A non-isothermal pressure-balanced bubble-growth (PBB) model has been proposed based on mass, momentum and energy conservation, which additionally considered the decrease in the internal energy of gas due to the work done by gas expansion in bubble. The model could accurately predict the bubble size and expansion ratio for the melt foaming of four polymers for a wide range of cell densities from 1.5×1013 to 1.9×1015 cells/m3. Furthermore, the simulation results indicate that the bubble shell resisted bubble growth and consumed significant energy, preventing the growth of some small nucleations. During the melt foaming process, the energy cost of the linear polymer had a long-term effect, which reduced the bubble size, while that of the long-chain branched polymer had a short-term effect, thereby increasing the expansion ratio. Finally, we defined the gas efficiency of the foaming agent to evaluate the economic feasibility of the foaming agent in a foaming process.

The asymmetric sulfoxidation catalyzed by soybean pod peroxidase (SPP) in water-in-oil microemulsions were carried out with the yield of 91.56% and e.e of 96.08% at the activity of SPP of 3200 U ml-1 and 50℃ for 5 h. The mechanism with a two-electron reduction of SPP-I is accompanied with a single-electron transfer to SPP-I and nonenzymatic reactions, indicating that three concomitant sub-mechanisms contribute to the asymmetric oxidation involving five enzymatic and two nonenzymatic reactions, which can represent the asymmetric sulfoxidation of organic sulfides to form enantiopure sulfoxides. With 5.44% of the average relative deviation, a kinetic model fitting experimental data was developed. The enzymatic reactions may follow ping-pong mechanism with substrate inhibition of H2O2 and product inhibition of esomeprazole, while nonenzymatic reactions, a power law. Those results indicate that SPP with a lower cost and higher thermal stability may be used as an effective substitute for Horseradish Peroxidase.

Machine Learning (ML) algorithms can be combined with the modular automation protocol (MTP) and recognize the flooding behavior of laboratory fluids separation columns. Hence, artificial intelligence (AI) tools with deep learning (DL) offer a high potential for the process industry and allow to capture operating states that are otherwise difficult to detect or model. However, the advanced methods are only hesitantly applied in practice. This article provides an overview on how artificial intelligence-based algorithms can be implemented in existing laboratory plants. Process sensor data as well as image data are used to model the flooding behavior of distillation and extraction columns and the system is adapted to the existing modular automation standard of the Module Type Package (MTP).

Objectives: In this study, we designed a new technique for open septal reduction using a polydioxanone (PDS) plate and compared it with closed reduction. Design, Setting, Participants: This study included nineteen consecutive patients with nasoseptal fracture: ten receiving open reduction with a PDS plate (PDS group) and nine undergoing closed reduction (CR group). Open septal reduction was performed after closed reduction for nasal bone fracture. A mucoperichondrial flap was unilaterally elevated, and the deviated septal cartilage was reduced. The PDS plate was inserted horizontally above the vomerine suture. Surgical outcome was analyzed with three-dimensional volumetry and with a quality-of-life scale for nasal obstruction (NOSE scale). Results: Complications included one case of septal perforation in the CR group and one case of PDS exposure and septal hematoma in the PDS group. In the 3D volumetric analysis of the PDS group, the median value of the nasal cavity change significantly differed between 1.14 mL (interquartile range; 0.46 to 2.4) at the preoperative CT scan and 0.33 mL (interquartile range; -0.22 to 1.29) at the postoperative CT scan (**p = 0.0039). The NOSE scale revealed significant improvement in nasal obstruction postsurgically (median value, 42.5 to 7.5; *p = 0.0139) in the PDS group. Conclusion: PDS plates potentially present a new concept of open septal reduction in terms of septal reinforcement compared with the subtractive approach of open septal reduction.

