BACKGROUND AND GOAL OF STUDY Postoperative myocardial infarction is a serious and frequent complication of cardiac surgery. Nonetheless, diagnosis in this context it is occasionally challenging. We sought to evaluate the kinetics and diagnostic accuracy of the new biomarker ? heart-type fatty acid-binding protein ? (h-FABP) in the early detection of myocardial injury in patients undergoing off-pump coronary artery bypass grafting, compared with classical biomarkers. MATERIALS AND METHODS A prospective study was conducted on 17 consecutive patients who underwent off-pump coronary artery bypass grafting during a 2 month period. Blood samples were drawn for measurement of myocardial ischemic injury biomarkers (h-FABP, troponin, creatine kinase [CK] and CK-MB), at baseline (T1), immediate post-coronary artery bypass grafting (T2), on ICU admission (T3), and after 4 (T4), 8 (T5), 24 (T6) and 48 h (T7). Perioperative ischemic complications, defined according to electrocardiographic, echocardiographic and hemodynamic criteria, were recorded. RESULTS Earlier biomarkers peak plasma values occurred at T4 with troponin (2.9 5.2 ng/mL), and at T5 with h-FABP (37.9 55.5 ng/mL). Maximum values of CK and CK-MB occurred later, both in T6 (741 779 and 37 51 U/L, respectively). The optimized cut-off obtained for h-FABP was 19 ng/mL, providing a sensitivity and specificity of 77 and 75%, respectively, for diagnosis of perioperative ischemic injury, with an area under the ROC curve for h-FABP of 0.83 (95% CI 0.6-1.0) vs. 0.63 (95% CI 0.33-0.83) for troponin. This cut-off value for h-FABP is reached on average at T2 (mean value of h-FABP at T2: 18.9 21.5 ng/mL). CONCLUSION This is the first study evaluating the kinetics of h-FABP biomarker in perioperative off-pump coronary artery bypass grafting, and the cut-off value established could help to extend earlier detection of myocardial ischemia in this context.

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic posed a serious public health concern and started a race against time for researchers to discover an effective and safe therapy for coronavirus disease 2019 (COVID-19), the disease caused by SARS-CoV-2. This review aims to describe the history, efficacy, and safety of five potential therapeutics for COVID-19, remdesivir, favipiravir, hydroxychloroquine, tocilizumab, and convalescent plasma. A literature review was conducted through October 2020 to identify published studies evaluating the efficacy and safety of these five potential therapeutics. Clinical improvement was used to assess the efficacy, while reported withdrawals from study participation and adverse events were used to evaluate the safety. In total, 95 clinical studies (6 interventional and 89 observational studies) were obtained, of which 42 were included in this review. The evaluation of the efficacy and safety profiles is challenging due to the limitations of the clinical studies on one hand, and the limited number of randomized controlled trials (RCTs) on the other. Moreover, there was insufficient evidence to support repurposing remdesivir, favipiravir, and tocilizumab for COVID-19.

The rupture of an intracranial aneurysm, which can result in severe mental disabilities or death, affects approximately 30,000 people in the United States annually. The traditional surgical method of treating these arterial malformations involves a full craniotomy procedure, wherein a clip is placed around the aneurysm neck. In recent decades, research and device development have focused on new endovascular treatment methods to occlude the aneurysm void space. These methods, some of which are currently in clinical use, utilize metal, polymeric, or hybrid devices delivered via catheter to the aneurysm site. In this review, we present several such devices, including those that have been approved for clinical use, and some that are currently in development. We present several design requirements for a successful aneurysm filling device and discuss the success or failure of current and past technologies. We also present novel polymeric-based aneurysm filling methods that are currently being tested in animal models that could result in superior healing.

