Background Recent epidemiologic data has indicated coronavirus to be highly contagious with high risk of person-to-person transmission. On March 11, 2020, the World Health Organization (WHO) declared COVID-19 a pandemic. With the increasing number of confirmed cases and the accumulating clinical data, the cardiac manifestations induced by COVID-19 have generated great concern. COVID-19 was also associated with cardiac arrest, acute-onset heart failure, and myocarditis. COVID-19 has not been reported as the cause of abnormalities of cardiac conduction system. Case Presentation Our patient was transferred from a long-term care facility with history of new onset bradycardia and fall. Patient had no classical symptoms of viral infection, including fever, dyspnea or any classical radiological finding like bilateral ground glass opacities. Initial EKG was noted for 3rd degree AV and heart rate 30 BPM. He was taken to cardiac catheterization lab for an emergent temporary transvenous pacemaker. Patient subsequently had permanent pacemaker implanted electively. Discussion and Conclusions This case represents cardiac conduction abnormality requiring therapeutic pacing as a presenting symptom of SARS-CoV-2 Health care professionals need to be vigilant about atypical, noval presentation of this disease in patients belonging to risk groups such as over 60 years age, immunocompromised, residents of long-term facilities, and with medical conditions such as heart disease, lung disease, diabetes, stroke, renal disease, cirrhosis, and diabetes. Currently there is no proven treatment for this infection and individuals in these at-risk groups are susceptible to higher morbidity and mortality.