Objective: Novel Coronavirus disease is a new infectious agent of the respiratory tract characterized by a severe acute respiratory syndrome. For this disease, there are limited data with regard to the clinical characteristics of the patients and prognostic factors. Study Design: Retrospective Cohort Setting: Secondary Referral Center Methods: We collected data from 213 patients who were hospitalized into COVID-19 isolation with positive PCR test results. We recorded various patient values, including blood test results. We also noted age, gender, additional diseases, duration of discharge, whether they live or die, whether they smoke, and their radiological staging. Results: In CT imaging with a staging of maximum 4 points and minimum 0 points, the mean value resulted in 1.95. The average radiological stage of the dead patients group was reported as 2.56. There was a correlation between the radiological predictor and the outcome status (p-value: 0.002). The number of smokers was 14 (6.5%). Of the 26 patients who died, 3 were smokers and 23 were non-smokers. Conclusion: 14 of the patients in the study were smokers (6.5%). One in four people in Turkey is a smoker, while in COVID-19 isolation service only a 6.5% rate of smoking was observed. That supports the theory that smoking hasn’t negative impact on COVID-19 development. The average radiological stage was reported as 2.56 in the dead patients’s group. There was a correlation between the radiological predictor and the outcome status (p-value: 0.002). It seems that an elevated radiological stage is a predictor of death. Keywords: Covid-19, SARS-CoV-2, smoking, computed tomography, predictor factors. Key points: to learn relations between smoking and covid-19, effect of Ct stages on the disease severity, effect of blood analysis on Covid-19, the parameters in deaths of Covid-19, ratio of smoking in Covid-19 inpatients

OBJECTIVE. For many years, functional tricuspid regurgitation (FTR) was considered negligible after treatment of left-sided heart valve surgery. The aim of the present network meta-analysis is to summarize the results of four approaches in order to establish the possible gold standard. METHODS A systematic search was performed to identify all publications reporting the outcomes of four approach for FTR, not tricuspid annuloplasty (no TA), suture annuloplasty (SA), flexible (FRA), rigid rings (RRA). All studies reporting at least one the four endpoints (early and late mortality, early and late moderate or more TFR) were included in a Bayesian network meta-analysis. RESULTS There were 31 included studies with 9,663 patients. Aggregate early mortality was 5.3% no TA, 7.2% SA, 6.6% FRA and 6.4% RRA; Early TR moderate-or-more was 9.6%, 4.8%, 4.6% and 3.8%; Late mortality was 22.5%, 18.2%, 11.9% and 11.9%; Late TR moderate-or-more was 27.9%, 18.3%, 14.3% and 6.4%. Rigid or semirigid ring annuloplasty was the most effective approach for decreasing the risk of late moderate or more FTR (–85% vs. no TA; –64% vs. SA; –32% vs. FRA). Concerning late mortality, no significant differences were found among different surgical approaches, however, flexible or rigid rings reduced significantly the risk of late mortality (78% and 47%, respectively) compared with not performing TA mortality. No differences were found for early outcomes. CONCLUSIONS. Ring annuloplasty seems to offer better late outcomes compare to either suture annuloplasty or not performing TA. In particular rigid or semirigid rings provides more stable FTR across time.

Background and aim of the study: Sutureless and rapid-deployment bioprostheses have been introduced as alternative to traditional prosthetic valves to reduce cardiopulmonary and aortic cross-clamp times during aortic valve replacement.These devices have been employed also in extremely demanding surgical settings as underlined in the present review. Methods: A search on PubMed and Medline databases aimed to identify, from the English literature, the reported cases where both sutureless and rapid- deployment prostheses were employed in challenging surgical situations, usually complex reoperations sometimes even performed as a bail out procedures. Results: We have identified 25 patients in whom a sutureless or a rapid-deployment prosthesis were used in complex redo procedures. In 17 patients a failing stentless bioprosthesis was replaced with a sutureless (n=14) or a rapid deployment valve (n=3). Bioprostheses implanted at first operation were mainly Freestyle (n=11) or Prima Plus (n=3) aortic roots, while Perceval (n=13) and Intuity (n=3) were those most frequently employed at reoperation. A failing homograft was replaced in 6 patients using a Perceval (n=5) or an Intuity (n=1) bioprosthesis while a Perceval was used to replace the aortic valve in 2 patients to treat failure of a valve-sparing procedure. All patients survived reoperation and are reported alive 3 months to 4 years postoperatively. Conclusions: Sutureless and rapid-deployment bioprostheses have proved effective in replacing degenerated stentless bioprostheses and homografts in challenging redo procedures. In these setting, they should be considered as a valid alternative not only to traditional prostheses but also in selected cases to transcatheter valve-in-valve solutions.

