In this research, the extended finite element method (XFEM) in conjunction with the combined approximation (CA) is utilized for estimating the fatigue life of two-dimensional isotropic bodies under variable-amplitude loading. In the proposed method, called CA-XFEM, in addition to the fact that no re-meshing process is required, the crack growth path is determined without the need to solve the whole system of equations which these features significantly reduce computational costs. The Willenborg model is employed for modeling the retardation effect due to the overloads in the load history. For validation of the method, the numerical results are compared with the existing experimental data for a compact tension specimen made of Al 7075-T6 and a compact tension shear specimen made of Al 5083-H111. It is observed that the developed CA-XFEM Matlab code has excellent capability in modeling variable-amplitude fatigue crack propagation considering the retardation effect. Also, the effect of ratio and sequence of overload and mixed-mode overloading on the fatigue crack growth are studied.

Background: Offspring size at birth is known to be associated with maternal cardiovascular disease (CVD) risk. Low birthweight (LBW), small for gestational age (SGA) and intrauterine growth restriction (IUGR) are all used to define infants considered small at birth. Objectives: To determine whether women who give birth to SGA/LBW/IUGR infants have higher levels of cardio-metabolic risk factors compared to women who give birth to average for gestational age infants or women. Search strategy: We performed a systematic literature search using PubMed, Embase and CINAHL. Selection criteria: Studies that compared cardio-metabolic risk factors in women who gave birth to SGA/LBW/IUGR infants compared to a control group. Data collection and analysis: Two independent authors screened and extracted data. Meta-analysis was performed on Review Manager 5.3. Main results: The meta-analysis showed a significantly increased CVD mortality among women who gave birth to SGA infants compared to AGA infants (relative risk 1.45, 95% confidence interval (CI) 1.40 to 1.52; 2,584,533 participants, three studies; heterogeneity: Chi2 P=0.48; I2=0%). Women who gave birth to growth restricted infants had significantly higher mean BMI (1.72kg/m2, 95% CI 0.97 to 2.47; 77 participants, two studies; heterogeneity: Chi2 P=0.35; I2=0%), and higher total mean cholesterol levels (0.32mmol/l, 95% CI 0.13 to 0.50; 77 participants, two studies; heterogeneity: Chi2 P=0.69; I2=0%) compared to women who had uncomplicated pregnancies. Conclusions: Women who give birth to small infants are at increased risk of CVD. Postpartum screening for CVD risk factors will help identify those at risk.

The usage of inorganic aromatic N-donor based ligands, whose electronic properties can be easily and extensively tuned, are still underdeveloped. One such system is cyclic compounds of sulfur-nitrogen, which is known to form η1 and η2-complexes with mono- and bi-metallic transition metal fragments. We have undertaken an extensive theoretical investigation of the bonding nature between S2N2 ligand and 14 valence electron (VE) metal fragments in the mono and bi-metallic S2N2[Mo(NO)Cl4]¯ and S2N2[Mo2(NO)2(Cl)8]2¯. Our results indicate that S2N2 ligand in S2N2[Mo(NO)Cl4]¯ is a σ-donor and π-acceptor. The EDA-NOCV analysis indicates that the interaction between S2N2 and metal fragments has a higher electrostatic character than a covalent character. The nature of S2N2 as a ligand is similar in the bi-metallic complex S2N2[Mo2(NO)2(Cl)8]2¯ as well. On the contrary, the σ-lone pair on N-atom in S2N2 is donated to the electron-deficient 12 valence electron [Mo(NO)Cl4]+ fragment in S2N2[Mo(NO)Cl4]+ and the electrons from the S2N2 π-MO are donated to the vacant d-orbitals of the metal fragment. Similar bonding nature is also observed in the bi-metallic S2N2[Mo2(NO)2(Cl)8]2+ complex. Besides, all these complexes show donation of lone pair on Cl attached to transition metal fragment to the S‒N σ*-MO, which is majorly located on the S-atom. Here, the S-atom in S2N2 can be considered as a σ-hole, which is involved in the chalcogen bond formation by accepting an electron pair from Cl-atom. Hence, our theoretical calculations suggest that the S2N2 is a versatile ligand which can be tuned as σ-donor, σ- acceptor, π-donor and π-acceptor.

