Abstract: Backgraound: Transcatheter aortic valve implantation (TAVI), with its improved valve technologies will also be an option for patients in the near future and improved operator experience. Cerebrovascular events are among the most feared complications of TAVI, since they cause high morbidity and mortality. Case: After the patient with EuroSCORE II = 8.6% was considered to be at high risk in terms of surgery, the decision to perform TAVI was taken. The valve (Medtronic 26 mm) was successfully placed during the 110 min procedure. Blood loss was 140 mL, no red blood cell (RBC) transfusion and catecholamines requirements were present, no VF (ventricular fibrillation) and cardiac tamponade were observed and post procedure left ventricular ejection fraction (LVEF) was 60%. At the end of the procedure, the BIS value of the patient was 70, regression in the Glasgow Coma Score (GCS = 12), anisocoria in the pupils (R = 2 mm < L = 4 mm) and motor loss in the right arm (3/5) and right leg (3/5) were detected. Modified Rankin scale (mRS) was evaluated as 4. Conclusions: The neurological complication rate of up to 80% during and in the days following the procedure, the long recovery period after embolism, the possibility of being a nursing patient and even the risk of death, remind us that the TAVI procedure and the sedation given during the procedure should never be underestimated. Keywords: Transcatheter aortic valve implantation, cerebral embolism, complications, neuroradiology, monitorized anaesthesia care, aort stenosis.

Ischemia-mediated ventricular rupture is a rarely encountered process in the era of early percutaneous revascularization. Contained rupture, or pseudoaneurysm often occurs as a result of pericardial adhesions. Even more uncommon is the presence of associated infection involving the rupture. We present the case of a patient with an infected intrapericardial thrombus in the setting of a left ventricular free wall rupture who underwent successful repair.

The mirid bugs Stenotus rubrovittatus and Trigonotylus caelestialium, which cause pecky rice, have become a threat to rice cultivation in Asia. Damage caused by these pests has rapidly become frequent since around 2000 in Japan. Their expansion pattern is not simple, making it difficult to manage them by prediction. Some insects with wide distributions have locally adapted variations in life-history traits. We performed laboratory rearing experiments to assess the geographical scale of intraspecific variations in life-history traits of S. rubrovittatus and T. caelestialium. These were aimed at increasing the accuracy of occurrence estimates and the number of generations per year. These results were compared with previous research, and differences in development rates were observed between populations of different latitudes, but not of the same latitude. Finally, plotting the timing of adult emergence and the potential number of generations per year on maps with a 5-km grid revealed that they differed greatly locally at the same latitude. These maps can be used for developing more efficient methods of managing mirid bugs in integrated pest management.

An adult male with alcoholic cirrhosis presented with acute blood loss anemia, hypotension and a painful bruise over his body's left side. He denied any trauma or falls. Computed tomography of the chest showed left chest wall hematoma. Emergent angiography with successful embolization of the left intercostal artery was performed.

The repeated transition from outcrossing to selfing is a key topic in evolutionary biology. However, the molecular basis of such shifts has been rarely examined due to lack of knowledge of the genes controlling these transitions. A classic example of mating system transition is the repeated shift from heterostyly to homostyly. Occurring in 28 angiosperm families, heterostyly is characterized by the reciprocal position of male and female sexual organs in two (or three) distinct, usually self-incompatible floral morphs. Conversely, homostyly is characterized by a single, self-compatible floral morph with reduced separation of male and female organs, facilitating selfing. Here, we investigate the origins of homostyly in Primula vulgaris and its microevolutionary consequences by integrating surveys of the frequency of homostyles in natural populations, DNA sequence analyses of the gene controlling the position of female sexual organs (CYPᵀ), and microsatellite genotyping of both progeny arrays and natural populations characterized by varying frequencies of homostyles. As expected, we found that homostyles displace short-styled individuals, but long-style morphs are maintained at low frequencies within populations. We also demonstrated that homostyles repeatedly evolved from short-styled individuals in association with different types of loss-of-function mutations in CYPᵀ. Additionally, homostyly triggers a shift to selfing, promoting increased inbreeding within and genetic differentiation among populations. Our results elucidate the causes and consequences of repeated transitions to homostyly within species, enabling a likely explanation for the fact that homostyly has not become fixed in P. vulgaris. This study represents a benchmark for future analyses of losses of heterostyly.

