Introduction The term preterm birth (PTB) is defined by World Health Organization (WHO) as babies born alive before completions of 37 weeks of gestational age [1]. In the early days, the determination of prematurity relied on birth weight. The low birth weight (LBW), with less than 2300 or 2500 grams, was considered for describing prematurity [2]. It is sub-categorized based on the gestational age such as extreme preterm (less than 28 weeks), very preterm (28 to 32 weeks), and moderate to late preterm (32 to 37 weeks) [1]. Moreover, preterm birth can also be sub-classified into two broad subtypes based on its cause such as spontaneous preterm birth and provider-initiated preterm birth. The spontaneous preterm birth occurs after spontaneous onset of labor following prelabour premature rupture of membranes whereas, the provider-initiated preterm birth occurs as induction of labor or elective cesarean delivery before 37 weeks of gestation for maternal or fetal indications or non-medical reasons [3]. According to the born too soon report published by WHO (2012), estimated that 15 million babies are born too early every year. Premature birth is one of the leading causes of neonatal morbidity and mortality in children below 5 years of age. Approximately 1 million children die each year due to complications of preterm birth [4]. Across 184 countries, the rate of preterm birth ranges from 5% to 18% of the babies born [5]. In developed and developing countries, medically unnecessary inductions and cesarean section deliveries before full term also increase preterm birth rate. The actual rate of preterm birth remains unexplained in many countries [4,6]. Sub-Saharan Africa and South Asia account for over 60% of preterm births worldwide. In India, 3,341,000 babies are born too early from the expected date [8], and 361,600 children under five years of age die due to complications associated with preterm birth. According to Indian Foundation for Premature Babies (2013), India contributes 23.6% of the global preterm births, of which 13% are live preterm births (babies born <37 weeks), and 28% are with low birth weight [7, 8], and babies born per year <28 weeks are165,800 in India [7,8]. Studies have reported that in India 33,41,000 babies were born preterm per year, the ratio of boys to girls born preterm is 1.23, impaired preterm survivors per year are 80,700, and direct preterm child death per year are 3,61,600 [3,7,8]. According to every preemie scale report of India [8], hypertension (25%), anemia (55%), and diabetes (9%) are found to be significant risk factors that contribute to preterm birth. Though, further studies are required to understand the aetiology of PTB as it is a complex and multifactorial in nature. However, limited studies have been conducted in India to explore the possible risk factors that contribute to PTB. Moreover, most of the available literatures were confined only to some particular regions of the country. Therefore, the present systematic review and meta-analysis was carried out to investigate the potential and absolute risk factor(s) associated with preterm birth from the available literatures to control and take preventive measures in time. Moreover, an attempt was also made to understand the overall trend of the prevalence rate of preterm birth in India

Objective: To examine whether a modified endometriosis fertility index (EFI) can better predict the rate of pregnancy without assisted reproductive technologies (ART) after laparoscopic surgery in infertile women with endometriosis. Design: Retrospective cohort study. Setting: A university medical center. Population: 564 infertile patients who received laparoscopic surgery for endometriosis. Methods: 472 patients were used to modify the EFI based on new, optimal cutoffs for its predictor variables. The predictive accuracy of the modified EFI was examined in the other 92 patients. Main outcome measures: post-surgical non-ART pregnancy. Results: Among the patients for the EFI modification, the multivariable Cox regression results showed that historical factors were more contribution in predicting non-ART pregnancy rate than surgical factors both in modified EFI (C-index: historical factors 0.617 vs surgical factors 0.558) and the original EFI (C-index: historical factors 0.600 vs surgical factors 0.549). No significant relationship between the prior pregnancy and post-operative non-ART pregnancy rates was detected by both modified EFI and original EFI (P=0.530 and 0.802, respectively). In the patients for assessing the modified EFI, the predictive accuracy of two modified EFI models (C-index: 0.627 and 0.632, respectively) for non-ART pregnancy rates were superior to that of the original EFI (C-index: 0.602). Conclusions: A modified EFI based on population-specific optimal cutoffs and weight might be more suitable for estimating the rate of non-ART pregnancy after laparoscopic surgery in infertile women with endometriosis. Funding: This study received no external funding. Key words: endometriosis fertility index / pregnancy rate / predicting factors / model