The COVID-19 pandemic has had far-reaching consequences beyond the disease itself, including economic, social, political, religious and psychological implications. This novel coronavirus has been shown to have cardiovascular manifestations in the form of arrhythmias, conduction disturbances, myocarditis, stress cardiomyopathy, myocardial injury and myocardial ischemia or infarction from increased microvascular and/or macrovascular coagulopathy. However, in addition to these direct effects, we are now starting to recognize indirect cardiovascular effects of COVID-19 in the form of increased incidence of Takutsobo cardiomyopathy in patients without any evidence of coronavirus infection. In this case series, we present two post-menopausal women, presenting with chest pain and acute coronary syndrome, who are finally diagnosed with stress cardiomyopathy, triggered by increased emotional stress related to the pandemic. There is data from a retrospective cohort analysis showing a four-fold increase in the incidence of acute coronary syndrome resulting from stress cardiomyopathy during the pandemic period compared to similar times periods before the pandemic. Hence, health care providers need to cognizant of the emotional ramifications of the ongoing pandemic in the form of increased risk of Takotsubo cardiomyopathy. Moreover, urgent measures need to be taken to help at-risk population cope with the ongoing stressors to help decrease the incidence of this cardiomyopathy.

Background:The advent of TAVR changed the practice for treating patients with severe aortic stenosis. Heart-Teams improved their decision-making process to refer patients to the best and safest treatment. Evidence allowed centers to increase funding and TAVR volume and extend indications to different risk category of patients. This study evaluates the outcomes of intermediate-risk patients treated for severe aortic stenosis in an academic center. Methods:Between 2012 and 2019, 812 patients with aortic stenosis underwent TAVR or SAVR. A propensity score-matching analytic strategy was used to balance groups and adjust for time periods. Outcomes were recorded according to the Society of Thoracic Surgeons Guidelines; primary outcome being 30-day mortality and secondary outcomes being perioperative course and complications. Results:No difference in mortality was seen but complications differed: more postoperative transient ischemic attacks, permanent pacemaker implantations and perivalvular leaks in the transcatheter group, while more acute kidney injuries, atrial fibrillation, delirium, postoperative infections and bleeding, tamponade and need for reoperation in the surgical group as well as longer hospital length-of-stay. However, over the years, morbidities/mortality decreased for all patients treated for aortic stenosis. Conclusions:Data showed an improvement in morbidities/mortality for intermediate risk patients treated with SAVR or TAVR. Increased funding allowed for higher TAVR volume by increasing access to this technology. Also, the difference in complications could impact healthcare cost. By incorporating important metrics such as length-of-stay, readmission rates and complications into decision-making, the Heart-Team can improve clinical outcomes, healthcare economics and resource utilization.

The selective control of photoassociation of Yb2 molecule is investigated in theory. Based on ab initio to rationalize Franck-Condon filtering, the optimal target states of photoassociation have been obtained. That correspond to vibrational transition levels from X1Σ+g to excited state (A1Σu+, B1Πu , C1Σu+, D1Πu) are v’=23, 50, 55, and 0, respectively. The proposed laser drive transitions to target states for association process at wavelength A1Σu+: 464.7nm, B1Πu: 373.1nm, C1Σu+: 361.8nm, D1Πu: 339.1nm are determined. By using quantum wave-packet dynamic methods, we calculated the yields with time evaluation for the selected target states. Interacting with a resonant laser pulse, the projections of time-dependent wave functions of initial states on the target vibrational eigenstates reflected the photoassociation yields of Yb2. For target A1Σu+, using gaussian pulse made the value of v’=23 up to 97% at 725fs. After a laser pulse, that the positive chirp promotes the yield of projection of vibrational states to increase, but the negative chirp inhibits it decrease. For D1Πu state, when laser intensity is 1.0×1014 W/cm2, not only the purity is high but also the yield is high reached 99% of target state v’=0 at 1570fs. That is to say, by changing the laser parameters and pulse shapes, it could much easier control the photochemical along our desired direction. These conditions will provide an important reference and suggest a scheme for a feasible photoassociation for further experimental and theoretical researches.

Objective: To investigate the changes in the psychological status of infertile women and men who had infertility treatment interrupted or postponed because of the COVID-19 pandemic. Design: Cross-sectional study (NCT04400942) performed between April and June 2020. Population: Patients having in-vitro fertilization (IVF) treatments at our institution interrupted or postponed due to the COVID-19 emergency. Methods: An electronic survey was e-mailed to investigate presence, severity of anxiety and depression using the Generalized Anxiety Disorder-7 (GAD-7) and the Patient Health Questionnaire-9 (PHQ-9). Subjects with pre-existing psychiatric disorders diagnosed by DSM-V criteria were excluded from the analysis. Main Outcome Measures: Presence, severity of anxiety and depression; risk factors related to these psychological disorders. Results: Overall, 524 out of 646 patients (80.9%) completed the survey. The prevalence of anxiety and/or depression was significantly higher in women (41.5%, p=0.012), in particular, if aged more than 35 years (50.2%, p=0.023) and with a previous IVF attempt (57.6%, p=0.031). The occurrence of these psychological disorders was significantly associated with the time spent on COVID-19 related news per day (> 1 hour per day, p=0.034) and partner with evidence of psychological disorder (p=0.017) and, in females, with a diagnosis of poor ovarian reserve (p=0.052), diagnosis of endometriosis (p<0.001) or uterine fibroids (p=0.037). Conclusions: The psychological impact of the COVID-19 pandemic on the infertile couples who should have undergone IVF treatment was significant. IVF centers should systematically offer these couples an adequate psychological counseling to improve quality of life and mental health. Funding: - Keywords: INFERTILITY: ASSISTED CONCEPTION; PSYCHOLOGY

