Objectives: Drainless parotidectomy has been reported infrequently, mostly in patients undergoing limited partial parotidectomies. Evicel is a fibrin sealant (FS) glue whose use has not been reported in head and neck surgeries so far. The aim of the study was to investigate the impact of drainless parotidectomy using FS on the surgical outcome. Design: A retrospective matched case-control series. Settings: A single academic center, Participants: All cases of patients who underwent drainless parotidectomies, including deep lobe tumors and revision surgeries, were compared to age, sex, body mass index and tumor-matched controls in which a suction drain was inserted. Main outcome measures: length of hospital stay (LOS). Secondary outcomes included post-operative seroma and related complications. Results: A total of 123 patients (41 cases and 82 controls) were included in the study. Pre-operative and intra-operative characteristic did not differ significantly between the FS group and controls. A borderline significance was found for surgery type as the FS group had higher rates of total parotidectomy compared with the control group (25.0% vs. 10.5%, p=0.054). LOS was significantly shorter in the FS group (1.0±0.3 vs. 1.5±0.6 days, p<0.001). The rates of post-operative seroma, aspirations, local infection and post-operative antibiotic treatment were all lower in the FS group compared with the control group, but did not reach statistical significance. Conclusion: A drainless parotidectomy using the EVICEL FS is safe, reduces LOS, and may reduce post-operative seroma and its associated complications. This procedure may be applied to deep parotid tumors, parapharyngeal involvement and revision surgery.

ABSTRACT Objectives Anecdotal evidence suggests that oropharyngeal squamous cell carcinoma (OPSCC) should be suspected in patients presenting with symptoms of peritonsillar abscess (PTA) or cellulitis (PTC). The aim of this study was to estimate the prevalence of OPSCC in patients presenting with symptoms of PTA/PTC. Method, Setting and Participants We retrospectively identified all adults with a coded diagnosis of PTA or PTC who presented between 2012-2016 inclusive, across six ENT units in ——–. Records were compared to that of the centralised regional head and neck cancer database. The clinical records of a subset of patients were reviewed for the purposes of data validation. Results A total of 1975 patients with PTA/PTC were identified. Three patients were subsequently diagnosed with OPSCC. None of the three actually had an objective underlying diagnosis of PTA/PTC on the same side. The prevalence of OPSCC in patients admitted with symptoms of PTA/PTC was 0.15%, or approximately 1:650 admissions. The records of 510 patients who presented over a one-year period (2016) were reviewed in even greater detail. There were 298 patients with PTA (59.4%), 151 with PTC (29.1%) and 61 had an alternative diagnosis (11.9%). High risk features (age ≥40, tonsillar asymmetry or tonsillar lesion) were present in 106 patients (24%). Urgent follow up was expedited for 77 patients (73%). Conclusion This study estimates the risk of OPSCC in patients with peritonsillar symptoms. The prevalence is low, even in a region with a relatively heavy disease burden. Clinicians should, however, retain a high level of suspicion in patients with persistent symptoms.

Background and purpose: To investigate the role of bromodomain-containing protein 4 (Brd4) in regulating B cell differentiation and its therapeutic potential for B cell-mediated autoimmune diseases such as systemic lupus erythematosus (SLE). Experimental Approach: Human and murine B cells were purified and cultured with different stimuli. B cell surface markers, proliferation and apoptosis were estimated by flow cytometry. Gene expression was measured by quantitative real-time PCR. Brd4 binding sites were analysed by the luciferase reporter assay and the chromatin immunoprecipitation (ChIP) assay. PFI-1 or JQ1 was used to inhibit Brd4. Mice with B cell-specific deletion of the Brd4 gene (Brd4flox/floxCD19-Cre+/-) and MRL/lpr mice were used to perform the in vivo experiments. Key Results: Brd4 inhibition suppressed plasmablast-mediated plasma cell differentiation but did not influence proliferation or apoptosis in healthy human and murine CD19+ B cells. PFI-1 treatment reduced the secretion of IgG and IgM in the supernatants of costimulation-induced B cells. Mechanistically, Brd4 regulates the terminal differentiation of B cells into plasma cells by targeting BLIMP1 by directly binding and activating the endogenous BLIMP1 promoter. Interestingly, PFI-1 treatment decreased the percentages of plasmablasts and plasma cells from patients with SLE. PFI-1 administration reduced the percentages of plasma cells, hypergammaglobulinemia and attenuated nephritis in MRL/lpr mice. Pristane-injected Brd4flox/floxCD19-Cre+/- mice exhibited improved nephritis and reduced percentages of plasma cells. Conclusions and Implications: Brd4 is an essential factor in regulating plasma cell differentiation. Brd4 inhibition may be a potential new strategy for the treatment of B cell-associated autoimmune disorders, including SLE.

