A 34-year-old woman was hospitalized with shortness of breath and chest tightness and pain. She had undergone aortic valve replacement for aortic stenosis at the age of 18 years. Transthoracic echocardiography showed left ventricular asynergy and a high aortic valve pressure gradient. Thus, structural valve deterioration was diagnosed. Coronary computed tomography and coronary angiography revealed left main trunk ostial stenosis that had caused acute anteroseptal myocardial infarction. Urgent surgery revealed pannus formation around the prosthetic valve and covering the ostium of the left main trunk. A Bentall procedure and coronary artery bypass grafting were performed. The postoperative course was uneventful.

Noonan syndrome is a genetic multisystem disorder characterized by distinctive facial features, developmental delay, congenital heart disease, and other conditions. It is associated with mutation of genes encoding the proteins in the RAS-MAPK pathway, including PTPN11. We herein describe the first case of Noonan syndrome complicated with hepatocellular carcinoma.

Looping  Mission w/ DronesObjectives:Students will be able to: Identify the benefits of using a loop structure instead of manual repetition. Differentiate between commands that need to be repeated in loops and commands that should be used on their own. Vocabulary Loop - The action of doing something over and over again. Repeat - To do something again. IntroductionRemind students of the work they did in the previous Drone Legends mission. Open a discussion about what they learned, why they think it might be useful, and if they had any fun. Here are some discussion starters. This mission highlights the power of loops with creative and personal designs.Offered as a project-backed sequence, this progression will allow students to build on top of their own work and create amazing artifacts. ·        What did you learn in the “Mt. Erebus” mission?·        What are the three main components of a loop?·        Why do you think a loop might be helpful in programming?o   Many students might not know an answer to this. Let them hypothesize, but don't dwell on this question for too long.·        Did you have fun learning about loops? Why or why not?·        Are you excited to use loops in Drone Legends missions?Main Activity (45 min)Split up the students of your class into groups of 2 or 3. Each member begins with one of three roles, Pilot in command, Visual Observer, and Safety Officer. These roles will rotate throughout the lesson.  Ideally have the groups be the same from the “Mt. Erebus” mission. Explain the scenario of the drone rescue mission to students making sure to include its relevance to loops. The use of looping will be required to complete this mission successfully. After explaining and answering any questions, allow students 15 minutes to plan their rescue mission.   Begin Activity (mission) Wrap Up (15 min)JournalingHaving students write about what they learned, why it’s useful, and how they feel about it can help solidify any knowledge they obtained today and build a review sheet for them to look to in the future.Journal Prompts:·        What was today’s lesson about?·        How did you feel during today’s lesson?·        How is a for loop different from a repeat loop?·        Why do you think loops could be useful? Standards Alignment3-5-ETS1-2: Generate and compare multiple possible solutions to a problem based on how well each is likely to meet the criteria and constraints of the problem. 4-LS1-2. Use a model to describe that animals receive different types of information through their senses, process the information in their brain, and respond to the information in different ways. [Clarification Statement: Emphasis is on systems of information transfer.]  

Abstract Objectives: To determine the incidence, risk factors, and outcomes of new-onset atrial fibrillation (NOAF) in a cohort of critically ill patients with coronavirus disease 2019 (COVID-19). Methods: We conducted a retrospective study on patients admitted to the intensive care unit (ICU) with a diagnosis of COVID-19. NOAF was defined as atrial fibrillation that was detected after diagnosis of COVID-19 without a prior history. The primary outcome of the study was the effect of NOAF on mortality in critically ill COVID-19 patients. Results: We enrolled 248 eligible patients. NOAF incidence was 14.9% (n=37), and 78% of patients (n=29) were men in NOAF positive group. Median age of the NOAF group was 79.0 (interquartile range, 71.5-84.0). Hospital mortality was higher in the NOAF group (87% vs 67%, respectively, p=0.019). However, in multivariate analysis, NOAF was not an independent risk factor for hospital mortality (OR 1.42, 95% CI 0.40–5.09, p=0.582) Conclusions: The incidence of NOAF was 14.9% in critically ill COVID-19 patients. Hospital mortality was higher in the NOAF group. However, NOAF was not an independent risk factor for hospital mortality in patients with COVID-19. Keywords: Atrial fibrillation, critical care, intensive care unit, COVID-19, mortality, hospital mortality

