Background: Although diastolic dysfunction is common among patients treated with cancer therapy, no clear evidence has been shown that it predicts systolic dysfunction. This study evaluated the correlation of longitudinal diastolic strain time (Dst) with the routine echocardiography diastolic parameters and to estimated its role in the early detection of cardiotoxicity among patients with active breast cancer. Methods: Data were collected as part of the Israel Cardio-Oncology Registry (ICOR), a prospective registry enrolling all adult patients referred to the cardio-oncology clinic. All patients with breast cancer, planned for Doxorubicin therapy were included. Echocardiography, including Global longitudinal systolic strain (GLS) and Dst, was assessed at baseline before chemotherapy (T1), during Doxorubicin therapy (T2) and after the completion of Doxorubicin therapy (T3). Cardiotoxicity were determined by GLS relative reduction of ≥15%. Dst was assessed as the time measured (ms) of the myocardium lengthening during diastole. =diastolic time (ms) measured. Results: Among 69 patients, 67 (97.1%) were females with a mean age 52±13years. Diastolic strain timeDst measurement was significantly associated with the standard routine diastolic parameters. Significant GLS reduction was observed in 10 (20%) patients at T3 . Both in a univariate and a multivariate analyses the change in Ds basal time from T1 to T2 emerged to be significantly associated with GLS reduction at T3 (p<0.04). Conclusions: Among breast cancer patients, Dst time showed high correlation to standard the routine diastolic echocardiography parameters. Relative reductionChange in Ds basal time emerged associated with clinically significant systolic dysfunction as measured by GLS reduction.

Myocardial non-compaction (NC) is a rare genetically heterogeneous cardiomyopathy which is characterized by excessively prominent ventricular trabeculations with deep intertrabecular recesses. It is commonly believed to be due to an intrauterine arrest of the endomyocardial morphogenesis. Left ventricle (LV) is the usual site of affection, but very rarely right ventricular (RV) or both ventricles may be involved. It can be isolated or associated with other cardiac diseases or neuromuscular disorders. It has a wide spectrum of clinical manifestations that range from asymptomatic status, progressive ventricular dysfunction, arrhythmias and congestive heart failure that have been found to be associated with myocardial fibrosis. Cardiac Magnetic resonance (CMR) is the gold standard non-invasive modality for the diagnosis of cardiomyopathies. In NC cases, late gadolinium enhancement (LGE) of the trabeculated layer or mild fibrosis of the compacted layer was previously described in the literature, however extensive fibrosis in the compacted layer only with no fibrosis at the trabeculated layer was not described before. We report a male patient presented with heart failure symptoms, echocardiogram showed severe LV and RV systolic dysfunction with prominent bi-ventricular trabeculations. CMR confirmed the diagnosis of bi-ventricular non-compaction with peculiar pattern extensive fibrosis of the compacted layer of LV in LGE. To the best of our knowledge, our case is the first case to report extensive fibrosis in the compacted layer only with no fibrosis at the trabeculated layer.

There are views prevalent in the noncovalent chemistry literature that i) the O atom in molecules cannot form a chalcogen bond, and ii) if formed, this bond is very weak. We have shown here that these views are not necessarily true since the attractive energy between the oxygen atom of some molecules and several electron-rich anionic bases examined in a series of 34 ion-molecule complexes varied from the weak (ca –2.30 kcal mol-1) to the ultra-strong (–90.10 kcal mol-1). The [MP2 /aug-cc-pVTZ] binding energies for several of these complexes were found to be comparable to or significantly larger than that of the well-known hydrogen bond complex [FH···F]– (~ 40 kcal mol-1). The nature of the intermolecular interactions was examined using the quantum theory of atoms in molecules, second-order natural bond orbital and symmetric adaptive perturbation theory energy decomposition analyses. It was found that many of these interactions comprise mixed bonding character (ionic and covalent), especially manifest in the moderate to strongly bound complexes. All these can be explained by an n (lone-pair bonding orbital) -> σ* (anti-bonding orbital) donor-acceptor charge transfer delocalization. This study, therefore, demonstrates that the covalently bound oxygen atom in molecules can have a significant ability to act as an unusually strong chalcogen bond donor.

