The analysis of the dynamics of interaction networks (i.e. trophic webs) better capture the state of ecosystem facing a perturbation than individual species dynamics could. We propose a framework that examines network robustness to a given perturbation at the local (species), mesoscale (species directly linked together) and global (network) level, based on traits and the topology of the network. Using the Celtic Sea as an example, we showed that the network was the least robust to the simulated loss of forage taxa and the most exposed taxa to fishing pressure, indicating conservation priority could be focused on these taxa. However estimating the sensitivity to fishing at the taxa ‘level was insufficient to predict the robustness of the network. The network appeared relatively robust to the simulated loss of the most central taxa, suggesting that mesoscale metrics such as centrality, although widely used, are not always adapted to prioritize species conservation.

We describe a patient in whom this anomaly was diagnosed during cardiac catheterization for evaluation of progressive shortness of breath and mild to moderate mitral regurgitation founded on a transthoracic echocardiogram.A 58-year-old hypertensive female was evaluated for progressive shortness of breath. Her physical examination showed a regular heart rate and rhythm, with normal heart sounds with a holosystolic systolic murmur on the 4th intercostal midclavicular line on auscultation. Electrocardiography showed normal sinus rhythm and criteria and possible left ventricular hypertrophy. Stress Echocardiogram showed with no evidence of ischemia preserved left ventricular function with an ejection fraction of 55-60%, with mild to moderate mitral regurgitation. Patient underwent a coronary catheterization for persistent shortness of breath which indicated no evidence of obstructive coronary disease, normal left ventricular function with mild to moderate mitral insufficiency. Angiography of the right coronary artery showed a very large and tortuous artery that collateralizes into the left main system and supplies the entire left coronary artery system. The left main coronary origin was from the pulmonary artery. CTA confirmed the same findings. The recommendations between cardiology and cardiothoracic surgery were to maximize medical therapy and follow up due to lack of myocardial ischemia or severe valvular disease. Currently there are no guidelines or gold standard management for patients with adult form of ALCAPA that present without ischemic burden or for patients with the disease that present asymptomatic with significant coronary collateralization.

Males have the ability to compete for fertilizations through both pre-copulatory and post-copulatory intrasexual competition. Pre-copulatory competition has selected for large weapons and other adaptations to maximize access to females and mating opportunities while post-copulatory competition has resulted in ejaculate adaptations to maximize fertilization success. Negative associations between these strategies support the hypothesis that there is a trade-off between success at pre- and post-copulatory mating success. Recently, this trade-off has been demonstrated with experimental manipulation. Male leaf-footed cactus bugs, Narnia femorata, that lose a weapon by autotomy during development invest instead in large testes. While evolutionary outcomes of the trade-offs between pre- and post-copulatory strategies have been identified, less work has been done to identify proximate mechanisms by which the trade-off might occur, perhaps because the systems in which the trade-offs have been investigated are not ones that have the molecular tools required for exploring mechanism. Here we applied knowledge from a related model species for which we have developmental knowledge and molecular tools, the milkweed bug Oncopeltus fasciatus, to investigate the proximate mechanism by which autotomized N. femorata males developed larger testes. Autotomized males had evidence of a higher rate of transit amplification divisions in the spermatogonia, which would result in greater sperm numbers. Identification of mechanisms underlying a trade-off can help our understanding of the direction and constraints on evolutionary trajectories and thus the evolutionary potential under multiple forms of selection.

