BACKGROUND: Nav1.5, which is encoded by the SCN5A gene, is the predominant voltage-gated Na+ channel in the heart. Several mutations of this gene have been identified and have been reported to be involved in several cardiac rhythm disorders, including type 3 long QT syndrome (LQT3), that can cause sudden cardiac death. We analyzed the biophysical properties of two novel variants of the Nav1.5 channel (Q1491H and G1481V) detected in 5- and 12-week-old infants diagnosed with a prolonged QT interval. METHODS: The Nav1.5 wild-type (WT) and the Q1491H and G1481V mutant channels were reproduced in vivo. WT or the mutant channels were co-transfected in HEK 293 cells with the beta 1 regulatory subunit. Na+ currents were recorded using the whole-cell configuration of the patch-clamp technique. RESULTS: The Q1491H mutant channel exhibited a lower current density, a persistent Na+ current, an enhanced window current due to a +20-mV shift of steady-state inactivation, a +10-mV shift of steady-state activation, a faster onset of slow inactivation, and a recovery from fast inactivation with fast and a slow time constants of recovery. The G1481V mutant channel exhibited an increase in current density and a +7-mV shift of steady-state inactivation. The observed defects are characteristic of gain-of-function mutations typical of LQT3. DISCUSSION AND CONCLUSION: The 5- and 12-week-old infants displayed prolonged QT intervals. Our analyses of the Q1491H and G1481V mutations correlated with the clinical diagnosis. The observed biophysical dysfunctions associated with both mutations were most likely responsible for the sudden deaths of the two infants.

Is Otsu Thresholding the Answer to Reproducible Quantification of Left Atrial Scar from Late Gadolinium-Enhancement MRI?Suvai Gunasekaran, PhDa, Daniel Kim, PhDa,ba Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, IL, United Statesb Department of Biomedical Engineering, Northwestern University, Evanston, IL, United StatesPlease send correspondence to:Daniel Kim, PhDDepartment of RadiologyNorthwestern University737 N. Michigan Avenue Suite 1600Chicago, IL 60611 daniel.kim3@northwestern.edu O:312.926.1733 F:312.926.5991

Wrasses are distributed worldwide in coral reef environments, and display a specialized feature of paired pharyngeal bones united into a single jawbone. Among wrasses, Cheilinus undulatus is an endangered species with high economic and ecological values. Here, we present genome assembly of C. undulatus, using Illumina, Nanopore, and Hi-C sequencing. The 1.17 Gb genome was generated from 328 contigs with an N50 length of 16.5 Mb, and anchored to 24 chromosomes. A total of 22,218 genes were functionally annotated, and 96.36% of BUSCO genes were completely represented. Transcriptomic analyses showed to express 96.79% of the predicted gene. Transposons were most abundant, accounting for 39.88% of genome, with low divergence, owing to evolve with close species approximately 58.37 million years ago, and 560/1,848 gene families were expanded and contracted in the reconstructed phylogeny, respectively. Additionally, 46 genes underwent positive selection. Comparative genomic analyses with other fishes revealed unexpected expansion of opsins SWS2, LWS1, and Rh2, showing single-gene expansion up to five copies in tandem arrays. Gene conversion was responsible for abundance of opsin specific for C. undulatus, and the uneven distribution of transposons in opsin windows and adjacent windows probably contributed to gene conversion, providing gene function fluidity. Divergence of opsin expression in tissues indicated alternative adaptations of the increased opsin copies for the visual foraging and sexual behavior. Genome sequencing of the humphead wrasse provides valuable resources for future investigation of conservation, evolution, and functional morphology of fishes.

Plastid genomes are unique to plants and play an important role in genomics and evolutionary biology. Next-generation sequencing has revolutionized plastid genome data acquisition in a way that genome assembly and annotation became bottlenecks for large plastid genome data usage. Here we develop a novel open-source, cross-platform tool, NOVOWrap, with both command-line and graphical user interfaces for plastid genome automatic assembly using personal computers. With minimum inputs and user intervention, NOVOWrap could automatically assemble plastid genomes, validate results and standardize the structure with affordable computer resources. The performance of the software has been successfully benchmarked against eleven plastid genomes of species belonging to lycopods, gymnosperms, and angiosperms. The program is expected to liberate researchers from laborious computer manipulations and create reliable and standard genomic data.

Apoptotic signaling pathway is obviously disordered in systemic lupus erythematosus (SLE). The contemporaneous occurrence of enhanced apoptosis and impaired phagocytosis lead to the cumulative exposure to autoantigens, resulting in autoantibody production and autoimmunity. Natural IgM (nIgM) plays a key role in the clearance of apoptotic cells and prevents them from inducing abnormal autoimmunity. B-1 cells and innate-like B cells (ILBs) are proved to be the major producer of natural IgM. Human CD27+IgD+B cells, also termed as un-switched memory B cells, are recently proposed to be a kind of ILBs. However, functional features and characteristics of these cells in SLE remain poorly understood.In this study, we find that in SLE patients the frequencies of CD27+IgD+B cells are significantly decreased. Moreover, these cells are functionally impaired in producing natural antibody-like IgM. These CD27+IgD+B cells are negatively correlated with SLE patient clinical and immunological features. After effective therapy with disease remission in SLE, the frequencies of these cells could be recovered. Taken together, our results suggest that the dysfunction of CD27+IgD+B cells potentially contribute to the exacerbation of SLE, and modulating the features of these cells might provide therapeutic target for this persistent disease.

