Background: Elephant trunk repair of the aortic arch cannot be performed with a branched prosthesis. We conceived two different modifications of the original technique to perform an arch replacement with a branched graft, while arranging an adequate landing zone for a subsequent TEVAR, without the need of dedicated material. Methods: Eight consecutive patients underwent arch replacement with one of our techniques. Five were emergency patients with acute aortic dissection, and 3 suffered chronic expansive disease. The “modified elephant trunk” includes a separate anastomosis of an endo-luminal prosthetic segment in the descending aorta. Subsequently, the branched arch prosthesis is anastomosed to the distal aortic stump with the attached trunk. In the “prophylactic debranching”, a tail is left on the distal end of the arch prosthesis, so that the branches for the supra-aortic vessels will remain displaced proximally, allowing a “zone 1” available for landing. Results: Three patients experienced transient cerebral deficits (1 TIA and post-operative delirium in 2 cases), 1 required re-operation for bleeding and 2 needed prolonged intubation. One died for multi-organ failure. Conclusion: Both techniques proved to be easily reproducible, and allow an adequate landing zone for a subsequent endovascular procedure, while keeping the advantages of using a tetra-furcated prosthesis. They are a viable alternative in case a hybrid prosthesis cannot be implanted.

Theoretical and empirical studies have shown that species radiations are facilitated when a trait under divergent natural selection is also involved in sexual selection. It is yet unclear how quick and effective radiations are where sexual selection is unrelated to the ecological environment. We address this question using grasshopper species of the genus Chorthippus, which have evolved strong assortative mating while lacking noticeable eco-morphological divergence. Mitochondrial genomes suggest that the radiation is relatively recent, dating to the mid-Pleistocene, which leads to extensive incomplete lineage sorting throughout the mitochondrial and the nuclear genomes. Nuclear data show extremely low genomic differentiation among species, yet hybrids are absent in sympatric localities. Demographic analyses shed some light into these seemingly contradictory patterns. The estimated demographic model shows a long period of geographic isolation, followed by secondary contact and extensive introgression. This suggests that an initial period of geographic isolation might favor the coupling of male signaling and female preference, which currently maintains species boundaries in the face of long-term gene flow. More generally, these results suggest that sexual selection can lead to radiations without a primary role of divergent natural selection, resulting in cryptic species that are genetically, morphologically and ecologically similar, but otherwise behave mostly as good biological species.

The microstructure and precipitate characterizes in the API X90 hot bend related to mechanical properties was investigated by OM, TEM, EBSD and mechanical tests. X90 pipeline steel is consist of quasi-polygonal ferrite (QPF), acicular ferrite (AF), lath bainite (LB) and a small amount of M/A constituents. The width of bainite lath is about 0.2 ~ 0.3 μm. After hot induction bending, hardly observe AF in the bend zone. In the outer arc side, the width of LB was coarsened to 0.53 ~ 1.34 μm, and sharp M/A constituents formed along the prior austenite grain boundaries. Compared to the parent pipe, the strength of X90 bend decreased 30 ~ 80 MPa, and the Charpy impact energy increased 20 J. The outer arc side with the weakest low temperature impact toughness, is 153 J. The main component of the precipitate is NbC with a small amount of TiC, possibly (Ti, Nb) C, and the size is about 15nm. The fraction of the high angle grain boundaries (HAGBs) and the kernel average misorientation (KAM) value of the outer arc side is 21% and 0.62 ° respectively, which is the higher than the other positions.

The performance of a series of density functionals has been tested for the insertions of ethylene, methyl acrylate (MA), and vinyl bromide (VB) catalyzed by α-diimine palladium complexes. Sixty-seven density functionals are screened, and the results are compared with available experimental data. Eleven hybrid functionals (M06, BHandH, mPW1PW91, HSEh1PBE, mPW3PBE, LC-ωPBE, mPW1PBE, PBE0, M06-HF, M06-2X, M05-2X) showed better performance in the insertions of both ethylene and MA, and could be therefore suitable for ethylene-MA copolymerization. Meanwhile, three GGA (PW91PW91, HCTH, HCTH407), two meta-GGA (TPSSTPSS, tHCTH), and ten hybrid functionals (M06, BHandH, TPSSh, B971, B98, B1B95, PBE0, M06-2X, tHCTHhyb, M05-2X) perform well in the ethylene-VB copolymerization. Besides, nine D3 or D3BJ augmented functionals are found to be suitable for both copolymerization systems. The D2 dispersion correction overestimated insertion energy barriers of these monomers and is unsuitable for such copolymerization. In addition, the double-zeta basis set is found to be sufficient for solvation single-point calculation of these systems.

