Objective: To assess whether dose adjustments of linezolid were needed based on renal function and body weight against methicillin-resistant Staphylococcus aureus (MRSA) infections. Methods: Monte Carlo simulations (MCSs) were conducted to simulate pharmacokinetic/pharmacodynamic (PKPD) model. Area under the concentration time curve (AUC)/ minimum inhibitory concentration (MIC) ratio and percentage of time above the MIC (%T>MIC) were regarded as PKPD targets. The probability of target attainment (PTA) and cumulative fractions of response (CFR) were calculated to assess the efficacy. Regarding safety, trough plasma concentration (Cmin) > 8 mg/L was used to target for toxicity. Results: Using AUC /MIC > 100 as the parameter, the CFR of linezolid at the standard dose [600 mg every 12 h (q12h)] were 57.01%, 93.22% and 99.93% in patients with normal renal function, patients with renal dysfunction and low body weight patients with renal dysfunction, respectively. Using 100%T > MIC as the parameter, all the CFR of three population groups were more than 90% at the standard dose. The percentages of Cmin > 8 mg/L at the standard dose of linezolid were 24.16%, 53.24% and 90.10% in three population groups on day 7. Conclusions: The risk of thrombocytopenia of linezolid was extremely high in low body weight patients with renal impairment when receiving standard linezolid dose. 600 mg q12h might be effective and safe against MRSA infection in patients with normal renal function, while 450mg q12h and 300mg q12h in patients with renal dysfunction and low body weight patients with renal dysfunction, respectively.

This study compared the antimicrobial resistance (AMR) among commensal Escherichia coli in the fecal microbiota of young calves raised on organic and on conventional dairy farms in Switzerland. Further, fecal carriage of extended-spectrum beta-lactamase (ESBL) producing Enterobacteriaceae was assessed for calves from both farming systems. Where possible, data on antimicrobial usage (AMU) were obtained. Antimicrobial susceptibility testing was performed on a total of 71 isolates using the disk diffusion method. ESBL producers were characterized by PCR-based multilocus sequence typing and sequencing of the blaESBL genes. Organically raised calves were significantly more likely to harbor E. coli that showed antimicrobial resistance to ampicillin (OR 2.78, 95%CI 1.02–7.61, p=0.046), streptomycin (OR 3.22, 95%CI 1.17–8.92, p=0.046), kanamycin (OR 11.3, 95%CI 2.94–43.50, p<0.001), and tetracycline (OR 3.25, 95%, 95%CI 1.13–9.31, p=0.028). Calves with reported AMU were significantly more likely to harbor E. coli with resistance to ampicillin (OR 3.91, 95%CI 1.03–14.85, p=0.045), streptomycin (OR 4.35, 95%CI 1.13–16.7, p=0.045), and kanamycin (OR 8.69 95%CI 2.01–37.7, p=0.004). ESBL-producing Enterobacteriaceae (18 E. coli and 3 Citrobacter braakii) were detected exclusively among samples from conventionally farmed calves (OR infinity (∞), 95%CI 2.3–∞, p< 0.0013). The observations from this study suggest that AMR is highly prevalent among commensal E. coli in young dairy calves, irrespective of the farm management system, with proportions of certain resistance phenotypes higher among organic calves. By contrast, the occurrence of ESBL producers among young dairy calves may be linked to factors associated with conventional farming.

Background Human Parainfluenza viruses (HPIV) comprise of four members of the genetically distinct genera of Respirovirus (HPIV1&3) and Orthorubulavirus (HPIV2&4), causing significant upper and lower respiratory tract infections worldwide, particularly in children. However, despite frequent molecular diagnosis, they are frequently considered collectively or with HPIV4 overlooked entirely. We therefore investigated clinical and viral epidemiological distinctions of the relatively less prevalent Orthorubulaviruses HPIV2&4 at a regional UK hospital across four autumn/winter epidemic seasons. Methods A retrospective audit of clinical features of all HPIV2 or HPIV4 RT-PCR-positive patients, diagnosed between 1st September 2013 and 12th April 2017 was undertaken, alongside sequencing of viral genome fragments in a representative subset of samples. Results Infection was observed across all age groups, but predominantly in children under nine and adults over 40, with almost twice as many HPIV4 as HPIV2 cases. Fever, abnormal haematology, elevated C-reactive protein and hospital admission were more frequently seen in HPIV2 than HPIV4 infection. Each of the four seasonal peaks of either HPIV2, HPIV4 or both, closely matched that of RSV, occurring in November and December and preceding that of Influenza A. A subset of viruses were partially sequenced, indicating co-circulation of multiple subtypes of both HPIV2&4, but with little variation between each epidemic season or from limited global reference sequences. Conclusions Despite being closest known genetic relatives, our data indicates a potential difference in associated disease between HPIV2 and HPIV4, with more hospitalisation seen in HPIV2 mono-infected individuals, but a greater overall number of HPIV4 cases.

