Canine parvovirus (CPV) is a major enteric pathogen of dogs worldwide that emerged in the late 1970s from a feline parvovirus (FPV)-like ancestral virus. Shortly after its emergence, variant CPVs were generated by acquiring amino-acid (aa) mutations in key capsid residues, associated with biological and/or antigenic changes. This study aimed to identify CPV variants amongst Australian dogs, to gain insights into the evolution of CPV in Australia through phylogenetic analysis of these variants, and to investigate relationships between the disease and vaccination status of dogs from which isolates were collected. CPV VP2 sequences were amplified from 79 faecal samples collected from dogs with parvoviral enteritis at 20 veterinary practices in 5 Australian states. The median age at diagnosis was 4 months (range 1 to 96 months). Only 3.7% of dogs with vaccination histories had completed recommended vaccination schedules, while 49% were incompletely vaccinated and 47.2% were unvaccinated. For the first time, CPV-2b has emerged as the dominant antigenic CPV variant circulating in dogs with parvoviral enteritis in Australia, comprising 54.4% of strains, while CPV-2a and CPV-2 comprised 43.1% and 2.5% of strains. CPV-2c strains were not identified. Analysis of translated VP2 sequences revealed a vast repertoire of aa mutations. Several Australian CPV strains displayed signatures in the VP2 protein typical of Asian CPVs, suggestion introduction of CPV strains from Asia, and/or CPV circulation between Asia and Australia. Strains of CPV were identified containing aa residues typical of FPV at capsid (VP2) key positions, representing reverse mutations or residual mutations retained from CPV-2 during adaptation from an FPV-like ancestor, suggesting that evolutionary intermediates between CPV-2 and FPV are circulating in the field. Similarly, intermediates between CPV-2a-like viruses and CPV-2 were also identified. These findings help inform a better understanding of the evolution of CPV in dogs.

Participatory approaches such as community photography can engage the public in questions of societal and scientific interest. We combined data extracted from community-sourced, spatially-explicit photographs with research findings from 2018 fieldwork in the Yukon, Canada, to evaluate winter coat moult patterns and phenology in mountain goats (Oreamnos americanus), a cold-adapted, alpine mammal. Leveraging the community science portals iNaturalist and CitSci, in less than a year we amassed a database of several hundred unique photographs spanning some 4500 kms between latitudes 37.6°N and 61.1°N from 0m to 4333m elevation. Using statistical methods accounting for incomplete data, a common issue in community science datasets, we evaluated effects of intrinsic (sex and presence of offspring) and environmental (latitude and elevation) factors on moult onset and rate and compared our findings with published data. Shedding occurred over a 3-month period, May 29-September 6. Effects of sex and offspring on the timing of moult were consistent between the community-sourced and our Yukon data and with findings on wild mountain goats at a long-term research site in west-central Alberta, Canada. Males moulted first followed by females without offspring (6.4 days later in the coarse-grained, geographically-wide community science sample; 23.7 days later in our fine-grained Yukon sample) and lastly females with new kids (5.5; 17.9, respectively). Shedding was later at higher than at lower elevations. Northern latitudes had slightly later but shorter shedding periods. We detected a possible shift in moult timing in recent years (2015-2018) that warrants additional investigation. Despite data limitations, such as bias towards recent photographs, our findings establish a basis for employing community photography to examine broad-scale questions about the timing of ecological events, as well as sex differences in response to possible climate drivers. As such, community photography can inspire public participation in environmental and outdoor activities with reference to iconic wildlife.

SARS-CoV-2 has claimed more than 300,000 lives while infecting 4 million individuals worldwide. There are no specific treatments for COVID-19. Symptoms vary from very mild/asymptomatic to severe, including admission to ICU. Strong sex-bias in COVID-19 have been noted with males showing more than double the odds of requiring ICU admission and higher mortality. Reproductive steroids, including estrogens, progesterone and its physiologically-active metabolite, allopregnanolone exert anti-inflammatory actions and influence the immune system. Intriguingly, pregnant women with COVID-19 appear to experience milder symptoms. In some pregnant women escalated symptoms severity is observed immediately postpartum in coincidence with the rapid hormonal drop associated with parturition. This finding suggests that reproductive steroids’ anti-inflammatory effects and their role in reshaping competence of immune cells may protect during pregnancy. The hypothesis that estradiol, progesterone may provide a treatment against COVID-19 in men and in postmenopausal women is discussed.

