Jannik Pieper und Hans-Peter Zenner J. Pieper, M.Sc., Associate,  Prof. Dr. H.P. Zenner, MBA , Tübingen, Germany  DOI: 10.22541/au.159103722.24471046 Zusammenfassung 

Background: Coronavirus disease 2019 (COVID-19) is associated with diffuse alveolar damage (DAD) and coagulopathy in severe ill patients. Objective: To better understand and disease management, we investigated postmortem needle biopsies of lung, liver, and kidney pathologic changes along with clinical course, hematologic and imaging findings in two COVID-19 decedents. Patients and method We examined pathology of two patients with confirmed positive SARS-CoV-2 test died from respiratory failure. Computed tomography (CT) of the chest, Clinical and laboratory findings were investigated. Postmortem needle biopsies of lung, liver, and kidney were performed with complete protection. Results: The patients died from acute respiratory distress syndrome (ARDS). One of the patients was 56-year old man without any predisposing factor and the other (83-year old man) had hypertension, diabetes mellitus and renal failure. The patients had lymphopenia, elevated C-Reactive Protein (CRP), ferritin and D-Dimer. Axial CT images show diffuse ground glass opacity with some crazy paving and consolidation. The main pathologic finding of lungs revealed DAD. Intravascular micro-thrombi were detected despite anticoagulant prophylaxis. Renal autopsy demonstrated acute tubulointerstitial nephritis (ATIN) with tubular epithelium attenuation. Liver biopsy was consisted of lobular and portal inflammation and steatosis Conclusion This study emphasis that diffuse alveolar damage and microvascular pulmonary thrombosis in SARS-CoV-2 patients caused by either direct viral cytopathic effect or host immune and inflammatory reaction. Due to severe hypoxemia in COVID-19 patients suffering ARDS, appropriate oxygen support and anticoagulation therapy with strict monitoring is recommended

