Background: The aim of this study was to assess the effect on short-term outcomes and long-term survival in patients following coronary artery bypass grafting in whom second arterial conduit(right internal thoracic artery-RITA or radial artery-RA) or saphenous vein was grafted and between RITA and RA as second best arterial conduit. Methods: Between January-2006 and June-2018, 7857-patients met the inclusion criteria and were divided into two groups: single internal thoracic artery: SITA+Vein group(n=7140) and 2nd-arterial conduit group(n=717), of these 537-patients received RITA and 180-patients received RA. Short‐term outcomes included: 30-day mortality and Major Adverse Cardiac and Cerebral Events(MACCE), reoperation for bleeding and deep sternal wound infection(DSWI). The long‐term outcome was all‐cause mortality. propensity score(PS) matching was used to match patients between the groups. Results: Before as well as after PS-matching, no significant differences were observed between 2nd-arterial conduit vs SITA+Vein groups and between RITA vs RA groups in terms of 30-day mortality, 30-day MACCE, reoperation for bleeding and incidence of DSWI. The use of 2nd-arterial conduit was associated with a significant reduction in long-term mortality before(HR:0.52;95%CI;0.43-0.64;p<0.001) as well as after PS-matching(HR:0.77;95%CI;0.60-0.99;p=0.04). RA and RITA as second arterial conduit had comparable long-term mortality before(HR:1.22;95%CI;0.82-1.82;p=0.3) as well as after PS-matching(HR:0.96;95%CI;0.58-1.58;p=0.87). Conclusions: The use of 2nd-arterial conduit vs vein is associated with improved long-term survival. As for the 2nd-best arterial conduit, RA and RITA had comparable long-term mortality.

Massive parallel sequencing technology has become the predominant technique for genetic diagnostics and research. Many genetic laboratories have wrestled with the challenges of setting up genetic testing workflows based on a completely new technology. The learning curve we went through as a laboratory was accompanied by growing pains while we gained new knowledge and expertise. Here we discuss some important mistakes that have been made in our laboratory through ten years of clinical exome sequencing but that have given us important new insights on how to adapt our working methods. By providing these examples and the lessons that we learned from them, we hope that other laboratories do not need to make the same mistakes.

Crop wild relatives, the closely related species of crops, may harbor potentially important sources of new allelic diversity for (a)biotic tolerance or resistance. However, to date wild diversity is only poorly characterized and evaluated. Banana has a large wild diversity but only a narrow proportion is currently used in breeding programs. The main objective of this work was to evaluate genotype-dependent transpiration responses in relation to the environment. By applying continuous high-throughput phenotyping, we were able to construct genotype-specific transpiration response models in relation to light, VPD and soil water potential. We characterized and evaluated 6 (sub)species and discerned four phenotypic clusters. Significant differences were observed in leaf area, cumulative transpiration and transpiration efficiency. We confirmed a general stomatal-driven ‘isohydric’ drought avoidance behavior, but discovered genotypic differences in the onset and intensity of stomatal closure. We pinpointed crucial genotype specific environmental conditions when drought avoidance mechanisms were initiated and when stress kicked in. Differences between (sub)species were more pronounced under certain environmental conditions, illustrating the need for high-throughput dynamic phenotyping, modelling and validation. We conclude that the banana wild relatives contain useful drought tolerance traits, emphasizing the importance of their conservation and potential for use in breeding programs.

This paper, which drew on quantitative and qualitative data, was mainly aimed at examining the perceptions of higher institution lecturers in Nigeria concerning the effectiveness, facilitators, and inhibitors of CPD activities provided by their higher institutions and/or the Ministry of Education. The researchers employed and adapted the data collection instrument by Sywelem & Witte (2013) designed to collect data on perceptions of teachers regarding professional development opportunities and activities that exist in Saudi schools. The interview questions were designed by the researchers to access lecturers' evaluation of the professional development programs and activities in their institutions. Research survey was sent to lecturers in 3 representative higher institution in Anambra state, 213 survey responses and 15 interviews were received and analyzed. Results showed that the participants did recognize the importance and usefulness of CPD activities and expressed how CPD activities has impacted them as professionals. Lecturers expressed their expectations with regards to program content, time management, financial and moral sponsorship and support, etc. It was recommended that for lecturers to be effective at their jobs in the higher institution system, their professional development and in-service training programs must be given good attention by the management.

