Dear Editor, We really appreciate MN van IJsselmuiden et al. for their efforts in conducting the first ever multicenter randomized controlled trial to compare laparoscopic sacrohysteropexy (LSH) with sacrospinous hysteropexy (SSHP).1 However, I have some questions regarding the methodology and results of this trial. What are the reasons for including patients with histories of previous pelvic floor or prolapse surgery in the exclusion criteria? Would randomly and equally allocating these patients into two surgical groups affect the study result or design? Nevertheless, we are really interested in the conduct of anterior or posterior colporrhaphy through the laparoscopic method.Patients presented with anterior vaginal wall prolapse are higher in number: POP-Q stage- Aa or Ba > 0 (LSH group:81%; SSHP group:72.6%) than those presented with apical prolapse (LSH group:46.6%; SSHP:45.6%) in Table 1. The majority of study population appears to have combined anterior and apical compartment prolapse rather than apical prolapse alone. Furthermore, Table 2 shows that the overall anterior compartment failure rates are 50.9% and 56.9% in the LSH and SSHP groups, respectively, in a 1 year follow-up interval. The failure rate is extraordinarily high compared with that in a previous study.2 Hysteropexy surgery is beneficial for patients with apical prolapse. It is not beneficial for patients with combined anterior and apical compartment prolapse with prominent cystocele. Most patients are satisfied with the 1 year surgical results and would recommend surgery to someone else (LSH: 87.7%; SSHP: 89.7%) despite the high recurrence rate of anterior wall prolapse in a 1 year follow-up.In the statistical analysis section, additional anterior vaginal wall repairs are significantly higher in the SSHP group than those in the LSH group (SSHP: n = 61, 98.4%; LSH: n = 55, 85.9%, P = 0.010). I would like to know how this small number difference (61 − 55 = 6) in these groups can cause significant difference in P value and how this P value is calculated. This trial assumes a failure rate of 3% on the basis of the outcomes of SSHP in a previous prospective study. However, the data population is relatively small, and the non-inferiority margin was set at 10%.The primary outcome is defined as a composite outcome of the surgical failure of the apical compartment after 12 months of follow-up and as the recurrence of uterine prolapse (POP-Q ≥ stage 2). Surgical success is defined as the absence of prolapse beyond the hymen. In the POP-Q stage system, POP-Q stage 2 is defined as the most distal prolapse between 1 cm above and 1 cm beyond the hymen.3 The most prominent prolapse, which descends beyond hymen, is the stage 2 prolapse. It elicits clinical controversy and conflicts with regard to the definitions of surgical failure and success. We hope that this letter will deliver the message that precise preoperative patient selection and study design are crucial, as they may have substantial impacts on clinical outcomes and treatment success.Min-syuan Huang,2, 3 Zi-Xi Loo,1Kun- Ling Lin,1, 2 Cheng-Yu Long1, 21 Department of Obstetrics and Gynecology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan2 Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan3 Department of Obstetrics and Gynecology, Kuo General Hospital, Tainan, Taiwan

IgE, the key molecule in atopy has been shown to bind two receptors, FcRI, the high affinity receptor and FcεRII (CD23), mostly found on B cells and that binds IgE with lower affinity. Whereas cross-linking of IgE on FcRI triggers allergic reaction, binding of IgE to CD23 is known to play an important role in both IgE synthesis and presentation. Thus, targeting IgE-immune complexes on B cells has shown to enhance antibody and T cell responses in mice and humans. However, the mechanisms that regulate the targeting of the two receptors and the respective function of the two pathways in inflammation or homeostasis are still matter of debate. Here, we discuss several mechanisms related to IgE and IgE binding to both receptors, as well as the influence of the antigen binding on different immune cells expressing the receptors. One recent paper has shown that free IgE preferentially binds to FcRI whereas IgE immune complexes (IgE-ICs) are preferentially captured by CD23. Binding of IgE-ICs to CD23 on B cells can on one hand regulate serum IgE and prevent effector cell activation and on the other hand facilitate the antigen presentation by delivering antigen to dendritic cells. The data suggest that CD23 play a multifunctional role in regulating the allergic response pathway.

