Background: SARS-CoV-2 variation represents a serious challenge to current COVID-19 vaccines. Recent reports suggest that B.1.351 and other variants may escape the neutralization activity of the antibodies generated by current vaccines. Methods: Ninety-nine healthcare workers undertaking BNT162b2 mRNA vaccination were sampled at baseline, on the day of the second dose, and 14 days after the latter. Neutralization activity against SARS-CoV-2 B.1, B.1.1.7 and B.1.351 was investigated using a Vero-E6 model. Results: Eleven of the study participants had prior infection with SARS-CoV-2. Neutralization titers against the B.1 and the B.1.1.7 variants were not statistically different and were significantly higher than titers against the B.1.351 variant across pre-exposed and non-pre-exposed vaccinated individuals ( p<0.01). While all vaccinated individuals presented neutralizing antibodies against B.1 and B 1.1.7 after the second dose, 14% were negative against B.1.351, and 76% had low titers (1/20-1/80). Pre-exposed vaccinated individuals showed higher titers than non-pre-exposed after the first (median titers of 1/387 versus 1/28, respectively) and the second doses (1/995 versus 1/703, respectively). As high as 72% of the pre-exposed vaccinees presented titers >1/80 after a single dose, while only 11% of non-exposed vaccinated individuals had titers >1/80. Conclusions: BNT162b2 mRNA-induced antibodies show a lower in vitro neutralizing activity against B.1.351 variant compared to neutralization against B.1.1.7 or B.1 variants. Interestingly, for individuals pre-exposed to SARS-CoV-2, one dose of BNT162b2 mRNA may be adequate to produce neutralizing antibodies against B.1.1.7 and B.1, while two doses of BNT162b2 mRNA provide optimal neutralizing antibody response against B.1.351 too.

ABSTRACT: Culture is widely accepted as an important social factor present across a wide range of species. Bears have a culture as defined as behavioral traditions inherited though social learning usually from mothers to offspring. Successful bear cultures can enhance fitness and resource exploitation benefits. In contrast, some bear cultures related to response to humans and human-related foods can be maladaptive and result in reduced fitness and direct mortality. In environments with minimal human influence most bear culture has evolved over generations to be beneficial and well adapted to enhance fitness. However, most bears across the world do not live in areas with minimal human influence and in these areas, bear culture is often changed by bear interactions with humans, usually to the detriment of bear survival. We highlight the importance of identifying unique bear cultural traits that allow efficient use of local resources and the value of careful management to preserve these adaptive cultural behaviors. It is also important to select against maladaptive cultural behaviors that are usually related to humans inorder to reduce human-bear conflicts and high bear mortality. We use examples from Yellowstone National Park to demonstrate how long-term management to reduce maladaptive bear cultures related to humans has resulted in healthy bear populations and a low level of human-bear conflict in spite of a high number of Park visitors in close association with bears.

Background and Aim of the Study: Congenital heart disease is the most common congenital defect among infants born in the United States. Within the first year of life, 1 in 4 of these infants will need surgery. Only one generation removed from an overall mortality of 14%, many changes have been introduced into the field. Have these changes measurably improved outcomes? Methods: The literature search was conducted through PubMed MEDLINE and Google Scholar from inception to October 31, 2021. Ultimately, 78 publications were chosen for inclusion. Results: The outcome of overall mortality has experienced continuous improvements in the modern era of the specialty despite the performance of more technically demanding surgeries on patients with complex comorbidities. This modality does not account for case-mix, however. In turn, clinical outcomes have not been consistent from center to center. Furthermore, variation in practice between institutions has also been documented. A recurring theme in the literature is a movement towards standardization and universalization. Examples include mortality risk-stratification that has allowed direct comparison of outcomes between programs and improved definitions of morbidities which provide an enhanced framework for diagnosis and management. Conclusions: Overall mortality is now below 3%, which suggests that more patients are surviving their interventions than in any previous era in congenital cardiac surgery. Focus has transitioned from survival to improving the quality of life in the survivors by decreasing the incidence of morbidity and associated long-term effects. With the transformation towards standardization and interinstitutional collaboration, future advancements are expected.

