We report mild COVID-19 manifestation in high-risk patient with sufficient plasma 25-OH-Vitamin D3 level. Given the global pandemic of vitamin D deficiency, as well as its likely beneficial effects during SARS-CoV-2 infection, report highlights importance of routine 25-OH-Vitamin D3 measurement, either for clinical course prediction or deciding on supplementation.

Cyclohexanone monooxygenase (CHMO), a member of the Baeyer-Villiger monooxygenase family, is a versatile biocatalyst that efficiently catalyzes the conversion of cyclic ketones to lactones. In this study, an Acidovorax-derived CHMO gene was expressed in Pseudomonas taiwanensis VLB120. Upon purification, the enzyme was characterized in vitro and shown to feature a broad substrate spectrum and up to 100% conversion in 6 h. Further, we determined and compared the cyclohexanone conversion kinetics for different CHMO-biocatalyst formats, i.e., isolated enzyme, suspended whole cells, and biofilms, the latter two based on recombinant CHMO-containing P. taiwanensis VLB120. Biofilms showed less favorable values for KS (9.3-fold higher) and kcat (4.8-fold lower) compared to corresponding KM and kcat values of isolated CHMO, but a favorable KI for cyclohexanone (5.3-fold higher). The unfavorable KS and kcat values are related to mass transfer- and possibly heterogeneity issues and deserve further investigation and engineering, in order to exploit the high potential of biofilms regarding process stability. Suspended cells showed an only 1.8-fold higher KS, but 1.3- and 4.2-fold higher kcat and KI values than isolated CHMO. This together with the efficient NADPH regeneration via glucose metabolism makes this format highly promising from a kinetics perspective.

Purpose To evaluate the effect of risk factors and selected surgical methods on operative and oncological results of patients undergoing radical prostatectomy (RP) with high-risk prostate cancer (HRPC). Methods Retrospective analysis of patients, who underwent RP for HRPC from 13 urology centers between 1990 to 2019, was performed. Groups were created according to the risk factors of D’Amico classification. Patients with one risk factor were included in group 1 where group 2 consisted of patients with two or three risk factors. Results A total of 1519 patients were included in this study and 1073 (70.6%) patients assigned to group 1 and 446 (29.4%) patients to group 2. Overall (biochemical and/or clinical and/or radiological) progression rate was 12.4% in group 1 and 26.5% in group 2 (p =0.001). Surgical procedure was open RP in 844 (55.6%) patients and minimally invasive RP in 675 (44.4%) patients (laparoscopic and robot-assisted RP in 230 (15.1%) and 445 (29.3%) patients, respectively). Progression rates were similar in different types of operations (p=0.22). Progression rate was not significantly different in patients who either underwent pelvic lymph node dissection (PLND) or not in each respective group. Conclusion RP alone is an effective treatment in the majority of patients with HRPC and PLND did not affect the progression rates after RP. According to the number of preoperative high-risk features, as the number of risk factors increases, there is a need for additional treatment.

We carefully read the recent paper by Hammond et al. (1) on the use of sutureless bioprosthetic valve for homograft failure in the setting of infective endocarditis (IE). This article is the latest demonstration that new sutureless and rapid deployment (RD) valve prostheses are safe and easy-to-use devices for surgical aortic valve replacement, and indicates their suitability for different scenarios and peculiar surgical situations as infective endocarditis (IE).

We aimed to infer the phylogenetic relationships of populations of Lobelia columnaris using chloroplast genomes and estimate the divergence time to reconstruct its historical colonization on the sky islands of Bioko and Cameroon. Specifically, we aim to answer the following questions: (1) What is the phylogenetic relationship among Bioko Island and Cameroon populations? (2) Are the older populations found on the older sky islands? (3) Does the colonization history reflect the age of the sky islands? We assembled novel plastomes from 20 individuals of L. columnaris from five mountain systems. The plastome data was explored with phylogenetic analyses using Maximum likelihood and Bayesian Inference. The complete plastome size varied from 164,609 bp to 165,368 bp. The populations of L. columnaris have a monophyletic origin, subdivided into three plastome-geographic clades. The plastid phylogenomic results and age of the sky islands indicate that L. columnaris colonized first along the Cameroon Volcanic Line’s young sky islands. The earliest divergent event (1.54 Ma) split the population in South Bioko from those on the mainland and North Bioko. The population of South Bioko was likely isolated during cold and dry conditions in forest refugia. Presumably, the colonization history occurred during the middle-late Pleistocene from South Bioko’s young sky island to North Bioko and the northern old sky islands in Cameroon. Furthermore, the central depression with lowland forest between North and South Bioko is a current geographic barrier that keeps separate the populations of Bioko from each other and the mainland populations. The Pleistocene climatic oscillations led to the divergence of the Cameroon and Bioko populations into three clades. L. columnaris colonized the older sky island in mainland Cameroon after establishing South Bioko’s younger sky islands. The biogeography history was an inverse progression concerning the age of the Afromontane sky islands.

