Double-outlet left ventricle (DOLV) is a rare congenital cardiac anomaly. The aorta and the main pulmonary arterial trunk arises predominantly from the left ventricle(LV) and is associated with a malaligned ventricular septal defect(VSD), various degrees of hypoplasia of the right ventricle, and presence or absence of pulmonary stenosis. Bi-ventricular repair is the preferred treatment option whenever possible. Various techniques for bi-ventricular repair have been described. The best option for DOLV correction is by translocating the pulmonary root to the right ventricle(RV)[1]. In this series, we report four patients who underwent biventricular repair of DOLV in our institute with excellent outcomes. All patient details were collected from the institute patient record system. Echocardiographic data were obtained from the records. Intraoperative charts were reviewed for further information on the surgical procedure and cardiopulmonary bypass. Postoperative data included survival, functional status and followup echocardiography. Of the four children, three underwent pulmonary root translocation and one child underwent Reparation al etage Ventriculaire(REV) procedure. There was no mortality and all children are in stable clinical condition in the recent follow-up and no re-operations or interventions were required following primary surgical correction. Thus DOLV is anatomically and surgically a challenging subset. Pulmonary root translocation in this anatomy is technically challenging but safe and superior option when compared to other alternative surgical procedures and it can be performed with excellent results, even in infants.

Objective: The aim of this study was to analyse the relation between adverse childhood experiences exposure and repeated induced abortion considering the potential effect of social deprivation and intimate partner violence. Design: An observational cross-sectional survey. Setting: This survey was conducted within the framework of the regional health agency of the Aquitaine area in each of the 25 induced abortion centres from June 15 to September 15, 2009, as well as to all women over 18 having an induced abortion with a liberal doctor under convention with of the centres previously referred to. Sample: 806 women asking for an induced abortion who responded to questions regarding adverse childhood experiences and previous abortion. Methods: Collecting data was achieved by a self-conducted anonymous questionnaire. Main outcome measure: The percentage of repeated induced abortion. Results: The percentage of patients with no exposure to adverse childhood experiences decreases (28%; 20%; 9%) when induced abortion are repeated according to the abortion rank (first, 2nd, 3rd or +), whereas the percentage of women with high exposure increases (17%; 27%; 32%). The adjusted odds ratio of a third request or more for abortion is 7.73 (3.56-16.77) for patients with high exposure to adverse childhood experiences when compared to women with no exposure who had a first induced abortion. Conclusion: There is a strong graded link between the magnitude of exposure to adverse childhood experiences and repeated induced abortion.

Objective: To investigate current practice patterns of tranexamic acid (TXA) use by Obstetricians and Gynecologists. Design: A cross-sectional, web based survey. Population: Members of the Central Association of Obstetricians and Gynecologists (CAOG). Methods: The anonymous survey regarding demographics, circumstances of use, and barriers of TXA use was emailed to CAOG members October 2018 – December 2018. Results: There were 81 responses with a response rate of 27%. The majority of respondents were general obstetricians and gynecologists (63%). TXA used mostly during postpartum hemorrhage (72%), followed by heavy cyclic bleeding (42%), and then benign gynecological surgeries (5%). The majority of participants had TXA as part of their hospitals hemorrhage protocol (73%) and increase use was associated with having a hospital protocol (86%). The largest concern with TXA use was thromboembolic events (48%). The majority of respondents had a favorable view of TXA being incorporated into hospital protocols (95%). Conclusion: To our knowledge this is the first survey among obstetricians and gynecologist to elicit current practice patterns with TXA. This study illustrates an association between increase use of TXA when it is incorporated into a hospital protocol for postpartum hemorrhage. This finding suggests that to an individual provider, local hospital recognition of the safety and effectiveness of TXA is more impactful and influential than the World Health Organization to an individual obstetrician in practice. The major concern with TXA use was increased risk of a thromboembolic event, an overwhelming number of respondents would support incorporating TXA into their hospital’s protocols