Arthritis is a common clinical feature of systemic lupus erythematosus (SLE) and is usually non-erosive as opposed to rheumatoid arthritis (RA). While RA synovial pathology has been extensively studied, little is known about the pathophysiology of lupus arthritis. Here, we aimed to explore the cytokine and cellular compartments in synovial fluids of SLE patients with arthritic manifestations. Acellular synovial fluid and paired serum samples from SLE patients (n=17) were analyzed with cytokine bead array for T helper associated cytokines. From two SLE patients, synovial fluid mononuclear cells (SFMC) were analyzed by multiparameter flow cytometry to dissect T cell, B cell, monocyte and dendritic cell phenotypes. SLE-derived SFMC were further stimulated in vitro to measure their capacity for producing IFN and IL-17A. All patients fulfilled the ACR 1982 classification criteria for SLE. Clinical records were reviewed to exclude the presence of comorbidities such as osteoarthritis or overlap with RA. IL-17A and IL-6 levels were high in SLE synovial fluid. A clear subset of the synovial CD4+ T cells expressed CCR6+, a marker associated with Th17 cells. IL-17-production was validated amongst CD4+CCR6+ T cells following in vitro stimulation. Furthermore, a strong IFN production was observed in both CD4+ and CD8+ cells. Our study shows high IL-17A and IL-6 levels in synovial fluids of patients with lupus arthritis. The Th17 pathway have been implicated in several aspects of SLE disease pathogenesis and our data points to Th17 involvement also for lupus arthritis.

Background: To describe how parents and families of children with cancer evaluate the benefits and risks of using social media (SM) and how they navigate disagreements between oncologists’ advice and information found on SM. Procedure: Parents of children who had been previously diagnosed with cancer, and who had used SM for a purpose related to that child’s health were recruited through SM sites and nonprofit organizations across the U.S. and were invited to complete questionnaires about their experiences using SM; a subset of participants also completed a follow-up in-depth interview. Open-ended responses and interviews were analyzed using thematic analysis. Results: 90 parents completed written questionnaires; 21 completed follow-up interviews. 70% described experiencing a situation in which information shared on SM conflicted with information provided by their child’s oncologist. Although 86% discussed it with the oncologist and 70% described the response as positive, 78% retained negative feelings about the experience. Openness to discussing SM, honesty, transparency and humility regarding the limits of medicine, and shared decision-making regarding information found on SM were connected with reported trust in the oncologist. Conclusions: Parents offered valuable insights regarding their experiences navigating SM, including 8 recommendations for how pediatricians might approach discussing parental SM use. Future studies will evaluate the utility of these recommendations for pediatric clinicians.

Introduction: Despite eradication and control measures applied across Europe, bovine tuberculosis (bTB) remains a constant threat. In Belgium, after several years of bTB disease freedom status, routine movement testing, as currently practiced, revealed itself inadequate to detect some sporadic breakdown herds. The aim of this study was to strike the balance between cost and effectiveness of different surveillance system components to identify sustainable alternatives for early detection and substantiation of freedom of bTB while maintaining acceptance of these amongst the different animal health stakeholders. Methods: Stochastic iteration model was built to simulate, first, the expected current surveillance system performance in terms of sensitivity and specificity of detection. These results were then descriptively compared to observed field results. Secondly, the cost and effectiveness of simulated alternative surveillance components were quantified. To measure impact of key assumptions (i.e. regarding diagnostic tests and true prevalence), sensitivity analysis was performed. Results: Discrepancies between the predicted and observed performance of bTB surveillance in Belgium were observed. Secondly, simulated alternatives revealed that targeted IFN-γ as well serological testing with Antibody ELISA towards risk herds would enable increasing the overall cost and effectiveness of the Belgian bTB surveillance system. Sensitivity analysis showed that results remained constant despite modification of some key assumptions. Discussion: Performance of current bTB surveillance system performance in Belgium was questionable. This exercise highlighted that not only sensitivity, but specificity is a key driver for surveillance performance. The quantitative and participative conceptual framework revealed itself a useful tool to allow evidence-based decision making regarding future tuberculosis surveillance in Belgium, as required by the international standards.

The stability of plant biomass production in the face of environmental change is fundamental for maintaining terrestrial ecosystem functioning, as plant biomass is the ultimate source of energy for nearly all life forms. However, most studies have focused on the stabilizing effect of plant diversity, neglecting the effect of soil biodiversity, the largest reservoirs of biodiversity on Earth. Here we investigated the effects of plant and soil biodiversity on the temporal stability of biomass production under varying simulated precipitation in grassland microcosms. Soil biodiversity loss reduced temporal stability by suppressing asynchronous responses of plant functional groups. Greater plant diversity, especially in terms of functional diversity, promoted temporal stability, but this effect was independent of soil biodiversity loss. Moreover, multitrophic biodiversity, plant and soil biodiversity combined, was positively associated with temporal stability. Our study highlights the importance of maintaining the biodiversity of multiple trophic levels for sustainable biomass production.

