ABSTRACT The epoxide ring opening reaction (ROR) can be considered the most important side reaction occurring in the epoxidation of soybean oil reaction network. This reaction consistently reduces the selectivity to epoxidized soybean oil (ESBO). In this work, this reaction has been studied in different operative conditions to evaluate the effect on ROR rate of respectively: (i) the Bronsted acidity of the mineral acid (H2SO4 or H3PO4), used as catalyst for promoting the oxidation with hydrogen peroxide of formic to performic acid, that is, the reactant in the epoxide formation; (ii) the concentration of the nucleophilic agents, normally present during the ESBO synthesis like HCOOH, HCOOOH, H2O, H2O2; (iii) the stirring rate that changes the oil-water interface area; (iv) the adopted temperature. Many different kinetic runs have been made, in different operative conditions, starting from an already epoxidized soybean oil. On the basis of these runs two different reaction mechanisms have been hypothesized, one promoted by the Bronsted acidity mainly occurring at the oil-water interface and one promoted by the nucleophilic agents, in particular by formic acid. As it will be seen, the kinetic laws corresponding to the two mentioned mechanisms are quite different and this explain the divergent data reported in the literature on this subject. All the kinetic runs have been correctly interpreted with a new developed biphasic kinetic model.

We present a patient with a rare ectopic retrosternal goitre that underwent a right hemithyroidectomy via an open cervical and video assisted thoracoscopic surgery (VATS). This case report reviews the work-up and radiological features of retrosternal goitre(RSG) and provides an update on the management of RSG.

This case highlights the anterior neck as an unusual location for a lipoma. It is often mistaken for a thyroid nodule as they typically are located on the posterior or lateral neck. It also emphasizes the accuracy of fine need aspiration (FNA) in diagnosing lipomatous tumors.

In order to improve the accuracy of the relationship between standard deviation and stress with a small number of fatigue test data, the specimen information reconstruction method is proposed in this paper. Meanwhile, the new maximum likelihood method is designed for P-S-N curve fitting, which is based on the specimen information reconstruction and the life equivalent principle. According to the main type of welded joint on the 80t gondola car body, the T-joint specimens were fabricated and tested, then the P-S-N curve is fitted and extrapolated. Finally, according to the result of measured stress spectrum on 80t gondola car body, it is verified that the accuracy of the P-S-N curve fitted in this paper is higher, and it is indicate that maximum likelihood method based on specimen information reconstruction and life equivalent principle is a better way for P-S-N curve fitting, especially for the small number of fatigue test data.

Mini-commentary on BJOG-19-0970.R4: External validation of a simple risk score based on the ASPRE trial algorithm for preterm preeclampsia considering maternal characteristics in nulliparous pregnant women: a multicentric retrospective cohort study

The (COVID-19) coronavirus disease 19 is a highly transmittable and pathogenic viral infection that is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which has recently emerged in Wuhan province of China and rapidly spread throughout the world. Though the intermediate source of origin and its transfer to humans is not very well known, but the fast human to human transfer has been confirmed widely. There is no clinically approved antiviral drug or vaccine developed so far to be used against COVID-19. In the current review, we summarize and comparatively analyse the deadly virus and how it poses a constant threat to sub continental nations especially India. A number of ecological interventions are also suggested to protect humans and keep the virus carrying bats at a distance.

Background In cervical cancer, the benefits of sentinel lymph node biopsy (SLNB) have long been confined by the lack of precise intraoperative pathological examination. Objective To determine the diagnostic performance and optimal protocol of frozen section examination (FSE) in SLNB for cervical cancer. Search Strategy PubMed, EMBASE, Web of Science, Cochrane Library, Wanfang Data and China National Knowledge Infrastructure were searched from inception to July 30, 2019. Selection Criteria Studies reporting the data of SLNB combined with FSE in cervical cancer were included. Data Collection and Analysis Two independent reviewers extracted the data. Bivariate mixed-effects regression model was applied for analyses. Sensitivity of FSE in detecting SLN metastasis was the primary diagnostic indicator for evaluation. Main Results The pooled sensitivity of FSE among 31 eligible studies (1887 patients) was 0.77 (95% CI 0.66–0.85) with high heterogeneity (I2=69.73%). Two representative FSE protocols were identified from 26 studies, described as equatorial (E-protocol, SLN was bisected) and latitudinal (L-protocol, SLN was cut at intervals). Meta-regression showed that FSE protocol was the only source of heterogeneity (p<0.001). The pooled sensitivity was 0.86 (95% CI 0.79–0.91, I2=0%) and 0.59 (0.46–0.72, I2=58.47%) for FSE using L- and E- protocol, respectively. The pooled sensitivity of FSE using L-protocol would reach 0.97 (0.89–0.99) if only marcometastases were considered. These findings were robust to sensitivity analyses. Conclusions With L-protocol, FSE can provide precise intraoperative pathology for SLNB, which enables immediate decision-making for individualized managements. Keywords Cervical cancer, sentinel lymph node, metastasis, frozen section, sensitivity, meta-analysis.