Drawn Parasitology: an auxiliary tool in the learning of students of the veterinary medicineThe purpose of this goal was to introduce a tool to promote greater learning and fixation of the content of the discipline of veterinary parasitology, through the didactic game “Drawn Parasitology”. The game was developed based on the design and guessing of parasites based on morphological characteristics. The game was applied for nine consecutive years, totaling 441 students involved and it was possible to observe that there were changes in the teacher-student interaction, using the most pleasant teaching and learning processes. The game is a proposal to support the pedagogical practice of teachers in the teaching and learning processes of students in parasitology content, as a valid and positive playful activity for the appropriation of knowledge, the development of creativity and the encouragement of socialization; therefore its methodology can be recommended for Higher Education and can be applied in several other subjects and areas of knowledge. Keywords: university education. ludic. active learning.

A floating thrombus formation in the ascending aorta is a rare finding, which poses great challenges for treating physicians. Treatment strategies for this pathology are poorly defined and mainly depending on the clinical experience of the team. Using a case study, we discuss the underlying pathology, treatment options and patient management.

CaseA 35-year-old pregnant woman, 34 weeks gestation, was admitted to a tertiary hospital after 3 hours of clear vaginal fluid discharge. Labor occurred spontaneously on that day, and a healthy female baby was delivered with no evidence of infection (SARS-CoV-2 negative upon throat swab). This was the mother’s second pregnancy and delivery. On the second day after vaginal delivery, the patient presented with persistent low fever and dry cough. Laboratory investigations showed white blood cell count (WBC) 7.1×\(10^{9}\)/L (reference range 3.5-9.5), neutrophil ratio (N%) 84.7% (reference range 40-75), lymphocyte count (L#) 0.69×\(10^{9}\)/L (reference range 1.1-3.2), and C-reactive protein (CRP) 73.63 mg/L (reference range 0.0-0.4). Throat swabs from the patient tested positive for SARS-CoV-2 by real-time RT-PCR assays, and the chest CT scan showed multiple infiltrations of different sizes in both lungs and a small amount of fluid on both sides of the chest. Considering these findings, the patient was diagnosed with SARS-CoV-2 and isolated. She had no other history of comorbidities, and was treated with i.v. antibiotics and hormones, and was administered oxygen through a nasal catheter (Figure 1). The patient experienced dyspnea and cyanosis on the following day. Considering her critical condition, she was transferred to the intensive care unit (ICU) for further treatment.After transferring to the ICU, she quickly developed severe acute respiratory distress syndrome (ARDS), and her symptoms did not improve after she was given a non-invasive ventilator. The CT scan showed a density shadow and a large-scale ground-glass opacity in both lungs, which had progressed in severity compared with the scan on Day 2 post-delivery. She required tracheal intubation on the 14th day of hospitalization. Gram-positive and gram-negative bacteria (Acinetobacter baumannii, Klebsiella pneumoniae) were positively cultured in her sputum. Antibiotics were administered according to the results of a drug sensitivity test. Empirical antifungal treatment was also given. Antiviral, nutritional and symptomatic treatments were also performed simultaneously. After 11 days of ICU treatment, the patient’s condition significantly improved. Tracheal intubation was removed and replaced with non-invasive ventilator. The patient was changed to high-flow humidified oxygen several days later, and she was transferred to the general ward for treatment. Her symptoms and primary treatment strategy are illustrated as shown in Figure 1.

