Purpose: To investigate the relationship between lesion size determined using mpMRI and histopathological findings of specimens obtained after mpMRI fusion biopsy and radical prostatectomy. Material and Methods: We retrospectively analyzed 590 patients with PCa who underwent an MRI fusion biopsy between 2017-2019. We measured the diameter of suspicious tumor lesions on diffusion-weighted mpMRI and stratified the cohort into two groups. Group A included patients with a suspicious tumor lesion equal and smaller than 10 mm and Group B included those with a suspicious tumor lesion larger than 10 mm. RP was performed in 53 patients. The patients in Groups A and B were compared according to their pathological findings obtained with fusion biopsy and RP. Results: After applying the inclusion and exclusion criteria, Group A consisted of 144 patients and Group B comprised 146. In Group B, PI-RADS score determined in mpMRI was higher than Group A, and there was a statistically significant difference between the two groups in terms of clinical T-stage. The PCa detection rate and the number of positive cores were statistically significantly higher in Group B than in Group A. In addition, there was a statistically significant difference between the two groups in relation to the biopsy, the ISUP grades and the presence of clinically significant PCa. In Group B, pathological T-stage and extraprostatic extension (EPE) and surgical margin (SM) positivity were found to be higher among the patients who underwent RP. In the multivariate analysis, the mpMRI lesion size being >10 mm was found to be an independent predictive factor for SM and EPE positivity. Conclusion: The radiologists and clinicians should be awared of the possibility of presence of features that may affect local staging, such as EPE positivity, in the presence of lesions larger than 10 mm in which prostate cancer is detected.

Exact nonlinear partial differential equation solutions are critical for describing new complex characteristics in a variety of fields of applied science. The aim of this research is to use the F-expansion method to find the generalized solitary wave solution of the regularized long wave (RLW) equation of fractional order. Fractional partial differential equations can also be transformed into ordinary differential equations using fractional complex transformation and the properties of the modified Riemann–Liouville fractional-order operator. Because of the chain rule and the derivative of composite functions, nonlinear fractional differential equations (NLFDEs) can be converted to ordinary differential equations. We have investigated various set of explicit solutions with some free parameters using this approach. The solitary wave solutions are derived from the moving wave solutions when the parameters are set to special values. Our findings show that this approach is a very active and straightforward way of formulating exact solutions to nonlinear evolution equations that arise in mathematical physics and engineering. It is anticipated that this research will provide insight and knowledge into the implementation of novel methods for solving wave equations.

The actinomycete Lentzea aerocolonigenes produces the antitumor antibiotic rebeccamycin. In previous studies the rebeccamycin production was significantly increased by the addition of glass beads during cultivation in different diameters between 0.5 – 2 mm and the induced mechanical stress by the glass beads was proposed to be responsible for the increased production. Thus, this study was conducted to be a systematic investigation of different parameters for macroparticle addition, such as bead diameter, concentration and density (glass and ceramic) as well as shaking frequency, for a better understanding of the particle induced stress on L. aerocolonigenes. The induced stress for optimal rebeccamycin production can be estimated by a combination of stress energy and stress frequency. In addition, the macroparticle-enhanced cultivation of L. aerocolonigenes was combined with soy lecithin addition to further increase the rebeccamycin concentration. With 100 g L-1 glass beads in a diameter of 969 µm and 5 g L-1 soy lecithin a concentration of 388 mg L 1 rebeccamycin was reached after 10 days of cultivation, which corresponds to the highest rebeccamycin concentrations achieved in shake flask cultivations of L. aerocolonigenes stated in literature so far.

By designing a novel combined event-triggered control technique, this article analytically studies the distributed leader-following consensus problem of nonlinear fractional chaotic multi-agent systems. First, a novel combined event-triggered mechanism which takes into account both the relative error and the absolute error of the samples is proposed, under which each follower agent executes control update independently at its own event times. Next, a fully distributed event-triggered consensus protocol is designed and the sufficient conditions of consensus are attained. Finally, compared with other event-triggered mechanisms, the simulation experiments illustrate that the event-based consensus protocol proposed in this article can effectively reduce the frequency of actuator data update while ensuring desired consensus performance.

Left atrial intramural hematoma is a rare complication of percutaneous coronary intervention. We report a case of left atrial intramural hematoma after percutaneous coronary intervention that was successfully treated by combining surgery with interventional therapy.

