Introduction: Ablation of slow pathway (SP) for AV nodal reentry tachycardia (AVNRT), by visualization of low voltage bridges using non-contact force sensing (CFS) catheters and cryo-ablation has been described. This study aims to demonstrate the use of voltage mapping using CFS catheters in patients with AVNRT undergoing SP modification by Radiofrequency ablation (RFA). Methods Three-dimensional mapping was performed using CFS catheter in adult patients undergoing AVNRT ablation. Voltage values from intracardiac recordings were adjusted until a low voltage bridge was observed. Both electro-anatomical data and low voltage bridges were used to guide ablation. Distance from the earliest His signal to the site of SP (His-SP) and the area of the Koch’s triangle (KTArea) was measured. Results A total of 41 adult patients (63% female, 48±15 years) underwent RFA using CFS catheters. Median follow up was 12 months. There were no recurrences in any patients. When indexed to body surface area (BSA), both mean His-SP distance (p=0.038) and mean KTArea (p=0.019) was greater in patients with atypical AVNRT (n=5) than in patients with typical AVNRT (n=32). Conclusion RFA of AVNRT by visualization of low voltage bridges using CFS is effective. In patients with atypical AVNRT, SPs are particularly distant from the His region. Patients with atypical AVNRT have a larger Koch’s triangle than patients with typical AVNRT.

Introduction: Elevated left atrial pressure (LAP) during catheter ablation of atrial fibrillation (AF) is associated with an increased risk of AF recurrence, but it is unknown if this correlates with heart failure (HF). The objective of the study was to determine if elevated LAP after AF ablation correlates with HF events. Methods: Prospective, single center, cohort study measuring LAP and RAP during AF ablation in 100 patients. The primary endpoint was clinical HF within 30 days of ablation. The secondary outcome was AF-free HF. Results: 100 patients (63% male, mean age 64.5) were enrolled and 20% had clinical HF within 30 days. Bivariate correlates included mitral valve (MV) disease, persistent AF, class III antiarrhythmics, LAP, and recurrent AF. Multivariate analysis revealed class III antiarrhythmics were protective (OR 0.24 [0.1–0.5], p=0.04), while MV disease (OR 8.7 [3.3—23], p=0.03) and loop diuretics (OR 4.8 [2.6–9.1], p=0.01) were hazardous. AF-free HF occurred in 9% of patients and correlated with higher LAP and RAP, and CKD. Conclusion: Patients with HF after AF ablation had higher LAP. MV disease, diuretic use, and class III antiarrhythmics also correlated to HF. These present opportunities to target future interventions to reduce a common complication of AF ablation.

Ventricular tachycardia and premature ventricular complexes (PVCs) arising from right ventricular outflow tract (RVOT) are the most common type of ventricular arrhythmias (VAs) in patients without structural heart disease. Radiofrequency ablation is now the gold standard of treatment in this setting due to high efficacy rates and optimal safety profile [2] During the last few years, the pulmonary valve (PV) and the pulmonary artery (PA) have attracted much attention as reliable sites of origin of RVOT-type arrhythmias. In the mean while intracardiac echocardiogram (ICE) has undoubtedly improved our understanding and approach to manage these arrhythmias accurately characterizing the PV and its contiguous structures. Aim of this paper is to provide an illustrated step-by-step guide on how to use ICE with the CARTOSOUND module to visualize and reconstruct 3D shell of the RV, the PV, as well of other anatomical structures (i.e., the aortic valve and coronary arteries) to perform aware and safe ablation in this region. A new reconsideration of the existent classification of these VAs is also provided.

Food allergy is an increasingly common disease worldwide, and is thought to be driven by an uncontrolled type 2 immune response. Current knowledge about the underlying mechanisms that initiate and promote an inappropriate immune response to dietary allergens is limited. Sensitization through the skin in early life is considered to be a key event. Food allergy results from a dysregulated type 2 response to food allergens, characterized by enhanced levels of IgE, IL-4, IL-5 and IL-13 with infiltration of mast cells, eosinophils and basophils during acute reactions. Recent data implies a possible role of innate lymphoid cells (ILCs) in driving food allergy. ILCs represent a group of lymphocytes that lack specific, recombined antigen receptors. They contribute to immune responses not only through the release of cytokines and other mediators, but also by responding to cytokines produced by activated cells in their local microenvironment. Due to their localization at barrier surfaces of the airways, gut and skin, ILCs form a link between the innate and adaptive immunity. This review summarizes recent evidences on how skin and gastrointestinal mucosal immune system contribute to both homeostasis and the development of food allergy, as well as the involvement of ILCs towards inflammatory processes and regulatory mechanisms.

