Acute ST-elevation Myocardial Infarction due to Coronary Embolism from Left Atrial

Left Ventricular Thrombus Formation in aCOVID-19 Patient with a Complex Course of Pericarditis and Myocardial Infarction.

Tracheostomies are indicated in children to facilitate long-term ventilatory support, aid in the management of secretions, or to manage upper airway obstruction. Children with tracheostomies often experience ongoing airway complications, of which respiratory tract infections are common. They subsequently receive frequent courses of broad spectrum antimicrobials for the prevention or treatment of respiratory tract infections. However, there is little consensus in practice with regard to the indication for treatment/ prophylactic antimicrobial use, choice of antimicrobial, route of administration, or duration of treatment between different centres. Routine antibiotic use is associated with adverse effects and an increased risk of antimicrobial resistance. Tracheal cultures are commonly obtained from paediatric tracheostomy patients, with the aim of helping guide antimicrobial therapy choice. However, a positive culture alone is not diagnostic of infection and the role of routine surveillance cultures remains contentious. Inhaled antimicrobial use is also widespread in the management of tracheostomy associated infections; this is largely based upon theoretical benefits of higher airway antibiotic concentrations. The role of prophylactic inhaled antimicrobial use for tracheostomy associated infections remains largely unproven. This systematic review summarises the current evidence base for antimicrobial selection, duration, and administration route in paediatric tracheostomy associated infections. It also highlights significant variation in practice between centres and the urgent need for further prospective evidence to guide the management of these vulnerable patients.

INTRODUCTION: Chronic Lung Aspiration (CLA) is a major cause for repeated hospitalizations in neurologically impaired (NI) children. This can be due to both gastroesophageal reflux disease (GERD) and drooling. Successful surgical treatment of GERD alone does not guarantee the prevention of further episodes of inhalation. The aim of the study was to analyze our experience with combined surgical treatment of GERD and drooling, consisting in a single-stage procedure combining Nissen Fundoplication (NF) and Subtotal Functional Sialoadenectomy (SFS). METHODS: retrospective analysis of consecutive patients treated in our pediatric tertiary center (period: 2012-20). Inclusion criteria: NI pediatric patients with CLA, with simultaneous refractory GERD and drooling, minimal follow-up (FU) ≥12 months. RESULTS: 17 patients were included. Before surgery, 4 (24%) had ≤1 aspiration pneumonia/year, while 13 (76%) had recurring episodes (≥2 per year) before surgery. The median age at surgery was 8.2 years-old (range: 0.8-18.5). Three patients (17%) had early major complications (Clavien-Dindo ≥IIIa). No surgery related death occurred. During the follow-up, the study population showed a significant decrease in vomiting/regurgitation (p=0.0004), drooling (p=0.0039), and mean episodes of pneumonia/year (p=0.0009). One patient (6%) needed to re-do fundoplication for GERD recurrence. One patient underwent tracheostomy due to respiratory failure. Conclusions: A combination of NF and SFS may be considered for NI patients with CLA caused by refractory GERD and drooling. This approach could effectively treat symptoms and slow respiratory deterioration in this high-risk subgroup of patients, reducing the rate of patients necessitating a tracheostomy to manage pulmonary secretions.

Children with home invasive mechanical ventilation need special health care and rehabilitation services due to complications caused by both the pulmonary system and limitation of movement. The need for rehabilitation in this patient group is increasing day by day. In this treatment method, whose importance and application area is increasing, life expectancy is prolonged, respiratory morbidity decreases and quality of life increases with effective rehabilitation. The main purpose of rehabilitation is to reduce morbidity, increase the independence of the child in activities, and improve the quality of daily life and life as much as possible. Physical therapy and exercise practices applied in this patient group can be divided into two; those for the whole body and those for the pulmonary system. Parent and/or caregiver education is important to ensure effective invasive mechanical ventilation. In this review, although full standard approaches have not been determined yet, rehabilitation approaches for children dependent on home-type invasive mechanical ventilator will be discussed.

