Objectives: To determine the temporal persistence of residual cell-free DNA (cfDNA) of deceased co-twin in maternal circulation after selective fetal reduction and evaluate its long-lasting effect on noninvasive prenatal testing (NIPT) results. Design: Prospective observational study Setting: The Third Affiliated Hospital of Guangzhou Medical University Population: Dichorionic diamniotic twins (n=5) underwent selective fetal reduction of a co-twin with trisomy. Methods: With consent, maternal blood was collected immediately before reduction and periodically after reduction until birth. CfDNA of each maternal blood sample was sequenced for NIPT and analyzed for fetal trisomies and fetal fractions. Main Outcome Measured: Detectable T-scores for trisomy identification and three types of fetal fractions including the total fetal fraction, the fetal fraction of the deceased co-twin, and the fetal fraction of the surviving co-twin.

Salinity stress is one of the most important abiotic stress factors affecting rice (Oryza sativa) production worldwide. Using a forward genetics approach, we isolated a salt insensitive TILLING line 1 (sitl1) rice mutant from a gamma-ray irradiated TILLING population. This sitl1 mutant line showed increased salinity tolerance due to reduced Mg2+ and Na+ uptake in root and shoot tissues and in the xylem sap. Whole genome resequencing and RNA-sequencing analyses identified a single nucleotide T insertion in exon 5 of Os01g47460 (putative metal ion transporter) with the CorA-like ZntB cation transfer domain (OsMGT1). Transient expression of the OsMGT1-sGFP fusion protein in rice protoplasts showed OsMGT1 was localized to the plasma membrane. Expression analysis of various tissues and at different growth stages showed that the OsMGT1 was mainly expressed in roots and leaf tissues as an early response to salinity stress. Complementation and overexpression assays in the yeast (Saccharomyces cerevisiae) CM66 strain and wild type showed that the OsMGT1 protein possessed both Mg2+ and Na+ transport activity. Taken together, the mutation of the OsMGT1 gene in the sitl1 mutant reduced the transport abilities of both Na+ and Mg2+ conferring salinity insensitivity in rice.

The COVID-19 pandemic has led to a dramatic shift in the clinical practice of women’s health and routine care for endometriosis has been severely disrupted. Endometriosis is defined as an inflammatory disease characterised by lesions of endometrial-like tissue outside the uterus that is associated with pelvic pain and/or infertility.1 It affects approximately 10% of reproductive age women worldwide, is diagnosed by surgically visualisation or by radiological imaging, and is treated with hormone treatments or by laparoscopic removal of lesions.2,3Under the guidance of international gynaecological organisations4–6, many centres have temporarily ceased offering outpatient appointments, diagnostic imaging for non-acute pelvic pain, surgery for endometriosis, and fertility treatments. This means that endometriosis sufferers are be feeling particularly vulnerable and that resultant stress and anxiety may contribute to a worsening of symptoms. The pandemic poses several important questions for healthcare providers on how best to deliver care with these restrictions. Herein, we present clinical guidance on the management of endometriosis during the COVID-19 pandemic (Box 1).

