We report an emergent complex hybrid repair of a type A Intramural Hematoma with a tear of the aortic arch at the site of Kommerell's Diverticulum and an Aberrant Right Subclavian Artery. We identified a type Ia endoleak intraoperatively, which was managed immediately with proximal extension. Performing this operation in the hybrid operating room facilitated optimal surgical management.

The challenge of multiple paediatric febrile neutropenia clinical decision rules has been well described, and the difficulties with ever-expanding variants based on individual datasets discussed extensively.1 The re-calibration of the SPOG rule undertaken by Haeusler and colleagues2 (creating the ‘AUS’ rule) for a practical, bedside tool which would be able to risk stratify episodes of FN. This letter reports a further validation in a meta-analytic dataset from the ‘Predicting Infectious Complications in Children with Cancer’ (PICNICC) collaboration.Briefly, the PICNICC collaboration was formed to develop a robust prediction rule for febrile neutropenia, with methods and materials detailed in previous publications.1,3 Over 8000 episodes of 33 different candidate predictor variables and seven clinically relevant outcomes have been collated from 26 study groups, with varied completeness. The ‘AUS’ rule uses three equally weighted factors to scale the risk of complications in an episode of FN, summed between 0 and 3.These factors are: preceding chemotherapy more intensive than acute lymphoblastic leukaemia maintenance, platelet count less than 50 g/L, total white cell count lower than 300 cells/mm3. The clinical response can be scaled according to this score, with values of 0 and 1 considered as ‘lower risk’.We evaluated the association between the AUS rule and bacterial infection using these data, reporting the discrimination (Area Under the receiver-operator Curve, AUC) and proportion of episodes classed as lower risk (scoring 0 or 1). Analyses were undertaken using R (v3.2.0).1520 episodes contributed to the analysis, with 301 episodes of documented bacterial infection. The discriminatory ability appeared very similar to Haeusler’s values; AUC 0.64 (95% CI 0.61 to 0.68) compared with the original AUC 0.67 (95% CI 0.63 to 0.71). Using the AUS rule on the PICNICC dataset would have identified 44% (668/1520) of the population as a lower risk group (score 1 or 0).This reassuring data has led to the introduction of an AUS rule based system to shorten the duration of antibiotic therapy, in concordance with UK National and International guidelines[3,4]. This now-validated rule will reduce hospitalisation for febrile neutropenic episodes in the UK, which was of particular importance during the 2020 SARS-CoV-2 coronavirus pandemic.

Hexokinase (HK) is one of the key regulatory enzymes for glycolysis. HK catalyses the phosphorylation of glucose to glucose – 6 – phosphate resulting in irreversible transfer of high-energy phosphate from ATP to glucose. HK deficiency is a rare red cell enzyme defect. There are approximately 30 cases and 10 mutations of HK deficiency reported till date. Many patients remain undiagnosed due to mild manifestations of the disease. Here we report a case of a 3-year-old boy who presented with haemolytic anaemia and was found to have HK deficiency with a novel mutation at exon 1 of HK1 gene.

Gastropleural fistula (GPF) is a pathological communication between the stomach and the pleura. Here we describe the first case of pediatric GPF secondary to sleeve gastectomy that was which was managed endoscopically with an over the scope clip (OVESCO) after failure of surgical repair.

Transfusion Related Acute Lung Injury (TRALI) has been associated with neutrophil reacting antibodies in transfused blood products. We report a case of life threatening TRALI in an obstetric patient triggered by transfusion from a non-transfused male blood donor. A residual risk of TRALI exist, even in a male-only plasma setting.

Nasal packing constitutes a common step in nasal procedures. A correct fixation is of uttermost importance to avoid posterior dislocation and aspiration. This case report highlights the risk of acute airway situations involving nasal packs and discuses common errors that should be avoided to prevent this life-threatening complication.

Objective Heredity has a remarkable effect on obesity in an obesogenic environment. Despite numerous genetic variants contributing to obesity-related traits, none of them was identified from Chinese children. We aim to identify novel variants and genes associated with childhood obesity in China. Methods We obtain promising single nucleotide variants from 76 obese and 74 normal weight children by whole-exome sequencing, and interrogate their associations with obesity traits in an additional 6,334 children cohort. We then depict the effects of genome-wide significant (P < 5E-8) variants on expression of implicated genes in blood and adipose tissues by transcriptome sequencing. Results We identify two coding variants associated with obesity at genome-wide significance: rs1059491 (P = 2.57E-28) in SULT1A2 and rs189326455 (P = 8.98E-12) in MAP3K21. In addition, rs1058491 is also significantly associated with several obesity traits. Transcriptome sequencing demonstrates that rs1059491 is an eQTL site associated with the expression levels of several obesity-related genes, such as SULT1A2, ATXN2L, and TUFM. Conclusions Our work identifies two coding variants affecting the expression of obesity-related genes based on a large Chinese pediatric adiposity cohort and provide new insights for the pathophysiology of Chinese childhood obesity.