A previously healthy 4-year-old female presented for a cough that was not responsive to treatment of inhaled corticosteroid (ICS). Pertinent history included meconium aspiration with no respiratory support required and a course of confirmed SARS-CoV-2 with fever and mild respiratory symptoms of a cough, that resolved in 2-3 weeks. Child was seen in Allergy clinic 2 months before first Pulmonary clinic appointment with a compliant of cough that redeveloped. Cough was dry, associated with strenuous activity, and noticeably present at night. She was started on albuterol 2 puffs every 4 hours, as needed.

Reactance Inversion in persistent asthma: artifact or airway narrowing marker?

Group A Rotavirus (RVA), which causes acute gastroenteritis (AGE) in children worldwide, is categorized mainly based on VP7 (genotype G) and VP4 (genotype P) genes. Genotypes that circulate at <1% are considered unusual. Important genes are also VP6 (genotype I) and NSP4 (genotype E). VP6 establishes the group and affects immunogenicity, while NSP4, as enterotoxin, is responsible for the clinical symptoms. Aim of this study was to genotype and molecularly characterize the VP6 and NSP4 genes of unusual RVA. Unusual RVA strains isolated from fecal samples of children ≤16 years with AGE, were genotyped in VP6 and NSP4 genes with Sanger sequencing. Phylogenetics was performed using the MEGA 11 program. In a 15-year period (2007-2021), 54.8% (34/62) of unusual RVA were successfully I and E genotyped. Three different I and E genotypes were identified; I2 (73.5%, 25/34) and E2 (35.3%, 12/34) were the commonest. E3 genotype was detected from 2017 onwards. The uncommon combination of I2-E3 was found in 26.5% (9/34) of the strains and G3-P[9]-I2-E3 was the most frequent G-P-I-E combination (20.6%, 7/34). Statistical analysis showed that children infected with E2 strains had a higher relative frequency of dehydration (50%) compared to those with the E3 genotype ( p=0.019). Multiple substitutions were detected in both genes, but their functional effect remains unknown. The results of this study highlight the genetic diversity of RVA strains. Continuous surveillance of the RVA based on the whole genome will provide a better knowledge of its evolution.

Background Recommendations have been issued on healthy complementary feeding (CF) strategies for infants, to reduce food allergy. This is a study of routine guidance provided by Greek pediatricians on the timing of CF for healthy infants and those at high risk for allergy. Methods Pediatricians in Greece completed an anonymous online questionnaire covering demographic information and recommended CF, specifically the foods, preparation methods, supplements, time interval between introduction of new foods for infants at low and high risk for allergy, and foods delayed in the case of high allergy risk. Results The respondents (n=233) recommended introducing: at 6 months, fruits, starchy non-gluten-grains, vegetables, olive oil and meat; at 7 months, gluten-rich grains; at 8 months, yogurt, hard-boiled egg and legumes; at 8.5 months, fish; at 9 months, nuts. A longer interval between new foods (≥ 4 days) was recommended, for low-risk infants, by male pediatricians (p=0.04), and for infants at high risk of allergy, by pediatricians with no subspecialty (p<0.001) and those practicing in a rural/semi-urban area (p=0.002). Pediatric practice of < 15 years was a predictor for earlier introduction of egg, seafood, gluten-rich grains, legumes and nuts for infants at high risk of allergy, and parenthood and male sex for egg and grains. Conclusions Greek pediatricians use a food introduction schedule for CF of infants, and, although not explicitly recommended in current guidelines, they delay introduction of common food allergens and suggest longer time intervals between introduction of new foods, especially for infants at high risk of allergy.

