Bats are a natural reservoir of many pathogenic and non-pathogenic viruses with the chance of spill over via the intermediate host and/ directly to human. The number of zoonotic and deadly viruses especially RNA viruses originated from bats is remarkable. The recent outbreak of COVID 19 or SARS-Cov-2 is the novel or new version of continuation of virus spill over the last few decades. The previous outbreaks as such MERS, SARS predominantly infect human respiratory systems with limited human to human transmission capability. The human interface with wildlife along with deforestation, urbanization, overgrown population, bush meat hunting, wildlife trade significantly increase the reassortment of bat originated virus with other intermediate host to jump in to human species. In this review, we discussed the history of bat borne pathogen and the triggering factors that impose their spill over to human for generating current and future pandemics.

Objective: To determine whether hyperglycaemia in the gestational diabetes (GDM) range independently predicts adverse pregnancy outcomes in Uganda. Design: Prospective observational cohort study. Setting:Five major hospitals in urban/semi-urban central Uganda. Sample:237 women with gestational diabetes, 2,641 normoglycaemic controls. Methods:Women were screened with oral glucose tolerance test (OGTT) at 24-28 weeks of gestation. Cases of GDM were identified (WHO 2013 diagnostic criteria) and received standard care. Data was collected on maternal demographics, anthropometrics, prenatal management, umbilical cord c-peptide levels, and pregnancy outcomes. Participants with diabetes in pregnancy (DIP) were excluded from the analysis. Outcomes:Primary outcomes: Birthweight large for gestational age (LGA; >90th centile) and perinatal death. Secondary outcomes: Caesarean delivery, preterm birth <37 weeks, umbilical cord c-peptide concentration >90th centile (>1.35 mcg/L), and neonatal admission. Results:Women with GDM had a median of only two glucose measurements recorded in third trimester, and only one fifth received therapeutic management (mostly metformin, one participant received insulin). GDM was not independently associated with LGA (adjusted odds ratio, aOR 1.12; 95% CI 0.81-1.56) or perinatal death (aOR 0.66; 95% CI 0.26-1.66), but increased the risk of Caesarean delivery. Mid-gestational BMI of >30kg/m2 was strongly associated with LGA, and mean arterial pressure >90 mmHg was the strongest predictor of perinatal death. Conclusions:Even without active management, GDM was not associated with large birthweight or perinatal death in this population. Interventions that target blood pressure and obesity are likely to be more beneficial in improving LGA and perinatal mortality, than management of GDM. Funding:Medical Research Council Keywords:Gestational diabetes, Africa

Avian transgenesis has served as a suitable approach to generate bioreactors for the manufacturing of recombinant proteins. Production in chicken cells comes with significant advantages over other systems including providing the human-like glycosylation on target proteins. In this regard, the oviduct-specific ovalbumin promoter has been one of the ideal candidates to drive the expression of transgenes. Previous plasmid-based studies on the regulatory sequences of ovalbumin promoter have led researchers to exploit ovalbumin regulatory elements out of their native genomic context (ex situ) to direct transgene expression in the transgenic chicken bioreactors. Although the inherent limitations on the ex situ use of ovalbumin promoter have promoted the use of native ovalbumin promoter for the expression of a transgene, generation of transgenic chicken is relatively difficult, inefficient, and time-consuming. To overcome these obstacles, in this study we show that CRISPR-mediated deletion of some distal ovalbumin promoter sequences in a non-oviduct cell can lead to the significant expression of the ovalbumin gene, and also a knocked-in reporter, in an estrogen-independent manner. These findings overcome the limitation of cloned promoters, where the promoter regulatory sequences have to be taken out of their cis context and also their native spatial nuclear organization into a plasmid.