Down-regulation of photosynthesis in elevated CO2 (eCO2), could be attributed to depletions in nitrogen (N) availability after long term exposure to eCO2 (progressive nitrogen limitation, PNL) or N dilution due to excessive carbon accumulation of nonstructural carbohydrates. To investigate this, we examined N availability, photosynthetic characteristics, and leaf N allocation in Pinus densiflora, Fraxinus rhynchophylla, and Sorbus alnifolia, grown under three different CO2 concentrations, ambient CO2 (aCO2), aCO2 × 1.4 ppm (eCO21.4), and aCO2 × 1.8 ppm (eCO21.8), for 9 years. N availability increased under eCO21.8, and its allocation to chlorophyll (NFchl) and photosynthetic N use efficiency also increased under eCO2. The maximum carboxylation rate, leaf N per mass (Nmass), and N allocation to Rubisco (NFRub), however, were all lower under eCO21.8. There were interactions in NFchl between canopy × species × CO2 concentrations. The greatest changes in N allocation under eCO2 were in the lower canopy of S. alnifolia, the most shade-tolerant species and this species have relatively high flexibility in N operations compared to shade-intolerant species. Based on the reduction in Nmass that was diluted by increased nonstructural carbohydrates and increased N availability, down-regulation of photosynthesis was found to be caused by the dilution and change in N allocations, rather than PNL.

The synthesis of starch-based physical hydrogels in combination with chitosan and polyvinyl alcohol, and their potential co-application with chitosan nanoparticles was evaluated. The potential of starch-chitosan hydrogel obtained by physical/chemical method for tissue engineering uses was also studied in a mouse wound healing model. Although the microscopical structure of each synthesized hydrogel suggests a possible biological application, starch-polyvinyl alcohol hydrogel exhibited rigid behavior with minor channel diameters, a lower swelling rate (less than 300%), and negatively affected cell viability in a cytotoxicity assay. Starch-chitosan hydrogel obtained by chemical crosslinking with glutaraldehyde demonstrated the higher swelling rate (about 1100%), cell viability values over 80%, and a homogeneous tri-dimensional structure; along with an excellent interaction with chitosan nanoparticles. This type of hydrogel was selected for an in vivo experiment, showing significant differences in wound healing process against a non-treated control, in terms of inflammation, exudate production and tissue recovering.

Introduction: Atrial fibrillation (AF) predisposes patients to heart failure (HF) and a resultant increase in mortality, however, little is known regarding what characteristics of AF are related to HF. Our aim is to clarify the characteristics of AF with subsequent HF by analysis of R-R interval during every 1-h segment. Method and Results: We retrospectively analyzed 188 Holter electrocardiograms of patients with continuous AF. A histogram of normal R–R intervals was plotted for each hour, the mean R-R intervals (mean R-R) and the standard deviation of R–R intervals (SD R–R) were calculated. Mean R-R and SD R-R demonstrated circadian variations in 167 patients without subsequent HF. In 21 patients with subsequent HF, SD R–Rs were significantly shorter than those in patients without HF at 1:00–2:00 (174.9 ± 46.4 vs. 207.3 ± 67.5 ms), at 2:00–3:00 (180.4 ± 42.8 vs. 212.7 ± 68.1 ms), at 3:00–4:00 (181.9 ± 52.7 vs. 216.1 ± 71.0 ms), and at 4:00–5:00 (187.9 ± 50.0 vs. 220.7 ± 72.0 ms). Mean R-R and SD R-R kept in low values during night-time in β-blocker users of the HF group. The attenuation of circadian variations of mean R-R and SD R-R were also recognized in patients with reduced ejection fraction. Conclusions: The analyses of R-R interval under the consideration of the circadian variations and the usage of β-blocker were suspected to predict subsequent HF in patients with continuous AF.

