Background: Coronavirus disease 2019 (COVID-19) is highly contagious and has affected the whole world. We aim to investigate the clinical and laboratory characteristics of COVID-19 patients in high altitude areas of Sichuan, China. Methods: In this retrospective cohort study, a total of 67 patients with laboratory-confirmed SARS-CoV-2 infection in Tibetan Qiang Autonomous Prefecture of Ngawa, Sichuan were included from February 1, 2020 to March 2, 2020. The clinical characteristics as well as their radiological and laboratory features were extracted. Results: 4(6.0%) patients were categorized into severe cases, 39(58.2%) were non-severe cases, and 24(35.8%) were asymptomatic cases. 46(68.7%) patients were associated with cluster infection events in this study. The most common symptoms were cough, sputum production, dyspnea, fatigue or myalgia, and headache. 7(10.4%) patients showed leucopenia and 20 (29.9%) patients showed lymphopenia. Lymphocyte count and neutrophil-to-lymphocyte ratio (NPR) was different between three groups. 14 (20.9%) patients had thrombocytopenia, prothrombin time (PT) and fibrinogen levels differed between groups. We also found significant difference of sodium, chloride, and calcium levels between three groups. Antiviral therapy did not lead to obvious adverse event or shorter duration from initial positive to subsequent negative nuclei acid tests. Advanced age, hypertension, high neutrophil count, neutrophil-to-lymphocyte ratio, fibrinogen, and lactate dehydrogenase level were identified as independent risk factors for symptomatic cases of COVID-19. Conclusions: The symptoms of patients in high altitude areas were mild and about one third were asymptomatic. We also identified several independent risk factors for symptomatic cases of COVID-19.

Establishing a procedure which divides geographic environment into different spatial units with certain geographic homogeneity is the perquisite of resource management, but it is a challenging task owing to the complexity of geographic environment. Land-type research which aims to map patterns and interactions of geographic components (e.g., climate type, landform, soil type, and land cover etc.) lays foundation to division of geographic environment. Although national standard of land-type in China provided a framework for land survey, it weakened the importance of human activity. Combining multi-source data and geospatial analysis methods, this study identified agricultural land quality and urban functional areas as proxies for land-use intensities and further proposed a 1:100,000 hierarchical classification system that integrated landform type, soil type, land-use type, and land-use intensity. Factors in the classification system were represented by parameter layers. Using this classification system, Changzhou City land was classified into 3 classes, 37 subclasses, and 137 land units. The land-type map and analyses of human–land relationship could support current land-use planning in China which needs a comprehensively knowledge of geographic environment rather than just land-cover/land-use.

In this study, the photovoltaic properties of the organic dyes based on triphenylamine having a D--A structure including TC201, TC202, TC203, TC601, H-P, F-P, FF-P, T-F, and P1B were investigated theoretically. In this model, triphenylamine was used as an electron donor, cyanoacrylic acid, and benzoic acid as the electron acceptors, and anthracene phenyl, anthracene vinyl phenyl, anthracene ethynyl phenyl, ethynyl anthracene phenyl, styryl phenyl, styryl-2-fluorophenyl, styryl-2,6-difluorophenyl, styryl furan, and styryl as the π-conjugated systems. The results show that a change in the -conjugated system and electron acceptor affect the properties of the dye-sensitized solar cell (DSSC). Also, TC601 dye having the ethynyl anthracene phenyl -conjugated system shows the highest charge transfer distance (DCT) and the least overlap of the electron-hole distribution (S) in comparison with other dyes. Moreover, the presence of a triple bond in the vicinity of triphenylamine increases the resonance effect of the -electrons that facilitates the process of charge transfer in this dye. Spectroscopic analysis shows that H-P and F-P dyes have the higher molecular absorption coefficients and TC202, TC203, F-P, and T-F dyes show a red shift in comparison with other dyes. Moreover, the voltage-current curve of the studied dyes shows that the highest values of the open circuit voltage and short circuit current density are related to P1B and TC601 dyes, respectively. Finally, TC601 and P1B are proposed as the best candidates to be used in the DSSCs due to their maximum incident photon to current conversion efficiency.