The COVID-19 pandemic has caused an unprecedented public health, social, and economic crisis. Improving understanding on available tests for detecting COVID-19 is critical for effective management of the pandemic. We proposed that a multidisciplinary expert panel can establish recommendations on ideal use of diagnostic tools, with a focus on RT-PCR and serological high-affinity antibodies (both IgM and IgG) tests for the Latin America region. STUDY DESIGN: A collaborative multidisciplinary panel of 5 recognized experts in Latin America (an infectious disease specialist, three pathologists and an immunologist) was convened and supported by Roche Diagnostics to develop standard guidelines and an evidence-based document of best practices on the use of diagnostic tools for COVID-19. RESULTS: The authors reached consensus on the applicability of diagnostic tools to provide testing algorithms for the use of RT-PCR and serological high-affinity antibodies (both IgM and IgG) tests in three settings: 1) For asymptomatic subjects exposed to a SARS-CoV-2 infected person; 2) For epidemiological purposes and; 3) For symptomatic subjects. CONCLUSION: The serological high-affinity SARS-Cov-2 antibodies (both IgM and IgG) tests play a key role in COVID-19 diagnosis. These tests can be applied for suspected false-negative RT-PCR results and for individual determination of response. The use of these tests can also contribute greatly to public health strategies, such as population screening and supporting vaccination planning. Serological status for high-affinity antibodies (both IgM and IgG) should be performed ideally 21 days after potential infectious contact, given that the majority of exposed individuals will have seroconverted.

The Salmonella enterica subspecies serovar Enteritidis is the one of main serovars isolated from human patients with food poisoning and poultry without clinical signs. Consumption of poultry products contaminated with Salmonella Enteritidis is a common source of human salmonellosis. This study was aimed to determine the genetic relationships between Salmonella Enteritidis strains isolated from human patients and those isolated from poultry sources using whole-genome sequencing analysis. Seven of multi-drug resistant (MDR) strains of Salmonella Enteritidis were isolated from 234 retail chicken meats, internal organs of chicken, and straw bedding samples at chicken farms. Whole genome sequences of the MDR strains were determined using the Oxford Nanopore sequencing and compared with available whole genome sequences of the Salmonella Enteritidis strains previously isolated in Korea. Single-nucleotide polymorphism analysis of the whole genomes showed that all MDR Salmonella Enteritidis strains were genetically close and related to the FORC_019 strain isolated from human blood in 2015 in Korea. All of the MDR Salmonella Enteritidis strains contained a 110 kb of plasmid, and comparative plasmid analysis showed that all of the MDR Salmonella Enteritidis strains carried a novel fusion plasmid with genes coding virulence factors and antibiotic resistance proteins. The almost identical plasmid, with an extra 7.5-kb insertion sequence was also found in the FORC_019 strain. These results suggested that the single genetic lineage of MDR Salmonella Enteritidis that can cause salmonellosis in human is currently contaminating the Korean poultry industry.

Invasive ants shape assemblages and interactions of native species, but their effect on fundamental ecological processes is poorly understood. In East Africa, the big-headed ant (Pheidole megacephala) invades monodominant stands of the ant-tree Acacia drepanolobium, displacing native ant defenders and rendering trees vulnerable to elephants (Loxodonta africana) and other browsing ungulates. We quantified A drepanolobium photosynthesis and transpiration pre- and post-invasion by P. megacephala. After ca. 5 years, ant invasion resulted in 69% lower whole-tree carbon fixation during the growing season, despite shorter-term (< 1 year) positive effects on photosynthetic rates coinciding with the displacement of energetically costly native ants. By experimentally excluding ants and large herbivores, we demonstrate that reduced carbon fixation resulted largely from browsing on trees by large herbivores in invaded areas. Our results from individual trees likely scale up, highlighting the potential of invasive species to alter carbon fixation and other biogeochemical cycles at ecosystem scales.

Shared decision making (SDM) is a model of communication processes that facilitate cooperative decision making between a patient and medical practitioner regarding treatment. The use of assessment instruments is an important way to gain insight into the practice of SDM. In order to fully utilize the various assessment tools available for use, it is important to not only reveal what instruments are used to measure SDM but also shed light on which aspects of SDM are captured by different instruments. However, the instruments currently used to measure SDM are unclear, as are the aspects of SDM processes each instrument reflects. So that, we reviewed assessment instruments used in studies on SDM with the aim of clarifying what aspects of SDM processes each instrument was intended to capture in this study. As a result, we identified 16 assessment instruments used in 115 articles concerning SDM as the main theme. The most commonly used instrument was the OPTION scale, followed by SDM-Q-9. Step 4 (“informing on the benefits and risks of the options”) was covered by most instruments, followed by Step 5 (“investigation of the patient’s understanding and expectations”). In the future, assessment instruments for SDM will likely be used primarily in areas in which there is considerable uncertainty about evidence, and where multiple options exist. When you assess SDM, it is necessary to be able to select the evaluation indicator that suits the purpose.