Background: Endoscopic methods, especially the intragastric balloon (IGB), have been shown to be effective for the treatment of excess weight. This study aimed to assess the tolerance, complications and efficacy of excess weight treatment with a non-adjustable IGB during 6 months. Methods: A total of 5,874 patients treated with a liquid filled IGB (600-700mL) and followed up by a multidisciplinary team were evaluated.  Participants presented an initial body mass index (BMI) ≥25 kg/m2 and were stratified according to sex and degree of overweight (pre-obesity and obesity grade I, II and III).  Results: The incidence of complications was 7.32% (n=430): 6.10% (n=357) early IGB removal, 0.20% (n=12) gas production inside the balloon, 0.54% (n=32) leakage, 0.32% (n=19) pregnancy, 0.07% (n=4) gastric perforation, 0.05% (n=3) upper digestive bleeding,  0.01% (n=1) Wernick Korsakoff syndrome due to excessive vomiting, 0.02% each (n=1) pancreatitis and esophagus perforation. The 5,444 remaining patients (4081 women, 38±38years) presented a weight loss of 19.13±8.86kg and a BMI decreased significantly (p<0.0001) (36.94±5.67 vs. 30.08±5.06 kg/m2). The % total weight loss (%TWL) was 18.42±7.25% and % excess weight loss (%EWL) 65.66±36.24%. The treatment success rate (%TWL≥10%) was 85%. The %EWL was higher in the pre-obese group (122.19%), followed by obesity grades I (76.67%), II (56.01%) and III (45.45%), with p<0.0001 for each group. %EWL was higher in women (69.71%) than in men (53.39), with p<0.0001 for each group. There was also a statistical difference between the TWL and EWL groups, with p<0.001 for all analyzes. Conclusion: Endoscopic IGB treatment for excess weight is an excellent therapeutic option for patients with different degrees of overweight. Keywords: Intragastric balloon. Orbera balloon. Bariatric endoscopy. Endoscopic. Obesity treatment.

Their radically large brains and obligate bipedalism set humans apart from the rest of the primates. These features are studied in conjunction with their relationship to obstetric practices found universally in modern humans but hypothesized also to have emerged in Australopithecus. Given the emergence of modern-human obstetric practices as necessary for maternal-and-infant survival during parturition, I hypothesize that birth assistance must in the prehistoric past have become indispensable to the ongoing evolution of bipedalism and a big brain in the human lineage. Beginning at a critical point in our prehistoric past, obstetrics began giving humans both bipedalism and big brains.

In the present study, green tea extract was encapsulated in liposomes prepared by Mozafari method (without any organic solvents) and characterized for its physicochemical properties e.g. encapsulation efficiency, particle size and z- potential. The obtained results for encapsulation efficiency, particles size and z- potential were 51.34, 419 nm and -57 mV, respectively. Total polyphenol content of green tea was obtained 164.2 mg gallic acid /g extract. Free radical scavenging activities of free and liposomal extract, with using DPPH method were measured 90.6% and 93.37% respectively. Antioxidant activity of ethanolic extract of green tea in free and liposomal form were measured at concentration of 200, 600 and 1000 mg/L on the oxidative stability of canola oil during 60°C temperature for 0, 4, 8, 12, 16, 20, 24, 28 and 32 days. The results compared with synthetic antioxidant butylated hydroxytoluene at 200 mg/L. To evaluate antioxidant activity on canola oil stability, peroxide value, Thiobarbitoric acid, anisidine value, TOTOX and rancimat test measured. Results showed that liposomal green tea extract acted more effective than free extracts. Also, 600 mg/L concentration of green tea extract showed significant antioxidant activity in compare to others. The increasing storage time and different concentrations of ethanolic green tea extracts had significant effects on canola oil stability (P≤0.05). The obtained results showed green tea extract could act as an effective antioxidant. Green tea extract in free and liposomal form at 600 mg/L concentration resulted stronger function than butylated hydroxytoluene synthetic antioxidant.

