To contain transmission of COVID-19, lockdown or strict restriction of people’s mobility outside their residence was imposed worldwide. In Nepal, the first phase of nationwide lockdown was observed from March 24 to July 21, 2020. This sudden halt in human activities brought positive and negative impacts on forests and wildlife. We undertook a study was undertaken to know the impact of the CoViD-19 lockdown on wildlife and forests in the protected areas (PAs) of Nepal. The study was carried in July and September 2020, data of illegal activities recorded by the PAs and also those reported by media were obtained and analyzed. Key Informant Interview (KII) was done with the park officers and security personnel by virtual communication that included telephone, messenger app, and ZOOM video meeting to collect detailed information and for verification. The collected data were categorized into four groups: i) wildlife killed, ii) wildlife injured, iii) arrest incidents related to forest crime, and iv) arrest incidents related to wildlife crime. Data from the fiscal year 2019-2020 were analyzed, comparing before lockdown and after. The study found trends of substantial increases in. wildlife death in two PAs, Banke National Park and Bardia National Park out of 20 during the lockdown. Similarly, Chitwan National Park (CNP) and Shivapuri Nagarjun National Park (SNNP) witnessed a rise in wildlife poaching. CNP and SNNP are located close to highly populated cities and also having human settlements in their peripheries. Interestingly, wildlife was easily sighted inside PAs during the lockdown, presumably because the absence of visitors and human activities during the lockdown decreased disturbance. Thus, a paradoxical situation was observed with the wildlife enjoying the freedom of movement on the one hand, but with poachers, many of them laid off from other activities, taking advantage of the lapse in security.

The TGF-β-Th2 axis: a new target for cancer therapy?García de Durango C1, Escribese MM2, Rosace D3.1: DKTK Research Group, Oncogenic Signalling Pathways of Colorectal Cancer, Institute of Pathology, Ludwig-Maximilians-Universität München, Munich, Germany.2: Institute of Applied Molecular Medicine (IMMA), Department of Basic Medical Sciences, Facultad de Medicina, Universidad San Pablo-CEU, CEU Universities, Urbanización Montepríncipe, 28660 Boadilla del Monte, Madrid, Spain.3: Centro De Investigación Del Cáncer and Instituto De Biología Molecular Y Celular Del Cáncer, Consejo Superior De Investigaciones Científicas (CSIC) - Universidad de Salamanca, Salamanca, Spain.Correspondence :Domenico Rosace, Centro De Investigación Del Cáncer and Instituto De Biología Molecular Y Celular Del Cáncer, Consejo Superior De Investigaciones Científicas (CSIC) - University of Salamanca, Salamanca, Spain. [email protected]

Objective The My Baby’s Movements (MBM) trial aimed to evaluate the impact on stillbirth rates of a multifaceted awareness package (MBM intervention). Design Stepped-wedge cluster-randomised controlled trial. Setting Twenty-seven maternity hospitals in Australia and New Zealand. Population Women with a singleton pregnancy without major fetal anomaly ≥28 weeks’ gestation from August 2016-May 2019. Methods The MBM intervention was implemented at randomly assigned time points with sequential introduction into 8 clusters of 3-5 hospitals at four-monthly intervals. The stillbirth rate was compared in the control and intervention periods. Generalised linear mixed models controlled for calendar time, clustering, and hospital effects. Outcome Measures Stillbirth at ≥28 weeks’ gestation. Results There were 304,853 births with 290,219 meeting inclusion criteria: 150,079 in control and 140,140 in intervention periods. The stillbirth rate during the intervention was lower than the control period (2.2/1000 births versus 2.4, odds ratio [OR] 0.91, 95% Confidence Intervals [CI] 0.78-1.06, p=0.22). The decrease was larger across calendar time with 2.7/1000 in the first 18 months versus 2.0/1000 in the last 18 months (OR 0.74; 95% CI 0.63-0.86; p≤0.01). Following adjustment, stillbirth rates between the control and intervention periods were not significantly different: (aOR 1.18, 95% CI 0.93-1.50; p=0.18). No increase in secondary outcomes, including obstetric intervention or adverse neonatal outcome, was evident. Conclusion The MBM intervention did not reduce stillbirths beyond the downward trend over time, suggesting hospitals may have implemented best practice in DFM management outside their randomisation schedule. The role of interventions for raising awareness of DFM remains unclear

