We present the challenging case of a patient with severe COVID-19 pneumonia complicated with cardiogenic shock and refractory complete AV block. The patient presented with wall motion abnormalities on echocardiography, and cardiac magnetic resonance revealed finding compatible with myocarditis. Myocardial injury may occur in up to 31% of patients with Covid-19 pneumonia and has been related to increased mortality. However, whether myocardial injury might result from direct damage from the virus or related to complications of the disease is still unclear. Although myocarditis is not common in COVID patients, it should be considered as a possible diagnosis.

Bipolar neutrosophic set(BNS) is a generalization of bipolar fuzzy set and neutrosophic set that can describe the uncertain information from both positive and negative perspectives. In this contribution, we study the multi-attribute decision making methods based on the distance measure under the uncertain information which the attribute weights are incompletely known or completely unknown. We first propose the distance measures of the bipolar neutrosophic sets and analyze the properties of the distance measures. Then, based on the bipolar neutrosophic information, we establish the programming models to derive the attribute weights of the alternatives. Furthermore, we give the multi-attribute decision making method using the distance measure under the environment of BNS. At last, we give a practical application and the result shows the reasonable and effective of the proposed method in dealing with decision making problems.

In this paper, we consider fractional differential hemivariational inequalities (FDHVIs, for short) in the framework of Banach spaces. The aim of this paper is three folds. The first one is to investigate the existence of mild solutions for FDHVIs and by means of a fixed point technique we are able to avoid the hypothesis of compactness on the semigroup. The second aim is to study the existence of decay mild solutions for FDHVI via giving asymptotic behavior of Mittag-Leffler function. Finally, a mathematical model is provided to illustrate our abstract results.

Based on the least square method, we proposed a new algorithm to obtain the solution of the second kind regular and weakly singular Volterra-Fredholm integral equations in reproducing kernel spaces. The stability and uniform convergence of the algorithm are investigated in details. Numerical experiments verify the theoretical findings. Meanwhile this method is also applicable to the nonlinear Volterra integral equations. Test problems which have non-smooth solutions are also considered and our proposed method is efficient as some recent Krylov subspace methods such as LSQR and LSMR.

This work is the first attempt to show the impacts of irregularity and compressional initial stresses on the dilatation waves propagating in a single-walled carbon nanotube (SWCNT) with the use of Donnell thin shell approach. The irregularity is taken in the parabolic form at the surface of SWCNT. A new closed-form of the characteristics equation of the natural frequencies of propagation is derived and matched with the case of the absent of irregularity and compressional stresses effects. The theoretical analysis show that, the presence of irregularity and initial compressional stresses effects the natural frequency of dilatation waves propagating in SWCNT. The numerical results show that, the increasing of the initial stress and irregularity parameters decreasing the values of the natural frequencies of dilatation waves in SWCNTs. Thus, it can be concluded that, the investigation presented may be provide useful information for the next generation studies and accurate deigns of nanomachines and can be used as a useful reference for the designs of Nanodrive devices, Nanooscillators and Nanosensors.

The Markov evolution is studied of an infinite age-structured population of migrants arriving in and departing from a continuous habitat $X \subseteq\mathds{R}^d$ – at random and independently of each other. Each population member is characterized by its age $a\geq 0$ (time of presence in the population) and location $x\in X$. The population states are probability measures on the space of the corresponding marked configurations. The result of the paper is constructing the evolution $\mu_0 \to \mu_t$ of such states by solving a standard Fokker-Planck equation for this models. We also found a stationary state $\mu$ existing if the emigration rate is separated away from zero. It is then shown that $\mu_t$ weakly converges to $\mu$ as $t\to +\infty$.