Background: N-ERD is a syndrome characterized by chronic rhinosinusitis nasal polypsasthma and aspirin intolerance. An imbalance of eicosanoid metabolism with overproduction of CysLTs has been associated with N-ERD however, the precise mechanisms underlying N-ERD are unknown. Objective: To establish the transcriptome of the nasal polyp airway epithelial cells derived from N-ERD patients to uncover the gene expression patterns during this disease. Methods: Nasal airway epithelial cells were isolated from 12 N-ERD polyps and 9 N-ERD non polyp nasal mucosa as controls from the same subjects. RNA was sequenced on the Illumina HiSeq 2500. Potential gene candidate DMRT3 was selected from the differentially expressed genes for validation. Results: Comparative transcriptome profiling of nasal epithelial cells was achieved in N-ERD. 18 genes had twofold mean regulation expression differences or greater. 5 genes were upregulated including DMRT3 and 12 genes were down-regulated. Differentially regulated genes included inflammation, defense and immunity. Significantly enriched pathways were metabolic process and embryonic development. ELISA results of DMRT3 in N-ERD patients was significantly upregulated when compared to controls (p= 0.03). IHC of N-ERD nasal polyps localised DMRT3 and was predominantly released in the airway epithelia. These results corroborate with our findings. Conclusion: Findings suggest that DMRT3 could be potentially involved in nasal polyps development in N-ERD patients. Known functions of DMRT3 include nucleic acid binding and highly expressed during embryonic development. Several genes are downregulated, hinting dedifferentiation phenomenon in N-ERD polyps. However, further studies are required to confirm the exact mechanism of polyps formation in N-ERD patients.

Background: Breastfeeding is associated with long-term health benefits, such as a lower incidence of allergy, asthma, diabetes or celiac disease. However, little is known regarding how the maternal and neonatal immune systems interact after parturition when the neonate receives nutrition from maternal breastmilk. Methods: We undertook a comparative analysis of immune repertoire and function at birth and 3 weeks of age in a cohort of 38 term neonates born by caesarean section grouped according to feeding method (breastmilk versus formula). We used flow cytometry to study the immune phenotype in neonatal and maternal blood samples and mixed lymphocyte reactions to establish the proliferation response of neonatal versus maternal lymphocytes and vice versa. The microbiome of neonatal stool samples was also investigated using 16S rRNA sequencing. Results: We show that the proportion of regulatory T cells (Tregs) increases in this period and is nearly two-fold higher in exclusively breastfed neonates compared to those who received formula milk only. Moreover, breastfed neonates show a specific and Treg-dependent reduction in proliferative T cell responses to non-inherited maternal antigens (NIMA), associated with a reduction in inflammatory cytokine production. Conclusions: These data indicate that exposure of the neonate to maternal cells through breastfeeding acts to drive the maturation of Tregs and ‘tolerizes’ the neonate towards NIMA.

The mechanical, structural, and morphological properties of polystyrene (PS) under fatigue combined with accelerated aging were investigated. The results revealed that under the condition of fatigue (tension–tension) combined with UV-B exposure, in the periods of 336 and 575 h, the mechanical resistance presented is lower when compared to PS subjected to only fatigue. The modifications produced by the irradiation were evaluated by physical-chemical tests, which resulted in changes in the properties of the degraded materials, such as reduced molecular mass due to chain cleavage and increased crystallinity. The predominant failure mechanism in mechanically fractured specimens was also influenced by irradiation, so that the hardening of the surface layer was characterized by Vickers microhardness.