Identification of Pediatric Bronchiolitis Obliterans Syndrome Post Hematopoietic Stem Cell Transplantation; Surveillance Is the KeyShivanthan Shanthikumar1,2,3, Liam Welsh1, 2, Nicole Westrupp1,2, Theresa Cole3,4, Katherine B Frayman1,2,3, Colin F Robertson1,2,3, Sarath C Ranganathan1,2,3Respiratory and Sleep Medicine, Royal Children’s Hospital, Melbourne, AustraliaRespiratory Diseases, Murdoch Children’s Research Institute, Melbourne, AustraliaDepartment of Paediatrics, University of Melbourne, Melbourne, AustraliaAllergy and Immunology, Royal Children’s Hospital, Melbourne, AustraliaCorresponding Author; Dr Shivanthan Shanthikumar; Respiratory Medicine, Royal Children’s Hospital, 50 Flemington Road, Parkville, VIC, 3052, Australia; shivanthan.shanthikumar@rch.org.auAcknowledgements; The authors have no conflicts of interest to declareDear Editor,We read with great interest the article by Walther et al1 regarding long term outcomes of bronchiolitis obliterans syndrome (BOS) in children following haematopoietic stem cell transplantation (HSCT). The authors are to be commended on their study as it is an important contribution to a field where there is a relative paucity of evidence. Given the increasing numbers of HSCT being performed and improved outcomes, timely identification and management of pulmonary complications such as BOS is vital.In particular, the study used multibreath washout to calculate lung clearance index, a more sensitive test for BOS than traditional spirometry.2 In addition, the identification of three trajectories for children diagnosed with BOS; rapid persistent decline, persistent obstructive disease with secondary restriction, and resolution, is an important and novel description. This more nuanced understanding of the natural history of BOS in this setting will be an important consideration when designing therapeutic intervention trials. Given there are now ample data showing that around 4.8-6.5% children post HSCT will develop BOS, with significant associated morbidity and mortality, well designed intervention trials should be strongly considered.There are however limitations of Walther et al’s study that warrant more detailed discussion, as they limit the applicability of this single centre retrospective chart review to wider clinical practice. The manuscript does not adequately describe the institution’s clinical practice regarding evaluation for BOS post-HSCT, although the authors acknowledge a “lack of a standardised follow up protocol for lung function. ” This is not in keeping with current international practice. International guidelines3-5 consistently recommend scheduled lung function surveillance. In addition, in a recent survey of HSCT physicians and pediatric pulmonologists from North America and Australasia, 71.4% reported that a protocol for monitoring lung function post HSCT existed at their hospital and 53.6% reported adhering “well” or “very well” to surveillance protocols.6 A retrospective review of a centre with a screening program in place showed 75.2% of patients had a lung function test 12 months post HSCT.7 These data indicate that the majority of HSCT centres have a screening protocol in place, and within the limitations of self-reported and single centre data, protocols are adhered too. A potential explanation for the lack of a protocol in the study is that the review period started in 2000, which predates the guidelines. However, if the results are to influence contemporary practice, clinicians must be able to relate the reported findings to current standards of care. In the absence of a standardised follow up protocol, it would be useful if the authors reported the proportion of the 526 eligible patients who underwent lung function assessment, and what triggered a referral for testing (i.e. clinical symptoms, graft vs. host disease (GVHD) in another organ). If a high proportion of patients underwent testing then their findings will be more comparable to current international practice, however if only a small proportion underwent testing this is a significant limitation.The prevalence of BOS in the current study is lower than that reported in the wider literature. We suspect their prevalence is underestimated. The overall GVHD rate (45%) is higher than might be expected for a cohort that includes nearly 50% matched sibling donors.8, although GVHD grading is not reported. Given the high GVHD rate in this cohort it would be expected that the prevalence of BOS should also be higher or at least in keeping with the literature. The lack of a standardised protocol for screening lung function would likely lead to an underestimation of the prevalence of BOS. It is well established that the early phases of BOS are often asymptomatic and diagnosed based on lung function abnormality.9 All 14 BOS cases in this study were symptomatic, suggesting that asymptomatic early cases of BOS cases may have been missed due to lung function not being performed. In particular, this would underestimate BOS cases which follow the resolution trajectory as well as potentially the persistent obstruction trajectory. It also would affect two of the key conclusions of the paper; that BOS incidence is low and that BOS is associated with high mortality.In summary, the article by Walther et al is a useful contribution to what is an area of growing clinical importance. Strengths of the study include the use of the most sensitive test of small airway function (multibreath washout with calculation of the lung clearance index) and description of three trajectories post BOS diagnosis. However, the lack of a formal surveillance program and likely resultant underestimation of BOS cases is a significant limitation that should be acknowledged before efforts are made to prevent or attenuate lung function decline in BOS

2 Results2.1 Detection of IL-10, IL-1β, IL-6, MCP-1, TNF-α, IP-10 and IL-4 in serum samples of patients with COVID-19, patients with other diseases and healthy people by ELISAAfter statistical analyse, as Table 1 shows, it was found that the level of IL-10, IL-1β, MCP-1, TNF-α, IP-10 and IL-4 in the serum of patients with COVID-19 was significantly higher than that in the serum of healthy people (P = 0.006, 0.000, 0.001, 0.000, 0.024, 0.000). The level of IL-6 in the serum of patients with COVID-19 was higher than that in the serum of healthy people, but there was no significant difference (P = 0.054). The serum levels of IL-10, MCP-1 and IL-4 in patients with COVID-19 were significantly higher than those in patients with other diseases (P = 0.003, 0.001, 0.000), the serum levels of IL-6 in patients with COVID-19 were significantly lower than those in patients with other diseases (P = 0.000), while the serum levels of IL-1β, TNF-α and IP-10 in patients with COVID-19 and healthy people were not significantly different (P = 0.158, 0.159, 0.612）.Table 1 Levels of IL-10, IL-1β, IL-6, MCP-1, TNF-α, IP-10 and IL-4 in serum samples of patients with COVID-19, patients with other diseases and healthy people by ELISAx±SD (pg/ml)

