Objective: To evaluate the accuracy of radiological staging, especially renal venous and perirenal fat invasion, in renal cell carcinoma (RCC). Material & Methods: Data of 4823 renal tumor patients from Renal Tumor Database of Association of Uro-oncology in Turkey were evaluated. Of 4823 patients, 3309 RCC patients had complete radiological and histopathological data were included to this study. The Pearson Chi-squared test (χ2) was used to compare radiological and histopathological stages. Results: The mean (SD) age of 3309 patients was 58 (12.3). Preoperative radiological imaging was performed using computed tomography (CT) (n=2510, 75.8%) or magnetic resonance imaging (MRI) (n=799, 24.2%). There was a substantial concordance between radiological and pathological staging (к=0.52, p<0.001). Sensitivities of radiological staging in stage I, II, III and IV were 90.7%, 67.3%, 27.7% and 64.2%, respectively. The sensitivity in stage III was lower than the other stages. Sub-analysis of stage IIIa cases revealed that, for perirenal fat invasion and renal vein invasion, sensitivity values were 15.4% and 11.3%, respectively. Conclusions: There was a substantial concordance between radiological (CT and/or MRI) and pathological T staging in RCC. However, this is not true for T3 cases. Sensitivity of preoperative radiological imaging in patients with pT3a tumors is insufficient and lower than the other stages. Consequently, preoperative imaging in patients with T3 RCC has to be improved, in order to better inform the patients regarding prognosis of their disease.

Background: Cytoreductive surgery in combination with hyperthermic intraperitoneal chemotherapy has been established as a novel treatment approach for peritoneal sarcomatosis. Despite promising clinical reports, there is still a lack of knowledge regarding optimal drug usage and local effects. Therefore, we intended to establish a murine animal model for further evaluation. Procedure: Alveolar rhabdomyosarcoma cells were xenotransplanted into NOD/LtSz-scid IL2Rγnullmice (n=100). The mice received a continuous intraperitoneal lavage with isotonic saline solution as control- or with cisplatin (30 or 60 mg/m2) as treatment group for 60 minutes at 37 or 42 °C (6 subgroups, each n=16). Tumor spread was documented by an adapted peritoneal cancer index and MRI (n=4). Tumor and tissue samples, harvested at the end of the perfusion, were evaluated regarding morphology, proliferation and apoptosis (H&E-, Ki-67-, Cleaved Caspase 3-staining, TUNEL-assay). Results: Extensive peritoneal sarcomatosis in over 91% of the cases was observed. HIPEC was feasible without acute side effects. Ki-67 staining revealed concentration- or temperature-dependent effects of cisplatin-based HIPEC on the tumors. While Cleaved Caspase-3 showed only sporadic apoptotic effects. TUNEL-assay detected concentration- or temperature-dependent apoptotic effects at the outer tumor surface. MRI scans confirmed the observed tumor dissemination. Conclusion: This is the first animal model for evaluation of HIPEC in pediatric RMS in mice. Cisplatin-based HIPEC had early effects on the proliferation whereas circumscribed apoptotic effects could be detected at the tumor surface. This model allows further insights on the possible efficiency of HIPEC in RMS. Further studies using other drug combinations and treatment will follow.

The paper investigates the exponential stability criterion for an axially moving string system driven by a nonlinear partial differential equation with nonlinear boundary feedback.The control criterion based on a sector condition contains a large class of nonlinearities, which is a negative feedback of the velocity at the right boundary of the moving string. By invoking nonlinear semigroup theory, the well-posedness result of the closed-loop system is verified under the sector criteria. Furthermore, a novel energy like function is constructed to establish the exponential stability of the closed-loop system by using a integral-type multiplier method and the generalized Gronwall-type integral inequality.