Background Understanding the cellular host factors that promote and inhibit viral entry is important for identifying viral countermeasures. CRISPR whole genome screens can be used to rapidly discover host factors that contribute to or impair viral entry. However, when using the live viruses and cellular lethality for selection, these screens can identify an overwhelming number of genes without specificity for the stage of the viral infection cycle. New screening methods are needed to identify host machinery contributing to specific steps of viral infection. Here, we developed a CRISPR whole genome screen and counter screen strategy based on a pseudoviral platform that allowed identification of genes specific to SARS-CoV-2 spike and vesicular stomatitis virus glycoprotein VSV-G mediated entry. Methods To focus the screen onto the entry step, we used non-lytic fluorescent reporters in combination with a comparative counter screen strategy to distinguish host genes affecting the pseudoviral reporter from those unique to envelope-mediated entry. Screening of SARS-CoV-2 spike and VSV-G on the same lentiviral pseudovirus allowed identification of entry-specific genes relative to genes associated with retro-transcription, integration, and reporter expression from the lentiviral pseudovirus. Second, a Cre-Gag fusion protein in the pseudovirus was used to bypass retro-transcription and integration by directly activating a floxed GFP reporter upon entry to reduce the number of gene hits and increase specificity for viral entry. Results Our approach correctly identified SARS-CoV-2 and VSV-G receptors ACE2 and LDLR, respectively and distinguished genes associated with retroviral reporter expression from envelope-mediated entry. Moreover, the CRE-Gag fusion/flox reporter increased the screen specificity for viral entry associated genes. Validation of a few hits demonstrates that this approach distinguishes envelope-specific host factors from genes affecting reporter expression. Conclusion Overall, this approach provides a new strategy for identifying host genes influencing viral entry without the confounding complexity of live-viral screens which produce long gene lists associated with all aspects of viral pathogenesis and replication. This approach provides a pathway for increasing the specificity of CRISPR whole genome screens for identifying host genes contributing to specific steps in viral infection.

Background and Objectives: Kaposiform hemangioendothelioma (KHE) and tufted angioma (TA) are rare vascular tumors in children historically associated with significant morbidity and mortality. This study was conducted to determine first line therapy in the absence of available prospective clinical trials. Methods: Patients from 17 institutions diagnosed with KHE/TA between 2005-2020 with > 6 months follow-up were included. Response rates to sirolimus and vincristine were compared at 3 and 6 months. Durability of response and response to other treatment modalities were also evaluated. Results: Of 159 unique KHE/TA subjects, Kasabach-Merritt phenomenon (KMP) was present in 64 (40.3%) and only 2 patients were deceased (1.3%). Over 60% (n=96) demonstrated treatment response at 3 months and >70% (n=114) by 6 months (no significant difference across groups). The vincristine group had higher radiologic response at 3 months compared to sirolimus (72.7% vs 20%, p=0.03) but there was no differences between these groups at 6 months. There were no differences in rates of recurrent or progressive disease between vincristine and sirolimus. Conclusions: In this large, multicenter cohort of 159 patients with KHE/TA, rates of KMP were consistent with historical literature but the mortality rate (1.3%) was much lower. Overall treatment response rates were high (>70%) and there were no significant difference in treatment response or durability of disease comparing sirolimus to vincristine. Our results support individualized treatment decision plans depending on clinical scenario and patient/physician preferences. Response criteria and response rates reported here will be useful for guiding future treatment protocols for vascular tumors.

Hydrogen is considered a promising alternative to fossil fuels in integrated energy systems (IES). In order to reduce the cost of hydrogen energy utilization and carbon emissions in IES, this paper proposes a dispatching strategy that coordinates green hydrogen and blue hydrogen in IES. This strategy takes into account the economic and low-carbon complementarity between hydrogen production through water electrolysis and natural gas. To ensure the refined utilization of different types of hydrogen energy, the paper introduces the green hydrogen production-storage-use module (GH-PSUM) and the blue hydrogen production-storage-use module (BH-PSUM). Additionally, the paper analyzes the flexibility in hydrogen load supply and proposes the dynamic response mechanism of hydrogen load supply structure (DRM-HLSS) to further reduce operating costs and carbon emissions. Furthermore, the paper introduces the carbon trading mechanism (CTM) to control the carbon emissions of the integrated energy system. The paper establishes a low-carbon economic dispatch model by comprehensively considering the constraints of each equipment and minimizing the total economic cost of wind power operation, wind power curtailment penalty cost, energy purchase cost, blue hydrogen purification cost, and carbon transaction cost. The rationality of the scheduling model is verified through comparative analysis of the scheduling results under multiple operating scenarios.