OBJECTIVES: The supra-annular aortic valve replacement (SA-AVR) allows for implantation of larger prostheses. We describe the technique, early post-operative outcomes and hospital mortality. METHODS: Patients who underwent SA-AVR with the Carpentier-Edwards Magna Ease bioprosthesis between December 2010 and December 2017 were retrospectively reviewed. The prosthesis was sutured to the aortic annulus along the coronary sinuses, and in a supra-annular position along the non-coronary sinus. RESULTS: 115 patients were included (mean age: 71,6 years ± 9,4). Mean bioprosthesis diameter was 23,3 ± 1,7 mm. Four early deaths were observed in the ICU. Early post-operative complications included: re-operation for bleeding (n=6), tamponade (n=7), permanent atrioventricular block (n=4) and hemodialysis (n=2). In-hospital mortality was 3,48%. Postoperative echocardiography showed a marked decrease in the mean left ventricle – aorta gradient (50,4 ± 16,1 mmHg vs 11,3 ± 4,05 mmHg). CONCLUSION: SA-AVR is safe and associated with favourable immediate outcomes in patients with small aortic annulus.

Background:Although the sensitivity of third generation anti-HCV CIA tests is high, false positivity rates, especially in populations with low HCV infection endemicity, are still high. Objectives:We aimed to determine the S/Co cut-off value of anti-HCV in the diagnosis of real positive patients based on the CIA test kit absorbance routinely used in our laboratory and to reveal the potential cost effectiveness of confirmatory tests for false positive samples. Methods:All anti-HCV CIA test results which were performed in the microbiology laboratory of our hospital between 2016-2019 were retrospectively screened and S/Co values of the patients were recorded. Among these, the results that were confirmed with HCV-RNA real-time PCR test were included. Patients who were previously diagnosed and treated were excluded. Results:A total of 257 patients, who were tested for HCV-RNA after reactive anti-HCV test results, were included in the study. Of the cases, 84(32.68%) had positive HCV-RNA. According to the ROC analysis, the optimal S/Co value was 8.58 with the sensitivity and specificity values 95.24% and 85.55%, respectively. According to this 8.58S/Co value, anti-HCV test was reactive in 105 cases and 80(76.2%) of these cases had active HCV infection. In order to prevent the false-negativity, the additional cost of using 1.0S/Co value to our institution was 4114.64USD, meaning that we spent 1028.66USD to diagnose per true-case of active HCV infection when using 1.0S/Co value. In our institution, approximately 6.25 working hours are spent to finalize the HCV-RNA PCR test. The hours spent for S/Co of 1.0 and 8.58 were 1606.25 and 658.25, respectively. Conclusions:False positive anti-HCV results are an economic burden on health economics of countries. At least, different S/Co values might be used in accordance with the purpose of the screening (like blood donors or pre-operative screening) and prevalence of HCV infection in different laboratories and different populations.

The massive raise of COVID-19 cases all over the world is leading to unprecedented pressures on healthcare services. Growing evidence is highlighting that COVID-19 is a systemic condition that requires doctors with multiple expertise. Paediatricians are trained in these skills. Considering the issue of staff shortage that is facing every country in the world, and the complexity of COVID-19, paediatricians may represent an important source of ready and skilled specialists that can quickly translate the paediatric practice in the COVID-19 care. We report our experience of paediatricians engaged in the fight against COVID-19 within adult COVID-19 wards. In particular, we focus on the importance of a skill of some paediatricians in their clinical practice, namely the use of lung ultrasound which has also become fundamental in the management of adult patients with COVID-19, especially for some categories such as pregnant women.

