OBJECTIVE. For many years, functional tricuspid regurgitation (FTR) was considered negligible after treatment of left-sided heart valve surgery. The aim of the present network meta-analysis is to summarize the results of four approaches in order to establish the possible gold standard. METHODS A systematic search was performed to identify all publications reporting the outcomes of four approach for FTR, not tricuspid annuloplasty (no TA), suture annuloplasty (SA), flexible (FRA), rigid rings (RRA). All studies reporting at least one the four endpoints (early and late mortality, early and late moderate or more TFR) were included in a Bayesian network meta-analysis. RESULTS There were 31 included studies with 9,663 patients. Aggregate early mortality was 5.3% no TA, 7.2% SA, 6.6% FRA and 6.4% RRA; Early TR moderate-or-more was 9.6%, 4.8%, 4.6% and 3.8%; Late mortality was 22.5%, 18.2%, 11.9% and 11.9%; Late TR moderate-or-more was 27.9%, 18.3%, 14.3% and 6.4%. Rigid or semirigid ring annuloplasty was the most effective approach for decreasing the risk of late moderate or more FTR (–85% vs. no TA; –64% vs. SA; –32% vs. FRA). Concerning late mortality, no significant differences were found among different surgical approaches, however, flexible or rigid rings reduced significantly the risk of late mortality (78% and 47%, respectively) compared with not performing TA mortality. No differences were found for early outcomes. CONCLUSIONS. Ring annuloplasty seems to offer better late outcomes compare to either suture annuloplasty or not performing TA. In particular rigid or semirigid rings provides more stable FTR across time.

In this paper, we consider the generalized approximate boundary synchronization for a coupled system of wave equations with Dirichlet boundary controls. We analyse the relationship between the generalized approximate boundary synchronization and the generalized exact boundary synchronization, give a sufficient condition to realize the generalized approximate boundary synchronization and a necessary condition in terms of Kalman's matrix, and show the meaning of the number of total controls. Besides, by the generalized synchronization decomposition, we define the generalized approximately synchronizable state, and obtain its properties and a sufficient condition for it to be independent of applied boundary controls.

Cardiac arrythmia is a major complication of COVID-19. This occurs often in patients with severe COVID-19 with pre-existing cardiovascular diseases. We report an unusual case of paroxysmal atrial fibrillation in an adult male with low cardiovascular risk factor who presented with a moderate form of COVID-19.

Pulmonary Tuberculosis (PTB) and Novel Coronavirus disease 2019 (COVID 19) primarily affect the lungs. Both diseases present with fever, cough, and shortness of breath and possess thrombotic potential as well. Therefore in COVID 19 pandemic, PTB must be taken into consideration for suspected cases in order to avoid fatal consequences.

Background and objectives: Shared decision making (SDM) prior to non-urgent tracheostomy in a child with chronic respiratory failure (CRF) is recognized as the standard of care, but has proven challenging to implement in practice. We hypothesize that utilization of the microsystem model for analysis of the complex ecosystem in which SDM occurs will yield insights that enable formation of a reproducible, measurable SDM process. Methods: Retrospective chart review of a case series of children with CRF in whom a SDM process was pursued. The process included a palliative care consult, a validated decision aid and 12 key questions designed to elucidate information integral to an informed decision. Investigators reviewed a single hospital admission for each child, focusing on the 3 core elements of a medical microsystem- the patient, the providers, and information. Results: 29 patients who met inclusion criteria ranged in age from 0 to 19 years (median 1.7) and remained in the hospital from 10 to 316 days (median 38). Patients were medically complex with multiple and varied respiratory diagnoses, multiple and varied comorbidities, and varying psychosocial environments. 14/29 children received tracheostomies. Each child encountered a mean of 6.2 medical specialties, 1.9 surgical specialties and 8.5 non-physician led services. Answers to 12 key questions were not documented systematically and often not found. Conclusion: A unique SDM microsystem is formed around each child but not optimally utilized. Explicit recognition of these microsystems would enable team formation and an SDM process comprised of measurable steps and communication patterns.

