Purpose: To evaluate and compare the efficacy of corticosteroid and vincristine (VCR) in the treatment of kaposiform hemangioendothelioma (KHE) and tufted angioma (TA). Methods: This was a multicenter prospective randomized controlled study. All patients with KHE/TA who meet the diagnostic criteria were included. The patients were randomized to methylprednisolone (MP) group and VCR group. The primary outcome was the single main parameter effective rate (SMPE) and overall effective rate (OE) of corticosteroid and VCR over one month after treatment. The single main parameters included platelets, fibrinogen, tumor size, texture and appearance. Results: In single main parameters, VCR was superior to corticosteroid in the relief of platelet (80.0% vs 44.0, P = 0.019) and tumor texture (68.9% vs 30.8%, P = 0.007). Although the efficacy of VCR on fibrinogen (23.3% vs 20.7%, P=1.000), tumor size (23.3% vs 13.8%, P=0.273) and appearance (65.5% vs 46.2%, P=0.120) were higher than that of corticosteroid, there was no significant difference (P > 0.05). And the overall effective rate of VCR was higher than that of corticosteroid (31.0% and 56.7% vs 31.0%), but the differences were also not statistically significant. (P=0.067). Conclusions: Our prospective data show that the therapeutic effect of VCR was significantly greater than that of corticosteroid with regard to treating thrombocytopenia and improving tumor texture. So, we recommend that VCR could be an option for first-line treatment in KHE/TA patients.

Giant cell hepatitis (GCH) with autoimmune hemolytic anemia (AIHA) is a rare entity in children. GCH is commonly described in infants. Vaccination has been incriminated as a trigger of development of AIHA in infants and children. However, vaccination has not been reported, till the time of writing the manuscript, to trigger the combination of Giant cell hepatitis with autoimmune hemolytic anemia. GCH with AIHA is usually fatal. Immunosuppressive treatment with conventional drugs offers some temporary response. We, herein, report a case of GCH with AIHA in a 4-month old male infant, following receipt of oral polio vaccine (OPV) and intramuscular diphtheria-tetanus-pertussis (DPT) vaccine. The patient was resistant to standard immunosuppressive combinations, and rescue therapy with Rituximab was used.

Background. The aim of our study was to describe the efficacy of RBCx procedure using a Spectra Optia® automated apheresis system in children with sickle cell disease (SCD). Methods.We used automated red blood cell exchange to treat acute and chronic complications in 75 children with SCD who had a median age of 10 years [7-13]. We analysed 649 exchange sessions. Results. Peripheral venous access was limited in a number of the children, thus requiring a femoral central double‐lumen venous catheter. We recommend the use of heparin locking, with 500 units in each lumen of adouble‐lumen central venous catheter. This method was well tolerated, with few complications during the procedure. For preoperative prevention, all of the patients had achieved a post-RCE HbS level of <30%. For chronic transfusion, with a post-RCE Hb level of approximately 10-11 g/dL, a blood exchange volume of ≥32 mL/kg, and an interval between each RBCx procedure of ≤30 days, it is able to maintain the residual HbS level below 30%. For acute transfusion, a multiple logistic regression analysis showed that a post-exchange Hb level >=10 g/dL (p<0.001) and a total exchange volume >=35 ml/Kg (p = 0.001) are the best way to reduce the rate of HbS<30%. In this multivariate model, the area of the ROC curve was 0.84. Conclusion: Erythrocytapheresis is useful and safe for children with SCD. We recommend the use of heparin locking, with 500 units in each lumen of a double‐lumen central venous catheter.

