In the present work flow is developed for unsteady MHD 2nd grade fluid between two periodically oscillating plates.The flow behavior is categorized in the three cases, namely Couette flow, Poiseuillie flow and combination of these two flows. The partial differential equation arises from modeling of these problems have been analytically solved by using two well-known techniques Optimal Homotopy Asymptotic Method (OHAM) and Adomian Decomposition Method (ADM). The comparison of these two methods has been shown numerically as well as graphically and found in excellent agreement. Finally the heat transfer analysis and the effect of physical parameters during periodic motion of fluid flow has been analyzed and discussed

X-linked agammagobulinemia (XLA) is a primary immunodeficiency disorder caused by a mutation in the Bruton Tyrosine Kinase (BTK). Usually, patients present severe infections before the age of 2, and require immunoglobulin replacement therapy during all their life. We present the case of a 16-years-old male for whom the diagnosis was incidental. He did not present any infection since childhood. At the age of 4, immunoglobulin assay was performed because he had recurrent fever episodes. A panhypogammaglobulinemia was identified, but the boy became asymptomatic and explorations were stopped. At the age of 16, the patient’s parents suggested a control of the deficit which was confirmed. Genetic testing revealed a novel mutation on BTK, located in the pleckstrin homology domain [c.70A>C, p.(Asn24His)]. Initially, he received immunoglobulin substitution at the rate of one subcutaneous injection per week but stopped it after 2 years of treatment by immunoglobulin and continued to present no symptom. We thereafter report the case of an asymptomatic patient presenting a novel missense mutation of BTK. The patient doesn’t have circulant B cell. He doesn’t receive immunoglobulin substitution and doesn’t present infectious diseases.

The interannual variation (IAV) of net ecosystem carbon production (NEP) plays an important role in understanding the mechanisms of the carbon cycle in the agriculture ecosystem. NEP is usually partitioned into the diffecence between gross ecosystem productivity (GEP) and ecosystem respiration (RE), or the integration of the carbon uptake or release peak and the corresponding duration. In this study, the climatic and biotic controls of the IAV of NEP, which were expressed as annual values and anomalies, were investigated based on an eddy covariance dataset of rain-fed spring maize during 2005–2018 in the northeast of China. The annual NEP was 270±115 g C m−2yr −1. Annual values and anomalies of NEP were positively correlated with that of precipitation (PPT), GEP and daily maximum NEP (NEPmax). 78.9% of annual anomalies of NEP were explained by the interaction of climate, soil and plant variables, and the atmospheric water vapor deficit (VPD) played a dominated role. Annual anomalies of NEP were dominantly and positively controlled by the soil water content (SWC) through GEP and the soil temperature (Ts) through RE. In comparison, annual anomalies of NEP were dominantly and negatively controlled by summer VPD through the NEPmax, positively adjusted by spring precipitation and the effective accumulative temperature through the beginning date (BDOY) of the affecting carbon uptake period (CUP), and by autumn precipitation and leaf area index through the end date (EDOY) of the affecting CUP. Residues restrained the carbon release at the beginning of the year, and accelerated the carbon release at the end of the year. Our results hightlight that NEP might be more sensitive to the change of water condition (such as PPT, SWC and VPD) induced by the climate changes.

Inclusion body hepatitis and hydropericardium syndrome (HHS) associated with fowl adenovirus (FAdV) infections occurred worldwide. In this study, we confirmed an outbreak of HHS in captive peacocks in Henan Province, China. The causative agent fowl adenovirus serotype 4 (FAdV-4) was isolated and designated HN19. Phylogenetic analysis showed that HN19 isolate was clustered in FAdV-C. Animal experiments showed that HN19 exhibited high pathogenicity to chickens. The findings suggested that the possibility risk of cross-host transmission of FAdV-4.