To the editor:Cow’s milk allergy (CMA) is the most common food allergy in children, with a prevalence of 1 to 3% (1). While the vast majority of CMAs clear after five years (2), some children have a persistent and severe disease associated with a risk of life-threatening allergic reactions (3). For those patients, oral immunotherapy (OIT) is now recommended (4); it consists in a tolerance induction by daily ingestion of allergen. However, in the most severe cases which react with a very low quantity of cow’s milk (CM), classic OIT cannot be initiated due to the impossibility of increasing the daily doses of CM. The adjunction of omalizumab, a monoclonal anti-IgE antibody, to OIT (oma-OIT), could be a safe and effective alternative in those cases; however, only a few studies have been published to decisively assess both the safety and efficiency of oma-OIT (5–8). The aim of our study was to evaluate both the effectiveness and safety in an oma-OIT protocol in children with persistent and very severe CMA.In this study performed in Lyon, France, children who initiated an oma-OIT protocol for a persistent and very severe CMA were included. These patients were considered as severely allergic due to failure in initiation of a classic OIT to CM or an history of severe reaction with very small amounts of CM. Initiation of oma-OIT was decided in a concertation meeting of allergist experts in OIT. Briefly, the oma-OIT protocol was performed as following: (1) subcutaneous omalizumab was administrated at a frequency (every 2 or 4 weeks) and a dose that depended on the patient’s weight and total IgE (same dose used as the one recommended for severe asthma); (2) after 16 weeks of omalizumab use alone, OIT was initiated. The induction phase began with the introduction of diluted amounts of CM (first daily dose: 1 mg of CM proteins), followed by introduction of non-diluted doses and daily increases of CM doses until a predefined threshold. Oral food challenges (OFCs) were performed every month or two months at hospital, under the supervision of a medical team trained for the management of high-risk OFCs, in order to establish the cumulative tolerated dose (CTD) and the new threshold to reach by up-dosing. After each OFC, the new threshold was reached at home in one week, and maintained for several weeks, until the next OFC. Allergy tests were usually performed at each OFC (skin prick-test [SPT], specific IgE [sIgE] to CM and CM components and specific IgG4 [sIgG4] to CM, Phadia 250 Thermofisher, Uppsala, Sweden). Additionally, the patients and their parents reported any allergic reactions which occurred at home in a notebook, if applicable. We retrospectively collected the general characteristics of each patient at the initiation of the protocol. We also collected the initial grade and the most severe grade of allergic reactions to CM, using the Ring and Meissmer classification (9), the results of OFCs, the allergy tests and allergic reactions and the use of epinephrine during OFCs and at home. In addition, we collected responses from a satisfaction survey which was completed by the children and their parents after OFC4.In order to evaluate the effectiveness of the initiation of oma-OIT protocol, the primary outcome was the change in the CTD of ingested fresh CM between OFC1 and OFC4. The secondary outcomes were the changes in allergy tests, the occurrence of allergic reactions during OFCs and at home, and the results of the satisfaction survey. Statistical tests were performed using GraphPad Prism version 8.02 for Windows, GraphPad Software, La Jolla California USA, www.graphpad.com.Eight children (3 boys and 5 girls, median age of 14.5 years [12-16]) with very severe CMA who received an oma-OIT treatment were included in this study (Table 1). The median administrated dose of omalizumab was 487.5 mg [300-600] every 2 or 4 weeks. The median time between OFC1 and OFC4 was 127 days [84-427] for a total number of 1,342 ingested doses at home. After four OFCs (Table I and Figure S1), the CTD of CM was significantly increased (median CTD1 = 0.96 mg [0.64;15.04] and CTD4 = 160 mg [12.8;480], 167-fold change, p = 0.0078 ). The anti-CM sIgE moderately decreased (sIgE1 = 476.0 kU/L [227.0;2048.0] and sIgE4 = 460.0 kU/L [97.2;1482.0], change -3.4%, p = 0.0391 ) and ratio anti-CM sIgG4/sIgE increased (sIgG4/sIgE1 = 8.6 [1.8;16.2] and sIgG4/sIgE4 = 17.5 [3.3;223.1], change +103.5%,p = 0.0313 ). There were no significant changes in SPT wheal and anti-CM component sIgEs. During the 32 OFCs performed in the 8 children under oma-OIT, 8 allergic reactions occurred in 6 children: 4 were grade 1 and 4 grade 2 according to the Ring and Meissner classification. These children were treated with oral antihistamine; none needed an epinephrine administration. Among the 1,342 ingested doses at home, two doses induced allergic reactions in two children: one grade 2 and one grade 3. The severe reaction was treated by epinephrine at home. Of note, a reactogenic cofactor (physical activity) without adaptation of the protocol was found for this severe reaction. Finally, all the children and their parents were globally very satisfied with the oma-OIT protocol, even if they expressed relative anxiety due to the risk of adverse reactions during the OFCs and the dose intake (Table S1). Interestingly, omalizumab injections were not considered as a constraint by most of the children and their parents (Table S1).Thus, in this cohort of children with very severe CMA, the adjunction of omalizumab to OIT was effective and globally well tolerated, during the first months of the protocol. The main limitations of our study are the absence of a control group (placebo or no treatment), the limited size of our cohort, and the duration of follow-up. These are preliminary results and they need to be confirmed. Moreover, our patients were more severe than those included in previous studies, in terms of initial CTD and sIgE (5–8). Thus, this preliminary study encourages continuation of further oma-OIT protocols in cohorts of patients with very severe CMA.