Background: This study was conducted to evaluate the surgical results of the arterial switch operation for Taussig-Bing variants, at a single institution in a lower-middle income country. Methods: Between June 2010 and December 2018, all consecutive patients diagnosed with Taussig-Bing variants who underwent the arterial switch operation and ventricular septal defect closure were included in the study. Results: A total of 72 patients of Taussig-Bing variants who underwent arterial switch operation and ventricular septal defect closure. There were 10 early deaths (13.9%) and 2 late deaths (2.8%). Intraoperative ventricular septal defect enlargement [hazard ratio (HR) 7.23, 95% confidence interval (CI) 3.1294-16.7167; P < 0.001], secondary aortic cross clamping (HR 28.38, 95% CI 4.8427-166.3484; P < 0.001), post-operative pneumonia (HR 5.64, 95% CI 1.2724-24.9917; P = 0.023), and post-operative sepsis (HR 5.28, 95% CI 1.3512-20.6553; p = 0.017) were risk factors for overall mortality by competing risk analysis. Sixty patients (83.3%) required septoparietal trabeculation division/resection during the arterial switch operation in an attempt to avoid right ventricular outflow tract obstruction. The reoperation rate for right ventricular outflow tract obstruction at last follow up was 6% (3 patients). The estimated freedom from reoperation for right ventricular outflow tract obstruction at 1 year, 5 year and 9 year was 98.3%, 91.9% and 91.9 , respectively. Conclusions: The results of arterial switch operation for Taussig-Bing variants were satisfactory in the operative setting of a lower-middle income country, and performing extensive septoparietal trabeculation division might reduce the reintervention rate for right ventricular outflow tract obstruction in these patients.

Spontaneous rupture of abdominal wall herniaTakanobu Hirosawa1 MD, Taro Shimizu1 MD, PhD, MPH, MBA1. Department of Diagnostic and Generalist Medicine, Dokkyo Medical UniversityAll authors have no conflict of interest and grant to declare.Written informed consent was obtained from the patient to publish this report in accordance with the journal’s patient consent policy.

Introduction: The extravascular ICD (EV ICD) system with substernal lead placement is a novel non-transvenous alternative to current commercially available ICD systems. The EV ICD provides defibrillation and pacing therapies without the potential long-term complications of endovascular lead placement. Methods: This paper summarizes the development of the EV ICD, including the pre-clinical and clinical evaluations that have contributed to system and procedural refinements to date. Results: Extensive pre-clinical research evaluations and 4 human clinical studies with >140 combined acute and chronic implants have enabled the development and refinement of the EV ICD system, currently in worldwide pivotal study. Conclusion: The EV ICD may represent a clinically valuable solution in protecting patients from sudden cardiac death while avoiding the long-term consequences of transvenous hardware. The EV ICD offers advantages over transvenous and subcutaneous systems by avoiding placement in the heart and vasculature; relative to subcutaneous systems, EV ICD requires less energy for defibrillation, enabling a smaller device, and provides pacing features such as anti-tachycardia and asystole pacing in a single system.

Introduction: Drug-drug interaction (DDI) warnings are employed in many institutions when more than one QTc-prolonging medication is prescribed; however, this leads to alert fatigue where alerts are frequently overridden by clinicians due to patient non-specificity or low risk. This study aimed at reducing alert fatigue through developing a custom alert triggered by a patient-specific QTc-prolongation risk score, and validating it against database-driven DDI warnings for QTc prolongation. Methods and Results: Between November 23, 2019 and January 31, 2020, inpatients with a baseline and a follow-up 12-lead ECG reading within 14 days were identified. Each time a QTc-prolonging medication order was signed or verified, the QTc-prolongation risk score was calculated in the electronic health record (EHR), triggering a custom alert in the background. Follow-up 12-lead ECG readings were used to calculate sensitivity and specificity for both the custom alert and the DDI warning. A total of 100 patients had a risk score calculation and were included in our analysis, representing 521 custom alerts and 449 DDI warnings. The preliminary QTc-prolongation risk score did not achieve a reduction in false positive alerts with a cutoff of 10 points. A multiple logistic regression was performed to re-arrange the components and optimize the risk score. Conclusion: Our adjusted QTc-prolongation risk score, with a cutoff of 5 points, achieved a specificity of 66% and a negative predictive value of 83%. These results will allow us to integrate the risk score into the EHR as a guidance tool to predict QTc-prolongation.

