This letter is in response to the case report by Kuzmin et al. entitled “Left atrial appendage occlusion device causing coronary obstruction: A word of caution” , published in November 2020 issue of Journal of Cardiac Surgery. The report describes a circumflex lesion occurring following mitral valve (MV) repair, tricuspid valve repair, and left atrial appendage closure (LAAO) using AtriClip device. The authors concluded that LAAO is a safe procedure, but in the setting of a concomitant MV surgery LAAO may be a contributor to the reported event. Circumflex coronary artery occlusion or impingement during MV repair is well described in the literature. On the reported two-dimensional cine, the position of the stenosis is typical of mitral repair induced injury. A ring suture can gather and compress tissue adjacent to the coronary creating stenosis without a discrete ligation. It is also true that vigorous traction on the LAA without due attention to distortion of the adjacent circumflex might be capable of creating compression or accordioning of the vessel. To mitigate this, the clip should be placed at the true base of the appendage. A residual pouch carries as much or more risk as not attempting to close the appendage at all. The authors’ recommendation to place the clip more distally will inevitably lead to incomplete closures. In conclusion, the reported event was more likely due to a mitral stitch, the path of which is not directly visualized after it breaches the endocardium.

In receptors of solid organ transplant, calcineurin inhibitors has become a pillar of immunosuppressive treatment. Several case reports have shown hypertrophic and dilated cardiomyopathy as a side effect of tacrolimus. We present the case of a woman receptor of a kidney transplant who developed hypertrophic cardiomyopathy due to Tacrolimus.

Omphalolith is a rare and underdiagnosed entity due to the accumulation of sebum and keratin in the umbilicus. It usually occurs in the elderly with deep and narrow umbilicus. Early recognition of omphalolith is important to prevent complications, unnecessary investigations and anxiety. We report herein two new cases of omphalolith.

We report the case of a 65-year-old woman who presented to our hospital with a complaint of abdominal pain due to undigested mochi, which was resolved by snare cutting.

In this paper, we are concerned with the non-relativistic limit of a class of computable approximation models for radiation hydrodynamics. The models consist of the compressible Euler equations coupled with moment closure approximations to the radiative transfer equation. They are first-order partial differential equations with source terms. As hyperbolic relaxation systems, they are showed to satisfy the structural stability condition proposed by W.-A. Yong (1999). Base on this, we verify the non-relativistic limit by combining an energy method with a formal asymptotic analysis.

Non covalent biliproteins are found in a growing number of living organisms and even in viruses, such as SARS-CoV-2. Unlike the well described covalent biliproteins, such as the phytochromes, they present a vast structural and functional diversity, and often with limited experimental information. A very important tool (and sometimes the only one available) to study these systems is the UV-Vis spectrum, which is modulated both by conformational changes of the biliverdin chromophore and specific interactions with the apoprotein. In this work we present a theoretical study of the microscopic determinants of the UV-Vis spectrum of these compounds through the use of hybrid QM(TD-DFT)/MM techniques and molecular dynamics simulations. Comparing our results with existing experimental data, we prove that it is possible to predict spectroscopic properties, such as relative position and intensity ratio of main bands, with affordable methods, and to provide a microscopic explanation of them. This systematic information can be very useful for the study of described biliproteins or for those yet unknown.

The last influenza pandemic in 2009 emerged from swine and surveillance of swine influenza is important for pandemic preparedness. Movement of swine during husbandry, trade or marketing for slaughter provide opportunities for transfer and possible genetic reassortment of swine influenza viruses. Over 90% of the swine slaughtered at the central swine abattoir in Hong Kong are imported from farms located in multiple provinces in mainland China. There is opportunity for virus cross-infection during this transport and slaughter process. Of the 26,980 swabs collected in the slaughterhouse in Hong Kong from 5 th January 2012 to 15 th December 2016, we analyzed sequence data on influenza A (H3N2) virus isolates (n = 174) in conjunction with date of sampling and originating farm. Molecular epidemiology provided evidence of virus cross-infection between swine originating from different farms during transport and also evidence of a virus lineage persisting in a swine farm for over 2 years. We used virus serology and isolation data from 4,226 paired pig serum and nasal swabs collected from swine originating from Guangdong Province to compare the force of infection (FOI) during transport and within farms. The mean weekly FOI during transport was λ t = 0.0286 (95% CI = 0.0211-0.0391) while the weekly FOI in farms was λ f = 0.0089 (95% CI = 0.0084-0.0095), assuming a duration of stay in farm of 28 weeks, suggesting increased force of infection during the transport process. Potential risk factors for infection including the duration in transport, length of stay at slaughterhouse and farm-level seroprevalence were also assessed by multivariable logistic regression analysis. Transport may increase virus cross-infection rates and provide opportunities for virus reassortment potentially increasing zoonotic risk to those involved in the transportation and slaughtering processes.