Abstract: Modern aerodynamics is the dynamics of gas propulsion. It requires precise data, material resources, manpower, and time. It is urgent to find a more suitable power source. Based on the gravitational effects of dark energy and dark matter, the cyclic process of cosmic physics black holes to odd black holes and dark energy black holes, special fusion and fission phenomena are common in the universe, and theoretical studies such as Einstein’s general theory of relativity are no exception. Through the study of the source of cosmic elements, the formation environment of stellar elements, the theory and method of modern physical artificial elements，as well as atomic bombs, hydrogen bombs, and nuclear reactors to precipitate elemental products，we have designed a device which can synthesize physically stable elements and discover new chemical elements. A device capable of synthesizing physically stable elements and discovering new chemical elements is designed.

Background：Pulmonary arterial hypertension (PAH) is a rare disease in children, with significant mortality. Because of the limited research on pediatric PAH, firstly systematic review of related drugs is conducted，and then economic evaluation of PAH drug treatment programs is conducted, which to provide a reference for the choice of more cost-effective treatment options. Methods: The search includes electronic databases such as Pubmed, ScienceDirect, Embase. Through inclusion and exclusion criteria, screen high-quality randomized controlled trials. We used TreeAge Pro 2011 software to construct the markov model, that to simulate the total medical cost and quality-adjusted life years (QALYs), and to calculate the incremental cost-effectiveness ratio (ICER). Sensitivity analysis of transfer probability, utility and cost was carried out. Results: Incorporate two studies that meet the criteria, one compared the therapeutic effects of bosentan and placebo on pediatric PAH, the other compared therapeutic effects of sildenafil and placebo on pediatric PAH, both articles were of good quality. Compared with the sildenafil group (3.38QALYs and $161120.14),the QALY of the bosentan treatment group (3.33QALYs and $257411.29) was reduced by 0.05,and the cost increased by $96291.15.The estimated improvement to quality of life and reduced costs result in an estimate of economic dominance for sildenafil over bosentan. This dominant result persisted probabilistic analyses. Conclusions: Based on this model,a more cost-effective treatment drug for PAH in children is sildenafil.

Background: Three-dimensional echocardiography (3DE) evaluation of left ventricular (LV) volume and function in pediatrics compares favorably with cardiac magnetic resonance imaging. A multicenter trial with automated and semi-automated LV quantification allows for generation of normative data in large pediatric patients. The aims of this study were to evaluate the feasibility and reproducibility of measuring three-dimensional echocardiography (3DE) volumes and function in pediatric patients in a multicenter trial; to determine if automated software (without contouring edits) will improve the reproducibility in volume and function analysis; and thus establish normal z score values in this unique population. Methods: Six hundred and ninety-eight healthy children (ages 0 to 18 years) were recruited from 5 centers. Left ventricular (LV) 3DE was acquired from the 4-chamber view. A vendor independent software analyzed end-diastolic volume (EDV), end-systolic volume (ESV), stroke volume (SV), and ejection fraction (EF) using automated and semi-automated quantification. Feasibility and reproducibility were assessed. Body surface area (BSA) based z-scores were generated. Results: Feasibility was 79% (523/658). Reproducibility was good between centers using the semi-automated quantification. Reproducibility was decreased using the automated quantification. Therefore, Z-scores were generated for ESV, EDV, and SV using the semi-automated method. Conclusions: 3DE can reliably evaluate LV volumes and EF in pediatric patients at different centers. We report pediatric Z-scores for normal LV volumes using the semi-automated method. Further optimization of technology will be necessary for reliable use of fully automated quantification by 3DE in children.