A document by Yunhai Chuai. Click on the document to view its contents.

Purpose: To determine outcomes after successful fallopian tube recanalization (FTR) in women who suffer infertility with documented tubal occlusion on hysterosalpingogram.(HSG) Methods: A retrospective review of consecutive successful FTR procedures from January 2010 to December 2016 was performed. 53 women who had HSG confirmed tubal occlusion from a single academic medical center and successful FTR were eligible for inclusion. 35 (66.0%) patients had follow up at 12 months after FTR, with 13 conceiving within a year of the procedure. Complication, conception, and take-home-baby (THB) rates were recorded. The average age of patients was 32.3 years (range 26-42 years). All patients received peri- and post-procedure antibiotics. Results: Average follow-up after FTR was 1335 days. All patients tolerated the procedure well with no immediate complications. 13 (37.1%) became pregnant after FTR. Of these women, 2 had ectopic pregnancies and 2 patients had spontaneous abortions. The THB rate after FTR for all patients was 25.7%. The THB rate in women who became pregnant after FTR was 69.2%. Of those women who did not become pregnant after FTR, 19 (84.6%) went to assisted reproductive techniques, and of those, 8 (42.1%) became pregnant. Conclusion: Infertility affects 8.4% of U.S. women, with tubal disease a major causative factor. In our study, successful FTR led to pregnancy in over a third of the patients with the majority giving birth to healthy babies. Given the success of obtaining pregnancy in combination with a low complication rate, FTR is a viable option in women who suffer from tubal infertility

The use of electrochemical methods to study living systems, including cells, has been of interest to researchers for a long time. Thus, controlling the polarization of the electrode contacting living cells, one can influence, for example, their proliferation or the synthesis of specific proteins. Moreover, the electrochemical approach formed the basis of the biocompatibility improvement of the materials contacting with body tissues that use in carbon hemosorbents and implants development. It became possible to reach a fundamentally new level in the study of cell activity with the introduction of optically transparent electrodes in this area. The use of such materials allowed approaching to the study of the influence of the electrode potential on adhesion activity and morphology of the different cell types (HeLa cells, endothelial cell, etc.) more detailed. There are a negligible number of publications in this area despite the obvious advantages of the usage of optically transparent electrodes to study living cells. This mini review is devoted to some aspects of the interaction of living cells with conductive materials and current advances in the use of optically transparent electrodes for the study of living cells, as well as the prospects for their use in cellular technologies.

Individuals with single-ventricle congenital heart disease who are palliated to a Fontan circulation are at risk for heart failure and liver disease, with recurrent ascites being one potentially debilitating cause of late morbidity. Although ascites associated with heart failure or liver failure is usually characterized by a high serum-ascites albumin gradient (SAAG), we have observed multiple instances of ascites in Fontan patients with low SAAG, suggesting an inflammatory process. We present three cases in which recalcitrant ascites severely and adversely impacted quality of life, and describe our initial experience with intraperitoneal corticosteroids in this setting.

Organisms exposed to endocrine disruptors in early life can show altered phenotype later in adulthood. Although the mechanisms underlying these long-term effects remain poorly understood, an increasing body of evidence points toward the potential role of epigenetic processes. In the present study, we exposed hatchlings of an isogenic lineage of the self-fertilizing fish mangrove rivulus for 28 days to 4 and 120 ng/L of 17-α-ethinylestradiol. After a recovery period of 140 days, reduced representation bisulfite sequencing (RRBS) was performed on the liver in order to assess the hepatic genome-wide methylation landscape. Across all treatment comparisons, a total of 146 differentially methylated fragments (DMFs) were reported, mostly for the group exposed to 4 ng/L, suggesting a non-monotonic effect of EE2 exposure. Gene ontology analysis revealed networks involved in lipid metabolism, cellular processes, connective tissue function, molecular transport and inflammation. The highest effect was reported for nipped-B-like protein B (NIPBL) promoter region after exposure to 4 ng/L EE2 (+ 21.9%), suggesting that NIPBL could be an important regulator for long-term effects of EE2. Our results also suggest a significant role of DNA methylation in intergenic regions and potentially in transposable elements. These results support the ability of early exposure to endocrine disruptors of inducing epigenetic alterations during adulthood, providing plausible mechanistic explanations for long-term phenotypic alteration. Additionally, this work demonstrates the usefulness of isogenic lineages of the self-fertilizing mangrove rivulus to better understand the biological significance of long-term alterations of DNA methylation by diminishing the confounding factor of genetic variability.

