Introduction: Pulmonary sarcomatoid carcinoma is characterized by poor survival rates compared with other non-small cell lung cancer. Prognostic nutritional index has significant prognostic value in many malignant tumors. We conducted this retrospective study to investigate the role of prognostic nutritional index in patients with pulmonary sarcomatoid carcinoma and to determine prognostic factors. Methods: Of 8176 patients with resected lung cancer in a single high-volume institution between 2008 and 2015, 91 patients with pathologically diagnosed sarcomatoid carcinoma were included in our study and evaluated. Kaplan-Meier analysis and Cox regression analysis were conducted to analyze clinicopathologic data. Subgroup analysis of overall survival and recurrence-free survival among pulmonary sarcomatoid carcinoma patients were also conducted. Results: Univariate and multivariate analysis showed that, for OS, the pathological stage (HR: 2.464; 95%CI: 1.388-4.376; P=0.002) nodal metastasis (HR: 0.432; 95%CI: 0.201-0.927; P=0.031) and PNI (HR: 0.102; 95%CI: 0.050-0.207; P<0.001) were independent prognostic factors. And for RFS, We found PNI as an independent prognostic factor (HR: 0.078; 95% CI, 0.036–0.169; P<0.001), along with nodal metastasis (HR: 0.418; 95%CI, 0.193-0.906; P=0.027) and the pathological stage (HR: 2.448; 95%CI, 1.364-4.393; P=0.003). In the subgroup of patients with PNI≥49.4, univariate analysis showed treatment modality was a significant factor of overall survival (P=0.001); multivariate analysis showed patients received postoperative chemotherapy (HR: 0.288; 95%CI, 0.095-0.874; P=0.028) or postoperative chemotherapy with targeted therapy (HR: 0.148; 95%CI, 0.030-0.726; P=0.019) has better overall survival rates. Conclusion: The PNI and the pathological TNM stage are independent prognostic factors for pulmonary sarcomatoid carcinoma. PNI is an important indicator for the selection of postoperative adjuvant therapy. Patients with PNI ≥ 49.4 may benefit from postoperative chemotherapy and targeted therapy. We still need further prospective studies to confirm these results

Clintonia udensis is a perennial herb possessing two cytotypes diploid (2n=14) and tetraploid (4n=28). In the Hualongshan Mountains, the diploid of C. udensis primarily grows in 2450 m areas on the south slopes, while the tetraploid grows mainly in 1900 m areas on the north slopes. So, this intra-polyploidy is regarded as an excellent material to study the origination, evolution and adaption of plant polyploidy. Through field investigations and molecular genotyping, we initially analyzed the bud bank spatial characteristics, clonal growth, and spatial genetic structure populations between the different ploidy of C. udensis. It found that the rhizome knot styles of C. udensis had zigzag, C, V, and Y models between the two cytotypes. There was no dominated clone present in the diploid or tetraploid. The clone architectures of two ploidies were both phalanxes. However, the number of rhizome knots, the number of buds of each rhizome knot, the ratio of rhizome branches, and average tetraploid clones were higher than that of the diploid. The diversity indices of the tetraploid, such as clone diversity index, genetic distribution uniformity, and genetic diversity index, were also slightly higher than that of the diploid. Thus, clonal reproduction differentiation and significant genetic variations occurred between the diploid and tetraploid of C. udensis. These two cytotypes, through seed reproduction and clonal growth, became a facultative clonal species and maintained its survival stability and reproduction. During the evolutionary process, the tetraploid of C. udensis with higher clonal diversity and genetic diversity responded and adapted to new surroundings that different from the ancestral diploid in the Hualongshan Mountains.

