Several species of soil free-living saprotrophs can sometimes establish biotrophic symbiosis with plants, but the basic biology of this association remains largely unknown. Here, we investigate the symbiotic interaction between a common soil saprotroph, Clitopilus hobsonii (Agaricomycetes), and the American sweetgum (Liquidambar styraciflua). Notably, the colonized root cortical cells contain numerous microsclerotia-like structures. Fungal colonization led to increased plant growth and facilitated potassium uptake, particularly under potassium limitation (0.05 mM K+). The expression of plant genes related to potassium uptake is not altered during symbiosis, whereas the transcripts of three fungal genes encoding ACU, HAK, and SKC involved in K+ nutrition is found in colonized roots. We confirmed the K+ influx activities by expressing the ChACU and ChSKC genes into a yeast K+-uptake-defective mutant. Upregulation of the ChACU under 0.05 mM K+ and no K+ conditions was demonstrated in planta and in vitro compared to normal condition (5 mM K+). In addition, colonized plants displayed a larger accumulation of soluble sugars under 0.05 mM K+. The present study highlights that potassium limitation promotes this novel tree-fungus symbiosis mainly through a reciprocal transfer of additional carbon and potassium to both partners, and the role of dual soil saprotroph/symbiotroph in tree nutrition.

Patients with aortic dissection during pregnancy and postpartum period exhibit high mortality. At present, a complete overview of aortic dissection during pregnancy and postpartum period is lacking. This systematic review includes 80 reports published from 2000-2020, comprising a total study population of 103 patients with aortic dissection. It was suggested that Stanford Type A aortic dissection is more likely to occur in the third trimester, while Stanford Type B is more likely to occur within 12 weeks postpartum. The most common risk factor was connective tissue disease, with no other known risk factors. Mode of delivery has no significant effect on the type of postpartum aortic dissection. Reduced maternal and fetal mortality was observed when patients with Stanford Type A aortic dissection occurring after 28 gestational weeks underwent aortic replacement after cesarean section. Patients with Stanford Type B aortic dissection were treated mainly with medication and/or endovascular repair. Contemporary management of patients during pregnancy and within 12 weeks postpartum requires multidisciplinary cooperation and includes serial, non-invasive imaging, biomarker testing, and genetic risk profiling for aortopathy. Early diagnosis and accurate treatment are essential to reduce maternal and fetal mortality.

Objective: To assess the impact of surgeon experience on the outcomes of degenerative mitral valve disease. Methods: We reviewed all patients who had surgery for degenerative mitral valve disease between 2011-2016. Experienced surgeon was defined as performing  25 mitral valve operations/year. Patient characteristics and outcomes were compared. Multivariable analysis was performed to identify factors associated with MR recurrence. Survival analysis for mortality was done using Kaplan Meier curve and Cox proportional Hazard method. Results: There were 575 patients treated by 9 surgeons for severe mitral regurgitation caused by degenerative mitral valve disease between 2011-2016. Three experienced surgeons performed 77.2% of the operations. Patients treated by less experienced surgeons had worse comorbidity profile and were more likely to have an urgent or emergent operation (P=0.001). Experienced surgeons were more likely to attempt repair (P=0.024), to succeed in repair (94.7% vs 87%, P=0.001), had shorter cross-clamp times (P=0.001), and achieved higher repair rate (81.3% vs 69.7%, P=0.005). Experienced surgeons were more likely to use neochordae (P=0.001) and less likely to use chordae transfer (P=0.001). Surgeon experience was not associated with recurrence (moderate or higher MR) within the first two years after surgery but was an independent risk factor for mortality (HR= 2.64, P=0.002). Conclusions: Techniques of degenerative mitral valve surgery differ with surgeon experience, with higher rates of repair and better outcomes associated with more experienced surgeons.

