Apoptosis is a form of programmed cell death, which maintains cellular homeostasis by eliminating pathogen-infected cells. It contains three signaling pathways: death receptor pathway, mitochondria-mediated pathway and endoplasmic reticulum pathway. Its importance in host defenses is highlighted by the observation that many viruses evade, hinder or destroy apoptosis, thereby weakening the host’s immune response. Flaviviruses such as Dengue virus, Japanese encephalitis virus and West Nile virus utilize various strategies to activate or inhibit cell apoptosis. This article reviews the research progress of apoptosis mechanism during flaviviruses infection, including flaviviruses proteins to regulate apoptosis by interacting with host proteins, as well as various signaling pathways involved in flaviviruses-induced apoptosis, which provides a scientific basis for understanding the pathogenesis of flaviviruses and helps in developing an effective antiviral therapy.

Background: Brazil is an upper-middle-income country in South America with the world’s sixth largest population. Little is known on the volume, outcomes and trends of coronary artery bypass grafting (CABG) in Brazil’s public health system. Objective: The aim of this study was to evaluate the outcome of CABG in the public health system in from January 2008 to December 2017 through the database DATASUS. Methods: This study is based on publicly available material obtained from DATASUS, the Brazilian Ministry of Health’s data processing system, on numbers of surgical procedures, death rates, length of stay, and costs. Only isolated CABG procedures were included in our study. We used the TabNet software from the DATASUS website to generate reports. Chi-square test was used to compare death rates. A p-value of <0.05 was considered statistically significant. Results: We identified 226,697 CABG procedures performed from January 2008 to December 2017. The overall in-hospital mortality over the 10-year period was 5.7%. We observed statistically significant differences in death rates between the five Brazilian macro regions. Death rates by state ranged from 2.6% to 13.1%. The national average mortality rate remained stable over the course of time. Conclusion: Over 10 years, a high volume of CABG was performed in the Brazilian Public Health System with significant differences in mortality, number of procedures, and distribution of surgeries by region. Future databases involving all centers that perform CABG and carry out risk-adjusted analysis will help improve Brazilian results, and enable policymakers to adopt appropriate health care policies for greater transparency and accountability.

We present a case of a 75-year-old woman with typical myocardial infarction, however coronary angiogram was negative. Echocardiography identified the rare cause of chest pain, as a mobile mass of aortic valve was found to obstruct the coronary ostium. histopathology revealed a papillary fibroelastoma (PFE). Chest pain was relieved after surgical resection of the mass.

Lipomatous Hypertrophy of the Interatrial Septum (LHIS) is an unusual condition that can be presented as a mass-like bulge that typical spares of the fossa ovalis. We describe a 73-year-old overweight woman with dyspnea on exertion and two episodes of paroxysmal atrial fibrillation for the last eight months. A big sessile mass was detected in the interatrial septum measuring 3.7 x 4.7cm during transesophageal echocardiography. The patient underwent resection of the mass and pericardial patch reconstruction of the defect with significant improvement of her clinical status during the follow-up period. The histopathological analysis suggested LHIS.

Catheter-related DVT under the setting of TTP or TTP recovery stage may be presented as a more fulminant form. Certain guidelines for anticoagulation and antiplatelet therapy for thrombosis early should be further established. We present here a case of a patient presented with Comb (+) TTP and developed catheter-associated deep vein thrombosis (DVT). The patient was firstly diagnosed with Evans syndrome. However, he was refractory to a methylprednisolone pulse therapy with a combination of platelet transfusion and eventually developed microangiopathy of central nerve system. The immediate start of PEX (1500ml/d) induced a complete remission of acquired TTP and disappearance of neurological signs and symptoms. However, external iliac and femoro-popliteal venous thrombosis was diagnosed subsequently, inferior vena cava filter (IVC) filter was immediately planting accompanied with anticoagulation therapy. Meanwhile, PEX session was sustained as well as oral anticoagulant (rivaroxaban). 14 days later, the patient got full recovery. Our report aims at raising awareness of Catheter-related DVT under the setting of TTP should be cautious. It is necessary to start anticoagulation and antiplatelet therapy for thrombosis early, especially in such cases when PLT count > 50×109/L.

