Key Clinical Message:Clinicians should recognize the importance of evaluating iron overload in those with alcoholic liver diseases. Markedly elevated serum ferritin levels are a diagnostic clue for secondary hemochromatosis, necessitating the iron depletion therapy.

In December 2019, a novel coronavirus (Sars-CoV-2 ) emerged from Wuhan, Hubei province, China, and has spread worldwide, with more than 4 million confirmed cases[1,2,3]. Available literature on the clinical characteristics and natural history of pediatric patients infected with Sars-CoV-2 is limited and less has been established regarding guidelines for the treatment of immunocompromised pediatric patients. This is a case report on the clinical course and management of a 6 year old female with acute lymphoblastic lymphoma with Sars-CoV-2. The goal is to highlight the need for management guidelines in the care of pediatric cancer patients with Sars-CoV-2.

46, XX male syndrome is a rare disorder of sex development. One-tenth of 46, XX male syndrome is sex-determining region Y (SRY)-negative. We used whole-exome sequencing (WES) analysis associated genes to investigate the underlying genetic etiology of 46, XX male syndrome patients with bone marrow failure with a typical male phenotype. WES reveals SRY and SRY-box family genes were negative. Simultaneously, gene variants were detected in female pathway, testis development, and steroid receptor genes. There are undefined gene variants associated with congenital bone marrow failure. WES proved an efficient diagnostic method toward 46, XX male syndrome patients with hematological disorder.

Cognitive impairment in children with sickle cell disease (SCD) is thought to reflect the complex pathophysiology of the disease. Hydroxyurea (HU) is used in children with SCD to increase fetal hemoglobin (HF), contributing to a decrease in physical symptoms and to potential protection against cerebral microvasculopathy. There has been minimal investigation into the association between HU use and cognition in this population. This study examined the relationship between HU status and cognition in young children with SCD. Neuropsychological data were collected in a prospective study from 38 children with SCD HbSS or HbS/0 thalassaemia ages 4 to 11 years with no history of overt stroke or chronic transfusion. Controlling for hemoglobin, children on HU performed significantly better than children who were not on HU on measures of attention/executive functioning and nonverbal skills. Performance on verbal measures was similar between groups. Though not statistically significant, duration of HU use was positively associated with better performance in all domains. These results provide preliminary evidence that treatment with HU may not only reduce physical symptoms, but may also be protective against cognitive dysfunction in young children with SCD, particularly in regard to attention/executive functioning and nonverbal skills. Replication with larger samples and longitudinal studies are warranted.

Bilateral concomitant inguinal and femoral hernias are very rare. Preoperative examinations may not be able to detect coexisting inguinal hernias. However, laparoscopic surgery can identify these subclinical hernias and repair them appropriately. We report about the use of laparoscopic surgery to repair coexisting bilateral inguinal and femoral hernias.

A 14-year-old girl presented with the rapid growth of bilateral breasts within a year, causing her chest discomfort, and pressure sores in the inframammary fold. Bilateral reduction mammoplasty with free nipple-areola graft was performed. Nine kilograms of breast tissue, accounting for 15% of her total body weight, were excised.

Systemic mastocytosis (SM) can be extremely heterogeneous and its treatment should be highly individualized. We reported a description of clinical management of an aggressive SM characterized at diagnosis by multiple organ involvement. The patient underwent to different lines of treatment, from standard chemotherapy to the novel tyrosine kinase inhibitor midostaurin.

