The song from my radio filled the car, and floated out into the air and mingled with the cool breeze. Today the chirping of birds were clear and I could hear the rustling leaves. When I stopped at the traffic light, I realized that I never saw how green the trees were and how beautiful the sky with a few wispy clouds passing. Nature seemed to be at peace even when the world around me groaned due to this virus. By whatever name you call it, it is a symbol of tear and fear.Just as I step out of my car, I remember to don my mask and quickly walk along the walkway to the entrance. I look to the branches of a tree on the right of the walkway and noticed the little robin who sings daily without fail. I know the screening questions by heart now and the thermometer scans my forehead. The little sticker placed on my badge feels like a gold star that I received in kindergarten for good behavior. I start another day at the hospital.Everything has changed since this pandemic began. I miss seeing the smiles of people and hearing their voices now muffled through the masks. How this invisible thing has visibly altered the world, as we know it. How every touch and every breath became calculated. You really want to hug a patient as their silent tears soak their masks and you just have to hold back. Nevertheless, I remember that our presence and words can embrace people around us, to comfort and strengthen them.We zoom in for meetings and you may or may not see the face behind the voices or the silent listeners. Birthdays, graduations and send off parties are on hold. Patients lie alone on their beds as their families see and talk to them from a screen. A stranger holds their hand and watch their breathing as the machines chime. Many lives are lost and funerals held quietly and far from homes.I long for the days when we could meet friends in the park or stroll through the mall. Will the days come back when we ate in a restaurant or enjoyed a walk along the beach? I wish those moments could be frozen and kept in a glass jar that could never be shattered.As the orange glow of the sun drenches everything around me, I slowly walk back to my car. A silent prayer floats in the evening breeze; the drive is quite, the sky an impossible hue of gold and purple. The leaves gently rustle and believe it, the birds are still chirping!

Aims: We aim to find out the factors affecting the use of anticoagulants and the intensity of their choices, and to establish a basis for improving neurologists’ effective implementation of the guidelines. Methods: A cross-sectional study is conducted in Hubei province in central China. Each neurologist completes a standard-structured anonymous questionnaire through face-to-face interviews. The problems include the attitude and options about anticoagulant therapy. Results: A total of 611 neurologists from 38 hospitals respond to this survey. For the best treatment of atrial fibrillation, more than 80% of physicians choose anticoagulant therapy. For patients with atrial fibrillation and cerebral infarction, physicians think Warfarin is the preferred drug as high as 93.8%. Among the anticoagulant drugs ever used by clinicians, the use rate of Warfarin is 93.8%, but the use rate of direct oral anticoagulants is extremely low. The use of direct oral anticoagulants is related to the educational level and the geographical location of the hospital. Bleeding risk is the first reason influencing clinicians’ choice of Warfarin, accounts for 88.9%. 97.7% of the clinicians recommend patients with Warfarin regularly monitoring the INR, but the frequency of monitoring is inconsistent. Clinicians have a high willingness to learn about AF, but the proportion of hospitals carry out appropriate training is low. Conclusions: There are still some gaps with the guidelines on the choice of anticoagulant drugs. Neurologists have positive attitude towards anticoagulant therapy and a strong willingness to learn, but the corresponding training is lacking. Continuous professional training is necessary.

Objective: There are many clinical conditions that need to be followed and treated during pandemic like lung cancer. Carrying out health care for these patients who are immune-suppresive require extra care. Method: Among 108 lung cancer patients who has been hospitalized during pandemic, 18 of them with respiratory symptoms were evaluated. Results: Median age was 64±9.4 with male predominance (male n=16, female n=2). Thirteen of them was non-small cell lung cancer (NSCLC) and 5 of them was small cell lung cancer (SCLC). Nine (50%) patients were receiving chemotherapy. The most common symptom was shortness of breath (n=14, 77.8%), followed by fever (n=10, 55.6%). Findings confirmed on computed thorax tomography (CTT) were as follows: Consolidation (n=8, 44.4%), ground glass opacities (n=8, 44.4%) and thoracic tumour/mediastinal-hilar lymphadenopathy (n=3, 16.7%). Hypoxia was seen in 11 patients (61.1.%). Twelve patients had elevation of LDH (median=302±197) and lymphopenia (median=1055±648). There were 5 (27.7%) highly suspected cases for COVID-19. Any of their nasopharyngeal swap was positive. Two of these 5 patients received COVID-19 specific treatment even they have negative PCR results for 3 times. They responded well both clinical and radiological. For one case with SCLC receiving immunotherapy metil-prednisolone was initiated for radiation pneumonitis after excluding COVID-19. Conclusion: In line with the health policies of the countries and the adequacy of the health system, the necessity of a multidisciplinary approach in the management and treatment of complications in patients with lung cancer becomes even more important in this pandemic.

