The Recurring Theme of Gender Difference in Cardiac Surgical OutcomesJohn S. Ikonomidis MD, PhDDivision of Cardiothoracic Surgery, University of North Carolina at Chapel HillWord Count: 1144References: 13Address correspondence to:John S. Ikonomidis MD, PhDProfessor and Chief,Division of Cardiothoracic SurgeryUniversity of North Carolina at Chapel Hill3034 Burnett Womack Building160 Dental Circle,Chapel Hill, NC27599e-mail: john_ikonomidis@med.unc.eduTel: (919) 966-3381In this issue of the Journal of Cardiac Surgery,1Newell and colleagues examined contemporary national outcomes following surgical resection of benign primary atrial and ventricular tumors. The 2016-2018 Nationwide Readmissions Database was queried for all patients > 18 years of age with a primary diagnosis of benign neoplasm of the heart who underwent resection of the atria, ventricles, or atrial/ventricular septum. A weighted total of 2,557 patients met inclusion criteria. Mean age was 61 years, 67.9% were female, and patients had relatively low comorbidity burdens. The authors found that while there was no difference in 30-day mortality (2.1% vs 1.3%, p=0.550), 30-day readmission (7.0% vs 9.1%, p=0.222), or 30-day composite morbidity (56.8% vs 53.8%, p=0.369) between females and males respectively, on multivariable analysis, female sex was independently associated with increased risk of 30-day mortality (OR 2.65, p=0.028).Overall, this was a well study which documents a large contemporary cohort of benign cardiac tumor resections. However, perhaps the most interesting feature of this study is the finding of sex as an independent predictor of 30 day mortality after propensity matching. Cardiac surgery suffers from a gender gap in terms of its outcomes. It has been well established that for many procedures such coronary bypass surgery (CABG), aortic valve replacement, mitral valve surgery, and aortic surgery.2 For CABG, women referred for surgery are typically older than men, have a higher comorbidity (hypertension, renal failure, diabetes, peripheral vascular disease) profile, and more often present in urgent or emergent status for surgery.3 Large, risk-adjusted, propensity matched studies have documented increased mortality in women as compared with men.4-7 This difference also extends into the interventional cardiology realm, where mortality and complication rates have been shown to be higher in women following percutaneous interventions for ST-elevation myocardial infarction.8For aortic valve replacement, a Nationwide Inpatient Sample study of 166809 patients with aortic stenosis from 2003 to 2014 found that women experience higher inpatient mortality (5.6% versus 4%, P<0.001) which persisted after propensity matching (3.3% versus 2.9%, P<0.001).9 For mitral valve surgery, a randomized controlled trial of patients with severe ischemic mitral insufficiency undergoing repair versus replacement found that women had higher mortality than men (27.1% versus 17.4%, p<0.03).10 For aortic surgery, female gender was associated with a higher mortality after both aortic dissection and aortic arch repair.11,12 Reduction in surgical stress through application of minimally invasive approaches still resulted in female sex being a risk factor for higher in-hospital mortality.13 The findings of the present study add further support to the above observations, with the potential addition that, in contrast to the other disease processes described, the majority of patients presenting for surgical removal of benign cardiac tumors were likely free of either symptoms or cardiac sequelae due to the disease, but nevertheless still the gender disparity in mortality persisted.While it is obvious that the above disease processes and their related surgical remedies are quite disparate, the association with increased mortality seen in females seems to be constant. Why is this? A considerable amount has been written regarding sex bias in referral patterns for surgery and even decreased functional reserve and health profiles of women when they are referred for surgical intervention compared with men.2 With regard to these referral patterns, published guidelines directing practitioners regarding indications for surgery are, in general, based upon studies in which the majority of patients were male. Interestingly, in the present study, females made up over two thirds of the patient population.1 While this suggests that females carry a disproportionately more benign cardiac tumors amenable to surgery, the post-surgical mortality disparity remained.The exact reasons for the above disparity remain unelucidated and further work is required to eliminate the gender gap in cardiac surgical outcomes. There is considerable focus on the removal of sex bias in animal and human research, as well as the development of disease treatment guidelines that consider gender in the algorithms. Hopefully and these and other sex-balanced approaches will reveal new insights that will allow us to bring equipoise to gender-stratified cardiac surgical outcomes.

