We report a rare case of successful left ventricular restoration of left ventricular hypertrabeculation/noncompaction (LVHT) after Bentall procedure in a patient with severe aortic regurgitation (AR) and aortic root aneurysm. At 1-year follow-up, he remained well with echocardiography showing the improved contractility of the noncompacted left ventricle. This case report emphasize that timely surgical correction of severe AR may also lead to improvement of systolic dysfunction along with concomitant LVHT.

This paper is concerned with the asymptotic stability of global weak and strong solutions for a 3D incompressible functional Brinkman-Forchheimer equation with delay. Under some appropriate assumptions on the external forces especially the averaged state, the well-posedness of 3D functional Brinkman-Forchheimer flow model and its steady state equation have been obtained rstly, then the asymptotic stability of global solutions also derived via the convergence of trajectories for the corresponding systems.

Background: Thromboembolism-associated stroke is the most feared complication of Atrial fibrillation (AF). Percutaneous left atrial appendage closure (pLAAC) is indicated for stroke prevention in patients with AF who can’t tolerate long-term anticoagulation. We aim to study gender differences in peri-procedural and readmissions outcomes in pLAAC patients. Methods: Using the national readmission database from January 2016 to December 2018, AF patients undergoing the pLAAC procedure were identified. We used multivariate logistic regression analyses and time-to-event Cox regression analyses to conduct the study. Propensity matching with the Greedy method was done for the accuracy of results. Result: 28,819 patients were included in our study. Among them 11,946 (41.5%) were women and 16,873 (58.6%) were men. The mean age of overall population was 76.1 ± 8.5 years, with women ~ 1 year older than men. The overall rate of complications was higher in women (8.6% vs 6.6%, P<0.001), primarily driven by bleeding-related complications i.e., Major bleed (OR: 1.32 95% CI: 1.03-1.69, p=0.029), blood transfusion (OR: 1.45, 95% CI: 1.06-1.97, p=0.019) and cardiac tamponade (OR: 1.80, 95% CI: 1.13-2.89, p=0.014). Women had two times higher peri-procedural ischemic stroke. There was no difference in peri-procedural mortality. Women remained at 20% and 13% higher risk for readmission at 30 days and 6 months of discharge. Conclusion: Women had higher peri-procedural complications and were at higher risk of readmissions at 30 days and six months. However, there was no difference in mortality during the index hospitalization. Further studies are necessary to determine causality.

Harvesting can magnify the destabilizing effects of environmental perturbations on population dynamics and, thereby, increase extinction risk. However, population-dynamic theory predicts that impacts of harvesting depend on the type and strength of density-dependent regulation. Here, we used logistic population growth models and an empirical reindeer case study to show that low to moderate harvesting can actually buffer populations against environmental perturbations. This occurs because of density-dependent environmental stochasticity, where negative environmental impacts on vital rates are amplified at high population density due to intraspecific resource competition. Simulations from our population models show that even low levels of harvesting may prevent overabundance, thereby dampening population fluctuations and reducing the risk of population collapse and quasi-extinction following environmental perturbations. Thus, depending on the species' life history and the strength of density-dependent environmental drivers, low to moderate harvesting can improve population resistance to increased climate variability and extreme weather expected under global warming.

The ongoing explosion of fine-resolution movement data in animal systems provides a unique opportunity to empirically quantify spatial, temporal, and individual variation in transmission risk and improve our ability to forecast disease outbreaks. However, we lack a generalizable framework that can leverage movement data to quantify transmission risk and how it affects pathogen invasion and persistence on heterogeneous landscapes. We developed a flexible framework “Movement-driven modeling of spatio-temporal infection risk” (MoveSTIR) that leverages diverse data on animal movement to derive metrics of direct and indirect contact by decomposing transmission into constituent processes of contact formation and duration and pathogen deposition and acquisition. We use MoveSTIR to demonstrate that ignoring fine-scale animal movements on actual landscapes can mis-characterize transmission risk and epidemiological dynamics. MoveSTIR unifies previous work on epidemiological contact networks and can address applied and theoretical questions at the nexus of movement and disease ecology.

