A 52-year-old patient with previous catheter ablation of AV nodal reentrant tachycardia (AVNRT) had a redo procedure for reported recurrence. During the study AVNRT was not inducible, but a previously unrecognized left-sided Mahaim type accessory pathway was diagnosed and ablated successfully.

BACKGROUND: Physical exercise adds benefits improving evolution of the ischemic heart disease, enhancing individual functional capacity and preventing ventricular remodeling. In this study we investigated the impact of a program of physical training started after an uncomplicated post-acute myocardial infarction (AMI) on the mechanics of left ventricle (LV) contraction. METHODS: A total of 53 patients were included, 27 of whom were randomized to a supervised training program (TRAINING group), and 26 to a CONTROL group, who received usual orientations for physical exercise after AMI. All patients underwent cardiopulmonary stress testing and an echocardiogram with speckle tracking technique to measure several parameters of LV contraction mechanics at 1 month and 5 months after AMI. RESULTS: No significant difference in the analysis of LV longitudinal, radial and circumferential strain parameters between groups after the training period was found. After the training program, analysis of torsional mechanics demonstrated a reduction in the LV basal rotation of the TRAINING group in comparison to the CONTROL group (TRAINING, -5.9±2.3 vs CONTROL, -7.5±2.9 o; P=0.03), and in the basal rotational velocity ​​( TRAINING, -53.6±18.4 vs CONTROL, -68.8±22.1 º/s; P=0.01), twist velocity (TRAINING, 127.4±32.2 vs CONTROL, 149.9±35.9 vs º/s; P=0.02) and torsion (TRAINING, 2.4±0.4 vs CONTROL, 2.8±0.8 vs º/cm; P=0.02). CONCLUSIONS: Physical activity did not cause a significant improvement in LV longitudinal, radial and circumferential deformation parameters. However, the exercise had a significant impact on the LV torsional mechanics, composed particularly of a reduction in basal rotation, twist velocity, torsion and torsional velocity which can be interpreted as a ventricular “torsion reserve” in this population.

Understanding the frequency, spatiotemporal dynamics and impacts of parasite coinfections is fundamental to developing control measures and predicting disease impacts. The European turtle dove (Streptopelia turtur) is one of Europe’s most threatened bird species. High prevalence of infection by the protozoan parasite Trichomonas gallinae has previously been identified, but the role of this and other coinfecting parasites in turtle dove declines remains unclear. Using a high-throughput sequencing approach, we identified seven strains of T. gallinae, including two novel strains, from ITS1/5.8S/ITS2 ribosomal sequences in turtle doves on breeding and wintering grounds, with further intra-strain variation and four novel sub-types revealed by the iron-hydrogenase gene. High spatiotemporal turnover was observed in T. gallinae strain composition, and infection was prevalent in all populations (89–100%). Coinfection by multiple Trichomonas strains was rarer than expected (1% observed compared to 38.6% expected), suggesting either within-host competition, or high mortality of coinfected individuals. In contrast, coinfection by multiple haemosporidians was common (43%), as was coinfection by haemosporidians and T. gallinae (90%), with positive associations between strains of T. gallinae and Leucocytozoon suggesting a mechanism such as parasite-induced immune modulation. We found no evidence for negative associations between coinfections and host body condition. We suggest that longitudinal studies involving the recapture and investigation of infection status of individuals over their lifespan are crucial to understand the epidemiology of coinfections in natural populations.

The emergence of Zika virus (ZIKV) infection, which is unexpectedly associated with congenital defects, has prompted the development of safe and effective vaccines. The gram-positive enhancer matrix-protein anchor (GEM-PA) display system has emerged as a versatile and highly effective platform for delivering target proteins for vaccines. In this article, we developed a bacterium-like particle vaccine ZI-△-PA-GEM based on the GEM-PA system. The fusion protein ZI-△-PA, which contains the prM-E-△ protein of ZIKV (with a stem-transmembrane region deletion) and the protein anchor PA3, was expressed. The fusion protein was successfully displayed on the GEM surface, forming ZI-△-PA-GEM. Moreover, when BALB/c mice were immunized intramuscularly with ZI-△-PA-GEM combined with 201 VG and poly(I:C) adjuvants, durable ZIKV-specific IgG and protective neutralizing antibody responses were induced. Potent B cell/DC activation was also be stimulated early after immunization. Remarkably, splenocyte proliferation, the secretion of multiple cytokines, T/B cell activation and central memory T cell responses were elicited. These data indicate that ZI-△-PA-GEM is a promising bacterium-like particle vaccine candidate for ZIKV.

