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A steroid- and cyclosporine A- resistant case of Pfeiffer-Weber-Christian disease (PWCD) was remitted completely with sequential treatment with Histobulin and IVIG. The multiple food allergies and the atopic dermatitis of this PWCD patient were also improved with Histobulin treatment. The upper respiratory infections were improved by Histobulin therapy also.

Dear Editor,We reviewed the article entitled: “Analysis of reflux as the etiology of laryngeal dysplasia progression through a matched case-control study ”.1 The authors did not find differences in the level of pepsin, enterokinase and bilirubin in laryngeal dysplasia (LD) of patients with malignant transformationversus those without transformation. The involvement of reflux in the development of LD and laryngeal cancers is an important topic and the realization of such a study is important. However, we wish to draw attention to many points.First, it is difficult to know if the included patients with tissue pepsin really suffered from reflux. The detection of pepsin into the tissue means that patients had some pharyngeal reflux events the day before the surgery but cannot confirm the diagnosis. The sensitivity of pepsin detection in laryngeal tissue depends on the technique and the material (antibodies), reaching 75 to 85% depending on the type of reflux (acid versus nonacid).2 Moreover, we have no detailed information about the immunostaining technique, limiting the reproducibility of the protocol. The presence of pepsin into the tissue does not ensure the reflux diagnosis. Thus, for example, it has been showed that the back flow of gastric content and the deposit of pepsin into the tissue are influenced by the meals preceding the sample collection, making the pepsin tissue a poorly reliable marker of reflux.3 To improve the sensitivity, authors1 could have performed hypopharyngeal-esophageal pH-impedance monitoring, which is the only way to confirm the diagnosis.4Second, the LD malignant transformation involves many factors such as tobacco history, environmental factors, genetic, or immune response.5 The authors did not provide information about the tobacco history (pack-year data) of groups, which is an important data to consider the risk of malignant transformation. Even many years after the tobacco cessation, it is conceivable that patients with long/more severe history of tobacco consumption may have more cell mucosa DNA impairments and a higher risk to develop cancer.Third, the focus on pepsin as the only enzyme associated with malignant transformation limits the understanding of transformation mechanisms. More than 50% of patients had mixed or nonacid reflux,4 in which the activity of pepsin is decreased regarding the alkaline pH of refluxate. To reliably investigate the involvement of reflux in the malignant transformation, authors have to consider the entire content of refluxate, including bile salts and trypsin.4 Furthermore, bile salts may be involved in laryngopharyngeal malignant transformation.6In future studies, reflux has to be diagnosed at the LD diagnosis time and physicians have to follow the reflux clinical course over the time. More than 50% of reflux patients had chronic course,4which leads to a potential higher risk to develop cell DNA damage and lesions. Thus, cross-sectional study design is probably not adequate to study a disease association involving chronic and repeated exposure.Acknowledgments: No.

Background: Right ventricular failure (RVF) after left ventricular assist device (LVAD) implantation is a major cause of postoperative morbidity and mortality. Despite the availability of multiple imaging parameters, none of these parameters had adequate predictive accuracy for post-LVAD RVF. Aim: To study whether right ventricular pressure-dimension index (PDI), which is a novel echocardiographic index that combines both morphologic and functional aspects of the right ventricle, is predictive of post-LVAD RVF and survival. Methods: 49 cases that underwent elective LVAD implantation were retrospectively analyzed using data from an institutional registry. PDI was calculated by dividing systolic pulmonary artery pressure to the square of the right ventricular minor diameter. Cases were categorized according to tertiles. Results: Patients within the highest PDI tertile (PDI>3.62 mmHg/cm2) had significantly higher short-term mortality (42.8%) and combined short-term mortality and definitive RVF (50%) compared to other tertiles (p<0.05 for both, log-rank p for survival to 15th day 0.014), but mortality was similar across tertiles in the long-term follow up. PDI was an independent predictor of short-term mortality (HR:1.05–26.49, p=0.031) and short-term composite of mortality and definitive RVF (HR:1.37–38.87, p=0.027). Conclusions: Increased PDI is a marker of an overburdened right ventricle. Heart failure patients with a high PDI is at risk for short-term mortality following LVAD implantation.

