Objective To describe the results of improving availability of, and access to emergency obstetric care (EmOC) services in underserved rural Tanzania. Design Prospective cohort study Settings Rural Tanzania Methods Forty two associate clinicians from five health centres were trained in teams for three months in emergency obstetric care and anaesthesia. Two health centres were unexposed to the intervention and served as controls. Following training, virtual teleconsultation, quarterly on-site supportive supervision and continuous mentorship were implemented to reinforce skills and knowledge. Main outcome measures Proportion of all births in emergency obstetric care facilities, met need for EmOC and case fatality rate. Results The met need for EmOC increased significantly from 45% (459/1,025) at baseline (July 2014 – June 2016) to 119% (2,010/1,691) during the intervention period (Jul 2016 – June 2019). The met need for EmOC in the control group also increased from 53% (95% CI 49%-58%) to 77% (95% CI 74%-80%). Forty maternal deaths occurred during the baseline and intervention periods in the control and intervention health centres. The direct obstetric case fatality rate decreased slightly from 1.5% (95% CI 0.6%–3.1%) to 1.1% (95% CI 0.7%–1.6%) in the intervention group and from 3.3% (95% CI 1.2%–7.0%) to 0.8% (95% CI 0.2%–1.7%) in the control group. Conclusions When EmOC services are made available the proportion of obstetric complications treated in the facilities increases. However, the effort to scale up EmOC services in underserved rural areas should be accompanied by strategies to reinforce skills and the referral system.

Nitrogen is a major constituent of proteins and enzymes that regulates photosynthetic capacity in plants. We use a novel approach for nitrogen allocation (N-allocation) that aims to maximize photosynthesis by allocating nitrogen in plant leaves in two steps: (i). vertical distribution of leaf nitrogen based on an optimal exponential distribution through the vertical canopy structure, and (ii). balancing the leaf-level nitrogen between chlorophyll and rubisco to maintain the photosynthetic rate. We incorporated this N-allocation approach in a multilayer canopy‐soil‐root system model (MLCan) that was then validated for maize (C4) using observed data at Urbana, Illinois, USA. The model evaluation shows that the N-allocation method established the coupling between ecohydrological processes and soil-nitrogen dynamics. The simulation results indicated the strength of feedback between leaf-level nitrogen and eco-physiological processes. This relationship was affected by changes in the fertilizers and key climatic variables such as CO2, precipitation and ambient temperature. The sensitivity of temperature increased after the implication of the N-allocation method. The vertical profiles of net photosynthetic rate (An) were resolved based on the vertical distribution of photosynthetic nitrogen. The increase in temperature lowered the vertical gradient of photosynthetic nitrogen and in response, the vertical profile of was reformed.

Deception detectors are used as aids in crime detection and military security systems. Artificial intelligence has been used to classify deceptive and truthful messages using physiological parameters recorded from individuals. This study aims to utilize deep learning networks to detect deception using the extracted temperature signal on the face. Facial thermal data sets of 32 subjects were recorded. Data sets in the time of a mock crime scenario in two groups of deceptive and truthful using the control question test were divided. The five temperature signals were extracted from thermal videos by averaging the 30% of the maximum and minimum of the region of interests (periorbital, forehead, cheeks, perinasal, chin). This signal was used as the input of the deep learning network. The long short-term memory network was used to classify the extracted signals. We evaluated the network performance using sensitivity, specificity, and accuracy criterias. The obtained accuracy value was 93.75%, specificity 96.87%, sensitivity 90.63% which shows notable results compared to previous research.

