Recent research has shown that plants can distinguish genetically-related individuals from strangers (kin recognition) and exhibit more cooperative behaviours towards these more related individuals (kin discrimination). The first evidence for this was found when Cakile edentula plants growing with half-sibs allocated relatively less biomass to roots than plants growing with unrelated individuals, indicating that kin recognition can reduce the intensity of competition (Dudley & File, 2007). Since then, kin discrimination has been shown to result in reduced competition for soil resources (Semchenko, Saar, & Lepik, 2014), light (Crepy & Casal, 2015) and pollinators (Torices, Gómez, & Pannell, 2018). On the other hand, allelopathy, plants producing chemical compounds that negatively affect performance of neighbour plants, has also been widely documented (Inderjit & Duke, 2003) and shown to profoundly affect local species coexistence and plant community structure (Meiners, Kong, Ladwig, Pisula, & Lang, 2012). In crops allelopathy can also be beneficial in suppressing weeds (Macías, Mejías, & Molinillo, 2019). In the current issue, Xu, Cheng, Kong, and Meiners (2021) published the first study to show that kin discrimination can also affect the balance between direct competition for resources and allelopathy, and this together may lead to improved weed suppression in rice.

Background and Purpose: Sepsis-induced acute kidney injury (AKI) and acute lung injury (ALI) have high morbidity and mortality, with no effective clinically available drugs. Anti-inflammation is effective strategy in the therapy of AKI and ALI. NF-κB is a target for the development of anti‑inflammatory agents. The purpose of the study is to evaluate the effect of 270, self-developed NF-κB inhibitor, in LPS-induced AKI and ALI. Experimental Approach: LPS-induced macrophages were used to examine the anti-inflammation activity of 270. Sepsis-induced AKI and ALI mice models were established by intraperitoneal injection of LPS (10 mg/kg) for 24 h. Oral administration 270 for 14 days before LPS stimulation. Plasma, kidney and lung tissues were collected and used for histopathology, biochemical assay, ELISA, RT-PCR, and western blot analyses. Key Results: In vitro, we showed that 270 suppressed the inflammation response in LPS-induced RAW 264.7 macrophages and bone marrow derived macrophages. In vivo, we found that 270 ameliorated LPS-induced AKI and ALI, as evidenced by improving various pathological changes, reducing the expression of pro-inflammation genes, blocking the activation of NF-κB and JNK pathways, attenuating the elevated myeloperoxidase (MPO) activity and malondialdehyde (MDA) content, ameliorating the activated ER stress, reversing the inhibition effect on autophagy in kidney and lung tissues, and alleviating the enhanced plasma level of creatinine (Crea), blood urea nitrogen (BUN) and pro-inflammation cytokines. Conclusions and Implications: Our investigations provides evidence that NF-κB inhibitor 270 is a potential drug against LPS-induced AKI and ALI in the future.

Background: While many risk models have been developed to predict prognosis in heart failure (HF), these models are rarely useful for the clinical practitioner as they include multiple variables that might be time-consuming to obtain, they are usually difficult to calculate and they may suffer from statistical overfitting. Present study aimed to investigate whether a simpler model, namely ACEF-MDRD score, could be used for predicting one-year mortality in HF patients. Methods: 748 cases within the SELFIE-HF registry had complete data to calculate ACEF-MDRD score. Patients were grouped into tertiles for analyses. Results: Significantly more patients within the ACEF-MDRDhigh tertile (30.0%) died within one year, as compared to other tertiles (10.8% and 16.1%, respectively, for ACEF-MDRDlow and ACEF-MDRDmed, p<0.001 for both comparisons). There was a stepwise decrease in one-year survival as ACEF-MDRD score increased (log-rank p<0.001). ACEF-MDRD was an independent predictor of survival after adjusting for other variables (OR: 1.14, 95%CI:1.04 – 1.24, p=0.006). ACEF-MDRD score offered similar accuracy to GWTG-HF score for prediction of one-year mortality (p=0.14). Conclusions: ACEF-MDRD is a predictor of mortality in patients with HF, and its usefulness is comparable to similar yet more complicated models.