Viruses, including the recent, COVID-19-causing SARS-CoV-2 rely on their host for re-production. Here, we made use of genomic and structural information from SARS-CoV-2 and related viruses to create a biomass function capturing the stoichiometric amino and nucleic acid requirements of SARS-CoV-2. By incorporating this function into a stoichiometric metabolic model of the human cell and applying metabolic flux balance analysis, we identified host-based metabolic perturbations inhibiting SARS-CoV-2 reproduction. Our results highlight reactions in the central metabolism, as well as amino acid and nucleotide biosynthesis pathways. By incorporating host cellular maintenance into the model based on available protein expression data from human lung cells, we find that only few of these metabolic perturbations are able to selectively inhibit virus reproduction without significantly affecting host maintenance. Key reactions that are able to do so are found in metabolic junctions in amino acid biosynthesis pathways and in mitochondrial metabolite shuttles. We note that some of the catalysing enzymes of such reactions have demonstrated interactions with existing drugs, which can be used for experimental testing of the presented predictions. The developed computational approach offers a platform for rapid, experimentally testable generation of drug predictions against existing and emerging viruses based on their biomass requirements and their host’s metabolism.

Background: In light of the COVID-19 pandemic, there has been a rapid increase in telemedicine visits. Otolaryngology patient satisfaction with these visits has not yet been extensively studied using a validated survey. Methods: All patients who had telemedicine visits with three head and neck surgeons, by phone or video-based platform, between March 25, 2020 and April 24, 2020. Retrospective chart reviews were conducted to determine demographic, disease and treatment information. Patients who had a video visit were contacted by telephone and, if they could be reached and consented, were administered the Telehealth Usability Questionnaire (TUQ).Results: 100 surveys were completed. The average score across all questions was 6.01 on a scale from 1-7, where 7 indicated the highest level of patient agreement. The highest scores were for questions related to satisfaction with telehealth (6.29), while the lowest were related to reliability (4.86). Conclusions: Patients are generally highly satisfied with telemedicine.

Background: Cobalt has been associated with allergic contact dermatitis and occupational asthma. However, the link between skin exposure and lung responses to cobalt is currently unknown. We investigated the effect of prior dermal sensitization to cobalt on pulmonary physiological and immunological responses after subsequent challenge with cobalt via the airways. Methods: BALB/c mice received epicutaneous applications (25 μl/ear) with 5% CoCl2*6H2O (Co) or the vehicle (Veh) dimethyl sulfoxide (DMSO) twice; they then received oropharyngeal challenges with 0.05% CoCl2*6H2O or saline five times, thereby obtaining four groups: Veh/Veh, Co/Veh, Veh/Co and Co/Co. To detect early respiratory responses non-invasively, we performed sequential in vivo micro-computed tomography (µCT). One day after the last challenge, we assessed airway hyper-reactivity (AHR) to methacholine, inflammation in bronchoalveolar lavage (BAL), innate lymphoid cells (ILCs) and dendritic cells (DCs) in lung, and serum IgE. Result: Compared with the Veh/Veh-group, the Co/Co-group showed increased µCT-derived lung response, increased AHR to methacholine, mixed neutrophilic and eosinophilic inflammation, elevated monocyte chemoattractant protein-1 (MCP-1) and elevated keratinocyte chemoattractant (KC) in BAL. Flow cytometry in the Co/Co-group demonstrated increased DC, type 1 and type 2 conventional DC (cDC1/cDC2), monocyte-derived DC, increased ILC group 2 and NCR-ILC group 3. The Veh/Co-group showed only increased AHR to methacholine and elevated MCP-1 in BAL, whereas the Co/Veh-group showed increased cDC1 and ILC2 in lung. Conclusion: We conclude that dermal sensitization to cobalt may increase the susceptibility of the lungs to inhaling cobalt. Mechanistically, this enhanced susceptibility involves changes in pulmonary DCs and ILCs.

Russeting occurs via the epidermal suberin accumulation model in the phenol-ester protection system in pears, especially under excessive rainfall. To clarify the role of rain in the russeting mechanism, we applied multi-omics (transcriptome, metabolome, and proteome) integrated analysis from three colored pear cultivars grown under two rainfall conditions, including a no rain control (C) and a rain-abundant (R) treatment. Broad alterations occurred in 29 overlapping differentially expressed genes (DEGs) involved in the response to stress and secondary metabolite biosynthesis. Three overlapping differentially expressed proteins (DEPs) and seven differentially expressed metabolites (DEMs) were identified among the three comparison groups. Cross-comparison of mRNA and protein data revealed co-expression of DEGs and DEPs. Suberin and phenylpropane were markedly enhanced, while cutin biosynthesis and fatty acid elongation were depressed in russet pears under R. In russet pears, the triacontane associated with wax composition was abruptly missing. Moreover, The PpyHHT1 (103966555) gene and encoded protein HHT1 (694406379), which acts as a ‘bridge’ between phenol- and ester- polymerization, had significantly upregulated expression. Collectively, we provide a comprehensive model of the molecular russeting mechanism, which provides powerful insight into russeting and shows the plasticity of plant defenses to cope with the harsh natural environment.

