Background. We sought to determine the relationship between tricuspid right ventricular (RV) and tricuspid valve (TV) remodeling and late failure of tricuspid annuloplasty. Methods. From May 2009 to December 2015, 423 patients undergoing tricuspid annuloplasty (TA) for functional TR at a single were analyzed. Residual TR was defined TR moderate-or-more at discharge. Recurrent TR was defined TR-moderate-or-more at follow up. RV remodeling was defined RV dysfunction and/or dilatation. Results. Residual TR after TA was recorded in 54. Five-year freedom from TR recurrence was 86.3±2.3% for patients without residual TR vs 57.6±7.6% for patients with residual TR, p<0.001. Evaluating late results of 369 patients without residual TR, following risk factors were identified: preoperative pulmonary pressure, pre RV remodeling, pre TR and TV remodeling, functional mitral regurgitation. Conclusions. Prophylactic tricuspid annuloplasty should be encouraged among surgeons. TA at the time of left-sided valve surgery should take into consideration not only annular size, but also tethering severity and RV remodeling.

Two patients suffering from recurrent coarctation after native coarctation surgery, were scheduled for cardiac catheterization in a hybrid setting by the age of two & three years. Through right anterior mini-thoracotomy unmounted stents were successfully placed in the coarctant segment. One-year follow-up did not show echocardiographic improvement, yet, they were controlled on medical therapy. Five-years follow-up showed stent breakage in the first case, while the second showed stent stenosis that needed balloon dilatation.

For patients undergoing cardiopulmonary bypass, myocardial protection is a key for successful recovery and improved outcomes following cardiac surgery that requires cardiac arrest. Different solutions, components, and modes of delivery have evolved over the last few decades to optimise myocardial protection. These include; cold and warm, blood and crystalloid solution through antegrade, retrograde or combined cardioplegia delivery approach. However, each method has its own advantages and disadvantages, posing a challenge to establish a gold standard cardioplegic solution with an optimised mode of delivery for enhanced myocardial protection during cardiac surgery. The aim of this review is to provide a brief history of the development of cardioplegia, explain the electrophysiological concepts behind myocardial protection in cardioplegia, analyse the current literature and summarise existing evidence that warrants the use of varying cardioplegic techniques. We provide a comprehensive and comparative overview of the effectiveness of each technique in achieving optimal cardioprotection and propose novel techniques for optimising myocardial protection in the future.

Antigenic competition in the skin is a phenomenon in which the current dermatitis is distributed away from the area of previously existing dermatitis. We experienced antigenic competition-like phenomenon in bullous pemphigoid. Our case differs from typical presentations of antigenic competition, since the responsible antigen was the same.

Clinical outcomes of salvage endoscopic nasopharyngectomy in recurrent nasopharyngeal carcinoma

In this clinical image, we presented a rare case of shortness of breath as a symtom of McKittrick-Wheelock syndrome(MWS). The patient’s symptom and electrolyte disorders improved with the resection of the rectal villous tumor. We should aware of this rare symtom in case of the diagnosis of MWS.

Aims: To determine if the combination of exercise and statin could normalize postprandial triglyceridemia (PPTG) in hypercholesteraemic individuals. Mehods: Eight hypercholesteraemic (blood cholesterol 182±38 mg·dL-1; LDL-c 102±32 mg·dL-1) overweight (BMI 30±4 kg·m-2) individuals with metabolic syndrome (i.e., Met Synd) were compared to a group of eight metabolically healthy controls (i.e., MetH, blood cholesterol 149±23 mg·dL-1; LDL-c 77±23 mg·dL-1, and BMI 23±2 kg·m-2). Each group underwent two PPTG tests, either 14-h after a bout of intense exercise (EXER) or without previous exercise (REST). Additionally, Met Synd individuals were tested 96 h after withdrawal of their habitual statin medication (PLAC trials) to study medication effects. Results: A bout of exercise before the test meal did not reduce PPTG in Met Synd (P=0.347), but reduced PPTG by 46% in MetH (224±142 to 413±267 mg·dL-1·for 5 h iAUC; P=0.02). In both trials (i.e., REST and EXER) statin withdrawal in Met Synd greatly increased PPTG (average 65%; P<0.01), mean LDL-c (average 25%; P<0.01), total cholesterol (average 16%; P<0.01) and Apo B48 (24%; P<0.01), without interference from exercise. However, Apo B100 was not affected by statin withdrawal. Conclusions: Hypercholesteraemic Met Synd individuals (compared to metabolically healthy controls) are resistant to the effects of exercise on reducing PPTG. However, chronic statin medication blunts the elevations in TG after a fat meal (i.e., iAUC of PPTG) reducing their cardiovascular risk associated to their atherogenic dyslipidemia. Statin decreases PPTG by reducing the secretion or accelerating the catabolism of intestinal Apo B48.