In this letter, we commented on several issues of the recent study entitled “Hypothermic circulatory arrest time affects neurological outcomes of frozen elephant trunk for acute type A aortic dissection: A systematic review and meta‐analysis” by Dr. Mousavizadeh et al. We hope to improve the clarity of this research and call attention to the methodological quality of performing a meta-analysis.

The introduction of Transcatheter Aortic Valve Implantation (TAVI) has transformed interventional cardiology and minimally invasive cardiac surgery. TAVI is a relatively new technique that is rapidly expanding in its indications and technology as well as places of practice. De-centralisation of this previous supra-specialised procedure can be done safely and efficaciously, to improve the health inequalities across regional and remote Australia. The purpose of this study is to detail the introduction of the TAVI program at a geographically isolated tertiary hospital in regional Australia. Illustrating the safe introduction of TAVI in this location may guide other isolated hospitals on the introduction of the service.

Introduction Pseudomonas aeruginosa is the most commonly isolated organism in children with ventilator-associated tracheobronchitis (VAT). Enteral treatment with ciprofloxacin or levofloxacin is sometimes employed, but supportive data are limited. The purpose of this study was to evaluate the effectiveness and safety of enteral ciprofloxacin and levofloxacin administration for VAT in children. Methods This was a retrospective review of electronic medical records for children less than 18 years of age who received enteral ciprofloxacin or levofloxacin for the treatment of VAT from January 2013 through January 2020 at an academic children’s hospital. Results Seventy-six children (median age 9.5, IQR 3.6-13.1 years), received ciprofloxacin or levofloxacin for VAT treatment during the study period. Median treatment duration was 8 (range 7-10) days. Most tracheostomy cultures (n=70/82, 85%) were polymicrobial, with P. aeruginosa most commonly isolated (n=67/224 organisms, 30%). Sixty-five children (86%) were successfully treated with an enteral fluoroquinolone. Antibiotics were changed or extended for two (3%) children. Ten (13%) children were prescribed antibiotics and eight (11%) required hospitalization for a lower respiratory tract infection within 30 days of completion of their fluoroquinolone course. Six (8%) patients received a seizure rescue medication, seven (9%) experienced emesis, and one (1%) had elevated transaminases. Tendonitis, tendon rupture and QTc prolongation were not observed. Conclusions The results of this study suggest enteral fluoroquinolones may be effective for the treatment of VAT in children. Further study is warranted to clarify the role of these agents in pediatric VAT.

The priority principle of storage allocation rules of serial cascade reservoirs within an inter-basin water supply can reduce water loss and reduce water supply times. Reasonable balancing curves for reservoirs in parallel are proposed and the proportional distribution of water is determined to illustrate the optimal allocation rule for different scheduling periods of reservoirs. The mutation point and slope are used to describe the segmentation of reservoirs in parallel. In addition, the optimization model is established with the objective function to minimize times of water shortage while the particle swarm optimization algorithm based on the immune evolutionary algorithm is applied to calibrate the balancing curves. Finally, the relative optimal water supply rule is obtained, providing a larger water supply capacity and higher storage synchronization of member reservoirs. The reservoir groups downstream of Luan River are used as an example, with the results showing that the suggested method can effectively improve the operational performance and meet shared water demands in an inter-basin multi-reservoir. This article highlights the superior results obtained compared to the current storage allocation rules to meet shared water demands.

