Leishmania donovani is the causative agent of historically anthroponotic visceral leishmaniasis (VL) on the Indian subcontinent (ISC). L. donovani is transmitted by the sand fly species Phlebotomus argentipes. Our collaborative group and others have shown that sand flies trapped outside in endemic villages have fed on cattle and dogs in addition to people. Domestic animals are reservoirs for L. donovani complex spp., particularly L. infantum, in other endemic areas. Multiple studies using quantitative PCR or serological detection methods have demonstrated that goats, cattle, rats and dogs were diagnostically positive for L. donovani infection or exposure in eastern Africa, Bangladesh, Nepal and India. There is a limited understanding of the extent to which L. donovani infection of domestic animals drives transmission to other animals or humans on the ISC. Evidence from other vector-borne disease elimination strategies indicated that emerging infections in domestic species hindered eradication. The predominant lesson learned from these other situations is that non-human reservoirs must be identified, controlled and/or prevented. Massive efforts are underway for VL elimination on the Indian subcontinent. Despite these herculean efforts, residual VL incidence persists. The specter of an animal reservoir complicating elimination efforts haunts the final push toward full VL control. Better understanding of L. donovani transmission on the Indian subcontinent and rigorous consideration of how non-human reservoirs alter VL ecology are critical to sustain elimination goals.

Current results do not provide conclusive evidence on the effect of BCG vaccination on COVID-19 alone or in combination with other factors. To address this limitation, in this study we used a citizen science initiative on the COVID-19 pandemic to collect data worldwide during October 2-30, 2020 (1,233 individuals) in a structured way for analyzing factors and characteristics of affected individuals in relation to BCG vaccination. For the first time, the results of our study suggested that vaccination with BCG may increase the risk for COVID-19 at certain age, particularly in individuals vaccinated at childhood. A reasonable explanation for this effect is the activation of certain innate immunity mechanisms associated with inflammatory reactions, which should be considered when analyzing the risks associated with this global pandemic. These factors should be considered when analyzing the risks associated with this global pandemic.

Several plastic degrading enzymes have been described in the literature, most notably PETases that are capable of hydrolyzing polyethylene terephthalate (PET) plastic. One of them, the PETase from Ideonella sakaiensis, a bacterium isolated from environmental samples within a PET bottle recycling site, was the subject of extensive studies. To test how widespread PETase functionality is in other bacterial communities, we used a cascade of BLAST searches in the JGI metagenomic datasets and showed that PETases can also be found in other metagenomic environmental samples from both human affected and relatively pristine sites. To confirm their classification as PETases, we verified that the newly identified proteins have the PETase sequence signatures common to all PETases and that phylogenetic analyses group them with the experimentally characterized PETases. Additionally, docking analysis was performed in order to further confirm the functional assignment of the putative environmental PETases.

Epilepsy is a common neurological disorder characterized by repeated and spontaneous epileptic seizures, which is not well controlled by current medication. Traditional theory supports that epilepsy results from the imbalance of excitatory glutamate neurons and inhibitory GABAergic neurons. Recently, shreds of evidence from available clinical and preclinical researches suggest that histamine in the central nervous system plays an important role in the modulation of neural excitability and pathogenesis of epilepsy. Many histamine receptor ligands show positive response in animal epilepsy models, among which the H3R antagonist pitolisant even has shown a good anti-epileptic effect in clinical trials. New insights are focusing on the potential action of histamine receptors to control and treat epilepsy. This review summarizes the findings from animal and clinical researches on the role of brain histamine and histamine receptor in epilepsy. Importantly, we further provide perspectives on some possible research directions for future studies.

Kayexalate® is associated with gastrointestinal injury that can be fatal. Physicians must be aware of the adverse events when prescribing this therapy. Clinical data and medication history should follow the biopsy material given to the pathologist, who will look for Kayexalate® crystals. Pathologists and physicians should work hand in hand.