Soil seed banks may offer great potential for restoring and maintaining desert ecosystems that have been degraded by climate change and anthropogenic disturbance. However, few studies have explored the annual dynamics in the composition and relative abundance of these soil seed banks. We conducted a long-term observational study to assess the effects of environmental factors (meteorology and microtopography) and aboveground vegetation on the soil seed bank of the Tengger Desert, China. The desert seed bank was dominated by annual herbs. We found that more rainfall in the growing season increased the number of seeds in the soil seed bank, and that quadrats at relatively higher elevations had fewer seeds. The species composition had more similarity in the seed bank than in the aboveground vegetation, though the seed bank and aboveground vegetation did change synchronously due to the rapid propagation of annuals. Together, our findings suggest that the combined effects of environmental factors and plant life forms determine the species composition and size of soil seed banks in deserts. Thus, if degraded desert ecosystems are left to regenerate naturally, the lack of shrub and perennial herb seeds could crucially limit their restoration. Human intervention and management may have to be applied to enhance the seed abundance of longer-lived lifeforms in degraded deserts.

Background: The purpose of this study was to investigate the incidence, predictors, and long-term impact of gastrointestinal (GI) complications following adult cardiac surgery. Methods: Index Society of Thoracic Surgeons (STS) adult cardiac operations performed between January 2010 and February 2018 at a single institution were included. Patients were stratified by the occurrence of postoperative GI complications. Outcomes included early and late survival as well as other associated major postoperative complications. A sub-analysis of propensity score matched patients was also performed. Results: 10,285 patients were included, and the overall rate of GI complications was 2.4% (n=246). Predictors of GI complications included dialysis dependency, intra-aortic balloon pump, congestive heart failure, chronic obstructive pulmonary disease, and longer aortic cross-clamp times. Thirty-day (2.6% vs 24.8%), one- (6.3% vs 41.9%), and three-year (11.1% vs 48.4%) mortality were substantially higher in patients who experienced GI complications (all P<0.001). GI complication was associated with a three-fold increased hazard for mortality (HR 3.1, 95% CI 2.6-3.7) after risk adjustment, and there was an association between the occurrence of GI complications and increased rates of renal failure (39.4% vs 2.5%), new dialysis dependency (31.3% vs 1.5%), multisystem organ failure (21.5% vs 1.0%), and deep sternal wound infections (2.6% vs 0.2%)(all P<0.001). These results persisted in propensity-matched analysis. Conclusions: GI complications are infrequent but have a profound impact on early and late survival, and often occur in association with other major complications. Risk factor modification, heightened awareness, and early detection and management of GI complications appears warranted.

Background The impact of lockdown measures can be widespread, affecting both clinical and psychosocial aspects of health. This study aims to assess changes in health services access, diabetes self-care, behavioral and psychological impact of COVID-19 and partial lockdown in Singapore. Methods We conducted a cross-sectional online survey amongst people with diabetes with the Diabetes Health Profile-18 (DHP-18). Hierarchical regression analyses were performed for each DHP-18 subscale (Psychological Distress, Disinhibited Eating and Barriers to Activity) as dependent variables in separate models. Results Among 301 respondents, 45.2% were women, majority were ethnic Chinese (67.1%), aged 40 to 49 years (24.2%), have Type 2 diabetes (68.4%) and on oral medications (42.2%). During the lockdown, nearly all respondents were able to obtain their medications, supplies (94%) and contact their doctors (97%) when needed. Respondents reported less physical activity (38%), checking of blood pressure (29%) and blood glucose (22%). Previous diagnosis of mental health conditions (β=11.44, p= 0.017), diabetes-related comorbidities (β= 3.98, p= 0.001) and Indian ethnicity (β= 7.73, p= 0.018) were significantly associated with higher psychological distress. Comorbidities were associated with higher disinhibited eating (β= 2.71, p= 0.007) while mental health condition was associated with greater barriers to activities (β= 9.63, p= 0.033). Conclusion Health services access were minimally affected but COVID-19 and lockdown had mixed impact on self-care and management behaviors. Greater clinical care and attention should be provided to people with diabetes with greater number of comorbidities and previous mental health disorders during the pandemic and lockdown.

