Introduction: Due to the high mortality of coronavirus disease 2019 (COVID-19), there are difficulties in the managing emergency department. We investigated whether the d-dimer/albumin ratio (DAR) and fibrinogen/albumin ratio (FAR) predicts mortality in the COVID-19 patients.Methods: A total of 717 COVID-19 patients who were brought to the emergency department from March to October 2020 were included in the study. Levels of d-dimer, fibrinogen, and albumin, as well as DAR, FAR, age, gender, and in-hospital mortality status of the patients were recorded. The patients were grouped by in-hospital mortality. Statistical comparison was conducted between the groups.Results: Of the patients included in the study, 371(51.7%) were male, and their median age was 64 years (50–74). There was in-hospital mortality in 126 (17.6%) patients. The area-under-the-curve (AUC) and odds ratio values obtained by DAR to predict in-hospital mortality were higher than the values obtained by the all other parameters (AUC of DAR, albumin, d-dimer, FAR, and fibrinogen: 0.773, 0.766, 0.757, 0.703, and 0.637, respectively; odds ratio of DAR>56.36, albumin<4.015, d-dimer>292.5, FAR>112.33, and fibrinogen>423: 7.898, 6.216, 6.058, 4.437, and 2.794, respectively). In addition; patients with concurrent DAR>56.36 and FAR>112.33 had an odds ratio of 21.879 with respect to patients with concurrent DAR<56.36 and FAR<112.33.Conclusion: DAR may be used as a new marker to predict mortality in COVID-19 patients. In addition the concurrent high DARs and FARs were found to be more valuable in predicting in-hospital mortality than either separately.Keywords: Covid-19, D-dimer, Fibrinogen, Serum Albumin, in-Hospital Mortality

Background :The aim of this study was to validate whether pulmonary capillary wedge pressure estimated using transoesophageal echocardiography in anaesthetised patients receiving mechanical ventilation can be comparable to gold standard method of estimating PCWP by using pulmonary artery catheter. Methods : A cross sectional validity study conducted in a tertiary care cardiac centre in south India over a period of 6 months from February 2016 – August 2016 among 100 patients undergoing cardiac surgery where intraoperative TEE and pulmonary artery catheter used. In anesthetised patients, after the insertion of TEE probe, the following echocardiography ratios were calculated: 1) SF = S ⁄ S + D (systolic fraction of pulmonary venous flow 2) Systolic ⁄ diastolic (S ⁄ D ratio) 3) E ⁄ Ea 4) E ⁄ Vp 5) E ⁄ A ratio , for three consecutive cardiac cycles and averaged by two independent and blinded observers. All the echo measurements were taken pre cardiopulmonary bypass at end expiration and during a stable period of hemodynamics. Simultaneously PCWP was recorded from PAC. The ability of these variables to predict PCWP was tested for previously determined cutoffs as per extant guidelines and validity parameters such as sensitivity, specificity, predictive value of positives, predictive value of negatives & accuracy were computed. Conclusion : Use of E/A,DT,S/D,SF ratio & E/Vp reveal poor predictive capacity for detecting high left sided filling pressures. The use of E/Ea is reasonable to predict an elevated PCWP especially if the cohort predominantly comprises of patients with normal ejection fraction

Potential evapotranspiration (ET0) is an essential component of the hydrological cycle, and quantitative estimation of the influence of meteorological factors on ET0 can provide a scientific basis for studying the impact mechanisms of climate change. In the present research, the Penman-Monteith method was used to calculate ET0. The Mann-Kendall statistical test with the inverse distance weighting were used to analyze the spatiotemporal characteristics of the sensitivity coefficients and contribution rates of meteorological factors to ET0 to identify the mechanisms underlying changing ET0 rates. The results showed that the average ET0 for the Yanhe River Basin, China from 1978–2017 was 935.92 mm. Save for a single location (Ganquan), ET0 increased over the study period. Generally, the sensitivity coefficients of air temperature (0.08), wind speed at 2 m (0.19), and solar radiation (0.42) were positive, while that of relative humidity was negative (-0.41), although significant spatiotemporal differences were observed. Increasing air temperature and solar radiation contributed 1.09% and 0.55% of the observed rising ET0 rates, respectively; whereas decreasing wind speed contributed -0.63%, and relative humidity accounted for -0.85%. Therefore, it was concluded that the decrease of relative humidity did not cause the observed ET0 increase in the basin. The predominant factor driving increasing ET0 was rising air temperatures, but this too varied significantly by location and time (intra- and interannually). Decreasing wind speed at Ganquan Station decreased ET0 by -9.16%, and was the primary factor underlying the observed, local “evaporation paradox.” Generally, increases in ET0 were driven by air temperature, wind speed and solar radiation, whereas decreases were derived from relative humidity.

