Antibiotic concentration in pancreas tissue is very important for the treatment of severe acute pancreatitis (SAP) with infection. We report a case of a 44-year-old female with SAP on treatment of vancomycin. The time courses of vancomycin concentration in serum and pancreas tissue of the patient was described. This case demonstrated that it took about 30 minutes for vancomycin to get through from serum to pancreas tissue and about 76% of vancomycin could move into pancreas tissue for SAP patients.

Introduction: Cardiac resynchronization therapy (CRT) improves outcomes in heart failure (HF) patients with left bundle branch block (LBBB). However, the benefits of CRT in patients with previous pacing are uncertain, specially in a population witch Chagas disease is a prevalent cause of HF. Methods and Results: Prospective cohort study that included HF patients indicated for CRT with left ventricular ejection fraction (LVEF) of less than 35%. Clinical and demographic data were collected to investigate mortality predictors after 1 year. The overall survival was calculated by the Kaplan-Meier method and multivariate analysis using Cox’s regression model was performed. Between May 2017 and September 2019, 93 patients were evaluated with a mean follow-up of 1,0 (0.6) year. Of these, 22 (23,7%) were upgraded from right ventricular pacing. Chagas Disease was the most prevalent cause of HF 29 (31,2%). In overall patients, LVEF at 6 months increased after CRT: 24,0% (7,8) to 30,3% (11,5), p=0.007, and there was no significant difference between upgraded patients and de Novo CRT, p=0.26. Overall mortality at 1-year was 28 (30,1%). In the univariate analysis, Chagas disease and upgraded therapy were associated with mortality at follow-up, HR: 3.9, CI: 1.8-8,4, p = 0.001 and HR: 4.7, CI: 2.2-9.9, p < 0.001, respectively. In the multivariate model, only upgraded therapy remained independently associated with the outcome, adjusted HR: 2.9, CI: 1.2-7,2, p = 0.02. Conclusion: In this specific HF population, with a high prevalence of Chagas disease cardiomyopathy, upgraded therapy was independently associated with worsened 1-year survival after CRT.

Why ICD still send out atrial pacing pulse after ventricular extrasystole occurrence in a patient with old myocardial infarctionKang Li,MD,Yansheng Ding,MD ,Jing Zhou*,MDDepartment of Cardiology, Peking University First Hospital, Beijing, China*Corresponding author: Jing Zhouzhoujing123@gmail.comPostal address:Xishiku Str.8,Xicheng District,Beijing,China,100034Conflict of interest：NoneA 78-year-old male with ischemic cardiomyopathy and old myocardial infarction (the posterior inferior left ventricle and interventricular septum), left ventricular ejection fraction 30%,initially had a dual-chamber implantable cardioverter-defibrillator (ICD) placed 6 years ago. After that, AAI pacing was dominant in managed ventricular pacing mode (MVP mode :AAIR<=>DDDR and AAI<=>DDD，Medtronic), the pacing rate was previously set to 55 times / min),with paroxysmal atrial fibrillation and frequent premature ventricular contraction (PVC), without sustained ventricular tachycardia recording or discharge events. And judging from QRS morphology of the PVC: it maybe originated from the scar zone of old myocardial infarction in the posterior inferior left ventricle.(Figure-1:①)He underwent a routine ICD (Medtronic Evera S DR DDBC3D4) replacement when the existing device reached the recommended replacement time. Both leads were tested at that time and found to be fine,located in the right auricle and the right ventricular apex. Just after the replacement procedure,we found something like troubleshooting(Figure-1: ②).Why did ICD still send out atrial pacing(AP) pulse and follow-up ventricular safety pacing (VSP) after the occurrence of PVC? Obviously,there was a significant delay from the onset of PVC to the sense of PVC by the ventricular electrode(VS). The interval between PVC and previous AP was 920ms, and the right ventricular electrode was delayed for 90ms to detect PVC(Figure-1: ②). Because of the default pacing rate of 60 times / min, ICD sended out AP pulse according to the pacing interval of 1000ms, which was 10 ms earlier than the delayed perception of PVC. Then the ventricular electrode sensed the ventricular activation of PVC,and sended out the VSP after the AP pulse(Figure-1:②). When VSP function was turned off, ICD still sended out AP pulse after PVC as a result of the conduction delay of 90ms, but no VSP was released again. AP produced atrial activation and failed to transmit down due to falling into ventricular refractory period(Figure-1:③).We adjusted the pacing rate of ICD from 60 to 55 times / min, then the pacing interval was 1090ms. The ventricular electrode could sense the PVC(920ms + 90ms = 1010ms) from the delayed conduction to the left ventricular posterior inferior origin without overlapping the AP pulse. After MVP turned on, it took 40 ms for AP+VS to transmit the ventricular activity from the atrioventricular node to the right ventricular electrode, and 90 ms for AP+PVC to transmit the scar zone of ventricular myocardium due to old myocardial infarction to the right ventricular electrode(Figure-2:①). We modified the sense polarity of the right ventricular electrode from “tip to ring” to “tip to coil”, but there seemed to be no significant difference in the delay of ventricular perception.Later, when the patient’s oral dosage of beta blocker was increased, the AV delay was prolonged and the conduction block was more severe than before. Because of MVP function, inhibiting ventricular pace(VP),thus AP+VSP and AS without VP appeared regularly (Figure-2: ②). Because of the regular occurrence of ventricular pacing missing, the patient’s palpitation became worse.And the increase in the proportion of right ventricular apical pacing may worsen cardiac function. Finally, our solution is to reduce the dosage of beta blocker, set ICD pacing rate of 55 times / min, MVP on, VSP on, and suggested the strategy of catheter ablation of PVC.The main reason for the delay of ventricular electrode perception is the slow conduction through the scar zone of posterior inferior left ventricle and interventricular septum due to the old myocardial infarction(Figure-3). The second reason is the deterioration of conduction system itself（senile degeneration, old myocardial infarction involving conduction system, ventricular septal conduction time delay）.The latter was confirmed by the significant atrioventricular block after increasing the dose of beta blocker.

