Take the bull by its horn: ‘Prophylactic aortic intervention’ in uncomplicated type B aortic dissectionRunning title: Prophylactic intervention in uncomplicated TBADDr. A. Mohammed Idhrees MCh, FIASORCID ID : 0000-0001-5981-9705Consultant,Institute of Cardiac and Aortic Disorders (ICAD),SRM Institutes for Medical Science (SIMS Hospital), Chennai.

Objective To gain insight into perinatal outcomes in women with chronic conditions, in order to contribute to the optimization of personalized perinatal care. Design Population-based study using data of the Dutch national perinatal registry between 2010-2019. Setting Nationwide. Population Pregnancies of women who were diagnosed with chronic medical conditions by a medical specialist before pregnancy (n=36,835), divided over seven subgroups and a reference group of pregnancies of women without known chronic medical conditions (n=1,084,623). Methods Descriptive and testing statistics. Main outcome measures The primary outcome was mode of birth. Secondary outcomes were onset of labor, preterm birth, asphyxia, NICU admission, and perinatal mortality. Results Spontaneous birth ranged from 45.0% (orthopedic conditions) to 71.3% (neurological conditions) to 82.6% in the reference group. Instrumental vaginal birth (p<0.001), planned Cesarean birth (p<0.001) and emergency Cesarean birth (p<0.001) differed significantly in all groups if compared to the reference group. Preterm birth was significantly more present in the studied groups (p<0.001) as well as perinatal asphyxia (p<0.001) and NICU admission (p<0.001). Adjusting for mode of birth, parity, age and ethnicity did not change the outcomes for the total group of women with chronic medical conditions. Perinatal mortality was seen in all groups but in none of the separate groups significantly more than in the reference group. Conclusions Women with chronic conditions more often are confronted with preterm birth, Cesarean deliveries, NICU admission of the newborn, and perinatal mortality

Background and purpose: We have no definitive treatment for dementia characterized by prolonged neuronal death due to cerebrovascular degeneration or the enormous accumulation of foreign matters, such as β-amyloid. Since these diseases develop slowly, we may be able to delay the onset and improve these symptoms by enhancing the energy metabolism of individual neurons to assist their viabilities. We examined the effect of TND1128, a derivative of 5-deazaflavin, proven to have the self-redox ability as a possible candidate for a direct activator for mitochondrial energy synthesis. Experimental Approach: We prepared brain slices obtained from mice 22 ± 2 hours pretreated with TND1128 or β−ΝΜΝ used as an active control. We measured Ca2+ concentrations in the cytoplasm ([Ca2+]cyt) and mitochondria ([Ca2+]mit) by using fluorescence Ca2+ indicators, Fura4F, and X-rhod-1, respectively, and examined the protective effects of TND1128 and β−ΝΜΝ on overloaded cytosolic and mitochondrial Ca2+ by repeating 80K exposure. Key Results: TND1128 (0.01, 0.1, and 1 mg/kg s.c.) mitigates the dynamics of both [Ca2+]cyt and [Ca2+]mit in a dose-dependent manner. β−ΝΜΝ (10, 30, and 100mg/kg s.c.) showed significant dose-dependent facilitatory effects on the recovery of [Ca2+]cyt during washing for 5 minutes. However, there was no significant effect on the [Ca2+]mit dynamics. Conclusion and implications: TND1128 works as a cofactor for activating cellular energy production machinery. TND1128 would rescue deteriorating neurons in various cerebrovascular disorder-related diseases, including Alzheimer’s disease and Parkinson’s disease. Furthermore, TND1128 will rescue patients with disorders of respiratory organs, such as pulmonary emphysema and COVID-19, which causes respiratory disability

Precursor B-cell Acute Lymphoblastic Leukemia in a pediatric patient with Bainbridge-Ropers Syndrome

Beyond the care

Presented is an improved bandgap reference, which has the performance of high accuracy and can generate the required voltage reference. In this bandgap reference, the improved base current compensation is proposed to eliminate the effect of the base current. Meanwhile, a high reference voltage generator is used to provide configurable output voltages of 1.2/1.8/2.5/3.3V needed by DC-DC converters. The bandgap reference is realized in a standard 180nm CMOS process with an area of 0.05 mm×mm. Among the 5 sample chips of the reference, in the temperature range of -40 oC to 125 oC, the temperature coefficients of all the reference voltages range from 3 ppm/oC to 38 ppm/oC. The best average value of temperature coefficients is 6.03 ppm/oC when the reference voltage is 2.5V. The best line sensitivities (LS) is 0.23%/V when the reference voltage is 1.8V with the power consumption of 150μW@VDD=5V;