This systematic review evaluates the efficacyand safety of omalizumab for chronic spontaneous urticaria (CSU). Pubmed, EMBASE and Cochrane Library were searched for RCTs. Critical and important CSU-related outcomes were considered. The risk of bias and the certainty of the evidence were assessed using GRADE. Ten RCTs including 1620 subjects aged 12 to 75 years old treated with omalizumab for 16 to 40 weeks were evaluated. Omalizumab 150 mg: does not result in clinically meaningful improvement(high certainty) of the urticaria activity score (UAS)7 (mean difference (MD) -5; 95%CI -7.75 to -2.25) and the itch severity score(ISS)7 (MD -2.15; 95% CI -3.2 to -1.1); does not increase (moderate certainty) quality of life (QoL) (Dermatology Life Quality Index (DLQI); MD -2.01; 95%CI -3.22 to -0.81); decreases (moderate certainty) rescue medication use (MD -1.68; 95%CI -2.95 to -0.4). Omalizumab 300 mg:results in clinically meaningful improvements(moderate certainty)of the UAS7 (MD -11.05; 95%CI -12.87 to -9.24), theISS7 (MD -4.45; 95%CI -5.39 to -3.51), and QoL (high certainty)(DLQI; MD -4.03; 95% CI -5.56 to -2.5); decreases (moderate certainty) rescue medication use (MD -2.04; 95%CI -3.19 to -0.88) and drug-related serious AEs (RR 0.77; 95%CI 0.20 to 2.91).

Aim: to assess and evaluate the Left Atrial (LA) dysfunction by two-dimensional speckle tracking echocardiography (2DSTE) in patients with diastolic heart failure (DHF) and systolic heart failure (SHF). Materials and methods: The study included 74 patients with DHF, 26 patients with SHF, and 50 normal matched subjects. The LA phasic functions, LA volume index and E/e~ were evaluated by conventional echocardiography.The2DSTE used to evaluate both the left ventricular global strain (LVGS) and The Left Atrial Global Strain (LAGS) and reevaluate the LA phasic functions through Peak-atrial longitudinal strain (PALS), peak-atrial contraction strain (PACS), and PALS-PACS which reflecting LA reservoir, pump, and conduit function, respectively. Results: The LVGS was -19.54±1.42 % in controls, -18.66±1.15 % in DHF and -14.72±1.97 % in SHF (P-value <0.0001); LAGS was 52.62±6 %in controls,37.86±4.59 in DHF and 21±5.37 in SHF (P-value <0.0001); The PALS was 49.9±4.83 in controls, 33.26 ±4.82 in DHF and 19.69±5.55 in SHF(P-value was<0.0001);The PACS was 20.19±2.25 in controls, 12.47±2.29 in DHF and 8.35±2.71 in SHF (P-value <0.0001); The PALS-PACS was29.57±4.02 in controls, 20.76±3.8 in DHF and 11.35±3.14 in SHF (p-value <0.0001). Conclusion: LA phasic function was worse in SHF compared with those with DHF. Early LA dysfunction in Heart failure can be detected accurately and easily by speckle tracking technique more than conventional echocardiography suggesting that The LA myocardial deformation analysis by 2-D STE could be a promising tool to better understand of heart failure and its classification. Key words: Speckle tracking; systolic heart failure; diastolic heart failure; left atrial dysfunction.

Aims: Variability of ACE2 expression encoded by the ACE2 gene may be important for susceptibility and clinical outcomes of SARS-CoV-2 infection. This study was aimed to identify potential single nucleotide polymorphisms (SNPs) of ACE2 relevant to SARS-CoV-2 infection and predictively assigned risk phenotypes. Methods: Literature was searched in different databases to identify the SNPs of ACE2 that may regulate ACE2 expression in different human tissues relevant to either SARS-CoV-2 or SARS-CoV infection. Allele and genotype information of rs2285666 SNP of ACE2 was obtained from the 1000 Genomes project Phase III in line with Fort Lauderdale principles and phenotypes were assigned accordingly based on carrying characteristics ACE2 allele. Results: About 16 SNPs of ACE2 as potential venture for susceptibility to SARS-CoV-2 infection was identified from the literature. Predicted high-risk phenotypes of ACE2 expressor due to carrying rs2285666 SNP of ACE2 was highly prevalent in East Asia (40.7%; 95% CI 36%-45%), followed by South Asia (36.8%; 95% CI 33%-41%), America (22.8%; 95% CI 18%-27%), Europe (14.5%; 95% CI 11%-18%) and Africa (12.3%; 95% CI 10%-15%), respectively. In total, ~25% of the world population participated in the 1000 Genomes project was predictively identified as being at high-risk for SARS-CoV-2 infection due to carrying rs2285666 ACE2 genetic polymorphism. Conclusion: Identification of high-risk phenotypes for SARS-CoV-2 infection through screening of ACE2 genetic polymorphisms may be valuable for SARS-CoV-2-related COVID-19 prevention and treatment in the population. Customized DNA microarray techniques or next generation sequencing may holistically advance this newly evolving research area of infection genetics.

