Introduction: There is evidence for increased risk of eating disorders in individuals with diet-treated chronic illnesses, however, data in patients with Cystic Fibrosis (CF) is less clear. No studies have evaluated avoidant/restrictive food intake disorder (ARFID) in the CF population. We investigated the prevalence of disordered eating, including ARFID, in adolescents and young adults with CF. Methods: Patients with CF aged 14-35 years were recruited to complete three validated surveys: (1)Eating Disorder Examination Questionnaire (EDE-Q), (2)Nine-Item Avoidant/Restrictive Food Intake Disorder Scale (NIAS), and (3)Cystic Fibrosis Questionnaire-Revised (CFQ-R). Univariate linear regression analysis identified baseline risk factors associated with these survey scores. Variables with univariate p<0.20 were considered for inclusion in a multivariable linear regression model. Backwards stepwise linear regression was used to identify the final model. Results: A total of 52 patients enrolled. The prevalence of eating disorder measured on the EDE-Q was 9.6%, and on the NIAS was 13.5%. The CFQ-R eating and weight subscales were associated with scores on the EDE-Q, and CFQ-R eating subscale and being dF508 homozygous were correlated with the NIAS total score. Discussion: A clinically significant number of participants screened positive for disordered eating on the EDE-Q and NIAS. Scores on the eating and weight scales of the CFQ-R were associated with the scores on these surveys. Further work is needed to better understand the optimal way to use such tools to screen and treat for eating disorders in individuals with CF.

Threshold and safe ingestion dose among infants sensitized to hen’s eggMasatoshi Mitomori,a Noriyuki Yanagida,aMakoto Nishino,a Kyohei Takahashi,aKen-ichi Nagakura,a Kiyotake Ogura,aMari Takei,b Sakura Sato,b Motohiro EbisawabaDepartment of Pediatrics, National Hospital Organization, Sagamihara National Hospital, Kanagawa, JapanbClinical Research Center for Allergy and Rheumatology, National Hospital Organization, Sagamihara National Hospital, Kanagawa, JapanRunning title: Threshold and safe ingestion dose of egg

Background: Genetic areas of FOXP3 TSDR, HLA-G upstream of CpG island 96, CpG41 and CpG73 islands of the HLA‐DRB1 and HLA-DQB1 genes respectively, previously documented to display immune modulatory properties, were subjected to epigenetic/genetic analysis to assess their influence in IgE-mediated food allergy (FA) development in children. Methods: 64 orally challenged and IgE- tested food allergic subjects together with 44 controls were recruited. Targeted pyrosequencing analysis, to detect DNA methylation status and genetic variations was utilized and experimental results obtained were analysed by statistical software platform and correlated to clinical data. Also, transcription factor (TF) binding sites at study areas were unmasked by the JASPAR prediction database. Results: Parents’ smoking was significantly correlated with aberrant methylation patterns, regardless food allergic or control status. HLA-G promoter region showed a trend for hypomethylation in food allergic subjects, with one of the CG sites displaying significantly decreased methylation values. Rs1233333, residing within HLA-G promoter region preserved a protective role towards DNA methylation. Variable methylation patterns were recorded for CpG41 of the HLA‐DRB1 gene and hypermethylation of the region was significantly correlated with the presence of (Single Nucleotide Polymorphisms) SNPs. TFs’ recognition sites, located at studied genetic areas and exerting pivotal regulatory biological roles, are potentially affected from divergent DNA methylation status. Conclusions: We propose that HLA-G expression is triggered by food derived allergens, providing a TregFoxP3-/HLA-G+ subpopulation generation and direct immune-tolerance. Furthermore, clear evidence is provided for the underlying co-operation of genetic polymorphisms with epigenetic events, mainly at CpG41 island of HLA-DRB1 gene, which need an extended investigation and elucidation.

Objectives To investigate the extent to which observer variability of CT lung nodule assessment may affect clinical treatment stratification in Wilms Tumor (WT) patients, according to the recent SIOP-RTSG UMBRELLA protocol. Methods I: CT thoraces of children with WT submitted for central review, were used to estimate size distribution of lung metastases. II: Scans were selected for blinded review by five radiologists to determine intra and inter-observer variability. They assessed identical scans on two occasions six months apart. III: Monte Carlo simulation (MCMC) was used to predict the clinical impact of observer variation when applying the UMBRELLA protocol size criteria. Results Lung nodules were found in 84 out of 360 (23%) children with WT. For 21 identified lung nodules, inter-observer limits of agreement (LOA) for the five readers were ±2.4mm and ±1.4mm (AP diameter), ±1.9mm and ±1.8mm (TS diameter) and ±2.0mm and ±2.4mm (LS diameter) at assessments 1 and 2. Intra-observer LOA across the three dimensions were ±1.5mm, ±2.2mm, ±3.5mm, ±3.1mm and ± 2.6mm (readers 1-5). MCMC demonstrated that 17% of the patients with a ‘true’ nodule size of 3mm will be scored as <3 mm, and 21% of the patients with a ‘true’ nodule size of <3mm will be scored as being 3 mm. Conclusion A significant intra-inter observer-variation was found when measuring lung nodules on CT for patients with WT. This may have significant implications on treatment stratification, and thereby outcome, when applying a threshold of 3 mm for a lung nodule to dictate metastatic status.