In this paper, we investigate the global well-posedness of the system of incompressible viscous non-resistive MHD fluids in a three-dimensional horizontally infinite slab with finite height. We reformulate our analysis to Lagrangian coordinates, and then develop a new mathematical approach to establish global well-posedness of the MHD system, which requires no nonlinear compatibility conditions on the initial data.

In this paper we consider a viscoelastic double-Kirchhoff type wave equation of the form $$ u_{tt}-M_{1}(\|\nabla u\|^{2})\Delta u-M_{2}(\|\nabla u\|_{p(x)})\Delta_{p(x)}u+(g\ast\Delta u)(x,t)+\sigma(\|\nabla u\|^{2})h(u_{t})=\phi(u), $$ where the functions $M_{1},M_{2}$ and $\sigma, \phi$ are real valued functions and $(g\ast\nabla u)(x,t)$ is the viscoelastic term which are introduced later. Under appropriate conditions for the data and exponents, the general decay result and blow-up of solutions are proved with positive initial energy. This study extends and improves the previous results in the literature to viscoelastic double-Kirchhoff type equation with degenerate nonlocal damping and variable-exponent nonlinearities.

Bacteria in the human gut contend with numerous fluctuating environmental variables, including bouts of extreme selective agents like antibiotics. Theory predicts that oscillations in the adaptive landscape can impose balancing selection on bacterial populations, leaving characteristic signatures in the sequence variation of functionally significant genomic loci. Despite their potential importance for gut bacterial adaptation, the metagenomic targets of balancing selection have not been identified. Here, I present population genetic evidence that balancing selection maintains allelic diversity in multidrug efflux pumps of multiple predominant bacterial species in the human gut metagenome. Metagenome wide scans of 566,958 core open reading frames (CORFs) from 287 bacterial species represented by 118,617 metagenome assembled genomes (MAGs) indicated that most CORFs have been conserved by purifying selection. However, dozens of CORFs displayed positive Tajima’s D values that deviated significantly from their species’ genomic backgrounds, indicating the action of balancing selection. The AcrB subunit of a multidrug efflux pump (MEP) in Bacteroides dorei displayed the highest Tajima’s D of any CORF, and AcrB and other MEPs from a diversity of bacterial species were significantly enriched among the CORFs with the highest Tajima’s D values. Crystal structures indicated that the regions under balancing selection bind tetracycline and macrolide antibiotics. Other proteins identified as targets of balancing selection included synthases, hydrolases, and ion transporters. Intriguingly, bacterial species experiencing balancing selection were the most abundant in the human gut based on metagenomic data, further suggesting fitness benefits of the allelic variation identified.

Aims: The MicraTM transcatheter pacing system (TPS) (Medtronic) is the only leadless pacemaker that promotes atrioventricular (AV) synchrony via accelerometer-based atrial sensing. Data regarding the real-world experience with this novel system are currently lacking. We sought to characterize patients undergoing MicraTM -AV implants, describe percentage AV synchrony achieved, and analyze the causes for suboptimal AV synchrony. Methods: In this retrospective cohort study, electronic medical records from 56 consecutive patients undergoing MicraTM -AV implants at the Mayo Clinic sites in Minnesota, Florida, and Arizona with a minimum follow-up of 3 months were reviewed. Demographic data, comorbidities, echocardiographic data, and clinical outcomes were compared among patients with and without atrial synchronous-ventricular pacing (AsVP) ≥70%. Results: Fifty-six percent of patients achieved AsVP ≥70%. Patients with adequate AsVP had smaller body mass indices, a lower proportion of congestive heart failure and pulmonary hypertension. Echocardiographic parameters and procedural characteristics were similar across the two groups. Active device troubleshooting was associated with higher AsVP. The likely reasons for low AsVP were persistent atrial arrhythmias, small A4-wave amplitude, and inadequate device reprogramming. Importantly, in patients with low AsVP, subjective clinical worsening was not noted during follow-up. Conclusion: With the increasing popularity of leadless PM, it is paramount for device implanting teams to be familiar with common predictors of AV synchrony and troubleshooting with MicraTM -AV devices.

