What is the impact of the Covid-19 pandemic on the ENT surgical volume? A multicentric study in 3 university unitsAuthors have no financial interest nor conflict of interest in the topic discusses in this paperNo financial support was obtained – No financial disclosureManuscript words count: 1250

Objectives: Chronic rhinosinusitis (CRS) is prevalent in the Cystic Fibrosis (CF) population. CRS exacerbations in CF are thought to contribute to pulmonary exacerbations. Literature regarding the impact of endoscopic sinus surgery (ESS) is inconclusive. This study examines rates of lung function decline and pulmonary exacerbation in CF patients who have undergone ESS. Design: Retrospective review of medical records. Setting: Academic Hospital. Participants: 40 adult CF patients. Main outcome measures: Rate of lung function decline (Forced Expiratory Volume1(FEV1) % predicted), number of pulmonary exacerbations (IV/oral antibiotic therapy +/- hospital admission) and total number days hospitalized 2 years post-operatively was collected. CRS patients undergoing ESS were matched to those without ESS by gender, age, and F508del genotype. Results: Forty patients (mean age 37.4, 60% male) were reviewed. No significant difference was found between the surgical group and controls in baseline FEV1(72.5% vs. 72.7%, p=0.98), 2-year pre-operative number of pulmonary exacerbations (3.05 vs. 1.65, p=0.10), or Lund-Mackay scores (12.25 vs. 11.55, p=0.71). No significant difference was found in 1-year (70.5% vs. 72.8%, p=0.84) or 2-year (70.4% vs. 72.6% p=0.80) post-operative FEV1 and 2-year post-operative pulmonary exacerbations (1.7 vs. 1.45, p=0.87). A significant increase was identified in total number days hospitalized post-operatively (4.85, p=0.02). In the surgical group, no significant difference was identified between preoperative and postoperative FEV1, 1 -year (-2.51%, p=0.32) and 2-years after ESS (-3.10%, p=0.51), postoperative rate of pulmonary exacerbations (-1.28, p=0.11), or in total number days hospitalized (3.74, p=0.14). Conclusions: In this study, ESS does not appear to significantly improve FEV1 or decrease the number of pulmonary exacerbations post-operatively.

Introduction The correlation of the right ventricular (RV) systolic function and functional capacity (FC) assessed by cardiopulmonary exercise testing (CPET) in HFrEF patients were demonstrated in previous studies In this study, we aimed to determine the correlation of RV free wall strain (RVfwlS) , left ventricular (LV) strain parameters and other standart echocardiographic parameters with the FC assessed by the 6 minutes walk test 6MWT in HfrEF patients. Also, according to the calculated RVfwlS, the differences among HFrEF patients were examined. Method Dilated cardiomyopathy patients with an EF lower than 40 % included in our study. After echocardiographic examinations, and venous blood sampling for NT-pro-BNP, the 6MWT performed for each participant by a physician blinded to echocardiographic examination. Results 50 patients with a mean EF of 28,78 ± 6,0 % were included. The distance walked in 6MWT ( 6MWT-dis) was significantly correlated with the NT-pro-BNP levels, E/Em-mean, left atrial volume index, RvfwlS, Sc (circumferential strain) and the Sl (longitudinal strain) . The Sc and the RVfwlS were found to be the independent predictors of the 6MWT-dis in multivariate analysis. According to mean RvfwlS which was -18,50 ± 4,83, we grouped patients; Group 1 (n= 26) RvfwlS > -18.5% and Group 2 (n=24) RVfwlS < -18.5%. The Group 2 patients have higher NT-pro-BNP levels (p<0.01) , lower 6MWT-dis (p<0.01), higher E/Em-mean (p<0.01) and lower Sl (p<0.01). Conclusion The low RVfwlS in HFrEF patients could indicate cumulative exposure of RV to chronic increased LV filling pressures due to LV remodelling and dilatation.