As clinicians, we are familiar with the Hippocratic albatross ‘Primum non nocere’, ‘first, do not harm’. We understand that every weapon in our clinical armour chest is double-edged, and every cure has a potential harm, this has never more true than during the global pandemic of SARS-CoV-2.In these unprecedented times, the UK government acted swiftly to try to first contain the virus and then flatten the peak of admissions to hospital. On 16th March, pregnant women were placed in the most vulnerable, ‘at risk’, category advising them to self-isolate. This message has been carefully observed by women. Whilst the press ‘floods’ us with images of overwhelmed hospitals, the normal patient throughput in obstetrics and gynaecology to semi-urgent care is anecdotally at an all-time low. Women with pain and bleeding, in early pregnancy, are staying away from hospital. Antenatal women are not presenting with, ‘threatened’, labour nor reduced fetal movements. The true incidence of these conditions has not simply declined. Certainly, some of these women are not presenting and are suffering at home.According to NHS England figures, there was a 29% drop in numbers of people attending Accident and Emergency departments in March 2020 –1.5 million compared with 2.2 million in March 2019 (NHS England figures). The Royal College of Midwives became concerned patients were not attending scheduled appointments for pregnancy care, this led to a joint statement with the Royal College of Obstetricians and Gynaecologists (RCOG) emphasising the importance of antenatal care. There is concern that women may be self-isolating at home to their detriment. If they do develop medical problems, they may defer contacting medical professionals until symptoms are severe, and in some cases life-threatening, for example in ectopic pregnancies.In order to limit hospital-footfall, women are being asked to attend alone. In normal circumstances, partners provide-support during antenatal ultrasounds or consultations, a time which some may receive upsetting news. Additionally, with centralisation of services to depleted staff numbers, there is less choice in the location of pregnancy-related care and birthplace. Important appointments are being missed, and in obstetrics, ‘the clock’ does not stop because of Covid-19.A wider part of the role of the obstetrician is safeguarding. Children are out of school and domestic violence prevalent 1. We are missing opportunities to identify vulnerable women, and to intervene for the safety and wellbeing of her and her children. Much emotional and practical support is now also lacking. Isolation to prevent coronavirus spread means grandparents cannot visit new babies, families struggle with the provision of childcare for existing children. The networking women partake in at antenatal classes, nor the support from visiting postnatal midwives nor breastfeeding support is happening. This, combined with the anxiety and fear felt during a global pandemic2, may be associated with a resurgence in postnatal mental health disorders.Despite this difficult time, there are positives. Patient care has been rapidly remodelled across the country with services streamlined in record time. For example, ‘one stop’, antenatal booking clinics encompass ultrasound, venepuncture and a face-to-face midwife consult. Previously this necessitated multiple appointments, with impacts on work and family life. Like most areas of medicine, clinics are being performed via telephone or online conference calls. This is time and cost-saving for both parties. The necessity or validity of investigations is being questioned more ruthlessly, perhaps as we should be doing routinely.With reduced patient numbers, women in early pregnancy are being triaged and seen faster. The number of invasive surgical procedures performed for miscarriage and ectopic pregnancies has plummeted (University Hospital Southampton data 2020). Partly because women are encouraged to have less invasive management, thereby circumventing surgical risk. However, fewer ultrasounds are being performed for vague symptoms. Resulting in fewer women having, ‘pregnancies of unknown location’, a diagnosis fraught with iatrogenic anxiety and distress. Women are feeling more empowered to self-manage conditions that we have always advocated self-care for in the first instance. Fewer women are requesting induction of labour, usually a huge burden of work on innundated labour wards.By responding to the global pandemic, we are likely causing harm to some of the women we have a duty of care for, we plan to look at national data to assess the level of secondary harm caused. The ameliorating benefits are that the NHS is being treated as a precious commodity, it is imperative that innovative changes and optimal uses of services bring about long term benefit. The UK healthcare system will change forever as a result of Covid-19; it is the responsibility of doctors and patients to ensure that this is for the better and to minimise harm to women and their families in the meantime.

This research reports on an image processing technique used to merge Magnetic Resonance Imaging (MRI) or Magnetic Resonance Angiography (MRA) with their intensity-curvature functional (ICF). Given a two-dimensional MR image, six 2D model polynomial functions were fitted to the image, and six ICF images were calculated. The MR image and its ICF were direct Fourier transformed. The phase of MR image was estimated pixel-by-pixel as arctangent of ratio between imaginary and real components of k-space and is called phase ratio. The phase of ICF is the phase of inverse Fourier transformation and is called base phase. The two values of phase were summed up and used to reconstruct ICF images through inverse Fourier transformation. The reconstructed image is the combination of MR and ICF. Data obtained with T2-MRI and MRA indicates that the technique improves vessel detection in T2-MRI and contrast enhances T2-MRI and MRA.