Respiratory syncytial virus (RSV) is the leading cause of severe lower respiratory infection and therefore, a major threat to global health. In the Philippines, RSV is the second most common respiratory viral pathogen next to rhinovirus among children with severe pneumonia. Since 2006, national influenza-like illness (ILI) and severe acute respiratory infection (SARI) surveillances have been mainly focused only on influenza viruses. The prevalence and genetic diversity of RSV in the last decades were not completely elucidated. This study determined the epidemiological and molecular characteristics of RSV among (ILI) and (SARI) cases of children in the Philippines. The Philippine National Influenza Centre (PNIC) collected oropharyngeal swab and nasopharyngeal swab samples from patients under the age of five who are presented with ILI and SARI for the period of 2006-2016. These swabs have been examined for RSV subgroup by multiplex real-time qRT-PCR. Sequencing and phylogenetic analyses were used to determine the genotype of RSV samples. A total of 1,036 samples were systematically selected and tested. Of these samples, 122 were RSV-positive at 11.8 % prevalence rate, and 58.2% (71/122) were classified as RSV-A. Six genotypes were identified, which included NA1 (27/122, 22.1%), ON1 (5/122, 4.1%), GA2 (1/122, 0.8%) and GA5 (1/123, 0.8%) for RSV-A; and BA2 (13/122, 10.7%) and BA9 (1/122, 0.8%) for RSV-B. Most RSV-related cases were significantly associated with pneumonia and bronchitis. The pattern of RSV activity in the Philippines resembles the transmission of RSV globally.

Hydrological drought has wide-ranging impacts on water quality, nutrient and carbon metrics that are critical to investigate with the increased drought frequency predicted with climate change. This study compared physicochemical parameters (temperature, conductivity, pH and DO), nutrients (TN, NO X, NH 3, TP) and carbon (TOC and DOC) between hydrological drought conditions (2006–2009) and hydrological normal conditions (2016–2019) at five sites along the lower Savannah River (Georgia, USA). We unexpectedly found temperature (F 1,220=4.27, p=0.04) was significantly lower during drought conditions. Levels of pH (F 1,220=11.99, p<0.01) and DO (% saturation; F 1,220=9.17, p=0.01; and mg L –1; F 1,220=4.04, p<0.01) were significantly higher during drought. We found TN (F 1,220=5.23, p=0.02), TOC (F 1,220=30.22, p<0.01) and DOC concentrations (F 1,220=30.22, p<0.01) were significantly lower during drought, but NO X concentrations (F 1,219=4.04, p=0.05) were significantly higher during drought. Conductivity only varied at the lower river sites, being significantly higher during drought at Sites 3 (F 1,47=12.56, p<0.01), 4 (F 1,47=12.96, p<0.01) and 5 (F 1,34=17.60, p<0.01). These complex changes could be attributed to volume reductions coupled with an increase in the percentage of total flow originating from groundwater and limnetic reservoir inputs, persistent point source pollution, reduced natural catchment inputs and/or reduced floodplain interactions. The changes that occurred during drought may be disruptive to aquatic life, not only from reduced water quantity but also due to a scarcity of some biologically essential materials and lower food resources, combined with artificially high levels of some other potentially stressful materials.

