Sexual dimorphism (SD) is a main source of intraspecific morphological variation, however sexual shape dimorphism (SShD) was long time neglected in evolutionary research. Especially in cold-blooded animal groups only subtle shape differences are expressed between males and females and the selective forces behind it are poorly understood. Crocodile newts of the genera Echinotriton and Tylototriton are highly polymorphic in their reproductive ecology and hence, are a highly suitable model system to investigate potential evolutionary forces leading to SShD differences. We applied 3D geometric morphometrics to the cranial and humerus morphology of nine species of crocodile newts to investigate patterns of SShD in relation to the different mating modes. Trajectories of shape differences between males and females differ in both, cranium and humerus but mating mode does explain differences in SShD trajectories between species only in cranial morphology. Nevertheless, cranial morphology shape differed between the amplecting and circle dancing species. Hence, other selective forces must act here. Variable interspecific allometric trajectories are a potential source of shape differences whereas these trajectories are quite stable for the sexes irrespective of the species.

AbstractIn individuals showing Marcus Gunn phenomena, it is characterized when the upper eyelid shows involuntary movement (continuous rising motion – more like a wink) every time the jaw is moved, like while eating. It is a congenital disease as it is generally seen to be present since birth, and in certain cases various other anomalies and abnormalities in the eye may also occur, for example: Strabismus and other vision impairments. Despite the fact that it for the most part influences one eye, it can influence the two eyes in uncommon cases.Study of Marcus Gunn PhenomenaMarcus Gunn phenomena also known as Jaw winking condition can be observed in congenital blepharoptosis. This phenomena was first depicted by a Scottish ophthalmologist, named Dr.Robert Marcus Gunn in the year 1883. This disorder for the first time was observed in a 15-year-old young lady as one-sided ptosis related with the upper eyelid constriction on a similar side.Marcus Gunn jaw-winking syndrome (MGJWS) over the years have also acquired various names such as, Pterygoid-levator synkinesis, Marcus Gunn jaw winking trigemino-oculomotor synkinesis, Marcus Gunn ptosis, and Maxillopalpebral synkinesis. Synkinesis or synkinetic movement is a neurological condition wherein an intentional movement of the muscle causes the synchronous constrictions and contraction of other involuntary muscles. In MGJWS, during masticating motions of the jaw, it is linked to synkinetic movements of the upper eyelid. This usually is unilateral, but can also be bilateral in some cases. This is caused by a persistent connection which is abnormal linking the superior division of oculomotor nerve with the motor branches of the trigeminal nerve.Causes and speculationStudies show that people with Marcus Gunn disease may not necessarily have any past familial records concerning this disorder. Hence it can be safely said that this disorder is not passed down within generations. However, some cases do report multiple cases of this phenomena occurring within one family at a given point of time, but so far the genetic lineage causing this phenomena is unknown.Roughly fifty percent of the MGJWS cases are discovered to be congenital. Since any hereditary relationship linking to this disorder is yet to be discovered, it can be assumed that it occurs due to genetic variations during foetal development. It has been seen that there could be various reasons leading up to Marcus Gunn phenomenon and in certain cases children born with this disorder are also born with other congenital defects caused by genetic or chromosomal mutation.InheritanceIn every living being, the nucleus of every cell contains the genetic material which is passed down within species and is the unique identity of an individual. The humans, contain chromosomes in the nucleus which are 46 in number. These are further paired in 23 groups, numbered from 1 to 22 and known as Autosomal chromosomes. The 23rdpair known as the sex chromosome has 2 designated chromosomes namely, X and Y. Apart from the 22 autosomal pair, males have XY sex chromosome pair and females have XX. On the basis of banding patterns, chromosomes are then subdivided and each band is numbered. These bands contains thousands of genes whose location are distinguished by the numbering. Furthermore, every chromosome consist of a long arm ‘q’ and a short arm ‘p’. For example, 18q12 refers to the 12th band of the long arm in the 18th chromosome.Genomic disorders such as Marcus Gunn phenomena hence can be ascertained on the basis of gene combinations for a particular trait which are inherited from either of the parental chromosome. In the case of MGJWS, some clinical researchers hypothesize that there is a chance of around half of the MGJWS cases can be ascertained through genetic combinations. The exact location of the gene on the chromosomal sites and its nature is still unknown for this disorder, but some studies suggest that there is a chance that it could be disseminated as an autosomal dominant trait.Diagnosis and TherapyIn infants, the visual acuity is checked to see if there is any presence of Lazy eye or Amblyopia (a disorder in which an abnormal visual development leads to reduced vision capabilities in one of the eyes).Tests like Pupillary examinations to check focus of the eye and Cycloplegic refraction tests are carried out to find any disorders wherein the eye might have varying refractive powers (Anisometropia).Ptosis can be assessed by considering the degree of it (refer to the table below) that is, from mild ptosis to severe ptosis. The head position is evaluated, as in a child with ptosis lifting of the chin is seen to attain better vision. Vision loss may occur in cases wherein if ptosis remains untreated. At severe stage surgery can be considered.