Objective: To determine the risk of thrombocytopenia on postoperative complication following hysterectomy for benign indications. Design: Retrospective Cohort Setting: American College of Surgeons National Surgical Quality Improvement database. Population: Women undergoing hysterectomy by any route between 2014 and 2018 Methods: Patients stratified into three groups: normal platelet count, mild thrombocytopenia defined as a platelet count between 100 – 149 x 103 per microliter, and moderate thrombocytopenia defined as a platelet count between 50 x 99 x 103 per microliter. Three group comparison was performed using Kruskal-Wallis. If results were found to be statistically significant, then pairwise analysis was performed between reference group (normal platelet count) and experimental groups (mild and moderate thrombocytopenia). Pairwise comparison was performed using the Wilcoxon rank-sum test, Student’s t-test or Fisher’s exact test where appropriate. Multivariable logistic regression was used to determine the relationship between mild and moderate thrombocytopenia and the main outcome measures. Main Outcome Measures: Postoperative transfusion, infectious morbidity, readmission, reoperation, operating time and duration of hospitalization. Results: Moderate thrombocytopenia was associated with an increased risk of perioperative transfusion (aOR=2.87, 95%CI: 1.96-4.21) and reoperation (aOR=4.03, 95%CI: 1.94-17.33) while mild thrombocytopenia was not. The risk of infection increased with both mild and moderate thrombocytopenia, (aOR=1.38, 95%CI 1.12-1.69) and (aOR=2.00, 95%CI:1.23-3.22). Thrombocytopenia did not increase the risk of readmission, prolonged hospitalization or longer operating time. Conclusion: Thrombocytopenia is associated with increased infectious morbidity after hysterectomy, and moderate thrombocytopenia is associated with an increased risk of perioperative transfusion and reoperation.

Coronavirus (COVID-19), as a respiratory disease, has become a serious globally issue (December 2019), China. There is a strong immunenutrition relationship with the respiratory viruses as coronavirus. Moreover, a decline in the immunity function is regularly inevitable with poor micronutrient, inflammation and the declining (T cell) function. Nutrition weapon can be one of the main factors for immune response activation. Therefore, there is a globally necessary need to join hands for human survival. This report focuses on the recommendations for maintaining an efficient immune system during quarantine are; getting balanced healthy food, supplements and planning meal times accompanied by light sports for immune cell triggering and functional expression against coronavirus.

Novel coronavirus (COVID-19) outbreak infections have posed a considerable impendences globally, while millions of infections and thousands of death rates are gradually reported day by day. Due to the instant absence of vaccine, it is extremely necessary to find out unconventional, ecofriendly and effective approaches to control/prevent the further spreading of this serious infection. The present article expresses the potential nutritional recommendations from prevention of novel Covid-19 pandemic infection. It also provides facts about the bioactive ingredients of special supplements, foods and herbs for human immune system reinforcement against the infection.

Microbial-based biostimulants can improve crop productivity by modulating cell metabolic pathways including hormonal balance. However, little is known about the microbial-mediated molecular changes causing yield increase. The present study elucidates the metabolomic modulation occurring in pepper (Capsicum annuum L.) leaves at the vegetative and reproductive phenological stages in response to microbial-based biostimulants containing the arbuscular mycorrhizal fungi Rhizoglomus irregularis and Funneliformis mosseae as well as Trichoderma koningii. Application of endophytic fungi significantly increased total fruit yield by 23.7% compared to that of untreated plants. Multivariate statistics indicated that the biostimulant treatment substantially altered the shape of the metabolic profile of pepper. Compared to the untreated control, the plants treated with microbial biostimulants presented with modified gibberellin, auxin, and cytokinin production and distribution. The biostimulant treatment also induced secondary metabolism and caused carotenoids, saponins, and phenolic compounds to accumulate in the plants. Differential metabolomic signatures indicated diverse and concerted biochemical responses in the plants following the colonisation of their roots by beneficial microorganisms. The above findings demonstrated a clear link between microbial-mediated yield increase and a strong up-regulation of hormonal and secondary metabolic pathways associated with growth stimulation and crop defence to environmental stresses.

A document by Maximilian Richter, written on Authorea.

