Neuroblastoma is the most common extracranial solid tumor in children. A 10-month-old boy was presented with neuroblastoma misdiagnosis of family violence bruised and swollen right periorbital region with no obvious proptosis or abnormal eye movements. Neuroblastoma was confirmed with histopathology and bone marrow. After treatment, the symptoms were resolved.

A document by Céline Delestrain. Click on the document to view its contents.

A previously fit 14-year old girl presented with a 3-day history of cough, chest discomfort, abdominal pain and rigors, following her first exposure to vaping 48 hours earlier. Her symptoms rapidly progressed and she required escalating amounts of respiratory support. Within 48-hours of presentation she was ventilated at high pressure and progressed to need oscillation and nitric oxide. She improved by day-8 of symptom onset and was breathing unassisted in air prior to discharge from intensive care.

ABSTRACT BACKGROUND: Smoking is the major risk factor for development of bladder cancer (BC). We evaluated the rate and the time of cessation of smoking in patients with BC and analysed the effect of ongoing smoking at recurrence and progression. METHODS: All patients were informed at the time of BC diagnosis about the correlation between smoking and BC and strictly warned to quit smoking. The demographic properties, pathologic characteristics and smoking status of the patients were evaluated retrospectively. Both the patients and the family members were questioned to evaluate the smoking status of the patient during the follow-up period. The disease recurrence and progression was correlated with the habitual attitude of patients in terms of smoking status. RESULTS: A total of 245 patients were included to the study. The mean follow-up period was 37.3±27.8 months (7-143 months). There were 102(41.6%) patients who were smoker and 143(58.4%) patients who were non-smoker at the time of diagnosis. Among the smoker patients, 34(33.3%) stopped smoking after the diagnosis of BC. The median smoking cessation time was 1.5 months and 64.7% of these patients stopped smoking in the first six months after the diagnosis. The Cox regression model did not show any relationship between the smoking status and recurrence/progression. CONCLUSION: The rate of cessation of smoking at BC patients was low. The first months of the diagnosis were the most suitable period for the patients to stop smoking. The smoking status after the diagnosis was not related with the tumor recurrence and progression.

Background: Presently, it is still lack of evidence whether a mechanical prosthesis is superior or inferior to a biological prosthesis in patients with Ebstein’s anomaly. The aim of this study was to compare the long-term results of mechanical and biological prostheses of patients with Ebstein’s anomaly at two major cardiac surgical centers in central China. Methods: From January 1999 to June 2020, 85 patients with Ebstein’s anomaly (mean age: 42 ± 17 years, male to female ratio = 19: 66) underwent tricuspid valve replacement. 22 patients (26%) underwent mechanical valve implantation, and 63 (74%) were implanted with a bioprosthesis. Median follow-up duration was 145 months and mean follow-up duration was 146 ± 13 months. Operative results, long-term survival, and tricuspid valve-related events were compared. Results: Eight patients suffered from cardiac failure and died within 30 days after the surgery. Mechanical prostheses demonstrated a better survival outcome compared with biological prostheses before (p = 0.043) and after (p = 0.039) propensity score matching. Tricuspid valve-related events occurred in 20 patients. There was no statistical significance between mechanical and biological tricuspid valves before (p = 0.87) and after (p = 0.91) propensity score matching. Conclusions: Tricuspid valve replacement for patients with Ebstein’s anomaly is a high-risk operation and should be cautious, especially for patients with poor conditions. Although mechanical prostheses demonstrated a better survival outcome compared with biological prostheses in our study, the selection of prostheses should be individualized and consider each patient’s characteristics and needs.

Objectives Because there is no validated speech audiometry word list in Albanian, the aim of this study was to create and evaluate lists of words in normal hearing children and young adults. Methods In total, 20 lists of 10 spondaic disyllabic words were created, taking into account the idiosyncrasies of the Albanian language. Eighty-three young adults and 86 children were included. For each ear, the difference between the speech recognition threshold (SRT) and the pure tone average threshold (PTA) was calculated. The psychometric function slope was also calculated. Results The difference between the SRT and PTA was 3.2±2.1dB in adults and 3.3±2.4dB in children. A value ≤7dB was observed in 93% of adults and 92% of children. The psychometric function slope was 7.3%/dB in adults and 7.9%/dB in children. Conclusion Speech audiometry in the Albanian language can now be performed using the lists defined in the present study.