A versão original da tabela abaixo traduzida encontra-se nas páginas 6-7 do Programme Guide do Horizonte Europa, disponível in https://ec.europa.eu/info/funding-tenders/opportunities/docs/2021-2027/horizon/guidance/programme-guide_horizon_en.pdfExplicação da TerminologiaRisco crítico (Critical risk) Um risco crítico constitui uma ocorrência ou questão plausível que poderá causar um acentuado impacto adverso sobre a capacidade para atingir os objetivos do projeto. Nível de probabilidade (likelihood) de ocorrência: baixo/médio/alto. A probabilidade (likelihood) é a estimativa da probabilidade (estimated probability) de que o risco venha a materializar-se mesmo após levar em conta as medidas de mitigação ou atenuação (mitigating measures) estabelecidas. Nível de gravidade: baixo/médio/alto. Trata-se da importância relativa (relative seriousness) do risco e o significado dos seus efeitos.Prestação (Deliverable)Trata-se de um relatório dirigido à Comissão [Europeia] ou à Agência [Executiva], contendo informações que se destinam a assegurar uma acompanhamento eficaz (effective monitoring) do projeto. Estão previstos diferentes tipologias de prestações (e.g., relatórios de atividades ou resultados específicos, planos de gestão de dados, requisitos éticos ou de segurança).Repercussões (Impacts)Efeitos alargados a longo prazo sobre a sociedade (incluindo o ambiente), a economia e a ciência, propiciados (enabled) pelas decorrências de investimentos em I&I (longo prazo). Remete para o contributo específico do projeto relativamente às repercussões previstas no programa de trabalho conforme descritas no destino (destination). As repercussões dão-se geralmente algum tempo após a conclusão do projeto. Exemplo: A implementação (deployment) do sistema de previsão avançada habilita cada aeroporto a aumentar a capacidade máxima de passageiros em 15% e o rendimento médio por passageiro em 10%, resultando numa redução de 28% nos custos de expansão das infraestruturas.Marcos (Milestone)Pontos de controlo que contribuem para traçar o progresso do projeto. Os marcos poderão corresponder à consecução de um resultado decisivo, possibilitando iniciar uma nova fase do trabalho. Também poderão revelar-se necessários em momentos intermédios (intermediary points) de modo a que possam ser tomadas medidas de correcção, sempre que tenham surgido problemas. Um marco poderá constituir um ponto crítico de decisão no projeto no qual, inter alia, um consórcio deverá decidir quais dentre várias tecnologias irá adoptar para ulterior desenvolvimento. A consecução de um marco deverá ser passível de verificação.Objetivos (Objectives)Metas respeitantes à investigação e ao conteúdo inovador no âmbito do projeto. Estas traduzir-se-ão em atividades do projeto. Estas poderão ir da abordagem de questões específicas de investigação até à demonstração da viabilidade de determinada inovação e à partilha de conhecimentos entre as partes interessadas (stakeholders) acerca de questões específicas. A natureza dos objetivos dependerá do tipo de ação e do âmbito do tópico.Decorrências (Outcomes)Os efeitos expectáveis (expected effects) a médio prazo em projetos apoiados ao abrigo de um determinado tópico. Os resultados de um projeto deverão propiciar as decorrências, particularmente através de medidas de disseminação e valorização (dissemination and exploitation measures) (compreendendo a adopção, divulgação, implementação, e/ou utilização dos resultados do projeto por parte de públicos-alvo diretos).  As decorrências verificam-se geralmente no decurso ou pouco tempo após o termo do projeto. Exemplo: 9 aeroportos europeus adoptam o sistema de previsão avançada apresentado (demonstrated) durante o projeto.Trajetória de impacto (Pathway to impact)Passos lógicos conducentes à materialização, ao longo do tempo, das repercussões previstas a nível do projeto, em particular para além da duração deste. Uma trajetória tem início a partir dos resultados dos projetos, passando pela sua disseminação, valorização e comunicação, contribuindo para propiciar simultaneamente as decorrências expectáveis sob o tópico do programa de trabalho e, em última instância, as repercussões científicas, económicas e sociais mais abrangentes do destino do programa de trabalho.Produção científica ou Produtos resultantes da investigação (Research output)Resultados gerados pela ação a que se pode ter acesso na forma de publicações científicas, de dados ou outras decorrências e processos resultantes da engenharia, designadamente programas informáticos, algoritmos, protocolos e cadernos electrónicos.Resultados (Results)Aquilo que se gera ao longo da implementação do projeto. Tal poderá incluir, por exemplo, saber-fazer (know-how), soluções inovadoras, algoritmos, provas de viabilidade, novos modelos de negócio, recomendações em matéria de políticas, orientações (guidelines), protótipos, demonstradores (demonstrators), bases e conjuntos de dados, formação de investigadora/es, novas infraestruturas, redes (networks), etc. A maioria dos resultados dos projetos (invenções, trabalhos científicos, etc.) constituem "Propriedade Intelectual", a qual pode ser protegida por "Direitos de Propriedade Intelectual" formalizados, caso se justifique. Exemplo: Demonstrador de grande envergadura bem sucedido: ensaio, junto de 3 aeroportos, de um sistema de previsão avançada com vista a uma gestão proactiva dos fluxos de passageiros em aeroportos.

