Classical absent pulmonary valve syndrome (APVS) with tetralogy of Fallot (TOF) is a rare congenital cardiac anomaly commonly associated with absent of patent ductus arteriosus (PDA), which is mostly diagnosed after 20 weeks of gestation by fetal echocardiography. This case of APVS with TOF was suspected at 13 weeks of gestation and diagnosed at 14 weeks of gestation with an obvious PDA. The pulmonary arterial trunk and the branches did not dilated obviously. 15 days later, the PDA narrowed down with the discovery of pulmonary artery ectasia at the same time. This progress indicated that the absent of PDA is not necessary for the survival of APVS with TOF in utero, in contrast, the absent or restriction of PDA may be nothing less than adaptation to the disease. Fetal autopsy confirmed the accuracy of fetal echocardiography. Chromosome microarray analysis (CMA) showed 20p12 deletion in this fetus, which is rare among TOF cases.

For consideration introduced inhomogeneous near the singularity (0, 0) little-studied regular system consisting of two third-order partial differential equations. Distinctive features of constructing a general solution of an inhomogeneous system are installed. A number of specific systems are highlighted from the corresponding generalized homogeneous system of hypergeometric form. For them established a common method for constructing a solution and have been determined the number of linearly independent particular solutions, at the same time regularity conditions are found near the singularity (0, 0) and compatibility conditions as well as integrability. The Frobenius-Latysheva method shows the features of constructing general and particular solutions of a homogeneous Clausen system. Constructing a general and particular solutions of nonhomogeneous system Clausen and one partial differential equation of the third order obtained by adding the two equations nonhomogeneous system shown Clausen method of undetermined coefficients.

Acute pulmonary embolism (APE) is a life-threatening disease. Rapid and accurate diagnosis is crucial for the clinical management.We report a case of a 74-year-old man diagnosed intermediate-risk APE as several pulmonary emboli in pulmonary artery were seen in multidetector computed tomographic pulmonary angiography with normal blood pressure and echocardiographic right ventricular overload. And we found a pulmonary artery clot in the right pulmonary artery through transthoracic echocardiography by using a new view. The view could provide correct diagnoses by identifying the clot size and location visually. Knowledge of the echocardiography results of APE would aid the diagnosis.

         Hypatia fikirleriyle ve öğrenmeye olan aşkıyla döneminin tüm baskılarına rağmen hayatı sorgulamaktan asla vazgeçmeyen, İskenderiye’nin sönen ışığıydı. Dünya tarihinin gelmiş geçmiş en büyük ve değerli kütüphanelerinden biri olan İskenderiye Kütüphanesi yağmalanırken tek bir parşömen parçası için bile canını feda etmeye hazır matematikçi Hypatia’nın hayatı, 2009 yılında Agora filmiyle beyaz perdeye taşındı. MMMT olarak bu yazımızda filmi izlerken dikkatimizi çeken noktalara değinmeye çalıştık. 

Objectives: The ongoing outbreak of novel coronavirus (2019-nCoV) infection (COVID-19) has been declared as a global pandemic by the World Health Organization. It is a highly contagious disease that poses a grave threat to human health. Dental practice involves close contact with the airway and dental procedures entail generation of intense aerosol sprays; the virus particles can survive within small droplets in the air for several hours. Thus, dental practice is associated with a high risk of cross infection. This article describes the patient management process and its performance at the outpatient department of a specialized dental hospital during the COVID-19 epidemic in Xi’an, China. The objective is to provide a reference for management protocols for dental clinics and dental specialty centers across the world. Methods: A specialized management protocol for staff, patients, and material management for dental clinic during the epidemic was implemented since February 3 2020. The numbers of outpatient visits, distribution of oral diseases, demographic characteristics of patients, and COVID-19 infection among patients and staff from February 3 to March 15 are described. Results: The management protocols at the dental clinic were tailored according to the level of national emergency response for COVID-19. The number of physical consultations at the hospital was effectively controlled with use of online consulting service. Dental emergency patients were managed safely. Conclusion: The management protocol and infection prevention and control strategies adopted at our institution are effective in treating dental emergencies while controlling the spread of COVID-19 virus in oral clinics.

We report the successful surgical closure of right pulmonary artery to left atrium fistula (RPALAF) with secondary atrial septal defect (ASD) in 3.5 years old girl, who had suffered with central cyanosis and exertional dyspnea.