The novel coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) still has serious negative effects on health, social life, and economics. Recently, vaccines from various companies have been urgently approved to control SARS-CoV-2 infections. However, any specific antiviral drug has not been confirmed so far for regular treatment. An important target is the main protease (Mpro), which plays a major role in replication of the virus. In this study, Gaussian and residue network models are employed to reveal two distinct potential allosteric sites on Mpro that can be evaluated as drug targets besides the active site. Then, FDA-approved drugs are docked to three distinct sites with flexible docking using AutoDock Vina to identify potential drug candidates. 14 best molecule hits for the active site of Mpro are determined. 6 of these also exhibit high docking scores for the potential allosteric regions. Full-atom molecular dynamics simulations with MM-GBSA method indicate that compounds docked to active and potential allosteric sites form stable interactions with high binding free energy (∆Gbind) values. ∆Gbind values reach -52.06 kcal/mol for the active site, -51.08 kcal/mol for the potential allosteric site 1, and -42.93 kcal/mol for the potential allosteric site 2. Energy decomposition calculations per residue elucidate key binding residues stabilizing the ligands that can further serve to design pharmacophores. This systematic and efficient computational analysis successfully determines ivermectine, diosmin and selinexor currently subjected to clinical trials, and further proposes bromocriptine, elbasvir as Mpro inhibitor candidates to be evaluated against SARS-CoV-2 infection

Long-term, individual-level records are of great importance in biological sciences. By understanding how individuals contribute to their populations during representative temporal scales, we can answer pressing questions in ecology, evolution, and conservation biology. These questions include identifying which, how, and where species’ populations will go extinct or become invasive. Calls for the collection, curation, and release of these kinds of ecological data have contributed to the open data revolution in ecology. Birds, particularly, have been the focus of much citizen science and international research for decades, resulting in a number of uniquely longterm studies. However, accessing some of these individual-based, long-term datasets can be challenging. Culina et al. (2021) introduce an online repository of individual level, long-term bird records with ancillary data (e.g. genetics). Similar efforts have also been undertaken for mammals, fish, and even more recently for corals and insects. By releasing these ecological data open-access, the research community is starting to fill “Noah’s ecological ark”. However, important challenges still lay ahead to address the most pressing research questions. Here, I briefly overview the open access landscape of long-term animal ecological studies, provide suggestions for how to most efficiently expedite our knowledge of long-term animal population dynamics, and highlight four key challenges in the use (and misuse) of these large volumes of animal ecological data.

A psychological assessment using biofeedback was performed for an adjustment disorder inpatient who showed less verbal and non-verbal expressions, and experienced difficulty in receiving favorable results from treatment. The assessment revealed hidden problems behind the symptoms. She was subsequently discharged, after which no clinical intervention was required, including medication.

1. The use of machine learning technologies to process large quantities of remotely-collected audio data is a powerful emerging research tool in ecology and conservation. 2. We applied these methods to a field study of tinamou (Tinamidae) biology in Madre de Dios, Peru, a region expected to have high levels of interspecies competition and niche partitioning as a result of high tinamou alpha diversity. We used autonomous recording units to gather environmental audio over a period of several months at lowland rainforest sites in the Los Amigos Conservation Concession and developed a Convolutional Neural Network-based data processing pipeline to detect tinamou vocalizations in the dataset. 3. The classified acoustic event data are comparable to similar metrics derived from an ongoing camera trapping survey at the same site, and it should be possible to combine the two datasets for future explorations of the target species’ niche space parameters. 4. Here we provide an overview of the methodology used in the data collection and processing pipeline, offer general suggestions for processing large amounts of environmental audio data, and demonstrate how data collected in this manner can be used to answer questions about bird biology.

Community composition is a primary determinant of how biodiversity change influences ecosystem functioning and, therefore, the relationship between biodiversity and ecosystem functioning (BEF). We examine the consequences of community composition across six structurally realistic plant community models. We find that a positive correlation between species’ functioning in monoculture vs. their dominance in mixture with regards to a specific function (the “function-dominance correlation”) generates a positive relationship between realized diversity and ecosystem functioning across species richness treatments. However, because realised diversity declines when few species dominate, a positive function-dominance correlation generates a negative relationship between realized diversity and ecosystem functioning within species richness treatments. Removing seed inflow strengthens the link between the function-dominance correlation and BEF relationships across species richness treatments but weakens it within them. These results suggest that changes in species’ identities in a local species pool may more strongly affect ecosystem functioning than changes in species richness.