Coronary artery aneurysm (CAA) has been increasingly reported in recent years. The symptoms are related to myocardial ischemia, such as angina pectoris, myocardial infarction, sudden death and congestive heart failure. This report describes a case of a giant CAA with calcification and stenosis involving two coronary arteries, and the patient underwent a complete arterialized coronary artery bypass graft successfully. In this report, all cases related to CAA with calcification and stenosis are summarized. According to the data, the following conclusions can be drawn: CAA seem to be more common in men; Kawasaki disease is likely to be a causative factor in some patients with asymptomatic CAA involving calcification and stenosis; CABG is a feasible treatment option for CAA with calcification and stenosis.

High alpha-fetoprotein levels after liver transplantation in hepatoblastoma: Does it matter?Hetzer Benjamin, M.D.1, Oberhuber Rupert, M.D.2, Entenmann Andreas, M.D.1, Schneeberger Stefan, M.D.2, Crazzolara Roman, M.D.1,*1Department of Pediatrics I, Medical University of Innsbruck, Innsbruck, Austria2Department of Visceral, Transplant and Thoracic Surgery, Medical University of Innsbruck, Innsbruck, Austria*Correspondence to:Roman Crazzolara, M.D., Department of Pediatrics, Anichstrasse 35, 6020 Innsbruck, Austria; Tel.: 0043-512-504-23600; Fax: 0043-512-504-24934; Email: roman.crazzolara@i-med.ac.at

In this paper, we consider the generalized approximate boundary synchronization for a coupled system of wave equations with Dirichlet boundary controls. We analyse the relationship between the generalized approximate boundary synchronization and the generalized exact boundary synchronization, give a sufficient condition to realize the generalized approximate boundary synchronization and a necessary condition in terms of Kalman's matrix, and show the meaning of the number of total controls. Besides, by the generalized synchronization decomposition, we define the generalized approximately synchronizable state, and obtain its properties and a sufficient condition for it to be independent of applied boundary controls.

Background: Erythrocytes and platelets have been demonstrated to play a critical role in inflammatory processes. However, little is known about the diagnostic value of these indices in RA patients. The aim of this study was to evaluate the clinical significance of blood counts-related parameters such as counts of red blood cells (RBCs) and platelets (PLTs), hemoglobin (Hb), red blood cells-platelet ratio (RPR) and hemoglobin-platelet ratio (HPR) in rheumatoid arthritis (RA) and their association with disease activity. Methods: Clinical and laboratory data from 178 RA patients and 164 healthy controls were collected and analyzed. RA patients were divided into inactive group and active group according to disease activity score in 28 joints based on C-reactive protein (DAS28-CRP). The relationship between blood RBC, Hb, PLT, RPR and HPR and DAS28-CRP was detected by Spearman correlation method. Receiver operating characteristic (ROC) curve was used to assess the diagnostic value of these parameters. The predictive role of these indices for RA disease activity was evaluated by logistical regression analysis. Results: Active RA patients exhibited lower levels of blood RBC counts, Hb, HCT, RPR and HPR but significantly higher level of PLT counts compared with those in inactive groups (P < 0.01). Spearman analysis showed that blood RBC counts, HCT, RPR and HPR were negatively but PLT counts were positively related with DAS28-CRP (P < 0.001) in RA. ROC curve analysis revealed that the AUC of RBC and Hb was higher than that of ESR, RF and CCP for distinguishing active RA from inactive group. Logistical regression analyses showed that PLT is an independent predictor for RA disease activity. Conclusion: Blood RBC counts, Hb, RPR and HPR were negatively but PLT counts were positively related with RA disease activity. Blood PLT may act as a novel inflammatory factor for predicting disease activity in RA.

