Cardiac Transplantation as Surgical Treatment for Cardiac Sarcoidosis Ali Ghodsizad MD, PhD, FACC, FETCS, FACSSarcoidosis is a complex disease with different clinical presentations that can involve multiple organs (1). The lung is typically the most common organ involved, multiple organ involvements with pulmonary and cardiac sarcoidosis account for most of the morbidity and mortality observed with this disease (1). Cardiac sarcoidosis presents as a progressive infiltrative cardiomyopathy that can lead to heart failure, arrhythmia and death (1).Here McGoldrick and colleagues report on their database study with data from Organ Procurement and Transplantation Network (OPTN) involving 289 cardiac sarcoidosis patients with end stage restrictive cardiomyopathy, who needed cardiac transplantation and compared them with all non-sarcoid patients undergoing cardiac transplantation for restrictive cardiomyopathy and end stage heart failure of other causes between Jan 1999 to March 2020 (n=41447).Patients with cardiac sarcoidosis had a comparable survival to non-sarcoid patients at 1 and 5 years and a significantly longer survival at up to 10 years.Patients with cardiac sarcoidosis had an increased chance to die from aspergillus infections at 1 year. Jackson et al showed in their multicenter trial comparable survival, rate of graft failure, and incidence of treated rejection at 1 year when compared to matched non-sarcoid patients. Sarcoid patients after heart transplantation were less likely to be hospitalized for infection in their study at 1 year (2). Liu et al performed a similar UNOS data base study showing that cardiac sarcoidosis heart transplant recipients were an older population with less underlying co-morbidities with a lower overall mortality (3).The diagnosis of cardiac sarcoidosis in patients who undergo left ventricular assist device implantation can be confirmed by histological examination of myocardium at the time of ventricular assist device insertion, but unclear is the predictive value (4,5).McGoldrick and colleagues excluded patients who required multiorgan transplantation in all 3 groups and we have to consider that multiorgan recipients belong to the sickest subpopulation.McGoldrick et al and other groups confirm the role of cardiac transplantation as a viable option for patients with cardiac sarcoidosis. Considering the increasing number of the cardiac transplantation for sarcoidosis in recent years, the 10 years survival data may have to be reevaluated with more follow up time in future.

