COVID-19 is a complex disease and many difficulties are faced today especially in the proper choice of pharmacological treatments. The role of antiviral agents for COVID-19 is still being investigated. The evidence for immunomodulatory and anti-inflammatory drugs is quite conflicting, while the use of corticosteroids is supported by robust evidence. The use of heparins in hospitalized critically ill patients is preferred over other anticoagulants. Lastly, conflicting data were found regarding to the use of convalescent plasma and vitamin D. According to data shared by the WHO, many vaccines are under phase 3 clinical trials and some of them already received the marketing approval in EU countries and in the US. In conclusion, drugs repurposing has represented the main approach recently used in the treatment of patients with COVID-19. At this moment, the analysis of efficacy and safety data of drugs and vaccines used in real life context is strongly needed.
Background The maturation of innate immune responses in health and atopy is still incompletely understood. Methods We aimed to evaluate age-related trajectories of the TLR3 and TLR7/8 pathways across the lifespan and whether these differ between healthy and atopic individuals. Peripheral blood mononuclear cells (PBMCs) were isolated from 39 otherwise healthy atopic and 39 non-atopic subjects, aged 0-45 years. Selected cytokines involved in antiviral responses were measured by Luminex in culture supernatants of poly(I:C)- and R848-stimulated PBMCs. The non-parametric correlation between age and cytokine expression and differences in developmental trajectories between healthy and atopic were estimated. Patterns of cytokine development were identified with principal component analysis. Results Normal innate immune maturation entails significant and progressive age-related changes in the production of IL-1β, TNF-α, MIP-1β, MCP-3, IP-10, IL-10, IL-12p70 and IFN-γ upon TLR3 and/or TLR7/8 stimulation. Individual cytokines made small contributions to the observed variability; chemokines MCP-3 and IP-10 were key contributors. The development of these pathways deviated in atopic subjects with significant differences observed in the trajectories of IL-1β, MIP-1β and IL-10 synthesis. Conclusion TLR3 and TLR7/8 pathways mature during childhood, while atopy is associated with an abnormal maturation pattern. Suboptimal responses in Th1, inflammatory cytokine and chemokine production may be implicated in poor antiviral immunity in atopics, while deficient maturation of IL-10 producing capacity in the breaking of tolerance.
T cell receptor excision circles (TRECs) are small circularized DNA elements produced during rearrangement of T cell receptor (TCR) genes. Because TRECS are fairly stable, do not replicate during mitosis, and are not diluted during division of naïve T cells1, they are suitable for assessing the number of newly formed T cells 2. In this study, we detected TRECs in 475 healthy Chinese children aged 0–18 years in different clinical settings. We found a strong correlation between TRECs levels and peripheral CD4 naïve T cell numbers, but not between TRECs levels and effector or memory CD4 and CD8 T cell numbers. TRECs levels fell significantly compared with normal controls in patients with severe combined immunodeficiencies (SCID) (n=7), wiskott-aldrich syndrome (WAS) (n=22), or activated PI3Kδ syndrome (APDS) (n=5). TRECs levels in those with signal transducer and activator of transcription 1 (STAT1) deficiency (n=8) decreased or did not change significantly, a finding consistent with that for CD4 naïve T cells. We also measured TRECs levels in seven PIDs after hematopoietic stem cell transplantation (HSCT) (WAS=5; chronic granulomatous disease (CGD)=2), and found the complications after HSCT may reduce TRECs levels by interfering with production of naïve T cells. In conclusion, we established reference values for TRECs, which can be used to screen for primary immunodeficiency diseases (PIDs) during early life and track immune reconstitution after HSCT.
Background: This study evaluates the impact of peak preoperative troponin level on outcomes of coronary artery bypass grafting (CABG) for non-ST-elevation myocardial infarction (NSTEMI). Methods: This was a retrospective review of patients undergoing isolated CABG from 2011-2018 with presentation of NSTEMI. Patients were stratified into low- and high-risk groups based on median preoperative peak troponin (1.95ng/dL). Major cardiac and cerebrovascular events (MACCE) and mortality were compared. Multivariable analysis was performed to model risk factors for MACCE and mortality. Results: This study included 1,211 patients, 607 low- (≤1.95ng/dL) and 604 high-risk (>1.95ng/dL). Patients were well-matched with respect to age and comorbidity. High-risk patients had lower median preoperative ejection fraction (46.5% [IQR 35.0%-55.0%] vs 53.0% [IQR 40.0%-58.0%]) and higher incidence of preoperative intra-aortic balloon pump (15.9% vs 8.73%). Intensive care unit (47 hours [IQR 26-82] vs 43 hours [IQR 25-69]) and hospital lengths of stay (10 days [IQR 8-13] vs 9 days [IQR 8-12]) were longer in the high-risk group (each P<0.05). Postoperative complications and thirty-day, one- and five-year rates of both MACCE and survival were similar between groups. Peak troponin >1.95ng/dL was not associated with increased hazards for MACCE, mortality, or readmission in multivariable modeling. In sub-analyses, neither increasing troponin as a continuous variable nor peak troponin >10.00ng/mL were associated with increased hazards for these outcomes. Conclusions: Higher preoperative troponin levels are associated with longer lengths of stay but not MACCE or mortality following CABG. Dictating timing of CABG for NSTEMI based on peak troponin does not appear to be warranted.
