Objectives: To understand the epidemiological and clinical characteristics of pediatric SARS-CoV-2 infection during the early stage of Omicron variant outbreak in Shanghai. Study designs: This study included local COVID-19 cases<18 years in Shanghai referred to the exclusively designated hospital by the end of March 2022 since emergence of Omicron epidemic. Clinical data, epidemiological exposure and COVID-19 vaccination status were collected. Relative risks (RR) were calculated to assess the effect of vaccination on symptomatic infection and febrile disease. Results: A total of 376 pediatric cases of COVID-19 (median age:6.0±4.2 years) were referred to the designated hospital during the period of March 7-31, including 257 (68.4%) symptomatic cases and 119 (31.6%) asymptomatic cases. Of the 307 (81.6%) children ≥3 years eligible for COVID-19 vaccination, 110 (40.4%) received 2-dose vaccines and 16 (4.0%) received 1-dose vaccine. The median interval between 2-dose vaccination and infection was 3.5 (IQR: 3, 4.5) months (16 days-7 months). Two-dose COVID-19 vaccination reduced the risks of symptomatic infection and febrile disease by 35%(RR 0.65, 95% CI: 0.53-0.79) and 33% (RR 0.64, 95% CI: 0.51-0.81). Two hundred and sixteen (83.4%) symptomatic cases had fever (mean duration:1.7±1.0.8 days), 104 (40.2%) had cough, 16.4% had transient leukopenia; 307 (81.6%) had an epidemiological exposure in household (69.1%) , school (21.8%) and residential area (8.8%). Conclusion: The surge of pediatric COVID-19 cases and multiple transmission model reflect wide dissemination of Omicron variant in the community. Asymptomatic infection is common among Omicron-infected children. COVID-19 vaccination can offer some protection against symptomatic infection and febrile dise
Background Microbiome studies are often limited by a lack of statistical power due to small sample sizes and a large number of features. This problem is exacerbated in correlative studies of multi-omic datasets. Statistical power can be increased by finding and summarizing modules of correlated observations, which is one dimensionality reduction method. Additionally, modules provide biological insight as correlated groups of microbes can have relationships among themselves. Results To address these challenges, we developed SCNIC: Sparse Cooccurrence Network Investigation for compositional data. SCNIC is open-source software that can generate correlation networks and detect and summarize modules of highly correlated features. Modules can be formed using either the Louvain Modularity Maximization (LMM) algorithm or a Shared Minimum Distance algorithm (SMD) that we newly describe here and relate to LMM using simulated data. We applied SCNIC to two published datasets and we achieved increased statistical power and identified microbes that not only differed across groups, but also correlated strongly with each other, suggesting shared environmental drivers or cooperative relationships among them. Conclusions SCNIC provides an easy way to generate correlation networks, identify modules of correlated features and summarize them for downstream statistical analysis. Although SCNIC was designed considering properties of microbiome data, such as compositionality and sparsity, it can be applied to a variety of data types including metabolomics data and used to integrate multiple data types. SCNIC allows for the identification of functional microbial relationships at scale while increasing statistical power through feature reduction.
Sickle cell disease (SCD) requires coordinated, specialized medical care for optimal outcomes. There are no United States (US) guidelines that define a pediatric comprehensive SCD program. We report a modified Delphi consensus-seeking process to determine essential, optimal, and suggested elements of a comprehensive pediatric SCD center. Nineteen pediatric SCD specialists participated from the US. Consensus was predefined as 2/3 agreement on each element’s categorization. Twenty-six elements were considered essential (required for guideline-based SCD care), ten were optimal (recommended but not required), and five were suggested. This work lays the foundation for a formal recognition process of pediatric comprehensive SCD centers.
The direct Z-scheme provide a potential strategy for high efficient CO2 photoreduction, whereas the heterointerface contact resistance is significantly limited the interfacial electron transfer kinetic. Herein, we build the directional charge-transfer channels in a direct Z-scheme system over metal−organic frameworks (MOFs), that is the lattice-guided MOF-on-MOF hybrids, to facilitate CO2 photoreduction. The heteroepitaxial lattice growth along the c-axis of MIL-88B(Fe) via the high-activity (001) facet over the stable (111) facet of UiO-66-NH2. Theoretical calculations and experimental results provide the direct evidence that engineering direct Z-scheme of these MOFs hybrids can induce the electrons migration from UiO-66-NH2 to the holes of MIL-88B(Fe) by directional charge-transfer channels owing to their lattice match. This can dramatically boosts photocatalytic CO2-to-CO selectivity up to nearly 100%, with a rate of 2.26 μmol·g-1·h-1. This work demonstrates that the efficiently selective CO2 photoreduction processes can be achieved by engineering Z-scheme via lattice intergrown of MOF hybrids strategy.
