A 78 years-old woman was found with worsening hypercalcemia, osteopenia and memory loss during the past 2 years. Multiple, repeated imaging studies failed to reveal the aetiology of the primary hyperparathyroidism. Bilateral neck exploration revealed a 4.5X2,3 cm right superior parathyroid adenoma in an ectopic position.

Small-to-medium businesses are always seeking affordable ways to advertise their products and services securely. With the emergence of mobile technology, it is possible than ever to implement innovative Location-based Advertising (LBS) systems using smartphones that preserve the privacy of mobile users. In this paper, we present a prototype implementation of such systems by developing a distributed privacy-preserving system, which has parts executing on smartphones as a mobile app, as well as a web-based application hosted on the cloud. The mobile app leverages Google Maps libraries to enhance the user experience in using the app. Mobile users can use the app to commute to their daily destinations while viewing relevant ads such as job openings in their neighborhood, discounts on favorite meals, etc. We developed a client-server privacy architecture that anonymizes the mobile user trajectories using a bounded perturbation strategy. A multi-modal sensing approach is proposed for modeling the context switching of the developed LBS system, which we represent as a Finite State Machine (FSM) model. The multi-modal sensing approach can reduce the power consumed by mobile devices by automatically detecting sensing mode changes to avoid unnecessary sensing. The developed LBS system is organized into two parts: the business side and the user side. First, the business side allows business owners to create new ads by providing the ad details, Geo-location, photos, and any other instructions. Second, the user side allows mobile users to navigate through the map to see ads while walking, driving, bicycling, or quietly sitting in their offices. Experimental results are presented to demonstrate the scalability and performance of the mobile side. Our experimental evaluation demonstrates that the mobile app incurs low processing overhead and consequently has a small energy footprint.

Removing forest cover for oil palm plantations has raised questions about climate change problems and debates and their associated impacts. The design of the pruned fronds of the trees does not make them ideal for use as mulch cover on the entire farm, but they are heaped between the plant rows. This research investigated the changes in the physicochemical properties of soils under oil palm plantations of different ages. Soil surface (0-20 cm) and subsurface (20-40 cm) samples have been obtained from various ages of oil palm plantations (0-5, 5-10, 10-15 and, 15-20 years). Two distinct samples were taken on the same farm, under alleys and heaped pruned fronds. Soil samples used as a standard (control) were collected from adjacent forest land. Analyses of particle size showed that the soils were sandy loam to sandy clay loam texture soils. Bulk density was low and varied with age and depth. The soils were moderate to slightly acidic pH, relatively low organic carbon, total nitrogen, and available phosphorus contents. Based on the standard ratings, exchangeable bases and cation exchangeable capacity content were also low, while high percent base saturation was observed. Research findings have shown that the soil properties of different ages of oil palm plantations vary and should therefore be handled differently based on of their characteristics. Accumulation of organic residue on the floor of the plantations should be encouraged as this will help to increase organic matter levels.

Different lymphocyte subsets are involved in autoimmune pathogenesis of Type 1 Diabetes (T1D). Previous studies suggested a role of CD5 expressing T and B cells including rare unconventional lymphocytes with combined T- and B-cell features (DE cells). We performed algorithm-supported multi-parameter flow cytometry and quantitative PCR to investigate immune cell subsets and DE cells in children with T1D (n=20) and matched controls (n=20). Comparisons of conventional immune cells detected increased proportions of CD3+ T cells in T1D patients whereas CD19+ B cell proportions were comparable to controls. Self-organizing maps for flow cytometry analyses (FlowSOM) showed highly similar CD5 expressing B-cell subsets and no differences for DE cells were detected between the study groups by flow cytometry or specific quantitative PCR. Notably, differences in CD8 positive T cells were indicated by FlowSOM and similarity-based tSNE analyses. Study group comparison confirmed significantly reduced CD8+ T-cell proportions with moderate or low CD5 expression in T1D patients. Finally, In vitro experiments showed stable CD5 expression differences of CD8+ T cells after T-cell activation, cytokine stimulation and culture. We observed differences of T-cell co-receptor CD5 expression in T1D patients with potential relevance for immune regulation of CD8+ T-cell activation.