Flaviviruses West Nile (WNV), Usutu (USUV) and Bagaza (BAGV) virus and avian malaria parasites are vector borne pathogens that circulate naturally between avian and mosquito hosts. WNV and USUV and potentially also BAGV constitute zoonoses. Temporal and spatial co-circulation and co-infection with Plasmodium spp., and West Nile virus has been documented in birds and mosquito vectors, and fatally USUV infected passerines coinfected with Plasmodium spp. had more severe lesions. Also, WNV, USUV and BAGV have been found to co-circulate. Yet little is known about the interaction of BAGV and malaria parasites during consecutive or co-infections of avian hosts. Here we report mortality of free-living red-legged partridges in a hunting estate in Southern Spain due to coinfection with BAGV and Plasmodium spp. The outbreak occurred in the area where BAGV first emerged in Europe in 2010 and where co-circulation of BAGV, USUV and WNV was confirmed in 2011 and 2013. Partridges were found dead in early October 2019. Birds had mottled locally pale pectoral muscles, enlarged, congestive greenish-black tinged livers and enlarged kidneys. Microscopically congestion and predominantly mononuclear inflammatory infiltrates were evident and Plasmodium phanerozoites were present in the liver, spleen, kidneys, muscle and skin. Molecular testing and sequencing detected Plasmodium spp. and BAGV in different tissues of the partridges, and immunohistochemistry confirmed the presence and co-localization of both pathogens in the liver and spleen. Although Plasmodium spp. are known to be highly prevalent in red-legged partridges, this is the first account of mortality caused by co-infection with BAGV and Plasmodium sp. Due to the importance of the red-legged partridge in the ecosystem of the Iberian Peninsula and as driver of regional economy such mortalities are of concern. Also, they may reflect climate change related changes in host, vector and pathogen ecology and interactions that could emerge similarly in other pathogens.

Telomerase activity and telomere restoration in certain somatic cells of human adults maintain the proliferative capacity of these cells and contribute to their regenerative potential, and telomerase activity and telomere length are commonly considered lifespan predictors. Eusocial insects provide excellent model systems for aging research based on their extraordinary caste-related lifespan differences that contradict the typical fecundity/lifespan trade-off. In agreement with the common presumption, telomerase activity is upregulated in the reproductive, long-lived individuals of eusocial insects such as queens and kings, proposing that telomerase activity acts as a key factor in their extended longevity. But, as documented by the presence of telomerase in somatic tissues of numerous invertebrate and vertebrate species, the connection between telomerase activity and the predicted lifespan is not clear. Here, I ask whether somatic telomerase activity in eusocial reproductives may serve its non-canonical function to protect its individuals against the exacerbated metabolic stress upon reproduction and be a reflection of a more common phenomenon among species. I propose a hypothesis that the presence of telomerase activity in somatic cells reflects a different reproduction strategy of the species.

We write to address recent claims by Gompert et al. (2021) about the potentially important and underappreciated phenomena of “indirect selection”, the observation that neutral regions may be affected by natural selection. We argue both that this phenomenon – generally known as genetic hitchhiking – is neither new nor poorly studied, and that the patterns described by the authors have multiple alternative explanations.

In the manufacture of therapeutic monoclonal antibodies (mAbs), the clarified cell culture fluid is typically loaded onto an initial protein A affinity capture column. Imperfect mass transfer and loading to maximum capacity can risk antibody breakthrough and loss of valuable product, but conservative underloading wastes expensive protein A resin. In addition, the effects of column fouling and ligand degradation require the frequent optimization of IgG loading to avoid wastage. Therefore, continuous real-time monitoring of IgG flowthrough is of great interest. We previously developed a fluorescence-based monitoring technology that allows mix-and-read mAb detection in cell culture fluid. Here we report the use of reporters immobilized on CNBr-activated Sepharose 4B resin for continuous detection of IgG in column breakthrough. The column effluent is continuously contacted with immobilized fluorescein-labeled Fc-binding ligands to produce an immediately detectable change in fluorescence intensity. The technology allows rapid and reliable monitoring of IgG in a flowing stream of clarified cell culture fluid emerging from a Protein A column, without prior sample preparation. We observed a significant change in fluorescence intensity at 0.5 g/L human IgG, sufficient to detect a 5% breakthrough of a 10 g/L load, within 2 minutes at a flow rate of 0.5 mL/min.