Precise assessment of soil organic carbon (SOC) storage requires understanding how vegetation and soil physicochemical properties differ in SOC fractions. Therefore, we aimed to analyze the dynamics of aggregate-associated, liable organic carbon (LOC) fractions corresponding to depth to clarify the effect of vegetation and soil properties on water stable aggregate (WSA) mineral adsorption in subtropical, red soil with five vegetation restoration regimes. The results showed that the large macro-aggregate fraction dominated the degraded red soil, which had the highest content of dissolved organic carbon (DOC). WSA-associated, easily oxidized organic carbon (EOC) varied from 6.26 to 20.02 g/kg and was not affected by vegetation types. Schima superba pure forest (SP) significantly increased DOC (0.38 g/kg on average) and particulate organic carbon (POC, 7.92g/kg on average), which had the highest biomass. Along with soil depth, WSA-associated POC declined, while exhibiting a growth trend with decreasing particle size, e.g., the highest POC was found in silt + clay fraction. The RDA ordination indicated that soil porosity and TN were the main soil parameters that explained the most variance. Meanwhile, the vegetation biomass, except for litter, were all significantly positively correlated with silt + clay fractions. Leaf biomass played the most important role on DOC in macro-aggregate with a 53.42% contribution. For aggregate-related POC, the largest contribution was from the interactions between branch biomass and pH (47.78%) followed by TN (35.1%) of micro-aggregate-related POC. Leaf biomass, silt + clay fractions, and TN can be used as indicators to evaluate the impact of vegetation restoration on WSA-associated SOC fractions. Broad leaved forest or combined with indigenous coniferous species was a better choice for SOC sequestration improvement in the study area.

To improve sresponse performance of the magnetically suspended gimballing flywheel in wide frequency range, a spherical magnetic bearing with dual-winding structure is proposed. Working principle of dual-winding structure is introduced, and electromagnetic characteristics of the rotor in wideband range are analyzed by using equivalent magnetic circuit method and finite element simulation method. Simulation errors of the maximum electromagnetic force under low-frequency and high-frequency suspension are only 0.085 and 0.054 respectively. Experimental results show that the response time of the rotor from low frequency to high frequency is only 40ms. Simulation and experimental results is much better than those of the single winding structure.

Tacheng tick virus 1 (TcTV-1), emerging tick-borne orthonairoviruses, was firstly isolated from a tick bite patient in northwestern China. However, TcTV-1 in livestock, wildlife, and potential vectors was still unknown. From 2017 to 2021, 1495 samples included 180 engorged adult female ticks, 180 egg batches, 84 larvae, 896 adult ticks, 148 livestock blood samples, and 7 spleens from red foxes were collected from 14 counties or cities of southern and eastern Kazakhstan, and northwestern China. The samples were tested for the presence of TcTV-1 using the viral L segments by reverse transcriptase–polymerase chain reaction (RT-PCR). The infection rates of TcTV-1 were 7.78% (14/180), 3.89% (7/180), and 2.47% (2/84) in engorged adult female Hyalomma asiaticum ticks and their offsprings (eggs and larvae), respectively. 6.45% (9/148) blood samples of livestock and 14.29% (1/7) spleen samples of red foxes tested positive to TcTV-1. TcTV-1 was detected in 13.08% (34/260) adult hard ticks from Kazakhstan and 5.35% (34/636) ticks from China. This findings suggests that i) the pastured cattle, sheep, camel and wild red fox act as natural reservoirs for TcTV-1; ii) TcTV-1 is detected in genera of Hyalomma, Dermacentor, Rhipicephalus and Ixodes both originated from northwestern China and southeastern Kazakhstan; and iii) Hy. asiaticum is a potential vector of TcTV-1 due to its transovarial transmission.