AbstractIntroduction: It is not unusual for temporary transvenous cardiac pacing (TVCP) leads to penetrate and occasionally perforate the right ventricular wall, which generally is asymptomatic. The definition of myocardial injury is evidence of elevated cardiac troponin (cTn) values above the 99th percentile upper reference limit (URL). Myocardial injury is associated with an adverse prognosis. The present study was designed to evaluating myocardial injury complicated by TVCP.Methods: Retrospective study from August 2018 to March 2020, 33 consecutive patients undergo elective TVCP support for non-cardiac procedures, 22 of them had cardiac biomarkers assays before and after TVCP. These 22 eligible patients had a median age of 66 (50-83) years, 6 (27.3%) were women, and all baseline cTn <1 URL. Compare cardiac biomarkers before and after TVCP.Results: 20 (91%, N=22) patients detect cTn >1 URL after pacing. Paired t-test compare before and after pacing leads insertion showed a mean cTn elevation of 3.599 (95% CI, 1.566 to 5.632, P<0.01）URL, and no significantly creatine kinase-MB elevation of 0.1550 (95% CI, -0.01239 to 0.3224, P>0.05 ) URL.Conclusion: This study demonstrates a high incidence of substantial myocardial injury by TVCP, which should be concerned.Introduction:Temporary transvenous cardiac pacing（TVCP）is a reliable heart rate control and potentially life-saving intervention. Primary indication is life-threatening bradyarrhythmia with hemodynamic compromise, include bradyarrhythmia due to atrioventricular blocks or sinus node dysfunction. Other indications include tachyarrhythmias needing overdrive pacing, and dysrhythmias needing rate support to allow the use of medications directed toward treatment of tachyarrhythmias that might exacerbate bradycardia such as beta blockers.1, 2Complications can be considered in two broad categories: relate to the venous access or relate to pacing catheter.3 The use of ultrasound guidance result in safer venous access, and the complication rate is statistically insignificant between novice and experienced clinicians.4Central venous access–associated complications were rare when venous access was obtained with ultrasound guidance.5-7Complications or concerns relate to pacing catheters also can be divided into two categories: electrical performance and mechanical effects.2 Electrical performance requires proper catheter placement, the lead stability, firm connections to the external generator, and external generator management to achieve pacing function. But mechanical effects are adverse complications.The TVCP lead is relatively stiff, promotes ventricular ectopic activity, or ventricular tachycardia during catheter insertion is common and occasionally prolonged ventricular arrhythmias.8 It is not unusual for these leads to penetrate and occasionally perforate the right ventricular wall.2 This is usually manifest by raised pacing thresholds and occasionally by pericarditic pain and a pericardial friction rub.9 Rarely this will result in cardiac tamponade which associated with increase in risk for in-hospital death10. Pericardial tamponade, perforate or penetrate the ventricular wall are literally myocardial injuries. The term myocardial injury used nowadays is when there is evidence of elevated cardiac troponin (cTn) values with at least one value above the 99th percentile upper reference limit (URL).11 Myocardial injury is associated with an adverse prognosis.12, 13 However, there is no study evaluating myocardial injury complicated with TVCP by cTn assays. Therefore, the objective of this study was to investigate myocardial injury caused by TVCP.Methods:Study design and patientsRetrospect study consecutive 33 cases/patients undergo elective TVCP placed by the first author (Meng L) for scheduled non-cardiac surgery from August 2018 to March 2020. 22 of them have measured cardiac biomarkers values before and after TVCP placement. Analysis of the values changes of the cardiac biomarkers. The Hunan Provincial People’s Hospital Ethics Committee granted study approval (reference number: 2020-07) and waived the usual requirement for informed consent as all data were de-identified and analyzed anonymously.22 eligible patients had a median age of 66 (50-83) years, and 6 (27%) were women, 13 (59%) from the cancer center, others from hepatobiliary surgery, general surgery, and spine surgery department. None of the patients had history recorded of myocardial infarction, stroke, heart failure, chronic kidney disease, anemia. No remarkable structure abnormality findings in echocardiography. B-type natriuretic peptide (BNP) and hemoglobin were normal. Except for slightly elevated creatinine in 1 case (120.5umol/L), creatinine was normal. Decisions of TVCP were made by surgeons after consultation with cardiologists or/and anesthesiologists. Except for the bradyarrhythmia, patients with low cardiovascular risk, so TVCP were simply placed bedside, rather than catheter lab. TVCP indications and baseline characteristics of patients included in table 1.Table 1. Baseline characteristics of patients and indication of temporary transvenous pacing.CharacteristicAll（N=22）Age，y55-83 (median 66)Female6 (27.3%)Hypertension3 (13.6%)Diabetes mellitus3 (13.6%）Coronary artery disease1 (4.5%)Smoking8 (36.4%)Surgery typeTumor ectomy 13 (59.1%)Bile duct stones 4 (18.2%)Spine diseases 3 (13.6)Intestinal obstruction 1 (4.5%)Hernia 1 (4.5%)IndicationMobitz type II AVB 1 (4.5%)Sinus pause 1 (4.5%)Sinus bradycardia andJunctional rhythm 1 (4.5%)SVT/AT 2 (9.1%)1°AVB & CRBBB 1 (4.5%)High risk intraoperative bradycardia 12(54.5%)Absent response to atropine test 4 (18.2%)Caption of table 1: Sinus bradycardia: Sinus rate <50 bpm; AVB, atrioventricular block; CRBBB, complete right bundle branch block; SVT: supraventricular tachycardia; AT: atrial tachycardia.TVCP catheter was placed within 12 hours before surgery. The catheter placed from 6 to 24 hours, and withdraw soon after surgery in 21 cases, placed 3 days in 1 case. Cardiac biomarkers values were measured within 2 weeks before TVCP and at night (2) or next morning (20) after surgery.2, Material and temporary pacemaker placementMaterialMedtronic, model 5348 or 5392 temporary pacemaker. 7 French (F) hemostasis introducer (Fast-CathTM & Cath-LockTM, ST. JUDE MEDICAL) and 6 F non-floating right heart curve bipolar pacing catheter (PACELTM, ST. JUDE MEDICAL). Catheter tip has two electrodes, which are about 1 cm apart. The distal tip is a negative and active electrode, and the proximal electrode is positive and indifferent.Bedside temporary pacemaker placementThe primary access site was through the right internal jugular vein (16 cases, 73%), followed by subclavian vein (4 cases, 18%) when surgery involved the right neck. The femoral vein approach was used (2 cases, 9%) after difficulty was experienced in advancing TVCP catheter through the subclavian vein or right internal jugular vein site. Except for subclavian vein access, all central venous access was under ultrasound guidance.Pacing catheterization guided by bipolar (both proximal electrode and distal electrode connect to separate V lead) intracavity electrocardiography (IC-ECG).14, 15The bipolar IC-ECG monitoring plus direction control skill of the catheter tip made bedside TVCP catheter placement feasible and ‘visible’.14Target proximal electrode IC-ECG was slightly ST-segment elevation <2 mV which constitute a proper position against the ventricular wall and adequate pacing site,16 but it is impossible to maintain it if patient change positions (Fig 1). All placement was further confirmed by following standard 6-lead pacing ECG that II, III, and aVF QRS waves downward.Figure 1. Unstable pacing lead.

