Background: Malnutrition is a common complication in children with cancer. Cancer treatment and malnutrition can disrupt gut microbiome diversity and composition. This study aims to compare the dietary intakes between children with solid tumors post-chemotherapy and healthy controls, and investigate associations between the dietary intakes and the gut microbiome. Procedure: Children (7-18 years) with solid tumors were recruited during year 1 after the completion of chemotherapy from Children’s Healthcare of Atlanta, Atlanta, Georgia. Healthy controls were recruited via flyers. Children completed the Block Kids Food Screener for dietary intakes in the past week. Fecal specimens were collected and processed for the gut microbiome. QIIME2 and Mann-Whitney U tests were conducted to answer the research questions. Results: Forty-nine children (25 cancers vs 24 controls) were analyzed. Two groups had no differences in age, race, sex, and body mass index. Children with solid tumors reported significantly higher mean daily intakes of macronutrients: calories, protein, fat, carbohydrate, and fiber, and antioxidant nutrients (vitamin E, vitamin C, and selenium) than controls. Children with adequate vitamin B6 had a higher Chao1 diversity index than children with inadequate or excessive intake (P = 0.0004). Children with excessive selenium intake had a trend of higher Pielou’s_e index than children with inadequate intake (P = 0.091). Conclusion: Children with cancer reported significantly higher intakes of macronutrients and antioxidant nutrients than healthy children, but no differences in major energy ratios. Macronutrients, particularly antioxidant nutrients, were associated with disruptions of the gut microbiome in children with solid tumors.

In the present manuscript, we present a new sequence of operators, i:e:, -Bernstein-Schurer-Kantorovich operators depending on two parameters 2 [0; 1] and > 0 foe one and two variables to approximate measurable functions on [0:1+q]; q > 0. Next, we give basic results and discuss the rapidity of convergence and order of approximation for univariate and bivariate of these sequences in their respective sections . Further, Graphical and numerical analysis are presented. Moreover, local and global approximation properties are discussed in terms of rst and second order modulus of smoothness, Peetre’s K-functional and weight functions for these sequences in dierent spaces of functions.

Background: Concern exists regarding adequacy of visualization of stress echocardiograms performed without intravenous contrast in persons with Class III obesity (body mass index ≥ 40 kg/m2). Methods: Dobutamine stress echocardiography (DSE) was performed on 128 candidates for bariatric surgery with class III obesity without chest pain or pre-existent coronary artery disease (CAD). DSE without intravenous contrast was initially performed on 62 patients with class III obesity, then was subsequently was performed with intravenous contrast on 66 patients with class III obesity. Left ventricular (LV) regional wall motion was assessed at baseline and peak stress using the 16-segment model. Results: In the intravenous contrast group 1046 of 1056 LV segments studied (99.1%) were well-visualized and interpretable at baseline and 1044 of 1056 LV segments studied (98.9%) were well-visualized and interpretable at peak stress. In the non-contrast group 905 of 992 segments studied (91.2%) were well-visualized and interpretable at baseline and 886 of 992 segments studied (89.3%) were well-visualized and interpretable at peak stress. A significantly greater number of LV segments were well-visualized and interpretable in the intravenous contrast group than in the group compared to the non-contrast group, at baseline and at peak stress (p < 0.00001 for both). DSE was positive for ischemia in 1 patient. All patients underwent bariatric surgery without cardiovascular complications. Six months after surgery, all patients were alive; none developed cardiovascular events. Conclusion: The use of intravenous contrast during DSE significantly improves visualization and interpretability of LV segments in patients with class III obesity.