Eltrombopag is a highly effective treatment for immune thrombocytopenia (ITP). Cases of durable remission after the discontinuation of eltrombopag in adult ITP have recently been reported; however, the frequency and mechanisms responsible for this phenomenon remain unknown. In the present study, we examined the phenotypes of lymphocytes in ITP to clarify whether they predict outcomes after the discontinuation of eltrombopag. We examined 56 adult newly diagnosed ITP patients treated with eltrombopag after a median time from diagnosis of 48 months. Among the 38 patients who achieved complete remission, eltrombopag was discontinued in 26. Among the 26 patients, 12 (46.2%) had an immediate relapse after discontinuing eltrombopag and 16 (53.8%) showed sustained response without additional ITP therapy, despite discontinuing eltrombopag, with a median follow-up of 52 months. No significant differences were observed in platelets, the median duration of eltrombopag, the absolute number of T, B, and NK cells at the initiation of eltrombopag between patients who sustained response and those who relapsed after discontinuing eltrombopag. However, the number of B and NK cells at the discontinuation of eltrombopag was higher in patients who sustained response than in those who relapsed (p=0.022 and p=0.012, respectively). The present results indicate that the absolute number of B (≥ 0.20 x 109/L) and NK (≥ 0.36 x 109/L) cells at the discontinuation of eltrombopag contributes to the prediction of outcomes.

Our findings illustrate the widespread collateral impact of implementing measures to mitigate the impact of COVID-19 in people with, or being investigated for diabetes mellitus (DM). Ironically, failure to focus of the wider implications for people with DM and other groups with long-term conditions, may place them at increased risk of poor outcomes from SARS-CoV-2 infection itself, irrespective of the implications for their longer-term health prospects.

Background Ventricular arrhythmias (VAs) originating from ventricular outflow tracts can possess a high similarity of QRS configuration resulting in an inaccurate localization, while the reminder of mapping or ablation in the lower right ventricular outflow tract (RVOT) commonly provide the preferred transformation strategy. Methods We retrospectively analyzed the total of 958 patients who were referred for radiofrequency (RF) ablation of VAs in our center. VAs with the sinus of valsalva (SoV) origins were enrolled. Results A total of 120 consecutive patients (mean age 45.0 ± 15.5 years) undergoing the ablation of VAs arising from the left-sided ventricular outflow tracts were included, with 55 (45.8%) female. All patients had a QRS morphology of the LBBB pattern and an inferior axis, with the mean earliest ventricular activation (EVA) of target site of 34.9 ± 8.8ms. 37 (30.8%), 60 (50.0%), and 23 (19.2%) patients obtained the successful RF ablation at the right sinus cusp (RCC), left sinus cusp (LCC), and the commissure of RCC and LCC (R-LCC), respectively. 62 (51.7%) target sites of SoV could record a high-frequency potential. Moreover, 25 (20.8%) patients were continuously recorded an early ventricular activation in the lower RVOT and achieved the elimination of VAs in SoV. Conclusions VAs originating from the SoV could show a low specificity of QRS morphology mimicking the RVOT-like ECG feature. An early ventricular activation mapped in the lower RVOT or RF ablation with poor response likely demonstrated the VAs originating from the SoV, especially the RCC.

Objective To compare the effectiveness, safety and acceptability of medical abortion before and after the introduction of no-test telemedicine Design Cohort study Setting The three main abortion providers in England Population All patients having an early medical abortion (comprising 85% of all medical abortions performed nationally) Methods Comparison of no-test telemedicine hybrid model vs. traditional model (blanket in-person provision including ultrasound), adjusted for baseline differences Main outcome measures Access: waiting time, gestation Effectiveness: successful medical abortion Safety: significant adverse events; ectopic pregnancy and late gestation Acceptability: Patient-reported outcomes Results 52,142 medical abortions were conducted, 29,984 in the telemedicine-hybrid cohort and 22,158 in the traditional cohort. Mean waiting times were 4.2 days shorter in the telemedicine-hybrid cohort and 40% were ≤6 weeks’ gestation vs. 25% in the traditional cohort (p<0.001). There was no difference in success rates (98.8% vs. 98.2%, p=1.0), nor in prevalence of serious adverse events (0.02% vs. 0.04%, p=0.557). Incidence of ectopic pregnancy was equivalent in both cohorts (0.2%, p=0.796); 0.04% of abortions appeared to have been provided after 10 weeks’ gestation with all completed safely at home. In the telemedicine-hybrid cohort, effectiveness was higher in the telemedicine group vs. the in-person group (99.2% vs. 98.1%, p<0.001). Acceptability was high (96% satisfied), 80% reported a future preference for telemedicine, and none reported that they were unable to consult in private using teleconsultation. Conclusions Medical abortion provided through a hybrid model that includes no-test telemedicine without ultrasound is effective, safe, acceptable, and improves access to care. Funding None

A document by Natalija Novak. Click on the document to view its contents.