1. This study is the first to quantitatively measure of the courtship flights of Latham’s snipe (Gallinago hardwickii), a migratory shorebird on the East Asian-Australasian Flyway, which is nearly threatened in their major breeding ground in Japan. 2. We localised the fine-scale movements of their display flights performed at high altitude and high speed, using a 16-channel microphone array, and assessed the direction from which each sound arrived using robot audition. 3. Preliminary analyses of the azimuthal and elevation angles of the display flights partially revealed a fine-scale flight trajectory, in which a male Latham’s snipe gradually gained elevation while vocalising sharp and harsh repeating calls until it reached the flight peak elevation and then dove down to the ground with a winnowing along wetland zones without tall vegetation. 4. Not only is this observation methodologically useful for better understanding Latham’s snipe display flight site selection, but can also be extended to investigate other rare nocturnal or crepuscular birds, that are too timid to risk ringing or tagging.

Background Linezolid is often used for the infections caused by drug-resistant Gram-positive bacteria. Recent studies suggested that large between-subject variability (BSV) and within-subject variability could alter drug pharmacokinetics (PK) during linezolid therapy due to pathophysiological changes. Objective The review synthesized information on linezolid population PK studies and summarized the significant covariates that influence the PKs of linezolid. Methods A literature search was performed from PubMed, Web of Science, and Embase from their inception to 30 September 2021. Published studies were included if they contained data analyzing linezolid PK parameters in humans using a population approach with a nonlinear mixed-effects model. Results Twenty-five studies were included in adults and five studies in pediatric patients. One- and two-compartment models were the commonly used structural models for linezolid. Body size [weight, lean body weight, and body surface area], creatinine clearance (CLcr), and age significantly influenced linezolid PK. The median clearance (CL) values (range) in infants [0.128 L/h/kg (0.121-0.135)] and children [0.107 L/h/kg (0.088-0.151)] were higher than in adults [0.098 L/h/kg (0.044-0.237)]. For patients with severe renal impairment (CLcr ≤ 30 mL/min), the CL was 37.2% (15.2-55.3%) lower than in patients with normal renal function. Conclusion Linezolid’s optimal dosage could be adjusted based on the patient’s body size, renal function, and age. More studies are needed to explore the exact mechanism of elimination of linezolid and evaluate PK characteristics in pediatric patients.

Intraspecific genetic variation in foundation species such as trembling aspen shapes their impact on forest structure and function. Identifying genes and genomic regions underlying ecologically relevant traits is key to understanding that impact. Previous studies using genome-wide association (GWA) analyses to identify candidate genes have identified fewer genes than anticipated for highly heritable traits. Mounting evidence suggests that polygenic control of quantitative traits is largely responsible for this “missing heritability” phenomenon. Our research characterized the genetic architecture of 40 functional traits using genomic and transcriptomic analyses in an association mapping population of aspen. A multi-marker association model revealed that most traits displayed a polygenic architecture, with most variation explained by loci with small effects (below the detection levels of single-marker GWA methods). Consistent with a polygenic architecture, our single-marker GWA analyses found only 35 significant SNPs in 22 genes across 15 trait/trait combinations. Next, we used differential expression analysis on a subset of aspen genets with divergent concentrations of salicinoid phenolic glycosides (key defense traits). This alternative method to traditional GWA discovered 1,243 differentially expressed genes for a polygenic trait. Soft clustering analysis revealed three gene clusters (246 candidate genes) involved in secondary metabolite biosynthesis and regulation. Our results support the omnigenic model that complex traits are largely controlled by many small effect loci, most of which may not have obvious connections to the traits of interest. Our work reveals that functional traits governing higher-order community- and ecosystem-level attributes of a foundation forest tree species have complex underlying genetic structures and will require methods beyond traditional GWA analyses to unravel.

Endometriosis is a common chronic disease of women characterized by ectopic localization of the endometrial tissue in the peritoneal cavity. The pathogenesis of endometriosis closely resembles that of gynecological cancers in ways of menstruation- and ovulation-driven, wide intraperitoneal seeding, somatic hypermutation, and immune escape. While retrograde menstruation is regarded as the primary cause of endometriosis, the role of ovulation in the development of endometriosis has long been overlooked. We present the double engines, one checkpoint theory of the evolution of endometriosis. This new theory may lead to new concepts and strategies for preventing and treating this disease.

