The giant left atrium is described as atrium with a diameter of 6.5 cm or larger, and can rarely cause dysphagia by compressing on esophagus. We wanted to present this case since we successfully reduced left atrial volume and eliminated gastrointestinal and cardiac complaints with a successful surgery. Cardiac causes of dysphagia are rare, but should be kept in mind in differential diagnosis. With early diagnosis and treatment, cardiac mortality and morbidity can be prevented.

Background and aim: The incidence of symptomatic cerebral infarction after minimally invasive cardiac surgery (MICS) with retrograde perfusion has been increasing. However, there is no report about silent brain infarction (SBI) after MICS with retrograde perfusion. Because SBI may cause delirium and decline of cognitive function, this condition is important clinically. Thus, the current study aimed to investigate the occurrence of SBI after MICS via magnetic resonance imaging (MRI). Methods: Between July 2014 and July 2018, 174 patients underwent MICS with retrograde perfusion and postoperative MRI in this study. Univariate and multivariate analyses were performed to examine the occurrence of SBI and to identify its risk factors. Results: Of 174 patients, 26 (14.9%) presented with SBI. The univariate analysis revealed that age and aortic valve stenosis (AS) are the risk factors of SBI. Meanwhile, multivariate analysis revealed AS as the only risk factor of SBI. Conclusions: At our institution, the incidence of SBI after MICS with retrograde perfusion was acceptable.

Coronavirus Disease 2019 (COVID-19) is associated with hypercoagulability and adult guidelines have been published regarding the evaluation and anticoagulation of adults infected with COVID-19. Pediatric resources on this topic are lacking. We developed preliminary recommendations for the thrombotic evaluation and anticoagulation treatment for children hospitalized with COVID-19 by reviewing the available literature and guidelines and adapting the information for the pediatric population through a multidisciplinary consensus driven approach.

Severe eosinophilia and toxoplasmosis – an uncommon association.

AbstractBackground: Vigilance ensures safety in cardiac surgery. Performance in cardiac surgery is often measured by short-term mortality. Several risk factors like advanced age, female gender, higher body mass index, decreased left ventricular function, emergent, and redo operations have appeared recurrently as poor prognostic variables. Evaluation of postoperative mortality is crucial to find loopholes to provide proper care and reduce preventable mortality after cardiac surgery in developing countries with limited infrastructures and resources.Methods: This is a retrospective study conducted in the Department of Cardiac Surgery, Bangabandhu Sheikh Mujib Medical University. Perioperative data of 100 cases of mortality after cardiac surgery performed from 1 January 2014 to 30 May 2018 were collected from the university medical record. The data on age, gender, body mass index, preoperative investigations, diagnoses, types of operations, details of cardiopulmonary bypass, and postoperative period of the study populations were evaluated.Results: During the study period, about 1627 cases of cardiac surgery were done with an overall mortality rate of 6.15%. The mean age was 41.05 ± 20.19 (0 - 68) years, and 66% of patients were male. Preoperative ejection fraction (EF) of the study population was an average 56.63% ± 11.85%; 9% of the patients had EF < 40%. Off-pump coronary artery bypass (32.27%) was the most commonly performed surgery followed by mitral valve replacement (24.28%). On-pump cardiac surgery was done among 65% of the study population with a mean cross-clamp time and bypass time of 32.56 ± 11.55 minutes and 80.57 ± 18.09 minutes, respectively. Most of the mortality was found in the first two weeks after surgery.Conclusion: Mortality after cardiac surgery is multifactorial. A large-scale prospective study with comparative groups is required to find out preventable measures of mortality after cardiac surgery which will improve the quality of services provided to the patients in developing countries.Keywords:Cardiac Surgery, Morbidity, Mortality, Evaluation

Postoperative thoracic aortic graft infection (TAGI) is a serious and potentially fatal complication. The classical approach is to replace the infected graft. However, this approach has a high mortality rate. Alternatively, treatment of TAGI without graft replacement can be performed. Herein, we present successful treatment of the case of a 72-year-old patient with mediastinitis and graft infection after type A aortic dissection operation for whom we performed omental flap coverage following vacuum-assisted wound closure therapy without graft replacement. The patient had an uneventful postoperative course and remained infection free for the last 36 months to date.

