Relationship between FEV1/FVC and age in children with asthma

INTRODUCTION

Forced expiratory volume in the first second (FEV1)/forced vital capacity (FVC) normally decreases through childhood, increases briefly during early adolescence, and then declines throughout life. The physiology behind this temporary increase during early adolescence is not well understood. The objective of this study was to determine if this pattern occurs in children with asthma.

DESIGN

Single-center, cross-sectional, retrospective analysis of pulmonary function tests obtained over a 5-year period in children 5-18 years of age with persistent asthma.

RESULTS

A total of 1793 patients satisfied all inclusion and exclusion criteria. The mean age (±SD) was 10.4 ± 3.8 years. Forty-eight percent were female. Mean FEV1/FVC was 0.83 ± 0.09. FEV1/FVC was lower at 5 years of age than in healthy children, declined from age 5 to 11 by 5.7% compared to 7.3% in healthy girls, and 5.8% compared to 9.4% in healthy boys. FEV1/FVC increased in early adolescence, but at age 16, was 5.6% lower in male children compared to healthy children, and 5.4% lower in females. The ratio was lower in obese children at all ages but demonstrated the same curvilinear shape as healthy children. In absolute terms, FEV1 grew proportionately more than FVC during early adolescence, so the ratio of FEV1/FVC increased during that period. The curvilinear shape of the curve remained in postbronchodilator testing, though significantly blunted.

CONCLUSIONS

FEV1/FVC is lower in children with persistent asthma than healthy children, but the "Shepherd's Hook" pattern is preserved. This was true in obese patients with asthma, although their FEV1/FVC ratios were lower throughout all stages of childhood and adolescence.

Long-Term Effects of COVID-19 on the Cardiopulmonary System in Adults and Children: Current Status and Questions to be Resolved by the National Institutes of Health Researching COVID to Enhance Recovery Initiative

TOPIC IMPORTANCE

Long COVID may occur in at least 10% of patients recovering from SARS-CoV-2 infection and often is associated with debilitating symptoms. Among the organ systems that might be involved in its pathogenesis, the respiratory and cardiovascular systems may be central to common symptoms seen in survivors of COVID-19, including fatigue, dyspnea, chest pain, cough, and exercise intolerance. Understand the exact symptomatology, causes, and effects of long COVID on the heart and lungs may help us to discover new therapies. To that end, the National Institutes of Health is sponsoring a national study population of diverse volunteers to support large-scale studies on the long-term effects of COVID-19.

REVIEW FINDINGS

The National Institutes of Health Researching COVID to Enhance Recovery (RECOVER) initiative currently is recruiting participants in the United States to answer critical questions about long COVID. The study comprises adult and pediatric cohorts as well as an electronic health record cohort. Based on symptoms, individuals undergo prespecified medical testing to understand whether abnormalities can be detected and are followed up longitudinally. Herein, we outline current understanding of the clinical symptoms and pathophysiologic features of long COVID with respect to the cardiopulmonary system in adults and children and then determine how the clinical, electronic health record, and autopsy cohorts of the RECOVER initiative will attempt to answer the most pressing questions surrounding the long-term effects of COVID-19.

SUMMARY

Data generated from the RECOVER initiative will provide guidance about missing gaps in our knowledge about long COVID and how they might be filled by data gathered through the RECOVER initiative.

Association between anxiety and elevated blood pressure in adolescent patients: a single-center cross-sectional study

OBJECTIVE

Although anxiety is known to be associated with elevated blood pressure and hypertension in adults, this has not been studied in children. The aim of this study was to determine the association between anxiety and elevated blood pressures in adolescents.

METHODS

Adolescents, aged 12-18 years old, referred to the nephrology clinic were eligible to participate. Elevated blood pressure was defined as either SBP or DBP measurement above the 95th percentile for age, height, and sex. Participants were evaluated for anxiety using the validated Screen for Child Anxiety Related Disorders questionnaire filled independently by the child (SCARED-C) and parent (SCARED-P) evaluating the child.

RESULTS

Two hundred adolescents participated in this study. Thirty-one (53%) of SCARED-P-positive participants were found to have elevated blood pressure compared with 27 (19%) of SCARED-P negative, P 0.03. Twenty-five (43%) of SCARED-P positive had elevated DBP compared with 31 (28%) of SCARED-P negative ( P 0.003). In SCARED-P positive, mean DBP (78.4 ± 9.9) was higher compared with SCARED-P negative (74.9 ± 9.2) ( P 0.03). In a subgroup of adolescents (№ 130) not treated with blood pressure medications mean DBP was higher in both SCARED-P (79.0 ± 10.1) and SCARED-C (77.1 ± 10.4) positive groups compared with SCARED-P (73.6 ± 9.3) and SCARED-C (73 ± 8.9) negative, respectively.