Two papers in this issue, on births to Covid-19 infected mothers, are important additions to this rapidly evolving literature. They are both broadly reassuring.The paper from Lombardy, the epicentre of the pandemic in Italy, is the first detailed report of pregnancies from this large region (Ferrazzi et al. BJOG 2020 xxxx). Among 42 affected women, 19 developed pneumonia, of whom seven required oxygen and four critical care. Eighteen babies were delivered by Caesarean, although in eight the indication was unrelated to Covid-19. Three babies tested positive for SARS-COV-2. Two to women who had developed Covid-19 postnatally and had breast-fed without a mask; the presumed source was the mother. One baby who delivered vaginally and did not breast-feed, developed respiratory symptoms requiring one day’s ventilation and tested positive. No mothers or babies died.The paper from China reports SARS-COV-2 viral tests in a range of body fluids from mothers and babies with COVID-19, cared for at Renmin Hospital of Wuhan University (RHWU) (Yanting Wu et al. BJOG 2020 xxxx). This hospital appears on the Global Research Identifier Database (GRID) here https://grid.ac/institutes/grid.412632.0. Readers should know that the GRID database reports that RHWU has the following English aliases “People’s Hospital of Wuhan University”, “Hubei Provincial People’s Hospital”, “First Affiliated Hospital of Wuhan University”, “Wuhan University Renmin Hospital” and “Hubei General Hospital”. This raises the possibility that some or all of the cases may have been reported previously.With this proviso, the detailed information that 1/9 stool samples, 0/13 vaginal samples, and 1/3 breast milk samples were positive is important. Of the five babies who have delivered, none tested positive for Covid-19, although two, both preterm, had pneumonia diagnosed on chest x ray. Apart from one biochemical pregnancy in the first trimester in which a serum human chorionic gonadotrophin of 25.9 IU/L reverted to negative, no mothers or babies died.Taken together with other accumulating data, it is already clear that Covid-19 is less severe in pregnancy than the two previous coronavirus infections, Severe Acute Respiratory Syndrome-related coronavirus (SARS) and Middle East Respiratory Syndrome-related coronavirus (MERS). Nevertheless, four of the mothers from Lombardy required critical care, and there have been other reports of both mother and baby deaths in association with Covid-19. It remains an important disease in pregnancy, which should be taken seriously.No disclosures. A completed disclosure of interest form is available to view online as supporting information.

IntroductionScottish Government guidelines state that 95% of patients diagnosed with cancer should begin treatment within 31 days of diagnosis and 95% of those referred with a suspicion of cancer should begin treatment within 62 days of referral (1). However, these targets currently apply to 10 major cancer groups, which excludes thyroid cancer (1). The biology of differentiated thyroid cancer (DTC) is favourable in comparison to most malignancies. However, the oncological and psychological impact of potential treatment delays in DTC is not clear. The aim of this study was to assess times from referral to diagnosis and treatment, with a focus on factors that influence times within our cancer network.

Large-scale spatial gradients of environmental conditions shape organisms, populations and ecosystem. Even though environmental gradients are a key research theme in macro-ecology and biogeography, the effects of large-scale, east-west, environmental gradients are largely overlooked compared with north-south gradients. Our study focused on feather moult, an important and energy demanding process in birds. By comparing Eastern and Western Palearctic populations of 21 species, we found that passerines in the Eastern and Western Palearctic differ in the number of feathers moulted. This difference is most likely the result of a large-scale climatic gradient in cold season duration and differences in time available for moulting. Eastern populations were characterized by a limited extent of feather moult that was additionally affected by migration distance and body mass. These results highlight the importance of linking annual cycle processes at the organismal level to the specific environmental conditions in the distribution range of each species.

The emergence and outbreak of coronavirus disease 2019 (COVID-19) poses great challenges to our society, economy, and public health, and has already become an international public health emergency. The prevention and control of COVID-19 requires early detection and the timely and effective control of virus dissemination. Front-line medical personnel in the outpatient and emergency departments of hospitals, quarantine centers, and entry and exit ports are key to the early detection and control of COVID-19. Based on experiences in the prevention and control of other new and recurrent infectious diseases, epidemiologists previously proposed the concept of “vital sign zero” and the “Identify-Isolate-Inform” (3I) system for the detection and control of infectious diseases. The use of “vital sign zero” and the “3I system” for COVID-19 will facilitate the prevention and control of new infections, provide more timely treatment and effective isolation of patients, and protect the safety and health of medical workers. These concepts will also prevent the spread of COVID-19 and help to ensure public health and safety.

