Objectives: The aim of this study was to explore the associations of abdominal muscles thickness and inter-recti distance (IRD) at late pregnancy with birth-related outcomes and umbilical cord blood (CB) gas values. Design: cross-sectional study. Setting: Sport and Health University Research Institute Sample: One hundred and fifty-two pregnant women. Main outcome measures: The thickness of the abdominal muscles (transverse abdominis [TrA], internal [IO] and external obliques [EO]) and the IRD were measured by ultrasound at the 34th gestational week. Birth outcomes were collected from obstetric medical records. Umbilical CB gas concentrations were assessed after birth using a blood analyzer. Results: Greater TrA and IO thickness were associated with a higher venous CB PO2 value, both at muscular rest (respectively, p<0.01 and p<0.05) and during activation (both p<0.05). A greater activated TrA thickness was associated with a higher venous CB oxygen saturation (p<0.05). EO thickness at rest was positively related to arterial CB pH (p<0.05), and during activation to the 1-minute Apgar test (p<0.05). A greater IRD was associated with higher arterial (at rest p<0.01; during crunches p<0.05) and venous CB (at rest, p<0.05) PCO2 values, and with lower arterial CB PO2 (p<0.05), arterial CB oxygen saturation (at rest, p<0.05; during crunches p<0.01), and venous CB oxygen saturation (during crunches, p<0.05, and lower venous pH (p<0.05). Conclusion: Greater abdominal muscle thicknesses and a smaller IRD at late pregnancy are related to better umbilical CB gas values at birth. ClinicalTrials.gov Identifier: NCT02582567

High-risk human papillomavirus (hrHPV) is the major cause of cervical cancer. The majority of hrHPV infections resolve spontaneously. However, when hrHPV escapes host’s immune system and establishes persistent infection in basal keratinocytes, self-clearance of the infection becomes exactly difficult, and medical intervention is urgently needed to eradicate viral infection and prevent cervical cancer. This review aimed to summarize our findings and achievements on REBACIN®—an anti-viral biologic with low cost, no cold chain and no hospitalization, and demonstrated that REBACIN® exhibits potent efficacy in clearing persistent hrHPV infections, promotes regression of associated lesions via targeted inhibition of viral E6/E7 oncogenes.

H63D syndrome, now clinically known as Oslo syndrome (synonymous), is considered a very rare disorder that is difficult to recognize due to its multifaceted nature. Even with homozygous mutation of the HFE gene H63D and the simultaneous presence of the typical clinical symptoms, few clinicians dare to care for affected patients. This is inexplicable, because Oslo syndrome (H63D syndrome) looked at on the meta-level is nothing more than Wilson disease caused by NTBI iron.

1. The encroachment of woody plants into grasslands is an ongoing global problem that is largely attributed to anthropogenic factors such as climate change and land management practices. Determining the mechanisms that drive successful encroachment is a critical step towards planning restoration and long-term management strategies. Feedbacks between soil and aboveground communities can have a large influence on the fitness of plants and must be considered as potentially important drivers for woody encroachment. 2. We conducted a plant-soil feedback experiment in a greenhouse between eastern redcedar Juniperus virginiana and four common North American prairie grass species. We assessed how soils that had been occupied by redcedar, a pervasive woody encroacher in the Great Plains of North America, affected the growth of big bluestem, little bluestem smooth brome, and western wheatgrass over time. We evaluated the effect of redcedar on grass performance by comparing the height and biomass of individuals of each grass species that were grown in live or sterilized conspecific or redcedar soil. 3. We found that redcedar created a negative plant-soil feedback that limited the growth of two species. These effects were found in both live and sterilized redcedar soils, indicating redcedar may exude an allelochemical into the soil that limits grass growth. 4. Synthesis. By evaluating the strength and direction of plant-soil feedbacks in the encroaching range, we can further our understanding of how woody pants successfully establish in new plant communities. Our results demonstrate that plant-soil feedback created by redcedar inhibits the growth of certain grass species. By creating a plant-plant interaction that negatively affects competitors, redcedars increase the probability of seedling survival until they can grow to overtop their neighbors. These results indicate plant-soil feedback is a mechanism of native woody plant encroachment that could be important in many systems yet is understudied.

