Background: Lung cancer is one of the leading causes of cancer mortality in the US. The use of precision medicine in the past 10 years has significantly changed the therapeutic landscape of lung cancer. Management of advanced non-small cell lung cancer (NSCLC) has transitioned from a chemotherapeutic approach to targeted treatments and immunotherapeutic agents. Several tyrosine kinase inhibitors (TKIs) have been approved for patients with targeted mutations while patients who do not have driver mutations; immunotherapy has been recently approved as frontline therapy, which has resulted in marked improvement in overall survival and added a new tool in our armamentarium. Aims: The purpose of this review is to highlight recent advancements in diagnostic approach and management strategies in patients with metastatic NSCLC. Materials and methods: Published studies included in Medline (via PubMed) and National Comprehensive Cancer Network Guidelines were reviewed for data gathering. Conclusion: The use of next generation sequencing has significantly changed our understanding of molecular oncogenic mechanisms of lung cancer. These advancements have created a paradigm shift in the treatment strategies of metastatic lung cancer from primarily chemotherapeutic approach to increasing use of targeted therapies and immune check point inhibitors (ICI) leading to better survival rates and lesser toxicity.

Barriers to gene flow (BGF) play a pivotal role in the dynamics of population genetics promoting genetic differentiation, thus, are inexorably associated with the development and maintenance of phylogeographic structure. Phylogeographic structure resulting from BGF represents data that help the management of natural genetic resources, aiding in the recognition of areas of conservation interest. Several geographic and oceanographic processes found along the Brazilian coast have been proposed as BGF. However, no consensus exist identifying which of them represents the most important in shaping biodiversity. Therefore, this study provides a synthesis of the scientific literature on Brazilian marine phylogeography and used published data to build datasets that allowed us apply linear (lm) and generalized additive models (gam) to identify spatially congruent phylogeographic breaks among marine species (as areas of high BGF frequency occurrence). Lm identified a significant negative correlation between the occurrence of BGF and latitude, suggesting that population in the tropics are genetically more structured than in higher latitudes. This result bears strong association with the latitude species diversity gradient observed worldwide. Gam identified Cape São Roque (05° 28’ S) as the main BGF for populations with continuous distribution along the Brazilian coast. Cape São Roque is located near the center point region where the South Equatorial Current splits into the northward North Brazil Current and the southward Brazil Current. This study represents the first literature synthesis of Brazil’s marine phylogeography and provides a novel explicit quantitative approach to comparative phylogeography.

Umbilical cord blood allogeneic hematopoietic stem cell transplantation(UCBT) has been gradually applied in the treatment of patients with blood system diseases. This paper reports a case of a child patient with highly invasive T-cell lymphoma who underwent UCBT after chemotherapy and developed minimal change glomerulopathy after transplantation.

In response to the needs of Chinese community residents for property management, this article designed and developed a residential property management information system based on the B/S model. The system development adopts the browser/server (B/S) architecture, Java as the development language, the framework adopts Spring MVC mode, the MySQL database is used, the source code and database interaction process uses the Mybatis framework, and the front-end display uses the VUE.js framework to realize the residential property. Manage the data reporting and statistics of each link.Functional modules include:owner information, real estate information, engineering equipment, personnel management, lease management.The system has passed the functional test,，It has been in trial operation for one year in multiple residential communities. The results show:the system has the characteristics of simple operation, stable operation, strong scalability, etc., which can assist property managers in scientific, convenient and efficient community property management, improve the informatization and modernization of community property management, enhance the experience of community owners, and improve the satisfaction of community owners degree.

Nasopharyngeal RT-PCR swab test for COVID-19 diagnosis has a high specificity but also a low sensitivity. The high false-negative rate and the overconfidence in negative results sometimes lead to hospital outbreaks. Therefore, we recommend always integrating the clinical assessment in the diagnostic process, mostly after the test, to determine what degree of confidence can be attributed to a negative result.

Organophosphate poisoning by self-injection is rare. Current case report describes a man with subcutaneous self-injected OP. poisoning presenting with delayed. He was treated with pralidoxime. Through the observation, dose and the time between poisoning until time to start treatment we can conclude different presentations and outcomes of OP poisoning.