CONCLUSION

Our study demonstrates an association between anxiety and elevated DBP in adolescent children. Screening adolescents for anxiety should be a part of the routine evaluation of adolescent children.

Plant size, latitude, and phylogeny explain within-population variability in herbivory

Interactions between plants and herbivores are central in most ecosystems, but their strength is highly variable. The amount of variability within a system is thought to influence most aspects of plant-herbivore biology, from ecological stability to plant defense evolution. Our understanding of what influences variability, however, is limited by sparse data. We collected standardized surveys of herbivory for 503 plant species at 790 sites across 116° of latitude. With these data, we show that within-population variability in herbivory increases with latitude, decreases with plant size, and is phylogenetically structured. Differences in the magnitude of variability are thus central to how plant-herbivore biology varies across macroscale gradients. We argue that increased focus on interaction variability will advance understanding of patterns of life on Earth.

Epidemiology of cancers among older adults in India: findings from the National Cancer Registry Programme

OBJECTIVE

This study describes the epidemiology, clinical extent of disease at diagnosis and treatment modalities of cancer among older adults (aged 60 years and older) in India.

STUDY DESIGN

Secondary data analysis of the National Cancer Registry Programme, which includes 28 Population-Based Cancer Registries (PBCRs) and 96 Hospital-Based Cancer Registries (HBCRs).

METHODS

PBCR data were used to estimate the incidence in terms of crude rate (CR), age-adjusted incidence rate (AAR), age-specific rate (ASpR) and cumulative risk. Trends in the AAR were calculated with the Annual Percentage Change (APC) using join-point regression. HBCR data were used to describe the clinical extent of the disease at diagnosis and the treatment modalities.

RESULTS

There is a wide heterogeneity across the country for the incidence of cancer and for the leading cancer sites among older adults. Males had a higher incidence rate compared to females in the majority of the registries. Aizawl had the highest AARs among both genders (males: 1388.8; females: 1033.0). Females had the highest ASpR at 65-69 years (482.8), whereas for males it was above 75 years (710.4). Cervical, stomach and oesophageal cancers were on the decline. The incidence of cancer among older adults was estimated to increase by 13.5% in 2025 as compared to 2020.

CONCLUSION

The increasing cancer incidence among older adults in India poses a huge burden on the health system. There is a need to increase their participation in clinical trials, advocating comprehensive geriatric assessment and strengthening geriatric oncology within programs addressing older adult's care to deal with the rising cancer burden on the health system borne by them.

Changes in Body Mass Index in Children and Adolescents with Asthma during the COVID-19 Pandemic

Background: Increased weight gain in children during the COVID-19 pandemic has been reported. Changes in weight in children with asthma during this period have not been well described. Methods: Retrospective review of children with asthma, 6-18 years of age, seen in 2019 and 2020. Mean monthly rates of change in body mass index (BMI) were compared between years. Demographic and asthma-related factors were examined. Results: Two hundred sixty-seven patients were enrolled. BMI increased by 0.128 ± 0.283 kg/m²/month during the pandemic year as compared with 0.084 ± 0.160 kg/m²/month during the previous year (P = 0.03). Patients with baseline overweight or obesity trended toward higher rates of BMI increase than those starting with normal weight, with the greatest BMI increase occurring in the severely obese. Conclusions: In this single-site study of children with asthma, there was a greater monthly rate of BMI gain during the early pandemic as compared with that observed in the previous year.

Validation of the TNM-8 AJCC classification for HPV-positive oropharyngeal cancers in patients undergoing trans-oral robotic surgery

High-risk human papillomaviruses (HPV) are associated with some oropharyngeal squamous cell carcinomas (OPSCC). HPV-OPSCC have better survival outcomes compared to HPV negative tumours. The new TNM-8 AJCC staging (2018) is based on ICON-S data with 98% of patients treated with primary chemoradiation. To validate the TNM-8 AJCC classification in HPV-OPSCC treated primarily with surgery (trans-oral robotic surgery or open). There were 102 patients with HPV-OPSCC treated between July 2009 and December 2014 at the Royal Adelaide Hospital. The median age was 57 years (range: 38-83) and mostly males (84.5%). 27.2% were active smokers and 50.5% reformed smokers. Early T-stage cancer in 72.8%. Primary treatment was surgery & adjuvant therapy (70%) while primary chemoradiation (30%). Survival analyses were performed for the 7th and 8th AJCC systems. The reclassification to the AJCC 8th edition staging system resulted in a change of 54 patients from stage 4 to stages 1 and 2. This was mainly an effect of changes with N2a and N2b nodal disease being reclassified to N1. Survival outcomes were comparable with the ICON-S data. The new TNM-8 classification is, therefore, validated in a cohort treated, predominantly, with primary surgery and adjuvant therapy.

