In this paper, we obtain the stationary elliptic- and hyperbolic-function solutions of the nonlocal reverse-time and reverse-space-time nonlinear Schrödinger (NLS) equations based on their connection with the standard Weierstrass elliptic equation. The reverse-time NLS equation possesses the bounded dn-, cn-, sn-, sech-, and tanh-function solutions. Of special interest, the tanh-function solution can display both the dark- and antidark-soliton profiles. The reverse-space-time NLS equation admits the general Jacobian elliptic-function solutions (which are exponentially growing at one infinity or display the periodical oscillation in x), the bounded dn- and cn-function solutions, as well as the K-shifted dn- and sn-function solutions. At the degeneration, the hyperbolic-function solutions may exhibit an exponential growth behavior at one infinity, or show the gray- and bright-soliton profiles.

Lipoma arborescens is a benign intra-articular tumor characterized by joint effusions, pain and reduced range of motion. It is rare in adults and children. We present a case of Lipoma arborescens in a 16 year old male. The work up involved plain radiographs, MRI, incisional biopsy and laboratory analysis.

We report a child with persistently low SpO2 with delayed diagnosis due to the co-existing CPAM with possible AVM. The diagnosis was only achieved after low SpO2 incidentally discovered from the child's father. The eventual cause was Haemoglobin I-Toulouse, making both patients the first reported cases with low SpO2.

The increasing pressure on water resources demands integrated multidisciplinary approaches to deal with environmental, scientific, and social issues related to water availability in watersheds. In large watersheds, many factors control hydrological processes, requiring the application of a methodology capable of describing water dynamics in complex situations. This study uses stable isotope (2H and 18O) modeling to characterize groundwater contribution in an area of heterogeneous hydrogeological framework and advanced anthropization, located in the Piracicaba-Capivari-Jundiaí (PCJ) and Tietê-Jacaré (TJ) water management units – central-eastern portion of the State of São Paulo, Brazil. Groundwater dynamics is controlled by the direct interaction of the rainfall regime with hydrogeological domains. The modeling performed in this study indicates that a portion ranging from 60 to 80% of the total volume of streamflow comes from groundwater discharge (for studied year). However, in the crystalline domain, the aquifer capacity of storing surplus water is smaller, increasing the importance of rainfall for the generation of direct runoff and maintenance of the streamflow. In most of the PCJ unit, there is a greater dependence on surface water and vulnerability to prolonged droughts. On the other hand, in the sedimentary areas, the contribution of groundwater discharge is around 80%, showing that the aquifer storage capacity guarantees homogenization of the discharge throughout the year, and ensures water security in drought periods. This study attests to the successful application of stable isotope modeling to large basins, as the method is able to describe natural hydrological processes occurring in watersheds with a heterogeneous hydrogeological framework and the effects of the anthropogenic action. It is concluded that the use of stable isotopes can aid water resources management in expanding the capacity of monitoring surface and groundwater resources to identify negative effects on water availability.

We report the first published case of a mucocele found in a pneumatized pterygoid process (PPP) managed by endonasal endoscopic surgery. This case report highlights the difficulties that can arise from PPP during functional endoscopic sinus surgery (FESS) as the one encountered here

Understanding drivers of disease vectors’ population dynamics is a pressing challenge for human health, however, for short-lived organisms like mosquitoes, landscape-scale models must account for the highly local and rapid scale of their life cycle. Aedes aegypti, a vector of multiple emerging diseases, has been increasing in abundance in desert population centers, where water from precipitation could be a limiting factor. To explain this apparent paradox, we examined daily precipitation and Ae. aegypti abundances at >660 trapping locations per year for 3 years in the urbanized Maricopa County (metropolitan Phoenix), Arizona, USA. Through kriging of weather station data, we connected daily precipitation to subsequent trapped abundances of mosquitoes, and determined the timing and amount of precipitation that result in thresholds of interference with mosquito abundance. Large rainfall events resulted in no trapped mosquitoes 6-8 and 13-14 days later, while 10% of all mosquitoes were trapped in long, precipitation-free periods.

