Complete transposition of the great arteries is incompatible with life without corrective surgery in the neonatal period. Even in the presence of large intracardiac shunts, a case of un-operated d-TGA that survived to late adulthood is thought-provoking. We described a case of un-operated d-TGA presenting at 46 years of age who had large secundum type ASD, pulmonary hypertension, pulmonary artery aneurysm, situs inversus, mirror image dextrocardia and abnormal origin of the coronary artery. The management of an un-operated case of d-TGA surviving to late adulthood has made it important to share case-based experiences as there are no evidence-based data.

An 11-year-old boy affected by pulmonary atresia with intact ventricular septum (AP-IVS) was listed for percutaneous pulmonary valvuloplasty and closure of multi-fenestrated atrial septal defect (ASD). Intraprocedural transesophageal echocardiography arose the suspect of abnormal coronary artery pattern while selective angiography documented a single sinoatrial node artery (SANa) with an unusual retro-aortic course. As consequence, we proceeded to effectively close the defects with a not self-centering device placed in the most central side hole. This case supports the hypothesis that sometimes arrhythmic complication during ASD closure procedures might be due to unrecognized injury of the SANa.

We report the first incidental finding of congenital unilateral absence of the vas deferens and ipsilateral renal agenesis during endoscopic totally extraperitoneal inguinal hernia repair. The absence of the vasa deferentia occurs unilateral, associated with renal anomalies, or bilateral which has a genetic link to cystic fibrosis.

We study the asymptotic behaviors of the semigroup generated by the linearized Landau operator in the case of the very soft potentials and Coulomb potential. Compared with the hard potentials, Maxwellian molecules and moderately soft potentials, there is no spectral gap for the linearized Landau operator with the very soft and Coulomb potentials. By introducing a new decomposition of the linear Landau collision operator $L$ including an accretive operator and a relatively compact operator, we establish the complete spectrum structure for the linearized Landau operator with the very soft and Coulomb potentials and furthermore derive the time decay estimates of the corresponding semigroup in a weighted velocity space.

Comparisons of microsatellite and single-nucleotide polymorphisms (SNPs) have found that SNPs outperform microsatellites in population genetic analyses, calling into the question the continued utility of microsatellites in population and landscape genetics. Yet highly polymorphic markers may be of value in species that have reduced genetic variation. This study repeated analyses previously done using microsatellites with SNPs developed from ddRAD sequencing in the black-capped vireo source-sink system. SNPs provided greater resolution of genetic diversity, population differentiation, and migrant detection but could not reconstruct parentage relationships due to insufficient heterozygosities. The biological inferences made by both sets of markers were similar: asymmetrical gene flow from source populations to the remaining sink populations. With the landscape genetic analyses, we found different results between the two molecular markers, but associations of the top environmental features (riparian, open habitat, agriculture, and human development) with dispersal estimates were shared between marker types. Despite the higher precision of SNPs, we find that microsatellites effectively uncover population processes and patterns and are superior for parentage analyses in this species with reduced genetic diversity. This study illustrates the continued applicability and relevance of microsatellites in population genetic research.

Background: This study investigated the impact of weight change in waitlisted candidates on posttransplant outcomes following orthotopic heart transplantation (OHT). Methods: The United Network for Organ Sharing database was queried to identify adult patients undergoing isolated, primary OHT from 1/1/2010 to 3/20/2020. Patients were stratified into 3 cohorts based on percent weight change from listing to OHT. The primary outcome was one-year survival, and multivariable modeling was used for risk-adjustment. A secondary analysis compared outcomes of recipients waitlisted ≥90 days. Results: A total of 22,360 patients were included, 18,826 (84.2%) with stable weight, 1,672 (7.5%) with ≥5% weight loss, and 1,862 (8.3%) with ≥5% weight gain. Median age was similar across cohorts. Waitlist time was longest in patients with weight gain and shortest in those with stable weight (417 vs 74 days, P<0.001). The weight loss cohort had higher rates of dialysis dependency, pacemaker, and drug-treated acute rejection at one year (all P<0.05). Ninety-day and one-year posttransplant survival was lowest in the weight loss cohort. Multivariable modeling identified both ≥5% weight loss (HR 1.26, 95% CI 1.07-1.48) and decreasing weight (per 1%, HR 1.02, 95% CI 1.01-1.03) as risk-adjusted predictors of one-year mortality. In sub-analysis of recipients waitlisted ≥90 days, ≥5% weight loss and decreasing weight remained significant independent predictors for mortality. Conclusion: Waitlisted OHT candidates with ≥5% weight loss comprised a small, but higher-risk population with increased rates of postoperative complications and decreased survival. Efforts focused on nutritional optimization and preventing weight loss while awaiting OHT appear warranted.

