We report an initial five-year follow-up of a novel mini-invasive procedure for epicardial ablation applied in our center. The initial five-year survival rate of the applied procedure is acceptable and comparable with that of hybrid ablation.

A comprehensive undertanding of land-use/cover(LUC) change processes, their trends and future trajectories is essential for the development of sustainable land-use management plans. While contemporay tools can today be employed to monitor historical land-cover changes, prediction of future change trajectories in most rural agro-ecological landscapes remains a challenge. This study evaluated potential LUC changes in the transboundary Sio-Malaba-Malakisi River Basin of Kenya and Uganda for the period 2017-2047. The land use change drivers were obtained through a rigorous fieldwork procedure and the Logistic Regression Model (LGM) to establish key factors for the simulation. The CLUE-S model was subsequently adapted to explore future LUC change trajectories under different scenarios. The model was validated using historical land cover maps for the period of 2008 and 2017, producing overall accuracy result of 85.7% and a Kappa coefficient of 0.78. The spatial distribution of vegetation cover types could be explained partially by proximate factors like soil cation exchange capacity, soil organic carbon and soil pH. On the other hand, built-up areas were mainly influenced by population density. Under the afforestation scenario, areas under forest cover expanded further occupying 54.7% of the basin. Conversely, under the intense agriculture scenario, cropland and pasture cover types occupied 78% of the basin. However, in a scenario where natural forest and wetlands were protected, cropland and pasture only expanded by 74%. The study successfully outlined proximate land cover change drivers, including potential future changes and could be used to support the development of sustainable long-term transboundary land-use plans and policy.

This work aims to reveal the anisotropic full-field displacemnet and the progressive failure behaviors of interbedded marble under uniaxial compression using three dimensional digital image correlation (3D DIC) technique. The effects of the interbed orientation on the field displacement and strain pattern and the crack evolution were analyzed qualitatively and quantitatively. Testing results show that different stress strain responses can be generated depending on the interbed orientation, and the interbeds influence the localized deformation and high strain concentration pattern. The field displacement evolution curves present different pattern and are impacted by the localized deformation. In addition, the strain localization takes places progressively and develops at a lower rate for rock with 0° and 90° interbed than those of 30° and 60° interbed rock. The quick shear-sliding along the interbed leads to the minimum strength of rock having 30° interbed orientation. It is suggested that rock anisotropic field deformation is structure depended.

May 3, 2021Suggested time: 50-60 minutesOverview The students will learn about the bases of water´s superficial tension and elasticity of materials by doing trials, and at the end they will apply all the things that they have learned by doing a fish that moves with a mechanism made with recycled materials.Materials •       2 plastic bottles•       Foami •       Scotch tape•       Wooden sticks •       Wooden popsicle sticks •       Silicon •       Scissors•       Rubber bands•       Needle •       Toilet paper•       Cup of wáter Multimedia ResourcesLearn about superficial tension (1:30 – 2:02) https://www.youtube.com/watch?v=JZA_NV8I5y0

Changes in land cover have persisted throughout the history of mankind, and are the direct and indirect consequence of human actions to secure essential resources. Understanding direct and indirect factors that influence land use cover change (LUCC) is essential for modelling future LUCC in developing countries. The study analyses local drivers of LUCC in Southwestern Ghana using the mixed-method approach. The approach aided in identifying key drivers of LUCC, using different research strategies for comparisons through confidence level analysis and Analytic Hierarchy Process (AHP). We used expert interviews, literature review and geostatistical tools to ascertain causative factors triggering such unprecedented changes. Geospatial analysis depicted a decline in forests (-1.65 km2yr-1.) and areas covered by water bodies (-0.55 km2yr-1.). A remarkable increase in built-up (+25.77 km2yr-1.) and farmlands/shrubs (+7.4km2yr-1.) areas were also observed. Population growth, expansion of settlements and infrastructure, coupled with agricultural expansion are at the centre of the LUCC-environment nexus, based on the confidence level table. A steady increase in surface temperature can be attributed to the unprecedented LUCC over the past 50 years. Socio-economic development in Southwestern Ghana is fuelling interest in the relation between LUCC and environmental change. Biophysical, cultural and technological factors are also considered key drivers despite the “medium-to-very low confidence” in results generated. They could potentially impact climate-sensitive sectors that significantly modify land-use systems from the pessimists and optimist’s perspective. We, therefore, propose further analyses of LUCC drivers with medium to very low confidence levels.