Soil microbiota play an important and diverse roles in horticultural crop nutrition or productivity. However, the soil microbial community composition and the relationships within the taxa in the microbial community populations after cover grass treatments in apple orchards are not well understood. We analysed the microbial community diversity, composition and microbial network of an apple orchard after covering with native wild grasses at different intensities for 2 years in the Loess Plateau, China. The cover grass intensities were 0%, 20%, 40%, 60% and 80%. Soil microbial community diversity was not obviously change by cover grass in the apple orchard. Cover grass altered the microbial bacterial community compositions, their changes exhibited significant differences at the phylum level that were caused by the Proteobacteria, Bacteroidetes, Chloroflexi, Gemmatimonadetes, Nitrospirae. However, low-intensity (20%) and moderate-intensity (40%) treatments were the only cover grass intensities that altered the soil fungal community composition; but their changes did not exhibit significant differences at the phylum level. The positive links among the bacterial taxa decreased with the increasing cover intensity, primarily among Proteobacteria, Acidobacteria, Actinobacteria, Chloroflexi and Gemmatimonadetes. Although cover grass increased the positive links between fungal taxa, these taxa were reduced with the increasing cover intensity. Here we demonstrate that cover grass changed the soil microbial community, and the changes may be attributed to the given phyla in the bacterial community; furthermore, the antagonistic effect between the soil bacterial and fungal communities was significantly increased by higher coverage than by lower coverage.

Level and duration of protective immunity against SARS-CoV-2 after primary infection is of crucial importance for preventive approaches. In order to provide evidence for the longevity of specific antibodies, we investigated the generation and maintenance of neutralizing antibodies of convalescent SARS-CoV-2-afflicted patients over a five month period post primary infection using an immunofluorescence assay, a commercial chemiluminescent immunoassay and an in-house enzyme-linked plaque-reduction neutralization assay. We present the successful application of an improved version of the plaque-reduction neutralization assay, which can be analyzed optometrically, significantly simplifying the interpretation of the results. Based on the results of the plaque-reduction neutralization assay, neutralizing antibodies were maintained in 85.3% of convalescent individuals without significant decay over five months. Furthermore, a positive correlation between severity of infection and neutralizing titer was shown. In conclusion, SARS-CoV-2-afflicted individuals have been proven to be able to establish and maintain neutralizing antibodies over a five months’ period after primary infection which allows to hope for long-lasting presumably protective humoral immunity after wild-type infection or even after vaccination.

Kauri dieback, caused by Phytophthora agathidicida, is an ecosystem disturbance that poses a recent threat to the survival of kauri (Agathis australis) forests in New Zealand. Throughfall and stemflow play an important role in meeting the nutrient requirements of kauri forests. However, the effects of kauri dieback on canopy nutrient deposition remain unknown. Here we measured throughfall, stemflow and forest floor water yield and nutrient concentrations and fluxes (potassium, calcium, magnesium, manganese, silicon, sulphur, sodium, iron) of ten kauri trees differing in soil P. agathidicida DNA concentration and health status. We did not observe an effect of soil P. agathidicida DNA concentration on throughfall and stemflow water yield. Throughfall and forest floor nutrient concentrations and fluxes tended to decrease (up to 50%) with increasing soil P. agathidicida DNA concentration. Significant effects were found for potassium and manganese fluxes in throughfall, and calcium and silicon fluxes in forest floor leachate. The decline in nutrient input will have implications on plant nutrition, tree health and susceptibility to future pathogen infection in these ecologically unique kauri forests. Given our findings and the increasing spread of Phytophthora species worldwide, research on the underlying physiological mechanisms linking dieback and plant-soil nutrient fluxes is critical.

