Background: The prevalence of tree nut allergy has increased worldwide, and cashew has become one of the most common food allergens. More critically, cashew allergy is frequently associated with severe anaphylaxis. Despite the high medical need, no approved treatment is available and strict avoidance and preparedness for prompt treatment of allergic reactions are considered dual standard of care. In the meantime, Phase III study results suggest investigational epicutaneous immunotherapy (EPIT) may be a relevant and safe treatment for peanut allergy and may improve the quality of life for many peanut allergic children. Objective: We aimed to evaluate the capacity of EPIT to provide protection against cashew-induced anaphylaxis in a relevant mouse model. Methods: A mouse model of IgE-mediated cashew anaphylaxis was first developed. Based upon this model, the efficacy of EPIT was evaluated by applying patches containing cashew allergens to cashew-sensitized mice. Cashew-specific antibody titers were measured throughout treatment. Treated mice were challenged orally to cashew and anaphylactic symptoms were monitored. Additionally, plasma levels of mast-cell proteases (mMCP)-1/7 were quantified from blood samples collected after challenge to evaluate IgE-induced mast-cell activation. Results: EPIT significantly decreased anaphylactic symptoms following challenge and increased cashew-specific IgG2a (equivalent of human IgG1). Interestingly, this protection was associated with a sharp decrease in mast-cell reactivity. Conclusion: We demonstrate that EPIT markedly reduced IgE-mediated allergic reactions in a mouse model of cashew allergy, which suggests that EPIT may be a relevant approach to treating cashew allergy.

Background. Sublingual allergen immunotherapy (SLIT) is recognized as both efficacious and safe, especially when using monomeric allergoids. Its mechanism of action is based on the differentiation, activation, and maturation of allergen-specific Regulatory T-cells (Tregs), fundamental for the activation and maintenance of immune tolerance. Tregs, originally identified as a subpopulation of Foxp3 expressing CD4+CD25high T-cells; however, under inflammatory conditions, they are conveniently identified by the surface antigen CD127 and are subtyped as Resting, Activated and Effector Tregs by surface expression of CD45RA, HLA-DR and CD39 that represent markers of differentiation status, inhibitory and recall potential. Hence, in this study, circulating Tregs were characterized in pediatric patients suffering from allergic rhinitis (AR) treated by SLIT and to verify the possible correlation between some Treg subsets with successful SLIT. Methods. Twenty children suffering from mite AR and/or asthma were enrolled. AR severity was assessed by evaluating ACT and ARIA scores at baseline and after 12-months of mite-SLIT. Treg analysis of PBMC pre- and post-SLIT, was based on cytofluorimetric determination of total Tregs, as CD4+CD25highCD39+CD127low/neg, further characterized for CD45RA, HLA-DR and CD39 expression. Results. After SLIT, Resting Tregs were significantly reduced whilst Activated/Effector Tregs CD45RAneg (memory Tregs) resulted increased; moreover, CD39 and HLA-DR expression on Tregs was significantly increased. Notably, the intensity of HLA-DR expression on Tregs positively correlated with the improvement of the clinical scores. Conclusions. Our findings suggest that effective SLIT is associated with re-patterning of the differentiation status of Tregs, particularly with the generation of allergen-specific memory effector Tregs.

Cardiac involvement in electrical injury is rare yet poses serious manifestations with high mortality rate. In most cases, symptoms occur immediately after the incident. We present a case of cardiac arrest six hours following uneventful electrocution. The case emphasis the potential late sequel of cardiac injury.

Olfactory and gustatory dysfunctions are common presentations in COVID-19 patients. We present three patients who received smell and taste tests after recovery. The smell test suspected persistent impairment of olfactory function in these patients. The report proposes continued evaluation of olfactory function by a smell test in COVID-19 patients.

The analysis of stable isotope composition is an important tool in research on plant physiological ecology. However, large-scale patterns of leaf stable isotopes for aquatic macrophytes have received considerably less attention. In this study, we examined the spatial pattern of the leaf δ13C and δ15N of macrophytes collected across the arid zone of northwestern China and tried to illustrate how they were affected by different environmental factors. Our results showed that the mean values of leaf δ13C and δ15N in the macrophytes sampled from the arid zone were -24.49‰ and 6.82‰, respectively, which were drastically higher than the values of terrestrial plants. In addition, leaf δ13C varied significantly among different life forms, possibly reflecting the complex photosynthetic fixation and adaptations of macrophytes. In addition to, our studies indicated that the foliar δ13C values of all the aquatic macrophytes were only negatively associated with precipitation, but the foliar δ15N values were mainly associated with temperature, precipitation and potential evapotranspiration. Therefore, we speculated that the determinant of the leaf δ13C of macrophytes in the arid zone of northwestern China is water factors and the leaf δ15N values is the complex combination of water and energy factors.