Tracheo-innominate artery fistula (TIF) is a rare and fatal complication that can be seen after tracheostomy, neck and trachea surgery. In this report, we present the surgical treatment of TIF, which is a major bleeding after neck surgery in a 24-year-old male patient.

Background – The impact of post-operative complications on long-term survival is not well characterized. We sought to study the prevalence of post-operative complications after cardiac surgery and their impact on long-term survival. Methods – Operative survivors (n=26,221) who underwent coronary artery bypass grafting (CABG) (n=13054, 49.8%), valve surgery (n=8667, 33.1%) or combined CABG and valve surgery (n=4500, 17.2%) from 1993 to 2019 were included in the study. Records were reviewed for post-operative complications and long-term survival. The associations between post-operative complications and survival were assessed using a Cox-proportional model. Results – Complications occurred in 17,463 (66.6%) of 26,221 operative survivors. A total of 17 post-operative complications were analyzed. Post-operative blood product use was the commonest (n=12397, 47.3%), followed by atrial fibrillation (n=8399, 32.0%), prolonged ventilation (n=2336, 8.9%), renal failure (n=870, 3.3%), re-operation for bleeding (n=859, 3.3%) and pacemaker/ICD insertion (n=795, 3.0%). Stroke (HR 1.55, 95%CI 1.36-1.77), renal failure (HR 1.45, 95% CI 1.33-1.58) anticoagulant-related events (HR 1.26, 95%CI 1.02-1.56) and pneumonia (HR 1.23, 95%CI 1.11-1.36) had the strongest impact on long-term survival. Long-term survival decreased as the number of post-operative complications increased. Conclusions – Post-operative complications after cardiac surgery significantly impact outcomes that extend beyond the post-operative period. The presence, number and type of post-operative complications adversely impact long-term survival. Stroke, renal failure, anticoagulant-related events and pneumonia are particularly associated with poor long-term survival.

Localized hair loss is a common complaint among clients of dermatologists. A rare form of that is caused by a certain ant and its diagnosis can be out of the dermatologist's mind. Here, we report a case of barber ant-induced alopecia in a young man.

Congenital epulis is a rare tumor of the the newborns. We found a case of soft elastic pedunculated masses in the left maxillary and mandibular anterior areas, protruding out of the oral cavity.They were diagnosed histopathologically and immunocamically as congenital granular cell epulis. These were no complication after surgery.

First principles calculations by using of projected augmented plane-wave method have been performed to investigate the structural, elastic and electronic properties of MgB2C2 under different pressures. The results indicate that the ternary compound of MgB2C2 remains mechanically stable under pressure ranging from 0 to 50 GPa. Elastic analysis is performed and it is found that MgB2C2 always shows obvious intrinsic brittleness under pressure, although an increasing trend of the ductility both from BH/GH and vH with increasing pressure. (100), (010) and (1-10) planes show strong anisotropy and the degree of anisotropy decreases with increasing pressure, in the meantime, it is interesting to find that the degree of anisotropy is reduced in order of planes (1-10)-(100)-(010) under the same pressure.

A special class of conjugated hydrocarbons known as phenylenes, which is composed of a special arrangement of six- and four-membered rings. In particular, any two six-membered rings (hexagons) are not adjacent, and every four-membered ring(square) is adjacent to a pair of nonadjacent hexagons. If each hexagon of phenylene is adjacent only to two squares, then the obtained chain is called the phenylene chain. The main object of this paper is to determine the expected values of the sum-connectivity, harmonic, and symmetric division indices of this class of conjugated hydrocarbons. The comparisons between the expected values of these indices with respect to the random phenylene chains have been determined explicitly. The graphical illustrations have been given in terms of the differences between the expected values of these indices.