Reliable manipulation of soil organic matter (SOM) – a necessity for optimal land management – is constrained by our limited mechanistic understanding of SOM formation. Here we add to existing frameworks a novel mechanistic element that may underpin SOM dynamics, based on evolutionary-ecological rather than chemical or physical limitations to decomposition. We argue that decomposition of some substrates may be ecologically constrained in mycelial fungi, evolutionarily constrained in co-operating bacteria, and geometrically constrained in unicellular microbes. We describe and test a mathematical model based on our framework, providing a proof-of-concept that substrate can plausibly be spared decomposition and accumulate even when it is physically and chemically accessible. Our framework can explain a variety of SOM dynamics, including priming and the suppression of decomposition by nitrogen addition, as well as the typical composition of SOM. An augmented mechanistic framework for understanding SOM dynamics can help guide targeted empirical study, which in turn can contribute to more optimised land management.

Cough is one of the most common complaints that lead patients to see a doctor. It is not only a basic respiratory sign but also an important neurological sign. There are 3 main types of cough: reflex cough (type I), voluntary cough (type II), and evoked cough (type III). Reflex cough sensitivity may be increased in many neurological disorders, such as space-occupying lesion of the brainstem, medullary lesions secondary to type I Chiari malformations, tics disorders such as Tourette’s syndrome, somatic cough, neurodegenerative disorders of the cerebellum, and chronic vagal neuropathy due to allergic and nonallergic diseases. On the other hand, cough sensitivity decreases in the cerebral hypoxia, cerebral hemispheric stroke with a brainstem shock, dementia due to Lewy body disease, Parkinson’s disease, amyotrophic lateral sclerosis, multiple sclerosis, and peripheral neuropathy such as hereditary sensory and autonomic neuropathy type IV, diabetic neuropathy, vitamin B12, and folate deficiency. The ear-cough reflex of Arnold’s nerve, syncopal cough, cough headache, opioid associated cough and cough-anal reflex are signs that can help in the diagnosis of underlying neurological disorders. The cough reflex test is a quick, easy, and inexpensive test that can be performed during the cranial nerve exam. In this article, we have discussed cough reflex testing and various neurological disorders that increase or decrease cough sensitivity.

Objectives: One of the most severe and devastating complications following coronary artery bypass grafting (CABG) are cerebro-vascular accidents. Atherosclerotic disease of the ascending aorta and epi-aortic trunks has been considered the most probable cause of cerebral embolization during CABG due to aortic manipulation and clamping. The aim of this study is to investigate if single or double aortic clamping may impact the incidence of neurological events. Methods: This is a retrospective study which includes a series of patients who underwent CABG from a single surgeon at our Institution from March 2006 to December 2012. Patients were divided into two homogenous groups based on the surgical technique: single-aortic clamping (SAC) (118 patients) and double aortic clamp (DAC) (133 pt). Results: Median surgical time was longer for the DAC group than for the SAC group (p= 0.015), but no significant differences were found for the primary outcomes of stroke and transient ischemic attack. The two groups presented a similar 30-day survival. The follow-up was completed at 82% (median 11 years). The Kaplan-Meier estimates a survival at 11 years of 81% and 88% for the DAC and SAC group, respectively. Conclusions: Incidence of stroke seems to be independent from cross-clamping technique and we could infer that the global rate of stroke after CABG in low to moderate risk patients is probably more influenced by other factors that further studies need to address. Moreover, the appearance of the aorta at the time of surgery is crucial to analyse to better personalize the strategy.

Genetic characterization may provide useful insights into severe acute respiratory coronavirus 2 (SARS CoV 2) circulating in Bangladesh. Here we analyzed the SARS Cov 2 positive 41 nasopharyngeal samples collected in lysis buffer obtained at different regional national laboratories of Bangladesh during July – December 2020. Full length spike gene was amplified and SARS CoV 2 was confirmed upon Sanger sequencing. Multiple ClustalW alignment and phylogenetic study of 15 strains showed that genetically diverse SARS CoV 2 is circulating in the country where 80 documented and 55 novel substitutions have been observed in different regions of spike glycoprotein. Major mutations and/or deletions was identified at conserved amino acid positions that are functionally linked to host transition, antigenic drift, host surface receptor binding or antibody recognition sites, and viral oligomerization interfaces that may have significant effects on pathogenic capacity and epidemiological signatures.