Much has been discussed about the curve of COVID-19 as it ravages through our countries, our cities, our homes. Politicians readily refer to it in addressing the various nations of the world. They ask us to “flatten the curve to save lives” 1,2. Effectively, the way to flatten the curve is to abide by social distancing measures.Nevertheless, even among medical specialists, there are common misconception about the curve and how it affects population outcomes. Understanding the fundamental characteristics of a problem can allow us to see the problem with more clarity. Herein, I aim to provide a simple understanding of the various population dynamics at play. We will review how principles such as the area under the curve and thethreshold of capacity can be conceptualized.The discussion will begin as rudimentary. However, it will add gentle layers of complexity. Hopefully, by the end, it will provide the reader a sense of insight.

Our pediatric hematology/oncology fellowship program set out to create a case-based learning curriculum for common hematologic malignancies that would apply principles of adult learning theory and improve fellows’ retention of information in a supportive, goal-oriented learning environment. A framework we employed in developing this curriculum is that of “flow theory,” which parallels many of the tenets of adult learning theory. After implementing this curriculum, which we call “the unknown case,” the percentage of fellows correctly identifying common hematopathologic diagnoses improved from 50% to 85%.

A local outbreak of initially unknown cause pneumonia was detected in Wuhan (Hubei, China) in December 2019 and a novel coronavirus, the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), was quickly found to be causing it. Since then, the epidemic has spread to all of China’s mainland provinces as well as 58 other countries and territories, with more than 87,137 confirmed cases around the globe, including 79,968 from China, 7,169 from other countries as of 1 March 2020, as stated by the World Health Organization (WHO) in the COVID-19 situation report - 41. In response to this current public health emergency, this study done a statistical analysis and visualized reported cases of coronavirus disease 2019 (COVID-19) based on the open data collection provided by Johns Hopkins University. Where the location and number of confirmed infected cases have been shown, there have also been deaths, recovered cases and comparisons of the growth rates between the Globe countries. This was intended to provide researchers, public health officials and the general public with exposure to the epidemic.

Canine parvovirus (CPV) is a major enteric pathogen of dogs worldwide that emerged in the late 1970s from a feline parvovirus (FPV)-like ancestral virus. Shortly after its emergence, variant CPVs were generated by acquiring amino-acid (aa) mutations in key capsid residues, associated with biological and/or antigenic changes. This study aimed to identify CPV variants amongst Australian dogs, to gain insights into the evolution of CPV in Australia through phylogenetic analysis of these variants, and to investigate relationships between the disease and vaccination status of dogs from which isolates were collected. CPV VP2 sequences were amplified from 79 faecal samples collected from dogs with parvoviral enteritis at 20 veterinary practices in 5 Australian states. The median age at diagnosis was 4 months (range 1 to 96 months). Only 3.7% of dogs with vaccination histories had completed recommended vaccination schedules, while 49% were incompletely vaccinated and 47.2% were unvaccinated. For the first time, CPV-2b has emerged as the dominant antigenic CPV variant circulating in dogs with parvoviral enteritis in Australia, comprising 54.4% of strains, while CPV-2a and CPV-2 comprised 43.1% and 2.5% of strains. CPV-2c strains were not identified. Analysis of translated VP2 sequences revealed a vast repertoire of aa mutations. Several Australian CPV strains displayed signatures in the VP2 protein typical of Asian CPVs, suggestion introduction of CPV strains from Asia, and/or CPV circulation between Asia and Australia. Strains of CPV were identified containing aa residues typical of FPV at capsid (VP2) key positions, representing reverse mutations or residual mutations retained from CPV-2 during adaptation from an FPV-like ancestor, suggesting that evolutionary intermediates between CPV-2 and FPV are circulating in the field. Similarly, intermediates between CPV-2a-like viruses and CPV-2 were also identified. These findings help inform a better understanding of the evolution of CPV in dogs.