A comprehensive evaluation indicator system is needed to provide a integrated assessment of the degree of sloped cropland degradation. We employed bibliometrics to perform statistical analysis on research studies involving cropland degradation. Frequency analysis was then used to identify high-frequency indicators with which to construct a total index set (TIS) for evaluation of the degree of sloped cropland degradation in black soil region. In addition, soil measurement data from sloped cropland in Baiquan and Keshan Counties, Heilongjiang province, China, were used as a basis to construct a minimum index set (MIS). The TIS included A-horizon thickness, clay content, organic matter content, pH, slope gradient, ridge-slope angle, gully density, bulk density, large water-stable aggregate content, soil cation exchange capacity, and crop yield. The first six of these were included in the MIS. In the studied area, undegraded soil, mildly degraded soil, and moderately degraded soil and above accounted for 7%, 48% and 45% of investigated sloped croplands, respectively. Slope gradient is one of the main factors affecting soil degradation. Soil degradation mainly presented as worsening of soil physicochemical characteristics. In addition, downslope and small-angle ridge cultivation are benefit for soil organic matter maintenance and the soil structure and nutrient retention capacity is better than soil with contour or large-angle ridge cultivation. The reason might be that downslope and small-angle ridge cultivation are usually employed on soil with small slope. The study results provide a scientific basis for improving the quality and productivity of sloped cropland in black soil region.

In this paper, we construct an example to show that wellposedness and norm inflation are compatible.

Objective: Description of the use of corticosteroids for the management of parapneumonic pleural effusion in children. Methods: Retrospective monocenter cohort study of all children hospitalized with a discharge diagnosis of parapneumonic pleural effusion during a 15-year period. Results: We documented 97 cases of parapneumonic effusion during the study period, with a median age (interquartile range (IQR)) of 43 (33-61) months. Most of the children benefited from an evacuation of the pleural effusion (89/97, 91.8%): 21 patients (21.6%) were treated with needle thoracocentesis only, while a chest tube was inserted in 68 children (70.1%). Thirty-two patients (33%) were treated with intrapleural fibrinolysis. Fifty-five children (56.7%) received corticosteroids for persistent fever. The median time (IQR) between hospital admission and initiation of corticosteroids was 5.5 (4-7) days. When corticosteroids were initiated, children were febrile since 9 (IQR 8-11) days. The fever ceased in a median (IQR) of 0 (0-1) day after corticosteroids initiation. Only 1 patient required a video-assisted thoracoscopy that was provided because of morphological reasons (morbid obesity). No children treated with corticosteroids required surgery. All children were discharged alive from hospital. The median (IQR) hospital length of stay was 11 (8-14) days, with no difference between children with and without corticosteroids. Conclusion: Our results indicate that corticosteroids could be associated with a significant reduction in the use of surgical procedures and with a prompt clinical improvement. Corticosteroids could thus offer a non-invasive therapeutic alternative for children with parapnemonic effusions when antibiotics and pleural drainage are considered a failure.

BACKGROUND. Mitral valve (MV) repair with MitraClip system is a safe treatment option for high-risk patients with significant mitral regurgitation (MR). We aimed to characterize, by three-dimensional echocardiography (3D-E), changes occurring in MV after implantation of third generation MitraClip XTR device, with specific reference to the underlying MR mechanism (functional vs. degenerative, FMR vs DMR). METHODS. We prospectively enrolled 59 patients, who underwent intra-procedural 3D-E before and after device deployment. Three-D datasets were analysed off-line, using a dedicated semiautomatic software, to obtain parametric quantification of mitral anatomy. RESULTS. Post-procedural MR of mild or lesser degree was achieved in 40 patients (68%), with no differences between FMR and DMR (p 0.9). After MitraClip XTR implantation, the FMR group experienced an immediate annular resizing, with reduction of antero-posterior diameter (p 0.024) and sphericity index (p 0.017), next to a recovery of physiological saddle-shape, defined by lower non-planar angle (p ≤0.001) and higher annulus height to commissural width ratio (p ≤0.001). On the opposite, the DMR group revealed a significant decrease of maximum annular velocity (p 0.027), addressing a mechanic effect of the device deployment. Finally, baseline anterior mitral leaflet angle was found as the strongest independent predictor of acute procedural result (OR 0.91, [CI 0.84-0.99], p = 0.030). CONCLUSIONS. MitraClip XTR implantation acts in restoring the original mitral geometry, with distinctive effects according to MR mechanism. Three-D parametric quantification of MV sheds new light on changes occurring in the valvular apparatus, and helps identifying possible new predictors of acute procedural success.