Background: Intrapersonal resources are significant preditors of human flourishing. The study examined the mediating role of self-esteem between the relationship of self-forgiveness and human flourishing. Methods: A correlation research design was used. Two hundred and fourteen participants (MAge = 22.07(1.80)) comprising 100 males (MAge = 22.15(1.61)) and 114 females (MAge = 22.00(1.95)) were chosen as the participants by a convenience sampling. Self-esteem, self-forgiveness and human flourishing were measured with standardized tools. Results: The results showed significant interdependence among self-esteem, self-forgiveness and human flourishing as evident in their positive correlations. Self-esteem and self-forgiveness accounted for significant variability in human flourishing. These results are prerequisite condition to further carry out mediation analysis that showed self-esteem to emerge as a significant partial mediator between the relationships between self-forgiveness and human flourishing. Conclusions: Self-esteem represents self-worth and personal values that are essential ingredients to prepare a person to forgive himself/herself that, in turn, may cultivate positive affect and cognition leading one to achieve flourishing. Self-esteem helps to understand transgressing situations and the exact role of the various stakeholders. These positive attributions may have facilitated self-forgiveness and finally flourishing. It was evident that both self-esteem and self-forgiveness are relevant to understand human flourishing and the impacts of self-forgiveness are mediated by self-esteem. In essence, intrapersonal resources carry significance to enhance human flourishing. The findings represent a significant contribution to understanding the relationships among self-esteem, self-forgiveness and human flourishing.  Keywordsself-esteem, self-forgiveness, human flourishing, mediation analysis.

Background: The study explored the basic features of positive body image intending to standardize a scale for it employing an Exploratory Research Design. Participants and Procedure: The study was conducted in two phases. In the first phase, 17 males and 18 females with age range 21 to 30 years were chosen as per the screening criteria based on the scores of body mass index and body appreciation scale. The semi-structured interviews were conducted followed by its verbatim inscription for developing themes and basic descriptions of positive body image. The second phase involved 507 participants (268 males and 239 females) with the age span of 20 to 35 years on whom the newly developed positive body image scale and general health and quality of life measures meant for validation were administered Results:  A phenomenon with complex facets, linked with self, social realities and life outcomes, health practices and social relevance were the major themes generated in the first phase. The second phase resulted in the development of a new positive body image scale with 24 items comprising two components namely body appreciation and body effectiveness with desirable psychometric properties.Conclusions: A set of theoretically sound and practically relevant attributes of positive body image was identified. The test-retest reliability showed significant levels while coefficients of correlations of the derived measure with general health and quality of life represented its validity. Further verifications of the findings are recommended. The study may carry implications for researchers, practitioners and policymakers.Keywordspositive body image, body appreciation, body effectiveness, general health, exploratory research design.

Hindu Marriage is a sacrament that has been conceived to achieve a variety of worldly and spiritual goals. Some forms of hurt, untruthful or betrayal may involve in a marriage relationship that may significantly impact forgiveness behaviours of one or other member of married couples influencing their flourishing. The study examined the role of some biographic features, the forgiveness of self, others and situations in shaping the well-being of the married Hindu couples. Employing a correlational design, the study recruited 300 married Hindu couples with age ranging from 25 to 50 years by a snowball sampling. Forgiveness and well-being were measured with the help of The Heartland Forgiveness Scale (Thompson et al., 2005) and Mental Health Continuum (Keyes, 2005). The findings showed that education, age, domicile, occupation and years of marriage and the three types of forgiveness exhibited significant positive correlations with the indices of well-being whereas gender, number of children, nature of family (nuclear or joint), number of family members and socioeconomic status showed negative correlations with the same. Employment status and age emerged as the most significant predictors for hedonic and psychological well-being, respectively. Conversely, others forgiveness did the same for social and eudaimonic well-being and flourishing. Indian socio-cultural conditions, the conceptualization of Hindu marriage and relevant earlier studies have been used to discuss the findings. Some biographic attributes, inclination towards postmodern lifestyle and others forgiveness seem to shape the well-being outcomes of the married Hindu couples. Directions of future researchers have been discussed.KeywordsForgiveness; hedonic well-being; eudaimonic well-being; human flourishing; Hindu married couples.

