A 52-year-old man was admitted to our hospital for “CT-diagnosed thoracic-abdominal aortic aneurysm”. One week ago, the patient had repeated dry coughs and went to the local hospital for treatment. A chest radiograph revealed a huge mass in the left thoracic cavity. A further chest CT examination revealed a thoracic-abdominal aortic aneurysm and was transferred to our hospital for surgical treatment.The patient is almost healthy, with no fever, no severe chest and abdomen pain, no dyspnea, no dysphagia or other clinical symptoms. Ten years ago, the patient underwent “ascending aorta and total aortic arch replacement surgery” in another cardiovascular hospital due to aortic dissection involving the ascending aorta and aortic arch (Debakey I).The patient’s thoracic-abdominal aortic aneurysm is huge and has a high risk of rupture. Recently, the patient has undergone thoracic-abdominal aortic replacement surgery and is recovering well.

This clinical case demonstrated surgical management of a giant congenital left ventricular aneurysm in a 2-month-old female using the Dor procedure. Transthoracic echocardiography performed at 6-month follow-up showed an ejection fraction of 66%.

There has been a compelling body of evidence of COVID-19 causing cardiac complications such as myocarditis and increased risk of coronary thrombosis. Acute coronary syndrome due to coronary vasospasm is an unusual occurrence.

Mechanical complications of myocardial infarction are rare. However, the consequences are catastrophic if missed; here, we present a case highlighting the red flags that can guide the diagnosis of mechanical complications of MI.

The Gillespie algorithm, which is a stochastic numerical simulation of continuous-time Markovian processes, has been proposed for simulating epidemic dynamics. In the present study, using the Gillespie-based epidemic model, we focused on each single trajectory by the stochastic simulation to infer the probability of controlling an epidemic by non-pharmaceutical interventions (NPIs). The single trajectory analysis by the stochastic simulation suggested that a few infected people sometimes dissipated spontaneously without spreading of infection. The outbreak probability was affected by basic reproductive number but not by infectious duration and susceptible population size.　A comparative analysis suggested that the mean trajectory by the stochastic simulation has equivalent dynamics to a conventional deterministic model in terms of epidemic forecasting. The probability of outbreak containment by NPIs was inferred by trajectories derived from 1000 Monte Carlo simulation trials using model parameters assuming COVID-19 epidemic. The model-based analysis indicated that complete containment of the disease could be achieved by short-duration NPIs if performed early after the import of infected individuals. Under the correctness of the model assumptions, analysis of each trajectory by Gillespie-based stochastic model would provide a unique and valuable output such as the probabilities of outbreak containment by NPIs.

Ruptured thoracic mycotic aneurysm is fatal, and surgical resection of the aorta may be unavailable because of occurrence of preoperative shock in such a patient. In the present case, the thoracic mycotic aneurysm ruptured during hospital stay, causing acute hypovolemic shock but was successfully repaired by thoracic endovascular aortic repair (TEVAR) with video-assisted thoracic surgery (VATS) drainage.

Background: Mitral annular calcification (MAC) represents an important risk factor in mitral valve (MV) surgery. Despite several procedures have been described, no surgical treatment of choice has been yet established. Materials and Methods: A systematic review of the literature and meta-analysis on patients undergoing MV surgery associated to MAC was performed. The meta-analysis primary endpoints were 30-day mortality and late overall and cardiac-related mortality. Secondary endpoints were early reintervention, re-exploration for bleeding, postoperative pacemaker implantation, cerebrovascular accident, atrioventricular groove rupture, acute myocardial infarction and late recurrences of mitral regurgitation (MR) or paravalvular leak and reintervention. Primary and secondary endpoints were also evaluated in the subgroup analysis between MV repair and replacement surgery. Meta-regression was used to analyze the influence of decalcification and annular reconstruction on endpoints. Results: Among 1429 papers, 25 papers studying 1327 patients were included. In the pooled analysis, the 30-day mortality event rate was 2.89% (95%Confidence Interval [CI], 1.48%-5.57%) and 7.72% (95%CI, 2.95%-18.71%) for MV repair and replacement respectively. At mid-term follow-up, MV repair revealed a significantly lower incidence rate (IR) of death compared to MV replacement (p=0.043), with a trend of higher reoperation IR compared to replacement (p=0.051) and a trend of higher recurrent MR2+ in MV repair (p=0.071). Annular reconstruction was associated with a significant increase in re-exploration for bleeding at univariate analysis, but not at the multivariate meta-regression. Conclusions: The current meta-analysis suggests that MV repair in MAC patients may provide better short and mid-term survival outcomes when compared to replacement.

