[A case of follicular lymphoma with recurrent fever and pulmonary infiltrates].

We reported a case of a 65-year-old male who had been treated with obinutuzumab and chemotherapy for follicular lymphoma. He was infected with SARS-CoV-2 after the second course of therapy. He developed fever, cough and bilateral pulmonary infiltrates. His nasopharyngeal swab became negative only temporarily after repeated courses of antiviral therapy, and the symptoms and pulmonary infiltrates waxed and waned. He presented to our hospital with exertional dyspnea and hypoxemia after his nasopharyngeal swab was positive for SARS-CoV-2 for the fourth time. He had an elevated serum lactate dehydrogenase and a positive 1, 3-ß-D-glucan test. The PCR test for Pneumocystis jirovecii in the sputum was positive. The patient was diagnosed with persistent COVID-19 and Pneumocystis jirovecii pneumonia. He responded well to the combination treatment of antiviral medication, convalescent plasma, trimethoprim-sulfamethoxazole and corticosteroids.

Pediatricians' Awareness of Pediatric Psoriasis in the Makkah Region, Saudi Arabia.

Background Psoriasis is an autoimmune disease characterized by the typical appearance of red, thickened, scaly patches on the skin (plaques). These plaques can vary in size and distribution from person to person. In some individuals, it may affect small areas of skin, while in others, large areas covering their body may be involved. Patients with psoriasis might be identified by pediatricians before being seen by dermatologists, highlighting the need for pediatricians to be aware and knowledgeable about pediatric psoriasis. Objective To evaluate the knowledge and management of pediatric psoriasis among pediatricians and pediatric residents in the Makkah region, Saudi Arabia. Methods This was a cross-sectional study using a questionnaire targeted at pediatricians. It inquired about sociodemographic details, knowledge of psoriasis risk factors, diagnosis, management, comorbidity screening, and indications for consulting a dermatologist. The knowledge score cut-off was set at 60%, with scores below this threshold considered indicative of poor knowledge and scores above it reflecting good knowledge. Results A total of 139 participants completed the questionnaire; 103 (74.1%) were from Jeddah, 101 (72.7%) were pediatric residents, 118 (84.9%) were general pediatricians, and 18 (15.1%) were in subspecialties. About a third, 49 (35.3%), reported having seen a child with psoriasis. Most participants, 84 (60.4%), had a good knowledge level regarding psoriasis. The vast majority, 119 (85.6%), stated that topical therapies are the first-line treatment; 105 (75.5%) reported being confident in diagnosing psoriasis, and having previously seen a patient with psoriasis was associated with certainty in diagnosis (p-value=0.048); 82 (59%) referred patients to dermatologists. Physician position (p-value=0.049) and being in a general specialty (p-value=0.048) were associated with higher knowledge. Conclusion Overall, participants had good knowledge of pediatric psoriasis and its management. However, there is still a need for improvement.

Corrigendum: Use of autologous cord blood mononuclear cells infusion for the prevention of bronchopulmonary dysplasia in extremely preterm neonates: a study protocol for a placebo-controlled randomized multicenter trial [NCT03053076].

[This corrects the article DOI: 10.3389/fped.2020.00136.].

Variations of olfactory function with circadian timing and chronotype.