A document by josef finsterer. Click on the document to view its contents.

Osteoporotic fractures cause major morbidity and mortality in the aging population. Genome-wide association studies (GWAS) have identified USF3 as the novel susceptibility gene of osteoporosis. However, the functional role in bone metabolism and the target gene of the bHLH transcription factor USF3 are unclear. Here we show that USF3 enhances osteoblast differentiation and suppresses osteoclastogenesis in cultured human osteoblast-like U-2OS cells. Mechanistic studies revealed that transcription factor USF3 antagonistically interacts with anti-osteogenic TWIST1/TCF12 heterodimer in the WNT16 and RUNX2 promoter, and counteracts CREB1 and JUN/FOS in the RANKL promoter. Importantly, the osteoporosis GWAS lead SNP rs2908007 risk A allele abolishes USF3 binding in the WNT16 promoter, conferring allele-specific downregulation of the osteoclastogenesis suppressor WNT16. While the risk G allele of osteoporosis GWAS lead SNP rs4531631 facilitates binding of CREB1 and JUN/FOS in the RANKL promoter, resulting in enhanced transactivation of RANKL, the principal contributor to osteoclastogenesis. Our findings uncovered functional mechanisms of osteoporosis novel GWAS associated gene USF3 and lead SNPs rs2908007 and rs4531631 in the regulation of bone formation and resorption.

Many surgeons have modified the technique to reduce bleeding from anastomosis line since Bentall and De Bono introduced aortic root replacement using a composite graft. We present a new composite, butterfly wing shaped, valve graft fixated using hand-made double sewing cuff. The “Wings of a butterfly” technique is a method of reinforcement suturing between an added sewing cuff and residual aortic wall at the proximal stump, and helps to reduce bleeding after the modified Bentall’s procedure.

We present a case of Tetralogy of Fallot accompanied by a type II Aorto-Pulmonary Window with severe pulmonary arterial hypertension in a pediatric patient. A successful repair of TOF with trans-pulmonary patch closure of APW was done.

Since publication of our initial experience with non-sternotomy minimally invasive pulmonary embolectomy (MIPE) via a left mini thoracotomy, we have expanded our experience, refined the operation and streamlined the post-operative management of patients. Our initial publication described three patients who underwent MIPE.1 We described our technique which included peripheral cardiopulmonary bypass (CPB) via femoral arterial and venous cannulation, left sided 5cm anterior thoracotomy in the 3rd intercostal space, identification and incision of the main pulmonary artery distal to the pulmonic valve, extraction of clot with subsequent primary closure of the pulmonary artery, and use of a 5mm, 30 degree laparoscope as an adjunct to assess clearance of the pulmonary artery.2 The patients included in this series had no post-operative complications, had a mean hospital length of stay of three days with mid-term follow-up up to 8-months revealing no untoward complications of the procedure. With early success of the MIPE at our institution, we began employing it preferentially over sternotomy with central CPB and pulmonary embolectomy. Since initial publication of our results, we have performed the MIPE in two additional patients with excellent outcomes. We herein present augmentations we’ve made to the procedure with a case-presentation which highlights these adaptations.

