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Background: In-hospital permanent pacemaker implantation (PPMI) is a frequent and well-known complication of transcatheter aortic valve replacement (TAVR) procedure. The period of monitoring for need for pacing after discharge remains poorly understood. Methods: The National Readmission Database from first six months of calendar year 2016 and 2017 was queried for patient discharged alive after TAVR. All patients with prior pacemakers were excluded. Patients who received pacemaker after discharge (d-PPMI) were compared to a) patients receiving no pacemaker (o-PPMI) or b) patients receiving pacemaker on index admission(i-PPMI) over a 6 month follow-up. Results: Out of 39,993 patients who did not have a prior pacemaker, 4001(10.0%) underwent PPM implantation during index admission (i-PPMI) while over the next 6 months, a further 734 (1.8%) patients underwent the procedure (d-PPMI). For patients receiving PPMI during follow-up post TAVR discharge, the majority (68%) occurred within 14 days. The primary cause of readmission for d-PPMI was heart block in majority of the cases (73%; complete heart block 49%, second degree heart block 4%, bradycardia/other heart block 20%). The d-PPMI group also had a relatively shorter length of stay and a lower comorbidity burden when compared to the i-PPMI group. When compared to the o-PPMI group, the d-PPMI group were more likely to have higher advanced heart block. Conclusions: About one-fifth of pacemakers implanted post TAVR procedures happen during follow-up with a majority of them happening immediately after discharge. Risk stratification at discharge may help to identify patients who undergo PPMI post discharge.

The clinical characteristics of COVID-19 patients with pneumonia in family clustersGuangchuan Dai1*, Yating Gao2*, Likun Zhou3,4*, Zhen Zhou3*, Weiwei Gao1, XiangrongZhang1, Tingqiu Ge1, Yi zeng1#, Xia Zhang1#, Yongxiang Yi1#1Affiliated Hospital of Nanjing University of Chinese Medicine, The Second Hospital of Nanjing, Nanjing Municipal Public Health Medical Center, Nanjing, Jiangsu 210003, P.R. China2Graduate School, Anhui University of Chinese Medicine, Hefei, Anhui 230012, P.R. China3Nanjing Drum Tower Hospital Center of Molecular Diagnostic and Therapy, State Key Laboratory of Pharmaceutical Biotechnology, Jiangsu Engineering Research Center for MicroRNA Biology and Biotechnology, NJU Advanced Institute of Life Sciences (NAILS), NJU Institute of AI Biomedicine and Biotechnology, School of Life Sciences, Nanjing University, Nanjing 210023, P.R. China4Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin’s Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin 300060, P.R. China*These authors contributed equally# Correspondence: Yi Zeng(960559051@qq.com) or Xia Zhang(zhangxia365@sina.com) or Yongxiang Yi (ian0216@yeah.net)Affiliated Hospital of Nanjing University of Chinese Medicine, The Second Hospital of Nanjing, Nanjing Municipal Public Health Medical Center, No.1, Kangfu Road, Jiangning District, Nanjing City, Jiangsu Province, P.R. China.Tel:+86-025-85091652Keywords: COVID-19 ; clinical characteristics ; family clusters

Background A diagnosis of childhood cancer results in new parent-child communication challenges. Little is known about how communication changes over time after diagnosis or relapse. The objective of this study was to determine the effect of time since diagnosis and relapse on quality of parent-child communication. We hypothesized that there would be a positive correlation between time and quality of parent-child communication. Methods Cross-sectional study in children (7 to 17 years) with relapsed/refractory cancer and their caregivers, who spoke English, were not cognitively impaired, and had internet access. Parents were recruited through Facebook ads. Parents and children completed the Parent-Adolescent Communication Scale (PACS), a 20-item measure of communication quality, with openness and problem subscales. Spearman’s Rho coefficients assessed correlations between PACS scores and time since diagnosis/relapse. Results There was a statistically significant negative correlation between parent PACS scores and time since child’s cancer diagnosis (Spearman’s Rho = - 0.21, p = 0.02), indicating a tendency for overall worsening communication as time since diagnosis increased. There was a positive correlation between the parent PACS problem scores and time since diagnosis (Spearman’s Rho = + 0.22, p = 0.01), indicating more problematic communication as time since diagnosis increased. Correlations of time since relapse and PACS scores were small and not statistically significant. Conclusion Parent-child communication worsens over time following a child’s cancer diagnosis with more communication problems, contrary to our hypothesis. Future studies are needed to evaluate intervention timing to best support parent-child communication beyond the new diagnosis period.