Species interactions and mechanisms affect plant coexistence and community assembly. Despite increasing knowledge of kin recognition and allelopathy in regulating interspecific and intraspecific interactions among plants, little is known about whether kin recognition mediates allelopathic interference. We used allelopathic rice cultivars with the ability for kin recognition grown in kin vs. non-kin mixtures to determine their impacts on paddy weeds in field trials and a series of controlled experiments. We experimentally tested potential mechanisms of the interaction via altered root behavior, allelochemical production, and soil microbial community composition, as well as carbon and nitrogen partitioning in the weeds. We consistently found that the establishment and growth of paddy weeds were more inhibited by kin mixtures compared to non-kin mixtures. The effect was driven by kin recognition that induced altered root placement, established similar soil microbial communities, and altered weed carbon and nitrogen partitioning. Importantly, genetic relatedness enhanced the production of intrusive roots towards weeds and reduced the production of rice allelochemicals. These findings suggest that relatedness allows allelopathic plants to discriminate their neighboring collaborators (kin) or competitors and then adjust their growth, competitiveness and chemical defense accordingly.

Background: in recent years, High Flow Nasal Cannula (HFNC) has been considered an alternative to non-invasive mechanical ventilation (NIMV) in severe asthma respiratory management in children. Objective: to describe the use of HFNC in children with severe asthma admitted to pediatric critical care unit (PICU). To compare its clinical characteristic and evolution with those receiving NIMV or other respiratory support. Methods: prospective observational study done in children admitted to PICU with severe asthma (October 2017 to October 2019). Data collected: epidemiological, clinical, respiratory support, thorax x-ray, pharmacological treatments and days of admission. Patients were divided into groups: 1) Only HFNC 2) HFNC and NIMV, and 3) Only NIMV. Results: Seventy-six patients included, 39 girls. The median age was two years and one month (range 160). The median pulmonary score was 5 (range 7). PICU admission lengths a median of 3 days (range 9), hospital 6 days (range 23). There were no epidemiological or clinical differences between groups. Children with only HNFC showed a shorter time of PICU days (p 0,025) and none of them required NIMV. In the group receiving both modalities, NIMV was used first and then HFNC in all cases. Children with HFNC showed higher SaO2/FiO2 ratio (p=0,025) and lower PCO2 level (p=0,032). There were no deaths. Conclusions: in our study the HFNC did not require escalation to NIMV and did not increase the length of PICU or hospital days. Normal initial blood gases and absence of high oxygen requirements were useful to select responders to HNFC.

Background: Despite numerous prior interventions to reduce unnecessary visits to the emergency department (ED), overutilization and overreliance on EDs continue to negatively impact quality of care and cost. Objective: Motivated by finding solutions to ED overuse, we evaluated the effect of COVID19 on pediatric ED utilization, specifically focusing on patients with pulmonary diagnoses. Methods: A retrospective study was conducted to review visits to the pediatric ED at Phoenix Children’s Hospital. The baseline pre-COVID19 period ranged from 01/01/2016 to 03/14/2019. Post-COVID19 data were collected from 03/15/2020 to 07/31/2020. Study subjects included all patients between 0-18 years of age. Data was collected biweekly for the number of ED visits, admission to hospital from ED, presenting diagnosis and pulmonary consults. Results: The average number of biweekly ED visits decreased significantly from 3437 during baseline to 2061 post-COVID19, while the percent of hospital admissions increased from 0.14% to 0.18% (p< 0.01). A significant decrease was also observed in the biweekly average number of pulmonology consults (527 to 250), and the percent of pulmonology consults (0.15% to 0.11%), presenting diagnosis of asthma (130 to 59), tracheostomy (7 to 6), cystic fibrosis (7 to 5), cough/wheeze (66 to 41) and bronchiolitis/upper and lower respiratory tract infections (300 to 126). No changes were detected in chronic respiratory failure, respiratory distress or hypoxemia. Conclusion: Many factors including telehealth, improved infection control measures, social responsibility, and fear of getting sick may have played a role in the reduction in our ED visits during the COVID pandemic.