IntroductionOne of the most common terrestrial carnivores in the world, the domestic dog (Canis familiaris ) is found on every continent that humans have settled (Gompper 2014). More than 70% of the global dog population (estimated at > 700 million to ~1 billion) comprises of free-ranging dogs (FRD) (Hughes and Macdonald 2013; Gompper 2014). In many developing countries, FRD are associated with the transmission of zoonotic diseases such as rabies, zoonotic visceral leishmaniasis, canine echinococcosis, and soil-borne helminths (Jaleta et al. 2017; Deplazes et al. 2011; Ashford et al. 1998; Quinnell and Courtenay 2009; Carmena and Guillermo 2013). Rabies alone is responsible for an estimated 60,000 human deaths per year worldwide, with a majority of these deaths occurring in Asia and Africa (Hampson et al. 2015). India alone accounts for an estimated 20,000 human rabies deaths per annum (Sudarshan et al. 2007; Hampson et al. 2015).Apart from dog-mediated rabies deaths, dog attacks also result in direct human fatalities in India (e.g. https://www.nationalheraldindia.com/india/stray-dogs-terror-in-sitapur-six-children-killed-in-one-week accessed on 19/Jun/2020). An estimated 20 million people are bitten by dogs every year in India (Gongal and Wright 2011). In addition, dogs are an important and emerging threat for livestock (Home et al. 2017) as well as biodiversity (Vanak and Gompper 2009; Doherty et al. 2017; Belsare, Vanak, and Gompper 2014; Hughes and Macdonald 2013; Gompper 2014). Furthermore, FRD also suffer from poor health, high mortality, and abuse (Jackman and Rowan 2007). There is thus a strong and urgent need to control free-roaming dog populations in India.Efforts to control dog populations in India using a variety of lethal and non-lethal methods have been unsuccessful so far. Lethal methods were implemented haphazardly for many years, but without ancillary measures to restrict access to resources and restricting roaming behaviour, the dog populations rebounded. These methods were also criticized for being unnecessarily cruel and were subsequently outlawed in India. Since 2001, the only legal method of population control, involving capture-neuter-vaccinate-release (Animal Birth Control – ABC) was promulgated. As per the World Organisation for Animal Health (OIE), one of the main objectives of dog population control programmes like ABC is to reduce the abundance of FRD (OIE 2015). However, as several reports have shown, these measures were neither fully implemented nor evaluated (e.g. Totton et al., 2010; Uniyal & Vanak, 2016). Indeed, almost all ABC programs have only targeted urban centres. Even here, model simulations suggest that a sustained and well implemented ABC only program may result in a population reduction of ~70% over a 13-18 year period in the best case scenario of ~85% population coverage (Totton et al. 2010).Dog population management approaches such as the ABC program which mandates surgical sterilisation, requires considerable financial, infrastructural and personnel support. Operationalising any such program therefore requires careful thought and planning for successful implementation. Often however, there is a lack of understanding of the effort required to significantly and sustainably reduce dog populations. Indeed, the general perception is that a one-time or short burst of surgical interventions will result in permanent eradication or “stray dog free” cities (https://www.royalpatiala.in/mission-patiala-to-be-first-stray-dog-free-city-bhullar/ accessed on 22/Jun/2020). Government authorities and non-government organizations (NGOs) routinely report the number of surgeries performed as a measure of success, without any mention of the baseline population size. There is thus a strong need for setting the context and realistic targets, so that the success of the ABC program can be monitored.Population models that allow for simulation of various scenarios are often an effective planning and monitoring tool. If properly parameterised, these can be used to understand the scale of effort needed to achieve a set target reduction in population or to understand that challenges that emerge from improperly planned interventions. However, in India, such models are rarely, if ever, used by government agencies for scenario building and planning. There are several reasons behind this, including a lack of technical expertise, and the perception that such models are the domain of mathematical experts.We have developed an agent-based model that generates a realistic in silico dog population, and projects it over a desired number of years. Model-generated dog populations incorporate individual attributes and characteristics (like age, sex, reproductive status, accessibility, catchability, age-specific mortality) that underpin heterogeneity observed in the real-world free-ranging dog populations. Here we apply the model to evaluate the success as well as cost-effectiveness of dog population management interventions like ABC and also if it achieves the targets necessary for rabies control. Specifically, we examine the effect of ABC interventions on dog abundance, dog recruitment in the population and population-level anti-rabies coverage.