The ion current generated during the operation of UHVDC (Ultra-high Voltage Direct Current) transmission lines has an increasingly prominent impact on the electromagnetic environment. At present, electric field line method and finite element method are commonly used to achieve fine steady-state solution of ion flow field, but the dynamic process of corona discharge is not analyzed. Therefore, based on the dilute species theory, the real-time motion state of charge is considered, and the behavior law of ions in complex flow field and electric field is emphasized. The effect of wind speed on space charge distribution is also analyzed. It provides reference for the electromagnetic environment prediction, control, and evaluation of UHVDC transmission projects. The results show that the microscopic process of positive and negative corona discharge is different. It also shows that the two have different mechanisms for maintaining self-maintained discharge. According to the established ±800kV UHVDC transmission line model, the maximum ion current density near the ground is 32.62nA/m2. Affected by the wind speed, the ground ion current density on the downwind side gradually decreases, while the upwind side gradually increases. When the wind speed is greater than or equal to 3m/s, the ground ion current density on the downwind side decreases to 0.

High-fidelity numerical simulations of wind turbines are often performed through a computational fluid dynamics (CFD) model in which the wind turbine is parametrized using an actuator line model, as fully blade-resolved simulations are computationally expensive at the large Reynolds numbers involved. When applying such an actuator line approach to the modeling of wind turbines, the two main issues to consider are the free-stream velocity sampling and the choice of the regularization kernel used to project the computed body forces onto the domain. In this work, a novel velocity sampling method - the so-called effective velocity model (EVM) - is implemented in the CFD software SOWFA and assessed against pre-existing approaches. Results show superior method robustness with respect to the regularization kernel width choice while preserving acceptable accuracy.

Cloud computing technology significantly emerged in various systems to enhance the platform and infrastructure of services. Fog and Edge computing technologies transform computing power and processing close to the end-user and resolve many data processing challenges. Healthcare IoT systems refer to using medical sensors and mobile computing to manage patients’ conditions and use cloud-based technologies to transfer collected patients’ data to the cloud computing storage. Many previous research efforts focused on the use of edge, fog, and cloud computing technologies in the field of healthcare IoT systems. However, no previous research study summarized the main research topics and trends in these research efforts. To that end, we conducted a systematic and comprehensive empirical research study to understand the main research topics and the employed computing technologies and trends in these research topics. This study investigated 100 research studies focusing on cloud-based technologies in the filed of healthcare IoT systems published in highly reputable venues over the past decade. We created a taxonomy of the main research topics of the investigated research manuscripts and reported the main focus of these research efforts and the trends in this field. Our investigation concluded that the researchers mainly focused on the following five research topics: big data, security, network latency, energy efficiency, and QoS. However, some research topics are well studied while others are poorly investigated and need more attention. We found that the highest number of research papers focused on big data, i.e., 63% of the studied papers, while the energy efficiency topic had the lowest number of papers, i.e., 17% of the papers. Researchers and practitioners interested in the cloud-based healthcare IoT systems can use our findings to gear their work on the areas that are poorly investigated to find better solutions.