Objective: To evaluate early changes in left ventricular systolic function in patients with systemic lupus erythematosus (SLE) using three-dimensional speckle tracking imaging (3D-STI). Methods: Thirty SLE patients and 30 healthy people (control group) were selected, the patients were further divided into subgroups according to their Safety of Estrogens in Lupus Erythematosus National Assessment version of the SLE Disease Activity Index (SELENA-SLEDAI) score: SELENA-SLEDAI ≤ 12 (mild-to-moderate group), SELENA-SLEDAI > 12 (severe group). Blood samples were obtained from patients and laboratory investigations were performed. All participants were examined using 3D-STI, the 3D conventional and strain parameters were obtained. The above parameters were compared in the three studied groups. Receiver operating curves (ROC) were prepared for above parameters and analyzed to identify correlations among LVEF, GLS, GCS, LVtw, Tor, MCI and hs-TropT. Results: Compared with the control group, the absolute values of LVEDV, LVEF, GLS, GCS, LVtw, Tor and MCI decreased, LV EDmass, LV ESmass and PSD increased in the mild-to-moderate and the severe groups (P2 < 0.05, P3 < 0.05). There was statistically significant difference in terms of strain parameters between the mild-to-moderate group and the severe group (P1 < 0.05). The highest area under the ROC for MCI was 0.909, the highest sensitivity for MCI was 90.00%, and the highest specificity for Tor was 86.67%. Correlation analysis showed that there was a good correlation between the MCI and hs-TropT (r = − 0.677). Conclusion: 3D-STI technology may help detect early changes in left ventricular systolic function in patients with SLE

Immunoglobulin E (IgE)-mediated allergy is the most common hypersensitivity disease affecting more than 30% of the population. In genetically-predisposed subjects exposure to minute quantities of allergens leads to the production of IgE antibodies which is termed allergic sensitization and mainly occurs in early childhood. Allergen-specific IgE then binds to the high (FcRI) and low affinity receptors (FcRII, also called CD23) for IgE on effector cells and antigen-presenting cells, respectively. Subsequent and repeated allergen exposure increases allergen-specific IgE levels and, by receptor cross-linking, triggers immediate release of inflammatory mediators from mast cells and basophils whereas IgE-facilitated allergen presentation perpetuates T cell-mediated allergic inflammation. Due to engagement of receptors which are highly selective for IgE even tiny amounts of allergens can induce massive inflammation. Naturally occurring allergen-specific IgG and IgA antibodies usually recognize different epitopes on allergens compared to IgE, and do not efficiently interfere with allergen-induced inflammation. However IgG and IgA antibodies to these important IgE epitopes can be induced by allergen-specific immunotherapy or by passive immunization. These will lead to competition with IgE for binding with the allergen and prevent allergic responses. Similarly, anti-IgE treatment does the same by preventing IgE from binding to its receptor on mastcells and basophils. Here we review the complex interplay of allergen-specific IgE, IgG and IgA and the corresponding cell receptors in allergic diseases and its relevance for diagnosis, treatment and prevention of allergy.

De-oiled canola meals are sources of protein-containing flavor-active phenolic compounds. Conventional canola oil processing utilizes an excess amount of solvents and is associated with the release of high-intensity bitter flavor-active phenolic compounds, limiting the use of the canola meal. Recent advances in the extraction and isolation of the bitter favor-active phenolic compounds from canola by-products produce protein isolates, however, would benefit the industry by producing a side-stream ingredient rich in phenolics. High temperature and pressure-aided processing, namely the accelerated solvent extraction (ASE) was investigated to extract the flavor-active bitter molecules from the canola meal. The extractability of flavor-active phenolic compounds including the major sinapates, kaempferol derivatives, and other thermo-generative compounds including thomasidioc acid (TA) was evaluated. The effects of temperature, solvent extractant and concentration, and the particle size of the meal, were examined on the extraction efficiency of these phenolic compounds. Extraction temperature (180oC) was the primary determinant (p<0.05) for the attenuation of major sinapates including sinapine and sinapic acid. Both ethanol and methanol extractants at a concentration of 70% (v/v) significantly (p<0.05) extracted the flavor-active phenolic compounds. The pressurized high temperature through optimized ASE conditions attenuated the bitter undesirable flavor-active phenolic molecules from canola meal thereby facilitating a potential value-added phenolic-rich by-product.

In this paper, we investigate the decay properties of suspension bridge with memories in one dimension. To prove our results, we use the energy method to build some very delicate Lyapunov functionals that give the desired results.

Title of the manuscriptComment on: Parents’ responses to prognostic disclosure at diagnosis of a child with a high-risk brain tumor: Analysis of clinician-parent interactions and implications for clinical practiceThe role of reflection in dealing with uncertainty

A 52-year-old man was admitted to our hospital for “CT-diagnosed thoracic-abdominal aortic aneurysm”. One week ago, the patient had repeated dry coughs and went to the local hospital for treatment. A chest radiograph revealed a huge mass in the left thoracic cavity. A further chest CT examination revealed a thoracic-abdominal aortic aneurysm and was transferred to our hospital for surgical treatment.The patient is almost healthy, with no fever, no severe chest and abdomen pain, no dyspnea, no dysphagia or other clinical symptoms. Ten years ago, the patient underwent “ascending aorta and total aortic arch replacement surgery” in another cardiovascular hospital due to aortic dissection involving the ascending aorta and aortic arch (Debakey I).The patient’s thoracic-abdominal aortic aneurysm is huge and has a high risk of rupture. Recently, the patient has undergone thoracic-abdominal aortic replacement surgery and is recovering well.

This clinical case demonstrated surgical management of a giant congenital left ventricular aneurysm in a 2-month-old female using the Dor procedure. Transthoracic echocardiography performed at 6-month follow-up showed an ejection fraction of 66%.