Bullying-induced dyspnoea in children: a case seriesIan P. Sinha 1,2Claire Hepworth 1Sujata De 1Sunil D. Sharma 1Ian Street 1Philip J. Lawrence 1Thomas Hampton* 1,21 Alder Hey Children’s Hospital, Liverpool, UK2 Division of Child Health, University of Liverpool, UK*Corresponding author (Thomas.hampton@nhs.net)Dear EditorWe conduct a multidisciplinary complex breathlessness clinic for children1. We conduct spirometry before and after a treadmill exercise test (until the child is breathless), continuous nasal laryngoscopy, pulse oximetry, and calculation of maximal oxygen consumption (VO2max). Here we describe a series of children who presented with troublesome breathlessness that appeared to be caused, or exacerbated by, being bullied.Case 1 (14 year old white female): She was a highly competitive sportsperson, but was recently unable to train or compete. She described her breathlessness as ‘air getting stuck in her throat’, and had a non-specific cough. She had frequent admissions to hospital, treated as presumed asthma attacks. The referring clinician felt her asthma was of insufficient severity to cause her problems. She had no documented obstruction on spirometry in clinic, nor and Fractional Exhaled Nitric Oxide (FeNO) was normal. In clinic she managed a few minutes of running, before suddenly stopping. There was no evidence of exercise-induced bronchoconstriction or exercise-induced laryngeal obstruction (EILO), but she had features of dysfunctional breathing (DB). On questioning she described feeling bullied by parents of other children in her sports team, whom she described as overcritical and disparaging. She was taught breathing exercise and referred to psychological services. Her symptoms and asthma attacks improved, and she recommenced competitive sports.Case 2 (10 year old white female): She had a chronic wet cough since the age of six months. She underwent flexible bronchoscopy which identified mild tracheobronchomalacia. She recently described breathlessness on mild exertion that was disproportionate to the degree of tracheobronchomalacia. Physiological testing never demonstrated airways obstruction, or raised FeNO. In clinic she started running but stopped within minutes, with no physiological evidence of increased work of breathing or bronchoconstriction. Laryngoscopy was normal. On questioning she described that she was bullied at school. Specifically, she described that children would not sit near her because of her cough. She was followed up in respiratory physiotherapy clinic, and her symptoms and exercise tolerance improved.Case 3 (13 year old white female): She had no medical diagnoses at the time of testing, but previously had tonsillectomy because of recurrent tonsillitis. She described breathlessness on exertion. She stopped running very suddenly, as soon as she felt breathless on the treadmill. The breathlessness started as discomfort underneath her ribs and in her throat. Spirometry and laryngoscopy were normal before and after exercise. She had apical breathing and hyperventilation at rest, suggestive of dysfunctional breathing. She described being bullied at school. She did not attend follow up sessions with physiotherapy and was discharged from the service.Case 4 (9 year old black male): He was treated for mild asthma which had, until recently, been well controlled. He had become withdrawn, and was not enjoying playing sports despite previously being very athletic. On questioning he described suffering significant and long-standing racial bullying at school. He discussed this with the teachers but his symptoms seemed to develop after he felt like his complaints were not taken seriously. His breathlessness and exercise tolerance improved temporarily after enrolling in a community sports program for children with asthma 2, and he was much better after moving school.Across these cases, we identified common themes:The character and severity of the breathlessness was out of keeping with their underlying diagnoses, and was intensely unpleasant. All children described non-specific and variable symptoms of pain in their abdomen, joints, or chest.They appeared withdrawn, unhappy, and lacking in self-confidence. They had slouched posture, and spoke quietly.They had very sudden and surprising termination of exercise after starting to feel breathless, with no significant physiological evidence of increased work of breathing – we noticed a stark difference compared with other children who saw breathlessness as a challenge and would continue to run long after showing signs of tachypnoea and tachycardia.In all cases, it was the healthcare professionals who raised the subject of bullying. The children had felt that they had raised concerns about being bullied but felt these were dismissed.When children engaged with physiotherapy, we noticed improvements. The children were relieved when we did not find significant anatomical or physiological diagnoses, and all agreed their breathlessness was caused by bullying.We feel that these patterns relate to a phenotype of childhood dyspnoea specifically related to bullying. Anxiety is associated with tachypnoea, but in our experience the pattern of breathing in these children was different: their shallow, rapid breathing at rest was felt to be related to a slouched posture causing restriction, and all had a sudden cessation to exercise after very minimal exertion. We suggest these are manifestations, specifically, of low self-esteem. It was notable that they described the breathlessness as intensely uncomfortable. The neural pathways involved in driving respiration, and sensing breathlessness, are complex, and we postulate that they are affected by low self-esteem.This, to our knowledge, is the first description of bullying-induced dyspnoea in children, as a separate phenomenon to anxiety-related hyperventilation. There may be crossover with other psychological, physiological and anatomical problems, and further research is warranted. Having asthma is a risk factor for being bullied3, and bullying is associated with worse asthma control4. A recent review has also identified possible associations between bullying and the development of childhood asthma5. It is important ask about bullying when taking a history from a child with unexplained or disproportionate breathlessness.