The relationship of host and symbionts is complex and dynamic. Symbionts can significantly impact host phenotypes and parasite epidemics may be influenced by interactions among symbionts. Aphids are well known for their symbiotic associations with bacteria. However, few studies have examined the offsprings of parasitized host and the ecological implications of a dynamic microbiome longitudinaly. In the present study, we surveyed the microbiota in non-parasitized aphids and parasitized aphids its offspring for over four consecutive generations by using high-throughput 16S rRNA sequencing. Across hosts, parasite strongly altered symbiont composition of parasitized aphids offspring, especially in the fourth generation. Moreover, parasitism reduced weight and reproductive capacity of the parasitized offspring and influenced parasite epidemics. Taken together, these results indicate that parasitoids can influence host-microbiome interactions by altering the symbionts composition in the host offspring. Our findings further supports the importance host-parasite-microbiome tirad interactions, which can create intense reciprocal selection resulting in coevolution between species.

Clonal selection and vegetative propagation determine low genetic variability in grapevine cultivars, although it is common to observe diverse phenotypes. Environmental signals may induce epigenetic changes altering gene expression and phenotype. The range of phenotypes that a genotype expresses in different environments is known as phenotypic plasticity. DNA methylation is the most studied epigenetic mechanism, but only few works evaluated this novel source of variability in grapevines. In the present study, we analyzed the effects on phenotypic traits and epigenome of three Vitis vinifera cv. Malbec clones cultivated in two contrasting vineyards of Mendoza, Argentina. Anonymous genome regions were analyzed using Methylation-Sensitive Amplified Polymorphism (MSAP) markers. Clone-dependent phenotypic and epigenetic variability between vineyards were found. The clone that presented the clearer MSAP differentiation between vineyards was selected and analyzed through Reduced Representation Bisulfite Sequencing. Twenty-nine differentially methylated regions (DMRs) between vineyards were identified and associated to genes and/or promoters. We discuss about a group of genes related to hormones homeostasis and sensing that could provide a hint of the epigenetic role in the determination of the different phenotypes observed between vineyards and conclude that DNA methylation has an important role in the phenotypic plasticity and that epigenetic modulation is clone-dependent.

Background: To assess an improved version of sublingual AIT performed by applying a novel short-course oromucosal allergen administration strategy in a translational allergic pig model by prolonged and enhanced tolerogenic presentation of intact allergen with a novel mucoadhesive patch technology. Methods: Newborn piglets sensitized intraperitoneally with the common egg allergen ovalbumin (OVA) were sublingually treated five times using a dose ascending administration schedule with nanofiber-based mucoadhesive patches carrying OVA allergen, formulated with immune tolerogenic particles derived from the probiotic bacterium Lactococcus lactis (TBP). Immunologic assessment was conducted by the use of the intradermal test of immediate allergic reactions to OVA. Results: Five weekly treatments with the mucoadhesive patch carrying OVA alone or OVA and TBP resulted in significant desensitisation, being 8% and 45% respectively, as measured by intradermal testing. Mucoadhesive patch-based administration of OVA together with TBP resulted in the allergen localisation to submucosa tissue and draining lymph nodes and resulted in better desensitization compared with patch containing OVA allergen alone. Conclusion: A first demonstration of short-course SLIT approach which we term Specific Oromucosal Immunotherapy (SOMIT) has been successfully carried out in a new translational therapeutic porcine model of allergy. The results suggest that an improved short-course SLIT approach is feasible by prolonging allergen delivery using a mucoadhesive patch and proper stimulation of a privileged tolerogenic immune compartment by tolerogenic probiotic bacterial particles.

