A Tunisian male diagnosed with an acute lymphoblastic leukemia was admitted to our hospital for a chemotherapy cure . During the hospitalization, he presented an acute epigastric pain with fever. Abdominal CT scan showed circumferential gastric thickening with an enhancement defect suggestive of gastric ischemia associated with segmental pulmonary embolism.

Primary rectal lymphoma (PRL) is the rarest primary rectal cancer. Clinical presentation is similar to rectal carcinoma. The role of surgery is still controversial and the benefit of chemotherapy and radiotherapy is not well established. We here report the case of female patient suffering from PRL completely disappeared with chemotherapy.

The World Health Organisation has set a target for elimination of cervical cancer within the next century and increasing screening uptake is important. An audit of vaginal swabs, a less invasive sample received for HPV testing outwith screening programme showed that the main clinical indications for these requests were inability to take a standard cervical smear sample for cytology or inability to visualise the cervix followed by women's unwillingness or inability to tolerate speculum due to pain or previous trauma. Offering vaginal swabs where there is clinical justification can provide a means of HPV based screening for cervical cancer.

Background Sarajevo Canton in the Federation of Bosnia and Herzegovina has recorded several waves of high SARS-CoV-2 transmission and has struggled to reach adequate vaccination coverage. We describe the evolution of infection- and vaccine-induced SARS-CoV-2 antibody response and persistence. Methods We conducted repeated cross-sectional analyses of blood donors aged 18-65 years in Sarajevo Canton in November-December 2020 and 2021. We analyzed serum samples for anti-nucleocapsid (anti-N) and anti-spike (anti-S) antibodies. To assess immune durability, we conducted longitudinal analyses of seropositive participants at 6 and 12 months. Results 1015 participants were included in Phase 1 (November-December 2020), and 1152 in Phase 2 (November-December 2021). Seroprevalence increased significantly from 19.2% (95% CI: 17.2-21.4%) in Phase 1 to 91.6% (95% CI: 89.8-93.1%) in Phase 2. Anti-S IgG titers were significantly higher among vaccinated (58.5%) than unvaccinated infected participants across vaccine products (p<0.001), though highest among those who received an mRNA vaccine. At 6 months, 78/82 (95.1%) participants maintained anti-spike seropositivity; at 12 months, 58/58 (100.0%) participants were seropositive and 33 (56.9%) had completed the primary vaccine series within 6 months. Among 11 unvaccinated participants who were not reinfected at 12 months, anti-S IgG declined from median 770.1 (IQR 615.0-1321.7) to 290.8 (IQR 175.7-400.3). Anti-N IgG antibodies waned earlier; from 35.4% seropositive at 6 months to 24.1% at 12 months. Conclusions SARS-CoV-2 seroprevalence increased significantly over 12 months from end of 2020 to end of 2021. Although individuals with previous infection may have residual protection, COVID-19 vaccination is vital to strengthening population immunity.

Atypical polypoid adenomyoma (APA) is considered as an uncommon benign uterine tumor. However, more and more cases show that it has characteristics similar to malignant tumor, such as high recurrence and malignant transformation. There is no consensus on the standard treatment for APA now. Total hysterectomy is the main treatment modality for APA patients, but a conservative treatment can be performed in young patients who wish to preserve their fertility. This article aims to summarize the current knowledge about APA from several aspects, which may provide theoretical basis for the clinical treatment of this rare disease in the future.

Background: The presence of an epicardial connection (EC) decreases the success rate of pulmonary vein isolation (PVI); however, the effect of designing isolation lines has not been evaluated. Objective: We sought to clarify the effects of designing an anterior line for right-sided PVI considering the presence and location of the EC. Methods: Seventy-four consecutive patients who underwent initial catheter ablation for atrial fibrillation were retrospectively included in this study. The presence of the EC was determined by the left atrial (LA) activation map during right atrial pacing, and patients were divided into EC-positive (n=23, 31%) and EC-negative (n=51, 69%) groups. EC-positive patients were further subdivided based on the EC location: on-the-line group, (EC on the PVI line, n=11); inside-line group (EC on the pulmonary vein [PV] side, n=10); and outside-line group (EC on the LA side, n=2). The PVI parameters were compared among the three groups. Results: The success rates of the first-pass isolation were comparable between the EC-negative and EC-positive groups (70.6% vs. 60.9%, ns), but the success rate was significantly higher in the on-the-line group than in the inside-line group (91% vs. 20%, p=0.002). First-pass isolation was successful in both patients in the outside-line group. Additional carina ablation was required only in the inside-line group. Conclusions: The association between the EC site and the right-sided PV anterior isolation line affected the success rate of first-pass isolation. For successful right-sided PVI, it is important to consider the EC site when designing the PVI line.