Mitral commissural prolapse or flail, either isolated or combined with more extensive degenerative valve disease imposes several challenges both on its diagnosis and management whilst being a risk factor for valve reoperation after mitral valve repair. Accurate identification of the prolapsing segment is often not feasible with transthoracic 2D echocardiography, with transesophageal 3D imaging then required for correct diagnosis and surgical planning. Various surgical techniques employed alone or in combination, have yielded good results in the repair of commissural prolapse. Herein, we analyze the specific characteristics of commissural disease focusing our attention on 2D and 3D echocardiographic findings and we briefly comment on techniques employed for surgical correction of the disease.

Objectives: to evaluate the effectiveness of uterine tamponade devices for atonic refractory postpartum haemorrhage (PPH) after vaginal birth, and the effect of including uterine tamponade devices in institutional protocols. Search strategy: databases in PubMed, EMBASE, CINAHL, LILACS and POPLINE. Study selection: randomised and non-randomised comparative studies. Outcomes: composite outcome including surgical interventions (artery ligations, uterine compressive sutures or hysterectomy) or maternal death, and hysterectomy. Results: all four included studies were at high risk of bias. The certainty of evidence rated as very low to low. One randomised study measured the effect of the the condom-catheter balloon compared to standard care and found unclear results for the composite outcome (RR 2.33, 95%CI 0.76-7.14) and hysterectomy (RR 4.14, 95%CI 0.48-35.93). Three comparative studies assessed the effect of including UBTs in institutional protocols. A stepped-wedge study suggested an increase in the composite outcome (RR 4.08, 95%CI 1.07-15.58), and unclear results for hysterectomy (RR 4.38, 95% CI 0.47-41.09) with the use of the condom-catheter or surgical glove balloon. One non-randomised study showed unclear effects on the composite outcome (RR 0.33, 95%CI 0.11-1.03) and hysterectomy (RR 0.49, 95%CI 0.04-5.38) after the inclusion of Bakri balloon. The second non-randomized study found unclear effects on the composite outcome (RR 0.95, 95%CI 0.32-2.81) and hysterectomy (RR 1.84, 95%CI 0.44-7.69) after the inclusion of Ebb or Bakri balloon. Conclusions: the effect of uterine tamponade devices for the management of atonic refractory PPH after vaginal delivery is unclear, as is the role of the type of device and the setting.

• The UK National Institute for Health and Care Excellence has estimated a 70% increase in demand resulting from the 2019 modification to cochlear implant criteria • We modelled the projected increase using our large database of pure tone audiometry results, and adjusted for frailty as a marker of risk of general anaesthesia • Our results suggest an overall 79% increase in demand, with most of this for adult implantation, and in particular for those over the age of 65 • Our findings are important for those planning delivery of cochlear implant services

Interleukin-31 has been implicated in the pathophysiology of multiple atopic disorders such as atopic dermatitis (AD), rhinitis and airway hyperreactivity. In AD, IL-31 has been identified as one of the main ‘drivers’ of its cardinal symptom pruritus. Here, we aim to summarize the mechanisms by which IL-31 modulates inflammatory and allergic diseases. TH2 cells play a central role in AD and release high levels of TH2-produced cytokines including IL-31, thereby mediating inflammatory responses, initiating immunoregulatory circuits, and stimulating itch and neuronal outgrowth through activation of the heterodimer receptor IL-31 receptor alpha (IL31RA)/Oncostatin M receptor β. IL31RA expression is found on human and murine dorsal root ganglia neurons, epithelial cells including keratinocytes as well as various innate immune cells. IL-31 is a critical cytokine involved in neuro-immune communication, which opens new avenues for cytokine modulation in neuroinflammatory diseases including AD/pruritus, as validated by recent clinical trials using an anti-IL-31 antibody. Accordingly, inhibition of IL-31 downstream signaling may be a beneficial approach for various inflammatory diseases including prurigo nodularis. For example, whether downstream JAK inhibitors directly block IL-31-mediated-signaling needs to be clarified. Targeting the IL-31/IL31RA/OSMRβ axis appears to be a promising approach for inflammatory, neuroinflammatory and pruritic disorders in the future.