Purpose: This study was a quality-control study of resting and exercise echocardiography (EDE) variables measured by 19 echocardiography laboratories with proven experience participating in the RIGHT Heart International NETwork. Methods: All participating investigators reported the requested variables from ten randomly selected exercise stress tests. Intraclass correlation coefficients (ICC) were calculated to evaluate the inter-observer agreement with the core laboratory. Inter-observer variability of resting and peak exercise tricuspid regurgitation velocity (TRV), right ventricular outflow tract acceleration time (RVOT Act), tricuspid annular plane systolic excursion (TAPSE), tissue Doppler tricuspid lateral annular systolic velocity (S’), right ventricular fractional area change (RV FAC), left ventricular outflow tract velocity time integral (LVOT VTI), mitral inflow pulsed wave Doppler velocity (E), diastolic mitral annular velocity by TDI (e’) and left ventricular ejection fraction (LVEF) was measured. Results: The accuracy of 19 investigators for all variables ranged from 99.7% to 100%. ICC was > 0.80 for all observers. Inter-observer variability for resting and exercise variables was for TRV = 3.8 to 2.4%, E = 5.7 to 8.3%, e’ = 6 to 6.5%, RVOT Act = 9.7 to 12, LVOT VTI = 7.4 to 9.6%, S’= 2.9 to 2.9% and TAPSE = 5.3 to 8%. Moderate inter-observer variability was found for resting and peak exercise RV FAC (15 to 16%). LVEF revealed lower resting and peak exercise variability of 7.6 and 9%. Conclusions: When performed in expert centers EDE is a reproducible tool for the assessment of the right heart and the pulmonary circulation

Borna disease virus (BoDV) can cause neurological disease in several vertebrate species, especially in horses and sheep. The recent cases of fatal encephalitis caused by BoDV in humans have raised concern regarding the zoonotic character of this virus. BoDV infection in horses is endemic in Central Europe, whereas in Spain the disease is regarded as an exotic disease in horses and serological investigations in these animals have never been performed. The aim of this study was to investigate the exposure to BoDV in breeding and sport horses in Spain and to determine risk factors for the transmission of the virus. Serum samples from 495 horses (260 sport horses and 235 Spanish Purebred breeding horses) were tested by an Indirect Fluorescence Antibody Test (IFAT). From the SP breeding horses we examined factors putatively associated with seropositivity to BoDV. A total of 164 horses (33.1%; 95% CI 29.0-37.3) showed antibodies against BoDV. Factors associated with BoDV seropositivity in the SP breeding horses were climate, age and the time of the year when the horses were sampled. This is the first report on the presence of BoDV antibodies in apparently asymptomatic breeding and sport horses in Spain. Our results demonstrate the need for BoDV surveillance in horses and possible reservoir hosts in this country, and suggests that BoDV should be included in the differential diagnosis of equine and human cases of encephalitis.

Mycoplasma hyopneumoniae (M. hyopneumoniae, Mhp) is an etiological agent that causes mycoplasma pneumonia of swine (MPS), this is a chronic respiratory disease present in every major swine-producing country worldwide. It is well elucidated, Mhp infections may downregulate the host immune system and enhance the infection and replication of other pathogens. However, the mechanisms of interaction between Mhp and other pathogens is still missing. Though, additional studies have reported that several cofactors such as bacteria, vaccination failure, stress or crowing and other swine viruses in combination with Mhp, lead to MPS. Aside these cofactors, the co-infection of Mhp with other viruses, such as Porcine Circovirus, Porcine Reproductive and Respiratory Syndrome Virus, Swine Influenza Virus, Pseudorabies Virus, and other bacteria, such as Pasteurella multocida, Actinobacillus pleuropneumoniae have been widely studied for many years. In this review, we summarized the co-infection of Mhp with other swine pathogens based our studies made, the co-infection with other viruses and bacteria, revealed the interaction mechanism of different pathogens with Mhp in the host