Objective: To estimate the incidence of influenza-associated hospitalizations and deaths in Brazil from 2010 to 2016. Method: Records of hospital discharges and deaths (mortality system) were used by ICD codes J09-J18, data from laboratory influenza surveillance, and census population projections adjusted by the percentage of those using public health services. Meta-analysis was performed to determine the incidences of hospitalizations and deaths by age group in the five geographic regions of Brazil. Results: The estimates were 645,661 hospitalizations and 160,089 deaths from influenza from 2010 to 2016. The highest incidences of hospitalization occurred in older adults with ≥65 years (258.6/100.000) and children <5 years old (180.1/100,000), while deaths stood out among individuals aged ≥65 (142.9/100,000) and aged 50 to 64 years (22.1/100,000). Regional differences were found, with higher incidences predominantly in the Midwest, Southeast, and South regions. Conclusion: The burden of influenza in Brazil is of concern, with a high number of hospitalizations and deaths from the disease. Regional and age group differences provide evidence to support vaccination policy and the improvement of the influenza surveillance system. Key Words: Human Influenza, Incidence, Mortality, Hospitalization, Meta-analysis

Abstract: Objective Patients’ demographics, perioperative data and reasons of using MDT pattern were all analyzed to report preliminary application experiences of an MDT pattern using in the robotic-assisted gynaecological surgery at a single institution. Design Retrospective and descriptive study. Setting Tertiary referral center with one surgical team. Population All the 39 patients who have undergone robotic-assisted MDT gynaecological surgeries from 2018 to 2021 in Chinese PLA General Hospital. Methods Various types of robotic-assisted MDT gynaecological surgeries were carried out by the Da Vinci SI Surgical System. Patients’ demographics, perioperative data and reasons of applying MDT surgeries were described. Main Outcome Measures Patients’ demographics, perioperative data and reasons of applying MDT surgeries. Results Most patients undergone robotic-assisted MDT gynaecological surgeries have at least one abdominal surgery before. The operation cost and hospital expense were higher than common laparoscopy. Hospital stays ranged from 7 to 42 days. General surgery department and urological surgery department were the top two familiar departments involved in robotic-assisted MDT gynaecological surgeries. Only 4 cases appeared intraoperative complications in these surgeries. However, postoperative infection needed to be closely monitored. Conclusions It was indicated that robotic-assisted MDT gynaecological surgeries applied in severe diseases could provide both safety and precision, and the pattern was proved to demonstrate the concept of patient-centered and holistic treatment. Simultaneously, the MDT pattern could cultivate teamwork in various departments in the hospital, thus it was beneficial to both patients and hospitals. Keywords Multi-Disciplinary Teamwork; Robotic-Assisted Surgery; Minimally Invasive Surgery; Gynaecology

Ectopic pituitary adenoma is a rare benign neoplasm defined by the presence of hypophyseal tissue into the nasosinusal tract without any connection with normal pituitary gland. A postero-septal localisation of the tumor without a sphenoidal localisation seems to be rarer. We report here one of the first resection movie.

Objective: To understand the changes of high-risk human papillomaviruses (HR-HPV) infection and detection of cervical high-grade squamous intraepithelial lesion or higher (HSIL+) from 2012 to 2021. Design: Retrospective observational study. Setting: A tertiary hospital in northwest China. Population: Women aged >25 years who underwent primary HR-HPV testing and referred for colposcopy biopsy from January 2012 to December 2021. Methods: The trends of HR-HPV infection and detection of HSIL+ were described and analyzed. All participants were divided into four groups with 25-35, 36-45, 46-55, and >55 years, respectively. Main outcome measures: HR-HPV infection was screened out by HPV examination. Cervical cancer and HSIL were confirmed in biopsies. Results: Our data indicated that the HR-HPV infection rate showed a general decreasing trend (APC = -7.34%, 95%CI: -11.38% ~ -3.13%) from 2012 to 2021. Population with the highest infection rate of HR-HPV was over 55 years group. On the contrary, the detection rates of cervical HSIL+ showed an increasing trend (APC=15.30%, 95%CI: 9.64% - 21.25% ). However, the detection rate of cervical cancer showed a downward trend (APC = -12.65%, 95%CI: -17.68% - -7.32%). Unsurprisingly, the detection rate of cervical lesions in population over 55 years was the highest among different groups. The common HR-HPV subtypes were HPV52 (20.96%), HPV16 (16.70%), HPV58 (13.95%), HPV56 (13.04%) and HPV51 (12.31%). Conclusions: Our data suggested that proactive prevention and screening measures helped to decrease HR-HPV infection rates and decrease detection rate of cervical cancer past ten years and should be further advocated in other areas.