Hospital administrations and providers are more than ever in need for new technologies and innovative methods with clinical benefit at lower costs. Surgeons and clinicians depend on conventional risk stratification scores developed to allow physicians to establish the risk of perioperative mortality. However, the current practiced models of preventive cardiology largely depend on patient motivation and awareness to be able to apply such risk scores appropriately. It was not until the appearance of miniaturized pocket-sized, user-friendly digital technologies that the awareness started to grow, highlighting the importance of role of technology and artificial intelligence (AI) in modern day medicine.

Case reportWe report the case of a 77-year-old man affected by type II diabetes, arterial hypertension, and dyslipidaemia. At age 56 years he underwent cardiac surgery for aortic valve endocarditis due to streptococcus started from a dental abscess. The aortic root replacement was performed, and a 27 mm homograft was implanted. At age 69 years he presented a recurrence of endocarditis on the homograft, causing severe valve regurgitation. At that time the isolated bacterium was an Enterococcus faecalis ,  started from diverticulosis. Despite optimal medical therapy based on gentamicin, ceftriaxone, and vancomycin, he did not improve, and due to worsening clinical conditions, the patient was transferred to our department for surgery.The clinical examination observed a temperature of 38,5°C, dyspnoea at rest, and sinus tachycardia. Transthoracic echocardiography (TTE) revealed a 9 mm vegetation on the homograft with severe aortic valve regurgitation. Urgent surgery was performed; the aortic prosthesis was resected, the infective tissue removed and the Perceval bioprosthesis (Livanova Group S.p.A., Saluggia,Italy) XLwas implanted.The Cross-Clamp time was 35 minutes with a total cardiopulmonary bypass (CPB) time of 73 minutes. The post-operative transesophageal echocardiogram (TEE) showed good results without paravalvular leaks. The ICU stay was 4 days, and the total hospital stay was 19 days. The patient was periodically controlled with regular echocardiographic analysis.At the moment, the patient lives with his wife. He is in good clinical condition, with NYHA functional class I, and no other symptoms are reported. The last TTE shows a mean transprosthesis gradient of 12 mmHg (Fig.1) without paravalvular leaks and normal ejection fraction (57%), no infective or embolic episodes were reported during the 7 years and three months follow-up time.

Eosinophilic pustular folliculitis (EPF) of infancy (EPFI), as a rare variant of EPF, is an inflammatory dermatosis characterized by recurrent outbreaks, itchy papulopustules and involvement of scalp and other body areas. In our case, we present a 3-month-old boy with persistent itchy vesiculopustular rashes on the scalp, hands and feet, eosinophilia in the peripheral blood test, widespread eosinophil clusters in the swab of the pustule and egg allergy in the skin prick test. This is the first case of EPFI associated with food allergy that is permanently suppressed by elimination diet with the limited use of cetirizine.