We described a 15-year-old boy who underwent the catheter ablation for the nodoventricular tachycardia that had difficulty in differentiation from atrioventricular nodal reentrant tachycardia with upper common pathway. The slow pathway ablation revealed an anterograde conduction of nodoventricular fiber. We successfully performed the catheter ablation targeting for the right ventricular insertion site of the nodoventricular fiber.

Background— According to published evidence, Coronavirus Disease‐2019 (COVID‐19) is associated with myocardial injury and could lead to higher risk of arrhythmic complications. However, there is a substantial lack of wide population data on the arrhythmogenic effect of the disease. Objective—to describe the effect of COVID-19 epidemic on arrhythmic burden among high risk patients Methods— This cross-sectional comparative study describes the incidence of ventricular arrhythmia (VA) during the epidemic outbreak (study period) and compares it to the same timeframe in 2019 (reference period). Inclusion criteria were age (>18 years) and having an implantable cardiac defibrillator (ICD). Results – Among 455 patients (mean age 64.9 ± 15.7 years), 25.1% were females and 39.6% had a CRTD. In the study period, 45 (9.9%) patients experienced a total of 86 VA; 8 patients (1.7%) required anti-tachycardia-pacing (ATP) and 6 (1.3%) at least one shock. In the reference period, a total of 69 events occurred in 36 patients (7.9%). 6 patients (1.3%) required ATP and 3 (0.7%) at least one shock. The number of patients that suffered from any arrhythmic events in the study period (9.9 vs 7.9%) did not significantly differ from the reference period (χ2 = 1.09, p = 0.29). The main predictor of VA during COVID-19 epidemic was previous history of any ICD therapy (OR = 3.84, p < 0.001). Conclusions – No evidence of increase of arrhythmic burden was found during COVID-19 epidemic. The present study contributes to illustrate the impact of the COVID-19 on the cardiovascular system.

Over the past 90 years, anthropogenic degradation of soil caused by alkaline, magnesium-rich dust deposit has presented a serious problem near magnesite processing factories in Jelšava and in Lubeník (Slovakia). The objective of this study was to investigate the chemical and biological soil properties in 14 sampling sites at different distances from factories, and based on the results, to propose further use of affected land. Results revealed that the available Mg 3–68 fold exceeded very high content for texturally medium soils at all grassland sampling sites, and areas close factory contained up to 14.4–17.4 g kg-1. Higher excess of available Mg caused significant increase of soil pH (up to 9.39) and worsened the conditions for the growth of vegetation. As a result, lower stock of newly formed organic matter (0.50–0.96 g kg-1 of labile carbon) with consequently weaker enzymatic activity occurred. Therefore, enrichment by organic matter provides a measure to support the biological activity of soil. The content of monitored heavy metals (Zn, Cu, Pb and Ni) was not related to Mg and did not influence the enzymatic activity of soil. Because alkaline emissions have decreased by 99.8% since 1970, the application of classical measures (mechanical removal of the Mg-rich crust, incorporation of gypsum and manure to the soil), or newer methods (growing of Mg hyper-accumulating plants) can offer more lasting positive effects than those of 50 years ago. This study concluded that Mg-rich, alkaline dust deposition causes long-lasting anthropogenic soil degradation.

