A six-year old boy presented with mycoplasmal pneumonia combined with recurrent pneumothorax. The patient had been treated with azithromycin and methylprednisolone for mycoplasmal pneumonia after admission, however his condition deteriorated. We increased the dosage of methylprednisolone and changed to erythromycin from azithromycin, his condition improved progressively. He presented pneumothorax twice during recovery phase. He was put on thoracic closed drainage and was cured. Pneumothorax is rare complication of mycoplasmal pneumonia. Here we reported the case to raise awareness of this condition.

Adoptive immunotherapy using Epstein-Barr Virus (EBV)-specific T cells is a potentially curative treatment for patients with EBV-related malignancies where other clinical options have proved ineffective. We describe improved GMP-compliant culture and analysis processes for conventional lymphoblastoid cell line (LCL)-driven EBV-specific T cell manufacture, and describe an improved phenotyping approach for analyzing T cell products. We optimized the current LCL-mediated clinical manufacture of EBV-specific T cells to establish an improved process using xenoprotein-free GMP-compliant reagents throughout, and compared resulting products with our previous banked T cell clinical therapy. We assessed effects of changes to LCL: T cell ratio in T cell expansion, and developed a robust flow cytometric marker panel covering T cell memory, activation, differentiation and intracellular cytokine release to characterize T cells more effectively. These data were analyzed using t-Stochastic Neighbour Embedding (t-SNE) algorithm. The optimized GMP-compliant process resulted in reduced cell processing time and improved retention and expansion of central memory T cells. Multi-parameter flow cytometry determined the optimal protocol for LCL stimulation and expansion of T cells and demonstrated that cytokine profiling using IL-2, TNF-α and IFN-γ was able to determine the differentiation status of T cells throughout culture and in the final product. We show that fully GMP-compliant closed-process culture of LCL-mediated EBV-specific T cells is feasible and profiling of T cells through cytokine expression gives improved characterization of start material, in-process culture conditions and final product. Visualization of the complex multi-parameter flow cytometric data can be simplified using t-SNE analysis.

We aimed to test the hypothesis that a lung ultrasound severity score (LUS) and assessment of left ventricular eccentricity index of the interventricular septum (LVEI) by focused heart ultrasound can predict extubation success in mechanically ventilated infants. We conducted a prospective study on premature infants <34 weeks’ of gestation. LUS was performed on postnatal days 3 and 7 by an investigator who was masked to infants’ ventilator parameters. LVEI and pulmonary artery pressure (PAP) were measured at postnatal day 3. A receiver operator curve was constructed to assess the ability to predict extubation success. Spearman correlation was performed between LVEI and PAP. A total of 104 studies were performed to 66 infants; of them 39 had mild and 65 had moderate-severe lung disease. LUS predicted extubation success with a sensitivity and a specificity of 91% and 69%, respectively. Area under the curve was 0.83 (CI: 0.75-0.91). LVEI did not differ between infants that succeeded and failed extubation. It correlated with PAP during systole (r=0.66). We conclude that LUS predicts extubation success in mechanically ventilated preterm infants whereas LVEI correlates with high PAP.

Aerococcus urinae is rare in infective endocarditis. The best known risk factors are urogenital comorbidities. We report the case of a 46-year-old male with Down’s syndrom with infective endocarditis. The patient underwent successful treatment with amoxicillin and heart surgery with valve replacement.He had an unknown ventricular septal defect

As the clinical course of COVID-19 infection in SCD patients is not clear, close monitoring is essential. We emphasize that RBC exchange should be offered early to avoid possible deterioration. We present a case of COVID-19 infection in a SCD patient causing severe hemolysis, that improved after RBC exchange.

The case of ischemic upper extremity disease caused by guide catheter-induced injury is rare. We present a case of right axillary artery occlusion, after percutaneous coronary intervention (PCI), treated by endovascular stent-grafting successfully.

