Objective: Malnutrition is associated with poor clinical outcomes in many diseases. The Controlling Nutritional Status (CONUT) is an objective index used for evaluating nutritional status of hospitalized patients. The aim of this study was to investigate the relationship between malnutrition assessed by CONUT score and the prognosis in patients undergoing carotid artery stenting (CAS). Methods: The study included 170 patients who underwent CAS due to symptomatic or asymptomatic severe carotid artery stenosis. Median follow-up period was 50 (interquartile range [IQR], 41-60) months. Patients were divided into two groups according to the CONUT score: (i) normal nutrition (<2) and (ii) malnutrition (≥2). Primary endpoint was accepted as MACE (major adverse cardiac events) including all-cause death and ischemic stroke. Results:The prevalence of MACE was significantly higher in the malnutrition group (p=0.001). Kaplan Meier analysis showed lower survival rates in the malnutrition group (log rank = 9.36, p=0.002; Figure 4). In multivariate logistic regression analysis, age and CONUT score were independent predictors of all-cause death and stroke after adjustment for confounding factors, respectively, (OR: 1.058, 95% CI: 1.013-1.105, p=0.011, OR: 1.318, 95% CI: 1.017-1.881, p=0.039). Conclusion: Higher CONUT scores were associated with adverse outcomes in patients with CAS. Malnutrition assessed by the CONUT score may provide valuable prognostic information in patients with CAS.

Noninvasive ventilation (NIV) use was initially reported in cystic fibrosis (CF) in 1991 as a bridge to lung transplantation, and over the decades the use of NIV has increased in the CF population. Individuals with CF are prone to various physiologic changes as lung function worsens, and they may benefit from NIV for advanced lung disease. As life expectancy in CF has been increasing due to advances such as highly effective modulator therapy, people with CF are now subject to the same co-morbidities that may benefit from NIV as their age matched cohorts. NIV can improve gas exchange, quality of sleep, exercise tolerance and augment airway clearance in CF, and it is important that CF providers are comfortable with this therapeutic modality. In this review, we will summarize the physiologic basis for NIV use in CF, describe indications for initiation of NIV, and postulate a practical approach for CF clinicians to take fin monitoring patients on NIV. We will discuss aspects unique to people with CF and the use of NIV. We hope that this serves as a resource for CF providers, especially those of us who do not have dedicated training in sleep medicine, as we continue to care for our patient population.

A document by Ian Dickie. Click on the document to view its contents.

Background: There is a lack of studies on outcomes in cystic fibrosis (CF) in children from developing countries like India. Identifying risk factors for mortality may help identify the high-risk group and plan policy management of such patients. Objective: To determine the factors associated with outcomes among Indian children with CF. Design: Retrospective analysis of data collected from January 2010 to Dec 2020. Setting: Tertiary care hospital in Northern India. Participants: Children diagnosed with CF during the study period. Methods: We extracted data related to demography, clinical features, laboratory data and outcome from children’s medical records with CF. Bivariate and multivariate analysis was performed to identify variables associated with mortality. Results: We enrolled 178 children, and there were 32 (18.0%) deaths. Significant factors associated with mortality included history of neonatal complications; hazard ratio (HR): 8.5 (95% CI, 3.0 - 23.9, p < 0.001), low Z-scores for body mass index (BMI) at the time of diagnosis; HR: 7.1 (95% CI 2.3 - 22.0, p < 0.001), FEV1/FVC at the time of diagnosis; HR: 5.1 (95% CI, 1.65 - 15.4, p-value < 0.004), and FEV1 25-75; HR: 3.6 (95% CI, 1.1- 11.8, p-value = 0.03). Conclusions: Factors associated with increased risk of mortality included presence of neonatal complications, low BMI and lower pulmonary function test results. Low BMI and low PFT indices are modifiable and possibly can be improved by early diagnosis. A new-born screening test may help in early diagnosis and identification of the neonatal problem of CF.

A rare autosomal recessive condition, Arterial tortuosity syndrome (ATS) presents with ectactic blood vessels, cutaneous laxity, and bowel rupture. We report a case of an asymptomatic infant with arterial tortuosity syndrome who presented with left ventricular hypertrophy without any obvious obstruction to the outflow tract.