The relationship between weight and pulmonary outcomes in overweight and obese people with cystic fibrosis: A retrospective observational study

Background

A major focus in cystic fibrosis (CF) care aims to increase weight gain. Rates of overweight and obese people with CF have gradually increased over the past decade. Obesity could be a risk for restriction of lung volumes and airway obstruction as well as increase rates of pulmonary exacerbations in people with CF.

Aim

To assess the relationship between weight categories and pulmonary outcomes in children and adults with CF.

Methods

Patients 6 years of age and older were categorized into weight categories based on the Centers for Disease Control and Prevention (CDC) definitions. A retrospective chart review was conducted to obtain lung function testing and other outcomes.

Results

One hundred five patients with a median age of 20.6 years were included in this analysis. 8.4%, 64%, 18%, and 10% of patients were underweight, normal/healthy weight, overweight, and obese, respectively. Forced expiratory volume in 1 s (FEV₁) and forced vital capacity (FVC) (% predicted) did not differ between patients with weights in the normal range versus patients in the overweight/obese categories. Linear regression analysis showed a direct correlation between body mass index (BMI) and FEV₁ that continued as BMI entered overweight and obese categories in both pediatric and adult patients. Overweight/obese patients did not have increased rates of pulmonary exacerbations compared to those in the normal/healthy weight category.

Conclusion

As CF therapies continue to improve, an increasing number of people with CF are exceeding the CDC's normal-weight range. Gaining weight past the normal range does not appear to negatively impact pulmonary health of people with CF. If this trend of increased weight gain continues, it remains to be seen if it will eventually negatively affect lung health.

Tetrathiafulvalene Derivatives as Hole-Transporting Materials in Perovskite Solar Cell

Over a couple of decades perovskite solar cells have become a highly promising photovoltaic technology. Choosing a dopant-free Hole-Transporting Material (HTM) that offers protection to a perovskite layer from oxidation is one of the viable strategies while addressing the stability of perovskite solar cell. In this line of interest, tetrathiafulvale (TTF) derivatives have shown promise in the past. However, studies that focus on small-molecule TTF derivatives as potential HTM options are scarce. The present study is an attempt to explore the applicability of a few TTF derivatives as HTM in a perovskite solar cell. Here four TTF derivatives, namely, TTF-1 (experimentally reported in a previous study), TTF-2, DBTTF1, and TMTSF1, were studied through electronic structure calculations. The properties concerning HTM, such as impact of adsorption on molecular structure, absorption spectra, distribution of frontier molecular orbitals, interaction energy between TTF derivative and MAPbI₃ surface, and charge transfer at an interface, were analyzed. Results show that TTF-2 has the expected energy-level alignment, transparency in the visible range of solar spectrum, and good charge-injection ability at the interface with a perovskite layer. Hence, TTF-2 could be a potential hole-transporting material for a perovskite solar cell, and it can perform better than TTF-1.

Lung Transplant for Patients with COVID-19 Bridged with VV ECMO: Initial Experience

Purpose

During the COVID-19 pandemic, veno-venous Extracorporeal Membrane Oxygenation (VV ECMO) has been used extensively for respiratory failure refractory to conventional mechanical ventilation (MV) and rescue maneuvers. However, the worldwide experience with COVID-19 patients undergoing lung transplant (LTx) with pre-LTx VV ECMO support is limited. Therefore, we sought to report our institution's early experience with COVID-19 patients who underwent LTx after VV ECMO.

Methods

We retrospectively identified 5 COVID-19 patients who underwent LTx after VV ECMO support. Patients were required to have a negative nasopharyngeal swab and a negative bronchoalveolar lavage for COVID-19 prior to LTx listing. We analyzed preoperative and operative characteristics, details of VV ECMO support and early post-transplant outcomes.