Rural communities in the drylands of Sub-Saharan Africa (SSA) derive their livelihoods primarily from their natural resource base. Unprecedented changes in these environments over the past few decades are likely to intensify in the future and land users need to develop sustainable adaptation strategies. This study aims to identify land use and land cover (LULC) changes and their drivers in a Sub-Saharan dryland, between 1986 and 2017, by integrating local knowledge and remote sensing analysis. Local knowledge and environmental perception are used as the basis for defining LULC classes and for training and validation of change detection. This study identifies bush encroachment into former pastures as the dominant LULC change with an increase of woodland by 39 % and a decrease of grassland by 74%. This process is perceived as severe degradation by local respondents and is linked to changing management regimes and unreliable rainfall patterns. Deforestation and woodland thinning can be traced back to increased habitation and farming, though the local community also identifies charcoal production as a driving factor. The integration of remote sensing and local knowledge provides a holistic view on LULC change in Pokot Central, Kenya, and offers a solid base for site specific and actor-centred management approaches necessary for sustainable pathways of drylands.

Introduction: Tuberculosis is still a leading cause of morbidity and mortality in the world, especially the low and middle income countries. While a lot is being done on the programmatic level, the burden of the disease is still underestimated owing to problems in diagnostics and infrastructure. Objective: The objective of this study was to estimate the prevalence of Latent Tuberculosis infections in the pediatric household contacts of patients of pulmonary tuberculosis in India. Methods: We searched electronic databases PubMed, EMBASE and Ovid for relevant articles. Search of grey literature and unpublished data was also done.The protocol of the study was registered in the PROSPERO. The quality of included studies was assessed using the Hoy et, al. checklist. The data extraction from relevant studies and subsequent data synthesis and analysis was done. The calculation of the pooled prevalence of LTBI, and the construction of galbraith plot for heterogeneity was done using STATA software. Result: The searches yielded 600 studies out of which 19 were included in the review. The pooled prevalence of LTBI among household contacts was 39.27[26.05-52.49]. On subgroup analysis, the prevalence of LTBI from studies with only pediatric contacts included was 26.73[17.70-35.76].There was significant heterogeneity amongst the various studies with overall I2=99.7%. A Galbraith Plot was constructed which also shows significant heterogeneity among the different studies. All studies had a low risk of bias with a score of 3 or less, except one, which had a moderate risk of bias with a total score of 4.

Radioactive iodine (RAI)-induced thyrocyte destruction may lead to uncontrolled inflammation. This study was designed to evaluate the prophylactic and therapeutic immunomodulatory effects of omega-3 fatty acids in patients with differentiated thyroid cancer scheduled for RAI ablation. A total of 85 patients were divided into two groups based on radioiodine dosage after thyroidectomy: high-dose with 150 mCi and intermediate-dose with 100 mCi. Then patients in each group were randomly divided into three subgroups: G1 with RAI ablation only, G2 treated with omega-3 for 30 days before RAI ablation, and G3 treated with omega-3 for 30 days after RAI ablation. Serum cytokine levels were determined with the cytometric bead assay at different time points. Within-group comparisons showed transient elevation of IL-13 after pretreatment with omega-3, significant reductions in Th1+Th17/Th2+Th22 ratio after high-dose RAI ablation, and decreased Th1+Th17/Th2+Th22 and Th1+Th17/Th2+Th9+Th22 ratios after intermediate-dose RAI ablation in G2. Between-group comparisons showed that IL-10 level in G3 was significantly higher than in G1 1 week after high-dose RAI ablation, whereas Th1+Th17/Th2+Th22 and Th1+Th17/Th2+Th9+Th22 ratios were significantly lower in G3 than G2 1 month after intermediate-dose RAI ablation. However, cytokine changes 1 week and 1 month after RAI ablation when adjusted for baseline values showed no differences among groups. Despite observing within-group changes in some cytokines, we found no real changes attributable to a prophylactic or therapeutic anti-inflammatory effect of omega-3. Because of the specific effect of radioactive iodine on thyroid cells, extensive systemic inflammation may not be induced after RAI ablation.

We isolated avian, swine, human influenza viruses, and one hybrid influenza virus from minks in China. The H5N1 hybrid virus had pandemic potential because its seven genomic segments were from H1N1 human influenza virus and its HA gene was from H5N6 highly pathogenic avian influenza virus carrying multiple mammalian-adaptive mutations.