ABSTRACT Objective: We aimed to investigate the prognostic significance of intraductal carcinoma in radical prostatectomy (RP) specimens and predictive value of IDC-P for biochemical recurrence and adjuvant therapy decision. Method: Patients who underwent RP between 2000-2014 with final pathological stage pT3a and negative surgical margins (Group 1, n=35) and pT2 with positive surgical margins (Group 2, n=32) were included. RP specimens were re-evaluated for the presence of IDC-P component and other prognostic factors. In both groups, prognostic factors were compared according to the presence of IDC-P and biochemical recurrence status. Results: In group 1, IDC-P was detected in 5 cases and biochemical recurrence was detected in 3 cases. Patients with IDC-P showed significantly higher biochemical recurrence than those without IDC-P (p=0.002). In univariate analysis, IDC-P was found to be significantly associated with worse progression free survival (p<0.001). In group 2, IDC-P was detected in 4 cases and biochemical recurrence was detected in 10 cases. Also, tumor volume was significantly higher in patients with IDC-P than those without IDC-P (p=0.02). IDC-P was also significantly associated with worse progression free survival in group 2 (p=0.033). Conclusions: In both groups, IDC-P is a prognostic factor for progression free survival and / or biochemical recurrence. Especially in these patients, presence of IDC-P might be helpful for postoperative adjuvant therapy management decision. Keywords: radical prostatectomy, intraductal carcinoma of prostate (IDC-P), prostate cancer, biochemical recurrence, progression free survival.

PURPOSE: We aim to do an efficacy-safety analysis of Mirabegron-Tamsulosin combination therapy versus tamsulosin-placebo monotherapy in a select subset of medication virgin BPH patients with coexisting predominantly overactive bladder symptoms (OABS). METHODS: After prior written informed consent and institutional ethics clearance, 80 patients of uncomplicated BPH with coexisting OABS and IPSS of >7 were computer randomized and allocated to receive therapy with either [50mg Mirabegronplus Tamsulosin 0.4 mg (Intervention arm)]or [Tamsulosin 0.4 mg plus capsule lactobacillus (Comparator arm)] once daily for a period of 8 weeks. Efficacy was evaluated using the OABS Score (OABSS), mean change in the frequency of nocturnal voiding, post void residue (PVR) and international prostate symptom score (IPSS) while safety was assessed by recording treatment emergent adverse events (TEAE). The protocol was registered prospectively with the clinical trials registry of India (CTRI/2018/12/016541). RESULTS: Significant improvements were visualised in the primary endpoint total OABS subscore (OABSS-ss) at the end of 8 weeks in the combination group (mean difference -5.62 vs -2.22p< 0.001).Similar significant improvements were seen with most of the secondary parameters such as the mean change in voiding episode/night, IPSS, IPSS-ss,OABS-ss, voided volume/micturition, Qmax, and Quality of Life (QOL) indices (p<0.001). No significant increase in PVR was observed in the Mirabegron arm and no patient developed urinary retention. The TEAE were minor, self-limiting and were managed symptomatically without any treatment discontinuity. CONCLUSION: Mirabegron was significantly efficacious and safe in ameliorating OABS induced by BPH versus placebo. This efficacy can be safely enhanced by initiating Mirabegron-Tamsulosin combination therapy from the start in medication virgin patients as opposed to the usual add on therapy protocol. This combination appeared to be superior in terms of overall safety, minimal side effects, better compliance and tolerability versus Tamsulosin monotherapy particularly in the select subset of patients of with BPH coexisting/predominant OABS.

Objective: Our study aimed to the efficacy of silodosin in patients with LUTS associated with BPH who were not-responder to previous ARs blocker therapy. Methods: Patients who did not benefit from alpha blockers treatment, but did not want surgical treatment are included in this study. At enrollment, 75 patients and 75 patients were assigned to group 1 and group 2, respectively. Group 1 received silodosin 8 mg, group 2 received their previous α blocker. Results: Although, in group 1 mean IPSS score at baseline was 20,81±0,97, and it significantly decreased to 17,12±1,25 at third months, in group 2 no significant changes were observed. On the other hand in group 1 a decrease was also observed for both IPSS sub score was significantly reduced at third months, when it is compared with baseline. At the end of the third month, a significant improvement in this parameter was observed after switching to silodosin, as compared with first value (p< 0,05). As to the residual urine, significant improvement was observed in the silodosin group but no significant improvement was observed in group 2. Conclusion: This study was conducted to investigate the effectiveness and safety of silodosin in patients with BPH who had not achieved satisfactory symptom control with other α blockers in routine clinical practice before surgical treatment. Thus, at least patients who have different comorbidities will be protected from morbidities of surgery.