Globally, there is an increasing demand for sources of plant-based protein. While Brassica napus L. is an important oilseed crop worldwide, there is also interest in improving its ability to serve as a valuable source of plant-based protein. Cruciferin, a seed storage protein that makes up 60% of the protein found in mature seeds of B. napus, is of interest for human consumption as a source of protein and as an ingredient in food products due to its functional properties. Existing methods for quantification of cruciferin protein are often time consuming and destroy the seed. This study explored the potential for the measurement of cruciferin protein content in whole seeds of B. napus by near-infrared spectroscopy (NIRS), to allow for efficient and non-destructive screening of breeding material. An enzyme-linked immunosorbent assay (ELISA)-based reference method was utilized to assess cruciferin content in a diverse population of B. napus. Scanning of whole seed samples produced spectra that were used to develop NIRS calibration equations. Statistical analysis of the calibration results indicated that the NIRS equations developed are poorly suited for prediction of cruciferin content.

Rivers provide excellent models to understand how species diversity is generated and maintained across heterogeneous habitats. The lower Congo River (LCR) consists of a dynamic hydroscape exhibiting extraordinary aquatic biodiversity, endemicity, and ecological specialization. Previous studies have suggested that the numerous high-energy rapids throughout the LCR form physical barriers to gene flow, thus facilitating diversification and speciation, and generating ichthyofaunal diversity. However, this hypothesis has not been fully explored using genome-wide SNPs for fish species distributed across the LCR. In this study, we examined four species of lamprologine cichlids endemic to the LCR, of which three are sequentially distributed along the LCR without range overlap. Using genome-wide SNP data, we tested the hypotheses that high-energy rapids serve as physical barriers to gene flow that generate genetic divergence at inter- and intraspecific levels, and that gene flow occurs primarily in a downstream direction. Our results are consistent with the prediction that the rapids sometimes serve to reduce gene flow, but also suggest that at certain temporal and spatial scales, they may also act as promoters of gene flow. Furthermore, we detected both upstream and downstream gene flow between some populations of Lamprologus tigripictilis as well as hybridization between congeneric species. These results suggest that powerful high-energy rapids may therefore provide occasional multidirectional dispersal opportunities for riverine cichlid fishes, highlighting the complexity of factors driving evolutionary processes in the LCR.

The use of organic solvents to remove SO2 from flue gas has the advantages of low investment cost, convenient operation, high efficiency, and reusability. We prepared three absorbents in this paper, namely tetraethylenetetramine (TETA), triethylenetetramine /triethylene glycol dimethyl ether (TriEDGME), and triethylenetetramine/triethylene glycol dimethyl ether/H2O. The atmospheric bubbling method absorbs SO2. The experimental results show that the three kinds of absorbents formed white precipitates after adsorbing SO2. The infrared spectra analysis and element analysis of the three types of precipitate showed that their chemical structures were basically the same. The structural formula is NH2(CH2)2NH(CH2)2NH3SO3NH2·2H2O; the product was determined to be a shaped crystal structure by XRD and SEM. In addition, the thermal stability analysis of the product revealed that the product sublimed at 123 °C and decomposed at about 185 °C.