Inherent errors in tipping bucket flow meters may limit monitoring data reliability. In this work, we perform the static and dynamic calibration of four large tipping buckets, apply different regression curves and investigate the possible measurement error sources. The volumetric capacity (static calibration) of each piece of equipment was determined. They were tested (dynamic calibration) under ten flow intensities, ranging from low to high rainfall intensities (return period larger than 100 years). For each flow rate, the measurement was recorded during six time intervals (1, 2, 5, 10, 20 and 30 minutes) and four regression equations - linear, potential, T vs. 1/Q and quadratic - were tested. According to the static calibration, the equipment has a volumetric capacity of 11.63 mL (TB1), 64.16 mL (TB2), 139.86 mL (TB3) and 660.95 mL (TB4). When tested under different flow rates (dynamic calibration), underestimations were identified according to the size of the cavity: TB1 (3.31%), TB2 (5.75%), TB3 (9.33%) and TB4 (13.57%). Among the alternative curves, linear regression showed the best correlation (above 99%) with the monitored data. Using this method, the measurement errors were reduced to -1.35% (TB1), 0.04% (TB2), 3.18% (TB3) and 3.73% (TB4). We investigated how the different variables (tipping speed, cavity volumetric capacity and time interval of data collection) influenced the error. Errors follow a parabolic function of tipping velocity and a linear function of cavity volumetric capacity. The time interval of data collection interfered in the data sampled, however no statistical correlation was found. Among those variables, cavity size is the most important one. Given its low cost we aimed to minimize the inherent error in large tipping buckets flow meters and encourage its application, increasing in-situ collection of hydrological data.

Graph theory has supported chemist with topological indices which predict different physicochemical properties such as boiling point, entropy, acentric factor etc. of chemical compounds. In this article, we introduce two new topological indices called degree locating indices, based on the degree and location of the vertices, we present exact expressions for some families of standard graphs and we get the exact values of these indices for any graph of diameter two. Finally, we compute these indices for the join of graphs, book graph and firefly graph.

Background: Systemic inflammation and tonsil microbiome have been linked to chronic intermittent hypoxia during sleep in children with obstructive sleep apnea (OSA). However, their relationships have not been comprehensively studied. Here, we investigated the associations between systemic inflammation, tonsil microbiome, OSA severity, and surgical outcome in pediatric OSA patients regarding different weight status. Methods: We recruited 33 children with OSA and non-healthy-weight (cases) and 33 children with OSA and healthy-weight (controls) were prospectively recruited and matched by the proportion of chronic tonsillitis. Each patient underwent adenotonsillectomy and received at least 3-month follow-ups. Systemic inflammatory biomarkers (interleukin [IL]-6, IL-10) were detected in the blood sampled in the morning. Tonsil microbiome was identified with 16S ribosomal RNA gene sequencing. OSA severity was assessed by standard whole-night polysomnography. Results: Differences in systemic inflammatory biomarkers, tonsil phyla, and apnea-hypopnea index were not statistically significant between both groups. After adenotonsillectomy, all OSA severity variables significantly improved; however, apnea-hypopnea index was significantly higher in the non-healthy-weight group and serum level of IL-6 significantly reduced in the healthy-weight group. The percentage changes in IL-6 and minimal pulse oxygen saturation were respectively associated with Deinococcus-Thermus and Eremiobacteraeota in the non-healthy-weight group, whereas the percentage change in IL-6 was associated with Patescibacteria and Cloacimonetes in the healthy-weight group. Furthermore, chronic tonsillitis was related to Chloroflexi, Acidobacteria, Euryarchaeota, Thermotogae, Hydrogenedentes, and Rokubacteria in the non-healthy-weight group. Conclusion: These preliminary findings are novel and provide insight for future research to understand the pathogenesis of the disease and to develop personalized treatments.