The authors declare no conflicts of interest.Financial Support: Japan Society for the Promotion of Science 19K08299Keywords: Patients with Hermansky–Pudlak syndrome, Pulmonary fibrosis,AP3B1 mutation, Hemophagocytic lymphohistiocytosis, NeonatalTo the Editor,Hermansky–Pudlak syndrome (HPS) is an inherited disorder characterized by albinism of the oculocutaneous region and hemorrhagic disease. Eleven genes causative of HPS have been identified, and the clinical phenotypes of the condition differ depending on which gene is affected. HPS type 2 (HPS2) is an autosomal recessive inherited disease caused by mutations in AP3B1 , resulting in pulmonary fibrosis (PF) and immunodeficiency1. Patients with HPS2 also have neutropenia and decreased NK cell cytotoxicity, which can lead to hemophagocytic lymphohistiocytosis (HLH); however, the total number of HPS2 cases reported was less than 40 as of March 20211, making it difficult to accurately assess the risk of HLH associated with this disease. In addition, although PF occurs earlier in HPS2 than in other types of HPS, HPS2 with PF in the neonatal period has never been reported. Here, we report a case of HPS2 with neonatal PF harboring mutations in both AP3B1 alleles, one of which is novel.The patient is female, the second child of a non-consanguineous marriage, and was born at 39 weeks 4 days (birth weight, 3798 g) by spontaneous vaginal delivery. Apgar score was 9 at 1 minute; however, respiratory failure gradually developed, resulting in endotracheal intubation and mechanical ventilation. At 20 hours after birth, a right tension pneumothorax developed, which required thoracentesis, thoracic drainage, and nitric oxide inhalation therapy. A computerized tomography scan at 6 days of age revealed PF (Fig. 1). Septic workup, including blood and throat swabs, was negative. Respiratory distress syndrome was less likely due to term delivery; therefore, we suspected hereditary interstitial lung disease and tested the SFTPB , SFTPC ,ABCA3 , FOXF1 , NKX2.1 , GATA2 , CSF2RA , and CSF2RB genes, all of which were negative2. Since she had albinism, we performed genetic analysis of 22 albinism-related genes, which revealed two heterozygous variants inAP3B1 : c.1122_1123insAG (p.Phe375fs*) and c.2546T>A (p.Leu849Ter). The former variant is a novel frameshift mutation, and the latter is a nonsense mutation that was recently reported as the causative mutation in a patient with HPS2 in Japan3. Neither variant is recorded in the Exome Aggregation Consortium (ExAC, http://exac.broadinstitute.org/) database, and both are considered pathological. Each parent carried one of the variants; therefore, we diagnosed the patient with HPS2 caused by AP3B1 mutations. The patient also suffered from mitral regurgitation, which did not require additional medication.The patient’s respiratory condition improved, and she was discharged from hospital at 190 days of age, with the introduction of home oxygen therapy. At 9 months old, she was hospitalized due to HLH. Physical examination revealed no abnormal findings, other than pharyngeal injection and slight fever. Laboratory tests showed thrombocytopenia, with platelets 3.0 × 104/μL and white blood cell count 1100/μL (2.8% neutrophils). Ferritin was not raised; however, soluble IL2 receptor levels were elevated at 7469 U/mL. Bone marrow examination showed evidence of hemophagocytosis. CD107a expression was decreased in CD3–CD56+ NK cells compared with control NK cells, detected as previously described4, suggesting a decrease in cytotoxic degranulation (Fig. 2). Blood samples were negative for Epstein–Barr virus, cytomegalovirus, and human parvovirus B12. The patient was diagnosed with HLH associated with viral infection. A primary immunodeficiency gene panel, comprising approximately 400 genes, was evaluated; no mutations in PFR1 ,UNC13D , STX11 , STXBP2 , RAB27A , orLYST were detected. She was treated with dexamethasone (10 mg/m2/day) and immunoglobulin (2.5 g/dose), with good clinical response. We started G-CSF for continuous neutropenia after recovery from HLH. She had another episode of fever with thrombocytopenia due to viral infections at the age of 1 year 9 months.Among the primary immunodeficiency diseases affecting cytotoxic granules, patients with hereditary granulopathies, such as Chediak–Higashi and Griscelli syndrome type 2, are at high risk of severe HLH, and early hemopoietic stem cell transplantation (HSCT) is a treatment option5. By contrast, complication of HLH occurs less frequently in HPS2, although there is a risk of developing HLH in some patients with the condition. Jessen et al. reported that the risk of developing HLH was relatively low in a mouse HPS2 model affecting Ap3b1 (the pearl mouse)6, which is compatible with reports regarding patients with HPS2; however, Dell’Acqua et al. cautioned of the risk of HLH in HPS2, in their report of a case with lethal HLH7.Further delineation of