Allopreening occurs in many species of birds and is known for providing hygienic and social benefits. While this behavior has been studied between conspecifics, its occurrence among different species remains mysterious. Outside of captive environment, only a few records of interspecific allopreening exist. In this study, we describe our observations of Spot-necked Babbler (Stachyris strialata) preening Nonggang Babbler (Stachyris nonggangensis) in a non-captive environment in southern China. We provide three hypotheses (social dominance, cleaning mutualism, and hybridization) to explain the occurrence of this understudied behavior. We suggest that interspecific allopreening may not be as rare as we thought if we study this behavior under circumstances where it most frequently occurs. This study contributes to our understanding of not only the potential mechanism(s) for interspecific allopreening but also the behavioral ecology of the vulnerable Nonggang Babbler.

High Density Pace-Mapping for Scar-related Ventricular Tachycardia AblationTravis D. Richardson MD and William G. Stevenson MD.1 Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, TN, USARunning Title: High Density Pace MappingCorresponding Author:Travis D. Richardson, MDDivision of Cardiovascular MedicineVanderbilt University Medical Center1211 Medical Center DrNashville, TN 37232USAEmail: [email protected] Count: 2,225Conflicts of Interest :Dr. Stevenson has received speaking Honoria from: Boston Scientific, Medtronic, Abbott, Johnson and Johnson, and Biotronik; he is co-holder of a patent for irrigated needle ablation that is consigned to Brigham and Women’s Hospital.Dr. Richardson has received research funding from Medtronic Inc, Abbott Inc and served as a consultant for Philips Inc and Johnson and Johnson.This work did not receive any funding.Despite advances in medical and interventional therapies, ventricular tachycardia (VT) due to reentrant activity within complex regions of myocardial scar remains a common late complication of myocardial infarction.1 While implantable defibrillators (ICD) may prevent sudden death, ICD shocks are painful and impact quality of life2. Catheter ablation reduces the likelihood of ICD therapies and it’s role early in the course of disease is expanding3–5. However, several factors limit the success and safety of catheter ablation procedures. Scar-related reentry circuits can be large with a critical isthmus shared by multiple loops. Ablation of the isthmus is associated with a low risk of recurrence of that VT6,7. The critical isthmus can be identified during VT by detailed activation mapping and entrainment. However, prolonged mapping during VT is often not feasible or desired. Patients undergoing VT ablation often have severe systolic heart failure as well as other comorbid conditions. VT is often not hemodynamically tolerated and even when tolerated, prolonged time in VT may lead to decompensation. Strategies to limit initiation and mapping of VT may improve procedural safety8. Methods to guide ablation based on characterization of the sinus rhythm substrate alone have generally shown good results9. A number of approaches have been applied, including ablation over the entire low voltage area (scar homogenization)10. While this is often successful, areas of scar can be quite extensive, and undoubtedly this technique leads to ablation of more areas than absolutely necessary for success. This approach is also more effective if epicardial ablation is routinely included, which has the potential to increase procedural risk. A strategy to focus on the critical regions, particularly when a clinically relevant VT is known, remains a reasonable first step in the procedure. A variety of electrogram markers of critical regions have been described including late potentials, potentials that display variable coupling to surrounding tissue during programmed stimulation11 , and areas of slow conduction identified by high density mapping 12,13. While these are likely to increase the specificity of ablation targets compared to electrogram voltage alone, they are also seen at bystander areas14.Pace-mapping during sinus rhythm is useful to help identify the general location of focal arrhythmia sources,15 and can also be used in scar related reentry.16,17 At the reentry circuit exit region the paced QRS morphology often resembles the VT QRS, and this will also occur at sites proximal to the exit provided that the stimulated wavefront follows the reentry path to the exit. A stimulus – QRS > 40 ms is also consistent with slow conduction away from the pacing site, that can be a marker for reentry substrate17.In this issue of the Journal of Cardiovascular Electrophysiology,Guenancia et al. review their technique of using high density pace mapping to guide VT ablation18. Their method takes advantage of software available in electroanatomic mapping systems that assigns a measure of correlation between two different QRS morphologies; in this case the VT and the paced QRS morphology.19 A pacing correlation map is generated by pacing multiple sites within the ventricle and color coding the algorithmically derived score for display at each point on the anatomic map. Sites near the exit from the reentry circuit isthmus, typically along the border of a scar, will display good correlation with induced VT. As one moves along the isthmus deeper into the low voltage scar the S-QRS prolongs due to the conduction time between the pacing site and the exit region. If the isthmus is anatomically defined, such that it is present during VT and sinus rhythm, the QRS morphology remains similar to the VT as long as the paced wavefront follows the isthmus out to the exit. Moving to the entrance or adjacent sites outside the isthmus can produce an abrupt transition to a markedly different paced QRS because the wavefront can propagate away without following the path of the isthmus.20 Thus, the pace-map correlation maps can outline the location of a reentry circuit isthmus during sinus rhythm, as they illustrate.Their method can also help identify cases in which the critical isthmus is not located on the surface being mapped. When the VT circuit is epicardial or intramural, the earliest endocardial activation may appear focal. Similarly, the pace-map correlation maps may reveal a concentric or focal pattern of matching, potentially allowing recognition of this situation without the need for activation mapping during VT.We agree with the fundamental principles described, and feel this technique can be a helpful substrate mapping approach. There are several caveats. Evaluation to clarify its specificity and sensitivity is limited. The authors report that in their unpublished experience an abrupt transition is seen in the majority of post-infarct cases, they have also published a series of 10 post-infarct patients undergoing VT ablation during which the pacing correlation maps visually matched VT activation maps.21This technique is likely to be effective in cases where the VT isthmus is confined to the ventricular surface being mapped. Pacing can capture deep to the endocardium depending on current strength.22 Whether this technique can detect intramural isthmuses and whether deep tissue that can be captured with pacing can also be ablated from the pacing site is not clear.It is important to point out that very good correlations with VT can be observed pacing in an outer loop immediately adjacent to the exit where one would not anticipate RF ablation delivery would be effective. If a focal pattern is seen on both the endocardial and epicardial surfaces very little can be inferred about the VT circuit; the site with better correlation would be expected to be closer to the exit. In this setting entrainment during a brief episode of induced VT with assessment of the post-pacing interval can potentially clarify