Results of the preparation of biodegradable porous scaffolds using an original modification of a wet phase inversion method were presented. Influence of gelatin nano-non-woven as a non-classic pore precursor and polyvinylpyrrolidone, Pluronic® as classic pore precursors on the structure of obtained scaffolds was analyzed. It was shown that the addition of gelatin nano-non-wovens enables the preparation of scaffolds, which allow for the growth of cells (size, distribution, and shape of pores). Mechanical properties of the obtained cell scaffolds were determined. The influence of pore precursors on mass absorption of scaffolds against isopropanol and plasma was investigated. Interaction of scaffolds with a T-lymphocyte line (Jurkat) and with fibroblasts (L929) was investigated. Obtained scaffolds are not cytotoxic and can be used as implants, e.g. the regeneration of cartilage tissue.

The rapid shift to online teaching in spring 2020 meant most of us were teaching in panic mode. As we move forward with course planning for fall and beyond, we can invest more time and energy into improving the online experience for our students. We advocate that instructors use inclusive teaching practices, specifically through active learning, in their online classes. Incorporating pedagogical practices that work to maximize active and inclusive teaching concepts will be beneficial for all students, and especially those from minoritized or underserved groups. Like many STEM fields, Ecology and Evolution shows achievement gaps and faces a leaky pipeline issue for students from groups traditionally underrepresented in science. Making online classes both active and inclusive will aid student learning and will also help students feel more connected to their learning, their peers, and their campus. This approach will likely help with performance, retention, and persistence of students. In this paper we offer strategies and techniques that weave together active and inclusive teaching practices and challenge faculty to commit to making small changes in the fall as a first step to more inclusive teaching in ecology and evolutionary biology courses.

Body mass is often viewed as a proxy of past access to resources and of future survival and reproductive success. Links between body mass and survival or reproduction are, however, likely to differ between age classes and sexes. Remarkably, this is rarely taken into account in selection analyses. Selection on body mass is likely to be the primary target accounting for juvenile survival until reproduction but may weaken after recruitment. Males and females also often differ in how they use resources for reproduction and survival. Using a long-term study on yellow-bellied marmots (Marmota flaviventer), we show that body mass was under stabilizing selection in the first years of life, before recruitment, which changed to positive directional selection as age increased and animals matured. We found no evidence that selection across age-classes on body mass differed between sexes. By investigating the link between running speed and body mass, we show that the capacity to escape predators was not consistent across age classes and followed a quadratic relationship at young ages only. Overall, our results indicate that mature age classes exhibit traditional patterns of positive selection on body mass, as expected in a hibernating mammal, but that mass in the first years of life is subject to stabilizing selection which may come from additional predation pressures that negate the benefits of the largest body masses. Our study highlights the importance to disentangle selection pressures on traits across critical age (or life) classes.

1. Ongoing intensification and fragmentation of European agricultural landscapes dramatically reduce biodiversity and associated functions. To sustain ecosystem services such as ant mediated pest control, the enhancement of perennial non-crop areas holds great potential. 2. To study the potential of newly established grasslands to enhance ant diversity and associated functions, we used hand collection data to investigate differences in ant community composition (a) between cereal crops, old grasslands, and new grassland transects of three years age; (b) depending on ant functional traits; and linked to (c) natural pest control services quantified through predation experiments. 3. Ant species richness did not significantly differ between new and old grasslands, but was significantly higher in grasslands compared to cereal crops. Contrary, ant community composition of new grasslands was more similar to cereal crops and distinct from the species-pool of old grasslands. The functional trait space covered by the ant communities overlapped between old and new grasslands but was extended in the old grasslands. Pest control did not differ significantly between habitat types, and therefore could not be linked to the prevalence of functional traits related to biocontrol services in new grasslands. 4. Our findings show trends of convergence between old and new grasslands, but also indicate that enhancing ant diversity through newly established grasslands takes longer than three years to provide comparable biodiversity and functions. 5. Synthesis and applications Newly established grasslands can increase ant species richness, abundance, and pest control in agroecosystems. However, three years after establishment, new grasslands were still dominated by common agrobiont ant species and lacked habitat specialists present in old grasslands, who require a constant supply of food resources and long colonization times. New grasslands represent a promising measure for enhancing agricultural landscapes but must be preserved in the longer term to sustain biodiversity and associated ecosystem services.

