In the survivorship setting, adolescent and young adult (AYA) cancer survivors frequently demonstrate little knowledge of infertility risk, are unclear regarding their fertility status and may under- or over-estimate their treatment-related risk for infertility. In female AYA survivors, ovarian function usually parallels fertility, and can be assessed with serum hormone levels and ultrasonography. Post-treatment fertility preservation may be appropriate for survivors at risk for primary ovarian insufficiency. In male AYA survivors, fertility and gonadal function are not always equally affected, and can be assessed with a semen analysis and serum hormones, respectively. As reproductive health issues are commonly cited as an important concern by survivors of AYA cancer, multidisciplinary care teams including oncology, endocrinology, psychology, and reproductive medicine are advocated, with the aim of optimal provision of fertility advice and care for AYA cancer survivors.

Rhombencephalitis refers to inflammatory diseases of the rhombencephalon. The encephalitic processes located to the rhombencephalon are frequently associated with Listeria monocytogenes and enterovirus infections. We report a case of community-acquired Klebsiella Pneumoniae systemic infection with CNS involvement in an adult patient without significant comorbidities.

Severe acute respiratory syndrome corona virus 2 (SARS-CoV-2), a new virus from Corona viruses family, was detected in China in December 2019. The virus was suddenly and vigorously disseminated among individuals allover the world hence the control on the virus was lost and COVID-19 pandemic was announced. Scientists start to screen all the available options to treat this newly evolved virus. Till now there is no validated treatment for SARS-CoV-2 patients and all drugs are under clinical investigation. This mini-review represents a summarized insight for the pathophysiology and the available SARS-CoV-2 therapy with the clinical trials associated with each drug category including antivirals, monoclonal antibodies, anticoagulants, convalescent plasma therapy, miscellaneous and adjuvant therapies.

A patient with Birt-Hogg-Dubé Syndrome (BHDS) developed metastatic follicular thyroid cancer, which until now has never been described in someone with BHDS. Thyroid cancer is not currently recommended for screening with BHDS. This case presents implications for future guidelines and planning for renal transplant in patients with this condition.

The investigation of ecological processes that maintain species coexistence is important in harsh environments, as they act as strong drivers of species selection. Congeneric species are a good model to investigate the relative importance of such processes, as closely related species tend to have similar niches. We aim to find evidence for the action and relative importance of different ecological processes hypothesized to maintain species coexistence in a tropical forest subject to seasonal flooding, using the spatial structure of populations of three congeneric species. We collected data on a 1-ha plot of a Brazilian white-sand flooded tropical forest, where individuals of three Myrcia species were tagged, mapped, and measured for diameter at soil height. We also sampled seven environmental variables in the plot. We employed several spatial point pattern models to simultaneously investigate habitat filtering, interspecific competition, stochasticity, and dispersal limitation. Habitat filtering was the most important process driving the local distribution of the species, as they showed associations, albeit of different strength, to environmental variables related to flooding. We did not detect spatial patterns consistent with interspecific competition, i.e. spatial segregation and smaller size of nearby congeners. The three species do not seem to show evidence of stochasticity even though congeners were spatially independent, since they responded to differences in the environment. Last, dispersal limitation only led to spatial associations of different size classes for one of the species. Using data from congeneric species in a harsh environment as a model, we demonstrated that habitat filtering to areas subject to flooding is the most important ecological process driving the local distribution of the species studied in a white-sand forest. Even though many studies on topo-edaphic variation in tropical forests have shown that habitat filtering is an important ecological process, other processes that drive community structuring may have gone undetected.