Introduction: In this study, we aimed to compare the early postoperative period results of type 2 diabetes patients taking oral antidiabetics or insulin medications, with microalbuminuria and normal creatinine levels after coronary artery bypass. Materials and methods: Eighty patients with type 2 diabetes and taking oral antidiabetics or receiving insulin medication all with normal creatinine levels with microalbuminuria were included in this study. Preoperative creatinine values of the patients, albumin levels in spot urine, creatinine levels on the postoperative 3rd day, duration of ventilation, amount of drainage, length of stay in the intensive care unit, length of stay in the hospital, mediastinitis and mortality rates were recorded. Results: A statistically significant increase in creatinine was found in both taking oral antidiabetics type 2 diabetes and insulin medication patient groups with microalbuminuria. When the two groups were compared with each other, increase in creatinine levels of the patients using insulin was higher than the patients taking oral antidiabetics, and was statistically significant. Conclusion: According to the result of our study it can be suggested that postoperative creatinine elevation is observed in patients with type 2 diabetes mellitus with microalbuminuria and with normal creatinine levels, either having insulin medication or not. The elevation is higher in patients having insulin medication while other results are similar, except for impaired renal function. Keywords: Type 2 diabetes mellitus, insulin, microalbuminuria, coronary artery bypass.

Introduction Pre-operative management of neonates with esophageal atresia and tracheoesophageal fistula (EA/TEF) requiring positive pressure ventilation (PPV) support is clinically challenging. This study evaluates the safety, feasibility and value of flexible endoscopy with noninvasive ventilation and sustained pharyngeal inflation (FE-NIV-SPI) in diagnosis and placing a naso-tracheo-fistula-gastric (NTFG) tube before surgery. Methods A retrospective study conducted from 2017 to 2020 in neonates with Type-C EA/TEF and respiratory distress, where FE-NIV-SPI performed with NTFG tube placement before surgery. Results Five neonates were collected, one with duodenal atresia and one with transposition of great artery. At FE-NIV-SPI, median body weight was 2,399 g and mean age was 15.2 hours. Four neonates yielded severe (>80% collapsed) tracheomalacia. With this FE-NIV, all tracheal, fistulas and esophageal lumens could clearly assess and manage. All fistulas were less than 8mm proximal to carina with mean orifice width of 5 mm. All NTFG tubes placed successfully after confirmed the EA/TEF. Three neonates had co-intubated with nasal endotracheal tube and 2 neonates had received nasal prongs PPV. Mean procedural time of FE-NIV was 13.6±4.5 minutes. All neonates received gastric decompression and feeding via NTFG tubes for mean of 11.4±18.2 days and had stable pre-surgical courses. No adverse associated complication noted. Conclusion FE-NIV-SPI technique enables safe and accurate measurement of EA/TEF anatomy and placing NTFG tube. It could avert emergent gastrostomy, aid gastric decompression, feeding, and ETT intubation, improve PPV, provide pre-surgical stabilization and identify the fistula location during the surgical correction.

Aims Idiopathic epicardial ventricular arrhythmias (VAs) are clustered in the areas of the summit and crux. This study was to report a group of idiopathic epicardial VAs remote from the summit and crux areas. Methods In total, 9 patients (6 males, mean age 32±13 years) were enrolled. The locations were identified by epicardial mapping and ablation. The electrocardiographic and electrophysiological characteristics were compared to those of 9 patients who had VAs ablated at the opposite endocardial site. Results VAs were identified at the epicardium, with 4 patients had VAs located at the inferior wall, one at the anterior wall, one at the apex and 3 patients had VAs at the lateral wall. A “QS” type at the location-related leads was the only identified surface electrocardiogram indication suggesting epicardial origin (compared to that of the controls, 100% vs 0%, p<0.001). Endocardial and epicardial mapping revealed pre-maturities of -11±4 ms and -25±8 ms, respectively (VS. -28±8 ms revealed by endocardial mapping in control patients, p<0.001 and p=0.389, respectively). All of the study cases demonstrated an “rS” pattern in the endocardial unipolar electrogram. Acute and long-term successful ablation (a median of 11 months of follow-up) was achieved in all patients without complications. Conclusion A distinct group of idiopathic VAs remote from the summit and crux areas warranting ablation by a subxiphoid approach were identified. Morphological ECG features of a “QS” type among the location-related grouped leads combined with the mapping findings helped in the identification of the epicardial site of origin.

