We describe here the third reported case of anaphylaxis after ingestion of some leavers of Moringa oleifera, causing a widespread angioedema, a respiratory distress and an elevation of serum tryptase. Moringa oleifera leavers were confirmed as the causative allergen by prick testing with fresh leavers.

Hemolytic disease of the fetus and newborn can cause hydrops and intrauterine death due to fetal anemia. Immunoglobulin and plasmapheresis have been used to defer blood transfusions to later gestational ages and treat fetal anemia in patients who were immunized early in pregnancy, with different success.

Recombination is responsible for breaking up haplotypes, influencing genetic variability, and the efficacy of selection. Bird genomes lack the protein PRDM9, a key determinant of recombination dynamics in most metazoans. The historical recombination maps in birds show an apparent stasis in the positioning of recombination events. This highly conserved recombination pattern over long timescales should constrain the evolution of recombination in birds, but extensive variation in recombination rate across the genome and between different species has been reported. Here, we characterise a fine-scale historical recombination map of an iconic migratory songbird, the European blackcap (Sylvia atricapilla) using a LD-based approach which accounts for population demography. We found variable recombination rates among and within chromosomes, which associate positively with nucleotide diversity and GC content, and a negatively with chromosome size. The recombination rates increased significantly at regulatory regions and not necessarily at high-dense gene regions. CpG islands associated strongly with recombination rates; however, their specific position and local DNA methylation patterns likely influenced this relationship. The association with retrotransposons varied according to specific family and location. Our results also provide evidence of a heterogeneous conservation of recombination maps between the blackcap and its closest sister taxon, the garden warbler at the intra-chromosomal level. These findings highlight the considerable variability of recombination rates at different scales and the role of specific genomic features at shaping this variation. This study opens the possibility of further investigating the impact of recombination in specific population-genomic features.

Cryptogenic stroke is a complication commonly associated with patent foramen ovales (PFOs). However, current guidelines do not address PFO management in COVID-19 patients. This report describes a challenging case of an unvaccinated patient with recurrent strokes and refractory hypoxemia secondary to COVID-19 pneumonia who underwent a PFO closure using NobleStitch.

Rickettsial infections and Q fever are a common cause of acute febrile illness globally. Data on the role of climate and altitude on the prevalence of these infections in lacking from Southern India. In this study, we determined the sero-prevalence of scrub typhus (ST), spotted fever (SF), murine typhus (MT) and Q Fever (QF) in 8 eight geographical regions of North Tamil Nadu by detecting IgG antbodies using ELISA. Totally we tested 2565 people from 86 localities. Among the 27.3 % positives, approximately 5% were IgG positive for two or more infections. Seroprevalence to rickettsioses and Q fever was highest for individuals from rural areas and increased with age (>30 years). Those in the Nilgiris highlands (wetter and cooler) and Erode, which has the most land under irrigation, demonstrated the least exposure to rickettsioses and Q fever. Lowland plains (AOR: 8.4-22.9; 95% CI: 3.1-55.3) and highland areas upto 1000 metres (AOR: 6.1-10.3; 95% CI: 2.4-23.9) showed the highest risk of exposure to scrub typhus. For spotted fever, the risk of exposure was highest in Jawadhi (AOR:10.8; 95% CI: 2.6-44.3) and Kalrayan (AOR:16.6; 95% CI: 4.1–66.2). Q fever positivity was most likely to be encountered in Salem (AOR: 5.60; 95% CI: 1.01 – 31.08) and Kalrayan hills (AOR:12.3; 95% CI:2.9 – 51.6). Murine typhus risk was significant only in Thiruvannamalai (AOR:24.2; 95% CI: 3.3 – 178.6). Based on the data generated it seems that rickettsial infections and Q fever prevalence is low in areas which receive rainfall of ≥150 cm/yr, with average minimum and maximum temperatures between 15-25 oC and elevation in excess of 2000 metres. It is also low in low land and irrigated lands with dry climate. These preliminary findings need to be validated by conducting active surveillance in these areas.