BACKGROUND AND PURPOSE Diosmetin exhibits a series of therapeutic efficacy but little is known of its effects on colitis. EXPERIMENTAL APPROACH In this study, two mouse models of DSS (the concentration of 3% and 5%)-induced colitis and Caco2 and IEC-6 cells were employed. The 16S amplicon sequencing was used to assess Gut microbiota changes by diosmetin. Various physical signs of mice (body weight, colon length and DAI score), proinflammatory cytokines and antioxidant enzymes were tested. KEY RESULTS The results showed that diosmetin can markedly decrease the disease activity index and microscopic colon tissue damage, increase the expression of tight junction protein (Occludin, Claudin-1 and Zo-1) and reduce the secretion of proinflammatory cytokines. And diosmetin also significantly inhibited colon oxidative damage through adjusting the levels of intracellular ROS, mitochondrial ROS, GSH-Px, SOD, MDA and GSH in vitro and in vivo. Furthermore, it was found that diosmetin can modulate the abundance of Bacteroidetes, Actinobacteria, Cyanobacteria and Firmicutes, which were reported to be the crucial bacteria related to inflammatory bowel disease (IBD). CONCLUSIONS AND IMPLICATIONS Our data suggested that diosmetin ameliorated the colitis in mice induced by DSS in the potential mechanism that it alleviates intestinal epithelial barrier damage, inhibits the secretion of proinflammatory cytokines, decreases oxidative stress and modulates gut microbiota. It implies that diosmetin may be a novel candidate to alleviate DSS-induced colitis or a lead compound for future optimization and modification.

Through this case, we present the thought process, team-based strategy and sequel of managing a complex, critically ill pregnant with ARDS and COVID-19 pneumonia. This case also confirms the feasibility of using convalescent plasma and ECMO during early postnatal period in acutely ill parturient with respiratory failure.

Here, we describe a successful catheter-based closure of a recurrent post-infarction VSR using a new custom-made device in a 50-year-old man who had previously undergone emergency surgical repair for acute PIVSR with bovine pericardial patch, coronary artery bypass grafting and mitral valve replacement with mechanical prosthesis.

Objectives: To investigate the effect of NBI examination on the differentiating between benign and malignant neoplasms involving nasal cavity. Design, Setting, Participants: A retrospective case series from January 2018 to December 2019 were performed at a single center. A total of 188 consecutive patients who were first diagnosed with lesions in unilateral nasal cavity underwent complete examination with white light endoscopy (WLE) and NBI endoscopy, respectively. Biopsy was harvested from the target lesion and sent to the pathologist for definite diagnosis. Participants with a history of congenital malformation, trauma and surgery in nasal cavity were excluded from the study. Main outcome measures: Endoscopic diagnosis was assessed using sensitivity, specificity, accuracy and positive and negative predictive values (PPV and NPV, respectively). Results: In identifying benign and malignant lesions of nasal cavity, NBI had a significant higher sensitivity (92.7% vs 70.7%, P = 0.020) and NPV (98% vs 92.3%, P = 0.032) than WLE, but there were no significant differences between NBI and WLE in specificity (98.6% vs 97.3%, P = 0.684), accuracy (97.3% vs 91.5%, P = 0.416) and PPV (95% vs 87.9%, P = 0.400). Conclusion: The emerging technique of NBI can improve the diagnostic accuracy of distinguishing benign and malignant lesions in nasal cavity, and remains a promising and helpful adjunct to the traditional endoscopy techniques.