Background: CRC incidence is increasing in our region. There is no specific CRC control program or national cancer registry in Pakistan. Previously no data has been published on presentation and diagnosis delay of CRC in our region. This study is conducted to determine the factor affecting delay in presentation and diagnosis and to provide baseline information to launch a CRC control program. Primary objective is to determine factor causing delay in diagnosis of CRC. Secondary objective is to evaluate relationship between tumor site and stage of CRC with presenting symptoms and symptom duration. Methods: This project is a prospective cross-sectional study on 113 biopsy-proven CRC patients admitted to the surgical ward of civil hospital Karachi. Results: A total number of participants was 113. Presentation delay was observed in 83.2% of patients. The main reasons for a reported delay in the presentation were lack of patients’ knowledge that these symptoms may be cancer (60.4%), the wrong diagnosis by the primary physician (34.6%), or the patient didn’t want to visit the doctor (0.04%). Most tumors (95%) originated from the sigmoid and rectum. 38.9% and 44.2% of the patients diagnosed at Stage 4 and 3 respectively. Conclusions: This study revealed that CRC patients in Pakistan are facing delays in presentation and diagnosis. This is the reason behind diagnosis at the advanced stage with a poor prognosis. Based on this study findings CRC control program should be introduced to detect CRC at an early stage. Keywords: Colorectal cancer, Colon, Rectum, Cancer, Presentation delay, Diagnosis delay.

Introduction:Gasrtric cancer is a major global public health problem. It is the fourth most common cancer and the second cause of cancer-related deaths worldwire. Despite advances in the field of medical and radiation oncology, surgical resection is crucial intervention and remains the mainstay the gold standard treatment. Recently, the effects of anesthesia method(s) and/or anesthetic agent(s) on survival for different types of cancers gained attention. So we want to summarize the evidences of anesthesia methods and/or anesthetic agents prefererred for gastric cancer surgery on the survival. Material-method: Web of Science software was used for the search and the analysis. To analyse scientific productivity of all scientific papers published about survival of patients due to the anesthesia methods or anesthetic agents on gastric cancer in Science Citation Index Expanded (SCI-E) from 1980 to December 5 th, 2020; the date of the search, were searched by using the terms of “gastric cancer”, “survival” and “anesthesia” in the topic search section of the software. Results: Overall fifteeen papers were related to our topic. Four of these studies compared TIVA with general anesthesia; five of these compared general anesthesia with general anesthesia combined with epidural anesthesia/analgesia for gastric cancer, three of these studies investigated effect of anesthetic agents for gastric cells in in vitro conditions. Other publications were review on this topic. Conclusion: The important role of anesthesia in treatment of gastric cancer patients, is still controversial. Further prospective randomized studies are needed.

Background: Asthma exacerbations, a common reason for Pediatric Emergency Department (PED) referral, can be triggered by multiple factors, including infections, air pollution and allergens. Lockdown measures and other public health interventions during the SARS-CoV-2 pandemic determined radical changes to behavioral and social habits, that were reflected by a reduction in the transmission of all respiratory pathogens and in the emissions of relevant air pollution anthropogenic sources. Objective: This study aims to describe how restrictions during SARS-CoV-2 pandemic impacted the PED referral for asthma exacerbations and their potentially associated environmental triggers in densely populated urban areas. Methods: PED referrals for acute asthma from 2015 to 2020 were compared to air pollution and pollen data. To this purpose, historical daily concentration records of PM2.5, PM10 (including specific chemical tracers), as well as NO2, C6H6, tree, grass and weed pollen were analyzed. Results: In 2020, asthma-related PED referrals decreased up to 85%, compared to the average referral rate of the previous 5 years (P<0.01). The drastic drop in PED referrals was associated with a reduction of high-priority cases by 50-60%, unlike PED referrals for overall diagnoses, showing a larger contribution for severe outcomes. A concomitant diminished contribution of traffic-related air pollution was shown. Conclusions: The lower rate of asthma exacerbations in childhood can be related to synergic interactions of the multiple effects of lockdown measures which induced lower viral infection rates and decreased exposure to outdoor allergens. The reduction of traffic-related air pollution determined a weakening of inflammatory properties of urban PM.

