Background/Aims: Gastric polyps are often detected incidentally during endoscopic procedures performed for different reasons and may sometimes be manifested by gastric bleeding, pyloric stenosis, iron deficiency anemia and abdominal pain. In our study, we aimed to investigate the demographic data of the cases who were found to have gastric polyps at the gastroenterology endoscopy unit, histologic type of the polyps, their localization and size, and their relationship with Helicobacter Pylori. Materials and Methods: Between September 2016 - September 2019, gastric polyps were detected in 255 of 9771 cases who underwent upper gastrointestinal system endoscopy at the Gastroenterology Endoscopy Unit of …….. Training and Research Hospital. Demographic data, endoscopy reports and pathology results of these patients were retrospectively reviewed from the hospital registry system. Results: Of 255 cases included in the study, 160 (62.7%) were female and 95 (37.3%) were male, with a mean age of 56.9 (min: 19, max: 95). A total of 336 polyps were detected in 255 cases, with 1.3 polyps per case. 36 (10.7%) of gastric polyps were found to be fundic gland polyps, 32 (9.5%) were found to be foveolar hyperplasia, 137 (40.8%) were found to be hyperplastic polyps, 5 (1.5%) were found to be xanthomas, and 6 (1.8%) were found to be neuroendocrine tumors. Conclusion: According to this study, 90% of gastric polyps detected endoscopically in southeast Turkey are smaller than 5 mm and located most commonly in the corpus; the most common histologic subtype is hyperplastic polyps.

Objectives: A significant proportion of COVID-19 patients may have cardiac involvement including arrhythmias. Although arrhythmia characterization and possible predictors were previously reported, there are conflicting data regarding the exact prevalence of arrhythmias. Clinically applicable algorithms to classify COVID patients’ arrhythmic risk are still lacking, and are the aim of our study. Methods: We describe a single center cohort of hospitalized patients with a positive nasopharyngeal swab for COVID-19 during the initial Israeli outbreak between 1/2/2020 –30/5/2020. The study’s outcome was any documented arrhythmia during hospitalization, based on daily physical examination, routine ECG’s, periodic 24-hour Holter, and continuous monitoring. Multivariate analysis was used to find predictors for new arrhythmias and create classification trees for discriminating patients with high and low arrhythmic risk. Results: Out of 390 COVID-19 patients included, 28 (7.2%) had documented arrhythmias during hospitalization, including: 23 atrial tachyarrhythmias, combined atrial fibrillation (AF) and ventricular fibrillation, ventricular tachycardia storm, and 3 bradyarrhythmias. Only 7/28 patients had previous arrhythmias. Our study showed significant correlation between disease severity and arrhythmia prevalence (p<0.001) with a low arrhythmic prevalence among mild disease patients (2%). Multivariate analysis revealed background heart failure (CHF) and disease severity are independently associated with overall arrhythmia while age, CHF, disease severity, and arrhythmic symptoms are associated with tachyarrhythmias. A novel decision tree using age, disease severity, CHF, and troponin levels was created to stratify patients into high and low risk for developing arrhythmia. Conclusions: Dominant arrhythmia among COVID-19 patients is AF. Arrhythmia prevalence is dependent on age, disease severity, CHF, and troponin levels. A novel simple Classification tree, based on these parameters, can discriminate between high and low arrhythmic risk patients.

Purpose: Safety and toxicity evaluation of a nove liposome-encapsulated rapamycin formulation, intended for autoimmune ocular disorders. Methods: The formulation (60 and 180 µg for subconjunctival and 40 and 440 µg for intravitreal administration) were assessed through micronucleus polychromatic erythrocytes production, and irritability by HET CAM and pyrogenicity testing. Subconjunctival and intravitreal administration of the formulation were performed to evaluate subacute and acute toxicity, respectively. Shapiro Wilk and Kolmogorov-Smirnov tests were applied for normality. Pearson and Spearman Correlation tests for variable comparison. Differences between groups in biochemical and hematological parameters were evaluated by ANOVA test with significance determination by t-Holm-Sidak post-hoc test. A t-test was employed to compare independent, normally distributed variables. Numeric score was assigned to histopathological classification. Data was analyzed by a one way no parametric Kruskal-Wallis and the Mann-Whitney tests. Significance was considered when p<0.05 Results: No significant toxicity directly related to the preparation was detected. Micronucleus count, mucous irritation score, and pyrogenicity were negative. Pathology demonstrated no damage related to the formulation after subconjunctival injection. After intravitreal injection, only lens injury associated with the technique was observed. Retinal function was also conserved in electroretinography. (ERG). Conclusions: The preparation evaluated offers a good toxicity and safety profile when injected in a subconjunctival or intravitreal manner in an animal model. A clinical trial conducted in humans is highly warranted, as it could reveal an alternative immunosuppressive treatment for ophthalmological immune-mediated pathologies.