In late December 2019, Chinese citizens of the city of Wuhan, China, had shown symptoms of viral pneumonia that were not very common, with various presentations with different grades of severity, and poor response to the regular treatment. With tremendous clinical and research work, the causative of the disease outbreak has been identified as COVID-19 and has been recognized as the novel coronavirus (SARS-CoV-2), which later continued to make the headlines when the World Health Organization announced it as a pandemic on March 11, 2020, after it had hit many parts in the globe with worrying rates of morbidity and mortality. Although available data has expressed that moderate or even mild forms of the disease are expected amongst most of the pediatrics cases, very limited data are available on the prognosis and the complications of the disease on the immunocompromised, especially oncology patients. We report a case of relapsed Precursor B-cell acute lymphoblastic leukemia (ALL) of a child with Down syndrome (DS) and COVID-19 and outline the treatment regimen that we used.

Rheumatoid arthritis(RA) is a chronic systemic autoimmunediseasecharacterized by synovitis and the destruction of small joints.Emerging evidence had shown thatthe stimulation of immunoglobulin D (IgD) induced T cell activation which may contribute to diseases pathogenesis in RA.In this study we demonstrated that IgD could induce the activation of T cells through affecting IgDR-Lck-ZAP70- PI3K-NF-κB signaling, IgD-induced CD4+T cells promoted the proliferation of CD19+B cells in RA patients. IgD-Fc-Ig fusion protein (composed of human IgD Fc domain and IgG1 Fc domain, specifically blocks the IgD-IgDR pathway)inhibited the co-expression of IgDR and p-Lck and the expressions of p-Lck, p-ZAP70, p-PI3K on CD4+T cells, and decreased NF-κB nuclear translocation in Jurkat cells. Meanwhile, IgD-Fc-Ig down-regulated the protein expressions of CD40L on CD4+T cells and CD40, CD86 on CD19+B cells in RA patients and healthy controls. It also decreased the protein expressions of CD40L on CD4+T cellsand CD40 on CD19+B cells from spleens of CIA mice and reduced IL-17A level in mouse serum. Moreover, in vivo, IgD-Fc-Ig administration dose-dependently down-regulated the protein expressions of CD40, CD40L and IgD in spleens from CIA mice. IgD-Fc-Ig restrains the activations of T cells through inhibiting IgD-IgDR-Lck-ZAP70- PI3K-NF-κB signaling, thus inhibiting the activation of B cells.Our data provides experimental evidence for application prospect of IgD-Fc-Ig as a highly selective targeting T cell treatment for RA.

Background: FESS encompasses numerous component procedures including antrostomy, ethmoidectomy, sphenoidotomy and frontal sinusotomy. The extent of FESS procedure will vary between patients depending on indications, imaging and surgical experience. Each procedure is remunerated according to procedural components with each component assigned an OPSC-4 cost code. In NHS hospitals, this relies on clinical coders’ interpretation from the operation note, and may potentially be subject to incorrect coding and remuneration. Background: We have devised a FESS documentation tool which includes a tick box system for each component and allied procedures performed, together with relevant OPSC-4 codes.The aim of this novel FESS operation note is to improve accuracy of coding for procedures, avoid misinterpretations and ensure accurate remuneration for FESS procedures. Design: Retrospective quality improvement study. Methods: The tool was implemented in our hospital in April 2019. Codes and costs applied to each patient undergoing FESS for a 6-month period between April to October 2019 were compared for all cases performed during the same 6 month period in 2018. Data review of coding information was performed between the two time periods including T-test analysis to calculate for statistical significance. Results: 66 patients underwent FESS in 2018 compared to 70 patients in 2019, during the equivalent 6 month period. The tool was not used in two cases in the 2019 cohort. In 2018, the average cost applied to each FESS case was £1,676, compared to £1,953 per patient in the 6 months after the tool was implemented. This resulted in an average uplift of £277 in revenue per patient where the tool was used (p=0.003), due to more accurate capture and coding of FESS component parts. On average ,approximately 140 patients undergo FESS per year in our department; using the newly devised FESS documentation tool, we can estimate a potential increase in revenue of £38,780 per annum for FESS procedures alone. Conclusion: Our novel documentation tool has improved the clarity of recording endoscopic sinus surgery allowing more accurate interpretation and application of OPSC-4 coding. It also aids in understanding complex composite procedures and can be extended to other surgical specialties.