Shobith Suresh*

Behavioral and neural correlates of response inhibition are assumed to manifest in self-reported impulsivity and compulsivity, but findings are inconsistent. Existing studies often examined only isolated components of the complex underlying neural process and used sumscores of impulsivity and compulsivity. Yet, there is evidence suggesting that alterations in response inhibition may be linked to specific subfacets of the multidimensional constructs. Therefore, our aim was twofold: to investigate behavioral and neural correlates of response inhibition in a comprehensive way, and to examine whether these effects are associated with urgency, compulsivity, or the interaction of both. We examined 233 participants who performed a stop-signal task while electroencephalography (EEG) was recorded. The analysis involved single-trial regression and latency analyses, exploring the relationships with self-reported urgency and compulsivity. Stop-signal reaction time (SSRT) was not related to urgency or compulsivity. SSRT and urgency scores were negatively associated with an attenuated successful inhibition-P3 effect. Crucially, whereas long SSRT was associated with a reduced attention-P1 effect and a later onset and peak of the P3, we observed the opposite pattern for higher urgency with higher P1 related activity and an earlier onset and peak of the successful inhibition-P3. Associations with compulsivity were not observed. The absence of a direct association between urgency and SSRT can possibly be clarified by considering early attentional processes reflected in P1 and latency effects during response inhibition. Urgency appears to be related to increased recruitment of early attention and a faster action cancellation process that may compensate the reduced P3 related activity.

Aims: to systematically review the prevalence of DCD in individuals born preterm; explore this prevalence according to gestational age and different assessments cut-offs; and compare to full-term peers. Methods: The eligibility criteria was observational and experimental studies reporting the prevalence of DCD in preterm individuals. A systematic search was performed in databases from inception until March 2022. The selection was performed by two independent reviewers. Study quality assessment was performed using the checklists from Joanna Briggs Institute (JBI). Data analysis were performed on Excel and Review Manager Software 5.4. Results: Among the 1774 studies identified, 32 matched the eligibility criteria. The pooled estimates of DCD rate in preterm was 21% (95% CI 17.8–24.3). The estimate rates were higher as gestational age decreased, and preterm children are two times more likely to have DCD than their full-term peers RR 2.2 (95% IC 1.77–2.79). Interpretation: The limitation was high heterogeneity between studies: the assessment tools and cut-off points, as well as the age at assessment, were diverse. This study provided evidence that preterm children are at higher risk for DCD than full-term children, and the risks increased as gestational age decreased.

Schizophrenia is an incurable psychotic illness. Those diagnosed have limited pharmacological treatment options, many of which do not provide long term relief and come with unpleasant side effects. The endocannabinoid and serotonergic systems are important neuromodulators in psychotic illness. We hypothesize that cannabidiolic acid methyl ester (HU-580) that exerts action on both these systems could have therapeutic potential by antagonizing cannabinoid receptor-1 (CB1R) and agonizing 5-hydroxytryptamine receptor-1A (5-HT1AR). We employed behavioural and brain protein analyses in male and female mice exposed to MK-801, which precipitated schizophrenia-related reactivity across a number of behavioural dimensions. C57BL/6 mice were subjected to a battery of behavioral tests, and we found that subchronic treatment of MK-801 (once daily for seven days) induced positive-like, negative-like, and cognitive-related behavioral deficits; primarily in females. Sub-chronic treatment of MK-801 (once daily for 17 days) induced positive- and negative-like behavioral deficits in females. Low-dose (0.01ug/kg) but not high-dose (0.05 ug/kg) treatment rescued female mice from schizophrenia-related behavioral deficits. Altogether, these data suggest that HU-580 may have dose-dependent antipsychotic-like potential that rely on mechanisms that recruit CB1R and 5-HT1AR.

