Calcineurin inhibitors (CNI), cyclosporine and tacrolimus, are commonly used for pharmacotherapeutic prophylaxis of Graft-vs.-Host disease after hematopoietic cell transplantation (HCT). Unfortunately, their use is associated with significant toxicities. While intolerance to CNI is well defined, there is very little data on how they impact outcomes after HCT in children. Our retrospective study in a cohort of 82 children, shows a high intolerance rate of 39% in this population associated with lower event free survival and a higher transplant-related mortality.

The rise of deepfakes and AI-generated images has raised concerns regarding their potential misuse in society. However, this commentary highlights the valuable opportunities these technologies offer for neuroscience research. Deepfakes provide accessible, realistic, and customisable dynamic face stimuli, while generative adversarial networks (GANs) can generate and modify diverse and high-quality static content. These advancements enhance the variability and ecological validity of research methods, and enable the creation of previously unattainable stimuli. When AI-generated images are informed by brain responses, they provide unique insights into the structure and function of visual systems. The authors encourage experimental psychologists and cognitive neuroscientists to stay informed about these emerging tools and embrace their potential to advance visual neuroscience.

INTRODUCTIONSchizencephaly is an uncommon anomaly of the brain characterized by abnormal gray matter lined clefts extending from the ependymal surface of the ventricle to the subarachnoid space. There are two distinct subtypes. Cleft with fused lips is a type 1 or closed type whereas unopposed lips allowing communication of the cleft to the ipsilateral ventricle is an open type.[1] Although the exact cause of this disorder is uncertain, diverse theories have been put forward to establish a definite underlying etiology. A defect in neuronal migration[2] or some form of molecular genetic abnormalities such as mutation in EMX2 [1], SHH and SIX 3 gene [3] , intrauterine infections[4] are few of the probable causes advocated in literature. MRI is the best suited imaging modality for diagnostic evaluations owing to its superiority in gray and white matter distinction, and hence distinguishing the entity from porencephaly or any other post infectious, postoperative or post necrotic lesions.[2][5]

A document by Tatsuya Horibe. Click on the document to view its contents.

Heterotaxy pattern associated with Sinus Node Dysfunction in an adult: A case report.Authors : Naman Shah MBBS1, Sankalp Acharya2, Apoorva Tripathi MBBS2, Himanshi Bisht MBBS2,Maitri Shah MBBS1, Aayushi Pareek MBBS3, Asmit Gera MBBS4, Abhigan Babu Shrestha, MBBS5, Vikash Jaiswal MD61. GMERS Medical college Sola, Ahmedabad, India2. B. J. Medical College, Ahmedabad, India3. RHUS College of Medical Science, Jaipur, Rajasthan4. JCCR Cardiology Research, Varanasi, India5. M Abdur Rahim Medical College, Dinajpur, Bangladesh6. AMA School of Medicine, Makati, Philippines

The study’s foundation is a scenario analysis of a textile mill’s weaving department, with the goal of determining the necessity of a reliable and comprehensive plan for scheduling maintenance time. According to the background information and problem statement, incidents of Run failure maintenance and lengthy downtime (up to 60 days) undermine the machines’ availability (Schmidt, Galar & Wang, 2016).The desired efficiency and production are 90% and 194.76 m, respectively, however, the preliminary result indicate less. This indicates a gap that must be closed by implementing regular and appropriate maintenance plans. Additionally, the the incoherent and inconsistencies points at a lack of an efficient maintenance plan. It was established that the current strategy is not optimized and does not ensure machine availability because there are disparities and irregularities in the maintenance of crucial equipment. The objective of the study was to map out the critical equipment and collect data on the number and time between failures encountered in the weaving section of the textile manufacturing processes. Failure mode and effect analysis and fish-bone diagram were used in the analysis of the data. Mapping results indicates downtime up to 60 days, the productivity was estimated at 194.76 meters, and efficiency was 90%. The results showed that weaving looms were the essential piece of machinery.