Postnatal SARS-CoV-2 Infection and Immunological Reaction: A Prospective Family Cohort Study

Disseminated Mycobacterium simiae infection in a patient with complete IL-12p40 deficiencySeyed Alireza Mahdaviani, MDa, Majid Marjani, MDb, Mahnaz Jamee, MDc,d*, Armin Khavandegar, MDc,d, Hosseinali Ghaffaripour, MDb, Golnaz Eslamian, MDe, Mehdi Ghaini, MDe, Shabnam Eskandarzadeh, MDe, Jean-Laurent Casanova, MD, PhDf,g,h,i, Jacinta Bustamante, MD, PhDf,g,j, Davood Mansouri, MDa,b , Ali Akbar Velayati, MDa

L’inquinamento, provocato da attività agricole e industriali, può causare la contaminazione delle matrici ambientali, costituendo un rischio significativo per l'approvvigionamento di acqua potabile e per gli ecosistemi. Pertanto, negli Stati Uniti e in Europa si sono sviluppate, nel corso degli anni, diverse tecniche di bonifica. In particolare, per il risanamento di acque sotterranee, un metodo in situ relativamente nuovo e potenzialmente importante è la barriera reattiva permeabile (BRP). Essa prevede la realizzazione di una barriera all’interno della zona satura del terreno con materiali reattivi per il trattamento di contaminanti organici e inorganici presenti in forma disciolta nell’acqua di falda. L'articolo illustra il funzionamento delle BRP attraverso l’esposizione di un caso studio, dove tale tecnologia ha permesso di ridurre le concentrazioni di uranio nelle acque sotterranee di un sito di stoccaggio. 

TitleA mouse model of asthma­–chronic obstructive pulmonary disease overlap induced by intratracheal papain

PR is an endemic disease in most regions of China, but the report about the dynamics of PRV gI antibody in one farm was rarely. In order to analyze the dynamics of PRV gI antibody in one farm, 1513 serums from the different pigs in a farm were collected to detect the gI antibody by ELISA. The results in July 2015 indicated only the gilts were PRV gI antibody positive, and the other pigs were all PRV gI antibody negative. But the brain PRV gE gene from 10 piglets were almost positive, their PRV gI antibody were all negative. The results from October 2015 to July 2018 indicated that in the boar herd, 3 positive individuals were found in October 2015 and subsequently they were culled. In the following tests, the boar herd always kept the negative state. The positive rate in the sow herd was always more than 70% from October 2015 to October 2017. In January 2018, the positive rate decreased to 27%, but it was up to 40% and 52% in April and July 2018. For 100-day pigs, the positive rate obviously decreased in October 2016 and then always kept less than 30% in the later detection. For 150-day pigs, the positive rate obviously decreased to 16% in January 2017 and transferred to the negative in July 2017. The positive trends from the 40-day pig to the 150-day pig were all remarkably decreased in three tests in 2018. These results indicate that the serological detection is not appropriate in the early stage of the PRV infection, and the introduction of gilts is a risk factor for a PRV-negative farm. The dynamic data of the PRV gI antibody provide the reference for the farm that want to carry out the PR eradication program.

The elimination of a foreign animal disease requires an efficient means of disposal for infected or exposed mortality and carcasses. Limited studies have been performed on the monitoring of swine viruses over time in compost piles, and this study looked to fill those knowledge gaps. The majority of the pig population in the United States resides in the Midwest, where adverse weather conditions in the winter exist. Therefore, this study aimed to evaluate the ability to grind carcasses for windrow formation to eliminate viral pathogens in the face of adverse weather conditions. This study further evaluated the environmental safety of the grinding processes and the potential for contamination from compost windrows themselves. The study reveals that grinding of infected carcasses in cold weather conditions is a low potential risk for environmental contamination of the air and groundwater. There is an observable difference between the compared compost materials used in virus elimination potential. The grinding and compost method is a viable option for carcass disposal in the face of a Foreign Animal Disease outbreak for pathogen elimination.

Anxiety and Depression Scores in Maternity Healthcare Workers during the Covid-19 PandemicGillian A. Corbett1, Sarah J. Milne1, Suruchi Mohan2, Shuja Reagu3, Stephen W. Lindow1, Mark P. Hehir1, Michael P O’connell1.