Background and purpose: GPR55 is activated by the endogenous lipid lysophosphatidylinositol, but also sensitive to cannabinoids and antagonized by cannabidiol. While classical cannabinoid receptors are known to crucially impact on myocardial infarction (MI) repair, a function of GPR55 herein is poorly understood. Thus, we investigated the role of GPR55 in cardiac physiology and post-MI inflammation and remodelling. Experimental approach: Following baseline characterization, permanent MI was induced in global GPR55-/- and wildtype (WT) mice as well as in bone marrow chimaeras with sole haema-topoietic GPR55 depletion. Sarcomere length was measured in isolated adult, unstressed GPR55-/- and WT left ventricular (LV) myocytes. Key results: GPR55-/- deficiency was basally associated with bradycardia, increased diastolic LV volume and sarcomere length and an immune profile resembling stretch-induced inflammation. While infarct size and myeloid cell infiltration were unaffected by the lack of GPR55, chemokine induction was prolonged until day 3 post-MI. Additionally, GPR55-/- hearts exhibited a premature expansion of pro-reparative and phagocytic macrophages paralleled by early up-regulation of ex-tracellular matrix (ECM) factors 3 days post-MI, which could be mimicked by sole haematopoietic GPR55 depletion. Moreover, global GPR55 deficiency mitigated MI-induced foetal gene re-programming and cardiomyocyte hypertrophy, culminating in aggravated LV dilatation and infarct expansion. Conclusions and implications: GPR55 regulates cardiac homeostasis and ischaemia respons-es by maintaining adequate LV filling and modulating three crucial processes post-MI: wound healing kinetics, hypertrophy and maladaptive remodelling. While patients might benefit from GPR55 stimulation post-MI, consumption of GPR55 antagonist cannabidiol should be carefully considered in view of potential adverse cardiac effects.

The production of exogenous recombinant proteins is constrained by the complexity of the connections between cellular physiology and recombinant protein synthesis. Here, we developed a rational and highly efficient approach to improve bacterial engineering, using HPV16-L1 as a protein candidate. Comparing the transcriptomic profiles of the strain under leaky expression and low temperature-induced stress, we found that leaky expression accelerated host energy metabolism and altered ribosome synthesis assembly, and inducing overexpression of the heterologous protein under low-temperature conditions led to an upregulation in polysaccharide transport, and cell motility, and a downregulation in oxidation-reduction, and anaerobic respiration. Subsequently, we selected and knocked out 36 hub genes to determine the potential impact of these genes on protein production. Deletion of bluF, cydA, mngR, and udp led to a significant decrease in soluble recombinant protein production. Moreover, knocking out several motility-related DEGs (ER2666-ΔflgH-ΔflgL, ER2666-ΔflgH-ΔflgL-ΔflgK) simultaneously improved the protein yield by 1.5-fold at 24°C or 37°C induction. This study highlights a rational and efficient strategy to increase the yield of recombinant proteins in model or non-model organisms, and lays a solid foundation for the engineering of bacterial strains for recombinant technological advances.

Objectives: Transfusion-associated iron overload may cause liver fibrosis. We compared transient elastography (TE) and aspartate aminotransferase-platelet ratio index (APRI), non-invasive markers for hepatic fibrosis, to percutaneous liver biopsy in children and young adults with sickle cell disease (SCD). Methods: Subjects had serum ferritin was >500 ng/mL and lacked history of viral hepatitis. APRI scores, FerriScan® R2-MRI, liver biopsies, and TEs were obtained. Hepatic fibrosis was scored according to Metavir system. Age-matched controls with SCD but without iron overload were enrolled for APRI and TE assessments. Results: Nineteen subjects (cases: 12 males, 7 females), ages 10-21 years (mean 15.9 years), were transfused an average of 9.67 years, had a mean serum ferritin of 4,899±2849 ng/mL (range 693-11,604 ng/mL), and a liver iron concentration (LIC) of 8.46±3.95 mg/g dry liver weight by R2-MRI. Mean APRI was 0.33±0.13 (0.13-0.61) in cases and 0.27±0.10 in five controls. The mean liver stiffness measures (LSM) in cases, assessed by TE, was 8.46±3.95 kPa, ranging from 3.5-14.6 kPa (expected normal less than 7 kPa). Controls had a mean LSM of 5.72±1.74 kPa (4.6-8.7 kPa). Comparison of LSM to histological fibrosis for cases revealed a T-value of 6.94, p<0.0001. There was no significant correlation between APRI and histological fibrosis and between LSM and APRI or LSM and ferritin. Conclusion: TE measures but not APRI significantly correlated with histologic fibrosis. Although the small sample size limits generalization, LSM > 10 kPa suggests liver fibrosis in children and young adults with SCD and may merit histologic confirmation especially if persistent.