Suspended sediment delivery and deposition in proglacial lakes is generally sensitive to a wide range of hydrometeorologic and geomorphic controls. High discharge conditions are of particular importance in many glaciolacustrine records, with individual floods potentially recorded as distinctive turbidites. We used an extensive network of surface sediment cores and hydroclimatic monitoring data to analyze recent flood turbidites and associated sediment transfer controls over instrumental periods at Eklutna Lake, western Chugach Mountains, Alaska. Close to a decade of fluvial data from primary catchment tributaries show a dominating influence of discharge on sediment delivery, with various interconnections with other related hydroclimatic controls. Multivariate fluvial models highlight and help quantify some complexities in sediment transfer, including intra-annual variations, meteorological controls, and the influence of subcatchment glacierization. Sediments deposited in Eklutna Lake during the last half century are discontinuously varved and contain multiple distinctive turbidites. Over a 30-year period of stratigraphic calibration, we correlate the four thickest flood turbidites (1989, 1995, 2006, 2012) to specific regional storms. The studied turbidites correlate with late-summer and early-autumn rainstorms with a magnitude of relatively instantaneous sedimentation 3 to 15 times greater than annual background accumulation. Our network of sediment core data captured the broad extent and sediment variability among the study turbidites and background sediment yield. Within-lake spatial modelling of deposition quantifies variable rates of downlake thinning and sediment focusing effects, and highlights especially large differences between the thickest flood turbidites and background sedimentation. This we primarily relate to strongly contrasting dispersion processes controlled by inflow current strength and turbidity. Sediment delivery is of interest for this catchment because of reservoir and water supply operations. Furthermore, although smaller floods may not be consistently represented, the lake likely contains a valuable proxy record of regional flooding proximal to major population centers of south-central Alaska including Anchorage.

Pangolins in the genus Manis are nocturnal, burrowing, insectivorous mammals listed as Critically Endangered or Endangered by the International Union for Conservation of Nature. Of the eight extant pangolin species worldwide, two species are found in Nepal: the Chinese pangolin (Manis pentadactyla) and the Indian pangolin (Manis crassicaudata). Despite having a great ecological role by controlling the ants or termite population, little attention has been given to the conservation interventions of both species of pangolins found in the Terai region (low land) of Nepal. The present study assesses habitat use and factors affecting the habitat choice of pangolins in low land (Terai), Nepal. The research was focused on Amritdharapani community forest of Chitwan district. Pangolin burrows were used as the indirect signs of pangolin presence. A total of thirty-nine burrows were observed at elevations ranging from 301 to 413 m asl. Burrows were frequently associated with north-west aspects, gentle slope (15º to 20º), moderate canopy cover (51 to 75%), red-colored soil, and acidic soils with pH 6.5 to 7. The burrows were most common in areas with weak human disturbance (i.e. 1500 to 1700 m from settlements), 800 to 1200 m from roads, and with-in 300 m from a water source and with-in 20 m from the nearest termitarium. This study revealed distance to settlement, distance to road, soil pH, and canopy cover as major factors affecting the habitat choice of pangolins in the study area.

Soil moisture signatures provide a promising solution to overcome the difficulty of evaluating soil moisture dynamics in hydrologic models. Soil moisture signatures are metrics that represent catchment dynamics extracted from time series of data and enable process-based model evaluations. To date, soil moisture signatures have been tested only under limited land-use types. In this study, we explore soil moisture signatures’ ability to discriminate different dynamics among contrasting land-uses. We applied a set of nine soil moisture signatures to datasets from six in-situ soil moisture networks worldwide. The dataset covers a range of land-use types, including forested and deforested areas, shallow groundwater areas, wetlands, housing areas, grazed areas, and cropland areas. These signatures characterize soil moisture dynamics at three temporal scales: event, seasonal, and time-series scales. Statistical and visual assessment of extracted signatures showed that (1) storm event-based signatures can distinguish different dynamics for most land-uses, (2) season-based signatures are useful to distinguish different dynamics for some types of land-uses (forested vs. deforested area, greenspace vs. housing area, and deep vs. shallow groundwater area), (3) timeseries-based signatures can distinguish different dynamics for some types of land-uses (forested vs. deforested area, deep vs. shallow groundwater area, non-wetland vs. wetland area, and ungrazed vs. grazed area). We compared signature-based process interpretations against literature knowledge: event-based and time series-based signatures were generally matched well with previous process understandings from literature, but season-based signatures did not. This study demonstrates the best practices of extracting soil moisture signatures under various land-use and climate environments and applying signatures for model evaluations.