There has been a compelling body of evidence of COVID-19 causing cardiac complications such as myocarditis and increased risk of coronary thrombosis. Acute coronary syndrome due to coronary vasospasm is an unusual occurrence.

Mechanical complications of myocardial infarction are rare. However, the consequences are catastrophic if missed; here, we present a case highlighting the red flags that can guide the diagnosis of mechanical complications of MI.

A document by Joan Lalor. Click on the document to view its contents.

Cysticercosis in humans is a serious public health problem, predominantly affecting low and middle-income countries (LMICs). Cysticercosis, the infection with the larval form of the pork tapeworm, Taenia Solium has high prevalence in areas where there are poor sanitary conditions and domestic pig without adequate veterinary control. Humans are the definitive host and pigs are the main source of infection. Human infection occurs when pork is eaten raw or undercooked. Ingested eggs or proglottids hatch into larvae form, which penetrate the intestinal wall into the blood stream and migrate into different organs including subcutaneous tissues, brain, eyes and rarely heart or lung, where they mature into cysticerci. Pulmonary cysticercosis has been rarely described; case reports are predominantly in adults and are usually of disseminated disease. In children the data are very scarce, with a single case report of a two-year old child with pulmonary infiltration, eosinophilia and subcutaneous cysticercosis.

Abstract Introduction: Linear ablation in addition to pulmonary vein antrum isolation (PVAI) has failed to improve the success rate for persistent atrial fibrillation (PeAF), due to incomplete block of ablation lines, especially in the mitral isthmus (MI). Methods and results: The study enrolled 191 patients (66 in group 1 and 125 in group 2). In group 1, EI-VOM was firstly performed, followed by radiofrequency (RF) applications targeting bilateral PVAI and bidirectional block in the roofline, cavotricuspid isthmus, and MI. In group 2, PVAI and the three linear ablations were completed using only RF energy. MI block was achieved in 63(95.5%) and 101(80.8%) patients in group 1 and 2, respectively (p=0.006). Patients in group 1 had shorter ablation time for left pulmonary vein antrum (8.15 min vs 12.59 min, p<0.001) and MI (7.0 min vs 11.8 min, p<0.001) and required less cardioversion (50(78.5%) vs 113(90.4%), p=0.007). During the 12-month follow-up, 58 (87.9%) patients were free from AF/AT in group 1 compared with 81 (64.8%) in group 2 (p<0.001). In multivariate cox regression, the ‘upgraded 2C3L’ procedure is associated with a lower recurrence rate (HR 0.27, 95%CI 0.12-0.59). Conclusion: Compared with the conventional ‘2C3L’ approach, the ‘upgraded 2C3L’ approach has higher effectiveness for ablation of PeAF.

Background - Since SARS-CoV-2 spread, evidences regarding sex differences in progression and prognosis of COVID-19 have emerged. Besides this, studies on patients’ clinical characteristics have described electrolyte imbalances as one of the recurrent features of COVID-19. Methods - We performed a case-control study on all patients admitted to the emergency department (ED) from 1st March to 31st May 2020 who had undergone a blood gas analysis and a nasopharyngeal swab test for SARS-CoV-2 by rtPCR. We defined positive patients as cases and negatives as controls. The study was approved by the local ethics committee Area 3 Milan. Data were automatically extracted from the hospital laboratory SQL-based repository in anonymized form. We considered as outcomes potassium (K+), sodium (Na+), chlorine (Cl-) and calcium (Ca++) as continuous and as categorical variables, in their relation with age, sex and SARS-CoV-2 infection status. Results - We observed a higher prevalence of hypokalemia among patients positive for SARS-CoV-2 (13.7% vs 6% of negative subjects). Positive patients had a higher probability to be admitted to the ED with hypokalemia (OR 2.75, 95% CI 1.8-4.1 p<0.0001) and women were twice as likely to be affected than men (OR 2.43, 95% CI 1.67-3.54 p<0.001). Odds ratios for positive patients to manifest with an alteration in serum Na+ was (OR 1.6, 95% CI 1.17-2.35 p<0.001) and serum chlorine (OR 1.6, 95% CI 1.03-2.69 p<0.001). Notably, OR for positive patients to be hypocalcemic was 7.2 (95% IC 4.8-10.6 p<0.0001) with a low probability for women to be hypocalcemic (OR 0.63, 95% IC 0.4-0.8 p=0.005). Conclusions - SARS-CoV-2 infection is associated with a higher prevalence of hypokalemia, hypocalcemia, hypochloremia and sodium alterations. Hypokalemia is more frequent among women and hypocalcemia among men.

Studies reporting S. warneri in infective endocarditis (IE) are rare. We presented a 72-year-old woman with native mitral valve S. warneri IE associated with spondylitis and cerebellar infarction. Physicians should be wary of IE and disseminated lesions when blood cultures reveal S. warneri, especially in elderlies with valvular heart disease.

Lipomatous hypertrophy of the interatrial septum (LHIAS) is a benign cardiac tumor. Differential diagnosis of LHIAS consists of atrial masses such as myxomas or lipomas. Herein, we report a 66-year-old male, admitted as a case of severe COVID-19 and was found to have a LHIAS extending to the crista terminalis.