Monitoring of anaesthetic depth has come a long way from observation of clinical signs. We report here, a useful clinical indicator of anaesthetic depth that has not been reported on before. A clinical sign, that as ENT surgeons we are often in a unique position to observe. We outline our supportive theory and respectfully highlight this to our colleagues.

A 53 year old man presented with symptomatic severe pulmonary valve regurgitation. He underwent a diagnostic catheterization. A heavily calcified pericardium and the pressure tracings illustrate typical features of constrictive pericarditis physiology. This condition is important to recognize given the progressive nature and poor prognosis when left untreated.

The emergence of new type of viral pneumonia cases in China, on December 31, 2019; identified as the cause of human coronavirus, labeled as “COVID-19,” took a heavy toll of death and reported cases of infected people all over the world, with the potential to spread widely and rapidly, achieved worldwide prominence but arose without the procurement guidance. There is an immediate need for active intervention and fast drug discovery against the 2019-nCoV outbreak. Herein, the study provides numerous candidates of drugs (either alone or integrated with another drugs) which could prove to be effective against 2019-nCoV, are under different stages of clinical trials. This review will offer rapid identification of a number of repurposable drugs and potential drug combinations targeting 2019-nCoV and preferentially allow the international research community to evaluate the findings, to validate the efficacy of the proposed drugs in prospective trials and to lead potential clinical practices.

Herein, we report an unusual case of metallic foreign body consisting of blades of scissors in the maxillary sinus for about 40 years. Even though there are potential risk for sinus infection, not all retained foreign body require prompt removal.

Background and Purpose: Asthma is a chronic inflammatory lung disorder with continuously increasing prevalence worldwide. Novel strategies are needed to prevent or improve asthma. The aim of this study was to investigate the effects of sophoricoside from Sophora japonica on allergic asthma. Experimental Approach: Sophoricoside was isolated from the mature seeds of S. japonica. Allergic asthma and passive cutaneous anaphylaxis (PCA) models were generated by ovalbumin (OVA) treatment or antibody-allergen reaction in mice. Allergic and asthmatic symptoms, immune cell infiltration, and the amounts of histamine, lipid metabolites, and pro-inflammatory cytokines were determined, and in vitro CD4+ T cell differentiation was performed. Key Results: The mature seeds of S. japonica contain a large amount of sophoricoside. Sophoricoside reduced allergic and asthmatic symptoms by suppressing airway inflammation and antibody-antigen reaction in mouse models. In particular, sophoricoside suppressed immune cell recruitment into the airway lumens of the lungs and production of pro-inflammatory cytokines in the bronchoalveolar lavage fluid (BALF) of OVA-induced mice. It also decreased the amounts of histamine and lipid metabolites released in OVA-induced mice and antibody-antigen stimulated mast cells. In addition, sophoricoside decreased differentiation of naïve CD4+ T cells into T helper type 1 (Th1), Th2, and Th17 cells. Conclusions and Implications: Sophoricoside from S. japonica inhibited allergic asthma by suppressing mast cell activation and CD4+ T cell differentiation. Thus, it is a promising candidate molecule for the treatment of allergic asthma. Keywords Airway inflammation; Allergic asthma; CD4+ T cell; Mast cell; Ovalbumin; Sophora japonica; Sophoricoside

Effectiveness of floods and landslide early warning systems can be clearly improved by reliable quantitative predictions of rainfall, which represents the main precursor. With this aim, a methodology for probabilistic rainfall nowcasting, based on a coupling between a stochastic model and outputs provided by a Numerical Weather Prediction (NWP) model is proposed in this paper. The coupling among different types of models usually allows for improving the prediction, as the positive aspects of all the model components are merged. In this paper, the hybrid model, named PRAISE-ME (Prediction of Rainfall Amount Inside Storm Events with MEteo), is proposed. This model allows improving the rainfall prediction at hydrological scales, where only NWP models are not so suitable and the simple use of stochastic models provides the same forecast, regardless of weather forecasts as they depend only on previous rainfall. PRAISE-ME provides probabilistic quantitative predictions and it can be easily set up as input in other models for Rainfall-Runoff or Landslide prediction, as in the application case here illustrated. In this work, PRAISE-ME was used with the empirical FLaIR model (Forecasting of Landslides Induced by Rain-fall, Capparelli and Versace 2011) in order to obtain in real-time indications about exceedance probabilities associated to specific thresholds. The procedure was applied for a landslide case study, occurred in Montenero di Bisaccia (Central Italy) in March 2006. The obtained results encourage the use of this methodology as a component of early warning systems.

