Background: Takotsubo Syndrome (TTS) is characterized by acute and reversible left ventricular dysfunction with apical ballooning arising during acute stress situations. Acute Ischemic Stroke (AIS) is one of the known triggers to TTS, however, the impact of TTS on in-hospital outcomes of AIS remains unexplored. Methods: We utilized data from the National Inpatient Sample (2007-2014) and using ICD-9-CM diagnosis codes to identify admissions for AIS with TTS and evaluated the temporal trends, baseline characteristics, in-hospital complications, length of stay (LOS) and all-cause mortality. Survey multivariable logistic regression was used to compute adjusted Odds Ratios (OR and 95% confidence intervals (CI). Results: An estimated 2,242 (0.4%) TTS cases were identified among AIS hospitalizations (N=43,92,471). The frequency of TTS was higher in elderly, whites and females (82.2%). After adjustment for confounders, TTS incidence in AIS was associated with higher odds of in-hospital complications including cardiogenic shock (OR8.84, CI:4.07-19.17, p<0.001), cardiac arrest (OR3.17, CI:1.57-6.42, p=0.001), and venous thromboembolism (OR1.68, CI:1.14-2.47, p=0.008). Moreover, AIS hospitalizations with TTS showed higher odds of developing respiratory failure (OR3.13, CI:2.42-4.05, p<0.001) and required mechanical ventilation/intubation (OR4.09, CI:3.14-5.32, p<0.001) more frequently compared to non-TTS cohort. The AIS-TTS cohort had longer LOS (8.59 vs 5.22 days) and the mortality was doubled (10.2% vs 5.1% p<0.001) compared to those without TTS. Conclusion: The prevalence of TTS in AIS remained ~20 times higher than the general inpatient population and it predisposed AIS patients to worse inpatient outcomes. Further studies are needed to evaluate the impact of TTS on long-term outcomes in AIS.

Food-and-mouth disease (FMD) is endemic in Cambodia. The control program for FMD has relied on vaccination, with poor vaccination uptake by smallholder farmers an increasing concern. A study to improve the understanding of farmer knowledge, attitudes and practices of FMD and FMD vaccination was conducted in two Cambodian provinces. The aim was to identify opportunities to improve the disease control programs provided by both the government and private sectors. The survey comprised 300 smallholder farmers using a one-on-one interview technique. Results identified that over two-thirds of the respondent farmers had not vaccinated their cattle over two years. Of those who did, most cattle were vaccinated either once a year or once every three years. A booster had never been administered. FMD outbreaks occurred every year during the study period, with a morbidity rate of over 30%. Isolation of first infected cattle from the household herd was not practiced, with treatment identified as the first preference intervention. Farmers often assisted other farmers to restrain and treat infected cattle both before (57%) and after (43%) their own cattle were infected. This indicated that most farmers did not practice basic biosecurity measures and chose to report FMD outbreaks to the village animal health workers (VAHW), friends, neighbors, and relatives in preference to government officials. It was concluded that poor knowledge of disease transmission and biosecurity, with low FMD vaccination coverage and a focus on treatment, contribute to regular FMD outbreaks in these communities. Improvement of FMD control requires the cooperation of villagers, VAHWs, and village leaders in disease reporting, with either improved funding of government vaccination services or private FMD vaccination service. Training programs for farmers on disease transmission, and the importance of biosecurity and vaccination, including information on the cost-benefits of treatment versus full fee bi-annual FMD vaccination, are required.

