Background : Testing for SARS-CoV-2 is important for decision making prior to surgery in otolaryngology. An understanding of current and developing testing methods is important for interpreting test results.Methods : We performed a literature review of current evidence surrounding SARS-CoV-2 diagnostic testing highlighting its utility, limitations, and implications for otolaryngologists.Results : The currently accepted RT-PCR test for SARS-CoV-2 has varying sensitivity according to which subsite of the aerodigestive tract is sampled. Nasal swab sensitivities appear to be about 70%. Chest CT imaging for screening purposes is not currently recommended.Conclusion : Due to the current sensitivity of RT-PCR based testing for SARS-CoV-2, a negative test cannot rule out COVID-19.  Full PPE should be worn during high risk procedures such as aerosol generating procedures even if testing is negative. Patients who test positive during screening should have their surgeries postponed if possible until asymptomatic and have tested negative for SARS-CoV-2.

Separation of higher hydrocarbons from methane is an important and energy-intensive operation in natural gas processing. We present a detailed investigation of thin and oriented MFI zeolite membranes fabricated from 2D MFI nanosheets on inexpensive α-alumina hollow fiber supports, particularly for separation of n-butane, propane, and ethane (“natural gas liquids”) from methane. The present MFI membranes display high permeances and selectivities for C2-C4 hydrocarbons over methane, driven primarily by stronger adsorption of C2-C4 hydrocarbons. We study the separation characteristics under unary, binary, ternary and quaternary mixture conditions, including the pressure dependence. The membranes are highly effective in quaternary mixture separation at elevated feed pressures, for example allowing n-butane/methane separation factors of 170–280 and n-butane permeances of 710–2700 GPU in the 1-9 bar feed pressure range. Furthermore, we parametrize and apply multicomponent Maxwell-Stefan transport equations to predict the main trends in separation behavior over a range of operating conditions.

Objective : To investigate olfactory dysfunction (OD) in patients with mild COVID-19 through patient-reported outcome questionnaires and objective psychophysical testing.Methods : COVID-19 patients with self-reported sudden-onset OD were recruited. Epidemiological and clinical data were collected. Nasal complaints were evaluated with the sino-nasal outcome-22 (SNOT-22). Subjective olfactory and gustatory status was evaluated with the National Health and Nutrition Examination Survey (NHNES). Objective OD was evaluated using psychophysical tests.Results : Eighty-six patients completed the study. The most common symptoms were fatigue (72.9%), headache (60.0%), nasal obstruction (58.6%) and postnasal drip (48.6%). Total loss of smell was self-reported by 61.4% of patients. Objective olfactory testings identified 41 anosmic (47.7%), 12 hyposmic (14.0%), and 33 normosmic (38.3%) patients. There was no correlation between the objective test results and subjective reports of nasal obstruction or postnasal drip.Conclusion : A significant proportion of COVID-19 patients reporting OD do not have OD on objective testing.

BackgroundTracheotomy, through its ability to wean patients off ventilation, can shorten ICU length of stay and in doing so increase ICU bed capacity, crucial for saving lives during the COVID-19 pandemic. To date, there is a paucity of patient selection criteria and prognosticators to facilitate decision-making and enhance precious ICU capacity.MethodsProspective study of COVID-19 patients undergoing tracheotomy (n=12) over a 4-week period (March-April 2020). Association between pre- and post- operative ventilation requirements and outcomes (ICU stay, time to decannulation, and death) were examined.ResultsPatients who sustained FiO2≤50% and PEEP≤8cm H2O in the 24h pre-tracheotomy exhibited a favourable outcome. Those whose requirements remained below these thresholds post-tracheotomy could be safely stepped down after 48h.ConclusionSustained FiO2≤50% and PEEP≤8cm H2O in the 48h post-tracheotomy are strong predictive factors for a good outcome, raising the potential for these patients to be stepped down early, thus increasing ICU capacity.

Immunosuppressive therapies, such as multiple sclerosis, are a risk for people with this condition because they can expose them to a greater risk of Sars-CoV-2 infection. For these reasons, recommendations from agencies, patient associations and scientific societies follow one another quickly so that therapy is guaranteed with good efficacy and without risk, choosing from the many drugs available in multiple formulations.

