2q37.3 Deletion with Complex Heart Defects Suggesting Interruption of Early Ventricular Looping

A maternally inherited 828 kb microdeletion of 2q37.3 manifested in a 3-week-old premature boy as left juxtaposition of the atrial appendages associated with tricuspid atresia,double outlet infundibulum,subvalvar pulmonary atresia,large secundum atrial septal defect,and right aortic arch with mirror-image branching,consistent with developmental arrest early in heart looping.To the best of our knowledge,no previous 2q37 deletion syndrome has been reported with such a severe cardiac dysmorphology.Hence,this case adds to the cardiac phenotypes identified in 2q37 deletion syndrome.

Isolated Aplasia Cutis Congenita on Left Foot in Chinese Neonate

Aplasia Cutis Congenita (ACC) is a rare condition characterized by absence of skin layers, usually on the scalp, but can also affect the foot. ACC can occur as an isolated condition or in the presence of the other congenital anomalies. Here we describe a case of a 1-day-old baby boy with an isolated ACC of the left foot, with no family or siblings positive disease history. The patient was managed by both conservatively and surgically until the defect has formed scar tissue 5 months later.

A Tutorial on Common Differential Equations and Solutions Useful for Modeling Epidemics Like COVID-19: Linear and Non-Linear Compartmentation Models

Purpose: To review some of the basic models, differential equations and solutions, both analytic and numerical, which produce time courses for the fractions of Susceptible (S), Infectious (I) and Recovered (R) fractions of the population during the epidemic and/or endemic conditions. Methods: Two and three-compartment models with analytic solutions to the proposed linear differential equations as well as models based on the non-linear differential equations first proposed by Kermack and McKendrick (KM) [1] a century ago are considered. The equations reviewed include the ability to slide between so-called Susceptible-Infected-Recovered (SIR), Susceptible-Infectious-Susceptible (SIS), Susceptible-Infectious (SI) and Susceptible-Infectious-Recovered-Susceptible (SIRS) models, effectively moving from epidemic to endemic characterizations of infectious disease. Results: Both the linear and KM model yield typical “curves” of the infected fraction being sought “to flatten” with the effects of social distancing/masking efforts and/or pharmaceutical interventions. Demonstrative applications of the solutions to fit real COVID-19 data, including linear and KM SIR fit data from the first 100 days following “lockdown” in the authors’ locale and to the total number of cases in the USA over the course of 1 year with SI and SIS models are provided. Conclusions: COVID-19 took us all by surprise, all wondering how to help. Spreading a basic understanding of some of the mathematics used by epidemiologists to model infectious diseases seemed like a good place to start and served as the primary purpose for this tutorial.

The birth of a new pediatric medical journal:Pediatric Investigation

Nothing crosses borders and boundaries of all kinds in our world like a willingness to work together to provide the best possible health care for children.It is in that spirit that we announce the inaugura-tion of a new medical journal,Pediatric Investigation,that will be devoted to harnessing and disseminating innovative basic,transla-tional,and implementation science research.

Interleukin-10 suppresses lipid metabolism-mediated intestinal inflammation

In a recent paper published in Nature,York et al.reported that the anti-inflammatory cytokine interleukin(IL)-10 regulates sphingolipid metabolism to limit NF-κB-mediated inflammation.Deletion of Il10 in mice,or genetic mutation of IL10 in humans,predisposes to inflammatory bowel disease,which may be overcome by restoring homeostatic sphingolipid metabolism.

Applications of mPCR testing reduced initial antibiotic use and duration of mechanical ventilation in virus-infected children with severe community-acquired pneumonia admitted to the PICU

Community-acquired pneumonia(CAP)remains the leading cause of morbidity and mortality among children worldwide.It is critical for these patients to select and timely initiate appropriate empirical antimicrobial therapy against the causative pathogens[1].However,conventional pathogen-detecting methods,such as culture and serology,have no prospect of altering empiric therapy owing to their time delay in obtaining results and to their lower detection rates[2].Recent advances in molecular diagnostic assays,such as multiplex polymerase chain reaction PCR(mPCR)methods,have been used to detect multiple pathogens in CAP simultaneously within two hours and have dramatically improved the ability to diagnose respiratory pathogens[3].However,whether this molecular diagnosis method can reduce the use of antibiotics and can improve prognosis in severe CAP children,especially those less than 5 years old,remains to be explored.

“Closing the chasm”-guidelines bridge the gap from evidence to implementation

Since the beginning of the Coronavirus Disease 2019(COVID-19)pandemic,over 9000 articles related to COVID-19 have been released in print by the end of December 2020.1 A majority of these articles were commentaries,several hundred were observational studies,55 were systematic reviews,and 4 were randomized controlled trials.The American College of Rheumatology has published updated clinical guidance for the management of multisystem inflammatory syndrome in children associated with SARS-CoV-2,the most recent version in April 2021.2,3 Additionally,practice guidelines for pediatric specialties in the setting of COVID-19 have also been published,including pulmonology,anesthesiology,infectious disease,orthopedics,and anticoagulation.4-8 The rapid development and dissemination of these guidelines during the pandemic has been unprecedented.Many of these guidelines are based primarily on consensus statements rather than randomized control trials,which have been the gold standard of evidence-based medicine.In this commentary,we discuss the role of practice guidelines from credible sources that are based on incrementally emerging evidence to guide bedside practice,until they can be updated with more robust data from meta-analyses of randomized trials.

An evaluation of treatments and survival rates for pancreatic adenocarcinoma through survival analysis with inverse probability of treatment weighting:a population-based study

Objective:This study conducted inverse probability of treatment weighting(IPTW)survival analysis to examine survival in pancreatic adenocarcinoma patients.Methods:In this population-based study,data from the Surveillance,Epidemiology,and End Results program of the United States were analyzed to identify patients diagnosed with adenocarcinoma of the pancreas 2004 to 2014.Differences in survival rates were examined among patients who underwent pancreatectomy alone,radiotherapy alone,and those who had pancreatectomy plus adjuvant radiotherapy.Kaplan-Meier estimates and Cox proportional hazards models with the IPTW were performed to determine the effect of different treatments on overall and cancer-specific survival.This study was approved by the Ethics Review Board of Weifang Medical University.Results:A total of 8191 patients were included,with 3409 taking pancreatectomy only,2865 taking radiotherapy only,and 1917 taking pancreatectomy plus adjuvant radiotherapy.Patients who received surgery plus adjuvant radiotherapy had statistically a higher survival rate than those who received the other 2 treatments.Survival analysis with the IPTW for the 3 different groups showed that the difference in median overall survival time among these patient groups was significant.Conclusion:Using IPTW survival analysis,the present study shows that surgery with adjuvant radiotherapy is significantly associated with improved overall and cancer-specific survival among patients with pancreatic adenocarcinoma.