Cardiovascular disturbances are the leading causes of morbidity and mortality in patients of spinal cord particularly cervical cord injury accounting for approximately 30% of deaths. Most common cardiovascular dysfunctions are sinus bradycardia, hypotension, cardiac arrest, supraventricular tachycardia and all these occurs due to sympathetic withdrawal and unopposed vagal action. Here we are reporting a case of acute cervical cord injury with neurogenic shock in a 25 year young patient who developed polymorphic ventricular tachycardia, which degenerated to ventricular fibrillation and cardiac arrest. We described all possible mechanisms of development this arrythmia and its management.
In this paper, we consider the Cauchy problem for a family of evolution-parabolic coupled systems, which are related to the classical thermoelastic plate equations containing non-local operators. By using diagonalization procedure and WKB analysis, we derive representation of solutions in the phase space. Then, sharp decay properties in a framework of $L^p-L^q$ are investigated via these representations. Particularly, some thresholds for the regularity-loss type decay properties are found.
Colloids are often in forms of inorganic and organic particles whose particle sizes (dp) are ranging from 1.0 nm to 10.0 μm. On the one hand, their transport processes in the hyporheic zone such as deposition, resuspension, clogging and release are substantially affected by hyporheic exchange. On the other hand, the existence of colloids can modify the hydraulic structure of the hyporheic zone due to clogging. Despite the general acknowledgement that particle size plays an important role in contaminant adsorption and clogging, it remains unclear how the particle size of colloids changes during their transport processes in the hyporheic zone. This study aims to investigate the variation of the particle size of colloids in the overlying water and the effects of settlement and convection-diffusion via laboratory experiment and numerical simulation. The results show that both settlement and convection-diffusion play roles in the exchange of colloids between the stream and the streambed. More specifically, settlement is the dominant factor affecting the exchange process of large-sized particles (dp > 3.06 μm) in the hyporheic zone as the high settling velocity dominates the outflux of colloids in the overlying water; the exchange process of small-sized particles (dp < 1.10 μm) is more affected by convection-diffusion and some of them can be released from the streambed to the overlying water; while the exchange process of middle-sized particles (1.10 μm < dp < 3.06 μm) is affected by both convection-diffusion and settlement. Thus, this study may provide important insights into the variation of the particle size of colloids in the overlying water and the effects of settlement and convection-diffusion.
The out-of-plane displacement (OPD) of a circular dielectric elastomer actuator (DEA) membrane has been explored in recent years for a variety of important applications. Circular DEAs consist of an elastomer membrane that is prestretched to a rigid frame and coated with compliant electrodes. Such a simple configuration has found many interesting applications such as in, pumps, pulse tracking, hopping search and rescue robots, dielectric elastomer (DE) generators for renewable energy harvesting, linear actuators, and many others. Here, we present an easy-to-follow implementation of the OPD equations for circular DEAs via a detailed numerical solution using the shooting method (SM) on a system of differential algebraic equations (DAE), based on previous theoretical work. The SM numerical solution to the system of DAEs is applied to a practical range of values based on the reported literature. Analysis of the results and comparison against other studies are provided. The current work provides a go-to framework for implementation in further research and development.
