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Published data on coronavirus disease 2019 (COVID-19) convalescent plasma (CCP) use in children and obstetric patients are limited. We describe a single-center experience of hospitalized patients who received CCP for acute COVID-19.A retrospective review of children 0-18-years-old and pregnant patients hospitalized with laboratory-confirmed acute COVID-19 who received CCP from March 1, 2020 to March 1, 2021 was performed. Clinical and laboratory data were collected to assess the safety of CCP administration. Antibodies to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) were measured in the CCP products and in patients before transfusion and at various time points post-transfusion. Correlation between the administered SARS-CoV-2 administered versus the SARS-CoV-2 anti-spike immunoglobulin response in patient serum was assessed.Twenty-two children and ten obstetric patients were eligible. Twelve pediatric and eight obstetric patients had moderate disease and ten pediatric and two obstetric patients had severe disease. Five pediatric patients died. Eighteen of 37 (48.6%) CCP titers that were measured met US Food and Drug Administration (FDA) criteria for high immunoglobulin G (IgG) antibody titer. There were no complications with transfusion. High-titer CCP showed a positive correlation with rise in patient total immunoglobulin levels only in obstetric patients but not in pediatric patients. Among pediatric patients, the median serum antibody level increased over time after transfusion.Coronavirus 2019 convalescent plasma was administered safely to our patients. Our study suggested that CCP did not interfere with endogenous antibody production. The antibody titer of CCP correlated with post-transfusion response only in obstetric patients. Randomized trials in pediatric and obstetric patients are needed to further understand how to dose CCP and evaluate efficacy.

von Willebrand factor (VWF) is a glycoprotein that plays a central role in the initiation of blood coagulation. VWF performs two important functions: it acts as a molecular bridge between platelets and as a carrier for coagulation factor VIII (FVIII). von Willebrand disease (VWD) and acquired von Willebrand syndrome (AVWS) are caused by the absence of and/or abnormality in VWF. The pathophysiology of VWD and AVWS is complex and, therefore, it is difficult to diagnose them by conducting the same laboratory tests in all patients. To develop useful monoclonal antibodies (mAbs) for the diagnosis of VWD and AVWS, rat mAbs against human VWF were generated. Immunoblotting analysis revealed that mAbs recognized the reduced and nonreduced VWF protein and endogenous VWF in normal human plasma. Furthermore, we developed a highly sensitive monoclonal antibody-based sandwich enzyme-linked immunosorbent assay technique. In conclusion, the development of VWF-specific mAbs would be useful in the diagnosis of VWD and AVWS.

Dam‐mediated biological invasions are a serious problem all over the world. Once established in reservoirs, the invasive species have catastrophic impacts on the river ecosystems downstream, and thus, rapid monitoring of invasive species is an urgent issue for the effective removal of them and the conservation management of native ecosystems. Here, we verified the utility of environmental DNA (eDNA) analysis as a tool to effectively monitor three invasive fish species (bluegill, largemouth bass, and smallmouth bass) in reservoirs using multiplex real‐time PCR. First, to determine the optimal sampling location and season to detect eDNA from these species, we analyzed the eDNA in water samples from shore and offshore sites in three reservoirs all year around. We found that eDNA detection rates either did not differ between sampling locations or were higher for shore than offshore sites. In addition, eDNA detection rates were higher in spring (breeding season of target species) and/or summer than winter. Second, we extensively surveyed the distribution of the three species in 30 reservoirs in Japan using eDNA analysis. Consequently, a single eDNA‐based surveillance in summer allowed to match approximately 90% of the presence/absence of the invasive fish species known from 27 yr of administrative capture‐based surveillances. Given these results, we recommend collecting the replicated water samples from shore sites in summer or the breeding season for the effective detection of invasive fish eDNA in reservoirs. Our eDNA assays with multiplex real‐time PCR enable the rapid and sensitive monitoring of invasive fish distribution in reservoirs.

BACKGROUND: Childhood TB cases can be found using passive case finding (PCF), i.e., by diagnosing children presenting with symptoms, or using active case finding (ACF), i.e., by identifying children with TB through contact tracing. Our study determined epidemiologic, clinical, and radiographic differences between these groups.DESIGN/METHODS: Retrospective cohort study of children aged 0–19 years diagnosed with TB from January 1, 2012 to December 31, 2019 at a U.S. TB clinic, comparing clinical, radiographic, microbiologic, and epidemiological characteristics of children identified using PCF and ACF.RESULTS: Of 178 eligible patients, 99 (55.6%) were diagnosed using PCF. Children identified using PCF were older (mean 8.9 vs. 6.1 years, P = 0.003), more often non-US-born (OR 2.29, 95% CI 1.12–4.67), had more extrapulmonary disease (44.4% vs. 3.8%, OR 20.27, 95% CI 5.98–68.64) and severe intrathoracic findings (39.4% vs. 10.1%, OR 5.77, 95% CI 2.50–13.29). Children identified using ACF were often asymptomatic, had isolated hilar/mediastinal adenopathy, but had more availability of drug susceptibility data from a link to a source case.CONCLUSION: Children identified using PCF had more severe manifestations, while those identified using ACF had greater availability of drug susceptibility data. Clinicians should be aware that clinical and radiographic presentations in children identified using PCF and those identified using ACF differ, and that the latter may be eligible for shorter treatment regimens.

