Drought-related tree mortality is increasing globally, but the sequence of events leading to it remains poorly understood. To identify such sequence, we used a 2016 tree mortality event in the semi-arid pine forest of Yatir were dendrometry and sap flow measurements were carried out in 31 trees, of which seven died. A comparative analysis revealed three stages leading to mortality. First, a decrease in tree diameter in all dying trees, but not in the living ones, eight months ‘prior to the visual signs of mortality’ (PVSM; e.g., brown needles). Second, a decay to near zero in the diurnal stem swelling/shrinkage dynamics, reflecting the loss of stem radial water flow in the dying trees, six months PVSM. Third, cessation of stem sap flow three months PVSM. Eventual mortality could therefore be detected long before visual signs are observed, and the three stages identified here demonstrated the differential effects of drought on stem growth, water storage capabilities, and soil water uptake. The results indicated that breakdown of radial stem water flow and phloem functionality is a critical element in defining the ‘point of no return’ in the sequence of events leading to mortality of mature trees.

Technological advances in DNA sequencing over the last decade now permit the production and curation of large genomic datasets in an increasing number of non-model species. Additionally, this new data provides the opportunity for combining datasets, resulting in larger studies with a broader taxonomic range. Whilst the benefits of new sequencing platforms are obvious, shifts in sequencing technology can also pose challenges for those wishing to combine new sequencing data with data sequenced on older platforms. Here, we outline the types of studies where the use of curated data might be beneficial, and highlight potential biases that might be introduced by combining data from different sequencing platforms. As an example of the challenges associated with combining data across sequencing platforms, we focus on the impact of the shift in Illumina's base calling technology from a four-channel to a two-channel system. We caution that when data is combined from these two systems, erroneous guanine base calls that result from the two-channel chemistry can make their way through a bioinformatic pipeline, eventually leading to inaccurate and potentially misleading conclusions. We also suggest solutions for dealing with such potential artifacts, which make samples sequenced on different sequencing platforms appear more differentiated from one another than they really are. Finally, we stress the importance of archiving tissue samples and the associated sequences for the continued reproducibility and reusability of sequencing data in the face of ever-changing sequencing platform technology.

The literature describes multiple approaches for the repair of stenosed branch pulmonary arteries. Regardless of the technique, restenosis is undesirably and notoriously common. We describe a case of severe left pulmonary artery stenosis repaired with a novel technique in consideration of factors leading to restenosis. The native main pulmonary artery was transected and turned down to create a direct anastomosis with the left pulmonary artery. The child had a normal sized main pulmonary artery with tricuspid atresia and pulmonary atresia with ductus arteriosus feeding the severely stenosed left pulmonary artery. Our novel technique resulted in hemodynamically gratifying results with a tension free tissue-tissue anastomosis with potential for growth.

Background: Vernal keratoconjunctivitis (VKC) is a rare chronic conjunctivitis characterized by a predominantly eosinophil-mediated inflammatory disorder that could develop critical complications such as blindness. Oxidative stress plays a pivotal role in the pathogenesis of several allergic diseases. The role of oxidative stress has been hypothesized in VKC, but no study explored this issue.Furthermore, cyclosporine A (CsA) exerts an anti-inflammatory and antioxidant action on the conjunctiva. This study aims to assess oxidative stress in VKC patients and controls and to study the effect ofCsA on oxidative stress in these subjects. Methods:Thirty-six consecutive children, including 12 VKC(9 males, 75%; mean age 10,17; SD ± 2.48) patients without treatment,12 VKC treated with CsA(9 males, 75%; mean age 9,08; SD± 2.75) and 12 controls (CT) (7males,58%; mean age8,58; SD ±1,78) were recruited. A cross-sectional study was performed to compare H2O2 in the serum and the tears ofthese children. Results: Compared with CT and VKC children treated with CsA, VKCuntreated children had significantly higher values ofHydrogen peroxide (H2O2) in theserum and the tears.No significant differences were observed between CT and VKC treated with CsA. A significant correlation was found at the linear regression analysis between serum and tear H2O2 levels. Conclusion: This study provides the first report attesting that patients with VKC have high oxidative stress; furthermore, it suggests that CsA could have an anti-inflammatory and antioxidant action that could be useful to prevent the poor VKC outcome.