The Vero cell line is the most used continuous cell line in viral vaccine manufacturing. This adherent cell culture platform requires the use of surfaces to support cell growth, typically roller bottles or microcarriers. We have recently compared the production of rVSV-ZEBOV on Vero cells between microcarrier and fixed-bed bioreactors. However, suspension cultures are considered superior with regards to process scalability. Therefore, we further explore the Vero suspension system for rVSV-vectored vaccine production. Previously, this suspension cell line was only able to be cultivated in a proprietary medium. Here, we expand the adaptation and bioreactor cultivation to a serum-free commercial medium. Following small scale optimization and screening studies, we demonstrate bioreactor productions of highly relevant vaccines and vaccine candidates against Ebola virus disease, HIV and COVID-19 in the Vero suspension system. rVSV-ZEBOV, rVSV-HIV and rVSVInd-msp-SF-Gtc can replicate to high titers in the bioreactor, reaching 3.87 × 107 TCID50/mL, 2.12 × 107 TCID50/mL and 3.59 × 109 TCID50/mL, respectively. Further, we compare cell specific productivities, and the quality of the produced viruses by determining the ratio of total viral particles to infectious viral particles

Letter to EditorTo the EditorEgg-allergic children have higher ovomucoid (OVM)-specific IgD (sIgD) levels compared to the atopic controls.1 Within the egg-allergic group, children with higher levels of OVM-sIgD have a decreased risk of anaphylactic reactions. Ovalbumin (OVA)-sIgD increases in egg-allergic children desensitized by oral immunotherapy (OIT) but not in children unresponsive to OIT or with sustained unresponsiveness to OVA challenge.2 The natural development of tolerance and the acquisition of sustained unresponsiveness by OIT in egg-allergic children are associated with an increase in OVM-specific IgG4 (sIgG4) levels and a decrease in OVM-specific IgE (sIgE) levels.3 To elucidate the potential role of IgD in the outgrowing of egg allergy, we analyzed levels of egg white (EW)-, OVM-, and OVA-sIgD and sIgG4 in sera from 57 egg-allergic children (28 avoided all forms of egg in the diet (complete avoidance of egg: CAE), 18 were able to ingest at least 1/32 cooked whole egg but not one cooked whole egg (partial avoidance of egg: PAE), and 11 outgrew egg allergy (OGE)) and 23 healthy non-egg allergic children (non-egg allergy: NEA) (Table S1). The study was approved by The Research Ethics Committee of University of Fukui (#20110052), and written informed consent was obtained from the parent or guardians.EW-, and OVM-sIgE levels measured using ImmunoCAP (Thermo-Fisher Inc., MA) were higher in the CAE group, followed by the PAE, OGE, and NEA groups (Fig 1, Fig S1). The CAE group exhibited lower serum levels of EW- and OVA-sIgD compared to the NEA group and the PAE group, respectively, and had the lowest OVM-sIgD serum levels among all groups, suggesting that OVM-sIgD levels are associated with outgrowing egg allergy. We observed the lowest serum levels of EW-, OVA-, and OVM-sIgG4 in the CAE group, followed by the PAE and OGE groups. The ratio of OVM-sIgD to OVA-sIgD increased as children outgrew egg allergy, whereas the ratio of OVM-sIgG4 to OVA-sIgG4 did not change. Thus, the production of OVM-sIgD differs from OVM-sIgG4 as children naturally outgrow egg allergy.High-affinity, but not low-affinity, IgE is known to cause anaphylaxis.4 High-affinity IgE is derived from memory IgG1+ B cells, whereas low-affinity IgE is derived from naïve IgM+IgD+ B cells. Considering class switching pathways, switching direction from IgM to IgD, and from IgG1 to IgE or IgG4, elevated OVM-sIgD levels might be associated with low-affinity OVM-sIgE levels as children outgrow egg allergy, resulting in hypo-responsiveness to OVM.A recent study found that OVM-sIgE avidity was more effective at differentiating clinically reactive egg-allergic patients from those tolerant of heated egg compared to EW-sIgE.5 The ratio of OVM-sIgE to OVM-sIgD or sIgG4 in the CAE group was significantly higher compared to the PAE, OGE, and NEA groups (Fig 2). Receiver operating analysis revealed that the ratio of OVM-sIgE to OVM-sIgD discriminated non-tolerant from partially-tolerant egg-allergic patients with the largest area under the curve (AUC = 0.965) compared with levels of OVM-sIgE or the ratio of OVM-sIgE to OVM-sIgG4. The optimal cutoff for the ratio of OVM-sIgE to OVM-sIgD had 86.5% sensitivity and 96.4% specificity to identify high-risk subjects (Table S2).There are several limitations to this study. First, there was a small number of patients. Second, all children were only challenged with heated egg and were instructed to avoid egg of any form if they tested positive with less than 1/32 cooked whole egg. Finally, there was a lack of trajectory of sIgD levels during natural tolerance development.In conclusion, the ratio of OVM-sIgE to OVM-sIgD is a useful marker to identify high-risk egg-allergic patients capable of ingesting a low-dose of cooked whole egg who might be a good candidate for low-dose OIT.