Background: This study aimed to investigate the relationship between the experience level of physicians who initially make a clinical diagnosis of patients with ST segment elevation myocardial infarction in the emergency department and door-to-balloon time (DBT). Material and methods: Between January and December 2018, the research group was selected randomly among 522 patients with ST elevation myocardial infarction who were immediately treated in the catheter laboratory. Angiography images were monitored from the patients’ records in the catheter laboratory. The time of admission to the emergency room was obtained using the hospital registration system. The experience level of physicians who initially clinically diagnosed patients in the emergency department was divided into three groups: medical practitioner (who did not receive emergency training), assistant physician (undergoing emergency medicine training), and emergency medicine specialist. Results: The study included 522 patients who underwent primary percutaneous intervention due to ST segment elevation myocardial infarction. The mean age was lower, and cardiogenic shock and mortality rates were lower in the group with DBT<60 /min compared with the group with DBT>60/min. In the expert group, the mean DBT was lower, but the cardiogenic shock and mortality rates were higher (p<0.05). Conclusions: The duration of DBT decreases as the experience level of the emergency physician increases, but randomization is required to determine its clinical benefit

Large occurrence datasets provide a sizable resource for ecological analyses, but have substantial limitations. Phenological analyses in Fric et al. (2020) were misleading due to inadequate curation and improper statistics. Our reanalysis of 22 univoltine species with sufficient data for independent analysis found substantive differences in macroscale phenological patterns.

The hybrid impression technique consists of an initial alginate impression that provides a pre-operative cast upon which a diagnostic wax-up and a silicone index impression are made. This work is digitized; thus, the altered final digital impression is limited to absolute minimum time, effort and ensures comfort for the patient.

Objective All cancer sites show considerable social inequality in risk and patient survival. Despite the advantages of healthcare professionals (HPs) systematically registering information about patients’ social circumstances, this is not routine practice. Our aim was to understand the barriers to registering patients’ social histories. Methods We observed 104 outpatient encounters and interviewed 30 HPs treating malignant melanomas, urological cancer or lung cancer. We explored interactive (e.g. processes and activities) and interpretative (e.g. perspectives and meanings) aspects of barriers to recording patients’ social data. Using Kirk´s theoretical framework developed in hospital settings, we conducted a qualitative analysis to address organizational and professional barriers. Results Unevenness in registration was due to 1) organizational barriers (interdisciplinarity, time and technical challenges), 2) professional barriers (prioritization, meeting patients where they are, and reliance on HP’s own judgements). HPs neglected to use medical records, preferring to form their own pictures of patients´ needs to avoid prejudices and to promote equality. However, HPs did not systematically verify these impressions with the patients. Conclusion To facilitate systematic recording of patients’ social histories and address the barriers identified in our study, there is a need to: 1) develop a electronical tool for recording patients’ social circumstances that is aligned with HP’s daily practices 2) introduce training programmes targeting all barriers, and 3) provide time and opportunities to support patients.

Introduction: Left bundle branch pacing is a recently described form of conduction system pacing which can correct left-bundle branch block and deliver cardiac resynchronization therapy (CRT). The WiSE-CRT system delivers leadless endocardial pacing and can improve symptoms and left ventricular remodelling in CRT non-responders. Case Report: We describe the case of a 57 year old male who underwent implantation of the WiSE-CRT system after failed conventional CRT. Pacing the left bundle during implant achieved superior electrical resynchronization and equivalent hemodynamic response compared to pacing the lateral wall. Conclusion: This case demonstrates the potential for leadless left bundle branch pacing.