Grasses are cosmopolitan, existing in many biome and climate types from xeric to tropical. Traits that control physiological responses to drought vary strongly among grass lineages, suggesting that tolerance strategies may differ with evolutionary history. Here, we withheld water from 12 species representing 6 tribes of grasses to compare how tolerant and intolerant species respond to drought in different grass lineages. We measured physiological, morphological, and microanatomical traits. Dominant lineages from tropical savannas, like Andropogoneae, tolerated drought due to above and belowground morphological traits, while temperate grasses utilized conservative leaf physiology (gas exchange) and microanatomy. Increased intrinsic water-use efficiency (iWUE) coincided with a larger number of stomata, resulting in greater water loss (with inherently greater carbon gain) and increased drought sensitivity. Inherent leaf and root economic strategies impacting drought response were observed in all species, resulting in either high SLA or SRL, but not both. Our results indicate that grasses subjected to severe drought were influenced by microanatomical traits (e.g., number of stomata and xylem area) which were shared within lineages. In addition, grasses recovered at least 50% of physiological functioning across all lineages and 92% within Andropogoneae species, illustrating how drought can influence functional responses across diverse grass lineages.

A 27-year-old G2P1 woman, admitted at 37 weeks of gestation after complaints of nausea, vomiting, and vaginal bleeding. An emergent vaginal delivery was performed which was complicated by significant blood loss. Thrombotic thrombocytopenic purpura was thought to be the most probable cause, requiring administration of caplacizumab and daily TPE.

Infrequent use of inhaled corticosteroids (ICS) and/or over-reliance of short-acting beta agonists (SABA) are recognised as key contributors to increased morbidity and mortality in asthma. The most frequent measures of ICS adherence and SABA use relies on patient reported questionnaires or prescription refill records, neither of which are considered sufficiently reliable. Technological advancements in the development of electronic monitoring of inhaler devices allow for monitoring of use, as well as recording and feedback of inhaler technique for some devices. Most electronic monitoring devices (EMDs) are paired with a smartphone application, allowing patients to set reminders and display both preventer and reliever use over time. This allows identification of intentional and unintentional ICS non-adherence as well as frequency of SABA use. This information assists clinicians in distinguishing difficult-to-control from severe asthma. Although cost currently limits widespread use, the introduction of EMDs into the asthma armoury is a significant step-forward in asthma care and has the potential to improve asthma related outcomes.

Rationale: To understand the risk factors for catheter-related infection during treatment of pediatric cancer is essential to implement measures to prevent its occurrence. Methods: We performed a systematic review of the literature with meta-analysis to identify and synthesize the main risk factors for catheter-related infection in children with cancer. Systematic searches were conducted in Medline, Embase, Lilacs, and BVS. Results: Thirteen studies were included. Risk factors were divided into host-related, assistance-related, and catheter types. Diagnosis of hematological neoplasm, the intensity of treatment, blood transfusion in the 4-7 days before the infection, type of long-term catheters, inpatient treatment, and a longer period of hospitalization were the most consistent risk factors. Conclusions: Education for preventive measures, reduction of hospitalization, wisely choosing the most adequate type of catheter, and the best moment for catheter insertion may reduce the occurrence of catheter-related infection.

Using non model-organisms is becoming increasingly common in NGS. Different NGS techniques have different demands of DNA extraction; abundant DNA, “clean” HMW DNA, to be cheap, to be quick, and increasingly considered, to use minimal plastics. Here we compare five DNA extraction methods: a phenol-based extraction, salting-out protocol, and three commercially available kits from Qiagen: Blood and Tissue Kit, Plant Mini kit, and PowerSoil Pro kit. These protocols were tested across non-model organisms: deep-sea octocorals and scleractinians. We included four individuals from each of the octocorals, Acanella arbuscula, Paragoria sp., and Pennatula sp., as well as four individuals from each of the scleractinian corals, Madrepora oculata, Lophelia pertusa, and Desmophyllum dianthus. DNA yield and quality were measured and compared across methods. Phenol yielded the most DNA per mg of tissue across all corals except Acanella and Madrepora- where salting-out yielded the most DNA. The Qiagen Plant Mini kit produced the highest ratio of HMW DNA to degraded DNA in all corals tested. The purity of DNA (measured by absorbance) was equal across methods. The amount of plastic used for each protocol was also measured with kit DNA extractions using significantly more plastics than non-kit protocols. We also make recommendations on how to reduce future plastic usage. Overall, it was found that recovering HMW DNA across extraction methods was genus specific, and the method used by researchers should take into account their specific research needs.