Lobular breast cancer is rarely known to metastasise to the gastrointestinal tract. This article explores a case of a patient in remission from lobular breast cancer, who presented with bowel obstruction secondary to metastatic lobular cancer.

Hyperhemolysis syndrome (HS) should be considered in a multiply transfused thalassemia patient. HS in this patient was attributed to a combination of factors including multiple transfusions, presence of anti-Cw, macrophage hyperactivity, hypersplenism and suppression of erythropoiesis.

Vehicle traffic induced soil compaction has negative effects on soil functions and ecosystems which may cause the degradation of farmland. This study investigated the magnitude and distribution of soil stress under the tracked and tired vehicles to explore the penitential of using rubber track instead of tire to reduce the subsoil compaction. The field experiment in this study included three replicates and was conducted on a sandy loam soil. Vertical and horizontal soil stress were measured under the centerlines of the rubber track and tire at a depth of 0.35m by using embedded transducers. The SoilFlex model was applied to simulate vertical and horizontal stress in the soil profile. Unevenly distributed vertical and horizontal stress were observed under the tire and rubber track. The vertical stress was characterized by one peak under the tire and several peaks under each of track wheels and rollers. The horizontal stress exhibited peaks before and after the tire and each of track wheels and rollers. The measured maximum stress was significantly higher under the tire than under the rubber track: that is, vertical and horizontal stress were approximately 3.4 and 2.0 times higher, respectively. This finding indicated that using rubber track maybe an effective method to reduce soil stress when compared with the tire, and was more effective in reducing the vertical stress than horizontal stress. Improving the uniformity of stress distribution under the track is the key to improve the ability of tracked vehicle to mitigate soil compaction.

Mini-commentary on BJOG-20-1640.R2: Aetiologic testing compared with syndromic management for sexually transmitted infections in Human Immunodeficiency Virus-infected pregnant women in South Africa: a non-randomised prospective cohort study

We present the mathematical analysis of the Isolation Random Forest Method (IRF Method) for anomaly detection, introduced in {\sc F.~T. Liu, K.~M. Ting, Z.-H. Zhou:}, {\it Isolation-based anomaly detection}, TKDD 6 (2012) 3:1–3:39. We prove that the IRF space can be endowed with a probability induced by the Isolation Tree algorithm (iTree). In this setting, the convergence of the IRF method is proved, using the Law of Large Numbers. A couple of counterexamples are presented to show that the method is inconclusive and no certificate of quality can be given, when using it as a means to detect anomalies. Hence, an alternative version of the method is proposed whose mathematical foundation is fully justified. Furthermore, a criterion for choosing the number of sampled trees needed to guarantee confidence intervals of the numerical results is presented. Finally, numerical experiments are presented to compare the performance of the classic method with the proposed one.

Emphysematous cholecystitis is caused by gas-forming micro-organisms, primarily in patients with immunosuppression and diabetes mellitus. It leads to a signature radiological finding with air in gall bladder wall as described in this report. Clinicians should be aware of this critical differential diagnosis.

In wireless networked iterative learning control systems, the controller is separated from the plant, and additive noises, random delays and data dropouts arise in both sensor-to-controller and controller-to-actuator channels. In order to guarantee the convergence performance of such systems with the effect of these uncertainties, an input filter is designed based on a proportional iterative learning controller, so that updated inputs can be filtered at the actuator side. Specifically, two data transmission processes are first developed to describe the mix of those uncertainties in both channels by Bernoulli and Gaussian distributed variables with known distributions. Based on state augmentation, the two data transmission processes are further combined with the iterative learning process of controllers to build a unified filtering model. According to this unified model, an optimal filter is designed via the projection theory and implemented at the actuator side to filter the updated inputs in iteration domain. Moreover, the convergence performance of the filtering error covariance matrix is proved theoretically. Finally, some numerical results are given to illustrate the effectiveness of the proposed method.

