The contribution of wild insects to crop pollination is becoming increasingly important as global demand for crops dependent on animal pollination increases. If wild insect populations are to persist in agricultural landscapes, there must be sufficient floral resources (FR) over time and space. The temporal, within-season component of FR availability has rarely been investigated, despite growing recognition of its likely importance for pollinator populations. Here, we examined the visitation rates of common bee genera and the spatiotemporal availability of FR in agroecosystems over one season to determine whether local bee activity was limited by the abundance of landscape FR, and if so, whether it was limited by the present or past abundance of landscape FR. Visitation rates and landscape FR were measured in 27 agricultural sites in Ontario and Québec, Canada, across four time periods and three spatial scales. Landscape FR at varying spatial scales predicted visits for the seven most commonly observed bee genera. Bombus visitation rates were higher in landscapes that had greater cumulative seasonal abundance of FR, suggesting the importance of early-season FR for this taxon. Visits from Halictus and Lasioglossum were higher in landscapes that provided either a stable or increasing amount of FR over the season and were lower in landscapes that experienced a decrease in FR over the course of a season. Andrena, Augochlorella, Megachile, and Peponapis visits were not measurably influenced by FR in previous months but were lower in landscapes that had a higher present abundance of FR, perhaps reflecting pollinator movement or dilution. Our research provides insight into how seasonal fluctuations in floral resources affect bee activity, and by examining each bee genus separately, we could observe how differences in foraging periods, foraging ranges, and the number of broods per season influence how bee taxa respond to food availability within agroecosystems.

Rationale, aims and objectives: Between January 2016 and March 2019, an estimated 12,800 Canadians died from an opioid-related overdose. A contributing factor has been the abuse of legally obtained prescription opioids. The use of plant derived cannabinoids for chronic pain has been growing in recent years. In October 2018, recreational cannabis became legal in Canada, which resulted in increased access and a reduction in the stigma associated with usage. The purpose of this study was to assess trends in the amount and total cost of opioid prescribing in Canada prior to and following cannabis legalization. Methods: National monthly prescription claims data for public and private payers were obtained from January 2016 to June 2019. The drugs evaluated consisted of morphine, codeine, fentanyl, hydrocodone, hydromorphone, meperidine, oxycodone, tramadol and the non-opioids gabapentin and pregabalin. All opioid volumes were converted to a mean morphine equivalent dose (MED)/claim. Gabapentin and pregabalin claims data were analyzed separately from the opioids. Time series regression modelling was undertaken with dependent variables being mean MED/claim and total monthly spending. The slopes of the time series curves were then compared pre vs. post cannabis legalization. Results: Over the 42-month period, the mean MED/claim declined within public plans (p < 0.001). However, the decline in MED/claim was 5.4 times greater in the period following legalization (4.1 vs. 22.3 mg/claim). Total monthly opioid spending by public payers was also reduced to a greater extent post legalization ($95,000 vs. $267,000 per month). The findings were similar for private drug plans; however, the absolute drop in opioid use was more pronounced (30.8 mg/claim pre vs. 76.9 mg/claim post). Over the 42-month period, gabapentin and pregabalin usage also declined. Conclusions: Our findings support the hypothesis that easier access to cannabis for pain may reduce opioid use for both public and private drug plans.

Abstract Rationale: Our current global healthcare system is not sustainable. It is structured based on the principles of reductionist science which was discovered and developed over the past 400 – 600 years. Because of increasing pace of change and increasing complexity in our world we have increased fragmentation in our healthcare system leading to more harm and waste. Over 100 years ago, the principles of systems, or complexity, science were discovered, first in the discipline of physics. These principles accommodate the constant change and biologic variability in our world. While reductionist principles would be applicable in a static, mechanical world where parts of the system could be isolated, this does not exist in the real biologic world. Method: For the past decade, our abdominal wall hernia team has been applying the principles of systems science to real patient care. Some of the tools we have applied include continuous quality improvement for whole hernia patient processes and non-linear analytical tools to gain insight to improve value-based outcomes. Until we learn to apply and scale these principles across our whole global healthcare system, we will continue to suffer the consequences of our current unsustainable system. Results: We have learned that the application of systems and complexity science to real patient care can lead to lower costs and better outcomes in the context of patients with complex hernia problems. However, these concepts have not yet been adopted in our global healthcare system. Conclusion: Applying the principles of systems and complexity science to our global healthcare system has the potential to lower costs and improve patient outcomes for any patient care process to which it is applied.