Background: The emergence of the coronavirus disease in late 2019 (COVID-19) has become one of the greatest health problems of the 21st century. Many aspects of this viral disease are still hidden. The current study is conducted to investigate COVID-19’s clinical manifestation, mortality factors, and their association with each other in the COVID-19 pandemic in Razavi-Khorasan province, Iran. Methods & Materials: This retrospective epidemiological population-based study was conducted from January 21, 2020, to March 20, 2021. The data including demographic characteristics and clinical presentations of the patients were extracted from the Medical Care Monitoring System (MCMC), disease management portal in the deputy of health and Hospital Information System (HIS). Results: A total of 80499 patients were admitted to all hospitals of Khorasan-Razavi University of Medical Sciences with laboratory/clinical COVID-19 confirmed disease, between January 2020 and March 2021. The male-to-female ratio was 1.10:1 and the mean age of our COVID-19 individuals was 55.67 ± 23.27. The most frequently reported presenting symptoms at admission were respiratory distress (58.2%), fever (36.7%), and cough (34.9%), and alternation in smell/taste (0.9%) was the less frequent. Being male, aging older than 60 years and having comorbidities were significantly associated with higher mortality rates. Conclusion: Due to the genetic mutations in the virus and the emergence of the new variants of the virus, clinical presentations, and mortality rates of the COVID-19 have been shifted through three reviewed waves. Further studies are needed to determine the impact of the new variants of the virus on individuals.

Objective The aim of this study was to evaluate the effect of preoperative anxiety on depth of anesthesia and IVF success. Design Population-based cohort study. Setting Trakya University Population or Sample 131 patients between 25 and 43 years of age who were scheduled for oocyte retrieval under sedation. Methods The patients were divided according to Beck Anxiety Inventory (BAI): patients without anxiety were enrolled in the low-anxious group (Group L) and patients with anxiety were included in the high-anxious patient group (Group H). Hemodynamic stability, fertilization rate and good quality embryo (GQE) rate were recorded. Total propofol and fentanyl consumption was assessed intraoperatively. Main Outcome Measures Depth of anesthesia and IVF success Results The fertilization rate and GQE rate were not significant between the group L and group H. Total propofol consumption was significantly higher in group H than in groups L. The Heart rate (HR) at preoperative and postoperatively and systolic arterial pressure (SAP) at preoperatve and diastolic arterial pressure (DAP) at postoperative were significantly increased in groups H than in group L. The time for Modified Aldrete score (MAS) to reach 9 was significantly increased in group H than in group L. The effect of variables that were found significantly in the univariate analysis (Propofol, HRpreop, HRpostop, SAPpreop, DAPpostop, and MAS reach of time 9) on BAI score. Conclusions Total propofol consumption was higher in the high level of anxiety patients, but it was not have negative effect on IVF success. Funding Project by the Trakya University

Increasing empirical evidence has revealed that host-switching is more common than cospeciation in the history of parasites. Here, we investigated how the intensity of host-switching, mediated by opportunity and compatibility, affects the phylogenetic history and ecology of the parasites. We developed a theoretical model to simulate the evolution of populations of parasites that can explore and colonize new hosts under variable host-switching intensities. Eco-evolutionary patterns (beta diversity/normalized Sackin index) obtained from parasite simulations were compared to nine empirical cases. Our model reproduced the empirical patterns, and such simulations varied in host-switching intensity according to the analysed case. This intensity does not differ among cases of ecto and endoparasites, but it was stronger in local cases when compared to a regional scale. Our results highlight the importance of contact opportunity, and suggest that host-switching intensity mediates the exploration and colonization of new hosts promoting variation in the eco-evolutionary patterns.