Background and Purpose: In accord with ICH S7B guidelines, an in vitro human ether-a-go-go-related gene (hERG) assay is conducted to assess risk for delayed ventricular repolarization. Function of hERG could be affected by direct and acute mechanisms, or by indirect and chronic mechanisms. Oligonucleotides have unique mechanisms and time courses of action. To help frame the strategy of hERG assay for siRNA, investigation was performed to assess the time-course for siRNA-mediated inhibition of hERG function and gene expression. Experimental Approach: Commercially available siRNAs of hERG were evaluated in a stable hERG expressed cell line by whole-cell voltage clamp using automated electrophysiology and polymerase chain reaction (PCR). Key Results: In the acute hERG study, no effects were observed by applying 100 nM siRNA for 20 min. The chronic effects of 100 nM siRNAs on hERG function were evaluated by transfection and recorded over 8-48 hrs, after transfection. At 8 hrs there was no significant effect, while 81% reduction was observed at 48 hrs. Measurement of hERG mRNA levels demonstrated a 79% and 93% decrease of hERG mRNA at 8 and 48 hrs., respectively, consistent with a preceding effect on gene expression compared to protein function. Conclusion and Implications: Results presented here indicate that an anti-hERG siRNA requires a long exposure time (48 hrs.) in the hERG assay to produce a maximal effect; short exposures (20 min-8 hrs.) had no effect. These findings imply that oligonucleotides require specific and appropriate protocols to characterize their potential off-target effects on hERG channel.

Background: Realgar-Indigo naturalis formula (RIF) containing A 4S 4 as a major ingredient is an oral arsenic available in China. The efficacy of RIF on pediatric acute promyelocytic leukemia (APL) is comparable to arsenic trioxide (ATO). However, it remains to be explored that the effects of these two arsenicals on differentiation syndrome (DS) and coagulation disorder which are the two main life-threatening events in children with APL. Procedure: We analyzed 68 consecutive children with newly diagnosed APL involved in SCCLG-APL study (NCT02200978). Patients received all-trans retinoic acid (ATRA) on day 1 of induction therapy. ATO (0.16 mg/kg·d) or RIF (135 mg/kg·d) was administrated on day 5 after mitoxantrone on day 3 (non-high-risk group, NHR) or day 2-4 (high-risk group, HR). Results: The incidences of DS were 3.0% and 5.7% in ATO (n = 33) and RIF (n = 35) groups ( p = 0.590), and 10.3% and 0% in patients with and without differentiation-related hyperleukocytosis, respectively ( p = 0.04). The dynamic changes of WBC between the ATO and RIF groups were not statistically different. However, patients with high WBC counts or percentage of promyelocytes in peripheral blood tended to develop differentiation-related hyperleukocytosis. The improvement of coagulation indexes in the ATO and RIF groups had no statistical difference. Fibrinogen and prothrombin time had the quickest recovery rate. Conclusions: This study provides evidences that the incidence of DS and recovery of coagulopathy are similar whenever treating with RIF or ATO in children with APL.

Logical deductions from experimental data have been unable to explain the origin of the current monkeypox outbreaks in multiple countries. But upon illustrating the reality in which these outbreaks occur, it was found to be that in which different diseases of the same immunological nature, the nature that permits them to be rendered asymptomatic simultaneously without the elimination of their different causes, appear simultaneously when conditions that permitted immune mechanisms to bring about such protection disappear. An outbreak of such immunologically equivalent diseases therefore does not require the spread of those that are pathogens among the causes of such diseases to occur. And the manifestations of such diseases will become widespread in a population when factors that cause the disappearance of conditions that permitted them to be rendered asymptomatic by immune mechanisms become widespread in the population. If we will escape the threat that the catastrophically widespread appearance of manifestations such as Ebola and malignancies will pose to our species, our topmost research priority ought to be the immunological nature of the pathological effects of the pathogens that are linked with them.

Objective: To evaluate the long-term outcomes of vulvar or vaginal cancer patients undergoing laparoendoscopic single-site inguinal lymphadenectomy (LESS-IL). Design: Prospective cohort study. Setting: Single centre in Zhongda Hospital, Southeast University from July 2018 to April 2021. Population: A total of 16 women diagnosed with vulvar or vaginal cancer. Methods: Women with vulvar or vaginal cancer underwent LESS-IL performed by the same surgeon from July 2018 to April 2021. Main outcome measures: Short- and long-term complications, and oncologic outcomes Results: A total of 16 patients undergoing 28 LESS-IL procedures were identified, among whom 4 underwent unilateral LESS-IL. Median numbers of excised groin lymph nodes were 9.0 (6.5-11.8) and 10.5 (8.3-12.0) in each left and right groin, respectively. Short-term complications occurred in 4 (25%) patients, including 18.7% lymphocele and 6.3% wound infection. Long-term complications regarding lower limb lymphedema appeared in 6 (37.5%) patients. Most of the short- and long-term complications were Clavien-Dindo 1 or 2, accounting for 90% of all postoperative issues. After a median follow-up of 23 (17.3‐31.8) months, only 1 patient (6.3%) had isolated inguinal recurrence at 13 months postoperatively. No local or distant recurrence occurred. Conclusion: Our results suggest that LESS-IL is associated with little incidence of complications and promising oncologic outcomes, further demonstrating the safety and feasibility of LESS-IL technique in patients requiring IL. Keywords Laparoendoscopic single-site inguinal lymphadenectomy, vulvar cancer, vaginal cancer, compliaction, oncologic outcome