Dear Sir, Whilst the primary focus of our commentary was to reflect upon the multitude of clinical and institutional changes prompted by COVID-19 to help adopt a more streamlined approach to healthcare,1we thank Herron et al for highlighting the importance of partner support during labour.2 However, we note that even during the peak of the first wave of infections, the Royal College of Obstetricians and Gynaecologists (RCOG) continued to advocate the presence of a single birth partner throughout labour. Many obstetric units, including our own, managed to successfully adhere to this practice throughout the pandemic. However, guidance from the RCOG for women attending antenatally, for face to face clinic appointments or ultrasound scans, was to attend alone. This was subsequently implemented in most hospitals in order to reduce the number of visitors.1 Whilst necessary during the initial fear and uncertainty surrounding COVID-19, moving forward it is important to consider the potential negative impact of partner non-attendance antenatally, as well as intrapartum. Partners often positively encourage women to seek care and prepare for birth complications, thereby preventing delay in treatment and helping to manage expectations, which have been shown to positively impact outcomes.3 Whilst undoubtedly an exciting time for many, pregnancy and the prospect of motherhood is daunting to others. Partners provide support and facilitate decision making throughout the antenatal process, particularly in difficult circumstances such as following the diagnosis of a missed miscarriage, during counselling for pregnancies affected by genetic abnormalities, or after an intrauterine death. The restrictions on partner attendance may therefore inadvertently prevent a number of women seeking care during pregnancy, for fear of having to face procedures or receiving bad news alone. Evidence from a London hospital supports this notion after demonstrating a significant increase in stillbirth rate during the pandemic compared to pre-pandemic (9.31 per 1000 births Vs 2.38 per 1000 births; p=0.01). Of significance, no cases were affected by COVID-19, nor were there any post-mortem findings suggestive of the virus.4The utilisation of remote consultations with a woman and her partner offers a suitable option in appropriately triaged cases.1 Even in remote consultations where inadvertent difficult decisions arise, the presence and support of their partner facilitates collaborative decision making. Ironically, those with high risk enough pregnancies to warrant in person consultations, where additional support could offer significant value, are those whereby partners are not permitted. Prior to the pandemic, partners often reported feeling excluded, fearful of the uncertainty of pregnancy and labour and frustrated by perceived lack of support from healthcare professionals.5 This may subsequently negatively impact their relationship because of the inability to adequately support their partners. Their exclusion from the majority of antenatal care therefore, may not only negatively impact psychological wellbeing of women which may in turn result in suboptimal outcomes, but also negatively impact their future relationship. As such, we agree with Herron et al and support their notion that attempts should be made towards delivering individualised patient centred care both antenatally and intrapartum.Lorraine S Kasaven1,2, Srdjan Saso1,2, Jen Barcroft1,2, Joseph Yazbek1,2, Karen Joash1, Catriona Stalder1, Jara Ben Nagi,2 J Richard Smith,1,2 Christoph Lees1,2, Tom Bourne1,2, Benjamin P Jones1,21 Queen Charlotte’s and Chelsea Hospital, Department of Cancer and Surgery, Imperial College NHS Trust, W12 0HS London, UK.2 Imperial College London, Department of Cancer and Surgery, London W12 0NN, UK.

Background The fate of the aorta after tube graft replacement remains unclear as is the future of aortic dilatation in patients receiving other cardiac operations. We investigated the evolution of aortic dilatation after non aortic cardiac operations and the dimensions of the root and arch after ascending aorta replacement. Methods From 252 patients with aortic dilatation operated from January 2010 to June 2019, 160 were followed with computed tomography angiography. Two groups were formed according to the initial operation received. Group I (n=36) included patients with a dilated aorta, unreplaced during different indication cardiac surgery. Group II (n=124) included patients receiving tube graft aorta replacement with or without aortic valve replacement. Mean preoperative and follow-up diameters of the different aortic segments were compared in both groups using the two sided paired t-test for repeated measurements. Results 18 patients died during follow-up, with one death occurring during reoperation for a false aneurysm of the distal anastomosis on the aortic arch. There was no other re-operation for aortic aneurysm, rupture or dissection. In group I the aortic arch diameter increased slightly, while the rest of the aortic segments remained stable. In group II the aortic root diameter decreased slightly while the aortic arch remained stable. Conclusion Ascending aorta replacement with a tube graft remodeled the aortic root and did not allow progressive dilatation of the aortic arch. In patients with moderate ascending aorta dilatation, the unreplaced ascending aorta and aortic root remained relatively stable but the aortic arch increased slightly during followup.

Silver sillago, Sillago sihama is a member of the family Sillaginidae and found in all Chinese inshore waters. It is an emerging commercial marine aquaculture species in China. In this study, high-quality chromosome-level reference genome of S. sihama was first constructed using PacBio Sequel sequencing and high-throughput chromosome conformation capture (Hi-C) technique. A total of 66.16 Gb clean reads were generated by PacBio sequencing platforms. The genome-scale was 521.63 Mb with 556 contigs, and 13.54 Mb of contig N50 length. Additionally, Hi-C scaffolding of the genome resulted in 24 chromosomes containing 96.93 % of the total assembled sequences. A total of 23,959 protein-coding genes were predicted in the genome, and 96.51 % of the genes were functionally annotated in public databases. A total of 71.86 Mb repetitive elements were detected, accounting for 13.78% of the genome. The phylogenetic relationships of silver sillago with other teleosts showed that silver sillago was separated from the common ancestor of S. sinica about 7.92 million years ago. Comparative genomic analysis of silver sillago with other teleosts showed that 45 unique and 100 expansion gene families were identified in silver sillago. Expansion gene families were involved in immune and olfactory receptors. In this study, the genomic resources provide valuable reference genomes for functional genomics research of silver sillago.