We describe a case of frozen elephant trunk deployment unintentionally malpositioned into the false lumen. An 83-year-old man underwent total arch repair with a frozen elephant trunk for type A acute aortic dissection complicated by mesenteric malperfusion. However, intraoperative transesophageal echocardiography showed expansion of the false lumen in the descending aorta, suggesting a malpositioned frozen elephant trunk into the false lumen. Endovascular fenestration of the dissecting flap and subsequent endograft deployment from the inside of the malpositioned frozen elephant trunk graft to the true lumen of the descending aorta was successfully performed under intravascular ultrasound guidance.

Impact of COVID-19 on Coronary Artery Surgery: Hard lessons learnedAuthor: Luis Alberto O. Dallan1; Luiz Augusto F. Lisboa1; Luis Roberto P. Dallan1; Fabio B. Jatene1.1 Department of Cardiovascular Surgery, Heart Institute from University of São Paulo Medical School (InCor), São Paulo, São Paulo, Brazil.Corresponding author:  Luis Alberto O. Dallan, Dr. Enéas de Carvalho Aguiar, 44, Postal Code:05403-900. Pinheiros, São Paulo, SP – Brazil. Phone: +55 (11) 2661-5014. E-mail: dcidallan@incor.usp.br.Since March 11th, 2020 when coronavirus disease 2019 (COVID-19) was declared a pandemia, hospitals had to be adapted quickly to increase the assistance capacity for a large part of the population that needed hospitalization for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection (1,2). Major disruptions on routine hospital services have occurred, with health professionals needed to assume functions beyond their usual routines and beds were adapted for intensive care due to the increased demand in the treatment of severe acute respiratory failure. Cardiovascular surgery was particularly affected by the coronavirus outbreak, since most of the elective surgeries were canceled and ICU beds, normally dedicated to the postoperative period of cardiac surgery, were transferred to patients with COVID-19 (3-5).In this context, Kalil and Col.(6) examine the impact of the Covid-19 pandemic in the number of procedures and death rate of CABG performed in 2020 in Brazil. They analyzed patients undergoing CABG in the public health system between 2008 and 2020. The data were collected from DATASUS, the data processing system of the Brazilian Ministry of Health, which collects information from every patient who needs in-hospital care and was admitted to a public hospital. Patients operated on the private system were not captured in the database and were excluded from the analysis. The results showed that in 2020, during the pandemic period, there was an average reduction of 25% in the number of CABG performed in Brazil, with the majority of procedures (75%) being performed in the south and southeast regions of the country. Regarding postoperative mortality, they observed an opposite effect with an increase in mortality from 5.6% to 6.3% during this pandemic period (6).This study has some limitations due to results extracted from an administrative database, good for epidemiological analysis such as gender, age, number and type of surgeries performed. Considering the reduction in surgical volume during the pandemic period, surgical status was analyzed altogether (whether elective, or urgent or emergency CABG), expressing a general view of the situation.Brazil was the epicenter of the coronavirus outbreak in Latin America and other publications from Brazil showed different and more detailed results in relation to the pandemic period (7,8). One by Omar et al. (7) who used data from the São Paulo Registry of Cardiovascular Surgery (REPLICCAR), a multicenter registry, showed a 60% reduction in surgical CABG volume during COVID-19 pandemic. Regarding mortality, CABG surgeries had a 2.8-fold increased mortality risk (CI95%,1-7.6, P=0.041), patients who evolved with COVID-19 had a 11-fold increased mortality risk (CI95%, 2.2-54.9, P<0.003), rates of morbidities and readmission to the intensive care unit. (7), compared to 2019.In our own series at the Heart Institute University of Sao Paulo Medical School - Brazil, we observed a 65.8% reduction in cardiac surgery volume in 2020, during the pandemic period, and 2/3 of these were urgent or emergency procedures. Regarding the CABG in-hospital mortality, there was increased from 1.2% (2019) to 3.0% (2020) among elective procedures and from 4.5% (2019) para 18.2% (2020) among urgent or emergency procedures. Patients who had postoperative COVID-19, the in-hospital mortality rate was significantly higher (38.5%).Other publications reported a reduction in surgical volume of more than 70% during the peak disruption due to COVID-19 (9,10). Salenger et al. (11) reported that the volume of cardiac surgery fell to 54% of baseline after the restrictions were implemented and they also estimated a necessity of 2.5 times increase in numbers of procedures in post-COVID-19 era to restore balance to elective surgeries waiting lists. In the COVIDSurg collaborative, in a multi centric cohort of surgeries performed in 24 countries (235 hospitals), found that 75% of the procedures from 1 January and 31 March 2020, were non-elective and the mortality was 24%. Their cohort included 50 patients who underwent cardiac surgery and 30-day mortality was 34%, among the patients who had perioperative SARS-CoV-2 infection (12). Clinical studies have shown that in addition to severe acute respiratory distress syndrome, the coronavirus-2 infection also affects micro-circulation, has prothrombotic state and can cause myocardial injury, even in patients without coronary artery disease (13-14). This may be one of the reasons for the high mortality among patients who undergo surgery and present COVID-19 in the perioperative period, particularly in CABG surgery, where there is also a higher incidence of elderly, hypertensive and diabetic patients.While the COVID-19 pandemic continues to increase globally, measures to control SARS-CoV-2 infection and patient safety need to be established to maintain cardiovascular surgery, even if in small numbers. The consequences of delayed recognition of a patient with COVID-19 are significant. Protocols for triage, early diagnosis, isolation in specific areas and treatment of patients with COVID-19 with cardiovascular complications should be developed to minimize the risk of in-hospital transmission and greater safety for hospitalized patients without COVID-19 and healthcare professionals (15,16).A large number of operations were canceled or postponed due to interruptions caused by COVID-19. Coincidentally, our institution have reported an increased number of mechanical complications, that maybe related to decreased number of patients seeking for medical assistance (17).Studies conducted in the first months of the pandemic showed that if countries increased their normal surgical volume by 20%, it would take an average of 45 weeks to balance the backlog of operations resulting from the interruption of COVID-19 (18). Patients awaiting elective cardiac surgery need to be proactively managed, reprioritizing those with high-risk anatomy or whose clinical status is deteriorating. In this regard, governments must mitigate this heavy burden on patients by developing recovery plans and implementing strategies to safely restore surgical activity as soon as possible.

