Demonstration that the myocardial sleeves of the pulmonary veins (PVs) are the main triggering and maintaining foci for paroxysmal atrial fibrillation (AF) have stimulated studies investigating electrophysiological properties of PVs and the adjacent left atrial (LA) myocardium. It has been shown that PV myocytes have a shorter action potential duration and are more prone to effects of local autonomic nerve stimulation in terms of shortening of action potential duration, early after depolarization formation and triggered firing compared to left atrial myocytes (1). The intrinsic cardiac autonomic nervous system (ICANS) forms clusters of neurons called ganglionic plexi (GPs), and studies using histologic examination of heart sections have shown that these GPs are localized preferentially at certain epicardial sites adjacent to the left and right atria (2). The precise role of ICANS in AF continues to be an area of intense research (3), and matters are not helped by the uncertainty regarding the best way to identify and target ICANS peri-procedurally. As there can be significant variability of GP sites in individual patients, endocardial high-frequency stimulation (HFS) has been used to aid their localization in the electrophysiology laboratory (4).

Despite great advances in surgeries, the management of patients with impaired left ventricular ejection fraction is still challenging. Furthermore, evidences on outcomes of off-pump coronary artery bypass surgery (OPCAB) in this population are inconsistent. We conducted present study to compare the short and long-term outcomes in patients with different ejection fractions undertaken OPCAB.

Background：Depression is one of the most common and specific symptoms among postmenopausal women, leading to significant personal, family, and economic burdens. Some studies have shown that phytoestrogens can help relieve symptoms of depression. Objectives: This systematic review and meta-analysis aims to assess the efficacy and safety of phytoestrogens in treating depression among postmenopausal women. Methods: A comprehensive search for relevant studies published until November 25, 2020, was conducted in PubMed, the Cochrane Library, Chinese Biomedical Literature Database, Web of Science, and EMBASE. Statistical analyses were performed with Stata12.0, Comprehensive Meta-Analysis 3.0, and Review Manager 5.4. Results: 2,183 studies were identified and 10 studies were included, involving 1,248 participants. The quality of the four studies was assessed as high risk, six studies were assessed as unclear. The analyses conducted according random effects model indicated a positive effect on depressive symptoms for postmenopausal women compared to the placebo (SMD=-0.45; 95% [CI]= -0.60 to -0.29; Q=40.42, df=18, P=0.002; I2=55.5%). The high dose phytoestrogens (dose>100mg/day) have better effectiveness (SMD =-0.48; 95%[CI]= -0.76 to -0.20; I2=52.8%, P<0.05) than low dose (25mg/day≤dose≤100mg/day) (SMD=-0.45; 95%[CI]=-0.68 to-0.23; I2=66.7%; P>0.05) and ultralow dose (00.05). Isoflavones had better effectiveness (SMD=-0.52; 95% [CI]= -0.75 to 0.30; I2=65.8%, P<0.05) than lignans of phytoestrogens (SMD= -0.23; 95% [CI]= -0.05 to 0.01; I2=0%, P>0.05). The effectiveness varies in regions. The adverse reactions frequently reported were gastrointestinal symptoms and cold or upper respiratory tract infection. Conclusions: Phytoestrogen can relieve depression symptoms among postmenopausal women. High-dose isoflavones is the most effective. Although mild adverse reactions have been reported, phytoestrogen could be considered as a complementary treatment for postmenopausal depression.

This paper is devoted to study the discrete Sturm-Liouville problem $$ \left\{\begin{array}{ll} -\Delta(p(k)\Delta u(k-1))+q(k)u(k)=\lambda m(k)u(k)+f_1(k,u(k),\lambda)+f_2(k,u(k),\lambda),\ \ k\in[1,T]_Z,\\[2ex] a_0u(0)+b_0\Delta u(0)=0,\ a_1u(T)+b_1\Delta u(T)=0, \end{array}\right. $$ where $\lambda\in\mathbb{R}$ is a parameter, $f_1, f_2\in C([1,T]_Z\times\mathbb{R}^2, \mathbb{R})$, $f_1$ is not differentiable at the origin and infinity. Under some suitable assumptions on nonlinear terms, we prove the existence of unbounded continua of positive and negative solutions of this problem which bifurcate from intervals of the line of trivial solutions or from infinity, respectively.

Thrombocytosis, an uncommon side effect of all-trans retinoic acid (ATRA) treatment, occurs in some patients with acute promyelocytic leukemia. Our case showed thrombocytosis on day 26 to day 32 of ATRA and arsenic trioxide therapies and then started to decrease gradually without changing ATRA dosage. Thrombocytosis may associate with cytokine.