ABBREVIATIONSCA cannabis allergyCCDs cross-reactive carbohydrate determinantsCI confidence intervalCSA cannabis sativa allergic patientsnsLTP s nonspecific lipid transfer proteinsP+LTP- controls sensitized to pollen without nsLTP sensitizationP+LTP+ controls sensitized to pollen and nsLTPs(r) recombinantsIgE specific immunoglobulin EST skin teststIgE total immunoglobulin EKEYWORDSCannabis allergy, sIgE, total IgE, allergy diagnosis, sIgE-to-total IgE ratioTo the Editor,The most important “diagnostic test” for CA is a detailed history. However, a positive history is no absolute proof of CA, mainly because of physiological effects of cannabis i.e. (rhino)conjunctivitis presence and possibly because of incorrect interpretation or recollection of symptoms by the patients under the drug’s influence. Consequently, clinical suspicion of CA requires confirmatory testing. A cannabis challenge, being excluded for obvious ethical/legal reasons, documentation of CA generally starts with skin testing (ST) or specific IgE-quantification. However, in the absence of a standardized extract for ST, many will use prick-prick tests (e.g., with buds, leaves, seeds)1 2. Crude plant parts or extracts thereof, can contain both genuine and cross-reactive allergenic components. Consequently, positive results of crude extract ST and sIgE should always be interpreted cautiously, as it might merely reflect (cross-) sensitization instead of allergy.Here, we sought to investigate whether serological diagnosis of CA could benefit from an adjustment for tIgE. For this purpose, sIgE-to-tIgE ratios were calculated for sIgE hemp (FEIA, ImmunoCAP ThermoFisher Scientific), sIgE to recombinant (r) Can s 3 and rCan s 5 (Cytometric Bead Assay) as detailed elsewhere 3. A sIgE rCan s 3-to-rPru p 3 and sIgE rCan s 5-to-rBet v 1 ratio was also calculated. Negative sIgE values were excluded, as these cannot benefit from such an adjustment. Patients were selected from our previously published data3 4; cannabis sativa allergic patients (CSA), controls with a pollen but no nsLTP sensitization (P+LTP-) and controls with both pollen and nsLTP sensitizations (P+LTP+) were enrolled.Detailed demographic information is shown in table 1 of our previously published article3. As shown in figure 1, the distribution of the sIgE hemp-to-tIgE ratio and sIgE rCan s 5-to-tIgE differed significantly between controls and CSA. Using a cut-off of 0.02 for sIgE hemp-to-tIgE, it was shown that a specificity of 93% (95% confidence interval (CI), 85-98%) could be reached (table 1). A second, lower cut-off (0.005) can benefit most of the CSA population (sensitivity 77% (95% CI 67-85%)) and retains a relatively good specificity 79% (95% CI 68-87%).For sIgE rCan s 5-to-tIgE, a cut-off of 0.01 could possibly be beneficial. However, small group numbers make it difficult to estimate its true value. The ratio of sIgE rCan s 3-to-tIgE did not show added value (p=0.86).Comparing CSA patients with and without anaphylaxis; no added value was found to identify (a risk of) cannabis related anaphylaxis for any of the explored sIgE-to-tIgE ratios (sIgE hemp-to-tIgE->p=0.104; sIgE rCan s 3-to-tIgE->p=0.416; sIgE rCan s 5-to-tIgE->p=0.84, data not shown).Finally, ratios of similar protein families i.e. sIgE rCan s 3-to-sIgE rPru p 3 and sIgE rCan s 5-to-sIgE rBet v 1 were explored, showing no additional diagnostic value (see figure E1 in the online repository).These results indicate that sIgE-to-tIgE ratios might have a place in the diagnostic approach of CA. In the case of a definite history of cannabis related symptoms we recommend (figure E2) a sIgE hemp assay (sensitivity 82% (95% CI 74-89%) and specificity 32% (95% CI 20-45%)) 3. A negative result significantly reduces the chance of IgE-mediated CA. A positive result should be followed by a sIgE hemp-to-tIgE ratio as it notably increases test specificity. Where available, it is worthwhile using cannabis component resolved diagnostics as it was shown that over two-thirds of CSA who experienced anaphylaxis are Can s 3 sensitized 3. This study is bound by certain limitations; group numbers vary between the different analyses because of insufficient patients’ sera. Additionally, we could not explore sIgE rCan s 2-to-tIgE, sIgE rCan s 4-to-tIgE and sIgE rCan s 4-to-sIgE rBet v 2, because of insufficient group numbers. Finally, there is no guarantee that these results can be extrapolated to other CSA populations or different geographical regions. The results of these study are of a preliminary nature. Repetition of our methods in other, ideally larger populations are feasible to see whether these results can be confirmed and remain intact in different CA populations.FIGURES & TABLESFIGURE 1

A 13-year-old woman was underwent transthoracic two-dimensional echocardiography (2DE), which revealed that only a small anterolateral papillary muscle was observed in the left ventricle (LV). Additional transthoracic three-dimensional echocardiography (3DE) revealed the posteromedial-papillary muscle which has not correctly delaminated from the LV wall and directly connected to the mitral valve leaflets without tendon chordae. She was diagnosed as a parachute-like asymmetric mitral valve rather than a true-parachute mitral valve. It was difficult to understand the precise anatomy evaluated by the 2DE. However, additional 3DE provided helpful information to reveal the exact characteristics of papillary muscle tissue.

A 63 year old male with congenital bicuspid aortic valve status post Ross procedure complicated by multiple sternotomies to treat a failed pulmonic homograft and pseudoaneurysm repair of both ventricular outflow tracts, bioprosthetic aortic valve replacement with subsequent endocarditis who presented with recurrent pulmonic/aortic vavlulopathy successfully treated with transcatheter intervention.

Noncompaction of ventricular myocardium (NVM) is a rare and specific type of congenital cardiomyopathy that occurs in only 0.05% in adults. Cardiac resynchronization therapy (CRT) improves cardiac function and long-term prognosis in patients with heart failure with left bundle branch block, but its efficacy on NVM is uncertain

HIT is a massive thrombotic storm. The incidence of thrombotic complications is up to 50%, and the mortality rate is up to 20% in untreated cases. The patient’s presentation was subtle, with mild thrombocytopenia. The consequences would have been catastrophic if cardioversion was done using the standard guidelines.

‘Crazy-paving’ refers to the superimposition of ground-glass opacity and linear pattern on computed tomography (CT) images. ‘Crazy-paving’ was initially pathognomonic for alveolar proteinosis. Lung adenocarcinoma demonstrating both solid and crazy-paving appearances on CT is a rare occurance.