Reforestation is widely used to restore degraded infertile soils in the coastal area. Substantial attention has been paid to the functioning of AMF in vegetation restoration because arbuscular mycorrhizal fungi (AMF) are considered beneficial to this process. However, little is known about the effect of AMF product, glomalin-related soil protein (GRSP), on soil organic carbon (SOC) sequestration during the forest restoration. We conducted a study in a tropical region where the native forest has been seriously deforested with only a few grasses and then a series of restoration approaches have been made to restore the forest ecosystem. The study sites include a barren land (BL), a Eucalyptus exserta planted forest (EF), a mixed broadleaved forest (MF) and a secondary natural forest (SF), which represents the un-, early-, middle- and late-restoration stage, respectively. The results showed that the restoration increased EE-GRSP and T-GRSP by 3.9-12.3 times and 1.9-4.6 times compared with the barren land, respectively. The proportion of GRSP in SOC is 1.6-2.0% (EE-GRSP/SOC) and 6.5-15.8% (T-GRSP/SOC), respectively. Also, a significantly positive relationship was found between the proportion of GRSP in SOC and recalcitrant SOC composition percentage (aromatic C), as well as between GRSP and soil aggregate stability. These results together suggest that the restoration of the degraded tropical forest is beneficial to soil C sequestration with the accumulation of GRSP, most likely, through an improvement of the soil aggregate stability and increase of the proportion of recalcitrant soil C chemical composition.

Detectors for the passive acoustic monitoring (PAM) of bats have become invaluable research tools, especially for surveys, monitoring programs and environmental impact assessments. However, little is known about the small-scale (within-site) variability of PAM recordings and especially about the influence of detector identity and distance, and of microphone orientation on the statistical confidence of activity estimates and species detection probabilities. We recorded vocalizations in a homogeneous meadow with no trees, bushes or tall ground vegetation. Eight detector pairs were arranged in an octagon, the two detectors of a pair facing in opposite directions. The call sequences of eight species were analyzed. The deviations of individual detectors from the overall mean were generally small, but large outliers occurred both at the file (temporal resolution: five seconds) and the night (resolution: one night) scale. All devices detected the main temporal patterns of calling activity in the study period, but three devices deviated systematically from the others and the sensitivity of two devices deteriorated over time. Detector orientation and distance were significant, yet small, sources of variability. The probability of detecting the presence of species correlated with species’ activity and ranged on average from 100 % for bats in total to only 18.8 % for the least active Myotis myotis. The sample sizes necessary to achieve 90 % statistical confidence of activity estimates ranged from 7 to 16 detectors and from 5 to 12 nights, depending on taxon. Increasing the number of nights resulted in much higher confidence than increasing the number of detectors. We recommend PAM studies of bats to frequently calibrate detector sensitivity; deploying at least three detectors per study site; sampling longer periods instead of deploying more detectors; randomly assigning and swapping detectors among sites, treatments, strata, etc.; and statistically scrutinizing the sample data, especially for outliers.

Background: Asthma is a leading cause of pediatric hospitalization in the United States. Children hospitalized with asthma are often cared for in different care settings during a single hospitalization. Our objective was to study the reliability and safety of a new pediatric hospital-wide asthma severity score (HASS) across different care units within a single tertiary-care pediatric center. Methods. 150 patients between the ages of 2 and 18 years hospitalized with a principal diagnosis of status asthmaticus were included. Study patients were followed from initial triage in the emergency department until the time of medical readiness for discharge. Rates of medical errors, early transfers to a higher level of care and medically indicated hospital length of stay (LOS) were compared between 75 patients prior to and 75 patients after implementation of the HASS using retrospective chart review. Inter-rater reliability was determined by collecting independent HASS scores from blinded staff members after tandem or simultaneous patient assessment. Results. Inter-rater reliability among untrained staff members using the HASS was high. Rates of preventable adverse events and medical errors were low and not significantly different before and after implementation of the HASS. LOS was shorter after implementation of the HASS but without statistical significance. Rates of early transfer to a higher level of care were unchanged between study years. Conclusion. The HASS is a reliable asthma severity tool that can be used throughout hospitalization and also among multiple clinical providers to trend clinical progress and optimize communication, particularly during times of care handoffs.

Systemic contact dermatitis (SCD) is a condition occurring in previously sensitized individuals after systemic re-exposure to the same or cross-reacting substance. Pigmented systemic contact dermatitis after intake of cobalt containing diet has never been reported.

