Generations of cryoballoon transformed the atrial fibrillation ablation landscape. New advancements continue to make cryoballoon more successful and safer treatment. A new cryoballoon PolaRx from Boston Scientific has unique features compared to that of the Medtronic Arctic Front Advance system. Comparison of the two available cryoballoons will require ongoing larger trial and clinical experience.

Very late recurrences after ablation of AVNRT have been reported. Age related alterations of nodal tissues caused by fibrous and fatty tissue infiltration and changes of the sympathovagal influence on the AV node, in turn altering AV nodal conduction and refractoriness, could set the stage for a previously not present substrate for AVNRT. Consequently, the occurrence of AVNRT many years after an ablation procedure may perhaps not always implicate a recurrence but instead an arrhythmia caused by a new substrate.

PIM-1 is a serine-threonine kinase which is mainly expressed in tissues such as Thymus, spleen, bone marrow, and liver. This protein takes a role in many stages of the cell cycle, including the regulation of cell cycle progression and apoptosis. According to many studies, overexpression of PIM kinases happens in various types of human tumors; such as lymphomas, prostate cancer, and oral cancer. As a result, the design of drugs to inhibit PIM-1 in cancerous cells has attracted many attentions in recent years. This study aimed to design the alternative inhibitors for PIM-1 kinase, which are based on carbohydrates and amino acids and are expected to be non-toxic and to have the same chemotherapeutic effects as the traditional agents. The combinatorial use of quantum mechanics studies and molecular dynamic simulation (MD) has enabled us to precisely predict the mechanism of the inhibition of PIM-1 kinase by the novel designed drugs and to compare them with the recently synthesized chemotherapeutic drugs; such as DBC.

Allergy to Galactose-Alpha-1,3-Galactose is an allergy to mammalian proteins, that are present on the surface of standard bioprosthestic valves, and could result in catastrophic allergic reaction or may cause early deterioration of the bioprostheses. Aortic homograft is an acceptable alternative to standard prosthetic valves (biological and mechanical) to avoid a potential allergic manifestation and the need of definitive oral anticoagulation. We report the implantation of an aortic homograft in a patient with an aortic stenosis who present a documented Alpha-Gal allergy.

Neutral zinc-air batteries (ZABs) are promising candidates for the next-generation power devices with considerably elongated lifetime comparing to conventional alkaline ZABs. However, neutral cathodic oxygen reduction reaction is seriously limited by the mass transfer efficiency of hydroxyl due to insufficient interfacial chemical potential-gradient between catalytic layer and electrolyte. Herein, we highlight that electrochemical oxidation induced surface microenvironment optimization could realize optimal chemical potential-gradient around catalytic sites and bring outstanding neutral ORR activity. The electro-deposited sub-nano Pt decorated surface-microenvironment-optimized Co2N samples (denoted as Pt-SMO-Co2N NWs) possessed 92 mV and 365 mV lower overpotential than commercial Pt/C and pristine Co2N in 0.2 M PBS. As for neutral ZABs, Pt-SMO-Co2N NWs cathode delivers a power density of 67.9 mW*cm−2 and displays negligible decay after nearly 80 hours stability test at 20 mA*cm-2. In depth characterization proposes that remarkable performance improvement originates from optimized microenvironment which increases the surface chemical potential gradient and facilitates proton coupled electron transfer during ORR. We anticipated that such synergetic optimization of microenvironment and intrinsic activity of active sites is an effective strategy which may be extended the catalytic reactions beyond ORR.