L'energia eolica negli ultimi anni ha avuto un forte incremento e la dismissione degli impianti eolici già esistenti sta suscitando molto interesse sul possibile recupero delle risorse. Una turbina eolica ha una durata media di vita tra 20-25 anni, e oggi 34,000 turbine in Europa hanno 15 anni o più. Una stima di 14,000 pale potrebbe essere disattivata entro il 2023, un equivalente tra 40,000 e 60,000 tonnellate. Pertanto, un mercato potenziale per le turbine eoliche fuori uso e i loro prodotti recuperati deve essere stabilito in Europa.Circa l'85-90% della massa totale delle turbine eoliche può essere riciclata. Il problema principale rimane sulle pale, che sono realizzate in materiale polimerico rinforzato con fibre, i cui metodi di riciclaggio non sono tecnologicamente sviluppati.La situazione di fine vita di un parco eolico richiede una decisione tra differenti possibili progetti sostenibili per l'medio ambiente. La decisione finale sarà influenzata da diversi fattori.

We thank Shixiong Wei et al for their interest in our technical paper on Robotic Septal myectomy for HOCM and their letter to the editor. Their technique of using the Computed Tomography Angiography (CTA) along with 3D Printing technology for the better delineation of the anatomy of HOCM has been an evolving way to approach the problem. As they have mentioned in their letter, we used cardiac magnetic resonance imaging (MRI) predominantly for all our patients who undergo septal myectomy. Using 3D printing technology augmenting CTA or MRI can certainly augment the surgical planning in complex patients. In their case report, Wei et al have shaved off most of the subvalvular tissue along with the mitral valve. Removal of the entire mitral valve definitely would have enhanced the exposure to the mid-ventricular cavity and the apex for their thoracoscopic approach. It will be interesting to know whether they tried to repair the valve before replacement. Our technique of Robotic mitral valve repair, septal myectomy, and particularly papillary muscle re-orientation tries to preserve the sub-valvular apparatus even after completely relieving the mid-cavitary obstruction and this may provide better ventricular re-modeling. We congratulate them on providing a successful surgical option to this complex subset of patients using novel evolving technology and meticulous surgical planning.

Liana Okudzhava 1, Marcus Heldmann1,2, Thomas F. Münte 1,21Dept. of Neurology, University of Lübeck, Lübeck, Germany2Dept. of Psychology, University of Lübeck, Lübeck, GermanyCorresponding Author :Thomas F. MünteDepartment of NeurologyUniversity of LübeckRatzeburger Allee 16023538 LübeckEmail: Thomas.muente@neuro.uni-luebeck.deKeywords : obesity, diffusion tensor imaging, body mass index

A document by Shashikant Sholapurkar. Click on the document to view its contents.

Microaxial LVADs are increasingly used for cardiogenic shock treatment. We compared the short-term outcome of patients supported with different microaxial devices for cardiogenic shock. A retrospective propensity score-adjusted analysis was performed in cardiogenic shock patients treated with either the Impella CP (n=64) or the Impella 5.0/5.5 (n=62) at two tertiary cardiac care centers between 1/14 and 12/19. Patients in the Impella CP group were significantly older (69.6±10.7 vs 58.7±11.9 years, p=0.001), more likely in an INTERMACS level 1 (76.6% vs 50%, p=0.003) and post CPR (36% vs 13%, p=0.006). The unadjusted 30-day survival was significantly higher in Impella 5.0/5.5 group (58% vs 36%, p=0.021, odds ratio (OR) for 30-day survival on Impella 5.0/5.5 was 3.68 (95% CI [1.46-9.90], p=0.0072). After adjustment, the 30-day survival was similar for both devices (OR 1.23, 95% CI [0.34-4.18], p=0.744). Lactate levels above 8 mmol/L and preoperative CPR were associated with a significant mortality increase in both cohorts (OR=10.7, 95% CI [3.45-47.34], p<0.001; OR=13.2, 95% CI [4.28-57.89], p<0.001, respectively). Both Impella devices offer a similar effect with regards to survival in cardiogenic shock patients. Preoperative CPR or lactate levels exceeding 8 mmol/L immediately before implantation have a poor prognosis on Impella CP and Impella 5.0/5.5.