Opportunities for process intensification and increased productivity have made the field of Continuous Biomanufacturing an area of high interest and active research. Within the purification train of producing biologics, Tangential Flow Filtration (TFF) is typically employed after chromatographic separations, to increase drug substance concentration, making the process more economical and further meeting dosage specifications. In a batch operation, concentration occurs via recirculation of the feed material where desired output concentration is attained through multiple pump-passes over the TFF membrane, while steadily excluding the buffer. Single-Pass Tangential Flow Filtration (SPTFF) enables continuity of this process by achieving similar concentration factors through a single – pass over these membranes while operating at low feed flow rates. Our work elucidates the development of a mechanistic process model to predict SPTFF performance across a relatively wide design space using a first principles approach. The developed model is found to be accurate for a range of high feed flow rates but is inaccurate at flow rates below 25 L/m2/hr. At very low flow rates, small differences in the mass transfer coefficient have been observed to significantly alter the prediction of the retentate concentration. We thus describe the challenges in predictive process modeling of SPTFF in antibody biomanufacturing.

Objectives: Review of radiological images of the keystone area to assess risk of disruption to the nasal dorsum when separating the osseo-cartilaginous junction in septoplasty. Methods: A Cross sectional radiological study of adults who underwent CT scan of paranasal sinuses. Outcome measures included were: The Length of the keystone area (shorter length implies a higher risk of disruption) and a high-risk shape (high risk shape implies shorter keystone area) that can predispose to disruption of nasal dorsal integrity during septoplasty surgery. Certain nasal dimensions were evaluated to determine if they add risk to the dorsum. Results: CT scans of 343 patients were reviewed. The mean keystone area length was initially 10.42 mm that came down to 7.43 mm after adjustment in patients with high-risk shape. 31.5% of subjects were at risk of disruption to the dorsum due to short keystone area length <5 mm. Relatively shorter nasal bones (nasal bone length: overall dorsal length <0.49%) were associated with a shorter keystone area length (P = 0.004). Age, gender, septal deviation are not risk factors as they did not significantly influence keystone area length. Conclusions: One third of our patients (31.5%) had short KSA length < 5mm which carries higher risk of disruption to the dorsum integrity upon complete detachment of osseo-cartilaginous junction. We recommend preoperative CT imaging for thorough evaluation and precise measurement of KSA. Patients with relatively shorter nasal bones detected on examination (and confirmed radiologically), need to be recognized as they are more likely to have shorter KSA

Scattering solutions and several properties of scattering function of a discrete Sturm-Liouville boundary value problem with point interaction (PBVP) are derived. Moreover, resolvent operator, continuous and discrete spectrum of this PBVP are investigated. An asymptotic equation is utilized to get the properties of eigenvalues. An example illustrating the main results is given.

Youth with sickle cell disease (SCD) and their caregivers are susceptible to stress and depression, perhaps exacerbated by pandemic-associated health and economic concerns. Most of the 50 youth-caregiver dyads enrolled in the multi-site HABIT trial took an on-line survey of self-reported mental health symptoms and food insecurity during the 2020 COVID-19 pandemic. Compared to largely pre-pandemic results, prevalence of mental health symptoms in dyad members appeared to have shifted: fewer youth and more caregivers were affected during the pandemic; many of both groups lacked optimism. Pandemic screening of youth with SCD for mental health symptoms and food insecurity appears warranted.

Co-infection between SARS-CoV-2 and other pathogens have become a serious threat. There are reports of fungal, bacterial and viral co-infections with SARS-COV-2. Herein, we report the unusual case of concomitant aspergillosis, mucormycosis, cytomegalovirus pneumonia and also klebsiella pneumoniae empyema as the complication of COVID-19 infection.

Protists represent the majority of the eukaryotic diversity in the oceans. They have different functions in the marine food web, playing essential roles in the biogeochemical cycles. Meanwhile the available data is rich in horizontal and temporal coverage, little is known on their vertical structuring, particularly below the photic zone. The present study applies DNA metabarcoding to samples collected over three years in conjunction with the BATS time-series to assess marine protist communities in the epipelagic and mesopelagic zones. The protist community showed a dynamic seasonality in the epipelagic, responding to hydrographic yearly cycles. Mixotrophic lineages dominated throughout the year; however, autotrophs bloomed during the rapid transition between the winter mixing and the stratified summer, and heterotrophs had their peak at the end of summer, when the base of the thermocline reaches its deepest depth. Below the photic zone, the community, dominated by Rhizaria, is depth-stratified and relatively constant throughout the year, mirroring local hydrographic and biological features such as the oxygen minimum zone. The results suggest a dynamic partitioning of the water column, where the niche vertical position for each community changes throughout the year, likely depending on nutrient availability, the mixed layer depth, and other hydrographic features. Finally, the protist community closely followed mesoscale events (eddies), where the communities mirrored the hydrographic uplift, raising the deeper communities for hundreds of meters, and compressing the communities above.