Background: Leiomyosarcoma occurs commonly in the abdomen, retroperitoneum, large blood vessels, and uterus[1]. Cardiac leiomyosarcoma is a rare and highly aggressive sarcoma. Methods and Results: Here, we report the case of a 63-year-old male with pulmonary artery leiomyosarcoma. Transthoracic echocardiography showed a large 4.4×2.3 cm hypoechoic mass in right ventricular outflow tract and pulmonary artery. Pulmonary computed tomography angiography showed a filling defect in similar location. Surgery was performed due to tend to occlusion. A yellow mass adhered to ventricular septum and pulmonary artery wall was detected and compressed pulmonary valve. By immunohistochemistry, the tumor cells stained positive for Desmin and smooth muscle actin, and stained negative for S-100, CD34, myogenin, or myoglobin, KI67(+)80%, supported leiomyosarcoma. Conclusion: The patient had recovered from surgery and had been on following-up.

Although autotrophic or chemotrophic microorganisms can assimilate CO2 or carbonate, it is still unclear how microorganisms convert soil inorganic carbon (SIC) to organic carbon (SOC), owing to the lack of a microbial indicator between SIC and SOC. Herein, we hypothesized that carbonate-rich saline soils are a potential source that contribute to the SOC pool through the transformation of microbial necromass. SIC levels linearly decreased with an increase in salinity, while SOC and microbial residues exponentially declined. A structural equation model verified the causality of SIC-microbial residues-SOC, suggesting that microbial residues can serve as an indicator of SIC transition to SOC. This study highlights the regulation of microbial necromass in SIC cycling, thus enhancing the application of SIC for C biogeochemical cycles and enriching organic C reservoirs in global saline or dry lands.

Introduction: Cardiac resynchronization therapy (CRT) may be proarrhtyhmic in patients with non-left bundle branch block (non-LBBB). We hypothesized that combined assessment of risk factors (RF) for ventricular tachyarrhythmias (VTA) can be used to stratify non-LBBB patients for CRT implantation. Methods: The study comprised 412 non-LBBB patients from MADIT-CRT randomized to CRT-D (n=215) vs. ICD-only (n=197). Best-subset regression analysis was performed to identify RF associated with increased VTA-risk in CRT-D patients without LBBB. The primary endpoint was first occurrence of sustained VTA during follow-up. Secondary endpoints included VTA/death, and appropriate shock. Results: Four RFs were associated with increased VTA risk: Blood Urea Nitrogen >25mg/dl, ejection-fraction <20%, prior non-sustained VT, and female gender. Among CRT-D patients, 114 (53%) had no RF, while 101 (47%) had ≥ 1 RF. The 4-year cumulative probability of VTA was higher among those with ≥ 1 RF compared with those without RF (40% vs. 14%, p<0.001). Multivariate analysis showed that in patients without RF, treatment with CRT-D was associated with a 61% reduction in VTA compared with ICD-only therapy (p=0.002), whereas among patients with ≥ 1 RF treatment with CRT-D was associated with a corresponding 73% (p=0.025) risk-increase. Consistent results were observed when the secondary endpoints of VTA/death and appropriate ICD shocks were assessed. Conclusion: Combined assessment of factors associated with increased risk for VTA can be used for improved selection of non-LBBB patients for CRT-D.

Influenza A virus (IAV), a deadly zoonotic pathogen, occasionally cross-species transmission among humans, swine and avian. The ectodomain of matrix protein 2 (M2e) is highly conserved in IAV, and multi-copy M2e from different species are usually displayed on the surface of nanoparticles to improve immunogenicity and constitute universal IAV nanovaccines. In our previous study, three M2e were inserted into the C-terminal of Cap protein of porcine circovirus type 2 (PCV2) to form a universal nanovaccine that protects PCV2 and different subtypes of IAV. Howerer, M2e adopts at least two converted conformations, and the intermolecular linker of M2e enhances the conformational instability, which limits the recognition of B cell receptors and production of high-level antibodies. Here, we report that the permutation of the M2e affects immune effect of nanovaccines. Three M2e derived from humans, swine and avian IAV were inserted into the C-terminal of the Cap protein to form nanovaccines. Immunoprotective effects of different M2e arrangements were explored in mice. Results showed that the M2e closest to the surface of nanoparticle induced the most efficient protection against IAV derived from corresponding species. The results will help to develop more effective universal IAV and PCV2 bivalent nano-vaccines, as well as universal IAV vaccines for specific species.