Objective: This prospective observational study aims to measure the epiglottic thickness by ultrasonography (US) in healthy volunteers. Methods: Healthy adult volunteers were recruited from the National Taiwan University Hospital between October and November 2019. Exclusion criteria included preexisting airway diseases, neck tumors, and a history of neck operation. Epiglottic thickness was measured at the midpoint, right and left edges of the epiglottis. Age, sex, height, weight, and body mass index (BMI) were collected. The linear regression model was employed to identify parameters to be associated with the epiglottic thickness. Coefficients and 95% confidence intervals (CIs) were computed. The literature was also reviewed. Results: There were 124 Chinese adults and 63 were men. The average age was 32.5±10.4 years. The midpoint, right edge and left edge of the epiglottic thickness was 2.03±0.42 mm, 2.14±0.42 mm and 2.21±0.42 mm, respectively. Male gender (midpoint, coefficient, 0.38, 95% CI, 0.35-0.43; right edge, coefficient, 0.33, 95% CI, 0.31-0.35; left edge, coefficient, 0.31, 95% CI, 0.29-0.35) and BMI (midpoint, coefficient, 0.02, 95% CI, 0.019-0.021; right edge, coefficient, 0.02, 95% CI, 0.019-0.022; left edge, coefficient, 0.02, 95% CI, 0.018-0.022) were associated with the epiglottic thickness. The epiglottis was thinner in normal Chinese adults, compared with that in Americans in the literature. Conclusions: US allows the depiction and assessment of the epiglottis in healthy volunteers. Male gender and higher BMI are associated with a thicker epiglottis. Future studies are warranted to evaluate race differences in the dimension of the epiglottic thickness.

Introduction Treating locally advanced laryngeal squamous cell carcinoma (LSCC) with primary chemoradiotherapy (CRT) can preserve the larynx without compromising survival. However, whether this is associated with good functional outcomes remains up for debate. The aim of this study was to evaluate survival and functional outcomes in patients with locally advanced LSCC treated with primary CRT. Methods We retrospectively analysed data from all consecutive patients with stage III-IV (M0) disease treated with primary CRT between April 2010 and December 2017. Study endpoints were overall survival (OS), disease free survival (DFS), laryngectomy free survival (LFS), laryngo-oesophageal dysfunction free survival (LEDFS) and functional preservation rates. Prognostic factors were assessed by univariate and multivariate analysis. Results 69 consecutive patients treated with primary CRT were analysed. All patients were treated with Intensity Modulated Radiotherapy (IMRT). 29 patients received induction chemotherapy prior to CRT. 60 patients (87%) received concomitant platinum-based chemotherapy, and 9 (13%) concomitant Cetuximab. The median follow-up was 57 months (range 4-96). The completion rate for prescribed RT was 98.5%. The 2- and 5 year OS rates were 81.1% and 52.1%. For patients with T3 disease, the 2- and 5 year OS rates were 82.4% and 61.6%. Positive nodal status, N2b-N3 nodal staging, or stage IV disease were associated with poor OS on univariate, but not multivariate, analysis. Functional preservation was 69.1% at 2 years in all patients alive (68.1% in T3 patients). The 2-year LEDFS rate was 52%. The 2- and 5-year LFS rates was 72.4% and 43.3% respectively. There was no significant difference in LFS rate between primary tumour localization, baseline laryngeal fixation or cartilage invasion. Conclusion Our study illustrates survival and functional outcomes in line with contemporary studies. The survival and function preservation rates suggest that carefully selected patients with locally advanced LSCC can successfully be treated with larynx-preserving primary CRT.

We present a Behcet's like disease case that was accidental observed because of urinary tract infection. The ulceration was pretty serious, but the patient can't even notice. And the ulcers self-healed after antibiotic treatment.

Alzheimer’s disease (AD) is characterized by neurofibrillary tangles (NFTs), formed as a consequence of hyperphosphorylation of tau. The extent of phosphorylation of tau is regulated by protein phosphatases (PPs) like PP1, PP2A/Bα, PP2B and PP5. Interestingly, PP2A/Bα, is a major brain tau phosphatase which account for 70% of the dephosphorylation events in brain and, its activity is known to decrease by half under AD conditions. The down regulation of PP2A leads to hyperphosphorylation of Tau in the brains of AD patients. Hence, the process of reversal of tau phosphorylation needs to be achieved by the activation of PP2A, through specific molecules, as this could pave way towards development of novel therapeutics for AD. The key objective of the current study was thus to understand the affinities of various small molecules that could function as potential activators of PP2A. Molecules like Xylulose-5-Phosphate, Dihydroxy Phenylethanol, EGCG, Memantine, Sodium Selenate, Tetralone and Quinolone exhibit strong interactions across identified binding pockets of PP2A. The investigation not only confers that there could be more than one activation site in PP2A, but also offers clues as to how these molecules facilitate restoration of the phosphatases activity, thus proposing newer avenues for the treatment of AD.