BACKGROUND: Hoarseness in school-aged children may affect their educational achievement and interfere with their communication and social skills development. The global prevalence of hoarseness in school-aged children ranges between 6% and 23%. OBJECTIVE: Measure the prevalence of hoarseness among school-aged children and identify its associated factors. DESIGN: Cross-sectional questionnaire-based survey. SETTING: Randomly selected primary and early childhood schools in Saudi Arabia. PATIENTS AND METHODS: Data were collected using a questionnaire completed by the children’s parents, which included sociodemographic aspects, health and related comorbidities, history of frequent crying during, history of letter pronunciation problems and stuttering, history of vocal fold surgery, the Reflux Symptom Index (RSI), and Children’s Voice Handicap Index-10 for parents (CVHI-10-P). MAIN OUTCOME MEASURES: Determinants of hoarseness were investigated using the chi-square test, Fisher exact test, and adjusted and unadjusted logistic regression models SAMPLE SIZE: 428 children RESULTS: The mean age of the study children was 9.05 ± 2.15 years, of whom 69.40% were male. The rate of hoarseness in the participants was 7.5%, 9.90% were female and 6.40% were male. Hoarseness was found to be significantly associated with a history of excessive crying in infancy (12.24%, x2=7.54, p=0.006), letter pronunciation issues, especially ‘R’ and ‘S’ (13.56%, x2=8.71, p=0.003), stuttering (16.39%, x2=8.08, p=0.004), and those with a previous history of hoarseness (p=0.023). In addition, having symptoms of gastrointestinal reflux increased the risk of hoarseness by four times (OR=4.77, 95% CI= 2.171, 10.51) after adjustment for age and gender. CONCLUSIONS: Hoarseness in children may be underestimated as it may reflect the presence of speech problems (i.e., letter articulation and stuttering) in addition to the presence of laryngopharyngeal reflux. Hoarseness was assumed on the basis of parental complaints. Therefore, further research with diagnosis based on clinical assessment is needed to understand the magnitude of the hoarseness and its consequences

Background: The differentiation between systemic inflammatory response syndrome (SIRS) and sepsis, which is sometimes difficult, is very important as it determines essential treatment decisions, such as selection, initiation, and duration of antibiotic therapy. Thus we aimed to investigate the diagnostic value of procalcitonin (PCT), monocyte chemoattractant protein-1 (MCP-1), soluble mannose receptor (sMR), presepsin as early biomarkers of pediatric sepsis in comparison to SIRS in a group of severely ill children. Methods: The study included 58 and 24 children diagnosed as having sepsis and SIRS without infection respectively. All the plasma levels of the studied sepsis biomarkers were measured and ROC curves were created for all the tested parameters to discriminate between sepsis and SIRS. Results: The best discriminative performance was for MCP-1 with AUC of 0.996 (0.986-1.005) with sensitivity 98.3% and specificity 100%. The sMR had the highest sensitivity (100%), with AUC equals 0.952(.0.887-1.017) and specificity of 91.8%. The cut-off values for PCT, presepsin, sMR, and MCP-1 and were: 2.1 ng/ml, 256 pg/ml, 24 ng/ml and 105 pg/ml, respectively. In septic cases, both soluble Mannose Receptor and Procalcitonin have positive correlations with the severity of sepsis (PRISM III), low GCS, ventilatory support, use of inotropic drugs, and mortality rate (r= 0.950, 0.812, 0.795, 0.732 and 0.861respectively) for soluble Mannose Receptor and (0.536, 0.473, 0.422, 0.305 and 0.474 respectively) for Procalcitonin. By the logistic regression analysis, the sMR was the only significant predictor of sepsis. Conclusion: The present study has found that sMR, presepsin, and MCP-1 are new biomarkers that can be used to differentiate between sepsis and SIRS in critically-ill children. These findings may direct clinicians in their practical decision-making and complex management of severely-ill children who need much interference in short time.

Background Indomethacin, a well-known non-steroidal anti-inflammatory drug (NSAID), with effective broad spectrum anti-viral activity, was evaluated for efficacy and safety of indomethacin in treating RT-PCR positive covid-19 patients Materials and Methods Patients with RT-PCR positive covid-19 who were admitted to hospital were offered the option to receive indomethacin 50 to 75mg daily in addition to the Indian council of medical research (ICMR) standard covid-19 treatment. Patients who declined the indomethacin option were offered paracetamol for pain and fever. The endpoint was the development of hypoxia. Secondary endpoints were time to become afebrile and time to resolution of cough and myalgia. Propensity Score Matching was used to compare indomethacin and paracetamol treatments. A separate group of severely ill patients who were admitted with hypoxia were treated with indomethacin 75mg; the endpoint was the requirement for mechanical ventilation or admission to the intensive care unit (ICU). Blood chemistry was collected before and after the treatment. The patients were monitored every day for clinical parameters. . Results A total of 104 patients received indomethacin, 82 with mild-moderate disease and 22 with severe disease. Matching reduced the number of patients to 72. In the indomethacin mild-moderate disease group, one patient out of 72 in the matched group developed hypoxia and required oxygen compared with 28 out of 72 patients in the matched group who received paracetamol. Patients who received indomethacin also experienced more rapid symptomatic relief compared to paracetamol arm. In the indomethacin severe disease group no patient deteriorated enough to require mechanical ventilation. There were no adverse reactions to indomethacin or deterioration of renal or liver function. Conclusion The use of indomethacin compared with paracetamol, in addition to the standard ICMR treatment in hospitalised covid-19 patients was associated with marked reductions in the severity and duration of illness, without any adverse effects.