Congenital left atrial appendage aneurysm is an extremely rare anomaly. It is seen at any time ranging from fetal to ninth decade of life. Patients with left atrial appendage aneurysm may be asymptomatic, or present with dyspnea, arrhythmias, thromboembolic phenomenon. We report a case of prenatal diagnosis at 26 weeks of gestation , postnatal management and outcome of left atrial appendage aneurysm.

A Kalman reduced form is obtained for linear systems over Hermite rings. This reduced form gives information of the set of assignable polynomials to a given linear system.

Aortic atresia is uncommonly associated with atrioventricular and ventriculoarterial discordance.(1) Presence of severe regurgitation of Ebsteinoid malformation of the tricuspid valve in this subset results in reduced aortic blood flow in-utero. The hemodynamic explanation of this anomaly was reported by Celermajer and colleagues.(2) We report here a term neonate with this anomaly detect antenatally.

Long-term application of high nitrogen and phosphorus fertilizer and mono-tillage practices can adversely affect soil health, carbon sequestration and crop growth. A 10-year field experiment was conducted in a wheat-maize cropping system on the Loess Plateau in China to explore fertilization and tillage methods that improve SOC sequestration and crop yields. We evaluated the effects of (1) fertilization (balanced fertilization (BF), low fertilization (LF), and conventional fertilization (CF)) and (2) alternating years of different tillage (no-tillage and subsoiling (NS), subsoiling and ploughing (SP), ploughing and no-tillage (PN)) or continuous ploughing tillage (PP) on input-C, SOC pool, and crop yields. BF and rotational tillage (NS, SP, and PN) increased the amount and stabilization rate of input-C, thereby increased SOC storage, and the highest effect was found in BF+NS treatment. Simultaneously, BF produced higher contents of SOC, readily oxidizable carbon (ROC), particulate organic carbon (POC) and dissolved organic carbon (DOC) and C pool management index (CMI) at 0-10 cm depth. For tillage, rotational tillage increased labile C contents and CMI at 0-10 cm, 20-35 cm and 35-50 cm depths, which improved soil quality. Crop yields showed an increase tendency with the increases of SOC content, labile C fraction contents, and CMI. Therefore, the higher yields of wheat and maize were found in BF and rotational tillage; the highest were in BF+NS treatment. Our finding suggested that NS combined with BF may be the best management to increase SOC storage, improve soil quality and productivity on China’s Loess Plateau.

We describe a novel surgical technique of 31 patients with histopathologically–confirmed placenta accreta spectrum (PAS) disorders managed by a multidisciplinary team using prophylactic infrarenal abdominal aortic cross-clamping technique during cesarean hysterectomy. We conclude that this new surgical procedure is a safe and effective technique to reduce operative blood loss. Hopefully, our pioneer work will stimulate others to develop protocols assessing this innovative technique to improve surgical outcome of PAS disorders.

