Pelizaeus-Merzbacher Disease (PMD) is a rare genetic disorder affecting brain and spinal cord. We report a 11-year-old child with PMD with multiple caries for teeth extraction under general anaesthesia. Prolonged neuromuscular blockade is of major concern in these patients and hence the importance of appropriate neuromuscular blockade management during procedure.

A kind of nonlinear non-instantaneous impulsive equation with state-dependent delay is studied here. By ultilizing suitable fixed point theorem and the theory of semigroup in Banach space, the uniqueness and existence results of S-asymptotically w-periodic mild solutions are obtained, respectively. In the end, two examples are presented to demonstrate the validity of the obtained results.

Here we present the case of giant multinodular goiter with retrosternal extension in an old lady with dyspnea for 3 months. The patient was treated with Microscopic assisted thyroidectomy without complication.

In this paper, we analyze multi-dimensional Besicovitch almost periodic type functions. We clarify the main structural properties for the introduced classes of Besicovitch almost periodic type functions, explore the notion of Besicovitch-Doss almost periodicity in the multi-dimensional setting, and provide some applications of our results to the abstract Volterra integro-differential equations and the partial differential equations.

Peutz-Jeghers syndrome is a rare but potentially life threating syndrome. We report here the case of a young girl who presented recurrent small bowel intussusceptions. Laparotomy exploration showed many jejunal polyps leading to jejunojejunal intussusceptions. These were removed via mini enterotomies and pathological examination concluded to Peutz-Jeghers polyps.

1. This study assessed the ecological effects of substituting pasture for forest through changes to benthic macroinvertebrate assemblages. 2. Rapid river assessment protocol (RRAP) scores were determined for eight river stretches, four stretches from each one of the two matrix category, where benthic macroinvertebrates were also sampled. 3. All forest fragment stations were sorted into the natural category, but one, which was categorized as altered; all pasture stations were sorted into the impacted category; there were statistically significant differences in terms of RRAP scores and macroinvertebrate assemblage structures between the two matrix types; 18 taxonomic units contributed the most to this difference; Concerning their water-quality tolerance, seven were considered intolerant, eight tolerant, and one resistant to pollution while two could not be placed into any pollution resistance category; 39.44% of all specimens collected was herbivores, 8.06% was detritivores, 7.92% was predators, and 44.57% of them could not be categorized into a feeding category; forest fragment river stretches had greater taxon richness and relative abundances of pollution-intolerant taxa and predators than pasture river stretches; a positive relationship was found between RRAP score and intolerant taxa abundance. 4. These results may be a consequence of changes to habitat properties related to the matrix substitution, such as greater fine sediment suspension, greater nutrient concentration, and lower availability of food resources; the stress imposed by these changes mainly selects the more resistant taxonomic groups over the more sensitive ones, such as Ephemeroptera, Plecoptera, and Trichoptera; this indicates a reduction in water quality of river stretches without riparian forests.

A 50-year-old lady with dilated cardiomyopathy and scar VT underwent single chamber implantable cardioverter-defibrillator (ICD, Medtronic Ltd, Evera XT VR, DVBB2D1) implantation 2 months back. A Sprint Quattro secure 6947 DF1 dual coil lead was placed at RV apex. Now, she presents with an episode of ICD shock while having breakfast. The device interrogation shows a 36 J shock in VF zone (Fig 1A). However, the stored electrograms (EGM) reveal distinct QRS complexes in the far-field EGM; hence, suggesting the shock is related to oversensing. Fig 1B shows 2 panels of another recent episode. Fortunately, there was aborted therapy as there was intermittent resolution of the oversensing. The lead impedance was normal but threshold was high. Is it possible to predict the reason for the oversensing from the EGM and how to troubleshoot?