Background. There is an emergency need for early ambulatory treatment of COVID-19 in acutely ill patients in an attempt to reduce disease progression and the risks of hospitalization and death. Methods and Results. We recently reported results on 320 high-risk (age > 50 with ≥ 1 comorbidity) COVID-19 cases and have updated our results with 549 additional cases in period ending December 16, 2020. Our protocol utilizes at least two agents with antiviral activity against SARS-CoV-2 (zinc, hydroxychloroquine, ivermectin) and one antibiotic (azithromycin, doxycycline, ceftriaxone) along with inhaled budesonide and/or intramuscular dexamethasone. Albuterol nebulizer, inhaled budesonide, intravenous volume expansion with supplemental parenteral thiamine 500 mg, magnesium sulfate 4 grams, folic acid 1 gram, vitamin B12 1 mg, are administered for severely ill patients who either present or return to the clinic with severe symptoms. In period 1 (April-September, 2020) 6/320 (1.9%) and 1/320 (0.3%) patients were hospitalized and died, respectively. In period 2, (September-December, 2020) 14/549 (2.6%) and 1/549 (0.18%) were hospitalized and died, respectively. For comparison, we used the Cleveland Clinic COVID-19 hospitalization calculator and based on average age and comorbidities the expected rate of hospitalization for both periods was 18.5%. The cumulative mortality among confirmed and suspected COVID-19 in Collin, Dallas, Denton, and Tarrant counties was 0.76, 1.04, 0.90, and 0.97. As a result, our early ambulatory treatment regimen was associated with estimated 87.6% and 74.9% reductions in hospitalization and death respectively, p<0.0001. Conclusions. We conclude that early ambulatory, multidrug therapy is associated with substantial reductions in hospitalization and death compared to available rates in the community. Prompt ambulatory treatment should be offered to high-risk patients with COVID-19 instead of watchful watching and late-stage hospitalization for salvage therapies.

Objective This study aimed to describe the clinical and laboratory findings of patients diagnosed with pleural tuberculosis (PT) at two tertiary university hospitals in Southern Brazil. Methods Patients below 18 years of age admitted to the study hospitals were retrospectively evaluated. Medical and epidemiological history, tuberculin skin test (TST) results, radiological and pathological findings, and pleural fluid (PF) analysis were retrieved from health records. Results Ninety-two patients with PT were identified during the study period. Among them, 51 (55%) were males. The mean age was 10.9 years old. Twenty-one percent was represented by children aged six years or less. The most common symptoms were fever (88%), cough (72%) and chest pain (70%). The time between the onset of symptoms and diagnosis varied between 2 and 300 days, with a median of 16 days. Unilateral pleural effusion was described in 96% of the cases. Lymphocyte predominance was found in 90% of PF samples. The adenosine deaminase dosage of PF was greater than 40 U/L in 85% of the patients. Prior diagnosis of community acquired pneumonia and antibiotic use were observed in 76% of the cases. Conclusion We suggest consider the diagnosis of PT in children and adolescents with the following characteristics: fever, cough and thoracic pain as presenting symptoms; history of contact with tuberculosis; Mantoux test 10 mm; unilateral pleural effusion; lymphocytes predominance in PF sample; pleural fluid ADA greater than 40 U/L and poor response to antibiotics prescribed for community-acquired pneumonia.

