Objective This study has been compared the effectiveness of different surgical methods in the treatment of mitral regurgitation (MR) in adults by using network meta-analysis method, so as to provide reference for clinical selection of the best surgical scheme. Methods The PubMed, EMBASE, the Cochrane Library, CNKI and Chongqing VIP Information databases were comprehensively searched until December 2020. We collected retrospective comparative studies on surgical procedures including 3D endoscopic mitral valve surgery(3D-MVS), robot assisted mitral valve surgery(R-MVS); totally thoracoscopic mitral valve surgery(T-MVS), small incision mitral valve surgery (M-MVS) and traditional thoracotomy mitral valve surgery(C-MVS). Addis1.16.8 software was used for network meta-analysis. Results A total of 31 studies were included, 12998 patients, involving 5 surgical methods. Network Meta analysis showed that: in terms of complications (OR: 0.65, 95% CI: 0.13 to 3.00, probability rank = 0.37) and mitral regurgitation (OR:0.03, 95%CI: 0.0 to 8315, probability rank=0.64), the 3D-MVS group had the lowest event rate. In terms of blood transfusion rate (OR: 0.55, 95% CI: 0.16 to 1.84, probability rank=0.45), T-MVS had the lowest event rate. In addition, with the exception of operation time and chest drainage, the R-MVS group has the best curative effect. Conclusion These minimally invasive surgery has their own advantages and disadvantages. Overall, 3D-MVS is most satisfactory, but more samples are needed.

Introduction: Standard two-dimensional (2D), phased-array intracardiac echocardiography (ICE) is routinely used to guide interventional electrophysiology (EP) procedures. A novel four-dimensional (4D) ICE catheter (VeriSight Pro®, Philips, Andover, MA) can obtain 2D and three-dimensional (3D) volumetric images and cine-videos in real time (4D). The purpose of this study was to determine the early feasibility and safety of this 4D ICE catheter during EP procedures. Methods: The 4D ICE catheter was placed from the femoral vein in ten patients into various cardiac chambers to guide EP procedures requiring transseptal catheterization, including ablation for atrial fibrillation and left atrial appendage closure. 2D- and 3D- ICE images were acquired in real time by the electrophysiologist. A dedicated imaging expert performed digital steering to optimize and post-process 4D images. Results: Eight patients underwent pulmonary vein isolation (cryoballoon in 7 patients, pulsed field ablation in 1, additional radiofrequency left atrial ablation in 1). Two patients underwent left atrial appendage closure. High quality images of cardiac structures, transseptal catheterization equipment, guide sheaths, ablation tools, and closure devices were acquired with the ICE catheter tip positioned in the right atrium, left atrium, pulmonary vein, coronary sinus, right ventricle, and pulmonary artery. There were no complications. Conclusion: This is the first-in-human experience of a novel deflectable 4D ICE catheter used to guide EP procedures. 4D ICE imaging in safe and allows for acquisition of high-quality 2D and 3D images in real-time. Further use of 4D ICE will be needed to determine its added value for each EP procedure type.

Background and aim of the study: Blood cysts of cardiac valves are generally seen in newborns and infants and very rarely in adults. Although in most cases they are incidental findings they may be associated to severe cardiac or systemic complications. This study analyzes incidence, presentation and treatment of valvular blood cysts in adults. Methods: A review of the pertinent literature through a search mainly on PubMed and Medline was performed. Results: In patients ≥ 18 years of age, our search disclosed 54 patients with mitral blood cysts (mean age, 48±18 years), 9 with a tricuspid valve cyst (mean age, 67±15 years), 3 with a blood cyst on the pulmonary valve (age 31, 43 and 44 years) and 1 aortic valve cyst in a 22-year-old man. Most patients were asymptomatic while stroke, syncope or myocardial infarction occurred in 6 patients with a mitral valve cyst. Blood cysts were removed surgically in 70% of patients with a mitral cyst, in 55% with a tricuspid cyst and in all those with a pulmonary or aortic cyst. At histology the cyst wall was composed mainly by fibrous tissue and with the inner surface lined with typical endothelium. Conclusions: Blood cysts of cardiac valves are rare in adults but may cause life-threatening complications particularly when located on the mitral valve. For such reason surgical removal appears advisable, with low-risk procedures. Widespread use of multimodality imaging techniques will most likely increase the number of valvular blood cysts diagnosed also in adults.