Background. Electrocardiographic (ECG) changes during stress testing are a common and perplexing finding during non-ischaemic stress echocardiography (SE). Research has provided conflicting results regarding the implications. Methods. SE was performed after maximal Bruce protocol treadmill exercise. Results. 3020 consecutive patients, mean age 58±12 years, 36% female, were followed-up for up to 9 years (mean 36±21 months) post SE. Time to first cardiac event (composite of heart failure admission, worsening New York Heart Association class, worsening ejection fraction, acute coronary syndrome, revascularization, angina or cardiovascular death) was analyzed and adjusted using Cox proportional hazards regression. Prognostic significance was found with 1.5mm of downsloping or horizontal ST depression. Adjusting for baseline differences, increased risk of composite major adverse cardiac events was shown with at least 1.5mm of exercise induced ST depression (Hazard ratio [HR] of 2.47, 95% Confidence ratio [CI] 1.67-3.72, p<0.0001). Patients achieving high level exercise capacity (≥13 metabolic equivalents or METs) with ST depression lower risk of cardiac events during follow-up Conclusion. Patients with ST segment depression but non-ischaemic stress imaging have poorer prognosis compared to patients with non-ischaemic stress echocardiograms with normal stress ECGs. ST depression of 1.5mm or more was established as a prognostically significance value. High exercise capacity improves prognosis, and ECG changes in that setting can be regarded as false positives. Overall, however, ST depression during non-ischaemic stress imaging is not a benign finding.

Under the background of global climate change and the human activities, the stock of natural capital and the the ability of ecosystem services are facing increasing pressure, and the contradiction between natural capital protection and people’s livelihood development is also increasing. Therefore, it is urgent to integrate ecosystem value estimation into the development decision-making of countries all over the world. As a new ecosystem research method, ecosystem gross product (GEP) accounting is widely used in China, and often used to reflect the effectiveness of regional ecological protection and the coordination relationship between development and protection. We found that : (1) GEP accounting can reflect the overall situation of ecological environment and service quality, and help decision-makers and managers formulate and implement sustainable development strategies and ecological protection policies. (2) The contradiction between the depletion of global ecosystem capital and the development of people’s livelihood continues to intensify. About 68.7% of developing countries facing “low-low development model” (low GEP and low GDP). (3) We have constructed the path model of GEP working system and the path model of ecological protection compensation mechanism in China. The GEP accounting system of “from point to area, from top to bottom”, the parallel evaluation strategy of GDP and GEP and the comprehensive ecological compensation system of “vertical and horizontal combination” implemented can be popularized to countries all over the world.

This paper is concerned with the study of the nonlinear elliptic equations in a bounded subset Ω ⊂ RN Au = f, where A is an operator of Leray-Lions type acted from the space W1,p(·)0(Ω) into its dual. when the second term f belongs to Lm(·), with m(·) > 1 being small. we prove existence and regularity of weak solutions for this class of problems p(x)-growth conditions. The functional framework involves Sobolev spaces with variable exponents as well as Lebesgue spaces with variable exponents.

Although oophorectomy for ovarian metastasis from colorectal cancer is encouraged to improve the prognosis, that is also performed to relieve the symptom such as abdominal distention. We report a surgical case of intestinal obstruction due to ovarian metastasis after ileocecal resection for cecal cancer diagnosed at 77 years old.