Objective: To describe the kinetic profile of arrhythmia in pregnant women with heart diseases in different cardiovascular risk according to mWHO classification. Design: Prospective observational study Setting: Cardiac and Vascular Diseases, Institute of Cardiology, CMUJ, John Paul II Hospital, Krakow, Poland Population: 103 pregnant women with organic heart disease(HD) Methods: 24-hour ECG-Holter was obtained in each trimester of pregnancy and post-partum period Main outcome measures: Supraventricular arrhythmia(SA): supraventricular tachycardia (SVT), supraventricular extrasystole (significant when SVE >30/hour), atrial tachycardia (AT), atrial fibrillation (AF);Ventricular arrhythmia(VA): ventricular premature contractions (PVCs >30/h), non-sustained, sustained tachycardia (nsVT, sVT);Conduction disturbances: low grade: AV I degree block, Mobitz I, high grade: Mobitz II,III degree blocks. Results: The prevalence of arrhythmia was 45.6 % of women, SA occured in 24.3 % and VA in 31.1%. Episodes of nsVT were more common in women with serious HD (mWHO class II-II, III, IV) than in women with milder HD (mWHO I, II) in each trimester: trimester1: 1,7% vs. 13,6%, p=0,02; trimester2: 5,1% vs. 18,2%, p=0,03; trimester3: 2,3% vs. 13,9 %, p=0,04,respectively.The kinetic profile of arrhythmia throughout pregnancy was different among groups: ventricular arrhythmia had tendency to increase in both groups, supraventricular arrhythmia declined in women with milder CHD and increased in serious CHD group. The highest rate of arrhythmia was in the 2nd trimester in both groups (29,2%). Conclusion: The kinetic profile of arrhythmia during pregnancy was different between groups with lower and higher cardiac risk, with more favorable profile in lower cardiac risk group. Keywords: Arrhythmia, Cardiovascular disease, Pregnanc

When it comes to coronavirus and biology - sex matters Scott M Nelson, MD PhD1,2Martina Capuzzo3Antonio La Marca, MD PhD31School of Medicine, University of Glasgow, UK2NIHR Bristol Biomedical Research Centre, Bristol, UK3Department of Medical and Surgical Sciences for Children and Adults, University of Modena and Reggio Emilia, Modena, ItalyCorresponding author:Prof Scott M Nelson University of Glasgow New Lister Building Glasgow Royal Infirmary Glasgow G31 2ER, UK +44 (0)141 201 8581 Scott.Nelson@glasgow.ac.ukWord count: Text 1058The male dominance in COVID19 morbidity and mortality figures has been a consistent feature from the early reports emerging from Wuhan, to national intensive care data, through to more recent comprehensive population mortality data. Men are more than twice as likely to become severely ill and require intensive care than women and at least twice as likely to die, with further widening of the mortality discordance with increasing age. These differences do not appear to be caused by differential rates of infection, as equal numbers of men and women catch SARS-CoV-2. Nor do they appear to reflect clustering of unhealthy behaviour and comorbidities in men, as even after adjustment, male sex is associated with a hazard ratio (HR) of death from COVID19 of HR 1.99, (95%CI 1.88-2.10)1. These sex-specific differences in severity and fatality were also observed for the 2002-2003 SARS-CoV outbreak, and the Middle East respiratory syndrome (MERS)-CoV2. So, what underlies this sex-specific susceptibility difference for pathogenic coronaviruses? Several early lifestyle theories were proposed, but rather more fundamental sex-specific discordances in steroid hormones, x-linked genes and the innate immune response are likely to underlie this sexual dimorphism.

We present a patient with myocardial infarction and cardiogenic shock who underwent high-risk percutaneous coronary intervention with Impella support, and developed iliac artery thrombosis at the Impella access site. Percutaneous thrombectomy was accomplished using the FlowTriever system, highlighting this approach as a potentially safe and effective alternative to surgery.

While there is significant awareness regarding droplet and contact transmission, aerosols are generally underestimated as a potential mode of transmission of SARS-Cov-2 infection. With the gradual resumption of cardiac surgical activities, the cardiac surgical operating room will become an important potential source of infection to the cardiac surgeon and other healthcare workers participating in the operation. There is also diminished awareness about the different aerosol generating procedures (AGP) in the cardiac surgical operating room. In this mini-review we intend to highlight the various aerosol generating procedures that are common in cardiac surgery. This will help increase the awareness among surgeons to AGP. A practical approach to taking preventive measures have also been discussed.