Letter to the Editor, BJOG Exchange

Third generation sequencing technologies, such as Oxford Nanopore Technologies (ONT) and Pacific Biosciences (PacBio), have gained popularity over the last years. These platforms can generate millions of long read sequences. This is not only advantageous for genome sequencing projects, but also for amplicon-based high-throughput sequencing experiments, such as DNA barcoding. However, the relatively high error rates associated with these technologies still pose challenges for generating high quality consensus sequences. Here we present NGSpeciesID, a program which can generate highly accurate consensus sequences from long-read amplicon sequencing technologies, including ONT and PacBio. The tool includes clustering of the reads to help filter out contaminants or reads with high error rates and employs polishing strategies specific to the appropriate sequencing platform. We show that NGSpeciesID produces consensus sequences with improved usability by minimizing preprocessing and software installation and scalability by enabling rapid processing of hundreds to thousands of samples, while maintaining similar consensus accuracy as current pipelines 

Rationale, aims, and objective: Evidences show that the level of awareness about H.pylori is still low, and working on this issue is expected to be very impactful to improve infection rates and disease spread. This research aimed is to assess the level of knowledge and the degree of awareness among undergraduate pharmacy students in regard to H pylori diagnosis and management before and after delivering an educational pharmacy intervention. Methods: This is a randomized controlled study that was conducted in May 2020. During the study period, 72 pharmacy students were invited to attend a workshop about H pylori management and diagnosis. Participants’ knowledge and general awareness about H pylori infection was evaluated before and after the workshop (25-minute educational lecture for the intervention group and educational pamphlet for the control group). At the end of the workshop participants’ ability to distinguish and correctly diagnose virtual cases was tested. Results: Most of the participating students (n=58, 80.6%) haven’t been involved in similar workshops previously. Following education workshop, students in the intervention group showed a significant improvement in their knowledge score (from 9.2 (SD=1.9) pre-workshop to 10.4 (SD= 1.9) post-workshop, (P-value =0.001) while students in the control group didn’t (pre-workshop knowledge score of 9.1 (SD= 2.2) and post-workshop score of 9.4 (SD= 1.6), (P-value =0.324). Also, students in the intervention group produced better results than the control group in distinguishing and diagnosing provided H pylori cases in the workshop with higher score of 2.2 for the intervention group compared to 1.6 for the control group (P-value= 0.026). Conclusion: Education workshops about H pylori infection are needed to build a strong base of qualified healthcare providers as an outstanding output of our higher educational programs, which in turn improves the quality and reduces the burden on healthcare systems.

Light-regime variability is an important environmental factor which shapes a forest community. So far, none focused on the phylogenetic pattern of plant light receptors, which reflects how genes’ evolution influences the coexistence of species in a community. In this study, we analyzed community phylogenetic structure of the south subtropical forest by sequences of plant blue light receptor cryptochrome (CRY) and compared the results of DNA barcodes. Patterns of community assembly was estimated by net relatedness index (NRI) and nearest taxon index (NTI). We found that CRY showed quite different phylogenetic structure as compared to DNA barcoding results, all habitats displayed consistent phylogenetic structure patterns, suggesting a convergent evolution of light sensing system of plant in local adaptation. Also, both NRI and NTI values increased through the time, indicating that the phylogenetic structure of tree community became more overdispersion as succession proceeds; phylogenetic closely-related species tended to co-occur and environmental filtering played a more important role in the community assembly. Furthermore, phylogenetic patterns were more clustering in upper canopy layers, and NTI values of all canopy layers were above zero, suggesting that phylogenetically related species tended to coexist and adapted to similar light conditions.

Background Pediatric hematology/oncology providers frequently have challenging discussions with patients/families, yet receive little formal training in communication. Our institution aimed to meet this need with a workshop in relationship-centered communication (RCC), which focuses on empathy, reflective listening, and patient/family understanding. This study evaluates the efficacy of this intervention to improve patient/family experience in healthcare encounters. Procedure Our team at Texas Children’s Hospital (TCH), a quaternary care pediatric and women’s hospital, developed a 5.5-hour RCC skills workshop in collaboration with the Academy of Communication in Healthcare (ACH). ACH-trained TCH providers led participants in 3 pediatric-specific skill sets that incorporated didactics, role-playing skills practice, and reflective feedback. Patient experience was measured using Press Ganey email surveys (PGS) that were collected for a minimum of 12 months pre-course and 3 months post-course. Results Forty-nine pediatric hematology/oncology providers voluntarily participated in the RCC skills workshop over a 3-year period. The majority of participants were physicians (77.6%), female (85.7%), and in the first 10 years of practice (61.2%). Of the 15 participants who had both pre- and post-course PGS available, scores significantly improved in all areas of the care provider section (P < 0.05). Conclusions RCC skills training improved pediatric hematology/oncology patient/family experience.