First described in 1965 by Johnson and Wilcox, partial absence of the tricuspid valve (TV) associated with a ventricular septal defect(VSD) is a very rare malformation.(1) Heart failure secondary to severe TV regurgitation results in-utero fetal compromise. (2) We present here a fetus with partial absence of the tricuspid valve with conoventricular septal defect.

Congenital aneurysm of the ductus arteriosus is reported in 0.8% in neonatal autopsies, however true incidence is unknown because of high rate of asymptomatic cases and spontaneous regression. Possible complications in symptomatic cases are; thromboembolism, spontaneous rupture, erosion, infection, compression of airways and death. In this report we present a newborn with giant DAA diagnosed in first day of life, surgically treated after thrombosis of aneurysm.

Theory suggests that genetic diversity may influence species coexistence and that species diversity may influence genotype coexistence by altering competitive outcomes among species and genotypes, respectively. However, other coexistence mechanisms such as microbe-mediated plant-soil feedbacks (PSF), may also contribute. Interspecific PSF promotes species coexistence when plants grow better with heterospecific soil microbes than with conspecific microbes, and similarly, intraspecific PSF promotes genotype coexistence when plants grow better with heterogenotypic than with congenotypic microbes. Here, we tested whether genetic diversity influences the strength or direction of interspecific PSF and whether species diversity influences the strength or direction of intraspecific PSF. We found that genetic diversity reduced the capacity for interspecific PSF to promote species coexistence, and, for one study species, species diversity reduced the capacity for intraspecific PSF to promote genotype coexistence. These results suggest that genetic diversity and species diversity may weaken the ability of PSF to promote coexistence.

Species delimitation is a difficult task in traditional morphology-based taxonomy. The ultra-barcoding approach, which uses whole plastid genomes (plastomes) and nuclear ribosomal DNA (nrDNA) regions as extended DNA barcodes for species identification and delimitation, has been recommended as one of the candidate techniques for plant barcoding 2.0. Yet, the efficacy of this approach in delineating species boundaries remains poorly understood. Here, we attempt to decipher species delimitation in the taxonomically challenging clade, Paris L. section Axiparis H. Li, using phylogenetic inference and multiple sequence-based species delimitation methods (ABGD, SDP, and mPTP) utilizing complete plastomes and nrDNA clusters from multiple accessions per described species. The results suggest that only two species-level taxonomic units that possess not only morphological uniqueness but also genetic distinctiveness and evolutionary independence can be recognized in P. sect. Axiparis. Therefore, previous taxonomic work overemphasized minor intraspecific morphological differences to establish species, and thus resulted in proliferation of as many as seven synonyms in this clade. Inferred from ultra-barcoding analyses, we propose a taxonomic revision of P. sect. Axiparis which will help inform future decisions regarding species conservation in the commercially valuable and severely threatened genus Paris. This case study indicates that the ultra-barcoding approach has great promise for developing a rigorous species delimitation framework that will facilitate credible taxonomic revision especially in taxonomically difficult plant taxa.

Background: Anomalous origin of pulmonary artery branch from ascending aorta(AOPA) in the presence of two separate semilunar valves is a rare but important entity necessitating early diagnosis and surgery to prevent development of irreversible pulmonary vascular disease. We evaluated our experience with the technique and outcome of eleven patients with this condition. Methods: Between January 2000 and December 2018, eleven patients were diagnosed with AOPA. Echocardiographic data were collected from the records, regarding the site of origin of the anomalous pulmonary artery, additional defects, biventricular function and pulmonary artery pressures. Intraoperative charts were reviewed for the details of the surgical procedure and cardiopulmonary bypass. Postoperative data included survival, ventilatory support and duration of hospital stay. After discharge, children were reviewed at 1 month, 3 months, 6 months and then at yearly intervals. Results: Of the eleven patients, male to female ratio was 4:7 with a median age of six months(15 days - 28 years) and median weight of 5.7 kg(1.8 kg - 40 kg). Nine patients underwent direct re-implantation of anomalous pulmonary artery branch to main pulmonary artery. The survival rate was 91% in our series. On follow-up, no re-operations or re-interventions were required and all patients who underwent surgical correction were in stable clinical condition. Conclusion: Early and midterm outcomes of children who underwent surgery for AOPA is good. Early direct re-implantation of the anomalous branch PA to main pulmonary artery is the optimal surgical strategy for these patients