Otolaryngology (ENT) is a surgical speciality commonly known for its rapid advanceement and routine incorporation of newer technologies into routine clinical practice. Routine clinical integration of artificial intelligence (AI) is a field that is garnering significant interest. Within ENT, it holds a lot of potential. I will explore the use and challenges of AI in ENT by exploring case studies of particular pathologies, and look at some of its future applications.

Lactobacillus (L.) plantarum is widely distributed in the natural environments and previous studies failed to identify habitat-specific genomic signatures. Thus, comparative genomic analysis together with genome-wide association study of 551 L. plantarum genomes were performed to investigate how natural habitats shaped the bacterial genomes. Firstly, the study constructed a phylogenic tree using a strict core-genome of L. plantarum, followed by refining the clades with genome-wide single nucleotide polymorphisms (SNPs). Our data showed that plant-originated isolates dispersed evenly across the phylogenetic tree, supporting a previously reported model of nomadic lifestyle. Isolates from animal and dairy sources showed significant biases in clade distribution, suggesting close association between bacterial genomes and habitats. The animal-originated isolates distributed mainly to clade A and were characterized with more carbon utilization-associated genes. The dairy isolates distributed mainly to subclades B2 and B3, which harbor more nitrogen utilization-associated genes. Both animal and dairy isolation sources were directly linked with the development of human civilization in the aspects of food culture and food industry. Furthermore, based on five population genetic signals, subclade B2 had the highest genetic diversity and SNP distance. Subclade B1 had the highest mutation rate, possibly resulted from recombination events. The animal-originated isolates had lower nucleotide diversity and higher recombination/mutation ratio, which might be the genetic trail remained from the adaptation process. Our data have provided an explanation for the high versatility of L. platnarum on the genomic level and showed that the L. plantarum species is more genetically diverse than previously expected.

Objective: Drug-related problems (DRPs) can lead to consequences such as morbidity, mortality and increased costs. An electronic expert support system (EES) has been developed by the Swedish eHealth Agency to help pharmacists in community pharmacies identify potential DRPs, and to resolve actual DRPs. The objective of this study was to examine whether the use of the EES in a Swedish community pharmacy will result in more identified and resolved DRPs. Methods: In an open, prospective and controlled study, prescriptions were dispensed by three pharmacists with the use of EES during two weeks and without EES during two weeks in the spring of 2019. A DRP documentation template was developed and used. Identified DRPs, suggested actions and actions presented to patients and prescribers, and resolved DRPs, were documented and compared using Chi2-tests. Key findings: 100 patients were included in both the EES intervention group and in the control group. At least one actual DRP was identified in 26 intervention patients and 28 control patients. The number of patients with at least 1, 2 or 3–5 DRPs did not differ, but including the total number of DRPs reached statistical significance, favouring the EES-support group. EES-support helped pharmacists to present suggestions to physicians and consequently to resolve DRPs, primarily drug-drug interactions. Conclusion: Our study indicates that the EES dispensing support system contributes to the identification and resolution of DRPs, mainly DRPs related to drug-drug interactions and suggestions to the prescriber.