Introduction: Cryoballoon ablation (CBA) has become a standard treatment for paroxysmal atrial fibrillation (PaAF) but limited data is available for outcomes in patients with persistent atrial fibrillation (PeAF). Methods: We analyzed the first 944 patients included in the Spanish Prospective Multi-center Observation Post-market Registry to compare characteristics and outcomes of patients undergoing CBA for PeAF versus PaAF. Results: A total of 944 patients (57.8±10.4 years; 70.1% male) with AF (27.9% persistent) were prospectively included from 25 centers. PeAF patients were more likely to have structural heart disease (67.7 vs 11.4%; p<0.001) and left atrium dilation (72.6 vs 43.3%; p<0.001). CBA of PeAF was less likely to be performed under general anesthesia (10.7 vs 22.2%; p<0.001), with an arterial line (32.2 vs 44.6%; p<0.001) and assisted transeptal puncture (11.9 vs 17.9%; p=0.025). During an application, PeAF patients had a longer time to -30°C (35.91±14.20 vs 34.93±12.87 sec; p=0.021) and a colder balloon nadir temperature during vein isolation (-35.04±9.58 vs -33.61±10.32ºC; p=0.004), but received fewer bonus freeze applications (30.7 vs 41.1%; p<0.001). There were no differences in acute pulmonary vein isolation and procedure-related complications. Overall, 76.7% of patients were free from AF recurrences at 15-month follow-up (78.9% in PaAF vs. 70.9% in PeAF; p=0.09). Conclusions: Patients with PeAF have a more diseased substrate, and CBA procedures performed in such patients were more simplified, although longer/colder freeze applications were often applied. The acute efficacy/safety profile of CBA was similar between PaAF and PeAF patients, but long-term results were better in PaAF patients.

Background: Data regarding ventricular tachycardia (VT) or premature ventricular complex (PVC) ablation following MVS is limited.) CA can be challenging given perivalvular substrate in the setting of mitral annuloplasty or prosthetic valves. Objective: To investigate the characteristics, safety, and outcomes of radiofrequency catheter ablation (CA) in patients with prior mitral valve surgery (MVS) and ventricular arrhythmias (VA). Methods: We identified consecutive patients with prior MVS who underwent CA for VT or PVC between January 2013- December 2018. We investigated the mechanism of arrhythmia, ablation approach, peri-operative complications, and outcomes. Results: In our cohort of 31 patients (77% men, mean age 62.3±10.8 years, left ventricular ejection fraction 39.2±13.9%) with prior MVS underwent CA (16 VT; 15 PVC). Access to the left ventricle was via transseptal approach in 17 patients, and a retrograde aortic approach was used in 13 patients. A combined transseptal and retrograde aortic approach was used in one patient, and a percutaneous epicardial approach was combined with trans-septal approach in 1patient. Heterogenous scar regions were present in 94% of VT patients and scar-related reentry was the dominant mechanism of VT. Clinical VA substrates involved the peri-mitral area in 6 patients with VT and 5 patients with PVC ablation. No procedure-related complications were reported. The overall recurrence-free rate at 1-year was 72.2%; 67% in the VT group and 78% in the PVC group. No arrhythmia-related death was documented on long-term follow-up. Conclusion: CA of VAs can be performed safely and effectively in patients with MVS

Background Pericardiectomy for post-radiation constrictive pericarditis has been reported to generally have unfavorable outcomes. This study sought to evaluate surgical outcomes in a large cohort of patients undergoing pericardiectomy for radiation-associated pericardial constriction. Methods A retrospective analysis of all patients (≥18years) who underwent pericardiectomy for a diagnosis of constrictive pericarditis with a prior history of mediastinal irradiation from June 2002 to June 2019 was conducted. There were 100 patients (mean age 57.2±10.1 years, 49% females) who met the inclusion criteria. Records were reviewed to look at surgical approach, extent of resection, early mortality and late survival. Results The overall operative mortality was 10.1% (n=10). The rate of operative mortality decreased over the study period; however, the test of trend was not statistically significant (P=0.062). Hodgkin’s disease was the most common malignancy (64%) for which mediastinal radiation had been received. Only 27% patients had an isolated pericardiectomy, and concomitant pericardiectomy and valve surgery was performed in 46% patients. Radical resection was performed in 50% patients, whereas 47% patients underwent a subtotal resection. Prolonged ventilation (26%), atrial fibrillation (21%) and pleural effusion (16%) were the most common post-operative complications. The overall 1,5- and 10-years survival was 73.6%, 53.4% and 32.1% respectively. Increasing age (HR 1.044, 95%CI 1.017-1.073) appeared to have a significant negative effect on overall survival in the univariate model. Conclusion Pericardiectomy performed for radiation associated constrictive pericarditis has poor long-term outcomes. The early mortality, though high (~10%), has been showing a decreasing trend in the test of time.