Patients with a compromised immune system suffer a wide variety of insults. Pulmonary complications remain a major cause of both morbidity and mortality in immunocom-promised patients. When such individuals present with radio-graphic infiltrates, the clinician faces a diagnostic challenge. The differential diagnosis in this setting is broad and includes both infectious and non-infectious conditions. Evaluation of the immunocompromised host with diffuse pulmonary infiltrates can be difficult, frustrating, and time-consuming. This common and serious problem results in significant morbidity and mortality, approaching 90%. Infections are the most common causes of both acute and chronic lung diseases leading to respiratory failure. Non-invasive diagnostic methods for evaluation are often of little value, and an invasive procedure (such as bronchoalveolar lavage, transbronchial biopsy or even open lung biopsy) is therefore performed to obtain a microbiologic and histologic diagnosis. Bronchoscopy allows certain identification of some aetiologies, and often allows the exclusion of infectious agents. Early use of computed tomography scanning is able to demonstrate lesions missed by conventional chest X-ray. However, even when a specific diagnosis is made, it might not impact patients overall survival and outcomes.

Profesi dokter dalam melaksanakan tugas dan tanggungjawabnya tidak hanya mampu mendiagnosa pasien saja namun juga harus mampu berkomunikasi yang efektif dengan pasien sehingga pasien dapat dengan jujur menjelaskan gejala yang dirasakan oleh pasien. Dalam penelitian ini komunikasi dokter yang berpusat pada pasien terutama di masa pandemic seperti ini yang dikuatirkan adalah komunikasi yang terjalin adalah komunikasi yang kurang efektif dikarenakan rasa kuatir dan ketakutan. Komunikasi Dokter yang berpusat pada pasien meliputi enam aspek yaitu: 1) Memperkuat hubungan (fostering the relationship) 2) Mengumpulkan informasi (gathering information) 3) Memberikan informasi (providing information) 4) Mengambil keputusan (desicion making) 5) Merespon emosi (responding the emotions) 6) memampukan perilaku terkait pengobatan penyakit. (Enabling disease and treatment related behavior) yang merupakan pembahasan dalam penelitian ini.

For the first time in history the Olympic Games were postponed for a year, from 2020 to 2021. This chapter aims at analysing the impact of the crisis on the business model of the Olympic Games and what opportunities the crisis has given to the organisers to rethink the Olympics in a more sustainable way. Using the Stakeholder Theory Framework, the chapter will illustrate the consequences of the postponement on the main actors involved in the Games. This research would like to demonstrate how the crisis, initially considered a negative event, can instead prove to be an opportunity to formulate a new and more inclusive business model. ? 2022, The Author(s), under exclusive license to Springer Nature Switzerland AG.

Abstract The Rotavirus genus belongs to the family Reoviridae and its genome consist of 11 segments of double-stranded RNA. Group A rotaviruses (RV-A) are the main etiological agent of acute viral gastroenteritis in infants and young children worldwide. Understanding the extent and causes of biases in codon usage is essential to the understanding of viral evolution. However, the factors shaping synonymous codon usage bias and nucleotide composition in human RV-A are currently unknown. In order to gain insight into these matters, we analyzed the codon usage and base composition constraints on the two genes that codify the two outer capsid proteins (VP4 [VP8*] and VP7) of 58 P[4]G2 RV-A strains isolated in Brazil and investigated the possible key evolutionary determinants of codon usage bias. The results of these studies revealed that the frequencies of codon usage in both RV-A proteins studied are significantly different than the ones used by human cells. In order to observe if similar trends of codon usage are found when RV-A complete genomes are considered, we compare these results with results found using a dataset of 10 reference strains for whom the complete codes of the 11 segments are known. Similar results were obtained using capsid proteins or complete genomes. The general correlations found between the position of each sequence on the first axis generated by correspondence analysis and the relative dinucleotide abundances indicate that codon usage in RV-A can also be strongly influenced by underlying biases in dinucleotide frequencies. CpG and GpC containing codons are markedly suppressed. Thus, the results of this study suggest that RV-A genomic biases are the result of the evolution of genome composition in relation to host adaptation and the ability to escape antiviral cell responses.