Background: During the process of generating diverse T and B cell receptor (TCR and BCR, respectively) repertoires, double strand DNA breaks are produced. Subsequently, these breaks are corrected by a complexed system led mainly by the non-homologous end-joining (NHEJ). Mutations in proteins involved in this process, including the XLF/ Cernunnos gene, cause severe combined immunodeficiency syndrome (SCID) along with neurodevelopmental disease and susseptability to inoizing radiation. Objective: To provide new clinical and immunological insights on XLF/Cernunnos deficiency, arising from a newly diagnosed patient with severe immunodeficiency. Methods: A male infant, born to consanguineous parents, suspected of having primary immunodeficiency underwent immunological and genetic work up. This included a thorough assessment of T cell phenotyping and lymphocyte activation by mitogen stimulation tests, whole exome sequencing (WES), TCR repertoire Vβ repertoire via flow cytometry analysis and TCR and BCR via next generation sequencing (NGS). Results: Clinical findings included microcephaly, recurrent bacterial viral pneumonia and failure to thrive. Immune workup revealed lymphopenia, reduced T cell function and hypogammaglubolinemia. A skewed TCR Vβ repertoire, TCR gamma (TRG) repertoire and BCR repertoire were determined in the patient. Genetic analysis identified a novel autosomal recessive homozygous missense mutation in XLF/Cernunnos c. A580Ins.T; p. M194fs. The patient underwent a successful hematopoietic stem cell transplantation (HSCT). Conclusions: A novel XLF/Cernunnos mutation is reported in a patient presented with SCID phenotype that displayed clonally expanded T and B cells. An adjusted HSCT was safe to ensure full T cell immune reconstitution.

Luminescence, a physical phenomenon that producing cool light in vivo, has been found in bacteria, fungi and anminals but not yet in terrestrial higher plants. Through genetic engineering, it is feasible to introduce luminescence system into living plant cells as biomarkers. Recently, some plants transformed with luminescent systems can glimmer in darkness, which can be observed by our naked eyes and provide a novel lighting resource. In this review, we summarized the development of luminescence in plant cells, followed by exampling the successful cases of glowing plants transformed with diverse luminescent systems. The potential key factors to optimize a glowing plant are also discussed. Our review is useful for the creation of the optimized glowing plants, which can be used not only in scientific research, but also as promising substitutes of artificial light sources in the future.

Aim: We aimed to compare pre-voiding bladder and post-voiding residual (BV, PVR) volumes measured by portable ultrasonic scanner (PUS) in standing and supine positions. Material and Methods: A total of 436 children were included. We composed 2 groups (group-1: PUS vs. volume by catheter, group-2: PUS vs. infused volume during urodynamic study) to evaluate the agreement of PUS measurements with actual bladder volume and then third group (group-3) to analyze the correlation of PUS measurements in standing vs. supine positions. In groups 1 and 2, agreement of measurements were evaluated by paired sample T or Wilcoxon signed rank tests. Following confirmation of agreement, correlations were analyzed by Pearson’s or Spearman’s coefficients in all groups. Interpretation of coefficients were done as 0.90-1.00 (very high correlation) and 0.70-0.90 (high correlation), respectively. Results: In group-1, measurements (catheter vs. PUS) were similar (Wilcoxon Signed rank test, p= 0.976) and were highly correlated (r=0.873). In group-2, measurements of bladder volumes infused by urodynamic device and volumes by PUS were similar that revealed the agreement of PUS measurements on different volumes and highly correlated at the 25th and very highly correlated at the 50th, 75th and 100th percentiles of the EBC (estimated bladder capacity related to age). In group-3, BV and PVR measurements by PUS in standing and supine positions were highly correlated that revelaed PUS can be used in both positions. Conclusion: Measurements of BV before uroflowmetry or PVR volume by PUS in standing position gave similar results with those in supine position.