Abstract Rationale aims and objectives Physiotherapy is recommended for cervicogenic headache (CGH) with 4% of headache patients currently referred to secondary care. The aim of this service evaluation was to explore knowledge of CGH signs and symptoms (SS) and headache red flags (HRF) among musculoskeletal (MSK) physiotherapists during a headache training session. This session was identified as a training need by the learning and development team following a previous headache training session. Post training, treatment choices and patient outcomes for 10 patients were explored as recommended by an Audit Committee. METHOD Nine physiotherapists undertook a 3-hour training session on headaches, completing an HRF/SS questionnaire focused on CGH, before and after training. Post training, 10 CGH patient were assessed and treated by participants. Treatment choices were compared with current best practice and patient outcomes were collected, using the Neck Pain Bournemouth questionnaire (NP BQ). Treatment data was gathered via an electronic patient record system between June 2016 and August 2017. Results Prior to training, participants achieved a correct answer frequency of 58% and 64% for HRF and SS respectively. Post training, this increased to 87% and 91% respectively. Post treatment, 70% of patients had an improvement of over 80% and 30% had an improvement of between 30% and 43%. In terms of modalities used, 40% of participants received acupuncture and 12% had manual therapy. Advice was given to 5.8% and 4.6% used exercises. Soft tissue massage and balance were used in 2.3% an 1.2% respectively. Conclusion Clear training needs were identified initially, and knowledge improved after training, together with evidence-based choices for treatments. All patient symptoms improved during care.