A document by Isioma Okolo. Click on the document to view its contents.

Sexual signals are important in speciation, but understanding their evolution is complex as these signals are often composed of multiple, genetically interdependent components. To understand how signals evolve, we thus need to consider selection responses in multiple components and account for the genetic correlations among components. One intriguing possibility is that selection changes the genetic covariance structure of a multicomponent signal in a way that facilitates a response to selection. However, this hypothesis remains largely untested empirically. In this study, we investigate the evolutionary response of the multicomponent female sex pheromone blend of the moth Heliothis subflexa to 10 generations of artificial selection. We observed a selection response of about 3/4s of a phenotypic standard deviation in the components under selection. Interestingly, other pheromone components that are biochemically and genetically linked to the components under selection did not change. We also found that after the onset of selection, the genetic covariance structure diverged, resulting in the disassociation of components under selection and components not under selection across the first two genetic principle components. Our findings provide rare empirical support for an intriguing mechanism by which a sexual signal can respond to selection without possible constraints from indirect selection responses.

Objective: To assess the utility of a test-based approach to shorten isolation of healthcare workers with COVID-19 in the setting of the highly transmissible omicron variant Methods: Between December 24th, 2021, to January 5th, 2022 HCWs who tested positive for SARS-CoV-2 were re-tested at least five days since onset of symptoms. Results: 46 sequential fully COVID-19 vaccinated HCWs who had tested positive for SARS-CoV-2 underwent follow up testing. All the isolates were confirmed as omicron variants and only 4 (8.7%) were negative 5 days or more since onset of symptoms., Conclusions: Implementation of a test-based strategy is logistically challenging, increases costs and did not lead to shorter isolation in our institution.

Asthma is a chronic inflammatory airway disease resulting in airflow obstruction, which in part can become irreversible to conventional therapies, defining the concept of airway remodeling. The introduction of biologics in severe asthma has led in some patients to the complete normalization of previously considered irreversible airflow obstruction. This highlights the need to distinguish a “fixed” bronchial obstruction due to structural changes unresponsive to current therapies, from a “reversible” one as demonstrated by lung function normalization during biological therapies not previously obtained even with high dose systemic glucocorticoids. The mechanisms by which exposure to environmental factors initiates the inflammatory responses that trigger airway remodeling are still incompletely understood. Alarmins represent tissue-derived cytokines that initiate immunologic events leading to inflammatory airway remodeling. Biological therapies can improve airflow obstruction by addressing these airway inflammatory changes. In addition, biologics might prevent and possibly even revert “fixed” remodeling due to structural changes. Hence, it appears clinically important to separate the therapeutic effects (early and late) of biologics as a new paradigm to evaluate the effects of these drugs and future treatments on airway remodeling in severe asthma.