Stump appendicitis has been reported after either open or laparoscopic appendectomy. Because of the low index of suspicion owing to a previous history of appendectomy, the diagnosis is often delayed and complications can occur. We report a 30-year-old patient with Stump appendicitis, who underwent completion appendectomy laparoscopally.

Revegetation programs aim to avoid land degradation, control soil erosion, reduce floods, and improve ecological conditions. China has planted billions of trees over the past 20 years. However, little is known about the effectiveness of this artificial revegetation, and its consequences on China’s national conservation policies and changes in biophysical factors at the county level. Here we use satellite time series data and develop a new metric, the revegetation index (RVI), that quickly monitors revegetation and its long-term changes. We found that the amount of regions where the Grain to Green Program (GTGP) successfully was implemented only about 55.8% of the areas of GTGP implementation. Surprisingly, we provide observational evidence that the implementation of the GTGP can decrease soil erosion and drought, and increase water availability, but revegetation in the Yangtze River Basin (YRB) in China has a limited impact on soil erosion, water and drought. In particular, for revegetation between 1999 and 2016, indicating that previous an assessment by the government revealed as official statistics may have overestimated the effects of the ecological restoration practices.

Abstract Sinus of Valsalva aneurysm (SVA) is a life-threatening condition that should be intervention as an emergency. Unruptured SVA is usually asymptomatic, ruptured SVA (RSVA) presented diversity especially as cardiovascular problems. This case report describes a patient with acute hepatic injury caused by RSVA. RSVA caused elevated central venous pressure and decreased portal venous inflow. The purpose of this report is to illustrate the influence of RSVA on liver.

Vector-borne pathogens exist in obligate transmission cycles between vector and reservoir host species. Host shifts can lead to geographic expansion and the emergence of new diseases. Three etiological agents of human Lyme borreliosis (Borrelia afzelii, Borrelia bavariensis, and Borrelia garinii) predominantly utilize two distinct tick species as vectors in Asia (Ixodes persulcatus) and Europe (Ixodes ricinus) but how and in which order they colonized each continent remains unknown. Here, by reconstructing the evolutionary history of 142 Eurasian isolates, we show that all three Borrelia genospecies evolved from an Asian origin, suggesting that successful expansion into Europe resulted through invading a novel vector. The pattern of gene flow between continents is different between genospecies and most likely conditioned by reservoir host association and their dispersal. Our results highlight that Eurasian Lyme borreliosis agents are all capable of geographic expansion through vector shifts, but potentially differ in their capacity as emergent pathogens.