Foot-and-mouth disease virus (FMDV) is widespread throughout much of the world, including parts of South East Asia. As part of the World Organisation for Animal Health (OIE)’s South East Asia and China Foot‐and‐Mouth Disease Project (SEACFMD), field sampling was performed to help understand evidence of widespread virus exposure observed previously. Serum and dry mucosal swabs were collected to evaluate the presence of FMDV RNA on the nasal, oral, and dorsal nasopharyngeal mucosal surfaces of 262 healthy cattle (n=38 in Laos; n=47 in Myanmar) and buffalo (n=12 in Laos; n=2 in Myanmar) immediately following slaughter in three slaughterhouses. Swabs and serum were tested by the OIE FMD world reference laboratory using pan‐serotypic real‐time reverse transcription‐PCR (RT‐PCR) and serum was evaluated using the FMD PrioCHECK non-structural protein (NSP) ELISA. In total, 7.3% of animals had detectable FMDV RNA in one or more of the three sites including 5.3% of nasopharyngeal swabs, 2.3% of oral swabs, and 1.5% of nasal swabs. In all animals, serum was found not to contain detectable FMDV RNA, and 37.8% of animals were positive for NSP antibodies, indicating likely past exposure to FMDV. Results were comparable for Laos and Myanmar, and were similar for both cattle and buffalo. The current study demonstrates the utility of detection by swabbing the nasopharynx in the post-mortem context, in situations such as post-mortem where probang samples are not feasible. Additionally, FMDV present on the oral and nasal mucosa of clinically-healthy large ruminants in Laos and Myanmar, if viable, may potentially play a role in the epidemiology of FMD in these countries, and perhaps more widely within Southeast Asia.

Introduction: Moving sources emitting spiral waves (SSp) such as cardiac rotors, do not exhibit frequency changes typical of classic Doppler effect (CDE) physics. Rotors exhibited fastest and slowest frequencies at either side when migrating passed electrodes, not directly in front and behind as in CDE. A new spiral wave frequency effect (SFE) equation required derivation to accurately describe and predict WF frequency changes observed near a moving SSp. Methods and Results: Rotational and spiral math were developed to derive new rotational wave frequency effect (RFE) and SFE equations in two dimensions. Wave front (WF) strikes from SR occur when clock angle equaled the line of sight (LOS) angle. WF strikes from spiral sources occurred when spiral summation angle equaled LOS angle. SFE is analyzed by varying spiral size and distance from SSp. New RFE and SFE equations predict diametric changes in frequency that occur simultaneously on either side of a passing rotor. Conclusions: WF frequency changes near a moving SSp exhibit 3 main differences compared to CDE: side-dependent frequency changes, a strong-side unpaired WF strike, and a reversal of sequence of activation. These differences, predicted by new RFE and SFE equations, constitute the unique diametric property of the rotating waves. Moving bodies that spin, or moving sources of WFs that rotate, result in perceived frequency differences that are relative to side of observation. Additionally, increasing and decreasing frequencies observed, no longer always represent an approaching and receding SR and SSp (respectively), especially when observed near the source.

Abstract: A significant milestone in cardiac pacing occurred approximately two decades ago when the primary operating mode was reimagined to more closely mimic normal top-down cardiac activation. Managed Ventricular Pacing (MVP™) was an unprecedented dual-chamber mode as it preferentially paced the right atrium in the AAI/R mode and simultaneously protected against transient heart block, but only in the instance of a dropped ventricular beats. At the time, dual chamber DDD/R with atrial based timing and programmable atrioventricular (AV) delay was the state of the art. MVP “unlocked” conventional dual-chamber pacing by not consistently requiring a 1:1 atrioventricular relationship as defined by an AV delay during its primary operating mode (i.e. AAI/R+). Described herein is the remarkable story of MVP, conceived before the pivotal and highly supportive Dual-Chamber and VVI Implantable Defibrillator (DAVID) Trial was introduced and rooted in lessons learned from “first-in man” permanent His bundle pacing.