CO2 methanation is one of the vital reactions to utilize CO2 and realize power to gas process. To decrease the CO2 capture cost and alleviate the hot spots during the strong exothermic methanation reaction, here, we report a coupling of CO2 capture process with in situ CO2 methanation process through a ceramic-molten carbonate (MC) dual phase membrane reactor over the Ni-based catalyst. The performance of the membrane reactor was systematically investigated and compared with the traditional fixed-bed reactor. The results show that the performance of the membrane reactor is higher than that of the fixed-bed reactor, since the produced steam through the methanation process can be partially removed through the dual-phase membrane, which promotes the reaction shift to right side. A stability test shows no obvious degradation within 32 h. These results indicate that the membrane reactor is promising for coupling CO2 capture with in situ methanation process.
An important hypothesis for how plants respond to introduction to new ranges is the evolution of increased competitive ability (EICA). EICA predicts that biogeographical release from natural enemies initiates a tradeoff in which exotic species in non-native ranges become larger and more competitive, but invest less in consumer defenses, relative to populations in native ranges. This tradeoff is exceptionally complex because detecting concomitant biogeographical shifts in competitive ability and consumer defense depend upon which traits are targeted, how competition is measured, the defense chemicals quantified, whether defense chemicals do more than defend, whether “herbivory” is artificial or natural, and where consumers fall on the generalist-specialist spectrum. Previous meta-analyses have successfully identified patterns but have yet to fully disentangle this complexity. We used meta-analysis to reevaluate traditional metrics used to test EICA theory and then expanded on these metrics by partitioning competitive effect and competitive tolerance measures and testing Leaf Specific Mass in detail as a response trait. Unlike previous syntheses, our meta-analyses detected evidence consistent with the classic tradeoff inherent to EICA. Plants from non-native ranges imposed greater competitive effects than plants from native ranges and were less quantitatively defended than plants from native ranges. Our results for defense were not based on complex leaf chemistry, but instead were estimated from tannins, toughness traits, and primarily Leaf Specific Mass. Species specificity occurred but did not influence the general patterns. As for all evidence for EICA-like tradeoffs, we do not know if the biogeographical differences we found were caused by tradeoffs per se, but they are consistent with predictions derived from the overarching hypothesis. Underestimating physical leaf structure may have contributed to two decades of tepid perspectives on the tradeoffs fundamental to EICA.
Guillain-Barré syndrome is an acute immune-mediated demyelinating disease. Typical features include progressive ascending lower extremity weakness and areflexia. Several variants have been described which can make the diagnosis challenging . Here, we report a case of GBS presenting with progressive lower limb weakness and T6 sensory level.
Background: Desmoid tumor (DT) is rare and challenging, often affects head neck (HN) region in children, and its appropriate treatments are under discussed. This study aimed to retrospectively evaluate long-term effectiveness and safety of 125I seed brachytherapy for pediatric DT in HN. Procedure: Seven pediatric patients with median age of 3 years old suffered from DT in HN treated with 125I brachytherapy from January 2008 to June 2018 were included. Among which, 5 underwent sole brachytherapy and the others combined with surgery under a prescription doses ranging from 10 000 cGy to 12 000 cGy. The rate of local control (LC), complete response (CR) and partial response (PR) were calculated after evaluation by radiological and pathological means. The radiation-associated toxicities were also evaluated Results: The LC rate was 7/7 during the follow-up time ranging from 43 to 135 months and with a mean of 57 months. No recurrent lesion was found in the patients receiving surgery combined with brachytherapy. In patients treated with sole brachytherapy, the radiological PR rate and CR rate were 4/5 and 1/5, respectively. In those reaching radiological PR, 3/4 were pathological CR. Slight acute radiation-associated toxicities were observed in all patients, and no late or severe acute toxicity was observed. Conclusion: 125I brachytherapy is effective and safe in the management of pediatric DT in HN as sole modality or combined with surgery in long term.
Despite the growing number of dam removals, very few have been studied to understand their impacts on stream fish communities. An even smaller proportion of dam removal studies focus on the impacts of low-head dam removals, although they are the most common type of dam. Instead, the majority of removal studies focus on the impacts of larger dams. In this study, two previously impounded Illinois rivers were monitored to assess the impacts of low-head dam removal on the functional assemblage of stream fishes. Study sites were sampled each fall from 2012-2015 (pre-dam removal) and 2018-2020 (post-dam removal) in three habitat types: downstream of the dam, impounded areas, and runs of rivers. Fishes were aggregated into habitat and reproductive guilds, relating community changes to habitat, environmental metrics, and stream quality. Prior to removal, the slackwater guild was the most prevalent habitat guild throughout both rivers, while nest builders and benthic spawners were the most abundant reproductive guilds. During the two years following removal, habitat conditions and fish assemblages improved throughout both rivers, with improvements in QHEI, IBI, water temperature, and dissolved oxygen, as well as a shift to more evenly distributed representation of habitat and reproductive guilds. The improvements in environmental metrics and overall stream quality, particularly in the formerly impounded habitats, indicate diminished habitat homogeneity, and a shift towards natural habitat diversity. This habitat diversification likely led to the restoration of a range of potential niches, thereby increasing the array of guild types inhabiting these rivers, while simultaneously preventing single-guild dominance.