Post-operative ileus (POI) is a frequent complication after abdominal surgery. The consequences of POI can be potentially serious such as bronchial inhalation or acute functional renal failure. Numerous advances in peri-operative management, particularly early rehabilitation, have made it possible to decrease POI. Despite this, the rate of prolonged POI ileus remains high and can be as high as 25% of patients in colorectal surgery. From a pathophysiological point of view, POI has two phases, an early neurological phase and a later inflammatory phase, to which we could add a “pharmacological” phase during which analgesic drugs, particularly opiates, play a central role. The aim of this review article is to describe the phases of the pathophysiology of POI, to analyse the pharmacological treatments currently available through published clinical trials and finally to discuss the different research areas for potential pharmacological targets.

The paper discusses various partial solutions used for estimating fatigue life under variable amplitude multiaxial loading in the high-cycle fatigue domain. The concurring effects are treated, and their proposed solutions are commented upon. The major focus is on the categories of the phase shift effect and of cycle counting, and on the scope and quality of data, which support discussed theories. Results of own new experimental data set on specimens from S355 steel are provided. Fatigue life estimates for McDiarmid and Findley multiaxial methods and for two different methods of load path decomposition to cycles are shown to highlight some of the points open for discussion. It is concluded that the available experimental data are not sufficient to substantiate a clear decision to follow a definite algorithm.

Background and purpose Statins, inhibitors of HMG-CoA reductase, are mainstay treatment for hypercholesterolemia. However, muscle pain and weakness prevent many patients from benefiting from their cardioprotective effects. We previously demonstrated that simvastatin activates skeletal ryanodine receptors (RyR1), an effect that could be important in initiating myopathy. We therefore investigated if RyR1 activation is a standard property of commonly-prescribed statins. Using a range of structurally-diverse statin analogues we examined structural features associated with RyR1 activation, aiming to identify statins lacking this property. Experimental Approach Compounds were screened for RyR1 activity utilising [3H]ryanodine binding. Mechanistic insight into RyR1 activity was studied by incorporating RyR1 channels from sheep, mouse or rabbit skeletal muscle into bilayers. Key Results All UK-prescribed statins activated RyR1 at nanomolar concentrations. Cerivastatin, withdrawn from the market due to life-threatening muscle-related side effects, was more effective than currently-prescribed statins and possessed the unique ability to open RyR1 channels independently of cytosolic Ca2+. We synthesised the statin pharmacophore and it did not activate RyR1. We also identified five analogues retaining potent HMG-CoA reductase inhibition that inhibited RyR1 and four analogues that lacked the ability to activate RyR1. Conclusion and Implications That cervistatin activates RyR1 most strongly supports the hypothesis that RyR1 activation is implicated in statin-induced myopathy. Demonstrating that statin-regulation of RyR1 and HMG-CoA reductase are separable effects allows the role of RyR1 in statin-induced myopathy to be further elucidated by the tool compounds identified, thus paving the way for the development of effective cardioprotective statins with improved patient tolerance.

The Heteroduplex mobility assay (HMA) has proven to be a robust tool for the detection of genetic variation. Here, we describe a simple and rapid application of the HMA by microfluidic capillary electrophoresis, for phylogenetics and population genetic analyses (pgHMA). We show how commonly applied techniques in phylogenetics and population genetics have equivalents with pgHMA: phylogenetic reconstruction with bootstrapping, skyline plots, and mismatch distribution analysis. We assess the performance and accuracy of pgHMA by comparing the results obtained against those obtained using standard methods of analyses applied to sequencing data. The resulting comparisons demonstrate that: (1) there is a significant linear relationship (R = 0.992) between heteroduplex mobility and genetic distance; (2) phylogenetic trees obtained by HMA and nucleotide sequences present nearly identical topologies; (3) clades with high pgHMA parametric bootstrap support also have high bootstrap support on nucleotide phylogenies; (4) skyline plots estimated from the UPGMA trees of HMA and Bayesian trees of nucleotide data reveal similar trends, especially for the median trend estimate of effective population size; and (5) optimized mismatch distributions of HMA are closely fitted to the mismatch distributions of nucleotide sequences. In summary, pgHMA is an easily-applied method for approximating phylogenetic diversity and population trends. KEYWORDS: bootstrap, heteroduplex mobility assay, mismatch distribution, phylogenetics, skyline plot

Animal personality has received increasing interest and acknowledgement within ecological research over the past two decades. However, some areas are still poorly studied and need to be developed. For instance, field studies focused on invertebrates are currently highly underrepresented in the literature. More studies including a wider variety of traits measured and species tested is needed to improve our understanding of trait-correlation patterns and generalities. We studied nine behavioural traits, in the damselfly Calopteryx splendens, from an array of three experiments: (i) courtship, (ii) aggressiveness and (iii) boldness, and calculated their repeatability. The behaviours were measured twice, in two different contexts: (i) undisturbed territory and (ii) partially deteriorated territory. All behavioural traits measured, except for two, were repeatable across the two contexts. This work demonstrates, for the first time, the presence of within population personality differences in an adult damselfly in the wild. We further propose Calopteryx splendens as a promising model species for testing personality in the wild under highly controlled environmental conditions.

