Amyoplasia is the most common form of arthrogryposis, a congenital condition characterized by multiple joint contractures. Current literature on amyoplasia suggests it is a sporadic condition without a genetic basis. We describe a patient with the musculoskeletal characteristics of amyoplasia and an underlying rare and possibly causal genetic variant.

Aims: Saline-irrigated radiofrequency ablation (RFA) for atrial fibrillation (AF) is limited by the absence of reliable thermal feedback limiting the utility of temperature monitoring for power titration. The DiamondTemp (DT) ablation catheter allow efficient temperature-controlled irrigated ablation. We sought to assess the 1-year clinical safety and efficacy of the DT catheter in treating drug-refractory paroxysmal AF. Methods and results: The TRAC-AF trial (NCT02821351) is a prospective, multi-center (n=4), single-arm study that enrolled patients with symptomatic, drug-refractory paroxysmal AF. Using the DT catheter, point-by-point ablation was performed around all pulmonary veins (PVs) to achieve PV isolation (PVI). Ablation was performed in a temperature-control mode (60oC, max 50 W) until the split-tip EGM amplitude decreased by ≤75%. The primary efficacy endpoints included acute procedural success and freedom from AF at 12 months. A total of 62 patients (age 60.3 ± 11.4 years; 60% male) were evaluated after AF ablation using the DT catheter. The mean fluoroscopy and RF ablation times were 9.4±6.4 min and 19.8±8.6 min, respectively. Acute isolation of all PVs was achieved in 100% of patients. There were no steam pops and there were not seen any char or caugulum on the catheter tip after ablation. There were very few serious procedure/device-related adverse events including a single case of cardiac tamponade (1.6%). At 1 year, the freedom from AF was 74.2%. Conclusion: This first in man series demonstrates that temperature-controlled irrigated RFA with the DT catheter is efficient, safe, and effective in the treatment of paroxysmal AF.

Background and aim: The search for early and emergency effective treatments for COVID-19 infection may have led to loss of sight of treatments safety. In addition, characteristics of drug-drug interactions (DDIs)-related adverse drug reactions (ADRs) in COVID-19 patients have not yet been studied in depth. The aim of the present case-series study is to describe clinical and pharmacological characteristics of SARS-CoV-2 inpatients, focusing on ADRs, particularly those related to DDIs. Methods: We evaluated all reports of COVID-19 medications-related ADRs collected within the COVID-19 Units of Careggi University Hospital, Florence (Italy), between January 1st and 31st May 2020. Information regarding COVID-19 medications, patients’ demographic and clinical characteristics, concomitant drugs, ADRs description and outcome, were collected. Each case was evaluated for the causality assessment and to identify the presence of DDIs. Results: During the study period, 23 Caucasian patients (56.5% males, mean age 76.1 years) experienced one or more ADRs. The majority of them were exposed to polypharmacy and 17.4% presented concomitant conditions. ADRs were referred to cardiovascular, psychiatric and gastrointestinal disorders. The most frequently reported preferred term was QT prolongation (mean QT interval 496.1 msec). ADRs improved or resolved completely in 60.8% of cases. For all patients, a case-by-case evaluation revealed the presence of one or more DDIs, especially those related to pharmacokinetic interactions. Conclusions: Despite the small number of patients, our evidence underline the clinical burden of DDIs in SARS-CoV-2 inpatients and the risk of unexpected and uncommon psychiatric ADRs.

Vascular tissues are main routes of resource transport, which are crucial for the growth of fleshy fruit. Very few quantitative data of the total and active areas of xylem and phloem are available for herbaceous plants and their variabilities are unknown. In this study, histological approach and process-based modeling of tomato fruit growth were combined to evaluate the potential contribution of the pedicel anatomy to fruit mass variations. Eleven genotypes were described and the impact of water deficit was studied depending on stress intensity and stage of application. In parallel, MRI experiments allowed to better understand the source of variability in xylem flow along the main stem. Our results suggested that the genetic and water deficit-induced variations in the areas of vascular tissues in the pedicel partly contributed to fruit mass variability. Flow-MRI appeared to be a complementary non-destructive method to phenotype vascular tissues. Whereas the flow velocity in active xylem vessels was rather stable along the main stem, the decrease in the number of active vessels strongly reduces the effective flow from the bottom to the top of the plant. Fruitful interactions between modeling, histology and flow-MRI are promising and worth exploring, to predict water fluxes within plant architecture.