Background Patients with atrial fibrillation are increasingly prescribed a direct oral anticoagulant (DOAC) over warfarin and seek to avoid anticoagulation even without a history of major bleeding. This study explores the outcomes of patients implanted with a Watchman device in relation to anticoagulation choice (warfarin versus DOAC) in the post-procedure period and a history of bleeding. Methods Patients implanted with a Watchman device at a single center were retrospectively analyzed. Characteristics including anticoagulation in the first 45 days and history of major bleed were assessed and efficacy (thromboembolism) and safety (bleeding) outcomes compared by Kaplan-Meier analysis. Results 209 patients were implanted (57% male, age 74.6  7.8 years) and followed for 23.5 ± 7.1 months. In the first half of patients, 98% were prescribed warfarin, which dropped to 51% in the second half (p<0.0001). A history of major bleed was present in 80.8% of the first half of patients and decreased to 60% in the second half (p=0.001). There were 16 safety and 4 efficacy events. There was no difference in safety outcomes according to history of major bleeding or anticoagulant choice in the first 45 days. There was no difference in efficacy outcomes over the duration of follow up according to anticoagulation choice in the first 45 days. Conclusions Patients implanted with a Watchman device were increasingly over time prescribed a DOAC and implanted without a history of major bleeding. Bleeding and thromboembolic events were infrequent and related neither to choice of anticoagulant nor to prior major bleeding.

Lumpy skin disease (LSD) is an emerging viral disease, particularly of cattle and water buffalo. The disease is caused by lumpy skin disease virus (LSDV), a member of the genus Capripoxvirus of family Poxviridae which is manifested by characteristic skin nodules, pyrexia, lachrymation, nasal discharge, and swelling of superficial lymph nodes. Lumpy skin disease causes huge economic losses to the livestock farmers due to significant milk loss, damage of the hides, and reproductive problems such as abortion and infertility in affected animals. Initially, LSD was confined to Africa but later spread to Asia and Europe, particularly after 2012. This article describes the spatial and temporal patterns of LSD outbreaks that occurred from 2005-Mid-September, 2020 using the publicly available outbreak data from the World Animal Health Information System (WAHIS) of the World Organization for Animal Health (OIE). There were 3118 LSD outbreaks reported in the last 15 years with 2265 (72.6%) from Europe, 462 from Asia (14.8%), and 391(12.5%) outbreaks from Africa. 3070 (98.46%) of the total outbreaks during the study period occurred since 2012, with the highest month-wise outbreaks observed in July (778) and seasonally in the summer season (1873) which corresponds with the vector season. Since 2012, around 3 (2.78) new countries per year are being affected by LSD. The current situation of LSD spread demands for globally coordinated efforts to control this transboundary disease. Effective surveillance for early detection, vector control measures, vaccination, and regulation of animal movement is necessary to curb down the further spread of LSD.

In this work, the effect of residual stress on mixed-mode crack propagation behavior in friction stir welded (FSW) 7075-T6 panel under biaxial loading was investigated. The cruciform sample was designed and manufactured by FSW. Residual stress profiles across the welded sample were measured by the X-ray diffraction technique. Crack propagation behaviors were simulated with five different biaxial loading ratios. Stress intensity factors (KΙ and KΙΙ) were evaluated by finite element method (FEM) and used to study the effects of residual stress on crack behaviors. It was observed that residual stress has a considerable effect on the mixed-mode crack growth. In most of the cases, the crack deflection is mainly affected by residual stress at the beginning of crack propagation. The variation of crack propagation path is strongly linked with the residual stress as well as the biaxial loading ratio. In addition, KΙ and KΙΙ are susceptible to residual stress under biaxial loading conditions. Residual stresses contribute to a higher proportion of KΙΙ compared to that of KΙ. KΙ and KΙΙ in the retreating side are more affected by the residual stress.