Background: Influenza is an acute respiratory viral infection that can induce severe complications, hospitalization, and even death among older adults. Seasonal influenza vaccination has proposed for its prevention. The aim of this study was to determine the related factors of influenza vaccination among Iranian Older Adults in 2018 based on Health Belief Model. Methods: In this cross-sectional study, 206 participants aged 65 years and over were examined. The data collection tool was a questionnaire based on Health Belief Model constructs. The logistic regression model was used for data analysis. Results: Only 24.3% of the participants had been seasonally vaccinated, over the past year, and 58.3% had received at least one dose of seasonal flu vaccine from the age of 65. Cues to action (OR=1.52, P-value=0.002), Knowledge (OR = 1.27, P-value =0.020), and Perceived Susceptibility (OR=1.18, P-value=0.007) were statistically significant predictors of seasonal influenza vaccination. Conclusion: The cues to action stood as the strongest predictor of seasonal influenza vaccination, which should be addressed in health promotion intervention programs in the elderly.

Abstract. The Controlled Human Infection Model and specifically the Human Viral Challenge Model are not dissimilar to standard clinical trials while adding another layer of complexity and safety considerations. The models deliberately infect volunteers, with an infectious challenge agent (CA) to determine the effect of the infection and the potential benefits of the experimental interventions. The Human Viral Challenge Model studies can shorten the time to assess the efficacy of a new vaccine or treatment by combining this with the assessment of safety. The newly emerging SARS-COV-2 virus is highly contagious and the cause pandemic disease COVID-19. An urgent race in is on to develop a new vaccine against this virus in a timeframe never attempted before. The use of the Human Viral Challenge Model has been proposed to accelerate the development of the vaccine. In the early 2000’s the authors successfully developed a pathogenic Human Viral Challenge Model for another virus for which there was no effective treatment and established it to evaluate potential therapies and vaccines against Respiratory Syncytial Virus. The authors feel that the experience gained in the development of that model can help with the development of a COVID-19 HVCM and describe it here. Word count: 197

13-year-old female twins presented one week apart with documented Mycoplasma pneumoniae respiratory infection. Each developed venous thrombosis/pulmonary emboli in association with transient self-limited para-infectious anti phospholipid antibodies. Comprehensive evaluation reveled no identifiable genetic prothrombotic variables. Both children recovered after receiving antibiotics and anti-coagulation therapy. Thrombotic complications associated with Mycoplasma pneumoniae infections are rare, particularly in children; the occurrence of this complication in identical twins has not been previously reported.

Earthworms are a major component of soil fauna communities with positive effects on soil chemical, biological and physical processes. A study was carried out at Chinhoyi University of Technology experimental farm, Zimbabwe, to investigate the medium-term effects of cultural practices on earthworm communities in a maize-based cropping system. Data were collected in the 2018/2019 cropping season from a six-year old experiment with tillage system (conventional, rip line seeding and basin planting), fertiliser application rate (zero, low: 35.2 kg ha−1 N + 12.2 kg ha−1 P2O5 + 6.6 kg ha−1K2O, medium: 41.5 kg ha−1 N + 14 kg ha−1 P2O5 + 7 kg ha−1 K2O, and high: 83 kg ha−1 N + 28 kg ha−1 P2O5: 14 kg ha−1 K2O.) and weeding intensity (twice, four times and clean weeding) as the main, sub- and sub-subplots, respectively. Lumbricus (34.4%) and Diplocardia (38.3%) were the dominant genera while endogeic earthworms (48.4%) dominated the community structure among other earthworm functional groups. Lumbricus abundance, total earthworm abundance, genus richness and Shannon diversity index were higher in clean weeded plots under the basin planting system relative to other treatments. Inorganic fertiliser application in the conventional tillage (CT) system reduced Eisenia abundance and genus richness. There was a positive correlation between total earthworm abundance (r = 0.34, P < 0.001) and negative correlation of Diplocardia abundance (r = -21, P < 0.05) with maize grain yield. These results suggest that in minimum tillage systems clean weeding has positive effects on earthworms while in CT, application of high doses of inorganic fertiliser is detrimental to earthworm communities.