The stable hydrogen and oxygen isotopes as well as their correlation in precipitation have been widely investigated for the understanding of various hydrological processes. Monthly precipitation data were usually recommended in order to establish a linear relationship between the stable hydrogen and oxygen isotope ratios (also known as local meteoric water lines or LMWL for a specific location); however, the LMWL based on daily (or event-based) precipitation data is usually different from that using monthly data. Based on 83 sampling stations across the world from 2000 to 2017, local meteoric water lines were calculated using daily (or event-based) precipitation data (n=9354) and corresponding monthly data (n=1895), respectively; multiple regression methods were used, including ordinary least squares, reduced major axis and major axis regressions as well as their precipitation-weighted counterparts. The global meteoric water line from daily data is δ2H = (7.72 ± 0.02) δ18O + (6.84 ± 0.15) (n=9354, r2=0.96) and from monthly data is δ2H = (7.81 ± 0.04) δ18O+(7.61 ± 0.32) (n=1895, r2=0.96). The stations used in this study were grouped into five climate types, according to the Köppen Climate classification. The precipitation-weighted regression may increase the long-term receptiveness of LMWL using daily-based (or event-based) samples, not only for arid regions, but also for cold regions. When only relatively short-term isotopic records in event-based precipitation samples are available, which is usual in modern hydrological studies, the weighted regression (especially precipitation weighted ordinary least squares regression, PWLSR) is helpful to create a respective local meteoric water line.

Heavy increase in urbanization, industrialization and population is causing an increase in emissions of greenhouse gases (GHG) and this causes variations in atmosphere. Climate change causes extreme rainfall events and these events are expected to be enhanced in the future. Since flooding is influencing urban areas, controlling and management of flooding is a major necessity. Intensity-Duration-Frequency (IDF) curves play a huge role in representing rainfall characteristics by linking intensity, duration, and frequency of rainfall. Analysing short-duration rainfall is crucial for urban areas due to fast responses of drainage systems against heavy rainfall events. IDF curves were generated via the Gumbel method for rainfalls from 5-min to 24-h in this study. However, providing short-duration rainfall data is challenging due to the low capacity, costs and geographic conditions. Therefore, the HYETOS disaggregation model was applied to obtain sub-hourly data. IDF curves are stationary since they only consider historical events. However, IDF curves must be non-stationary and time varying based on preparation for upcoming extreme events. This study aims to generate IDF curves under climate change scenarios. The Regional Climate Model (RCM) HadGEM2-ES generated under Representative Concentration Pathways (RCP) 4.5 and 8.5 scenarios and was used in the study to represent future rainfalls. Future daily rainfalls were disaggregated into sub-hourly using disaggregation parameters of corresponding station’s historical rainfall data since it is impossible to estimate parameters when hourly data is not available. With this new approach, future daily rainfall data is disaggregated into 5-min data by complying with historical rainfall patterns rather than complying with randomly selected rainfall characteristics. The study concluded that future rainfall intensities increases compared to historical IDF curves. RCP8.5 scenarios have higher rainfall intensities for all return periods compared to RCP4.5 scenarios for all stations except a station. In addition, the accuracy of the selected disaggregation model was verified.

We report an unusual finding of DCIS within a cystic lesion in a black man highlighting the need for adequate workup, and timely follow-up for men with breast/chest wall masses given the lack of screening in this population. Furthermore, we will explore how race contributes to prognosis and health outcomes.