Objective: COVID-19 is one of the most important health problems concerning the last century and our knowledge of the disease is still limited. In our study, we aimed to compare serum-soluble urokinase plasminogen activator receptor (suPAR) and kidney injury molecule-1 (KIM-1) level with clinical course in COVID-19 patients. Methods: Our study included 102 patients over the age of 18 who were diagnosed with Covid-19 between September 2020 and December 2020 by taking nasopharyngeal swap and using real time PCR method and 30 volunteer medical personnel over the age of 18 who were PCR negative after the nasopharyngeal swap. KİM-1 and suPAR were measured by enzyme-linked immunosorbent assay. Results: NLR, LDH, prothrombin time, CRP, PaO2/FiO2, D-Dimer, ferritin and fibrinogen levels, which have been mentioned in previous studies to be of prognostic importance for COVID-19, were observed to be higher in the severely ill group (p=0,001, 0,001, 0,05, 0,001, 0,001, 0,005, 0,001, 0,001 respectively). suPAR and KIM-1 levels were statistically significantly higher in patient groups compared to the control group (p=0.001 for all). While suPAR level was statistically significantly lower in severe patients compared to moderate patients (p=0.034), KIM-1 level was observed to be higher in severe patients (p=0.001). Conclusion: The increased level of KIM-1 in severe patients, which is thought to play an important role in the endocytosis of SARS-CoV-2 to the cell, may have an important place for the therapeutic target in the future. SuPAR can be considered to play an important role especially in the defense mechanism and fibrinolysis and its decreased level in severe patients may be associated with poor prognosis in the early period. However, extensive studies are needed to reach a definitive opinion about suPAR.

We report here the complete genome sequence of the Rhizobium rhizogenes (formerly Agrobacterium rhizogenes) strain LBA9402 (NCPPB1855rifR), a pathogenic strain causing hairy root disease. In order to assemble a complete genome we obtained short-reads from Illumina sequencing as well as long-reads from Oxford Nanopore Technology sequencing. The genome consists of a 3,958,212 bp chromosome, a 2,005,144 bp chromid (secondary chromosome) and a 252,168 bp Ri plasmid (pRi1855), respectively. The primary chromosome was very similar to that of the avirulent biocontrol strain K84, but the chromid showed a 724 kbp deletion accompanied by a large 1.8 Mbp inversion revealing the dynamic nature of these secondary chromosomes. The sequence of the agropine Ri plasmid was compared to other types of Ri and Ti plasmids. Thus we identified the genes responsible for agropine catabolism, but also a unique segment adjacent to the TL-region that has the signature of a new opine catabolic gene cluster including the three genes that together encode an opine dehydrogenase. Our sequence analysis also revealed a novel gene at the very right end of the TL-DNA, which is unique for the agropine Ri plasmid. The protein encoded by this gene was most related to the succinamopine synthases of chrysopine and agropine Ti plasmids and thus may be involved in synthesis of the unknown opine that can be degraded by the adjacent catabolic cluster. The available sequence will facilitate the use of R. rhizogenes and especially LBA9402 in both the laboratory and for biotechnological purposes.

Objective: This study aimed to discover the prevalence of infant mortality and to assess how different factors influence infant mortality in 24 developing countries by utilizing the latest DHS data. Methods: This study used a mixed-method design to assemble cross-sectional studies to integrate data from 24 other countries due to a widening perspective of infant mortality. Most recent available DHS data of 24 different developing countries from the year 2013 to 2019 was used to conduct the study. Descriptive analysis, binary logistic regression model, random-effect meta-analysis, and forest plot have been used for the final analyses. Results: Binary logistic regression model revealed for Bangladesh that, higher education level of fathers (OR: 0.344, 95% CI: 0.147; 0.807), being 2nd born or above order infant (OR: 0.362, 95% CI: 0.248, 0.527), taking ANC (OR: 0.271, 95% CI: 0.192; 0.382 for 1-4 visits), taking PNC (OR: 0.303, 95% CI: 0.216; 0.425) were statistically significant determinants of lowering infant death. While carrying multiple fetus (OR: 6.634, 95% CI: 3.247; 13.555) was exposed as a risk factor of infant mortality. Most significant factors influencing infant mortality for all 24 developing countries were number of fetus (OR: 0.193, 95% CI: 0.176; 0.213), taking ANC (OR: 0.356, 95% CI: 0.311; 0.407) and taking PNC (OR: 0.302, 95% CI: 0.243; 0.375). Conclusion In this study, the number of the fetus, taking ANC and PNC, was the most significant factor affecting the risk of infant mortality in developing countries. So, anticipation and control projects ought to be taken in the field in regard to these hazard factors.