The hydrolysis of formaldehyde (HCHO) assisted by bimolecular acidic catalysts of H2SO4●●●H2O and (H2SO4)2 under different concentrations of H2SO4 and H2O were performed by quantum chemical calculations and the Master Equation method. The calculated results show that H2SO4●●●H2O and (H2SO4)2 catalyzed hydrolysis reaction of HCHO can occur through both one-step route and stepwise process. Effective rate coefficients (kt′) within the temperature range of 280-320 K show that H2SO4●●●H2O assisted reaction via stepwise route exerts the strongest catalytic role in increasing the rate of the hydrolysis of HCHO among all the hydrolysis reactions with H2SO4●●●H2O and (H2SO4)2 with its effective rate coefficient larger by at least 1 order of magnitude. As compared with the naked hydrolysis of HCHO, the favorable route of the hydrolysis of HCHO with H2SO4●●●H2O can reduce the energy barrier by 32.0 kcal·mol-1. Meanwhile, this reaction is also lower by another 0.8-17.6 kcal·mol-1 than that with H2SO4, HCOOH, HNO3, CH3COOH, H2O and (H2O)2. The calculated kt′ also reveals that the hydrolysis of HCHO with H2SO4●●●H2O ([H2SO4] =108 molecules∙cm-3 and [H2O] at 20%-100% RH) is more effective than that with H2O and (H2O)2 within 280-320 K, and can compete well with the hydrolysis of HCHO in the presence of HCOOH (2-10 ppbv), HNO3 (1011 molecules●cm-3), CH3COOH (1-5 ppbv) within 280-320 K. So, this work predicts that H2SO4●●●H2O can play a significant role in the hydrolysis of HCHO in the condition of wet areas with relatively high H2SO4-polluted.

This work reports on a novel computational approach to the efficient evaluation of one-electron coupling coefficients as they are required during spin-adapted electronic structure calculations of the configuration interaction type. The presented approach relies on the equivalence of the representation matrix of excitation operators in the basis of configuration state functions and the representation matrix of permutation operators in the basis of genealogical spin eigenfunctions. After the details of this connection are established for every class of one-electron excitation operator, a recursive scheme to evaluate permutation operator representations originally introduced by Yamanouchi and Kotani is recapitulated. On the basis of this scheme we have developed an efficient algorithm that allows the evaluation of all nonredundant coupling coefficients for systems with 20 unpaired electrons and a total spin of S = 0 within only a few hours on a simple Desktop-PC. Furthermore, a full-CI implementation that utilizes the presented approach to one-electron coupling coefficients is shown to perform well in terms of computational timings for CASCI calculations with comparably large active spaces. More importantly, however, this work paves the way to spin-adapted and configuration driven selected configuration interaction calculations with many unpaired electrons.

Nowadays, there are a few therapeutics to prevent or treat COVID-19. Because the development of safe and effective drugs is expensive and time-consuming, drug repurposing is now part of the arsenal of drug discovery. Herein, we focus on the repurposing of relatively large FDA-approved drugs (MW > 500, LogP ≤ 5) that target the receptor-binding domain (RBD) of SARS-CoV-2 spike protein. We performed a computational study incorporating molecular docking, molecular dynamics simulations, and relative binding energy calculations to discover prospective compounds with high affinity towards the viral RBD. We found that the most promising drugs, namely, Atazanavir, Zazole, Valrubicin, and Telotristat, influence hotspot residues of the RBD protein and may interfere with the human angiotensin-converting enzyme-2 (ACE2) receptor. Our findings corroborate with the present literature and can accelerate the rational design of selective inhibitors against SARS-CoV-2.

Partial anomalous pulmonary venous connection (PAPVC) is an unusual congenital anomaly with variable sites of attachment of the atypical pulmonary veins. Anomalous right pulmonary vein return can be surgically corrected if left to right shunt physiology becomes hemodynamically significant. In such patients, as in the general population, the development of arrhythmia-associated heart failure due to atrial fibrillation prompts consideration of pulmonary vein isolation. There are limited reports of pulmonary vein isolation on surgically repaired PAPVC. This case highlights successful isolation of surgically corrected right pulmonary veins in a patient with PAPVC and atrial fibrillation associated heart failure.

Open-cell foams as the column tray are promising candidates for the purpose of process intensification in the distillation process. In this paper, the real foam porous structure is obtained based on Micro Computed Tomography (µ-CT), and the bubble formation process on pore-scale foam tray is discussed based on the VOF-CSF model (volume of fluid method-continuous surface force). The results show that the wettability (CA), superficial gas velocity (Ug), porous structure, and clear liquid layer height (HCL) all affect a crucial factor of the foam tray - the liquid holdup in the porous channels (LHPC). It determines the effective porosity, which in turn affects the bubbling frequency and pressure drop. Meanwhile, the evolutionary mechanism of instantaneous pressure drop is analyzed based on the flow patterns, force analysis and interfacial phenomena. Moreover, the new model to predict pressure drop is proposed based on LHPC, which shows good consistency with experiments.