Objective To explore the prevalence of contraceptive use, unintended pregnancy, and induced abortions within 24 months postpartum in eastern, central, and western regions of China and in China overall. Design A retrospective cohort study. Setting Hospital-based Maternity units. Population Women who delivered a live baby between 12 and 24 months. Methods: We randomly selected postpartum women at 60 hospitals in eastern, central, and western regions of China. We applied descriptive statistics and life-table analyses. Main outcome measures Prevalence of contraception, unintended pregnancy, and abortions. Results: A total of 18,045 participants were enrolled and interviewed, and 12-, and 24-month contraceptive rates were 85.7% (95% CI 85.2-86.2 ), and 86.8% (95% CI 86.3-87.2 ), respectively. Condoms accounted for 79% of contraceptive initiators. The 12-, and 24-month rates were 5.3% (95% CI 5.0-5.6) , and 13.6% (95% CI 12.2-15.0) for unintended pregnancy; and 4.0% (95% CI 3.7-4.3), and 10.8% (95% CI 9.5-12.1) for induced abortion, respectively. Three-quarters of unintended pregnancies ended in abortion. Postpartum contraceptive use was higher in the western region relative to the eastern or central regions, but the risks of unintended pregnancy and induced abortion were also higher in the west. Conclusions: Postpartum contraception use was relatively high in China but dominated by less-effective methods, and these may contribute to higher risks of unintended pregnancy and induced abortion during the postpartum period. Use of long-acting reversible contraceptives and effective and reliable short-acting methods should thus be fostered in postpartum family planning services in China.

Ebstein’s anomaly is a rare and complexed heart defect that affects the tricuspid valve and is accountable for around 1% of congenital cardiac abnormalities. It is one of the most common congenital causes of tricuspid valve regurgitation. Ebstein’s anomaly is often diagnosed prenatally due to its severe cardiomegaly. Some individuals with this anomaly do not experience any complications until adulthood and even then its mostly minor complaints like exercise intolerance. Atrial septal defect is most commonly (70-90%) associated with Ebstein’s anomaly. However, ventricular septal defect (VSD) can be associated with 2-6% of the cases. This particular report presents a case of surgical intervention for a 20 years old female with Ebstein’s anomaly that had multiple VSD’s and a severe Pulmonary Stenosis (PS).