At date, research is moving for a direct SARS-CoV-2 antiviral, which will be, probably, the ideal solution to defeat the virus. In the meantime, evidences have shown that effective improvements for health status of infected patients can be found in the decrease or stop of the hyper inflammatory state. Experts have divided the SARS-CoV-2 infection in three phases. In the last one, phase 3, the most severe, the immune system goes an overdrive status and, as consequence, it launches a large-scale assault versus all the tissues. This phenomenon is known as “cytokine storm” and it can lead to a damage of organs and, in some cases to death. Several studies showed that blocking the cytokine storm or acting advance with a prevention of the phenomenon, can be effective; studies are ongoing to evaluate agents that can be able to reduce this hyperinflammatory state, as, for example, IL-6 or IL-1 inhibitors. However, other drugs that are able to block the cytokine cascade can also be considered. In this article is reported the scientific and molecular motivation related to the use of colchicine as monotherapy or in association in all three phases of infection by SARS-CoV-2 modulating the inflammatory state. Colchicine can be considered safe and effective for the treatment and prevention of Cytokine Storm in patients affected by SARS-CoV-2 infection, in particular as a remedy added to other therapeutical agents. In fact, colchicine, probably, provides a bigger benefit to all current agents and its safety profile is superior to the one provided by other drugs, such as corticosteroids and immunosuppressive drugs.

Objective Olfactory Findings in Hospitalized Severe COVID-19 Patients.Jerome R. Lechien, MD, PhD, MS1-4, Morgane Ducarme, MD5, Sammy Place, MD6, Carlos M. Chiesa-Estomba, MD, MS1,7, Mohamad Khalife, MD1,8, Giacomo De Riu, MD9, Luigi Angelo Vaira, MD9, Christophe de Terwangne, MD10, Shahram Machayekhi, MD10, Arnaud Marchant, MD, PhD11, Fabrice Journe, PhD2*, Sven Saussez, MD, PhD1,2,4*

Beckgroung: The global pandemic Sars-Cov-2 (COVID-19) is causing thousands of deaths worldwide, and is one of the greatest health challenges ever faced in human history. Sars-Cov-2 infection can cause fatal lung injuries caused by a generalized inflammatory state associated with multi-organ dysfunction. Objective: In this context, it is essential to recognize the factors that increase the risk of viral infection. People with pre-existing conditions, such as diabetes, are at greater risk of complications and death caused by COVID-19. Materials and Method: Old age, possible chronic drug therapies, kidney failure, hyperglycemia, heart disease, are predictive factors of a bad outcome for the diabetic patient. The regulation of glycaemia and the adoption of appropriate measures are critical aspects to be taken into consideration for the diabetic patient in this pandemic period, especially in the patient with ongoing infection. Results: In the latter, the use of drugs used to fight COVID-19 infection, such as antivirals or immunomodulants, must be well controlled to avoid possible drug interactions and major complications. People with diabetes fall into the category of fragile and at-risk population, and if a COVID-19 infection is also ongoing the patient must be managed optimally, trying to fight the virus but also without neglecting homeostasis and glycemic control. Conclusion: This analysis highlights current knowledge and challenges for the prevention and management of patients with diabetes and COVID-19 infection.

While rainfall interception controls how much water will be ultimately available for many ecological functions, it is not well understood how canopy structure controls the spatial and temporal distribution of throughfall inside forests. Specially in subtropical and highly heterogenous forests, such as the Atlantic Forest in Brazil, rainfall interception has been only timidly studied. In this paper we investigated how the spatial and temporal variations of throughfall are controlled by the canopy structure. Throughfall spatial variability was measured for a period of over a year using 28 throughfall gauges uniformly distributed in a 28 m² Atlantic Forest plot in Southern Brazil. We proposed the use of the number of overlapping crowns (NOC) as a measure of canopy structure and compared it to the commonly adopted Canopy Cover Fraction (CCF) and the Leaf Area Index (LAI). Locations with a higher CCF, LAI and NOC have a large throughfall variability among rainfall events, even though throughfall amounts could not be directly related to those canopy cover indices. This result implies that the throughfall variability is due to preferential pathways created by the overlapping canopy layers. Additionally, throughfall spatial distribution for periods with lower amounts of gross rainfall is similar to NOC, suggesting that for smaller events the canopy storage capacity is the major control of the amount of rainfall reaching the soil.