Botrytis cinerea is responsible for the gray mold disease, severely affecting Vitis vinifera grapevine and hundreds of other economically important crops. However, many mechanisms of this fruit-pathogen interaction remain unknown. The combined analysis of the transcriptome and metabolome of green fruits infected with B. cinerea from susceptible and tolerant genotypes was never performed in any fleshy fruit, mostly because green fruits are widely accepted to be resistant to this fungus. In this work, peppercorn-sized fruits were infected in the field or mock-treated, and infected berries were collected at green (EL32) stage from a susceptible (Trincadeira) and a tolerant (Syrah) variety. RNAseq and GC-MS data suggested that Syrah exhibited a pre-activated/basal defense relying on specific signaling pathways, hormonal regulation, specifically jasmonate and ethylene metabolism, and linked to phenylpropanoid metabolism. In addition, putative defensive metabolites such as shikimic, ursolic/ oleanolic, and trans-4-hydroxy cinnamic acids, and epigallocatechin were more abundant in Syrah than Trincadeira before infection. On the other hand, Trincadeira underwent relevant metabolic reprogramming upon infection but was unable to contain disease progression. RNA-seq analysis of the fungus in planta revealed an opposite scenario with higher gene expression activity within B. cinerea during infection of the tolerant cultivar and less activity in infected Trincadeira berries. The results suggested an activated virulence state during interaction with the tolerant cultivar without visible disease symptoms. Together, this study brings novel insights related to early infection strategies of B. cinerea and the green berry defense against necrotrophic fungi.

A document by Mohammad Fakhrolmobasheri. Click on the document to view its contents.

Objectives: To determine the patient and treatment characteristics associated with delay in post-operative radiation therapy (PORT) for patients treated surgically for head and neck squamous cell cancer (HNSCC) at our institution. Design: Single institution retrospective review Setting: Tertiary care academic medical center Participants: Patients treated surgically for HNSCC that underwent PORT between 2013-2016 Main outcomes measures: Time from surgery to initiation of PORT. Results: 140 patients met inclusion criteria. A majority did not start radiotherapy within six weeks. Factors associated with a delayed initiation of PORT included length of stay >8 days, 30-day readmission, no adjuvant chemotherapy, post-operative complications, and fragmented care. Conclusion: A majority of patients did not initiate PORT within the guideline-recommended 6 weeks. Modifiable risks factors that delay initiation of PORT were identified.

Free-living amoebae (FLA) are cosmopolitan microorganisms known to be pathogenic to humans who often have a history of contact with contaminated water. Swimming pools and recreational waters are among the environments where the greatest human exposure to FLA occurs. This study aimed to determine the prevalence of FLA in swimming pools and recreational waters, through a systematic review and meta-analysis that included studies published between 1977 and 2021. 71 studies were included and an overall prevalence of FLA in swimming pools and recreational waters of 40.89% (95% CI = 33.97–48.00) was found. Considering the studies published up to 2010 (1977 - 2010) and after 2010 (>2010 - 2021) the prevalence were 51.54% (95% CI = 36.65-66.29) and 37.95% (95% CI = 30.34 – 45.86), respectively. The highest prevalence were found in the American continent (59.52%), in Malaysia (89.33%) and in indoor hot pools 52.27%. In studies that used morphological methods, PCR and both methods simultaneously to identify FLA, the prevalence was 56.41, 22.32 and 39.94%, respectively. Considering only PCR-based studies, the prevalence of Naegleria spp., Acanthamoeba spp., Hartmanella spp. and Vermamoeba spp. was 10.01, 15.38, 16.40 and 16.06%, respectively. There is considerable risk of AFL infection in swimming pools and recreational waters. Recreational water safety needs to be routinely monitored and, in case of risk, locations need to be identified with warning signs and users need to be educated. Swimming pools and artificial recreational water should be properly disinfected. Photolysis of NaOCl or NaCl in water by UV-C radiation is a promising alternative to disinfect swimming pools and artificial recreational waters.