Comment on Matricardi PM et al.: The first, holistic immunological model of COVID-19: implications for prevention, diagnosis, and public health measuresTO THE EDITOR:We read with great interest the review article by Matricardi and colleagues [1] depicting mechanisms of disease for COVID-19 and analyzing both viral and host factors influencing its course. We particularly agree with Authors on the pivotal role of innate immunity in the very early phase of disease, being crucial for the subsequent evolution. Most known weapons of innate immune system are represented by natural antibodies, non-specific antimicrobial proteins, interferons, cytokines and cellular elements (i.e. natural killer cells).[1] However, innate immunity could be influenced by other, still underrecognized, factors.At present, a solid proof of evidence is available on the ability of vitamin D in modulating immune response.[2] Most of data are available from the field of bacterial infections and sepsis,[3] being low vitamin D levels associated with a higher risk of infection and mortality.[4]In addition, vitamin D could play a role against viruses by maintaining physical barriers (i.e. tight junctions, gap junctions, etc.), enhancing natural immunity (i.e. production of cathelicidin, defensins, etc.) and modulating adaptive immune response (i.e. modulation of TH1/TH2 response and inflammation).[5] On this connection, emerging data support the role of vitamin D supplementation in reducing the risk and severity of influenza.[5] Both influenza and COVID-19 show their maximum spread in winter season and the highest severity in elderly people. Reduced vitamin D levels could represent a possible pathophysiological explanation, among others, in both cases.[5,6] With this regard, it has been hypothesized that variations in vitamin D status across countries and latitudes could, at least in part, explain variations of mortality from COVID-19.[6,7]However, at present the exact vitamin D status among COVID-19 patients is unknown.[7] Moreover, the role and mechanisms of vitamin D in the treatment of COVID-19 are still unexplored and several interventional trials are ongoing. Should these hypotheses be confirmed, universal vitamin D supplementation would represent a possible and inexpensive strategy to enhance natural immunity against COVID-19.Antonio Mirijello, MDMaria Maddalena D’Errico, MDAntonella Lamarca, MDPamela Piscitelli, MDSalvatore De Cosmo, MDDepartment of Medical Sciences, IRCCS Casa Sollievo della Sofferenza Hospital, San Giovanni Rotondo, Italy

Background：Kawasaki disease, a systemic vasculitis in children, may bring serious complications. However, the etiology of KD remains unclear. AIM2, an intracellular receptor, plays a vital role during the infection caused by a variety of pathogens. However, its role in KD remains unclear. The principal aim of the present research is to concentrate on the relation between AIM2 and KD. Methods: We detected the serum level of AIM2, IL-18 and IL-1β in all subjects by ELISA. The conventional inflammatory indices were detected in all subjects, such as WBC, HB, CRP and so on. Results: The serum concentrations of AIM2, IL-18 and IL-1β were notably increased in the KD group compared to the febrile group and healthy group, respectively. And the three indicators in the KD patients were greatly reduced after interpreted with IVIG. Furthermore, the expressions of IL-18 and IL-1β were positively correlated with AIM2. Meanwhile，the cutoff value of serum AIM2 level for the diagnosis of KD was 541.90 ng/L with the specificity of 60% and sensitivity of 92.5 %，compared to the febrile controls. And the area under curve (AUC) of AIM2 was 0.771. And no difference was observed in the CALs group when compared without the CALs group. Conclusions: The serum AIM2, IL-18 and IL-1β might play a critical role during the progress of KD. AIM2 can be considered as a candidate indicator for Kawasaki disease diagnosis. Keywords: AIM2 · IL-18· IL-1β · Kawasaki disease · Intravenous immunoglobulin ·coronary artery lesions