There is no question that developing new medications in children is fraught with challenges, particularly for rare conditions including pediatric venous thromboembolism (VTE). This is due to both logistical and ethical considerations which are nicely described in a document on the Food & Drug Administration (FDA) website.[1] Furthermore, gaining an approval from the FDA for pediatric use requires a functional partnership between pharmaceutical companies (Pharma), academia, and the regulators/officers at the FDA. When this relationship works well, novel agents can be made available to children that have the assurance of efficacy and safety which is in the best interest of all involved parties, especially patients. The licensure of emicizumab for the prevention of bleeding in hemophilia A patients is one excellent example in which a serious unmet need for a rare disease was addressed in a timely manner (~18 months from the start of a phase 3 trial to approval), and where the labelled indication even includes the word “newborn” with respect to the included age groups. [2,3]Unfortunately, this is not the case with respect to anticoagulants in children, and there is plenty of blame to go around including Pharma, academia (myself included), but also the FDA. I know this all too well as I have had a front seat view having served as an advisor to the FDA on this very topic in 2011 as well as on several other occasions involving specific discussions regarding fondaparinux and rivaroxaban. Although the authors and investigators of this report [4] are to be commended for the significant effort it took to achieve an FDA-approved indication, one can’t help but feel that with respect at least to injectable anticoagulants that “the ship has sailed.” What do I mean by this? Enoxaparin is the most commonly used low molecular weight heparin (LMWH) and anticoagulant in children with fondaparinux also gaining more use with the prime advantage being that it is a once-a-day option. Despite dalteparin (a less commonly used LMWH) now being licensed for children [5], I doubt it will ever supersede enoxaparin in prescriptions nor does it have the advantages of fondaparinux, particularly once daily dosing.How did we arrive at such an unenviable situation? Certainly, it is nobody’s fault that enoxaparin does not have a pediatric indication—the author’s clearly explained the fact that enoxaparin came to the market prior to the Pediatric Research Equity Act (PREA), and at this point, despite the sheer volume of data on the pediatric use of enoxaparin, it will likely never be licensed for children. This is not the case, however, for fondaparinux which has been in regulatory limbo with respect to pediatric use for nearly 15 years. This, despite the fact that there is more published data on fondaparinux than dalteparin including a similarly (to dalteparin) designed, prospective, dose-finding, pharmacokinetic, efficacy and safety study [6-8], and the fact that the Pharma companies (the compound has changed hands a few times) have been in discussions with the FDA repeatedly. Unlike with dalteparin, the FDA has placed numerous and pointless hurdles upon the responsible Pharma for capricious reasons succeeding only in potentially putting children at increased risk of harm by, for example, requiring a dose-finding study when the dose of fondaparinux is already well-established. This is the antithesis of what the FDA should be doing. This unending process of which I have played a significant part as an academician has been nothing short of befuddling. While the FDA clearly went to great lengths to work with the sponsor to have dalteparin approved for children, they owe the pediatric hematology community an explanation on what has gone so wrong with fondaparinux.So, where does this leave us currently and what would I recommend pediatric hematologists