Introduction: Data regarding coronavirus disease 2019 (COVID-19) description are still limited in pediatric oncology. The French society of pediatric oncology (SFCE) has initiated a study to better describe the presentation and evolution of COVID-19 in patients followed in French pediatric oncology and hematology wards. Methods: All patients diagnosed with COVID-19 (polymerase chain reaction [PCR] positive for severe acute respiratory syndrome coronavirus 2 [SARS-CoV-2], or positive IgM serology, or chest computed tomography scan and clinical signs typical of COVID-19) and followed in a SFCE center were enrolled. Data from medical records were analyzed for all patients enrolled up to the end of May 2020. Results: Data was available for 37 patients. Thirty-one were children under 18 years of age. Nineteen patients were female. Seventeen patients had a solid tumor, 16 had a hematological malignancy and four recently underwent hematopoietic stem cell transplantation (HSCT) for non-oncological conditions. Twenty-eight patients presented symptoms, most often with fever, cough, rhinorrhea and asthenia. Ground-glass opacities were the most frequent radiological finding with abnormalities mostly bilateral and peripherally distributed. Twenty-four patients received chemotherapy a month prior to COVID-19 diagnosis. Most patients did not require hospitalization. Three patients required oxygen at the time of diagnosis. In total, five patients were admitted in an intensive care unit because of COVID-19 and one died from the disease. Conclusion: Children and young adults infected with SARS-CoV-2 and treated for a cancer and/or with a HSCT may be at risk for severe COVID-19 and should be closely monitored. (NCT04433871)

Sulfate-reducing prokaryotes (SRPs) are crucial participants in the cycling of sulfur, carbon, and various metals in the natural environment and in engineered systems. Despite recent advances in genetics and molecular biology bringing a huge amount of information about the energy metabolism of SRPs, little effort has been made to link this important information with their biotechnological studies. This study aims to construct multiple metabolic models of SRPs that systematically compile genomic, genetic, biochemical, and molecular information about SRPs to study their energy metabolism. Pan-genome analysis is conducted to compare the genomes of SRPs, from which a list of orthologous genes related to central and energy metabolism is obtained. 24 SRP metabolic models via the inference of pan-genome analysis are constructed efficiently. The reference model of the well-studied model SRP Desulfovibrio vulgaris Hildenborough (DvH) is validated via Flux balance analysis (FBA). The DvH model predictions match reported experimental growth and energy yields, which demonstrates that the core metabolic model works successfully. Further, steady-state simulation of SRP metabolic models under different growth conditions shows how the use of different electron transfer pathways leads to energy generation. Three energy conservation mechanisms are identified, including menaquinone-based redox loop, hydrogen cycling, and proton pumping. Flavin-based electron bifurcation (FBEB) is also demonstrated to be an essential mechanism for supporting energy conservation. The developed models can be easily extended to other species of SRPs not examined in this study. More importantly, the present work develops an accurate and efficient approach for constructing metabolic models of multiple organisms, which can be applied to other critical microbes in environmental and industrial systems, thereby enabling the quantitative prediction of their metabolic behaviors to benefit relevant applications.

Background: Tuberculosis (TB) is one of the major global public health concern particularly affecting population of low-income countries. Early detection of disease coupled with other parameters help in treatment and reducing disease transmission. Methods: The current study was conducted to assess the sensitivity and specificity of the GeneXpert MTB/RIF (Cepheid Sunnyvale, CA, United States) in comparison to conventional techniques used for the diagnosis of TB. Our study is one of the first ones from Pakistan investigating and assessing the performance of GeneXpert. We recruited eight hundred clinically TB suspects initially and included seven hundred and sixteen clinically TB suspects in the final analysis. Results: The results of GeneXpert were compared with Mycobacteria Growth Indicator Tube (MGIT) and Ziehl-Neelsen (ZN) staining. In comparison to MGIT and ZN staining the sensitivity of GeneXpert with 95 % confidence interval (CI) was (99.7 %, CI 0.98-0.99) and (95.1 %, CI 0.92-0.97) respectively. The positive and negative predictive values with 95 % CI were (97.1 %, CI 0.94-0.98) and (99.7 %, CI 0.98-0.99) when results of GeneXpert were compare with MGIT results. Conclusion: The results of this study confirms the performance of GeneXpert. With high sensitivity and rapid detection, GeneXpert is ready to be considered as preferred diagnostic tool for TB.

