The clinical manifestation of coronavirus disease 2019 (COVID-19) overlap with other disorders especially cardiovascular diseases (CVD). We report a 58 years old female presented with syncope episodes and dyspnea on exertion with the left atrial mass, candidate for surgical removal and mitral valve replacement. Nearly 3 months later, she developed dyspnea, fever, and a sore throat cause to admit her with suspected COVID-19. During diagnostic evaluation, a larger LA mass detected that seemed to be COVID-19 induced organized thrombus with prosthetic mitral valve malfunction. the mass resected and immunohistochemistry revealed liposarcoma. The unusual early recurrence of liposarcoma and misdiagnosis with COVID-19 induced thrombosis are the hallmark of the present case.

This paper presents an extremely rare and difficult case report of criss-cross heart (CCH) with a combination of cc-TGA and aortic coarctation of the fetal heart at 33 weeks of gestation. Despite very complicated heart anatomy, the proper perinatal care and early cardiac surgery allowed us to observe normal development of the child without any problems during his first six and ten months of postnatal life. The impossibility to: image proper four-chamber view, obtain parallel tricuspid and mitral valve, visualize symmetrical valve motion and laminar flow from the atrium to the ventricle might be the first clues to diagnose CCH.

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Background. Rheumatoid arthritis (RA) flare is related to an increased joint damage, disability and healthcare use. The impact of short-term air pollution exposure on RA activity is still a matter of debate. We investigated in a cross-sectional study whether short-term exposure to particulate matter (PM)10, PM2.5, nitrogen dioxide (NO2) and ozone (O3) affected RA disease activity. Methods. 422 consecutive RA patients resident in Lombardy, North of Italy were studied. Air pollutant concentrations, estimated by Regional Environmental Protection Agency (Lombardy – Italy) at municipality resolution, were used to assign short-term exposure from the day of visit back to 14 days. Results. Sparse punctual significant negative associations emerged between PM10, PM2.5, NO2 and RA disease activity, whereas positive associations were observed for O3. Moreover, patients were stratified according to their ongoing Disease Modifying anti-Rheumatic Drugs (DMARDs) treatment: no DMARDs (n=25), conventional synthetic - csDMARDs (n=108), and biological or targeted synthetic b/tsDMARDs (n=289). At visit, an inverse association was observed in the b/tsDMARDs group between PM2.5 and Disease Activity Score on 28 joints (DAS28) (-0.047±0.020, p=0.023), a positive tendency in the no-DMARD group (0.125±0.070, p=0.075) and no association for csDMARDs group (0.042±0.039, p=0.288). The association between O3 the day before the visit and DAS28 was positive only in the b/tsDMARDs group (0.038±0.009, p<0.001). Conclusion. The impact of air pollution short-term exposure seems minimally clinical relevant, as the scattered significant differences were observed. Further evidence is needed to elucidate determinants of RA flare and the implications for management.

Backgroud: 37 publications and seven previous meta-analyses have been reported to investigate the correlation between CYP1A1 T3801C and A2455G polymorphisms with CRC risk. However, the results were contradictory. Original studies were not involved in previously published meta-analyses. Moreover, their meta-analyses did not evaluate positive results to identify multiple comparisons. Objectives: We performed an updated meta-analysis and systematically evaluated the published meta-analyses on the association between CYP1A1 T3801C and A2455G polymorphism with CRC susceptibility. Results: CYP1A1 T3801C polymorphism was not associated with CRC risk when all the selected studies were merged. However, subgroup analyses according to ethnicity, geographic region, location of CRC, gender and smoking, showed a significant association in rectal cancer and females. However, after BFDP correction, false significant associations were observed in rectal cancer (CC vs. TT: BFDP = 0.998; CC vs. (TT + TC): BFDP = 0.998; C vs. T: BFDP = 0.999) and females (TC vs. TT: BFDP = 0.999). A significantly increased CRC risk was yielded in overall analysis, Caucasians, Europe countries populations, and males for CYP1A1 A2455G polymorphism. After BFDP correction, associations still be significant only in Europe countries populations (AG vs. AA: BFDP = 0.680; (AG + GG) vs. AA: BFDP = 0.475; G vs. A: BFDP = 0.126). However, when we further performed a sensitivity analysis and BFDP test, false significant associations were observed in all analyses (BFDP > 0.8). Conclusions: In summary, this study suggests that these positive findings may result from false-positive results, rather than from true associations or biological factors.