Introduction: Evidence for the effectiveness of surgical electrophysiological therapy for malignant ventricular tachycardia (VT) after myocardial infarction is lacking. Methods and Results: We report a case of a 50-year-old man with VT caused by left ventricular aneurysm (LVA). Unipolar radiofrequency ablation (RFCA) failed to treat VT. Nonetheless, bipolar RFCA forcep guided by CARTO mapping was used to ablate the LVA and peripheral myocardium during traditional surgery. There were no postoperative complications, and 1-year follow-up showed no malignant VT occurred in 24-hours. Conclusion: Bipolar RFCA assisted by CARTO mapping was an effective surgical electrophysiological therapy for refractory VT caused by LVA.

The 20 km² Galabre catchment belongs to the French network of critical zone observatories. It is representative of the sedimentary geology and meteorological forcing found in Mediterranean and mountainous areas. Due to the presence of highly erodible and sloping badlands of various lithologies, the site was instrumented in 2007 to understand the dynamics of suspended sediments (SS) in such areas. Two meteorological stations including measurements of air temperature, wind speed and direction, air moisture, rainfall intensity, raindrop size and velocity distribution are installed both in the upper and lower part of the catchment. At the catchment outlet, a gauging station records the water level, temperature and the turbidity (10 min. time-step). Water and sediment samples are collected automatically to estimate SS concentration-turbidity relationships, providing SS fluxes quantifications with known uncertainties. The sediment samples are further characterized by measuring their particle size distributions (PSD) and by applying a low-cost sediment fingerprinting approach using spectrocolorimetric tracers. Thus, the contributions of badlands on different lithologies to total SS flux are quantified at a high temporal resolution providing the opportunity to better analyze the links between meteorological forcing variability and watershed hydrosedimentary response. The set of measurements was extended to the dissolved phase in 2017. Both the river electrical conductivity and its major ion concentrations are measured each week and every three hours during storm events. This allows progress in understanding both the origin of the water during the events and the partitioning between particulate and dissolved fluxes in the critical zone.

The Budyko curve, relating a catchment’s water and energy balance, provides a useful tool to analyse how physio-climatic and socio-economic characteristics may impact long-term runoff. Often a parametric form of the curve, the Fu’s equation, is used to represent the catchment’s long-term water partitioning behaviour. Fu’s parameter ω, typically derived from observed climate and runoff data, can further be related to catchments’ physio-climatic characteristics to enable understanding the main drivers of their water balance. At times, prior analyses have reported potentially conflicting controls of characteristics on ω. Based on the rationale that several hydrological processes act across varying spatio-temporal scales, we hypothesize that the impact of a physio-climatic factor on ω is driven by its broader regional setting. We test our hypothesis by developing relationships between ω and a curated database of 33 physio-climatic and socio-economic characteristics for 534 regional divisions of India. We employ two related data-space splitting algorithms: classification and regression trees (CART) and random forest (RF) to study the effects of potential controlling factors within their regional context. The algorithms diagnose a hierarchy of representative vegetation, climate, soil, land use land cover, topography and anthropogenic controls. The most important characteristics controlling ω were found to be: long-term temperature, percentage of short rooted vegetation, population density, and long-term precipitation. We show the significance of considering the regional context by highlighting contrasting effects of two factors: long-term temperature and the proportion of sand to silt content on ω. Anthropogenic activities were found to be decisive in governing the effect of long-term temperature, indicating their influence on hydrological processes across the Indian subcontinent.

