Background. The aim of this study was to evaluate the efficacy and safety of innominate artery cannulation strategy with side graft technique in proximal aortic pathologies. Methods. A total of 70 patients underwent innominate artery cannulation with a side graft for surgery on the proximal aorta from 2012 to 2020. There were 46 men and 24 women with an avarage age of 56 ±13 years. The indications of surgery were type A aortic dissection in 17 patients (24.3%), aortic aneurysm in 52 patients (74.3%) and ascending aorta pseudoaneurysm in 1 patient (1.4%). The innominate artery was free of disease in all patients. Hypothermic circulatory arrest with antegrade cerebral perfusion was utilized in 60 patients (85.7%). 3 patients had previous sternotomy (4.2%). The most common surgical procedure was ascending aorta and hemiarch replacement in 34 patients (48.5%). Results. The mean cardiac ischemia and cardiopulmonary bypass times were 116+46 minutes and164+56 minutes, respectively. The mean antegrade cerebral perfusion time was 27+14 minutes. The patients were cooled between 22’C and 30’C during surgery. 30-day mortality rate was 7.1% with 5 patients. 1 patient (1.4%) had stroke, 1 patient (1.4%) had temporary neurologic deficit and 8 patients (11.4%) had confusion and agitation that resolved completely in all cases. There was no local complication or arterial injury was encounterd. Conclusions. Cannulation of the innominate artery with side graft is safe and effective for both cardiopulmonary bypass and antegrade cerebral perfusion. This technique provides excellent neurologic outcomes for proximal aortic surgery.

We report a case of cardiac hibernoma, which is a very rare type of benign lipomatous tumour. They are usually asymptomatic and therefore remain undetected or are found incidentally. When symptomatic, they vary and depend on location of heart involved. The patient had a hibernoma on right atrial wall invading the intra-atrial groove and extending over superior vena cava (SVC), causing significant symptoms of SVC obstruction and tamponade. The patient therefore underwent emergency operation, in which the tumour was resected and the right atrium was reconstructed with Bovine pericardial patch. He was discharged home well.

Changing and moving toward online shopping has made it necessary to customize customers' needs and provide them more selective options. The buyers search the products' features before deciding to purchase items. The recommender systems facilitate the searching task for customers via narrowing down the search space within the specific products that align the customer needs. Clustering, as a typical machine learning approach, is applied in recommender systems. As an information filtering method, a recommender system clusters user's data to indicate the required factors for more accurate predictions by calculating the similarity between members of a cluster. In this study, using the Gaussian mixture model clustering and considering the scores distance and the value of scores in the Pearson correlation coefficient, a new method is introduced for predicting scores in machine learning recommender systems. To study the proposed method's performance, a Movie Lens data set is evaluated, and the results are compared to some other recommender systems, including the Pearson correlation coefficients similarity criteria, K-means, and fuzzy C-means algorithms. The simulation results indicate that our method has less error than others by increasing the number of neighbors. The results also illustrate that when the number of users increases, the proposed method's accuracy will increase. The reason is that the Gaussian mixture clustering chooses similar users and considers the scores distance in choosing similar neighbors to the active user.

The ongoing respiratory disease pandemic COVID-19 caused by a newly emerging highly infectious virus Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) is aggravating the world's health, economy and regular life. This unprecedented respiratory outbreak has already infected more than 43 million individuals and taken more than 1.1 million lives. The habitation of over 21% of the world's population- the SAARC region is also susceptible to COVID-19 and comprises of more than 20% of the total infected cases. Demographic analysis showed that males and younger populations are mostly infected in South Asian countries. Similar genomic variations were observed in the countries such as variations in the ORF1ab, ORF1a, ORF3a and S genes were largely seen. As no effective treatment strategy hasn’t developed yet, only timely testing and tracing can mitigate the loss from the disease which led the way to the development of alternate screening methods with higher efficiency and timely results. Since no unanimously recognized treatment option is available, existing medicines and treatments are being utilized to treat the patients. Currently, a vaccine can be the ideal solution for this rapidly evolving disease and hence two South Asian country- Bangladesh and India has joined the race of vaccine development and one of them succeeded the phase II clinical trial. As the ‘Second Wave of COVID-19’ is approaching, it has become a matter of urgency to appraise the existing policies and strategies in order to ascertain and implement effective schemes that can mitigate the ramifications of the disease.