Objective: The aim of this meta-analysis was to compare the safety and efficacy of second-generation and first-generation drug eluting stents (DES) for the treatment of left main coronary artery (LMCA) stenosis. Background: Studies have evaluated the safety and efficacy of between second-generation and first-generation DES in LMCA stenosis patients and the results of these studies were inconsistent. Methods: PubMed, EmBase and Cochrane Library were searched to identify eligible studies comparing the safety and efficacy of second-generation DES and first-generation DES for the treatment of LMCA stenosis. Odds ratios (ORs) with 95% confidence intervals (CIs) were used to summary the estimates. Results: We identified 11 studies (1 was RCTs and 10 were observational studies) involving 4345 LMCA patients who treated with second-generation and first-generation DES. Second-generation DES had lower risk of MACE (15.4% vs.18.5%; OR 0.69 (0.52, 0.91); P=0.009), stent thrombosis (1.1% vs.2.4%; OR 0.46 (0.28, 0.74); P＝0.001) , TVR (6.8% vs.13.4%; OR 0.48 (0.35, 0.66); P＜0.0001) , and MI (1.6% vs.3.5%; OR 0.58 (0.35, 0.94); P=0.03) compared with first-generation DES. There were no differences in the risks of all-cause mortality (6.8% vs.7.9%; OR 0.88 (0.68, 1.15); P=0.36), cardiac mortality (3.4% vs.4.5%; OR 0.73 (0.51, 1.03); P=0.07), and TLR (8.7% vs.7.8%; OR 1.09 (0.86, 1.39); P=0.48) between second-generation and first-generation DES. Conclusions: In LCMA patients, compared with first-generation DES, second-generation DES was associated with lower risk of MACE, stent thrombosis, TVR, and MI. No differences were found with respect to all-cause death, cardiac death, and TLR. Key words: Second-generation stents; Drug-eluting stents; Percutaneous coronary intervention; Left main; Meta-analysis

We present a case of koebner phenomenon induced by friction, caused by tightness of ear loops of face mask, used as protective measure against spreading COVID-19 infection.

In modern society, cardiovascular disease remains the biggest single threat to life, being responsible for approximately 1/3 of worldwide deaths. Male prevalence is significantly higher than that of women until after menopause, when the prevalence of CVD increases in females until, over the age of 80, it eventually exceeds that of men. Because of the coincidence of CVD prevalence increasing after menopause, the role of estrogen in the cardiovascular system has been intensively researched during the past 2 decades in vitro, in vivo and inobservational studies. Most of these studies suggested that endogenous estrogen confers cardiovascular protective and anti-inflammatory effects. However, clinical studies of the cardioprotective effects of hormone replacement therapies (HRT) not only failed to produce proof of protective effects, but also revealed the potential harm estrogen could cause. The “critical window of hormone therapy” hypothesis affirms that the moment of its administration is essential for positive treatment outcomes, pre-menopause (3-5 years before menopause) and immediate post menopause being thought to be the most appropriate time for intervention. Since many of the cardioprotective effects of estrogen signaling are mediated by effects on the vasculature, this review aims to discuss the effects of estrogen on vascular smooth muscle cells (VSMCs) and endothelial cells (ECs) with a focus on the role of estrogen receptors (ERα, ERβ and GPER) in triggering the more recently discovered rapid or membrane delimited (non-genomic) signaling cascades that are vital for regulating the vascular tone, preventing hypertension and other cardiovascular diseases.

Diberyllium complexes with an ultrashort metal–metal distance (USMMD, dM–M < 1.900 Å) are fascinating for the nature of the valence electronic structure of beryllium. In this paper a family of diberyllium complexes, in which Be2H3+ was coordinated by N-heterocyclic carbenes or mesoionic carbenes, were studied using density functional theory which generated an ultrashort Be–Be distance of 1.754–1.779 Å. Based on bonding nature and electronic structure studies, the ultrashort Be–Be distance was attributed to multiple bonding orbitals and directly orbital overlapping between the two beryllium atoms. These diberyllium complexes exhibited great stability with large HOMO-LUMO gaps and high dissociation energies, and were potential targets in future experiments.