We have reported the electronic, magnetic, and optical properties of the top layer carbon-doped hexagonal Boron Nitride(h-BN) bilayer at B/N-sites using the density functional theory implemented in Quantumwise VNL-ATK package. The calculated structural and electronic properties of the h-BN bilayer are in agreement with the previously reported results. A single carbon doping on B and N sites modifies the large band gap semiconducting behaviour of h-BN bilayer similar to dilute magnetic semi-conducting material with a net magnetic moment of 1.001 μ B and 0.998 μ B , respectively. For double doping at B/N sites net magnetic moment increases to 1.998 μ B and 1.824 μ B , respectively. Whereas for triply carbon doped bilayer system at B/N sites, the system changes to metallic behaviour. Upon carbon doping at N-site, we obtained transition from Non-Magnetic semiconductor(Pristine) → Magnetic semiconductor(1C) → Half-Metal ferromagnetic(2C) → Metal(3C). Whereas, in case of doping at the B-site, we observed transition from Non-Magnetic Semiconductor(Pristine) → Magnetic Semiconductor(1C) → Metal (2C, 3C). Analysis from the PDOS plot of the car- bon doped systems reveals that the net magnetic moments are contributed by the 2p orbitals of carbon and partial contribution from the neighboring nitrogen and boron atoms, respectively. As 1,2C doping at the B-site reduces the energy band gap to 0.81-1.8 eV which falls in the visible spectrum and thus such system further opens up an opportunity to be utilised as a photocatalys material. Our carbon doped systems show a magnetic semiconducting behavior with a nite magnetic moment which is one of the criteria for a spintronic material. So, our system looks promising in this regard. Also, Carbon doping can be considered as a simple approach to tune the band gap of the Boron Nitride bilayer system.

In the present study, the course of SARS-CoV-2 natural infection in two asymptomatic cats is investigated. The source of the virus for the cats was their COVID-19-affected owner, with whom they were in continuous proximity, in a small household setting. Oropharyngeal and fecal swabs were collected to investigate the course of SARS-CoV-2 RNA concentrations, as well as the directionality of the chain

In May, nations of the world will meet to negotiate the post-2020 Global Biodiversity Framework under the Convention on Biological Diversity. An influential ambition is “bending the curve of biodiversity loss”, which aims to reverse the decline of global biodiversity indicators. A second relevant, yet less prominent, milestone is the 20th anniversary of the publication of The Unified Neutral Theory of Biodiversity and Biogeography. Here, I apply neutral theory to show how global biodiversity indicators for population size (Living Planet Index) and extinction threat (Red List Index) decline under neutral ecological drift. This demonstrates that declining indicators alone do not necessarily reflect deterministic species-specific or geographical patterns of biodiversity loss. Thus, “bending the curve” could be assessed relative to a counterfactual based on neutral theory, rather than static baselines. If used correctly, the 20-year legacy of neutral theory can be extended to make a valuable contribution to the post-2020 Global Biodiversity Framework

Placenta accreta spectrum: Welcome progress and a call for standardization.Mini-commentary for BJOG on Kayem et al 2021 BJOG-20-1462R3Placenta accreta spectrum (PAS) is among the most feared causes of maternal morbidity worldwide, and yet few prospective data are available to inform best practice. PAS is rare enough that rigorous study in a single center is difficult, but common enough that most obstetric hospitals now encounter PAS. Management and outcomes vary strikingly between hospitals and best practice, regrettably, is guided more by expert consensus than by level I evidence. In fact, most clinical questions regarding management of PAS are informed by essentially no prospective data (Collins et al. Am J Obstet Gynecol. 2019;220:511-526).Into this data void has come the PACCRETA cohort (Kayem et al. Act Obstet Gynecol Scand 2013;92:476-482) and some of its first results, published in this issue of BJOG (Kayem et al. BJOG 2021). PACCRETA is a prospective population-based study from 176 hospitals in France, capturing 30% of all French deliveries, from from 2013 to 2015. The study investigators identified 249, or 4.8 per 10,000, cases of PAS.Of all PAS patients, Kayem and colleagues found that a full half did not have the classic combination of risk factors for PAS (previa with history of cesarean). This group had lower morbidity and milder disease than those with the classic combination. Only 17% of those without classic risk factors were diagnosed antenatally. The message here is mixed: those without classic PAS risk factors are less likely to be diagnosed antenatally (bad) but appear to suffer less morbidity overall (good).But did these patients actually have PAS? Only 21% of those without prior cesarean and previa had a hysterectomy. Although this could be due to a regional preference for conservative treatments, the presence of false positives seems likely. Without a hysterectomy specimen, the diagnosis of PAS is difficult, controversial, and (in our opinion) highly susceptible to overdiagnosis. The authors define “strict” criteria for true cases of PAS, but several criteria depended entirely on the subjective assessment of a clinician faced with a difficult placental removal and the flawed principle of PAS as diagnosis of exclusion . Difficulty in manual placental removal or massive bleeding from an implantation site does not always indicate that microscopic PAS was present. Similarly, areas of prior cesarean section scar dehiscence (windows) where the placenta can be seen through the serosa are often diagnosed as percreta (Figure) without any histological evidence of the villous tissue having invaded through the serosa or beyond (Hecht et al. Modern Pathol 2020;33:2382-2396).We congratulate Kayem and colleagues for the current study and all of their important contributions to our understanding of PAS. However, these data illustrate the need for standardization of the definition of PAS, especially in conservatively managed cases with considerable potential for misdiagnosis. There is a desperate need for controlled studies of patients with antenatally suspected PAS with detailed and objective documentation of imaging, intra-operative findings, and when available, histopathological examination. In absence of such studies, the void of definitive data to guide treatment options will remain wide open.