The New Reality is VirtualWilliam L. Carroll, MD*Perlmutter Cancer Center, NYU-Langone Medical Center, New York, New York*Correspondence to: William L. Carroll, MD Division of Pediatric Hematology-Oncology, Departments of Pediatrics and Pathology, Perlmutter Cancer Center, NYU-Langone Medical Center, 560 East First Avenue, Smilow Room 1211, New York, NY, 10016E-mail: [email protected] COVID-19 pandemic led to a precipitous and severe disruption to healthcare delivery and consumption worldwide. Ongoing analyses (and debate) about the effectiveness of early response measures will continue, but there is no doubt the pandemic brought about dramatic changes to health care, some of which are likely to last.The health care industry is built on a model of in-person visits between patients and providers, which is reinforced by economic incentives. However, tremendous pressure was put on health care systems to pivot quickly from in-person visits given the explosive spread of COVID-19. Non-essential in-person visits and elective procedures were reduced, or paused, allowing hospitals to marshal capacity for a surge in COVID-19 cases and to mitigate risk of infection to patients and staff. Patients deferred care, in many cases with negative results1. Outpatient in-person volume plummeted over 40%2.In any crisis, opportunities emerge and telehealth visits surged providing a safe alternative to in-person visits3. Telehealth or virtual visits are not novel and has been in place since the mid 1990’s especially for rural care but regulation and reimbursement limited its application4. With changes in payer reimbursement, telehealth visits increased dramatically. Early in the pandemic up to a third of office visits were through virtual care. This trend was most pronounced in primary care and mental health/psychiatry but whether it can be applied safely to patients with complex conditions requiring therapy with medications associated with a narrow therapeutic index like cancer is less certain.In this issue of Pediatric Blood and Cancer Rabinowicz et al, raise the question of how essential are in-person visits during maintenance therapy for B acute lymphoblastic leukemia (ALL), the most common childhood cancer5. The authors conducted a retrospective study to determine if an in-person visit was essential to detect an abnormal finding on physical examination especially if it resulted in a change in medical management. They excluded patients during the first three months of maintenance when more frequent laboratory evaluations are needed to titrate medication dosages, when children required intrathecal or intravenous therapy, or when other specialists saw patients. All others could be considered candidates for virtual care delivery. Seventy-five children with 240 routine visits were analyzed. Fourteen were associated with a new abnormal finding and in only six cases was a direct physical examination deemed required for diagnosis. Only three such visits resulted in a change in medical management. Based on these results, the authors argue, justifiably, that there is a large potential for virtual visits during maintenance treatment.The results of this study are not surprising especially as most patients, including the fourteen with new findings on exam in this report, will have symptoms (not analyzed in the study) alerting parents and providers to new medical conditions warranting in-person visits. Most ALL treatment protocols mandate physical examination with routine laboratory monitoring on a monthly basis and it is hard to justify more frequent intervals in the absence of follow up medication adjustments or specific problems. There might a subset of families with particular hardships related to travel where the in-person interval can be extended further. COG protocols now use every 12 week vincristine/decadron pulses with intrathecal methotrexate administration. Home phlebotomy services have been piloted to obtain laboratory blood draws and perform port flushes6. Virtual visits can be used to ascertain any side effects, adjust medications, and emphasize compliance. Another positive aspect of the pandemic is the widespread adaption of at home viral testing and there is no doubt that COVID-19 has changed the future of in-home medical diagnostics.The authors provided a thoughtful, balanced analyses and discussion of the pros, including decreasing the burden of care (e.g. school absences, time off work for parents, and transportation costs) and cons of virtual visits. Two important considerations are warranted when deciding on frequency of virtual vs. in-person visits. First, a “digital divide” is well described where limited access to high-speed internet services, lower socioeconomic status and limited English proficiency are barriers to access. Second, medical monitoring is only one part of a broader strategy in pediatric cancer care to decrease the physical, neuropsychological, educational and financial burden of cancer on children and their families. Thus, children and their families may routinely interact with physicians, nurses, social workers, physical therapists, child life therapists, teachers and psychologists as part of a personalized care model during clinic visits. Such multidisciplinary services may be difficult to replicate through virtual care delivery.It is also time to consider other aspects of digital technology that can enhance the health of our patients and their families7. Mobile health is especially attractive as the overwhelming majority of adults and adolescents have access to a smartphone8. Applications such as MyChart (EPIC) allows patients and parents to view their electronic record in real time and interact with providers. Multiple studies have shown that customized, interactive apps can also be used to augment education about disease and management, manage side effects such as nausea and vomiting, and promote medication adherence9,10. It is time to accelerate the implementation of these tools in every day practice.The article by Rabinowicz and colleagues should motivate us to consider implementing and expanding adaptive strategies developed in response to the COVID-19 pandemic to improve patient care for children and their families with cancer. Virtual visits can never completely replace in-person visits where emotional bonds and trust between providers and patients are required to promote optimal outcomes. However after such relationships are cemented early in treatment virtual visits can reduce the burden of therapy without sacrificing quality.1. Quarello P, Ferrari A, Mascarin M, et al. Diagnostic Delay in Adolescents with Cancer During COVID-19 Pandemic: A New Price for Our Patients to Pay. J Adolesc Young Adult Oncol. 2021.2. Dupraz J, Le Pogam MA, Peytremann-Bridevaux I. Early impact of the COVID-19 pandemic on in-person outpatient care utilisation: a rapid review. BMJ Open. 2022;12(3):e056086.3. Uscher-Pines L, McCullough C, Dworsky MS, et al. Use of Telehealth Across Pediatric Subspecialties Before and During the COVID-19 Pandemic.JAMA Netw Open. 2022;5(3):e224759.4. Werner RM, Glied SA. Covid-Induced Changes in Health Care Delivery - Can They Last? N Engl J Med. 2021;385(10):868-870.5. Rabinowicz R, Maguire B, Hitzler J, Punnett A. How Essential are In-Person Clinic Visits During Maintenance Treatment of Children with Acute Lymphoblastic Leukemia? Pediatric Blood & Cancer. 2022.6. Sisler I, Cohen D, Skinner LA, Aiken C, Laver J. Feasibility of a Pilot Home Phlebotomy Program for Pediatric Hematology/Oncology Patients During the COVID-19 Pandemic. J Pediatr Hematol Oncol.2022;44(1):e185-e187.7. Keesara S, Jonas A, Schulman K. Covid-19 and Health Care’s Digital Revolution. N Engl J Med. 2020;382(23):e82.8. Nievas Soriano BJ, Uribe-Toril J, Ruiz-Real JL, Parron-Carreno T. Pediatric apps: what are they for? A scoping review. Eur J Pediatr. 2022;181(4):1321-1327.9. Heneghan MB, Hussain T, Barrera L, et al. Access to Technology and Preferences for an mHealth Intervention to Promote Medication Adherence in Pediatric Acute Lymphoblastic Leukemia: Approach Leveraging Behavior Change Techniques. J Med Internet Res. 2021;23(2):e24893.10. Semerci R, Akgun Kostak M, Taskin C. The effect of using an interactive mobile application for the management of chemotherapy-induced nausea and vomiting in children: Randomized controlled study. Eur J Oncol Nurs. 2022;58:102121.