Objective To establish pregnancy-specific reference ranges for fasting and postprandial total serum bile acids (TSBA) levels. Design Cross-sectional study. Setting Tertiary care university hospital. Population Healthy pregnant women at term admitted to the Obstetrics Department over one year. Exclusion criteria were an established diagnosis of intrahepatic cholestasis of pregnancy (ICP) or any co-existing condition of increased risk for ICP. Methods and Main Outcome Measures Both fasting and postprandial TSBA levels were measured in 612 women (528 fasting and 377 postprandial samples). Results Reference intervals of 4.4-14.1 µmol/L for fasting TSBA, and 4.7-20.2 µmol/L for postprandial TSBA were established. The postprandial values were significantly higher than the fasting measurements, with a mean increase of 1.77 µmol/L (22%). A correlation between fasting TSBA levels and postprandial levels was found, as well as with fetal gender, parity, and the use of assisted reproductive technologies. A seasonal pattern was noticed for both fasting and postprandial TSBA, with the highest values in the winter season (p < 0.01 and 0.02, respectively). Conclusions Normal pregnancy is a sub-cholestatic state and is associated with a physiological elevation of TSBA levels, therefore a higher threshold should be considered for the diagnosis of ICP. We suggest using the upper reference limit observed in our healthy pregnant population (fasting ≥14 µmol/L and postprandial ≥20 µmol/L). As the fasting measurement is more specific for the diagnosis, and the postprandial is essential for severity assessment, it is recommended to measure both values, rather than use random samplings. Funding No funding to declare.

The present study aimed to report a case with COVID-19 with a history of chronic diseases, beta thalassemia intermedia, and DM. A 25-year-old man visited with covid 19 and treatment with IFN-β1a. According to the present report, the use of IFN-β1a was effective as a treatment option for COVID-19.

The pre-loading on the engineering materials or structures may produce pre-strain, especially plastic strain, which would change the fatigue failure mechanism during their service time. In this paper, an energy-based method for fatigue life prediction on high strength steel welded joints under different pre-strain levels was presented. Three kinds of tensile pre-straining were conducted on the specimens, and the cyclic stress and strain responses with pre-loading were compared with the ones without pre-loading at the same strain level. The experimental work showed that the plastic strain energy density of pre-strained welded joints was enlarged, while the elastic strain energy density of pre-strained welded joints was reduced. Then, based on the strain energy density method, a fatigue life estimation model of the high strength steel welded joints in consideration of the pre-straining was proposed. The predicted results agreed well with the test data.

Objective To compare daytime and nighttime use and outcome for non-invasive respiratory intervention (NIRI) during initial admission to a pediatric post-acute care hospital (PACH). Method Retrospective examination of initial PACH admissions (October 2018 through September 2020) for infants and children requiring NIRI during the day and night. Measures included: 1) Demographics (e.g. age, diagnostic group); 2) Daytime and nighttime NIRI type (supplemental oxygen therapy via low flow nasal cannula or positive airway pressure (PAP) via high-flow nasal cannula, continuous positive airway pressure (CPAP), or biphasic positive airway pressure (BiPAP) at admission and discharge; and 3) Outcome (reduction, increase, or no change) in NIRI support for daytime and nighttime from admission to discharge. Results Thirty-eight infants and children (mean age=3.64 years; premature infants, n=20, other diagnoses, n=18) were included. For the total sample (n=38), daytime vs. nighttime NIRI type was significantly different (p<.001). At both admission and discharge, supplemental oxygen was the most common NIRI during the day, while PAP was most common at night. From admission to discharge, 7 (18%) children had a positive change (reduced NIRI) during the day, while 9 (24%) had a positive change at night. At discharge, 11/38 (29%) children required no daytime NIRI, while 4/38 (11%) required no day or night NIRI. Conclusion NIRI type differs between day and night at PACH admission and discharge. Reductions in NIRI were achieved during the day and at night from PACH admission to discharge for premature infants and for children with congenital or neurological diagnoses.