Introduction: The cardiovascular complications related to COVID-19 have led to the need for echocardiographic services for these patients to help with the management and identification of complications. The aim of this study was to identify echocardiographic findings in COVID-19 infection and its utility in management. Methods: We included in our study patients who were COVID-19 positive by polymerase chain reaction test (PCR) and had echocardiogram done during the same admission. Results: A total of 45 patients were evaluated, the mean age was 61.4 ± 12.2 years. Hypertension 29 (64%) and in diabetes mellitus in 25 patients ( 55%) were the most common comorbidities followed by congestive heart failure(CHF) in 11 patients (24%), Coronary artery disease (CAD) in 9 patients (20%) and valvular heart disease in 3 patients (7%). Eight patients (18%) had of myocardial injury suggested by elevated troponin (n=44) and BNP was found to be elevated in 14 patients (35.8 %) (n=39) patients. Majority 93 % (n=29) had elevated LDH and 87.8 % (n=33) had elevated ferritin. and D dimer 88 % (n=27). 14 patients had left ventricular dysfunction (31%). 6 patients with right ventricular (RV) dilatation and 5 patients with reduced RVEF. Pressure and volume overload were seen in 3 of our patients. In one patient RV thrombus was visualized. Pulmonary pressure was found to be elevated in 10 patients (24%). Conclusion: 2-dimensional echocardiography can be an important bedside tool in the assessment of left and right ventricular function and hemodynamic status COVID-19 patients.

Background The COVID-19 pandemic has led to radical political control of social behaviour. The purpose of this paper is to explore data trends from the pandemic regarding infection rates/policy impact, and draw learning points for informing the unlocking process. Methods The daily published cases in England in each of 149 Upper Tier Local Authority (UTLA) areas were converted to Average Daily Infection Rate(ADIR), an R-value - the number of further people infected by one infected person during their infectious phase with Rate of Change of Infection Rate(RCIR) also calculated. Stepwise regression was carried out to see what local factors could be linked to differences in local infection rates. Results By the 19th April 2020 the infection R has fallen from 2.8 on 23rd March before the lockdown and has stabilised at about 0.8 sufficient for suppression. However there remain significant variations between England regions. Regression analysis across UTLAs found that the only factor relating to reduction in ADIR was the historic number of confirmed number infection/000 population, There is however wide variation between Upper Tier Local Authorities (UTLA) areas. Extrapolation of these results showed that unreported community infection may be >200 times higher than reported cases, providing evidence that by the end of the second week in April, 29% of the population may already have had the disease and so have increased immunity. Conclusion Analysis of current case data using infectious ratio has provided novel insight into the current national state and can be used to make better-informed decisions about future management of restricted social behaviour and movement.

Background and Purpose: Activation of hepatic thyroid hormone receptor ß (THR-ß) is associated with systemic lipid lowering, increased bile acid synthesis and fat oxidation. In patients with non-alcoholic steatohepatitis (NASH), treatment with THR-ß agonists led to reduction in hepatic steatosis and circulating lipids, and resolution of NASH. We chose resmetirom (MGL-3196), a liver-directed, selective THR-ß agonist, as a prototype to investigate the effects of THR-ß agonism in mice with diet-induced obesity (DIO) and biopsy-confirmed advanced NASH with fibrosis. Experimental Approach: C57Bl/6J mice were fed a diet high in fat, fructose and cholesterol for 34 weeks, and only biopsy-confirmed DIO-NASH mice with fibrosis were included. Resmetirom was then administered at a daily dose of 3 mg/kg p.o. over a period of eight weeks. Systemic and hepatic metabolic parameters, histological NAFLD activity and fibrosis scores, and liver RNA expression profiles were determined to assess the effect of THR-ß agonism. Key Results: Treatment with resmetirom did not influence body weight but led to significant reduction in liver weight (-43 %, p<0.001), hepatic steatosis (-53 %, p<0.001), plasma ALT activity (-49 %, p<0.001), liver and plasma cholesterol (-27 % and -60 %, respectively, p<0.001), and blood glucose (6.3 vs. 7.5 mmol/l, p<0.001). These metabolic effects translated into significant improvement in NAFLD activity score. Moreover, lower alpha-smooth muscle actin content and down-regulation of genes involved in fibrogenesis indicated a decrease in hepatic fibrosis. Conclusion and implications: Our model robustly reflected clinical observations of body weight-independent improvements in systemic and hepatic metabolism including anti-steatotic activity.