Purpose: The long-term management of childhood cancer survivors is complex. Electronic health (eHealth) technology has the potential to significantly improve the management of late effects for childhood cancer survivors and assist their General Practitioners (GP) to coordinate their care. We assessed the acceptability of and perceived benefits and barriers to eHealth use amongst survivors, parents, and GPs. Methods: We conducted semi-structured telephone interviews with survivors of childhood cancer, parents of childhood cancer survivors and their nominated GP. We described a hypothetical eHealth tool and asked participants how likely they would use the tool to manage their survivorship care and their perceived benefits and concerns for use of the tool. We used content analysis to synthesise the data using QSR NVivo12. Results: We interviewed 31 survivors (mean age: 27.0), 29 parents (survivors’ mean age: 12.6) and 51 GPs (mean years practising: 28.2). Eighty-five percent of survivors and parents (n=51), and 75% of GPs (n=38) indicated that they would be willing to use an eHealth tool. Survivors and parents reported that an eHealth tool would increase their confidence in their ability, and their GP’s ability, to manage their survivorship care. GPs agreed that an eHealth tool would provide easier access to survivors’ medical information and increase their capacity to provide support during survivorship. 7% of GPs (n= 4) and 43% of survivors (n=26) reported being hesitant to use eHealth tools due to privacy/security concerns. Conclusion: Overall, eHealth tools were reported to be acceptable to childhood cancer survivors, their parents, and their GPs.

Intravenous epoprostenol remains an important treatment for pulmonary arterial hypertension (PAH) but can only be given intravenously. Until recently the only formulation available to our patients (Flolan 10.5) was thermolabile and required daily preparation. In 2016, we transitioned all patients in our service to a new, thermostable formulation (Flolan 12). All patients in our unit using epoprostenol as of November 2016 were recruited to this prospective study which examined for safety issues and effects on QoL, 6MWD and serum NT-proBNP. We also collected qualitative data regarding activities of daily living. The transition process did not result in any clinical deterioration. There were no safety issues identified and all but one of the participants preferred the new formulation. We therefore conclude that transitioning patients from intravenous Flolan 10.5 to Flolan 12 is safe, does not lead to any clinical deterioration and is acceptable to patients for reasons of convenience.

Investigating diversity gradients helps to understand biodiversity drivers and threats. However, one diversity gradient is seldomly assessed, namely how plant species distribute along the depth gradient of lakes. Here, we provide the first in-depth characterization of depth diversity gradients (DDG) of submerged macrophytes across different lakes. We characterize the DDG for additive richness components (alpha, beta, gamma), assess environmental drivers and address temporal change over recent years. We take advantage of yet the largest dataset of macrophyte occurrence along lake depth (274 depth transects across 28 deep lakes) as well as of physio-chemical measurements (12 deep lakes from 2006 to 2017 across Bavaria), provided publicly online by the Bavarian State Office for the Environment. We found a high variability in DDG shapes across the study lakes. The DDG for alpha and gamma richness are predominantly hump-shaped, while beta richness shows a decreasing DDG. Generalized additive mixed-effect models indicate that the maximum alpha richness within the depth transect (Rmax) is significantly influenced by lake area only, whereas for the corresponding depth (Dmax) are influenced by light quality, light quantity and layering depth. Most observed DDGs seem generally stable over recent years. However, for single lakes we found significant linear trends for Rmax and Dmax going into different directions. The observed hump-shaped DDGs agree with three competing hypotheses: the mid-domain effect, the mean-disturbance hypothesis, and the mean-productivity hypothesis. The DDG amplitude seems driven by lake area (thus following known species-area relationships), whereas skewness depended on physio-chemical factors, mainly water transparency and layering depth. Our results provide insights for conservation strategies and for mechanistic frameworks to disentangle competing explanatory hypotheses for the DDG.

Familial hypercholesterolemia is a rare inherited disease that results in elevated levels of low-density lipoprotein (LDL) and clinically leads to early coronary artery disease. It is rare for this disease to be associated with the coarctation of the aorta. In this report, we review the clinical case of an 18-year-old who was referred to our center with angina pectoris manifestation. A comprehensive clinical and investigative evaluation of the patient pre-operatively showed the presence of familial hypercholesterolemia, Coarctation of the aorta, and ischemic cardiomyopathy that required coronary artery bypass surgery.

Cardiovascular syphilis occurs 15 to 30 years after infection. Syphilitic aortitis is the most common manifestation and typically involves the ascending aorta. Aneurysm formation is the least common complication of aortitis; the majority of aneurysms are single and usually saccular. We report the images of a 51-year-old man with a history of chest pain that began one month before. An aneurysm of the ascending aorta was documented. The nontreponemal and treponemal tests were reactive. Other venereal diseases, as well as neurological involvement, were discarded. The patient received treatment for non-neurologic tertiary syphilis and surgical repair by the Bentall procedure with re-implantation of the coronary arteries. Pathology showed the aortic arterial layer displaying myxoid changes in the tunica intima, as well as inflammatory infiltrate. The vasa vasorum demonstrates inflammatory infiltration with lymphocytes and plasma cells. The previous findings support the diagnosis of syphilitic aortitis. The patient’s evolution was satisfactory with no current cardiovascular symptoms.

