A middle-aged woman with history of the administration of COVID-19 vaccine and valve replacement surgery before her symptoms, was admitted with bilateral palpable purpuric lesions in the lower extremities and headache . Based on the initial diagnosis of vasculitis , corticosteroid therapy was initiated and resolved the skin lesion

Aim: The aim of this study was to describe the experiences of parents handling oral anticancer drugs in a home setting. Methods: Parents of children with cancer were recruited from a pediatric oncology ward in Sweden to participate in an interview. The interviews were transcribed verbatim and subjected to qualitative content analysis. Results: We found the following categories and subcategories: parents’ views on the provided information - lack of, too little or contradictory information, and parents’ preferences for information delivery; safety over time; correct drug dose; and drug administration. As time passed, most parents adapted to their child’s illness, felt safer, and found it easier to take in and process any given information. Parents preferred information in different formats (written, movie clips and orally) and in their mother tongue. Many parents were aware of the importance of giving an accurate dose to their child and described the process of drug administration as overwhelming. Conclusions: Parents need to be provided with accurate, timely, nonconflicting and repeated information – in different forms and in their mother tongue – on how to handle oral anticancer drugs at home.

Malignant melanoma presenting as an inflammatory skin metastasis has been described but is an exceedingly rare phenomenon. We report a case of inflammatory metastasis of cutaneous melanoma (CM)

Fat necrosis (FN) is an uncommon etiology of panniculitis. It is mainly caused by trauma and may be associated to other conditions such as pancreatic disease. We report an interesting case of subcutaneous FN caused by intramuscular injections of cefazolin and meglumine antimoniate in a 38-year-old female patient.

Objective: To compare the incidences of early and late onset neonatal sepsis, including group B streptococcus (GBS) and Escherichia coli (E.coli) before and after implementation of universal screening. Design: Retrospective cohort study Setting: Eight public hospitals with obstetrics services under the Hospital Authority and 31 Maternal and Child Health Centres (MCHC) under the Department of Health in Hong Kong Population: 460552 women attending routine antenatal service from 2009 to 2020. Methods: Universal culture-based GBS screening was offered to eligible women since 2012. Total maternity, births, GBS screening tests, GBS isolated in maternal genital tract, neonatal sepsis with positive blood or cerebrospinal fluid were retrieved from clinical and laboratory database of the Hospital Authority using clinical data analysis and reporting system (CDARS) and clinical system of MCHCs. Main outcome measures: Maternal GBS colonisation rate, early onset GBS disease, early onset E. coli infection, late onset GBS disease, and late onset E. coli infection Results: Of 318740 women with universal culture-based screening, 63767 women (20.0%) were screened positive. After implementation of GBS screening, the incidences of both early and late onset neonatal sepsis reduced significantly, including those caused by GBS. There was no change in the incidence of early onset E.coli sepsis, while the incidence of late onset E.coli sepsis reduced. Conclusions: Universal culture-based GBS screening in Hong Kong has been successful in prevention of early and late onset neonatal sepsis, including those caused by GBS. E.coli has become more common than GBS in early neonatal sepsis, although the incidence remained similar.

Although the use and development of molecular biomonitoring tools based on eNAs (environmental nucleic acids; eDNA and eRNA) have gained broad interest for the quantification of biodiversity in natural ecosystems, studies investigating the impact of site-specific physicochemical parameters on eNA-based detection methods (particularly eRNA) remain scarce. Here, we used a controlled laboratory microcosm experiment to comparatively assess the environmental degradation of eDNA and eRNA across an acid-base gradient following complete removal of the progenitor organism (Daphnia pulex). Using water samples collected over a 30-day period, eDNA and eRNA copy numbers were quantified using a droplet digital PCR (ddPCR) assay targeting the mitochondrial cytochrome c oxidase subunit I (COI) gene of D. pulex. We found that eRNA decayed more rapidly than eDNA at all pH conditions tested, with detectability—predicted by an exponential decay model—for up to 57 hours (eRNA; neutral pH) and 143 days (eDNA; acidic pH) post organismal removal. Decay rates for eDNA were significantly higher in neutral and alkaline conditions than in acidic conditions, while decay rates for eRNA did not differ significantly among pH levels. Collectively, our findings provide the basis for a predictive framework assessing the persistence and degradation dynamics of eRNA and eDNA across a range of ecologically relevant pH conditions, establish the potential for eRNA to be used in spatially and temporally sensitive biomonitoring studies (as it is detectable across a range of pH levels), and may be used to inform future sampling strategies in aquatic habitats.

