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Objective: To study the prevalence of health disorders among computer professionals and its association with working environment conditions. Study design: Cross sectional. Materials and Methods: A sample size of 200 computer professionals, from Delhi and NCR which included software developers, call centre workers, and data entry workers. Result: The prevalence of visual problems in the study group was 76% (152/200), and musculoskeletal problems were reported by 76.5% (153/200). It was found that there was a gradual increase in visual complaints as the number of hours spent for working on computers daily increased and the same relation was found to be true for musculoskeletal problems as well. Visual problems were less in persons using antiglare screen, and those with adequate lighting in the room. Musculoskeletal problems were found to be significantly lesser among those using cushioned chairs and soft keypad. Conclusion: A significant proportion of the computer professionals were found to be having health problems and this denotes that the occupational health of the people working in the computer field needs to be emphasized as a field of concern in occupational health.

Nevus anemicus is an uncommon, localized, congenital vascular malformation. It occurs due to hyper sensitization of an area to the circulating catecholamines with normal histology. A giant nevus anemicus of this magnitude has not been reported until date and we report this unusual case of giant nevus anemicus in a 4-month-old male child. [ABSTRACT FROM AUTHOR]

Dilatation and oesophageal body aperistalsis in achalasia can lead to stasis which in turn can induce repeated microaspiration. It is therefore conceivable that patients with achalasia may also have abnormalities in lungs secondary to repeated episodes of microaspiration. There is a lack of systematic study on involvement of lungs in patients with achalasia. Thirty patients with achalasia underwent pulmonary function tests (spirometry, and carbon mono-oxide diffusion capacity) and high resolution computerized tomography (HRCT) of the chest. The mean age of patients and mean duration of disease were 33.5 ± 10.9 years and 28.1 ± 27.3 months respectively. Regurgitation was present in 22 (73.3%) of them. Respiratory symptoms in them were dry cough in 17 (56.6%), and chest pain in 18 (60%). The oesophagus was dilated in 26 (86.6%) and 13 (43.3%) had residue in oesophagus. Sixteen (53.3%) patients had either anatomical changes as seen on HRCT or functional changes as observed on pulmonary function tests. Of those with functional abnormalities, five (16.6%) and one (3.3%) had restrictive and obstructive airways disease respectively. While evidence of tracheo-bronchial compression by dilated oesophagus was present in eight (26.6%), 10 (33.3%) patients had parenchymal lung disease [nodular opacities in five (16.6%), ground glass appearance six (20%), patchy pulmonary fibrosis five (16.6%), air trapping two (6.6%), consolidation and bronchiectasis one (3.3%) each]. There was a significant association between presence of regurgitation and dilatation of oesophagus ( P = 0.032). More than half (53.3%) of patients with achalasia have structural and/or functional abnormalities in lungs. [ABSTRACT FROM AUTHOR]

Factors predicting survival after pediatric combined heart-kidney transplantation (HKTx) are unclear. We examined pre-transplant recipient characteristics that determine survival following pediatric combined HKTx. The Scientific Registry for Transplant Recipients heart and kidney databases were used to identify 159 combined heart-kidney transplants, between 1992 and 2018 (age ≤21 years). Cox regression analysis was performed to identify pre-transplant recipient characteristics associated with reduced 1-year survival following pediatric combined HKTx. Using the relative risks calculated in regression analysis, points were assigned for each risk factor. Points for each risk factor were combined allowing for the construction of a total risk score (low-risk <4, moderate-risk 4 to 5, and high-risk ≥6). Risk factors associated with reduced 1-year survival included the recipient's age ≥12 years, African American race, diabetes mellitus, and chronic dialysis (defined as dialysis for 6 months or longer) at the time of transplantation. Further stratification by estimated glomerular filtration rate (eGFR) was performed based on a previous study showing decreased survival of patients undergoing isolated heart transplants with a preoperative eGFR of <35 mL/min/1.73m2. Low-risk score patients with an eGFR of <35 mL/min/1.73m2 undergoing combined HKTx had significantly better 1-year survival compared with isolated heart transplants with similar range eGFR and risk score (86.6% [66.3, 92.1] versus 68.7% (64.3, 72.7), P=0.01). There was no survival advantage for combined HKTx over heart-alone transplant in patients with the high-risk score (63.9% [59.3, 68.1] versus 60.3% [55.6, 64.6], P=0.7). Low-risk score patients with combined heart and kidney failure (eGFR <35 mL/min) have a survival benefit from pediatric combined HKTx. On the other hand, there is no significant advantage for combined HKTx over heart-alone transplant in patients classified as high-risk and associated with poor survival. [ABSTRACT FROM AUTHOR]