Objective: To compare maternal outcomes for placenta praevia (PP) between those who experience antepartum haemorrhage (APH) and those without APH. Design: Retrospective cohort study. Setting: Royal Brisbane & Women’s Hospital, Australia. Population: Over ten years, a total of 368 women with placenta praevia (PP) were recruited and divided into APH (n=230) and No APH (n=138). Methods: Data retrieved from institution-based obstetric database were analysed using logistic regressions for binary outcomes and Poisson or negative binomial regressions for counts. Main Outcome Measures: Type of PP, timing and mode of delivery, intra-operative and postpartum complications, volume of blood loss and number of blood transfusions. Results: Compared to women without APH, women who experienced APH had a greater proportion of major PP (OR=2.88,p<0.001), emergency lower uterine segment (OR=6.24,p<0.001) and classical (OR=14.9,p<0.001) sections, use of general anaesthesia (OR=3.14,p<0.001), preterm delivery (median 35.4 vs 38.0 weeks, p<0.001). There was no significant differences intra-operatively (number of uterotonics used or additional surgical techniques), greater volume of bloods loss (IRR=1.20,p=0.006), increased frequency of blood transfusion (IRR=3.36,p<0.001), and longer post-operative hospital stay (IRR=1.27,p=0.001). There was a total of four hysterectomies and no intensive care unit admissions or maternal deaths. Conclusions: Women with PP who experienced APH had a tendency for preterm delivery, emergency caesarean section, greater blood loss requiring more blood transfusion and longer hospital admissions. However, a lack of serious maternal morbidity among these women provides support for an individualised approach towards management of bleeding in PP. Funding: No funding body. Keywords: Antepartum Haemorrhage, Placenta Praevia, maternal outcomes.

Introduction: muscle pain/fibromyalgia (FM) is common among individuals with myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). We recently demonstrated that during orthostatic stress testing, adults with ME/CFS reported increased pain. In the current study, we hypothesized that pain pressure thresholds (PPT) would decrease and temporal summation (windup) would increase after head-up tilt testing (HUT), and that the presence of co-morbid FM would be associated with greater change in both measures. Methods and Results: 248 ME/CFS patients (164 with FM and84 without FM), and 22 healthy controls (HC) were analyzed. In HC there were no significant differences in PPT between pre- and post-HUT (finger: from 4.7(1.6) to 4.4(1.5); shoulder: from 2.8(1.0) to 2.9(1.0)). In ME/CFS patients with and without FM, a significant decrease in PPT post-HUT was found compared to HC (both p<0.0001). Patients with FM had a lower PPT pre- and post-HUT (finger: from 2.0(0.9) to 1.5(0.8); shoulder: from 1.2(0.5) to 1.0(0.5) compared to patients without FM (finger: from 5.0(1.6) to 3.3(1.5); shoulder: from 2.2(0.9) to1.9(1.0) (p ranging from 0.001 to <0.0001). In contrast to HC in ME/CFS patients windup was increased compared to HC pre-HUT (both p<0.0001), but did not significantly change post-HUT. Conclusions: Pressure pain threshold decreased in ME/CFS patients with or without fibromyalgia after head-up tilt test (HUT), compared to healthy controls. Windup pre-and post-HUT was significantly higher compared to healthy controls, but did not change from pre- to post-HUT. These results demonstrate that, like exercise, orthostatic stress can negatively influence the physiology of pain perception in ME/CFS.

This article comments on: “Melatonin improves rice salinity stress tolerance by NADPH oxidase-dependent control of the plasma membrane K+ transporters and K+ homeostasis”.