Laparoscope minimally invasive surgery has gradually become one of the options for the treatment of early gynecologic malignancies for that it is superior to open surgery in perioperative efficacy and has no disadvantage in oncological outcomes. Nevertheless, the Laparoscopic Surgical Pathway for Cervical Cancer study has shown that early-stage cervical cancer patients owns higher recurrence rates and shorter overall survival with laparoscopic surgery compared to open surgery. In this review, we discuss the current status and controversies regarding the use of minimally invasive surgery in common gynecologic malignancies.

Multiple morphological abnormalities of the sperm flagella (MMAF) is an important cause of male infertility and is defined as absent, short, coiled, bent irregular flagella. In this study, we identified a novel missense mutation (c.1414G>A; p.V472M) in Cilia and flagella associated protein 47( CFAP47, NG_016381.2) in two unrelated patients with asthenoteratozoospermia. In addition to the typical MMAF phenotype very analogous to that of Cfap47 mutant male mice, the two patients also presented abnormal morphology of sperm heads, mitochondrial sheath disorganization, and defects of sperm annulus. Further functional experiments confirmed that the expression of CFAP47 was markedly reduced in the spermatozoa of the patients. Moreover, coimmunoprecipitation and immunofluorescence showed that CFAP47 might regulate CFAP65 and CFAP69 through physical interactions and is thus involved in sperm morphogenesis. In conclusion, we reveal a novel recurrent mutation in CFAP47 and further expand the clinical and mutational spectrum of CFAP47, finally providing important guidance for genetic counseling and targeted treatment.

Time for a Reboot:

In order to study the asymptotic behavior, several authors claimed global existence in time of solutions to a tritrophic food chain models following a modied Leslie-Gower formulation considering the interactions between three species: a generalist top predator depredating on a middle predator, that in turn is depreds a prey. To the contrary it is shown nite time blow-up in such models can occur. We show in this work that blow up in nite time persists even when the intermediate (middle) predator is abscent to the contrary to what it is claimed by Kundu and Patra (2022, [13]). It is shown under some restrictions on the parameters, the model has bounded solutions for all positive initial conditions. We show that this is not true. Solutions to the model can blow up in nite time, for initial data suciently large, even under the restrictions derived by the authors. We can show same results even for small initial data but we concentrate our proofs for the rst case. We also show similar results for the spatially extended system. We illustrate all our results through numerical simulations.

Introduction: Increasing evidence has suggested improved outcomes in atrial fibrillation (AF) patients with heart failure (HF) undergoing catheter ablation (CA) as compared to medical therapy. We sought to investigate the benefit of CA on outcomes of patients with AF and HF as compared to medical therapy. Methods and Results: A systematic review of PubMed, Embase, and Cochrane Central Register of Clinical Trials was performed for clinical studies evaluating the benefit of CA for patients with AF and HF. Primary endpoint was all-cause mortality. Secondary endpoints included atrial-arrhythmia recurrence and improvement in left ventricular ejection fraction (LVEF). Eight randomized controlled trials were included with a total of 2121 patients (mean age: 65 ± 5 years; 72% male). Mean follow-up duration was 32.9 ± 14.5 months. All-cause mortality in patients who underwent CA was significantly lower than in the medical treatment group (8.8% vs. 13.5%, RR 0.65, 95% CI 0.51-0.83, P=0.0005). A 35% relative risk reduction and 4.7% absolute risk reduction in all-cause mortality was observed with CA. Rates of atrial-arrhythmia recurrence were significantly lower in the CA group (39.9% vs 69.6%, RR 0.55, 95% CI 0.40-0.76, P=0.0003). Improvement in LVEF was significantly higher in patients undergoing CA (+9.4 ±7.6%) as compared to conventional treatment (+3.3±8%) (Mean difference 6.2, 95% CI 3.6-8.8, P<0.00001). Conclusion: CA for AF in patients with HF decreases all-cause mortality, improves atrial-arrhythmia recurrence rate and LVEF when compared to medical management. CA should be considered the treatment of choice to improve survival in this select group of patients.