The long-term planting of alfalfa (Medicago sativa L.) gradually reduces the yield and causes severe soil desiccation in semiarid areas. Converting alfalfa pasture into cropland (rotation cropland, RC) is a common way of land use to restore soil moisture. However, it is a challenge for RC to achieve high productivity and maintain high soil organic carbon (SOC) achieved by previous alfalfa. Here, we conducted a nine-year field experiment, with continuous cropland (CC) under plastic film mulching as reference, to evaluate soil moisture restoration, crop productivity, and SOC in RC also under plastic film mulching, in the case of fertilization and non-fertilization, respectively. After the long-term alfalfa pasture was converted to RC, Soil moisture at the upper 2 m profile, especially the upper 0.6 m, restored rapidly to the levels like the CC. The crop yield and biomass were not significant between RC and CC following the second year of conversion in both fertilization and without fertilization cases. The SOC content in RC without fertilization decreased gradually with the conversion years. However, it had no significant difference in RC with fertilization with the previous alfalfa pasture throughout the nine-year experiment. These findings imply that fertilization allowed the RC under plastic film mulching to keep similar productivity to CC and maintain SOC continuously the same as the previous alfalfa pasture while gradually restore soil moisture. This study provided promising adaptive management for increasing agricultural carbon sequestration and crop productivity in semi-arid Loess Plateau and other similar areas.

Mini-commentary on BJOG-20-0142.R1: Acupuncture for recurrent urinary tract infection in women: A systematic review and meta-analysis

Background: Lung ultrasound (US) proved useful in patients with COVID-19, but limited data are available about its use in affected children. Aim: Lung ultrasound (US) is in the front door in the assessment of patients with coronavirus disease 19 (COVID-19), but limited data are available about its use in affected children. We aimed to describe lung US features and discuss its potential applications in COVID-19 children considering the usually mild disease course. Methods: We performed lung US to children with COVID-19 admitted between March 1st and April 27th, 2020. Clinical and radiological data were collected. One or more subsequent lung US were obtained from all subjects. Results: A series of 13 confirmed COVID-19 children were recruited. 8/13 patients showed signs of respiratory interstitial syndrome as for focal or coalescent B-lines or white lung, also in the absence of relevant clinical symptoms. Conclusions: As clinical characteristics of pediatric COVID-19 differ from adults, it is of interest to determine whether pediatric lung US shares the same imaging pattern of adults and whether COVID-19 pneumonia may differ from other virus pneumonia. Our small series highlighted that lung US documented signs of interstitial pneumonia in paucisymptomatic or asymptomatic pediatric patients. In conclusion, we pinpoint the usefulness of point of care lung US for the evaluation of infected children correlated with clinical information.

A document by Aruna Herath. Click on the document to view its contents.

Background and aim: Revascularization guidelines support routine heart team (HT) discussion of appropriate patients. The effect of HT on decision making and clinical outcomes hasn’t been explored. The aim of our study is to investigate the impact of the HT on the mode and delay to revascularization. Methods: We compared data from a prospective cohort of consecutive patients with multivessel coronary artery disease referred for HT discussion between 2016-2017 (HT group) with a historic control group of patients matched according to clinical and angiographic characteristics treated between 2005-2015 (No HT group). Results: There were 93 patients in each group. The HT group and the No HT groups had a similar rate of ACS as well as cardiovascular risk factors and significant left ventricular (LV) dysfunction. No difference was observed in the mean Society of Thoracic Surgery (STS) score (2.5± 3 vs. 3 ±3 p=0.32) and the mean SYNTAX score was low and similar in both groups (21±6 vs. 19±6 p=0.59). The treatment recommendations changed greatly, with 63% of patients being referred for coronary artery bypass grafting (CABG) after HT discussion but only 23% in the no HT group (p<0.01). HT discussion led to a significant delay to PCI (8±5 vs. 1.8±4 days, p=0.02), while surgical revascularization times were not affected. Conclusion: HT discussion in patients with multivessel CAD was associated with an increased referral to CABG but led to a significant delay in revascularization by angioplasty. The impact of these findings on patient satisfaction and outcome should be further investigated.

This case report defines an infrequent complication of unicompartmental knee replacement. Periprosthetic supracondylar femoral fracture after total knee replacement is a challenging problem for orthopedic surgeon. To our knowledge, this is the only case describing periprosthetic supracondylar femoral fracture after unicondylar knee replacement.