Letter to the Editor, BJOG Exchange

Background The Infection of aortic valve graft conduit is still burdened by notable morbidity and mortality. Medical and surgical strategies play a crucial role in patient outcome and vary depending on infection extend into adjacent cardiac structures, systemic spread and micro-organism involved. Methods In this retrospective study, we report our experience in the management of thirty consecutive patients admitted to our centre with composite aortic valve graft infection during the period 2008-2018. We review the early and mid-term outcomes of patients who underwent a reoperation or received a conservative medical treatment. Results Twenty patients underwent redo surgery with an early mortality of 10% and a survival of 83% at 7-year follow-up. Ten patients were treated medically and experienced an early mortality of 30% and a mid-term survival of 33%. Conclusion A surgical reoperation, despite a non-negligible perioperative risk, is the only radical treatment able to provide a good survival also in patients with complicated infective endocarditis.

The factors responsible for the spectrum of COVID-19 disease severity and the genesis and nature of protective immunity against COVID-19 remain elusive. Multiple studies have investigated the immune responses to COVID 19 in various populations, including those without evidence of COVID 19 infection. Information regarding innate and adaptive immune responses to the novel SARS-CoV-2 has evolved rapidly. Here, data are accumulating defining disease phenotypes that aid in rational and informed development of new therapeutic approaches for the treatment of patients infected with SARS-CoV-2 and the development of novel vaccines. In this article, we summarize data on important innate immune responses including cytokines, specifically IL-6 and complement, and explore potential treatments. We also examine adaptive immune responses and derivative therapeutics such as monoclonal antibodies directed at spike proteins. Finally, we explore data on real-time assessments of adaptive immune responses which include CD4+/CD8+ T-cells, NKT-cells, memory B-cells, and T-follicular cells with specificities for COVID-19 peptides in infected individuals and normals. Data of two novel vaccines have been released, both showing >95% efficacy in preventing SARS-CoV-2 infection. Analysis of humoral and cellular responses to the vaccines will determine the robustness and durability of protection. In addition, long-term assessment of SARS-CoV-2 memory B and T-cell mediated immune responses in patients recovering from an infection or those with cross-reactive immunologic memory will help to define risk for future SARS-CoV infections. Finally, patients recovering from SARS-CoV-2 infection may experience prolonged immune activation likely due to T-cell exhaustion. This will be an important new frontier for study.

Background: The primary nonresponse (PNR) rate of Infliximab (IFX) varies from 20% to 46% for the treatment of Crohn’s disease (CD). Detected PNR reduces the improper use of specific treatments. To date, there is hardly any knowledge regarding early markers of PNR. The aim of this study was to evaluate the role of Interleukin-6 (IL-6) as an early predictor of PNR of IFX for the treatment of CD. Methods: We enrolled 322 bio-naïve patients diagnosed with CD from January 2016 to May 2020. Primary response was determined at week 14. Multivariable logistic regression was used to construct prediction models. The discrimination, calibration and clinical validity of the models in the validation cohort were assessed by area under the curve (AUC), calibration and decision curves analyses. GEO data were analyzed to identify potential mechanisms of IL-6 in IFX therapy for CD. Results: PNR occurred in 31.06% (100 of 322) patients who were assessable at week 14. IL-6 levels significantly decreased after IFX therapy (P < 0.001). The validation model containing IL-6 presented enhanced discrimination with an AUC of 0.908 and high calibration. Decision curve analysis (DCA) indicated that the model added extra predictive value. GEO data confirmed the IL-6 levels were increased in the PNR group and IL-6-related differently expressed genes (DEGs) were enriched in the inflammatory response. Conclusion: We concluded that IL-6 may be used as a predictive factor to assess the risk of PNR to IFX therapy.