INTRODUCTION: We previously reported the clinical benefits of radiofrequency catheter ablation (RFCA) of premature ventricular contractions (PVCs) from the right ventricular outflow tract or near His-bundle, which often can deteriorate clinical status and cause left ventricular (LV) dilation that develops into heart failure. This study aimed to evaluate the role of ablating PVCs per RFCA from a trans-interatrial septal approach in the LV dilation and clinical status in patients with PVCs from the mitral annulus (MA) (MA-PVCs) without structural heart disease. METHODS: The frequency of PVCs per the total heart beats by 24-h Holter monitoring, left ventricular ejection fraction (LVEF) and left ventricular end-diastolic (LVDd) and -systolic (LVDs) internal dimensions by echocardiography, New York Heart Association (NYHA) functional class, and serum brain natriuretic peptide (BNP) concentration in 22 patients with MA-PVCs were evaluated before and 6 months after RFCA. RESULTS: Before the RFCA, the patients with frequent (20% <) PVCs demonstrated a significantly reduced LVEF, enlarged LVDd and LVDs, deteriorated NYHA functional class, and elevated serum BNP concentration as compared to the subgroup with rare (≤ 20%) PVCs. Furthermore, ablating MA-PVCs readily produced an improvement in those abnormalities as compared to that before the RFCA. Interestingly, the MA-PVCs were successfully ablated from not only the ventricular side of the MA (68%) or coronary sinus (5%), but also the left atrial side of the MA (18%). CONCLUSIONS: RFCA produces clinical benefits in patients with MA-PVCs. Further, it may be necessary to initially consider a trans-interatrial septal approach to ablate these PVCs.

Letter to the Editor

Background Data on the optimal location of the ECG leads for the diagnosis of drug-induced long QT syndrome (diLQTS) with Torsades de Pointes (TdP) are lacking. Methods We systematically reviewed the literature for ECGs of patients with diLQTS and subsequent TdP. We assessed T-wave morphology in each lead and measured the longest QT interval in the limb and chest leads in a standardized fashion. Results Of 84 patients, 61.9% were female and mean age was 58.8 years. QTc was significantly longer in chest versus limb leads (mean (standard deviation) 671 (102) vs 655 (97) ms, p=0.02). Using only limb leads for QT interpretation, 18 (21.4%) ECGs were non-interpretable: 10 (11.9%) due to too flat T-waves, 7 (8.3%) due to frequent, early PVCs and 1 (1.2%) due to too low ECG recording quality. In the chest leads, ECGs were non-interpretable in 9 (10.7%) patients: 6 (7.1%) due to frequent, early PVCs, 1 (1.2%) due to insufficient ECG quality, 2 (2.4%) due to missing chest leads but none due to too flat T-waves. The most common T-wave morphologies in the limb leads were flat (51.0%), broad (14.3%) and late peaking (12.6%) T-waves. Corresponding chest lead morphologies were inverted (35.5%), flat (19.6%) and biphasic (15.2%) T-waves. Conclusions Our results indicate that QT evaluation by limb leads only underestimates the incidence of diLQTS experiencing TdP and favors the screening using both limb and chest lead ECG.

During the SARS-Cov-2 pandemic, it is essential to identify the risk factors that can cause a higher probability of infection and, therefore, worsen the patient's health. In fact, the known risk factors include already existing diseases and associated pharmacological treatments. A patient with multiple sclerosis takes immunomodulatory drugs and certainly has a high risk. Evidence and literature have shown that SARS-Cov-2 infection causes severe lung damage due to a poorly functioning immune system and overexpression of cytokines. Therefore the management of multiple sclerosis treatments in immunomodulating therapy must be carefully monitored. This article on the one hand analyzes and recalls the safety profile of all drugs for multiple sclerosis, on the other the recommendations adopted by different countries are highlighted, trying to understand if the suspension of MS treatment must actually materialize in order not to incur lethal covid pneumonia.