As an example of an aerodynamics prototypical study, we examined a two-dimensional low Reynolds number flow over obstacles immersed in a stream of infinite extent. The Navier Stokes equation is being discretized by non conforming finite element method approach. The resulting discretized nonlinear algebraic system is being solved by using the fixpoint method and the Newton method and multigrid method for the linear sub-problem employed. The magnitude of the uniform upstream velocity under the study of the problem for Reynolds number in the range 1 < Re < 100 and the angle of attack of the upstream velocity at α = -5; 0; 5 degrees performed. Analysis of the resulting drag and lift forces acting on obstacles with respect to the angle of attack of the upstream velocity and the Reynolds number is made. Moreover, the influence of one obstacle on the resulting drag and lift coefficients of other obstacles determined. The results are being presented in a graphical and vector form.

Land degradation is a global problem. One of the main factors of this degradation is intense winds in the world’s arid and semi-arid regions. The wind acts on soils without vegetation cover in increasingly large regions. The impact of dust storms is considerable, from massive soil deterioration to health problems. In the arid regions of northern and central Mexico, the problem of changing land use from grasslands and forests to rainfed agriculture has increased notably in recent decades. Recurring dust storms due to winds associated with the passage of cold fronts have become a severe environmental problem. The Weather Research and Forecasting Model (WRF-Chem) was applied to analyze dust storms that occur mainly during the winter. An analysis was performed for wind speed data in the period from October 2005 to April 2018. It revealed that about 20 events per year exceeded a threshold erosion speed of 9 m/s. Fifteen events with the potential to generate dust storms were selected. The total amount of dust emitted was added together, and an average dust storm was calculated. Since the massive land-use change began approximately 50 years ago, a total erosion effect was estimated for this period. The characterization of eight soil samples revealed the texture of fine silty sands with low clay content and low organic content due to the mechanical processes of removing the finest fraction. Comparison between observed and modeled dust storm events showed good agreement.

Through competition and collaboration, students will learn about and then employ problem solving strategies to create solutions in the field of sustainable engineering. Necessary Vocabulary • Bioaccumulation • Sustainability • Structural engineering • Footprint • Electrical engineering • Estuary • Benzene • Power systems • Boring (soil boring) • Biotransformation • Hazard protection • Transportation • Criteria Pollutants • Project Management • Energy efficiency • Intelligent buildings Objectives • Students will learn about and apply collaborative problem-solving methods.

Stratifikasi sosial adalah sebuah konsep yang termanifestasi ke dalam sistem bermasyarakat, berbangsa dan bernegara. Oleh karena itu, diperlukan prosedur analisis yang tepat, agar hasil dari analisis tersebut dapat digunakan untuk berbagai tujuan yang bermanfaat bagi komunitas itu sendiri atau bagi mereka yang menginginkan menjadi agen perubahan sosial, ekonomi, politik, hukum dan bahkan budaya. Definisi, stratifikasi sosial adalah sebuah konsep yang menunjukkan adanya pembedaan dan/atau pengelompokan suatu kelompok sosial (komunitas) secara bertingkat. Misalnya: dalam komunitas tersebut ada strata tinggi, strata sedang dan strata rendah. Pembedaan dan/atau pengelompokan ini didasarkan pada adanya suatu simbol-simbol tertentu yang dianggap berharga atau bernilai baik berharga atau bernilai secara sosial, ekonomi, politik, hukum, budaya maupun dimensi lainnya dalam suatu kelompok sosial (komunitas). Simbol-simbol tersebut misalnya, kekayaan, pendidikan, jabatan, kesalehan dalam beragama, dan

Mitral valve replacement in the setting of mitral annular calcification (MAC) remains a surgical challenge fraught with several known complications. We present an innovative and hybrid approach involving robotic-assisted deployment of a SAPIEN S3 (Edwards Lifesciences, Irvine, CA) in the mitral position of a patient with severe MAC in the setting of previous sternotomy for aortic valve replacement. The robotic platform allowed avoidance of redo sternotomy, paravalvular leaks adjustment through excellent visualization from the right chest, and better assessment of the risk of left ventricular outflow tract obstruction. This report serves as an alternative technique for the management of mitral valve surgery associated with MAC in the era of transcatheter and minimally-invasive cardiac operations.