5 | CONCLUSIONThe interannual vegetation activity on the Tibetan Plateau shows an overall increasing trend, but there is strong spatial heterogeneity. The NDVI of the alpine desert increased the most significantly of all studied vegetation types. The NDVI values of four types of vegetation, namely, alpine meadow, subalpine scrub, needleleaf forest and broadleaf evergreen forest, showed a decreasing trend, but their NDVI values were typically larger than those of the other vegetation types.The responses of vegetation to temperature, precipitation and relative humidity have certain lag periods. The alpine meadow, alpine desert, temperate desert steppe and temperate desert respond more significantly to temperature than to other climate factors, and the length of the lag period varies greatly in different vegetation ecosystems and growth stages. Desert vegetation is the most sensitive to precipitation, followed by grassland vegetation and finally shrubs. The response of vegetation activity to precipitation generally occurs with a lag period of 1 or 2 months. During the whole growing season, the correlation between vegetation activity and precipitation first increased to reach a peak and then decreased.At the start of the growing season, temperature is the main climatic factor that affects the activity of most vegetation. After that, precipitation begins to have an effect on vegetation. The duration of sunshine has a relatively important impact on the vegetation activity in the alpine meadow, alpine sparse vegetation, subalpine scrub, needleleaf forest, and broadleaf evergreen forest. At the end of the growing season, many climatic influencing factors simultaneously affect vegetation activity.This study mainly provided an overview of how different climate factors affect domain types of vegetation on the Tibetan Plateau. These findings will provide a better understanding of the climate change trends and contribute to the general knowledge of the drivers and mechanisms of ecosystem-dependent vegetation degradation on the Tibetan Plateau. For further study, high spatial and temporal resolution data are required for more accurate analyses of the lag effects and ecological mechanisms.

Background: Asthmatic children present variable degrees of airway inflammation, remodeling and resistance, which correlates with disease control and severity. Chronic inflammatory process of the airways triggers airway remodeling, which reflects the degree of airway resistance. Pro-inflammatory and pro-fibrotic mediators are centrally involved in this process. This study has investigated for the first time, whether the levels of pulmonary and systemic pro-inflammatory and pro-fibrotic mediators present correlation with the resistance of respiratory system and of proximal and distal airways. Methods: 24 asthmatic children (persistent mild and moderate) and 24 non-asthmatic children (both between 6-13 years old) were evaluated for anthropometric characteristics, lung function and mechanics, pulmonary and systemic immune response. Results: Asthmatic children showed an increased number of blood eosinophils (p<0.04), basophils (p<0.04), monocytes (p<0.002) and lymphocytes (p<0.03). In addition, asthmatic children showed an impaired lung function, as demonstrated by FEV1%pred. (p<0.0005) and FEV1/FVC (p<0.004), decreased total resistance of respiratory system (R5Hz; p<0.009), increased resistance of proximal airways (R20Hz; p<0.02), increased elastance (Z5Hz; p<0.02) and increased reactance (X5Hz; p<0.002). Moreover, the following inflammatory factors were significantly higher in asthmatic than non-asthmatic children: GM-CSF in the breath condensate (BC) (p<0.0001) and in the serum (p<0.0001); TGF-beta in the BC (p<0.0001) and in the serum (p<0.004); IL-5 in the BC (p<0.02) and in the serum (p<0.01); IL-4 in the serum (p<0.0002). Conclusions: Impulse oscillometry is a sensitive method to detect airway resistance in asthmatic children, reflecting airway remodeling, an event followed by increased levels of pro-inflammatory and pro-fibrotic mediators.

Background. Coronavirus disease 2019 (COVID-19) is expected to continue to cause worldwide fatalities until the World population develops ‘herd immunity’, or until a vaccine is developed and used as a prevention. However, the vaccine may prove ineffective due to rapid changes in viral antigenic determinants. Bacillus Calmette–Guérin (BCG) vaccine has been recognized for its beneficial effects on the immune system, and it is currently in being tested in clinical trials for COVID-19. However, BCG shortages may affect clinical decisions regarding the prioritization of BCG to protect from viral infections, hence, small-molecule BCG-mimics will be valuable alternatives. Methods. We developed and applied a systems biology workflow capable of identifying antiviral drugs and vaccines that can boast immunity and impact viral disease pathways to prevent the fatal consequences of COVID-19. Results. Our results indicate that BCG and small-molecule BCG-mimics affect the production and maturation of naïve T cells, which results in enhanced long-lasting innate immune responses to tackle novel viruses. Our workflow identified several antiviral drugs including raltegravir and lopinavir as high confidence BCG mimics. Top hits including emetine and lopinavir were validated to inhibit the growth of novel coronavirus SARS-CoV-2 in vitro. Conclusions. Herein, we provide systems biology support for using BCG as a protection measure from the lethal consequences of emergent viruses including SARS-CoV-2. We also provide systems biology evidence that certain small molecule drugs could mimic the effects of BCG and serve as alternatives to BCG.