Coxiella burnetii is a causative agent of Q fever which is highly infectious zoonotic disease. C. burnetii has become one of the most important causes of abortion in livestock, which can lead to widespread abortions in these animals. There are very limited studies on the prevalence of C. burnetii infection in cases of animal abortion in Iran. The aim of this study was to investigate C. burnetii in livestock abortion samples in Iran. Abortion samples from cattle, sheep and goat were collected from different parts of Iran and were tested using Real-time PCR targeting IS1111 gene of C. burnetii. In this study, 36 samples (24.66%) of the 146 collected samples were positive for C. burnetii. The prevalence of C. burnetii was 21.78% (20 of 94 samples) in sheep samples. Also, 10 of 46 cattle samples (21.74%) were positive. All six goat abortion samples were positive for C. burnetii. The findings of the study demonstrate that C. burnetii have important role in livestock abortions in Iran and more attention should be paid to Q fever by the health care system and veterinary organization.

Lumpy Skin Disease virus (LSDV) is involved in the genus Capripoxvirus(CaPV) of the family Poxviridae. Sheep and goat pox (SGP) vaccine is used heterologously against Lumpy Skin Disease(LSD) in Turkey. In the presented study, it was investigated the propagation of SGP vaccine virus that attenuated in primary lamb kidney cell, in bovine origin MDBK cells and evaluated the immunity of vaccine against LSD in cattle with comparison to the commercial SGP vaccine (Penpox-M) are used in the field. 2 cattle were vaccinated with 10 doses of SGP vaccine produced in MDBK. In efficacy study, 3 cattle were vaccinated with SGP vaccine produced in MDBK, 3 cattle vaccinated with Penpox-M. 2 cattle were not vaccinated as control animal. After vaccination on the day 31, all animals were challenged with virulent Pendik strain and blood samples were taken periodically. Logarithmic differences of the challenge titres between vaccinated and non-vaccinated were calculated. In safety study, clinical sign wasn’t observed in animals vaccinated with 10 doses. It was determined that difference between the animals vaccinated with vaccine produced in MDBK cell and unvaccinated was less than log 2.5 and the viremia occurred in vaccinated animals. The titre difference was higher than log 2.5 in animals vaccinated with the Penpox-M, and viremia didn’t occur. In conclusion, this study revealed that SGP vaccine virus was propagated in MDBK cells and it is safe to administered in cattle but it didn’t provide fully protection, Penpox-M provided protection against LSD.

Abstract : The Blasius equation is a well recognized third-order nonlinear ordinary differential equation which arises in certain boundary layer problems in the fluid dynamics. This article presents a way of applying He’s variational iteration method to solve the Blasius equation. Approximate analytical solution is derived with help of Padde approximate method and compared to the numerical result obtained from Adomian decomposition method.. Comparisons show that the present technique is precise and the using of He’s method does accelerate the convergence of the power series. And finally to see the behavior of that solution a robust and efficient algorithm is also programmed using Mathematica based on the present approach which can be easily employed to solve Blasius equation problems.

Due to the increasing need for energy and limited fossil resources on the one hand, and the increasing environmental pollution caused by the burning of these resources, on the other hand, the use of renewable energy has become more and more important. Wind and solar energy are one of the main types of renewable energy that has long attracted the human mind, so he has always thought about using these energies in the industry. In this study, the optimal combination of scattered production sources (wind-solar) has been added to a 33 IEEE bus system and beta distribution has been used to model wind speed. Also, load and production planning is 24 hours. The aim of this study is to improve voltage profiles, increase reliability and reduce losses. As a result, a 39% reduction in casualties in the presence of wind turbines and a 40% reduction in the presence of photovoltaic cells highlights the role of these resources in the grid.