A delayed hemolytic transfusion reaction (DHTR) is a potential complication for patients with sickle cell disease (SCD) who develop red blood cell (RBC) alloimmunization to foreign antigens from allogeneic transfusions, resulting in life-threatening hemolytic anemia between 24 hours and 28 days after the transfusion. Guidelines have suggested obtaining an extended RBC antigen profile by genotyping in patients with SCD to provide increased accuracy for antigen matching. We present a pediatric patient with SCD and a rare RBC antigen genotype who developed DHTR to describe the significant challenges with antibody identification, the process of obtaining compatible blood, and our medical management.

Background: Methotrexate is safely administered to most patients but can also cause severe toxicities. It is necessary to individualize methotrexate dose to maintain suf-ficient exposure while minimizing toxicities. Procedure: We enrolled 1174 cycles of high-dose methotrexate chemotherapy from 294 patients treated following the CCCG-ALL-2015 protocol and explored risk fac-tors of toxicities, methotrexate clearance delay and relapse. We compared those who received a fixed-dose reduction (Program 1) with those who were dose-adjusted by added methotrexate concentration test at 16h (Program 2) after methotrexate clear-ance delay existed the last cycle. Results: Female, IR/HR group, BSA<0.69m2 and C44h≥1.0 μ mol/L were risk factors of toxicities(P<0.05). Significant covariates on methotrexate clearance delay were age >6years, male and IR/HR group (P<0.01). Male, IR/HR and C68h≥0.2μmol/L group patients were at higher risk of relapse(P<0.05). No significant association was observed between methotrexate dose and relapse-free survival. 405 cycles from 168 patients were dose-adjusted by Program 1 and 118 cycles from 43 patients by Pro-gram 2. Patients who used Program 2 had a higher actual methotrexate infusion dose and infusion rate and was better in keeping C44h in our target value (P<0.001). Ab-normal serum potassium was more frequently in patients using Program2 (P<0.001), and prolonged myelosuppression was more commonly seen in IR/HR patients with Program2(P=0.003). Conclusions: No significant correlation between methotrexate dose or C44h and re-lapse-free survival time was found. Patients who were dose-adjusted by Program 2 received a higher therapeutic dose and better controlled the methotrexate concentra-tion to our target range.

Intestinal epithelioid angiosarcoma is an uncommon, aggressive and invasive neoplasm of vascular origin. We report a case of a 77-year-old male patient who was hospitalized with severe symptomatic anaemia due to bleeding jejunal ulcers and confirmed epithelioid angiosarcoma. Intraoperative enteroscopy enabled detection of multifocal bleeding lesions of the jejunum.

This case highlights an atypical presentation of a patient with no history of mental illness who has been diagnosed with a bipolar disorder associated with severe COVID-19 symptoms. Neuroimaging was only positive for subtle white matter changes; he was treated with antipsychotics and mood-stabilizing agents until he reached partial remission.

A 44-year-old man presented to our hospital with lower gastrointestinal bleeding. We performed balloon-assisted enteroscopy, which revealed diverticulum and stricture at the ileum . The patient underwent segmental small bowel resection and diagnosed with Meckel's diverticulum. We should keep in mind the possibility of intestinal stricture due to Meckel's diverticulum.