In March 2020 a pandemic was declared due to a novel coronavirus strain. The virus can create a hypercoagulable state. This case is one of the first to report the development of a pulmonary embolism in an infected patient with no known risk factors in an outpatient setting.

Increasing anthropogenic loading of phosphorus (P) threatens aquatic ecosystems. The bioavailability of P in sediments for algal growth depends on several physiochemical properties such as silt, clay, mineralogy, pH, electrical conductivity (EC), and carbonate-content. This study was aimed on selecting the best chemical extraction method to characterize P-availability for the algae Selenastrum capricornutum. Principal component analysis (PCA) of the data identified two components that cover 79.3% of the total variation, and these components were dominated by particle size distribution, active calcium carbonate equivalence (ACCE), and EC. Many of the considered extractions were positively correlated with each other, with the exception being Bray-II. The sediments of some rivers had a higher Olsen-extractable P than 20 mg kg-1, that is considered a threshold value above which the aquatic environment may become negatively affected. The average rank order of P extraction by single extractants was: Colwell > Mehlich III > NaOH 0.1 M > Olsen > Morgan > AB-DTPA > Bray II. The Colwell-extractable P concentrations of sediments varied from 1.44 to 88.0 mg kg-1. This extractant significantly correlated with algal growth (r2=0.92, P<0.001) and gave a rough estimate of the amount of bioavailable P in sediments. Therefore, the bioavailable content of P in sediments is quite high in comparison with the soils (agronomic requirement = 15 mg P kg-1) around the Urmia Lake basin.

The pandemic of coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has made widespread impact recently. We aim to investigate the clinical characteristics of COVID-19 children with different severities and allergic status. Pediatric COVID-19 patients tended to have a mild clinical course. Patients with pneumonia had higher proportion of fever and cough and increased inflammatory biomarkers than those without pneumonia. There was no difference between allergic and non-allergic COVID-19 children in aspects of incidence, clinical features, laboratory and immunological findings. Allergy was not a risk factor for developing and severity of SARS-CoV-2 infection and hardly influenced the disease course of COVID-19 in children.

Dear Editor,With great interest, I read the article by Yim and associates1 and congratulate them for the quality of the review carried out on the internal mammary artery harvesting techniques. However, I would like to help clarify some aspects specifically related to the history of this procedure.The skeletonized IMA harvesting technique is usually considered to be newer than pedicle dissection. Actually, when Arthur Vineberg first implanted an IMA in a human heart in 1950, he only separated the arterial vessel from the chest wall. For more than a decade, only arteries were implanted according to Vineberg’s proposed method, and it wasn’t until the early 1960s that William Sewel proposed implanting a pedicle into the myocardium, that also contained the internal mammary vein and other tissues (”pedicle operation”) with the intention of draining excess blood and avoiding the formation of myocardial hematomas.2It is also incorrect to claim that skeletonized IMA harvesting was introduced due to concerns offered by reduced sternal blood flow and potential mediastinitis. In January 1972, David Galbut and his group introduced systematic skeletonized harvesting into their series of patients revascularized with bilateral internal mamary arteries, some time before that procedure began to be linked with deep sternal wound infections. Galbut probably only took advantage of obtaining longer arteries and easier construction of sequential anastomoses.2Furthermore, when Cunningham first described the IMA’s skeletonized harvesting technique in 1992 he specified that to avoid thermal injury to the artery, it was extremely important to keep the cautery setting on low throughout the dissection.3 After this advice, smoke never seems to have been a concern for surgeons, so it was hardly the reason for the introduction of harmonic technology in IMA dissection, which was also initially used in the “open harvesting” technique.4Finally, I consider it curious that this review does not include the semiskeletonization technique, introduced in 19975 and currently used by various groups.References1. Yim D, Wong WYE, Fan KS, Harky A. Internal mammary harvesting: Techniques and evidence from the literature. J Card Surg. 2020;35(4):860-7.2. López de la Cruz Y, Nafeh Abi-Rezk M, Betancourt Cervantes J. Internal mammary artery harvesting in cardiac surgery: an often mistold story. CorSalud. 2020;12(1):64-76.3. Cunningham JM, Gharavi MA, Fardin R, Meek RA. Considerations in the skeletonization technique of internal thoracic artery dissection. Ann Thorac Surg. 1992;54(5):947-50.4. Higami T, Kozawa S, Asada T, Shida T, Ogawa K. Skeletonization and harvest of the internal thoracic artery with an ultrasonic scalpel. Ann Thorac Surg. 2000;70:307-8.5. Horii T, Suma H. Semiskeletonization of Internal Thoracic Artery: Alternative Harvest Technique. Ann Thorac Surg. 1997;63:867-8.Note: The author of this manuscript is not an employee of any agency of the Cuban government; he is only a cardiovascular surgeon in a public hospital. The author of this manuscript also does not represent the Cuban government in relation to this “letter to the editor”.