Chow et al (1) report that significant financial resources are spent on surgical AF ablation in Canada with unclear long-term benefits and “scientifically rigorous” data regarding reduction in mortality and stroke risks. The authors call for large prospective studies examining clinically important outcomes to justify the routine use of concomitant surgical AF ablation (SA) and to guide allocation of healthcare funds. Based on their analysis, they assert that concomitant surgical AF ablation during cardiac surgery should be reconsidered. To better put these findings into context, it is important to examine the assumptions made and data utilized to assess both cost and benefit.The authors admit that their methods for cost derivation are significantly limited and do not “constitute the precision of a detailed prospective cost-utility analysis.” However, even their “simple methods” are incomplete and miss important alternative costs if SA is abandoned. They describe the incremental costs associated with surgical ablation of AF in a specific geographic location - Ontario (Canada). The authors aggregate costs from a variety of sources but base much of their calculations on an increased hospital length of stay (LOS) and increased pacemaker implantation rate from a recent systematic review and meta-analysis of RCTs of surgical ablation of AF (2).This systematic review describes an increased hospital LOS of ~ 1.67 days and a trend (not statistically significant) of increased permanent pacemaker implantation at hospital discharge, although risk of pacemaker implantation was not increased in the long term. Using this information plus Ontario-specific information of institutional costs, physician remuneration and device costs, they generate Ontario-specific financial costs for the procedure and calculate the incremental cost associated with this intervention as $4287 CAD per patient. The authors state that their calculations likely underestimate the true cost of surgical AF ablation but that at least over $10 million (CAD) was spent in Ontario province on surgical AF ablation between 2006-2017. The authors fail to consider, however, the alternative costs associated with NOT performing SA in patients with AF undergoing surgery. While surgery for the primary structural abnormality may alleviate the patients’ symptoms, it is likely that patients with pre-existing AF will continue to have AF if SA is not performed. Patients whose AF is left untreated could continue to have symptoms related to AF necessitating multiple procedures, including cardioversions, hospitalization for initiation of antiarrhythmic drugs, and catheter ablation. Even patients with asymptomatic to minimally symptomatic AF are often treated with this multiplex of therapies, each of which has more limited efficacy than SA. Given the likelihood of multiple treatments and procedures if SA is not performed, any clinically relevant cost analysis must incorporate this real cost. Consequently, the true incremental cost of SA is likely substantially less than the numbers generated by Chow et al.When analyzing the benefits of SA, the conclusions draw heavily from a recent systematic review and meta-analysis that describes several key points regarding surgical AF ablation: 1) surgical AF ablation during cardiac surgery improved freedom from AF at 12 months; 2) there was no statistically significant evidence of impact on mortality, thromboembolic or neurovascular events with limited long-term follow-up; and 3) the evidence for improvement in health-related quality of life was limited (2). It is important to note that of the 23 studies in this meta-analysis, only 5 had follow-up >12 months and only 1 > 24 months. This reported time frame may be inadequate to detect significant differences in clinical outcomes, particularly long-term outcomes such as incident stroke and mortality.As a comparison, in the world of catheter-based ablation, we have recently had the results of the CABANA trial (3). In the intention-to-treat analysis, this trial did not demonstrate statistically significant differences between catheter ablation and anti-arrhythmic drug therapy with regard to the primary composite endpoint of death, disabling stroke, serious bleeding, or cardiac arrest. However, there was a substantial and clinically important benefit of catheter ablation over drug therapy in reducing recurrent symptomatic and asymptomatic AF over 5 years of follow-up (4). There were also clinically important and significant improvements in quality of life (QOL) at 12 months in symptomatic patients (5). There was also a signal for decreased cardiovascular hospitalizations, although not centrally adjudicated, and there may be a signal for mortality benefit of catheter ablation in the subgroup of patients with systolic dysfunction (6). On-treatment analysis showed even more significant benefits, even with mortality reduction.Currently, the American Heart Association and the European Society of Cardiology provide a Class IIa recommendation for concomitant surgical AF ablation to maintain sinus rhythm in symptomatic patients. The guidelines consider surgical AF ablation with cardiac surgery a “reasonable” treatment, including patients with persistent or permanent AF (7, 8). The recent 2017 STS guidelines outline that concomitant surgical ablation to restore normal sinus rhythm during mitral valve procedures is a Class 1 recommendation, level of evidence A. Similarly, surgical ablation at the time of isolated AVR and AVR with CABG is a Class 1 recommendation, level of evidence B-NR (9).We believe the authors’ suggestion that the incremental cost of surgical AF ablation, based on this incomplete analysis, is too great to be shouldered by the taxpayers of Canada is unjustified. This manuscript touches on some interesting topics regarding the rendering of medical care, namely – what patient outcomes justify the financial costs of a procedure and what bar do we set for the level of evidence needed to justify the performance of a procedure but their cost-benefit analysis is incomplete requiring careful reevaluation of its conclusions.The importance of freedom from AF and protection from AF relapses for patients, in particular those with symptomatic AF, cannot be underestimated. Both catheter ablation studies such as CABANA and studies of surgical ablation support a clear decrease in AF burden with ablation. In CABANA, freedom from AF was long-lasting with the benefit of ablation sustained, although attenuated, at 5-year follow-up. Interestingly, the CABANA trial also included patients who had MI, PCI, or valve/bypass surgery > 3 months prior to enrollment although we do not have subgroup-specific data. In regard to freedom from AF, the surgical ablation data from the referenced meta-analysis only extends on average to 12 months (2), but we cannot exclude the possibility of a more sustained treatment effect like that seen in CABANA. In a study of SA, risk-adjusted survival differences were assessed in 372 propensity matched pairs; at last follow-up, 78% of SA patients were free of AF, and restoration of sinus rhythm was associated with improved survival (10). While large-scale data on mortality following SA remain sparse, the Society of Thoracic Surgeons’ report of over 28,000 propensity score matched patients with and without SA support improved survival at 30 days (11).There is strong evidence for improved symptoms and quality of life in patients after ablation. In the DISCERN AF study which evaluated symptomatic and asymptomatic episodes of AF pre and post radiofrequency ablation using long-term continuous monitoring, rates of symptomatic AF approached 50% (12). After ablation, arrhythmia events were 3 times more likely to be asymptomatic and the proportion of asymptomatic episodes approached 80%. This was also substantiated by CABANA trial data that showed that when AF recurred after catheter ablation it was more likely to be asymptomatic – at five years, freedom from recurrence of symptomatic AF episodes was ~ 80% (4). Health-related quality of life was also significantly improved at 12 months in the ablation group versus medical therapy (5). In the systematic review from McClure et al, there was a significant difference in physical role functioning post-operatively even though there were only two studies that could be included in the analysis (2). Granted, in patients undergoing cardiac surgery, health-related QOL outcomes are confounded by improvements in treating the underlying heart disease in addition to the restoration of sinus rhythm (13).Overall, the relatively small cost of $4287 CAD per patient, which would represent a much smaller incremental cost when accounting for the subsequent cost for AF treatment if SA is not performed, strongly supports undertaking this procedure despite the small increased risk of pacemaker implantation and increased hospital stay given the known and established benefits of freedom from AF and improvement in symptoms and quality of life. Additionally, the use of this procedure should not be halted since there is short-term and mid-term surgical mortality data that support its use (9-11), and we cannot rule out mortality and stroke benefit over a period of 5 or more years because of the limited data available. In this sense, we agree with the authors that updated long-term outcomes should be pursued to enhance our understanding and to refine decision making.

