Background: Hereditary angioedema (HAE) attacks can be provoked with psychological factors. The aim of this study was to assess the effects of anxiety, depression and stress related to COVID-19 pandemic on disease activity of HAE patients during the quarantine period (QP) and the return to normal period (RTNP). Methods: This prospective study was conducted between March 2020 and September 2020 in four allergy centres. Demographic, clinical features and mental health status were evaluated in QP (from March to the beginning of June) and RTNP (from June to the beginning of September) was applied by the government. The 10-point visual analogue scale (VAS10) was used to define the severity of HAE attacks. Depression-Anxiety- Stress Scale-21 (DASS-21) and Fear of Covid-19 (FC-19) scales were performed to assess mental health status. Results: 139 HAE patients were included in the study. In QP, median attack numbers and median VAS10 scores were 5 (min-max: 0-45) and 6 (min-max: 0-10), respectively. HAE attack numbers, DASS-21 stress, anxiety, depression and total DASS-21 scores, as well as FC-19 scores were higher in QP than RTNP (p= 0.001, p <0,001, p = 0,001, p <0,001, p <0.001, p<0.001, respectively). However, there was no difference in attack severity scores between the two periods (p>0.05). Conclusions: This study revealed that the restriction measures during Covid-19 outbreak causes an increase in the number of HAE attacks in relation to anxiety, depression, stress and fear of Covid-19 pandemic. Therefore, it is important to provide psychological support to HAE patients during the pandemic.

Background: Food allergy is a major health problem that significantly impacts quality of life (QoL). There is growing focus to evaluate food allergy related QoL and treatment value beyond the clinical effectiveness perspective by engaging patients and caregivers. We aimed to identify and prioritize outcomes important to food allergy parents of children and patients allergic to milk, egg, and/or peanut, to guide comparative effectiveness research (CER) that focuses on evaluating food allergy treatment decisions. Methods: We conducted a modified 3-round Delphi study to identify and derive consensus on priority treatment outcomes for parents of children and adult patients with diagnosed allergies to at least one of three major allergenic foods (milk, egg, and peanut) from across the United States. Results: Round 1 yielded 44 statements for round 2, and 39 statements reached the agreement level for round 3 ranking. Statements were organized under 4 sections: 1) food allergy problems, 2) treatment experiences, 3) important treatment outcomes, and 4) value of different treatment options. Conclusion: Food allergy parents and patients face several social, psychological, medical, healthcare, financial, food selection, and awareness challenges. The areas of consensus on important treatment outcomes revealed shared priority for reducing the risk of potentially fatal allergic reactions and having reliable treatments. The most valued treatment options reflect hope for permanent cure and fear of serious allergic reactions.

The importance of del nido cardioplegia solution in coronary artery bypass surgeryMehmet Senel Bademcia MD, Cemal Kocaaslana MD Fatih Avni BayraktaraMD, Ahmet Oztekina MD, Huseyin Bilal Aydina MD, and Ebuzer Aydin a MD.a Istanbul Medeniyet University, Medicine Faculty, Department of Cardiovascular Surgery, Istanbul, TurkeyCorresponding Author: Mehmet Senel Bademci,M.D, Assist.Prof.Post Publication Corresponding Author: Mehmet Senel Bademci,M.D, Assist.Prof.Istanbul Medeniyet University Medicine Faculty, Department of Cardiovascular Surgery.Address: Dr. Erkin St. No:12 Kadikoy, Istanbul, 34722, Turkey.Mail address: [email protected] Editor;We read with interest the article by Algarni [1] published entitled “Routine use of del Nido cardioplegia compared with blood cardioplegia in all types of adult cardiac surgery procedures.” Algarni KD. Routine use of del Nido cardioplegia compared with blood cardioplegia in all types of adult cardiac surgery procedures. J Card Surg. 2020;10.1111/jocs.15060In this study; Del Nido cardioplegia group has shorter aortic cross-clamp time for coronary artery by pass graft patients. But there is no sufficient data about the number of distal anastomosis between cardioplegia groups. If there is a significant difference between groups, this answer can change the aortic cross clamp times regardless of cardioplegia.We congratulate Algarni et al. for their valuable manuscript about cardioplegia solutions in coronary artery bypass surgery. We would like to hear authors’ opinion on this matter.References:1. Algarni KD. Routine use of del Nido cardioplegia compared with blood cardioplegia in all types of adult cardiac surgery procedures. J Card Surg. 2020;10.1111/jocs.15060.