In the 1980-ies, virus inactivation steps were implemented into the manufacturing of biopharmaceuticals in response to earlier unforeseen virus transmissions. The most effective inactivation process for lipid-enveloped viruses is the treatment by a combination of detergents, often including Triton X-100 (TX-100). Based on recent environmental concerns, the use of TX-100 in Europe will be ultimately banned, which forces the pharmaceutical industry, among others, to switch to an environmentally friendly alternative detergent with fully equivalent virus inactivation performance as TX-100. In this work, a structure-activity relationship study was conducted that ultimately led to the synthesis of several new detergents. One of them, named ‘Nereid’, displays inactivation activity fully equivalent to TX-100. The synthesis of this replacement candidate has been optimized to allow for the production of several kg of detergent at lab scale, to enable the required feasibility and comparison virus inactivation studies needed to support a potential future transition. The 3-step, chromatography-free synthesis process described herein uses inexpensive starting materials, has a robust and simple work-up, and allows production in a standard organic laboratory to deliver batches of several hundred grams with >99% purity.

Concerns about climate change and the search for renewable energy sources together with the goal of attaining sustainable product manufacturing have boosted the use of microbial platforms to produce fuels and high-value chemicals. In this regard, Y. lipolytica has been known as a promising yeast with potentials in diverse array of biotechnological applications such as being a host for different oleochemicals, organic acid and recombinant protein production. Having a rapidly increasing number of molecular and genetic tools available, Y. lipolytica has been well studied amongst oleaginous yeasts and metabolic engineering has been used to explore its potentials. More recently, with the advancement in systems biotechnology and the implementation of mathematical modeling and high throughput omics data-driven approaches, in-depth understanding of cellular mechanisms of cell factories have been made possible resulting in enhanced rational strain design. In case of Y. lipolytica, these systems-level studies and the related cutting-edge technologies have recently been initiated which is expected to result in enabling the biotechnology sector to rationally engineer Y. lipolytica-based cell factories with favorable production metrics. In this regard, here, we highlight the current status of systems metabolic engineering research and assess the potential of this yeast for future cell factory design development.