Introduction Viral infections are associated with pulmonary exacerbations in children with Cystic Fibrosis (cwCF), but after 3 years of SARS-CoV-2 pandemic, whether cwCF are at higher risk of developing COVID-19 or its adverse consequences remains controversial. Methods We conducted an observational, multicenter, cross-sectional study of cwCF infected by SARS-CoV-2 between March 2020 and June 2022, (1 st to 6 th COVID-19 pandemic waves) in Spain. The study aimed to describe patients’ basal characteristics, SARS-CoV-2 clinical manifestations and outcomes, and whether there were differences across the pandemic waves. Results During study time, 351 SARS-CoV2 infections were reported among 341 cwCF. Median age was 8.5 years (range 0-17) and 51% were female. Cases were unevenly distributed across the pandemic, with most cases (82%) clustered between November 2021 and June 2022 (6 th wave, also known as Omicron Wave due to the higher prevalence of this strain in that period in Spain). Most cwCF were asymptomatic (24.8%) or presented with mild Covid-19 symptoms (72.9%). Among symptomatic, most prevalent symptoms were fever (62%) and increased cough (53%). No multisystem inflammatory syndrome (MIS-C), persisting symptoms, long-term sequelae or deaths were reported. Conclusions Spanish current data indicate that cwCF do not experience higher risks of SARS-CoV-2 infection nor worse health outcomes or sequelae. Changes in patients’ basal characteristics, clinical courses and outcomes were detected across waves. While the pandemic continues, and new SARS-CoV-2 variants are being identified, a worldwide monitoring of COVID-19 in pediatric CF patients is needed.

Objective: To evaluate the frequency and burden of disease of SARS-CoV-2 and other respiratory viruses in children under the age of 2 months. Methods: A retrospective, cross-sectional, single-center study was conducted between March 2021, and February 2022. All children under the age of 2 months and tested for SARS-CoV-2 were included. The frequency of SARS-CoV-2, of other respiratory viruses and the burden of disease caused by SARS-CoV-2 and other respiratory viruses were evaluated. Results: 727 children with an RT-PCR test for SARS-CoV-2 were included (mean age: 0.9 months (±0.6); boys: 57%); 514 (71%) in the emergency room and 213 (29%) in hospital. Among them, 62 (8.5%) had a positive RT-PCR test for SARS-CoV-2, more often in the Omicron period (23%) than in the Alpha period (4%). Of the 565 (78%) with a multiplex RT-PCR test for other viruses, 325 (58%) were positive. Children with a positive SARS-CoV-2 were less likely to have required respiratory support (p=.001), enteral nutrition (p=.03), or intensive care admission (p=.01) and had a shorter hospital stay than children with other respiratory viruses (5d vs. 7d, p=.007). Conclusion: In this young population of children, SARS-CoV-2 infection was less frequent and less severe than other viral respiratory infections.

INTRODUCTIONMerkel Cell Carcinoma (MCC) is a rare, life-threatening tumor with neuroendocrine features. Due of its extremely low occurrence worldwide, epidemiological data on the disease is limited. (1). Commonly recognized risk factors include fair skin, history of skin cancer, old age, chronic immunosuppression, chronic ultraviolet (UV) light exposure, and Merkel cell polyomavirus (MCPyV) infection (2). Amongst these factors, MCPyV and UV exposure play a fundamental role with synergistic effects in the pathophysiology of MCC (3). Despite being a part of normal skin flora in most individuals, MCPyV DNA can clonally combine with the genome of neoplastic cell precursors at the initial phases of carcinogenesis (4, 5). Concurrently, UV exposure elicits antigen-presenting dendritic cells to produce inflammatory cytokines, leading to local immunosuppression and creating an ideal environment for tumoral growth (6). Moreover, immune hypersensitivity from UV exposure facilitates the viral tumorigenic process (2).Merkel cells cannot be derived from the MCC because they lack the ability to proliferate. Merkel cell precursors (perhaps generated from epidermal stem cells or hair follicle stem cells) and pre- and pro-B cells appear to have histopathology, genetics, and molecular characteristics with malignant cells instead (7).MCC often presents as a single, asymptomatic erythematous or violaceous nodule, often mistaken for cysts or abscesses. It usually originates from the head or neck and generally spares the extremities (8). Immunohistochemical (IHC) staining is required to validate histopathological findings of small round cells that infiltrate cutaneous or subcutaneous area. (7). Although MCC responds to the combination of excisional surgery, radiotherapy, and chemotherapy, it requires continuous follow-ups within the first year of diagnosis due to the high recurrence rate (9).Here, we present a 32-year-old Iranian (non-Caucasian) immunocompetent female with a small nodule on her left arm at the disease onset finally diagnosed as MCC. In this report, we aim to emphasize the significance of early diagnosis and management of this cancer and highlight the complications that a late diagnosis would entail for these patients.