ETHICS APPROVAL AND CONSENT TO PARTICIPATEThe study design was approved by the appropriate ethics review board. Informed consent was obtained from the patient and parents to participate.CONSENT FOR PUBLICATIONConsent for publication was obtained from the patient and parents.CONFLICT OF INTERESTThe authors have no conflicts of interest relevant to this article to disclose.AUTHOR CONTRIBUTIONSDai Keino : Conceptualization (lead); Writing – original draft (lead); Writing – review and editing (equal). Kensuke Kondoh : Writing – review and editing (equal). Yuhwa Kim : Writing – review and editing (equal). Akina Sudo : Writing – review and editing (equal). Ryo Ohyama : Writing – review and editing (equal). Mizuho Morimoto : Writing – review and editing (equal). Hiroshi Nihira : Investigation (equal). Kazushi Izawa : Investigation (equal). Sachiko Iwaki-Egawa : Investigation (equal). Tetsuya Mori : Writing – original draft (supporting); Writing – review and editing (equal). Akitoshi Kinoshita : Conceptualization (supporting); Writing – review and editing (equal).Keywords: Adenosine deaminase 2 deficiency, cyclosporine, anti-tumor necrosis factor, etanercept, pure red cell aplasiaTo the EditorDeficiency of adenosine deaminase 2 (DADA2) is an autoinflammatory disease caused by loss-of-function homozygous or compound heterozygous mutations in CECR1 (cat eye syndrome chromosome region 1).1,2 The phenotype of the DADA2 is widely heterogeneous with a variable age of onset. Manifestations include fever, early-onset lacunar stroke, livedo, portal hypertension, nodular vasculitis, immunodeficiency, hepatospenomegaly, pure red cell aplasia (PRCA), lymphopenia, cytopenia, and hypogammaglobulinemia. Treatment mainly consists of anti-tumor necrosis factor (TNF) agents. Steroids are also widely used for treatment and have shown variable success but often with flares of inflammation and vasculitis upon tapering. Cyclosporine (CyA), tacrolimus, cyclophosphamide, azathioprine, and methotrexate have all been used with little success.1,2 Although anti-TNF agents prevent strokes and improve the manifestations of vasculitis in DADA2, their efficacy for treating PRCA and bone marrow failure is less clear.3 Hematopoietic stem cell transplantation may be considered for patients with severe hematologic presentations.4Here, we present here a young female patient who was initially diagnosed with idiopathic PRCA and later identified to have had compound a heterozygous mutation in ADA2 associated with DADA2. Administration of CyA and an anti-TNF agent (etanercept) successfully induced and maintained remission.A 13-year-old girl was admitted to our hospital with fatigability and pallor. She has past histories of rash on her extremities at 8 months old and erythema multiforme at 11 years old. Her physical examination revealed palpebral conjunctival pallor and livedo reticularis of the lower limbs. Laboratory examinations indicated anemia (white blood cell count, 2900/μL; neutrophils, 70.0%; lymphocyte, 21.5%; blasts, 0.0%; hemoglobin (Hb), 4.6 g/dL; mean corpuscular volume, 81 fL; HbF, 0.4%; Reticuro, 1.9 × 104/μL; and platelet count, 25.8 × 104/μL). Transaminase and lactate dehydrogenase were within normal ranges. IgA, IgM, and IgG were 42, 46, and 848 mg/dL, respectively. Erythropoietin was 4,650 mIU/mL. Parvovirus, Epstein-Barr virus, and cytomegalovirus were serologically negative.Bone marrow aspirate and biopsy indicated marked erythroid hypoplasia, and her nucleated cell count was 10.8 × 104/μL. Chromosomal banding of bone marrow cells was 46,XX[14/14]. Bone marrow examination indicated no T cell receptor rearrangement. Computed tomography of the chest revealed no thymoma. Mutations affecting genes encoding ribosomal proteins causing Diamond Blackfan anemia were not detected.She was diagnosed with idiopathic pure red cell aplasia (PRCA). Cyclosporine A (CyA) 4.5 mg/kg/day was started at approximately 1.5 months after admission because she was dependent on red blood cell transfusion. Biopsy of the skin of the lower limb revealed necrotizing vasculitis, and a diagnosis of cutaneous polyarteritis nodosa (cPAN) was made (Fig 1). She responded to treatment with CyA and became transfusion-independent. The dose of CyA was gradually reduced, and approximately 10 months after diagnosis, she self-interrupted treatment with CyA. Six months after self-interruption, she became transfusion-dependent again. Resumption of CyA improved her anemia.At the age of 17 years, no ADA2 enzyme activity was detected in the patient’s plasma (0.0 nmole/min/mL, normal range 2.38 ± 0.95 nmole/min/mL). The results of CECR1 sequencing revealed compound heterozygous mutations: c.744delG p.Arg248fs and c.278T>C p.lle93Thr. Thus, the patient was diagnosed with DADA2. Both parents and her sister were not carriers. Magnetic resonance imaging of the head showed no abnormal findings.She continued to administer CyA but cPAN did not improve. She started administration of an anti-TNF agent (etanercept) in combination with CyA and noted improvement in her symptom sof cPAN such as livedo, edema, and fatigue in the lower limbs. More than a year has passed since starting etanercept with no adverse effects. Because Hb has remained at 11–12 g/dL, the amount of CyA has been tapered and is currently 0.5 mg/kg/day.PRCA is a rare hematological disease characterized by bone marrow erythroid aplasia. PRCA may be congenital or acquired; the acquired form of chronic PRCA may present as a primary hematological disease in the absence of any other diseases or secondary to thymoma, lymphoproliferative disorders, infections, and collagen vascular diseases or after exposure to various drugs or chemicals. PRCA associated with DADA2 was described initially in three patients by Hashem et al. and Ben-Ami et al. and further confirmed in additional reports.5,6 A very early age of onset has been reported for PRCA (median, 0.3 years; range, 0.1–12 years).7Initial treatment for PRCA includes the cessation of potentially deleterious drugs and careful observation for one month while making efforts to identify the cause of PRCA. Sawada et al. reported that CyA and corticosteroids induced remission in 74% and 60% of patients, respectively, and that discontinuance of maintenance therapy was strongly correlated with relapse.8 Although PRCA and other types of hematologic dysfunction associated with DADA2 generally do not respond well to immunosuppressive agents such as azathioprine and CyA,9 our patient achieved a response to CyA. CyA may be useful for treating PRCA associated with DADA2.PAN is considered a disease of adulthood with a median age of disease onset of approximately the 4th to 5th decade of life. The annual incidence of childhood vasculitis is estimated to be 20 per 100,000 individuals under 17 years of age.10 Many children with PAN were found to have biallelic mutations inADA2 .1,2,9 The mainstay of treatment for vasculitis/vasculopathy consists of anti-TNF agents (etanercept, infliximab, adalimumab). Although CyA was ineffective for cPAN in our patient, anti-TNF agents (etanercept) was effective, and at the age of 20 years, our patient has no neurological complications such as ischemic strokes, intracranial hemorrhage, and a wide range of neuropathies.REFERENCES1. Zhou Q, Yang D, Ombrello AK, et al. Early-onset stroke and vasculopathy associated with mutations in ADA2. N Engl J Med . 2014;370:911-20.2. Navon Elkan P, Pierce SB, Segel R, et al. Mutant adenosine deaminase 2 in a polyarteritis nodosa vasculopathy. N Engl J Med . 2014;370:921-31.3. Ombrello AK, Qin J, Hoffmann PM, et al. Treatment strategies for deficiency of adenosine deaminase 2. N Engl J Med . 2019;380:1582-4.4. Hashem H, Kumar AR, Muller I, et al. Hematopoietic stem cell transplantation rescues the hematological, immunological, and vascular phenotype in DADA2. Blood . 2017;130:2682-8.5. Ben-Ami T, Revel-Vilk S, Brooks R, et al. Extending the clinical phenotype of adenosine deaminase 2 deficiency. J Pediatr . 2016;177:316-20.6. Hashem H, Egler R, Dalal J. Refractory pure red cell aplasia manifesting as deficiency of adenosine deaminase 2. J Pediatr Hematol Oncol . 2017;39:e293-6.7. Lee PY, Kellner ES, Huang Y, et al. Genotype and functional correlates of disease phenotype in deficiency of adenosine deaminase 2 (DADA2). J Allergy Clin Immunol 2020; doi: 10.1016/j.jaci.2019.12.908.8. Sawada K, Hirokawa M, Fujishima N, et al. PRCA Collaborative Study Group: Long-term relapse-free survival and overall survival of patients with acquired primary idiopathic PRCA receiving cyclosporine A: A nationwide cohort study in Japan for the PRCA Collaborative Study Group.Haematologica . 2007;92:1021-8.9. Hashem H, Kelly SJ, Ganson NJ, et al. Deficiency of Adenosine Desminase 2 (DADA2), an Inherited Cause of Polyarteritis Nodosa and a Mimic of Other Systemic Rheumatologic Disorders. Curr Rheumatol Rep . 2017;19:70.10. Gardner-Medwin JM, Dolezalova P, Cummins C, et al. Incidence of Henoch-Schonlein purpura, Kawasaki disease, and rare vasculitides in children of different ethnic origins. Lancet . 2002;360:1197-202.Figure legendFIGURE 1. Skin of lower limb biopsyLivedo reticularis was observed in both lower limbs to the acrotarsiums.B, C. Necrotizing vasculitis (fibrinoid necrosis) accompanied by neutrophil infiltration was found in the subcutaneous fatty tissue.