Aims:Erectile dysfunction (ED) is a common condition affected by many factors. We aimed to show the impact of the metabolic syndrome (MeTS) on male sexual function based on VAI and the impact of increased levels of the VAI was investigated in patients with ED among the patients with and without MeTS. Methods:Participants who met MeTS criteria (Group 1, n=96) and without MeTS (Group 2, n=189) were included in this cross-sectional study. The MeTS diagnosis was made in the presence of at least three of the following criteria: serum glucose level higher than 100 mg/dl, HDL cholesterol level below 40 mg/dl, triglyceride level greater than 150 mg/dl, waist circumference greater than 102 cm and blood pressure greater than 130/85 mmHg. Demographic data were recorded; biochemical and hormonal tests were measured. Erectile and other sexual function scores were recorded. The VAI was calculated using the [(WC/39.68)+(1.88xMI)]xTG/1.03x1.31/HDL formula. Results:Mean age, smoking volume, T and T/E2 ratios of the groups were similar (p>0.05). Mean VAI was two-fold higher in patients in Group 1 (p<0.001) and erectile function score was lower in Group 1 than Group 2 (p=0.001). Other sexual function scores were similar (p>0.05). The METS was associated with an increased risk of ED (p=0.001). Logistic regression analysis showed that each integer increase of the VAI was associated with a 1.4-fold increased risk of ED (p<0.001). Higher T values were associated with a better erectile function (p=0.03). For the VAI=4.33, receiver-operating characteristic analysis showed a sensitivity of 89.6 % and specificity of 57.7 %. Conclusion:Compared to non-MeTS, the presence of MeTS has emerged as a risk factor for patients with ED with high VAI levels while the other sexual functions are preserved. Management of ED patients with MeTS should cover a comprehensive metabolic and endocrinological evaluation in addition to andrological work up.

Purpose: We designed a multicenter, retrospective study to investigate the current trends in initial management of reflux with respect to EAU guidelines in Urology clinics of our country. Materials and Methods: The study group consisted of 1988 renal units (RU) of 1345 patients treated surgically due to VUR between years 2003-2017 in 9 different institutions. Patients were divided into 2 groups according to time of initial treatment and also grouped according to risk factors by “EAU guidelines on VUR”. Results: 1426 RUs were treated initially conservatively and 562 RUs were initially treated with surgery. In initially surgically treated group, success rates of surgery decreased significantly in low and moderate risk groups after 2013 (p=0.046, p=0.0001, respectively), while success rates were not significantly different in high risk group (p=0.46). While 26.6% of patients in low risk group were initially surgically treated before 2013, this rate has increased to 34.6% after 2013, but the difference was not statistically significant (p=0.096). However, performing surgery as the initial treatment approach increased significantly in both moderate and high risk groups (p=0.000 and p=0.0001, respectively) after 2013. Overall success rates of endoscopic and UNC operations were 65% and 92.9% before 2013, 60% and 78.5% after 2013, respectively. Thus the overall success rate for surgery was 72.6%. There was significant difference between success rates of UNC operations before and after 2013(p=0.000), while the difference was not significant in the STING group (p=0.076). Conclusion: Current trends in management of reflux in our country do not yet follow the EAU guidelines on VUR in low and moderate risk groups.

Na+,K+ATPase (NKA), a transmembrane protein essential for maintaining the electrochemical gradient across the plasma membrane, acts as a receptor for cardiotonic steroids (CTS) such as ouabain. CTS binding to NKA, triggers signalling pathways or inhibits NKA activity in a concentration-dependent manner, resulting in a modulation of Ca2+ levels, which are essential for homeostasis in neurons. However, most of the pharmacological strategies for avoiding neuronal death do not target NKA activity, due to its complexity and poor comprehension of the mechanisms involved in NKA modulation. The present review aims to discuss two points regarding the interplay between NKA and Ca2+ signalling in the brain: NKA impairment causing illness as well as neuronal death due to Ca2+ signalling and benefits to the brain by modulating NKA activity. These interactions play an essential role in neuronal cell fate determination and are relevant to finding new targets for the treatment of neurodegenerative diseases.

A document by Maria Montilla Velasquez. Click on the document to view its contents.