Results

The mean age of our cohort was 50 years (range 39-57 years) and all patients were male. Mean recipient BMI was 30 (range 22-37). Mean duration of VV ECMO pre-Ltx was 60 days (range 44-72 days). At the time of the LTx operation, 60% (3/5) of patients were on VV ECMO, 20% (1/5) were on mechanical ventilation (MV), and 20% (1/5) were on supplemental oxygen only. Preoperatively, 80% (4/5) had acute kidney injury and 20% (2/5) were on dialysis. LTx was performed via clamshell approach with intraoperative venoaterial ECMO support in all cases. For 60% (3/5) patients, VV ECMO support was continued after LTx and discontinued on postoperative days 0, 1 and 6, respectively. All-cause mortality was 40% (2/5), related to sepsis and multi-organ failure, and both deaths occurred an average of 115 days post-LTx. Mean length of stay for surviving patients was 59 days (range 22-117). In the first 3 months postop-LTx, grade A2 acute cellular rejection was noted in 2 patients, A1 in 2 patients, and antibody-mediated rejection in 1 patient.

Conclusion

Our early experience with LTx for COVID-19 patients supported with VV ECMO support is notable for 1) prolonged VV-ECMO duration and significant morbidity pre-LTx, and 2) early mortalities related to sepsis and multiple organ failure. These data highlight a uniquely complex patient population that carries high risk of multi-organ failure and other comorbidities dictating careful selection for transplant.

Modified fullerenes as acceptors in bulk heterojunction organic solar cells - a theoretical study

In the present study, electronic structure calculations were used to provide strategies for designing poly(3-hexylthiophene) (P3HT)-fullerene-derivative-based donor-acceptor materials for use in high-efficiency bulk heterojunction organic solar cells (BHJ OSCs). The work systematically analyses the impact of electron-donating and -withdrawing substituents on the opto-electronic properties of the fullerene structures. Parameters relating to the absorption spectra, orbital distributions, and energy ordering of the frontier molecular orbitals (FMO), the interactions between P3HT and the fullerene derivatives, and charge transfer across the interface were investigated. We found that substitution with the electron-withdrawing group NO₂ enhances the electronic coupling between the fullerene and P3HT; however, it reduces the open-circuit voltage (V_OC) of the OSC through lowering the LUMO energy level. Furthermore, the results show that substitution with an electron-withdrawing group (NO₂) and electron-donating group (OCH₃) can improve the power conversion efficiency (PCE) of the OSC, since this slightly improves the photon absorption abilities and charge transfer coupling at the interface without overly compromising V_OC relative to PC₆₁BM. Our study shows that alkyl chain modification in the PC₆₁BM acceptor is a promising strategy for improving the performances of OSCs.

Charge Transport and Optical Absorption Properties of Dibenzocoronene Tetracarboxdiimide Based Liquid Crystalline Molecules: A Theoretical Study

Structure, optical absorption, and charge transport properties of dibenzocoronene tetracarboxdiimide (DCDI) based molecules were studied using electronic structure calculations. Based on the optimized neutral, cationic, and anionic geometries the ionized state properties, such as ionization potential, electron affinity, hole extraction potential, electron extraction potentials, and reorganization energy, were calculated. On the basis of the ground state geometry of the studied molecules, the absorption spectra were calculated using the time-dependent density functional theory (TDDFT) method at the PBE0/def-TZVP level of theory. It has been observed that the substitution of different functional groups significantly alters the absorption spectra of DCDI. The methoxy- (OCH₃-) substituted DCDI molecule has a maximum absorption wavelength of 529 nm. The charge transport parameters, such as the charge transfer integral, spatial overlap integral, and the site energy, are calculated directly from the Kohn-Sham matrix elements. The reorganization energy for the presence of excess positive and negative charges and the charge transfer rate calculated from Marcus' theory were used to find the mobility of charge carriers. The computed results show that the mobility of charge carriers is strongly influenced by the functional groups present on the DCDI molecule. The effect of intermolecular structural fluctuations on charge transport properties was studied through molecular dynamics and Monte Carlo simulations based on the polaron hopping mechanism. The calculated charge carrier mobility shows that the cyano- (CN-) substituted DCDI molecules are having n-type semiconducting property while, methoxy- (OCH₃-) and thiol- (SH-) substituted DCDI molecules exhibit ambipolar semiconducting properties.

