Background: Chronic spontaneous urticaria is well-described in adults, but less so in children. The aim of this study is to describe the demographics, clinical characteristics, comorbidities, and outcomes of children with chronic, spontaneous urticaria. Methods: This retrospective study followed children up to 18 years-old, diagnosed with chronic spontaneous urticaria, between the years 2002-2018 and treated in a tertiary referral allergy and clinical immunology center. Data including demographics, clinical characteristics, comorbidities, treatments and outcomes was extracted from electronic medical records. Results: Records of 380 children coded to have chronic urticaria were reviewed, of which 250 (65.8%) fulfilled the diagnostic criteria for chronic spontaneous urticaria. There were 136 females (54.4%). Mean age at diagnosis was 11.4 years, 122 (48%) were adolescents. The average duration of chronic spontaneous urticaria was 12.25±15.2 months. The urticaria in 208 children )83.2%) resolved within 24 months. Eighty-seven patients (34.8%) had at least one atopic disease. Atopic comorbidities included atopic dermatitis in 17.2%, allergic rhinitis in 16%, asthma in 13.2% and food allergy in 3.2%. Eighteen patients (7.2%) had a concomitant autoimmune disease. Nine (3.6%) had thyroid disease. Conclusions and clinical relevance: Chronic spontaneous urticaria in children is a self-limited disease with favorable prognosis. Atopic diseases are more prevalent in children with chronic spontaneous urticaria than in the general pediatric population; increasing the possibility of a special subgroup of TH2-related chronic urticaria in children.

Background: Selective IgM deficiency (sIgMD), classified under primary immunodeficiencies, is characterized by low serum IgM(<2SD for age), normal IgG and IgA levels. The aim of this study was to define immunologic and clinical features of sIgMD. Method: We assessed a retrospective medical record of patients who fullfilled the criteria for sIgMD in a Pediatric Immunology department. Results: There were 55 patients with sIgMD. Out of 55 patients, thirteen(23.6%) diagnosed with a well-defined primary immunodeficiency (PID) during the follow-up.The ratio of the sIgMD was %0.12 in the out-patient clinic of pediatric immunology. Out of 33 patients, 8(23.5%) were asymtomatic during the follow-up period. Fifteen(45.4%) patients presented with several type of infections). Six patients (18%) had chromosomal anomaly, or syndrome (trisomy 21, 22q11.2 deletion 1p deletion, CHARGE syndrome, and Cohen Syndrome). Six (18%) had autoimmune/inflammatory diseases, such as Behcet’s disease, immune thrombocytopenic purpura, Crohn disease, Guillain Barre syndrome, and diabetes mellitus. Five(15%) had allergic disorders. Three(9%) have developed malignancy. The diagnoses of thirteen PID patients were combined immunodeficiency, common variable immunodeficiency, autoimmune lymphoproliferative syndrome, chronic granulomatous disease, adenosine deaminase deficiency, and congenital neutropenia. Genetic disorders, autoimmune/inflammatory and allergic diseases may accompany sIgMD. Approximately one third of the patients were asymptomatic in our series. Malignancy risk is relatively increased. We observed that an important ratio of patients with low IgM (23.6%) got sooner the diagnosis of a specific PID in the follow-up period. Conclusion: Thus, patients with sIgMD should be followed regularly in immunology clinics.

We present a class of higher-dimensional Hilbert-type inequalities on a fractal set $(\mathbb{R}_+^{\alpha n})^{k}$. The crucial step in establishing our results are higher-dimensional spherical coordinates on a fractal space. Further, we impose the corresponding conditions under which the constants appearing in the established Hilbert-type inequalities are the best possible. As an application, our results are compared with the previous results known from the literature.

We report on pregnant woman affected by NF1 and HIV infection. So far, both NF1 and HIV in pregnancy had never reported. During 7-year follow-up, she experienced 4 pregnancies without any complication linked to NF1. The newborns were HIV-negative. A multidisciplinary counseling could improve ante and post-partum management.

For nearly all organisms, dispersal is a fundamental life history trait that can shape their ecology and evolution. Variation in dispersal capabilities within a species exists and can influence population genetic structure and ecological interactions. In fungus-gardening (attine) ants, co-dispersal of ants and mutualistic fungi is crucial to the success of this obligate symbiosis. Female-biased dispersal (and gene flow) may be favored in attines because virgin queens carry the responsibility of dispersing the fungi, but a paucity of research has made this conclusion difficult. Here, we investigate dispersal of the fungus-gardening ant Trachymyrmex septentrionalis using a combination of maternally- (mitochondrial DNA) and biparentally-inherited (microsatellites) markers. We found three distinct, spatially isolated mitochondrial DNA haplotypes. Two were found in the Florida panhandle and the other was found in the Florida peninsula. In contrast, biparental markers illustrated significant gene flow across this region and minimal spatial structure. The differential patterns uncovered from mitochondrial DNA and microsatellite markers suggest that most long-distance ant dispersal is male-biased and that females (and concomitantly the fungus) have more limited dispersal capabilities. Consequently, the limited female dispersal is likely an important bottleneck for the fungal symbiont. This bottleneck could slow fungal genetic diversification, which has significant implications for both ant hosts and fungal symbionts regarding population genetics, species distributions, adaptive responses to environmental change, and coevolutionary patterns.

Carcinoid disease is a rare neoplasm but it's an important etiology of intrinsic right heart valve disorders that leads to right heart failure. carcinoid heart involvement is a common complication of disease that effects on morbidity and mortality of the patient.

In this paper, a dynamic biomass gasification model was developed based on the hybrid peripheral fragmentation and shrinking-core (HPFS) model. To improve the accuracy of syngas generation transient prediction, the chemical kinetic model was trained using global surrogate optimization techniques. The pre-exponential factors of kinetic reactions are calibrated under non-catalytic conditions, employing experimental transient data of syngas generation rate and compositions under different temperatures and gasifying agents. The DYCORS and GOMORS were employed as the numerical solvers for finding the global optimum solution of the pre-exponential factors. The calibrated kinetic models based on both single-objective and multi-objective approaches have been validated by experimental data in four different biomass gasification scenarios. The calibrated kinetic model shows an over 95% decrease in terms of integrated squared error (ISE)-based model mismatch when compared to the original kinetic model.

Background and Purpose: Cigarette smoking (CS) is the major risk factor for developing COPD and related skeletal muscle dysfunction. It has been postulated that CS exposure may directly causes muscle dysfunction via the induction of oxidative stress. The present study examined the effect of a potent Nox inhibitor and ROS scavenger, apocynin on CS-induced muscle dysfunction. Experimental Approach: Male BALB/c mice were exposed to either room air (sham) or CS generated from 9 cigarettes per day, 5 days a week for 8 weeks with or without apocynin treatment (5 mg·kg-1 w/v, intraperitoneal injection). C2C12 myotubes exposed to either hydrogen peroxide (H2O2) or water-soluble cigarette smoke extract (CSE) with or without apocynin (500 nM), was set up as an experimental model in vitro. Key Results: Eight weeks of CS exposure caused significant lung inflammation and muscle dysfunction in mice; evidenced by a 10% loss in muscle mass and 54% loss in contractile function of tibialis anterior, attributable to altered myogenic homeostasis and protein oxidation. These effects were prevented by apocynin administration. In C2C12 myotubes, direct exposure to H2O2 or CSE caused myofiber wasting, which was associated with altered myogenic homeostasis marked by ~50% loss in muscle-derived insulin-like growth factor (IGF)-1 and 1.5-fold increase in myostatin expression. Apocynin treatment completely attenuated CSE-induced Nox2 expression, preserving muscle-derived IGF-1 expression and downstream mammalian target of rapamycin (mTOR) signaling pathway, thereby preventing myofiber wasting. Conclusion and Implications: Targeted pharmacological inhibition of Nox-derived ROS may alleviate the lung and systemic manifestations in smokers with COPD.

Aim: Aspects of parenting is an under-investigated topic among children with voiding complaints. We aimed to investigate the association between voiding complaints among children and two specific parenting related behaviors: 1) parental availability during the child’s leisure time and 2) frequency of witnessing interparental conflict. Material and Method: Children aged between 6 and 11 years with their parents were the participants. Two survey forms and informed consent form were sent to potential participants via children’s teacher. Voiding dysfunction complaints were evaluated with the Dysfunctional Voiding and Incontinence Symptom Scale (DVISS). Results: Data analyses were performed with 1101 eligible participants. Mean duration of parental availability during the child’s leisure time was below 2 hours per day. Nearly one out of every four children witnessed interparental conflict at least once a month. Age, educational level of the mother, parental availability for the child’s leisure time, and frequency of witnessing parental conflicts were found to be significantly associated with DVISS ratings. Adjusting age, socioeconomic level, and educational level of the parents and later adjusting parental availability during the child’s leisure time did not change the association of frequency of witnessing interparental conflict with DVISS rates. Increase in the age, educational level of the mother, and parental availability during the child’s leisure time were correlated with better scores on DVISS while increase in the frequency of witnessing interparental conflict strongly correlated with worse scores. Conclusion: Exposing children to interparental conflicts and shorter togetherness with their leisure time is associated with voiding complaints.

Abstract: Critical airway stenosis presents a challenge for surgeons and anesthesiologists alike in securing a reliable airway for adequate ventilation. The use of veno-venous (VV) extra-corporeal membrane oxygenation (ECMO) has been described as a strategy to provide adequate gas exchange in such instances. We present a case of a young female with a complex paratracheal mass significantly compressing the trachea in whom a planned intra-operative VV ECMO was instituted to allow safe oro-tracheal intubation of a double lumen endotracheal tube for lung isolation and tumor resection.

Objectives: In this paper we outline how inflammation related to oral disease such as periodontitis, bacteraemia and pulpal lesions have been linked to cardiovascular disease and undertake a systematic review of the literature focused on acute dental infection and cardiac arrhythmia. We also describe an illustrative case where an acute oral infection was associated with occurrence of new onset atrial fibrillation (AF). Methods: An electronic search was undertaken using MEDLINE and SCOPUS from 01 Jan 1970 until 30 June 2020. We also undertook manual searches using forward and backward citation chasing. Inclusion criteria were any primary research studies investigating symptomatic apical infections or dental abscess with outcomes of arrythmia. Results Over the last fifty years, only two low quality studies have been investigated this area. Our illustrative case involved a 58-year-old who was diagnosed with an acute dental infection from an upper canine tooth. The patient later developed tachycardia and new-onset AF. Conclusions: Based on the biological plausibility of a link between acute dental infection and arrythmia, together with the case report presented, it is evident that further study in this area is needed. If there are possible cardiovascular consequences for patients suffering acute dental infections, this has future implications for healthcare staff as they can integrate professional advice related to oral health and cardiovascular disease. Screening programmes situated in dental settings can also facilitate early intervention and prevention producing benefits not just for patients, but in savings to the health system.

BACKGROUND:There are studies reporting that uric acid elevation is a marker for hypoxemia and pulmonary hypertension secondary to some diseases. AIM: The aim of this study is to investigate the relationship between serum uric acid level and uric acid/creatinine ratio with COPD exacerbation, hypoxemia in exacerbation and development of cor pulmonale. METHODS: A total of 96 COPD patients who were admitted to Ondokuz Mayıs University Faculty of Medicine emergency department and Chest Diseases outpatient clinic and whose written consent was obtained, were included in our study. 43 of these patients were in the period of exacerbation (Group 1) and 53 were in the stable period (Group 2). Complete blood count, blood biochemistry (including serum uric acid level) and arterial blood gas analysis were performed in our patients. In addition, spirometry and echocardiography findings were examined. RESULTS: Serum uric acid level of Group 1 was 6.97 ± 1.34 and Group 2 was 4.30 ± 1.01 (p <0.05). Uric acid/creatinine ratios; in group 1; 8.00 ± 2.06, in group 2; It was 5.52 ± 1.57 (p <0.05). In patients with hypoxemia, serum uric acid level and uric acid / creatinine ratio were significantly higher than non-hypoxemic (p <0.05). Serum uric acid level and serum uric acid/creatinine ratio of Group 1 were significantly higher than Group 2 (p <0.001). Serum uric acid level and serum uric acid / creatinine ratio of patients who developed cor-pulmonale were significantly higher than patients without cor-pulmonale (p <0.05). CONCLUSION: Serum uric acid level and uric acid/creatinine ratio were found to be higher in patients with exacerbation of COPD and those developing cor pulmonale. Consequently, it suggests that serum uric acid level and serum uric acid/creatinine ratio may be a stimulating laboratory test for the severity of COPD and the development of COPD based cor pulmonale.