BOOK REVIEW: Technical Aspects of Modern Coronary Artery BypassRobert F Tranbaugh, MDDepartment of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NYData Availability: NAFunding: NoneConflict of Interest: NoneInternational Review Board: NAInformed Consent: NACorresponding author:Robert F Tranbaugh, MDDepartment of Cardiothoracic SurgeryWeill Cornell Medicine505 East 68th StreetNew York, NY [email protected] Count: 484After recently purging most of my reference textbooks (many from the 1970’s and 1980’s and including the big names from the “Golden Age” of cardiac surgery—Glenn, Sabiston and Kirklin), I wondered if the era of the well-recognized, authoritative textbook was over. I actually cannot remember the last textbook I purchased. While a resident at UCSF, textbooks were critically important as the library closed at midnight. I grew up with the “red book”, Dunphy and Way’s “currentSurgical Diagnosis and Treatment”. This paperback nicely covered the basics of surgery and, importantly, was readily available for residents well before Google. Primarily for sentimental reasons, I kept my 1983 edition.So, why a surgical textbook in 2021? What is the appeal, attraction and need?Gaudino’s “Technical Aspects of Modern Coronary Artery Bypass Grafting” has enormous appeal. For one, it is beautifully illustrated with very useful drawings along with attractive and detailed operative photos. At times, I felt like I was visiting the author-surgeon in his or her operating room. The world’s leading experts have provided detailed step by step technical instructions, which are clear, concise and very helpful. For cardiac surgeons considering starting a multiple arterial grafting (MAG) program, this textbook is a needed and wonderful resource.The attractions of Gaudino’s testbook are many. First, “Technical Aspects” clearly reflects Gaudino’s stellar and highly productive career as an investigator and practitioner of MAG. He has systematically addressed the details of MAG. Conduit selection, harvest and utilization are all outlined in exquisite step by step detail. Complex grafting techniques are reviewed and beautifully illustrated. I especially enjoyed Chapter 12 by Rocha and his colleagues on their nicely done essay on the proximal anastomosis, or what I consider to be “the forgotten anastomosis”. The authors review the many important technical details and critical issues impacting the patency of a bypass graft.All of the chapters are well written, beautifully illustrated, highly practical and very helpful for residents in training, for early career surgeons and for well-established cardiac surgeons interested in coronary artery bypass. Gaudino should also be commended for the addition of Chapter 23 by Fremes and Tatoulis on the management of perioperative ischemia and Chapter 24 by Lazar on optimizing medical therapy. These are incredibly important chapters on “non-technical” yet critical issues with excellent recommendations.Gaudino’s “Technical Aspects” is a clearly needed and a highly authoritative textbook which will serve as an excellent roadmap for surgeons interested in starting a MAG program. It hopefully will allow surgeons to move from the “house special” CABG (one internal mammary and veins) mentioned by Girardi in his thoughtful Foreward to more arterial grafting performed with greater confidence and commitment. “Technical Aspects” will also serve as an important resource for surgeons at all levels of training and expertise. I currently have lots of room on my near empty book shelf. “Technical Aspects” will be on my book shelf and belongs on yours!

Mitral valve (MV) repair for mitral regurgitation (MR) due to posterior leaflet (PL) prolapse is achieved nowadays with a great success rate and a good survival, similar, in certain subgroups. In this paper, Sakaguchi et al describe their results in two groups of patients with PL prolapse. Some patients underwent resection (resection group) and others chordal replacement with/out limited resection (respect group). Results were similar in terms of survival and MR recurrence. Our goal is to eliminate, as much as possible, MR when a patient with degenerative MR is operated on. Reduction of the mitral orifice and consequently an increase of the transmitral gradient is the rule. MV repair for degenerative MR provides great results, but there is not a single surgical technique. A close evaluation of the anatomical findings will allow us to choose the best strategy for the individual patient. An open mind is the most important characteristic that a surgeon should have to repair a prolapsing PL without residual regurgitation and dangerous gradients.

Large studies demonstrated that moderate or severe patient-prosthesis mismatch (PPM) occurs in 44.2% to 65% of patients undergoing aortic valve replacement. If there is general agreement that patients with PPM have worse outcome than patients without, it is difficult to understand how to prevent this dangerous complication. The formula used to calculate the effective orifice area (EOA) of an implanted aortic prosthesis has many weak points that produce inconsistent results using the same prosthetic valve (type and size). The observed EOA (3 to 6 months postoperatively) of a #23 biological prosthesis can range from 0.9 to 3.5 cm², making PPM prevention impossible using projected EOA, where only the mean value is reported (1.83 cm² for the same #23 biological prosthesis). An EACTS-STS-AATS Valve Labelling Task Force has been established to suggest the manufacturers to present essential information on valvular prosthesis characteristics in standardized Valve Charts. For valves used in the aortic position, Valve Charts should include a standardized PPM chart to assess the probability of PPM after implantation. This will not solve completely the conundrum of prevention, but most likely it will be a step ahead.

Background: Hepatic metastasis from retinoblastoma (RB) is rare. We evaluated clinical features, imaging manifestations, treatment, and prognosis in these patients. Procedure: Clinical data of five patients diagnosed with hepatic metastases of RB at the Department of Pediatrics in Beijing Tongren Hospital between January 2009 and January 2019 were analyzed retrospectively. Results: Two patients had bilateral lesions, while three had unilateral lesions. Among the seven eyes with lesions, six and one were classified as stage E and C, respectively (International Integrated Reporting Council staging). On computed tomography (CT), low-density foci were observed (three, multiple foci and two, single foci). After chemotherapy, tumor regression was observed in four patients, while there was no response in one patient. Three patients who underwent enucleation were at high risk for extensive choroidal invasion. All patients had severe disease with multiple system involvement, including central nervous system (CNS) and bone metastases. Neuron-specific enolase (NSE) and lactate dehydrogenase (LDH) levels were significantly elevated in all patients; after treatment, they decreased in four patients and remained unchanged in one patient with end-stage disease. Two patients died, with survival durations of 1 and 3 months following the diagnosis of hepatic metastasis. Three patients survived and continued treatment. Conclusion: Hepatic metastasis from RB is rare and usually occurs with CNS and bone metastases. On CT, hepatic foci could be indicated by low-density lesions with calcification. Chemotherapy could be effective for hepatic metastases. The prognosis of these patients is poor; however, hepatic metastasis is not a direct cause of death.