Less Invasive Surfactant Administration (LISA) is a growing method for treatment of respiratory distress syndrome. Although it has become standard of care in parts of Europe[1], its adoption in North America remains slow[2], but with increased interest. Many centers are developing their own guidelines and procedures[3, 4]. This study in Pediatric Pulmonology directly compares two different techniques for administration of surfactant via thin catheter (LISA). Studies like this highlight the importance of fine-tuning techniques for common procedures using an evidence-based approach; allowing new therapies to reach our patient population.Prospective trials of LISA were first performed by Verder et all[5]. A thin, flexible catheter is guided into the trachea and surfactant is administered. The thin catheter does not occlude the airway, allowing the infant to remain on non-invasive respiratory support. While comparable to Intubate-Surfactant-Extubate (INSURE), the use of an endotracheal tube occludes the infant’s airway and nessecitates the use of positive pressure ventilation (PPV). The avoidance of PPV prevents volutrauma and the subsequent inflammatory cascade that is associated with chronic lung disease of prematurity or bronchopulmonary dysplasia[6, 7]. Randomized control trials and subsequent meta-analyses demonstrated that LISA reduced rates of bronchopulmonary dysplasia and death compared to the CPAP, surfactant and mechanical ventilation and the standard of care, INSURE [8-11].Thin catheter administration of surfactant is one of the most popular ways to administer surfactant. Two main techniques have emerged over the past decade. Both techniques require direct visualization of the airway. The first technique is insertion of a rigid catheter (such as the off-label use of an Angiocath) using direct manipulation. The second technique involves the use of Magill forceps to guide a more flexible catheter (such as a feeding tube) into the airway for instillation of surfactant. Both techniques require a highly skilled operator who is familiar with direct visualization of the airway. The study shared in this issue of Pediatric Pulmonology compares the two techniques and demonstrated decreased time to placement and increased success at first attempt with a rigid vs. soft catheter. As this practice was refined most institutions have reappropriated instruments and devices intended for another purpose to successfully implement this practice. Quality improvement initiatives have been helpful in streamlining this process and guiding implementation at individual institutions [3]. It is important for each institution to identify the target patient population, standardize the instruments used for the procedure, and adequately train staff on the procedure.In recent years, some manufacturers have recognized the need for specialized equipment for this procedure. There are three devices that have been specifically designed for surfactant administration, including Surfcath™ (Vygon, Ecouen, France), LISAcath® (Chiesi, Parma, Italy), and Neofact® (Lyomark Pharma, Oberhaching, Germany). Surfcath™ has added benefits over an Angiocath, including a centimeter marking to guide insertion. The distal tip of the device is a blunt black tip of 2 cm, bent at 30 degrees which allows ease of use for insertion. It can be manipulated into the desired shape more easily than an Angiocath. LISAcath® is very similar including a rounded, soft tip at the distal edge and printed markings on the outer surface. One multi-center study surveyed neonatologists and found that they preferred the LISAcath® for ease of use and safety compared to an Angiocath[12]. LISAcath® is currently no longer being produced. Neofact® is an application device with a tracheal catheter. It has an angled applicator tip which allows for positioning directly in front of the glottis. This facilitates the use of a flexible catheter without the use of Magill forceps. This device was studied in a feasibility study and found to be successful in 19 of 20 infants, with a median of 2 attempts[13]. These devices are not available for use in the United States at the time of this publication.Ultimately, direct laryngoscopy remains a noxious procedure for neonates despite incremental improvements over intubation. Alternative approaches continue to be tested including techniques such as surfactant administration via laryngeal or supraglottic airways. These techniques allow for administration of surfactant without direct visualization of the airway. This could be especially helpful in settings where a provider skilled in airway manipulation is not available[14]. Meanwhile, the search for a nebulized surfactant product with similar efficacy continues as a method for truly non-invasive surfactant administration to treat respiratory distress syndrome.1. Klotz, D., et al., European perspective on less invasive surfactant administration—a survey. European journal of pediatrics, 2017. 176 : p. 147-154.2. Kurepa, D., et al., The use of less invasive surfactant administration (LISA) in the United States with review of the literature. Journal of Perinatology, 2019. 39 (3): p. 426-432.3. Conlon, S.M., et al., Introducing less-invasive surfactant administration into a level IV NICU: a quality improvement initiative.Children, 2021. 8 (7): p. 580.4. Williamson, S.L., H. McDermott, and H. Gowda, Implementing less invasive surfactant administration on a neonatal unit. Archives of Disease in Childhood-Education and Practice, 2022. 107 (4): p. 298-301.5. Verder, H., et al., Surfactant treatment of newborn infants with respiratory distress syndrome primarily treated with nasal continuous positive air pressure. A pilot study. Ugeskrift for laeger, 1992. 154 (31): p. 2136-2139.6. Keszler, M. and G. Sant’Anna, Mechanical ventilation and bronchopulmonary dysplasia. Clinics in perinatology, 2015.42 (4): p. 781-796.7. Walsh, M.C., et al., Impact of a physiologic definition on bronchopulmonary dysplasia rates. Pediatrics, 2004. 114 (5): p. 1305-1311.8. Rigo, V., C. Lefebvre, and I. Broux, Surfactant instillation in spontaneously breathing preterm infants: a systematic review and meta-analysis. European journal of pediatrics, 2016. 175 : p. 1933-1942.9. Mehler, K., et al., Developmental outcome of extremely preterm infants is improved after less invasive surfactant application: developmental outcome after LISA. Acta Paediatrica, 2021.110 (3): p. 818-825.10. Göpel, W., et al., Less invasive surfactant administration is associated with improved pulmonary outcomes in spontaneously breathing preterm infants. Acta paediatrica, 2015. 104 (3): p. 241-246.11. Göpel, W., et al., Avoidance of mechanical ventilation by surfactant treatment of spontaneously breathing preterm infants (AMV): an open-label, randomised, controlled trial. The Lancet, 2011.378 (9803): p. 1627-1634.12. Fabbri, L., et al., Five‐country manikin study found that neonatologists preferred using the LISA cath rather than the Angiocath for less invasive surfactant administration. Acta Paediatrica, 2018.107 (5): p. 780-783.13. Maiwald, C.A., et al., Clinical evaluation of an application aid for less-invasive surfactant administration (LISA). Archives of Disease in Childhood-Fetal and Neonatal Edition, 2021. 106 (2): p. 211-214.14. Zapata, H.A., et al., Surfactant administration through laryngeal or supraglottic airways (SALSA): A viable method for low-income and middle-income countries. Frontiers in Pediatrics, 2022.10 .