As a continuation of Part I (Int. Journal of Quantum Chem. 2021; 121: qua.26586), dedicated to the ground state of He-like and Li-like isoelectronic sequences for nuclear charges Z ≤ 20, a few ultra-compact wave functions in the form of generalized Hylleraas-Kinoshita functions are constructed, which describe the domain of applicability of the Quantum Mechanics of Coulomb Charges (QMCC) for energies (4-5 significant digits (s.d.)) of two excited states of He-like ions: the spin-singlet (first) excited state 2¹S and for lowest spin-triplet 1³S state. For both states it provides absolute accuracy for energy ∼10−3a.u., exact values for cusp parameters and also for 6 expectation values the relative accuracy ∼10−2. Bressanini-Reynolds observation about the special form of nodal surface of 2¹S state for Helium is confirmed and extended to ions with Z > 2. Critical charges Z = ZB, where ultra-compact trial functions loose their square-integrability, are estimated: ZB(1¹S)≈ZB(2¹S)∼0.905 and ZB(1³S)∼0.902. For both states the Majorana formula - the energy as the second degree polynomial in Z - provides accurately the 4-5 significant digits for Z ≤ 20.

When grown under cool temperature, winter annuals upregulate photosynthetic capacity as well as freezing tolerance. Here, the role of three cold-induced C-repeat-Binding Factor (CBF1–3) transcription factors in photosynthetic upregulation and freezing tolerance was examined in two Arabidopsis thaliana ecotypes originating from Italy (IT) or Sweden (SW), and their corresponding CBF1–3-deficient mutant lines it:cbf123 and sw:cbf123. Photosynthetic, morphological, and freezing-tolerance phenotypes as well as gene expression profiles were characterized in plants grown from seedling stage under different combinations of light level and temperature. Under high light and cool growth temperature (HLC), a greater role of CBF1–3 in IT versus SW was evident from both phenotypic and transcriptomic data, especially with respect to photosynthetic upregulation and freezing tolerance of whole plants. Overall, features of SW were consistent with a different approach to HLC acclimation than seen in IT, and an ability of SW to reach the new homeostasis through involvement of transcriptional controls other than CBF1–3. These results provide tools and direction for further mechanistic analysis of the transcriptional control of approaches to cold acclimation suitable for either persistence through brief cold spells or for maximization of productivity in environments with continuous low temperatures.

Achieving a healthy weight balance has been a central focus of care for people who have cystic fibrosis (CF). Over the years, the emphasis has primarily been on promoting weight gain in order to optimize pulmonary outcomes. With continued improvements in CF care, including highly effective CF modulator available for many people, the CF community is now experiencing a new challenge: addressing the concern that some people are gaining weight excessively. While at this time, we do not know to what extent overweight and obesity will affect health outcomes for people with CF, it is likely that excessive weight gain may have negative health impacts similar to those seen in the general population. In this paper, we review the history of nutritional guidelines for people with CF, as well as more recent trends toward overweight and obesity for some. A multidisciplinary approach is needed to collaboratively start the oftentimes difficult conversation regarding excessive weight gain, and to identify resources to help people achieve and maintain a healthy weight through diet, exercise, and behavioral modification.

Cutaneous Leishmaniasis (CL) is the most prevalent clinical form of leishmaniasis. CL is difficult for the clinicians to diagnose because of the rarity of the disease and non-specific presentation. As CL is rare and given the limitation of available diagnostic modalities in a resource poor setting, diagnosis can be confusing.