Participatory approaches such as community photography can engage the public in questions of societal and scientific interest. We combined data extracted from community-sourced, spatially-explicit photographs with research findings from 2018 fieldwork in the Yukon, Canada, to evaluate winter coat moult patterns and phenology in mountain goats (Oreamnos americanus), a cold-adapted, alpine mammal. Leveraging the community science portals iNaturalist and CitSci, in less than a year we amassed a database of several hundred unique photographs spanning some 4500 kms between latitudes 37.6°N and 61.1°N from 0m to 4333m elevation. Using statistical methods accounting for incomplete data, a common issue in community science datasets, we evaluated effects of intrinsic (sex and presence of offspring) and environmental (latitude and elevation) factors on moult onset and rate and compared our findings with published data. Shedding occurred over a 3-month period, May 29-September 6. Effects of sex and offspring on the timing of moult were consistent between the community-sourced and our Yukon data and with findings on wild mountain goats at a long-term research site in west-central Alberta, Canada. Males moulted first followed by females without offspring (6.4 days later in the coarse-grained, geographically-wide community science sample; 23.7 days later in our fine-grained Yukon sample) and lastly females with new kids (5.5; 17.9, respectively). Shedding was later at higher than at lower elevations. Northern latitudes had slightly later but shorter shedding periods. We detected a possible shift in moult timing in recent years (2015-2018) that warrants additional investigation. Despite data limitations, such as bias towards recent photographs, our findings establish a basis for employing community photography to examine broad-scale questions about the timing of ecological events, as well as sex differences in response to possible climate drivers. As such, community photography can inspire public participation in environmental and outdoor activities with reference to iconic wildlife.

SARS-CoV-2 has claimed more than 300,000 lives while infecting 4 million individuals worldwide. There are no specific treatments for COVID-19. Symptoms vary from very mild/asymptomatic to severe, including admission to ICU. Strong sex-bias in COVID-19 have been noted with males showing more than double the odds of requiring ICU admission and higher mortality. Reproductive steroids, including estrogens, progesterone and its physiologically-active metabolite, allopregnanolone exert anti-inflammatory actions and influence the immune system. Intriguingly, pregnant women with COVID-19 appear to experience milder symptoms. In some pregnant women escalated symptoms severity is observed immediately postpartum in coincidence with the rapid hormonal drop associated with parturition. This finding suggests that reproductive steroids’ anti-inflammatory effects and their role in reshaping competence of immune cells may protect during pregnancy. The hypothesis that estradiol, progesterone may provide a treatment against COVID-19 in men and in postmenopausal women is discussed.

Down-regulation of photosynthesis in elevated CO2 (eCO2), could be attributed to depletions in nitrogen (N) availability after long term exposure to eCO2 (progressive nitrogen limitation, PNL) or N dilution due to excessive carbon accumulation of nonstructural carbohydrates. To investigate this, we examined N availability, photosynthetic characteristics, and leaf N allocation in Pinus densiflora, Fraxinus rhynchophylla, and Sorbus alnifolia, grown under three different CO2 concentrations, ambient CO2 (aCO2), aCO2 × 1.4 ppm (eCO21.4), and aCO2 × 1.8 ppm (eCO21.8), for 9 years. N availability increased under eCO21.8, and its allocation to chlorophyll (NFchl) and photosynthetic N use efficiency also increased under eCO2. The maximum carboxylation rate, leaf N per mass (Nmass), and N allocation to Rubisco (NFRub), however, were all lower under eCO21.8. There were interactions in NFchl between canopy × species × CO2 concentrations. The greatest changes in N allocation under eCO2 were in the lower canopy of S. alnifolia, the most shade-tolerant species and this species have relatively high flexibility in N operations compared to shade-intolerant species. Based on the reduction in Nmass that was diluted by increased nonstructural carbohydrates and increased N availability, down-regulation of photosynthesis was found to be caused by the dilution and change in N allocations, rather than PNL.