We report applications of novel high-frame rate blood speckle tracking (BST) echocardiography in a series of infants with congenital heart disease (CHD). BST echocardiography was highly feasible, reproducible, and fast. High-frame rate BST provided complimentary information to conventional color-Doppler data enhancing the visualization and understanding of anomalous blood trajectories (e.g., shunt direction, regurgitant volumes, and stenotic jets) and vortex formation. High-frame rate BST echocardiography is a new, promising imaging tool that may be helpful for deeper understanding of complex CHD physiology.

Identifying factors that influence sea otter (Enhydra lutris) population density can provide insight into why it varies spatially and temporally and when a recovering population has reached an equilibrium density because of food resources (i.e., carrying capacity K). Although food availability is widely recognized as an important extrinsic factor affecting sea otter density, how do we determine when a population has reached K? The goal of this study was to estimate K for Simpson Bay, Alaska by measuring the abundance of edible bivalves, the primary prey for sea otters for over 40 years. We then compared prey abundance and estimated replacement rate (i.e., the mean age of bivalves predated by sea otters) to estimated annual prey consumption based on the mean population density for the past 18 years. On average, 110 adult sea otters (5.2 km−2) have occupied Simpson Bay annually since 2001 consuming an estimated 176,660 kg of bivalves. The total mass (standing stock) of the major bivalves (predominately butter clams and stained macomas) was 785,730 kg, so adult sea otters consumed about 22% annually. Based on these observations and calculations, the estimated annual number of sea otters occupying Simpson Bay appears to be at or near K based on the replacement rate of food resources. However, other intrinsic (e.g., male territoriality and emigration) and extrinsic (e.g., predation, disease, human-related mortality) factors may influence equilibrium density, which varies spatially and temporally, resulting in a mosaic of subpopulations with different densities, rates of growth and discontinuous distributions. Understanding the balance among these factors may be one of the most challenging ecological questions for sea otter conservation and management as populations recover from their range-wide decimation during the Maritime Fur Trade in the late 18th and 19th centuries

Objective: The potential benefit of a combined adenotonsillectomy and bronchoscopy with bronchoalveolar lavage (TA-B-BAL) in preschool children with asthma has been debated in the literature. We aimed to describe the clinical course of preschool children with severe asthma undergoing this combined procedure. Study Design: This is a retrospective case-control study. Patient Selection: Preschool patients diagnosed with severe asthma who underwent TA-B-BAL treatment between 2012 and 2019 were included as cases. Controls were age and sex matched patients receiving standard asthma care. Methodology: A retrospective patient chart review was conducted. Data on demographics, clinical characteristics, medication use, virology and microbiology from bronchoalveolar lavage, and asthma control questionnaires were collected. Cases and controls were compared with t-tests and regression analysis. Results: Eighteen preschool subjects (mean age 3.19±1.13 years) in the case group were matched to eighteen control subjects receiving standard care. A Poisson mixed effects regression analysis revealed reduced risk of oral corticosteroid use (RR 0.39, 95%CI 0.18, 0.83, p=0.014), reduced emergency department visits (RR 0.36, 95%CI 0.17, 0.75, p=0.01) and reduced risk of asthma exacerbations (RR 0.58, 95%CI 0.28, 1.20, p=0.14) in cases compared to controls. Ten patients experienced clinically meaningful improvements in TRACK scores after the procedure (p<0.001). Conclusion: This pilot study provides early evidence that preschool children with severe asthma may benefit from combined adenotonsillectomy and bronchoscopy with bronchoalveolar lavage procedure. The procedure is a useful adjunct for reduction of medication use and hospital visits for preschool age patients with severe asthma.