An efficient numerical method is presented in this study to discuss the effects of variable heat flux, viscous dissipation and the slip velocity on the viscous Casson flow and heat transfer due to an unsteady stretching sheet taking into account the influence of heat generation or absorption. Industrially, this type of fluid can describe the flow of blood in an industrial artery, which can be polished by a material governing the blood flow. The spectral collocation method based on Chebyshev polynomials of the third-kind is employed to solve the resulting system of ordinary differential equations which describe the problem. Influence of the parameters governing the flow and heat transfer such as unsteadiness parameter, slip velocity parameter, Casson parameter, local Eckert number, heat generation parameter and the Prandtl number are discussed and presented through tables and graphs. Also, the local skin-friction coefficient and the local Nusselt number at the stretching sheet are computed and discussed. Finally, the results show that the given procedure is an easy and efficient tool to investigate the solution of such fluid models.

In this paper we first give the general solution of the following inverse palindromic eigenvalue problem (IPEP): Given matrices $\Lambda= \mbox{diag}\{\lambda_{1}, \cdots, \lambda_{p}\} \in {\mathbb{C}}^{p\times p}$, $\lambda_{i}\neq \lambda_{j}$ for $i \neq j$, $i, j= 1, \cdots, p$, $X= [x_{1}, \cdots, x_{p}] \in {\mathbb{C}}^{n \times p}$ with $\mbox{rank}(X)= p$, and both $\Lambda$ and $X$ are closed under complex conjugation in the sense that $\lambda_{2i}= \bar{\lambda}_{2i-1} \in {\mathbb{C}}$, $x_{2i}= \bar{x}_{2i-1} \in {\mathbb{C}}^{n}$ for $i= 1, \cdots, m$, and $\lambda_{j} \in {\mathbb{R}}$, $x_{j} \in {\mathbb{R}}^{n}$ for $j= 2m+1, \cdots, p$, find a matrix $A \in {\mathbb{R}}^{n \times n}$ such that $AX= A^\top X\Lambda.$ We then consider a best approximation problem (BAP): Given $\tilde{A} \in {\mathbb{R}}^{n \times n}$, find $\hat{A} \in {\mathcal{S}}_{A}$ such that $\|\hat{A}-\tilde{A}\|= \min_{{A} \in {\mathcal{S}_{A}}} \|A-\tilde{A}\|,$ where $\|\cdot\|$ is the Frobenius norm and ${\mathcal{S}}_{A}$ is the solution set of IPEP. We show that the best approximation solution $\hat{A}$ is unique and derive an explicit formula for it.

Objectives We aimed to assess cognitive function in women with pre-eclampsia stratified by severity, before and after onset of disease. Design Prospective case control study Setting Single center study at a referral hospital in Cape Town, South Africa. Population Pregnant women between 20 and 42 weeks gestation with eclampsia, pulmonary oedema, pre-eclampsia without severe features a normotensive pregnancy. Methods Women were included at diagnosis (cases) or at admission for delivery (controls). Two cognitive assessments, the Cognitive Failure Questionnaire (CFQ) to assess the cognitive function subjectively before inclusion in the study, and Montreal Cognitive Assessment (MoCA) to assess the current cognitive function objectively before discharge from the hospital after delivery were performed. Main outcome measures Total- and subscores from the CFQ and MoCa tests. Results We included 61 women with eclampsia, 28 with pre-eclampsia complicated by pulmonary oedema, 38 with pre-eclampsia without severe features and 26 with normotensive pregnancies. There was no difference in cognitive function from early pregnancy between groups. Women with eclampsia and pre-eclampsia complicated by pulmonary oedema scored lower on the MoCA assessment at time of discharge compared to women with normotensive pregnancies. The results were attenuated in pulmonary oedema after adjustment for confounders. Conclusion Women with pre-eclampsia complicated by pulmonary oedema and in particular eclampsia had impaired cognitive function after onset of disease compared to normotensive pregnant controls. The impairment did not seem to be present before onset of disease. Women with pre-eclampsia without severe features did not have impaired cognitive function.