Energetic compounds containing long nitrogen chain, have been a research hotspot. Fused heterocycles are stable due to their aromatic systems. The compound obtained by combining long nitrogen chain and fused ring can not only retain good energetic property, but also ensure better stability. This work designed eight fused heterocycle-based energetic compounds, 3H-tetrazolo[1,5-d]tetrazole (1) and its derivatives (2-8), containing a nitrogen chain with seven nitrogen atoms. The HOF, thermal stability, and energetic properties of these compounds were studied by using the DFT method. The results show that the introduction of -NO2, -N3, -NF2, -ONO2, -NHNO2 groups increased the density, HOF, detonation velocity, and detonation pressure greatly. The densities of 3, 5, 7, and 8 fall within the range designated for high-energy-density materials. The calculated detonation velocity of the compounds 3 and 8 are up to 9.86 km s-1 and 9.78 km s-1, which are superior to that of CL-20. The kinetic study of the thermal decomposition mechanism indicates that the N-R bonds maybe not the weakest bonds of these compounds. The tetrazole ring opening of the heterocycle-based energetic compounds, followed by N2 elimination is predicted to be the primary decomposition channel, whether or not they have substituent groups.

The use of zolpidem has been driven by the still-widespread false belief among doctors that, since zolpidem is chemically not a benzodiazepine, it cannot lead to addiction and tolerance. We would like to contribute to better highlight certain characteristics of zolpidem and its potential as a substance of abuse due to the fact that our operating unit, which is entirely dedicated to medication abuse, has described among the most numerous cases of addiction to high doses of benzodiazepines and related hypnotics. - Zolpidem was in fourth place among the 29 molecules present on the Italian market; - We believe it’s now time to drop the term “Z-drugs”: zolpidem, zopiclone e zaneplon all have different chemical structures, they bind to different receptors and have completely different abuse potentials3. In our case history, both zopiclon and zaneplon were virtually absent, albeit being commonly used in Italy; - Istvan & colleagues highlight the fact that addiciton and abuse are prevalent in samples suffering from mental illness. In our case history this hasn’t been confirmed: about half of our patients had no history of psychiatric illnesses, nor a history of addiction to illicit substances or alcohol; - Lastly, regarding zolpidem’s hazardousness, we would like to report the fact that the drug was significantly preferred by addicts with a positive ADHD test result. In conclusion, the 2000s saw solid confirmation of the effectiveness of partial agonists in the treatment of some common addictions, such as buprenorphine, varenicline, cytisine. This didn’t happen for BZs

Negli ultimi anni si ha la crescente preoccupazione per la presenza e il destino di farmaci nell'ambiente acquatico, i cui potenziali effetti ambientali sono in gran parte sconosciuti quando tali composti sono compresenti in miscela.  La volontà di impedire completamente il loro ingresso negli ecosistemi, mossa dalla precauzione, stimola la ricerca su metodi di trattamento alternativi, tra questi il trattamento combinato con ozono e ultrasuoni. Da svariati studi si evince che le rese del processo per la rimozione di singoli composti farmaceutici selezionati sono efficaci ma nella realtà gli impianti devono fronteggiare reflui dalle caratteristiche sempre diverse e con miscele di contaminanti in differenti concentrazioni. Bisogna dunque mirare alla caratterizzazione di tali prodotti, comprendere meglio i processi e migliorare le tecnologie in modo da poter perseguire l’obiettivo.

The study is aimed to investigate the nature and extent, and assess perception of local community towards wildlife. A total of 140 household heads were selected randomly from nine survey villages using structured and semi-structured questionnaire for interviews. Focus group discussion, key informant interview and personal observation were held used to achieve the study objectives. Data were analyzed using descriptive statistics and responses compared using Chi-square test (2 tailed), one-way ANOVA and Pearson correlation coefficient. Besides, Likert scale statements were used to assess the attitudes of local people towards wildlife conservation. About 47.1% of sampled respondents thought that they experienced livestock predation whereas 57(40.7%) of the respondents faced both crop damage and livestock predation problems. A total of 932.43TLU livestock and 218 Dogs losses reported by households due to predators over the last five years. Thus, large numbers (848.6TLU livestock and 218 Dogs) of attack was happened due to Spotted Hyena (Crocuta crocuta). The frequency of livestock predation (F = 8.157, df = 8, P < 0.05) and type of predators involved (χ2=79.719, df = 8, p <0.05) were significantly differ across study villages. Nearly half, 69(49.3%) of respondents ranked Warthog (Phacochoerus africanus) as primary crop raider. Whilst majority of the respondents 115(82.1%) perceived Maize was frequently and severely damaged cereal crop. Most 80 (57.1%) respondents used different methods simultaneously to minimize damage caused by wild animals. Nearly half, (48.6%) of respondents had negative and strong negative attitude towards wildlife conservation. Level of education and amount of money imposed as penalty for illegal grazing were the most important factors affecting the local community attitudes towards wildlife conservation. Improve livestock husbandry, use appropriate guarding methods, education and make the community the actor of conservation would be vital to enhance the peaceful co-existence between human and wildlife in the study area.

