Abstract: Background: The 2019 coronavirus disease (COVID-19) pandemic is a public health emergency and constitutes a challenge to psychological health. This study aimed to assess the psychological conditions among university students in Saudi Arabia during the COVID-19 pandemic. Material and Methods: During the period between the 4th and 18th of June 2020, the students at Umm AlQura University in Saudi Arabia were invited to complete an online survey. The survey assessed their sociodemographic characteristics, educational disciplines, and manifestations of depression, anxiety, and stress as determined by the Depression Anxiety Stress Scale-21 (DASS-21). Results: The study included 936 students. Of them, 41.1% had depressive symptoms (31.7% mild to moderate and 9.4% severe to very severe), 26.9% had anxiety symptoms (15.8% mild to moderate and 11.1% severe to very severe), and 22.4% had stress symptoms (15.2% mild to moderate and 7.2% severe to very severe). Students who reported having a friend or relative infected with or died from COVID-19, watching or reading news about the pandemic ≥2 hours/day, and not having emotional support from family, university, and society were more likely to show psychological problems. Conclusion: Symptoms of depression, anxiety, and stress were common among Saudi university students. Psychological counseling and support should be provided to university students in Saudi Arabia. Keywords: Depression; Anxiety; Stress; COVID-19; University students; Saudi Arabia

Background: Contrast computed tomography (CT) is a useful tool for the detection of intracardiac thrombi. We aimed to assess the accuracy of the late-phase prone-position contrast CT (late-pCT) for thrombus detection in patients with persistent or long-standing persistent atrial fibrillation (AF). Methods: Early and late-phase pCT were performed in 300 patients with persistent or long-standing AF. If late-pCT did not show an intracardiac contrast defect (CD), catheter ablation (CA) was performed. Immediately prior to CA, intracardiac echocardiography (ICE) from the left atrium was performed to confirm thrombus absence and the estimation of the blood velocity of the left atrial appendage (LAA). For patients with CDs on late-pCT, CA performance was delayed, and late-pCT was performed again after several months following oral anticoagulant alterations or dosage increases. Results: Of the 40 patients who exhibited CDs in the early phase of pCT, six showed persistent CDs on late-pCT. In the remaining 294 patients without CDs on late-pCT, the absence of a thrombus was confirmed by ICE during CA. In all six patients with CD-positivity on late-pCT, the CDs vanished under the same CT conditions after subsequent anticoagulation therapy, and CA was successfully performed. Furthermore, the presence of residual contrast medium in the LAA on late-pCT suggested a decreased blood velocity in the LAA (≤ 15 cm/s) (sensitivity = 0.900 and specificity = 0.621). Conclusions: Late-pCT is a valuable tool for the assessment of intracardiac thrombi and LAA dysfunction in patients with persistent or long-standing persistent AF before CA.

A patient with diagnosed MELAS (mitochondrial encephalomyopathy, lactic acidosis and stroke-like episodes) syndrome had developed psychological and behavioural disturbances at a later stage of his illness. Psychiatric care for this patient would not be possible without a multidisciplinary team approach involving multi-prong interventions from the different team members.

The lifetime reproductive success (LRS) of individuals is affected by random events such as death, realized growth, or realized reproduction, and the outcomes of these events can differ even when individuals have identical probabilities. Another source of randomness arises when these probabilities also change over time in variable environments. For structured populations in stochastic environments, we extend our recent method to determine how birth environment and birth stage determine the random distribution of the LRS. Our results provide a null model that quantifies effects on LRS of just the birth size or stage. Using Roe deer Capreolus capreolus as a case study, we show that the effect of an individual’s birth environment on LRS varies with the frequency of environments and their temporal autocorrelation, and that lifetime performance is affected by changes in the pattern of environmental states expected as a result of climate change.

The congenital sideroblastic anemias (CSAs) are a heterogeneous group of inherited disorders of erythropoiesis characterized by pathologic deposits of iron in the mitochondria of developing erythroblasts. Mutations in the mitochondrial glycine carrier SLC25A38 cause the most common recessive form of CSA. Nonetheless, the disease is still rare, there being fewer than 70 reported families. Here we describe the clinical phenotype and genotypes of 31 individuals from 24 families, including 11 novel mutations. We also review the spectrum of reported mutations and genotypes associated with the disease, describe the unique localization of missense mutations in transmembrane domains and account for the reoccurrence of several alleles in different populations.

A simplified delivery technique for the frozen elephant trunk procedure allows the distal suture to be performed on a perfused and loaded aorta in moderate hypothermia—or even normothermia—reducing circulatory arrest time to just a few minutes. Two surgical sealing tourniquets are placed around the aortic arch, usually between the brachiocephalic trunk (BCT) and the left common carotid artery and the aorta is cross-clamped and cardioplegia started. Once in mild hypothermia, the BCT is disconnected and circulatory arrest is initiated while cerebral perfusion is maintained. This modified technique can be used in all pathologies, including dissections.