There are an increasing number of consumer smartphone and eHealth applications that are potentially helpful for controlling the COVID-19 pandemic. These applications include contact tracing, proximity tracking, eThermometers and heart rate monitoring. Consumers should have access to their data and the ability to share as much or as little, as they see fit, with public health agencies, healthcare providers or researchers--thereby respecting their privacy and their wishes. One patient's choice or risk does not affect another's. We recommend applying FAIR data principles, supported by changes to laws and governance, to meet these needs.

Background: The novel coronavirus disease (Covid-19) can progress with mild to moderate or self-limiting clinical findings in children. The aim of this study was to investigate the disease features of Covid-19 in Turkish children. Methods: Children diagnosed by the method of RT-PCR for Covid-19 at the Dicle University Department of Pediatric, between April and June 2020, were evaluated. Hospital records were investigated retrospectively. Results: One hundred and five patients children with the mean age of 108.64±65.61 were enrolled in this study. The most common cause of transmission in pediatric patients was contacting with a family member diagnosed with COVID-19 (n=91, 86.7%).The most common admission complaints were dry cough (n=17, 16.2%), fever (n=16, 15.2%), lassitude and fatigue (n=14, 13.3%) respectively. More than 95 % of all children with Covid-19 had asymptomatic, mild, or moderate cases. CRP was identified only independent factor associated with long duration of hospitalization. Conclusion: The results of this study show preliminary results of a study investigating the effect of Covid-19 on Turkish children. A clear understanding of the local epidemiology of corona virus infections and identification of risk factors is critical for the successful implementation of the prevention and control program.

Photoperiod and circadian controls play crucial roles in the regulation of chloroplast biogenesis. To understand more about the regulation of this process, we compared the greening of the first leaves of wild type barley and two WHIRLY1 (WHY1)-deficient lines. Seedlings were grown in darkness for 4 days prior and then exposed to light at the beginning of the photoperiod on the 5th day or under standard photoperiod conditions. The accumulation of chlorophyll, as well plastid-encoded photosynthetic transcripts and proteins was delayed in the WHY1-deficient lines under standard photoperiod conditions because of defects in plastid gene expression, ribosomal processing and photosynthetic protein accumulation. The acquisition of full photosynthetic capacity was delayed by about 11 days in the first leaves and the newly forming leaves of the WHY1-deficient lines compared to the wild type. However, the light-dependent accumulation of pigments, transcripts and photosynthetic proteins was similar in all lines when etiolated seedlings were exposed to light. These results demonstrate that WHY1 is required for the integration of photoperiod-dependent signalling and chloroplast development in barley leaves.

Background: Multiple breath washout (MBW) is increasingly used in the clinical assessment of patients with cystic fibrosis (CF). Guidelines for MBW quality control (QC) were developed primarily for retrospective assessment and central overreading. We assessed whether real-time QC of MBW data during the measurement improves test acceptability in the clinical setting. Methods: We implemented standardized real-time QC and reporting of MBW data at the time of the measurement in the clinical pediatric lung function laboratory in Bern, Switzerland in children with CF aged 4-18 years. We assessed MBW test acceptability before (31 tests; 89 trials) and after (32 tests; 97 trials) implementation of real-time QC and compared agreement between reviewers. Further, we assessed the implementation of real-time QC at a secondary center in Zurich, Switzerland. Results: Before implementation of real-time QC in Bern, only 68% of clinical MBW tests were deemed acceptable following retrospective QC by an experienced reviewer. After implementation of real-time QC, MBW test acceptability improved to 84% in Bern. In Zurich, after implementation of real-time QC, test acceptability improved from 50% to 90%. Further, the agreement between MBW operators and an experienced reviewer for test acceptability was 97% in Bern and 100% in Zurich. Conclusion: Real-time QC of MBW data at the time of measurement is feasible in the clinical setting and results in improved test acceptability.