Evolutionary theory predicts that a host infected with a parasite that reduces its future survival and/or fecundity should be selected towards an increased investment in current reproduction. In this study we use the cestode Ligula intestinalis and its intermediate fish host Engraulicypris sardella in Wissman Bay, Lake Nyasa (Tanzania) as a model system. Using data about infestation of E. sardella fish hosts by L. intestinalis collected for a period of 10 years, we explored (i) whether parasite infection affects the fecundity of the fish host E. sardella and (ii) whether host reproductive investment has increased at the expense of growth at maturity. We found that L. intestinalis had a strong negative effect on the fecundity of its intermediate fish host. For the non-infected fish we observed an increase in relative gonadal weight over the study period, while somatic growth at maturity decreased during the study period. Our findings suggest that the cestode L. intestinalis might have selected for increased investment in current reproduction in its fish host E. sardella in Lake Nyasa. This calls for further studies to assess whether these changes reflect plastic or evolutionary responses. We also discuss the synergy between parasite and fishery-mediated selections as a possible explanation for the decline of E. sardella stock in the lake. KEYWORDS Engraulicypris sardella; Ligula intestinalis; life history evolution; selective agents; parasitism; fishing.

Ranaviruses can infect both captive and wild cold-blooded vertebrates, leading to significant economic and environmental losses. With the cases of ranavirus infection increasing, many ranavirus genomic sequences were published, but little is known about ranavirus taxonomy on a whole genome level. In this study, 44 ranaviruses core genes were identified in 32 ranaviruses genome suquences by using PanX. The Neighbor joining phylogenetic trees (NJ-tree) based on 44 ranaviruses core genes and 24 iridoviridae core genes and composition vector phylogenetic tree (CV-Tree) based on whole genome were constructed. The three of phylogenetic trees showed that 32 ranavirus isolates can be divided to 4 different subspecies including GIV-like, EHNV-like, FV3-like and CMTV-like, and subspecies taxonomic position of three phylogenetic trees were consistent. However, the phylogenetic position of ToRV could not be determined if it belongs to FV3-like or CMTV-like group. Subsequently, we carried out dot plot analysis and confirmed that ToRV should belong to CMTV-like group. Based on dot plot analysis and phylogenetic trees, taxonomic classification of ranaviruses were confirmed. Finally, 4 genes which are suitable for the construction of phylogenetic tree were selected from ranavirus core genes by recombination analysis, substitution saturation analysis and single-gene phylogenetic analysis. Phylogenetic tree based on concatenated sequences of the 4 selected genes showed that classification of subspecies was identical with 3 of the phylogenetic trees. Conclusion: our results confirmed taxonomic identification of ranaviruses, the 4 selected genes used in phylogenic analysis will make taxonomic identification more convenient and accurate.

Purpose: High altitude pulmonary edema (HAPE) has rapid onset and development, and may be life-threatening if not treated in time. It is important to correctly identify and recognize the characteristics of HAPE and to provide timely treatment. We aimed to summarize the characteristics of patients with HAPE by analyzing their general information, clinical symptoms, examination and laboratory results. Methods: 429 HAPE patients were enrolled in our study, and 200 of them were divided into three groups according to the period from their arrival in Naqu to the onset of the disease. We collected and analyzed the demographic information, results of laboratory tests, imaging and electrocardiography of all the participants at admission. The patients’ results of laboratory tests and imaging at admission were compared with those at discharge. The results of blood routine were compared among different groups. Results: Most of the HAPE patients were male (90.21%). The average white blood cell and neutrophil counts, alanine aminotransferase and aspartate aminotransferase levels, uric acid level, lactic dehydrogenase and creatine kinase levels were increased among HAPE patients at admission. The counts of white blood cell, neutrophil and lymphocyte, and the concentration of hemoglobin in HAPE patients at admission were higher than those at discharge (p<0.05).The counts of white blood cell and neutrophil were higher in the patients who developed the disease within 1 day than in those who developed the disease in more than 7 days (p<0.05). Conclusion: The proportion of males in HAPE patients was higher. Hepatocyte and myocardium in HAPE patients were more likely to be damaged. The white blood cell and neutrophil counts were significantly higher than normal range, and their increment was reduced as the incubation period extended.