Sentinel lymph node (SLN) refers to the initial site of the lymphatic drainage from a primary tumor area. Accordingly, sentinel lymph node mapping (SLNM) has been brought up and widely applied to cancer therapy for its illuminating role in clinical lymph node resection. Furthermore, sufficient information to guide surgical pathological staging and adjuvant treatment in endometrial cancer can be rendered by SLNM, hence minimizing surgery injury and reducing the incidence of complications. This review aims to systematically summarize the advances and application prospects of SLNM in endometrial cancer, with an expectation of furnishing reference for the clinical application.

A document by I-Le Hsu. Click on the document to view its contents.

Aim: To evaluate the safety, tolerability, pharmacokinetics and pharmacodynamics of SHR2285, the first oral coagulation factor XIa (FXIa) inhibitor developed in China in combination with aspirin, clopidogrel or ticagrelor in healthy subjects. Methods: This study was a single-center, randomized, double-blind, placebo-controlled (only SHR2285) design. A total of 52 healthy subjects, 29 male and 23 female, were enrolled in this study. The subjects were divided into three groups: A, B and C, 16 subjects in group A (aspirin+clopidogrel+placebo or SHR2285 200mg bid (1:3)), 16 subjects in group B (aspirin+clopidogrel+placebo or SHR2285 300mg bid (1:3)) and 20 subjects in group C (aspirin+ticagrelor+placebo or SHR2285 300mg bid (2:3)), respectively. All groups were administered orally for 6 consecutive days. Results: 1. SHR2285 was well tolerated, and all adverse events were mild. There was no evidence of an increased risk of bleeding. 2. After 6 days of twice-daily administration, SHR2285 could reach a steady state. The half-life of SHR2285 was 13.9h, 14.5h and 13.8h respectively. 3. SHR2285 markedly inhibited FXI: C and prolonged APTT. The maximum inhibition rates of FXI: C in the three groups were 84.8%, 89.3% and 92.2% and the maximum prolongation time of APTT was 2.08-, 2.36-, and 2.26-fold, respectively. 4. The combination of aspirin, clopidogrel or ticagrelor had limited effect on the AUC of SHR2285. Conclusion: These data suggest that SHR2285, a potential oral FXIa inhibitor, is expected to become a novel, safe and effective anticoagulant.

Supersymmetry arguments are used to derive the wave function of a two-level atom interacts with a single mode cavity field through a multi-photon transition in the presence of a Kerr-like medium and Stark term. The supersymmetric operators related to the atomic system are introduced to diagonalize the Hamiltonian with a canonical transformation technique. Also, the eigenvalues spectrum and eigenvectors are exactly given.

Background Human Metapneumovirus (hMPV) is an important cause of pediatric respiratory infection. We leveraged the Nicaraguan Pediatric Influenza Cohort Study (NPICS) to assess the burden and seasonality of symptomatic hMPV infection in children. Methods NPICS is an ongoing prospective study of children in Managua, Nicaragua. We assessed children for hMPV infection via RT-PCR. We used classical additive decomposition analysis to assess the temporal trends and Generalized Growth Models (GGMs) were used to estimate effective reproduction numbers. Results From 2011-2016 there were 564 hMPV symptomatic infections yielding an incidence rate of 5.74 cases per 100 person-years (95% CI 5.3, 6.2). Children experienced 3,509 Acute Lower Respiratory Infections (ALRIs), of which 160 (4.6%) were associated with hMPV infection. Children under the age of one had 55% of all symptomatic hMPV infections (62/112) develop into hMPV-associated ALRIs and were five times as likely as children over one to have an hMPV-associated ALRI (Rate Ratio 5.5 95% CI 4.1, 7.4 p <0.001). Additionally, symptomatic reinfection with hMPV was common. In total, 87 (15%) of all observed symptomatic infections were reinfections. The seasonality of symptomatic hMPV outbreaks varied considerably. From 2011-2016, four epidemic periods were observed, following a biennial seasonal pattern. The mean ascending phase of the epidemic periods were 7.7 weeks, with an overall mean estimated reproductive number of 1.2 (95% CI 1.1, 1.4). Conclusions Symptomatic hMPV infection was associated with substantial burden among children in the first year of life. Timing and frequency of symptomatic hMPV incidence followed biennial patterns.