Integrated study combining electrical resistivity tomography, geology, hydrogeomorphology, and weighted overlay analysis of various surface and subsurface thematic layers proved to be a very useful tool for evaluating the heterogeneous hard aquifer systems for groundwater assessment and development. A comprehensive study was carried out at representative and varied geological settings viz., Chotanagpur Granite-Gneiss Complex (CGGC), Ranchi has been accomplished from geology and geophysical datasets. The electrical resistivity tomography results revealed potential target zones at three sites in the study area up to a maximum of 170 m depth with a large variation in aquifer resistivity ranging from 80 to 800 Ω.m. These significant findings depicted a good correlation and are validated with the lithology in the surrounding of the resistivity tomography results. Nevertheless, the weighted overlay technique act as an essential tool for spatial analysis and interpretation of potential groundwater zones in the study area as well as validated the geophysical depth models whereas in-depth study on geology and hydrogeomorphology provides a detailed hydrogeological scenario throughout the study area for the long-term sustainability of the groundwater resources both at a local and in regional scale in the typical hard rock aquifer system.

Gastrointestinal duplication cysts are actually rare congenital anomalies that can accompany various anomalies and are most frequently seen in the small intestine. Gastrointestinal duplication may accompany anomalies such as vertebral anomalies, spinal cord malformations. Depending on the location, symptoms such as chest pain, shortness of breath, cough, asthma-like symptoms, hemoptysis, cyanosis, vomiting, difficulty swallowing, weight loss, hematemesis and melena can be observed. To our knowledge, we report a rare case that has not been reported in pediatric palliative care. We present a case operated for diaphragmatic hernia in the neonatal period. A 3-month-old patient with respiratory distress who was followed up in pediatric palliative care was reoperated and pathologically diagnosed as gastrointestinal duplication cyst. Thoracic cysts can have a wide variety of etiology. The correct diagnosis can be made by performing further examinations and appropriate surgery.

Objective: Diabetes is one of the most common chronic disease that requires comparatively more care to achieve optimal therapeutic outcomes. The aim of this study was to study the impact of pharmacist intervention on glycemic control of type 2 diabetes patients in a tertiary care hospital. The objectives were: To assess the parameters of glycemic control namely FBS, PPBS, and HbA1c; To provide patient education to one group of patients while other group of patients get standard care; To assess the impact of the educational intervention on blood sugar levels and HbA1c. Materials and methods: It was hospital based prospective interventional study carried out in the general medicine out-patient department of St. Philomena’s hospital, a tertiary care hospital, in Bangalore, India. The patients recruited were divided equally and randomly into control and intervention groups. Patients in the interventional group received patient informational leaflets, and education in addition to standard treatment, while the control group patients received only standard treatment. Parameters of glycemic control namely FBS, PPBS, and HbA1c of the patients were measured at baseline and at the end of the follow up period of 3 months and compared using appropriate statistical tests. Result: 50 patients having HbA1c value of >8% were included in the study. FBS, PPBS, and HbA1c values of all patients were measured at baseline and compared to the values obtained at the end of the follow up period, and was found to be statistically significant (p < 0.05). The difference in the baseline and follow up values between the control and intervention groups was also compared and found to be statistically significant (p< 0.05). Conclusion: It was observed from our study that pharmacist led educational intervention program for the management of type 2 diabetes had a positive impact in lowering the levels of glycemic parameter.

We provide parameter dependent version of the Browder–Minty Theorem in case when the solution is unique utilizing different types of monotonicity and compactness assumptions related to condition (S)2. Potential equations and the convergence of their Euler action functionals is also investigated. Applications towards the dependence on parameters for both potential and non-potenial nonlinear Dirichlet boundary problems are given.