Purpose: The field of cancer nanomedicine has made significant progress, but its clinical translation is impeded by many challenges, such as the difficulty in analysing intracellular anticancer drug release by the nanocarriers due to the lack of suitable tools. Here, we propose the development of a combinatorial imaging and analysis technique to evaluate anticancer drug such as doxorubicin HCl (DOX) released by a nanocarrier inside the HCT116 colon cancer cells and its subsequent intracellular accumulation. Procedure: Fluorescent cell images were captured and subjected to combined image analysis and machine learning based procedures to assess and quantify the delivery and retention rate of DOX inside the cancer cells by multifunctional CNT-DOX-Fe3O4nanocarrier. Results: We show that DOX in HCT116 cells was higher for multifunctional CNT-DOX-Fe3O4nanocarrierthan free DOX, indicating efficient and steady release of DOX as well as superior retentive property of the nanocarrier. Initially (1 h and 4 h) the luminance intensity of DOX in the cell cytoplasm delivered by CNT-DOX-Fe3O4nanocarrier was ~0.34 times and ~0.42 times lesser than that of free DOX delivered normally. However, at 24 h and 48 h post treatment the luminance intensity of DOX for CNT-DOX-Fe3O4nanocarrier was ~1.98 times and 1.92 times higher than that of free DOX. Furthermore, the luminance intensity of DOX for CNT-DOX-Fe3O4in the whole cell was ~1.35 times and ~1.62 times higher than that of free DOX at 24h and 48 h, respectively. Conclusions: The high-throughput nature of our image analysis workflow allowed us to automate the process of DOX retention analysis, and enabled us to devise machine learning-based modeling to predict the percentage of anticancer drug retention in cells. The development of models to automatically quantify and predict intra-cellular drug release in cancer cells could benefit personalized treatments by optimizing the design of nanocarriers.

Total anomalous pulmonary venous connection (TAPVC) with congenital diaphragmatic hernia (CDH) is a disease entity with high mortality rate. Association with atretic left pulmonary artery increased the complexity of the anomalies. Here, we reported a newborn baby with these complex congenital anomalies successfully treated surgically. Over 13 years after surgery, there was substantial growth of left pulmonary artery which was angiographically atretic at his newborn stage, which was rarely reported. Currently, this patient is drug free and is in functional class I of New York heart association.

Seed dispersal by ants is an important means of migration for plants. Although many 34 myrmecochorous plants have seeds containing elaiosome, a nutritional reward for ants, some 35 non-myrmecochorous seeds without elaiosomes are also dispersed by ant species. However, the 36 mechanism by which seeds without elaiosomes enable efficient dispersal by ants is scarcely 37 investigated. The seeds of the achlorophyllous and myco-heterotrophic herbaceous plant 38 Monotropastrum humile are very small without elaiosomes and require a fungal host for 39 germination and survival. We performed a bioassay using seeds of M. humile and the ant 40 Nylanderia flavipes to demonstrate ant-mediated seed dispersal. We also analyzed the volatile 41 odors emitted from M. humile seeds and conducted bioassays using dummy seeds coated with 42 seed volatiles. Although elaiosomes were absent from the M. humile seeds, the ants carried the 43 seeds to their nests. They also carried the dummy seeds coated with the seed volatile mixture to 44 the nest, and left some dummy seeds inside the nest and discarded the rest of the dummy seeds 45 outside the nest with a bias toward locations with moisture conditions, which might be 46 conducive to germination. We concluded that seeds of M. humile were dispersed by the ants, 47 and that seed odors were sufficient to induce directed dispersal even without elaiosomes. It is 48 probable that the fleshy fruit producing genus Monotropastrum evolved from the related 49 anemochorous genus Monotropa, which produces capsule fruit. This transformation from 50 anemochory to myrmecochory presents a novel evolutionary pathway toward ant-mediated seed 51 dispersal in an achlorophyllous plant.

As with almost all data, museum collection catalogues are largely unstructured, variable in consistency and overwhelmingly composed of thin records. The form of these catalogues means that the potential for new forms of research, access and scholarly enquiry that range across multiple collections and related datasets remains dormant. In the project Heritage Connector: Transforming text into data to extract meaning and make connections, we are applying a battery of digital techniques to connect similar, identical and related items within and across collections and other publications. In this paper we describe a framework to create a Linked Open Data knowledge graph (KG) from digital museum catalogues, connect entities within this graph to Wikidata, and create new connections in this graph from text. We focus on the use of machine learning to create these links at scale with a small amount of labelled data, on a mid-range laptop or a small cloud virtual machine. We publish open-source software providing tools to perform the tasks of KG creation, entity matching and named entity recognition under these constraints.

Primary effusion lymphoma (PEL) is a distinct disease entity of large B-cell lymphomas most often occurring in immunocompromised patients. We present a rare case of extracavitary PEL primary to the bone marrow in a HIV-positive patient.