Coronavirus-2019 (COVID-19) pandemic is a global health challenge where pregnant women are potentially more vulnerable to respiratory infections. We describe the successful management of a case a 35 years old pregnant woman, G3, P1, with a history of caesarian section who tested positive for COVID-19 and required critical care support

Physical disruption of gene flow among mountains is commonly viewed as an important process for the generation of hyperdiverse tropical mountain biotas. However, the role of in situ diversification within mountains has been seldom explored. Here we evaluate spatially fine-scale patterns of arthropod community assembly within a single mountain to understand the role of dispersal limitation and landscape features as drivers of tropical mountain diversity. We focus on a single tropical sky-island of the Transmexican Volcanic Belt, where we sampled whole-communities of arthropods for eight orders with a comparable design at a spatial scale ranging from 50 m to 20 km, using 840 pitfall traps and whole community metabarcoding. We explored multiple hierarchical levels, from individual haplotypes to lineages at 0.5, 1.5, 3, 5, 7.5% similarity thresholds, to evaluate patterns of richness, turnover and distance decay of similarity with isolation-by-distance and isolation-by-resistance approaches. Our results showed that distance and altitude influence distance decay of similarity at all hierarchical levels. This holds for arthropod groups of contrasting dispersal abilities, but with different strength depending on the spatial scale. Our results suggest long-term persistence of lineages within sky islands, combined with local-scale differentiation, may be an important driver of high arthropod biodiversity in tropical mountains.

Primary cardiac lymphoma is rare, with a frequency of 1.0% to 1.6% among cardiac malignant tumors. Chemotherapy is often selected as first-line treatment for primary cardiac lymphoma. However, when the tumor causes heart failure or life-threatening hemodynamic collapse, antecedent urgent surgery is required. We herein report a successful case of complete tumor resection and reconstruction of the right atrium and right ventricle using a bovine pericardial patch combined with tricuspid valve replacement in a patient with a huge primary cardiac lymphoma filling the right heart that manifested as tricuspid valve stenosis and subsequent heart failure.

Background: Many arguments suggest that neutrophils could play a prominent role in COVID-19. However, the role of key components of neutrophil innate immunity in severe forms of COVID-19 has deserved insufficient attention. We aimed to evaluate the involvement of Neutrophil Elastase, histone-DNA, and DNases in systemic and multi-organ manifestations of COVID-19. Methods: We performed a multicenter study of markers of neutrophil innate immunity in 155 cases consecutively recruited in a screening center (ambulatory subjects), local hospitals, and two regional university hospitals. The case were evaluated according to clinical and biological markers of severity and multi-organ manifestations and compared to 35 healthy controls. Results: Blood Neutrophil Elastase, histone-DNA, myeloperoxidase-DNA and free dsDNA were dramatically increased, and DNase activity decreased by 10-fold, compared to controls. Neutrophil Elastase and histone-DNA were associated with intensive care admission, body temperature, lung damage and markers of cardiovascular outcomes, renal failure and increased IL-6, IL-8 and CXCR2. Neutrophil Elastase was an independent predictor of the computed tomography score of COVID-19 lung damage and the number of affected organs, in multivariate analyses. The increased blood concentrations of NE and neutrophil extracellular traps were related to exacerbation of neutrophil stimulation through IL8 and CXCR2 increased concentrations and increased serum DAMPs, and to impaired degradation of NETs as a consequence of the dramatic decrease of blood DNase activity. Conclusion: Our results point out the key role of neutrophil innate immunity exacerbation in COVID-19. Neutrophil Elastase and DNase could be potential biomarkers and therapeutic targets of severe systemic manifestations of COVID-19.

Catchments in the Luquillo Mountains of Puerto Rico are warm, wet, and tropical with steep elevational relief creating gradients in temperature and rainfall. Long-term objectives of research at the site are to understand how changing climate and disturbance regimes alter hydrological and biogeochemical processes in the montane tropics and to provide information critical for managing and conserving tropical forest ecosystems globally. Measurements of hydrology and meteorology span decades, and currently include temperature, humidity, precipitation, cloud base, throughfall, groundwater table elevation, and stream discharge. The chemistry of rain, throughfall, and streams is measured weekly, and lysimeters and wells are sampled monthly to quarterly. Multiple data sets document the effects of major hurricanes including Hugo (1989), Georges (1998), and Maria (2017) on vegetation, biota, and catchment biogeochemistry and provide some of the longest available records of biogeochemical fluxes in tropical forests. Here we present an overview of the findings and the data sets that have been generated from the Luquillo Mountains, highlighting their importance for understanding montane tropical watersheds in the context of disturbance and global environmental change