Background: Pulmonary veins reconnection due to insufficient lesions is an important cause of recurrence of atrial fibrillation (AF). High power ablation (HPA) with shorter duration or guided by Ablation index (AI) seen to increase efficacy and safety. This analysis aimed to evaluate the clinical benefits of HPA in patients with AF. Methods: The Medline, PubMed, Embase, and the Cochrane Library databases were searched for studies comparing HPA and conventional power ablation (CPA). Results: A total of nine trials with 2297 patients were included in the analysis. Pooled analyses demonstrated that HPA showed a benefit of first-pass pulmonary vein isolation (PVI) and acute PVs reconnection [risk ratio (RR): 1.27; 95% confidence interval (CI): 1.18–1.37, P < 0.001] and (RR: 0.52; 95% CI: 0.30–0.88, P = 0.01). HPA could reduce recurrence of atrial arrhythmias (RR: 0.71; 95% CI: 0.53–0.97, P = 0.03). Additionally, HPA was more beneficial in terms of procedural time [Weighted Mean Difference, (WMD): −41.19; 95% CI, −56.01 to −26.36, P < 0.001], ablation time (WMD: −19.45; 95% CI: −23.11 to −15.78, P < 0.001), and fluoroscopy time (WMD: −3.10; 95% CI: −5.52 to −0.68, P < 0.001) compared with the CPA approach. Moreover, HPA was associated with low complications (RR: 0.60; 95% CI: 0.36–0.99, P = 0.05). Conclusion: The HPA was a safe and effective approach for treating AF with clear advantages of procedural features. It was also associated with higher first-pass PVI, fewer acute PVs reconnection, recurrence of atrial arrhythmias and complications compared with the CPA approach.