Cardiac allograft vasculopathy (CAV) is a leading cause of death and retransplant after heart transplantation (HTx). Coronary aneurysms are not typically seen in CAV. We present a case of atypical CAV with coronary aneurysms resulting in premature death. A 4-year-old male underwent HTx after failed single ventricle palliation. His first year after HTx was uneventful with no cellular rejection score greater than 1R and no antibody mediated rejection on multiple surveillance endomyocardial biopsies. Coronary angiography was normal at 3 months. At 1-year post-HTx, surveillance coronary angiography demonstrated a diffusely dilated appearance with multiple aneurysmal segments of the right and left coronary systems (Figure). No filling defects or areas of focal stenosis were appreciated. His pulmonary capillary wedge pressure was elevated at 15 mmHg, but stable from previous assessments. There was no known history of Kawasaki disease in the donor. The patient had no history of prolonged fevers or other symptoms of vasculitis. He was placed on enoxaparin and aspirin for anticoagulation. He remained asymptomatic with no regional wall abnormalities and normal systolic function by echocardiogram. He denied episodes of palpitations and had a Holter without any ectopy or arrhythmias. While awaiting further evaluation with additional advanced imaging, he had a sudden cardiac arrest and died 10 months after coronary aneurysms were found. His autopsy revealed segmental fusiform aneurysmal expansion with severe concentric intimal fibrosis and luminal narrowing of multiple segments of the right and left coronary systems consistent with severe CAV. Left ventricular histopathology exhibited chronic ischemic changes to the subendocardium. Our patient with severe CAV presented with coronary aneurysm formation within 1 year of HTx. Coronary aneurysm formation may be an atypical and more severe form of CAV that should prompt close monitoring and early consideration for retransplant. [ABSTRACT FROM AUTHOR]

Ventricular assist device (VAD) driveline infections are a source of significant morbidity and recurrence can result in multi-drug resistant infections (MDRIs). Bacteriophage (BP) therapy has been successfully used for MDRIs, but it has not been described in a pediatric VAD-specific MDRI. We present the case of BP therapy used for the control of a Klebsiella pneumoniae VAD-specific MDRI in a pediatric patient. A 10 y/o highly sensitized male with a HeartWare HVAD™ (Medtronic, Fridley, MN) in place for heart failure secondary to congenital heart disease developed a MDR K. pneumoniae VAD pump pocket and deep driveline infection. He underwent debridement, creation of fistulous tract for additional drainage, and prolonged IV antibiotic therapy (including extended infusions of meropenem). He continued to have purulent drainage from his fistulous tract, intermittent fevers, and evidence of worsening infection on serial imaging. Fifteen months after the infection was identified, he developed worsening heart failure and concern for pump thrombosis prompting plans for device exchange. Given the high risk of infection of the new VAD, BP therapy was developed (TAILOR, Baylor College of Medicine, Houston, TX) and administered under an emergency Investigational New Drug application with the US Food and Drug Administration. After 4 days of systemic BP therapy he underwent VAD explant to extracorporeal membrane oxygenation (ECMO) support followed by serial mediastinal washouts with antibiotic and local BP application prior to placement of the new VAD. He completed a 6 week course of systemic BP with ongoing meropenem therapy. No adverse reactions associated with BP were observed. He subsequently underwent heart transplant on day 37 of 42 of BP therapy when a donor organ became available. No evidence of mediastinitis was observed intra-operatively at time of transplant; cultures and PCRs from the mediastinal tissue were negative. He is now 6 months post-transplant without any evidence of infection recurrence. Bacteriophage played a significant role in the eradication of a VAD-specific MDRI in a pediatric patient. This may represent a safe and effective therapy for device-related MDRIs refractory to antibiotic and surgical therapy in pediatric patients. [ABSTRACT FROM AUTHOR]

RYR2 mutations are known to cause catecholaminergic polymorphic ventricular tachycardia (CPVT), an inherited disorder with risk for life threatening atrial (AT) and ventricular (VT) arrhythmias. Individuals with RYR2 mutation less commonly exhibit arrhythmogenic right ventricular cardiomyopathy (ARVC). We report the first case of a pediatric patient with RYR2 mutation, manifesting with CPVT, ARVC, and severe dysfunction requiring heart transplant (HTx). A 4.5 year old male with developmental delay presented after multiple syncopal episodes both at rest and with activity. A Holter showed AT, and he was started on a beta adrenergic antagonist with decreased frequency of syncopal episodes. He then developed sinus bradycardia with marked sinus pauses, prompting dual chamber pacemaker placement at age 6 years. He later exhibited bidirectional VT and whole exome sequencing identified a de novo, likely pathogenic variant in RYR2. He was medically managed until 16 years of age when he had syncope with exercise and was found to have both frequent AT and moderately depressed ventricular function with an ejection fraction of 45%. Given recurrent syncope with exercise, he underwent uncomplicated sympathectomy and optimization of his medical antiarrhythmic management. Over the next few months, he developed progressive heart failure symptoms and was admitted with worsening biventricular dysfunction and tachyarrhythmias. During his admission, he had a cardiac arrest with initial monitoring demonstrating VT, and was placed on extracorporeal membrane oxygenation support. He was transitioned to a durable left ventricular assist device (VAD), and was eventually listed for HTx. His VAD course was complicated by RV dysfunction needing PDE5 inhibitor; his arrhythmia burden was managed on flecainide, sotalol, and nadolol. After 80 days of VAD support, he underwent HTx. Pathology of his explanted heart revealed biventricular fibrofatty myocardial replacement consistent with ARVC with prominent LV involvement. This case highlights an expanded spectrum of RYR2 mutation related disease which may include prominent atrial arrhythmias, ARVC, and developmental delay. Patients with CPVT and RYR2 mutation warrant close monitoring for ventricular dysfunction, especially if there is a significant arrhythmia burden. [ABSTRACT FROM AUTHOR]