Do Tigers like Politics?Aishwarya Maheshwari1* and Rajeev Maheshwari21Department of Wildlife Sciences, College of Forestry, Banda University of Agriculture and Technology, Banda-210001, Uttar Pradesh, India (ORCID: 0000-0002-6338-4254).*Corresponding author: aishwaryamaheshwari@icloud.com2Independent Political Analyst, India.In the geopolitically globalised world, political decisions and anthropogenic activities have a direct influence on the survival of wildlife and their interactions with human (1, 2 ). In such scenario, continuous decline in wildlife has generally been as “non-political” amongst political parties (2, 3 ). In the disastrous deterioration of wildlife, increase in number of a globally threatened flagship species (such as tiger Panthera tigris ) appears a rare phenomenon in India (4 ). Moreover, such recovery of a large predator entails with healthier natural ecosystems, as a whole and indicates sensible and timely political decisions.Wildlife conservation is a global environmental concern and inherently politically complex in most parts of the world (5, 6 ). Political parties are the key actors shaping wildlife policies both at national and international level (2, 7 ). As relation between wildlife and politics has for long been a close one in India (3, 8 ). The pre-historic Hindu mythological beliefs are evident with association of the Gods and Goddesses with different vahanas (animal vehicles) in antiquity and epics such as Ramayana and Mahabharata gave protection to wild species (8 ). In recent decades, world has come to recognize the central importance of wildlife to humanity in terms of the crucial contribution it makes to the cultural, economic, spiritual and social well-being of communities worldwide (9 ). For example, recent recognition of India’s tiger census in 2018 has earned the Guinness Book of World Records for being the world’s largest camera-trap wildlife survey and based on the recent knowledge accumulated over the years, India has over 80% of world’s tiger population (4, 10 ). Tiger population in India has remarkably increased over the previous decade, with over 110% since 2006, systematic all India tiger estimation exercise revealed recent numbers ranging around 2603 to 3346 (4 ). The knowledge that such nationwide exercises acquire is made available to policy makers so that accountable decisions can be made through integrated approach of the politics, science and society.The purpose of this article is to assess the relationship between ruling political party and estimated tiger population in India. In particular, we seek to determine if and how tiger numbers vary in terms of the ruling political party in the tigers occupying states in India. In addition, Jhala et al. (2019) stated, “Sustained conservation efforts through continued “political will” have resulted in an increase in tiger numbers”, and we attempted to assess ruling parties and tiger population dynamics with this article.We compiled data on tiger population and the ruling political party in 20 states of the respective year, in which the tiger population report was released. We considered the ruling party, whose Chief Minister is in the office, in case of a coalition government is formed. Furthermore, if elections were taken place in the same year when tiger population repot was released, two parties were considered for that particular year. There have been four cycles of all India tiger estimation project since 2006, estimated tiger populations 1411, 1706, 2226 and 2967 in 2006, 2010, 2014 and 2018 respectively. If there are elections or any change of the ruling party government, we credited both the parties in that particular year except the President’s rule (as it doesn’t belong to any political party).In 2006, of 20 ruling political parties, the Indian National Congress (INC) was leading with 6.5 tiger occupied states (comprising total tiger population 630) followed by the Bharatiya Janta Party (BJP) (four states with 356 tigers) and the CPI (1.5 states and 33 tigers). Similarly, in 2010 the INC was leading with five tiger occupied states with 424 tigers, closely followed by the BJP ruling 4.5 states with almost doubling the tiger numbers (815) in comparison with the INC ruling states (adding two prominent BJP ruling states Uttarakhand and Karnataka) and the Communist Party of India (CPI) (2 states with 141 tigers). Once again, in 2014, the INC was leading with 6.5 tiger occupied states (1175 tigers), closely followed by the BJP’s five ruling states (500.5 tigers). In contrast, in 2018, the BJP taken over with huge victory with 8.5 tiger occupied states (1688.5 tigers) and the INC trailed in three states with 603.5 tigers (Table 1).We acknowledge that our approach has possible short-comings such as selection of the ruling political party for the same year in which the tiger numbers were released, whereas the tiger estimation exercise might have been taken under the political regime of previous another party. This problem is difficult to avoid in assessing party specific political agenda would be focusing on a broad policy dimension. Our results suggest that there is no relationship between major ruling political party and tiger population in any of the 20 states in India. Tiger appears to be apolitical, as this study did not approach identity in any instance. Perhaps our most important implication pertains to the ideological foundation of each apolitical party in periodically monitoring tiger population.This brief study contributes to the nascent literature on bringing together both tiger numbers and ruling political parties by presenting a new approach that we applied to 20 tiger harbouring states in India. Unlike Western political system, green parties are lacking in India and wildlife has difficulties with getting involved in political discourse. However, India has achieved its target of doubling the tiger count four years ahead of 2022 (4 ) which reflects favourable conservation policy and “political will” for tigers in India.ReferencesJ.A. McNeely, M. Gadgil, C. Leveque, C. Padoch, K. Redford (lead authors). 1995. Characterization of biodiversity. In: Heywood, V.H., Watson, R.T., and Baste, I. (eds.). Global biodiversity assessment. Cambridge University Press. Cambridge. Pp. 715–821.T. Hodgetts, D. Burnham, A. Dickman, E. A. Macdonald, D. W. Macdonald. 2019. Conservation Geopolitics. Conservation Biology 33:250-259. doi:10.1111/cobi.13238V. K. Saberwal. 2000. Conservation as politics: Wildlife conservation and resource management in India, Journal of International Wildlife Law & Policy, 3:166-173. doi: 10.1080/13880290009353954Y. V. Jhala, Q. Qureshi, A. K. Nayak (eds). 2019. Status of tigers, co-predators and prey in India 2018. Summary Report. National Tiger Conservation Authority, Government of India, New Delhi & Wildlife Institute of India, Dehradun. TR No./2019/05.Jean-Louis Martin, V. Maris, D. S. Simberloff. 2016. Limits challenge society and conservation science. Proceedings of the National Academy of Sciences, 113: 6105-6112, doi:10.1073/pnas.1525003113S. J. Song, R. M. M’Gonigle. 2001. Science, power, and system dynamics: The political economy of conservation biology. Conservation Biology, 15:980–989C. A. Simon, B. S. Steel, N. P. Lovrich. 2018. State and local government and politics: Prospects for sustainability, 2nd edition, Oregon State University Corvallis.M. Rangarajan. 2001. India’s wildlife history. Permanent Black and Ranthambore Foundation, New Delhi.Ph. Chardonnet, B.des Clers, J. Fischer, R. Gerhold, F. Jori, F. Lamarque. 2002. The value of wildlife. Scientific and Technical Review of the Office International des Epizooties, 21:15-51.Millward. 2020. Indian tiger study earns its stripes as one of the world’s largest wildlife surveys. https://www.guinnessworldrecords.com/news/2020/7/indian-tiger-study-earns-its-stripes-as-one-of-the-world’s-largest-wildlife-surve-624966Table 1. Tiger harbouring states and their numbers during four phases of All India Tiger Monitoring exercise.

Bronchopulmonary dysplasia (BPD) is a common chronic lung disease of preterm neonates; the underlying pathogenesis is not fully understood. Recent studies suggested microRNAs (miRNAs) may be involved in BPD. In the present study, we performed miRNA and mRNA microarrays to analyze the expression profiles of miRNA and mRNA in BPD and control lung tissues. Our results showed that a total of 192 differentially expressed miRNAs (74 downregulated and 118 upregulated) and 1225 differentially expressed mRNAs (479 downregulated and 746 upregulated) were identified between BPD mice and normoxia-control mice. Bioinformatics methods including Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) were performed to predict the potential functions of differentially expressed genes. For downregulated genes, the top significant enriched GO terms and KEGG pathways were both mainly related to immune and inflammation processes. For upregulated genes, the top significant enriched GO terms and KEGG pathways were both mainly related to ECM remodeling. Quantitative Reverse Transcription-PCR, protein-protein interaction (PPI) network and miRNA-mRNA regulatory network construction were further performed to analyze the key genes and pathways associated with inflammation and immune regulation. Our findings may provide novel insights into the development of new promising biomarkers for the treatment of BPD.