CH4 oxidation in Arctic soil plays a crucial role in Arctic CH4 dynamics whereby up to 90% of CH4 produced in soils can be removed. Previous studies have noted the influence of temperature rise on CH4 oxidation, but effects of inorganic nitrogen (N) have been less studied because the Arctic is typically N-limited. However, climate change-induced increases in available N have been reported recently, which may drastically change CH4 oxidation in Arctic soils. Here, we show that excessive levels of soil available N increase net CH4 emissions by attenuating soil CH4 oxidation in Arctic tundra. In-vitro experiments proved consistent with NO3− being responsible for the decrease in CH4 oxidation, leading us to propose that NO3− indirectly inhibits CH4 oxidation by reducing bacterial diversity, a previously unrecognized mechanism. We provide evidence that increased available N can enhance CH4 emissions in Arctic tundra, with profound implications for modeling CH4 dynamics in Arctic.

Objective: 1. Measure pregnant people’s experience of unexplained abdominal pain, their recognition of ‘Round Ligament Pain’ (RLP) and whether medical carers are providing this education. 2. Describe the features of participants’ unexplained abdominal pain and their crossover with those of abdominal wall pain (AWP), a treatable condition. Design: Prospective observational cohort. Setting: Single antenatal clinic in New Zealand. Population: 203 pregnant adults over 20 weeks’ gestation. Method: Written questionnaire. Main Outcome Measures: Presence of unexplained abdominal pain in pregnancy, knowledge of RLP, source of information on RLP and the descriptors participants used for their pain. Results: Objective 1. The majority had experienced unexplained abdominal pain in pregnancy (68.5%). Recognition of RLP was common (54%). Those with unexplained abdominal pain had an odds ratio of 9.23 of citing a medical carer as their RLP information source when compared to those without pain (95% CI 3.5-24.4). Objective 2. Most participants used multiple AWP descriptors, with a mean number of 4.06/10 (95% CI 3.71-4.41). Descriptors with the highest frequency of clustering with others were “pain worsened by lightly pushing on the painful area” (6.71/10, 95% CI 5.94–7.49), followed by “when in pain, sensation over the painful area feels different” (5.78/10, 95% CI 4.68-6.88). Conclusions: Unexplained abdominal pain in pregnancy is common and medical carers continue to cite RLP. Our participants’ unexplained abdominal pain shared many historical features with AWP. Funding: Nil sought. Keywords: Round ligament pain, abdominal wall pain, Anterior Cutaneous Nerve Entrapment Syndrome (ACNES), Pregnancy-Related Abdominal Wall Neuropathy (PRAWN), neuropathic pain.

The objective of this study was to identify risk factors related to reproductive disorders caused by bacterial infections in goats in north-eastern Thailand. Two hundred and twenty farms were investigated, and 49 herds were found to have clinical reproductive disorders. Moreover, 96% (47/49) of herds showing clinical reproductive failure preferred to circulate bucks between herds. A total of 118 sera, including 85 clinical reproductive disorders cases such as abortion (n=70), abortion with arthritis (n=1), orchitis (n=3), repeat breeder (n=6), sterile (n=1) and weak kids (n=4) and 33 bucks’ circulation were serologically tested for bacterial infections caused by Coxiella burnetii, Chlamydophila abortus and Brucella spp. Results showed 69% (81/118 cases) were seropositive for Q fever (n=55; 46.61%), brucellosis (n=8; 6.78) and chlamydiosis (n=18; 15.25%), respectively; 82% of herds (40/49 herds) were infected with at least one of those diseases. Moreover, 40% of infected herds (16/40) had co-infection between three of those diseases. Approximately 60% (20/33) of buck circulation showed seropositivity to at least one of the diseases, and 85% of infected bucks were seropositive for Q fever (17/20). Buck circulation between herds is a risk factor for diseases on farms ( p=0.001); odds ratio [OR] = 109.29; 95% confidence interval [CI] = 6.61–1,807.38). Moreover, the annual brucellosis test is a protective factor against reproductive failure cases on farms ( p=0.022; OR = 0.45; 95% CI = 0.23–0.89). Reproductive disorder cases can be caused by sexual transmission, so buck circulation can yield Q fever, brucellosis and chlamydiosis in communities. This investigation is the first report of chlamydiosis infection in our area. Concerning Q fever, chlamydiosis and brucellosis are zoonotic diseases that impact animal health and production losses. Control and prevention measures related to risk factors together with active surveillance programs should be incorporated into client education.