Nitric oxide (NO) is a comprehensive regulator of vascular and airway tone. Endogenous NO produced by nitric oxide synthases regulates multiple signaling cascades, including activation of soluble guanylate cyclase to generate cGMP, relaxing smooth muscle cells. Inhaled NO is an established therapy for pulmonary hypertension, especially in neonates, and has been recently proposed for treatment of hypoxic respiratory failure and acute respiratory distress syndrome due to COVID-19. In this review, we summarize the effects of endogenous and exogenous NO on protein S-nitrosylation, which is the selective and reversible covalent attachment of a nitrogen monoxide group to the thiol side chain of cysteine. This post-translational modification targets specific cysteines based on the acid/base sequence of surrounding residues, with significant impacts on protein interactions and function. S-nitrosothiol (SNO) formation is tightly compartmentalized and enzymatically controlled, but also propagated by non-enzymatic transnitrosylation of downstream protein targets. Redox-based nitrosylation and denitrosylation pathways dynamically regulate the equilibrium of SNO-proteins. We review the physiological roles of SNO proteins, including nitrosohemoglobin and autoregulation of blood flow through hypoxic vasodilation, and pathological effects of nitrosylation including inhibition of critical vasodilator enzymes; and discuss the intersection of NO source and dose with redox environment, in determining the effects of protein nitrosylation.

Automotive radar is one of the key sensor technologies for active safety and comfort advanced driver assistance systems(ADAS). Vehicles equipped with radar sensors can determine the range, velocity and angle of arrival of multiple targets simultaneously in a highly dynamic environment. At 77 GHz, road infrastructure and buildings are an ever present source of clutter that can affect crucial target detection. Guardrails present a unique clutter challenge due to their ubiquity, proximity to ego vehicle and extremely large radar cross section(RCS). Due to their large RCS, guardrails can mask the existence of soft targets such as pedestrians in their vicinity. Therefore, it is crucial for sensor perception algorithms to identify and filter out the effects of guardrails. This paper presents a full-physics, simulation-based study of several full-scale road traffic scenes with different guardrail arrangements. By studying the Range-Doppler(RD) plots of each of the scenes at 77 GHz, we demonstrate the distinctly different radar signatures of guardrails in four key road settings that normally occur in driving. Using the results from this study, we characterize both the range and velocity behavior of various guardrail sections. Results from this study can be used to train perception algorithms to accurately identify and filter out guardrail systems in different driving scenarios and thus potentially prevent future accidents.

Huanglongbing (HLB) is the most devastating citrus disease worldwide. The causal organism of the disease is spread by an insect vector, Diaphorina citri, commonly known as Asian citrus psyllid (ACP). Current management of HLB relies either on physical removal of the infected plants or on chemical control of ACP. Both methods are not overly effective and costly. In addition, public concerns regarding insecticide residues in fruit have greatly increased in recent years. It has been hypothesized that plant volatiles could act as repellents to ACP, thus reduce the incidence of HLB. To test this hypothesis, the repellency of fresh tissues of 41 aromatic plant species to ACP was investigated. The repellency of individual species was determined using a Y-tube olfactometer. Our results showed that volatiles of five plant species were highly effective in repelling ACP with repellency as much as 76%. Among these, the tree species, Camptotheca acuminate, and the two shrubs, Lantana camara and Mimosa bimucronata, could potentially be planted as a landscape barrier. The two herbs, Capsicum annuum and Gynura bicolor, could potentially be used as interrow plantings in orchards. This is the first time that the repellency of fresh tissues from a diverse range of plant species to ACP has been determined. Although further field evaluation of various interplanting regimes and landscape barriers are needed to assess their effectiveness, our results showed that these aromatic species, being highly repellent to ACT, offer great potential as more cost-effective and environmentally sustainable alternatives to the current methods of managing HLB.