Sudden cardiac arrest (SCA) is a serious heart problem which occur without any apparent symptoms and warning. SCA leads to a large amount of fatality. Hence, predicting the occurrence of SCA is very important. Current traditional methods for predicting a ventricular fibrillation (VF) onset requires a considerably longer-monitoring time of patients, resulting in unprecedented complications. The emerging technology, in particular machine learning techniques have gained popularity due to the effectiveness. However, most of existing techniques heavily rely on a set of hand-engineered features which may results in poor generalization when presented out of distribution patient data. On the other hand, existing deep learning approaches rely heavily on large training data which is not available publicly. In this study, we proposed a deep learning approach based on 1D convolutional neural network trained with discrete Fourier transform (DFT) features from raw electrocardiogram (ECG) signals. As demonstrated in the results, our method can predict accurately around 90 minutes before the onset of SCA with an accuracy of 96%. The advance prediction might save many lives. That is, optimized deep learning models offer better generalization than hand-crafted features while detecting long-term signal relations.

Fungal infections cause serious problems in many aspects of human life; especially infections by fungal species represent problems in immunocompromised patients. Current antifungal antibiotics target various metabolic pathways, predominantly the cell wall or cellular membrane. However, numerous compounds are available to combat fungal infections, their efficacy is far from being satisfactory and some of them display substantial toxicity. The emerging resistance represents a serious issue as well; thus, there is a considerable need for new anti-fungal compounds with lower toxicity and higher effectiveness. One of the unique antifungal antibiotics is sordarin, the only known compound that acts on the fungal translational machinery per se. It has been shown that sordarin inhibits protein synthesis at the elongation step of the translational cycle, acting on eukaryotic elongation-factor-2. In this review, we are aiming to deliver a robust scientific platform promoting the development of antifungal compounds, especially focusing on molecular action of sordarin.

Sexual size dimorphism (SSD) arises when natural selection and sexual selection act differently on males and females. Rensch’s rule predicts that SSD increases with body size in species when males are the larger sex. However, male-biased SSD is rare in insects and the rule does not always hold between species and even among populations. Here, we investigate intra-specific variation in SSD as well as relative investment in precopulatory (horn length) and postcopulatory traits (sperm length and testes weight), in a tropical rainforest dung beetle Onthophagus babirussa across Singapore and Peninsular Malaysia. Overall, three out of four populations displayed significant male-biased SSD but contrary to Rensch’s rule, SSD was greater in populations with smaller overall body size. Average male body size was similar across all populations, but female body size differed significantly suggesting that the pronounced SSD may also be due to weaker fecundity selection on female body size. Across all populations, horn length showed a strong positive static allometry while postcopulatory traits showed negative allometry (in all but one population), which suggests an evolutionary trade-off between precopulatory and postcopulatory traits in this species.

Ecological theory suggests that predators should keep prey populations healthy by reducing parasite burdens. However, empirical studies show that predators often have minimal effects on, or even increase, parasitism in prey. To quantify the overall magnitude and direction of the effect of predation on parasitism in prey, we conducted a meta-analysis of 50 empirical studies. We also examined how key attributes of these studies, including parasite type, study design, and predator interaction type (consumptive vs. non-consumptive) contributed to variation in the predator-prey-parasite interaction. We found that the overall effect of predation on parasitism differed between parasites and parasitoids and that predator interaction type, and whether a predator was a non-host spreader of parasites were the most important traits predicting the parasite response. Our results suggest that the mechanistic basis of predator-prey interactions strongly influences the effects of predators on parasites and that these effects, while context dependent, are predictable.

