Background: Hepatic metastasis from retinoblastoma (RB) is rare. We evaluated clinical features, imaging manifestations, treatment, and prognosis in these patients. Procedure: Clinical data of five patients diagnosed with hepatic metastases of RB at the Department of Pediatrics in Beijing Tongren Hospital between January 2009 and January 2019 were analyzed retrospectively. Results: Two patients had bilateral lesions, while three had unilateral lesions. Among the seven eyes with lesions, six and one were classified as stage E and C, respectively (International Integrated Reporting Council staging). On computed tomography (CT), low-density foci were observed (three, multiple foci and two, single foci). After chemotherapy, tumor regression was observed in four patients, while there was no response in one patient. Three patients who underwent enucleation were at high risk for extensive choroidal invasion. All patients had severe disease with multiple system involvement, including central nervous system (CNS) and bone metastases. Neuron-specific enolase (NSE) and lactate dehydrogenase (LDH) levels were significantly elevated in all patients; after treatment, they decreased in four patients and remained unchanged in one patient with end-stage disease. Two patients died, with survival durations of 1 and 3 months following the diagnosis of hepatic metastasis. Three patients survived and continued treatment. Conclusion: Hepatic metastasis from RB is rare and usually occurs with CNS and bone metastases. On CT, hepatic foci could be indicated by low-density lesions with calcification. Chemotherapy could be effective for hepatic metastases. The prognosis of these patients is poor; however, hepatic metastasis is not a direct cause of death.

Introduction: Irritable bowel syndrome (IBS) is one of the most widely recognized functional bowel disorders (FBDs) with a genetic component. SCN5A gene and SCN1B loci have been identified in population-based IBS cohorts and proposed to have a mechanistic role in the pathophysiology of IBS. These same genes have been associated with Brugada syndrome (BrS). The present study examines the hypothesis that these two inherited syndromes are linked. Methods and Results: Prevalence of FBDs over a 12 months period were compared between probands with BrS/drug-induced type 1 Brugada pattern (DI-Type1 BrP) (n=148) and a control group (n=124) matched for age, female sex, presence of arrhythmia and co-morbid conditions. SCN5A/SCN1B genes were screened in 88 patients. Prevalence of IBS was 25% in patients with BrS/DI-Type1 BrP and 8.1% in the control group (p=2.34×10−4). On stepwise logistic regression analysis, presence of current and/or history of migraine (OR of 2.75; 95% CI: 1.08 to 6.98; p=0.033) was a predictor of underlying BrS/DI-Type1 BrP among patients with FBDs. We identified 8 putative SCN5A/SCN1B variants in 7 (12.3%) patients with BrS/DI-Type1 BrP and 1 (3.2%) patient in control group. Five out of 8 (62.5%) patients with SCN5A/SCN1B variants had FBDs. Conclusion: IBS is a common co-morbidity in patients with BrS/DI-Type1 BrP. Presence of current and/or history of migraine is a predictor of underlying BrS/DI-Type1 BrP among patients with FBDs. Frequent co-existence of IBS and BrS/DI-Type1 BrP necessitates cautious use of certain drugs among the therapeutic options for IBS that are known to exacerbate the Brugada phenotype.

Multiple correspondence analysis is an extension of correspondence analysis that consent one to examine the stencil of intercourses of several categorical dependent variables. The aim of this study is to analyze the cognitions, feelings, and thoughts of early childhood children who stayed at home during the quarantine process due to coronavirus with multiple correspondence analysis. The theory and commentary of multiple correspondence analysis in the case of two and more than two variables are provided through an example. The result from multiple correspondence analysis is a graphical monitor of the rows and columns of a contingency table that is conceived to permission visualization of the prominent correlations among the variable responses in a low-dimensional space. Such a presentment discloses a more global picture of the correlations among row-column pairs.