Background Abdominal wall endometriosis (AWE) is the most common type of extrapelvic endometriosis in women of reproductive age, and several studies have compared high-intensity focused ultrasound (HIFU) ablation with surgical resection in the management of AWE; however, the results are controversial. Objective To compare the efficiency and safety of HIFU ablation with surgery in the treatment of AWE. Search strategy Literature on surgery versus HIFU ablation for treating AWE was identified using the PubMed, Embase, Web of Science, China National Knowledge Infrastructure, WANFANG Database and the Cochrane Library databases. Selection Criteria Full-text manuscripts comparing HIFU ablation and surgery for treating AWE were included. Data collection and analysis Two independent reviewers reviewed and extracted data from the articles, and the risk of bias was assessed according to the Cochrane Handbook for Systematic Reviews of Interventions. Data analysis was performed using RevMan 5.4. Main results We included 7 studies involving 405 patients. Compared with the surgery group, the immediate posttreatment visual analogue scale (VAS) score was lower in the HIFU group (mean difference [MD] -1.58, 95% CI -2.56 to -0.59), the length of hospitalization was shorter in the HIFU group (MD -1.95 days, 95% CI −2.43 to −1.48), and the incidence of adverse events was lower in the HIFU group (relative risk 0.32, 95% CI 0.15 to 0.65). There was no significant difference in the symptom recurrence rate, VAS score at the 3-, 6- and 12-month follow-ups, or treatment time between the two groups. Conclusions Compared with surgery, immediate postoperative VAS scores were lower, hospitalization times were shorter, and the risk of adverse events were lower in patients receiving HIFU ablation treatment for AWE.

Among the tasks to investigate decisional processes, the Iowa Gambling Task (IGT) appears to be the most effective since it offers the opportunity to deepen the progressive learning process based on feedbacks derived by previous choices. Recently, the study of decision making through the IGT has been combined with the application of the transcranial direct current stimulation (tDCS) to further deepen the cognitive mechanisms and the neural structures involved. This scoping review wants to provide a comprehensive exploration of the effects of tDCS in modulating decisional processes assessed through the IGT, offering an analysis of the state of literature. Results highlighted a pivotal role of the dorsolateral prefrontal cortex and the orbitofrontal cortex in risky and ambiguous decisions. Overall, tDCS improved decisional processes in healthy subjects and patients, confirming its potential in enhancing decision making in everyday contexts. Suggestions for further studies are provided to delve into decisional mechanisms and how to better support them.

Alzheimer’s disease (AD) is the most common form of dementia in the elderly without cure approaches. Increasing evidence indicates that the activation of p38 MAPK is highly expression in AD brain and involved in the AD pathological process. However, whether specific inhibition of p38α/β MAPK activation could prevent disease progression and its underlying mechanisms remains completely unclear. In this study we investigated the potential disease-modifying therapeutic effect and its underlying mechanisms of specific inhibition of p38α/β MAPK activation by SB239063, a potent and selective p38α/β MAPK specific inhibitor, in six-month-old male APPswe/PS1dE9 mice. Our results revealed that chronic treatment of SB239063 potently inhibited p38 MAPK activation, which led to a marked improvement of cognitive impairments, dramatic reduction in Aβ production, tau hyperphosphorylation and synaptic impairments in APPswe/PS1dE9 mice. In addition, SB239063 treatment strongly enhanced nonamyloidogenic APP processing and inhibited amyloidogenic APP processing via regulating APP-cleavage secretase expression as well as inhibited tau phosphorylation kinase activation in APPswe/PS1dE9 mice. Collectively, this study demonstrates that chronic SB239063 treatment potently inhibits p38α/β MAPK activation, which prevents the disease progression by markedly attenuating multiple AD-associated key neuropathologies and cognitive dysfunction. Our findings provide novel insights of the mechanisms of inhibition of p38α/β MAPK activation for the treatment of AD and highlight that specific inhibition of p38α/β MAPK activation by SB239063 treatment may be a promising therapeutic strategy for AD treatment.

A document by Margot Landa - Pliquet. Click on the document to view its contents.

Vitus Kajerero1, Okoa Sukunala1, Remigius A. Rugakingira1, Alphonce Chandika2 Orgeness J. Mbwambo3, Edward Msokwa41Department of Urology, Benjamin Mkapa Hospital, P.O Box 11088 Dodoma, Tanzania.2Departiment of General Surgery, Benjamin Mkapa Hospital, P.O Box 11088 Dodoma, Tanzania3Department of Urology, Kilimanjaro Christian Medical University College.P.O.Box 2240, Moshi.Tanzania.4Departiment of Surgery, School of Medicine and Dentistry, University Of Dodoma P.O Box 259 Dodoma, Tanzania