Objective: This study aimed to assess the possible role of dermoscopy in the diagnosis of different nail disorders compared with the clinical and histopathological diagnosis. Methods: This study included 104 patients with any nail disorders of both sex and any age. All the patients were subjected to a detailed medical history taken, clinical general examination, clinical and dermoscopic examinations of 20 nails. Potassium hydroxide examination was used to examine all patients with suspicious of onychomycosis. Histopathological evaluation was used to examine of clinically ambiguous nail disorders. Results: The most common nail diseases were onychomycosis (54.81%) followed by nail psoriasis (19.2%), and nail lichen planus (3.8%). Conclusion: Clinical evaluation was an important in diagnosis of different nail diseases. Nail dermoscopy could confirm clinical diagnosis and help in getting an accurate diagnosis of nail diseases and guide in the management of nail diseases by permitting better visualization of nail structure and pathology. Histopathological examination provided the most definitive method in reaching an accurate diagnosis due to it could provide etiologic, diagnostic, and prognostic information. There was good agreement between clinical, dermoscopic, and histopathological examinations for accurate diagnosis of different nail diseases.

The total impact of the worldwide COVID-19 pandemic is still emerging, changing all relationships as a result, including those with pet animals. In the infection process, the use of Angiotensin-converting enzyme 2 (ACE2) as a cellular receptor to the spike protein of the new coronavirus is a fundamental step. In this sense, understanding which residue plays what role in the interaction between SARS-CoV-2 spike glycoprotein and ACE2 from cats, dogs, and ferrets is an important guide for helping to choose which animal model can be used to study the pathology of COVID-19 and if there are differences between these interactions and those occurring in the human system. Hence, trying to help to answer these questions, we performed classical molecular dynamics simulations to evaluate, from an atomistic point of view, the interactions in these systems. Our results show that there are significant differences in the interacting residues between the systems from different animal species, and the role of ACE2 key residues are different in each system and can assist in the search for different inhibitors for each animal.

Toxoplasma gondii was initially classified in three main lineages related to its virulence: Types I, II and III. The recombination of genes during sexual cycle in felids gut led to more than 200 genotypes, found in ToxoDB database, using 11 RFLP markers. Free-range chickens are good bioindicators of soil contamination with T. gondii oocysts. In this sense, there are systematic reviews regarding data of genetic characterization of this parasite in felines and ruminants, but not in chickens heretofore, what makes this work necessary. A systematic review in the literature was performed with papers published prior to September 21st, 2020. The main inclusion criteria was the presence of T. gondii genotypes, isolated strictly from free-range chickens, in experimental works. Initially, a total of 1,343 studies related to the terms were identified on databases and 30 studies were selected to be systematically reviewed. A total of 561 isolates of T. gondii from 6,356 free-range chickens were analyzed for genotyping, revealing 190 genotypes. ToxoDB #59 and #2 were the most frequent in America, #1 was the most frequent in Africa and 3 atypical isolates from genotype ToxoDB #9 were found in Asia. There is not data from Europe and Oceania. The majority of studies were Brazilian (16/30). A total of 68 RFLP genotypes were recognized among the 561 isolates’ DNAs analyzed from the 30 studies. Some studies show new genotypes never described before, which reinforces the idea that some years from now, even more new genotypes will be isolated, due to progressive genetic recombination. The large amount of undefined genotypes makes it necessary to perform Nested PCR technique when genotyping. Moreover, the lack of data in Continents such as Europe, Asia and Oceania makes it necessary to perform new isolating and genotyping studies in these places.

In this paper, with the purpose of improving the mechanical behavior of DeepCwind semi-submersible floating offshore wind turbine (FOWT) platform mooring lines, nonlinear catenary cables of platform are divided into multi-segments and intermediate buoy. The mathematical formulations of the dynamic equation acted on the cable with buoys are described. Present study is employed to the OC4-DeepCwind semi-submersible FOWT platform. It is designed for 200-meter water depth with mooring lines consist of three catenary steel chain cables that have an angle of 120 degrees to each other. The dynamic response of multi-segment catenary mooring line with different buoys radiuses and different positions along the cables were investigated. The full-scale platform was modeled in ANSYS-AQWA software and the simulations are performed in harsh offshore. The tension, strain, anchor uplift, cable uplift for different buoy radiuses and its position along cable are presented and discussed. Moreover, platform motions at three directions (surge, heave and pitch) are also analyzed. It is concluded that by correct selection of the buoy volume and position along cable, the tension of the cable may be reduced up to 45%. By incorrect selection of the buoy, the results will cause adverse effects.