Objective The aim of this study was to compare the outcomes of laparotomy and laparoscopy in the treatment of high-risk caesarean scar pregnancy (CSP) and evaluate the optimal treatment measure. Design A retrospective study. Setting Tongji Hospital. Population Two hundred seventy-eight patients with CSP between 2013 and 2018. Methods We compared and analysed the characteristics of laparoscopic and open surgery in the treatment of high-risk CSP and the advantages and disadvantages of different methods of vascular pretreatment. We also systematically evaluated CSP patients undergoing laparoscopic or laparotomic surgery. Results The intraoperative bleeding volume, transfusion rate, and total number of days of hospitalization and postoperative hospitalization were better in the laparoscopy group than in the laparotomy group (p<0.05). There were no differences in factors (β-hCG decrease, reoperation and residual tissue) closely related to surgical success between the two groups. Furthermore, we pretreated blood vessels differently before the operation. The residual tissue, reoperation and intraoperative blood transfusion rates in patients treated with temporary vascular occlusion were better than those in patients treated with permanent vascular occlusion. A systematic review of English literature showed that most of the current studies on CSP are case reports and retrospective analyses (67.74% and 29.03%, respectively), and the sample sizes of these studies are very small. Conclusions This study reveals that laparoscopic surgery is superior to laparotomic surgery in the treatment of high-risk CSP. Patients benefitted from temporary arterial occlusion in both groups. Temporary arterial occlusion with laparoscopic surgery may be the best treatment for high-risk CSP.

Key points: Chondrolaryngoplasty or “tracheal shaving” is cosmetic surgery to reduce the laryngeal prominence in transgender women. Chondrolaryngoplasty represents a challenge in seeking a balance between aesthetics and function: a very conservative resection of the thyroid cartilage may lead to aesthetic dissatisfaction, while excessive resection may destabilize the anterior commissure tendon, causing permanent vocal damage. This was the first study to assess fundamental frequency and GRBAS scale before and after the surgery and there was no permanent vocal change in any of the patients. The midpoint of the height of the thyroid cartilage was a simple, easy to perform and safe parameter to locate and preserve the anterior commissure. Smoothing the edges and flattening the residual laryngeal prominence with a 4 mm diamond burr enabled major remodeling without a temerarious resection. All 15 patients presented a positive variation in the visual analogue score for aesthetic satisfaction, with a mean improvement of 8.6 ± 1.9 out of 10. Chondrolaryngoplasty led to significant aesthetic satisfaction in transgender women. The surgery caused no vocal change.

This study investigates the hydromagnetic stagnation point flow to Casson fluid towards a vertically stretching sheet with convective surface boundary condition. Casson fluid model is used to characterize the non-Newtonian fluid behavior. Using similarity transformation, the governing nonlinear partial differential equations are transformed into coupled nonlinear ordinary differential equations which are solved numerically by employing Runge-Kutta Fehlberg integration scheme with shooting technique. Graphical results showing the effects of various thermophysical parameters on the velocity and temperature profiles are presented and discussed quantitatively.

Carbapenemase-producing Enterobacteriaceae (CPE) , multidrug resistant (MDR) threatens children undergoing chemotherapy. A previous survey reported increase of bloodstream infections and colonization in a 2 year-observation time. To test the efficacy of the measures put in place , a second survey was performed. Data were collected from 13 Italian pediatric cancer centers of AIEOP network. The colonization rate per 1000 hospitalizations days was 0.5 (0.37-0.65) not different from the 0.48 rate (0.36-0.63) observed previously .Yet the 0.12 rate of bacteriemia (0.07-0.21) compared favorably with the 0.42 (0.31-0.57) observed. The awareness of colonization status allowed reducing CPE related morbidity and mortality.

There is scarce information available in regards to the survival outcome of non-Hodgkin lymphoma (NHL) in South East Asia regions. Reports on the outcome of High dose therapy followed by autologous haematopoietic stem cell transplantation (AHSCT) were mainly from developed countries. In this study, we present the outcome of NHL patients treated with AHSCT from year 1997 to 2016 in two urban hospitals in Malaysia. A total of 140 patients were identified, majority of whom had B cell lymphoma (54.3%). Majority of patients (89.3%) were in complete remission at AHSCT. The overall survival (OS) and event-free survival (EFS) at 3 years were 70.7% and 62.1% respectively. The transplant-related mortality was 3.4%.