An 11-year-old female with a congenitally malformed left hand, sickle-cell trait, asthma, and history of appendicitis was transferred from Zambia for evaluation and treatment of widespread suppurative and ulcerative skin lesions that typically appeared following trauma to her skin. The ulcers first presented 3 years earlier but had markedly worsened in the 9 months prior to transfer, spreading circumferentially on her extremities and abdomen at the site of an appendectomy. They were painful and did not resolve with multiple courses of intravenous (IV) antibiotics and close management by a Pediatric Infectious Disease specialist working for a non-governmental organization (NGO) in her home country. The child had participated annually in health screenings at the NGO and previously had been average weight-for-age. The NGO arranged for international transfer to our pediatric academic medical center. Upon presentation she was severely malnourished with lesions covering approximately 35% of her body. Initial workup found leukocytosis of 21 × 10(3) cells/μL (79% neutrophils), hemoglobin 6.1g/dL, and MCV 66 fl. Iron studies showed iron 18μg/dL, ferritin 55ng/mL, total iron binding capacity 222μg/dL, and transferrin saturation 8%. Inflammatory markers were elevated, CRP 20.1mg/dL, ESR 131mm/hr. A chest CT demonstrated bilateral pulmonary nodules, the largest in her left upper lobe measuring 2.4 × 2.0 × 1.9 cm. Our panel of experts reviews the evaluation and treatment of this patient with extensive suppurative and ulcerative skin lesions, severe malnutrition, hematological abnormalities and pulmonary nodules and the factors considered in offering charity care to international patients. TABLE OF CONTENTS SUMMARY: A previously healthy 11-year-old girl from southern Africa presents with widespread suppurative and ulcerative skin lesions that appear following trauma to her skin.

5-Hydroxymethylfurfural (HMF) is one of the most important intermediate platforms for production of both chemicals and liquid fuel derived from biomass. The one-pot production of HMF from cellulose was conducted in a batch reactor in the presence of various solid acid catalysts. The prepared catalysts were characterized by means of Brunauer–Emmett–Teller measurement and pyridine adsorption FT-IR to investigate their pore structure and acidic properties. The presence of gaseous hydrogen enhanced the formation of HMF by suppressing the formation of byproducts. Increasing the acid amount of the catalyst caused an increase in the conversion and selectivity for organic acid and a decrease in the HMF selectivity. A Bronsted-type catalyst (Al-SBA-15) favored the formation of HMF. The reaction conditions of 220 °C, 5 min, and a hydrogen pressure of 1 MPa resulted in the highest yield of HMF, and selectivity of 26.9% was achieved when the Al-SBA-15 catalyst was used. Moreover, under the same conditions, cellulose extracted from eucalyptus, a practical biomass, was converted to HMF in a one-pot synthesis with a yield of 13.0 C-mol.%.

Background Childhood tuberculosis can be found via passive case finding (PCF), diagnosing a symptomatic child, and active case finding (ACF), discovering a child through contact tracing. Most high prevalence areas perform PCF, but as ACF is introduced, the clinical and radiologic findings may differ. We compare clinical, radiographic, microbiologic and epidemiological characteristics of children diagnosed through PCF and ACF. Methods A retrospective cohort study of all patients diagnosed with TB from 01/01/2012-12/31/2019 at Texas Children’s Hospital. ACF is TB in a child who had not previously sought care before identified via contact tracing, immigration screening, or screening for incarceration. Severity of disease was based on location of illness, imaging and bacteriology/histopathology. Associations between PCF/ACF and demographics, disease severity, and microbiology were analyzed. Results Of 178 patients, 80 (45%) were diagnosed via ACF. ACF patients were more likely to be US-born (OR: 2.29, [95% Confidence interval (CI): 1.12-4.67]) and younger (mean 6.18 vs 8.84 years, p= 0.016). Only 2.5% of ACF patients had extrapulmonary disease, compared to 45% of the PCF group (p< 0.0001). All 14 severe extrathoracic cases were in the PCF group (10 central nervous system disease, 3 ocular disease, 1 spondylitis). Fewer patients in the ACF group had severe intrathoracic findings (11% vs 39%, p< 0.001): miliary disease (0% vs 10%, p=0.006), cavity (1% vs 9%, p=0.04), and multilobar involvement (7.5% vs 22.4%, p=0.006). ACF patients had more hilar/mediastinal adenopathy (OR: 2.51, [CI: 1.34-3.72], p=0.004). ACF patients were less often cultured (38% vs 89%, p< 0.0001) and had less microbiological confirmation by cultures or PCR (21% vs 52%, p=< 0.0001). Conclusion Patients in the ACF group were younger, had less severe clinical manifestations, and had almost no extrathoracic disease. Clinicians need to be aware that the common clinical and radiographic presentations in children differ between PCF and ACF. Disclosures Jeffrey R. Starke, MD, Otsuka Pharmaceuticals (Other Financial or Material Support, Member, Data Safety Monitoring Board)