Organisms have evolved effective and distinct adaptive strategies to survive. Stipa grandis is one of the widespread dominant species on the typical steppe of the Inner Mongolian Plateau, and is regarded as a suitable species for studying the effects of grazing in this region. Although phenotypic (morphological and physiological) variations in S. grandis in response to long-term grazing have been identified, the molecular mechanisms underlying adaptations and plastic responses remain largely unknown. Accordingly, we performed a transcriptomic analysis to investigate changes in gene expression of S. grandis under four different grazing intensities. A total of 2,357 differentially expressed genes (DEGs) were identified among the tested grazing intensities, suggesting long-term grazing resulted in gene expression plasticity that affected diverse biological processes and metabolic pathways in S. grandis. DEGs were identified that indicated modulation of Calvin–Benson cycle and photorespiration metabolic pathways. The key gene´expression profiles encoding various proteins (e.g., Ribulose-1,5-bisphosphate carboxylase/oxygenase, fructose-1,6-bisphosphate aldolase, glycolate oxidase etc.) involved in these pathways suggest that they may synergistically respond to grazing to increase the resilience and stress tolerance of S. grandis. Our findings provide scientific clues for improving grassland use and protection, and identify important questions to address in future transcriptome studies.

In eukaryotes, alternative splicing (AS) is a crucial regulatory mechanism that modulates mRNA diversity and stability. The contribution of AS to stress are known in many species related to stress. But the post-transcriptional mechanism in poplar under cold stress is still unclear. Recent studies have utilized the advantages of Single Molecular Real Time (SMRT) sequencing technology from Pacific Bioscience (PacBio) to identify full-length transcripts. We, therefore, used a combination of single-molecule long-read sequencing and Illumina RNA sequencing (RNA-Seq) for a global analysis of AS in two poplar species (Populus trichocarpa and P. ussuriensis) under cold stress. We further identified 1261 AS events in P. trichocarpa and 2101 in P. ussuriensis, among which intron retention, with a frequency of more than 30%, was the most prominent type under cold stress. RNA-Seq data analysis and annotation revealed the importance of calcium, abscisic acid, and reactive oxygen species signaling in cold stress response. Besides, the low temperature rapidly induced multiple splicing factors, transcription factors, and differentially expressed genes through AS. In P. ussuriensis, there was a rapid occurrence of AS events. This study provides new insight into the complexity and regulation of AS during cold stress response in two poplar species.

Abstract: Bardet–Biedl syndrome is a rare autosomal recessive disorder falls under the spectrum of ciliopathy disorders. Its characterized by rod-cone dystrophy, renal malformations, postaxial polydactyly, learning difficulties, central obesity and hypogonadism. Hyponatremia, hepatic haemangioma, gall bladder stones and subclinical hypothyroidism rarely described in the literature as clinical presentations in BBS.

Cardiac arrythmia is a major complication of COVID-19. This occurs often in patients with severe COVID-19 with pre-existing cardiovascular diseases. We report an unusual case of paroxysmal atrial fibrillation in an adult male with low cardiovascular risk factor who presented with a moderate form of COVID-19.

Pulmonary Tuberculosis (PTB) and Novel Coronavirus disease 2019 (COVID 19) primarily affect the lungs. Both diseases present with fever, cough, and shortness of breath and possess thrombotic potential as well. Therefore in COVID 19 pandemic, PTB must be taken into consideration for suspected cases in order to avoid fatal consequences.

In times of health crisis, including the current COVID-19 pandemic, the potential benefit of botanical drugs and supplements emerges as a focus of attention, although controversial efficacy claims are rightly a concern. Phytotherapy has an established role in everyday selfcare and health care, and since botanical preparations contain many chemical constituents rather than single compounds, challenges arise in demonstrating efficacy and safety. However, there is ample traditional, empirical and clinical evidence that botanicals can offer some protection and alleviation of disease symptoms as well as promoting general well-being. Newly emerging viral infections, specifically COVID-19, represent a unique challenge in their novelty and absence of established antiviral treatment or immunization. We discuss here the roles and limitations of phytotherapy in helping to prevent and address viral infections, and specifically regarding their effects on immune response. Botanicals with a documented immunomodulatory, immunostimulatory, and anti-inflammatory effect include adaptogens, Boswellia spp., Curcuma longa, Echinacea spp., Glycyrrhiza spp., medicinal fungi, Pelargonium sidoides, salicylate-yielding herbs, and Sambucus spp. We further provide a clinical perspective on applications and safety of these herbs in prevention, onset, progression, and convalescence from respiratory viral infections.

