Background: Obstructive sleep apnea (OSA), the most common upper-airway disease, is closely associated with cardiovascular risk. However, the early screening of OSA is challenging, relying on polysomnography (PSG) or home sleep apnea test (HSAT) in hospitals. Photoplethysmography (PPG) has been developed as a novel technology for OSA screening, but the validation of PPG-based smart devices is limited as compared to that for PSG or HSAT. Objective: This study aimed to investigate the feasibility and validity of PPG-based smart devices in the screening of OSA. Methods: A total of 119 consecutive outpatients were recruited from the Chinese PLA General Hospital and assessed for a whole-night sleep using a smartwatch, PSG, or HSAT. Results: 17/119 patients were excluded from the study due to the poor quality of PPG signals. Among the remaining, 83 patients were diagnosed with OSA. Compared to HSAT devices, the accuracy, sensitivity, and specificity of PPG-based smart devices in predicting moderate-to-severe OSA patients (apnea-hypopnea index, AHI≥15) were 87.9%, 89.7%, and 86.0%, respectively. Compared to PSG, the accuracy, sensitivity, and specificity in predicting sleep apnea in patients (AHI≥5) were 81.1%, 76.5%, and 100%, respectively. Moreover, for moderate-to-severe OSA patients (AHI≥15), the predictive ability of PPG-based smart devices in OSA did no differ significantly as compared to HSAT (P=0.75) or PSG (P=0.52). Conclusions: The PPG-based smart devices performed adequately in detecting OSA; nevertheless, validation in a large-scale population is imperative.

Aims of the study To assess the effectiveness of medicine and immunotherapy on secretory azoospermia. Methods used to conduct the study The husband with azoospermia was 63 years old and his 35-year-old wife presented secondary infertility for 5 years. The male had operation and chemotherapy of stomach cancer five years ago. After operation and chemotherapy,the male made the treatment on immunotherapy until today. In this treatment, andriol and aescuven forte was given. The total treatment were fourteen months. Semen, blood hormone and pregnancy were detected. Results of the study Six months after treatment, sperm appeared in the semen（2018-12-13：sperm concentration 3×106/ml，PR 0%）, ICSI was made while ET was failure. 1 year later, the semen was changed greatly (2019-01-29：sperm concentration 43×106/ml，PR 15%，acrosin 43.1μIU/106), second ICSI was made and TET was failed. In May,2020, third cycle ICSI was made,frozen embryo was transplanted in December and in March the wife was conceived for morn than four months. Conclusions We have discussed and published the medicine treatment of azoospermia in 2017 while it is the first time to find the relationship between the spermatogenesis and immunotherapy. Form this case, it could been concluded that Aescuven Forte with Testosterone Undecanoate is good for the patient with testicle dysfunction whhile the time of medicine treatment is better for more than six months. Immunotherapy might be good for spermatogenesis. FSH is a good for ample in the treatment on azoospermia.

Chenopodium quinoa (quinoa) is considered a superfood, as it has favourable nutrient composition and is gluten free. Quinoa has high tolerance to several abiotic stresses, i.e. salinity, water deficit (drought) and cold. The tolerance mechanisms are yet to be elucidated. Quinoa has Epidermal Bladder Cells (EBCs) that densely cover the shoot surface, particularly the younger parts of the plant. Here, we report on the EBC’s primary and secondary metabolomes, as well as the lipidome in response to abiotic stresses. EBCs were isolated from plants after cold, heat, high-light, water deficit and salt treatments. We used untargeted Gas Chromatography-Mass Spectrometry (GC-MS) to analyse metabolites and untargeted and targeted Liquid Chromatography-MS (LC-MS) for lipids and secondary metabolite analyses. We identified 64 primary metabolites, including sugars, organic acids and amino acids, 19 secondary metabolites, including phenolic compounds, betanin and saponins and 240 lipids categorized in five groups including glycerolipids and phospholipids. Although we found only few changes in the metabolic composition of bladders in response to abiotic stresses, metabolites related with heat, cold and high-light treatments, but not salt stress, were changed significantly. Na+ concentrations were low in EBCs with all treatments, and approximately two orders of magnitude lower than K+ concentrations.