Recurrent cervical osteomyelitis after radiation therapy in a patient with oropharyngeal cancerYoji Hoshina MD1* , Takashi Takeuchi MD21Department of General Medicine, Chiba University Hospital, Japan2Department of Radiology, Chiba University Hospital, Japan

Extrahepatic Mucinous Biliary Cystadenoma is an extremely rare clinical entity which can present with varieties of vague clinical signs and symptoms. Gastric outlet obstruction caused due to this has never been reported before. We highlighted the diagnostic dilemma we faced, when radiological investigations couldnot suggest the accurate organ of origin.

Background: The left ventricle (LV) journey in their transition from hypertrophy to heart failure is marked by many subcellular events partially understood yet. The moment in which the structural abnormalities reach the umbral to induce myocardial dysfunction remains elusive. Aims: To evaluate the anatomic-functional relationship between LV wall thickness and longitudinal systolic dysfunction. Material and Methods: We prospectively performed clinical history and transthoracic echocardiogram on healthy individuals and patients with hypertension, left ventricle ejection fraction (LVEF) ≥50%, and absence of heart failure symptoms. Results: A total of 226 patients and 101 healthy individuals were recruited. The distribution for sex was similar between groups. The mean age was 67±13 years old in the patients, and 44% had concentric LV hypertrophy. LVEF was identical in both groups (63±6%); in contrast, global longitudinal strain (GLS) (-18.8±2.5% vs. -20.4±2%) and mitral annulus plane systolic excursion (MAPSE) (13.8±2.8 vs. 15.5±2mm) were lower. ROC curve classified optimally decreased GLS with LV septum thickness ≥13mm and decreased MAPSE with thickness ≥14mm. Multivariable logistic regression found that LV septum thickness is the only variable associated with longitudinal systolic dysfunction (OR= 1.1, CI95%= 1.05 – 1.15, p= 0.001, R squared= 0.38). Discussion: A progressive increase in LV wall thickness due to myocyte hypertrophy and interstitial expansion is associated with LV systolic longitudinal dysfunction. Conclusions: Patients with moderate or severe ventricular hypertrophy (septum ≥13mm) had longitudinal systolic dysfunction, GLS decreases with minor structural change than MAPSE, and LVEF is insensitive in detecting longitudinal myocardial dysfunction in patients with hypertension.

Despite many studies showing biodiversity responses to warming, the generality of such responses across taxonomic groups remains unclear. Very few studies have tested for evidence of bryophyte community responses to warming, even though bryophytes are major contributors to diversity and functioning in many ecosystems. Here we report an empirical study comparing long-term change of bryophyte and vascular plant communities in two sites with contrasting long-term warming trends, using “legacy” botanical records as a baseline for comparison with contemporary resurveys. We hypothesized that ecological changes would be greater in sites with a stronger warming trend, and that vascular plant communities, with narrower climatic niches, would be more sensitive than bryophyte communities to climate warming. For each taxonomic group in each site, we quantified the magnitude of changes in species’ distributions along the elevation gradient, species richness, and community composition. We found contrasted temporal changes in bryophyte vs. vascular plant communities, which only partially supported the warming hypothesis. In the area with a stronger warming trend, we found a significant increase of local diversity and beta-diversity for vascular plants, but not for bryophytes. Presence absence data did not provide sufficient power to detect elevational shifts in species distributions. The patterns observed for bryophytes are in accordance with recent literature showing that local diversity can remain unchanged despite strong changes in composition. Regardless of whether one taxon is systematically more or less sensitive to environmental change than another, our results suggest that vascular plants cannot be used as a surrogate for bryophytes in terms of predicting the nature and magnitude of responses to warming. Thus, to assess overall biodiversity responses to global change, abundance data from different taxonomic groups and different community properties need to be synthesized.