Precipitation is the sole input of regional water resources in mountainous or hilly areas that are not traversed by large rivers. A prerequisite for using isotopic techniques to study the regional water cycle of a mountainous area is to examine the stable isotopic composition of its precipitation. The findings are of great significance for in-depth understanding of the water-cycle processes. In this study, each event of precipitation was sampled and used to investigate the characteristics of stable hydrogen and oxygen isotopes (δ2H and δ18O, respectively) in precipitation on the Jiaolai Plain and its surrounding areas. NCEP/NCAR data was used for the wind speed and direction, relative humidity, and precipitable amount in the study area during the sampling period. The water vapor sources of precipitation over the plain were revealed through a comparative analysis of seasonal variations in precipitation isotopes, between the Global Network of Isotopes in Precipitation (GNIP) stations located along different vapor transport paths. The results showed that the local meteoric water line (LMWL) was δ2H = 6.38 δ18O + 0.72, with a gradient less than 8. This indicated that the precipitation process was affected by non-equilibrium evaporation occurred when the drops fell below the cloud base. Significant temperature and amount effects existed in the δ18O of precipitation, although the altitude effect was not significant. The water vapor source of the precipitation was controlled predominantly by the East Asian Monsoon from June to September, with the main source being evaporation from the adjacent Pacific Ocean. The plain was controlled by Westerlies from October through May, with the predominant vapor source being local evaporation. Water vapor from the polar region had minimal impact. During the sampling period, water vapor brought by Typhoon Lekima produced heavy precipitation on the plain. There was a significant depletion of δ18O in the precipitation at that time, indicating the existence of the cloud–rain zonal effect. These findings can serve as the basis for studying surface water–groundwater–seawater transformation.

Regional climate change impacts show wide range of variations under different levels of global warming. Watersheds in the northeastern region of United States (NEUS) are projected to undergo most severe impacts from climate change in the forms of extreme precipitation events, floods and drought, sea level rise etc. As such, there is high possibility that hydrologic regimes in the NEUS may get altered in the future which can be absolutely devastating for managing water resources and ecological balance across different watersheds. In this study, therefore, we present a comprehensive impact analysis using different hydrologic indicators across selected watersheds in the NEUS under different thresholds of global temperature increases (1.50C, 2.00C and 3.00C). Precipitation and temperature projections from fourteen downscaled GCMs under RCP8.5 greenhouse gas concentration pathway are used as inputs into a distributed hydrological model to obtain future streamflow conditions. Overall, the results indicate that majority of the selected watersheds will enter into a wetter regime particularly during the months of winter while flow conditions during late summer and fall indicate a dry future under all three thresholds of temperature increases. The estimation of time of emergence of new hydrological regimes show large uncertainties under 1.50C and 2.00C global temperature increases, however, most of the GCM projections show strong consensus that new hydrological regimes may appear in the NEUS watersheds under 3.00C temperature increase.

The cutterhead of tunnel boring machine is a large-scale metal welding structure, which is prone to problems such as wear and cracking during the tunnelling process. For the issue, the fatigue crack propagation rate model of cutterhead under different reliability was established, based on the damage tolerance of cutterhead. Its dangerous position of cutterhead failure was determined by using finite element method. According to the fatigue load spectrum, the fatigue propagation life of cutterhead under different reliability was calculated, the main factors affecting the reliability of cutterhead were analyzed and the engineering experiment is carried out. The results show that three dangerous positions of the cutterhead failure are the junction of the split plane, the maximum deformation of the block and the central cutter seat. The load stress amplitude and initial crack size are the main factors affecting the crack propagation life and the reliability of cutterhead. With the increase of load stress amplitude and initial crack size of cutterhead, the fatigue crack propagation life of cutterhead decreases and the reliability is worse. When the initial crack size of cutterhead is greater than 0.5mm, the fatigue crack propagation life of cutterhead decreases obviously. The research results provide a scientific basis for crack detection, life prediction and reliability evaluation of cutterhead structure.

Trans-catheter PFO closure is typically done utilizing femoral access for both ICE and device deployment. We hereby report the first two cases of PFO closure through the jugular veins guided by ICE from the arm in patients without any femoral options.