Background: Whether perioperative glycemic control or markers of inflammation is associated with neurocognitive decline (NCD) after cardiac surgery was examined. Methods: Thirty patients undergoing cardiac surgery utilizing cardiopulmonary bypass (CPB) were screened for NCD preoperatively and on post-operative day four (POD4). Serum cytokine levels were measured and human transcriptome analysis was performed on blood samples. Neurocognitive data are presented as a change from baseline to POD4 in a score standardized with respect to age and gender. Results: A decline in neurocognitive function was identified in 73% (22/30) of patients on POD4. Patients with postoperative leukocytosis (WBC ≥ 10.5) had more NCD when compared to their baseline function (p=0.03). Patients with elevated IL-8 levels at 6 hours postoperatively had a significant decline in NCD at POD4 (p=0.04). Surprisingly, TNF-α, IL-1β, IL-2, or IL-6 levels were not associated with NCD (p>0.3 for all). There was no difference in neurocognitive function between patients with elevated HbA1c levels preoperatively (p=0.973) or elevated fasting blood glucose levels the morning of surgery (>126mg/dL, p=0.910), or a higher maximum blood glucose levels during CPB (>180mg/dL, p=0.252), or higher average glucose levels during CPB (>160mg/dL, p=0.639). Human transcriptome analysis demonstrated unique and differential patterns of gene expression in patients depending on the presence of DM and NCD. Conclusions: Perioperative glycemic control does not have an effect on NCD soon after cardiac surgery. Postoperative leukocytosis and elevated IL-8 levels are associated with neurocognitive decline. The profile of gene expression was altered in patients with NCD with or without diabetes.

Cadmium (Cd) pollution in soil pose a grave threat to human health. Combining various approaches to reduce Cd accumulation in crops is an active area of research to remediate farmlands with medium-high levels of Cd contamination. The Mercapto-functionalized palygorskite (PGS-SH) and zinc (Zn) application alone or in combination was investigated to explore reduction of Cd uptake in B. chinensis L and transformation of Cd in soil. The sole application of Zn or PGS-SH increased the biomass of B. chinensis L. and decreased the concentration of Cd in plants, but more improvements were observed from the combined application of Zn and PGS-SH. Low concentration of exogenous Zn (50 mg/kg) significantly increased the soil respiration rate (SRR) and the soil dehydrogenase activity (sDHA), while promoted B. chinensis L. growth while inhibiting Cd uptake. However, excessive exogenous Zn (≥ 200 mg/kg) significantly inhibited B. chinensis L. growth and soil microbial activity. The combined application of PGS-SH and Zn had the highest sDHA (145.59%) and lowest transport factor (TF) (27.59%) compared with the CK. The combination of PGS-SH and Zn fertilizer is a safe and effective means for remediating Cd-contaminated soil and restoring microbial activity.

Worker reproduction in social insects is often regulated by the queen’s presence but can be regulated by other colony members, such as the brood and nestmates. Adults and brood may induce the same outcomes in subordinates but may use different mechanisms. Here, we compared gene expression patterns in bumble bee workers (Bombus impatiens) in response to the queen, the brood, both or none. RNA‐seq analysis of workers’ brain identified 27 differentially expressed genes regulated by the queen and the brood. Expression levels of 8 candidate genes were re-tested using qRT-PCR in worker brain and fat body. Our results show that the brood’s effect on gene expression is substantially weaker than the queen, and a greater impact on gene expression was caused by the combined presence of the queen and the brood. All the genes that were explained by the brood presence were also regulated by the queen presence. A significant amount of the variation in gene expression was explained by the queen, that regulated the expression of key regulators of reproduction and brood care across insects, such as neuroparsin and vitellogenin. A comparison of the data with similar datasets in the honeybee and the raider ant revealed that neuroparsin is the only differentially expressed gene shared by all species. These data highlight the need to consider components other than the queen when examining mechanisms regulating worker sterility and provide information on key genes regulating reproduction that are likely to play an important role in the evolution of sociality.