The ecological consciousness has driven developed societies to explore alterna- tives to the growing need for energy and the consequent increase in waste pro- duction. The adjustment towards the waste recovery and their transformation into energy, by various processes, is then necessary. However, so far the domain has not benefited much from a mathematical modeling approach. The main con- tribution of this work consists of building a bio-economic model describing the problem of a potential investor who aims to maximize his net profit generated by selling the produced energy from the household waste transformation. We first study the evolution of a waste stock, the energy quantity produced and the capital dedicated to the transformation process in a giving landfill and recovery center. Then we insert decision variables to this dynamic which are both the investment and the part of waste to be treated. This leads to an optimal control problem which we solve by the deductive method. The resulted solution is then illustrated by some numerical simulations. This investment policy would be to support the decision-makers to go toward investment in this activity.

In this paper, the asymptotic behavior of quenching solutions for quasilinear parabolic equa- tions with singular logarithm boundary flux arising in an electrostatic micro-electromechanical system (MEMS) is studied. Under certain assumptions for the initial data, the existence of quenching solutions, blowup phenomenon of time derivative, estimates of lower and upper bounds of quenching rate and asymptotic behavior of solutions near quenching time are studied theoretically and verified numerically.

Saudi Arabia lies in an arid region where groundwater has become main resource. Due to the increase of water demand; therefore, it is essential to understand groundwater dynamics for the best groundwater management practice in Saudi Arabia. In Hadat Ash-Sham Farm Experimental Station, Saudi Arabia, water table data from 11 wells and rainfall data were monitored for 16 months. These water table data is analyzed using the geostatistical method with ordinary Kriging technique, to generate the best water table spatial distribution map for each month and the expected flow direction. The cross-validation technique is used to evaluate the quality of the developed water table maps. The Kriging maps show two regimes: weak spatial dependence (WSD, the ratio of the nugget to sill >75%) and strong spatial dependence (SSD, the ratio of the nugget to sill <25%). The WSD regime happens during dry seasons, while the SSD happens during wet seasons. The SSD gives better results and better accuracy compared to WSD. The root-mean-square error (RMSE) of water table varies between 0.26 – 3.4 m in the case of SSD, while it varies between 0.51-4.8 m in the case of WSD. Water table maps show groundwater flow direction in the study area is from East to West and South-East to North-West during the wet season (SSD). This direction is parallel with the relative orientation of surface stream with higher elevation to the surface stream with lower elevation, where study area is between these surface streams. While during the dry season (WSD), there is no preferred direction since there is almost no flow.