Objective To clarify the association between anaesthetic technique and maternal and neonatal outcomes in parturients with CHD. Design Retrospective observational cohort study. Setting Academic hospital. Population A total of 263 consecutive parturients with congenital heart disease (CHD) who underwent caesarean section. Methods Charts from 1994–2019 were reviewed. Main outcome measures We compared postpartum cardiovascular events (composite of heart failure, pulmonary hypertension, arrhythmia, and thromboembolic complications) and neonatal outcomes (intubation and Apgar score <7 at 1 or 5 minutes) by anaesthetic technique. Results Among 263 caesarean sections, general anaesthesia was performed in 47 (17.9%) parturients and neuraxial anaesthesia in 214 (81.3%) parturients. Cardiovascular events were more common in the general anaesthesia group (n=7; 14.9%) than in the neuraxial anaesthesia group (n=17; 7.9%). Generalized linear mixed models assuming a binomial distribution (i.e., mixed-effects logistic regression) with a random intercept for each modified World Health Organization classification for maternal cardiovascular risk revealed that general anaesthesia is not significantly associated with cardiovascular events (odds ratio [OR], 1.00; 95% confidence interval [CI], 0.30–3.29). In addition, general anaesthesia was associated with composite neonatal outcomes (Apgar score <7 at 1 or 5 minutes or need for neonatal intubation; OR, 13.3; 95% CI, 5.52–32.0). Conclusion Anaesthetic technique is not significantly associated with postpartum composite cardiovascular events. General anaesthesia is significantly associated with increased need for neonatal intubation and lower Apgar scores. Funding No external funding was used in the conduct of this study. Keywords Anaesthesia, caesarean section, postpartum, cardiovascular events, congenital heart disease, neonatal outcomes

This paper deals with the stability analysis of the fractional nonlinear systems. It treats the asymptotic stability of the fractional nonlinear systems with Hurwitz state matrix, using the Lyapunov direct method. We give algebraic conditions under which the fractional nonlinear systems are asymptotical stable. Two numerical examples are provided to illustrate the proposed theoretical results.

The heavy metals pollution represents one of the important issues in the environmental field since they are involved in many pathologies from cancer, neurodegenerative and metabolic diseases. We propose an innovative portable biosensor for the determination of traces of trivalent Arsenic (AsIII) and bivalent mercury (HgII) in water. The system implements a strategy combining two advanced sensing modules consisting in (a) a whole cell based on engineered Escherichia coli as selective sensing element towards the metals and (b) an electrochemical miniaturised silicon device with three microelectrodes and a portable reading system. The sensing mechanism relies on the selective recognition from the bacterium of given metals producing the 4-aminophenol (PAP) redox active mediator detected through a cyclic voltammetry analysis. The miniaturized biosensor is able to operate a portable, robust and high-sensitivity detection of AsIII with a sensitivity of 0.122 µA ppb-1, LoD of 1.5 ppb and a LoQ of 5 ppb. The LoD value is one order of magnitude below of the value indicated to WHO to be dangerous (10 μg/L). The system was proved to be fully versatile being effective in the detection of Hg(II) as well. A first study on Hg(II) showed sensitivity value of 2.11 µA/ppb a LOD value of 0.1 ppb and LoQ value of 0.34 ppb. Also in this case, the detected LOD was ten time lower than that indicated by WHO (1 ppb). These results pave the way for advanced sensing strategies suitable for the environmental monitoring and the public safety.

S V Sai Abitha 13/06/2020Computer  Science and Engineering

Neck masses can be a challenge because several cancers metastasize in this area. Head and neck tumors are more commonly responsible of lymph nodes in neck. However, also gastric cancer can be metastatic in this area. We present a rare case of neck gastric meta with negative Virchow's lymph node.

The incidence of bone marrow metastasis (BMM) in newly diagnosed Ewing sarcoma (ES) is variable across studies. An optimal staging strategy for detecting BMM is not defined. While BM biopsy and/or aspirate (BMBA) have been the gold standard, [F-18]fluorodeoxyglucose positron emission tomography (FDG-PET) to detect BM metastasis may decrease reliance on BMBA. We conducted a systematic review to assess incidence of BMM and the role of FDG-PET. We observed a pooled incidence by BMBA of BMM of 4.8% in all newly diagnosed ES patients and 17.5% among patients with metastatic disease. Only 1.2% of patients had BMM as their sole metastatic site. FDG-PET detection of BMM compared to BMBA demonstrated pooled 100% sensitivity and 96% specificity, positive predictive value of 75% and negative predictive value of 100%. In the era of FDG-PET imaging, omission of BMBA may be considered in patients with otherwise localized disease after initial staging studies.

