CONSTANS-LIKE (COL) family members are commonly implicated in light signal transduction during early photomorphogenesis. However, some of their functions remain unclear. Here, we propose a role for COL13 in hypocotyl elongation in Arabidopsis thaliana. We found that COL13 RNA accumulates at high levels in hypocotyls and that a disruption in the COL13 function via a T-DNA insertion or RNAi led to the formation of longer hypocotyls of Arabidopsis seedlings under red light. On the contrary, overexpression of COL13 resulted in the formation of shorter hypocotyls. Using various genetic, genomic, and biochemical assays, we proved that another COL protein, COL3, directly binds to the promoter of COL13, and the promoter region of COL3 was targeted by the transcription factor LONG HYPOCOTYL 5 (HY5), to form an HY5-COL3-COL13 regulatory chain for regulating hypocotyl elongation under red light. Additionally, further study demonstrated that COL13 interacts with COL3, and COL13 promotes the interaction between COL3 and CONSTITUTIVE PHOTOMORPHOGENIC1 (COP1), suggesting a possible COP1-dependent COL3-COL13 feedback pathway. Our results provide new information regarding the gene network in mediating hypocotyl elongation.

Abstract: Background: COVID-19 burst in Wuhan China in December 2019 and soon became a worldwide emergency. To help further understand COVID-19. Here we report the epidemiological, clinical features, potential biomarkers, and CT changes of cases in Wenzhou. Methods:All 64 cases were diagnosed by positive of PCR test. Clinical laboratory tests, CT and treatment were performed in the level 3 of protection. Data and clinical characteristics feature were collected by 4th March. The correlation was analyzed. Results:Most cases were light. The average of latency was 3.4 days, ranged from 1-14. The median age was 44, ranged from 2.2-67; 36 male and 28 female; 59 had fever, 38 with high temperate (>38℃); 45 had respiratory symptoms; 28 had gastrointestinal symptoms; 39 weakness; one asymptomatic case was found. Most with low LC, K+, Na+, OI and high LDH, CRP, D-dimer. Pneumonia, both lungs involvement, ground-glass opacity and consolidation were shown by CTs. Minor had electrocardiography change. Conclusions:The clinical features, abnormality lab indexes and CT characteristics of COVID-19 were like SARS, majored in fever, weakness along with dry cough, diarrhea. LC, LDH could be good biomarkers monitoring progress. The elders, hypertension patients and smokers were more vulnerable. COVID-19 was milder, but more transmissible than SARS. Latency could be up to 14 days without symptoms. CT and PCR shall be both considered in clinical high suspicion. There are still further efforts to be made as to preventing and control the epidemic and the cost in world wild.

Rationale, aims, and objectives: Post-hospitalization follow-up within 30 days following discharge has been shown to positively impact time to readmission, healthcare costs, and patient self-reported adherence and satisfaction. We aimed to improve resident satisfaction with the process of establishing post-hospitalization, primary care provider (PCP) follow-up. Methods: In this quality improvement study we surveyed all internal medicine residents at our institution regarding their satisfaction with the process of establishing PCP follow-up at the time of hospital discharge. A streamlined process was developed and two subsequent interventions were enacted; a dedicated teaching session and distribution of pocket cards outlining the process. Residents were then surveyed following each intervention to assess for impact on overall satisfaction and burden of work. Results: Initially, 77.3% of residents were not satisfied with the process of establishing post-hospitalization PCP follow-up. Following the first intervention there was a trend towards increasing satisfaction rates by 16.7% (p= 0.20), and after the second intervention there was a statistically significant increase in satisfaction rates from baseline by 44% (p= 0.007). There was also a reduction in the feeling of workload burden associated with establishing PCP follow-up from 32% to 25%, and over 67% of participants either agreed or strongly agreed that the workload was not too burdensome. Conclusion: This quality improvement initiative established that resident physicians at our institution previously found the process of establishing PCP follow-up at the time of patient discharge both confusing and burdensome. Through the implementation of our interventions we were able to achieve our aims of improving resident satisfaction.