Background: Recurrence after Radiofrequency catheter ablation（RFCA） of persistent atrial fibrillation (PeAF) is still elusive. The present study aimed to evaluate the relationship between the left atrial appendage peak flow velocity(LAAV) and atrial fibrillation(AF) recurrences in PeAF patients after their initial RFCA. Method: This study included 164 consecutive PeAF patients who performed initial RFCA from January 2018 to December 2019. Transesophageal echocardiography was used to collect the LAAV before ablation. Patients’ demographic and clinical information was gathered. To detect the recurrences of AF, patients were checked up at routine intervals. A Cox proportional hazards regression analysis was adopted to evaluate the LAAV and other clinical variables as predictors of AF recurrences throughout follow-up. Results: AF recurrence resulted in 43 (26.2%) patients after a median follow-up of 15 months (IQR: 12-18 months). LAAV reduced in patients with AF recurrences (0.36±0.15m/s vs. 0.45±0.17m/s, P = 0.004). A Kaplan-Meier study revealed that the low LAAV(≤0.37m/s) group had a lower event-free survival rate than the high LAAV (>0.37m/s) group (17.6 months vs. 21.2 months, Log Rank P = 0.002). LAAV≤0.37m/s (HR 2.32, 95%CI 1.177-4.227, P = 0.014) was found to be independent predictors of AF recurrence after RFCA in the multivariate Cox regression. Conclusion: A low LAAV is linked to AF recurrence and acts as a predictor of AF recurrence after the initial RFCA of peAF. This would aid in treatment strategy optimization and management of patients with peAF.

Children frequently respond differently to therapies compared to adults. Differences also exist between paediatric age groups for pharmacokinetics and pharmacodynamics in both efficacy and safety. Paediatric pharmacovigilance requires an understanding of the unique aspects of children with regards to, for example, drug response, growth and development, clinical presentation of adverse drug reactions (ADRs), how they can be detected and population specific factors (e.g. more frequent use of off-label/unlicensed drugs). In recognition of these challenges a group of experts has been formed in the context of the conect4children (c4c) project to support paediatric drug development. This expert group collaborated to develop methodological considerations for paediatric drug safety and pharmacovigilance throughout the life-cycle of medicinal products which is described in this article. These considerations include practical points to consider for the development of the paediatric section of the risk management plan (RMP), safety in paediatric protocol development and safety data collection and analysis. Furthermore, they describe the specific details of post-marketing pharmacovigilance in children using, for example, spontaneous reports, electronic health care records, registries and record-linkage, as well as the use of paediatric pharmacoepidemiology studies for risk characterisation. Next the details of the assessment of benefit-risk and challenges related to medicinal product formulation in the context of a Paediatric Investigation Plan (PIP) are presented. Finally, practical issues in paediatric signal detection and evaluation are included. This paper provides practical points to consider for paediatric pharmacovigilance throughout the life-cycle of medicinal products for RMPs, protocol development, safety data collection and analysis and PIPs.

The assessment of CASP models for utility in molecular replacement is a measure of their use in a valuable real-world application. In CASP7, the metric for molecular replacement assessment involved full likelihood-based molecular replacement searches; however, this restricted the assessable targets to crystal structures with only one copy of the target in the asymmetric unit, and to those where the search found the correct pose. In CASP10, full molecular replacement searches were replaced by likelihood-based rigid-body refinement of models superimposed on the target using the LGA algorithm, with the metric being the refined likelihood (LLG) score. This enabled multi-copy targets and very poor models to be evaluated, but a significant further issue remained: the requirement of diffraction data for assessment. We introduce here the relative-expected-LLG (reLLG), which is independent of diffraction data. This reLLG is also independent of any crystal form, and can be calculated regardless of the source of the target, be it X-ray, NMR or cryo-EM. We calibrate the reLLG against the LLG for targets in CASP14, showing that it is a robust measure of both model and group ranking. Like the LLG, the reLLG shows that accurate coordinate error estimates add substantial value to predicted models. We find that refinement by CASP groups can often convert an inadequate initial model into a successful MR search model. Consistent with findings from others, we show that the AlphaFold2 models are sufficiently good, and reliably so, to surpass other current model generation strategies for attempting molecular replacement phasing.