Porcine Deltacoronavirus is a newly emergent enteric pathogen affecting swine farms worldwide. It has been detected in several countries in Europe, Asia and North America; yet, it has not been reported in South America. In November 2019, an enteric disease outbreak in a pig farm located in San Martin, Peru; was reported along with submission of three intestinal samples from pigs who succumbed to the disease. Samples were processed for molecular detection by qRT-PCR, viral isolation and further sequencing analysis. A taqman-based RT-PCR was performed to differentiate among the most relevant swine enteric coronaviruses described to date. All samples were positive to Porcine Deltacoronavirus with a cycle threshold (Ct) value between 9-14, revealing a high viral load, while testing negative to Porcine Epidemic diarrhea and Transmissible Gastroenteritis viruses. Following detection, viral isolation was performed using PK-15 and Vero cell lines. After 5 days of inoculation, no cytopathic effect was observed. A second blind passage allowed the observation of cytopathic effect on PK-15 cells, while it remained absent in Vero cells. A fluorescence test using an anti-N monoclonal antibody confirmed viral replication. One sample was processed for whole genome sequencing (NGS). In short, raw reads were imported into CLC genomics and assembled de novo. Out of 479k reads generated from the sample, 436k assembled into a 25501 bp contig which was 99.5% identical to a reference Porcine Deltacoronavirus strain from US within the North American phylogroup. Yet, there are relevant differences at the nucleotide and amino acid levels compared to previously described Porcine Deltacoronavirus strains. Altogether, our findings represent the first report of Porcine Deltacoronavirus in South America, its genomic characterization, which provides information of its evolutionary origin. Thus, this study offers new insights into the molecular epidemiology of Porcine Deltacoronavirus infections in the swine industry.

Introduction: Left atrial posterior wall isolation (LAPWI) is often performed in addition to pulmonary vein isolation (PVI) to improve outcome in patients with persistent atrial fibrillation (AF). In this setting, LAPWI + PVI using cryoballoon ablation had comparable results with radiofrequency ablation (RFA). The aim of the study is to evaluate the feasibility and safety of a new cryoballoon ablation system in PVI + LAPWI isolation, comparing it with the historical platform. Methods: The study was a prospective, non-randomized, single center study. Forty consecutive patients, undergoing PVI + LAPWI with the novel POLARx™, were compared to 40 consecutive patients who underwent the same procedure with the established Arctic Front Advance PRO™. Results: Acute isolation was achieved in all PVs in both groups and LAPWI was achieved in 38 patients (95%) in the POLARx group and in 36 patients (90%) in Arctic Front group. Procedural outcomes were similar between the two groups, except for lower temperatures during cryoapplications in the POLARx group, for both PVI and LAPWI. The complication rate was low and similar between groups. Conclusion: LAPWI+PVI with the novel POLARx™ Cryoballoon is feasible and safe; the results are comparable with the Arctic Front Advance PRO™ system.

It is important to give parents accurate information about complication rates as part of the process of informed consent for surgery.  National, routinely-collected data give an opportunity to estimate the rates of rare adverse events such as bleeding, blood transfusion and death.We reviewed data for all Scottish NHS hospitals over the time period 2000-2018 to identify all children (aged 0-16 years) undergoing tonsillectomy, and to identify adverse events occurring within 30 days of the procedure.Readmission to hospital was required in 2%.Surgical arrest of haemorrhage was required in 1%.Blood transfusion occurred in 0.1% and death occurred in one child out of 50,194.