The chances of detecting congenital heart disease are improved following structured protocols. Fetal heart disease is one of the main serious congenital malformations. The objective of this review is to present the benefits of sequential and routine cardiac evaluation in the first and early second trimesters and to identify the structures and pathologies that can be detected at this gestational age. The databases of PubMed, Medline, MD consult, Embase, Clinical Key, Scielo, and ScienceDirect, as well as specialized texts in Spanish and English were searched for diagnostic studies, systematic reviews, and meta-analysis related to the terms “early fetal echocardiography” and “congenital heart malformations” published between 2000 and 2019. Technological advances have revolutionized the fetal echocardiographic examination making possible the diagnosis of congenital heart disease from the first and early second trimester of pregnancy. However, it should be recognized that early fetal echocardiography has limitations such as the evaluation of pulmonary veins and cardiac lesions that are progressive. The benefit found was earlier detection of pathologies with high sensitivity and specificity. A fetal cardiac evaluation sequence was included in these early fetal echocardiographic examinations due to the awareness of fetal anatomical and hemodynamic differences in the first trimester and the beginning of the second trimester. Early fetal echocardiography is a very useful tool for the detection of congenital heart disease; it allows parents to be informed about the prognosis and possible treatments early. Fetal cardiac examination in the first trimester is safe and can detect the most of heart congenital malformation.

Background and Aim of the Study: Negative impact of prosthesis-patient mismatch (PPM) on long term survival after valve replacement has been reported. However, the effect of PPM after bioprosthetic mitral valve replacement (MVR) has not yet been well examined. The purpose of this study was to investigate the effect of PPM on late outcomes after bioprosthetic MVR for mitral regurgitation (MR). Methods: A total of 181 patients underwent bioprosthetic MVR between April 2008 and December 2016. After excluding patients with mitral stenosis and those with incomplete data, 128 patients were included in the study. Postoperative transthoracic echocardiography was performed for all patients and the effective orifice area (EOA) was calculated using the pressure half-time method. The effective orifice area index (EOAI) was calculated by the formula: EOA/body surface area (BSA). PPM was defined as a postoperative EOAI ≤ 1.2 cm2/m2. The characteristics and outcomes were compared between the groups. Results: There were 34 patients (26.6%) with PPM and 94 patients (73.4%) without PPM. Although proportion of males and BSA were higher in the PPM group, valve size distributions were similar between the two groups. There were no significant differences in the in-hospital mortality and morbidities. Multivariable analysis showed that PPM was an independent predictor of late mortality (hazard ratio [HR] 3.38; 95% confidence interval [CI] 1.69-6.75; p = .001) and death from heart failure (HR 31.03, 95% CI 4.49-214.40, p < .001). Conclusions: PPM after MVR for MR was associated with long-term mortality and death from heart failure.

Aim: Angiotensin-converting enzyme 2 (ACE2) has a significant physiological role in the renin – angiotensin – aldosterone system (RAAS) pathway. The ACE2 receptor acts as a virus receptor in the pathogenesis of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) disease. In this study, we aimed to investigate the effects of ACEIs use on radiological imaging and clinical course in COVID-19. Methods: In this study, patients who had been using medications for the diagnosis of hypertension and who were hospitalized in Haydarpasa Numune Training and Research Hospital due to COVID-19 pneumonia were retrospectively evaluated. Results: The mean age of 107 patients included in this study was 68,49±11,95, and 50.5% (n = 54) of them were male. The patients were divided into two separate study groups as ACEIs users and non-users. In the first of these groups, 55 patients were using ACEIs due to hypertension. In the second group, 52 patients were using calcium channel blockers (CCBs), β-blockers, alpha-2 blockers, or diuretics, alone or in combination. When the lung computed tomography images were examined, multilobar findings were less common in the ACEIs group, which was remarkable (p <0.001). When the clinical endpoint was evaluated, the findings showed that the mortality rates were different in the groups ACEIs users and non-users (12.7% vs. 32.7%, respectively, p=0.013). Conclusion: Although the role of RAAS blockade in COVID-19 is still not fully elucidated, we have shown that COVID-19 progresses with less damage in the lungs with patients who have been using ACEIs.