Bronchopulmonary dysplasia is a relatively common and severe complication of prematurity, and its pathogenesis remains ambiguous. Revolutionary advances in microbiological analysis techniques, together with the growing sophistication of the gut-lung axis hypothesis, have resulted in more studies linking gut microbiota dysbiosis to the occurrence and development of bronchopulmonary dysplasia. The present article builds on current findings to examine the intrinsic associations between gut microbiota and bronchopulmonary dysplasia. The gut microbiota affects bronchopulmonary dysplasia via several potential mechanisms including alteration of the gut-lung axis, promotion of inflammation and the ensuing growth effects, therefore these are also investigated. By evaluating the potential mechanisms, new therapeutic targets and potential therapeutic modalities for BPD can be identified from a microecological perspective.

It has been recognized the need to consider some photosynthetic processes in their transient states since those are more representative of the natural environment. The combination of mathematical models with the available data provides a tool to understand the dynamic responses of plants to fluctuating environments and can be used to make predictions on how photosynthesis would respond to unsteady state conditions. Here we present a leaf level system dynamic photosynthetic model based and validated on an experiment performed on two soybean varieties, the wildtype Eiko and the chlorophyll deficient mutant Minngold, grown in constant and fluctuating light conditions. This mutant is known to have similar steady-state photosynthesis compared to the green wildtype, but it is found to have less biomass at harvest. It has been hypothesized that this might be due to an unoptimized response to non-steady state conditions, therefore this mutant seems relevant to investigate dynamic photosynthesis. The model explained well the photosynthetic responses of these two varieties to fluctuating and constant light conditions and allowed to make relevant conclusions on the different dynamic responses of the two varieties. Furthermore, due to its simplicity, the model could provide the basis of an upscaled dynamic model at plant level.

Angiomyolipoma(AML) is one of the most common benign renal tumors. Classical AML is benign, but it can be locally invasive, extending into perirenal fat, or in rare cases, invading the renal collecting system, renal vein or inferior vena cava and right atrium. About 10% of patients clinically diagnosed with renal AML have tuberous sclerosis complex. Tuberous sclerosis complex can be diagnosed by genetic diagnosis or clinical manifestation. We report a rare case of a 35-year-old woman who was diagnosed with tuberous sclerosis complex caused by TSC2 gene mutation, which was characterized by multiple angiomyolipoma in the right kidney and extended growth to the inferior vena cava and right atrium. Intracardiac extension is often observed in the malignant tumor and only seldom seen in benign tumors. Our case reminds the rare possibility of intracardiac extension in renal AML, which may potentially result in fatal complications if not appropriately managed.