The Kirchhoff index and degree-Kirchhoff index have attracted extensive attentions due to their wide applications in physics and chemistry. These indices have been computed for many interesting graphs, such as linear polyomino chain, linear / Möbius / cylinder hexagonal chain, and linear octagonal chain. In the present paper, we consider Möbius octagonal chain (Mn) and cylinder octagonal chain (M’n). Explicit closed-form formulae of the Kirchhoff index and the number of spanning trees are obtained for Mn and M’n.

Breast cancer is a heterogeneous pathology. There are subgroups with different molecular characteristics, and they must be identified to direct the therapy and to have a clear prognosis. HER2/neu (human epidermal growth receptor factor 2/neuro glioblastoma derived oncogene homolog) receptor overexpression is a characteristic that must be evaluated in each population. We apply the monoclonal antibody technique in the indigenous population of Peru, we also correlate the presence of the receptor with global survival. It’s an experimental, prospective and analytical study. Twenty three samples were evaluated, obtained from patients with adenocarcinoma of the breast. The HER2/neu expression was determined by immunohistochemical technique (monoclonal antibodies). The results were verified 10 cases were positive for overexpression (43.47%). The negative cases were 13 (56.52%). The overall survival at 3 years was 69.90% for the Her2/neu positive and 85.00% for negative, showed statistically significant differences (p=0.017). Finally, it was feasible to apply the monoclonal antibody technique and to statistically correlate HER2/neu overexpression with TNM clinical stage, predicting less survival when present. Applying an immunohistochemical technique is feasible in native Peruvian women. The main benefit is to apply biological therapy with monoclonal antibodies, according to their molecular profile.

The growth of silica nanoparticles by agglomeration and viscous flow sintering is studied from free molecular to transition regime at high temperatures by discrete element method simulations. The effect of temperature on the aggregate mobility and gyration radii, particle morphology and collision frequency function is elucidated as function of the number of primary particles. The ratio between the characteristic sintering time and characteristic collision time controls the particle size and structure, quantified by the mass fractal dimension. The effect of this ratio of characteristic times on aggregate morphology is illustrated at various temperatures. Finally, when sintering is negligible, the overall collision frequency is 90% larger than that predicted by the classic Fuchs collision kernel for monodisperse agglomerates in the near free molecular and transition regime. For comparable coagulation and sintering rates, where aggregates with sinter bonds are formed, the overall collision frequency increases an enhancement of <90% is observed.

Vegetation restoration can input amounts of organic matter into soils to improve soil aggregate stability; for this process, the interaction between organic matter and charged soil particles is a key. However, the molecular-scale knowledge about organic matter-mineral interactions remains largely qualitative. Here, we analyzed soil particles surface electrochemical properties and soil internal forces (electrostatic, hydration , and van der Waals forces) along vegetation restoration to quantitatively evaluate how SOM increase the stability of soil aggregate. Our results revealed that the enrichment of SOM after revegetation increased the cation exchange capacity (CEC), specific surface area (SSA), and soil surface charge density (σ0), thereby strengthening the electrostatic repulsive pressure. Besides, the increasing SOM led to the increase in Hamaker constant at the molecular level and thus enhanced the van der Waals attractive force. As a result, the net pressure of soil internal forces was repulsive and decreased with increasing SOM during vegetation restoration. Meanwhile, the net pressure increased first and then leveled off with the decrease of electrolyte concentration in the bulk solution. The determined soil aggregate breaking strength showed similar trends to that of net pressure. Soil aggregate stability under different succession stages followed the order of farmland < grassland < shrub < forest. Overall, the experimental results of soil aggregate stability were in excellent consistent with the theoretical predictions of soil internal forces. Consequently, we conclude that organic matter input during vegetation restoration increased aggregate stability mainly due to the decrease of the repulsive net pressure of soil internal forces.

