We are presenting a unique case, based on peri-operative management of a patient who was brought to the operating room for video-assisted thoracoscopy (VATS) for lung abscess decortication end up with right upper lobe of lung resection via thoracotomy in an emergency.

We report physiotherapy management of two patients with severe cystic fibrosis (CF) lung disease and upper limb deep vein thrombosis (DVT). These patients were admitted due to a pulmonary exacerbation. Following peripherally inserted central catheters they were diagnosed with an upper limb DVT. Due to their underlying lung disease, physiotherapy was mandatory for improvement. However, the DVT and anticoagulation treatment raised concerns for pulmonary emboli and hemoptysis. A framework for physiotherapy management in these patients, using a set of precautions and restrictions to maintain airway clearance while minimizing risk for pulmonary emboli and hemoptysis, was established. Using these set of instructions, the patients experienced no major adverse event while maintaining sufficient airway clearance to allow respiratory improvement. These precautions were continued until the upper limb DVTs resolved. To our knowledge there are currently no guidelines nor expert opinions available. Therefore, this framework can help guide physiotherapy management.

Background: Group 2 innate lymphoid cells (ILC2s) play a critical role in asthma pathogenesis. Non-steroidal anti-inflammatory drug (NSAID)-exacerbated respiratory disease (NERD) is associated with reduced signaling via EP2, a receptor for prostaglandin E 2 (PGE 2). However, the respective roles for the PGE 2 receptors EP2 and EP4 (both share same downstream signaling) in the regulation of lung ILC2 responses has yet been deciphered. Methods: The roles of PGE 2 receptors EP2 and EP4 on ILC2-mediated lung inflammation were investigated using genetically modified mouse lines and pharmacological approaches in IL-33- and Alternaria alternata (A.A.)-induced lung allergy models. The effects of PGE 2 receptors and downstream signals on ILC2 metabolic activation and effector function were examined using in vitro cell cultures. Results: Deficiency of EP2 rather than EP4 augments IL-33-induced lung ILC2 responses and eosinophilic inflammation in vivo. In contrast, exogenous agonism of EP4 but not EP2 markedly restricts IL-33- and Alternaria alternata-induced lung ILC2 responses and eosinophilic inflammation. Mechanistically, PGE 2 directly suppresses IL-33-dependent ILC2 activation through the EP2/EP4-cAMP pathway, which downregulates STAT5 and MYC pathway gene expression and ILC2 energy metabolism. Blocking glycolysis diminishes IL-33-dependent ILC2 responses in mice lacking endogenous PG synthesis but not in PG-competent mice. Conclusion: We have defined a mechanism for optimal suppression of lung ILC2 responses by endogenous PGE 2-EP2 signaling which underpins the clinical findings of defective EP2 signaling in patients with NERD. Our findings also indicate that exogenously targeting the PGE 2-EP4-cAMP and energy metabolic pathways may provide novel opportunities for treating ILC2-initiated lung inflammation in asthma and NERD.

FeNO levels are not useful either for diagnosis or for evaluating response to treatment. Although, subjects without asthma with FeNO-l ≥ 30 ppb have probability to EoE,

Uremic stomatitis is a rare manifestation associated with longstanding uremia in chronic renal failure patients. Its evolution is favorable with earlier institution of renal replacement therapy. We report a case of hyperkeratotic uremic stomatitis that revealed decompensation of chronic kidney disease.

The thromboembolism (TE) as a complication of nephrotic syndrome (NS) is rare and serious and may involve renal, cerebral, pulmonary, or peripheral venous and/or arterial thrombosis. Here, we describe a 4.5-year-old male with a history of nephrotic syndrome, who developed a hemorrhagic stroke in the territory of middle cerebral artery.

Though the incidence of aneurysms involving the aortic root and/or ascending aorta is common, the combination of aortic root aneurysm and the right atrial clot is extremely rare. No such case is reported in literature till date. This case report presents a 52-year gentleman who came to our emergency department with complaints of breathlessness, abdominal distention, pedal swelling, and decreased urine output with extremely poor general condition. After hemodynamic stabilization and preoperative optimization and workup, he was managed with Bentall procedure with right atrial clot removal. The immediate postoperative course was normal except for deranged liver function tests. The patient was discharged on postoperative day ten.