Background: The delivery of reproductive and child health services is of utmost importance and prime concern in India particularly because of huge population with limited resources, poor infrastructure and huge demand on healthcare system. The SARS-CoV-2 pandemic had presented a challenge even for developed healthcare systems around the world. Objectives: The main aim of this research is to find out Impact of SARS-CoV-2 pandemic on the Reproductive and Child Health Programme in India over the 3 months after Lock down imposition countrywide in March 2020 due to Covid-19 pandemic. Settings & Design: Different indicators group of RCH programme 2020 (immunisation, maternal & child health, family planning) for India were collected from Ministry of Health & Family Welfare, Government of India and compared from previous year 2019 data for the period of three months(April/May/June) and presented in tables and graphs to understand the situation. Materials & Methodology: Secondary data from HMIS of Ministry of Health & Family Welfare Government of India for 3 month of April, May, June 2019 & 2020 were taken for analysing and understanding the impact of pandemic on RCH programme over 3 months after nationwide lock down announced in march 2020 viz. April/May/June 2020. The data obtained is analysed by using Microsoft Office software.Result: The analysis of secondary data obtained from HMIS of Ministry of Health & Family Welfare website (Provisional figure & mentioned free for distribution) for RCH programme of India shows that the lock down period & initial early phase of SARS-CoV-2 during above mentioned 3 months pandemic have a negative impact over the delivery of Reproductive & Child Health services reflected through important indicators of which are also affected negatively. Besides the pandemic the Nation is also having lack of resources, manpower poor infrastructure as well as lack of positive deviance at community level. These are the barriers in fact beside the epidemic. It seems that there is lack of proper plan to deal with such pandemic situation.Conclusion: India has taken various strategies to ensure delivery of RCH services but it seems to be insufficient to give the desired results. The barriers of healthcare system and delivery of services constraints should be rectified added with a proper dynamic plan to carry on usual RCH services even in pandemics and natural disasters. India needs to develop an exclusive plan to tackle such situations such as establishment of separate cadre of health worker for RCH services to ensure the healthcare of women and children’s in any natural disasters and calamities.

A document by Joan Lalor. Click on the document to view its contents.

Objective：To clarify the epidemiological characteristics, risk factors, clinical symptoms and signs, laboratory features, and pregnancy outcomes of women with mixed vaginitis during late pregnancy. Methods：The study population consisted of 1103 women in late pregnancy who attended the Tianjin Medical University General Hospital from November 2019 to September 2020. Results：The incidence rate of mixed vaginitis during late pregnancy is 4.1% (44/1075). The independent risk factors for women with mixed vaginitis in late pregnancy are a positive glucose tolerance test (OR = 2.697, 95% CI 1.293-5.625) and a history of vaginitis during pregnancy (OR = 2.276, 95% CI 1.030-5.032). Compared with women with single vaginitis, women with mixed vaginitis only have statistically significant differences in the yellow discharge (77.3% vs. 58.9%) and malodor (40.9% vs. 22.7%) (P＜0.05), so they are easily confused with single vaginitis in clinical symptoms and signs. Compared with women with single vaginitis, women with mixed vaginitis have a significant difference in pH＞4.5 (72.7% vs. 36.2%) and WBC＞10/hpf (81.8% vs. 38%) in laboratory examination(P＜0.05). Therefore, laboratory diagnosis is the main method to distinguish single and mixed vaginitis. Compared with women without vaginitis, women with mixed vaginitis have an increased incidence of postpartum puerperal infections (6.8% vs. 1%; P＜0.05). Conclusions：Mixed vaginitis in late pregnancy leads to an increased incidence of puerperal infections. Therefore, more attention should be paid to the early intervention of mixed vaginitis during pregnancy to prevent adverse pregnancy outcomes.

Cysticercosis in humans is a serious public health problem, predominantly affecting low and middle-income countries (LMICs). Cysticercosis, the infection with the larval form of the pork tapeworm, Taenia Solium has high prevalence in areas where there are poor sanitary conditions and domestic pig without adequate veterinary control. Humans are the definitive host and pigs are the main source of infection. Human infection occurs when pork is eaten raw or undercooked. Ingested eggs or proglottids hatch into larvae form, which penetrate the intestinal wall into the blood stream and migrate into different organs including subcutaneous tissues, brain, eyes and rarely heart or lung, where they mature into cysticerci. Pulmonary cysticercosis has been rarely described; case reports are predominantly in adults and are usually of disseminated disease. In children the data are very scarce, with a single case report of a two-year old child with pulmonary infiltration, eosinophilia and subcutaneous cysticercosis.