Obstetric anal sphincter injury by maternal origin and length of residence: a letterIt gives us great pleasure to read the study entitled “Obstetric anal sphincter injury (OASI) by maternal origin and length of residence: a nation-wide cohort study” by Sorbye and Bains et al1. We appreciate the authors for conducting a large scale multicentric cohort study on this newer aspect of OASI. However, we wish to make certain observations to further help in comprehending the results.Firstly, the eligibility criteria for the recruitment of participants needs clarification as to why foreign-born women with Norwegian-born parents were excluded from enrolment. Keeping them as a separate group could have been beneficial in assessing whether environmental factors due to migrating out of Norway had an impact on the incidence of OASI. Futhermore, the greater odds of OASI among women with foreign-born partners has to be digested with a pinch of salt. A subgroup analysis comparing the newborn birth weight (NBW) and head circumference (HC) could be instrumental in solving this dilemma. Prior studies by Vik et al from Norway had demonstrated similar outcomes in neonatal survival as well2. In the absence of significant difference in NBW and HC, social issues need due consideration. It probably opens up the arena for potential future research in this very field.The study does mention that the mean HC of newborns to foreign-born women with OASI did not differ from Norwegian-born counterparts without OASI. But the p value mentioned alongside in the text is 0.000, which would amount to high significance. This area needs clarification.Table 3 has stratified the association between OASI and the length of residence in Norway. We appreciate this robust comparison as this outcome was vital in hypothesizing the impact of environment and lifestyles on the incidence of OASI. But, it is quite strange to note that women who had childbirth before their lawful residence (probably had immigrated recently) had lesser odds of OASI compared to those who had legal residence upto 4 years. Discrete analysis of this subgroup of patients might give us a better comprehension. Another analysis which can be done is to assess whether the place of delivery (government or private setup) was significantly affecting the prevalence of OASI. It can be thought of as an auxiliary outcome. This will ultimately help in addressing the barriers to optimal utilization of resources and will probably stimulate the health care policy to achieve equitable care across the nation.References:Sorbye IK, Bains S, Vangen S, Sundby J, Lindskog B, Owe KM. Obstetric anal sphincter injury by maternal origin and length of residence: a nation-wide cohort study. BJOG. 2021 Oct 28. doi: 10.1111/1471-0528.16985. Epub ahead of print. PMID: 34710268.Vik ES, Aasheim V, Nilsen RM, Small R, Moster D, Schytt E. Paternal country of origin and adverse neonatal outcomes in births to foreign-born women in Norway: A population-based cohort study. PLoS Med. 2020 Nov;17(11):e1003395.

The sacroiliac joint is rarely affected by tuberculosis. Only few cases have been reported. Consequently, the diagnosis is often delayed. This case report highlights the importance of continued awareness for early detection and treatment of a tuberculous sacroiliac joint infection.

This paper offers a critique of UK government policy based on mode of transmission of SARS-CoV-2 (which in turn followed misleading advice from the World Health Organisation) through the lens of policymaking as narrative. Two flawed narratives—“Covid is droplet- not airborne-spread” and “Covid is situationally airborne” (that is, airborne transmission is unusual but may occur during aerosol-generating medical procedures and severe indoor crowding)—quickly became dominant despite no evidence to support them. Two important counter-narratives—“Covid is unequivocally airborne” and “Everyone generates aerosols; everyone is vulnerable”— were sidelined despite strong evidence to support them. Tragic consequences of the flawed policy narrative unfolded as social dramas. For example, droplet precautions became ritualised; care home residents died in their thousands; public masking became a libertarian lightning rod; and healthcare settings became occupational health battlegrounds. In a discussion, we call for bold action to ensure that the science of SARS-CoV-2 transmission is freed from the shackles of historical errors, scientific vested interests, ideological manipulation and policy satisficing.

Passive collection is an emerging sampling method for environmental DNA (eDNA) in aquatic systems. Passive eDNA collection is inexpensive, efficient, and requires minimal equipment, making it suited to high density sampling and remote deployment. Here, we compare the effectiveness of nine membrane materials for passively collecting fish eDNA from a 3 million litre marine mesocosm. We submerged materials (cellulose, cellulose with 1% and 3% chitosan, cellulose overlayed with electrospun nanofibers and 1% chitosan, cotton fibres, hemp fibres and sponge with either zeolite or active carbon) for intervals between five and 1080 minutes. We show that for most materials, with as little as five minutes submersion, mitochondrial fish eDNA measured with qPCR, and fish species richness measured with metabarcoding, was comparable to that collected by conventional filtering. Furthermore, PCR template DNA concentrations and species richness were generally not improved significantly by longer submersion. Species richness detected for all materials ranged between 11 to 37 species, with a median of 27, which was comparable to the range for filtered eDNA (19-32). Using scanning electron microscopy, we visualised biological matter adhered to the surface of materials, rather than entrapped, with images also revealing a diversity in size and structure of putative eDNA particles. Environmental DNA can be collected rapidly from seawater with a passive approach and using a variety of materials. This will suit cost and time-sensitive biological surveys, and where access to equipment is limited.