Spinal Muscular Dystrophy (SMA) is one of the leading causes of death in children from heritable diseases. It is reported that the incidence of SMA is higher in the Saudi population. 4198 healthy volunteers between 18 to 25 years old were included in this study of which (54.7% males vs 45.3% females). Whole blood was spotted from finger pricks onto IsoCode StixTM and genomic DNA was isolated using one triangle from the machine. Carrier frequency and population-level data were used to estimate the prevalence of SMA in the population utilizing the life table method. Results showed the presence of one copy of the SMN1 gene in 108 samples, two copies in 4090 samples, and a carrier frequency of 2.6%. Carrier figurine was twofold in females and 27% of participants were children of first-cousin marriages. The birth incidence of SMA was estimated to be 32 per 100,000 birth and the total number of people living with SMA in KSA to be 2,265 of which 188 are type I, 1,213 are type II, and 864 are type III. The SMA carrier rate of 2.6 % in Saudi subjects is slightly higher than the reported global frequency with links to the consanguineous marriages.

We consider the nonlinear massless wave equation belonging to some family of the Friedmann–Lemaître–Robertson–Walker (FLRW) spacetime. We prove the global in time small data solutions for supercritical powers in the case of decelerating expansion universe.

Introduction: Necrotising otitis externa (NOE) is a serious, progressive infection of the external ear canal. If untreated, it can invade into temporal bone, skull-base and surrounding tissue resulting in cranial nerve palsies, neurological infections and death. Patients present with unremitting, severe otalgia, otorrhoea and oedematous ear canals containing granulation. Surgery has a limited role; the mainstay of treatment involves a long course of intravenous antibiotics. Currently, there is no data on the complications of antibiotic treatment for NOE. This project aims to provide evidence on the nature/frequency of severe treatment-related complications requiring a change in antibiotic regime. Methods: A retrospective 5-year cohort analysis was performed on 64 patients who were treated for confirmed NOE with intravenous antibiotic therapy. Clinical notes, blood results and antibiotic prescriptions were documented and analysed. Results: Average duration of treatment was 11 weeks (range=38 weeks). There was an average of 2.1 antibiotic regimes per patient with 10 cases requiring inpatient admission due to treatment-related complications. 63% of treatment changes were directly related to adverse effects of intravenous antibiotics. Drug allergy/intolerance (n=18) and clinical deterioration i.e. Lack of symptomatic improvement and/or worsening inflammatory markers (n=18), were the most common reasons for antibiotic change. Neutropenia, deranged liver function tests and acute kidney injury were also recognised adverse effects of treatment. Conclusion: This study provides the first evidence on the notable frequency of antibiotic-related complications in NOE patients. Larger, multicentre studies are required in the future to validate our findings and will better inform both clinicians and patients of the risks of treatment.

Background: Cross-reactivity between wheat and other cereals is an essential issue in the management of wheat allergy. Few studies have reported in vitro cross-reactivity in immediate-type wheat allergy. This study aimed to examine cross-reactivity of the three fractions (albumin/globulin, gliadin, and glutenin fractions) among cereals in children with wheat allergy. Methods: Sera from 128 children with immediate-type wheat allergy were collected. We measured specific immunoglobulin E (sIgE) levels against each fraction of wheat, barley, and rye by using an enzyme-linked immunosorbent assay (ELISA). Cross-reactivities of each fraction among wheat, barley, and rye were examined via inhibition ELISA. Results: All subjects were sensitized to all the fractions of wheat, and also those of barley and rye. The wheat sIgE levels were significantly higher than those of barley and rye in all the fractions (p ≤ 0.001) and were significantly correlated with sIgE levels to them in each fraction (r = 0.887–0.969, p < 0.001). On inhibition ELISA, wheat inhibited the IgE binding to most of the solid phases at the lower protein levels compared to barley and rye in all fractions. Conclusions: In children with immediate-type wheat allergy, sensitization to all the three fractions of wheat was observed. In addition, they showed sensitization to barley and rye caused by in vitro cross-reactivity with wheat in each fraction. When managing children with wheat allergy, sensitization to barley and rye caused by the cross-reactivities should be considered.