Membraneless organelles (MLOs) form via liquid-liquid phase separation (LLPS). The liquid-like MLOs afford multifold peculiarities including high dynamics, reversibility and responsiveness. The MLOs are typically metastable with a tendency to undergo fast, drastic and reversible formation and dissolution, as well as transition into more stable glassy or gel-like states. Moreover, the alteration of metastability of LLPS is linked with cellular pathology. Here, we review the crucial and ubiquitous ‘metastability’ of MLOs driven by liquid phase separation, from multifaceted regards including energy state, molecular interactions, molecular structure, materials state, as well as the associations with diseases. This review can help to advance the insight into properties and pathogenesis associated with LLPS of biological matter.

Grazing management practices are a major factor regulating nutrient cycling and plant growth in grasslands. However, the response of long-term grazing regimes to ecosystem carbon and nitrogen accumulation and plant productivity remains uncertain in karst landscapes. A 17 year-long field experiment, constituting the methods of grazing exclusion (GE), continuous grazing (CG), mowing and grazing (MG), and rotational grazing (RG), was conducted to assess the effects of long-term management measures on plant biomass, ecosystem organic carbon, and nitrogen stocks in a karst alpine grassland of the Yunnan-Guizhou Plateau. Our results showed that grazing significantly reduced the aboveground biomass (CG, MG, and RG) and root biomass (MG and RG) compared to GE, but there were no differences between the results obtained using the various grazing methods. The root/shoot ratio increased by 55.98% in CG and decreased by 52.96% and 37.14% in MG and RG, respectively, compared to that achieved with GE. Soil organic carbon (SOC) of GE was higher than that of CG, MG, and RG in each soil layer, while it was significantly higher at 0–10 cm and 20–30 cm. Grazing promoted the mean total N content with a significant increase in CG and RG, and significantly increased total P content in each soil layer compared to GE. Grazing significantly decreased the C/N and C/P ratios at each soil depth. GE significantly increased the ecosystem organic carbon stocks (EOCs) and decreased the ecosystem total nitrogen stocks (ETNs). Although there were no significant changes among the grazing methods, the EOCs increased by 22.29% (MG) and 16.31% (RG) and ETNs increased by 7.76% (RG) when compared to those obtained with CG. EOSs were positively correlated with SOC, stoichiometry (C: N: P), and aboveground biomass, while being negatively correlated with TP; ETNs were positively correlated with N and P, while being negatively correlated with C/N, C/P, aboveground biomass, and root biomass. Our results indicate that GE can provide significant improvements in plant recovery and ecosystem organic carbon storage, whereas RG is beneficial for promoting both EOCs and ETNs under the condition of pasturing utilisation in karst grasslands.

Soil erosion is the prominent ecological and environmental problem in karst area of southwest China, which seriously restricts the sustainable development of the region. Determining the priority areas of soil erosion governance and its driving factors can significantly improve the efficiency of prevention and control. However, at present, there are few researches on the priority areas of governance that comprehensively consider karst landform types and management requirements. Based on the minimum administrative unit and karst landform types, this study identified the priority areas of soil erosion control by comprehensive use of spatial clustering method and geographic detectors, and quantified the driving factors and their interactions. The results indicated that: (i) Priority areas within the smallest administrative unit are clustered in the southwest, southeast and northeast of the study area, overlapping with areas of intense erosion; Geomorphological differentiation of multi-factor gradient risk zones is obvious, but the areas with strong erosion are all controlled by bedrock exposure rate, altitude and slope aspect. (ii) The soil erosion in the priority area is concentrated and intense. By treating the priority area, which accounts for 12.77% of the total area, soil erosion can be reduced by 27.66%. (iii) The driving factors have a strong dependence on karst landforms, showing obvious differences in different karst landform areas; Interaction of factors, especially the interaction between human disturbance factors and natural influence factors, can significantly enhance the explanatory power of soil erosion. The research results have important theoretical significance for the planning and control of soil and water loss in karst areas.

Evidence-based medicine has shown for many years that homozygous mutations of the HFE gene H63D are by no means negligible. Not only can it cause, usually after a second hit, rather mild classical hemochromatosis, but it can also cause numerous other disorders of iron metabolism, such as hypotransferrinemia, changes in binding capacity, and others. In addition, it may lead - among other symptoms - to damages of the heart and the substantia nigra via a causal relationship that remains to be investigated, most likely via a cascade dysfunction in iron metabolism. The clinical facts are compelling. Any physician who dismisses mutations of the HFE gene H63D as clinically irrelevant risks the health and life of his patient. We report two patients with an HFE H63D mutation who were treated almost too decades too late because of outdated expertise.

