Objectives: To study clinical profile of obstetric patients admitted to intensive care unit and to analyze the relation of demographic factors like age, parity, literacy level, socio economic status, APACHE 2 score and level of delay with fetomaternal outcome. Design: Prospective Cross sectional Observational Setting and Population: Obstetric Admissions to ICU of tertiary hospital in North India Methods: After admission to ICU a detailed history, analysis of basic demographic variables along with level of delay was done. APACHE II score was calculated. These parameters were correlated with fetomaternal outcome. The Chi-square test was used to compare categorical variables. The one-way analysis of variance was used to compare the continuous variables among the strata with Tukey’s post hoc test. Outcome: Prolonged ICU stay, maternal mortality, perinatal morbidity, perinatal mortality and long hospital stay. Results: Incidence of obstetric ICU admission was 0.77%. Mean age was 26.03years. Most common indication of ICU admission was obstetrical hemorrhage (37.1%) followed by hypertensive disorders of pregnancy (25.8%). Type 1 delay was the most common followed by type 2 delay. Mean APACHE II score was 14.77±6.85. Observed mortality rate (30.6%) was found to be higher than predicted mortality rate (25%). APACHE II score was significantly high in the presence of level 1 (p=0.003) and level 2 delay (p=0.0001). Also, it was significantly increased with the duration of delays. Conclusion: Unbooked and referred cases had high incidence of ICU admission. Presence of delay was associated with poor outcome

Aims: The aim of this double-blind randomized clinical trial was to determine the effects of FBX in comparison with hydroxychloroquine (HCQ) on clinical symptoms, laboratory tests and chest CT findings in patients with COVID-19-causing moderate symptomatic disease. Methods: We conducted a randomized, double blind clinical trial involving adult outpatients’ patients with COVID-19 infection, which causes the moderate respiratory illness. Sixty patients were randomly assigned to receive either FBX or HCQ for 5 days. The measured variables were clinical and laboratory data including rate of fever, cough, berating rate, C-Reactive Protein level, lymphocytes count at onset of admission and was well as at 5 days of treatments. In addition, CT lesions were evaluated on admission and 14 days of treatments in both groups. Results: Fever, cough and tachypnea significantly mitigated in both groups after five days of treatments. The lymphocytes count significantly increased in both treatment groups and the CRP values were dropped in normal range (negative) in major of patients receiving FBX or HCQ treatment. It was not observed any significantly difference between FBX and HCQ in frequency of these symptoms. The mean percentages of CT abnormality scores were significantly reduced to 7.3% and 8% after 14 days of FBX and HCQ treatments, respectively. In adult outpatients with moderate symptomatic Covid-19, the effectiveness of FBX was same to HCQ in improvement of clinical manifestations, laboratory tests and CT lesions. Conclusion: These findings suggest FBX as an alternative treatment for Covid-19 infection in patients with contraindication or precaution to HCQ.

Background and Aims: Mutations of the NT5E gene encoding the cluster of differentiation 73 (CD73) protein have been found in patients with characteristic calcification of joints and arteries (CALJA). CD73 plays a protective role against aortic valve calcification and its deletion results in aortic valve calcification. However, there have been no reports of a patient with CALJA with aortic stenosis. Methods: We describe two extremely rare cases of two sisters with identical NT5E gene mutation patterns, both of whom presented severe aortic stenosis and limb ischemia. Genetic examination for definitive diagnosis was also performed in both patients. Results: Both patients underwent aortic valve replacement and bilateral distal arterial bypass surgeries successfully. They were genetically diagnosed with CALJA based on the NT5E mutation. Conclusions: NT5E mutation should be considered in patients requiring aortic valve replacement for a calcified aortic valve and bypass surgery for specific calcified and occluded arteries.