In various guises, this is a common question, seemingly innocent, but actually betraying a fundamental confusion about LaTeX directory, and the levels of operation in the TeX World; concepts, distributions, distributions, variants and the TeX family and friends (i.e., users, contributors, dependent and extended language & softwares). TeX is a typesetting language developed by Donald E. Kunth, today's worldwide de facto standard for high quality document typesetting.  LateX is a Tex based typesetting system and collection of macros for document compilation and publication - not a word processor. MiKTeX is a compiler and an  Windows O/S based TeX/LaTeX distributions. The purpose of this read is to clear the confusion and give a comprehensive introduction to the World of LaTeX, hence provide information and technical bases for anyone, authors including academias to choose between LaTeX/Tex distributions to install given the features of the offered LaTeX engines and Compilers needed by their project or document typesetting. This fills the gaps in knowledge and literature, aside numerous plagiarized blogs , confusing articles (as learning latex itself) , confusing articles (as learning latex itself) and guidelines relating to scientific typesetting, LaTeX distributions, .tex editors, LaTeX distributions, .tex editors, Latex2e, LaTeX3 and the the LaTeX family.

One of the challenges compounding the complexity of reoperative cardiac surgery are the surgical adhesions, which can be responsible for adverse intraoperative events. In such situations implantation of a substitute neo-pericardium has become a frequently used solution for avoiding injuries to the heart and great vessels, with rising numbers of reoperations. The pericardium can be reconstructed using biological (heterologous or autologous) or synthetic material, each having their pros and cons. In this report we present a case of relapsing constrictive pericarditis after implantation of expanded polytetrafluoroethylene neo-pericardium (GORE®). A highly differentiated algorithm and a careful preoperative review of indication is recommended in order to plan the optimal method of pericardioplasty, taking into account the pros and cons of each available material.

A 33-year-old primiparous woman presented with reduced fetal movements during the gestational age of 33 weeks. Ultrasonography showed a heterogeneous and hypoechoic placental lesion measuring 8 cm. A week later, the patient delivered a live healthy male neonate. Histological examination of the placental mass established the diagnosis of placental chorioangioma.

Abstract Introduction: Linear ablation in addition to pulmonary vein antrum isolation (PVAI) has failed to improve the success rate for persistent atrial fibrillation (PeAF), due to incomplete block of ablation lines, especially in the mitral isthmus (MI). Methods and results: The study enrolled 191 patients (66 in group 1 and 125 in group 2). In group 1, EI-VOM was firstly performed, followed by radiofrequency (RF) applications targeting bilateral PVAI and bidirectional block in the roofline, cavotricuspid isthmus, and MI. In group 2, PVAI and the three linear ablations were completed using only RF energy. MI block was achieved in 63(95.5%) and 101(80.8%) patients in group 1 and 2, respectively (p=0.006). Patients in group 1 had shorter ablation time for left pulmonary vein antrum (8.15 min vs 12.59 min, p<0.001) and MI (7.0 min vs 11.8 min, p<0.001) and required less cardioversion (50(78.5%) vs 113(90.4%), p=0.007). During the 12-month follow-up, 58 (87.9%) patients were free from AF/AT in group 1 compared with 81 (64.8%) in group 2 (p<0.001). In multivariate cox regression, the ‘upgraded 2C3L’ procedure is associated with a lower recurrence rate (HR 0.27, 95%CI 0.12-0.59). Conclusion: Compared with the conventional ‘2C3L’ approach, the ‘upgraded 2C3L’ approach has higher effectiveness for ablation of PeAF.

The elimination of lower trophic levels following severe habitat disturbance can trigger new community assembly processes. However, little is known about how past habitat disturbances have affected codependent evolution of trophically-linked and closely interacting taxa. Using genome-wide analysis of a macroalgal community affected by ancient catastrophic coastal uplift, we track the ecological dynamics of past co-dispersal and co-diversification among obligate interacting taxa. Our study reveals rapid and concerted reassembly of an intertidal community following disturbance. Specifically, hierarchical co-demographic analyses of multispecies genomic data support synchronous expansions of four strictly intertidal species in the wake of tectonic disturbance. These data show that tight algal-epifaunal links underpin parallel demographic responses across distinct trophic levels. These results highlight that high-resolution comparative genomic data can elucidate the strength of obligate ecological interactions, and the evolutionary dynamics of past co-dispersal and co-diversification in post-disturbance communities.

