During the first phase of COVID-19 pandemic in Italy, several strategies have been taken to deal with the pandemic outbreak. The Regional Authority of Lombardy remodeled the hospitalization system in order to allocate appropriate resources to treat COVID-19 patients and to identify “Hub/Spoke” hospitals for highly specialized medical activities. The Hubs hospitals were required to guarantee full time evaluation of all patients presenting with cardiovavascular diseases with an independent pathway for patients with suspect or confirmed COVID-19 infection. San Raffaele Hospital was identified as Hub for cardiovascular emergencies and the Vascular Surgery Department was remodeled to face this epidemic situation. Surgical treatment was reserved only to symptomatic, urgent or emergent cases. Large areas of the hospital were simultaneously reorganized to assist COVID-19 patients. During this period, 135 patients were referred to San Raffaele Vascular Surgery Department. COVID-19 was diagnosed in 24 patients and, among them, acute limb ischemia was the most common cause of admission. At this time, the COVID-19 trend is in decline in Italy and the local authorities reorganized the health care system in order to return to normal activities avoiding new escalations of COVID-19 cases. Several strategies have been taken to ensure the safety of the San Raffaele hospital, and maintaining potentially suspected patients with COVID-19 separated from other patients. The aim of this paper is to report the remodeling of the Vascular Surgery Department of San Raffaele Hospital as regards the strategies of preparation, escalation, de-escalation and return to normal activities during the COVID-19 pandemic.

Introduction: Self-medication has been very popular and globally prevalent for a long time. Aim: This research aims to present pharmacists’ engagement in the process of self-medication in the Sarajevo Canton. Methods: A total of 312 respondents completed an anonymous questionnaire-based survey. The first group (165 respondents) was surveyed in the pharmacy after buying a non-prescription drug, and the second group (147 respondents) outside the pharmacy. Results: The most commonly purchased drug was paracetamol, whereas headache was dominant amongst health conditions for which treatment respondents intended to use the purchased drug. A belief that respondents could cure themselves was the most common answer when asked why they had not visited a doctor, whereas previous experience with the purchased drug prevailed as an answer when asked from whom they had gotten information about the adequacy of the purchased drug for their health problem. Respondents mostly bought drugs for themselves. Pharmacists instructed 65% of respondents on how to take the purchased drug and checked whether 55% of respondents bought an appropriate drug for their health problem. Only 25% and 29% of respondents were informed about the adverse effects and potential contraindications or interactions of the purchased drug, respectively. According to 45% of respondents, pharmacists spent up to one minute in a conversation with them about the purchased drug. Conclusion: In the Sarajevo Canton, pharmacists should be more actively involved in the process of self-medication and provide the necessary advice to patients consuming non-prescription drugs. Further research is needed to create a clearer picture.

Acute myocardial infarction (AMI) is a common medical condition that requires appropriate revascularization in a timely manner. Percutaneous revascularization (PR) was the first line treatment option when feasible. Limited data is available comparing PR to surgical revascularization (SR) in the AMI setting. Study population was extracted from the 2016 Nationwide Readmissions Data using International Classification of Diseases, tenth edition codes for AMI, PR, SR, and procedural complications. Endpoints included in-hospital all-cause mortality, length of index hospital stay (LOS), stroke, acute kidney injury, bleeding, blood transfusion, acute respiratory failure, and total hospital charges. The study identified 45,539 discharges with a principal admission diagnosis of AMI who had either PR or SR as a principal procedure. Single vessel revascularization was performed in 67.8% (93.1% had PR versus 6.9% had SR, p<0.01). Multivessel revascularization was performed in 32.2% (64.8% had PR versus 35.2% had SR, p<0.01). In comparison to SR, PR was associated with higher in-hospital all-cause mortality (P<0.01), shorter LOS (p<0.01), and lower incidence of post-procedural stroke (p<0.01), acute kidney injury (p<0.01), bleeding (p<0.01), need for blood transfusion (p<0.01), acute respiratory failure (p<0.01), and total hospital charges (p<0.01). In a subgroup analysis, SR mortality benefit persisted in patients who had multivessel revascularization, but not in single vessel revascularization. In patients presented with AMI, PR was associated with higher in-hospital all-cause mortality but lower morbidity, shorter LOS, and lower total hospital charges than SR. However, the mortality benefit of SR was seen in multivessel revascularization only, and not in single vessel revascularization.