This article reports an association of thrombotic thrombocytopenic purpura(TTP) with COVID-19. A 49-year old male presented with fever, diarrhea and altered mentation, was found to have COVID-19. On sixth hospital day, he developed thrombocytopenia, microangiopathic hemolytic anemia with schistocytes on peripheral blood film and worsening renal function signifying TTP.

88-year-old male with recent history of mastoiditis status post completing outpatient antibiotic regimen presented with worsening neck pain. Found to have complications of cerebral venous sinus thrombosis, skull base osteomyelitis and a retropharyngeal mass. This is the eleventh case in medical literature reporting on this phenomenon.

Endocarditis due to multidrug-resistant Enterococci and specifically multidrug-resistant Enterococcus faecium (E. fαecium) is rare. Optimal antimicrobial therapy still remains undefined and a challeging issue. We report a case of native valve endocarditis due to vancomycin-resistant E. faecium (VRE) in a 65-years-old man with significant comorbid conditions.

The occurrence of Noonan with refractory chylothorax with RIT1 gene mutation is very rare. The right lymphatic vessel and thoracic duct were compressed by the surrounding tissue, resulting in obstruction. After releasing the surrounding tissue, the chylothorax disappeared.

We describe a case of permanent pacemaker implantation in a 59-year-old male with subclavian vein occlusion undergoing hemodialysis. The balloon-target puncture technique aided successful and safe transvenous permanent pacemaker implantation.