Hybridization has fascinated biologists in recent centuries for its evolutionary importance, especially in plants. Hybrid zones are commonly located in regions across environmental gradients due to more opportunities to contact and ecological heterogeneity. For aquatic taxa, intrazonal character makes broad overlapping regions in intermediate environments between related species. However, we have limited information on the hybridization pattern of aquatic taxa across an altitudinal gradient. In this study, we aimed to test the hypotheses that niche overlap and hybridization might be extensive in related aquatic plants in alpines. We evaluated the niche overlap in three related species pairs on the Qinghai-Tibetan Plateau and assessed the spatial pattern of hybrid populations. Obvious niche overlap and common hybridization were revealed in all three pairs of related aquatic plants. The plateau edge and river basins were broad areas for the sympatry of divergent taxa, where a large proportion of hybrid populations occurred. Hybrids are also discretely distributed in diverse habitats on the plateau. Differences in the extent of niche overlap, genetic incompatibility and phylogeographic history might lead to inconsistences in hybridization patterns among the three species pairs. Our results suggested that plateau areas are a hotspot for ecologically divergent aquatic species to contact and mate and implied that hybridization may be important for the freshwater biodiversity of highlands.

Carbon quantum dots (C-QDs) show great potential to replace traditional semiconductive quantum dots as the next generation of fluorescent probes. We demonstrate here a new C-QD production process using lignin, a high-volume but low market-value industrial waste and/or environmental hazards, as the starting carbon source. By adding a small amount of inorganic acid, the rich phenolic components in lignin were successfully converted to C-QDs through a coking formation mechanism similar to what happens on solid acid catalysts in traditional fossil fuel cracking process. The aqueous solution presence of the received lignin C-QDs is beneficial for brain cell imaging applications, attributing to their fast internalization, low toxicity, tunable photoluminescence by appropriate acidity and reaction temperature during hydrothermal synthesis. This method not only provides a low-cost C-QDs production route, but also helps gain extra profit and/or improve environment for many small agricultural business and paper and pulp industry located in rural area.

This letter is meant to inform the community of pediatricians/pediatric intensivists that we suspect SARS-CoV-2 to cause life-threatening bronchiolitis in infants and we therefore suggest maintaining a high level of suspicion of COVID-19, irrespective of an initially negative SARS-CoV-2 RT-PCR testing, when other causes of bronchiolitis are unidentifiable in young children.

Objective: Chronic cough is one of the most common and frequently-occurring diseases in children. We investigated the etiologies and clinical features of children with chronic cough (CC), in order to improve the diagnostic and treatment of the disease by pediatricians. Methods: Participating 420 children, aged 1-14 years old, from 5 hospitals in different regions of Shanghai, between September 2017 and July 2019. Children with chronic cough were enrolled to identify the specific cause and clinical information based on a questionnaire survey. All the data were collected and statistically analyzed by Chi-square test to identify the constituent ratio of each cause. Results: The etiology component ratio showed that 146 cases (34.8%) had PIC; 96 cases (22.9%) had UACS; 90 cases (21.4%) had CVA; 75 cases (17.9%) had AC; 11 cases (2.6%) had TS; 2 cases (0.5%) had GERD. For the children with CC, the mainly age of onset is 3-6 years (54.05%). The mainly cough character is wet cough (65.7%). 67.1% of children with chronic cough were prescribed antibiotics, of which 41.7% were azithromycin. Various cough drops, antihistamines, aerosolized inhalation, montelukast, etc. were often used in the treatment of children’s chronic cough. Conclusion: The leading 3 causes of chronic cough in children were PIC, UACS and CVA. The mainly age of onset is 3-6 years; mainly cough character is wet cough. Antibiotics are the mainly treatment, often combined with cough medicine and atomization.

