Abstract Objective: To evaluate whether smoking cessation has an effect on female sexual function and quality of life. Methodology: After approval by the local ethics committee, smoking and non-smoking female participants were included in the study and all participants filled the female sexual function index (FSFI) and the short form 36 (SF-36). The same questionnaires were filled again at the 9th month control after smoking cessation. The scores of these questionnaires were compared between the groups. In addition, the FSFI and SF-36 scores of the participants in the smoking group were also compared with the scores at the 9th month after smoking cessation. Results: The rate of FSD was significantly higher in the smoking group when compared with control group (86.0% vs 32.5%; p<0,001). The FSFI total and sub domains score was significantly lower in the smoking group when compared control group [21.5 (min:14.4-max:28.69) and 28.9 (min:17.7-max:32.8); p<0.001 respectively]. The rate of FSD was significantly decreased after nine months smoking cessation (86% to 35.1%; p<0.001). After smoking cessation significant improvements on FSFI total and sub-domain scores and SF-36 sub-domain scores were determined. Conclusion: In this study, it was shown that smoking negatively affected FSD and QOL when compared to healthy non-smoking women, and smoking cessation caused significant improvements in FSFI and SF-36 scores in these women after 9 months. Keywords: female sexual dysfunction, female sexual function index, smoking cessation, the Short Form 36, quality of life.

Spinal cord ischemia remains a dreadful complication after thoracoabdominal aortic aneurysm repair. The role of cerebrospinal fluid drain in such patients needs further clarifications. Tam and colleagues carried out an interesting decision analysis study that supports the routine use of the cerebrospinal fluid drain after thoracoabdominal aneurysm repair. They also demonstrated that the use of the cerebrospinal drain was safe. Here, we firstly discuss the paper's finding and methodology and, secondly, we try to simply explain what a decision analysis study is and, broadly, and how to construct a Markov model.

Sustained ventricular tachycardia and ventricular fibrillation (VF) are life-threatening arrhythmias which remain highly prevalent in patients with advanced heart failure. These ventricular arrhythmias may impair the support provided by CF-LVADs and lead to frequent hospitalizations, antiarrhythmic medication use, external defibrillations, and need for heart transplantation. We report a case in which a patient with a CF-LVAD and an ICD at end-of-life (EOL) presented with asymptomatic low-flow alarms and was found to have VF of unknown duration. Unique in our case was the presence of organized contractility and rhythmic opening of the mitral valve on echocardiogram despite VF on ECG.

A document by Nilay Aksoy. Click on the document to view its contents.

This is an invited commentary on robotic reoperative surgery without cardioplegia. Tips and shortfalls are discussed.

A rapid biodiversity assessment of insects and associated Laboulbeniales fungi was conducted over the course of five nights in August, 2018 at two central Florida lakes: Lake Eustis and the nearby protected and restored National Natural Landmark, Emeralda Marsh Conservation Area (EMCA), which encompasses a portion of Lake Griffin. These locations were selected because Lake Eustis was surveyed for Laboulbeniales in 1897 by mycologist Dr. Roland Thaxter, but has not since been investigated. Because Lake Eustis has been urbanized, with the lake perimeter almost entirely altered by human development, the site offers a look into Laboulbeniales diversity across a 121 year timeline, before and after human development. By surveying Lake Eustis and EMCA, a modern case study comparison of Laboulbeniales and insect diversity between a developed and unrestored system and a protected and restored system is made. A total of 4,022 insects were collected during the rapid assessment. Overall, insect abundance was greater at EMCA, with 3,001 insects collected, compared to 1,021 insects collected from Eustis. Though family level insect richness was comparable between sites, with 55 families present at EMCA and 56 at Eustis, 529 out of 3,001 (17.6%) of the insects collected at EMCA were hosts to parasitic Laboulbeniales fungi whereas only 2 out of 1,021 (0.19%) collected from Eustis were infected. There were 16 species of Laboulbeniales found at EMCA compared to only one at Eustis. The current number of Laboulbeniales species documented at Eustis was incredibly depauperate compared to the 27 species recorded by Thaxter in 1897, suggesting the possibility of utilizing Laboulbeniales as indicators of ecosystem health. A figure displaying host-parasite records and a species list of Laboulbeniales fungi is compiled and updated occurrence records for species of Ceratomyces and Hydrophilomyces are provided.

