Objectives: We aimed to validate the vasoactive-ventilation-renal (VVR) score and to compare with other indices as a predictor of outcome in neonates recovering from surgery for critical congenital heart disease. We also sought to determine the optimal time at which VVR score should be measured. Methods: We retrospectively reviewed neonates recovering from cardiac surgery between July 2017 and June 2020. The VVR score was calculated at admission, 24, 48 and 72 hours postoperatively. Max values, defined as the highest of the four measurements were also noted. Main outcome of interest was composite outcome which is prolonged intensive care unit stay plus mortality. Receiver operating characteristic curves were generated, and areas under the curve with 95% confidence intervals were calculated for all time points. Multivariable logistic regression modelling was also performed. Results: We reviewed 73 neonates and 21 of patients had composite outcome. The area under the curve value for VVR score as a predictor of composite outcome was greatest at postoperative 72 hour max (AUC= 0,967; 95% confidence interval, (0,927-1). On multivariable regression analysis, the VVR max 72 hour VVR score remained a strong independent predictor of prolonged ICU stay and mortality (odds ratio, 1.4 52; 95% confidence interval, 1.036 – 2.035). Conclusions: We validated the utility of the VVR score in neonatal cardiac surgery for critical congenital heart disease. The VVR follow up in postoparative 72 hours is superior to other indeces and especially the maximum VVR value is potentially powerful clinical tool to predict ICU stay and mortality.

Here we report the seven-year long-term survival after Aspergillus fumigatus mediastinitis after heart transplantation, an uncommonly described condition. A 66-year-old male developed infection with A. fumigatus covering the entire thoracic cavity with a fungal turf after orthotopic heart transplantation. Repeated surgical removal of infectious and necrotic tissue together with innovative topical treatment using voriconazole and chlorhexidine combined with systemic antifungal treatment lead to control of infection. Definitive wound closure was achieved by standard sternal refixation and latissimus dorsi muscle flap plasty. Survival after A. fumigatus mediastinitis after heart transplantation was achieved with sequential debridement in combination with topical application of antifungal agents.

Background. Ventricular aneurysms develop after transmural myocardial infarctions and can significantly worsen clinical outcomes. We report an unusual case of the giant inferior wall aneurysm, successfully treated by surgical resection. Case presentation. The 65-year-old male was diagnosed with a giant inferior wall left ventricular aneurysm after worsening of his dyspnoea. Four months prior to the admission, he had ST-elevation inferior myocardial infarction, complicated by pericarditis. During the 4-month follow-up period, the aneurysm has significantly increased in size. Unrecognized ventricular wall rupture was supposed. The precise anatomy of the aneurysm was established by cardiac MRI. Surgical resection of the aneurysm was performed with uneventful patient's recovery. Conclusion. Timely surgical treatment of the rapidly growing aneurysms is recommended. In such cases cardiac MRI can specify anatomy and coordinate surgical strategy.

Background: In March 2020, in response to the COVID19 outbreak, ENT UK issued guidance recommending that all routine clinics should be cancelled and telephone review should be the first approach for all outpatients who do not need urgent treatment. Our district general hospital department therefore organised telephone reviews for all patients referred with dizziness. It was decided to trial a questionnaire to help clinicians with this new approach to assessing patients with dizziness. Study Design: Prospective Single Centre Randomised Pilot Study. Methods: Local ethics approved was obtained and all 115 patients awaiting otolaryngological assessment for balance were randomised to receive a validated dizziness questionnaire or not. Questionnaires were posted to the patients prior to their appointment. They were then contacted for a planned telephone consultation for dizziness. Data on the outcome and effectiveness of the consultation was collected by the clinicians conducting the consultation. Results were analysed using Microsoft Excel and Fisher’s exact test was used for the statistical analysis. Results: 82/115 patients had consultations with complete data collection, 35 in the questionnaire group (QG) and 47 in the no questionnaire group (NQG). Response rate (returned completed questionnaires) in the QG was 70%. Clinicians were able to make a provisional diagnosis in 77% of QG patients vs 57% of NQG patients. QG patients only required additional investigations 26% of the time compared to 72% in the NQG (p<0.05). Only 17% of QG patients needed additional telephone follow up, compared to 43% of NQG patients (P<0.05). Conclusion: Using an abbreviated dizziness questionnaire can increase clinicians’ ability to come to a diagnosis at the end of a telephone consultation. It may reduce the need for additional investigations and further telephone follow-up, thereby keeping patients away from the hospital and freeing up capacity.