Utility of the E/e’ index in ventilated patients and those with sepsisImran Sunderji 1, Alan G Fraser 2(Reply to the letter from Filippo Sanfilippo and colleagues, ECHO-2020-0930)1 Department of Cardiology, Castle Hill Hospital, Hull, U.K.2 Department of Cardiology, University Hospital of Wales, Cardiff, U.K.Address for correspondence :Professor Alan G. Fraser,University Hospital of Wales,Heath Park,Cardiff, CF14 4XW,Wales, U.K.fraserag@cf.ac.ukTelephone: +44 (0)29 2074 5366Fax: +44 (0)29 2074 4473915 wordsWe thank Sanfilippo and his colleagues for their interest in our paper, and for the opportunity thus afforded to comment on the E/e’ index in critically ill patients and in those who have severe sepsis.We agree that the E/e’ index has some utility in predicting successful weaning from mechanical ventilation, as they have shown in their most recent meta-analysis,1 but published studies show high heterogeneity, there are often only small initial differences in mean E/e’ between patients who will remain off ventilation and those who will not, and average E/e’ values in both groups are sometimes within normal or intermediate ranges. Earlier systematic reviews also concluded that a higher E/e′ ratio is associated with weaning failure in ventilated patients2 and that E/e′ (as well as other markers of diastolic dysfunction) predicts mortality in critically ill patients.3 In a large study of 161 patients, however, neither E/e’ at the lateral mitral annulus nor any other echocardiographic index predicted success in weaning.4The heterogeneity of criteria for diastolic dysfunction in these studies is illustrated by cut-points for abnormal E/e’ varying between 8 and 12 at the lateral mitral annulus and 8 and 9.6 at the medial (septal) annulus.3In ventilated as in other patients, both E and e’ are preload-dependent.5 Positive end-expiratory pressure (PEEP) reduces both; for example PEEP of 12 cm H2O decreased lateral e’ by 19.7% and E by 13.7%, so E/e’ was unchanged.6 An increase in e’ when a patient is taken off a ventilator could indicate a response to changed loading rather than an improvement in intrinsic diastolic function. Before concluding that observed changes in E/e’ imply corresponding changes in left ventricular (LV) filling pressures, we should consider if E/e’ has been validated by correlation with pulmonary capilllary wedge pressure (PCW) measured with Swan Ganz catheters, specifically in ventilated and critically ill patients.In 39 patients there was no difference in E/e’ before a trial of spontaneous breathing, between those subjects in whom it was successful (defined as PCW remaining <18 mmHg after 60 minutes; mean baseline E/e’ 8.0) and those in whom it was not (PCW increasing to >18 mmHg; baseline E/e’ 7.6).7 The area under the receiver operating characteristic curve (AUC) for E/e’ as a guide to PCW at the end of the trial of spontaneous breathing was 0.8. In an earlier study of patients in intensive care who were also breathing spontaneously, E/e’ had a modest correlation with PCW (r=0.69); a patient with E/e’ of around 10 could have a PCW ranging from <10 to >20 mmHg.8 In other studies of ventilated patients, the correlation of lateral E/e’ with PCW was 0.849 and its AUC was 0.91.10Recently, Brault et al reported that the 2016 American Society of Echocardiography and European Association of Cardiovascular Imaging guidelines for diastolic dysfunction did not accurately assess PCW in 98 ventilated and critically ill patients, of whom 54% experienced septic shock. The diagnostic score was indeterminate in 49% of patients, sensitivity and specificity were both 74%, and agreement between echocardiography and PCW was moderate (Cohen’s Kappa, 0.48). The best echocardiographic predictor of a normal PCW was not the E/e’ ratio but a lateral e′ >8.11From experimental and clinical observations it is clear that severe sepsis can depress myocardial contractile function, probably through multiple mechanisms.12 In 40 patients with sepsis, however, there were no significant correlations between serum concentrations of inflammatory cytokines and measurements of e’ or calculated E/e’.13 In another study, mortality was predicted by the APACHE II score and mitral annular systolic excursion (MAPSE) with an AUC of 0.88, while the E/e’ index was not selected as a predictor in a logistic regression analysis.14Reproducibility of echocardiographic measurements in patients with septic shock is moderate to good15 but it is difficult to rely on single observations to guide clinical decisions.In patients with sepsis and severe diastolic dysfunction, failure to respond to volume replacement may be caused by impaired early diastolic relaxation and LV suction, which cannot be detected by the E/e’ index. In a randomised trial, an intravenous infusion of esmolol to slow the heart rate prolonged LV filling and increased stroke volume, with a subsequent reduction in mortality.16 In a prospective observational study, levosimendan increased the probability of successful weaning from ventilation, and averted any increase in E/e’;17 that could also be explained by improved early diastolic relaxation and filling, since levosimendan is positively lusitropic.18 Detailed echocardiographic assessment of ventilated patients after cardiac surgery showed that levosimendan increased early diastolic strain rate by 30%.19 Thus changes in E/e’ as a marker of mean PCW do not necessarily confirm a causal relationship with any particular aspect of LV diastolic function, while more comprehensive echocardiographic analysis of pathophysiological mechanisms may be more informative.These thoughts reinforce some of the conclusions that we drew in our review. Many studies are difficult to interpret because the E/e’ index is reported without information on changes in its individual components, and because dichotomising patients into normal or diastolic dysfunction (grades) loses information from multiple continuous variables that are inter-related but may change with differing patterns according to particular circumstances. It is unwise to use discrete cut-points especially if they are unadjusted for age and gender, and mistaken to conclude that LV diastolic function has changed when there are significant differences in the E/e’ index but its mean values remain within the normal range. The optimal assessment of diastolic dysfunction in septic and ventilated patients requires a multiparametric approach and we caution against over-reliance on E/e’.