Summary — Large Low Earth Orbit satellite constellations require Machine Learning methods for enabling autonomy in health keeping of the satellites. Autonomy in health keeping entail’s fault detection, isolation and reconfiguration. However, prior to building model building, it becomes imperative to conduct Exploratory Data Analysis of the data to gain an intuition of data and to decide the best model. Univariate Exploratory data analysis has been carried out on a BUS CURRENT sensor of Electrical Power System of a Low Earth Orbit Satellite to gain an understanding of data. Various aspects of data like presence of outliers, sampling frequency, missing values, comparison of imputation methods to fill missing values seasonality and trend analysis, stationarity test on data, rolling mean, and auto correlation and partial auto correlation plots have been made and a detailed statistical analysis of results has been conducted.

Two-dimensional (2D) membranes have demonstrated potential for molecular separation; however, their applicability for Li/Mg ion separation has been restricted by their negatively-charged and easily-swellable properties in water. Moreover, their practical application has been hindered by the challenge of producing significant quantities of single-layer nanosheets. To overcome these challenges, we have developed a scalable method for synthesizing micro-sized nitrate ZnAl layered double hydroxide (LDH) and subsequent exfoliating to yield monolayer nanosheets for the construction of 2D membranes. The sub-nanometer channels of the LDH membrane is positively charged, which prevents the passage of magnesium ions. These channels also impede the flow of magnesium ions that are more difficult to dehydrate. As a result, the LDH membranes exhibit robust lithium-magnesium separation ability, with a separation ratio of 6 (Li/Mg). This work provides a method for producing high-quality LDH nanosheets and validates the enormous potential of LDH membranes in the field of lithium-magnesium separation.