Objectives: Epistaxis is the second most common referral to the Ear nose and throat (ENT) department. Frailty, a marker for biological vulnerability, has been shown to increase the risk of haemorrhage, but its impact in epistaxis patients is unknown. We aim to establish the impact of Clinical Frailty score, as well as other established risk factors for epistaxis, on the likelihood of admission in patients presenting to secondary care with epistaxis. Design: Retrospective cohort study Setting: University hospital Otolaryngology department Participants: Adult patients presenting to hospital with epistaxis between March 2019 and March 2020. Main outcome measures: We compare the clinical frailty score of patients admitted with epistaxis to those patients seen and treated same day. Results: 299 epistaxis presentations were identified, of which 122 (30.8%) required admission for further management. Clinical frailty score of ≥4 had an increased odds for admission (OR 3.15 (95% CI:1.94 – 5.16), p<0.001). In the majority of presentations (66.2%), patients were taking either an antiplatelet, anticoagulant or a combination of them. Of these presentations, the use of an anticoagulant (OR: 2.00 (95% CI: 1.20-1.92), p:0.10) and dual antiplatelet (OR: 2.82 (95% CI: 1.02-7.86), p:0.10, p:0.07) demonstrated increased odds of admission. Conclusions: We have shown that frailty increases the risk of admission in adult patients presenting with epistaxis. Frailty is becoming an increasingly apparent independent cause for haemorrhage in the elderly population. Careful consideration of bleeding risks, particularly in frail patients, needs addressing due to the morbidity associated with epistaxis.

Evaluation of postoperative practices by 55 French otologists

Background and Purpose: Bladder cancer has a high rate of recurrence and drug resistance due to a lack of effective therapies. IR-780 iodide, a near-infrared (NIR) mitochondria-targeting fluorescent agent, has been demonstrated to achieve higher selectivity than other drugs in different tumor types. In the study, we aimed to investigate the anti-tumor effect of IR-780 combined with hyperbaric oxygen (HBO) on bladder cancer. Experimental Approach: Using in vitro cell line data, in vivo model data and clinical data, we tested the ability of IR-780 to selectively accumulate in bladder cancer. We also evaluated the anti-tumor effect of IR-780 combined or not with HBO both in vitro and in vivo, and explored the potential mechanism of its anti-tumor effect. Key Results: We revealed for the first time that IR-780 selectively accumulated in bladder cancer (bladder cancer cells, xenografts and bladder cancer samples from patients) and could induce cancer cell apoptosis by targeting the mitochondrial complex I protein NDUFS1. Further study displayed that the combination with HBO could significantly enhance the antitumor effect of IR-780 in vitro by promoting cancer cell uptake and inducing excessive mitochondrial reactive oxygen species (ROS) production, while suppressing tumor growth and recurrence in animal models without causing apparent toxicity. Moreover, this combination antitumor strategy was also demonstrated in drug-resistant bladder cancer cells (T24/DDP) and xenografts. Conclusion and Implications: These data identify for the first time a combination of IR-780 and HBO (IR-780+HBO), which exhibits mitochondria-targeting and therapeutic capabilities, as a novel treatment paradigm for bladder cancer.