In this study, the impact of integrating four different sea surface temperatures (SST) datasets on the accuracy of the Weather Research and Forecasting (WRF)-Hydro system to simulate hydrological response during two catastrophic flood events triggered by the changes in SST is investigated. The selected events occurred over Eastern Black Sea (EBS) and Mediterranean (MED) regions of Turkey, where complex geographical characteristics exist and flash flood occurrences are associated with climatic conditions. Three time-varying and high-resolution external SST products (GHRSST, Medspiration, and NCEP-SST) and one coarse-resolution SST product (ECMWF-SST and GFS-SST for EBS and MED regions, respectively) already embedded in the initial and boundary condition dataset of WRF model are used in deriving near-surface weather variables through WRF. Using these meteorological inputs, the flood hydrographs of topographically complex small catchments located over EBS and MED regions are derived by a calibrated WRF-Hydro model coupled one way with WRF 3-km nest domain. After the proper event-based calibration performed to the WRF-Hydro using hourly and daily streamflow data of small catchments in both regions, model simulations for independent SST events are conducted to assess the impact of SST-triggered precipitation on simulated extreme runoff. The calibrated model over both regions revealed significant improvement in flood hydrographs. Some localized and temporal differences in the occurrence of the flood events with respect to observations depending on the SST representation are noticeable. The high-resolution SST dataset cases (Medspiration and GHRSST) show error reduction up to 20% and increase in correlation from 0.3 to 0.8 with respect to the coarse SST in simulated runoffs of the EBS region. The error reduction reached 35% after the calibration. The same high-resolution SST data revealed the exact match with the observed runoff peak after 100 m3/s reductions obtained with calibration in the MED region.

Abstract: Backgraound: Transcatheter aortic valve implantation (TAVI), with its improved valve technologies will also be an option for patients in the near future and improved operator experience. Cerebrovascular events are among the most feared complications of TAVI, since they cause high morbidity and mortality. Case: After the patient with EuroSCORE II = 8.6% was considered to be at high risk in terms of surgery, the decision to perform TAVI was taken. The valve (Medtronic 26 mm) was successfully placed during the 110 min procedure. Blood loss was 140 mL, no red blood cell (RBC) transfusion and catecholamines requirements were present, no VF (ventricular fibrillation) and cardiac tamponade were observed and post procedure left ventricular ejection fraction (LVEF) was 60%. At the end of the procedure, the BIS value of the patient was 70, regression in the Glasgow Coma Score (GCS = 12), anisocoria in the pupils (R = 2 mm < L = 4 mm) and motor loss in the right arm (3/5) and right leg (3/5) were detected. Modified Rankin scale (mRS) was evaluated as 4. Conclusions: The neurological complication rate of up to 80% during and in the days following the procedure, the long recovery period after embolism, the possibility of being a nursing patient and even the risk of death, remind us that the TAVI procedure and the sedation given during the procedure should never be underestimated. Keywords: Transcatheter aortic valve implantation, cerebral embolism, complications, neuroradiology, monitorized anaesthesia care, aort stenosis.