The association between Salmonella spp. and osteoarticular infections in pediatric patients with major sickle hemoglobinopathies has been well established. However, the contemporary microbiology of these infections in such patients is unknown. We conducted a retrospective review of medical records at Texas Children's Hospital in Houston from 2000 to 2018 to investigate this question. Fifty cases were identified. In 23 (46%) cases, a pathogen was identified. Salmonella was the most common pathogen isolated, accounting for 61% of culture-positive cases followed by Staphylococcus aureus (21.7%).

Microwave irradiation efficiently assists extraction of substitution-inert platinum group metals like Ru(III) and Rh(III) from HNO3(aq) to betainium bis(trifluoromethylsulfonyl)amide ([Hbet][Tf2N]) ionic liquid to give nearly quantitative yields within 101–102 s. The rapid microwave heating also facilitates to mix the aqueous/IL biphasic system homogeneously without vigorous shaking because of its thermomorphic behavior. Rapid and efficient extraction of substitution-inert platinum group metals has been achieved in use of thermomorphic ionic liquid and microwave irradiation.

Background Osteoarticular infections (OAI) are common in patients with major sickle hemoglobinopathies (Hemoglobin [Hgb] SS, Hgb SC, and Hgb Sβ thalassemia). Although Salmonella spp. cause a substantial number of OAIs in these patients, contemporary data regarding the most common etiology in the era of community-acquired methicillin-resistant Staphylococcus aureus (MRSA) are lacking. This introduces challenges for selecting empiric antimicrobial therapy. We evaluated the microbiology and management of OAI in children with sickle hemoglobinopathies. Methods Children with sickle hemoglobinopathies admitted to Texas Children’s Hospital with acute hematogenous OAI from 2011 to 2018 were identified based on ICD10 codes and the consult database of the pediatric infectious diseases service. Culture-negative cases were included if treated for OAI. Medical records were reviewed. Statistical analyses were conducted with STATA ver. 13. Results 36 patients met inclusion criteria; 53% were diagnosed with isolated osteomyelitis and 47% with osteomyelitis and septic arthritis. In 42% a microbial etiology was identified (Figure 1) with Salmonella spp. being the most common (n = 7, 47%) followed by S. aureus (n = 5, 33%).11 (31%) patients had subperiosteal or intraosseous abscesses and 26 (72%) underwent diagnostic and/or therapeutic surgical procedures; 36% had positive blood cultures. Children with Salmonella spp. infections had a longer duration of fever (median-5, range: 4–9 days) compared with those caused by other pathogens (median-2, range: 0–6 days; P = 0.04). The median duration of IV therapy was longer in culture-positive than culture-negative cases (30 vs.10 days, P = 0.009); the total duration of therapy was similar for all cases (32 days, IQR: 28–42). No patients were readmitted due to OAI. Conclusion At our institution, Salmonella spp. were the most common cause of OAI among children with sickle hemoglobinopathies. Subperiosteal/intraosseous abscess formation and the need for surgical procedures were common. The role of oral antibiotics for the treatment of Salmonella OAI in patients with sickle hemoglobinopathies warrants further study. Disclosures All authors: No reported disclosures.

Increased cellular ploidy is widespread during developmental processes of multicellular organisms, especially in plants. Elevated ploidy levels are typically achieved either by endoreplication or endomitosis, which are often regarded as modified cell cycles that lack an M phase either entirely or partially. We identified GIGAS CELL1 (GIG1)/OMISSION OF SECOND DIVISION1 (OSD1) and established that mutation of this gene triggered ectopic endomitosis. On the other hand, it has been reported that a paralog of GIG1/OSD1, UV-INSENSITIVE4 (UVI4), negatively regulates endoreplication onset in Arabidopsis thaliana. We showed that GIG1/OSD1 and UVI4 encode novel plant-specific inhibitors of the anaphase-promoting complex/cyclosome (APC/C) ubiquitin ligase. These proteins physically interact with APC/C activators, CDC20/FZY and CDH1/FZR, in yeast two-hybrid assays. Overexpression of CDC20.1 and CCS52B/FZR3 differentially promoted ectopic endomitosis in gig1/osd1 and premature occurrence of endoreplication in uvi4. Our data suggest that GIG1/OSD1 and UVI4 may prevent an unscheduled increase in cellular ploidy by preferentially inhibiting APC/CCDC20 and APC/CFZR, respectively. Generation of cells with a mixed identity in gig1/osd1 further suggested that the APC/C may have an unexpected role for cell fate determination in addition to its role for proper mitotic progression.