Background: Recent SIOPEL studies have shown cisplatin monotherapy to be equally effective in management of Standard risk Hepatoblastoma (SRHB) as compared to PLADO. Aim: To study the chemotherapy, response and outcomes in children with SRHB in a Resource Challenged Nation (RCN). Material and Methods: A retrospective study was conducted and all children with SRHB who were treated by us from June 2007 to December 2017 were included. All patients with standard risk hepatoblastoma who had received at least 2 courses of chemotherapy were included. Data regarding the demographics, PRETEXT stage, chemotherapy, response to chemotherapy and outcomes were recorded. Kaplan Meier survival analysis was performed to calculate 5-year overall survival (OS) and event free survival (EFS). Results: Thirty-two children were included in the study. Nineteen children (59.4%) received Cisplatin monotherapy and of these 6 patients (all PRETEXT III) had poor response and were upgraded to PLADO. The remaining 13 (40.6%) received upfront PLADO. The 5-year OS and EFS was 100% in the monotherapy group (n=13), 92% and 69% in the upfront PLADO group (n=13), and 62% and 22% in the upgraded to PLADO group (n=6). Patients in upgraded to PLADO group had significantly lower 5-year EFS (70% vs 22%; p= 0.036) compared to upfront PLADO group. Conclusion: Two thirds of SRHB patients with PRETEXT stage III who received cisplatin monotherapy showed poor response and were upgraded to PLADO chemotherapy. These patients had a significantly poorer outcome compared to the rest of the cohort. PRETEXT stage III standard-risk hepatoblastoma may benefit from PLADO chemotherapy instead of cisplatin monotherapy.

A document by Muhamad Chairul Basrun Umanailo. Click on the document to view its contents.

Title: COVID-19 vaccine anaphylaxis: IgE, complement or what else? A reply to: “COVID-19 vaccine anaphylaxis: PEG or not?”

Persistent fifth aortic arch (PFAA) is a rare anomaly often associated with aortic coarctation or interruption, and various surgical techniques for this anomaly have been reported. Herein, we show a case of an infant with PFAA and severe aortic coarctation. The aortic arch was reconstructed using end-to-side anastomosis between the fifth aortic arch and the descending aorta without any artificial conduit or patching material. This approach is easy and effective, has growth potential, and an additional surgery is not needed in the future.

Background: Hereditary angioedema (HAE) attacks can be provoked with psychological factors. The aim of this study was to assess the effects of anxiety, depression and stress related to COVID-19 pandemic on disease activity of HAE patients during the quarantine period (QP) and the return to normal period (RTNP). Methods: This prospective study was conducted between March 2020 and September 2020 in four allergy centres. Demographic, clinical features and mental health status were evaluated in QP (from March to the beginning of June) and RTNP (from June to the beginning of September) was applied by the government. The 10-point visual analogue scale (VAS10) was used to define the severity of HAE attacks. Depression-Anxiety- Stress Scale-21 (DASS-21) and Fear of Covid-19 (FC-19) scales were performed to assess mental health status. Results: 139 HAE patients were included in the study. In QP, median attack numbers and median VAS10 scores were 5 (min-max: 0-45) and 6 (min-max: 0-10), respectively. HAE attack numbers, DASS-21 stress, anxiety, depression and total DASS-21 scores, as well as FC-19 scores were higher in QP than RTNP (p= 0.001, p <0,001, p = 0,001, p <0,001, p <0.001, p<0.001, respectively). However, there was no difference in attack severity scores between the two periods (p>0.05). Conclusions: This study revealed that the restriction measures during Covid-19 outbreak causes an increase in the number of HAE attacks in relation to anxiety, depression, stress and fear of Covid-19 pandemic. Therefore, it is important to provide psychological support to HAE patients during the pandemic.

