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Objectives explore thoughts and feelings of children on COVID-19, find out how they cope, and what they did during lockdown. It was total lockdown in Luzon, Philippines, April 2020 – when survey was conducted; pre-tested open-end questionnaire was administered to children who answered either by paper and pen, or through social media, with parents’ cooperation. Participants 200 boys and girls, 6-12 years old, public and private schools in NCR-Luzon. Results Participants heard COVID-19, pandemic and lock down from media and family; described as deadly, dangerous, contagious, world-wide, death-causing virus; about 90% expressed sadness, fear, boredom, anger, disappointments and difficult time; employed self-enhanced coping mechanisms, and engaged in hobbies and interests to assuage thoughts and feelings; family appeared as saving grace. Recommendations: develop strategies to assist children during critical events; studies – find out effects of pandemic on participants’ health; visit participants after two years to find out reminiscence of pandemic experience.

Background Elevated triglycerides to high-density lipoprotein cholesterol (TG/HDL-C) ratio has been utilised as a predictor of outcomes in patients with adverse cardiometabolic risk profiles. In this study, we examined the prognostic value of elevated TG/HDL-C level in an Australian population of patients with high clinical suspicion of coronary artery disease (CAD) presenting for coronary angiography. Methods Follow-up data was collected for 482 patients who underwent coronary angiography in a prospective cohort study. The primary endpoint was all-cause mortality and the secondary endpoint was a major adverse cardiac event (MACE). Patients were stratified into two groups according to their baseline TG/HDL-C ratio, using a TG/HDL-C ratio cut point of 2.5. Results The mean follow-up period was 5.1 ± 1.2 years, with 49 all-cause deaths. Coronary artery disease on coronary angiography was more prevalent in patients with TG/HDL-C ratio ≥2.5 (83.6% vs. 69.4%, p = 0.03). On the Kaplan-Meier analysis, patients with TG/HDL-C ratio ≥2.5 had worse long-term prognosis (p = 0.04). On multivariate Cox regression adjusting for established cardiovascular risk factors and CAD on coronary angiography, TG/HDL-C ratio ≥2.5 was an independent predictor of long-term all-cause mortality (hazard ratio [HR] 2.10, 95% confidence interval [CI] 1.04–4.20, p = 0.04). On multivariate logistic regression adjusting for known cardiovascular risk factors and CAD on coronary angiography, TG/HDL-C ratio ≥2.5 was strongly associated with an increased risk of long-term MACE (odds ratio [OR] 2.72, 95% CI 1.42–5.20, p = 0.002). Conclusions Elevated TG/HDL-C ratio is an independent predictor of long-term all-cause mortality and is strongly associated with an increased risk of MACE.

Background Rural patients with atherosclerotic cardiovascular disease (ASCVD) experience greater cardiovascular morbidity and mortality than their urban counterparts. Statin therapy is a key component of ASCVD treatment. The extent to which there may be regional differences in long-term adherence to statins is unknown. Objective To assess long-term rates of adherence to statins in a high-risk ASCVD cohort, and whether regional differences exist between rural and urban patients. Methods Follow-up was conducted in patients who underwent coronary angiography at a single tertiary center between 2009 and 2013. Adherence was defined as consumption of prescribed statin ≥6 days per week. Patients were divided into remoteness areas (RAs), classified as RA1 (major city), RA2 (inner regional), and RA3 (outer regional) based on the Australian Standard Geographical Classification. Results Five hundred twenty-five patients (69% male, mean age 64 ± 11 years) were followed-up after a median of 5.3 years. Baseline characteristics were similar between RAs. Overall adherence was 83%; however, rural patients were significantly more adherent to their statin therapy (80% in RA1, 83% in RA2, and 93% in RA3, P = .04). Living in RA3 independently predicted greater statin adherence than living in RA1 (odds ratio: 2.75, 95% CI: 1.1–7.8, P = .03). All-cause mortality was significantly higher in RA3 than other regional areas (6% RA1, 12% RA2, and 18% RA3, P = .01). Conclusions Despite higher all-cause mortality, rural patients with ASCVD demonstrate significantly greater long-term adherence to statins than urban patients. Other factors, such as reduced access to health care and delayed diagnosis may explain the gap in outcomes between rural and urban patients.