Background and aim of the study: We report our one-year single-center experience of a new technique of aortic valve replacement using a rapid-deployment valve (RD-AVR) to avoid postoperative complications. We also report the unexpected pitfalls and handling techniques that we have seen in past cases. Methods: We performed aortic valve replacement on 38 patients between May 2019 and April 2020. Their mean age was 74 years. The primary outcomes were in-hospital mortality and short-term results during a one-year follow-up period, while the secondary outcomes were related to prosthetic valve function, especially paravalvular leakage (PVL). We further analyzed the relationship between the new technique and its outcomes. Results: The mean operative time was 196 min. There were no in-hospital deaths, and the mean duration of postoperative hospital stay was 11.8 days. Valvular measurements using 3-dimensional computed tomography (3D-CT) were larger and more accurate than those measured using ultrasonic echocardiography Postoperative RD-AVR prosthetic valve function was excellent. However, PVL occurred in 4 cases one week and one year postoperatively and regurgitation did not improve. A gap associated with PVL was identified below the right-noncoronary commissure. To prevent PVL, we additionally stitched this gap in the later 18 cases; there was no case of PVL and no new pacemaker implantation in these cases. Conclusions: PVL is more likely to occur if there is a gap below the R-N commissure, especially in cases with a large annulus; therefore, applying an additional stitch to the R-N commissure is extremely useful.

Purpose: The FDA-issued PLATO trial dataset revealed that some primary deaths causes (PDC) were inaccurately reported favoring ticagrelor. However, the PLATO Investigators operated the shorter death list of uncertain quality. We compared if PDC match when trial fatalities were reported to the FDA and by the PLATO investigators. Method: The FDA list contains precisely detailed 938 PLATO deaths, while shorter investigators dataset consists of 905 deaths. We matched 4 vascular (sudden, post-MI, heart failure and stroke), and 3 non-vascular (cancer, sepsis and suicide) PDC between death lists. Results: There were more sudden deaths in the shorter list than in the FDA dataset (161 vs.138; p<0.03), post-AMI (373 vs.178; p<0.001) but fewer heart failure deaths (73 vs.109; p=0.02). Stroke numbers match well (39 vs. 37; p=NS) with only 2 ticagrelor cases removed. Cancer matched well (32 vs.31; p=NS), and sepsis cases were identical (30 vs. 30; P=NS). However, 2 extra clopidogrel suicides in the shorter list are impossible to comprehend. Conclusions: The PLATO trial PDC were mismatched between FDA and Investigators sets. We are kindly asking the ticagrelor sponsor or/and concerned PLATO Investigators to clarify the PDC dataset match.

Atrial septal device embolization within transcather structural heart disease although rare is life threatening. We present a case of a 15-year-old female who presented with a large 17mm septum secundum atrial septal defect associated with a left to right shunt and right heart dilation. The closure with atrial septal occluder (ASO) embolised into the left ventricle and couldn’t be retrieved by percutaneous methods. This otherwise healthy young female underwent emergency retrieval of the ASO via minimal access surgery with a right anterolateral mini thoracotomy. It’s important to highlight the role of minimal access surgery for retrieval of embolised percutaneous devices.