genotype–phenotype correlations betweenAP3B1 mutations and complication of HLH indicated that truncating mutations, rather than non-truncating changes such as missense mutations, may be associated with a higher risk of developing HLH, which is consistent with our case having nonsense and frameshift mutations inAP3B1. Regarding genotype–phenotype correlation of PF in HPS2, 17 of 37 cases are reported to have developed PF, all of which had homozygous or compound heterozygous truncating mutations. The lack of missense mutations among HPS2 cases with HLH and/or PF suggests that missense variants may be less pathogenic, in terms of HLH and PF. It will be necessary to accumulate additional cases of HPS2 and follow their clinical courses in detail to understand these genotype–phenotype correlations more precisely.To the best of our knowledge, this is the first case of HPS2 with PF observed in the neonatal period. Among types of HPS, PF occurs mainly in HPS1, HPS2, and HPS4. In HPS1 (the most frequent type), 100% of patients develop PF in their thirties or forties8. Hengst et al. reported six cases of HPS2 with PF, with a mean age of 8.8 years, respiratory symptoms 3.3 years before diagnosis, and a minimum age of 0.8 years9. It has not previously been reported that patients with HPS2 suffer from mitral regurgitation, which may contribute to early onset of PF. In any case, the onset of PF in our case is the earliest recorded to date, and suggests that neonatologists should consider HPS2 as a diagnosis for neonates presenting with PF and albinism.In conclusion, we report a case of HPS2 with neonatal-onset PF and an episode of HLH, caused by truncating compound heterozygous mutations of AP3B1 . Clinicians should be aware of the importance of accurate genetic analysis of AP3B1 to evaluate the severity of clinical phenotypes, particularly the onset of PF and morbidity from HLH.Keigo Matusyuki1Mizuki Ide1Keishirou Houjou1Saho Shima1Seiji Tanaka1Yoriko Watanabe1Tomoko Egashira2Hiroyuki Tomino2Toshimitsu Takayanagi2Tashiro Katsuya3Ken Okamura4Tamio Suzuki4Ryuta Nishikomori11Department of Pediatrics and Child Health, Kurume University School of MedicineKurume, Fukuoka, Japan2National Hospital Organization Saga National HospitalSaga, Saga, Japan3Karatsu Red Cross HospitalKaratu, Saga, Japan4Department of Dermatology, Faculty of Medicine, Yamagata UniversityYamagata, Yamagata, JapanAcknowledgmentsWe thank Ms. Ohhinata for technical assistance.Key Message: Hermansky–Pudlak Syndrome type2 can develop pulmonary fibrosis in the neonatal periodReferences1. Huizing M, Malicdan M, Gochuico B, Gahl W. Hermansky-Pudlak Syndrome.GeneReviews 2000; https://www.ncbi.nlm.nih.gov/books/NBK1287/, may 2021.2. Okamura K, Hayashi M, Abe Y, et al. NGS-based targeted resequencing identified rare subtypes of albinism: Providing accurate molecular diagnosis for Japanese patients with albinism. Pigment Cell Melanoma Res. 2019;32(6):848-853.3. Nishikawa T, Okamura K, Moriyama M, et al. Novel AP3B1 compound heterozygous mutations in a Japanese patient with Hermansky-Pudlak syndrome type 2. J Dermatol. 2020;47(2):185-189.4. Shibata H, Yasumi T, Shimodera S, et al. Human CTL-based functional analysis shows the reliability of a munc13-4 protein expression assay for FHL3 diagnosis. Blood. 2018;131(18):2016-2025.5. Sharma P, Nicoli ER, Serra-Vinardell J, et al. Chediak-Higashi syndrome: a review of the past, present, and future. Drug Discov Today Dis Models. 2020;31:31-36.6. Jessen B, Bode SF, Ammann S, et al. The risk of hemophagocytic lymphohistiocytosis in Hermansky-Pudlak syndrome type 2. Blood.2013;121(15):2943-2951.7. Dell’Acqua F, Saettini F, Castelli I, Badolato R, Notarangelo LD, Rizzari C. Hermansky-Pudlak syndrome type II and lethal hemophagocytic lymphohistiocytosis: Case description and review of the literature.J Allergy Clin Immunol Pract. 2019;7(7):2476-2478 e2475.8. Vicary GW, Vergne Y, Santiago-Cornier A, Young LR, Roman J. Pulmonary Fibrosis in Hermansky-Pudlak Syndrome. Ann Am Thorac Soc.2016;13(10):1839-1846.9. Hengst M, Naehrlich L, Mahavadi P, et al. Hermansky-Pudlak syndrome type 2 manifests with fibrosing lung disease early in childhood.Orphanet J Rare Dis. 2018;13(1):42.Figure legendsFig 1. CT image of interstitial pneumonia at 6 days of age.Bilateral lung fields showing diffuse ground-glass opacity and bronchioles dilated to obliteration. Some dorsal lung fields are hyperintense, possibly reflecting the effect of gravity.Fig 2. Patient genotype and NK cell activity.(a) Chromatogram demonstrating compound heterozygous mutations, c.1122_1123insAG (p.Phe375fs)* and c.2546T>A (p.Leu849Ter), in AP3B1 .(b) Analysis of NK cell degranulation by flow cytometric analysis. Profiles show CD56 versus CD107a staining on CD3−CD56+NK cells after stimulation. CD107a expression was significantly decreased in patient cells (above) relative to control cells (below). The assay was performed as previously described4.