We report a case of a 17-year-old healthy male presenting with multisystem hyperinflammatory shock temporally associated with COVID-19. Cardiac involvement was suspected based on evidence of significant cardiac injury (elevated cardiac biomarkers, electrocardiographic and echocardiographic abnormalities). Cardiac magnetic resonance imaging was performed demonstrating global biventricular systolic dysfunction, as well as a small area of T2 hyperintensity and mid wall late gadolinium enhancement. This case discusses the varied cardiac involvement in pediatric patients with COVID-19 infection and highlights that cardiac injury is not just limited to hyperinflammatory syndrome related global dysfunction but a more focal myocarditis can also be seen.

Background Pediatric anticancer drug development has numerous challenges. Pediatric Research Equity Act (PREA) and the Best Pharmaceuticals for Children Act (BPCA), has been put forth to address the deficiency in pediatric drug development in general. Until recently, the requirement for pediatric evaluation of most oncology products for adult cancers was waived, because children typically do not have adult-type cancers or the indication or drug had been granted orphan designation. PREA therefore had no impact. Pediatric studies for labeling updates are largely done through BPCA by a Written Request (WR), issued by FDA. Because pediatric and adult populations do not share the same biology, natural history, or disease progression, there are limited opportunities to extrapolate adult information to pediatric. The requirements for the pediatric studies can vary greatly. Procedure In this study, we searched WRs that were issued by the FDA since 2001. We found 42 requests for pediatrics in oncology drugs and biologics. Results Studies included in 25 of the WRs have concluded, 18 have been given exclusivity, and 4 drugs have been approved for use in pediatric populations. The current status of the WRs are presented from regulatory, study design, dosing, formulation, analysis plan, evidential standard of efficacy and safety. Conclusions This would serve the purposes to study what has been requested over the years and what have been completed in response to the requirements. We consider this to be the anchor of pediatric cancer development for current stage and can potentially provide insight on how pediatric cancer drug development would change for the future years.

This is the first report of marked improvement of oral intake by third-line nivolumab monotherapy in a gastric cancer patient with insufficient oral intake and European Cooperative Oncology Group performance status 2. We should consider immune checkpoint inhibitors for microsatellite instability-high gastric cancer, regardless of the patient's general condition.

We report a case of perforation of the superior vena cava caused by a multi-lumen central venous catheter. Diagnosis was delayed because extra-corporeal blood flow was not interrupted. Clinicians should be aware of potential vascular complications associated with multi-lumen catheters even in cases in which hemodialysis continues with no complications.

Background: Elephant trunk repair of the aortic arch cannot be performed with a branched prosthesis. We conceived two different modifications of the original technique to perform an arch replacement with a branched graft, while arranging an adequate landing zone for a subsequent TEVAR, without the need of dedicated material. Methods: Eight consecutive patients underwent arch replacement with one of our techniques. Five were emergency patients with acute aortic dissection, and 3 suffered chronic expansive disease. The “modified elephant trunk” includes a separate anastomosis of an endo-luminal prosthetic segment in the descending aorta. Subsequently, the branched arch prosthesis is anastomosed to the distal aortic stump with the attached trunk. In the “prophylactic debranching”, a tail is left on the distal end of the arch prosthesis, so that the branches for the supra-aortic vessels will remain displaced proximally, allowing a “zone 1” available for landing. Results: Three patients experienced transient cerebral deficits (1 TIA and post-operative delirium in 2 cases), 1 required re-operation for bleeding and 2 needed prolonged intubation. One died for multi-organ failure. Conclusion: Both techniques proved to be easily reproducible, and allow an adequate landing zone for a subsequent endovascular procedure, while keeping the advantages of using a tetra-furcated prosthesis. They are a viable alternative in case a hybrid prosthesis cannot be implanted.