Defect and doping are effective methods to modulate the physical and chemical properties of materials. In this report, we investigated the structural stability, electronic properties and quantum capacitance (Cdiff) of Zr2CO2 by changing the dopants of Si, Ge, Sn, N, B, S and F in the substitutional site. The doping of F, N, and S atoms makes the system undergo the semiconductor-to-conductor transition, while the doping of Si, Ge, and Sn maintains the semiconductor characteristics. The Cdiff of the doped systems are further explored. The B-doped system can be used as cathode materials, while the systems doped by S, F, N, Sn atoms are promising anode materials of asymmetric supercapacitors, especially for the S-doped system. The improved Cdiff mainly originates from Fermi-level shifts and Fermi-Dirac distribution by the introduction of the dopant. The effect of temperature on Cdiff is further explored. The result indicates that the maximum Cdiff of the studied systems gradually decreases with the increasing temperature. Our investigation can provide useful theoretical basis for designing and developing the ideal electrode materials for supercapacitors.

Introduction: The current study aims to evaluate the relationship between C-reactive protein (CRP) levels, thorax CT findings and CT-SS in patients presenting to the emergency department with COVID-19. Methods: Patients diagnosed with COVID-19 by nasopharyngeal rt-PCR (+) in the emergency department were included in the study. In addition to the CRP, ferritin and D-dimer examinations of patients at admission, thorax CT involvement findings and CT-SS results were recorded. The relationship of CRP value with CT-SS and clinical outcome was evaluated. Results: A total of 974 COVID-19 patients, 572 males (58.7%) and 402 females (41.3%), with a mean age of 59.64±17.34 years, were included in the study. The CRP values of the patients who needed intensive care and needed respiratory support were also significantly higher at admission (95.1 mg/dL vs. 31.05 mg/dL) (p<0.001). The CRP values of the patients who developed any complications during the treatment of COVID-19 were higher (79.9 mg/dL vs. 41.85 mg/dL) (p<0.001). In the case of CRP >124.5, a thorax CT density score 7.35 times higher was determined to be severe. In addition, it was determined that there was a 9.09-fold increase in the incidence of negative imaging findings in terms of COVID-19 in cases where the CRP value was <12.5 mg/dL. Conclusion: The CRP levels of COVID-19 patients measured upon admission to the emergency room are correlated with the severity of lung involvement and are an important predictor of clinical outcomes.

To enhance the catalytic performance of H2SO4-catalyzed alkylation, various catalytic additives have drawn considerable attention. Herein, the effects of deep eutectic solvents additives (DESs) on catalytic performance and interfacial properties of H2SO4 alkylation were systematically investigated using experimental methods and molecular dynamics (MD) simulation. Experimental results indicate that DESs additives with the optimal concentration about 1.0 wt% can efficiently improve C8 selectivity and research octane number (RON) of alkylate. However, DESs additives contribute less to the quality of alkylate at low temperature and to the lifetime of H2SO4. MD results reveal that the phenyl molecules of DESs additives play a major role in enhancing interfacial properties of H2SO4 alkylation, including enlargement of interfacial thickness, promotion of isobutane relative solubility and diffusion to butene, which is probably the main reason for the better quality of alkylate. This work gives a good guideline for the design of novel DESs for H2SO4 alkylation.

A class of time-varying delay distributed parameter systems with input saturation is investigated in this paper. The periodic intermittent control method is adopted to make the system stable in finite time, improve the control performance of the system, and save on control cost. A periodic intermittent controller combined saturated input is designed to ensure the stability of the proposed system in finite time. Lyapunov--Krasoviskii stability theory and Matrix inequality techniques are used to analyze the finite-time stability of the system, and sufficient conditions for the system to be stable in finite time are obtained. Finally, the correctness of the theorems is verified by simulation experiments.