Woody plantations play a curtail role in ecological security along coastal zones. Understanding of energy partitioning and evapotranspiration (ET) over black locust plantations can reveal land-atmosphere interaction process and help us to optimize this plantation for land management in the Yellow River Delta. In this study, we investigated energy fluxes, ET in particular, and their related biophysical factors using eddy covariance techniques over a black locust plantation in 2016, 2018, and 2019. Downward longwave radiation offsets 84%–85% of upward longwave radiation, upward shortwave radiation accounted for 12%–13% of downward shortwave radiation, and the ratio of net radiation (Rn) to downward radiation was 18%–19%in the three years. During growing seasons, latent heat flux was the largest components among radiation balance terms; during non-growing seasons, sensible heat flux was a dominant component. ET was mainly controlled by Rn, air temperature, vapor pressure deficit and leaf area index (LAI). Annual ET was smaller than the sum of precipitation and irrigation, and cumulative ET was larger than cumulative precipitation during non-growing seasons. The phenology of black locust influenced the seasonal variation in daily ET, mainly via LAI. ET was larger under sea wind than under land wind, mainly because soil water content at 10-cm depth was greater under sea wind in daytime. Seasonal patterns of daily evaporative fraction, Bowen ratio, crop coefficient, Priestley–Taylor coefficient, surface conductance (gs), and decoupling coefficient were mainly controlled by LAI, and the threshold value of daily gs was approximately 8 mm s−1 over the studied plantation.

Background Physical distancing and facemask use are worldwide recognized as effective non-pharmaceutical interventions (NPIs) against the coronavirus disease 2019 (COVID-19). Since January 2020, Taiwan has introduced both NPIs but their effectiveness on non-COVID-19 respiratory viruses (NCRVs) remain underexplored. Methods This retrospective observational study examined electronic records at a tertiary hospital in northern Taiwan from pre-COVID (January–December 2019) to post-COVID period (January–May 2020). Patients with respiratory syndromes were tested for both enveloped (e.g. influenza virus and seasonal coronavirus) and non-enveloped RVs (e.g. enterovirus and rhinovirus) using multiplex reverse-transcription polymerase chain reaction assays. Monthly positivity rates of NCRVs among adult and pediatric patients were analyzed with comparison between pre- and post-COVID periods. Results A total of 9693 patients underwent 12127 multiplex RT-PCR tests. The average positivity rate of NCRVs reduced by 11.2% (25.6% to 14.4%) after nationwide PHIs. Despite the COVID-19 pandemic, the most commonly identified enveloped and non-enveloped viruses were influenza virus and enterovirus/rhinovirus, respectively. Observed reduction in NCRV incidence was predominantly contributed by enveloped NCRVs including influenza viruses. We did not observe epidemiological impacts of NPIs on non-enveloped viruses but an increasing trend in enterovirus/rhinovirus test positivity rate among pediatric patients. Our data were validated using Taiwan’s national notification database. Conclusions Our frontline investigation suggests that the current NPIs in Taiwan might not effectively control the transmission of non-enveloped respiratory viruses, despite their protective effects against influenza and seasonal coronavirus. Hydrogen peroxide or chloride-based disinfectants should be integrated into national preventative strategies against respiratory viral infections in the post-COVID-19 era.

OBJECTIVE: The objective of this study was to evaluate C-section rates, before and after the implementation of the Project Appropriate Birth based on the Robson 10-group classification system. DESIGN: An observational, cross-sectional study. SETTING: Maternity hospital in South Brazil. POPULATION: All pregnant women attending, April 2016 through April 2017 (phase 1, pre-implementation of the Project Appropriate Birth) and June 2017 through June 2018 (phase 2, post-implementation of the Project Appropriate Birth). METHODS: Maternal and obstetric characteristics were evaluated, including Robson’s classification, based on the characteristics of pregnancy and childbirth. Chi-square test and crude and adjusted prevalence ratios were used to analyze study variables. The significance level was set at 5%. MAIN OUTCOME MEASURES: C-section rate for each group, their contribution to the overall c-section rate and the differences in these contributions before and after PPA implementation. RESULTS: C-section rates decreased from 62.4% to 55.6%, which represented a 10.9% reduction after the implementation of the Project Appropriate Birth. Pregnant women in Robson classification groups 1 through 4 had the greatest decrease in C-section rates, ranging from 49.1% to 38.6%, which represents a 21.5% reduction. The greatest contributors to the overall C-section rates were group 5 and group 2, accounting for more than 60% of the C-section deliveries. CONCLUSION: The Project Appropriate Birth had an important impact on the reduction of C-section rates, especially in Robson classification groups 1 through 4, which indicates that providing mothers with evidence-based interventions for labor and childbirth assistance will contribute to reduce C-section rates.