A 46-year-old gentleman had a complicated course of COVID-19 pneumonia. Despite the recovery of the respiratory status, he developed corpus callosum hematoma and critical illness neuropathy/myopathy, the clinical situation became more complicated by developing pulmonary embolism that required anticoagulation. Fortunately, the patient made a good recovery.

Background: Cow’s milk allergy(CMA) is the most common allergy in infants that decreases the quality of life of patients and their families. Standard treatment for CMA is the strict avoidance of milk, new treatment strategies such as oral immunotherapy (OIT) have been sought for patients with CMA . We aimed to assess the clinical efficacy and safety of OIT in the treatment of children with IgE-mediated cow’s milk allergy (IMCMA). Methods: We searched all randomized controlled trials (RCTs) in which OIT is used to treat children with IMCMA from 5 international electronic databases. We estimated a pooled relative ratio (RR) for each outcome using a Mantel-Haenzel fixed-effect model if statistical heterogeneity was low. Results: Eleven studies were chosen for meta-analysis, including a total of 469 children (242 OIT, 227 control). 176 patients (72.7%) in the OIT were desensitized compared to 49 patients in the control group (RR 7.35, 95%CI 2.82-19.13, p<0.0001). The desensitization effect of OIT was particularly significant in children over 3 years old (RR 18.05, 95%CI 6.48-50.26, p<0.00001). Although adverse effects were common, they usually involved mild reactions, but epinephrine use was more common in the OIT group (RR 7.69, 95%CI 2.16-27.33, p<0.002). Conclusion: OIT can lead to desensitization in the majority of individuals with IMCMA, especially in patients over 3-years old. A major problem of OIT is the frequency of adverse events, although most are mild. OIT may be an alternative treatment in the future.

Poly(vinyl butyral) is selected as a promising ethanol-permselective membrane based the solubility parameter theory, however it exhibits anomalous water perm-selectivity in practical pervaporation process. Comprehensive analysis based on experimental and theoretical methods were carried out to explore the inherent mechanism of the anomalous performance. Firstly, sum frequency generation vibrational spectra and contact angle were developed to quantify the surface reconstruction of membrane in air and ethanol, which indicated that hydrophilic hydroxyl tended to expose on membrane surface with ethanol thus improved the membrane affinity to water. Meanwhile, swelling behaviors proved more water would accumulate in the ethanol swollen membrane. Furthermore, theoretical analysis in terms of sorption and diffusion process, based on the UNIFAC-FV model and Fujita free volume theory, confirmed the mechanism of anomalous phenomenon of poly(vinyl butyral) membrane. The comprehensive investigation was expected to provide insights into the basic separation mechanism of pervaporation process.

With the catalytic induction of EG, anhydrous DMEA shows CO2 absorption performance via chemical binding and physical storage under normal pressure. Among the absorbents, pure DMEA can hardly absorb CO2 directly but when the zwitterionic alkylcarbonates are formed between CO2 and DMEA-EG which can be characterized by 13C NMR and FTIR, the absorption rate of CO2 will be improved at this time. An increasing the CO2 loading as the mass fraction of EG in DMEA-EG, 90wt.% EG captures up to 0.72 mol/mol. The amount of chemically bound and physically stored is directly dependent on temperature, within the range of 293 to 323K, an absorption-regeneration cycle can be formed in a closed vessel because of the zwitterion DMEA-EG-CO2 is unstable at the higher temperature. In other words, DMEA-EG-CO2 can be easily regenerated upon appropriate depressurization or heating, corresponding thermodynamic calculations prove that the regenerative energy of DMEA-EG-CO2 is 25.49kJ/mol.