The inversion from L- to D-stereochemistry endows peptides improved bioactivity and enhanced resistance to many proteases and peptidases. To strengthen the biostability and bioavailability of peptide drugs, enzymatic epimerization becomes an important way to incorporate D-amino acid into peptide backbones. Recently, a bifunctional thioesterase NocTE, which is responsible for the epimerization and hydrolysis of the C-terminal (p-hydroxyphenyl)glycine residue of β-lactam antibiotic nocardicin A, exclusively directs to the generation of D-diastereomers. Different from other epimerases, NocTE exhibits unique stereochemical selectivity. Herein, we investigated the catalytic mechanism of NocTE via molecular dynamic (MD) simulations and quantum mechanical/molecular mechanics (QM/MM) calculations. Through structural analyses, two key water molecules around the reaction site were found to serve as proton mediators in epimerization. The structural characteristics inspired us to propose a substrate-assisted mechanism for the epimerization, where multi-step proton transfers were mediated by water molecules and β-lactam ring, and the free energy barrier was calculated to be 20.3 kcal/mol. After that, the hydrolysis of D-configured substrate was energetically feasible with the energy barrier of 14.3 kcal/mol. As a comparison, the energy barrier for the direct hydrolysis of L-configured substrate was obtained to be 24.0 kcal/mol. Our study provides mechanistic insights into catalytic activities of bifunctional thioesterase NocTE, uncovers more clues to the molecular basis for stereochemical selectivity and paves the way for the directed biosynthesis of novel peptide drugs with various stereostructural characteristics by enzyme rational design.

Rationale: Obstructive sleep apnea and asthma often coexist; besides, they share a bidirectional influence towards the other condition. In adults, obstructive sleep apnea is more prevalent in men and asthma in women. However, during childhood, obstructive sleep apnea prevalence is equal in boys and girls while asthma has a strong influence of puberty in its prevalence, with pubescent girls more affected than boys. Objectives: To analyze the prevalence of obstructive sleep apnea in: 1) boys and girls and 2) severe asthma versus moderate and mild cases. We hypothesized that girls and severe asthma would have a higher prevalence of obstructive sleep apnea. Methods: Cross-sectional evaluation of asthmatic children attending a tertiary Pediatric Pulmonology clinic. Measurements: History, physical examination, Pulmonary Function Test, and Home Sleep Apnea Test. Main Results: We studied 80 consecutive patients, 7 to 18 years-old, mean age 11.6 years (standard deviation 2.7), 51.3% female, and 18.5% obese. Pulmonary Function Tests were obtained from 71 volunteers, 45% with obstruction pattern. Home Sleep Apnea Tests were available from 76 volunteers, with mean obstructive respiratory index of 1.8 events/h. Obstructive sleep apnea was found in 69 volunteers (86.2%). We did not find associations of obstructive sleep apnea and sex or asthma severity. Conclusions: Obstructive sleep apnea was frequent among these asthmatic children. Sex and asthma severity were not risk factors. Considering the interrelationship of both diseases, it is worth to keep in mind the possibility of obstructive sleep apnea among children and teenagers with asthma.

Background and Purpose: Psoriasis is an inflammatory skin disease of chronic recurrence mediated by the interaction between IL-17 and keratinocytes, which sustains a vicious circle of inflammation. Currently, there is no safe and effective natural medicine for the clinical treatment of psoriasis. Given its prominent anti-proliferative and anti-inflammatory properties, we investigated the mechanism of allicin improving psoriasis. Experimental Design: Pharmacodynamics and toxicology experimental studies were estimated after topical administration of allicin on the skin of mice. Changes in inflammatory factors expression were analyzed by qPCR and immunohistochemistry after topical treatment with allicin in mice with psoriasis-like lesions induced by imiquimod. The impacts of allicin on proliferation and apoptosis of keratinocytes were analyzed by CCK8 assay and flow cytometry. The interaction between IL-17A and keratinocytes was studied using HaCaT cells, and the mechanism of action of allicin was explored by Western Blot. Transcriptomic changes following the action of allicin were probed by RNA-seq. Key Results: Our study demonstrated that allicin significantly improved the epidermal structure by inhibiting excessive proliferation and evasion of apoptosis of keratinocytes. Furthermore, allicin reduced the secretion of inflammatory cytokines (IL-17A/F, IL-22, IL-12, IL-20), chemokines (CXCL2, CXCL5, CCL20), and antibacterial peptides (S100A8/9). Mechanistically, allicin directly inhibited the IL-17-induced TRAF6/MAPK/NF-κB and STAT3/NF-κB signaling cascades in keratinocytes, thus breaking the positive inflammation feedback and alleviating imiquimod-induced psoriasis-like dermatitis in mice. Importantly, topical administration of allicin did not cause skin allergy, and the safety and adaptability of long-term application were verified.