Cytogenetic diagnosis of disseminated epithelioid glioblastoma harboringBRAF V600E mutationManabu Natsumeda1, Yu Kanemaru1, Yukie Kawaguchi2, Hajime Umezu2, Akiyoshi Kakita3, Yukihiko Fujii11 Department of Neurosurgery, Brain Research Institute, Niigata University, Niigata, Japan2 Division of Pathology, Niigata University Medical & Dental Hospital, Niigata, Japan3 Department of Pathology, Brain Research Institute, Niigata University, Niigata, JapanCorrespondence:Manabu Natsumeda, Department of Neurosurgery, Brain Research Institute, Niigata University, 1-757 Asahimachidori, Chuo-ku, Niigata, Japan 951-8585ACKNOWLEDGMENTSThe authors would like to acknowledge Jotaro On, Shoji Saito and Shingo Nigorikawa for help with sequencing.INTRODUCTIONEpithelioid glioblastoma is a rare, aggressive variant of glioblastoma, characterized by frequent dissemination, poor prognosis and recurrentBRAF V600E mutations.1 Dramatic response to BRAF and MEK inhibitor treatment, including the present case,2 has been reported, so screening for BRAFV600E in epithelioid glioblastoma is imperative. We have previously reported reliable detection of the driver mutation MYD88 P265L in circulating tumor DNA (ctDNA) extracted from the cerebrospinal fluid (CSF) of primary central nervous system lymphoma (PCNSL).3, 4 In the present case, cytopathologic examination and liquid biopsy of CSF was diagnostic for BRAFV600E-mutant epithelioid glioblastoma.CASE REPORTA 57-year-old man presented with headaches and dysphasia. A left frontal tumor, relatively well circumscribed, showing subependymal enhancement of the left frontal horn, was observed on MR images.2Total removal of the parenchymal tumor was achieved. Hematoxylin eosin staining of the tumor revealed the presence of discohesive, round tumor cells with abundant cytoplasm and laterally positioned nuclei and focal necrosis in a mucinous background (Figure 1A). Thus, the pathological diagnosis was epithelioid glioblastoma. BRAF V600E mutation was detected by both droplet digital PCR (ddPCR) (Figure 1B) and the Sanger method (Figure 1C). Variant allele frequency (VAF) determined by ddPCR was 52.1%. During radiation and concomitant temozolomide treatment, the patient became comatose and MR images subsequently taken showed hydrocephalus and diffuse leptomeningeal enhancement. An emergent lumbo-peritoneal shunt was placed, but obstruction of the lumbar side shunt tube was observed after only three days, so the shunt was removed, and an external ventricular drainage was placed. Hematoxylin and eosin staining of the obstructed shunt tube revealed aggregation of tumor cells (Figure 1D).After completion of adjuvant treatment, a ventriculo-peritoneal shunt procedure was performed. However, immediately after shunting, the patient displayed symptoms of paraplegia. Spinal MR images showed thick spinal dissemination and diffuse syringomyelia.2Cytological analysis of cerebrospinal fluid (CSF) by Papanicolaou staining revealed apparent epithelioid tumor cells with abundant cytoplasm, laterally displaced nuclei and lacking cellular processes (Figure 2A). BRAF V600E mutation from circulating tumor DNA was detected by both Sanger sequencing (Figure 2B) and ddPCR (Figure 2C) after approval from the institutional review board of Niigata University (#G2018-0008) and obtaining written consent. VAF was comparable to that of the tumor at 47.5%. The disseminated lesions showed dramatic response to whole spine irradiation and combined BRAF and MEK inhibitor treatment, which has previously been reported in detail.2DISCUSSIONIn the present case, tumor cells with epithelioid appearance were found by cytological analysis of CSF in an epithelioid glioblastoma patient with spinal dissemination. Leptomeningeal dissemination is observed in a third of these patients,1 and survival after dissemination is especially dismal. We speculate that epithelioid glioma can easily disseminate because of two reasons. First, these glioma cells are unique in that they lack cytoplasmic processes and are round shaped. This morphological characteristic may help these tumor cells readily spread through the neuraxis. Induction of BRAF V600E mutation in neuroprogenitor cells in Ink4a/Arf knockout mice produced well demarcated gliomas with growth into subarachnoid and Virchow-Robin perivascular spaces.5 Secondly, these cells are naturally discohesive, and may be able to stay alive and multiply even at the single cell state in CSF. We established the cell line NGT41 from tumor cells taken at autopsy of the present patient.2These cells grew as neurospheres from single cells in serum free culture media and had high expression of CD133. Interestingly, epithelioid glioblastoma cells are morphologically similar to melanoma cells,1 and cultured melanoma cells, which frequently harbor BRAF V600E mutations, are known to have increased expression of stem cell markers including CD133, CD166 and nestin.6Liquid biopsy, usually by detection of circulating tumor cells or circulating tumor DNA (ctDNA), has revolutionized the diagnosis, treatment and monitoring of cancer.7 Both methods are promising, but presently, methods to detect ctDNA are more sensitive. We have previously reported reliable detection MYD88 L265P mutation in ctDNA extracted from CSF in primary central nervous system lymphomas using the Maxwell RSC ccfDNA Plasma Kit (RSC; Promega, Leiden, the Netherlands) is feasible.3, 4 Using the same methods, we were able to detect BRAF V600E in CSF by both Sanger sequencing and ddPCR. ddPCR is 100 times more sensitive than Sanger sequencing, and we found that of 10 (40%) lymphoma cases which were thought to be MYD88 P265L wildtype by Sanger sequencing, 4 (40%) were in fact P265L mutant by ddPCR.4 However, in cases such as the present one, in which diffuse spinal dissemination is observed, mutations may be detected by Sanger sequencing alone.Though detection of BRAF V600E is not diagnostic for epithelioid glioblastoma, as it is also found in brain tumors such as pleomorphic xanthoastrocytoma, ganglioglioma and pediatric low-grade gliomas, it can serve as a rationale for targeted treatment. Next generation sequencing panels for liquid biopsy such as Guardant360R and FoundationOneR Liquid CDx are available for use in solid tumor patients, albeit from blood. At least one genetic alteration was found from plasma in 55% of glioblastoma patients by Guardant360R,8 but concentrations of ctDNA is known to be in higher in CSF of brain tumor patients compared to plasma.3 Clinical application of a liquid NGS panel analyzing ctDNA extracted from CSF in brain tumor patients,9 is awaited.Because of the high risk of dissemination in epithelioid glioblastoma, CSF cytology and post-contrast whole spine MRI should be periodically repeated. For patients with evidence of dissemination at diagnosis, we propose that craniospinal irradiation should be performed. In a different epithelioid glioblastoma patient showing disseminating disease of the cervical spine at presentation, CSI was performed upfront and lead to long-term control of disseminating disease for more than 2.5 years (Figure S1). Other brain tumors showing leptomeningeal dissemination include glioblastoma, PCNSL, metastatic brain tumors such as metastasis of breast cancer and EGFR -mutant non-small cell lung cancer (NCSLC), medulloblastoma, atypical teratoid rhabdoid tumor and malignant germ cell tumors. Screening for ctDNA can be sequentially performed to monitor for disseminating disease or CNS relapse in addition to CSF cytology and/or tumor markers such as AFP and β-HCG in germ cell tumors. Hotspot (C228T, C250T) TERT promoter mutations for glioblastoma and oligodendroglioma, IDH1 R132H forIDH1 -mutant gliomas, MYD88 L265P for PCNSL,3 EGFR mutations for metastatic NCSLC10 are just some of the possible examples of diagnostic markers for the various brain tumors.CONFLICT OF INTERESTThe authors have no conflict of interest to declare.REFERENCES1. Louis DN, Ohgaki H, Wiestler OD, et al. WHO classification of tumours of the central nervous system . IARC; 2016.2. Kanemaru Y, Natsumeda M, Okada M, et al. Dramatic response of BRAF V600E-mutant epithelioid glioblastoma to combination therapy with BRAF and MEK inhibitor: establishment and xenograft of a cell line to predict clinical efficacy. Acta Neuropathol Commun . Jul 25 2019;7(1):119.3. Watanabe J, Natsumeda M, Kanemaru Y, et al. Comparison of circulating tumor DNA between body fluids in patients with primary central nervous system lymphoma. Leuk Lymphoma . Dec 2019;60(14):3587-3589.4. Watanabe J, Natsumeda M, Okada M, et al. High detection rate of MYD88 mutations in cerebrospinal fluid from patients with central nervous system lymphomas. JCO Precis Oncol . 2019;3:1-13.5. Robinson JP, VanBrocklin MW, Guilbeault AR, Signorelli DL, Brandner S, Holmen SL. Activated BRAF induces gliomas in mice when combined with Ink4a/Arf loss or Akt activation. Oncogene . Jan 21 2010;29(3):335-44.6. Klein WM, Wu BP, Zhao S, Wu H, Klein-Szanto AJ, Tahan SR. Increased expression of stem cell markers in malignant melanoma. Mod Pathol . Jan 2007;20(1):102-7.7. Ignatiadis M, Lee M, Jeffrey SS. Circulating Tumor Cells and Circulating Tumor DNA: Challenges and Opportunities on the Path to Clinical Utility. Clin Cancer Res . Nov 1 2015;21(21):4786-800.8. Piccioni DE, Achrol AS, Kierdrowski LA, et al. Analysis of cell-free circulating tumor DNA in 419 patients with glioblastoma and other primary brain tumors. CNS Oncol . 2019;8(CNS34)9. Miller AM, Shah RH, Pentsova EI, et al. Tracking tumour evolution in glioma through liquid biopsies of cerebrospinal fluid. Nature . Jan 2019;565(7741):654-658.10. Shingyoji M, Kageyama H, Sakaida T, et al. Detection of epithelial growth factor receptor mutations in cerebrospinal fluid from patients with lung adenocarcinoma suspected of neoplastic meningitis. J Thorac Oncol . 2011;6(7):1215-1220.