In our everyday practice, we see ulcers in dialysis patients; we usually think blindly about calciphylaxis. Sometimes even we start patients on empiric treatment based on that assumption, but let us assume that something simpler may be going on, as seen in this case.

Deep rooting is often thought as a promising phenotype for resource extraction, but on soils with constraints, desired rooting depth was rarely observed. We hypothesised that if the genetic effect on root growth and rooting depth were separated from other effects, the determinants of root growth and rooting depth could be quantified. The conventional core-breaking method was used to measure root growth of wheat at two sites in two successive years under rain fed conditions. The Bayesian hierarchical nonlinear mixed models (HNLMMs) were employed to estimate root distribution, heritability and rooting depth. We found that root penetration from the non-sodic top to the sodic subsoil was most critical in determining rooting depth. Our study indicates that focusing on root-soil interaction at the transition layer where soil constraints start to emerge would lead to a more effective solution to develop resilient roots. Our work not only serves as a guide for selecting genotypes in pot trials, but also provides a theoretical support to breed advance crops with better soil adaptation.

In Africa, agriculture is largely based on low-input and small-holder farming systems that use little inorganic fertilizers and have limited access to irrigation and mechanization in comparison to modern agricultural systems. Improving agricultural practices and developing new cultivars adapted to these low-input environments, where production already suffers from climate change, is a major priority for ensuring food security in the future. Root phenes improving water and nutrient uptake could represent a solution toward achieving these goals. In this review, we illustrate how breeding for specific root phenes could improve crop adaptation and resilience in Africa using three case studies covering very contrasted low-input agro-ecosystems. We conclude with a discussion on how these phenes could be validated and made available to breeders and agronomists.

Tumor necrosis factor (TNF) alpha inhibitors are widely used to treat inflammatory bowel disease (IBD) and Sweet syndrome is known as an extra-intestinal cutaneous manifestation of IBD. We wish to highlight a paradoxical case and successful management of anti-TNF-agent-induced Sweet syndrome compared with Sweet syndrome treated by anti-TNF agents.

In this article, we established a wide range of fractional mean-type integral inequalities for notable Hilfer fractional derivative using twice differentiable convex and $s$-convex functions for $s\in(0,1]$ with related identities. Also the results for Caputo fractional derivatives are derived as a special case of our general results.

In this paper, we use the modified potential well method to study the long time behaviors of solutions to the heat flow of H-system in a bounded smooth domain of $R^2$. Global existence and finite time blowup of solutions are proved when the initial energy is in three cases. When the initial energy is low or critical, we not only give a threshold result for the global existence and blowup of solutions, but also obtain the decay rate of the $L^2$ norm for global solutions. When the initial energy is high, sufficient conditions for the global existence and blowup of solutions are also provided. We extend the recent results which were obtained in \cite{r4}.

A woman aged 41, referred with spotting, abdominal and cervical motion tenderness and adnexal mass. βHCG was positive and ultrasonography confirmed tubal pregnancy with an alive fetus. Pathology showed intact dilated fallopian tube with a fetus of 10 weeks.Advanced tubal pregnancy is uncommon and never lead to alive fetus.

Light chain systemic amyloidosis has low clinical incidence rate and poor prognosis. Relevant diagnosis depends on the biopsy results, and many patients were not confirmed until autopsy. Once amyloidosis is suspected, it is necessary to communicate with their families on the risks for treatment methods and prognosis.

Ventricular storms and fibrillation are potentially lethal arrhythmias with limited treatment options. Failed catheter ablation is associated with a fourfold maortality increase in this population. Stereotactic body radiotherapy has been proposed as last resort. We report a patient in whom radiotherapy was safely performed leading to the elimination of arrhythmias

There are number of innovations have been made in the field of medicine to give the ill patient the best of the treatment. As such the use of nanoparticles has also become an increasing demand because of their remarkable actions on the edge of targeted drug therapy. There are number of disorders that must be treated by the way as a specific treatment for the diseases like cancer in which the main purpose of the formation of these particles is to protect the healthy cells from the harmful effects of the drugs. And this could be only possible by making the drugs as specific in their action so these can only target the cells of interest as the abnormal one. Nano medicines are small particles which when given to the patient cause san improvement in the abnormality by better absorption and better distribution to the cells like abnormal one. So it is need of hour to make such drugs which have remarkable effects on the diseased part of body.