Anthroponotic cutaneous leishmaniasis (ACL) due to Leishmania tropica is spreading to new areas. Exposure to the vector, Phlebotomus sergenti, is the only proven risk factor. Our objective was to compare the densities and genetic characteristics of P. sergenti populations in two nearby localities in Morocco, one within an ACL endemic area (El Borouj) and another undamaged (Sidi Hajjaj). Statistically significant differences were detected between P. sergenti densities with a higher density of P. sergenti in the endemic town (p≤ 0.032). A different main P. sergenti mitochondrial lineage was evidenced in each one of the 2 localities, and for the first time, the lineage of P. sergenti specimens that are acting as a vector of L. tropica has been identified. Bioclimatic differences were detected between both localities. In conclusion, between an ACL endemic locality and another ACL free there are differences in both the density of P. sergenti and the mitochondrial lineage that may explain the different epidemiological situation. Given that the density of P. sergenti in the locality without ACL cases seems sufficient to allow transmission, the main factor that would justify its ACL undamaged character could be the absence of P. sergenti Lineage IV, which seems to prefer warmer and drier climates.

Atrial fibrillation (AF) is the most common heart rhythm disorder in adults and a major cause of stroke. Unfortunately, current treatments for AF are suboptimal as they are not targeting the molecular mechanisms underlying AF. In this regard, gene therapy is emerging as a promising approach for mechanism-based treatment of AF. In this review, we summarize recent advances and challenges in gene therapy for this important cardiovascular disease.

This paper starts with an overview of the application of the three guidelines (GL) of the German Research Association of Mechanical Engineers (FKM). Each of these provides algorithms for calculating fatigue lives of components under constant or variable amplitude loading, however, with underlying different failure criteria, i.e. technical crack initiation life (GL-nonlinear), fatigue crack growth life (GL-fracture mechanics), and total fracture life (GL-linear). This paper introduces the U-Concept which has been evaluated from a large structural durability database. The U-Concept is a small add-on to the Local Strain Approach (LSA) which is the backbone of the GL-nonlinear. It enables 1) to directly calculate the fatigue life to total fracture based on elastic-plastic material behaviour according to the LSA, or 2) to estimate the remaining fatigue life from crack initiation to fracture without a crack growth simulation.

Introduction: Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia, and results in significant morbidity and mortality. The Cox-Maze IV procedure (CMP-IV) has been shown to have excellent efficacy in returning patients to sinus rhythm, but there have been few reports of late follow-up in sizable cohorts of patients with longstanding persistent AF, the most difficult type of AF to treat. Methods & Results: Between May 2003 and March 2020, 174 consecutive patients underwent a stand-alone CMP-IV for longstanding persistent AF. Rhythm outcome was assessed postoperatively for up to 10 years, primarily via prolonged monitoring (Holter monitor, pacemaker interrogation, or implantable loop recorder). Fine-Gray regression was used to investigate factors associated with atrial tachyarrhythmia (ATA) recurrence, with death as a competing risk. Median duration of preoperative AF was 7.8 years (interquartile range [IQR] 4.0-12.0 years), with 71% (124/174) having failed at least one prior catheter-based ablation. There were no 30-day mortalities. Freedom from ATAs was 94% (120/128), 83% (53/64), and 88% (35/40) at 1, 5, and 7 years, respectively. On regression analysis, preoperative AF duration and early postoperative ATAs were associated with late ATAs recurrence. Conclusion: Despite the majority of patients having a long-duration of preoperative AF and having failed at least one catheter-based ablation, the stand-alone CMP-IV had excellent late efficacy in patients with longstanding persistent AF, with low morbidity and no mortality. We recommend consideration of stand-alone CMP-IV for patients with longstanding persistent AF who have failed or are poor candidates for catheter ablation.