Background: Left ventricular (LV) outflow tract (LVOT) obstruction increases mortality in patients undergoing transcatheter mitral valve implantation (TMVI) in degenerated bioprostheses, annuloplasty rings, and native mitral valves. We aimed to evaluate the left ventricular outflow tract area after TMVI using 3-diensional (3D) transesophageal echocardiography (TEE) and to investigate the pre-procedural cardiac geometry affects the LVOT area after TMVI. Methods: We retrospectively reviewed echocardiography data in 43 patients who had TMVI. A change in pressure gradient across LVOT from before to after TMVI (∆PG) and post-procedure 3D cross sectional area (CSA) at the level of the most distal portion of the mitral valve stent that was closest to the LV apex were assessed as evidence of LVOT narrowing. Results: TMVI with the use of balloon-expandable valve system was performed for 24 bioprostheses, 7 annuloplasty rings, and 12 native valves. Compared to patients without increase in LVOT gradient (∆PG <10 mmHg; n=33), patients with increase in LVOT gradient (∆PG ≥10 mmHg; n=10) had smaller LV end-systolic volume (LVESV), greater LV ejection fraction (LVEF) and smaller aorto-mitral (AM) angle. CSA at the valve stent distal edge showed strong association with ∆PG (r=-0.68, P<0.0001). Only small AM angle was associated with small CSA at the valve stent ventricular edge on multivariable analysis, independent of LVESV and LVEF. Conclusion: Pre-procedural AM angle as well as LVESV and LVEF were associated with LVOT narrowing in patients undergoing transcatheter mitral valve-in-valve, valve-in-ring, and valve-in-native valve implantation. These data may be useful for preprocedural planning.
Purpose: To observe and describe the stiffness changes of the optic nerve in the patients with multiple sclerosis (MS) with or without optic neuritis and healthy adults via shear wave elastography (SWE). Methods: Seventy optic nerves from thirty-five patients with MS and sixty optic nerves from thirty healthy subjects were included prospectively in the study. The optic nerve (ON), optic disc (OD), and perineural area were evaluated with SWE and optic nerve sheat diameter (ONSD) was measured by ultrasound. Results The mean age of patients was 39.68 ± 9.99 years. There was no statistically significant difference between the groups in terms of ONSD, SWE ON, SWE OD, and SWE perineural area levels (p> 0.05). In the MS group; No statistically significant difference was found between patients with and without optic neuritis for the mean age, gender distribution, duration of MS, types of MS, ONSD, SWE ON, SWE OD, SWE perineural area, and Expanded Disability Status Scale (EDSS) scores (p> 0.05). No statistically significant difference in terms of ONSD, SWE ON, SWE OD, and SWE perineural area between the MS patients with or without optic neuritis and the control group (p> 0.05). Conclusion: Shear wave elastography measurements of the optic nerve, optic disc, and perineural area do not contribute to the evaluation of optic neuritis in a patient with MS.
A new perspective of localized shear strain accumulation was proposed to elucidate the formation mechanism of fine granular area (FGA) generated in a high strength steel under very-high-cycle fatigue (VHCF). On the one hand, experiments of VHCF under the negative stress ratio of -1 was carried out, and the microstructure of FGA was found and characterized by using Scanning Electron Microscope, Transmission Electron Microscopy, and Transmission Kikuchi Diffraction. The results show that the FGA consists of high-density dislocations, sub-grains, and fine grains with high angle grain boundaries. On the other hand, the evolution of shear strain and fatigue damage at the vicinity of an inclusion was modelled by using crystal plasticity finite element method at both positive and negative stress ratios. The results show that although the overall strain in VHCF is negligible, significant shear strain is accumulated at the vicinity of the inclusion. Such a large local strain is the driving force for the formation of FGA. The results also suggest that with the accumulation of shear strain and damage, the positive stress ratio is gradually evolved into negative. This may explain why FGA has also been reported at positive stress ratios in some literatures.
Both termites and large mammalian herbivores (LMH) are savanna ecosystem engineers that have profound impacts on ecosystem structure and function. Both of these savanna engineers modulate many common and shared dietary resources such as woody and herbaceous plant biomass, yet few studies have addressed how they impact one another. In particular, it is unclear how herbivores may influence the abundance of long-lived termite mounds via changes in termite dietary resources such as woody and herbaceous biomass. While it has long been assumed that abundance and areal cover of termite mounds in the landscape remains relatively stable, most data are observational, and few experiments have tested how termite mound patterns may respond to biotic factors such as changes in large herbivore communities. Here, we use a broad tree density gradient and two landscape-scale experimental manipulations—the first a multi-guild large herbivore exclosure experiment and the second a tree removal experiment– to demonstrate that patterns in termite mound abundance and cover are unexpectedly dynamic. Termite mound abundance, but not areal cover not significantly, is positively associated with experimentally controlled presence of cattle, but not wild mesoherbivores (15-1000 kg) or megaherbivores (elephants and giraffes). Herbaceous productivity and tree density, termite dietary resources that significantly affected by different LMH treatments, are both positive predictors of termite mound abundance. Experimental reductions of tree densities are associated with lower abundances of termite mounds. These results reveal a richly interacting web of relationships among multiple savanna ecosystem engineers and suggest that termite mound abundance and areal cover is intimately tied to herbivore-driven resource availability.