Aortopulmonary collaterals (APCs) frequently develop in children with single ventricle (SV) physiology. The prevalence and clinical impact of APCs after pediatric heart transplant (HT) are unknown. We highlight a case of an infant with failed SV palliation with post-HT diastolic heart failure due to a significant burden of APCs. A 1-year old infant with hypoplastic left heart syndrome underwent first and second-stage surgical palliation. He developed end-stage heart failure due to systemic right ventricular systolic dysfunction and subsequently underwent HT (recipient/donor weight: 0.89). The extent of APCs was unknown at the time of HT. Post-HT, he had ongoing evidence of diastolic dysfunction with a significant diuretic requirement, persistently elevated BNPs (≈600-800pg/ml), and chronic kidney disease throughout the first year after HT. He had no evidence of graft rejection or coronary allograft vasculopathy. There was suspicion for APCs given holodiastolic flow reversal in the abdominal aorta seen on echocardiography. Cardiac catheterization revealed diastolic dysfunction with left ventricle end-diastolic pressures of 17-23mmHg. There was a step up of saturation from superior vena cava to pulmonary artery (∆15%). Angiography revealed 6 APCs from the right and left internal mammary, right and left thoracic, and right axillary arteries (Figure 1A). Embolization was performed utilizing 33 coils (Figure 1B). Cerebral near infrared spectroscopy immediately improved from 50s to 80s after coiling. Seven months after this procedure, the BNP decreased to 200-300 pg/ml, the LVEDP decreased to 12mmHg, and his diuretic requirement significantly improved. APCs may be a cause of persistent diastolic dysfunction and heart failure after HT in patients with previous SV physiology. Interrogation for APCs in these patients should be considered post-HT to aid in early diagnosis, and treatment may yield significant clinical improvement. [ABSTRACT FROM AUTHOR]

Valvular disease in pediatric donor hearts may be a relative contraindication to graft use. Outcomes following use of donor hearts with milder forms of valvular disease have not been previously reported. We describe 4 cases of pediatric heart transplantation (HTx) in which the donor heart had a bicuspid aortic valve (BAV). Of the 469 HTx performed at our center since 1985, 4 donor hearts had a BAV. All recipients were female; median age 11 years (range 0.3 to 19 years). In all cases, the BAV was not discovered until after HTx. All donors were less than 30 years old. The patients were followed for a median of 6 years (range 2 to 9 years) with all patients alive at last follow up. Two patients transferred to adult care and 2 patients are followed by our clinic. In follow up, no patient required an aortic valve intervention or had infective endocarditis. At last review, no patient had greater than mild aortic insufficiency or more than mild aortic stenosis. Three patients developed mild to moderate left ventricular hypertrophy in the first year post-transplant that improved over time. One patient experienced a peri-operative embolic stroke at time of transplant unrelated to the bicuspid aortic valve. On short- and intermediate-term follow up, donor hearts with bicuspid aortic valve demonstrated acceptable graft longevity and valvular function. A functionally normal bicuspid aortic valve in a pediatric heart transplant donor should not be a contraindication to organ acceptance. [ABSTRACT FROM AUTHOR]

Graft failure after heart transplant (HTx) due to allograft rejection or coronary artery vasculopathy (CAV) can result in cardiogenic shock requiring mechanical circulatory support (MCS). We present our institutional experience with the Impella®, a percutaneous ventricular assist device (VAD), in HTx patients in cardiogenic shock due to graft failure. This is a single center, retrospective review of HTx patients who underwent Impella implantation from 10/2014 to 4/2020. Demographics, device implant techniques, complications, and clinical outcomes were analyzed. There were 19 Impella implants in 11 HTx patients with median age and weight of 16 years (range 6-25) and 61 kg (range 23-124). Graft failure was due to rejection in 55% (6/11), CAV in 18% (2/11), and non-specific graft failure in 27% (3/11). Median time from HTx to Impella implant was 42 months (range 9-175). Impella devices included CP (n=11), 5.0 (n=5), 2.5 (n=1), and RP (n=2). Median length of support per implant was 5 days (range 3-21). Devices were placed via femoral (15/19) or axillary (4/19) arterial access. Seven patients received Impella support once with a single implant each. One patient required 3 distinct admissions for shock due to rejection and received Impella support each time. Three patients required 9 device implants during their course primarily for recurrence of heart failure (HF) after trial off device. Two of these received simultaneous support with CP and RP devices for biventricular HF. ECMO with Impella was required in 4 patients; 2 had Impella after ECMO for left heart decompression and 2 were placed on ECMO after Impella to augment cardiac support. Device related complications per patient included: device malfunction in 2, major bleeding requiring transfusion in 2, hemolysis in 5, extremity arterial thrombus in 2, intracardiac thrombus in 1, and transient foot drop in 3. There was no limb ischemia, stroke, infection, or increase in aortic insufficiency in the study cohort. Survival to hospital discharge was 91% (10/11). Six patients were explanted for recovery, 2 were transitioned to durable VAD, and 2 were bridged to HTx. Impella is a promising temporary MCS option with an acceptable risk profile for adolescent and young adult HTx patients in cardiogenic shock due to graft failure with means to facilitate recovery or bridge to durable VAD or re-transplant. [ABSTRACT FROM AUTHOR]