Revealing the dynamics of groundwater movement in the vadose zone is crucial to groundwater management and artificial recharge. The traditional hydrographic surveys are usually indirect, costly, and infrequent. In this study, the groundwater flow characterization of a pumping experiment in Jilin University campus was monitored through combining time-lapse electrical resistivity tomography (ERT) and self-potential (SP) data tomography. The ERT datum depicts the spatial distribution of resistivity, which is related to the dynamics of soil moisture content during the pumping process. We are able to correlate hydraulic heads and SP signal during a decline and recovery groundwater level period leading to interesting perspectives in understanding the dynamics of complex groundwater flow. The SP method provides a direct way to estimate the potential field distribution, which can be further used to invert soil permeability. A total of 24 hours of time-lapse geophysical surveys revealed a significant increase in resistivity but a decrease in permeability during water pumping and groundwater recharge, representing the process of groundwater decline and recovery. Results derived from time-lapse geophysical surveys matched well with in situ monitoring of the groundwater level. The study demonstrates that the combined ERT and SP data can provide a direct and reliable way to monitor groundwater flow or other time-lapse hydrogeological surveys.

Bronchiectasis (BE) is defined as a permanent, irreversible dilation of the bronchial tree. In the pediatric population, this disease process is most commonly associated with patients with Cystic Fibrosis (CF). However, bronchiectasis unrelated to cystic fibrosis is increasingly noted as a cause of chronic respiratory related morbidity worldwide. Chronic inflammation and recurrent infection result in cellular cascades that lead to irreversible structural changes of the airways. When these architectural changes occur, they confer extensive risks to morbidity usually due to continued infections. In the adult population, bronchiectasis has been associated with chronic obstructive pulmonary disease, which is mainly caused by cigarette smoking. In this report, the authors reviewed various cases of bronchiectasis in the pediatric population where the only inciting factor was electronic cigarette use.

Introduction: Acute pulmonary vein reconnection (PVR) is associated with longer procedure time and radiofrequency time during pulmonary vein isolation (PVI). However, determinants of acute PVR after high-power, short-duration PVI (HPSD-PVI) in the guidance with unipolar signal modification (USM) remain unclear. Methods and Results: We evaluated 62 patients (age, 62±12 y; 45 men) with paroxysmal atrial fibrillation undergoing USM-guided HPSD-PVI. A 50-W radiofrequency (RF) was applied for 3–5 s after unipolar signal modification. In the segments adjacent to the esophagus (SAE), RF time was limited to 5 s. Each circle was subdivided into 12 segments. For each radiofrequency tag within the circle, possible predictors of acute PVR, including minimum contact force, minimum force-time integral, minimum ablation index (AImin), minimum impedance drop (Imp-min), and maximum inter-lesion distance (ILDmax) were assessed. Acute PVR was observed in 43 (7%) SAE and 21 (17%) other segments (p = 0.001). RF energy, RF application time and bilateral isolation time were 28±8 kJ, 10±3 min, and 27±11 min, respectively. Imp-min and ILDmax had the highest area under the curve (0.69 and 0.68) and of all indices, and were the sole independent predictors of acute PVR in segments other than the SAE and SAE, respectively, after adjusting for other cofounders (odds ratio [OR]: 0.90 [0.85–0.95], p = 0.0003; and OR: 1.39 [1.11–1.74], p=0.005). Conclusions: In HPSD-PVI, a non-negligible amount of acute PVR was still observed, which was possibly dealt with an optimal target value of impedance drop and lesion distance.

We report a case of catheter ablation of Brugada syndrome (BrS) in a patient with refractory ventricular fibrillation (VF) despite quinidine therapy. We performed epicardial substrate mapping which identified an area of abnormal fractionated, prolonged electrogram in the anterior right ventricular outflow tract. Warm saline infusion into the pericardial space induced further delay of the local electrogram, consistent with BrS physiology. Coronary angiogram confirmed the area was distant from major coronary arteries. Ablation was performed in this area which eliminated local abnormal electrograms and led to the disappearance of coved-type ST elevation in V1-V2. No VF recurred at 3-month follow-up.