Summer heat waves are the principal global driver of mortality in reef-building corals. Resilience-based genetic management may increase coral heat tolerance, but it is unclear how temperature responses are regulated at a genomic level and thus how corals may adapt to warming naturally or through selective breeding. Here we combine phenotypic, pedigree, and genomic marker data from colonies sourced from a warm reef on the Great Barrier Reef reproductively crossed with conspecific colonies from a cooler reef to produce combinations of warm and cool purebred and hybrid larvae and juveniles. Intra-population breeding created significantly greater genetic diversity across the coral genome and maintained diversity in key regions associated with heat tolerance and fitness. High-density genome-wide scans of single nucleotide polymorphisms (SNPs) identified alleles significantly associated with offspring reared at 27.5°C (87 – 2,224 loci), including loci putatively associated with proteins involved in responses to heat stress (cell membrane formation, metabolism, and immune responses). Underlying genetics explained 43% of PCoA variation in juvenile survival, growth, and bleaching responses at 27.5°C and 31°C between the multilocus genotypes. Genetic marker contribution to total variation in fitness traits (narrow-sense heritability) were high for survival but not for growth and bleaching in juveniles, with heritability of these traits influenced more at 31°C relative to 27.5°C. Using only a limited number of crosses, the mechanistic understanding presented here demonstrates that allele frequencies are affected by one generation of selective breeding, key information for the assessments of genetic intervention feasibility and modelling of reef futures.

Mosquitoes utilize their sense of smell to locate prey and feed on their blood. Repellents interfere with the biochemical cascades that detect odors. Consequently, repellants are highly effective and resource-efficient alternatives for controlling the spread of mosquito-borne illnesses. Unfortunately, the discovery of repellents is slow, laborious and error-prone. To this end, we have improved the speed and accuracy of repellant discovery by constructing a whole-cell biosensor for accurate detection of mosquito behavior-modifying compounds such as repellants. We genetically engineered Pichia pastoris to express the olfactory receptor co-receptor (Orco) of Anopheles gambiae mosquitoes. This transmembrane protein behaves like a cationic channel upon activation by stimulatory odorants. When the engineered Pichia cells are cultured in calcium-containing Hank’s buffer, induction of the medium with a stimulatory odorant results in influx of calcium ions into the cells, and the stimulatory effect is quantifiable using the calcium-sequestering fluorescent dye, fluo-4-acetoxymethyl ester. Moreover, the stimulatory effect can be titrated by adjusting either the concentration of calcium ions in the medium or level of induction of the stimulatory odorant. Subsequent exposure of the activated Pichia cells to a repellant molecule inhibits the stimulatory effect and quenches the fluorescent signal, also in a titratable manner. Significantly, the modular architecture of the biosensor allows easy and efficient expansion of its detection range by co-expressing Orco with other olfactory receptors. The high-throughput assay is also compatible with robotic screening infrastructure, and our development represents a paradigm change for the discovery of mosquito repellants.

Background Pediatric solid tumors require coordinated multidisciplinary specialist care. However, expertise and resources to conduct multidisciplinary tumor board (MDTB) meetings are lacking in low- and middle-income countries (LMICs). We aimed to profile practices and perceptions on MDTBs among pediatric solid tumor units (PSTUs) in Southeast Asian LMIC countries. Methods Using online survey forms, availability of specialty manpower and MDTBs among PSTUs was first determined. From the subset of PSTUs with MDTBs, 1 pediatric surgeon and 1 pediatric oncologist from each center were queried using 5-point Likert scale questions adapted from published questionnaires. Results In 37/46 (80.4%) identified PSTUs, pediatric-trained oncologists, surgeons, radiologists, pathologists, radiation oncologists, nuclear medicine physicians and nurses were available in 94.6%, 91.9%, 54.1%, 40.5%, 29.7%, 13.5% and 81.1% of PSTUs, respectively. Availability of pediatric-trained surgeons, radiologists and pathologists were significantly associated with existence of MDTBs (p=0.037, 0.005, 0.022 respectively). Among 43/48 (89.6%) respondents from 24 PSTUs with MDTBs, 90.5% of oncologists reported >50% oncology-dedicated workload versus 22.7% of surgeons. Views on benefits and barriers did not significantly differ between both groups. Majority agreed MDTBs helped improve accuracy of treatment recommendations and team competence. Complex cases, insufficient radiology and pathology preparation, and need for supplementary investigations, were the top barriers. Conclusions Availability of pediatric-trained subspecialists was a significant prerequisite for pediatric MDTBs. Most PSTUs lacked pediatric-trained pathologists and radiologists. Correspondingly, gaps in radiographic and pathological diagnoses were the commonest limitations. Greater emphasis on holistic multidisciplinary subspecialty development is needed to advance pediatric solid tumor care in Southeast Asia.