Many SARS-CoV-2 variants of concern has been reported recently which were linked to increased transmission. In our earlier study on virus shedding using VOC 202012/01(UK variant) and D614G variant in hamster model, we observed significantly higher viral RNA shedding through nasal wash in case of UK variant. Here, we have compared the transmission of both the UK and D614G variant by various routes in Syrian hamsters to understand the transmission efficiency of the variant. The study demonstrated comparable transmission efficiency of both UK and D614G variants of SARS-CoV-2 in Syrian hamsters.

Objectives: To evaluate whether readout-segmented echo-planar imaging (RS-EPI) diffusion-weighted imaging (DWI) can reduce image distortion and improve the lesion identification in parathyroid adenomas (PTAs) compared to single-shot EPI (SS-EPI) DWI, and to determine whether PTAs can be differentiated from other soft tissue structures of the head and neck region by using the apparent diffusion coefficient (ADC) value. Design: Retrospective study. Setting: Kyoto University Hospital. Participants: 24 patients who underwent a magnetic resonance imaging (MRI) scan for the preoperative diagnosis of PTAs from January 2012 to March 2020 were enrolled. Main outcome measures: MRI was performed with the acquisition of a 1.5T MR imaging system (Avanto or Trio, Siemens, Erlangen, Germany) or a 3T MR imaging system (Prisma or Skyra, Siemens). Image quality and distortion of PTAs on RS-EPI and SS-EPI was evaluated using a reported five point score, and the ADC values of PTAs, thyroid glands and cervical neck lymph nodes were compared. Results: RS-EPI provided significantly less distortion but did not improve the lesion identification compared to SS-EPI. On SS-EPI, the PTAs had significantly higher ADC values compared to the cervical lymph nodes. On RS-EPI, the PTAs had significantly higher ADC values compared to the thyroid glands and cervical lymph nodes. Conclusions: RS-EPI reduces the DWI distortion in PTAs. The ADC value obtained using RS-EPI enables the differentiation of PTAs from nearby structures, such as thyroid glands and cervical lymph nodes.

INTRODUCTION: The COVID-19 infection, along with various drugs administered for its treatment may prolong ventricular repolarization and QT interval, increasing the risk of potentially fatal arrhythmias. Electrocardiogram (ECG) tracing with conventional devices increases health worker exposure to COVID-19. METHODS: In sequential tests, corrected QT interval (QTc) of electrocardiographic tracing obtained with AliveCor® single-lead (DI) Kardia Mobile (KM) was compared to QTc obtained with a 12-lead ECG. Authors evaluated numeric precision (proportion of measurements with a difference <10 msec), and consistency between the two devices in determining QTc prolongation (QTc ≥470 ms in male, or ≥480 ms in female), with kappa statistics. RESULTS: Records of 128 hospitalized patients with a suspected or confirmed COVID-19 diagnosis in the Hospital Universitario San Ignacio, Bogotá D.C. (Colombia) were included. The QTc interval measured with KM was similar to the interval measured with conventional ECG (442.5 ± 40.5 vs. 442.4 ± 40.2 ms, p: 0.986). Numeric precision was 93%. Concordance between the two devices for determining QTc prolongation was excellent, both in females (kappa: 0.901) and males (kappa: 0.896). CONCLUSION: Single-lead electrocardiographic tracing obtained with the AliveCor® Kardia Mobile allows accurate QTc interval assessment. Since KM use is fast and practical, it is ideal for reducing the exposure time of healthcare workers in the COVID-19 pandemic. The KM is capable of detecting prolonged QTc during treatment in COVID-19 patients. KEY WORDS: Kardia Mobile; AliveCor; corrected QT; QT interval; smart phone, ventricular arrhythmias, COVID-19.