Objectives: In this study, we aimed to evaluate the perspectives of the citizens ranking last in COVID-19 vaccination groups towards the vaccination process. Materials and Methods: In-depth interviews were made with the participants using video conferencing method. Twenty-eight video conferencing interviews were conducted with citizens who ranked last in the vaccination groups. With the permission of the participants, audio recording was obtained in all interviews, transcribed verbatim and checked. Thematic approach was used to analyze the data. Data were collected until saturated. Results: Findings were summarized into three main categories. The first was “Satisfaction.” Participants expressed their satisfaction about process management, home vaccinations and continuous information. The second theme was “Dissatisfaction.” Some participants expressed their dissatisfaction with the prioritization of elderly people in vaccination and late vaccination of actively working individuals. The third theme was “Reservations.” Participants stated that they have reservations regarding possible complacency in the society after vaccination and delay in vaccination of non-prioritized groups. In general, participants stated that they were satisfied with the supply of vaccines and applications. However, active working individuals think that they should have priority over the elderly in vaccination. Conclusion: To ensure full compliance with the vaccine administration, it is necessary to enlighten all individuals, especially those ranking last in the vaccination groups, about the prioritization process and which variables are given importance.

Background: Preoperative bladder urine culture (PBUC) analysis has become a standard application before any stone surgery. When growth is detected in PBUC, it is contraindicated to perform flexible ureterorenoscopy (f-URS). The results of the PBUC susceptibility test do not correlate well with those of the renal pelvic urine culture (RPUC) analysis. Previous studies have demonstrated the positivity of RPUC as an important marker for the development of infections after endoscopic operations. In the current study, we aimed to evaluate the consistency between PBUC and RPUC and to identify preoperative markers associated with a positive RPUC. Methods: Data from 129 patients who underwent f-URS on renal and proximal ureteral stones in two centers between 2015 and 2020 were prospectively recorded in a database and retrospectively analyzed. PBUC was obtained from all the patients preoperatively, and RPUC was taken at the beginning of the f-URS operation. The results of the two cultures were compared. Results: There was growth in PBUC in 25 (19.4%) patients and RPUC in 35 (27.1%) patients. Possible predictive markers in predicting a positive RPUC were evaluated using multivariate logistic regression analysis. Preoperative urine density at the renal pelvis [odds ratio (OR): 0.848, p<0.001],grade≥2 hydronephrosis (OR:18.970,p=0.001), and lower calyceal stone localization (OR:0.033,p=0.017) were determined as independent predictive factors for a positive RPUC. The ability of pelvis urine density to predict positive RPUC positivity was evaluated using the receiver operating characteristic analysis, in which the area under the curve value was determined to be 0.858 (0.780-0.936). The cut-off value of pelvis urine density in the prediction of RPUC positivity was 4.5, at which it had 80% sensitivity and 77.7% specificity. Conclusions: PBUC may not represent true colonization. Although bladder urine culture is negative before the operation, patients with preoperative hydronephrosis and low pelvis urine density may have RPUC growth.

This paper mainly studies the average sampling and reconstruction in shift-invariant subspaces of mixed Lebesgue spaces $L^{p,q}(\mathbb{R}^{d+1})$, under the condition that the generator $\varphi$ of the shift-invariant subspace belongs to a hybrid-norm space of mixed form, which is weaker than the usual assumption of Wiener amalgam space and allows to control the orders $p,q$. First, the sampling stability for two kinds of average sampling functionals are established. Then, we give the corresponding iterative approximation projection algorithms with exponential convergence for recovering the time-varying shift-invariant signals from the average samples.

Abstract Purpose: There are an increased number of reports being published on rasburicase-induced methemoglobinemia recently. We aimed to identify and critically evaluate all the descriptive studies that described the rasburicase-induced methemoglobinemia, its treatment approach, and their outcomes. Methodology: PubMed and grey literature databases were searched from inception to January 2021 using search terms “rasburicase” and “methemoglobinemia” without any language and date restriction. A bibliographic search was also done to find additional studies. Only descriptive studies on Rasburicase-induced methemoglobinemia were included for our review. Two contributors worked independently on study selection, data abstraction, and quality assessment, and any disagreements were resolved by consensus or discussion with a third reviewer. Result: A total of 22 reports including 25 patients (21 male, 3 female patients, and 1 study did not specify the gender of the patient) aged from 6 to 75 years were included in the review. Immediate withdrawal of the drug and administering methylene blue, ascorbic acid, blood transfusion, and supportive oxygen therapy are the cornerstone in the management of rasburicase-induced methemoglobinemia. Conclusion: Rasburicase administration should be followed by careful monitoring of patients for any severe complication and treat it as early as possible appropriately. In a patient who presents with rasburicase-induced haemolysis or methemoglobinemia, it is often important to expect a diagnosis of G6PD deficiency unless otherwise confirmed and to avoid administering methylene blue, even though the patient is from a low-risk ethnicity for G6PDD. PROSPERO Registration number: CRD42021234132