Wilms Tumour also known as nephroblastoma,a highly malignant embryonal neoplasm,involving one or both kidney. It affects children between 3 to 5 years of age and unilateral but 5% cases bilateral. Disease occur in about 1 out of 2-2.5 lakh children. Hypertension is noted in children with wilms tumour either at

Introduction: Bronchopulmonary dysplasia (BPD) is the most common chronic lung disease in premature newborns. It is most defined as a need for supplemental O 2 for 28 days or at 36 weeks postmenstrual age (BPD36w). Objective: In premature newborns born at less than 32 weeks (PNBs<32) in a neonatal unit in Santiago, Chile, between 2012 and 2019: 1.-) evaluate the O 2 requirement at 28 days of life (BPD28d) and 36 weeks postmenstrual age (BPD36w). 2.-) Describe and determine the incidence of BPD36w in PNBs<32. Methods: Descriptive, retrospective study with an analytical component. Results: 722 PNBs<32 were born at the healthcare center. Mortality was 12.19%. The study population was 535 PNBs<32. The incidence of BPD28d and BPD36w was 35% and 28%, respectively. Of the 242 newborns BPD28d, 203/242 (83.88%) still needed O 2 at 36 weeks. Sixteen from 242 (6%) required O 2 for less than 28 consecutive days, 7 of them still required O 2 at 36 weeks. The predictors of BPD36w were male sex (OR 2.42, 95% CI:1.24-4.69), birth weight (OR 1, 95% CI:0.99-1), gestational age (OR 0.75, 95% CI:0.57- 0.97), APGAR at 5 min, (OR 0.01, 95% CI:0.003-0.05), continuous positive airway pressure/ high-flow nasal cannula requirement (OR 1.1, 95% CI:1.04-1.17) and days of invasive mechanical ventilation (OR 1.1,95% CI: 1-1.2). Conclusions: Most PNBs<32 with O 2 at 28 days of age will require O 2 at 36 weeks. The predictors associated with BPD36w were male gender, birth weight, gestational age, APGAR score, a positive airway pressure requirement and days of invasive mechanical ventilation.

Objective: The purpose of this meta-analysis is to investigate the effect of prophylactic caffeine use in the treatment of apnea and other clinic outcomes in very low birth weight infants. Methods: From inception to 20 May 2022, PubMed, Embase, Web of Science, Scopus, EBSCO, CNKI, and Cochrane databases were systematically searched. The meta-analysis was carried out using STATA and RevMan software. Results: Eleven randomized controlled trials including a total of 4375 very low birth weight infants were evaluated. The pooled demonstrated that prophylactic caffeine use was linked with a significantly lower probability of AOP (OR 0.31, 95%CI: 0.19-0.49, P<0.001), duration of mechanical ventilation, and oxygen therapy when compared to control group. It also reduced the incidence of BPD (OR 0.62, 95%CI: 0.54-0.71, P<0.001), PDA (OR 0.49, 95%CI: 0.30-0.80, P=0.005) and ROP (OR 0.76, 95%CI: 0.65-0.90, P=0.001), without raising the risk of NEC, IVH and death before hospital discharge ( P＞0.05). Conclusion: This meta-analysis confirmed the beneficial effects of prophylactic caffeine for preventing apnea of prematurity as well as for improving clinical outcomes. However, further research is needed before recommending widespread use of caffeine as a prophylactic treatment in the management of all preterm infants.

Introduction: Some patients suffer recurrent syncope following cardioneuroablation (CNA) for vasovagal syncope (VVS), yet no cases of repeat CNA have been described in detail. Methods and Results: Our present patient suffered a recurrence seven months following successful CNA and wished for a repeat CNA. Pre-procedurally, she lacked an atropine response. During CNA, high-frequency stimulation (HFS) at ganglionated plexi (GP) would not trigger cardioinhibitory events. Ablation was delivered based on anatomy and fractionation mapping, producing characteristic tachycardia at 2 GP sites. Conclusion: Repeat CNA is feasible and safe, and characterized by unique physiology.