Haemorrhagic cholecystitis (HC) is a rare cause of cholecystitis that can be fatal if management is delayed. HC could present in the setting of trauma, malignancy and bleeding diathesis, such as renal failure, cirrhosis and anticoagulation. Its symptoms are easily confused with acute calculous or acalculous cholecystitis and might include haemobilia or hematemesis as blood drains from the gallbladder into the gastrointestinal tract. Imaging of HC can be misleading unless the possibility of this diagnosis is considered. In this report, we present an interesting case of HC in a patient with none of the above comorbidities and the patient who was not on anticoagulation neither anti platelets. The case includes relevant imaging and a review of the literature on this rare subject.

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Since November 6th, 2020, Italian regions have been classified according to four levels, corresponding to specific risk scenarios, for which specific restrictive measures have been foreseen. By analyzing the time evolution of the reproduction number [Formula: see text] , we estimate how much different restrictive measures affect [Formula: see text] , and we quantify the combined effect of the diffusion of virus variants and the beginning of the vaccination campaign upon the [Formula: see text] trend. We also compute the time delay between implementation of restrictive measures and the resulting effects. Three different models to describe the effects of restrictive measures are discussed and the results are cross-checked with two different algorithms for the computation of [Formula: see text] .

A simulation tool that supports developers to build scenarios automatically in multiple simulation platforms is proposed. As an essential part of this simulator, this study proposed an activity schedule generator to mimic the daily life of elderly people living alone. This generator outperforms existing methods of activity schedule planning in three aspects: 1) it is adaptive to the layout of a simulated smart house; 2) there is no unspecified time in the timeline of generated schedules; and 3) it generates stable, but not tedious schedules for a number of days. A real-time location data generator is proposed to convert generated schedules to simulated real-time location data of the resident, and a proposed interface converts these simulated location data to simulated records of virtual passive infrared (PIR) sensors, which can be used to optimize placement of PIR sensors in a smart house.

Coronavirus disease 2019 (COVID-19) is rapidly spreading. Researchers around the world are dedicated to finding the treatment clues for COVID-19. Drug repositioning, as a rapid and cost-effective way for finding therapeutic options from available FDA-approved drugs, has been applied to drug discovery for COVID-19. In this study, we develop a novel drug repositioning method (VDA-KLMF) to prioritize possible anti-SARS-CoV-2 drugs integrating virus sequences, drug chemical structures, known Virus-Drug Associations, and Logistic Matrix Factorization with Kernel diffusion. First, Gaussian kernels of viruses and drugs are built based on known VDAs and nearest neighbors. Second, sequence similarity kernel of viruses and chemical structure similarity kernel of drugs are constructed based on biological features and an identity matrix. Third, Gaussian kernel and similarity kernel are diffused. Forth, a logistic matrix factorization model with kernel diffusion is proposed to identify potential anti-SARS-CoV-2 drugs. Finally, molecular dockings between the inferred antiviral drugs and the junction of SARS-CoV-2 spike protein-ACE2 interface are implemented to investigate the binding abilities between them. VDA-KLMF is compared with two state-of-the-art VDA prediction models (VDA-KATZ and VDA-RWR) and three classical association prediction methods (NGRHMDA, LRLSHMDA, and NRLMF) based on 5-fold cross validations on viruses, drugs, and VDAs on three datasets. It obtains the best recalls, AUCs, and AUPRs, significantly outperforming other five methods under the three different cross validations. We observe that four chemical agents coming together on any two datasets, that is, remdesivir, ribavirin, nitazoxanide, and emetine, may be the clues of treatment for COVID-19. The docking results suggest that the key residues K353 and G496 may affect the binding energies and dynamics between the inferred anti-SARS-CoV-2 chemical agents and the junction of the spike protein-ACE2 interface. Integrating various biological data, Gaussian kernel, similarity kernel, and logistic matrix factorization with kernel diffusion, this work demonstrates that a few chemical agents may assist in drug discovery for COVID-19.