Percutaneous coronary intervention (PCI) continues to evolve with shifting patient demographics, treatments, and outcomes. We sought to document the specific changes observed over a 9-year period in a contemporary Australian PCI cohort. The Melbourne Interventional Group is an established multicenter PCI registry in Melbourne, Australia. Data were collected prospectively with 30-day and 12-month follow-ups. Demographic, procedural, and outcome data for all consecutive patients were analyzed with a year-to-year comparison from 2005 to 2013. National Death Index linkage was performed for long-term mortality analysis; 19,858 procedures were captured over 9 years. Patient complexity and acuity increased with a higher proportion of traditional risk factors and more elderly patients who underwent PCI. Angiographic lesion complexity increased with more multivessel coronary artery disease and more American College of Cardiology/American Heart Association type B2/C lesions proceeding to PCI. The 30-day rate of death, myocardial infarction, or target vessel revascularization has not changed nor has 12-month mortality, myocardial infarction, or major adverse cardiovascular event rates. The strongest independent predictor of long-term mortality was cardiogenic shock at presentation (hazard ratio [HR] 2.95, p

Postoperative atrial fibrillation (POAF) is a common complication after coronary artery bypass grafting (CABG) and is associated with increased short-term and long-term mortality. While the precise etiology of POAF remains unclear, inflammation is a known contributing factor. Preliminary studies have suggested that an elevated preoperative platelet-to-lymphocyte ratio (PLR), an inexpensive and readily available novel inflammatory biomarker, may be associated with increased incidence of POAF after CABG. This study sought to further investigate this hypothesis.The study cohort included all patients undergoing isolated CABG, with no prior history of arrhythmia, who were operated on between August 1, 2010, and December 31, 2018, at a major Australian tertiary center (n = 1457). Patients were divided into low (86) or high (≥86) PLR groups based on an optimal cutoff derived from receiver-operating characteristic curve analysis. The incidence of POAF was then compared. Categorical variables were analyzed using the chi-square test and continuous variables using logistic regression.Of 1457 patients, 495 (34.0%) developed POAF. There was no statistically significant difference in the incidence of POAF between patients in the high-PLR and low-PLR groups (34.8% vs 31.0%; P = .22). Using multivariable logistic regression analysis, high PLR was not independently associated with POAF (odds ratio, 1.04; P = .78).Elevated preoperative PLR is not independently associated with POAF in patients undergoing isolated CABG. The findings of this study differ from those of 2 previous smaller studies.

Background Although acute coronary syndromes (ACS) are a major cause of morbidity and mortality, relationships with biologically active lipid species potentially associated with plaque disruption/erosion in the context of their lipoprotein carriers are indeterminate. The aim was to characterize lipid species within lipoprotein particles which differentiate ACS from stable coronary artery disease. Methods and Results Venous blood was obtained from 130 individuals with de novo presentation of an ACS (n=47) or stable coronary artery disease (n=83) before coronary catheterization. Lipidomic measurements (533 lipid species; liquid chromatography electrospray ionization/tandem mass spectrometry) were performed on whole plasma as well as 2 lipoprotein subfractions: apolipoprotein A1 (apolipoprotein A, high‐density lipoprotein) and apolipoprotein B. Compared with stable coronary artery disease, ACS plasma was lower in phospholipids including lyso species and plasmalogens, with the majority of lipid species differing in abundance located within high‐density lipoprotein (high‐density lipoprotein, 113 lipids; plasma, 73 lipids). Models including plasma lipid species alone improved discrimination between the stable and ACS groups by 0.16 (C‐statistic) compared with conventional risk factors. Models utilizing lipid species either in plasma or within lipoprotein fractions had a similar ability to discriminate groups, though the C‐statistic was highest for plasma lipid species (0.80; 95% CI, 0.75–0.86). Conclusions Multiple lysophospholipids, but not cholesterol, featured among the lipids which were present at low concentration within high‐density lipoprotein of those presenting with ACS. Lipidomics, when applied to either whole plasma or lipoprotein fractions, was superior to conventional risk factors in discriminating ACS from stable coronary artery disease. These associative mechanistic insights elucidate potential new preventive, prognostic, and therapeutic avenues for ACS which require investigation in prospective analyses.