Accessory mitral valve tissue (AMVT) is a rare congenital cardiac anomaly, which is associated with other congenital heart diseases. It is diagnosed in neonates or childhood and rarely in adulthood. Nevertheless, AMVT is an incidental finding or described as isolated. Echocardiography, especially three-dimensional(3D) echocardiography is considered as an optimal imaging technique for AMVT diagnosis. We herein presented the two asymptomatic adult cases with AMVT, who presented with varying degrees of symptomatic left ventricular outflow tract (LVOT) obstruction. One presented with mild LVOT obstruction and no surgery was required, and another one with significant LVOT obstruction was recommended for surgical excision.

A previously healthy 68-year-old woman with abrupt weakness in her left limbs underwent transthoracic echocardiography for paroxysmal atrial fibrillation, which showed normal left ventricular function and no abnormalities except for left atrial dilation. However, transesophageal echocardiogram showed two leaflet-shaped loose left atrial masses were attached to the atrial septum near the oval fossa. Further CDFI found a few small vessels at the base, confirming the atrial myxoma. Surgery was performed to resect the intracardiac mass, and the histologic examination showed cardiac myxoma with glandular structure.

Introduction In the current literature, several studies show that pulmonary artery stiffness (PAS) is associated with right ventricular (RV) dysfunction, pulmonary arterial hypertension (PAH), and disease severity in patients with structural heart disease, human immunodeficiency virus (HIV), and chronic lung disease. Hence, in this study, we aimed to use PAS to show the early changes in the pulmonary vascular bed in patients with cirrhosis. Material and Methods In this prospective, cross-sectional study, 39 subjects who were being followed up with cirrhosis and 41 age- and sex-matched healthy participants were enrolled. For each case, the PAS value was calculated by dividing mean peak velocity of the pulmonary flow by the pulmonary flow acceleration time (PfAT). Results The measured PAS was 23.62 ± 5.87 (Hz/msn) in cirrhotic patients and 19.09 ± 4.16 (Hz/msn) in healthy subjects (p < 0.001). We found a positive statistical significance between PAS and systolic pulmonary arterial pressure (sPAP) (r = 0.378; p = 0.001). PAS was an independent predictor that was associated with cirrhosis disease according to multivariate logistic regression analysis (OR: 1.209; 95% CI: 1.059–1.381; p = 0.005). Conclusion Based on the study results, we consider that PAS may help in the early detection of changes in the pulmonary vascular bed, even if the RV function parameters or sPAP are within the normal range.

Understanding hobby beekeepers’ perception of risks affecting bee health and mortality is essential to analyse the reasons for adopting or rejecting good management practices. A perception survey on how beekeepers perceive and manage risks related to climate change, Varroa infestation, management practices, and pesticide exposure was designed and launched online. This unpreceded sociological survey involved 355 beekeepers spread all over Belgium. A two-sample t-test with unequal variances comparing beekeepers with colony mortality rates below or exceeding the acceptable level, i.e. <10% and ≥10%, indicates that beekeepers (N=213), with colony mortality rates <10% generally have greater levels of perceived risk and the benefits of action that lead to increased motivation to act in better ways. The results of this survey highlight the importance of taking socio-economic determinants into account in any risk mitigation strategy associated with bee mortality when dealing with hobby beekeepers.

