers. Methods: A randomized controlled trial was carried over the period December 2018-June 2019 at Family Health Centers in Turkey with 64 mothers (study group: 33 and control group: 31). The study group were provided with education with structured educational material and followed. Data were collected with a Descriptive Information Form, a Breastfeeding Follow-up Form and the IMDAT- Scoring System for Measuring a Baby’s Intake of Breast Milk. Results: Mothers in the study group started breastfeeding their babies in the first one hour after birth (study: 97.0%; control: 77.4%; χ² = 5.586, p = 0.018). It was observed at each monitoring that a significantly greater percentage of the mothers in the study group believed their milk to be sufficient (study: 84.8%, 90.9% and 78.8; control: 38.8%, 38.8% and 38.8%, respectively) and that they fed their babies exclusively with breast milk (study: 84.8%, 87.9% and 78.8; control: 32.3%, 38.7% and 35.5%, respectively) in the tree follow-ups. The data obtained at all three tracking times showed that that the baby’s amount of milk intake in the study group (%81.8; %78.8 and %60.6, respectively) were better than in the control group (%54.8; %48.4 and %29.0, respectively); these differences were seen to be statistically significant. These results were also confirmed by regression analysis, in which education level, working status and having experience in breastfeeding were considered as impact modifier variables. Conclusion: This study concluded that the structured education and follow-ups increased the feeding 0-2 month-old babies exclusively breast milk and the amount of the baby’s milk intake, and while perceptions of breast milk deficiency diminished

Background Left bundle branch (LBB) area pacing emerged as a promising alternative to His bundle (HB) pacing in difficult cases of physiological pacing and failed cases of cardiac resynchronization. So, it is important to understand ECG features of LBB area pacing in various subsets of patients. Objective We wanted to find out different morphological patterns and characteristic ECG features of LBB area pacing. Method Medtronic 3830 pacing lead was used to pierce the interventricular septum 1-2 cm distal towards the RV cavity to a previously placed electrophysiology catheter at distal HB region to reach the LBB area in the right anterior oblique (RAO) 30 degree projection. We observed paced QRS morphology in lead V1 and paced QRS duration. Results We have analyzed ECG features of 60 patients who had undergone LBB area pacing and 60 patients with RV apical pacing. LBB area pacing resulted in narrower paced QRS complex than conventional RV apical pacing. In patients with baseline LBBB QRS shortening from LBB area pacing was more in comparison to patients with RBBB (34.45 ±8.07 ms vs. 19.78±10.24 ms; p value 0.004). Paced QRS morphological pattern in lead V1 was most commonly qR pattern followed by Qr pattern. Conclusions LBB area pacing results in narrower paced QRS duration than RV apical pacing. The morphological pattern is most commonly a qR or Qr pattern in lead V1. Patients with baseline RBBB showed lesser paced QRS shortening in comparison to patients with baseline LBBB.

Introduction: Adaptive cardiac resynchronization therapy (aCRT) is known to have clinical benefits over conventional CRT. We aimed to compare the effects of aCRT and conventional CRT on electrical dyssynchrony. Methods: We conducted a double-blind, randomized controlled trial in patients receiving CRT for routine clinical indications. Participants underwent cardiac computed tomography and 128-electrodes body surface mapping. We measured electrical dyssynchrony on the epicardial surface using noninvasive electrocardiographic imaging (ECGI) before and 6 months post-CRT. Ventricular electrical uncoupling (VEU) was calculated as the difference between the mean left ventricular (LV) and right ventricular (RV) activation times. An electrical dyssynchrony index (EDI) was computed as the standard deviation of local epicardial activation times. Results: We randomized 27 participants (mean age 64±12 y; 34% female; 53% ischemic cardiomyopathy; LV ejection fraction 28±8%; QRS duration 155±21 ms; strict left bundle branch block (LBBB) in 13%) to conventional CRT (n=15) versus aCRT (n=12). In atypical LBBB (n=11;41%) with S-waves in V5-V6, conduction block occurred in the anterior RV, as opposed to the interventricular groove in those who met the strict LBBB criteria. As compared to baseline, VEU reduced post-CRT in aCRT (median reduction 18.9 (interquartile range 4.3-29.2 ms; P=0.034), but not in conventional CRT (21.4 (-30.0 to 49.9 ms; P=0.525) group. There were no differences in the degree of change in VEU and EDI indices between treatment groups. Conclusion: The effect of aCRT and conventional CRT on electrical dyssynchrony is largely similar.