Letter to the EditorCoronavirus disease COVID-19 has deeply modified national health services with a profound impact on hospital and in particular emergency and intensive care units (ICU) activities. As recently reported in Italy pediatric emergency accesses substantially decreased likely due to the instructions to prevent overcrowding in emergency rooms and spread of SARS-CoV-2 infection and to fear of the infection.1 At the Santobono-Pausilipon Hospital (Neaples), pediatric emergency accesses in March 2020 were only one fifth of those registered in 2019 in the same period. Likewhise a marked reduction of consultations occurred also in family pediatricians clinics.2We report here 3 children who arrived at hospital in life-threatening conditions at the onset of Acute Lymphoblastic Leukemia (ALL) between March 14 and April 10, 2020.First case: a 2-year-old-child arrived at the emergency department with a 15 days history of fatigue, pallor and dyspnea, in a comatose state, with severe anemia, respiratory distress, hematemesis and metabolic acidosis. Chest X-ray showed interstitial pneumonia. Blood tests showed: hemoglobin 2.7 gr/dL, WBC count 185.000/μl, platelets (PTL) 10.000/μl, LDH 3609 U/L. Peripheral blood was diagnostic for CD10, CD19 and CD58 positive ALL (B-lineage ALL). The patient, admitted at the ICU, intubated, transfused with RBC, PTL and plasma, died 12 hours after arrival at the hospital due to progressive worsening of clinical conditions. The nasal swab was negative for SARS-CoV-2 and positive for adenovirus.Second case: a 5-year-old-child arrived at the emergency department with a one month history of respiratory distress. Imaging showed a mediastinal mass compressing the brachiocephalic vein, the aorta, the pulmonary trunk and the left pulmonary artery, tracheal deviation, compression of the left main bronchus, left lung atelectasis and pleural effusion. Blood tests showed: hemoglobin 14.5 gr/dL, WBC count 37.000/μl, PTL 294.000/μl, LDH 6153 U/L, creatinine 1.9 mg/dl. Peripheral blood was diagnostic for CD5, CD7, CyCD3 and CD8 positive ALL (T-ALL). Steroid treatment was started. Clinical conditions deteriorated rapidly with cardiac and renal failure. The patient, admitted to ICU 2 hours after arrival at the hospital and intubated, died 24h later. The nasal swab was negative for SARS-CoV-2.Third Case: a 4-year-old child arrived at the hospital with one month history of fever, cough and shortness of breath treated at home with antibiotics and steroids without improvement. Imaging showed a mediastinal mass compressing the left brachiocephalic, azygos and superior cava veins, and right pulmonary artery and vein; mild tracheal deviation, compression of the left main bronchus; pericardial and pleural effusion; nephro-hepato-splenomegaly and ascites. Due to signs of cardiac tamponade, pericardiac and pleural drainage were placed and the patient was admitted at ICU and intubated. Blood tests showed: normal hemoglobin, WBC and PTL counts; LDH 2732 U/L, creatinine 2.98 mg/dl, K 8 mEq/L, Ca 5.4 mEq/L. Bone marrow was diagnostic for CD2, CD5, CD7, CD99 and CyCD3 positive ALL (T-ALL). Treatment with steroids was started. Due to progressive renal failure hemodialysis was performed for 9 days. Clinical conditions improved with rapid shrinking of mediastinal masses and resolution of pericardial and pleural effusion. The patient was thus extubated and treatment for ALL was instituted with good response to induction therapy. The nasal swab was negative for SARS-CoV-2.The 3 cases of ALL here described, 2 of them fatal, arrived at the hospital in critical conditions, most likely as a consequence of fear of COVID-19. Delay in diagnosis of neoplastic disease is a well-known problem in low-middle income countries (LMIC), but is quite rare in high-income countries (HIC). Actually, this combination of events never occurred in the past at the Santobono-Pausilipon Hospital, where, at the time of writing, no SARS-CoV-2 positive cases have been identified among children treated for cancer.Considering low prevalence of virus spreading in children and that SARS-CoV-2 positive children are generally asymptomatic or have a very mild course of the disease there is a substantial risk that collateral effects of COVID-19 pandemic, i.e. delays in diagnosis, chemotherapeutic treatments and treatment of chemotherapy complications, may be worse than those posed by the disease itself.3,4,7 Recently the major pediatric cancer scientific associations have expressed great concern on the risk that fear to access to medical care raised by Covid-19 may cause these delays not only in LMIC but also in HIC with dramatic consequences we are not used to face.5-6 Our experience confirms the occurrence of these collateral effects, indicating that there is a need of awareness of this risk and careful medical attention to assure timely diagnoses and adequate treatment adherence in childhood cancer.