Foot-and-Mouth Disease Virus (FMDV) causes an acute disease with important economy losses worldwide. Currently available vaccines are based on inactivated FMDV and oil-adjuvants. The use of Virus-Like Particles (VLPs) for subunit vaccines has been reported to be promising since it avoids the biological hazard of using virus in vaccine production while conserving conformational viral epitopes. However, a more efficient and cost-effective adjuvant than those currently used is needed. Immunostimulant-Particle Adjuvant (ISPA) is an Immune Stimulating Complex (ISCOM) - type adjuvant formulated with dipalmitoyl-phosphatidylcholine, cholesterol, stearylamine, alpha tocopherol and QuilA. In the present work, we have evaluated the immune response against FMDV using VLPs and ISPA as adjuvant. VLPs (serotype A/Arg/01) were obtained by transient gene expression in mammalian cell cultures, and a previously developed murine model, able to predict the ability of a vaccine to induce protection in cattle, was used for vaccination experiments in a first approach. The VLPs-ISPA vaccine induced protection in mice against challenge and elicited a specific antibody response in sera. In a second approach, the VLPs-ISPA vaccine was tested in calves. Interestingly one vaccine dose was enough to induce total α-FMDV antibodies , as measured by ELISA, as well as neutralizing Abs. Antibody titers reached an Expected Percentage of Protection higher than 90%. The EPP index calculates the probability that livestock will be protected against a challenge of 10.000 bovine infectious doses after vaccination. Moreover, IFN-γ levels secreted in vitro by mononuclear cells of VLP-ISPA vaccinated animals were significantly higher (p <0.05) than in the non-adjuvanted VLPs group. Overall, the results demonstrate that VLPs and ISPA are a promising combination for the development of a novel FMD vaccine, since no infectious FMDV is used and a protective immune response can be induced in calves, comparable to that achieved with the commercial FMDV vaccine.

Food handlers regardless whether preparing or serving food, key roles in transmission of food-borne infections. This study aimed to evaluate the prevalence of intestinal parasitic infections in food handlers. In present study, a comprehensive literature search was carried out in electronic databases including: PubMed, Scopus, Google Scholar, Science Direct, Magiran, Scientific Information Database (SID), Iran Medex and Iran Doc to identify all the published studies from 2000 to 31st April, 2019. A total of 25 articles from different regions of Iran identified and fulfilled our eligibility criteria. Totally 140447 cases were examined and 1163 cases were infected with intestinal parasites. Of all cases, 19516 were male and 5901 were female with 1163 and 652 infected case respectively. The overall prevalence of intestinal parasitic infections was evaluated 14% [95%CI: 11-17%]. Results indicated that protozoan such as Giardia lamblia, with prevalence of 41.0% [95%CI: 25.0%-59.0%], Blastosystice hominis with 28% [95%CI: 15.0%-44.0%] and Entamoaba coli with 22.0% [95%CI: 16.0%-29.0%] had the highest prevalence while, Dientamoeba fragilis 5.0% [95%CI: 4.0%-7.0%], Iodamoeba. bütschlii 5.0% [95%CI: 2.0%-8.0%], Chilomastix mesnili 5.0% [95%CI: 2.0%-9.0%] and Endolimax. nana with 3.0% [95%CI: 1.0%-7.0%], were less prevalent. Infection with Ascaris lumbricoides 7.0% [95%CI: 0.0%-29.0%] was more prevalent helminthes followed with Enterobius vermicularis 3.0% [95%CI: 1.0%-5.0%], Hymenolepis nana 2.0% [95%CI: 1.0%-3.0%], Taenia spp 2.0% [95%CI: 0.0%-7.0%] and Trichuris. trichiura 1.0% [95%CI: 0.0%-1.0%]. Our results revealed the high prevalence of intestinal parasitic infection in food handlers in Iran. Monitoring programs to prevent and controlling of transmission to individuals are needed