This paper retrieves some new optical solutions to the Kundu–Mukherjee–Naskar (KMN) equation in the context of nonlinear optical fiber communication systems. In this regard, the generalized Kudryashov and new auxiliary equation methods are applied to the KMN equation and consequently, dark, bright, periodic U-shaped and singular soliton solutions are explored. The discrepancies between the present obtained solutions and the previously obtained solutions by using different methods are discussed. The time fractional derivative and an oblique wave transformation in coordination with the methods of interest are considered for acquiring new optical wave solutions of the KMN equation in the sense of conformable derivative and wave obliqueness, respectively. The effects of obliqueness and fractionality on the attained solutions are demonstrated graphically along with its physical descriptions. It is found that the optical wave phenomena are changed with the increase of obliqueness as well as fractionality. All the obtained optical solutions are found to be new in the sense of conformable derivative, wave obliqueness, and the applied methods. Finally, it is found that the utilized methods and the relevant transformation are powerful over the other methods and it can be applicable for further studies to explain the pragmatic phenomena in optical fiber communication systems.

Frequency discrimination is an acclaimed topic of study in cognitive neuroscience since various tones provoke different behavioral and neuropsychological responses. In this study the method of electroencephalography (EEG) was used to extract event-related potentials (ERPs) linked to the P300 component which is associated with the processing of frequency variance. An oddball paradigm was used containing hard and easy deviants embedded with standard tones. The behavioral data indicated shorter reaction times for the easy deviants vs hard deviants. The ERP analysis focused on the P300 waveform across nine electrodes for two types of condition (easyhard). The results indicated that easy targets elicited higher amplitude across parietal electrodes. This report, although completed with a limited sample size, adds up to the discourse about how frequency discrimination is perceived and expressed by behavioral and neurophysiological markers. In line with other studies, the P300 component is found to be involved in the processing of auditory stimuli. The constellation of information invites further research to investigate whether such results are consistent across conditions and different participants.

Mini-commentary on BJOG-20-0320.R1: Cesarean section in the second delivery to prevent anal incontinence after asymptomatic obstetrical anal sphincter injury: the EPIC multicenter randomized trialAn obstetric anal sphincter injury poses an important clinical dilemma for subsequent vaginal deliveries, which may be complicated by recurrent obstetric anal sphincter injury and / or worsening or de novo anal incontinence.Recurrent obstetric anal sphincter injury has a similar incidence to primary obstetric anal sphincter injury (6.3% vs 5.7%), and similar associated risk factors including instrumental delivery with either forceps [OR 3.12, 95% confidence interval (CI) 2.42-4.01) or ventouse (OR 2.44, 95%CI 1.83-3.25), birth weight ≥4 kg (OR 2.29, 95%CI 2.06-2.54) and previous fourth-degree tear (OR 1.7, 95%CI 1.24-2.36) (Jha S, Parker V: Int Urogynecol J. 2016 Jun;27(6):849-57).The risk of long-term anal incontinence is also related to the degree of sphincter tear. Women with a fourth-degree sphincter injury in the first delivery are at higher risk for anal incontinence compared to women with a third-degree injury (58.8% vs. 41.0%). (Jangö H et al. 2018 Feb;218(2):232.e1-232.e10. Am J Obstet Gynecol). Although primary caesarean may be protective against anal incontinence, the previous observational evidence is consistent in finding that adjusted odds of long-term anal incontinence do not differ significantly by mode of second delivery after obstetric anal sphincter injury, and specifically that subsequent elective cesarean delivery is not protective (Jangö H et al, Am J Obstet Gynecol. 2016;214(6):733.e1-733.e13.) However, previous observational studies may suffer from confounding by indication, due to widespread adoption of planned caesarean for subsequent deliveries in women with incontinence symptoms or persistent sphincter defectsThere have been no previous randomised trials to test whether anal incontinence could be prevented by planned cesarean section for the second delivery. Abramowitz and colleagues’ (Abramowitz L et al. BJOG 2020) RCT provides us with a better understanding of the role of caesarean in women with asymptomatic third degree anal sphincter injury. There was limited cross-over between groups: of the 112 women randomized to the vaginal delivery group, 17 (15.6%) had a caesarean section for obstetric indications. For those randomized to the planned cesarean section, 18 (16.58%) delivered vaginally. One fifth of the randomized women did not complete the post-partum follow-up, but their characteristics did not differ between the two study groups. In this RCT, planned cesarean section in the second delivery was unequivocally not protective against anal incontinence at 8 months post-partum, with low rates of symptoms in both groups (Vaizey score 1/24 vs. 1/24 p=0.34). As rates of incontinence were lower than expected, the trial may have been underpowered for a clinically relevant difference between groups. In an unplanned analysis, there was however, an interaction between baseline Vaizey score, and worsening symptoms after vaginal delivery, with significantly worse symptoms after vaginal delivery for women with pre-existing mild symptoms.The authors rightly suggest that the findings are useful when counseling women about risks and benefits of caesarean at their second delivery. These results do not support advising systematic cesarean after asymptomatic third degree obstetric anal sphincter injury. The medicalization of pregnancy associated with planned caesarean is undesirable from both individual and societal perspectives, and cesarean delivery is associated with a number of health risks when compared to vaginal delivery (NICE Clinical Guideline CG132, https://www.nice.org.uk/guidance/cg132/). Important questions remain for future work whether subsequent cesarean section may be useful in the long term, among women with mildly symptomatic anal incontinence, or for women with asymptomatic fourth degree obstetric anal sphincter injury.Disclosure of interests: Tähtinen declares honoraria from Olympus. Cartwright declares no conflicts of interest. Completed disclosure of interest forms are available to view online as supporting information.