Currently, the only widely accepted indication for interventional treatment in cases of pulmonary embolism is hemodynamic instability or cardiogenic shock. However, the presence of a right-heart thrombus along with a pulmonary embolism is a poor prognostic indicator, and catheter-directed thrombolysis with the use of thrombolytic agents should also be considered in this circumstance. Optimal management of right heart thrombus and high-risk pulmonary embolism is still uncertain. Herein, we present the case of an 81-year-old woman who presented at our hospital after progressive dyspnea and a syncopal event. The transthoracic echocardiography showed massive bilateral pulmonary, right ventricular, and mobile atrial thrombus and also right-sided enlargement. The patient was successfully treated with acoustic pulse thrombolysis using the EKOS EkoSonic system and echocardiography revealed complete resolution of her right-heart thrombus and her high-risk pulmonary embolism 2 days later.

Abdominal wall endometrioma is an extremely rare entity with a precise incidence of 0.07%–0.47% remaining an insidious cause of usually delayed diagnosis. Differential diagnosis should include that rare condition and ultrasonography remains a pivotal tool to unravel that enigma as well.

Infected coronary artery aneurysms present high mortality and surgical management is the treatment of choice in most cases. We present a case of a giant infected aneurysm of the mid right coronary artery complicated with purulent pericarditis in an 83-year-old male patient. It is unknown whether the aneurysm or purulent pericarditis preceded. The patient underwent urgent aneurysm resection and coronary artery distal bypass grafting. He died 24 hours after the operation. When purulent pericarditis and ICAA co-exist the riddle of the chicken and the egg becomes apparent.

In this paper, we are concerned with the problem of counting the multiplicities of a zero-dimensional regular set's zeros. We generalize the squarefree decomposition of univariate polynomials to the so-called pseudo squarefree decomposition of multivariate polynomials, and then propose an algorithm for decomposing a regular set into a finite number of simple sets. From the output of this algorithm, the multiplicities of zeros could be directly read out, and the real solution isolation with multiplicity can also be easily produced. As a main theoretical result of this paper, we analyze the structure of dual space of the saturated ideal generated by a simple set as well as a regular set. Experiments with a preliminary implementation show the efficiency of our method.

Part of the training module on publishing with the Council of Australian University Librarians, this 1h webinar provides tips to Early Career Researchers on how to write and accompany an article through the peer-review process. Not specific to Wiley journals, but why go elsewhere, really?

Background Pregnancy and liver cirrhosis is a rare but increasing combination. Liver cirrhosis can raise the chance of maternal and fetal mortality and morbidity, although the exact risks remain unclear. Objective To provide a systematic literature review and meta-analysis on maternal, fetal and obstetric complications among pregnant women with liver cirrhosis. Search strategy We performed a systematic literature search in the databases PubMed/MEDLINE and EMBASE (Ovid) from inception through 25 January 2021. Selection criteria Studies including pregnancies with liver cirrhosis and controls were eligible. Data collection and analysis Two reviewers independently evaluated study eligibility. We used the random-effects model for meta-analysis. Main results Our search yielded 3118 unique papers. We included 11 studies, including 2912 pregnancies in women with cirrhosis from 1982-2020. Seven studies were eligible for inclusion in the meta-analysis. The overall maternal mortality rate was 0.89%. Maternal mortality and variceal hemorrhage decreased comparing recent and older studies. Most cases of maternal mortality due to variceal hemorrhage (70%) occurred during vaginal delivery. Pregnant women with liver cirrhosis had a higher chance of preterm delivery (OR 6.7 95% CI 5.1- 9.1), cesarean section (OR 2.6, 95% CI 1.7-3.9), preeclampsia (OR 3.8, 95% CI 2.2-6.5) and small for gestational age neonates (OR 2.6, 95% CI 1.6-4.2) compared to the general obstetric population. Subgroup-analyses could not be conducted. Conclusions Liver cirrhosis in pregnant women is associated with serious increases in maternal mortality and obstetric and fetal complications. Large international prospective studies are needed to identify risk factors for unfavorable outcome.