The range of the Canada lynx (Lynx canadensis) has contracted substantially from its historical range prior to the 19th century. Using harvest records, we found that the southern range of the lynx in Ontario in the late 1940s collapsed and then in a short period of time increased to its largest extent in the mid-1960s where the lynx range spread south of the boreal forest for a decade. After this expansion the southern range contracted northwards beginning in the 1970s. Most recently, there has been a slight expansion between 2010-2017. We have attributed these dynamics on the southern range periphery to the fluctuation of the boreal lynx population in the core of the species’ range. In addition, connectivity to boreal lynx populations and snow depth seemed to condition whether the lynx expanded into an area. However, we did not find any evidence that would suggest that these changes were due to anthropogenic disturbances or competition. The boreal lynx population does not reach numbers as it once did, consequently we likely will not see large expansions of the southern lynx range as in the mid-1960s. Our results suggest that southern lynx range in Ontario have been driven by the magnitude of the boreal lynx population cycle, connectivity to the boreal forest and snow conditions. Therefore, it is quite unlikely that southern lynx population in the Great Lakes will ever recover, since the warming climate and forestry practices are causing a northward contraction of the boreal forest and likely with it the core lynx populations.

The assignment of protein secondary structure elements (SSEs) underpins the structural analysis and prediction. The backbone of a protein could be adequately represented using a pc-polyline that passes through the centers of its peptide planes. One salient feature of pc-polyline representation is that the secondary structure of a protein becomes recognizable in a matrix whose elements are the pairwise distances between two peptide plane centers. Thus a pc-polyline could in turn be used to assign SSEs. Using convolutional neuron network (CNN) here we confirm that a pc-polyline indeed contains enough information for it to be used for the accurate assignments of six types of secondary structure elements: α-helix, β-sheet, β-bulge, 3 10 -helix, turn and loop. The applications to three large data sets show that the assignments made by our CNN-based P2PSSE program agree very well with those by DSSP , STRIDE and quite well with those by five other programs. The analyses of the assignments by P2PSSE and those by other programs raise some general questions about the characterizations of protein secondary structure. In particular the analyses illustrate the difficulty with giving a quantitative and consistent definition for each of the six SSE types especially for 3_10 -helix, β-bulge, turn or loop in terms of either backbone H-bond patterns, or backbone dihedral angles, or Cα -polylines or pc-polylines. The difficulty suggests that the SSE space though being dominated by the regions for the six SSE types is to a certain degree continuous.

Host cell proteins (HCPs) are process-related impurities that may co-purify with biopharmaceutical drug products. Within this class of impurities there are some that are more problematic. These problematic HCPs can be considered high-risk and can include those that are immunogenic, biologically active, or enzymatically active with the potential to degrade either product molecules or excipients used in formulation, and often are difficult-to-purify. Why should the biopharmaceutical industry worry about these high-risk host cell proteins? What approach could be taken to understand the origin of this co-purification and to deal with these high-risk HCPs? To answer these questions, the BioPhorum Development Group (BPDG) HCP Workstream initiated a collaboration among its 26-company team with the goal of industry alignment around high-risk HCPs. A sub team was formed, in which the members performed literature searches and discussed the information available around this topic. A survey to the BPDG HCP Workstream team members led to team discussions and insights into a list of frequently seen problematic HCPs. These HCPs were further classified based on their potential impact into different risk categories that could be beneficial to the biopharmaceutical industry for targeted monitoring of those HCP impurities in CHO-produced biologics to minimize risk to product quality, safety, and efficacy.

Objective: To determine the predictors of postoperative AKI following non-emergent cardiac surgery among patients with variable preoperative eGFR levels. Methods: Retrospective study of patients who underwent elective or in-hospital cardiac surgical procedures performed between January 2006 and November 2015. The procedures included isolated CABG, isolated AVR or combined CABG and AVR. The primary outcome AKI (any stage) following non-emergent cardiac surgery utilizing the 2012 KDIGO criteria. Patients were categorized based the following renal outcomes: mild AKI, severe AKI (KDIGO stage 2 or 3) and post-operative dialysis.. Results: A total of 6713 patients were included in our study. The mean age was 66.8 years (SD ± 10.3), with 76.2% being males. A total of 4487 patients had normal or mildly decreased eGFR (G1 or G2) preoperatively (66.8%), while 1960 patients were in the G3 category (29.1%). Only 266 patients (3.9%) had G4 or worse renal function. A total of 1489 (28.5%) patients experienced post-operative AKI. The need for postoperative dialysis occurred in 4.2% of the AKI subgroup. In-hospital mortality was higher among the AKI subgroup (7.3% vs 0.5%, p<0.0001). In an adjusted model, a lower pre-operative eGFR category was the strongest predictor of AKI. A practical scorecard for the preoperative estimation of severe AKI for non-emergent cardiac procedures incorporating these parameters was developed. Conclusions: Preoperative eGFR is the strongest predictor of post-operative AKI in individuals undergoing non-emergent cardiac surgery. A practical scorecard incorporating preoperative predictors of AKI may allow informed decision making and to predict AKI following non-emergent cardiac surgery