Vanessa Yee Jueen Tan MBBS (S’pore), MRCS (Glasgow), MMed (ORL) Department of Otorhinolaryngology – Head and Neck Surgery Singapore General HospitalEdward Zhiyong Zhang MBBS (S’pore), MRCS (Glasgow), MMed (ORL), MCI, FAMS (ORL) Department of Otolaryngology – Head and Neck Surgery Sengkang General HospitalDan Daniel PhD Institute of Materials Research and EngineeringAnton Sadovoy PhD Institute of Materials Research and EngineeringNeville Wei Yang Teo MBBS (S’pore), MRCS (Glasglow), MMed (ORL) Department of Otorhinolaryngology – Head and Neck Surgery Singapore General HospitalKimberley Liqin Kiong MBBS (S’pore), MRCS (Edinburgh), MMed (ORL), FAMS (ORL) Department of Otorhinolaryngology – Head and Neck Surgery Singapore General HospitalSong Tar Toh MBBS (S’pore), MRCS (Edin), MMed (ORL), MMed (Sleep Med), FAMS (ORL) Department of Otorhinolaryngology – Head and Neck Surgery Singapore General HospitalHeng Wai Yuen MBBS (S’pore), MRCS (Edinburgh), MMed (ORL), DOHNS (England), GDFM Ear Nose Throat, Head and Neck Surgery Changi General HospitalCorresponding author: Vanessa Yee Jueen Tan vanessa.tan.y.j@singhealth.com.sg

Antiadherent Immune Response (AAIR) against serotype 026: EPEC (Enteropathogenic (invasive) Escherichia coli) a fatal diarrhoea was successful in Balb/c mice experiment by the author. IS(Insertion Sequence) represented by IS1,IS2,IS3,-……IS10 flanking transpons ( Tn)”IS-TN-IS” and its illegitimate recombination was also studied curiously by the author to observe their spontaneous jumping, illegitimate recombination among DNA, chromosome and plasmids in Escherichia coli. Considering the fatality rate of corona as pandemic globally, the author has attempted to realise the possible application of AAIR and IS-Tn-IS mixed hybrid concept, in designing vaccine against corona, to prevent corona virus not to adhere in trachea and lung cells, to bring healthy life to mankind. IS-Tn-IS was studied in Maize by Barbara Mc Clintock, USA, Peter Starlinger and H.Saedler, Germany studied the same in bacteria.. In this paper the author describes the possible AAIR vaccine against corona. A mixture of combine strategy corona vaccine with IS-Tn-IS gene expression.

A document by Paul Angers, written on Authorea.

The intra-aortic balloon pump (IABP) was first successfully used by Kantrowitz and colleagues in 1968 . Traditionally, IABPs are inserted via the femoral artery. However, this approach is usually contraindicated in patients with severe peripheral vascular disease (PVD). Noël and colleagues were the first to report transbrachial insertion of an 8 Fr IABP catheter for ventricular assistance during percutaneous coronary intervention. However, in almost all the reported cases in which transbrachial insertion of an IABP was performed, it was done for hemodynamic support during percutaneous coronary intervention or coronary artery bypass grafting. We present a case involving a patient with endocarditis-associated structural aortic valve deterioration and severe left ventricular dysfunction, as well as total occlusion of both external iliac arteries. The patient was successfully treated using a 7 Fr transbrachial IABP. A left transbrachial percutaneous approach may thus be a safe and effective alternative if femoral artery access cannot be achieved.

African swine fever virus variants with different numbers of a 10-bp tandem repeat were isolated in South Korea soon after being identified in wild boar. The short emergence periods and sympatric distributions within a narrow geographical region suggest that the variants were sporadically generated in the pre-existing viral population.

Yeast manganese (Mn) trafficking transporter for mitochondrial Mn-containing superoxide dismutase (MnSOD), yMTM1, belongs to mitochondrial carrier family (MCF) and is crucial for yeast MnSOD (ySOD2) activation. Arabidopsis AtMTM1 and AtMTM2 are homologs of yMTM1 and share conserved MCF motif sequence. We confirmed that AtMTM1 and AtMTM2 interacted with AtMnSOD (AtMSD1) in mitochondria and recovered ySOD2 activity in yMTM1-mutant cells. The redundant AtMTM1 and AtMTM2 have different gene expression patterns in tissues and methyl viologen (MV)-induced oxidative stress and also responded to most metal stresses along with AtMSD1. Bioassay revealed the contrasting root phenotype in microRNA-mediated AtMTM1 mutant (mtm1-i) and AtMTM2-null mutant (mtm2) under MV stress, and Mn supplement complemented the root lengths in single and mtm1-i mtm2-double mutants. We found decreased MnSOD activity was accompanied by increased FeSOD activity in double mutant. Transient expression of chloroplast-destined AtMSD1 highlighted that unidentified factors participated in AtMSD1 activation. Besides, the exogenous-expressed AtMSD1 activity was decreased in double mutant, and inductively coupled plasma optical emission spectrometry results showed that AtMTM1 and AtMTM2 involved in Mn and Fe homeostasis with a reciprocal regulation. Overall, AtMTM1 and AtMTM2 are important for MnSOD metalation and ion homeostasis, and their physiological regulations may stretch across mitochondria and chloroplasts.