the proximity to the reentry circuit.During VT, areas of functional conduction block may be present that are absent during sinus rhythm. Functional block can also occur remote from the reentry isthmus and alter activation wavefronts during VT changing the QRS morphology. Theoretically it is then possible to have poor correlation between the VT and paced QRS at its exit. In animal models of post-infarction VT exit regions have been shown to harbor very slow areas of conduction which could be prone to altering total ventricular activation during VT.23.We would caution against generalizing these techniques to patients with dilated cardiomyopathies where confluent regions of low voltage scar are absent. Diffuse interstitial fibrosis may play a greater role in some of these VT circuit and anatomically fixed isthmus sites are less likely to be present.Further study is needed before utilizing this technique when anatomical structures within the ventricle are involved in the VT circuit. Structures such as the moderator band may by definition have multiple exits and varied QRS morphologies24, and papillary muscles may display large areas of similar paced morphology25, potentially distorting pacing correlation maps.This technique is unlikely to correctly characterize VT circuits that involve a portion of the cardiac conduction system as occurs in some scar-related VTs and in bundle-branch reentry.26 These circuits may demonstrate a focal pattern at the left or right ventricular apical septum on pacing correlation maps due to the long, insulated nature of the reentrant circuit itself, and ablation at the exit site is very unlikely to be effective.This strategy of high density pace mapping adds to the available substrate mapping methods for guiding VT ablation while limiting VT induction. This strategy does not rely on electrogram interpretation, making it of particular interest in regions of very low voltage. Indeed, when utilizing larger recording electrodes, such as an ablation catheter, pacing will often reveal the presence of excitable tissue where a local electrogram is not always apparent. In post-infarct ventricular tachycardia circuits with a well-defined scar and a short anatomically bounded isthmus, pacing correlation maps are likely to be revealing. More study is warranted to further assess this method in relation to other substrate mapping methods, in complex substrate with intramural components, and in other disease substrates. It is useful to have multiple tools in the tool box. More studies are needed to further define which tools work best for which substrate.References:1. Stevenson WG: Ventricular Tachycardia After Myocardial Infarction: From Arrhythmia Surgery to Catheter Ablation. J Cardiovasc Electrophysiol 1995; 6:942–950.2. Moss AJ, Schuger C, Beck CA, et al.: Reduction in inappropriate therapy and mortality through ICD programming. N Engl J Med 2012; 367:2275–2283.3. Sapp JL, Wells GA, Parkash R, et al.: Ventricular Tachycardia Ablation versus Escalation of Antiarrhythmic Drugs. N Engl J Med 2016; 375:111–121.4. Cronin EM, Bogun FM, Maury P, et al.: 2019 HRS/EHRA/APHRS/LAHRS expert consensus statement on catheter ablation of ventricular arrhythmias: Executive summary. Heart Rhythm 2020; 17:e155–e205.5. Della Bella P, Baratto F, Vergara P, et al.: Does Timing of Ventricular Tachycardia Ablation Affect Prognosis in Patients With an Implantable Cardioverter Defibrillator? Results From the Multicenter Randomized PARTITA Trial. Circulation 2022; .6. Hadjis A, Frontera A, Limite LR, et al.: Complete Electroanatomic Imaging of the Diastolic Pathway Is Associated With Improved Freedom From Ventricular Tachycardia Recurrence. Circ Arrhythm Electrophysiol 2020; 13:e008651.7. Tokuda M, Kojodjojo P, Tung S, et al.: Characteristics of Clinical and Induced Ventricular Tachycardia Throughout Multiple Ablation Procedures. J Cardiovasc Electrophysiol 2016; 27:88–94.8. Yu R, Ma S, Tung R, et al.: Catheter ablation of scar-based ventricular tachycardia: Relationship of procedure duration to outcomes and hospital mortality. Heart Rhythm 2015; 12:86–94.9. Irie T, Yu R, Bradfield JS, et al.: Relationship between sinus rhythm late activation zones and critical sites for scar-related ventricular tachycardia: systematic analysis of isochronal late activation mapping. Circ Arrhythm Electrophysiol 2015; 8:390–399.10. Di Biase L, Santangeli P, Burkhardt DJ, et al.: Endo-Epicardial Homogenization of the Scar Versus Limited Substrate Ablation for the Treatment of Electrical Storms in Patients With Ischemic Cardiomyopathy. J Am Coll Cardiol 2012; 60:132–141.11. de Riva M, Naruse Y, Ebert M, et al.: Targeting the Hidden Substrate Unmasked by Right Ventricular Extrastimulation Improves Ventricular Tachycardia Ablation Outcome After Myocardial Infarction. JACC Clin Electrophysiol 2018; 4:316–327.12. Anter E, Neuzil P, Reddy VY, et al.: Ablation of Reentry-Vulnerable Zones Determined by Left Ventricular Activation From Multiple Directions: A Novel Approach for Ventricular Tachycardia Ablation: A Multicenter Study (PHYSIO-VT). Circ Arrhythm Electrophysiol 2020; 13:e008625.13. Tung R: Substrate Mapping in Ventricular Arrhythmias. Card Electrophysiol Clin 2019; 11:657–663.14. Nayyar S, Wilson L, Ganesan AN, et al.: High-density mapping of ventricular scar: a comparison of ventricular tachycardia (VT) supporting channels with channels that do not support VT. Circ Arrhythm Electrophysiol 2014; 7:90–98.15. Bennett R, Campbell T, Kotake Y, et al.: Catheter ablation of idiopathic outflow tract ventricular arrhythmias with low intraprocedural burden guided by pace mapping. Heart Rhythm O2 2021; 2:355–364.16. Brunckhorst CB, Delacretaz E, Soejima K, Maisel WH, Friedman PL, Stevenson WG: Identification of the ventricular tachycardia isthmus after infarction by pace mapping. Circulation 2004; 110:652–659.17. Stevenson WG, Sager PT, Natterson PD, Saxon LA, Middlekauff HR, Wiener I: Relation of pace mapping QRS configuration and conduction delay to ventricular tachycardia reentry circuits in human infarct scars. J Am Coll Cardiol 1995; 26:481–488.18. Guenancia C, Supple GE, Sellal J-M, et al.: How to use pace mapping for ventricular tachycardia ablation in post-infarct patients. J Cardiovasc Electrophysiol .19. de Chillou C, Sellal J-M, Magnin-Poull I: Pace Mapping to Localize the Critical Isthmus of Ventricular Tachycardia. Card Electrophysiol Clin 2017; 9:71–80.20. Hanaki Y, Komatsu Y, Nogami A, et al.: Combined endo- and epicardial pace-mapping to localize ventricular tachycardia isthmus in ischaemic and non-ischaemic cardiomyopathy. Eur Eur Pacing Arrhythm Card Electrophysiol J Work Groups Card Pacing Arrhythm Card Cell Electrophysiol Eur Soc Cardiol 2022; 24:587–597.21. de Chillou C, Groben L, Magnin-Poull I, et al.: Localizing the critical isthmus of postinfarct ventricular tachycardia: the value of pace-mapping during sinus rhythm. Heart Rhythm 2014; 11:175–181.22. Itoh T, Yamada T: Excellent Pace Maps Recorded from Two Remote Sites Inside and Outside the Scar in a Patient with Ischemic VT: What Is the Mechanism? Pacing Clin Electrophysiol 2017; 40:72–74.23. Anter E, Tschabrunn CM, Buxton AE, Josephson ME: High-Resolution Mapping of Postinfarction Reentrant Ventricular Tachycardia: Electrophysiological Characterization of the Circuit. Circulation 2016; 134:314–327.24. Jiang C-X, Long D-Y, Li M-M, et al.: Evidence of 2 conduction exits of the moderator band: Findings from activation and pace mapping study. Heart Rhythm 2020; 17:1856–1863.25. Itoh T, Yamada T: Usefulness of pace mapping in catheter ablation of left ventricular papillary muscle ventricular arrhythmias with a preferential conduction. J Cardiovasc Electrophysiol 2018; 29:889–899.26. Bogun F, Good E, Reich S, et al.: Role of Purkinje fibers in post-infarction ventricular tachycardia. J Am Coll Cardiol 2006; 48:2500–2507.