Introduction: The subcutaneous-ICD (S-ICD) and its electrode were developed to avoid long-term complications of transvenous leads in the vasculature. Methods: We report a case of unexpected, inappropriate S-ICD shocks due to oversensing of high amplitude, non-physiologic, electrical noise artifacts that were not preceded by high impedance alerts or sensing electrogram noise detections. Results: Following explant, high-magnification, X-ray imaging of the S-ICD electrode demonstrated partial fracture of the distal sensing conductor located near a short radius bend in the electrode at the electrode-header interface. Conclusions: Clinicians should be aware of a potential for fatigue failure fracture of the S-ICD electrode. Recommendations for systematic S-ICD follow-up and troubleshooting are discussed.

Opportunistic diversification has allowed ferns to radiate into epiphytic niches in angiosperm dominated landscapes. However, our understanding of how ecophysiological function allowed establishment in the canopy and the potential transitionary role of the hemi-epiphytic life form remain unclear. Here, we surveyed 39 fern species in Costa Rican tropical forests to explore epiphytic trait divergence in a phylogenetic context. We examined leaf responses to water deficits in terrestrial, hemi-epiphytic, and epiphytic ferns and related these findings to functional traits that regulate leaf water status. Epiphytic ferns had reduced xylem area (-63%), shorter stipe lengths (-56%), thicker laminae (+41%), and reduced stomatal density (-46%) compared to terrestrial ferns. Epiphytic ferns exhibited similar turgor loss points, higher osmotic potential at saturation, and lower tissue capacitance after turgor loss than terrestrial ferns. Overall, hemi-epiphytic ferns exhibited traits that share characteristics of both terrestrial and epiphytic species. Our findings clearly demonstrate the prevalence of water conservatism in both epiphytic and hemi-epiphytic ferns, via selection for anatomical and structural traits that avoid leaf water stress. Even with likely canalized physiological function, adaptations for drought avoidance have allowed epiphytic ferns to successfully endure the stresses of the canopy habitat.

Metastasis of renal cell carcinoma to the heart is a rare event. Herein we present a case of renal cell carcinoma presenting with progressive fatigue, abdominal pain, and weight loss. Imaging studies revealed complex renal mass with extension to right atrium and histopathology confirmed the metastatic renal cell carcinoma.

Our patient is a 19-year-old female who presented with left shoulder pain. Diagnostic arthroscopy revealed an articular-sided supraspinatus tear. When the shoulder was taken out of traction and placed in 90 degrees of abduction and external rotation, we visualized the biceps tendon directly impinging the undersurface of the supraspinatus tendon.

We report two cases of patients with concurrent osteoarthritis of the knee and the ipsilateral ankle. Patients were treated with high tibial osteotomy (HTO). In well-planned and selected cases, HTO may be effective in treating not only the knee but also the ankle in patients with ipsilateral double-joint osteoarthritis.

Surgical site infections (SSI) after left ventricular assist device (LVAD) implantation are associated with high mortality, while surgical prophylaxis is variable. This retrospective study included adult patients who underwent LVAD implantation at a single center. We compared outcomes in patients who received narrow antimicrobial prophylaxis (cefazolin, vancomycin or both) to those who received broad antimicrobial prophylaxis (any antimicrobial combination targeting gram-positive and gram-negative organisms not included in the narrow group) at 30 days and 1 year post-implantation. Cox-proportional hazards models and log-rank tests were used for survival analysis. Among the 39 and 65 patients comprising narrow and broad groups respectively, there was no difference in rate of SSI at 30 days (6.2% vs 12.8%, p = 0.290) and 1 year (16.9% vs 25.6%, p = 0.435). Comparing narrow to broad prophylaxis, the risk of mortality [HR (95% CI): 0.44 (0.15. 1.35), logrank P = 0.14], and composite of mortality and infection was reduced [HR (95% CI): 0.92 (0.45, 1.88), logrank P = 0.83], but did not reach statistical significance. Most culture positive infections were due to gram-positive bacteria (70%) and the most common organisms were the Staphylococcus spp (47%). There were no significant differences in the rate of SSI at 1-year (p=1.00) and mortality (p=0.33) by device type. The rates of infection and all-cause mortality were not different between patients who received narrow or broad prophylaxis. This highlights an opportunity for institutions to narrow their surgical infection prophylaxis protocols to primarily cover gram-positive organisms.