Background and Purpose Cordyceps is a widely used traditional Chinese medicine due to its many health benefits, such as immune regulation. As Cordyceps’ major component, polysaccharides are of great attention serving as a potential drug or vaccine with nontoxicity. However, little is known about the underlying immunomodulatory mechanism of Cordyceps caterpillar polysaccharide (CCP). In this present study, we investigated the immunomodulatory effects of CCP on macrophages in vitro and in vivo and its underlying mechanism. Experimental Approach Macrophage cell line RAW 264.7 cells, bone marrow-derived macrophages (BMDMs), wild-type, and gene-deficient (TLR2-/- and TLR4-/-) mice were used in the study. Using a series of molecular biology methods, we identified the direct target of CCP on macrophage and the downstream signaling pathways. Besides, using in vivo animal studies, we examined and confirmed the effects of CCP on macrophages. Key results CCP could trigger TNF-α and IL-6 production of macrophages by targeting toll-like receptor 4 (TLR4). The CCP-induced TLR4-downstream is the MyD88/p38 signaling pathway. The immune-regulation of CCP on macrophages was not detected in TLR4-deficient mice. Conclusion and Implications The TLR4/MyD88/p38 signaling pathway plays a crucial role in the immune regulation of Cordyceps on the innate immune, which offers a better understanding of polysaccharide-based dietary and medicinal benefits and provides a scientific foundation for Cordyceps’ application.

Nuclear translocation regulated by phosphorylation is a key step in providing activated mitogen-activated protein kinases (MAPKs) access to their nuclear targets; however, the mechanisms linking MAPK-induced nuclear translocation and target gene expression mediating oncologic activity remain obscure. Here, we show that the MAPK extracellular signal-regulated kinase (ERK) 1, but not ERK2, phosphorylated intestine-specific homeobox (ISX), leading to its nuclear translocation and downstream oncogenic signaling. Mechanistically, ERK1 phosphorylated serine 183 of ISX, facilitating its nuclear translocation and downstream target gene expression. In contrast, dominant-negative ERK1 expression in hepatoma cells inhibited the nuclear translocation of ISX and the expression of downstream genes involved in cell proliferation, malignant transformation, and epithelial-mesenchymal transition in vitro and in vivo. An activating mutation in ISX (S183D) exhibited a constitutive nuclear localization and resistance to sorafenib. Additionally, in 576 paired clinical hepatocellular carcinoma (HCC) samples and adjacent normal tissues, ERK1 and ISX were co-expressed in a tumor-specific manner at mRNA and protein levels, while their mRNA levels showed significant correlation with survival duration, tumor size, number, and stage. These results highlight the significance of ERK1/ISX signaling in HCC progression and its potential as a prognostic and therapeutic target in HCC.

Objective: To evaluate the use of social support in a Facebook community of Essure® Problems Netherlands. Design: All post in the Facebook group between March 8 and May 8 of 2018 were included. Setting: A closed online Facebook group named: Essure Problems Netherlands. Population: All members of the Facebook community. Methods: In total 3,491 Facebook posts were analysed using a modified version on the social support behaviour code created by Cutrona and Suhr (1992). Main Outcome Measures: Posts were abstracted and aggregated into a database. Two investigators evaluated the posts, developed a modified version on the social support behaviour code book, and applied codes to data. Results: Results show that 92% messages contained a form of social support. In 68,8% of posting social support was given and in 31,2% social support was received. Informational and emotional support are the most frequently used form of given social support (53.4 and 43.6%, respectively). The same distribution is seen with receiving social support: informational support in 81,5% and emotional in 17,4% of the cases. Conclusions: The main purpose of women in the Essure® problems group was to give and receive informational and/or emotional support.