The novel coronavirus severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) has posed a serious threat to global public health. Respiratory failure followed by cardiovascular complications with wide-spread endothelial dysfunction and inflammation is rapidly emerging as a key threat in COVID-19. ACE-2 receptors are the cell-entry gate for SARS-CoV-2. Valproic Acid (VPA) is a proposed potential drug to treat COVID-19 but its mechanism of action is not well understood. We demonstrate that VPA-treatment significantly reduced ACE-2 expression in endothelial cells. VPA-treatment significantly reduced the expression of inflammatory cytokines IL-6 along with the endothelial activation marker ICAM-1. We provide evidence and discuss the plausible mechanism in detail for VPA use to prevent and treat COVID-19 in a personalized manner. Our study is expected to entice the scientific and clinical society to investigate VPA as a potential therapeutic option against COVID-19.

Osmium analogue to ruthenium anticancer drug NAMI-A; (ImH)[trans-OsCl4(DMSO)(Im)] (Im=imidazole, DMSO=dimethyl sulfoxide) (Os-NAMI-A) shows a three-fold higher activity in colon carcinoma. Hydrolysis mechanism of Os-NAMI-A has been investigated using density functional theory (DFT) in combination with CPCM solvation model. Calculated activation free energy values for the first chloro ligand hydrolysis in the gaseous and aqueous medium are found to be ΔGg=31.79 and ΔGaq=28.72 kcal/mol, respectively. While, activation free energy for the second cis chloro ligand hydrolysis calculated in the gas and solvent phases are observed to be significantly lower (ΔGg=29.12 and ΔGaq=22.61 kcal/mol), suggesting enhanced feasibility of second hydrolysis. However, hydrolysis of DMSO ligand in the formation of cis-[OsCl2(H2O)3(Im)]+ (P-3cis) is found to be thermodynamically preferred in aqueous medium (19.49 kcal/mol) with rate constant value of 3.20×10-2 s-1. In addition, molecular docking simulation reveals that cis-diaquated Os-NAMI-A (P-2cis) interacts with DNA (PDB ID: 1pgc) more effectively having binding energy -5.63 kcal/mol. Therefore, results of this investigation may lead us to understand the solution behaviour of osmium azole complexes as well as their mode of interaction with biomolecules which in return helps in potential anticancer drug designing.

Background: With the limited number of available suitable donor hearts resulting in plateaued numbers of heart transplantations, short- and long-term mechanical circulatory support devices, including the implantation of total artificial hearts (TAH) are modalities that are increasingly being used as treatment options for patients with end-stage heart failure. The superior vena cava syndrome has been described in this context in various disease processes. We report successful venoplasty for superior vena cava syndrome in a patient with a TAH. Case Presentation: A 65 years old man with a history of non-ischemic cardiomyopathy had received a left ventricular assist device, and then two years later underwent orthotopic heart transplantation using the bicaval anastomosis technique. The post procedural course was complicated by primary graft failure, resulting in the need for the implantation of a TAH. About 5 months after the TAH implantation he started to develop complications such as volume retention, swelling of the upper extremities, and was diagnosed to have a superior vena cava syndrome. The patient underwent a successful venoplasty of his superior vena cava by interventional radiology with resolution of upper body edema, normalization of renal and liver function. Conclusion: Potential fatal complications caused by catheter or wire entrapment in the right sided mechanical valve of a TAH have been reported. We describe a safe method for the treatment of superior vena cava syndrome in patients with TAH.