Introduction—We aimed to apply machine learning (ML) to develop a prediction model for cardiac resynchronization therapy (CRT) response. Methods and Results—Participants from the SmartDelay Determined AV Optimization (SMART-AV) trial (n=741; age, 66 ±11 yrs; 33% female; 100% NYHA III-IV; 100% EF≤35%) were randomly split into training & testing (80%; n=593), and validation (20%; n=148) samples. Baseline clinical, ECG, echocardiographic and biomarker characteristics, and left ventricular (LV) lead position (43 variables) were included in 6 ML models (random forests, convolutional neural network, lasso, adaptive lasso, plugin lasso, elastic net, ridge, and logistic regression). A composite of freedom from death and heart failure hospitalization and a >15% reduction in LV end-systolic volume index at 6-months post-CRT was the endpoint. The primary endpoint was met by 337 patients (45.5%). The adaptive lasso model was more accurate than class I ACC/AHA guidelines criteria (AUC 0.759; 95%CI 0.678-0.840 versus 0.639; 95%CI 0.554-0.722; P<0.0001), well-calibrated, and parsimonious (19 predictors; nearly half are potentially modifiable). The model predicted CRT response with 70% accuracy, 70% sensitivity, and 70% specificity, and should be further validated in prospective studies. Conclusions—ML predicts short-term CRT response and thus may help with CRT procedure planning.

Background: H1-antihistamines (AHs) are widely used for the treatment of allergic diseases, being one of the most commonly prescribed classes of medications in Pediatrics. Newer-generation AHs are associated with fewer adverse effects compared to first-generation. However, their relative harms in the pediatric population still need scrutiny. Methods: We performed a systematic review of randomized controlled trials (RCTs) which included comparisons of safety parameters between an orally administered newer-generation AH with another AH (first- or second- generation), montelukast or placebo in children aged≤12 years. We searched MEDLINE and CENTRAL, independently extracted data on study population, interventions, adverse events (AEs) and treatment discontinuations, and assessed the methodological quality of the included RCTs using the Cochrane’s risk of bias tool. Results: Fourty-five RCTs published between 1989 and 2017 met eligibility criteria. The majority of RCTs included school-aged children with allergic rhinitis and had a follow-up period of up to a month. Four RCTs reported serious AEs in patients receiving a newer-generation AH, but only two patients experienced a possibly drug-related serious AE. The occurrence of AEs, drug-related AEs and treatment discontinuations due to AEs varied between RCTs. Most AEs reported were of mild intensity. Indirect evidence indicates that cetirizine is more sedating than the other newer-generation AHs. Conclusion: Our findings confirm that newer-generation AHs have a favorable safety and tolerability profile. However, we could not draw firm conclusions regarding the comparative safety profile of the newer-generation AHs due to the paucity of head-to-head RCTs, variation in definitions and reporting of AEs, and short follow-up duration.

Introduction: Children with allergy may increase a chance to sensitize the allergic pollens with several environmental changes. Purpose of this study was to investigate the correlation with alternation of pollination associated with meteorological changes and increased sensitization rate of pollen allergens of children in Seoul metropolitan area, Korea. Methods: There were recruited 8,295 children who visited the pediatric allergic clinics at Hanyang University Seoul and Guri Hospital for allergy symptoms from January 1st, 1998 to December 31st, 2019. The pollen was collected by Burkard 7 days-sampler in 2 hospitals during the study. Meteorological data was investigated from Korea Meteorological Administration. Results: Allergic sensitization of oak, hazel, and alder pollens had the highest rate of increase among major tree pollens, an increase of 0.28% annually. The sensitization rate to pollen was increased with younger age group yearly. The duration of pollen season was 98 days in 1998, but 140 days in 2019. The duration of the pollen seasons and pollen sensitization rate to trees were positively correlated. The relationship between the sensitization rate to pollens and accumulated temperature were also correlated, positively. Conclusions: This study demonstrates the correlation between the weather changes and consequent changes of pollen seasons with increasing the sensitization rate to allergic pollens in children in Seoul metropolitan area. In addition, there was an increase in the sensitization rate in younger age group from year to year. Continuous changes in distribution of pollens raised from meteorological changes are expected from now on.