Objective: The short arm of chromosome 16 consists of several copy number variants (CNV) that are crucial in neurodevelopmental disorders; however, incomplete penetrance and diverse phenotypes after birth aggravate the difficulty of prenatal genetic counseling. Design: Case series. Setting: This study uses data from National Taiwan University Hospital. Sample: We screened 15,051 pregnant women who underwent prenatal chromosomal microarray analysis between July 2012 and December 2017. Methods: Patients with positive array results were divided into four subgroups based on the type of mutation identified on screening (16p13.3, 16p13.11, 16p12.2, and 16p11.2), and the maternal characteristics, prenatal examinations, and postnatal outcomes of different cases were reviewed. Main outcome measured: Postnatal prognosis. Results: Chromosome 16 CNVs were identified in 35 fetuses, including four with 16p13.3 CNVs, 22 with 16p13.11 CNVs, two with 16p12.2 microdeletions, and seven with 16p11.2 CNVs. Of the 35 fetuses, 17 delivered without early childhood neurodevelopmental disorders, three developed neurodevelopmental disorders during childhood, and 11 were terminated. Conclusion: Incomplete penetrance and variable expressivity make prenatal counseling challenging. We report a few cases of de novo 16p CNVs without further neurodevelopmental disorders.

Objective: To evaluate whether acupuncture pretreatment followed by letrozole leads to a higher live birth rate in PCOS when compared with letrozole alone. Design: Multicenter randomised controlled trial. Setting: Three hospitals in China. Population or Sample: Anovulatory women with PCOS aged from 20 to 40 years who had at least one patent tube. Methods: Participants were randomly assigned to receive acupuncture pretreatment followed by letrozole (pretreatment group) or letrozole alone (control group). Acupuncture pretreatment was given three times per week for 16 weeks, and letrozole was given five days per cycle for up to four cycles. Main outcome measures: The cumulative live birth rate (defined as a delivery after 20 weeks’ gestation). Results: The cumulative live birth rate was 41.1% (79/192) in the pretreatment group and 34.4% (66/192) in the control group with no significant difference between groups but was significantly higher in the pretreatment group (48/98, 49.0%) among those with baseline HOMA-IR <2.14, when compared with the control group (19/66, 28.8%). No significant differences were found between groups stratified by the letrozole cycle number, body mass index, age, PCOS phenotype, or hyperandrogenism. Conclusions: Acupuncture pretreatment followed by letrozole did not increase the cumulative live birth rate of anovulatory women with PCOS when compared with letrozole alone but may increase the cumulative live birth rate in those whose baseline HOMA-IR is <2.14. Key words: acupuncture, letrozole, live birth, PCOS, pretreatment

Introduction Although several studies are available regarding baseline Electrocardiographic (ECG) parameters, major and minor ECG abnormalities, there is a big controversy regarding their age and gender differences in literature, thus we aimed to investigate any possible age or gender ECG discrepancies in general adult population. Methods Data of 7630 adults aged ≥35 years from Tehran Cohort Study who were registered between March 2016 to March 2019 were collected. ECG basic values, major, and minor ECG abnormalities-defined according to the Minnesota Code-were analyzed and compared between genders, and four distinct age groups. Odds ratio of having any major ECG abnormality between males, and females stratified by age, and number of cardiovascular risk factors was calculated. Results ECG information of 7630 participants was available. The average age was 53.6 (±12.66), and women made up 54.2% (n=4132) of subjects. The average heart rate (HR) was higher among women(p<0.0001), while the average values of QRS duration, P wave duration, and RR intervals were higher among men(p<0.0001). Major ECG abnormalities were observed in 2.9% of study population (with right bundle branch block, left bundle branch block, and Atrial Fibrillation being the most common) and were more prevalent among men compared to women (3.1% vs 2.7% p=0.188). Moreover, minor abnormalities were observed in 25.9% of study population, and again were more prevalent among men (36.4% vs 17% p<0.001). Prevalence of major ECG abnormalities was significantly higher in participants older than 65 years old, and participants who had ≥3 conventional cardiovascular (CV) risk factors. Conclusion Basic ECG values is different in male and female general population. In addition, major and minor ECG abnormalities were roughly more prevalent in male subjects. In both genders, odds of having major ECG abnormalities surges with increase in number of conventional CV risk factors and age.