This study evaluates through modeling the possible individual and combined effect of three populational parameters of pathogens (reproduction rate; rate of novelty emergence; and propagule size) on the colonization of new host species – putatively the most fundamental process leading to the emergence of new infectious diseases. The results are analyzed under the theoretical framework of the Stockholm Paradigm using IBM simulations to better understand the evolutionary dynamics of the pathogen population and the possible role of Ecological Fitting. The simulations suggest that all three parameters positively influence the success of colonization of new hosts by a novel parasite population but contrary to the prevailing belief, the rate of novelty emergence (e.g. mutations) is the least important factor. Maximization of all parameters result in a synergetic facilitation of the colonization and emulates the expected scenario for pathogenic microorganisms. The simulations also provide theoretical support for the retention of the capacity of fast-evolving lineages to retro-colonize their previous host species/lineage by ecological fitting. Capacity is, thus, much larger than we can anticipate. Hence, the results support the empirical observations that opportunity of encounter (i.e. the breakdown in mechanisms for ecological isolation) is an fundamental determinant to the emergence of new associations - in special of Emergent Infectious Diseases - and the dynamics of host exploration, as observed in SARS-CoV-2. Insights on the dynamics of Emergent Infectious Diseases derived from the simulations and from the Stockholm Paradigm are discussed.

Background The same dosing schedule, 1000 SQ-U times three, with one-month intervals, have been evaluated in most trials of intralymphatic immunotherapy (ILIT) for the treatment of allergic rhinitis (AR). The present studies aimed to evaluate if a dose escalation in ILIT can enhance the clinical and immunological effects, without compromising safety. Methods Two randomized double-blind placebo-controlled trials of ILIT for grass pollen induced AR were performed. The first included 29 patients that had recently ended 3 years of SCIT and the second contained 39 not previously vaccinated patients. An up-dosage of 1000-3000-10 000 SQ-U with one month in between was evaluated. Results ILIT in doses up to 10 000 SQ-U was safe after recent SCIT. The combined symptom-medication scores (CSMS) were reduced by 31% and the grass specific IgG4 levels in blood were doubled. In ILIT de novo, the two first patients that received active treatment developed serious adverse reactions at 5000 SQ-U. A modified up-dosing schedule; 1000-3000-3000 SQ-U appeared to be safe but failed to improve the CSMS, quality of life and nasal provocation response. Flow cytometry analyses could not detect any T-cell changes, while lymph node derived dendritic cells showed increased activation. Conclusion ILIT in high doses after SCIT appears to further reduce grass pollen induced seasonal symptoms and may be considered as an add-on treatment for patients that do not reach full symptom control after SCIT. Up-dosing schedules de novo with three monthly injections that exceeds 3 000 SQ-U should be avoided.

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African swine fever (ASF) is a viral disease that affects members of the Suidae family. The notifiable disease is considered a major threat to the pig industry, animal health, and food security worldwide. According to the European Food Safety Authority, ASF virus (ASFV) survival and transmission in feed and feed materials is a major research gap. Against this background, the objective of this study was to determine the survival of ASFV on re-contaminated spray dried porcine plasma (SDPP) when stored at two different temperatures. To this means, commercial SDPP granules were contaminated with high titers of ASFV in a worst-case re-contamination scenario. Three samples per time point and temperature condition were subjected to blind passaging on macrophage cultures and subsequent haemadsorption test to determine residual infectivity. In addition, viral genome was detected by real-time PCR. The results indicate that heavily re-contaminated SDPP stored at 4°C remains infectious for at least five weeks. In contrast, contaminated SDPP stored at room temperature displayed a distinct ASFV titer reduction after one week and complete inactivation after two weeks. In conclusion, the residual risk of ASFV transmission through re-contaminated SDPP is low, if SDPP is stored at room temperature for a period of at least two weeks before feeding.

No countermeasures have been established against horizontal infection in non-vaccinated children. We reported about siblings with different clinical courses of HBV paternal infection. To eradicate HBV, we should encourage HBV vaccination of all children and HBV infection screening of fathers and other family members.

Fish bones have a risk of damaging the mucosa when lodged in the pharynx. Fish bones migrated into surrounding tissues is relatively unusual. We present 2 cases of patients who ingested fish bone, which migrated into retropharyngeal space and hypopharynx. All fish bones were removed without complications.

Introduction: Despite eradication and control measures applied across Europe, bovine tuberculosis (bTB) remains a constant threat. In Belgium, after several years of bTB disease freedom status, routine movement testing, as currently practiced, revealed itself inadequate to detect some sporadic breakdown herds. The aim of this study was to strike the balance between cost and effectiveness of different surveillance system components to identify sustainable alternatives for early detection and substantiation of freedom of bTB while maintaining acceptance of these amongst the different animal health stakeholders. Methods: Stochastic iteration model was built to simulate, first, the expected current surveillance system performance in terms of sensitivity and specificity of detection. These results were then descriptively compared to observed field results. Secondly, the cost and effectiveness of simulated alternative surveillance components were quantified. To measure impact of key assumptions (i.e. regarding diagnostic tests and true prevalence), sensitivity analysis was performed. Results: Discrepancies between the predicted and observed performance of bTB surveillance in Belgium were observed. Secondly, simulated alternatives revealed that targeted IFN-γ as well serological testing with Antibody ELISA towards risk herds would enable increasing the overall cost and effectiveness of the Belgian bTB surveillance system. Sensitivity analysis showed that results remained constant despite modification of some key assumptions. Discussion: Performance of current bTB surveillance system performance in Belgium was questionable. This exercise highlighted that not only sensitivity, but specificity is a key driver for surveillance performance. The quantitative and participative conceptual framework revealed itself a useful tool to allow evidence-based decision making regarding future tuberculosis surveillance in Belgium, as required by the international standards.