Introduction: A weight-based heparin dosing policy that adjusted for pre-procedural oral anticoagulation was implemented to reduce the likelihood of sub-therapeutic dosing during left atrial catheter ablation procedures. Our hypothesis was that initiation of the protocol would result in a greater prevalence of therapeutic Activated Clotting Time (ACT) values and decreased time to therapeutic ACT during left atrial ablation procedures. Methods: A departmental protocol was initiated for which subjects received intravenous unfractionated heparin (UFH) to achieve and maintain a goal of ACT >300 seconds. Initial bolus dose was adjusted for pre-procedure oral anticoagulation and weight as follows: 50 units/kg for those receiving warfarin, 75 units/kg for those not anticoagulated, and 120 units/kg for those on direct oral anticoagulants. An UFH infusion was initiated at 10% of the bolus per hour. An observational study was performed on 100 consecutive left atrial ablation procedures with usual care, versus 100 with protocol guided peri-procedural care. Results: When usual care and protocol guided cohorts were compared, significant findings were limited to those on pre-procedure direct oral anticoagulant (DOAC). The initial UFH bolus increased from 97±29 units/Kg to 113±29 units/Kg (p<0.001), the proportion of therapeutic ACT on first draw after heparin administration increased from 58% to 77% (p=0.010), and the time to therapeutic ACT after UFH administration decreased from 37.8±19.8 minutes to 30.2±16.4 minutes (p=0.032). Conclusion: A weight-based protocol for peri-procedural UFH administration resulted in a higher proportion of therapeutic ACT values and decreased the time to therapeutic ACT for those on pre-procedure DOAC.

The COVID-19 global pandemic unprecedently disturbed the education system in the United States and lead to the closure of all planetariums that were providing immersive science communication. This situation motivates us to examine how accessible the planetarium facilities were before the pandemic. We investigate the most important socioeconomic and geographical factors that affect the planetarium accessibility using the U.S. Census Bureau data and the commute time to the nearest planetarium for each ZIP Code Tabulated Area. We show the magnitude of the effect of permanent closure of a fraction of planetariums. Our study can be informative for strategizing the pandemic response.