Extreme weather events are increasing in frequency and intensity due to global climate change. We hypothesized that these have a strong impact on the stem radial growth and the dynamic of non-structural carbohydrates (NSCs). In order to assess the effects on mature trees of a late frost occurred in spring 2016 and a drought event characterizing the summer 2017, we monitored the phenology, the radial growth and the dynamic of starch and soluble sugars in a Mediterranean beech forest. Growth was much more reduced by spring late frost than by summer drought, while NSCs dynamic was deeply involved in counteracting the negative effects of both events, supporting plant survival and buffering source-sink imbalances under such stressful conditions, resulting in a strong trade-off between growth and NSCs dynamic in trees. Overall, our results highlight the key role of NSCs on trees resilience to extreme weather events, confirming the relevant adaptability to stressful conditions. Such an insight is useful to assess how forests may respond to the potential impacts of climate change on ecosystem processes and to define how future management strategies can help adaptation of beech forests in the Mediterranean area.

In order to study the fatigue damage and cycle life of TC4 titanium alloy for aero-engine blade under various load conditions, uniaxial fatigue, multi-stage loading and multiaxial fatigue tests were carried out on the titanium alloy sample. For uniaxial fatigue, the damage and life distribution of the alloy under different stress ratios and mean stresses were counted by axial fatigue test. In view of the shortcomings of the linear damage model, based on the Chaboche nonlinear damage model, the nonlinear damage evolution equation of TC4 titanium alloy was derived and the parameters were fitted. For multiple variable amplitude loadings, the calculation method of equivalent cycle number was deduced. The relationship between loading sequence and cumulative damage was studied. For multiaxial fatigue, 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. According to the simulation results of flow field of compressor blade under maximum continuous working condition, the stress time history of compressor blade was calculated. Based on the stress intensity interference model, the residual strength model of TC4 material was described. Combined with 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.

In newest development, waste is being refined into a biofuel or being recycled. This is to say lots of works has done to turn or transform waste into useful materials. Waste management has being an important factor in community development. Therefore, data base must be developed to know the amount of waste accumulated or generated over a given period of time. Taken into consideration the incremental factor, degradable waste ratio and burning and recycle reduction factor. This paper look for a mathematical formula that can be used to generate data for amount of solid waste accumulated over time for geographical location in respect of mass.

In this paper, we study the following nonlinear Schrödinger-Bopp-Podolsky system: −∆u + u + l(x)φu = a(x)|u|p−2u + µb(x)|u|q−2u + |u|5, in R3, −∆φ + a2∆2φ = l(x)u2, in R3, where p,q ∈ (4,6), µ > 0, l(x), a(x) and b(x) are nonnegative continuous functions. Under some certain assumptions, we prove the above system have ground state and multiple solutions by using variational.

Objective Studies restricted to live births may underestimate severe teratogenic effects. We address the limitation by including data from both prenatal and postnatal diagnoses of cardiac malformations. Design Register-based study. Setting Denmark. Population 364,012 singleton pregnancies from 2007 to 2014. Methods We used data from five nationwide registries. Exposure to antidepressants was measured using redeemed prescriptions. Main Outcome Measures Pregnancies with cardiac malformations that end in miscarriage, termination, stillbirth, postnatal death or cardiac surgery <1 year of birth were classified as severe cardiac malformations (SCM). Propensity scores with adjusted prevalence ratios (PRs) were calculated. Results SCM were reported in 972 / 364 012 pregnancies overall and in 16 / 4105 exposed. PRs for SCM were 1.09 (95%CI: 0.52-2.30) for selective serotonin reuptake inhibitors (SSRIs) and 2.13 (95%CI: 0.89-5.13) for venlafaxine. Among the venlafaxine-exposed pregnancies, there was a cluster of hypoplastic left heart syndromes (HLHS) (crude PR 17.4 (95%CI: 6.41-47.2)) of which none ended in a live birth. For HLHS, the absolute risk increase was 4.4 per 1000, the number needed to harm (NNH) was 225. PRs for cardiac malformations not classified as SCM were 1.38 (95%CI: 1.00-1.92) for SSRIs, and 1.73 (95%CI: 1.08-2.77) for venlafaxine. Conclusions Pregnancy exposure to venlafaxine, but not SSRIs, is associated with an increased risk of SCM but with a low absolute risk. Potential mechanisms include direct effects or confounding by indication. Venlafaxine exposure is a marker for risk pregnancies for which fetal echocardiography may be considered. Keywords pregnancy, antidepressants, SSRI, venlafaxine, prenatal ultrasound, selection bias