The synthesis of starch-based physical hydrogels in combination with chitosan and polyvinyl alcohol, and their potential co-application with chitosan nanoparticles was evaluated. The potential of starch-chitosan hydrogel obtained by physical/chemical method for tissue engineering uses was also studied in a mouse wound healing model. Although the microscopical structure of each synthesized hydrogel suggests a possible biological application, starch-polyvinyl alcohol hydrogel exhibited rigid behavior with minor channel diameters, a lower swelling rate (less than 300%), and negatively affected cell viability in a cytotoxicity assay. Starch-chitosan hydrogel obtained by chemical crosslinking with glutaraldehyde demonstrated the higher swelling rate (about 1100%), cell viability values over 80%, and a homogeneous tri-dimensional structure; along with an excellent interaction with chitosan nanoparticles. This type of hydrogel was selected for an in vivo experiment, showing significant differences in wound healing process against a non-treated control, in terms of inflammation, exudate production and tissue recovering.

Introduction: Atrial fibrillation (AF) predisposes patients to heart failure (HF) and a resultant increase in mortality, however, little is known regarding what characteristics of AF are related to HF. Our aim is to clarify the characteristics of AF with subsequent HF by analysis of R-R interval during every 1-h segment. Method and Results: We retrospectively analyzed 188 Holter electrocardiograms of patients with continuous AF. A histogram of normal R–R intervals was plotted for each hour, the mean R-R intervals (mean R-R) and the standard deviation of R–R intervals (SD R–R) were calculated. Mean R-R and SD R-R demonstrated circadian variations in 167 patients without subsequent HF. In 21 patients with subsequent HF, SD R–Rs were significantly shorter than those in patients without HF at 1:00–2:00 (174.9 ± 46.4 vs. 207.3 ± 67.5 ms), at 2:00–3:00 (180.4 ± 42.8 vs. 212.7 ± 68.1 ms), at 3:00–4:00 (181.9 ± 52.7 vs. 216.1 ± 71.0 ms), and at 4:00–5:00 (187.9 ± 50.0 vs. 220.7 ± 72.0 ms). Mean R-R and SD R-R kept in low values during night-time in β-blocker users of the HF group. The attenuation of circadian variations of mean R-R and SD R-R were also recognized in patients with reduced ejection fraction. Conclusions: The analyses of R-R interval under the consideration of the circadian variations and the usage of β-blocker were suspected to predict subsequent HF in patients with continuous AF.

The global pandemic from Sars-cov-2 has down caused thousands of deaths worldwide, triggering a health crisis in the various countries involved, with few precedents in history. To date there are no vaccines for prophylaxis, and there are no antivirals directed against the virus. Among the therapeutic options that have shown effectiveness is passive immunization with immune plasma from convalescent patients cured of the infection. Plasma collected from patients cured of Sars-cov-2 infection is rich in antibodies that neutralized the pathogen. Plasma therapy has already demonstrated its efficacy in other epidemics, such as Sars-Cov and MERS. To date, there are limited data for its use in sars-Cov-2 infection, both for prophylaxis and treatment, but the few existing data bode well for the scientific world. Many questions are still unresolved, when to administer it? At what dosage? When is it most appropriate to take the plasma from the cured patient? Are there different answers depending on gender and age? Certainly in view of the high number of patients infected and cured by Sars-Cov-2, there could be a high amount of plasma from donor patients. In this article we want to give an overview on a current and important topic in the perspective of the battle against the new Sars-Cov-2, analysing the therapeutic successes in past epidemics, the clinical data currently available, the future prospect and an expert opinion.

Irregular narrow QRS complex tachycardia with intermittent atrioventricular dissociation: What is the mechanism?Atsushi Doi, MD, PhD; Naoko Miyazaki, MD; Tomohiko Goda, MD; Haruya Yamane, MD; Kei Tanaka, MD; Ryo Araki, MD,PhD; Fumi Sato, MD, PhD; Takayuki Yamada, MD.Department of Cardiovascular Medicine, Otemae Hospital, 1-5-34 Otemae, Chuo-ku, Osaka, 540-0008, Japan.Correspondence to Atsushi Doi, MD, PhD. Department of Cardiovascular Medicine, Otemae Hospital, 1-5-34 Otemae, Chuo-ku, Osaka, 540-0008, Japan.Tel: 81-6-6941-0484, Fax: 81-6-6942-2848E-mail; m1410001@med.osaka-cu.ac.jp

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.