BACKGROUND The aim of this study was to investigate the progress made with pediatric oncology care in Cameroon from 2000 to 2020. METHOD A literature search was conducted for published articles on childhood cancer in Cameroon and relevant documents and conference abstracts were reviewed. The articles were analysed under eight themes: covering detection, diagnosis, management and program development. RESULTS Forty publications were analysed. Cancer diagnosis was achieved with cytology, histology and simple imaging. Management for common and curable cancers was with use of modified treatment regimens for low- and middle- income settings. There was good collaboration between the pediatric oncology professionals nationally and international partners. Advocacy led to the support of the Ministry of Health with pediatric oncology specific priority actions in the latest national cancer control plan. CONCLUSION Commitment of childhood cancer specialists, non-governmental organizations, and the government can lead to successful childhood cancer management in a low-income country.

Population-based data on survival from childhood cancers in sub-Saharan Africa is sparse. We report data for nine childhood cancers in the population of Kampala Uganda. Survival for eight out of nine cancers was below the WHO’s global target of 60% (the exception was Hodgkin lymphoma (86% at 3 years)). There was significant (p<0.05) decline in survival between 1 and 3 years for Wilms tumour and Kaposi sarcoma (30% and 34% at 3-years respectively). Survival from Burkitt lymphoma, Wilms tumour and Kaposi sarcoma has not changed since 2005.

Background Identification of published data on prevalent/incidence of atrial fibrillation/flutter (AF) often relies on inpatient/outpatient claims, without consideration to other types of healthcare services and pharmacy claims. Purpose To examine AF prevalence/incidence and associated individual comorbidity and multi-morbidity profiles for a large US adult cohort spanning across a wide age range for both males/females based on both medical/pharmacy claims. Methods We studied a population of 8,343,992 persons across many geographical areas in the U.S. continent from 1 January /2016 to 31 October 2019. The prevalence and incidence of AF were comparatively analyzed for different healthcare parameters. Results Based on integrated medical and pharmacy claims, AF prevalence was 12.7% in the elderly population (> 65 years) and 0.9% in the younger population (< 65 years). These prevalence rates are different from estimates provided by the US CDC for those aged > 65 years (9%) and age < 65 years (2%); thus, the prevalence is under-estimated in the elderly population and over-estimated in the younger population. The incidence ratios for elderly females relative to younger females was 15.07 (95%CI 14.47-15.70), a value that is about 50% higher than for elderly males (10.57 (95%CI 10.24-10.92)). Comorbidity risk profile for AF identified on the basis of medical and pharmacy criteria varied by age and sex. The proportion with multimorbidity (defined as ≥2 long term comorbidities) was 10-12%. Conclusion Continued reliance only on outpatient and inpatient claims greatly underestimates AF prevalence and incidence in the general population by over 100%. Multimorbidity is common amongst AF patients, affecting approximately 1 in 10 patients. AF patients with 4 or more co-morbidities captured 20 to 40% of the AF cohorts depending on age groups and prevalent or incident cases. Our proposed methodology can guide future analysis of quality/cost of care for progressive medical conditions at the population level.