Background: Abdominal pain constitutes the most common complaint for geriatric patients who present to the emergency department, with nearly 20% suffering from acute appendicitis (AA). Although key for diagnosis, clinical symptoms tend to be weak and atypical in the elderly. Therefore, patients present late to health institutions. Hence, prognosis and complication rates are worse in the elderly. Here, we aimed to reveal the role of basic laboratory parameters in diagnosing AA and determining disease severity. Methods: 143 elderly patients who underwent appendectomy were retrospectively analyzed. The patients were divided into three groups based on AA severity as Group I: negative appendectomy (n=15); Group IIa: uncomplicated appendicitis (n=79); Group IIb: complicated appendicitis (n=49). Results: We found no difference between the groups for age, sex, or comorbid diseases (p>0.05). As the time of admission to the hospital increases, the severity of the disease increases. Group IIb had higher length of stay and complication rates (p<.0.05) Conclusions: Preoperative WBC, neutrophil, NLR, MPV, CRP, and direct and total bilirubin levels can be used as biomarkers to determine AA diagnosis in the elderly. NLR, PLR, RDW, CRP, and direct and total bilirubin levels can be used to determine the presence of complications in appendicitis.

This article aims to discuss the approximate controllability of multivalued impulsive stochastic fractional differential equations with ABC derivatives in Hilbert space. Firstly, with the help of stochastic analysis, theory of resolvent operators and the fixed point technique, we confirm the existence of mild solutions for the proposed control system. Secondarily, we show that the proposed system of equations is approximately controllable under a certain hypothesis. To confirm the applicability of the obtained results, an example is provided at the end of this paper.

Objective: To compare peripartum outcomes of uterus preserving procedures to caesarean hysterectomy in women with placenta accreta spectrum (PAS), and to identify risk factors associated with adverse maternal outcomes. Design: Retrospective study (ClinicalTrials.gov identifier: NCT04384510) Setting:11 tertiary centres from 9 countries Population or Sample: women with of PAS who were managed in participating centres between January 1st, 2010 and December 31st, 2019. Women who had confirmed diagnosis with PAS with adequate documentation and follow-up, were considered eligible. Main Outcome Measures: Primary outcome was massive PAS-associated perioperative blood loss (intraoperative blood loss ≥ 2500 ml, bleeding associated massive transfusion protocol, or complicated by disseminated intravascular coagulopathy). Results: Out of 797 women, 727 were eligible for the study. Five hundred ninety-two (81.43%) women were managed by uterus preserving procedures versus 135 (18.56%) who underwent caesarean hysterectomy. After adjustment for significant or close-to-significance variables, type of management was not associated with higher risk of massive blood loss (aOR 1.71, 95% CI 0.78 - 3.81). Other factors that were significantly associated with higher risk of massive PAS-associated blood loss included body mass index, preoperative haemoglobin, centrally located placenta, diffuse placental invasion, parametrial invasion, and intrauterine foetal death. Conclusions: In the presence of sufficient experience, uterus preserving procedures may not be associated with higher risk of massive blood loss compared to caesarean hysterectomy. Funding: none