Reanalysis meteorological datasets have been widely used for hydrological simulation research in areas where meteorological stations are scarce. However, most of them focus on the applicability of datasets to basin or hydrological model and pay little attention to the influence of meteorological elements of dataset on hydrological modeling. In this study, the precipitation, temperature and solar radiation from three meteorological datasets, gauge dataset (GD), the China Meteorological Assimilation Driving Datasets for the Soil and Water Assessment Tool (SWAT) model (CMADS), and Climate Forecast System Reanalysis (CFSR), were cross-combined with multiple scenarios to drive SWAT models in Yellow River Source Region (YRSR). After a comprehensive comparison of all the scenarios, the main conclusions are as follows: (1) replacing precipitation data has a large impact on streamflow simulation of SWAT model, and using observed precipitation from sparse stations consistently yielded better performance than using precipitation from CMADS and CFSR. (2) In the scenarios adopting observed precipitation as input, using temperature from CMADS and CFSR datasets yielded better performance than using observed temperature. (3) replacing solar radiation has slight impact on the streamflow simulation, and the solar radiation of CFSR is more suitable for hydrological simulation than that of CMADS in YRSR. (4) the SWAT model driven by different meteorological datasets shows that the runoff simulation of GD with CFSR solar radiation data (S6) is optimal with “very good” performance, while the simulation performance of CMADS and CFSR are poor with clearly underestimation for CMADS and significantly overestimation for CFSR, especially in the dry season. These result indicated that the element combination method of the meteorological dataset has been proven to be useful in YRSR, which provides a new insight for hydrological simulation research in areas where meteorological stations are scarce.

Left atrial appendage inversion is a rare event in cardiac surgery and can often be mistaken for a mass, thrombus or vegetation. This can be a challenge especially in case of a left ventricular assist device (LVAD) where a correct diagnosis is of crucial significance. Intra-operative TEE, is an invaluable tool to detect an inverted left atrial appendage and differentiate it from other potentially dangerous diagnosis like left atrial clot. Knowledge of this entity along with a high index of suspicion can help early diagnosis of this scenario and avoid unnecessary reinstitution of cardiopulmonary bypass and re-surgery

A preterm neonate delivered at 28 weeks gestation, mother had antenatal steroid. Blood counts showed leukemoid reaction, blood culture, procalcitonin and peripheral blood film was normal. Baby was stabilized in the NICU, recovered and the WBC count done serially showed a downward trend. The leukemoid reaction was presumed to come from antenatal steroid use. The diagnostic and management challenges encountered in managing the infant in resource constrained environment like ours is presented alongside