Nanocomposites are heterogeneous media with two or more microstructural levels. For instance, a nano-level characterized by isolated nano-inclusions and a micro-level represented by the clusters resulting from aggregation processes. Our goal is to present a procedure to study the influence of this aggregation process and interfacial thermal resistance on the effective thermal conductivity. The procedure is based on the Reiterated Homogenization Method and consists of two stages. First, an effective intermediate thermal property is obtained by taking into account only the influence of the individual nano-inclusions in the matrix. Second, the final effective thermal coefficient ($\hat{k}_{RH}$) is calculated considering the clusters immersed in the intermediate effective medium derived in the first step. The conductivity gain ($k_{gain}$) is defined as the quotient ($\hat{k}_{RH}/\hat{k}_{CH}$) where $\hat{k}_{CH}$ is the effective thermal coefficient computed considering only one micro-structural level. The scheme is exemplified for 2-D square arrays of circular cylinders. The analytical formulas of the effective coefficient used in the calculations generalize other well known formulas reported in the literature. Finally, the effect of thermal conductivity gain is illustrated as a function of the Biot number, the quotient of the thermal conductivity, the fibers volume fraction and an aggregation parameter. The present contribution could be useful for nano-reinforced fibers applications and nanofluids. Furthermore, the present formulas can be used to assess numerical computations. An appendix is included showing similarities and differences between the obtained analytical formulas of effective coefficients, for different truncation orders, and those derived from the trifasic model.

The subject of this research is the time-domain scattering problem for a three-dimensional layered elastic shell submerged in a two-layered fluid separated by an unbounded rough surface. The essence of the problem is to model the scattering interaction between the given elastic shell and some incident wave in a two-layered medium. Using the exact transparent boundary condition (TBC), we reformulate the unbounded scattering problem into an equivalent initial-boundary value problem. The well-posedness is proved for the problem by the Laplace transform and variational method in the s-domain. Moreover, we show that the reduced problem has a unique weak solution by the energy method. The priori estimates with explicit dependence on the time are derived for the acoustic pressure and the elastic displacement in the time domain.

Title: A prospective study comparing Itraconazole and systemic steroids as an adjunct to topical steroids in the post-operative management of Allergic fungal rhinosinusitis ABSTRACT Objectives The objective of this study was to compare the efficacy of Itraconazole and systemic steroids as an adjuvant to topical steroids in post-operative patients with Allergic Fungal Rhinosinusitis (AFRS) using both subjective and objective outcome measurements. Methods A prospective comparative study was conducted in a tertiary care center on 60 patients diagnosed with AFRS. Patients with chronic systemic illness and those undergoing revision surgery were excluded. Post-operative patients were divided into two groups of 30 each which received Itraconazole 400 mg OD or Methylprednisolone in tapering doses over six weeks. The outcomes were measured at the end of 6 weeks -Kupferberg endoscopic staging, Absolute Eosinophilic Count (AEC), Serum Immunoglobulin (IgE), and Sino Nasal Outcome Test - 20 scores. Results Our study showed no statistical significance in outcomes between the two groups treated with Itraconazole and Methylprednisolone regarding recurrence, AEC, IgE, and Quality of Life Assessment (p<0.01). Conclusion Itraconazole was comparable to Methylprednisolone in preventing disease recurrence in the post-operative management of AFRS. It may be a viable alternative to replacing systemic steroids where the latter may be contraindicated. Itraconazole given at a dose of 400 mg once daily for six weeks was a safe dose. Keywords: Allergic Fungal Rhinosinusitis, Itraconazole, endoscopy, Quality of Life, Methylprednisolone Key points: • Itraconazole was comparable to systemic steroid (Methylprednisolone) in preventing disease recurrence in the post-operative management of AFRS. • It may be a viable alternative to replacing systemic steroids where the latter may be contraindicated. • Itraconazole given at a dose of 400 mg once daily for six weeks was a safe dose. • Recurrence may be treated safely with Itraconazole than with steroids. • The course may be repeated in case of recurrence with close monitoring.