Introduction: Asthma involves an increase in airway resistance even in periods between attacks, which generates changes in thoracoabdominal kinematics as well as adaptations of the respiratory dynamics that are intensified during physical exertion. The aim of the present study was to detect these adaptations at rest and after physical effort. Methods: A cross-sectional study was conducted. Evaluations were performed using optoelectronic plethysmography at rest and immediately after physical effort of moderate intensity. Results: Thirty-two children and adolescents participated in the present study. Mean age was 8.9 ± 2.4 years in the asthmatic group (AG) and 10 ± 3.9 in the healthy control group (CG). Significant intergroup differences (p < 0.05) were found regarding FEV1 (%) (84.8 ± 10.2 in the AG and 104.4 ± 20.1 in the CG). After exercise, the AG exhibited a smaller change in minute volume (3.4 vs. 4.9 liters) as well as a smaller change in tidal volume (66 vs. 153 ml), and a smaller change in respiratory rate (2 vs. 6). Opposite kinematic behavior was found; the contribution of the thoracic compartment was greater at rest and was reduced after effort in the AG, whereas the contribution of the abdominal compartment was greater at rest and was reduced after effort in the CG. Expiratory time was greater in the AG than the CG at both evaluation times. Conclusion: The kinematic behavior of thoracoabdominal motion was the inverse of that found in healthy controls. These findings suggest mechanical and physiological adaptations to minimize the possible swirling of the airflow and reduce the impact of airway resistance during physical exertion. Moreover, these changes are found even at rest and in patients whose asthma is clinically controlled.

A 33-year-old man was admitted to the hospital for bowel obstruction secondary to fistulizing and stenosing Crohn's disease. A computerized tomography scan of abdomen showed a duplication of the inferior vena cava.

Background COVID 19 is the most recent cause of Adult respiratory distress syndrome ARDS. Extracorporeal membrane oxygenation (ECMO) can support gas exchange in patients failing conventional mechanical ventilation, but its role is still controversial. We conducted a systematic review and meta-analysis on ECMO for COVID-associated ARDS to study its outcome. Materials and Methods CENTRAL, MEDLINE/PubMed, Cochrane Library, and Scopus were systematically searched from inception to May 28, 2020. Studies reporting five or more patients with COVID 19 infection treated venovenous with ECMO were included. The main outcome assessed was mortality. Baseline, procedural, outcome, and validity data were systematically appraised and pooled with random-effect methods. The validity of all the included observational studies was appraised with the Newcastle Ottawa scale. Meta-regression and publication bias were tested. This trial was registered with PROSPERO under registration number CRD42020183861 Results From 1647 initial citations, 34 full text articles were analysed and 12 studies were selected, including 194 patients with confirmed COVID 19 infection requiring ICU admission and venovenous ECMO treatment. Random-effect pooled estimates suggested an overall in-hospital mortality risk ratio of 0.49 (95% confidence interval 0.259 to 0.721; I2 = 94%). Subgroup analysis according to country of origin showed persistent heterogeneity only in the 7 Chinese studies with pooled estimate mortality risk ratio of 0.66 (I2 = 87%) (95% CI = 0.39-0.93), while the later larger studies coming from the USA showed pooled estimate mortality risk ratio of 0.41 (95% CI 0.28-0.53) with homogeneity (p=0.67) similar to France with a pooled mortality risk ratio of 0.26 (95% CI 0.08-0.43) with homogeneity (p=0.86).

Aim There are few types of drugs that can be used in the active phase of Peyronie’s disease. Methylprednisolone is a corticosteroid with a strong anti-inflammatory effect. In this study, we aimed to evaluate the effect of intralesional low dose methylprednisolone treatment on patients in the active phase of Peyronie’s disease. Patients and Methods Forty-eight patients suffering from Peyronie’s disease active phase symptoms were included in the study. Methylprednisolone was administered intralesionally for 8 weeks, once per week, at a dose of 40 mg. The injection was applied into the plaques, which causes maximum curvature. Patients were evaluated before and after treatment for plaque size, angle of curvature, and erectile dysfunction according to the International Index of Erectile Function-5 and Peyronie’s Disease Questionnaire. Results The mean age of the patients was 61.1 (43-78) years. Mean duration of the symptoms was 3.4 (0-9) months. The average plaque size before treatment was 13.6 mm (7.1-16.8) and after treatment, this value decreased to 10.8 mm (4.3-14.6) (p:0.025). The average scores of Peyronie’s Disease Questionnaire elements; symptom severity, penile pain and bother/discomfort were 12.3, 19.1 and 6.2, respectively before the treatment. These scores were decreased to 8.9, 9.6 and 4.4, respectively after treatment. All subgroups of Peyronie’s Disease Questionnaire scores were significantly improved after treatment (p:0.001, p<0.001, p:0.045, respectively). No adverse events were observed during or after treatment. Conclusion In order to recover the symptoms and signs, new and easily accessible drugs are required for use in the acute period of Peyronie’s disease. In this context, treatment with intralesional low dose methylprednisolone in acute phase Peyronie’s Disease is a promising and safe treatment option.