Background and Purpose: Cancer cachexia and cancer-associated thrombosis are potentially fatal outcomes of advanced cancer. Nevertheless, thrombin expression in NSCLC primary tumor tissues and the association between prognosis of NSCLC patients remain largely unknown. Experimental Approach: Clinical pathological analysis was performed to determine the relationship between thrombin and tumor progression. Effect of r-hirudin and DTIP on cancer progression were evaluated. Western blotting, immunohistochemistry, and immunofluorescence were used to explore the inhibition mechanism of r-hirudin and DTIP. Therapeutic effect of combination of DTIP and chemotherapy was determined. Key Results: We illustrated thrombin expression in NSCLC tissues is closely related to clinicopathological features and the prognosis of patients. Thrombin deficiency inhibited tumor progression. The novel thrombin inhibitors, r-hirudin and DTIP, inhibited cell invasion and metastasis in vitro. They inhibited tumor growth and metastasis in orthotopic lung cancer model; inhibited cells invasion and prolonged survival after injection tumor cells via tail vein; they also inhibited angiogenesis and spontaneous metastases from subcutaneously inoculated tumors. The promotional activity of thrombin in invasion and metastasis was abolished in PAR-1 deficient-NSCLC cells. r-hirudin and DTIP inhibit tumor progression through the thrombin-PAR-1-mediated RhoA and NF-κB signaling cascades via inhibiting the MMP9 and IL6 expression. DTIP potentiated chemotherapy-induced growth and metastatic inhibition and inhibited chemotherapy-induced resistance in mice. Conclusions and Implications: Thrombin makes a substantial contribution, together with PAR-1, to NSCLC malignancy. We concluded the anticoagulants, r-hirudin and DTIP, could be expanded for anti-tumor therap. Combination therapy of DTIP and chemotherapy might achieve a better therapeutic effect.

Accurate salinity prediction can support the decision-making of water resources management to mitigate the threat of insufficient freshwater supply in densely populated estuaries. Statistical methods are low-cost and less time-consuming compared with numerical models and physical models for predicting estuarine salinity variations. This study proposed an alternative statistical model that can more accurately predict the salinity series in estuaries. The model incorporates an autoregressive model to characterize the memory effect of salinity and includes the changes of salinity driven by river discharge and tides. Furthermore, the Gamma distribution function was introduced to correct the hysteresis effects of river discharge, tides and salinity. Based on fixed corrections of long-term effects, dynamic corrections of short-term effects were added to weaken the hysteresis effects. Real-world model application to the Pearl River Estuary obtained satisfactory agreement between predicted and measured salinity peaks, indicating the accuracy of salinity forecast. Cross-validation and weekly salinity prediction under small, medium and large river discharges were also conducted to further test the reliability of the model. The statistical model provides a good reference for predicting salinity variations in estuaries.

Objective- To assess maternal endothelial function in singleton pregnancies complicated by intrauterine growth restriction (IUGR) due to placental dysfunction. Design- Prospective cohort study. Setting- 37 pregnant women who underwent endothelial function assessment using EndoPATTM device. Population or Sample- Study population included two groups: 1. Pregnancies with estimated fetal weight below 10th percentile and abnormal umbilical artery flow (n=15); 2. Pregnancies with normal fetal growth without placental complications matched by gestational age (n=22). Exclusion criteria included diseases with potential vascular dysfunction or smoking. Methods- EndoPAT device evaluates changes in peripheral vascular flow and tone in reaction to temporal ischemia. Normal post-ischemic endothelial reaction is an increase in vascular flow. A ratio of the readings before and after ischemia is used to calculate the score for endothelial function, called reactive hyperemic index (RHI). Low RHI value indicates endothelial dysfunction. Main outcome measures- RHI values. Results- Mean gestational age at endoPAT examination was comparable between the IUGR and control group (32.5 ± 2.2 vs, 31.6 ± 3.2, respectively; p=0.21). Mean RHI was significantly lower in the IUGR group compared to the control group (1.32 ± 0.16 vs 1.51 ± 0.31, p= 0.02, respectively). As expected, mean gestational age at delivery and neonatal birth weight were lower in the IUGR group compared to the control group (35.4 ± 2.3 vs 37.3 ± 2.6 p=0.04; 1640 ± 414 grams vs 2785 ± 587 grams, p<0.001 respectively). Conclusions- Pregnant women with isolated IUGR due to placental dysfunction had impaired endothelial function.