A patient with a history of Mandibular hypoplasia, Deafness, Progeroid Features Associated Lipodystrophy Syndrome (MDPL), a familial lipodystrophy presented with hypertriglyceridemia induced pancreatitis with triglycerides in the 3000s. This lipodystrophy occurs due to a mutation in the POLD1 gene (DNA polymerase delta 1).

A 48-year -old male patient with Type 2 diabetes mellitus(T2D) on insulin replacement therapy, glipizide and Dapagliflozin admitted for generalized weakness found him in euglycemic diabetic ketoacidosis which means normal or near normal glucose levels with high anion gap metabolic acidosis recovered on insulin drip per DKA protocol.

Electrogram-guided Endomyocardial Biopsy Yield in Patients with Suspected Cardiac SarcoidosisAbbas Hoteit MD, Marwan M. Refaat, MDDivision of Cardiology, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, LebanonRunning Title: Electrogram-guided Biopsy in Cardiac SarcoidosisWords: 819 (excluding the title page and references)Keywords: Cardiac Sarcoidosis, Heart Diseases, Cardiovascular Diseases, Cardiac ArrhythmiasFunding: NoneDisclosures: NoneCorresponding Author:Marwan M. Refaat, MD, FACC, FAHA, FHRS, FASE, FESC, FACP, FAAMAAssociate Professor of MedicineDirector, Cardiovascular Fellowship ProgramDepartment of Internal Medicine, Cardiovascular Medicine/Cardiac ElectrophysiologyDepartment of Biochemistry and Molecular GeneticsAmerican University of Beirut Faculty of Medicine and Medical CenterPO Box 11-0236, Riad El-Solh 1107 2020- Beirut, LebanonUS Address: 3 Dag Hammarskjold Plaza, 8th Floor, New York, NY 10017, USAOffice: +961-1-350000/+961-1-374374 Extension 5353 or Extension 5366 (Direct)Sarcoidosis is a multisystem disease that is characterized by T-cell mediated formation of noncaseating granulomas in affected organs. The disease commonly might involve hilar lymphadenopathy, lungs, liver, spleen, heart, and other organs. The natural course and prognosis of the disease generally depends on the extent of the disease and the organs affected where spontaneous remission occurs in around two-thirds of patient.1 Involvement of the heart is recognized in around 30% of patients and is associated with poor prognosis.2 The presentation of patients with cardiac sarcoidosis varies significantly; it can range from mild to severe disease such as heart failure and fatal arrhythmias. Patients with cardiomyopathies might require implantable cardiac defibrillators or cardiac resynchronization therapy for sudden death prevention.3,4 Cardiac sarcoidosis can either present alongside extracardiac manifestations or isolated.5Diagnosis of cardiac sarcoidosis presents a particular challenge since there is no gold standard diagnostic tool and the presentation is variable.6 There are no disease-specific biomarkers that can reliably be used for diagnosis. Clinicians typically rely on current published guidelines for diagnostic criteria of cardiac sarcoidosis such as those of Heart Rhythm Society (HRS) and the Japanese Ministry of Health and Welfare (JMHW). The revised JMHW criteria provide a diagnosis either through histological evidence on biopsy or through the fulfillment of major and minor criteria that do not include cardiac PET whereas the HRS criteria provide either a definite pathway for diagnosis through histology or a clinical pathway for diagnosis of probable cardiac sarcoidosis that includes both cardiac PET and CMR as criteria.7,8 A definitive diagnosis of cardiac sarcoidosis can be obtained if endomyocardial biopsy can show noncaseating granulomas in the context of suspected cardiac sarcoidosis and other granulomatous diseases are excluded. However, endomyocardial biopsy has a low sensitivity of 20-30% since it is limited by several factors such as technique, sampling, patchy distribution of granulomas, location of lesions, and stage of the disease at the time of biopsy.5 Areas of inflammation and scarring typically show abnormal electrogram morphology, hence, it is thought that electrogram guidance may help in increasing the yield of endomyocardial biopsies. Electrogram guidance would potentially help avoiding normal myocardium during biopsy leading to increased yield and sensitivity.9In their study, Ezzedine et al. assessed the diagnostic yield of electrogram-guided endomyocardial biopsy and investigated association between positive endomyocardial biopsy and prognosis in patients with suspected cardiac sarcoidosis.10 This retrospective observational study included seventy-nine patients between 2011 and 2019 who had suspected cardiac sarcoidosis based on clinical presentation and findings on late gadolinium-enhancement cardiac magnetic resonance and/or cardiac positron emission tomography-computed tomography with N-13 NH3 perfusion imaging and F-18 fluorodeoxyglucose. Biopsy was done in patients suspicious of cardiac sarcoidosis in patients without extracardiac sarcoidosis or those with extracardiac disease but atypical/equivocal findings of cardiac sarcoidosis on imaging and meeting criteria in HRS guidelines as per the routine practice in Mayo Clinic. Mapping of the heart was performed prior to biopsy with partial guidance based on pre-procedural cardiac