Myonecrosis and compartment syndrome are rarely seen in sickle cell disease (SCD). Myonecrosis and compartment syndrome have not been previously reported in HbSC. This case report presents the first case of an HbSC patient presenting to emergency department (ED) with bilateral leg pain and swelling.

Colonic malignancy generally presents as a mass lesion and lights up on positive positron emission tomography (PET) scan. Crohn’s Disease (CD) leads to transmural inflammation that can present as a colonic mass with a positive PET that can mimic malignancy. Early treatment improves outcomes.

Solid Pseudopapillary Tumors of the Pancreas (SPTPs) are rare tumors with non-specific presentation which makes them a difficult diagnostic challenge. the morphologic features of the cells were similar to the cells seen in neuroendocrine tumors. Immunohistochemistry cleared up the doubts and made the diagnosis of SPTP the definitive diagnosis.

Weisz-Prater number (NW-P) is often applied to assess the internal diffusion effect in heterogeneous catalytic reactions. However, the traditional calculation method with excessive empirical reference values affects the accuracy remarkably. A series of Pt/HPMo/SBA-15 catalysts with the pore size as a single variable were prepared to calculate the NW-P with a developed model combining the diffusion-reaction kinetic method. Utilizing dimensionless variables, internal effectiveness factor (η) and Thiele modulus (Φ_n), and the apparent activities over catalysts with different diffusion capacity, NW-P is obtained with improved accuracy. For the diffusion effect on the hydrotreatment of n-C16, according to the more precise NW-P, the pore size should be not less than 10 nm to avoid the step-limitation of internal diffusion in the premise of adequate acid sites. Using the novel method, a conclusion is drawn that the formation of m-i-C16 is more susceptible to internal diffusion than the consumption of n-C16.

A micro membrane adsorber with deep-permeation nano structure (DPNS) has been successfully fabricated by flowing synthesis. The nanoparticles are in situ assembled in membrane pores and immobilized in each membrane pores along the direction of membrane thickness. The nanoparticles with a lower size and thinner size distribution can be achieved owing to the confined space effect of the membrane pores. As a concept-of-proof, the nano ZIF-8 and ZIF-67 are fabricated in porous membrane pores for Methyl orange (MO) and Rhodamine B (RhB) adsorption. The adsorption rate is increased significantly owing to the enhanced contact and mass transfer in the confined space. The adsorption capacity for the RhB is also increased, since the size of the nanoparticles assembled in membrane pores is smaller with more active sites exposed. This micro membrane adsorber with DPNS has good reusability, and can provide a promising prospect for industrial application.

A highly dispersed monometallic palladium catalyst for selective hydrogenation of acetylene was prepared using N-containing silane coupling agent (SCA) as a modifier. The catalyst exhibited 90.3% ethylene selectivity with full acetylene conversion under 240 °C with a GHSV(C2H2) of 1200 h-1 and performs good stability within a 200 h tolerance test. Characterization results reveal that the excellent ethylene selectivity is mainly derived from the special Pd nanoparticle structure with Pd (111) lattice relaxation and distortion. The N-containing SCA modified catalyst shows more C atoms penetrating into the Pd lattice to form a stable PdC phase. This unique structure possesses an obvious suppression of hydrogen migration from the bulk Pd hydride to the surface and makes the catalyst have more abundant spillover hydrogen on the carrier surface. In addition, it has also weakened the ethylene adsorption ability and led a strong interaction between the Pd nanoparticles and surface.

The purpose of this paper is to improve mass transfer by using nanoparticles and surfactant simultaneously that the use of surfactant has not been investigated by researchers. Hence, the influences of various concentrations of SiO2 nanoparticle and Sodium dodecyl sulfate surfactant on hydrodynamic characteristics and the mass transfer coefficient were surveyed. The results show that the droplet size was decreased by increasing volume fraction of nanoparticles and surfactant. The effect nanoparticles concentration in chemical system on mass transfer coefficient was investigated. It was found that molecular diffusion coefficient was a dominant mechanism which by adding nanoparticle from 0.01 to 0.1 vol.% extraction efficiency was raised from 46% to 78%. Also, by adding surfactant from 0.003 vol.% to 0.01 vol.% to the chemical system, the extraction efficiency enhanced dramatically from 70% to 90%. Finally, using Newman, Krong and Hendlos theories, the mass transfer coefficient was predicted with and without nanoparticles.