The frequency distribution of individual body sizes in animal communities (i.e. the size spectrum) provides powerful insights for understanding the energy flux through food webs. However, studies of size spectra in rocky and coral reef communities typically focus only on fishes or invertebrates due to taxonomic and data constraints, and consequently ignore energy pathways involving the full range of macroscopic consumer taxa. We analyse size spectra with co-located fish and mobile macroinvertebrate data from 3,391 reef sites worldwide, specifically focusing on how the addition of invertebrate data alters patterns. The inclusion of invertebrates steepens the size spectrum, more so in temperate regions, resulting in a consistent size spectrum slope across latitudes, and bringing slopes close to theoretical expectations based on energy flow through the system. These results highlight the importance of understanding contributions of both invertebrates and fishes to reef food webs worldwide.

A novel multi-axial energy-based approach is presented and used to demonstrate the influence of different finite element (FE) modelling techniques on the prediction of the fatigue life of a rubber composite with long oriented fibres. It is shown that the simplest modelling methods using 2D elements with rebar layers, layered 2D elements or layered 3D elements do not allow for a precise determination of the critical location and damage value. In contrast, modelling methods with 3D matrix and discrete reinforcement provide much better results. The predicted critical location corresponds to the measured one, although the predicted fatigue life still differs from the measured results. The most complex microscopic modelling method shows the best agreement between the predicted and measured fatigue life. Since microscopic modelling is not suitable for modelling larger products made of rubber fibre composite, it is also noted that modelling techniques with 3D matrix and discrete reinforcing elements can be used with the same accuracy if the fatigue life curve is obtained from measurements on the specimens made of composite material rather than the specimens made of the critical base material (rubber).

A new procedure introduced as variational iterative stiffness method (VISM) to overcome the difficulties of the application of variational iteration method to free vibration analysis of higher order beams consist of sixth order differential equation with complex boundaries. A higher order trigonometric shear deformation theory denoted Touratier beam which is considering rotary inertia is used for the mathematical model to perform free vibration analysis of beams with a uniform cross-section, subjected to a compressive axial load, resting on Winkler and Pasternak foundations with various boundary conditions, in this study. Circular frequencies obtained by using VISM are compared with DSM and analytical method (ANM) results based on Touratier and Timoshenko beam theories where a very good agreement is observed. In addition to the obtained circular frequency values, normalised lateral displacements, bending rotation, rotation of the normal to the axis, shear forces and bending moments diagrams of first modes are represented in graphics.

DFT/B3LYP calculations have been carried on natural products of eugenol (clove) cinnamic aldehyde (cinnamon) and curcumin (curcuma) and on their various combinations predicting their biological activities. Our findings show that the presence of either cinnamic aldehyd or curcumin ameliorates the biological activities with the regard to the calculated chemical descriptors. The molecular structures of the studied compounds are evaluated on the basis of the intermolecular interactions which are governed by hydrogen bonds. The cinnamic aldehyde synergizes well with the curcumin as combinations of two and with curcumin and ascorbic acid as three components seeing the resulting chemical descriptors, in agrrement with the reduction the HOMO-LUMO gaps and suggesting numerous and interesting biological activities. However, eugenol exhibits low chemical descriptors as individual compound and combined with either ascorbic acid or hesperidin. The combined complexes of cinnamic aldehyde could be excellent blood thinners with the regard to their polarity’s enhancement. The combined compounds of cinnamon and curcuma should have broad biological properties that advance human health and help to reduce the menace of diseases.

Children are affected by a broad spectrum of acute and chronic respiratory disorders. The number of children with respiratory disease is increasing, as are the complexity of disease pathophysiology and the management demands on pediatric pulmonologists. Despite slowing increasing numbers of board-certified pediatric pulmonologists, large areas of the country are underserved and there is a perception of an impending workforce crisis. There are multiple reasons for these concerns. A joint effort between the Pediatric Pulmonology Division Directors Association and Pediatric Pulmonary Training Directors Association was undertaken to address these issues.