Abstract Background: Currently, the most common surgical modalities used for recurrent respiratory papillomatosis resection are microdebrider, CO2 laser, and KTP laser. However, complication rates vary among different surgical modalities and have been controversial in different studies. Objective of review: This study systematically reviews the available studies which reported intraoperative and postoperative complications, aiming to compare the safety of microdebrider, CO2 laser, and KTP laser. Type of review: Meta-analysis. Search strategy: Seven electronic databases (PubMed/MEDLINE, EMBASE[Ovid], Scopus, Cochrane Library, and Web of Science) were searched from inception through April 28th,2022. Randomized controlled, prospective or retrospective observational studies that recorded the complications of three different surgical modalities for recurrent respiratory papillomatosis resection were included in the meta-analysis. Evaluation method: Outcomes of interest were intraoperative and postoperative complications, and complication rate was calculated to evaluate the safety of surgical methods. Results: Twenty different studies was included in quantitative synthesis. Only one study compared outcomes of those three kinds of treatment modalities simultaneously, two studies compared microdebrider and CO2 laser, and the remaining studies focused on only one of three treatments. The weighted average complication rate for microdebrider was 0.03(95% confidence interval [CI] 0.00-0.21), n = 6, for CO2 laser treatment was 0.16 (95% confidence interval [CI] 0.09-0.25), n = 14，and for KTP laser treatment was 0.04 (95% CI 0.00-0.14), n =4. Conclusion：The limited evidence demonstrated that CO2 lasers in the surgical treatment of RRP may lead to more surgical complications, and microdebrider and KTP lasers may be safer. However, the heterogeneous data limits any strong comparison of outcomes of different treatment of laryngeal papillomas. Future randomised controlled trials that directly compare the safety of different surgical modalities are needed.