The significance of atypical infiltrates, defined as eosinophils or plasma cells on endomyocardial biopsy (EMB) after pediatric heart transplant (HTx) is not known. We hypothesize that atypical infiltrates are associated with worse post-HTx outcomes. We performed a retrospective cohort study of 96 consecutive patients status-post primary HTx (age <18 years) from 2013 to 2017 who underwent total of 753 EMBs. Clinical characteristics and pathologic findings were reviewed. Patients status-post heart re-transplant or multi-organ transplant were excluded. The number of EMBs with atypical infiltrates and whether atypical infiltrates were rare versus abundant by pathologist review were noted. Primary outcome was a composite of cardiac allograft vasculopathy (CAV), graft failure (defined as re-listing or re-transplant), or death. Groups were compared using Cox regression with time-dependent covariates. Atypical infiltrates were seen in 24/96 (25%) patients. Of these patients, 14/24 (58%) had 1 EMB and 10/24 (42%) had >2 EMB with atypical infiltrates. Atypical cells were abundant in 6/24 (25%), while they were a rare cell type in 18/24 (75%). The presence of atypical infiltrates on EMB was associated with higher likelihood of reaching the composite outcome compared to no atypical infiltrates (HR 6.9 [2.9-16.3], Fig 1A). Two or more EMBs with atypical infiltrates were associated with greater risk of composite outcome compared to no atypical infiltrates (HR 11.1 [4.2-29.1], Fig 1B). All patients with abundant atypical infiltrates met the composite outcome within the study period (HR 21.6 [7.7-60.2], Fig 1C, compared to no atypical infiltrates). Atypical infiltrates on EMB are associated with increased risk of CAV, graft failure, or death after HTx. The risk is higher with increasing frequency and greater extent of atypical infiltrates on EMB. Patients with atypical infiltrates are an at-risk population that require close follow up. [ABSTRACT FROM AUTHOR]

The hemodynamic profiles (HDPs) among pediatric heart transplant (HT) recipients after the 1st year post-HT is understudied. We aim to describe HDPs following the 1st year post-HT and assess associations with long term outcomes. HDPs were collected from patients who underwent HT between 2013-2020. Patients were excluded if they did not have at least 2 catheterizations 1-year after HT. LOESS graphs were created to trend HDPs >1 year. Linear mixed models were used to assess the effects of selected variables on HDPs. In total, 435 studies from 115 patients were included (median 3 studies/patient and median time of cath since HT: 839 days). The "normal control group" post-HT HDPs (Fig 1, Black Trendline) were created from 212 studies from 67 patients with no history of rejection or known CAV at any point. In multivariate analysis, those who later develop CAV (Fig 1; Blue Trendline) had lower cardiac index (CI) values (mean difference: -0.523±0.238, p=0.030) prior to angiographic diagnosis of coronary artery vasculopathy (CAV). Other factors found to influence HDPs included rejection (n=41), and angiographic evidence of CAV (n=44) which were associated with higher filling pressures and lower CI; Table 1. Independent of other variables, right atrial mean, right ventricular end diastolic, and wedge pressures increased and CI decreased with time (Table). Our study establishes normal expected HDPs following 1-year post-pediatric HT. Compared to those with no CAV, those who later develop CAV have decreased CI prior to angiographic diagnosis and may warrant more frequent surveillance. [ABSTRACT FROM AUTHOR]

Bipolaris oryzae causes brown spot in rice ( Oryza sativa) inflicting substantial grain yield losses worldwide. Knowledge of the population structure, genetic diversity and sexual recombination of the fungal pathogen can help to implement effective disease management strategies. In this study, B. oryzae isolates sampled from Iran, the Philippines and Japan were analysed with 12 simple-sequence repeat ( SSR) markers, newly developed from the genome sequence of the fungus. Among the 288 B. oryzae isolates genotyped, 278 unique haplotypes were identified. High genotype numbers (richness) with even distribution (evenness) were found within the collection sites. Both mating types, MAT1-1 and MAT1-2, were present in each collection area, and the sexual state was induced under controlled conditions with production of viable ascospores. However, the tests of linkage disequilibrium rejected of the hypothesis of random mating. Discriminant analysis of principal components ( DAPC) revealed that the B. oryzae collection formed three clusters, each consisting of isolates from different collection sites. Analysis of molecular variance ( amova) showed that genetic variation among clusters was 18.7%, with the rest of the variation distributed within clusters ( RST = 0.187, P < 0.001). Statistically significant pairwise genetic differentiation was found between the clusters. These results show that Asian B. oryzae isolates are genetically diverse, and, overall, distributed in three groups. These findings will be helpful in managing the disease and guide the use of representative isolates needed for selection of resistant rice varieties. [ABSTRACT FROM AUTHOR]

Epitope-based human leukocyte antigen (HLA) molecular typing techniques now permit the assessment of a donor-recipient "match". We sought to determine the HLA epitope mismatch load among different pediatric heart transplant (PHT) donor-recipient race/ethnicity pairs. We performed high resolution HLA typing and epitope mismatch analysis (HLA Matchmaker) on all primary PHT (2014-2020) at a single center. Race/Ethnicity categories were defined as Non-Hispanic White (NHW), Non-Hispanic Black (NHB), and Hispanic; patients categorized as other, mixed, or missing were excluded. HLA epitope mismatch load was compared between those with and without a donor/recipient (D/R) race/ethnicity (R/E) mismatch and among all donor-recipient race/ethnicity pairs. Data were available to assess D/R R/E pairs and HLA epitope mismatch load among 119 patients (29% NHW; median age 5.8 years). There were 45 (38%) D/R R/E matched organs. There was no difference in the number of HLA epitope mismatches at any locus among those who received a D/R R/E matched pair vs those that did not (Table). When comparing among all D/R R/E matched pairs, there was no difference in the HLA epitope mismatch load at any locus (Class I, Class II, and DQ shown in Figure). There was no difference in the HLA epitope mismatch load between pediatric patients receiving a donor-recipient race/ethnicity matched organ or among any donor-recipient race/ethnicity pair. HLA diversity transcends the social construct of race, and non-immunologic factors such as social determinants of health should be addressed to help improve PHT outcomes. [ABSTRACT FROM AUTHOR]