A patient had undergone surgical resection twice for primary and metastatic dedifferentiated liposarcomas. Follow-up computed tomography revealed a new tumor mass located at the cavoatrial junction. Prompt surgical resection of the tumor with thrombectomy was successfully performed using cardiopulmonary bypass with hypothermic circulatory arrest. We report a rare case of a patient surviving for 8 years after the first tumor resection despite the poor prognosis of metastatic or recurrent liposarcoma.

Background: This study evaluated the impact of various sizing metrics on outcomes of female donor to male recipient orthotopic heart transplantation (OHT). Methods: We queried the United Network of Organ Sharing database to analyze all isolated, primary adult OHTs from 1/12010-3/20/2020. Patients were stratified by donor-recipient sex pairing. Logistic regression was used to investigate risk-adjusted effects of current size matching criteria (weight ratio, body mass index (BMI) ratio, predicted heart mass (pHM) ratio) on one-year post-transplant mortality. Kaplan-Meier analysis was used to compare posttransplant survival among cohorts. Results: A total of 22,450 patients were analyzed, of which 3,019 (13.4%) underwent female-to-male transplantation. Of sex-matched pairs, female-to-male donation had the lowest proportion of undersized hearts using weight and BMI ratio metrics (10.5% and 5.2%) but had the highest proportion of undersizing using pHM metrics (48.1%) (all P<0.001). Female-to-male recipients had the lowest rate of unadjusted one-year survival (90.0%, P = 0.0169), and increased hazards of mortality after risk adjustment (OR 1.17, 95% CI 1.01-1.36, P=0.034)). Undersizing using pHM (donor-recipient ratio < 0.85) was the only metric found to be associated in increased mortality after risk adjustment (OR 1.32, 95% CI 1.02 to 1.71, P=0.035). Conclusions: Female-to-male heart transplantation has the worst survival of all sex-matching combinations. Although female donors in this cohort are appropriately sized using traditional metrics, half are under-sized using pHM. This, combined with its strong association with mortality, underscores the importance of routine pHM assessment when evaluating female donors for male recipients.

A 75 years old man with previous aortic abdominal aneurysm surgery through a transverse laparotomy underwent bilateral internal mammary artery (BIMA) to coronary artery bypass grafting (CABG). He immediately thereafter developed a severe chest and upper abdominal walls ischemia with metabolic acidosis, and finally deep sternum wound infection and upper abdominal wall necrosis. He benefitted from sternal reconstruction and vaccum assisted treatment, with delayed pectus major flap reconstruction. Chest and abdominal wall infarction following BIMA harvesting is a very rare but life-threatening complication. Caution use of BIMA should be in order in patients with inferior epigastric artery flow impairment.

Here we describe two clinical prenatal cases with rare de novo RIT1 variants which showed more severe clinical manifestations than other Noonan Syndrome genotypes, resulting in fetal death. It is recommended that extra attention would be exercised when these variants are detected, and an appropriate patient counselling would be provided.

Drooping wildryegrass (Elymus nutans) has been widely planted together with other perennial grasses for rebuilding degraded alpine meadow atop the Tibetan Plateau. However, the rebuilt sown pastures begin to decline a few years after establishing. One of the possible causes for degradation of sown grassland may come from allelopathy of planted grasses. The purpose of this study was to examine allelopathic potential of drooping wildryegrass. Three types aqueous extracts from drooping wildryegrass and its root zone soil were prepared and 5 highland crops and 5 perennial grasses were used as recipient plants. Drooping wildryegrass exhibited strong allelopathic potential on germination and seedling growth of 5 crops germination and growth, but different crops or perennial grasses respond to the extracts differently. The pieces extract has stronger inhibition than others. Hulless barley, oat and Chinese fescue were the most affected, while quinoa and Siberian wildryegrass were the least affected. Drooping wildryegrass presented less influence on Kentucky bluegrass and crymophylla bluegrass than on Chinese fescue. It is recommended that the species combination of mixture for restoration should consider allopathic effects of the co-seeding and decrease the seeding rate ratio of drooping wildryegrass. The annual dicot crop quinoa and rape seeds can be used as alternative subsequent crop for seed field of drooping wildryegrass monoculture.