In \cite{YZ}, the author proved the global existence of the two-dimensional anisotropic quasi-geostrophic equations with condition on the parameters $\alpha,$ $\beta$ in the Sobolev spaces $H^s( \R^2)$; $s\geq 2$. In this paper, we show that this equations has a global solution in the spaces $H^s(\R^2)$, where $\max\{2-2\alpha,2-2\beta\}< s<2$, with additional condition over $\alpha$ and $\beta$. The proof is based on the Gevrey-class regularity of the solution in neighborhood of zero.

This paper deals with a class of fractional Schr\”{o}dinger-Poisson system \[\begin{cases}\displaystyle (-\Delta )^{s}u+V(x)u-K(x)\phi |u|^{2^*_s-3}u=a (x)f(u), &x \in \R^{3}\\ (-\Delta )^{s}\phi=K(x)|u|^{2^*_s-1}, &x \in \R^{3}\end{cases} \]with a critical nonlocal term and multiple competing potentials, which may decay and vanish at infinity, where $s \in (\frac{3}{4},1)$, $ 2^*_s = \frac{6}{3-2s}$ is the fractional critical exponent. The problem is set on the whole space and compactness issues have to be tackled. By employing the mountain pass theorem, concentration-compactness principle and approximation method, the existence of a positive ground state solution is obtained under appropriate assumptions imposed on $V, K, a$ and $f$.

Lycopene content is one of important factor for determining watermelon fruit quality. In this study, a small-type watermelon was grown in a greenhouse with supplementary red lighting 10 h per day after pollination 10 days. The results showed that supplementary red lighting promoted the lycopene accumulation earlier in watermelon flesh than the control. qRT-PCR analysis showed that among the lycopene metabolism pathway genes, ClPSY1 (phytoene synthase) expression increased significantly. Moreover, we identified PHYTOCHROME INTERACTING FACTORS 3 (ClPIF3) and bZIP transcription factor ELONGATED HYPOCOTYL 5 (ClHY5) in watermelon flesh, and red light has opposing effects on ClHY5 and ClPIF3 expression levels. The interaction experiments showed that ClHY5, a potent ClPIF3 antagonist, regulated ClPSY1 expression by directly targeting a common promoter cis-element (G-box). Collectively, our findings unraveled that ClHY5 and ClPIF3 form a dynamic activation-suppression transcriptional module responsive to red light cues to regulate watermelon lycopene accumulation.

Owing to high mixing efficiency, microreactors are used to synthesize uniform BaSO4 nanoparticles, but application in industrial scale is limited due to poor throughput. In this work, a high-throughput passive four-stage asymmetric oscillating feedback microreactor using chaotic mixing mechanism was developed to prepare BaSO4 nanoparticles of high size uniformity. Three-dimensional unsteady simulations showed that chaotic mixing could be induced by three unique secondary flows (i.e., vortex, recirculation, and oscillation), and the fluid oscillation mechanism was examined in detail. Simulations and Villermaux-Dushman experiments indicate that almost complete mixing in molecular level could be achieved when total volumetric flow rate Qtotal was larger than 10 mL/min, and the prepared BaSO4 nanoparticles were with narrow particle size distribution (PSD). Through the adjustment of Qtotal and reactant concentrations, it is easy to control the average size. An average size of 26 nm with narrow PSD could be achieved at Qtotal = 160 mL/min.

We report a case of congenital absence of left atrial appendage in a 68 years old female who was going to proceed a left atrial appendage occlusion for ischemic stroke in whom we observed the absence of left atrial appendage by Real-Time 3D Transesophageal echocardiography (RT 3D TEE).