Objective To establish a quantitative evaluation of the left ventricle’s systolic function in patients with chronic kidney failure (CKF) by three-dimensional speckle-tracking echocardiography(3D-STE). Methods Two-dimensional transthoracic echocardiography and three-dimensional transthoracic echocardiography were performed on 30 patients with CKF. The ejection fraction (EF), mass and global peak longitudinal strain (GL), global circumferential strain (GC), global area strain (GA), and global radial strain (GR) of the left ventricle were calculated. Results (1) EF, GL, GC, GA, and GR in the CKF group were significantly lower than in the control group. Meanwhile, GL, GC, GA, and GR were well correlated with EF. (2) For patients with normal EF in the CKF group, GL, GC, GA, and GR were lower than in the control group, while the left ventricular mass was significantly higher than in the control group. (3) For patients with hypertension in the CKF group, EF, GL, GC, GA, and GR calculated using three-dimensional echocardiography were significantly lower than in patients with normal blood pressure; however, the myocardial mass was higher. Conclusions Parameters calculated using three-dimensional speckle-tracking software were lower in the CKF group. Simultaneously, the left ventricular mass was higher than in the control group, showing that the myocardial contraction function was impaired and that myocardial reconstruction occurred.

Intraprocedural rotational intracardiac echocardiography by Ultra ICE allowed qualitative information consistent with a prominent mobile Crista Terminalis. The correct diagnosis of this right atrial pitfall zeroed the risk to mistake it for tumors or thrombi, avoiding needlessly costly additional investigations.

Background; Osteoporosis is one of such disease which causes bone mass reduction by decreased formation of new bones. Low bone mineral density is frequent factor for osteoporosis. Increased osteoclast life span and advanced osteocytes as well as osteoblasts apoptosis is well adopted pathophysiological mechanism for low bone mass. Women are more prone than man. Approximately 200 million women have osteoporosis worldwide. Objective; Therefore, this study is designed to compare efficacy of bisphosphonates and recombinant human Para-thyroid hormone in treatment of osteoporosis. Main outcome measures; The comparison of these two treatment strategies is based upon therapeutic effectiveness, cost of therapy and availability of the drugs. Methods; The total duration of study was 1 year and during the study period a total 60 samples were analyzed randomly. Data was collected using a well-designed questionnaire. Results; rhPTH increase bone mass density (BMD) by 8-9% while bisphosphonates and estrogen therapy increase BMD 3-5% during the same time period. Conclusion; The current study was conducted in local population so that we could offer them the test possible treatment among the two most common treatment therapies available for osteoporosis.

Phenotypic variation in natural populations is crucial for rapid adjustment to challenging environmental conditions such as exposure to heavy metal pollution. Hence, the study of variation in traits related to plant response to heavy metal stress provides valuable insight into the likelihood of a population’s survival. We investigate the patterns and mechanisms of intraspecific phenotypic variation for heavy metal accumulation and tolerance in bryophytes, one of the most resilient yet relatively understudied taxa. Two terrestrial mosses exposed to Cd and Cu in the laboratory, the heavy metal specialist Scopelophila cataractae and the facultative metallophyte Ceratodon purpureus, showed intraspecific differences in tolerance to these metals. Only the heavy metal specialist showed differences in accumulation which in the case of Cu could be associated to preferential relocation towards the stem to protect their main photosynthetic organs. We also report the first evidence for sexual dimorphism for Cd tolerance in C. purpureus (females being more tolerant than males). Our results provide support for high variation in the capacity of bryophytes to respond to environmental challenge despite potentially low levels of genetic variation and lack of previous exposure to stress, as well as evidence for metal-dependent, sex-specific differences in heavy metal tolerance in bryophytes.

Abstract This letter compares cetane index (CI) with biodiesel cetane index (BCI) of total fatty acid methyl esters (FAME) present in six seed oils. BCI of these FAME compositions estimated from its predicted and experimental densities is within the range of measured derived cetane numbers (DCN) in comparison to CI. Predicted and experimental densities of FAME compositions have a linear relationship with BCI compared to the reported plot of a single FAME density with cetane numbers. In conclusion, BCI estimated from FAME compositions of several lipid sources is a credible method to select fewer samples for measuring derived cetane numbers.