1:2 atrioventricular (AV) conduction is characterized by one atrial activation antegrade conduction down fast and slow pathways, which results in two ventricular activations. This phenomenon also referred to as a “double fire”. When this phenomenon repeats rapidity, dual atrioventricular node non-re-entrant tachycardia (DAVNNT) occurs. We report the case of irregular QRS complexes tachycardia with a comprehensive record of this phenomenon including, routine electrocardiogram, Holter recordings, and intracardiac electrophysiological study (EPS). In conclusion, through analysis of the ECG and intracardiac recording during tachycardia, we presume that the most likely electrophysiological explanation of our case is the “double ventricular response to a single sinus beat”.

In order to fully evaluate the seroprevalence and risk factor of avian influenza A (H9N2) virus infection among humans in China, a systematic review and meta-analysis was performed. The literature on the seroprevalence of human H9N2 infection in China was searched from inception to March 20, 2020 in English and Chinese databases, including PubMed, Clinical Trial, VIP, CNKI and databases. Duplicated literature, and literature with incomplete data were excluded, leaving the results from 41 studies on H9N2 infection among humans in China being analyzed quantitatively by meta-analysis. A total of 41 studies (including data of 47,743 humans) met the inclusion criteria. In China, the overall seroprevalence of H9N2 infection among humans was 4.10% (95%CI= 3.20-5.07), while in those from north China the prevalence was 5.94% (95%CI= 4.75-7.13), greater than in other regions of China. The seroprevalence of H9N2 infections was associated with test method, sampling time, gender and demographic characteristics of the groups. This review clearly indicates that the risk factors for H9N2 infection varies with multiple factors. Thus, further research is needed on how to formulate specific measures to minimize the emergence and transmission of influenza virus.

In December 2019, an unknown pneumonia-disease outbreak emerged in in Wuhan, China. The incriminated causative pathogen, later termed SARS-CoV-2, was found to be a novel lineage of betacoronavirus, belonging to subgenus sarbecovirus. Although China has roughly controlled the epidemic, but the situation in the rest of the world is becoming less and less optimistic. Scientists and pharmaceutical companies around the world are actively looking for treatment options. Till now, there are couple of drugs undergo the clinical trial including convalescent plasma, which possess valid methods of treating or preventing the disease. And since considerable studies had already been carried out based on the analysis of SARS-CoV-2’s genome sequence and its comparison with that of the other SARS-like virus, let us review in detail and, hopefully, they might provide us with some key features for answering some of the crucial questions relating to its origin, epidemiology, and treatment to better contain the virus. Basing on that, clues on how to develop a fast and accurate viral diagnostic method and the way of treating it may also be provided. Up to now, the treating option constrained only in a few drugs (Remdesivir, Chloroquine, Hydroxychloroquine, Favipiravir etc.), in addition to the Chinese herb as well as convalescent plasma. More drugs are only roughly screened by virtual screening, and they are still far from not achieving the minimum standards for clinical treatment application. Also, the expected vaccine was reported but it just started the very first trial and still needs time to apply on a large scale. Although the very origin of this virus has been determined to be bats, but till now we still can’t determine what kind of animal plays the role of the intermediate host, leaving an issue that needs a further investigation.

The aim of this study was to define the correlation between visual qualitative method and semi-quantitative method for the study of the extension of myocardial edema by CMR in patients with Takotsubo syndrome (TTS). We analyzed 22 consecutive patients with a diagnosis of typical apical TTS. A total of 374 myocardial segments were analyzed. A high correlation between visual method and the semi-quantitative method of the T2 SI ratio (Pearson’s r = 0.82, p <0.001) was found. In the clinical setting the visual method provides a valid and reliable quantification of myocardial edema extension in patients with TTS.