The basal zone of glaciers is characterised by physicochemical properties that are distinct from firnified ice because of strong interactions with underlying substrate. Basal ice ecology and the roles that the microbiota play in biogeochemical cycling, weathering, and proglacial soil formation, remains poorly known. We report bacterial diversity and potential ecological roles at three temperate Icelandic glaciers. We sampled three physically distinct basal ice facies (stratified, dispersed, debris bands) and found biological similarities and differences between them; basal ice character is therefore an important sampling consideration in future studies. High abundance of silicates and Fe-containing minerals could sustain the basal ice ecosystem, in which chemolithotrophic bacteria (~23%), especially Fe-oxidisers and hydrogenotrophs, can fix C, which can be utilised by heterotrophs. Methanogenic-affiliated detected sequences showed that silicate comminution-derived hydrogen can also be utilised for methanogenesis. Metabolism predicted by 16S rRNA diversity revealed that methane metabolism and C-fixation are the most common pathways, indicating the importance of these metabolic routes. Carbon concentrations were low compared to other ecosystems, but we report the highest carbon concentration in basal ice to date. Carbon release from melting basal ice may play an important role in promoting pioneering communities establishment and soil development in deglaciating forelands.

In the microbiological diagnosis of bloodstream infections (BSI), blood culture (BC) is considered the gold standard test despite its limitations such as low sensitivity and slow turnaround time. A new FDA-cleared and CE-marked platform utilizing magnetic resonance to detect amplified DNA of the six most common and/or problematic BSI pathogens (Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, and Escherichia coli) is available and may shorten the time to diagnosis and potentially improve antimicrobial utilization. Whole blood samples from hospitalized patients with clinical signs of sepsis were analyzed using the T2Bacteria Panel (T2Biosystems) and compared to simultaneously collected BC. Discrepant results were evaluated based on clinical infection criteria, combining supporting culture results and the opinion of treating physicians. A total of 55 samples from 53 patients were evaluated. The sensitivity and specificity of the T2Bacteria panel was 94% (16 out of 17 detections of T2Bacteria-targeted organisms) and 100%, respectively, with 36.4% (8 of 22) causes of BSI detected only by this method. The T2Bacteria Panel detected pathogens on average 55 hours faster than standard BC. In our study, 9 of 15 patients with positive T2Bacteria Panel results received early-targeted antibiotic therapy, and/or their antimicrobial treatment was modified based on T2Bacteria Panel findings. Given the high reliability, faster time to detection, and easy workflow, the technique qualifies as a point of care testing approach.

In this paper, we study the conditions under which the following symmetric system of difference equations with exponential terms: \[ x_{n+1} =a_1\frac{y_n}{b_1+y_n} +c_1\frac{x_ne^{k_1-d_1x_n}}{1+e^{k_1-d_1x_n}},\] \[ y_{n+1} =a_2\frac{x_n}{b_2+x_n} +c_2\frac{y_ne^{k_2-d_2y_n}}{1+e^{k_2-d_2y_n}}\] where $a_i$, $b_i$, $c_i$, $d_i$, $k_i$, for $i=1,2$, are real constants and the initial values $x_0$, $y_0$ are real numbers, undergoes Neimark-Sacker, flip and transcritical bifurcation. The analysis is conducted applying center manifold theory and the normal form bifurcation analysis.

In this paper we present the phase-field models to describe nonisothermal solidification of ideal multicomponent and multiphase alloy systems. Governing equations are developed for the temporal and spatial variation of three phase-field functions, as well as the temperature field. The global existence of weak solutions to parabolic differential equations in three dimension was proved by the Galerkin method. The existence of a maximum theorem are also extensively studied.

Background Airway obstruction in a child requires expedite management in addition to comprehensive discussion between the Otolaryngology and Anaesthesiology team to formulate a treatment plan to ensure safe airway. Juvenile-onset recurrent respiratory papillomatosis (JORRP) is an exophytic benign laryngeal lesion which poses a great challenge when presented with respiratory distress. Objective: This paper presents a novel, safe and cost-effective approach to temporary tracheal ventilation of the obstructed airway in a child with juvenile-onset recurrent respiratory papillomatosis using the laryngeal suction tube connected to general anaesthetic (GA) machine. Result and Conclusion Rigid laryngeal suction tube is placed through the side-port of Lindholm laryngoscope and connected to breathing circuit of GA machine via modification of the suction tubing and endotracheal tube (ETT) 15mm male connector. Manual bagging ventilation with 100% FiO2 achieved good oxygenation throughout the debulking of the papilloma without hindering the surgical field. Our technique utilizes the readily available equipment whilst enabling safe anaesthesia and providing good surgical field during excision of obstructive papillomatous airway lesion.