Introduction: There is evidence for increased risk of eating disorders in individuals with diet-treated chronic illnesses, however, data in patients with Cystic Fibrosis (CF) is less clear. No studies have evaluated avoidant/restrictive food intake disorder (ARFID) in the CF population. We investigated the prevalence of disordered eating, including ARFID, in adolescents and young adults with CF. Methods: Patients with CF aged 14-35 years were recruited to complete three validated surveys: (1)Eating Disorder Examination Questionnaire (EDE-Q), (2)Nine-Item Avoidant/Restrictive Food Intake Disorder Scale (NIAS), and (3)Cystic Fibrosis Questionnaire-Revised (CFQ-R). Univariate linear regression analysis identified baseline risk factors associated with these survey scores. Variables with univariate p<0.20 were considered for inclusion in a multivariable linear regression model. Backwards stepwise linear regression was used to identify the final model. Results: A total of 52 patients enrolled. The prevalence of eating disorder measured on the EDE-Q was 9.6%, and on the NIAS was 13.5%. The CFQ-R eating and weight subscales were associated with scores on the EDE-Q, and CFQ-R eating subscale and being dF508 homozygous were correlated with the NIAS total score. Discussion: A clinically significant number of participants screened positive for disordered eating on the EDE-Q and NIAS. Scores on the eating and weight scales of the CFQ-R were associated with the scores on these surveys. Further work is needed to better understand the optimal way to use such tools to screen and treat for eating disorders in individuals with CF.

Aim: This prospective study aims to investigate the factors influencing voriconazole trough concentration (Cmin), develop a population pharmacokinetics (PPK) model and recommend an appropriate voriconazole dosing regimen for children with hematological malignancies. Methods: Prospectively enrolled a total of 70 children aged <18 years and 149 samples. The factors influencing voriconazole Cmin were analyzed by univariate analysis and multiple linear regression analysis. Nonlinear mixed effects modeling (NONMEM) was applied to establish the PPK model. Dosage simulation based on albumin (ALB) levels and CYP2C19 genotype. Results: Multiple linear regression results demonstrated that route of administration, ALB and concomitant administration with glucocorticoid (GLU) and proton pump inhibitors (PPIs) were significant factors of voriconazole Cmin. A one-compartment model could best describe the pharmacokinetics of voriconazole. The extensive metabolizers (EM), ALB were significant covariates of clearance (CL). The typical value of CL, the volume of distribution (V) and oral bioavailability (F) were 1.52 L/h, 35.7 L and 0.909, respectively. The recommended dosing regimens for EM patients with ALB level of 20.0~35.0 g/L, 35.1~45.0 g/L and 45.1~55.0 g/L were4, 8 and 12 mg/kg intravenously or orally twice daily, respectively, and were 2, 4 and 7 mg/kg by intravenous or oral administration twice daily for non-EM. Conclusion: We found that route of administration, ALB and co-administration of GLU and PPI had quantitative relationships with voriconazole Cmin. The combination of CYP2C19 genotype and ALB levels to determine the initial dosing regimen of voriconazole could provide a reference for individualized treatment in children with hematological malignancies.

Threshold and safe ingestion dose among infants sensitized to hen’s eggMasatoshi Mitomori,a Noriyuki Yanagida,aMakoto Nishino,a Kyohei Takahashi,aKen-ichi Nagakura,a Kiyotake Ogura,aMari Takei,b Sakura Sato,b Motohiro EbisawabaDepartment of Pediatrics, National Hospital Organization, Sagamihara National Hospital, Kanagawa, JapanbClinical Research Center for Allergy and Rheumatology, National Hospital Organization, Sagamihara National Hospital, Kanagawa, JapanRunning title: Threshold and safe ingestion dose of egg