Background: Pannexins are newly discovered proteins that were first discovered by Panchin et al. in 2000. This aim of this work was to examine the presence and function of pannexins in the porcine splenic artery (PSA) in which α1A–adrenoceptors are present. Materials and Methods: The involvement of pannexin channels was studied using several pannexin inhibitors, i.e. mefloquine (a non-selective pannexin inhibitor), probenecid (a selective pannexin-1 inhibitor at low concentrations) and carbenoxolone (a selective pannexin-1 inhibitor). Additionally, the involvement of ATP (via activation of P2 purinoceptors) in NA-induced contractile responses as well as sympathetic nerve activation was examined using P2 purinoceptor antagonists (PPADS and suramin). Results: Our data showed that both pannexin-1 and pannexin-2 are present in the PSA. Mefloquine and probenecid reduced the responses to both noradrenaline-induced contractions and the frequency-dependent response curves generated to sympathetic nerve stimulation, whereas carbenoxolone, suramin and PPADS had no effect on responses to neither exogenous NA nor those caused by activating the sympathetic nerves, arguing against the role of ATP in mediating noradrenaline-induced responses in the PSA. This is because mefloquine demonstrated non-selective inhibitory actions on contractile responses since it was also shown to inhibit responses to 5-HT and U46619 (the thromboxane mimetic). Conclusion: The present work therefore provided evidence for the involvement of pannexin channels in conducting responses to NA-induced α1-adrenoceptor-mediated vasoconstriction in blood vessels in PSA, although great care must be taken in interpreting this data on the basis of a lack of selectivity of the pharmacological agents currently available as pannexin inhibitors

Evolutionary theory predicts that infection by a parasite that reduces future host survival or fecundity should select for increased investment in current reproduction. In this study we use the cestode Ligula intestinalis and its intermediate fish host Engraulicypris sardella in Wissman Bay, Lake Nyasa (Tanzania) as a model system. Using data about infection of E. sardella fish hosts by L. intestinalis collected for a period of 10 years, we explored whether parasite infection affects the fecundity of the fish host E. sardella, and whether host reproductive investment has increased at the expense of somatic growth. We found that L. intestinalis had a strong negative effect on the fecundity of its intermediate fish host. For the non-infected fish we observed an increase in relative gonadal weight at maturity over the study period, while size at maturity decreased. These findings suggest that the life history of E. sardella has been shifting towards earlier reproduction. Further studies are warranted to assess whether these changes reflect plastic or evolutionary responses. We also discuss the interaction between parasite and fishery-mediated selection as a possible explanation for the decline of E. sardella stock in the lake. KEYWORDS Life history evolution; African Great Lakes; Lake Nyasa; Usipa; Lake Malawi sardine; Parasite invasion; Environmental change.

There is a successful use of protamine-insulin formulation (Zn+insulin+protamine) to treat diabetes in which protamine is added to the stable form of hexameric insulin (Zn-insulin). The biophysical characterization of Zn-insulin, which can dissociate to form biologically active monomers, is well reported. However, its interaction with protamine, which is at the core of the mode of action in many pharmaceutical formulations, is unresolved. Through biophysical characterization, we have tried to dissect the interactions driving the Zn-insulin-protamine complexation. Based on the thermal melting study, it was found that protamine indulges in the destabilization of Zn-insulin. Fluorescence results revealed that Zn-insulin experiences Tyr quenching in the presence of protamine, undergoing a significant conformational change. As shown by the molecular docking study, protamine disturbs the H-bonding network at the dimer interface by binding to the amino acid residues involved in the dimer stabilization. It may result in the freeying of B-chain, introducing conformational fluctuations in the insulin. This is well supported by the loss of helical content seen in circular dichroism. Further, the insulin-protamine complex formation was strongly dominated by hydrogen bonding and a few hydrophobic contacts. The endothermic heat and positive entropy observed in isothermal titration calorimetry in the dissociation of Zn-insulin-protamine is a reflection of that. Finally, the ANS binding study proposed the adaption of a flexible conformation by the Zn-insulin-protamine complex containing exposed hydrophobic residues, a potential arrangement for successful receptor binding.