This paper is concerned with the following nonlocal Schr\”{o}dinger-Poisson type system: \begin{equation*} \begin{cases} -\left(a-b\int_{\Omega}|\nabla_{H}u|^{2}dx\right)\Delta_{H}u+\mu\phi u=\lambda|u|^{q-2}u, &\mbox{in} \ \Omega,\\ -\Delta_{H}\phi=u^2 & \mbox{in}\ \Omega,\\ u=\phi=0 & \mbox{on}\ \partial\Omega, \end{cases} \end{equation*} where $a, b>0$ and $\Delta_H$ is the Kohn-Laplacian on the first Heisenberg group $\mathbb{H}^1$, $\Omega\subset \mathbb{H}^1$ is a smooth bounded domain, $\lambda>0$, $\mu\in \mathbb{R}$ are some real parameters and $1“”

Qualification & Affiliation-M.B.B.S., Bihar Health Services, Government of Bihar, IndiaThe current ongoing coronavirus pandemic caused by SARS-CoV-2/covid-19/novel coronavirus is an acute infectious communicable disease spreading mainly via respiratory, eye, mouth and other possible routes from person to person as well as through contact with infected non living objects. Added to previous global burden of NCDs (non communicable diseases) & other communicable diseases this new pandemic burden of covid-19 pandemic have put a stress on already overstressed health system of India particularly poor states like Bihar.11Kumar P. What Impact Have SARS-CoV-2/Covid-19 Pandemic on the Reproductive and Child Health Programme of Bihar in India over the 3 months after nationwide Lock down announcement in March 2020? How SARS-CoV-2 Pandemic era does influence RCH Programme? Immunisation, Maternal Health, Family Planning, Research Square, 2021 DOI: 10.21203/rs.3.rs-348841/v4. The delivery of health services is of utmost importance and prime concern in India particularly poor states like Bihar due to high population load with limited resources, poor infrastructure and huge demand on healthcare system. The Healthcare workers (HCWs) are particularly vulnerable group hence this topic needs essential attention and protection.22https://www.researchsquare.com/article/rs-360551/v1The SARS-CoV-2 pandemic had presented a challenge even for developed healthcare systems around the world.33https://europepmc.org/article/ppr/ppr304897 A sense of fear gripped the whole world due to pandemic and India is not an exception. The scarce healthcare resources including manpower, infrastructure, transportation (ambulance services) etc. have been largely deployed to tackle the situation of pandemic of Covid-19. This shift & covid-19 pandemic has tremendous and detrimental effects on HCWs. The healthcare workers of India as well as Bihar are getting frequently infected leading to death of thousands of healthcare workers till date . Although there are several guidelines issued for precaution and safety at workplace by WHO (world Health Organization) & several accredited organizations but a protective and supportive approach from local management and governance is need of the hour . It seems that there is failure of protective and preventive measures at workplace documented and evidenced by several deaths of healthcare workers. Consequently it is apparent from above scenario to ensure the health and safety of healthcare workers in order to control the outbreak and decrease panic and fear among healthcare workers. In this article I am sharing methods and various ways for protecting healthcare workers (HCWs) while having hospital duties as well as policy makers and management people can also find this article useful while making policies for protecting and safeguarding HCWs. This article aims to reduce incidence/prevalence as well as mortality and morbidity of HCWs in Bihar by suggesting important precautions, preventive measures and other facts to be adopted by healthcare workers at workplace as well as drawing attention of policy maker, important stakeholders and management people to provide protection to HCWs.Healthcare workers (HCWs), covid-19 infection, safety, pandemicBackground: The case fatality rate among doctors due to Covid-19 infection is far more in Bihar says IMA (Indian Medical Association) official “Doctors account for 0.5 per cent of the total deaths in India due to Covid-19. However, in Bihar, the percentage of doctors’ death is 4.75 per cent, which is nine times more than the national average,” said senior vice-president of IMA-Bihar Dr Ajay Kumar. “In other states, doctors doing duty in Covid-19 wards are quarantined for 15 days after 15 days of continuous work. This arrangement is not followed in Bihar, as a result of which our doctors remain exposed to Covid-19 patients far longer than in other states. In fact, in Bihar, doctors are working continuously at a stretch since mid-March2020, without even an off day,” said Dr Kumar. Protective gears available here are questionable .44https://www.hindustantimes.com/india-news/death-rate-among-doctors-due-to-covid-far-more-in-bihar-says-ima-official/story-I6hRm0eoJAVXMWSgcyu8zN.htmlThere is a growing concern and sense of fear among healthcare workers of Bihar erupting from the news regarding daily death of HCWs due to covid-19 infections acquired at workplace, violence & struggle at workplace, scarcity and supply of inferior quality PPE55https://www.telegraphindia.com/india/bihar-doctor-deaths-blamed-on-inferior-ppe/cid/1788730 