Background: Anaphylaxis following influenza vaccination is a rare but serious problem. The underlying immune responses are not well understood. This study elucidated the IgE and IgG antibody responses in healthy children and adolescents following inactivated influenza vaccines (IIVs). Methods: The efficacy and safety of quadrivalent IIV (QIV) and trivalent IIV (TIV) were compared in healthy subjects aged 0-18 years. Serum IIV-specific IgE, IgG and IgG4 levels (sIgE, sIgG, sIgG4) were measured with ImmunoCAP. Hemagglutinin inhibition (HI) assay was performed for each influenza virus subtype. Sera from earlier patients who developed anaphylaxis to different IIVs were similarly tested. Results: A total of 393 subjects were enrolled: 96 were 6 months -2 years old, 100 were 3-5 years old, 100 were 6-12 years old, and 97 were 13-18 years old. No anaphylaxis was observed. Generally, QIV and TIV induced similar antibody responses. IIV-sIgE levels rose significantly after vaccination in the 6m-2y and 3-5y groups, did not change in the 6-12y group, and decreased in the 13-18y group. In contrast, the IIV-sIgG4/sIgE ratio increased significantly after vaccination in all age groups. Sensitized subjects had significantly higher HI titers and IIV-sIgG levels in the youngest age group and higher IIV-sIgG4 levels in all age groups compared with the non-sensitized. The IIV-sIgG4/sIgE ratio in 5 patients with anaphylaxis was significantly lower than in age-matched healthy subjects. Conclusion: IIVs induce IgE sensitization in healthy children, but also robust IgG4 responses that may protect them from anaphylaxis.