Objectives: To evaluate the efficacy of the combination of platelet-rich fibrin (PRF) and mineralized bone allograft on the volume of the new bone formation in the sinus floor augmentation of the severely atrophic residual alveolar crest with simultaneous dental implant placement. Materials and Methods: All clinical and radiological data of patients treated with sinus floor augmentation using the combination of PRF and demineralized bone allograft with simultaneous dental implant placement between 01/04/2013 and 01/03/2020 were retrieved from the archives. The main inclusion criterion for the study was a residual ridge height less than 2 mm. The volume of the maxillary sinus cavity was measured by a software program on pre-operative and post-operative cone beam computerized tomography (CBCT) sections. The graft volume was calculated by subtracting pre-operative and post-operative total sinus volume. Residual and post-operative ridge heights were measured by the software program on the mid-coronal and mid-sagittal sections of pre-operative and post-operative CBCT images. Results: Eighteen patients with 26 sinus augmentations were included in the study. Forty-six dental implants were placed simultaneously with sinus floor augmentation. The follow-up periods of cases varied between 19 and 29 months. All cases showed new bone regeneration on axial, coronal and sagittal sections of post-operative CBCT data. The mean volume of newly regenerated bone was calculated as 2.1(±0.9) ml. Post-operative ridge heights was significantly increased compared to pre-operative residual ridge heights (p<0.05). There was no sign of a relationship between residual and post-operative ridge heights (p>0.05). Conclusion: The PRF and demineralized bone allograft combination used in sinus floor augmentation may provide healthy new bone that supports simultaneously placed dental implants in function in the severely atrophic alveolar crests with a residual ridge height less than 2 mm. Keywords: Sinüs floor augmentation ; allograft ; cone-beam computed tomography ; dental implant

IntroductionGraft-versus-host disease (GVHD) is a potentially serious complication of allogenic stem cell transplantation (allo-SCT), but patients who develop GVHD also have a low incidence rate of leukemia recurrence, suggesting a graft-versus-leukemia effect due to the donor lymphocytes.1 This effect has also been suggested in solid tumors. In the case here, cervical cytology transformed from squamous cell carcinoma to negative for intraepithelial lesion or malignancy (NILM), possibly due to a graft-versus-tumor (GVT) effect following allo-SCT. The cervical cytology has continued changing, although the dose of immunosuppressant likely also has an effect. Here we describe our experience in this case and review the literature.

Polynomial interpolation with equidistant nodes is notoriously unreliable due to the Runge phenomenon, and is also numerically ill-conditioned. By taking advantage of the optimality of the interpolation processes on Chebyshev nodes, one of the best strategies to defeat the Runge phenomenon is to use the mock-Chebyshev points, which are selected from a satisfactory uniform grid, for polynomial interpolation. Yet, little literature exists on the computation of these points. In this study, we investigate the properties of the mock-Chebyshev nodes and propose a subsetting method for constructing mock-Chebyshev grids. Moreover, we provide a precise formula for the cardinality of a satisfactory uniform grid. Some numerical experiments using the points obtained by the method are given to show the effectiveness of the proposed method and numerical results are also provided.

Abdominal pregnancy is a very rare, life-threatening form of ectopic pregnancy, in which implantation occurs within the peritoneal cavity. The advantages of a laparoscopic approach over a laparotomy in this setting include a reduced estimated blood loss, a shorter operating time, reduced analgesic requirements, shorter hospital stay and convalescence.

A case of a 42-year-old woman, Para 3 who had an unplanned pregnancy despite bilateral tubal ligation for contraception, and Novasure® endometrial ablation for persistent Heavy Menstrual Bleeding (HMB). The pregnancy was complicated by missed miscarriage at 14 weeks and placenta accreta. This is an uncommon event.

Plasmapheresis for the management of acute cyanide poisoning : A case report and review of literatureNavid Namakizadeh EsfahaniIsfahan University of Medical Sciences, Isfahan, Irannavidnamakizadeh@gmail.comShafeajafar ZoofaghariDepartment of Clinical Toxicology, Isfahan Clinical Toxicology Research Center, Khorshid hospital, Isfahan, Iranshafeajafar@med.mui.ac.irAmirhossein Akhavan Sigari (corresponding author)Isfahan University of Medical Sciences, Isfahan, Iranamirsigari@aol.comTel: +989132151729PO: 8174673461Gholamali DorooshiDepartment of Clinical Toxicology, Isfahan Clinical Toxicology Research Center, Khorshid hospital, Isfahan, Irangdorvashy@med.mui.ac.ir