Cryptococcosis is one of the common mycological conditions leading to morbidity and mortality in patients with AIDS. We are presenting a case of disseminated cryptococcosis in a patient infected with human immunodeficiency virus (HIV-1), which were both diagnosed postmortem using Minimally Invasive Tissue Sampling Method.

This paper investigates the effect of inlet shape, entrance length and turbulence promoters on mass transfer by using 3D printed electrolyzers. Our results show that the inlet design can promote turbulence and lead to an earlier transition to turbulent flow. The Reynolds number at which the transition occurs can be predicted by the ratio of the cross-sectional area of the inlet to the cross-sectional area of the electrolyzer channel. A longer entrance length results in more laminar behavior and a later transition to turbulent flow. With an entrance length of 550mm, the inlet design did no longer affect the mass transfer performance significantly. The addition of gyroid type turbulence promoters resulted in a factor 2 to 4 increase in mass transfer depending on inlet design, entrance length and the type of promoter. From one configuration to another, there was a minimal variation in pressure drop (<16 mbar).

This study develops a model to predict the CO2 hydrate layer thickness. As to achieve this, we need the mass transfer coefficients at the interface between water phase and CO2 hydrate layer and the diffusion coefficients in CO2 hydrate. Firstly, we conducted the visualization experiment of CO2 hydrate layer dissolution behavior. From the experiment, we obtain the mass transfer coefficient on the CO2 hydrate layer. The experimental results show good agreement with the existing empirical equation. Secondly, we conducted the molecular dynamics simulation of CO2 hydrate to obtain the self-diffusion coefficients of CO2 and H2O molecules. As to calculate the self-diffusion coefficients, we identified inter-cage hopping and intra-cage movement of molecules based on each molecule travel distance. Finally, the results indicate that the kinetic model we proposed reproduce the layer thickness on the order.

Anomalous Aortic Origin of Coronary Artery (AAOCA) is a rare finding, with varied presentation and symptomatology. Increasingly recognized by cardiac imaging, when found it raises questions about the appropriate approach and management. We present a case of an 11-year-old female who presented with episodes of shortness of breath, angina and syncope during exercise. Further investigation demonstrated episodes of nonsustained ventricular tachycardia on Holter and coronary angiotomography revealed that the left coronary artery had an anomalous origin from the right cusp with initial short intramural segment and significant external compression in its initial course between the aorta and the pulmonary artery. Patient was submitted to surgical correction with dissection of left coronary artery posterior to the pulmonary artery, coronary arteriotomy, roof ampliation with autologous pericardium and creation of neo-ostium in aorta. Patient had satisfactory postoperative recovery, was discharged on the fifth day post op, and remains asymptomatic after six months follow-up. Herein we present surgical video and postoperative echo and CT scan.

The pandemic has had a dramatic and negative impact on opportunities for training in pediatric airway endoscopy. This commentary discusses ways in which training programs can address this issue.

Lorlatinib is a third-generation anaplastic lymphoma kinase (ALK) tyrosine kinase inhibitor (TKI) designed to penetrate the blood brain barrier. We report 2 cases of patients with ALK-rearrangement non-small cell carcinoma associated with severe symptomatic CNS metastases and poor performance status. Treatment with lorlatinib improved their neurological condition and performance status.

We presented an unusual case of iatrogenic esophageal perforation(EP) following trans-esophageal echocardiography(TEE) in a patient with COVID-19.Force applied during the intubation on an inflammatory and fragile wall caused by COVID-19 probably represented the underlying condition that contributed to the EP.Early diagnosis and urgent treatment are essential for a favorable prognosis

Objectives: In Wilms Tumor (WT) secondary malignancies caused by the side effects of intensive treatments remain one of the important problems. Therefore, there is a need for new studies to identify low- and high-risk groups for WT and to improve the treatment regimens of children in the low-risk group. Therefore, in our study, we aimed to determine the prognostic significance of the cyclooxygenase-2 (COX-2) biomarker in WT. Materials and Methods: Our study included 24 patients diagnosed with WT between January 2010 and December 2019. The correlation between COX-2 expression and significant prognostic parameters was investigated by studying COX-2 antibody using the immunohistochemical method. Results: COX-2 expression was observed in 22 of the patients, and the expression was more evident especially in the epithelial component. There was no significant correlation between COX-2 positivity and prognostic parameters. Conclusions: In our study, no significant relationship was found between significant prognostic parameters and COX-2 expression. We think that the COX-2 pathway is effective during the development phase of WT, since COX-2 expression was observed in almost all patients, therefore it may be beneficial to add COX-2 inhibitors to the treatment, and that a sufficient number of studies should be conducted in this respect.

A document by Adrian Gaspar. Click on the document to view its contents.