The number of patients with failing single ventricle physiology is increasing, and ventricular assist device (VAD) support in this population is challenging. The purpose of this study was to describe our clinical experience with VAD for failing Glenn physiology. A retrospective review of clinical outcomes was conducted in patients that underwent durable VAD placement for failing Glenn circulation between 2010 and 2020 at Texas Children's Hospital. Ten patients met inclusion criteria; all had a morphologic right ventricle (RV): 6 hypoplastic left heart syndrome/variant and 4 with isomerism with RV dominant atrioventricular septal defect. INTERMACS profiles were 1 in 3 patients (1 with ECMO) and 2 in 7 patients. Four patients were intubated. Age, weight, and body surface area at VAD implantation were 3.2 (0.9-10.1) years, 13.0 (7.7-22.8) kg, and 0.50 (0.36-0.90) m2, respectively. The device-strategy included HVAD in 6, Jarvik 2015 in 1, and Berlin cannula (with Berlin and/or Rotaflow pumps) in 3. Concomitant Fontan completion was performed in 5 patients (1 with fenestration), while the other 5 remained with Glenn circulation. PaO2/FiO2 ratio (median, range) on postoperative day 1 was significantly higher with Fontan completion [192 (53-336)] than without [76 (59-78), p=0.05] except a patient with Glenn circulation on ECMO. The median duration of mechanical ventilation after VAD was 2 days (range, 1 - 14). There was 1 early mortality 8 days after HVAD placement with Fontan completion due to neurologic insult intraoperatively. The remaining 9 patients (90%) were bridged to transplant at a median support duration of 3.8 (0.1-16.6) months. Five of the 6 HVAD patients were able to be discharged home prior to transplant. One patient encountered a pump thrombus requiring pump exchange and 1 patient suffered a thromboembolic stroke due to a mobile intraventricular thrombus. One patient had a subdural and subarachnoid hemorrhage 27 days after VAD implantation, with complete neurologic recovery without deficits. This single-institutional experience suggests long term VAD support is sustainable for failing Glenn physiology with accompanying Fontan completion in selected patients. Further studies are warranted to optimize long term VAD support in this challenging population. [ABSTRACT FROM AUTHOR]

The significance of atypical infiltrates, defined as eosinophils or plasma cells on endomyocardial biopsy (EMB) after pediatric heart transplant (HTx) is not known. We hypothesized that atypical infiltrates are associated with worse post-HTx outcomes. We performed a retrospective cohort study of 96 consecutive patients aged <18 years who underwent primary HTx from 2013 to 2017. Patients who underwent heart re-transplant or multi-organ transplant were excluded. The number of EMBs with atypical infiltrates and burden of atypical infiltrates (rare vs predominant on pathologist review) were recorded. Primary outcome was a composite of cardiac allograft vasculopathy, graft failure (defined as re-listing or re-transplant), or death. Groups were compared using Cox regression with time-dependent covariates and mixed effects logistic regression accounting for repeated measures. Atypical infiltrates were seen in 27/96 patients (28%). The presence of atypical infiltrates on EMB was associated with higher likelihood of reaching the composite outcome compared to no atypical infiltrates (HR 5.82, 95% CI 2.5-13.6, p<0.001). This finding persisted when accounting for rejection. Two or more EMBs with atypical infiltrates were associated with greater risk of composite outcome compared to no atypical infiltrates (HR 10.5, 95% CI 2.86-38.5, p=0.001), as was having atypical infiltrates as the predominant feature on EMB (HR 19.1, 95% CI 6.51-56.0, p<0.001). Patients with atypical infiltrates by their 1-year post-transplant biopsy had survival free of primary outcome of 48% at 5 years, compared to 90% if no atypical infiltrates had been seen by the 1-year post-transplant biopsy (log rank = 0.002, Figure). Atypical infiltrates on EMB are associated with poor outcomes following HTx. The risk is higher with increasing frequency and greater extent of atypical infiltrates. Patients with atypical infiltrates are an at-risk population that require close follow up. [ABSTRACT FROM AUTHOR]

Recent data in adult solid organ transplantation suggest that epitope-based human leukocyte antigen (HLA) matching may permit better risk assessment of de novo donor‐specific antibody (dnDSA) development compared to antigen-based HLA matching, but data in pediatric heart transplantation (PHTx) are scarce. We evaluated the association between epitope mismatches and dnDSA in PHTx. We performed high resolution HLA typing and epitope mismatch analysis (HLA Matchmaker) in children undergoing primary PHTx at a single center from 2014 - 2020. DSA >1000 MFI (Luminex Single Antigen Bead Assay; One Lambda) were considered positive. Data are presented as median (interquartile range). Epitope and dnDSA data were available in 109 transplants (age 5.8 years [1-12], 66% male, 32% non-Hispanic White, follow-up 2.5 years [1.3 - 4.7]). There was significant diversity in the number of epitope mismatches within each HLA locus (Fig 1A), and the number of mismatches were: A 20 (13-28), B 17 (12-22), C 10 (6-15), DR 16 (8-30), DQ 12 (8-16), and DP 8 (3-13). The number of epitope mismatches did not differ among any donor-recipient race combination (not shown). The development of dnDSA was not associated with a higher number of epitope mismatches at any HLA-loci (Fig 1B). However, patients with antibody mediated rejection (AMR) had more DQ mismatches (15 vs 11; p=0.04) than those without AMR, and there were more anti-DQB1 DSA than any other DSA in the cohort (Figure 1C). There is significant variability in the number of HLA epitope mismatches within each HLA locus. These data suggest that it may not be the total number of epitope mismatches but rather epitope mismatches at specific loci that vary in location and function that are of immunogenic importance. Further investigation of epitope-matching in PHTx may permit a more personalized immunosuppressive approach based on individualized alloimmune risk assessment in the future. [ABSTRACT FROM AUTHOR]