Most studies of plant--animal mutualistic networks have been temporally static. This approach has revealed many general patterns in the structure of complex webs of mutualistic interactions, but limits our ability to understand the ecological and evolutionary processes that shape these networks, and to predict the consequences of natural and human-driven disturbance on species interactions. The growing availability of temporally explicit data is allowing ecologists to move beyond this static perspective. We review the growing literature dealing with temporal dynamics in plant--animal mutualistic networks including pollination, seed dispersal and ant defence mutualisms. We identify general patterns of temporal variation in these networks across temporal scales. We discuss potential mechanisms underlying variation in interactions, ranging from behavioural and physiological processes at the narrowest temporal scales to ecological and evolutionary processes operating over much broader temporal scales. We conclude by discussing priorities for future research, including an improved understanding of the abiotic and biotic factors driving temporal network change, and further development and refinement of analytical tools. Our review highlights the key role of the importance of considering the temporal dimension for our understanding of the ecology and evolution of complex webs of mutualistic interactions.

Aim: COVID-19, a newly discovered virus disease, can be affected by probiotics. So, we tried to review the possible effects and associations of probiotics on viral infections focusing on SARS-CoV-2. Methods: We searched on PubMed, EMBASE, Google Scholar, Science Direct, Scopus and Web of Science up to May 2020 to identify interventional & observational studies documenting the effects of probiotics strains on interleukins, virus titres, and antibody production with a focus on confirmed diagnosis of SARS-CoV-2 infection. Results: From a total of 93 records, 21 studies were obtained and classified into three domains based on the efficacy of probiotics on 1)the level of interleukins (n=7), 2)virus titres reduction (n=2), and 3)antibody production (n=12). The suppuration of proinflammatory interleukins and type I interferon (IFN) production seemed to be the main anti-viral strategy of probiotics. Conclusion: Based on evidence, some probiotic strains may be useful in SARS-CoV-2 infection; randomized trials are needed to confirm these findings.

Aims: To assess whether randomized clinical trials (RCTs) proposed to evaluate treatment of COVID-19 with HQ or chloroquine include outcome definitions and data collection plans to produce meaningful efficacy/effectiveness and safety outcomes. Methods: We searched the World Health Organization International Clinical Trials Registry Platform (WHO-ICTRP) database for registers of RCTs evaluating HQ or chloroquine, alone or in any combination, to treat patients diagnosed with COVID-19 compared with any other treatment option. The final search was performed on April 8th, 2020. Results: Among 51 registered RCTs (median sample size of 262; IQR: 100, 520), 34 (67%) reported a clinical outcome, 12 (24%) a surrogate outcome, and five (10%) a combination of clinical and surrogate outcomes as primary endpoints. Clinical status/recovery and all-cause mortality/mortality accounted for 49% of the unique domains among 20 different clinical outcome domains of efficacy. Twenty-four (47%) RCTs did not describe plans to assess safety outcomes; when assessed, safety outcomes were determined in generic terms of total, severe or serious adverse events. Conclusions: The RCTs investigating HQ or chloroquine include heterogenous and insufficient approaches to measure efficacy/effectiveness and safety that are relevant to patients and clinical practice. These findings provide important insights to inform clinical and regulatory decisions that can be drawn about the efficacy/effectiveness and safety of these agents in patients with COVID-19.

Introduction: A novel ablation catheter that can measure local impedance (LI) was recently launched. We aimed to explore target LI measurements at each radiofrequency application (RFA) for creating sufficient ablation lesions during pulmonary vein (PV) isolation. Methods: This prospective study included 15 consecutive patients scheduled to undergo an initial ablation of paroxysmal atrial fibrillation (AF). Circumferential ablation around both ipsilateral PVs was performed using a 4-mm irrigated ablation catheter with an LI sensor. Point-by-point ablation was used with a 4-mm inter-ablation-point distance. Operators were blinded to LI measurements during the procedure. Creation of sufficient ablation lesions was assessed by the absence of a conduction gap. Results: After first-pass encircling PV antrum ablation, left atrium to PV conduction remained in 12 of 30 (40%) ipsilateral PVs. Mapping using the mini-basket catheter identified 48 ablation points through which the propagation wave entered the PV. At ablation points with a gap, the LI drop during RFA was half that at points without a gap (12 ± 7 vs. 23 ± 12 ohm, p<0.001). The GI drop did not differ between ablation points with and without a gap (12 ± 7 vs. 14 ± 10 ohm, p=0.10). An LI drop of 15 ohm predicted sufficient lesion formation without a gap with a sensitivity of 0.71, specificity of 0.81, and predictive accuracy of 0.75. Conclusion: A target LI drop of 15 ohm at each RFA with a 4-mm distance between adjacent ablation points may facilitate creation of sufficient ablation lesions during PV isolation