Myxoma is the most frequent primary cardiac tumor. The treatment of choice is complete surgical resection. We present the case of a patient assessed for a long history of dyspnea on exertion. The patient was diagnosed with a large left atrial myxoma that obstructed the left ventricular inflow tract. Multimodal imaging played a key role in diagnosis, planning of surgery, and management of the complications arising from the condition.

Background. Anti-citrullinated protein/peptide antibodies (ACPA) play important roles in the pathogenesis of rheumatoid arthritis (RA). ACPA-positive (ACPA+) and ACPA-negative (ACPA-) RA were suggested to be different disease subsets with distinct differences in genetic variation and clinical outcomes. The aims of the present study were to compare gene expression profiles in ACPA+ and ACPA- RA and identify novel candidate gene signatures that might serve as therapeutic targets. Methods. Comprehensive transcriptome analysis of peripheral blood mononuclear cells (PBMCs) from ACPA+ and ACPA- RA patients, and healthy controls was performed via RNA sequencing. A validation cohort was used to further investigate differentially expressed genes via PCR and ELISA. Spearman’s correlation test was used to evaluate the correlation of differentially expressed genes and the clinical and laboratory data of the patients. The role of differentially expressed genes in osteoclastogenesis was further investigated. Results. Expression of C-X-C motif chemokine ligand 2 (CXCL2) was significantly increased in ACPA+ RA than in ACPA- RA, which was validated in PBMCs and serum. CXCL2 promoted the migration of CD14+ monocytes and increased osteoclastogenesis in RA patients. RAW264.7 macrophages were used to investigate specific mechanisms, and the results suggested that CXCL2 stimulated osteoclastogenesis via ERK MAPK and NFκB pathways. Conclusion. CXCL2 was highly expressed in ACPA+ RA than in ACPA- RA. CXCL2 promoted osteoclastogenesis and was related to bone erosion in RA, which suggest that the blockade of CXCL2 might be a novel strategy for the treatment of RA.

Tuberculosis (TB) is one of the top 10 causes of mortality worldwide from a single infectious agent and has significant implications for global health. In 2018, 1.5 million people died from TB worldwide and 440,000 of those were from India. The WHO End-TB strategy aims to reduce TB deaths by 95% and new TB cases by 90% by 2035, with a call for more basic research on TB pathogenesis and immunity. A major hurdle in the development of effective TB vaccines and therapies is the absence of defined immune-correlates of protection. In this context, the role of regulatory T cells (Treg), which are essential for maintaining immune homeostasis, is even less understood. This review aims to address this knowledge gap by providing an overview of the emerging patterns of Treg function in TB. The review also provides a comprehensive critical analysis of the key features of Treg cells in TB; highlights the importance of a balanced immune response as being important in TB and discusses the importance of probing not just Treg frequency but also qualitative aspects of Treg function as part of a comprehensive search for novel TB treatments.

Forest structural dynamics is governed by tree growth and mortality; While the mean growth rate has been integrated in mathematical derivation of forest size structure, variance in growth is always ignored. Here by solving Kolmogorov forward equation, I show the significant difference in forest size structure predictions with and without considering of the variance, which just solved the puzzle of mismatch between observation and theoretical prediction in previous studies. An asymptotically power-law relationship between tree size and growth rate variance was found and statistically interpreted, which is the key link in connecting all the evidences in forest size structure formation.

SARS-CoV-2 has infected millions of people around the world, with most cases recorded among adults. The cases reported among children have been acknowledged to be minimal in comparison to adults. Nevertheless, COVID-19 has been reported to affect children at all ages, including newborns. The symptoms among children have also been identified to be similar to those observed among adults, although pediatric patients have been noted to display spectrum of clinical features ranging from asymptomatic through mild to moderate symptoms. Despite ample publications on the ongoing pandemic, the literature is only replete with guidelines on treating SARS-CoV-2 infection among older people. In this narrative review, comprehensive updates on the infection in children have been discussed. The latest information on the spread of the disease among children around the world, the clinical features observed among the pediatric population, as well as recommended pharmaceutical treatments of COVID-19 among this special group of patients have been covered. Further, expert consensus statements regarding the management of this highly contagious disease among pregnant women and neonates have been discussed. It is believed that this comprehensive review will provide updated information on the epidemiology and clinical features of the ongoing pandemic among pediatric patients. Additionally, the guidelines for handling SARS-CoV-2 among pregnant women and children, as reviewed in this article, are anticipated to be useful to frontline clinicians battling this fatal disease around the globe.