Objectives: In this retrospective cross-sectional study, it was aimed to evaluate pain management after Ferguson Hemoroidectomy. Design&Setting: 151 patients who underwent Ferguson Hemorrhoidectomy between June 2017 and July 2019 were retrospectively included in the study. Postop, 1st day and 1st week Visual Analog Scale (VAS) and follow up durations based on different pain management groups were compared. Results: VAS level was highest in both groups on 1st day and 1st week in the group administered 150 mg pethidine (sc), and the difference was statistically significant (p<0.05). In the group treated with 200 mg tremadol (iv) + 150 mg diclofenac sodium (im), the VAS level was the lowest on 1st day and 1st week. The highest VAS levels were in the local lidocaine group on 1st day and 1st week, whereas the lowest values were in the 150 mg diclofenac sodium (im) + 50 mg dexketoprofen (oral) group. Conclusion: There was four common pain management procedure during hospitalization, whereas six pain management procedures were cumulated after hospitalization. Results reveal that although there have been a unique pain management procedure or a guideline on pain management after Ferguson Hemoroidectomy, clinical research results may have contribution for effective pain management after Ferguson Hemoroidectomy.

Community assembly theory proposed a hierarchy by which local composition is determined by both regional processes, e.g. dispersal and migration, and local processes, e.g. local filtering by environmental conditions and competition. How these factors interact and combined govern local species assembly and trait composition is poorly known. Thereto, we propose a conceptual model in which strong dispersal ability (linked to low environmental tolerance) is fitness-dependent, promoting species to track environmental changes; weak dispersal (linked to high tolerance) should be fitness-independent, enhancing the influence of competition. Conquently, local trait dissimilarity should have a positive humpback shape, while regional trait dissimilarity should have an upturned-humpback relationship with a dispersal trait gradient. We found strong empirical support for this concept in trait distribution patterns of stream macroinvertebrates from five basins across China. These findings are discussed in terms of metacommunity theory and merit further testing of our concept across ecosystems and organism worldwide.

Objective To evaluate factors affecting cesarean section (CS) rates in groups 1, 2A, 3, 4A, 5 and 10 of the “Ten Group Classification System” (TGCS). Design Retrospective analysis of deliveries occurred from January 1996 to December 2019. Setting A single hospital in Milan. Population Pregnant women belonging to groups 1, 2A, 3, 4A, 5 and 10 of the TGCS. Methods A binary logistic regression analysis was conducted. Included independent variables were maternal age, neonatal birthweight, immigrant status, use of obstetric analgesia, presence of diabetes, hypertension and obesity. Main outcome measures The effect of independent variables on CS rate was expressed as odds ratio. Results A total of 30591 deliveries were recorded. Advanced maternal age was an independent risk factor (RF) in groups 1, 2A, 3, and 4A; diabetes was a risk factor in groups 1 and 5; obesity was a RF in groups 1 and 2A and a protective one in group 5; hypertension was a RF in groups 2A, 5 and 10; macrosomia was a RF in groups 1, 2A and 3; use of obstetric analgesia was either a RF in group 1, and a protective factor in groups 2A, 5 and 10; immigrant status was either a protective factor in groups 1 and 10, and a RF in group 4A. Conclusion The TGCS is a well-established method to compare CS rates between institutions; however, inside each group, many factors can influence the CS rate and they have to be taken into consideration when comparing CS rates.

Coronavirus disease 2019 (COVID-19) has a microembolic pathogenesis. We reviewed the incidence of microembolic complications of pregnancy during the COVID-19 pandemic period compared to the pre-pandemic period, specifically in-utero death (IUD) and placental abruption. Design A retrospective case review. Setting Patients were identified from the Datix reporting system and anonymised data was collected from the electronic health records. Population or Sample Women suffering an IUD or placental abruption during the review periods. Methods A retrospective review of the frequency and clinical characteristics of cases of IUD and placental abruption between 1st Jan 2020 – 30th June 2020 was compared to those from the 1st Jan 2019 – 30th June 2019. Main Outcome Measures To evaluate the frequency and clinical characteristics of women suffering IUD and placental abruption during the pandemic period in 2020, and compare them to the pre pandemic period in 2019. Results There was a increase in the rates of IUD from 2019 to 2020, 1.22/1000 births compared to 2.85/1000 births (p= 0.10). There was no difference in the rates of placental abruption (p= 0.03). Conclusions Our review has demonstrated a non-significant rise in the frequency of IUD in the pandemic period in 2020 compared to those in 2019. Additionally, there was a significantly lower lymphocyte count during the pandemic period- a marker known to be associated with COVID-19. This warrants further investigation to explore the link between COVID-19 and disorders of poor placental perfusion, particularly the rates of IUD.