Objective: To evaluate adherence to the 2012 ASCCP guidelines by physicians referring patients to a large academic center for a colposcopy and to understand the factors associated with incorrect referrals. Design: A retrospective observational study Setting: A large tertiary referral hospital Population: Woman referred to Virginia Commonwealth University for colposcopy or loop electrosurgical excision procedure from January 2015 to December 2016. Methods: Data on patient demographics, cervical cytology, human papillomavirus status, and the recommended interventions were gathered. Main Outcome Measures: Concordance with ASCCP guidelines Results: Referral requests for 430 women were reviewed. Of the referrals, 17.4% were discordant with the ASCCP guidelines. The most common discordant colposcopy referrals were for low-grade squamous intraepithelial (LSIL) lesion (48%) and atypical squamous cell of undetermined significance (29%). The likelihood of incorrect referral was decreased for high grade lesions (OR 0.03), increased in women age < 25 (OR 31.6) and those referred by family medicine (OR 3.6) or internal medicine (OR 4.4). Ten patients were referred for cervical cytology collected on vaginal cuffs despite hysterectomies performed for benign reasons. Conclusions: Patients referred outside of the guidelines were most often women age < 25 with low-grade lesions. Referrals outside of evidence-based guidelines may lead to unnecessary procedures and added healthcare expense. Our results help identify areas for provider education and potential areas for concern in the implementation of the 2019 ASCCP updates.

Background: Food allergy is a major health problem that significantly impacts quality of life (QoL). There is growing focus to evaluate food allergy related QoL and treatment value beyond the clinical effectiveness perspective by engaging patients and caregivers. We aimed to identify and prioritize outcomes important to food allergy parents of children and patients allergic to milk, egg, and/or peanut, to guide comparative effectiveness research (CER) that focuses on evaluating food allergy treatment decisions. Methods: We conducted a modified 3-round Delphi study to identify and derive consensus on priority treatment outcomes for parents of children and adult patients with diagnosed allergies to at least one of three major allergenic foods (milk, egg, and peanut) from across the United States. Results: Round 1 yielded 44 statements for round 2, and 39 statements reached the agreement level for round 3 ranking. Statements were organized under 4 sections: 1) food allergy problems, 2) treatment experiences, 3) important treatment outcomes, and 4) value of different treatment options. Conclusion: Food allergy parents and patients face several social, psychological, medical, healthcare, financial, food selection, and awareness challenges. The areas of consensus on important treatment outcomes revealed shared priority for reducing the risk of potentially fatal allergic reactions and having reliable treatments. The most valued treatment options reflect hope for permanent cure and fear of serious allergic reactions.

Background: Systematic reviews of clinical trials frequently reveal heterogeneity in the number and types of outcomes reported. To counteract this, a Core Outcome Set (COS) may be applied. Objectives: A systematic review of all completed and ongoing COS related to pregnancy and childbirth Search strategy: COMET up to January 2020, Ovid MEDLINE, EMBASE, PsycINFO, Academic Search Elite, CINAHL and SocINDEX up to June 2019. Selection criteria: Studies which prioritized outcomes using some form of consensus method (such as the Delphi technique) were included. Data collection and analysis: All included studies were checked for compliance with the Core Outcome Set–STAndards for Reporting. Information about population, setting, method and outcomes was extracted. Main results: Nineteen completed studies and thirty-nine ongoing studies were included. The number of outcomes included in various COS ranged from 6 to 48. Most COS were for conditions related to physical complications during pregnancy. No COS were identified for perinatal mental health. Conclusion: This review discloses a growing number of COS within the field of pregnancy and childbirth. Many of the completed studies follow the proposed reporting. However, several of the COS included a large number of outcomes. There is a need to consider the number of outcomes which may be included in a COS while retaining its applicability in future research. Funding This article is adapted from a report undertaken by the SBU, who provided funding for the study. Keywords: Childbirth, Core outcome set, Maternal health, Obstetric care, Pregnancy

