A CAR-T-cell recipient developed severe COVID-19, intractable RNAemia, and viral replication lasting >2 months. Pre-mortem endotracheal aspirate contained 2x10 10 SARS-CoV-2 RNA copies/mL and infectious virus. Deep sequencing revealed multiple sequence variants consistent with intra-host virus evolution. SARS-CoV-2 humoral and cell-mediated immunity were minimal. Prolonged transmission from immunosuppressed patients is possible.

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Objective: Cancer and its treatment are known to be important risk factors for sepsis, contributing to an estimated 12% of U.S. sepsis admissions in the 1990s. However, cancer treatment has evolved markedly over the past 2 decades. We sought to examine how cancer-related sepsis differs from non–cancer-related sepsis. Design: Observational cohort. Setting: National Readmissions Database (2013–2014), containing all-payer claims for 49% of U.S. population. Patients: A total of 1,104,363 sepsis hospitalizations. Interventions: We identified sepsis hospitalizations in the U.S. National Readmissions Database using explicit codes for severe sepsis, septic shock, or Dombrovskiy criteria (concomitant codes for infection and organ dysfunction). We classified hospitalizations as cancer-related versus non–cancer-related sepsis based on the presence of secondary diagnosis codes for malignancy. We compared characteristics (site of infection and organ dysfunction) and outcomes (in-hospital mortality and 30-d readmissions) of cancer-related versus non–cancer-related sepsis hospitalizations. We also completed subgroup analyses by age, cancer types, and specific cancer diagnoses. Measurements and Main Results: There were 27,481,517 hospitalizations in National Readmissions Database 2013–2014, of which 1,104,363 (4.0%) were for sepsis and 4,150,998 (15.1%) were cancer related. In-hospital mortality in cancer-related sepsis was 27.9% versus 19.5% in non–cancer-related sepsis. The median count of organ dysfunctions was indistinguishable, but the rate of specific organ dysfunctions differed by small amounts (e.g., hematologic dysfunction 20.1% in cancer-related sepsis vs 16.6% in non–cancer-related sepsis; p < 0.001). Cancer-related sepsis was associated with an adjusted absolute increase in in-hospital mortality ranging from 2.2% to 15.2% compared with non–cancer-related sepsis. The mortality difference was greatest in younger adults and waned with age. Patients (23.2%) discharged from cancer-related sepsis were rehospitalized within 30 days, compared with 20.1% in non–cancer-related sepsis (p < 0.001). Conclusions: In this cohort of over 1 million U.S. sepsis hospitalizations, more than one in five were cancer related. The difference in mortality varies substantially across age spectrum and is greatest in younger adults. Readmissions were more common after cancer-related sepsis.

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Soil has an interactive relationship with hydrology. It is a product of water related processes (physical and chemical) and a first order control of the destiny of rainwater. It is mapable with transfer functionality. These properties make it an appropriate entity for classification of hillslope hydrological responses. Hillslopes from all over South Africa were surveyed and hydropedologically interpreted. Soils were classified and based on the interpretation of the dominant hydrological pathway grouped into five hydrological soil types. The type and position of a hydrological soil types in a hillslope served as basis for the hillslope classification. Each of the hillslopes surveyed were assigned to one of six hillslopes classes. A flow diagram of the hydrology is presented. Arrows indicate the dominant flowpaths, and a hydrograph shows the anticipated impact on streamflow. The results made an impact on distributed modeling and land‐use decisions, including land‐use change to forestry and selection of on‐site sanitation limiting water pollution. The composition and distribution of hydrological hillslope classes can serve as a basis for classification of catchments.

Both the adaptive and innate arms of immunity are altered in patients with cirrhosis, which have both prognostic and clinical implications. Acute on chronic liver failure (ACLF), defined as decompensated cirrhosis with associated organ failure, carries a high risk of 28-day mortality and is marked by a significant inflammatory response. Patients with decompensated chronic liver disease display a shift from a chronic low-grade inflammatory state to one of intense inflammation, followed by the development of immunoparalysis. Considerable heterogeneity exists depending on the nature of the inciting cause and duration of ACLF. In this review, we will highlight the changes that immune cell populations in the liver undergo during decompensated liver disease, underscoring the immunological paradox between inflammation and increased susceptibility to infection that occurs during ACLF and progressive cirrhosis, as well as provide future perspectives regarding potentially useful biomarkers and possible avenues for treatment.

There is an interactive relationship between soil and hydrology. Identifying and interpreting soil properties active in this relationship can enhance our understanding of the hydrological behaviour of soils and the hillslopes in which they occur. This study was conducted in the Weatherley research catchment, South Africa, where a hillslope in the upper part of the catchment was selected for detailed study. Soil properties and their spatial distribution in the hillslope were interpreted and related to their predicted hydrological response. From these interpretations a conceptual model of hillslope hydrological behaviour was developed. Vertical drainage was considered to be dominant in the upper areas of the hillslope as indicated by the presence of freely-drained apedal soils. These soils recharge the mid-and lower slope. Soils showing clear indications of interflow (A/B and soil/bedrock interface) dominate on the midslope. The valley bottom is covered by gleyed soils which is an indication of long periods of saturation. These saturated conditions favour overland flow due to saturation impairing infiltration. The conceptual model was then evaluated using hydrometric measurements in the form of tensiometers and streamflow hydrographs. Results confirm the reliability of the model and accentuate the contribution that soil science can make to the science of hydrology.

Pulmonary hypertension (PH) is a progressive and often fatal illness presenting with nonspecific symptoms of dyspnea, lower extremity edema, and exercise intolerance. Pathologically, endothelial dysfunction leads to abnormal intimal and smooth muscle proliferation along with reduced apoptosis, resulting in increased pulmonary vascular resistance and elevated pulmonary pressures. PH is subdivided into five World Health Organization groups based on the disease pathology and specific cause. While there are Food and Drug Administration-approved medications for the treatment of pulmonary arterial hypertension (PAH; Group 1 PH), as well as for chronic thromboembolic PH (Group 4 PH), the morbidity and mortality remain high. Moreover, there are no approved therapies for other forms of PH (Groups 2, 3, and 5) at present. New research has identified molecular targets that mediate vasodilation, anti-inflammatory, and antifibrotic changes within the pulmonary vasculature. Given that PAH is the most commonly studied form of PH worldwide and because recent studies have led to better mechanistic understanding of this devastating disease, in this review we attempt to provide an updated overview of new therapeutic approaches under investigation for the treatment of PH, with a particular focus on PAH, as well as to offer guidelines for future investigations.