Aims Conduction system pacing has gained steady interest over recent years. While the majority of tools and delivery techniques were developed for His bundle pacing (HBP), the feasibility and reproducibility of using these similar tools for left bundle branch pacing (LBBP) has yet to be determined. We describe our technique for performing LBBP using the Abbott Agilis HisProTM Steerable Catheter. Methods and results A series of 22 patients with a mean age of 71.7 years (16 males, 72.7%), underwent LBBP procedure with this catheter between May and October 2021. Nineteen patients (86%) had successful LBBP lead implantation. There were no major complications or mortality. Conclusion The Agilis HisProTM catheter along with the stylet driven Tendril STS Model 2088TC lead is a safe and feasible delivery system for LBBP.

Abstract Background: Lung ultrasound (LUS) has become an important tool in diagnosing and following an adult patient with COVID-19; however, the literature for the pediatric age group is limited. Herein, we reviewed the up-to-date literatures on ultrasound use for COVID-19 pediatric patients for better management of COVID-19 in children. Methods and Objectives: The search terms “COVID-19,” “SARS-CoV2,” “coronavirus,” “2019-nCoV,” “lung ultrasound,” “sonography,” “adolescents” “children,” “childhood” and “newborn” were searched on the online databases PubMed, Embase and Medline. Articles meeting the inclusion criteria were included in the analysis and review. Results: We identified only fifteen studies to date using LUS to diagnose SARS-CoV-2 infection in children. These studies involved a total of 334 newborns, children and adolescents. Regarding the use of chest X-ray (CXR) and LUS in pediatric patients with COVID-19, we identified six studies with a total of 162 participants, with the following results: 33patients(14.11%) with lung abnormalities on lung US had a normal CXR; however, no patients with normal lung US had abnormalities on the CXR. In addition, regarding the use of computed tomography (CT) and LUS in pediatric patients with COVID-19 infection, we identified five studies with a total of 50 participants and 3 patients(6%) with lung abnormalities on chest LUS had a normal CT. Conclusion: Our findings suggest that LUS is a useful tool in the diagnosis of children and reduction in chest CT assessments may be possible when LUS is used in early diagnosis and follow-up monitoring of COVID-19 pneumonia in the children.

Introduction Previous evidence has shown that FeNO and EO are cost-effective relative to standard of care in guiding the management of children with persistent asthma. There is some doubt as if there are differences between these two biomarkers in terms of costs and benefits. Clarifying this doubt would allow to prioritize in the design of clinical practice guidelines. The study aimed to compare in terms of costs and benefits these biomarkers in patients with asthma between 4 and 18 years of age.3 Methods A Markov model was used to estimate the cost-utility of asthma management using FeNO and EO in patients between 4 and 18 years of age. Transition probabilities, cost and utilities were estimated from previously published local studies, while relative risks were obtained from the systematic review of published randomized clinical trials. The analysis was carried out from a societal perspective. Results FeNO was associated with lower cost (US$ 1333 CI 95% US$ 1331-1335 vs US$ 1452 CI 95% US$ 1449-1454) and highest QALY (0.93 CI 95% 0.93-0.94 vs 0.92 CI 95% 0.91-0.92) than EO. In the sensitivity analyses, our base‐case results were robust to variations of all assumptions and parameters. Conclusion Our study demonstrates that FeNO-guided treatment is better than EO because it offers a greater number of years of life with a lower cost per patient. This evidence should encourage the adoption of any of these techniques to objectively guide the management of children with asthma in routine clinical practice in low resource settings.