Introduction:Stand-alone substrate ablation without baseline ventricular tachycardia (VT) induction and activation mapping has become a standard VT ablation strategy. We sought to evaluate the influence of baseline VT inducibility and activation mapping on ablation outcomes in patients with structural heart disease (SHD) undergoing VT ablation. Methods:This is a single center, observational and retrospective study including consecutive patients with SHD and documented VT undergoing ablation. Baseline VT induction was attempted before ablation in all patients and VT activation mapping performed when possible. Ablation was guided by activation mapping for mappable VTs plus substrate ablation for all patients. Ablation outcomes and complications were evaluated. Results: 160 patients were included (203 VT ablation procedures) and were classified in 3 groups according to baseline VT inducibility: group 1 (non inducible, n=18), group 2 (1 VT morphology induced, n=53), and group 3 (>1VT morphology induced, n=89). VT activation mapping was possible in 35%. After a median follow-up of 38.5 months, baseline inducibility of >1VT morphology was associated with a significant incidence of VT recurrence (42% for group 3 vs. 15.1% for group 2 and 5.6% for group 1, Log-rank p<0.0001) and activation mapping with a lower rate of VT recurrence (24% vs. 36.3%, Log-rank p=0.035). Independent predictors of VT recurrences and mortality were baseline inducibility of >1VT morphology (HR 12.05 IC 95% 1.60-90.79, p=0.016) and LVEF<30% (HR 2.43 IC 95% 1.45-4.07, p=0.001), respectively. Complications occurred in 11.2% (5.6% hemodynamic decompensation). Conclusions:Baseline VT inducibility and activation mapping may add significant prognostic information during VT ablation procedur

We report on a long-term survivor of an atypical teratoid/rhabdoid tumor (ATRT-TYR) as an index patient, who carries a SMARCB1 exon 6 gain inherited from his father. The father was diagnosed with an unusual sequence of a myxopapillary INI1-negative ependymoma and a relapsing BRAF V600 wild type hairy-cell leukemia. He has two yet healthy sisters aged 33 and 38 years carrying the same variant, from which one had lost an infant to a malignant brain tumor. This family highlights the existence of RTPS1-associated SMARCB1 germline alterations with reduced penetrance and extends the spectrum of involved diseases

In this investigation, it is found that the generated elastic stress during the unconstraint vibration treatment process can act as the dislocation driving stress on the dislocation in the micro-scale. When the sum of the dislocation driving stress, the image stress and the back stress exceeds the motion resistance of the dislocations in a pile-up, the dislocations begin to reverse back, and the pile-up disappear. Based on this principle, a fatigue damage-healing model under unconstraint vibration condition was proposed. The verified results showed that the damaged copper film can be effectively healed by the vibration guided by the model calculation.

Background Hypertension is an early finding of autosomal dominant polycystic kidney disease (ADPKD) and is related to different mechanisms. Cyst expansion related renin secretion or early endothelial dysfunctions are some of these hypotheses. Different course of hypertension in ADPKD preoccupies that relatives of ADPKD patients may also be under risk for this underlying mechanisms. In this study, we aimed to find blood pressure response problems to exercise as an initial vascular problem in unaffected relatives of hypertensive ADPKD patients. Methods The cross-sectional study included 24 unaffected relatives (siblings and children) of ADPKD patients and 30 healthy controls that performed a cycle ergometer test. Additionally, as a marker for endothelial function, nitric oxide (NO) and asymmetric dimethylarginine (ADMA) levels at baseline and post exercise were measured. Results Systolic blood pressure (SBP) and diastolic blood pressure (DBP) increases were similar in both groups during the 1st, 3rd, and 6th min of exercise. During the exercise recovery phase SBP decreased in both groups; however, in the relatives of ADPKD patients DBP remained high at the end of the 6th min, suggesting impaired capacity for exercise-induced vasodilatation. Baseline NO and ADMA, and 1-min NO and ADMA were similar in both groups. Conclusion Abnormal blood pressure response to exercise stress was observed in unaffected normotensive relatives. The observed abnormal DBP response pattern to exercise suggests that arterial vascular responses might be already altered in unaffected relatives of hypertensive ADPKD patients; however, long-term clinical trials are needed to clarify the significance of these findings.