OBJECTIVE To assess the impact of the surgical delay for localized prostate cancer (PCa) on adverse pathological features and oncological outcomes. MATERIALS AND METHODS Patients who underwent surgery for localized prostate cancer were included from the Turkish Urooncology Association (TUA) Prostate Cancer database. A History of previous treatment or active surveillance (AS) were considered as exclusion criteria from the study. Patients were divided into two groups according the time period between the diagnosis and surgery; less than or equal to 90 days (group 1) or longer than 90 days (group 2). Surgical pathology results and oncological outcomes were compared between the two groups. RESULTS A total of 2454 out of 3646 patients were assessed. Pathological findings of the radical prostatectomy (RP) specimens were similar between two groups. However, there was slightly more seminal vesicle invasion in final surgical pathology in group 1 (12.9% vs. 9.3%, respectively p=0.042). 5-year biochemical recurrence free survival times were similar across all D’Amico risk categories between two groups. The regression analysis demonstrated the seminal vesicle invasion as the only factor affecting time to PSA progression in high-risk patients (p<0.001 HR:2.51 CI: 1,58-4,45). CONCLUSION In conclusion, our results in this large cohort suggest that surgical delay does not cause a deterioration for prostate cancer surgical outcomes even in high-risk group of patients. These findings may be helpful for planning the limited healthcare resources especially in conditions like the Covid-19 pandemic where the availability and optimal use of healthcare system resources is crucial.

Metabarcoding is an important tool for understanding fungal communities. The internal transcribed spacer (ITS) rDNA is the accepted fungal barcode but has known problems. The large subunit (LSU) rDNA has also been used to investigate fungal communities but available LSU metabarcoding primers were mostly designed to target Dikarya (Ascomycota + Basidiomycota) with little attention to early diverging fungi (EDF). However, evidence from multiple studies suggests that EDF comprise a large portion of unknown diversity in community sampling. Here we investigate how DNA marker choice and methodological biases impact recovery of EDF from environmental samples. We focused on one EDF lineage, Zoopagomycota, as an example. We evaluated three primer sets (ITS1F/ITS2, LROR/LR3, and LR3 paired with new primer LR22F) to amplify and sequence a Zoopagomycota mock community and a set of 146 environmental samples with Illumina MiSeq. We compared two taxonomy assignment methods and created an LSU reference database compatible with AMPtk software. The two taxonomy assignment methods recovered strikingly different communities of fungi and EDF. Target fragment length variation exacerbated PCR amplification biases and influenced downstream taxonomic assignments, but this effect was greater for EDF than Dikarya. To improve identification of LSU amplicons we performed phylogenetic reconstruction and illustrate the advantages of this critical tool for investigating identified and unidentified sequences. Our results suggest much of the EDF community may be missed or misidentified with “standard” metabarcoding approaches and modified techniques are needed to understand the role of these taxa in a broader ecological context.

A popular measure of differentiation in biodiversity is the Bray Curtis index of dissimilarity. It has recently also been proposed for use in molecular ecology. However, this measure currently cannot be predicted under specified conditions of population size, dispersal and speciation or mutation. Here I show forecasts for Bray-Curtis for two-variant systems such as single-nucleotide polymorphisms (SNPs) (or two species ecosystems). These are derived from well-known equations in population genetics, for forecasting measures such as G_ST, and shown to be appropriate by simulation. Thus, Bray-Curtis can now be used for assessment of differentiation, in order to understand natural or artificial processes, thus complementing other measures with different sensitivities, such as Morisita-Horn/D_EST, G_ST and Shannon Mutual Information/Shannon Differentiation.

Although infrequent, drug-induced agranulocytosis can be stimulated by antibiotics. Here, we analyzed the Japanese Adverse Drug Event Report database to identify profiles of antibiotic-induced agranulocytosis. Ten of 60 antibiotics showed signals for agranulocytosis; the reporting odds ratios (95% confidence intervals) for ampicillin/sulbactam, amikacin, cefmetazole, cefozopran, clindamycin, ciprofloxacin, imipenem/cilastatin, kanamycin, teicoplanin, and vancomycin were 2.65 (1.79–3.80), 2.49 (1.91–4.34), 4.48 (2.27–6.92), 2.77 (1.88–3.95), 1.64 (1.04–2.47), 2.01 (1.40–2.82), 2.78 (2.11–3.60), 6.05 (2.16–13.7), 2.05 (1.31–3.07), and 3.54 (2.73–4.54), respectively. The median times-to-onset of agranulocytosis for ampicillin/sulbactam, cefmetazole, cefozopran, clindamycin, imipenem/cilastatin, kanamycin, teicoplanin, and vancomycin were 20, 6, 10, 16, 12, 3, 18, and 13 days, respectively. The 95% confidence intervals of the Weibull shape parameter β for these antibiotics were over and excluded 1, indicating that the antibiotics were the wear out failure type. These findings provided insights into the characteristics of antibiotic-induced agranulocytosis.