Cardiotoxicity is the most dramatic complications of cancer therapies, leading to halt in potentially life-saving anti-tumor treatment regimens and a poor survival prognosis in a non-negligible percentage of patients. Angiotensin converting enzyme inhibitors (ACEIs) and β-blockers are effective in the treatment of the cancer therapy–related cardiac dysfunction (CTRCD), while their roles in the prevention of cardiotoxicity are unclear. Sacubitril/valsartan was advantageous over ACEI in heart failure patients for further reduction of cardiovascular death or heart failure re-hospitalization. However, there is short of well-established testimony of its efficacy and safety in the prevention and treatment of CTRCD in the cardio-oncology setting. Although some small observational studies found a good performance of sacubitril/valsartan in patients with CTRCD, large-scale prospective clinical studies are required to confirm its excellent results. In this paper, we review the potential benefit of sacubitril/valsartan in human subjects with CTRCD.

Phenotypic divergence is an important consequence of restricted gene flow in insular populations. This divergence can be challenging to detect when it occurs through subtle shifts in morphological traits, particularly in traits with complex geometries, like insect wing venation. Here, we employed geometric morphometrics to assess the extent of variation in wing venation patterns across reproductively isolated populations of the social sweat bee, Halictus tripartitus. We examined wing morphology of specimens sampled from a reproductively isolated population of H. tripartitus on Santa Cruz Island (Channel Islands, Southern California). Our analysis revealed significant differentiation in wing venation in this island population relative to conspecific mainland populations. We additionally found that this population-level variation was less pronounced than the species-level variation in wing venation among three sympatric congeners native to the region, Halictus tripartitus, Halictus ligatus, and Halictus farinosus. Together, these results provide evidence for subtle phenotypic divergence in an island bee population. More broadly, these results emphasize the utility and potential of wing morphometrics for large-scale assessment of insect population structure.

A document by Martin Frasch. Click on the document to view its contents.

Objective: to evaluate effects of different ovarian stimulation protocols on in vitro fertilization(IVF) or intracytoplasmic sperm injection (ICSI) outcomes in infertile women with adenomyosis. Design: A retrospective, cohort study Setting: Tertiary referral hospital Population: A total of 562 cycles were included in the study with 257 cycles of fresh ET and 305 cycles of FET in patients with adenomyosis. Methods: According to ovarian stimulation protocol in fresh ET and embryo origin in FET, ultra-long, long, short and antagonist subgroups were divided. Main Outcomes Measure(s)：clinical pregnancy rate (CPR), implantation rate(IR), miscarriage rate (MR) and live birth rate (LBR). Results：Compared with ultra-long and long protocols, IR (28.2% versus 49.7%, 52.1%, P=0.001) and CPR (35.6% versus 64.3%, 57.4%, P=0.004) in short protocol significantly decreased. Similarly, a decreased inclination of IR (33.3% versus 49.7%, 52.1%) and CPR (38.2% versus 57.4%, 64.3%) existed in antagonist protocol, although no statistical significance was detected because of strict P adjustment of Bonferroni method (Padj=0.008). Compared with long protocol, LBR in short protocol decreased obviously (48.2% versus 20.3%, P<0.001). LBR in antagonist protocol was also similarly poor (39.8% versus 26.5% and 20.3%). In FET cycles, no matter which origin of embryo, IR, CPR and LBR had no statistical difference. Conclusions：In fresh ET cycles, ultra-long or long protocol could be appropriate choices. whole embryo frozen combined with FET might recover the poor outcomes of antagonist and short protocols in fresh ET. embryo origin had no impact on pregnancy outcomes in FET cycles.