Ecological theory predicts that the soil seed bank stabilizes the composition of plant communities in the face of environmental variability. Using one of the longest seed bank-vegetation databases, we tested whether the composition of the seed bank is more stable than the standing vegetation in annual communities across a rainfall gradient. The composition of the seed bank differed from the vegetation throughout the years with a higher abundance of small-seeded and persistent-seeded species. Year-to-year variability in composition increased with increasing aridity, but its magnitude was similar in the seed bank and the vegetation. Importantly, the rate of long-term compositional change was much slower in the seed bank. These results support the hypothesis that the seed bank can buffer against climatic shifts and increases the resistance of plant communities to directional trends. We conclude that the seed bank plays a crucial role in the stability of plant communities under global changes.

We present a novel method, Neural Ordinary Differential Equations, for learning ecological and evolutionary processes from time series data. The method consists in modelling dynamical systems with Ordinary Differential Equations and dynamic functions with Artificial Neural Networks, which upon successful training converge to functional shapes that best describe the processes. We tested NODEs by inferring per-capita growth rates of hare and lynx in simulated and real time series, which revealed that prey-predator oscillations were mainly driven by stronger predation at low hare and lynx density, as well as negative density-dependence in lynx, in line with the literature, thus demonstrating the validity and utility of NODEs. The approach is applicable to any system that can be modelled with differential equations, and particularly suitable for linking ecological, evolutionary, and environmental dynamics where parametric approaches are too challenging to implement, opening new avenues for theoretical and empirical investigations.

Sánchez-Tójar et al. (2020, Ecol Lett) questioned the methodology, transparency and conclusion of our study (Yin et al. 2019, Ecol Lett, 22, 1976). I feel that these arguments ignore critical assumptions and are based on the misunderstanding of our peer-review process. General does not mean always; the jury of our study is in revealing when and where a transgenerational effect is beneficial, which enlightens future research.

In natural forests, it is increasingly suggested that stand factors are far more important for community biomass and productivity than biodiversity, but the relative importance of stand factors vs. diversity on ecosystem stability, and how their relative roles change with grain size, still remain unclear. Using inventory data from tropical forest plots in southwestern China from 2004 to 2010, we found that stand factors were clearly more stronger drivers than diversity for forest biomass and productivity (at each grain size from 400 m2 to 0.25 ha), while diversity was predominate for temporal stability of biomass and productivity. The effect of diversity on biomass and productivity increased with increasing grain size, but did not change clearly for ecosystem stability. Functional diversity was more important for ecosystem functions and stability than taxonomic and phylogenetic diversity, and richness was more important than the other two diversity components (evenness and divergence). Our results reconcile the recent debate on the relative importance of diversity vs. stand factors on ecosystem properties, and suggest that forest management to adjust stand structure is an effective way to increase forest carbon storage rapidly, but biodiversity conservation may be crucial for long-term ecosystem stability under climate change.