This study includes 11 cases of PPH seen during Caesarean section by a single surgeon Dr. Sadhna Mathur during the last 7years where this hemostatic suture was used to control PPH from placental site in uterine cavity after the medical measures failed to control the bleeding from placental site(uterine cavity). The bleeding point was localized and a haemostatic suture in the overlying uterine musculature was applied. It was found to be completely effective hence it is being shared through this paper.

Objective: This study aimed to investigate the risk of Graves’ disease in Polycystic ovary syndrome (PCOS) patients. Design: Population-based retrospective cohort study. Setting: We utilized the medical records randomly selected from the Taiwan National Health Insurance Research Database (NHIRD) during period between 2000 and 2013. Population: We included women aged between 20 and 50 who have no previous Graves’ disease diagnosis records. Methods: We matched the baseline characteristics and the index date of the PCOS-free cohort to the PCOS cohort at a ratio of 4:1 by propensity score matching method. Cox proportional hazards model was used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs). Main outcome measure: To analyze the cumulative incidence and the hazard ratio of Graves’ disease events in both PCOS group and PCOS-free cohort. Results: We identified 5927 patients as the PCOS cohort, and included 23708 patients as the PCOS-free cohort. The PCOS group had a significant increased risk of Graves’ disease with an adjusted hazard ratio (aHR) of 1.34 (95% CI= 1.00-1.81). The p-value was 0.03 in log-rank test. PCOS patients without anxiety, chronic obstructive pulmonary disease, hypertension or hyperlipidemia had a higher risk of Graves’ disease in the stratification analysis. Conclusions: This study revealed a significant association between PCOS and subsequent risk of developing Graves’ disease. Funding: Nil. Tweetable abstract: PCOS increase the risk of Graves’ disease. Keywords: Polycystic ovary syndrome, PCOS, Graves’ disease, GD, hyperthyroidism, autoimmune thyroiditis, cohort, hazard ratio, epidemiology, Taiwan National Health Insurance Research Database

To assess the impact of COVID-19 restrictions on cystic fibrosis (CF) pulmonary exacerbations (PEx) we performed a retrospective review of PEx events at our CF Center and compared the rate of PEx in 2019 vs 2020. Restrictions on social interaction due to the COVID-19 pandemic were associated with a lower rate of PEx at our pediatric CF Center, suggesting that these restrictions also reduced exposure to other respiratory viral infection in children with CF.

Aim: Although the advantages of laparoscopic inguinal hernia repair in the general population have been shown, its role in octogenarians has yet to be elucidated. This retrospective study compared laparoscopic and open inguinal hernia repair in octogenarians; the experience was summarized to aid in selecting surgical and anesthesia options in this age group. Materials and methods: The data of octogenarians who underwent laparoscopic (n = 81) or open (n = 121) inguinal hernia repair in our center from January 2017 to December 2019 were collected. Statistical analysis variables included basic epidemiological data of patients, anesthesia methods, surgical procedures, comorbidities, postoperative pain, complications, recurrence, and other data. Results: There were no significant differences between the two groups in terms of sex, body mass index, recurrent hernias, comorbidities, postoperative complications, and recurrence. The American Society of Anesthesiologists (ASA) class and the proportion of scrotal hernias in the open group were higher than those of the laparoscopic group, whereas the proportion of bilateral hernias in the laparoscopic group was higher than that in the open group. The postoperative pain scores of the laparoscopic group were lower than those of the open group. The proportion of patients with ASA class III–IV was highest in patients receiving local anesthesia, and the proportion of bilateral hernias was higher in the patients receiving general anesthesia than that in those receiving local or spinal anesthesia. Conclusion: In octogenarians, both laparoscopic and open inguinal hernia repair are safe and feasible, but an appropriate surgery and anesthesia plan should be determined according to the patient’s specific conditions.