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Global mRNA translation may differ dramatically between progenitor cells and their differentiated progeny. One way cell type-specific translation is established is through ribosome concentration. In addition to addressing unique metabolic needs, changes in ribosome concentration may influence cell fate. The mechanisms that determine ribosome abundance in progenitors versus differentiated progeny are not fully understood. Here we investigated this process by focusing on ribosomal RNA (rRNA) synthesis in Drosophila neural progenitors and neurons. We found that rRNA synthesis is robust in neural progenitors but is limited in post-mitotic neurons. Newly born neurons inherit rRNA from their progenitor parent and this inherited rRNA is sufficient for protein synthesis in neurons. Our findings support a model in which neuron-specific translation programs are established by rRNA inheritance.

Increased evidence shows that the pathogenesis of Kawasaki disease (KD) is caused by abnormal and unbalanced innate and adaptive immune responses. However, the changes in and functions of adaptive immune cells in KD peripheral blood are still controversial. In this study, three different methods, CIBERSORT, Immune Cell Abundance Identifier (ImmuCellAI), and immune cell markers, were used to evaluate the proportions and abundances of immune cells in eight KD datasets (GSE9863, GSE9864, GSE18606, GSE63881, GSE68004, GSE73461, GSE73463, and GSE64486; a total of 1,251 samples). Compared with those in normal controls and convalescent KD samples, the proportions and abundances of innate immune cells such as neutrophils, monocytes, and macrophages in acute KD peripheral blood samples were significantly increased, while those of adaptive immune cells such as B and T cells were significantly decreased. The change tendency of these immune cells was similar to that seen in other febrile illnesses but more dramatic. However, in the coronary artery tissue of KD patients, adaptive immune cells, especially B cells and CD8+ T cell subsets, were significantly increased. This result suggests that adaptive immune cells are selectively recruited from peripheral blood into the coronary arteries. In addition, we found that elevated neutrophils in peripheral blood could be used as a biomarker to assist in the differential diagnosis of KD, but we did not find immune cells that can accurately predict intravenous immunoglobulin (IVIG) response in multiple datasets.

Objective:The aim of this study is to evaluate the effect of iohexol as a contrast agent on the anticoagulant activity of oral factor Xa inhibitors. Methods:The study included 65 people who underwent contrast computerized tomography (CT). Patients in group 1 were using rivaroxaban (20 patients), patients in group 2 were using apixaban (20 patients), patients in group 3 were using edoxaban (20 patients), and group 4 was the control group (5 volunteers). Iohexol (60ml) was used as a contrast agent. Two tubes were used to collect 2 ml of blood from the patients at 4 hours after the drug dose (rivaroxaban, apixaban, or edoxaban) and 1 hour after the contrast CT (CT was performed 3 hours after the drug was taken). In the control group, at any time and 1 hour after contrast CT, 2 tubes of 2 ml of blood were collected. The anticoagulant properties of rivaroxaban, apixaban, and edoxaban were evaluated using anti-factor Xa levels. Results:The anti-factor Xa level was increased after using the contrast agent in the rivaroxaban group (0.66±0.32U/ml vs. 0.67±0.32U/ml; p=0.01) and the edoxaban group (0.74±0.35 U/ml vs. 0.76±0.36 U/ml; p=0.006). However, there was no significant difference in the apixaban group (0.66±0.33U/ml vs. 0.66±0.32U/ml; p=0.21) and control group (0.02±0.01U/ml vs. 0.03±0.01U/ml; p=0.33). Conclusion:The anticoagulant properties of rivaroxaban and edoxaban tended to increase significantly, but there was no statistically significant difference in the anticoagulant properties of apixaban with contrast agent. The increasing is too small so that these laboratory results need to validate with larger clinical trials(NCT04611386).

There has been an increased prevalence of Group B Streptococcal disease over the last two decades with a mortality rate of ∼25% for invasive infection. We report a patient whom we discovered Monoclonal B cell Lymphocytosis that led to disseminated GBS disease . Likely source was asymptomatic bacteriuria following TURP

Arteriovenous malformation of the pancreatic head is a relatively rare disease that can cause gastrointestinal bleeding and abdominal pain and requires appropriate and prompt treatment. Herein, we discuss the clinical presentation and management of a patient with arteriovenous malformation of the pancreatic head.