Aim To identify common drug-related problems (DRPs) during pharmaceutical intervention and consultation in an intensive care unit (ICU); to explore the gap between physicians and pharmacists on their understanding of each other’s capabilities and needs. Method A single-center prospective study was conducted in the ICU of a tertiary academic hospital for 21 months. A pharmaceutical care (PC) model was implemented by pharmacy care team, and data was collected during pharmaceutical intervention and consultation. Data analysis was performed on identified DRPs, causes and their relationships. DRPs’ frequency during intervention and consultation was compared. Problem-level descriptive analysis and network analysis were conducted using R 3.6.3. Result Implementation of PC model greatly improved the efficacy of pharmacists in both interventions proposed to solve DRPs (from 13.6 to 20.1 cases per month) and number of patients being closely monitored (from 7.7 to 16.9 per month). Pharmacists identified 427 DRPs during pharmaceutical intervention with primarily adverse drug events (ADEs, 34.7%) and effect of treatment not optimal (25.5%), and 245 DRPs during consultation (mainly ADEs, 58.4%). About three-fifths DRPs were caused by antibiotics. Comparing DRPs identified during pharmaceutical intervention and consultation, physicians consulted pharmacists more on questions related to medication safety, while pharmacists also paid attention to treatment effectiveness being consulted less commonly. Conclusion Implementation of PC model is beneficial in guiding pharmacy practice and improving efficacy especially under limited human resources. Physicians and pharmacists shall continue ensuring drug safety and be familiar with the scope of PC and clinical need for a better cooperation.