Abstract Objectives: Earlier researches suggested patients should be routinely screened for bacteria and fungi infection after COVID-19 being confirmed. Here, we enrolled 236 patients with COVID-19 to analyze the clinical characteristics, fungal strains, mortality, and laboratory data of different groups. Design: Single center retrospective study Patients: A total of 236 COVID-19 patients from Huoshenshan Hospital were included in this study, consisting of 14(6%) died cases, 222(94%) discharged cases . Results: The result revealed that 5 mortality in positive group were all related to aspergillus infection while candida infection rarely caused death. Aspergillus was most common in non-survivors while candida was most common in survivors. In terms of interleukin-6 (IL6), viral loads, nucleic acid clearance time, etc, fungal serologically positive group had a higher level than negative group. Conclusions: Non-survivors of Covid-19 with fungal infection were almost associated with aspergillus infection. Aspergillus infection, instead of candida infection might be fatal for critical ill patients with COVID-19. There is great significance to carry out routine screening for fungal infection especially for critical patients to enable early treatment to be implemented. Keywords: coronavirus disease 2019 (COVID-19); fungal infection; aspergillus; mortality

It is well-known fact that some drugs and drug candidates are remarkably “promiscuous” molecules. That means they bind to many various targets. Especially confusing is the case of disulfiram, an old drug used in alcohol aversion therapy.

The coordination of plant leaf water potential (ΨL) regulation and xylem vulnerability to embolism is fundamental for understanding the tradeoffs between carbon uptake and risk of hydraulic damage. A legacy of observations in drylands suggests plants with vulnerable xylem more carefully regulate ΨL than plants with resistant xylem. We synthesized over 1600 ΨL observations, 122 xylem embolism curves, and xylem anatomical measurements of Quercus alba L., Liriodendron tulipifera L., and Acer saccharum Marsh. across ten contrasting forests to evaluate if the paradigm linking conservative ΨL regulation to vulnerable xylem applies to temperate deciduous trees. Additionally, we explored generalizable patterns of hydraulic trait acclimation in relation to forest age and climate. Contrary to the dryland paradigm, we found that the tree species with the most vulnerable xylem (e.g., Q. alba) regulated ΨL less strictly (anisohydric behavior) than the species with xylem more resistant to embolism (e.g., A. saccharum and L. tulipifera). This relationship was found across all sites, suggesting coordination among traits was largely unaffected spatio-temporal factors. Our findings indicate drought-response traits of temperate deciduous forest species are coordinated in fundamentally different ways than vegetation in arid climates.

Mast cells are (in)famous for their role in allergic diseases, but the physiological and pathophysiological roles of this ingenious cell are still not fully understood. Mast cells are important for homeostasis and surveillance of the human system, recognizing both endogenous and exogenous agents, which induce release of a variety of mediators acting on both immune and non-immune cells, including nerve cells, fibroblasts, endothelial cells, smooth muscle cells and epithelial cells. During recent years, clinical and experimental studies on human mast cells as well as experiments using animal models have resulted in many discoveries that help decipher the function of mast cells in health and disease. In this review we focus particularly on new insights into mast cell biology, with a focus on mast cell development, recruitment, heterogeneity and reactivity. We also highlight the development in our understanding of mast cell driven-diseases and discuss the development of novel strategies to treat such conditions.

Under environmental stress plants and algae employ a variety of strategies to avoid damage to the photosynthetic apparatus and maintain photosynthetic capacity. To date, most studies on stress acclimation have focused on model organisms possessing limited tolerance to elevated stress levels. We compared the long-term acclimatory capacities of a mesophilic alga (Chlamydomonas raudensis SAG 49.72; SAG 49.72) and an Antarctic halotolerant psychrophile (Chlamydomonas sp. UWO 241; UWO 241) by monitoring photobiology, cyclic electron flow (CEF) and ROS defense in cultures acclimated to long-term low temperature, high salinity or high light stress. SAG 49.72 responded to long-term stress by increasing chlorophyll a/b ratio and redistributing absorbed light energy from photosystem II (PSII) to photosystem I (PSI). In contrast, the psychrophile exhibited faster half times for P700+ re-reduction under all treatments, suggesting high CEF rates. High CEF was accompanied by increased capacity for nonphotochemical quenching. Last, UWO 241 exhibited constitutively high activity of two key ascorbate cycle enzymes, ascorbate peroxidase and glutathione reductase, as well as a large ascorbate pool. Our results suggest that UWO 241 relies on high PSI-mediated CEF and ROS detoxification to protect the photosynthetic apparatus while minimizing energy expenditure on repairs.