Pneumonia is a frequent manifestation of COVID-19 in hospitalized children. Methods The study involved 80 hospitals in the SARS-CoV-2 Spanish Pediatric National Cohort. Participants were children <18 years, hospitalized with SARS-CoV-2 community-acquired pneumonia (CAP). We compared the clinical characteristics of SARS-CoV-2-associated CAP with CAP due to other viral etiologies from 2012 to 2019. Results In total, 151 children with SARS-CoV-2-associated CAP and 138 with other viral CAP included. Main clinical features of SARS-CoV-2-associated CAP were cough 117/151(77%), fever 115/151(76%) and dyspnea 63/151(46%); 22/151(15%) patients were admitted to a pediatric intensive care unit (PICU), and 5/151(3%) patients died. Lymphopenia was found in 63/147(43%) patients. Chest X-ray revealed condensation (64/151[42%]) and other infiltrates (87/151[58%]). Compared with CAP from other viral pathogens, COVID-19 patients were older (8 vs.1 year; odds ratio [OR] 1.42 [95% confidence interval, CI 1.23;1.42]), with lower CRP levels (23 vs.48 mg/L; OR 1 [95%CI 0.99;1]), less wheezing (17 vs.53%; OR 0.18 [95%CI 0.11;0.31]) and greater need of mechanical ventilation, MV (7 vs.0.7%, OR 10.8 [95%CI 1.3;85). Patients with non-SARS-CoV-2-associated CAP had a greater need for oxygen therapy (77 vs.44%, OR 0.24 [95%CI 0.14;0.40]). There were no differences in the use of CPAP or HVF or PICU admission between groups. Conclusion SARS-CoV-2-associated CAP in children presents differently to other virus-associated CAP: children are older and rarely have wheezing or high CRP levels; they need less oxygen but more CPAP or MV. However, several features overlap, and differentiating the etiology may be difficult. The overall prognosis is good.

Introduction: It has been reported that ventricular tachycardia (VT) non-inducibility at the end of ablation is associated with less likely VT recurrence. However, it is not clear whether we should use VT non-inducibility as routine end point in VT ablation. The aim of this study was to evaluate VT recurrence in patients in whom VT non-inducibility could not be achieved at the end of the RF ablation and the factors attributing to the VT recurrence. METHODS and RESULTS: We analyzed 84 consecutive patients that underwent RF ablation, and 64 patients in whom VT non-inducibility could not be achieved were studied. The primary endpoint was recurrence of any sustained VT during the follow-up. During a median follow-up period of 1.4 years (IQR:0.3-2.0), 22 (34%) of the cases had VT recurrences. In the multivariate analysis showed that an LVEF≥35% (HR:0.21; 95% CI:0.07- 0.54; P<0.01) and successful identification and ablation of all clinical VT isthmuses (HR:0.21; 95% CI:0.03- 0.72; P=0.01) were independent predictors of fewer VT recurrences. RF ablation was associated with a 91.1% reduction in VT episodes. CONCLUSION: Even if VT non-inducibility could not be achieved, the patients with LVEF≥35% or in whom all clinical VT isthmuses could successfully be identify and ablated might be prevented from having VT recurrences. The validity of VT non-inducibility of any VT should be evaluated by each patient’s background and the results of the procedure.

Background: The treatment strategies for ovarian clear cell carcinoma (OCCC) are the same as those for epithelial ovarian cancer. Due to the rarity of OCCC, no prospective studies of its surgery have been reported. Therefore, the therapeutic significance of lymphadenectomy for OCCC needs to be further clarified. Objectives: To assess the effectiveness of lymphadenectomy in patients with ovarian clear cell carcinoma by a meta-analysis. Search Strategy: The Web of Science, Scopus, PubMed, and other sources (e.g. Google Scholar) were searched from each database’s earliest inception to June 2021. Selection Criteria: English-language publications of observational studies that investigated the role of lymphadenectomy in patients with OCCC were included. Data Collection and Analysis: The pooled hazard ratio (HR) and 95% confidence interval (CI) were calculated. Main Results: The analysis demonstrated that lymphadenectomy is associated with significantly improved disease-specific survival (DSS) (HR=0.76; 95%CI=0.60-0.95; P=0.02; I2= 0.0%) and disease-free survival (DFS) (HR=0.58; 95%CI=0.33-1.00; P=0.05; I2=61%), but not for overall survival (OS) (HR=0.80; 95%CI=0.60-1.06; P=0.12; I2= 19%) and progression-free survival (PFS) (HR=0.95; 95%CI=0.64-1.42; P=0.79; I2= 0.0%). But it is worth noting that several single studies indicated a tendency of improved OS, PFS, DFS, DSS with lymphadenectomy. Conclusions: Lymphadenectomy could not significantly improve OS and PFS for OCCC, but is associated with improved DFS and DSS. Gynecologic oncologists should tailor treatment to patients to achieve optimal outcomes. And further studies are necessary to validate the impact of lymphadenectomy on OCCC. Keywords: ovarian clear cell carcinoma, lymphadenectomy, survival, systematic review, meta- analysis