BACKGROUND: Cumulative animal studies have suggested that olfaction can be regulated by circadian clock. However, human studies on the topic are relatively limited. The present study thus aimed to investigate diurnal variation in olfaction in healthy adults while examining potential modulating factors. METHODS: We conducted four rounds of testing on 56 healthy adults (32 women) aged 31 ± 12 years, throughout a single day, during morning (8:00-10:00 h), noon (12:00-14:00 h), afternoon (16:00-18:00 h), and evening (20:00-22:00 h). At the first appointment, participants completed full olfactory function testing using the Sniffin’ Sticks, questionnaires on medical history, nasal symptoms, sleep quality, and chronotype, and were assessed for blood pressure, heart rate, peak nasal inspiratory flow (PNIF), attention level, and rated their smell ability, nasal patency, wakefulness, and concentration level using visual analog scale (VAS) ratings. Subsequent appointments measured olfactory threshold, attentional level, PNIF, blood pressure, heart rate and VAS ratings repeatedly. RESULTS: Olfactory threshold (OT) scores varied significantly between different times of the day, with the highest score in the evening and the lowest in the morning. Similar differences were also observed in PNIF, with the highest value in the evening and the lowest in the morning. However, there were no significant correlations between OT score and PNIF across all four-time testing, as well as between differences in [OT evening â€" OT morning] and [PNIF evening â€" PNIF morning]. Furthermore, a generalized linear mixed model indicated that the testing time of the morning, evening chronotype, self-reported body mass index (BMI), rated smell ability, and rated nasal patency significantly predicted the Sniffin' Sticks OT score. CONCLUSIONS: Olfactory function fluctuates throughout the waking hours of the day, with the highest olfactory sensitivity observed in the evening and the lowest in the morning. This pattern is also seen in nasal patency. However, it appears that the circadian changes of nasal airflow may not significantly depend on the circadian changes of the olfactory sensitivity. In addition, chronotype and BMI may regulate such olfactory-circadian variation. These findings provide important insights for future research on the accurate diagnosis and treatment of olfactory dysfunction.

[Nontuberculous mycobacteria infection and pulmonary alveolar proteinosis in a patient with hematopoietic defects].

A 28-year-old male with a history of leukopenia was admitted with complaints of fever, cough, and dyspnea for 3 months. Initial work-up identified reduced circulating levels of granulocytes, monocytes, lymphocytes, and NK cells. Computed tomography revealed bilateral reticulonodular opacities and mediastinal lymph node enlargement. Peripheral blood culture and mediastinal lymph node aspiration yielded Mycobacterium avium. Genetic testing revealed a heterozygous germline GATA2 mutation (c.1187G>A, R396Q). Despite standard anti-mycobacterial therapy, the patient's dyspnea worsened and subsequent imaging studies revealed diffuse ground-glass opacification. A transbronchial lung biopsy confirmed the development of pulmonary alveolar proteinosis. Bone marrow transplantation had not been performed due to the unavailability of suitable donors. The disease progressed after whole lung lavage, and the patient died at the age of 31 years from respiratory failure. The current case report emphasized the importance of raising awareness about the rare GATA2 deficiency, which is characterized by hematologic abnormalities, primary immunodeficiency, and pulmonary alveolar proteinosis.

[The analgesic efficacy and safety of non-steroidal anti-inflammatory drugs combined with medial canthus peribulbar block for postoperative pain in patients with thyroid-associated ophthalmopathy after orbital decompression].

Objective: To explore the analgesic efficacy and safety of non-steroidal anti-inflammatory drugs (NSAIDs) combined with medial canthus peribulbar block for postoperative pain in patients with thyroid-associated ophthalmopathy (TAO) after orbital decompression. Methods: This study was a single-center, single-blind, randomized controlled study. From June 2020 to December 2020, sixty TAO patients in Zhongshan Ophthalmic center, Sun Yat-sen University who were allocated to receive orbital decompression under general anesthesia, were randomly and equally divided into two groups (n=30): the control group (group C) and the medial canthus peribulbar block group (group PB). All patients received intravenous infusion of flurbiprofen axetil 50 mg at 15 min before the end of surgery. In PB group, patients received peribulbar block via caruncular approach for postoperative pain management upon completion of wound closure, while patients in group C did not receive the peribulbar block. If patient sufferred significant postoperative pain (NRS score≥4), Ketorolac 10 mg would be prescribed as analgesic rescue. Postoperative NRS pain scores were recorded at 2, 4, 8, 24, 48 h after the surgery. The usage of Ketorolac during 0-24 h and 24-48 h postoperatively were also recorded. Postoperative complications during the hospital stay were recorded. Severity of orbital swelling would also be evaluated at 24 h after surgery. Results: The NRS pain scores [M(Q1, Q3)] in group PB were 2.50(2.00, 3.00)and 2.00(1.75, 3.00), which were both significantly lower than those in group C of 4.50(3.00,5.00), 3.00(2.00,4.25)at 2 h, 4 h after surgery respectively(P=0.001,0.045). During the first 24 h, the usage rate of Ketorolac in group C was 40%(12/30), which was higher than that in the group PB (13.3%, 4/30) with statistical significance (P=0.041). There was no significant difference in the incidences of postoperative nausea, vomiting, dizziness during the first 48 h, as well as the moderate to severe intensity of orbital swelling at 24 h after surgery (all P>0.05). There were no obvious complications of medial canthus peribulbar block in group PB. Conclusions: NSAIDs combined with medial canthus peribulbar block can provide satisfactory analgesia for TAO patients after orbital decompression, which is safe with little complications, and is beneficial to enhanced recovery after surgery.