do with the data from this report [4] and the licensure of dalteparin for children? Importantly, off-label use in the pediatric setting is quite common typically ranging around 50% depending on the setting [9] so there is no need for any pediatric treater to fret over prescribing anticoagulants as such. Thus, if you are comfortable using enoxaparin or fondaparinux based on the available data, the collective pediatric experience and your personal experience, then I would advocate that you continue to do so until there are better options (more on that later). If, however, you prefer to prescribe medications per the prescribing information (to the extent possible) and you find the data from this study compelling, then certainly you may choose dalteparin as your anticoagulant of choice for your pediatric patients with VTE.Above I discussed the current situation, however on a strongly positive note, there has been outstanding cooperation between Pharma, academicians and the FDA when it comes to the development of the direct oral anticoagulants (DOACs) which without a doubt will dramatically change the management of pediatric VTE. While I have been privy to discussions with the FDA regarding rivaroxaban and have served on the steering committee for the rivaroxaban and edoxaban studies, I am also aware of the productive discussions with respect to dabigatran and apixaban. This trilateral collaboration is the epitome of what PREA is for, and in the coming year or two, it is highly likely that several DOACs will be licensed for use in children and will also lead to the availability of pediatric-friendly formulations.In conclusion, the approval of dalteparin is on the one hand far too little and too late to be of any meaningful clinical use, yet it does set an example of what fruitful pediatric drug development can look like in hematology/oncology (and other specialties as well) particularly for rare diseases. It is incumbent upon the academic community not to request, but in fact to demand that Pharma fund proper studies (not just ones that “check the box”), and that the FDA review data in a fair and reasonable manner such that the future will be filled with more examples like dalteparin and fewer debacles like fondaparinux.Referenceshttps://www.fda.gov/drugs/drug-information-consumers/drug-research-and-children [Accessed September 9, 2020]Young G, Liesner R, Chang , Sidonio R, Oldenburg J, Jimenez-Yuste V, Mahlangu J, Kruse-Jarres R, Wang M, Uguen M, Doral MY, Wright LY, Schmitt C, Levy GG, Shima M, Mancuso ME. A multicenter, open-label, phase 3 study of emicizumab prophylaxis in children with hemophilia A with inhibitors. Blood 2019; 134: 2127-2138.https://www.accessdata.fda.gov/drugsatfda_docs/label/2017/761083s000lbl.pdf [Accessed September 9, 2020]Merino M, Richardson N, Reaman G, Ande A, Zvada S, Liu C, Hariharan S, De Claro A, Farrell A, Pazdur R. FDA approval summary: Dalteparin for the treatment of venous thromboembolism in pediatric patients. Pediatr Blood Cancer 2020 (in press).https://www.accessdata.fda.gov/drugsatfda_docs/label/2019/020287s072lbl.pdf [Accessed September 9, 2020]Young G, Yee DL, O’Brien SH, Khanna R, Barbour A, Nugent DJ. FondaKIDS: A prospective pharmacokinetic and safety study of fondaparinux in children between 1 and 18 years of age. Pediatr Blood Cancer 2011; 57: 1049-1054.Ko RH, Michieli C, Lira JL, Young G. FondaKIDS II: Long-term follow-up data of children receiving fondaparinux for treatment of venous thromboembolic events. Thromb Res 2014; 134: 643-647.Shen X, Wile R, Young G. FondaKIDS III: A long-term retrospective cohort study of fondaparinux for treatment of venous thromboembolism in children. Pediatr Blood Cancer 2020; 67:e28295.Yackey K, Stukus K, Cohen D, Kline D, Zhao S, Stanley R. Off-label prescribing practices in pediatrics: An update. Hosp Pediatr 2019; 9:186-193.