RESPONSE FOR THE LETTER TO THE EDITORDon’t miss a chance taking the best shot!!Kunihiko KiuchiDivision of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of MedicineAddress for correspondence:Kunihiko Kiuchi, MD, FHRSSection of Arrhythmia, Division of Cardiovascular Medicine,Department of Internal Medicine, Kobe University Graduate School of Medicine7-5-2 Kusunoki-chou chuou-ku, Kobe, Hyogo, JapanTelephone: (81)-78-382-5846Fax: (81)-78-382-5859E-mail: kunihikokiuchi@yahoo.co.jpDisclosures:The Section of Arrhythmia was supported by an endowment from Medtronic JAPAN and Abbott JAPAN. The authors have reported that they have no relationships relevant to the contents of this paper to disclose.Funding: NoneTo the Editor,We thank Dr. Althoff and Mont for their interest, comments, and suggestions related to our paper.1 In our study, as they suggested, LGE-MRI was acquired 1-3 months after the ablation. An animal study reported that ablation lesions are fully formed by 3 weeks and are dense with collagen and fat deposition by 6 weeks.2 In our pilot study, the ablation lesion area dramatically diminished from 1 week to 6 weeks after the procedure in most of the patients. Furthermore, the ablation lesion area was comparable between 6 weeks and just 3 months after the ablation. Of interest, the ablation lesion disappeared after 5-6 months following the procedure in some patients without AF recurrence. We speculated that the shrinkage of the ablation lesion might have occurred during the pathophysiological healing process and reverse remodeling of the left atrium. Therefore, we considered that the time point of taking the “best shot” might have been earlier than we expected. Furthermore, the dose of the contrast agent was important for determining the time point. Our dose of the contrast agent was 0.1mmol/kg, which was relatively lower than that of the other groups. To address this issue, further study will be needed.As for an internal reference for normalization, the threshold of the signal intensity was initially determined according to the signal intensity histogram on the “whole LA wall” in our previous studies.3,4 However, as the authors suggested, neither the ablation lesion nor atrial fibrosis could be accurately visualized in some patients with advanced atrial remodeling. Therefore, the internal reference was changed from the “whole LA wall” to the “healthy LA wall” in our recent studies.1,5 We believed that this simple but important tip might make it possible to sensitively identify pre-existing atrial fibrosis, particularly interstitial fibrosis. The signal intensity of ablation lesion was significantly higher than that of the pre-existing atrial fibrosis. Our question is whether the ablation lesion characteristics dramatically differed between the different references in patients without atrial remodeling. Although we re-analyzed the LGE-MRI with two different references (“whole LA wall” and “healthy LA wall”), no significant difference in the lesion characteristics could be found. Cryoballoon ablation and RF ablation with contact-force sensing catheter induced intensive inflammation which followed by the artificial fibrosis.6 In this study, we focused on the visualization of the ablation lesion not the pre-existing atrial fibrosis, and patients without atrial remodeling were enrolled. We considered that the impact of the difference in the reference could be less than we expected, when we focused on the ablation lesions in patients without atrial remodeling.To visualize the atrial fibrosis and the ablation lesion, different visualization methods were developed. However, very few histological validations could be found. Furthermore, the dose of the contrast agents, MRI system, and visualization software completely differed due to the regulations in each institution. Therefore, it is not surprising that the image differed between each visualization technique. It is important to note the reproducibility of the visualization method and clinical implication of the best shot. The authors had already reported the reproducibility of their method.7 However, this issue is still in debate.8 We would like to challenge to improve the quality of our “best shot” and strengthen both reproducibility and clinical implication in a further study.References1. Kurose J, Kiuchi K, Fukuzawa K, et al. Lesion characteristics between cryoballoon ablation and radiofrequency ablation with a contact-force sensing catheter: late-gadolinium enhancement magnetic resonance imaging assessment. J Cardiovasc Electrophysiol. 2020.2. Avitall B, Kalinski A. Cryotherapy of cardiac arrhythmia: From basic science to the bedside. Heart Rhythm. 2015;12(10):2195-2203.3. Shigenaga Y, Kiuchi K, Ikeuchi K, et al. Fusion of Delayed-enhancement MR Imaging and Contrast-enhanced MR Angiography to Visualize Radiofrequency Ablation Scar on the Pulmonary Vein. Magn Reson Med Sci. 2015;14(4):367-372.4. Kiuchi K, Okajima K, Shimane A, et al. Visualization of the radiofrequency lesion after pulmonary vein isolation using delayed enhancement magnetic resonance imaging fused with magnetic resonance angiography. J Arrhythm. 2015;31(3):152-158.5. Akita T, Kiuchi K, Fukuzawa K, et al. Lesion distribution after cryoballoon ablation and hotballoon ablation: Late-gadolinium enhancement magnetic resonance imaging analysis. J Cardiovasc Electrophysiol. 2019.6. Kiuchi K, Fukuzawa K, Mori S, Watanabe Y, Hirata KI. Feasibility of Imaging Inflammation in the Left Atrium Post AF Ablation Using PET Technology. JACC Clin Electrophysiol. 2017;3(12):1466-1467.7. Benito EM, Carlosena-Remirez A, Guasch E, et al. Left atrial fibrosis quantification by late gadolinium-enhanced magnetic resonance: a new method to standardize the thresholds for reproducibility.Europace. 2017;19(8):1272-1279.8. Kamali R, Schroeder J, DiBella E, et al. Reproducibility of Clinical Late Gadolinium Enhancement Magnetic Resonance Imaging in Detecting Left Atrial Scar after Atrial Fibrillation Ablation. J Cardiovasc Electrophysiol. 2020 in press.

Abstract Background: The increasing incidence of cesarean section around the world is becoming a matter of concern. Many obstetricians consider it to be the easier option as opposed to vaginal delivery. However we must not forget that caesarean section is associated with increased morbidity to the patient. WHO (World Health Organization) in 2015 introduced the Robson’s criteria as a standardized method to determine the rate and indications of cesarean section within a healthcare facility. We here present a retrospective analysis of 5000 cesarean sections by Robson’s criteria. Material Methods: A retrospective analysis of total 5000 LSCS (lower segment cesarean section) as per Robson criteria was carried out at MGM hospital Kalamboli from 1st January 2015 to 25th December 2019. The indications for LSCS and the maternal and fetal complications were noted. Results: The overall cesarean section rate during the study period was 28%. Out of the 5000 study population 32.7% comprised of group 5 (Previous Caesarean section) of Robson’s classification followed by 23.04% in group 2 (labour induced or LSCS before labour starts).

This note presents corrections to our paper [1]. We also give remarks and additions related to other papers [2]-[15].