see figure 3 a doctor (author himself) working in Bihar using bedcover as PPE kit for protection due to scarcity of PPE kit. The healthcare workers are under undue stress due to several factors added to this which may affect mental health as well as physical and social health status of care providers. On March 11, 2020, the World Health Organization announced covid-19 as a pandemic and within no time infection first discovered in china (december2019), Hubei province reached India in January 2020. The health work force in Bihar is struggling since then with strict regulation and legal bindings as well as scare resources added with regular death of workers and patients creating stress and panic. In the current year 2021 and last year 2020 healthcare workers have had a high rate of infection hence for safety of healthcare workers it’s important to ensure that procedures, equipment and training are fully protective. At the same time long term, nursing, and resident care providers should have guidance for long term care, nursing homes, assisted patient living facilities and other resident care facilities such as ICU/covid-19 wards for protective measures to reduce the high incidence and prevalence of covid-19 cases and deaths of workers. Emergency services must have critical infrastructure to be able to function properly including law enforcement, fire and violence safety etc. This time last year in 2020 India was under lockdown phase, many theories about India’s surprisingly low rates of Sars-CoV-2 infection included variety of factors including hot weather, natural immunity, heard immunity, robust health system, highly qualified doctors and the country’s high proportion of young people; some also attributed it to the country’s harsh lockdown. India was doing so well that in megacities like Mumbai and Delhi, officials had begun dismantling temporary COVID-19 facilities. Comparing it to current scenario in April 2021, cases and deaths are soaring. The shortage of beds and space is so acute that people are dying in car parks and other places while waiting to be admitted in hospitals. Daily rates are currently over 300,000, the world’s highest-ever daily infection rate. The SARS-CoV-2/COVID-19 pandemic is still going on and globally as well as in India particularly healthcare system is overstressed with this new burden added with previous NCD(non communicable diseases) & CD(communicable diseases). The First human case of this global pandemic was reported from Wuhan city of China in December 2019. The first case of COVID-19 in India was found in January 2020. Today India is having more than 3 lakh cases per day and thousands of deaths daily due to this pandemic. The situation is very worse as compared to previous year and is worsening day by day due to several factors.66https://covidscholar.org/article/608d13484e85066fbf2f1797Objective and Goals: The key objectives and goals are to increase safety and healthy lifestyle adoption among healthcare workers & providers to reduce mortality and morbidity. Creating awareness & providing training to health care workers for infection control, protective measures, home care, long term care, clinical care etc. The government and policy makers should ensure making and enforcement of safety/preventive/protective protocols to ensure safety at workplace by reducing exposure to SARS-CoV-2 infection sources by using PPE & WASH measures etc. The health department should provide training for Capacity building & awareness among healthcare workers to protect themselves & Creating awareness particularly about good nutrition and sleep which often remain neglected.Establishment of Central advisory committee and research wing at state level to keep health workers updated about latest information and guidelines of treatment as these things are changing continuously & almost daily with new findings. Use of reliable and highly accredited sources such as WHO, ICMR, MoHFW, CDC , peer reviewed publications of reputed science journals etc. for providing information to healthcare workers can be utilized to explain basic factsheet of covid-19 virus and disease through IEC etc., incubation period & transmission through droplet, aerosol, contact and other possible routes (stool etc). Risk assessment of workplace should be carried out by analyzing various parameters related to infection & Stepwise approach instead of high technical letters to demonstrate steps of worker protection in real scenario by experts giving clear description and vision on worker protection and IPC (infection prevention and control).Special capacity building & training of healthcare workers involved particularly in invasive and aerosol generating procedures to protect themselves as well as training of healthcare workers for using PPE , respirators, ventilators etc as well as regarding decontamination of medical and surgical equipments. Health promotion and motivation of healthcare workers by traditional yoga, moral and financial support as well as providing working environment with adequate rest hours to ensure good health added with entertainment programs to divert anxiety.