Most studies on biological invasions focus on the later stages of the invasion process, i.e. after species have already become naturalized. It is frequently overlooked, however, that patterns in origin, phylogeny, and traits of naturalized alien species might largely reflect which species have been introduced in the first place. Here, we quantify and account for such introduction biases by analyzing 5,317 plant species introduced for cultivation in Southern Africa. We show that this cultivated alien flora represents a non-random subset of the global flora, and that this bias at the introduction stage largely drives patterns in origin, growth form and phylogenetic composition of the naturalized flora. For example, while species from Australasia are, compared to the global flora, disproportionally overrepresented in the naturalized cultivated flora of Southern Africa, this pattern is solely driven by their higher likelihood of having been introduced for cultivation. We also show that among cultivated aliens, naturalization success was correlated with intermediate seed mass and height, as well as high specific leaf area. Our quantification of introduction biases demonstrates that they are huge, and that accounting for it is essential to avoid over- or under-estimation of the characteristics of successfully naturalized alien plants.

The study sought to investigate the effect of roasting temperatures on antioxidant components and oxidative stability of peanut oils. The total phenolic content, total flavonoid content, α–tocopherol content, and phytosterol content in peanut oils was influenced by roasting at temperatures of 120℃, 140℃, and 160℃, while those roasting temperatures had no effect on the fatty acid profile and γ–tocopherol content of peanut oils. Roasting promotes the quality of peanut oil aroma via the Maillard reaction, particularly those derived from N–heterocyclic compounds (such as pyrazine and pyrrole). The oxidative stability of peanut oils was investigated using the Rancimat method, and the results show that there is a linear relationship between roasting and natural logarithm of induction period (R2: 0.959~0.998). This was determined based on the Arrhenius equation, which indicated the activation energy (Ea) were 82.08~108.61 KJ/mol. In PCA analysis, the antioxidant stability of the increase levels of phenols released in the peanut oils was found to be rise with increment of roasting temperatures. The data obtained in this study should be confirmed to the nutritional benefits of peanut oils that will be most appealing to consumers.

Increases in atmospheric CO2 concentration ([CO2]) drive increases in biomass production via impacts on photosynthesis and water use. In grasslands, the scale of this stimulation is related to soil water availability. Recently, seasonal influences on how precipitation controls elevated CO2 (eCO2) effects on grassland biomass production have emerged. We established the TasFACE2 experiment in a well-fertilised perennial ryegrass (Lolium perenne) monoculture with four seasonal irrigation schedules to determine how seasonal water availability affects aboveground, belowground and total biomass responses to three CO2 concentrations. While total biomass production was strongly stimulated by eCO2, this effect was almost entirely driven by belowground responses. The relationship between soil water content and aboveground biomass varied seasonally but there was a strong positive relationship between soil water content and root biomass production in all seasons. Increases in soil moisture caused by eCO2, therefore, contributed to increases in root growth. However, root biomass production was also stimulated directly by eCO2 regardless of eCO2 impacts on soil moisture, further increasing the biomass allocation belowground. Restriction of irrigation, therefore, suppressed the belowground response to eCO2 and created a non-linear response of biomass to CO2 concentration. Thus, total biomass responses to eCO2 cannot be predicted from aboveground measurements alone.