Objective The aim of this study is to evaluate the attitude, knowledge and anxiety status of individuals about COVID-19 at the first period of the outbreak. Methods This was an observational study carried out in Turkey. An online semi-structured questionnaire was developed by using google forms and the link of the questionnaire was sent through emails, WhatsApp and other social media to the contacts of the investigators between 20th March 2020 and 25th March 2020. The questionare contained 21 questions and Beck anxiety scale. Results 1070 people were included in the study. Approximately one fifth of the participants had no idea about treatment and immunization against COVID19. According to the categorization of Beck Anxiety Inventory scores 8.6% showed severe anxiety symptoms. Anxiety levels of women, healthcare workers and those with psychiatric illness were higher (p <0.05). It was observed that women, healthcare professionals, those with chronic diseases, and those with moderate to severe anxiety used the medical facemask more frequently (p <0.05). 73% of the participants thought that they fully implemented the proposed measures; 25.2% of the them stated that population did not take any measures for the COVID-19. Conclusion: According to the results of the study individuals usually had better awareness and positive attitudes towards COVID 19 pandemic, but there were also things that needed improvement. The community anxiety rates in the early stages of the epidemic with low case rates also reveal that measures should be taken in this regard.

Objective: In medical education and clinical practice, emotional intelligence (EI) has been related to improved doctor-patient relationships. Here, EI was measured among Palestinian medical stu-dents in two stages of their studies, clinical and basic sciences, and factors that may affect it were assessed. Moreover, EI scores were compared between participating universities to detect possible differences. Methods: A quantitative, cross-sectional, questionnaire-based, online survey was conducted on 692 medical students attending Al-Quds and Al-Najah Universities in Palestine. Emotional intel-ligence was evaluated using the 33-item scale introduced by Schutte et al. (1998). Data was ana-lyzed in a quantitative manner using the Statistical Package for Social Sciences (Ver. 20.0). Results: The mean EI was 3.83 (SD=0.41) out of maximum possible score of 5, with 69.1% hav-ing high EI (>3.68). EI decreased significantly at α≤0.05 across basic and clinical stages of study, with a negative correlation between EI and academic year (PCC= -0.086). This indicates that as academic year increases, EI decreases (p=0.023). Moreover, EI is affected positively and signifi-cantly at α≤0.05 by having a hobby or doing extracurricular activities. In addition, students who indicate continual regret for studying medicine tend to have lower EI, which may reflect a lack of interest in studying this field. Conclusion: The study found no significant differences in mean EI at α ≤0.05 between the stu-dents of Al-Quds (mean=3.83) and Al-Najah universities (mean=3.84). At these universities, par-ticipating medical students, both male and female, had relatively high levels of emotional intelli-gence. Students in the clinical stage had lower EI than those in the basic sciences stage, which indicates a conflict between objectivity and humanity while training clinically. Therefore, emo-tional support during clinical years would aid in improving EI. Moreover, EI being affected by hobbies or extracurricular activities indicates that EI can be modulated through encouragement of such activities.

Background:Radiofrequency catheter ablation(RFCA) has now become the standard and effective therapy for paroxysmal supraventricular tachycardias, but the success rates of ablation were reported different in a large number of single-centers. It is estimated that there are still thousands of cases of relapse in China every year, among which the main cases are of accessory pathways(Aps) mediated tachycardia.Objective: The purpose of this study was to compare the efficacy and safety of two different radiofrequency ablation strategies, improve ablation method and reduce the recurrence rate of ablation of accessory pathway mediated tachycardia.Method and Result: 1712 consecutive cases of AVRT with 1741 accessory pathways were analyzed in our retrospectively observational study. They were divided into group S and group M (undergone complementary ablation) according to different strategies of RFCA. 882 cases with 898 Aps were enrolled in group S versus 830 cases with 843 Aps in group M. The results showed the cumulative recurrence number (rate) at the 1st, 3rd, 6th, 12th, and 24th month after ablation were 4(0.5%) vs 17 (1.9%) p=0.007, 5(0.6%) vs 27(3.0%) p=0.000, 6(0.7%) vs 34 (3.8%) p=0.000, 6(0.7%) vs 58 (6.5%) p=0.000, 7(0.8%) vs 63(7.1%) p=0.000, respectively; Complications of chest pain, over vasovagal reaction, steam pop, angina pectoris, and embolism were rare in both groups; No Valve damage, myocardial infarction, cardiac tamponade, periprocedural death or other serious adverse events occurred in the both groups. Conclusions：The strategy of complementary ablation significantly reduced the recurrence rate of radiofrequency ablation of accessory pathway without increasing the risk of complications.