Background: Angiotensin-converting enzyme 2 (ACE2) is primarily involved in the ma-turation of angiotensin. It also represents the main receptor for the Severe Acute Respiratory Syn-drome coronavirus 2 (SARS-CoV-2) that caused a serious epidemic COVID-19. Available evi-dence indicates that at the cell membrane, ACE2 can form heteromeric complexes with other mem-brane proteins, including the amino acid transporter B0AT1 and G protein-coupled receptors (G-PCR). Objective: It is well known that during the formation of quaternary structures, the configuration of every single monomer is re-shaped by its interaction pattern in the macromolecular complex. There-fore, it can be hypothesized that the affinity of ACE2 to the viral receptor-binding domain (RBD), when in a heteromeric complex, may depend on the associated partner. Methods: By using established docking and molecular dynamics procedures, the reshaping of monomer was explored in silico to predict possible heterodimeric structures between ACE2 and GPCR, such as angiotensin and bradykinin receptors. The associated possible changes in the bind-ing affinity between the viral RBD and ACE2 when in the heteromeric complexes were also esti-mated. Results and Conclusion: The results provided support to the hypothesis that the heteromerization state of ACE2 may modulate its affinity to the viral RBD. If experimentally confirmed, ACE2 heteromerization may contribute to explain the observed differences in susceptibility to virus infec-tion among individuals and to devise new therapeutic opportunities.

BACKGROUND: The SARS-CoV-2 infection has emerged as a rapidly spreading infection. Today it is relatively easy to isolate Covid-19 symptomatic cases, while remains problematic to control the disease spread by infected but symptom-free individuals. The control of this possible path of contagion requires drastic measures of social distancing, which imply the suspension of most activities and generate economic and social issues. This study is aimed at estimating the percentage of asymptomatic SARS-CoV-2 infection in a geographic area with relatively low incidence of Covid-19. METHODS: Blood serum samples from 388 healthy volunteers were analyzed for the presence of anti-SARS-CoV-2 IgG by using an ELISA assay based on recombinant viral nucleocapsid protein. RESULTS: We found that 7 out of 388 healthy volunteers, who declared no symptoms of Covid-19, like fever, cough, fatigue etc., in the preceding 5 months, have bona fide serum anti-SARS-CoV-2 IgG, that is 1.8% of the asymptomatic population (95% confidence interval: 0.69-2.91%). CONCLUSIONS: The estimated range of asymptomatic individuals with anti-SARS-CoV-2 IgG should be between 26,565 and 112, 350. In the same geographic area, there are 4665 symptomatic diagnosed cases.

Background: The state of Cear (Northeast Brazil) has shown a high incidence of coronavirus disease (COVID-19), and most of the cases that were diagnosed during the epidemic originated from the capital Fortaleza. Monitoring the dynamics of the COVID-19 epidemic is of strategic importance and requires the use of sensitive tools for epidemiological surveillance, including consistent analyses that allow the recognition of areas with a greater propensity for increased severity throughout the cycle of the epidemic. This study aims to classify neighborhoods in the city of Fortaleza according to their propensity for a severe epidemic of COVID-19 in 2020. Methods: : We conducted an ecological study within the geographical area of the 119 neighborhoods located in the city of Fortaleza. To define the main transmission networks (infection chains), we assumed that the spatial diffusion of the COVID-19 epidemic was influenced by population mobility. To measure the propensity for a severe epidemic, we calculated the infectivity burden (I ty B), infection burden (I on B), and population epidemic vulnerability index (PEVI). The propensity score for a severe epidemic in the neighborhoods of the city of Fortaleza was estimated by combining the I on B and PEVI. Results: : The neighborhoods with the highest propensity for a severe COVID-19 epidemic were Aldeota, Cais do Porto, Centro, Edson Queiroz, Vicente Pinzon, Jose de Alencar, Presidente Kennedy, Papicu, Vila Velha, Antonio Bezerra, and Cambeba. Importantly, we found that the propensity for a COVID-19 epidemic was high in areas with differing socioeconomic profiles. These areas include a very poor neighborhood situated on the western border of the city (Vila Velha), neighborhoods characterized by a large number of subnormal agglomerates in the Cais do Porto region (Vicente Pinzon), and those located in the oldest central area of the city, where despite the wealth, low-income groups have remained (Aldeota and the adjacent Edson Queiroz). Conclusion: Although measures against COVID-19 should be applied to the entire municipality of Fortaleza, the classification of neighborhoods generated through this study can help improve the specificity and efficiency of these measures.