Optical artificial neural networks (ONNs) have significant potential for ultra-high computing speed and energy efficiency. We report a novel approach to ONNs that uses integrated Kerr optical micro-combs. This approach is programmable and scalable and is capable of reaching ultra-high speeds. We demonstrate the basic building block ONNs-a single neuron perceptron-by mapping synapses onto 49 wavelengths to achieve an operating speed of 11.9 x 10 9 operations per second, or Giga-OPS, at 8 bits per operation, which equates to 95.2 gigabits/s (Gbps). We test the perceptron on handwritten-digit recognition and cancer-cell detection-achieving over 90% and 85% accuracy, respectively. By scaling the perceptron to a deep learning network using off-the-shelf telecom technology we can achieve high throughput operation for matrix multiplication for real-time massive data processing.

Title: Gradual prolongation of PR interval followed by a pause. What’s the mechanism?

We review theories of polyelectrolyte (PE) coacervation, which is the spontaneous association of oppositely charged units of PEs and phase separation into a polymer-dense phase in aqueous solution. The simplest theories can be divided into “physics-based” and “chemistry-based” approaches. In the former, polyelectrolytes are treated as charged, long-chain, molecules, defined by charge level, chain length, and chain flexibility, but otherwise lacking chemical identity, with electrostatic interactions driving coacervation. The “chemistry-based” approaches focus on the local interactions between the species for which chemical identity is critical, and describe coacervation as the result of competitive local binding interactions of monomers and salts. In this article, we show how these approaches complement each other by presenting recent approaches that take both physical and chemical effects into account. Finally, we suggest future directions towards producing theories that are made quantitatively predictive by accounting for both long range electrostatic and local chemically specific interactions.

Arthropods are recognised as potential mechanical and biological vectors for infectious diseases in outdoor environments. However, a comprehensive understanding of the indoor arthropod community diversity and of the role that their associated microbiota may have as disease vectors is largely unexplored. Here, we study the arthropod community and the associated microbiota diversity of twenty indoor environments, sampled over a period of twelve months from urban and suburban households by citizen scientists in the West Midlands (UK). We compare the arthropods diversity between environments and over the sampling months. We characterize the exogenous (exoskeleton) and endogenous (gut) bacterial communities associated with all specimens of arthropods actively captured using both a traditional culture-based and an unbiased metabarcoding approach. For the first time, we describe the exogenous and endogenous microbiota composition and diversity of 14 arthropod families found in indoor environments. We find that both the exogenous and the endogenous microbiota are potential carriers of human opportunistic pathogens, with potential implications for public health. We discover that many bacteria families are shared across the exogenous microbiota of arthropods, likely influenced by the bacteria present in the environment. Conversely, the endogenous microbiota composition is unique to the arthropod families, and likely genetically determined. We show that the metabarcoding unbiased approach is a superior tool to characterize the microbiota associated with each arthropod family. This study provides new insights into bacterial carriage in household arthropods as potential reservoirs of infectious disease.

In the humid tropics, forest conversion and climate change threaten the hydrological function and stationarity of watersheds, particularly in steep terrain. As climate change intensifies, shifting precipitation patterns and expanding agricultural and pastoral land use may effectively reduce the resilience of headwater catchments. Compounding this problem is the limited long-term monitoring in developing countries for planning in an uncertain future. In this paper, we asked which change, climate or land use, more greatly affects stream discharge in humid tropical mountain watersheds? To answer this question, we used the process-based, spatially distributed Soil Moisture Routing model. After first evaluating model performance (Ns = 0.73), we conducted a global sensitivity analysis to identify the model parameters that most strongly influence simulated watershed discharge. In particular, peak flows are most influenced by input model parameters that represent baseflow and shallow subsurface soil pathways while low flows are most sensitive to antecedent moisture, macropore hydraulic conductivity, soil depth and porosity parameters. We then simulated a range of land use and climate scenarios in three mountain watersheds of central Costa Rica. Our results show that deforestation influences streamflow more than altered precipitation and temperature patterns through changes in first-order hydrologic hillslope processes. However, forest conversion coupled with intensifying precipitation events amplifies hydrological extremes, reducing the hydrological resilience to predicted climate shifts in mountain watersheds of the humid tropics. This finding suggests that reforestation can help mitigate the effects of climate change on streamflow dynamics in the tropics including impacts to water availability, flood pulses, channel geomorphology and aquatic habitat associated with altered flow regimes.