Hypertrophic cardiomyopathy (HCM) with apical aneurysm (AA) is rare, but have been reported to be associated with refractory ventricular tachycardias (VTs). Majority of such cases had a central isthmus of the reentry circuit on the border zone of AA. In this report, we describe a rare case of the successful epicardial ablation for a refractory VT originating from a true apex of the aneurysm in a HCM patient. Mid-diastolic potential during sustained VT was recorded at the isolated epicardial myocardium surround by the gross unexcitable scar in AA, and radiofrequency current application rendered VT non-inducible.

Deformation behavior and fracture mechanism of cast duplex stainless steels tubular specimen under different tensile stages were investigated through experimental and numerical evaluation. The results showed that the axial stress was redistributed due to the necking of the tubular specimen, and the axial stress near the internal wall was larger than those near the external wall and its maximum axial stress was distributed between the internal wall and the center of wall thickness. Microcracks and voids were initiated under the maximum shear stress along the δ/γ phase interface, and propagated to the ferrite interior. The voids were connected and merged into the main crack through the propagation of the microcracks. Moreover, the main crack first propagated to the internal wall and then rapidly propagated to the external wall. The fracture morphology can be divided into three types: shear lip zones can be both found on the internal and external walls, shear lip zones can be found only on the internal wall or only on the external wall.

The goal of the HPC Certification Forum is to categorize, define, and examine competencies expected from proficient HPC practitioners. The community-led forum is working toward establishing a globally acknowledged HPC certification process, a process that engages with HPC centres to identify gaps in users’ knowledge, and with users to identify the skills required to perform their tasks. In this article, we introduce the forum and summarize the progress made over the last two years. The release of the first officially supported certificate is planned for the second half of 2020. 

Abstract:Background: The present study was carried out to examine the case fatality rate (CFR) and recovery rate (RR) during the pandemic of COVID-19 in the states of India as of 14th April, 2020 as these are important figures during epidemics and pandemics. Methods: The data were obtained from accurate databases including Ministry of Health and family welfare (MoHFW) and World Health Organization (WHO). A comparison of CFR and RR between states with total cases ≥ 100 was made as of14th of April, 2020.Results: India’s CFR was reported to be 3.26% as of April 14, 2020 and it seem to be less in comparison to some European and Asian countries. Interstate CFR comparison reveals that the Madhya Pradesh’s CFR was the highest of all the states (7.11) compared with India’s CFR and Kerala’s RR was highest (52.2%) compared with the India’s RR (10.99%). Conclusion: In India especially in states with the high CFR’s, strategies must be employed to ensure that high-risk groups, such as old age, children and people underlying diseases such as diabetes and cancer, receive adequate protection from COVID-19. In addition, case studies with detailed and accurate medical history, and scoring CFR alongside RR, should be adopted in hospitals which may be helpful in exactly pointing the hotspots of infection. These, strategies may help in early detection of COVID-19 followed by access to medical care, which enhances the chances of recovery rates from COVID -19. Key words: COVID-19, CFR, RR, SARS-CoV-2, Pandemic, India, States

Background : One of the highest causes of cardiac mortality is ST Elevation Myocardial Infarction (STEMI). Delay in the management of STEMI patients resulted high mortality, morbidity, and economic burden. CODE STEMI is a protocol to reduce door to balloon time and improve patient’s quality care and clinical outcome. Objectives : To determine the effect of the implementation of CODE STEMI on clinical outcome and cost efficiency of a quality care of STEMI patients at Dr. Cipto Mangunkusumo General Hospital. Method: This is a retrospective cohort study that reviewed 207 medical records of STEMI patients who underwent primary percutaneous coronary intervention (PPCI) in 2015-2018. The patients were divided into two groups. The first group was treated prior to establishing the CODE STEMI and the other group was treated with CODE STEMI protocol. The primary outcome was to measure in-hospital mortality and morbidity and total hospital cost between both groups. Secondary end-points included length of stay (LOS) and Cost Efficient Analysis. Data analysis was done using Mann Whitney and Chi square test. Results: There were 72 and 135 patients in Pre‐CODE STEMI and CODE STEMI groups respectively. In CODE STEMI group, median D2BT was significantly reduced by 130 min (P< 0.001), median LOS was reduced by 1 day (P=0.009) and there was cost reduction by approximately USD 1,000. There were declining trend of in-hospital mortality rates (8.3% vs 4.4%) and MACE at 30 days (48.61% vs 37.78%). Conclusion: Implementation of CODE STEMI can improve clinical outcome, reduce length of stay and cost efficiency of STEMI patients in general hospitals.