A document by Anees Ahmed. Click on the document to view its contents.

Here, we report a case of a dissected thoracoabdominal aortic aneurysm repair after frozen elephant trunk implantation, using aortic balloon occlusion technique to simplify the proximal anastomosis and avoid deep hypothermic circulatory arrest. In addition, detailed CT follow-up pictures showed that false lumen thrombosis is a time-dependent and reversible variable. Repeated measurements with time series analysis should be performed to explore false lumen remodeling.

Similar IgE Binding Patterns in Gulf of Mexico and Southeast Asian Shrimp Species in US Shrimp Allergic PatientsSara Anvari1,2*, Shea Brunner1,2*, Karen Tuano1,2, Brenda Bin Su1,2, Shaymaviswanathan Karnaneed3, Andreas L. Lopata3, Carla M. Davis1,21Baylor College of Medicine, Texas Children’s Hospital, Department of Pediatrics, Section of Immunology, Allergy and Retrovirology, Houston, Texas2Baylor College of Medicine, William T. Shearer Center for Human Immunobiology, Houston, Texas3James Cook University, Australian Institute of Tropical Health and Medicine, Centre for Molecular Therapeutics, Douglas, QLD, Australia*co-first authors

1. The recovery of terrestrial carnivores in Europe is a conservation success story. Initiatives focused on restoring top predators, require information on how resident species may interact with the re-introduced species as their interactions have the potential to alter food webs, yet such data are scarce for Europe. 2. In this study, we assessed patterns of occupancy and interactions between three carnivore species in the Romanian Carpathians. Romania houses one of the few intact carnivore guilds in Europe, making it an ideal system to assess intraguild interactions, and serve as a guide for reintroductions elsewhere. 3. We used camera trap data from two seasons in Transylvanian forests to assess occupancy and co-occurrence of carnivores using multispecies occupancy models. 4. Mean occupancy in the study area was highest for lynx ( winter= 0.76 95% CI: 0.42-0.92; autumn= 0.71 CI: 0.38-0.84) and wolf (winter= 0.60 CI: 0.34-0.78; autumn= 0.81 CI: 0.25-0.95) and lowest for wildcat (winter= 0.40 CI: 0.19-0.63; autumn= 0.52 CI: 0.17-0.78) 5. We found that marginal occupancy predictors for carnivores varied between seasons. We also found differences in predictors of co-occupancy between seasons for both lynx-wolf and wildcat-wolf co-occupancy. For both seasons, we found that conditional occupancy probabilities of all three species were higher when another species was present. 6. Our results indicate that while there are seasonal differences in predictors of occupancy and co-occupancy of the three species, co-occurrence in our study area is high, and is dependent on the existence of continuous, relatively undisturbed forests. 7. Terrestrial carnivore recovery efforts are ongoing worldwide. Insights into interspecific relations between carnivore species are critical when considering the depauperate communities they are introduced in. Our work showcases that apex carnivore coexistence is possible, but dependent on protection afforded to forest habitats and their prey base.

Earthworms can variously affect soil properties and resource availability by feeding, burrowing, and casting activities. Figuring out the relationship among earthworms, soil and plant properties is beneficial for understanding the ecological functions of earthworms. Different densities of earthworms (high density, HDE; medium density, MDE; low density, LDE; control, CK) in soil columns were studied to reveal how earthworms influence soil physical and chemical properties and clover plant growth. The results showed that earthworms increased the large and medium aggregate content and decreased the microaggregate content. Soil aggregates in MDE were the most stable. Both the mean mass diameter (MWD) and geometric mean diameter of soil aggregates increased with the densities of earthworms. The average contents of soil organic carbon (SOC) in large-, medium-, and micro-aggregates were 5.5, 4.2, and 4.2 g kg-1 in the treatments with earthworms. There was a significant correlation between SOC content and macroaggregate organic carbon content. The root characteristic values of earthworm-treated clover were significantly higher than those of the control. The clover root indexes were positively correlated with the SOC content and soil aggregates. We considered that earthworms altered the soil aggregate contents and promoted soil organic carbon storage, and thus promote the development of vegetation roots. This study provides scientific supports for a deeper understanding of the mechanism of earthworms on soil carbon storage.

Ecologists often rely on observational data to understand causal relationships. Although observational causal inference methodologies exist, model selection based on information criterion (e.g., AIC) remains a common approach used to understand ecological relationships. However, such approaches are meant for predictive inference and is not appropriate for drawing causal conclusions. Here, we highlight the distinction between predictive and causal inference and show how model selection techniques can lead to biased causal estimates. Instead, we encourage ecologists to apply the backdoor criterion, a graphical rule that can be used to determine causal relationships across observational studies.