Phaeohyphomycosis due to Veronaea botryosa in cultured white sturgeon (Acipenser transmontanus Richardson) from California USA during 2006 to 2015.

Infection with Veronaea botryosa can result in rare cutaneous or disseminated, granulomatous to pyogranulomatous phaeohyphomycosis in humans, although disease due to the fungus has also been reported in non-mammalian vertebrates. This report documents disease due to V. botryosa in captive, juvenile to subadult or young adult white sturgeon (Acipenser transmontanus Richardson) from California USA and complements a previous report of the disease in captive Siberian sturgeon (Acipenser baerii) from Florida USA. Pathological examinations revealed granulomatous to pyogranulomatous inflammation of multiple organs. Isolates of the fungal agent were phenotypically consistent with V. botryosa, and molecular analyses of the D1/D2 region of the fungal 28S rRNA gene and the internal transcribed spacer (ITS) region located between the fungal 18S and 28S rRNA genes confirmed the aetiologic agent as V. botryosa. The disease in captive sturgeon results in a considerable economic encumbrance to the producer due to the loss of the cumulative financial resources invested in the production of older subadult to young adult sturgeon.

Hemodynamic effects of norepinephrine versus phenylephrine infusion for prophylaxis against spinal anesthesia-induced hypotension in the elderly population undergoing hip fracture surgery: a randomized controlled trial.

BACKGROUND: Elderly population are at increased risk of spinal anesthesia-induced hypotension increasing their risk for postoperative morbidity and mortality. This study aimed to compare the hemodynamic effects of prophylactic infusion of norepinephrine (NE) versus phenylephrine (PE) in elderly patients undergoing hip fracture surgery under spinal anesthesia. METHODS: Elderly patients scheduled for hip fracture surgery were randomized to receive either NE infusion (8 µg/min) (NE group, n = 31) or PE infusion (100 µg/min) (PE group, n = 31) after spinal anesthesia. Outcomes included mean heart rate, mean blood pressure, cardiac output, incidence of spinal anesthesia-induced hypotension, incidence of bradycardia, and incidence of hypertension. RESULTS: Sixty-two patients with a mean age of 71 ± 6 years were included in the final analysis (31 patients in each group). The NE group showed a higher mean heart rate and cardiac output than the PE group. The NE group had a lower incidence of reactive bradycardia (10% vs. 36%, P = 0.031) and hypertension (3% vs. 36%, P = 0.003) than the PE group. No study participant developed hypotension, and the mean blood pressure was comparable between the two groups. CONCLUSIONS: Both NE and PE infusions effectively prevented spinal anesthesia-induced hypotension in elderly patients undergoing hip fracture surgery. However, NE provided more hemodynamic stability than PE; maintaining the heart rate, higher cardiac output, less reactive bradycardia, and hypertension.