Theoretical and empirical studies have shown that species radiations are facilitated when a trait under divergent natural selection is also involved in sexual selection. It is yet unclear how quick and effective radiations are where sexual selection is unrelated to the ecological environment. We address this question using grasshopper species of the genus Chorthippus, which have evolved strong assortative mating while lacking noticeable eco-morphological divergence. Mitochondrial genomes suggest that the radiation is relatively recent, dating to the mid-Pleistocene, which leads to extensive incomplete lineage sorting throughout the mitochondrial and the nuclear genomes. Nuclear data show extremely low genomic differentiation among species, yet hybrids are absent in sympatric localities. Demographic analyses shed some light into these seemingly contradictory patterns. The estimated demographic model shows a long period of geographic isolation, followed by secondary contact and extensive introgression. This suggests that an initial period of geographic isolation might favor the coupling of male signaling and female preference, which currently maintains species boundaries in the face of long-term gene flow. More generally, these results suggest that sexual selection can lead to radiations without a primary role of divergent natural selection, resulting in cryptic species that are genetically, morphologically and ecologically similar, but otherwise behave mostly as good biological species.

The microstructure and precipitate characterizes in the API X90 hot bend related to mechanical properties was investigated by OM, TEM, EBSD and mechanical tests. X90 pipeline steel is consist of quasi-polygonal ferrite (QPF), acicular ferrite (AF), lath bainite (LB) and a small amount of M/A constituents. The width of bainite lath is about 0.2 ~ 0.3 μm. After hot induction bending, hardly observe AF in the bend zone. In the outer arc side, the width of LB was coarsened to 0.53 ~ 1.34 μm, and sharp M/A constituents formed along the prior austenite grain boundaries. Compared to the parent pipe, the strength of X90 bend decreased 30 ~ 80 MPa, and the Charpy impact energy increased 20 J. The outer arc side with the weakest low temperature impact toughness, is 153 J. The main component of the precipitate is NbC with a small amount of TiC, possibly (Ti, Nb) C, and the size is about 15nm. The fraction of the high angle grain boundaries (HAGBs) and the kernel average misorientation (KAM) value of the outer arc side is 21% and 0.62 ° respectively, which is the higher than the other positions.

The performance of a series of density functionals has been tested for the insertions of ethylene, methyl acrylate (MA), and vinyl bromide (VB) catalyzed by α-diimine palladium complexes. Sixty-seven density functionals are screened, and the results are compared with available experimental data. Eleven hybrid functionals (M06, BHandH, mPW1PW91, HSEh1PBE, mPW3PBE, LC-ωPBE, mPW1PBE, PBE0, M06-HF, M06-2X, M05-2X) showed better performance in the insertions of both ethylene and MA, and could be therefore suitable for ethylene-MA copolymerization. Meanwhile, three GGA (PW91PW91, HCTH, HCTH407), two meta-GGA (TPSSTPSS, tHCTH), and ten hybrid functionals (M06, BHandH, TPSSh, B971, B98, B1B95, PBE0, M06-2X, tHCTHhyb, M05-2X) perform well in the ethylene-VB copolymerization. Besides, nine D3 or D3BJ augmented functionals are found to be suitable for both copolymerization systems. The D2 dispersion correction overestimated insertion energy barriers of these monomers and is unsuitable for such copolymerization. In addition, the double-zeta basis set is found to be sufficient for solvation single-point calculation of these systems.

Background: Endoscopic methods, especially the intragastric balloon (IGB), have been shown to be effective for the treatment of excess weight. This study aimed to assess the tolerance, complications and efficacy of excess weight treatment with a non-adjustable IGB during 6 months. Methods: A total of 5,874 patients treated with a liquid filled IGB (600-700mL) and followed up by a multidisciplinary team were evaluated.  Participants presented an initial body mass index (BMI) ≥25 kg/m2 and were stratified according to sex and degree of overweight (pre-obesity and obesity grade I, II and III).  Results: The incidence of complications was 7.32% (n=430): 6.10% (n=357) early IGB removal, 0.20% (n=12) gas production inside the balloon, 0.54% (n=32) leakage, 0.32% (n=19) pregnancy, 0.07% (n=4) gastric perforation, 0.05% (n=3) upper digestive bleeding,  0.01% (n=1) Wernick Korsakoff syndrome due to excessive vomiting, 0.02% each (n=1) pancreatitis and esophagus perforation. The 5,444 remaining patients (4081 women, 38±38years) presented a weight loss of 19.13±8.86kg and a BMI decreased significantly (p<0.0001) (36.94±5.67 vs. 30.08±5.06 kg/m2). The % total weight loss (%TWL) was 18.42±7.25% and % excess weight loss (%EWL) 65.66±36.24%. The treatment success rate (%TWL≥10%) was 85%. The %EWL was higher in the pre-obese group (122.19%), followed by obesity grades I (76.67%), II (56.01%) and III (45.45%), with p<0.0001 for each group. %EWL was higher in women (69.71%) than in men (53.39), with p<0.0001 for each group. There was also a statistical difference between the TWL and EWL groups, with p<0.001 for all analyzes. Conclusion: Endoscopic IGB treatment for excess weight is an excellent therapeutic option for patients with different degrees of overweight. Keywords: Intragastric balloon. Orbera balloon. Bariatric endoscopy. Endoscopic. Obesity treatment.