We studied the psychosocial impact of the start of the COVID-19 pandemic on Dutch children with cancer in outpatient care and their caregivers (n=799) using regular monitoring and screening outcomes. No differences were observed between the pre-COVID-19 and COVID-19 era in health-related quality of life and fatigue of children. Fewer caregivers were distressed during the COVID-19 era than pre-COVID-19. In conclusion, the additional stress of COVID-19 did not deteriorate psychosocial functioning of children with cancer and their caregivers. Results may be explained by alleviating daily life changes, experience in coping with medical traumatic stress and appropriate care and support.

Improving synchrony in young infant supported by noninvasive ventilation for severe bronchiolitis: Yes we can… so we should!C Milési, MD1, J Baleine, MD1, G Cambonie, MD, PhD11Department of Neonatal Medicine and Pediatric Intensive Care, Arnaud de Villeneuve Hospital, Montpellier University Hospital Center, Montpellier, FranceCorrespondence: Christophe Milési, MD, Department of Neonatal Medicine and Pediatric Intensive Care Unit, Arnaud de Villeneuve Hospital, Montpellier University Hospital, 371 Avenue du Doyen Gaston Giraud, 34295 Montpellier Cedex 5, FranceTel: +33 467 336 556, Fax: +33 467 336 228, e-mail:[email protected] count: 1391; references: 43Keywords: asynchrony, bronchiolitis, noninvasive ventilation, neurally adjusted ventilatory assist, infantAdmission to a pediatric intensive care unit (PICU) is required for 9-14% of infants with acute viral bronchiolitis (AVB) and evolving respiratory distress.1,2 In this context, AVB generally presents as severe obstructive lung disease, which causes an increased load on the respiratory muscles.3,4 As no pharmaceutical treatment currently in use is able to rapidly reduce airway obstruction, the management of these patients is focused on providing respiratory support to reduce respiratory muscle fatigue and prevent intubation. Noninvasive ventilation (NIV), delivered by continuous positive airway pressure (CPAP) or bilevel positive airway pressure (BiPAP), has traditionally been applied and is associated with reductions in intubation rates, ventilation-associated complications, and duration and cost of hospitalization.5,6 More recently, a third device was introduced to administer a heated and humidified mixture of air and oxygen with high-flow nasal cannulae (HFNC). PICU clinicians thus currently have at their disposal several respiratory assistance modalities for infants with moderate to severe AVB, but few high-grade evidence studies to guide their choice.7 Indeed, most of the studies carried out in this field have been observational, with comparisons with historical cohorts,5,6,8-10 or physiological, assessing differences with and without noninvasive respiratory support.4,11-13 In this issue of Pediatric Pulmonology , Delacroix et al. re-evaluates the use of BiPAP as the first-line respiratory support in less-than-6-months patients with bronchiolitis.14 In their single-center retrospective study, they report longer durations of noninvasive support and longer PICU stays in the patients supported with BiPAP compared with CPAP and HFNC. The authors should be congratulated for this analysis covering more than 250 infants, one of the largest cohorts treated with this device. This work usefully complements the information provided by two recent observational studies that focused on the comparison of these three techniques in this specific group of patients.15,16 The inherent limitation of these retrospective studies, whether monocentric14,16 or database-driven,15 is the presence of confounders, which influence both the choice of the initial respiratory support and the outcome. It was particularly interesting to note in Delacroix et al.’s study that the clinicians’ preferred choice was BiPAP, although no local written protocol required it in this situation. However, the BiPAP-treated group also included a higher rate of premature infants, a condition associated with the immaturity of immune defenses and airway development and ventilation-induced airway injury that predisposes to more severe bronchiolitis.17Several national and multinational surveys have demonstrated that pediatric intensivists currently select HFNC for initial respiratory care in cases of severe bronchiolitis.18,19 This popularity among caregivers appears to be associated with the perception of a technique that is easy to implement, with comparable effectiveness and fewer complications than CPAP.20 The physiological background for using CPAP in this instance is that the application of nearly constant pressure support is associated with rapid unloading of respiratory muscles, increased expiratory time, and concomitantly improved respiratory distress.4,11,21 Reduced respiratory effort and a change in breathing pattern suggest that CPAP improves the work of breathing by offsetting the patient’s inspiratory effort to overcome intrinsic end-expiratory pressure (PEEPi). In addition, positive airway pressure helps maintain airway patency and alleviate bronchiolar obstruction, a ‘stenting’ effect that in turn reduces respiratory system resistance. HFNC also generates some degree of airway distenting pressure, which supports inspiratory effort. The reduced diaphragmatic electrical activity and decreased esophageal pressure swings also confirm the effectiveness of HFNC to reduce the work of breathing in AVB.12,13 Randomized controlled trials, however, have found that neither CPAP nor HFNC reduces the need for intubation in infants with bronchiolitis, probably due to