Background - Since SARS-CoV-2 spread, evidences regarding sex differences in progression and prognosis of COVID-19 have emerged. Besides this, studies on patients’ clinical characteristics have described electrolyte imbalances as one of the recurrent features of COVID-19. Methods - We performed a case-control study on all patients admitted to the emergency department (ED) from 1st March to 31st May 2020 who had undergone a blood gas analysis and a nasopharyngeal swab test for SARS-CoV-2 by rtPCR. We defined positive patients as cases and negatives as controls. The study was approved by the local ethics committee Area 3 Milan. Data were automatically extracted from the hospital laboratory SQL-based repository in anonymized form. We considered as outcomes potassium (K+), sodium (Na+), chlorine (Cl-) and calcium (Ca++) as continuous and as categorical variables, in their relation with age, sex and SARS-CoV-2 infection status. Results - We observed a higher prevalence of hypokalemia among patients positive for SARS-CoV-2 (13.7% vs 6% of negative subjects). Positive patients had a higher probability to be admitted to the ED with hypokalemia (OR 2.75, 95% CI 1.8-4.1 p<0.0001) and women were twice as likely to be affected than men (OR 2.43, 95% CI 1.67-3.54 p<0.001). Odds ratios for positive patients to manifest with an alteration in serum Na+ was (OR 1.6, 95% CI 1.17-2.35 p<0.001) and serum chlorine (OR 1.6, 95% CI 1.03-2.69 p<0.001). Notably, OR for positive patients to be hypocalcemic was 7.2 (95% IC 4.8-10.6 p<0.0001) with a low probability for women to be hypocalcemic (OR 0.63, 95% IC 0.4-0.8 p=0.005). Conclusions - SARS-CoV-2 infection is associated with a higher prevalence of hypokalemia, hypocalcemia, hypochloremia and sodium alterations. Hypokalemia is more frequent among women and hypocalcemia among men.

Background Melasma, also known as chloasma or mask of pregnancy, is a common, acquired, hyperpigmentary disorder usually affecting females. Tranexamic acid (TA), a derivative of amino acid lysine has shown promising results over the past few years when used along with other therapies as well as when used as a stand-alone therapy. Aim of the Work In this study, we aimed to evaluate and compare the effectiveness of topically applied tranexamic acid after microneedling versus topically applied hydroquinone 4% alone in patients with melasma. Patients and Methods Fifty selected patients were divided randomly according to the random number allocation method into two groups (25 patients each) of A (topical 4% hydroquinone, nightly application) and B (microneedling + topical 4% TA, every other week). Results After Eight weeks of treatment, the mean modified MASI score of the HQ treated side changed from 6.604±4.02 to 3.032±1.19 with a mean decrease percentage of 54.8%±19.4%. This reduction in modified MASI score was found to be statistically significant, (p<0.001). MASI score of group B (TA + microneedling) changed from 6.348±3.84 to 3.712±1.19 with mean decrease percentage of 57.4%±23.4% which was also statistically significant, (p<0.001). Conclusion We demonstrated safety and efficacy of both used modalities and with minimal side effects. Topical HQ application achieved minimal non significant higher satisfactory results among raters and subjects

Aims: We carried out a systematic literature review and meta-analytic synthesis to find out association between DM and related outcomes in patients with COVID-19 infection. Methods: We systematically searched MEDLINE, and Web of Science to identify studies investigating comorbidities, clinical manifestations and resource utilization of diabetic patients exposed with COVID-19 published from inception to January 2021. Meta-analysis was carried out using Review Manager 5.3. Random effects model was used to compute the pooled estimates of odds ratio/mean difference (OR)/(MD) and 95% confidence intervals (CI). Results: Results from the pooled meta-analysis found that CVD, hypertension, AKI, cerebrovascular disease, AKI and ARDS were significantly associated with DM in COVID-19 infected patients compared to non-diabetic patients. There is significant association found between mortality and DM compared to non-diabetic patients [OR (95% CI): 2.46 (1.68, 3.58)]. ICU admission and use of mechanical ventilation was significantly associated with DM and COVID-19 vs. non-diabetic [OR (95% CI): 2.79 (1.79,4.34) and 3.33 (2.05, 5.42)] respectively. However, LOS, hospitalization, and ICU admission were not significantly differing between diabetes vs. non-diabetes. Conclusions: The results showed a significant association between mortality and DM exposed with COVID-19. Other co-morbidities especially CVD/hypertension could be a serious threat for DM COVID-19 infected patients for the higher mortality.