Objective: To evaluate the auditory perception outcomes of cochlear implant (CI) in children with different types of inner ear malformations (IEMs) and to compare them with CI users with the normal cochlea. Design: Retrospective and prospective data collection. Settings: Tertiary referral hospital. Participants: There were 274 CI users with and without IEMs as two groups. Both groups’ chronological age at implantation and duration of cochlear implant usage was matched (±8 months). Main outcome measures: All subjects were evaluated preoperatively and postoperatively with Ling’s sound test and auditory perception test battery, which includes the Meaningful Auditory Integration Scale (MAIS), close-set Pattern Perception Test (PPT), and open-set Sentence Recognition Test (SRT). Also, children with IEMs were assessed for language development. Results: The incidence of IEMs were incomplete partition-II, 40 (29.19%), incomplete partition-I, 36 (26.2%), cochlear hypoplasia, 26 (18.9%), enlarged vestibular aqueduct, 14 (%10.2), incomplete partition-III, 10 (%7.2), common cavity, 8 (5.8%) and dilatation of vestibule, 3 (2.1%) patients. The significant difference was seen in Ling’s sound test and auditory perception test battery scores of children with incomplete partition-I, cochlear hypoplasia, and common cavity (p-value < .005). Conclusion: IEMs group showed different progress according to the type of ear anomaly. Although CI users with enlarged vestibular aqueduct (EVA) had the highest scores, users with common cavity had the lowest scores. Taking these results, caused by anatomical differences, in to account is very critical in follow-ups and rehabilitation programs. Each cochlear implant user should be evaluated according to his/her individual needs.

The role of CD4+ Treg in immune responses has been well established. More recently a role of CD8+ Treg in the regulation of immune responses in health and autoimmune diseases has been investigated. Furthermore, different investigators have used different markers to define CD8 Treg. Finally, regulatory effects of CD8 Treg have been studied against T cell responses; however, their role in regulating B cell proliferation and immunoglobulin production has not been evaluated. Therefore, in this study we examined the effect of two types of CD8 Treg on B cell proliferation and immunoglobulin production. Methods: Purified CD8+ T cells were activated with anti-CD3/CD28 for 48 hours and then sorted into two different types of CD8 Treg as defined by two different sets of markers, CD8+CD183+CCR7+CD45RA-, and CD8+CD183+CD25highCD278+. Purified B cells were co-cultured with sorted CD8 Treg at 1:1, 1:1/2, 1:1/4 ratios, and activated with anti-CD40 and CpG. B cell proliferation was assessed by CFSE dye dilution assay and immunoglobulin production by ELISA assay. Results: Our data show CD183+CCR7+CD45RA- CD8 T reg significantly inhibited B cell proliferation and inhibited IgM and IgG production but not of IgA production at 1:1 ratio only. However, CD183+CD25highCD278+ CD8 Treg inhibited significantly B cell proliferation at 1:1 and 1:1/2 ratio and IgM, IgG, and IgA production at all ratios. In Conclusion, CD8 Treg regulate B cell responses, and CD183+CD25highCD278+ CD8 Treg are more powerful regulators of B cell proliferation and Immunoglobulin production than CD183+CCR7+CD45RA- CD8 Treg.

“Men’s crops” and “women’s crops” suggest that men and women smallholder farmers in sub-Saharan Africa grow different crops. Yet, this gender division of crops is not considered in the valuation of wild pollinators to crop productivity, and therefore remains unknown, despite considerable coverage of wild pollination ecosystem services. We link a nationally representative panel survey of over 10,000 actual plots managed by male and female farmers; with spatially and temporally land cover maps; together with robust fixed-effects production function methods. We find evidence of gendered-crops and variation in pollination dependency in male- and female-managed farms. Furthermore, statistically significant fixed-effects estimates produce an exponential function which shows that proximity to wild pollinators’ natural habits - forests - is important, and that at shorter distances female-managed farms benefit four times more than male-managed farms, and this tapers off as distance increases producing convergence in benefits. We are able to conclude that conservation that preserves the natural habitants of wild pollinators will enhance crop yield especially among female-managed farms. This demonstrates the importance of gender in ecosystem services and suggests that to fully understand their benefits, gender needs to be incorporated into natural capital and sustainable development policies governing smallholder agriculture rich regions.

In December 2019, Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is widely spread and causes a critical threat to clinical burden and public healthcare. The outbreak of COVID-19 has aroused widespread concern in the rheumatology community.