Reducing Emissions from Deforestation and Forest Degradation (REDD+) has emerged as a prominent potential climate change mitigation measures which aims at conservation of forests to sequester carbon. A key task of a REDD+ project is determination of historical deforestation rates and patterns, as well as the proximate causes and underlying forces of such deforestation. This baseline mapping is critical for identification of future REDD+ project scenarios to conserve carbon. The study demonstrates the potential use of mapping technologies like satellite remote sensing and Geographic Information System (GIS) in modeling REDD+ baselines for Balpakram-Baghmara Landscape (BBL) in Meghalaya, north-east region of India. The landscape is characterized by rapid deforestation and forest degradation. Temporal satellite remote sensing data of 1991, 2000 and 2011 were used to assess spatio-temporal patterns of forest cover changes. Based on quantitative analysis of the changes (1991-2011) deforestation rate was estimated to be 2.35% annually. Spatio-temporal datasets along with biotic and abiotic variables provide opportunities to model forest cover change further. Land Change Modeller (LCM) was used to predict forest cover status for 2021 and 2031 using current disturbance scenarios. Comparing actual land-use land-cover (LULC) of 2011 with the predicted LULC of 2011 validated change prediction model and agreement was 65.22%. Expansion in cropland area, which has increased more than five times, has been the major force behind continuing forest loss. [ABSTRACT FROM AUTHOR]

Determine the association of socioeconomic disadvantage (SED) and race/ethnicity with post-heart transplant (HTx) outcomes in children. A retrospective single-center cohort study of patients &lt 18 years of age who underwent HTx between 1/2006-12/2020 was performed. The Area Deprivation Index (ADI), a validated census-based neighborhood deprivation tool (higher value = more disadvantaged) that incorporates income, education, employment, and housing quality, was used to determine SED status. Patients were divided into less disadvantaged ("no SED"; ADI &lt 25%-ile) and more disadvantaged ("SED"; ADI &gt 25%-ile) as previously described. Outcomes included post-HTx survival (Kaplan-Meier curves and cox-proportional regression) and rejection (total episodes per year of follow-up were compared using linear regression). The cohort included 290 HTx (median age 5 yr [IQR 1- 13 yr], median weight 16kg [IQR 8 - 43 kg]). Median follow-up time from HTx was 4.3 yr (IQR: 1.7 - 7.3 yr). The cohort was 40% Hispanic, 33% Non-Hispanic White (NHW), 20% Non-Hispanic Black (NHB) and 7% Other. Median ADI was 63 (IQR: 43 - 83). Patients with SED had a significantly greater risk of death (HR: 4.2, 95% CI: 1.01 - 17.3) compared to those with no SED; Fig 1A. After adjusting for ADI, patients identifying as NHB (HR: 2.2, 95% CI: 1.03 - 4.6) and Other (HR: 3.8, 95% CI: 1.4 - 10.2) had a significantly higher risk of death compared to NHW (Fig 1B). Compared to NHW, only "Other" had an increased frequency of rejection (p = 0.01). Patients with SED did not have more episodes of rejection per year of follow up (0.21 vs 0.18; p = 0.8). Socioeconomic disadvantage and race/ethnicity (independent of ADI) are associated with worse post-HTx survival. Socioeconomic disadvantage was not associated with frequency of rejection; neither was NHB norHispanic race/ethnicity. Identifying and addressing any potentially modifiable determinants of SED is imperative to improve survival after pediatric HTx. [ABSTRACT FROM AUTHOR]

The Australian Air Quality Forecasting System (AAQFS) is the culmination of a 3-yr project to develop a numerical primitive equation system for generating high-resolution (1–5 km) short-term (24–36 h) forecasts for the Australian coastal cities of Melbourne and Sydney. Forecasts are generated 2 times per day for a range of primary and secondary air pollutants, including ozone, nitrogen dioxide, carbon monoxide, sulfur dioxide, and particles that are less than 10 μm in diameter (PM10). A preliminary assessment of system performance has been undertaken using forecasts generated over a 3-month demonstration period. For the priority pollutant ozone it was found that AAQFS achieved a coefficient of determination of 0.65 and 0.57 for forecasts of peak daily 1-h concentration in Melbourne and Sydney, respectively. The probability of detection and false-alarm rate were 0.71 and 0.55, respectively, for a 60-ppb forecast threshold in Melbourne. A similar level of skill was achieved for Sydney. System performance is also promising for the primary gaseous pollutants. Further development is required before the system can be used to forecast PM10 confidently, with a systematic overprediction of 24-h PM10 concentration occurring during the winter months. [ABSTRACT FROM AUTHOR]