Characterization of microbial assemblages via environmental DNA metabarcoding is increasingly being used in routine monitoring programs due to its sensitivity and cost-effectiveness. Several programs have been developed recently which infer functional profiles from 16S rRNA gene data using hidden-state prediction (HSP) algorithms. These might offer an economic and scalable alter-native to shotgun metagenomics. To date, HSP-based methods have seen limited use for benthic marine surveys and their performance in these environments remains unevaluated. In this study, 16S rRNA metabarcoding was applied to sediment samples collected at 0 and ≥ 1200 m from Norwegian salmon farms, and three metabolic inference approaches (PAPRICA, PICRUSt2 and TAX4FUN2) evaluated against metagenomics and environmental data. While metabarcoding and metagenomics recovered a comparable functional diversity, the taxonomic composition differed be-tween approaches, with genera richness up to 20× higher for metabarcoding. Comparisons between the sensitivity (highest true positive rates) and specificity (lowest true negative rates) of HSP-based programs in detecting functions found in metagenomics data ranged, respectively, from 0.52 and 0.60 to 0.76 and 0.79. However, little correlation was observed between the relative abundance of their specific functions. Functional beta-diversity of HSP-based data was strongly associated with that of metagenomics (r ≥ 0.86 for PAPRICA and TAX4FUN2) and responded similarly to the impact of fish farm activities. Our results demonstrate that although HSP-based metabarcoding approaches provide a slightly different functional profile than metagenomics, partly due to recovering a distinct community, they represent a cost-effective and valuable tool for characterizing and assessing the effects of fish farming on benthic ecosystems.

Background: Platelet-activating factor (PAF) has a direct role as a mediator in the pathogenesis of various disorders with an inflammatory component, including those with allergic aetiology. The peripheral blood concentration of PAF is dynamically regulated by plasma PAF acetylhydrolase (PAF-AH). Previous studies suggest that low activity of plasma PAF-AH could be a predictive marker for increased severity of some types of allergic hypersensitivity reactions – especially anaphylaxis. Aim of the study: The purpose of the study was to evaluate the association between plasma PAF-AH activity and severity in patients with anaphylactic reactions following a wasp or bee sting. Methods: The study group of 89 patients was divided into two subgroups depending on the increasing severity of the most severe anaphylactic reaction in the past, which was assessed according to the Müller’s scale. A control group of 20 people was established. Plasma PAF-AH activity was measured using a colorimetric method. Results: It has been observed that plasma activity of platelet-activating factor acetylhydrolase was significantly lower in patients with anaphylaxis history compared to the control group with negative atopic history (on average 21.38 nmol/min/ml for the control group, 9.47 nmol/min/ml for the first subgroup and 10.16 nmol/min/ml for the second subgroup, in both cases p < 0.0001). Conclusion: The plasma activity of PAF-AH is a promising parameter that can help to distinguish a group of patients not threatened with development of anaphylaxis and not requiring laborious or expensive prophylactic procedures.