Mini-commentary on BJOG-19-1876.R1: Glycosylated fibronectin point-of-care test for diagnosis of preeclampsia in a low-resource setting: a prospective Southeast Asian population study

Il Soil Washing è una tecnica di bonifica che consente di rimuovere in modo permanente i metalli dal suolo. Lo scopo del presente articolo è  quello di esaminare i principali aspetti del soil washing.  I vantaggi e gli svantaggi di questa tecnologia sono stati messi in evidenza attraverso l'analisi di un caso studio condotto in Corea del Sud in un sito contaminato da piombo. Poiché questa particolare tecnica di bonifica vede un'alta produzione di rifiuti a valle del processo, lo studio ne ha evidenziato gli impatti ambientali nell'ambito della Green and Sustainable Remediation, secondo cui è opportuno valutare l’aspetto sostenibile della tecnica di bonifica, in termini di impatto sociale, economico e ambientale, e l’aspetto “green”, valutando l’applicabilità del processo relativamente a cinque elementi fondamentali: aria, energia, risorse idriche, materiali e rifiuti, terra ed ecosistema. Lo studio ha, quindi, stimato l’impatto che ogni singola fase del processo ha avuto sull’ambiente in termini di emissioni gas serra, consumo di energia ed acqua, produzione di NOx, SOx e PM10.   

Background: Although diastolic dysfunction is common among patients treated with cancer therapy, no clear evidence has been shown that it predicts systolic dysfunction. This study evaluated the correlation of longitudinal diastolic strain (Ds) with echocardiography diastolic parameters and to estimate its role in the early detection of cardiotoxicity among patients with active breast cancer. Methods: Data were collected as part of the Israel Cardio-Oncology Registry (ICOR), a prospective registry enrolling all adult patients referred to the cardio-oncology clinic. All patients with breast cancer, planned for Doxorubicin therapy were included. Echocardiography, including Global longitudinal systolic strain (GLS) and Ds, was assessed at baseline before chemotherapy (T1), during Doxorubicin therapy (T2) and after the completion of Doxorubicin therapy (T3). Cardiotoxicity were determined by GLS relative reduction of ≥15%. Ds was assessed as the time of lengthening =diastolic time (ms) measured. Results: Among 69 patients, 67 (97.1%) were females with a mean age 52±13years. Diastolic strain time measurement was significantly associated with the standard diastolic parameters. Significant GLS reduction was observed in 10 (20%) patients at T3 . Both in a univariate and a multivariate analyses the change in Ds basal time from T1 to T2 emerged to be significantly associated with GLS reduction at T3 (p<0.04). Conclusions: Among breast cancer patients, Ds time showed high correlation to standard diastolic echocardiography parameters. Relative reduction in Ds basal time emerged associated with clinically significant systolic dysfunction as measured by GLS reduction.

Background: Left ventricular ejection fraction (LVEF) is calculated from volumetric change without representing true myocardial properties. Strain echocardiography has been used to objectively measure myocardial deformation. Myocardial strain can give accurate information about intrinsic myocardial function, and it can be used to detect early-stage cardiovascular diseases, monitor myocardial changes with specific therapies, differentiate cardiomyopathies, and predict the prognosis of several cardiovascular diseases. Sacubitril/Valsartan has been shown to improve mortality and reduce hospitalizations in patients with heart failure with reduced ejection fraction (HFrEF). The effect of Sacubitril/Valsartan on LV ejection fraction (EF) and torsion dynamics in HFrEF patients have not been previously described. Results: ARNI group of patients showed improvement of symptoms, LVGLS% and diastolic parameters including, E/A, E/e’, TV, untwist onset and rate after 6 months of therapy in comparison to the traditionally treated patients. The improvement continued for 11 months with in additional significant improvement of systolic parameters in the form of LVGLS%, EF%, Twist, Apical and basal rotations, main dependent parameters for improvement of EF% was LVGLS% and Apical rotation. Conclusion: To our knowledge this is the first study to demonstrate that therapy with Sacubitril/Valsartan in HFrEF patients could create a state of gradual and chronic LV deloading which cause relieving of myocardial wall tensions and decreasing the LV end diastolic pressure this state could cause cardiac reverse remodeling and reestablishment of starling forces proprieties of LV myocardium, which lead to increase of LV ejection fraction.