Interspecific hybrid frequencies can vary considerably across contact zones of a single pair of progenitor species. The reasons for this are not well understood, but could help explain processes such as species diversification or the range expansion of invasive hybrids. The widespread cattails Typha latifolia and T. angustifolia seldom hybridize in some parts of their range, but in other areas produce the dominant hybrid T. × glauca. We used a combination of field and greenhouse experiments to investigate why T. × glauca has invaded wetlands in the Laurentian Great Lakes region of southern Ontario, Canada, but is much less common in the coastal wetlands of Nova Scotia in eastern Canada. One potentially important environmental difference between these two regions is salinity. We therefore tested three hypotheses: 1) T. latifolia and T. angustifolia in Nova Scotia are genetically incompatible; 2) the germination or growth of T. × glauca is reduced by salinity; and 3) T. latifolia, a main competitor of T. × glauca, is locally adapted to saline conditions in Nova Scotia. Our experiments showed that Nova Scotia T. latifolia and T. angustifolia are genetically compatible, and that saline conditions do not impede growth of hybrid plants. However, we also found that under conditions of high salinity, germination rates of hybrid seeds were substantially lower than those of Nova Scotia T. latifolia. In addition, germination rates of Nova Scotia T. latifolia were higher than those of Ontario T. latifolia, suggesting local adaptation to salinity in coastal wetlands. This study adds to the growing body of literature which identifies the important roles that local habitat and adaptation can play in the distributions and characteristics of hybrid zones.

Abstract: Purpose: We aimed to evaluate whether early TRAP exposure is associated with the development of AR during preschool years, stratified by sex, parental allergy, or stressful family events. Methods: A nested case-control study including 398 was conducted in Shenyang. TRAP exposure in early childhood was estimated by nitrogen oxides (NOx) air dispersion modeling. We used multinomial logistic regression models to assess the association between early TRAP exposure and preschool children AR, stratified by potential confounders including sex, parental allergy, or stressful family events. Results: Life-time prevalence of AR in children aged 4 years (6.4%) was associated with TRAP exposure during early children, with an increased odds ratio (OR) [adjusted OR=2.18; 95% confidence interval (CI),1.35 to 3.52] for an interquartile range (38 μg/m3) increase in NOx levels. A relative risk for AR of of 1.88 (95% CI, 1.26 to 2.81) with boys, of 1.91 (95% CI, 1.28 to 2.85) among with eczema during the first year, of 2.94 (95% CI, 1.77 to 4.87) with parents allergy, of 4.14 (95% CI, 2.65 to 6.49) with stressful family events, was also observed. TRAP exposure was significantly associated with AR in preschool children who are boys (adjusted OR=2.13; 95% CI, 1.31 to 3.45), with parental having allergy (adjusted OR=2.06, 95% CI, 1.27 to 3.36), and a history of stressful family events (adjusted OR=1.94, 95% CI, 1.18 to 3.20). Conclusions: Early childhood TRAP exposure, boys, parental allergy, stressful family events may contribute to AR in children at 4 years of age.

Idiopathic ventricular arrhythmias (VA) are common and treatment options include anti-arrhythmic drugs (AAD) or catheter ablation. Patients presenting with idiopathic VA which is originating from the left ventricular summit (LVS) poses a particular challenge as the success for catheter ablation is low and AAD’s may not be used long-term due to side effects. Ivabradine is an inhibitor of funny current (If) in cardiac pacemaker cells by blocking hyperpolarization-activated cyclic nucleotide-gated (HCN) and recommended for the treatment of heart failure with reduced ejection fraction and stable coronary artery disease. Recently, several cases described patients with atrial and junctional ectopic tachycardias who were successfully treated with ivabradine. In the present case, we reported the use of ivabradine in the treatment of idiopathic VA which was originated from the LVS and was resistant to multiple AAD’s and catheter ablation.