Letter to the Editor, BJOG Exchange

Kawasaki disease epidemic: the dilemma of evaluating clinical modelsRomina Gallizzi 1, Giovanni Battista Pajno 1.1 Department of Human Pathology of Adulthood and Childhood Gaetano Barresi, Gaetano Martino University Hospital, University of Messina, Messina, Italy*Corresponding AuthorRomina GallizziDepartment of Human Pathology of Adulthood and Childhood Gaetano Barresi, University of Messina, Messina, ItalyGaetano Martino University Hospital, UOC PediatriaVia Consolare ValeriaMessina, 98125, ItalyTel: 090 221 3154Fax: 090 221 3170E-mail: rgallizzi@unime.itTo the Editor,Following the outbreak of the coronavirus 2019 disease (Covid-19) pandemic, some authors have highlighted a link between severe forms of Covid-19 disease and the so-called cytokine storm, with increased levels of ferritin (1), characterized by an abnormal activation of the patient’s immune system with the release of numerous inflammation mediators such as IL-1, IL-6, TNF and numerous chemokines.This scenario is very heterogeneous. Some patients with Sars-Cov-2 infection develop secondary lymphohistiocytic hemophagocytosis (sHLH), while others, do not meet the criteria of sHLH but show some characteristics similar to hyperferritinemic syndrome (2).In the pediatric field, a new multisystem inflammatory disease similar to Toxin Shock Syndrome (TSS) and atypical Kawasaki disease (KD) with exposure or suspected or proven SARS-CoV 2 infection has been reported in the UK (3), while an increase in the frequency of KD-like has been reported in Italy (4).Evaluating clinical models it is clear that:-Kawasaki disease (KD) is a rare acute pediatric vasculitis with coronary artery aneurysms as its main complication. The diagnosis is based on the presence of persistent fever, exanthema, lymphadenopathy, conjunctival injection, and changes in the mucosae and cutaneous extremities of hands and feet (5).-Toxic Shock Syndrome (TSS) is a disease caused by toxins produced by Staphylococcus Aureus but also related to group A Streptococcus, is characterized by fever, diffuse macular erythroderma, peeling 1–2 weeks after getting the rash, hypotension and multisystem implication of three or more of the following organ systems: gastrointestinal, muscular, mucous, renal, hepatic, haematological, central nervous system (6). However, isolation in biological samples of one of the bacteria mentioned above is necessary to make the diagnosis. It is possible to hypothesize that SARS-CoV2, alone or in combination, may trigger or facilitate TSS.-Secondary Hemophagocytic lymphohistiocytosis (sHLH) is a severe systemic inflammatory syndrome that can be fatal, often triggered by infection. The diagnosis is based on a number of clinical signs and laboratory findings, five out of the following nine diagnostic criteria must be met: fever, splenomegaly, cytopenias (affecting two or more of three lineages in the peripheral blood), hypertriglyceridemia, hypofibrinogenemia, elevated ferritin, hemophagocytosis in bone marrow/spleen/lymph nodes, low or absent natural killer (NK)-cell activity, or elevated soluble CD25 (7).The pediatric cases described during the Covid 19 pandemic, labeled as atypical KD or hyperinflammatory syndrome, have clinical features and laboratory tests that are reminiscent of both KD, TSS and sHLH, but do not fully meet any of the clinical criteria for these diseases.It is possible to hypothesize that there is a new pediatric pathological entity characterized by a state of hyperinflammation and manifested by fever, systemic involvement, gastrointestinal symptoms mostly abdominal pain, cardiogenic shock due to severe myocarditis and acute kidney injury. Numerous definitions have been proposed of which pediatric inflammatory multisystem syndrome (PMIS) temporally associated with SARS-CoV-2 (8).PMIS appears to be a postinfectious inflammatory process, suggested by the fact that it is delayed after the COVID peak, by the negativity of the nasopharyngeal swab and by the antibody positivity. The characteristics that allow us to distinguish PMIS from KD are: the different age group affected, as PIMS mostly affects children with an average age of 8-10 years including adolescents. Another element of difference lies in the geography of the affected areas given the less frequent Chinese cases, despite being the country most affected at the beginning of the pandemic.From available clinical data and reports, differences between PMIS and KD are evident: in KD involvement of the gastrointestinal and renal systems are uncommon. In addition, to the laboratory tests, it is possible to find some major analogies between PIMS and sHLH for example hyperferritinemia, D-dimer increase, and to the cytokine storm of TSS (9).Patients have improved coincident with IVIG with or without steroids, suggesting that this kind of therapy, in KD, TSS and in this new inflammatory syndrome is effectively modulating cytokine activation.It is necessary to collect further factors that allow us to better understand this emerging new hyperinflammatory pathology (PMIS) and its overlap with other inflammatory disorders (Figure 1). In the meantime strict medical surveillance is pivotal in order to maintain low the transmission of Sars-CoV-2 in childhood .REFERENCES1 Alunno A, Carubbi F, Rodríguez-Carrio J. Storm, typhoon, cyclone or hurricane in patients with COVID-19? Beware of the same storm that has a different origin. RMD Open 2020;6:e001295. doi:10.1136/ rmdopen-2020-0012952 Henderson LA, Canna SW, Schulert GS, et al. On the alert for cytokine storm: immunopathology in COVID-19. Arthritis Rheumatol 2020.3 Riphagen S, Gomez X, Gonzalez-Martinez C, Wilkinson N, Theocharis P. Hyperinflammatory shock in children during COVID-19 pandemic [published online ahead of print, 2020 May 7]. Lancet. 2020;S0140-6736(20)31094-1. doi:10.1016/S0140-6736(20)31094-14 Verdoni L, Mazza A, Gervasoni A, et al. An outbreak of severe Kawasaki-like disease at the Italian epicentre of the SARS-CoV-2 epidemic: an observational cohort study [published online ahead of print, 2020 May 13]. Lancet. 2020;10.1016/S0140-6736(20)31103-X. doi:10.1016/S0140-6736(20)31103-X5 Dietz SM, van Stijn D, Burgner D, et al. Dissecting Kawasaki disease: a state-of-the-art review. Eur J Pediatr 2017; 176: 995–1009.6 Availablehttps://wwwn.cdc.gov/nndss/conditions/toxic-shocksyndrome-other-than-streptococcal/case-definition/2011/7 George MR. Hemophagocytic lymphohistiocytosis: review of etiologies and management. J Blood Med . 2014;5:69‐86. Published 2014 Jun 12. doi:10.2147/JBM.S462558 Viner RM, Whittaker E. Kawasaki-like disease: emerging complication during the COVID-19 pandemic [published online ahead of print, 2020 May 13]. Lancet . 2020;10.1016/S0140-6736(20)31129-6. doi:10.1016/S0140-6736(20)31129-69 Shulman ST. Pediatric COVID-associated Multi-system Inflammatory Syndrome (PMIS) [published online ahead of print, 2020 May 22]. J Pediatric Infect Dis Soc . 2020;piaa062. doi:10.1093/jpids/piaa062