Cryptococcosis is one of the common mycological conditions leading to morbidity and mortality in patients with AIDS. We are presenting a case of disseminated cryptococcosis in a patient infected with human immunodeficiency virus (HIV-1), which were both diagnosed postmortem using Minimally Invasive Tissue Sampling Method.

Background COVID-19 pandemic is experienced intensely in our country like others. The presence of cancer in the patients is associated with morbidity and mortality in the course of COVID-19 disease. In this study, we aimed to evaluate the level of knowledge, attitude and behaivours regarding coronavirus disease in cancer patients. Methods This study is a single-center study which consists of 220 cancer patients who treated in our clinic. A questionnaire which consisted of three parts measuring the knowledge, attitudes and behaviours among cancer patients about COVID-19 was completed by each patient face-to-face during June, 2020. Results Most patients were familiar with the general information on COVID-19. Most cancer patients were aware of the symptoms of COVID-19 and that they were at greater risk. In 50% of the patients participating in the survey, it was observed that the covid-19 outbreak did not thought delaying cancer treatments. Half of the cancer patients who didn’t receive active cancer treatment preferred to have control tests performed at the time deemed appropriate by their doctors during the pandemic. 38.6% of them wanted to have control examinations done on the scheduled time. All of the patients wore masks when going out during the outbreak. Nearly all of the participants (99%) washed their hands to prevent contamination. 95% of the participants paid attention to social distance with other people. Contributors in the questionnaire with higher educational level had significantly higher knowledge mean scores compared to those with others. Conclusion In general, cancer patients are conscious about pandemic. They move with high compliance with their doctors in this period. Since COVID-19 infection is more severe in cancer patients, it is very important to evaluate these parameters to increase their knowledge and to correct their incomplete or incorrect information about this disease.

Objective To verify serum PLA2R antibody and glomerular PLA2R antigen expression in membranous nephropathy as well as to explore their relationship with clinical presentation and disease prognosis. Methods We retrospectively analyzed 155 patients clinical figures who were diagnosed with primary membranous nephropathy by kidney biopsy. Patients were divided into 6 groups according to their serum PLA2R antibody or glomerular PLA2R antigen positiveness and the level of serum PLA2R antibody titer. Both clinical features and pathological characteristics were recorded, and remission rate as well as time to response were compared among groups. Correlation between clinical figures and titer of PLA2R antibody or semi-quantity of PLA2R antigen were detected. Results Among patients with positive serum PLA2R antibody and tissue PLA2R antigen, higher baseline PLA2R antibody levels were associated with lower remission rate and longer remission time. A positive correlation between time to partial remission and serum PLA2R antibody titer was found. Among patients with serum PLA2R antibody titer <150U/L, there were shorter remission time in negative tissue PLA2R antigen group compared with positive tissue PLA2R antigen, and a positive correlation between time to complete remission and semi-quantity of tissue PLA2R antigen was found. Conclusion Both glomerular PLA2R antigen and serum PLA2R antibody play a role in disease presentation and prognosis in primary membranous nephropathy. Glomerular PLA2R antigen has a major role on disease prognosis when serum PLA2R antibody titer is less than 150U/L, while serum PLA2R antibody has predominant role in MN prognosis when serum PLA2R antibody titer is above 150 U/L.