Purpose: Storage symptoms significantly deteriorate the quality of life in men with benign prostate enlargement (BPE). Muscarinic receptor antagonists (MRAs) and β3-adrenergic receptors agonists alone, or in combination with selective α1-alpha-antagonists (ARAs), are considered as the most effective medicines relieving storage symptoms. The aim of this study was to analyze pharmacotherapy of storage symptoms in men with BPE, and their compliance with the European Association of Urology (EAU) guidelines. Patients and methods: The survey was conducted in 2018 by 261 urologists among 37,165 outpatients with lower urinary tract symptoms (LUTS) treated pharmacologically, including 24,613 men with BPE (age 69 ± 8 years). Data concerning recent severity of non-neurological LUTS and storage symptoms (urinary urgency, frequency and nocturia) and pharmacotherapy were collected. Results: Storage symptoms were reported by 12,356 patients (50.2%) with BPE, more frequently nocturia (75.8%), than urinary urgency (57.8%) and urinary frequency (44.3%). Patients with storage symptoms were more frequently prescribed with MRAs and mirabegron (43.1% vs. 5.0%; p < 0.001; and 2.4% vs 0.3%; p < 0.001; respectively). Of note, 54.5% of patients with storage symptoms were treated neither with MRAs nor β3-adrenergic receptors agonists. In the subgroup with storage symptoms, the increasing severity of LUTS accounted for more frequent prescription of MRA based pharmacotherapy (2.1% vs 29.1% vs 42.8% in patients with mild, moderate, and severe LUTS, respectively). Decision tree analysis revealed that patients with urinary urgency and urinary frequency as well as younger ones with urinary urgency but without urinary frequency were more frequently prescribed with MRAs. Conclusion: Urinary urgency and frequency are associated with increased utilization of MRAs in men with BPE in daily clinical practice. The attitude of Polish urologists toward management of persistent storage symptoms in BPE patients is in line with the EAU guidelines.

There are multiple surgical approaches described to repair the left pulmonary artery (LPA). Regardless of the technique used, rate of restenosis is very high. We describe a case of discontinuous LPA which was treated by turning down the entire autologous main pulmonary artery (MPA) and creating a direct anastomosis between the MPA and LPA. This was in background of tricuspid and pulmonary atresia, hypoplastic right ventricle with atrial and ventricular septal defects and ductus arteriosus feeding the left pulmonary artery. This new technique resulted in a tension free tissue-tissue anastomosis with potential for growth and produced hemodynamically gratifying short-term results.

The coronavirus disease 2019 (COVID-19) pandemic introduced an abrupt change in human behavior globally. Here, we discuss unique insights into the eco-evolutionary role of pathogens in ecosystems and present data that indicates the pandemic can fundamentally change our learning choices. This pathogen has indirectly affected many organisms and processes by globally changing the behavior of humans to avoid being infected. The pandemic also changed our learning behavior by affecting the relative importance of information and forcing teaching and learning into a framework that accommodates human behavioral measures to avoid disease transmission. Not only are these indirect effects on the environment occurring through a unique mechanistic pathway in ecology, the pandemic along with its effects on us provides a profound example of the role risk can play in the transmission of information between the at-risk. Ultimately, these changes in our learning behavior led to this special issue “Taking learning online in Ecology and Evolution.” The special issue was a call to the community to take learning in new directions, including online and distributed experiences. The topics examined include a significant component of DIY ecology and evolution that is experiential and but done individually, opportunities to use online tools and apps to be more inclusive, student-focused strategies for teaching online, how to reinvent conferences, strategies to retain experiential learning safely, emerging forms of teaching such as citizen science, apps and podcasting, and ideas on how to accommodate ever changing constraints in the college classroom, to name a few. The collective consensus in our fields is that these times are challenging but we can continue to improve and innovate on existing developments, and more broadly and importantly, this situation may provide an opportunity to reset some of the existing practices that fail to promote an effective and inclusive learning environment.