Porcine circovirus 4 (PCV4), a novel and unclassified member of the genus Circovirus, was first reported in China in 2019. Aimed at providing more evidence about the active circulation of PCV4, this study screened 335 pooled internal organs and detected the virus (i) at the rates of 3.28%, (ii) from both clinical healthy and clinical sick pigs of various age groups, and (iii) in six out of nice provinces of Korea. The complete genomic sequence of a Korean PCV4 strain (E115) was 1,770 nucleotides in length and had 98.5% to 98.9% identity to three PCV4 strains available at GenBank up to date. Utilizing a set of bioinformatic programs, it was revealed that the Korean PCV4 strain contained several genomic features of (i) a palindrome stem-loop structure with conserved nonanucleotide, (ii) packed overlapping ORFs oriented in different directions, and (iii) two intergenic regions in between genes encoding putative replication- associated protein (Rep) and capsid (Cap) proteins. This study also predicted the presence of essential elements known so far for the replication of circoviruses, for example, the origin of DNA replication, endonuclease and helicase domains of Rep, the nuclear localization signal on the putative Cap protein. Finally, based on the phylogeny inferred from sequences of the putative Rep protein, it was suggested that PCV4 belong to genus Circovirus of family Circoviridae and losely related to three previous known porcine circoviruses of PCV1, PCV2 and PCV3.

KEYWORDSArctic, benthic, catchment, climate change, discharge, long-term monitoring, nutrient enrichment, nutrients

Two experimental basins – the Cariri basins – were installed in a typically semiarid region in the State of Paraíba, Brazil, for obtaining reliable estimates of runoff and soil erosion in different scales to evaluate the influence of the human activities and other factors over the processes of runoff and erosion. In the first basin, located in the municipality of Sumé, the field studies were carried out at three different scales: four micro-basins with an area of around 0.5 ha; nine standard Wischmeier-type erosion plots of 100 m2 and seven sample plots of 1 m2. The experimental units had varied vegetal cover and management and, except the sample plots, were subjected to natural rainfall events only, and were monitored from 1982 to 1991. The total runoff and total sediment yield were determined for each of the events of precipitation. The installations of the second basin, in the near municipality of São João do Cariri, were planned for the continuation of the studies initiated at Sumé, and include erosion plots (100 m2), micro-basins, and sub-basins, which are being monitored for runoff and sediment production up to now. Among them, two nested micro-basins were monitored to detect any scale effect at the micro-basin level. Nearly 600 events of natural precipitation, that produced runoff in at least one of the experimental units, have been registered. This bulk of data was utilised to evaluate the influence of various factors, including cultivation practices. The data collected so far has been successfully used to calibrate hydrological models for plots and micro-basins. Parameters have been tested by means of cross validations among micro-basins and sub-basins. The data sets, in part, have been made available to researchers in Brazil and now the updated data files are being made available to all the researchers in hydro-sedimentology at: https://doi.org/10.5281/zenodo.4044690

Local community and research interest to better understand regional climate change impacts has led to the establishment of a long-term soil moisture and weather observation network in the Roaring Fork catchment of the Colorado River Headwaters. This catchment-wide suite of 10 stations collects frequent and continuous data on soil moisture, soil temperature, rain, air temperature, relative humidity, and (at some stations) snow across an elevational gradient from 1,800m to 3,680m in elevation. We demonstrate how this effort can support research on mountain hydrology with applications for resource management and climate change adaptation decision making. We also share perspectives on the value and opportunities a community science approach can bring to catchment studies moving forward. All data from this project are publicly available.

IntroductionThe Turkey Lakes Watershed (TLW) study (https://www.canada.ca/en/environment-climate-change/services/turkey-lakes-watershed-study.html) was established in 1979 and is one of the longest running watershed-based ecosystem studies in Canada (Foster, Beall & Kreutzweiser, 2005; Jeffries, Kelso & Morrison, 1988; Morrison, Cameron, Foster & Groot, 1999). The watershed drains 10.5 km2 of Eastern Temperate Mixed Forest (Baldwin et al., 2018) or Great Lakes – St. Lawrence forest region (Rowe, 1972) within the Boreal Shield Ecozone (Wiken, 1986), and is located approximately 60 km north of Sault Ste. Marie, Ontario (47°03’N, 84°25’W) (Figure 1). Researchers from several federal government departments (Natural Resources Canada (NRCAN), Environment and Climate Change Canada (ECCC) and Fisheries and Oceans Canada (DFO) established this research watershed to evaluate the impacts of acid rain on terrestrial and aquatic ecosystems (e.g., Foster, Hazlett, Nicolson & Morrison, 1989; Hazlett, Curry & Weldon, 2011; Jeffries, Semkin, Beall & Franklyn, 2002; Kelso 1988). Since its inception, many studies have taken a multi-disciplinary, whole-ecosystem approach to investigate the processes governing terrestrial and aquatic responses to natural and anthropogenic disturbances. This holistic approach has allowed research to expand from its original acidification focus to address a range of other ongoing and emerging environmental issues (e.g. habitat alteration, organic contaminants, forest management, climate change) and to involve numerous academic, government and industrial collaborators.