imaging. In patients with no identifiable abnormalities on electrogram, biopsies were taken from areas corresponding to those with abnormalities on pre-procedural imaging. Collected specimens were processed according to protocol and assessed by a blinded specialist. These specimens were considered positive if there was a combination of non-necrotizing granulomas, interstitial fibrosis, and scatted eosinophils. The study showed that electrogram-guided endomyocardial biopsy was associated with an adequate negative predictive value but low positive predictive value. A diagnosis of probable cardiac sarcoidosis can be made in patients with extracardiac manifestations according to established guidelines whereas in patients with suspected isolated cardiac sarcoidosis this is more difficult and as such biopsies play a more major role here. This study showed that, when guided by electrograms, endomyocardial biopsies had a higher diagnostic yield (41%) than that established in literature around 20-25%. Utilizing both abnormalities seen on both electrograms and on CMR or PET showed the highest diagnostic yield in endomyocardial biopsies. This acts as an important point of consideration for further research because accurate and timely diagnosis is paramount due to the diagnostics challenges and poor prognosis seen in cardiac sarcoidosis.10Previous evidence had shown that a positive endomyocardial biopsy for sarcoidosis was associated with poor prognosis.11However, LVAD and transplantation-free survival was found to be similar regardless of status of endomyocardial biopsy in this study.10 The authors explained that this could be explained by earlier detection of disease, differences in treatment, or more subtle detection of areas of involvement through electrograms. This study was well conducted but has been limited by its nature of being a retrospective observational study. Also, mapping was mostly limited to the right ventricle which may have underestimated the diagnostic yield of biopsies. This study represents the management done in a single tertiary care center which may not represent the same practice in other institutions with different facilities. Further multicenter and prospective studies are warranted to corroborate the data here and assess diagnostic and therapeutic modalities and long-term outcomes in patients.ReferencesStatement on sarcoidosis. Joint Statement of the American Thoracic Society (ATS), the European Respiratory Society (ERS) and the World Association of Sarcoidosis and Other Granulomatous Disorders (WASOG) adopted by the ATS Board of Directors and by the ERS Executive Committee, February 1999. Am J Respir Crit Care Med Aug 1999 ;160(2):736-55.Sekhri V, Sanal S, Delorenzo LJ, Aronow WS, Maguire GP. Cardiac sarcoidosis: a comprehensive review. Arch Med Sci Aug 2011; 7(4):546-54.AlJaroudi WA, Refaat MM, Habib RH, Al-Shaar L, Singh M, Gutmann R, Bloom HL, Dudley SC, Ellinor PT, Saba SF, Shalaby AA, Weiss R, McNamara DM, Halder I, London B; for the Genetic Risk Assessment of Defibrillator Events (GRADE) Investigators. Effect of Angiotensin Converting Enzyme Inhibitors and Receptor Blockers on Appropriate Implantable Cardiac Defibrillator Shock: Insights from the GRADE Multicenter Registry. Am J Cardiol Apr 2015; 115 (7): 115(7):924-31.Refaat M, Mansour M, Singh JP, Ruskin JN, Heist EK: Electrocardiographic Characteristics in Right Ventricular Versus Biventricular Pacing in Patients With Paced Right Bundle Branch Block QRS Pattern. J Electrocardiol Mar-Apr 2011; 44 (2): 289-95.Isobe M, Tezuka D. Isolated cardiac sarcoidosis: Clinical characteristics, diagnosis and treatment. Int J Cardiol Mar 2015; 182:132-40.Ahmed AI, Abebe AT, Han Y, Alnabelsi T, Agrawal T, Kassi M, Aljizeeri A, Taylor A, Tleyjeh IM, Al-Mallah MH. The prognostic role of cardiac positron emission tomography imaging in patients with sarcoidosis: A systematic review. J Nucl Cardiol Jul 2021; doi: 10.1007/s12350-021-02681-z. Online ahead of print.Sharma A, Okada DR, Yacoub H, Chrispin J, Bokhari S. Diagnosis of cardiac sarcoidosis: an era of paradigm shift. Ann Nucl Med Feb 2020;34(2):87-93.Ha FJ, Agarwal S, Tweed K, Palmer SC, Adams HS, Thillai M, Williams L. Imaging in Suspected Cardiac Sarcoidosis: A Diagnostic Challenge. Curr Cardiol Rev 2020;16(2):90-97.Liang JJ, Hebl VB, DeSimone CV, Madhavan M, Nanda S, Kapa S, Maleszewski JJ, Edwards WD, Reeder G, Cooper LT , Asirvatham SJ. Electrogram guidance: a method to increase the precision and diagnostic yield of endomyocardial biopsy for suspected cardiac sarcoidosis and myocarditis. JACC Heart Fail Oct 2014;2(5):466-73.Ezzedine FM, Kapa S, Rosenbaum A, Blauwet L, Deshmukh AJ, AbouEzzeddine OF, Maleszewski JJ, Asirvatham SJ, Bois JP, Schirger JA, Chareonthaitawee P, Siontis KC. Electrogram-guided Endomyocardial Biopsy Yield in Patients with Suspected Cardiac Sarcoidosis and Relation to Outcome. J Cardiovasc Electrophysiol Jul 2021; In Press.Ardehali H , Howard DL, Hariri A, Qasim A, Hare JM, Baughman KL, Kasper EK. A positive endomyocardial biopsy result for sarcoid is associated with poor prognosis in patients with initially unexplained cardiomyopathy. Am Heart J Sep 2005 ;150(3):459-63.