Background and Purpose Ca2+ influx via TRPV4 triggers Ca2+ release from the IP3-sensitive internal store to generate repetitive oscillations. While mitochondria are acknowledged regulators of IP3-mediated Ca2+ release, how TRPV4-mediated Ca2+ signals are regulated by mitochondria is unknown. We show that depolarised mitochondria switch TRPV4 signalling from relying on Ca2+-induced Ca2+ release at IP3 receptors, to being independent of Ca2+ influx and instead mediated by ATP release via pannexins. Experimental Approach TRPV4 evoked Ca2+ signals were individually examined in hundreds of cells in the endothelium of rat mesenteric resistance arteries using the indicator Cal520. Key ResultsTRPV4 activation with GSK1016790A(GSK) generated repetitive Ca2+ oscillations that required Ca2+ influx. However, when the mitochondrial membrane potential was depolarised, by the uncoupler CCCP or complex I inhibitor rotenone, TRPV4 activation generated large propagating, multicellular, Ca2+ waves in the absence of external Ca2+. The ATP synthase inhibitor oligomycin did not potentiate TRPV4 mediated Ca2+ signals. GSK-evoked Ca2+ waves, when mitochondria were depolarised, were blocked by the TRPV4 channel blocker HC067047, the SERCA inhibitor cyclopiazonic acid, the phospholipase C (PLC) blocker U73122 and the inositol triphosphate receptor (IP3 R) blocker caffeine. The Ca2+ waves were also inhibited by the extracellular ATP blockers suramin and apyrase and the pannexin blocker probenecid. Conclusion and Implications These results highlight a previously unknown role of mitochondria in shaping TRPV4 mediated Ca2+ signalling by facilitating ATP release. When mitochondria are depolarised, TRPV4-mediated release of ATP via pannexin channels activates plasma membrane purinergic receptors to trigger IP3 evoked Ca2+ release.

Permafrost thaw has been observed in recent decades in the Northern Hemisphere and is expected to accelerate with continued global warming. Predicting the future of permafrost requires proper representation of the interrelated surface/subsurface thermal and hydrologic regimes. Land surface models (LSMs) are well suited for such predictions, as they couple heat and water interactions across soil-vegetation-atmosphere interfaces and can be applied over large scales. LSMs, however, are challenged by the long-term thermal and hydraulic memories of permafrost and the paucity of historical records to represent permafrost dynamics under transient climate conditions. In this study, we address the challenge of model initialization by characterizing the impact of initial climate conditions and initial soil frozen and liquid water contents on the simulation length required to reach equilibrium. Further, we quantify how the uncertainty in model initialization propagates to simulated permafrost dynamics. Modelling experiments are conducted with the Modélisation Environmentale Communautaire – Surface and Hydrology (MESH) framework and its embedded Canadian Land Surface Scheme (CLASS). The study area is in the Liard River basin in the Northwest Territories of Canada with sporadic and discontinuous regions. Results show that uncertainty in model initialization controls various attributes of simulated permafrost, especially the active layer thickness, which could change by 0.5-1.5m depending on the initial condition chosen. The least number of spin-up cycles is achieved with near field capacity condition, but the number of cycles varies depending on the spin-up year climate. We advise an extended spin-up of 200-1000 cycles to ensure proper model initialization under different climatic conditions and initial soil moisture contents.

Background and purpose- Prostacyclin mimetics are widely used clinically. As such it is pertinent to understand the mechanisms underlying the vasoactive response to such agents, yet to date, no study has considered sex as a factor. The aim of this study was to characterise the effect of prostacyclin mimetics, Iloprost and MRE-269, on precontracted arterial tone from male and female Wistar arteries. As a secondary consideration, we investigated Kcnq-encoded KV7 channels as potential downstream targets of prostacyclin-IP-receptor mediated signalling. Experimental approach- Relative mRNA transcript and protein abundance were determined by RT-qPCR and immunocytochemistry respectively. The effect of Iloprost and MRE-269 was determined on pre-contracted arterial tone in the presence of pharmacological modulators of potassium channels and molecular interreference of KV7.1 within 2nd order mesenteric and left anterior descending arteries from male and female Wistar rats. Key results- Iloprost evoked a bi-phasic response in male mesenteric arteries, at low concentrations relaxing, then contracting the vessel at high concentration in a process attributed to IP and EP3 receptors respectively. Secondary contraction was absent in the females, potentially underpinned by a reduction in Ptger3. Pharmacological inhibition and molecular interference of KV7.1 significantly attenuated MRE-269 mediated relaxation in male and female Wistar in Diestrus / Metoestrous, but not Pro-oestrus / Oestrus. Conclusions and implications- Stark sexual dimorphisms in Iloprost mediated vasoactive responses are present within mesenteric arteries. KV7.1 is implicated in IP-receptor mediated vasorelaxation and is impaired by the Oestrus cycle.