Background: Acute type A aortic dissection(ATAAD) is life-threatening and requires immediate surgery. Sudden chest pain may lead to a risk of misdiagnosis as acute coronary syndrome and may lead to subsequent antiplatelet therapy. We used the Chinese Acute Aortic Syndrome Collaboration Database (AAS) to study the effects of antiplatelet therapy (APT) on clinical outcomes. Methods: The AAS database is a retrospective multicentre database where 31 of 3092 had APT with aspirin or clopidogrel or both before surgery. Before and after propensity score matching, the incidence of complications and mortality was compared between APT and non-APT patients by using a logistic regression model. The sample remaining after PSM was 30 in the APT group and 80 in the non-APT group. Results: The sample remaining after matching was 30 in the APT group and 80 in the non-APT group. We found 10 cases with percutaneous coronary intervention in the APT group(33.3%). The APT group received more volume of packed red blood cell (RBC), 8.4±6.05 units; plasma, 401.67±727 ml, and platelet transfusion(14.07±8.92 units). The drainage volume was much more in the APT group( 5009.37±2131.44ml, P=0.004). Mortality was higher in APT group(26% vs 10%, P=0.027). The preoperative APT was independent predictor of mortality(OR 6.808, 95% CI1.554-29.828, P = 0.011). Conclusion: APT prior to ATAAD repair was associated with more transfusions and higher early mortality. The timing of surgery should be carefully considered based on the patient’s status and the surgeon’s experience.

What makes a model organism? Identifying the qualities of a model organism has been given a great deal of attention in the biomolecular sciences, but less so in the fields of evolution, ecology, and behavior (EEB). In EEB, biotic and abiotic variation are features to understand, not bugs to get rid of, and EEB scientists often select organisms to study which best suit the scientific question at hand. Successful EEB model organisms can be studied at multiple biological scales and have a wealth of accumulated knowledge on which current research programs build. A recent call within EEB to invest in the inclusive development of diverse model systems and scientists has led us to evaluate the standing of the widespread, abundant, terrestrial salamander we study, the eastern red-backed salamander (Plethodon cinereus). We first look at salamanders as EEB models more generally, to determine where P. cinereus fits in this broader context. We next present a comprehensive review of the literature on the eastern red-backed salamander (Plethodon cinereus) since the last comprehensive review was completed in 1998. The core of our paper reviews 410 recent studies and highlights inconsistencies, gaps in our knowledge, and future directions in the context of the 1998 review. Finally, we present a collaborative research network, SPARCnet, as a nascent infrastructure for continued research on P. cinereus. Here, we especially discuss how this type of infrastructure can be broadly applied not just to other salamanders, but to other model systems, so that the future of EEB research may benefit from models which accurately represent, in Darwin’s words, “endless forms most beautiful and most wonderful.”

Discrete wavelet transform and discrete periodic wavelet transform have been widely used in image compression and data approximation. Due to discontinuity on the boundary of original data, the decay rate of the obtained wavelet coefficients is slow. In this study, we use the combination of polynomial interpolation and one-dimensional/two-dimensional discrete periodic wavelet transforms to mitigate boundary effects. The decay rate of the obtained wavelet coefficients in our improved algorithm is faster than that of traditional two-dimensional discrete wavelet transform. Moreover, our improved algorithm can be extended naturally to the higher-dimensional case.