Three oleogeletors molecules (Triacontane (TC), Stearic acid (SA), and Behenyl Lignocerate (BL)) were studied individually, in pairs, or all together to make an oleogel using triolein as the oil. WAXS, SAXS and USAXS were used to elucidate the solid structures from angstroms to a few micrometers. A two-dimensional mapping of atomic positions for each molecule was carried out to understand the crystalline multilayer structures formed. We assumed that the molecules were rigidly extended and that they underwent no significant (hindered) rotations so that the free energy is determined by the Lennard-Jones interactions of closely-packed multilayers. TC molecules were predicted to form a tilt angle of θt ≈ 33°, yielding a SAXS line at q≈ 0.194 Å-1, in acceptable agreement with the measured q=0.181 Å-1.For SA crystals θt ≈ 33° (predicted) yielding a SAXS line at q=0.150 Å-1 compared to q=0.159 Å -1 (observed). No mixed crystals were observed for any pair of molecules or when all three were used. USAXS data showed that SA forms large nanocrystals compared to TC and BL. All three combinations of molecular pairs showed basic scatterers smaller or similar to those of individual molecules. The theory presented here, together with the experimental results, showed why no mixed crystals are formed from two or all three molecules. Data from the USAXS region suggested that, when using all three molecules, a more compact fractal structure was obtained, compared with those if one or two of the molecules were used.

Excess nitrate and sediment, mobilized by precipitation events and transported into surface waters, is a global water quality challenge. Recent advances in high frequency, in-situ water quality monitoring sensors have created opportunities to investigate constituent concentration dynamics during short-term hydrological changes. In this study, we characterized the event-scale variability of nitrate ( NO 3 -   ) and turbidity (a surrogate for sediment transport) in two large agricultural watersheds of the Upper Mississippi River Basin using hysteresis loop characteristics to determine sources and dominant transport mechanisms. We then applied factor analysis to detect variable groupings and thus determine controls on nitrate and sediment dynamics. We found that NO 3 -   hysteresis behavior was consistent between the two watersheds and demonstrated distal contributions and/or late-event mobilization and flushing that was controlled by the characteristics of the event hydrology (such as, event duration and magnitude of event discharge). In contrast, turbidity hysteresis loops indicated sediment delivery differed between the two watersheds; the smaller watershed with more diverse land use demonstrated consistent early-event flushing or rapidly responding pathways whereas the larger, more agricultural watershed showed variability between dilution vs. flushing as well as delivery pathways between events. This dynamic behavior as well as the magnitude of the hysteretic response was principally related to the time lag between turbidity and discharge peaks for the smaller site, and to the event peak discharge and subsequent stream erosive power at the larger site that switched behavior. This result is critical for watershed water quality management especially in the context of a changing climate and further underscores the utility of high-frequency sensors monitoring data to offer deep insights into hydrological processes controls on contaminant transport and delivery.

Omicron BF.7 became the predominant SARS-CoV-2 variant in Beijing after the adjustment of COVID-19 response strategies in December 2022. The ability of antibodies elicited by BF.7 infection to cross-react with SARS-CoV-2-like viruses is unknown. This study aimed to investigate the cross-reactive neutralizing antibodies against SARS-CoV-2-related pangolin coronavirus GX_P2V in sera from vaccinated and/or SARS-CoV-2 infected individuals. All vaccinated individuals who recovered from Omicron BF.7 breakthrough infections exhibited substantially higher levels of neutralizing antibodies against GX_P2V among collected subject populations (geometric mean titer [GMT] = 362). Uninfected individuals who received four-mixed-dose vaccines also demonstrated higher levels of neutralizing antibodies (GMT = 44) against GX_P2V than those who received two- or three-dose vaccines and those who recovered from wild type SARS-CoV-2. This finding highlights the significance of prior and hybrid booster vaccinations with wild-type SARS-CoV-2 vaccines in generating potent cross-protective immunity against future spillovers of SARS-CoV-2-like viruses.