A hyperacute immune map of ischaemic stroke patients reveals alterations to circulating innate and adaptive cells

Systemic immune changes following ischaemic stroke are associated with increased susceptibility to infection and poor patient outcome due to their role in exacerbating the ischaemic injury and long-term disability. Alterations to the abundance or function of almost all components of the immune system post-stroke have been identified, including lymphocytes, monocytes and granulocytes. However, subsequent infections have often confounded the identification of stroke-specific effects. Global understanding of very early changes to systemic immunity is critical to identify immune targets to improve clinical outcome. To this end, we performed a small, prospective, observational study in stroke patients with immunophenotyping at a hyperacute time point (< 3 h) to explore early changes to circulating immune cells. We report, for the first time, decreased frequencies of type 1 conventional dendritic cells (cDC1), haematopoietic stem and progenitor cells (HSPCs), unswitched memory B cells and terminally differentiated effector memory T cells re-expressing CD45RA (TEMRA). We also observed concomitant alterations to human leucocyte antigen D-related (HLA-DR), CD64 and CD14 expression in distinct myeloid subsets and a rapid activation of CD4+ T cells based on CD69 expression. The CD69+ CD4+ T cell phenotype inversely correlated with stroke severity and was associated with naive and central memory T (TCM) cells. Our findings highlight early changes in both the innate and adaptive immune compartments for further investigation as they could have implications the development of post-stroke infection and poorer patient outcomes.

Regulation of Thiamine (Vitamin B1)-Dependent Metabolism in Mammals by p53

Transcriptional factor p53 is a master regulator of energy metabolism. Energy metabolism strongly depends on thiamine (vitamin B1) and/or its natural derivatives. Thiamine diphosphate (ThDP), which is a major thiamine derivative, affects p53 binding to DNA. In order to elucidate the mechanism of regulation of thiamine-dependent metabolism by p53, we assessed putative p53-binding sites near transcription starting points in genes coding for transporters and enzymes, whose function is associated with thiamine and/or its derivatives. The predictions were validated by studying cell metabolic response to the p53 inducer cisplatin. Expression of p53 and its known target, p21, has been evaluated in cisplatin-treated and control human lung adenocarcinoma A549 cells that possess functional p53 pathway. We also investigated the activity of enzymes involved in the thiamine-dependent energy metabolism. Along with upregulating the expression of p53 and p21, cisplatin affected the activities of metabolic enzymes, whose genes were predicted as carrying the p53-binding sites. The activity of glutamate dehydrogenase GDH2 isoenzyme strongly decreased, while the activities of NADP+-dependent isocitrate dehydrogenase (IDH) and malic enzymes, as well as the activity of 2-oxoglutarate dehydrogenase complex at its endogenous ThDP level, were elevated. Simultaneously, the activities of NAD+-dependent IDH, mitochondrial aspartate aminotransferase, and two malate dehydrogenase isoenzymes, whose genes were not predicted to have the p53-binding sequences near the transcription starting points, were upregulated by cisplatin. The p53-dependent regulation of the assayed metabolic enzymes correlated with induction of p21 by p53 rather than induction of p53 itself.

The influence of the shape and configuration of sensitizer molecules on the efficiency of DSSCs: a theoretical insight

The sensitizer is an active component of dye sensitized solar cell (DSSC) technology, which is highly influential for the performance of DSSCs. The present study attempts to investigate the relationship between the shape of the sensitizer molecule and efficiency of DSSCs. Specifically, 17 different structures were investigated, and classified into four categories based on the shape of the dye molecule, namely L-shaped (linear), V-shaped, X-shaped and Y-shaped, and into two different categories based on the donor moiety. The five of studied structures contained a triphenylamine (TPA) donor moiety, and twelve structures contained carbazole (CAR) donor moiety. Parameters related to the performance of DSSCs such as absorption spectra, intramolecular charge transfer indices, frontier molecular orbitals, light harvesting efficiency, excited-state lifetime, exciton binding energy, electrostatic potential, charge transfer and electron injection ability were studied using results obtained from electronic structure calculations. The analysis of these various parameters showed that the linear-shaped and V-shaped sensitizers possess better photon absorption ability, and the V-shaped structure is best suited shape for applications in high performance DSSCs.

Numerous studies have reported that the shape of a sensitizer matters for DSSC performance, while the present study investigates why and how it matters.

Students Perception of their Educational Environment in a Medical College in India- A Survey using DREEM Questionnaire