33-year-old Sudanese male patient with type one diabetes presented with progressive, severe bilateral thigh pain with low grade fever. The patient was diagnosed initially as diabetic ketoacidosis with pyomyositis and receive analgesic and insulin the patient partially improved. Diagnosis of diabetic myonecrosis was made based on MRI of the thigh.

Due to the emerging rise of multi-drug resistant bacteria, the discovery of novel antibiotics is of high scientific interest. Through their high chemodiversity of bioactive secondary metabolites, cyanobacteria have proven to be promising microorganisms for the discovery of antibacterial compounds. These aspects make appropriate antibacterial screening approaches for cyanobacteria crucial. Up to date, screenings are mostly carried out using a phenotypic methodology, consisting of cyanobacterial cultivation, extraction, and inhibitory assays. However, the parameters of these methods highly vary within the literature. Therefore, the common choices of parameters and inhibitory assays are summarized in this review. Nevertheless, less frequently used method variants are highlighted, which lead to hits from antimicrobial compounds. In addition to the considerations of phenotypic methods, this review provides an overview of developments in the genome-based screening area, be it in-vivo using PCR technique or in-silico using the recent genome-mining method. Though, up to date these techniques are a lot less applied than phenotypical screening.

Viruses of veterinary significance such as African swine fever virus, are known to survive for extended periods in plant-based feed ingredients imported into North America. To reduce the likelihood of virus introduction, high-risk ingredients, such as oil seed meals, are stored in designated facilities for extended periods under controlled environmental conditions to minimize viral infectivity prior to use in diets. While 30 days has become a standard storage period, the required ambient temperature to inactivate viruses during this time is not known. To address the question, 1-metric ton totes of conventional soybean meal were inoculated with PRRSV 144 lineage 1C variant and SVA prior to storage for 30 days at 23.9º C, 15.5º C, or 10º C, and feeding to pigs. Virus infectivity was evaluated through detection of viral RNA in oral fluid samples, along with clinical signs. Results indicated that inactivation of both viruses occurred in soy stored at 23.9º C. In contrast, SVA infectivity was observed in soy stored at both 15.5º C and 10º C, while PRRSV 144 L1C variant infectivity was only observed in soy stored at 10º C. These results suggest that a storage period of 30-days and a temperature of 23.9º C are required to reduce the risk of virus contaminated plant-based feed ingredients, such as soybean meal.

Lynch syndrome (LS) is the most common hereditary colon cancer syndrome caused by germline mutations in mismatch repair (MMR) genes. In this series, we outline 3 pediatric patients who presented with vague symptoms due to colorectal cancer who were eventually diagnosed with Lynch syndrome with multiple gene mutations. The diagnosis of colorectal cancer in pediatrics warrants timely recognition, inclusion of Lynch syndrome in the differential diagnosis, multi-gene testing, and genetic counseling for the patient and family.

Spatial and temporal heterogeneity, or messiness, is a broadly desirable characteristic of river corridors and an indicator of many of the geomorphic processes that sustain fluvial ecosystems. However, quantifying geomorphic heterogeneity is complicated by a lack of consistent metrics, classification schemas for dividing the river corridor into the patches that form the basis for those metrics, and guidance on interpreting metrics. Drawing from both geomorphic and landscape ecology concepts, we offer ideas and guidance intended to help investigators, from researchers to restoration practitioners, more effectively and reliably use heterogeneity to describe river corridor processes and characteristics. We define geomorphic heterogeneity both spatially and temporally. Spatially, heterogeneity can be described by diversity, or the evenness and richness of geomorphic units, and spatial configuration, or the arrangement and shape of geomorphic units. Temporally, heterogeneity can be described by turnover rate, or the rate of change of geomorphic units. Interpretation of heterogeneity metrics depends integrally on the definition of the geomorphic unit schema on which metrics are based. Contextual information, such as measurements of process space (i.e., how much room a river has to move), disturbance frequency, and geomorphic trajectory, can also be key to interpreting measurements of heterogeneity. Geomorphic applications of heterogeneity require carefully defined geomorphic unit schemas that reflect processes and characteristics of interest, robust metrics of heterogeneity whose meaning is appropriate to the question at hand, and interpretation of those metrics based on the context of expected geomorphic processes and the disturbance regime.

In patients with Uveal melanoma, cardiac metastases can present without any symptoms and carries a poor prognosis. It is becoming more common than previously thought and highlights the importance of routine surveillance after definitive treatment.

We experienced the case of a patient with advanced breast cancer who failed to receive comprehensive care despite regular video conferencing with her physician during the COVID-19 pandemic, resulting in delayed detection of liver metastasis. Inter-hospital collaboration is required to provide uninterrupted cancer care to those disproportionately affected by crises.

In total arch replacement, using frozen elephant trunk (FET) or elephant trunk techniques ensures proximalization of the distal anastomosis. However, in some cases, the left subclavian artery (LSCA) is deeply located and difficult to visualize. Therefore, surgeons face technical challenges during the LSCA reconstruction. We report an end-to-side anastomosis technique that enables safer and easier anatomical reconstruction of the LSCA.