BACKGROUND: Although basophils are considered to play an important role for maintenance of type 2 inflammation in atopic dermatitis (AD), studies on basophils in AD patients are limited. Some studies have reported the activation status, including CD203c and CD63, of peripheral blood basophils in AD patients. OBJECTIVE: To examine the features of circulating basophils in AD patients by assessing and comparing cell surface marker expressions, total serum IgE, and basophil responsiveness to stimulation between AD patients and healthy controls (HCs). In addition, to examine the correlations among AD severity, laboratory factors, and features of basophils. METHODS: Blood samples from 38 AD patients and 21 HCs were analyzed. Basophil response markers CD203c and CD63, and expression of surface-bound IgE and FcεRI on basophils were measured. CD203c and CD63 expressions induced by stimulation with anti-IgE and anti-FcεRI antibodies were measured. Clinical/laboratory factors including total serum IgE were examined for correlations with these basophil parameters. RESULTS: Basophils in AD patients were activated spontaneously without stimulation and exhibited low responsiveness to anti-IgE antibody stimulation. Responsiveness to anti-FcεRI stimulation was higher than anti-IgE stimulation, contrary to HCs. FcεRI expression on basophils was higher in AD patients than in HCs, although surface-bound IgE on basophils was equivalent. Total serum IgE had negative correlations with surface-bound IgE and CD63 responsiveness to anti-IgE stimulation. CONCLUSIONS: Our findings illustrate the characteristic basophil status in AD. Despite high serum IgE and high basophil FcεRI expression, surface-bound IgE on basophils remained relatively low and basophils were spontaneously activated under steady-state conditions.

Little is known about the possible influence of hyperbaric oxygen therapy on the function of the central nervous system (CNS) during rehabilitation after a traumatic brain injury. The aim of the study was to analyse the case of a patient treated in a hyperbaric chamber during rehabilitation after a TBI.

Background. Allergic disorders such as atopic dermatitis (AD), allergic rhinitis, asthma, and food allergy show a predominant immune response by type 2 helper T (Th2) cells. We previously revealed that Rosae multiflorae fructus extract ameliorates ovalbumin-induced allergic rhinitis symptoms in a mouse model and identified miquelianin (quercetin 3-O-glucuronide, MQL) as the active compound. However, it is unknown if MQL affects allergic diseases or regulates Th2 immune responses. In this study, we investigated the anti-allergic effects of MQL. Methods. To investigate anti-allergic effects of MQL, we used an ovalbumin (OVA)-induced Th2-dominant mouse model and assessed cytokine production, cell proliferation, and upstream signaling pathways. Results. Oral administration of MQL suppressed the production of Th2 cytokines and IL-2, and cell proliferation. Additionally, heme oxygenase-1 (HO-1) expression was increased by MQL in splenocytes. In ex vivo studies using splenocytes and CD4+ T cells from mice, MQL suppressed Th1- and Th2-related immune responses by inhibiting CD4+ T cell proliferation. Furthermore, MQL increased HO-1 expression by activating the C-Raf -ERK1/2-NRF2 pathway by inducing the generation of intracellular reactive oxygen species in CD4+ T cells. Finally, to verify the effects of MQL in vivo during an allergic disorder, we used a trimellitic anhydride-induced AD-like mouse model. Both topical treatment and oral administration of MQL ameliorated AD symptoms by suppressing Th2 immune responses, including serum IgE production Th2 cytokine production in draining lymph nodes. Conclusions. MQL can be used as a therapeutic agent for CD4+ T cell-mediated diseases such as allergic diseases.

We explain our concerns on using plain LU score to predict extubation failure in preterm infants, as gestational age at birth can be an important confounder.