We can safely treat mitral valve disease with mitral annular calcification using Sapien 3 valve through the incision of the right side of the left atrium under direct visualization preventing atrio-ventricular disruption and left ventricular outflow tract obstruction.

COVID-19 is the global-pandemic targets human-lung-ACE2 that converts Angiotensin-II to (1-7) peptide causing vasodilatation. Vasoconstriction caused by Angiotensin-II is produced from Angiotensin-I by ACE1. The vaso-status maintains blood-pressure/vascular-health of the individuals which is demolished in Covid-19 infection manifesting aldosterone/salt-deregulations/inflammations/endothelial-dysfunctions/hyper-hypo- tension, sepsis/hypovolemic-shock and vessel-thrombosis/coagulations. These cause comorbidity patients. Here, nigellidine, an indazole-alkaloid was analyzed by molecular-docking for binding to different Angiotensin-binding-proteins (enzymes, ACE1(6en5)/ACE2(4aph)/receptors, AT1(6os1)/AT2(5xjm)) and COVID-19 spike-glycoprotein(6vsb). Data suggest that nigellidine strongly binds to the spike-protein at the hinge-region/active-site-opening which may hamper proper-binding of nCoV2-ACE2 surface. Nigellidine strongly (-7.54 kcal/mol, -211.76, Atomic-Contact-Energy; ACE-value) binds (>known-binderEGCG; -4.53 and Theaflavin-di-gallate; -2.85) in the Angiotensin-II binding-site/entry-pocket at ACE2 with Ki 8.68 and 8.3 µmol. Further, Nigellidine showed strong-binding (best Ki, 50.93µmol/binding-energy -5.48 kcal/mol) to both mono- and multi-meric ACE1-forms. Moreover, this compound binds Angiotensin-receptors, AT1/AT2 (Ki, 42.79/14.22 µmol, binding-energy, -5.96/-6.61 kcal/mol) at active-sites, respectively. Here, we first-time report that nigellidine can block all angiotensin-binding proteins where, the Angiotensin-bonded amino acids were more or less similar/analogous and effectively blocked by nigellidine. The ACEs-blocking could restore Angiotensin-level and restrict vaso-turbulence in Covid-infected patients and receptor-blocking might stop inflammatory/vascular impairment. Further, nigellidine may slowdown the vaso-fluctuations due to Angiotensin deregulations in Covid-infected patients. Angiotensin II-ACE2 binding (ACE-value -294.81) is more favorable than nigellidine-ACE2. Contrarily, nigellidine-ACE1 binding-energy/Ki are lower than nigellidine-ACE2 values indicating a balanced-state between constriction-dilatation. It is also noticed that nigellidine binds to the viral-spike, closer proximity to its ACE2 binding-domain. Taken together, Covid-infected-patients/elderly-patients/comorbid-patients (with hypertensive/diabetic/cardiac/renal impairment, counting >90% of non-survivors) could be greatly benefited.

Objective: Comparison of birthweight references for diagnosing SGA. To provide denominator data for suspicion and diagnosis of SGA. Design: A retrospective cohort study of 10,616 babies. Setting: A regional obstetric centre. Population: 10,616 consecutive newborns, born in Derriford Hospital, University Hospitals Plymouth NHS Trust (UPHT), whilst using the GROW package,1 compared with using Intergrowth 21st (IG21),2 and British 1990 (UK90) references.3 Methods: Statistical analysis of centile data from GROW, IG21 and UK90 references. Main outcomes: Induction rates, detection of suspected and/or diagnosed SGA. Assessment of goodness of fit to the Plymouth population. Results: GROW and IG21 showed bias. GROW had a systematic bias towards smaller centiles (skewness 0.169). IG21 had a systematic bias towards larger centiles (skewness -0.452). UK90 was best fit to the Plymouth dataset with insignificant bias across centiles (skewness -0.047). Conclusions: GROW and IG21 are not appropriate gold standards for our population for allocation of birthweight centile. The size of the population suggests the conclusions may be extrapolatable to other centres. UK90 does not have everyday accessible tools compared with GROW and IG21. A continual local audit of birthweight would be ideal, enabling accurate local centile allocation. If a national SGA screening programme monitoring units’ ability to detect SGA was introduced, it could not start without validated, unit specific birthweight data. Funding: The statistician’s funding was obtained from UHPT Research and Development generic funding.