Their radically large brains and obligate bipedalism set humans apart from the rest of the primates. These features are studied in conjunction with their relationship to obstetric practices found universally in modern humans but hypothesized also to have emerged in Australopithecus. Given the emergence of modern-human obstetric practices as necessary for maternal-and-infant survival during parturition, I hypothesize that birth assistance must in the prehistoric past have become indispensable to the ongoing evolution of bipedalism and a big brain in the human lineage. Beginning at a critical point in our prehistoric past, obstetrics began giving humans both bipedalism and big brains.

In the present study, green tea extract was encapsulated in liposomes prepared by Mozafari method (without any organic solvents) and characterized for its physicochemical properties e.g. encapsulation efficiency, particle size and z- potential. The obtained results for encapsulation efficiency, particles size and z- potential were 51.34, 419 nm and -57 mV, respectively. Total polyphenol content of green tea was obtained 164.2 mg gallic acid /g extract. Free radical scavenging activities of free and liposomal extract, with using DPPH method were measured 90.6% and 93.37% respectively. Antioxidant activity of ethanolic extract of green tea in free and liposomal form were measured at concentration of 200, 600 and 1000 mg/L on the oxidative stability of canola oil during 60°C temperature for 0, 4, 8, 12, 16, 20, 24, 28 and 32 days. The results compared with synthetic antioxidant butylated hydroxytoluene at 200 mg/L. To evaluate antioxidant activity on canola oil stability, peroxide value, Thiobarbitoric acid, anisidine value, TOTOX and rancimat test measured. Results showed that liposomal green tea extract acted more effective than free extracts. Also, 600 mg/L concentration of green tea extract showed significant antioxidant activity in compare to others. The increasing storage time and different concentrations of ethanolic green tea extracts had significant effects on canola oil stability (P≤0.05). The obtained results showed green tea extract could act as an effective antioxidant. Green tea extract in free and liposomal form at 600 mg/L concentration resulted stronger function than butylated hydroxytoluene synthetic antioxidant.

Objective: To determine the risk of thrombocytopenia on postoperative complication following hysterectomy for benign indications. Design: Retrospective Cohort Setting: American College of Surgeons National Surgical Quality Improvement database. Population: Women undergoing hysterectomy by any route between 2014 and 2018 Methods: Patients stratified into three groups: normal platelet count, mild thrombocytopenia defined as a platelet count between 100 – 149 x 103 per microliter, and moderate thrombocytopenia defined as a platelet count between 50 x 99 x 103 per microliter. Three group comparison was performed using Kruskal-Wallis. If results were found to be statistically significant, then pairwise analysis was performed between reference group (normal platelet count) and experimental groups (mild and moderate thrombocytopenia). Pairwise comparison was performed using the Wilcoxon rank-sum test, Student’s t-test or Fisher’s exact test where appropriate. Multivariable logistic regression was used to determine the relationship between mild and moderate thrombocytopenia and the main outcome measures. Main Outcome Measures: Postoperative transfusion, infectious morbidity, readmission, reoperation, operating time and duration of hospitalization. Results: Moderate thrombocytopenia was associated with an increased risk of perioperative transfusion (aOR=2.87, 95%CI: 1.96-4.21) and reoperation (aOR=4.03, 95%CI: 1.94-17.33) while mild thrombocytopenia was not. The risk of infection increased with both mild and moderate thrombocytopenia, (aOR=1.38, 95%CI 1.12-1.69) and (aOR=2.00, 95%CI:1.23-3.22). Thrombocytopenia did not increase the risk of readmission, prolonged hospitalization or longer operating time. Conclusion: Thrombocytopenia is associated with increased infectious morbidity after hysterectomy, and moderate thrombocytopenia is associated with an increased risk of perioperative transfusion and reoperation.