Ischemia-mediated ventricular rupture is a rarely encountered process in the era of early percutaneous revascularization. Contained rupture, or pseudoaneurysm often occurs as a result of pericardial adhesions. Even more uncommon is the presence of associated infection involving the rupture. We present the case of a patient with an infected intrapericardial thrombus in the setting of a left ventricular free wall rupture who underwent successful repair.

The mirid bugs Stenotus rubrovittatus and Trigonotylus caelestialium, which cause pecky rice, have become a threat to rice cultivation in Asia. Damage caused by these pests has rapidly become frequent since around 2000 in Japan. Their expansion pattern is not simple, making it difficult to manage them by prediction. Some insects with wide distributions have locally adapted variations in life-history traits. We performed laboratory rearing experiments to assess the geographical scale of intraspecific variations in life-history traits of S. rubrovittatus and T. caelestialium. These were aimed at increasing the accuracy of occurrence estimates and the number of generations per year. These results were compared with previous research, and differences in development rates were observed between populations of different latitudes, but not of the same latitude. Finally, plotting the timing of adult emergence and the potential number of generations per year on maps with a 5-km grid revealed that they differed greatly locally at the same latitude. These maps can be used for developing more efficient methods of managing mirid bugs in integrated pest management.

An adult male with alcoholic cirrhosis presented with acute blood loss anemia, hypotension and a painful bruise over his body's left side. He denied any trauma or falls. Computed tomography of the chest showed left chest wall hematoma. Emergent angiography with successful embolization of the left intercostal artery was performed.

The molecular basis of phenotypic convergence, a key topic in evolutionary biology and ecology, has been investigated especially between species. However, it remains unclear whether mutations in the same or different positions of the same gene, or in different genes underlie phenotypic convergence within species. A classic example of convergence is the transition from outcrossing to selfing in plants, illustrated by the repeated shift from heterostyly to homostyly. Heterostyly is characterized by the reciprocal position of male and female sexual organs in two (or three) distinct, incompatible floral morphs, while homostyly is characterized by a single, self-compatible floral morph. Primula has long served as the prime model for studies of heterostyly and homostyly. Here, we elucidate the phenotypic and molecular origins of homostyly in P. vulgaris and its microevolutionary consequences by integrating microsatellite analyses of both progeny arrays and natural populations characterized by varying frequencies of homostyles with DNA sequence analyses of the gene controlling the position of female sexual organs (CYPᵀ). We found that: homostyles evolved repeatedly from short-styled individuals in association with different types of loss-of-function mutations in CYPᵀ and, consequently, short-styled individuals occur at lower frequencies than long-styled individuals across populations with all three morphs; the shift to homostyly promotes a shift to selfing; and intra-population frequency of homostyles is positively correlated with selfing rate and inbreeding level, increasing genetic differentiation among populations. These results elucidate the connections between the genotypic and phenotypic levels of convergence and the effects of contrasting floral morphologies on reproductive strategies.

First described in 1965 by Johnson and Wilcox, partial absence of the tricuspid valve (TV) associated with a ventricular septal defect(VSD) is a very rare malformation.(1) Heart failure secondary to severe TV regurgitation results in-utero fetal compromise. (2) We present here a fetus with partial absence of the tricuspid valve with conoventricular septal defect.

Congenital aneurysm of the ductus arteriosus is reported in 0.8% in neonatal autopsies, however true incidence is unknown because of high rate of asymptomatic cases and spontaneous regression. Possible complications in symptomatic cases are; thromboembolism, spontaneous rupture, erosion, infection, compression of airways and death. In this report we present a newborn with giant DAA diagnosed in first day of life, surgically treated after thrombosis of aneurysm.