Background: Vitamin D Deficiency in children is a worldwide health problem. Yet, there is little known about awareness of parents regarding this issue in Jordan. The recent study aimed to assess the mothers’ knowledge and practices toward vitamin D deficiency in infants and up to age of 6 years. Methods: an online questionnaire was distributed as Google Form on mothers of children between 0-6 yeas, assessing their knowledge about vitamin D, its deficiency, and their practices toward vitamin D deficiency for their children, Descriptive statistics and Chi-Square test were performed. Results: Most of mothers (64.8%) were aged between 30-40 years, and had education level of Bachelor’s degree (63.3%). Sunlight was considered the main source of vitamin D (89.1%), while fish and eggs were the main dietary sources (63.5%, 65.5%, respectively). Vitamin D was considered important for bone and teeth health (93.9%). The majority of participants reported lack of sun exposure and decreased vitamin D rich foods as risk factors and rickets as complication of vitamin D deficiency (98.5%, 96.4%, 89.3%, respectively). Most of mothers (65.1%) indicated the time before 10 AM as the best time of day to expose baby/child to the sun. The majority of participants (82.2%) believe that vitamin D deficiency is a common health problem in children in our country, and 86.4% think they need more information on vitamin D deficiency in children. Age, nationality, nature of housing, and age group of children had an impact on knowledge’s level of participants. Conclusion: Most of participants were aware of vitamin D sources, benefits, risk factors and complications of deficiency, although there was inadequate knowledge among respondents was found in certain domains of vitamin D. More education is required for mothers about vitamin D and its deficiency.

Background: Transvenous lead extraction (TLE) is standard of care for the management of patients with cardiac implantable electronic device infection or lead related complications. Currently, objective data on TLE in Latin America is lacking. Objective: To describe the current practice standards in Latin American centers performing TLE. Methods: An online survey was sent through the mailing list of the Latin American Heart Rhythm Association (LAHRS). Online reminders were sent through the mailing list; duplicate answers were discarded. The survey was available for one month, after which no more answers were accepted. Results: A total of 48 answers were received, from 44 different institutions (39.6% from Colombia, 27,1% from Brazil), with most respondents (83%) being electrophysiologists. Twenty-nine institutions (66%) performed less than 10 lead extractions/year, with 7 (15%) institutions not performing lead extraction. Although most institutions in which lead extraction is performed reported using several tools, mechanical rotating sheaths were cited as the main tool (73%), 13.5% reported the use of mechanical extraction sheaths and only 13.5% reporting the use of laser sheaths. Management of infected leads was performed according to current guidelines. Conclusion: This survey is the first attempt to provide information on TLE procedures in Latin America and could provide useful information for future prospective registries. According to our results, the number of centers performing high volume lead extraction in Latin America is smaller than that reported in other continents, with most interventions performed using mechanical tools. Future prospective registries assessing acute and long-term success are needed.

Introduction Programmed electrical stimulation is an essential part of VT ablation procedures but VT is not always inducible, usually for reasons that are not clear. We sought to review pacing site-specific failure of programmed electrical stimulation (PES) to induce scar-related ventricular tachycardia (VT). Methods A series of patients in whom aggressive programmed stimulation from traditional RV pacing sites failed to induce VT, but VT was easily inducible from a non-traditional site are reviewed. Computer simulations in a simple 2-dimensional model of reentry were performed. Results Six patients who had no inducible sustained VT from the RV apex/outflow tract with at least 3 extrastimuli, but relatively easily induced VT from the LV, basal RV, epicardium, or atrium are described. In 5 of these patients, the site that induced VT was closer to the likely reentry circuit region based on mapping and ablation. Computer simulations illustrated that the spatial relation between the pacing site and the entrance and exits of a reentry isthmus can determine the ease of initiation of reentry by determining the time available for recovery of excitability at the initial region of block. Conclusions The site of PES has a marked effect on inducibility of VT in some patients such that PES from the RV apex and outflow regions will fail to expose clinically relevant VTs. The frequency with which this occurs is not certain. Stimulation from alternative sites is a reasonable consideration in selected patients.