Background and purpose: Bradykinin [BK-(1-9)] is an endogenous nonapeptide involved in multiple physiological and pathological processes. A long-held belief is that peptide fragments of BK-(1-9) are biologically inactive. Here, we have tested the biological activities of BK-(1-9) and two major peptide fragments in human and animal systems. Experimental Approach: Levels of BK peptides in male Wistar rat plasma were quantified by mass spectrometric methods. Nitric oxide was quantified in human, mouse and rat cells, and loaded with DAF-FM. We used aortic rings from adult male Wistar rats to test vascular reactivity. Changes in blood pressure and heart rate were measured in conscious adult male Wistar rats. Key results: Plasma levels of BK-(1-7) and BK-(1-5) in rats were increased following infusion of BK-(1-9). All tested peptides induced NO production in all cell types tested. However, unlike BK-(1-9), NO production elicited by BK-(1-7) or BK-(1-5) was not inhibited by B1 or B2 receptor antagonists. BK-(1-7) or BK-(1-5) also induced concentration-dependent vasorelaxation of aortic rings, without involving B1 or B2 receptors. In vivo, either intravenous or intra-arterial administration of BK-(1-7) or BK-(1-5) induced similar hypotension response. Conclusions and implications: BK-(1-7) and BK-(1-5) are endogenous peptides present in plasma. They are formed, at least partially, through the BK-(1-9) proteolysis. BK-related peptide fragments show biological activity, not mediated by B1 or B2 receptors. These BK-fragments could constitute new, active components of the kallikrein-kinin system.

We present a case of a young woman with a mangled leg, that could be salvaged with a combination of negative pressure wound therapy, Matriderm® augmented split-skin grafting, and maggot biodebridement. The aim of this case report is to outline alternative treatment options in severe soft tissue injuries.

Pembrolizumab is considered to be an effective therapy for patients with microsatellite instability (MSI)-high cancer. Here, we report a case of MSI-high cholangiocarcinoma effectively treated with pembrolizumab. MSI status should be actively evaluated in patients with cholangiocarcinoma.

Rationale: Methicillin resistant Staphylococcus aureus (MRSA) is prevalent and consequential in cystic fibrosis (CF). Whole genome sequencing (WGS) could reveal genomic differences in MRSA associated with poorer outcomes or detect MRSA transmission. Objectives: To identify MRSA genes associated with low lung function and identify potential MRSA transmission in CF. Methods: We collected 97 MRSA isolates from 74 individuals with CF from 2017 and performed short-read WGS. We determined sequence type (ST) and the phylogenetic relationship between isolates. We aligned accessory genes from 25 reference genomes to genome assemblies. We classified the MRSA by accessory gene content and correlated the accessory genome to clinical outcomes. Results: The most prevalent ST were ST5 (N=55), ST105 (N=14), and ST8 (N=14). Closely related MRSA strains were shared by family members with CF, but rarely between unrelated individuals. Three distinct clusters of MRSA were identified by accessory genome content. The first included ST5 and ST105 strains and was common among older patients with lower FEV1. The second cluster included ST8, which was generally identified in younger patients. Sputum density of MRSA and Pseudomonas aeruginosa was higher in cultures from patients with ST5/ST105 compared to patients with ST8 at similar ages. Conclusions: In this CF cohort, we identified MRSA subtypes that predominate at different ages and differ by accessory gene content. ST5 and ST105 represented the most prevalent cluster of MRSA. ST8 MRSA was more common in younger patients and thus has the potential to rise in prevalence as these patients age.

BACKGROUND: COVID-19 has significantly impacted the healthcare landscape in the United States in a variety of ways including a nation-wide reduction in operative volume. The impact of COVID-19 on the availability of donor organs and the impact on solid organ transplant remains unclear. We examine the impact of COVID-19 on a single, large-volume heart transplant program. METHODS: A retrospective chart review was performed examining all adult heart transplants performed at a single institution between March 2020 and June 2020. This was compared to the same time frame in 2019. We examined incidence of primary graft dysfunction (PGD), continuous renal replacement therapy (CRRT) and 30-day survival. RESULTS: From March-June 2020, 43 orthotopic heart transplants were performed compared to 31 performed during 2019. Donor and recipient demographics demonstrated no differences. There was no difference in 30-day survival. There was a statistically significant difference in incidence of post-operative CRRT (9/31 v. 3/43; p = .01). There was a statistically significant difference in race (23W/8B/1AA v. 30W/13B; P=.029). CONCLUSION: We demonstrate that a single, large-volume transplant program was able to grow volume with little difference in donor variables and clinical outcomes following transplant. While multiple reasons are possible, most likely the reduction of volume at other programs allowed us to utilize organs to which we would not have previously had access. More significantly, our growth in volume was coupled with no instances of COVID-19 infection or transmission amongst patients or staff due to an aggressive testing and surveillance program.

A 14-year-old boy presented to our Emergency Department complaining of fever, and abdominal pain. An abdominal computed tomography showed a large abscess of the spleen. Percutaneous aspiration of the lesion was performed. Splenectomy was performed 38 days after percutaneous aspiration because of the abscess's considerable size.