Rosai-Dorman-Disease is one subgroup of Non-Langerhans cell histiocytosis with massive lymphadenopathy. It is a generally a benign and self-limiting disease, but an association to hemato-lymphoid malignancies or immune diseases is suspected. We present the case of a 6-year old male patient with multifocal extranodal RDD developing a secondary biphenotypic, treatment-resistant leukemia during treatment. Hypothysing that RDD and the secondary leukemia could be based on the same malign clone or on a cancer predispostion syndrome, whole-exome-sequencing of a saliva sample and leukemic cells were performed. A common marker of cell lines of histiocytosis and leukemic blasts has not been found.

In the utilization of acetylene as the raw material in chemical engineering, the understanding of its pyrolysis mechanism is a key issue to avoid its explosion. The ReaxFF molecular dynamics method has been employed to explore the pyrolysis process of acetylene at different temperatures and pressures, and the reaction mechanism and kinetic model were determined. The simulation results showed that the pyrolysis mechanism of acetylene can be divided into three temperature ranges. The simulation results further revealed the influence of pressure on the pyrolysis of acetylene. Through the identification, quantification and evaluation of the reaction trajectory, the reaction network for the pyrolysis of acetylene to generate species below C10 is obtained.The kinetic model of acetylene pyrolysis has been revised and perfected, and the results obtained are in good agreement with the experimental data.

Multifluid model (MFM) simulations have been carried out on liquid-solid fluidized beds (LSFB) consisting of binary and higher-order polydisperse particle mixtures. The role of particle-particle interactions was found to be as crucial as the drag force under laminar and homogenous LSFB flow regimes. The commonly used particle-particle closure models are designed for turbulent and heterogeneous gas-solid flow regimes and thus exhibit limited to no success when implemented for LSFB operating under laminar and homogenous conditions. A need is perceived to carry out Direct Numerical Simulations of liquid-solid flows and extract data from them to develop rational closure terms to account for the physics of LSFB. Finally, a recommendation flow regime map signifying the performance of the MFM has been proposed. This map will act as a potential guideline to identify whether or not the bed expansion characteristics of a given polydisperse LSFB can be correctly simulated using MFM closures tested.

Objective: Compare maternal and perinatal outcomes between emergency and elective caesarean-hysterectomy for placenta accreta spectrum (PAS) disorders managed by a multidisciplinary team. Design and setting: Single-centre retrospective cohort study Population: 125 cases of antenatally suspected and pathologically confirmed PAS disorder. Methods: Maternal and perinatal outcomes were analyzed. Multivariate logistic regression was used to test associations, adjusting for potential confounders. Survival curves exploring risk factors for emergency delivery were sought. Main Outcome Measures: Maternal outcomes including hemorrhagic morbidity, operative complications. Perinatal outcomes included gestational age at delivery, birthweight, Apgar scores and perinatal death. Results: 25 (20%) and 100 (80%) patients had emergency and elective delivery, respectively. Emergency delivery had a higher estimated blood loss (median IQR 2772 [2256.75] vs. 1561.19 [1152.95], p<0.001), with a higher rate of coagulopathy (40 vs. 6%; p<0.001) and bladder injury (44 vs. 13%; p<0.001). Emergency delivery was associated with increased rates of blood transfusion (aOR 4.9, CI95% 1.3-17.5, p=0.01), coagulopathy (aOR 16.4, CI95% 2.6-101.4, p=0.002) and urinary tract injury (aOR 6.96, CI95% 1.5-30.7, p=0.01). Gestational age at delivery was lower in the emergency group (mean SD 35.19 [2.77] vs. 31.55 [4.75], p=0.001), no difference in perinatal mortality was found (aOR 0.01, CI95% <0.001-17.5, p=0.53). A sonographically short cervix and/or history of APH had an increased cumulative risk of emergency delivery with advancing gestational age. Conclusions: Patients with PAS disorders managed in a tertiary centre by a multidisciplinary team requiring emergency delivery have increased maternal morbidity and poorer perinatal outcomes than those with elective delivery.