To the Editor,We have read with great interest the article entitled ‘Electrogram-only guided approach to His bundle pacing with minimal fluoroscopy: A single-center experience’ by Zanon et al1 in the latest issue of the journal. We would like to thank the authors for their study regarding the use of electrograms during implantation of the His lead with minimal or no fluoroscopy. Related radiation dose parameters such as fluoroscopy time and dose area product (DAP) were also presented. Radiation dose related to the fluoroscopy system is generally dependent on various autoregulated variables including the tube voltage, the tube current and the pulse duration. In addition, various programmable settings including the frame rate, collimation, and magnification are used to regulate the amount of radiation although the number of variables which can be programmed in the manufacturer specific system varies. Fluoroscopy time should not be an estimation factor for radiation dose because its correlation with other standard radiation measures is weak. Manufacturer specific calculations, either total time while pressing on the fluoroscopy pedal or only a sum of fluoroscopic pulses, make the radiation dose difficult to estimate. The air kerma area product, or DAP (Gy.cm2) is accepted as the most accurate measurement of radiation energy given for fluoroscopic purposes. Roughly, the effective dose (ED) (mSv) of fluoroscopic source of radiation can be calculated using a conversion factor of 0.20 from the DAP measurement. For instance, routine single/dual-chamber pacemaker/defibrillator implantation has an average ED of 4 mSv, compared to an average ED of nearly 20 mSv for a cardiac resynchronization therapy device implantation.2 The frame rate, collimation and magnification should be properly set to reduce the DAP/ED values.The frame rate seems as the most important programmable factor related to the radiation dose. Continuous fluoroscopy has generally the frame rate of ≥30 frames per second (fps), which is associated with increased radiation exposure. Therefore, the frame rate should be set as low as achievable. Decreasing the frame rate from 30 fps to 7.5 fps reduces the ED by 75%. Compensatory tube current increase generally occurs during pulsed fluoroscopy, which is associated with the same number of x-rays produced during continuous fluoroscopy. However, significantly decreased number of pulses cause significant reduction of radiation exposure in a linear way. The frame rates as low as ≤3 fps should be used during diagnostic and ablation procedures and device implantations in the electrophysiology laboratory although reduced temporal resolution.2,3 Furthermore, configuring the frame rate ≤1 fps using the ECG triggering or pacing artifact can be the best approach. Configuration of the pulsed fluoroscopy at the lowest frame rate needed has the greatest potential for ensuring radiation dose at the lowest level.Properly configured and applied collimation, reduction of radiation to an anatomical area that requires imaging, has an important role in reducing both the direct and the scattered radiation. Collimation, especially the asymmetric one, reduces visualization area and decreases the DAP/ED in a linear way. During the procedure, the use of collimation restricts the view on the cardiac contour. After viewing the whole anatomy, re-collimation should be performed.Another option for reducing the radiation dose is to set the largest field of view, or the smallest magnification, possible. In the smallest field of view mode, or the largest magnification mode, a smaller radiation area is projected in the image intensifier and, a larger image is produced on the screen. This process is related to a lower radiation output and a dimmer image. The fluoroscopy unit has an automatic system for controlling the brightness sensed. Therefore, the automatic system compensates for the lower brightness by increasing radiation exposure from the tube. With the use of magnification, the radiation dose increase in flat-panel detectors is lower compared to the image-intensifiers, however it is still remarkable.4In the light of all above-mentioned settings, the fluoroscopy time should not be used as an important variable measuring the radiation dose. Instead, the DAP/ED values should be reported.Keywords: dose area product/effective dose; fluoroscopy; programmable; radiation dose