Purpose: Left ventricular diastolic dysfunction (LVDD) is associated with poor outcomes in intensive care unit (ICU). Nonetheless, precise reporting of LVDD in COVID-19 patients is currently lacking and assessment could be challenging. Methods: We performed an echocardiography study in COVID-19 patients admitted to ICU with the aim to describe the feasibility of full or simplified LVDD assessment and its incidence. We also evaluated the association of LVDD or of single echocardiographic parameters with hospital mortality. Results: Between 06.10.2020 and 18.02.2021, full diastolic assessment was feasible in 74% (n=26/35) of patients receiving full echocardiogram study. LVDD incidence was 46% (n=12/26), whilst the assessment produced different results (incidence 81%, n=21/26). Nine patients were hospital-survivors (39%); incidence of LVDD (full assessment) was not different between survivors (n=2/9, 22%) and non-survivors (n=10/17, 59%; p=0.11). Also, the E/e’ ratio lateral was lower in survivors (7.4 [3.6] vs non-survivors 10.5 [6.3], p=0.03). We also found that s’ wave was higher in survivors (average, p=0.01). Conclusion: In a small single-center study, assessment of LVDD according to latest guidelines was feasible in three quarter of COVID-19 patients. Non-survivors showed a trend towards greater LVDD incidence; moreover, they had significantly worse s’ values (all) and higher E/e’ ratio (lateral).
Herein, we propose a novel method to enhance the photoreactivity of an MOF catalyst by grafting isocyanate bonds (−N=C=O) and sulfhydryl-complexed copper (−SCu) onto ZIF-8 (NIF-SCu). The grafting process intercalated interlayer bands between the conduction and valence bands of ZIF-8, thereby providing a “ladder” for facile electron transition. The extreme improvement in the photoreactivity of NIF-SCu could be attributed to the enhancement in light responses in the range of 350–450 nm by −N=C=O groups and the widening of the visible light range of the MOF by −SCu groups. The formation of staggered energy levels in NIF-SCu could also narrow the band gap, lower the resistance, and facilitate the transfer of photogenerated carriers, thereby generating electrons with strong reduction potential in the −SCu conduction band. This study provides a new strategy for improving or even endowing the photoactivity of environmental functional materials with wide bandgaps.
George and colleagues report their experience with a non-transplant left ventricular assist device program (1). This manuscript spans a decade’s experience with LVADs and clearly demonstrates that LVAD therapy is possible in centers without a heart transplant program. 100 LVADs were placed during this period. The positive findings from this report include that as volume increased, the complications of right heart dysfunction and bleeding decreased. Noteworthy is that 85 of the 100 patients were implanted with a fully magnetically levitated ventricular assist device. Given the superior performance of a fully magnetically levitated device to a rotary pump (2) these findings are relevant for all contemporary centers with LVAD programs.The authors importantly sought the resources of a transplant center to ensure that patients who were offered LVAD in their non-transplant center were indeed not candidates for cardiac transplantation. In addition to this fundamental necessity, three features are necessary for a successful non-transplant LVAD program. Firstly, the institution must offer robust infrastructure and support. Secondly there must be a strong surgeon-leader dedicated to overseeing the program. Lastly, cardiologists who are dedicated to heart failure are essential to guide patients to this therapy.The extension of LVAD therapy to patients in non-transplant centers is essential for durable mechanical circulatory support to remain as a vital part of advanced therapies for heart failure. VADs will continue to play an important role in the management of end-stage heart failure for patients who are not eligible for cardiac transplantation. The 2020 Society of Thoracic Surgeons INTERMACs report now offers patients a 5-year survival of 45%(3). The survival of patients with LVADs continues to increase. The data in this current report offer a new perspective and increased access to LVAD therapy for patients with end stage heart failure.ReferencesGeorge TJ, Aldrich A, Smith III RL, et al. Development of a Non-Transplant Left Ventricular Assist Device Program. J Card SurgMehra MR, Uriel Y, Naka Y, et al. A Fully Magnetically Levitated Left Ventricular Assist Device – Final report. N Engl J Med 2019:380:1618-27.Molina EJ, Shah P, Kierman MS, et al. The Society of Thoracic Surgeons Intermacs 202 Annual Report. Ann Thorac Surg 2021;111:778-92.
Bladder cancer treatment remains a challenge to every oncologist. We report the case of a 57-year-old man with BCG-refractory bladder cancer, who had a complete response to the intravesical Gemcitabine to shine the light on the role of Gemcitabine as a bladder sparing treatment in BCG-failure patients.