Background: Cystic fibrosis (CF) pulmonary exacerbations (PEx) are associated with significant drop in pulmonary function. The clinical value of measuring bronchodilator (BD) responsiveness during treatment for PEx to monitor or predict recovery of lung function is unclear. Methods: A retrospective analysis of spirometry with BD response testing obtained during hospital admissions for PEx in pediatric CF patients. Repeated events were included for patients with BD testing during multiple admissions. Results: 249 spirometries with BD testing in 102 patients were completed around day 7 (day 4-10) of hospital admission for treatment of CF PEx. Median (IQR) forced expiratory volume in one second (FEV1) was 70.6% predicted (58.1, 84.6) prior to the PEx event (best FEV1 in 6 months prior to admission), 54.4% (41.5, 66.9) at admission, 62.3% (48.4, 74.7) around day 7 of admission and 67.1% predicted (53.8, 78.2) at end of treatment. BD response around day 7 correlated poorly with FEV1 prior to PEx (r=-0.16, p=0.02), and did not correlate with recovery to baseline FEV1 at end of treatment (r=0.08, p=0.22). Only 23/249 (9%) patients had a BD response of ≥12 % and 200 ml. BD response was not related to age or severity of lung disease and led to an immediate change in clinical management in only 4 cases. CONCLUSIONS: BD response in CF patients treated for PEx is poorly correlated with baseline pulmonary function and does not correlate with recovery of FEV1 with treatment. These data suggest that routine testing for BD response is not indicated during PEx.

Unloading compliance (UC) method and normalization method (NM) are two of the most commonly used methods for determining the fracture toughness of materials. However, considerable differences often exist in the fracture toughness determined by these two methods, which solicits a new method to determine the fracture toughness accurately. In this paper, the compliance of crack length differences as measured by the crack length difference ratio Si is discovered, analysed and verified by experiments. Based on this compliance, a new accurate method, known as AJR, is developed and verified by test results. Factors that exhibit the advantages of the developed new AJR method are also investigated. It is found that the J-R curves determined by the new AJR method are more accurate than those determined by UC and NM. The new AJR method should be the first choice for steels with a small strain hardening ratio and low effective yield strength, and thicker CT specimens with shallower initial crack length. This is because the disagreement between UC and NM is unacceptably large. The developed new AJR method and the results presented in this paper can assist engineers and researchers to determine J-R curves and fracture toughness of steels more accurately and can contribute to the body of knowledge of fracture mechanics.

1. Insects are responsible for the quantity and quality of one-third of all agricultural production worldwide through pollination. The quality of the pollination service and the safety of the honey production depends on the health and nutritional condition of the hives, which, for an important part is related to management practices. 2. This study aims to identify the stressors that lead to the loss of bee health and its consequences for the productivity of the hives. Different aspects related to management practices, productivity, clinical observations related to diseases, presence of health issues in the hives or in the apiaries, to the structure of the hives, weather and infestation rates by Varroa sp. mites were measured. The information was collected during two field surveys in 53 apiaries in the Province of Santa Fe, Argentina. 3. The results show correlations among many of the management practices, health condition and productivity of the hive, with most importantly the change of the bee queen, the disinfection of the beekeeping material and the number of combs in the brood chamber. 4. Although honey production is important in the region, the hive structure was deficient and inadequate during both surveys. Due to its dependence on management by the beekeeper, this suggests that a holistic approach can improve the hive structure, increasing the honey production.

CABG (Coronary Artery Bypass Grafting) has been the treatment of choice for coronary artery disease for over 50 years and is the most common cardiac surgery procedure performed. Traditionally CABG was performed with the use of cardiopulmonary bypass and the use of cardioplegia to allow the surgeon to operate on a stable field. In the mid-1990s, interest emerged in performing CABG without the use of cardiopulmonary bypass - off pump CABG. This invited commentary focuses on sharing our experience with Low Ejection fraction off-pump CABG and why this approach could be beneficial to this patient population.

Amyloid arthropathy is often underdiagnosed. The articular forms of AL amyloidosis may mimick the rheumatoid arthritis. The presence of macroglossia should draw attention to chronic polyathralgia.