The aim of this study is to model the responses of Hangar watershed Hydrology to future climate changes under the two Representative concentration pathway (RCP) scenarios. Future changes in precipitation and temperature were produced using output of dynamically downscaled data of Regional Climate Model (RCM) 50 Km resolution under RCP 4.5 and RCP 8.5 scenarios for 2025-2055 and 2056-2086. The future projection of the RCM model of climate parameters showed an increasing trend relative to the base period (1987-2017). At 2025-2055 an annual average precipitation increment of +15.7% and +19.8% expected for RCP 4.5 and RCP 8.5 respectively. For 2056-2086 of RCP 4.5 and RCP 8.5, also similar trend showed in which change in average annual precipitation may increase by +20.1% and +23.4% respectively. The changes of climate parameters used as input in to SWAT hydrological model to simulate the future runoff at the out let of gauging station. The increment in precipitation projection resulted in positive magnitude impact on average runoff flow. The average annual change in runoff at 2025-2055 of both RCP 4.5 and RCP 8.5 may by +260.01m3/s and +733.18m3/s respectively. At 2056-2086, change in average annual runoff of +257.08m3/s and +732.26m3/s for RCP 4.5 and RCP 8.5 may expected respectively. This increment may create an opportunity for community of the area to harness enough amount of water during most increased season for later use.

Objectives: Twin-to-twin transfusion syndrome (TTTS) is a severe condition causing preterm delivery, fetal death, and neurodevelopmental disorders. The aim of this study was to develop a simple procedure for amnioreduction that would be controlled by the amniotic pressure and volume removed. Design: Prospective study of cases diagnosed with TTTS. Setting: Lis Maternity and Women’s Hospital, Israel. Population: Eleven patients with severe TTTS at stages II and III of Quintero classification were enrolled in the study. Methods: The amniotic pressure was measured along with the removed volume of the amniotic pressure between 17-34 weeks of gestation. The umbilical artery systolic/diastolic ratio for each twin was measured at the beginning and after every 500cc of removed amniotic fluid. Long-term neurodevelopmental outcome of infants with TTTS was performed. Main Outcome Measures: The survival rate was 86.4% although 91% of all twins were Quintero stage III. Results: 18 procedures were performed in this study without any maternal complications. The pattern of amniotic pressure versus the volume removed demonstrated an exponential relationship with a plateau. No tendency in the systolic/diastolic ratio variations was observed during the procedure. Of the 19 surviving twins, 13(59.1%) were considered neurologically normal, 5 (22.73%) neurologically subnormal and 1 (4.55%) abnormal. Results were compared to classical amnioreduction and laser technique procedures. Conclusions: The procedure resulted in a high rate of twin survival. The amniotic pressure was reduced towards normal values. The new procedure seems to be more efficient in terms of twin survival and positive long-term outcomes. Clinical trial ID: NCT04148

We conducted a comprehensive analysis of the phylogenetic, phylogeographic, and demographic relationships of Caspian cobra (Naja oxiana; Eichwald, 1831) populations based on a concatenated dataset of two mtDNA genes (cyt b and ND4) across the species’ range in Iran, Afghanistan, and Turkmenistan, along with other members of Asian cobras (i.e. subgenus Naja Laurenti, 1768). Our results provided strong support that N. oxiana is monophyletic and its divergence from its sister taxon, N. kaouthia, during early Pleistocene. Our results also highlight the existence of only one major evolutionary lineage in the Trans-Caspian region, suggesting a rapid expansion of the Caspian cobra from eastern to western Asia, coupled with a rapid range expansion from east of Iran to the northeast. However, the subdivision of eastern and northeastern populations in Iran was not supported; hence we propose only one evolutionary significant unit across the Iranian range of N. oxiana to be considered for conservation efforts.

In boreal landscapes, emphasis is currently placed on close-to-nature management strategies, which aim to maintain the biodiversity and ecosystem services related to old-growth forests. The success of these strategies, however, depends on an accurate understanding of the dynamics within these forests. This study aims to reconstruct the disturbance and post-disturbance dynamics in boreal old-growth forests that are driven by recurrent moderate-severity disturbances. We studied eight old-growth forests in Québec, Canada, that has recorded recurrent and moderate to severe spruce budworm (Choristoneura fumiferana [Clem.]) outbreaks over the 20th century. To reconstruct the disturbance history and the post-disturbance dynamics of the study sites, we used dendrochronological data and k-means clustering to identify growth releases and growth patterns in the studied trees. We identified nine growth patterns; these patterns represented trees differing in age, size, and canopy layer, and indicated different tree histories. Spruce budworm outbreaks caused recurrent moderate-severity disturbances within the study sites. The canopy gaps created by these disturbances were filled mainly by understorey trees, which responded by single and significant increases in radial growth and height. In contrast, overstorey trees had little influence on gap filling; thus, trees were mostly from the dominant and codominant canopy layers. Our study underlines the resistance of boreal old-growth forests to recurrent and moderate-severity disturbances, as understorey trees can rapidly fill the resulting gaps. However, trees that are unable to attain the canopy following the disturbance then tend to remain in the lower canopy layers. Therefore, reaching the canopy represents a once-in-a-lifetime opportunity, where success or failure depends on a relatively short window of time. This gap-filling dynamic produces, however, a vertical structure that is often similar to the expected structure in even-aged forests. Our results highlight the efficacy of identifying tree growth patterns to reconstruct stand disturbance dynamics and contribute to developing closer to nature forest management strategies.