Background: Temporary cardiac pacing is frequently required during heart surgery due to life-threatening complications of arrhythmias. The conventional method of epicardial pacing could have risks such as bleeding and myocardial tears. Transvenous endocardial pacing provides another option. The efficiency of transvenous epicardial and endocardial pacing were compared in this study. Methods: We performed a retrospective study and reviewed medical records in patients who received either thoracoscopic cardiac surgery with transvenous endocardial pacing or median sternotomy with transvenous epicardial pacing between June 2019 and January 2021. Patients were assigned into two groups depending on the surgical type and pacing method. Preoperative patient characteristics and perioperative outcomes were collected. The efficiencies of endocardial and epicardial pacing were compared and analyzed in SPSS. Results: A total of 68 patients were included. Thirty-five (51.5%) patients were in the thoracoscopic cardiac surgery group with transvenous endocardial pacing. Thirty-three (48.5%) patients were in the median sternotomy group with transvenous epicardial pacing. Intensive care unit (ICU) time (p = 0.014), in-hospital duration (p = 0.036), operation time (p = 0.005), and the 24-h drainage volume (p < 0.001) showed significant differences between the two groups. There was no significant difference between the pre- and post-operative heart rate and rhythm compared between two groups. Conclusions: Compared with transvenous epicardial pacing, transvenous endocardial pacing showed no significant differences in heart rate and arrhythmia during the perioperative period. Transvenous endocardial pacing was also associated with better operative measurements.

Backgroud The long-term outcomes of this combined procedure remain elusive. This meta-analysis aimed to assess the long-term efficacy and safety of combined procedure. Methods PubMed, Embase, Cochrane Library, and Web of Science were systematically searched from the establishment of databases to 1 January 2021. Studies on the long-term (defined as a mean follow-up of approximately 12 months or longer) efficacy and safety outcomes of combined ablation and LAAC were included for meta-analysis. Results A total of 16 studies comprising 1,428 patients were included in the meta-analysis. The pooled long term freedom rate from atrial arrhythmia was 0.66 (95% confidence interval [CI], 0.59-0.71), long-term successful rate sealing of LAAC was 1.00 (95% CI, 1.00-1.00), and ischemic stroke/transient ischemic attack/systemic embolism during follow-up was 0.01 (95% CI, 0.00-0.02). Meanwhile, the rates of peri-procedural adverse events included phrenic nerve palsy, intracoronary air embolus, device embolization, peri-procedural death of 0.00 (95% CI, 0.00-0.00), procedure-related bleeding events of 0.03 (95% CI, 0.02-0.04), and pericardial effusion requiring or not requiring intervention of 0.00 (95% CI, 0.00-0.01). Moreover, the rates of long-term adverse events rate included device dislocation, intracranial bleeding, and pericardial effusion requiring or not requiring intervention, and all-cause mortality of 0.00 (95% CI, 0.00-0.00), device embolization of 0.01 (95% CI, 0.00-0.01), and other bleeding events of 0.01 (95% CI, 0.00-0.03). Conclusion This meta-analysis suggests that the strategy of combined atrial ablation and LAAC is effective and safe during long-term follow-up

Objectives As we pass the anniversary of the declaration of a global pandemic by the World Health Organisation, it invites us to reflect upon the inescapable changes that coronavirus has wrought upon ENT and, in particular, rhinological practice. As it remains unclear when we will globally emerge from the shadow of COVID-19, a critical analysis of the evidence base on both the assessment and mitigation of risk is vital for ENT departments worldwide. This article presents a systematic review of the literature examining articles which consider either the quantification of risk or strategies to mitigate risk specifically in the setting of rhinological surgery. Design Systematic literature review. Results The literature search yielded a total of 3406 returns with 24 articles meeting eligibility criteria. A narrative synthesis stratified results into two broad themes: those which made an assessment as to the aerosolisation of droplets during sinus surgery, further subdivided into work which considered macroscopically visible droplets and that which considered smaller particles, and those studies which examined the mitigation of this risk. Conclusion Studies considering the aerosolisation of both droplets and smaller particles suggest endonasal surgery carries significant risk. Whilst results both highlight a range of innovative adjunctive strategies and support suction as an important variable to reduce aerosolisation, appropriate use of personal protective equipment (PPE) should be considered mandatory for all healthcare professionals involved in rhinological surgery given studies have demonstrated that close adherence to PPE use is effective at preventing COVID-19 infection.