Abstract: The objective of this study was to identify patient and hospitalization characteristics associated with in-hospital mortality in infants with truncus arteriosus. We conducted a retrospective analysis of a large administrative database, the National Inpatient Sample dataset of the Healthcare Cost and Utilization Project for the years 2002-2017. We also sought to evaluate the resource utilization in the subgroup of subjects with truncus arteriosus and 22q11.2 deletion syndrome. Neonates with truncus arteriosus were identified by ICD-9 and ICD-10 codes. Hospital and patient factors associated with inpatient mortality were analyzed. Overall, 3009 neonates met inclusion criteria; a total of 326 patients died during the hospitalization (10.8%). Extracorporeal membrane oxygenation utilization was 7.1 %. Univariate and multivariate logistic regression analyses were used to identify risk factors for in-hospital mortality. Independent risk factors for mortality were prematurity (aOR = 2.43, 95% CI: 1.40–4.22, p = 0.002), diagnosis of stroke (aOR = 26.2, 95% CI: 10.1–68.1, p < 0.001), necrotizing enterocolitis (aOR= 3.10, 95% CI: 1.24-7.74, p=0.015) and presence of venous thrombosis (aOR = 13.5, 95% CI: 6.7–27.2, p < 0.001). Patients who received ECMO support or had cardiac catheterization procedure during the hospitalization had increased odds of mortality (aOR = 82.0, 95% CI: 44.5–151.4, p < 0.001, and aOR = 1.65, 95% CI: 0.98–2.77, p = 0.060, respectively). 22q11.2 deletion syndrome was associated with an inverse risk of death despite having more non-cardiac comorbidities; this patient subpopulation also had higher length of stay and increased cost of hospitalization.

Background Previous reports demonstrated that the early recurrence of atrial fibrillation (ERAF) after pulmonary vein isolation (PVI) was associated with the inflammatory process. The neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR) have been proposed as indicators of a systemic inflammatory response. However the relationship between NLR/PLR and clinical outcomes after PVI remains unclear. Methods and Results We enrolled 633 consecutive atrial fibrillation (AF) patients who underwent PVI from September 2014 to June 2018. The NLR and PLR in peripheral blood leukocytes 1 day before and 36-48 hours after PVI were measured. We compared the NLR and PLR changes in each parameter (ΔNLR and ΔPLR) between a late recurrence of AF group after the PVI (LRAF, during 1 year after PVI) and the no-LRAF group. We also evaluated the relationship between the ΔNLR /ΔPLR and pulmonary vein (PV) reconnections in repeated ablation procedures. The LRAF patients consisted of 151 patients (23.9%). The ΔNLR and ΔPLR were significantly higher in the LRAF group than no-LRAF group (p=0.021, p=0.011). The ΔNLR in the initial ablation sessions was significantly higher in patients with right PVs reconnections than in those without in the repeat ablation sessions (0.914±1.199 vs 2.316±3.615, p=0.032). Conclusion The NLR and PLR changes were associated with an LRAF. A higher NLR change in the initial ablation session was associated with a right PV reconnection in the repeat ablation session.

Introduction: The clinical efficacy and safety of hot balloon ablation (HBA) for treatment of persistent AF (PerAF) remain unclear. We aimed to evaluate the clinical efficacy and safety of HBA vs. cryoballoon ablation (CBA) as treatment for PerAF. Methods: Of 195 consecutive patients who underwent initial catheter ablation for PerAF (AF lasting >7 days but <12 months), 158 propensity score-matched (79 HBA and 79 CBA) patients were included in our study. All patients who underwent HBA received applications of energy to the upper posterior LA wall with a larger balloon in addition to single shots to each pulmonary vein (PV) ostium, whereas those who underwent CBA received simple single-shot applications. The electrically isolated surface area (ISA), including the PV antrum and part of the posterior LA wall, was assessed by high-resolution mapping. Results: Success of the PV isolation with balloon shots alone did not differ between HBA and CBA (81% vs. 85%; P = 0.52). The ISA was generally wide in both groups and significantly larger in the HBA group than in the CBA group (61 ± 16% vs. 51 ± 12%, P < 0.001). The incidence of procedure-related complications did not differ significantly (HBA 4% vs. CBA 1%; P = 0.62) nor did the arrhythmia recurrence rate (HBA 11% vs. CBA 18% at 18 months; P = 0.26). Conclusion: Despite the difference in protocols, HBA and CBA performed for PerAF appear comparable in terms of wide antral lesion creation, clinical efficacy, and safety.