【Abstract】 Background:Cardiac pacemakers are still an effective method for the treatment of atrioventricular block diseases(AVB). Ventricular pacing results in adverse clinical outcome. For patients with atrioventricular conduction system disease, minimization ventricular pacing not be used to reduce the proportion of ventricular pacing and improve cardiac function. Recent studies have shown that His bundle pacing(HBP) can be an effective treatment for patients with atrioventricular block . The purpose of this study was to evaluate the effectiveness of His bundle in patients with AVB. Methods:We searched the studies from Pubmed,Embase and Cochrane Library database to evaluate the application of HBP in patients with AVB. From these studies, we extrated and summarized the related data such as implantation success rate, QRS width, pacing threshold at baseline and follow-up, assessment left ventricular function, complications. Results:This Meta- analysis included eight studies, including 430 patients. The success rate of implantation varied from 65% to 93%. The main indications of HBP were patients with AVB, including patients with atrioventricular node block and intranodal block. Left ventricular function(left ventricular ejection fraction) was not significantly improved during follow-up. The duration of QRS after HBP implantation was more narrow (113±18ms). Compared with the baseline level, the threshold of HBP was not significantly increased during follow-up. During an average of 12 months of follow-up, pacemaker-related complications occurred in 16 patients. Conclusion:Permanent HBP has shown promising results for patients with AVB in small observational studies. Randomized controlled trials are needed to assess the efficacy of HBP in these patients.

To accurately analyze and evaluate the comparison and selection of multi-index and multi-route highway route schemes and address the disadvantages of traditional scheme evaluations, we focus on the economic costs of construction and improve on previous qualitative and quantitative analysis. A comprehensive weight and intelligent selection algorithm are introduced into the optimization of highway route schemes. This paper presents an evaluation index system for highway route schemes based on the full life cycle and considering technology, the ecological environment, the social environment and the economy. We propose an evaluation system for highway route schemes based on a comprehensive weight. Additionally, an optimization method for highway route schemes based on the TOPSIS model is studied. Finally, the optimal highway route scheme is obtained by calculation. According to the results of the research, the construction of evaluation indexes directly influences the results of the scheme evaluation. When established operations, management and maintenance indexes are based on the full life cycle, the evaluation results are more accurate. In addition to avoiding the defects of a single weighting method, the comprehensive weight vector uses subjective data as well as expert opinion. In addition, the comprehensive weight vector introduces a preference coefficient so that analysers can determine a scheme based on the accuracy of subjective and objective information and requirements. This method uses a large number of evaluation populations to evaluate schemes, and the result is more objective.

Molecular Dynamics (MD) simulations are widely used to predict the behavior of molecular systems over time. However, one of the great challenges of MD simulations is how to treat the thousands of configurations obtained from calculations, since the number of the quantum calculations (QM) required for evaluating electronic parameters is too high and, sometimes, computationally impracticable. Thus, an efficient and accurate sampling protocol is essential for combining classical MD and QM calculations. In this article, based on the OWSCA methodology, 93 wavelet signals were analyzed in order to further refine the methodology and identify the best wavelet family for [Fe(H2O)6]2+ and [Mn(H2O)6]2+ complexes in solution. Our results point out that the bior1.3 was the best wavelet, values closest to the experimental data were obtained for both studied systems.

Allergic diseases like asthma, allergic rhinitis, or food allergy have a high prevalence in women of childbearing age and may affect up to 30% of this age group. A multitude of immunological changes characterizes pregnancy to create the optimal milieu for the unborn child. Both these immunological changes and pre-conceptional, sub-optimal disease control may affect the severity of the respective allergic disease manifestations during pregnancy and pose a risk for mother and child. Due to apparent limitations in conducting clinical trials, safety data on anti-allergic drugs during pregnancy are limited. This lack of clinical evidence demands to counsel between potential and known risks and benefits of anti-allergic drugs. This includes the potential of disease aggravation in the absence of treatment. By doing so, informed decisions and shared decision-making is facilitated. In particular, in patients with severe asthma, education about the risk of uncontrolled asthma for mother and child should be part of regular care. This review focuses on the management of allergic diseases during pregnancy, maternal counseling, and available information/evidence regarding allergic diseases’ management and treatment during pregnancy. Furthermore, we discuss the challenges of treating patients with allergic diseases and covid-19 during pregnancy.