The performance of the Australian Air Quality Forecasting System (AAQFS) is examined by means of a case study of a 7-day photochemical smog event in the Sydney region. This was the worst smog event for the 2000/ 01 oxidant season, and, because of its prolonged nature, it provided the opportunity to demonstrate the ability of AAQFS to forecast situations involving recirculation of precursors and remnant ozone, fumigation, and complex meteorological dynamics. The forecasting system was able to successfully predict high values of ozone, although at times the peak concentrations for the inland stations were underestimated. The dynamics for the Sydney region require a sensitive balance between the synoptic and mesoscale flows. Often high concentrations of ozone were advected inland by the sea breeze. On two occasions the system forecast a synoptic flow that was too strong, which blocked the inland advancement of the sea breeze. The peak ozone forecasts were underpredicted at the inland stations on those occasions. An examination of possible factors causing forecast errors has indicated that the AAQFS is more sensitive to errors in the meteorological conditions, rather than in the emissions or chemical mechanism in the Sydney region. [ABSTRACT FROM AUTHOR]

A 4-day photochemical smog event in the Melbourne, Victoria, Australia, region (6–9 March 2001) is examined to assess the performance of the Australian Air Quality Forecasting System (AAQFS). Although peak ozone concentrations measured during this period did not exceed the 1-h national air quality standard of 100 ppb, elevated maximum ozone concentrations in the range of 50–80 ppb were recorded at a number of monitoring stations on all four days. These maximum values were in general very well forecast by the AAQFS. On all but the third day the system predicted the advection of ozone precursors over Port Phillip (the adjacent bay) during the morning, where, later in the day, relatively high ozone concentrations developed. The ozone was advected back inland by bay and sea breezes. On the third day, a southerly component to the background wind direction prevented the precursor drainage over the bay, and the characteristic ozone cycle was disrupted. The success of the system's ability to predict peak ozone at individual monitoring stations was largely dependent on the direction and penetration of the sea and bay breezes, which in turn were dependent on the delicate balance between these winds and the opposing synoptic flow. [ABSTRACT FROM AUTHOR]

Angiotensin II type 1 receptor antibodies (AT1R-Ab) are associated with non-human leukocyte antigen (HLA) mediated antibody mediated rejection (AMR) and graft failure in adult renal transplantation. They can be stimulated by ventricular assist device (VAD) support, but data regarding AT1R-Ab in pediatric heart transplantation (HT) are scarce. The purpose of this study is to describe the incidence of non-HLA mediated AMR and identification of AT1R-Ab in a pediatric HT cohort. We performed a single-center retrospective review of children who underwent primary HT from July 2016 to July 2020. AMR was defined by the presence of complement deposition (+C4d) on heart biopsy. Non-HLA mediated AMR was defined by the absence of donor-specific HLA antibodies (HLA-DSA). AT1R-Ab testing was defined as < 10 negative, 10-17 borderline, and > 17 positive (ELISA). There were 100 patients who underwent primary HT during the study period (median age 4.5 years). There were 19 episodes of AMR in 17 patients. HLA-DSA were present in 12 episodes (63%) and absent in 7 (37%) episodes. Non-HLA mediated AMR occurred earlier post-HT compared to AMR with HLA-DSA (median 7 days vs 244 days, p = 0.04). Four patients with AMR in the absence of HLA-DSA were tested for AT1R-Ab; 3 were positive and 1 was borderline. Of the 3 patients with positive AT1R-Ab, 2 were previously supported on VAD, 2 had symptomatic AMR, 2 subsequently received losartan, and none have had recurrence of AMR (Table). Non-HLA mediated AMR accounted for 37% of AMR episodes and occurred earlier post-HT compared to AMR with HLA-DSA in a single-center cohort. AT1R-Ab were present in 3 of 4 patients with non-HLA mediated AMR in whom AT1R-Ab testing was performed. In light of the recent data regarding AT1R-Ab in renal transplantation, investigation of the prevalence and clinical significance of AT1R-Ab in pediatric HT, particularly in early non-HLA mediated AMR and in those bridged to HT with VAD, is warranted. [ABSTRACT FROM AUTHOR]

Background: Immune effector cell (IEC) therapies, including chimeric antigen receptor (CAR)-modified T-cell therapy, have shown efficacy in pediatric B-cell acute lymphoblastic leukemia (B-ALL) and are being investigated for other malignancies. A common toxicity associated with IEC therapy is cytokine release syndrome (CRS), which can lead to cardiovascular decompensation due to systemic inflammation. Data are limited regarding cardiovascular adverse effects in children. This study aims to describe the cardiovascular adverse effect profile of IEC therapies in pediatric patients with hematologic and solid tumor malignancies., Methods: We retrospectively reviewed patients who received IECs directed towards various targets in patients with hematologic, solid, and brain tumor malignancies from January 2014 to June 2023 at Texas Children's Hospital. The primary end point was hypotension requiring vasoactive support and/or heart failure within 30 days of infusion., Results: A total of 203 patients met inclusion criteria. Pretreatment echocardiogram was available for 142 (70%) pediatric patients, of whom 140 (96%) had normal baseline systolic function. Hypotension requiring vasoactive support occurred in 26 (13%) patients. Hematologic malignancy indications (p = 0.002), total body irradiation (TBI) (p = 0.002), and allogenic hematopoietic stem cell transplants (HCT) (p = 0.035) were associated with increased risk of hypotension requiring vasoactive support. Follow-up echocardiograms were available for 14 patients who met the primary end point, and all showed return to baseline within 6 months., Conclusions: Significant hemodynamic compromise occurred in a minority of patients treated with IEC therapies. All experiencing cardiac dysfunction had recovery of function, and there was no cardiovascular-related mortality., (© 2025 Wiley Periodicals LLC.)