Cost-effective use of limited conservation resources requires understanding which data can most contribute to alleviating biodiversity declines. Interventions might reasonably prioritise life-cycle transitions with the greatest influence on population dynamics, yet some contributing vital rates are particularly challenging to document; such pragmatic decision-making risks suboptimal management if less is known about influential rates. We aimed to explore whether study effort aligns with demographic impact on population growth rate, λ. We parameterised a matrix population model using meta-analysis of vital rates for the common eider (Somateria mollissima), an increasingly threatened yet comparatively data-rich species of seaduck. Female common eiders exhibit intermittent breeding, with some established breeders skipping one or more years between breeding attempts. We accounted for this behaviour by building breeding propensity (= 0.72) into our model with a discrete and reversible ‘non-breeder’ stage (to which surviving adults transition with a probability of 0.28). The transitions between breeding and non-breeding states had twice the influence on λ than fertility (summed matrix-element elasticities of 24% and 11%, respectively), whereas almost 15 times as many studies document components of fertility than breeding propensity (n = 103 and n = 7, respectively). Through comparative re-analyses, we find similar results for two amphibian species, further supporting our finding that study effort does not always occur in proportion to relative influence on λ. Our workflow could form part of the toolkit informing future investment of finite resources, to avoid repeated disconnects between data needs and availability thwarting evidence-driven conservation.

Lobular endocervical glandular hyperplasia (LEGH) is characterized by clinically profuse and watery vaginal discharge. In pregnancy with LEGH, with watery fluid leakage persisting throughout pregnancy, it is often difficult to visually diagnose PROM. Adding to this difficulty, auxiliary diagnostic tests might also show positive results, complicating treatment and management.

The Synchronicity of Situs Inversus totalis (SIT) and infantile hypertrophic pyloric stenosis (IHPS) is a rare phenomenon. We have reported a case of this concurrency in a 3-day-old newborn with classic symptoms.