The global pandemic from Sars-cov-2 has down caused thousands of deaths worldwide, triggering a health crisis in the various countries involved, with few precedents in history. To date there are no vaccines for prophylaxis, and there are no antivirals directed against the virus. Among the therapeutic options that have shown effectiveness is passive immunization with immune plasma from convalescent patients cured of the infection. Plasma collected from patients cured of Sars-cov-2 infection is rich in antibodies that neutralized the pathogen. Plasma therapy has already demonstrated its efficacy in other epidemics, such as Sars-Cov and MERS. To date, there are limited data for its use in sars-Cov-2 infection, both for prophylaxis and treatment, but the few existing data bode well for the scientific world. Many questions are still unresolved, when to administer it? At what dosage? When is it most appropriate to take the plasma from the cured patient? Are there different answers depending on gender and age? Certainly in view of the high number of patients infected and cured by Sars-Cov-2, there could be a high amount of plasma from donor patients. In this article we want to give an overview on a current and important topic in the perspective of the battle against the new Sars-Cov-2, analysing the therapeutic successes in past epidemics, the clinical data currently available, the future prospect and an expert opinion.

Irregular narrow QRS complex tachycardia with intermittent atrioventricular dissociation: What is the mechanism?Atsushi Doi, MD, PhD; Naoko Miyazaki, MD; Tomohiko Goda, MD; Haruya Yamane, MD; Kei Tanaka, MD; Ryo Araki, MD,PhD; Fumi Sato, MD, PhD; Takayuki Yamada, MD.Department of Cardiovascular Medicine, Otemae Hospital, 1-5-34 Otemae, Chuo-ku, Osaka, 540-0008, Japan.Correspondence to Atsushi Doi, MD, PhD. Department of Cardiovascular Medicine, Otemae Hospital, 1-5-34 Otemae, Chuo-ku, Osaka, 540-0008, Japan.Tel: 81-6-6941-0484, Fax: 81-6-6942-2848E-mail; m1410001@med.osaka-cu.ac.jp

Background Recent epidemiologic data has indicated coronavirus to be highly contagious with high risk of person-to-person transmission. On March 11, 2020, the World Health Organization (WHO) declared COVID-19 a pandemic. With the increasing number of confirmed cases and the accumulating clinical data, the cardiac manifestations induced by COVID-19 have generated great concern. COVID-19 was also associated with cardiac arrest, acute-onset heart failure, and myocarditis. COVID-19 has not been reported as the cause of abnormalities of cardiac conduction system. Case Presentation Our patient was transferred from a long-term care facility with history of new onset bradycardia and fall. Patient had no classical symptoms of viral infection, including fever, dyspnea or any classical radiological finding like bilateral ground glass opacities. Initial EKG was noted for 3rd degree AV and heart rate 30 BPM. He was taken to cardiac catheterization lab for an emergent temporary transvenous pacemaker. Patient subsequently had permanent pacemaker implanted electively. Discussion and Conclusions This case represents cardiac conduction abnormality requiring therapeutic pacing as a presenting symptom of SARS-CoV-2 Health care professionals need to be vigilant about atypical, noval presentation of this disease in patients belonging to risk groups such as over 60 years age, immunocompromised, residents of long-term facilities, and with medical conditions such as heart disease, lung disease, diabetes, stroke, renal disease, cirrhosis, and diabetes. Currently there is no proven treatment for this infection and individuals in these at-risk groups are susceptible to higher morbidity and mortality.