Hirudo nipponia is not only an important economic pillar for farmers, but is also a precious raw material for medicinal materials. However, in recent years, H. nipponia suffered from diseases with symptoms including systemic edema and hyperemia. It has not yet been demonstrated which pathogen causes this disease and whether this could be transmitted to humans. In this study, Klebsiella pneumoniae was isolated and identified from diseased H. nipponia and the pathogenicity of the isolated strain was confirmed. Furthermore, by comparing the sequence of the pathogen isolated from leeches to the same pathogen infecting humans, we identified that the isolated strain is a threat to human health. This work emphasizes the importance of the first discovery of pathogenic bacteria from leeches similar to human pathogens, as well as the need for identifying comorbidities for both humans and aquatic animals.

A document by 11, written on Authorea.

Assessing the impacts of climate change on cotton is essential for maintaining a stable fibre production in the future. Here, cotton plants (Gossypium hirsutum L.) were raised under two temperature regimes (28/18 oC and 32/22 oC) and their corresponding nocturnal warming (+4oC) scenarios (i.e. 28/22 oC and 32/26 oC), and subsequently exposed to two water (Well-watered and Water deficit) and heatwave treatments (Control and Heatwave). Warmer day growth temperatures increased growth rate and leaf carbon gain, but decreased aboveground biomass. Water treatment independently or interactive affected leaf physiology and yield with growth temperature, but these impacts were generally small. Nocturnal warming did not strongly alter leaf carbon balance and its impacts on biomass were thermal regime specific. Warm temperature preconditioning did not ameliorate the negative effects of heatwave on carbon gain, but biomass accumulation was less affected due to high resilience. Overall, both short- and long-term elevated daytime temperature decrease cotton yield, while nocturnal warming has limited capacity to buffer that impact. Moderate water deficit will not strongly reduce carbon gain and growth. Findings of this study improve the knowledge regarding the response of cotton plants to climate change and underscore the complexity of plant response to multiple environmental factors.

Background: COVID-19 has become a global pandemic. Studies about SARS-CoV-2 co-infection with influenza A virus (IAV) in the influenza season will contribute to the antiviral interventions of co-infected patients. Methods: A cohort of 145 COVID-19 patients in Wuhan union hospital were reviewed and we found 2 patients were co-infected with both SARS-CoV-2 and IAV. Then we searched from PubMed, Web of Science and CNKI with combinations of the following key words: “COVID-19, SARS-COV-2, influenza A and co-infection” from January 1 up to May 1, and 6 studies were included in this descriptive analysis. Results: Of the 13 co-infected patients, 2 were from Wuhan union hospital, another 11 were collected from the reports published on PubMed, Web of Science and CNKI. Of the 13 patients, the median age was 50 years (IQR, 40.5-67.5). Among the 13 patients, 7 (53.8%) were severe types, 7 were males and 5 had comorbidities. The most common symptoms among the 13 patients were cough (100%), fever (92.3%) and dyspnea (76.9%). 8 patients had lymphocytopenia on admission and all the 13 patients had abnormal radiological changes in their first examination after admission. The median time from symptom onset to hospital admission was 4.5 days (IQR, 2.75-5.5), and the median time of hospital stay was 17 days (IQR,15-20). 7 patients were discharged, and the clinical outcomes of the remaining 6 patients were unclear. Conclusion: Patients with both SARS-COV-2 and IAV infection showed similar changes in symptoms and radiological images with patients infected with SARS-COV-2 only. SARS-COV-2 co-infection with IAV can lead to more severe clinical condition but had similar hospital stay compared with patients infected with SARS-COV-2 only in the fast review.