Background: We studied whether significant differences in care gaps exist between specialists and PCPs. Methods: GOAL Canada enrolled patients with CVD or familial hypercholesterolemia (FH) and LDL-C > 2.0 mmol/L despite maximally tolerated statin therapy. During follow-up, physicians received online reminders of treatment recommendations based on Canadian Guidelines. Results: A total of 177 physicians (58% PCPs) enrolled 2009 patients; approximately half of the patients were enrolled by each physician group. Patients enrolled by specialists were slightly older (mean age 63 years vs. 62), female (45% vs. 40%), Caucasian (77% vs. 65%), and had a slightly higher systolic pressure and lower heart rate. Patients enrolled by specialists had less frequent history of familial hypercholesterolemia, diabetes, hypertension, chronic kidney disease and liver disease but more frequent history of coronary artery disease, atrial fibrillation and premature family history of CVD. There was no significant baseline difference in LDL-C, HDL-C, or non-HDL-c, although total cholesterol and triglycerides were slightly higher in patients managed by PCPs. At baseline, PCPs were more likely to use statins (80% vs.73%, p=0.0002) and other therapies such as niacin or fibrate (10% vs. 6%, p=0.0006) but similar use of ezetimibe (24% vs. 27%, p=0.15). At the end of follow up, specialists used less statins (70% vs. 77%, p=0.0005) and other therapies (6% vs. 10%, p=0.007) but more ezetimibe (45% vs. 38%, p=0.01) and the same frequency of PCSK9i (28% vs. 27%, p=0.65). The proportion of patients achieving the recommended LDL-C level of 2.0 mmol/L or below (primary endpoint) was similar at last available visit between specialists and PCPs (44% vs. 42%, p=0.32). Conclusion: Despite minor differences in the clinical profile of their patients, both PCPs and specialists actively participate in the management of lipid lowering therapy in high risk CVD patients and experience similar challenges and care gaps.

Fast-growing plantations have been expanding in Brazil in the last 50 years, increasing productivity by over 40 m3 / ha in reduced cycles between 5 and 15 years. In the 1990s, environmental warnings about these plantations guided research projects seeking to understand their effects on water and propose forest management actions to minimize them. The assessment of forest management effects on water resources is conducted by long-term experiments in paired catchments. In this study, we present some studies conducted at the hydrological monitoring center of Itatinga Experimental Station, of the University of São Paulo, where hydrological monitoring began in 1987, and currently conduct 4 catchments under different forest management regimes: fast-growing industrial management, long-term forest mosaic management, native forest restoration and long-term coppiced management. Results show that in a site with deep soils and good natural water regulation, main hydrological effects still occur when forest management intensifies, increasing water consumption and making the flow regime vulnerable to intra- and inter-annual seasonality. Regarding water quality, weekly sampling showed little interference of forest management on water chemistry; besides, more intensive management increased the concentration of nutrients in the water. There were no differences in water use in Eucalyptus plantations aged between 10 and 17 years and the use of coppice management had in the first 2 years higher water use than new plantations. The different types of management adopted directly affected the amount of water used, showing that high water demand forest plantations at water deficit regions, water availability is directly controlled by the forest management regime.

The aim of this study was to describe the occurrence, angulation and mesialization ratio of the ectopic eruption of the maxillary permanent first molar (PFM) and its correlation with the pathological resorption of maxillary primary second molar (PSM). This retrospective study was performed using the panoramic radiographs of 11.924 child patients aged 6–10 years. Ectopic eruption status is categorized as self-corrected and impacted types. To evaluate the differences between the two groups (self-corrected and impacted), the angulation of PFM, mesialization ratio of PFM, and degree of adjacent PSM root resorption were also assessed. The data were statistically analyzed using ANOVA and chi-square tests. Pearson correlation was used to analyze whether a quantitative relationship exists between PFM mesialization ratio and PSM root resorption. Ectopic eruption frequency was determined as 0.83%. The distribution of ectopic eruption according to gender shows a higher prevalence in males than females. In most of the eruption status of cases with ectopic eruption were impacted. The impacted PFMs showed more negative vertical and positive horizontal angle between the PSM and PFM. There was no significantly difference eruption status and angles. Mesialization ratio of impacted PFMs were significantly higher than self-corrected PFMs. There was significant difference between the PFM mesialization ratio and the degree of PSM root resorption. Early diagnosis and detailed imaging techniques evaluation are important to prevent premature loss of arch size.

We first report a successful transcatheter aortic valve implantation using J-Valve system in an elder patient with high-risk pure aortic regurgitation (PAR) and type III endoleak after thoracic endovascular aortic repair (TEVAR).