Myocardial injury after temporary transvenous cardiac pacing1. Meng Liu, MD2. Pingsheng Wu, MDFrom Cardiology Department, Nanfang Hospital, Southern Medical University, Guangzhou, China; Emergency Department, Hunan Provincial People’s Hospital, Medical School of Hunan Normal University, Changsha, ChinaCorrespondence to Pingsheng Wu. Cardiology Department, Nanfang Hospital, Southern Medical University. No. 1838, north Guangzhou Road, Guangzhou, China.Keywords: Temporary pacemaker; Temporary transvenous cardiac pacing; Myocardial injury; Bradyarrhythmia; Perioperative myocardial injury.AbstractIntroduction: It is not unusual for temporary transvenous cardiac pacing (TVCP) leads to penetrate and occasionally perforate the right ventricular wall, which generally is asymptomatic. The definition of myocardial injury is evidence of elevated cardiac troponin (cTn) values above the 99th percentile upper reference limit (URL). Myocardial injury is associated with an adverse prognosis. The present study was designed to evaluating myocardial injury complicated by TVCP.Methods: Retrospective study from August 2018 to March 2020, 33 consecutive patients undergo elective TVCP support for non-cardiac procedures, 22 of them had cardiac biomarkers assays before and after TVCP. These 22 eligible patients had a median age of 66 (50-83) years, 6 (27.3%) were women, and all baseline cTn <1 URL. Compare cardiac biomarkers before and after TVCP.Results: 20 (91%, N=22) patients detect cTn >1 URL after pacing. Paired t-test compare before and after pacing leads insertion showed a mean cTn elevation of 3.599 (95% CI, 1.566 to 5.632, P<0.01）URL, and no significantly creatine kinase-MB elevation of 0.1550 (95% CI, -0.01239 to 0.3224, P>0.05 ) URL.Conclusion: This study demonstrates a high incidence of substantial myocardial injury by TVCP, which should be concerned.

INTRODUCTION: We previously reported the clinical benefits of radiofrequency catheter ablation (RFCA) of premature ventricular contractions (PVCs) from the right ventricular outflow tract or near His-bundle, which often can deteriorate clinical status and cause left ventricular (LV) dilation that develops into heart failure. This study aimed to evaluate the role of ablating PVCs per RFCA from a trans-interatrial septal approach in the LV dilation and clinical status in patients with PVCs from the mitral annulus (MA) (MA-PVCs) without structural heart disease. METHODS: The frequency of PVCs per the total heart beats by 24-h Holter monitoring, left ventricular ejection fraction (LVEF) and left ventricular end-diastolic (LVDd) and -systolic (LVDs) internal dimensions by echocardiography, New York Heart Association (NYHA) functional class, and serum brain natriuretic peptide (BNP) concentration in 22 patients with MA-PVCs were evaluated before and 6 months after RFCA. RESULTS: Before the RFCA, the patients with frequent (20% <) PVCs demonstrated a significantly reduced LVEF, enlarged LVDd and LVDs, deteriorated NYHA functional class, and elevated serum BNP concentration as compared to the subgroup with rare (≤ 20%) PVCs. Furthermore, ablating MA-PVCs readily produced an improvement in those abnormalities as compared to that before the RFCA. Interestingly, the MA-PVCs were successfully ablated from not only the ventricular side of the MA (68%) or coronary sinus (5%), but also the left atrial side of the MA (18%). CONCLUSIONS: RFCA produces clinical benefits in patients with MA-PVCs. Further, it may be necessary to initially consider a trans-interatrial septal approach to ablate these PVCs.

Letter to the Editor

Background Data on the optimal location of the ECG leads for the diagnosis of drug-induced long QT syndrome (diLQTS) with Torsades de Pointes (TdP) are lacking. Methods We systematically reviewed the literature for ECGs of patients with diLQTS and subsequent TdP. We assessed T-wave morphology in each lead and measured the longest QT interval in the limb and chest leads in a standardized fashion. Results Of 84 patients, 61.9% were female and mean age was 58.8 years. QTc was significantly longer in chest versus limb leads (mean (standard deviation) 671 (102) vs 655 (97) ms, p=0.02). Using only limb leads for QT interpretation, 18 (21.4%) ECGs were non-interpretable: 10 (11.9%) due to too flat T-waves, 7 (8.3%) due to frequent, early PVCs and 1 (1.2%) due to too low ECG recording quality. In the chest leads, ECGs were non-interpretable in 9 (10.7%) patients: 6 (7.1%) due to frequent, early PVCs, 1 (1.2%) due to insufficient ECG quality, 2 (2.4%) due to missing chest leads but none due to too flat T-waves. The most common T-wave morphologies in the limb leads were flat (51.0%), broad (14.3%) and late peaking (12.6%) T-waves. Corresponding chest lead morphologies were inverted (35.5%), flat (19.6%) and biphasic (15.2%) T-waves. Conclusions Our results indicate that QT evaluation by limb leads only underestimates the incidence of diLQTS experiencing TdP and favors the screening using both limb and chest lead ECG.