Case PresentationA 62 year old man with a past medical history of hypertension and mild coronary artery disease underwent dual chamber permanent pacemaker (PPM) implantation in April of 2015 for complete heart block. A Boston Scientific Ingenio K173 (Boston Scientific, St. Paul, MN) generator was inserted and connected to 2 Medtronic 5076 pacing leads (Medtronic, Minneapolis, MN) which were positioned in the right atrium (RA) and right ventricle (RV). The operative report noted “normal testing results” with an acute RV lead bipolar pacing threshold of 0.6 V at 0.4 msec and pacing impedance of 550 Ω. The PPM was programmed DDDR 60-130 bpm with RA and RV lead outputs programmed 3 times threshold.He had no further syncope after implant but continued to complain of intermittent lightheadedness as soon as a week out from the implant. Multiple pacemaker interrogations revealed stable atrial and ventricular lead function and he was told that his symptoms were likely due to low blood pressure which resulted in his blood pressure medicines being adjusted. The patient presented to his local hospital with recurrent syncope without warning 14 months after the initial implant. PPM interrogation recorded noise resulting in RV pacing inhibition (Figure 1). RV bipolar lead pacing threshold was 0.6 V at 0.4 msec and the pacing impedance measured 660 Ω. Historical RV lead pacing threshold and impedance trends were stable. RV lead oversensing was suspected and pocket manipulation, deep inspiration, Valsalva maneuver, arm isometrics, left arm extension, abduction and adduction did not duplicate the noise. The device was reprogrammed to asynchronous mode (DOO at 80 bpm) and the patient was transferred to our hospital for lead extraction.After confirming the interrogation findings, a chest radiograph was performed which showed no obvious fracture, gross dislodgement or lead discontinuity. What is the likely cause of the noise on the RV lead and this patient’s recurrent syncopal episodes?

Introduction: no data are provided about the effect of triple combination therapy with Lopinavir/Ritonavir (LPN/RTN), hydroxychloroquine (HQ) and azithromycin (AZT) on corrected QT (QTc) interval and arrhythmic risk, in COVID-19 patients. This study aims to describe the incidence of extreme QTc interval prolongation among COVID-19 patients on this experimental treatment and to identify the clinical features associated with extreme QTc prolongation. Materials and methods: data of 87 COVID-19 patients, treated with triple combination including LPN/RTN, HQ and AZT, were analyzed. QT interval was obtained by the tangent method and corrected for heart rate using Bazett’s formula. Extreme QTc interval prolongation was considered an absolute QTc interval ≥ 500 ms or an increase in QTc intervals of 60 milliseconds or greater (ΔQTc ≥ 60 milliseconds) compared with baseline. Results: Hypertension (66.7%) and diabetes (25.3%) were the most prevalent cardiovascular comorbidities. 20 patients (23%) showed extreme QTc interval prolongation; No clinical, electrocardiographic or pharmacological characteristics have been associated to extreme QTc prolongation, except the history of ischemic stroke (P= 0,007). One torsade de pointes (TdP) in patient with QTc extreme prolongation (QTc: 560 ms) after 5 days of therapy was recorded. Conclusions: We observed a high incidence of extreme QTc interval prolongation among COVID-19 patients on triple combination therapy. The incidence of malignant arrhythmias seems to be low, a careful electrocardiographic monitoring would be advisable.

Letter to the Editor, BJOG Exchange

Anthropogenic effects, such as nitrogen (N) enrichment and mowing, are constantly changing the function and structure of grassland ecosystems. In order to test whether the magnitude and frequency of N addition, as well as occurrence of mowing, affects gross N turnover. We designed a long-term field experiment which included 5 levels of N addition (0, 2, 10, 20, and 50 g N m-2 yr-1) and mowing in a typical grassland of northern China. To test the effects of N addition frequency, the amount of N applied was separated evenly by two times (twice a year, low frequency) or twelve times (monthly, high frequency) that results were compared against a control site where none of the treatments were applied. Mowing effects were also considered at each N treatment levels. Our results showed that the N level, the frequency of N addition, and mowing significantly influenced gross ammonification (GA) and nitrification (GN) rates. Specifically, the effect of N addition frequency was significantly different under the highest N addition level (50 g N m-2 yr-1), lower frequency (twice a year) significantly increased N turnover rates. Mowing significantly increased the GA rate, while decreased GN rate both under the highest N addition level (50 g N m-2 yr-1) and lower N addition frequency. Further long-term study of the effects of the interactions between N addition and mowing on N turnover will be needed for understanding the mechanisms by which nutrient cycling in typical grassland ecosystems may change in the future.