Theory suggests that genetic diversity may influence species coexistence and that species diversity may influence genotype coexistence by altering competitive outcomes among species and genotypes, respectively. However, other coexistence mechanisms such as microbe-mediated plant-soil feedbacks (PSF), may also contribute. Interspecific PSF promotes species coexistence when plants grow better with heterospecific soil microbes than with conspecific microbes, and similarly, intraspecific PSF promotes genotype coexistence when plants grow better with heterogenotypic than with congenotypic microbes. Here, we tested whether genetic diversity influences the strength or direction of interspecific PSF and whether species diversity influences the strength or direction of intraspecific PSF. We found that genetic diversity reduced the capacity for interspecific PSF to promote species coexistence, and, for one study species, species diversity reduced the capacity for intraspecific PSF to promote genotype coexistence. These results suggest that genetic diversity and species diversity may weaken the ability of PSF to promote coexistence.

Species delimitation is a difficult task in traditional morphology-based taxonomy. The ultra-barcoding approach, which uses whole plastid genomes (plastomes) and nuclear ribosomal DNA (nrDNA) regions as extended DNA barcodes for species identification and delimitation, has been recommended as one of the candidate techniques for plant barcoding 2.0. Yet, the efficacy of this approach in delineating species boundaries remains poorly understood. Here, we attempt to decipher species delimitation in the taxonomically challenging clade, Paris L. section Axiparis H. Li, using phylogenetic inference and multiple sequence-based species delimitation methods (ABGD, SDP, and mPTP) utilizing complete plastomes and nrDNA clusters from multiple accessions per described species. The results suggest that only two species-level taxonomic units that possess not only morphological uniqueness but also genetic distinctiveness and evolutionary independence can be recognized in P. sect. Axiparis. Therefore, previous taxonomic work overemphasized minor intraspecific morphological differences to establish species, and thus resulted in proliferation of as many as seven synonyms in this clade. Inferred from ultra-barcoding analyses, we propose a taxonomic revision of P. sect. Axiparis which will help inform future decisions regarding species conservation in the commercially valuable and severely threatened genus Paris. This case study indicates that the ultra-barcoding approach has great promise for developing a rigorous species delimitation framework that will facilitate credible taxonomic revision especially in taxonomically difficult plant taxa.

Background: Anomalous origin of pulmonary artery branch from ascending aorta(AOPA) in the presence of two separate semilunar valves is a rare but important entity necessitating early diagnosis and surgery to prevent development of irreversible pulmonary vascular disease. We evaluated our experience with the technique and outcome of eleven patients with this condition. Methods: Between January 2000 and December 2018, eleven patients were diagnosed with AOPA. Echocardiographic data were collected from the records, regarding the site of origin of the anomalous pulmonary artery, additional defects, biventricular function and pulmonary artery pressures. Intraoperative charts were reviewed for the details of the surgical procedure and cardiopulmonary bypass. Postoperative data included survival, ventilatory support and duration of hospital stay. After discharge, children were reviewed at 1 month, 3 months, 6 months and then at yearly intervals. Results: Of the eleven patients, male to female ratio was 4:7 with a median age of six months(15 days - 28 years) and median weight of 5.7 kg(1.8 kg - 40 kg). Nine patients underwent direct re-implantation of anomalous pulmonary artery branch to main pulmonary artery. The survival rate was 91% in our series. On follow-up, no re-operations or re-interventions were required and all patients who underwent surgical correction were in stable clinical condition. Conclusion: Early and midterm outcomes of children who underwent surgery for AOPA is good. Early direct re-implantation of the anomalous branch PA to main pulmonary artery is the optimal surgical strategy for these patients

Background and aim of the study: We report our one-year single-center experience of a new technique of aortic valve replacement using a rapid-deployment valve (RD-AVR) to avoid postoperative complications. We also report the unexpected pitfalls and handling techniques that we have seen in past cases. Methods: We performed aortic valve replacement on 38 patients between May 2019 and April 2020. Their mean age was 74 years. The primary outcomes were in-hospital mortality and short-term results during a one-year follow-up period, while the secondary outcomes were related to prosthetic valve function, especially paravalvular leakage (PVL). We further analyzed the relationship between the new technique and its outcomes. Results: The mean operative time was 196 min. There were no in-hospital deaths, and the mean duration of postoperative hospital stay was 11.8 days. Valvular measurements using 3-dimensional computed tomography (3D-CT) were larger and more accurate than those measured using ultrasonic echocardiography Postoperative RD-AVR prosthetic valve function was excellent. However, PVL occurred in 4 cases one week and one year postoperatively and regurgitation did not improve. A gap associated with PVL was identified below the right-noncoronary commissure. To prevent PVL, we additionally stitched this gap in the later 18 cases; there was no case of PVL and no new pacemaker implantation in these cases. Conclusions: PVL is more likely to occur if there is a gap below the R-N commissure, especially in cases with a large annulus; therefore, applying an additional stitch to the R-N commissure is extremely useful.