ABSTRACT Drought along with high temperature around flowering is becoming more frequent to strongly influence maize production. However, the impacts of independent and combined drought and heat stress during this stage on subsequent grain filling have received limited attention. Here we investigated the response of grain development to three stresses (drought, heat and combined drought and heat stresses (DS, HS, DHS)) around flowering in ponds covered with a rain shelter in field. In additional, some grains were incubated in laboratory after pollination. Compared with control treatment, the decreased rate of grain weight was in the order of HS≤DS≤DHS in both experiments. In field, grain weight was decreased by 5-11% in stresses. The leaf senescence was accelerated together with decreased photosynthesis rate. Grain weight was still reduced largely in stresses with sufficient source supply in laboratory, which implicated a subsequent sink (grain) limit by early stresses. This mainly resulted from the disturbed carbohydrate metabolism and starch synthesis such as the activities of surcose invertase, sucrose synthase, ADP Glc pyrophosphorylase and starch synthase at early grain filling stage. This study provided information on how to promote drought and heat tolerance hybrids and mitigated management strategy.

Background: The rapid spread of COVID-19 has placed tremendous strain on the American healthcare system. Few prior studies have evaluated the well-being of or changes to training for American resident physicians during the COVID-19 pandemic. We aim to study predictors of trainee well-being and changes to clinical practice using an anonymous survey of American urology residents. Methods: An anonymous, voluntary, 47-question survey was sent to all ACGME-accredited urology programs in the United States. We executed a cross-sectional analysis evaluating risk factors of perception of anxiety and depression both at work and home and educational outcomes. Multiple linear regressions models were used to estimate beta coefficients and 95% confidence intervals. Results: Among approximately 1,800 urology residents in the USA, 356 (20%) responded. Among these respondents, 24 had missing data leaving a sample size of 332. Important risk factors of mental health outcomes included perception of access to PPE, local COVID-19 severity, and perception of susceptible household members. Risk factors for declination of redeployment included current redeployment, having children, and concerns regarding ability to reach case minimums. Risk factors for concern of achieving operative autonomy included cancellation of elective cases and higher level of training. Conclusions: Several potential actions, which could be taken by urology residency program directors and hospital administration, may optimize urology resident well-being, morale, and education. These include advocating for adequate access to PPE, providing support at both the residency program and institutional levels, instituting telehealth education programs, and fostering a sense of shared responsibility of COVID-19 patients.

Cardiovascular disease and the impact of COVID-19Running Head: COVID-19 and cardiovascularAnusha Yoganathan1, Menahel Sajjad1, Amer Harky1,2University of Liverpool, Liverpool, UKDepartment of Cardiothoracic Surgery, Liverpool Heart and Chest, Liverpool, UK

In this paper, we are motivated to establish a generalization of $_pR_q(\alpha,\beta;z)$ function in terms of incomplete exponential functions and obtain some properties of the incomplete exponential $_pR_q(\alpha,\beta;z)$ function. Further we give generating relations for incomplete exponential $_pR_q(\alpha,\beta;z)$ function. Some applications related to ground water pumping (Hydrology) modelling and probability theory have also been discussed.

In this work, we consider the inverse scattering transform and multi-solition solutions of the sextic nonlinear Schr\“{o}dinger equation. The Jost functions of spectrum problem are derived directly, and the scattering data with $t=0$ are obtained according to analyze the symmetry and other related properties of the Jost functions. Then we take use of translation transformation to get the relation between potential and kernel, and recover potential according to Gel’fand-Levitan-Marchenko (GLM) integral equations. Furthermore, the time evolution of scattering data is considered, on the basic of that, the multi-solition solutions are derived. In addition, some solutions of the equation are analyzed and revealed its dynamic behavior via graphical analysis, which could be enriched the nonlinear phenomena of the sextic nonlinear Schr\”{o}dinger equation.

In this paper, we consider a dynamic frictional contact problem between two electro-elasto-viscoplastic bodies with internal state variables and damage. The contact is frictional, modeled with a normal damped condition involving adhesion effect of contact surfaces. We present a variational formulation for the model and state an existence and uniqueness result of the weak solution. The proof is based on arguments of time dependent variational inequalities, differential equations and fixed point.

In this paper, we considered a one-dimensional problem for a half-space in generalized thermoelastic for two models; Lord-Shulman (L-S) and the dualphase-lag (DPL) theories. The surface of the half-space is assumed to be traction free and subjected to the effects of a heat source varying exponentially with time at the boundary. The homotopy perturbation method is applied to obtain the approximate solution of thermoelastic interactions with boundary condition. The numerical results obtained are displayed graphically to show the influences of the new parameters.The effects of the heat source varying with time and zero traction force are studied on displacement, temperature and stress.