Background and objectives: Shared decision making (SDM) prior to non-urgent tracheostomy in a child with chronic respiratory failure (CRF) is recognized as the standard of care, but has proven challenging to implement in practice. We hypothesize that utilization of the microsystem model for analysis of the complex ecosystem in which SDM occurs will yield insights that enable formation of a reproducible, measurable SDM process. Methods: Retrospective chart review of a case series of children with CRF in whom a SDM process was pursued. The process included a palliative care consult, a validated decision aid and 12 key questions designed to elucidate information integral to an informed decision. Investigators reviewed a single hospital admission for each child, focusing on the 3 core elements of a medical microsystem- the patient, the providers, and information. Results: 29 patients who met inclusion criteria ranged in age from 0 to 19 years (median 1.7) and remained in the hospital from 10 to 316 days (median 38). Patients were medically complex with multiple and varied respiratory diagnoses, multiple and varied comorbidities, and varying psychosocial environments. 14/29 children received tracheostomies. Each child encountered a mean of 6.2 medical specialties, 1.9 surgical specialties and 8.5 non-physician led services. Answers to 12 key questions were not documented systematically and often not found. Conclusion: A unique SDM microsystem is formed around each child but not optimally utilized. Explicit recognition of these microsystems would enable team formation and an SDM process comprised of measurable steps and communication patterns.

Mitral commissural prolapse or flail, either isolated or combined with more extensive degenerative valve disease imposes several challenges both on its diagnosis and management whilst being a risk factor for valve reoperation after mitral valve repair. Accurate identification of the prolapsing segment is often not feasible with transthoracic 2D echocardiography, with transesophageal 3D imaging then required for correct diagnosis and surgical planning. Various surgical techniques employed alone or in combination, have yielded good results in the repair of commissural prolapse. Herein, we analyze the specific characteristics of commissural disease focusing our attention on 2D and 3D echocardiographic findings and we briefly comment on techniques employed for surgical correction of the disease.

Objectives: to evaluate the effectiveness of uterine tamponade devices for atonic refractory postpartum haemorrhage (PPH) after vaginal birth, and the effect of including uterine tamponade devices in institutional protocols. Search strategy: databases in PubMed, EMBASE, CINAHL, LILACS and POPLINE. Study selection: randomised and non-randomised comparative studies. Outcomes: composite outcome including surgical interventions (artery ligations, uterine compressive sutures or hysterectomy) or maternal death, and hysterectomy. Results: all four included studies were at high risk of bias. The certainty of evidence rated as very low to low. One randomised study measured the effect of the the condom-catheter balloon compared to standard care and found unclear results for the composite outcome (RR 2.33, 95%CI 0.76-7.14) and hysterectomy (RR 4.14, 95%CI 0.48-35.93). Three comparative studies assessed the effect of including UBTs in institutional protocols. A stepped-wedge study suggested an increase in the composite outcome (RR 4.08, 95%CI 1.07-15.58), and unclear results for hysterectomy (RR 4.38, 95% CI 0.47-41.09) with the use of the condom-catheter or surgical glove balloon. One non-randomised study showed unclear effects on the composite outcome (RR 0.33, 95%CI 0.11-1.03) and hysterectomy (RR 0.49, 95%CI 0.04-5.38) after the inclusion of Bakri balloon. The second non-randomized study found unclear effects on the composite outcome (RR 0.95, 95%CI 0.32-2.81) and hysterectomy (RR 1.84, 95%CI 0.44-7.69) after the inclusion of Ebb or Bakri balloon. Conclusions: the effect of uterine tamponade devices for the management of atonic refractory PPH after vaginal delivery is unclear, as is the role of the type of device and the setting.