OBJECTIVE: The present study aimed to evaluate anxiety in patients and to monitor their heart rate (HR) and blood oxygenation (SpO(2)) before, during, and after a root canal treatment (RCT) during the state of alarm in two different periods of strict and partial confinement. METHODS: The patients that required a primary RCT were selected. Demographic, pre-, and postoperative variables were registered, including perceived dental anxiety, fear, HR, and SpO(2). Spearman correlation, X(2), Mann-Whitney, and Kruskal-Wallis tests were used for frequency distribution and variable interaction, and Wilcoxon and Mann-Whitney tests to compare HR and SpO(2) between groups and different treatment points. RESULTS: Ninety-six patients were included. Median MDAS was 8 [6, 9.25] and 6 [5,5; 8] in patients treated during the strict and partial confinement periods. Fear median score was 2 [0; 5] and 3 [1; 5] respectively. Having a previous dental bad experience resulted in higher dental anxiety and fear (p < 0.05). HR was increased in patients with higher MDAS and fear scores and in those treated during the strict confinement (p < 0.05). In T6 and T7, HR decreased compared to the other evaluated treatment time points (p < 0.05). No clinical differences were found regarding SpO(2). CONCLUSIONS: Self-perception on dental anxiety and fear was similar to other studies in a non-pandemic context. Patients with higher levels of dental anxiety and those treated in the strict confinement period presented an elevated HR. However, it can be stated that RCT performed by endodontists does not result in a significant alteration in patients.

Background: Face masks are an effective, non-pharmacological strategy to reduce the transmission of Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) and other pathogens. However, it is a challenge to keep masks sealed during exercise, as ventilation can increase from 5-10 L/min at rest to up to 200 L/min so that masks may be blown away from the face. To reduce leakage e.g. during exercise, a face mask was developed that is taped onto the face. The aim of this study was to investigate during a graded cycle ergometry test the effect of a taped mask on the perception of breathlessness, heart rate, lactate, and oxygen saturation when compared to a surgical mask and no mask. Methods: : Four trained and healthy males and females each (n=8 in total) performed incremental cycle ergometer tests until voluntary exhaustion under three conditions: (1) No mask/control, (2) surgical mask or (3) taped mask. During these tests, we measured perception of breathlessness, heart rate, the concentration of blood lactate and peripheral oxygen saturation and analysed the resultant data with one or two-way repeated measures ANOVAs. We also used a questionnaire to evaluate mask comfort and analysed the data with paired t-tests. Results: : When compared to wearing no mask, a taped face mask significantly reduces the maximal workload in a graded exercise test by 126% (p=0.001). Moreover, with a taped face mask, subjects perceive severe breathlessness at 129% lower workload (p=0.012) and oxygen saturation at 65% of the maximal workload is 1.5% lower (p=0.018) when compared to wearing no mask. Heart rate and the concentration of lactate were not significantly different at any workload. When compared to wearing a surgical mask, wearing a taped face mask has a significantly better wearing comfort (p=0.038), feels better on the skin (p=0.004), there is a lower sensation of moisture (p=0.026) and wearers perceive that less heat is generated (p=0.021). We found no sex/gender differences for any parameters. Conclusions: : A taped mask is well tolerated during light and moderate exercise intensity but reduces maximal exercise capacity.