Background: COVID-19, a novel pneumonia associated with the 2019 coronavirus infected pneumonia suddenly broke out in the world. The aim of this study is to analyze and summarize the clinical characteristics of pediatric patients with COVID‐19. Patients and method: Twenty-one patients confirmed by clinical and laboratory findings from 20 February to 19 April, 2020 in North of Iran were included. Demography information, clinical, laboratory and radiological findings, and treatment strategies of patients were evaluated. All statistical analyses were performed using SPSS version 13.0 software. Results: Body temperature was ≥38ºC in 11(52.4%) patients. Eleven (52/3%) patients had tachypnea and 4(19%) of them developed tachycardia. Six (30%) of patients suffered from a decrease in white blood cells. Also a decrease in creatine phosphokinase level was seen in 1(33%) of patients. Nine CT scans (42.85%) demonstrated a halo sign. Seven patients’ (33.33%) CT scans showed a patchy infiltration. Nine (42.85%) CT scans had bilateral crazy-paving pattern. 38.1% of patients were treated with chloroquine and oseltamivir. Four (19.04%) patients died and 17(80.95%) patients were discharged from the hospital. One of the patients who died suffered from acute respiratory distress syndrome. Conclusion: We found out that pediatrics, especially boys are more susceptible to COVID‐19 and it is more common in school-age and toddlers. Manifestations are milder than adults and severe cases associated with underlying disease. The effectiveness of medications used in the treatment of this disease need further study.

A novel anaerobic digester system called Holistic DigesterTM System (HDS) was developed. The pilot prototype was constructed and tested twice (4 months each) at the NCSU Field Laboratory for raising 60 feeder pigs to market age for each test. The structure and operation of HDS, the performance of live animal growth, chemical analyses of biogas and the resulting digestate, and the production of a potential organic fertilizer, are presented in this communication. It was concluded that: 1) this operation demonstrated the feasibility of HDS with live animals on farm; 2) daily biogas (approximately 50% methane) was produced consistently during each of the two studies; 3) animals grew well in the modified house with a pit for manure slurry collection. The weight gain of the pigs and feed conversion rate met the top 25% of the industrial average; and 4) the liquid digestate of the primary digester flowed into the secondary digester preloaded with dry switchgrass, which absorbed the liquid and incubated into a final product. Chemical analysis indicated that NPK values were retained and enriched in the final product, potentially, an organic fertilizer. The new prototype HDS that co-produces biogas and organic fertilizer was successfully tested and, furthermore, HDS left no waste nor wastewater on farm. It is believed that HDS will not only improve the cyclic bioeconomy, but also enforce the environmental and economic sustainability of animal agriculture.

This paper investigates the effect of inlet shape, entrance length and turbulence promoters on mass transfer by using 3D printed electrolyzers. Our results show that the inlet design can promote turbulence and lead to an earlier transition to turbulent flow. The Reynolds number at which the transition occurs can be predicted by the ratio of the cross-sectional area of the inlet to the cross-sectional area of the electrolyzer channel. A longer entrance length results in more laminar behavior and a later transition to turbulent flow. With an entrance length of 550mm, the inlet design did no longer affect the mass transfer performance significantly. The addition of gyroid type turbulence promoters resulted in a factor 2 to 4 increase in mass transfer depending on inlet design, entrance length and the type of promoter. From one configuration to another, there was a minimal variation in pressure drop (<16 mbar).

This study develops a model to predict the CO2 hydrate layer thickness. As to achieve this, we need the mass transfer coefficients at the interface between water phase and CO2 hydrate layer and the diffusion coefficients in CO2 hydrate. Firstly, we conducted the visualization experiment of CO2 hydrate layer dissolution behavior. From the experiment, we obtain the mass transfer coefficient on the CO2 hydrate layer. The experimental results show good agreement with the existing empirical equation. Secondly, we conducted the molecular dynamics simulation of CO2 hydrate to obtain the self-diffusion coefficients of CO2 and H2O molecules. As to calculate the self-diffusion coefficients, we identified inter-cage hopping and intra-cage movement of molecules based on each molecule travel distance. Finally, the results indicate that the kinetic model we proposed reproduce the layer thickness on the order.