Latin America accounts for roughly one-quarter of global COVID-19 cases and one-third of deaths. Health inequalities in the region lead to barriers regarding the best use of diagnostic tests during the pandemic. There is a need for a simplified guideline in the region that takes into consideration the available health resources, international guidelines, medical literature, and local expertise.Nine experts from different Latin American countries developed a simplified algorithm for COVID-19 diagnosis in the region, using a modified Delphi method. Twenty-four questions related to diverse diagnostic settings were initially proposed, followed by an extensive discussion of the literature and experts' experience.According to time from close contact or symptom onset, the algorithm considers three different timeframes (≤7 days, 8–13 days, and ≥14 days) and discusses diagnostic options for each one. SARS-CoV-2 real-time reverse transcription polymerase chain reaction (rRT-PCR) continues to be the diagnostic test of choice from Day 1 to Day 14 after symptom onset or close contact, although antigen testing may be used in high-prevalence settings or in particular situations (such as from Day 0 to Days 5–7 of symptom onset). Antibody assays may be used for diagnostic confirmation, mainly after Day 14, if there is an epidemiological or individual need. If the clinical suspicion is very high, but other tests are negative, these assays may be used as an adjunct to decision-making from Days 8–13.The proposed algorithm is intended to be used as a support for COVID-19 diagnosis decision-making in Latin America.

Understanding what variables affect ungulate neonate survival is imperative to successful conservation and management of the species. Predation is commonly cited as a cause-specific source of mortality and ecological covariates often influence neonate survival. However, variation in survival estimates related to capture methodology has been documented with opportunistically captured neonates generally displaying greater survival than those captured via aid of vaginal implant transmitters (VITs), likely because of increased left truncation observed in the opportunistically captured datasets. Our goal was to assess if 3- and 6-month survival estimates varied by capture method while simultaneously assessing if capture method affected model selection and interpretation of ecological covariates for white-tailed deer neonates captured from three study sites in North Dakota and South Dakota, USA. We found survival varied by capture method for 3-month neonate survival with opportunistically captured neonates displaying up to 26% greater survival than their counterparts captured via VITs; however, this relationship was not present for 6-month survival. We also found model selection and subsequent interpretation of ecological covariates varied when analyzing datasets comprised of neonates captured via VITs, neonates captured opportunistically, and all neonates combined regardless of capture method. When interpreting results from our VIT only analysis for 3-month survival, we found survival varied by three time intervals and was lowest in the first two weeks of life. Capture method did not affect 6-month survival which was most influenced by total precipitation occurring during 3 – 8 weeks of a neonate’s life and percent canopy cover found at a neonate’s capture site. Our results support previous research that capture method must be accounted for when deriving survival estimates for ungulate neonates as it can impact derived estimates and subsequent interpretation of results.

Introduction: Advanced intraocular retinoblastoma can be cured by enucleation, but spread of retinoblastoma cells beyond natural limits of the eye may lead to metastatic disease which is related to a high mortality. Adjuvant therapy after enucleation has been shown to prevent metastasis in children with risk factors for extraocular retinoblastoma. However, histological criteria and adjuvant treatment regimens vary and there is no unifying consensus on the optimal choice of treatment. Method: Data on guidelines for adjuvant treatment in European retinoblastoma referral centres were collected in an online survey among all members of the European Retinoblastoma group (EURbG) network. Extended information were gathered via personal Email communication. Results: Data were collected from 26 centres in 17 countries. Guidelines for adjuvant treatment were in place at 92.3% of retinoblastoma centres. There was a consensus on indication for and intensity of adjuvant treatment among more than 80% of all centres. The majority of centres use no adjuvant treatment for isolated focal choroidal invasion or prelaminar optic nerve invasion. Patients with massive choroidal invasion or postlaminar optic nerve invasion receive adjuvant chemotherapy, while microscopic invasion of the resection margin of the optic nerve or extension through the sclera are treated with combined chemo- and radiotherapy. Conclusion: Indications and adjuvant treatment regimens in European retinoblastoma referral centres are similar but not uniform. Further biomarkers in addition to histopathological risk factors could improve treatment stratification. The high consensus in European centres is an excellent foundation for a common European study with prospective validation of new biomarkers.