The nutritional diversity of resources can affect the adaptive evolution of consumer metabolism and consumer diversification. Omega-3 long-chain polyunsaturated fatty acids (n-3 LC-PUFA) have a high potential to affect consumer fitness, through their widespread effects on reproduction, growth, and survival. However, few studies consider the evolution of fatty acid metabolism within an ecological context. In this review, we first document the extensive diversity in both primary producer and consumer n-3 LC-PUFA distributions among major ecosystems, between habitats, and among species within habitats. We highlight some of the key nutritional contrasts that can shape behavioral and/or metabolic adaptation in consumers, discussing how consumers can evolve in response to the spatial, seasonal, and community-level variation of resource quality. We propose a hierarchical trait-based approach for studying the evolution of consumers’ metabolic networks, and review the evolutionary genetic mechanisms underpinning consumer adaptation to n-3 LC-PUFA distributions. In doing so, we consider how the metabolic traits of consumers are hierarchically structured, from cell membrane function to maternal investment, and have strongly environment-dependent expression. Finally, we conclude with an outlook on how studying the metabolic adaptation of consumers within the context of nutritional landscapes can open up new opportunities for understanding evolutionary diversification.

We report a case of 66-year-old female patient who presented with unstable angina and New York Heart Association Class III symptoms. Transthoracic Echocardiogram demonstrated severe wall motion abnormalities in the anterior and inferior walls of the heart. Coronary angiography demonstrated a severely diseased right coronary artery and an anomalous left main coronary artery arising from the opposite coronary sinus and courses posterior to the aorta and runs between the aorta and the main pulmonary artery with severe multiple atherosclerotic disease. Patient underwent successful coronary artery bypass grafting and was dismissed in good general status.

Aortopulmonary Window is a rare congenital heart defect comprising 0.1-0.2% of the total spectrum. Spontaneous closure of this defect is unknown and survival into childhood and adult life is rarely seen. Severe pulmonary artery hypertension develops and causes dilatation of the pulmonary artery. Left main coronary artery extrinsic compression by an enlarged pulmonary artery is a rare complication and a potential cause for chest pain and sudden cardiac death in patients with pulmonary hypertension.

Plant growth depends on the diurnal regulation of cellular processes, but it is not well understood if and how transcriptional regulation controls diurnal fluctuations at the protein-level. Here we report a high-resolution Arabidopsis thaliana (Arabidopsis) leaf rosette proteome acquired over a 12 h light : 12 h dark diurnal cycle and the phosphoproteome immediately before and after the light-to-dark and dark-to-light transitions. We quantified nearly 5000 proteins and 800 phosphoproteins, of which 288 fluctuated in their abundance and 226 fluctuated in their phosphorylation status. Of the phosphoproteins, 60% were quantified for changes in protein abundance. This revealed six proteins involved in nitrogen and hormone metabolism that had concurrent changes in both protein abundance and phosphorylation status. The diurnal proteome and phosphoproteome changes involve proteins in key cellular processes, including protein translation, light perception, photosynthesis, metabolism and transport. The phosphoproteome at the light-dark transitions revealed the dynamics at phosphorylation sites in either anticipation of or response to a change in light regime. Phosphorylation site motif analyses implicate casein kinase II and calcium/calmodulin dependent kinases among the primary light-dark transition kinases. The comparative analysis of the diurnal proteome and diurnal and circadian transcriptome established how mRNA and protein accumulation intersect in leaves during the diurnal cycle of the plant.

In this paper, we present splitting methods that are based on iterative schemes for stochastic differential equations. The methods are applied to plasma simulations. The motivation arose from solving problems involving Coulomb collisions, which are modeled by nonlinear stochastic differential equations. We apply Langevin equations to model these collisions and we obtain coupled nonlinear stochastic differential equations, which are difficult to solve. We propose stochastic splitting schemes that generalise well-known deterministic splitting schemes. The benefit of decomposing the equations into different parts and solving each part individually is taken into account in the analysis of the new iterative splitting schemes. The increase in the convergence order of the iterative splitting scheme with the number of iteration steps is an important and valuable property. The numerical analysis and applications to various problems involving Coulomb collisions in plasma applications are presented, and show the benefits of the iterative splitting schemes.