Objectives The impact of the COVID 19 pandemic on the treatment of patient with aortic valve stenosis is unknown and there is uncertainty on the optimal strategies in managing these patients. Methods This study is supported and endorsed by the Asia Pacific Society of Interventional Cardiology. Due to the inability to have face to face discussions during the pandemic, an online survey was performed by inviting key opinion leaders ( cardiac surgeon/interventional cardiologist/echocardiologist) in the field of transcatheter aortic valve implantation (TAVI) in Asia to participate. The answers to a series of questions pertaining to the impact of COVID-19 on TAVI were collected and analyzed. These led subsequently to an expert consensus recommendations on the conduct of TAVI during the pandemic Results The COVID 19 pandemic had resulted in a 25% (10-80) reduction of case volume and 53% of operators required triaging to manage their patients with severe aortic stenosis. The two most important parameters used to triage were symptoms and valve area. Periprocedural changes included the introduction of teleconsultation, pre-procedure COVD 19 testing, optimization of pre-tests and catheterization laboratory set up. In addition, length of stay was reduced from a mean of 4.4 to 4 days. Conclusion The COVID-19 pandemic has impacted on the delivery of TAVI services to patients in Asia. This expert recommendations on best practices may be a useful to guide to help TAVI teams during this period until a COVID 19 vaccine becomes widely available

We report the successful endovascular repair of a rare case of aortic rupture caused by axillary intra-aortic balloon pump insertion failure. A 38-year-old Jehovah’s Witness female with situs inversus totalis was referred to our hospital for acute decompensated heart failure. We placed an axillary intra-aortic balloon pump for circulatory support. However, an exchange was required due to balloon malfunction (kinked driveline). Unfortunately, the exchange was complicated by an iatrogenic aortic rupture along with large hematoma compressing the trachea. Emergent endovascular repair was performed successfully without any blood transfusion. Postoperative computed tomography showed a successfully repaired aorta and resolving hematoma.

Sexual dimorphism of plumage color is common in avians. A well-known example is mallard, in which drakes exhibit green head feathers, while females exhibit dull head feather color. Through microscopy observations, melanin was observed to be continuously deposited in feather barbules and to form a two-dimensional hexagonal lattice, which conferred the green feather coloration of drakes. Additionally, transcriptome analysis revealed that most pigmentation genes were highly expressed in feather follicles during the development of green feathers, which may contribute to melanin deposition. We identified 18 consensus differentially expressed genes in feather follicles by comparing the transcriptome differences in the male head vs. female head, male head vs. male back, and male head in the 7th week vs. male head in the 11th week. Among these genes, TYRP1 located on Z-chromosome of the mallard genome, showed an increasing trend in the feather follicles of drake heads during green feather development. In particular, its expression was 256 and 32 times higher in the head follicles of males than in those of the female head and the male back, respectively. Hence, the green feathers were determined by TYRP1 through sex-biased expression, which is common for genes linked with Z-chromosome in avians. The differential expression of TYRP1 in different body parts of males and among different time points may be due to differences in cis-regulation by transcription factors. We also demonstrated that the beautiful feather color of other male avians is largely caused by the sex-biased expression of pigmentation genes linked with Z-chromosome.

Hyponatremia is a recognized but underreported complication of the peripartum period. However, maternal hyponatremia in the peripartum period is a very rare cause of seizure. In this case, we highlight hyponatremia as a cause of seizures during the peripartum period.

39y old HIV positive female with isolated manifestations of pulmonary Mycobacterium Avium Complex infection being initial presentation.Pulmonary MAC infection is extremely rare, with an incidence of 1 case per 100,000 per year. we have not found any cases of newly diagnosed HIV/AIDS patients with pulmonary MAC being the initial symptom

Background: There are no reports regarding false positive reverse transcriptase polymerase chain reaction (RT-PCR) for novel coronavirus in preoperative screening.Methods: Pre-operative patients had one or two nasopharyngeal swabs, depending on low or high risk of viral transmission. Positive tests were repeated. Results: Forty-three of 52 patients required 2 or more pre-operative tests. Four (9.3%) had discrepant results (positive/negative). One of these left the COVID unit against medical advice despite an orbital abscess, with unknown true disease status. The remaining 3 of 42 (7.1%) had negative repeat RT-PCR. Although ultimately considered false positives, one had been sent to a COVID-unit postoperatively, and two had urgent surgery delayed. Assuming negative repeat RT-PCR, clear chest imaging, and lack of subsequent symptoms represent the "gold standard”, RT-PCR specificity was 0.97.Conclusions: If a false positive is suspected, we recommend chest computed tomography and repeat RT-PCR. Validated immunoglobulin testing may ultimately prove useful.