Background: Periodontitis is a risk factor for atherosclerosis and coronary heart disease (CHD). This research evaluated the relationship between periodontal conditions and postoperative outcome in patients undergoing coronary artery bypass grafting (CABG). Methods: 101 patients with CHD (age 69 years, 88.1 % males) and the necessity of a CABG surgery were included. Periodontal diagnosis was made according to the current classification of periodontal diseases (2018) and the guidelines of the “Centers for Disease Control and Prevention” (2007). Additionally, periodontal epithelial surface area (PESA) and periodontal inflamed surface area (PISA) were determined. Survival analyses were carried out after a one-year follow-up period with Kaplan-Meier survival plots and Logrank test. Hazard ratios (HRs) were determined using Cox regression. Results: 14 patients (13.9 %) suffered from a new cardiovascular event (11 x angina pectoris, 2 x cardiac decompensation, 1 x cardiac death). Patients with an event reported significantly more often tooth loss probably caused by periodontitis among 1st degree relatives, (HR = 2.2, 95 % CI 1.1-4.4, p = 0.006). No other periodontological parameter was significantly associated with the outcome. Internal risk factors were a history of peripheral arterial disease (HR = 3.7, 95 % CI 1.-11.4, p = 0.013), history of myocardial infarction (HR = 4.0, 95 % CI 1.4-11.5, p = 0.006) and borderline significant previous atrial fibrillation (HR = 2.9, 95 % CI 0.9-9.4, p = 0.056). Conclusion: Putative familial aggregation of periodontitis but not severity of the disease was associated with new adverse events after CABG surgery.

Red blood cells (RBCs) are the most abundant cell type in the bloodstream, serving for oxygen transport. Although RBCs have been considered as possible vehicles of virus transmission to target cells, the mechanism is much less well understood. Here, we showed that porcine epidemic diarrhea virus (PEDV), a coronavirus that caused acute and devastating intestinal disease in suckling piglets, could cause typical diarrhea in newborn piglets through hijacking RBCs. Firstly, PEDV could bind and internalize into neonatal RBCs through CD71 and clathrin-mediated endocytosis, and maintain its viability for 12 h. Subsequently, after autotransfusion with PEDV-loaded RBCs, PEDV could infect and colonize intestinal epithelial cells, causing typical diarrhea symptoms in newborn piglets. Moreover, PEDV-loaded RBCs could transfer the virus to CD3+ T cells by formation conjugation structure. PEDV could continue to hitchhike CD3+ T cells to reach intestine mucosa and cause infection. Finally, PEDV-loaded RBCs were found in nasal capillary after intranasal infection with PEDV. Further, higher oxygen concentration was determined as a promoter of PEDV binding RBCs. Therefore, nasal capillary was speculated to be the entry for PEDV binding RBCs. Collectively, our studies illustrated the mechanism that PEDV could cause intestine infection through hijacking RBCs, further providing a novel insight into the role of RBCs in coronavirus pathogenesis as potential cells for viral transmission.

Trauma is a major cause of morbidity and mortality throughout the world. Alarmingly the mortality rate, owing to multiple causes with or without sepsis, is now reported to cross the value of 50%. The preliminary study was conducted in humans to investigate the 1) safety of estrogen therapy following trauma hemorrhage 2) Does estrogen reduced the inflammatory storms caused due to trauma 3) Does estrogen affects the survival of THS patients and prevent the advancement of sepsis-associated problems. 40, THS patients and 20 healthy controls were recruited. THS patients were divided into experimental groups and placebo controls based on the estrogen administration in the ED. Serum level of cytokines and immune cells were measured at different time points on days 0, 3, 7, and 14 in both groups of THS patients. Patients receiving intravenous estrogen beside standard of care as per ATLS guidelines did not develop any major or minor adverse events and showed favorable clinical outcomes during their course of stay in the ED and ICU. The levels of T regulatory cells, monocytes, and systemic cytokines were significantly reduced in THS patients who received estrogen. Again, THS patients who received estrogen recovered early, do not have side effects and showed a balanced inflammatory response. In conclusion, this preliminary study showed that intravenous estrogen therapy is safe and overcame the problem of inflammatory insults caused due to trauma hemorrhagic shock. It may protect from sepsis-associated complications among THS patients.