Introduction Idiopathic hyper eosinophilic syndrome (HES) is a rare disease characterized by sustained increase in eosinophilia. Lesions can affect various organs and systems. The global prevalence rate is unknown, and the prognosis is poor. At present, most of the literature reports are based on cases. Heart involvement may be present in 50% to 60% of patients, this is called Loffler endocarditis. Loffler endocarditis is a serious complication of hyper eosinophilia syndrome, which is characterized by a special type of fibrotic endocarditis. Loffler endocarditis is an inflammatory cardiac condition characterized by eosinophilic infiltration in the heart. Methods In this article we report an 8-year-old girl who was diagnosed as having Loffler endocarditis in thrombotic phase and treated by surgery successfully. Results Our patient had a good prognosis during the follow up of half year. She had no symptoms of heart failure and echocardiography findings were normal. Discussion The cardiac damage occurs in three stage processes: the necrotic, thrombotic, and fibrotic stages. This unusual but sometimes life-threatening disease is often detected in the late phase, resulting in no curative strategy available to reverse the disease process. The overall prognosis of patients with Loffler endocarditis is very poor. Current treatments include anticoagulation and anti-eosinophils therapy，surgery only used in selected cases. Surgical treatment of HES in adolescents is very rare. The present case illustrates that with well controlled peripheral eosinophilia, proper surgical treatment in selected patients can improve their prognosis in the near future but long-term follow up is necessary.

Background: The disease burden of seasonal influenza is substantial in China, while there lacks nation-wide economic burden estimates. This study aims to examine influenza-like illness (ILI) prevalence, healthcare seeking behaviors, economic impact of ILI and its influencing factors among children, chronic disease patients and the elderly during the 2018–19 influenza season. Methods: From August to October 2019, 6668 children’s caregivers, 1735 chronic disease patients, and 3849 elderly people were recruited from ten provinces in China to participate in an on-site survey. The economic burden of ILI consisted of direct (medical or non-medical) and indirect burden, and multivariate linear regression was adopted to predict the influencing factors of total economic burden. Results: There were 45.73% children, 16.77% chronic disease patients and 12.70% elderly people reporting ILI, and most participants chose “Outpatient service only”, “Over-the-counter (OTC) medication only” or “Outpatient + OTC” after ILI. The average total economic burden of ILI was 1848 yuan (USD266.1) for children, 1105 yuan (USD159.1) for chronic disease patients and 2064 yuan (USD297.2) for the elderly. Multivariate linear regression showed that boys, the only child in family, and urban adult residents tended to have larger economic burden after ILI. Conclusions: Large economic burden of ILI was highlighted, especially among the elderly with less income and larger medical burden, as well as children with higher prevalence and higher self-payment ratio. It is important to adopt targeted interventions for high-risk groups, and this study can help national-level decision-making on the introduction of influenza vaccination as public health project.

Extraverts have been reported to be happier than introverts. The study explored the mechanisms behind differences in the perceived happiness of the introverts and extraverts. The verbatim transcriptions of semi-structured interviews were analyzed through the thematic analysis. Five themes were generated: dissimilar conceptualizations of happiness, differences in the inclination towards happiness, dissimilar loci of happiness and differences in the sources of happiness. The extraverts were more inclined towards short-lived and dynamic nature of happiness whereas permanency, meaningfulness, and stability pervaded in the meaning of happiness by the introverts. The introverts valued internal and achieved sources whereas external and ascribed sources of happiness find expressions in extraverts. Thus, both introverts and extraverts reported perceived happiness that suggested dissimilar sources and mechanisms. Further studies may help a better understanding of the positive life outcomes of personality using qualitative methods and live experiences. Psychological interventions may be developed keeping these findings in mind.Keywords: extraversion; happiness; introversion; thematic analysis; personality.