This study aimed to describe an outbreak of abomasal bloat in kid goats and its clinical, pathological, microbiological, molecular, and epidemiological characteristics. In the kidding season, increased mortality of kid goats with a history of abdominal bloating, dullness, and death was reported. Clinical examinations were carried out, and biological samples from necropsied kids (n = 11) were collected for pathological, microbiological, and molecular diagnosis. Likewise, an epidemiological survey was carried out in order to verify possible associated factors related to the disorder. A therapeutic protocol was also implemented. The main necropsy findings were dehydration, pale mucosa, ascites, abomasal and intestinal meteorism and congestion, emphysematous abomasitis, and cranial areas of lung consolidation. Through staining techniques for cytological evaluations of the abomasum, it was possible to identify Gram positive bacteria, coccoid, with a cuboid shape suggestive of Clostridium ventriculi, Gram positive bacilli suggestive of Clostridium perfringens and ovoid basophilic yeasts compatible with Saccharomyces cerevisiae. By anaerobic culture and molecular tests, C. ventriculi and C. perfringens type A were confirmed. The main histopathological findings were cholangiohepatitis, nephrosis, emphysematous abomasitis, hyalinization of the gastric and intestinal walls, gastroenteritis, intestinal thromboembolism, pulmonary edema, and non-purulent pneumonia, overall suggesting a systemic enterotoxemia picture. The early detection of sick kids and quick initiation of treatment were the primary determinants of the prognosis of each case. There was a final mortality rate of 24.4% (20/82), and the agents C. perfringens type A and C. ventriculi were identified as the main ones involved, with the possible participation of S. cerevisiae. Among the possible associated factors, the erroneous use of the milk replacer associated with inadequate kid management was verified. Among the prophylactic measures, hygiene care, proper use of milk replacer, vaccination plan containing C. perfringens alpha toxoid associated with a good colostrum management were suggested.

The Coronavirus disease 2019 (COVID-19) pandemic caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is overwhelming healthcare resources and infrastructure worldwide. Cardiac surgical operating capacity during the COVID-19 pandemic is dramatically lower due to postponement or cancellation of elective or semi-urgent procedures. Earlier reports have demonstrated complicated post-operative courses and high fatality rates in patients undergoing emergent cardiothoracic surgery who were diagnosed post-operatively with COVID-19. These reports raise the possibility that active COVID-19 might precipitate a catastrophic pathophysiogical response to infection in the post-operative period and lead to unfavorable surgical outcomes. Hence, it is imperative to screen patients with SARS-CoV-2 infection prior to surgery and to carefully monitor them in the post-operative period to identify any early signs of active COVID-19. In this report, we present the successful outcome of coronary artery bypass grafting (CABG) operation in a patient with asymptomatic SARS-CoV-2 infection presenting with an acute coronary syndrome and requiring urgent surgical intervention. We employed a meticulous strategy to identify subclinical COVID-19 disease, and after confirming the absence of active disease, proceeded with the CABG operation. The patient outcome was successful with the absence of any overt COVID-19 manifestations in the post-operative period.

Background: Non-pharmacological interventions (NPIs) remain central for the management of COVID-19 as there are no licensed vaccines or safe and effective antivirals to treat coronavirus yet. A rapid systematic review reported the main publications on NPIs to cope with the global COVID-19 outbreak. Methods: The research was conducted according to the PRISMA statement, from January 31 to March 31, 2020, in PubMed, Embase, Scopus, and Web of Science databases. Results: A total of 26 publications were included as comments, viewpoints, original articles, and studies on mathematical modeling. It was published by 251 researchers and four investigation groups from 23 countries. Conclusion: In summary, the publications pointed out that the social isolation, staying home, social distancing, quarantine, and contact tracing are essential and that NPIs could be combined to cope with the COVID-19 outbreak. It is recommended to value, intensify, and commend the efforts of countries that have implemented NPIs as extremely bold and robust measures to contain coronavirus disease.

Odontogenic cysts are derived from odontogenic epithelium which may develop before or after the formation of tooth. Most of these are developmental in origin. While dentigerous cysts are common odontogenic cysts that are related to the crown of the impacted tooth and known to arise from reduced enamel epithelium.