Introduction: Educational plays an important role in the achievement of student’s academic success. Understanding the perception of students towards their educational environment helps to identify the lacunae in the curriculum and make the changes accordingly. Aim: To assess the perceptions of the students towards medical education using Dundee Ready Educational Environment Measure (DREEM) questionnaire as a tool. Materials and Methods: This was a cross-sectional study done at NRI Medical College, Guntur, Andhra Pradesh, India, from September 2020 to December 2020. A total of 414 students participated in the study. The DREEM questionnaire was used to collect the data. The questionnaire consists of five components with 50 statements assessed on five-point Likert scale (0-4). Data were expressed as mean and standard deviation, frequency, and percentages. Independent t-test and one-way Analysis of Variance (ANOVA) were used for comparing the groups. Results: Out of 600 students, 414 filled in the forms and submitted them (response rate was 69%). 266 (64.2%) were female and 148 (35.8%) were males. Age of the students ranged from 17 to 25 years with mean age 22.64±2.62 years. The mean DREEM score of study population was 130±6.7/200 which indicated a more positive than negative perception of learning. Subscale scores for student’s perception of learning, perceptions of teachers, academic self-perceptions, perceptions of atmosphere and social self-perceptions were 30.9±2.4, 28.9±1.5, 22.4±3.1, 30.8±2.3 and 16.9±1.7 respectively. Conclusion: There was a positive perception of students towards their educational environment. Strong areas were student’s confidence, teacher’s knowledge, and curricular relevance. Weak areas were identified as the inability to provide constructive criticism by teachers, the teachers were authoritarian and necessary steps can be taken for the improvement.

Airway closing index in school-age children during exercise bronchoprovocation

OBJECTIVE

Airway Closing Index (ACI), the ratio of % change in FVC to % change in FEV₁ with bronchoprovocation, may represent changes in airflow due to airway closure, as opposed to airway narrowing. The objective of this study was to evaluate ACI during exercise bronchoprovocation (EB) in children.

METHODS

Children, 6 to 18 years of age, who underwent EB using a stationary bicycle ergometer over a 6-year period were reviewed. Pulmonary function, including ACI, in patients with a positive exercise challenge, defined as ≥10% decrease in FEV₁ following exercise, were compared to patients with a negative challenge.

RESULTS

A total of 1030 children with a median age of 13 (IQR 11-15) underwent EB, of which 376 (37%) had a positive exercise challenge. There was wide variability in ACI, with a median of 0.75 (0.28-1.21). Median ACI in those with a positive test was 0.68 (IQR 0.41-0.93) compared to 0.84 (IQR 0.09-1.06) for those with a negative test, p = 0.017. Median ACI was higher in older children (p < 0.001) and females (p < 0.0001). Median percent change in FEV₁ following bronchodilator for children in the highest quintile for ACI was 4.5 (IQR 1.3-8.1) compared to 5.5 (IQR 2-9.2) for children in the lowest quintile, p = 0.04.

CONCLUSIONS

There is wide variability in the ACI in children undergoing EB. ACI was lower in children with a positive challenge, the significance is unknown. Children with higher ACI may have increased airway closure with bronchoprovocation, and less response to bronchodilators.

Transmitted Home Oximetry and Duration of Home Oxygen in Premature Infants

OBJECTIVES

To determine if a home oxygen therapy (HOT) management strategy that includes analysis of recorded home oximetry (RHO) data, compared with standard monthly clinic visit assessments, reduces duration of HOT without harm in premature infants.

METHODS

The RHO trial was an unmasked randomized clinical trial conducted in 9 US medical centers from November 2013 to December 2017, with follow-up to February 2019. Preterm infants with birth gestation ≤37 + 0/7 weeks, discharged on HOT, and attending their first pulmonary visit were enrolled. The intervention was an analysis of transmitted RHO between clinic visits (n = 97); the standard-care group received monthly clinic visits with in-clinic weaning attempts (n = 99). The primary outcomes were the duration of HOT and parent-reported quality of life. There were 2 prespecified secondary safety outcomes: change in weight and adverse events within 6 months of HOT discontinuation.

RESULTS

Among 196 randomly assigned infants (mean birth gestational age: 26.9 weeks; SD: 2.6 weeks; 37.8% female), 166 (84.7%) completed the trial. In the RHO group, the mean time to discontinue HOT was 78.1 days (SE: 6.4), compared with 100.1 days (SE: 8.0) in the standard-care group (P = .03). The quality-of-life scores improved from baseline to 3 months after discontinuation of HOT in both groups (P = .002), but the degree of improvement did not differ significantly between groups (P = .75).

CONCLUSIONS

RHO was effective in reducing the duration of HOT in premature infants. Parent quality of life improved after discontinuation. RHO allows physicians to determine which infants can be weaned and which need prolonged oxygen therapy between monthly visits.