BACKGROUND AND PURPOSE Despite the observation of synergistic interactions between the urotensinergic and angiotensinergic systems, the interplay between the urotensin II receptor (hUT) and the angiotensin II type 1 receptor (hAT1R) in regulating cellular signaling under physiological and pathophysiological conditions remains incompletely understood. Notably, the interaction between hUT and hAT1R could engender reciprocal allosteric modulations of their signaling signatures, defining a unique role for these complexes in cardiovascular physiology and pathophysiology. EXPERIMENTAL APPROACH The physical interaction between hUT and hAT1R receptors was evaluated by co-immunoprecipitation, bioluminescence resonance energy transfer (BRET) and FlAsH BRET-based conformational biosensors. To analyze how this functional interaction regulated proximal and distal hUT-associated signaling pathways, we used BRET-based signaling biosensors and western blots to profile pathway-specific signaling in HEK 293 cells expressing hUT, hAT1R or both. KEY RESULTS We observed that hUT-hAT1R heterodimers triggered distinct signalling outcomes, in particular Gq/ G13/Gi/DAG/-arrestin-1/ERK1/2, compared to their respective parent receptors alone. Notably, co-transfection of hUT and hAT1R slightly potentiated hUII-induced Gq activation but significantly reduced the potency and efficacy of Ang II to mediate Gq activation. Using a FlAsH-walk approach, we observed that the presence of unliganded hUT altered conformational dynamics of hAT1R but that addition of hUII or URP did not produce further modulations. CONCLUSION Assembly of hUT with hAT1R might be important for allosteric modulation of outcomes associated with specific hardwired signaling complexes in healthy and disease states. Our work validates such complexes as potential targets to promote the design of compounds that modulate heterodimer function selectively.

Background and Purpose: Cooperative defect is one of the earliest manifestations of patients with Alzheimer’s disease (AD), but the underlying mechanism remains unclear. The purpose of the current study was to address this issue. Experimental Approach: The cooperative function of APP/PS1 transgenic AD model mice at ages 2, 5 and 8 months was evaluated by a cooperative drinking task. Neuropathological changes were examined in the medial prefrontal cortex (mPFC), a key brain area regulating social behavior. Another experiment was designed to observe whether miconazole, a drug has a protective effect on myelin sheath, could promote cooperative ability of APP/PS1 mice in the early AD-like stage. The protective effects of miconazole on cultured mouse cortical oligodendrocytes exposed to human amyloid β peptide (Aβ1-42) peptide were also investigated. Key Results: There was an age-dependent impairment of cooperative drinking water behavior in APP/PS1 mice. AD mice with cooperative dysfunction showed decreases in myelin sheath thickness, oligodendrocyte nuclear heterochromatin percentage and myelin basic protein expression levels in the mPFC. The cooperative ability was significantly improved in APP/PS1 mice treated with miconazole. Consistently, miconazole increased oligodendrocyte maturation and myelin sheath thickness, without reducing Aβ plaque deposition in the mPFC. Miconazole protected cultured oligodendrocytes from the toxicity of Aβ1-42. Conclusions and Implications: These results demonstrate that mPFC myelin hypomyelination is involved in cooperative deficits of APP/PS1 mice. Improving myelination via miconazole therapy may offer a potential therapeutic approach for early intervention of AD.

BACKGROUND Rheumatic heart disease (RHD) is an autoimmune disease that often leads to irreversible valve damage and heart failure. Surgery is currently an effective treatment, but it may have risks when performing the surgery and some people may not accept it since it is invasive. Therefore, we should find a new effective method to treatment it. CASE SUMMARY A 57 year old woman came to Zhongshan Hospital of Fudan University for cardiac color Doppler ultrasound, left heart function test and DTI evaluation, which showed mild mitral stenosis with mild moderate regurgitation and mild moderate aortic regurgitation, confirming the diagnosis of rheumatic valvular disease. The symptoms becames severe and ventricular tachycardia occurred frequently with the heart rate more than 200 and surgical treatment was recommended in 10 days. Patient wanted to treat with traditional Chinese medicine treatment during this period. The symptoms improved significantly especially the ventricular tachycardia is disappear after 1 week of treatment. Follow up visit 3 months after medication, ultrasound showed mild mitral stenosis with mild regurgitation and mild aortic regurgitation, and the operator notified no need for surgical treatment. CONCLUSION Traditional Chinese medicine treatments represent a potential treatment for RHD, mainly valvular stenosis and regurgitation.