Vector-borne parasites often manipulate hosts to attract uninfected vectors. For example, parasites causing malaria alter host odor to attract mosquitoes. Here we discuss the ecology and evolution of fruit-colonizing yeast in a tripartite symbiosis – the so-called “killer yeast” system. “Killer yeast” consists of Saccharomyces cerevisiae yeast hosting two double stranded RNA viruses (M satellite dsRNAs, L-A dsRNA helper virus). When both dsRNA viruses occur in a yeast cell, the yeast converts to lethal toxin‑producing “killer yeast” phenotype that kills uninfected yeasts. Yeasts on ephemeral fruits attract insect vectors to colonize new habitats. As the viruses have no extracellular stage, they depend on the same insect vectors as yeast for their dispersal. Viruses also benefit from yeast dispersal as this promotes yeast to reproduce sexually, which is how viruses can transmit to uninfected yeast strains. We tested whether insect vectors are more attracted to killer yeasts than to non‑killer yeasts. In our field experiment, we found that killer yeasts were more attractive to Drosophila than non-killer yeasts. This suggests that vectors foraging on yeast are more likely to transmit yeast with a killer phenotype, allowing the viruses to colonize those uninfected yeast strains that engage in sexual reproduction with the killer yeast. Beyond insights into the basic ecology of the killer yeast system, our results suggest that viruses could increase transmission success by manipulating the insect vectors of their host.