Background and Objective: Compared with adult patients infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), children have a higher proportion of re-detectable positive (RP) in the recovery period.The underlying risk factors remain unknown.We aimed to identify the early risk factors for RP, and to provide a basis for early clinical prediction and risk stratification. Methods: A retrospective analysis was performed on all pediatric cases diagnosed with coronavirus disease 2019 (COVID-19). Results: 14 of 38 (36.8%) pediatric patients were RP.Children have a significantly higher percentage of RP (OR[95%CI] 4.84[2.21-10.59];P=.000).Compared with control group (n=24),RP group (n=14) had more family cluster infections (1.59[1.1-2.3];P=.030),while age ([7.2±4.8] vs [7.6±5.1]),and percentage of male gender (35.7% vs 45.8%), fever (21.4% vs 45.8%),respiratory or digestive symptoms (71.4% vs 50%), asymptom (28.6% vs 33.3%), computed tomography positive findings (85.7% vs 83.3%) and co-infection (7.1% vs 8.3%) were statistically nonsignificant.The laboratory data of RP group had a relatively higher white blood cell count (WBC) (7.5[5.1-9.8] vs 4.8[4.4-7.5];P=.009) and longer plasma prothrombin time (PT) ([12.6±0.7] vs [12.1±0.5];P=.023),while neutrophil percentage and count, lymphocyte percentage and count, hemoglobin, platelets,erythrocyte sedimentation rate,high sensitivity C-reactive protein, interleukin 6,procalcitonin, activated partial thromboplastin time ([37.5±4.6] vs [34.2±5.1]; P=.057),fibrinogen,antithrombin III and D-dimer showed no statistical difference. Conclusions:Family cluster infection,higher WBC and longer PT are the main risk factors for RP in the recovered COVID-19 children.Early activation of coagulation and WBC may be involved in SARS-CoV-2 clearance.

Title: COVID-19: Precautions with children in home mechanical ventilation.Authors: Luis Vasconcello-Castillo1, Rodrigo Torres-Castro MSc1, Roberto Vera-Uribe MSc1, Rebeca Paiva MD2.1Departamento de Kinesiología, Facultad de Medicina, Universidad de Chile, Santiago, Chile2Ministerio de Salud, Programa de Asistencia Ventilatoria No Invasiva Domiciliaria, Santiago, Chile

Background: There is limited data on the safety and efficacy of a novel high-definition mapping catheter with 16 equidistant electrodes (Advisor HD Grid). We describe procedural details for the treatment of complex atrial arrhythmias and associated outcomes using this novel catheter design. Methods and Results: The HD Grid was employed for patients with clinically relevant arrhythmia using the EnSite Precision™ electroanatomic mapping system. AVRT and typical flutter cases were excluded. Major procedural complications were defined as bleeding, stroke or TIA, sepsis, and death from any cause, whereas minor complications were defined as no changes to the length of hospital stay or to the expected management of the patient. Recurrence was defined as sustained tachycardia after 3 months post-procedure. Consecutive patients attending for the treatment of paroxysmal atrial fibrillation (66), persistent atrial fibrillation (38), atrial tachycardia (29), and atypical flutter (18) were included, resulting in a final inclusion of 142 patients and 151 procedures. Eighty-four patients (55.3%) received general anesthetic and intracardiac echocardiography was used in 23 (15.1%). Long term follow-up was available in 150/151 procedures, mean 185.2±134.3 days; 32 patients (21.3%) documented recurrence. Three (2.0%) patients experienced complications within 30-days of the procedure including acute tamponade (1), TIA (1) and stroke (1) and 1 (0.7%) died from complications of septic arthritis 183 days post-procedure. Conclusion: The novel HD Grid differs significantly in design and handling compared to the traditional multielectrode catheters. Our data report procedural outcomes in line with contemporary clinical expectations with low complication and recurrence rates.