The ecosystem of tea plantations portrays a special interaction among environment, soil microorganisms and tea trees. Under the influence of environmental factors and human management, the growth, quality, yield of tea trees and the tea leaves may also be dependent upon the changes in the soil microbial community. However, little is known about the composition and structure of soil bacterial and fungal communities in hundred-year-old tea plantations and the mechanisms by which they are affected. In this regard, we characterized the microbiome of tea plantation soils by considering the bacterial and fungal communities in 448 soil samples from 101 ancient tea plantations in eight counties of Lincang city, which is one of domestication centers of tea trees in the world. We applied 16S and ITS rRNA high-throughput sequencing techniques, and found that the effect of pH and altitude changes on the relative abundance of fungal communities was more pronounced than that on bacteria. In terms of the influence of pH and altitude on soil microbial communities, the abundance and diversity of bacterial communities were more sensitive to pH than those of fungi. The α-diversity of bacterial communities peaked in the pH 4.50-5.00 and altitude 2,200 m group, and the highest α-diversity of fungi showed in the pH 5.00-5.50 and 900 m group. While all microbes varied similarly changing with environment and geographies, and further correlations were found that the composition and structure of bacterial communities were more sensitive to latitude and altitude than that of fungal communities.

Background: We developed an integrated triple-branched stent to treat acute DeBakey type I aortic dissection and modified it to enhance its adaptability. However, whether the patients treated by the modified stent would achieve better long-term prognosis is unknown. Methods: This study enrolled 147 patients with acute DeBakey type I aortic dissection. The original integrated triple-branched stents were used in 57 patients (group A) between July 2012 and August 2013, and the modified stents in 90 patients (group B) between September 2013 and March 2015. Clinical characteristics, surgical data, postoperative complications, mortality, and follow-up data of the two groups were analyzed. Results: The two groups presented comparable early death rate (group A=7.0%, group B=5.9%, p=0.719). The incidence of postoperative acute kidney injury was lower in group B (10.0%) vs group A (24.6%) (p=0.018). Compared with the original integrated triple-branched stent graft, the modified stent could reduce the risk of early postoperative acute kidney injury [OR (95%CI)=0.36(0.14, 0.94)]. Early endoleak rate was lower in group B (1.0%) vs group A (9.4%) (p=0.004). During follow-up, there were five deaths in group A (9.4%) and six deaths in group B (7.2%) (p=0.646). Chronic kidney injury (7.5% vs 3.6%, p=0.311), delayed endoleak (11.3% vs 4.8%, p=0.157), and late reinterventions (7.5% vs 2.4%, p=0.155) in the two groups were similar. Conclusions: In patients with acute DeBakey type I aortic dissection, the modified stent could provide feasible and safe treatment outcomes, with better protection of kidney function and reduced early endoleak. However, they had similar long-term effects.

Aims To investigate a modified method of epicardial left atrial appendage (LAA) occlusion under the guidance of thoracoscopy and transesophageal echocardiography (TEE) during radiofrequency ablation of atrial fibrillation. Methods and Results 19 patients with atrial fibrillation underwent left atrial appendage occlusion and atrial fibrillation radiofrequency ablation in two centers under the guidance of thoracoscopy and TEE. All of the surgeries were completed in a general surgery setting, avoiding fluoroscopy, and in each case the entire procedure was guided by TEE. Radiofrequency ablation of atrial fibrillation was performed by Wolf mini-maze. All operations went smoothly with no serious complications. Postoperative TEE indicated that each device was in a good position and there was no residual shunt around any of the devices. Conclusions It is safe and reliable to apply the left atrial appendage closure device to perform epicardial left atrial appendage occlusion guided only by TEE, which is radiation-free. And it can be performed simultaneously during the thoracoscopic radiofrequency ablation of atrial fibrillation.