Livestock industry supports the livelihood of around 1.3 billion people in the world, with swine industry contributing with 30 % of total livestock production worldwide. To maintain and guarantee this production, a pivotal point according to the OIE is addressing potential biohazards. To control them, permanent sero-surveillance is crucial to achieve more focused veterinary public health intervention and prevention strategies, to break the chains of transmission, and to enable fast responses against outbreaks. Within this context, multiplex assays are powerful tools with the potential to simplify surveillance programs, since they reduce time, labour, and variability within analysis. In the present work, we developed a multiplex bead-based assay for the detection of specific antibodies to six relevant pathogens affecting swine: ASFV, CSFV, PRRSV, SIV, TB, and HEV. The most immunogenic target antigen of each pathogen was selected as the target protein to coat different microsphere regions in order to develop this multiplex assay. A total of 1544 serum samples from experimental infections as well as field samples were included in the analysis. The 6plex assay exhibited credible diagnostic parameters with sensitivities ranging from 87.0 % to 97.5 % and specificities ranging from 87.9 % to 100.0 %, demonstrating it to be a potential high throughput tool for surveillance of infectious diseases in swine.

Migration is often thought to be driven by poor environmental conditions during one season and to permit avoidance of harsh weather or resource shortage and tracking of more favourable conditions. Here, we tested this hypothesis in seabirds at the global scale by quantifying niche occupancy during the breeding and non-breeding periods over multiple marine ecoregions and exploring whether the niche dynamics reflects changes in environmental conditions at the breeding and non-breeding grounds. We demonstrate that migratory species exhibit more divergent seasonal niches than resident and dispersive ones. In most cases, migratory status was not related to unavailability of favourable conditions at the breeding or non-breeding grounds, suggesting that niche availability is not the main driver of migration. We hypothesize that this unexpected pattern might arise from strong constraints imposed on seabirds by scarcity of suitable sites breeding which constrain the range of environments available for optimizing reproductive success.

Monogenean infection of the internal organs is extremely rare when compared to external infections. This study describes mass mortality of Nile tilapia (Oreochromis niloticus L.) originating from co-infection with Enterogyrus spp. and Aeromonas jandaei following transport stress. The first fish deaths occurred on day 1 post-transport, while cumulative mortality reached approximately 90% by day 10 post-stocking. An atypical amount of pale (whitish) faeces floating on the surface of the water as well as typical clinical signs of motile Aeromonas septicemia, were reported. Adult monogeneans and countless eggs of monogeneans were found in the stomachs and the intestines of both moribund and dead fish, respectively. Two strains of A. jandaei were isolated from the kidneys. Scanning electron microscope microphotographs of the stomach revealed the presence of numerous monogeneans penetrating deep into the gastric tissue, and diffuse lesions filled with bacilliform bacteria. This is the first report of co-infection by Enterogyrus spp. and A. jandaei in Nile tilapia and the first report of E. coronatus, E. foratus, and E. malbergi parasitizing tilapia in Brazil. These findings indicate that synergic co-infection by Monogenean stomach parasites (E. coronatus, E. foratus, and E. malbergi) and A. jandaei may induce high mortalities in tilapia following transport stress.

Phylogenetic trees have been extensively used in community ecology. However, how the phylogenetic reconstruction affects ecological inferences is poorly understood. In this study, we reconstructed three different types of phylogenetic trees (a synthetic-tree generated using VPhylomaker, a barcode-tree generated using rbcL+matK+trnH-psbA and a genome-tree generated from plastid genomes) that represented an increasing level of phylogenetic resolution among 580 woody plant species from six dynamic plots in subtropical evergreen broadleaved forests of China. We then evaluated the performance of each phylogeny in estimations of community phylogenetic structure, turnover and phylogenetic signal in functional traits. As expected, the genome-tree was most resolved and most supported for relationships among species. For local phylogenetic structure, the three trees showed consistent results with Faith’s PD and MPD; however, only the synthetic-tree produced significant clustering patterns using MNTD for some plots. For phylogenetic turnover, contrasting results between the molecular trees and the synthetic-tree occurred only with nearest neighbor distance. The barcode-tree agreed more with the genome-tree than the synthetic-tree for both phylogenetic structure and turnover. For functional traits, both the barcode-tree and genome-tree detected phylogenetic signal in maximum height, but only the genome-tree detected signal in leaf width. This is the first study that uses plastid genomes in large-scale community phylogenetics. Our results highlight the outperformance of genome-trees over barcode-trees and synthetic-trees for the analyses studied here. Our results also point to the possibility of Type I and II errors in estimation of phylogenetic structure and turnover and detection of phylogenetic signal when using synthetic-trees.