1. Tropical deciduous forests show strong seasonal variations due to temporal dynamics of precipitation and temperature and therefore, resource availability for animals are also limited accordingly. Certain harsh environment even pushes animals to seasonal movements towards available resources. 2. We hypothesize that the density distribution of four sympatric ungulate species is structured by habitat covariates but more affected by seasonality. We then investigated density gradient of these species between contrasting season and correlated with environmental covariates. 3. We used distance-based density surface modelling with survey effort of 518 km in winter and 356 km in summer and with count data as a function of environmental variables in generalised additive modelling framework. We extrapolated seasonal abundance of each species and calculated coefficient of variation to ensure precision for the entire study area. 4. We observed a clear seasonal shift in the density distribution of all four species between summer (more abundant in valley) and winter (evenly distributed), significantly influenced by anthropogenic and topographic factors. Solitary species were congregated in larger groups during summer while group living species were in larger groups during winter. 5. Our study provides a clear understanding of species-habitat relationship as a function of seasonality in tropical forest and is useful in spatial prioritization of the habitats for relevant management inputs.

Subtropical areas are often struck by typhoons. The sediment disasters that accompany typhoons severely affect the environment. However, sediment yield (SY) data usually lack integrity. This study used long-term daily river discharge and SY data to establish a runoff–SY rating curve (Q–Qs rating curve) and used it to estimate the SY of typhoon events. In addition, based on the curve number, this study analyzed the relationship between the potential maximum retention (S) and SY; the results showed that different amounts of cumulative rainfall correspond to different S–SY functions; thus, the potential maximum erosion (A) of the catchment area could be estimated using this characteristic. For a sediment management strategy, this study took subdivisions as a unit and incorporated the potential maximum erosion (A) and slope to establish a map indicating the spatial distribution of sediment disaster risks. To determine the priority areas for management, the relationship between the cumulative number of subdivisions and landslide rate could be used to determine the areas with high potential, which can serve as a reference for related management research.

This paper presents the integrated machine learning and HEC-RAS models for flood inundation mapping in Baro River Basin, Ethiopia. A predictive rainfall-runoff and spatially distributed river simulation models were developed using Artificial Neural Networks (ANNs) and HEC-RAS respectively. Daily rainfall and temperature data of 7-yrs and Topographical Wetness Index (TWI) with a spatial resolution of 50 x 50m were used to train the ANN in R studio. The integration of the spatial and temporal variability in this paper improved the accuracy of the predictive models integrated with ANN and HEC-RAS. The predictive ANN model was tested with the observed daily discharge of the same temporal resolution and the rainfall-runoff result obtained from the tested ANN model was used as input for the HEC-RAS. The flood event of 2005 was used to verify the accuracy of flood generated in the HEC-RAS model by implementing the Normal Difference Water Index (NDWI). The comparison was made between the flood inundation map generated by HEC-RAS and flood events of different periods based on coverage percentage areas and a good agreement was reached with 96 % overlapped areas. The performance of ANN and HEC-RAS models were evaluated with 0.86 and 0.88 values at the training and testing period respectively. Finally, it was concluded that the integration of a machine learning approach with the HEC-RAS model in developing a flood inundation mapping is an appropriate tool to warn residents in this river basin.

A document by Raksmey Ang. Click on the document to view its contents.

Comprehensive studies of the contributions of climate variation and anthropogenic activities to runoff alterations are essential for sustainable management of water resources in Central Asian countries. In the Kofarnihon River Basin (KRB) in Central Asia, both changing climate conditions and anthropogenic activities are known to have caused variations to the hydrological cycle. Therefore, quantifying the net influence of human contribution to the runoff changes is a challenge. In this study, by applying the original and modified Mann–Kendall trend test, Pettitt test, double cumulative curve and elasticity methods the historical trends and breakpoint changes of the hydro-climatic variables including temperature, precipitation, potential evapotranspiration, and runoff over the 1950–2016 along were determined, in addition the contributions of climate variation and anthropogenic activities to runoff changes in the KRB were evaluated. The trend analysis exhibited a significant increasing trend in annual temperature and potential evapotranspiration and the annual precipitation trend showed insignificant decreasing trend during the 1950–2016 time period. The breakpoint change was detected in runoff occurs in 1991. Further, the time series (1950–2016) are separated into the prior impacted period (1950–1991) and post impacted period (1992–2016) with trend test. The results showed that anthropogenic activities played a dominant role in changes in the runoff with a contribution of 79.94% in the upstream and 97.78% in the downstream of the KRB. Climate change contributed to 20.06% in the upstream and 7.53% in the downstream of the catchment during the post impacted period. In the land-use type changes, the dominant role played construction land which showed that the area from 248.63 km2 in 1990 increased to 685.45 km2 (175.69%) in 2015. The findings suggest that it is essential to adopt effective steps for sustainable development of ecological, hydrological and social order in the KRB in Central Asia.

This is the first case report of 2 depressed Malay females prescribed quetiapine, the first developed sleep related eating disorder (SRED) on 200 mg per day and the second at 50 mg per day. Both resolved with discontinuation.Assessment for SRED should be done at every follow up.

Follicular lymphoma is the second most common type of non-Hodgkin’s lymphoma. Hepatic accumulation observed on FDG-PET/CT, which is the most useful imaging finding, is observed in 15% of cases. Secondary hepatic lymphoma is defined based on distant involvement, and it typically presents as diffuse infiltration, as in this case.

Higher risk of allergies at 4-6 years of age after systemic antibiotics in the first week of life To the editor,In humans, the first 100 days appear to be a ”critical window” of colonization during which microbial communities shape immune maturation.1,2. The use of antibiotics early in life may disrupt the normal maturation process leading to adverse health outcomes such as atopic disorders 1,3-5. The effects of antibiotic exposure immediately in the first week of life have rarely been investigated, nor the differences between treatment of 2-3 days and a prolonged treatment of 5-7 days. In the INCA study, a prospective birth cohort study of 151 infants receiving broad-spectrum antibiotics in their first week of life (AB+), and 285 healthy controls (AB-), we previously showed that antibiotic treatment in the first week of life was associated with an increased risk of wheezing, infantile colic and a trend towards more allergic sensitization in the first year of life6. The aim of this follow-up study in 418 eligible children was to determine if antibiotic treatment in the first week of life in term-born children was associated with an increase in atopic disorders at 4-6 years of age, using ISAAC questionnaires filled out by parents, ICPC codes derived from general physicians, and pharmaceutical records from local pharmacies. Detailed information regarding the subjects and methods is described in the online Appendix.In total, 341 of 418 (82%) questionnaires were filled out (114 AB+ and 227 AB-), Parental reported allergy was significantly higher in AB+ vs AB- children (23% vs 11% respectively, p=0.003) as was doctor-diagnosed allergy (12% vs 4% respectively, p=0.008). Confirmed food allergies were more common in AB+ children compared with AB- children (10 vs. 4% respectively, p=0.03). After correcting for sex, age, daycare attendance, family atopy, and parental level of education, parental-reported allergy was clearly associated with antibiotics use in the first week of life (aOR 2.40 [95%CI 1.22-4.72, p=0.01]). Additional adjustment for treatment duration showed that only 5-7 and not 2-3 days AB treatment was associated with a higher risk of parental reported allergy (aOR 2.85 [95%CI 1.37-5.91, p=0.005]). More importantly, this effect was independent of exposure to acid-suppressive drugs or additional antibiotics in the first two years of life (36% and 35% in AB- and AB+ group, respectively). The prevalence of eczema, wheezing/asthma, or allergic rhinitis was not different between AB+ and AB- children (Table 2).These results suggest that very early exposure to AB in the first week of life has a higher impact on microbiota and immune development than when administered later in childhood. It also emphasizes the need for judicious use of AB in neonates, especially prolonged treatment of 5-7 days. Moreover, our findings accentuate the need for finding strategies to modify microbiome development after AB exposure to minimize aberrant immune development.Strengths of this study are the prospective design, the high response rate (82%), and the combined information collected from doctors and pharmacists, contributing to the reliability of the reported results, which allowed us to distinguish between the effect of antibiotics within and after the first week of life. A limitation of the study is the 4-6-year follow-up, which may have been too short for diagnosing asthma and allergic rhinitis.In conclusion, the risk of having an allergy at 4-6 years of age increased nearly 3-fold in children after antibiotic treatment for 5-7 days in their first week of life, independent of later AB treatment. These long-term adverse health effects of neonatal antibiotic use emphasize the need to implement AB stewardship programs to avoid AB overuse and reduce the duration of AB treatment where possible in the first week of life.

A 60-year-old female was referred to our clinic for evaluation of her rapidly progressive dyspnea, she had no previuos history of heart disease. A murmur was noted on her examination and transthoracic echocardiography was so difficult to be performed due to poor acoustic windows so she was referred to do a transesophageal echocardiography that showed an ostium primum atrial septal defect (ASD) with left to right shunt and a quadrileaflet mitral valve with severe regurgitation. Later on, she underwent surgery with Ostium Primum ASD closure by a patch and double cleft repair by suture after right heart catheterization.

Background: Outcomes of catheter ablation (CA) among patients with non-paroxysmal atrial fibrillation (AF) are largely disappointing. Objective: We sought to evaluate the feasibility, effectiveness, and safety of a single-stage stepwise endo-/epicardial approach in patients with persistent/longstanding-persistent AF. Methods: We enrolled 25 consecutive patients with symptomatic persistent (n=4) or longstanding-persistent (n=21) AF and at least one prior endocardial procedure, who underwent CA using an endo-/epicardial approach. Our anatomical stepwise protocol included multiple endocardial as well as epicardial (Bachmann’s bundle [BB] and ligament of Marshall ablations) components, and entailed ablation of atrial tachycardias emerging during the procedure. The primary outcome was freedom from any AF/atrial tachycardia episode after a 3-month blanking period. The secondary outcome was patients’ symptom status during follow-up. Results: The stepwise endo-/epicardial approach allowed sinus rhythm restoration in 72% of patients, either directly (n=6, 24%) or after AF organization into atrial tachycardia (n=12, 48%). BB’s ablation was commonly implicated in arrhythmia termination. After a median follow-up of 266 days (interquartile range, 96 days), survival free from AF/atrial tachycardia was 88%. Antiarrhythmic drugs could be discontinued in 22 patients (88%). As compared to baseline, more patients were asymptomatic at 9-month follow-up (0% vs- 56%, p=0.02). Five patients (20%) developed mild medical complications, whereas one subject (4%) had severe kidney injury requiring dialysis. Conclusion: a single-stage endo-/epicardial CA resulted in favorable rhythm and symptom outcomes in a cohort of patients with symptomatic persistent/longstanding-persistent AF and one or more prior endocardial procedures. Epicardial ablation of BB was commonly implicated in procedural success.

Through a case of IHH complicated consumptive hypothyroidism and literature review, this study highlight better treatment protocol for these rare patients. It is helpful that simultaneous anti-tumor and thyroid replacement make diffuse IHH patients with consumptive hypothyroidism recovery better.