Objective: To compare clinical and functional outcomes of regional and urban pa-tients after transcatheter aortic valve implantation for severe aortic stenosis. Methods: Data were collected at patient follow- up post- transcatheter aortic valve implantation at 30 days and 12 months. Patients were stratified by residential post-codes into remoteness areas using the Australian Statistical Geography Standard. Design: Retrospective cohort study. Setting: Single- centre tertiary referral hospital. Participants: Patients undergoing transcatheter aortic valve implantation (n = 142) from 2009 to 2018 were analysed, with 77 patients (54.2%) residing in regional Victoria and New South Wales. Main outcome measures: Procedural success, adverse event rates, readmission rates, mortality rates, loss to follow- up and functional improvement. Results: Patients residing in regional areas had a lower mean age (81.8 vs 83.7 years) and proportion of Stage 4 or 5 chronic kidney disease (1.3% vs 9.2%), compared with urban patients. Procedural characteristics and immediate post- procedural outcomes were similar between both groups. There was no statistically significant difference in mortality, readmission rates or loss to follow- up between the two cohorts. Regional pa-tients demonstrated poorer rates of functional improvement at 30 days (50.7% vs 67.7%); however, this difference was not sustained at 12 months (79.2% vs 71.0%). Frailty was demonstrated to be an independent predictor of poor 30- day functional improvement. Conclusion: Regional patients treated with transcatheter aortic valve implantation for severe aortic stenosis have non- inferior 30- day and 12- month outcomes, when compared with urban patients. Frailty is a predictor of poor functional improvement post- transcatheter aortic valve implantation.

Platelet-to-lymphocyte ratio (PLR) has recently been studied as a biomarker in patients with established coronary artery disease (CAD). The association between PLR and long-term all-cause mortality is unclear in patients at high risk of CAD who undergo coronary angiography for various indications. Follow-up was completed for 514 patients who underwent coronary angiography in a prospective study cohort. The primary end point was all-cause mortality. Patients were classified into tertiles based on preangiography PLR and also dichotomized based on the optimal cutoff at a PLR of 137, determined from the receiver operating characteristic curve analysis. The mean follow-up period was 5.0 ± 1.3 years, with 50 all-cause deaths. On the Kaplan-Meier analysis, patients in Tertile 3 (PLR > 145) had worse prognosis than patients in Tertiles 1 (PLR ≤ 106) and 2 (PLR 106.1 to 145) (p = 0.0075), and patients with PLR ≥ 137 had a significantly higher rate of all-cause mortality than those with PLR

Purpose: This cross-sectional study included 653 children aged 2–18 years located in Jeddah, Saudi Arabia (2015–2016). This study aimed to determine the association between dietary intake (daily, weekly and rarely) and anthropometric measurements. Method: Both child and family questionnaire was given, followed by weight and height measurements. The questionnaire consisted of general demographic information, anthropometric measurements, analysis of various nutritional element of daily intake. Using one-way ANOVA test after checked all assumptions. Also, Welch test was using whiles the assumption of homogeneity of variance not satisfied by levene test. Results: Higher mean BMI in children consuming legumes daily than weekly and rarely and also higher BMI mean in children drinking milk rarely than daily and weekly. While lower mean BMI in children drinking soft drinks rarely. For children height, the means among eating proteins, vegetables and drinking milk daily have lower heights mean than weekly and rarely. Height means in children who eating and drinking daily fat, fast food, and soft drinks have higher heights mean than weekly and rarely. Weight SDs with various nutrition elements shows no significant relation. Conclusion: Different type of nutritional elements and its effect on children’s growth so further studies should be made to identify the values of the level of food intake and its benefit on the child growth.

Introduction Intracortical inhibition (ICI) and facilitation (ICF) in the primary motor cortex (M1) can be measured using a paired-pulse transcranial magnetic stimulation (ppTMS) protocol. The aim of the present study is to characterize the M1 connectivity (inhibition and facilitation) by means of navigated-ppTMS and cognitive assessment using the attention switching task (AST) through the Cambridge Neuropsychological Test Automated Battery. Methods We examined the responses of the left and right M1 to sub-threshold and supra-threshold single and pp stimulation in healthy (n = 50; 46% men; age, 35.5 ± 14.9 years) right-handed individuals using ppTMS. The subjects were evaluated using a combination of physiological motor evoked potentials (MEPs), motor threshold (MT), 3 ms intracortical inhibition (SICI), 7 ms and 12 ms ICF, and long intracortical inhibition (LICI) (100 ms). The cognitive function was evaluated using the AST. Results We report significant SICI (3 ms), ICF (12 ms), and LICI (100 ms) in the left and right hemispheres. We found significant differences in the right hemispheric cortico-spinal excitability (12 ms) between men and women. A correlation analysis revealed no significant relationship between AST performance and MEPs in subjects prior to and following ppTMS. Conclusion ppTMS is a promising tool to better characterize the regulation of the balance between inhibition and facilitation within the M1.