Aberrant common hepatic artery originating from the left gastric artery without connecting the gastroduodenal artery is extremely rare. In gastrectomy, accidental ligation or injury of the aberrant common hepatic artery can lead to hepatic arterial ischemia. Reconstructions of CT images may be useful to avoid complications related to vascular anomaly.

A 30-year-old female with clinical manifestations of palpitations and goiter was admitted to our department of endocrinology. Laboratory tests showed elevated thyroid hormone with non-suppressed TSH. Genetic analysis identified heterozygous mutation of the THRB exon10 c.G1378A (p.E460K). The proband’s kindreds had the same mutation, but their clinical manifestations were different.

The kidneys are normally blooded from renal artery that anatomically originates from the abdominal aorta. However, there are accessory polar artery variations. Incidence varies ranges from 11.3% to 59.5% depending on ethnicity. We also wanted to show two different cases of accessory polar renal artery (APRA).

The Paradigmatic Shift Towards Research Impact in the AcademyIn the last four decades there has been increased emphasis for faculty to show and effectively expand the impact of their Academic Research Work*. This trend has occurred nationally, internationally, and is expected to persist through recent national and international events. There are now summits and conferences such as the National Alliance for Broader Impacts Summit (NABI) now called Advancing Research in Society (ARIS) in the United States (US) and International Impact for Science, Humanities, and Social Science Conferences. Many of these international conferences that focus on pushing forward the impact agenda are facilitated by The Network for Advancing & Evaluating the Societal Impact of Science (AESIS).There is rapid proliferation of both new businesses and independent organizations that focus on helping others manage and maximize the impact of their research. These businesses and organizations range from assessment to communications and scholarship, to training individuals on how to extend the reach of their research work. Some examples of these are: Knowledge Translation Australia by Tamika Heiden who also facilitates the largest online impact summit; Jenny Ames Consulting Ltd in the United Kingdom (UK) by Jenny Ames; Institute for Knowledge Mobilization and Peter Norman Levesque Consulting in Canada by Peter Levesque; and Broader Impacts Productions, LLC in the United States (US) by Kirsten Sanford.Simultaneously, impact blogs and blogging have increased in number over the last ten years. These impact blogs are also increasingly gaining support and recognition in the Academy. For example, one of these is the London School of Economic and Political Science (LSE) Impact Blog. The LSE Impact blog is based in the LSE Communications division and is financially supported by the HEIF5 program ran by LSE Knowledge Exchange.Evidence of this paradigmatic shift can also be seen by the number of societal benefitting-like terms, names and phrases now being used around the world. Many of these terms, names, and phrases have been contextualized for maximizing the impact of academic research. These include but are not limited to phrases, terms, and concepts such as: Capacity Building in Africa; Equity in Development in India; Broader Impacts, Broader Implications, Collective Impact, and Relevant or Ultimate Outcomes in the US; the Engagement and Impact Assessment (EI) Framework and Knowledge Exchange in Australia; Knowledge Mobilization in Canada; Valorization in the Netherlands; Harmonious Development in South America; Economic & Social Development and Influence in China; and the Research Excellence Framework (REF) in the European Union. Almost every country, roughly eighty-two percent (82%), uses a societal-benefit name, term, phrase, or concept that indicates ARI is important. This is accompanied by the growing number of professionals and positions to address and actionize these concepts, names, and phrases in academic institutions, agencies, organizations, and governance. For example, there is Susan Renoe, Director of NABI and ARIS who started The Connector formally called the Broader Impacts Network (BIN) in the US; David Phillips who leads an award-winning Knowledge Mobilization Unit in Canada; Julie Bayley who is the Director of Impact Development and Mark Reed who is a professor and transdisciplinary researcher specializing in environmental governance and research impact in peatlands and agri-food systems both in the UK; and Emma Johnston who initiated a Science for Impact Center in Australia focusing on Knowledge Exchange.In addition, some ranking organizations have started to include Overall Impact on Society (OIS) metrics to rank universities and colleges. This includes how university’s and college’s research are benefiting society. For example, in 2019 “THE WORLD University Rankings” facilitated by Times Higher Education, provided their first ever rankings specifically focused on University’s and College’s Impact on Society. These impact rankings are based on the United Nations (UN) seventeen (17) Sustainable Development Goals (SDGs) provided in Figure 1.