Background : Critically ill patients with coronavirus disease 2019（COVID-19）was surging and far outnumbered existing beds. Aims :  To describe how to rapidly convert general wards to intensive care units for critically ill patients with COVID-19. Materials & Methods :  Comprehensive assessment and analysis of available resources and standard requirements. Results : The ICUs were successfully assembled in four days. The conversion included environment reconstruction, configuration and management of equipment, information system construction and human resource allocation. A total of 172 critically ill patients had been admitted to the contemporary ICUs and none medical staff was infected. Discussion :  The epidemic situation of COVID-19 poses a great challenge to various management departments of the hospital, especially for critically ill patients with high mortality rate. To save more critically ill patients, the conversion of a general ward to a quarantine ICU ward must be completed in a short time, and the optimal allocation of resources must be appropriate to ensure that the medical team works effectively and is of high quality. In face of the overloaded medical system, the ideal non-negative pressure ward is hard to achieve. However, we have demonstrated with evidence that our conversions are effective in both providing care to the critical patients and protecting the safety of our staff. Conclusion:  The conversion is successful and the running experience would be a reference for hospitals in other areas nationally or globally.

AIM: to determine if patients with heart failure and preserved ejection fraction (HFpEF) and type 2 diabetes mellitus (T2DM) have a higher comorbidity burden than those without T2DM, if other comorbidities are preferentially associated with T2DM, and if these conditions confer a worse patient prognosis. METHODS AND RESULTS: Cohort study based on the RICA Spanish Heart Failure Registry, a multicenter, prospective registry that enrolls patients admitted for decompensated HF and follows them for 1 year. We selected only patients with HFpEF, classified as having or not having T2DM, and performed an agglomerative hierarchical clustering based on variables such as the presence of arrhythmia, chronic obstructive pulmonary disease, dyslipidemia, liver disease, stroke, dementia, body mass index (BMI), hemoglobin levels, estimated glomerular filtration rate, and systolic blood pressure. 1,934 patients were analyzed: 907 had T2DM (mean age 78.4+/-7.6 years) and 1,027 did not (mean age 81.4+/- 7.6 years). The analysis resulted in 4 clusters in patients with T2DM, and 3 in the reminder. All clusters of patients with T2DM showed higher BMI, and more kidney disease and anemia than those without T2DM. Clusters of patients without T2DM had neither significantly better nor worse outcomes. However, among the T2DM patients, clusters 2, 3 and 4 all had significantly poorer outcomes, the worst being cluster 3 (HR 2.0, 95% CI 1.36-2.93, p=0.001). CONCLUSIONS: Grouping our patients with HFpEF and T2DM into clusters based on comorbidities revealed a greater disease burden and prognostic implications associated with the T2DM phenotype, compared to those without T2DM.

Polycystic ovary syndrome (PCOS) is one of the most common endocrine and metabolic conditions in childbearing women. Polycystic ovary syndrome (PCOS) is characterized by hyperandrogenism, ovulatory dysfunction, and morphology of polycystic ovaries. Clinical signs of hyperandrogenism include hirsutism, acne, and alopecia. Acne is a chronic, inflammatory disease of the pilosebaceous unit that may have a severe impact on an individual’s life. The objective of this review is to highlight the treatment options for female patients with acne associated with PCOS. The selection of treatment is dependent on multiple fac¬tors including the patient’s age, clinical presenta¬tion medication history, pregnancy, and patient preference