ABSTRACT Purpose In our study, we aimed to evaluate the sleep disorders, sleep quality of the patients who applied to family health centers, to determine the situations that might be related with insomnia and to determine the insomnia rates of the general population in primary care. Methods This study is a descriptive research and conducted in Ankara Güdül, Antalya Değirmenözü, Bursa Sırameşeler, Gaziantep Family Health Center policlinics. The study population consisted of all patients over 18 years of age who were admitted to the family health centers for any reason. A 10-question questionnaire, Berlin questionnaire, Pittsburgh sleep quality index and insomnia severity scales were collected by the researchers from October to December 2017 using face-to-face interview method. Results 299 people participated in study and 54.5% of them were women. According to the results of Pittsburgh Sleep Quality Scale, it was found that 27.1% of the participants’ sleep quality was good and 72.9% of them were poor; according to the Berlin sleep questionnaire, 27.4% had high OSAS risk and 72.2% had a low OSAS risk. According to total Insomnia Severity Index, 27.1% had insomnia lower threshold, 15.4% had moderate insomnia, 3.7% severe insomnia was detected. Conclusions In this context, it will be very effective in terms of the quality of life of patients in order to determine the conditions that disrupt sleep hygiene and to perform the necessary interventions which can be intervened in the primary health care institutions and the other patients to be delivered to the related upper levels.

Extra Corporeal Membrane Oxygenation (ECMO) is a supportive therapy used to provide cardiac support with or without respiratory support in the event of cardiopulmonary failure. The two main types of ECMO are Veno-arterial ECMO (VA-ECMO) and Veno-venous ECMO (VV-ECMO). The use of ECMO in cardiac surgery has been established in cases of post-cardiotomy cardiogenic shock which is refractory to conventional therapy with inotropes and intra-aortic balloon pulsation support. Survival for this, otherwise, fatal condition has been shown to be improving through the use of ECMO. However, the decision and timing to initiate ECMO therapy remains selective and is dependent on a range of factors such as patient factor, clinician’s judgement, meaning there is no consistent and solid ground regarding the timing of ECMO initiation. This article will provide an extensive review of ECMO indications, contraindications, complications and outcomes to analyse the survival benefit of ECMO following cardiac surgery.

Quaricuspid aortic valve (QAV) is a very rare congenital heart defect characterized by the presence of four valves of the same or different sizes. This anomaly may cause progressive aortic regurgitation or rarely valve stenosis. The diagnosis of QAV may be difficult, misdiagnosed or overlooked if careful evaluation is not made. Here, a 13-year-old patient with QAV who presented to the outer center with a complaint of chest weight, who was mistakenly diagnosed with insidious rheumatic carditis due to aortic regurgitation, was presented, and and it was aimed to draw attention to this rare congenital heart valve disease.

In December 2019, with the outbreak of the unidentified pneumonia in Wuhan, China, a novel coronavirus was confirmed to be accountable for this disease and aroused great attention of the entire world. World Health Organization (WHO) officially named the novel coronavirus as SARS-CoV-2 and the unknown pneumonia as Corona Virus Disease (COVID-19). Up to April 13, 2020, there have been 83696 confirmed cases in China and 1837079 cases were totally confirmed in 209 countries outside of China with 119138 fatalities. The main manifestations are usually fever, cough, fatigues, breathlessness, and among others. To date, specific antiviral agents against the SARS-CoV-2 are not available. Extensive measures to reduce person-to-person transmission of COVID-19 have been implemented to control the current outbreak. In this review, we detail current evidence and understanding of the etiology, epidemiology, clinical symptoms and current strategies on diagnosis, treatment, and prevention of COVID-19, which may provide a reference for future studies and help for the prevention and control of the COVID-19 epidemic.

Bioprocess modeling has become a useful tool for prediction of the process future with the aim to deduce operating decisions (e.g. transfer or feeds). Due to variabilities, which often occur between and within batches, updating (re-estimation) of model parameters is required at certain time intervals (dynamic parameter estimation) to obtain reliable predictions. This can be challenging in the presence of low sampling frequencies (e.g. every 24 hours), different consecutive scales and large measurement errors, as in the case of cell culture seed trains. In this contribution, two estimation techniques, which differ in terms of their objective functions, were investigated regarding robustness concerning the aforementioned challenges and the required amount of experimental data (estimation horizon). A common weighted least squares estimation (WLSE) and a moving horizon estimation (MHE), which takes prior knowledge about model parameters into account, were applied for re-estimation of model parameters over three consecutive cultivation scales (40 - 2,160 L) of an industrial cell culture seed train. It is shown how the proposed MHE can deal with the aforementioned difficulties by integration of prior knowledge, even if only data at two sampling points are available, outperforming the classical WLSE approach. A workflow illustrating the required steps is presented.