Biosensors are the analytical tools with great application in healthcare, food quality control, and environmental monitoring. They are of considerable interest to be designed by using cost-effective and high efficient approaches. Designing biosensors with improved functionality or application in new target detection has been converted to a fast-growing field of biomedicine and biotechnology branches. Experimental efforts have led to valuable successes in biosensor designing; however, some deficiencies limit their utilization for this purpose. Computational design of biosensors has been introduced as a promising key to eliminate the gap. A set of reliable structure prediction of the biosensor segments, their stability, and accurate descriptors of molecular interactions are required to computationally design of biosensors. In this review, we provide a comprehensive insight into the progress of computational methods to guide the biosensor design, including molecular dynamics (MD) simulation, quantum mechanics (QM) calculations, molecular docking, virtual screening, and a combination of them as the hybrid methodologies. With relying on the recent advances in computational methods, an opportunity has been emerged for them to be complementary or alternative to the experimental methods in the field of biosensor design.

Purpose: In epilepsy patients, fatigue and sleep are among the important problems and they negatively affect the patient’s quality of life. The purpose of the present study is to examine epilepsy patients’ fatigue and quality of sleep. Method: The sample of this descriptive cross-sectional study consisted of 166 epilepsy patients undergoing outpatient treatment at a University Hospital Neurology Outpatient Clinic. In the study, Patient Information Form (PIF), Fatigue Severity Scale (FSS) and Pittsburg Sleep Quality Index (PSQI) were used in data collection. Data analysis was performed in SPSS 22.0 package program. Results: It was determined that the mean FSS in epilepsy patients was 4.44±1.72. The mean PSQI was found to be 13.05±4.35. While the relationship of patients’ mean FSS scores with gender, and with the frequency of seizures in the recent year was found significant (p<0.05), the relationship of patients’ mean PSQI scores with gender, marital status, the frequency of seizures, the presence of another disease other than epilepsy, the use of drugs other than antiepileptic drugs, and the number of drugs used, was also determined to be significant (p<0.005). In addition, a positive and statistically significant relationship was observed between FSS and PSQI (p<0.001). Conclusion: As a result, in the present study, patients with epilepsy were found to have a poor quality of sleep and the fatigue at the borderline. The data of the study demonstrates that the treatments and attempts to improve the quality of sleep also alleviate the fatigue of patients. For this reason, it is important to routinely handle sleep and fatigue problems of patients with epilepsy with a multidisciplinary approach and to develop effective approaches for their solution.

COVID-19 caused by the novel SARS Coronavirus-2 (SARS-CoV-2) is causing serious blockades in the global public health sphere. In the absence of specific antiviral treatment, exploration of plant-based products with antiviral potential has gained attention. We present the research prospects of utilizing coconut oil directly or its derivatives such as monolaurin in treating COVID-19 with a special emphasis on the biochemical characteristics features. The potential pitfalls therein and way forward are also highlighted. Possibility of developing a medium chain fatty acid-based nasal spray as a prophylactic or therapeutic is also discussed. Nevertheless, the potential impediments in devising suitable therapeutic models are also presented.