Background: Transvenous permanent pacemaker related infection is a severe condition associated with significant morbidity and mortality. Leadless pacemakers may be more resistant to bacterial seeding during bloodstream infection because of its small surface area and encapsulation in the right ventricle. This study reports the incidence and outcomes of bacteraemia in patients implanted with a Micra leadless pacemaker. We present 18F-FDG PET/CT findings obtained in a sub-group of patients. Methods: We report a retrospective cohort study of 155 patients who underwent a Micra TPS implant procedure at the University Hospitals of Leuven between July 2015 and July 2019. We identified the patients who developed an episode of bacteraemia, proved by ≥2 positive blood cultures. Results: Of the 155 patients, 15 patients presented an episode of bacteraemia at a median of 226 days (range: 3-1129) days after the implant procedure. Gram positive species accounted for 73.3% (n=11) of the bacteraemia including Staphylococcus (n=5), Enterococcus (n=3) and Streptococcus (n=3). The source of infection was identified in 9 patients (60%) including endocarditis in 4 patients, urinary tract in 3 patients, and skin in 2 patients. 18F-FDG PET/CT imaging performed in 6 patients did not show sign of infection around the leadless pacemaker. Bacteraemia was resolved in all patients after adequate antibiotherapy. Four patients died early during follow up. For all other patients, there were no recurrence of bacteraemia during a median follow up of 263 days (range 15-1134). Conclusion: In our small cohort, no leadless pacemaker endocarditis was observed among patients with bacteraemia.

Introduction：LAmbre occluder (Lifetech Scientific, Shenzhen, China), a new device for left atrial appendage (LAA) occlusion, is increasingly used, but the procedure for retrieval after dislodgement has rarely reported in human. Methods and Results：An 80-year-old male patient with permanent atrial fibrillation underwent the implantation of LAA occlusion device. The occluder dislodged to left atrium (LA) at the end of procedure. We failed to retrieve device in LA with a LASSO catheter and forceps with the 8.5F sheath. After it suddenly flowing into aortic arch, we successfully retrieved with a 14F flexible sheath and forceps. We also discussed reasons for the device dislodgment and reported experiences for device retrieval. Conclusion: Combination of the 14F flexible sheath and forceps could be used to retrieve the dislocation of LAA occlusion device.

Background Impella support during Posterior Vein Isolation/Posterior Wall Isolation (PVI/PWI) in the setting of persistent cardiogenic shock due to refractory atrial fibrillation with rapid ventricular response (AF/RVR), to the best of our knowledge, has not been reported in the literature. Case A 61-year-old male trucker was admitted with acute HFrEF with AF/RVR 130 – 150 bpm. EF was 20% with global hypokinesis. He was diuresed and cardioverted to sinus rhythm and a QTc of 532 msec. He reverted to AF/RVR in less than 24 hours and requiring amiodarone drip but was discontinued due to severe intolerance. Subsequently, he developed cardiogenic shock, worsening cardiorenal syndrome, and shock liver requiring continuous renal replacement therapy (CRRT) in the CCU. Inotropes and vasopressors were contraindicated. AV node ablation was refused because he wanted to return to truck driving. Right heart catheterization showed PASP 53, PADP 38, and PCWP 37 with RAP 28mmHg. Coronary angiogram was normal. An Impella device was inserted, with P6 support at 3.4 L/min cardiac output. PVI with cryoablation, PWI, and anterior mitral isthmus ablation was successful with RFA. There was a complete exit block 30 mins after ablation. Normal sinus rhythm was restored after cardioversion. Echocardiography 48 hours later revealed improvement in EF from 10% to 40% in sinus rhythm. Follow up six months in the clinic showed EF recovery to 62%. Conclusion This case report demonstrates that in patients with refractory atrial fibrillation causing cardiogenic shock, PVI/PWI, while on Impella support, could be a good treatment option.