Aims: As a population of immunosuppressive cells, polymorphonuclear-myeloid derived suppressor cells (PMN-MDSCs) are responsible for lung cancer metastasis, and metastasis is a main cause of the recurrence after surgery of non-small-cell lung cancer (NSCLC). Lectin-type oxidized LDL receptor 1 (LOX-1) is a newly confirmed maker for identifying PMN-MDSCs in human. In this study, we tried to confirm the relationship between the frequency of newly identified CD15+LOX-1+ PMN-MDSCs and NSCLC recurrence after surgery. Methods: Flow cytometry (FCM) was used to detect the proportion of CD15+LOX-1+ PMN-MDSCs in the peripheral blood (PB) cells of healthy controls (HC) and NSCLC patients. The correlation of CD15+LOX-1+ PMN-MDSC frequency with levels of cytokeratin 19-fragments (CYFRA21-1), carcinoembryonic antigen (CEA), and carbohydrate antigen 125 (CA125) was analyzed. Receiver operating characteristic (ROC) curve was used to estimate the diagnostic efficacy of CD15+LOX-1+ PMN-MDSC frequency for NSCLC. Additionally, the association of CD15+LOX-1+ PMN-MDSCs with NSCLC prognosis and recurrence after surgery was explored. Results: The proportion of CD15+LOX-1+ PMN-MDSCs increased significantly in PB of NSCLC patients. CD15+LOX-1+ PMN-MDSC proportion was positively correlated with levels of CEA and CYFRA21-1, but not CA125. The area under the ROC curve (AUC) of PMN-MDSC percentage was higher than CYFRA21-1, CEA and CA125. Compared to NSCLC patients before surgery, the proportion of CD15+LOX-1+ PMN-MDSCs decreased in patients after surgery. The frequency of CD15+LOX-1+ PMN-MDSCs was lower in NSCLC patients without recurrence compared to those with recurrence after surgery. Conclusions: Circulating CD15+LOX-1+ PMN-MDSCs are a potential diagnostic marker for NSCLC, and are associated with NSCLC recurrence after surgery.

The number of active cases of COVID 19 and deaths is markedly escalating. The pandemic had affected almost every aspect of our lives including geopolitics, health, economics, education and sociocultural events. However, the pandemic crisis besides its negative impacts succeeded in initiating some positive impacts as well. These are represented by increasing our awareness of the importance of daily hygienic practices, digital inequality, benefits of global collaboration in research and the search for a promising vaccine, online education, close family relationships and much more. This review addresses the impacts of COVID 19 pandemic on various important aspects of life.

Tuberculosis (TB), regardless of being the oldest disease is still a menace that humans have not been able to control. With the advancement in the drug discovery programme, target-based drug discovery appears to be one of the promising techniques for the development of future therapeutics. It involves identifying an essential gene involved in the pathogenesis of the disease and then targeting the protein against a defined chemical library. Shikimate kinase is one such validated target in mycobacterium. It is vital for the growth of bacteria and is absent in mammals, making it an ideal drug target. Here 6427 compounds were screened through structure based virtual screening where compound S-014-1049 was found active against H37Rv and proven non-cytotoxic in in vitro studies. It specifically binds to the core domain of MTSK.

Concepts for crack propagation as well as fatigue assessment under variable mechanical and thermal loadings are unestablished. For variable mechanical loadings, the damage parameter PJ is well known, for thermal loadings the damage parameter DTMF is established. Both parameters base on the effective cyclic J-Integral, still the definition is different. The damage parameters PJ considers the effective stress and strain ranges from the upper reversal point of each load cycle to the point of crack closure. Depending on the loading sequence the point of crack closure is treated as a history variable. In addition, with a crack length dependant fatigue limit, the most important sequence effects are considered. A new PJ-based concept is developed by considering additional sequence effects. In comparison to experimental results, the developed concept is able to reduce scattering in the range of constant amplitude loading tests.

COMMENTARY

Management of water, regionally, nationally and globally will continue to be a priority and complex undertaking. In riverine systems, biotic components like flora and fauna, play critical roles in filtering water so it is available for human use and consumption. Preservation of ecosystems and associated ecosystem functions is therefore vital. In highly regulated large river basins, natural ecosystems are often supported through provision of environmental flows. Flow delivery, however, should be underpinned by rigorous monitoring to identify and prioritise biotic water requirements. Broadscale monitoring solutions are thus integral and for woody tree vegetation species, this is can be via measurement of field evapotranspiration, regionally scaled using remote sensing. However, as there is generally a mismatch between field data collection area and remote sensing pixel size, new methods are required to proportion tree evapotranspiration based on tree fractional canopy area per pixel. Within, we present a novel method to derive tree fractional canopy cover (FTCC) at 20 m resolution, in semi-arid and arid floodplain areas. The method employs LiDAR as a canopy area field measurement proxy (10 m resolution). Sentinel-1 and Sentinel-2, radar and multispectral imagery, were used in Random forest analysis, undertaken to develop a predictive FTCC model trained using LiDAR for two regions in the Murray-Darling Basin. A predictor model, combing the results of both regions, was able to explain between 85-91% of FTCC variation when compared to LiDAR FTCC, output in 10% increments. Development of this method underpins the advancement of woody vegetation monitoring to inform environmental flow management in the Murray-Darling Basin. The method and fine scale outputs will also be of value to other catchment management concerns such as altered catchment water yields related to bushfires and as such, has application to water management worldwide.