Historical settlements can reflect the harmonious coexistence between ancient people and the local climate & geographical environment. In ancient times, many villages were formed during the period of war. To escape from the war, ancient people moved to places with good climate and suitable environment, and continued to improve their quality of life during the development and construction. The site selection, layout planning, architectural layout and material selection of these settlements have valuable scientific design concepts. Wind environment factors have significant influence on the construction of villages. However, the research about the influence of outdoor wind environment in traditional villages’ livable environment is still insufficient. In this paper, a village called Guzhu Village located in typical hot summer and cold winter zone in Jiangxi Province of China is selected to analyze the local climate environment. Computational fluid dynamics (CFD) simulation technology is used to study the selection of places for living in terms of outdoor wind environment. The results of the simulations confirm the habitability of the villages and the need to preserve such treasure.

A document by Saurabh Deshpande, written on Authorea.

ABSTRACT Background: Epistaxis is a mostly self-limiting condition common among children and is rarely severe. In this study, it was aimed to evaluate the incidence, demographic characteristics, causes of bleeding and treatment methods of patients who applied to the Pediatric Emergency Department (PED) with epistaxis, and to determine in which cases a laboratory test should be used. Method: Admitted to Gazi University Faculty of Medicine, PED which provides trauma care and is a tertiary hospital, between January 1, 2019 and December 31, 2019, 452 patients aged 0-18 years who presented with epistaxis to any reason or secondary to systemic disease were analyzed retrospectively. Results: The annual incidence was found 1.23%. The median age was 63 months, 258 of the cases (57.1%) were male. It was found that the cases most frequently applied to the hospital in the autumn months (37.6%). Sixty of the patients (13.3%) had a chronic disease and 54 (11.9%) had a history of drug use. Bleeding time was less than 5 minutes in 75.2% and 84.4% of the bleeding was unilateral. Nasal bleeding is local in 73.4%; 4.7% of them developed due to systemic reasons. The most common cause of epistaxis; while they were trauma at the first 10 years of age, they were idiopathic causes after the age of 10 years. In 434 (96%) of the patients, epistaxis spontaneously stopped and there was no need for additional treatment. Conclusion: As a result of this study, it was concluded that laboratory tests should be performed in cases with chronic disease history, bilateral bleeding, active bleeding and nontraumatic epistaxis. The situation that causes epistaxis in the childhood age group should be determined with a good history and physical examination, laboratory tests should not be used in every patient. Key Words: pediatric emergency, epistaxis, laboratory examinations, complete blood count

Objective: To describe the burden of influenza among pregnant women and their young infants. Design: Prospective cohort study. Setting: Rural western Kenya. Population: Pregnant women below 31 weeks of gestation and their infants aged 6 months and below Methods: We conducted weekly follow-up until 6 months postpartum to identify acute respiratory illnesses (ARI). We collected nasal/nasopharyngeal and oropharyngeal swabs from mothers/infants with ARI and tested for influenza A and B using polymerase chain reaction. We calculated incidence of laboratory-confirmed influenza per 1,000 person-months. Main outcome measure: Incidence of medically attended influenza illness among pregnant women and its impact on birth outcomes. Results: During June 2015–May 2020, we enrolled 3,026 pregnant women at a median gestational age of 16 weeks (interquartile range [IQR], 13, 18) and followed 2,550 infants. Incidence of laboratory-confirmed influenza during pregnancy (10.3 episodes per 1,000 person-months [95% CI 8.6–11.8]) was 2-fold higher than in the postpartum period (4.0 [95% CI 2.6–5.5]; p<0.01), and significantly higher among HIV-infected pregnant women (15.6 [95% CI 11.0–20.6] vs. 9.1 [95% CI 7.5–10.8]; p<0.01). Incidence among young infants was 4.4 (95% CI 3.0–5.9) and similar among HIV-exposed and HIV-unexposed infants. Conclusion: Our findings suggest a substantial burden of influenza illnesses during pregnancy, with a higher burden among HIV-infected mothers. Kenyan authorities should consider the value of vaccinating pregnant women, especially if HIV-infected. Funding: This work was supported by funding [Grant number GH002133] from the U.S. CDC, through the Influenza Division. Keywords: Burden, influenza, pregnant women, infants