Background: Cancer diagnosis and its treatment may impair the long-term body image of childhood cancer survivors. This may be particularly relevant in adolescence, a critical period of psycho-social development. We compared the body image between adolescent cancer survivors and their siblings, and determined whether survivors’ body image is associated with socio-demographic characteristics, clinical characteristics, and health conditions. Procedure: As part of the nationwide Swiss Childhood Cancer Survivor Study, we sent questionnaires to adolescents (aged 16-19 years), who survived >5 years after having been diagnosed with childhood cancer between 1976-2010. Siblings received the same questionnaire. We assessed the level of agreement with three body image statements referring to body satisfaction and preferences for changes. Chronic health conditions were classified into cardiovascular, pulmonary, endocrine, musculoskeletal, renal/ digestive, neurological, and hearing or vision impairment. We used ordered logistic regression models to identify determinants of a more negative body image. Results: Our study included 504 survivors (48% female) with a median age at study of 17.7 years (IQR 16.8-18.6) and 136 siblings. Survivors and siblings reported overall comparable levels of the three body image statements (all p>0.05). Female survivors (all ORs ≥ 1.7), survivors treated with haematopoietic stem cell transplantation (all ORs ≥ 2.2), and survivors with ≥ 2 chronic health conditions (all ORs ≥ 1.4) reported a more negative body image. This was particularly pronounced for survivors suffering from musculoskeletal or endocrine conditions. Conclusion: Clinicians should address body image concerns in adolescent survivors with chronic conditions and offer psycho-social support if necessary.

Ecohydrological investigations commonly use the stable isotopes of water (hydrogen and oxygen) as a conservative ecosystem tracer. This approach requires accessing and analyzing water constrained within plant and soil matrices. Generally, there are six steps that researchers must pass through to retrieve hydrogen and oxygen isotope values from these plant and soil matrices: (i) sampling, (ii) sample storage and transport, (iii) extraction, (iv) pre-analysis processing, (v) isotopic analysis, and (vi) post-processing and correction. At each of these steps cumulative errors can be introduced which sum to non-trivial magnitudes. These errors can impact subsequent interpretations about water cycling through the soil-plant-atmosphere continuum. But these steps in the research ‘process chain’ are just the tip of the iceberg when it comes to uncertainly in published findings. At each of these discreet steps, there are multiple possible options to select from resulting in, as we will show, tens of thousands of possible combinations used by researchers to go from plant and soil samples to isotopic data. In a newly emerging science, so many options can create interpretive confusion and major issues with data comparability. This points to the need for the development of shared standardized approaches. Here we critically examine the state of the process chain, reflecting on the issues associated with each step, and end with suggestions to move our community towards standardization. We hope that critically assessing this common approach will help us see the current problem in its entirety and facilitate community action toward agreed upon standardized approaches.

Background Right ventricular dysfunction is a major cause of heart failure and mortality in end-stage renal disease patients. Scarce data is available regarding the comparison of echocardiographic right ventricular function in end-stage renal disease patients on hemodialysis (HD) and peritoneal dialysis (PD). The aim of the study was to evaluate the long-term impacts of different dialysis modalities on right ventricular function assessed by conventional echocardiography, in end-stage renal disease patients with preserved left ventricular function. Methods The study included 120 patients grouped as follows: PD(n=40), HD with arterio-venous fistula (n=40) and healthy control subjects (n=40). Conventional echocardiography was performed in all patients. A classification of right ventricular function was defined in HD patients by using tricuspid annular plane systolic excursion (TAPSE), right ventricular myocardial performance index (RV-MPI), fractional area change (FAC) and tricuspid lateral annulus systolic velocity (Sa) values. Correlation analysis was performed by using right ventricular dysfunction score, clinical and echocardiographic parameters. Results The mean age of the study population was 51.9±13.1 years and 47.5% were females. TAPSE and Sa velocity were found to be significantly lower and RV-MPI was significantly higher in patients undergoing HD, compared with control and PD patients. Logistic regression analysis showed that HD treatment was an independent risk factor for developing right ventricular dysfunction. Conclusion RV function was impaired in patients undergoing HD compared with patients on PD.