Self-esteem and self-compassion represent well-known positive self-resources with significant implications for life outcomes of people belonging to individualistic and collectivistic cultures, respectively. Both the constructs have been suggested to shape the nature and extent of self-forgiveness through dissimilar mechanisms. The study examined the mediating role of positive and negative self-compassion between the relationship between self-esteem and self-forgiveness. Employing a convenient sampling, 144 male (M = 22.10, SD = 1.66) and 124 female participants (M = 21.98, SD = 1.90) were chosen for a correlational research design. The findings showed that Self-Esteem and Positive Self-Compassion had significant positive correlations with Self-Forgiveness. Conversely, Negative Self-Compassion exhibited negative correlations with these measures. Self-esteem and Positive Self-Compassion accounted for significant positive variance in Realization & Reparation and Overall Self-Forgiveness and significant negative variability in Attribution. Negative Self-Compassion accounted for positive significant variance in Guilt and negative significant variability in Realization & Reparation and Attribution. Both Positive and Negative Self-Compassion significantly mediated the relationships among Self-Esteem and Realization & Reparation, Guilt and Attribution. It evinced coexistence and working of self-esteem and self-compassion in a collectivistic culture with more pronounced effects of the later. Re-conceptualization of self-compassion is recommended. Keywords                                         self-esteem; positive and negative self-compassion; self-forgiveness; mediation analysis; path analysis.

Geographical gradients in species diversity have long fascinated biogeographers and ecologists. However, the extent and generality of the positive/negative effects of the important factors governing functional diversity (FD) patterns are still debated, especially for the freshwater domain. We examined lake productivity and functional richness (FRic) of waterbirds sampled from 35 lakes and reservoirs in northern China with a geographic coverage of over 5 million km2. We used structural equation modelling (SEM) to explore the causal relationships between geographic position, climate, lake productivity and waterbirds FRic. We found unambiguous altitudinal and longitudinal gradients in lake productivity and waterbirds FD, which were strongly mediated by local environmental factors. Specifically, we found 1) lake productivity increased northeast but decreased with altitude, and the observed gradients were driven by climate and nutrient availability, with 93% of variation explained in the individual SEM; 2) waterbirds FD showed similar geographic and elevational gradients.; the environmental factors which had direct and/or indirect effects on these geographic and elevational gradients included climate, lake productivity and morphology, which collectively explained more than 56% of the variation in waterbirds FD; and 3) a significant (P = 0.029) causality between lake productivity and waterbirds FD was confirmed. Nevertheless, the causality link was relatively weak in comparison with climate and lake area (standardized path coefficient was 0.65, 0.21, and 0.17 for climate, area, and productivity, respectively). Through articulating the dominant causality paths, our results could contribute to the mechanistic explanations underlying the observed broad–scale biodiversity gradients.

The experimental data used for testing the applicability of the thermodynamic equations presented in the theoretical section were obtained from an ecological restoration project implemented at a manganese tailing site. Restoration of the plant community was shown to be an irreversible process characterized by spontaneous increases in its total biomass CT and total number of plant species N associated with increases in its enthalpy H, Gibbs free energy G and entropy S. Species enrichment was the cause for the decease in mass ratio xi (biomass of a species Ci divided by CT) and biomass growth potential μi (the partial derivative of Gi with respect to Ci). The increase in s/CT (s denoting the ratio of S to gas constant R) associated with decrease in f/CT (f denoting the ratio of G to RT) with increasing N confirmed that the restored plant community possessed natural trends towards increase in its species richness and evenness. The observed trends gave support to use of the thermodynamic functions for describing the productivity-biodiversity relationship. The present analysis did not fully prove the use of the Shannon form of information entropy as a biodiversity index for the investigated plant communities. Because of the presence of significant differences in individuals among species, the biodiversity of the plant community could not be uniquely determined by its individual numbers. In comparison, the entropy factor s was shown to be a suitable biodiversity index. The fact that N is the key factor that determines the changes in s/CT and f/CT makes △N > 0 a useful index for determining the direction of spontaneous changes for all open systems with continuous input of matter and energy. As a measure of disorder, s can be generally applied as a diversity index for all systems involving transformations of matter and energy.