The state function based on fatigue accumulation model has a great influence on accuracy of fatigue reliability analysis of components. A nonlinear fatigue accumulation model considering the interaction of loads is proposed in this paper. By introducing the square ratio of front and back loads as the new load interaction factor into the conventional toughness exhaustion model, thus it is improved to reflect the load sequence and interaction effect simultaneously. Moreover, the fatigue state function based on proposed model is constructed, which is analyzed by the probability density evolution method. The time-varying fatigue reliability curve is obtained by analyzing the generalized density evolution equation. The proposed model are verified using four experimental data, and results shows that the predication residual life fraction such obtained is more accurate. And accuracy and efficiency of the proposed time-varying fatigue reliability analysis method is validated using multi-level loading experimental data.

Objective: To determine whether high-flow nasal cannula oxygen (HFNCO) provided enhanced respiratory support in bronchiolitis than low-flow oxygen (LFO). Methods: We conducted a prospective, randomized controlled trial in children between 1-24 months diagnosed with moderate-to-severe bronchiolitis requiring oxygen therapy. Participants received LFO via face mask (6-10 L/min) or HFNCO (2 L*kg/min). Primary outcomes were the time that heart rate (HR) and respiratory rate (RR) return to their normal range for age and the time that baseline clinical respiratory score (CRS) regress to a lower severity score. Secondary outcomes were changes in HR, RR, and CRS over time, length of stay (LOS), duration of oxygen requirement, treatment failure, and adverse event (AE). Results: Eighty-seven children were enrolled (48 in LFO; 39 in HFNCO). The time that HR and RR baseline values reached their normal range for age was shorter in HFNCO therapy (2.0h [1.0-4.0] vs. 12.0h [2.0-24.0] and 4.0 h [2.0-12.0] vs. 24.0 h [4.0-48.0], respectively; P< .001); additionally, the improvement in CRS emerged more quickly in children treated with HFNCO (2.0 h [1.0-4.0] vs. 4.0 h [2.0-24.0]; P = .003). While the duration of oxygen requirement (19.0 h [4.0-30.0] vs. 29.5 h [14.0-45.7]; P = .009) and treatment failure (3% vs. 21%) was statistically lower in children who received HFNCO, there were no differences in LOS and AE between groups. Conclusion: HFNCO may provide enhanced respiratory support with a notable improvement in HR, RR, and CRS than LFO. Comprehensive studies are needed to assess the clinical efficacy of HFNCO therapy.

This work investigates the influence of temperature on the creep damage behaviors of red sandstone. The samples treated at 25 ℃, 200 ℃, 400 ℃ and 600 ℃ are selected to carry out the uniaxial compression and creep experiments. It is found that temperature has obvious influence on uniaxial compressive strength, Young’s modulus and failure modes of red sandstone. It can be also believed that the temperature can degrade the mechanical behaviors of red sandstone. However, as the temperature increases, the damage value does not always increase, the damage variable has a negative value at 25 ~ 400 ℃. It can be found that the higher the temperature, the larger the effect of loading ratio on the ratio of creep strain to instantaneous strain, that is, temperature reduces the ability of red sandstone to resist creep deformation. Acoustic emission (AE) technology has been also used in the loading process of uniaxial compression and creep tests. It is found that the probability density of AE absolute energy of different samples still satisfies the Gutenberg-Richter law well. In uniaxial compression test, as the temperature increases, the absolute value of the critical index increases exponentially. In the uniaxial creep test, as the loading ratio increases, the absolute value of the critical index first decreases and then increases. When the loading ratio is the same, as the temperature increases, the absolute value of the critical index also increases exponentially.