References 1. Wang H, Li T, Barbarino P, Gauthier S, Brodaty H, Molinuevo JL, Xie H, Sun Y, Yu E, Tang Y, Weidner W. Dementia care during COVID-19. Lancet. 2020;395(10231):1190.2. Caraci F, Sultana J, Drago F, Spina E. Clinically relevant drug interactions with anti-Alzheimer’s drugs. CNS & Neurological Disorders-Drug Targets. 2017;16(4):501-13.3. University of Liverpool. COVID-19 Drug Interactions. 2020. https://www.covid19-druginteractions.org. Accessed 21 April, 2020.4. Pytliak M, Vargová V, Mechírová V. Drugs and hypoglycemia. Hypoglycemia–causes and occurrences. Shanghai: InTechOpen. 2011:131-48.5. Pasqualetti G, Tognini S, Calsolaro V, Polini A, Monzani F. Potential drug–drug interactions in Alzheimer patients with behavioral symptoms. Clinical Interventions in Aging. 2015;10:1457.

Anomalous origin of the left circumflex artery (LCA) arising from the right coronary sinus was observed in a 45 year-old man with aortic root aneurysm. Valve-sparing aortic root replacement (VSARR) was decided despite the subannular course of the LCA. A modified Tirone David procedure was performed with specific consideration for distribution of the proximal suture line due to the peri-aortic and subannular course of the LCA. Due to the risk of LCA injury, a coronary artery bypass grafting was performed using the left internal thoracic artery to secure the perfusion of the LCA. The challenging association of aortic root aneurysm and anomalous origin and course of the LCA was managed successfully during VSARR.

AIMS To report the major characteristics and clinical outcomes of COVID-19 patients treated with ACE inhibitors and ARBs and compare the different effects of the two drugs for outcomes of COVID-19 patients. METHODS This is a retrospective, two-center case series of 198 consecutive COVID-19 patients with a history of hypertension. RESULTS Among 198 patients, 58 (29.3%) and 16 (8.1%) were on were on ARB and ACEI, respectively. Patients who were on ARB or ACEI/ARB had a significantly lower rate of severe illness and ARDS when compared with patients treated with ACEI alone or not receiving RAAS blocker (P＜0.05). The Kaplan-Meier survival curve showed that patients with ARB in their antihypertensive regimen had a trend towards a higher survival rate when compared with individuals without ARB (adjusted hazard ratio, 0.27; 95% CI, 0.07-1.02; P=0.054). The occurrence rates of severe illness, ARDS, and death were similar in the two groups regardless of receiving ACEI. The Cox-regression analysis to compared ACEI vs. ARB groups showed a significantly lower mortality rate in the ARB group (adjusted hazard ratio, 0.03; 95% CI, 0.00-0.58; P=0.02). CONCLUSIONS Our data may provide some evidence of using ARB, but not ACEI, was associated with a reduced rate of severe illness and ARDS, indicating their potential protective impact in COVID-19. Further large sample sizes and multiethnic populations are warranted to confirm our findings.

Background The aim was to describe the profile of Head and Neck Cancers (HNC) at a referral centre in South Africa. Methods Records from January 2015 to December 2017 were reviewed. Variables analysed were site, histologic type, age, sex, HIV status, p16 status, treatment intent/ modality, and the Eastern Cooperative Oncology group performance (ECOG). Results Of 854 patients, 71% were male. Median age was 58. Smoking was a risk factor in 86.3% (n=737) and alcohol in 74.2% (n=634). 53.86% (n=460) and 27.17% (n=232) had ECOG scores of 1 and 2 respectively. 9% (n=56) were HIV positive. 167 had oropharyngeal primaries, and 9.58% (n=16) were p16-positive. 53.87% (n=466) had locally advanced disease, and 47.42% (n=405) received palliative treatment. Conclusion At this centre, HNC affects older adult males of lower socioeconomic status, who often smoke and drink and present with locally advanced disease, requiring palliative oncologic care. HPV and HIV play a minor role.