Hemodynamic effects of norepinephrine versus phenylephrine infusion for prophylaxis against spinal anesthesia-induced hypotension in the elderly population undergoing hip fracture surgery: a randomized controlled trial / 대한마취과학회지

Background@# Elderly population are at increased risk of spinal anesthesia-induced hypotension increasing their risk for postoperative morbidity and mortality. This study aimed to compare the hemodynamic effects of prophylactic infusion of norepinephrine (NE) versus phenylephrine (PE) in elderly patients undergoing hip fracture surgery under spinal anesthesia. @*Methods@# Elderly patients scheduled for hip fracture surgery were randomized to receive either NE infusion (8 µg/min) (NE group, n = 31) or PE infusion (100 µg/min) (PE group, n = 31) after spinal anesthesia. Outcomes included mean heart rate, mean blood pressure, cardiac output, incidence of spinal anesthesia-induced hypotension, incidence of bradycardia, and incidence of hypertension. @*Results@# Sixty-two patients with a mean age of 71 ± 6 years were included in the final analysis (31 patients in each group). The NE group showed a higher mean heart rate and cardiac output than the PE group. The NE group had a lower incidence of reactive bradycardia (10% vs. 36%, P = 0.031) and hypertension (3% vs. 36%, P = 0.003) than the PE group. No study participant developed hypotension, and the mean blood pressure was comparable between the two groups. @*Conclusions@# Both NE and PE infusions effectively prevented spinal anesthesia-induced hypotension in elderly patients undergoing hip fracture surgery. However, NE provided more hemodynamic stability than PE; maintaining the heart rate, higher cardiac output, less reactive bradycardia, and hypertension.

Hemodynamic effects of norepinephrine versus phenylephrine infusion for prophylaxis against spinal anesthesia-induced hypotension in the elderly population undergoing hip fracture surgery: a randomized controlled trial / 대한마취과학회지

Background@# Elderly population are at increased risk of spinal anesthesia-induced hypotension increasing their risk for postoperative morbidity and mortality. This study aimed to compare the hemodynamic effects of prophylactic infusion of norepinephrine (NE) versus phenylephrine (PE) in elderly patients undergoing hip fracture surgery under spinal anesthesia. @*Methods@# Elderly patients scheduled for hip fracture surgery were randomized to receive either NE infusion (8 µg/min) (NE group, n = 31) or PE infusion (100 µg/min) (PE group, n = 31) after spinal anesthesia. Outcomes included mean heart rate, mean blood pressure, cardiac output, incidence of spinal anesthesia-induced hypotension, incidence of bradycardia, and incidence of hypertension. @*Results@# Sixty-two patients with a mean age of 71 ± 6 years were included in the final analysis (31 patients in each group). The NE group showed a higher mean heart rate and cardiac output than the PE group. The NE group had a lower incidence of reactive bradycardia (10% vs. 36%, P = 0.031) and hypertension (3% vs. 36%, P = 0.003) than the PE group. No study participant developed hypotension, and the mean blood pressure was comparable between the two groups. @*Conclusions@# Both NE and PE infusions effectively prevented spinal anesthesia-induced hypotension in elderly patients undergoing hip fracture surgery. However, NE provided more hemodynamic stability than PE; maintaining the heart rate, higher cardiac output, less reactive bradycardia, and hypertension.

Use of Autologous Cord Blood Mononuclear Cells Infusion for the Prevention of Bronchopulmonary Dysplasia in Extremely Preterm Neonates: A Study Protocol for a Placebo-Controlled Randomized Multicenter Trial [NCT03053076].