Aims: This article describes the report of a rare case of fungal ball in the frontal sinus in an adult male and discuss about the variables of this condition related to the patient. Additionally, this study aims to identify the state of the art of fungal ball in paranasal sinuses, especially in the frontal sinus. Method: We performed a literature review on fungal ball in the paranasal sinuses and described a rare case of fungal ball in the frontal sinus, which is listed as the paranasal sinus most rarely affected by fungal ball. Result: All reported cases of fungus ball in the frontal sinus affected male patients, contrary to the common prevalence of females in fungal ball of the other paranasal sinuses. Of the total of 8 patients with fungal ball in the frontal sinus reported, 40% had unilateral disease and 60% bilateral, also contrary to the incidence data of the other paranasal sinuses, with unilateral prevalence. However, with the present study, this index changes, with 50% unilateral and 50% bilateral in frontal sinus involvement. The average age of cases reported in the frontal sinus is 65.29 years, with a minimum age of 61.16 and a maximum of 69 years. As for the etiologic agent, Aspergillus sp., the endonasal endoscopic therapeutic approach corresponded to 80% of cases, while frontal osteoplasty accounted for 20% of cases, reaffirming this prevalence data from other studies. Conclusion: Despite being a low incidence entity, frontal sinus fungal ball should be considered in patients with pain in the frontal region refractory to the usual clinical treatments. We hope to contribute to the knowledge of this presentation as a differential diagnosis and reinforce the importance of thorough clinical investigation.

Superalkalis have lower ionization energy than that of alkali atoms and superhalogens have higher electron affinity than that of halogen atoms. This property can be exploited to improve the efficacy of redox reactions that are routinely used in the scientific and industrial laboratories. Some of these reactions are theoretically studied and their thermodynamic parameters are analyzed. Alternatives to these reactions with the use of superalkalis and superhalogens are suggested by assuming similar behavior to that of their alkali metal or halogen analogues. Consequently, these reactions are analyzed, and their properties are compared to the existing reactions. Particularly, the change in reaction enthalpy, Gibbs free energy and their electrochemical potential are compared. Quantification of the reducing property of the superalkalis is also studied in the present situation by using an ionic equation. In all the cases, the results are promising and consequently, some of their applications are contemplated.

Objective Acute fatty liver of pregnancy (AFLP) substantially contributes to maternal and neonatal morbidity and mortality. The aim of this study was to investigate angiogenic profiles by measuring soluble fms-like tyrosine kinase-1 (sFlt-1) and placental growth factor (PLGF) in pregnancies compromised by AFLP and to compare them to those complicated by HELLP (haemolysis, elevated liver enzyme, low platelet) syndrome. Methods In pregnant patients affected by AFLP or HELLP syndrome sFlt-1 and PLGF serum levels were measured. To assess the diagnostic potential of these angiogenic markers in AFLP as well as discriminating it from HELLP syndrome, non-parametric tests were used and receiver-operating-curves (ROC) were calculated. Results Six cases with AFLP and 48 women with HELLP syndrome were included into the study. Patients with AFLP showed significantly higher sFlt-1 levels (median: 57570pg/ml [range: 31609-147170pg/ml]) than patients with HELLP syndrome (9713pg/ml [1348-30781pg/ml ; p<0.001). PLGF serum levels were increased in patients with AFLP compared to those with HELLP syndrome (197 pg/ml [127-487pg/ml] versus 40 pg/ml [9-644pg/ml], respectively, p<0.01,). sFlt-1/PLGF-ratios were not significantly different between AFLP and HELLP syndrome patients (192 [157-1159] versus 232 [3-948], respectively, NS). A sFlt-1 cut-off value of 31100pg/ml allowed differentiating between these two diseases with a sensitivity and specificity of 100%. Conclusions AFLP is associated with very high serum levels of sFlt-1. Besides the suggested Swansea criteria to diagnose AFLP a sFlt-1 value above 31100 pg/ml may be also an additional biochemical feature improving discrimination between AFLP and HELLP syndrome. Funding:NA Keywords:AFLP, HELLP syndrome, preeclampsia, sFLT-1, PLGF