Objective: To evaluate pharyngeal sensory function by Current Perception Threshold (CPT) measurement from healthy and paresthetic pharynx. Methods: In total, 122 healthy volunteers and 70 patients with pharyngeal paresthetic symptoms underwent CPT evaluation. Pharyngeal paresthesia (n=70) were classified into three categories based on aetiologies: six cases with pain in pharynx; 38 neuropathic patients with glossopharyngeal nerve and/or vagus nerve injury; and 26 patients with globus pharyngeus. CPT measurements were obtained from bilateral palatoglossal arch and tongue base at 2000Hz, 250Hz and 5Hz stimulation frequencies. Results: Ranked from high to low, the CPT values for the bilateral palatoglossal arches and tongue bases were: neuropathic patients, globus pharyngeus and normal patients. The CPT values for neuropathic patients on the injured side were significantly higher than those on the healthy side (P<0.05). The CPT values for patients with pain in pharynx were significantly lower than those of normal subjects (P<0.05) when the bilateral tongue bases were stimulated. Conclusion: The CPT testing is a reliable method for objectively and quantitatively assessing pharyngeal sensory function and able to differentiate pharyngeal paresthesia between neuropathic and subjective discomfort. Pharyngeal sensory function is more sensitive in patients with pain in pharynx. Pharyngeal sensory function is significantly reduced in neuropathic patients, especially on the injured side. Patients with globus pharyngeus have pharyngeal hyposensitivity.

Abstract Background There is a growing relationship between PD-1/PD-Ls and autoimmune disease We attempted to explore the relationship of the PD-L2 expression in patients with thymoma, especially with Myasthenia Gravis (thymomatous MG). Methods Seventy patients with thymoma who underwent surgical resection between January 2017 to December 2018 were retrospectively reviewed. The PD-L2 expression was evaluated by immunohistochemistry. The association between the PD-L2 expression and the clinicopathologic features was investigated, especially thymomatous MG. Results The PD-L2 expression was positive in 41 patients (58.6%) and negative in 29 patients (41.4%). The PD-L2 expression was significantly associated with WHO histology of type B2 and B3 thymoma (p=0.008) and the status of MG (p=0.002). In addition, PD-L2 positive tumors showed a significantly smaller tumor size (P=0.017). Ectopic thymus was significantly more often seen in the PD-L2 positive group (p=0.035). The patients with MG (p=0.001) and WHO type B2 and B3 (p=0.007) have significantly higher PD-L2 scores. Multivariate logistic regression model showed the status of MG (OR 12.601, 95%CI 2.406-65.995, p=0.02) and age (OR 0.199, 95%CI 0.046-0.863, p=0.031) were significantly associated with the expression of PD-L2. The analysis of 33 patients with MG shows age was not associated with the expression of PD-L2 (OR 0.04, 95%CI 0.001-3.2, p=0.15). Conclusions A strong expression of PD-L2 in thymoma was significantly associated with thymomatous MG and WHO histologic type B2 and B3. In addition, PD-L2 may play a potential role in the pathogenesis of thymomatous MG.

Aims: Develop a population pharmacokinetic model describing propofol pharmacokinetics in (pre)term neonates and infants, that can be used for precision dosing of propofol in this population. Methods: A non-linear mixed effects pharmacokinetic analysis (Monolix 2018R2) was performed, based on a pooled study population in 107 (pre)term neonates and infants. Results: 836 blood samples were collected from 66 (pre)term neonates and 41 infants originating from three studies. Body weight (BW) of the pooled study population was 3.050 (0.580 – 11.440) kg, postmenstrual age (PMA) was 36.56 (27.00 – 43.00) weeks and postnatal age (PNA) was 1.14 (0 – 104.00) weeks (median and range). A three compartment structural model was identified and the effect of BW was modeled using fixed allometric exponents. Elimination clearance maturation was modeled accounting for the maturational effect on elimination clearance until birth (by GA) and postpartum (by PNA/GA). The extrapolated adult (70 kg) population propofol elimination clearance (1.63 L min-1) is in line with estimates from previous population pharmacokinetic studies. Empirical scaling of BW on the central distribution volume (V1) in function of PNA improved the model fit. Conclusions: It is recommended to describe elimination clearance maturation by GA and PNA instead of PMA on top of size effects when analyzing propofol pharmacokinetics in populations including preterm neonates. Changes in body composition in addition to weight changes or other physio-anatomical changes may explain the changes in V1. The developed model may serve as a prior for propofol dose finding in (preterm) neonates.