The new coronavirus has been named severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) responsible of the COVID-19 illness, it is a virus that belongs to the Coronavirus family, it is the third virus in this family that causes an epidemic. It originated in China and has spread throughout the world. It is highly pathogenic and transmissible that mainly affects the respiratory tract and can cause death. There is not antiviral drug or vaccines against COVID-19 illness, infected person only have supportive treatments. Recently, some antiviral drugs and vaccines are being valued. In this review, we described the general characteristics of HCoVs and latest research of the transmission, prevention and clinical characteristics of SARS-CoV-2 and some treatments and vaccines more development for to combat COVID-19 illness.

To the Editor,We read the letter entitled “Acute lymphoblastic leukemia onset in a 3-year-old child with COVID-19 ” by Marcia et al . with great interest and we hereby suggest to start chemotherapy within the same timeline as for non-COVID-19 acute lymphoblastic leukemia (ALL) patients, following our experience managing a 3-year-old boy with concomitant diagnoses of precursor B-ALL and COVID-19. The patient was a previously healthy boy who presented to our hospital with a two-month history of intermittent fevers, night sweats, fatigue and cervical lymphadenopathies. His mother had been tested positive for COVID-19 three months earlier. He had been seen by his family physician by teleconference at the onset of his symptoms, at which point a COVID-19 infection was suspected but not confirmed. The persistence of symptoms and new onset of bone pain led his parents to reconsult at our hospital. At presentation, he had no respiratory symptoms. Physical examination was remarkable for fever, tachycardia and cervical lymphadenopathies. Bloodwork revealed pancytopenia and circulating peripheral blasts. Inflammatory markers were elevated (fibrinogen 7.08 g/L; C-reactive protein 255 mg/L; sedimentation rate 63 mm/h; ferritin 185 ug/L; D-dimers 0.51 ug/ml). Capillary gas, renal function, hepatic function, coagulation studies (INR/aPTT) and cardiac biomarkers (troponin and pro-BNP) were normal. Chest radiograph (CXR) was normal. COVID-19 testing by nasopharyngeal swab was positive. Bone marrow aspiration revealed 80% precursor B lymphoblasts of hyperdiploid subtype.Patient was admitted to a dedicated COVID-19 ward. Given the absence of SARS-CoV-2 infection’s severity criteria, no COVID-19-specific treatment was initiated. Chemotherapy was started promptly once the diagnostic work-up was completed, 6 days following the patient’s confirmed COVID-19 diagnosis. The patient was treated with a three-drug chemotherapy induction based on National Cancer Institute standard-risk criteria consisting of methylprednisolone, vincristine and asparaginase. Supportive treatment consisted of intravenous hydration and allopurinol for tumor lysis prevention, empirical antibiotics, blood transfusions and prophylactic low molecular weight heparin for COVID-19-associated thromboembolic complications. The patient’s clinical course was favorable; fevers, bone pains, peripheral blasts and inflammatory markers resolved quickly following the steroid prophase. Persistent and unexplained tachycardia led to extensive investigations given concerns for COVID-19-related thromboembolic complications. Troponins, pro-BNP, electrocardiogram, echocardiography, CXR and chest CT scan were unremarkable, and the tachycardia improved with packed red blood cell transfusion. The first negative COVID-19 test was obtained on day 4 of induction therapy but came back positive 48 hours later. The patient was discharged on day 13 of induction therapy. Three consecutive nasopharyngeal swabs were negative on days 21, 23 and 38 following COVID-19 diagnosis (Fig.1). End-induction bone marrow aspiration was consistent with morphologic remission and end-induction minimal residual disease by flow cytometry was positive at 0.025%.This case demonstrates the feasibility of treating children with newly diagnosed ALL who tested positive for COVID-19, without chemotherapy delay or modification, nor specific COVID-19 treatments, as done by Marcia et al . The province of Quebec constitutes the COVID-19 epicenter in Canada with half of all Canadian cases; the prevalence of COVID-19-positive cases was 3.3% among children under the age of 10, 5.3% between the age of 10-20 years and 49.2% for people aged 50 years and above.1 Importantly, no death has been reported among children in the province of Quebec, while 97.6% of COVID-related deaths were among individuals over the age of 60 years.1 Children appear to be less affected from COVID-19 infection and exhibit a milder disease course compared to adults, although the impact of COVID-19 infection among pediatric oncology patients remains unknown.2-4 Current published recommendations in the management of pediatric oncology patients during