Objective: (1) Demonstrate how machine learning can be used for prediction modeling by predicting the treatment patients with T1-2, N0-N1 Oropharyngeal Squamous Cell Carcinoma receive. (2) Assess disparities in the treatment of this population. Design: Retrospective cohort. The data was split into 80/20 distribution for training and testing, respectively. Machine learning algorithms were explored for development. Area Under the Curve, accuracy, precision, and recall were calculated for the final model. The permutation feature scores highlight significant variables within the model. Setting: National Cancer Database. Participants: Adults diagnosed with T1-2, N0-N1 Oropharyngeal Squamous Cell Carcinoma from 2004 to 2013 were eligible Main Outcome Measure: Primary treatment modality Results: Among the 19,111 patients in the study, the mean (standard deviation) age was 61.3 (10.8) years, 14,034 (73%) were male, and 17,292 (91%) were white. Surgery was the primary treatment in 9,533 (50%) cases, and radiation in 9,578 (50%) cases. The final model yielded an Area Under the Curve of 78% (95% CI, 77% to 79%), accuracy of 71%, precision of 72%, and recall of 71%. The T-stage, primary site, N-stage, grade, and type of treatment facility were impactful variables included in the model. Conclusion: Machine learning was used to predict primary treatment modality for T1-2, N0-N1 Oropharyngeal Squamous Cell Carcinoma. This study demonstrates how machine learning can be used for prediction modeling. The results also suggest treatment is influenced by clinical staging and type of treatment facility.

Key Points- Congenital anosmia is usually associated with Kallmann syndrome, which is characterized by hormonal abnormalities such as hypogonadotropic hypogonadism.- On very rare occasions, an isolated congenital anosmia presents as olfactory bulb agenesis without this associated syndrome.- In previous studies of such cases, diagnosis is usually based on the absence of an olfactory bulb on structural MRI, rather than on objective functional measures.- Simultaneous functional MRI and olfactory event-related potential recordings can provide highly objective evidence of olfactory function.- We examined both structural and functional MRI and olfactory event-related potential data to diagnose isolated congenital olfactory bulb agenesis, gaining objective evidence of olfactory function.

Currently as of May 2020, there are more than 8 potential candidate vaccines against COVID19 in clinical evaluation and another 100 in preclinical evaluation. Considering the governing rules and regulations with respect to non-clinical and clinical evaluations, it may take around 5-6 months at the earliest to have an efficacious COVID 19 vaccine. The question lies ‘DO WE HAVE THAT MUCH TIME?’ The challenges faced today not only have implications to the public health but also the masked social and economic implications as well. Hence, it is imperative to have a Blitz Krieg solution against COVID19.

A 24-year-old male presented with radiating back pain and progressive neurological deficit. MRI revealed spinal epidural tumor at the thoracolumbar junction. He underwent decompression and excisional biopsy. Histopathology and immunohistochemistry identified it as diffuse large B-cell lymphoma. He received chemotherapy and is asymptomatic at one-year follow-up.

Epidermolytic hyperkeratotic EN (epidermal nevus) is a rare variant of EN, which can be congenital or developed later in adulthood. A 23 years old female presented with a pathologic confirmed epidermolytic hyperkeratotic EN. Dermoscopy can be helpful in the diagnosis of EN, but not in differentiating the variant.

Multiple lung nodules in atopic dermatitis patients may reflect infective endocarditis. Our case underlines the importance of potentially severe infections due to staphylococci associated with atopic dermatitis.