The keystone species, Pisaster ochraceus, suffered mass mortalities along the northeast Pacific Ocean from Sea Star Wasting Syndrome (SSWS) outbreaks in 2013-2016. Causation of SSWS is still debated, leading to concerns as to whether outbreaks will continue to impact this species. Considering the apparent link between ocean temperature and SSWS, the future of this species and intertidal communities remains uncertain. We surveyed populations of sea stars along the Oregon coast in 2016, two years after the epidemic began. Cohabitation of asymptomatic and symptomatic individuals allowed us to ask whether lower susceptibility in asymptomatic individuals differed genetically. We performed restriction site-associated DNA sequencing (2bRAD-seq) to genotype thousands of single nucleotide polymorphism (SNP) loci. By comparing allele frequencies between symptomatic and asymptomatic individuals, we detected three loci that may be under selection. A multivariate analysis showed a clear separation between groups based on disease status in two of the three geographic regions, along with several regions across the genome having small statistical contributions to this separation. A draft annotation of protein-coding regions allowed us to identify 120 predicted genes that are linked to these markers and are putatively associated with lower susceptibility. Our results suggest that some variation in disease severity can be attributed to genetic variation. However, differences in phenotype have a highly polygenic nature with no single or few genomic regions having strong predictive effects. The genes associated with these regions may form the basis for functional studies aiming to understand disease progression in infected individuals.

Backgrounds: Left atrial appendage (LAA) isolation (LAAI) has been described as an adjunctive ablation strategy for patients with recurrent atrial fibrillation (AF). Objectives: We compared the clinical impact of persistent LAAI durability between radiofrequency catheter (RF)-guided wide-area LAAI and cryoballoon (CB)-guided ostial LAAI. Methods: Consecutive patients who underwent RF- or CB-guided LAAI were retrospectively analyzed. RF-guided LAAI was performed by combining anterior, roof and mitral isthmus linear ablation. CB-guided LAAI was performed by LAA ostial ablation. After LAAI, patients underwent invasive re-mapping study. LAA closure was performed if persistent durability was confirmed. Procedural data, LAAI durability and ATa recurrence were assessed. Results: A total of 260 patients (RF:n=201, CB:n=59) undergoing LAAI were identified out of 7630 AF ablation procedures. Acute rate of procedural LAAI was significantly higher in CB group (RF: 82.6% vs. CB: 94.9%, P=0.02) and associated with a lower rate of pericardial effusion (RF: 7.5% vs. CB: 0%, P=0.03). Six-week durable LAAI was similar between two groups (RF: 78.1% vs. CB: 66.0%, P=0.103). One-year freedom from ATa recurrence was higher in the patients with durable LAAI after RF-guided wide-area LAAI irrespective of arrhythmia types (overall; RF:76.3% vs. CB:56.7%, P=0.0017, only AF; RF:81.3% vs. CB:57.5%, P=0.0013, respectively). Multivariate analysis revealed that RF-guided LAAI was a predictor of freedom from ATa recurrence (HR: 0.41, 95%CI: 0.221–0.766, P=0.0056). Conclusions: Acute LAAI can be more readily and safely achieved by CB-guided ostial ablation. In patients with confirmed LAAI, however, the freedom from ATa recurrence was higher after a RF-guided wide-area isolation.