Cross validated serum small extracellular vesicle microRNAs for the detection of oropharyngeal squamous cell carcinoma

BACKGROUND

Oropharyngeal squamous cell carcinoma (OPSCC) is often diagnosed at an advanced stage because the disease often causes minimal symptoms other than metastasis to neck lymph nodes. Better tools are required to assist with the early detection of OPSCC. MicroRNAs (miRNAs, miRs) are potential biomarkers for early head and neck squamous cell cancer diagnosis, prognosis, recurrence, and presence of metastatic disease. However, there is no widespread agreement on a panel of miRNAs with clinically meaningful utility for head and neck squamous cell cancers. This could be due to variations in the collection, storage, pre-processing, and isolation of RNA, but several reports have indicated that the selection and reproducibility of biomarkers has been widely affected by the methods used for data analysis. The primary analysis issues appear to be model overfitting and the incorrect application of statistical techniques. The purpose of this study was to develop a robust statistical approach to identify a miRNA signature that can distinguish controls and patients with inflammatory disease from patients with human papilloma virus positive (HPV +) OPSCC.

METHODS

Small extracellular vesicles were harvested from the serum of 20 control patients, 20 patients with gastroesophageal reflux disease (GORD), and 40 patients with locally advanced HPV + OPSCC. MicroRNAs were purified, and expression profiled on OpenArray™. A novel cross validation method, using lasso regression, was developed to stabilise selection of miRNAs for inclusion in a prediction model. The method, named StaVarSel (for Stable Variable Selection), was used to derive a diagnostic biomarker signature.

RESULTS

A standard cross validation approach was unable to produce a biomarker signature with good cross validated predictive capacity. In contrast, StaVarSel produced a regression model containing 11 miRNA ratios with potential clinical utility. Sample permutations indicated that the estimated cross validated prediction accuracy of the 11-miR-ratio model was not due to chance alone.

CONCLUSIONS

We developed a novel method, StaVarSel, that was able to identify a panel of miRNAs, present in small extracellular vesicles derived from blood serum, that robustly cross validated as a biomarker for the detection of HPV + OPSCC. This approach could be used to derive diagnostic biomarkers of other head and neck cancers.

Impact of Synthesis Technique on Lanthanum Doped Copper Oxide Nanocrystals, an Alternative Counter Electrode for Pt-Free Dye-Sensitized Solar Cells

The ascendancy of a counter electrode (C.E) in a dye-sensitized solar cell (DSSC) has an unrivaled impact on the performance of the dye-sensitized solar cell, where the Pt-based C.E has set up a phenomenal benchmark against its counterparts. Due to the high cost of such noble metals, an operative and a much cost effective replacement were greatly in demand to gratify this need. To address this issue, monoclinic lanthanum doped copper oxide (CuO) nanoparticles were prepared by solution combustion and co-precipitation techniques respectively as they possess highly superior optoelectronic, catalytic and charge transfer properties. The effect of incorporating lanthanum (La) ions and the variation of synthesis technique on their structural, optical, photo-thermal and morphological properties are empirically investigated by XRD, FTIR, TEM, UV-Vis, Raman and Photoacoustic Spectroscopy (PAS). The X-ray diffraction pattern revealed the formation of La-doped CuO nanoparticles. The finger-print vibrational modes of the as-synthesized samples are confirmed by the FTIR spectra. The required optical properties of the as-synthesized nanocrystals were confirmed using UV-Vis absorption spectra, from which the bandgap was determined by Kubelka-Munk plot. The Raman modes were determined using Raman spectra, further a multi-phonon band was revealed, which was formed due to the plasmon-phonon coupling. The photothermal phenomenon was revealed using the photoacoustic spectra. The morphological investigation by TEM found the change in the morphology of the material as the synthesis route is varied. The power conversion efficiency results unveiled that the combustion-derived C.E posted a promising efficiency (η) of 0.20% and the co-precipitation derived C.E posted an efficiency of 0.02%. Overall results suggest that the combustion derived La doped CuO nanostructures exhibited substantive properties with deeper implication and also stood out to be a viable, cost-effective and self-exemplifying replacement for Pt as C.E in DSSC's.

A systematic review and meta-analysis of cancer patients affected by a novel coronavirus

BACKGROUND

Cancer patients with COVID-19 disease have been reported to have double the case fatality rate of the general population.

MATERIALS AND METHODS

A systematic search of PubMed/MEDLINE, Embase, Cochrane Central, Google Scholar, and MedRxiv was done for studies on cancer patients with COVID-19. Pooled proportions were calculated for categorical variables. Odds ratio and forest plots were constructed for both primary and secondary outcomes. The random-effects model was used to account for heterogeneity between studies.