In most HIV models, the emergence of backward bifurcation means that the control for basic reproduction number less than one is no longer effective for HIV treatment. In this paper, we study an HIV model with CTL response and cell-to-cell transmission by using the dynamical approach. The local and global stability of equilibria is investigated, the relations of subcritical Hopf bifurcation and supercritical bifurcation points are revealed, especially, the so-called new type bifurcation is also found with two Hopf bifurcation curves meeting at the same Bogdanov-Takens bifurcation point. Forward and backward bifurcation, Hopf bifurcation, saddle-node bifurcation, Bogdanov-Takens bifurcation are investigated analytically and numerically. Two limit cycles are also found numerically, which indicates that the complex behavior of HIV dynamics. Interestingly, the role of cell-to-cell interaction is fully uncovered, it may cause the oscillations to disappear and keep the so-called new type bifurcation persist. Finally, some conclusions and discussions are also given.

Aim: The risk-benefit profile of angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) in coronavirus disease 2019 (Covid-19) is still a matter of debate. With growing evidence on the protective effect of this group of commonly used antihypertensives in Covid-19, we aimed to thoroughly investigate the association between the use of major classes of antihypertensive medications and Covid-19 outcomes in comparison with the use of ACEIs and ARBs. Methods: We conducted a population-based study in patients with pre-existing hypertension in the UK Biobank. Multivariable logistic regression analysis was performed adjusting for a wide range of confounders. Results: The use of either beta-blockers (BBs), calcium-channel blockers (CCBs), or diuretics was associated with a higher risk of Covid-19 hospitalization compared to ACEI use (adjusted OR, 1.63; 95% CI, 1.40 to 1.90) and ARB use (adjusted OR, 1.50; 95% CI, 1.27 to 1.77). The risk of 28-day mortality among Covid-19 patients was also increased among users of BBs, CCBs or diuretics when compared to ACEI users (adjusted OR, 1.64; 95% CI, 1.23 to 2.19) but not when compared to ARB users (adjusted OR, 1.18; 95% CI, 0.87 to 1.59). However, no associations were observed when the same analysis was conducted among hospitalized Covid-19 patients only. Conclusion: Our results suggest protective effects of blocking of the renin-angiotensin-aldosterone system on Covid-19 hospitalization and mortality among patients with pharmaceutically treated hypertension, which should be addressed by randomized controlled trials. If confirmed, this finding could have high clinical relevance for treating hypertension during the SARS-CoV-2 pandemic.

Background: The effects of infection and developmental adaptations in infancy on the prevalence of subsequent atopy-related diseases at different ages during childhood are not fully determined. This study aims to examine the similarities and differences in the age-specific association of asthma, allergic rhinitis/conjunctivitis, and atopic dermatitis with early life infection (i.e., daycare, older siblings, and severe airway infection) and developmental adaptations (i.e., preterm birth and overweight gain) in children. Methods: In this longitudinal cohort study (n = 47,015), children were followed from 0.5 to 11 years. The potential risks and protective factors, including daycare attendance at 0.5 years, existence of older siblings, history of hospitalization due to cold/bronchitis/bronchiolitis/pneumonia during 0.5–1.5 years, preterm birth, and overweight gain at 1.5 years, were assessed using multivariable logistic regression with adjustments for potential confounders. Results: A negative association was observed between early life daycare attendance and asthma at 5.5–9 years, which disappeared after 10 years. A negative association was also noted throughout childhood between early life daycare attendance and the presence of older siblings with allergic rhinitis/conjunctivitis. However, the association between early daycare and atopic dermatitis was found to be positive during childhood. In contrast, the early life history of hospitalization owing to cold/bronchitis/bronchiolitis/pneumonia was identified to be a risk factor for developing both asthma and allergic rhinitis/conjunctivitis. Preterm birth was a significant risk factor for childhood asthma. Conclusion: Different age-specific patterns were demonstrated in the relationship between early life daycare, severe airway infection, preterm birth, and atopy-related diseases in childhood.