Nitric oxide (NO) is a unique signaling molecule in the mammalian species. NO is produced by a variety of cell types to elicit distinct physiological actions. In the vascular system, NO is produced by the endothelium, a single layer of cells forming the inner lining of all blood vessels. Endothelium-derived NO has several different functions, one of which is vascular smooth muscle relaxation, resulting in vasodilation and a consequent decrease in blood pressure and increase in local blood flow. In the erectile tissue, NO is released as a neurotransmitter from the nerves innervating the corpus cavernosum during sexual stimulation, and causes profound smooth muscle relaxation and increased blood flow to the erectile tissue. This results in engorgement with blood and consequent penile erection.The uniqueness of NO as a signaling molecule derives, at least in part, by the fact that it is a gaseous molecule in its native state. However, despite being a gas, NO, like oxygen (O2), elicits its pharmacological effects as a solute in aqueous solution. Another unique characteristic of NO is its fleeting action because of its highly unstable chemical nature and reactivity. Unlike many other signaling molecules, NO elicits its wise array of physiological effects by distinct mechanisms. For example, vascular and nonvascular smooth muscle relaxation, and inhibition of platelet function are mediated by intracellular cyclic GMP (cyclic 3’, 5’-guanosine monophosphate). NO elicits many cyclic GMP-independent effects as well. For example, nitric oxide is a reactive free radical that can covalently modify protein function. One good example is protein S-nitrosylation, which can result in both regulatory and aberrant effects. By this and a variety of other mechanisms, NO also reacts with other molecules, such as reactive oxygen species, in invading cells such as bacteria, parasites and viruses to kill them or inhibit their replication or spread.The first pharmacological action of nitric oxide, demonstrated several years before it’s production in mammals was actually discovered, was vascular and nonvascular smooth muscle relaxation. One of many examples of the latter is the smooth muscle enveloping the sinusoidal cavities within the corpus cavernosum. Another important example is the airway smooth muscle in the trachea and bronchioles of the lungs. Indeed, inhalation of NO gas causes bronchodilation and increased delivery of air into the lungs. However, perhaps more significant than the bronchodilator effect of inhaled NO is its vasodilator effect. In fact, advantage was taken of the vasodilator action of NO in the lungs by Warren Zapol, MD, from the Massachusetts General Hospital in Boston, who discovered that inhalation of very small amounts of NO gas by newborn babies with life-threatening, persistent pulmonary hypertension (PPHN) results in a dramatic and permanent reversal of pulmonary vasoconstriction. Inhaled NO (INO) literally turned blue babies into pink babies. Without INO, most babies would have died while others would have required highly invasive procedures (extracorporeal membrane oxygenation; ECMO) to oxygenate their lungs, and may not have survived.Regarding its antiviral action, NO has been shown to increase the survival rate of mammalian cells infected with SARS-CoV (Severe Acute Respiratory Syndrome caused by coronavirus). In an in vitrostudy, NO donors (i.e., S-nitroso-N-acetylpenicillamine) greatly increased the survival rate of SARS-CoV-infected eukaryotic cells, suggesting direct antiviral effects of NO (1). In this study, NO significantly inhibited the replication cycle of SARS CoV in a concentration-dependent manner. NO also inhibited viral protein and RNA synthesis. Furthermore, NO generated by inducible nitric oxide synthase inhibited the SARS CoV replication cycle. The coronavirus responsible for SARS-CoV shares most of the genome of COVID- 19 indicating potential effectiveness of inhaled NO therapy in these patients.In 2004, during the SARS-CoV outbreak in China, the administration of inhaled NO reversed pulmonary hypertension, improved severe hypoxia and shortened the length of ventilatory support as compared to matched control patients with SARS-CoV (2). The mechanism of action was thought to be pulmonary vasodilation and consequent improved oxygenation in the blood of the lungs, thereby killing the virus, which does not do well in a high oxygen environment. In addition, however, I would offer the opinion that the NO also interacts directly with the virus to kill it and/or inhibit its replication, as shown in a prior study (1).Although studies have not yet been reported with COVID-19, NO has been shown to have an antiviral effect on several DNA and RNA virus families (3). The NO-mediated S-nitrosylation of viral molecules might be an intriguing general mechanism for the control of the virus life cycle. In this regard, it is conceivable that NO could nitrosylate cysteine-containing enzymes and proteins, including nucleocapsid proteins and glycoproteins, present in the coronavirus.In view of the knowledge gained by treating SARS-CoV patients with INO, it follows that INO might be effective in patients with the current SARS CoV-2 (COVID-19) infection. Indeed, a clinical trial of inhaled nitric oxide in patients with moderate to severe COVID-19 with pneumonia and under assisted ventilatory support recently received IRB (Institutional Review Board) approval at the Massachusetts General Hospital. Warren Zapol is director of this project. This trial has now been expanded to include at least two additional hospitals in the U.S. In the successful treatment of persistent pulmonary hypertension in newborns, the amount of NO inhaled is generally one ppm (part per million). In the clinical trial using COVID-19 patients, the amount of NO will be approximately 100-fold higher, about 100 ppm. This is a safe dose of INO, which could prove to be effective in killing the virus and allowing recovery of the patient. The effective use of INO would also lessen the need for oxygen, ventilators, and beds in the ICU.One thing I urge everyone to practice during this coronavirus pandemic is to breathe or inhale through your NOSE and exhale through your mouth. Swedish investigators at the Karolinska Institute in Stockholm have shown that the cells and tissues in the nasal sinusoids, but not the mouth, constantly and continuously produce nitric oxide, which is a gas, and can be easily detected in the exhaled breath. The physiological significance of this is that nasally-derived NO, when inhaled through the nose, improves oxygen delivery into the lungs by causing bronchodilation. This physiological action of inhaled NO is well-known by competitive athletes, especially runners. Moreover, when inhaling through the nose, your nasal nitric oxide is inhaled into your lungs where it stands a chance of meeting up with the coronavirus particles and killing them or inhibiting their replication. Inhaling through your mouth will NOT accomplish this. By the same token, exhaling through your nose is highly wasteful in that you would be expelling the NO away from the lungs, where it is needed most.“INHALE THROUGH YOUR NOSE, AND EXHALE THROUGH YOUR MOUTH!”