R A L A B ST R who discontinued on the day of surgery. Fifty-one percent of current smokers resumed smoking in the year after surgery, with 80% of these resuming within 2 weeks. Conclusion: The timing of smoking cessation prior to surgery does not impact on cardiovascular, major medical outcomes or death in the perioperative period. Therefore, physicians seeing a patient even within 8 weeks of surgery should have no reservations about encouraging abstinence. Resumption of smoking after surgery is common and indicates that there are opportunities to encourage more sustained abstinence. Disclosure of Interest: None Declared A C T S O063

Large sessile lipomas, adenomas, and other tumors are often not amenable to endoscopic excision, due to the risk of bleeding or perforation. Resection of these lesions has traditionally required laparotomy with enterotomy for complete removal. A novel technique, described here, is the combination of laparoscopy and simultaneous endoscopy, allowing for complete removal of these lesions while preserving the benefits of minimally invasive surgery.

Complications following pancreaticoduodenectomy are common, partly because of nutritional debilitation. The aim of this study was to evaluate the impact of early postoperative tube feeding on outcome of pancreaticoduodenectomy and determine the best method for delivering enteral feeding. A retrospective review of 180 consecutive patients undergoing Whipple operations from 1994 to 2000 was performed. Two nonrandomized patient groups were retrospectively studied: those with early postoperative tube feeding vs. those with no planned feeding. Ninety-eight patients (54%) received postoperative jejunal feeding, whereas 82 patients (46%) did not. Jejunal feeding was delivered via a bridled nasojejunal tube in 55 patients (56%) and a gastrojejunal tube in 43 (44%). Vomiting (10% vs. 29%; P = 0.002) and use of total parenteral nutrition (6% vs. 27%; P < 0.0001) were less in the jejunal feeding group as well as rates of readmission (12% vs. 27%; P = 0.022), early (52% vs. 62%; P = 0.223) and late (12% vs. 31%, P = 0.005) complications, and infections (13% vs. 20%, P = 0.014). Tube-related complications occurred in 6 of 98 patients, all of which were associated with gastrojejunal tubes (P = 0.021). Early postoperative tube feeding after pancreaticoduodenectomy is associated with significantly less use of total parenteral nutrition and lower rates of readmission and complications. A bridled nasojejunal feeding tube appears to be a safe and reliable method of short-term enteral feeding.

Intercellular secretory capillaries in parotid glands, eccrine sweat glands and intracellular secretory capillaries in parietal cells of gastric glands were demonstrated histo-chemically by the use of the Wachstein-Meisel adenosinetriphosphatase (ATPase) technique in the rabbit, rat and guinea pig. However, with the Wachstein-Meisel 5-nucleotidase technique, secretory capillaries were not stained. For parotid glands, optimal incubation in ATPase substrate mixture was: in rabbit, 15 min; in rat, 2.5 hr; and in guinea pig, 2 hr. For eccrine sweat glands, optimal incubation was 15 min in rabbit, 30 min in rat and 15 min in guinea pig. For parietal cells of gastric glands, optimal incubation was 3 hr for all three species. Secretory capillaries were best demonstrated in the parotid by using rabbit tissue; in eccrine sweat glands, with rat tissue, and in parietal cells, guinea pig tissue. Since ATPase activity in cell membranes of secretory cells may play a part in the mechanism of transport of secretory produ...

The presence in the rat omentum of intercellular pores (the classical stomata of von Recklinghausen) between the mesothelial cells overlying aggregates of lymphoreticular cells (the classical milky spots of Ranvier) and the apparent migration of lymphocytes through these stomata were recorded for the first time by scanning electron microscopy. Previous studies on passage of cells across the peritoneum and omentum used experimentally administered cells, while in the present study no cells were administered to the rats and their own lymphocytes were observed in situ. The possible role of lymphocytes in the peritoneal cavity is also briefly discussed.

Eleven reproductive and 25 specimens postmenopausal human endometrium were used in this study. Histologic examination showed 5 endometria in proliferative phase and 6 in secretory phase of the cycle. The postmenopausal specimens showed a senile atrophic pattern in 8 cases, inactive cystic pattern in 10 cases, proliferative pattern in 6 cases, and adenomatous hyperplasia in one case which was excluded. Histochemical demonstration of nonspecific alkaline and acid phosphatases, ATPase, 5-nucleotidase, nonspecific simple esterase, and succinic dehydrogenase was carried out on the 24 normal postmenopausal patterns as well as on the 11 reproductive patterns. Results suggest that the different enzymes investigated are likely to be dependent upon estrogen. Progesterone, on the other hand, seems to augment the activity of acid phosphatase, ATPase, 5-nucleotidase, and esterase, and to inhibit the activity of alkaline phosphatase and succinic dehydrogenase.

The effect of short-term protein synthesis inhibition produced by the administration of a single injection of actinomycin D and of long-term inhibition induced by hypophysectomy, on the ATPase histochemical staining of the rabbit and rat parotid acinar secretory capillaries was studied and was found to cause almost a total abolition of that reaction.