Internal presentation (Lunch & Learn, 2019) on the Journal Impact Factor. What it is, and what is not.

Abstract Objective: To compare current the third stage management to expedient squatting at 3 minutes postpartum. Design, Setting, Sample and Methods: A retrospective cohort study of 1,098 planned, attended low risk vaginal births in Israel using Judy’s 3,4,5 minute third stage protocol compared to 2,691 attended low risk vaginal births in British Columbia using various forms of active or expectant management of the third stage of labor. Main Outcome measures: PPH>1000, PPH>500 and manual removal of placenta Results: Among similar groups of low risk births, active management, or expectant management resulted in 4.1% PPH over 1000 cc, whereas Judy’s 3,4,5 minute protocol resulted in 0% PPH over 500 cc. Conclusion: Evidence supports less postpartum bleeding and postpartum hemorrhage when women deliver the placenta in squatting 3 minutes after birth. The risks are minimal and the data suggests the likelihood of a very positive outcome, making it recommended for practitioners in all settings to try it.

Background: There is a great need to make a rapid differential clinical diagnosis of COVID-19 among respiratory disease patients and determining the prevalence rate of these diseases among the COVID-19 population. Method: Approximately 522 patients with allergic rhinitis, asthma, COPD, and COVID-19 were analyzed for demographic and clinical features. Radiological features were analyzed only for COVID-19 patients. Results: COPD and asthma were more common among COVID-19 patients than allergic rhinitis. All chest CT scans of COVID-19 patients showed bilateral ground-glass opacity. Fever, dry cough, diarrhea, loss of sense of smell and taste, shortness of breath, and blue lips were significantly higher in all COVID-19 patients compared to COPD, asthma, and allergic rhinitis patients. Conclusion: The presence of clinical symptoms such as fever, dry cough, diarrhea, loss of sense of smell and taste, shortness of breath, and blue lips in COVID-19 patients, can be used for differential diagnosis between COVID-19 patients and other respiratory diseases. Then, the diagnosis can be confirmed by chest CT scan for COVID-19 patients without the need for a nasopharyngeal swab or PCR test, especially in epidemic countries. Allergic rhinitis patients are the least exposed to COVID-19 infection among other respiratory disease patients.

An academic article is often regarded just as an archival device for storing a completed research program. Actually, a successful paper is also the blueprint for planning your research in progress. We will discuss how to write articles that not only successfully navigate the peer-review process, but are also discovered, read, cited, and make an impact in the research community. 

Background: Patients with late, occurring ≥18 months post-diagnosis, isolated central nervous relapse (iCNS-R) of B-acute lymphoblastic leukemia (ALL) have excellent outcomes with chemotherapy plus cranial radiotherapy, with 5-yr overall survival (OS) approaching 80% in POG 9412. Subsequent relapse and radiation-related morbidity remain the causes of treatment failure and long-term sequelae. COG AALL02P2 aimed to maintain outcomes in patients with late iCNS-R using intensified chemotherapy and a decrease in cranial irradiation from 1800 to 1200 cGy. Procedures: COG AALL02P2 enrolled 118 eligible patients with B-ALL and early iCNS-R who received intensified systemic therapy, triple intrathecal chemotherapy and 1200 cGy cranial irradiation delivered at 12 months, with maintenance chemotherapy continuing until104 weeks post-diagnosis. Results: The 3-yr event-free and overall survival (EFS) and OS were 64.3±4.5% and 79.6±3.8%, with 46.1% (18/39) of relapses including the CNS. Of the 112 patients who completed therapy, 78 received protocol-specified radiation. Study enrollment was closed after interim monitoring analysis showed inferior EFS compared to POG 9412. Patients with initial NCI standard risk classification fared better than high risk patients. Conclusions: COG AALL02P2 showed inferior EFS but similar OS compared to POG 9412. Limitations included a small sample size, more intensive prior therapies, and a significant number of patients (34/118, 29%) who did not receive protocol-directed radiation due to early relapse prior to 1 year or did not otherwise follow the treatment plan. New approaches are needed to improve outcome for these patients and determine the optimal timing and dose of cranial radiation in the treatment of iCNS-R.