A document by Lijun Sui. Click on the document to view its contents.

A novel technique is proposed for finding an approximate solution of the strongly nonlinear ordinary differential equation for the charged damped pendulum with one degree of freedom. The method relies on a transformation of the governing nonlinear differential equation that keeps unchanged the order of the highest derivative, in conjunction with a modified homotopy perturbation technique (MHPM). Only quadratic damping is considered for the numerical computations. To validate the used technique, the obtained results are compared to those arising from a numerical solution by Runge-Kutta of the fourth order (RK4) and by finite differences (FD). Good agreement between the two solutions is reached when quadratic damping is suppressed. In the presence of damping, agreement takes place only for a rather limited range of times. Plots of the analytical solutions are provided for both cases. The proposed method may be used to analyze a wide class of nonlinear differential equations.

This research studies Graphene Quantum Dots (GQDs) adsorption on Staphylococcus aureus surface protein G (SasG) using the molecular dynamics simulation method that in addition to investigating various aspects of adsorption, including edge and surface effects of GQDs, and effects of orientation and size of GQDs, proposes a new study method in edge effects studies. Through our simulations to find edge effects, we found that even if GQD approaches the protein with its edges, GQDs’ edges are not freely adsorbed on the protein because when the particles interact with each other, GQD rotates and then adsorbs the protein with its surface; therefore, GQD having initial velocity was applied to the protein to force the protein to interact with GQDs’ edges to find both surface and edge effects. This is a new way of investigating that we propose to study edge effects in the molecular dynamics simulation method.

Background: Adolescent and young adult (AYA) cancer patients experience complex physical and psychosocial development and diverse lifestyle changes. Therefore, each may have generation-specific needs. This study aimed to develop the Japanese version of the Cancer Needs Questionnaire – Young People (CNQ-YP-J) and verify its reliability and validity among AYA cancer patients in Japan. Methods: The CNQ-YP-J was developed using a standardized translation methodology. Content validity was assessed by a group of experts, and a pilot test was conducted on six AYA cancer patients. About 87 Japanese patients with AYA cancer participated in this study. After exploratory factor analysis was conducted, the scale’s reliability was examined using Cronbach’s α, item-total correlations, and intraclass correlation coefficient (ICC) of the retest. Criterion-related validity was analyzed using correlations between total needs and concerns about physical effects and quality of life (QOL). Results: Factor analysis showed an eight-factor structure, different from the original scale, with one item excluded, resulting in a 69-item scale. Cronbach’s α coefficient and ICC were above the minimum acceptable criterion of 0.70, demonstrating high reliability. Concerning criterion-related validity, high needs were positively correlated with high concerns about physical effects and tended to be negatively correlated with QOL. Conclusion: The CNQ-YP-J is a reliable and valid scale to comprehensively assess the needs of AYA cancer patients in Japan.

We shall investigate the asymptotic behavior of solutions to the Cauchy problem for the one-dimensional bipolar quantum Euler-Poisson system with time-dependent damping effects $\frac{J_i}{(1+t)^{\lambda}}(i=1,2)$ for $-1<\lambda<1$. Applying the technical time-weighted energy method, we prove that the classical solutions to the Cauchy problem exist uniquely and globally, and time-algebraically converge to the nonlinear diffusion waves. This study generalizes the results in [Y.-P. Li, Nonlinear Anal., 74(2011), 1501-1512] which considered the bipolar quantum Euler-Poisson system with constant coefficient damping.

We report seven patients who underwent bail out cryoballoon ablation of ventricular arrhythmias refractory to conventional endocardial radiofrequency ablation. Ablated arrhythmia substrates included right ventricular moderator band (n=2), left ventricular (LV) papillary muscle (n=2), left fascicular (n=1) and deep LV myocardial (n=2). Cryoballoon ablation was successful in 5/7 patients. Advantages of cryoballon ablation include adhesive stability on endocavitary structures and creation deep homogeneous myocardial lesionds. Newer balloon technologies designed to improve myocardial contact that incorporate high density mapping on the balloon surface may expand utility of this technology for ablation of ventricular arrhythmias.

Arterial bleeding can take a dramatic course with severe bleeding, therefore it requires an immediate diagnosis and treatment. In this case series, we present 2 cases of arterial injury during pacemaker implantation.