The blends of coal combustion by-products (CCBs) with organic wastes (sewage sludge and spent mushroom compost) were investigated for elaboration of soil substitutes for land rehabilitation of coal mine affected areas. The study incudes four types four types of habitat with different water retention and fertility i.e.: dry and moderate fertility (A1-A3), mesic and low fertility (B1-B3), mesic and moderate fertility (C1-C3), humid and low fertility (D1-D3). Obtained results revealed that the amounts of macronutrients were sufficient for supporting plant growth i.e.: N (0.44-0.60 %), P (0.13-021 %), K (1.63-1.98 %), Mg (1.01-1.38 %), Ca (5.32-8.23 %), S (2.66-4.12 %), whereas the concentration of organic matter varied within the range 20.3-27.9 %. Phytotest using white mustard (Sinapis alba) seeds under laboratory conditions showed that the best results of sprouting i.e: 56 and 66 % were obtained for D2 and D3, respectively. The values of pH (8.16-8.78) and electrical conductivity (5.28-6.73 mS·cm-1) of tested soil substitutes were found to be the decisive factors limiting the germination process. The coefficients between the parameters of soil substitutes and the Sinapis alba sproutings have revealed negative correlation with electrical conductivity (r = -0.46). Additionally, tests with meadow vegetation gave promising opportunity for the use of soil substitutes in the process of land rehabilitation. The cover of the mesic and dry meadow vegetation reached 90%. The Principal Component Analysis (PCA) has outlined that pH, content of P and organic matter, are the most important factors that influence cover of meadow vegetation.

Pesticide pollution has gradually caused land degradation. In order to avoid this problem, it is recommended to use enantiomeric pesticides that have less impact on the soil. The degradation of CYF enantiomers and the effect on soil functions are closely related to microorganisms. (+)-CYF enantiomer is degradable preferred and further discovered that related microorganism that degrades enantiomers. CYF enantiomers alter the bacteria structure and decreased the bacteria abundance. The combination of high-throughput and quantitative PCR results showed that the diversity of the (+)-CYF treatment was significantly lower than that of the (-)-CYF (-30.41 to 44.60) treatment and the (+)-CYF treatment (-27.80 to 56.70%) was more capable of causing the decrease in the number of soil microorganisms. In addition, (+)-CYF severely interferes with nitrogen cycling-related functions. Furthermore, the soil microbial structure was changed to its original level by enantiomers posed. In the study of nitrogen cycle function, we found that both enantiomers can restrain the abundance of nitrogen cycle-related genes, especially the (+)-CYF treatment decreased more. CCA showed that g-Massilia and g-Arthrobacter are closely related to nitrogen fixation genes and nitrification genes and degradation of the two enantiomers of CYF by g-Arthrobacter is closely related. The biological effects of cyflumetofen enantiomers remain unclear. Bioassay results show that enantiomers have similar virulence to Tetranychus cinnabarinus. Therefore, while achieving the prevention and control effect, the use of a single isomer (+)-CYF has a higher potential risk to the soil ecosystem.

A document by Arik Makovitzki. Click on the document to view its contents.

McArdle disease (Glycogen storage disease type V, GSDV ) is an inherited disorder of glycogen metabolism affecting only skeletal muscles. A 56-year-old male patient with McArdle disease had the symptoms such as fatigue, muscle weakness since he was 8 years old in his history. A Pre-emptive kidney transplant from his wife was performed on the patient who has gone through rhabdomyolysis attacks during his life period. As far as known, this is the first case in the literature. We aim to share this process before and after the transplantation.

Objective: In this study, it was aimed to focus on the psychological aspect of unexplained infertility by comparing the mental symptoms of infertility due to known causes and fertile patients. Patients and Methods: 60 unexplained infertility patiens, 50 infertile patients with a known cause and 56 fertile patients were included in the study. Socio-demographic data form, Toronto Alexithymia Scale (TAS-20), Somatosensory Amplification Scale (SAS) and Anxiety Sensitivity Index (ASI-3) were applied to the patients. Results: No significant differences in the levels of alexithymia, somatosensory amplification, and anxiety sensitivity were detected across the groups (p>0.05). When the correlation of clinical scale scores with each other was analyzed in the whole group of infertile patients regardless of the cause, anxiety sensitivity was found increased as difficulty identifying feelings increased. Conclusion: In our study, it has been found out that; regardless of the knowledge of the etiology of infertility, the levels of alexithymia, somatosensory amplification, and anxiety sensitivity of infertile cases did not differ from those of fertile women. However, it has been shown that as the difficulty in identifying emotions increases in infertile cases, anxiety sensitivity, which may cause psychological infertility, also increases.

Background: The aim of this study was to investigate the effect on the occurrence of emergence delirium of propofol and ketofol with intranasal dexmedetomidine and midazolam applied as premedication to paediatric patients during magnetic resonance imaging (MRI). Methods: The study included children aged 2-10 years who received sedation for MRI, separated into four groups. Group MP received intranasal midazolam (0.2 mg/kg) for premedication and IV propofol (1 mg/kg) as the anaesthetic agent. Group MK received intranasal midazolam (0.2 mg/kg) for premedication and IV ketofol (1 mg/kg) as the anaesthetic agent. Group DP received intranasal dexmedetomidine (1 mcg/kg) for premedication and IV propofol (1 mg/kg) as the anaesthetic agent. Group DK received intranasal dexmedetomidine (1 mcg/kg) for premedication and IV ketofol (1 mg/kg) as the anaesthetic agent. The Paediatric Anaesthesia Emergence Delirium (PAED) scale was used to evaluate delirium. A PAED score ≥ 10 was accepted as delirium. Results: The need for additional anaesthetic was highest in Group DP at 94.3% and lowest in Group DK at 14.3%. The mean Aldrete and PAED scores were lower and the length of stay in the recovery room was shorter in Group DP than in the other groups. Delirium only developed in two patients in Group MP (5.7%) at 5 mins after anaesthesia. Conclusion: In our study, delirium was seen at a very low rate only in the Group MP and it is difficult to say the best combination in terms of delirium frequency with this result.

Human activity and natural processes have led to widespread dissemination of metals and metalloids, many of which are toxic and have a negative impact on agronomic production. Roots, as the first point of contact, are essential in endowing plants with tolerance to excess metal(loid) in the soil. The most important root responses include: adaptation of transport processes that affect uptake, efflux and long distance transport of metal(loid)s; metal(loid) detoxification within root cells via conjugation to thiol rich compounds and subsequent sequestration in the vacuole; plasticity in root architecture; the presence of bacteria and fungi in the rhizosphere that impact on metal(loid) bioavailability; the role of root exudates. In this review we will provide details on these processes and assess their relevance for the detoxification of arsenic, cadmium, mercury and zinc. Furthermore, we will assess if any of these methodologies has been tested in field conditions and whether they are effective in terms of improving crop metal(loid) tolerance.

Le bioplastiche, fin dal loro inserimento nei processi produttivi, sono state considerate come una alternativa sicura ed ecosostenibile alle “normali” plastiche (a base di petrolio) ree di danneggiare invariabilmente l’ecosistema, in particolare quello marino. Di fatti, è stimato che circa il 56% della plastica prodotta annualmente non venga riciclata o incenerita, bensì venga scartata soprattutto negli oceani in forma di microplastiche. Di conseguenza, la ricerca sulle bioplastiche e specificamente sul loro ciclo vitale è un campo di studio di notevole interesse ed in rapida crescita. Tuttavia, pensare alle bioplastiche come la perfetta soluzione al problema dell’inquinamento da plastica sarebbe un grossolano errore nonostante la loro produzione avvenga a partire da fonti rinnovabili.  Infatti, la maggior parte delle bioplastiche sono biodegradabili ma non compostabili.Il fine di questo lavoro è quindi quello di dare luce alla parte meno conosciuta, e spesso ignorata, delle bioplastiche; ovvero il loro potenziale dannoso sia durante la loro produzione, sia nei vari processi di smaltimento, ed in particolare in ambiente marino; nonché sull’applicazione del criterio e delle tecnologie di economia circolare per il recupero, ed il riutilizzo delle bioplastiche all’interno degli impianti di smaltimento delle acque reflue.

Renal coloboma syndrome (RCS) is an autosomal dominant disorder associated with the PAX2 gene. With variable expressivity, renal and ocular abnormalities are reported in a majority of individuals affected. We highlight a mother and her newborn with RCS, both presenting prenatally, showing self-resolving severe oligohydramnios as an early prenatal finding.

Neurological manifestation and complications are common due to COVID-19. It affects higher functions, cranial nerves and the motor system. The authors report a case of GBS as an example of a success story in managing a complicated case of COVID-19 in an elderly male with signs of a poor prognosis.

Background: We hypothesized that the geographic distributions of COVID-19 prevalence and risky alpha-1-antitrypsin allele prevalence are similar. We aimed to investigate whether there is a relationship between the geographical density of the COVID-19 pandemic and the distributions of risky alpha-1-antitrypsin alleles. Methods: This research is a cross-sectional study. Alpha-1-antitrypsin PI*SZ and PI*ZZ genotypes frequencies of European and American countries were compared with the case and death data related to the COVID-19 pandemic as of March 30, 2021. The relationship between the data was evaluated using Linear regression analysis. Results: According to the linear regression analysis results, a significant relationship was found between the number of COVID-19 cases in both European and American countries and the sum of PI*SZ and PI*ZZ genotypes. Similarly, according to the linear regression analysis results, a significant relationship was found between the COVID-19 death numbers in both European and American countries and the sum of PI*SZ and PI*ZZ genotypes. Conclusions: The findings showed that the prevalence distribution of the risky alleles of the gene defect that causes alpha-1-antitrypsin insufficiency is related to the prevalence of COVID-19 pandemic data.