Lingual thyroglossal duct cysts can be a rare cause of feeding difficulties in infants. Here, we describe a case of an undiagnosed lingual thyroglossal duct cyst in an infant with vomiting and feeding difficulty, who underwent surgery for Hirschsprung's disease and had an unexpected difficult airway during anesthesia induction.

Background His-Purkinje system pacing(HPSP) combined with atrioventricular node (AVN) ablation is an effective therapy for atrial fibrillation (AF) patients with heart failure (HF).However, AVN ablation is accompanied with some limitations and disadvantages. HPSP combined with β -blocker reduces inherent heart rate and increases pacing ratio, which may be an alternative to HPSP combined with AVN ablation. This study was to assess the therapeutic effect of different His-Purkinje system pacing proportions on AF patients with HF. Methods The study enrolled 30 consecutive persistent AF patients with HF who underwent HPSP. Heart rate was controlled by medical therapy. New York Heart Association (NYHA) classification, serum NT-proBNP concentration, echocardiographic parameters were assessed at each follow-up. Results The best cut-off value of pacing proportion to predict MACE by ROC analysis was 71%. In high pacing proportion group, there were significant improvements of NYHA classification, NT-proBNP concentration, LVEF and LVEDD from the baseline in wide QRS complex patients and HFrEF patients, and there were significant improvements in NYHA classification, NT-proBNP concentration from baseline in narrow QRS complex patients and HFpEF patients, moderate but no significant improvements of LVEF and LVEDD were observed in those patients groups. In low pacing proportion group, there were no significant improvements of NT-proBNP concentration, LVEDD or LVEF regardless of baseline QRS duration or LVEF (P > 0.05). Conclusion High pacing proportion of HPSP has a beneficial effect on the prognosis of persistent AF patients with heart failure.

Background Estimates of the disease burden associated with different respiratory viruses are severely limited in low- and middle-income countries, especially in Africa. Methods We estimated age-specific numbers and rates of medically and non-medically attended influenza-like illness (ILI) and severe respiratory illness (SRI) that were associated with influenza, respiratory syncytial virus (RSV), rhinovirus, human metapneumovirus, adenovirus, enterovirus and parainfluenza virus types 1-3 after adjusting for the attributable fraction (AF) of virus detection to illness in South Africa during 2013-2015. Rates were reported per 100,000 population. Results The mean annual rates were 51,383 and 4,196 for ILI and SRI, respectively. Of these, 26% (for ILI) and 46% (for SRI) were medically attended. Among outpatients with ILI, rhinovirus had the highest AF-adjusted rate (7,221), followed by influenza (6,443) and adenovirus (1,364); whereas, among inpatients with SRI, rhinovirus had the highest AF-adjusted rate (400), followed by RSV (247) and influenza (130). Rhinovirus (9,424) and RSV (2,026) had the highest AF-adjusted rates among children aged <5 years with ILI or SRI, respectively; whereas rhinovirus (757) and influenza (306) had the highest AF-adjusted rates among individuals aged ≥65 years with ILI or SRI, respectively Conclusions There was a substantial burden of ILI and SRI in South Africa during 2013-2015. Rhinovirus and influenza had a prominent disease burden among patients with ILI. Rhinovirus had the highest burden of illness among patients of any age with SRI, followed by RSV. RSV and influenza were the most prominent causes of SRI in children and the elderly, respectively.

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Nurunnahar Akter,a Elena Kulinskaya,a Nicholas Steel,b Ilyas Bakbergenulya a School of Computing Sciences, University of East Anglia, Norwich, UKb Norwich Medical School, University of East Anglia, Norwich, UKCorrespondence: Nurunnahar Akter, School of Computing Sciences, University of East Anglia, Norwich Research Park, Norwich, NR4 7TJ, UK. Email: n.akter@uea.ac.ukRunning title: HRT and its impact on all-cause mortality.