Partial clonality is widespread across the tree of life, but most population genetics models are designed for exclusively clonal or sexual organisms. This gap hampers our understanding of the influence of clonality on evolutionary trajectories and the interpretation of population genetics data. We performed forward simulations of diploid populations at increasing rates of clonality (c), analysed their relationships with genotypic (clonal richness, R, and distribution of clonal sizes, Pareto β) and genetic (FIS and linkage disequilibrium) indices, and tested predictions of c from population genetics data through supervised machine learning. Two complementary behaviours emerged from the probability distributions of genotypic and genetic indices with increasing c. While the impact of c on R and Pareto β was easily described by simple mathematical equations, its effects on genetic indices were noticeable only at the highest levels (c>0.95). Consequently, genotypic indices allowed reliable estimates of c, while genetic descriptors led to poorer performances when c<0.95. These results provide clear baseline expectations for genotypic and genetic diversity and dynamics under partial clonality. Worryingly, however, the use of realistic sample sizes to acquire empirical data systematically led to gross underestimates (often of one to two orders of magnitude) of c, suggesting that many interpretations hitherto proposed in the literature, mostly based on genotypic richness, should be reappraised. We propose future avenues to derive realistic confidence intervals for c and show that, although still approximate, a supervised learning method would greatly improve the estimation of c from population genetics data.

Amitraz is a broad-spectrum insecticide for the control of aphids, psyllids, ticks and mites. Current evidence suggests that ticks and phytophagous mites have developed strong resistance to amitraz. Previous studies have shown that the I61F mutation in the β-adrenergic octopamine receptor is related to amitraz resistance in ticks, but the mutation was not found in Panonychus citri. We therefore used whole genome sequencing and bulked segregant analysis to identify the mechanism by which P. citri is resistant to amitraz. High-quality assembly of the whole P. citri genome was completed, resulting in a genome of approximately 83.97 Mb and a contig N50 of approximately 1.81 Mb. Gene structure predictions revealed 11,577 genes, of which 10,940 genes were annotated. Trait-associated regions in the genome were mapped with bulked segregant analysis and 38 candidate SNPs were obtained, of which T752C had the strongest correlation with the resistant trait, located at the 5’ untranslated region (UTR) of the β-2R adrenergic-like octopamine receptor gene. The mutation resulted in the creation of a short hairpin loop structure in mRNA and gene expression was down-regulated by more than 50% in the amitraz-resistant strain. Validation of the T752C mutation in field populations of P. citri found that the correlation between the resistance ratio and the base mutation was 94.40%. Our results suggest that this 5’ UTR mutation of β-2R octopamine receptor gene confers amitraz resistance in P. citri and different species may share different mechanisms of resitance to amitraz.

In this study, we established a rapid method for intraoperative identification of thyroid carcinoma metastatic lymph nodes. We developed a rapid method of thyroid globulin (Tg) detection called Tg-POCT based on time-resolved fluorescence immunoassay and validated reagent performance. Thyroid and lymph node tissues with metastatic thyroid cancer were considered as the positive group, and muscle, fiber, fat, and other tissues were considered as the negative control group to verify the above method combined with fine needle puncture. CV of the same batch number was 8.38% and that of different batch numbers was 11.24%. The minimum detection limit was 0.02 ng/mL. The test conformity of tissue samples was 100% by using the self-designed reference value. Thus, Tg-POCT is feasible as a rapid intraoperative method to identify thyroid cancer metastatic lymph nodes.

Conservation genomics is an important tool to manage threatened species under current biodiversity loss. Recent advances in sequencing technology mean that we can now use whole genomes to investigate demographic history, local adaptation, inbreeding, and more in unprecedented detail. However, for many rare and elusive species only non-invasive samples such as faeces can be obtained, making it difficult to take advantage of whole genome data. We present a method to extract DNA from the mucosal layer of faecal samples to reconstruct high coverage whole genomes using standard laboratory techniques, therefore in a cost-effective and efficient way. We use wild collected faecal pellets collected from wild caribou (Rangifer tarandus), a species undergoing declines in many parts of its range in Canada and subject to comprehensive conservation and population monitoring measures. We compare four faecal genomes to two tissue genomes sequenced in the same run. Quality metrics were similar between faecal and tissue samples with the main difference being the alignment success of raw reads to the reference genome likely due to differences in endogenous DNA content, affecting overall coverage. One of our faecal genomes was only reconstructed at low coverage (1.6X), however the other three obtained between 7 and 15X, compared to 19 and 25X for the tissue samples. We successfully reconstructed high-quality whole genomes from faecal DNA and, to our knowledge, are the first to obtain genome-wide data from wildlife faecal DNA in a non-primate species, representing an important advancement for non-invasive conservation genomics.