Introduction - The impact of manufacturer labelled prosthesis size and predicted effective orifice area (EOA) on long term survival after aortic valve replacement is not clear although indexed effective orifice area (iEOA) has been associated with worse survival. Methods - Data was retrospectively collected from Jan 2000 – Dec 2019 for prosthesis type, model and size for isolated aortic valve replacements. Stratified survival was compared between groups and subgroups for labelled valve size, EOA and predicted PPM. Results – Total of 3444 patients were included. Moderate and severe PPM was 15.6% and 1.6% respectively. Cumulative life time hazard was worse for biological valves (mortality: biological 77.7% vs mechanical 64.8%, p=0.001). Mean survival was 132.7 months for biological versus 191.3 months for mechanical valves (p=0.001). Moderate prosthetic AS (EOA = 1-1.5 cm2) was12.1% and severe prosthetic AS (EOA≤1 cm2) was 0.8% respectively. Worse survival in the presence of moderate-severe prosthetic AS was seen in biological valves (115.2 months versus 133.7 months, p=0.001 for EOA≤1.5cm2 and >1.5cm2 respectively). There was a statistically significant correlation between survival and iEOA (Spearman’s rho=0.084, p=0.001, BCa bootstrap 95% CI;0.050, 0.120). Moderate to severe PPM (iEOA≤0.85cm2/m2) was a predictor of worse long term survival (HR 3.56; 95% CI: 1.37 - 9.25; p=0.009). Conclusion - Predicted prosthetic moderate to severe AS and moderate to severe PPM adversely affect long term survival. Smaller valves are associated with reduced survival in all groups.

Background: Although ibuprofen and other arylpropionic acid derivatives (APs) are among the non-steroidal anti-inflammatory drugs (NSAIDs) most consumed worldwide at all age ranges, little is known about hypersensitivity to this group of drugs. Our aim was to characterise in detail patients reporting hypersensitivity reactions induced by APs. Methods: We prospectively evaluated patients with symptoms suggestive of hypersensitivity to APs and analysed their clinical characteristics, the reported reactions, and the diagnosis approach. Results: A total of 662 patients confirmed as hypersensitive to APs were included: 489 as cross-reactive (CR) hypersensitivity type (73.86%) and 173 as selective responders (26.13%) (SR). The percentage of subjects reporting reactions induced by ibuprofen and dexketoprofen was higher in CRs (p=0.005 and p=0.01, respectively), whereas reactions induced by naproxen and ketoprofen were more frequent in SRs (p=0.0002 and p=0.00001, respectively). The most frequent symptoms induced by ibuprofen, dexketoprofen, and naproxen were isolated angioedema and urticaria combined or not with angioedema in both NIUA and SNIUAA. NPT-LASA was positive in 156 cases (77.14% of NERD and 68.18% of blended) and DPT to ASA was needed in 246 (50.3%) CR patients. In 28 SR cases (25 SNIUAA and 3 SNIDR), DPT with the culprit AP was required. Conclusions: Skin is the most common organ involved in hypersensitivity to APs, in both CR and SR, with ibuprofen and dexketoprofen inducing most frequently CRs, and naproxen and ketoprofen SRs. More studies are needed to clarify the underlying mechanism in DHR induced by APs.