Since chromatographic separation is a dynamic process, with the interactions between the drug and the chiral stationary phase mediated by the solvent, no single interacting structure, such as could be found by minimizing the energy, could possibly describe and account for the ratio of residence times in the chromatographic column for the enantiomeric pair. We describe the use of explicit-solvent fully atomistic molecular dynamics simulations, permitting all the interactions between the atoms constituting the chiral stationary phase, solvent molecules and the drug molecule. This allows us to better understand the molecular dynamic chiral recognition that provides the discrimination which results in the separation of enantiomers by high performance liquid chromatography. It also provides a means of predicting, for a given set of conditions, which enantiomer elutes first and an estimate of the expected separation factor. In this review we consider the use of molecular dynamics towards this understanding and prediction.

In this note, we introduce one basic concept in nonlinear optical spectroscopy: time-dependent Hamiltonian. Then we give one example of application of the time evolution operator.

Cervical lymphadenopathy is a very common complaint for patients presenting to an endocrinology clinic. This case highlights common locations that malignancy presents at as well as their ultrasound characteristics.

Background: Lung ultrasound (LUS) has been successfully used in the diagnosis of different pulmonary diseases. Present study design to determine the diagnostic value of LUS in the evaluation of children with COVID-19, and to compare chest X-ray and LUS results with tomography (CT).   Method and objectives: In this prospective multi-center study, 40 children with confirmed COVID-19 were included. LUS was performed to all patients at admission. The chest X‐ray and CT were performed according to the decision of the primary physicians. LUS results were compared with chest X-ray and CT. The sensitivity and specificity and diagnostic performance was determined. Results: Of the 40 children median (range) was 10.5 (0.4-17.8) years. Chest X-ray and LUS were performed on all and chest CT was performed on 28 (70%) patients at the time of diagnosis. Sixteen (40%) patients had no apparent chest CT abnormalities suggestive of COVID-19, whereas 12 (30%) had abnormalities. LUS confirmed the diagnosis of pulmonary involvement in 10 out of 12 patients with positive CT findings. LUS demonstrated normal lung patterns among 15 patients out of 16 who had normal CT features. The sensitivity identified by the chest X-ray and LUS tests was comparedand statistically significantly different (p=0.016). Chest X-ray displayed false-negative results for pulmonary involvement in 75% whereas for LUS it was 16.7%. Conclusions: LUS might be a useful tool in the diagnostic steps of children with COVID-19. A reduction in chest CT assessments may be possible when LUS is used in the initial diagnostic steps for these children.

Basin scale simulation is essential to understand the hydrological cycle, specify essential information for water management, for this reason the applicability of the Soil and Water Assessment Tool (SWAT) model is evaluated to simulate runoff in the semiarid basin of the River Tambo (Peru), due to the most economic activities are driven by available water. To achieve the objective of the study, SWAT model was configured using the basin properties such as soil type, digital reduction model, land use, meteorological information such as temperature, temperature of the network of meteorological stations (SENAMHI). The SWAT model was calibrated using the SUFI-2 algorithm for the periods from 1994 to 2001, with 3 years of warming and validated from 2002 to 2016 using daily river discharges. The results during the daily and monthly calibration period had Nash-Sutcliffe Simulation Efficiency (NSE) of 0.69 and 0.86, Determination Coefficient (R2) of 0.70 and 0.87, Percent bias (PBIAS) of -14.4 and Ratio of standard deviation of the observation of the root mean square error (RSR) of the root of 0.55 and 0.37, respectively. For the daily and monthly validation period, they had NSE of 0.52 and 0.70, R2 of 0.67 and 0.87, PBIAS of -6.1 and RSR of 0.69 and 0.55, respectively. These results indicate that the SWAT model has the ability to predict current flows within the river basin of the Tambo Valley in southern Peru, being a useful tool for a more detailed analysis of the effects of climate change, change of land use, water quality analysis and sediment performance analysis.

Purpose: The purpose of this study is to analyze the possible mediator effect of mindfulness in the relationship between perceived stress and quality of life in pediatric asthma. Methods: The sample of this study consisted of 100 asthmatic children aged between 9-12 years who applied to İstanbul University İstanbul Medical Faculty Hospital’s “Child Allergy Policlinic”. Sociodemographic information forms, Perceived Stress Scale in Children (8-11 years), Child and Adolescent Mindfulness Measure (CAMM) and Pediatric Asthma Quality of Life Questionnaire (PAQLQ) were used as data collection tools. Results: Linear hierarchical regression analysis was used during the process of analyzing data. It has been identified that mindfulness has a partial mediator role, in the relationship between perceived stress and quality of life (p=-,474), in the relationship between perceived stress and symptoms which is the subscale of quality of life (p=-,399) and in the relationship between perceived stress and emotional function (p=-,514) which is the quality of life’s subscale. The mediating role of mindfulness in the relationship between perceived stress and activity limitations could not been inspected due to the lack of a significant correlation between activity limitations which is subscale of quality of life and mindfulness (p=,136). Conclusions: When all these findings are evaluated, it might be beneficial for experts dealing with pediatric asthma to add psychotherapy interventions involving mindfulness practices to the treatment of the disease.