Transcatheter closure of atrial septal defect (ASD) has become a well-established surgical intervention for patients with atrial fibrillation (AF). The incidence of AF is still increased after ASD closure, compared with an age-matched general population. However, radiofrequency catheter ablation which has become an increasingly common therapy for AF is underutilized due to the difficulty of obtaining transseptal access in the presence of the closure device. We describe an extremely challenging case in which the transseptal puncture (TSP) was successfully completed with the use of a peripheral balloon dilatation catheter in the atrial septal defect (ASD) patient with an atrial septal occluder. For patients with fibrotic and thickened devices, peripheral balloon dilatation can facilitate transseptal passage safely and effectively.

Diffuse leptomeningeal glioneuronal tumor (DLGNT) is characterized by widespread leptomeningeal lesions with focal parenchymal involvement. We present a child with a large intramedullary spinal cord lesion, whose biopsy revealed a biphasic astrocytic tumor consistent with pilocytic astrocytoma. Next-generation sequencing revealed a KIAA1549-BRAF fusion, 1p/19q co-deletion, and no IDH1 mutation. Methylation profiling demonstrated a calibrated class score of 0.98 for DLGNT. Despite morphologic similarities to pilocytic astrocytoma and lack of oligodendroglial/neuronal components or leptomeningeal dissemination, the molecular profile definitively classified the tumor as DLGNT. This case highlights the importance of molecular and genetic testing in diagnosing pediatric central nervous system tumors.

Microalgae are currently being recognized as a sustainable resource for valuable products such as pigments for their superior antioxidant activities. Chlorella sorokiniana MB-1- M12 is a lutein-rich mutant capable of growth and lutein production in photoautotrophic, mixotrophic, heterotrophic, and photoheterotrophic metabolism. Despite the capacity of heterotrophic growth, light and CO2 were found to be critical for lutein accumulation in MB-1- M12. Thus, an innovative two-stage heterotrophic-mixotrophic process (TSHM) performed under optimal conditions brought about 10 g/L biomass and 7.42 mg/g lutein. Integration of fed-batch and semi-batch operational strategies and scale-up in a 5L bioreactor increased biomass production, lutein content, and lutein production to reach 20 g/L, 8.71 mg/g, and 181.11 mg/L, respectively. This work demonstrated that integration of the TSHM process with appropriate operational strategies (i.e., integrated fed-batch and semi-batch operation) could enhance the lutein accumulation in MB-1-M12, making it apt for marketable lutein production.

Pediatric AML with NUP98-NSD1 fusion defines a high-risk subset with a low remission and high relapse rates. There are a few studies on successful treatment of high-risk AML expressing NUP98-NSD1. We report a refractory pediatric case who received successful treatment with Bcl-2 inhibitor, venetoclax plus DCAG chemotherapy followed by HSCT, after two failure courses of conventional chemotherapies. Our case suggests that the combination of venetoclax and DCAG chemotherapy may be an effective salvage strategy to refractory AML with NUP98-NSD1. More studies and clinical trials should focus on the synergistic effect of Bcl-2 inhibitors and hypomethylation agents, especially in pediatric AML.

Endocarditis and cardiovascular implantable electronic device (CIED) infection are rare presentations of disseminated gonococcal infection (DGI). We report a case of gonococcal endocarditis with a large vegetation adherent to the tricuspid valve and CIED leads. Surgical intervention was able to be avoided through the use of transcatheter vegetation debulking and CIED extraction.

In this article, by using the atomic decomposition of weighted Herz-type Hardy spaces, the author obtains some strong type estimates for commutators of sveral square functions generated by $\mathrm{BMO}$ functions on these spaces. All these results are also new even for classical Herz-type Hardy spaces.

Pseudomyxoma peritonei (PMP) remains difficult to diagnose and has a guarded prognosis. Pseudomyxoma peritonei is a rare entity, of appendicular origin in the majority of cases. Its clinical symptomatology is not specific, the diagnosis is evoked by imaging and surgery, and confirmed by histology.