While many structural damage detection methods have been developed in recent decades, few data-driven methods in unsupervised learning mode have been developed to solve the practical difficulties in data acquisition for civil infrastructures in different scenarios. To address such a challenge, this paper proposes a number of improved unsupervised novelty detection methods and conducts extensive comparative studies on a laboratory scale steel bridge to examine their performances of damage detection. The key concept behind unsupervised novelty detection in this paper is that only normal data from undamaged structural scenarios are required to train statistical models with these methods. Then, these trained models are used to identify abnormal testing data from damaged scenarios. To detect structural damage in the form of loosening bolts in the steel bridge, four machine-learning methods (i.e., K-nearest neighbors method, Gaussian mixture models, One-class support vector machines, Density peaks-based fast clustering method) and one deep learning method using a deep auto-encoder are selected. Meanwhile, some modifications and improvements are made to enable these methods to detect structural damage in unsupervised novelty detection mode. In their comparative studies, the advantages and disadvantages of these methods are analyzed based on their results of structural damage detection.

‎We carry out the classification of abelian Lie symmetry algebras of‎ ‎two-dimensional second-order nondegenerate quasilinear evolution equations‎. ‎It is shown that such an equation is linearizable if it admits an abelian Lie symmetry algebra that is of dimension greater‎ ‎than or equal to five or of dimension greater than or equal to three with rank one.

Evapotranspiration (ET) constitutes the largest loss of water from subtropical grassland and wetland ecosystems, yet data in much of the world have high uncertainty at the landscape scale as there is little information on plant water use. Additionally, anthropogenic alterations to grasslands are a major threat globally and alter ecosystem water use, but the impact of these changes is often unquantified. A major reason for this is the complexity and expense of field-based ET quantification methods such as agricultural lysimeters and eddy covariance systems. Accurate measurements of ET are critical for sustainable water management. This study developed two different low-cost lysimeters – weighing-type and water level based, to measure ET under controlled conditions for single species as well as mixed grassland and wetland communities. Lysimeters were placed in an open sided shadehouse with a transparent roof to exclude rainfall. ET values were then compared with (i) Actual ET measurements from an eddy covariance tower onsite, (ii) vapor transport-based ET models – FAO Penman-, Modified Turc and Abtew Simple Radiation models, and (iii) ET data from the Florida Automated Weather Network. Both weighing-type and water level lysimeters showed seasonal patterns and annual magnitudes similar to the other ET methods. Annual ET measurements from weighing-type lysimeters (881-1278 mm for four plant species, n=5 per species, 20 in total) and water level lysimeters (1085 mm, plant community average, n = 31) were similar to model estimates (1000-1200mm). Actual ET from eddy covariance was 722 mm for ten months (missing data for February and March), while lysimeter measurements for the dominant grass Paspalum notatum was 885mm for the same 10 months. Low-cost lysimeters can inform regional ET models/remote sensing data lacking field validation and thus are potentially useful for water resources and ecosystem management in data-poor regions of the world.

The side effects of COVID-19 vaccination were mostly self-restricted local reactions that quickly resolved. Nevertheless, rare autoimmune hepatitis cases have been reported in some vaccinated individuals. This article presents a young man who developed fulminant hepatitis a few days after vaccination with the first dose of the AstraZeneca COVID-19 vaccine.

Spatially explicit population genetic models have long been developed, yet have rarely been used to test hypotheses about the spatial distribution of genetic diversity or the expected neutral levels of genetic divergence between populations. Here, we use spatially explicit coalescence simulations to explore the properties of the island model and the two-dimensional stepping stone model under a wide range of scenarios with spatio-temporal variation in deme size. We avoid the simulation of genetic data, using the fact that under the studied models, summary statistics of genetic diversity and divergence between demes can be approximated from coalescence times. We perform the simulations using gridCoal, a flexible spatial wrapper for the software msprime developed herein. In gridCoal, deme sizes can change arbitrarily across space and time, and migration rates between individual demes can be specified. We identify the different factors that can cause a deviation from the theoretical expectations, such as the simulation time in comparison to the effective deme size and the spatio-temporal autocorrelation across the grid. Our results highlight that Fst, a measure of the strength of population structure, principally depends on recent demography, which makes it robust to temporal variation in deme size. We also warn that predicting genetic diversity from coalescence times requires a much longer run time than needed for the estimation of Fst. Finally, we illustrate the use of gridCoal on a real-world example, the range expansion of silver fir (Abies alba Mill.) since the Last Glacial Maximum, using different degrees of spatio-temporal variation in deme size.

Understanding the factors affecting thermal tolerance is crucial for predicting the impact climate change will have on ectotherms. However, the role developmental plasticity plays in allowing populations to cope with thermal extremes is poorly understood. Here, we meta-analyse how thermal tolerance is acutely and persistently impacted by early thermal environments by using data from 150 experimental studies on 138 ectothermic species. Thermal tolerance only increased by 0.13°C per 1°C change in developmental temperature and substantial variation in plasticity (~36%) was the result of shared evolutionary history and species ecology. Aquatic ectotherms were more than three times as plastic as terrestrial ectotherms. Notably, embryos expressed weaker but more heterogenous plasticity than older life stages, with numerous responses appearing as non-adaptive. While we did not find universal evidence for developmental temperatures to have persistent effects on thermal tolerance, persistent effects were vastly under-studied, and their direction and magnitude varied with ontogeny. Embryonic stages may represent a critical window of vulnerability to changing environments and we urge researchers to consider early life stages when assessing the climate vulnerability of ectotherms. Overall, our synthesis suggests that developmental changes in thermal tolerance will rarely reach levels of perfect compensation and buffer ectotherms from rising temperatures.