Objective: Neurodevelopmental delay is common in children who undergo surgery for Congenital Heart Disease (CHD) in infancy. Cardiac surgery associated acute kidney injury (CS-AKI) occurs frequently in the paediatric cardiac Intensive care unit (ICU). Cardiac surgery associated acute kidney injury (CS-AKI) is associated with worse neurodevelopmental scores and delay in cognitive, language, and motor domains in children with CHD. No known data exist regarding the association of CS-AKI and motor and language subscales. In this study, we explored the relationship between CS-AKI and receptive and expressive language, as well as gross and fine motor delay., Methods: This was a single centre retrospective observational cohort study. Children who underwent surgery for CHD and developed recurrent CS-AKI in the first year of life who had follow-up neurodevelopmental testing using the Bayley Scale of Infant Development Version III were included. Neurodevelopmental delay subscales assessed included: receptive and expressive language, fine and motor skills., Results: The study cohort included 203 children. Recurrent CS-AKI was significantly associated with lower scores in receptive and expressive language, as well as fine and gross motor on unadjusted analyses. On adjusted analyses, recurrent CS-AKI was significantly associated with severe receptive language delay., Conclusion: The independent association of recurrent CS-AKI with severe language delay in children who undergo surgery for CHD in infancy is novel. Our findings may contribute to the understanding of language impairment in this population. Further studies are required to better understand this relationship and any potentially modifiable factors.

Objective: CHD predisposes children to neurodevelopmental delays. Frequent, prolonged hospitalisations during infancy prevent children with heart disease from participating in recommended language and cognitive development programmes, such as outpatient early childhood literacy programmes, and contribute to caregiver stress, a risk factor for adverse developmental outcomes. This study aims to describe the implementation of a single-centre inpatient early childhood literacy programme for hospitalised infants with heart disease and assess its impact on reading practices and patient-family hospital experience., Methods: Admitted infants ≤1 year old receive books, a calendar to track reading frequency, and reading guidance at regular intervals. Voluntary feedback is solicited from caregivers using an anonymous, QR-code survey on books. A prospective survey also assessed programme impact on hospital experience., Results: From February 2021 to November 2023, the Books@Heart programme provided 1,293 books to families of 840 infants, of whom 110 voluntarily submitted feedback. Caregivers reported a significant improvement in access to books (p < 0.001) and increased reading frequency after learning about Books@Heart ( p = 0.003), with the proportion reading to their child daily increasing from 27% to 62%. Among 40 prospective survey responses, caregivers reported feeling a sense of personal fulfillment (60%), self-confidence (30%), connection (98%), and personal well-being (40%) while reading to their child., Conclusion: An inpatient early childhood literacy programme is a well-received intervention for infants with heart disease that promotes development, improves book access, increases reading exposure, and engages families. Further studies are needed to assess its impact on sustained reading practices and neurodevelopmental outcomes.

Introduction: Surgeons and military personnel are subjected to high-stress scenarios, which leads to greater rates of burnout. There is room to optimize performance and longevity in these careers by better understanding the body's stress response and applying it to stress management training. This study aims to understand the physiological response in those engaged in trauma scenarios by examining 6 hormones and 42 cytokines during the Intensive Surgical and Trauma Skills Course held at Strategic Operations Inc in San Diego, CA., Methods: Thirty-seven military medical students participated in full immersion, hyper-realistic, and experiential mass casualty high-stress scenarios. Participants were exposed to both operating and emergency room scenarios. Saliva samples were taken after stress inoculation (postinoculation) and again 1 hr after each scenario (recovery). Saliva samples were analyzed using plex assays from Eve Technologies. Data were grouped and analyzed by location and timing using mixed effect nonlinear models. Distributions were compared by location and were analyzed with respect to biomarker levels over the 4-day training period., Results: For emergency room scenarios, there was a decrease in the following cytokines from postinoculation to recovery: epidermal growth factor (EGF), granulocyte colony stimulating factor (G-CSF), epidermal growth factor, granulocyte colony stimulating factor, interleukin 1alpha (IL-1α), interleukin 1beta (IL-1 β), IL-1RA, IL-4, IL-8, IL-10, IL-18, monocyte chemotactic protein (MCP) 1, macrophage colony stimulating factor (M-CSF), macrophage derived chemokine (MDC), CXC motif ligand 9 (MIG/CXCL9), regulated upon activation, normal T cell expressed and secreted (RANTES), and vascular endothelial growth factor (P < 0.05, t > 3.0). For operating room scenarios, there was a decrease in the following cytokines: EGF, G-CSF, IL-1α, IL-1 β, IL-1RA, IL-6, IL-8, IL-10, IL-18, M-CSF, MDC, MIG/CXCL9, RANTES, and tumor necrosis factor alpha. In operating room scenarios, an increase in the hormone levels of progesterone and triodothyronine were observed. The cytokines observed in both groups included EGF, IL-1α, RANTES, MDC, EGF, G-CSF, IL-1RA, IL-18, MIG/CXCL9, IL-8, IL-1β, M-CSF, and IL-10. These significant biomarkers were also graphed and visualized as variable throughout the week., Conclusions: These preliminary data narrow a wide array of stress biomarkers to a smaller, significant group. Surgeons and military personnel are subjected to extraordinary levels of stress with narrow margins for error. To optimize performance and outcomes, it is pertinent to understand the physiological stress response. Future investigation and pairing of cytokine measurements with neuropsychological and performance-based testing will target opportunities to direct training and identify profiles of individuals well suited for stressful environments., (Copyright © 2024 Elsevier Inc. All rights reserved.)