In this paper, we investigate the dynamics of a fractional zika virus model (ZIKV) with Caputo, Caputo-Fabrizio-Caputo (CFC) and Atangana-Baleanu-Caputo (ABC) derivatives. Firstly the basic properties of the classical integer order model are furnished followed by the equilibrium points and basic reproduction number. Furthermore, with respect to the Caputo, CFC and ABC derivatives, we establish via a fixed point technique that under certain conditions the fractional ZIKV model admits a unique system of solutions. The Adams-Bashforth numerical scheme incorporating the fractional order parameter is then used to obtain numerical schemes for the approximate solutions of the fractional ZIKV model with respect to each of the considered fractional differential operators. Finally, with a view to visualize the behaviour of the approximate solutions to fractional ZIKV model with respect to each of the fractional differential operators, we do some numerical simulations for distinct values of the fractional order parameter.

Objective: Persistent pulmonary interstitial emphysema (PPIE) is always related to mechanical ventilation and preterm. Its relationship with respiratory infection has rarely been reported in the literature. PPIE is difficult to diagnosis, always mimics with other cystic lesions. The objective of this study was to evaluate clinicopathological radiographic features of PPIE with respiratory infection and to detect the possible infectious pathogens. Methods: We retrospectively reviewed a total of 237 patients pathologically diagnosed with cystic lesions in West China Hospital of Sichuan University from January 2011 to April 2019. This retrospective cohort study analyzed clinicopathological radiographic features and to detect the infectious pathogens by metagenomic next-generation sequencing (mNGS). Results: Six cases were presented with primary syndrome of respiratory infection. There were four girls and two boys, ranged from 2 months to 5 years. 100% (5/5) available cases were full-term and without mechanical ventilation. CCAM were suspected in 66.7% (4/6) patients. 66.7% (4/6) cases affected only a single lobe, and 33.3% (2/6) cases affected both lung lobes. The pathologic characteristics showed lung cysts with variable size along the bronchovaslcular bundles, the cysts had a discontinuous fibrotic wall with a smooth inner surface, lined with uninucleated and/or multinucleated macrophages. Conclusions: Six rare cases of PPIE with respiratory infection were treated by lobectomy. All available five cases were full-term infants without mechanical ventilation. And we firstly tried to detect of infectious pathogens by mNGS, however, there was no certain infectious pathogen associated with PPIE in our study.

For the carbon dioxide desorption in anaerobic fermentation process, a mathematical model for the micro-interface mass transfer of a multi-component single bubble was established. Based on the theory of gas generation, the relationships between bubble shape, mass transfer and energy consumption required for bubble generation were discussed. Design indicator such as effective mass transfer height and effective stay time of the bubbles have been established to guide the optical selection of initial bubble size and liquid level height (reactor height). On this basis, calculation of multi-bubble system was further performed to evaluate the influence of bubble size on the gas holdup, and energy consumption. It was found that the performance evaluation based on gas flux was obtained, and the influence of bubble radius on gas mass transfer rate and gas holdup under a certain flux was investigated