A 71-year-old man had disordered consciousness whose Glasgow Coma Scale was E4V1M5. His blood pressure was high, but there was no abnormality in the cerebrospinal fluid examination. The MRI finding reveals a high-intensity area at the pons without the blood flow interruption. Thus, he has diagnosed with brainstem PRES

Background and aim: On the basis of previously published accounts, coupled with our own experience, we have assessed the surgical approaches to patients with isomeric atrial appendages. Methods: We reviewed pertinent published studies on surgical treatment of individuals with isomeric atrial appendages, with the pertinent surgical details provided by most of the manuscripts. Results: Half of patients with right isomerism, and two-thirds of those with left isomerism have bilateral superior caval veins. Azygos extension of the inferior caval vein is reported in three-quarters of those with left isomerism. The coronary sinus is universally absent in right isomerism, along with totally anomalous pulmonary venous connection, and is absent in two-fifths of those with left isomerism.. Univentricular atrioventricular connections are expected in up to three-quarters of those with right isomerism. Atrioventricular septal defect is reported in up to four-fifths, more frequently in right isomerism, with such patients typically having discordant ventriculoatrial connections or double outlet right ventricle. Reported mortalities extend to 85% for those with right, and 50% for those with left isomerism. In right isomerism, mortality is up to 54% for systemic-to-pulmonary arterial shunting, up to 75% for univentricular repair, and up to 95% for repair of totally anomalous pulmonary venous connection itself. No more than one-quarter had undergone Fontan completion, with reported mortalities of 21%. Conclusion: Early surgical results are satisfactory in patients with left isomerism, but disappointing for those with right. Recent advances in cardiac and liver transplantation may offer improved survival.

Although uncommonly encountered, dual atrioventricular nodal non-reentrant tachycardia (DAVNNRT) is a well described arrhythmia that can manifest in patients with dual atrioventricular nodal pathways physiology. This arrhythmia is characterized on ECG by a single P wave followed by two conducted QRS complexes, and on intracardiac EGMs by a single atrial electrogram followed by two separate His deflections and ventricular electrograms. Our case demonstrates a rare case of “triple atrioventricular non-reentrant tachycardia” in which a patient was found to have 3 distinct AV nodal pathways and multiple “triple fire responses”, both on surface ECG and intracardiac electrograms.

The combination of plastic film mulching and subsurface organic amendment is a novel strategy for saline soil amelioration and utilization in China. However, how the strategy affect soil organic carbon (SOC) contents directly and indirectly (physical protection and microbiological regulation) were still not-documented. Therefore, four treatments, i.e., no amendment with and without plastic film mulching, subsurface (10-30 cm soil depth) organic amendment with and without plastic film mulching, were arranged and sampled after three-year filed experiment. Compared with no amendment with and without plastic film mulching, subsurface organic amendment increased the SOC content in the 0-40 cm soil depth by 70% and 90%, respectively. Plastic film mulching decreased SOC by 16% without organic amendment. Subsurface organic amendment transformed the dominant aggregation particles from <0.053 mm to 0.25-2 mm, indicating that both direct carbon input and indirect physical protection contributed to SOC increment. Conversely, SOC decreased with plastic film mulching due to the 14% lower fungal diversity compared with soil without plastic film mulching, was supported by the positive path coefficient from fungal diversity to SOC. Therefore, the combination of plastic film mulching and subsurface organic amendment increased SOC by 61% by direct carbon input and indirect physical protection and microbial regulation. In conclusion, subsurface organic amendment with plastic film mulching reinforced soil organic carbon increment through altering saline soil aggregate structure and regulating fungal community, and confirmed it is a feasible way to increase SOC for saline soil amelioration.

In this study, Dihydroartemisinin (DHART)-loaded polycaprolactone collagen nanofibers (PCL/Col NFs) were constructed as effective biocompatible scaffolds through adjusting the proportions of hydrophobic/ hydrophilic polymers for enhanced osteoblastic differentiation of human adipose-derived stem cells (hADSCs). The designed NFs were characterized through FTIR, XRD, TGA, FE-SEM, and tensile testing. DHART-loaded PCL/Col electrospun NFs provide an ideal solution, with the potential of sustained drug release as well as inhibition of drug re-crystallization. Interestingly, inhibiting DHART re-crystallization can improve its bioavailability, providing a more effective therapeutic efficacy. Besides, the data set found through FE-SEM, MTT, PicoGreen, qPCR, and alkaline phosphatase (ALP) assays revealed the improved adhesion and proliferation rate of hADSCs cultured on PCL/Col/DHART (5%) NFs after 14 and 21 days of incubation. These findings confirmed the potential of the designed NF scaffolds for sustained/controlled release of DHART therapeutic molecules toward bone tissue regeneration and engineering.

Myocardial damage from external cardiac massage can occur with either manual massage or with an automatic external device. We report the case of a patient with an aortic valve bioprosthesis undergoing advanced resuscitation with an automated external device for out-of-hospital-cardiac arrest, in whom the prolonged compressions caused an aortic root dissection.