A 12-year-old male being treated for a high-risk relapsed T-acute lymphoblastic leukemia presented progressive weakness and numbness of both legs after having received a chemotherapy regimen that included bortezomib. Diagnosis of acute Guillain-Barré syndrome (GBS)-like inflammatory demyelinating polyneuropathy was made following clinical examination, cerebrospinal fluid analysis, electrodiagnostic studies, magnetic resonance imaging, and serum immunoglobulin antibodies to anti-ganglioside. Intravenous immunoglobulin (IVIG) treatment was started, resulting in complete clinical recovery. Although in rare cases, GBS after bortezomib therapy has been reported; this paper suggests that GBS may occur when bortezomib is administered and high‑dose IVIGs lead to a resolution of the symptoms.

We study a new Jerk equation involving three fractional derivatives and anti periodic conditions. By Banach contraction principle, we present an existence and uniqueness result for the considered problem. Then, by applications of Krasnoselskii fixed point theorem, another result for the existence of at least one solution is established. Also, An illustrative example is discussed. At the end, an approximation for Caputo derivaitive is proposed and some chaotic behaviours are discussed by means of the Runge Kutta 4th order method.

Objective: To assess the nutritional status of pregnant and postpartum women with COVID-19 and to verify the association with clinical outcomes of mortality and prematurity of childbirth. Design: Retrospective observational longitudinal study. Setting: University hospital in Goiânia-Goiás-Brazil. Population or sample: 34 patients with confirmed diagnosis of COVID-19, between June and September 2020. Methods: Medical records was analysided. All eligble cases was included. The collected data refer to demographic, clinical, obstetric and neonatal and anthropometric variables. Main outcome measures: Maternal deaths and prematury of childbirth. Results: 34 patients were evaluated (n=29 pregnants and n=5 postpartum women), with a mean age of 28.71±4.79 years. Of the total, 91.20% were overweight or obese with a current average BMI of 32.10±7.67 kg/m2. Of these cases, 14 had previous diseases, as well as the majority of these are in the overweight group (n=11) and had clinical complications, with ICU stay and use of ventilatory support. The clinical outcomes of mortality and premature birth accounted for 14.70% vs 68.70% of the sample, respectively, with one death in the eutrophic group and four in those with overweight/obesity (p=0.38), as well as the 11 premature births, 90.0% occurred in this group (p=0.47), with an average gestational age of delivery of 33.56±3.98 weeks. Conclusion: There was no association between nutritional status and maternal and perinatal outcomes, although most patients are overweight or obese, with severe clinical complications.

Objective: to assess the effect of a simulation -based training program (PROMPT) on the mode of delivery of breech presentation and to evaluate the neonatal outcomes. Design: a retrospective cohort study Setting: Rafic Hariri University Hospital (RHUH), a tertiary center in Beirut, Lebanon Population: A total of 92 pregnant women delivering a singleton with a breech presentation between June 2018 and December 2019 Methods: We used data from the local perinatal registry at the RHUH. Clinical outcomes were analyzed according to whether the obstetrician attended the “Train The Trainer” course of the PROMPT or not. Main outcome measures: Clinical measures include: the prevalence of cesarean deliveries in the groups R6 and R7 according to the Robson’s classification and neonatal outcomes (Apgar score at 1 and 5 minutes and admission to the neonatal intensive care unit (NICU) Results: The prevalence to deliver a breech presentation by assisted vaginal delivery is increased in group R6 of Robson’s classification and not in group R7 after the simulation and the retention of skills is time-related. No adverse neonatal outcomes were noted in both groups. Conclusion: The simulation-based course improved the management of assisted vaginal delivery in breech presentation mainly in group R6 of Robson classification, without increasing neonatal complications and the retention of skills decreases over time. Keywords: simulation, breech delivery, Robson classification, PROMPT

A document by Yeshey Dorjey. Click on the document to view its contents.