Severe fever with thrombocytopaenia syndrome virus (SFTSV) and Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) can cause the hyperproduction of inflammatory cytokines, which have pathological effects in patient including severe or fatal cytokine storms. To characterize the effect of SFTSV and SARS-CoV-2 infection on the production of cytokines in SFTS and COVID-19 patients, we performed an analysis of cytokines in SFTS and COVID-19 patients and also investigated the role of IL-10 in vitro studies: LPS-induced THP-1-derived macrophages, SFTSV infection of THP-1 cells, and SARS-CoV-2 infection of THP-1 cells. In this study, we found that levels of both IL-10 and IL-6 were significantly elevated, the level of TGF-β was significantly decreased and IL-10 was elevated earlier than IL-6 in severe and critical COVID-19 and fatal SFTS patients, and inhibition of IL-10 signalling decreased the production of IL-6 and elevated that of TGF-β. Therefore, the hyperproduction of IL-10 and IL-6 and the low production of TGF-β have been linked to cytokine storm-induced mortality in fatal SFTS and severe and critically ill COVID-19 patients and that IL-10 can play an important role in the host immune response to severe and critical SARS-CoV-2 and fatal SFTSV infection.

Introduction: The advancement of artificial intelligence (AI) has aided clinicians in the interpretation of electrocardiograms (ECGs) serving as an essential tool to provide rapid triage and care. However, in some cases, AI can misinterpret an ECG and may mislead the interpreting physician. Therefore, we aimed to describe the rate of ECG misinterpretation and its potential clinical impact in patient’s management. Methods: We performed a retrospective descriptive analysis of misinterpreted ECGs and its clinical impact from May 28, 2020 to May 9, 2021. An electrophysiologist screened ECGs with confirmed diagnosis of atrial fibrillation (AF), sinus tachycardia (ST), sinus bradycardia (SB), intraventricular conduction delay (IVCD), and premature atrial contraction (PAC) that were performed in the emergency department. We then classified the misinterpreted ECGs as pseudo-AF, ST, SB, IVCD, or PAC into the correct diagnosis and reviewed the misinterpreted ECGs and medical records to evaluate inappropriate use of antiarrhythmic drugs (AAD), beta-blockers (BB), calcium channel blockers (CCB), anticoagulation, or resource utilization of cardiology and/or electrophysiology (EP) consultation. Results: A total of 4,969 ECGs were screened with diagnoses of AF (2,282), IVCD (296), PAC (972), SB (895), and ST (638). Among these, 101 ECGs (2.0%) were misinterpreted. Pseudo-AF (58.4%) was the most common followed by pseudo-PAC (14.9%), pseudo-ST (12.9%), pseudo-IVCD (7.9%) and pseudo-SB (6.0%). Patients with misinterpreted ECGs were aged 76.6±11.6yr with male (52.5%) predominance and hypertension being the most prevalent (83.2%) comorbid condition. The misinterpretation of ECGs led to the inappropriate use of BB (19.8%), CCB (5.0%), AAD therapy (7.9%), anticoagulation (6.9%) in patients with pseudo-AF, as well as inappropriate resource utilization including cardiology (41.6%) and EP (8.9%) consultations. Conclusions: Misinterpretation of ECGs may lead to inappropriate medical therapies and increased resource utilization. Therefore, it is essential to encourage physicians to carefully examine AI interpreted ECG’s, especially those interpreted as having AF.

The paper focuses on the problem of formal synthesis of controllers for control-affine nonlinear systems against complex properties. Our goal is to design a closed-form control policy that guarantees the satisfaction of complex properties that are expressed using ( ω)-regular languages and equivalently recognized by Non-deterministic Büchi Automata (NBA). We propose leveraging a funnel-based control approach to provide a closed-form solution to the problem. Our approach decomposes the specification represented by NBA into a sequence of reachability problems which we solve using a funnel-based control approach. Controllers associated with each reachability problem are then combined to design a hybrid control policy enforcing the desired ( ω)-regular property. We demonstrate the effectiveness of the proposed results on room temperature control and mobile robot motion control case studies.