the COVID-19 pandemic emphasize on the importance of pursuing protocol-prescribed chemotherapy regimens based on the curable nature of most pediatric malignancies and the milder COVID-19 disease course observed in the pediatric population.4 However, case reports of severe COVID-19 disease in pediatric oncology patients start to emerge,5 and management of concomitant COVID-19 infection and newly diagnosed ALL can be challenging. First, our patient presented with a multisystem inflammatory syndrome which made it difficult to discern whether he was symptomatic from the COVID-19 infection versus the leukemia itself. Furthermore, we questioned whether the positive COVID-19 test by polymerase chain reaction (PCR) amplification in our patient truly reflects active infection since there was a nearly 3-month period between the first positive test in his family and when our patient was first tested positive. The positive PCR test could result from prolonged viral shedding in an immunocompromised patient affected by his leukemia onset. Alternatively, a positive test does not necessarily indicate the presence of viable virus as Wolfel and colleagues demonstrated that virus could not be grown from samples obtained from hospitalized patients beyond the eighth day of illness.6 Therefore, the general approach to await a negative result prior to begin chemotherapy might cause significant therapy delay and adversely impact outcomes in newly diagnosed ALL patients during the COVID-19 pandemic. Indeed, our patient took over 23 days to have 2 consecutive negative PCR tests 48 hours apart. Furthermore, the use of COVID-19-specific antiviral treatment in non-critically ill children is controversial given the lack of efficacy in this population.7Antiviral treatment may have significant drug interactions with chemotherapy and contribute to additive gastrointestinal and myelosuppressive toxicities. Nevertheless, the benefit of dexamethasone in COVID-19-positive patients requiring respiratory support in reducing early mortality8 and the exquisite sensitivity of lymphoblasts to corticosteroids could be an effective early strategy to safely initiate therapy in newly diagnosed ALL patients affected with COVID-19, particularly for those presenting with oncologic emergencies such as hyperleukocytosis or mediastinal mass. As the COVID-19 pandemic continues to evolve, pediatric oncologists will be confronted with the ongoing challenge to manage newly diagnosed cancer patients with concomitant COVID-19 infection. International COVID-19 registries in pediatric oncology are actively collecting clinical data to comprehensively assess the impact of COVID-19 within this patient population and to develop standardized management guidelines.9 As for now, an assessment of risks and benefits to initiate or delay cancer therapy will need to be carefully balanced on a case-by-case basis according to the patient’s clinical symptoms, type of malignancy, evidence-based treatment options, and emerging knowledge of COVID-19’s impact in our young cancer patients.CONFLICT OF INTEREST: The authors declare no conflict of interest.REFERENCES1. INSPQ. Données COVID-190 au Québec. 2020.2. Lu X, Zhang L, Du H, et al. SARS-CoV-2 Infection in Children. N Engl J Med. 2020;382(17):1663-1665.3. Cruz AT, Zeichner SL. COVID-19 in Children: Initial Characterization of the Pediatric Disease. Pediatrics. 2020;145(6).4. Bouffet E, Challinor J, Sullivan M, Biondi A, Rodriguez-Galindo C, Pritchard-Jones K. Early advice on managing children with cancer during the COVID-19 pandemic and a call for sharing experiences. Pediatr Blood Cancer. 2020;67(7):e28327.5. Stokes CL, Patel PA, Sabnis HS, Mitchell SG, Yildirim IB, Pauly MG. Severe COVID-19 disease in two pediatric oncology patients.Pediatr Blood Cancer. 2020;67(9):e28432.6. Wolfel R, Corman VM, Guggemos W, et al. Virological assessment of hospitalized patients with COVID-2019. Nature.2020;581(7809):465-469.7. Chiotos K, Hayes M, Kimberlin DW, et al. Multicenter initial guidance on use of antivirals for children with COVID-19/SARS-CoV-2. J Pediatric Infect Dis Soc. 2020.8. Group RC, Horby P, Lim WS, et al. Dexamethasone in Hospitalized Patients with Covid-19 - Preliminary Report. N Engl J Med. 2020.9. Sullivan M, Bouffet E, Rodriguez-Galindo C, et al. The COVID-19 pandemic: A rapid global response for children with cancer from SIOP, COG, SIOP-E, SIOP-PODC, IPSO, PROS, CCI, and St Jude Global.Pediatr Blood Cancer. 2020;67(7):e28409.Figure 1. Variation of C-reactive protein (CRP) throughout the hospitalization course (blue line). COVID-19 test results are identified in green when positive and red when negative. The day of ALL diagnosis, the day of chemotherapy start (black arrows), the duration of hospitalization (red box) and the duration of symptoms (green box) are indicated. Induction chemotherapy includes: Methylprednisone/prednisone (Day 1-32), Vincristine (Day 4, 11, 18, 25), PEG-Asparaginase (Day 7) and intrathecal cytarabine (Day 1 & 18).