PURPOSE: To evaluate the rates of post-intravitreal injection related endophthalmitis during the COVID-19 pandemic with institution of both physician and patient face masking. METHODS: All eyes receiving intravitreal injections of any kind from a single large tertiary retina practice in Houston, TX, USA before (August 2017-March 22, 2020) and after (March 23, 2020-Sept 2020) COVID-19 pandemic universal masking protocols. The total number of injections and cases of acute injection-related endophthalmitis were determined from billing records and subsequent retrospective chart review. The primary outcome was the rate of endophthalmitis after intravitreal injection. Secondary outcomes included visual acuity, time until initial presentation, patient age, and differences in overall number of injections performed monthly pre- and post-COVID 19. RESULTS: A total of 134, 097 intravitreal injections were performed during the study period (111,679 pre-COVID-19 and 22,418 post-COVID-19 masking protocols). A total of 41 cases of acute endophthalmitis occurred in the pre-COVID group (0.04%, 1 in 2500) and 7 cases in post COVID group (0.03%, 1 in 3333) p = 0.85. CONCLUSION: In this single center, retrospective study, the implementation of universal patient and physician masking as practiced during the COVID-19 pandemic did not significantly affect the rate of post intravitreal injection endophthalmitis.

INTRODUCTION Covid 19 infections has been shown to be associated with a range of thromboembolic disease that has implications for the neuro-endovascular management of large vessel occlusions METHODS Five consecutive Covid-19 positive patients presented with large vessel occlusions to our institution Covid-19 testing was performed using nasal swab All thrombectomy cases was performed under general endotracheal anesthesia using a stent-aspiration combination as primary thrombectomy technique The technical details of each case and the angiographic outcome are described Routine labs including D-dimer, platelet count, coagulation panel (aPTT, INR), Interleukin 6 (IL-6), erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) were evaluated in all patients Rotational thrombelastography (ROTEM) was performed on the patients' blood samples to assess real-time clot formation/dissolution properties RESULTS Four patients had anterior circulation large vessel occlusions and one patient had both anterior and posterior circulation occlusions Mean age was 52 8 years and 80% were males TICI 3 revascularization was achieved in one patient, TICI 2B achieved in two patients andTICI 2A in two patients In our cohort, patients were on average 52 8 years old and presented with a median NIHSS of 27 All our patients had very proximal occlusions Three patients presented with intra-cranial ICA occlusions Two patients presented with a tandem carotid bulb thrombus in conjunction with an intracranial vessel occlusion One patient had an ICA terminus occlusion with a concomitant basilar occlusion Second, the intravascular clots in all our patients were prone to fragment and migrate into both new vascular territories and into distal downstream vasculature Distal emboli into a different territory (anterior cerebral artery occlusion) was seen in two two of our five patients (40%) and distal emboli into a downstream territory was seen in all five patients (100%) An average of 2 7 pstent-retriever passes was needed to achieve a final TICI revascularization of IIb or better CONCLUSION Covid-19 patients are predisposed to a hypercoagulable state When presenting with large vessel occlusions, these patients present unique challenges that make successful revascularization difficult

ABSTRACT: We assess the utility of a Centers for Disease Control and Prevention (CDC) guidelines-based coronavirus disease 2019 (COVID-19) screening checklist for postmortem severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) surveillance, detailing the relationship between the histologic findings at autopsy and attribution of death to COVID-19.SARS-CoV-2 nasopharyngeal swabs were collected at the time of autopsy in all "checklist-positive" decedents. Additional "checklist-negative" decedents were randomly tested daily. Lung slides were blindly reviewed by 3 pathologists, assessing for the presence of diffuse alveolar damage (DAD) and other findings. Sixteen decedents had positive postmortem SARS-CoV-2 nasopharyngeal swabs and underwent complete autopsies. Seven decedents had positive screening checklists. Of these, 4 had DAD and 1 had COVID-19-associated thromboembolic disease. Of the 9 decedents with negative screening checklists, 2 had DAD, but only 1 was attributed to COVID-19; the other was likely drug related. Acute bronchopneumonia was the second most common finding, and aspiration was the likely etiology in cases without concomitant DAD. COVID-19-related DAD was identified more commonly in decedents who screened positive by CDC checklist, but false-negatives did occur. Medical examiner offices should maintain a low threshold for random testing of decedents even when COVID-19 is not suspected.