There is an increasing use of left ventricular assist devices (LVADs) as bridge to transplantation or permanent destination therapy in the heart failure patient population. Infection remains a common complication in LVADs, with Gram-positive skin flora as predominant pathogens implicated, including Staphylococcus aureus. While there is emerging evidence for synergistic antibiotic combinations with methicillin resistant Staphylococcus aureus, there remains a significant gap in the literature for persistent methicillin susceptible Staphylococcus aureus (MSSA) bacteremia. In this article, we describe the first successful treatment of persistent LVAD-related bacteremia with salvage oxacillin plus ertapenem. The salvage therapy described here must be balanced by the risks for toxicity, impact on resistance, microbiota disruption, drug shortages, and patient costs. This combination warrants further evaluation in the clinical setting to better establish its role in our expanding patient population.

Hyalomma ticks are important vectors of Crimean-Congo Haemorrhagic Fever Virus (CCHFV) and other pathogens. They are frequently carried as immatures from Africa, the Middle East and Mediterranean areas to temperate Europe via migratory birds and emergence of its adults has been reported in many countries where it has so far been non-endemic. Our aim was to implement the first steps of the DAMA (Document, Assess, Monitor, Act) protocol by monitoring the potential arrival of adult Hyalomma ticks in Hungary applying citizen-science methods. Ticks were collected from April-December 2021 by asking volunteer participants through a self-made website to look for unusual hard ticks on themselves, their pets and livestock. Owing to the intensive media campaign, the project website had over 31 thousand visitors within seven months and 137 specimens and several hundreds of photos of hard ticks were submitted by citizen scientists from all over the country. Beside Ixodes ricinus, Dermacentor reticulatus, Dermacentor marginatus and Haemaphysalis inermis, a specimen from a dog was morphologically identified as a male Hyalomma marginatum and another removed from a cattle as a male Hyalomma rufipes. The dog and the cattle had never been abroad, they were approximately 280 km apart, thus the two Hyalomma observations can be considered as separate introductions. Amplification of the partial mitochondrial cytochrome C oxidase subunit I gene was successful for both specimens. Sequencing verified the previous morphological identification for both ticks. Based on the phylogenetic analyses the Hy. marginatum individual most likely belongs to the Eurasian population and the Hy. rufipes to a clade of mixed sequences from Europe and Africa. We summarize the scattered historical reports about the occurrence of Hyalomma ticks and CCHFV in Hungary. Our data highlight the effectiveness of citizens science programmes in the monitoring and risk assessment of CCHFV emergence and preparedness in our region.

A document by Aashish Kumar. Click on the document to view its contents.

The diagnosis of primary ciliary dyskinesia (PCD) is made through a combination of clinical features supported by a panel of diagnostic tests. Our cases highlight the similarities in the clinical presentation of patients with the specific immunodeficiency activated phosphatidylinositol 3-kinase delta syndrome 1 (APDS1 or PIK3CD) and PCD. We highlight the importance of repeating nasal nitric oxide testing (nNO) when PCD has not been confirmed by genetic or ciliary electron micrograph (EM) analysis in the setting of an expanded suppurative lung disease differential that includes considerations for immunodeficiency as well as PCD.

Key Points 1. This study reports clinical outcome data on 76 patients with platinum-resistant recurrent or metastatic head and neck squamous carcinoma treated with nivolumab, making it the largest published single centre case series of its kind. 2. Radiotherapy was administered alongside systemic therapy with nivolumab, defined as radiotherapy within 8 weeks of prior systemic therapy, in 16 of 76 patients (21%). 3. Nivolumab was continued following radiotherapy completion due to ongoing clinical benefit from the drug in 9 of 16 patients (56%). 4. Durable complete response following radio-immunotherapy was seen in 2 of the 9 patients (22%) who continued nivolumab subsequent to radiotherapy. 5. Indications for radiotherapy included symptom control (3 of 9), oligoprogression (5 of 9) and incomplete response (1 of 9).

Title: Looking for Lead Adhesions While Planning for Transvenous Lead ExtractionAuthor: Callahan, Thomas DAuthor Expanded:Thomas D. Callahan, IV, MD, FACC, FHRSDirector, Inpatient Inpatient ServiceAssociate Program Director, Cardiovascular Medicine FellowshipCleveland ClinicClinical Assistant Professor of MedicineCleveland Clinic Lerner College of MedicineCleveland [email protected] 216-444-2267Fax: 216-636-6953Corresponding Author: Thomas D. Callahan, IV, MD, FACC, FHRSFunding: NoneDisclosures:Thomas D. Callahan, IV, MD serves as a consultant to Biotronik. (modest)Key words:Transvenous lead extraction, TLE, adhesion, planning, predictionAcknowledgements: None