Herein, we report a new process for intensified hydro-upgrading of a biocrude produced from the hydrothermal processing of Auxenochlorella pyrenoidosa (AuP) in tetralin at a mass ratio of 1:1 with the addition of 10 wt.% Pt/C and 8 MPa H2 at different temperatures (300-480 °C) and times (1-8 h). Under the selected reaction conditions, the gaseous products were replaced with fresh H2 at regular time intervals; this process was then continued until the total reaction time was over. Increasing the number of H2 replacement times decrease the C, N, O, and S contents and increased the H content. The treated bio-oil mainly consisted of aromatic, saturated and unsaturated hydrocarbons. Overall, H2 replacement removed some of the denitrogenation, desulfurization, and deoxygenation products and avoided secondary reactions of gaseous products with the bio-oil, thus promoting the hydrogenation reaction and N, O, and S removal from the treated bio-oil.

Lesson ObjectivesScientifically examining how animals and humans build shelters to survive the elements. Learn how people survive when lost in the wild.How we can apply all these skills and see how we can help the homeless in extreme weather conditions. Materials Needed: - Different types of materials that would be great for keeping heat in as well as material that will help you stay cool (e.g. cotton, feathers, tin foil, fleece etc...) - a pin- magnet- something to balance the pin (pin must be able to spin) -different types of sticks (so that we can see which ones are best for kindling and why green pieces do not work as well). - two different size of rocks - paper and pencil for recording.-  water bottle-  hairdryer and ice- digital thermometer -3D printerLesson Plan: Using the 5 parts of STEAM we will exam the following ways of how we can solve our problem of surviving the wild to helping our homeless. Day 1 Part A: (30mins)Scientifically we start with looking at how animals have adapted to harsh weather. How they can survive in the artic or in the desert. What are some of the unique ways they survive? Research how we as humans have studied animals to develop ways for us to survive in hot summers and cold winters. Allow the children to discuss what they think will work and research online to see what other scientist have found about animals and how they adapt. Day 1 Part B: (20mins)Start to experiment with the different types of materials to see which ones would work best for heat retention and heat loss. You can use a water bottle that is at room temperature. The goal is for the children to see what materials retain heat the best when wrapped around the water bottle does the temperature stay the same or get hotter or cooler when we use the hair dryer and when we place the bottle in ice. Day 2 Part A: (15 mins)Show a video on survival shelters like: https://youtu.be/tzUpH0Zft5cAllow the children to discuss why these types of shelters would work. Challenge the children to write down how they would start a fire or build a compass. What other ways can they stay safe if they were ever lost in the wild? Day 2 Part B: (30mins)Using the skills we know start to design ways we could help the homeless stay warm without big bulky things to carry. As we know most homeless people are limited to how they can keep their personal items. Using what we know about shelters, animals and survival how can we design a unique item that could help the homeless. A good example is to show the youtube video of a lady who designed portable sleeping bags that double as a jacket. Here is the link: https://youtu.be/6vaO_GPBAzADay 3: This would be the final day where the children would get to explore TinkerCad and design their prototypes to present to the rest of the class how it works and how it could help the homeless (after it is printed from the 3D printer). 