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Background: Clinical trial simulations and pharmacometric modeling of biomarker profiles for under-represented groups are challenging because the underlying studies frequently do not have sufficient participants from these groups. Objectives: To investigate generative adversarial networks (GANs), an artificial intelligence (AI) technology that enables realistic simulations of complex patterns, for modeling clinical biomarker profiles of under-represented groups. Methods: GANs consist of generator and discriminator neural networks that operate in tandem. GAN architectures were developed for modeling univariate and joint distributions of a panel of 16 diabetes-relevant biomarkers from the National Health and Nutrition Examination Survey (NHANES), which contains laboratory and clinical biomarker data from a population-based sample of individuals of all ages, racial groups, and ethnicities. Conditional GANs were used to model biomarker profiles for race/ethnicity categories. GAN performance was assessed by comparing GAN outputs to test data. Results: The biomarkers exhibited non-normal distributions and varied in their bivariate correlation patterns. Univariate distributions were modeled with generator and discriminator neural networks consisting of two dense layers with rectified linear unit-activation. The distributions of GAN-generated biomarkers were similar to the test data distributions. The joint distributions of the biomarker panel in the GAN-generated data were dispersed and overlapped with the joint distribution of the test data as assessed by three multi-dimensional projection methods. Conditional GANs satisfactorily modeled the joint distribution of the biomarker panel in the Black, Hispanic, White, and “Other” race/ethnicity categories. Conclusions: GAN are a promising AI approach for generating virtual patient data with realistic biomarker distributions for under-represented race/ethnicity groups.

Background: Inappropriate humidification of inspired gas during mechanical ventilation can impair lung development in extremely low birthweight (ELBW) infants. Humidification depends on multiple factors, such as the heater-humidifier device used, type of ventilation, and environmental factors. Few studies have examined inspired gas humidification in these infants, especially during high-frequency oscillatory ventilation (HFOV). Our objective was to compare humidity during HFOV and intermittent positive pressure ventilation (IPPV), in vitro and in vivo. Methods: In-vitro and in-vivo studies used the same ventilator during both HFOV and IPPV. The bench study used a neonatal test lung and 2 heater-humidifiers with their specific circuits; the in-vivo study prospectively included preterm infants born before 28 weeks of gestation.  Results: On bench testing, mean absolute (AH) and relative (RH) humidity values were significantly lower during HFOV than IPPV (RH = 79.4% ± 8.1% vs 89.0% ± 6.2%, P<0.001). Regardless of the ventilatory mode, mean relative humidity significantly differed between the 2 heater-humidifiers (89.6% ± 6.7% vs 78.7% ± 6.8%, P=0.003). The in-vivo study included 10 neonates (mean ± SD gestational age: 25.7 ± 0.9 weeks and birth weight: 624.4 ± 96.1 g). Mean relative humidity during HFOV was significantly lower than during IPPV (74.6% ± 5.7% vs 83.0 ± 6.7%, P=0.004).  Conclusion: Relative humidity was significantly lower during HFOV than IPPV, both in vitro and in vivo. The type of heater-humidifier also influenced humidification. More systematic measurements of humidity of inspired gas, especially during HFOV, should be considered to optimize humidification and consequently lung protection in ELBW infants.

Arrestins are important scaffolding proteins that are expressed in all vertebrate animals. They regulate cell signaling events upon binding to active G-protein coupled receptors ( GPCR) and trigger endocytosis of active GPCRs. While many of the functional sites on arrestins have been characterized, the question of how these sites interact is unanswered. We used anisotropic network modelling ( ANM) together with our covariance compliment techniques to survey all of the available structures of the non-visual arrestins to map how structural changes and protein-binding affect their structural dynamics. We found that activation and clathrin binding have a marked effect on arrestin dynamics, and that these dynamics changes are localized to a small number of distant functional sites. These sites include α-helix 1, the lariat loop, nuclear localization domain, and the C-domain β-sheets on the C-loop side. Our techniques suggest that clathrin binding and/or GPCR activation of arrestin perturb the dynamics of these sites independent of structural changes.