Background and Aims: COVID-19, caused by SARS-CoV-2 is a newly emerged disease. Since December 2019, more and more confirmed COVID-19 cases and deaths are reported by almost all of countries in the world. In the present study, we report the various clinical features of 12 confirmed COVID-19 cases in our hospital, Guangzhou. Methods: Electronic medical records of 12 confirmed COVID-19 patients who had been referred to the Third Affiliated Hospital of Guangzhou Medical University were collected. The clinical manifestations, laboratory examinations and related imaging results were analyzed, respectively. Results: Twelve confirmed patients had different clinical manifestations, ranging from asymptomatic, mild to severe manifestations. Seven patients had a fever as the main symptom. Three patients showed nasal obstruction, or stuffy nose, or sore throat without fever. Nine patients did not show abnormal white blood cell and lymphocyte counts. Seven patients did not show radiological features of COVID-19. The first symptoms of Case 4 were vomiting, diarrhea, and Case 4 was wrong diagnosed as gastroenteritis when he saw a doctor firstly. Two patients had negative qRT-PCR results for SARS-CoV-2, but their serum IgM and IgG antibodies to SARS-CoV-2 were positive. Conclusion: The clinical characteristics of SARS-CoV-2 infection are very complex and diverse. More attention should be paid to observe the characteristics of COVID-19 in order to correctly recognize and diagnose cases with SARS-CoV-2 infection as soon as possible.

Abstract Background: Nasal polyp is a common disease in otorhinolaryngology, and its clinical diagnosis often needs pathological examination. At present, 3.0T1H-MRS can analyze the spectrum of brain glioma and other diseases, get biochemical metabolism information with clinical diagnosis value, and correctly diagnose brain glioma. Therefore, we use 3.0T1H-MRS to analyze the spectrum of nasal mucosa polyp, in order to make a clear diagnosis of nasal mucosa polyp through 3.0T1H-MRS. Objective： To analyze and study the 3.0T1H-MRS characteristics of nasal polyps, and to explore the value of 3.0T1H-MRS in the diagnosis of nasal polyps. Methods： 50 patients with nasal polyps from January 2010 to June 2019 were randomly selected from our department for study. All patients were pathologically verified and 3.0T was performed MRI, 3.0T1H-MRS focus detection, and quantitative analysis were compared with the normal brain tissue in the same side of the forehead. The main study was acetic acid (Ace), lactic acid (Lac), n-acetylaspartic acid (NAA), choline (Cho), creatine (Cr) peak integral value and the ratio of each integral value: Cho / NAA, Cr / Lac, Cr / NAA, Cho / Cr,Lac / NAA and Lac / Ace. Results：The expression of 3.0T1H-MRS in nasal polyps was significantly different from that in normal brain tissues: NAA decreased, Cho increased,Lac increased, Ace increased and most obvious; Lac / NAA ratio increased; Cho / NAA ratio increased and more obvious; Lac / Ace ratio decreased and most obvious; The difference between the two groups was statistically significant (P < 0.05). Conclusions： The analysis of 3.0T1H-MRS can get the biochemical metabolism information of clinical value: Ace（11.43 ± 6.11）, NAA (17.76 ± 6.20), Cho (23.19 ± 6.91), Lac (12.51 ± 3.42), Lac / Ace (1.09 ± 0.56); Cho / NAA (1.34 ± 1.10), Lac / NAA (0.70 ± 0.55). According to the different integral values of acetic acid, lactic acid, n-acetylaspartic acid, choline and creatine, it is helpful for the correct diagnosis of nasal mucosa polyp.