The present work aims to provide reliable estimates of extreme discharge flows and their probability of occurrence. Such estimates are important for the assessment of the associated hydrological risk of hydraulic infrastructures, such as bridges and dams, in the design process as well as during their operations. The hydrological modeling herein developed was applied to estimate the design floods approaching the new Hintze Ribeiro bridge, in the north of Portugal. It proposes a statistical analysis of the maximum annual streamflow data by using a flood frequency analysis technique. The data series were subject to a reliability analysis and the specific modeling assumptions, required for the study, were appropriately given and tested. An extrapolation technique of the missing instantaneous discharge data was herein derived. Such technique was validated by two distinct methods. The estimations are accurate with a mean deviation of 7.2% relative to the observed data. A set of probabilistic models were considered and the models’ performance verified by the goodness-of-fit tests and Q-Q plots. The model and the parameter uncertainties were taken into account. Model uncertainties were addressed by comparing the estimated design floods through selecting the best fitting probability model (MS) with the approach that considered the distribution functions which fit well the data (MM). On the other hand, the computed flow rates were estimated with 95% of confidence to reduce the inherent parameter uncertainties. An additional accuracy assessment of the parametric approaches was performed through a comparative analysis of such design floods with the ones retrieved by application of the non-parametric Kernel density estimate (KDE). The MM approach showed a lower discrepancy (18.5%) to KDE estimates, when compared with the MS results. A sensitivity analysis of the associated hydrological risks was also undertaken.

A 33-year-old male admitted with sudden and spontaneous painless left infraorbital swellings after forceful nose-blowing. He was diagnosed orbital emphysema with orbital floor blow-out fracture. This case shows that forceful nose-blowing can cause orbital floor fracture and subcutaneous orbital emphysema by rapid increase in pressure in the upper airways.

This is a response to the Letter to Editor received regarding the article “The effect of patient obesity on extracorporeal membrane oxygenator outcomes and ventilator dependency.” We aim to address the authors’ comments regarding the relationship between BMI and survival after venoarterial extracorporeal membrane oxygenation (VA-ECMO).

La contaminazione dei suoli dovuta ai metalli pesanti rende sempre più spesso necessario intervenire mediante azioni di messa in sicurezza e bonifica per salvaguardare la salute dell’uomo e dell’ambiente naturale. Nella pratica esistono numerose tecniche e tecnologie di bonifica, ognuna con finalità e limiti differenti. La letteratura scientifica mostra come i trattamenti di solidificazione/stabilizzazione (S/S) ex situ presentino buone prestazioni in termini di costi/benefici e questo fa si che risultino un buon investimento per l'operatore che deve commissionare un intervento di risanamento ambientale. Il caso studio preso in esame si concentra su una tecnologia ex situ, che prevede il trattamento di un suolo contaminato da metalli pesanti e acque reflue,  mediante un legante chimico di nuova generazione chiamato SPC (un superfosfato e ossido di calcio a base idrossiapatite).  

Mitral valve abscess is a well-known complication of infective endocarditis, often requiring surgical treatment. Usually, the most typical localization is postero-lateral mitral annulus or mitral-aortic curtain at the base of the anterior leaflet in aortic valve endocarditis. We describe a 64-year-old male diagnosed with the abscess on the free margins of the mitral leaflets secondary to concomitant vertebral osteomyelitis. A favorable resolution of the abscess during the intravenous dual antibiotic therapy is presented.

In 1891 Georg Cantor published his Diagonal Argument which, he asserted, proved that the real numbers cannot be put into a one-to-one correspondence with the natural numbers.In this paper we will see how by varying the initial conditions of the demonstration we can use Cantor’s method to produce a one-to-one correspondence between the set of natural numbers and the set of infinite binary decimals in the open interval \((0, 1)\).