How plants respond to germination timing via morphological plasticity is not well documented, in spite of its importance for understanding plant strategies in dealing with natural environmental challenges of complicacy, especially in the perspective of the entire life cycle of plants. To address this issue, we conducted a field experiment with Abutilon theophrasti by growing plants in four periods, as four germination treatments (GT1~GT4), before measuring a number of mass and morphological traits on them at three (or four) growth stages (EX, I~III). Results the optimal germination time for A. theophrasti was late spring, as plants that germinated in this period achieved the maximum total mass, with the highest stem and reproductive allocation and the lowest leaf allocation, among plants of all germination treatments. Plants that germinated earlier in spring used a longer time for vegetative growth and did not outperform late-spring germinants, probably due to exposure to spring drought and response to competition. Delaying germination into summer led to a faster growth, increased leaf allocation, decreased stem allocation, advanced reproduction and shorter life cycle, but further delay of germination into late summer led to insufficient reproduction and incomplete life cycle due to extremely short growth period. Results suggested plants that germinated within the optimal period can maximize their growth potential in relatively favorable conditions. In spite of conspicuous disadvantages, plants with advanced and delayed germinated were still able to use different strategies to better adapt to subsequent environments, via plasticity in a number of allocation and morphological traits. Root plasticity may play a predominant or fundamental role in plant response to environments, or it is crucial to maintain root allocation stable, while stem or leaf allocation can often be sacrificed depending on specific situations.

Background and Purpose: Nitidine chloride (NC) is a standard active component of a traditional Chinese medicine Zanthoxylum nitidum (Roxb.) DC. (ZN). NC has certain toxic effects which make it a potential anti-tumor monomer. However, the cardiotoxicity of anti-tumor drugs has been a concern, the cardiotoxicity of NC has not been reported. Thus, we aimed to investigate the cardiotoxicity of NC and elucidate its mechanism of action. Experimental Approach: The aqueous extract of ZN was administered intraperitoneally to rats, and NC was similarly administered to beagles and mice once daily for 4 weeks. Cardiac function was assessed by echocardiography while NC-induced changes in cardiac signaling pathways were investigated using proteomics and western blot. To investigate the mechanism of NC-induced toxicity, adeno-associated virus 9-autophagy-related 4B cysteine peptidase (ATG4B) was injected into mice. Corresponding in vitro experiments were performed. Key Results: ZN and NC induced cardiac hypertrophy in rats and mice, respectively. Beagle death resulted from NC was mediated by NC-induced changes to mitochondrial components and peptidase activity of the heart. Consistently, we observed reduced cardiac autophagy levels in NC-treated mice. Specifically, we found that ATG4B may be a potential target of NC as the overexpression of ATG4B reversed cardiac hypertrophy and reduced autophagy levels observed in NC-treated mice. Conclusion and Implications: ZN resulted in cardiac hypertrophy in rats. NC induced cardiac hypertrophy via ATG4B-mediated downregulation of autophagy in mice. Thus, this study provides guidance for the safe clinical application of ZN and the use of NC as an anti-tumor drug.

In order to guide the accurate control of the sulfides in gasoline and diesel of Fluid Catalytic Cracking (FCC) process, a molecular-level model was established based on the Structure Oriented Lumping (SOL) method. According to the molecular composition characteristics of FCC feed oil, a molecular composition matrix containing 4,148 row vectors was constructed with 24 structural increments. Using MATLAB software, the SOL reaction rules were compiled and a complex reaction network containing of about 110,000 reactions was established. According to the classification rules, the sulfides in gasoline and diesel represented by 32 and 136 structural vectors were divided into mercaptans, thioethers, monocyclic thiophenes, benzothiophenes and dibenzothiophenes, respectively. The conversion law of sulfides in gasoline and diesel was investigated by tracking their generation paths and reaction paths in the reaction network. The effects of the operation conditions on the sulfide contents in gasoline and diesel were calculated quantitatively.