Alternative reproductive tactics (ARTs) have provided valuable insights into how sexual selection and life history tradeoffs can lead to variation within a sex. However, the possibility that tactics may constrain evolution through intralocus tactical conflict (IATC) is rarely considered. In addition, when IATC has been considered, the focus has often been on the genetic correlations between the ARTs, while evidence that the ARTs have different optima for associated traits and that at least one of the tactics is not at its optima is often missing. Here we investigate selection on three traits associated with the ARTs in the swordtail fish Xiphophorus multilineatus; body size, body shape and the sexually selected trait for which these fishes were named, sword length (elongation of the caudal fin). All three traits are tactically dimorphic, with courter males being larger, deeper bodied and having longer swords, and the sneaker males being smaller, more fusiform and having shorter swords. Using measures of reproductive success in a wild population we calculated selection differentials, linear and quadratic gradients, demonstrate that the tactics have different optima and at least one of the tactics is not at its optima for body size and sword length. Our results provide the first evidence of selection in the wild on the sword, an iconic trait for sexual selection. In addition, given the high probability that these traits are genetically correlated to some extent between the two tactics, our study suggests that IATC is constraining both body size and the sword from reaching their phenotypic optima. We discuss the importance of considering the role of IATC in the evolution of tactical dimorphism, how this conflict can be present despite tactical dimorphism, and how it is important to consider this conflict when explaining not only variation within a species but differences across species as well.

Many insects possess the plastic ability to either develop directly to adulthood, or enter diapause and postpone reproduction until the next year, depending on environmental cues (primarily photoperiod) that signal the amount of time remaining until the end of the growth season. These two developmental pathways often differ in co-adapted life history traits, e.g. with slower development and larger size in individuals headed for diapause. The developmental timing of these differences may be of adaptive importance: if pathways diverge late, the scope for phenotypic differences is smaller, whereas if pathways diverge early, the risk is higher of expressing a maladaptive phenotype if the selective environment changes. Here we explore the effects of changes in photoperiodic information during life on pupal diapause and associated life history traits in the butterfly Pararge aegeria. We find that both pupal diapause and larval development rate are asymmetrically regulated: while exposure to long days late in life (regardless of earlier experiences) was sufficient to produce nondiapause development and accelerate larval development accordingly, more prolonged exposure to short days was required to induce diapause and slow down pre-diapause larval development. While the two developmental pathways diverged early in development, development rates could be partially reversed by altered environmental cues. Meanwhile, pathway differences in body size were more inflexible, despite emerging late in development. Hence, in P. aegeria several traits are regulated by photoperiod, along subtly different ontogenies, into an integrated phenotype that strikes a balance between flexibility and phenotype-environment matching.

Aiming at improving the visible-light photocatalytic activities of TiO2(101) surface (TiOS) we make an in-dept study on the TiOS doped with 4d transition metal (TM) atoms. It is shown that the 4d TM dopings can not only produce new impurity energy bands in the bandgap but also result in the semiconductor-metal phase transition. Consequently, the visible-light absorption is strongly strengthened due to the dopings of Y, Zr, Nb, Mo, and Ag, while it is only weakly improved for Tc, Ru, Rh, Pd, and Cd dopings. The improvement in visible-light absorption can be attributed to the intraband or interband transition of electrons. Moreover, the photocatalytic activities are explored, and we find Y and Ag dopings can effectively enhance the photocatalytic activity of TiOS. Thus the mechanism of improving photocatalytic activity of TiOS has been clearly addressed, which is beneficial to further experimental and theoretical researches on TiO2 photocatalysts.

Rationale, Aims and Objectives: One of the sectors challenged by the COVID-19 pandemic is medical research. COVID-19 originates from a novel coronavirus (SARS-CoV-2) and the scientific community is faced with the daunting task of creating a novel model for this pandemic or, in other words, creating novel science. This paper aims to explore the intricate relationship between the different challenges that have hindered biomedical research and the generation of scientific knowledge during the COVID-19 pandemic. Methods: During the early stages of the pandemic, research conducted on hydroxychloroquine (HCQ) was chaotic and sparked several heated debates with respect to the scientific methods used and the quality of knowledge generated. Research on HCQ is used as a case study in this paper. The authors explored biomedical databases, peer-reviewed journals, pre-print servers and media articles to identify relevant literature on HCQ and COVID-19, and examined philosophical perspectives on medical research in the context of this pandemic and previous global health challenges. Results: This paper demonstrates that a lack of prioritization among research questions and therapeutics was responsible for the duplication of clinical trials and the dispersion of precious resources. Study designs, aimed at minimizing biases and increasing objectivity, were, instead, the subject of fruitless oppositions. These two issues combined resulted in the generation of fleeting and inconsistent evidence that complicated the development of public health guidelines. The reporting of scientific findings highlighted the difficulty of finding a balance between accuracy and speed. Conclusions: The COVID-19 pandemic presented challenges in terms of (1) finding and prioritizing relevant research questions, (2) choosing study designs that are appropriate for a time of emergency, (3) evaluating evidence for the purpose of making evidence-based decisions and (4) sharing scientific findings with the rest of the scientific community. This paper demonstrates that these challenges have often compounded each other.