Anomalous Aortic Origin of Coronary Artery (AAOCA) is a rare finding, with varied presentation and symptomatology. Increasingly recognized by cardiac imaging, when found it raises questions about the appropriate approach and management. We present a case of an 11-year-old female who presented with episodes of shortness of breath, angina and syncope during exercise. Further investigation demonstrated episodes of nonsustained ventricular tachycardia on Holter and coronary angiotomography revealed that the left coronary artery had an anomalous origin from the right cusp with initial short intramural segment and significant external compression in its initial course between the aorta and the pulmonary artery. Patient was submitted to surgical correction with dissection of left coronary artery posterior to the pulmonary artery, coronary arteriotomy, roof ampliation with autologous pericardium and creation of neo-ostium in aorta. Patient had satisfactory postoperative recovery, was discharged on the fifth day post op, and remains asymptomatic after six months follow-up. Herein we present surgical video and postoperative echo and CT scan.

Mitral annular disjunction (MAD) is a structural abnormality of the mitral annulus, defined by a detachment of the atrial wall-mitral valvular junction from the left ventricular (LV) free wall. This structural abnormality in mitral annulus fibrosus is significantly associated with the presence of mitral valve prolapse (MVP) [1], but it can be also detected in normal cases as an anatomical variation of the mitral annulus fibrosus [2]. The main tools to detect MAD are echocardiography and cardiac magnetic resonance. Prevalence of MAD in the general population ranges from 7% [1] to 9% [2]. Several studies proved an association between MAD and arrhythmic events, independently of concomitant mitral valve abnormalities, suggesting the existence of a novel entity: MAD arrhythmic syndrome [3]. Herein we describe a case report of a middle age man with MAD who experienced ventricular arrhythmias and placement of an implantable cardioverter-defibrillator (ICD).

The pandemic has had a dramatic and negative impact on opportunities for training in pediatric airway endoscopy. This commentary discusses ways in which training programs can address this issue.

Si presenta una delle autorizzazioni necessarie in termini di rispetto ambientale, l’Autorizzazione Unica Ambientale (AUA), ovvero una procedura che semplifica la richiesta dei titoli autorizzativi ai fini di esercitare la propria attività. Questa procedura è stata prevista come risposta alla richiesta delle imprese di facilitare i procedimenti attinenti ad una molteplicità di autorizzazioni e comunicazioni in materia ambientale, per il tramite del Suap, mantenendo un elevato livello di tutela ambientale. Oggi è fondamentale parlare di ambiente ed in particolare di rispetto per esso. Dal punto di vista normativo, in Europa, si sta cercando di “essere sensibili” alla salute del pianeta. Per poter raggiungere l’obiettivo prefissato, tale sensibilizzazione deve avvenire in ogni campo. Una delle categorie più “colpite” è, infatti, quella edilizia. L'AUA, perciò, risulta essere necessaria ai fini del perseguimento dell'obiettivo definito in precedenza. 

A new method for the comparison of fatigue performance among different materials is proposed by using Monte-Carlo technology. The uncertainty of material's fatigue property and the diversity of service loads are respectively described as a reliability index and a probability distribution. Using fatigue life as the standard measure of fatigue performance, two kinds of diagrams are developed as the dominance distributions for fatigue performance of materials. After the implication in the material selection from two casting alloys, the results show that the new method can evaluate the fatigue performance among different materials no matter withsanding constant or variable amplitude loading, which is very easy to guide the judgment whether the material has better fatigue performance or not.

Lorlatinib is a third-generation anaplastic lymphoma kinase (ALK) tyrosine kinase inhibitor (TKI) designed to penetrate the blood brain barrier. We report 2 cases of patients with ALK-rearrangement non-small cell carcinoma associated with severe symptomatic CNS metastases and poor performance status. Treatment with lorlatinib improved their neurological condition and performance status.