Objective: To study the risk of CD for each gestational week among ongoing pregnancies of nulliparous women at term. Design: A retrospective, population-based cohort study from January 1, 2016, through December 31, 2017 Setting: a French perinatal network of the Yvelines district, France Population: 11 308 nulliparous women with a singleton fetus in a cephalic presentation and delivered at term (≥37-week +0 day) Methods: for each week of gestation at term, we defined ongoing pregnancies as all pregnancies undelivered at the start of each week. Regression models adjusted by maternal characteristics and hospital status were used to compare the CD risk between ongoing pregnancies and the pregnancies delivered the preceding week. The same methods were applied to subgroups defined by the mode of labor onset. Main outcome measure: The caesarean delivery rate (CD) Results: Ongoing pregnancies > 40 weeks+0 days were associated with a higher risk of CD compared with pregnancies delivered the previous week: 24.3% in ongoing pregnancies ≥ 40 weeks +0 days versus 19.9% in deliveries between 39 weeks +0 days and 39 weeks+6 days (Odd ratio adjusted of 1.28, 95%CI [1.15-1.44]; 30.4% in ongoing pregnancies ≥ 41 weeks +0 days versus 19.6% in deliveries between 40 weeks +0 days and 40 weeks+6 days (OR 1.73, 95%CI [1.51-1.96]). This was also shown for all modes of labor onset and in every maternity unit. Conclusions: CD rates increased starting at 40 weeks +0 days in ongoing pregnancies, regardless of the mode of labor onset.

This was a rare case of wandering spleen with splenomegaly and abdominal pain due to splenic arteriovenous torsion after childbirth.

In this paper, we propose a novel solution strategy to explicitly describe the design space in which no recourse is considered for the realization of the parameters. First, to smooth the boundary of the design space, the Kreisselmeier-Steinhauser (KS) function is applied to aggregate all inequality constraints, and project them into the design space. Next, for creating a surrogate polynomial model of the KS function, we focus on finding the sampling points on the boundary of KS space. After testing the feasibility of Latin hypercube sampling points, two methods are presented to efficiently extend the set of boundary points. Finally, a symbolic computation method, cylindrical algebraic decomposition, is applied to transform the surrogate model into a series of explicit and triangular subsystems that can be further converted to describe the KS space. Two case studies are considered to show the efficiency of the proposed algorithm.

Objective: Crimean–Congo hemorrhagic fever (CCHF) is a zoonotic infection characterized by fever and hemorrhage that is endemic to northeastern Turkey. This study aimed to examine the association between procalcitonin and venous blood gas parameters and clinical course and prognosis in patients with CCHF. Methods: A total of 96 CCHF patients who were followed up in the infectious diseases department between March and September 2020 were included in the study. The patients’ routine laboratory tests, serum procalcitonin, and results of venous blood gas analysis were analyzed retrospectively. Results: There were statistically significantly differences in serum platelet, aspartate transaminase, alanine transaminase, creatinine kinase, lactate dehydrogenase, potassium, C-reactive protein, sedimentation, D-dimer, activated partial thromboplastin time, ferritin, procalcitonin and lactate levels, and platelet/lymphocyte ratio among the patients with mild, moderate and severe disease (p=0.017 for potassium and p=0.001 for rest of others). In receiver operating characteristic (ROC) curve analysis of serum lactate for the differentiation of patients with severe disease and those with mild/moderate disease, the area under the curve was 0.802 and a cut-off value of 1.9 mmol/L had 77.8% sensitivity and 76.9% specificity. For serum procalcitonin, the area under the ROC curve was 0.892 and a cut-off value of 0.61 ng/ml had 83.3% sensitivity and 89.7% specificity. Conclusion: Serum procalcitonin and lactate levels may be useful and easily obtained parameters to guide the evaluation of clinical severity and follow-up in patients with CCHF.