Background: Despite the rapid advance of neonatal care, bronchopulmonary dysplasia (BPD) remains a significant burden for the preterm population, and there is a lack of effective intervention. Stem cell depletion because of preterm birth is regarded as one of the underlying pathological mechanisms for the arrest of alveolar and vascular development. Preclinical and small-sample clinical studies have proven the efficacy and safety of stem cells in treating and preventing lung injury. However, there are currently no randomized clinical trials (RCTs) investigating the use of autologous cord blood mononuclear cells (ACBMNC) for the prevention of BPD in premature infants. The purpose of this study is to investigate the effects of infusion of ACBMNC for the prevention of BPD in preterm neonates <28 weeks. Methods: In this prospective, randomized controlled double-blind multi-center clinical trial, 200 preterm neonates <28 weeks gestation will be randomly assigned to receive intravenous ACBMNC infusion (5 × 107 cells/kg) or placebo (normal saline) within 24 h after birth in a 1:1 ratio using a central randomization system. The primary outcome will be survival without BPD at 36 weeks of postmenstrual age or at discharge, whichever comes first. The secondary outcomes will include the mortality rate, other common preterm complication rates, respiratory support duration, length, and cost of hospitalization, and long-term outcomes after a 2-year follow-up. Conclusion: This will be the first randomized, controlled, blinded trial to evaluate the efficacy of ACBMNC infusion as a prevention therapy for BPD. The results of this trial will provide valuable clinical evidence for recommendations on the management of BPD in extremely preterm infants. Clinical Trial Registration: ClinicalTrials.gov, NCT03053076, registered 02/14/2017, retrospectively registered, https://register.clinicaltrials.gov/prs/app/action/SelectProtocol?sid=S0006WN4&selectaction=Edit&uid=U0002PLA&ts=2&cx=9y23d4 (Additional File 2).

[Epidemiological analysis of pathogens causing bloodstream infections in department of hematology in Guangdong Province].

Objective: To evaluate the epidemiology of bacterial bloodstream infections in patients submitted to hematologic wards in southern China. Methods: A total of 50 teaching hospitals were involved based on the China Antimicrobial Resistance Surveillance System. The data of clinical isolates from blood samples were collected from January 1, 2019, to December 31, 2019. Antimicrobial susceptibility testing was conducted by the Kirby-Bauer automated systems, and the results were interpreted using the CLSI criteria. Results: The data of 1,618 strains isolated from hematologic wards in 2019 were analyzed, of which gram-negative bacilli and gram-positive cocci accounted for 71.8% and 28.2%, respectively. Of those, the five major species were most often isolated, including Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, coagulase-negative staphylococcus, and Streptococcus viridans. The prevalence rates of methicillin-resistant strains in Staphylococcus aureus and coagulase-negative staphylococcus were 19.7% and 80.6%, respectively. No gram-positive cocci were resistant to vancomycin, linezolid, and teicoplanin, and none of the enterococci were resistant to linezolid. The resistance rate of S. viridans to penicillin G was 6.9%, and those to ceftriaxone and cefotaxime were more than 25%. The resistance rate of E. coli and K. pneumoniae in Enterobacteriaceae was higher in children than that in adults. The resistance rate of K. pneumoniae to meropenem was 14.1%. The resistant rate of Enterobacter cloacae to carbapenem was more than 25%. P. aeruginosa was more sensitive to more antibiotics than 80%, but the resistance rate to meropenem in children was higher than that in adults (11.8% vs. 6.5%). The proportion of gram-positive cocci in the ICU and respiratory departments was higher than that in the hematology department. The detection rates of carbapenem-resistant E. coli and K. pneumoniae in the respiratory department were the lowest with 0.3% and 3.7%, respectively, while those of CRPA and CRAB in the hematology department were the lowest with 8.3% and 25.8%, respectively. The detection rate of all carbapenem-resistant organisms in the ICU was the highest among the three departments. Conclusion: The etiology and drug resistance of bacteria from blood samples in the hematology department are different from those in the ICU and respiratory departments. The proportions of K. pneumoniae, P. aeruginosa, E. cloacae, and S. viridans dominating in the department of Hematology were significantly higher than those in the ICU and respiratory departments in Guangdong region.

TUG1 promotes diabetic atherosclerosis by regulating proliferation of endothelial cells via Wnt pathway.