Vasomotor symptoms (VMS), namely hot flashes and night sweats, are the key symptoms of menopause. Women frequently seek healthcare interventions for these bothersome symptoms. Early menarche ≤11 years has been associated with an earlier onset of menopause (Mishra et al.Hum Reprod 2017;32:679-86), that may subsequently exert a negative impact on fat distribution and glucose homeostasis (Mauvais-Jarvis et al. Endocr Rev 2017;38:173-88). To date, the relationship between early menarche and the frequency/severity of VMS, and if it is modified by obesity, is unclear.In this issue of BJOG , Chung et al. put into context the complex interplay of several factors that contributed to a higher frequency or severity of VMS by harmonising individual-level data of six cohort studies involving 18,555 women (median age 48 years; 91.2% White, 4.6% African Americans and 4.2% Asians) (Chung et al. BJOG 2020). Compared with women with age at menarche ≥14 years, women with early menarche ≤11 years were at increased risk for frequent hot flashes and night sweats, showing a relative risk (RR) of 1.48 (95% confidence interval [CI] 1.24-1.76) and 1.59 (95% CI 1.49-1.70), respectively. The corresponding RRs for severe hot flashes and night sweats were 1.16 (95% CI 0.94-1.42) and 1.27 (95% CI 1.01-1.58). When adjusting for body mass index (BMI) in midlife, the associations were attenuated but remained significant (except for severe hot flashes). Compared with women with age at menarche ≥14 years and midlife BMI<25 kg/m2, women with early menarche ≤11 years had an RR of 2.36 (95% CI 2.17-2.57) when BMI was 25-29.9 kg/m2, and 2.87 (95% CI 2.79-2.95) when BMI ≥30 kg/m2 for frequent hot flashes, suggestive of a dose-response relationship. Despite these encouraging results, the majority of studies involved the White populations, which might limit the generalisability of the results to other populations.Given the increasing burden of obesity in childhood/adolescence and women (Afshin et al. N Engl J Med 2017;377:13-27), the results have important clinical implications. We now have stronger evidence to not only suggest that early menarche contributes to increased risk of frequent and/or severe VMS, but also having a higher midlife BMI can potentially exacerbate the condition. For example, a woman who attained menarche at an age younger than 11, irrespective of prior genetic and/or environmental influences, is more likely to experience frequent and/or severe VMS. The good news is that she may at least halve the risk by striving to maintain a normal BMI in midlife.These results will add strength to the recommendation of weight reduction as one of the effective non-pharmacological approaches to relieve VMS (Menopause 2015;22:1155-74). The impact of weight reduction will likely extend beyond management of VMS, to also reduce the incidence of non-communicable diseases in perimenopausal women. While questions regarding the risks and benefits of menopausal hormonal therapy on cardiovascular and cancer outcomes remain (The NAMS 2017 Hormone Therapy Position Statement Advisory Panel. Menopause2017;24:728-53), an emphasis for the role of non-pharmacological management of VMS may be pertinent now more than ever.Disclosure of Interests: LLL has received research grants and/or speaker honoraria from AstraZeneca, Boehringer Ingelheim, Merck Serono, Merck Sharp & Dohme, Novartis, Novo Nordisk, Pfizer, Procter & Gamble Health, Sanofi and Servier outside of this work. QHL declared no potential conflict of interest.

Leiomyomata are common benign pelvic masses that occur in up to 77% of reproductive aged women (Flyckt et al Clin Obstet Gynecol 2017;60(2):252-272). Myomectomies are frequently performed for symptomatic leiomyoma unresponsive to non-surgical treatments and can be performed via laparotomy (open) or minimally invasive approaches. Open myomectomies are often performed because of lack of access to or training with minimally invasive approaches, or secondary to concerns surrounding morcellation.Misoprostol is a relatively inexpensive readily accessible uterotonic and vasoconstrictive medication. Based on mechanism of action, misoprostol is often used at the time of myomectomy to decrease blood loss. This led Wali et al. (Wali et al BJOG 2020 xxxx) to perform a systematic review on the effectiveness of preoperative misoprostol specifically at the time of open myomectomy. Eight randomized-controlled trials met inclusion criteria and were included in this systematic review with a total of 385 participants, 192 in the misoprostol group 193 in the control group.These studies provide moderate to high quality evidence on the following six outcomes: 1) estimated blood loss, 2) drop in haemoglobin, 3) need for blood transfusion, 4) operative time, 5) post-operative fever, and 6) length of hospital stay. The specific findings for those six outcomes are as follows. Compared to placebo, misoprostol significantly reduced estimated blood loss by a mean of 170cc with an associated haemoglobin decrease of 0.48 g/dL. Perhaps the most clinically significant finding was that preoperative misoprostol led to a three-fold lower risk of blood transfusion with an odds-ratio of 0.31. The use of preoperative misoprostol also led to a decreased operative time of 11 minutes, which is probably clinically significant based on the relative low expense of misoprostol and relative high cost of time in the operating theater. There was no statistically significant difference in the rates of postoperative fever or length of hospital stay. Patients in the misoprostol group were discharged an average of 3.5 hours earlier than the placebo group which is probably not clinically significant.Based on the overall risk-benefit profile identified in this study, it would seem that preoperative misoprostol should be recommended for most patients prior to open myomectomy. The findings from this systematic review are particularly important for low-resource settings where access to minimally invasive approaches and the availability of blood for possible transfusion are limited. Although there was variability in the timing and the dose of preoperative misoprostol, Wali et al (Wali et al BJOG 2020 xxxx) suggest the evidence supports a single dose of 400μg of misoprostol 30 to 60 minutes prior to surgery, or two doses 3 hours apart. A protocol of one dose of misoprostol 30 minutes prior to taking a patient to the operating theater could be implemented as part of a standard preoperative order set and administered in the pre-anesthesia care unit. This study highlights a simple, low-cost intervention that can significantly improve patient outcomes.Disclosure of interest: None to declare. A completed disclosure of interest form is available to view online as supporting information.