Background and Purpose Farfarae Flos (FF), derived from the flower buds of Tussilago farfarae L., is used as a traditional folk medicine for the treatment of cough, bronchitis and asthmatic disorders. However, its antitussive mechanism is unknown yet. Experimental Approach The antitussive mechanism of FF was investigated from the perspective of gut microbiota. The antibiotic pretreatment and fecal microbiota transplantation (FMT) were used to investigated the microbiota-host interaction after FF treatment. The composition of gut microbiota was detected by using 16S ribosomal RNA (rRNA) sequences. The gut metabolites variations were evaluated by LC-MS based metabolomic analysis and GC-MS based targeted short-chain fatty acids (SCFAs) profiling. Key Results FF increased the abundance of SCFAs-producing bacteria, which consequently led to the elevated SCFAs levels. SCFAs supplementation further confirmed the importance of SCFAs for the antitussive effect of FF. The antitussive effect of FF was gut microbiota dependent, as demonstrated by antibiotic treatment and FMT. FF could also probably regulate Argnine/NO metabolism by inhibiting arginase which was confirmed by antitussive effect of Argnine supplementation. Caffeic acid (CA) and quinic acid (QA), intestinal metabolites of caffeylquinic acids metabolized by Lactobacillus and Bifidobacterium, showed antitussive effect by increasing the butyrate, and butyrate-producing bacteria (Clostridium and Ruminococcus) were also enriched by QA. Conclusion and Implications Our study shows that CA and QA were proved as the key bioactive metabolites for the antitussive effect of FF. This study may present a novel approach for investigating the antitussive mechanism of herbal drug from the perspective of gut microbiota.

Aim: We aimed to detect the predictive value of CS distal delay interval for differentiating the left from right sided PVCs. Methods: We included 137 patients with symptomatic frequent premature ventricular contractions (PVCs) who underwent successful catheter ablation retrospectively (67 male, 70 female; mean age 46.0 ± 16.2 years). Patients were classified into two groups as left sided and right sided PVCs. Decapolar catheters were placed in the coronary sinus before the procedure. CS distal delay interval (Q-CSd) was measured as the interval from onset of earliest QRS complex of premature ventricular contractions in 12 lead ECG to distal CS EGM signal. Results: CS distal delay interval was found to be significantly lower in left sided PVCs. The cutoff value of CS distal delay interval obtained by ROC curve analysis was 48,5 ms for prediction of right sided origin (sensitivity: 91,5%, specificity: 85.9%). The area under the curve (AUC) was 0.911 (p<0.001). Conclusion: CS distal delay interval is a novel and simple measurement for accurately differentiating the left from right sided PVCs. The use of this simple measurement could be beneficial for decreasing ablation duration, radiation exposure and the number of arterial or venous punctures.

Same-day discharge after AF ablation procedure is becoming the preferred trend. Vascular closure devices have shortened the postprocedural bedrest, associated with increased patient satisfaction. Although this approach comes with a cost, it might benefit also the healthcare system.

Understanding the mechanisms that drive community assembly in species-rich tropical forest remains a fundamental challenge in ecology. Here, we integrated trait dimensions, metabolomics, and phylogeny to test whether interspecific variation over multivariate trait dimensions contribute to coexistence among Euphorbiaceae species. We measured 41 functional traits related to resource acquisition, photosynthetic capacity, hydraulic safety and efficiency, and defense in all 26 Euphorbiaceae species in a 20-ha forest dynamics plot in tropical southwestern Yunnan, China. Network analysis revealed that a small number of traits with high network centrality reflected variation in ecological strategy among the Euphorbiaceae. Further, we observed significant turnover with respect to these high-centrality traits over environmental gradients at distinct spatial and temporal scales. Whereas resource-utilization traits and the habitat associations they mediate exhibited consistent phylogenetic signal. Phylogenetic divergence in chemical defenses likely represents an additional trait dimension that enhances local diversity of closely related Euphorbiaceae in southwestern China.

Acute Mesenteric Ischemia (AMI) is a life-threatening complication that may occur in COVID-19 patients. It should be suspected in COVID-19 patients complaining of severe abdominal pain. This report highlights a case of AMI with patent mesenteric vessels in CECT, and the importance of monitoring hospitalized patients along with thromboembolism prophylaxis.

Staircase testing is a standard method for evaluating the fatigue strength of components. However, staircase testing assumes a normal distribution, while components can display bimodal behavior due to flaws in material, or issues during the manufacturing process. Three unique step loading data sets on different production crankshafts provide evidence that step loading reliably identifies material or manufacturing issues, that lower a component’s fatigue strength. Staircase testing has an 87% or greater chance of overestimating the component’s fatigue strength, which in turn overestimates the component’s expected reliability. For example, a component with a 99.9% reliability, based on staircase testing would only have a 74% reliability based on step loading. If a component contains an undetectable manufacturing defect, staircase testing has a 99% chance of overestimating the component’s fatigue strength. Step loading reliably improves the estimation of a component’s fatigue strength distribution while providing insights into a component’s defect tolerance.