NADC34-like PRRSV strains were first detected in China in 2017, with epidemic potential. In this study, the phylogenetic, epidemic, and recombinant properties of NADC34-like PRRSV in China were evaluated comprehensively. From 2020 to October 2021, 82 NADC34-like PRRSV isolates were obtained from 433 PRRSV-positive clinical samples. These strains accounted for 11.5% and 28.6% of positives in 2020 and 2021, respectively, and have spread to eight provinces. We selected 15 samples for whole-genome sequencing, revealing genome lengths of 15,009 to 15,113 nt. Phylogenetic analysis revealed that Chinese NADC34-like strains cluster with American sublineage 1.5 strains and do not form an independent branch. Recombination analysis revealed that six of fifteen complete genome sequences derived from recombination between NADC34-like and NADC30-like or HP-PRRSV; they all recombined with local strains in China, exhibiting a complex recombination pattern. Partial Nsp2 sequence alignment showed that nine of fifteen isolates have a continuous 100-aa deletion (similar to IA/2014/NADC34); other isolates have a 131-aa discontinuity deletion (similar to NADC30). Five of them also have additional amino acid deletions, all of which are reported for the first time here. In the last two years, NADC34-like PRRSV has become one of the main epidemic strains in some areas of China; it has changed significantly, its homology has decreased significantly, and it has undergone complex recombination with local Chinese strains. These results are of great significance for understanding the current epidemic situation of PRRSV in China.

Sexual Function after Childbirth: A Meta-analysis base on Mode of DeliveryAbstractBackground: Although many women report sexual dysfunction in the postpartum period, controversial research has been reported the relationship between delivery mode and sexual function.Objectives: This meta-analysis aimed to investigate the sexual function after childbirth and identify the difference of sexual function in women with elective cesarean section and spontaneous vaginal delivery.Search Strategy: Studies were found by searching in Medline, PubMed, Web of Science, Scopus, Google Scholar databases and considering the references of the related papers.Selection Criteria: All observational studies in English that reported the mean and SD of score of sexual function and its domains based on the mode of delivery were included in this meta-analysis.Data Collection and Analysis: Finally, 17 articles with a total population of 3410 were included in the meta-analysis. Random effect model was used to combine the results of included studies on female sexual function and its subdomains.Main Result: The subgroup analysis showed that there were no significant differences in the mean score of sexual function and subdomain among the three delivery groups(P>0.05). However, the mean score of sexual function was significantly differed in the term of time elapsed since delivery (P = 0.04) and studied country (P < 0.001).Conclusions: The result indicated that the mode of delivery are not associated with the female sexual function. As a result, women’s preference for cesarean section to avoid possible impairment of sexual function has gone almost under-questioned.Keywords: Spontaneous vaginal delivery, Episiotomy, Elective cesarean section, Sexual function

Introduction:Depression is a common mental health disorder that is estimated to change the public health of 350 million people worldwide [1]. Also, it is estimated that depression affects 10-15% of all mothers in the postpartum period [2], and even in the case of maternal morbidities, it reaches twice that amount [3].Postpartum depression (PPD) has a notable burden on the infant, partners, and family members, adversely affecting social and marital relationships due to unhealthy lifestyle and sleep patterns [4,5]. PPD is associated with poor mother-infant bonding, which can interfere with the infant’s emotional and cognitive development [6]. Mother with PPD have fewer interactions to respond to infant signals or have more negative emotions toward their infants [7]. PPD is also significantly associated with breastfeeding practice [8]. It is reported that breastfeeding has a bidirectional relationship with PPD [9]. Sufficient studies have indicated that women who were not exclusively breastfed are at higher risk of PPD [10]. In this regard, other studies have reported that PPD might have a negative impact on breastfeeding with decreasing the likelihood of breastfeeding [11] [12]. This study systematically reviewed the literature to find the effect of postnatal depression on exclusive breastfeeding.