A document by Anthony Gebran. Click on the document to view its contents.

This case is a challenging case review of a successful removal of sharp and deep located airway foreign body using ventilating bronchoscopy.

Root exudates play an essential role in plant-soil-abiotic stress interactions. However, we still know little about the influence of stress combinations on the root exudation profile. Using targeted and untargeted metabolomics, here we test the effect of drought, heat stress, and their combination on the maize root exudates, also considering the differences that might exist between root types (seminal and primary) and root zones (apical and sub-apical). In addition, we built an analytical framework that relate the root exudation profile with the characterization of the rhizosphere bacterial community, enabling us to dissect the interactions between specific root exudates and microbial taxa. Our results suggest that the composition of root exudates has a different outcome according to the single or combined stress and to the root zone but not between root types. Further, we found that stress-specific exudates influence the relative abundance of specific microbial taxa, some of which are known to be beneficial microorganisms. Therefore, the stress-specific root exudate composition selecting specific microbial taxa, here observed, represent a contribute on the effects of climate changes on crops increasing thus the potential impact on the current trend of crafting agricultural practices within a wider point of view of plants-microbe-environment interactions.

Background: Coronary artery bypass grafting is still a therapy of choice for complex ischemic heart disease. The purpose of the study was to compare the relation between obesity and blood flow through aorto-coronary bypass grafts with coexisting preoperative inflammatory state presented neutrophil-to-lymphocyte and platelets-to-lymphocyte ratios in retrospective analysis. Methods: We analyzed 50 consecutive patients (mean age 65 +/- 8) who underwent off-pump coronary artery bypass grafting (OPCAB) in our department in 2018. Graft blood flow measurements, as well as platelet-to-lymphocyte (PLR) and neutrophil-to-lymphocyte (NLR) ratios were evaluated. Results: Obese patients undergoing arterial revascularization were characterized by statistically significant lower arterial grafts flow for RIMA (p=0.0043), LIMA (p=0.0023) and RA (p=0.0214) with satisfactory medium term (897 +/- 123 days) results. The chronic inflammatory parameters including NLR and PLR were significantly differed between obese and non-obese patients (p=0.0312 and p=0.0003, respectively) referred for surgery. The inverse correlation between BMI and NLR (r=0.307) and PLR(r=0.413) was noted. Conclusion: Obese patients referred for CABG present a decreased graft blood flow velocity combined with an increased neutrophil-to-lymphocyte and platelet-to-lymphocyte ratio.

Introduction: Lead damage can occur during cardiovascular implantable electronic device (CIED) generator replacement procedures, resulting in additional procedures and added costs. PlasmaBlade (PL) and PhotonBlade (PH) are two commercially available insulated electrocautery devices designed to reduce this risk. Objective: This study compared complication rates of PL and PH in CIED generator replacement procedures. Methods: This retrospective study analyzed transvenous CIED generator replacements using PL or PH from 2017-2020. The primary endpoint was lead damage. Secondary endpoints included rate of pocket hematoma, superficial infection, and infections requiring device removal. Results: A total of 209 patients were included for analysis, including 86 procedures (188 leads) using PL and 123 procedures (266 leads) using PH. Lead insulation material consisted of 237 (52.2%) silicone, 66 (14.5%) polyurethane, and 151 (33.3%) copolymer leads, with no significant difference in frequency of insulation materials (p=0.91). The rate of lead damage was low for both PL and PH (0 vs. 0.4%, p=0.59). There was no significant difference in pocket hematoma (1.2% vs. 1.6%, p=0.43), superficial infection (1.2% vs. 0.8%, p=0.49), or infection requiring device removal (1.2% vs. 0%, p=0.41). The mean absolute change in lead impedance from pre- to post-procedure was similar between PL and PH (72.3 ± 126.1 ohms vs. 60.6 ± 72.3 ohms, p=0.10). Conclusions: There was a low rate of complications after CIED replacement procedures, with no significant difference between the PL and PH groups. A majority of leads with silicone insulation material may have contributed to the low rate of lead damage.