Needle embolization in intravenous drug users to the lung is rarely reported in the literature. The management of these patients is controversial. We presented a male patient aged 33-year-old who presented with a broken needle in the left arm after trial of self-drug injection. During the trial to retrieve the needle, the needle embolized to the lung. Chest X-ray showed the needle in the right lower lobe, and the chest CT scan confirmed the diagnosis. The patient complained of non-specific right-side chest pain that was controlled with analgesics. The patient was managed conservatively and was discharged on antiplatelet therapy. After the 6-month follow-up, the patient was asymptomatic with no complication.

In human lysozyme (hLYZ) production by P. pastoris, severe reactive oxygen species (ROS) accumulation occurred during the cell growth phase when using DO-stat control mode, leading to a limited expression of hLYZ. In this study, a novel periodic dissolved oxygen concentration (DO) control strategy was proposed to solve these problems. This strategy intermittently/periodically switched the cultivation environment from “high DO-low glycerol concentration” (DO-stat control mode) to “low DO-high glycerol concentration” for 4 cycles. With the strategy: (1) the highest cell concentration (~120 g-DCW L-1) with healthy and functional skeleton was achieved at the end of cell growth phase by controlling ROS levels below 48.35 Fluorescence intensity g-DCW-1; (2) cells metabolic activities in the successive induction phase were largely enhanced; (3) hLYZ activity reached the highest level of 2.18×105 IU mL-1, which was about 2-fold than that obtained with the DO-stat control mode, when the same induction strategy was adopted.

eparation and recovery of C2H6 and C3H8 from natural gas is a potentially economical but challenging subject in the petroleum industry. In this work, we report a stable pillared-layer microporous MOF, Ni(TMBDC)(DABCO)0.5 for the separation of C2H6 and C3H8 from natural gas. Ni(TMBDC)(DABCO)0.5 remained intact structure after exposure to humid air with RH = 100% for days. Derived from the combination of dense and accessible methyl group and methylene group in the channel, Ni(TMBDC)(DABCO)0.5 exhibited strong affinity toward C3H8 and C2H6, with remarkably high capacities of 2.80 mmol/g at 1 kPa and 3.37 mmol/g at 5 kPa for C3H8, as well as 2.93 mmol/g at 10 kPa for C2H6. Its IAST selectivities of C3H8/CH4 and C2H6/CH4 reached 274 and 29, respectively. The complete separation of CH4/C2H6/C3H8 ternary mixture on breakthrough experiment demonstrated the great potential on recovery of C2H6 and C3H8 from natural gas through a Ni(TMBDC)(DABCO)0.5 packed column.

We study a coupled Navier–Stokes–Nernst–Planck–Poisson system arising from electrohydrodynamics in critical Besov-weak-Herz spaces. When the initial value sufficiently small, we prove the existence and uniqueness of global mild solution to the cauchy problem in this spaces for $n\geq3$. The spaces is larger than some other known critical spaces.

We propose a new type of generalized fractional derivatives with respect to (wrt) another function. These new generalized fractional derivatives generalize $\psi$–Caputo, Riemann–Liouville (R–L) wrt another function, Caputo Hadamard wrt another function, R–L Hadamard wrt another function, Caputo, R–L, Caputo Hadamard and R–L Hadamard fractional derivatives. We propose a newly modified Laplace transform for linear $\psi$–Katugampola fractional differential equations (FDEs). Properties of this newly generalized Laplace transform are analyzed. Cauchy problems and mass-spring damper system with $\psi$–Katugampola fractional derivative are solved analytically by means of modified Laplace transform. Finally, a new numerical method is proposed for nonlinear $\psi$–Katugampola FDEs.

In this work two-phase Stefan problem for the cylindrical heat equation is considered. One of the phase turns to zero at initial time. In this case, it is difficult to solve by radial heat polynomials because the equations are singular. The solution is represented in linear combination series of special functions Laguerre polynomial and confluent hyper-geometric function. The free boundary is given and heat flux is found. The numerical and approximate test problem is compared graphically. The undetermined coefficients are founded. The convergence of series proved.