Introduction: Hyperhemolysis is a life-threatening condition of exaggerated hemolysis of red blood cells which occurs in patients receiving chronic transfusion therapy. Results: We present a 19-year-old male with β-thalassemia major with an episode of hyperhemolysis. Hemolysis was initially unresponsive to immunosuppression, but responded to with the addition of eculizumab. Several weeks after stabilization, hemolysis returned which was also successfully managed with immunosuppression and eculizumab. Discussion: Hyperhemolysis is unique in β-thalassemia due to the underlying dysfunctional erythropoiesis and transfusion dependence. Immunosuppression with eculizumab successfully slowed the hemolysis and allowed for resumption of transfusions.

Retroviral gene delivery is widely used in T cell therapies for hematological cancers. However, viral vectors are expensive to manufacture, they integrate genes in semi-random patterns, and their transduction efficiency is highly variable. In this study, several non-viral gene delivery vehicles, promoters, and additional variables were compared to optimize non-viral transgene delivery and expression in both Jurkat and primary T cells. Overall, transfecting Jurkat cells in X-VIVOTM 15 media with Lipofectamine LTX provided a high transfection efficiency (63.0±10.9% EGFP+). However, the same method yielded a much lower transfection efficiency in primary T cells (8.1±0.8% EGFP+). Subsequent confocal microscopy revealed that a majority of the lipoplexes did not enter the primary T cells, which might be due to relatively low expression levels of heparan sulfate proteoglycans (HSPGs) detected via mRNA-sequencing. PYHIN DNA sensors (e.g., AIM2, IFI16) were also expressed at high levels in Primary T cells, which can induce apoptosis when bound to cytoplasmic DNA. Therefore, transfection of primary T cells appears to be limited at the level of cellular uptake and/or DNA sensing in the cytoplasm, so both of these factors should be considered in the development of future viral and non-viral T cell gene delivery methods.

Data for visual acuity (VA) after treatment of neurofibromatosis type 1-associated optic pathway gliomas (NF1-OPGs) is limited. We retrospectively collected VA, converted to logMAR, before and after targeted therapy with everolimus for NF1-OPG, and compared to radiologic outcomes (14/18 with NF1-OPG, 25 eyes [3 without quantifiable vision]). Upon completion of treatment, VA was stable in 19 eyes, improved in 4 eyes, and worse in 2 eyes; visual and radiologic outcome were discordant. In summary, the majority of children with NF1-OPG exhibited stabilization of their VA after everolimus treatment. A larger, prospective study will help delineate visual outcomes after targeted therapy.

Population-level estimates of the survival of children from low- and middle-income countries diagnosed with solid tumors do not currently exist, in contrast to outcomes of hematologic and central nervous system cancers, which have been collated from population-based cancer registries and published by the CONCORD Programme. To fill this knowledge gap, we conducted a systematic review of PubMed Legacy, Embase, Web of Science, Cochrane Central Registry of Controlled Trials, and three regional databases for publications that reported survival of children diagnosed age 0-14 years with any malignancy from January 2011 to December 2016. The search identified 4695 original records; 51 articles met inclusion criteria. The range of survival reported was broad; for instance, 5-year overall survival for retinoblastoma ranged from 48% in Central America to 98% in China. However, the paucity of published statistics prevented approaches for meta-analyses and emphasizes the need for more standardized data collection and reporting.

A document by Ai Yamada. Click on the document to view its contents.

NTRK gene-fusions are rare but can occur in diverse cancers. The NTRK inhibitor larotrectinib is newly approved by the FDA. This paper reports the first case of a man with a NTRK-rearranged soft tissue sarcoma treated with larotrectinib in the neoadjuvant setting, in Belgium, to avoid limb amputation.