Objectives To examine the effects of single- and double-layer uterine closure techniques on uterine scar healing following cesarean delivery. Design Randomised controlled trial Setting University Hospital of Başkent from July 2018 to September 2019 Population This study assessed a total of 282 women between 18-45 years of age who had singleton pregnancies and had not previously undergone uterine surgeries. Methods Participants were randomized into two following treatment groups: single-layer closure with locking and double-layer closure with locking in the first layer, but not in the second layer (NCT03629028). Participants were evaluated at 6-9 months after cesarean section by saline infusion sonohysterography to assess cesarean delivery scar defects. Experienced sonographers who were not informed about the uterine closure technique conducted these procedures. Results Of the 225 final participants, 116 received the double-layer closure technique, while 109 received the single-layer technique. In this regard, the niche rates and median niche depths based on transvaginal ultrasounds and sonohysterography investigations were 21%, 0.9±1.8mm, and 41%, 2.1±1.9mm (p<0.001, p<0.001), respectively. The niche rates were 37% for the single-layer group and 45.7% for the double-layer group (p=0.22). Median niche widths were higher in the double-layer group (p=0.006). Conclusions The single- and double-layer closure techniques did not produce different impacts on uterine scare niche development. However, the median niche width was higher for the double-layer closure group. Tweetable abstract There was no difference between single- and double layer closure in the rate of scar niche development following cesarean delivery. Keywords cesarean delivery, isthmocele, niche, uterine closure

Single atom catalysts with iron ions in the active site, known as FeNC catalysts, show high activity for the oxygen reduction reaction and hence hold promise for access to low cost fuel cells. Due to the amorphous, multi-phase structure of the FeNC catalysts, the iron environment and its electronic structure are poorly understood. While it is widely accepted that the catalytically active site contains an iron ion ligated by several nitrogen donors embedded in a graphene-like plane, the exact structural details such as the presence or nature of axial ligands are unknown. Computational chemistry in combination with Mössbauer spectroscopy can help to unravel the geometric and electronic structures of the active sites. As a first step towards this goal, we present a calibration of computational Mössbauer spectroscopy for FeN4-like environments. The uncertainty of both the isomer shift and the quadrupole splitting prediction is determined, from which trust regions for the Mössbauer parameter predictions of computational FeNC models are derived. We find that TPSSh, B3LYP, and PBE0 perform equally well; the trust regions with B3LYP are 0.13 mm s−1 for the isomer shift and 0.45 mm s−1 for the quadrupole splitting. The calibration data is made publicly available in an interactive notebook that provides predicted Mössbauer parameters with individual uncertainty estimates from computed contact densities and quadrupole splitting values. We show that a differentiation of common FeNC Mössbauer signals by a separate analysis of isomer shift and quadrupole splitting will most likely be insufficient, whereas their simultaneous evaluation will allow the assignment to adequate computational FeNC models.

La bonifica dei siti contaminati è una delle problematiche più rilevanti nell’ambito degli interventi di recupero e di risanamento ambientale. Si definiscono “contaminate” quelle aree in cui, a causa di sversamenti accidentali, depositi abusivi ma anche condizioni naturali, sono presenti nel suolo sostanze inquinanti tali da risultare pericolose per l’uomo e per l’ambiente. Negli ultimi decenni si sono sviluppate alcune tecniche di bonifica che sfruttano la degradazione dei contaminanti ad opera di microrganismi con lo scopo di arrecare un minore impatto sull’ecosistema e un considerevole risparmio economico. Tra le molteplici tecniche trova spazio il Bioventing, una tecnologia adoperata nella zona insatura del terreno che consente l’utilizzo di microrganismi autoctoni per la degradazione di composti organici adsorbiti dalle frazioni minerali e organiche del suolo. In questo articolo si fa riferimento ad un caso studio che ha trattato la tecnica del Bioventing per la rimozione di idrocarburi del petrolio.