We evaluated the interpretation of atrophic endometrium (AE) histology as a common cause for postmenopausal bleeding (PMB). In our opinion, AE is physiologic and ubiquitous in postmenopausal women, but is not a cause of PMB. Referring to AE as a cause of PMB may result in misdiagnosis of cancer and delay in management. Endometrial sampling are notorious for missing focal lesions and transvaginal sonogram should be considered in cases of PMB and AE histology. If endometrial thickness is found, it is not compatible with AE and further workup is warranted to exclude focal lesions which are common cause for PMB.

Many have wondered if Japan possessed an ”X-factor” that led to a low COVID-19 death rate.We note that the mask non-wearing rate in mid-March alone was predicted to contribute up to 72% of variations in the number of deaths per million1. In addition, there was a remarkable difference in face mask wearing rates between Western countries and Asian countries, especially in East Asian countries including Japan1. The county’s policy for wearing a face mask alone cannot explain this significant difference. For example, there is a high rate of wearing face masks in Japan even though this practice has never been declared mandatory. We speculate that cultural differences may be the major reason.Many Japanese wear surgical masks on a daily basis not with the purpose of shedding infections or pollens but to achieve inscrutability, similar to the Westerners wearing sunglasses.It is referred to as ”mask dependency” in a number of cases2. While people may wish to achieve anonymity, they also want to avoid making others uncomfortable. Jack, Caldara, and Schyns state, “whereas Western Caucasian internal representations predominantly featured the eyebrows and mouth, East Asian internal representations showed a preference for expressive information in the eye region”3. This tendency may be the major reason why it is considered rude to wear sunglasses among eastern Asians and why wearing face masks among Westerners is considered suspicious, which could be why the western population exhibits a low face mask wearing rate.Additionally, the Japanese generally remain silent while using public transportation as loudness is a sign of rudeness in Japan4. This may also contribute to the ”X-factor” because a very high proportion of aerosols are exhaled from asymptomatic individuals while speaking rather than breathing5. In addition, the viral density of aerosols is expected to vary between speaking and breathing as the origin of the aerosols is different. Aerosols originating from the mouth may contain more virus than those from the lungs in asymptomatic individuals.Although face mask wearing has not yet been proven as an independent risk factor of COVID-19 mortality, a high rate of mask wearing in Japan may be the major candidate for the so called ”X-factor.”

A 70-year-old diabetic woman was admitted to our hospital with a complaint of high fever accompanying shaking chills for three days. The patient had no abdominal symptoms and no history of eating raw food. The patient’s body temperature was increased to 39 oC, and blood analysis showed elevations of leukocytes (17,400 /µL) and C-reactive protein (16.5 mg/dL). Computed tomography revealed air density spots in the aortic wall (Fig A ), and Salmonella enteritidis serotype O9 was detected by blood culture. Under a tentative diagnosis of Salmonella-induced infective aortic aneurysm, the patient underwent antibiotic treatment with ampicillin/sulbactam. On day 11, the air had disappeared and the aortic wall showed a varicose deformity, leading to a differential diagnosis of infective aortic aneurysm (Fig B ). The patient recovered completely with 8-week antibiotic therapy without any operation.Cases of infective aortic aneurysms account for only about 1% to 3% of total cases of aortic aneurysm. However, the case fatality has been reported to be as high as 18 percent in two years1, and an early diagnosis is essential. Salmonella species are known as a common pathogen of the crucial infection2, and so clinicians should pay attention to the development of the disease.

Patients who undergo hematopoietic stem cell transplantation may present with a variety of dermatologic complications. Clinicians must be careful to maintain a broad differential and seek a biopsy proven diagnosis as soon as possible when there is ambiguity as to cause.