This experiment was carried out to evaluate the underlying mechanisms of chickpea genotypes (MCC797; cold-tolerant and MCC505; cold-sensitive) responses to freezing temperatures (-3, -6, -9, -12 ℃). The increment of leaf malondialdehyde, H2O2, and electrolyte leakage due to freezing stress was greater in the cold-sensitive genotype. The plant survival was also dramatically decreased in the cold-sensitive genotype exposed to freezing stress (20% at -12 ℃), while it remained constant (100%) in the cold-tolerant genotype. The fv’/fm’ and fq’/fm’ was increased sooner during the recovery period in the cold-tolerant (24 h after stress) compare to the cold-sensitive genotype (48 h after stress). Proline and enzymatic antioxidants activity, including APX, CAT, POD, and SOD, were increased more rapidly in the cold-tolerant genotype. The relative gene expression of catalase (cat), peroxidase (pod), and proline were also more stimulated in the cold-tolerant genotype. Freezing temperatures increased the expression of cat, pod, and proline on average by 4, 3, and 6 folds, respectively, in the cold-sensitive, while their upregulation was 16, 13, and 16 folds, respectively, in the cold-tolerant genotype. The greater gene expression and, consequently, the higher antioxidant content of leaves led to lower lipid peroxidation after the cold adaptation in the cold-tolerant genotype.

Sustained pharyngeal inflation (SPI) with pharyngeal oxygen and nose-close (PhO2-NC) can create positive inflation pressure (PIP) inside the pharyngolaryngeal space (PLS). This study measured and compared effects of different SPI durations in the PLS. Method: A one-year prospective study, 20 consequent infants whose age less than 3-year-old and scheduled for elective FB were enrolled. SPI performed in four different durations (0.0, 1.0, 3.0 and 5.0 seconds) consequently. Each infant did two cycles of SPI. Measured the PIP of each SPI in the pharynx, and simultaneously took images at three locations of oropharynx, supra-larynx and larynx. Data of infant’s demographics, PIP levels, space expansion scores and images were collected and analyzed. Results: Total 20 studied infants, the mean (SD) age was 11.6 (9.1) month-old, the mean (SD) body weight was 6. 8 (2.4) kg and the mean (SD) study time was 3.8 (1.1) minutes. The measured mean (SD) pharyngeal PIPs were 4.1 (3.3), 21.9 (7.0), 42.2 (12.3) and 65.5 (18.5) cmH2O at SPI duration of 0.0, 1.0, 3.0 and 5.0 seconds, respectively. Which showed positively and significantly (p<0.001) correlations. At these assigned locations, the corresponding PLS images also show significant lumen expansion correlated with the PIP. Especially, when there existed pathologic or occult lesions. No any study related complication was noted. Conclusions: SPI with PhO2-NC up to 5 seconds is a simple, safe and feasible clinical ventilation modality. Which could provide enough PIP to expand the PLS and benefit FB performance in infants.