Objective: Eosinophils and basophils both play important roles in the immune response, but the relationships between them and allergy in adenotonsillar hypertrophy (ATH) children is unclear. This study aimed to investigate the relationship between eosinophil/basophil counts and peripheral specific IgE levels, and identify the common allergens in children with ATH. Methods: We initially screened 931 consecutive children who underwent adenotonsillectomy in our department from 2018 to 2019 , and finally included 676 children. The eosinophil count, basophil count, and specific IgE levels were evaluated. The eosinophil count, basophil count and levels of specific IgE were collected. Logistic regression analyses were performed to evaluate the odds ratios (ORs) and 95% confidence intervals (95% CIs) for atopy. Results: The eosinophil and basophil counts in atopic participants were significantly higher compared to non-atopic participants. The eosinophil count correlated with the levels of IgE specific to all allergens, and eosinophilia was independently associated with all tested atopy allergens other than atopy to dander after multivariate adjustment for age, sex, vitamin D, BMI, and visiting season. Additionally, the basophil count correlated with the IgE levels specific to A. alternate and food mix, and basophilia was significantly associated with atopy to food mix after multivariable adjustment. Furthermore, among allergic participants, D. farinae was the most prevalent allergen, followed by food mix, D. pteronyssinus and A. alternata. Conclusion: Eosinophils were more relevant to allergic sensitization than basophils, with eosinophils being significantly associated with all tested atopy allergens apart from dander, and basophils being associated with atopy to food mix. Furthermore, D. farinae was the most prevalent allergen and may be indicative of desensitization therapy.

In this paper, the very high-cycle fatigue performance of TC17 titanium alloys under corrosion environment and laser shock was studied by the load of first-order bending vibration. The results show that the very high cycle fatigue performance of TC17 titanium alloys has no fatigue limit in the traditional sense and different surface processing has different effects on the very high cycle fatigue properties of TC17 titanium alloys. The very high cycle fatigue performance of TC17 under corrosion environment did not decrease significantly, but the very high cycle fatigue performance of TC17 strengthened by laser shock treatment could be greatly improved. With the SEM analysis, it was found that the specimen crack initiation showed two modes: surface and sub-surface, which was independent of the internal inclusions and defects. No sign of internal crack initiation was found and the sub-surface crack propagation did not show “fish-eye”.

Background Atopic dermatitis (AD) is the chronic inflammatory disorder that affects both in childhood and adulthood. Mounting evidence indicates that gut dysbiosis contributes to AD via the gut-skin axis. Constipation can result in alteration of the gut microflora. The clinical impact of constipation on AD has not been researched. Therefore, we aim to assess the risk of AD in constipated patients by the population-based cohort study. Methods We collected 87015 constipated people and 87015 people without constipation between 1999 and 2013 from the Taiwanese National Health Insurance Research Database. Propensity score analysis was administrated to match age, gender, comorbidities, and medications at a ratio of 1:1. Multiple Cox regression analysis was utilized to evaluate the adjusted hazard ratio of AD. In addition, sensitivity tests and a stratified analysis were conducted. Results The incidence of AD was 4.7 per 1,000 person-years in the constipation group, which was higher than the rate of 2.2 per 1,000 person-years observed in the non-constipation group. After adjustment for age, gender, comorbidities, corticosteroids, and antihistamine, constipated people had a 2.11-fold greater risk of AD compared to those without constipation (adjusted hazard ratio [aHR]: 2.11 (95% C.I. 1.98-2.24). Moreover, constipated people had a higher likelihood of AD, regardless of gender, comorbidities, as well as the usage of corticosteroids, and antihistamines. Conclusion Constipation is associated with a significantly risk factor of AD. Clinicians should be careful of the possibility of AD in constipated people. Further study is warranted to investigate the possible pathological mechanisms of this relationship.

Nutritional geometry has advanced our understanding of how macronutrients (e.g., proteins and carbohydrates) influence the expression of life history traits and their corresponding trade-offs. For example, recent work has revealed that reproduction and immune function in male decorated crickets are optimized at very different protein:carbohydrate (P:C) dietary ratios. However, it is unclear how an individual’s macronutrient intake interacts with its perceived infection status to determine investment in reproduction or other key life history traits. Here, we employed a fully factorial design in which calling effort and immune function were quantified for male crickets fed either diets previously demonstrated to maximize calling effort (P:C = 1:8) or immune function (P:C = 5:1), and then administered a treatment from a spectrum of increasing infection cue intensity using heat-killed bacteria. Both diet and a simulated infection threat independently influenced the survival, immunity, and reproductive effort of males. If they called, males increased calling effort at the low infection cue dose, consistent with the terminal investment hypothesis, but interpretation of responses at the higher threat levels was hampered by the differential mortality of males across infection cue and diet treatments. A high protein, low carbohydrate diet severely reduced the health, survival, and overall fitness of male crickets. There was, however, no evidence of an interaction between diet and infection cue dose on calling effort, suggesting that the threshold for terminal investment was not contingent on diet as investigated here.