During the SARS-Cov-2 pandemic, it is essential to identify the risk factors that can cause a higher probability of infection and, therefore, worsen the patient's health. In fact, the known risk factors include already existing diseases and associated pharmacological treatments. A patient with multiple sclerosis takes immunomodulatory drugs and certainly has a high risk. Evidence and literature have shown that SARS-Cov-2 infection causes severe lung damage due to a poorly functioning immune system and overexpression of cytokines. Therefore the management of multiple sclerosis treatments in immunomodulating therapy must be carefully monitored. This article on the one hand analyzes and recalls the safety profile of all drugs for multiple sclerosis, on the other the recommendations adopted by different countries are highlighted, trying to understand if the suspension of MS treatment must actually materialize in order not to incur lethal covid pneumonia.

In March 2020 a pandemic was declared due to a novel coronavirus strain. The virus can create a hypercoagulable state. This case is one of the first to report the development of a pulmonary embolism in an infected patient with no known risk factors in an outpatient setting.

Increasing anthropogenic loading of phosphorus (P) threatens aquatic ecosystems. The bioavailability of P in sediments for algal growth depends on several physiochemical properties such as silt, clay, mineralogy, pH, electrical conductivity (EC), and carbonate-content. This study was aimed on selecting the best chemical extraction method to characterize P-availability for the algae Selenastrum capricornutum. Principal component analysis (PCA) of the data identified two components that cover 79.3% of the total variation, and these components were dominated by particle size distribution, active calcium carbonate equivalence (ACCE), and EC. Many of the considered extractions were positively correlated with each other, with the exception being Bray-II. The sediments of some rivers had a higher Olsen-extractable P than 20 mg kg-1, that is considered a threshold value above which the aquatic environment may become negatively affected. The average rank order of P extraction by single extractants was: Colwell > Mehlich III > NaOH 0.1 M > Olsen > Morgan > AB-DTPA > Bray II. The Colwell-extractable P concentrations of sediments varied from 1.44 to 88.0 mg kg-1. This extractant significantly correlated with algal growth (r2=0.92, P<0.001) and gave a rough estimate of the amount of bioavailable P in sediments. Therefore, the bioavailable content of P in sediments is quite high in comparison with the soils (agronomic requirement = 15 mg P kg-1) around the Urmia Lake basin.

The pandemic of coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has made widespread impact recently. We aim to investigate the clinical characteristics of COVID-19 children with different severities and allergic status. Pediatric COVID-19 patients tended to have a mild clinical course. Patients with pneumonia had higher proportion of fever and cough and increased inflammatory biomarkers than those without pneumonia. There was no difference between allergic and non-allergic COVID-19 children in aspects of incidence, clinical features, laboratory and immunological findings. Allergy was not a risk factor for developing and severity of SARS-CoV-2 infection and hardly influenced the disease course of COVID-19 in children.