ABSTRACT Objective We assessed the prevalence, clinical characteristics, and severity of respiratory tract and ear symptoms among Finnish Non-steroidal anti-inflammatory drug (NSAID) exacerbated respirato-ry disease (N-ERD) patients. Design A retrospective cross-sectional questionnaire study. Setting A university tertiary care center. Participants A total of 232 patients with both asthmatic and polypoid ICD-10 diagnoses treated at our universi-ty tertiary care center between January 2016 and May 2017 were identified by an electronic patient record search. The patient charts were manually reviewed and 102 patients with speci-fied symptoms on NSAID exposure, in addition to asthma and nasal polyposis diagnosis, were considered potential N-ERD patients. The patients received a questionnaire with an informed consent form, and the 66 patients who responded and confirmed diagnoses of asthma, nasal polyposis, and acetylsalicylic acid (ASA) or NSAID intolerance were included. Results The first diagnosis received was asthma, followed by NSAID intolerance and nasal polyposis, when evaluated by mean age of contracting the condition. When evaluating individual patients, there was considerable variation in the order and timing of the separate conditions. The majority of the patients received all three diagnoses within a few years’ time. The diagnostics and treat-ment of N-ERD patients seemed to only partially follow the international guidelines. The propor-tion of N-ERD patients with recurrent or chronic middle ear infection was 18%. Patient-reported disease control was good in asthma, but only mediocre in nasal polyposis and ear symptoms. As many as 14% reported a positive family history of N-ERD. Conclusions Structured cross-department diagnostics and care could benefit N-ERD patients in Finland. Rhi-nological and aural symptoms seem to affect a patient’s quality of life more than asthma. The high proportion of familial cases warrants further studies. Keywords: Asthma, Aspirin-Induced, Nasal Polyps, Aspirin, NSAIDs, Heredity, Ear, Middle, Fin-land

Abstract Background We aimed to investigate the clinical effect of implantation of artificial chordae tendineae with appropriate length in Mitral Valve Replacement (MVR) for rheumatic heart disease. Methods The clinical data of a total of 105 patients with rheumatic mitral stenosis who underwent MVR in the Second Affiliated Hospital of Nanchang University from July 2017 to July 2018 were analyzed retrospectively. According to whether the artificial chordae tendineae were implanted during the operation, the patients were divided into Mitral Valve Replacement with artificial chordae tendineae implantation group (experimental group, n=55) and simple Mitral Valve Replacement group (control group, n=50).Compared two groups of patients with early postoperative mortality and complications, postoperative cardiac structure and left ventricular function changes. Result Compared with the control group, the ascending aorta occlusion time, cardiopulmonary bypass time and operation time in the experimental group were slightly longer than those in the control group, but there was no significant difference between the two groups (P > 0.05).One patient died early after operation in the control group and none in the experimental group. All patients had no complications such as prosthetic valve dysfunction, peri-valvular leakage and ventricular rupture. There were significant differences in left ventricular ejection fraction (LVEF), left ventricular end-diastolic diameter (LVEDD), left ventricular end-systolic diameter (LVESD) and cardiac function grade between the two groups at 5 days, 3 months and 1 year after operation. Conclusion Implantation of artificial chordae tendineae with appropriate length into MVR in patients with rheumatic heart disease can effectively maintain left ventricular function, reduce postoperative complications and improve postoperative quality of life. Keywords Rheumatic heart disease; Mitral Valve Replacement; Artificial chordae tendineae

Herein we report a case of a ten years old boy with rare clinical manifestations associated with COVID-19, in which the first clinical symptoms were urticaria and fever, and then he developed arthritis. The possibility of post-COVID-19, reactive arthritis, or postinfectious arthritis can be expected from this virus.

We are reporting an African female patient who is found to has thrombocytopenia secondary to iron deficiency anemia (IDA), and she responded to iron replacement therapy initially with a transient drop in platelets, followed by a gradual rise in platelets till platelets reached to the normal level.