Understanding community assembly mechanism is essential for us to predict community dynamics and restoration process in the context of intensive human activities. In this study, we aimed to explore how the removal of shrub canopy influenced the community assembly in shrub-encroached grassland by both trait-based and phylogenetic approaches. We carried out an experiment of shrub canopy removal with three frequencies (no removal, removal once and twice a year) in a shrub-encroached grassland in China. We investigated community species composition under each treatment and collected plant functional traits for each species. We calculated the standard effect size (SES) of phylogenetic and trait-based functional diversity based on null model analysis to determine the dominant community assembly process. By phylogenetic analysis, the random process drove the community assembly, being independent of the removal frequencies and locations; while by trait-based approach, random process dominated the assembly in communities under ‘no removal’ treatment beneath shrub and under ‘removal twice a year’ treatment in shrub-interspace when using some certain single traits, and the limiting similarity process dominated the assembly in the rest communities. Removal of shrub canopy twice a year released more niches which promoted the performance of herbaceous species beneath shrub and promoted the settlement of annuals in shrub-interspace. Compared with phylogenetic analysis, the results of trait-based approach were more sensitive to the human activities. All these findings indicated that removal of shrub canopy twice a year would be an effective way for the restoration of shrub-encroached grassland.

Screening strategies for SARS-CoV-2 in pregnant women at term gestationAntonio Ragusa1, Alessandro Svelato1, Martina Bartolone2, Caterina De Luca3

This study investigates propagation effects of CMORPH rainfall estimation errors on streamflow simulation for a headwater catchment of the Zambezi River. Model simulations (2006-2012) by the Representative Elementary Watershed (REW) framework are carried out for uncorrected and for bias corrected CMORPH product (the Climate Prediction Center Morphing technique of the National Oceanic and Atmospheric Administration, or NOAA). As a benchmark to assessments, the model is run for in-situ observed rainfall obtained from 6 stations at a daily timestep. Analysis of CMORPH rainfall necessitates bias correction. A suite of performance indicators indicates that uncorrected CMORPH estimates show substantial augmentation of rainfall error to streamflow simulation mismatch whereas bias corrected estimates show attenuation of error. The ɛ-NSGAII algorithm is selected for single and multi-objective calibration to assess CMORPH error propagation to REW streamflow results. Improved hydrograph simulation is achieved by multi-objective calibration. Flow discharge simulation during the dry season shows more substantial error attenuation compared to wet season high flow discharge simulation. Further, this study shows that ratios of model based actual evapotranspiration over rainfall (ETa/R) and stream flow over rainfall (Qs/R) (runoff coefficient) at seasonal base change subject to selected uncorrected and corrected CMORPH. REW water storage (ΔS) is affected as well as calibrated model parameters. The paper provides new insights on propagation effects of satellite based rainfall errors in stream flow modelling.

Over the last two decades, the medical community witnessed an outstanding and accelerated development on minimally invasive therapies. With the dorsal spine of supportive data from large randomized control trials, transcatheter aortic valve replacement (TAVR), aortic and mitral valve-in-valve, mechanical circulatory support and peripheral endovascular interventions all share the need of accessing a vascular bed with a large bore catheter. Nevertheless, to date, there has yet to be a universal consensus on defining large-bore vascular access (LBVA) in the world of transcatheter therapies. We explore the evolution, characteristics and vascular compatibility of the current commercially available devices, analyze the devices along with access site-specific complications rates and finally review the present methods for percutaneous vascular closure.

Backgrounds: Allergic rhinitis (AR) is highly prevalent worldwide, but its treatment is poor. Myofascial trigger point (MTrP) injections have been effectively used for the management of many chronic painful diseases. Latent MTrPs (we called Qi points, QiPs) could be with autonomic nerve phenomena. Little is known about the correlation between QiPs and AR. Therefore, we proposed the hypothesis that QiPs might play a role in the pathophysiological mechanisms of AR. The current study was designed to investigate the efficacy and safety of QiPs injection therapy for AR. Methods: Sixty-five patients who suffered from moderate to severe AR were enrolled in this study. All patients received QiPs injection therapy in the referred facial and cervical muscles only once. The total nasal symptom score (TNSS) and side-effects was collected during the following 24 weeks. Results: The patients reported that their nasal and eye symptoms were significantly improved compared to those previously reported. The TNSS in the 15 minutes after treatment was significantly lower compared with the score before treatment, and the effect was maintained for at least 24 weeks. No obvious side effects were recorded during the treatment or the follow-up period. Conclusions: QiPs injection therapy provided long-term clinical efficacy with few adverse events in moderate to severe AR patients. QiPs inflammation in the facial and cervical regions, which causes nasal mucous oversecretion by regulating upper cervical sympathetic nerve ganglion and sphenopalatine ganglion activity, might play a novel role in the etiology of AR.