Background: We aimed to determine the relationship of ischemia-modified albumin (IMA) with diabetic foot ulcers and its predictive value in the Wagner classification. Methods: Our cross-sectional study was conducted in 120 diabetic foot patients and 60 healthy individuals with similar body mass index and age. Patients with a diabetic foot were classified according to the Wagner classification. Biochemical parameters, C-reactive protein (CRP) and IMA levels were measured in all patients and healthy volunteers. Screening performance characteristics of CRP and IMA were calculated according to Wagner classes and the presence of osteomyelitis. Results: CRP and IMA levels in the patient group were significantly higher than the control group. The highest IMA levels were detected in Wagner grade 5. CRP had higher sensitivity and specificity than IMA in the discrimination of other grades, except for grade 4-5 separation. For Wagner grade 4-5 distinction, IMA had 84.6% sensitivity and 94.7% specificity. Conclusion: IMA may play a role in the pathogenesis of diabetic foot ulcers and had a higher predictive value in discrimination of the Wagner grade 4 and 5. In the management of diabetic foot patients, it may be recommended that IMA is evaluated by clinicians.

Aims: The COVID-19 pandemic led to hospitals in the United Kingdom substituting face-to-face (FtF) clinics with virtual clinic (VC) appointments. We evaluated the impact of virtual two-week wait (2-ww) lower gastrointestinal (LGI) consultations on stakeholders at a district general hospital in England. Methods: Patients undergoing index outpatient 2-ww LGI clinic assessment between 01/06/2019-31/10/2019 (FtF group) and 01/06/2020-31/10/2020 (VC group) were identified. Relevant data were obtained using electronic patient records. Compliance with national cancer waiting time targets (WTT) was assessed. Environmental and financial impact analyses were performed. Results: In total, 1531 patients were analysed (median age=70, male=852, 55.6%). Of these, 757 (49.4%) were assessed virtually via telephone; the remainder were seen FtF (n=774, 50.6%). Ninety two (6%, VC=44, FtF=48) patients had malignant pathology and 64 (4.2%) had colorectal cancer (CRC); of these, 46 (71.9%, VC=26, FtF=20) underwent treatment with curative intent. The median waiting times to index appointment, investigation and diagnosis were significantly lower following VC assessment (p<0.001). The cancer detection rates (p=0.749), treatments received (p=0.785) and median time to index treatment for CRC patients (p=0.156) were similar. A significantly higher proportion of patients were seen within two weeks of referral in the VC group (p<0.001). VC appointments saved patients a total of 9288 miles, 0.7 metric tonnes of CO2 emissions and £7482.97. Taxpayers saved £80,242.00 from VCs. No adverse events or complaints were reported in the VC group. Conclusion: Virtual 2-ww LGI clinics were effective, safe and were associated with tangible environmental and financial benefits for stakeholders.