Left ventricular electrical delay can differentiate between ventricular and supraventricular tachycardia in cardiac resynchronization devices Alexander H. Maass, MD, PhD, Hessel F. Groenveld, MD, PhD, Bart A. Mulder, MD, PhD, Michiel Rienstra, MD, PhD, Yuri Blaauw, MD, PhD From the University of Groningen, University Medical Center Groningen, Heart Center, Department of Cardiology, Groningen, The NetherlandsAddress for correspondence: Alexander H. Maass, MD, PhD, University of Groningen, University Medical Center Groningen, Heart Center, Department of Cardiology, P.O. Box 30.001, 9700 RB Groningen, The Netherlands Telephone +31 50 3612355, Fax +31 50 3614391 E-mail: a.h.maass@umcg.nl Disclosures: none Funding: none Keywords: ICD, discriminator, inappropriate therapy, morphology, intracardiac signals.

African swine fever (ASF) is one of the most severe infectious diseases of pigs. In this study, a LAMP assay coupled with the CRISPR Cas12a system was established in one tube for the detection of the ASFV p72 gene. The single-strand DNA-fluorophore-quencher (ssDNA-FQ) reporters and CRISPR-derived RNA (crRNAs) were screened and selected for the CRISPR detection system. In combination with LAMP amplification assay, the detection limit for the LAMP-CRISPR assay can reach 7 copies/μl of p72 gene per reaction. Furthermore, this method displays no cross-reactivity with other porcine DNA or RNA viruses. The performance of the LAMP-CRISPR assay was compared with real-time qPCR tests for clinical samples, a good consistency between the LAMP-CRISPR assay and real-time qPCR was observed. In the current study, a LAMP coupled with the CRISPR detection method was developed. The method shed a light on the convenient, portable, low cost, highly sensitive and specific detection of ASFV, demonstrating a great application potential for monitoring on-site ASFV in the field.

Background Patients with hypertension complicated by acute myocardial infarction (AMI) have a poor prognosis. Identification of powerful predictors of recurring cardiovascular events (RCEs) is very important. This study sought to evaluate the predictive value of three-dimensional (3D) strain parameters for RCEs in patients with hypertension complicated by AMI. Methods We successfully followed up 62 patients with hypertension and AMI. Participants underwent three-dimensional echocardiography before, one week after, and one month after percutaneous coronary intervention (PCI). Left ventricular (LV) structural function parameters and three-dimensional strain parameters (3-dimensional global longitudinal strain (3D-GLS), 3-dimensional global circumferential strain (3D-GCS), 3-dimensional global radial strain (3D-GRS), and 3-dimensional global area strain (3D-GAS)) were acquired. We used a Cox model to determine the relationships between these parameters and RCEs. Results During follow-up (41.27±20.45 months), 20 patients (32.8%) had RCEs, which were independently predicted one month after PCI by 3D-GLS (HR: 1.481, 95%CI: 1.202-1.824) and 3D-GAS (HR: 1.254, 95%CI: 1.093-1.440). The optimal 3D-GLS and 3D-GAS cutoffs for predicting cardiac events were >-12.5% [area under the receiver operating characteristic curve (AUC) 0.736, 95%CI 0.611-0.862, P=0.003)] and >20.5% (AUC 0.685, 95%CI 0.551-0.818, P=0.020), respectively. Using logistic regression analysis, we constructed joint predictor=(3D-GLS)+(3D-GAS)×0.303/0.558, and its cutoff point was -22.36% (AUC 0.829, 95%CI 0.722-0.937, P<0.001). Conclusions 3D-GLS and 3D-GAS assessed one month after PCI can predict RCEs in patients with hypertension complicated by AMI. Additionally, the predicted value of (3D-GLS)+ (3D-GAS)×0.303/0.558 was higher than the predicted value of either parameter alone.

The ability to predict the onset of labour is seen to be an important tool in a clinical setting. Magnetomyography has shown promise in the area of labour imminency prediction, but its clinical application remains limited due to high resource consumption associated with its broad number of channels. In this study, five electrode channels, which account for 3.3% of the total, are used alongside a novel signal decomposition algorithm and low complexity classifiers (logistic regression and linear-SVM) to classify between labour imminency due within 0–48hrs and >48hrs. The results suggest that the parsimonious representation comprising of five electrode channels and novel signal decomposition method alongside the candidate classifiers could allow for greater affordability and hence clinical viability of the magnetomyography-based prediction model, which carries a good degree of model interpretability.