According with latest guidelines, percutaneous mitral commissurotomy (PMC) represents the first-line treatment for symptomatic severe mitral valve stenosis (SMVS) with favourable morphology, We report a successful surgical treatment of a potential life-threatening complication occurred during PMC. Heart-Team discussion and closed collaboration with Centres are crucial for decision-making and Cardiac Surgery onsite should be ensured for high-risk procedures.

BACKGROUND: To assess the feasibility and outcome of Continuous Cerebral and Myocardial Selective Perfusion (CCMSP) during aortic arch surgery in neonates. METHODS: This retrospective single-center study was conducted between 2008 and 2019 in neonates undergoing aortic arch surgery, accompanied or not by cardiac malformation repair. CCMSP at moderate hypothermic of 28°C was achieved using selective brachiocephalic artery and ascending aorta cannulation. Target rates of cerebral and myocardial perfusion were 25-35 mL/kg/min and 150/m2/min. Cardiopulmonary bypass (CPB) variables and clinical outcomes were analyzed. RESULTS: Overall, 69 neonates underwent either isolated aortic arch repair (n=31) or aortic arch repair with ventricular septal defect (VSD) closure (n=38). The mean age and weight were 9.79±7.1 days and 3.17±0.4Kg, respectively. Mean CPB and aortic clamping times were 133.5±47.0 and 25.2±5.3 min for isolated aortic arch repair, and 158.4±47.9 and 75.4±30.5 min for aortoplasty accompanied by VSD closure. Mean CCMSP time was 51.6±21.5 min with cerebral rate of 32.6±10.0mL/Kg/min. Two major complications arose: stroke (n=1; 1.44%) and transient renal failure requiring dialysis (n=2; 2.89%). Neither myocardial nor visceral ischemia occurred. In-hospital mortality was 1/69 (1.44%). CONCLUSIONS: CCMSP is a safe and reproducible strategy for cerebral, myocardial and visceral protection in neonatal aortic arch repair, with or without VSD closure, resulting in low complication and mortality.

Background: Cardiac surgeries use 10%–15% of red blood cells transfused in the United States, despite benefits of limiting transfusions. We sought to evaluate the the feasibility and impact of a restrictive transfusion protocol on blood use and clinical outcomes in patients undergoing isolated primary coronary artery bypass grafting (CABG). Methods: Blood conservation measures, instituted in 2012, include preoperative optimization, intraoperative anesthesia and pump fluid restriction with retrograde autologous priming and vacuum-assisted drainage, use of aminocaproic acid and cell saver, intra- and postoperative permissive anemia, and administration of iron and lowdose vasopressors if needed. Medical records of patients who underwent isolated primary CABG from 2009–2012 (group A; n=375) and 2013–2016 (group B; n=322) were compared. Results: CABG with grafting to 3 or 4 coronary arteries was performed in 262 (70%) and 222 (69%) patients and bilateral internal thoracic artery grafting in 202 (54%) and 196 (61%) patients in groups A and B, respectively. Mean preoperative and intraoperative hematocrit was 40.3% and 40.7%, 28.9% and 29.4% in groups A and B, respectively. Total blood transfusion was 24% and 6.5%, intraoperative transfusion 10% and 1.2%, postoperative transfusion 19% and 5.3% (p<0.0001 for all) in groups A and B, respectively. Median postoperative length of stay was 5.0 days in group A and 4.5 days in group B (p =.02), with no significant differences between groups in mortality or morbidity. Conclusions: A restrictive transfusion protocol reduced blood transfusions and postoperative length of stay without adversely affecting outcomes following isolated primary CABG.

Isolated transposition of great arteries (TGA) is a congenital heart disease that presents with severe cyanosis after birth and a fetal diagnosis is crucial for preserving life. The I-shaped sign (I-sign) is useful as a fetal screening method for TGA. We herein present a tricky fetal case of isolated TGA in the side-by-side arterial position without the I-sign. Severe cyanosis immediately after birth necessitated urgent interventions. Death was prevented because of the fetal diagnosis. In the fetal diagnosis of isolated TGA, it is important to not only detect the I-sign, but also conventionally examine the ventricular outflow tract.