RESULTS

This systematic review of 31 studies and meta-analysis of 181,323 patients from 26 studies involving 23,736 cancer patients is the largest meta-analysis to the best of our knowledge assessing outcomes in cancer patients affected by COVID-19. Our meta-analysis shows that cancer patients with COVID-19 have a higher likelihood of death (odds ratio, OR 2.54), which was largely driven by mortality among patients in China. Cancer patients were more likely to be intubated, although ICU admission rates were not statistically significant. Among cancer subtypes, the mortality was highest in hematological malignancies (OR 2.43) followed by lung cancer (OR 1.8). There was no association between receipt of a particular type of oncologic therapy and mortality. Our study showed that cancer patients affected by COVID-19 are a decade older than the normal population and have a higher proportion of co-morbidities. There was insufficient data to assess the association of COVID-directed therapy and survival outcomes in cancer patients. Despite the heterogeneity of studies and inconsistencies in reported variables and outcomes, these data could guide clinical practice and oncologic care during this unprecedented global health pandemic.

CONCLUSION

Cancer patients with COVID-19 disease are at increased risk of mortality and morbidity. A more nuanced understanding of the interaction between cancer-directed therapies and COVID-19-directed therapies is needed. This will require uniform prospective recording of data, possibly in multi-institutional registry databases.

Investigation on Elastic, Magnetic, Optical and Electrical Impedance Properties of Dysprosium Doped Nickel Ferrite Nanocrystals

Rare earth dysprosium (Dy) doped nickel ferrite nanoparticles were synthesized via economically viable co-precipitation technique and studied for its elastic, structural, magnetic and electrical properties. X-ray diffraction analysis shows the formation of cubic spinel phase with a slight inclination in the cell parameters with respect to the concentration of dopant convivial. The crystallite size and strain of the nanoparticles were determined using Scherrer formula and the Williamson-Hall (W-H) technique. In addition, the theoretical parameters viz., cation distribution, bond length, oxygen positional parameters, etc., have been embrasured. The strength and types of interionic bonds in the nano ferrites were determined utilizing Fourier Transform Infrared spectral analysis. The magnetic properties were analysed using vibrating sample magnetometer at room temperature, it was found that as the dopant concentration increases, the coercivity and magnetic saturation decreases. This result is partially explained by the bridge networking of Dy³⁺-Fe³⁺ ions which is equated by Fe²⁺- Fe³⁺ ion interaction. This paper deals with the itinerant electron model to determine the distribution of cations by magnetization analysis. The optical properties of the samples were studied utilizing UV-Vis spectral analysis and the optical band gap was evaluated from Kubelka-Munk plot. Electrical impedance was analysed as a function of frequencies at room temperature. This analysis depicts the dielectric constant and loss factor tends to decline with applied frequency and AC conductivity elicits its semiconducting characteristic by obeying Jonscher's law.

Malignant Transformation of Hypertrophic Lichen Planus in a Young Pregnant Woman: A Case Report

In this article, we report a case of hypertrophic lichen planus transforming into cutaneous squamous cell carcinoma in a 24-year-old Indian woman at 34 weeks of gestational age. We hypothesize that immunologic alterations during pregnancy could transform a long-standing hypertrophic lichen planus into cutaneous neoplasm.

OS12.4 In vivo dynamics and targeting of vessel co-option in glioma

BACKGROUND

Gliomas comprise heterogeneous malignant glial and stromal cells. While blood vessel co-option is a potential mechanism to escape anti-angiogenic therapy, the relevance of glial phenotype in this process is unclear.

MATERIAL AND METHODS

Here, we intravitally study preclinical syngenetic models of glioma as well as patient-derived cells transplanted orthotopically. Moreover, we profoundly confirm our preclinical results with histological studies on patient specimens.

RESULTS

We show that Olig2+ oligodendrocyte precursor-like glioma cells invade by single-cell vessel co-option and preserve the blood-brain barrier (BBB). Conversely, Olig2-negative glioma cells form dense perivascular collections and promote angiogenesis and BBB breakdown, leading to innate immune cell activation. Experimentally, Olig2 promotes Wnt7b expression, a finding that correlates in human glioma profiling. Targeted Wnt7a/7b deletion or pharmacologic Wnt inhibition blocks Olig2+ glioma single-cell vessel co-option and enhances responses to temozolomide. Finally, Olig2 and Wnt7 become upregulated after anti-VEGF treatment in preclinical models and patients.

CONCLUSION

Here, we show that glioma is able to employ vessel co-option, i.e. the movement of tumor cells towards and along the pre-existing vasculature.

Glioma oligodendrocyte-like (OPCL) cells express Wnt7 that is necessary for vessel co-option and Wnt inhibitors significantly improve survival with temozolomide. Moreover, we demonstrated that anti-VEGF-treatment of glioma selects for Olig2/Wnt7+ cells