Background. Italy was the first European country suffering from COVID-19. Healthcare resources were redirected to manage the pandemic. We present our initial experience with the management of urgent and non-deferrable surgeries for sinus and skull base diseases during the COVID-19 pandemic. Methods. A retrospective review of patients treated in a single referral center during the first two months of the pandemic was performed. A comparison between the last two-month period and the same period of the previous year was carried out. Results. Twenty-four patients fulfilled the inclusion criteria. A reduction of surgical activity was observed (-60.7%).  A statistically significant difference in pathologies treated was found (p = .016), with malignancies being the most frequent indication for surgery (45.8%). Conclusions. Although we feel optimistic for the future, we don’t feel it is already time to restart elective surgeries. Our experience may serve for other centers who are facing the same challenges.

COVID-19 disease is associated with a high inflammatory load that can induce vascular inflammation, myocarditis, and cardiac arrhythmias. Mortality from COVID-19  disease in 2019 is strongly associated with cardiovascular disease, diabetes, and hypertension. These disorders share the underlying pathophysiology related to the renin-angiotensin system (SARS). Cardiovascular disease and SARS pharmacological inhibition increase ACE2 levels, which can increase coronavirus virulence in the lung and heart. On the other hand, there is evidence that coronavirus infection can decrease ACE2, leading to toxic over-accumulation of angiotensin II, which induces acute respiratory distress syndrome and fulminant myocarditis. In addition, there is scientific evidence that SARS-CoV-2 can bind chemically to the heme group of hemoglobin and thus cause the release of iron ions (Fe2+ and Fe3+) that can damage tissues, including the lungs and heart. Another important information is that the heme group is produced by mitochondria and, in this case, the oral or intramuscular use of Coenzyme Q10 (ubiquinone) is strongly recommended, as it stimulates the increase in mitochondrial production. Therefore, the use of chelators of iron ions is notorious, as well as the administration of Coenzyme Q10 as a treatment for patients infected with SARS-CoV-2. Keywords: SARS-CoV-2. Cardiovascular diseases. Heme group. Iron ions. Mitochondrial production.