Background: Sickle cell disease (SCD) vaso-occlusive episodes (VOEs) are managed primarily with opioids that can lead to dependence and tachyphylaxis. Ketamine mitigates opioid tolerance and appears efficacious for all-cause pain in the adult emergency department (ED). We hypothesized that ED treatment with low-dose adjuvant ketamine (LDK) for acute VOE is safe and decreases opioid usage in children and young adults with SCD. Procedure: In this exploratory study, patients with SCD aged 10-25 years presenting to UCSF Benioff Children’s Hospital Oakland ED with VOE were eligible for a single 0.2 mg/kg IV dose of LDK, after receipt of the first IV opioid dose. Safety, tolerability, and subjective experience were assessed prospectively. Pain scores, length of stay, likelihood of discharge from the ED, time to 50% pain reduction, and morphine equivalent usage (mg/kg/h) for the intervention visits were compared to the patient’s historical data within the year prior. Results: No serious treatment emergent adverse events occurred in the 62 enrolled patient-encounters in 25 individual patients. LDK decreased morphine equivalent usage by 0.06 mg/kg/h (15%; 95% CI [2.3%, 28%], p=0.004), but did not affect pain scores on discharge, time to or likelihood of 50% pain reduction, or likelihood of discharge. Subjectively, when assessed in their first LDK encounter, the majority of patients reported faster pain relief (60%) and desired LDK in the future (68%). Conclusions: LDK for SCD VOE in the pediatric ED is safe, subjectively improves the experience of pain, and decreases opioid usage. Larger studies are needed to confirm these findings.

We presented an unusual case of iatrogenic esophageal perforation(EP) following trans-esophageal echocardiography(TEE) in a patient with COVID-19.Force applied during the intubation on an inflammatory and fragile wall caused by COVID-19 probably represented the underlying condition that contributed to the EP.Early diagnosis and urgent treatment are essential for a favorable prognosis

Objectives: In Wilms Tumor (WT) secondary malignancies caused by the side effects of intensive treatments remain one of the important problems. Therefore, there is a need for new studies to identify low- and high-risk groups for WT and to improve the treatment regimens of children in the low-risk group. Therefore, in our study, we aimed to determine the prognostic significance of the cyclooxygenase-2 (COX-2) biomarker in WT. Materials and Methods: Our study included 24 patients diagnosed with WT between January 2010 and December 2019. The correlation between COX-2 expression and significant prognostic parameters was investigated by studying COX-2 antibody using the immunohistochemical method. Results: COX-2 expression was observed in 22 of the patients, and the expression was more evident especially in the epithelial component. There was no significant correlation between COX-2 positivity and prognostic parameters. Conclusions: In our study, no significant relationship was found between significant prognostic parameters and COX-2 expression. We think that the COX-2 pathway is effective during the development phase of WT, since COX-2 expression was observed in almost all patients, therefore it may be beneficial to add COX-2 inhibitors to the treatment, and that a sufficient number of studies should be conducted in this respect.

AbstractObjective: Laryngeal Squamous Cell Carcinoma (LSCC) has high recurrence, metastasis and mortality rates, thus determining the markers related to prognosis and the methods that can be effective in its treatment are important. The number of studies on the prognostic role of HSPA in LSCC is very few. We did not find any study investigating the prognostic role of HSPA-2 in LSCC in the literature. The aim of our study was to examine the relationship between HSPA-2 expression and clinicopathological parameters in LSCC. Material and Methods: HSPA-2 was studied on 104 cases who have been diagnosed with LSCC in the last 7 years. The connection between HSPA-2 expression and important prognostic parameters was investigated.Results: In all of the cases, positive immunoreactivity was determined with HSPA-2. A significant relationship was determined between the HSPA-2 expression and important prognostic parameters such as lymphovascular invasion, lymph nodule metastasis, the primary tumor, the TNM stage, recurrence, metastasis and survival rates.Conclusion: Our study supports the link between high HSPA-2 expression levels and poor prognostic parameters. Therefore we think that HSPA-2 can be used as a prognostic marker in laryngeal cancer. Also, we think that HSPA-2 is important in early diagnosis due to its increased expression even in LSCC precursor conditions. Keywords: Laryngeal Squamous Cell Carcinoma; HSPA-2; Prognostic Factors