The importance of del nido cardioplegia solution in coronary artery bypass surgeryMehmet Senel Bademcia MD, Cemal Kocaaslana MD Fatih Avni BayraktaraMD, Ahmet Oztekina MD, Huseyin Bilal Aydina MD, and Ebuzer Aydin a MD.a Istanbul Medeniyet University, Medicine Faculty, Department of Cardiovascular Surgery, Istanbul, TurkeyCorresponding Author: Mehmet Senel Bademci,M.D, Assist.Prof.Post Publication Corresponding Author: Mehmet Senel Bademci,M.D, Assist.Prof.Istanbul Medeniyet University Medicine Faculty, Department of Cardiovascular Surgery.Address: Dr. Erkin St. No:12 Kadikoy, Istanbul, 34722, Turkey.Mail address: mbademci@gmail.comDear Editor;We read with interest the article by Algarni [1] published entitled “Routine use of del Nido cardioplegia compared with blood cardioplegia in all types of adult cardiac surgery procedures.” Algarni KD. Routine use of del Nido cardioplegia compared with blood cardioplegia in all types of adult cardiac surgery procedures. J Card Surg. 2020;10.1111/jocs.15060In this study; Del Nido cardioplegia group has shorter aortic cross-clamp time for coronary artery by pass graft patients. But there is no sufficient data about the number of distal anastomosis between cardioplegia groups. If there is a significant difference between groups, this answer can change the aortic cross clamp times regardless of cardioplegia.We congratulate Algarni et al. for their valuable manuscript about cardioplegia solutions in coronary artery bypass surgery. We would like to hear authors’ opinion on this matter.References:1. Algarni KD. Routine use of del Nido cardioplegia compared with blood cardioplegia in all types of adult cardiac surgery procedures. J Card Surg. 2020;10.1111/jocs.15060.

Alternative reproductive tactics (ARTs) have provided valuable insights into how sexual selection and life history tradeoffs can lead to variation within a sex. However, the possibility that tactics may constrain evolution through intralocus tactical conflict (IATC) is rarely considered. In addition, when IATC has been considered, the focus has often been on the genetic correlations between the ARTs, while evidence that the ARTs have different optima for associated traits and that at least one of the tactics is not at its optima is often missing. Here we investigate selection on three traits associated with the ARTs in the swordtail fish Xiphophorus multilineatus; body size, body shape and the sexually selected trait for which these fishes were named, sword length (elongation of the caudal fin). All three traits are tactically dimorphic, with courter males being larger, deeper bodied and having longer swords, and the sneaker males being smaller, more fusiform and having shorter swords. Using measures of reproductive success in a wild population we calculated selection differentials, linear and quadratic gradients, demonstrate that the tactics have different optima and at least one of the tactics is not at its optima for body size and sword length. Our results provide the first evidence of selection in the wild on the sword, an iconic trait for sexual selection. In addition, given the high probability that these traits are genetically correlated to some extent between the two tactics, our study suggests that IATC is constraining both body size and the sword from reaching their phenotypic optima. We discuss the importance of considering the role of IATC in the evolution of tactical dimorphism, how this conflict can be present despite tactical dimorphism, and how it is important to consider this conflict when explaining not only variation within a species but differences across species as well.

Many insects possess the plastic ability to either develop directly to adulthood, or enter diapause and postpone reproduction until the next year, depending on environmental cues (primarily photoperiod) that signal the amount of time remaining until the end of the growth season. These two developmental pathways often differ in co-adapted life history traits, e.g. with slower development and larger size in individuals headed for diapause. The developmental timing of these differences may be of adaptive importance: if pathways diverge late, the scope for phenotypic differences is smaller, whereas if pathways diverge early, the risk is higher of expressing a maladaptive phenotype if the selective environment changes. Here we explore the effects of changes in photoperiodic information during life on pupal diapause and associated life history traits in the butterfly Pararge aegeria. We find that both pupal diapause and larval development rate are asymmetrically regulated: while exposure to long days late in life (regardless of earlier experiences) was sufficient to produce nondiapause development and accelerate larval development accordingly, more prolonged exposure to short days was required to induce diapause and slow down pre-diapause larval development. While the two developmental pathways diverged early in development, development rates could be partially reversed by altered environmental cues. Meanwhile, pathway differences in body size were more inflexible, despite emerging late in development. Hence, in P. aegeria several traits are regulated by photoperiod, along subtly different ontogenies, into an integrated phenotype that strikes a balance between flexibility and phenotype-environment matching.