Multiple reports all over the world are hypothesizing a possible relationship between BCG vaccination, and a lesser incidence of and mortality from COVID-191. China is considered as one of the heavily affected countries and it was the first to report COVID-19, the author will examine this hypothesis using China as an example.According to the WHO global tuberculosis report 20192, it’s stated that in 2018, among 180 countries for which data were collected, 153 countries have properly reported administration of BCG vaccination as a standard part of childhood immunization programmes, of which 113 reported coverage of ≥90% (Figure 1). In the same report, China has accomplished a 99% BCG vaccination coverage, to be considered as one of the top countries providing this coverage rate all over the world. Moreover, the reported estimates for the global BCG coverage according to the WHO monitoring system for vaccine-preventable diseases has revealed that BCG vaccination coverage in China to be either 99% or 100% for the years 2009 to 20183. Thus, we may reasonably consider that all children, currently 10 years old or younger and living in China, are efficiently covered and immunized by BCG vaccination.Interestingly, as of the 11th of February, 2020 the Chinese Center for Disease Control and Prevention has reported 416 laboratory-confirmed pediatric cases; aged 0–9 years4. Moreover, another study, published about one month later, has researched 2143 pediatric Chinese patients who were both laboratory-confirmed as well as suspected cases, and concluded that children at all ages appeared susceptible to COVID-19 and it’s also reported that the proportion of severe and critical cases was 10.6 %, 7.3%, 4.2% for the age group of <1, 1-5, 6-10, respectively. Noteworthy, this study has suggested that the majority of COVID-19 pediatric patients were less severe in their medical condition than adults’ cases because children are usually well cared for at home and might have relatively less opportunities to expose themselves to SARS CoV-25.Thus, basing on the above analysis, the author suggests that stating that BCG vaccination could prevent COVID-19 infection should be considered as a myth. Moreover, the author considers stating that countries which have adopted childhood BCG vaccination might be the reason for a lower morbidity or mortality of COVID-19 for adults immunized at birth, should be also considered as another myth, as revealed by the incidence of adults’ morbidity and mortality rates reported in China as well as several other countries that have adopted childhood BCG vaccination. However, BCG vaccination given once a month for three consecutive months has previously showed a benefit against adult upper respiratory tract infections in the elderly6 and it might prove the same benefits against COVID-19 if administered to unimmunized adults or re-administered to previously immunized adults waiting for the results of the undergoing clinical trials7. On the other hand, BCG vaccination might or might not have some ameliorative benefits for immunized children affected by COVID-19 and this suggested positive association is highly unlikely to be properly proved because of multiple confounding factors. Finally, please keep and remain vigilant till the world finds a cure for COVID-19, this is an evidence-based medicine piece of advice.Funding:NoneConflict of interests:NoneFinancial disclosure:None

Colorectal cancer (CRC) is a common tumor in digestive system with high morbidity and mortality. In this work, three datasets (GSE68468, GSE21510, and GSE9348) were selected from the public GEO database, and the deferentially expressed genes (DEGs) related to CRC were screened out by bioinformatics approach. The GO (gene ontology) analysis on DEGs was carried out and followed by the KEGG (kyoto encyclopedia of genes and genomes) analysis. Finally, protein-protein interaction (PPI) networks of DEGs were respectively constructed by using the STRING database. Our results showed that a total of 849 DEGs in common were identified from the three datasets, including 406 up-regulated genes and 443 down-regulated genes. The GO analysis demonstrated that the DEGs are mainly related to cell division, cell proliferation, cell signaling, and immune response. The KEGG analysis revealed that DEGs are mainly enriched in cell cycle and cell signaling pathway. Based on the PPI network analysis, we identified a total of 86 key genes: 72 up-regulated genes mainly consist of CD and KIF genes while 14 down-regulated genes are mainly composed of various members of CC genes. In particular, we found that the CRC proliferation should be enhanced by the interaction of CDK1 with CDKN3 and KIF15. On the one hand, CRC proliferation is enhanced by over-expressing the CD and KIF genes involving in cell division and cell proliferation. On the other hand, CRC proliferation is strengthened through silencing the expression of the CC genes associated with immune response.