Objective: To evaluate the effect of age on the success and complications of percutaneous nephrolithotomy (PCNL) in staghorn renal stones. Materials and Methods: The files of 182 patients who underwent single-access PCNL for staghorn renal stones between 2012 and 2017 were retrospectively analyzed. The patients were divided into two groups according to their age: those aged<65 years were defined as Group-1 and those aged≥65 years as Group-2. The demographic characteristics and perioperative and postoperative results were compared between the two groups. Results: Of the patients with staghorn renal stones,139 were in Group-1 and 43 were in Group-2. The mean age of the patients was 43.9±10.6 years for Group-1 and 67.8±2.1 years for Group-2(p=0.001). The amount of hemoglobin drop was statistically significantly higher in Group-1 (p=0.001). However, blood transfusion rate was higher in Group-2 than in Group-1 (18.6% and 7.2%, respectively). The stone-free rate was 54.7% in Group-1 and 67.4% in Group-2(p=0.139). According to the evaluation of the overall complication rates,34.5% of the patients in Group-1 and 46.5% of those in Group-2 developed complications(p=0.206). According to the Clavien scoring system, the rate of minor complications was found to be 22.3% in Group-1 and 41.9% in Group-2,and the difference was statistically significant (p=0.012). The major complication rates were determined as 4.7% and 12.2% for Group-1 and Group-2, respectively (p=0.155). The number of patients with Clavien grade-2 complications was statistically higher in the elderly patient group (p=0.019). Conclusions: PCNL can be used as an effective and safe treatment method in the treatment of complex stones in elderly patients.

Introduction: Vancomycin is a glycopeptide antibiotic that is considered as the drug of choice against many Gram-positive bacterial infections, especially Methicillin-resistant Staphylococcus aureus (MRSA). Also, it is a hydrophilic drug with predominantly renal elimination. Given the vancomycin narrow therapeutic index, therapeutic drug monitoring (TDM) is essential to achieve an optimum clinical response and avoid vancomycin-induced adverse drug reactions including nephrotoxicity and ototoxicity. Although different studies are available on vancomycin pharmacokinetic assessment and vancomycin TDM, still there are controversies regarding the selection among different pharmacokinetic parameters including trough concentration (Cmin), the daily area under the curve to minimum inhibitory concentration (AUC24h/MIC) ratio, AUC of intervals (AUCτ), elimination constant (k), vancomycin clearance (ClV) and methods of their calculations for TDM purposes. Methods: In this review, different pharmacokinetic parameters for vancomycin TDM have been discussed in detail along with corresponding advantages and disadvantages, based on the literature review. Determination of vancomycin concentration at steady state (Css) during 24h continuous injection are mentioned. Also, vancomycin pharmacokinetic assessments are discussed in detail in patients with altered pharmacokinetic parameters including those with renal and/or hepatic failure, critically ill patients, patients with burn injuries, intravenous (IV) drug users, obese and morbidly obese patients, those with cancer, patients undergoing organ transplantation, and vancomycin administration during pregnancy and lactation. Results and Discussion: An individualized dosing regimen is required to guarantee the optimum therapeutic results and minimize severe adverse reactions such as acute kidney injury (AKI) in these special groups of patients with altered pharmacokinetic parameters. Also, according to the pharmacoeconomic data on vancomycin TDM, pharmacokinetic assessments would be cost-effective in the mentioned groups of patients with altered pharmacokinetics and associated with shorter hospitalization period, faster clinical stability status, and shorter courses of inpatient vancomycin administration.

Primary cardiac tumors are extremely rare.Most primary tumors are benign,and malignant tumors comprise about 15%1.Angiosarcoma is the most common type of primary cardiac malignant tumors.Compared with the left atrium or ventricle,the tumor prefer to occur in the right atrium or ventricle,especially the right atrium.In this case report,we present the case of a 32-year-old female with cardiac angiosarcoma primary to the right atrial appendage(RAA).

Keywords: Pediatric, Renovascular, Hypertension, Evolution, MedicineAbbreviations: renal artery stenosis (RAS), fibromuscular dysplasia (FMD), Takayasu arteritis (TA), ACE insertion/deletion (ACE I/D), renovascular hypertension (RVH), angiotensin I (ang I), angiotensin II (ang II), angiotensin converting enzyme (ACE), midaortic syndrome (MAS), angiotensinogen (AGT)Correspondence: 1130 14th Street, Huntington, WV, 25701, Apartment 133Email: chhabra@marshall.edu