BACKGROUND AND PURPOSE Targeting AR-DBD is a potential strategy toward the treatment of CRPC, however, rational design of a small molecules targeting AR-DBD is still underdevelopment. EXPERIMENTAL APPROACH MST, ITC and other different assays has been used to confirm the binding of SBF-1 to AR, also CHIP has been used to confirm the blockade of AR binding to its target genes. The associated signaling pathway affected by SBF-1 has been identified by western blotting. Also, mutant AR-LBD and the the AR lacking DBD has led to the identification of the SBF-1 binding location in the AR. KEY RESULTS SBF-1 induced apoptosis and cell cycle arrest in both LNCaP and PC3/AR+ cell lines, also, inhibited the activation of the AR/IGF-1 and IGF1/AKT/FOXO1/PNCA pathways, which evidenced by decreased expression of p-AR, IGF-1, p-AKT, PCNA and Bcl-2. By using multiple methods, we found that SBF-1 could directly bind to AR and block the transcription of its target genes. Moreover, the interaction between SBF-1 and AR-DBD was confirmed, which overcame the re-activation of AR signaling by mutations in the AR-LBD. In the xenograft models of both ARWT and ARmutant prostate cancer, SBF-1 displayed a strong efficacy at very low doses including the inhibition of tumor growth, prolongation of survival time by inhibiting AR signaling. CONCLUSION AND IMPLICATIONS Our study here found a novel identified inhibitor of AR, SBF-1, for the first time, which is different from the current antiandrogens and may serve as a leading compound for the treatment of prostate cancer.

Objectives: To investigate the incidence of single umbilical artery (SUA), malformation, and postpartum outcomes in a retrospective analysis of 781 fetuses with SUA. Methods: A retrospective analysis of 781 pregnant women with singleton fetuses with SUA were diagnosed in the Gansu Provincial Maternal and Child-care Hospital from 2013 to 2019. Detailed data on maternal and fetal characteristics and postpartum outcomes were obtained. Results: A total of 624 (79.9%) fetuses were diagnosed with isolated SUA, whereas 157 (20.1%) fetuses had SUA with other structural and/or chromosomal abnormalities. The highest incidence of malformations was found in the urinary system, followed by the cardiovascular system and the digestive system. The incidence of SUA on the right side was 59.1% and life side was 40.9% respectively. Fetuses with SUA and other abnormalities showed a trend to be small for gestational age (3061 g vs 3201 g, p < 0.01) but not be delivered preterm. Conclusions: After a diagnosis of SUA, structural observation of the fetus is required. The urinary, cardiovascular, and digestive systems should be the focus of observation. If relevant malformations are found, genetic testing must be performed. With isolated SUA, it is recommended to dynamically monitor biological indicators to be alert for SGA, but genetic testing is not recommended.