This work deals with the existence of almost periodic solutions in a biological model, the model proposed by VG Nazarenko and E.E. Sel'kov of stem cell dynamics. This article demonstrates the existence of almost periodic solutions, for this purpose, the constant parameters of the system were changed to almost periodic functions which allows greater adaptability in biological cases such as this. This kind of changes have already been raised in other biological systems. In this case we will use the implicit function theorem to prove the existence of periodic solutions.

Introduction Many men with non-clinically significant PCa (N-CSPCa) will not progress to become symptomatic within their lifetime. If we can predict clinically significant PCa (CSPCa), we can prevent patients from unnecessary biopsies, overdiagnoses, and overtreatment. The purpose of this study was to determine whether PSAD and f/t PSA can predict CSPCa (Gleason ≥ 7) in patients diagnosed with prostate cancer on biopsy with a PSA level of 2.5-10 ng/ml or not. Materials and Methods 78 patients who underwent TRUSG-guided prostate biopsy with PSA 2.5-10.0 in our clinic between March 2017 - August 2020 and whose pathology result was reported as prostate adenocarcinoma, were retrospectively evaluated. In addition to the demographic content of the patients, PSA, free PSA, prostate size (with TRUSG), rectal examination findings and prostate biopsy pathology results were recorded. Clinically significant prostate cancer was defined as a Gleason score 7. Results The mean age of the patients was 66.9 ± 8.4, PSA value was 6.9 ± 1.8, free / total PSA ratio was 18 ± 8.1%, and PSA density was 0.150 ± 0.078. The P values of PSA, free PSA, PSAD, f/t PSA, and prostate volume between CSPCa and N- CSPCa groups were 0.010, 0.780, 0.001, 0.084, and 0.030, respectively. The area under the ROC curve (AUC) of the PSAD for predicting CSPCa was 0.719 with a 95% Cl (0.604–0.835), and the standard errors were 0.062 and 0.059, respectively. When PSAD cutoff was 0.130 for predicting CSPCa, sensitivity and specificity were 75% and 63%, respectively. Conclusion PSAD can be used for predicting CSPCa, but f/t PSA can not. PSAD is not a strong stand-alone tool with its sensitivity and specificity, but we suggest that PSAD can be a part of future nomograms for predicting CSPCa and future protocols for active surveillance. Key words:prostate-specific antigen; clinically significant prostate cancer

BACKGROUND The use of azoles for antifungal prophylaxis after familial allogeneic stem cell transplantation in children (SCT) is hindered by adverse events and drug interactions especially in children affected by sickle cell disease. Intermittent, higher dose of micafungin could be an alternative. METHODS A prospective, observational, longitudinal, single-center study was conducted between May 2015 and June 2018. The study included 30 patients between 2 and 18 years old who underwent allogeneic SCT and received prophylaxis with micafungin on alternating days after the bone marrow engraftment phase. FINDINGS Fifty transplants performed, 30 included prophylaxis against IFIs, with micafungin in an alternating pattern according to the previously described protocol. The indication for HSCT was hemoglobinopathies in 76.7%, acute leukemia in 20.0% and Fanconi anemia in 3.3%. The prophylaxis duration was 2.33 months (1.53 to 3.98). In our study, 40.0% (12/30) of the patients had acute GVHD, and 6.7% (2/30) had chronic GVHD, which prolonged the duration of alternating prophylaxis. No serious adverse effects of the use of micafungin were observed in any of the patients. There was also no breakthrough Invasive fungal infection (IFI) during alternating prophylaxis. CONCLUSION: In selected patients, micafungin was well tolerated without breakthrough IFI in our study.

Cardiac rhabdomyomas are the most common fetal cardiac tumors and can be diagnosed antenatally and postnatally by echocardiography. They are usually asymptomatic and spontaneously regress within the first three years of life and often associated with tuberous sclerosis (TS). The prognosis of patients with rhabdomyomas is mostly determined by the size and location of the lesion. Rhabdomyomas may cause hemodynamic disturbances or arrhythmias due to obstructing the inflow or ventricular outflow tracts or alter valve function, leading to poor prognosis. Although it may regress spontaneously, surgical excision is usually curative, especially in sporadic and single tumors. We report an unique case of antenatally diagnosed as a huge cardiac rhabdomyoma accompanied by hypoplastic left lung and left ventricle, mimicking significant obstruction of the left ventricular and left atrial chamber. The patient underwent urgent surgery, because of severe hemodynamic compromise on the first day of life due to signs of severe obstruction of the left ventricle and left atrium. The large, lobulated epicardial cardiac rhabdomyoma located anterolateral and inferior aspect of the heart; involved the whole left ventricle through the left atrium excised.