In this paper, an valid numerical algorithm is presented to solve variable fractional viscoelastic pipes conveying pulsating fluid in the time domain and analyze dynamically the vortex-induced vibration of the pipes. Firstly, Coimbra variable fractional derivative operators are introduced. Meanwhile, using Hamilton's principle and a nonlinear variable fractional order model, the governing system of equations is established. The unknown functions of the system of equations are approximated with shifted Legendre polynomials. Then, convergence analysis and numerical example investigate the effectiveness and accuracy of the proposed algorithm. Finally, the influences of different parameters on the dynamic response of the viscoelastic pipe are studied. The influencing factors and their ranges of the transient and long-term chaotic states of the pipe are analyzed. In addition, the proposed algorithm shows enormous potentials for solving the dynamics problems of viscoelastic pipes with the variable fractional order models.

Tropical montane cloud forests (TMCF) receive additional (‘occult’) inputs of water from fog and wind-driven rain. Together with the concomitant reduction in evaporative losses, this typically leads to high soil moisture levels (often approaching saturation) that are likely to promote rapid subsurface flow via macropores. Although TMCF make up an estimated 6.6% of all remaining montane tropical forest and occur mostly in steep headwater areas that are protected in the expectation of reduced downstream flooding, TMCF hillslope hydrological functioning has rarely been studied. To better understand the hydrology of a TMCF on heterogeneously layered volcanic ash soils under very high net rainfall conditions (up to 6,740 mm yr-1), we examined temporal and spatial soil water dynamics and their contribution to subsurface runoff and stormflow for a year (1 July 2003 – 30 June 2004) in a small headwater catchment on the Atlantic (windward) slope near Monteverde, NW Costa Rica. Particular attention was paid to partitioning of water fluxes into lateral subsurface flow and vertical percolation. The presence of a gravelly volcanic layer at shallow depth of very high hydraulic conductivity intercalated between two layers of lower conductivity, controlled both surface infiltration and delayed vertical water movement deeper into the soil profile. Soil water fluxes during rainfall were dominated by rapid lateral flow in the gravelly layer, particularly at high soil water contents. In turn, this lateral subsurface flow controlled the magnitude and timing of stormflow from the catchment. Stormflow amount increased rapidly once topsoil moisture exceeded a threshold value of ~0.58 cm3 cm-3. Responses were not affected appreciably by rainfall intensity because soil hydraulic conductivities across the profile largely exceeded prevailing rainfall intensities.

The δ2H and δ18O composition of 77 precipitation samples collected between January 2014 and April 2019 from two sites across the Guadalquivir Basin, SW Spain, were analyzed. Sampling was performed within intervals of at least 14 days basis if rain occurred but frequently intervals were longer according to the rainfall incidence. Precipitation weighted averages and local meteoric water lines are presented for use in hydrological applications. δ2H and δ18O values show a remarkably high variability attributed to the influence of Atlantic and Mediterranean vapor sources. Precipitation weighted average d-excess values of 12.5-13 ‰ confirm the Western Mediterranean influence. Temperature and amount effects were found to be weak but significant influence of secondary evaporation for single rainfall events during summer was identified by reduced d-excess values and enriched isotopic signatures plotting close or below the Global Meteoric Water line (GMWL). Isotopic signatures of both sites are very similar in general and any temperature related urban effects of Seville city compared to the rural site Doñana could not be identified with the present data

Introduction: In the era of data-driven decision-making, an unacceptable haziness and inconsistency surrounds the yearlong scientific and public debate on the school closure policy in the COVID-19 pandemic mitigation efforts. Aim: The present literature review stems out of the need for a clear scaffold collecting in one place all current evidence, as well as helping organizing incoming future evidence, concerning both the role of schools in driving the Sars-CoV-2 community spread and the cost-effectiveness of school closure in containing such spread. Methods: References for this review were initially identified through searches of PubMed, Scopus and Cochrane Library for articles published from March, 2020, to March, 2021 by use of the terms “Schools” “COVID-19” “pandemic” “clusters” “outbreak” “seroprevalence”. Further search was undertaken through Google Scholar and ResearchGate, and finally through Google. Results: School closure at times of high background prevalence of COVID-19 should not be considered a measure implemented to protect the health of children. Children had lower secondary attack rates than adults and that they infrequently represented the index case. One year of pandemic has been sufficient for the emergence of one indication of concern: a potentially increased burden of paediatric mental health disorders. Conclusions: A fact-based understanding of what is currently known on such a consequential policy is required to provide a basis of evidence for an advocacy of either school closure or school opening at times of high intensity community transmission of Sars-CoV-2.