Coronavirus (COVID-19), as a respiratory disease, has become a serious globally issue (December 2019), China. There is a strong immunenutrition relationship with the respiratory viruses as coronavirus. Moreover, a decline in the immunity function is regularly inevitable with poor micronutrient, inflammation and the declining (T cell) function. Nutrition weapon can be one of the main factors for immune response activation. Therefore, there is a globally necessary need to join hands for human survival. This report focuses on the recommendations for maintaining an efficient immune system during quarantine are; getting balanced healthy food, supplements and planning meal times accompanied by light sports for immune cell triggering and functional expression against coronavirus.

Novel coronavirus (COVID-19) outbreak infections have posed a considerable impendences globally, while millions of infections and thousands of death rates are gradually reported day by day. Due to the instant absence of vaccine, it is extremely necessary to find out unconventional, ecofriendly and effective approaches to control/prevent the further spreading of this serious infection. The present article expresses the potential nutritional recommendations from prevention of novel Covid-19 pandemic infection. It also provides facts about the bioactive ingredients of special supplements, foods and herbs for human immune system reinforcement against the infection.

Microbial-based biostimulants can improve crop productivity by modulating cell metabolic pathways including hormonal balance. However, little is known about the microbial-mediated molecular changes causing yield increase. The present study elucidates the metabolomic modulation occurring in pepper (Capsicum annuum L.) leaves at the vegetative and reproductive phenological stages in response to microbial-based biostimulants containing the arbuscular mycorrhizal fungi Rhizoglomus irregularis and Funneliformis mosseae as well as Trichoderma koningii. Application of endophytic fungi significantly increased total fruit yield by 23.7% compared to that of untreated plants. Multivariate statistics indicated that the biostimulant treatment substantially altered the shape of the metabolic profile of pepper. Compared to the untreated control, the plants treated with microbial biostimulants presented with modified gibberellin, auxin, and cytokinin production and distribution. The biostimulant treatment also induced secondary metabolism and caused carotenoids, saponins, and phenolic compounds to accumulate in the plants. Differential metabolomic signatures indicated diverse and concerted biochemical responses in the plants following the colonisation of their roots by beneficial microorganisms. The above findings demonstrated a clear link between microbial-mediated yield increase and a strong up-regulation of hormonal and secondary metabolic pathways associated with growth stimulation and crop defence to environmental stresses.

Rationale, aims and objectives In order to evaluate how the certification of specialised Oncology Centres in Germany affects the relative survival of patients with colorectal cancer (CRC), a national and international comparison was performed. Method Between 2007 and 2013, 675 patients with colorectal cancer treated at the Hildesheim Hospital, an academic teaching hospital of the Hanover Medical School (MHH), were included. A follow up of the entire patient group was performed until 2014. To obtain international data, a SEER-database search was done. The relative survival of 148,957 patients was compared to our data after 12, 36 and 60 months. For national survival data, we compared our rates with 36,048 patients of the Munich Cancer Registry (MCR) Results Relative survival at Certified Oncology Centres was significantly higher in advanced tumour stages compared with national and international cancer registry data. Nationally, we found only little variation in survival rates for low stage (UICC I, II) CRC, colon, and rectal carcinoma. Both colon and rectal carcinoma showed notable variations in their relative survival rates for advanced tumour stages. These variations were even more distinct for rectal carcinoma (Hildesheim Hospital: 89.9%, 40.3%, 30.1%; Munich Cancer Registry (MCR): 63.6%, 26.2%, 15.2%). The international comparison for colorectal cancer, colon cancer and rectal cancer showed significantly higher survival rates for patients with advanced tumour stages at the Certified Cancer Centre. CRC (UICC IV) at month 12 had a relative survival of 77% whereas the international survival was only 54,9% (raw p<0.001). Conclusion Our findings suggest that patients with advanced tumour stages of CRC and rectal cancer, benefit most from multidisciplinary treatment at Certified Oncology Centres as compared to low stage CRC and rectal carcinoma. However, the creation of unified national registry data bases is necessary for future evaluation of cancer treatment and improved international comparison.