A third trimester pregnant woman with critical illness from SARS-CoV2 infection treated with convalescent plasma: a case studyGaspare Cucinella1, Mario Tumminello2, Marianna Maranto3, Donatella Termini2, Silvia Culmone1, Baldassare Renda4, Vincenzo Lo Bue3, Massimo Donzelli4, Ettore Guastella3, Francesco Tarantino41 Department of Obstetrics and Gynecology, Villa Sofia Cervello Hospital, University of Palermo, Palermo, Italy2 Department of Neonatology and Neonatal Intensive Care Unit, Villa Sofia Cervello Hospital, Palermo, Italy3 Department of Obstetrics and Gynecology, Villa Sofia Cervello Hospital, Palermo, Italy4 Department of Anesthesia and Intensive Care II, Villa Sofia Cervello Hospital, Palermo, Italycorresponding authorMarianna Maranto , telephone number +393393549469; email addressmariannamaranto@libero.itmarianna_84@msn.comRunning Head

Objective: Electric toilet seats with water spray (bidets) are gaining in popularity all over the world. However, the extent of reduction in microbial contamination of hands with the use of bidets after defecation is not known. Methods: The microbe contamination of hands with and without the use of bidets after defecation with the participation of 32 nursing students was studied. Double gloves were worn on the dominant hand and four layers of toilet paper were used to wipe the buttocks after defecation and the microbe contamination of the second glove (outer glove) of the double gloves was examined. The volunteers were free to select flow volume, wash time of the bidet and even the type of bidet for use was left up the individual. Results: Without the use of a bidet, the average value ± standard deviation of the number of microbe attached to the gloves was 39,449.3 ± 77,768.3 colony forming units (cfu) / glove; however, it was 4,146.9 ± 11,427.7 cfu / glove when a bidet was used.The number of microbe adhering to gloves was significantly reduced when a bidet was used (p <0.0001, Wilcoxon singed-rank test). Conclusion: It was discovered that reduction of microbe contamination of hands was possible with the use of bidets after defecation.

Objective: To compare some characteristics of two subgroups of tinnitus, noise-induced tinnitus and age-related tinnitus. Design: An online survey from the Iowa Tinnitus Website was reviewed. The participants were divided into two subgroups according to their reported cause of tinnitus—noise or aging. Their answers to the questions about loudness, qualities, worsening and reducing factors of tinnitus were analyzed. Study sample: There were 16 patients of age-related tinnitus and 147 of noise-induced tinnitus. Results: Two groups did not differ significantly in loudness (U = 887.5, p > 0.05), qualities (X2 = 1.164, p > 0.05) or reducing factors (X2 = 1.984, p > 0.05). Ringing/whistling was the most common quality of both age-related (37.5%) and noise-induced tinnitus (51.7%). 42.9% of participants of noise-induced tinnitus and 31.3% of age-related tinnitus felt that nothing made tinnitus better. The main worsening factors for noise-induced tinnitus included being in a noisy place (44.2%) and lack of sleep (42.9%) , which differed from the age-related group (X2 = 6.169, p < 0.05). Conclusions: There was a great deal of overlap between two subgroups, with some differences in worsening factors, including noise environment and lack of sleep. This is an important ‘red flag’ in counseling, and should be considered by doctors when choosing therapy.

Objectives The association between diagonal ear lobe crease (DELC) and cardiovascular disease was first suggested in 1973 although some studies have attributed this to confounding cardiovascular factors. This review looked to see if there is a significant association between DELC and angiography-confirmed coronary artery disease (CAD) independent of other risk factors. Design Systematic review and meta-analysis of selected studies using the PRISMA checklist. Setting 12 different hospitals with angiography in eight countries. Participants 4960 adult patients undergoing coronary angiography. Main Outcome Measures • Presence/absence of diagonal ear lobe crease • Diagnostic Odds Ratio • Sensitivity/Specificity Results 12 studies were included in the meta-analysis. Findings from our study suggest: • Patients with DELC have a 4x increased likelihood of having CAD (OR 4.61 P<0.00001). • The relationship between DELC and CAD was independent of age and all other conventional cardiovascular risk factors. • Bilateral DELC has a stronger association with CAD than unilateral DELC. • Presence of DELC has insufficient sensitivity / specificity to be used as a diagnostic test for cardiovascular disease but instead should be used as a risk marker. Conclusions We found that DELC is associated with CAD independently of other known cardiovascular risk factors including age. Histology studies indicate that atherosclerosis is causing DELC and patients with DELC appear to have an increased risk of CAD. It has insufficient sensitivity or specificity to be used as a diagnostic test but should be used as a valuable risk marker to be aware of whilst examining ears.