Dear Editor,With great interest, I read the article by Yim and associates1 and congratulate them for the quality of the review carried out on the internal mammary artery harvesting techniques. However, I would like to help clarify some aspects specifically related to the history of this procedure.The skeletonized IMA harvesting technique is usually considered to be newer than pedicle dissection. Actually, when Arthur Vineberg first implanted an IMA in a human heart in 1950, he only separated the arterial vessel from the chest wall. For more than a decade, only arteries were implanted according to Vineberg’s proposed method, and it wasn’t until the early 1960s that William Sewel proposed implanting a pedicle into the myocardium, that also contained the internal mammary vein and other tissues (”pedicle operation”) with the intention of draining excess blood and avoiding the formation of myocardial hematomas.2It is also incorrect to claim that skeletonized IMA harvesting was introduced due to concerns offered by reduced sternal blood flow and potential mediastinitis. In January 1972, David Galbut and his group introduced systematic skeletonized harvesting into their series of patients revascularized with bilateral internal mamary arteries, some time before that procedure began to be linked with deep sternal wound infections. Galbut probably only took advantage of obtaining longer arteries and easier construction of sequential anastomoses.2Furthermore, when Cunningham first described the IMA’s skeletonized harvesting technique in 1992 he specified that to avoid thermal injury to the artery, it was extremely important to keep the cautery setting on low throughout the dissection.3 After this advice, smoke never seems to have been a concern for surgeons, so it was hardly the reason for the introduction of harmonic technology in IMA dissection, which was also initially used in the “open harvesting” technique.4Finally, I consider it curious that this review does not include the semiskeletonization technique, introduced in 19975 and currently used by various groups.References1. Yim D, Wong WYE, Fan KS, Harky A. Internal mammary harvesting: Techniques and evidence from the literature. J Card Surg. 2020;35(4):860-7.2. López de la Cruz Y, Nafeh Abi-Rezk M, Betancourt Cervantes J. Internal mammary artery harvesting in cardiac surgery: an often mistold story. CorSalud. 2020;12(1):64-76.3. Cunningham JM, Gharavi MA, Fardin R, Meek RA. Considerations in the skeletonization technique of internal thoracic artery dissection. Ann Thorac Surg. 1992;54(5):947-50.4. Higami T, Kozawa S, Asada T, Shida T, Ogawa K. Skeletonization and harvest of the internal thoracic artery with an ultrasonic scalpel. Ann Thorac Surg. 2000;70:307-8.5. Horii T, Suma H. Semiskeletonization of Internal Thoracic Artery: Alternative Harvest Technique. Ann Thorac Surg. 1997;63:867-8.Note: The author of this manuscript is not an employee of any agency of the Cuban government; he is only a cardiovascular surgeon in a public hospital. The author of this manuscript also does not represent the Cuban government in relation to this “letter to the editor”.

Ecological theory predicts that the soil seed bank stabilizes the composition of plant communities in the face of environmental variability. Using one of the longest seed bank-vegetation databases, we tested whether the composition of the seed bank is more stable than the standing vegetation in annual communities across a rainfall gradient. The composition of the seed bank differed from the vegetation throughout the years with a higher abundance of small-seeded and persistent-seeded species. Year-to-year variability in composition increased with increasing aridity, but its magnitude was similar in the seed bank and the vegetation. Importantly, the rate of long-term compositional change was much slower in the seed bank. These results support the hypothesis that the seed bank can buffer against climatic shifts and increases the resistance of plant communities to directional trends. We conclude that the seed bank plays a crucial role in the stability of plant communities under global changes.

We present a novel method, Neural Ordinary Differential Equations, for learning ecological and evolutionary processes from time series data. The method consists in modelling dynamical systems with Ordinary Differential Equations and dynamic functions with Artificial Neural Networks, which upon successful training converge to functional shapes that best describe the processes. We tested NODEs by inferring per-capita growth rates of hare and lynx in simulated and real time series, which revealed that prey-predator oscillations were mainly driven by stronger predation at low hare and lynx density, as well as negative density-dependence in lynx, in line with the literature, thus demonstrating the validity and utility of NODEs. The approach is applicable to any system that can be modelled with differential equations, and particularly suitable for linking ecological, evolutionary, and environmental dynamics where parametric approaches are too challenging to implement, opening new avenues for theoretical and empirical investigations.

Sánchez-Tójar et al. (2020, Ecol Lett) questioned the methodology, transparency and conclusion of our study (Yin et al. 2019, Ecol Lett, 22, 1976). I feel that these arguments ignore critical assumptions and are based on the misunderstanding of our peer-review process. General does not mean always; the jury of our study is in revealing when and where a transgenerational effect is beneficial, which enlightens future research.