High-commercial-value products are often susceptible to food fraud. Among them, Iberian dry-cured ham is highly appreciated due to its particular and sensory, but also nutritional, properties. There are four different Iberian ham categories (namely bellota, recebo, cebo de campo and cebo), which depend on the rearing system of the pig during the last stage of the fattening phase. However, there is still a lack of a normalized and robust method capable of authenticating the different product categories and, therefore, preventing mislabeling. In this work, we characterized the polymorphism of eighty raw lipid extracts belonging to the four categories of Iberian pig by using DSC and synchrotron radiation XRD techniques. The results showed that bellota and recebo samples exhibited essentially the same crystallization and polymorphic behavior and this was significantly distinguishable from that of cebo de campo and cebo categories. Crystallization and melting temperatures of bellota and recebo samples were significantly lower than those of cebo de campo and cebo, due to its more unsaturated fatty acids composition. Furthermore, lower amount of polymorphic forms was detected in bellota and recebo. By considering the differences in rearing systems of the pigs, we concluded that the key factor which determined the polymorphic behavior of Iberian pig lipid extracts was not the physical exercise practiced by the pig, but the inclusion of acorns in the feeding system. This work demonstrated that crystallographic techniques, like DSC and XRD, may be promoted to be used as fingerprinting tools for the authentication of high-value food products.

Background Atrial tachyarrhythmias (ATAs) are common within the three-month blanking period following catheter ablation of atrial fibrillation (AF). However, little evidence is available regarding the current guidelines on the blanking period after surgical AF ablation. We investigate the incidence and significance of early recurrence of atrial tachyarrhythmia (ERAT) and evaluate the optimal blanking period after surgical AF ablation. Methods Data from 259 patients who underwent surgical AF ablation from 2009 to 2016 were collected. ERAT was defined as documented ATA episodes lasting for 30 seconds. A multivariate Cox proportional hazard model was constructed to evaluate the role of ERAT as a predictor of late recurrences (LR) for AF. Results In total, 127 patients (49.0%) experienced their last episodes of ERAT during the first (n=65), second (n=14), or third (n=48) month of the three-month blanking period (p<0.001). One-year freedom from ATAs was 97.8% in patients without ERAT compared with 95.4%, 64.3%, and 8.3% in patients with ERAT in the first, second, and third month after the index procedure, respectively (p<0.001). Hazard ratios of LR according to the timing of the last episode of ERAT first, second, and third month after the procedure were 2.84, 16.70, and 119.75, respectively. Conclusions The ERAT occurred in 49.0% of patients within the first three months after surgical ablation. The occurrence of ERAT within three months after surgical AF ablation was a significant independent predictor of LR. Hence, the currently accepted three-month blanking period needs to be redefined in patients with AF surgical ablation.

Background: As the COVID-19 became a world wild infectious emergency, most of patients are cured and discharged. However, some patients are re-admitted due to re-fever, or the PCR test re-positive. To find out whether it is necessary to take them re-admitted, especially the asymptomatic patients, we summarize and analyze the clinical and treatment characteristics of patients with “re-admission” of COVID-19 during twice hospitalizations. Methods: 141 cases with COVID-19 admitted to Wenzhou Central Hospital from January 17, 2020 to March 5, were followed up until March 30. There were 12 patients re-admitted. Data were collected, including clinical records，lab indexes，CT and treatment strategy. The differences were analyzed. Results: Most patients had good results. Totally 12 (8.5%) were re-admitted. 1 (8.3%) had fever，high WBC and progressive CT changes，1 had increased transaminase; the PCR re-tests of these two patients were negative. Another 10 patients were admitted due to PCR test positive, 7 of which were clinical asymptomatic. Compared with 1st discharging, CT imaging of all was significantly improved. All re-admissions did not need oxygen inhalation or mechanical ventilation. Conclusions: The prognosis of patients re-admitted were good, and no serious cases. Staying at home or concentrated medical observation, is a safe and feasible method, if the patient has a positive PCR test and the clinical symptoms are not serious. During medical observation, patients with underlying diseases should be focused on, and most do not need to be re-admitted.