the current low occurrence of this event1,2,21-24 In practice, CPAP and HFNC are introduced early in the course of the disease—even as a preemptive measure in some cases—in infants generally not exhausted. While NIV is widely used to treat bronchiolitis,25 most clinicians, unlike in Delacroix et al.’s study,14 consider BiPAP the next step for patients failing with HFNC or CPAP.19 Failure rates vary widely, from 10% to 50% in the major randomized controlled studies,1,2,22-24and depend on multiple factors, the most important probably related to the criteria and delays in defining failure. According to the TRAMONTANE study, the main causes of failure are worsening respiratory distress, especially in patients supported by HFNC; patient discomfort, the leading cause in patients treated with CPAP; and the occurrence of apnea in a minority of cases in both groups.22 The very large cohort of almost 6500 patients collected by Clayton et al.15 in more than 90 PICUs in North America and Saudi Arabia gives credit to clinicians who turn to NIV in the event of failure, since this strategy seems to avoid escalation to invasive mechanical ventilation (IMV) in more than 70% of cases. There is a rationale for using BiPAP in infants with bronchiolitis and worsening respiratory failure, but is this technique being used optimally?Delacroix et al. point out that the unfavorable results in their BiPAP group may have resulted from a suboptimal patient-ventilator interaction.14 Indeed, use of pressure support in spontaneous/timed modes requires inspiratory synchrony, expiratory synchrony, and rapid compensation for leaks in order to reach pre-established pressure values during inspiration.26Infants, especially when exhausted, have a higher respiratory rate, lower tidal volume, and weaker inspiratory efforts, making synchronization with their ventilator more complex.27Patient-ventilator asynchrony is frequent during IMV or NIV with pressure support in infants and children.28,29 In an elegant physiological study performed in infants with AVB, Baudin et al. characterized the main inspiratory asynchronies with noninvasive pressure assist control ventilation from diaphragmatic electrical activity recordings.30 Autotriggering, double triggering, and above all non-triggered breaths were observed for nearly 40% of the respiratory cycles, highlighting difficulties in detecting inspiratory effort in patients younger than 6 months, the targeted population in the study by Delacroix et al.14 These triggering asynchronies are associated with leaks, notably when BiPAP is performed with a nasal interface.31 This issue is explained by the insufficient sensitivity of the triggers with regard to the modest volumes and flows generated during inspiration at this young age.32 In addition, airway obstruction and dynamic hyperinflation may increase the frequency of ineffective respiratory efforts.30 The asynchrony index could be even higher if premature and late cycling are considered, i.e., asynchronies related to excessively long or short ventilator inspiratory times in relation to the neural command.28 These expiratory asynchronies are influenced by the ventilator’s mode and algorithm and may be improved by adjustments of the cycling-off criterion, which remains a difficult bedside challenge.28 In adults, patient-ventilator asynchrony has been associated with increased duration of mechanical ventilation, sleep disorders, prolonged ICU stay, and increased mortality.33 Such a demonstration has not been made in pediatrics, but recognition of this phenomenon and the analysis of its risk factors and consequences are much more recent.34 Currently, technological advances in ventilators have opened new horizons regarding synchronization, even in this group of patients. NIV software, management of leaks, and turbines specifically dedicated to NIV are indisputable advances.35 Neurally adjusted ventilatory assist (NAVA), initially developed for intubated patients, offers another option. In the field of severe AVB, an early report highlighted the interest of NAVA in providing less aggressive IMV and more comfort to the child.36 Discomfort during NIV is common in infants,22 and the prescription of sedatives is systematically considered by some teams.37 The discomfort may have multiple origins, including intolerance of the interface, skin breakdown, conjunctivitis, and gastric distension.38 Patient-ventilator asynchrony is another important source,39 which can be significantly improved with NAVA. Indeed, the direct analysis of diaphragmatic depolarization reduces the trigger delay, leading to more effective synchronization than with conventional NIV, even after careful optimization of the expiratory trigger setting.28,30,40 The asynchrony index may be reduced to 2%-8%, i.e., lower than the critical threshold of 10% defined in the adult population,41 with a nasal interface and in the presence of large leaks. One of the restraints on using NAVA is the extra cost it entails. However, the targeted population is limited to HFNC or CPAP failure, corresponding to 10-15% of moderate to severe AVB.15 A recent physiological study in severe AVB infants found that, compared to CPAP, NAVA was associated with a decreased work of breathing, lower neural drive and lower Ti/Ttot ratio.42 The promising results of this study suggest that pediatric intensivists must be as ambitious in combating asynchrony as they have been in combating pain and discomfort.43The impact on patient outcome will be judged in randomized controlled trials targeting severe forms of the disease.Disclosure: The authors declare no conflict of interest.