Objective: To compare the experiences of women with gestational diabetes mellitus (GDM) from different culturally and linguistically diverse (CALD) backgrounds. Design: Mixed method study. Setting: Australia. Sample: 37 Australian-born and 43 women from CALD background diagnosed with GDM. Methods: Items from the questionnaire were derived from the Diabetes Self-Management Questionnaire (DSMQ), Culturally Based Communication about Health, Eating, and Food (CHEF), and Medical Social Self-efficacy (MSSES) scale. Semi-structured interviews were conducted to investigate participants’ experience with diagnosis and management of GDM. Main Outcome Measures: Factors affecting the experience of managing GDM. Results: Compared to Australian-born women, women from CALD backgrounds perceived healthcare professionals to have poorer knowledge of their cultural foods (P<0.001) and had less confidence in seeking medical information (P<0.006). 20 women partook the semi-structured interviews and 5 themes were identified: (1) Reaction to diagnosis; (2) Management issues; (3) Roles of friends and family; (4) Information access; and (5) Experience with healthcare services. The lack of culturally tailored dietary information, social support and language barriers were the main factors underpinning the differences in GDM experiences among women from CALD backgrounds versus Australian-born. Conclusions: Our study supports 5 dimensions of patient-centred care: emotional support, continuity and transition, involvement of friends and family, information and education, and access to care. Implementing models of care with these areas addressed will enhance the experience of GDM for women from all ethnic backgrounds. Funding: This study did not receive any funding. Keywords: Diabetes, gestational; Pregnancy; Prenatal care; Ethnic groups

Objective The aim of this study was to determine whether postmeal walking is an effective and feasible alternate to standard-care advice of 30-min continuous walking for the management of gestational diabetes (GDM). Design, Setting Randomised controlled trial conducted in Australia. Sample, Methods Forty women with GDM were randomised between 28-30 weeks’ gestation into either standard-care (CTL; 30-min continuous walking) or standard care with advice for PMW (10-min walking after main meals). ActivPAL inclinometers and continuous glucose monitors (CGM) were worn from 28 weeks to 35 weeks. Birth outcomes were also collected. A linear mixed model analysed the changes from baseline (28 week) through to 35 weeks’ gestation between continuous and postmeal walking. Main Outcome Measure Postprandial glucose. Results Twenty-six women (PMW: n=12, CTL: n=14; 35  5 y) completed the intervention. 3 h postprandial glucose at lunch and dinner, were ~0.25 and ~0.35 mmol/L, respectively higher in PMW vs. CTL (group: p = 0.04). 24 h, nocturnal and fasting glucose were similar. PMW spent ~57 min/d more in sitting time and ~11 min/d less stepping time vs. CTL (group: p= 0.02 and 0.05). Both PMW and CTL had high adherence to exercise prescriptions, physical activity decreased with gestation. No difference in birth outcomes. Conclusions Postmeal walking was less effective than the standard care physical activity guidelines of thirty minutes continuous walking. More research on the optimal duration and intensity of postmeal walks to improve postprandial responses are needed. Strategies that mitigate sedentary time in pregnancy are also warranted.