Filippos-Paschalis R et al1 described a very interesting and unique case of ectopic hepatocellular carcinoma (HCC) in the adrenal gland with inferior vena cava thrombosis and right atrial extension. The patient developed respiratory failure and required an urgent operation. The right adrenal gland was removed through the abdominal approach, but cardiopulmonary bypass (CBP) was needed in removing the right atrium extension. The ascending aorta, superior vena cava, and the right femoral vein were cannulated for arterial and venous access, respectively. They achieved systemic hypothermia (250 C), and antegrade cold cardioplegia was administered. The aorta was cross-clamped, and another vascular clamp was placed between the left common carotid artery and left subclavian artery. The adrenal gland, the right atrium tumor, and IVC tumor thrombus were removed successfully. During the placement of the venous cannulas, the authors were very careful to avoid dislodging the tumor thrombus. The surgery was meticulously planned, and the patient had an uneventful post-operative course.Ectopic hepatocellular carcinoma in the adrenal gland is a very rare tumor, but all adrenal tumors can extend into the IVC and even into the right atrium.2,3 Of note, renal cell carcinoma (RCC) can have the same behavior of vascular extension into the IVC and right atrium.4 Once these tumors extend into the IVC and go into the chest, hepatic veins can be obstructed, causing Budd-Chiari syndrome (BCS).5 Figure 1 showed that hepatic veins and IVC were dilated and obstructed; thus, the patient probably had BCS in this situation. Under such condition, the use of CPB is a must in order to remove the tumor from the hepatic vein and to avoid liver congestion. Also, the patient presented to the emergency department with signs and symptoms of pulmonary emboli (PE). Some of these patients can present with PE, which is a tumor thrombus that embolizes into the pulmonary arteries. In some cases the PEs also need to be removed if it is safe for the patient.6The use of CPB is indicated in cases like the one described by Filippos-Paschalis et al.1 The tumor was probably too bulky to be removed without the use of CBP; otherwise, the risk of … developing with the use of CBP may be unacceptably high. There are select cases of RCC and adrenal HCC with tumor thrombus extension which can be removed safely from the right atrium and IVC without the use of CPB.2,7,8 It is important to remember that these tumors do not cause thrombosis of the IVC, as the tumor thrombus (different from thrombosis) extends into the IVC. Tumor thrombus can cause blood thrombosis below its location,9 making it difficult to be able to place a cannula in the femoral veins.These complex extreme surgeries usually require a multidisciplinary team or a transplant surgeon who specializes in approaching these types of cases.

The polysaccharidic mucilage is a widespread plant trait with diverse features, often present around plant structures in contact with the environment, providing numerous functions including protection and adhesion. In myxodiasporous species, a mucilage is released upon the imbibition of the seed (myxospermy) or the fruit (myxocarpy), and therefore can play roles in the early seedling stages. It is unclear whether myxodiaspory has one or multiple evolutionary origins and why it disappeared in several species. Here, we summarize the recent advances on (i) the mucilage and mucilage secretory cell diversity, (ii) the evolution of the molecular actors involved in myxospermy underlying the observed inter- and intra-species natural diversity and (iii) the recently identified ecological functions. At the intra-species level, a high polymorphism was detected for a few genes in relation to the observed morphological diversity. Well characterized transcriptions factors interact in master regulatory complexes to balance carbon partitioning in Arabidopsis thaliana seeds. These transcription factors were sequentially recruited during seed plant evolution to control diverse traits including myxospermy, and their functions in seeds seem to be conserved across Rosids. Historically, the ecological functions of seed mucilage were mostly related to germination and seed dissemination but recently some exosystemic functions were uncovered such as soil micro-organism control and plant establishment support.

In this paper, we present the mathematical model for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The outbreak of SARS-CoV-2 has led to 2,192,469 confirmed cases as of April 17, 2020 and total deaths are 147,360 in 210 different countries, area or territories. The basic reproductive number is formulated using next generation approach. The sensitivity analysis of reproductive number and local stability analysis of mathematical model are discussed. Also, we present numerical approximations for the disease free and endemic equilibrium points for infection of SARS-CoV-2. Also, we propose an efficient SKAZI scheme. Lastly, we present numerical experimentation of SKAZI scheme. The disease free and endemic equilibrium points are graphical reveal for stability and instability of mathematical model.