The evolutionary origins and hybridization patterns of Canis species in North America has been hotly debated for the past 30 years. Disentangling ancestry and timing of hybridization in Great Lakes wolves, eastern Canadian wolves, red wolves, and eastern coyotes is most often partitioned into a 2-species model that assigns all ancestry to grey wolves and/or coyotes, and a 3-species model that includes a third, North American evolved eastern wolf genome. The proposed models address recent or sometimes late Holocene hybridization events but have largely ignored Pleistocene era opportunities for hybridization that may have impacted the current mixed genomes in eastern Canada and the United States. Here, we re-analyze contemporary and ancient mitochondrial DNA genomes with Bayesian phylogenetic analyses to more accurately estimate divergence dates among lineages. We combine that with a review of the literature on Late Pleistocene Canis distributions to illuminate opportunities for ancient hybridization events between extinct Beringian grey wolves (C. lupus) and extinct large wolf-like coyotes (C. latrans orcutti) that we propose as a potentially unrecognized source of introgressed genomic variation within contemporary Canis genomes. These events speak to the potential origins of contemporary genomes and provide a new perspective on Canis ancestry, but do not influence/negate current conservation priorities of dwindling wolf populations with unique genomic signatures and key ecologically critical roles.

1. The Cormack-Jolly-Seber (CJS) model and its extensions have been widely applied to the study of animal survival rates in open populations. The model assumes that individuals within the population of interest have independent fates. It is, however, highly unlikely that a pair of animals which have formed a long-term pairing have dissociated fates. 2. We examine a model extension which allows animals who have formed a pair-bond to have correlated survival and recapture fates. Using the proposed extension to generate data, we conduct a simulation study exploring the impact that correlated fate data has on inference from the CJS model. We compute Monte Carlo estimates for the bias, range, and standard errors of the parameters of the CJS model for data with varying degrees of survival correlation between mates. Furthermore, we study the likelihood ratio test of gender effects within the CJS model by simulating densities of the deviance. Finally, we estimate the variance inflation factor for CJS models that incorporate sex-specific heterogeneity. 3. Our study shows that correlated fates between mated animals may result in underestimated standard errors for parsimonious models, significantly deflated likelihood ratio test statistics, and underestimated values of the variance inflation factor for models taking sex-specific effects into account. 4. Underestimated standard errors can result in lowered coverage of confidence intervals. Moreover, deflated test statistics will provide overly conservative test results. Finally, underestimated variance inflation factors can lead researchers to make incorrect conclusions about the level of extra-binomial variation present in their data.

5 Key points: • As an aerosol-generating procedure (AGP), tracheostomy poses significant viral transmissions risks to health care workers • The decision about tracheostomy method and optimal setting depends on a multitude of local factors with no available studies to suggest the superior option • We describe our effective, safe and swift approach to bedside open tracheostomy during the COVID-19 pandemic • A key approach in performing an effective bedside tracheostomy is to ensure that the procedure is standardised and performed by highly experienced surgeons, anaesthetist and scrub team. • Our experience with bedside open tracheostomy demonstrated a short mean procedural time, with no tracheostomy-related complications and no reported viral transmission amongst the healthcare members involved.

1. Landscape change is a key driver of biodiversity declines due to habitat loss and fragmentation, but spatially shifting resources can also facilitate range expansion and invasion. Invasive populations are reproductively successful, and landscape change may buoy this success. 2. We show how modelling the spatial structure of reproductive success can elucidate the mechanisms of range shifts and sustained invasions for mammalian species with attendant young. We use an example of white-tailed deer (deer; Odocoileus virginianus) expansion in the Nearctic boreal forest, a North American phenomenon implicated in severe declines of threatened woodland caribou (Rangifer tarandus). 3. We hypothesized that deer reproductive success is linked to forage subsidies provided by extensive landscape change via resource extraction. We measured deer occurrence using data from 62 camera-traps in northern Alberta, Canada, over three years. We weighed support for multiple competing hypotheses about deer reproductive success using multi-state occupancy models and generalized linear models in an AIC-based model selection framework. 4. Spatial patterns of reproductive success were best explained by features associated with petroleum exploration and extraction, which offer early seral vegetation resource subsidies. Effect sizes of anthropogenic features eclipsed natural heterogeneity by two orders of magnitude. We conclude that deer populations are likely buffered from overwinter mortality by landscape change, wherein early seral forage subsidies support high springtime reproductive success to offset or exceed winter losses. 5. Synthesis and Applications. Modelling spatial structuring in reproductive success can become a key goal of remote camera-based global networks, yielding ecological insights into mechanisms of invasion and range shifts to inform effective decision-making for global biodiversity conservation.