Background: Persistent atrial fibrillation (PsAF) is a complex arrhythmia and achieving a high rate of freedom from recurrence of AF by catheter ablation has been challenging. CARTO® Ripple map has previously been identified as one possible method to improve ablation outcomes. Objective: To evaluate the relationship of AF termination and 18-month freedom from AF with Ripple Frequency measured via a novel CARTO® software algorithm. Methods: PsAF patients who underwent first time ablation were included. PV antral isolation was performed followed by locations with visually identified fast Ripple activations until AF termination. Patients were followed for 18 months. Retrospective analysis was performed using a novel CARTO® software algorithm to analyze Ripple Frequency. The Ripple Frequency algorithm quantifies amplitude changes in the bipolar electrogram over time. Results: 82 maps from 54 patients (mean age 65.4, 67% male) were analyzed. The top quartile of Ripple Frequency corresponded to a visual reference with 96.1% sensitivity and 84.7% specificity. AF terminated during ablation in 90.7% of patients: PV antrum alone (14.8%), or PV plus non-antral sites (85.2%). The top quartile of Ripple frequency was present in non-antral sites associated with AF termination with an 89.6% sensitivity and 87.7% specificity. After 18 months and a mean of 1.2 ablations, 53/54 patients (98.1%) were free of AF and 85.2% were free of any atrial arrhythmia. Conclusion: Automated analysis of CARTO® Ripple Frequency demonstrated good sensitivity and specificity for detecting atrial regions in PsAF where ablation is associated with AF termination and freedom from AF after 18 months.

Respiratory syncytial virus (RSV) hospitalizations disappear in 2020. Now, with winter 2021 completely over in southern hemisphere, RSV has returned. Despite it is difficult to measure the impact of pandemic mitigation measures, it appears that the acute respiratory infections in pediatrics are returning to their usual epidemiology.

Background: While the high burden of illness caused by seasonal influenza in children and the elderly is well-recognized, less is known about the burden in adults 50-64 years of age. The lack of data for this age group is a key challenge in evaluating the cost-effectiveness of vaccination programs. We aimed to assess influenza-associated hospitalization and mortality rates, and case fatality rates for hospitalized cases among adults aged 50-64 years. Methods: This review was conducted according to the PRISMA: we searched MEDLINE, EMBASE, Cochrane, Web of Science, and grey literature for articles and reports published since 2010. Studies reporting rates of hospitalization and/or mortality associated with laboratory-confirmed influenza among adults 50-64 or 45-64 years of age for the 2010-11 through 2019-20 seasons were included. Results: Twenty studies from 13 countries were included. Reported hospitalization rates associated with laboratory-confirmed influenza 5.7 to 112.8 per 100,000. Rates tended to be higher in 2015-2019 compared to 2010-2014, and were higher in studies reporting data from high income versus low and middle-income countries. Mortality rates were reported in only one study, with rates ranging from 0.8-3.5 per 100,000 in four different seasons. The case fatality rate among those hospitalized with influenza, as reported by population-based studies, ranged from 1.3% to 5.6%. Conclusions: Seasonal influenza imposes a significant burden of morbidity in adults 50-64 years of age, but with high heterogeneity across seasons and geographic regions. Ongoing surveillance is required to improve estimates of burden to better inform influenza vaccination and other public health policy.

Background: Human respiratory syncytial virus (HRSV) is a major cause of severe viral acute respiratory illness and contributes significantly to severe pneumonia cases in Africa. Little is known about its spatial-temporal distribution as defined by its genetic diversity. Methods: A retrospective study conducted utilizing archived nasopharyngeal specimens from patients attending outpatient clinics in hospitals located in five demographically and climatically distinct regions of Kenya; Coast, Western, Highlands, Eastern and Nairobi. The viral total RNA was extracted and tested using multiplex real time RT-PCR (reverse transcriptase polymerase chain reaction). A segment of the G-gene was amplified using one-step RT-PCR and sequenced by Sanger di-deoxy method. Bayesian analysis of phylogeny was utilized and subsequently median joining methods for haplotype network reconstruction. Results: Three genotypes of HRSVA were detected; GA5 (14.0%), GA2 (33.1%) and NA1 (52.9%). HRSVA prevalence varied by location from 33% to 13.2% in the Highlands and the Eastern regions respectively. The mean nucleotide diversity (Pi(π)) varied by genotype: highest of 0.018 for GA5 and lowest of 0.005 for NA1. A total of 58 haplotypes were identified (GA5 10; GA2 20; NA1 28). These haplotypes were introduced into the population locally by single haplotypes and additional subsidiary seeds amongst the GA2 and the NA1 haplotypes. Conclusions: HRSVA was found across all the regions throughout the study period and comprised three genotypes; GA5, GA2 and NA1 genotypes. The genotypes were disproportionately distributed across the regions with GA5 gradually increasing towards the Western zones and decreasing towards the Eastern zones of the country.