Introduction: Anaphylaxis is a potentially life threatening allergic reaction that is rapid in onset and multisystemic in nature. Distribution of anaphylaxis tends to fluctuate based on age, gender, race, geographical residence and socioeconomic status of the involved subjects. Diagnosis of anaphylaxis in children is generally underestimated particularly in developing countries, and when diagnosed, proper management is occasionally lacking. Aim of the study: to evaluate the frequency and pattern of anaphylaxis and mistakes in diagnosis and treatment among a group of Egyptian children and adolescents. Subjects and methods: This observational study was conducted over 6 months duration, from 1st of September 2019 to the end of February 2020, in Children’s hospital, Ain Shams University, Cairo, Egypt, on children presenting to emergency department (ED). Anaphylaxis frequency, presentation, triggers, diagnosis, management and long term follow up were assessed. Results: frequency rate of anaphylaxis among children and adolescents was 0.43% (80/18816) over a year. Sixty percent of patients were infants. Biphasic reactions were reported in 11.3% of patients. The commonest trigger was food (22.5%) followed by medications (8.8%). Epinephrine was given to all patients, in proper dosage and method in most occasions (78.7%). Long term management and follow up appointment were deficient. In conclusion: Anaphylaxis in children was relatively high, with food being the most common trigger. Diagnosis and early management of anaphylaxis was satisfactory, however, long term management and follow up were defective.

A 54 year old male, with multiple diseases(such as severe obesity, severe edema, atrial fibrillation, high atrioventricular block, global enlargement (lA55mm LV 62mm RA 69*55mm RV 46mm)), was diagnosed as heart failure with preserved ejection fraction (HFpEF). After treatment with drugs and implanting permanent cardiac pacemaker, the patient’s edema completely disappeared, weight loss of 42kg, heart failure symptoms disappeared left ventricular shrinkage (LV 59mm).

Background: Denosumab is a monoclonal antibody approved for the treat-ment of postmenopausal osteoporosis. The withdrawal of denosumab produc-es an abrupt loss of bone mineral density and may cause multiple vertebral fractures (MVF). Objective: To study the clinical, biochemical and densitometric characteristics in a large series of postmenopausal women who suffered MVF after deno-sumab withdrawal. Likewise, we try to identify those factors related to the presence of a greater number of vertebral fractures (VF). Patients and Methods: 56 patients (54 women) who suffered MVF after re-ceiving denosumab at least for 3 consecutive years and abruptly suspended it. A clinical examination was carried out. Biochemical bone remodeling markers (BBRM) and bone densitometry at the lumbar spine and proximal femur were measured. VF were diagnosed by MRI, X-ray or both at dorsal and lumbar spine. Results: 56 patients presented a total of 192 VF. 41 patients (73.2%) had not previously suffered VF. After discontinuation of the drug, a statistically signifi-cant increase in the BBRM was observed. In the multivariate analysis, only the time that denosumab was previously received was associated with the pres-ence of a greater number of VF (p = 0.04). Conclusions: We present the series with the largest number of patients col-lected to date. 56 patients accumulated 192 new VF. After the suspension of denosumab and the production of MVF, an increase in the serum values of the BBRM. The time of denosumab use was the only parameter associated with a greater number of fractures.