Cardiac-specific markers of myocardial injury, such as troponin I, are often elevated following procedures that stimulate the myocardium. The aim of this study was to determine the effect of synchronised DC cardioversion of an atrial arrhythmia on myocardial injury 6-hours post procedure, as measured by cardiac troponin I A total of 73 individuals (59 men, 14 women) undergoing DC cardioversion of an atrial arrhythmia agreed to participate in this study. Inclusion criteria included subjects older 18 who were undergoing DC cardioversion for an atrial arrhythmia. This included elective and non-elective admissions. Exclusion criteria included an MI or CABG within the past month, cardioversion for a ventricular arrhythmia, or any recent shocks by an implantable internal cardioverter defibrillator. Patients underwent standard procedure for DC cardioversion with blood work (troponin I and CRP) performed prior to and six hours post cardioversion. Primary outcome was change in troponin I. Secondary outcomes included changes in CRP, relationships between troponin I and cumulative energy and LVM, and a sub-group analysis stratified by the presence of cardiomyopathy. There was no significant change in troponin I following cardioversion (F[1,72]=2.651, p=0.108). There was a significant reduction in troponin I following cardioversion in the non-cardiomyopathy group (F[1,58]=6.481, p=0.014). There was no significant relationship between change in troponin I and cumulative energy or LVM (r=0.137, p=0.306 and r=0.125, p=0.412 respectively). Synchronised DC cardioversion of an atrial arrhythmia did not cause myocardial injury 6-hours post-cardioversion. Sub-group analysis suggests that cardioversion of patients with cardiomyopathy may result in normalization of tropo

Introduction: Open irrigation ablation catheters are now the standard in radiofrequency catheter ablation (RFCA) of atrial fibrillation (AF). Among various irrigation catheters, laser-cut slit-based irrigation system (Cool Flex and FlexAbility) has a unique design to cool the catheter tip more efficiently. We aimed to assess the safety of slit-based irrigation catheters regarding prevention of procedure-related ischemic complication in AF patients undergoing RFCA. Methods and Results: The analysis was performed with Korea University Medicine Anam Hospital RFCA registry. Procedure-related ischemic complication was defined as ischemic stroke or transient ischemic attack (TIA) occurring within 30 days after RFCA. Patients were divided into 3 groups: non-irrigation, hole-based irrigation, and slit-based irrigation catheter groups. A total of 3,120 AF patients underwent first RFCA. Non-irrigation, non-slit-based irrigation, and slit-based irrigation catheters were used in 290, 1,539, and 1,291 patients, respectively. As compared with non-irrigation and non-slit-based irrigation catheter groups, slit-based irrigation catheter group had significantly older age, higher prevalence of non-paroxysmal AF, large left atrial size, and decreased left atrial appendage flow velocity. The CHA2DS2-VASc score was not different among the 3 groups. Procedure-related ischemic complication occurred in 17 patients (0.54%) with 16 ischemic strokes and 1 TIA event: 5/290 (1.72%), 11/1,539 (0.71%), and 1/1,291 (0.08%) events in non-irrigation, non-slit-based irrigation, and slit-based irrigation catheter groups, respectively (p = 0.001). Slit-based irrigation catheter was superior in direct comparison with non-slit-based irrigation catheter (0.71% vs. 0.08%; p = 0.009). Conclusions: Slit-based irrigation catheters were highly effective in preventing procedure-related ischemic complications.

Targeted gene flow is an emerging conservation approach which involves introducing a cohort of individuals with particular traits to locations where they can effect a conservation benefit. This technique is being proposed to adapt recipient populations to a known threat, but questions remain surrounding how best to maximize conservation outcomes during periods of continuous directional environmental change. Here we introduce a new management objective — to keep the recipient population extant and with maximum diversity of local alleles — and we explore how varying the timing and size of a given introduction can maximise this objective. Our results reveal a trade-off between keeping a population extant and maintaining a high level of genetic diversity, but management levers can often optimize this so that nearly 100% of the allelic diversity is preserved. These optimum outcomes sets are highly sensitive to the predicted rate of environmental shift, as well as the level of outbreeding depression in the system.