Pursuit-evasion games are the next logical stage in the exploring of powerful, intelligent, adaptive performance. In fact the optimal strategy is known for games in an infinitely sized playing field. The quality of the machine learning methods can thus be compared to the optimal performance possible. Therefore, we consider in this study a pursuit-evasion differential game in Hilbert space l2 with a hybrid system of dynamics. The game consists of a non-inertial pursuer and an inertial evader where controls of the pursuer and the evader are satisfied to the integral constraints. The duration of the game, φ, is fixed. The position of the evader at time φ satisfies to the phase constraint. We obtain attainability domains of the players and then we make a winning strategy for the pursuer which guarantees capturing the evader. We show that our constructed strategy is admissible as well.

A 73-year-old man was hospitalized for arrhythmia and underwent intracardiac electrophysiologic examination and cryoablation treatment. Because of the complains of pain in the root of right thigh, he underwent arteriovenous ultrasound examination after interventional therapy. Ultrasound showed a heterogeneous mass on the posterolateral wall of the right common femoral vein ，which was mainly hypoechoic with small anechoic zone in the center. The pulsation of the anechoic area, the blood flow signal in it, and the characteristics of “to-and-fro” flow spectral pattern proved that the mass was a pseudoaneurysm, not a previously misdiagnosed venous thrombosis.

Epicardial cysts are rarer benign tumors than pericardial cysts. 17- year old boy presented with chest pain and palpitations and was diagnosed as mediastinal mass (pericardial cyst) on the basis of MRI and echocardiography. Surgical resection via thoracotomy was planned. Intraoperatively, the cyst was found to be epicardial in origin with close proximity to posterior descending artery. Therefore resection was concluded via midline approach and cardiopulmonary support. Despite detailed preoperative investigation and assessment, misdiagnosis of cardiac masses cannot be completely ruled out. Any undesired intraoperative diagnosis should be carefully dealt and a safer alternative approach can be considered for a better outcome.

Response surface methodology (RSM) was used to optimize the oxidation of the omeprazole sulfide to (S)-omeprazole catalyzed by environmentally friendly catalyst soybean pod peroxidase (SPP) in cetyltrimethylammonium bromide (CTAB)/isooctane/n-butyl alcohol/water water-in-oil microemulsions. With the initial concentration of SPP of 3200 U ml-1, the conversion of the omeprazole sulfide, the (S)-omeprazole yield and ee were 93.75%, 91.56% and 96.08%, respectively, under the optimal conditions: Wo of 15.85, the concentration of H2O2 of 22.44 mM and reaction temperature of 49.68 ℃, respectively. The proposed mechanism of asymmetric sulfoxidations catalyzed by SPP involves three concomitant mechanisms as follows: (1) a two-electron reduction of SPP-I, (2) a single-electron transfer to SPP-I and (3) nonenzymatic reactions, including five enzymatic and two nonenzymatic reactions, which is reasonable and can express the oxidations. With 5.44% of the average relative error, a kinetic model based on the mechanisms fitting observed data very well was established, and the SPP-catalyzed reactions including both the two-electron reduction and the single-electron transfer mechanisms obey ping-pong mechanism with substrate and product inhibition, while nonenzymatic reactions follow a power law. This study has also demonstrated the feasibility of SPP as a substitute with low cost, excellent enantioselectivity and better thermal stability.

The mechanical properties of biofilms can be used to predict biofilm deformation, for example under fluid flow. We used magnetic tweezers to spatially map the compliance of Pseudomonas aeruginosa biofilms at the micron scale, then used modeling to assess its effects on biofilm deformation. Biofilms were grown in capillary flow cells with Reynolds numbers (Re) ranging 0.28 to 13.9, bulk dissolved oxygen (DO) concentrations from 1 mg/L to 8 mg/L, and bulk calcium ion (Ca2+) concentrations of 0 and 100 mg CaCl2/L. Higher Re numbers resulted in more uniform biofilm morphologies. The biofilm was stiffer at the center of the flow cell than near the walls. Lower bulk DO led to more stratified biofilms. Higher Ca2+ led to increased stiffness and more uniform mechanical properties. Using the experimental mechanical properties, fluid-structure interaction models predicted up to 64% greater deformations for heterogeneous biofilms, compared to a homogeneous biofilms with the same average properties. However, the error depended on the biofilm morphology and flow regime. Our results show significant spatial mechanical variability exists at the micron scale, and that this variability can potentially affect biofilm deformation. The average mechanical properties, provided in many studies, should be used with caution when predicting biofilm deformation.