Abstract Objective Surgery is the main treatment of visual loss related to cataracts. There are multiple intraocular lens (IOL) options with certain advantages. Patient education on IOL types is necessary to achieve a successful shared decision making process and meet the expectations of the individual patient. Decision aids (DAs) are used for patient education and we developed a novel DA to assist patients during IOL type selection for their cataract surgery. Methods The Ottawa Personal Decision Guide and the ‘Workbook on Developing and Evaluating Patient Decision Aids’ were used in the development of this DA. General characteristics of cataracts, surgical treatment, and details including advantages and disadvantages of varying IOLs were included in the content of the DA. The DA was further evaluated by 3 physicians (Delphi assessment- International Patient Decision Aid Standards (IPDAS) Collaboration standards) and 25 patients (questionnaire of 6 questions with Five-point Likert scale). Results The DA was finalized with feedbacks from the experts. A total score of 50/54 was achieved in Delphi group assessment. Patient perception of the DA was favorable and patients also recommended its use by other patients. Conclusions This novel DA to assist IOL selection for cataract surgery was well accepted by the patients. There is a potential to improve patients’ level of knowledge and diminish decisional conflicts. This potential can also increase patients’ contribution on the shared decision making process. A further prospective randomized trial to compare with the standard patient informing process is also planned.

Background: The aim of this study is to evaluate the importance of ischemia changed albumin, in foreseeing fetal asphyxia and comparing it between normal and preeclamptic pregnant. Method: We planned our study as a prospective case-controlled study between May 2011 and June 2013. We recruited 104 pregnant women complicated by preeclampsia and 110 healthy pregnant women in the study. Doppler ultrasonography, non-stress test and fetal biometric measurements were performed. Venous blood samples taken to measure ischemia modified albumin (IMA). The presence of fetal hypoxia/acidosis was analyzed by conducting post-natal cord blood gas examination and 1.-5. minutes APGAR scoring. Results: IMA levels in the preeclamptic group were found statistically high (p<0,0001). The correlations between umbilical artery doppler systolic/diastolic (S/D) ratio, brain sparing effect, non stress test and IMA analyzed. We have found IMA statistically high when S/D ratio is above 2 standard deviations (preeclampsia; 11.83±1.33 vs 19.62±1.56 p<0.001, control; 10.28±1.57 vs 18.09±2.13 p<0.001) or brain sparing effect started (preeclampsia; 25.59±2.48 vs 9.16±1.99 p<0.001, control; 16.37±1.97 vs 6.72± 1.53 p<0.001) or abnormal NST findings occurred (preeclampsia; 10.69±1.92 vs 20.72±1.15 p<0.001, control; 7,42±1,94 vs 9,72±2,19 p<0.001). Conclusions: Maternal IMA levels are found high in preeclamptic pregnant women and it can be used as a biomarker for determining fetal wellbeing. What’s already known about this topic? Hypertensive disease of pregnancy is the most frequently complication of pregnancy, being 5-10%. It is the most important reason for perinatal morbidity and mortality. Preeclampsia develops in an abnormal hypoxic intrauterine environment characterized by reperfusion and oxidative stress. To determine the fetal wellbeing, various tests were suggested, yet many of them provided a few benefits. What does this article add? The detected elevations in serum concentrations of IMA propose that measurements of this biomarker may be useful in assessing fetal hypoxia and predicting pregnancies which preeclampsia may develop

Double chambered left ventricle is an exceedingly rare congenital anomaly. We report a case diagnosed prenatally at 24 weeks of gestation and its postnatal evolution to left ventricular dysfunction.

Pseudoaneurysms of the aorta are rare complications of cardiac surgery, and sternal re-entry to address the pathology is particularly challenging. In this case, we describe a rare presentation of thoracic aortic pseudoaneurysm due to chronic erosion from a sternal wire, 10 years following the index operation. The patient was treated in two-stages, including carotid-subclavian bypass, followed by sternal re-entry with total arch replacement and frozen elephant trunk, employing cardiopulmonary bypass via femoral and axillary cannulation. Despite the high risks of rupture/haemorrhage associated with sternal re-entry, operative success for aortic pseudoaneurysms can be achieved with careful planning and safe bypass strategies.

Clinical Images: