Aims:  In infants with chronic neonatal lung disease (CNLD), we aimed to identify predictors of home oxygen duration, predictors of discharge oxygen flow rates and the association of oxygen flow rates with respiratory outcomes.Methods:  Retrospective review of infants with CNLD requiring home oxygen in 2016 and 2017.  Hazard ratios (HR) were estimated from Cox proportional hazards regression models in the cohort.  A multinomial logistic regression model examined the effects of maternal and infant variables on discharge oxygen flow rates.  Kruskal-Wallis test with univariate linear regression and Fisher’s exact test with binomial univariate logistic regression were used to examine associations between oxygen flow groups and post-discharge clinical variables.Results:  149 infants were included.  Median corrected gestational age (CGA) at oxygen cessation was 6.8 months (IQR 4.4) with 87.2% of infants weaned by 12 months CGA.  Shorter initial neonatal intensive care unit (NICU) stay predicted faster oxygen weaning at 9 months (HR 0.99, 95%CI 0.98-1.00, p=0.02) and 12 months (HR 0.99, 95%CI 0.98-1.00, p=0.02).  Infants with hypercarbia at discharge or discharged from NICU at higher CGA had higher odds of requiring ≥200mL/min relative to ≤125 mL/min oxygen.  Infants discharged with >250mL/min oxygen were more likely to have a respiratory related admission before two years chronologic age. Conclusion:  Shorter initial NICU stay was the best predictor of earlier home oxygen cessation.  At NICU discharge, infants with hypercarbia or a higher CGA may require more home oxygen and experience more respiratory related hospital admission in the first two years of chronological age.

Introduction: Elevated left atrial pressure (LAP) during catheter ablation of atrial fibrillation (AF) is associated with an increased risk of AF recurrence, but it is unknown if this correlates with heart failure (HF). The objective of the study was to determine if elevated LAP after AF ablation correlates with HF events. Methods: Prospective, single center, cohort study measuring LAP and RAP during AF ablation in 100 patients. The primary endpoint was clinical HF within 30 days of ablation. The secondary outcome was AF-free HF. Results: 100 patients (63% male, mean age 64.5) were enrolled and 20% had clinical HF within 30 days. Bivariate correlates included mitral valve (MV) disease, persistent AF, class III antiarrhythmics, LAP, and recurrent AF. Multivariate analysis revealed class III antiarrhythmics were protective (OR 0.24 [0.1–0.5], p=0.04), while MV disease (OR 8.7 [3.3—23], p=0.03) and loop diuretics (OR 4.8 [2.6–9.1], p=0.01) were hazardous. AF-free HF occurred in 9% of patients and correlated with higher LAP and RAP, and CKD. Conclusion: Patients with HF after AF ablation had higher LAP. MV disease, diuretic use, and class III antiarrhythmics also correlated to HF. These present opportunities to target future interventions to reduce a common complication of AF ablation.

Food allergy is an increasingly common disease worldwide, and is thought to be driven by an uncontrolled type 2 immune response. Current knowledge about the underlying mechanisms that initiate and promote an inappropriate immune response to dietary allergens is limited. Sensitization through the skin in early life is considered to be a key event. Food allergy results from a dysregulated type 2 response to food allergens, characterized by enhanced levels of IgE, IL-4, IL-5 and IL-13 with infiltration of mast cells, eosinophils and basophils during acute reactions. Recent data implies a possible role of innate lymphoid cells (ILCs) in driving food allergy. ILCs represent a group of lymphocytes that lack specific, recombined antigen receptors. They contribute to immune responses not only through the release of cytokines and other mediators, but also by responding to cytokines produced by activated cells in their local microenvironment. Due to their localization at barrier surfaces of the airways, gut and skin, ILCs form a link between the innate and adaptive immunity. This review summarizes recent evidences on how skin and gastrointestinal mucosal immune system contribute to both homeostasis and the development of food allergy, as well as the involvement of ILCs towards inflammatory processes and regulatory mechanisms.

The 20 km² Galabre catchment belongs to the French network of critical zone observatories. It is representative of the sedimentary geology and meteorological forcing found in Mediterranean and mountainous areas. Due to the presence of highly erodible and sloping badlands of various lithologies, the site was instrumented in 2007 to understand the dynamics of suspended sediments (SS) in such areas. Two meteorological stations including measurements of air temperature, wind speed and direction, air moisture, rainfall intensity, raindrop size and velocity distribution are installed both in the upper and lower part of the catchment. At the catchment outlet, a gauging station records the water level, temperature and the turbidity (10 min. time-step). Water and sediment samples are collected automatically to estimate SS concentration-turbidity relationships, providing SS fluxes quantifications with known uncertainties. The sediment samples are further characterized by measuring their particle size distributions (PSD) and by applying a low-cost sediment fingerprinting approach using spectrocolorimetric tracers. Thus, the contributions of badlands on different lithologies to total SS flux are quantified at a high temporal resolution providing the opportunity to better analyze the links between meteorological forcing variability and watershed hydrosedimentary response. The set of measurements was extended to the dissolved phase in 2017. Both the river electrical conductivity and its major ion concentrations are measured each week and every three hours during storm events. This allows progress in understanding both the origin of the water during the events and the partitioning between particulate and dissolved fluxes in the critical zone.

RESPONSE FOR THE LETTER TO THE EDITORDon’t miss a chance taking the best shot!!Kunihiko KiuchiDivision of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of MedicineAddress for correspondence:Kunihiko Kiuchi, MD, FHRSSection of Arrhythmia, Division of Cardiovascular Medicine,Department of Internal Medicine, Kobe University Graduate School of Medicine7-5-2 Kusunoki-chou chuou-ku, Kobe, Hyogo, JapanTelephone: (81)-78-382-5846Fax: (81)-78-382-5859E-mail: [email protected]:The Section of Arrhythmia was supported by an endowment from Medtronic JAPAN and Abbott JAPAN. The authors have reported that they have no relationships relevant to the contents of this paper to disclose.Funding: NoneTo the Editor,We thank Dr. Althoff and Mont for their interest, comments, and suggestions related to our paper.1 In our study, as they suggested, LGE-MRI was acquired 1-3 months after the ablation. An animal study reported that ablation lesions are fully formed by 3 weeks and are dense with collagen and fat deposition by 6 weeks.2 In our pilot study, the ablation lesion area dramatically diminished from 1 week to 6 weeks after the procedure in most of the patients. Furthermore, the ablation lesion area was comparable between 6 weeks and just 3 months after the ablation. Of interest, the ablation lesion disappeared after 5-6 months following the procedure in some patients without AF recurrence. We speculated that the shrinkage of the ablation lesion might have occurred during the pathophysiological healing process and reverse remodeling of the left atrium. Therefore, we considered that the time point of taking the “best shot” might have been earlier than we expected. Furthermore, the dose of the contrast agent was important for determining the time point. Our dose of the contrast agent was 0.1mmol/kg, which was relatively lower than that of the other groups. To address this issue, further study will be needed.As for an internal reference for normalization, the threshold of the signal intensity was initially determined according to the signal intensity histogram on the “whole LA wall” in our previous studies.3,4 However, as the authors suggested, neither the ablation lesion nor atrial fibrosis could be accurately visualized in some patients with advanced atrial remodeling. Therefore, the internal reference was changed from the “whole LA wall” to the “healthy LA wall” in our recent studies.1,5 We believed that this simple but important tip might make it possible to sensitively identify pre-existing atrial fibrosis, particularly interstitial fibrosis. The signal intensity of ablation lesion was significantly higher than that of the pre-existing atrial fibrosis. Our question is whether the ablation lesion characteristics dramatically differed between the different references in patients without atrial remodeling. Although we re-analyzed the LGE-MRI with two different references (“whole LA wall” and “healthy LA wall”), no significant difference in the lesion characteristics could be found. Cryoballoon ablation and RF ablation with contact-force sensing catheter induced intensive inflammation which followed by the artificial fibrosis.6 In this study, we focused on the visualization of the ablation lesion not the pre-existing atrial fibrosis, and patients without atrial remodeling were enrolled. We considered that the impact of the difference in the reference could be less than we expected, when we focused on the ablation lesions in patients without atrial remodeling.To visualize the atrial fibrosis and the ablation lesion, different visualization methods were developed. However, very few histological validations could be found. Furthermore, the dose of the contrast agents, MRI system, and visualization software completely differed due to the regulations in each institution. Therefore, it is not surprising that the image differed between each visualization technique. It is important to note the reproducibility of the visualization method and clinical implication of the best shot. The authors had already reported the reproducibility of their method.7 However, this issue is still in debate.8 We would like to challenge to improve the quality of our “best shot” and strengthen both reproducibility and clinical implication in a further study.References1. Kurose J, Kiuchi K, Fukuzawa K, et al. Lesion characteristics between cryoballoon ablation and radiofrequency ablation with a contact-force sensing catheter: late-gadolinium enhancement magnetic resonance imaging assessment. J Cardiovasc Electrophysiol. 2020.2. Avitall B, Kalinski A. Cryotherapy of cardiac arrhythmia: From basic science to the bedside. Heart Rhythm. 2015;12(10):2195-2203.3. Shigenaga Y, Kiuchi K, Ikeuchi K, et al. Fusion of Delayed-enhancement MR Imaging and Contrast-enhanced MR Angiography to Visualize Radiofrequency Ablation Scar on the Pulmonary Vein. Magn Reson Med Sci. 2015;14(4):367-372.4. Kiuchi K, Okajima K, Shimane A, et al. Visualization of the radiofrequency lesion after pulmonary vein isolation using delayed enhancement magnetic resonance imaging fused with magnetic resonance angiography. J Arrhythm. 2015;31(3):152-158.5. Akita T, Kiuchi K, Fukuzawa K, et al. Lesion distribution after cryoballoon ablation and hotballoon ablation: Late-gadolinium enhancement magnetic resonance imaging analysis. J Cardiovasc Electrophysiol. 2019.6. Kiuchi K, Fukuzawa K, Mori S, Watanabe Y, Hirata KI. Feasibility of Imaging Inflammation in the Left Atrium Post AF Ablation Using PET Technology. JACC Clin Electrophysiol. 2017;3(12):1466-1467.7. Benito EM, Carlosena-Remirez A, Guasch E, et al. Left atrial fibrosis quantification by late gadolinium-enhanced magnetic resonance: a new method to standardize the thresholds for reproducibility.Europace. 2017;19(8):1272-1279.8. Kamali R, Schroeder J, DiBella E, et al. Reproducibility of Clinical Late Gadolinium Enhancement Magnetic Resonance Imaging in Detecting Left Atrial Scar after Atrial Fibrillation Ablation. J Cardiovasc Electrophysiol. 2020 in press.

This note presents corrections to our paper [1]. We also give remarks and additions related to other papers [2]-[15].

It is sometimes difficult to distinguish between multiple cancers and metastases using only diagnostic imaging, particularly when multiple hypervascular tumors are found in multiple organs. In such cases, preoperative histological evaluation may be essential for determining the management of tumors.

Aim Clinical application of insulin infusion therapy is usually accomplished with regular human insulin. It is known that the regular insulin adsorbed to the hydrophobic surfaces and different approaches were implemented into the clinical practices. It was aimed to evaluate the rate of adsorption of insulin to PP bags and PVC infusion sets and stability of insulin during the infusion. Methods 100 IU insulin was added to PP bags containing 100 ml of 0.9% NaCl solution(n = 6). The infusion was started at a rate of 2 ml/h using infusion sets in the PVC structure. Insulin quantification was performed in the samples taken both from the bag and from the end tip of the infusion set during infusion. The stability of insulin solutions stored at room (+24°C) and refrigerator (+4°C) temperatures were compared. Samples were analyzed using reverse-phase high-performance liquid chromatography. Results No statistically significant difference was found between the concentrations of the samples taken from the bags stored at room and refrigerator temperatures at the 4th, 12th, and 24th hours (p>0.05). It was seen that the adsorption rate of insulin to PVC set was 57% and PP bags is at most 5% at the 24th hour. Conclusion When PP bags are used for insulin infusion, it is predicted that 24-hour change can be made instead of frequent change. In addition, losses caused by the high rate of insulin adsorption to PVC infusion sets should be considered and PP infusion sets would be the better option to use if available.

Objectives: A significant proportion of COVID-19 patients may have cardiac involvement including arrhythmias. Although arrhythmia characterization and possible predictors were previously reported, there are conflicting data regarding the exact prevalence of arrhythmias. Clinically applicable algorithms to classify COVID patients’ arrhythmic risk are still lacking, and are the aim of our study. Methods: We describe a single center cohort of hospitalized patients with a positive nasopharyngeal swab for COVID-19 during the initial Israeli outbreak between 1/2/2020 –30/5/2020. The study’s outcome was any documented arrhythmia during hospitalization, based on daily physical examination, routine ECG’s, periodic 24-hour Holter, and continuous monitoring. Multivariate analysis was used to find predictors for new arrhythmias and create classification trees for discriminating patients with high and low arrhythmic risk. Results: Out of 390 COVID-19 patients included, 28 (7.2%) had documented arrhythmias during hospitalization, including: 23 atrial tachyarrhythmias, combined atrial fibrillation (AF) and ventricular fibrillation, ventricular tachycardia storm, and 3 bradyarrhythmias. Only 7/28 patients had previous arrhythmias. Our study showed significant correlation between disease severity and arrhythmia prevalence (p<0.001) with a low arrhythmic prevalence among mild disease patients (2%). Multivariate analysis revealed background heart failure (CHF) and disease severity are independently associated with overall arrhythmia while age, CHF, disease severity, and arrhythmic symptoms are associated with tachyarrhythmias. A novel decision tree using age, disease severity, CHF, and troponin levels was created to stratify patients into high and low risk for developing arrhythmia. Conclusions: Dominant arrhythmia among COVID-19 patients is AF. Arrhythmia prevalence is dependent on age, disease severity, CHF, and troponin levels. A novel simple Classification tree, based on these parameters, can discriminate between high and low arrhythmic risk patients.

The heavy metals pollution represents one of the important issues in the environmental field since they are involved in many pathologies from cancer, neurodegenerative and metabolic diseases. We propose an innovative portable biosensor for the determination of traces of trivalent Arsenic (AsIII) and bivalent mercury (HgII) in water. The system implements a strategy combining two advanced sensing modules consisting in (a) a whole cell based on engineered Escherichia coli as selective sensing element towards the metals and (b) an electrochemical miniaturised silicon device with three microelectrodes and a portable reading system. The sensing mechanism relies on the selective recognition from the bacterium of given metals producing the 4-aminophenol (PAP) redox active mediator detected through a cyclic voltammetry analysis. The miniaturized biosensor is able to operate a portable, robust and high-sensitivity detection of AsIII with a sensitivity of 0.122 µA ppb-1, LoD of 1.5 ppb and a LoQ of 5 ppb. The LoD value is one order of magnitude below of the value indicated to WHO to be dangerous (10 μg/L). The system was proved to be fully versatile being effective in the detection of Hg(II) as well. A first study on Hg(II) showed sensitivity value of 2.11 µA/ppb a LOD value of 0.1 ppb and LoQ value of 0.34 ppb. Also in this case, the detected LOD was ten time lower than that indicated by WHO (1 ppb). These results pave the way for advanced sensing strategies suitable for the environmental monitoring and the public safety.

Neck masses can be a challenge because several cancers metastasize in this area. Head and neck tumors are more commonly responsible of lymph nodes in neck. However, also gastric cancer can be metastatic in this area. We present a rare case of neck gastric meta with negative Virchow's lymph node.

The incidence of bone marrow metastasis (BMM) in newly diagnosed Ewing sarcoma (ES) is variable across studies. An optimal staging strategy for detecting BMM is not defined. While BM biopsy and/or aspirate (BMBA) have been the gold standard, [F-18]fluorodeoxyglucose positron emission tomography (FDG-PET) to detect BM metastasis may decrease reliance on BMBA. We conducted a systematic review to assess incidence of BMM and the role of FDG-PET. We observed a pooled incidence by BMBA of BMM of 4.8% in all newly diagnosed ES patients and 17.5% among patients with metastatic disease. Only 1.2% of patients had BMM as their sole metastatic site. FDG-PET detection of BMM compared to BMBA demonstrated pooled 100% sensitivity and 96% specificity, positive predictive value of 75% and negative predictive value of 100%. In the era of FDG-PET imaging, omission of BMBA may be considered in patients with otherwise localized disease after initial staging studies.

Herein we report a case of a ten years old boy with rare clinical manifestations associated with COVID-19, in which the first clinical symptoms were urticaria and fever, and then he developed arthritis. The possibility of post-COVID-19, reactive arthritis, or postinfectious arthritis can be expected from this virus.

We are reporting an African female patient who is found to has thrombocytopenia secondary to iron deficiency anemia (IDA), and she responded to iron replacement therapy initially with a transient drop in platelets, followed by a gradual rise in platelets till platelets reached to the normal level.

The evolutionary origins and hybridization patterns of Canis species in North America has been hotly debated for the past 30 years. Disentangling ancestry and timing of hybridization in Great Lakes wolves, eastern Canadian wolves, red wolves, and eastern coyotes is most often partitioned into a 2-species model that assigns all ancestry to grey wolves and/or coyotes, and a 3-species model that includes a third, North American evolved eastern wolf genome. The proposed models address recent or sometimes late Holocene hybridization events but have largely ignored Pleistocene era opportunities for hybridization that may have impacted the current mixed genomes in eastern Canada and the United States. Here, we re-analyze contemporary and ancient mitochondrial DNA genomes with Bayesian phylogenetic analyses to more accurately estimate divergence dates among lineages. We combine that with a review of the literature on Late Pleistocene Canis distributions to illuminate opportunities for ancient hybridization events between extinct Beringian grey wolves (C. lupus) and extinct large wolf-like coyotes (C. latrans orcutti) that we propose as a potentially unrecognized source of introgressed genomic variation within contemporary Canis genomes. These events speak to the potential origins of contemporary genomes and provide a new perspective on Canis ancestry, but do not influence/negate current conservation priorities of dwindling wolf populations with unique genomic signatures and key ecologically critical roles.

1. The Cormack-Jolly-Seber (CJS) model and its extensions have been widely applied to the study of animal survival rates in open populations. The model assumes that individuals within the population of interest have independent fates. It is, however, highly unlikely that a pair of animals which have formed a long-term pairing have dissociated fates. 2. We examine a model extension which allows animals who have formed a pair-bond to have correlated survival and recapture fates. Using the proposed extension to generate data, we conduct a simulation study exploring the impact that correlated fate data has on inference from the CJS model. We compute Monte Carlo estimates for the bias, range, and standard errors of the parameters of the CJS model for data with varying degrees of survival correlation between mates. Furthermore, we study the likelihood ratio test of gender effects within the CJS model by simulating densities of the deviance. Finally, we estimate the variance inflation factor for CJS models that incorporate sex-specific heterogeneity. 3. Our study shows that correlated fates between mated animals may result in underestimated standard errors for parsimonious models, significantly deflated likelihood ratio test statistics, and underestimated values of the variance inflation factor for models taking sex-specific effects into account. 4. Underestimated standard errors can result in lowered coverage of confidence intervals. Moreover, deflated test statistics will provide overly conservative test results. Finally, underestimated variance inflation factors can lead researchers to make incorrect conclusions about the level of extra-binomial variation present in their data.

1. Landscape change is a key driver of biodiversity declines due to habitat loss and fragmentation, but spatially shifting resources can also facilitate range expansion and invasion. Invasive populations are reproductively successful, and landscape change may buoy this success. 2. We show how modelling the spatial structure of reproductive success can elucidate the mechanisms of range shifts and sustained invasions for mammalian species with attendant young. We use an example of white-tailed deer (deer; Odocoileus virginianus) expansion in the Nearctic boreal forest, a North American phenomenon implicated in severe declines of threatened woodland caribou (Rangifer tarandus). 3. We hypothesized that deer reproductive success is linked to forage subsidies provided by extensive landscape change via resource extraction. We measured deer occurrence using data from 62 camera-traps in northern Alberta, Canada, over three years. We weighed support for multiple competing hypotheses about deer reproductive success using multi-state occupancy models and generalized linear models in an AIC-based model selection framework. 4. Spatial patterns of reproductive success were best explained by features associated with petroleum exploration and extraction, which offer early seral vegetation resource subsidies. Effect sizes of anthropogenic features eclipsed natural heterogeneity by two orders of magnitude. We conclude that deer populations are likely buffered from overwinter mortality by landscape change, wherein early seral forage subsidies support high springtime reproductive success to offset or exceed winter losses. 5. Synthesis and Applications. Modelling spatial structuring in reproductive success can become a key goal of remote camera-based global networks, yielding ecological insights into mechanisms of invasion and range shifts to inform effective decision-making for global biodiversity conservation.

Food habits are important factors for wild nonhuman primates’ environment adaptation. White-headed langurs (Trachypithecus leucocephalus) are endemic to the limestone forest and face to the habitat fragmentation, which have to adjust the food habits to adapt the special environment. In this study, we compared the dietary data for white-headed langurs living in Chongzuo White-headed Langur National Nature Reserve over two separate study periods to evaluate interannual variations in diet. Our results indicated that young leaves were the preferred major food for the langur. The plant parts consumption pattern was similar between the two separate study periods. The consumption of young leaves was varied with the availability of young leaves, whereas the consumption of mature leaves was negative correlated with the young leaf’s availability. The consumption of plant species and diet diversity varied in the two separate study periods, which were higher in 2013 than 2016. In both 2013 and 2016, the diet diversity varied with the consumption of mature leaves, but negative correlated with the consumption and availability of young leaves. Dietary interannual variation probably linked to the phenology variations, or probably mean that the white-headed langurs has a flexible ecological adaptation coping with habitat fragmentation.