Linkers are short or long stretch of amino acid sequences used to create chimeric proteins. Linkers can adopt various structures in a biological environment which is a deciding factor for the functionality of a chimeric protein. It is essential to generate fully separated proteins in the chimeric protein and an effectual linker design increases the stability and activity of the protein. In this review, we summarize the types of linkers and strategies for designing linkers in chimeric protein generation. Appropriate linker design results in the creation of recombinant fusion protein which can be employed in biochemical analysis, drug targeting, pharmaceuticals, diagnostic, and industrial and biotechnological applications.

Abstract Objective: Since technological devices used for communication affect communication between people, Nomophobia is a disorder of a new age. In this study, we discuss the relationship between nomophobia and smoking addiction and the factors affecting them. Methods: The Demographic Information Form and Nomophobia Scale (NMP-Q), ıf they were smoking we applied the Fagerström Test for Nicotine Dependence (FTND) Scales were directed among students (N = 641) at Süleyman Demirel University studying Medicine, Dental, Nursing, and Physiotherapy departments in the 1st and 4th grades. Mann-Whitney U, Kruskal Wallis test to compare the scores of the variables with more groups. Correlation analysis was performed between the NMP-Q and Fagerström Test for Nicotine Dependence scores by Spearman correlation. Bonferroni test applied as Post Hoc test for multiple comparisons of groups. Results: In our study, 267 (42,6%) of participants who had nomophobia refuse to be dependent and smartphone addiction level was found to be 99.69 for all students.Responses were received from 73,2% (n=469) female and 26,8% (n=172) male participants. There is no significant difference between smokers in terms of factors in nomophobia (p>0.05). Total score of the questionnaire (p<0.01*) by gender and averages scores of women were higher in all mentioned sub-dimensions and total scores. Conclusions: In our study, there was no correlation between nomophobia and cigarette addiction due to the low number of smokers participating in our survey. Therefore, new conflicts with wider audiences are needed to examine the relationship between these two addictions Keywords: Nomophobia, Smartphone Addiction, Cigarette, Addiction What’s Already Known About This Topic? All addictions trigger each other. Here, we examined the effects of these two addictions on each other. ’What does this article add? There are not many studies on the effects of nomophobia and smoking addiction on each other. People should be careful about these two addictions.

Aim: We aimed to investigate the predictor role of the systemic immune-inflammation index (SII) on Bacille Calmette Guerin (BCG) response in patients with high-risk non-muscle invasive bladder cancer (NMIBC). Methods: A total of 96 patients with high-risk NMIBC, who received intravesical BCG, were enrolled in the study. BCG responsive group (group 1) and BCG failure group (group 2) were compared in terms of demographic and pathological data, peripheral lymphocyte, neutrophil, and platelet counts, neutrophile lymphocyte ratio (NLR), platelet lymphocyte ratio (PLR), SII, recurrence free survival (RFS) and progression free survival (PFS). The prognostic ability of the SII for progression was analyzed with multivariate backward stepwise regression models. Results: The mean follow-up time 34.635±14.7 months. Group 2 had significantly higher SII, peripheral lymphocyte, neutrophil, and platelet counts than group 1. A ROC curve was plotted for the SII to predict the BCG failure and the cut-off point was calculated as 672.75. Effect of the SII to the model was statistically significant (p=0.003) and a higher SII increased the progression one-fold. A tumor greater than 30 mm in size and a high SII together increased the progression 3.6 folds. Conclusions: The SII might be a successful, non-invasive and low-cost parameter for prediction of BCG failure in patients with high-risk NMIBC. The cut-off value for SII is 672.75 and above this level BCG failure and progression to MIBC might be anticipated. However, these results should be validated in prospective randomized controlled studies with large patient groups.