Synthetic microbial communities have the potential to enable new platforms for bioproduction of biofuels and biopharmaceuticals. However, using engineered communities is often assumed to be difficult because of anticipated challenges in establishing and controlling community composition. Cross-feeding between microbial auxotrophs has the potential to facilitate co-culture growth and stability through a mutualistic ecological interaction. We assessed cross-feeding between 13 Escherichia coli amino acid auxotrophs paired with a leucine auxotroph of Bacillus megaterium. We developed a minimal media capable of supporting the growth of both bacteria and used the media to study co-culture growth of the 13 interspecies pairs of auxotrophs in batch and continuous culture, and on semi-solid media. In batch culture, eight of thirteen pairs of auxotrophs were observed to grow in co-culture. We developed a new metric to quantify the impact of cross-feeding on co-culture growth. Six pairs also showed long-term stability in continuous culture, where co-culture growth at different dilution rates highlighted differences in cross-feeding amongst the pairs. Finally, we found that cross-feeding-dependent growth on semi-solid media is highly stringent and enables identification of the most efficient pairs. These results demonstrate that cross-feeding is a viable approach for controlling community composition within diverse synthetic communities.

A document by Isabella Annesi. Click on the document to view its contents.

We describe a case of dynamic obstruction of the mesenteric arteries caused by aortic dissection. The flow pattern demonstrates a periodic flow variation, during which peak systolic velocity varied fourfold.

Background: Tens of thousands of Australians become ill with influenza annually, causing thousands of severe infections that require hospitalisation. However, only 40% of adults receive the annual influenza vaccine. We surveyed Australian adults to provide up-to-date data on the predictors and barriers of seasonal influenza vaccination. Methods: We administered an online survey to a nationally representative sample of Australian adults. We designed survey questions using the constructs of the health belief model. Using simple and multivariable Poisson regression, we identified attitudes and beliefs associated with influenza vaccination in 2019. Results: Among 1,444 respondents, 51.7% self-reported influenza vaccination in 2019. We estimated vaccine coverage to be 44% for adults under 45, 46% for adults aged 45 to 64, and 77% for adults aged 65 and over. The strongest individual predictors of self-reported vaccination were believing the vaccine is effective at preventing influenza (APR = 3.71; 95% CI = 2.87-4.80), followed by recalling their doctor recommending the vaccine (APR = 2.70; 95%CI = 2.31-3.16). Common perceived barriers that predicted self-reported vaccination included believing the vaccine could give you influenza (APR = 0.59; 95% CI = 0.52-0.67), believing the vaccine can make you ill afterwards (APR = 0.68; 95% CI = 0.62-0.74), and preferring to develop immunity “naturally” (APR = 0.38; 95% CI = 0.32-0.45). Conclusion: Although vaccine uptake in 2019 appears to be higher than previous years, there are perceived barriers which may limit uptake among Australians. Tailored interventions are needed to combat widespread influenza vaccine hesitancy, particularly among high risk grou

Effects of K deficiency have been investigated for several decades and recently, progress has been made in identifying metabolomics signatures thereby offering potential to monitor the K status of crops in the field. However, effects of low K conditions could also be due to the antagonism with other nutrients like calcium (Ca) and the well-known biomarker of K deficiency, putrescine, could be a response to Ca/K imbalance rather than K deficiency. We carried out experiments in sunflower grown at either low or high K, at high or low Ca, with or without putrescine added to the nutrient solution. Using metabolomics and proteomics analysis, we show that a significant part of the low-K response such as lower photosynthesis and N assimilation, is due to calcium and can be suppressed by low Ca conditions. Putrescine addition tends to restore photosynthesis and N assimilation but but aggravates the impact of low-K conditions on catabolism. We conclude that (i) effects of K deficiency can be partly alleviated by the use of low Ca and not only by K fertilization, and (ii) in addition to its role as a metabolite, putrescine participates in the regulation of the content in enzymes involved in carbon primary metabolism.

While pulmonary vein isolation (PVI) remains the cornerstone for invasive treatment of atrial fibrillation (AF), patients with persistent AF still have a high rate of recurrence with this method. Stochastic Trajectory Analysis of Ranked signals (STAR) mapping uses data from multiple individual wavefronts during ongoing AF to identify local drivers of persistent AF. In this non-randomized study, STAR mapping and ablation showed significantly lower recurrence of atrial arrhythmias compared to a consecutive PVI-only cohort and a propensity-matched ‘conventional ablation’ cohort (consisting of PVI plus complex fractionated atrial electrogram ablation or linear ablation). This benefit was driven by a much lower rate of AF recurrence in the STAR (6.2%) cohort vs PVI-only (44%) or ‘conventional’ (40%) with no significant difference in atrial tachycardia recurrence. Additionally, AF termination rates during ablation were approximately three times higher in the STAR cohort. While the analysis is retrospective and not randomized, the STAR cohort was also the only cohort with complete cessation of anti-arrhythmic drugs at three months and Holter monitoring at 6 and 12 months post-ablation per protocol. While STAR mapping appears to be a very promising new tool for treating persistent AF, history predicts at least some regression to the mean when future randomized comparisons are made. The authors have planned a multicenter randomized trial of PVI plus STAR mapping vs PVI-only for persistent AF. The global community of electrophysiologists and patients with AF eagerly awaits the results.