Objective:To assess the correlation between ProMisE classification and lymph node metastasis(LNM) of endometrial carcinoma(EC). Design:A retrospective cohort study. Setting:Department of gynecologic oncology at Liaoning Cancer Hospital in China. Population:From January 1st,2014 to December 31st, 2018,a total of 74 women with EC were included.32 cases had pelvic or para-aortic LNM and 42 cases had no LNM. Methods:The formalin-fixed paraffin-embedded(FFPE) tissue sections of EC patients were analyzed by the Proactive Molecular Risk Classifier for Endometrial cancer (ProMisE) classification,and to evaluate the correlation between ProMisE classification and LNM and prognosis of the patients receiving different postoperative adjuvant therapies. Main outcome measure:Correlation between ProMisE classification and LNM,Overall Survival(OS) and progression-free survival(PFS). Results: In the ProMisE classification,mismatch repair deficient(MMRd) was linked to low pathological grade (p value=0.006; correlation=-0.315), p53 abnormal subtype(p53abn) was correlated with LNM (p value=0.0004; correlation=-0.472) and late International Federation of Gynecology and Obstetrics (FIGO) stage (p value=0.005; correlation=-0.386).The 5-year overall survival was 100% in Polymerase Epsilon exonuclease domain mutated(POLE EDM), 85% in MMRd, 91.2% in p53 wild-type(p53wt) and 83.3% in p53abn.The 5-year PFS was 100% in POLE EDM, 95% in MMRd, 94.1% in p53wt and 77.8% in p53abn.We also found no statistical difference in patients‘ benefits from Radiotherapy(RT) alone and concurrent chemoradiotherapy(CCRT) in different molecular subtypes,however,the patients had a trend toward benefit from CCRT in the p53abn subtype. Conclusions:ProMisE classification can predict the risk of LNM,histological grade,clinical staging and prognosis, which is expected to guide the postoperative adjuvant treatment of EC patients.

Background: Measures introduced during the COVID-19 pandemic intended to address the spread of SARS-CoV-2 may also influence the incidence of other common seasonal respiratory viruses (SRV). This evaluation reports laboratory confirmed cases of common SRV in a well-defined region of central Canada to address this issue. Methods: Surveillance data for common non-SARS-CoV-2 SRV in the Ottawa, Canada region was provided by the Eastern Ontario Regional Laboratory Association (EORLA) reference virology lab. Weekly reports of the number of positive tests and proportion that yielded positive results was analyzed from August 26, 2018 to January 2, 2022. Results: A drastic reduction in influenza and other common SRV was observed during the 2020-2021 influenza season in the Ottawa region. Influenza was virtually undetected post SARS-CoV-2 emergence. Rhinoviruses and enteroviruses were the only viruses that remained relatively unaffected during this period. Conclusions: We speculated that the introduction of non-pharmaceutical measures including masking to prevent SARS-CoV-2 transmission contributed to the near absence of SRV in the Ottawa region. These measures should remain a key component in addressing spikes in SRV activity and future pandemics.

A document by 高逸 周. Click on the document to view its contents.

Background and Purpose: Invasive mucormycosis is a fatal disease caused by Mucorales species. Treatment therapy for CAM includes aggressive surgical debridement and systemic antifungals in Amphotericin B and Posaconazole as step-down therapy in the follow-up period. Despite being on oral antifungal Posaconazole therapy, patients have been observed to have a recurrence of mucormycosis in the follow-up period. Experimental Approach: An ambispective cohort study was done in the department of ENT and Pharmacology of All India Institute of Medical Sciences (AIIMS), Bhubaneswar, from April 2021 to September 2022. It includes patients on follow-up on the step-down therapy of Posaconazole. Medication adherence was measured based on the half-life of Posaconazole and participants not skipping a single dose. Key Results: The demographic data between the recurrence and non-recurrence groups, including age, sex and duration of stay, was not significant. Recurrence in mucormycosis was not found to be associated with medication adherence. By both methods of calculating medication adherence, the results were statistically insignificant. The difference in onset of recurrence of the disease between the two groups was statistically significant, with a p-value of 0.027 in patients who did not skip a single dose of Posaconazole with a hazard ratio of 3.887. There was a statistically significant difference in cost-effective analysis with a p-value of 0.042 between groups. Conclusion and Implications: Posaconazole medication adherence in the postoperative period does not affect the recurrence of mucormycosis during step-down therapy. However, it helps prolong the onset of disease recurrence in patients adhering to the medication.

Title: Vaccine Preventable Illness After Blinatumomab Therapy: A Case ReportAuthors: Katie Voelz MD1,2, Anthony Salvatore DO1, Sudarshawn Damodharan DO1,2 & Cathy Lee-Miller MD1,21Department of Pediatrics, University of Wisconsin School of Medicine & Public Health, Madison, WI, USA2Division of Pediatric Hematology, Oncology and Bone Marrow Transplant, University of Wisconsin School of Medicine & Public Health, Madison, WI, USACorrespondence:Cathy Lee-MillerUniversity of Wisconsin School of Medicine & Public Health1111 Highland Ave, WIMR 4105Madison, WI 53705Email: calee4@wisc.eduWord Count: Main Text: 848Manuscript contains 1 TableShort running Title: Vaccine-preventable, ALL, immunotherapyKeywords: Blinatumomab, ALL, vaccination, pediatrics