OBJECTIVE: To explore the specific role of TUG1 in regulating the occurrence and progression of diabetic atherosclerosis and its underlying mechanism. PATIENTS AND METHODS: TUG1 expressions in coronary artery disease (CAD) tissues, normal arterial tissues, endothelial cells induced by high-dose glucose and tumor necrosis factor-α (TNF-α) were detected by quantitative Real-time polymerase chain reaction (qRT-PCR). The effects of TUG1 on proliferation, migration and cell cycle of human umbilical vein endothelial cells (HUVECs) were detected by cell counting kit-8 (CCK-8), transwell assay and flow cytometry, respectively. Subsequently, protein expressions of proliferation-related genes, cell cycle-related genes and Wnt pathway-related genes were detected by Western blot after altering TUG1 expression in HUVECs. Further rescue experiments were carried out to explore whether TUG1 could regulate diabetic atherosclerosis via Wnt pathway. RESULTS: Overexpressed TUG1 was found in CAD tissues and endothelial cells induced by high-dose glucose and TNF-α compared with those of controls. TUG1 overexpression remarkably promoted proliferation, migration and cell cycle of HUVECs. Protein expressions of ß-catenin and c-Myc were upregulated by overexpression of TUG1. Rescue experiments indicated that XAV-939, the inhibitor of Wnt pathway, could partially reverse the increased proliferative and migratory changes in HUVECs induced by TUG1 overexpression. CONCLUSIONS: We found that overexpressed TUG1 stimulates proliferation and migration of endothelial cells via Wnt pathway, thereby promoting the occurrence and progression of diabetic atherosclerosis.

[Therapeutic effect of acid-suppressing therapy combined with voice therapy in patients with voice-related symptoms caused by laryngopharyngeal reflux].

Objective:Patients with laryngopharyngeal reflux frequently experience voice-related symptoms. This was a prospective study that designed to investigate the effectiveness of combined voice and medical therapy in comparison with medical therapy alone in the improvement of voice-related symptoms and parameters in patients with laryngopharyngeal reflux. Method: In this prospective study, total of 71 patients diagnosed with laryngopharyngeal reflux with voice symptoms were randomly divided into 2 groups (A and B). Thirty-five patients in group A were treated with medication alone, and 36 patients in group B were treated with medication plus voice therapy. The following data were recorded before treatment and at the end of treatment and 1, 2 months posttreatment: reflux symptom index(RSI), reflux finding score (RFS), voice handicap index(VHI), and change in grade, roughness, breathiness, asthenia, and strain scale (GRBAS) were analysised. The Electronic laryngoscopywere performed to assess efficacy. The numbers of patients showing clinically significant reductions in these parameters were compared between groups. Result:Significantly more patients in the B group showed a clinically significant change in RSI, VHI, and GRBAS score at the end time, 1-, and 2-month follow-up evaluations. No clinically significant change in RFS was achieved in either group at the end time or 1 month, but a significantly greater change was achieved in the study group at 2 months. Conclusion:Voice therapy may help to restore reversible mucosal change secondary to acidic reflux, inducing rapid resolution of symptoms and shortening of the treatment period.

Controlled reaction for improved CH3NH3PbI3 transition in perovskite solar cells.

Hybrid halide perovskites represent one of the most promising solutions toward the fabrication of all solid nanostructured solar cells, with improved efficiency and long-term stability. This article aims at investigating the properties of CH3NH3PbI3 with controlled loading time in CH3NH3I solution via a two-step sequential deposition and correlating them with their photovoltaic performances. It is found that the optimum PCE of the loading time in the CH3NH3I solution is possible only at a relatively short time (10 min). Prolonging the loading time will degrade the perovskite film, and deteriorate the device performance by introducing a large amount of excessive defects and recombination. However, even if the material band gap remains substantially unchanged, a suitable loading time can dramatically improve the charge transport within the perovskite layer, exhibiting the out-standing performances of meso-superstructured solar cells.