Valve-in-valve transcatheter aortic valve replacement (VIV TAVR) has been recently utilized as an alternative for prohibitive surgical risk patients with aortic insufficiency of the native valves. When using this approach, placing a single bioprosthetic valve could possibly leave the patient with persistent significant aortic insufficiency. Based on these circumstances, we developed an approach where we place a second TAVR valve within an already positioned valve to achieve an appropriate result. We present two cases of an elective VIV TAVR in a TAVR valve in cases of aortic insufficiency.

Aims: The storm-like nature of the health crises caused by COVID-19 has led to unconventional clinical trial practices such as the relaxation of exclusion criteria. The question remains: how can we conduct diverse trials without exposing sub-groups of populations to potentially higher drug exposure levels? The aim of this study was to build an extensive knowledge-base of the effect of intrinsic and extrinsic factors on the disposition of several repurposed COVID-19 drugs. Methods: Verified physiologically‐based pharmacokinetic (PBPK) models were used study the effect of COVID-19 drugs PK in geriatric patients, race, organ impairment, DDI risks, disease-drug interaction for repurposed COVID-19 drugs. Furthermore, these models were used to predict epithelial lining fluid (ELF) exposure which is relevant for COVID-19 patients by accounting for the interplay between cytokines and metabolic disposition. Results: The simulated PK profiles suggest no dose adjustments are required based on age and race for COVID-19 drugs; however, sometimes dose adjustments are warranted for patients exhibiting hepatic/renal impairment in addition to COVID-19 co-morbidity. PBPK model simulations suggest ELF exposure to attain a target concentration was adequate for most drugs except azithromycin, atazanavir and lopinavir/ritonavir. Conclusion: We demonstrate that systematically collated data on the ADME, human PK parameters, DDIs, and organ impairment has enabled verification of simulated plasma and lung tissue exposure of many repurposed COVID-19 drugs to justify broader recruitment criteria for patients. In addition, developed PBPK model helped to assess the correlation between target site exposure to relevant potency values from in vitro studies for SARS-CoV-2.

Background Stroke remains a devastating complication of cardiac surgery. The aim of this study was to characterise the incidence of stroke and analyse the impact of stroke on patient outcomes and survival. Methods A retrospective analysis was performed of patients with a CT-confirmed stroke diagnosis between 01/01/2015 and 31/03/2019 at a single centre. 2:1 propensity matching was performed to identify a control population. Results Over the period 165 patients suffered a stroke (1.99%), with an incidence ranging 0.85% for CABG to 8.14% for aortic surgery. The mean age was 70.3 years and 58.8% were male. 18% had experienced a previous stroke or TIA. Compared to the comparison group, patients experiencing post-operative stroke had a significantly prolonged period of ICU admission (8.0 vs 1.1 days p<0.001) and hospital length of stay (12.94 vs 8.0 days p<0.001). Patient survival was also inferior. In-hospital mortality was almost 3 times as high (17.0% vs 5.9%; p<0.001). Longer-term survival was also inferior on Kaplan-Meier estimation (p<0.001). The 1-year and 3-year survival were 61.5% and 53.8% respectively compared to 89.4% and 86.1% for the comparison group. Conclusion Perioperative stroke is a devastating complication following cardiac surgery. Perioperative stroke is associated with significantly inferior outcomes in terms of both morbidity and mortality. Notably a 28% reduction in 1-year survival. The potential to reduce morbidity and mortality with the emergence of mechanical thrombectomy, demonstrates the need for clear links between cardiothoracic and stroke teams to support individuals affected by perioperative stroke.

Diverse algae possess vegetative desiccation tolerance, the ability to recover from extreme desiccation without forming specialized resting structures. Green algal genera such as Tetradesmus (Sphaeropleales, Chlorophyceae) contain both terrestrial and aquatic species, providing an opportunity to compare physiological traits associated with the transition to land in closely related taxa. We subjected six species from aquatic and terrestrial habitats to three desiccation treatments varying in final relative humidity followed by short- and mid-term rehydration. We tested the capacity of the algae to recover from desiccation using the effective quantum yield of photosystem II as a proxy for physiological activity. The degree of recovery was dependent both on the habitat of origin and the desiccation scenario, with terrestrial, but not aquatic species, recovering from desiccation. Distinct strains of each species responded similarly to desiccation and rehydration, with the exception of one aquatic strain that recovered from the mildest desiccation. Cell ultrastructure was uniformly maintained in both aquatic and desert species during dehydration and rehydration, but staining with an amphiphilic styryl dye indicated desiccation-induced damage to the plasma membrane in the aquatic species. These analyses demonstrate that terrestrial Tetradesmus possess the vegetative desiccation tolerance phenotype, making these species ideal for comparative omics studies.