Lung transplantation is recognized as a treatment option for selected patients with end-stage lung disease and pulmonary vascular disorders. Overall, pulmonary hypertension (PH) is the second most frequent indication for children requiring lung transplantation. Pediatric lung transplantation can be complex; in PH patients timing for listing and the perioperative management can be particularly challenging making interdisciplinary collaboration with the referring PH team essential. Because pediatric patients typically have preserved cardiac index and exercise tolerance even with advanced disease, they should be referred early even if they do not meet the proposed criteria for listing by ISHLT published in 2015: NYHA functional class III or IV without improvement, cardiac index < 2 liters/min/m^2, mean right atrial pressure of > 15 mmHg. Bridging strategies with extracorporeal support should be determined at time of listing prior to transplantation anticipating the possibility of clinical deterioration. Bilateral lung transplantation using cardiopulmonary bypass to provide hemodynamics stability is the standard practice in pediatric centers. The immediate post-transplant period is characterized by dramatic normalization of PVR as well as changes in the RV and LV physiology and function which can be life-threatening. Induction, immunosuppression, prophylaxis and surveillance are not different from patients without PH. Overall, outcomes in pediatric lung and heart-lung transplant patients for PH are not different from those children undergoing lung or heart-lung transplant for other indications. In fact, long-term survival is superior in children with idiopathic PH compared to other diseases, there is also a dramatic improvement in quality of life in most recipients

Canine parvovirus type 2 (CPV-2) is a small, single-stranded DNA virus causing fatal hemorrhagic enteritis in dogs. Currently, CPV-2 has been classified into CPV-2a, CPV-2b, and CPV-2c based on genetic variation in the VP2 gene. The CPV-2c variant has become ubiquitous worldwide and gained attention for monitoring parvoviral evolution. In this study, we characterized the full-length genome sequences of CPV-2c isolates obtained from 59 dogs in Vietnam. Molecular analysis revealed that Vietnamese CPV-2c shared a common evolutionary pattern with the Asian CPV-2 clade, which is marked by genetic signature patterns in the structural and nonstructural proteins. In addition, these Vietnamese CPV-2c strains exhibited unique Thr112Ile and Ile447Met mutations in the VP1 and VP2 sequence, respectively. Interestingly, phylogenetic analysis indicated that the mutations of amino acid residues in both the structural and nonstructural genes have contributed to the emergence of a new clade, designated here as the Asia-IV clade. The substitution rates, estimated from a dataset containing 199 sequences over the last 40 years, confirmed that CPV-2 showed a high rate of nucleotide substitution, at about 2.49 x 10-4 nucleotide substitutions per site per year (nt/s/y), with VP1/2 and NS1/2 estimates of 3.06 x 10-4 and 3.16 x 10-4 nt/s/y, respectively. Even though no evidence of genetic recombination in these Vietnamese CPV-2c strains was established, potential positive selection sites were observed in both the structural and nonstructural genes, suggesting the viral evolutionary process has occurred in both the structural and nonstructural proteins. Genetic and evolutionary analysis of the full-length genome sequence is necessary to gain evolutionary insight of CPV-2. Further studies are needed to elucidate the potential role of these observed mutations in the novel Asia-IV clade.

Optical cables are enormous transmission media which carries high-speed data across transatlantic, intercontinental, international boundaries and cities. The optical cable is essential in data communication. The cable has become an indispensable component in optical communications infrastructure; hence, conscious efforts are always adopted to prevent or minimize faults in the optical network infrastructure. Typically, tracing fault in the underground optical network has been difficult even though optical time-domain reflectometer (OTDR) has been used to measure the distance of faults in the underground fiber cable. The methodologies deployed in the reviewed literature indicate a vast gap between the fault distance measured by the OTDR and the actual distance of fault. This paper observed the difficulties involved in tracing the actual spot of fault in the underground optical networks. The difficulty of tracing these underground faults mostly result in an undue delay and loss of revenue. This research presents a machine learning (ML) approach to predict the actual location of a fiber cable fault in an underground optical transmission link. Linear regression technique was used to predict the actual location of a fault. Single-layer perceptron and sigmoid activation function were applied in the predictive model to obtain good accuracy value.