Aim of study: Epilepsy is a chronic neurological disorder. Long-term antiepileptic drug use is associated with several metabolic and hormonal disorders. This study aims to investigate the potential effects of antiepileptic drugs on thyroid functions and complete blood counts. Methods: Epileptic adult patients followed up regularly were enrolled in the study. Laboratory parameters including serum thyroid hormone levels and complete blood counts were evaluated retrospectively. The effects of antiepileptic drugs on these parameters of the cases were investigated by comparing the laboratory recordings of the cases in the defined three periods [prior to antiepileptic drug treatment, in between 6 months to 1 year treatment (early stage) and after 1 year treatment (late stage)]. Results: A three hundred epileptic patients (F/M: 175/125) were included in the study. A statistically significant difference in TSH levels and sT4 levels in late stage compared to pre-treatment (p=0.006, p=0.0005, respectively). A statistically significant decrease was recorded in late stage mean leukocyte levels in comparison with pre-treatment levels (p=0.025). When pre-treatment and late stage mean thrombocyte levels were compared, a statistically significant decrease was observed in late phase (p=0.001). Conclusions: According to our study results, widely used antiepileptic drugs in the world have some effects on both thyroid functions and complete blood counts. It is important to emphasize epilepsy treating centers should monitor not only clinical features of the patients but also laboratory results periodically. Key words: epilepsy, antiepileptic drugs, thyroid functions, complete blood counts.

Introduction. Air pollution is considered a risk factor for several diseases, including respiratory and cardiovascular. However, the effects of air pollution on neurobehavioral disorders is not confirmed yet. Thus, this study aimed at determining the association of seven air pollutants with ADHD medication administration (ADHD-MA) in Pennsylvania-located elementary schools over a three-year period. Methods. An ecological study design involving records of 168,825 children from elementary schools in 49 Pennsylvania counties was used. The number of children with ADHD-MA was extracted from an online software specifically designed for allowing nurses to record health conditions in schools. Daily measurements of air pollutants were gained from the U.S Environmental Protection Agency. Results. The mean number of ADHD-MA significantly increased over the 3-year period [163.9 (+ 70.1) in 2008, 317.2 (+ 84.4) in 2009, and 427 (+ 101.4) in 2010]. The difference in the number of ADHD-MA among the three years and among the four seasons, for all years, were statistically significant (P<0.001). Three air pollutants (SO2, CO, and PM2.5) were significantly associated with ADHD-MA; no interactions among air pollutants were significant. Conclusion. Air pollution is likely associated with both ADHD incidence and ADHD-MA. Prospective epidemiological and biomedical studies could examine the relationship between air pollution and ADHD symptoms.

Objectives: To compare pain, quality of life(QoL), sexual function and lower urinary tract symptoms(LUTS) between rigid(RC) and flexible cystoscopy(FC). Methods: Forty-one patients who were planned control cystoscopies were enrolled the study. At the first cystoscopy, 20 patients(Group 1) and other 21 patients(Group 2) were performed by using flexible(15,5Fr) and rigid cystoscope(15,5Fr), respectively. At the second cystoscopies, the patients in group 1 and group 2 were performed by using rigid and flexible cystosacope, respectively. In all the patients, pain was measured with visual pain scale(VPS) shortly after cystoscopy. Also SF, QoL and LUTS were assessed by using IIEF, SF-36 and MLUTS forms, respectively. Results: While 22 of the patients preferred FC, the other 19 preferred RC(p>0,05). There were no statistically differences between VPS, IIEF, SF-36 and MLUTS scores of the two groups. In multivariate analysis regarding quality of life, although sexual function, pain and cystoscopy type did not affect QoL, voiding symptoms affected independently QoL. After the both cystoscopy type, IIEF, SF-36 and MLUTS scores did not change statistically. Conclusion: The results showed that the effects on pain, sexual function, QoL and LUTS of RC and FC were similar. In general, cystoscopy did not affect negatively on QoL, sexual function and LUTS of the patients.