We wish to highlight a new hypothesis, that the early phase of COVID-19 is characterised by non-cardiogenic pulmonary oedema (‘leaky lungs’). We hypothesize that COVID-19 complications in lungs might progress through the initial stages of ‘leaky lungs’, to ‘cytokine storm’ and Acute Respiratory Distress Syndrome (ARDS ) , with high case fatality rates once ARDS sets in. SARS-CoV spike protein binding to Angiotensin Converting Enzyme 2 cell membrane receptors with down-regulation of the latter, followed by increased Angiotensin II, has been shown to increase pulmonary vascular permeability, potentially inducing pulmonary oedema. This hypothesis is supported by serial computerised tomographic scan findings on COVID-19 patients from China and post-mortem studies from around the world. Early attention and targeted treatment towards this pathological feature of non-cardiogenic pulmonary oedema may be of benefit, and warrants a clinical trial.

Cryoglobulinemia is a cold-reactive autoimmune disease. A 64-year-old man with active cryoglobulinemia presented Stanford type A acute aortic dissection. He had been treated with immunosuppressive drugs and plasma exchange (PE) at our hospital; subsequently, qualitative analysis of cryogobulin (CG) was negative. He underwent emergency ascending aorta replacement using cardiopulmonary bypass (CPB) under deep hypothermia circulatory arrest with selective cerebral perfusion. The total CPB time, aortic cross clamp time, and selective cerebral perfusion time were 255, 153, 56 minutes, respectively, and the minimal nasopharyngeal temperature was 17.3°C. Our patient had no significant perioperative complications. Hence, if PE is performed appropriately and CG is negative, patients with cryoglobulinemia who exhibit severe preoperative symptoms can safely undergo surgery with deep hypothermia.

Radial arteriovenous fistula post coronary artery intervention is rare. Here we describe an extremely rare case of radial arteriovenous fistula (AVF) with retrograde filling through the deep palmar arch and presenting as early ischemic changes.

• NICE recommend that children with persistent bilateral otitis media with effusion (OME) documented over a 3-month period and associated hearing impairment should be considered for surgical intervention. • Treatment of OME often requires repeated tubulation of the tympanic membrane if the grommets are extruded before the disease of the middle ear has remitted. • Triune tubes appear to remain in situ and functional for longer than the standard ventilation tubes. • Use of triune grommets may reduce need for repeated tubulation of the tympanic membrane. • Complications from infection or recurrent effusion were similar, regardless of type of grommet used.

Background: The first case of COVID-19 in Israel was reported on February 21, 2020. Shaare Zedek (SZ), a 1000-bed tertiary care medical center in Jerusalem, Israel, cared for a significant number of these patients. While attention focused on COVID-19 patients, uninfected patients were admitted to decreasing numbers of available internal medicine (IM) beds as IM departments were converted to COVID-19 isolation wards. Due to the increase in COVID-19 patients, closure of IM wards, re-assignment of staff, and dynamic changes in available community placement options, we investigated the impact of the outbreak on IM patient not admitted for COVID-19. Methods: We reviewed IM admissions during March 15 – April 30, 2020 for patients without COVID-19. Characteristics assessed included number of admissions, age, length of stay, mortality rate, number of discharges, number discharged home, and functional status of the patients. Data was compared to the previous three years (2017 – 2019) during the same time period. Results: During March 15 – April 30, 2020 there were 409 patients admitted to IM compared to a mean of 557 over the previous three years. Fewer patients were admitted to the ED and the IM wards during the outbreak. There was no significant difference between the two groups with regards to gender, in-hospital mortality rate, number discharged, number discharged home, and patient functional level. Patients admitted during the outbreak to IM were younger (74.85 vs 76.86 years) and had a mean shorter hospital length of stay (5.12 vs 7.63 days) compared to the previous three years. Conclusion: While the characteristics of patients admitted to IM during the outbreak were similar, hospital length of stay was significantly shorter. Internal management processes, as well as patient preferences may have contributed to this observation. An infectious disease outbreak may have a significant effect on uninfected admitted patients.