Background: Genetic areas of FOXP3 TSDR, HLA-G upstream of CpG island 96, CpG41 and CpG73 islands of the HLA‐DRB1 and HLA-DQB1 genes respectively, previously documented to display immune modulatory properties, were subjected to epigenetic/genetic analysis to assess their influence in IgE-mediated food allergy (FA) development in children. Methods: 64 orally challenged and IgE- tested food allergic subjects together with 44 controls were recruited. Targeted pyrosequencing analysis, to detect DNA methylation status and genetic variations was utilized and experimental results obtained were analysed by statistical software platform and correlated to clinical data. Also, transcription factor (TF) binding sites at study areas were unmasked by the JASPAR prediction database. Results: Parents’ smoking was significantly correlated with aberrant methylation patterns, regardless food allergic or control status. HLA-G promoter region showed a trend for hypomethylation in food allergic subjects, with one of the CG sites displaying significantly decreased methylation values. Rs1233333, residing within HLA-G promoter region preserved a protective role towards DNA methylation. Variable methylation patterns were recorded for CpG41 of the HLA‐DRB1 gene and hypermethylation of the region was significantly correlated with the presence of (Single Nucleotide Polymorphisms) SNPs. TFs’ recognition sites, located at studied genetic areas and exerting pivotal regulatory biological roles, are potentially affected from divergent DNA methylation status. Conclusions: We propose that HLA-G expression is triggered by food derived allergens, providing a TregFoxP3-/HLA-G+ subpopulation generation and direct immune-tolerance. Furthermore, clear evidence is provided for the underlying co-operation of genetic polymorphisms with epigenetic events, mainly at CpG41 island of HLA-DRB1 gene, which need an extended investigation and elucidation.

Objective: Children with cystic fibrosis (CF) may experience elevated symptoms of depression and anxiety, as well as impairments in quality of life. To date, there is no mental health program specifically designed to address the mental health needs of children with CF. In the interest of informing the development of an accessible (i.e., Internet-delivered) mental health program, the present study examined the information and service needs of children with CF from the perspective of children with CF, their parents, and CF health care providers. Methods: A qualitative research design was used. Participants (n = 16) included children with CF (n = 5, Mage = 9.25, SD = 1.29), parents (n = 7, Mage = 36.43, SD = 3.46), and health care providers (n = 4, Mage = 44.00, SD = 10.46) recruited from regional CF clinics. Participants completed a brief demographic questionnaire. Semi-structured individual interviews were conducted with all participants. Results: Thematic content analysis generated four major themes: (1) challenges living with CF, (2) coping, (3) building independence, and (4) bridging gaps in services. Each theme was comprised of several subthemes. Conclusions: The findings highlight many emotional and social challenges experienced by children with CF and their families. Providing effective support for the entire family in managing and coping with CF was emphasized. Information gathered in the present study will be used, in combination with the empirical literature, to inform the development of an Internet-delivered mental health prevention program for children living with CF.

Objectives To investigate the extent to which observer variability of CT lung nodule assessment may affect clinical treatment stratification in Wilms Tumor (WT) patients, according to the recent SIOP-RTSG UMBRELLA protocol. Methods I: CT thoraces of children with WT submitted for central review, were used to estimate size distribution of lung metastases. II: Scans were selected for blinded review by five radiologists to determine intra and inter-observer variability. They assessed identical scans on two occasions six months apart. III: Monte Carlo simulation (MCMC) was used to predict the clinical impact of observer variation when applying the UMBRELLA protocol size criteria. Results Lung nodules were found in 84 out of 360 (23%) children with WT. For 21 identified lung nodules, inter-observer limits of agreement (LOA) for the five readers were ±2.4mm and ±1.4mm (AP diameter), ±1.9mm and ±1.8mm (TS diameter) and ±2.0mm and ±2.4mm (LS diameter) at assessments 1 and 2. Intra-observer LOA across the three dimensions were ±1.5mm, ±2.2mm, ±3.5mm, ±3.1mm and ± 2.6mm (readers 1-5). MCMC demonstrated that 17% of the patients with a ‘true’ nodule size of 3mm will be scored as <3 mm, and 21% of the patients with a ‘true’ nodule size of <3mm will be scored as being 3 mm. Conclusion A significant intra-inter observer-variation was found when measuring lung nodules on CT for patients with WT. This may have significant implications on treatment stratification, and thereby outcome, when applying a threshold of 3 mm for a lung nodule to dictate metastatic status.

A document by Anees Ahmed. Click on the document to view its contents.