Nel corso del tempo e soprattutto dall’introduzione  del concetto di sostenibilità, il comparto socio-economico e le leggi che lo governano rientrano in pieno nella tematica, divenendo elemento essenziale ed imprescindibile. Per l’assetto economico, la relazione con le altre componenti è determinata dall’interferenza reciproca tra le caratteristiche delle componenti ambientali (stato di qualità dell’aria, qualità delle acque, caratteristiche del suolo, ecc.…) i fattori ambientali individuati (rumore, vibrazione, traffico, radiazioni, rifiuti, energia, ecc.) e le caratteristiche del sistema produttivo. Le caratteristiche delle altre componenti e degli altri fattori ambientali possono infatti condizionare la sostenibilità ambientale del sistema produttivo, così come il sistema produttivo può condizionare la sostenibilità ambientale (ad esempio,  presenza di attività industriali che comportano rilevanti emissioni inquinanti in atmosfera condizionerà lo stato di qualità dell’aria).

Riverine dissolved inorganic nitrogen (DIN), when elevated by human activities (e.g., land-use change), can accelerate the nitrogen cycle and downstream dispersal. However, estimating DIN export coefficients for individual land-use types can be complex due to mosaic land-use patterns and interactions between fertilizers and hydrological processes. We propose a framework that integrates an empirical model, a moving-window method with an elasticity method to quantify seasonal DIN export coefficients for each land use in the Shixi Creek catchment, southeast China. Our model showed good agreement with field observations according to root mean square error and a normalized objective function. The DIN export coefficients of farmland and forest were the highest (9.16 mg/L) and lowest (2.91 mg/L), respectively, resulting in DIN exports for farmland and forest of 1,951 kg km-2 yr-1 and 619 kg km-2 yr-1, respectively. Urbanization was a dominant factor influencing DIN export represented by the export coefficient of built-up areas with the highest elasticity and highest uncertainty. This study can shed light on how to improve riverine N management in a catchment by considering the interactive effects of climate and land use changes.

Riparian areas and channel networks are important landscape compartments, with key hydrological and ecologic functions. Hence, defining their spatial boundaries is an important step towards sustainable riparian management. In tropical countries, riparian areas are rarely mapped, although they represent a crucial component of local livelihoods and ecosystems. In this study, topographic attributes generated with a 30m SRTM DEM were used to delineate wet areas and stream networks of two small catchments in Central Brazil. The topographic attributes were the local slope, the slope curvature, and the Topographic Wetness Index-TWI, respectively. Threshold values of the selected topographic attributes were calibrated in the Santa Maria catchment, comparing the synthetic wet areas and drainage networks with corresponding reference (map) features, and validated in the nearby Santa Maria basin. Drainage network and wet area delineation accuracies were estimated with multi-criteria and confusion matrix methods. The drainage network delineation accuracy was 67.2% and 70.7%, and wet area prediction accuracy was 72.7% and 73.8%, for the Santa Maria and Gama catchments, respectively. The delineation errors resulted from model incompleteness, DEM grid size and vertical inaccuracy, and from cartographic misrepresentation of the reference maps. The method performed equal or better than other studies in the literature, and could be used for preliminary mapping of riparian areas of tropical catchments.

The NRCS abstraction method is based on two assumptions. The first is that the ratio of actual water retention after ponding to maximum potential retention after ponding is equal to the ratio of actual surface runoff to potential surface runoff. The second assumption is that the initial abstraction for the watershed is twenty percent of the maximum potential retention. This study shows that both assumptions violate continuity principles and proposes a modification that renders an elementary relationship accounting for all abstraction forms by dividing them into a variable and constant components. Consequently, the surface runoff computation becomes dependent on the soil initial moisture content and implicitly influenced by the initial abstraction, while retaining the advantage of the subjective selection of curve number from extensive database from which the NRCS method has gained popularity. A new time of concentration model is also proposed to extend the computation for flood hydrograph generation.