A universal attribute of species is that their distributions are limited by numerous factors that may be difficult to quantify. Furthermore, climate change-induced range shifts have been reported in many taxa, and understanding the implications of these shifts remains a priority and a challenge. One approach is to employ species distribution models which correlates species presence data with a set of predictor variables. Here, we use MAXENT to predict current suitable habitat and to project future distributions of two closely related Phymata species in light of anthropogenic climate change. Using species occurrence data from museum databases and environmental data from WorldClim, we identified environmental variables maintaining the distribution of Phymata americana and Phymata pennsylvanica, and created binary suitability maps of current distributions for both species on ArcMap. We then predicted future distributions using the same environmental variables under different Representative Concentration Pathways (RCP), created binary suitability maps for future distributions, and calculated the degree of overlap between the two species. We found that the strongest predictor to P. americana ranges was precipitation seasonality, while precipitation of the driest quarter and mean temperature of the coldest quarter were strong predictors of P. pennsylvanica ranges. Future ranges for P. americana are predicted to increase northwestward and southward at higher CO2 concentrations. Suitable ranges for P. pennsylvanica are initially predicted to increase, but eventually decrease with slight fluctuations around range edges. There is an increase in overlapping ranges in all future predictions. These differences in optima provide evidence for different environmental requirements for P. americana and P. pennsylvanica, accounting for their distinct ranges. Because these species are ecologically similar and can hybridize, climate change has potentially important eco-evolutionary ramifications. Overall our results are consistent with effects of climate change that is highly variable across species, geographic regions and over time.

Phase-field models have been the subject of a great deal of research in recent years. Investigations have revealed that the phase-field model is capable of generating complex crack patterns. This is gained by replacing the sharp discontinuities with a scalar phase damage field comprising the diffuse crack topology. In the previous models, cracks are blurred into the surrounding areas due to introducing dependency of degradation function to a single parameter, strain threshold. The stable crack initiation and propagation require estimation of complex higher-order degradation function, which should be solved either by a new iteration scheme or using extremely small loading increment. However, this demands considerably high computational cost. In this study, the nonlinear coupled system comprising the linear momentum equation and the diffusion-type equation governing the phase-field evolution is solved concurrently through a Newton--Raphson approach. Moreover, an improved degradation function and staggered iteration scheme are solved by a one-step paradigm is proposed. Such that the computational costs can be reduced, and the stability of crack propagation can be improved. A phase-field model for ductile fracture is carried out in the commercial finite element software Abaqus by means of UEL and UMAT subroutines. Post-processing of simulation results is implemented through an added subroutine implemented in the visualization module. Several benchmark problems show the proposed model's ability to reproduce some essential phenomenological characteristics of ductile fracture as documented in the experimental literature.

The well known heat equation with finite speed of propagation proposed by Cattaneo is obtained by a more general fourth order PDE when a certain (small) parameters is put equal to zero. It seems that this fourth order equation has been essentially overlooked in the literature, in particular when it is subject to non homogeneous boundary conditions. In this paper we examine its well posedness and the asymptotic behavior when certain coefficients tend to singular values.

This paper deals with a fractional-order predator-prey model with Holling type II functional response incorporating a constant prey refuge and fear effect. Existence, uniqueness, non-negativity and boundedness of the solutions have been analyzed for the considered model. Existence conditions for different equilibrium points are discussed. Local and global stability of the equilibrium points is studied. We have checked how the impact of fear and fractional order can affect the stability of our proposed system. Finally, some numerical simulation has been performed to validate our theoretical findings.

The nano/microelectromechanical systems (N/MEMS) have been caught much attention in the past few decades for their attractive properties such as small size, high reliability, batch fabrication, and low power consumption. The dynamic oscillatory behavior of these systems is very complex due to strong nonlinearities in these systems. The basic aim of this manuscript is to investigate the nonlinear vibration property of N/MEMS oscillators by the homotopy perturbation method coupled with Laplace transform (also called as He-Laplace method in literature). A generalized N/MEMS oscillator is systematically studied, and a fairly accurate analytic solution is obtained. Three special cases for electrically actuated MEMS, multi-walled Carbon nanotubes-based MEMS, and MEMS subjected to van der Waals attraction are considered for comparison, and a good agreement with exact solutions is observed.

Olfactory and Taste Disorders and COVID-19: Our experience in 77 adults in the North East of England.