Intense fishing pressure and climate change are major threats to fish populations and coastal fisheries. Larimichthys crocea (large yellow croaker) is a long-lived fish, which performs seasonal migrations from its spawning and nursery grounds along the coast of the East China Sea (ECS) to overwintering grounds offshore. This study used length-based analysis and habitat suitability index (HSI) model to evaluate current life-history parameters and overwintering habitat suitability of L. crocea, respectively. We compared recent (2019) and historical (1971-1982) life-history parameters and overwintering HSI to analyze the fishing pressure and climate change effects on the overall population and overwintering phase of L. crocea. The length-based analysis indicated serious overfishing of L. crocea, characterized by reduced catch yield, size truncation, constrained distribution, and advanced maturation causing a recruitment bottleneck. The overwintering HSI modeling results indicated that climate change has led to decreased sea surface temperature during L. crocea overwintering phase over the last half-century, which in turn led to area decrease and an offshore-oriented shifting of optimal overwintering habitat of L. crocea. The fishing-caused size truncation may have constrained the migratory ability and distribution of L. crocea subsequently leading to the mismatch of the optimal overwintering habitat against climate change background, namely habitat bottleneck. Hence, while heavily fishing was the major cause of L. crocea collapse, climate-induced overwintering habitat suitability may have intensified the fishery collapse of L. crocea population. It is important for management to take both overfishing and climate change issues into consideration when developing stock enhancement activities and policy regulations, particularly for migratory long-lived fish that share a similar life history to L. crocea. Combined with China’s current restocking and stock enhancement initiatives, we propose recommendations for future restocking of L. crocea in China.

Understanding what drives the vast variability in species range size is still an outstanding question. Among the several processes potentially affecting species ranges, dispersal is one of the most prominent hypothesized predictors. However, the theoretical expectation of a positive dispersal-range size relationship has received mixed empirical support. Here, we synthesized results from 84 studies to investigate in which context dispersal is most important in driving species range size. We found that dispersal traits -- proxies for dispersal ability -- explain range sizes more often in temperate and subtropical regions than in tropical regions, when considering multiple components of dispersal, and when investigating a large number of species to capture dispersal and range size variation. In plants, positive effects of dispersal on range size were less often detected when examining broad taxonomic levels. In animals, dispersal is more important for range size increase in ectotherms than in endotherms. Our synthesis emphasizes the importance of considering different aspects of the dispersal process -departure, transfer, settlement-, niche aspects and evolutionary components, like time for range expansion and past geological-environmental dynamics. We therefore call for a more integrative view of the dispersal process and its causal relationship with range size.

Cisplatin is a widely used platinum-based chemotherapy agent. Its common adverse effects are neuropathy, nephrotoxicity, electrolyte abnormality, and rarely causing thrombotic vascular toxicity. We present a patient known to have Small-cell Lung Cancer who developed ischemic cerebrovascular accident (CVA) after receiving chemotherapy regimen including cisplatin.

Background: Multisystem Inflammatory Syndrome in Children (MISC) is a phenomenon that appeared in children infected with or exposed to SARS-CoV-2. The typical onset of MISC is 4-6 weeks following SARS-CoV-2 infection and is formulated to be due to an immune response. Methods: Our study retrospectively analyzed data from a tertiary center in UAE of MISC patients who were admitted to either general pediatric wards or pediatric intensive care (PICU) or who came exclusively for follow-up (post PICU admission) from May 2020 to August 2021.   Results: The total sample size is 50 patients and the study included a comparison of PICU admissions with none PICU admissions. The PICU sample size was 18 patients, 50% females, with mean age of 8.3 years all were previously healthy. PICU patients had deranged blood counts with a lower hemoglobin count, a more pronounced lymphopenia and thrombocytopenia along with hypoalbuminemia. PICU patients presented with relatively higher inflammatory markers: CRP, PCT, ferritin and D-dimer. Immunological studies were significantly higher for IL-6 levels in PICU patients. On echocardiography, higher myocardial dysfunction was more notable in patients admitted to PICU. Children admitted in PICU were provided with more extensive therapy. As part of our study course, we re-evaluated our PICU patients twice, once at 48 hours post PICU admission and again 4-6 weeks after discharge from the hospital. No deaths have been recorded in the cohort. Conclusion: This study evaluated risk factors of MISC and potential severity features. Follow up of patients on discharge showed improvement across all domains.