Background: To assess the efficacy and prognosis of computed tomography (CT)-guided 125I radioactive seeds implantation brachytherapy (RSI-BT) for recurrent nasopharyngeal carcinoma (NPC) after external beam radiotherapy (EBRT). Methods: Thirty-one patients with recurrent NPC (forty-one lesions) after EBRT from February 2003 to January 2019 were enrolled in this retrospective study. The work-follow of CT-guidance RSI-BT was: indication selection, patient set-up and immobilization on CT couch, CT-simulation, preoperative planning, prescription doses (PD) definition of 110-160Gy, seed implantation, postoperative dosimetric evaluation and postoperative follow-up. Median radioactivity of RSI was 0.43 (range 0.22-0.79, average 0.61) mCi. Median actuarial number of 125I seeds was 24 (range 3-83, average 37). Median value of post-operative D90 was 118.5 (range 62.4-246, average 136.2) Gy. Local control (LC) and overall survival (OS) were investigated for their relationship with the prognosis. The adverse events were evaluated by the Radiation Therapy Oncology Group (RTOG) classification criteria. Results: Median follow-up was 41.9 (range 2.1-60.2, average 44.1) months. Median LC was 35.8 (range 2.1-60.2, average 34.9) months. LC at 1-, 3- and 5-year was 71.3%, 41.9% and 27.9%, respectively. Median OS was 22.6 (range 2.1~60.2, average 27.1) months. OS at 1-, 3- and 5-years was 57.7%, 23.8% and 11.9%, respectively. Univariate analysis suggested that sex (P=0.037) and frequency of previous EBRT (P=0.001) were prognostic factors influencing LC. Moreover, univariate analysis also suggested that frequency of previous EBRT (P=0.012) was prognostic factors influencing OS. Prevalence of side effects (≥grade 3) was 6.5%. Conclusion: 125I RSI-BT was a safe and feasible salvage treatment for recurrent NPC after EBRT. Key words: recurrent nasopharyngeal carcinoma; External beam radiotherapy; 125I seed implantation brachytherapy; overall survival; local control; side effects.

Background: Overweight, obesity and lack of sleep quality as inflammatory states are the common problems among college students and the Association of Dietary Inflammatory Index (DII) with these problems among this population is unknown. We aimed to evaluate the relationship of the DII with obesity and sleep quality among Iranian female students. Methods: The present cross-sectional study was conducted in 249 female college students. The Dietary Inflammatory Index (DII) was calculated using a valid and reliable 147-item food frequency questionnaire (FFQ). To assess sleep quality, Pittsburgh Sleep Quality Index (PSQI) was used. Odds Ratio (OR) and 95% Confidence Intervals (CIs) were estimated for anthropometric indices and sleep quality according to DII score. Linear regression was used to estimate the relationship between DII score with sleep and anthropometric indices. Results: There was a significant association evident between DII and sleep quality(> 5 is considered as poor quality of sleep); i.e., the odds ratios between DII quartile 2 vs 1 (unadjusted model: OR= 0.33 (CI: 0.14-0.74), P for trend =0.002; model 1: the fully adjusted OR= 0.31(CI: 0.12-0.78), P for trend = 0.005; model 2:OR=0.30 (CI:0.12-0.78), P for trend = 0.005) to quartile 4(unadjusted model: OR= 1.13(CI: 0.45-2.80); model 1: OR= 1.11(CI: 0.44-2.79); model 2:OR=1.13(CI:0.44-2.87), P for trend = 0.005). Also, odds ratios increased significantly from quartile 2 to quartile 4 in all models for DII and sleep quality. According to the continuous score of DII, there was a significant positive association between DII and sleep quality in all 3 models: unadjusted, model 1, and model 2 (OR= 1.21 (CI: 1.05-1.40), OR= 1.21 (CI: 1.03-1.43), and OR= 1.22 (CI: 1.03-1.44), respectively. Conclusions: In this study, after removing the effect of confounding factors, participants in the highest quartile of DII score had significantly higher PSQI global score.

Objective The purpose of this systematic review was to assess the suitability of HRQOL questionnaires in patients with primary biliary cholangitis. Methods Five electronic databases were searched. The validity of translated questionnaires, floor and ceiling effects, internal consistency and test-retest reliability were investigated. Results Forty-four studies were included, of which fifteen HRQOL questionnaires were identified. The instruments used most frequently were the PBC-40 (n = 22), followed by the SF-36 (n = 19), PBC-27(n=4), CLDQ (n = 3) and NIDDK-QA(n=2), the remaining instruments were uesd only once. Tweenty-six studies used a translated HRQOL questionnaire and only six reported or referenced a validation of the translated questionnaire. Conclusions PBC-specific HRQOL questionnaires used in primary biliary cholangitis have generally good psychometric properties. But lots of studies directly applied the HRQOL tools without verifying the HRQOL tools validity and reliability in PBC patients. Thus, it is better for clinicians and researchers to test the measurement properties of HRQOL questionnaires before use it.