Complex biological traits often originate by integrating previously separate parts, but the organismal functions of these precursors are challenging to infer. If we can understand the ancestral functions of these precursors, it could help explain how they persisted and how they facilitated the origins of complex traits. Animal eyes are some of the best studied complex traits, and they include many parts, such as opsin-based photoreceptor cells, pigment cells, and lens cells. Eye evolution is understood through conceptual models that argue these parts gradually came together to support increasingly sophisticated visual functions. Despite the well accepted logic of these conceptual models, explicit comparative studies to identify organismal functions of eye-precursors are lacking. Here, we investigate how precursors functioned before they became part of eyes in Cnidaria, a group formed by sea anemones, corals and jellyfish. Specifically, we test whether ancestral photoreceptor cells regulated the discharge of cnidocytes, the expensive single-use cells with various uses including prey capture, locomotion, and protection. Similar to a previous study of Hydra, we show an additional four distantly related cnidarian groups discharge significantly more cnidocytes when exposed to dim blue light compared to bright blue light. Our comparative analyses support the hypothesis that the cnidarian ancestor was capable of modulating cnidocyte discharge with light. Although eye-precursors might have had other functions like regulating timing of spawning, our findings are consistent with the hypothesis that photoreceptor cells which mediate cnidocyte discharge predated eyes, perhaps facilitating the prolific origination of eyes in Cnidaria.

Senna didymobotrya is invasive native flowering shrubs mainly grow in Africa. Climate change thought to facilitates the introduction and spread of invasive alien species. The present study aimed at examining the present and future invasion of S. didymobotrya under the changing climatic using species distribution modeling. The mean AUC and TSS value of the model was (95%) and (81%), respectively, which put the model under an excellent category. Our result showed under the current climatic conditions 18.11% of the continent is suitable for S. didymobotrya invasion. Eastern African countries are found the most suitable habitat for S. didymobotrya invasion followed by southern African countries. The total highly suitable area for the species is 3.4% and 3.17% in 2050s under RCP4.5 and RCP8.5, respectively. In the 2070s, the highly suitable area is predicted as 3.18 % and 2.73% in RCP4.5 and RCP8.5, respectively. An area with the category of low to moderate suitability under RCP 4.5 and RCP8.5 in the 2050s is projected as 17.4 % and 20.5 % and this area is increased in the 2070s to19.11% and 22.82 for the RCP 4.5 and RCP 8.5, respectively. The results of this study showed a substantial contraction in the high suitability areas, but a large increase in the low and moderately suitable habitat. Despite the contraction in highly suitable areas, countries which are found suitable in the present climatic condition remains suitable for S. didymobotrya establishment. Our ensemble predicted a significant increase in the vulnerability of habitat for invasion under the future climatic scenarios. Our study suggests the future biodiversity conservation strategy and policy direction should focus on the means and strategy of limiting the rate of expansion of invasion and distribution in different ecosystem types, hence reduce the expected harm in the ecosystem services.

Polyandry, when females mate with more than one male, is theorised to play an important role in successful colonisation of new habitats. In addition to possible benefits from sexual selection, even mild polyandry could facilitate colonisation by protecting against inbreeding and reducing the costs of mating with incompatible or infertile males. Here, we measure the importance of mild polyandry for population viability and reproductive fitness following experimental founder events into a higher temperature regime. Using colonisation experiments with the model beetle Tribolium castaneum, in which females can produce offspring for up to 140 days following a single mating, we founded more than 100 replicate populations using single females that had been given the opportunity to mate with either one or two males, and then tracked their subsequent population dynamics. Following population viability and fitness across ten generations, we found that extinction rates were significantly lower in populations founded by females given polyandrous opportunities to mate with two males (9%) compared to populations founded by monogamous females (34%). In addition, populations founded by females that had been provided with opportunities to store sperm from two different males showed double the median productivity following colonisation compared to monogamous-founded populations. Notably, we identified short-term and longer-term benefits to post-colonisation populations from double-mating, with results suggesting that polyandry acts to both protect against mating with incompatible males through the founder event, and reduce inbreeding depression as the colonisation proceeds for ten generations. Our results therefore show that even mild polyandry provides both reproductive and genetic benefits for colonising populations.

The designation of subspecies has often been uncertain in systematics. In addition to phenotypic divergence, designation of subspecies may need to be supplemented by population genetic analyses. In this study, we perform such a survey of the mangrove tree Avicennia marina on Indo-West Pacific coasts. This species harbors three morphological groups. We collected samples from 16 populations (577 individuals) and sequenced 94 nuclear genes. Three genetic features support the subspecies designation for the three morphological subgroups. First, the observed genetic divergence is concordant with the morphological differences, with discordance found in zones of coexistence. Second, the three groups differ in the level of genetic diversity as well as in the demographic history, suggesting a degree of ecological differentiation. Third, and most important, the divergence level varies from locus to locus across the genome. A small portion of the genome is most informative about subspecies delineation, thus hinting the uneven exchange of genes. Such locus-dependent gene flow is expected for incompletely isolated groups. This last point suggests that the reduction in gene flow can be observed at some loci, thus hinting incipient reproductive isolation. In short, the three groups of A. marina appear to have evolved far beyond the stage of structured populations, but not to the point of full species. Hence, the subspecies designation is warranted. We believe these considerations can be generalized to other taxa.