Compared with other abiotic stresses, drought stress is a serious causal factor leading to crop yield reduction. Poly-γ-glutamic acid (γ-PGA)，as an environmental friendly biomacromolecule, plays an important role in plant growth and regulation. In this project, we studied the effect of exogenous application of γ-PGA on drought resistance of maize (Zea mays. L) and its mechanism were studied. Drought can significantly inhibit the growth and development of maize, but the exogenous application of γ-PGA can apparently increase the dry weight of maize and the contents of ABA, soluble sugar, proline, and chlorophyll under severe drought stress. RNAseq study found that γ-PGA may enhance drought resistance of maize by affecting the expression of the ABA biosynthesis and ABA signal transduction related genes, photosynthesis-related genes and other stress-responsive genes, which were also demonstrated by RT-PCR and promoter motif analysis. The results of diversity and structure analysis of rhizosphere soil bacterial community showed that γ-PGA could enrich the plant growth promoting bacteria such as Actinobacteria, Chloroflexi, Firmicutes, Alphaproteobacteria and Deltaproteobacteria, so as to improve the drought resistance of maize. This study emphasized the possibility of using γ-PGA to improve crop drought resistance and soil environment under drought condition.

AbstractBackground/aim: Intravenous lipid emulsion (ILE) is an established antidote for local anesthetic systemic toxicity and has been tested in various lipophilic drug intoxications, but its efficacy in pioglitazone toxicity remains unclear. This study evaluated biochemical and histopathological effects of pioglitazone and the potential protective role of ILE in an animal model. Materials and methods: Thirty-two male Sprague–Dawley rats were randomly assigned to four groups (n=8): Control, ILE (12.4 mL/kg, 20% IV), pioglitazone (PIO; ½ LD₅₀, 1,000 mg/kg), and PIO+ILE. ILE (or saline) was administered intravenously over ~2 minutes immediately after pioglitazone, with matched volume and duration. Animals were observed for 24 h with free access to food and water. At 24 h, rats were decapitated, and blood and tissue samples were analyzed.Results: Pioglitazone induced significant hepatic and renal injury (both p<0.001), while cardiac changes were minimal and nonsignificant. ILE administration did not reduce liver or kidney injury. The ILE-only group showed higher renal injury versus controls (p<0.001). Serum biochemistry revealed increased BUN and creatinine in PIO+ILE compared with Control and ILE (adjusted p<0.05), with no difference between PIO and PIO+ILE.Conclusion: ILE failed to reverse hepatic or renal injury in acute pioglitazone toxicity and was associated with potential nephrotoxic effects. These findings suggest limited utility of ILE for pioglitazone overdose, likely reflecting drug physicochemical properties (moderate lipophilicity, high protein binding) and timing/dosing constraints. Caution is warranted, particularly regarding renal effects.Keywords: Pioglitazone, intravenous lipid emulsion, hepatotoxicity, nephrotoxicity, drug intoxication, rat model.

I am a professor and attending pharmacist in the field of pharmaceutical sciences and writer or co-author of at least 5 manuscripts about different aspects of COVID-19. More than 15 months from the first report of COVID-19, over 120 million people all over the world infected by this virus, and more than 2.5 million of them have died. Although different treatment approaches have been proposed, management of the COVID-19 patients is steal remained controversial. In this regard, I want to share my personal experience from the exposure to the coronavirus and the consequence of this infection on my health status. I am a 51 years old male, known case of hypertension, dyslipidemia, and chronic kidney disease. During working hours of colleagues in the Faculty of Pharmacy, I visited one of my colleagues in his office. After leaving the Faculty, my colleague declares that his RT-PCR test of COVID-19 is positive and it took 3 days for me to experience the first sign of the COVID-19 as fever. Many complications have occurred for me during the different stages of COVID-19 infection that I shared and explained in detail with the suggested pharmacotherapies. According to the pathophysiology of COVID-19 infection and my personal experience during COVID-19 infection, I want to emphasize the necessity of early initiation of anti-inflammatory agents including corticosteroids and colchicine in high-risk patients with mild-to-moderate COVID-19 pneumonia who shows respiratory system involvement, in order to prevent progression to the severe and critical stages of this disease.

In this paper, a fractional SIRS model on heterogeneous complex networks is introduced. The asymptotic local and global stability of equilibrium points are studied, numerical simulation is used to support our theoretical results and show the effect of fractional order q and the influence of connectivity between individuals which represented as ψ(t).