Acute liver failure precipitated by acute Budd–Chiari syndrome and complete portal vein thrombosisYuji Suzuki MD, PhD; Akiko Suzuki MD, PhD; Keisuke Kakisaka MD, PhD; Yasuhiro Takikawa MD, PhDDivision of Hepatology, Department of Internal Medicine, Iwate Medical University School of Medicine, Yahaba-cho, Iwate, Japan

A phytobezoar occurring in the stomach is uncommon. The most frequent symptoms are dyspepsia, abdominal pain, nausea and vomiting. It is an important differential to remember in those patients with risk factors for developing phytobezoars, as phytobezoars can be managed conservatively in most cases.

Sarcoidosis shows various clinical and radiologic manifestations. Nodular sarcoidosis is an uncommon form of pulmonary sarcoidosis. Cases presenting as solid nodules are especially rare. We herein present a case of nodular sarcoidosis with a solid nodule that was suspected to be lung cancer.

Aim: Invasive alien species (IAS) threaten ecosystems and humans worldwide, and future climate change may accelerate the expansion of IAS. Predicting the suitable distributions of IAS can prevent their further expansion. Ageratina adenophora is a invasive weed over 30 countries in tropical and subtropical regions. However, the potential suitable distribution of A. adenophora remains unclear along with its response to climate change. This study explored and mapped the current and future potential distributions of Ageratina adenophora. Location: Global Taxa: Asteraceae A. adenophora (Spreng.) R.M.King & H.Rob. Commonly known as Crofton weed. Methods: Based on A. adenophora occurrence data and climate data, we predicted its potential distribution of this weed under current and future (four RCPs in 2050 and 2070) by MaxEnt model. We used ArcGIS 10.4 to explore the distribution characteristics of this weed and the ‘ecospat’ package in R to analyse its altitudinal distribution changes. Results: The area under the curve value (>0.9) indicated excelled model performance. Among environment factors, Mean Temperature of Coldest Quarter contributed most to the model. Globally, the suitable habitat for A.adenophora invasion decreased under climate change scenarios, although regional increase were observed, including in six biodiversity hotspot regions. The potential suitable habitat of A.adenophora under climate change moved toward regions with higher elevation. Main Conclusions: Temperature was the most important variable influencing the distribution of A. Adenophora. Under the background of warming climate, the potential distribution range of A.adenophora will shrink globally but increase regionally. The distribution of A.adenophora will shift toward higher elevation under climate change. Mountain ecosystems are of special concern as they are rich in biodiversity and sensitive to climate change, and increasing human activities provide more opportunities for IAS invasion.

The hypothesis that feed ingredients could serve as vehicles for the transport and transmission of viral pathogens was first validated under laboratory conditions. To bridge the gap from the laboratory to the field, this current project tested whether three significant viruses of swine could survive in feed ingredients during long-distance commercial transport across the continental US. One-metric ton totes of soybean meal (organic and conventional) and complete feed were spiked with a 10 mL mixture of PRRSV 174, PEDV, and SVA and transported for 23 days in a commercial semi-trailer truck, crossing 29 states, and 10,183 km. Samples were tested for the presence of viral RNA by PCR, and for viable virus in soy-based samples by swine bioassay and in complete feed samples by natural feeding. Viable PRRSV, PEDV, and SVA were detected in both soy products and viable PEDV and SVA in complete feed. These results provide the first evidence that viral pathogens of pigs can survive in representative volumes of feed and feed ingredients during long-distance commercial transport across the continental US.

The effects of human disturbance on the stability of alpine meadow communities, their diversity–stability relationship, and the underlying mechanisms are still not fully understood. Here, we performed a 12-year-long (2007–2018) two-factor (2 × 3) controlled experiment on Kobresia humilis on the Tibetan Plateau. The manipulations included three clipping levels (no clipping, NC; moderate clipping, MC; heavy clipping, HC) and two fertilization levels (no fertilization, NF; fertilization, F). Our results revealed that the two clipping manipulations significantly increased the temporal stability of alpine meadow communities, whose significant increase was more pronounced under the MC than HC treatment. Moreover, asynchrony effects, portfolio effects, and facilitation interactions were all present in the communities under the six types of experimental treatment combinations. Additionally, a selection effect was detected in the compound communities, demonstrating characteristics that are common to different mechanisms. There were no significant differences in the effects of these mechanisms on community temporal stability between the NC–NF and MC–NF interactive communities. The portfolio effects predominated when clipping intensity was moderate under both fertilization and non-fertilization conditions. By contrast, in the compound communities, the selection effect predominated. In summary, we conclude that in meadow communities that undergo clipping and fertilization disturbances, facilitation interactions and weak interactions make a greater contribution toward maintaining their temporal stability.