Posterior reversible encephalopathy syndrome (PRES) is identified on magnetic resonance imaging by posterior predominant white and gray matter lesions. PRES secondary to spinal disease is very rare. We report a case of clinical and imaging findings about PRES associated with spinal epidural hematoma.

Worldwide, wild birds are frequently suspected to be involved in the occurrence of outbreaks in captive-bred birds although proofs are lacking and most of the dedicated studies are insufficiently conclusive to confirm or characterize the roles of wild birds in such outbreaks. The aim of this study was to assess and compare, for the most prevalent peridomestic wild birds, the different exposure routes for Avian Influenza and Newcastle disease viruses in conservation breeding sites of Houbara bustards in the United Arab Emirates. To do so, we considered all of the potential pathways by which captive bustards could be exposed to Avian Influenza and Newcastle disease viruses by wild birds, and ran a comparative study of the likelihood of exposure via each of the pathways considered. We merged data from an ecological study dedicated to local wild bird communities with an analysis of the contacts between wild birds and captive bustards and with a prevalence survey of AIV and NDV in wild bird populations. We also extracted data from an extensive review of the scientific literature and by the elicitation of expert opinion. Overall, this analysis highlighted that captive bustards had a high risk of being exposed to pathogens by wild birds. This risk was higher for Newcastle disease virus than Avian influenza virus, and House sparrows represented the riskiest species for the transmission of both viruses through indirect exposure from consumption of water contaminated from the faeces of an infectious bird that got inside the aviary. Thus, this analysis reveals that wild peridomestic birds may play a role in the transmission of avian pathogens to captive bred birds. These results also reaffirm the need to implement sanitary measures to limit contacts between wild and captive birds and highlight priority targets for a thoughtful and efficient sanitary management strategy.

The anal sphincters may be divided by direct anal trauma or by severe pelvic injuries. The preoperative clinical assessment may correlate well with intra-operative assessment. As long as about half the sphincter ring remains active there is a good chance of restoring satisfactory faecal continence following a sphincteroplasty.

Numerous studies have unsuccessfully tried to unravel the definitive host of the coccidian parasite Besnoitia besnoiti. Cattle infections by B. besnoiti cause a chronic and debilitating condition called bovine besnoitiosis that has emerged in Europe during the last two decades, mainly due to limitations in its control associated to the absence of vaccines and therapeutical tools. Although the exact transmission pathway of B. besnoiti is currently unknown, it is assumed that the parasite might have an indirect life cycle with a carnivore as definitive host. Current lack of studies in wildlife might underestimate the importance of free-living species in the epidemiology of B. besnoiti. Thus, the aim of the present study is to assess the presence of Besnoitia spp. in free-ranging mesocarnivores in Spain. DNA was searched by PCR on faeces collected from wild carnivores as a first approach to determine which species could be considered as potential candidates for definitive hosts in further research. For this purpose, a total of 352 faecal samples from 12 free-living wild carnivore species belonging to the Canidae, Felidae, Herpestidae, Mustelidae, Procyonidae, and Viverridae families were collected in seven Spanish regions. PCR testing showed that Besnoitia spp. DNA was present in four faecal samples from red foxes collected in western Spain, an area with the greatest density of extensively reared cattle and associated to high incidence of bovine besnoitiosis in the country. To date, this is the first report of a Besnoitia besnoiti-like sequence (99.57% homology) from carnivore faeces in a worldwide context. Red foxes might contribute to the epidemiology of B. besnoiti, although further studies, mostly based on bioassay, would be needed to elucidate the accuracy and extent of these interesting findings.