While the global community has been struggling to contain the Sars-CoV-2 pandemic, another equally deadly enemy of humankind has been out of the general public's focus for years: iatrogenically caused infections and, as a result, deaths in alarming numbers. With this White Paper, we remind the medical community that this epidemic must also be brought to an end. As a prominent and abhorrent example we chose Germany.

Adoptive cell immunotherapy with chimeric antigen receptor (CAR) T cell has brought a revolutionary means of treatment for aggressive diseases such as hematologic malignancies and solid tumors. Over the last decade, FDA approved three types of CAR-T cells against CD19 hematologic malignancies, including Tisagenlecleucel (Kymriah), Axicabtagene ciloleucel (Yescarta), and Brexucabtagene autoleucel (Tecartus). Despite outstanding results gained from different clinical trials, CAR-T cell therapy is not free from side effects and toxicities, and needs careful investigations and improvements. Gene-editing technology, clustered regularly interspaced short palindromic repeats (CRISPR)/ CRISPR-associated protein 9 (Cas9) system has emerged as a promising tool to address some of the CAR-T therapy hurdles. Using CRISPR/Cas9 technology, CAR expression as well as other cellular pathways can be modified in various ways to enhance CAR-T cell’s anti-tumor function and persistence in immunosuppressive tumor microenvironment. CRISPR/Cas9 technology can also be utilized to reduce CAR-T cells toxicity and side effects. Hereby, we discuss the practical challenges and hurdles related to the accuracy, efficiency, efficacy, safety and delivery of CRISPR/Cas9 technology to the genetically engineered-T cells. Combining of these two state-of-the-art technologies, CRISPR/Cas9 and CAR-T cells, the field of oncology has an extraordinary opportunity to enter a new era of immunotherapy, which offers novel therapeutic options for different types of tumors.

A document by Lara Shemtob. Click on the document to view its contents.

Background Diabetic neuropathy is a complication seen in diabetic patients and involves motor, sensory or autonomic nerve fibres due to minor vessel damage. Aims This study was planned to determine the knowledge and awareness levels of physicians working in family health centres about diabetic neuropathy and their approach to diabetic neuropathy. Methodology Our study is a cross-sectional descriptive study conducted in 111 family health centres in Denizli. The data were obtained by face to face questionnaire method. Results Of the 219 people participating in the study, 70.8% (n = 155) were male and 6.8% (n = 15) were family medicine specialists. 52.5% (n = 115) of the participants allocated 6-10 minutes of examination time to diabetes mellitus patients, 77.6% (n = 170) did not receive diabetic neuropathy training after graduation, and 44.3% (n = 97) ) had not previously diagnosed any patient with diabetic neuropathy. 74.4% of the participants (n = 163) stated that they did not use any diabetic neuropathy diagnosis and screening tests in their daily practice. 31% (n = 68) of the participants stated that their level of knowledge on diabetic neuropathy was either poor or very poor. 45.7% of the participants (n = 100) thought diabetic neuropathy screening, diagnosis, treatment and follow-up could be made in primary care. 89.5% (n = 196) of the participants stated that they needed training on diabetic neuropathy. Those who rely on their knowledge and clinical experience in diagnosing, monitoring and treating diabetic neuropathy were 44.3% of the participants (n = 97). Conclusion Although diabetic neuropathy is one of the most critical complications of diabetes mellitus, there is a severe insufficiency in postgraduate education in primary health care services. Simple tests and methods for physicians working in primary care should be included in the daily polyclinic routine.

Gastric cancer rarely disseminates to the bone. Initial clinical presentation of bone metastasis without any preceding gastrointestinal symptoms in gastric cancer patient is also extremely infrequent. Herein, we report an original case of gastric cancer revealed by a pathologic fracture due to bone metastasis.

Objective: To investigate the symptomatic relief and functional preservation of a novel surgical strategy combined with triple semicircular canal occlusion and endolymphatic sac decompression in patients with intractable Meniere’s disease. Design: Retrospective analysis. Setting: Patients with intractable Meniere’s disease in the Department of Otolaryngology Head & Neck in the Second Affiliated Hospital of Nanchang University between July 2015 and June 2019. Participants: Data from 46 patients diagnosed with Meniere’s disease, and underwent surgery Methods: Triple semicircular canal occlusion combined with endolymphatic sac decompression was performed in all patients with intractable Meniere’s disease. Pre- and postoperative vertigo attacks, hearing levels, tinnitus, aural fullness, and equilibrium function rehabilitation were analyzed at defined time points during follow-up. Results: A significant vertigo control rate was observed in all patients postoperatively. The overall control rate of vertigo postoperatively was 100% in the entire follow-up, with a complete control rate of 97.8% and a substantial control rate of 2.2%. The rate of hearing preservation was 54.35%, and all patients suffering from hearing deterioration were at stages III and IV. The rate of tinnitus and aural fullness alleviation was 65.8% and 100%, respectively. Four patients failed to regain the equilibrium function postoperatively. Conclusion: Combining triple semicircular canal occlusion with endolymphatic sac decompression is an efficient strategy for vertigo control in patients with intractable Meniere’s disease. Patients in advanced stages suffered more from hearing function deterioration. Hearing preservation and tinnitus alleviation warrant further investigation.

Background: Perinuclear anti-neutrophil cytoplasmic antibodies (P-ANCA), a subset of ANCA, are associated with a multisystem vasculitis affecting small blood vessels in the body. A handful of adult patients who developed vasculitis post-COVID-19 infection have been reported. Although COVID-19 infection has been shown to drive an exaggerated immune response in the pediatric population, such as MIS-C (multisystem inflammatory syndrome in children), only one case of vasculitis following COVID-19 infection has been reported previously in children. Case presentation: Seventeen-year-old male with a past medical history of COVID-19 pneumonia two months prior presented with acute kidney injury/failure and diffuse alveolar hemorrhage (DAH). Rheumatologic workup revealed P-ANCA and Myeloperoxidase (MPO) positivity. Kidney biopsy showed necrotizing glomerulonephritis with limited immune complex deposition. Subsequently, he was treated with pulse steroids, plasmapheresis, and ultimately started on cyclophosphamide. Conclusions: To our knowledge, this report presents the second reported pediatric case of P-ANCA / MPO vasculitis following COVID-19 infection.

RT-PCR is currently the standard diagnostic method to detect symptomatic and asymptomatic individuals infected with SARS-CoV-2. However, RT-PCR results are not immediate and may falsely be negative before an infected individual sheds viral particle in the upper airway where swabs are collected. Infected individuals emit volatile organic compounds (VOCs) in their breath and sweat that are detectable by trained dogs. Here we evaluate the diagnostic accuracy of dog detection against SARS-CoV-2 infection. Fifteen dogs previously trained at two centres in Australia were presented to axillary sweat specimens collected from known SARS-CoV-2 human cases and non-cases. The true infection status of the cases and non-cases were confirmed based on RT-PCR results as well as clinical presentation. Across dogs, the overall diagnostic sensitivity (DSe) was 95.6% (95%CI: 93.6%-97.6%) and diagnostic specificity (DSp) was 98.1% (95%CI: 96.3%-100.0%). The DSp decreased significantly with non-case specimens sourced from UAE ( P-value < 0.001). The location of evaluation did not impact the detection performances. The accuracy of detection varied across dogs and experienced dogs revealed a marginally better DSp ( P-value = 0.003). The potential and limitations of this alternative detection tool are discussed.

Cardiac surgery in patients already implanted with subcutaneous implantable cardioverter defibrillators (S-ICD) represents a challenge. Although a few reports described successful surgical procedures in these patients, a traditional approach with median sternotomy might potentially cause S-ICD malfunctioning. Minimally invasive techniques (e.g. left anterior thoracotomy) should be considered the first choice in order to preserve the integrity of the S-ICD system in suitable patients. Herein, we provide the first report of a patient implanted with S-ICD due to post-ischemic left ventricular dysfunction who underwent successful minimally invasive direct coronary artery bypass (MIDCAB).