Background: Human serum albumin (HSA) is the most abundant protein in the circulatory system compared to other proteins and has been analyzed in a wide range of studies. In this research, molecular dynamics and docking of HSA with azapropazone have been simulated. Methods: The three-dimensional structure of human serum albumin was obtained to simulate molecular dynamics from RCSB. GROMACS was used for molecular dynamic simulations and received 30 frames. Autodock vina was used for docking between HSA and Azapropazone. Results: Based on the obtained results, the residues of Sudlow I junction have structural changes according to their chemical properties. Conclusion: In this study, a new method has been used on HSA compared to previous studies that can be used in drug design research. Understanding the structural and behavioral characteristics of HSA binding site can be a great help in drug design because structural changes in binding amino acids affect drug binding

Objectives: Myocardial injury during active coronavirus disease-2019 (COVID-19) infection is well described however, its persistence during recovery is unclear. We assessed left ventricle (LV) global longitudinal strain (GLS) using speckle tracking echocardiography (STE) in COVID-19 recovered patients and studied its correlation with various parameters.Methods: A total of 134 subjects within 30-45 days post recovery from COVID-19 infection and normal LV ejection fraction were enrolled. Routine blood investigations, inflammatory markers (on admission) and comprehensive echocardiography including STE were done for all. Results: Of the 134 subjects, 121 (90.3%) were symptomatic during COVID-19 illness and were categorized as mild: 61 (45.5%), moderate: 50 (37.3%) and severe: 10 (7.5%) COVID-19 illness. Asymptomatic COVID-19 infection was reported in 13 (9.7%) patients. Subclinical LV and right ventricle (RV) dysfunction were seen in 40 (29.9%) and 14 (10.5%) patients respectively. Impaired LVGLS was reported in 1 (7.7%), 8 (13.1%), 22 (44%) and 9 (90%) subjects with asymptomatic, mild, moderate and severe disease respectively. LVGLS was significantly lower in patients recovered from severe illness (mild: -21 ± 3.4%; moderate: -18.1 ± 6.9%; severe: -15.5 ± 3.1%; P < 0.0001). Subjects with reduced LVGLS had significantly higher interleukin-6 (P < 0.0001), C-reactive protein (P = 0.001), lactate dehydrogenase (P = 0.009) and serum ferritin (P = 0.03) levels during index admission. Conclusions: Subclinical LV dysfunction was seen in nearly a third of recovered COVID-19 patients while 10.5% had RV dysfunction. Our study suggests a need for closer follow-up among COVID-19 recovered subjects to elucidate long-term cardiovascular outcomes.

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Background: Human respiratory syncytial virus (RSV) is one of the leading causes of respiratory infections, especially in infants and young children. Previous RSV sequencing studies have primarily focused on partial sequencing of G gene (200-300 nucleotides) for genotype characterization or diagnostics. However, the genotype assignment with G gene has not recapitulated the phylogenetic signal of other genes and there is no consensus on RSV genotype definition. Methods: We conducted Maximum Likelihood phylogenetic analysis with 10 RSV individual genes and whole-genome sequence (WGS) that are published in GenBank. RSV genotypes were assigned by the statistical support monophyletic clusters with at least 10-year detection time from the WGS phylogeny. Results: In this study, we first statistically examined the phylogenetic incongruence, rate variation for each RSV gene sequence and WGS. We then proposed a new RSV genotyping system based on a comparative analysis of WGS and the spatial and temporal distribution of each lineage. We also provided an RSV classification tool to perform RSV genotype assignment. Conclusions: This revised RSV genotyping system will provide important information for disease surveillance, epidemiology, and vaccine development.

This paper deals with the stability analysis and controller design for linear systems with time-varying delays and parameter uncertainties. By choosing appropriate augmented Lyapunov-Krasovskii functionals, a set of Linear Matrix inequalities is derived to get advanced feasible region of stability, and controller gain matrices which guarantee the asymptotic stability of the concerned systems within maximum bound of time-delays and its time-derivative. To further reduce the conservatism of stabilization criterion a recently developed mathematical technique which constructed a new augmented zero equality is applied. Finally, two numerical examples are utilized to show the validity and superiority of the proposed methods.

In this work, we analyse the controllability for certain classes of impulsive integro - differential equations(IIDE) of fractional order via Atangana Baleanu derivative involving finite delay with initial and nonlocal conditions using Banach fixed point theorem.