In natural forests, it is increasingly suggested that stand factors are far more important for community biomass and productivity than biodiversity, but the relative importance of stand factors vs. diversity on ecosystem stability, and how their relative roles change with grain size, still remain unclear. Using inventory data from tropical forest plots in southwestern China from 2004 to 2010, we found that stand factors were clearly more stronger drivers than diversity for forest biomass and productivity (at each grain size from 400 m2 to 0.25 ha), while diversity was predominate for temporal stability of biomass and productivity. The effect of diversity on biomass and productivity increased with increasing grain size, but did not change clearly for ecosystem stability. Functional diversity was more important for ecosystem functions and stability than taxonomic and phylogenetic diversity, and richness was more important than the other two diversity components (evenness and divergence). Our results reconcile the recent debate on the relative importance of diversity vs. stand factors on ecosystem properties, and suggest that forest management to adjust stand structure is an effective way to increase forest carbon storage rapidly, but biodiversity conservation may be crucial for long-term ecosystem stability under climate change.

Objective: To evaluate the auditory perception outcomes of cochlear implant (CI) in children with different types of inner ear malformations (IEMs) and to compare them with CI users with the normal cochlea. Design: Retrospective and prospective data collection. Settings: Tertiary referral hospital. Participants: There were 274 CI users with and without IEMs as two groups. Both groups’ chronological age at implantation and duration of cochlear implant usage was matched (±8 months). Main outcome measures: All subjects were evaluated preoperatively and postoperatively with Ling’s sound test and auditory perception test battery, which includes the Meaningful Auditory Integration Scale (MAIS), close-set Pattern Perception Test (PPT), and open-set Sentence Recognition Test (SRT). Also, children with IEMs were assessed for language development. Results: The incidence of IEMs were incomplete partition-II, 40 (29.19%), incomplete partition-I, 36 (26.2%), cochlear hypoplasia, 26 (18.9%), enlarged vestibular aqueduct, 14 (%10.2), incomplete partition-III, 10 (%7.2), common cavity, 8 (5.8%) and dilatation of vestibule, 3 (2.1%) patients. The significant difference was seen in Ling’s sound test and auditory perception test battery scores of children with incomplete partition-I, cochlear hypoplasia, and common cavity (p-value < .005). Conclusion: IEMs group showed different progress according to the type of ear anomaly. Although CI users with enlarged vestibular aqueduct (EVA) had the highest scores, users with common cavity had the lowest scores. Taking these results, caused by anatomical differences, in to account is very critical in follow-ups and rehabilitation programs. Each cochlear implant user should be evaluated according to his/her individual needs.

The role of CD4+ Treg in immune responses has been well established. More recently a role of CD8+ Treg in the regulation of immune responses in health and autoimmune diseases has been investigated. Furthermore, different investigators have used different markers to define CD8 Treg. Finally, regulatory effects of CD8 Treg have been studied against T cell responses; however, their role in regulating B cell proliferation and immunoglobulin production has not been evaluated. Therefore, in this study we examined the effect of two types of CD8 Treg on B cell proliferation and immunoglobulin production. Methods: Purified CD8+ T cells were activated with anti-CD3/CD28 for 48 hours and then sorted into two different types of CD8 Treg as defined by two different sets of markers, CD8+CD183+CCR7+CD45RA-, and CD8+CD183+CD25highCD278+. Purified B cells were co-cultured with sorted CD8 Treg at 1:1, 1:1/2, 1:1/4 ratios, and activated with anti-CD40 and CpG. B cell proliferation was assessed by CFSE dye dilution assay and immunoglobulin production by ELISA assay. Results: Our data show CD183+CCR7+CD45RA- CD8 T reg significantly inhibited B cell proliferation and inhibited IgM and IgG production but not of IgA production at 1:1 ratio only. However, CD183+CD25highCD278+ CD8 Treg inhibited significantly B cell proliferation at 1:1 and 1:1/2 ratio and IgM, IgG, and IgA production at all ratios. In Conclusion, CD8 Treg regulate B cell responses, and CD183+CD25highCD278+ CD8 Treg are more powerful regulators of B cell proliferation and Immunoglobulin production than CD183+CCR7+CD45RA- CD8 Treg.