BACKGROUND AND PURPOSE Ionotropic GABA receptors (GABARs) in insects are the major inhibitory receptor and common targets in insecticides for pest control. Due to their high spatiotemporal resolution, the photopharmacological ligands have been developed in vertebrates, but only a few in insect yet. EXPERIMENTAL APPOACH In this study, two types of photoswitchable ligands (PCLs) by incorporating photoswitch azobenzene or dithienylethene into the antagonist, fipronil (FIP) generated the DTFIPs (DTFIP1 and DTFIP2) and ABFIPs (p-, m-, and o-ABFIP). Their photomodulation was measured by mosquito larval behavior, and the potential action mechanism of them was explored by two-electrode voltage clamp (TEVC) technique in vitro. KEY RESULTS DTFIP1 and m-ABFIP exhibited biggest difference of insecticidal activity between unirradiated and irradiated formation, and allowed for optical control of insect locomotors activity in swimming. The TEVC assay results indicted m-ABFIP and DTFIP1 enable optical control over the homomeric RDL-type GABAR, which is achieved by regulating the chloride channel of insect resistance to RDL-type GABAR by photoisomerization. CONSLUSION AND IMPLICATIONS Our results suggested that PCLs provide an alternative and precise tool for studying insect ionotropic GABARs and GABA-dependent behavior.

A 34-year-old woman presented with original Blalock Taussig shunt and tetralogy of Fallot. The anastomosis site of the original Blalock--Taussig shunt revealed stenosis and severe cyanosis. A central shunt was performed with 6mm artificial vessel, not a radical operation. After surgery, the cyanosis improved as intended.

Giant cell tumor of the tendon sheath is a rare benign neoplasia, which has variable clinical presentations, the localized and the diffuse forms. It is the second most common soft tissue tumor of the hand region in grown up population, therefore its presence in children is extraordinary.

Numerical method was widely used in bridge seismic performance analysis, but the diversity and complexity structures increased trouble in the modelling process. This paper presented a systematic, universal and flexible bridge numerical modelling method, and the seismic performance of a concrete filled steel tubes arch bridge was studied. The geometric/attribute model involved structural/stiffness equivalence, and the bridge parametric modeling strategy combined commercial computer-aided design language of software MATLAB and ANSYS. Data exchange in different fields and rapid reconstruction of numerical model were realized. Finally, the vibration mode, deformation and internal force of the bridge under seismic load was studied. The results indicated that the proposed parametric model formed a complete data transfer process, and the bridge model rapidly modified and reconstructed. The numerical calculation efficiency was greatly improved because of the structure element was employed instead of solid element. The displacement and internal force of arch rib were mainly controlled by lateral load under horizontal uni-input, and the combined horizontal and vertical load should be considered in seismic design. The leaning angle and width-span ratio of transverse braces are considered to improve the seismic performance of bridges.

Intrauterine pregnancy in the background of intrauterine devices heralds its rare but possible failure. Despite having an excellent contraceptive pearl index, clients with copper-T may present with typical pregnancy symptoms. Term pregnancies with excellent prognosis have been demonstrated in many studies after removal of intrauterine devices.

Penile's melanoma is a rare situation associated with late diagnosis and high morbi-mortality. We report the case of a 70-year-old. Represented skin lesions of the penile gland. A surgical biopsy established the diagnosis of Penile's melanoma in the metastatic stage. Malignant melanoma of the penis represents an exceptional situation

This paper is to study a Sturm-Liouville equation Ly:=-p(x)y’‘+q(x)y=\lambda y with discontinuities in the case that eigenparameter appears not only in the differential equation but also appears in both the boundary conditions \lambda(\alpha’_{1}&y(-a)-\alpha’_{2}y’(-a))-(\alpha_{1}y(-a)-\alpha_{2}y’(-a))=0, \lambda(\beta’_{1}y(b)-\beta’_{2}y’(b))+(\beta_{1}y(b)-\beta_{2}y’(b))=0 and transmission conditions as -y(0^{+})&\bigg(\lambda\eta-\xi-\sum_{i=1}^{N}\frac{b_{i}^{2}}{\lambda-c_{i}}\bigg)=y’(0^{+})-y’(0^{-}), y’(0^{-})&\bigg(\lambda\kappa+\zeta-\sum_{j=1}^{M}\frac{a_{j}^{2}}{\lambda-d_{j}}\bigg)=y(0^{+})-y(0^{-}). In particular, in the space L^{2}([-a,b])\oplus\mathbb{C}\oplus\mathbb{C}\oplus \mathbb{C}^{N’}\oplus \mathbb{C}^{M’}, the considered problem can be interpreted as the eigenvalue problem of self-adjoint operator A. Moreover, we construct the Green’s function of the considered problem and resolvent operator of A.