The active rock glacier “Innere Ölgrube”, and its catchment area (Ötztal Alps, Austria) are assessed using various hydro(geo)logical tools to provide a thorough catchment characterization and to quantify temporal variations in recharge and discharge components. During the period from June 2014 to July 2018, an average contribution derived from snowmelt, ice melt and rainfall of 35,8 %, 27,6 % and 36,6 %, respectively, is modelled for the catchment using a rainfall-runoff model. Discharge components of the rock glacier springs are distinguished using isotopic data as well as other natural and artificial tracer data, when considering the potential sources rainfall, snowmelt, ice melt and groundwater. Seasonal as well as diurnal variations in runoff are quantified and the importance of shallow groundwater within this rock glacier-influenced catchment is emphasized. Water derived from ice melt is suggested to be provided mainly by melting of two small cirque glaciers within the catchment and subordinately by melting of permafrost ice of the rock glacier. The active rock glacier is characterized by a layered internal structure with an unfrozen base layer responsible for groundwater storage and retarded runoff, a main permafrost body contributing little to the discharge (at the moment) by permafrost thaw and an active layer responsible for fast lateral flow on top of the permafrost body. Snowmelt contributes at least 1/3rd of the annual recharge. During droughts, meltwater derived from two cirque glaciers provides runoff with diurnal runoff variations; however, this discharge pattern will change as these cirque glaciers will ultimately disappear in the future. The storage-discharge characteristics of the investigated active rock glacier catchment are an example of a shallow groundwater aquifer in alpine catchments that ought to be considered when analysing (future) river runoff characteristics in alpine catchments as these provide retarded runoff during periods with little or no recharge.

Rock glaciers are increasingly influencing the hydrology and water chemistry of Alpine catchments, with important implications for drinking water quality and ecosystem health under a changing climate. During summers of 2017 - 2019, we monitored the physical and chemical conditions of springs emerging from two active rock glaciers (ZRG and SRG) with distinct geomorphological settings in the Eastern Italian Alps (Solda/Sulden catchment). Both springs had constantly cold waters (1.4 ± 0.1 °C), and their ionic composition was dominated by SO42-, HCO3-, Ca2+ and Mg2+. Concentrations of major ions and trace elements, and values of water isotopes (δ18O, δ2H), increased towards autumn with an asymptotic trend at SRG, and a positive unimodal pattern at ZRG, where concentrations peaked 60 - 80 days after the end of the snowmelt. Wavelet analysis on electrical conductivity (EC) and water temperature records revealed daily cycles only at SRG, and significant weekly/biweekly fluctuations at both springs attributable to oscillations of meteorological conditions. Several rainfall events triggered a transient (0.5 - 2 hrs) EC drop and water temperature rise (dilution and warming) at SRG, whereas only intense rainfall events occasionally increased EC at ZRG (solute enrichment and thermal buffering), with a long-lasting effect (6 - 48 hrs). Our results, supported by a limited but emerging literature, suggest that: i) the distinctive composition of the bedrock drives different concentrations of major ions and trace elements in rock glacier springs; ii) pond-like and stream-like springs have distinct fluctuations of water parameters at different timescales; iii) peaks of EC/solute concentrations indicate a seasonal window of major permafrost thaw for rock glaciers feeding pond-like springs. These results provide a first quantitative description of the hydrological seasonality in rock glacier outflows, and their hydrochemical response to precipitation events, bringing relevant information for water management in the European Alps under climate change.

Involvement of small airways, those of less than 2 mm in internal diameter, is present in all stages of asthma and contributes substantially to the pathophysiologic expression of asthma. Therefore, small airways are increasingly viewed as a potential target in optimal asthma control. Airway tone, which is increased in asthma, is mainly controlled by the vagus nerve that releases acetylcholine (ACh) and activates muscarinic ACh receptors (mAChRs) post-synaptically on airway smooth muscle (ASM). In small airways, M3 mAChRs are expressed, but there is no vagal innervation. Non-neuronal ACh released from the epithelial cells that may express choline acetyltransferase (ChAT) in response to inflammatory stimuli, as well as from other structural cells in the airways, including fibroblasts and mast cells, can activate these receptors. By antagonizing M3 mAChR, the contraction of the ASM is prevented and, potentially, local inflammation can be reduced and the progression of remodeling may be affected. In fact, ACh also contributes to inflammation and remodeling of the airways and regulates the growth of ASM. Several experimental studies have demonstrated the potential benefit derived from the use of mAChR antagonists, mainly long-acting mAChR antagonists (LAMAs), on small airways in asthma. However, there are several confounding factors that may cause a wrong estimation of the relationship between LAMAs and small airways in asthma.