Emerging or re-emerging zoonotic diseases are the main issue in global health and affect the well-being of nations. COVVID-19 originated from a wet market where wild animals are sold and rapidly outbreak across worldwide. Analysis outlined bats are key host, so COVID-19 is a zoonotic disease and crossed from animals into humans. Wildlife migration among world protected areas and disease transmission has caused an increased risk of emerging or re-emerging of zoonotic diseases such as COVID-19. Transboundary animal diseases (TDAs) make the health approach more crucial as these diseases cause many problems. Hence, the prevention and control of zoonotic diseases are critical. In this paper, we addressed world protect areas management, wildlife migration, and preventive and control measures aspects on zoonotic diseases such as COVID-19 that have already been globally recommended. South American and African countries due to higher coverage of protected areas in human development regions; and Asian and South American countries due to lack of protected area management assessment are more prone to transmit COVID-19 by wildlife migrations. World Health Organization should pay attention to the determined countries for more practical health care plans in protected area communities and settlement especially in facing with wildlife species.

Porcine epidemic diarrhea virus (PEDV) causes severe watery diarrhea with dehydration and high mortality in pigs, bringing huge economic losses to the swine industry worldwide. The current prevention of PEDV is mainly concentrated on inactivated vaccines. In this study, two novel B cell epitopes S1D5 (residues 744-759) and S1D6 (residues 756-771) of PEDV were displayed on capsid (Cap) protein of porcine circovirus type 2 (PCV2) in Escherichia coli (E. coli) expression system. The recombinant protein Cap-S1D can self-assemble into chimeric virus-like particles (VLPs), which were similar in size and morphology to native PCV2 particles. In addition, an effective affinity purification system for the purification of chimeric VLPs, referred to Gram-positive Enhancer Matrix-protein anchor domain-variable domain of heavy chain of heavy-chain antibody 8 (GEM-PA-VHH8), was screened and identified. The PA-VHH8 fusion protein can specifically bind to GEM particles by covalent bond adsorption, which contributes to display Cap-S1D chimeric VLPs on the surface of GEM particles. Cap-S1D chimeric VLPs were successfully purified with the developed purification system and the purification efficiency was close to 90%. What’s more, the purified chimeric VLPs homemade vaccine induced a stronger humoral and cellular immune responses compared to the unpurified recombinant protein in pigs. Thus, the GEM-PA-VHH system provided an effective and safe technology for the preparation and purification of chimeric VLPs to prevent PEDV and PCV2 infection.

Objectives: To assess the correlation between left atrial (LA) longitudinal strain and occurrence of atrial fibrillation (AF) in patients with dilated cardiomyopathy (DCM). Methods: 100 patients with DCM were evaluated. Conventional and speckle tracking echocardiography were done to evaluate LA diameters, volumes and longitudinal strain. Results: Left atrial dimensions and volumes were significantly greater in AF group. LA longitudinal strain and LA emptying fraction were significantly lower in AF group. LA longitudinal strain and LA minimal volume are independent predictors for AF presence. ROC curve showed that LA longitudinal strain cut-off value <11.1% can predict the presence of AF in DCM patients with 96% sensitivity and 95.3% specificity (AUC 0.982, 95% CI 0.959–1.0, P < 0.001) Conclusion: Left atrial longitudinal strain was significantly reduced in AF in the setting of DCM. LA longitudinal strain and LAVmin are independent predictors for AF occurrence in this group of patients with LA strain values <11.1% can be used to predict AF in DCM.

In this report, we present a case of the Superficial circumflex iliac perforator-intercostal artery perforator (SCIP-ICAP) compound flap after extensive debridement of the upper extremity with necrotizing soft tissue infection (NSTI). There has been no previous report of the SCIP-ICAP compound flap applied for the upper extremity with NSTI.

The occurrence of gangrenous cholecystitis as a complication of typhoid fever is rare. This is a case study of a 7 year old that presented with fever and abdominal pain and later developed abdominal distension. She was later diagnosed with a gangrenous cholecystitis and gall bladder empyema.

Synchronous brain tumors are rare in children. We present 2 unique cases of synchronous brain tumors and we elaborate on their presentation, diagnosis, approach to management, and outcome. The first case describes a unique and previously unreported combination of a supratentorial anaplastic ependymoma and a cerebellar low-grade glioma.

Neuropsychiatric systemic lupus erythematosus (NPSLE) is usually associated with a worse prognosis. However, there are few effective treatments for NPSLE. We described protein A immunoadsorption treatment for a patient with NPSLE. The patient’s brain lesions was improved rapidly after two sessions of protein A immunoadsorption combination with immunosuppressive agent treatment.