Background: During COVID-19 pandemic, a metered-dose inhaler (MDI) with a valved holding chamber (VHC) is a preferred route of bronchodilator delivery. We have developed a new homemade VHC, made of a paper coffee cup and a drinking water bottle. This study was conducted to compare the bronchodilator response in children with airway hyperresponsiveness after the use of our homemade VHC and that of a standard commercial one. Methods: In a randomized, two-period, two-sequence crossover design, we recruited 20 children, aged 6-15 years, who had greater than 12% increase in FEV1 after inhaled salbutamol. They were randomized into Group A and B. Group A used our VHC on the first day and Aerochamber® on the second day. Group B used the same VHCs but in alternate sequence. Spirometries were performed before and after 400 microgram of salbutamol MDI was administered via those VHCs. Results: Baseline demographic data and spirometric values did not have statistically significant differences between group A and B and between the first and second day (P > 0.05). After giving salbutamol MDI, both VHCs produced significant increases in FVC, FEV1 and FEF25-75% (P < 0.005). The improvement in FEV1 did not significantly differ between our homemade VHC and Aerochamber® (P > 0.05). Conclusion: Our homemade VHC is effective for an MDI bronchodilator delivery. Since it is very cheap and easy to make, it may be used as a disposable device to minimize airborne transmission especially when commercial VHC are not available.

Background: Deletion of cyclin-dependent kinase inhibitor 2A (CDKN2A) is prevalent in pediatric acute lymphoblastic leukemia (ALL) and the prognostic importance of CDKN2A deletion is still controversial. Procedure: A total of newly diagnosed 655 pediatric ALL cases were treated with Chinese Children’s Leukemia Group-acute lymphoblastic leukemia 2015 (CCLG-ALL 2015) protocol[1]. We investigated the difference among B-ALL and T-ALL patients with CDKN2A deletion for clinical characteristics at diagnosis, immunophenotype, risk stratification, cytogenetic risk group, and early treatment responses.We also analyzed the prognostic markers for event-free survival(EFS) in CDKN2A-deleted patients. Result: The incidence of CDKN2A gene deletion was presented in 14.6% (87/595) of B-ALL subgroup and 40.0% (24/60) of T-ALL subgroup. T-ALL subgroup was characterized by a higher male/female ratio, a higher proportion of older children (>10 years old) and WBC counts of greater than 50x109/L compared to B-ALL(P<0.05). In the univariate analysis, CNS 2, cytogenetic risk groups, prednisone poor responders (PPR), poor early response (PER), and MRD≥0.01% at day 46 (P<0.05) were associated with a poor event-free survival. Multivariable analysis revealed that PPR and MRD≥0.01% at day 46 were independent inferior prognostic factors for event-free survival(P<0.05). Conclusions: The incidence of CDKN2A deletion was more prevalent in T-ALL. CDKN2A deletion was significantly more prevalent in older (>10 years old) boys with leukocyte counts of greater than 50x109/L among T-ALL. PPR and MRD≥0.01% at day 46 were an independent prognostic factor for EFS in pediatric CDKN2A-deleted ALL.

Objective: To analyze the differential expression of related serum proteins was detected in patients with AR who were sensitized to dust mites pre- and 6-day post-RIT. Methods: Serum samples were collected from 15 AR, 15 6-day post-RIT and 10 healthy control patients. This analysis was performed using iTRAQ technique and was coupled with 2-dimensional gel electrophoresis and mass spectrometry. To determine the intimacy of the screened related differential proteins, a hierarchical analysis was performed with Cluster 3.0 software, and the results were visualized using Java TreeView software. Last, an ELISA was employed to validate the selected CRP, CTHRC1 and WDR89 protein expression data. Results: Compared with the healthy control group, the most upregulated protein in the AR group and the most downregulated proteins in the 6-day post-RIT group were CTHRC1 and WDR89. Compared with the healthy control group, the most downregulated protein in the AR group and the most upregulated protein of the 6-day post-RIT group was CRP. The serum protein levels of CRP, CTHRC1 and WDR89 proteins were determined by ELISA. It was found that the differential expression of CTHRC1 and WDR89 in the AR and 6-day post-RIT groups were statistically significant (P < 0.05), whereas no statistically significant difference (P > 0.05) was found in the differential expression of serum CRP in the AR and 6-day post-RIT groups. Conclusions: We found that CTHRC1 and WDR89 might be associated with the pathogenesis of AR, and they may play a regulatory role in the RIT.