Soil moisture is essential for vegetation restoration in arid and semi-arid regions. Ascertaining the vertical distribution and transportation of soil moisture under different vegetation restoration types has a profound impact on the ecological construction. In this study, the soil moisture at a depth of 500 cm for four typical vegetation types, including R. pseudoacacia (forestland), C. korshinskii (shrubland), S. bungeana (abandoned land), and corn (cropland) were investigated and compared in the Zhifanggou watershed of Loess plateau, China. Additionally, hydrogen and oxygen stable isotopes were detected to identify and reflect the characteristics of soil water. The results showed vertical distribution and transportation of soil moisture have different variations under different vegetation types. Depth-averaged soil moisture under S. bungeana and corn increased along the profile as a whole, while C. korshinskii and R. pseudoacacia showing a trend of weakly increasing and relatively stable state after an obvious decreasing trend (0–40 cm). The mean soil moisture under R. pseudoacacia is lower than other types, especially in deeper layers. In addition, it was observed that the longer vegetation age, the lower mean soil moisture, while this phenomenon was unobvious in S. bungeana. Planting arbor species such as R. pseudoacacia intensified the decline of soil moisture in the Loess Plateau, this limited the growth of arbor species in turn. The capacity of evaporation fractionation of soil moisture followed the sequence: corn > S. bungeana > R. pseudoacacia > C. korshinskii. Profiles of δ18O values of soil moisture under different vegetation types are quite different. On the whole, the δ18O values varied greatly in upper soil layers and tend to be consistent with the increase of soil depth. We estimate that piston flow is the main mode of precipitation infiltration, and the occurrence of preferential flow is related to vegetation types. These results are expected to help improve the understanding of the response of deep soil moisture to vegetation restoration and inform practices for sustainable water management.

Primary tuberculosis of the parotid gland is rare even in endemic countries. the clinical manifestations are polymorphic and non-specific. it is important for clinicians to be aware of this pathology.

Severe coronary calcification predicts stent under-expansion, malapposition, and poor outcomes in percutaneous coronary intervention. Rotational atherectomy permits debulking of coronary calcium allowing for stent expansion. More recently, intravascular lithotripsy has been used to fracture calcium and aid revascularization. Here we report two cases where both strategies were required for revascularization.

Sickle cell disease (SCD) patients are immunocompromised with multiple comorbidities and a hypercoagulation state. On the other hand COVID-19 is associated with cytokine storm and hypercoagulability. To find the susceptibility and the clinical course of COVID-19 in SCD patients we surveyed related published papers from USA, Europe, Middle East, few African patients and international SCD registry. The COVID-19 presentation was mild in children and moderate in many SCD adults. To explain these findings, possible benefits of high HbF level, and hydroxyurea therapy could be considered. The obtained results should be interpreted considering low cases from sub-Saharan people, younger age of SCD patients compared to general population, a bias toward registry of more severe form of the disease, the influence of preexisting comorbidities with multisystem organ damage in exacerbation of the COVID-19 and the fatality rate in SCD patients and the role of health socio-economic determinants.

Diabetes is a chronic metabolic disorder associated with the accelerated development of macrovascular (atherosclerosis, coronary artery disease) and microvascular complications (nephropathy, retinopathy and neuropathy), which remain the principal cause of mortality and morbidity in this population. Current understanding of cellular and molecular pathways of diabetes-driven vascular complications as well as therapeutic interventions have arisen from studying disease pathogenesis in animal models. Diabetes-associated vascular complications are multi-faceted, involving the interaction between various cellular and molecular pathways. Thus, the choice of an appropriate animal model to study vascular pathogenesis is important in our quest to identify innovative and mechanism-based targeted therapies to reduce the burden of diabetic complications. Herein, we provide up-to-date information on available mouse models of both Type 1 and Type 2 diabetic vascular complications as well as experimental analysis and research outputs.