Helminth diseases have long been a threat to the health of humans and animals. Roundworms are important organisms for studying parasitic mechanisms, disease transmission and prevention. The study of parasites in the giant panda is of importance for understanding how roundworms adapt to the host. Here, we report a high-quality chromosome-scale genome of Baylisascaris schroederi with a genome size of 253.60 Mb and 19,262 predicted protein-coding genes. We found that gene families related to epidermal chitin synthesis and environmental information processes in the roundworm genome have expanded significantly. Furthermore, we demonstrated unique genes involved in essential amino acid metabolism in the B. schroederi genome, inferred to be essential for the adaptation to the giant panda-specific diet. In addition, under different deworming pressures, we found that four resistance-related genes (glc-1, nrf-6, bre-4 and ced-7) were under strong positive selection in a captive population. Finally, 23 known drug targets and 47 potential drug target proteins (essential homologues linked to lethal phenotypes) were identified. The genome provides a unique reference for inferring the early evolution of roundworms and their adaptation to the host. Population genetic analysis and drug sensitivity prediction provide insights revealing the impact of deworming history on population genetic structure of importance for disease prevention.

Background: Monitored Anesthesia Care (MAC) has been increasingly used in lieu of general anesthesia (GA) for transcatheter aortic valve replacement (TAVR). We sought to compare outcomes and in-hospital costs between MAC and GA for TAVR at a single center Veterans Affairs Medical Center. Methods: A single-center retrospective review of 349 patients who underwent TAVR (MAC, n = 244 vs. GA, n = 105) from January 2014 to December 2019 was performed. Baseline patient characteristics, operating room (OR) time, intensive care unit (ICU) length of stay (LOS) and cost, total LOS, hospital cost, total cost, and complication rates were collected. Propensity matching was performed and resulted in 83 matched pairs. Results: In the unmatched TAVR cohort, MAC TAVR was associated with reduced OR time (146 vs. 198 minutes, P < .0001), ICU LOS (1.4 vs. 1.8 days, P < 0.0001), total hospital LOS (3.4 vs. 5.4 days, P < .0001), and lower index total cost ($81,3000 vs. $85,400, P = .010). After propensity matching, MAC TAVR patients had reduced OR time (146 vs. 196 minutes, P < 0.05), ICU LOS (1.2 vs. 1.7 days, P = .006), total LOS (3.5 vs. 5.1 days, P = .001), and 180-day mortality (2.4% vs. 12%, P < 0.03). There was no difference in total hospitalization cost or total cost. Conclusions: In propensity matched groups, TAVR utilizing MAC is associated with improved OR time efficiency, decreased LOS, and a reduction in 180-day mortality, but no significant difference in cost.

Aim: To examine the incidence and treatment of acute myocardial infarction (AMI) as well as 30-day and 1-year prognoses of patients in three major regions of Hungary by analysing data from the country’s continuous and mandated infarction registry. Methods and results: The total population of Hungary is currently 9.8 million: 39% live in the eastern region (ER), 31% in the Central region (CR) and 30% in the western region (WR). These regions exhibited significant differences in income and people exposed to poverty. Population over 30 years, the age-standardised incidence of AMI was 177.5 (175.7–179.3) per 100,000 person-year. During hospital treatment, 82.5%–84.6% of patients with ST-elevation (STEMI) and 54.8%–81.8% without ST-elevation (NSTEMI) underwent PCI. The total ischaemic time was shortest in WR:221 minutes. In the STEMI group, the 30-day mortality rates of males were lowest in the WR (p = 0.03). If PCI was performed, mortality rates for both sexes were lowest in the WR (p < 0.01; p = 0.04). The 1-year mortality rate in the male population who received PCI was lowest in the WR. In the NSTEMI group, the 30-day mortality rate exhibited no differences. Regarding 1-year mortality, those who underwent PCI in the WR showed the lowest mortality. Conclusion: The major regions of Hungary exhibited significant differences regarding the prehospital delay, the incidence, treatment and mortality of AMI. Logistic regression analysis confirmed the independent prognostic significance of the region on the 30-day mortality of patients with STEMI (Hazard ratio = 0.88, p = 0.0114).

EP Rounds

Foreign Body (FB) ingestion is common condition in pediatric population .Curious nature and tendency to put objects in mouth are the key factors for its higher prevalence among them. Most of the ingested FB pass through the entire alimentary tract uneventful, however some require surgical interventions for its removal.