Background: Reports of SARS-CoV-2 in animals have implicated human sources. Similarities in SARS-CoV-2 cell receptors between humans and animals suggest possible cross-transmission of COVID-19. Using a One-Health approach, we assessed exposure to SARS-CoV-2 in humans with no history of confirmed infection, selected domestic animals in their homesteads, and in wild animals in Uganda. Methods: A cross-sectional study was done in two districts where community COVID cases were first reported: and at Uganda Wildlife Education Centre (UWEC). Thirty-six humans and 48 domestic animals per district; and 14 animals at UWEC were sampled. Blood and nasopharyngeal or oropharyngeal samples were analysed for SARS-CoV-2 antibodies, viral antigens, and genome. Interviewer-administered questionnaire on socio-demographics, travel history, disease symptoms and knowledge on COVID-19 was conducted, data was analysed with STATA 16.0. Results: One hundred forty participants were interviewed, 77% were below 49 years old, 56% had only primary education, 50% were catholics; and 70% subsistence farmers. COVID-19-related information was majorly from radios (89%), families and or friends (55%). Over 60% were aware of at least two COVID-19 symptoms. In humans, sero-prevalence was 31.9%, 4.2% and 13.9% for IgG, IgM, and COVID-19 antigen, respectively. IgG sero-prevalence was significantly higher in females (47.2%) than males (16.7%) with p=0.005, and similar trends were noted for IgM and antigens. In domestic animals, caprine had the highest IgG seropositivity, followed by bovine, avian and lastly canine at 70.6%, 50.0%, 42.9% and 38.5%, respectively. IgM was detected in one dog. At UWEC, five animals had both IgG and IgM whereas two had only IgG. All human and animal samples were RT-PCR negative. Conclusion: A high sero-prevalence of IgG, indicates previous exposure. Ascertaining cross-species transmission at human-animal interface was unproven due to negative RT-PCR results, hence isolation and characterisation of virus were not done.

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Skip metastasis an uncommon finding in plain radiography of osteosarcoma cases. We reported a case of skip metastasis in juvenile osteosarcoma using simple X-ray. Further imaging and pathology assessment confirmed skip lesions in the background of high-grade chondroblastic osteosarcoma.

Phaeochromocytomas and paragangliomas (PPGL) are rare neuroendocrine tumors. Some advanced PPGLs are inoperable. Treatment strategies for inoperable PPGLs should be discussed case by case under the coordination of multidisciplinary team. Target organ management is crucial in improving life quality and prognosis.

Complex diseases generally result from dysfunction of relevant module molecules, which dynamically change with time and conditions, rather than that of an individual molecule. In this study, a novel network construction algorithm for identifying early warning network signals (namely, IEWNS) is proposed for improving the performance of early diagnosis. To this end, we theoretically derived a network-based dynamic criterion, namely, the relationship of variation (RV), to construct dynamic networks. RV infers correlation t statistics to measure dynamic changes in molecular relationships during the process of disease development. Based on the dynamic networks constructed by IEWNS, early warning network signals used to represent the occurrence of complex disease deterioration can be defined without human intervention. IEWNS was employed to perform a comprehensive analysis of gene expression profiles of lung adenocarcinoma (LUAD) from The Cancer Genome Atlas database and the Gene Expression Omnibus database. The experimental results suggest that the network biomarker selected by IEWNS can facilitate a better understanding of pathogenetic mechanisms and help to achieve effective early diagnosis of LUAD. In conclusion, IEWNS provides novel insight into the pathogenic mechanisms of complex diseases and helps to define prospective biomarkers for assessing disease deterioration.