Background: Adenoid hypertrophy (AH) is a common comorbidity in pediatric allergic rhinitis (AR). The role of the sensitization to aeroallergens in AR children with AH is still unclear. Methods: 5307 children (2-8 years) with nasal complaints were enrolled in our study to identify the prevalence of AR and the incidence of AH complicated by AR. A smaller cohort including 2292 children was recruited for further confirmation. Basic information, serum total and specific immunoglobulin E (tIgE, sIgE) test, physical examination, and fluoroscopy evaluation were obtained for each patient. Risk factors for AH were estimated by logistic regression analysis. Results: We found that 3066 of 5307 children with nasal complaints had an elevated sIgE for at least one aeroallergen. House dust mites (HDMs) were the most common aeroallergen with a prevalence of 65.7%. Of 3066 children with AR, 1440 developed a moderate to severe AH. AR children with AH had a significantly higher tIgE level compared with those without AH (178IU/ml [interquartile range, IQR: 61.2-423.8] vs. 102IU/ml [IQR: 60.0-303.8], p<0.001). Sensitivity to Aspergillus fumigatus (Odds ratio [OR]: 1.687; 95% confidence interval [95%CI]: 1.199-2.373, p=0.003) and cockroaches (OR: 2.295, 95%CI: 1.263-4.170, p=0.006) was statistically significant in the logistic regression model after adjusting for several likely confounders. Conclusions: HDMs are the most common causes among sensitized children with nasal discomforts. AR children with higher tIgE may have higher likelihood of developing AH. AR children with AH have a distinct sensitization profile, and Aspergillus fumigatus and cockroaches could be the main triggers in urban China.

In order to study the fatigue damage and cycle life of TC4 titanium alloy for aero-engine blades under various load conditions, uniaxial fatigue, multi-stage loading and multiaxial fatigue tests were carried out. The critical plane method combined with von Mises criterion was used to study the fatigue life distribution under various loading paths, and the results were verified by experiments. Based on the nonlinear residual strength model and Poisson stochastic process, the reliability prediction of aero-engine compressor blade under maximum continuous working condition was completed. The results show that the fatigue damage and life distribution of TC4 titanium alloy for aeroengine blade under various conditions can be accurately predicted by the method proposed in this paper and the reliability of the blade can still be maintained above 0.9 after it works for 3000 hours under the maximum continuous working condition.

Crying newborns could breathe into droplets with virus：the discussion of the possibility of intrapartum transmissionRui-Hong Xue1, He-Feng Huang2,3,4,5

Objective The purpose of this meta-analysis was to compare the effectiveness and safety of HIFU with surgical interventions for the treatment of symptomatic uterine fibroids in women according to the studies available in current literature. Main results A total of 10 studies involving 4450 women were included in our meta-analysis. Compared with surgery group, the reduction of uterine fibroid symptom (UFS) scores at 6- and 12-month follow-up were higher in HIFU group, with the overall MD -4.16 (95% CI, -7.39 to -0.94, P=0.01) and -2.44 (95% CI, -3.67 to -1.20, P=0.0001), respectively. The increase of quality-of-life (QoL) scores at 6- and 12-month follow-up were also higher in HIFU group, with the overall MD 2.13 (95% CI, 0.86 to 3.14, P=0.001) and 2.34 (95% CI, 0.82 to 3.85, P=0.003), respectively. Both of the duration of hospital stay and the time to return to work was significantly shorter in HIFU group, with the overall MD -3.41 (95% CI, -5.11 to -1.70, P<0.0001) and -11.61 (95% CI, -19.73 to -3.50, P=0.005), respectively. The incidence of significant complications was significantly lower in HIFU group, with the overall RR 0.33 (95% CI, 0.13 to 0.81, P=0.02). The difference of incidence of adverse events, effective rate, symptom recurrence rate, re-intervention rate and pregnancy rate between HIFU and surgery were not statistically significant. Conclusion Compared with surgical interventions, HIFU ablation therapy leads to more significant alleviation of symptoms and improvement of QoL, quicker postoperative recovery and fewer significant complications.