In this study, the photovoltaic properties of the organic dyes based on triphenylamine having a D--A structure including TC201, TC202, TC203, TC601, H-P, F-P, FF-P, T-F, and P1B were investigated theoretically. In this model, triphenylamine was used as an electron donor, cyanoacrylic acid, and benzoic acid as the electron acceptors, and anthracene phenyl, anthracene vinyl phenyl, anthracene ethynyl phenyl, ethynyl anthracene phenyl, styryl phenyl, styryl-2-fluorophenyl, styryl-2,6-difluorophenyl, styryl furan, and styryl as the π-conjugated systems. The results show that a change in the -conjugated system and electron acceptor affect the properties of the dye-sensitized solar cell (DSSC). Also, TC601 dye having the ethynyl anthracene phenyl -conjugated system shows the highest charge transfer distance (DCT) and the least overlap of the electron-hole distribution (S) in comparison with other dyes. Moreover, the presence of a triple bond in the vicinity of triphenylamine increases the resonance effect of the -electrons that facilitates the process of charge transfer in this dye. Spectroscopic analysis shows that H-P and F-P dyes have the higher molecular absorption coefficients and TC202, TC203, F-P, and T-F dyes show a red shift in comparison with other dyes. Moreover, the voltage-current curve of the studied dyes shows that the highest values of the open circuit voltage and short circuit current density are related to P1B and TC601 dyes, respectively. Finally, TC601 and P1B are proposed as the best candidates to be used in the DSSCs due to their maximum incident photon to current conversion efficiency.

Background：Pulmonary arterial hypertension (PAH) is a rare disease in children, with significant mortality. Because of the limited research on pediatric PAH, firstly systematic review of related drugs is conducted，and then economic evaluation of PAH drug treatment programs is conducted, which to provide a reference for the choice of more cost-effective treatment options. Methods: The search includes electronic databases such as Pubmed, ScienceDirect, Embase. Through inclusion and exclusion criteria, screen high-quality randomized controlled trials. We used TreeAge Pro 2011 software to construct the markov model, that to simulate the total medical cost and quality-adjusted life years (QALYs), and to calculate the incremental cost-effectiveness ratio (ICER). Sensitivity analysis of transfer probability, utility and cost was carried out. Results: Incorporate two studies that meet the criteria, one compared the therapeutic effects of bosentan and placebo on pediatric PAH, the other compared therapeutic effects of sildenafil and placebo on pediatric PAH, both articles were of good quality. Compared with the sildenafil group (3.38QALYs and $161120.14),the QALY of the bosentan treatment group (3.33QALYs and $257411.29) was reduced by 0.05,and the cost increased by $96291.15.The estimated improvement to quality of life and reduced costs result in an estimate of economic dominance for sildenafil over bosentan. This dominant result persisted probabilistic analyses. Conclusions: Based on this model,a more cost-effective treatment drug for PAH in children is sildenafil.

Rural communities in the drylands of Sub-Saharan Africa (SSA) derive their livelihoods primarily from their natural resource base. Unprecedented changes in these environments over the past few decades are likely to intensify in the future and land users need to develop sustainable adaptation strategies. This study aims to identify land use and land cover (LULC) changes and their drivers in a Sub-Saharan dryland, between 1986 and 2017, by integrating local knowledge and remote sensing analysis. Local knowledge and environmental perception are used as the basis for defining LULC classes and for training and validation of change detection. This study identifies bush encroachment into former pastures as the dominant LULC change with an increase of woodland by 39 % and a decrease of grassland by 74%. This process is perceived as severe degradation by local respondents and is linked to changing management regimes and unreliable rainfall patterns. Deforestation and woodland thinning can be traced back to increased habitation and farming, though the local community also identifies charcoal production as a driving factor. The integration of remote sensing and local knowledge provides a holistic view on LULC change in Pokot Central, Kenya, and offers a solid base for site specific and actor-centred management approaches necessary for sustainable pathways of drylands.

Letter to the Editor, BJOG Exchange

Third generation sequencing technologies, such as Oxford Nanopore Technologies (ONT) and Pacific Biosciences (PacBio), have gained popularity over the last years. These platforms can generate millions of long read sequences. This is not only advantageous for genome sequencing projects, but also for amplicon-based high-throughput sequencing experiments, such as DNA barcoding. However, the relatively high error rates associated with these technologies still pose challenges for generating high quality consensus sequences. Here we present NGSpeciesID, a program which can generate highly accurate consensus sequences from long-read amplicon sequencing technologies, including ONT and PacBio. The tool includes clustering of the reads to help filter out contaminants or reads with high error rates and employs polishing strategies specific to the appropriate sequencing platform. We show that NGSpeciesID produces consensus sequences with improved usability by minimizing preprocessing and software installation and scalability by enabling rapid processing of hundreds to thousands of samples, while maintaining similar consensus accuracy as current pipelines