To reveal whether the response of mulberry to phytoplasma infection is associated with DNA methylation changes, the methylome and transcriptome patterns of mulberry leaves in response to phytoplasma infection were explored. Though the average methylation level of infected leaves showed no significant difference with that of healthy leaves, there were 1253 differentially methylated genes and 1168 differentially expressed genes found in the infected leaves, and 215 genes were found simultaneously to be differently methylated and expressed. It was found that the expression of G-type lectin S-receptor-like serine/threonine protein kinase gene (Mu-GsSRK) was increased, but its methylation level was decreased in the infected leaves. Moreover, the expression of Mu-GsSRK was increased while its methylation level was reduced in mulberry treated with pathogen and SA. Expression of Mu-GsSRK in Arabidopsis enhanced transgenic plant disease resistance and the expressions of some defense genes when plants were inoculated with pathogens. In addition, the DNA methylation dynamic patterns and the roles of the differentially expressed and methylated genes were discussed. Our results suggested that DNA methylation has important roles in mulberry responses to phytoplasma infection, and the information provided there will facilitate to elucidate the epigenetic mechanisms underlying mulberry responses to phytoplasma infection.

Purpose: The purpose of this study is to present our surgical experience with symptomatic congenital cystic adenomatoid malformations (CCAMs) in neonates. Methods: The medical records of neonates who underwent surgery for symptomatic CCAM from 2010 to 2020 were retrospectively reviewed. Results: Of 24 cases, 10 involved open resection, and 14 involved thoracoscopic resection. Four cases of CCAMs located in the upper or middle lobes underwent lobectomy, and 20 cases underwent lung-preserving wedge resection in the lower lobe. Between the two groups, there was no statistically significant difference in related preoperative variables, including gestational age at birth, body weight, head circumference, lesion size, CVR, and age at operation (P>.05). The differences in intraoperative variables were statistically significant. The length of the surgical incision in the thoracoscopic resection group was significantly shorter than that in the open resection group (1.4 cm [1.3-1.8] vs 6.0 cm [5.0-8.0], P=.000), and there was significantly less operative blood loss (3 ml [1-6] vs 5 ml [2-10], P=.030), but the operation time was significantly longer (159 min [100-220] vs 110 min [70-170], P=.003). Regarding postoperative variables, ventilator days, duration of chest tube use and length of hospital stay were not statistically significant (P>.05). Conclusions: Thoracoscopic resection is a safe and favorable approach for symptomatic CCAM in neonates. It has minimal esthetic effects and does not increase the risk of surgical or postoperative complications. Lung-preserving resection is feasible for neonatal CCAM surgery.

Objective: Little is known regarding the effect of sleep duration and weekend catch-up sleep (WCUS), sleep time on weekends that exceeds sleep time on weekdays, on suicidal ideation among adolescents with asthma. We explored whether sleep factors were associated with suicidal ideation among adolescents with asthma. Hypothesis: Adolescents with asthma are likely to have shorter sleep duration and longer WCUS than those without asthma. Study Design: Secondary data analysis for cross-sectional, self-administered, online survey. Patients Selection: Adolescents participating in the annual Korean Youth Risk Behavior Web-based Surveys (KYRBS, completed from 2013 to 2017). Methodology: The KYRBS data were obtained from a stratified, multistage, clustered sample. Students responded prior diagnoses of asthma and sleep time. Associated factors for suicidal ideation were tested by logistic regression models. Results: Among 34,067 and 363,003 adolescents with and without asthma, respectively, adolescents with asthma had poorer sleep satisfaction (44.6% vs. 42.6%), slept less (sleep duration 6.59 ± 0.94 vs 7.29 ± 1.45 hr), and had longer WCUS (3.13 ± 0.01 vs 2.29 ± 0.01 hr) than did those without asthma. The odds ratio (OR) of suicidal ideation in those with short sleep duration (defined by ≤5h) was 1.37 (95% Confidence Interval [CI], 1.30–1.43). Notably, long WCUS (≥2hr) was significantly associated with a decreased risk of suicidal ideation (OR, 0.88 [95% CI, 0.86–0.93]). Conclusion: Although further research is needed to clarify this association, long WCUS, which is a compensatory phenomenon for insufficient weekday sleep, protects against suicidal ideation in adolescents with asthma.