Aim: Many concerns still existed about the safety of hydroxychloroquine (HCQ) in the treatment of Corona Virus Disease 2019 (COVID-19). The purpose of this study was to evaluate the safety of HCQ by performing a systematic review and meta-analysis. Methods: Randomized controlled trials reporting the safety of HCQ in PubMed, Embase, and Cochrane Library were retrieved from the establishment of the database to February 27, 2020. Literature screening, data extraction, and assessment of risk bias were performed independently by two reviewers. Results: We identified 34 eligible studies that involved 3,639 patients. The difference in the cumulative number of AEs between the HCQ and control group was statistically significant (P<0.0001). The pooled incidence of gastrointestinal AEs, which occurred most frequently in the HCQ group was higher than that in the control group (P<0.0001) according to the system organ class. In addition, the risks of skin and subcutaneous tissue AEs (P = 0.011), renal and urinary disorders (P=0.011), ear and labyrinth AEs (P = 0.045) and surgical and medical procedures AEs (P = 0.020) in HCQ group are also significantly increased compared with the control group. Meanwhile, the cumulative number of SAEs was similar between the two groups (P=0.222). Meta-analysis results indicated that the pooled incidences of all the AEs reported by two or more studies were similar except for the treatment discontinuation caused by AEs (RD 0.02, 95% CI: 0.00 to 0.06). Conclusion: HCQ was well tolerated and might be safe for clinical application under the outbreak of COVID-19.

More than one million patients worldwide have been diagnosed with coronavirus disease 19 (COVID-19) to date (WHO situation report, 8th April 2020). There is neither a vaccine to prevent infection with the causative organism, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), nor a cure. In the struggle to devise potentially useful therapeutics in record time, the repurposing of existing drugs is a key route of action. In this review we argue that the bisbenzylisoquinoline and calcium channel blocker tetrandrine, originally extracted from the plant Stephania tetrandra and utilised in traditional Chinese medicine, could be repurposed to treat COVID-19. We collate and review evidence for tetrandrine’s putative mechanism of action in viral infection, specifically its recently discovered antagonism of the two-pore channel 2 (TPC2). Consideration of its pharmacodynamics and pharmacokinetics suggests that oral tetrandrine at doses currently used in clinical practice could be an effective agent for the treatment of SARS-CoV-2 infection in humans.

Abstract Objective Evaluate Obstetrics and Gynaecology (O&G) trainees’ knowledge in surgical anatomy Designs Prospective cross-sectional study. Setting Departments of O&G in various hospitals Population Trainees in O&G recruited between 1st August to 1 December 2019 Method: Hard copy questionnaire based study. Information regarding demographics such as gender, year of training, attendance at applied anatomy workshop. In addition, perception of surgical anatomy knowledge was recorded. Main outcome measures Perception of surgical anatomy knowledge among trainees Results We recruited 271 trainees, mean age 29.3 years, and 80.1% rated value of medical school course as average or above. In addition, 90.8% never attended anatomy workshop, and 9.6% and 62% of first and fifth year residents respectively rated their knowledge as either good or very good, and 41.7% reported that anatomy demonstrations by senior doctors happened sometimes. Perception of knowledge was statistically significantly more in higher training years, higher perceived value in medical school course, attendance at anatomy lectures, more operating experience, and when senior doctors demonstrate anatomy more often . Conclusion Deficiencies were identified in surgical anatomy knowledge among resident in all years. Factors identified which may improve knowledge include more applied undergraduate anatomy courses, more operating sessions and anatomy workshops, and more senior colleagues’ demonstration of surgical anatomy . Overall knowledge in regards to anatomy needs to be improved for better patient safety. Keywords: obstetrics, gynaecology, surgical anatomy, medical students, resident doctors Tweetable abstract Do Obstetrics and Gynaecology trainees have adequate surgical anatomy knowledge? Funding: No funding was requited for this study