Introduction: The aim of our study is to determine whether insulin resistance has any effect on pancreatic exocrine function in people with insulin resistance. Method: The study included 43 insulin resistant cases with HOMA-IR≥2.5 and 43 controls (HOMA-IR <2.5.) without any disease, pregnancy. Fasting blood glucose, insulin, HbA1c, total cholesterol, triglyceride, HDL, LDL, creatinine, ALT, AST, Adiponectin, Leptin, pancreatic amylase, lipase were studied in both groups. Results: Statistically, both groups were similar in respect to gender and age (p: 0.25, 0.11, respectively). Body Mass Index were significantly higher in the case group (p 0.00). Fecal Elastase-1 levels were significantly lower in the IR group (p: 0.00). Blood glucose, insulin and HbA1c levels were significantly higher in the IR group than in the control (p: 0.00, 0.00, 0.00, respectively). Leptin levels were significantly higher in the IR group compared to the controls (p: 0.01). In the Pearson correlation analysis in the group with insulin resistance, a significant positive relation (p: 0.022 r: +0.34) was detected between HOMA-IR and Adiponectin. There was a significant negative relation between pancreatic amylase and HOMA-IR (p: 0.029, r: -0.33), a significant negative relation between Fecal Elastase-1 and Adiponectin (p: 0.038, r: -0.31), a significant positive relation between Leptin and Adiponectin (p : 0.00, r: 0.59). Conclusion: Fecal Elastase -1 level decreased markedly in patients with insulin resistance, showing pancreatic exocrine dysfunction.

Background: Telehealth is delivering health care services remote from health-care facilities using telecommunications. Egypt is aiming for Universal Health Coverage; this increases the demand of telehealth in routine health services. Objective: to measure the awareness of telehealth health care workers of primary health care units and to evaluate the effect of an orientation program on primary health care workers’ awareness and acceptance of application of telehealth. Methodology: This was an intervention study among health care workers. A self-administrated valid questionnaire for health care workers was designed, the questionnaire consists of different domains of knowledge in addition to advantages, disadvantages, security and necessity perceptions. Each domain consists of Likert scale questions of 5 points. The questions were scored as the worst answer (1) and the best (5). A total of 109 questionnaires were filled by participants who spent at least 6 months in primary health care units. Then the health care workers were attended an orientation program and the questionnaire was re-filled once more. A total of 104 was recollected. Ethical issues were considered. Results: 50.5% of health care workers were aware of telehealth; 66.7% of health care workers with master’s degree were aware of telehealth in comparison to 31.8% among those with a diploma, 64.3% of physicians were aware of telehealth while 9.6% of nurses were aware. The score of knowledge and attitude increased from 130±23.538 to 156.49±18.456 after the educational program. Conclusion: Half of health care workers were aware of telehealth; the orientation improved the Healthcare Workers’ knowledge and attitude.

Background and Purpose A novel curcumin (Cur) derivative 1g can inhibit the proliferation of colon cancer in vitro and in vivo. The purpose of this study was to explore the role of 1g in inducing apoptosis of colon cancer cells, especially mitochondrial apoptosis and endoplasmic reticulum (ER)-stress caused by reactive oxygen species (ROS). Experimental Approach Bioinformatics was used to analyze differentially expressed mrnas. Gene expression was measured by using qRT-PCR and protein expression was measured by using western blotting. Cell apoptosis, cycle, mitochondrial membrane potential and ROS were analyzed by flow cytometry. Experiments on transplanted tumors in animals. Key Results The mechanism of this effect was a change in mitochondrial membrane potential caused by 1g that increased its pro-apoptotic activity. In addition, 1g produced ROS, induced G1 checkpoint blockade, and enhanced ER-stress in colon cancer cells. On the contrary, pretreatment with the ROS scavenging agent N-acetyl-l-cysteine (NAC) inhibited the mitochondrial dysfunction caused by 1g and reversed ER-stress, cell cycle stagnation, and apoptosis. Additionally, pretreatment with the p-PERK inhibitor GSK2606414 significantly reduced ER-stress and reversed the apoptosis induced by colon cancer cells. Conclusion and Implications This study not only found that 1g inherits the safety of Cur and has a more inhibitory effect on colon cancer cells than Cur, but also revealed that excessive production of ROS is one of the mechanisms of anti-tumor action.