Currently, the environment plays an indispensable role in the interaction between plants and pathogens. However, the detailed mechanism of plant-pathogen interaction under different temperatures and humidity remain unclear. In this study, we deciphered detailed histological structure changes of the tomato and Botrytis cinerea (B. cinerea) during their interaction under different temperatures and humidity, and the dual transcriptome was deployed to elucidate the in-depth host-pathogens interaction mechanisms. The results showed that low humidity was adverse for hyphae differentiate of B. cinerea, leading unsuccessful infection of pathogen. The most severe infection was under the medium temperature and high humidity (MH) treatment, wherein the hyphae released cell wall–degrading enzymes to penetrate the host cells. High temperature induced the expression of heat stress and photosynthesis-related genes, enhanced SA signal transduction, and at the same time accumulated wax and other secondary metabolites, which lead to the thickening of host cell walls and the expansion of chloroplasts. Interestingly, the pathogenicity-related enzymes of B. cinerea were severely inhibited under high temperature, causing the mycelia grew without pathogenicity. While under low temperature, the cell metabolism-related genes of B. cinerea were significantly down-regulated, and the growth and development of the pathogens were restricted, resulting in a decrease in biomass of B. cinerea.

Cytomegalovirus (CMV) infection is a serious complication of paediatric hematopoietic stem cell transplant (HSCT). To date, antiviral therapy has been the mainstay of prophylaxis, with conflicting results regarding benefits of CMV-specific immunoglobulins (CMV-Ig). After introducing prophylactic CMV-Ig for HSCT recipients at risk (seropositive recipient and/or donor), we conducted a single center retrospective study comparing incidence and severity of CMV infection with and without CMV-Ig. We identified 49 ‘at risk’ recipients from 76 consecutive HSCTs over 3.5 years: in addition to standard antiviral prophylaxis, 10 patients received CMV-Ig and 39 did not. There was no significant difference in donor type, cell source, conditioning or CMV status between the groups. We observed a trend towards lower incidence of CMV reactivation with CMV-Ig (30%) vs without (38.4%). No patient who received CMV-Ig developed symptomatic or lethal infection. Duration of infection appeared shorter (21 (+/-7) vs 51.4 (+/- 55) days) and peak titers lower (4 578 (+/- 4 788) vs 24 131 (+/- 49 257)) with CMV-Ig. No adverse events were noted. The statistical significance of results is limited by the small sample size. These data raise interest in prophylactic CMV-Ig as a safe way of potentially reducing severity and duration of CMV reactivation in HSCT.

A 67-year-old woman presented to the emergency department for a simple partial seizure of her left upper and lower limbs that lasted for 1 hour and ultimately resolved before her presentation. She has no history of coronary artery disease, and her neurological exam was normal. Five hours later, she complained of chest pain, and an electrocardiogram showed ST-segment elevation in the lateral leads, and her troponin level was increased. We diagnosed her with Takotsubo cardiomyopathy. This case reflects the brain-heart connection and is the first reported case of Takotsubo cardiomyopathy following a simple partial seizure.

Background Systematic pain management of children is not enough in China, and there is no summary of pain in children with sarcoma. Methods Collect clinical data of newly diagnosed sarcoma patients admitted to the Medical Oncology Department of Beijing Children’s Hospital from October 2018 to December 2020. Pain assessment was completed by part-time palliative doctors. Children with pain received analgesic treatment and regular assessment. Results A total of 188 newly diagnosed sarcoma patients were included. 37 patients (19.7%) suffered from pain. 6 cases (16.2%) had mild pain, 17 (46.0%) moderate, and 14 (37.8%) severe. The daily life of 31 patients (83.8%) was affected by pain. 26 cases (70.3%) had bone invasion. The analgesic rate was 54.1% (20/37) before admission and 89.2% (33/37) after admission. 9 cases were treated with oral morphine regularly, all of whose pain relieved before chemotherapy, and the actual dose of morphine was 0.14±0.034mg/kgQ4H when the target was reached. No serious adverse reactions were observed. The total time of morphine application after chemotherapy was 5-9 days (median 6 days), and there was no withdrawal reaction during the process of reduction. Conclusion The pain in children with newly diagnosed sarcoma was mainly moderate to severe pain, and the incidence of pain in sarcoma originating from bone or invading bone was higher and the intensity was more severe. Patients who received standardized pain assessment and regular analgesic reached pain relief quickly, and no serious adverse reactions were observed within the recommended dosage.