Microbial transformation of cholesterol produces various steroid drugs and intermediates, such as cholest-4-en-3-one (C4EO), which is an important intermediate of hormone steroidal drugs. Cholest-4-ene-3,6-dione (CEDO) is another product of cholesterol biotransformation, with better medicinal value than cholest-4-en-3-one. It is indicated to improve fat metabolism, resistance to tumors and essential in the treatment of nerve injuries. This study proceeded using Burkholderia cepacia ZWS15, which is known to produce enzymes to transform cholesterol. Organic solvents were chosen to increase the solubility of the substrate cholesterol and the conversion of the product, and the organic solvent affects the mechanism of product conversion and cell membrane permeability. The use of organic solvents in this study prompted shifts in the composition of fatty acids in the cell membrane, inducing the production of more unsaturated fatty acids and reduction of saturated fatty acids. The alkenone products generated after transformation of cholesterol were isolated.

Music Therapy is a clinical use of music to achieve individual goals such as reducing stress, improving their mood and expression. This is an evidence-based treatment created in the health community. Music therapy experience may include listening, singing, playing or making music.

Introduction. Branchial cleft anomalies (BCA) can occur as sinuses, fistulas or cysts. They arise from the first, second, third or fourth pharyngeal cleft due to non-fusion or subinvolution. Mostly, located in Robbin’s neck-level II, BCA clinically present as a painless compressible swelling, cutaneous draining sinus, or fistula. Surgical treatment is the gold standard to prevent recurrence, though the necessity of ipsilateral tonsillectomy is discussed. Study Design. We conducted a retrospective comparative cohort study. Setting. Monocentric. Methods. In retrospect, data was collected from patients, that were admitted with the diagnosis BCA between 2006 and 2020 in an academic tertiary care center. Main outcome measures. 160 patients met inclusion criteria, the data was further evaluated, the focus was set on the occurrence of recurrence with or without tonsillectomy. Results. Recurrence of BCA was observed in 2 out of 160 surgically treated patients (1,25%), one of them with simultaneous tonsillectomy, the other without. Conclusion. A statistically significant difference in the recurrence-rate between these two groups (with/without tonsillectomy) could not be shown. The performance of an ipsilateral simultaneous tonsillectomy in the surgical workup of BCA cannot be recommended at the basis of our data.

In this paper, we study the multiple solutions of parametric quasilinear systems of the gradient-type on the Sierpi´nski gasket arising in physical problems leading to nonlinear models involving reaction-diffusion equations, in problems on elastic fractal media or fluid flow through fractal regions. By using some critical point theorems, we give some new results to establish one, two and three weak solutions for our system. Finally, we give four examples to illustrate the main results.

Today, the issue of crop yield and quality is one of the many challenges facing societies. Residues of pesticides, chemical fertilizers, hormonal compounds, and preservatives have caused many environmental issues. It is necessary to reduce these environmental crises by paying attention to the development of sustainable agriculture. Seed coating is considered one of the best methods to promote sustainable agriculture where the physical and physiological properties of seeds can be improved to facilitate planting, increase growth indices and alleviate abiotic and biotic stresses. Several methods of seed coating (e.g., dry powder coating, seed dressing, encrusting, seed pelleting, and film coating) are used to attain good application uniformity and adherence in the seed coating process. Seed coating has been tested in seeds of various plant species (e.g., vegetables, medicinal and other plants with small seeds) with different dimensions, forms, textures, and germination types. Plant beneficial microorganisms (PBM), such as rhizobia, bacteria, and fungi inoculated via seed inoculation can increase seed germination, plant performance and tolerance across biotic (e.g., pathogens and pests) and abiotic stress (e.g., salt, drought, and heavy metals) while reducing the use of agrochemical inputs. In this review, the microbial seed coating process and their ability to increase seed performance and protect plants from biotic and abiotic stresses are well discussed and highlighted in sustainable agricultural systems.

Synovial sarcoma(SS) occurs in various parts of the body,predominantly in extremities.It also occurs in organs without synoviom. Intracranial disease, has been reported as metastasis,but primary intracranial SS has been reported rarely. we report a pateint with hemiplegia and a mass on brain CT. pathology showed SS with no extracranial pathology