Abstract Background It is not clear if there is a inaccurate effect of obesity and pneumoperitoneum on non-invasive monitoring parameters Objectives To determine the effects of CO2 pneumoperitoneum and desufflation on non-invasive monitoring variables between obese and non-obese patients undergoing laparoscopic surgery. Methods Sixty patients were included in the study who underwent laparoscopic cholecystectomy between February 2019-November 2019. After anesthesia induction, systolic and diastolic blood pressures, heart rate(HR), operation and pneumoperitoneum durations, PVI and SpHg data were recorded. Results The patients were divided into two groups. There was no statistically significant difference between the groups in terms of chronic diseases, operation and pneumoperitoneum durations. Statistically no significant difference was found between the groups for PVI and SpHb values. In comparison of PVI measurement values according to T0, a significant difference was found in T3,T4 and T5 in Group 2 compared to T0 (p=0.010;0.012;0.041). In comparison of SpHb measurement values according to T0, a statistically significant difference was found in T1,T2 and T3 in Group 2 compared to T0 (p=0.008;0.010;0.037). In comparison to T5, there was a significant difference in T1,T2 and T3 in Group 2 (p=0.023;0.005;0.006). Conclusion In obese people, pneumoperitonium can lead to inaccuracies in monitoring PVI and SpHb. Although these two parameters are very valuable in intraoperative follow-up, they should be used carefully during laparoscopic procedures in obese patients. If these parameters (PVI and SpHb) are considered to be used in bariatric surgeries, this information should be considered.

A document by Andrea Leonardi. Click on the document to view its contents.

Purpose: Cardiac resynchronization therapy (CRT) has a positive effect on the improvement of functional mitral regurgitation in patients with heart failure with reduced ejection fraction. However geometric changes in the mitral valve apparatus, subvalvular structures and their contribution to the improvement of mitral regurgitation after CRT have not been clearly defined. The aim of our study was to evaluate the geometric parameters of mitral valve apparatus measured with 3Dimensional (3D) transesophageal echocardiography (TEE) before CRT implantation and to determine the parameters predicting the improvement of mitral regurgitation after CRT. Methods: In this prospective study thirty patients with moderate or severe mitral regurgitation with low EF heart failure planned for CRT implantation and had an indication for TEE were included. Effective regurgitant orifice (ERO) and regurgitant volume (RV) measurements were performed before CRT implantation. Detailed quantitative measurements of mitral valve were done from recorded images by 3D TEE. ERO, RV measurements were repeated to evaluate mitral regurgitation at the end of 3rd month. Results: There were no significant changes in left ventricular EF and left ventricular diameters at third month follow-up, whereas ERO and RV values were decreased. posterior leaflet angle was found higher in non-responder group compared to responder group. (28,93 ± 8,41 vs 41,25 ± 10,90, p = 0,006). Conclusion: Heart failure patients with moderate or severe functional mitral regurgitation who underwent CRT implantation were found lower posterior leaflet angle which was measured by 3D TEE in the patient group whose mitral regurgitation improved after CRT.

Transcatheter aortic valve implantation (TAVI) is the more common choice of procedure for the severe aortic stenosis patients with high surgical risk. While the popularity of TAVI increases, TAVI related complications, such as infective endocarditis (IE) increase in number. There are no specific guidelines for TAVI-IE, so shaping a path according to patient’s clinical status is more reasonable. With different advantages for each, multiple imaging modalities should be used for follow-up. In our case, repeated multiple imaging modalities were used to decide early surgery versus conservative approach by detecting periaortic pseudoaneurysm after TAVI.

Left atrial intramural hematoma (LAIH) is an uncommon entity for which a timely diagnosis is critical for decision making. Cardiac surgical or catheter-based procedures are potential causing factors. Though cardiac computerized tomography and magnetic resonance are highly accurate diagnostic modalities, their role is limited by the lack of widespread availability. The present clinical case illustrates the diagnostic features of LAIH that can be obtained using echocardiography at the bedside in critically ill patients. We report a case of LAIH, that followed a catheter ablation procedure and was complicated by cardiac and cerebral ischemia. Cardiac surgical management was required.