Central African rainforests are predicted to be disproportionately affected by future climate change. How species will cope with these changes is unclear, but rapid environmental changes will likely impose strong selection pressures. Here we examined environmental drivers of phenotypic and genomic variation in the central African puddle frog (Phrynobatrachus auritus) to identify areas of elevated environmentally-associated turnover where populations may have the greatest capacity to adapt. We also compared current and future climate models to pinpoint areas of high genomic vulnerability where allele frequencies will have to shift the most in order to keep pace with future climate change. Analyses of body size, relative leg length, and head shape suggest that seasonal aspects of temperature and precipitation significantly influence phenotypic variation, whereas geographic distance and precipitation seasonality are the most important drivers of SNP allele frequency variation. However, neither landscape barriers nor the effects of past Pleistocene refugia had any influence on genomic differentiation. Most phenotypic and genomic differentiation coincided with key ecological gradients across the forest-savanna ecotone, montane areas and a coastal to interior rainfall gradient. Areas of greatest vulnerability were found in the lower Sanaga basin and southeastern region of Cameroon. In contrast with past conservation efforts that have focused on hotspots of species richness or endemism, our findings highlight the importance of preserving environmentally heterogeneous landscapes to preserve putatively adaptive variation and ongoing evolutionary processes in the face of climate change.

Aim. Repurposing strategies to address the COVID-19 pandemic have been accelerated. As both pregnant and pediatric patients are likely to be excluded from most planned investigations, the list of repurposed options and the available data on these drugs and vaccines provides a baseline risk assessment and identifies gaps for targeted investigation. Methods. Clinical trials have been searched and reviewed; twenty-three repurposed drugs and drug combinations and 9 candidate vaccines have been assessed regarding the availability of relevant data in pediatrics and pregnant women and to evaluate expected or unanticipated risk. Results. Thirteen of the repurposed drugs or drug combinations are indicated for use in pediatrics in some age category albeit for indications other than COVID-19; 10 of these are indicated for use in pregnant women. Even in cases where these drugs are indicated in the populations, source data from which safety and or dosing could be extrapolated for use in COVID-19 is sparse. Vaccine trials are ongoing and generally exclude pregnant women; only in a few instances have pediatric subgroups been planned for enrollment. Data from individual case studies and RWD may suggest that subpopulations of both pediatric patients and pregnant women may be more at risk, particularly those in an increased inflammatory state. Conclusion. In conjunction with more prospective collaboration, plans are evolving to ensure that we will be better prepared to address similar situations especially in pediatrics and pregnant women where experience is limited and actual practice relies heavily on leveraging data from other populations and indications.

Spike development of wheat line 3558M was strongly inhibited by low temperature stress in spring. The fertile tiller inhibition (ftin) gene in the wheat line 3558M is associated with multiple phenotypes, including the production of fewer tillers, delayed floral transition, and death of the shoot apical meristem. In order to study the relationship between spike development inhibition and response to cold stress, we systematically investigated the genes and pathways underlying the differences using ITRAQ proteomics and RNA-sequencing technologies. The results showed that the cold acclimation pathway and multiple defence responses, including reactive oxygen species-mediated hypersensitive response, salicylic acid-mediated systemic acquired resistance, are activated and led to apex death of the wheat line 3558M under cold stress. Meanwhile, the cold acclimation pathway inhibited the SVP-SCO1-LFY flowering pathway and led to delayed floral transition. Two TaPIN proteins were significantly downregulated, and multiple auxin signalling genes were also differentially expressed. Particularly, knocking down the two TaPIN genes using RNAi technology significantly reduced the tiller number. The cold stress might disrupt the distribution of auxin and reduce the tillers of 3558M. Taken together, the ftin gene might be a cold-sensitive mutation and that is the cause of multiple biological pathways and phenotypic changes.

Ant Forest, a mobile app by the monolithic Alibaba Group, is greening individuals' daily activities and transforming human capacity to reverse global environmental degradation. Over 500 million e-trees being cultivated every day in China using Ant Forest. Over 122 million trees planted over more than 112,000 ha of degraded land areas. This is a showcase of how innovation via internet technology combined with digital finance is contributing to solving environmental issues, also the potential to match an individual's daily footprint to their digital footprint and converting this to an ecological footprint.