Diarrhea, vomiting and fever are common symptoms in pediatrics; on the other hand, recent studies have shown that, gastrointestinal symptoms are increasing in patients with COVID-19. This fact indicates the need to develop a screening and diagnostic algorithm in dealing with a patient with gastroenteritis in the epidemic SARS-CoV-2.

Karyotypic changes in chromosome number and structure are drivers in the divergent evolution of diverse plant species and lineages. This study aimed to reveal the origins of the unique karyotype (2n = 12) and phylogenetic relationships of the genus Megadenia (Brassicaceae). A high-quality chromosome-scale genome was assembled for Megadenia pygmaea using Nanopore long reads and high-throughput chromosome conformation capture (Hi-C). The assembled genome is 215.2-Mb and is anchored on six pseudo-chromosomes. We annotated a total of 25,607 high-confidence protein-coding genes and corroborated the phylogenetic affinity of Megadenia with the expanded Lineage II, which contains numerous agricultural crops. We dated the divergence of Megadenia from its closest relatives to 27.04 (19.11-36.60) million years ago. A reconstruction of the chromosomal composition of the species was performed based on the de novo assembled genome and comparative chromosome painting analysis. The karyotype structure of M. pygmaea is very similar to the previously inferred Proto-Calepineae Karyotype (PCK; n = 7) of the Brassicaceae Lineage II. However, an end-to-end translocation between two ancestral chromosomes reduced the chromosome number from n = 7 to n = 6, comparable to Megadenia. Our reference genome provides fundamental information for use in horticulture, plant breeding and evolutionary study of this genus.

Background: The health care delivery model in the United States does not work; it perpetuates unequal access to care, favors treatment over prevention, and contributes to persistent health disparities and lack of insurance. The historical lack of support in the United States for primary health care, universal health coverage, population health, addressing the social determinants of health, and community empowerment, creates opportunities for community health scientists to develop innovative solutions for addressing community health needs. Methods: We developed a model community health science approach combining community-oriented primary care (COPC), community-based participatory research (CBPR), asset-based community development, and service learning principles. The approach defines health as a social outcome, resulting from a combination of clinical science, collective responsibility, and informed social action. Results: From 2000-2020, we established partnerships with community organizations to reduce the risk of chronic disease in vulnerable minority communities. Our programs have provided structured community health science training for hundreds of physicians and other health care workers in training. Conclusion: As the U.S. begins to seek solutions to chronic health disparities and health inequities, community health science provides useful lessons in how to engage communities to address the deficits of the current system. Perhaps the greatest error that U.S. health care systems could make in trying to better address population health and the social determinants of health, would be ignoring the important community initiatives already underway in most local communities. Building partnerships based on local resources and ongoing social determinants of health initiatives is the key for medicine to meaningfully engage communities for reducing health disparities. This has been the greatest lesson we have learned during the past two decades, has provided the foundation for our community health science approach, and accounts for whatever success we have achieved.