As we know, numbers are involved in the phenomena of life and beyond, in various ways. Biomathematics and Bioinformatics nowadays are thriving and will have greater development in the future. Some number in particular have a lot of interest and give a special charm to both the inanimate and the living matter. For example, the p and f numbers are involved in many biological procedures in different ways. Specifically, p = 3.14159…, i.e. the quotient of the circumference of a circle to its diameter, is revealed in the formulas of the potential difference in the cell membranes, in the flow of liquid in vessels, etc. The f = 1.618 aka golden ratio appears in various proportions of the human body, in the way leaves are assembled in plants etc. The Fibonacci sequence is correlated to f, when calculating rabbit offspring. The sequence and thus the φ, are connected to the logarithmic spiral that we meet at the shape of the shells of land or marine organisms such as snails, nautilus etc.. Something remarkable with the f is the following: If the core volumes, the cytoplasm and the cell are consecutive geometric progression conditions it is known that\(\frac{Vkp}{Vp}\) = φ (cell-core constant).Because this may apply for each moment of a cell’s lifecycle, given that volumes can be multiplied by a coefficient (effective volume) we end up with the relationship \(\frac{Vkp}{Vp}\)= n ⋅ φThe disorder of the relationship between the volumes of nucleus-cytoplasm is of great interested in cases of malignancies, tumors, etc.  If somebody looks through a microscope, for instance, cells and their core, he will notice a huge difference between leukemic and normal cells. Another case is the number e = 2,711828, the base of natural logarithms. There is no science field which is not correlated with this number.In this paper we will deal more thoroughly with the prime numbers in biology. The prime numbers are integer positive numbers divisible only by themselves and the unit 1, eg. 2, 3, 5, 7, 11, 13,17... The primes that differ by 2 are called twin primes. Euclid was the first who proved that the number of primes is infinite. Today we know that the greater the interval between the numbers is, the more prime sparsity we have. On the other hand, complex numbers (all positive integers that are not primes) result as a raw product of primes, e.g. 70 = 2 x 5 x 7 etc. Therefore any positive integer greater than 1 is either a prime or a product of primes. Mathematicians for their own reasons, consider the number 1 neither a prime nor a complex number. Prime numbers, are for Mathematics what for Chemistry and Physics are atoms of matter: the building blocks upon which all other numbers are built, the ”atoms” that compose the Mathematics’ universe. Someone said that mathematicians love prime numbers, such as chemists love atoms and biologists love genes. The interest in prime numbers is big and despite the era, it remains at the forefront of scientific activity. Moreover, there are major unresolved problems over time regarding prime numbers (Riemann conjecture, Goldbach conjecture, conjecture of the twin primes etc.). Also, there are no mathematical formulas known to compute the next prime number, and how many prime numbers are smaller than a specific number. Two very characteristic sayings of great scientists about the importance of the above are the following: Hilbert, a great German mathematician had said that ”if it was possible after 1000 years from my death to come back to life, the first thing I would ask would be if Riemann’s conjecture has been resolved. ” This said, knowing, as all mathematicians, that the problem is extremely difficult and the solution of it will lead to numerous solutions of other mathematical problems.Paul Erdos, a Hungarian great mathematician who dealt with prime numbers, just before his death said: ”It will take one million years until we understand prime numbers.”Let’s have a look at primes’ relations with biology, starting with some simple observations:a) The codons of the genetic code that encode amino acids are 61, while there are three (dating) that do not encode any amino acid. Each codon consists of three nucleotides.b) Among the 37 genes of mitochondrial DNA 13 encode proteins.c) The smallest form of life, a bacterium that belongs to the mycoplasma has 521 genes (a prime number).d) To nucleic acids (DNA, RNA), the orientation of the polynucleotide chain is 5’ → 3’.e) Microtubules, which are structures of the cellular shell of the ciliums and flagellums of various eukaryotic cells, consist of 13 parallel protofibrils (with a 5nm diameter each) of alternating molecules of alpha and beta tubulin.f) 2 and 3 phosphate groups of nucleotides (ADP, ATP, etc.), 2, 3, 5, N atoms depending on the nitrogenous base of nucleotides, consist of 5 Carbon atoms therein. g) 5 radial symmetry in echinoderms, e.g. starfish. h) 23 chromosomes in human reproductive cell etc. i) In the genome of prokaryotic organisms, the genes for enzymes involved in a metabolic way, are organized in operons, i.e. groups that are subject to common control of their expression. The lactose operon has three structural genes, many other 2 or 3 structural genes, tryptophan has 5 etc.In order to avoid any misunderstanding, we clarify that in many biological issues where numerical quantities are involved, there may be no prime numbers, but can be complex or decimal numbers. However, our interest in this paper focuses on prime numbers and their correlation with biological issues. We continue with examples of prime numbers that appear in natural selection issues and in evolution of organisms. A known example from the field of the animal kingdom is that two kinds of cicadas Magicicada tredecim and Magicicada septendecim live in the same environment with a lifecycle of 13 and 17 years respectively. Throughout their life, except the last year, they live in soil and feed on the juices of tree roots. During the last year of their life, for a few weeks, they transform from larvae to adult, occupy the forest, eat, lay eggs and die. But how these species evolved so that their cycle of life is actual prime numbers? An answer is that their mutual emergence to the forest takes too long and happens once in 13 x 17 = 221 years. While if their life cycles were complex numbers, eg. 12 and 18 years in the above time they would have competed six times, as many are the common multiples of 12 and 18. As we can see, the prime numbers 13 and 17 are not something abstract and random, but the basis of their survival. Such examples are likely to exist in the animal and plant kingdom.The birthday paradox is very interesting. It belongs to the probability theory and refers to a problem which by the common sense has an unlikely answer. The formulation of the problem is this: In a group of 23 people which is the possibility that two among these individuals have their birthdays on the same day? The obvious answer is 23/365 = 0.063, i.e. 6%. Despite this, the mathematical solution is 50%. The possibility is even 100% when it refers to 367 people, including those who were born on February 29. 23 and 367 are prime numbers, and the reference to this paradox is used because it is related to people (biological entities) and a biological fact, their birth in a specific time period (birthday). It is worth mentioning that this paradox is the basis for one of the most common methods of cryptanalysis, in the corresponding field of computer science (cryptography).Prime numbers are related to the molecular basis of apoptosis, or programmed cell death, which was initially studied in the filamentary worm Caenorhabditis elegans. Later, it was studied in other invertebrates and vertebrates. Only in the hermaphrodite filamentary worm, we have the best of apoptosis study system, to the point that is considered to be created for this purpose. Apoptosis is a fundamental biological process that is necessary for the removal of surplus cells during embryonic development, maintaining the homeostasis in the adult organism, maturation of cell populations of the hematopoietic and immune system and malignant transformation.Typically the apoptosis is not a consequence of disfunction and therefore differs from necrosis, which is always a result of a harmful effect. In filamentary worm, during its development when 1090 cells are produced (hence 1091 total with the original zygote), of which 131 somatic cells are eliminated by the process of programmed cell death while 3 genes are responsible for it. 1091, 131 and 3 are prime numbers, and the above constitute an ascertainment, the causes of which are unknown for now. Maybe, in the future for the entire process of the phenomenon, emerge also a mathematical model.