Three novel materials have been developed based on hexachlorocyclotriphosphazene and octachlorocyclotetraphosphazene. The core phosphazene ring is substituted with varying ratios of fluorinated side groups and with 4-hydroxybenzaldehyde to allow a Schiff base reaction with diaminodiphenylmethane (DDM) to form a cyclomatrix or cyclolinear polymer compound. These compounds give excellent water repellence combined with good adhesion and viscoelasticity. In addition, the new materials undergo a surface reaction on exposure to atmosphere such that subsequent disturbance of the surface causes virgin material to become exposed giving clear evidence of such disturbance.

Post-Laryngectomy Voice Prosthesis Changes by Speech-Language Pathologists: Our Experience.

Objective: To propose a scoring system based on laryngoscopic characteristics for the differential diagnosis of benign and malignant vocal cord leukoplakia. Design: Retrospective study. Setting: Tertiary hospitals Participants: Laryngoscopic images from 200 cases of vocal cord leukoplakia were retrospectively analyzed. The morphologies of vocal cord leukoplakia under laryngoscopy were evaluated by two laryngologists. Main outcome measures: The laryngoscopic signs of benign and malignant vocal cord leukoplakia were compared, and statistically significant features were assigned and accumulated to establish the leukoplakia finding score (LFS). Results: A total of five indicators (size, thickness, texture, hyperemia, and anterior commissure involvement) associated with malignant vocal cord leukoplakia were included to construct the LFS, with a possible range of 0–10 points. The diagnosis of malignant vocal cord leukoplakia as a score of ≥6 points was the most efficient. The sensitivity, specificity, and accuracy of the LFS were 93.8%, 83.6%, and 86.0%, respectively. The consistency in the LFS obtained by different laryngologists was strong (kappa=0.809). Conclusion: This scoring system based on laryngoscopic characteristics has high diagnostic value for distinguishing benign and malignant vocal cord leukoplakia.

25-hydroxyvitamin-D (25(OH)D) level in the fetus entirely depends on the transport over placenta which is assumed to be obstructed with maternal levels <25nmol/L. Design Observational study. Setting Prospectively enrolling from September to December 2021 in a tertiary governmental hospital in a northern Emirate. Population Admission for spontaneous and elective labor. Methods 25(OH)D was analyzed in maternal serum at admission, respectively, in cord blood after delivery. Main outcome measures Factors affecting maternal and fetal 25(OH)D levels and the correlation between the two at delivery. Results 303 women were enrolled and 237 had complete maternal/umbilical cord blood samples. 138 (47.7%) of women were diagnosed with deficiency (25(OH)D<50nmol/L), whereas only 34 fetuses (13.8%) were deficient (25(OH)D<30nmol/L). The mean difference between maternal and cord blood 25(OH)D was negative in 91% of cases (-16.27nmol/L, SD=13.36). The correlation between maternal/umbilical cord levels was excellent (r = 0,906, p<0,000). After dividing into subgroups of maternal 25(OH)D levels, BMI, diabetes yes/no and delivery-mode the correlation was consistent, although the correlation coefficients in the subgroups of maternal 25(OH)D levels were lowered for all groups. Of factors studied, only the supplementation dose affected the maternal 25(OH)D level. 25(OH)D <50nmol/L was not associated to an increased risk for diabetes, preterm labor, preterm-rupture-of-membranes or low Apgar-score. Conclusion We found a higher 25(OH)D level in cord blood with consistent correlation to maternal levels. Of the studied factors only supplementation dose had significant impact on the maternal level. 25(OH)D <50nmol/l were not associated to increased risk for preterm-labor, preterm-rupture-of-membranes, diabetes or low AS.