Background Aortic root dilatation and aortic insufficiency can occur in patients with prior conotruncal defect surgery, the Ross procedure, and connective tissue disease (CTD). Valve-sparing aortic root replacement (VSRR) is an excellent choice for these young patients. We present the outcomes of young patients undergoing VSRR by congenital heart surgeons at a single center. Methods A single center retrospective chart review from April 2008 – April 2021 was performed. Patients with aortic root and valve pathology who underwent VSRR were identified. A total of 49 patients were identified by using the hospital surgical database. Three VSRR techniques were utilized during the study period; aortic valve-sparing root remodeling (Group 1, 7 patients), aortic valve-sparing root reimplantation (Group 2, 32 patients), and a modified root remodeling procedure utilizing a geometric annuloplasty ring (Group 3, 10 patients). Patient characteristics, post-VSRR echocardiogram studies and need for intervention, and survival were analyzed. Results Long-term survival after VSRR is excellent with only one death related to cardiac causes. Valve degeneration remains a concern with 13 patients (26%) requiring subsequent aortic valve replacement over the study period. Risk factors for aortic valve reintervention were the aortic root remodeling technique, mild or greater immediate post-operative aortic insufficiency and higher post-operative mitral insufficiency. Follow-up was significantly longer in Group 1 patients compared to Groups 2 and 3. Conclusions Valve-sparing aortic root replacement is safely performed by congenital heart surgeons in a heterogeneous patient population. Valve degeneration remains a concern and greater than trivial post-operative aortic insufficiency should prompt further attempts at valve repair or replacement.

Here, we report a case of a dissected thoracoabdominal aortic aneurysm repair after frozen elephant trunk implantation, using aortic balloon occlusion technique to simplify the proximal anastomosis and avoid deep hypothermic circulatory arrest. In addition, detailed CT follow-up pictures showed that false lumen thrombosis is a time-dependent and reversible variable. Repeated measurements with time series analysis should be performed to explore false lumen remodeling.

Similar IgE Binding Patterns in Gulf of Mexico and Southeast Asian Shrimp Species in US Shrimp Allergic PatientsSara Anvari1,2*, Shea Brunner1,2*, Karen Tuano1,2, Brenda Bin Su1,2, Shaymaviswanathan Karnaneed3, Andreas L. Lopata3, Carla M. Davis1,21Baylor College of Medicine, Texas Children’s Hospital, Department of Pediatrics, Section of Immunology, Allergy and Retrovirology, Houston, Texas2Baylor College of Medicine, William T. Shearer Center for Human Immunobiology, Houston, Texas3James Cook University, Australian Institute of Tropical Health and Medicine, Centre for Molecular Therapeutics, Douglas, QLD, Australia*co-first authors

1. The recovery of terrestrial carnivores in Europe is a conservation success story. Initiatives focused on restoring top predators, require information on how resident species may interact with the re-introduced species as their interactions have the potential to alter food webs, yet such data are scarce for Europe. 2. In this study, we assessed patterns of occupancy and interactions between three carnivore species in the Romanian Carpathians. Romania houses one of the few intact carnivore guilds in Europe, making it an ideal system to assess intraguild interactions, and serve as a guide for reintroductions elsewhere. 3. We used camera trap data from two seasons in Transylvanian forests to assess occupancy and co-occurrence of carnivores using multispecies occupancy models. 4. Mean occupancy in the study area was highest for lynx ( winter= 0.76 95% CI: 0.42-0.92; autumn= 0.71 CI: 0.38-0.84) and wolf (winter= 0.60 CI: 0.34-0.78; autumn= 0.81 CI: 0.25-0.95) and lowest for wildcat (winter= 0.40 CI: 0.19-0.63; autumn= 0.52 CI: 0.17-0.78) 5. We found that marginal occupancy predictors for carnivores varied between seasons. We also found differences in predictors of co-occupancy between seasons for both lynx-wolf and wildcat-wolf co-occupancy. For both seasons, we found that conditional occupancy probabilities of all three species were higher when another species was present. 6. Our results indicate that while there are seasonal differences in predictors of occupancy and co-occupancy of the three species, co-occurrence in our study area is high, and is dependent on the existence of continuous, relatively undisturbed forests. 7. Terrestrial carnivore recovery efforts are ongoing worldwide. Insights into interspecific relations between carnivore species are critical when considering the depauperate communities they are introduced in. Our work showcases that apex carnivore coexistence is possible, but dependent on protection afforded to forest habitats and their prey base.