Rice is one of the most susceptible plant to iron (Fe) deficiency under neutral and alkaline conditions. Alkaline stress induces H2O2 production and increases the deposition of Fe on roots surface, which causes leaf chlorosis and Fe deficiency in rice. Gene chip and qRT-PCR analysis indicated that the expression of nitrate reductase (NR) genes were down-regulated by alkaline treatment, which resulted in significantly decreased nitrate activities and nitric oxide (NO) production in epidermis and stele, where the H2O2 was accumulated. In contrast, treatment with sodium nitroprusside (SNP), a NO donor, strongly alleviates alkaline-induced Fe deficiency by limiting Fe plaque formation. Increasing the NO signal significantly reduces the accumulation of H2O2 and lignin barrier, but enhances phenolic acid secretion in root epidermis and stele under alkaline stress. The secreted phenolic acid effectively mobilized the apoplast Fe and increased Fe uptake in root, thus which alleviate the Fe deficiency response and down-regulate expression of Fe uptake genes under alkaline condition. In conclusion, alkaline stress inhibits the NR activity and NO production in roots of rice, which plays a vital role in mobilizing the apoplast Fe by regulation of H2O2 and phenolic acids concentrations.

Objectives: Multiple organ dysfunction syndrome (MODS) with secondary hemophagocytic lymphohistiocytosis (SHLH) causes significant mortality, while continuous renal replacement therapy (CRRT) is commonly conducted. The objective is to identify the predictor factors associated with poor outcomes in pediatric patients with SHLH-associated MODS who received CRRT. Design: A multicenter prospective nested case-control study. Setting: In four PICUs of tertiary university children’s hospital in Shanghai from September 2013 to August 2018. Patients: Pediatric patients receiving CRRT due to SHLH-associated MODS from September 2013 to August 2018. Interventions: None. Measurements and Main Results: Overall PICU mortality rate was 46.15% (24/52). Less respiratory (28.6% vs. 87.5%, P<0.001) or cardiovascular dysfunction (25.0% vs. 83.3%, P<0.001) caused in survivors at CRRT initiation, as well as reduced demands of mechanical ventilation and vasoactive agents (28.6% vs. 87.5%,17.9 % vs. 66.7 %, both P<0.001). Non-survivors had higher levels of serum LDH (1404.5 (713.25, 2793) vs. 982.7 (692, 1461) (U/L), P = 0.037), lactic acid (1.9 (1.3, 4.53) (mmol/L) vs. 1.65 (0.8, 2.45) , P=0.034), triglyceride (2.88 (1.94, 5.08) (mmol/L) vs. 2.41 (1.63, 3.32), P=0.032) and IL-6 (28.66 (17.77, 113.63) (pg/ml) vs.0.98 (0.1, 4.63) P=0.000). More than 3 organ dysfunction (Odd ratio [OR] : 3.464; 95% confidence interval [CI] [1.018-11.788], P = 0.047), and the serum IL-6 level higher than 13.12 pg/mL (OR:1.388; 95% CI [1.058-1.821], P = 0.018 ) were two independent risk factors for mortality. Conclusions: The number of organ dysfunction and IL-6 levels at CRRT initiation are the independent risk factors for mortality in SHLH-associated MODS patients.

Blastic plasmacytoid dendritic cell neoplasm is an aggressive and rare hematologic malignancy, exceptionally presented in children. This case reports an 11-year-old Peruvian boy, with a 2-year history of a purple-violate tumor in a leg, lymph node involvement, and histopathological study with immunohistochemistry: CD4+, CD56+, Tdt+, CD45+, TCL1+. An institutional treatment protocol for high-risk ALL was given. There was a diagnosis delay in a pediatric patient with a rare but very visible neoplasm in a low-middle income country. Despite this, the clinical course was of an indolent evolution. The institutional protocol was efficient to achieve complete oncological disease response.

Investigation of cooperative effect exhibited by purely C-H—O hydrogen bonded (H-bonded) networks in linear and cyclic clusters of (1,3-cyclohexanedione)n (n = 2 to 6) has been carried out using density functional theoretical calculations. Linear clusters were found to show anti-cooperative behavior, while the cyclic clusters showed positive cooperativity. H-bond strengths and binding energies per bimolecular interaction were found to decrease with increasing cluster size for the linear clusters whereas their cyclic counterparts showed opposite trends. The extent of cooperativity has been found to show monotonic behavior for both linear and cyclic clusters and was found to reach an asymptotic limit with increasing cluster size. Natural bond orbital (NBO) analysis and atoms in molecule (AIM) calculations were found to corroborate the obtained results.