Fluvoxamine, a usual SSRI antidepressant, has agonistic activity on Sigma-1 receptors in ER and inhibits IRE1, an important trigger of cytokine production; Sigma-1 receptor is a target of SARS-COV-2 protein Nsp6 and may start the cytokine storm. The available Sigma-1 agonists may represent important alternatives to treat the cytokine storm and save lives.

Objectives To determine the frequency by neck level of clinically known and occult lymph node metastasis in p16 positive oropharyngeal squamous cell carcinoma (p16+ve OPSCC). Design Retrospective study of 61 patients with p16+ve OPSCC whom had neck dissection and prior or simultaneous trans-oral surgery. Histopathology reports of neck dissection specimens were compared to preoperative clinical and radiological reports to determine the distribution of clinically known and occult nodal disease at each neck level and its concordance with preoperative findings. Positive and negative predictive values for pathological nodal disease (pN+ve or pN0) were assigned to clinically assessed node-positive (cN+ve) or node-negative (cN0) status at each neck level. Setting Single tertiary referral centre in the UK Participants 61 patients with p16+ve OPSCC with no prior head and neck cancer treatment. Main outcome measures Clinical, radiological, and pathological findings of nodal disease in the neck. Results Two-hundred individual neck level specimens were analysed. Seventy-seven levels were considered cN+ve, of which 83.1% (64/77) were also pN+ve. One hundred and twenty-three levels were considered cN0 of which 13% (16/123) were proven as pN+ve, demonstrating occult disease across various levels. This occult disease was identified in level II in 7 patients, level III in 6 patients and level IV in 3 patients, with no occult disease seen in cN0 level I or V. Conclusions These findings augment existing limited data on the distribution of occult nodes in OPSCC specific to p16+ve disease and reaffirm the rationale for dissecting at least levels II-IV in any cN0 neck.

Multi-level uniaxial fatigue loading experiments were carried out to reveal the fracture and energy evolution of naturally fractured granite using stress strain descriptions and post-test computed tomography (CT) technique. Results reveal the influence of natural fracture on mechanical properties of granite, regarding the fatigue lifetime, fatigue deformation characteristics, fatigue damage, energy evolution and fatigue failure pattern. Volumetric and shear processes caused by the sliding and shearing along the natural fracture control the whole failure process. The energy dissipation and releases characteristics are strongly impacted by natural fractures. The elastic energy and dissipated energy both decrease with increasing natural fracture volume, growth of the dissipated energy becomes faster for rock near to failure. Post-test CT scanning reveals the crack pattern, and failure changes from tensile mode to shear mode with the increasing natural fracture volume. It is proved that the dissipated energy is mainly used to activate the pre-existing natural fractures.

Introduction Fine needle aspiration cytology (FNAC) forms part of the routine workup for suspicious thyroid nodule. Whilst cytological analysis is less precise than histological assessment, it is quick and easy to perform and may avoid the need for invasive and potentially risky surgery. Methods This retrospective study spanning a 10-year period compared pre-operative FNAC with post-operative histology results to establish the accuracy of diagnosis and malignancy rates within our population. These results were then compared to the published figures in the literature. Results The histological reports of 659 consecutive cases of thyroid surgery between 2006 and 2015 were retrieved from our hospital’s database. Among the 471 patients (71.5%) who underwent preoperative FNAC, the postoperative histology was reported as benign in 352 (74.7%) and malignant in 119 cases (25.3%). PTC was the commonest histological diagnosis. Thy1 grade was reported in 165 (30%) cases, with 19.4% had a final histological diagnosis of malignancy. 85.3% of patients in the Thy2 group had a benign final histological diagnosis, while 14.7% had malignancy (false negative results). Malignancy was found in 89% of Thy4 and 100% of Thy5 group patients. Conclusions Rates of malignancy varied considerably from those in the published literature. Each centre should be able to quote a local malignancy rate during patient counselling. It is also prudent for all units performing thyroid diagnostics to investigate the factors that might lead to inaccuracies in reporting.