Objective To assess whether the implementation of patient-controlled analgesia (PCA) with piritramide using an automatic pump system under routine conditions is effective to reduce pain in late abortion inductions Design Prospective observational cohort study Setting Patients requiring medically indicated abortion induction from 14 weeks of pregnancy onwards between July 2019 and July 2020 at the department of Obstetrics and Prenatal Medicine of the Bonn University Hospital in Germany. Methods Evaluation of pain management after implementation of a PCA system compared with previous nurse-controlled tramadol-based standard under routine conditions. Patients answered a validated pain questionnaire and requirement of rescue analgesics was assessed. Pain intensity and satisfaction were measured on a ten-point numeric rating scale. Main Outcome Measure Maximal pain intensity Results Forty patients were included. Patients using Piritramide-PCA complained of higher pain sores than those in the standard group (6.90 (± 2.34) vs. 4.83 (± 2.87), (p < 0.05)). In both groups the level of satisfaction with the analgesia received was comparable (8.00 (± 2.45) vs 7.67 (± 2.62), (p = 0.7)). Patients in the PCA group suffered more nausea (63.2% vs 30% respectively, OR 4.0, 95% CI 1.05-15.20, p<0.05) and expressed more the desire for more analgesic support compared to the control group (OR 5.7 (1-33.25), p = 0.05). Conclusion Women with abortion induction after 14 weeks of gestation suffer from relevant severe pain, which requires adequate therapy. However, addition of PCA does not seem to bring any advantage in patients undergoing this procedure.

Objectives To establish anatomical structures responsible for a resistance force on a fetal head during vaginal delivery; assess the postpartum perception of perineal pain and superficial dyspareunia; develop a new episiotomy. Design A prospective observational case series study. Setting International sites. Population Eighteen pregnant women in labor Methods Small V-shape excision was made on the posterior-lateral vaginal outlet without incising the posterior perineum or vaginal wall. Simple interrupted sutures were used to repair the surgical defect (outlectorrhaphy). Histological examinations were performed on excised specimens. Main Outcome Measures The primary maternal outcome measured postpartum perineal pain; the secondary outcome measured occurrences of superficial dyspareunia, results of Ostrzenski’s vaginal outlectomy, and APGAR scores measured the neonatal outcome. Results The small V-shape excision widened the vaginal outlet sufficiently for a vaginal delivery. Outlectorrhaphy required two-three simple interrupted sutures. All subjects were delivered vaginally with median newborns’ weight of 3,550 gm ±250gm and median APGAR scores of 9 ±1 at 5 minutes. One patient experienced a grate II extension tear with bleeding heavier than an uncomplicated vaginal outlectomy. Postpartum patients reported no moderate or severe perineal pain and no superficial dyspareunia. Histology showed that the vaginal outlet was deferred from the vaginal walls. Conclusions The vaginal outlet is responsible for resistance force on a fetal head. No moderate or severe perineal pain or dyspareunia occurred in this study group. Ostrzenski’s vaginal outlectomy widens the vaginal outlet sufficiently for a fetal vaginal birth, and it is easy to repair.

Acute myocardial infarction can be treated aggressively with intravenous thrombolysis, percutaneous coronary intervention, and coronary artery bypass grafting; however, recanalization can cause myocardial ischemia-reperfusion injury (MIRI), This is an important reason that restricts the treatment effect of patients. After the ischemic myocardium is restored to perfusion, an inflammatory response can occur within minutes and peak within a few days. A large number of pro-inflammatory cytokines can seriously damage cardiac function. Inflammation can regulate cardiomyocyte apoptosis, autophagy, pyroptosis, and necrosis, and is the main initiating factor leading to MIRI in cardiomyocytes. This article reviews the mechanism of inflammatory response in ischemia-reperfusion period after acute myocardial infarction and the clinical value and application prospect of inhibiting inflammatory response in the treatment of acute myocardial infarction.

Detailed case reports of autologous recovery of hematopoiesis after hematopoietic stem cell transplantation with myeloablative conditioning (MAC) are scarce. We present a rare case of a 3-year-old male with relapsed KMT2A-rearranged acute lymphoblastic leukemia (ALL) who experienced autologous recovery following secondary engraftment failure after cord blood transplantation (CBT) with MAC. Similar to previous reports, we detected unusual chromosomal abnormalities, which differed at each bone marrow examination. He remains alive without relapse of ALL 12 months after CBT. As the rate of recurrence or late occurrence of secondary malignant neoplasm remains unclear, careful follow-up is required, especially in pediatric patients.