We present an adult patient with Crouzon syndrome manifesting with facial deformities and panhypopituitarism. Crouzon syndrome is a rare, autosomal dominant genetic disorder characterized by facial bone deformities, such as a prominent nose, frontal bossing, and ocular proptosis, as well as headaches, seizures, and developmental delay.

The case of a 71 year-old woman with rapid atrial fibrillation who underwent electrical cardioversion and amiodarone therapy. QT interval prolongation was observed with the development of torsades de pointes that required recurrent electrical cardioversion and temporal pacemaker implantation.

As the world learned about Covid-19, the application of ECMO also evolved as health systems in the United States had some time to prepare. We report our initial experience using extracorporeal support for Covid-19 patients with the resource challenges that attend a worldwide pandemic.

A 39-year-old woman was admitted with right leg deep venous thrombosis (DVT). She was started on apixaban tablets but developed pulmonary embolism. The medical history showed sleeve gastrectomy. The failure of the antithrombotic drug shed light on the efficacy and pharmacodynamic changes of DOACs after bariatric surgery

Experience and training in field work is a critical component of undergraduate education in ecology, and many university courses incorporate field-based or experiential components into the curriculum in order to provide students hands-on experience. Due to the onset of the COVID-19 pandemic and the sudden shift to remote instruction in the spring of 2020, many instructors of such courses found themselves struggling to identify strategies for developing rigorous field activities that could be completed online, solo, and from a student’s backyard. This case study illustrates the process by which one field-based course, a UC California Naturalist certification course offered at the University of California, Davis, transitioned to fully remote instruction. The transition relied on established, publicly available, online participatory science platforms (e.g., iNaturalist) to which the students contributed data and observations remotely. Student feedback on the course and voluntary continued engagement with the participatory science platforms indicates that the student perspective of the experience was on par with previous traditional offerings of the course. This case study also includes topics and participatory science resources for consideration by other faculty facing a similar transition from group field activities to remote, individual field-based experiences.

COVID-19 created a host of challenges for science education; in our case, the pandemic halted our in-person elementary school outreach project on bird biology. This project was designed as a year-long program to teach fifth grade students in Ithaca, New York, USA about bird ecology and biodiversity, using outdoor demonstrations and in-person games and activities to engage students in nature. As a central part of this effort, we set up nest boxes on school property and had planned to monitor them with students during bird breeding in the spring. Here, we describe our experiences transitioning this program online: we live streamed nest boxes to students’ virtual classrooms and used them as starting points for virtual lessons on bird breeding and nestling development. We suggest that instituting similar programs at local schools can promote equitable learning opportunities for students across geographical locations and with various living situations. In an era of social distancing and isolation, we propose that nest box live streaming and virtual lessons can support local communities by providing access to the outdoors and unconventional science learning opportunities for all students.

The first drug specific for cystic fibrosis (CF) was approved in 1993, and since then several other drugs have been approved. Median predicted survival in people with CF has improved from approximately 30 years to 44.4 years over that same period. In 2020, highly-effective modulators of the cystic fibrosis transmembrane conductance regulator became available to approximately 90% of people with CF ages 12 years and older. These transformative therapies will surely reduce morbidity and further extend longevity. The drug development pipeline is filled with therapies that address most aspects of CF disease. As survival and CF therapies have advanced, and the complexity of CF care increases, the process of drug development has become more sophisticated. In addition, detecting meaningful changes in clinical outcomes has become more difficult as the health status of people with CF improves. Design of clinical trials in CF has become more complex, and innovative approaches are required to continue to advance drug development. This review provides a general overview of drug development from the pre-clinical phase through Phase IV. Special considerations with respect to CF are integrated into the discussion of each phase of drug development. The dawn of a new era has arrived for people with CF. As CF care evolves, drug development must continue to evolve as well, until a one-time cure is available to all people with CF.