There is a large spectrum of abnormalities in the CFTR gene that leads to a partial function of the chloride channel and, thereby, an uncommon presentation of the disease, the “CFTR-related diseases”. This report aims to present a case of a patient with a single gene mutation related to cystic fibrosis, with an unusual clinical presentation among CFTR related diseases - chronic intestinal constipation. This patient is not a cystic fibrosis patient because he does not fulfil the disease’s classic criteria. Furthermore, since the mutation found is not yet described in the literature, it could be related to CFTR-related disease.

Objectives: Although albuterol, the most frequently used bronchodilator, has been traditionally and generally delivered via nebulization (NEB) with compressed air/oxygen, the benefits of metered‐dose inhalers with a spacer (MDI+S) have been widely recognized as an alternative method for albuterol administration. The aim of this systematic review was to compare the response to albuterol delivered through NEB with albuterol delivered through MDI+S in pediatric patients with asthma exacerbations. Methods: We conducted an electronic search in MEDLINE/PubMed, EMBASE, Ovid and ClinicalTrials. To be included in the review, a study had to a randomized clinical trial comparing albuterol delivered via NEB versus MDI+S; and had to report the rate of hospital admission (primary outcome), or any of the following secondary outcomes: oxygen arterial saturation, heart rate (HR), respiratory rate, the pulmonary index score (PIS), adverse effects, and need for additional treatment. Results: Fifteen studies (n=2057) met inclusion criteria. No significant differences were found between the two albuterol delivery methods in terms of hospital admission (RR 0.89; 95% CI 0.55 to 1.46; I2=32%; p=0.65). There was a significant reduction in the PIS score (MD -0.63; 95% CI -0.91 to -0.35; I2=0%; p < 0.00001), and a significantly smaller increase in HR (better) (MD -6.47; 95% CI -11.69 to -1.25; I2=0%; p=0.02) when albuterol was delivered through MDI+S than when it was delivered through NEB. Conclusions: This review showed a significant reduction in the PIS and a significantly smaller increase in HR when albuterol was delivered through MDI+S than when it was delivered through NEB.

TITLE PAGE TITLE : LEVEL OF BLOCKDESCRIPTION :Electrograms recorded from an electrophysiological study and ablation of manifest left lateral accessory pathway with demonstration of site of block during the case.

Distance learning has been a means to provide an education to those who are unable to participate in on-campus, face-to face classes. Teams of instructional design specialists that focus on online education put significant effort into course development. This planned process is very different from emergency remote education in response to a crisis. In early 2020, it was discovered that an extremely contagious respiratory illness termed COVID-19 had spread to every corner of the earth. As of mid-March 2020, the need to transition from face-to-face classroom instruction to exclusively online education landed on the doorstep of America’s universities. COVID-19 has catalyzed a transition in the ecology of American education for all students, but especially the underserved and minoritized. Ecology, by definition, is concerned with the interactions of an organism and its environment. The circumstances of the pandemic have caused vast and rapid change in both the internal and external environments of the organisms (e.g., students) and the systems in which they reside (e.g., U. S. educational systems). The purpose of this paper is to provide some considerations for instructors who find themselves “thrown into teaching remotely,” and help them think about how best to create sustainable systems, broaden participation and build capacity in a more equitable and inclusive manner.