Objective: According to Bernoulli Equation, systolic pulmonary artery pressure is obtained echocardiographically by adding estimated right atrial pressure (RAP) to the multiply of square of tricuspid regurgitation flow rate by four. RAP is estimated based on inferior vena cava (IVC) diameter and collapse. Our objective is to investigate usability of coronary sinus(CS) diameter and collapse, measured by echocardiography for estimating RAP. Methods: Our study is a single center, prospective study. 136 patients, over 18 years of age and without exclusion criteria, who admitted to Akdeniz University Hospital Cardiology Department between March 2017 and March 2018 and were scheduled to undergo right heart catheterization for any reason were included study. Results: Patients were divided into two groups as invasively measured RAP ≥10 mmHg (n: 57) and RAP <10 mmHg (n: 79). In group with RAP ≥10 mmHg, maximum IVC and CS diameter were higher than group with RAP <10 mmHg, IVC and CS collapse indices were lower (p <0.001). Optimal cut-off value for maximum IVC diameter was 19.6 mm (sensitivity 63.2%, specificity 87.3%), for IVC collapse index was 46.1 (sensitivity 75%, specificity 79.7%), for maximum CS diameter was 11 mm (sensitivity 64.9%, specificity 77%), for CS collapse index was 39.2 (sensitivity 75.4%, specificity 88.6%). Conclusion: Significant relationship was found between invasively measured RAP and maximum IVC diameter, collapse index and maximum CS diameter and collapse index. Results of CS parameters were as significant as results of IVC parameters therefore it shows that CS can also be used for estimating RAP.

Background: Patients with strong pulmonary vascular occlusive lesions are at risk of developing postoperative pulmonary hypertension (PH). We aimed to evaluate preoperative right ventricular (RV) function in patients with ventricular septal defect (VSD) who required cardiac surgery during infancy and consequently developed postoperative PH and to determine whether we could preliminarily evaluate postoperative PH in these patients. Methods: We retrospectively analyzed 55 infants with VSD who underwent cardiac surgery between March 2014 and April 2020. We evaluated the measurements of preoperative general function and 2D strain between these two groups: a group with postoperative PH (post-PH, n=10) and a group without postoperative PH (post-NPH, n=45). Results: Post-PH patients had a significantly lower tricuspid annular plane systolic excursion (TAPSE) (11.1 mm), TAPSERA (the proportion of TAPSE due to right atrial (RA) contraction alone) (7.0 mm), RA ejection fraction (36.1 %) and RA expansion index (56.4 %) than the post-NPH patients. Furthermore, the post-PH group had a significantly lower peak RA longitudinal strain (PRALS) (32.0 %) than the post-NPH group (43.0%). Multivariate logistic regression model demonstrated that PRALS was independent echocardiographic parameters for the presence of post-PH (OR 1.18, 95% CI: 1.02 - 1.36, p = 0.03) . The sensitivity and specificity of predicting post-PH for ≤ 35 % of the PRALS were 88.9 % and 70.0 %, respectively, with an area under the curve of 0.85 (p < 0.01). Conclusion: RA parameters demonstrated preoperative RV diastolic dysfunction in the post-PH group. PRALS could be useful factors for predicting postoperative PH.

Objective: The literature on the entity of the anterior larynx (AL) is restricted to little evidence on the difficulty encountered in exposing the larynx for intubation, perioperative morbidity and mortality, and scant reports on its prevalence in general adults and children. We here describe the prevalence of AL in a series of children presenting with aerodigestive symptoms and explore its association with functional abnormalities, congenital and structural anomalies or conditions. Setting: Tertiary pediatric center Methods: we conducted a retrospective case-control study. Using a prospectively collected surgical database we identified patients diagnosed with AL (grades IIb-III-IV Modified Cormack-Lehane scale) and sex and age-matched controls who had undergone full airway endoscopy for aerodigestive symptoms. We collected the demographics, presentations, associated diagnoses, and investigations. We compared the proportion of patients with large airway abnormalities and dysmorphism and estimated the prevalence of AL. Results: over a 5.5-year period, 58 children (28 females) were matched with 58 controls. Although both groups presented with permutations of stridor, respiratory failure, cyanotic spells, swallowing and feeding difficulties and SDB, AL presented much more with swallowing and feeding problems (33 vs 20, p<0.05). There were significantly more children with dysmorphism in the AL group (29 vs 9, P < 0.05). The prevalence of AL was 4.9%. Conclusions: This is the first study to report the prevalence of AL amongst a cohort of children with aerodigestive symptoms. Its significant association with dysmorphic features warrants genetic consultation. It is associated with swallowing abnormalities that justifies a systematic instrumental evaluation