Purpose: The FDA-issued PLATO trial dataset revealed that some primary deaths causes (PDC) were inaccurately reported favoring ticagrelor. However, the PLATO Investigators operated the shorter death list of uncertain quality. We compared if PDC match when trial fatalities were reported to the FDA and by the PLATO investigators. Method: The FDA list contains precisely detailed 938 PLATO deaths, while shorter investigators dataset consists of 905 deaths. We matched 4 vascular (sudden, post-MI, heart failure and stroke), and 3 non-vascular (cancer, sepsis and suicide) PDC between death lists. Results: There were more sudden deaths in the shorter list than in the FDA dataset (161 vs.138; p<0.03), post-AMI (373 vs.178; p<0.001) but fewer heart failure deaths (73 vs.109; p=0.02). Stroke numbers match well (39 vs. 37; p=NS) with only 2 ticagrelor cases removed. Cancer matched well (32 vs.31; p=NS), and sepsis cases were identical (30 vs. 30; P=NS). However, 2 extra clopidogrel suicides in the shorter list are impossible to comprehend. Conclusions: The PLATO trial PDC were mismatched between FDA and Investigators sets. We are kindly asking the ticagrelor sponsor or/and concerned PLATO Investigators to clarify the PDC dataset match.

Atrial septal device embolization within transcather structural heart disease although rare is life threatening. We present a case of a 15-year-old female who presented with a large 17mm septum secundum atrial septal defect associated with a left to right shunt and right heart dilation. The closure with atrial septal occluder (ASO) embolised into the left ventricle and couldn’t be retrieved by percutaneous methods. This otherwise healthy young female underwent emergency retrieval of the ASO via minimal access surgery with a right anterolateral mini thoracotomy. It’s important to highlight the role of minimal access surgery for retrieval of embolised percutaneous devices.

Objectives: To evaluate the efficacy of the combination of platelet-rich fibrin (PRF) and mineralized bone allograft on the volume of the new bone formation in the sinus floor augmentation of the severely atrophic residual alveolar crest with simultaneous dental implant placement. Materials and Methods: All clinical and radiological data of patients treated with sinus floor augmentation using the combination of PRF and demineralized bone allograft with simultaneous dental implant placement between 01/04/2013 and 01/03/2020 were retrieved from the archives. The main inclusion criterion for the study was a residual ridge height less than 2 mm. The volume of the maxillary sinus cavity was measured by a software program on pre-operative and post-operative cone beam computerized tomography (CBCT) sections. The graft volume was calculated by subtracting pre-operative and post-operative total sinus volume. Residual and post-operative ridge heights were measured by the software program on the mid-coronal and mid-sagittal sections of pre-operative and post-operative CBCT images. Results: Eighteen patients with 26 sinus augmentations were included in the study. Forty-six dental implants were placed simultaneously with sinus floor augmentation. The follow-up periods of cases varied between 19 and 29 months. All cases showed new bone regeneration on axial, coronal and sagittal sections of post-operative CBCT data. The mean volume of newly regenerated bone was calculated as 2.1(±0.9) ml. Post-operative ridge heights was significantly increased compared to pre-operative residual ridge heights (p<0.05). There was no sign of a relationship between residual and post-operative ridge heights (p>0.05). Conclusion: The PRF and demineralized bone allograft combination used in sinus floor augmentation may provide healthy new bone that supports simultaneously placed dental implants in function in the severely atrophic alveolar crests with a residual ridge height less than 2 mm. Keywords: Sinüs floor augmentation ; allograft ; cone-beam computed tomography ; dental implant