The first cases of novel coronavirus disease (COVID-19) were reported in late December 2019 in Wuhan City, Hubei Province of China. It has spread rapidly around the world. Taking preventive measures by the public plays the most important role in infection prevention and control of the COVID-19. One of the major challenges in preventing and controlling COVID-19 has been the proliferation of misinformation on social media. In such a special epidemic, assessment of knowledge and attitude of the public will help to reduce the uncoordinated social behavior arising from misinformation. The purpose of this cross-sectional online survey was to determine the level of knowledge, attitude and practice (KAP) of Iranian population toward outbreak of COVID-19. Data were collected by self-administrated questionnaire. Analytical statistics were performed on the results. The mean scores of respondents’ KAP were 87.7, 59.3, and 89.6, respectively. Married and females participants, who work in healthcare systems, participants in the age group of 36 to 45 years with a higher level of education, and those who studied in the fields related to health gained significantly higher knowledge scores. Most respondents (63.7%) had a negative attitude towards the observance of appointed prevention principles by others. Also, the results showed a statistically significant positive correlation between all sections of KAP. Our findings suggest that despite the rapid dissemination of reliable and unreliable information about COVID-19 through cyberspace, the Iranian people have sufficient knowledge to deal with COVID-19 outbreak.

Vitamin D (VD) is associated with the release of leptin, which promotes fat mobilization in the body. Diacylglycerol can reduce triacylglycerol formation. This study evaluated the effects of administration of VD and duck oil diacylglycerol on blood lipids, liver lipid metabolism and gut microflora in rats fed a high-fat diet. A total of 75 rats were allocated randomly to five treatments: non-obesity (NO), obesity control (OC), diacylglycerol:10 mL per kg body weight (DG10), VD:12.5 μg per kg body weight (VD12.5), and diacylglycerol + VD: 10 mL/d + 12.5 μg per kg body weight (DG10VD12.5). Rats in NO group was fed the diet containing 7% soybean oil, while the other four groups were fed a high-fat (3.3% soybean oil and 30.1% lard). VD and diacylglycerol were orally dosed once per day. The administration of VD+diacylglycerol significantly reduced the body weight gain and fat content. The change of fat deposit was accompanied with the reduction in serum lipids, the increase in the activity of enzymes involved in lipid metabolism in the liver, the suppression of fatty acid synthase and the enhance of carnitine fatty acyl transferase Ⅰ (CPT1) expression. The administration of VD and diacylglycerol also significant modulated the bacterial diversity profile in the cecum towards that in non-obesity rats. Those results suggest that the administration of VD and diacylglycerol could have significant roles in reducing fat deposit and altering gut microflora in rats fed the high-fat diet.