Size and shape profoundly influence an organism’s ecophysiological performance and evolutionary fitness, suggesting a link between morphology and diversity. However, not much is known about how body shape is related to taxonomic richness, in particular in the microbial realm. Here we analyse global datasets of unicellular phytoplankton, a major photosynthetic group with an exceptional diversity of cell sizes and shapes. Using two measures of cell shape elongation, we quantify taxonomic diversity as a function of cell size and shape. We find that cells of intermediate volume have the greatest shape variation, from oblate to extremely elongated forms, while small and large cells are mostly compact (e.g., spherical or cubic). Taxonomic diversity is strongly related with cell elongation and cell volume, with both traits, in combination, explaining up to 92% of total variance. Diversity decays exponentially with cell elongation and displays a log-normal dependence on cell volume, peaking for compact, intermediate-volume cells. These previously unreported broad patterns in phytoplankton diversity reveal selective pressures and ecophysiological constraints on the geometry of phytoplankton cells which may improve our understanding of marine ecology and the evolutionary rules of life.

Objective: To compare the number of units of red blood cells (RBCs) transfused in patients with placenta accreta spectrum (PAS) treated with or without a multidisciplinary algorithm including placental uterine arterial embolisation (P-UAE) and a selective use of delayed hysterectomy. Design: Retrospective review Setting: Tertiary care hospital, United States, 2001-2018 Population: Women with histologically-confirmed PAS delivered after 24 weeks gestation Methods: Comparison of transfusion outcomes among PAS cases managed with versus without a multidisciplinary algorithm. To improve the equity of comparison, analyses were made separately among scheduled and unscheduled cases. Subjects were assigned to one of four cohorts: scheduled/per-algorithm, scheduled/off-algorithm, unscheduled/per-algorithm, or unscheduled/off-algorithm. P values were adjusted for multiple testing. Main outcome measures: RBCs transfused and estimated blood loss (EBL). Secondary outcomes included peri-operative complications and intensive-care unit admissions. Results: 87 subjects were identified: 36 treated per-algorithm (30 scheduled, 6 unscheduled), 51 off-algorithm (24 scheduled, 27 unscheduled). Among scheduled deliveries, 9 (30.0%) subjects treated per-algorithm received RBCs, compared to 20 (83.3%) subjects treated off-algorithm (p<0.01), with a median (interquartile range[IQR]) of 3.0 (2.0, 4.0) and 6.0 (2.5, 7.5) units transfused (p=0.13), respectively. Among unscheduled deliveries, 5 (83.3%) subjects treated per-algorithm were transfused RBCs compared to 25 (92.6%) off-algorithm (p=0.47), with a median (IQR) of 4.0 (2.0, 6.0) and 8.0 (3.0, 10.0) units transfused (p=0.47), respectively. Peri-operative complications were similar between cohorts. Conclusions: A multidisciplinary algorithm including P-UAE and selective use of delayed hysterectomy is associated with a lower rate of blood transfusion in scheduled but not unscheduled cases.

Autoimmune neutropenia (AIN) in childhood is characterized by chronic neutropenia and positivity for antineutrophil antibodies, resulting in the excessive destruction of neutrophils. In this study, we investigated the involvement of regulatory T cells (Tregs) in the pathogenesis of AIN in childhood. Tregs have been classified into three subpopulations based on the expressions of CD45RA and FOXP3: resting Tregs, activated Tregs, and non-suppressive Tregs. The frequency of activated Tregs (CD4+CD25+FOXP3highCD45RA− T cells) as well as that of total Tregs (CD4+CD25+FOXP3+ T cells) in peripheral blood was significantly decreased in patients with AIN. Analysis of the T cell receptor (TCR)-Vβ repertoire of CD4+ T cells revealed skewed usages in patients with AIN compared with that observed in age-matched control subjects. Regarding T cell subsets, the use of four of 24 TCR-Vβ families in Tregs and one in conventional T cells were increased in patients with AIN. The number of patients with AIN who showed skewed usages of TCR-Vβ family in conventional and Tregs was significantly higher than that reported in control subjects. When the preference between Tregs and conventional T cells in each TCR-Vβ family was individually compared, different use was prominently observed in the TCR-Vβ 9 family in patients with AIN. These results suggest that the quantitative abnormalities of Tregs and the skew of the TCR-Vβ repertoire in CD4+ T cells, including Tregs and conventional T cells, may be related to autoantibody production through a human neutrophil antigen-reactive T cell clone.