Background: Abnormal wound repair is implicated in asthma pathogenesis. The nose is the point of first contact with the environment, yet wound repair ability of the nasal epithelium has received little attention. We sought to determine the impact of atopy and asthma on wound healing of nasal epithelium. Methods: Primary nasal epithelial cells harvested from adult volunteers classified into mutually exclusive groups [healthy (H), atopic non-asthmatic (ANA), non-atopic asthmatic (NAA) and atopic asthmatic (AA)] were grown into well-differentiated epithelium at the air-liquid interface. The ability of the epithelium to heal a mechanical wound was determined under various conditions. Results: Wound healing rate (%/hour) was slowest in ANA (2.9±1.8, vs 4.3±1.9 in H, p=0.02). Healing rates of AA (3.8±1.0) and NAA (4.1±1.1) were not different from H. Exogenous IL-13 slowed healing (2.2±1.1 vs 4.0±1.3, p<0.002) across all subject groups (p<0.001). However, blocking endogenous IL-13 had no effect on wound healing (p=0.68). Blocking endogenous EGF markedly slowed wound healing (0.6±0.4 vs 4.1±1.9, p=0.006), whereas adding exogenous EGF had no effect (p=0.58). Wound healing was significantly faster (4.4±1.0 vs 3.4±0.9, p=0.013) in subjects (6 AA, 9 NAA) who took regular inhaled corticosteroids prior to cell harvesting. Infecting epithelial cultures with RSV 6 days prior to wounding slowed healing in all groups (p<0.001). Prior inhaled steroids also improved wound healing following RSV infection (P<0.001). Conclusion: Nasal epithelium from atopic adults heal wounds more slowly. Inhaled corticosteroids taken in vivo prior to harvest influence their responses in vitro, improving wound healing.

A plant-complex substrate-microbe ecological restoration system was constructed in field and sludge was added to the reconstructed mine soils in order to speed up the reclamation process. The effect of sludge addition on plant growth, microbial activity, soil aggregate stability and aggregation-associated soil characteristics in 9-year chronosequences was monitored. The results showed that the height and the total biomass of ryegrass with sludge amendment increased with the reclamation time and eventually reached 1.5 times and 4.3 times respectively higher than the control (CK1) after 9 years. The sludge amendment enhanced the content of aggregate binding agents such as SOC and glomalin and the soil aggregate stability. The SOC, LFOC and HFOC in RMS were increased by 151.35%, 247.41% and 132.82% over the CK1, respectively. A similar trend was also observed for GRSP. Besides, the stable indexes of soil aggregates had been increasing until the seventh year. In short, the tested variables in reconstructed mine soils after 3-7 years were insignificantly different from them in the treatment without sludge amendment after 9 years (CK2). Furthermore, a significant positive correlation between GRSP and SOC was investigated in RMS, as well as GRSP and soil structure-related variables. Biological stimulation of SOC and GRSP to soil accelerated the recovery of soil structure and ecosystem function. Consequently, the plant-complex substrate-microbe ecological restoration system can be used as an effective technique in early mining soil reclamation.

Standardised assessment is key to structured surgical training. Currently, there is no consensus on the effectiveness of surgical assessment tools in gynaecologic surgery. The purpose of this review is to identify and assess measurement characteristics for assessment tools for measuring technical skills in gynaecologic surgery. Eight studies out of the 544 identified fulfilled the inclusion criteria. The assessment tools were categorised as global rating scales, global and procedure rating scales combined, task-specific rating scales or as non-procedure-specific error assessment. A combination of global and task-specific assessment tools appears to be the most comprehensive solution for observational assessment of technical skills

Foraging decisions are essential for survival, thus investigation of food preferences is a major goal in behavioral ecology. Cafeteria trials, in which multiple options are displayed to foragers simultaneously, can quantify these preferences. However, statistical analyses of these data are problematic. The aim of this research is to determine the efficacy of using Shannon Diversity (Hs) and Evenness (J) to quantify diet preferences and apply this approach to field data collected in a model system. Shannon Diversity (Hs) provides a single value to represent a forager’s diet, based on proportions of each food type offered. Shannon Evenness (J’) assesses the relative quantity of each food type consumed, and is an intuitive way to address foraging preferences. Null models inspected how values of Hs and J’ change with diet breadth. This approach was tested for a cafeteria trial of two common chipmunks [Eastern (Tamias striatus) and Least (Neotamias minimus)] with five different seed types [Red (Acer rubrum) and Sugar (A. saccharum) Maple, Balsam Fir (Abies balsamea), Pin Cherry (Prunus pensylvanica), and Beaked Hazelnut (Corylus cornuta)]. Hypothesis tests determined if observed diets were statistically different from those predicted based on equal preferences. Values of Hs increased with diet breadth; although mean J’ was unaffected by diet breadth, variability increased. Chipmunks displayed significant seed preferences: Tamias preferred Sugar Maple whereas Neotamias preferred Red Maple. Moreover, each species avoided the seed type preferred by the other chipmunk. Null models indicate that Hs accurately estimates real changes in diet breadth. The fact that J’ did not significantly change with increasing diet breadth also supports the utility of this approach to determine non-random diet preferences. Use of diversity indices to quantify feeding choices can be extended to other contexts (e.g., comparison of suites of foragers, and altering feeding context by changing amounts of each resource offered).