ABSTRACT Aim: The aim of our research was to investigate retrospectively the relationship between the symptoms and general characteristics, initial laboratory values and treatments in patients who had COVID- 19 and who applied to the chest diseases outpatient clinic for control after 1 month. Methods: Three hundred fifteen patients who were diagnosed with COVID- 19 and applied to the chest diseases outpatient clinic between May 2020 and August 2020 for control in the 1st month were included in the study. Patient information was collected from the hospital information system and the e-pulse system. Results: Females accounted for 50.2 % of the our patients and their mean age was 47.98 ± 14.81 (19-88) years. 14.3% (n: 45) of the individuals were 65 years of age and older. 20.6% (n: 65) of our patients were smoking. 70.2% (n: 221) of our patients were treated at home. 133 patients had at least one comorbid disease. The patients most frequently reported cough, dyspnea, weakness, myalgia and diarrhea. The most common symptoms were cough, dyspnea, weakness and myalgia in the first month. It was determined that the symptoms had persisted in patients who had been hospitalized, had dual therapy, had comorbid diseases and had more common pathologies in their pulmonary imagings. Conclusion: Symptoms may persist for a long time in hospitalized patients, in patients with COVID-19-related pneumonia and concomitant chronic diseases and in patients with high d-dimer and high CRP at the time of admission. Patients are informed that their symptoms may last for a long time, unnecessary hospital admissons can be avoided.

Ticks are involved in the transmission of various pathogens and some tick-borne diseases cause significant problems for the health of humans and livestock. Despite their obvious importance, the composition of viral communities in ticks, and their interactions with pathogens, is poorly understood, particularly in Eastern Europe that constitutes (via bird migrations for example) a major hub for animal-arthropod vectors exchanges. The aim of this study was first to describe the virome of Dermacentor sp., Rhipicephalus sp. and Haemaphysalis sp. ticks collected from poorly investigated regions of Romania (Iasi and Tulcea counties) located at the intersection of various biotopes, countries and routes of migrations. We then focused the study on viruses that could have potential relevance for human and animal health. More than 500 ticks were collected in 2019 from the environment and from small ruminants and analyzed by high-throughput transcriptome sequencing. Among the viral communities infecting Romanian ticks, viruses belonging to the Flaviviridae, Phenuiviridae and Nairoviridae families were identified and full genomes were derivedPhylogenetic analyses placed them in clades where mammalian isolates are found, suggesting that these viruses could constitute novel arboviruses. We also assessed the bacterial microbiome of the collected ticks. The characterization of these microbial communities increases the knowledge of the diversity of viruses in Eastern Europe and provide a basis for further studies on the relationship between ticks and tick-borne viruses.

Approximately 121.5 million individuals worldwide are diagnosed with cardiovascular diseases. Advancing age increases the risk of cardiovascular diseases in both genders. Circadian rhythm is accountable for well-ordered roles of many different body functions. The peak level of specific hormones and functions follow the biological interpretations of circadian rhythm, whether daylight or night time. Sleep disorders, aside from shift work, like obstructive sleep apnea, can induce circadian disruption that influences complex immunological, metabolic, and cardiovascular functions, eventually raising cardiovascular diseases risk. Online databases were systematically examined to investigate studies on randomized controlled trials (RCTs) from the past five years, assessing the impact of varying sleep disorders and shift work in inducing circadian disruption and its impact on the risk of cardiovascular diseases. After administering multiple inclusion and exclusion criteria, 18 studies were selected, but only eight documents were chosen to review after a comprehensive analysis of the studies. Each document was assessed for fitness of quality. Sleep-related disorders and shift work were discovered to induce circadian malfunction and disruption, and correlated with increased risk of cardiovascular diseases. Approaches to control disorders of cause should be developed to decrease the risk of cardiovascular diseases.