Lower limb salvage in severely injured burned patients with bone or tendon exposure may be a reconstructive challenge. In this cases, local or regional flaps and other more conservative therapies such as dermal substitutes and negative-pressure wound therapy are usually not available or are not good enough to solve the problem. In such situations, microsurgical reconstruction with distant flaps seems to be the best option, even though the particularities of the severe burn patient may decrease free flaps' success rate. We report the case of a patient with severe electrical injuries affecting 70% of the total body surface area who had full-thickness burns to the lower extremity with wide bone exposure and extensively drug-resistant Pseudomonas aeruginosa infection. We achieved limb salvation using rectus femoris muscle free flap plus lateral and medial gastrocnemius muscle flaps and soleus muscle flap, after two failed microsurgical coverture attempts and a long not useful periplus with conservative therapies such us negative-pressure wound therapy and dermal substitutes. After 3 years of follow-up, the patient can walk without aid, and he has recovered his social and employment situation prior to the accident.Coronavirus Disease 2019 (COVID-19) pandemic was declared on March 11, 2020, which led to the massive economic and social crisis in the world. Hospitals and healthcare systems faced the most changes during this time. As for any other medical departments, orthopedic departments were affected by this situation. Trauma and musculoskeletal injuries require emergency action or even operation which would not stop due to COVID-19 crisis. Special protocols and guidelines were used to minimize infection risks in Kashani educational trauma center. Here we explain the changes and protocols in the following sections Outpatient-Clinic, emergency department, Operation room and Orthopedic Ward. learn more These strategies included reducing the number of admitted patients in clinics, changing the decoration of waiting rooms, screening the patients at the entrance and personal protection equipment for staff. We also dedicated special emergency rooms for patients suspicious to COVID-19 infection and also special operation rooms and corridor for patients with COVID-19 infection. Changes in discharging protocols and continuous consultations with infectious diseases specialists brought us the ability to manage these patients. Here in the present paper, we described different strategies of the management of patients in Kashani hospital during COVID-19 outbreak. We hope that our experience of patient's management could help other physicians and hospitals. Advancement in the surgical techniques should translate into better outcome. The goal of this study was to evaluate mortality trends from aortic valve surgery in the United State using large inpatient database. The Nationwide Inpatient Sample (NIS) database was used to calculate the age-adjusted mortality rate from aortic valve surgery from 1988 to 2011 in the United State using ICD-9 coding for aortic valve surgery. We found that age adjusted mortality rate from aortic valve surgery gradually decreased from 1988 until end of study in 2011 to the lowest level with elimination of gender gap that was seen in the early years. For men, age adjusted mortality rate from aortic valve surgery in 1988 was 438 per 100,000 with steady reduction to the lowest level of 214 per 100,000 in 2011 which remained unchanged from 2007. For women, age adjusted mortality from aortic valve surgery was 620 per 100,000 in 1988 with steady reduction to the lowest level of 235 per 100,000 in 2011 which also remained unchanged since 2007. Age adjusted mortality from aortic valve surgery has been gradually decreasing in the last decade and remained stable at the lowest rates in recent years suggesting improvement in surgical technics and post-surgical care.Age adjusted mortality from aortic valve surgery has been gradually decreasing in the last decade and remained stable at the lowest rates in recent years suggesting improvement in surgical technics and post-surgical care.The relationship between alterations in left ventricular (LV) diastolic function and the incidence of recurrence, as well as the associated factors after cryoballoon (CB) and radiofrequency (RF) catheter ablation in patients with paroxysmal atrial fibrillation (Paf), require clarification. We enrolled 138 patients with Paf (RF/CB 69/69) who underwent the first catheter ablation and follow-up for 12 months. Transthoracic echocardiography was performed before and after ablation. An afterload-integrated index of LV diastolic function was calculated as diastolic elastance (Ed)/arterial elastance (Ea), Ed/Ea. No significant increases were observed in Ed/Ea 3 days after RF ablation in patients with (n=12) and without (n=57) recurrence. However, a significant increase was observed in recurrence-free patients with CB ablation (n=59; P less then 0.05), although this level was restored after 6 months. Ed/Ea 3 days after CB ablation was correlated with left atrial pressure immediately after (r=0.630, P less then 0.001), but not before (r=0.290, P=0.159), ablation. The increment of creatine kinase- myocardial band release was positively associated with that of Ed/Ea (r=0.388, P less then 0.05) after CB ablation. Thus, the transient manifestation of LV diastolic dysfunction after CB ablation, evaluated by a new echocardiographic index, was observed only in recurrence-free patients with Paf. Protracted impairment of left atrial compliance due to ablation-induced myocardial injury may be related to the lack of recurrence in patients after CB ablation. Mortality from acute coronary syndromes (ACS) is strictly related to early management. As female patients usually experience longer delays before diagnosis and treatment, we assessed whether women were more affected by the dramatic drop in hospital admissions for ACS during the Covid-19 pandemic. We performed a retrospective analysis of clinical and angiographic characteristics of consecutive patients who were admitted for ACS at 15 hospitals in Northern Italy comparing men and women data. The study period was defined as the time between the first confirmed case of Covid-19 in Italy (February 20, 2020) and March 31, 2020. We compared hospitalization rates between the study period and two control periods the corresponding period during the previous year (February 20 to March 31, 2019) and the earlier period during the same year (January 1 to February 19, 2020). Incidence rate ratios comparing the study period with each of the control periods were calculated with the use of Poisson regression. Of the 547 patients who were hospitalized for ACS during the study period, only 127 (23%) were females, accounting for a mean of 3.