Phenotypic variation among individuals and species is a fundamental principle of natural selection. In this review, we focus on numerous experiments involving the model species Daphnia (Crustacea) and categorize the factors, especially secondary ones, affecting intraspecific variations in inducible defense. Primary factors, such as predator type and density, determine the degree to which inducible defense expresses and increases or decreases. Secondary factors, on the other hand, act together with primary factors to inducible defense, or without primary factors on inducible defense. The secondary factors increase intra-species variation in inducible defense, and thus the level of adaptation of organisms varies within species. Future research will explore the potential for new secondary factors, as well as the relative importance between factors needs to be clarified.

Objective: To explore the optimal imaging parameters, including the optimal scan time and scan angle, of 3D-FLAIR imaging in labyrinthine for patients with vertigo and sensorineural hearing loss. Design: A prospective clinical study. Setting: Academic-tertiary center. Participants: Twenty-two patients with unilateral vertigo and sensorineural hearing loss were prospectively reviewed between July 2018 and June 2019. Main outcome measures: The corresponding signal-intensity-ratios and contrast-to-noise-ratios of these images acquired at different time points after the administration of gadolinium contrast agent at double dose were obtained on the 3D-FLAIR images. The scan angles, aiming to obtain the relative maximum areas of the saccule, utricle and lateral semicircular canal displayed at the same level, were also evaluated with the anterior skull base in the sagittal position. Results:3D-FLAIR images with double-dose injection of gadolinium contrast acquired at 6 hours post-injection showed the strongest image contrast in the cochlea compared to those at 4 and 8 hours (affected ear: 2.05±0.72 vs 1.85±0.76 vs 1.79±0.60, unaffected ear: 1.97±0.68 vs 1.59±0.28 vs 1.57±0.31). The significantly higher CNR values were shown at 6 hours in both the affected and unaffected ears than those acquire at other time points (P <0.05). In addition, the optimal angles ranging from 6.20 to 13.6 degrees (mean:10.74±2.24 degrees; P<0.01) were obtained. Conclusion: The optimal scan time was found at 6 hours after injecting contrast agent at double-dose. Together with the best scan angle obtained, the EH can be accurately assessed on 3D-FLAIR images.

We compared the use of phosphorus (P) and nitrogen (N) in slow-growing Banksia attenuata (Proteaceae), which resprouts after fire and naturally occurs on deep sand, with faster-growing opportunistic B. sessilis, which is killed by fire and occurs on shallow sand over laterite or limestone. We carried out pot experiments with plants on substrates with different P availability. We measured foliar nutrient concentrations, and P allocated to major biochemical fractions. The two species had similar foliar total P concentrations, but distinct patterns of P allocation to P-containing fractions. The foliar total N concentration of B. sessilis was greater than that of B. attenuata on all substrates. The foliar total P and N concentrations in both species decreased with decreasing P availability. The relative growth rate of both species was positively correlated with both foliar nucleic acid P and total N concentrations, but there was no correlation with other P and N fractions. Faster-growing B. sessilis allocated more P to nucleic acids than B. attenuata did, but other fractions were similar. We conclude that the nutrient-allocation patterns in faster-growing opportunistic B. sessilis and slower-growing B. attenuata revealed different strategies in response to soil P availability, which matched their contrasting growth strategy.

The aim is to look at the rate of macrolide resistance in a group of children admitted with mycoplasma pneumonia at a local hospital and to compare and analyze clinical features of macrolide-resistant Mycoplasma pneumoniae (MRMP) and macrolide-sensitive Mycoplasma pneumoniae (MSMP) to facilitate early recognition of likely resistance and to guide the choice of appropriate antibiotics for treatment. Paediatric patients with pneumonia with a real time mycoplasma PCR positive result were analyzed. Mutations associated with macrolide resistance were identified by direct DNA sequencing of the domain V of the 23S rRNA gene and patient. MRMP was identified in 43% of the patients tested within March 2013 to August 2013. No single clinical characteristic or laboratory markers were reliable in differentiating between MSMP and MRMP. A clinical parameter of non-defervescence at 72 hours was identified as a good clinical indicator for likely macrolide resistance. 96% of MSMP patients achieved defervescence by 72 hours. There were 5 patients that developed pleural effusion and 80% of them belonged to the MRMP group. All of the 15 patients treated with doxycycline, were able to achieve rapid defervescence within 24 hours. The overall length of stay was longer in the MRMP group. Macrolide resistance in Hong Kong appears to be lower than previous published data. With limited laboratory support to identity resistance, clinical parameters help facilitate and support the decision for alternative treatment options such as doxycycline to prevent complications and prolong length of stay in a common and treatable condition in the paediatric population.