Objectives: To evaluate the molecular epidemiology and mortality risk factors of nosocomial meningitis (NM) induced by multi-drug resistance Enterobacteriaceae (MDRE) in China. Methods: We performed a multi-center study of MDRE NM patients in 2 neurosurgical centers in China from 2014 to 2019. Molecular and phenotype microbiology epidemiology of each MDRE were reviewed and tested, and 21 clinical variables on mortality risk factors were extracted and evaluated by multivariate Cox analysis for NM. Results: In total, 90 MDRE NM patients were included in this study. Klebsiella (K.) pneumoniae occupied the highest proportion (51.11%, 46/90), 44 (44.44%) were meropenem-resistant, ceftriaxone resistance in target MDRE was relatively high (92.22%, 83/90), blaKPC (67.50%, 27/40) was the predominant carbapenem resistance gene, and blaCTX-M-1, blaTEM and blaCTM-M-9 were the three most popular extended spectrum β-lactamases (ESBLs) producing genes of the MDRE. Multivariate Cox analysis showed that external ventricular drainage (EVD, odds ratio (OR) 2.524, 95% confidence interval (CI) 1.101-5.787, P = 0.029) and Glasgow Coma Scale (GCS) ≤8 (OR 4.033, 95% CI 1.526-10.645, P = 0.005) were mortality risk factors of MDRE NM. Conclusions: NM caused by MDRE is an important sign of the failure of neurosurgery, and MDRE has multiple drug resistance genotypes, and EVD and GCS≤8 are independent mortality risk factors of MDRE NM, which deserves the attention of microbiologist and neurosurgical clinicians.

Background: Metabolic syndrome (MetS) is related with all-cause mortality. Caveolin-1 (Cav-1) has been widely studied in dyslipidemia, and several studies have indicated that Cav-1 genetic variations may correlate with dietary intake of fatty acids. The aim of the current study was therefore to evaluate the interaction of Cav-1 rs3807992 with types of dietary fatty acid in MetS risk factor status Methods: This cross-sectional study was carried out on 404 overweight and obese females. Dietary intake was obtained from a 147-item FFQ. The CAV-1 genotype was measured using the PCR-RFLP method. Anthropometric values and serum levels (TC, LDL, HDL, TG, FBS) were measured by standard methods. Results: It was observed that the (AA+AG) group had significantly higher BMI, WC and DBP (P=0.02, P=0.02 and P=0.01, respectively) and lower serum LDL, HDL and TC (P < 0.05) than the GG group. It was found that A allele carriers were at higher odds of MetS (P= 0.01), abdominal obesity (P=0.06), increased TG concentration (P=0.01), elevated blood pressure (BP) (P=0.01), increased glucose concentration (P=0.45), and decreased HDL-cholesterol concentration (P=0.03). Moreover, the interaction of Cav-1 and SFA intake was significant in terms of MetS (P=0.01), LDL (P=0.03), DBP (P=0.01) and LDL/HDL (P=0.05). Additionally, the (AA+AG) group was significantly related to PUFA intake in terms of MetS (P=0.04), TG (P=0.02), glucose (P=0.02) and HOMA-IR (P= 0.01). Conclusions: Higher PUFA consumption might attenuate the Cav-1 rs3807992 associations with MetS, and individuals with greater genetic predisposition appeared to have a higher risk of MetS, associated with higher SFA consumption To date, studies on this polymorphism have been animal studies and have not been performed on healthy and obese human society For the first time , this study provides information on the interaction of different fatty acids with the Caveolin gene, which is functionally effective in lipid metabolism