Percutaneous balloon pulmonary valvuloplasty is a preferred treatment in pulmonary valve stenosis children with higher success rate. It is important to study the risk factors of postoperative severe pulmonary regurgitation, residual stenosis, and re-stenosis.

A myocardial abscess is a rare and fatal disease, which is known to be challenging to diagnose, especially in case of isolated one without endocarditis. We present a case of emphysematous myocardial abscess detected by computed tomography, and echocardiography, and confirmed by surgery.

Background. Measurable residual disease (MRD) is a powerful prognostic factor in patients with acute myelogenous leukemia (AML). We previously conducted a prospective study on an MRD-based strategy for the treatment of children with AML, and its significance has been reported. The present retrospective study is a pooled analysis of 34 patients who were registered after the completion of the previous study. Procedure. Reduced-intensity conditioning (RIC) followed by allogeneic hematopoietic stem cell transplantation (RIC-HSCT) was adopted to increase survival rates and minimize toxicities. The strategy was also refined with a minor modification, with WT1 expression levels in peripheral blood, as an MRD marker after a 2nd course of chemotherapy (consolidation course 1), being measured in addition to WT1, chimeric mRNA, and aberrant surface markers in bone marrow. Results. Five-year relapse-free and overall survival rates were 76.5 and 85.2%, respectively. RIC-HSCT was safely and effectively performed on MRD-positive patients. Among patients who underwent RIC-HSCT, re-emerging/rising MRD and high levels of MRD before HSCT were risk factors for disease relapse early after HSCT. Conclusions. The MRD-based strategy and RIC-HSCT worked well for children with AML. HLA-haploidentical peripheral blood transplantation following RIC may be a promising candidate for further study on patients at very high risk of relapse.

SUCCESSFUL USE OF CRUSHED FORMULATION OF DABRAFENIB AND TRAMETINIB IN A PEDIATRIC GLIONEURAL TUMORTania Mamdouhi1, Anshul Vagrecha2, Alan A. Johnson1,3, Carolyn Fein Levy1,2, Mark Atlas 1,2, Julie I. Krystal 1,2 1 Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY2 Department of Pediatrics, Division of Hematology/Oncology and Cellular Therapy, Cohen Children’s Medical Center, New Hyde Park, NY3 Department of Radiology, Division of Neuroradiology, Long Island Jewish Medical Center, New Hyde Park, NYCorresponding Author : Julie Krystal. Cohen Children’s Medical Center, 269- 01 76th Avenue, Suite 255, New Hyde Park, NY 11040. Jkrystal12@northwell.edu. Phone 718-470-3460. Fax 718-343-4642.Tables: 0Figures: 1Supporting Information Files : 0Short running title: Use of crushed formulation of dabrafenib and trametinibKeywords : Dabrafenib, Trametinib, BRAF, crushedData Availability: The data that support the findings of this study are available from the corresponding author upon reasonable request.

Crossed pulmonary arteries (CPA) is an unusual malformation characterized by abnormal origination of the pulmonary arteries from the main pulmonary artery (MPA), which is usually associated with complex cardiac pathologies and chromosomal abnormalities. We report a case of crossed pulmonary artery (CPA) associated with tetralogy of Fallot (TOF), right aortic arch (RAA), and absence of ductus arteriosus. Sonographic findings, complicated malformations, genetic anomalies, differential diagnosis, and prognosis analysis are discussed. Although the isolated CPA is relatively asymptomatic, when it is accompanied by other cardiac anomalies, the prognosis needs to be reevaluated.

Arteriovenous Fistula (AVF) is an exceedingly rare sequelae following arthrocentesis of the temporomandibular joint. This case report discusses a constellation of symptoms, findings, and appropriate management of a patient with a superficial temporal AVF. Several findings in this case, including vertigo, nystagmus, and hearing loss, have not been previously documented.

The optimal pinning node selection for multi-agent flocking is a NP-hard problem. The current pinning node selection strategies mainly depend on complex network node characteristics which are lack of rigorous mathematical proof for flocking control. This paper studies the effect and selection strategy of pinning node based on matrix eigenvalue theory. Firstly, the effect on the eigenvalue of Laplacian matrix by pinning node is analyzed. Secondly, the synchronization index which reflects topology uniformity of multi-agent system is proposed to exert maximum influence on the system synchronizability. A practicable optimal pinning node selection method based on synchronization index is proposed and analyzed by the eigenvalue perturbation method. Finally, the simulations show the rate of system convergence by using optimal synchronizability pinning node is better than the maximum degree centrality.