Mini-commentary on BJOG-20-1459.R1: Caesarean birth and risk of subsequent preterm birth: retrospective cohort studyDeclarative title to be addedBradley de VriesSchool of Public HealthUniversity of SydneySydneyNew South WalesAustraliaWorldwide, preterm birth occurs in 11% of pregnancies and is the leading cause of childhood mortality. Complications from preterm birth are the most common cause of neonatal death in the United Kingdom, yet the incidence of preterm birth is not falling.In this issue of BJOG, Williams et al (BJOG xxxx) report on an observational study which identifies previous second stage caesarean birth as a risk factor for spontaneous preterm birth, confirming the results of other observational cohorts. Among women with one previous term birth, the adjusted odds ratio was 2.1 (95% confidence interval [CI] 1.3 to 3.1) for preterm birth before 37 weeks gestational age and 7.5 (95% CI 3.4 to 15) for preterm birth before 34 weeks, for previous second stage caesarean birth compared with previous vaginal birth. They adjusted for confounders not addressed in other studies including interpregnancy interval and maternal deprivation index, strengthening the existing evidence. The association is plausible because the cervix and lower uterine segment are anatomically merged in the second stage of labour and inadvertent cervical incision might damage the integrity of the cervix. The association was at least as strong as that described for previous excisional surgery for cervical dysplasia. Current National Institute of Clinical Excellence Guidelines recommend considering prophylactic cervical cerclage for an ultrasound-measured cervical length < 25mm if there is a history of cervical trauma. Given the plausibility and emerging epidemiological evidence, it would seem prudent to offer the same screening and treatment when there is a history of second stage caesarean birth.The observed association is relevant in other ways. Counselling about instrumental versus caesarean birth may be influenced by knowledge of future risks. Additionally, surgeons may need to be aware of the potential importance of avoiding inadvertent cervical incision, while still avoiding upper segment incision and its attendant risk of future intrapartum uterine rupture.The study by Williams et al is well designed, yet there remains potential for confounding not adjusted for in the analysis. Further, missing data for body mass index (1.6%) and cigarette smoking (13%) were classified as unknown and not imputed which can also cause bias. As there are only a handful of observational studies, it would be sensible to confirm the association, and explore potential causative mechanisms (e.g., by monitoring cervical length in subsequent pregnancies).Clinical prediction models for spontaneous preterm labour in asymptomatic women have been developed but need improvement before incorporation into clinical practice. Addition of new risk factors such as second stage caesarean birth and better understanding of the causes of preterm birth could improve these models and ultimately improve outcomes through offering prophylaxis with cervical cerclage, vaginal progesterone, or pessary for women at high risk.Given the massive personal, clinical, and economic burden imposed by preterm birth, the plausibility of the association, and the growing evidence from observational studies, I believe cervical surveillance warranted, with a view to offering prophylactic measures when there is a history of second stage caesarean birth.No disclosures: A completed disclosure of interest form is available to view online as supporting information.

Background The impact of physical activity during pregnancy and postpartum on urinary incontinence in women is unclear. Objectives To assess the association of physical activity and urinary incontinence during pregnancy and postpartum in a systematic review of the literature. Search Strategy A search of publications indexed in five major electronic databases (CENTRAL, PubMed, EMBASE, CINAHL and PEDro) was performed from their respective inception dates to the 30 March 2020 with a combination of keywords to identify studies of interest. Google Scholar was used for non-indexed literature. Selection Criteria All studies comparing physical activity with standard care in pregnant and postpartum women were selected. Data collection and Analysis Two reviewers, independently, selected studies, assessed quality and extracted data. Odds ratio with 95% confidence intervals were calculated using fixed effects or random effects meta-analyses (Mantel-Haenszel method), for low and moderate heterogeneity between studies, respectively. Main Results Seven studies (n = 12479) were included. Data of four studies could be pooled for meta-analyses; subgroup and sensitivity analyses were not possible. Physical activity, either during pregnancy or postpartum, is not associated with urinary incontinence, OR 0.90 (95% CI: 0.69–1.18) and OR 1.31 (95% CI: 0.74–2.34), respectively. Conclusions The ‘low’ quality of evidence (GRADE) does not show that physical activity during pregnancy or postpartum has any impact on urinary incontinence. Moderate physical activities should therefore be encouraged for the evidence-based benefits associated on other obstetrical outcomes. Funding None to declare. Keywords Pregnancy; postpartum; urinary incontinence; physical activity; exercise

The apoptotic signaling pathway is obviously disordered in systemic lupus erythematosus (SLE). Concurrent occurrence of induced apoptotic cell death and altered phagocytosis promotes autoantigen production, which leads to the biosynthesis of autoantibodies and autoimmune disorders. Natural IgM (nIgM) is important in clearing apoptotic cells and preventing them from triggering deleterious autoimmunity. B-1- and innate-like B- (ILBs) cells are the main nIgM producers. Human CD27+IgD+B cells (un-switched memory B cells) are considered ILBs. However, their functional properties in SLE remain undefined. Here, individuals with SLE showed markedly reduced CD27+IgD+B cell amounts. Moreover, these cells had altered function in terms of natural antibody-like IgM production. CD27+IgD+B cells also showed negative correlations with clinical and immunological properties in SLE patients. Following effective treatment achieving SLE remission, CD27+IgD+B cell amounts were restored. Jointly, these findings suggest that CD27+IgD+B cell dysfunction potentially contributes to the exacerbation of SLE, and modulating their features may represent a powerful tool for treating this persistent disease.