The importance of venous structure in the heart is usually overshadowed by that of the arterial system. Coronary sinus is a part of cardiac venous apparatus and connects left atria to the right atria. Other than having role in physiological contractions of both atria, it contributes substantially to cardiac electrical conduction system. Due to unique placement and connections of the CS, it has become growing interest in clinical cardiology. It is used in cardiac resynchronization therapy with biventricular pacing, left-sided catheter ablation of arrhythmias and administration of retrograde cardioplegia in cardiac surgery. In some individuals, CS is presented with anatomical variants. CS diverticulum is a congenital outpouching that provides muscular connection between atria and ventricle. This connection provides a suitable substrate for occurrence of arrhythmias, which even results in life-threatening events such as sudden cardiac death. Early diagnosis leads to treatment with ablation techniques which ultimately eliminates origins of arrhythmias.

INTRODUCTION: Different endpoint criteria, different durations of follow up and the completeness of follow up can dramatically affect the perceived benefits of Atrial Fibrillation (AF) ablation. METHODS: We defined three endpoints for recurrence of AF post ablation in a cohort of 200 patients with symptomatic AF, refractory to antiarrhythmic drugs (AADs). A “Strict Endpoint” where patients were considered to have a recurrence with any symptomatic or documented recurrence for ≥30 seconds with no blanking period, and off their AADs, a “Liberal Endpoint” where only documented recurrences after the blanking period, either on or off AADs were counted, and “Liberal Endpoint + Redo” which was the same as the Liberal endpoint but allowing for 1 redo ablation or 1 cardioversion (DCCV) during follow up. We also surveyed 50 patients on the waiting list for an AF ablation and asked them key questions regarding what they would consider to be a successful result for them. RESULTS: Freedom from recurrence of atrial tachyarrhythmias (AT) at 5 years was 62% for the strict endpoint, 73% for the liberal endpoint, and 80% for the liberal endpoint + redo group (p<0.001). Of the 50 patients surveyed awaiting AF ablation, 70% said they would still consider the procedure a success if it required one repeat ablation or one DCCV (p=0.004), and 76% would be accepting of one or two recurrences during follow-up (p<0.001). CONCLUSION: In this study the most important predictor of AT recurrence following AF ablation was the criteria used to define recurrence.

Background: Right ventricular failure (RVF) following Left Ventricular Assist Device (LVAD) implantation is associated with worse outcomes. Prediction and early identification of RVF with speckle-tracking echocardiography (STE) has been proposed. Methods: We queried multiple databases for articles reporting on pre-operative/intraoperative global longitudinal strain (GLS) and free-wall strain (FWS) in LVAD recipients. We performed a systematic review and meta-analysis of published literature. The standard mean difference (SMD) in GLS and FWS in patients with and without RVF postoperatively was pooled using random effects model. Results: Fifteen studies, with a total of 967 LVAD recipients were included. There was statistically significant difference in GLS among patients who did and did not develop RVF; SMD= -3.09 (95% CI: -4.62 to -1.57; p-value <0.0001). There was significant difference in FWS between two groups; SMD: -2.75 (95% CI: -3.72 to -1.79; p-value <0.0001). Upon subgroup analysis of imaging modality, transthoracic echocardiography (TTE)-derived GLS and FWS remained predictive for RVF with SMD of -3.97 (95% CI: -5.40 to -2.54; p-value <0.001) and -3.05 (95% CI: -4.11 to -1.99; p-value <0.001), respectively. However, there was no significant difference between RVF and non-RVF groups upon using transesophageal echocardiography (TEE) to assess GLS and FWS. Conclusion: GLS and FWS assessment of the RV by STE is a useful tool to predict postoperative RVF in LVAD recipients. While the predictive role of TTE was robust, the TEE-derived measures seemed to be less predictive. Future studies need to specify the strain cut-off value that can predict the adverse outcome of RVF