Food habits are important factors for wild nonhuman primates’ environment adaptation. White-headed langurs (Trachypithecus leucocephalus) are endemic to the limestone forest and face to the habitat fragmentation, which have to adjust the food habits to adapt the special environment. In this study, we compared the dietary data for white-headed langurs living in Chongzuo White-headed Langur National Nature Reserve over two separate study periods to evaluate interannual variations in diet. Our results indicated that young leaves were the preferred major food for the langur. The plant parts consumption pattern was similar between the two separate study periods. The consumption of young leaves was varied with the availability of young leaves, whereas the consumption of mature leaves was negative correlated with the young leaf’s availability. The consumption of plant species and diet diversity varied in the two separate study periods, which were higher in 2013 than 2016. In both 2013 and 2016, the diet diversity varied with the consumption of mature leaves, but negative correlated with the consumption and availability of young leaves. Dietary interannual variation probably linked to the phenology variations, or probably mean that the white-headed langurs has a flexible ecological adaptation coping with habitat fragmentation.

Triazolic fungicides are widely applied in crop production to protect plants against fungal pathogens. However, they may influence the biochemical processes in plants and other non-target species. This paper is aimed at the effect of triazoles (namely tebuconazole, cyproconazole, and penconazole) single/mixed applications on the phenolics production in tomato (Solanum lycopersicum L.) fruit peel, amount of chlorophyll a and b in tomato leaves as well as on basic plant growth parameters. For this purpose, cherry tomatoes were planted in the pot experiment and foliarly-treated weekly, with the same total triazoles dose of 3.52 μmol per plant (in mixtures of 1.71 or 1.17 μmol of each in two or three components, respectively). The treatments increased the weight of fruits in the 1st harvest about 43%, however, this effect was not observed in the next harvest. Increased oxidative stress in the triazoles presence was observed, based on the elevated production of antioxidant phenolics in the 1st harvest. Most alarming is the decrease of the weight of thin stems and foliage and the concentration of chlorophyll a (b) in leaves in all triazoles-treated variants. The non-target impacts on plant biochemical processes (related to the phenolics or chlorophylls production and functionality) were confirmed.

Bufonid herpesvirus 1 (BfHV1) was initially described in 2018 from cases of severe dermatitis in Swiss populations of the common toad (Bufo bufo). We identified a closely related herpes virus strain in a German toad population affected by an epidemic of multifocal proliferative to ulcerative dermatitis.

Mitral valve repair is the preferred treatment option in primary mitral valve disease especially degenerative mitral valve disease. Surgical results are quite successful with appropriate surgical techniques in suitable patients. But technically, surgery may result in any degree of narrowing of the orifice of the mitral valve. Also, surgical repair of rheumatic mitral valve disease is technically more demanding however, mitral repair is preferred over mechanical valve implantation if possible. İn this case report we presented the case of functional mitral stenosis after surgical mitral valve repair and annuloplasty ring implantation for rheumatic mitral regurgitation. Written and verbal consents of the patient were obtained prior to this case report.

Isolated congenital pulmonary valve regurgitation (IPVR) is very rare. Etiologies of absent pulmonary valve and bicuspid/dysplastic pulmonary valve are among the more common congenital causes of this condition. Here we present a rare cause of IPVR caused by absent single pulmonary cusp. Review of literature to establish timing and management of isolated pulmonary regurgitation is also attempted.

KeywordsDiabetes Mellitus; Parkinson’s disease; Glucose kinetics

Background The increase in the prevalence of aortic stenosis due to an aging population has led to an increasing number of surgical aortic valve replacements. Over the past 20 years, there has been a major shift in preference from mechanical to bioprosthetic valves. However, despite efforts, there is still no “ideal” bioprosthesis. It is crucial to understand the structure, biology, and function of native heart valves to design more intelligent, strong, durable and physiological heart valve tissues. Methods A comprehensive review of the literature was performed to identify articles reporting the basic mechanisms of bioprosthetic valve dysfunction and the biology of native valve cells. Searches were run in PubMed, MEDLINE® and Google Scholar. Search terms included subject heading and keywords for the following terms: “biological heart valve dysfunction”, “bioprosthesis dysfunction”, “bioprosthesis degeneration” and “tissue heart valves” Results All the relevant findings are summarized in specific illustrations and tables within the appropriate subsections. Structural dysfunction is a logical and expected consequence of the chemical, mechanical and immunological processes that occur during fixation, manufacture, and implantation. Conclusion Biological prosthesis valve dysfunction is a clinically significant process. It has become a major issue considering the growing rate of bioprosthesis implantation and improved long-term patient survival. Research on the field has improved in the past few years but there is still not an ideal bioprosthesis. Understanding bioprosthetic aortic valve degeneration from a basic science perspective is a key point to improve technologic advances and specifications that lead to new generation of bioprosthesis.