Background: Chronic spontaneous urticaria is well-described in adults, but less so in children. The aim of this study is to describe the demographics, clinical characteristics, comorbidities, and outcomes of children with chronic, spontaneous urticaria. Methods: This retrospective study followed children up to 18 years-old, diagnosed with chronic spontaneous urticaria, between the years 2002-2018 and treated in a tertiary referral allergy and clinical immunology center. Data including demographics, clinical characteristics, comorbidities, treatments and outcomes was extracted from electronic medical records. Results: Records of 380 children coded to have chronic urticaria were reviewed, of which 250 (65.8%) fulfilled the diagnostic criteria for chronic spontaneous urticaria. There were 136 females (54.4%). Mean age at diagnosis was 11.4 years, 122 (48%) were adolescents. The average duration of chronic spontaneous urticaria was 12.25±15.2 months. The urticaria in 208 children )83.2%) resolved within 24 months. Eighty-seven patients (34.8%) had at least one atopic disease. Atopic comorbidities included atopic dermatitis in 17.2%, allergic rhinitis in 16%, asthma in 13.2% and food allergy in 3.2%. Eighteen patients (7.2%) had a concomitant autoimmune disease. Nine (3.6%) had thyroid disease. Conclusions and clinical relevance: Chronic spontaneous urticaria in children is a self-limited disease with favorable prognosis. Atopic diseases are more prevalent in children with chronic spontaneous urticaria than in the general pediatric population; increasing the possibility of a special subgroup of TH2-related chronic urticaria in children.

Should cashew and pistachio be clinically considered as one allergen?Authors (Last Name and First Name): Manca Enrica1,2, Touati Nidhal1, De Filippo Maria1,3, Carboni Elena1,4, Diaferio Lucia1,5, Demoly Pascal1,6, Caimmi Davide1,6Affiliations :1. Allergy Unit of the Department of Respiratory Diseases, University Hospital of Montpellier, France.2. Pediatric Unit, University Hospital of Foggia, Italy.3. Pediatric Unit, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Italy.4. Pediatric Unit, Ospedale Maggiore, ASST Cremona, Italy.5. Department of Pediatrics, Giovanni XXIII Hospital, Aldo Moro University of Bari, Bari, Italy.6. UMR-S 1136 INSERM-Sorbonne Université, Equipe EPAR – IPLESP, Paris, France.Running title: Allergy to cashew and pistachio

Background: Allergic diseases in offspring are suggested to originate from fetal life. The role of in-utero stress exposures in early childhood allergic diseases development has not been completely elucidated. We aimed to determine the effect of exposures to different kinds of maternal stressed-affective factors during pregnancy on the risk of childhood allergy during first 2 years of life. Methods: A sample of 4178 children born in 2016-2018 from the Shanghai Maternal-Child Pairs Cohort were included in this study. Indicators for maternal stressed-affective factors included life events stress at early and late pregnancy, respectively, and prenatal depression and anxiety at late pregnancy, which were measured by the Life Events Scale for Pregnant Women (LESPW), Self-Rating Anxiety Scale (SAS) and Center for Epidemiologic Studies, Depression Scale (CES-D). The children’s allergic diseases or manifestations were assessed through the questionnaires at 2,6,12,24 months after birth, respectively, including eczema, atopic dermatitis, food allergy, wheezing, asthma, and allergic rhinitis. The impacts of maternal stressed-affective factors on child allergic diseases were analyzed using multivariable binary logistic regression adjusting for potential covariates. Results: During the first 2 years of life, all forms of allergic disease were continuously reported, with allergic diseases of skin preceded the development of other atopic diseases. Children whose mothers had high life events stress during the early pregnancy or the late pregnancy would have an increased risk of eczema at 2 months respectively (AdjOR:1.30, 95%CI:1.01-1.67; AdjOR:1.64, 95%CI:1.14-2.36). Children whose mothers with high life events stress in late pregnancy were also more likely to have food allergy at 6 months (AdjOR:3.22, 95%CI:1.27-8.12). Maternal prenatal anxiety may lead to offspring’s childhood wheeze at 24 months (AdjOR:2.15, 95%CI:1.09-4.27). Conclusions: Maternal stressed-affective factors could have effects on offspring’s allergic diseases, especially eczema at 2 months. Understanding the temporal-specific effects of maternal stressed-affective factors may better inform prevention strategies.