The multi-phase systems has found its applications in many fields. We shall apply this approach to investigate the multi-phase dynamics of sea-ice growth. In this paper, the weak solutions existence and uniqueness of parabolic differential equations are proved. Then large-time behavior of solutions are studied, also the existence of global attractor is proved. The key tool in this article is the energy method. Our existence proof is only in one dimension.

Background and Purpose: D-serine is a crucial endogenous co-agonist of NMDARs in the central nervous system and can affect the function of the BDNF system, which plays an essential role in modulating synaptic plasticity. The aim of the current investigation was to systematically evaluate the role and mechanisms of D-serine in depressive behavior in NAc. Experimental Approach: D-Serine concentration in the CSDS model in NAc was measured by HPLC. The antidepressant-like effects of D-serine were identified by the FST and TST in control mice, and then assessed in the CSDS model. We applied social interaction and sucrose preference tests to identify the susceptibility of CSDS model. Western blotting was further performed to assess the changes of BDNF signaling cascade in NAc after CSDS and D-serine treatment. The BDNF signaling inhibitor (K252a) was also used to clarify the antidepressant mechanism of D-serine. Moreover, effects of D-serine on synaptic plasticity in NAc were investigated by electrophysiological methods. Key Results: D-serine injections into the NAc exhibited antidepressant effects in the FST, TST and CSDS model. Next, D-serine down-regulated the BDNF signaling pathway in NAc during the CSDS procedure. Moreover, K252a enhanced the antidepressant effects of D-serine. We also found that D-serine was essential for NMDARs-LTD. Conclusion and Implications: Our results provide the first evidence that D-serine exerts antidepressant effects in mice mediated through restraining the BDNF signaling pathway and regulating synaptic plasticity in NAc, which indicates that D-serine may be an effective therapeutic agent for depression. KEYWORDS D-serine, depression, NAc, BDNF, CSDS, LTD

TITLE PAGETITLE : Sputum eosinophilia does not correlate with exacerbations in asthmatic children treated with mepolizumab.

A 62-year-old otherwise healthy patient was admitted with severe headache for several weeks. Initial imaging studies revealed multiple cystic lesions in both hemispheres. Neuroparasitic infections were considered as primary differential diagnosis. Open biopsy of a right frontal cortical lesion was performed. Pathohistological revealed the diagnosis of cerebral metastasis of adenokarcinoma.

Abstract Aim: This study aimed to investigate the in-vitro platelet aggregation and secretion tests in children patients with Henoch-schöenlein Purpura that recently referred to as Ig A vasculitis Methods: This is a cross-section study that included 55 patients with Henoch-schöenlein Purpura and 31 healthy children as a control group. Children who have a history of drug use, chronic diseases, and bleeding diseases were excluded from the study. Complete blood count, thrombocyte aggregation, and secretion tests were studied in both groups. These tests were re-evaluated in remission of the disease. Results: It was found that epinephrine-stimulated platelet aggregation and collagen, epinephrine, ristocetin, arachidonic acid, standard dose thrombin, and high dose thrombin-stimulated platelet secretion results were lower in the patients with Henoch-schöenlein Purpura compared to the healthy control group in the acute period (respectively P=0.014, 0,003; 0,003; 0,027; 0,034; 0,010; 0,049). When the values of patients with Henoch-schöenlein Purpura in the acute period and the remission of the disease were compared, collagen-stimulated platelet aggregation and epinephrine-stimulated platelet secretion values were found to be lower in patients with patients in the acute period (P= 0.016; 0.039) Conclusion: Impairment in vitro platelet aggregation and secretion tests in the patients with Henoch-schöenlein Purpura suggest that the tendency to bleeding in these patients may be due to platelet impairment function. Key Words: Henoch-schöenlein Purpura, platelet aggregation tests, platelet secretion tests, children, Ig A vasculitis. What’s already known about this topic? There is a tendency to bleeding in Henoch Shcöenlein Purpura patients, such as gastrointestinal bleeding, nonthrombocytopenic system purpura. What does this article add? It was found that impairment in-vitro platelet aggregation and secretion tests in Henoch Shcöenlein Purpura patients.