The fiber metal laminates (FMLs) of both Ti/APC-2 neat and nanocomposite laminates were fabricated. The double-edged cracks of both symmetry and anti-symmetry were cut in FMLs. From tensile tests we received the load vs. displacement curves and mechanical properties. From cyclic tests the load vs. cycles (P-N) curves, residual life, and failure mechanisms were obtained. The mechanical properties of symmetrically cracked specimens were slightly lower than those of anti-symmetrically cracked counterparts. As the crack length increasing and inclined angle decreasing, the fatigue life decreased. The enhancement of nano-powder improved the ultimate load and fatigue life. The local stress intensity at the crack tip dominates the fatigue responses. The piece of elliptical part was observed from cyclic tests at failure. Although the attraction of two crack tips accelerated the crack growth rate, however, the delay to failure was caused by forming a small piece of ellipse centrally.

Developing media to sustain cell growth and production is an essential and ongoing activity in bioprocess development. Modifications to media can often address host or product-specific challenges, such as low productivity or poor product quality. For other applications, systematic design of new media can facilitate the adoption of new industrially relevant alternative hosts. Despite manifold existing methods, common approaches for optimization often remain time and labor intensive. We present here a novel approach to conventional media blending that leverages stable, simple, concentrated stock solutions to enable rapid improvement of measurable phenotypes of interest. We applied this modular methodology to generate high-performing media for two phenotypes of interest: biomass accumulation and heterologous protein production, using high-throughput, milliliter-scale batch fermentations of Pichia pastoris as a model system. In addition to these examples, we also created a flexible open-source package for modular blending automation on a low-cost liquid handling system to facilitate wide use of this method. Our modular blending method enables rapid, flexible media development, requiring minimal labor investment and prior knowledge of the host organism, and should enable developing improved media for other hosts and phenotypes of interest.

Background/Objectives: The clinical characteristics and prognostic factors of aspiration pneumonia remain poorly defined. Geriatric nutrition risk index (GNRI) has recently been reported to exhibit a prognostic value for several diseases in older adults. Thus, we aimed to investigate the clinical characteristics and prognostic significance of GNRI for aspiration pneumonia in a sample of older adult patients. Design: Retrospective observational cohort study. Setting: Single-institute acute-phase community hospital. Participants: Patients with aspiration pneumonia diagnosed at our institute between April 2014 and March 2016. Measurements: Data on patient characteristics, microbiological findings, and clinical course were extracted from electronic medical records. The primary outcome was in-hospital mortality. Receiver operating characteristic curve (ROC) analysis was conducted to compare the predictive value of each parameter. Logistic regression analysis was performed to identify independent prognostic factors. Results: Overall, 587 patients with aspiration pneumonia aged ≥ 65 years were enrolled. The mean age was 86 years. Among the patients, 97 patients (16.5%) died. ROC analysis for in-hospital mortality revealed that GNRI had a greater area under the curve value than albumin, body mass index, and A-DROP score, with a significant difference between GNRI and albumin (p=0.0058). Male gender sex (odds ratio [OR]: 1.88, p = 0.028,), chronic heart failure (OR: 2.14, p = 0.023), history of malignancy (OR: 2.66, p = 0.0025), lower GNRI (OR: 0.94, p < 0.001), and initial antibiotic change (OR: 4.22, p < 0.001) were identified as independent adverse prognostic factors in the multivariate analysis. Conclusion: Our findings indicate that GNRI is a potential prognostic marker for older adults with aspiration pneumonia and may act as a proxy for disease severity. Our results support the use of GNRI in the clinical management of aspiration pneumonia.

H63D syndrome is a phenotype of a homozygous mutation of the HFE gene H63D, which is otherwise known to cause at most mild classical hemochromatosis. H63D syndrome leads to an iron overload in the body (especially in the brain, heart, liver, skin and male gonads) in the form of non-transferrin bound iron (NTBI) poisoning. Hallmark symptoms and causal factor for H63D syndrome is a mild hypotransferrinemia with transferrin saturation values >50%. H63D syndrome is an incurable multi-organ disease, leading to permanent disability. Our objective was to detect the prevalence of narcolepsy and narcolepsy with cataplexy in patients with H63D syndrome.