Conventional approach of establishing soil conservation strategies in degraded drylands has had negligible success. This has been contributed by many constraints, including; lagging of farmers in technology adoption, inadequate resources, and lack of motivation. Thus, a study was conducted among three agro-pastoral community farmer groups in Korellach Parak, Kapkitony, and Kaporowo villages domiciled in Chepareria ward, West Pokot, Kenya, to assess contributory factors and consequences of adopting terracing as a soil conservation measure. Mixed methods comprising; one-on-one interviews, cross-sectional field measurements, and focus group discussions (FGDs), were used for data collection. Results indicate that the agro-pastoral communities are fully aware of soil degradation and its impacts. Besides terracing, farmers practice stone bands, enclosures, agroforestry, and ridges. Terracing is a recently adopted farm-level soil conservation practice achieved through organized farmer groups dubbed “Kemorokorenyo” (meaning let us reclaim our land) merry-go-round. Within the three villages, 60% of the households have their farms terraced with an average terrace volume of 103.8±21.45m3, 105.89±33.126m3, and 129.6±15.966m3 in Parak Kapkitony and Kaporowo, respectively. Rapid sedimentation of terraces dykes, which contributes to the reduced effectiveness of the terrace system was identified as the major challenge. The sediment volume significantly differs along the slope, with the highest sediment build-up experienced on high slopes as shown by the Kruskal Wallis test; H (2) =6.699, p=0.035. Terrace embankments reinforcement practice to counter sedimentation challenge has faced slow adoption. The poor reinforcement is attributable to the lack of knowledge on suitable local context multipurpose materials to meet the community’s needs.

Background: While enhanced recovery after surgery (ERAS) pathways have been successfully applied for cardiac surgery, there has been limited research directly comparing ERAS protocols to ad hoc narcotic use after surgery. We hypothesized that a standardized ERAS protocol would provide similar pain management and psycho-emotional outcomes while decreasing the use of opioids in the hospital and after discharge. Methods: As part of a 7-month quality improvement project, cardiac surgery patients on a fast tracked to extubate pathway were assigned PRN narcotic pain management for 3 months (n=49). After a 1-month ERAS protocol optimization period, a separate group of patients were given the ERAS protocol (n=34). Clinical outcomes were gathered, and participants completed a quality of recovery survey that allowed for the assessment of pain and symptom control at 4 time-points post-surgery. Results: Among 83 participants, 66% were male and the mean age was 53 years. There were no differences in patient characteristics between PRN and ERAS groups (all p>0.244). There were no differences between ERAS and PRN groups for surgery characteristics (all p>0.060), inpatient outcomes (all p>0.658), or after-discharge outcomes (all p>0.397). Furthermore, across all time-point comparisons, there were no supported differences in patient-reported outcome and pain control between the ERAS and PRN narcotic groups (all p>0.075). Conclusions: An ERAS protocol demonstrated similar patient outcomes and pain control to traditional opioid use for postoperative cardiac surgery patients. Further research is recommended to further confirm the results of this study.

Emergency surgery for Type A Aortic Dissection in Octogenarians – do we still err on the side of caution?

In this paper we will see how by varying the initial conditions of Cantor's Diagonal Argument we can use the method to produce a one-to-one correspondence between the set of natural numbers and the set of infinite binary decimals in the open interval (0, 1). We concede that the initial list of infinite binary decimals is, in fact, incomplete and that the diagonal method does produce a number not contained in the list. Also, we'll agree that there are an infinite number of binary decimal numbers in the interval that aren't in the list. We will see how using the same diagonal method we can create infinitely many binary decimal numbers not initially contained in the interval and that each number we so create will correspond with one and only one natural number.

a) Introduction and objectives Postmortem explanted cardiac implantable electronic devices (CIEDs) from developed countries could provide patients unable to afford new devices in developing countries a treatment they lack nowadays. This study describes the preferences of cardiac electrostimulation specialists from Spain on the management of explanted CIEDs and opinions and concerns regarding reuse in developing countries. b) Methods A nationwide self-administered questionnaire was sent to Spanish members of the XXXX1 (n=1110), between December 2020 and January 2021. c) Results Forty-three responses were obtained (response rate 4%). There was a strong preference to donate explanted devices for reuse in humans (61.9%). The group of age younger than average was more against storing explanted CIEDs (p= 0.014). 57.1% considered it would be beneficial for patients to have a document so they could reflect their wishes regarding device handling after their death. 88.1% indicated that they would strongly agree or to implant postmortem resterilized pacemakers or ICDs (Implantable cardioverter defibrillator) containing >70% of the original battery life in patients who were unable to obtain a new one, the older than average age group was showed more agreement with this statement (p=0.02). The most mentioned concerns were device malfunction (57.1%) and infection (54.8%). d) Conclusions The majority of respondents support reusable CIEDs donation to developing countries. It would be interesting to study the feasibility of a nationwide CIED reutilization programme.