Title:A rare case of eczema herpeticum after subcutaneous immunotherapy

The mid-infrared (mid-IR) anisotropic optical response of a material probes vibrational fingerprints and absorption bands sensitive to order, structure and direction dependent stimuli. Such anisotropic properties play a fundamental role in catalysis, optoelectronic, photonic, polymer and biomedical research and applications. Infrared dual-comb polarimetry (IR-DCP) is introduced as a powerful new spectroscopic method for the analysis of complex dielectric functions and anisotropic samples in the mid-IR range. IR DCP enables novel hyperspectral and time-resolved applications far beyond the technical possibilities of classical Fourier-transform IR (FTIR) approaches. The method unravels structure–spectra relations at high spectral bandwidth (100 cm–1) and short integration times of 65 µs, with previously unattainable time resolutions for spectral IR polarimetric measurements for potential studies of noncyclic and irreversible processes. The polarimetric capabilities of IR-DCP are demonstrated by investigating an anisotropic inhomogeneous free-standing nanofiber scaffold for neural tissue applications. Polarization sensitive multi-angle dual-comb transmission amplitude and absolute phase measurements (separately for ss-, pp-, ps- and sp-polarized light) allow the in-depth probing of the samples’ orientation dependent vibrational absorption properties. Mid-IR anisotropies can be quickly identified by cross-polarized IR-DCP polarimetry.

Carbon dots (CDs) possess outstanding luminescence properties, leading to their use in a wide range of applications including optical displays, anti-counterfeiting systems, bioimaging and sensors. Presently, there is much debate about the classification of CDs, as well as their formation process, structure and fluorescence mechanisms. Aggregation plays an important role in both the formation of CDs and their fluorescence (e.g. aggregation-induced emission), yet is seldom studied in detail. This review aims fill this knowledge gap, by firstly exploring how aggregation leads to the formation of different types of CDs (e.g. graphene quantum dots, carbon quantum dots, and carbonized polymer dots), followed by a detailed examination of the effect of aggregation-induced morphology on the luminescence properties and application of CDs. Finally, opportunities and challenges for the application of CDs in various applications are discussed, with the need for better mechanistic understanding of aggregation-induced luminescence being an imperative.

Objectives: To explore the role of multidisciplinary team (MDT) in perioperative safety and feasibility evaluation and postoperative effect prediction of cochlear implantation (CI) in patients with bilateral profound sensorineural hearing loss (SNHL) after radiotherapy and chemotherapy for nasopharyngeal carcinoma (NPC). Methods: From 2017 to 2022, 11 patients with bilateral profound SNHL after radiotherapy and chemotherapy for NPC received CI in our department. MDT formulated diagnosis and treatment plan for all patients during their perioperative period. The MDT participants were from the following departments: otorhinolaryngology, radiology, radiotherapy, neurology, psychiatry, anesthesiology, and audiology and speech rehabilitation. Several hearing examinations were tested during the follow-up to dynamically observe the effectiveness of the hearing and speech rehabilitation in the patients. Results: Based on the MDT conclusion and decision, five patients underwent routine CI, two patients underwent simultaneously extended radical mastoidectomy and CI, and four patients underwent simultaneously subtotal petrosectomy, external auditory canal elimination, mastoid cavity obliteration by fat graft or musculoperiosteal flaps and CI. The pure tone average of all 11 patients was 39.5 ± 5.0 dB and the average speech discrimination score was 95.0 ± 9.7% postoperatively. One patient underwent a second surgery for the cochlear electrode prolapsed postoperatively. Conclusion: To some extent, CI is risky for patients after chemoradiotherapy for NPC. However, the MDT approach can reduce the risk fast, predict the auditory effect after implantation early, as well as predict and prevent the occurrence of postoperative complications. Therefore, MDT exerts a positive effect on the outcome of the relatively safe and feasible application of CI in these patients. Keywords: Multidisciplinary team, nasopharyngeal carcinoma, cochlear implantation.