Hemophilia B (HB) associates with pathogenic F9-variants. The literature showed that hemizygous deletions encompassing F9 and vicinal genes may express extra-phenotypes suggesting new causal relationships. Aim: Analyze the molecular basis of syndromic cases of HB, obesity (OB), severe global developmental delay (SGDD) and generalized hypotonia (GH). Whole F9-deletions were detected in 3 hemizygous probands with HB. Dense SNP-array and case-specific STS walking strategies allowed amplification and characterization of the deletion breakpoints. Bioinformatic/statistical analyses included data mining in HPO (Human Phenotype Ontology), OMIM, STRING (protein-protein interaction networks) databases and estimation of null-hypothesis-based Expected-values. Patients (cases#3-case#1) showed complete F9 deletions involving 0.16-4.34-Mb and 1-17 additional genes on Xq26.3-q27.2. Bioinformatic/statistical approaches revealed highly significant STRING-associations (P≤0.00115) between case#1/#2 common deleted genes (SOX3, FGF13, CXorf66) and those HPO associated with OB (20/343), GH (36/923) and SGDD (10/119). Only case#2 showed two extra-phenotypic abnormalities, anal atresia and pituitary hypothyroidism, and one extra-deleted gene, MAGEC2. Our bioinformatic/statistical approaches confirmed a previous involvement of SOX3 in OB suggesting additional roles in GH and SGDD, similar to FGF13 and CXorf66 (experimentally linked to POMGNT1, HPO-connected with all 3 phenotypes). Our findings highlight the importance to characterize X-chromosome deletion syndromes to unveil functional associations of the involved genomic regions.

En-bloc clearance of malignant deep lobe parotid tumours involving the stylomandibular tunnel and parapharyngeal space is challenging in view of the limited surgical access and the critical structures that are located in close proximity The technique that we describe is a combined transmandibular-transmastoid approach that allows complete en-bloc resection of the deep parotid lobe and stylomandibular tunnel with a lateral temporal bone resection and a marginal mandibulectomy This approach provides good exposure of the critical structures and allows for a safe en-bloc resection and good oncological margins This clinical scenario is common in Australia, due to the high incidence of cutaneous squamous cell carcinoma involving the parotid gland, either through direct invasion or lymphatic spread In this article we explain step-by-step how to perform these resections to allow potential cure in patients with very locally advanced disease

C:N:P stoichiometry is widely used in ecological research, but its role in the allocation of plant biomass is unclear. To explore this issue, we collected soil and alfalfa samples from 1, 2, 3, 5, 7, 9 and 10 year of alfalfa (Medicago sativa) plantations on the Mu Us Desert, China. We examined the aboveground and underground biomass of each plantation, the C, N, P contents, stoichiometric ratio of plants and soil, and soil biological characteristics. The C content of alfalfa increased first and then decreased with the growth age, which was opposite to N and P content, their most significant changes were in the 7-year stand. The individual changes of C-N-P in alfalfa led to the C:N and C:P increased first and then decreased, N:P increasing with the growth age. Soil OC, TN, C:P and N:P were increasing with the stand age, and TP content and C:N were increasing first and then decreasing. The C contents, C:P and N:P between alfalfa and soil were strongly correlated. N:P and underground biomass were positively correlated, while negatively correlated to aboveground. Our results show that the nutrient content and stoichiometric ratio in soil and plants were closely associated, after 7 years planting, the alfalfa’s growth was limited by P, it responds to the increased N:P by increasing root-shoot ratio, and soil fertility had also been improved at same time. Overall, these results provide a reference for further research on stoichiometry as an indicator to alfalfa yields on the Mu Us Desert.

Introduction: Mutations in adenosine triphosphate-binding cassette transporter A3 (ABCA3) (OMIM:601615) gene was the commonest genetic cause for severe neonatal respiratory distress syndrome (RDS) and childhood interstitial lung disease (chILD). Most literature review has been from patients of Caucasian heritage. Case Description: We report a case of a term male newborn of South East Asian heritage that developed severe respiratory distress soon after birth, and diagnosis was made on clinical, radiological and genetic basis without lung biopsy. He was found to have compound heterozygous variants for the adenosine triphosphate-binding cassette transporter A3 (ABCA3) gene: a novel c.3364G>A (p.Glu1122Lys) variant and previously reported pathogenic c. 737C>T (p.Pro246Leu). The variant c.3364G>A (rs1233043384) was not previously identified in clinical/disease databases such as ClinVar and The Human Gene Mutation Database. Further analysis and bioinformatics study indicated this variant was likely pathogenic. Parental genetic studies revealed parents had one mutation each. Conclusion: Newborns with unexplained respiratory distress syndrome (RDS) and pulmonary surfactant deficiency should have genetic sequencing study. This will be vital for early diagnosis, disease prognostication, treatment planning such lung transplantation, genetic counseling and provide the molecular basis for prenatal diagnosis and pre-implantation genetic diagnosis. It is important to raise awareness of this condition in the Southeast Asia region. Further larger population-based studies are required to determine the frequency of this mutation in our population. ABCA3 deficiency should be considered in term babies who develop severe respiratory distress syndrome in this region.