Background: This study evaluated the utilization and outcomes of postcardiotomy mechanical circulatory support (MCS). Methods: This was a retrospective, single institution analysis of adult cardiac surgery cases that required de novo MCS following surgery from 2011-2018. Patients that were bridged with MCS to surgery were excluded. The primary outcomes were early operative mortality and longitudinal survival. Secondary outcomes included postoperative complications, and five-year all-cause readmission. Results: 533 patients required de novo postcardiotomy MCS, with the most commonly performed procedure being isolated coronary artery bypass grafting (29.8%). Median cardiopulmonary bypass and cross clamp times were 185 (IQR 123-260) minutes and 122 (IQR 81-179) minutes, respectively. A total of 442 (82.9%) of patients were supported with intra-aortic balloon pump counterpulsation, 23 (4.3%) with an Impella device, and 115 (21.6%) with extracorporeal membrane oxygenation. Three (0.6%) patients had an unplanned ventricular assist device placed. Operative mortality was 29.8%. Longitudinal survival was 56.1% and 43.0% at 1- and 5-years, respectively. Survival was lowest in those supported with ECMO and highest with those supported with an Impella (P<0.001). Freedom from readmission was 61.4% at 5-years. Postoperative ECMO was an independent predictor of mortality (HR 5.1, 95% CI 2.0-12.9, P<0.001), but none of the MCS types predicted long-term hospital readmission after risk adjustment. Conclusions: Postcardiotomy MCS is associated with high operative mortality. Even patients that survive to discharge have compromised longitudinal survival, with nearly only half surviving to 1-year. Close follow-up and early referral to advanced heart failure specialists may be prudent in improving these outcomes.

In this research paper beginning from the fundamental concepts, all the basic approach is introduced for short. Then after obtaining the discrete Lagrange-dissipative model ({L,D}- model for short) of a discrete time observed physical/engineering dynamic system, the model will be used to develope the discrete Hamiltonian together with discrete dissipation energy as discrete Lyapunov function and as such, a systematic method is proposed to obtain discrete Lyapunov function in form of a residual energy function for discrete (time) observed physical systems to analyze the discrete time system related to stability. Stability analysis of a discrete time observed physical dynamic system is performed using discrete Lyapunov function in form of a residual energy function consisting of Hamiltonian together with dissipation energy. Application of the method was shown using two discrete time physical examples, one of which is a coupled one and time dependent. This coupled physical discrete time example is analyzed related to stability using two different formulations, one form of which leads to a result.

Improved treatment adherence and allergic disease control during a COVID-19 pandemic lockdownPauline Poh Lin Chan Ng, MBBS, MRCPCH1,2, Alicia Yi Hui Kang, BSc1, Liang Shen, PhD3, Lydia Su-Yin Wong, MBBS, MRCPCH1,2, Elizabeth Huiwen Tham, MBBS, MCI, MRCPCH*1,2,41Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore (NUS), Singapore2Khoo Teck Puat-National University Children’s Medical Institute, National University Health System (NUHS), Singapore3Biostatistics Unit, Yong Loo Lin School of Medicine, National University of Singapore (NUS), Singapore4Human Potential Translational Research Programme, Yong Loo Lin School of Medicine, National University of Singapore, Singapore

A long-overlooked aspect of fatigue crack growth is the potential contribution to it, of stable crack extension (SCE). Reduction in specimen size and increase in magnitude of cyclic loading will induce increased contribution of SCE. SCE as a load interaction effect is manifest in disproportionately high crack extension due to periodic overloads. SCE can exceed by more than an order of magnitude estimates of crack growth from the da/dN versus DK relationship. Simple equations are proposed to account for SCE in fatigue crack growth. A numerical analysis is performed to characterize the significance of SCE to constant amplitude and variable amplitude fatigue crack growth.

ToC Figure

Title Successful treatment with haploidentical PBSCT with post-transplant cyclophosphamide in a child with relapsed neuroblastoma after autologous PBSCT

We report a case of granulomatosis with polyangiitis (GPA) in a pediatric patient with a history of type 1 diabetes mellitus (T1DM) after a somewhat unusual presentation. Antineutrophil cytoplasmic antibody (ANCA)-associated vasculitides are a relatively rare entity in the general population, and are even less common amongst the pediatric population. Our patient’s chronic history of vague and systemic symptoms paired with social and environmental stressors contributed to her convoluted picture and late diagnosis. In addition, her T1DM adds an interesting element to her case, begging the question of whether her propensity for autoimmune conditions played a role in the development of this disease. With this case, we hope to increase clinician level of suspicion and promote early diagnosis and treatment for future pediatric patients.