Postnatal SARS-CoV-2 Infection and Immunological Reaction: A Prospective Family Cohort Study

Disseminated Mycobacterium simiae infection in a patient with complete IL-12p40 deficiencySeyed Alireza Mahdaviani, MDa, Majid Marjani, MDb, Mahnaz Jamee, MDc,d*, Armin Khavandegar, MDc,d, Hosseinali Ghaffaripour, MDb, Golnaz Eslamian, MDe, Mehdi Ghaini, MDe, Shabnam Eskandarzadeh, MDe, Jean-Laurent Casanova, MD, PhDf,g,h,i, Jacinta Bustamante, MD, PhDf,g,j, Davood Mansouri, MDa,b , Ali Akbar Velayati, MDa

L’inquinamento, provocato da attività agricole e industriali, può causare la contaminazione delle matrici ambientali, costituendo un rischio significativo per l'approvvigionamento di acqua potabile e per gli ecosistemi. Pertanto, negli Stati Uniti e in Europa si sono sviluppate, nel corso degli anni, diverse tecniche di bonifica. In particolare, per il risanamento di acque sotterranee, un metodo in situ relativamente nuovo e potenzialmente importante è la barriera reattiva permeabile (BRP). Essa prevede la realizzazione di una barriera all’interno della zona satura del terreno con materiali reattivi per il trattamento di contaminanti organici e inorganici presenti in forma disciolta nell’acqua di falda. L'articolo illustra il funzionamento delle BRP attraverso l’esposizione di un caso studio, dove tale tecnologia ha permesso di ridurre le concentrazioni di uranio nelle acque sotterranee di un sito di stoccaggio. 

TitleA mouse model of asthma­–chronic obstructive pulmonary disease overlap induced by intratracheal papain

PR is an endemic disease in most regions of China, but the report about the dynamics of PRV gI antibody in one farm was rarely. In order to analyze the dynamics of PRV gI antibody in one farm, 1513 serums from the different pigs in a farm were collected to detect the gI antibody by ELISA. The results in July 2015 indicated only the gilts were PRV gI antibody positive, and the other pigs were all PRV gI antibody negative. But the brain PRV gE gene from 10 piglets were almost positive, their PRV gI antibody were all negative. The results from October 2015 to July 2018 indicated that in the boar herd, 3 positive individuals were found in October 2015 and subsequently they were culled. In the following tests, the boar herd always kept the negative state. The positive rate in the sow herd was always more than 70% from October 2015 to October 2017. In January 2018, the positive rate decreased to 27%, but it was up to 40% and 52% in April and July 2018. For 100-day pigs, the positive rate obviously decreased in October 2016 and then always kept less than 30% in the later detection. For 150-day pigs, the positive rate obviously decreased to 16% in January 2017 and transferred to the negative in July 2017. The positive trends from the 40-day pig to the 150-day pig were all remarkably decreased in three tests in 2018. These results indicate that the serological detection is not appropriate in the early stage of the PRV infection, and the introduction of gilts is a risk factor for a PRV-negative farm. The dynamic data of the PRV gI antibody provide the reference for the farm that want to carry out the PR eradication program.