In this work, we prove Ostrowski-Mercer inequalities for differentiable harmonically convex functions. It is also shown that the newly proved inequalities can be converted into some existing inequalities. Furthermore, it is provided that how the newly discovered inequalities can be applied to special means of real numbers.

We, as students in the medical field, have the unique privilege of playing an influential role in transforming the system that we are trainees of. It is our prerogative to observe, internalize, scrutinize, and reform the medical curriculum to reflect what we believe will make the largest impact on our patients, and the patients of future students at our institution. Over the last twelve months, we have seen numerous efforts at medical schools across the nation to push forth a curriculum more mindful of health disparities and racism in medicine. Student-changemakers at our school have spearheaded a multi-year Health Equity curriculum, inspiring faculty to create coursework centered around educating students on social determinants of health, gender and race disparities in care, health outcomes based on age, incarceration, homelessness, and more.Our own impetus was borne of the realization that the healthcare system has devolved into a disease-care system. While the overwhelming majority of chronic disease can be altogether prevented through healthy lifestyle behaviors \cite{Ford2009}, few Americans engage in adequate physical activity, follow a healthy diet, maintain a healthy weight, and abstain from smoking \cite{Reeves2005}. These lifestyle deficiencies arise not from laziness; rather, numerous external factors induce these behaviors, such as proximity of grocers and famers markets, availability of safe recreation spaces, presence of community support, racial inequities, and influence of media and advertising. To educate our peers and the future medical students at our school, we created a seminar series and a health equity lecture to highlight the countless determinants at play when it comes to a patient’s health. By emphasizing the importance of lifestyle behaviors in preventing disease, and underscoring how to address these behaviors in a clinical encounter, we aim to erect a pillar of compassion in our curriculum, training future physicians to consider all potential influences on a patient’s health, and to advocate for them through the creation of wellness-centered policy. A gap in medical training is not just a lapse of understanding; it is an instant of substandard patient care that could be better – diseases that could be prevented, and lives that could be saved. By editing the next iteration of medical education, we, as medical students, hold the power to rewrite the future of the health of our country. ------------------------------------------------------------------------------------------------------------------------------------Acknowledgements: The authors thank Dr. Deepa Sannidhi, M.D., and Dr. Weena Joshi, M.D., for their guidance and mentorship in these endeavors. Funding/Support: None. Other disclosures: None. Ethical approval: Not applicable. Disclaimers: None.

The spatially inhomogeneous coagulation-condensation process is an interesting topic of study as the phenomenon’s mathematical aspects mostly undiscovered and has multitudinous empirical applications. In this present exposition, we exhibit the existence of a continuous solution for the corresponding model with the following \emph{singular} type coagulation kernel: \[K(x,y)~\le~\frac{\left( x + y\right)^\theta}{\left(xy\right)^\mu}, ~~\text{for} ~x, y \in (0,\infty), \text{where}~ \mu \in \left[0,\tfrac{1}{2}\right] \text{ and } ~\theta \in [0, 1].\] The above-mentioned form of the coagulation kernel includes several practical-oriented kernels. Finally, uniqueness of the solution is also investigated.

Atypical porcine pestivirus (APPV) belongs to the genus Pestivirus within the family Flaviviridae. Recently, APPV has been identified as the causative agent of congenital tremor (CT) type AII. The disease is a neurological disorder that affects newborn piglets and is characterized by mostly generalized trembling of the animals and often splay legs. CT is well known worldwide, and the virus seems to be highly prevalent in major swine producing areas. However, little is known about the epidemiology of the infection, the transmission and spread of the virus between herds. Here, we show the high prevalence of APPV in processing fluid samples collected from Hungarian pig herds which led us to investigate the cellular targets of the virus in the testicles of newborn piglets affected by CT. By the development of an RNA in situ hybridization assay and the use of immunohistochemistry on consecutive slides, we identified the target cells of APPV in the testicle: interstitial Leydig cells, peritubular myoid cells and endothelial cells of medium-sized arteries. Previous studies have shown that APPV can be found in the semen of sexually mature boars suggesting the role of infected boars and their semen in the transmission of the virus similar to many other members of the Flaviviridae family. As in our case, the virus has not been identified in cells beyond the blood-testis barrier, further studies on infected adult boars’ testicles are needed to analyze the possible changes in the cell tropism that enable the virus to be excreted by the semen.

We report a 60-year-old lady known to have a stable MS disease. Who presented with right-hand weakness on the same day of COVID 19 vaccine administration. MRI showed a relapse, and she was treated with steroids with improvement in her symptoms. neurological side effects can occur following COVID 19 vaccines