Objective To evaluate the efficacy, safeness and cost of ultrasound-guided local lauromacrogol injection(USG-LLI) combined with curettage and hysteroscopy for cesarean scar pregnancy(CSP) . Design A retrospective analysis. Setting Gynaecological department in 3 hospitals in China. Population Patients with stable cesarean scar pregnancy(CSP) . Main outcome measures Efficacy and cost difference between patients with CSP pretreated by different methods combined with curettage and hysteroscopy. Methods From June 2018 to December 2019 and included 151 CSP patients were diagnosed with CSP, and treated by USG-LLI or uterine artery embolization (UAE) combined with curettage and hysteroscopy. Clinical data and outcome were analysed. Results There were no significant differences in basic clinical characteristics in the two groups. The success rates of the two groups were similar, while the complication rates (5.81%, 24.62%) of USG-LLI group and UAE group were different significantly. The total cost between the two groups and found a statistical difference between the two groups, which was higher in the UAE group (P < 0.05). The non-medication cost and direct medical cost of the UAE group were higher than those in USG-LLI group (P < 0.05) . Conclusions The method of USG-LLI combined curettage and hysteroscopy was minimally invasion and efficiency for CSP, compared with curettage after UAE. USG-LLI resulted in lower complication rate and little expense.

Background: This bibliometric analysis is used to identify publications and highlights the key areas that have significantly shaped modern clinical practice for aortic valve replacement (AVR), which is becoming increasingly relevant. The top 100 most cited manuscripts for AVR were analysed. Method: The Thomson Reuters Web of Science database was searched using the terms ‘aortic valve replacement’, ‘replacement’, ‘aortic valve’ and/or ‘AVR’ for full manuscripts in English Language. The results were ranked by citation number and the top 100 articles were further analysed by subject, author, journal, year of publication, institution and country of origin. Results: 26,782 eligible papers were returned and accumulated 76,680 citations in total, with a mean citation of 767 per manuscript (350-3667). The New England Journal of Medicine accumulated the most citations whereas Circulation published the most papers. Majority of manuscripts examined patients with aortic stenosis, of which half also included aortic regurgitation. The United States of America contributed 51 manuscripts, accumulating 43629 citations. Conclusion: The most cited manuscript, by Leon et al., assessed the outcomes of transcatheter aortic valve implantation in patients with severe aortic stenosis who were unfit for surgical replacement. By providing the most influential references this work serves as a guide to topics of interest in the field of AVR.

We report a case of 41-year-old woman who presented with chest tightness and shortness of breath. Transthoracic echocardiogram (TTE) showed left ventricular (LV) pseudo-aneurysm of the inferior wall with preserved LV systolic function. Coronary angiogram was normal. Surgical repair of the pseudo-aneurysm with a pericardial patch was performed, and pathological results confirmed rupture of an isolated congenital LV diverticulum.as the most likely etiology.

The 2019–20 coronavirus (COVID-19) pandemic was affirmed to have spread to Bangladesh on March 2020. The initial three known cases were accounted for by the nation’s Institute of Epidemiology, Disease Control and Research (IEDCR) on 7 March 2020 [1]. As of 9th April 2020, the Government of Bangladesh has reported that there is a total of 330 confirmed cases, 33 recoveries, and 21 deaths in the whole country [2]. In this research, I try to forecast the COVID-19 outbreak in Bangladesh by using a well-known epidemiological model, Susceptible-Infectious-Recovered (SIR) model.

To develop a screening kit for detecting mutation hotspots of the PAH gene.. We designed and developed a screening kit to detect 9 mutation sites covering more than 50% of the PAH mutations found in Shaanxi province (c.728G>A, c.1197A>T, c.331C>T, c.1068C>A, c.611A>G, c.1238G>C, c.721C>T, c.442-1G>A, and c.158G>A) by using amplification refractory mutation system-polymerase chain reaction (ARMS-PCR) combined with fluorescent probe technology. Peripheral blood and dried blood samples from PKU families were used for clinical verification of the newly developed kit. PAH gene mutations were detected in 84 children diagnosed with PKU. A total of 159 mutant alleles were identified, consisting of 100 missense mutations, 28 shear mutations, 24 nonsense mutations, and 7 deletion mutations. Exon 7 had the highest mutation frequency (32.08%).the mutation frequency of p.R243Q was the highest, accounting for 20.13% of all mutations, followed by p.R111X, IVS4-1G>A, EX6-96A>G, and p.R413P; these 5 loci accounted for 47.17% (75/159) of all mutations. Fifteen mutation sites were identified in the 47 PAH carriers identified by NCS, which were verified by the newly developed kit, with an agreement rate of 100%.This newly developed kit based on ARMS-PCR combined with fluorescent probe technology can be used to detect common PAH gene mutations.