We examined whether the presence or absence of different environmental stressors influenced the reproductive potential of a saltmarsh species - Plantago maritima. We focused on total seed output, seed quality and biomass of progeny. So far, there are no studies trying to answer the question of how different saltmarsh management affects the quality of seed in saltmarsh species. For the purposes of the study, plots subjected to light mowing, light or heavy grazing, trampling or rooting were designated in three nature reserves in Poland. On each plot, the abundance of infructescences per sq. metre was calculated. Mature infructascences were collected and their length and no of fruit capsules were measured. The seeds obtained from fruit capsules were weighted and sown in controlled conditions. The germination rate and the final germination percentage were calculated. A representative number of sprouts were grown. After a period of two months, the specimens were harvested and their total dry mass was measured. It was found that heavy grazing had the greatest effect on all of the studied characteristics. The presence of this factor resulted in shorter infructescences with a smaller number of fruit capsules. However, this phenomenon was compensated by the higher abundance of infructescences per sq. metre. At the same time seeds produced by grazed specimens were significantly lighter. Intensive trampling by people affected specimens in a similar way to heavy grazing, while mowing and rooting had less impact on the considered characteristics. Although a positive correlation between seed mass and germination success was found, the altogether lower seed mass had a negligible effect on germination parameters. Also, the differences in seed parameters did not affect dry mass of obtained progeny grown in lab conditions.

Objective: The aim of this research was to compare the sensitivity and positive predictive value of contrast transcranial Doppler (c-TCD), contrast- transthoracic echocardiography (c-TTE) and contrast- transesophageal echocardiography (c-TEE), to determine the best method for diagnosing patent foramen ovale (PFO) and to provide a reference for the further improvement of clinical practice. Methods: We investigated 161 patients who suffered from migraines, cryptogenic stroke, TIA, and cerebral infarction of unknown cause. All patients underwent transcatheter examination, and the results of the right heart catheterization (RHC) were considered the gold standard for PFO diagnosis. Results: The present study revealed that c-TTE with the Valsalva maneuver had a higher sensitivity in detecting PFO related right-to-left shunt (PFO-RLS), but it might have a higher rate of misdetection than c-TCD. Conclusion: Patients with suspected PFO can be examined with c-TCD first, and if positive results are obtained, then c-TTE and c-TEE should be performed for further confirmation.

chylothorax is a relatively uncommon condition. It is characterized by the presence of chylous rich fluid within the pleural space. Spontaneous chylothorax usually refers to non-traumatic causes most common malignancy and infections. we present a case of a spontaneous chylothorax with evidence of resolution of pleural effusion without detectable cause.

The case report describes a newborn case of ACS based on clinical presentation(s) and microdeletions of 22q11.21 and 11p15.4 using DNA high throughput sequencing analysis. This finding has implications for ACS diagnosis and overcomes the limitations associated with FISH by using the DNA high throughput sequencing across the whole genome.

Although less common compared to postherpetic neuralgia, post herpes itch (PHI) is a known sequela after herpetic infections. PHI usually disappears over weeks to months, requiring only symptomatic management. Rarely, PHI can result in significant debilitation. We report one case of extreme post herpetic itching and review the available literature.

Objective: Cardiac tumors are rare conditions. The vast majority of them are benign yet they may lead to serious complications. Complete surgical resection is the gold standard treatment and should be performed as soon as the diagnosis is made. Median sternotomy (MS) is the standard approach and provides excellent early outcomes and durable results at follow-up. However, minimally invasive (MI) is gaining popularity and its role in the treatment of cardiac tumors needs further clarification. Methods: A systematic literature review identified 12 candidate studies; of these, 11 met the meta-analysis criteria. We analyzed outcomes of 653 subjects (294 MI and 359 MS) with random effects modeling. Each study was assessed for heterogeneity. The primary endpoints were mortality at follow-up and tumor relapse. Secondary endpoints included relevant intra- and post-operative outcomes; tumor size was also considered. Results: There were no significant between-group differences in terms of late mortality (incidence rate ratio (IRR): MI vs. MS, 0.98 [95% CI: 0.25¬–3.82], p = 0.98). Few relapses and redo surgery were observed in both groups (IRR: 1.13[0.26-4.88], p=0.87);( IRR: 1.92 [95% CI: 0.39-9.53], p=0.42); MI was associated to prolonged operation time yet with no effects on clinical outcomes. Tumor size did not significantly differ between groups. Conclusions: Both MI and MS are associated with excellent early and late outcomes with acceptable survival rate and low incidence of recurrences. This study confirms that cardiac tumor may be approached safely and radically with a MI approach.