Pediatric pulmonologists, and, indeed, general pediatricians, are exposed to the causative virus of Covid-19 , SARS-CoV2, in their daily outpatient practices from both symptomatic and asymptomatic patients. This risk naturally increases with multiple exposures over time. We have developed a simple equation to calculate the probability of a practitioner remaining Covid free over a specified time interval, given the local population prevalence of virus, the transmissibility of the organism or “attack rate,” the mitigating effects of personal protective equipment (PPE), and the number of patients seen over the time interval. The equation can be used to construct a Kaplan Meier -like plot for remaining Covid free. Since studies of transmission of SARS-CoV2 suggest a spectrum between droplet and aerosol spread, even in asymptomatic patients and absence of aerosol generating procedures, the type of masks protection worn by medical practitioners may mitigate risk to different degrees. Eye protection may mitigate the risk further. While the risk of acquiring Covid-19 in a year of practice is low, it is not negligible. However it can be minimized. These considerations may be helpful in deciding local risk to the practitioner according to practice volume and in choosing the level of PPE that would result in minimizing that risk.

Background: The quantitative assessment of neuroblastoma cell content in bone marrow aspirates for response evaluation has been introduced recently. Data on the concordance of interobserver reports are lacking so far. Methods: Investigators of seven European countries representing national reference or large oncological centres convened in 2016. They agreed to quantitatively assess routine bone marrow smears of the participating institutions and to discuss the discrepant results in joint meetings. Results From 2017 through 2019, three cytology rounds with 24, 28, and 28 bone marrow samples were run evaluating the representativity of the smears (yes/(restricted)/no) and the presence of tumors cells (yes/no and %). The comparison of the reports using κ (Fleiss) and α (Krippendorff) statistics demonstrated no robust reliabilities. The agreement on the representativity was moderate to poor, on the presence of tumor cells moderate to good and on the percentage of tumor cells slight to moderate. Though the unquestioned value of cytology to detect even tiny metastatic cells in bone marrow, the investigators unanimously agreed that a reliable quantification of the tumor cell content in bone marrow smears is unrealistic. For the key issue of representativity, a new practical definition was developed. Conclusion For any work with bone marrow aspirates the representativity of the material is of paramount importance. A practical definition is proposed. A reliable quantitative cytological assessment of tumor cell content in bone marrow aspirates is not feasible in metastatic neuroblastoma. Therefore its use as response criterion should be re-considered.

We experienced a case with accidental aspiration of a metallic round foreign body. As there is no established techniquefor retrieving a metallic round ball from an airway, we propose that endoscopic net forceps with the support of a laryngeal mask airway is the best choice for such occasions.

Environmental DNA (eDNA) metabarcoding can rapidly characterize the composition and diversity of benthic communities. As such, it has high potential utility for routine environmental assessments of benthic impacts of marine finfish farming. In this study, 126 sediment grab samples from 42 stations were collected along an organic enrichment gradient at six salmon farms in British Columbia, Canada, and benthic biotic community changes were assessed by both eDNA metabarcoding of metazoans and macrofaunal polychaete surveys. The latter was done by analyzing 11,466 individuals using a combination of morpho-taxonomy and DNA barcoding. Study objectives were to: (1) compare biotic signals associated with benthic impacts of salmon farming in the two data types; and (2) identify potential eDNA indicators to facilitate eDNA-based monitoring in Canada. Across both data types, alpha diversity parameters were reduced in sediments near fish cage edge and were negatively correlated with pore-water sulphide concentration. Presence/absence of known indicator taxon Capitella generally agreed well between the two methods despite that they differed in both the volume of sediment sampled and the molecular marker used. In eDNA data, there was a strong negative correlation between Nematoda OTU richness and pore-water sulphide concentration, and multiple approaches were used to identify OTUs related to organic enrichment statuses. We demonstrate that eDNA metabarcoding generates biotic signals that could be leveraged for environmental assessment of benthic impacts of fish farms in multiple ways: both alpha diversity and Nematoda OTU richness could be used to assess the spatial extent of impact, and OTUs related to organic enrichment could be used to develop a local biotic index.

Abstract: The orbital, ground and excited state energies of many electron atoms confined by an impenetrable spherical cavity with radius R are calculated using Quantum Genetic Algorithm (QGA) approach and Hartree-Fock Roothaan (HFR) theory. The important properties such as static and dynamic polarizability, oscillator strength and static pressure are investigated as perturbative. The results reveal that cavity radius and impurity charge have played an important role on the polarizability, the oscillator strength and pressure of the system. In addition, it is seen that when cavity radius is extremely large, all energies and the other physical parameters approach the energies and physical parameters of unconfined atom. As the dot radius decreases, the polarizability of system because of the strong spatial confinement decreases, but the pressure exerting on the system as the cavity radius R is shrunk increases. In addition, as the impurity charge increases, the magnitude of the oscillator strength decreases. Keywords: Orbital energy, static and dynamic polarizability, oscillator strength, pressure, many electron quantum dots.

In this work, methods based upon nonequilibrium thermodynamics are elucidated to predict stationary states of chemical reactions in nonequilibrium plasma, and limits for energy conversion efficiency. Two example reactions are used: CO2 splitting and NH3 synthesis, with emphasis on CO2 splitting. Expectations from the theoretical framework are compared to experimental results for both reactions, and reasonable agreement is obtained. The conclusion is that the probability of observing either reactants or products increases with the amount of energy dissipated by that side of the reaction as heat through collisions with hot electrons. The side of the reaction that dissipates more energy as heat has a higher probability of occurrence. Furthermore, endergonic chemical reactions in nonequilibrium plasma, such as CO2 splitting at low temperature, require an intrinsic energy dissipation to satisfy the 2nd law of thermodynamics – a sufficient and necessary waste. This intrinsic dissipation limits the maximum theoretical energy conversion efficiency