A document by Shannon Gabbard. Click on the document to view its contents.

A 68-year-old woman who had been well for 2 years after ascending aortic graft replacement experienced sudden chest pain. Computed tomography showed a large false aortic aneurysm around the prosthesis. However, the patient was hemodynamically stable and did not have anemia. Emergency surgery under hypothermic circulatory arrest revealed tears at both the proximal and distal anastomotic sites and blood circulating from the proximal (exit) to the distal (entry) tears underneath the pericardium. To our knowledge, the present case represents a previously unreported pathology that will be of great interest to cardiologists and cardiac surgeons.

Study Objective: To review our experience with low-grade endometrial cancer managed with vaginal natural orifice transluminal endoscopic surgery (vNOTES) to determine the feasibility of this approach. Design: Retrospective review of the first fifty cases of endometrial cancer treated by vNOTES Setting: Academic University Population: Fifty consecutive cases of vNOTES management of women with low-grade endometrial cancer were reviewed to detail patient characteristics, operative procedures and outcomes, complications and follow-up. Methods: Patients underwent vNOTES hysterectomy and bilateral salpingo-oophorectomy. If Mayo criteria for lymphadenectomy were met, a laparoscopic lymph node removal was performed. Main Results: Mean age was 63 (33-90); mean BMI was 35.4 (22-58). In 44 women, both tubes and ovaries were removed via vNOTES. Three women had their ovaries retained due to early age, one woman had exploration for removal of an ovary with metastatic disease, and two women had neither tubes nor ovaries removed due to atresia and inability to identify these organs. Two patients underwent laparoscopic lymphadenectomy on the bases of frozen section evaluation. Mean operative time was 98 minutes (30-215). Fourteen patients were discharged the day of surgery; 34 discharged after overnight observation; hospitalization was prolonged in one patient due to ileus and one patient underwent laparotomy 30 hours after vNOTES for bleeding. Conclusion: VNOTES is a feasible management strategy for women with low-grade endometrial cancer. It permits laparoscopic inspection of the abdomen and direct visualization of vascular pedicles. It can provide a rapid recovery with minimal discomfort and no visible scar.

Sural nerve entrapment is an impor¬tant but infrequent cause of pain. The sural nerve provides sensation to the posterolateral aspect of the leg, lateral foot and fifth toe. We present a case of sural nerve entrapment that was effectively treated by percutaneous ultrasound guided hydrodissection.

Urinary tract is a site for common anomalies both in upper and lower tracts, but gathering all of the anomalies reported in our patient and also being unilaterally, may be a rare entity. Hereby we report a case with such a rare condition.

The management of an unusual nasal foreign body is illustrated. A 34-year-old male presented to our outpatient clinic after inhalation of liquid cast during preparation of a plaster mask. The foreign body had solidified within the nasal cavities, causing obstruction and headache. Ambulatory removal was incomplete, therefore ESS was indicated.

We define multiplicative derivative and its properties on time scales. Then, we restate many concepts for multiplicative analysis such as derivative, Rolle's theorem, mean value theorem and increasing decreasing property on time scales. We aim to create important fields of study by carrying this most important issue of multiplicative analysis, which has applications in economics, finance and many other fields, to time scale calculus