Our experience: Surgical tracheostomy in 20 patients with COVID- 19 pneumonitis Key pointsThe potential for transmission of the SARS -CoV-2 virus to healthcare workers performing the tracheostomy necessitates changes to standard tracheostomy proceduresSurgical tracheostomy performed in a theatre environment enables surgical and anaesthetic teams to support critical care staff by taking ownership of this aspect of patient careAll ENT and Maxillofacial teams used PPE including FFP3 facemasks, visors, and disposable hoodsMedian (interquartile range) day to tracheostomy after intubation was 19 days (16-26.3). Median follow up was 17.5 days (range 3-24).None of the healthcare workers involved were clinically or PCR positive for COVID -19 in the post-operative periodKeywords SARS-CoV-2, Novel Coronavirus, COVID-19, Tracheostomy, Mechanical Ventilation

BACKGROUND: The availability and development of the methods testing the vestibuloocular reflex (VOR) bring a broader view into the lateral semi-circular canal (L-SCC) function. At the same time, a higher number of evaluated parameters increases demands on the specialist’s diagnose-making process. OBJECTIVE: To provide medical specialists a new diagnostic-graphic tool, Estimated Vestibulogram- EVEST, enabling a quick and easy-to-read visualization of the enhanced VOR test results within the L-SCC. METHODS: The research data for the development of the EVEST involved 148 participants including 49 healthy volunteers (28 female and 21 male) and 99 (58 female and 41 male) patients with a diverse degree of peripheral vestibular deficit. The correspoding L-SCC VOR test results, from patients meeting the diagnostic criteria, were used to create the EVEST. RESULTS: Based on the test results from the sample of 148 participants we demonstrate on cumulative and single EVEST graphs that the EVEST is a functional and reliable tool for quick graphic diagnosis of diverse types and levels of the peripheral vestibular loss. CONCLUSIONS: Unique patterns of the EVEST can help to easily distinguish various types and levels of the peripheral vestibular loss.

Key Points: 1. Clinical areas where Fibreoptic nasoendoscopy (FNE) and larygoscopy (FOL) are performed are high risk areas in the COVID-19 era as they are potential aerosol generating procedures (AGP). 2. Barrier protection remains the key to prevent transmission. This device is one that patients can wear to reduce potential aerosol contamination of the surroundings. 3. Seal can be verified and tested by the patient placing a thumb over the filter. 4. This device is simple, reproduceable, easy to use, economical and well tolerated. Full personal protection equipment (PPE) is still advisable to be worn by the operator. 5. This device may reduce potential aerosolisation and thus reduce the need to allow air changes in clinic rooms, freeing up clinical resources.

The world is in front of a risky epidemic due to novel coronavirus (2019-CoV or COVID-19). This virus is not only affected human health but it affected the economy and caused completely paralysis in many countries of the world. Various therapeutic, medicinal, scientific, and technological communities are demanding to find out specifically and to approve successful strategies for discovering the effective vaccine which can lead to stop the virus expansion, recognize medication, reduce humanity health hazards, serious infections, death rates. The importance of natural effective nutritious food and diet having peculiar immunity is highlighted which pointed out the unconfirmed dietary option risks which would lead to decline effective precautionary procedures. This report is aimed to focus on the most effective food and nutrients which trigger the body immunity system and prevent the coronavirus type infections.

The 2019 novel coronavirus disease (COVID-19) has affected all aspects of life globally and care of children with malignancies is no exception. We are part of a large tertiary care 2000 bedded university hospital in North India. Approximately 450 new malignancies are diagnosed annually, translating to 10 patients per week. About 200 children attend the clinics every week. Additionally, 15-20 walk-in patients are evaluated daily in the daycare. Patients travel from distances as far as 500 km to reach our center.  Merely 20% live within 50 km of the hospital, and approximately 35% reside at a distance exceeding 200 km. Two-third of the patients hail from urban areas and one third belong to rural areas. The majority of families stay in a patient hostel in the hospital premises, and a few rent a flat in the city for the 4-9 months duration of intensive phase of therapy. The Government of India mandated a lockdown on the 24th March 2020 in response to the coronavirus pandemic and the outpatient services of the hospital were closed. The borders with the neighboring states were sealed & vehicular movement curtailed with barring of public transport & suspension of all interstate and intercity travel. The citizens were advised to maintain social distancing. The unit was faced with the formidable challenge of ensuring the well-being of children under our care from a wide geographical spread with minimal access to Pediatric Oncology services in their   hometowns. How did we manage our patients?