Aims: To investigate current practices and problems of neurological prognostication in comatose cardiac arrest (CA) patients. Methods: An anonymous questionnaire was distributed to 1600 emergency physicians in 75 hospitals which were selected randomly from China between January and July 2018. Results: 92.1% respondents fulfilled the survey. The details of the neurological prognosis were not well understood. The predictive value of brain stem reflex, motor response and myoclonus was confirmed by 63.5%, 44.6% and 31.7% respondents respectively. Only 30.7% knew that GWR value <1.1 indicated poor prognosis and only 8.1% know the most commonly used SSEP N20. Epileptiform, burst suppression, and isoelectric was considered to predict poor outcome by 35.0%, 27.4% and 45.7% respondents. 46.7% knew NSE, and only 24.7% knew S-100β. Only a few respondents knew that neurological prognostication should be performed later than 72h from CA either in TTM or non-TTM patients. In practice, the most commonly used method was clinical examination (85.4%). 67.9% had used brain CT for prognosis, and 18.4% for MRI. NSE (39.6%) was a little more widely used than S-100β (18.0%). However, SSEP (4.4%) and EEG (11.4%) were occasionally performed. The survey may have been subject to bias ascertainment as only university affiliated hospitals and university teaching hospitals were selected, making it likely that the degree of neuroprognostication awareness and practice reflected in our survey is an optimistic perspective. Conclusions: Neurological prognostication in CA survivors had not been well understood and performed by emergency physicians in China. They were more likely to use clinical examination rather than objective tools, especially SSEP and EEG, which also illustrated that multimodal approach was not well performed in practice.

Uniaxial static and cyclic creep tests are carried out on a bainite 2.25Cr-1Mo steel at 455°C. The dependence of cyclic response on varied unloading conditions is investigated, with unloading rates from 0.6 MPa/s to 39 MPa/s and the valley stress duration from 0 to 30 min. Fracture surfaces of each specimen are analysed by using a scanning electron microscopy, and a systematic classification of strain components under cyclic creep is proposed to determine the actual damage. The results indicate that, the fracture modes under static and cyclic creep conditions both have ductile features. Due to the effect of anelastic strain recovery, the strain accumulation rate under cyclic creep is significantly retarded as compared with static creep, and the unloading conditions apparently influence the behaviour of anelastic strain recovery. Moreover, a life prediction method for cyclic creep tests based on mean actual strain deducted recovery strain is proposed.

Every organism on Earth depends on interactions with other organisms to survive. In each of these interactions, an organism must utilize the limited toolbox of genes and proteins it possesses to successfully manipulate or cooperate with another species, but it can also coopt the genome machinery of its partner. Insect-induced plant galls are an extreme example of this, wherein an insect hijacks the plant genome to direct the initiation and development of galls comprising of plant tissue. However, the mechanism(s) behind insect-induced gall induction and development remain elusive. Here we demonstrate that cynipid wasp Dryocosmus quercuspalustris create a complex and novel parasite-specific organ from red oak tissue via massive changes in host gene expression. Our results show that the gall wasp is not merely modifying oak leaf tissue but creating a novel organ, resulting in extensive changes in gene expression between galled and ungalled tissue (differential expression in 28% of genes) and distinct gall tissue types (20% of genes). The outer gall tissue showed increases in various plant defense systems, which is consistent with its predicted functional role of protecting the wasp larva. The inner larval capsule shows suppression of large parts of the plant innate immune system and evidence for the wasp utilizing the plant’s RNA interference mechanisms, which may be a potential mechanism of gall induction. We also find significant overlap between cynipid galls and agricultural gall pests, suggesting possible shared mechanisms for this complex species interaction even in disparate plants and insect galling guilds.

Background: Bacillus Calmette-Guérin (BCG) vaccination policies of countries are postulated to have effect on the course of coronavirus disease 2019 (COVID-19) pandemic. Methods: Retrospective cross-sectional study was conducted between March 11-June 10, 2020 in a chest clinic in a state hospital in Istanbul,Turkey. Adults with diagnosis of COVID-19 pneumonia confirmed with severe acute respiratory syndrome coronavirus 2 polymerase chain reaction positivity in a nasopharyngeal sample and pulmonary infiltrates in computed chest tomography were included consecutively. Sociodemographic characteristics, body-mass index, smoking status, comorbid diseases, income rates, and BCG-vaccination status were compared between severe and mild patients with COVID-19 pneumonia. Results: Study population consisted of 123 adults (mean age, 49.7 years [standard deviation, 13.3 years]; 82 (66.7%) male). The proportion of BCG-vaccinated cases was significantly lower among severe patients than mild patients with COVID-19 pneumonia (68.5% vs 88.2%; p=.026). Mean age (54.0 ± 11.5 years vs 38.3 ±10.7 years; p <.001), diabetes rate (32.6% vs 5.9%; p=.002) and low-income (84.3% vs 52.9% p<.001) are higher in patients with severe COVID-19 pneumonia than in patients with mild COVID-19 pneumonia. Multivariate logistic regression analysis showed that increasing age (odds ratio [OR], 1.112; 95% confidence interval [CI], 1.058 – 1.169; p<.001) and low income (OR, 3.369; 95% CI, 1.074 – 10.570; p =.037) are associated with severe COVID-19 pneumonia. Conclusion: Clinical data does not support that being vaccinated with BCG is associated with disease severity in COVID-19 pneumonia. Age and low-income are the major predictors for disease severity.

A document by Xiaohai Zheng, written on Authorea.