Enlargement of left ventricular outflow tract using an autologous pericardial patch for the anterior mitral valve leaflet and septal myectomy through trans-mitral approach for the hypertrophic obstructive cardiomyopathy Zhang et al (1) describe their experience in septal myectomy for hypertrophic obstructive cardiomyopathy. Of 247 consecutive cases with HOCM treated during 2016-2019 with a variety of techniques, this report is on 16 patients who underwent trans-mitral septal myectomy and enlargement of left ventricular outflow with an autologous pericardial patch in transverse configuration. The technique reportedly decreased the gradient from average 90+ to 10+ mm Hg and resolved systolic anterior leaflet motion in all with only mild residual mitral regurgitation. There were no deaths or any other major complications in this group. It is a small group of patients with excellent result but no definitive conclusion can be drawn regarding validity of the technique from this study. The controversy remains regarding the approach, trans-aortic vs. trans-mitral and whether leaflets should be left alone, plicated or lengthened as well as whether mitral valve should be repaired or replaced in addition to septal myectomy. One certainty remains, extended myectomy done either way, is the foundation of the surgical treatment of hypertrophic cardiomyopathy.

Objective: To investigate the effect of aortic esophageal fistula treatment after thoracic aortic endovascular repair (TEVAR) with artificial vessel bypass. Methods: The clinical data of 6 consecutive patients who received surgical treatment at Shanghai Deda Hospital from September 2019 to June 2021 due to aortic esophageal fistula after TEVAR were retrospectively analyzed. There were 6 males, aged (47.7±8.2) years old (range: 35-56 years old). All patients had recurrent fever, and 4 patients had positive blood cultures. According to the specific conditions of the patients, all patients underwent artificial blood vessel bypass and jejunostomy under general anesthesia without extracorporeal circulation. One case underwent artificially infected vascular segment resection and esophageal repair at the same time. 5 cases underwent artificial infection vascular resection, 4 of them underwent esophageal repair, and 1 case had a large intraoperative fistula and local resection of the esophagus. Sensitive antibacterial drugs were continued after the operation for 6 to 8 weeks. Results: There were 2 deaths in hospital, 1 case of large cerebral infarction early postoperatively, and 1 case of septic shock. The remaining 4 patients recovered well after the operation and were discharged. The follow-up period was 2 to 23 months. During the follow-up period, the remaining patients had no recurrence of infection and esophageal fistula. Conclusion ：In patients with aortic esophageal fistula after TEVAR, the establishment of artificial vascular bypass, the resection of the infected vascular segment, contemporaneous or staged esophageal repair, regular anti-infective treatment can obtain a good prognosis.

Abstract Objective: To evaluate the association between body mass index (BMI) and pregnancy outcomes in women receiving intrauterine insemination (IUI) treatment． Design: Retrospective cohort study. Setting: University-affiliated hospital. Population: Six thousand four hundred and seven women undergoing 13,745 IUI cycles stratified by body mass index (BMI). Method: Cox regression was used to analyze the association between BMI and cumulative live birth across multiple IUI cycles. GEE was used to analyze the live birth rate per cycle. Main Outcome Measure(s): Cumulative outcomes for IUI cycles. Result(s): Compared with normal weight women (n = 4,563), underweight women (n = 990) had a lower cumulative pregnancy and live birth rate (20.71% vs 25.93%, 17.07% vs 21.61%, respectively), while overweight women (n = 854) had a higher cumulative pregnancy and live birth rate (31.97%, 26.58%). Adjusted for confounders, hazard Ratio (HR) for achieving live birth following up to a maximal of 4 IUI cycles was 0.8(95%CI: 0.67-0.95) comparing underweight with normal weight. In generalized estimating equation (GEE) analyses, low BMI was also associated with a lower per-cycle live birth rate 0.77(95%CI: 0.64-0.92) with adjustment for cycle-specific parameters, including ovarian stimulation, endometrial thickness and follicular diameter. Conclusion(s): Underweight is associated with poor IUI outcomes. Funding: Clinical Research Special Fund of Chinese Medical Association (NO.18010360765) and Xiamen Medical Advantage Subspecialty Construction Project (2018[296])