The geometries of monocharged and neutral octafluoro-spirobi[triphosphazene] in singlet, doublet and/or triplet ground spin states were optimized. Their electronic structures are investigated in terms of Quantum Theory of Atoms-in-Molecules and compared with neutral hexafluorocyclotriphosphazene. The change of the total molecular charge implies mainly the change of the properties of the nitrogen atoms which are bonded to the central spiro-phosphorus atom. The charged systems in singlet spin states have stable structures of D2d symmetry only unlike the remaining ones of C2 symmetry within two geometry types. The existence of the less symmetric structures can be fully explained as a consequence of the (pseudo-) Jahn-Teller effect.

Objective: to describe the impact of COVID-19 on the management of patients with ectopic pregnancy. Design: a multicentre study comparing outcomes from a prospective cohort during the pandemic [Covid-ectopic pregnancy registry (CEPR)] compared to an historical pre-pandemic cohort [non-Covid ectopic pregnancy registry (NCEPR)]. Setting: five London university hospitals. Population and Methods: consecutive patients diagnosed clinically and/or radiologically with ectopic pregnancy (March/2020-Aug/2020) were entered into the CEPR and an exploratory matched analysis was performed comparing results to NCEPR patients (January/2019-June/2019). Main outcome measures: patient demographics, management (expectant, medical and surgical), length of treatment, number of hospital visits (non-surgical management), length of stay (surgical management) and 30-day complications. Results: 341 patients met inclusion: 162 CEPR and 179 NCEPR. A significantly higher percentage of women underwent non-surgical management versus surgical management in the CEPR versus NCEPR (58.6% [95/162] vs 72.6% [130/179]; p= 0.0084]. Amongst patients managed with expectant management the CEPR had a significantly lower mean number of hospital visits compared to NCEPR [3.6 [SD 1.4] vs 13.7 [SD 13.4], p= 0.0053]. Amongst patients managed with medical management, the CEPR had a significantly lower mean number of hospital visits [NCEPR 6.4 [SD 2.3] vs 8.8 [SD 3.9], p= 0.0014]. There was no observed difference in complication rates between cohorts. Conclusion: women were found to undergo significantly higher rates of non-surgical management during COVID-19 first wave vs NCEPR cohort. Women managed non-surgically in CPER cohort were also managed with fewer hospital attendances. This did not lead to an increase in observed complications rates.

This study aims to introduce Suzuki type Σcontraction mappings with simulation functions in the frame of modular b-metric spaces. Also, some coincidence and common fixed point results are obtained for four mappings using the weakly compatibility property that these results are the extensions and improvements of the existing literature. Finally, we also present two applications on graph theory and homotopy theory, which show applicability and validity of our results.

Background: The global cases of Covid-19 increasing day by day. On Nov. 25, 2020, a total of 59,850,910 cases reported globally with a 1,411,216 global death. In India, total cases in the country now stand at 91,77,841 including 86,04,955 recoveries and 4,38,667 active cases as of Nov. 24, 2020, as per data issued by ICMR. A new generation of voice/audio analysis application which can tell whether the person is suffering from COVID-19 or not. Aims: To describe how to establish a new generation of voice/audio analysis applications to identify the suspected covid-19 hidden cases in hotspot areas with the help of an audio sample of the general public. Materials & Methods: The different patents and data available as literature on the internet are evaluated to make a new generation of voice/audio analysis application with the help of an audio sample of the general public. Results: The collection of the audio sample will be done from the already suffered covid-19 patients in (.Wave files) personally or through phone calls. The audio samples like the sound of the cough, the pattern of breathing, respiration rate, and way of speech will be recorded. The parameters will be evaluated for loudness, articulation, tempo, rhythm, melody, and timbre. The analysis and interpretation of the parameters can be made through machine learning and artificial intelligence to detect corona cases with an audio sample. Discussion: The voice/audio application current project can be merged with a mobile App called “Aarogya Setu” by Govt. of India. The project can be implemented in the high-risk area of Covid-19 in the country. Conclusion: This new method of detecting cases will decrease the workload in the covid-19 laboratory.