Iron hydroxides is one of the main components of groundwater aquifer recharge clogging. Different concentrations of iron hydroxides lead to different type of clogging. Under constant flow rate, cake filtration was usually had better agreement with all the different concentration experimental results for typical single mode of clogging model. As the combined mode, the intermediate-standard and cake-intermediate models were more effective in description of the experimental data, and the combined model had more accurately fit result than the single mode model. Contributions analysis indicated that the cake filtration was the dominant clogging mechanisms for higher concentration and intermediate blocking was the dominant clogging mechanisms for lower concentration. Therefore, considering sequential intermediate blocking and cake filtration, an improved cake filtration model based on Hagen-Poseuille equation and Darcy's law was proposed. The improved model which had two model parameters, namely intermediate blocking coefficient and cake filtration coefficient are obtained by minimizing the error involved between calculated and experimental flux data. The experiment data of intermediate iron concentration was used to execute the verification model to derive two parameters which will be used to predict clogging laws of low and high iron concentration conditions, and the predicted results were fitted by experimental data. Comparing the prediction fitting error of the improved model, the result shows that it is more accurate and flexible than the original cake filtration model. Therefore, the results of the modified model can provide a basis for the subsequent use of backwash and other means to solve the blockage of colloids or complexes, thus improving the service life of the recharge facilities and saving the economic cost of the recharge.

Aims: The interaction between the heart and brain is highly complex. Left ventricular (LV) longitudinal contraction is the most sensitive to the presence of myocardial disease. Whether subclinical change in LV longitudinal contraction assessed by echocardiography is associated with cognitive impairment in the general population has not been investigated. Methods and Results: All residents aged ≥ 35 years, living in five villages of Shunyi, a suburb district of Beijing, were invited to participate in the study from June 2013 to April 2016. This was an exploratory cross-sectional analysis of the baseline data of 894 participants enrolled in the Shunyi Study. Cognitive status was evaluated using the Montreal Cognitive Assessment (MoCA). LV longitudinal contraction was assessed by the peak systolic velocity measured at the mitral annulus (Sm) obtained by Tissue Doppler imaging echocardiography. Cognitive impairment (MoCA score <26) was found in 771 (86.2%) participants. LV longitudinal myocardial contraction (Sm) and diastolic function (Em, E/A ratio, and E/e) were associated with cognitive impairment (all P<0.01). The association between Sm and cognitive impairment remained significant after adjusting for age, sex, education level, physical activity, vascular risk factors, and cerebral small-vessel disease (OR, 0.84; 95% CI, 0.73–0.97, P=0.02). Receiver operating characteristic curve analysis for Sm in identifying normal cognitive status showed the area under the curve of 0.59 (95% CI, 0.54–0.65; P<0.01). Conclusions: Our findings suggest that LV longitudinal myocardial contraction in the general population is associated with cognitive status in Chinese community-dwelling populations.

It is sometimes difficult to distinguish between multiple cancers and metastases using only diagnostic imaging, particularly when multiple hypervascular tumors are found in multiple organs. In such cases, preoperative histological evaluation may be essential for determining the management of tumors.

Aim Clinical application of insulin infusion therapy is usually accomplished with regular human insulin. It is known that the regular insulin adsorbed to the hydrophobic surfaces and different approaches were implemented into the clinical practices. It was aimed to evaluate the rate of adsorption of insulin to PP bags and PVC infusion sets and stability of insulin during the infusion. Methods 100 IU insulin was added to PP bags containing 100 ml of 0.9% NaCl solution(n = 6). The infusion was started at a rate of 2 ml/h using infusion sets in the PVC structure. Insulin quantification was performed in the samples taken both from the bag and from the end tip of the infusion set during infusion. The stability of insulin solutions stored at room (+24°C) and refrigerator (+4°C) temperatures were compared. Samples were analyzed using reverse-phase high-performance liquid chromatography. Results No statistically significant difference was found between the concentrations of the samples taken from the bags stored at room and refrigerator temperatures at the 4th, 12th, and 24th hours (p>0.05). It was seen that the adsorption rate of insulin to PVC set was 57% and PP bags is at most 5% at the 24th hour. Conclusion When PP bags are used for insulin infusion, it is predicted that 24-hour change can be made instead of frequent change. In addition, losses caused by the high rate of insulin adsorption to PVC infusion sets should be considered and PP infusion sets would be the better option to use if available.