Background A lower systolic blood pressure (SBP) target reduces major cardiovascular events and mortality from any cause in geriatric hypertension. However, the effect of different SBP targets on left ventricular (LV) function remains unclear. This study aimed to determine changes in LV strain in older hypertensive patients after 1 year of different SBP goals, and to evaluate its effects on LV function in this population. Methods We studied 313 hypertensive adults aged 60 years or older after 1 year of the Systolic Blood Pressure Intervention Trial. They were divided into the intensive group (target SBP: 110–130 mmHg) and the standard group (target SBP: 130–150 mmHg). All participants underwent echocardiography within 1 week after enrollment and 1 year after participating in the study. Global longitudinal strain (GLS) of the LV (endocardial, middle, and epicardial layer: GLS-end, GLS-mid, and GLS-epi, respectively) and improvement of GLS at 1 year (ΔGLS-end, ΔGLS-mid, and ΔGLS-epi) were measured. Results At 1 year, GLS-end in the intensive group was decreased compared with that before the trial (−23.78%±3.10% vs −22.58%±3.11%, P<0.05). The ΔGLS-end and ΔGLS-mid in the intensive group were higher than those in the standard group (both P<0.05). Moreover, SBP at 1 year and an angiotensin II type 1 receptor antagonist were independent factors that affected ΔGLS-end. Conclusions These trial results suggest that a lower SBP target is beneficial for LV myocardial function of older hypertensive patients at 1 year.

Nowadays, more and more heart failure patients need to be treated with cardiac resynchronization therapy (CRT). Traditional epicardial pacing has a high implantation failure rate and non-response rate, while left ventricular endocardial pacing therapy exactly overcomes these disadvantages, especially leadless endocardial pacing therapy has a broad application prospect.

Rolling Contact Fatigue (RCF) is harmful and inevitable to bearings and usually results in the initiation of subsurface damage. This paper focuses on the cumulative mechanism of subsurface damage in bearing steels arose from cementite during RCF. The distribution of subsurface shear stress in bearings was investigated by finite element simulations. A two-phase atomic model of bcc-Fe and cementite was built. Ten alternating shear load cycles were applied when the model was initially in the elastic, elastic-plastic and plastic stages, respectively. The results show that cyclic softening diversely occurs in all three types of stress responses, and the progress of plastic accumulation depends on the amplitude of cyclic load and cycles. Severe shear deformation eventually leads to the damage of the cementite phase, which might be the microscopic mechanism of the fatigue failure of bearing steels. The conclusions presented have general applicability to brittle inclusions in bearing steels.

Objective: To estimate the incidence of excessive distension absorption in the patient went through hysteroscopic surgery distended with 5% mannitol solution, to evaluate the use of 5% mannitol solution for hysteroscopic surgical procedure specifically and to testify the safe threshold for distension absorption. Design: Retrospective. Setting: Academic medical center. Patients: 10693 patients went through inpatient hysteroscopic surgery distended with 5% mannitol solution using monopolar electrosurgical instrument from Jan. 2015 to Sep. 2020. Intervention(s): None. This study has been approved by the Ethics Committee of Sun Yat-sen Memorial Hospital. Measurements and Main Results: Fluid deficit more than 1000mL is defined as excessive distension absorption. Incidence of excessive distension absorption in all the inpatient hysteroscopic surgeries is 0.46% (49/10693). It is 2.57% (16/623) in transcervical resection of fibroid (TCRF), 2.36% (9/381) in retained products of conception (RPOC) removal, 1.20% (6/501) in hysteroscopic uterine septum resection (HSR), 0.53% (14/2621) in transcervical resections of adhesion (TCRA) while in the severe cases it was 2.34% (14/598), 0.48% (4/828) in transcervical resection of the endometrium (TCRE). Excessive distension absorption developed within ten minutes in two cases. Twelve of thirty nine patients with fluid deficit under 2500mL presented with clinical consequences related to circulation overload. Conclusion: Incidence of excessive distension absorption could be low generally however it would be five times higher in TCRP, RPOC removal and TCRA. Resection by needle electrode may contribute to the excessive distension absorption developed within short time. 30.77% of the patients could not tolerate the less than 2500mL distension absorption.