Aortic stenosis is one of the most common degenerative valvular diseases in the elderly. Transapical aortic valve implantation (TAVI) is an innovative technique for high-risk patients with severe, symptomatic aortic stenosis and multiple comorbidities. However, potential obstruction to the left ventricular outflow tract, from a left ventricular thrombus, poses significant patient risk and challenge for the anesthetist. An 82-year-old man with these conditions underwent TAVI and intracardiac thrombectomy under general anesthesia, combined with cardiopulmonary bypass. We abandoned traditional surgical aortic valve replacement and thrombectomy; a fast-track cardiac anesthesia strategy was adopted. No complications were observed during recovery. Cardiac function was normal upon follow-up 1 year, post-operatively. Transapical aortic valve replacement aided by cardiopulmonary bypass, implemented under Enhanced Recovery After Surgery (ERAS) strategy, is suitable for high-risk patients under similar conditions. Strategies and equipment should be maximized for analgesia, organ protection, and circulatory homeostasis for perioperative safety and enhanced prognosis.

Expanding the armamentarium for reoperative coronary artery bypass graftingShort title : Expanding the armamentarium for redo CABGMaria Currie, MD PhD11 Department of Cardiothoracic Surgery, Stanford University School of Medicine

In this paper, a complete analytical solution to the integro-differential model describing the nucleation and growth of ellipsoidal crystals in a supersaturated solution is obtained. The asymptotic solution of the model equations is constructed using the saddle-point method to evaluate the Laplace-type integral. Numerical simulations carried out for physical parameters of real solutions show that the first four terms of the asymptotic series give a convergent solution. The developed theory was compared with the experimental data on desupersaturation kinetics in proteins. It is shown that the theory and experiments are in good agreement.

Aortic pseudocoarctation is a rare congenital aortic anomaly that causes elongation, stenosis and kinking of the aorta at the isthmus level. Although aortic coarctation and pseudocoarctation share a similar clinical spectrum, pseudocoarctation rarely results in a significant gradient in descending aorta and haemodynamic consequence. Therefore, it's critical to differentiate in coarctation. All imaging modalities but especially cardiac CT angiography and catheterization are very important in the differential diagnosis. Our case highlighted to differences between aortic pseudocoarctation and coarctation, with other cardiac anomalies accompanying pseudocoarctation. And also the importance of cardiac imaging in the differential diagnosis of pseudocoarctation was emphasized.

Ricinodendron heudelotii, Vitex doniana and Cleome gynandra are three indigenous species whose seeds contain oil that can provide interesting alternatives to conventional seed oil species. This review focused on the physicochemical characteristics of their seeds and the nutritional properties of the extracted oils. Scientific articles and reports were collected and needed information was extracted and synthesized. Ricinodendron seed oil is higher (51.83 mg/100 g) than that of Vitex (28.55 mg/100 g) and Cleome (27.35 mg/100 g). The three seed oils are polyunsaturated oils. Ricinodendron seed oil is composed mainly of linoleic acid (28.3-51.1%). Cleome seeds oil is mainly composed of linoleic acid (56.3% -61.1%) and oleic acid (19.6-23.9%). Ricinodendron seed oil can be used for the preparation of fast drying binder and resins. Vitex seed oil can be used for the production of resin, paint and skin cream production. No application of Cleome seed oil has been stated.

We are reporting a COVID-19 positive patient who developed diplopia and was found to have an isolated abducens palsy. We reviewed the available English literature of cranial mononeuropathy as a possible manifestation of COVID-19 infection.It is a rare presentation of COVID-19.