The growing epidemic of many age-related chronic diseases, such as cardiovascular diseases, diabetes, cancer, and neurodegenerative diseases, especially Parkinson's and Alzheimer's disease, places an increasing burden on the healthcare systems worldwide. In recent years, efforts to manipulate the consequences of aging have yielded some success, and naturally, identifying effective ways to slow down or even reverse aging has become increasingly popular. Importantly, existing drugs can be repurposed for anti-aging effects. Studies from model organisms and early stage human clinical trials have found that metformin and rapamycin, which respectively are an effective anti-diabetic medication and an immunosuppressant, have promising results in slowing aging and treating age-related diseases. These findings point to the possibility that these two anti-aging drug candidates, and especially their derivatives which may reduce side effects, are likely to become the first genuine rejuvenation medications to achieve healthy aging. Here, we present knowledge on the mechanisms that are involved in the anti-aging effect of the two molecules, followed by an outline of a host of potential aging-related clinical applications. We finally provide insights on the considerations and further directions for the development of anti-aging drugs.

Diastolic dysfunction (DD) is reported to affect up to 35% of the adult general population. The consequence of progressive DD is heart failure with preserved ejection fraction (HFpEF). Coronary microvascular dysfunction (CMD) has been suggested as one of the pathologic mechanisms leading to HFpEF. We investigated whether there was an association between coronary microvascular function and echocardiographic indices of left ventricular diastolic function in patients with chest pain and unobstructed coronary arteries (CPUCA). This retrospective observational study recruited patients referred to cardiology clinics assessment of chest pain who subsequently underwent assessment via CT coronary angiogram (CTA). Coronary microvascular dysfunction was determined by myocardial blood flow reserve (MBFR; <2.0) using myocardial contrast echocardiography. Echocardiographic indices of diastolic function (septal mitral annular e’; septal mitral annular E/e’) were measured from baseline transthoracic echocardiogram. 149 patients (52% men) with a mean age 59.7(9.5) years were recruited. Mean (standard deviation) MBFR was 2.2 (0.51). 37% (55/149) had MBFR<2.0. Median [interquartile range] septal mitral annular e’ velocity and septal mitral annular E/e’ were 7.6 cm/s [6.2, 8.9] and 9.5 [7.5, 10.8] respectively. Univariate regression analysis showed only age was a significant predictor of increasing septal mitral annular E/e’ (=+0.20 95% CI 0.13, +0.28, p<0.001) but not MBFR. Multivariable analysis also showed no association between these septal mitral annular E/e’ and MBFR after adjustment for cardiovascular risk factors. There was no relationship found between echocardiographic indices of left ventricular diastolic function and coronary microvascular function.

Background: In systemic hypertension, left ventricular remodeling results in an increase in ventricular wall thickness due to augmented ventricular afterload. Most studies on myocardial function in hypertensives are performed using imaging techniques in which the evaluation of myocardial wall thickness is performed without separating the LV myocardial triple layers from the endocardium to the pericardium. The specific myocardial function of each layer or layer-specific in both segmental and global form can also be examined using left ventricular strain analysis. The purpose of the present study was to evaluate the functional indices of each layer of the left ventricular myocardium using layer-specific strain analysis and also to evaluate the relationship between ventricular structural remodeling with the functional changes of the ventricle in each layer of the myocardium in hypertensive and normotensive individuals. Methods: Eighty eight patients (46.6% were normotensive and 53.4% were hypertensive) underwent two-dimensional echocardiography and longitudinal and circumferential strain indices were analyzed in all three layers . All parameters evaluated in terms of diastolic dysfunction were compared between two groups. Results: In patients with diastolic dysfunction, GLS and GCS strains significantly decreased in epicardial and mid myocardial layers in hypertensive patients, but these changes did not revealed in those without diastolic dysfunction. Conclusion: Decreases in GLS and GCS indices of the ventricular wall in mid myocardium and epicardial layers are predictable in the context of hypertension, and these changes in strain are evident in patients with ventricular diastolic dysfunctio