Background and Purpose: Adverse environments during pregnancy can increase susceptibility to chronic diseases in adult offspring, which might be related to intrauterine glucocorticoid-induced multi-organ developmental programming and homeostasis alterations. Dexamethasone is widely used for preterm delivery-related pregnancy diseases. Previous studies suggested that prenatal dexamethasone exposure (PDE) could cause developmental toxicity of adrenal gland in offspring and the underlying mechanism has not been elucidated. Experimental Approach: Wistar rats were subcutaneously injected with dexamethasone (0.2 mg/kg·d) during gestational day 9-20. The placentas and serum and adrenal samples were collected to identify the related indicators. In vitro, human adrenocortical cell lines (NCI-H295R) were treated with cortisol and dexamethasone to confirm the molecular mechanism, respectively. Key Results: PDE caused a low level of maternally derived glucocorticoid in male fetal blood. Furthermore, the serum corticosterone level, the H3K27ac and expression levels of the adrenal insulin-like growth factor 1 (IGF1), and steroidogenic function continuously decreased in the PDE male offspring rats. With chronic stress, the serum corticosterone level increased in the adult PDE offspring, while the above indicators were also increased correspondingly. In vitro, we further confirmed that the endogenous glucocorticoid positively programmed the adrenal IGF1 expression and steroidogenesis through the GRα/miR-370-3p/Sirt3 pathway. Conclusion and Implications: The low level of maternally derived glucocorticoid induced by PDE caused adrenal insufficiency of adult offspring rats through epigenetic positive programming of the glucocorticoid (GC)-IGF1 axis. This study firstly confirmed that exogenous glucocorticoids (dexamethasone) can alter the adrenal development programming and homeostasis in offspring by inhibiting maternal adrenal function.

Key PointsThe mean TOI-14 was 48.22 (SD 10.10).The mean HALT was 45.80 (SD 22.22).There was a significant correlation between the TOI-14 and HALT,r = 0.605, p<0.001.This is the first evidence that patients with poor quality of life due to sore throat also have poor quality of life due to halitosis.It is currently unknown if the HALT score is modified by tonsillectomy.

The efficacy of bacille Calmette-Guerin (BCG) vaccination against tuberculosis is highly variable, and protective immunity elicited by BCG is poorly understood. We compared the cytokine/chemokine profiles of peripheral blood mononuclear cells (PBMC) obtained from infants BCG-vaccinated at birth and from non-vaccinated infants. The PBMC from 10-week old BCG-vaccinated infants released higher levels of pro-inflammatory molecules than PBMCs from the non-vaccinated counterpart. In vitro exposure of PBMCs from BCG-vaccinated infants, to two different Mycobacterium tuberculosis strains, showed distinct pro- and anti-inflammatory patterns. Thus, BCG-induced infant immune responses and their protective ability may be shaped by the nature of the infecting Mtb strain.

La contaminazione delle acque sotterranee, causata soprattutto da pratiche inadeguate di smaltimento rifiuti, è un problema ormai diffuso e in crescita. L’inquinamento di queste acque spesso si traduce in problemi legati all’approvvigionamento idrico e di conseguenza in rischi significativi per la salute umana. È importante, dunque, prevenire la contaminazione e lì dove non è possibile attuare un’adeguata tecnica di bonifica. Il pump-and-treat (P&T) è una tecnologia convenzionale atta a contenere e controllare pennacchi di contaminanti del sottosuolo e nelle acque sotterranee; l'obiettivo è quello di valutarne l’efficacia attraverso un caso studio nel sud dell’Arizona, i cui risultati sono rappresentati da un set di dati storici corrispondenti a 23 anni di funzionamento di un sistema che inizialmente è solo P&T e successivamente è accompagnato da altre due tecniche di bonifica .

MYCN-amplified neuroblastoma demonstrating favorable histology, which is genotype–phenotype discordant, is extremely rare. This study reports two cases of peripheral neuroblastic tumors with genotype–phenotype discordance: a 3-month-old female and 10-month-old male patients with stage 4S and 2B neuroblastoma, respectively, harboring MYCN-amplification and favorable histology. Immunohistochemical staining was negative for N-myc. Both patients were treated with conventional chemotherapy and 13-cis-retinoic acid without autologous stem-cell rescue, and have been disease-free for 74 and 38 months post-resection, respectively. Nevertheless, chemotherapy could have been optimized on the basis of histological features of the tumors, showing no expression of N-myc.