Evaluating the effects of multiple stressors on ecosystems is becoming increasingly vital with global changes. The role of species interactions in propagating the effects of stressors, although widely acknowledged, has yet to be formally explored. Here, we conceptualize how stressors propagate through food webs and explore how they affect simulated 3-species motifs and food webs of the Canadian St. Lawrence System. We find that overlooking species interactions invariably underestimates the effects of stressors, and that synergistic and antagonistic effects through food webs are prevalent. We also find that interaction type influences a species’ susceptibility to stressors; species in omnivory and tri-trophic food chain interactions in particular are sensitive (weak entry points) and prone to synergistic (biotic amplifiers) and antagonistic (biotic buffers) effects. Finally, we find that apex predators were negatively affected and mesopredators benefited from the effects of stressors due to their trophic position in the St. Lawrence System, but that species sensitivity is dependent on food web structure. In conceptualizing the effects of multiple stressors on food webs, we bring theory closer to practice and show that considering the intricacies of ecological communities is key to assess the net effects of stressors on species.

Peste des petits ruminants (PPR) is a contagious disease affecting small ruminants. It has been targeted by the global community for eradication within the next 10 years. Implementing eradication requires significant financial efforts, human resources, coordination among actors, and individual commitments. The objective of this study is to estimate the cost of PPR at household level, thereby providing economic information about the potential benefits for small ruminant keepers of PPR control and management strategies. Fifteen Sub-Saharan countries are included in this study, for which publicly available household level data assembled by FAO were used. We built a bioeconomic model to estimate the impact of PPR for a standardized theoretical area where each household raises an average herd comprising either 6 goats or 3 sheep and their offspring. We then used the outputs of the model to estimate the income loss due to PPR at household level. We constructed different income scenarios to account for the variability of small ruminant income in total annual income. The household income losses ranged from 0.6 to 44.8 percent of the total annual income. The percentages vary depending on the income scenario and on the gross annual economic impact of PPR on small ruminant production, which ranges from 25 to 80 percent based on the results of the bioeconomic model. Regardless of the income scenario, households in lower income quintiles are relatively more affected by PPR than households in upper quintiles. As expected, the more small ruminant production contributes to household income the greater the impact. We provide here estimates that may help, from a policy perspective, identifying the most relevant strategies and tailoring them at regional level to mitigate PPR impacts.

A degenerated leiomyoma rarely ruptures during pregnancy. As the rupture of a degenerated leiomyoma can cause panperitonitis due to the leakage of fluid content into the peritoneal cavity, prompt diagnosis and surgical intervention are required.

An extreme preterm baby was presented in neonatal care unit with respiratory distress. The most disturbing stage here was the appearance of liver mass sizing 5.8cm×1.3cm with necrosis, diagnosed as hepatoblastoma which was evident with the aid of Ultrasound. Hence, chemotherapy was commenced which was in accordance with SIOPEL 3.

Livestock grazing strongly affects biodiversity and ecosystem functioning in grasslands. However, it remains unclear how different grazing impact multiple biodiversity, ecosystem multifunctionality (EMF), and their relationship with the interactions of grazing duration, livestock type and climatic factors. Here, we conducted a global synthesis from 104 published studies. Our results showed that light and moderate grazing improved multi-diversity, but heavy grazing significantly decreased multi-diversity and EMF. The grazing-induced decrease of EMF intensified with grazing duration, and the reduction of multi-diversity and EMF under intensive grazing was stronger in more arid climates. The response of EMF increased linearly with that of multi-diversity under all grazing intensities. Moreover, grazing intensity reduced EMF largely via decreasing multi-diversity, whereas a shift of livestock type from small to large size promoted EMF by increasing multi-diversity. This study provides first empirical evidence and new insights into the relationship between multi-diversity and EMF under grazing in global grasslands.

Production of specialty chemicals increasingly makes use of enzyme catalysts, and Novozym 435 (N435) is among most often applied. However, its polymeric skeleton is unstable in many solvents. In this context, we report results of a systematic study of the biocatalysts, fabricated using highly porous siliceous pellets/enzyme (MH), grafted with octyl (-O), amino (-A) and octyl and amino (-OA) groups, deployed in a rotating bed reactor and tested in hydrolysis and esterification reactions. N435 appeared the most active in both reactions, when activity was related to the catalyst’s mass, mainly owing to very large enzyme load. But its structure degraded in many typical solvents, whereas no such effect was detected in MH-O- and MH-OA-catalysts. MH-O showed the highest specific activity, however, a significant enzyme leaching was observed in a hydrolytic reaction, in contrast to MH-OA. In esterification reaction the MH-O-bound lipase was not only most active but also quite stable.