The right ventricular moderator band (MB) is increasingly being recognized as a source for PVCs and PVC-mediated ventricular fibrillation. Monomorphic PVCs, non-sustained monomorphic VT and ventricular fibrillation are all documented arrhythmias originating from the MB. The benign PVCs usually have a coupling interval in excess of 400 msec. When PVCs trigger VF, coupling intervals are typically short, less than 300 msec. We report here a case of long-standing frequent monomorphic PVCs with a coupling interval of > 400 msec from the right ventricular distal conduction system embedded in the moderator band that progressed to non-sustained ventricular tachycardia. Following suppression of the arrhythmia with RF ablation, the arrhythmia recurred with PVCs at a shorter coupling interval (<300 msec), with frequent repetitive non-sustained polymorphic VT and triggering of sustained ventricular fibrillation. The use of a cryoballoon to ablate over the course of the moderator band resulted in complete and durable suppression of ventricular arrhythmias.

Introduction: The aim of our study was to investigate the presence and mutual relationships of coronary vessels within the right atrial appendage RAA vestibule. Methods and Results: We examined 200 autopsied hearts. The RAA vestibule was cross sectioned along its isthmuses (superior, middle, and inferior). We assessed the presence and mutual relationships between coronary blood vessels. The right coronary artery (RCA) was present in 100% of the superior RAA isthmuses but absent in 2.0% of hearts within the middle isthmus and in 6.5% of hearts within the inferior RAA isthmus. Its diameter was quite uniform along the superior (2.6±0.8mm), middle (2.9±1.1mm) and inferior (2.7±0.9mm) isthmuses (p=0.12). The location of the RCA varied significantly, and it was sometimes accompanied by other accessory coronary vessels. In all the isthmuses, the RCA ran significantly closer to the endocardial surface than to the epicardial surface (p<0.001). At the superior RAA isthmus, the artery was furthest from the right atrial endocardial surface and this distance gradually decreased between the middle RAA isthmus and the inferior RAA isthmus (9.0±4.0 vs. 6.2±3.0 vs. 4.8±2.3mm, respectively; p<0.001). The interposed RCA was found in 7.0% of cases within the superior isthmus, in 2.5% within the middle isthmus and in 1.5% within the inferior isthmus. Conclusions: This study was the most complex analysis of the mutual arrangements and morphometric characteristics of coronary blood vessels within the RAA vestibule. Awareness of additional blood vessels within the vestibule can help clinicians plan and perform safe and efficacious procedures in this region.

The most effective way to prevent and control infectious disease outbreak is through vaccines. The increasing use of vaccines has elevated the need to establish new manufacturing strategies. One of the major approaches is cell-based production, which creates a need for high cell density to enable higher cell production levels. This has led to development of the technology of cell carriers, including micro and macro cell carriers. To follow the production process, quantifying the number of cells on these carriers is required, as well as the tracking of their viability and proliferation. However, owing to various carriers’ unique structures, tracking the cell’s is challenging using current traditional assays that were originally developed for monolayers of adherent cells. The current “gold standard” method is counting cell nuclei, separating cells from the carrier, staining with crystal violet and visually counting under a microscope. This method is tedious and counts both live and dead cells. A few other techniques were developed but were specific to the carrier type and involved specialized equipment. In this study, we describe a broadly ranging method for counting cells on carriers that was developed and employed as part of the production of a vaccine for use in the SARS-CoV-2 pandemic. The method is based on the Alamar blue dye, a well-known, common marker for cell activity, and was found to be successful in tracking cell adsorption, cell growth and viability on carriers. No separation of the cells from the carriers is needed, nor is any specialized equipment; the method is simple and rapid, and provides comprehensive details necessary for process control of viral vaccine production in cells. This method can be easily implemented in any of a number of cell-based processes and other unique platforms for measuring growth of encapsulated cells.

Americans, particularly younger adult generations, evidence an increasing fascination with socialism. This paper examines the Cold War realities, offering a narrative and personal experience to provide an overview of the consequences of adopting that system and ideology defeated by the English-speaking western nations in 1989–1991. Special attention is given to the People’s Socialist Republic of Albania as an example of socialism. This paper examines the Cold War realities, offering a narrative and personal experience to provide an overview of the consequences of adopting that system and ideology defeated by the English-speaking western nations in 1989–1991. Special attention is given to the People’s Socialist Republic of Albania as an example.