Background: Tricuspid regurgitation (TR) is associated with adverse prognosis in various patient populations but currently no data is available about the prevalence and prognostic implication of TR in ST-segment elevation myocardial infarction (STEMI) patients. We investigated the possible implication of TR among STEMI patients. Methods: We conducted a retrospective study of STEMI patients undergoing primary percutaneous coronary intervention (PCI), and its relation to major clinical and echocardiographic parameters. Patients records were assessed for the prevalence and severity of TR, its relation to the clinical profile, key echocardiographic parameters, in-hospital outcomes, and long-term mortality. Patients with previous myocardial infarction or known previous TR were excluded. Results: The study included 1071 STEMI patients admitted between September 2011 and May 2016 (age 61 ± 13 years; predominantly male). A total of 205 patients (19%) had mild TR while another 32 (3%) had moderate or greater TR was 3% (n = 32). Patients with significant TR demonstrated worse echocardiographic parameters, more likely to have in-hospital complications and had higher long-term mortality (28% vs. 6%; p<0.001). Following adjustment for significant clinical and echocardiographic parameters, mortality hazard ratio (HR) of at least moderate to severe TR remained significant (2.44; 95% CI, 1.06-5.6; P = .036) for patients with moderate-severe TR. Conclusions: Among STEMI patients after primary PCI, the presence of moderate-severe TR was independently associated with adverse outcomes and significantly lower survival rate. Keywords: Tricuspid Regurgitation; ST-segment elevation myocardial infarction; percutaneous coronary intervention; cardiac intensive care unit; cardiac intensive care unit; echocardiography; valvular regurgitation.

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Tietze's syndrome is an inflammatory disorder which is frequently misdiagnosed as the severe life-threating problem. Herein, we report a case of a 23-year-old male who he was diagnosed with Tietze's syndrome. Since the precise diagnosis of Tietze's syndrome has great importance, our report may raise consciousness to manage this condition.

Streptococcus Dysgalactiae, a group C streptococcus (GCS) has been mainly implicated as a pathogen associated with mucosal infections. This case corroborates the current emphasis toward Strep dysgalactiae as a pathogen of increasing suspicion when faced with variable clinical presentations.

Lupoid cutaneous leishmaniasis is identified by a broad range of clinical presentation with brown to red, yellowish-brown, apple-jelly papules. These papules enlarge to plaques, develop into granulomatous, crusted ulcers, which are as similar as cutaneous lesions of lupus vulgaris. Herein, we report a patient with lupoid CL mimicking lupus vulgaris

Random sampling is a ubiquitous tool in simulations and modeling in a variety of applications. There are efficient algorithms for these for several known distributions, but in general, one must resort to computing or approximating the inverse to the distribution to generate random samples, given a random number generator for a uniform distribution. In certain physical and biomedical applications with which we have been particularly concerned, it has proven to be more efficient to provide random times for a walk of a fixed length, rather than the conventional random step lengths in a given time step for the walker. For these, the hitting-time distributions which have to be sampled have been computed, and proved to be complicated expressions with no efficient method to compute the inverse. In this paper, we explore a well known probability (the F-ratio distribution) - whose inverses are efficiently computable - as an alternative to generating look-up tables and interpolations to obtain the required time samples. We find that this distribution approximates the hitting-time distribution well, and report on error measures for both the approximation to the desired, and the error in the generated time samples. Future Monte Carlo simulations in a number of fields of application may benefit from methods such as we report here.

In this paper, we characterize T−soft ideals,T−fuzzy soft normal ideals over a ring and give a portion of their properties. Likewise, we present homomorphism, hostile to homomorphism, isomorphism and anti- isomorphism of T−fuzzy soft normal-ideals ordinary standards over the ring. In addition, we show that the image and preimage of homomorphism, hostile to homomorphism, isomorphism and against isomorphism of T-fuzzysoft normal ideals over the ring under certain conditions.