Objectives The upper two-thirds of the vagina is most commonly affected by pelvic organ prolapse. This study aims to find a reference line proximate to the axis of this part of the vagina on MRI which is critical but lacking. Design Retrospective cross-section study Setting Two university-affiliated hospital in China (July 2018 - June 2019) Population Six hundred and fourteen women without prolapse Methods Two reference lines were introduced to compare with the upper two-thirds of the vagina on pelvic MRI: the pubococcygeal line (PCL) and a line passing through the inferior pubic symphysis to the midpoint of the third sacral vertebra (PS3L). Main outcome measures The distances and the angles between the vagina and both reference lines were measured. Results: The median distances from the distal, middle, and apical points to the PS3L were -0.5[interquartile range (IQR), -0.9 - 0.0] cm, 0.0[IQR, -0.4 - 0.6] cm, and -0.2[IQR, -0.9 - 0.0] cm, respectively, while the median distances to the PCL were 0.4[IQR, 0.0 - 0.7] cm, 2.1[IQR,1.7 - 2.5] cm, and 3.1[IQR, 2.5 - 3.7] cm, respectively. The median angle between the vagina and the PS3L was significantly smaller than that with the PCL (0.0[IQR, -4.0 - 7.0] degree vs 29.0[IQR, 23.0 - 34.0] degrees, p<.001). Conclusions: A line passing through the inferior portion of the pubic symphysis to the third sacral vertebra mostly conforms to the normal upper two-thirds of the vaginal axis.

The Sebou watershed is the main receiver of rainwater contributions in the North of Morocco. The present study is interested in the knowledge of the global Physical characteristics on water dynamics in the Sefrou watershed at the level of the Sefrou sub-watershed which belongs to this large hydrological unit and which occupies its south-western part. The approach followed in this study consisted initially, in acquiring the data, organizing it, and processing it by a geographic information system (GIS), in order to obtain a global idea on the distribution of the different parameters in the entourage concerned by this study. The application of geographic information system tools makes it possible to establish a set of maps that will help develop an excellent descriptive analysis characteristic of the watershed. In this paper, we present the analysis results of the geological, climatic and hydrological characteristics of an important area of the Middle Atlas, with the notable importance of precipitation, runoff and rivers for irrigation and the supply of drinking water. of cities in the region. The hydrological study of the Sefrou watershed has shown a typical Mediterranean regime, the watershed receives an average annual rainfall of 454.22 mm, with a volume input of 183,96*10 ^6 ^3/year and an average annual temperature of 16.62°C. The actual evapotranspiration in the watershed is 389.22 mm/year which is 161,28.10^6 m^3/year.

Objectives. Valve repair is considered the treatment of choice for native mitral valve regurgitation, although the rate of feasibility when the defect is caused by acute infective endocarditis (IE) is debated. We report the experience of valve repair versus replacement following IE in a high-volume surgical center. Methods. We retrospectively analyzed 363 consecutive patients (123 women) admitted with a diagnosis of definite IE. We selected 108 patients with native mitral IE, potentially eligible for surgical repair. Of these 108, 90 (83%) underwent surgery and 18 were treated conservatively. The two primary endpoints were all-cause mortality and freedom from recurrent endocarditis. Results. Mean age at surgery was 63.6 years (SD 13.5). Mean vegetation length was 11.6 mm (SD 7.7). Among the 90 surgical patients, 57 (63%) underwent valve replacement and 33 valve repair (37%). Mean follow-up duration was three years. All-cause short-term (30 days: 3±3 vs 4±2% for repair and replacement respectively) and long-term (3 years: 26±9 vs. 36±11%) mortality was lower, although not-significantly, for valve repair (figure 1), as well as nonfatal adverse events (15±4 vs. 20±2%) and relapse rate (1±1% vs. 3±1%) at three years. At echocardiographic follow-up, no differences were reported between the two groups in terms of left ventricular systolic function and valvular continence. Conclusions. In our experience, over one-third of consecutive patients with native mitral are amenable to valve repair in expert hands. Mid-term outcome of repair in IE is comparable to valve replacement, and should be considered whenever possible, as in degenerative valve disease.