Background: Evidence shows that the microbiome plays an important role in allergic diseases. The associations between the conjunctival microbiome dysbiosis and ocular allergy remain unknown. This study investigates the characteristics of the conjunctival microbiome in allergic conjunctivitis (AC). Methods: We performed metagenomic shotgun sequencing on conjunctival samples from 48 healthy subjects and 39 patients with AC. The AC group comprised 21 patients with seasonal allergic conjunctivitis or perennial allergic conjunctivitis (SAC/PAC) and 18 patients with vernal keratoconjunctivitis (VKC). Results: We identified a signature microbiome associated with the dysbiosis of conjunctival microbiota on the ocular surface of patients with AC. Interestingly, SAC/PAC and VKC harbor distinct microbial communities. Specifically, Brevibacterium aurantiacum is enriched in SAC/PAC, whereas a group of Streptococcus species and Haemophilus parainfluenzae are enriched in VKC. Conclusion: Dysbiosis of conjunctival microbiome is found on the ocular surface of AC patients. These results suggest a new microbial mechanism of AC and provide a potential target for AC treatment.

Objective To identify risk factors strongly associated with failed mid-cavity vacuum-assisted delivery (VAD) and construct a risk model that can be used to guide obstetricians in choosing between the standard delivery room or the operating theatre. Design Observational analytical predictive prospective monocentric study. Setting University Hospital of Besançon, France, 2010-2018. Population All successful (n=903) and failed (n=194) attempts at mid-cavity VAD among term singleton deliveries. Methods Bivariate and multivariate analyses with logistic regression were used to determine the effects of 15 potential factors on the risk of VAD failure. Main outcome measures Mode of delivery following an attempt at mid-cavity VAD. Results The score comprised seven variables significantly associated with failed mid-cavity VAD: head-perineum distance ≥51 mm (p<0.001), bulky caput succedaneum (p<0.001), maternal height ≤1.54 m (p<0.001), duration of expulsive efforts before vacuum <21 minutes or >30 minutes (p=0.0013), duration from five centimetres to complete cervical dilation ≥3 hours (p=0.0091), term ≥42 weeks of gestation (p=0.032), and occiput-posterior or occiput-transverse fetal head position (p=0.041). The model was reliable (Hosmer-Lemeshow test =8.5; p=0.39) and accurate (concordance index =0.74). The threshold for a transfer to the operating theatre was set at 16.3 %. Advanced preparation of caesarean section equipment and anticipated extension of epidural analgesia were significantly associated with a decrease in the delay between VAD failure and birth by caesarean section (p<0.001). Conclusions This model could help obstetricians to better assess the risk of failed mid-cavity VAD and to choose the appropriate place to perform it. Keywords Vacuum-assisted delivery; mid-cavity.

Purpose: Degenerative mitral stenosis (DMS) is an increasingly recognized cause of mitral stenosis. The goal of this study was to compare echocardiographic differences between DMS and rheumatic mitral stenosis (RMS), identify echocardiographic variables reflective of DMS severity, and propose a dimensionless mitral stenosis index (DMSI) for assessment of DMS severity. Methods: This is a single-center, retrospective cohort study. We included patients with at least mild MS and a mean transmitral pressure gradient (TMPG) ≥ 4 mmHg. Mitral valve area by the continuity equation (MVACEQ) was used as an independent reference. The DMSI was calculated as follows: DMSI = VTILVOT / VTIMV. All-cause mortality data were collected retrospectively. Results: A total of 64 patients with DMS and 24 patients with RMS were identified. MVACEQ was larger in patients with DMS (1.43  0.4 cm2) than RMS (0.9  0.3 cm2) by ~0.5 cm2 (p = <0.001) and mean TMPG was lower in the DMS group (6.0 2 vs. 7.93 mmHg, p=0.003). A DMSI of  0.50 and ≤ 0.351 were associated with MVACEQ ≤ 1.5 and MVACEQ ≤ 1.0 cm2 (p<0.001), respectively. With the progression of DMS from severe to very severe, there was a significant drop in DMSI. There was a non-significant trend towards worse survival in patients with MVACEQ ≤ 1.0 cm2 and DMSI ≤ 0.35, suggesting severe stenosis severity. Conclusion: Our results show that TMPG correlates poorly with MVA in patients with DMS. Proposed DMSI may serve as a simple echocardiographic indicator of hemodynamically significant DMS.