Bardet-Biedl syndrome (BBS) is a pleiotropic genetic disorder characterized by congenital and late onset defects. It is associated with retinal dystrophy, obesity, polydactyly, hypogonadism and renal dysfunction. Proper management and regular health visits are necessary to avoid complications. We present a patient with retinal dystrophy, obesity and new onset hypertension.

Abstract Hemoptysis is a rare, life-threatening condition in childhood defined as bleeding into the lungs due to underlying disorders or respiratory tract abnormalities. The bleeding from an arterial malformation to normal lung segments without underlying cardiovascular or pulmonary disorders is widely reported in adults but extremely rare in the pediatric age group. Bronchial artery aneurysm (BAA) is a rare vascular malformation complicated with a bronchial artery to pulmonary artery (BA PA) fistula. BAAs are life-threatening conditions because of the substantial risk of rupture that can cause massive hemoptysis. In such a case, BAA embolization (BAAE) has become essential management. We report here previously healthy child presented with massive hemoptysis due to systemic-pulmonary fistula, which was bleeding controlled by BAAE.

Neuromuscular medicine is being revolutionized by new genetic and molecular therapies. The purpose of this Special Issue is to present an overview of these new therapies, to examine their cardiopulmonary effects, and to consider the future of neuromuscular cardiopulmonary care. The emphasis will be on Duchenne muscular dystrophy (DMD) and, to a lesser extent, spinal muscular atrophy (SMA), as these are the diseases with the most robust new drug development and related cardiopulmonary outcome data. This Special Issue contains articles on a number of relevant topics, including an overview of new genetic and molecular therapies for DMD, examining the currently available cardiopulmonary outcome data; and a critical examination of pulmonary outcome measures, assessing which outcomes should be used in treatment studies. We will provide an overview of cardiopulmonary phenotypic variability and discordance and their implications for assessing patient prognosis and response to therapies, and present a new perspective on neuromuscular-induced sleep-disordered breathing, viewed in the context of new and emerging therapies. Finally, we will consider which cardiac imaging modalities should be used as outcome measures in studies assessing DMD heart function, and take a look at novel therapeutic approaches to DMD heart disease, including management of rhythm disorders and heart failure, and the use of left ventricular assist devices.

Environmental crisis challenges human race harder than ever before. Ecologists have produced a massive amount of data to cope with the crisis. Accordingly, so many ecological data platforms have been developed worldwide to manage and analyze these datasets. However, in Korea, ecological datasets produced by different research institutes for different purposes have not been integrated or serviced due to the lack of a well-designed information infrastructure. To address this obstacle, we present EcoBank (www.nie-ecobank.kr), an open, web-based ecological data platform designed to play an important role in ecological informatics in Korea. The architecture of EcoBank comprises core technologies of WebGIS, Application Programming Interface (API), responsive web, and open-source software (OSS). EcoBank has three conceptual modules: data management, analysis, and service. Diverse stakeholders of EcoBank can be classified into three groups: researchers, policymakers, and public users. EcoBank aims to expand its horizons through mutual communication between these stakeholders. As a part of the progress, EcoBank began to broaden its network by linking to other data platforms and repositories over the globe to find possible solutions to ecological issues in Korea.

Genetic differentiations and phylogeographical patterns of small organisms may be shaped by spatial isolation, environmental gradients and gene flow. However, knowledge about genetic differentiation of rotifers on intercontinental gradient is still limited. Polyarthra dolichoptera and P. vulgaris are cosmopolitan rotifers and tolerant to environmental changes, offering an excellent model to address the research gap. Here, we investigated the populations in Southern China and eastern North America, and evaluated the phylogeographical patterns from their geographical range sizes, geographic-genetic distance relationships and their response to spatial-environmental factors. Using mitichondrial cytochrome c oxidase subunit I gene as the DNA marker, we analyzed a total of 170 individuals. At least 24 putative cryptic species, including 20 of P. dolichoptera and 4 of P. vulgaris were detected based on three delimitation methods. Our results showed that some cryptic species were widely distributed but most of them were limited to single areas. The divergence of P. dolichoptera and P. vulgaris complexes indicated that gene flow between continents was limited while that within each continent was stronger. Furthermore, on the intercontinental scale spatial distance had a stronger influence than physicochemical variables on the genetic differentiations of P. dolichoptera and P. vulgaris complexes. However, the relationship between genetic distance and geographic distance was not continuously linear and the P. dolichoptera data best fitted the power-law model. This might be due to the effects of habitat heterogeneity, long-distance colonization and oceanographic barriers. Outliers above the correlation line between geographic distance and genetic distance suggest a significant dispersal barrier on large geographic scales studies.