Objectives: Describe an alternative to conventional LV lead placement. Background: Conventional left ventricular (LV) lead placement is not always possible due to anatomic and technical limitations. In selected patients LV endocardial lead placement is a viable alternative. Methods: Five patients on warfarin with unsuccessful coronary sinus lead placements and contraindications to epicardial lead placement elected to undergo addition of an LV endocardial lead. The left ventricle was accessed through the interatrial septum via a combined superior and inferior approach resulting in an active fix lead placed on the LV endocardial surface. Results: All patients underwent successful LV endocardial lead placement. There were no acute procedural complications. Two patients died 2 years following the procedure from unrelated causes. The other patients were alive and well at a mean follow up of 2.8 years, with significant symptomatic improvement and no evidence of cardioembolic complications. Conclusions: The placement of LV endocardial leads is a viable alternative in highly selected patients with limited options.

Objective: To evaluate the efficacy and side effects of each medication regime, a comparison was drawn between the administration of misoprostol with the combined use of misoprostol plus oxytocin and misoprostol plus methylergometrine for full expulsion of retained intrauterine tissues in patients who underwent a miscarriage. Design: randomized, double-blind, clinical trial Setting: gynecology and obstetrics clinic in Jahrom, Southern Iran Population: 90 patients with gestational age below 12 weeks and having undergone a recent miscarriage. Methods: They were randomly allocated into three groups after being screened for underlying diseases and coagulative blood disorders. For the first group, labeled as the control group, misoprostol was administered alone, while as, the combination of misoprostol plus methylergometrine and misoprostol plus oxytocin was prescribed for the second and third groups, respectively. Main Outcome Measures: Primary: Expulsion of retained products of conception; Secondary: Pain, Hemorrhage Results: Despite no significant statistical difference being observed in the expulsion of retained products of conception (RPOC)by the administration of misoprostol alone or with combined medical therapy of misoprostol with oxytocin or methylergometrine (P-value< 0.329), all of them showed a successful treatment. Additionally, the patients treated with misoprostol and oxytocin showed good results in expelling the RPOC(P=0.013); while as, those treated by misoprostol plus methylergometrine reported controlled pain and hemorrhage after an abortion (P=0.004). Conclusion: The course of medications viz. methylergometrine, oxytocin, and misoprostol indicated a successful outpatient treatment in patients that had experienced a miscarriage or an incomplete abortion. They are cost-effective and have shown lesser side effects.

Virus filtration is a critical process in the production of biotherapeutics and drug products derived by plasma fractionation. The processing steps upstream of virus removal filtration impact the filterability (throughput and flux) of process solutions. We processed mAb and plasma IgG spiked with aggregate by chromatography resins and examined the filterability of the output on a virus filter (Planova BioEX). The greatly reduced filterability for protein solutions with aggregate was improved by processing with specific chromatography resins. For mAb, mixed-mode AEX effectively reduced aggregate content and significantly improved filterability. Mixed-mode AEX was also effective for reducing aggregates in plasma IgG but modified CEX showed even greater improvement in filterability. The results clearly show that virus filter performance can be optimized by careful choice of column chromatography. Finally, applying the throughput and flux from the virus filter to four classical clogging models showed that mAb with aggregate was best fit to the standard blocking model and plasma IgG with aggregate was best fit to the complete blocking model, suggesting that differences in solution properties result in different clogging mechanisms.