Background: This study aimed to investigate the Hospital-Acquired Conditions (HACs) and find deficits in our hospital, so as to improve the incidence of HACs in China from our retrospect. Methods: We conducted statistics on the incidence and the percentage of HACs, and managed the cost and length of stay of the 950 patients went through HACs in our hospital from 2016 to 2018. Results: The overall incidence was 0.571%. The two most common conditions with the most cost were deep vein thrombosis (DVT) and pulmonary embolisms (PE) (351), and surgical site infections (SSI) (143), which were followed closely by manifestations of poor glycemic control (53), vascular catheter–associated infections (VCAIs) (52), stage III and IV pressure ulcers (49), catheter-associated urinary tract infections (CAUTIs) (33), and falls and trauma (30). Iatrogenic pneumothorax with venous catheterization (7) only occupied small portions. Blood incompatibility and air embolism didn’t happen in the three years. Conclusions: From the comparison of three years, the condition decreased in 2017, while met a higher increase in 2018. This may relative to the launch of medical reform in 2017. Chinese hospitals still need to investigate the HACs, give adaptable emphasis and concern to improve, and promote the overall level of medical management.

Striking features of the COVID-19 pandemic are the rapid spread of the SARS-CoV-2 virus and the relatively narrow profile of patients adversely affected. SARS-CoV-2 enters human cells by means of ACE2, destroying the protein in the process. ACE2 maintains renin-angiotensin-aldosterone system (RAAS) homeostasis and is upregulated in the setting of chronic RAAS disequilibrium seen in COVID-19-susceptible patients. The ACE2-depletion effect on angiotensin II (AngII) levels likely contributes to the spectrum of cytokine responses found in COVID-19 patients. However, as most of the inflammatory effects of AngII are amplified through aldosterone-activated mineralocorticoid receptors (MRs), blocking MRs may provide much-needed benefit. The MR-blockers, spironolactone and eplerenone, are relatively selective in exerting downstream dampening effects on RAAS stress and target the pathophysiological processes in COVID-19-susceptible patients where acute viral-induced ACE2 depletion could be responsible for a catastrophic aldosterone surge in severely ill patients.

• Respirators are currently recommended for use for any aerosol generating procedure • Verbal communication is impeded by the use of respirators • The authors have trialled a simple throat mic speaker system • The system improves both volume and clarity of speech • The authors recommend this, or similar systems to improve communication in theatre

Objectives: To evaluate the safety of intratympanic and intravenous dexamethasone administration for the treatment of sudden sensorineural hearing loss(SSNHL) and hearing improvement at low, mid and high frequencies. Methods: SSNHL patients were randomly divided into two groups within 72 hours after onset and received 24 days of dexamethasone therapy.The group A patients only received intravenous dexamethasone once every other day.Patients in group B received 12 days intravenous dexamethasome and six injection of intratympanic dexamethasome from the 13th day to 24th day like in Group A.Side effects and hearing recovery were compared. Results: The discomfort of intratympanic injection were mild and transient, no tympanic membrane perforation and otitis media, whereas the systemic adverse effects increased cumulatively over the course of intratympanic dexamethasone treatment in group A.The systemic side effects were more serious in group B than in group A. On day 7 (D7),the average 3-frequency PTA (250, 500, and 1000 Hz) was 34.10±9.14 dBHL in group A and 25.70±6.88 dBHL in group B(P<0.05). Hearing recovery was better in group A than group B,but there are the same long-term efficacy at the 90-day follow-up.Group A had slightly better high-frequency hearing recovery than group B, but this difference was not statistically significant. There were no significant differences in the total effective rate of hearing improvement. Conclusions: Early intratympanic dexamethasone intervention led to the rapid recovery of hearing loss, with a good remedial effect on hearing at low-mid frequencies. Intratympanic dexamethasone was safer than intravenous dexamethasone for SSNHL, and high-frequency hearing recovery may have been better with intratympanic dexamethasone, but the difference was not statistically significant. Therefore, it is necessary to make individualized treatment decisions according to the patient’s condition.

Presented is an interesting case of a patient with diagnosis of central nervous system (CNS) malignancy and Hashimoto thyroiditis, who developed anaphylaxis to low sorb tubing which was used for chemotherapy and supportive care medication. The patient had no known drug allergies and an unremarkable work up for hereditary angioedema, rheumatological and immunodeficiency disorders. This hypersensitivity reaction (HSR) has not been previously reported in literature and delayed the patient’s cancer related treatment, which has the potential of impacting patient outcomes. We report this rare case, discuss differential diagnosis for HSR in patients with negative allergy history, and provide management guidelines.

Infant acute lymphoblastic leukemia (infant ALL) is known for its poor prognosis. Current treatment protocols include aggressive chemotherapy and allogeneic stem cell transplantation but prognosis remains poor. Immunotherapy is a new approach with promising results. CAR-T cell therapy has recently been approved for relapsed or refractory childhood ALL but lacks documentation regarding infant ALL. We describe here two cases of patients suffering from infant ALL who were treated with CAR-T cell therapy, the feasibility and efficiency of treatment and their outcome.

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.