The aim of this work is to prove analytically the existence of symmetric periodic solutions of the family of Hamiltonian systems with Hamiltonian function H(q_1,q_2,p_1,p_2)= 1/2(q_1^2+p_1^2)+1/2(q_2^2+p_2^2)+ a q_1^4+b q_1^2q_2^2+c \q_2^4 with three real parameters a, b and c. Moreover, we characterize the stability of these periodic solutions as function of the parameters. Also, we find a first-order analytical approach of these symmetric periodic solutions. We emphasize that these families of periodic solutions are different from those that exist in the literature.

Background: Data related to electrophysiologic characteristics of atypical atrial flutter (AFL) following atrial fibrillation (AF) ablation and its prognostic value on repeat ablation success are limited. Methods: We studied consecutive patients undergoing a repeat LA ablation for either recurrent AF or atypical AFL, following 3 months after index AF ablation, between January 2012 and July 2019. The demographics, procedural data, complications, and 1-year arrhythmia-free survival rates were recorded for each subject after the first repeat ablation. Results: Of the total 336 included patients, 102 underwent a repeat ablation for atypical AFL and 234 for recurrent AF. The mean age was 63.7  10.7 years, and 72.6 % of patients were male. The atypical AFL cohort had significantly higher LA diameters (4.6 vs. 4.4 cm, p=0.04) and LA volume indices (LAVi; 85.1 vs. 75.4 ml/m2, p=0.03) compared to AF patients at repeat ablation. Atypical AFLs were roof-dependent in 35.6% and peri-mitral in 23.8% of cases. Major complications at repeat ablation occurred in 0.9 % of the total cohort. Arrhythmia-free survival at one year was significantly higher in the recurrent atypical AFL than the recurrent AF cohort (75.5 vs. 65.0 %, p=0.04). Conclusion: In our series, roof-dependent flutter is the most common form of atypical atrial flutter post AF ablation. Patients developing atypical AFL after index AF ablation have greater LA dimensions than patients with recurrent AF. The success rate of first repeat ablation is significantly higher among patients with recurrent atypical AFL compared to recurrent AF after index AF ablation.

Liu et al. reviewed case reports of type A acute aortic dissection occurring in the last trimester of pregnancy and described the fetal and maternal outcomes after cesarean section and aortic intervention.

A patient with hypothyroidism, Addison’s disease, and celiac disease had persistent hypothyroid symptoms, and frequent fluctuations in TSH, prompting transition to L-T4 sodium oral solution (Tirosint®-SOL). Implementing a gluten-free diet and switching to the oral solution significantly improved malabsorptive and subsequent hypothyroid symptoms without the need to increase L-T4 dosage.

Medullary and papillary thyroid carcinoma are two distinct neoplasms. Its simultaneous is uncommon and its occurrence as a mixed follicular medullary carcinomas is extremely rare. We present a 60-year-old man with the mixed medullary-papillary carcinoma of the thyroid and papillary and medullary component metastases on lymph nodes.

Mini-commentary on BJOG-20-1239.R3: Intramuscular oxytocin versus Syntometrine versus carbetocin for prevention of primary postpartum haemorrhage after vaginal birth: a randomised double blinded clinical trial of effectiveness, side effects and quality of life

Banks-Leite et al. (2021) claim that our suggestion of preserving ≥40% forest cover lacks evidence and can be problematic. We find these claims unfounded, and discuss why conservation planning urgently requires valuable, well-supported, and feasible general guidelines like the 40% criterion. Using region-specific thresholds worldwide is unfeasible and potentially harmful.

Background: Despite clear clinical benefits, there is limited evidence regarding possible complications of the novel mechanical support device Impella. Aortic and mitral valve regurgitation or injury are rare but potential complications following implantation of the Impella device. Methods: To evaluate valvular complications after the Impella device implantation, we have performed a comprehensive search of literature on multiple sites on this topic. Results and Conclusion: Ten case reports and one observational retrospective study were identified, with a total number of 19 patients identified. This article aims to draw attention to potential periprocedural complications relating to the Impella, in particular iatrogenic aortic and mitral valve injuries. Moreover, we have summarized our recommendations emphasizing the need for careful management and meticulous follow-up of these patients to avoid such potentially devastating complications.