INTRODUCTION: PD is more common with increasing age and shows male predominance, which is more obvious in Western studies. The reasons of this remain obscure. However, it has been suggested that exposure to endogenous and exogenous oestrogen contributes to these sex differences and that oestrogen prevents dopaminergic neuron depletion induced by neurotoxins in and therefore is neuroprotective. OBJECTIVES: we wanted to investigate if the exogenous administration of testosterone in males, and oestrogen with or without progesterone in females, had any protective effect towards to PD. METHODS: clinical records of 99929 residents in North West England were scrutinised in primary care setting for diagnosis of PD, HRT, and timing of onset in those cases were the adverse event had been identified.RESULTS: PD overall prevalence was of 0.55% in males and 0.36% in females (M/F=3:2). The NNT for HRT with testosterone was 1.016 (harm) significance level P<0.0001, and NNT for HRT oestrogen+/-progesterone was 17.092 (harm) significance level P<0.0001.CONCLUSIONS: HRT for males or females have not demonstrated any beneficial effects in terms of PD onset prevention or procrastination. On the contrary HRT, particularly with testosterone, is more likely to have a detrimental effect. Our results need to be interpreted cautiously as the treatment with HRT was not randomized and it cannot be excluded that stopping HRT may cause a sudden hormonal drop which in turn may have a negative effect.

Duodenal gastrointestinal stromal tumors (dGISTs) are rare, and a lack of consensus exists regarding their therapeutic management particularly for recurrent disease. We present even low-risk dGIST may metastasize and require long-term observation, and a long-term prognosis may be achieved by combining resection and imatinib therapy for liver metastases recurrence.

We present a 30-year-old male with end-stage renal disease (ESRD) secondary to anti-glomerular basement membrane (anti-GBM) disease who presented to the emergency room with hypertensive emergency and seizures. He was treated with antihypertensives and lorazepam. His seizure etiology was attributed to hypertensive emergency due to ESRD from anti-GBM disease.

Seneca Valley virus (SVV) is a novel Picornaviridae that is closely associated with porcine idiopathic vesicular disease (PIVD). Here, we report the detection and isolation of a novel strain of SVV, CH-GX-01-2019, from swine in Guangxi Province, China. The complete genomic sequence of CH-GX-01-2019 exhibited 93.3 - 98.9% identify with other SVV isolates at the nucleotide level. This new strain of SVV showed the highest level of similarity (98.9%) with Vietnamese strains and exhibited two consecutive mutations in the VP1 gene. Phylogenetic analysis based on the complete genome and the VP1 gene showed that Chinese forms of SVV can be divided into three clusters. We analyzed the geographical distributions of SVV strains in China and found that the epidemiology of these viruses in China is complicated; most strains are distributed predominantly in south and central China. Between 2015 and 2019, the dominant epidemic strains of Chinese SSV changed from clusters 1 and 3 to cluster 2. CH-GX-01-2019 (cluster 3) represents a recombinant strain from Colombia-2016 (cluster 2) and HB-CH-2016 (cluster 1). Our findings will enhance our understanding of the prevalence and genetic variation of SVV in the swine herds of China and provide important insights into the molecular epidemiology of SVV.

1.) Understanding how abiotic conditions influence dispersal patterns of organisms is important for understanding the degree to which species can track and persist in the face of changing climate. 2.) The goal of this study was to understand how weather conditions influence the dispersal pattern of multiple non-migratory grasshopper species from lower elevation grassland habitats in which they ¬¬complete their life-cycles to higher elevations that extend beyond their range limits. 3.) Using over a decade of weekly spring to late-summer field survey data along an elevational gradient, we explored how abundance and richness of dispersing grasshoppers were influenced by temperature, precipitation, and wind speed and direction. We also examined how changes in population sizes at lower elevations might influence these patterns. 4.) We observed that the abundance of displaced grasshoppers along the gradient declined 4-fold from the foothills to the subalpine and increased with warmer conditions and when wind flow patterns were mild or in the downslope direction. Thirty-eight unique grasshopper species from lowland sites were detected as dispersers across the survey years, and warmer years and weak upslope wind conditions also increased the richness of these displaced grasshoppers. The pattern of grasshoppers along the gradient was not sex biased. The positive effect of temperature on dispersal rates was likely explained by an increase in dispersal propensity rather than by an increase in the density of grasshoppers at low elevation sites. 5.) The results of this study support the hypothesis that the dispersal patterns of organisms are influenced by changing climatic conditions themselves and as such, that this context-dependent dispersal response should be considered when modeling and forecasting the ability of species to respond to climate change.