Telomere DNA length is a complex trait controlled both by multiple loci and environmental factors. Even though the use of telomere DNA length measurement, as a method of assessing stress accumulation and predicting how this will influence survival, is currently being studied in numerous human cohort studies, the importance of telomere length for stress response in ecological studies remains at its infancy. Here, we investigated the telomere changes occurring in the symbiotic coral Stylophora pistillata that has experienced a continuous darkness over six months. This stress condition led to the loss of its symbionts, as what is also observed when bleaching occurs in the field at a large-scale due to climate changes and anthropogenic activities, threatening the worldwide reef ecosystem. We found that the continuous darkness condition was associated with telomere DNA length shortening and a downregulation of the expression of the telomere-associated protein Pot2. These results pave the way for future studies on the role of telomere in coral stress response and the importance of telomere dysregulation in endangered coral species.

A document by Marguerite Lawler. Click on the document to view its contents.

Background: Inflammatory markers such as C-reactive protein and Albumin have previously been associated with poor prognosis in ST-elevation myocardial infarction (STEMI). Objective: The present study aims to investigate the relationship between the infarct-related arteries (IRA) patency and C-reactive protein/Albumin ratio (CAR) before primary percutaneous intervention (p-PCI) in patients with STEMI. Methods A total of 822 patients who underwent primary PCI (p-PCI) for acute STEMI were included in this study. Patients were divided into two groups according to IRA patency as TIMI flow 0-1 (n = 551) and TIMI flow 2-3 (n = 271). CAR ratio measured at admission was compared with IRA patency. Results: The average age of 822 patients was 55±12, and 84.3% (693) of the patients were male. The mean CAR level of the patients was determined as 0.26 (0.08-0.48). CAR level was statistically significantly higher in TIMI flow 0-1 group when compared to TIMI flow 2-3 group [0.31 (0.09-0.51) vs 0.23 (0.06-0.42); p<0.001]. In the multivariate logistic regression analysis a significant relation was found between CAR (odds ratio [OR]:1.56, 95% confidence interval [CI]:1.22-1.97, p<0.001), and neutrophil count (OR:1.72, 95% CI:1.33-2.25, p<0.001) in patients with TIMI flow 0-1 Conclusion: An inflammation-based risk index, CAR measured at admission in patients with anterior STEMI has been found to be a useful prognostic tool for predicting adverse cardiovascular outcomes. However, this finding needs to be confirmed in future prospective studies.

Thoracic endovascular aortic repair has been preferred over surgery for aortic lesions owing to its minimal invasiveness. Here we report the successful endovascular repair of a thoracic aortic pseudoaneurysm after esophageal perforation induced by accidental ingestion of a fishbone.

Statins are widely prescribed and well tolerated with most side effects now considered a nocebo effect. Occasionally, statins can be associated with immune mediated necrotizing myositis that is both difficult to diagnose and treat. Aggressive immunosuppressive therapy is the best recognized method of treatment of this complication.

Desertified land reclamation for the purposes of winegrape cultivation can profoundly alter the properties of the underlying soil and the microbial communities therein. Herein, we assessed the effects of such reclamation of non-productive desert land on the soil microbial communities associated with the resultant vineyards, and to identify key soil properties related to these changes. Soil was collected from natural desert land (DL) and from different reclaimed vineyard types: Cabernet Sauvignon (CS), Merlot (M), Chardonnay (C), and Italian Riesling (IR). High-throughput sequencing was used to assess microbial community composition and diversity in these samples. Significant differences in soil organic carbon (SOC), total nitrogen, available nitrogen, available phosphorus, and pH were detected when comparing soil from DL and reclaimed lands. CS, M, C, and IR soils exhibited higher relative Actinobacteria, Proteobacteria, and Ascomycota abundance, while DL soil exhibited higher relative Acidobacteria and Mortierellomycota abundance. In total, 165 and 55 bacterial and fungal amplicon sequence variants or operational taxonomic units (ASVs/OTUs) were shared across land use types. Following reclamation, soil bacteria ASVs/OTUs in CS, M, C, and IR soils rose to 2846, 3191, 7630, and 6373, respectively. Biomarkers of these different land use types were successfully identified via an LDA Effect Size (LEfSe) approach, while key soil properties including pH, SOC, and available nitrogen were found to be associated with these changes in microbial community structural composition following reclamation. As such, our data indicate that viticulture in desertified regions can enhance soil properties and microbial diversity, thereby supporting sustainable land use.