Background: Prolonged pleural drainage after the Fontan procedure is a common complication. Various protocols have been described, but there is no definitive consensus for the treatment of this complication. Materials and Methods: Our primary aim was to determine the effect of the protocol on the duration of drainage and hospital stay. Our secondary aim was to determine parameters affecting prolonged drainage after the Fontan procedure. Ninety two consecutive patients who underwent the Fontan operation retrospectively analyzed. A protocol-based postoperative management was adopted at July 2018. Patients operated before the protocol were defined as Group 1(n=48), and patients operated after the protocol were defined as Group 2(n=44). Results: The mean age was 5(IQR 4.0-6.9) years the mean body weight was 17.3 (IQR 15.1-21.8) kg.There were statistically significant differences between groups in terms of total drainage, duration of pleural drainage, prolonged drainage and, LOHS(p=0.05,p=0.04, p=0.04,p=0.04,respectively). In the multivariate analysis, the application of the protocol was observed to be the only factor for prolonged drainage (OR:2.46, 95% CI Lower-Upper:1.03-5.86,p=0.04). Conclusion: Standardization and strict application of the medical treatment within a specific protocol without being affected by doctor, nurse or patient-based factors increases the success. After the changes in our medical management strategy, along with the decrease in total drainage and duration of pleural drainage, LOHS was also reduced, of course together with a reduction in the cost. Key Words: Fontan, pleural drainage, hospital stay, protocol

Objective: A correct examination is essential during a differential diagnosis of neck pain patients. Therefore, the objective of this study was to provide an update on the properties considered most important by PTs when conducting accessory and physiological movement tests during the cervical spine physical examination. Methods: A total of 84 private physiotherapy centres participated in this online cross-sectional survey including 415 active physiotherapists and members of one autonomous Spanish Physiotherapists School. The main outcome measures were the frequency and the importance of mobility and pain responses assessed during cervical spine examination and the most commonly utilized reference to make a judgement. Results: Pain responses are most frequently used by physiotherapists at a rate of 79.8% and also rated as important by 42.65% respondents mobility aspects such as quality of end-feel (17.3%), quantity of translation (16.4%) and quality of resistance (13.3%) during passive accessory intervertebral movement tests. During passive and active physiological movement tests, the most frequent properties assessed were the quality of motion path (80,5% and 84.3% respectively) and quantity of angle bending (81,7% and 77.6% respectively). Pain responses are used as reference by 54.7% to make a clinical judgement during passive accessory intervertebral movement tests. Conclusion: Physical therapists face validity in relation to passive accessory intervertebral movement test for assessing spinal segmental motion aspects has been decreasing with more attention devoted to pain responses. The current skepticism regarding the motion properties assessed with these tests is associated with utility aspects such as validity, sensitivity, accuracy and specificity.

The Hammond Hill Research Catchment (HH) is a small (120 ha), temperate, second order tributary to Six Mile Creek, Cayuga Lake, and the Great Lakes (42.42°, -76.32°). The HH has been monitored since January 2017 for the purpose of understanding how recent infiltration mixes with antecedent soil water on hillslope forest floors and the spatial and temporal patterns of Root Water Uptake (RWU) by temperate northeastern US tree species (eastern hemlock [Tsuga canadensis], American beech [Fagus grandifolia], and sugar maple [Acer saccharum]). These data are informing us about the hydrologic consequences of anticipated tree species composition change and supporting the development of more refined ecohydrological models. The glaciated catchment is underlain by a shallow confining siltstone layer (1 – 1.5 m depth) and dense with a regrowth (approximately 60 years old) mixed species forest of hemlock, beech, and other deciduous tree species common to the northeastern US. Current datasets from the HH include fixed-internal precipitation snow water equivalent, and discharge, and associated isotopic water compositions (2H & 18O). Frequent (<1 month) measurements of shallow (top 10 cm) soil water content and bulk soil water and hemlock and beech xylem isotopic compositions are made at six locations across a topographic wetness gradient. The near-term role of the HH is to support an understanding of the environmental and ecological drivers of plant RWU competition and ecohydrologic education.