Background: Data on disease burden of respiratory syncytial virus (RSV) associated acute lower respiratory infection (ALRI) among young children are limited in China. This study aimed to estimate the hospitalization rate of RSV-associated ALRI (RSV-ALRI) among children aged 0~59 months in Suzhou, China. Methods: We retrospectively identified all hospitalized ALRI children aged 0~59 months in Suzhou University Affiliated Children’s Hospital during January 2010 to December 2014. Detailed diagnosis and treatment data were collected by individual medical chart review. Referring to WHO influenza disease burden estimation method, we estimated the hospitalization rate of RSV-ALRI among children aged 0~59 months in Suzhou, China. Results: Among 28,209 ALRI cases, 19,317 (68.5%) were tested for RSV and the RSV positive proportion was 21.3% (4,107/19,317). The average hospitalization rate of RSV-ALRI for children aged 0~59 months was 14 (95% confidence interval [CI]:14~14)/1,000 children-years, for children aged 0~5, 6~11, 12~23, and 24~59 months were 70 (95%CI: 67~73), 31 (95%CI: 29~33), 11 (95%CI: 10~12), and 3 (95%CI: 3~3) /1,000 children-years, respectively. Conclusion: There is considerable RSV-ALRI hospitalization among children aged 0~59 months, particularly among children aged <1 years. An effective monoclonal antibody or vaccine is urgently needed to address the substantial hospitalization burden owing to RSV infection. Key words: Respiratory syncytial virus, Hospitalization rate, Acute lower respiratory infection, Children, China

This case is about a child who had a ventriculoperitoneal shunt due to a hydrocephalus related to a cystic craniopharyngioma. Postoperative, he presented abdominal distension and meningismus. Imaging showed regression of the tumor. The cyst was drained by the shunt. No previous similar situations was reported in the literature.

In this work the boundaries of small-scale yielding (SSY) and large-scale yielding (LSY) have been experimentally evaluated from the analysis of crack tip opening displacement (CTOD) measured by Digital Image Correlation (DIC). The approach published in a previous numerical work [18] has been used to define the boundaries of SSY and LSY. According to this approach, CTOD must be resolved into its elastic and plastic components, analysing the ratio between the elastic CTOD range and the total CTOD range ( Δδe/ Δδt) to define the boundary where SSY conditions can be established. Three materials have been studied, commercially pure titanium and 2024-T3 and 7050-T6 aluminium alloys, tested at different stress ratio values (0.1 and 0.6 for titanium, and 0.1, 0.3 and 0.5 for the aluminium alloys). SSY conditions are shown to dominate when Δδe/ Δδt≥79% and ≥78% for titanium and the two aluminium alloys, respectively. In addition, LSY can be established when Δδe/ Δδt≤66.3% and ≤67.2% for titanium and for 2024-T3 and 7050-T6 aluminum alloys, respectively. Transition or LSY conditions are more probable in fatigue tests conducted at low R-ratio than in tests at high R-ratio. In addition, crack lengths above 40% with respect to the width of the specimen promote transition or LSY conditions. The results obtained in this work can assist to a better understanding of the mechanisms driving fatigue crack growth.

Primary oral mucosal melanoma is a rare disease. Etiopathogenesis of oral mucosal melanoma (OMM) is inadequately understood. The prognosis of OMM is very poor . Due to its low incidence and late recognition, the optimal treatment modality is not well established. Surgery with free margins is the mainstay of treatment.

Ossification of stylohyoid chain corresponds to the ossification of stylohyoid ligament that can vary from thin short to thick long ossification and can be associated with other calcifications. We report in this case a bilateral non painful complete ossification of the stylohyoid complex extended to the thyrohyoidien ligament.