Both two-dimensional (2D) and three-dimensional (3D) echocardiography can be used in the early diagnosis of myocardial toxicity in patients with anthracycline chemotherapy. However, there are few studies on the detection of early myocardial damage in specific regions. This study compared the role and significance of 2D strain and 3D strain in discovering early segmental dysfunction. We prospectively studied 56 breast cancer patients who received anthracycline therapy. The mean age of patients was 47.6 ± 8.1 years. They all received 4-6 cycles of chemotherapy. Before chemotherapy and after every two cycles, patients underwent standard echo, 2D and 3D speckle-tracking echocardiography (STE) and real-time three-dimensional echocardiography (RT-3DE). Compared with the baseline value (T0), 3D GLS was significantly reduced after two cycles (T2) (P<0.05), after four cycles (T4) 3D GCS was significantly reduced (P<0.05), after six cycles (T6) 2D derived EF, 2D GLS, E/e’ ratio, Fractional shortening (FS), 3D derived EF, 3D GAS, GRS were considerably decreased (P<0.05). The area supplying blood from the anterior descending branch of the left coronary artery was the most susceptible to chemotherapy, and 3D GLS was found earlier than 2D GLS which was decreased considerably after two cycles (P<0.05). In anthracycline chemotherapy patients, some regions of early myocardial dysfunction may be more easily involved, through the evaluation of 2D and 3D echocardiography, 3D speckle tracking echocardiography may be more able to identify the involved segments of myocardium early. Moreover, the apical segments of the left ventricle seem to be more susceptible to cardiotoxicity.

The care of patients with vascular anomalies is quickly becoming a complex field requiring high quality, coordinated multidisciplinary care. In this article, we review the history of multidisciplinary care in this field, discuss the benefits of this model of care, and outline some of the essential components and structure of a successful vascular anomalies team. We provide an overview of two example programs and a roadmap for other centers to develop their own multidisciplinary vascular anomalies teams.

A document by Denise Adams. Click on the document to view its contents.

Background: Invasive fungal diseases (IFD) are important causes of mortality in children with cancer. We aimed to determine the extent of survival in patients treated for IFD in the last nine years at our center. Procedure: a retrospective cohort of patients treated from January 1, 2011 to December 31, 2019. Weibull distribution was used to parameterize hazard ratios and accelerated failure time models, for the outcome “death attributed to IFD”. Results: We analyzed 152 patients with IFD (133 proven and 19 probable), with median age of 97 months. The most frequent diagnoses were leukemia (39, 25.7%) and central nervous system tumors (36, 23.7%). Thirty-seven patients received prophylaxis with fluconazole (24.3%). There were 133 fungi isolates, and most frequent were Candida species in blood (84, 55.2%). Forty-three deaths were attributed to IFD (28.3%). Survival probabilities were lower for pulmonary IFD (46.9%, p = 0.0017), leukemia (62.5%, p = 0.004), and neutropenia <500 cells/mm3 (55.4%, p < 0.0001). For Candida fungemia, survival probabilities were 76.6% (p = 0.043). In Weibull models, diagnosis of leukemia shortened survival times by a factor of 0.006, relapse of disease by 0.05, lymphoma by 0.04, pulmonary IFD by 0.04, and neutropenia by 0.015. Hematopoietic stem cell transplantation did not affect the survival times, as well as prophylaxis with fluconazole. Conclusions: Host factors, like neutropenia, relapse of disease and hematologic malignancies, are determinant in the survival times of children with IFD, as well as pulmonary involvement. Fluconazole prophylaxis and HSCT do not affect the hazards of death.