AIM: To report on the clinical, laboratory and radiological findings of adolescents who presented during the SARS-CoV-2 surge with symptoms of COVID-19, did not test positive for the infection and were diagnosed with e-cigarette and vaping product use associated lung injury (EVALI). Methods: A retrospective review of 12 cases of EVALI admitted to the Bristol Meyers Squibb Children’s Hospital between February 2020 and June 2020 was conducted. Results: The ages of the patients ranged from 14 to 19 years. There were 6 males and 6 females. Three patients had a past history of anxiety, depression or other psychiatric/mental health disorder, nine had prolonged coagulation profile (PT,PTT and/or INR) and eleven had elevated inflammatory markers. Eleven needed respiratory support. All 12 were negative for SARS-CoV-2 PCR. Four were tested for IgG Antibodies and were negative. As these cases were admitted to rule out COVID infection, initial treatment included hydroxychloroquine. Steroids were started only after SARS-CoV-2 PCR was shown to be negative. Urine THC was positive in all cases. CXR and CT findings showed ground glass opacities. CONCLUSIONS: Clinical and radiological features are similar in both EVALI and SARS-CoV-2 infection. Inflammatory markers are elevated in both conditions. A detailed social and substance use history in patients presenting with ‘typical’ COVID pneumonia like illness is important. EVALI should be ruled in early to start the appropriate treatment. Given the ongoing pandemic, pediatricians and other health care providers need to be aware of other conditions that can masquerade as SARS-CoV-2.

Susceptibility of turkeys, chickens and chicken embryos to SARS-CoV-2 virus was evaluated by experiment inoculation. Turkeys and chickens were inoculated using a combination of intranasal, oral and ocular routes. Both turkeys and chickens did not develop clinical disease or antibodies to the virus following inoculation. Viral RNA was not detected in oral and cloacal swabs and in tissues using quantitative real-time RT-PCR. In addition, chicken embryos were inoculated using the yolk sac, intravenous, chorioallantoic membrane and allantoic cavity routes did not support replication of the virus. SARS-COV-2 virus does not affect both turkeys and chickens in the current genetic state and does not pose any potential risk to establish in both species of domestic poultry.

Background: Fibrosa layer stripping (FLS) technique is a new approach to remove calcified aortic valve. In this study, we aimed to assess the effectiveness of the FLS technique by comparing with the conventional technique in minimally invasive aortic valve replacement (MIAVR). Methods: A prospective, single-center, randomized controlled trial was conducted at Beijing Anzhen Hospital. 70 patients diagnosed with severe calcific aortic stenosis were randomly assigned to undergo FLS (n=35) or conventional (n=35) technique to debride calcified aortic valve. Preoperative profile, procedural parameters, and postoperative outcomes were analyzed. Results: No significant difference was observed in the preoperative profile between two groups. Compared with the conventional technique, the FLS technique had significantly higher indexed effective orifice area and lower mean gradient. Moreover, FLS technique was associated with significantly reduced aortic cross-clamp time (41[38-44] vs 56[51-60] min, p<0.001), cardiopulmonary bypass (CPB) time (63[56-69] vs 81[75-84] min, p<0.001) and operative time (148[141-156] vs 173[169-180] min, p<0.001). Lastly, the length of intensive care unit stay (1.2±0.4 vs 1.5±0.8 days, p=0.041) and hospital stay (5.3±0.6 vs 6.0±1.4 days, p=0.020) was significantly reduced in the FLS group compared with those in the conventional group. Conclusions: FLS technique is effective in removing calcified tissue during MIAVR and is associated with shorter cross-clamp time and CPB time, and better hemodynamic performance than conventional technique.

Persistent left superior vena cava draining into the left atrium is a rare condition. We herein report the case of a 34-year-old male admitted at our institution for paroxysmal atrial fibrillation. Investigations revealed a large ostium secundum atrial septal defect, with a persistent left superior vena cava draining into the left atrium, while the coronary veins drained separately into the left atrium. Surgical correction was performed, closing the defect with a patch and connecting the left superior vena cava to the right atrial appendage with an extra-cardiac conduit.