Stevens–Johnson syndrome (SJS) with respiratory distress can lead to fatal outcomes. However, there are a few reports of drug-induced lung injury with diffuse alveolar damage caused by acetaminophen, the most severe type. Here, we describe a fatal case of acetaminophen-induced SJS in a child with irreversible lung lesions.

Anti-glutamic acid decarboxylase(Anti-GAD) are associated with various neurologic condition; but, no meningitis has been reported with it, so far. Evidence demonstrates the associated of autoimmune meningoencephalitis with Covid-19 infection. Here we report a 44-year-old female with progressive loss of consciousness with anti-GAD65 meningoencephalitis after Covid-19 infection.

In the last few decades, Silchar city and its surrounding areas have witnessed massive population growth due to local and migrated peoples, which led to the rapid transformation of its land use/land cover (LU/LC) pattern. For detailed micro-level LU/LC analysis, very high-resolution satellite data (VHRS) and on-screen visual interpretation techniques were used. The LU/LC classification of the city has been prepared for 2005, 2011 and 2018 with five major and further seventeen sub-classes. The wards of the city were classified into five zones and the Shannon entropy model applied to analyze the degree and trends of urban built-up development. The obtained results indicate that the Silchar city is compact near the center which follows the infill built-up growth trend. However, as the distance has increased from its center the scattering with infill growth pattern was observed. The accuracy assessment techniques are used to validate the results of the classification. The results of this study can provide detailed information for land-use planners, researchers, policy-decision makers, and municipal authorities.

The synergistic combination of carbon nanotubes (CNTs) and ductile thermoplastic resin has shown large potential in the improvement of fracture resistance for the epoxy matrix composites using the interleaving toughening method in recent years. The hybrid structure of CNTs and thermoplastic resin in interlayers affects directly the interlaminar structure and the resultant crack propagation path of the interleaved composites. In this work, the CNTs and thermoplastic polyetherketone-cardo (PEK-C) were used to prepare the interlayer with different hybrid structures to interleave the carbon fiber reinforced epoxy composites and the influence of hybrid structure on the interlaminar structure and the fracture toughness was investigated. The results showed that PEK-C/CNT/PEK-C sandwich interlayer produced the best toughening effect in mode I interlaminar fracture toughness (GIC) and the GIC was 446.76 J/m 2, increased by 138.11% compared to blank composites, which benefited from the multilayered structure in the interlaminar region formed during curing process and the resultant tortuous crack propagation.

In this paper we study the existence of a Nash-type equlibrium for a non-potential nonlinear system by combining variational methods with the monotonicity approach. The advance over existing research is that we can consider systems of Dirichlet problems in which the operator is not necessarily linear.

Abstract: In this paper, the nonlinear Schrödinger-type equation −(∇ + iA) ^2 u + u + λ[I_α*(K|u|^2)]Ku=af(|u|)u/|u| in R ^3 is considered in the presence of magnetic field, where A ∈ C ^1 (R ^3 ,R^ 3 ), α ∈ (0,3), I_α denotes the Riesz potential, K ∈ L^ p (R ^3 ,(0,∞)) for some p ∈ (6/(1 + α),∞], a ∈ L^ q (R 3 ,[0,∞)) \ {0} for some q ∈ (3/2,∞], and f ∈ C(R,[0,∞)) is assumed to be asymptotically linear at infinity. Under suitable assumptions regarding A, K, a, and f, variational methods are used to establish the existence of ground-state solutions of the above equation for sufficiently small values of the parameter λ.