Abstract Background: Subcutaneous implantable cardioverter defibrillators (S-ICDs) avoid complications secondary to transvenous leads, but inappropriate shocks (ISs) are frequent. Furthermore, IS data from patients with Brugada syndrome (BrS) with an S-ICD are scarce. Objective: We aimed to establish the incidence, mechanisms, and predictors of S-ICD in this population. Methods: We analyzed the clinical and electrocardiographic characteristics, automated screening test data, device programming, and IS occurrence in adult patients with BrS with an S-ICD. Results: Thirty-nine patients were enrolled (69% male, mean age at diagnosis 46±13 years, mean age at implantation 48±13 years). During a mean follow-up of 26±21 months, 18% patients experienced IS. Patients with IS were younger at the time of diagnosis (36±8 versus 48±13 years, p=0.018) and S-ICD implantation (38±9 versus 50±23 years, p=0.019) and presented with spontaneous type 1 Brugada ECG pattern more frequently at diagnosis or during follow-up (71% versus 25%, p=0.018). During automated screening tests, patients with IS showed lower QRS voltage in the primary vector in the supine position (0.58±0.26 versus 1.10±0.35 mV, p=0.011) and lower defibrillator automated screening score (DASS) in the primary vector in the supine (123±165 versus 554±390 mV, p=0.005) and standing (162±179 versus 486±388 mV, p=0.038) positions. Age at diagnosis was the only independent predictor of IS (hazard ratio=0.873, 95% confidence interval: 0.767-0.992, p=0.037). Conclusion: IS was a frequent complication in patients with BrS with an S-ICD. Younger age was independently associated with IS. A more thorough screening process might help prevent IS in this population.
BK polyomavirus (BKPyV) infections are an important cause of morbidity and mortality after hematopoietic stem cell transplantation (HSCT). Hemorrhagic cystitis (HC) may occur in patients undergoing HSCT due to the BKPyV reactivation. This study aimed to assess risk factors, clinical characteristics and treatment options of BKPyV infections after HSCT. A total of 54 patients with HSCT were retrospectively evaluated and BKPyV disease was found in 24 (44%). HC was seen in 20 (83%) of patients with BKPyV disease. The median age of patients was 42 and 50% of them were male. The most common underlying disease was Acute Myeloid Leukemia (62%). Five patients had autologous and 15 patients had allogeneic HSCT. The median time to engraftment was 15 days. GVHD was seen only in 7 patients. The median time elapsed to BKPyV disease after HSCT was found as 60 days. Nineteen patients with BKPyV disease had grade 3 and one patient had grade 2 HC. While BKPyV viremia was positive in five patients, viruria was detected in all patients. Eighteen (75%) of the patients with BKPyV disease were treated with cidofovir (5mg/kg IV) and 11 with ciprofloxacin (800 mg/day). Four of the patients who received intravesical cidofovir (dose). The complete response was obtained 53% of patients with BKPyV disease. In conclusion, BKPyV disease is an emerging clinical problem after HSCT causing morbidity and mortality. It can develop especially in the early period after allogeneic stem cell transplantation. This situation has been associated with the use of immunosuppressive treatments after transplantation. Close monitoring of BK virus in high-risk patients can be an important method to improve the complication in the early period.
Background: The role of laboratory parameters and the relationship of them with radiology reports, CT scan and clinical outcomes in screening of COVID-19 patients not been deﬁnitely established, but this disease presented a major challenge in the field of clinical tests, radiology reports, clinical outcomes that help to monitoring and treatment COVID-19 disease. Methods: This study was performed on 340 suspected COVID-19 patients, who presented to Chamran Hospital, Shiraz University of Medical Sciences Shiraz, Iran from 20 February to 31 August, 2020. Information each patient’s will be completed using a data collection forms based on records. The evaluation of lungs involvement in CT scan and their relationship with laboratory indicator including biochemical and hematological factors, is the best scale for the severity and prognosis of Covid 19 patients. Results and Conclusion: The ﬁndings of this study indicated ALT, AST, CRP, NEU, LDH, and Urea have very good accuracy in predicting cases with positive RT-PCR for COVID-19, respectively. In this study we shown the correlation of clinical and laboratory findings with CT-based quantitative score of pulmonary involvement in COVID-19 pneumonia and attempted that our findings could be usable to development future clinical research associated with COVID-19 infection and show the relationship of reports CT scan and clinical outcomes in the diagnosis and severity of patients with COVID-19.
Imatinib is used as first-line treatment for chronic myeloid leukemia (CML) even in patients with impaired renal function. We successfully used therapeutic drug monitoring to determine the dose for re-administration of imatinib in a CML patient who initiated dialysis for acute renal dysfunction associated with the initial imatinib therapy.