Bouveret syndrome is a rare cause of gastric outlet obstruction by passage of gallstone through a fistula between the gallbladder and proximal gastrointestinal tract, it is considered a proximal form of gallstone ileus. The clinical presentation is nonspecific, and imaging plays an important role in the diagnosis of this entity.

This article aims to provide a comprehensive review of the clinical features and genetics basis of multi-system pseudohypoaldosteronism type 1 caused by SCNN1B gene mutations.

Paediatric multisystem inflammatory syndrome: temporally associated with SARS-COV-2 (PIMS-TS) is a well described rare but severe COVID-19 related syndrome. PIMS-TS have been reported in children from geographical areas of high COVID-19 infection. Most children with PIMS-TS require management in an intensive care unit with variable respiratory involvement. Adults recovering from COVID-19 infection have been reported to suffer from respiratory morbidity but such outcomes are unknown in children. We present the first report of normal short term respiratory outcomes as measured by spirometry in children with SARS-COV-2 antibody positive, PIMS-TS syndrome managed at a specialist children’s hospital in the UK.

Introduction:It has been known that there is a complex interaction between asthma and cardiovascular physiology.Some investigations on echocardiography and electrocardiography(ECG) in asthmatic patients revealed many findings such as pulmonary hypertension(PHT) and arrhythmia.In this study,we aimed to perform tissue doppler imaging(TDIE) and conventional echocardiographic(CEI) assessment with many indexes of arrhythmia on electrocardiography(ECG) in asthmatic patients.Methods:A total of 89 patients,63 female(70.8%) and 26 male(29.2%),was included in this study.Patients were divided into three groups and then each group was separated in two 2 groups as mild-moderate and severe asthma.Results:There is no difference among groups with respect to age,gender and anthropometric data and no difference between groups with respect to indexes of arrhythmia on ECG(p> 0.05).It was determined that ventricular outflow systolic velocity recordings at aortic and pulmonary valve were similar(p> 0.05).MAPSE,TAPSE and both ventricular diastolic velocities on CEI were similar between groups,except for left ventricular A wave velocity which was higher in severe asthmatic patients(p< 0.05).No difference between groups was detected in left atrium(LA) TDIE diastolic velocities(p> 0.05).Investigation of time intervals of both ventricular diastolic filling velocities(e’ and a’) at the mitral lateral,septal and tricuspid lateral annulus revealed significant difference at Pa’m- 3 and Pa’s- 3 intervals based on TDEI(p<0.05).Investigation of the LA volumes determined that only maximal volume of the LA was higher in severe asthmatic patients(p< 0.05).However, there is no significant difference between LA-VpreA and LA-Vmin(p> 0.05).Conclusions:Based on these results, it can be suggested that LA mechanical functions and intra-atrial LA electromechanical durations were impaired in severe asthmatic patients.

Identifying factors that influence sea otter (Enhydra lutris) population density can provide insight into why it varies spatially and temporally and when a recovering population has reached an equilibrium density because of food resources (i.e., carrying capacity K). Although food availability is widely recognized as an important extrinsic factor affecting sea otter density, how do we determine when a population has reached K? The goal of this study was to estimate K for Simpson Bay, Alaska by measuring the abundance of edible bivalves, the primary prey for sea otters for over 40 years. We then compared prey abundance and estimated replacement rate (i.e., the mean age of bivalves predated by sea otters) to estimated annual prey consumption based on the mean population density for the past 18 years. On average, 110 adult sea otters (5.2 km−2) have occupied Simpson Bay annually since 2001 consuming an estimated 176,660 kg of bivalves. The total mass (standing stock) of the major bivalves (predominately butter clams and stained macomas) was 785,730 kg, so adult sea otters consumed about 22% annually. Based on these observations and calculations, the estimated annual number of sea otters occupying Simpson Bay appears to be at or near K based on the replacement rate of food resources. However, other intrinsic (e.g., male territoriality and emigration) and extrinsic (e.g., predation, disease, human-related mortality) factors may influence equilibrium density, which varies spatially and temporally, resulting in a mosaic of subpopulations with different densities, rates of growth and discontinuous distributions. Understanding the balance among these factors may be one of the most challenging ecological questions for sea otter conservation and management as populations recover from their range-wide decimation during the Maritime Fur Trade in the late 18th and 19th centuries