Object: To compare the clinical data of sternotomy and left intercostals incision, combined with the literature, to provide the best surgical incision for committed subarterial ventricular septal defect（DCS-VSD）. Methods: From July 2016 to July 2020, a total of 117 cases of occlusion surgeries for DCSVSD, which guided by transoesophagel echocardiography(TEE) were completed, including 34 cases with sternotomy incision and 83 cases with left intercostal incision. Statistics and analysis of the operation and follow-up. Results: 115 cases successfully occluded, the successful rate was 98.29%, and 1 case failed in each group. Pericardial effusion occurred in 5 children after the drainage device was removed, and the pericardial effusion disappeared after diuretic treatment. There was no statistical difference between the two groups in operation time, occlusion time, thoracotomy time and postoperative hospital stay. All the children recovered and were discharged from the hospital, and were followed up for 2-30 months after operation. Conclusion: TEE-guided intercostal DCS-VSD occlusion is safe and effective. There is no statistical difference between two approach with the operation time, chest opening and closing time, occluder placing time, and postoperative hospital staying. At the same time, the surgical incision by intercostal incisionis smaller and the operation invasion is less, it is a surgical approach which worth to develop.

Inhaled nebulised unfractionated heparin (UFH) has a strong scientific and biological rationale that warrants urgent investigation of its therapeutic potential in patients with COVID-19. UFH has antiviral effects and prevents the SARS-CoV-2 virus’ entry into mammalian cells. In addition, UFH has significant anti-inflammatory and anti-coagulant properties, which limit progression of lung injury and vascular pulmonary thrombosis. Methods and intervention The INHALEd nebulised unfractionated HEParin for the treatment of hospitalised patients with COVID-19 (INHALE-HEP) meta-trial is a prospective individual patient data analysis of on-going randomised controlled trials and early phase studies. Individual studies are being conducted in multiple countries. Participating studies randomise adult patients admitted to the hospital with confirmed SARS-CoV-2 infection, who do not require immediate mechanical ventilation, to inhaled nebulised UFH or standard care. All studies collect a minimum core dataset. The primary outcome for the meta-trial is intubation (or death, for patients who died before intubation) at day 28. The secondary outcomes are oxygenation, clinical worsening and mortality, assessed in time-to-event analyses. Individual studies may have additional outcomes. Analysis We use a Bayesian approach to monitoring, followed by analysing individual patient data, outcomes and adverse events. All analyses will follow the intention-to-treat principle, considering all participants in the treatment group to which they were assigned, except for cases lost to follow-up or withdrawn. Trial registration, ethics and dissemination The meta-trial is registered at ClinicalTrials.gov ID NCT04635241. Each contributing study is individually registered and has received approval of the relevant ethics committee or institutional review board.

SARS-CoV-2 infection may present with numerous neurological manifestations. We report the case of a young obese lady, recently discharged after treatment for COVID-19 infection, who later presented with headache and blurred vision, diagnosed to have pseudotumor cerebri and concurrent bilateral optic neuritis.

Cell viability evaluation is significantly meaningful for cellular assays. Some cells with weak viability are easily killed in the detection of anti-cancer drugs, while others with strong viability survive and proliferate, ultimately leading to the treatment failure or the inaccuracy of biological assays. Accurately evaluating cell viability heterogeneity still remains difficult. This paper proposed a multi-physical property information fusion method for evaluating cell viability heterogeneity based on multiple linear regression (MLR) on a single-channel integrated microfluidic chip. In this method, adhesion strengths τN, that are defined as the magnitude of shear stress needed to detach (100-N) % of cell population, were extracted as the independent variables of MLR model by calculating the linear fitting of the impedance-response curves for shear stress (cell detachment assay). Besides, by calculating the non-linear fitting of the drug dose-response curves for cancer cells (IC50 assay), the half-maximal inhibitory concentration (IC50) was extracted as the dependent variables of MLR model. The results show that the mean relative error of our fusion method reduces by 17.87% and 59.66% compared with the single-parameter method and the cell counting method. Moreover, through the theoretical analysis of the drug resistance heterogeneity model, it proved that there is a qualitative relationship between the cell adhesion strength and cell viability heterogeneity, which provides a theoretical basis for our fusion method.

This case report describes the clinical history of a COVID-19 patient with a non-immediate diagnosis of severe dysphagia that required a gastrostomy positioning. A vocal folds paresis was observed for the first time in the course of a Sars-CoV-2 infection. Thanks to intensive rehabilitation treatment, the outcome was favourable.

Koebner phenomenon regards the formation of a psoriatic lesion after a trauma, including tattoo, insect bite or other injuries. Although this manifestation is not specific for psoriasis, physicians should be aware because early recognition may be helpful in making the diagnosis when present.

Here we report a Turkish child with Ellis-van Creveld syndrome whose presentation was short strature, hypodontia, narrow thorax, dysplastic nails, cardiac abnormality and polydactyly. Genetic analysis revealed novel homozygous mutation in the EVC2 gene (c.3533_3546del). Further research is needed to elucidate the pathophysiological course