ABSTRACT Introduction: The disrespect and abuse of women during maternity care are problems that have been hidden by something that truth about a situation or behind doors that do not open but significantly impact women’s willingness to seek life-saving care in facilities. Disrespect and abuse are a factor that significantly impacts women’s willingness to seek care in developing countries. Therefore, this aimed to assess the levels and determinants of disrespect and abuse during childbearing women in Eastern Ethiopia. Methods: A mixed-method cross-sectional study was conducted in Eastern Ethiopia. Data were collected from women by administered questionnaires upon discharge and were triangulated with direct observation of provider-woman interaction. P-values of less than 0.05 was considered statistically significant. Result: A total of 592 questionnaires were administered to postnatal women with a response rate was 99% and supplemented with direct observation of 82 episodes of provider-woman interaction. Prevalence of 28.0% (95% CI, 24.45-31.85) had faced disrespect and abuse. The common types of disrespect and abuse were neglect 101(17.06%), followed by non-dignified care 100(16.89%). Our observation revealed that 24(30%) of the provider-woman interactions had disrespect and abuse. Disrespect and abuse were common among rural residence [AOR=3.32, 95% CI 1.96- 5.64] and having spontaneous vaginal delivery [AOR, 2.03; 95% CI, 1.34-3.00; p=0.001] were associated factors with disrespect and abuse. Conclusion: Disrespect and abuse were reported by more than one in four women during childbirth. Rural residents and women who delivered vaginally reported being abused twice compared to their counterparts.

Objective: This study aimed to compare posttraumatic stress symptoms (PTSS), depression and family functioning between families of children with cancer and families of healthy children, examine the relationships among children’s PTSS, parents’ PTSS and depression, and family functioning, and explore the effect of disease experience on PTSS and the association between pain and PTSS in children with cancer. Methods: Participants were children with cancer (n=91) and their parents (n=91), and healthy children (n=114) and their parents (n=96). The children were asked to self-report PTSS and self-rate their pain degree, and the parents completed self-reported measures of PTSS, depression, and general family functioning. Results: The prevalence of severe PTSS in parents of children with cancer (21.98%) was significantly higher than that in parents of healthy children (1.04%). No significant difference was found in the total PTSS scores between children with cancer and healthy children. The children’s PTSS was positively correlated with their parents’ PTSS and depression in cancer group but not in the control group. Family functioning affected children’s PTSS in both families of children with cancer and healthy families. In children with cancer, PTSS was positively correlated with pain during cancer treatment but not correlated with disease experience. Conclusions: Children with cancer perceive the fear of pain during cancer treatment, whilst their parents experience more psychological trauma. Apart from cancer treatment, attention should also be given to pain management in children with cancer and the mental health of the entire family.

Fanconi Anemia with Neuroblastoma Complicated by

In this study, an approach utilizing a conjunction of the extended finite element method (XFEM) and the GTN micro-mechanical damage model is proposed for predicting the ductile crack propagation of a mill-annealed Ti-6Al-4V alloy. The cohesive model based XFEM approach is used to capture the continuous crack propagation process and the GTN model is applied to describe the constitutive behavior of the material. Simulations are conducted by using the standard finite element code ABAQUS following a Newton-Raphson algorithm solution with employing the user material subroutine of the GTN model. In comparison to the experimental results of the smooth, notched and cracked titanium specimens, this approach is shown to be an efficient method for simulating the ductile crack propagation process under different stress triaxialities.

Propagation of fatigue crack in laser shock peened metallic component is retarded by introduction of deep compressive residual stresses during the process. Apart from large compressive residual stress build-up near the surface, surface topography is also significantly altered during laser shock peening. However, a systematic evaluation of the individual effects of residual stresses and surface topography as well as their interaction effects on fatigue crack initiation and growth is still lacking. This study investigates the effect of laser shock peening on near surface properties of Ti6Al4V and Al6061-T6 alloys and how these changes dictate their overall fatigue performance. The results show that both surface residual stresses and surface topography influence the fatigue life of a component. It is found that fatigue life of Ti6Al4V alloy increased by at least 1.28 times after laser shock peening. In contrast, the improvement is minimal for Al6061-T6 alloy due to the surface roughening effect introduced by laser peening which results in early crack initiation and negates the beneficial effect of compressive residual stresses.

Abstract: Background: The COVID-19 pandemic in late 2019 quickly stretched health care system across the globe. Mortalities, shortages in health care system capacity, and lack of experience in similar circumstances required innovation in the way health care is delivered. Health care systems changed operating schedules, staff work pattern, and how patients are cared for. The effects of these changes reached patients, staff and training in different ways. Methods: We search the Pubmed and EMBASE for articles related to COVID-19. We also searched local e-mails and information provided to staff during the pandemic Results: The COVID-19 pandemic affected organisations, patients and staff. The organisation and staff had to adapt to the times to provide a safe and appropriate service to our patients. Conclusion: The pandemic challenged and changed the way we work as health care providers, and how we train the future surgeons. Changes in the system was effective.