Background: The novel method of left bundle branch pacing (LBBP) has been reported to achieve better electrical and mechanical synchrony in the left ventricle than conventional right ventricular pacing (RVP). However, its effects on right ventricle (RV) performance are still unknown. Methods: Consecutive patients undergoing dual-chamber pacemaker (PM) implantation for sick sinus syndrome (SSS) with normal cardiac function and a narrow QRS complex were recruited for the study. The pacing characteristics and echocardiogram parameters were measured to evaluate RV function, interventricular and RV synchrony, and were compared among ventricular pacing‐on and native‐conduction modes. Results: A total of 84 patients diagnosed with SSS and an indication for pacing therapy were enrolled. Forty-two patients (50%; mean age 65.50 ± 9.30 years; 35% male) underwent successful LBBP and 42 patients (50%; mean age 69.26 ± 10.08 years; 33% male) RVSP, respectively. Baseline characteristics were similar between the two groups. We found no significant differences in RV function [RV-FAC (Fractional Area Change)%, 47.13±5.69 vs. 48.60±5.83, p=.069; Endo-GLS (Global Longitudinal Strain)%, -28.88±4.94 vs. -29.82±5.35, p=.114; Myo-GLS%, -25.72±4.75 vs. -25.72±5.21, p=.559; Free Wall St%, 27.40±8.03 vs. -28.71±7.34, p=.304] between the native‐conduction or LBBP capture modes, while the RVSP capture mode was associated with a significant reduction in the above parameters compared with the native‐conduction mode (P < .0001). The interventricular synchrony in the LBBP group was also superior to the RVSP group significantly. Conclusion: LBBP is a pacing technique that seems to associate with a positive and protective impact on RV performance.

Background The decision to conserve or replace the native aortic valve following acute type-A aortic dissection (ATAAD) is an area of cardiac surgery without standardised practice. This single centre retrospective study analysed the long-term performance of the native aortic valve and root following surgery for ATAAD. Methods Between 2009 and 2018 all cases ATAAD treated at Royal Brompton and Harefield NHS Foundation Trust were analysed. Patients were divided into 2 groups: a) ascending aorta (interposition) graft (AAG) without valve replacement; and b) non-valve-sparing aortic root replacement (ARR). Pre-operative covariates were compared, as well as operative characteristics and post-operative complications. Long-term survival and echocardiographic outcomes were analysed using regression analysis. Results In total, 116 patients were included: 63 patients in the AAG group and 53 patients in the ARR group. In patients where the native aortic valve was conserved, 9 developed severe aortic regurgitation and 2 patients developed dilation of the aortic root requiring subsequent replacement during the follow-up period. Aortic regurgitation at presentation was not found to be associated with subsequent risk of developing severe aortic regurgitation or reintervention on the aortic valve. Overall mortality was observed to be significantly lower in patients undergoing AAG (17.5% vs. 41.5%, p=0.004). Conclusions With careful patient selection, the native aortic root shows good long-term durability both in terms of valve competence and stable root dimensions after surgery for ATAAD. This study supports the consideration of conservation of the aortic valve during emergency surgery for type-A dissection, in the absence of a definitive indication for root replacement, including in cases where aortic regurgitation complicates the presentation.

In open bite cases, a comprehensive diagnostic differentiation is crucial in determining the best corrective therapy. In non-surgical open bite treatment, fixed appliances, either labial or lingual, are usually employed. With the addition of extra-radicular screws, more sophisticated orthodontic movements may now be performed without the necessity for orthognathic surgery.

We present a case of a man who had chronic otitis media caused acute bacterial meningitis due to Streptococcus pneumoniae. The neuroimaging indicated thick exudates in the CSF spaces. Our patient's CSF consisted of frank pus. The CSF white blood cell count was highly elevated, not reported in prior literature.